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Zheng G, Xie H, Lai M, Qin B, Liu X. Comparison of two ablation procedures combined with high ligation and foam sclerotherapy and compression therapy for patients with venous leg ulcers. Postgrad Med 2024; 136:514-522. [PMID: 38861319 DOI: 10.1080/00325481.2024.2366155] [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] [Received: 01/11/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
AIM To compare the ablation techniques' efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. METHOD 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. RESULTS One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75-1.5) months and 1.86(0.5-2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96-1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). CONCLUSION EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time.
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Affiliation(s)
- Guofu Zheng
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Hailiang Xie
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Minggui Lai
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Bao Qin
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
| | - Xiaochun Liu
- Department of General Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, People's Republic of China
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Mosti G, Wittens C, Caggiati A. Black holes in compression therapy: A quest for data. J Vasc Surg Venous Lymphat Disord 2024; 12:101733. [PMID: 38092227 DOI: 10.1016/j.jvsv.2023.101733] [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] [Received: 07/17/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE Although compression therapy (CT) is considered a crucial conservative treatment in chronic venous disease, strong evidence is missing for many clinical indications. This literature review aims to point out what strong evidence we have for CT and all the clinical scenarios where strong evidence still needs to be included. METHODS The research was conducted on MEDLINE with PubMed, Scopus and Web of Science. The time range was set between January 1980 and October 2022. Only articles in English were included. RESULTS The main problem with CT is the low scientific quality of many studies on compression. Consequently, we have robust data on the effectiveness of CT only for advanced venous insufficiency (C3-C6), deep vein thrombosis and lymphedema. We have data on the efficacy of compression for venous symptoms control and in sports recovery, but the low quality of studies cannot result in a strong recommendation. For compression in postvenous procedures, superficial venous thrombosis, thromboprophylaxis, post-thrombotic syndrome prevention and treatment, and sports performance, we have either no data or very debated data not allowing any recommendation. CONCLUSIONS We need high-level scientific studies to assess if CT can be effective or definitely ineffective in the clinical indications where we still have a paucity of or contrasting data.
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Affiliation(s)
- Giovanni Mosti
- Clinica MD Barbantini, Angiology Department, Lucca, Italy.
| | - Cees Wittens
- Department of Venous Surgery, Rotterdam, the Netherlands
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Kibrik P, Ali AB, Chait J, Arustamyan M, Khan H, Mazurovsky S, Alsheekh A, Marks N, Hingorani A, Ascher E. Value and limitations of postoperative duplex scans after endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord 2024; 12:101672. [PMID: 37678668 DOI: 10.1016/j.jvsv.2023.06.016] [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] [Received: 03/29/2021] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Endovenous thermal ablation (EVTA) of the lower extremity veins has risen to become the main treatment modality for symptomatic venous reflux disease. One of the main reported side effects of EVTA is recanalization. As of today, there is no clear protocol as to when follow-up duplex ultrasound scans should be performed. However, the standard for postoperative duplex after truncal ablation is within 1 week of the procedure. Our aim is to try to find whether there is a particular time period when postoperative duplex ultrasound scans should be performed to allow us to best diagnose recanalization. METHODS We retrospectively analyzed 9799 procedures in 3237 patients with chronic venous insufficiency owing to great, small, and anterior accessory saphenous vein insufficiency from 2012 to 2018. We excluded 466 perforator veins. All 9799 procedures were performed using EVTA in patients who failed to respond to conservative management initially. Postoperative duplex ultrasound scans were performed within 1 week (3-7 days postoperatively). We defined a successful obliteration as lack of color flow on postoperative scan. We defined symptomatic recanalization as presence of reflux on duplex ultrasound examination in the targeted vessel at follow-up with symptom recurrence. Follow-ups were performed every 3 months in the first year and every 6 months thereafter. RESULTS Patient ages ranged from 15 to 99 years. The median patient age at the time of the procedures was 63 years (interquartile range [IQR], 51-73 years). The median overall follow-up was 25 months (IQR, 4-56 months). The Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class of all the procedures were: C1, 21; C2, 208; C3, 3585; C4, 4680; C5, 188; and C6, 1117. There were 145 redo procedures performed after symptomatic recanalization was diagnosed in patients. CEAP class of the redo patients were: C1, 0; C2, 2; C3, 49; C4, 70; C5, 5; and C6, 19. CONCLUSIONS Most patients underwent a redo procedure performed within the first year after the initial procedure. Conversely, there was great variability as to when redo procedures were performed. Because there is no defined pattern as to when these symptomatic occurrences arise, it may not be required to perform postoperative duplex ultrasound scans after EVTA routinely, but instead when a patient comes back with symptoms such as swelling.
