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Endovenous Photocoagulation Using a Diode Laser for Complicated Varicose Veins Related to Stasis Ulcers. Ann Plast Surg 2018; 82:S103-S107. [PMID: 30461460 DOI: 10.1097/sap.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to assess the efficacy and safety of endovenous laser photocoagulation (EVLP) at a wavelength of 810 nm for treating complicated venous insufficiency associated with venous ulcers. MATERIALS AND METHODS A retrospective review of 110 patients with 180 legs having chronic venous insufficiencies associated with varicose veins treated over an 8-year period was conducted. Patients ranged from 16 to 80 years of age and included 85 women and 25 men. Of the 110 patients, 32 (29.10%) patients with 40 legs having varicose veins were defined as having complicated varicose veins associated with venous ulcers. All 32 patients received EVLP treatment using a diode laser. Complications were evaluated at 3 weeks (early), 6 weeks (late), and 6 months (final) after EVLP treatment. The primary efficacy and final outcome measurement were determined through quantitative assessment using Hach's and clinical, etiological, anatomical, and pathophysiological classification. Safety was evaluated for each treatment group by monitoring adverse effects. RESULTS Early complications were swelling, local paresthesia, pigmentation, minor superficial thermal injury, superficial phlebitis, and localized hematomas. All complications and ulcerations resolved completely within 2 weeks. No recurrence occurred after the study's 6-month follow-up period. Based on paired t test analysis, clinically significant differences in severity scores were discovered, which were based on Hach's classification before and after EVLP treatment at a wavelength of 810 nm. All patients achieved improvement from clinical, etiological, anatomical, and pathophysiological class C6 to C5. Permanent adverse effects were not observed. CONCLUSIONS Endovenous laser photocoagulation at the wavelength of 810 nm permitted the use of appropriate light doses for treating complicated varicose veins associated with venous ulcers and resulted in significant improvement in lesions.
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Lin YN, Hsieh TY, Huang SH, Liu CM, Chang KP, Lin SD. Management of venous ulcers according to their anatomical relationship with varicose veins. Phlebology 2017; 33:44-52. [DOI: 10.1177/0268355516676124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Adequately excising varicose and incompetent perforating veins is necessary for reducing their recurrence rate of venous ulcer. Method In total, 66 venous ulcers (C6) in 1083 legs with primary varicose veins were managed through endoscopic-assisted surgery. In an endoscopic operative view, the nonvaricose, varicose, and incompetent perforating veins were clearly visualized and precisely dissected. The varicose and incompetent perforating veins were divided and completely excised. Result The varicose veins were traced to the base or periphery of the 55 ulcers. Moreover, 89.4% of the ulcers healed within 14 weeks. Kaplan–Meier analysis revealed a five-year recurrence rate of 0.0%, and the satisfaction mean score was 4.6. Conclusion Endoscopic-assisted surgery can be used to radically excise varicose veins complicated with venous ulcers; the surgery yields low recurrence and high satisfaction rates.
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Affiliation(s)
- Yun-Nan Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tung-Ying Hsieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hung Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ming Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Kao-Ping Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sin-Daw Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Yu DY, Chen HC, Chang SY, Hsiao YC, Chang CJ. Comparing the Effectiveness of 1064 vs. 810 nm Wavelength Endovascular Laser for Chronic Venous Insufficiency (Varicose Veins). Laser Ther 2013; 22:247-53. [PMID: 24511201 DOI: 10.5978/islsm.13-or-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to compare the efficacy and safety of Endovenous Laser Photocoagulation (EVLP) at wavelengths of 1064 nm versus 810 nm for chronic venous insufficiency (varicose veins) in a large series of patients. STUDY DESIGN/MATERIALS AND METHODS A retrospective review was conducted of 108 patients with chronic venous insufficiency treated over a 8-year period. Subjects' ages ranged between 16 to 79 years; there were 83 females and 25 males, all of whom were Asian. Patients (n=54) received EVLP at wavelengths of 1064 nm (EVLP-1064 nm), Nd:YAG laser. Subsequent patients (n=54) received 810 nm (EVLP-810 nm), Diode laser. The primary efficacy measurement was the quantitative assessment of final outcome for 1064 nm versus 810 nm. Patients were monitored for adverse effects as well. RESULTS Complications were observed at 3 weeks (early), 6 weeks (late) and 6 months after EVLP. In both groups, the commonest complication in early convalescence was swelling. This was followed by Local paraesthesia, pigmentation, superficial burns, superficial phlebitis, and localized hematomas. At 6 weeks postoperatively, local paraesthesia, persistent hyperpigmentation, and minimal scarring were presented. These problems all disappeared completely after the 6 months study period. Based on chi-squared analysis, there were clinical, and statistically significant differences in the severity score of final results favoring the EVLP-810 nm group. CONCLUSION All patients achieved good or excellent improvement after EVLP-1064nm and EVLP-810nm. However, the difference of final outcome was significant, and indicates that improvement was greater in the Diode group. Further studies of different wavelengths and optimization of cryogen spray cooling (CSC) may lead to improved results in the eradication of varicose veins.
