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Juneja AS, Jain S, Silpe J, Landis GS, Mussa FF, Etkin Y. Scoping review of non-thermal technologies for endovenous ablation for treatment of venous insufficiency. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:413-419. [PMID: 33881285 DOI: 10.23736/s0021-9509.21.11900-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of this review article is to compare the outcomes of newer non-thermal endovenous ablation techniques to thermal ablation techniques for the treatment of symptomatic venous insufficiency. EVIDENCE ACQUISITION Three independent reviewers screened PubMed® and EMBASE® databases to identify relevant studies. A total of 1173 articles were identified from database search that met our inclusion criteria. Two articles were identified through reference search. Removal of duplicates from our original search yielded 695 articles. We then screened these articles and assessed 173 full-text articles for eligibility. Subsequent to exclusion, 11 full-text articles were selected for final inclusion. EVIDENCE SYNTHESIS The non-thermal techniques are similar to thermal techniques in terms of a high technical success rate, closure rate at 12 months, change in Venous Clinical Severity Score and change in quality of life after procedure. However, the length of procedure is shorter for non-thermal modalities and patient comfort is improved with lower pain scores. Return to work may also be earlier after non-thermal ablation. The rates of bruising, phlebitis and paresthesia are higher after thermal ablation. CONCLUSIONS The non-thermal modalities are safe and effective in treating venous reflux and have shown improved patient comfort and shorter length of procedure which may make them favorable for use compared to the thermal modalities.
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Affiliation(s)
- Amandeep S Juneja
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Shelley Jain
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Jeffrey Silpe
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Gregg S Landis
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Firas F Mussa
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA
| | - Yana Etkin
- Department of Surgery, Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwel, Hempstead, NY, USA -
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Au‐Yeung CLK, Tse OHR, Pang YCS, Tang CN. Review of thermal and non‐thermal based endovenous treatment: Our local experience. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - On Ho Ronald Tse
- Department of Surgery Pamela Youde Nethersole Eastern Hospital Hong Kong
| | - Yin Chun Skyi Pang
- Department of Surgery Pamela Youde Nethersole Eastern Hospital Hong Kong
| | - Chung Ngai Tang
- Department of Surgery Pamela Youde Nethersole Eastern Hospital Hong Kong
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Tawfik AM, Sorour WA, El-Laboudy ME. Laser ablation versus mechanochemical ablation in the treatment of primary varicose veins: A randomized clinical trial. J Vasc Surg Venous Lymphat Disord 2019; 8:211-215. [PMID: 31864932 DOI: 10.1016/j.jvsv.2019.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/24/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE to prospectively compare the surgical outcome of using endovenous laser ablation (EVLA) and mechanochemical ablation (MOCA) in management of patients with primary varicose veins (VV). METHODS The present study prospectively recruited 100 patients with primary VV. They were randomly and equally allocated to one of two treatment group: the EVLA group (n = 50) or the MOCA group (n = 50). Before intervention, all patients underwent to clinical and ultrasound assessment of the vascular system. The Venous Clinical Severity Score was used to assess clinical severity. In addition, patients completed the Chronic Venous Insufficiency Questionnaire. The primary study outcome was treatment success. After intervention, patients were followed up at 1 week, 1 months, 6 months, and 12 months. RESULTS Operative success was achieved in all patients. The MOCA group had a significantly shorter operative time when compared with EVLA group. The Venous Clinical Severity Score significantly improved in both groups over the follow-up period and showed significantly lower levels in the MOCA group. Perceived pain was significantly improved in both groups postoperatively with no significant differences. The Chronic Venous Insufficiency Questionnaire was significantly improved after 12 months of operation without significant differences between groups. MOCA patients had significantly lower rate of postoperative phlebitis and significantly shorter time to return to work. CONCLUSIONS MOCA for primary VV is a feasible, effective, and safe procedure with better clinical outcome and lower rate of postoperative phlebitis when compared with EVLA.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Vascular Surgery, Faculty of Medicine, Zagazig University, Zagazig, Sharqiyah, Egypt.
