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Woodhouse E, DiMusto P. Outcomes of a Single-center Experience In Eliminating Routine Postoperative Duplex Ultrasound Following Endovenous Ablation. J Vasc Surg Venous Lymphat Disord 2023; 11:642-647. [PMID: 36935080 DOI: 10.1016/j.jvsv.2023.01.007] [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: 10/29/2022] [Revised: 12/16/2022] [Accepted: 01/07/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES The current guidelines recommend routine postoperative screening duplex ultrasound (DUS) after endovenous ablation (EVA). This is a grade 2C recommendation and several contemporary reports have called for revision of this recommendation as there is insufficient evidence to support universal screening DUS after EVA. There are currently no studies that evaluate outcomes among EVA patients who did not have screening DUS. The aim of our study is to present outcomes from our single-center experience among patients who did not have DUS routinely performed after EVA. METHODS We performed a single-center, prospective cohort study that included consecutive patients undergoing EVA of the great saphenous vein at our institution between September 30, 2021 and March 15, 2022. At 30 days post procedure, electronic medical records were queried to identify patients who may have presented for evaluation of VTE symptoms. RESULTS Over the study period, a total of 80 lower extremity EVA procedures (71 EVLT, 9 RFA) were performed among 76 patients. Postoperative DUS was performed on 24 patients of which none were identified as having EHIT. Of the 54 patients who did not have DUS, a 30-day post procedure chart review revealed that none of these patients were seen for symptoms of venous thromboembolism (VTE). We estimate total cost savings of $14,289 by eliminating routine DUS without impact to clinical outcomes following EVA. CONCLUSION Postoperative DUS assessment after EVA comes with associated healthcare cost and has low yield given the incidence of clinically significant EHIT (3 and 4) is rare. In our experience, eliminating routine DUS had no impact on clinical outcomes, improved vascular lab access, and had a positive financial impact in our organization. Limiting DUS screening to EVA patients who exhibit symptoms of VTE can be a cost-effective approach that limits unnecessary imaging, time, and resources with no potential change in clinical outcomes based on our data. Further research is required and a randomized controlled trial would be ideal to answer this question.
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Affiliation(s)
- Erik Woodhouse
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI.
| | - Paul DiMusto
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, WI
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Chang SL, Hu S, Huang YL, Lee MC, Chung WH, Cheng CY, Hsiao YC, Chang CJ, Lee SR, Chang SW, Wen YW. Treatment of Varicose Veins Affects the Incidences of Venous Thromboembolism and Peripheral Artery Disease. Circ Cardiovasc Interv 2021; 14:e010207. [PMID: 33685215 DOI: 10.1161/circinterventions.120.010207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Shyue-Luen Chang
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Sindy Hu
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Yau-Li Huang
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Mei-Ching Lee
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Wen-Hung Chung
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Dermatology, Chang Gung Memorial Hospital, Xiamen, China (S.-L.C., S.H., Y.-L.H., M.-C.L., W.-H.C.)
| | - Chun-Yu Cheng
- Department of Dermatology, Vein Clinic, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.).,Department of Cosmetic Science, Chang Gung University of Science and Technology, Linkou, Taiwan (S.-L.C., S.H., Y.-L.H., M.-C.L., C.-Y.C., W.-H.C.)
| | - Yen-Chang Hsiao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (Y.-C.H.)