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Affiliation(s)
| | | | - Jesse Chait
- Vascular Institute of New York, Brooklyn, NY
| | | | - Hason Khan
- Vascular Institute of New York, Brooklyn, NY
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Athavale A, Monahan D, Fukaya E. A systematic review on ablation techniques for larger saphenous veins in patients with symptomatic superficial venous disease. J Vasc Surg Venous Lymphat Disord 2024; 12:101681. [PMID: 37703943 DOI: 10.1016/j.jvsv.2023.08.020] [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] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this study was to summarize the existing evidence for the treatment of saphenous veins >10 mm in diameter, to determine whether there were vein size limits for treatment modalities, and to determine if there are specific technical considerations for treatment of large veins. METHODS We searched the literature for reports of treatment methods and outcomes for patients with large-diameter saphenous veins treated with various ablation methods between 1993 and 2023. These studies were evaluated for the size of the vein determined as "large diameter," type of ablation method, study type, outcomes, adverse events, and any technical considerations noted. A systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The COVIDENCE software was used for full-text screening and data extraction. Three reviewers reviewed the data, and the content expert served as the tiebreaker. RESULTS Seventy-one records were identified, of which 24 studies were deemed appropriate for extraction. Most of the studies identified reported outcomes of endovenous thermal ablation modalities. There were fewer studies on non-thermal, non-tumescent techniques, and these studies reported an overall lower occlusion rate compared with endovenous thermal ablation techniques. CONCLUSIONS Large head-to-head trials or randomized controlled that compare all the modalities over a long follow-up duration are yet to be performed. In the existing literature, there is considerable heterogeneity in terms of the study size, design, definition of large veins, site of vein measurement, and follow-up periods, making it challenging to make fair comparisons and draw firm conclusions. Currently available evidence supports the use of endothermal ablation techniques for the treatment of veins >10 mm in diameter as they have a more favorable efficacy and safety profile and have a larger body of evidence available compared with non-thermal, non-tumescent techniques or surgery.
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Affiliation(s)
- Anand Athavale
- Division of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA
| | | | - Eri Fukaya
- Division of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA.
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Bontinis V, Bontinis A, Koutsoumpelis A, Chorti A, Rafailidis V, Giannopoulos A, Ktenidis K. A network meta-analysis on the efficacy and safety of thermal and nonthermal endovenous ablation treatments. J Vasc Surg Venous Lymphat Disord 2023; 11:854-865.e5. [PMID: 37030442 DOI: 10.1016/j.jvsv.2023.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE We assessed the mid-term efficacy and safety of thermal and nonthermal endovenous ablation for the treatment of lower limb superficial venous insufficiency. METHODS We performed a systematic review in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and a Bayesian network meta-analysis. The primary end points were great saphenous vein (GSV) closure and venous clinical severity score (VCSS) improvement. A meta-regression using GSV diameter as a covariate was undertaken for the two primary end points. RESULTS We included 14 studies and 4177 patients, with a mean follow-up of 25.7 months. Radiofrequency ablation (RFA; odds ratio [OR], 3.99; 95% confidence interval [CI], 1.82-10.53), cyanoacrylate ablation (CAC; OR, 3.09; 95% CI, 1.35-8.37), and endovenous laser ablation (EVLA; OR, 2.72; 95% CI, 1.23-7.38) displayed increased odds for GSV closure compared with mechanochemical ablation (MOCA). MOCA inferiority compared with RFA (mean difference [MD], 0.96; 95% CI, 