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Choinski KN, Dillard N, Beck AW, Smolock CJ. Appropriate Use Criteria Committees: The professional society role in the development and implementation of Appropriate Use Criteria. Semin Vasc Surg 2024; 37:111-117. [PMID: 39151991 DOI: 10.1053/j.semvascsurg.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 08/19/2024]
Abstract
Vascular surgeons have the ability to manage and intervene on numerous vascular diseases of both the arterial and venous systems. With the growing number of interventions available as endovascular technology evolves, it is important to determine when a procedure is safely indicated for a vascular surgery patient. Appropriate Use Criteria (AUC) offer synthesized clinical information and practice standards that can aid clinicians in making these management decisions. Professional societies, such as the Society for Vascular Surgery, bring experts in the field together to collaborate and create AUC for various vascular diseases and interventions. It is essential to publish these criteria in peer-reviewed journals, as well as make them available on public websites so the information is available to vascular surgeons and interventionalists from other specialties who also treat patients with vascular disease. Cardiology, interventional radiology, and interventional nephrology are some other specialties that perform procedures for vascular disease, and vascular interventions by nonsurgeon specialists continue to increase. The Society for Vascular Surgery has published AUC on intermittent claudication, carotid disease, and abdominal aneurysm management. These are intended to guide practice, but also have highlighted areas for improvement that would allow for more universal implementation of AUC in vascular patient care across medical specialties. Increased intersocietal participation and perhaps inclusion of government and other payer participation will allow professional society-sponsored AUC to evolve, resulting in coordinated, appropriate care for vascular surgery patients.
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Affiliation(s)
- Krystina N Choinski
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nathaniel Dillard
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam W Beck
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher J Smolock
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY.
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Alozai T, Lam YL, Schreve MA, de Smet AA, Vahl AC, Terlouw-Punt LC, Ünlü Ç, Wittens CH. A comparison of patient-reported outcome measures following technical success and technical failure in the treatment of great saphenous vein incompetence using ClariVein: A subanalysis of a multicenter randomized controlled trial comparing 2% and 3% polidocanol. Phlebology 2023; 38:532-539. [PMID: 37436708 DOI: 10.1177/02683555231189414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This study aimed to compare patient-reported outcomes after technical success (TS) and technical failure (TF) in treating great saphenous vein incompetence (GSV) with ClariVein. METHODS A subanalysis of a previous trial was conducted on symptomatic GSV incompetence patients who received ClariVein treatment with 2% or 3% polidocanol (POL) and were followed for 6 months. Blinding was implemented for observers and patients, and data from both POL groups were combined. TS was defined as at least 85% occlusion of the treated vein, while TF indicated failure to meet TS criteria. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), and Short-Form 36 Health Survey Questionnaire (SF-36). RESULTS Among the 364 patients included, the TS rate was 64.5%. Comparison of VCSS, AVVQ, and SF-36 scores between TS and TF groups did not yield significant differences. CONCLUSION This study indicates no significant variation in VCSS, AVVQ, and SF-36 scores between patients experiencing TS and TF following ClariVein treatment for GSV insufficiency.
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Affiliation(s)
- Tamana Alozai
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Yee Lai Lam
- Department of Dermatology, Zaans Medisch Centrum, Zaandam, the Netherlands
| | - Michiel A Schreve
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - André Aea de Smet
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG, Amsterdam, the Netherlands
| | | | - Çağdaş Ünlü
- Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands
- Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands
| | - Cees Ha Wittens
- Department of Surgery, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
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Rits J, Maurins U, Rabe E, Kadiss A, Prave S, Vigants R, Brunenieks I, Pannier F. Lower prevalence of stump reflux after endovenous laser flush ablation of the great saphenous vein. VASA 2022; 51:222-228. [DOI: 10.1024/0301-1526/a001007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: This single center prospective randomized study was performed to compare the effect of endovenous laser flush ablation (EVLAf) of the great saphenous vein (GSV) close to the sapheno-femoral junction (SFJ) with a standard ablation (EVLAs) up to two cm distally of the SFJ on reflux in the GSV stump. Patients and methods: Between April 2013 and January 2016, 146 legs in 146 consecutive patients, meeting the inclusion/exclusion criteria, were treated by EVLA. All patients were randomized into 2 groups. In group 1 EVLAf started from the SFJ level, and in group 2 EVLAs started two cm below the SFJ. The primary endpoint was reflux in the GSV stump after 900 days. Secondary endpoints were reflux in the anterior accessory saphenous vein (AASV), proximal clinically recurrent varicose veins related to reflux in the stump and/or the AASV. Results: At day 900, 27 patients were lost to follow-up. Reflux in the stump was detected in 3.6% in group 1 and in 22.2% in group 2 (p<0.05). Reflux in the AASV was present in 7.1% in group 1 and in 17.46% in group 2 (p=0.09). Proximal clinically recurrent varicose veins were observed in 8.9% in group 1 and in 19.1% in group 2 (p=0.12). The greatest diameter of the stump was significantly larger in group 2 (group 1: 0.41 cm, group 2: 0.6 cm, p<0.001). Conclusions: EVLAf is associated with a significantly lower incidence of reflux in the GSV stump, with a trend to a lower incidence of reflux in the AASV and with a lower incidence of proximal recurrent varicose veins after 900 days follow-up compared to EVLAs. EVLAf may improve the clinical recurrence rate after EVLA of the GSV.
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Affiliation(s)
| | | | - Eberhard Rabe
- Private Practice Dermatology & Phlebology, Bonn, Germany
| | | | | | | | | | - Felicitas Pannier
- Private Practice Dermatology & Phlebology, Bonn, Germany
- Department of Dermatology, University of Cologne, Germany
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Ho VT, Adkar SS, Harris EJ. Systematic review and meta-analysis of the management of incompetent perforators in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2022; 10:955-964.e5. [PMID: 35217217 DOI: 10.1016/j.jvsv.2021.12.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Incompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurement, size, and Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification. The objective of this study was to systematically review and synthesize current literature regarding surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation (EVLA), ultrasound guided sclerotherapy (USGS), and radiofrequency ablation (RFA). METHODS English-language literature published prior to November 2021 was reviewed from the PubMed, EMBASE, and MEDLINE databases for primary literature reporting safety and efficacy outcomes in the surgical treatment of incompetent perforating veins. Study quality and risk of bias was assessed using the Cochrane risk-of-bias tool for comparative studies and a modified version of the Newcastle-Ottawa Scale for non-comparative studies. A random effects model was used to pool effect sizes for efficacy outcomes of wound healing and freedom from wound recurrence. RESULTS A total of 81 studies were included for qualitative synthesis representing 7010 patients with a mean age of 54.7 years. Overall evidence quality was low to intermediate, with moderate to high risk of bias in comparative studies. There was an 11.3% complication rate across interventions, with no reported incidences of stroke or air embolism. With regards to efficacy, pooled estimates for short-term (up to 1-year) wound healing were 99.9% for USGS (95% CI 0.81 - 1), 72.2% for ligation (95% CI 0.04, 0.94) and 96.0% for SEPS (95% CI 0.79 -0.99). For short-term freedom from wound recurrence, the pooled estimate for SEPS is 91.0% (95% CI 0.3 - 0.99). CONCLUSION Current evidence regarding treatment of incompetent perforator veins is limited due to low adherence to reporting standards in observational studies and lack of randomization, blinding, and allocation concealment in comparative studies. Additional comparative studies are needed to guide clinical decision-making regarding invasive treatment options for incompetent perforator veins.
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Affiliation(s)
- Vy T Ho
- Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Shaunak S Adkar
- Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Edmund J Harris
- Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA
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Lam YL, Alozai T, Schreve MA, de Smet AAEA, Vahl AC, Nagtzaam I, Lawson JA, Nieman FHM, Wittens CHA. A multicenter, randomized, dose-finding study of mechanochemical ablation using ClariVein and liquid polidocanol for great saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord 2021; 10:856-864.e2. [PMID: 34781008 DOI: 10.1016/j.jvsv.2021.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/31/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The purpose of the present study was to identify the ideal polidocanol (POL) concentration for mechanochemical ablation (MOCA) of the great saphenous vein (GSV) using the ClariVein system (Merit Medical, South Jordan, Utah). METHODS We performed a multicenter, randomized, controlled, single-blind trial with a follow-up period of 6 months. Patients with symptomatic primary truncal GSV incompetence were randomized to MOCA + 2% POL liquid (2% group) or MOCA + 3% POL liquid (3% group). The primary outcome was technical success (TS), defined as an open part of the treated vein segment of ≤10 cm in length. The secondary outcomes were alternative TS, defined as ≥85% occlusion of the treated vein segment, postoperative pain, venous clinical severity scores, Aberdeen varicose vein questionnaire scores, and short-form 36-item health survey questionnaire scores, and complications. RESULTS From 2012 to 2018, 364 patients (375 limbs) were included, of which, 189 limbs were randomly allocated to the 2% group and 186 to the 3% group. The TS rate at 6 months was 69.8% in the 2% group vs 78.0% in the 3% group (P = .027). A higher overall TS rate was seen in GSVs of ≤5.9 mm compared with GSVs >5.9 mm (84.3% vs 59.5%, respectively; P < .001). The alternative TS rate at 6 months was 61.4% in the 2% group and 67.7% in the 3% group (P = .028). The venous clinical severity scores, Aberdeen varicose vein questionnaire scores, and most short-form 36-item health survey questionnaire domains had improved in both groups (P < .002). Postprocedural pain was low. Two pulmonary embolisms and two deep vein thromboses were seen. Superficial venous thrombosis had occurred more often in the 3% group (18 vs 8 in the 2% group; P = .033). CONCLUSIONS The results from the present study showed a higher success rate for MOCA with 3% POL liquid than for MOCA with 2% POL liquid at 6 months of follow-up. However, the difference in quality of life was not significant. Long-term follow-up studies are required to investigate whether these results will be sustained in the future.