| | - Waleed A Sorour
- Department of Vascular Surgery, Faculty of Medicine, Zagazig University, Zagazig, Sharqiyah, Egypt
| | - Medhat E El-Laboudy
- Department of Vascular Surgery, Faculty of Medicine, Zagazig University, Zagazig, Sharqiyah, Egypt
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Venous thromboembolism complications after endovenous laser ablation for varicose veins and role of duplex ultrasound scan. J Vasc Surg Venous Lymphat Disord 2019; 7:817-823. [DOI: 10.1016/j.jvsv.2019.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/09/2019] [Indexed: 12/20/2022]
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Vascular training does matter in the outcomes of saphenous high ligation and stripping. J Vasc Surg Venous Lymphat Disord 2019; 7:732-738. [DOI: 10.1016/j.jvsv.2019.01.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/19/2019] [Indexed: 01/10/2023]
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Kolvenbach RR, Elias S, Belinky A, Brandeis Z. The V-Block Occlusion Stent and Sclerotherapy Device for Varicose Vein Treatment: A Retrospective Analysis. Ann Vasc Surg 2019; 59:231-236. [PMID: 31009711 DOI: 10.1016/j.avsg.2019.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations. METHODS Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site. RESULTS Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period. CONCLUSIONS The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.
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Affiliation(s)
- Ralf R Kolvenbach
- Vascular Centre Catholic Hospital Group Duesseldorf, Augusta Hospital, Duesseldorf, Federal Republic of Germany.
| | - Steven Elias
- Center for Vein Disease, Englewood Hospital and Medical Center, Englewood, CO
| | - Alex Belinky
- Department of Cardiovascular Disease Rabin Medical Center, Beilinson Hospital, Tel Aviv, Israel
| | - Zeev Brandeis
- Centre for Outpatient Vascular Treatment CAT, Duesseldorf, Federal Republic of Germany
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Bittles M, Jodeh DS, Mayer JLR, Gallant M, Rottgers SA. Laser ablation of embryonic veins in children. Pediatr Int 2019; 61:358-363. [PMID: 30742735 DOI: 10.1111/ped.13804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trenaunay syndrome (KTS) and related overgrowth syndromes are rare conditions that often present to academic pediatric units and multidisciplinary vascular anomaly clinics. These conditions are commonly associated with abnormalities of the superficial and deep venous structures and carry an increased risk of venous thromboembolism. METHODS A retrospective chart review was completed of all patients treated at Johns Hopkins All Children's Hospital with endovenous laser ablation therapy (EVLT) for management of dilated embryonic veins in the setting of limb overgrowth. RESULTS Three patients with limb overgrowth underwent EVLT between 2015 and 2017. All patients had successful occlusion of the targeted veins on post-procedure imaging. One patient developed a cellulitis successfully treated with oral antibiotics. CONCLUSIONS Endovenous laser ablation therapy is a well-tolerated and safe procedure for prophylactic closure of abnormal superficial embryonic veins. This study supports the use of this technique in managing increased thromboembolic risk in this unique patient population and recognizes the need for a long-term study to determine its efficacy.
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Affiliation(s)
- Mark Bittles
- Department of Radiology, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Diana S Jodeh
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Jennifer L R Mayer
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Michael Gallant
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
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Varcoe RL, Thomas SD, Bourke V, Rübesamen NMK, Lennox AF. Utility of Adjunctive Digital Subtraction Venography for the Treatment of Saphenous Vein Insufficiency. J Endovasc Ther 2017; 24:290-296. [PMID: 28056580 DOI: 10.1177/1526602816686734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the use of adjunctive venography for the treatment of superficial venous reflux. METHODS Two hundred consecutive patients (mean age 60.9 years, range 33-86; 128 women) with chronic venous disease underwent saphenous or perforator vein ablation in 268 limbs (305 venous trunks) guided by adjunctive venography and fluoroscopy in addition to ultrasound between October 2010 and May 2016. Intraprocedural venograms were independently evaluated by 2 vascular specialists to identify the presence of venous anomalies and the need for fluoroscopy-guided maneuvers to successfully complete venous ablation. Intraprocedural venography results were compared with preoperative venous duplex scan reports to ascertain if the duplex study could be of value in identifying preoperatively any anatomical variants that may pose a technical challenge to the operator. RESULTS In this cohort, 542 venograms (2.0/limb) were performed with a mean duration of 4.9±9.1 minutes (range 1-48). Two thirds of patients (132, 66%) had anomalies or abnormalities within the target vein; more than a third (88, 44%) required an endovascular maneuver to successfully complete the ablation and 17% (34) of cases were impossible to complete without adjunctive fluoroscopic guidance. Per-patient comparison of intraprocedural venography with preoperative venous duplex reports identified 21 (11%) patients with abnormalities detected on ultrasound (23 anomalies) compared with 123 (64%) on venography (193 anomalies). This gave ultrasound a 17.1% sensitivity, 100% specificity and positive predictive value, and 40.7% negative predictive value. CONCLUSION Venography is a valuable addition to ultrasound to facilitate complete ablation of insufficient saphenous veins in selected patients with complex anatomy.
