1
|
Wang S, He Y, Xin S, Zhang J. Iliac vein stenting is a safe and effective treatment for iliac vein compression syndrome: A systematic review of Chinese data. Phlebology 2020; 35:752-770. [PMID: 32715909 DOI: 10.1177/0268355520940910] [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: 01/31/2023]
Abstract
OBJECTIVES This study was a systematic review of available data from China, and our aim was to evaluate the safety and efficacy of stenting in iliac vein compression syndrome. METHODS We searched the PubMed, National Knowledge Infrastructure, Chongqing Weipu Information Company, and Cochrane Central Register for Controlled Trials databases, and key references. RESULTS Twelve studies were included (nine retrospective analyses, two retrospective case series studies, and one prospective cohort study) involving 2292 patients and 1897 stented limbs. The overall primary patency rates ranged from 81.8% to 100%. Studies showed significant improvements in patients' symptoms, and ulcer healing rates ranged from 71.4% to 100% in stented limbs. The incidence of severe complications ranged from 0 to 16.8%. CONCLUSIONS For Chinese patients with iliac vein compression syndrome, stenting provided significant efficacy regarding favorable patency rates, symptom relief, and complications. However, the quality of evidence to support the use of iliac vein stenting to treat iliac vein compression syndrome is currently weak, especially for Chinese patients.
Collapse
Affiliation(s)
- Shiyue Wang
- Department of Vascular & Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Yuchen He
- Department of Vascular & Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular & Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular & Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
2
|
Lawrence PF, Hager ES, Harlander-Locke MP, Pace N, Jayaraj A, Yohann A, Kalbaugh C, Marston W, Kabnick L, Saqib N, Pouliot S, Piccolo C, Kiguchi M, Peralta S, Motaganahalli R. Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers. J Vasc Surg Venous Lymphat Disord 2020; 8:601-609. [PMID: 32089497 DOI: 10.1016/j.jvsv.2019.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/21/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the impact of three treatment modalities, superficial truncal vein ablation, perforator vein ablation, and deep venous stenting on venous leg ulcer (VLU) healing, as well as their cumulative effect on ulcer healing, in an attempt to establish the best algorithm for the treatment of chronic and recalcitrant VLUs. METHODS Multicenter retrospective cohort study using a standardized database to evaluate patients with chronic venous ulcers treated between January 2013 and December 2017. RESULTS Eight-hundred thirty-two consecutive patients with VLU were identified at 11 centers in the United States. All patients were initially managed with wound care and compression for at least 2 months. Compression and wound care management alone, used in 187 patients, led to ulcer healing in 75% of patients by 36 months. Ulcer recurrence in patients managed without surgery at 6, 12, and 24 months was 3%, 5% and 15%, respectively. Five hundred twenty-eight patients underwent ablation of incompetent superficial veins, and 344 of those also underwent incompetent perforator ablation. Patients who underwent truncal vein ablation alone had an ulcer healing rate of 51% at 36 months. Patients who received both superficial and perforator ablation were significantly younger, and had a 17% improvement in healing at 36 months (68% vs 51%, respectively), but there was no impact of combined superficial and perforator ablations on ulcer recurrence rates. One hundred thirty-four patients had stenosis of one of more lower extremity deep veins and 95 (71%) underwent endovenous stenting. Ulcer healing and recurrence rates for those who underwent stent placement alone was 77% and 27%, respectively, at 36 months. Patients who underwent deep venous stenting and ablation of both incompetent truncal and perforator veins had an ulcer healing rate of 87% at 36 months and ulcer recurrence of 26% at 24 months. CONCLUSIONS This study demonstrates that correction of superficial truncal vein reflux, as well as deep vein stenosis, both contribute to healing of VLU. Patients who fail to heal their VLU after superficial and perforator ablation should have the iliocaval system imaged to identify hemodynamically significant stenoses or occlusions amenable to stenting, which facilitates venous ulcer healing even in patients with large ulcers.