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Affiliation(s)
- Yee Lai Lam
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Tamana Alozai
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | | | - André A E A de Smet
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, OLVG, East Location, Amsterdam, The Netherlands
| | - Ivo Nagtzaam
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands
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Cost-effectiveness Analysis of Current Varicose Veins Treatments. J Vasc Surg Venous Lymphat Disord 2021; 10:504-513.e7. [PMID: 34450353 DOI: 10.1016/j.jvsv.2021.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the effectiveness and cost-effectiveness of technologies for treatment of varicose veins over 5 years - conservative care (CONS), surgery (HL/S), ultrasound guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA) and cyanoacrylate glue occlusion (CAE). METHODS A systematic review was updated and used to construct a Markov decision model. Outcomes were re-intervention on the truncal vein, re-treatment of residual varicosities and quality-adjusted life years (QALY) and costs over five years. RESULTS UGFS has a significantly greater re-intervention rate than other procedures, while there is no significant difference between the other procedures. The cost per QALY of EVLA versus UGFS in our base-case model is £16966 ($23700) per QALY, which is considered cost-effective in the UK. RFA, MOCA and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients. CONCLUSIONS EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, CONS and HL/S are not cost-effective at current prices in the UK National Health Service. MOCA and CAE appear promising but further evidence on effectiveness, re-interventions and health-related quality of life is needed, as well as how cost-effectiveness may vary across settings and reimbursement systems.
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A Randomized Controlled Trial of Endovenous Laser Ablation Versus Mechanochemical Ablation With ClariVein in the Management of Superficial Venous Incompetence (LAMA Trial). Ann Surg 2021; 273:e188-e195. [PMID: 31977509 DOI: 10.1097/sla.0000000000003749] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This RCT compares the clinical, technical and quality of life outcomes after EVLA and MOCA. SUMMARY OF BACKGROUND DATA Thermal ablation is the current mainstay treatment for SVI. Newer nonthermal methods of treatment have been developed which do not require the use of tumescent anesthesia. The potential advantages of these newer methods should be tested in RCTs to ascertain their role in the future treatments of SVI. METHODS This single-center RCT enrolled patients with symptomatic, unilateral, single-axis SVI. Eligible patients were equally randomized to either EVLA or MOCA, both with concomitant phlebectomy when necessary. The joint primary outcomes were intraprocedural axial ablation pain scores and anatomical occlusion at 1 year. Secondary outcomes included postprocedural pain, venous clinical severity score (VCSS), quality of life (Aberdeen varicose veins questionnaire and EuroQol 5-domain utility index), patient satisfaction and complication rates. RESULTS One hundred fifty patients were randomized equally between the 2 interventions. Both groups reported low intraprocedural pain scores; on a 100 mm visual analog scale, pain during axial EVLA was 22 (9-44) compared to 15 (9-29) during MOCA; P = 0.210. At 1 year, duplex derived anatomical occlusion rates after EVLA were 63/69 (91%) compared to 53/69 (77%) in the MOCA group; P = 0.020. Both groups experienced significant improvement in VCSS and AVVQ after treatment, without a significant difference between groups. Median VCSS improved from 6 (5-8) to 0 (0-1) at one year; P < 0.001. Median AVVQ improved from 13.8 (10.0-17.7) to 2.0 (0.0-4.9); P < 0.001. One patient in the MOCA group experienced DVT. CONCLUSIONS Both EVLA and MOCA were highly efficacious in treating SVI; patients improved significantly in terms of disease severity, symptoms, and QoL. Both resulted in low procedural pain with a short recovery time. Axial occlusion rates were higher after EVLA. Long term follow-up is warranted to assess the effect of recanalization on the rate of clinical recurrence.
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AlGhofili HH, Aljasser AA, Alyahya IA, Almohsen HA, Alwabel SA, Alhumaid AA, Iqbal K, Altuwaijri TA, Altoijry A. Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience. Semin Vasc Surg 2020; 32:89-93. [DOI: 10.1053/j.semvascsurg.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mousa A, El Azzazi M, Elkalla MA. Different management options for primary varicose veins in females: A prospective study. Surg Open Sci 2019; 1:25-33. [PMID: 32754689 PMCID: PMC7391904 DOI: 10.1016/j.sopen.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/26/2019] [Accepted: 05/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background The aim of this study was to evaluate the long-term follow-up results of different management modalities in treating primary uncomplicated lower limb female varicosities. Methods A prospective study took place within a 3-year period from June 2010 until May 2012. Patients were divided into 3 groups: group I (n = 35) included those who underwent open surgical treatment. Group II (n = 25) included those who subjected to ultrasound-guided foam sclerotherapy (USGFS). While group III (n = 20) included those who treated with endovenous laser therapy (EVLT). The patients were followed up for 6 years. Results All selected patients were female aged from 35-62 years with a mean of 47 ± 7.6 years. Thirty-five patients (43.75%) were treated surgically by saphenofemoral junction disconnection (SFJD), and great saphenous vein (GSV) stripping; 25 patients (31.25%) with ultrasound-guided foam sclerotherapy and the remaining 20 patients (25%) were treated with endovenous laser therapy. A significant success rate of GSV ablation was obtained for the endovenous laser therapy treated group over the ultrasound-guided foam sclerotherapy treated patients (P = .023). There was no significant difference between the surgically treated group and those group treated with endovenous laser therapy (P = .85). Recurrence was observed following long-term follow-up after 6 years in 8.5% in group I, 36% in group II, and 10% in group III, respectively. Venous clinical severity score (VCSS) and health-related quality of life score (HRQOLS) improved significantly in all treated groups. Conclusions Long-term follow-up of patients with primary superficial varicosities among females is mandatory to elucidate the postoperative recurrence, especially those who underwent ultrasound-guided foam sclerotherapy. In addition to the observation of the development of newly formed varicosities in susceptible individuals which might develop later following long-term follow-up.
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Affiliation(s)
- Ahmed Mousa
- Department of Vascular & Endovascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt.,Division of Vascular & Endovascular Surgery, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Mohamed El Azzazi
- Department of Diagnostic and Interventional Radiology, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Cairo, Egypt
| | - Mai A Elkalla
- Medical Student, Faculty of Medicine, Helwan University, Cairo, Egypt
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Mohamed A, Leung C, Hitchman L, Wallace T, Smith G, Carradice D, Chetter I. A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation. Phlebology 2019; 34:627-635. [DOI: 10.1177/0268355519835625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction Endovenous mechanochemical ablation (MOCA) is an increasingly popular non-thermal non-tumescent technique used to treat axial reflux in patients with superficial venous incompetence. However, the optimal management of varicose tributaries following this technique is unknown and may impact on patient outcomes. This study compares MOCA with concomitant phlebectomy (MOCAP) versus ablation with sequential phlebectomy if required (MOCAS). Methods Patients with symptomatic Comprehensive Classification System for Chronic Venous Disorders (CEAP C2–C6) unilateral axial reflux were studied. Patient choice determined whether concomitant treatment of varicosities was carried out. The primary outcome was the Aberdeen Varicose Veins Questionnaire (AVVQ) at one year. Secondary outcomes included: Venous Clinical Severity Scores (VCSS), EuroQol 5-Domain quality of life scores, complications, procedure duration, procedural and post-operative pain scores and need for secondary procedures. Outcomes were assessed at baseline and then one week, six weeks, six months and one year post intervention. Results Fifty patients underwent MOCAP and 33 patients MOCAS. The two groups were comparable at baseline. MOCAP was associated with lower (better) AVVQ scores at six weeks (3.4 (0.5–6.0) vs. 6.1 (1.8–12.1); P = 0.009) and at six months (1.6 (0.0–4.5) vs. 3.34 (1.8–8.4); P = 0.009) but by one year the difference was no longer statistically significant (1.81 (0.0–4.5) vs. 3.81 (0.2–5.3); P = 0.099). MOCAP was associated with longer procedural duration (45 min (36–56) vs. 30 min (25–37); P < 0.001) and higher maximal periprocedural pain (31 (21–59) vs. 18 (7–25); P = 0.001). VCSS at all time points were lower in favour of MOCAP (0 (0–1) vs. 1 (0–3); P < 0.001). MOCAP was associated with fewer episodes of clinically significant thrombophlebitis (6 of 50 (12%) vs. 10 of 33 (30%); P = 0.039) and lower numbers of secondary procedures (2 (4%) vs. 6 (18%); P = 0.032). Conclusion Concomitant treatment of tributary varicosities following MOCA improves quality of life and clinical severity, while reducing rates of re-intervention and post-operative thrombophlebitis compared to sequential treatment. The penalty is a modest increase in procedural duration and discomfort. Further evidence from longer-term follow-up is needed.
