Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results

Clinical outcomes after treatment of incompetent saphenous vein combined with segmental popliteal vein reflux

OBJECTIVE

This study aimed to evaluate whether differences exist in the quality of life changes and complication rates after treatment of incompetent saphenous vein (ISV) based on the presence of segmental popliteal vein reflux (SPVR).

METHODS

Patients who underwent treatment for ISV from July 2016 to July 2021 were included and divided into two groups: patients without deep venous reflux (DVR) and patients with SPVR. Patients with axial DVR, a history of deep vein thrombosis, a history of orthopedic surgery, previous venous treatment, and no postoperative follow-up were excluded from the study. Duplex ultrasound examination was performed preoperatively and at 6 and 12 months postoperatively.

RESULTS

The study included 233 patients (398 limbs), and 50 (64 limbs) had SPVR. Differences were not observed in gender, age, body mass index, distribution of clinical class according to Clinical-Etiology-Anatomy-Physiology classification, laterality, treatment method, and preoperative Venous Clinical Severity Score or Aberdeen Varicose Vein Questionnaire scores between the two groups with SPVR or without DVR. Furthermore, the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores at 6 and 12 months postoperatively were improved in both groups, although without significant differences. A significant difference was not observed in the rate of postoperative complications between the groups based on the presence of SPVR (1.8% vs 1.6%: P = .896). The SPVR improvement rate after ISV treatment was 25% (16/64), and patient-reported outcomes in patients combined with SPVR improved independent of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.

CONCLUSIONS

Complication rates and clinical outcomes after ISV treatment did not differ in the presence of SPVR. In patients with SPVR, after ISV treatment, quality of life improved regardless of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.

Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins

Great saphenous varicose vein (GSVV) is a venous reflux disease of the lower extremity. In order to explore the clinical effect of subfascial endoscopic perforator surgery (SEPS) with endovenous laser treatment (EVLT) in the treatment of GSVV, 80 patients who underwent unilateral saphenous varicose surgery are analyzed. The operation results show that the patients who used SEPS + EVLT have less operation time and mean blood loss, shorter postoperative active time and hospitalization stay, better curative effect, and higher notch aesthetics (P < 0.05). SEPS combined with EVLT has a remarkable curative effect in the treatment of saphenous varicose veins of lower extremity, which can significantly shorten the hospitalization time of patients and improve the coagulation index and stress index.

Outcomes of fluoroscopy-guided percutaneous high ligation of the great saphenous vein combined with foam sclerotherapy for symptomatic great saphenous veins

PURPOSE

To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the greater saphenous veins (GSV).

MATERIALS AND METHODS

This was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSV (133 limbs) which were treated with FPHL combined with FGFS between April 1, 2019 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was percutaneously ligated by a percutaneously positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods.

RESULTS

The technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%), and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events.

CONCLUSIONS

FPHL combined with FGFS to treat varicose veins in the GSV achieved an occlusion rate of 92% and improved the clinical symptoms within one year; this minimally invasive procedure was safe and effective.