| | - Chee Jen Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan (C.J.C., Y.-W.W.).,Research Services Center for Health Information (C.J.C., S.R.L.), Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
| | - Shu Ru Lee
- Research Services Center for Health Information (C.J.C., S.R.L.), Chang Gung University, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wen
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan (C.J.C., Y.-W.W.).,Clinical Informatics and Medical Statistics Research Center (C.J.C., S.-W.C., Y.-W.W.), Chang Gung University, Taoyuan, Taiwan
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The proximity of the superficial epigastric vein to the saphenofemoral junction is associated with endovenous heat-induced thrombosis after radiofrequency ablation for varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:669-675. [PMID: 32827735 DOI: 10.1016/j.jvsv.2020.08.023] [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: 06/12/2020] [Accepted: 08/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To elucidate the risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins in association with the superficial epigastric vein (SEV) position to the saphenofemoral junction (SFJ). METHODS We examined 125 legs from 218 patients (mean age, 67 years; 80 female legs) with great saphenous veins (GSVs) in association with the SEV proximity to the SFJ using the duplex ultrasound test. According to the Clinical, Etiology, Anatomy and Pathophysiology classification (CEAP; C1-C6), there were 62, 38, and 25 legs in the C2, C3, and C4-C6 categories, respectively. The postoperative duplex ultrasound tests, focused on EHIT, were conducted on days 1, 7, 30, and 90 after RFA. The EHIT analysis was based on Kabnick's classification (class 1-4). We compared the GSV diameter and the SEV-SFJ distance between the EHIT positive (n = 32) and negative groups (n = 93) using the Student t-test. The risk factors (age >75, male sex, ≥C3 classification, adjunctive phlebectomy, prior venous surgery history, GSV diameter of >7.5 mm, and short SEV-SFJ distance [<4 mm]) were examined using univariate and multiple logistic regression analyses. RESULTS The EHIT ratio after RFA was 25.6% (24, five, three, and no legs in classes 1, 2, 3, and 4, respectively). In the EHIT positive group, the mean GSV diameter and the SEV-SFJ distance were larger (8.0 ± 2.3 vs 6.4 ± 2.0 mm; P < .001) and shorter (5.2 ± 4.0 vs 6.8 ± 3.7 mm; P = .05) than the negative group. Using univariate analysis, the risk factors of EHIT after RFA were as follows: ≥C3 classification (odds ratio [OR], 4.15; P = .002), GSV diameter >7.5 mm (OR, 3.50; P = .003), and short SEV-SFJ distance (OR, 2.92; P = .01). Multiple logistic regression analysis showed that a classification of ≥C3 (OR, 3.39; 95% confidence interval [CI], 1.30-8.86; P = .013), GSV of >7.5 mm (OR, 3.32; 95% CI, 1.33-8.25; P = .010), and short SEV-SFJ distance (OR, 2.71; 95% CI, 1.09-6.71; P = .032) were also significant risk factors. CONCLUSIONS RFA treatment for patients with varicose veins should be considered postoperatively in combination with a classification of ≥C3, GSV diameter of >7.5 mm, and a history of deep venous thrombosis and concomitant procedures, because it is related with greater chances of EHIT development.
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Quehe P, Alavi Z, Kurylo-Touz T, Saliou AH, Badra A, Baudino L, Gladu G, Ledan F, Haudebourg R, Gestin S, Bressollette L. Endovenous Celon radiofrequency-induced thermal therapy of great saphenous vein: A retrospective study with a 3-year follow-up. SAGE Open Med 2018; 6:2050312118794591. [PMID: 30891243 PMCID: PMC6416801 DOI: 10.1177/2050312118794591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/20/2018] [Indexed: 01/20/2023] Open
Abstract
Objective: Our main objective was to evaluate the short- and long-term efficacy of Celon radiofrequency-induced thermal therapy for endovenous treatment of incompetent great saphenous vein. The secondary objectives were to report on possible short-term side effects and complications. Methods: This was a retrospective study of 112 consecutive patients included between 2013 and June 2015. These patients were treated (146 great saphenous vein, C2–C6) either at the hemodynamic room using local anesthesia or at the operating theater under general anesthesia with or without phlebectomy. All patients received radiofrequency-induced thermal therapy at 18 W power, 1 s/cm pullback rate and 5–7 pullbacks per segment of 10 cm (i.e. maximum 10 pullbacks). A clinical follow-up via ultrasound monitoring was done at 1 week, 1 month, 6 months, 1 year, 2 years and 3 years. Results: The 3-year survival occlusion rate was 96.71% and 98% for overall and radiofrequency-induced thermal therapy patients, respectively. No major side effects were observed. A case of endovenous heat-induced thrombosis was reported. Slight neurological disorders were reported (0.88%). Conclusion: Our unit’s endovenous Celon radiofrequency-induced thermal therapy of incompetent great saphenous vein was efficient, well tolerated, without major side effects. Moreover, in order to reduce possible neurological disorders, we advise multiple pullbacks at 1 s/cm and using tumescence anesthesia.