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Affiliation(s)
| | - Clement Leung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Louise Hitchman
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Tom Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - George Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Daniel Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
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Mohamed AH, Leung C, Wallace T, Pymer S, Harwood A, Smith G, Carradice D, Chetter IC. Mechanochemical ablation for the treatment of superficial venous incompetence: A cohort study of a single centre's early experience. Phlebology 2018; 34:466-473. [PMID: 30595100 DOI: 10.1177/0268355518818339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Mechanochemical ablation is an innovative non-thermal method of treating symptomatic axial superficial venous incompetence. This is a single-centre cohort study aiming to investigate the technical efficacy and clinical effectiveness at one year. Methods Patients with primary, unilateral, symptomatic axial incompetence were offered treatment with mechanochemical ablation using ClariVein® with 1.5% sodium tetradecyl sulphate. Assessments including clinical examination, duplex ultrasound and patient-reported health-related quality of life were performed at baseline and weeks 1, 6, 26 and 52. Results Thirty-two patients were recruited to the study. Complete target vein occlusion at one year was found in 21 (75%) patients. Six patients (21.4%) required secondary procedures, of which three had axial endovenous thermal ablation and three required ambulatory phlebectomy with perforator ligation. There was a significant improvement in the median (interquartile range) Venous Clinical Severity Score from baseline 6 (5–8) to a score of 1 (0–2) at one year (p < 0.001). There was also a significant improvement in health-related quality of life, both generic (p = 0.001) and disease specific (p < 0.001). One patient (3.1%) had a post-procedural non-fatal pulmonary embolus. Conclusions Mechanochemical ablation is a feasible and effective treatment for superficial venous incompetence. When using consensus definitions for anatomical closure, results for mechanochemical ablation may be less favourable than previously reported. Further studies are required to compare clinical and technical outcomes following mechanochemical ablation to other methods of endovenous ablation.
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Affiliation(s)
- Abduraheem H Mohamed
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Clement Leung
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Tom Wallace
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Sean Pymer
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Amy Harwood
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - George Smith
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Daniel Carradice
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
| | - Ian C Chetter
- Hull York Medical School, Academic Vascular Surgical Unit, Alderson House, Hull Royal Infirmary, Hull, UK
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12
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Hsieh CS, Tsai CT, Chen YH, Chang SN, Hwang JJ, Chuang EY, Wu IH. Global Expression Profiling Identifies a Novel Hyaluronan Synthases 2 Gene in the Pathogenesis of Lower Extremity Varicose Veins. J Clin Med 2018; 7:jcm7120537. [PMID: 30544995 PMCID: PMC6306753 DOI: 10.3390/jcm7120537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/24/2018] [Accepted: 12/07/2018] [Indexed: 11/16/2022] Open
Abstract
Lower extremities varicose veins (VV) are among the most easily recognized venous abnormalities. The genetic mechanism of VV is largely unknown. In this study, we sought to explore the global expressional change of VV and identify novel genes that might play a role in VV. We used next-generation ribonucleic acid (RNA) sequence (RNA seq) technology to study the global messenger RNA expressional change in the venous samples of five diseased and five control patients. We identified several differentially expressed genes, which were further confirmed by conventional reverse transcription polymerase chain reaction (RT-PCR). Using these significant genes we performed in silico pathway analyses and found distinct transcriptional networks, such as angiogenesis, cell adhesion, vascular injury, and carbohydrate metabolisms that might be involved in the mechanism of VV. Among these significant genes, we also found hyaluronan synthases 2 gene (HAS2) played a pivotal role and governed all these pathways. We further confirmed that HAS2 expression was decreased in the venous samples of patients with VV. Finally, we used a zebrafish model with fluorescence emitting vasculature and red blood cells to see the morphological changes of the venous system and blood flow. We found that HAS2 knockdown in zebrafish resulted in dilated venous structural with static venous flow. HAS2 may modulate the transcriptional networks of angiogenesis, cell adhesion, vascular injury, and carbohydrate metabolisms in venous tissues and downregulation of HAS2 may underlie the mechanism of VV.
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Affiliation(s)
- Chia-Shan Hsieh
- Department of Life Science, Genome and Systems Biology Degree Program, National Taiwan University, Taipei 10617, Taiwan.
- Bioinformatics and Biostatistics Core, Center of Genomic Medicine, National Taiwan University, Taipei 10055, Taiwan.
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei 10002, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan.
| | - Yau-Hung Chen
- Department of Chemistry, Tamkang University, Taipei 25137, Taiwan.
| | - Sheng-Nan Chang
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 64041, Taiwan.
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei 10002, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 64041, Taiwan.
| | - Eric Y Chuang
- Department of Life Science, Genome and Systems Biology Degree Program, National Taiwan University, Taipei 10617, Taiwan.
- Bioinformatics and Biostatistics Core, Center of Genomic Medicine, National Taiwan University, Taipei 10055, Taiwan.
| | - I-Hui Wu
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan.
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13
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Shutze W, Shutze R, Dhot P, Ogola GO. Patient-reported outcomes of endovenous superficial venous ablation for lower extremity swelling. Phlebology 2018; 34:391-398. [PMID: 30466354 DOI: 10.1177/0268355518814130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the effect of endovenous ablation in patients presenting with leg swelling. Methods We identified Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class 3 (C3) patients undergoing endovenous ablation from 21 January 2005 to 19 March 2015 with an 810-nm or 1470-nm laser. Patients were surveyed regarding the degree of edema, use of compression stockings, and satisfaction with the procedure. Results A total of 1634 limbs were treated by endovenous ablation for incompetent saphenous veins with or without adjunctive segmental varicose vein microphlebectomy. Of these, 528 limbs were treated for CEAP C3. The average time period from the procedure date until the survey date was 1494 days (range, 562–2795 days). Ninety-two respondents accounted for 130 ablations in 128 limbs with an average venous segmental disease score of 2.7. Ninety-seven limbs (75.8%) had reduced or resolved swelling, 29 limbs (22.6%) were unchanged, and 2 limbs (1.6%) had increased swelling. The vast majority (81%) were satisfied with their decision to have the procedure. Conclusions Endovenous ablation for edema secondary to superficial venous insufficiency is effective and has high patient satisfaction. Further investigation is needed regarding risk factors for immediate failure and delayed recurrence of edema.
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Affiliation(s)
- William Shutze
- 1 Texas Vascular Associates, Dallas, Texas, USA.,2 The Heart Hospital Baylor Plano, Dallas, Texas, USA
| | - Ryan Shutze
- 1 Texas Vascular Associates, Dallas, Texas, USA
| | - Paul Dhot
- 1 Texas Vascular Associates, Dallas, Texas, USA.,2 The Heart Hospital Baylor Plano, Dallas, Texas, USA
| | - Gerald O Ogola
- 3 Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, Texas, USA
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14
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Wallace T, El-Sheikha J, Nandhra S, Leung C, Mohamed A, Harwood A, Smith G, Carradice D, Chetter I. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg 2018; 105:1759-1767. [PMID: 30132797 DOI: 10.1002/bjs.10961] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/29/2018] [Accepted: 06/26/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Clinical guidelines recommend endovenous laser ablation (EVLA) over surgery based on short-term evidence, yet there are few studies reporting mid- to long-term outcomes. The aim of this study was to report the 5-year outcomes from an RCT of surgery versus EVLA for treatment of symptomatic great saphenous varicose veins. METHODS Patients with symptomatic varicose veins due to great saphenous vein (GSV) incompetence were followed up 5 years after enrolment in a randomized trial of either surgery (saphenofemoral junction ligation, GSV strip to the knee and multiple avulsions of varicosities) or EVLA plus multiple avulsions. Outcomes included: clinical recurrence, defined as new varicose veins greater than 3 mm in diameter; Venous Clinical Severity Score (VCSS); quality of life measured by means of Short Form 36, EuroQol Five Dimensions (EQ-5D™) and Aberdeen Varicose Vein Questionnaire (AVVQ); patient satisfaction; and duplex ultrasound examination (DUS) findings. RESULTS Some 218 of the 276 patients enrolled in the trial (79·0 per cent) were available for follow-up. Clinical recurrence was more frequent following surgery than EVLA at 5 years (34·3 versus 20·9 per cent; P = 0·010). Both groups demonstrated sustained significant improvements at 5 years over baseline in VCSS (surgery: median (i.q.r.) 1 (0-2) from 4 (3-5), P < 0·001; EVLA: 0 (0-1) from 4 (3-5), P < 0·001), AVVQ (surgery: 4·59 (0·56-9·78) from 13·69 (9·81-18·11), P < 0·001; EVLA: 3·35 (0·17 to 6·55) from 12·73 (9·41-17·32), P < 0·001) and EQ-5D™ (surgery: 1·000 (0·796-1·000) from 0·859 (0·796-1·000), P = 0·002; EVLA: 1·000 (0·796-1·000) from 0·808 (0·796-1·000), P = 0·002). VCSS was better for EVLA than surgery at 5 years (P = 0·031). Technical success assessed by DUS remained high at 5 years (85·4 per cent for surgery and 93·2 per cent for EVLA; P = 0·074). DUS-detected anatomical patterns of recurrence differed between the groups. CONCLUSION EVLA was more effective than surgery in preventing clinical recurrence 5 years after treatment of great saphenous varicose veins. Patient-reported outcome measures were similar. Registration number: NCT00759434 (http://www.clinicaltrials.gov).