Collapse
Affiliation(s)
- Peter F Lawrence
- Division of Vascular Surgery, Department of Surgery, University of California Los Angeles, Los Angeles Calif.
| | - Eric S Hager
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pa
| | | | - Nicholas Pace
- Department of Surgery, St. Dominics Hospital, Rane Center, Jackson, Miss
| | - Arjun Jayaraj
- Department of Surgery, St. Dominics Hospital, Rane Center, Jackson, Miss
| | - Avital Yohann
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Corey Kalbaugh
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - William Marston
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Lowell Kabnick
- Division of Vascular Surgery, Department of Surgery, New York University, New York, NY
| | - Naveed Saqib
- Division of Vascular Surgery, Department of Surgery, University of Texas - Houston, Houston, Tex
| | - Susan Pouliot
- Division of Vascular Surgery, Department of Surgery, University of Texas - Houston, Houston, Tex
| | | | | | - Sotero Peralta
- Division of Vascular Surgery, Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University, Indianapolis, Ind
| |
Collapse
|
3
|
Marston WA, Crowner J, Kouri A, Kalbaugh CA. Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation. J Vasc Surg Venous Lymphat Disord 2017. [PMID: 28623990 DOI: 10.1016/j.jvsv.2017.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Effect of Surgery and Compression on Healing and Recurrence (ESCHAR) trial previously reported that patients with venous leg ulcers treated with saphenous stripping experienced a significantly reduced incidence of ulcer recurrence compared with patients treated with compression therapy. Most patients with leg ulcers and saphenous insufficiency are currently treated with endovenous thermal ablation (EVTA), but little information is available on the long-term results after EVTA in Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class 5 (C5) and class 6 (C6) patients. METHODS We retrospectively reviewed all CEAP C5 or C6 patients treated with EVTA to define the incidence of ulcer healing and recurrence. Patients with active ulcers were managed weekly in a comprehensive wound center until healed. After healing, patients were treated with compression stockings and returned at 6-month intervals for follow-up. Time to healing and time to ulcer recurrence were determined by Kaplan-Meier survival analysis. Risk factors were assessed to determine their association with ulcer recurrence. RESULTS EVTA of the great saphenous vein (n = 146), small saphenous vein (n = 20), or both (n = 7) was performed on 173 limbs with active (n = 72) or healed (n = 101) ulcers. Deep venous insufficiency was present in 54 cases (31.2%). Concomitant phlebectomy was performed in 59 limbs (34%). Median follow-up time was 25.2 months after EVTA. Venous ulcers healed after EVTA in 57% of cases at 3 months, 74% at 6 months, and 78% at 12 months. Ulcers recurred in 9% of patients at 1 year after EVTA, 20% at 2 years, and 29% at 3 years of follow-up. Ulcers recurred significantly more often in patients with deep venous insufficiency and in patients who did not undergo phlebectomy of associated varicose veins at the time of EVTA. CONCLUSIONS Ulcers recurred in a minority of CEAP clinical C5 and C6 patients after EVTA of the saphenous veins. Ulcer recurrence was less frequent in patients without concomitant deep venous reflux and in those treated with phlebectomy of varicose veins at the time of EVTA. We suggest consideration of phlebectomy at the time of EVTA for patients with C5 and C6 venous insufficiency, particularly in those with isolated superficial venous insufficiency.
Collapse
Affiliation(s)
- William A Marston
- Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Jason Crowner
- Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ana Kouri
- Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Corey A Kalbaugh
- Division of Vascular Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
4
|
Nguyen T, Bergan J, Min R, Morrison N, Zimmet S. Curriculum of the American College of Phlebology. Phlebology 2016. [DOI: 10.1258/026835506779613534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T Nguyen
- Dermatology, Mohs Micrographic & Dermatologic surgery, Procedural Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
| | - J Bergan
- Department of Surgery, UCSD School of Medicine, San Diego, CA, USA
| | - R Min
- Department of Radiology, Cornell University School of Medicine, New York, NY, USA
| | - N Morrison
- Morrison Vein Institute, Scottsdale AZ, USA
| | - S Zimmet
- Zimmet Vein and Dermatology, Austin, TX, USA
| |
Collapse
|
5
|
