scholarly journals Cryosclerosis. Az elfelejtett endovénás cryoablatio a vena saphena magna elégtelenségének kezelésében. Egy prospektív összehasonlító vizsgálat középtávú eredményei

2016 ◽  
Vol 157 (50) ◽  
pp. 1994-2001
Author(s):  
István Bence Bálint ◽  
Ákos Farics ◽  
László Vizsy ◽  
Eszter Vargovics ◽  
Renáta Bálint ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Secondary Outcome ◽  
Rank Test ◽  
Clinical Failure ◽  
Severity Scores ◽  
Significant Difference ◽  
Vena Saphena Magna ◽  
Occlusion Rate

Introduction: Cryosclerosis was introduced by Milleret and Le Pivert in the 1980s. Method: A prospective non-randomized comparative study has been performed on initial 96 patients. 48 patients were treated by cryosclerosis and the others received conventional stripping. 52 cases were analyzed for 2-years. The primary end-point of the study was to determine the occlusion rate of cryosclerosis. The clinical failure, the improvement in the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores were analyzed as secondary outcome. Results: Total recanalization of the great saphenous vein causing clinical failure was observed in one case (4%). The reopening of the great saphenous vein was observed in 4 limbs (15%) that did not cause the incompetence of the trunk. The occlusion rate was 81%. Recurrent varicosity was observed by 35% and 42% of the patients in the cryosclerosis and stripping groups respectively. There was no significant difference between the groups (log rank test, p = 0.391). There was significant improvement in both the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores in each group without remarkable differences observed between the groups either at baseline or on the mid-term. Conclusions: Cryosclerosis seems to be effective in the remodeling of the great saphenous vein. The method has no remarkable mid-term clinical advantages over classical stripping so far. Orv. Hetil., 2016, 157(50), 1994–2001.

Mechanochemical ablation for symptomatic great saphenous vein reflux: A two-year follow-up

2016 ◽  
Vol 32 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Pamela S Kim ◽  
Muath Bishawi ◽  
David Draughn ◽  
Marab Boter ◽  
Charles Gould ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Saphenous Vein ◽  
Severity Score ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Mechanochemical Ablation ◽  
Venous Clinical Severity Score ◽  
Occlusion Rate ◽  
The Mean

Background Several studies have shown comparable early efficacy of mechanochemical ablation to endothermal techniques. The goal of this report was to show if early efficacy is maintained at 24 months. Methods This was a two-year analysis on the efficacy of mechanochemical ablation in patients with symptomatic C2 or more advanced chronic venous disease. Patients with reflux in the great saphenous vein involving the sapheno-femoral junction and no previous venous interventions were included. Demographic information, clinical, and procedural data were collected. The occlusion rate of treated veins was assessed with duplex ultrasound. Patient clinical improvement was assessed by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class and venous clinical severity score. Results Of the initial 126 patients, there were 65 patients with 24 month follow-up. Of these 65 patients, 70% were female, with a mean age of 70 ± 14 years and an average body mass index (BMI) of BMI of 30.5 ± 6. The mean great saphenous vein diameter in the upper thigh was 7.6 mm and the mean treatment length was 39 cm. Adjunctive treatment of the varicosities was performed in 14% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, 95% at 12 months, and 92% at 24 months. There was one patient with complete and four with partial recanalization ranging from 7 to 12 cm (mean length 9 cm). There was significant improvement in CEAP and venous clinical severity score (P < .001) for all time intervals. Conclusion Early high occlusion rate with mechanochemical ablation is associated with significant clinical improvement which is maintained at 24 months, making it a very good option for the treatment of great saphenous vein incompetence.

Radiofrequency ablation of the great saphenous vein, comparing one versus two treatment cycles for the proximal vein segment

2014 ◽  
Vol 30 (10) ◽  
pp. 724-728 ◽  
Author(s):  
S Sufian ◽  
A Arnez ◽  
N Labropoulos ◽  
K Nguyen ◽  
V Satwah ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Treatment Group ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Demographic Data ◽  
Duplex Ultrasound ◽  
Clinical Severity ◽  
Severity Scores ◽  
Vein Segment ◽  
Ceap Classification

Objective To evaluate the results of radiofrequency ablation (RFA) of the great saphenous vein (GSV) using one versus two 20 s energy cycle treatment in the proximal 7 cm segment of the GSV. Methods All patients who underwent RFA of the GSV from 1 May 2013 to 30 September 2013 in eight of our vein centers were included. Duplex ultrasound scans (DUSs) were performed prior to treatment on all patients and 2–3 days, and 1 month after procedure. Demographic data, GSV diameters, and other relevant data were recorded. Clinical, Etiologic, Anatomic, Pathologic (CEAP) classification and Venous Clinical Severity Scores (VCSSs) were determined prior to ablation and one month later. Patients who developed endovenous heat induced thrombosis (EHIT) were followed till resolution. Results A total of 205 patients had one cycle treatment (group A) and 204 had two cycle treatment (group B). The two groups were comparable in their demography, CEAP classification, and VCSS scores. The rate of failure of ablation and incidence of EHIT were also not significantly different. The incidence of complications was low, <5% in both groups and all were minor. Conclusion Two cycle treatment of the proximal GSV for vein ablation does not improve the success rate of vein closure in the short term, compared to one cycle treatment. It also does not increase the risks of DVT, EHIT, major bleeding, and other complications. However, we do not know at what diameter two cycles may be superior to one cycle.

