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Westby D, Gasior S, Twyford M, Power Foley M, Lowery A, Walsh SR. Pharmacological Thromboprophylaxis for VTE Post-Endovenous Ablation of Varicose Veins: Network Meta-Analysis. Vasc Endovascular Surg 2024; 58:623-632. [PMID: 38610070 DOI: 10.1177/15385744241245079] [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: 04/14/2024]
Abstract
OBJECTIVE Endovenous ablation has revolutionized treatment of varicose vein surgery but is associated with a risk of venous thromboembolism. There is no consensus regarding anticoagulation protocols for these patients. This network meta-analysis (NMA) aims to identify which anticoagulant is optimal in this cohort for clot prevention with minimal risk of adverse bleeding events. METHODS Library databases were searched for studies where patients were treated with one or more anticoagulants following endovenous ablation for varicose veins. The methodological quality of included studies was quantified using the Risk of Bias (ROB) assessment tools. Findings were reported using the meta-analysis of observational studies in epidemiology (MOOSE) checklist. Statistical analysis was carried out using metainsight (rpackage). RESULTS Observational data on just under 1500 patients prescribed post ablation anticoagulation (Rivaroxaban, Enoxaparin, Fondaparinux) were analyzed. Patient characteristics were comparable across the cohorts. 81 thrombotic and 40 minor bleeding events occurred in total. Overall rivaroxaban is found to be superior to the other agents. CONCLUSIONS This NMA indicates that prophylactic rivaroxaban is the highest ranked anticoagulant for thromboprophylaxis in patients post endovenous ablation for varicose veins, with a low risk of adverse bleeding. The choice whether to anticoagulate these patients is likely to remain at the discretion of the treating clinician.
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Affiliation(s)
- Daniel Westby
- Department of Vascular and Endovascular Surgery, University Hospital Galway, Galway, Ireland
| | - Sara Gasior
- Department of Vascular and Endovascular Surgery, University Hospital Galway, Galway, Ireland
| | - Mark Twyford
- Department of Vascular and Endovascular Surgery, University Hospital Galway, Galway, Ireland
| | - Megan Power Foley
- Department of Vascular and Endovascular Surgery, University Hospital Galway, Galway, Ireland
| | - Aoife Lowery
- Discipline of Surgery, University of Galway, Galway, Ireland
| | - Stewart R Walsh
- Department of Vascular and Endovascular Surgery, University Hospital Galway, Galway, Ireland
- Discipline of Surgery, University of Galway, Galway, Ireland
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Di Gangi S, Guillet C, Anzengruber F, Zechmann S, Meier TO. Deep vein thrombosis after sclerotherapy and endovenous laser ablation of varicose veins - an observational study. VASA 2024; 53:275-285. [PMID: 38867589 DOI: 10.1024/0301-1526/a001130] [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: 06/14/2024]
Abstract
Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.
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Affiliation(s)
- Stefania Di Gangi
- Institute for Primary Care, University Hospital Zurich, Switzerland
- Medical Faculty, University of Zurich, Switzerland
| | - Carole Guillet
- Medical Faculty, University of Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Switzerland
| | - Florian Anzengruber
- Medical Faculty, University of Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Switzerland
- Department of Dermatology, Cantonal Hospital of Grisons, Chur, Switzerland
| | - Stefan Zechmann
- Institute for Primary Care, University Hospital Zurich, Switzerland
- Medical Faculty, University of Zurich, Switzerland
| | - Thomas O Meier
- Medical Faculty, University of Zurich, Switzerland
- Clinic for Angiology, University Hospital Zurich, Switzerland
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Li Q, Zhang C, Yuan Z, Shao ZQ, Wang J. Endovenous laser treatment vs conventional surgery for great saphenous vein varicosities: A propensity score matching analysis. World J Clin Cases 2023; 11:8291-8299. [PMID: 38130604 PMCID: PMC10731202 DOI: 10.12998/wjcc.v11.i35.8291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/22/2023] [Accepted: 11/30/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins. AIM To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis. METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg. RESULTS Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients' characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% vs 21.46%, χ2 = 11.506, P = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% vs 19.54%, P = 0.000). CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.