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Affiliation(s)
- Ramon L Varcoe
- 1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.,2 Faculty of Medicine, University of New South Wales, Sydney, Australia.,3 The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Shannon D Thomas
- 1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.,2 Faculty of Medicine, University of New South Wales, Sydney, Australia.,3 The Vascular Institute, Prince of Wales Hospital, Sydney, Australia.,4 Southern Highlands Private Hospital, Bowral, Australia
| | - Victor Bourke
- 1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.,3 The Vascular Institute, Prince of Wales Hospital, Sydney, Australia.,5 North Gosford Private Hospital, Gosford, Australia
| | - Nicole M K Rübesamen
- 1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.,3 The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
| | - Andrew F Lennox
- 1 Department of Vascular Surgery, Prince of Wales Hospital, Sydney, Australia.,3 The Vascular Institute, Prince of Wales Hospital, Sydney, Australia
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Mou Y, Zhao Q, Zhong L, Chen F, Jiang T. Preliminary results of ultrasound-guided laser ablation for unresectable metastases to retroperitoneal and hepatic portal lymph nodes. World J Surg Oncol 2016; 14:165. [PMID: 27338093 PMCID: PMC4917948 DOI: 10.1186/s12957-016-0917-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laser ablation with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a minimally invasive approach which is able to achieve a precise tissue necrosis. The study was aimed to assess the feasibility and efficiency of laser ablation in the treatment of retroperitoneal and hepatic portal unresectable metastatic lymph nodes. METHODS Eight patients including 11 pathologically proven metastatic lymph nodes, 4 in retroperitoneal, 7 in hepatic portal region, were treated by laser ablation. Primary cancers were cholangiocarcinoma (n = 4) and hepatocellular carcinoma (n = 4). Under sonographic guidance, the laser ablation was performed percutaneously. Follow-up contrast computed tomography or magnetic resonance image was performed. RESULTS The treatments were completed in single process in all the patients. No severe complications occurred. Follow-up contrast computed tomography or magnetic resonance imaging at 1 and 3 months showed partial responses in 11 lymph nodes. The local response rate at the 6 month follow-up was 75.0 %. The overall response rate was 62.5 %. Abdominal pain scores decreased significantly in all patients. Tumor marker levels decreased in six patients. The Child-Pugh grade did not change. CONCLUSIONS The results suggest that sonographically guided laser ablation is technically feasible for the local treatment of unresectable retroperitoneal and hepatic portal lymph nodes from hepatic cancer. Although further study is needed to evaluate its long time efficacy, abdominal pain relief is prominent.
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Affiliation(s)
- Yun Mou
- />Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003 China
| | - Qiyu Zhao
- />Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003 China
| | - Liyun Zhong
- />Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003 China
| | - Fen Chen
- />Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003 China
| | - Tianan Jiang
- />Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003 China
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Sciatic and Peroneal Nerve Injuries After Endovascular Ablation of Lower Extremity Varicosities. Ann Plast Surg 2015; 74:64-8. [DOI: 10.1097/sap.0000000000000193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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King K, Landrigan-Ossar M, Clemens R, Chaudry G, Alomari AI. The use of endovenous laser treatment in toddlers. J Vasc Interv Radiol 2014; 24:855-8. [PMID: 23707092 DOI: 10.1016/j.jvir.2012.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/27/2012] [Accepted: 12/29/2012] [Indexed: 11/30/2022] Open
Abstract
The use of endovenous laser ablation therapy in children is limited. Klippel-Trenaunay syndrome (KTS) is associated with persistent ectatic anomalous veins within the affected extremity, with increased risk of thromboembolism. The present report describes four toddlers (<20 kg) with KTS of the lower extremity who underwent a total of five endovenous laser procedures for treatment of ectatic anomalous marginal venous system, without complications.