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Affiliation(s)
- De-Yi Yu
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Hung-Chang Chen
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Shu-Ying Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Cheng-Jen Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Kuo CJ, Liang SS, Hsi E, Chiou SH, Lin SD. Quantitative proteomics analysis of varicose veins: identification of a set of differentially expressed proteins related to ATP generation and utilization. Kaohsiung J Med Sci 2013; 29:594-605. [PMID: 24183353 DOI: 10.1016/j.kjms.2013.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/19/2012] [Indexed: 01/12/2023] Open
Abstract
Although morphological and anatomical studies indicate that varicose veins are characterized by venous wall weakening and subendothelial fibrosis, the exact underlying biochemical mechanism of their development remains unknown. Additionally, no quantitative proteomic study of venous proteins leading to decreased contractility of varicose veins has been reported to date. Therefore, to elucidate the molecular mechanism of altered vascular contractility, this study performed shotgun proteomic analysis to obtain protein expression profiles in patients with varicose veins. Stable isotope dimethyl labeling coupled with nanoLC-MS/MS revealed downregulation in 12 polypeptides, including myosin light chain kinase, creatine kinase B-type, ATP synthase, phosphoglycerate kinase, and pyruvate kinase. However, analyses of protein species associated with cytoskeletal assembly or with cellular morphology showed no clear up- or down-regulation. These results indicate that defects in ATP generation and utilization may account for the dysfunction of vascular smooth muscle following formation of varicose veins. Collectively, the severity of varicose veins depends on the regulatory roles of various protein factors in the metabolic coordination of physiological functions. This pilot study improves understanding of the pathogenesis of varicose veins and lays the foundation for further validation and clinical translation of biomarkers for targeted therapies in treating this disease.
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Affiliation(s)
- Chao-Jen Kuo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Research Resources and Development, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hsu TC. Comparison of holding power of metal and absorbable hemostatic clips. Am J Surg 2006; 191:68-71. [PMID: 16399109 DOI: 10.1016/j.amjsurg.2004.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 12/10/2004] [Accepted: 12/10/2004] [Indexed: 11/29/2022]
Abstract
PURPOSE Metal hemoclips remain in the tissue permanently. Metal clips will interfere with the interpretation of a computed tomography or magnetic resonance imaging scan. Polydixanone polymer clips (Absolak extra clips; Ethicon Endo-Surgery, Cincinnati, OH) are completely absorbable. Absolak extra clips will not interfere with a computed tomography or magnetic resonance imaging scan and will encircle 360 degrees vessels for extra security. The aim of this study was to test the holding strength of the metal hemoclips and Absolak clips and the amount of pressure that will cause slippage of the 2 types of clips. METHODS The study period was from April 2001 to December 2002 and the study included 74 patients undergoing colectomy. There were 40 men and 34 women. Patient ages ranged from 33 to 86 years (average, 64.5 y). The clips were applied on the dissected vessels of the specimen. Part I of the study was as follows: a rubber band was applied to the protruding part of the clip and a balance weight then was tied onto the rubber band. The weight was increased gradually by 50-g units. The weight that caused slippage of the clip was recorded. Part II of the study was as follows: a correctly sized angiocatheter was inserted individually into the artery and vein and attached to a sphygmomanometer. The intravascular pressure was increased by inflating the balloon of sphygmomanometer and the amount of pressure that caused slippage of the clips was recorded. RESULTS Part I of the study determined that an artery could hold 406.4 +/- 46.1 g, a vein could hold 247.3 +/- 36.5 g, and both arteries and veins could hold 621.6 +/- 24.9 g without slippage when a single hemoclip was applied. No slippage occurred when an Absolak or double hemoclips were applied to the vessel(s). Part II of the study determined that a hemoclip would slip off of a vein when the pressure was increased to 156.6 +/- 8.4 mm Hg. Double clips would slip off of a vein when the pressure was increased to 257.6 +/- 9.6 mm Hg. No hemoclip slipped off of an artery after application even if the amount of pressure was increased to 300 mm Hg. No Absolak clip slipped off after application to an artery or vein even if the amount of pressure was increased to 300 mm Hg. CONCLUSIONS Absolak clips can withstand a higher weight than single hemoclips without slipping off of an artery and/or vein. Likewise, Absolak clips can withstand a higher intravascular pressure without slippage than single or double hemoclips when applied to a vein.