A randomised controlled trial of perivenous tumescent anaesthesia in addition to general anaesthesia for surgical ligation and stripping of the great saphenous vein

2019 ◽  
Vol 35 (5) ◽  
pp. 305-315 ◽  
Author(s):  
Sandip Nandhra ◽  
Tom Wallace ◽  
Joseph El-Sheikha ◽  
Daniel Carradice ◽  
Ian Chetter
Keyword(s):  
Quality Of Life ◽  
General Anaesthesia ◽  
Saphenous Vein ◽  
Primary Outcome ◽  
Great Saphenous Vein ◽  
Bodily Pain ◽  
Secondary Outcome ◽  
Surgical Ligation ◽  
Significant Difference

Introduction Open surgical ligation and stripping of the great saphenous vein is a highly cost-effective treatment when compared with conservative management and foam sclerotherapy but has limitations including post-operative morbidity and pain. This study aims to identify if the addition of tumescent anaesthesia could improve patient outcomes following treatment. Methods Patients with primary superficial venous incompetence undergoing open surgical ligation and stripping of the great saphenous vein were randomised to either General Anaesthesia (GA) alone (GA) procedure or the addition of tumescent (G + T). The primary outcome was bodily pain (within SF-36) at one week. Additional outcomes included post-procedural pain score (100 mm visual analogue scale), complications and quality of life. Results A total of 90 patients were randomised for inclusion. There was no significant difference in primary outcome; bodily pain at one week. Secondary outcome of 4-h post-procedural scores were significantly lower in the G + T group (32 (20–54) mm vs. (GA alone) 56 (24–70) mm (P = 0.016)). Complications were minor and equivalent. Both groups saw a significant increase (worsening) in Aberdeen Varicose Vein Questionnaire scores at week 1 with the G + T group faring worse at six weeks (10.0 (Interquartile Range [IQR] 5.6–17.9) vs. 4.3 (IQR 2.7–7.9) P = 0.004). Conclusion The G + T group did not demonstrate a significant difference in the one-week bodily pain domain. The addition of tumescent anaesthesia does improve immediate post-operative pain but appears to negatively impact on six-week quality of life. EudraCT Number: 2011-005574-39

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)

2016 ◽  
Vol 32 (3) ◽  
pp. 194-199 ◽  
Author(s):  
Alptekin Yasim ◽  
Erdinc Eroglu ◽  
Orhan Bozoglan ◽  
Bulent Mese ◽  
Mehmet Acipayam ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Long Term Results ◽  
Early Results ◽  
Severity Scores ◽  
Endovenous Ablation ◽  
Vein Diameter

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors

2014 ◽  
Vol 30 (5) ◽  
pp. 325-330 ◽  
Author(s):  
S Sufian ◽  
A Arnez ◽  
N Labropoulos ◽  
S Lakhanpal
Keyword(s):  
Risk Factors ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Endovenous Laser Ablation ◽  
Severity Scores ◽  
Class 1 ◽  
Vein Diameter ◽  
Saphenofemoral Junction

Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2–3 days postoperatively. Results Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis ( p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients ( p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm ( p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis ( p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2–4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 ( p = .003) at one month. Conclusion Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2–4 weeks in most patients but it may worsen in few.

scholarly journals Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

2015 ◽  
Vol 14 (4) ◽  
pp. 282-289 ◽  
Author(s):  
Walter Junior Boim Araujo ◽  
Jorge Rufino Ribas Timi ◽  
Carlos Seme Nejm Júnior ◽  
Filipe Carlos Caron
Keyword(s):  
Energy Density ◽  
Clinical Outcomes ◽  
Saphenous Vein ◽  
Thermal Ablation ◽  
Lower Energy ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Venous Clinical Severity Score ◽  
Occlusion Rate ◽  
Lower Energy Density

Abstract Background Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV) occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs) underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS), and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%). Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

Great saphenous vein sparing versus stripping in Trendelenburg operation for primary varicose veins: a prospective study

2020 ◽  
Vol 93 (1) ◽  
pp. 34-39
Author(s):  
Ashikesh Kundal ◽  
Navin Kumar ◽  
Deepak Rajput ◽  
Udit Chauhan
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Randomized Study ◽  
Duplex Ultrasound ◽  
Operative Management ◽  
Clinical Severity ◽  
Below The Knee ◽  
Venous Clinical Severity Score ◽  
Significant Difference