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Affiliation(s)
- T Wallace
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - J El-Sheikha
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - S Nandhra
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - C Leung
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - A Mohamed
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - A Harwood
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - G Smith
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - D Carradice
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
| | - I Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, Hull, UK
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15
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Gloviczki P, Dalsing MC, Henke P, Lal BK, O'Donnell TF, Shortell CK, Huang Y, Markovic J, Wakefield TW. Report of the Society for Vascular Surgery and the American Venous Forum on the July 20, 2016 meeting of the Medicare Evidence Development and Coverage Advisory Committee panel on lower extremity chronic venous disease. J Vasc Surg Venous Lymphat Disord 2018; 5:378-398. [PMID: 28411706 DOI: 10.1016/j.jvsv.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/04/2017] [Indexed: 12/21/2022]
Abstract
On July 20, 2016, a Medicare Evidence Development and Coverage Advisory Committee panel assessed the benefits and risks of currently used lower extremity chronic venous disease (CVD) treatments and their effects on health outcome of the American adult population. The main purpose of the meeting was to advise the Centers for Medicare & Medicaid Services on coverage determination for interventions used for treatment of CVD. A systematic review of the Agency for Healthcare Research and Quality was presented, followed by lectures of invited experts and a public hearing of representatives of professional societies and the industry. After discussing critical issues, the panel voted for key questions. This report summarizes the presented evidence to support recommendations of the Society for Vascular Surgery/American Venous Forum coalition and the presentations on selected discussion topics. These included important venous disease evidence gaps that have not been sufficiently addressed, venous disease treatment disparities and how they may affect the health outcomes of Medicare beneficiaries, and mechanisms that might be supported by the Centers for Medicare & Medicaid Services to improve the evidence base to optimize the care of patients with lower extremity CVD.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Michael C Dalsing
- Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Peter Henke
- Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland, Baltimore, Md
| | | | - Cynthia K Shortell
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ying Huang
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jovan Markovic
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
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16
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Poder TG, Fisette JF, Bédard SK, Despatis MA. Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis. Can J Surg 2018; 61:128-138. [PMID: 29582749 PMCID: PMC5866149 DOI: 10.1503/cjs.010114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. METHODS We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. RESULTS The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. CONCLUSION Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.
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Affiliation(s)
- Thomas G Poder
- From the Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) and the Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Poder); the Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que. (Fisette); CRCHUS, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Bédard); and the Vascular Surgery Unit, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Despatis)
| | - Jean-François Fisette
- From the Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) and the Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Poder); the Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que. (Fisette); CRCHUS, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Bédard); and the Vascular Surgery Unit, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Despatis)
| | - Suzanne K Bédard
- From the Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) and the Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Poder); the Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que. (Fisette); CRCHUS, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Bédard); and the Vascular Surgery Unit, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Despatis)
| | - Marc-Antoine Despatis
- From the Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) and the Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Poder); the Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Que. (Fisette); CRCHUS, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Bédard); and the Vascular Surgery Unit, CIUSSS de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Que. (Despatis)
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Kwan SW, Charalel RA, Stover AM, Baumhauer JF, Cella D, Darien G, Durack JC, Gerson J, Opelka F, Patrick DL, Salem R, Spies JB, Wu AW, White SB. Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel. J Vasc Interv Radiol 2018; 29:1-8. [DOI: 10.1016/j.jvir.2017.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/27/2022] Open
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18
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Zheng X, Wei Q, Zhang H. Novel Developments in Polidocanol Sclerotherapy: A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/jbm.2018.68003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Nayman A, Yildiz I, Koca N, Deniz S, Koplay M, Oguzkurt L. Risk factors associated with recanalization of incompetent saphenous veins treated with radiofrequency ablation catheter. Diagn Interv Imaging 2017; 98:29-36. [DOI: 10.1016/j.diii.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/31/2016] [Accepted: 06/05/2016] [Indexed: 11/16/2022]
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20
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Kwak JH, Min SI, Kim SY, Han A, Choi C, Ahn S, Ha J, Min SK. Delayed Presentation of Endovenous Heat-Induced Thrombosis Treated by Thrombolysis and Subsequent Open Thrombectomy. Vasc Specialist Int 2016; 32:72-6. [PMID: 27386456 PMCID: PMC4928608 DOI: 10.5758/vsi.2016.32.2.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 11/20/2022] Open
Abstract
Although endovenous heat-induced thrombosis (EHIT) is frequently reported after endovenous laser ablation (EVLA), the incidence and timing of occurrence of EHIT are not fully understood. We present a case of EHIT successfully treated with a combination of surgical and endovascular treatments. A 57-year-old woman, two months post bilateral EVLA, presented with a swollen leg. Deep vein thrombosis was diagnosed by Doppler ultrasonography and computerized tomographic venography. We treated the patient with catheter-directed thrombolysis with urokinase after insertion of an inferior vena cava filter. After thrombolytic treatment, we performed surgical venous thrombectomy, due to the presence of a large thrombus in the femoral vein. During the operation, we found organized old thrombus at the great saphenous vein which connected to the deep femoral vein. From these findings, we confirmed the presence of EHIT despite a long time having passed after EVLA. The patient was placed on anticoagulation therapy with oral rivaroxaban for three months.
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Affiliation(s)
- Jung Hak Kwak
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Song-Yi Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chanjoong Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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21
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Changes in Saphenous Vein Stump and Low Incidence of Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation of Great Saphenous Vein Incompetence. Dermatol Surg 2016; 42:515-20. [DOI: 10.1097/dss.0000000000000674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Shutze WP, Kane K, Fisher T, Doud Y, Lassiter G, Leuking R, Nguyen E, Shutze WP. The effect of wavelength on endothermal heat-induced thrombosis incidence after endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2016; 4:36-43. [PMID: 26946893 DOI: 10.1016/j.jvsv.2015.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We hypothesized that the incidence of endothermal heat-induced thrombosis (EHIT) depends on the laser wavelength used in endovenous laser ablation (EVLA) of the saphenous veins. METHODS We identified patients undergoing EVLA in our office from 2005 to 2014 with an 810-nm (hemoglobin-specific) or 1470-nm (water-specific) laser. We reviewed the records for age, sex, body mass index, Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) class, vein diameter, vein(s) treated, adjunctive phlebectomy, energy delivered, laser pullback times, and EHIT (closure level ≥3) development. The Fisher exact test and Pearson χ(2) test were used to evaluate the association between EHIT and the categoric variables. Logistic regression was used to evaluate the relationship between EHIT and the continuous variables. RESULTS There were 1439 veins ablated in 1109 patients (769 female, 340 male). The great saphenous vein (GSV) was treated in 1332, the small saphenous vein (SSV) in 78, and both in 29 (22 procedures on accessory veins were excluded). The CEAP C class for these patients was 1 in 0, 2 in 616, 3 in 522, 4 in 150, 5 in 51, and 6 in 98, and was not recorded in 2. EHIT occurred in 76 cases (5.28%), in 73 after GSV ablation and in three after SSV ablation. The 810-nm laser was used in 1144 procedures, and EHIT developed in 69 patients (6.0%). The 1470-nm laser was used in 295 procedures, with EHIT developing in seven patients (2.4%; P = .0122 by Fisher exact test). The average energy delivered to the EHIT group (3517 ± 1998.1 J) was higher than for the non-EHIT group (2825.1 ± 1491.2 J; P = .0002). The average vein diameter was larger in the EHIT group (9.3 ± 3.8 mm) than in the non-EHIT group (7.2 ± 3.3 mm; P = .0001). EHIT occurred in 59 of 837 cases (6.6%) undergoing simultaneous stab phlebectomy compared with 17 of 525 cases (3.1%) undergoing only EVLA (P = .0049). Statistical analysis confirmed the association between EHIT and CEAP class was significant (P = .0001). No differences were seen for age, body mass index, sex, combined bilateral, and multiple or simultaneous GSV and SSV ablations between the two groups. A multivariate analysis confirmed that CEAP class, vein diameter, adjunctive phlebectomy, and laser wavelength were indeed risk factors for post-EVLA EHIT and that energy delivered and pullback time were not. CONCLUSIONS Water-specific laser fiber wavelength (1470 nm) reduces the risk of EHIT compared with a hemoglobin-specific wavelength (810 nm). CEAP class, simultaneous phlebectomy, and vein diameter >7.5 mm are associated with increased risk of EHIT after EVLA.