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Affiliation(s)
- Tzu-Chi Hsu
- Colon and Rectal Surgery, Mackay Memorial Hospital, Department of Surgery, Taipei Medical University, #92, Section 2, Chung-San North Rd., Taipei, Taiwan.
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Lin SD, Cheng KH, Lin TM, Chang KP, Lee SS, Sun IF, Wang WH, Lai CS. Management of the Primary Varicose Veins With Venous Ulceration With Assistance of Endoscopic Surgery. Ann Plast Surg 2006; 56:289-94. [PMID: 16508360 DOI: 10.1097/01.sap.0000197641.18499.b9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two hundred sixty-two cases of primary varicose veins in which the lesions extended to the areas of the lower third of the leg and/or the ankle were treated with the assistance of endoscopic surgery. The conditions of varicose veins were classified by the reporting standards in venous disease. The number of cases in lesions of C2, C4, C5, and C6 were 60, 156, 31, and 15, respectively. They were also classified into 4 clinicoanatomic types according to varicositic changes in normal veins. The number of cases in types I, II, III, and IV were 57, 88, 42, and 75, respectively. The incidence of skin changes resulting from varicosity were 100%, 90.5%, 53%, and 50% in types I, II, III, and IV, respectively. The incidence of skin changes in this series was 77.6%. About one fourth of the cases having skin changes progressed to C5 and/or C6 lesions. Early and radical treatment of varicose veins could prevent the occurrence of skin changes and subsequently avoid the incidence of C5 and/or C6 lesions. The mean number of incisions in each limb was 2.9. With good illumination and magnified monitor view, the varicose veins and incompetent perforating veins were radically excised, but the normal veins were preserved. Forty-six cases of C5 and C6 lesions were followed up at least 1 year postoperatively. Four cases were lost from follow-up. In all cases except 1, there has been no recurrence. The conditions of skin changes improved subsequently. The recurrent rate of ulceration was 2.4%. In treatment of primary varicose veins with or without ulceration, surgery with assistance of endoscopic surgery achieved a low recurrence of ulcerations and minimal operative scarring.
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Affiliation(s)
- Sin-Daw Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan.
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Abstract
BACKGROUND AND OBJECTIVES Untreated varicose veins have significant morbidity and potential mortality. Treatment aims to relieve symptoms, improve appearance, and to prevent deterioration. Current therapeutic options include graduated compression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation, and stripping. Results of laser photocoagulation of vascular anomalies have been encouraging. Applying these concepts of laser-tissue interactions, we developed a new method of treatment for varicose veins of the lower extremities. STUDY DESIGN/MATERIALS AND METHODS One hundred and forty-nine patients with 252 varicose greater saphenous veins underwent endovenous laser photocoagulation (EVLP) from January 1996 to January 2000. Subject's age ranged between 23 years 9 months and 80 years 7 months with a mean age of 50 years 8 months. There were 122 females and 27 males. Only patients with primary varicose veins and saphenofemoral reflux documented by Duplex ultrasound were treated. All patients received surgical ligation of the saphenofemoral junction (SFJ). EVLP was performed using the neodymium:yttrium-aluminium-garnet (Nd:YAG) (1,064 nm) laser, delivered with a 600 microm optical fiber. Laser power was set at 10 or 15 W, delivered with a pulse duration of 10 seconds. The outcome was compared before and after EVLP, based on the score of severity of the varicose veins by Hach's classification. RESULTS The range of total delivered energy is from 9,200 to 20,100 J. The entire procedure was completed in 95-175 minutes (mean 122.33 minutes) for bilateral procedures, and 65-100 minutes (mean 81.07 minutes) for unilateral procedures. The follow-up period ranged from 12 to 28 months with a mean of 19 months. One hundred and forty-one patients with 244 legs involved (96.8%) demonstrated remarkable improvement (P < 0.05). Common early complications of EVLP are: local paraesthesia of the treated area in 92 legs (36.5%), ecchymosis and dyschromia in 58 legs (23.0%), superficial burn injury in 12 legs (4.8%), superficial phlebitis in four legs (1.6%), and localized hematoma in two legs (0.8%) at 3 weeks post-operatively. The final outcome showed no significant morbidity or mortality. All patients recovered completely. CONCLUSIONS EVLP is a simple effective treatment modality for varicose veins. This less invasive method can minimize the complications of conventional surgery.
