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Jiang W, Liang Y, Long Z, Hu M, Yang H, Qin X. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: A meta-analysis. J Vasc Surg Venous Lymphat Disord 2024; 12:101842. [PMID: 38316290 DOI: 10.1016/j.jvsv.2024.101842] [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: 09/26/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Endovenous radiofrequency ablation (RFA) and laser ablation (LA) have been commonly used for treating lower extremity varicose veins (LEVVs). Their therapeutic effects have been widely recognized compared with conventional surgery. However, there have been some controversies regarding the choice between RFA and LA. The objective of our study was to conduct a systematic review and meta-analysis comparing the early and long-term outcomes of RFA and LA. METHODS A comprehensive search was performed in the PubMed, Embase, and Cochrane databases to identify relevant literature on endovenous thermal ablation for primary LEVV up until June 2023. Randomized controlled trials, cohort studies, and case-control studies involving RFA and LA for LEVV treatment were included. The primary endpoints were the occlusion rate of the great saphenous vein (GSV) and occurrence of venous thrombotic events. Secondary outcomes included nerve injury, hyperpigmentation, burns, recurrence of VVs, postoperative pain, and phlebitis. Data were analyzed using Review Manager 5.3 software. RESULTS A total of 29 studies met the inclusion criteria, consisting of 16 randomized controlled trials and 13 cohort studies. At 1 month, the occlusion rates of GSV were 98.35% for RFA and 98.04% for LA, whereas at 1 year, the rates were 93.13% for RFA and 94.18% for LA. Subgroup analyses revealed that RFA had higher GSV occlusion rates at 1 year since 2016 (93.27% vs 91.24%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.0-1.83; P = .05). The incidence of postoperative venous thrombotic events was 0.78% for RFA and 0.87% for LA at 1 month (OR, 1.46; 95% CI, 0.77-2.74; P = .24). RFA showed a reduced risk of burns and ecchymosis (OR, 0.65; 95% CI, 0.48-0.87; P = .005), postprocedural pain (mean difference, -0.85; 95% CI, -1.06 to -0.64; P < .001), recurrence of VVs (OR, 0.58; 95% CI, 0.36-0.92; P = .02), and paresthesia since 2016 (OR, 0.42; 95% CI, 0.19-0.91; P = .03), but an increased risk of skin pigmentation (OR, 1.75; 95% CI, 1.06-2.9; P = .03) compared with LA therapy. The rate of phlebitis was similar between RFA and LA (OR, 0.87; 95% CI, 0.33-2.27; P = .78). CONCLUSIONS RFA and LA demonstrated similar efficacy in terms of early and long-term occlusion rates of GSV and the incidence of thrombotic and phlebitis complications. However, since 2016, RFA has shown higher GSV occlusion rates compared with LA. Furthermore, RFA was associated with fewer complications such as paresthesia, burns and ecchymosis, and recurrence of VVs when compared with LA.
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Affiliation(s)
- Wenhong Jiang
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yanying Liang
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhen Long
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ming Hu
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Qin
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Hew CY, McElvenny DM, Onwudike M. Longer term follow-up of a randomized controlled trial on the role of compression after radiofrequency ablation of varicose veins. J Vasc Surg Venous Lymphat Disord 2024:101963. [PMID: 39181244 DOI: 10.1016/j.jvsv.2024.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/01/2024] [Accepted: 08/10/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Several studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term. METHODS All 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities. RESULTS Thirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (P = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), -7.3 to 1.1; P = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, -1.1 to 0.7; P = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, -0.22 to 1.17; P = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, -7.7 to 6.2; P = .83]). CONCLUSIONS This study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.
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Affiliation(s)
- Chee Yee Hew
- Manchester University NHS Foundation Trust, Manchester, UK.
| | - Damien M McElvenny
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK; Research Group, Institute of Occupational Medicine, Edinburgh, UK
| | - Madu Onwudike
- Bolton Hospitals NHS Foundation Trust, Bolton, UK; Institute of Medicine, University of Bolton, Bolton, UK
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Zhang DD, He XY, Yang L, Wu BS, Fu Y, Liu WS, Guo Y, Fei CJ, Kang JJ, Feng JF, Cheng W, Tan L, Yu JT. Exome sequencing identifies novel genetic variants associated with varicose veins. PLoS Genet 2024; 20:e1011339. [PMID: 38980841 PMCID: PMC11233024 DOI: 10.1371/journal.pgen.1011339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 06/13/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Varicose veins (VV) are one of the common human diseases, but the role of genetics in its development is not fully understood. METHODS We conducted an exome-wide association study of VV using whole-exome sequencing data from the UK Biobank, and focused on common and rare variants using single-variant association analysis and gene-level collapsing analysis. FINDINGS A total of 13,823,269 autosomal genetic variants were obtained after quality control. We identified 36 VV-related independent common variants mapping to 34 genes by single-variant analysis and three rare variant genes (PIEZO1, ECE1, FBLN7) by collapsing analysis, and most associations between genes and VV were replicated in FinnGen. PIEZO1 was the closest gene associated with VV (P = 5.05 × 10-31), and it was found to reach exome-wide significance in both single-variant and collapsing analyses. Two novel rare variant genes (ECE1 and METTL21A) associated with VV were identified, of which METTL21A was associated only with females. The pleiotropic effects of VV-related genes suggested that body size, inflammation, and pulmonary function are strongly associated with the development of VV. CONCLUSIONS Our findings highlight the importance of causal genes for VV and provide new directions for treatment.
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Affiliation(s)
- Dan-Dan Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xiao-Yu He
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bang-Sheng Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei-Shi Liu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Guo
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chen-Jie Fei
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ju-Jiao Kang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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Lee C. The Novel Surgical Technique in the Cyanoacrylate Closure for Incompetent Great Saphenous Veins. Vasc Endovascular Surg 2024; 58:486-490. [PMID: 38155556 DOI: 10.1177/15385744231225910] [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: 12/30/2023]
Abstract
OBJECTIVE The current Instructions for Use (IFU) of cyanoacrylate closure (CAC) is to start initial injection with the catheter tip positioned 5 cm distal to the sapheno-femoral junction (SFJ) to prevent endovenous glue-induced thrombosis (EGIT). However, this defensive design is responsible for the relatively long stump length. Although clinical studies on the long-term recurrence rate are still lacking, the long stump length can predict a higher long-term recurrence rate compared to other surgical methods. The author developed a novel surgical technique that can overcome the weakness of CAC, and the initial outcomes of this technique are described in this article. METHODS This study retrospectively reviewed 25 great saphenous vein (GSV) in 20 patients who underwent CAC for incompetent GSV at our hospital. The procedure from puncturing the GSV to insertion of the catheter is the same as the conventional method. Place the catheter tip 2-3 cm below the SFJ before cyanoacrylate injection. After confirming the position of the SFJ with the longitudinal view of the ultrasound, press the GSV directly above the SFJ transversely with the second to fifth fingertips of the left hand. Then, the ultrasound probe is placed against the distal part of the fingertips, and CA injection is performed while GSV is monitored in real time. RESULTS The mean stump length immediately after surgery was 19.3 (± 7.8) mm, with a range of .0-38.4 mm. The mean stump length after 1 week was 12.3 (± 7.4) mm and the range was .1-35.4 mm. The mean stump length after 1 month was 15.4 (± 10.1) mm, and the range was .0-35.4 mm. There was no case with EGIT or recanalization. CONCLUSIONS The author confirmed the possibility of safely reducing stump length with this novel surgical technique, and expect that this method can help overcome the weakness of CAC.
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Affiliation(s)
- Changhun Lee
- Department of Vascular Surgery, Chung-Ang University H.C.S Hyundae Hospital, Gyeonggi-do, Korea
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5
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Drgastin R, Boyle EM, Labropoulos N, Caggiati A, Gasparis A, Doganci S, Meissner M. The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology. Phlebology 2024; 39:325-332. [PMID: 38526968 PMCID: PMC11129522 DOI: 10.1177/02683555231223281] [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: 03/27/2024]
Abstract
OBJECTIVE The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage. METHODS A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated. RESULTS Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein. CONCLUSIONS Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
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Affiliation(s)
| | | | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | | | - Antonios Gasparis
- Division of Vascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Suat Doganci
- Department of Cardiovascular Surgery, Gulhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Mark Meissner
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
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Bozkurt AK, Balkanay OO, Dinc R. Comparative analysis of VenaBlock and VenaSeal Systems for catheter-guided endovenous cyanoacrylate closure in treating chronic venous insufficiency of the lower extremity: effectiveness and feasibility. INT ANGIOL 2024; 43:331-341. [PMID: 39041783 DOI: 10.23736/s0392-9590.24.05143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Cyanoacrylate adhesive closure (CAC) systems are widely used to treat varicose veins. In terms of efficacy and safety, these nonthermal, non-tumescent methods are noninferior to endovenous thermal ablation techniques. However, no published studies have compared products that use CAC systems. VenaSeal® (Medtronic, Santa Rosa, CA, USA) and VenaBlock® (Invamed) are the most commonly used CAC-based products worldwide. This study aimed to focus on the efficacy of these two commonly used products, with little emphasis on safety. Published full-text articles on the VenaBlock® and VenaSeal® systems were searched. Data for each product were evaluated by comparing them with each other in terms of effectiveness. In total, 1882 extremities from 11 studies using VenaBlock® and 524 extremities from eight studies using VenaSeal® were included and compared. Both devices were effective, and their cumulative recanalization-free survival rates were similar (P=0.188) at the 6-, 12-, 24-, 36-, and 60-month follow-ups. Both products improved the venous clinical severity score (VCSS) and quality of life (QoL) scores. VenaBlock® and VenaSeal® are effective in terms of cumulative recanalization-free survival rates, and no significant difference was found between the two groups (P=0.188). Both significantly improve the VCSS and QoL scores. CAC is feasible for the treatment of varicose veins.
