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Arslanturk O, Gumus F. Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of small saphenous veins. Phlebology 2023; 38:668-674. [PMID: 37644641 DOI: 10.1177/02683555231198625] [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: 08/31/2023]
Abstract
BACKGROUND The objective of this study was to compare the early and mid-term results of radiofrequency ablation and cyanoacrylate ablation used in the treatment of small saphenous insufficiency. METHODS A total of 84 patients with isolated small saphenous vein insufficiency who underwent either cyanoacrylate ablation (CA) (Group 1, n = 40) or radiofrequency ablation (RFA) (Group 2, n = 44) were analyzed retrospectively. RESULTS The occlusion rate of target vessel was 95% in Group 1 and 93.1% in Group 2 patients, respectively, at 1-year follow-up without any significant difference. Sural nerve injury was observed in 3 (6.8%) patients in Group 2 due to the thermal damage of the RFA device. CONCLUSIONS While both techniques can be used with satisfactory and safe results in 1-year follow-up period, cyanoacrylate ablation may have a better safety profile compared to radiofrequency ablation due to lower complication rates in terms of paresthesia and sural nerve damage with similar occlusion rates.
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Affiliation(s)
- Oguz Arslanturk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak
| | - Fatih Gumus
- Department of Cardiovascular Surgery, Memorial Hospital, Ankara, Turkey
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2
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Hong KP. Mid-term results of radiofrequency ablation with multiple heat cycles for incompetent saphenous veins. J Vasc Surg Venous Lymphat Disord 2022; 11:483-487. [PMID: 36581000 DOI: 10.1016/j.jvsv.2022.12.004] [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: 09/23/2022] [Revised: 10/29/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Recent reports suggest that the number of radiofrequency ablation (RFA) cycles impacts the depth of vein wall damage. This study evaluates the mid-term occlusion rate after delivering increased energy during RFA of incompetent saphenous veins. METHODS Between 2016 and 2019, consecutive patients who underwent RFA with multiple heat cycles were enrolled in the study. The exclusion criterion was previous treatment history for chronic venous disease. Duplex ultrasound data and medical records were reviewed retrospectively. RESULTS This study enrolled 217 patients (345 veins). Follow-up examinations were performed for 65% of treated veins after 6 months, 31% after 12 months, and 26% after more than 24 months with a mean follow-up period of 23 ± 18.9 months. The numbers of great saphenous and small saphenous veins were 178 and 62, respectively. According to the Kaplan-Meier method, the occlusion rate of saphenous veins was 100% at 3 years and 95.4% at 5 years. Except for one case (0.3%) of endovenous heat-induced thrombosis class 2, no significant side effects were noted. CONCLUSIONS Routine use of RFA with multiple heat cycles for incompetent saphenous veins exhibits good clinical outcomes considering mid-term occlusion rate without an increase in side effects.
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Affiliation(s)
- Ki-Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea.
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Yiğit G. How effective is cyanoacrylate closure in small saphenous vein insufficiency? A single center experience. Vascular 2021; 30:1182-1188. [PMID: 34649473 DOI: 10.1177/17085381211051494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study was aimed to evaluate the efficacy and early outcomes of n-butyl cyanoacrylate (NBCA) ablation in small saphenous vein (SSV) insufficiency. METHODS In this single-center, retrospective, single-arm study, NBCA ablation was performed in 80 patients with SSV insufficiency between September 2018 and May 2020. Primary outcomes (anatomic success rate and occlusion rate) and secondary outcomes (VCSS and AVVQ scores) of the patients were analyzed. RESULTS No technical failure and device-related complications were encountered. Anatomic success rate was 100% after procedures. Each treated SSV was occluded on colored Doppler ultrasonography immediately after the procedure, and all veins remained occluded at 2 weeks after the procedure. Partial recanalization was observed in five patients at 12-month follow-up. Kaplan-Meier analysis revealed an occlusion rates at 6 months and 12 months follow-up were 97.5% and 93.75%, respectively. The mean pretreatment VCSS (4.72 ± 2.04) decreased to 1.61 ± 0.93, 0.87 ± 0.58, and 0.73 ± 0.52 at 2 weeks, 6 months, and 12 months after treatment, respectively (p < .001). The mean pretreatment AVVQ score (11.92 ± 2.23) decreased to 8.2 ± 1.89, 4.2 ± 1.16, and 3.32 ± 1.19 at 2 weeks, 6 months, and 12 months after treatment, respectively (p < .001). The Clinical, Etiologic, Anatomic, and Pathophysiology clinical classification at 12 months demonstrated a significant reduction in disease severity compared with preoperative values (p < .001). There was no mortality and major adverse events including anaphylaxis and pulmonary thromboembolism (PTE) related to procedure after follow-ups. Moreover, there were no symptoms or signs of any sural nerve injury and no cases of skin necrosis, infection, or hyperpigmentation. In addition, no hematoma, deep venous thrombosis, and hypersensitivity reactions were observed. Phlebitis-like abnormal reaction was observed in three patients (3.8%). CONCLUSIONS In conclusion, in patients with SSV insufficiency, NBCA ablation with VenaBlock® system appears to be an effective and reliable treatment method. At the 12-month follow-up, the NBCA of SSVs showed a low recanalization rate and had a satisfactory improvement on the VCSS and AVVQ scores.