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Affiliation(s)
- Cheng-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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Lin SD, Chang KP, Yang YL, Lee SS, Lin TM, Tsai CC, Lai CS. Gross anatomy of primary varicose veins observed in endoscopic surgery. Ann Plast Surg 2002; 49:559-66. [PMID: 12461435 DOI: 10.1097/00000637-200212000-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The gross anatomy of varicose veins is one of the most important factors in the study of varicosity. Because of wide variations in the extent of involvement and degree of severity of varicose veins, it is difficult to obtain live and intact specimens of varicose veins. With good illumination and magnified monitor viewing, the varicositic main channel, its tributaries, and the incompetent perforating veins can be dissected and visualized clearly during endoscopic surgery. Thus, the whole range of varicosities can be observed directly in situ. Characteristic features of the varicosities of 350 limbs have been recorded by video and photographs for study and classification. These features include: 1) poor contractility of varicose veins; 2) dilated and tortuous changes of varicose veins; 3) saccular or lateral bulging deformities of vein walls, or both; 4) uniformly dilated and tortuous deformities of a long vein; 5) varicositic changes of the accessory vein; 6) anatomic abnormalities of varicose veins, such as supernumerary tributaries, varicositic clusters, and a crowded relationship among the long saphenous vein, perforating vein and tributaries; 7) various conditions of the perforating veins; and 8) the close relationship among the long saphenous vein, perforating veins, and the saphenous nerve. These data provide valuable information for the study and management of primary varicose veins.
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Affiliation(s)
- Sin-Daw Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
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Lin SD, Chang KP, Lu DK, Lee SS, Lin TM, Tsai CC, Lai CS. Endoscope-assisted management of varicose veins in the posterior thigh, popliteal fossa, and calf area. Ann Plast Surg 2002; 48:10-20. [PMID: 11773725 DOI: 10.1097/00000637-200201000-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Varicose veins of the posterior thigh, popliteal fossa, and calf area were managed with the assistance of endoscopic surgery in 136 patients. Patients were divided into four types according to the normal veins involved in varicosities. With good illumination and magnified monitor viewing by means of a surgical endoscope, the main channel, tributaries of varicosities, incompetent perforating veins, and healthy veins could be clearly visualized and identified. Even though these varicosities had aberrant and tortuous courses, they could be completely dissected, divided, and then removed through one or more access incisions (2.5-3.0 cm in length). The incompetent perforating veins were also dissected and divided. The mean number of access incisions for each lower extremity was 2.2, 1.9, 1.3, and 1.0 for types I, II, III, and IV respectively. In all cases, the mean number of incisions was 1.6 in each lower limb. The most frequent morbidity was maceration of the access incision. Three wounds in 3 patients required debridement and resuturing, but the other wounds healed satisfactorily. Transient discoloration caused by bruising and numbness may present at the dissected area. There was no hematoma formation. Ischemic change with bleb formation of the dissected skin occurred in 1 patient. Subsequent secondary healing resulted in slight scarring in this area. With the assistance of endoscopic surgery, all the varicosities and the incompetent perforating veins could be completely dissected and removed. Accomplishment of removal of varicosities was double-checked between the preoperative skin marks of varicosities and the endoscopic findings. There is very little possibility for recurrence, because there were no residual varicosities or incompetent perforating veins after this operation. There was no recurrence in follow-up at least 2 months postoperatively. Patients were satisfied with the minimal surgical scarring and the complete absence of disfiguring varicosities.
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Affiliation(s)
- Sin-Daw Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Chung-Ho Memorial Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
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