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Affiliation(s)
- Ahmet K Bozkurt
- Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ozan O Balkanay
- Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Rasit Dinc
- INVAMED Medical Innovation Institute, Ankara, Türkiye -
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Liu Y, Cao B, Wang X, Zhong J, Li Z, Peng R, Zhao D, Gu N, Yang Q. Ferumoxytol-enhanced MR venography for mapping lower-extremity venous networks and evaluating varicose veins in patients with diabetes. Eur Radiol 2024:10.1007/s00330-024-10772-x. [PMID: 38713277 DOI: 10.1007/s00330-024-10772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES Comprehensive evaluation of lower-extremity varicose veins (VVs) in patients with diabetes is crucial for treatment strategizing. The study aims to assess the feasibility of using ferumoxytol-enhanced MR venography (FE-MRV) for lower-extremity venous mapping and the detection of VVs in patients with diabetes. MATERIALS AND METHODS As part of a phase II clinical trial of a generic brand of ferumoxytol, documented patients with diabetes were enrolled and underwent FE-MRV on a 3-Τ MRI system. Two observers assessed FE-MRV images for image quality, signal intensity ratio (SIR), perforator (PV) diameter, and luminal signal uniformity in deep-to-superficial venous networks with the assessment of intra- and inter-rater reliability. FE-MRV was used to detect lower-extremity VVs. RESULTS Eleven patients underwent FE-MRV without adverse events. The average image quality, as scored by the two observers who assessed 275 venous segments, was 3.4 ± 0.6. Two observers strongly agreed on image quality (κ = 0.90) and SIR measurements (interclass correlation coefficient [ICC]: 0.72) and had good agreement on PV diameter (ICC: 0.64). FE-MRV revealed uniform luminal signals in deep and saphenous venous networks (0.13 ± 0.05 vs 0.08 ± 0.03). Below-knee segments exhibited a significantly higher heterogeneity index than above-knee (p = 0.039) segments. Superficial VVs were observed in 55% (12/22) of legs in 64% (7/11) of patients. Calf muscle VVs were present in 64% (14/22) of legs in 9 patients. CONCLUSION FE-MRV safely and robustly mapped entire lower-extremity venous networks, enabling the detection and pre-treatment evaluation of both superficial, and deep VVs in patients with diabetes. CLINICAL RELEVANCE STATEMENT Ferumoxytol-enhanced magnetic resonance venography offers a "one-stop" imaging strategy for the detection and pre-operative evaluation of both superficial and deep VVs in diabetic patients. KEY POINTS Diabetic patients with VVs are at a higher risk of ulcer-related complications. FE-MRV allowed rapid and comprehensive visualization of the lower-limb venous networks and abdominopelvic veins in diabetic patients. This technique allowed for the detection of superficial and deep VVs in diabetic patients before the development of severe peripheral artery disease.
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Affiliation(s)
- Yuehong Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bin Cao
- Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiali Zhong
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Li
- Department of Radiology, Central Hospital Affiliated to Xinxiang Medical University, Xinxiang, China
| | - Ruchen Peng
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Dong Zhao
- Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Ning Gu
- Medical School of Nanjing University, Nanjing, China.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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Huang Y, Li X, Niu L, Zhang H, Zhang C, Feng Y, Wang Z, Zhang F, Luo X. CT venography combined with ultrasound-guided minimally invasive treatment for recurrent varicose veins: a pilot paired-design clinical trial. Clin Radiol 2024; 79:363-370. [PMID: 38290939 DOI: 10.1016/j.crad.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/26/2023] [Accepted: 12/24/2023] [Indexed: 02/01/2024]
Abstract
AIM To compare 1-year outcomes of computed tomography venography (CTV) combined with ultrasound-guided minimally invasive treatment with ascending phlebography and ultrasound-guided treatment for recurrent varicose veins. MATERIALS AND METHODS Consecutive patients with unilateral recurrent varicose veins were matched by gender, age, C classification, and degree of obesity, and randomised in a 1:1 ratio to receive either CTV (CTV group) or ascending phlebography (control group) combined with ultrasound-guided minimally invasive treatment. Patients were followed up by clinical and ultrasound examination. Follow-up was scheduled at 1 week, and 3, 6, and 12 months. The primary outcome measure was the Venous Clinical Severity Score (VCSS) at 12 months. Measures of secondary outcome included Chronic Insufficiency Venous International Questionnaire-20 (CIVIQ-20) score, recurrence of varicose vein or ulcer during 12 months, ulcer healing time, detection and location of treated veins. RESULTS Eighty patients were enrolled. Median VCSS in the CTV group was lower than it in the control group (p=0.04) and the CIVIQ-20 score was higher than the control group (p=0.02). By 12 months, no symptomatically recurrent varicose veins or ulcers had occurred. The ulcer healing time in CTV group was shorter (p<0.01). A greater number of patients had treated veins detected using CTV than by ascending venography (p=0.01), especially among patients with recurrence reflux veins in the groin, perineum, and vulva (p<0.01). CONCLUSION CTV combined with ultrasound may be more helpful than ascending phlebography combined with ultrasound to improve treatment efficacy for recurrent varices. These results should be verified by an future study with more patients and long-term follow-up.
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Affiliation(s)
- Y Huang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - L Niu
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - C Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Y Feng
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Z Wang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - F Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Luo
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Drgastin R, Boyle EM, Labropoulos N, Caggiati A, Gasparis A, Doganci S, Meissner M. The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2024; 12:101856. [PMID: 38551528 DOI: 10.1016/j.jvsv.2024.101856] [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: 04/19/2024]
Abstract
OBJECTIVE The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage. METHODS A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated. RESULTS Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein. CONCLUSIONS Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
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Affiliation(s)
| | | | - Nicos Labropoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | | | - Antonios Gasparis
- Division of Vascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Suat Doganci
- Department of Cardiovascular Surgery, Gulhane School of Medicine, Health Sciences University, Ankara, Turkey
| | - Mark Meissner
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
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Baccellieri D, Ardita V, Pannone A, Valente FBA, Lembo R, Chiesa R, Melissano G. Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers. J Vasc Surg Venous Lymphat Disord 2024; 12:101675. [PMID: 37703941 DOI: 10.1016/j.jvsv.2023.08.014] [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: 05/25/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Recanalization of the saphenous vein trunk after endovenous radiofrequency ablation (RFA) is often associated with recurrent varicose veins (RVVs) or recanalization. This study aimed to assess the long-term results of RFA of the great saphenous vein (GSV) and identify the risk factors for GSV recanalization and RVVs during follow-up for patients presenting to dedicated outpatient vein centers. METHODS All consecutive patients with incompetent GSVs who underwent RFA between 2009 and 2019 were retrospectively analyzed. The primary study end points were freedom from GSV recanalization and the RVV rate during follow-up. The secondary study end points were the postoperative complication rate and the risk factors for GSV recanalization and RVVs. Univariate and multivariate analyses were performed to identify the potential risk factors for GSV recanalization and RVVs. RESULTS During the study period, 1568 limbs were treated in 1300 consecutive patients (mean age, 53.5 ± 12.9 years; 71.9% women; CEAP [clinical, etiology, anatomy, pathophysiology] C2-C6; venous clinical severity score >5). Technical success was achieved in 99.7% of cases. At a mean follow-up of 57.2 ± 25.4 months, the GSV occlusion and freedom from reintervention rates were 100% and 100% within 1 week, 97% and 95.7% at 1 year, 95.2% and 93.1% at 3 years, and 92.4% and 92.8% at 5 years, respectively. The recurrence rate was 10% (n = 158) during the follow-up period. On multivariate analysis, a direct confluence of the accessory saphenous vein into the saphenofemoral junction (odds ratio [OR], 1.561; 95% confidence interval [CI], 1.0-7.04; P = .032), a history of pregnancy >2 (OR, 3.68; 95% CI, 1.19-11.36; P = .023), C4 (OR, 6.41; 95% CI, 1.36-30.28; P = .019), and preoperative GSV diameter >10 mm (OR, 1.82; 95% CI, 1.65-4.03; P = .043) were risk factors for GSV recanalization. Moreover, age >70 years (OR, 1.04; 95% CI, 1.01-1.06; P = .014) and incompetent perforator veins (OR, 1.17; 95% CI, 0.65-2.03; P = .018) were also risk factors for RVVs. CONCLUSIONS RFA is a safe technique to ablate the GSV with a low complication rate and durability during 5 years of follow-up. However, patients with a high clinical score and those with direct confluence of the accessory saphenous vein into the saphenofemoral junction experienced higher long-term GSV recanalization and RVV rates.
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Affiliation(s)
- Domenico Baccellieri
- Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milan, Italy
| | - Vincenzo Ardita
- Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milan, Italy.
| | - Alfonso Pannone
- Department of Vascular Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Ferdinando B A Valente
- Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milan, Italy
| | - Rosalba Lembo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University School of Medicine, Milan, Italy
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11
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Ghanaati H, Jalali AH, Shakiba M, Zarei D, Ghavami N, Firouznia K. Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years. Int J Vasc Med 2024; 2024:6829868. [PMID: 38356738 PMCID: PMC10864052 DOI: 10.1155/2024/6829868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/19/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. Materials and Methods In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Results Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). Conclusion The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.
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Affiliation(s)
- Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Diana Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science (TUMS), Tehran, Iran
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Kikuchi R, Nhuch C, Drummond DAB, Santiago FR, Coelho F, Mauro FDO, Silveira FT, Peçanha GP, Merlo I, Corassa JM, Stambowsky L, Figueiredo M, Takayanagi M, Gomes Flumignan RL, Evangelista SSM, Campos W, Joviliano EE, de Araujo WJB, de Oliveira JCP. Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230064. [PMID: 38021274 PMCID: PMC10648055 DOI: 10.1590/1677-5449.202300642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.