0.71-1.20), EVLA (MD, 0.94; 95% CI, 0.61-1.24), and CAC (MD, 0.89; 95% CI, 0.65-1.15) was also depicted regarding VCSS improvement. EVLA resulted in an increased risk of postoperative paresthesia compared with MOCA (risk ratio [RR], 9.61; 95% CI, 2.32-62.29), CAC (RR, 7.90; 95% CI, 2.44-38.16), and RFA (RR, 6.96; 95% CI, 2.31-28.04). Although the overall analysis identified nonstatistically significant differences for Aberdeen varicose vein questionnaire score improvement, thrombophlebitis, ecchymosis, and pain, further investigation revealed an increase pain profile for EVLA at 1470 nm compared with RFA (MD, 3.22; 95% CI, 0.93-5.47) and CAC (MD, 3.04; 95% CI, 1.05-4.97). A sensitivity analysis displayed a persistent underperformance of MOCA compared with RFA (OR, 4.33; 95% CI, 1.15-55.54) for GSV closure and both RFA (MD, 0.99; 95% CI, 0.22-1.77) and CAC (MD, 0.84; 95% CI, 0.08-1.65) regarding VCCS improvement. Although no regression model reached statistical significance, the GSV closure regression model revealed a trend for considerably decreased efficacy for both CAC and MOCA with larger GSV diameters compared with RFA and EVLA. CONCLUSIONS Although our analysis has produced skepticism regarding the efficacy of MOCA in the mid-term period for VCSS improvement and GSV closure rates, CAC showed equivalent results compared with both RFA and EVLA. Additionally, CAC displayed a decreased risk of postprocedural paresthesia and pigmentation and induration compared with EVLA. Also, both RFA and CAC had an improved pain profile compared with EVLA 1470 nm. The potential underperformance of nonthermal, nontumescent ablation modalities in ablating large GSVs necessitates further research.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Alkis Bontinis
- Department of Vascular Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Chorti
- Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Rafailidis
- Department of Radiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argirios Giannopoulos
- Department of Vascular Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Terlecki P, Boryga M, Kołodziej P, Gołacki K, Stropek Z, Janczak D, Antkiewicz M, Zubilewicz T. Mechanical Characteristics of the Flebogrif System—The New System of Mechano-Chemical Endovenous Ablation. MATERIALS 2022; 15:ma15072599. [PMID: 35407933 PMCID: PMC9000315 DOI: 10.3390/ma15072599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
Non-thermal endovenous ablations, due to the lowest probability of complications, are the new method of treating chronic venous insufficiency—one of the most common diseases globally. The Flebogrif system (Balton Sp. z o.o., Warsaw, Poland) is a new mechano-chemical ablation system causing the mechanical damage of endothelium that allows for better sclerosant penetration into its wall. The purpose of the article is to provide mechanical characteristics in the form of force–displacement dependence for a single cutting element, and a bundle of cutting elements of Flebogrif as a whole for different levels of protrusion of the bundle of cutting elements. A TA.HD plus (Stable Micro Systems, Godalming, UK) analyzer equipped with special handles, was used for characteristics testing. The head movement speed used was 5 mm·s−1. The Flebogrif system was tested for three cutting element protrusion levels: L = Lmax, L = 0.9·Lmax, and L = 0.8·Lmax. Before testing, geometric measurement of the spacing of the cutting elements for three proposed protrusions was performed. It was established that decreasing the working length of the cutting elements will increase their rigidity, and, as a result, increase the force exerted on the internal surface of the vein wall. The obtained characteristics will allow for specifying contact force variability ranges and the corresponding diameter ranges of operated veins.
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Affiliation(s)
- Piotr Terlecki
- Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-081 Lublin, Poland; (P.T.); (T.Z.)
| | - Marek Boryga
- Department of Mechanical Engineering and Automation, Faculty of Production Engineering, University of Life Sciences in Lublin, 20-612 Lublin, Poland; (P.K.); (K.G.)