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Affiliation(s)
- William P Shutze
- Division of Vascular Surgery, Baylor University Medical Center, Dallas, Tex.
| | - Katherine Kane
- Division of Vascular Surgery, Baylor University Medical Center, Dallas, Tex
| | - Tammy Fisher
- Department of Surgery, Baylor Scott and White Health, Dallas, Tex
| | - Yahya Doud
- Department of Surgery, Baylor Scott and White Health, Dallas, Tex
| | - Grace Lassiter
- Texas A&M Health Science Center College of Medicine, Bryan, Tex
| | - Richard Leuking
- Texas A&M Health Science Center College of Medicine, Bryan, Tex
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Brittenden J, Cotton SC, Elders A, Tassie E, Scotland G, Ramsay CR, Norrie J, Burr J, Francis J, Wileman S, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, MacLennan G, Prior M, Bolsover D, Campbell MK. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess 2015; 19:1-342. [PMID: 25858333 DOI: 10.3310/hta19270] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins. DESIGN A parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation. SETTING Eleven UK specialist vascular centres. PARTICIPANTS Seven hundred and ninety-eight patients with primary varicose veins (foam, n = 292; surgery, n = 294; EVLA, n = 212). INTERVENTIONS Patients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres). PRIMARY OUTCOME MEASURES Disease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained. SECONDARY OUTCOME MEASURES Quality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs. RESULTS The results appear generalisable in that participants' baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size -1.74, 95% confidence interval (CI) -2.97 to -0.50; p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06; p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months. The trial-based cost-effectiveness analysis showed that, at 6 months, foam had the highest probability of being considered cost-effective at a ceiling willingness-to-pay ratio of £20,000 per QALY. EVLA was found to cost £26,107 per QALY gained versus foam, and was less costly and generated slightly more QALYs than surgery. Markov modelling using trial costs and the limited recurrence data available suggested that, at 5 years, EVLA had the highest probability (≈ 79%) of being cost-effective at conventional thresholds, followed by foam (≈ 17%) and surgery (≈ 5%). With regard to secondary outcomes, health gains at 6 weeks (p < 0.005) were greater for EVLA than for foam (EQ-5D, p = 0.004). There were fewer procedural complications in the EVLA group (1%) than after foam (7%) and surgery (8%) (p < 0.001). Participants returned to a wide range of behaviours more quickly following foam or EVLA than following surgery (p < 0.05). There were no differences in VCSS between the three treatments. Truncal ablation rates were higher for surgery (p < 0.001) and EVLA (p < 0.001) than for foam, and were similar for surgery and EVLA. CONCLUSIONS Considerations of both the 6-month clinical outcomes and the estimated 5-year cost-effectiveness suggest that EVLA should be considered as the treatment of choice for suitable patients. FUTURE WORK Five-year trial results are currently being evaluated to compare the cost-effectiveness of foam, surgery and EVLA, and to determine the recurrence rates following each treatment. This trial has highlighted the need for long-term outcome data from RCTs on QoL, recurrence rates and costs for foam sclerotherapy and other endovenous techniques compared against each other and against surgery. TRIAL REGISTRATION Current Controlled Trials ISRCTN51995477. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Brittenden
- Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
| | | | - Andrew Elders
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Emma Tassie
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Jill Francis
- School of Health Sciences, City University London, London, UK
| | - Samantha Wileman
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Bruce Campbell
- Department of Vascular Surgery, Royal Devon and Exeter Hospital (Wonford), Exeter, UK
| | - Paul Bachoo
- Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
| | - Ian Chetter
- Department of Vascular Surgery, Hull Royal Infirmary, Hull, UK
| | - Michael Gough
- Vascular Surgery, St James University Hospital, Leeds, UK
| | | | - Tim Lees
- Vascular Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Julian Scott
- Vascular Surgery, St James University Hospital, Leeds, UK
| | - Sara A Baker
- Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Maria Prior
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Denise Bolsover
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Davies HOB, Popplewell M, Darvall K, Bate G, Bradbury AW. A review of randomised controlled trials comparing ultrasound-guided foam sclerotherapy with endothermal ablation for the treatment of great saphenous varicose veins. Phlebology 2015; 31:234-40. [DOI: 10.1177/0268355515595194] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The last 10 years have seen the introduction into everyday clinical practice of a wide range of novel non-surgical treatments for varicose veins. In July 2013, the UK National Institute for Health and Care Excellence recommended the following treatment hierarchy for varicose veins: endothermal ablation, ultrasound-guided foam sclerotherapy, surgery and compression hosiery. The aim of this paper is to review the randomised controlled trials that have compared endothermal ablation and ultrasound-guided foam sclerotherapy to determine if the level 1 evidence base still supports an “endothermal ablation first” strategy for the treatment of varicose veins. Methods A PubMed and OVID literature search (until 31 January 2015) was performed and randomised controlled trials comparing endothermal ablation and ultrasound-guided foam sclerotherapy were obtained. Results Although anatomical success appeared higher with endothermal ablation than ultrasound-guided foam sclerotherapy, clinical success and patient-reported outcomes measures were similar. Morbidity and complication rates were very low and not significantly different between endothermal ablation and ultrasound-guided foam sclerotherapy. Ultrasound-guided foam sclerotherapy was consistently less expensive that endothermal ablation. Conclusions All endovenous modalities appear to be successful and have a role in modern day practice. Although further work is required to optimise ultrasound-guided foam sclerotherapy technique to maximise anatomical success and minimise retreatment, the present level 1 evidence base shows there is no significant difference in clinical important outcomes between ultrasound-guided foam sclerotherapy and endothermal ablation. As ultrasound-guided foam sclerotherapy is less expensive, it is likely to be a more cost-effective option in most patients in most healthcare settings. Strict adherence to the treatment hierarchy recommended by National Institute for Health and Care Excellence seems unjustified.
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Affiliation(s)
- Huw OB Davies
- Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK
| | - Matthew Popplewell
- Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK
| | - Katy Darvall
- North Devon District Hospital, Barnstaple, Devon, UK
| | - Gareth Bate
- Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK
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Nastasa V, Samaras K, Ampatzidis C, Karapantsios TD, Trelles MA, Moreno-Moraga J, Smarandache A, Pascu ML. Properties of polidocanol foam in view of its use in sclerotherapy. Int J Pharm 2014; 478:588-96. [PMID: 25433198 DOI: 10.1016/j.ijpharm.2014.11.056] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 11/16/2022]
Abstract
Foam sclerotherapy is a widely used method to treat varicose veins disease. It is easy to use and apply, affordable, and has high efficiency that depends on foam stability upon injection. Since sclerotherapy is usually applied in a medical doctor's office, one of the most employed methods to generate foam is based on the Tessari technique which uses pumping cycles of liquid and air in-and-out of a double syringe system. Finally, the produced foam exits through a small orifice (∼2mm) at the output of a three-way valve. The present work shows results regarding the factors that may influence foam stability (liquid to air ratio, type of connector, syringe diameter, number of pumping cycles, etc.) of a commonly used sclerosing agent (polidocanol). Furthermore, an effort is made to evaluate the effect of adding different substances on the stability of polidocanol foams (0.5% w/w) by altering the surface tension or/and the bulk and interfacial rheological properties of the fluids. It is shown that adding small concentrations of nonionic surfactants can increase foam stability with just a very small variation of the mean bubbles size.
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Affiliation(s)
- V Nastasa
- National Institute for Laser Plasma and Radiation Physics, Bucharest, Romania; Faculty of Physics, University of Bucharest, Romania
| | - K Samaras
- Aristotle University of Thessaloniki, Faculty of Chemistry, Thessaloniki, Greece
| | - Ch Ampatzidis
- Aristotle University of Thessaloniki, Faculty of Chemistry, Thessaloniki, Greece
| | - T D Karapantsios
- Aristotle University of Thessaloniki, Faculty of Chemistry, Thessaloniki, Greece
| | - M A Trelles
- Instituto Médico Vilafortuny/FUNDACION ANTONI DE GIMBERNAT, Cambrils, Spain
| | | | - A Smarandache
- National Institute for Laser Plasma and Radiation Physics, Bucharest, Romania; Faculty of Physics, University of Bucharest, Romania
| | - M L Pascu
- National Institute for Laser Plasma and Radiation Physics, Bucharest, Romania; Faculty of Physics, University of Bucharest, Romania.