<b>Objective:</b> The purpose of this study was to compare the outcome of the great saphenous vein (GSV) sparing versus stripping during Trendelenburg operation for varicose veins. <br><b>Methods:</b> This was a prospective randomized study of primary varicose vein patients who underwent Trendelenburg operation. Data of patients operated on over a period of 16 months was collected, including: below knee GSV diameter by Duplex Ultrasound and revised venous clinical severity score (rVCSS), calculated preoperatively and postoperatively at 2<sup>nd</sup>, 4<sup>th</sup>, and 8<sup>th</sup> week. <br><b>Results:</b> A total of 36 patients undergoing Trendelenburg operation were included in the study. Nineteen patients underwent GSV sparing while 17 underwent stripping of GSV till just below the knee after juxtafemoral flush ligation of the great saphenous vein. There was a significant decrease in the below-knee GSV diameter (19% after 2 months) and rVCSS (60.8%) in the sparing group. The stripping group also showed an almost similar decrease in below-knee GSV diameter (19.6% after 2 months) and rVCSS (66.3%). However, no significant difference was found between the two groups in terms of change in GSV diameter (P = 0.467) and rVCSS (P = 0.781). <br><b>Conclusion:</b> Trendelenburg procedure with sparing of GSV can be done routinely for operative management of varicose veins, where surgery is needed.

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

Vascular ◽  
2020 ◽  
Vol 28 (5) ◽  
pp. 597-603
Author(s):  
Nail Kahraman ◽  
Kadir K Özsin
Keyword(s):  
Saphenous Vein ◽  
Severity Score ◽  
Older Patients ◽  
Great Saphenous Vein ◽  
Visual Analog Score ◽  
Clinical Severity ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Venous Clinical Severity Score ◽  
Occlusion Rate

Objectives Although many published series have shown the results of ultrasound-guided catheter-directed foam sclerotherapy, little is known about the outcomes and complications in older patients. Methods A total of 152 patients older than 65 years (group 1: 61.8% male, mean age 69.0 ± 4.5 years) and 244 patients younger than 65 years (group 2: 48.8% male, mean age 45.7 ± 11.2 years) were included in the study. Ultrasound-guided catheter-directed foam sclerotherapy was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score and visual analog score were calculated pre- and post-intervention. Results Complete occlusion rate of the great saphenous vein at 12 months post-procedure for the groups 1 and 2 was 86.4% and 86.3%, respectively. Venous clinical severity score and visual analog score were significantly different before ultrasound-guided catheter-directed foam sclerotherapy and four weeks after ultrasound-guided catheter-directed foam sclerotherapy ( p < 0.001) in both the groups. There were no observed major complications in both the groups. Conclusions With low complication rate and acceptable total occlusion rate, ultrasound-guided catheter-directed foam sclerotherapy can be considered a reliable treatment for older patients.

scholarly journals Neovascularisation is not an Innocent Bystander in Recurrence after Great Saphenous Vein Surgery

2015 ◽  
Vol 97 (2) ◽  
pp. 102-108 ◽  
Author(s):  
CRR Corbett ◽  
V Prakash
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Duplex Ultrasonography ◽  
Common Source ◽  
Innocent Bystander ◽  
Venous Clinical Severity Score ◽  
Significant Difference ◽  
Chi Squared ◽  
Causes Of Failure

Introduction This study sought to establish the causes of failure of great saphenous vein surgery among patients in whom there was confidence that accurate saphenofemoral ligation had been carried and the great saphenous vein had been stripped at least to knee level. Methods This was an observational study of 100 limbs (66 patients) operated on by a single surgeon 5–22 years previously (mean: 12 years). The index operation was primary in 54 limbs and for recurrence in 46 limbs. Thirty-two patients were studied having been re-referred for recurrence while 34 were recalled for review. All were examined clinically and with duplex ultrasonography, and all completed questionnaires (Aberdeen varicose vein questionnaire [AVVQ] and EQ-5D-3L). In order to measure the extent of visible recurrence, a scoring system similar to that in the venous clinical severity score was used but with a range of 0–8. Results There were visible varicosities in 77 of the 100 limbs. Duplex ultrasonography showed that recurrent saphenofemoral incompetence (SFI) was present in 27% of the limbs. This was judged to result from neovascularisation and was the most common source of reflux. AVVQ scores for the 27 limbs with recurrent SFI (median: 34, interquartile range [IQR]: 20–42) were higher than for the 73 with no recurrent SFI (median: 17, IQR: 11–29), which was a significant difference (Mann–Whitney U test, p<0.01). Analysing clinical scores with chi-squared tests indicated fewer visible varicosities in limbs without recurrent SFI than in those with recurrent SFI (p<0.01). Conclusions Neovascularisation remains poorly understood but it cannot be considered an innocent bystander.

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