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John S, Yan Y, Abbasi S, Mehrmohammadi M. Ultrasound and Photoacoustic Imaging for the Guidance of Laser Ablation Procedures. SENSORS (BASEL, SWITZERLAND) 2024; 24:3542. [PMID: 38894332 PMCID: PMC11175072 DOI: 10.3390/s24113542] [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] [Received: 04/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
The accuracy and efficacy of laser ablation procedures depend on the accurate placement of the laser applicator within the diseased tissue, monitoring the real-time temperature during the ablation procedure, and mapping the extent of the ablated region. Ultrasound (US) imaging has been widely used to guide ablation procedures. While US imaging offers significant advantages for guiding ablation procedures, its limitations include low imaging contrast, angular dependency, and limited ability to monitor the temperature. Photoacoustic (PA) imaging is a relatively new imaging modality that inherits the advantages of US imaging and offers enhanced capabilities for laser-guided ablations, such as accurate, angle-independent tracking of ablation catheters, the potential for quantitative thermometry, and monitoring thermal lesion formation. This work provides an overview of ultrasound-guided procedures and how different US-related artifacts limit their utility, followed by introducing PA as complementary to US as a solution to address the existing limitations and improve ablation outcomes. Furthermore, we highlight the integration of PA-driven features into existing US-guided laser ablation systems, along with their limitations and future outlooks. Integrated US/PA-guided laser ablation procedures can lead to safer and more precise treatment outcomes.
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Affiliation(s)
| | | | | | - Mohammad Mehrmohammadi
- Imaging Science, University of Rochester Medical Center, Rochester, NY 14642, USA; (S.J.); (Y.Y.); (S.A.)
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Whiteley MS. Current Best Practice in the Management of Varicose Veins. Clin Cosmet Investig Dermatol 2022; 15:567-583. [PMID: 35418769 PMCID: PMC8995160 DOI: 10.2147/ccid.s294990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/27/2022] [Indexed: 12/01/2022]
Abstract
This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.
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Relationship between incompetent perforator veins and pigmentation below the knee in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:676-682.e2. [DOI: 10.1016/j.jvsv.2021.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/10/2021] [Indexed: 11/18/2022]
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Woodburn KR. Endothermal ablation for the treatment of clinically significant incompetent lower limb perforating veins: factors influencing the early outcomes. Phlebology 2020; 36:127-134. [PMID: 32903159 DOI: 10.1177/0268355520955085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To review the clinical experience and early outcomes of endothermal perforator ablation. METHOD Retrospective review of an endovenous practice from 2007-2019. Clinically significant incompetent perforators were treated by Endovenous Laser Ablation (EVLA), or segmental radiofrequency ablation (RFA). RESULT Complete data were available for 110 of the 116 symptomatic incompetent perforating veins treated. Radiofrequency ablation of 20 perforators produced a 55% perforator closure rate, while 90 EVLA perforator ablations resulted in a closure rate of 80%. Closure rates with EVLA varied by location and perforator length. Closure rates for truncal ablation were 95.5% for RFA and 97.2% for EVLA. CONCLUSION Early closure rates following endothermal ablation of incompetent lower limb perforating veins are lower than those obtained for truncal ablation. EVLA perforator closure appears to be more effective than segmental RFA in most situations but short treatment lengths and location at the ankle are associated with the poorest outcomes.