Abdul-Haqq R, Almaroof B, Chen BL, Panneton JM, Parent FN. Endovenous Laser Ablation of Great Saphenous Vein and Perforator Veins Improves Venous Stasis Ulcer Healing. Ann Vasc Surg 2013; 27:932-9. [DOI: 10.1016/j.avsg.2012.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/23/2012] [Accepted: 09/04/2012] [Indexed: 12/21/2022]
|
6
|
Rosales-Velderrain A, Gloviczki P, Said SM, Hernandez MT, Canton LG, Kalra M. Pulmonary embolism after endovenous thermal ablation of the saphenous vein. Semin Vasc Surg 2013; 26:14-22. [DOI: 10.1053/j.semvascsurg.2013.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Ye K, Lu X, Li W, Huang Y, Huang X, Lu M, Jiang M. Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease. J Vasc Interv Radiol 2012; 23:497-502. [DOI: 10.1016/j.jvir.2011.12.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022] Open
|
8
|
Passman MA, McLafferty RB, Lentz MF, Nagre SB, Iafrati MD, Bohannon WT, Moore CM, Heller JA, Schneider JR, Lohr JM, Caprini JA. Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg 2011; 54:2S-9S. [PMID: 21962926 DOI: 10.1016/j.jvs.2011.05.117] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 05/10/2011] [Accepted: 05/21/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several standard venous assessment tools have been used as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of Venous Clinical Severity Scoring (VCSS) and its integration with other venous assessment tools as a global venous screening instrument. METHODS The American Venous Forum (AVF), National Venous Screening Program (NVSP) data registry from 2007 to 2009 was queried for participants with complete datasets, including CEAP clinical staging, VCSS, modified Chronic Venous Insufficiency Quality of Life (CIVIQ) assessment, and venous ultrasound results. Statistical correlation trends were analyzed using Spearman's rank coefficient as related to VCSS. RESULTS Five thousand eight hundred fourteen limbs in 2,907 participants were screened and included CEAP clinical stage C0: 26%; C1: 33%; C2: 24%; C3: 9%; C4: 7%; C5: 0.5%; C6: 0.2% (mean, 1.41 ± 1.22). VCSS mean score distribution (range, 0-3) for the entire cohort included: pain 1.01 ± 0.80, varicose veins 0.61 ± 0.84, edema 0.61 ± 0.81, pigmentation 0.15 ± 0.47, inflammation 0.07 ± 0.33, induration 0.04 ± 0.27, ulcer number 0.004 ± 0.081, ulcer size 0.007 ± 0.112, ulcer duration 0.007 ± 0.134, and compression 0.30 ± 0.81. Overall correlation between CEAP and VCSS was moderately strong (r(s) = 0.49; P < .0001), with highest correlation for attributes reflecting more advanced disease, including varicose vein (r(s) = 0.51; P < .0001), pigmentation (r(s) = 0.39; P < .0001), inflammation (r(s) = 0.28; P < .0001), induration (r(s) = 0.22; P < .0001), and edema (r(s) = 0.21; P < .0001). Based on the modified CIVIQ assessment, overall mean score for each general category included: Quality of Life (QoL)-Pain 6.04 ± 3.12 (range, 3-15), QoL-Functional 9.90 ± 5.32 (range, 5-25), and QoL-Social 5.41 ± 3.09 (range, 3-15). Overall correlation between CIVIQ and VCSS was moderately strong (r(s) = 0.43; P < .0001), with the highest correlation noted for pain (r(s) = 0.55; P < .0001) and edema (r(s) = 0.30; P < .0001). Based on screening venous ultrasound results, 38.1% of limbs had reflux and 1.5% obstruction in the femoral, saphenous, or popliteal vein segments. Correlation between overall venous ultrasound findings (reflux + obstruction) and VCSS was slightly positive (r(s) = 0.23; P < .0001) but was highest for varicose vein (r(s) = 0.32; P < .0001) and showed no correlation to swelling (r(s) = 0.06; P < .0001) and pain (r(s) = 0.003; P = .7947). CONCLUSIONS While there is correlation between VCSS, CEAP, modified CIVIQ, and venous ultrasound findings, subgroup analysis indicates that this correlation is driven by different components of VCSS compared with the other venous assessment tools. This observation may reflect that VCSS has more global application in determining overall severity of venous disease, while at the same time highlighting the strengths of the other venous assessment tools.
Collapse
Affiliation(s)
- Marc A Passman
- Section of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 833] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Köroğlu M, Eriş HN, Aktaş AR, Kayan M, Yeşildağ A, Çetin M, Parlak C, Gürses C, Akhan O. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol 2011; 52:278-84. [PMID: 21498363 DOI: 10.1258/ar.2010.100356] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency. PURPOSE To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency). MATERIAL AND METHODS The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures. RESULTS At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II. CONCLUSION EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.