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Affiliation(s)
- Görkem Yiğit
- Department of Cardiovascular Surgery, 233009Yozgat City Hospital, Yozgat, Turkey
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Abstract
BACKGROUND As minimally invasive techniques were issued, endovenous thermal ablations have emerged. However, the thermal-associated complication has been reported in the treatment of small saphenous vein (SSV) insufficiency, such as sural nerve injury. Recently introduced cyanoacrylate closure (CAC) is a nonthermal modality, so this thermal-associated complication can be avoided. OBJECTIVE This retrospective study analyzed the feasibility, safety, and 2-year results of CAC for treating SSV insufficiency, particularly the incidence of sural nerve injury. MATERIALS AND METHODS One hundred sixty-three SSV insufficiencies in 128 patients were treated with CAC were reviewed. Pain, venous severity, and quality of life (QoL) scores were evaluated. Postoperative duplex scanning also evaluated anatomical and clinical success rates. RESULTS The mean patient age was 56.8 years. The initial technical success rate was 100%. The occlusion rate after 2 years was 96.3%. Pain, venous severity, and QoL scores were improved significantly from 2.4 to 0.0, 4.39 to 0.47, and 11.95 to 2.69, respectively, before and 2 years after CAC. No major complications were observed, such as sural nerve injury. CONCLUSION Cyanoacrylate closure for the ablation of SSV insufficiency could be a great alternative to endothermal ablation with an excellent success rate and shorter procedure time.
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Lomazzi C, Bissacco D, Logan MS, Grassi V, Piffaretti G, Trimarchi S, L Bush R. Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:427-434. [PMID: 34014061 DOI: 10.23736/s0021-9509.21.11908-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period.
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Affiliation(s)
- Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy -
| | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Viviana Grassi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, ASST Settelaghi University Teaching Hospital, Varese, Italy.,Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Ruth L Bush
- University of Houston College of Medicine, Houston, TX, USA
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Baccellieri D, Apruzzi L, Ardita V, Favia N, Saracino C, Carta N, Melissano G, Chiesa R. Early results of mechanochemical ablation for small saphenous vein incompetency using 2% polidocanol. J Vasc Surg Venous Lymphat Disord 2020; 9:683-690. [PMID: 32916372 DOI: 10.1016/j.jvsv.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the early results of mechanochemical ablation (MOCA) for the treatment of small saphenous vein (SSV) incompetence. METHODS We performed a single-center, retrospective analysis of a prospectively collected database of 60 patients treated with MOCA for single-axis SSV incompetence. All procedures were performed with the patient under local anesthesia using the ClariVein catheter (Merit Medical, South Jordan, Utah) combined with 2% polidocanol and, where appropriate, additional microphlebectomy. The primary study endpoint was to assess the SSV occlusion rate at the 1-, 6-, and 12-month follow-up examinations. The secondary endpoints included the Venous Clinical Severity Score, quality of life (QoL) assessment, periprocedural pain, and further complications after the intervention and during the follow-up period. Patient QoL was assessed using the Aberdeen Varicose Vein Questionnaire. Pain was measured using a 100-mm visual analog scale. RESULTS Technical success was achieved in 100% of the cases. The mean visual analog scale score on the first postoperative day was 15 mm. No major events were recorded. No neurological complications or deep vein thrombosis were observed. Minor complications included ecchymosis in 3.3% of cases (2 of 60), transient phlebitis of the SSV in 5% of cases (3 of 60), and itching in 3.3% of cases (2 of 60). At the 1-, 6-, and 12-month follow-up examinations, the occlusion rate was 100% (60 of 60), 98.3% (57 of 58), and 92.6% (50 of 54). The median Venous Clinical Severity Score had significantly decreased from 5 (interquartile range [IQR], 3-6) at baseline to 2 (IQR, 1-4) at the 1-month follow-up (P < .001), 1 (IQR, 1-2) at the 6-month follow-up (P < .001) and 1 (IQR, 0-1) at the 12-month follow-up (P < .001). The mean Aberdeen Varicose Vein Questionnaire score had improved from the baseline score of 25 ± 14.61 to 15.81 ± 13.76 at the 1-month follow-up (P < .001), to 9.81 ± 7.42 at the 6-month follow-up (P < .001) and 4.73 ± 3.32 at the 12-month follow-up (P < .001). CONCLUSIONS The results of our study have shown that MOCA is a feasible, safe, and painless procedure for the treatment of SSV incompetence with an occlusion rate of 92.6% at the 12-month examination. No sural nerve injuries or other major complications were observed. The procedure also provided good clinical results and positive effects on patient QoL.