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Kane K, Fisher T, Bennett M, Shutze W, Hicks T, Grimsley B, Gable D, Pearl G, Smith B, Shutze W. The Incidence and Outcome of Endothermal Heat-induced Thrombosis after Endovenous Laser Ablation. Ann Vasc Surg 2014; 28:1744-50. [DOI: 10.1016/j.avsg.2014.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
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Brittenden J, Cotton SC, Elders A, Ramsay CR, Norrie J, Burr J, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, Francis J, Tassie E, Scotland G, Wileman S, Campbell MK. A randomized trial comparing treatments for varicose veins. N Engl J Med 2014; 371:1218-27. [PMID: 25251616 DOI: 10.1056/nejmoa1400781] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasound-guided foam sclerotherapy and endovenous laser ablation are widely used alternatives to surgery for the treatment of varicose veins, but their comparative effectiveness and safety remain uncertain. METHODS In a randomized trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of foam, laser, and surgical treatments. Primary outcomes at 6 months were disease-specific quality of life and generic quality of life, as measured on several scales. Secondary outcomes included complications and measures of clinical success. RESULTS After adjustment for baseline scores and other covariates, the mean disease-specific quality of life was slightly worse after treatment with foam than after surgery (P=0.006) but was similar in the laser and surgery groups. There were no significant differences between the surgery group and the foam or the laser group in measures of generic quality of life. The frequency of procedural complications was similar in the foam group (6%) and the surgery group (7%) but was lower in the laser group (1%) than in the surgery group (P<0.001); the frequency of serious adverse events (approximately 3%) was similar among the groups. Measures of clinical success were similar among the groups, but successful ablation of the main trunks of the saphenous vein was less common in the foam group than in the surgery group (P<0.001). CONCLUSIONS Quality-of-life measures were generally similar among the study groups, with the exception of a slightly worse disease-specific quality of life in the foam group than in the surgery group. All treatments had similar clinical efficacy, but complications were less frequent after laser treatment and ablation rates were lower after foam treatment. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN51995477.).
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Affiliation(s)
- Julie Brittenden
- From the Division of Applied Medicine (J. Brittenden), the Health Services Research Unit (S.C.C., A.E., C.R.R., J.N., G.S., S.W., M.K.C.), and the Health Economics Research Unit (E.T., G.S.), University of Aberdeen, and the Department of Vascular Surgery, NHS Grampian, Aberdeen Royal Infirmary (P.B.), Aberdeen; the School of Medicine, Medical and Biological Sciences, University of St. Andrews, St. Andrews (J. Burr); the Department of Vascular Surgery, Royal Devon and Exeter Hospital, Exeter (B.C.); the Department of Vascular Surgery, Hull Royal Infirmary, Hull (I.C.); the School of Surgery, University of Leeds (M.G.), and Vascular Surgery, St. James University Hospital (J.S.), Leeds; Vascular Surgery, Gloucestershire Royal Hospital, Gloucester (J.E.); Vascular Surgery, Freeman Hospital, Newcastle upon Tyne (T.L.); the Vascular Surgical Unit, Royal Bournemouth Hospital, Bournemouth (S.A.B.); and the School of Health Sciences, City University London, London (J.F.) - all in the United Kingdom
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O'Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Henke PK, Gloviczki ML, Eklöf BG, Stoughton J, Raju S, Shortell CK, Raffetto JD, Partsch H, Pounds LC, Cummings ME, Gillespie DL, McLafferty RB, Murad MH, Wakefield TW, Gloviczki P. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg 2014; 60:3S-59S. [PMID: 24974070 DOI: 10.1016/j.jvs.2014.04.049] [Citation(s) in RCA: 384] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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van Eekeren RR, Boersma D, de Vries JPP, Zeebregts CJ, Reijnen MM. Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature. Semin Vasc Surg 2014; 27:118-36. [DOI: 10.1053/j.semvascsurg.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pavlović MD, Schuller-Petrović S, Pichot O, Rabe E, Maurins U, Morrison N, Pannier F. Guidelines of the First International Consensus Conference on Endovenous Thermal Ablation for Varicose Vein Disease--ETAV Consensus Meeting 2012. Phlebology 2014; 30:257-73. [PMID: 24534341 DOI: 10.1177/0268355514524568] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Endovenous thermal ablation (ETA) procedures are catheter-directed, ultrasound (US)-guided thermal methods for treatment in varicose veins disease. Radiofrequency, laser or steam energy thermally denatures vein wall collagen, leading first to vein wall inflammation, then fibrosis and finally to occlusion. The aim of this guideline is to give evidence-based recommendations for ETA procedures. METHODS These guidelines were drafted during a consensus meeting of a group of experts in the field of ETA in June 2012 (Hvar, Croatia) under the auspices of the International Union of Phlebology (IUP). These guidelines review the present state of knowledge as reflected in peer-reviewed published medical literature. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. RESULTS Recommendations on the use of ETA procedures were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. Health economics were not considered, since differences in national health systems and pricing make it difficult to form general conclusions that are relevant at an international level.
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Affiliation(s)
- Miloš D Pavlović
- Dermatology Centre Parmova & DCP-Venex Centre, Ljubljana, Slovenia
| | | | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
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Abdul-Haqq R, Almaroof B, Chen BL, Panneton JM, Parent FN. Endovenous Laser Ablation of Great Saphenous Vein and Perforator Veins Improves Venous Stasis Ulcer Healing. Ann Vasc Surg 2013; 27:932-9. [DOI: 10.1016/j.avsg.2012.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/23/2012] [Accepted: 09/04/2012] [Indexed: 12/21/2022]
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Perrins S, Cha A, Qaqish R, Plummer D, Hsu R, Dietzek AM. Clinical and anatomic outcomes of endovenous radiofrequency ablation performed on symptomatic small-diameter great saphenous veins. J Vasc Surg Venous Lymphat Disord 2013; 1:245-9. [PMID: 26992582 DOI: 10.1016/j.jvsv.2012.10.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The efficacy of radiofrequency ablation (RFA) for symptomatic varicose veins is well established. Alternatively, there is less consensus and little data on outcomes when treating great saphenous veins (GSV) of small diameter (≤5 mm). The purpose of this study is to assess clinical and anatomical outcomes of RFA on symptomatic patients with small GSV. METHODS A retrospective analysis was performed on our symptomatic patients who received RFA of incompetent GSV without any concomitant adjunctive procedures between January 2008 and December 2011. Limbs with GSV thigh diameter ≤5 mm and >5 mm on duplex while standing were subject to review. Clinical success was defined as an improvement in Venous Clinical Severity Score (VCSS) at 3 months. Anatomic success was defined as absence of venous flow ≤3 cm distal to the saphenofemoral junction on duplex ultrasound examination. Changes in CEAP class were noted. RESULTS In 307 patients, 55 limbs in 44 patients met inclusion criteria. Baseline median VCSS was 4 (interquartile range [IQR], 4, 5) for those patients with diameter ≤5 mm. Clinical success was seen in 83% of limbs at 3 months with a median VCSS change of -2 (IQR, -3, -1). None of the treated limbs had phlebectomy for symptomatic refluxing GSV varicosities prior to 3-month follow up. One phlebectomy was performed for cosmesis at 78 days postprocedure. Anatomic success was achieved in 96% of limbs at 3 months. Baseline median CEAP was 2 (IQR, 2, 2). The median CEAP change at 3 months was 0 (IQR, -1, 0). One patient experienced thrombus extension into the saphenofemoral junction at 4 days. CONCLUSIONS In our experience, RFA of symptomatic small-diameter GSV provides comparable clinical and anatomic outcomes to that of current published data. Our findings suggest that these patients benefit clinically from RFA.
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Affiliation(s)
- Steven Perrins
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Andrew Cha
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Robert Qaqish
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Dahlia Plummer
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Richard Hsu
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn
| | - Alan M Dietzek
- Department of Vascular Surgery, Danbury Hospital, Danbury, Conn.
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Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. The Aberdeen Varicose Vein Questionnaire May be the Preferred Method of Rationing Patients for Varicose Vein Surgery. Angiology 2013; 65:205-9. [DOI: 10.1177/0003319712474953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rationing treatment of varicose veins (VVs) is of importance in countries with a public health service and limited funds. This study examines why and how the Aberdeen varicose vein questionnaire (AVVQ) can be used in achieving rationing. Baseline assessments prior to endovenous treatment included the venous clinical severity score (VCSS), venous filling index (VFI), and the refluxing great saphenous vein (GSV) diameter. Absolute change in the AVVQ defined improvement. There was no significant correlation in AVVQ improvement compared to baseline VCSS, VFI, GSV diameter or when patients were divided into mild and severe disease (C2,3 vs C4-6) or laser ablation versus foam sclerotherapy. However, AVVQ improvement significantly correlated at 3 weeks (n = 84) and 3 months (n = 70) with their baseline values ( r = .5 and r = .585), P < .0005 (Spearman). In conclusion, patients with an initial poor quality of life may benefit most from endovenous treatment, irrespective of other baseline severity assessments.