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Affiliation(s)
- Qiang Li
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Chen Zhang
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Zhao Yuan
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Zi-Qi Shao
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Jian Wang
- Department of General Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
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Trippler L, Knopp S, Welsche S, Webster BL, Stothard JR, Blair L, Allan F, Ame SM, Juma S, Kabole F, Ali SM, Rollinson D, Pennance T. The long road to schistosomiasis elimination in Zanzibar: A systematic review covering 100 years of research, interventions and control milestones. ADVANCES IN PARASITOLOGY 2023; 122:71-191. [PMID: 37657854 DOI: 10.1016/bs.apar.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Zanzibar is among the few places in sub-Saharan Africa where interruption of Schistosoma transmission seems an achievable goal. Our systematic review identifies and discusses milestones in schistosomiasis research, control and elimination efforts in Zanzibar over the past 100 years. The search in online databases, libraries, and the World Health Organization Archives revealed 153 records published between May 1928 and August 2022. The content of records was summarised to highlight the pivotal work leading towards urogenital schistosomiasis elimination and remaining research gaps. The greatest achievement following 100 years of schistosomiasis interventions and research is undoubtedly the improved health of Zanzibaris, exemplified by the reduction in Schistosoma haematobium prevalence from>50% historically down to<5% in 2020, and the absence of severe morbidities. Experiences from Zanzibar have contributed to global schistosomiasis guidelines, whilst also revealing challenges that impede progression towards elimination. Challenges include: transmission heterogeneity requiring micro-targeting of interventions, post-treatment recrudescence of infections in transmission hotspots, biological complexity of intermediate host snails, emergence of livestock Schistosoma species complicating surveillance whilst creating the risk for interspecies hybridisation, insufficient diagnostics performance for light intensity infections and female genital schistosomiasis, and a lack of acceptable sanitary alternatives to freshwater bodies. Our analysis of the past revealed that much can be achieved in the future with practical implementation of integrated interventions, alongside operational research. With continuing national and international commitments, interruption of S. haematobium transmission across both islands is within reach by 2030, signposting the future demise of urogenital schistosomiasis across other parts of sub-Saharan Africa.
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Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | | | - Bonnie L Webster
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom
| | | | | | - Fiona Allan
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; University of St Andrews, St Andrews, United Kingdom
| | - Shaali Makame Ame
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Saleh Juma
- Neglected Diseases Programme, Zanzibar Ministry of Health, Mkoroshoni, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Programme, Zanzibar Ministry of Health, Lumumba, Unguja, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory - Ivo de Carneri, Wawi, Chake Chake, Pemba, United Republic of Tanzania
| | - David Rollinson
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Global Schistosomiasis Alliance, London, United Kingdom
| | - Tom Pennance
- Natural History Museum, London, United Kingdom; London Centre for Neglected Tropical Disease Research, London, United Kingdom; Western University of Health Sciences, Lebanon, OR, United States.
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Bossart S, Kos S, Keo HH, Staub D, Uthoff H. Combining Proximal Foam Sclerotherapy and Distal Endovenous Laser Ablation for Recurrent Varicose Vein Treatment. Dermatol Surg 2023; 49:575-580. [PMID: 36989122 DOI: 10.1097/dss.0000000000003765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Recurrent varicose veins with neovascularization are a common clinical problem. Although endovenous laser ablation (EVLA) has become the standard treatment modality to treat truncal veins, additional sclerotherapy is required to treat newly formed tortuous veins. A novel laser fiber with an injection channel (nLF) allows for such simultaneous proximal sclerotherapy and offers a potentially more effective treatment option. OBJECTIVE The aim of this study was to present our experience using the nLF for combined EVLA and sclerotherapy treatment of symptomatic recurrent varicose veins. MATERIALS AND METHODS A retrospective single-center cohort study analyzed the outcomes of all patients with symptomatic recurrent varicose veins, treated with an nLF between September 2020 and August 2022. RESULTS In total, 28 combined EVLA/sclerotherapy procedures performed with the nLF in 26 patients were analyzed. In all cases, neovascularizations were treated by sclerotherapy through the nLF catheter, followed by laser ablation of the remaining truncal veins. All follow-up ultrasound examinations showed persistent complete occlusion of the treated truncal veins and neovascularizations. No clinically relevant complications were observed. CONCLUSION Combining proximal foam sclerotherapy and distal EVLA using an nLF for the treatment of symptomatic recurrent varicose veins is safe and effective.
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Affiliation(s)
- Simon Bossart
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Kos
- Institute for Radiology and Nuclear Medicine Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Hak Hong Keo
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Daniel Staub
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
| | - Heiko Uthoff
- Gefässpraxis am See - Lakeside Vascular Center Lucerne, Lucerne, Switzerland
- Department of Angiology, University Hospital, University of Basel, Basel, Switzerland
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 224] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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Müller L, Alm J. Endovenöse Behandlung beim Crossenrezidiv: Technik, Limits und Übersicht zur vorhandenen Literatur. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1517-9498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Einleitung Die endovaskuläre Behandlung mittels Lasertechniken oder Radiofrequenz zur Primärbehandlung der Varikose ist weit etabliert und durch umfangreiche Literatur und Leitlinienempfehlungen fundiert. Demgegenüber existiert nur eine geringe Zahl publizierter Studien zur endovenösen Behandlungsform beim Rezidiv.