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Affiliation(s)
- Rodrigo Kikuchi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas Santa Casa de São Paulo – FCMSCSP, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
| | - Claudio Nhuch
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Vascular, Porto Alegre, RS, Brasil.
| | - Daniel Autran Burlier Drummond
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-Rio, Departamento de Ciências da Computação, Rio de Janeiro, RJ, Brasil.
| | - Fabricio Rodrigues Santiago
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
- Instituto de Doenças Venosas e Linfáticas – IDVL, Goiânia, GO, Brasil.
| | - Felipe Coelho
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Paraná – PUCPR, Departamento de Cirurgia, Londrina, PR, Brasil.
| | | | | | | | - Ivanesio Merlo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Jose Marcelo Corassa
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Leonardo Stambowsky
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Marcondes Figueiredo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Miriam Takayanagi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Ronald Luiz Gomes Flumignan
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal de São Paulo – UNIFESP, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Solange Seguro Meyge Evangelista
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Varizemed, Belo Horizonte, MG, Brasil.
| | - Walter Campos
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, Disciplina de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina – FMRP, Departamento de Cirurgia e Anatomia, São Paulo, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Paraná – UFPR, Residência em Angiorradiologia e Cirurgia Vascular, Hospital de Clínicas, Curitiba, PR, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia Geral e Especializada, Rio de Janeiro, RJ, Brasil.
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Hong KP. Clinical Efficacy of a Modified Surgical Procedure in the Treatment of Incompetent Great Saphenous Veins. J Chest Surg 2023; 56:387-393. [PMID: 37817432 PMCID: PMC10625963 DOI: 10.5090/jcs.23.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
Background The aim of this study was to evaluate the clinical efficacy of a modified surgical procedure for the treatment of varicose veins. Methods This retrospective analysis was conducted on lower extremities with symptomatic great saphenous vein (GSV) incompetence that underwent stripping from the groin to the knee, with preservation of the superficial epigastric vein (SEV), between January 2015 and April 2022. Follow-up assessments were performed using Doppler ultrasound, Venous Clinical Severity Score (VCSS), and the Aberdeen Varicose Vein Questionnaire (AVVQ) at 6 and 12 months after surgery. Results The study included 179 limbs from 120 patients (47 men and 73 women). The mean patient age was 56.5 years (range, 20-78 years), and the distribution of preoperative Clinical-Etiology-Anatomy-Pathophysiology clinical classes was 8% C0-C1, 88% C2, and 4% C3-C6. The preoperative diameter of the saphenofemoral confluence averaged 6.9 mm (range, 2.7-15.8 mm). After a mean postoperative follow-up period of 24 months, evidence of neovascularization around the stump of the saphenofemoral junction (SFJ) was observed in 2 limbs (1.1%). Additionally, varicose vein recurrence was found in 1 limb (0.6%) and was associated with an incompetent thigh perforator. At postoperative follow- up, both VCSS and AVVQ scores were significantly lower than the preoperative scores. Conclusion Modified surgical treatment of GSV incompetence, involving preservation of the SEV and stripping of a short segment up to the knee, demonstrated favorable clinical results in terms of postoperative complication rate, neovascularization rate around the SFJ stump, varicose vein recurrence rate, and improvement in lower extremity symptoms.
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Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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14
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Rochon PJ, Reghunathan A, Kapoor BS, Kalva SP, Fidelman N, Majdalany BS, Abujudeh H, Caplin DM, Eldrup-Jorgensen J, Farsad K, Guimaraes MS, Gupta A, Higgins M, Kendi AT, Khilnani NM, Patel PJ, Dill KE, Hohenwalter EJ. ACR Appropriateness Criteria® Lower Extremity Chronic Venous Disease. J Am Coll Radiol 2023; 20:S481-S500. [PMID: 38040466 DOI: 10.1016/j.jacr.2023.08.011] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Lower extremity venous insufficiency is a chronic medical condition resulting from primary valvular incompetence or, less commonly, prior deep venous thrombosis or extrinsic venous obstruction. Lower extremity chronic venous disease has a high prevalence with a related socioeconomic burden. In the United States, over 11 million males and 22 million females 40 to 80 years of age have varicose veins, with over 2 million adults having advanced chronic venous disease. The high cost to the health care system is related to the recurrent nature of venous ulcerative disease, with total treatment costs estimated >$2.5 billion per year in the United States, with at least 20,556 individuals with newly diagnosed venous ulcers yearly. Various diagnostic and treatment strategies are in place for lower extremity chronic venous disease and are discussed in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Arun Reghunathan
- Research Author, University of Colorado Denver, Denver, Colorado
| | | | - Sanjeeva P Kalva
- Panel Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicholas Fidelman
- Panel Vice-Chair, University of California, San Francisco, San Francisco, California
| | - Bill S Majdalany
- Panel Vice-Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Hani Abujudeh
- Detroit Medical Center, Tenet Healthcare and Envision Radiology Physician Services, Detroit, Michigan
| | - Drew M Caplin
- Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Jens Eldrup-Jorgensen
- Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery
| | | | | | - Amit Gupta
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | | | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Neil M Khilnani
- Weill Cornell Medicine-NewYork Presbyterian Hospital, New York, New York; American Vein and Lymphatic Society
| | - Parag J Patel
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| | - Eric J Hohenwalter
- Specialty Chair, Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
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Miranda M, Sousa J, Mansilha A. PREVAIT after modern open surgery and endothermal ablation: a systematic review. INT ANGIOL 2023; 42:436-447. [PMID: 37795801 DOI: 10.23736/s0392-9590.23.05082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Presence of varices after operative treatment (PREVAIT) is a common finding after varicose vein surgery, and has been shown to significantly reduce the quality of life of those it affects. As such, long-term results after varicose vein interventions have to be taken into account when choosing a technique. This study aims to systematically review current evidence on the recurrence of varicose veins after three different techniques: conventional surgery (HLS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). EVIDENCE ACQUISITION A literature search was performed on the PubMed and Web of Science databases, which returned 546 studies. Fourteen studies were included. Data were extracted using predefined forms. EVIDENCE SYNTHESIS A total of 2795 patients were included, for a total of 3056 legs treated. 503 legs (16.5%) were treated by HLS, 1791 (58.6%) by EVLA and 762 (25.0%) by RFA. PREVAIT was reported in 34.4% for patients treated by HLS, for a mean follow-up comprised between 18 months and 5 years; 16.6% by EVLA, for a mean follow-up between 112 days and 5 years and 6.7% of those treated by RFA, for a mean follow-up between 106 days and 5 years. Regarding patterns of recurrence, the development of new varicose veins was the most commonly reported mechanism of recurrence after HLS (range: 29.8-91%) and EVLA (range: 40-81.6%), but not RFA, where recanalization of the occluded saphenous trunk accounted for up to 67.0% of the cases. Only one study reported quality of life related recurrence, and included patients treated by HLS and EVLA, but not RFA. Aberdeen Varicose Vein Questionnaire (AVVQ) score, physical functioning domains of the SF-36 score and patient satisfaction were significantly worse in patients with clinical recurrence. Re-intervention rates after recurrence were reported in 5 studies, ranging between 7.7% and 37.7% for HLS and 0-57.0% for EVLA. Only one study reported data on re-intervention for RFA patients, which was 6.67%. CONCLUSIONS Recurrence is a reliable indicator of long-term efficacy of a varicose vein treatment and appears to occur more frequently after HLS. Although there are several mechanisms of recurrence, the development of new varicose veins was the most commonly observed. There is clear heterogeneity among definitions of recurrence and follow-up periods in literature.
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Affiliation(s)
| | - Joel Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal -
- Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
| | - Armando Mansilha
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Angiology and Vascular Surgery, Hospital de S. João, Porto, Portugal
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16
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Goyal VD, Misra G, Pahade A. Vein of Giacomini can lead to the recurrence of varicosities after endovenous laser ablation of varicose veins. Indian J Thorac Cardiovasc Surg 2023; 39:286-288. [PMID: 37124596 PMCID: PMC10140203 DOI: 10.1007/s12055-023-01490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/05/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Endovenous laser ablation is a commonly performed intervention in the treatment of varicose veins. The technique is generally safe and has low complication rates. A case of recurrent varicose veins that had undergone endovenous laser ablation multiple times is reported. The cause of recurrence, in this case, was the vein of Giacomini, the presence of which was probably missed at the time of initial intervention. This case highlights the importance of the vein of Giacomini in causing recurrent varicosities after laser ablation.
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Affiliation(s)
- Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Gaurav Misra
- Department of Anaesthesia, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP 243202 India
| | - Akhilesh Pahade
- Department of Anaesthesia, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP 243202 India
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Bissacco D, Malloggi C, Domanin M, Lomazzi C, Tolva V, Odero A, Trimarchi S, Casana R. Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation. Vascular 2023; 31:131-141. [PMID: 34908508 DOI: 10.1177/17085381211058587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). MATERIALS AND METHODS All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. RESULTS During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. CONCLUSION RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Laboratory of Research in Vascular Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, 9304Università degli Studi di Milano, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valerio Tolva
- Vascular Surgery Unit, 9338ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Odero
- Department of Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, 9339IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, 9304Università degli Studi di Milano, Milan, Italy
| | - Renato Casana
- Laboratory of Research in Vascular Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Surgery, 9354IRCCS Istituto Auxologico Italiano, Milan, Italy
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Costa D, Andreucci M, Ielapi N, Serraino GF, Mastroroberto P, Bracale UM, Serra R. Molecular Determinants of Chronic Venous Disease: A Comprehensive Review. Int J Mol Sci 2023; 24:ijms24031928. [PMID: 36768250 PMCID: PMC9916309 DOI: 10.3390/ijms24031928] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Chronic Venous Disease (CVD) refers to several pathological and hemodynamic alterations of the veins of lower limbs causing a wide range of symptoms and signs with a high prevalence in the general population and with disabling consequences in the most severe forms. The etiology and pathophysiology of CVD is complex and multifactorial, involving genetic, proteomic, and cellular mechanisms that result in changes to the venous structure and functions. Expressions of several genes associated with angiogenesis, vascular development, and the regulation of veins are responsible for the susceptibility to CVD. Current evidence shows that several extracellular matrix alterations (ECM) could be identified and in some cases pharmacologically targeted. This review shows the most up to date information on molecular determinants of CVD in order to provide a complete overview of the current knowledge on this topic. In particular, the article explores the genetic influence, the hormonal influence, ECM imbalance, and histopathology of CVD and the role of endothelial dysfunction in CVD.