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A prospective safety and effectiveness study using endovenous laser ablation with a 400-μm optical fiber for the treatment of pathologic perforator veins in patients with advanced venous disease (SeCure trial). J Vasc Surg Venous Lymphat Disord 2020; 8:805-813. [DOI: 10.1016/j.jvsv.2020.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
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Yan Y, John S, Ghalehnovi M, Kabbani L, Kennedy NA, Mehrmohammadi M. Photoacoustic Imaging for Image-guided Endovenous Laser Ablation Procedures. Sci Rep 2019; 9:2933. [PMID: 30814527 PMCID: PMC6393544 DOI: 10.1038/s41598-018-37588-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023] Open
Abstract
Accurate fiber tip tracking is a critical clinical problem during endovenous laser ablation (EVLA) of small perforating veins. Currently, ultrasound (US) imaging is the gold-standard modality for visualizing and for accurately placing the ablation fiber within the diseased vein. However, US imaging has limitations such as angular dependency and comet tail artifacts. In addition, EVLA is often performed without any real-time temperature monitoring, which could lead to an insufficient thermal dose or overheating the surrounding tissue. We propose a new technique that combines US and photoacoustic (PA) imaging for concurrent ablation fiber tip tracking and real-time temperature monitoring during EVLA procedures. Our intended implementation of PA imaging for fiber tracking requires minimal modification of existing systems, which makes this technology easy to adopt. Combining US and PA imaging modalities allows for simultaneous visualization of background anatomical structures as well as high contrast, artifact-free, and angle-independent localization of the ablation fiber tip. Preliminary data demonstrates that changes in the amplitude of the PA signal can be used to monitor the localized temperature at the tip of the ablation fiber, which will be invaluable during EVLA procedures. These improvements can enhance the physician's accuracy in performing EVLA procedures and will have a significant impact on the treatment outcomes.
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Affiliation(s)
- Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, 48202, USA
| | - Samuel John
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, 48202, USA
| | - Mahboobeh Ghalehnovi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, 48202, USA
| | - Loay Kabbani
- Department of Vascular Surgery, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Nicole A Kennedy
- Department of Vascular Surgery, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, 48202, USA.
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI, 48202, USA.
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Ozsvath K, Hager E, Harlander-Locke M, Masuda E, Elias S, Dillavou ED. Current techniques to treat pathologic perforator veins. J Vasc Surg Venous Lymphat Disord 2017; 5:293-296. [DOI: 10.1016/j.jvsv.2016.10.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/30/2016] [Indexed: 01/08/2023]
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Seren M, Dumantepe M, Fazliogullari O, Kucukaksu S. Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers. Phlebology 2015; 32:307-315. [DOI: 10.1177/0268355515594075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent perforating veins (IPVs) on ulcer recurrence rates in patients with progressive lipodermatosclerosis and impending ulceration. Methods Patients with nonhealing venous ulcers of >2 months’ duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Endovenous laser ablation (EVLA) of perforating veins was performed on patients with CEAP 6 disease with increasing hyperpigmentation, lipodermatosclerosis, and/or progressive malleolar pain. A minimum of 2 months of compressive therapy was attempted before endovenous ablation of IPVs. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Results Forty ulcers with 46 associated IPVs were treated with EVLA in 36 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (85.7%), calf (10.7%), and lateral ankle (3.5%). Endovenous laser ablation was successful in 76% (35/46) with the first laser treatment of incompetent perforator veins and 15.2% (7/46) additional ablation procedures were performed. Of the 46 treated IPVs, 42 (91.3%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 162 joule. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. Conclusion Especially in the case of liposclerotic or ulcerated skin in the affected region, PAP of IPVs is highly effective, safe, and appears to be feasible. Patients with active venous ulcers appear to benefit from EVLA of incompetent perforators in order to reduce the risk of ulcer recurrence.
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Affiliation(s)
- Mustafa Seren
- Department of Cardiovascular Surgery, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
| | - Mert Dumantepe
- Department of Cardiovascular Surgery, Medical Park Gebze Hospital, Kocaeli, Turkey
| | - Osman Fazliogullari
- Department of Cardiovascular Surgery, Medical Park Gebze Hospital, Kocaeli, Turkey
| | - Suha Kucukaksu
- Department of Cardiovascular Surgery, Medical Park Gebze Hospital, Kocaeli, Turkey
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Whiteley MS, O'Donnell TF. Debate: whether venous perforator surgery reduces recurrences. J Vasc Surg 2014; 60:796-803. [PMID: 25154966 DOI: 10.1016/j.jvs.2014.06.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice.