- Correspondence: (M.B.); (Z.S.)
| | - Paweł Kołodziej
- Department of Mechanical Engineering and Automation, Faculty of Production Engineering, University of Life Sciences in Lublin, 20-612 Lublin, Poland; (P.K.); (K.G.)
| | - Krzysztof Gołacki
- Department of Mechanical Engineering and Automation, Faculty of Production Engineering, University of Life Sciences in Lublin, 20-612 Lublin, Poland; (P.K.); (K.G.)
| | - Zbigniew Stropek
- Department of Mechanical Engineering and Automation, Faculty of Production Engineering, University of Life Sciences in Lublin, 20-612 Lublin, Poland; (P.K.); (K.G.)
- Correspondence: (M.B.); (Z.S.)
| | - Dariusz Janczak
- Department of Vascular Surgery, General and Transplant Surgery, Wroclaw Medical University, 50-556 Wrocław, Poland; (D.J.); (M.A.)
| | - Maciej Antkiewicz
- Department of Vascular Surgery, General and Transplant Surgery, Wroclaw Medical University, 50-556 Wrocław, Poland; (D.J.); (M.A.)
| | - Tomasz Zubilewicz
- Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-081 Lublin, Poland; (P.T.); (T.Z.)
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Correlation of body mass index with recanalization risk after endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord 2021; 10:82-86. [PMID: 34271246 DOI: 10.1016/j.jvsv.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Chronic venous insufficiency (CVI) has an increased prevalence among obese individuals with body mass indices (BMI) over 30. A safe, efficacious, and evidence-based recommended treatment for CVI due to superficial venous reflux (SVR) in great saphenous veins (GSVs), small saphenous veins (SSVs), accessory saphenous veins (ASVs), and reflux in the perforator veins (PVs) is endovenous thermal ablation (EVTA). We sought to identify if BMI is an independent risk factor for recanalization after EVTA. METHODS All patients with CVI were initially managed conservatively, and those with pathologic SVR refractory to compression therapy were offered EVTAs depending on the site of reflux. Sonographic confirmation of SVR was defined as >500 milliseconds of reflux in the GSVs, SSVs, and ASVs and a diameter >4 mm. PV reflux was confirmed as >350 milliseconds of reflux and a diameter >2.5 mm. All patients received a follow-up duplex ultrasound 1 week after the procedure, every 3 months for the first year, and every 6 months thereafter. Multivariate analysis with logistic regression was performed regarding patients' age, ablation modality (laser vs radiofrequency ablation), vein location and laterality, BMI, and recanalization. RESULTS From 2013 to 2018, 9739 endovenous ablations were performed on 3070 patients. Endovenous laser was used in 3862 procedures and radiofrequency ablation in 5831 procedures. Veins treated with EVTA were distributed as follows: 6182 GSVs, 2509 SSVs, 597 ASVs, and 451 PVs. The mean patient age was 61.1 years (15-99, standard deviation [SD] ±15.6) with a mean BMI of 31.2 kg/m2 (13.7-69.5, SD ±7.3). A total of 68.4% patients were women and 31.4% men. The mean follow-up was 25.8 months (0-65.9, SD ±12.9). Multivariate statistical analysis with logistic regression was used to determine potential statistical significance between BMI and vein recanalization after EVTA. Overall, obese patients experienced more recanalizations than nonobese patients (P = .032), with an average BMI of 33 kg/m2 for recanalizations. PVs were statistically more likely to recanalize than any other vein (P = .0001). A secondary analysis was performed with the exclusion of PVs, due to their five times increased risk of recanalization, and showed no significant difference of recanalization across all BMI subgroups (P = .127). CONCLUSIONS BMI does not predict recanalization risk after EVTA, except for ablations performed on PVs.