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Affiliation(s)
- Davide Costa
- Department of Law, Economics and Sociology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Nicola Ielapi
- Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Giuseppe Filiberto Serraino
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
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Attaran RR, Carr JG. Chronic Venous Disease of the Lower Extremities: A State-of-the Art Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100538. [PMID: 39132527 PMCID: PMC11307564 DOI: 10.1016/j.jscai.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 08/13/2024]
Abstract
Chronic venous disease is a common disease, the prevalence of which increases with age, and can cause debilitating symptoms that adversely affect the quality of life. The risk factors include family history, female sex, obesity, pregnancy, parity, and history of deep vein thrombosis. Moreover, it is associated with venous obstruction, reflux, or both, which, in turn, leads to ambulatory venous hypertension. Chronic venous disease is the leading cause of leg ulcers, which place a significant cost burden on the health care system. Compression therapy remains the cornerstone of treatment, particularly for more advanced disease. Superficial saphenous vein reflux can be associated with significant symptoms. Catheter techniques, both thermal and nonthermal, have demonstrated efficacy and safety in successful closure and symptom improvement. Deep vein obstruction can be broadly divided into thrombotic and nonthrombotic and can lead to symptomatic chronic venous disease. Recanalization using balloons and stents has been increasingly used and studied in such patients. It is critical to develop training opportunities and guidelines to improve evidence-based and appropriate care for cardiologists treating chronic venous disease.
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Affiliation(s)
- Robert R. Attaran
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey G. Carr
- CardiaStream at Tyler Cardiac and Endovascular Center, Tyler, Texas
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20
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Cryostripping-A Safe and Efficient Alternative Procedure in Chronic Venous Disease Treatment. J Clin Med 2022; 11:jcm11175028. [PMID: 36078958 PMCID: PMC9456708 DOI: 10.3390/jcm11175028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/27/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: The presentation of cryostripping as an alternative procedure useful in venous insufficiency treatment. Methods: This retrospective study presents the results of 1087 operated patients, including follow-ups. Cryostripping was practised in all mentioned cases. Patient follow-up was performed at one week, one month, and six months postoperatively by clinical examination, Doppler ultrasonography, CIVIQ-20 and r-VCSS questionnaires. Outcomes, complications, surgery and hospitalisation period, and benefits of the method were analysed. Results: Generally, good functional and aesthetic outcomes defined by clinical symptom remission, absence of insufficient veins on Doppler ultrasonography, QoL and r-VCSS improvement (p < 0.001) were obtained. Complications included bruising ⌀ < 2 cm (32.38%), haematoma (8.92%), saphenous nerve injury (3.49%), deep vein thrombosis (0.18%). Recurrence was noted in 2.94% cases. Mean duration of procedure was 42 ± 12.5 min, mean duration of hospitalisation was 1.05 ± 0.36 days. Compared to high ligation and conventional stripping, the postoperative complications were reduced; compared to other minimally invasive procedures, the costs were reduced. Conclusions: Cryostripping seems to combine the radicality and efficacy of the stripping technique with the cosmetic advantage of the endothermal procedures, being an effective therapeutic method perfectly adapted to the economic conditions of middle-income countries health system. It is also suitable as day-case surgery.
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21
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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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22
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Ahmed WUR, Kleeman S, Ng M, Wang W, Auton A, Lee R, Handa A, Zondervan KT, Wiberg A, Furniss D. Genome-wide association analysis and replication in 810,625 individuals with varicose veins. Nat Commun 2022; 13:3065. [PMID: 35654884 PMCID: PMC9163161 DOI: 10.1038/s41467-022-30765-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Varicose veins affect one-third of Western society, with a significant subset of patients developing venous ulceration, costing $14.9 billion annually in the USA. Current management consists of either compression stockings, or surgical ablation for more advanced disease. Most varicose veins patients report a positive family history, and heritability is ~17%. We describe the largest two-stage genome-wide association study of varicose veins in 401,656 individuals from UK Biobank, and replication in 408,969 individuals from 23andMe (total 135,514 cases and 675,111 controls). Forty-nine signals at 46 susceptibility loci were discovered. We map 237 genes to these loci, several of which are biologically plausible and tractable to therapeutic targeting. Pathway analysis identified enrichment in extracellular matrix biology, inflammation, (lymph)angiogenesis, vascular smooth muscle cell migration, and apoptosis. Using a polygenic risk score (PRS) derived in an independent cohort, we demonstrate its predictive utility and correlation with varicose veins surgery.
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Affiliation(s)
- Waheed-Ul-Rahman Ahmed
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Sam Kleeman
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, 11724, USA
| | - Michael Ng
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Wei Wang
- 23andMe, Inc., Sunnyvale, CA, USA
| | | | | | - Regent Lee
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Wellcome Centre for Human Genetics, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7BN, UK
| | - Akira Wiberg
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.,Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK. .,Department of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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23
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Eggen CAM, Alozai T, Pronk P, Mooij MC, Gaastra MTW, Ünlü Ç, Schreve MA, van Vlijmen CJ. Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. J Vasc Surg Venous Lymphat Disord 2022; 10:646-653.e1. [PMID: 34450354 DOI: 10.1016/j.jvsv.2021.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The long-term results of saphenofemoral ligation and stripping (SFL/S) were compared with 980-nm bare fiber endovenous laser ablation (EVLA) for the treatment of great saphenous vein (GSV) incompetence. METHODS This was a single-center, randomized, controlled trial with a follow-up time of 10 years. Patients with GSV incompetence were randomized to undergo SFL/S or EVLA under tumescent anesthesia. The primary outcome was recurrence of groin-related varicose veins seen on duplex ultrasound imaging and clinical examination. The secondary outcomes were (changes or improvement in) CEAP clinical class, venous symptoms, cosmetic results, quality of life, reinterventions, and complications. RESULTS Between June 2007 and December 2008, 122 patients (130 limbs) were included; of these, 68 limbs were treated with SFL/S and 62 limbs with EVLA. The 10-year estimated freedom from groin recurrence as seen on duplex ultrasound imaging was higher in the SFL/S group (73% vs 44% in the EVLA group; P = .002), and the same trend was seen for clinically evident recurrence (77% vs 58%, respectively; P = .034). Nine reinterventions (17%) were deemed necessary in the SFL/S group vs 18 (36%) in the EVLA group (P = .059). All reinterventions in the SFL/S group consisted of foam sclerotherapy. Reinterventions in the EVLA group included foam sclerotherapy (n = 5), crossectomy (n = 2), and endovenous procedures (n = 11). There was no significant differences in quality of life and relief of venous symptoms. Cosmetic appearance improved, with a better cosmetic rating in the SFL/S group compared with the EVLA group (P = .026). One patient in the SFL/S group had a persisting neurosensory deficit remaining at 10 years. CONCLUSIONS This study showed no clear long-term advantage of EVLA with a 980-nm wavelength and bare-tip fiber over high ligation and stripping of the GSV under local tumescent anesthesia.
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Affiliation(s)
- Céline A M Eggen
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands.
| | - Tamana Alozai
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Pascal Pronk
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | - Michael C Mooij
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | - Menno T W Gaastra
- Department of Phlebology, Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands
| | - Çağdaş Ünlü
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
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Svidersky Y, Goshchynsky V, Migenko B, Migenko L, Pyatnychka O. Anterior accessory great saphenous vein as a cause of postoperative recurrence of veins after radiofrequency ablation. J Med Life 2022; 15:563-569. [PMID: 35646185 PMCID: PMC9126448 DOI: 10.25122/jml-2021-0318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
There are problems of postoperative relapse of veins after radiofrequency ablation (RFA). The study aims to analyze the causes of postoperative recurrence of veins after RFA. 928 patients with varicose veins of the lower extremities, clinical classes C2-C4 according to the CEAP classification, were treated in the ambulatory surgery centers using RFA. The causes of varicose recurrence showed that it was caused by: a) high fusion of the anterior accessory great saphenous vein (AAGSV) with great saphenous vein (GSV) directly in the saphenofemoral junction (SFJ), which was not revealed by preoperative ultrasound (1.7%); a long stump of the GSV after the RFA (7.8%); progression of varicose disease with the small saphenous vein (SSV) and formation of new reflux associated with insufficiency of the saphenopopliteal junction (SPJ) (4.7%); d) insufficiency of perforating veins of the tibioperoneal group (Sherman, Boyd), as well as Gunter (3.8%); e) neovascularization with dilation of small vessels in the area of the saphenofemoral junction (0.97%). A comparative assessment of the quality of life (QL) after different surgery methods 3 years after implementation was carried out. Thus, QL in all patients who underwent surgery significantly improved than before surgery. However, after the RFA GSV+AAGSV, the patients had better QL by all scales than those who underwent only RFA GSV. Operations performed simultaneously on GSV and AAGSV have better functionality than GSV-only RFA.