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Affiliation(s)
- Mark S Whiteley
- The Whiteley Clinic, Guildford and London; and Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, United Kingdom.
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Whiteley M. Part One: For the Motion. Venous Perforator Surgery is Proven and Does Reduce Recurrences. Eur J Vasc Endovasc Surg 2014; 48:239-42. [DOI: 10.1016/j.ejvs.2014.06.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Donnell TF. Part Two: Against the Motion. Venous Perforator Surgery is Unproven and Does not Reduce Recurrences. Eur J Vasc Endovasc Surg 2014; 48:242-6. [DOI: 10.1016/j.ejvs.2014.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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O'Donnell TF, Passman MA, Marston WA, Ennis WJ, Dalsing M, Kistner RL, Lurie F, Henke PK, Gloviczki ML, Eklöf BG, Stoughton J, Raju S, Shortell CK, Raffetto JD, Partsch H, Pounds LC, Cummings ME, Gillespie DL, McLafferty RB, Murad MH, Wakefield TW, Gloviczki P. Management of venous leg ulcers: clinical practice guidelines of the Society for Vascular Surgery ® and the American Venous Forum. J Vasc Surg 2014; 60:3S-59S. [PMID: 24974070 DOI: 10.1016/j.jvs.2014.04.049] [Citation(s) in RCA: 387] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Toonder IM, Lam YL, Lawson J, Wittens CHA. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology 2014; 29:49-54. [DOI: 10.1177/0268355514529696] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Consideration of treating incompetent perforating veins remains a conundrum based on scientific evidence available till date. While subfascial endoscopic perforator surgery (SEPS) proved to be a worthy alternative for open surgery, other even less invasive techniques were being introduced by the late nineties of the last century. Percutaneous thermo-ablation techniques are still being used today and seem more effective than non-thermal techniques. However, thermal techniques require anaesthesia and potentially may cause inadvertent damage to surrounding tissues such as nerves. Cyanoacrylate adhesive has a proven record, but not for the treatment of chronic venous disease of the leg. Innovation has led to the development of the VenaSeal® Sapheon Closure System which has been designed to use a modified cyanoacrylate glue as a new therapy for truncal vein incompetence. This paper explores the feasibility of ultrasound guided cyanoacrylate adhesive perforator embolization (CAPE). Results show a 76% occlusion rate of incompetent perforating veins without serious complications leading to the conclusion that further investigation with a dedicated delivery device in a larger patient population is warranted.
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Affiliation(s)
- Irwin M Toonder
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
| | - Yee Lai Lam
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
| | - James Lawson
- Maastricht University Medical Centre, Department of Dermatology, the Netherlands
| | - Cees HA Wittens
- Maastricht University Medical Centre, Department of Vascular Surgery, the Netherlands
- Universitätsklinikum Aachen, Dept of Vascular Surgery, Germany
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Dumantepe M, Tarhan A, Yurdakul I, Özler A. Endovenous Laser Ablation of Incompetent Perforating Veins with 1470 nm, 400 μm Radial Fiber. Photomed Laser Surg 2012; 30:672-7. [DOI: 10.1089/pho.2012.3351] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mert Dumantepe
- Department of Cardiovascular Surgery, Memorial Atasehir Hospital Istanbul, Turkey
| | - Arif Tarhan
- Department of Cardiovascular Surgery, Memorial Atasehir Hospital Istanbul, Turkey
| | - Ilhan Yurdakul
- Department of Cardiovascular Surgery, Memorial Atasehir Hospital Istanbul, Turkey
| | - Azmi Özler
- Department of Cardiovascular Surgery, Memorial Atasehir Hospital Istanbul, Turkey
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Harlander-Locke M, Lawrence PF, Alktaifi A, Jimenez JC, Rigberg D, DeRubertis B. The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates. J Vasc Surg 2012; 55:458-64. [DOI: 10.1016/j.jvs.2011.08.054] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/26/2011] [Accepted: 08/28/2011] [Indexed: 11/16/2022]