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Affiliation(s)
- Philippe Quehe
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | - Zarrin Alavi
- Inserm CIC 1412, CHRU La Cavale Blanche, Brest, France
| | - Tatiana Kurylo-Touz
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | | | - Ali Badra
- Service de la chirurgie vasculaire, CHRU La Cavale Blanche, Brest, France
| | - Laurent Baudino
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | | | - Frederik Ledan
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | - Raphaël Haudebourg
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | - Simon Gestin
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
| | - Luc Bressollette
- L'unité d'écho-doppler et de médecine vasculaire, CHRU La Cavale Blanche, Brest, France
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de Araujo WJB, Timi JRR, Erzinger FL, Caron FC. Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura. J Vasc Bras 2016; 15:147-152. [PMID: 29930581 PMCID: PMC5829710 DOI: 10.1590/1677-5449.009816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/31/2016] [Indexed: 03/07/2023] Open
Abstract
Define-se trombose induzida pelo calor endovenoso como a propagação do trombo a partir de uma veia superficial em direção a uma veia mais profunda. Em geral, é considerada clinicamente insignificante quando não há propagação do trombo para o sistema venoso profundo. Essa condição pode ser tratada com terapia anticoagulante, embora a observação pareça ser suficiente, principalmente para graus menores. Neste estudo, relatamos dois casos de trombose induzida pelo calor endovenoso que teriam indicação de heparina de baixo peso molecular até a resolução do quadro. Porém, optou-se pelo uso da rivaroxabana (15 mg de 12 em 12h), com resolução completa do trombo em 4 semanas (caso 1) e em 7 dias (caso 2). A rivaroxabana pode ser uma alternativa promissora no tratamento da trombose induzida pelo calor endovenoso avançada, pela simplicidade da posologia, sem comprometimento da eficácia ou da segurança. São necessários estudos prospectivos, randomizados e controlados que possibilitem melhor entendimento da condição e o desenvolvimento de recomendações mais definitivas sobre opções de prevenção e tratamento.
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Affiliation(s)
| | | | - Fabiano Luiz Erzinger
- Universidade Federal do Paraná – UFPR, Departamento de Cirurgia, Curitiba, PR, Brasil.
| | - Filipe Carlos Caron
- Universidade Federal do Paraná – UFPR, Departamento de Cirurgia, Curitiba, PR, Brasil.
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Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: Best practice techniques and evidence. Phlebology 2015; 30:9-17. [DOI: 10.1177/0268355515592771] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Scope of the review This article systematically reviews the practice of radiofrequency ablation of lower limb varicose veins. We present the clinical evidence and best practice techniques for currently available devices. Methods Manufacturer’s instructions-for-use were requested for all radiofrequency devices. The MEDLINE and EMBASE databases were searched using the following keywords: ‘varicose veins’ AND ‘radiofrequency’ OR ‘radio frequency’ OR ‘Venefit’ OR ‘ClosureFAST’ OR ‘RFiTT’ OR ‘EVRF’ OR ‘VeinCLEAR’, generating 240 articles. Titles and abstracts were screened, yielding 63 articles directly relevant to the scope of the review. Reference lists for publications were also searched to identify further manuscripts of relevance. The Cochrane Database and current National Institute for Clinical and Healthcare Excellence guidelines for varicose veins were also searched from relevant articles. Results Four radiofrequency ablation (RFA) systems are currently commercially available. Generic practice methods (common to all RF systems) and device-specific techniques are described. The weight of current evidence relates to the use of Covidien Venefit™ (formerly VNUS ClosureFAST™), which clearly demonstrates clinical advantages over open surgery at least to 2 years follow up. However, contemporary studies of the radiofrequency-induced thermal therapy device (RFiTT®), show that in experienced hands, clinical equivalence to the Venefit™ procedure can be achieved. The evidence base for EVRF® and VeinCLEAR™ devices is currently weak and absent, respectively. Conclusions Despite widespread uptake of RFA and acceptance of its clinical advantages over open surgery there is a paucity of Class 1 A evidence. This results from incongruent reporting of clinical outcome measures within existing literature. Similarly, lack of long-term follow-up studies precludes comparison of the durability of short- and medium-term advantages of RFA with the longer term results of open surgery. There remains scope for a large prospective high-quality trial to assess the clinical, anatomical and cost-effectiveness outcomes for the four commercially available RFA devices, with a particular focus on long-term follow up.
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Affiliation(s)
- Stephen J Goodyear
- Department of Vascular Surgery, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, UK
| | - Isaac K Nyamekye
- Department of Vascular Surgery, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, UK
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