Early results of endovenous ablation with a 980-nm diode laser for an incompetent vein of Giacomini

Vena giacomini – so klein und unscheinbar?

In Giacominis Erstbeschreibung (1873) wurde über eine Vene berichtet, die über die Fossa poplitea zum dorsalen Oberschenkel (ohne in die V. poplitea einzumünden) weiter nach medial zieht, um in die V. saphena magna zu münden. Seither wurden zahlreiche weitere Mündungstypen (auch mit Einmündung in die V. poplitea) publiziert. Im klinischen Alltag erfährt diese Vene hingegen nur wenig Beachtung. Die Wahrscheinlichkeit, eine Insuffizienz der V. giacomini nachzuweisen, ist v. a. bei simultanem Vorliegen einer insuffizienten V. saphena parva um das knapp 12-Fache erhöht. Man unterscheidet 2 Refluxtypen der V. giacomini. Beim retrograden Reflux gelangt venöses Blut über die V. saphena magna, die Beckenvenen oder die Perforansvenen des Oberschenkels in die V. saphena parva. Beim wesentlich selteneren anterograden Reflux kommt es zu einem paradoxen (aufsteigenden) Reflux in der V. giacomini während der muskulären Diastole. Eine ausschließlich V.-saphena-fokussierte chirurgische Therapie ohne Berücksichtigung der Refluxtypen kann möglicherweise in einer Überbehandlung des Patienten enden und sollte im Zeitalter der therapeutischen Vielfalt und eines möglichst venenerhaltenden Vorgehens vermieden werden.

Aufgrund der anatomischen Enge der Fossa poplitea und der in der Vergangenheit zunehmend an Beliebtheit gewonnenen endoluminal-thermischen Verfahren ist die Kenntnis der topografischen Anatomie insbesondere zur Vermeidung von neurologischen Komplikationen von essenzieller Bedeutung.

Targeted endovenous treatment of Giacomini vein insufficiency-associated varicose disease: considering the reflux patterns

PURPOSE

We aimed to assess the technical feasibility of targeted endovenous treatment of Giacomini vein insufficiency (GVI)-associated varicose disease and report our early results.

METHODS

We retrospectively screened 335 patients with varicose disease who underwent endovenous laser ablation from September 2011 to January 2013, and determined 17 patients who underwent Giacomini vein ablation. Using a targeted endovenous treatment approach considering the reflux pattern, all healthy great saphenous veins (GSV) or vein segments were preserved while all insufficient veins (Giacomini vein, perforator veins, small saphenous vein, anterior accessory GSV, major tributary veins, or incompetent segments of the GSV) were ablated. Treatment success was analysed using Doppler findings and clinical assessment scores before and after treatment.

RESULTS

Targeted endovenous treatment was technically successful in all cases. Seven GSVs were preserved totally and three GSVs were preserved partially (10/17, 58%), with no major complications. Clinical assessment scores and Doppler findings were improved in all cases.

CONCLUSION

Targeted endovenous treatment of GVI-associated varicose disease is safe and effective. In majority of GVI cases saphenous vein can be preserved using this approach.

Guidelines of the First International Consensus Conference on Endovenous Thermal Ablation for Varicose Vein Disease--ETAV Consensus Meeting 2012

AIM

Endovenous thermal ablation (ETA) procedures are catheter-directed, ultrasound (US)-guided thermal methods for treatment in varicose veins disease. Radiofrequency, laser or steam energy thermally denatures vein wall collagen, leading first to vein wall inflammation, then fibrosis and finally to occlusion. The aim of this guideline is to give evidence-based recommendations for ETA procedures.

METHODS

These guidelines were drafted during a consensus meeting of a group of experts in the field of ETA in June 2012 (Hvar, Croatia) under the auspices of the International Union of Phlebology (IUP). These guidelines review the present state of knowledge as reflected in peer-reviewed published medical literature. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines.

RESULTS

Recommendations on the use of ETA procedures were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. Health economics were not considered, since differences in national health systems and pricing make it difficult to form general conclusions that are relevant at an international level.

Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini

PURPOSE

To retrospectively evaluate the feasibility and effectiveness of endovenous laser ablation or ultrasound-guided foam sclerotherapy for Giacomini vein insufficiency. This is the largest cohort of patients treated for Giacomini vein insufficiency with endovenous laser ablation or ultrasound-guided foam sclerotherapy.

MATERIAL AND METHODS

Over a three-year period, 23 females and nine males (age range, 19-67 years) treated for Giacomini vein insufficiency with or without saphenous vein insufficiency were retrospectively reviewed. Diagnosis of venous insufficiency was made by color Doppler ultrasonography. Symptomatic insufficiency of the Giacomini vein or the saphenous veins was treated with endovenous laser ablation. Ultrasound-guided foam sclerotherapy was used for tortuous incompetent Giacomini veins. The venous disease was categorized according to the clinical, etiological, anatomical, and pathological classification, and clinical severity was graded with the venous clinical severity score. Follow-up included clinical examination and color Doppler ultrasonography.

RESULTS

Thirty-nine limbs in 32 patients were treated (25 endovenous laser ablation and seven ultrasound-guided foam sclerotherapy). All procedures were technically successful. One patient in the ultrasound-guided foam sclerotherapy group had a recurrence with successful repeated treatment. Recurrence was not seen in the endovenous laser ablation group. No complications were observed. All patients had resolution and improvement in 100% of their symptoms at 12 months of follow-up.

CONCLUSION

Giacomini vein insufficiency is mostly seen with insufficiency of the great saphenous vein and can be effectively treated with endovenous laser ablation or ultrasound-guided foam sclerotherapy.