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Harlander-Locke M, Lawrence P, Jimenez JC, Rigberg D, DeRubertis B, Gelabert H. Combined treatment with compression therapy and ablation of incompetent superficial and perforating veins reduces ulcer recurrence in patients with CEAP 5 venous disease. J Vasc Surg 2011; 55:446-50. [PMID: 22104338 DOI: 10.1016/j.jvs.2011.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/02/2011] [Accepted: 08/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Patients with healed venous ulcers often experience recurrence of ulceration, despite the use of long-term compression therapy. This study examines the effect of closing incompetent superficial and/or perforating veins on ulcer recurrence rates in patients with CEAP 5 who have progressive lipodermatosclerosis and impending ulceration. METHODS Endovenous ablation was performed on patients with CEAP 5 disease and incompetent superficial and/or perforator veins and increasing lipodermatosclerosis and/or progressive malleolar pain. A minimum of 3 months of compressive therapy was attempted before endovenous ablation of incompetent veins. Demographic data, risk factors, CEAP classification, procedural details, and postoperative status were all recorded. Patients underwent duplex ultrasound scans before ablation to assess for deep, superficial, and perforator venous incompetence as well as postoperatively to confirm successful ablation. RESULTS Twenty-eight endovenous ablation procedures (superficial = 19; perforator = 9) were performed on 20 patients (limbs = 21). The mean patient age was 73 years old (range, 45-93 years) and the mean body mass index was 29.5 (18.9-58.4). Ninety-five percent of patients previously wore compression stockings (20-30 mm Hg = 9; 30-40 mm Hg = 10; none = 1) for a mean time of 23.3 months (range, 3-52 months) since the prior ulcer healed. Indications for venous ablation were increasing malleolar pain (55%) and/or lipodermatosclerosis (70%). Technical success rates for the ablation procedures were 100% for superficial veins and 89% for perforators (96.4% overall). All patients underwent closure of at least one incompetent vein. Postoperatively, 95% of patients were compliant with wearing compression stockings (20-30 mm Hg = 8; 30-40 mm Hg = 11; none = 1). Ulcer recurrence rates were 0% at 6 months and 4.8% at 12 and 18 months. These data compare with prior studies showing an ulcer recurrence rate up to 67% at 12 months with compression alone. CONCLUSION Patients with CEAP 5 healed venous ulcers that undergo endovenous ablation of incompetent superficial and perforating veins and maintain compression have reduced ulcer recurrence rates compared with historical controls that are treated with compression alone.
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Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers. J Vasc Surg 2011; 54:737-42. [DOI: 10.1016/j.jvs.2011.02.068] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 11/23/2022]
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Corcos L, Pontello D, DE Anna D, Dini S, Spina T, Barucchello V, Carrer F, Elezi B, DI Benedetto F. Endovenous 808-nm diode laser occlusion of perforating veins and varicose collaterals: a prospective study of 482 limbs. Dermatol Surg 2011; 37:1486-98. [PMID: 21883649 DOI: 10.1111/j.1524-4725.2011.02133.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovenous laser ablation (EVLA) was performed in the treatment of great and small saphenous veins (GSVs, SSVs), perforating veins (PVs), and varicose collaterals (VCs). OBJECTIVE To verify the outcome in PVs and VCs. MATERIALS AND METHODS Four hundred eighty-two limbs of 306 patients were studied. EVLA was performed on 167 GSVs, 52 SSVs, and 534 PVs of 303 limbs and on VCs of 467 limbs; 133 GSVs were stripped, 300 of saphenofemoral junctions (SFJs) and 45 saphenopopliteal junctions (SPJs) were interrupted. Limbs were selected using duplex ultrasound examination and photographs; PVs-VCs diameter (<4 mm) and VC length were measured. EVLA was performed using a 808-nm diode laser, 0.6-mm fibers, continuous emission, 4 to 10 W, and 10 to 20 J/cm. Follow-up on 467 limbs occurred over a mean 27.5 months (range 3 months to 6 years); 98 limbs were followed up for longer than 4 years. RESULTS Operating time range from 10 to 30 minutes per limb. Blood vaporization, thrombosis, fibrosis, and atrophy prevailed in PVs and in the large VCs (>4 mm) and massive coagulation in the smaller (<4 mm). High rate of occlusion was seen, with different rates of patent PV-VC mainly in diameter >6 mm. Thirty-nine out of 511 patent PVs (7.6%) and 96 out of 778 VCs (12-13%) were re-treated using EVLA or foam sclerotherapy. Minor complications occurred in 88 of the 778 (11%). CONCLUSIONS EVLA of PVs and VCs is effective and faster than surgery in 2- to 6-mm PVs and VCs using an 808-nm diode laser.