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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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Silva APP, Pinto DM, Milagres VAMV, Bez LG, Maciel JCA, Lopes CDS. Results of venous reflux treatment with 1,470 nm endolaser and correlation with degree of venous insufficiency. J Vasc Bras 2021; 20:e20200172. [PMID: 34093690 PMCID: PMC8147881 DOI: 10.1590/1677-5449.200172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Patients with advanced chronic venous disease are more likely to need additional procedures for relapsed varicose veins. It has not yet been established whether severity of venous insufficiency is a factor that influences the occlusion rate of saphenous veins treated with endolasers. Objectives To analyze occlusion rate of venous segments treated with endolaser and correlate it with patients’ Venous Clinical Severity Score (VCSS) and Clinical-Etiological-Anatomical-Pathological (CEAP) classification. Methods Retrospective analysis of a cohort of patients operated using a 1,470 nm endolaser from November 2012 to March 2020. Descriptive statistics were calculated and Kaplan-Meier survival curves were plotted with Cox regression for groups stratified by VCSS and CEAP. Results A total of 180 venous segments were analyzed in 170 patients. Mean age was 44.3 ± 9.2 and the majority of patients were female (71%). Mean energy density used in the great saphenous vein was 49.2 ± 8.3 J/cm. The most common complications were pain along the course of the saphenous vein (12.2%) and paresthesias at 6 months (17.2%). There was no difference in venous occlusion rate between groups with VCSS ≤ 7 and VCSS > 7 (p = 0.067). A group of patients classified as CEAP classes C4, C5, or C6 had a lower occlusion rate than a group at classes C2 or C3 (hazard ratio [HR] = 3.22; confidence interval [CI] 1.85, 5.61; p = 0.001]. Conclusions The occlusion rates of venous segments treated with endolaser were lower in patients with higher CEAP classes. It is probably necessary to use more energy in these patients to achieve effective treatment of saphenous veins.
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Affiliation(s)
- Ana Paula Pires Silva
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
| | - Daniel Mendes Pinto
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil.,Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Leonardo Ghizoni Bez
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
| | | | - Caetano de Souza Lopes
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
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杨 广, 栾 景, 贾 子. [Radiofrequency obliteration of varicose veins of lower extremity guided by combined venography and ultrasonography]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:332-336. [PMID: 33879907 PMCID: PMC8072433 DOI: 10.19723/j.issn.1671-167x.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. METHODS Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. RESULTS After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. CONCLUSION The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.
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Affiliation(s)
- 广鑫 杨
- />北京大学第三医院介入血管外科,北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 景源 栾
- />北京大学第三医院介入血管外科,北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - 子昌 贾
- />北京大学第三医院介入血管外科,北京 100191Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
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Healy DA, Twyford M, Moloney T, Kavanagh EG. Systematic review on the incidence and management of endovenous heat-induced thrombosis following endovenous thermal ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2021; 9:1312-1320.e10. [PMID: 33618065 DOI: 10.1016/j.jvsv.2021.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A systematic review and meta-analysis was performed to determine the incidence of endovenous heat-induced thrombosis (EHIT) and evaluate its management after endovenous thermal ablation of the great saphenous vein (GSV). METHODS MEDLINE and Embase were searched for studies with at least 100 patients who underwent great saphenous vein endovenous thermal ablation and had duplex ultrasound follow-up within 30 days. Data were gathered on the incidence of thrombotic complications and on the management of cases of EHIT. The primary outcome for the meta-analysis was EHIT types 2 to 4 and secondary outcomes were deep venous thrombotic events (which we defined as types 2-4 EHIT plus deep vein thrombosis [DVT]), DVT, and pulmonary embolism (PE). Pooled proportions were calculated using random effects modelling. RESULTS We included 75 studies (23,265 patients). EHIT types 2 to 4 occurred in 1.27% of cases (95% confidence interval [CI], 0.74%-1.93%). Deep venous thrombotic events occurred in 1.59% (95% CI, 0.95%-2.4%). DVT occurred in 0.28% (95% CI, 0.18%-0.4%). Pulmonary embolism occurred in 0.11% (95% CI, 0.06%-0.18%). Of the 75 studies, 24 gave a description of the management strategy and outcomes for EHIT and there was inconsistency regarding its management. Asymmetrical funnel plots of studies that reported incidence of EHIT 2 to 4 and DVT suggest publication bias. CONCLUSIONS The recently published guidelines on EHIT from the Society for Vascular Surgery/American Venous Forum provide a framework to direct clinical decision-making. EHIT and other thrombotic complications occur infrequently and have a benign course.
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Affiliation(s)
- Donagh A Healy
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Mark Twyford
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland
| | - Tony Moloney
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland.
| | - Eamon G Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, University of Limerick School of Medicine, Limerick, Ireland
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