Collapse
Affiliation(s)
- Mert Köroğlu
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Hüseyin Naim Eriş
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Aykut Recep Aktaş
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Mustafa Kayan
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Ahmet Yeşildağ
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Meltem Çetin
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Cem Parlak
- Antalya Education and Research Hospital, Department of Radiation Oncology, Antalya
| | - Cemil Gürses
- Antalya Education and Research Hospital, Department of Radiology, Antalya
| | - Okan Akhan
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| |
Collapse
|
11
|
Brar R, Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Surgical management of varicose veins: meta-analysis. Vascular 2010; 18:205-20. [PMID: 20643030 DOI: 10.2310/6670.2010.00013] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Open surgery remains the gold standard by which endovascular treatment of superficial chronic venous insufficiency is measured. This meta-analysis of randomized controlled trials reviews the current evidence base, comparing open and endovascular treatment of varicose veins. Systematic review of studies reporting duplex scan follow-up after open surgical, laser (endovenous laser therapy [EVLT]), or radiofrequency (VNUS Closure device, VNUS Medical Technologies, San Jose, CA) treatment of refluxing great saphenous veins was completed. Primary outcome measures were occlusion and complication rates and time taken to resume work. No significant difference in recurrence rates at 3 months between open surgery and EVLT (RR 2.19, 95% CI 0.99-4.85, p = .05) or VNUS device (RR 7.57; 95% CI 0.42-136.02) were found. Return to work is significantly faster following VNUS (by 8.24 days; 95% CI 10.50-5.97) or EVLT (by 5.02 days; 95% CI 6.52-3.52). Endovascular treatment of varicose veins is safe and effective and offers the significant advantage of rapid recovery.
Collapse
Affiliation(s)
- Ranjeet Brar
- St George's Vascular Institute, St George's Hospital, London, UK.
| | | | | | | | | |
Collapse
|
12
|
Noppeney T, Kluess H, Breu F, Ehresmann U, Gerlach H, Hermanns HJ, Nüllen H, Pannier F, Salzmann G, Schimmelpfennig L, Schmedt CG, Steckmeier B, Stenger D. Leitlinie zur Diagnostik und Therapie der Krampfadererkrankung. GEFASSCHIRURGIE 2010. [DOI: 10.1007/s00772-010-0842-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
13
|
Marston W. Summary of evidence of effectiveness of primary chronic venous disease treatment. J Vasc Surg 2010; 52:54S-58S. [DOI: 10.1016/j.jvs.2010.05.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D, Meissner MH, Rutherford RB. Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 2010; 52:1387-96. [DOI: 10.1016/j.jvs.2010.06.161] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/16/2010] [Accepted: 06/21/2010] [Indexed: 11/15/2022]
|
15
|
|
16
|
Khilnani NM, Grassi CJ, Kundu S, D'Agostino HR, Khan AA, McGraw JK, Miller DL, Millward SF, Osnis RB, Postoak D, Saiter CK, Schwartzberg MS, Swan TL, Vedantham S, Wiechmann BN, Crocetti L, Cardella JF, Min RJ. Multi-society Consensus Quality Improvement Guidelines for the Treatment of Lower-extremity Superficial Venous Insufficiency with Endovenous Thermal Ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:14-31. [DOI: 10.1016/j.jvir.2009.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 10/20/2022] Open
|
17
|
Sadick NS, Wasser S. Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: A 4‐year perspective. J COSMET LASER THER 2009; 9:9-13. [PMID: 17457762 DOI: 10.1080/14764170601126640] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Combination endovascular laser obliteration of the greater saphenous vein in conjunction with ambulatory phlebectomy has become the treatment of choice for superficial venous incompetence. OBJECTIVES The present study examines the treatment of saphenofemoral junction (SFJ) incompetence with simultaneous treatment of associated truncal varicosities by ambulatory phlebectomy. METHODS Four-year follow-up data for recurrence rate and complication profile was ascertained for 90 patients (mean age 40 years) with SFJ reflux associated with greater saphenous vein (GSV) incompetence (4-12 mm; mean 7.8 mm) and enlargement of branch varicosities as documented by Duplex ultrasound, which were treated with a combined approach of endovascular laser obliteration of the GSV (810 nm, Diomed S30) followed by hook avulsion (ambulatory phlebectomy) of the remaining truncal varicosities. Follow-up by Duplex ultrasound to ensure closure was carried out at week 1 and months 1, 3, 6, 12, 24, 36 and 48. RESULTS A total recurrence rate (r = 94 limbs) of 4.3 was found in the patient cohort. All recurrences occurred within 12 months, with the majority documented at month 6. CONCLUSIONS Combination endovascular laser treatment (EVLT) with ambulatory phlebectomy is an effective treatment modality for superficial venous incompetence in the outpatient ambulatory setting. Low recurrence rates are noted with this approach. In the present patient series, all recurrences were noted within 12 months of the aforementioned procedure. These results are comparable with other endovenous and radiofrequency technologies.