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Affiliation(s)
- Yrij Svidersky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Volodymyr Goshchynsky
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Bogdan Migenko
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine,Corresponding Author: Bogdan Migenko, Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine. E-mail:
| | - Liudmyla Migenko
- Second Department of Internal Medicine, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Oleg Pyatnychka
- Department of Surgery, Institute of Postgraduate Education, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Sánchez FSL, Martínez JAC, Méndez-García L, García-Cenador MB, Pericacho M. Endoglin and Other Angiogenesis Markers in Recurrent Varicose Veins. J Pers Med 2022; 12:jpm12040528. [PMID: 35455644 PMCID: PMC9025299 DOI: 10.3390/jpm12040528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Surgery on varicose veins (crossectomy and stripping) may lead to recurrence, with clinical and socioeconomic repercussions. The etiopathogenesis of varicose veins has yet to be fully understood. Objective: Study the expression of endoglin and other molecules involved in the neovascularisation process in patients suffering from this disease. Methods: Total of 43 patients that have undergone surgery for varicose veins (24 primary and 19 recurrent). Endoglin and other molecules were identified on the venous wall (proximal -saphenofemoral junction- and distal), via real-time RT-PCR, and in serum, via ELISA: endoglin (Eng), vascular endothelial growth factor (VEGF-A), its receptors 1 and 2 (VEGFR1 or FLT1), (VEGFR2 or FLK), and the hypoxia-inducible factor (HIF-1A). All the patients signed a consent form. Results: The recurrent group recorded a higher expression of Eng, VEGF-A, VEGFR1, and VEGFR2 at the level of proximal venous wall compared to the primary group. HIF-1A did not record any differences. As regards the determination of the distal venous wall, no markers recorded differences between the groups. Among the serum determinations, only sFLT1 recorded a significant drop among the patients with recurrent varicose veins. Conclusions: Patients with recurrent varicose veins record a higher expression of endoglin and other markers of angiogenesis in proximal veins. Endoglin in the blood (sEng) serves no apparent purpose in recurrent varicose veins.
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Affiliation(s)
- Francisco S. Lozano Sánchez
- Service of Angiology, Vascular and Endovascular Surgery, University Hospital of Salamanca (HUS), 37007 Salamanca, Spain; (F.S.L.S.); (J.A.C.M.)
- Department of Surgery, University of Salamanca (USAL), 37008 Salamanca, Spain
- Biomedical Research Institute (IBSAL), 37007 Salamanca, Spain; (L.M.-G.); (M.P.)
| | - José A. Carnicero Martínez
- Service of Angiology, Vascular and Endovascular Surgery, University Hospital of Salamanca (HUS), 37007 Salamanca, Spain; (F.S.L.S.); (J.A.C.M.)
- Department of Surgery, University of Salamanca (USAL), 37008 Salamanca, Spain
- Biomedical Research Institute (IBSAL), 37007 Salamanca, Spain; (L.M.-G.); (M.P.)
| | - Lucía Méndez-García
- Biomedical Research Institute (IBSAL), 37007 Salamanca, Spain; (L.M.-G.); (M.P.)
- Department of Physiology and Pharmacology, University of Salamanca (USAL), 37007 Salamanca, Spain
| | - M. Begoña García-Cenador
- Department of Surgery, University of Salamanca (USAL), 37008 Salamanca, Spain
- Biomedical Research Institute (IBSAL), 37007 Salamanca, Spain; (L.M.-G.); (M.P.)
- Correspondence:
| | - Miguel Pericacho
- Biomedical Research Institute (IBSAL), 37007 Salamanca, Spain; (L.M.-G.); (M.P.)
- Department of Physiology and Pharmacology, University of Salamanca (USAL), 37007 Salamanca, Spain
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Welch HJ. Combined Treatment of the Anterior Accessory Saphenous Vein and the Great Saphenous Vein. VASCULAR AND ENDOVASCULAR REVIEW 2022. [DOI: 10.15420/ver.2021.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The anterior accessory saphenous vein (AASV) is a common source of primary and recurrent lower extremity varicose veins. Reflux in the AASV can occur independently or simultaneously with great saphenous vein (GSV) reflux. A number of published reports describe recommendations and treatment of symptomatic refluxing AASVs, but descriptions of combined treatment are sparse. Treatment options for ablation of the AASV include both thermal and non-thermal techniques, and results are equivalent to ablation of the great and small saphenous veins. Although not commonly performed, concomitant ablation of the AASV and the GSV is effective and safe, and can be accomplished with minimal additional time. Concomitant treatment is an appropriate option that should be discussed with the patient.
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 251] [Impact Index Per Article: 125.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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Kamaev A, Bulatov V, Vakhratyan P, Volkov A, Volkov A, Gavrilov E, Golovina V, Efremova O, Ivanov O, Ilyukhin E, Katorkin S, Konchugova T, Kravtsov P, Maksimov S, Mzhavanadze N, Pikhanova Z, Pryadko S, Smirnov A, Sushkov S, Chabbarov R, Shimanko A, Yakushkin S, Apkhanova T, Derkachev S, Zolotukhin I, Kalinin R, Kirienko A, Kulchitskaya D, Pelevin A, Petrikov A, Rachin A, Seliverstov E, Stoyko Y, Suchkov I. Varicose Veins. FLEBOLOGIIA 2022; 16:41. [DOI: 10.17116/flebo20221601141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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Rajendran S, Nair HR, Irshad K M, Unais T M, Thaikattil NJ. Ultrasound-assisted varicose vein surgery and endovenous laser ablation using 1470-nm laser for treatment of great saphenous vein incompetence has similar outcomes at 1 year: A single-center prospective randomized study. J Vasc Surg Venous Lymphat Disord 2021; 10:370-375. [PMID: 34438089 DOI: 10.1016/j.jvsv.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Technical errors are the most common preventable cause of recurrence after high ligation and stripping procedures for the treatment of great saphenous vein incompetence. Ultrasound-assisted varicose vein surgery (UAVS) uses intraoperative ultrasound during high ligation and stripping to minimize such failures, although no data have been reported regarding its use during open surgery. The present study compared the short-term outcomes of UAVS and endovenous laser ablation (EVLA) with a 1470-nm laser. METHODS The present prospective randomized study was conducted from January 2019 to December 2019. We compared 40 patients who had undergone UAVS under regional anesthesia with an equal number of patients who had undergone EVLA under tumescent anesthesia. Both groups received 1 week of standardized postoperative analgesia. The improvements in the pain score, venous clinical severity score, and recurrence at 6 months and 1 year were studied. RESULTS No significant differences were found in either clinical or radiologic great saphenous vein recurrence after UAVS compared with EVLA at 1 year. The mean pain score at 8 hours after the procedure was higher in the UAVS group (3.7 ± 1.2 vs 2.9 ± 1.0; P = .03). At 1 week, the score was higher in the EVLA group (1.8 ± 0.7 vs 1.4 ± 0.5; P = .01). At 6 months, the venous clinical severity score had improved from 9.2 ± 3.7 to 2.4 ± 1.4 in the UAVS group and from 9.3 ± 3.2 to 2.1 ± 0.8 in the EVLA group (P = .64). At 1 year, the corresponding scores were 1.3 ± 0.7 and 1.4 ± 0.6 (P = .21). CONCLUSIONS UAVS has high technical success, making it a suitable alternative to EVLA using a 1470-nm laser.
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Affiliation(s)
- Sunil Rajendran
- Department of General Surgery and Vascular Surgery, MES Medical College, Perinthalmanna, Malaparamba, India.
| | | | - Mohammed Irshad K
- Department of General Surgery and Vascular Surgery, MES Medical College, Perinthalmanna, Malaparamba, India
| | - Muhammed Unais T
- Department of General Surgery, IQRAA Hospital, Malaparamba, India
| | - Navya J Thaikattil
- Department of Health, District Medical Office (Health), Malappuram, India
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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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Poschinger-Figueiredo D, Virgini-Magalhães CE, Porto LC, Amorim CS, de Araujo Gomes CF, Riguetti-Pinto CR, Mayall MR, de Castro LS, Fagundes FB. Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins. Vasc Health Risk Manag 2021; 17:379-387. [PMID: 34239304 PMCID: PMC8259833 DOI: 10.2147/vhrm.s313282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). DESIGN Prospective, single-centre, analytical cohort. MATERIALS AND METHODS Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. RESULTS The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. CONCLUSION Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.
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Affiliation(s)
- Douglas Poschinger-Figueiredo
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Carlos Eduardo Virgini-Magalhães
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
- Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Luís Cristóvão Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Roberto Alcantara Gomes Biology Institute (IBRAG), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Claudia Salvador Amorim
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Cristiane Ferreira de Araujo Gomes
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Cristina Ribeiro Riguetti-Pinto
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
- Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Monica Rochedo Mayall
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Leonardo Silveira de Castro
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Felipe Borges Fagundes
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
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Juneja AS, Jain S, Silpe J, Landis GS, Mussa FF, Etkin Y. Scoping review of non-thermal technologies for endovenous ablation for treatment of venous insufficiency. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:413-419. [PMID: 33881285 DOI: 10.23736/s0021-9509.21.11900-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this review article is to compare the outcomes of newer non-thermal endovenous ablation techniques to thermal ablation techniques for the treatment of symptomatic venous insufficiency. EVIDENCE ACQUISITION Three independent reviewers screened PubMed® and EMBASE® databases to identify relevant studies. A total of 1173 articles were identified from database search that met our inclusion criteria. Two articles were identified through reference search. Removal of duplicates from our original search yielded 695 articles. We then screened these articles and assessed 173 full-text articles for eligibility. Subsequent to exclusion, 11 full-text articles were selected for final inclusion. EVIDENCE SYNTHESIS The non-thermal techniques are similar to thermal techniques in terms of a high technical success rate, closure rate at 12 months, change in Venous Clinical Severity Score and change in quality of life after procedure. However, the length of procedure is shorter for non-thermal modalities and patient comfort is improved with lower pain scores. Return to work may also be earlier after non-thermal ablation. The rates of bruising, phlebitis and paresthesia are higher after thermal ablation. CONCLUSIONS The non-thermal modalities are safe and effective in treating venous reflux and have shown improved patient comfort and shorter length of procedure which may make them favorable for use compared to the thermal modalities.