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Affiliation(s)
| | - Luca Apruzzi
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Vincenzo Ardita
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Favia
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Concetta Saracino
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Niccolò Carta
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Vascular Surgery, "Vita-Salute San Raffaele" University, Milan, Italy
| | - Roberto Chiesa
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kubat E, Ünal CS, Geldi O, Çetin E, Keskin A, Karapınar K. Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers. SAO PAULO MED J 2020; 138:98-105. [PMID: 32491084 PMCID: PMC9662839 DOI: 10.1590/1516-3180.2019.0230.r1.06112019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.
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Affiliation(s)
- Emre Kubat
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Celal Selçuk Ünal
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Onur Geldi
- MD. Attending Physician, Department of Cardiovascular Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
| | - Erdem Çetin
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Aydin Keskin
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Kasım Karapınar
- MD. Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
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8
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Jahangir S, Prabakar D. Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_82_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Garagozlo C, Kadri O, Atalla M, Polanco F, Massaband A, Coey J, Sulaiman S. The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants. Clin Anat 2018; 32:277-281. [PMID: 30328148 DOI: 10.1002/ca.23302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Procedures involving the small saphenous vein (SSV) can result in sural nerve (SN) damage due to the proximity of the two structures. The relationship between the SN and SSV has previously been described in cadaveric studies with limited scope on surface landmarks. This study investigates the relationship between the SN and SSV in vivo through ultrasound. Transverse/short-axis ultrasound scans of 128 legs (64 healthy participants) were taken by a single observer using a GE Logiq e ultrasound system with a 5-13 Hz linear transducer (GE Logiq 12L-RS). The SN was identified and traced from the lateral malleolus to the popliteal fossa noting its course and proximity to the SSV. The distance between the SN and SSV was measured at points representing the distal 50% and 25% of the total leg length (the distance between the medial tibial condyle and the inferior edge of the medial malleolus). The SN and SSV were visualized in all participants regardless of BMI and atypical anatomical relationship were noted in 20.3%. The SN pierced the fascia in the distal 25.9% ± 5.3% of the total leg length. The distance between the SN and SSV was 4.06 ± 1.8 mm and 3.4 ± 1.4 mm in the distal 50% and 25% points of the total leg length, respectively. There was no significant effect of sex or body side. The SSV is a viable option for multiple vein harvest. Ultrasound visualization can be a beneficial tool for delineating variations of the SN in relation to SSV prior to surgery. Clin. Anat. 32:277-281, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Cameron Garagozlo
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Omar Kadri
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Mina Atalla
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Fernando Polanco
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Andrew Massaband
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - James Coey
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom.,Department of Anatomy, St. George's University, Grenada, West Indies
| | - Sara Sulaiman
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