Collapse
|
18
|
Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology 2009; 23:259-75. [PMID: 19029007 DOI: 10.1258/phleb.2008.008018] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The time is ripe for universal understanding and acceptance of outcome assessment in venous disease. Outcome studies promote understanding of the diseases we treat and the results of treatment. The choice of a valid and reliable assessment tool is crucial. Patient-generated quality-of-life tools include generic instruments and disease-specific instruments. Generic instruments evaluate overall well-being and provide subjective measurements of treatment outcomes in various disease states. The 36-Item Short Form Health Survey and the Nottingham Health Profile are widely used generic surveys. Disease-specific instruments relate to a particular disease state. They are popular in venous disease reporting and have high sensitivity. The Chronic Venous Insufficiency Questionnaire, the Venous Insufficiency Epidemiological and Economic Study, the Aberdeen Varicose Vein Questionnaire and the Charing Cross Venous Ulceration Questionnaire are such devices. Physician-generated measurement tools are used to evaluate and classify the consequences of venous disease. The clinical, aetiology, anatomy, pathophysiology classification (CEAP) is a popular descriptive platform for chronic venous disease. The Venous Severity Scoring (VSS) system was derived from the CEAP classification to provide evaluative capabilities. The three elements of the VSS are the venous disability score, the venous segmental disease score and the venous clinical severity score (VCSS). The VCSS facilitates the follow-up of features of venous disease that change with treatment. Each of these outcomes tools has been validated, and each has strengths and weaknesses. Maintaining the dynamic nature of assessment with periodic review and revision is the way forward to generating universal applicability. Although the choice of instrument is debatable, the most important factor in improving treatment outcomes is the decision to examine results and to share them in a meaningful way.
Collapse
Affiliation(s)
- M A Vasquez
- SUNY Buffalo Surgery, The Venous Institute of Buffalo, 415 Tremont Street, North Tonawanda, NY 14120, USA.
| | | |
Collapse
|
19
|
Samaraee AA, McCallum I, Mudawi A. Endovenous therapy of varicose veins: A better outcome than standard surgery? Surgeon 2009; 7:181-6. [DOI: 10.1016/s1479-666x(09)80043-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Hoggan B, Cameron A, Maddern G. Systematic Review of Endovenous Laser Therapy Versus Surgery for the Treatment of Saphenous Varicose Veins. Ann Vasc Surg 2009; 23:277-87. [DOI: 10.1016/j.avsg.2008.11.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/06/2008] [Accepted: 11/06/2008] [Indexed: 11/17/2022]
|
21
|
Marston WA, Brabham VW, Mendes R, Berndt D, Weiner M, Keagy B. The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous saphenous ablation. J Vasc Surg 2008; 48:400-5; discussion 405-6. [DOI: 10.1016/j.jvs.2008.03.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/15/2008] [Accepted: 03/17/2008] [Indexed: 11/16/2022]
|
22
|
Marston W. Evaluation and treatment of leg ulcers associated with chronic venous insufficiency. Clin Plast Surg 2007; 34:717-30. [PMID: 17967625 DOI: 10.1016/j.cps.2007.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The successful management of patients who have leg ulcers related to chronic venous disease requires optimal management of the wound bed, elimination of edema with compression, and correction of venous hypertension whenever possible. Healing of the wound itself requires compression, debridement, bacterial control, and stimulation of the wound bed. Prevention of ulcer recurrence is most effective if the patient is amenable to correction of the venous insufficiency. This is most successful when the superficial or perforator veins are the primary source. Quality diagnostic studies are critical in determining the anatomy and hemodynamic importance of various venous abnormalities and can guide appropriate interventional treatment. Venous corrective procedures usually can be performed using minimally invasive endovenous methods, which are associated with fewer complications and more rapid recovery than are major surgical techniques.