Methoden In dieser Arbeit wird zunächst diese vorhandene Literatur analysiert. Im Anschluss werden eigene Erfahrungen und Techniken zur endovaskulären Rezidivbehandlung präsentiert und mögliche Limitationen der Methode diskutiert.
Ergebnisse In einer PubMed-Recherche wurden 7 relevante Arbeiten zu Beobachtungsstudien gefunden. In einer Arbeit wurden die Ergebnisse einer prospektiv-randomisierten Studie zum Vergleich Radiofrequenz versus Operation dargestellt. In den meisten publizierten Studien erfolgte eine Fallselektion, wobei das Vorhandensein eines längeren Stammvenensegments Voraussetzung für eine thermische Ablation darstellte. Die Ergebnisse bezüglich Morbidität und Verschlussraten sind günstig, Langzeitdaten fehlen allerdings. In der eigenen Praxis werden regelmäßig Crossenrezidive endovenös therapiert, hauptsächlich mit den aktuellsten radialen Lasern. Es werden dabei auch solche Befunde behandelt, die keinen oder nur kurzstreckig einen geraden Venenverlauf aufweisen, zum Beispiel Crossenstümpfe oder Neovaskularisationen, die einer thermischen Behandlung zugänglich sind. Technische Hilfsmittel, die eine effektive Ablation eines Rezidivs in den meisten Fällen ermöglichen, werden in dieser Arbeit dargestellt. Besonders hervorzuheben ist die direkte Punktion eines Crossenstumpfes oder kürzerer Venensegmente sowie das Auffädeln im Rahmen der Punktion von gewundenen Venensegmenten. Zu diskutieren sind anatomische Konstellationen, in denen eine endovenöse thermische Ablation eventuell nicht die Methode der ersten Wahl darstellt. Beispiele hierfür sind extrem gewundene, stark dilatierte Venenabschnitte oder aber sehr diffuse, kleinkalibrige Neovaskularisationen.
Schlussfolgerung Zusammengefasst erscheint die endovenöse thermische Ablation bei der Rezidivvarikose als eine effektive Behandlungsmethode, die auch bei anatomisch herausfordernden Situationen mit kurzem Crossenstumpf und gewundenen Venenverläufen funktioniert. Eine breiter aufgelegte Begleitforschung wäre allerdings wünschenswert.
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Affiliation(s)
| | - Jens Alm
- Gefäßabteilung, Dermatologikum Hamburg
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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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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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Endovenous Thermal Ablation of Recurrent Varicose Veins due to Residual Great Saphenous Venous Insufficiency After Saphenous Venous Surgery: A Comparative Study. Dermatol Surg 2018; 44:1287-1294. [PMID: 29781902 DOI: 10.1097/dss.0000000000001543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Redo surgery for recurrent varicose veins of the great saphenous vein (GSV) is technically more challenging than the initial surgery. OBJECTIVE To compare 980 and 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of residual GSV insufficiency after saphenofemoral ligation ± stripping. MATERIALS AND METHODS Thirty-seven limbs in 29 patients with recurrent varicose veins were retrospectively evaluated. Patients were divided into 3 groups: 980-nm EVLA (group A), 1,470-nm EVLA (group B), and RFA (group C). Duplex ultrasonography, Venous Clinical Severity Score (VCSS), and adverse events were examined at intervals of 1 week, 1, 3, 6, and 12 months. RESULTS Complete closure was achieved in 35 (94.6%) limbs at 12 months. Venous Clinical Severity Score decrease in group C (3.6 ± 0.5) was significantly (p < .017) greater compared with that of group A (2.6 ± 0.9). Ecchymosis grade was significantly (p < .017) lower in group C (0.1 ± 0.3) than that in group A (1.6 ± 1.5). CONCLUSION Endovenous thermal ablation using EVLA or RFA is safe and effective for treatment of recurrent varicose veins resulting from residual GSV insufficiency after saphenous venous surgery. The RFA is superior to 980-nm EVLA in terms of postprocedural ecchymosis and improvement in VCSS.