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Ayala Á, Guerra JD, Ulloa JH, Kabnick L. Compliance with compression therapy in primary chronic venous disease: Results from a tropical country. Phlebology 2018; 34:272-277. [PMID: 30189813 DOI: 10.1177/0268355518798153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe compliance rates of compression therapy in a cohort of patients with chronic venous disease and also to describe frequent causes of non-compliance. METHODS A total of 889 patients with primary chronic venous disease were prescribed compression therapy after being evaluated by vascular surgeons. Subjects had a first visit during which time compression therapy was prescribed in addition to a follow-up visit. Strength of compression, type, prescription duration, and reasons of non-compliance were queried at follow-up. RESULTS Only 31.8% of the patients reported wearing compression therapy as prescribed, 31.4% reported wearing compression most days, 28.3% reported wearing compression intermittently, and 8.5% of the patients reported not wearing compression at all. The main reasons of non-compliance were: uncomfortable (49.4%), too difficult to put on (34.5%), skin problems (itching) (21.5%), and unattractive (19.8%). CONCLUSIONS Compliance with compression therapy in chronic venous disease is still a subject of concern as most patients are not using compression therapy as prescribed.
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Affiliation(s)
- Álvaro Ayala
- 1 Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Jose D Guerra
- 1 Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Jorge H Ulloa
- 1 Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.,2 Vascular Surgery Section, Hospital Universitario Fundación Santafé de Bogotá, Bogotá, Colombia
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Alsheekh A, Hingorani A, Marks N, Ostrozhynskyy Y, Ascher E. Clinical correlation with failure of endovenous therapy for leg swelling. Vascular 2017; 25:249-252. [PMID: 28409546 DOI: 10.1177/1708538116667325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The development and use of minimally invasive procedures provide improved options for the management of symptoms of chronic venous insufficiency. While many patients with iliac venous occlusive disease and superficial venous insufficiency improve with combined iliac venous stenting and correction of superficial venous reflux, some patients have symptoms which persist. The goal of this study was to identify clinical factors related to persistent symptoms in patients with leg swelling after treatment of both iliac vein stenting and thermal ablation. Methods This observational study analyzed data for patients who underwent both iliac vein stent placement as well as endovenous ablation (either RFA or EVLT) as a management for chronic venous insufficiency between February 2012 and February 2014. Follow-up was performed after completion of both procedures and inquiring for improvement of swelling. Statistical analysis performed using Chi-square and student's t-test. Results Of the total 173 patients who underwent both endovenous closure and iliac vein stent placements, 55 (31.8%) patients were men; 29 (16%) patients stated they had no improvement after these procedures. The average age of patients who did not improve was 68.8 (±16.7 SD) years and 66.2 (±13.3 SD) years for patients who improved. Over all, the classification of the presenting symptoms by CEAP classification demonstrated 25.4%, 53.2%, 5.8%, and 15.6%, for C3-C6, respectively. There was no correlation with failure to improve the swelling with: age ( P = .44), gender ( P = .33), presenting symptom ( P = .67), use of calcium channel blockers ( P = .85), nitroglycerin ( P = .86), Plavix ( P = .07), aspirin ( P = .55), Synthyroid ( P = .55), Coumadin ( P = .14), angiotensin receptor blocker ( P = .81), β Blockers ( P = .61), angiotensin converting enzyme inhibitors ( P = .88), furosemide 40 mg ( P = .74), hydrochlorothiazide 12.5 mg ( P = .07), hydrochlorothiazide 25 mg ( P = .48), and EVLT vs. RFA ( P = .91). The use of furosemide (20 mg) was associated with continued swelling ( P = .01). The use of dual diuretics (furosemide and hydrochlorothiazide) was associated with persistent swelling even after these combined endovenous procedures P = .03). Conclusion These preliminary data suggest that the treatment with diuretics may be associated with failure to relieve lower extremity swelling despite combined endovascular therapy for chronic venous insufficiency.