Collapse
Affiliation(s)
- William Marston
- UNC Vascular Surgery, 3024 Burnett Womack Building, CB7212, Chapel Hill, NC 27599-7212, USA.
| |
Collapse
|
23
|
Sharif MA, Lau LL, Lee B, Hannon RJ, Soong CV. Role of endovenous laser treatment in the management of chronic venous insufficiency. Ann Vasc Surg 2007; 21:551-5. [PMID: 17823037 DOI: 10.1016/j.avsg.2007.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/26/2007] [Accepted: 07/16/2007] [Indexed: 10/21/2022]
Abstract
Endovenous laser therapy (EVLT) is a recognized option in the treatment of uncomplicated varicose veins. This uncontrolled case series evaluates its effectiveness in the management of chronic venous insufficiency. Patients with a history of active or healed ulcers were selected for EVLT. The procedure was carried out in an outpatient setting over a period of 12 months. Assessment was carried out for evidence of ulcer healing and recurrence, long saphenous vein occlusion, and patient satisfaction at 3, 12, and 22 months. Results are expressed as means with range. EVLT was used to treat 23 limbs in 20 patients with a median age of 59 years (range 32-76) including 12 females and eight males. All patients had evidence of chronic venous insufficiency, graded at C5 or greater on the CEAP classification (C5 16, C6 7). Patients with long saphenous vein insufficiency were included, whereas those with either deep or combined deep and superficial venous incompetence were excluded. The cumulative 3-, 12-, and 22-month healing rates were 87% (20/23), 100% (23/23), and 95% (21/22), respectively. The only patient having a recurrence of ulcers at 22 months' follow-up (CEAP 6) had mid-calf perforator incompetence with recanalized long saphenous vein. Duplex scan demonstrated long saphenous vein occlusion in 100% (23/23), 96% (22/23), and 91% (20/22) at 3, 12, and 22 months, respectively. In all, 84% (16/19) of patients were satisfied with the results of treatment without any major procedure-related complication. These results demonstrate that EVLT, carried out in an outpatient setting, is effective in the treatment and prevention of chronic venous ulcers, with good patient satisfaction and no major complication.
Collapse
Affiliation(s)
- M A Sharif
- Department of Vascular and Endovascular Surgery, Belfast City Hospital, Belfast, Northern Ireland, UK.
| | | | | | | | | |
Collapse
|
24
|
Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg 2007; 35:88-95. [PMID: 17920307 DOI: 10.1016/j.ejvs.2007.08.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 08/09/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the last decade, several new treatments of truncal varicose veins have been introduced. Of these new therapies, endovenous laser therapy (EVLT) is one of the most widely accepted and used treatment options for incompetent greater and lesser saphenous veins. OBJECTIVE The objective of this report is to inform clinicians about the EVLT procedure and to review its efficacy and safety in treatment of truncal varicose veins. Also, we discuss some of the underlying theoretical principles and laser parameters that affect EVLT. METHODS We carried out a literature review of EVLT;s efficacy and safety. We included reports that included 100 or more limbs with a follow-up of at least 3 months. The principals and procedure of EVLT are described. Of the laser parameters, mode of administration, wavelength, fluence, wattage and pullback speed are discussed. CONCLUSION EVLT appears to be a very effective and safe option in the treatment of varicose veins but large randomized comparative studies are needed.
Collapse
|
25
|
Abstract
The classic varicose vein operation still represents the "gold standard" in the operative therapy of varicose veins. The results of this procedure in view of perioperative complications are very good, with the incidence of perioperative deep venous thrombosis varying between 0.05% and 0.1%. Recurrence rates between 6% and 60% are published. However, the true recurrence rate is unknown since an exact definition of recurrent varicosis is still lacking. In recurrent varices it is essential to distinguish between disease progression, including neorevascularisation, and technical errors. Endovascular procedures for elimination of the superficial venous system - radiofrequency obliteration and endovenous laser therapy - meanwhile have established themselves as alternative, minimally invasive procedures. The perioperative complication rate of endovenous procedures is very low and comparable to that of the classic operation. Good results, with occlusion rates of the treated vein around 87% to 93% up to 2 years postoperatively, have been published for both endovenous laser therapy and radiofrequency obliteration. For the latter, 5-year results were published, with occlusion of the treated vein in 87%. Results in the literature for radiofrequency are better documented than for endovenous laser treatment because there are now five prospective randomised trials for the former and most publications for endovenous laser treatment are single-center experiences. The advantage of endovenous procedures, especially radiofrequency obliteration, over the classic operation is the lower rate of perioperative pain and better quality of life. The spectrum of operative treatment methods of the superficial venous system has increased tremendously due to new technical developments. For the surgeon this implies the necessity of informing patients conscientiously about the pros and cons and available results of each procedure, and carefully weighing which methods are at the time best for the patient.
Collapse
Affiliation(s)
- T Noppeney
- Zentrum für Gefässmedizin, Obere Turnstrasse 8-10, 90429, Nürnberg, Deutschland.
| | | | | | | | | |
Collapse
|