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Affiliation(s)
- Amandeep S Juneja
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Shelley Jain
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Jeffrey Silpe
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Gregg S Landis
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Firas F Mussa
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Yana Etkin
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA -
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Ko H, Min S, Ahn S, Han A, Kim J, Min SK. Stump Length Changes after Endovenous Cyanoacrylate Closure or Radiofrequency Ablation for Saphenous Vein Incompetence. Vasc Specialist Int 2021; 37:14-21. [PMID: 33795549 PMCID: PMC8021488 DOI: 10.5758/vsi.210006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of this study was to analyze changes in stump length over time in patients with saphenous vein incompetence treated with cyanoacrylate closure (CAC) or radiofrequency ablation (RFA). Methods Materials and We retrospectively analyzed data collected from patients with saphenous vein incompetence who underwent either CAC or RFA at Seoul National University Hospital between November 2015 and December 2018. The stump lengths were measured using duplex ultrasonography (DUS) within 1 month and 6 months after treatment. The Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) score were used to assess clinical outcomes. Results A total of 97 veins (64 great saphenous veins and 33 small saphenous veins) were analyzed. The stump length was not significantly different between the two groups at <1 month (P=0.311). However, the stump length in the CAC group was significantly longer than that in the RFA group at 6 months (P=0.004). At 6 months, the mean change in stump length was 1.41±2.28 cm in the CAC group and 0.51±0.54 cm in the RFA group (P=0.006). The VCSSs and AVVQ scores significantly improved after both procedures but were not significantly different between the two groups. Conclusion DUS at 6 months after treatment showed that the stump length in the CAC group increased more than that in the RFA group. No other factors affected the changes in stump length.
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Affiliation(s)
- Hyunmin Ko
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jungsun Kim
- 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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Welch HJ, Schul MW, Monahan DL, Iafrati MD. Private payers' varicose vein policies are inaccurate, disparate, and not evidence based, which mandates a proposal for a reasonable and responsible policy for the treatment of venous disease. J Vasc Surg Venous Lymphat Disord 2021; 9:820-832. [PMID: 33684590 DOI: 10.1016/j.jvsv.2020.12.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Varicose veins afflict more than one in five Americans, and although varicose veins may be an asymptomatic cosmetic concern in some, many others experience symptoms of pain, aching, heaviness, itching, and swelling. More advanced venous disease can result from untreated venous insufficiency. The complications of chronic venous disease, including bleeding, thrombosis, and ulceration, are seen in up to 2 million Americans annually. Numerous reports have documented venous disease adversely affects quality of life and that treatment of venous disease can improve quality of life. It has previously been documented that private insurers, and Centers for Medicare & Medicaid Services subcontractors for that matter, have disparate policies that in many instances are self-serving, contain mistakes, use outdated evidence, and disregard evidence-based guidelines. The two leading venous medical societies, the American Venous Forum and the American Venous and Lymphatic Society, have come together to review the varicose vein coverage policies of seven major U.S. private medical insurance carriers whose policies cover more than 150 million Americans. The authors reviewed the policies for venous disease and, if significant gaps or inconsistencies are found, we hope to point them out, and, finally, to propose a thoughtful and reasonable policy based on the best available evidence.
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Affiliation(s)
- Harold J Welch
- Department of Vascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass.
| | - Marlin W Schul
- Lafayette Regional Vein and Laser Center, Lafayette, Ind
| | | | - Mark D Iafrati
- Department of Vascular Surgery, Tufts Medical Center, Boston, Mass
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Wilczko J, Szary C, Plucinska D, Grzela T. Two-Year Follow-Up after Endovenous Closure with Short-Chain Cyanoacrylate versus Laser Ablation in Venous Insufficiency. J Clin Med 2021; 10:jcm10040628. [PMID: 33562190 PMCID: PMC7914451 DOI: 10.3390/jcm10040628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The current treatment of venous disease is focused on the minimally invasive exclusion of the affected vein. Besides widely used thermal ablation, chemical ablation with cyanoacrylate, reported as safe and highly effective, has been gaining increasing interest. Patients and methods: In the current report, we present data from a two-year observation in 89 patients (61 female/28 male, mean age 44.3 ± 13.5) suffering from venous insufficiency (C2–C4), treated either using short-chain cyanoacrylate, the VenaBlock system (n = 43) or laser thermoablation with ELVeS 1470 (n = 46). The assessment comprised the occurrence of venous disease-related symptoms and the ultrasound examination of the leg venous system. Results: The frequency of recanalization after 2 years from the VenaBlock procedure was significantly higher than after laser treatment (37.2 vs. 8.7%). Apart from recanalization, in some individuals from both groups, the symptoms of recurrence and/or disease progression, including the development of insufficiency in other veins of treated or contralateral legs (9.3 vs. 15.2% and 9.3 vs. 17.4%, respectively), were observed. Unexpectedly, the general prevalence of the disease progression did not differ significantly between the VenaBlock and ELVeS groups (44.2 vs. 34.8%, respectively). Conclusions: Despite the higher recanalization rate of VenaBlock compared to ELVeS, the overall effectiveness of cyanoacrylate and laser thermoablation after two years was similar. Therefore, both methods similarly failed to prevent recurrence and disease progression, which seem to be method-independent.
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Affiliation(s)
- Justyna Wilczko
- Clinic of Phlebology, 02-034 Warsaw, Poland; (J.W.); (C.S.); (D.P.)
| | - Cezary Szary
- Clinic of Phlebology, 02-034 Warsaw, Poland; (J.W.); (C.S.); (D.P.)
- Diagnostic Imaging Center MRI & CT, Center of Sport Medicine, 02-034 Warsaw, Poland
| | | | - Tomasz Grzela
- Clinic of Phlebology, 02-034 Warsaw, Poland; (J.W.); (C.S.); (D.P.)
- Department of Histology & Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland
- Correspondence: or
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Szary C, Wilczko J, Plucinska D, Pachuta A, Napierala M, Bodziony A, Zawadzki M, Leszczynski J, Galazka Z, Grzela T. The Analysis of Selected Morphological and Hemodynamic Parameters of the Venous System and Their Presumable Impact on the Risk of Recurrence after Varicose Vein Treatment. J Clin Med 2021; 10:455. [PMID: 33503977 PMCID: PMC7865955 DOI: 10.3390/jcm10030455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The current treatment of venous disease is focused on reflux elimination in main venous trunks, especially in the saphenous vein. However, a high recurrence rate, independent of the method of treatment, suggests that the reason of low effectiveness may be due to a strategy focused on symptoms, without considering their origin. METHOD The aim of study was the comparison of retrospective data from 535 women with venous disease, either after treatment (n = 183) or not treated before (n = 352). The analysis concerned clinical symptoms and the results of the extended diagnostics, including the examination of the lower limb, pelvic and abdominal veins either using duplex-doppler ultrasound as well as venography with computed tomography or magnetic resonance. RESULTS The comparison of selected venous system parameters revealed more advanced disease progression in previously treated patients, compared to non-treated individuals (e.g., ipsi- or bilateral incompetence of sapheno-phemoral junction-29.5% vs. 20.4%, at P < 0.05 and 13.6% vs. 7.7% at P < 0.05, respectively). This difference could be explained by post-treatment alterations in the venous system, an older age and the higher number of pregnancies in the recurrence group. However, both groups did not differ in regards to the symptoms of pelvic venous insufficiency or the frequency of relevant variants/abnormalities in venous system. CONCLUSIONS Based on the aforementioned findings, we postulate the revision of treatment strategy, which should consider abdominal and pelvic veins as the source of reflux in many female subjects.
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Affiliation(s)
- Cezary Szary
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
- Diagnostic Imaging Center MRI & CT, Center of Sport Medicine, 02-034 Warsaw, Poland
| | - Justyna Wilczko
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
| | - Dominika Plucinska
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
| | - Anna Pachuta
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
| | - Marcin Napierala
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
| | - Anna Bodziony
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
| | - Michal Zawadzki
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
- Department of Radiology, Center of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Jerzy Leszczynski
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Zbigniew Galazka
- Department of General, Endocrine and Vascular Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tomasz Grzela
- Clinic of Phlebology, 02-034 Warsaw, Poland; (C.S.); (J.W.); (D.P.); (A.P.); (M.N.); (A.B.); (M.Z.); (J.L.)