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12
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Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient. J Lasers Med Sci 2017; 8:13-16. [PMID: 28912938 DOI: 10.15171/jlms.2017.03] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction: To compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in different legs in the same individual in patients with venous insufficiency. Methods: Sixty patients with bilateral saphenous vein insufficiency were included. EVLA or RFA was applied to one of the patient's legs and RFA or EVLA to the other leg. Results: EVLA and RFA complications were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. Conclusion: EVLA procedure may be superior to RFA in certain respects.
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Affiliation(s)
- Orhan Bozoglan
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Departments of Cardiovascular Surgery, Turkey
| | - Bulent Mese
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Departments of Cardiovascular Surgery, Turkey
| | - Erdinc Eroglu
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Departments of Cardiovascular Surgery, Turkey
| | | | - Alptekin Yasim
- Kahramanmaras Sutcu Imam University, Faculty of Medicine, Departments of Cardiovascular Surgery, Turkey
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13
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Nayman A, Yildiz I, Koca N, Deniz S, Koplay M, Oguzkurt L. Risk factors associated with recanalization of incompetent saphenous veins treated with radiofrequency ablation catheter. Diagn Interv Imaging 2017; 98:29-36. [DOI: 10.1016/j.diii.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/31/2016] [Accepted: 06/05/2016] [Indexed: 11/16/2022]
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14
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Rodriguez-Acevedo O, Elstner KE, Martinic K, Zea A, Diaz J, Martins RT, Arduini F, Hodgkinson A, Ibrahim N. Hydrodisplacement of sural nerve for safety and efficacy of endovenous thermal ablation for small saphenous vein incompetence. Phlebology 2016; 32:482-487. [DOI: 10.1177/0268355516671233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endovenous radio frequency ablation for small saphenous vein incompetence by and large appears to be superior and safer than conventional open surgery. Small saphenous vein ablation from approximately mid-calf to the point proximally where the small saphenous vein dives into the popliteal fossa is considered to be safe, as the sural nerve is in most cases separated from this segment of the small saphenous vein by the deep fascia. The outcome of the distal incompetent small saphenous vein remains unclear. Efficacy of the endovenous radio frequency ablation can be enhanced by increasing the length of the ablatable small saphenous vein segment. Methodology To optimise endovenous radio frequency ablation outcome, the distal small saphenous vein may be made amenable to ablation if safety of the sural nerve can be assured. The sural nerve was successfully located using duplex ultrasound in 100% of our cohort in this study. The standard entry point for venous access was just above the lateral malleolus. After introduction of the introducer sheath, the radio frequency catheter was advanced proximally; the sural nerve was displaced from the small saphenous vein by approximately 1 cm with the administration of tumescent anaesthesia ( hydrodisplacement). A total of 118 patients underwent extended endovenous radio frequency ablation of 124 incompetent small saphenous vein trunks using the method described. Results Successful extended ablation of the small saphenous vein was achieved in 100% of cases and it was confirmed by duplex scanning at one and six weeks. Two neurological events were recorded during the study: 1. One patient with temporary foot drop lasting for less than 6 h with complete recovery. 2. A second patient with a sural nerve sensory deficit reported by the patient at day 2–3, which remains current at six weeks. Conclusions Extended endovenous radio frequency ablation of the small saphenous vein to optimise length of the ablatable vein segment is feasible with careful identification and hydrodisplacement of the sural nerve. This method is shown to be associated with fewer neurological complications than other methods reported in the literature.