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Affiliation(s)
- Christopher R. Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Mustapha Azzam
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
| | - George Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital Middlesex, UK
- Department of Surgery and Cancer, Imperial College, London, UK
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Lattimer CR, Kalodiki E, Azzam M, Geroulakos G. Responsiveness of individual questions from the venous clinical severity score and the Aberdeen varicose vein questionnaire. Phlebology 2012. [DOI: 10.1258/phleb.2012.012080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The venous clinical severity score (VCSS) and the Aberdeen varicose vein questionnaire (AVVQ) improve after treating chronic venous insufficiency (CVI). The aim was to examine how and why they improve by evaluating the change in each individual question. Methods This was an analysis on prospectively collected data from a clinical study on 100 patients (58% female) with CVI (C2 = 34, C3 = 14, C4a = 29, C4b = 9, C5 = 7, C6 = 7) who were randomized to endovenous laser ablation ( n = 50) or foam sclerotherapy ( n = 50). The change scores (performance) of each question of the VCSS (questions 1–10) and the AVVQ (questions 1–13) were calculated by subtracting the score at three weeks, and three months, from the pre-treatment score. Results Both the median, interquartile range (IQR), VCSS and the AVVQ scores improved from 6 (4) and 21.4 (15.1) at baseline to 3 (4) and 18.6 (12.1) at three weeks ( P < 0.0005, P = 0.031) to 2 (3) and 8.8 (13.6) at three months, ( P < 0.0005, P < 0.0005), respectively. The performance of the first three questions of the VCSS (pain, extent of varicosities, oedema) were the most contributory to the overall score. Questions 5, 7, 8, 9 on ulceration improved the most individually but did not contribute significantly to the overall score. Questions 5, 9 of the AVVQ on stocking use and ulceration failed to contribute statistically to the overall improvement at three months. Conclusion The majority of the individual questions of the VCSS and AVVQ responded to change. However, the cause of a poor response was multifactorial with statistical dilution playing a significant role. Stratification of patients according to ulceration may allow better comparisons.
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Long-term results of a randomized controlled trial on ultrasound-guided foam sclerotherapy combined with saphenofemoral ligation vs standard surgery for varicose veins. J Vasc Surg 2012; 55:451-7. [DOI: 10.1016/j.jvs.2011.08.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 08/18/2011] [Accepted: 08/22/2011] [Indexed: 11/20/2022]
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Corcos L, Pontello D, DE Anna D, Dini S, Spina T, Barucchello V, Carrer F, Elezi B, DI Benedetto F. Endovenous 808-nm diode laser occlusion of perforating veins and varicose collaterals: a prospective study of 482 limbs. Dermatol Surg 2011; 37:1486-98. [PMID: 21883649 DOI: 10.1111/j.1524-4725.2011.02133.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovenous laser ablation (EVLA) was performed in the treatment of great and small saphenous veins (GSVs, SSVs), perforating veins (PVs), and varicose collaterals (VCs). OBJECTIVE To verify the outcome in PVs and VCs. MATERIALS AND METHODS Four hundred eighty-two limbs of 306 patients were studied. EVLA was performed on 167 GSVs, 52 SSVs, and 534 PVs of 303 limbs and on VCs of 467 limbs; 133 GSVs were stripped, 300 of saphenofemoral junctions (SFJs) and 45 saphenopopliteal junctions (SPJs) were interrupted. Limbs were selected using duplex ultrasound examination and photographs; PVs-VCs diameter (<4 mm) and VC length were measured. EVLA was performed using a 808-nm diode laser, 0.6-mm fibers, continuous emission, 4 to 10 W, and 10 to 20 J/cm. Follow-up on 467 limbs occurred over a mean 27.5 months (range 3 months to 6 years); 98 limbs were followed up for longer than 4 years. RESULTS Operating time range from 10 to 30 minutes per limb. Blood vaporization, thrombosis, fibrosis, and atrophy prevailed in PVs and in the large VCs (>4 mm) and massive coagulation in the smaller (<4 mm). High rate of occlusion was seen, with different rates of patent PV-VC mainly in diameter >6 mm. Thirty-nine out of 511 patent PVs (7.6%) and 96 out of 778 VCs (12-13%) were re-treated using EVLA or foam sclerotherapy. Minor complications occurred in 88 of the 778 (11%). CONCLUSIONS EVLA of PVs and VCs is effective and faster than surgery in 2- to 6-mm PVs and VCs using an 808-nm diode laser.
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Affiliation(s)
- Leonardo Corcos
- Department of Surgical Sciences, Postgraduate School of Vascular Surgery, University of Udine, Udine, Italy.
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De Maeseneer M, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith P. Duplex Ultrasound Investigation of the Veins of the Lower Limbs after Treatment for Varicose Veins – UIP Consensus Document. Eur J Vasc Endovasc Surg 2011; 42:89-102. [DOI: 10.1016/j.ejvs.2011.03.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 833] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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In prospective study using Specific Quality of Life & Outcomes Response-Venous (SQOR-V) questionnaire the recall bias had the same magnitude as the minimally important difference. Qual Life Res 2011; 20:1589-93. [DOI: 10.1007/s11136-011-9910-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
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Spreafico G, Kabnick L, Berland TL, Cayne NS, Maldonado TS, Jacobowitz GS, Rockman CR, Lamparello PJ, Baccaglini U, Rudarakanchana N, Adelman MA. Laser saphenous ablations in more than 1,000 limbs with long-term duplex examination follow-up. Ann Vasc Surg 2011; 25:71-8. [PMID: 21172581 DOI: 10.1016/j.avsg.2010.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 09/23/2010] [Accepted: 09/28/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the duplex results of endovenous laser ablation in the treatment of incompetent great saphenous veins (GSV) and small saphenous veins (SSV) with at least 1-year follow-up. METHODS A retrospective registry was entered by 11 centers from Europe and America, organized by the International Endovenous Laser Working Group. Data concerning 1,020 limbs in patients with incompetence of the GSV and/or SSV, treated with the Endovenous Laser Ablation (EVLA) procedure, were collected. EVLA failures were defined on duplex imaging as reflux confined to the saphenofemoral or saphenopopliteal junction, reflux confined to the main saphenous trunk, or reflux of both junction and main trunk (totally patent saphenous vein) were analyzed at one or more years postoperatively. RESULTS The mean age of patients was 54 ± 5 years (range: 18-91 years). The average body mass index was 25. There was a paucity of severe complications: One case of third-degree skin burn, six patients with postsurgical deep vein thrombosis (0.6%), and 27 cases of sensory nerve damage (2.7%). At 1-year, the rate of complete occlusion of the saphenous trunk was 93.1%. There were 79 cases of treatment failures as evidenced by duplex: 22 isolated junction failures (2.2%), 44 isolated trunk failures (4.4%), and 13 totally patent veins (1.3%). Two-year duplex results were reported for 329 limbs with the identification of 19 new cases of failure. No new cases of failure were reported at 3-year follow-up of 130 limbs. Cumulative failure rates estimated by Kaplan-Meier analysis were 7.7% at 1-year and 13.1% at 2- and 3-year follow-up. CONCLUSIONS On the basis of a duplex scan performed at least 1-year post-treatment, this multicenter registry confirms the safety and efficacy of the EVLA procedure in the treatment of GSV and SSV reflux. Considering the continued failure rate documented in the present study, an annual follow-up by duplex is recommended to 2 years after EVLA.