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Affiliation(s)
- Kendall King
- Division of Vascular and Interventional Radiology, Children's Hospital Boston, Boston, MA 02115, USA
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Bakker NA, Schieven LW, Bruins RMG, van den Berg M, Hissink RJ. Compression stockings after endovenous laser ablation of the great saphenous vein: a prospective randomized controlled trial. Eur J Vasc Endovasc Surg 2013; 46:588-92. [PMID: 24012465 DOI: 10.1016/j.ejvs.2013.08.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/07/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if the duration of wearing compression stockings after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) has influence on pain and quality of life. METHODS This was a prospective randomized controlled trial. Between December 2006 and February 2008, 109 consecutive patients with EVLA of the GSV were analyzed. Deep vein insufficiency, ulceration, more than one insufficient vein in one leg, and use of anticoagulants were exclusion criteria. Group A used compression stocking for 48 hours after therapy, group B for 7 days. Pain (visual analogue scale [VAS]) and quality of life (SF-36) were analyzed 48 hours, 1 week, and 6 weeks after therapy. Three months after treatment, duplex ultrasound imaging was performed to assess occlusion rates. RESULTS Both groups (group A, n = 37; group B, n = 32) where comparable at baseline. After 1 week, there was a significant difference in pain (VAS score 3.7 [± 2.1] vs. 2.0 [± 1.1], p ≤ .001), and physical dysfunction (group A, 85.1 [± 11.2] vs. group B, 95.7 [± 10.1]; p < .001) as well as vitality (group A, 75 [± 13.0] vs. group B, 83.7 [± 13.4]; p = .03), all in favor of group B, which disappeared after 6 weeks. After 6 weeks, no significant differences in all endpoints were present. Duplex ultrasound imaging revealed complete GSV occlusion in all patients, while no cases of deep venous thrombosis had developed. CONCLUSIONS Prescribing compression stockings for longer than 2 days after endovenous GSV ablation (without simultaneous phlebectomies) leads to reduced pain and improved physical function during the first week after treatment.
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Affiliation(s)
- N A Bakker
- Department of Neurosurgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Lin JC, Peterson EL, Rivera ML, Smith JJ, Weaver MR. Vein Mapping Prior to Endovenous Catheter Ablation of the Great Saphenous Vein Predicts Risk of Endovenous Heat-Induced Thrombosis. Vasc Endovascular Surg 2012; 46:378-83. [DOI: 10.1177/1538574412449392] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We investigate the value of vein mapping for predicting the risk of endovenous heat-induced thrombosis (EHIT) after endovenous laser treatment (EVLT) and radiofrequency ablation (RFA) of the great saphenous vein (GSV). Methods: In all, 355 consecutive vein mappings were retrospectively analyzed. A generalized estimating equations approach to linear logistic regression was used to evaluate the variables. Results: Among the 312 vein ablation of the GSV, 10 (3.2%) developed EHIT. When comparing the group of patients who developed EHIT versus no EHIT, the mean GSV diameter was 13.05 ± 5.59 mm versus 8.39 ± 3.38 mm (odds ratio [OR]: 1.25, P = .001), the presence of valvular incompetence at the saphenofemoral junction (SFJ) was 10.71% versus 0.44% (OR: 27.75, P =.001), and 3.09% in RFA versus 3.33% in EVLT (OR: 1.09, P = .89). Conclusions: Patients with valvular insufficiency of the SFJ and a large proximal GSV diameter had a significantly higher risk of developing heat-induced thrombosis after endovenous catheter ablation.