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Affiliation(s)
| | - Kristen E Elstner
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Kui Martinic
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Aaron Zea
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Jenny Diaz
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Rodrigo T Martins
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Fernando Arduini
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Alexandra Hodgkinson
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Nabeel Ibrahim
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
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15
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Rodriguez-Acevedo O, Elstner K, Zea A, Diaz J, Martinic K, Ibrahim N. The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation. Phlebology 2016; 32:49-54. [PMID: 26826266 DOI: 10.1177/0268355515627262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Neurological complications are well documented in association with both surgical stripping or disconnection and thermal ablation of the small saphenous vein. The sural nerve (medial sural cutaneous nerve) is most vulnerable due to its close relationship to the small saphenous vein. Objective This is a cross-sectional observational study of the sonographic anatomy of 115 Australian patients to determine the course of the sural nerve and its relationship to the small saphenous vein, and to identify its relevance in the thermal ablation of the small saphenous vein. Method Sonographic mapping of the right sural nerve was performed with a Philips L12.5 and Sonosite 10.5 MHz ultrasound machine on 115 patients. The sural nerve was traced proximally from the level of the lateral malleolus to the popliteal fossa in order to measure its distance from the small saphenous vein at four reference points in the lower leg. Results A total of 115 patients were studied (females 82, males 33). The sural nerve was identified in 100% of patients; 64 patients (55.7%) showed usual sural nerve anatomy, while 51 patients (44.3%) demonstrated a range of anatomical variations, including the sural nerve becoming epifascial at a higher point than usual. Conclusion The sural nerve was identifiable on duplex ultrasound in 100% of cases. Classic anatomical relations and the perceived protection of the sural nerve conferred by the deep fascia of the upper calf are unreliable. Preoperative strategies can help to approach and protect the sural nerve in the endovenous ablation setting.
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Affiliation(s)
- Omar Rodriguez-Acevedo
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Kristen Elstner
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Aaron Zea
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Jenny Diaz
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Kui Martinic
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
| | - Nabeel Ibrahim
- Australian Laser and Vein Clinic & Sydney Centre for Venous Disease, Sydney, New South Wales, Australia
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16
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Bozoglan O, Mese B, Eroglu E, Erdogan MB, Erdem K, Ekerbicer HC, Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient. Vasc Endovascular Surg 2016; 50:47-51. [DOI: 10.1177/1538574415625813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To compare endovenous laser ablation (EVLA) and radiofrequency venous ablation (RFA) in different legs in the same patients with venous insufficiency. Methods: Sixty patients with bilateral saphenous vein insufficiency were included. Endovenous laser ablation or RFA was applied to one of the patient’s legs and the remaining procedure, RFA or EVLA, to the other leg. Results: Minor complications in EVLA and RFA were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in the EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both the procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. Conclusion: The EVLA procedure may be superior to RFA in certain respects.
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Affiliation(s)
- Orhan Bozoglan
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Bulent Mese
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Erdinc Eroglu
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | | | - Kemalettin Erdem
- Department of Cardiovascular Surgery, Faculty of Medicine, Bolu Abant Izzet Baysal University, Turkey
| | | | - Alptekin Yasim
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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17
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Boersma D, Kornmann VNN, van Eekeren RRJP, Tromp E, Ünlü Ç, Reijnen MMJP, de Vries JPPM. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2015; 23:199-211. [PMID: 26564912 DOI: 10.1177/1526602815616375] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. METHODS A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. RESULTS The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). CONCLUSION Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.
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Affiliation(s)
- Doeke Boersma
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Verena N N Kornmann
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Çagdas Ünlü
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
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18
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Schuller-Petrović S, Pavlović M, Schuller-Lukić B, Schuller S. Retrospective analysis of routine use of a double heat cycle (DHC) during radiofrequency segmental ablation (ClosureFAST™
) of saphenous veins. J Eur Acad Dermatol Venereol 2015; 30:1009-12. [DOI: 10.1111/jdv.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
Affiliation(s)
- S. Schuller-Petrović
- VENEX - Vein and Dermatology Centre; Vienna Austria
- DCP-VENEX Center & Dermatology Centre Parmova; Ljubljana Slovenia
| | - M.D. Pavlović
- DCP-VENEX Center & Dermatology Centre Parmova; Ljubljana Slovenia
| | - B. Schuller-Lukić
- VENEX - Vein and Dermatology Centre; Vienna Austria
- Department of Dermatology; Rudolfstiftung; Vienna Austria
| | - S. Schuller
- VENEX - Vein and Dermatology Centre; Vienna Austria
- Department of Dermatology; SMZ Ost; Vienna Austria
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19
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van Eekeren RR, Boersma D, de Vries JPP, Zeebregts CJ, Reijnen MM. Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature. Semin Vasc Surg 2014; 27:118-36. [DOI: 10.1053/j.semvascsurg.2015.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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