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Affiliation(s)
- Giorgio Spreafico
- Centro Multidisciplinare Day Surgery, Azienda Ospedaliera-Università, Padova, Italy
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Shepherd AC, Gohel MS, Lim CS, Davies AH. A study to compare disease-specific quality of life with clinical anatomical and hemodynamic assessments in patients with varicose veins. J Vasc Surg 2011; 53:374-82. [PMID: 21129895 DOI: 10.1016/j.jvs.2010.09.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
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Duplex Ultrasound Outcomes Following Ultrasound-Guided Foam Sclerotherapy of Symptomatic Primary Great Saphenous Varicose Veins. Eur J Vasc Endovasc Surg 2010; 40:534-9. [DOI: 10.1016/j.ejvs.2010.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 06/20/2010] [Indexed: 11/20/2022]
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Vasquez MA, Munschauer CE. The Importance of Uniform Venous Terminology in Reports on Varicose Veins. Semin Vasc Surg 2010; 23:70-7. [DOI: 10.1053/j.semvascsurg.2010.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Darvall KAL, Sam RC, Bate GR, Silverman SH, Adam DJ, Bradbury AW. Changes in health-related quality of life after ultrasound-guided foam sclerotherapy for great and small saphenous varicose veins. J Vasc Surg 2010; 51:913-20. [PMID: 20347688 DOI: 10.1016/j.jvs.2009.11.045] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 10/19/2009] [Accepted: 11/07/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) improves after superficial venous surgery for varicose veins, but the effect of ultrasound-guided foam sclerotherapy on HRQOL is unknown. The aim of this study was to determine changes in HRQOL after ultrasound-guided foam sclerotherapy for varicose veins. METHODS Consecutive patients undergoing ultrasound-guided foam sclerotherapy for varicose veins were sent the Short Form 12 (SF-12) questionnaire, a generic measure of HRQOL, and the Aberdeen Varicose Vein Symptom Score (AVSS) questionnaire, a disease-specific measure of HRQOL, 1 week before treatment and 1, 6, and 12 months after treatment. RESULTS The study enrolled 296 patients (34% male; 395 treated legs) with a median age of 57 years (range, 22-89 years). Of these, 24% had had previous superficial venous surgery, and 66% were CEAP C(2-3) (uncomplicated varicose veins). Questionnaire completion rates were 82%, 73%, and 69% at 1, 6, and 12 months after treatment. The median Physical Component Summary score of the SF-12 (higher score indicates better HRQOL) improved from 47.6 pretreatment to 49.4 at 1 month (P < .008, Wilcoxon signed rank test), to 51.9 at 6 months (P < .0005), and to 52.9 at 12 months (P < .0005). The median AVSS (lower score indicates better HRQOL) improved from 19.0 pretreatment to 16.5 at 1 month (P < .0005), to 8.7 at 6 months (P < .0005), and to 8.6 at 12 months (P < .0005). CONCLUSIONS Ultrasound-guided foam sclerotherapy for great and small saphenous varicose veins leads to significant improvements in generic and disease-specific HRQOL for at least 12 months after treatment.
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Affiliation(s)
- Katy A L Darvall
- Birmingham University Department of Vascular Surgery, Heart of England NHS Trust, Birmingham, United Kingdom.
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Abstract
BACKGROUND Polidocanol is a liquid surfactant having endothelial cell lytic properties. In the form of a controlled, dispensed microfoam it is administered endovenously as a sclerosing agent in the treatment of varicose veins. OBJECTIVE This review summarizes efficacy of polidocanol endovenous microfoam sclerotherapy using a proprietary dispensing system to control foam characteristics and gas content for treating varicose veins. METHODS We reviewed in vitro, Phase I, Phase II and limited Phase III data for polidocanol microfoam with a focus on controlled foam formulation in therapy. RESULTS/CONCLUSIONS Clinical trials of controlled dispensing of polidocanol microfoam provide evidence of effective treatment of chronic venous insufficiency with low toxicity, minimal risk and few complications.
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Affiliation(s)
- David M Eckmann
- University of Pennsylvania, 331 John Morgan Building/6112, 3620 Hamilton Walk, Philadelphia, PA 19104-4215, USA.
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Lugli M, Cogo A, Guerzoni S, Petti A, Maleti O. Effects of eccentric compression by a crossed-tape technique after endovenous laser ablation of the great saphenous vein: a randomized study. Phlebology 2009; 24:151-6. [PMID: 19620697 DOI: 10.1258/phleb.2008.008045] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effect of eccentric compression applied by a new crossed-tape technique on procedure-related pain occurrence after endovenous laser ablation (ELA) of the great saphenous vein (GSV). METHODS From April 2005 to June 2006, 200 consecutive ELA procedures were randomized to receive (group A: 100) or not (group B: 100) an eccentric compression applied in the medial aspect of the thigh. Patients were scheduled for a seven-day examination to assess the level of pain experienced. Pain intensity was measured using a visual analogue scale giving a numerical grade from 0 (no pain) to 10 (worst pain ever). RESULTS The intensity of postoperative pain was significantly reduced (P < 0.001) in the eccentric compression group as compared with the non-compression one. CONCLUSIONS This technique of eccentric compression greatly reduces the intensity of postoperative pain after ELA of the GSV.
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Affiliation(s)
- M Lugli
- Hesperia Hospital - CardioVascular Surgery, Via Arquà 80/A, Modena 41100, Italy.
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Suzuki M, Unno N, Yamamoto N, Nishiyama M, Sagara D, Tanaka H, Mano Y, Konno H. Impaired lymphatic function recovered after great saphenous vein stripping in patients with varicose vein: venodynamic and lymphodynamic results. J Vasc Surg 2009; 50:1085-91. [PMID: 19632804 DOI: 10.1016/j.jvs.2009.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 06/01/2009] [Accepted: 06/01/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Venodynamics and lymphodynamics may interact as an inseparable and mutually dependent dual outflow system. This study investigated the effect of surgical treatment on lower limb lymph flow in patients with varicose veins. METHODS Thirty-nine patients with varicose veins in the lower limb (28 patients with unilateral limb, 11 patients with bilateral limb), who demonstrated great saphenous vein reflux, were investigated with air-plethysmography and indocyanine green (ICG) fluorescence lymphography before surgical treatment and 6 months later. Fifteen healthy volunteers participated in this study as a control. With air-plethysmography, venous volume (VV) and venous filling time were measured. Venous filling index (VFI) was calculated. For ICG lymphography, 0.3 mL of ICG (0.5%) was subcutaneously injected at the dorsum of the foot. After the injection, fluorescent image of ICG dye was traced on real-time video images using a near-infrared camera system. The interval until the dye reached the knee was measured (transit time [TT]) in a standing position, which was previously demonstrated to correlate with the interval measured using dynamic isotope lymphoscintigraphy. RESULTS In CEAP clinical stage venous disease, TT in patients with C4 approximately 6 and C2 approximately 3 was significantly longer than that in the control group (587 +/- 97 seconds, 484 +/- 82 seconds, 252 +/- 29 seconds, respectively, mean +/- SD, P < .01). Among all limbs with varicose veins, there were correlations between TT and VV (Pearson r = 0.31, P < .01), between TT and VFI (Pearson r = 0.48, P < .01). All patients underwent great saphenous vein stripping. Six months later, the venous clinical severity score significantly improved with significant reductions in both VV and VFI values. TT 6 months postoperatively was also significantly shorter than that before surgical treatment (501 +/- 67 seconds, 340 +/- 38 seconds, respectively, mean +/- SD, P < .01). CONCLUSIONS Varicose veins could affect lymphatic function and delay lymphatic flow in the lower limbs. Derangement of lymph flow may correlate with the severity of clinical venous disease and/or the magnitude of venous reflux, which could be reversible with surgical treatment of venous incompetence.
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Affiliation(s)
- Minoru Suzuki
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology 2009; 23:259-75. [PMID: 19029007 DOI: 10.1258/phleb.2008.008018] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The time is ripe for universal understanding and acceptance of outcome assessment in venous disease. Outcome studies promote understanding of the diseases we treat and the results of treatment. The choice of a valid and reliable assessment tool is crucial. Patient-generated quality-of-life tools include generic instruments and disease-specific instruments. Generic instruments evaluate overall well-being and provide subjective measurements of treatment outcomes in various disease states. The 36-Item Short Form Health Survey and the Nottingham Health Profile are widely used generic surveys. Disease-specific instruments relate to a particular disease state. They are popular in venous disease reporting and have high sensitivity. The Chronic Venous Insufficiency Questionnaire, the Venous Insufficiency Epidemiological and Economic Study, the Aberdeen Varicose Vein Questionnaire and the Charing Cross Venous Ulceration Questionnaire are such devices. Physician-generated measurement tools are used to evaluate and classify the consequences of venous disease. The clinical, aetiology, anatomy, pathophysiology classification (CEAP) is a popular descriptive platform for chronic venous disease. The Venous Severity Scoring (VSS) system was derived from the CEAP classification to provide evaluative capabilities. The three elements of the VSS are the venous disability score, the venous segmental disease score and the venous clinical severity score (VCSS). The VCSS facilitates the follow-up of features of venous disease that change with treatment. Each of these outcomes tools has been validated, and each has strengths and weaknesses. Maintaining the dynamic nature of assessment with periodic review and revision is the way forward to generating universal applicability. Although the choice of instrument is debatable, the most important factor in improving treatment outcomes is the decision to examine results and to share them in a meaningful way.
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Affiliation(s)
- M A Vasquez
- SUNY Buffalo Surgery, The Venous Institute of Buffalo, 415 Tremont Street, North Tonawanda, NY 14120, USA.
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Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg 2009; 49:498-501. [DOI: 10.1016/j.jvs.2008.09.014] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 09/05/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
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Endovenous laser ablation: Venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg 2008; 48:1538-45. [DOI: 10.1016/j.jvs.2008.07.052] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/22/2022]
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