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Affiliation(s)
- Leonardo Corcos
- Department of Surgical Sciences, Postgraduate School of Vascular Surgery, University of Udine, Udine, Italy.
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De Maeseneer M, Pichot O, Cavezzi A, Earnshaw J, van Rij A, Lurie F, Smith P. Duplex Ultrasound Investigation of the Veins of the Lower Limbs after Treatment for Varicose Veins – UIP Consensus Document. Eur J Vasc Endovasc Surg 2011; 42:89-102. [DOI: 10.1016/j.ejvs.2011.03.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
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O'Donnell TF. Reply to letter regarding: ‘The role of perforators in chronic venous insufficiency’ by TF O'Donnell. Phlebology 2010;25:3–10. Phlebology 2010. [DOI: 10.1258/phleb.2010.010r01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T F O'Donnell
- Benjamin Andrews Professor of Surgery (Emeritus), Tufts University School of Medicine and Director of the Vein Centers at Tufts Medical Center and Dedham Medical Associates
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O'Donnell TF. The Rationale for Ablation of Incompetent Perforating Veins Is Not Substantiated by Current Clinical Evidence. Dis Mon 2010; 56:663-74. [DOI: 10.1016/j.disamonth.2010.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Innovative Treatments in Chronic Venous Insufficiency: Endovenous Laser Ablation of Perforating Veins: A Prospective Short-term Analysis of 58 Cases. Eur J Vasc Endovasc Surg 2010; 40:403-6. [PMID: 20547462 DOI: 10.1016/j.ejvs.2010.04.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 04/18/2010] [Indexed: 11/20/2022]
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Elias S. Minimally Invasive Vein Surgery: Latest Options for Vein Disease. ACTA ACUST UNITED AC 2010; 77:270-8. [DOI: 10.1002/msj.20186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Thesis Venous ulcers (VU) consume considerable resources in healthcare systems, up to 1% of healthcare budgets in industrialized countries. Best practice guidelines (GLs) incorporate evidence-based diagnostic and therapeutic recommendations in a cost-effective manner and have been associated with improved and less costly outcomes for many diseases. Objectives To determine whether there are common elements in GLs for VU and their evidentiary strength. Methods A systematic analysis of GLs for VU that were identified through clinicaltrials.gov, a government-sponsored website, and from experts outside the USA. Results Ten of 12 GLs on VU (7 North America and 5 Europe) were evidence-based, with the majority using the GRADE method. Only two had been developed or updated within the last three years. Venous duplex and ankle ABIs were recommended in all. Debridement was suggested in two, while simple non-adherent wound dressings were favoured in nine, and hydrocolloid in two. Only one GL discussed a range of dressing options, dependent on the condition of the VU. High pressure multi-layer compression bandages were favoured in 10. Only two focused on the importance of improving ankle joint mobility. Conclusions While there are numerous evidence-based GLs for VU, the majority may lag recent developments in the field. There is consensus on the elements for dressings and compression among the various GLs, which should facilitate the development of a common consensus GL, similar to that for DVT/PE. To improve patient care and reduce wasted resources, it is imperative for specialty societies to develop this consensus document.
