Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients

Outcomes of cyanoacrylate closure of the truncal varicose vein insufficiency: A comparison between young and elderly patients

OBJECTIVES

Cyanoacrylate closure (CAC) procedure has become an alternative treatment method that has become increasingly popular in the treatment of chronic venous insufficiency (CVI) in recent years. The present study was designed to assess the feasibility, tolerance, results, and efficacy of CAC for truncal varicosities in elderly population.

METHODS

In this retrospective single-center observational cohort study, CAC procedure was performed in 160 patients (184 limbs) with truncal varicose vein insufficiency. The patients were divided into two groups: elderly group, and younger group. The primary outcome of this study was to assess the feasibility, tolerance, and safety of the CAC procedure for truncal varicosities in elderly population over 70 years. The Venous Clinical Severity Score (VCSS), visual analogue scale of pain (VASP) and occlusion rate of the treated target veins of the patients were evaluated and compared among groups. The secondary outcomes were to evaluate and compare technical success, mortality, major adverse events, and other postoperative complications between the groups.

RESULTS

All operations were carried out under local anesthesia. There were no technical failures or device-related complications. Anatomic success rate was 100% after procedures. The occlusion rate for the elderly group at 2 weeks, 6 months, and 12 months was 100%, 92.3%, and 92.3%, respectively, while the occlusion rate for the younger group was 100%, 97%, and 94.7%, respectively. There was no significant difference in occlusion rates between two groups (p > .05) (Log Rank = 0,231). Improvement in the VCSSs was statistically significant between baseline and 12 months after procedure in both groups (p < .001). Improvement in the VASPs was statistically significant between baseline and 2 weeks after procedure in both groups (p < .001). There were no symptoms or signs of sural nerve injury, hematoma, or phlebitis in either group.

CONCLUSIONS

Although it has some potential risks, it is conceivable that the CAC procedure may be applied in selected fit elderly patients for the treatment of CVI. Age appeared to have no effect on the early and mid-term prognosis of the CAC procedure performed in the study cohort.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy

OBJECTIVES

Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated.

METHODS

In this retrospective study, treatment and clinical outcomes of patients' who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed.

RESULTS

A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation.

CONCLUSION

Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.