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Affiliation(s)
- Judith C. Lin
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Edward L. Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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Jover Clos RJ, Javurek GO, Alamo JP, Dionisio de Cabalier ME, Bustos HF, Gramática L. [Gallbladder ablation with a laser in an animal model]. Cir Esp 2011; 90:102-6. [PMID: 22172771 DOI: 10.1016/j.ciresp.2011.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/06/2011] [Accepted: 10/03/2011] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Attempts to remove the gallbladder by non-surgical means began in the 1980's, by applying chemicals, heat or laser to remove its mucosa and reduce it to an innocuous scar. The aim of this work is to determine whether complete ablation of this organ is possible using total ablation by applying a diode laser. MATERIAL AND METHODS Thirty rabbits were divided into 3 groups of 10 animals. The gallbladder was surgically accessed and a 980 nm diode laser was applied endoluminally using fibre optics until it shrunk. Ethanol was used as a sclerosing agent plus a fibrin tail to seal the gallbladder lumen in one of the control groups, and a physiological solution was used in the rest. The animals were slaughtered at 65 days and the results of the procedure were observed macroscopically and histologically, evaluating the remains of the gallbladder lumen, fibrosis, and areas of re-epithelialisation. Statistical analysis was made using the Fisher test. RESULTS Eight of the gallbladders treated by laser disappeared leaving a small sub-hepatic scar. There were no complications during or after surgery. The results were successful in only case in the ethanol group, and there was no ablation with physiological solution. The comparison of the results showed a significant positive difference in the group treated with laser compared to those with ethanol plus fibrin tail (P<.0055) and the physiological solution (P<.0007). CONCLUSIONS Ablation of the gallbladder using a diode laser was possible in this experimental model.
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Affiliation(s)
- Rafael José Jover Clos
- Unidad Hospitalaria de Cirugía n.° 1, Hospital Nacional de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, República Argentina.
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Bisang U, Meier TO, Enzler M, Thalhammer C, Husmann M, Amann-Vesti BR. Results of endovenous ClosureFast treatment for varicose veins in an outpatient setting. Phlebology 2011; 27:118-23. [DOI: 10.1258/phleb.2010.010089] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Endovenous methods are increasingly used to treat varicose veins. We evaluated the outcome of patients treated with the new radiofrequency ablation (RFA)-ClosureFast catheter in an outpatient setting. Method Retrospective analysis of postinterventional duplex ultrasound (DUS), complication rate and quality of life of patients treated for incompetent saphenous veins. Results Between 2007 and 2009, 155 patients had been treated with ClosureFast. DUS was available from 73 (47%) patients (102 great [GSV] and 16 small [SSV] saphenous veins). After a mean follow-up of 12.2 months (range 1–29 months), DUS showed six (5.9%) open GSV and an occlusion of all treated SSV. One pulmonary embolism had occurred. Mean patient's satisfaction was 8.7 (10 = very satisfied), pain after one week 2.0 (no pain = 0, maximal = 10) and absence of work was 0.9 day (range 0–14 days). Conclusion RFA for incompetent saphenous veins can safely be performed in an outpatient setting with a low complication rate, minimal pain and fast recovery.
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Affiliation(s)
- U Bisang
- Clinic for Angiology, University Hospital Zurich
| | - T O Meier
- Clinic for Angiology, University Hospital Zurich
| | - M Enzler
- Klinik Hirslanden, Vascular Surgery, Zurich, Switzerland
| | - C Thalhammer
- Clinic for Angiology, University Hospital Zurich
| | - M Husmann
- Clinic for Angiology, University Hospital Zurich
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Helmy ElKaffas K, ElKashef O, ElBaz W. Great saphenous vein radiofrequency ablation versus standard stripping in the management of primary varicose veins-a randomized clinical trial. Angiology 2010; 62:49-54. [PMID: 20724299 DOI: 10.1177/0003319710380680] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Chronic venous insufficiency is the most common vascular disease in the adult population. However, randomized clinical trials (RCTs) comparing therapeutic options are limited. PATIENTS AND METHODS A total of 180 patients with saphenofemoral junction and great saphenous reflux detected on duplex were randomized to either ultrasound-guided radiofrequency ablation (RFA) or standard surgical treatment. The study participants blindly chose an assignment card that placed them in either group A (ultrasound-guided RFA of the great saphenous vein [GSV]; n = 90); or group B (surgical management n = 90). Patients were followed up for 24 months. RESULTS The primary occlusion rate in group A was 94.5% versus 100% in group B. Radiofrequency ablation had a lower overall complication rate (P = .02) and shorter post-intervention hospital stay (P = .001). Kaplan-Meier analysis showed no significant differences in recurrence rates at 24 months follow-up (P = .45). Radiofrequency ablation was significantly more expensive (P = .003). CONCLUSION Great saphenous vein occlusion was achieved efficiently in 94% of our group using RFA with minimal complications and obvious advantages as compared to standard surgery.
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Endovenous laser ablation: Venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg 2008; 48:1538-45. [DOI: 10.1016/j.jvs.2008.07.052] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/22/2022]
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