- Department of Histology and Embryology, Medical University of Warsaw, 02-002 Warsaw, Poland
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Cavezzi A. Medicine and Phlebolymphology: Time to Change? J Clin Med 2020; 9:E4091. [PMID: 33353052 PMCID: PMC7766771 DOI: 10.3390/jcm9124091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
Biomedical science is undergoing a reappraisal of its scientific advancement process and of the related healthcare management. Progress in medicine should combine improvements of knowledge, efficacy, and safety of diagnostic/therapeutic procedures, with adequate cost-effectiveness profiles. This narrative review is aimed at assessing in medicine, more specifically in phlebology and lymphology: (a) scientific literature possible biases, (b) the level of evidence, comprehensiveness, and cost-effectiveness of the main therapeutic options, and (c) the possible contribution of integrative and translational medicine. Current medical research may have cognitive biases, or industry-tied influences, which impacts clinical practice. Some reductionism, with an increasing use of drugs and technology, often neglecting the understanding and care of the root causative pathways of the diseases, is affecting biomedical science as well. Aging brings a relevant burden of chronic degenerative diseases and disabilities, with relevant socio-economic repercussions; thus, a major attention to cost-effectiveness and appropriateness of healthcare is warranted. In this scenario, costly and innovative but relatively validated therapies may tend to be adopted in venous and lymphatic diseases, such as varicose veins, leg venous ulcer, post-thrombotic syndrome, pelvic congestion syndrome, and lymphedema. Conversely, a more comprehensive approach to the basic pathophysiology of chronic venous and lymphatic insufficiency and the inclusion of pharmacoeconomics analyses would benefit overall patients' management. Erroneous lifestyle and nutrition, together with chronic stress-induced syndromes, significantly influence chronic degenerative phlebo-lymphatic diseases. The main active epigenetic socio-biologic factors are obesity, dysfunctions of musculo-respiratory-vascular pumps, pro-inflammatory nutrition, hyperactivation of stress axis, and sedentarism. An overall critical view of the scientific evidence and innovations in phebolymphology could be of help to improve efficacy, safety, and sustainability of current practice. Translational and integrative medicine may contribute to a patient-centered approach. Conversely, reductionism, eminence/reimbursement-based decisional processes, patients' lack of education, industry-influenced science, and physician's improvable awareness, may compromise efficacy, safety, appropriateness, and cost-effectiveness of future diagnostic and therapeutic patterns of phlebology and lymphology.
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Wang CM, Zhao SL, Feng QC, Gai S, Li X. One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia. Phlebology 2020; 36:268-274. [PMID: 33201775 DOI: 10.1177/0268355520973488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. METHODS Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. RESULTS The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively (t= 29.644, P= .000). CONCLUSIONS In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.
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Affiliation(s)
- Chang-Ming Wang
- Department of Vascular Surgery and Interventional Radiology, 66482Peking University Third Hospital, Beijing, China
| | - Shi-Lu Zhao
- Department of Vascular Surgery and Interventional Radiology, 66482Peking University Third Hospital, Beijing, China
| | - Qi-Chen Feng
- Department of Vascular Surgery and Interventional Radiology, 66482Peking University Third Hospital, Beijing, China
| | - Shuo Gai
- Department of Vascular Surgery and Interventional Radiology, 66482Peking University Third Hospital, Beijing, China
| | - Xuan Li
- Department of Vascular Surgery and Interventional Radiology, 66482Peking University Third Hospital, Beijing, China
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Erben Y, Vasquez I, Li Y, Gloviczki P, Kalra M, Oderich G, De Martino RR, Bjarnason H, Neisen MJ, Moore JF, Da Rocha-Franco JA, Sanchez-Valenzuela MC, Frey G, Toskich B, Devcic Z, Farres H, Oldenburg WA, Gomez-Perez J, Yarbrough JR, Adalia M, Stone W, Meltzer AJ, Hakaim AG. A multi-institutional review of endovenous thermal ablation of the saphenous vein finds male sex and use of anticoagulation are predictors of long-term failure. Phlebology 2020; 36:283-289. [PMID: 33176592 DOI: 10.1177/0268355520972923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To review long-term outcomes and saphenous vein (SV) occlusion rate after endovenous ablation (EVA) for symptomatic varicose veins. METHODS A review of our EVA database (1998-2018) with at least 3-years of clinical and sonographic follow-up. The primary end point was SV closure rate. RESULTS 542 limbs were evaluated. 358 limbs had radiofrequency and 323 limbs had laser ablations; 542 great saphenous veins (GSV), 106 small saphenous veins (SSV) and 33 anterior accessory saphenous veins (AASV) were treated. Follow-up was 5.6 ± 2.3 years; 508 (74.6%) veins were occluded, 53 (7.8%) partially occluded and 120 (17.6%) were patent. On multivariable Cox regression analysis, male sex (HR 1.6, 95% CI [0.46-018], p = 0.012) and use anticoagulation (HR 2.0, 95% CI [0.69-0.34], p = 0.044) were predictors of long-term failure. On Kaplan-Meier curve, we had an 86.3% occlusion rate. CONCLUSION Our experience revealed a 5-year closure rate of 86.3%. Ablations have satisfactory occlusion rate.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Isabel Vasquez
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Haraldur Bjarnason
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - Melissa J Neisen
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, MN, USA
| | - January F Moore
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - Gregory Frey
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Beau Toskich
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Zlatko Devcic
- Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Warren A Oldenburg
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Jessica Gomez-Perez
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Justin R Yarbrough
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Michael Adalia
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - William Stone
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew J Meltzer
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, USA
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Richards T, Anwar M, Beshr M, Davies AH, Onida S. Systematic review of ambulatory selective variceal ablation under local anesthetic technique for the treatment of symptomatic varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:525-535. [PMID: 33137495 DOI: 10.1016/j.jvsv.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The ambulatory selective variceal ablation under local anesthesia (ASVAL) technique subscribes to the "ascending" theory of varicose vein etiology, which recommends primary ambulatory phlebectomy as a treatment for tributary varicosities and truncal vein incompetence. This systematic review explores the efficacy and safety of the ASVAL technique for the treatment of symptomatic varicose veins. METHODS A comprehensive search of the Medline and Embase databases and the Cochrane Register of Controlled Trials in May 2019 revealed 11 original articles that were qualitatively reviewed. The primary outcome was the absence from recurrent varicose veins at 1-year follow-up. Secondary outcomes were resolution of great saphenous vein (GSV) reflux on duplex ultrasound, change in GSV diameter, objective and subjective clinical improvement in chronic venous disease, and patient-reported outcome measures. RESULTS A total of 2106 limbs underwent intervention in 1734 patients reported in two randomized controlled trials, one case control study, three cohort studies, and five case series. Varicosity recurrence at 1 year ranged from 0.5% to 13.5% in patients. Of 1622 limbs with diagnosed GSV incompetence before intervention, 1114 were competent at 1 year (mean, 68.2% [±12.62%]). All studies measuring GSV diameter reported statistically significant reductions in vein size. CONCLUSIONS ASVAL may be considered as a minimally invasive treatment for early stages of chronic venous disease in the presence of truncal reflux. The evidence base should be strengthened by prospective randomized controlled trials that follow standardized procedures and report according to recognized measures of quality of life alongside clinical and hemodynamic data.
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Affiliation(s)
- Thomas Richards
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Muzaffar Anwar
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Mostafa Beshr
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sarah Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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Karam B, Moussally M, Nassar H, Ataya K, Jaafar R, Haddad F. Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up. Phlebology 2020; 36:43-47. [PMID: 32660372 DOI: 10.1177/0268355520939744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. METHODS This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. RESULTS Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. CONCLUSION EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.
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Affiliation(s)
- Boutros Karam
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Moussally
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Nassar
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim Ataya
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Jaafar
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Haddad
- Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
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Affiliation(s)
- Eleanor Atkins
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Nadeem A Mughal
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Patrick A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Pavei P, Spreafico G, Bernardi E, Giraldi E, Ferrini M. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord 2020; 9:352-360. [PMID: 32599308 DOI: 10.1016/j.jvsv.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Scarce information is available on the long-term results of endovenous laser ablation (EVLA) for great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency. We sought to provide data on the status of patients at least 9 years after EVLA. METHODS In 2018, we undertook a cross-sectional survey of ambulatory patients who had undergone EVLA in our tertiary care center in 2008-2009. Of 240 eligible patients, 5 died of causes not related to EVLA, 20 refused to participate, and 12 were lost to follow-up. Thus, 203 patients were re-evaluated; of them, 161 (79%) had GSV insufficiency and 42 (21%) had SSV insufficiency. The mean follow-up was 114 months (standard deviation, 11 months). All included patients underwent an echocardiography-color Doppler (ECD) evaluation, a clinical visit, and a standardized medical history. We assessed the competence of the junction and of the treated and untreated saphenous trunk and the presence of recurrent varicose veins. The trunk was considered ablated if it was nonvisible on B-mode or, when visible, if it was noncompressible or without flow or reflux on color flow Doppler analysis. Any recurrent varicose vein with the leakage point located in the treated saphenous vein was considered a failure. We asked patients about the effect of EVLA on their preoperative complaints and about any new or recurrent symptoms. We also recorded any complication or additional subsequent treatment and all data necessary to calculate the clinical class (C of the Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification) and the Venous Clinical Severity Score (VCSS). Finally, we investigated potential associations between the study outcomes and variables by multiple logistic regression techniques. RESULTS Some 10 years after EVLA, we performed a single clinical and ECD evaluation in 203 patients. Only one recanalization (0.5%; 95% confidence interval, 0.0-2.7) of the treated GSV trunk was observed in an otherwise asymptomatic patient. Up to 98% of patients were asymptomatic or significantly improved after EVLA. Additional subsequent treatments occurred in 21% of patients with GSV insufficiency and 5% of patients with SSV insufficiency. Three complications were observed, two in the GSV group (varicophlebitis, saphenous nerve damage) and one (varicophlebitis) in the SSV group. The mean C class of CEAP and the mean VCSS were significantly lower at the end of follow-up, both in patients with GSV insufficiency (C class, 3.2 vs 1.5 [P = .00001]; VCSS, 6.3 vs 1.6 [P = .001]) and in patients with SSV insufficiency (C class, 2.9 vs 1.1 [P = .00001]; VCSS, 5.4 vs 0.7 [P = .001]). Only the maximum diameter of the GSV at the junction independently correlated with ECD-confirmed reflux in the treated saphenous trunk or in the anterior accessory saphenous vein (odds ratio, 1.10; 95% confidence interval, 1.01-1.21). CONCLUSIONS EVLA using a 1470-nm diode laser with radial fibers provides stable and valuable long-term results in patients with either GSV or SSV insufficiency.