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Abstract
SummaryIntroduction: Although varicose vein recurrence is common and 10–30 % of all varicose vein surgery is done for recurrence of some sort, there are very few studies that can guide us to the best re-treatment option. With the introduction of minimal invasive endovenous treatments there is a variety of possible options besides traditional open surgical techniques.Method: The Scandinavian Venous Forum held a symposium at the GSP meeting in Lü-beck 2012 and this review article is based on data from the presentations at that symposium. Further data has been added regarding new knowledge that was not available a year ago, from PubMed search and article references.Results: The most common reasons for recurrence are discussed and also the discrepancy between neovascularization (NV) and recurrence due to technical failures. It is likely that NV is the most commonly duplex detected type of recurrence following open groin surgery, less common early after endovascular techniques. However, technical or tactical failures are the most common reasons for redo surgery because of symptomatic recurrence. NV seldom leads to symptomatic recurrences and thus a need for re- treatment. There is a risk that the stumps left following endovenous treatments will become a source for symptomatic recurrence after 5–10 years and indications of that have been reported in the few available 5 year RCT-reports following laser treatments. Treatment of recurrence due to stumps in the groin can be done safely within a reasonable operating time through a medial approach and the stump itself can generally not be treated with any of the endovenous alternative methods. Foam treatment can be used for most other recurrent veins but the durability is unknown. Endovascular thermal ablation can only be used for reopened or remaining saphenous veins and accessory saphenous veins while tributaries have to be treated by stab excisions or foam.Conclusion: Long term reports of results of redo surgery are limited but suggest reasonably good results from open surgical intervention and are non-existent for the endovenous techniques. So far groin recurrence seems best treated surgically by an indirect approach, preferably medial. More studies are needed to find the best treatment regime for varicose vein recurrence in general and hybrid procedures might be the way forward by combinations of different techniques.
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Barrier Patch Implantation during Redo Surgery for Varicose Vein Recurrences in the Groin: 1-Year Results. Ann Vasc Surg 2016; 35:98-103. [DOI: 10.1016/j.avsg.2016.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/20/2016] [Accepted: 01/20/2016] [Indexed: 11/18/2022]
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Boersma D, de Borst GJ, Moll FL. A proof-of-concept study of the VeinScrew: A new percutaneous venous closure device. Vascular 2016; 25:105-109. [PMID: 27189850 DOI: 10.1177/1708538116644117] [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: 11/16/2022]
Abstract
Objective This study evaluated the concept of percutaneous closure of insufficient veins using the VeinScrew principle. Methods The VeinScrew is designed to place a spring-shaped implant that contracts and clamps around the vein. The ability of the device to occlude adequately was tested in a bench model experiment. The feasibility of accurate placement and adequate venous occlusion was evaluated in an animal experiment and in a human cadaveric experiment. Results The VeinScrew implant occluded up to a pressure of 135 mmHg. In vivo studies confirmed that deployment was challenging but technically feasible, and subsequent phlebography showed closure of the vein. The cadaveric study showed that percutaneous placement of the evolved VeinScrew around the great saphenous vein was feasible and accurate. Conclusions The current studies show the feasibility of the VeinScrew concept. Future developments and translational studies are necessary to determine the potential of this technique as a new option in the phlebologist's toolbox.
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Affiliation(s)
- Doeke Boersma
- 1 Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,2 Department of Surgery, Jeroen Bosch Hospital, Den Bosch, Utrecht, The Netherlands
| | - Gert Jan de Borst
- 1 Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frans L Moll
- 1 Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Lawson JA, Toonder IM. A review of a new Dutch guideline for management of recurrent varicose veins. Phlebology 2016; 31:114-24. [PMID: 26916778 DOI: 10.1177/0268355516631683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.
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Affiliation(s)
- James A Lawson
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands
| | - Irwin M Toonder
- Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands Department of Vascular Surgery, Maastricht University Medical Centre, The Netherlands
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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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Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Park JY, Galimzahn A, Park HS, Yoo YS, Lee T. Midterm Results of Radiofrequency Ablation for Incompetent Small Saphenous Vein in Terms of Recanalization and Sural Neuritis. Dermatol Surg 2014; 40:383-9. [DOI: 10.1111/dsu.12456] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Altin FH, Aydin S, Erkoc K, Gunes T, Eygi B, Kutas BH. Endovenous laser ablation for saphenous vein insufficiency: Short- and mid-term results of 230 procedures. Vascular 2014; 23:3-8. [DOI: 10.1177/1708538114522997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The present study aimed to evaluate the efficacy of endovenous laser ablation with a 1470-nm laser and to analyze the short- to mid-term results of endovenous laser ablation procedures to treat great saphenous vein insufficiency. Method In this retrospective study, 200 patients (230 limbs) with symptomatic varicose veins secondary to great saphenous vein insufficiency treated with 1470-nm endovenous laser ablation were studied. Patients were evaluated clinically on the first day, first week, first month, and sixth month after the operation. Treated limbs were evaluated as separate treatment events. Results The short-term occlusion rate was 99% and mid-term occlusion rate was 100%. Induration or swelling was the most common minor complication (13%). No major complication such as deep venous thrombosis and pulmonary embolus occurred. Preoperatively documented mean venous clinical severity score significantly reduced from 4.9 ± 2.3 to 2.5 ± 1.1 ( p < 0.05). Conclusion Endovenous laser ablation procedure of great saphenous vein with a 1470-nm diode laser is a minimally invasive, safe, and efficient treatment option in all-suitable patients with high short- and mid-term success rate.