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Affiliation(s)
- T F O'Donnell
- Venous Center, Tufts Medical Center, Director of the Venous Centers at Tufts Medical Center and Dedham Medical Associates
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van den Bos RR, Wentel T, Neumann MHA, Nijsten T. Treatment of incompetent perforating veins using the radiofrequency ablation stylet: a pilot study. Phlebology 2009; 24:208-12. [PMID: 19767487 DOI: 10.1258/phleb.2009.008090] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the role of incompetent perforating veins (IPV) in chronic venous insufficiency remains controversial, they are often treated by surgical or by minimal invasive techniques. OBJECTIVES To describe the procedure of radiofrequency ablation (RFA) of IPV and to evaluate its short-term effectiveness and safety. METHODS In a clinical pilot study, 14 IPV in 12 patients were treated with a radiofrequency stylet. After three months, ultrasound (US) examination was used to assess anatomical success rate and exclude deep venous thrombosis. Also, self-reported side-effects were investigated. RESULTS Of the 14 treated IPV, nine (64%) were obliterated on US examination and the others showed remaining reflux. Two patients reported localized paresthesia, but no deep venous thrombosis was recorded. CONCLUSION RFA of IPV may be a promising procedure, but patient and incompetent perforator vein selection is important and further standardization of the procedure is required. Comparative clinical trials between RFA and other therapies are warranted.
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Affiliation(s)
- R R van den Bos
- Department of Dermatology, Erasmus MC, Burgs' Jacobusplein 51, 3015 CA Rotterdam, The Netherlands
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Hingorani AP, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. Predictive factors of success following radio-frequency stylet (RFS) ablation of incompetent perforating veins (IPV). J Vasc Surg 2009; 50:844-8. [DOI: 10.1016/j.jvs.2009.04.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 04/09/2009] [Accepted: 04/18/2009] [Indexed: 11/24/2022]
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27
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Ozkan U. Endovenous laser ablation of incompetent perforator veins: a new technique in treatment of chronic venous disease. Cardiovasc Intervent Radiol 2009; 32:1067-70. [PMID: 19609603 DOI: 10.1007/s00270-009-9646-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 02/16/2009] [Accepted: 06/23/2009] [Indexed: 11/24/2022]
Abstract
The aim of this study was to assess the feasibility of endovenous laser ablation of incompetent perforator veins in a patient with incompetency of the small saphenous vein and multiple perforator veins. Two different methods were used to ablate seven perforator veins with a laser giving 50-60 J/cm energy. Total occlusion was observed in six perforators, and partial ablation in one perforator, at 1-month follow-up. To our knowledge, endovenous laser ablation of incompetent perforator veins is easy and a good therapeutic method.
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Affiliation(s)
- Ugur Ozkan
- Faculty of Medicine, Department of Radiology, Baskent University, Dadaloglu Mahallesi, Adana, Turkey.
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28
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Poblete H, Elias S. Venous ulcers: new options in treatment: minimally invasive vein surgery. THE JOURNAL OF THE AMERICAN COLLEGE OF CERTIFIED WOUND SPECIALISTS 2009; 1:12-9. [PMID: 24527103 PMCID: PMC3478919 DOI: 10.1016/j.jcws.2008.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients.
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Affiliation(s)
- Honesto Poblete
- Center for Vein Disease, Mt. Sinai School of Medicine, New York, NY, USA
| | - Steven Elias
- Center for Vein Disease, Mt. Sinai School of Medicine, New York, NY, USA
- Center for Vein Disease, Englewood Hospital and Medical Center, Englewood, NJ, USA
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29
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The present status of surgery of the superficial venous system in the management of venous ulcer and the evidence for the role of perforator interruption. J Vasc Surg 2008; 48:1044-52. [DOI: 10.1016/j.jvs.2008.06.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/04/2008] [Accepted: 06/04/2008] [Indexed: 11/20/2022]
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