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Affiliation(s)
- Patrizia Pavei
- Department of Surgery, Multidisciplinary Center for Day Surgery, University Hospital of Padua, Padua, Italy.
| | | | - Enrico Bernardi
- Emergency Department, ULSS2 "Marca Trevigiana", Treviso, Italy
| | | | - Maurizio Ferrini
- Department of Surgery, Multidisciplinary Center for Day Surgery, University Hospital of Padua, Padua, Italy
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Nicolaides A, Kakkos S, Baekgaard N, Comerota A, de Maeseneer M, Eklof B, Giannoukas A, Lugli M, Maleti O, Mansilha A, Myers KA, Nelzén O, Partsch H, Perrin M. Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part II. INT ANGIOL 2020; 39:175-240. [PMID: 32214074 DOI: 10.23736/s0392-9590.20.04388-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | | | | | - Bo Eklof
- American Venous Forum, Hoffman Eastates, IL, USA
| | | | | | | | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Department of Angiology and Vascular Surgery, S. João Hospital, Porto, Portugal
| | | | - Olle Nelzén
- Vascular Surgery Unit, Skaraborg Hospital, Kärnsjukhuset, Skövde, Sweden
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Campbell B, J Franklin I, Gohel M. The choice of treatments for varicose veins: A study in trade-offs. Phlebology 2020; 35:647-649. [DOI: 10.1177/0268355520922708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Bruce Campbell
- University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter Hospital, Exeter, UK
| | | | - Manj Gohel
- Cambridge University Hospitals NHS Healthcare Trust, Cambridge, UK
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Rodriguez Santos F, Loson V, Coria A, Marquez Fosser C, Dotta M, Katsini R, Pared C, Bauzá Moreno H, Martínez H. Secondary Ablation of Recanalized Saphenous Vein after Endovenous Thermal Ablation. Ann Vasc Surg 2020; 68:172-178. [PMID: 32339689 DOI: 10.1016/j.avsg.2020.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/01/2020] [Accepted: 04/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND To describe the occlusion rate and clinical response of a redo ablative procedure in symptomatic patients with recanalization of saphenous vein after endovascular thermal ablation. METHODS A retrospective cohort study was performed in a prospectively collected data of symptomatic patients with recanalization of the great saphenous vein (GSV) or small saphenous vein (SSV) after endovascular thermal ablation who underwent a secondary ablation (SA) from June 2015 to May 2018. RESULTS Ten patients (15 limbs) with recanalization of the GSV or SSV were treated with SA. The median age was 67 years and 60% were men. The median time from the first ablation was 7.3 years (interquartile range [IQR] 6.5-9.6). For SA, radiofrequency ablation was performed in 12 limbs (80%) and ultrasound-guided foam sclerotherapy in 3 cases (20%). The GSV was the treated vessel in 14 cases (93.3%). No complications were reported. Median follow-up was 13 months. Preoperative and 1-year follow-up Venous Clinical Severity Score was 9 (IQR 5-10) and 4 (IQR 2-8), respectively. Duplex ultrasound evaluation after 1 year showed an occlusion rate of 93.3% evidencing a partially recanalized vein in 1 treated limb. CONCLUSIONS In this study, the occlusion rate was 93.3% at 1 year after SA; clinical improvement and no complications were reported. SA appears to be a valid option for the treatment of symptomatic patients with recanalized GSV or SSV.
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Affiliation(s)
- Fanny Rodriguez Santos
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina.
| | - Victoria Loson
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Agustín Coria
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Carolina Marquez Fosser
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Mariana Dotta
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Roxana Katsini
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Carlos Pared
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Hernan Bauzá Moreno
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
| | - Hugo Martínez
- Phlebolymphology Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Argentina
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Spinedi L, Stricker H, Keo HH, Staub D, Uthoff H. Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction. J Vasc Surg Venous Lymphat Disord 2020; 8:1006-1013. [PMID: 32284310 DOI: 10.1016/j.jvsv.2020.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The optimal ablation distance from the catheter tip to the common femoral vein during endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a matter of debate. In this study, we evaluated the feasibility and safety of flush ablation (fEVLA) of the GSV. METHODS This single-center, retrospective analysis of prospectively collected data included all consecutive fEVLA interventions of the GSV between September 2017 and October 2018. Interventions were performed with a 1470-nm radially emitting fiber. Primary end points were technical feasibility of fEVLA and endovenous heat-induced thrombosis (EHIT) class 2 to class 4. Secondary end points were procedure-related complications; anatomic success at week 6; and flush occlusion at day 1, day 10, and week 6. RESULTS A total of 135 consecutive intended fEVLA procedures were performed in 113 patients (86 female, 27 male). The average body mass index was 24.9 ± 4.3 kg/m2. The Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class for these patients was C2 in 78 (57.8%), C3 in 48 (35.6%), C4 in 8 (5.9%), and C5 in 1 (0.7%). The GSV diameter at the saphenofemoral junction was 9.4 ± 2.7 mm with a maximum of 16 mm. In 126 cases (93.3%), concomitant treatment of tributaries with phlebectomy or foam sclerotherapy was performed. In 127 cases (94.1%), fEVLA was technically feasible; in 8 cases (5.9%), appropriate catheter tip placement was not possible. In these cases, "standard" GSV ablation 10 to 20 mm distal to the saphenofemoral junction was performed. In the remaining 127 cases, one (0.8%) EHIT class 2 and one (0.8%) EHIT class 3 developed at day 10. After a 2- to 3-week course of anticoagulation with rivaroxaban, these EHIT cases resolved without sequelae. Furthermore, one (0.8%) superficial vein thrombosis and one (0.8%) calf vein thrombosis at the site of phlebectomy were observed. No local groin complication occurred. Flush occlusion was observed in 94.5%, 95.3%, and 88.2% of the cases at day 1, day 10, and week 6, respectively. Multivariate regression analysis revealed no significant association between flush ablation at day 1 and age, body mass index, CEAP class, fiber type, maximum vein diameter, or applied joules per centimeter. CONCLUSIONS The results of this study suggest that fEVLA of the GSV using a radial emitting laser is feasible and seems to be safe.
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Affiliation(s)
- Luca Spinedi
- Department of Angiology, Ospedale Regionale di Locarno, Locarno, Switzerland.
| | - Hans Stricker
- Department of Angiology, Ospedale Regionale di Locarno, Locarno, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland; Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Heiko Uthoff
- Department of Angiology, University Hospital Basel, University of Basel, Basel, Switzerland; Gefässpraxis am See, Lakeside Vascular Center, Lucerne, Switzerland
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48
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Encarnacion S N, Onida S, Lane TRA, Davies AH. Do we need another modality for truncal vein ablation? Phlebology 2020; 35:644-646. [DOI: 10.1177/0268355520913390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nelson Encarnacion S
- Department of Vascular Surgery, National Medical Center “20 de Noviembre”, Mexico City, Mexico
| | - Sarah Onida
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan RA Lane
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alun H Davies
- Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Masuda E, Ozsvath K, Vossler J, Woo K, Kistner R, Lurie F, Monahan D, Brown W, Labropoulos N, Dalsing M, Khilnani N, Wakefield T, Gloviczki P. The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord 2020; 8:505-525.e4. [PMID: 32139328 DOI: 10.1016/j.jvsv.2020.02.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stimulated by published reports of potentially inappropriate application of venous procedures, the American Venous Forum and its Ethics Task Force in collaboration with multiple other professional societies including the Society for Vascular Surgery (SVS), American Vein and Lymphatic Society (AVLS), and the Society of Interventional Radiology (SIR) developed the appropriate use criteria (AUC) for chronic lower extremity venous disease to provide clarity to the application of venous procedures, duplex ultrasound imaging, timing, and reimbursements. METHODS The AUC were developed using the RAND/UCLA Appropriateness Method, a validated method of developing appropriateness criteria in health care. By conducting a modified Delphi exercise and incorporating best available evidence and expert opinion, AUC were developed and scored. RESULTS There were 119 scenarios rated on a scale of 1 to 9 by an expert panel, with 1 being never appropriate and 9 being appropriate. The majority of scenarios consisted of symptomatic indications were deemed appropriate for venous intervention. For scenarios with anatomically short segments of reflux and/or no symptoms, the indications were rated less appropriate. For the indication of edema, a wide dispersion of ratings was observed especially for short segments of saphenous reflux or stenting for iliac/ inferior vena cava disease, noting that there are multifactorial causes of edema, some of which could coexist with venous disease and possibly impact effectiveness of treatment. Several scenarios were considered never appropriate, including treatment of saphenous veins with no reflux, iliac vein or inferior vena cava stenting for iliac vein compression as an incidental finding by imaging with minimal or no symptoms or signs, and incentivizing sonographers to find reflux. CONCLUSIONS The AUC statements are intended to serve as a guide to patient care, particularly in areas where high-quality evidence is lacking to aid clinicians in making day-to-day decisions for common venous interventions. This may also prove useful when applied on a population level, such as practice patterns, and not necessarily to dictate decision making for individual cases. As a product of a collaborative effort, it is hoped that this could be utilized by physicians and multiple stakeholders committed toward improving patient care and to identify and stimulate future research priorities.
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Affiliation(s)
- Elna Masuda
- Straub Medical Center, Hawaii Pacific Health, Honolulu, Hawaii.
| | | | | | - Karen Woo
- Department of Surgery, University of California, Los Angeles, Los Angeles, Calif
| | | | | | | | - William Brown
- William Beaumont Hospital and Wayne State University School of Medicine, Bingham Farms, Mich
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Persistent symptoms after endovenous thermal ablation may suggest proximal venous outflow obstruction. J Vasc Surg Venous Lymphat Disord 2020; 8:231-236. [DOI: 10.1016/j.jvsv.2019.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/20/2019] [Indexed: 02/04/2023]
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