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Affiliation(s)
- Firat H Altin
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Selim Aydin
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Kamuran Erkoc
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Tevfik Gunes
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Bortecin Eygi
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Baris H Kutas
- Department of Cardiovascular Surgery, Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
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The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation. J Vasc Surg 2012; 56:181-8. [PMID: 22503186 DOI: 10.1016/j.jvs.2011.11.127] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/15/2011] [Accepted: 11/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thermal damage to peripheral nerves is a known complication of endovenous thermal ablation (EVA) of the small saphenous vein (SSV). Therefore, the main objective of this anatomic study was to define a safe zone in the lower leg where EVA of the SSV can be performed safely. METHODS The anatomy of the SSV and adjacent nerves was studied in 20 embalmed human specimens. The absolute distances between the SSV and the sural nerve (SN) (closest/nearest branch) were measured over the complete length of the leg (>120 data points per leg), and the presence of the interlaying deep fascia was mapped. The distance between the SSV and the tibial nerve (TN) and the common peroneal nerve was assessed. A new analysis method, computer-assisted surgical anatomy mapping, was used to visualize the gathered data. RESULTS The distance between the SSV and the SN was highly variable. In the proximal one-third of the lower leg, the distance between the vein and the nerve was <5 mm in 70% of the legs. In 95%, the deep fascia was present between the SSV and the SN. In the distal two-thirds of the lower leg, the distance between the vein and the nerve was <5 mm in 90% of the legs. The deep fascia was present between both structures in 15%. In 19 legs, the SN partially ran beneath the deep fascia. In the saphenopopliteal region, the average shortest distance between the SSV and the TN was 4.4 mm. In 20%, the distance was <1 mm. The average, shortest distance between the SSV and the common peroneal nerve was 14.2 mm. The distance was <1 mm in one leg. CONCLUSIONS At the saphenopopliteal region, the TN is at risk during EVA. In the distal two-thirds of the lower leg, the SN is at risk for (thermal) damage due to the small distance to the SSV and the absence of the deep fascia between both structures. The proximal one-third of the lower leg is the optimal region for EVA of the SSV to avoid nerve damage; the fascia between the SSV and the SN is a natural barrier in this region that could preclude (thermal) damage to the nerve.
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Monahan TS, Belek K, Sarkar R. Results of Radiofrequency Ablation of the Small Saphenous Vein in the Supine Position. Vasc Endovascular Surg 2011; 46:40-4. [DOI: 10.1177/1538574411425108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To report the results of a novel approach using supine positioning for radiofrequency ablation (RFA) of the small saphenous vein (SSV) with combined ablation of the great saphenous vein (GSV). Methods: Over a 24-month period, we identified patients with symptomatic SSV incompetence. Access to the SSV was accomplished by ultrasound-guided venipuncture with the patient in the supine position. Results: Small saphenous vein ablation was performed on 27 limbs in 26 patients. Median follow-up was 94 days (interquartile range [IQR] 26, 171). Mean clinical–etiologic–anatomic–pathophysiologic (CEAP) score was 3.5 ± 1.3. Small saphenous vein ablation was performed in conjunction with GSV ablation in 17 patients and with phlebectomy in 14 patients. Postoperative ultrasound was performed after 26 of 27 procedures. The SSV was sealed in all 26 cases. Two patients (8%) had a deep venous thrombosis (DVT). Conclusions: The SSV can be effectively sealed by RFA from the supine position and combined SSV/GSV ablation can be carried out in a single setting.
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Affiliation(s)
- Thomas S. Monahan
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kyle Belek
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Rajabrata Sarkar
- Division of Vascular Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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Affiliation(s)
- C J Smith
- Research Department of Infection and Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, UK
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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.
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