Impact of a new maneuver on foam sclerotherapy for the treatment of large varicose veins with a one-step approach

FUNDAMENTAL CONSIDERATIONS Physiologic Observations on Causes of Varicose Veins. Anatomic Observations on the Cuases of Varicose Veins. Pathogenesis of Varicose Veins and Chronic Venous Insufficiency. Common Anatomic Patterns of Varicose Veins DIAGNOSTIC EVALUATION Laboratory Evaluation of Varicose Veins. Pretreatment Testing of Patients with Varicose Veins and Telangiectatic Blemishes TREATMENT OPTIONS Compression Therapy. Historical Development of Varicose Vein Surgery. Treatment of Varicosities of Saphenous Origin : Comparison of Ligation, Selective Excision, And Sclerotherapy. Treatment of Varicosities of Saphenous Origin: A Dialogue. Treatment of Varicose Veins By Sclerotherapy : An Overview. Compression Sclerotherapy for Large Varicose Veins and Perforator Veins : A Personal Technique. Role of Sclerotherapy in Greater Saphenous Vein Incompotence. Adverse Sequelae of Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins. Complications of Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins COMPLEX PROBLEMS INVOLVING VARICOSE VEINS Treatment of Varicose Veins Associated with Congenital Vascular Malformations. Varicose Veins and Venous Ulceration : Rationale for Conservative Treatment. Pelvic and Vulvar Varices : Pelvic Congestion Syndrome TELANGIECTATIC LEG VEINS Treatment of Telangiectasias. Painful Telangiectasias : Diagnosis and Treatment. Techniques of Small Vessel Sclerotherapy

The aim of this study was to demonstrate that sclerotherapy of exceptionally large varicose veins, i.e., >2.0 cm in diameter, is achievable, and should be the method of choice if one wishes to preserve the greater saphenous vein as a source for future bypass grafts. There is an increasing propensity toward microphlebectomy when treating varicose veins in America today. And, there is a corresponding reluctance to perform sclerotherapy, especially when dealing with the larger varices. The following are possible reasons for these decisions: 1. Unsatisfactory sclerotherapy results obtained by the clinician; 2. A belief that sclerotherapy is not useful for large veins; 3. A belief that only ligation and stripping or microphlebectomy can eliminate these huge veins; 4. Unsatisfactory scarring from stripping procedures; and/or 5. Difficulty in obtaining third-party reimbursement for sclerotherapy. Once deep vein pathology has been ruled out, sclerotherapy can be a successful treatment for any large vein. The second caveat is that significant saphenofemoral junction (SFJ) reflux (>1 second) must be eliminated prior to sclerotherapy; the author feels this should be accomplished surgically, not with sclerotherapy. With large varices, if the SFJ is competent then there is most likely a responsible perforator that must either be ligated and/or injected with sclerosant. Less frequently the short saphenous may be involved, and in these cases there are several alternatives, i.e., sclerotherapy or ligation and stripping of the short saphenous vein. Finally, but of great importance, ligation and stripping the greater saphenous vein in order to eliminate the varices that are merely branches of it, creates an unacceptable loss of potential bypass grafts for future CAD patients. This, alone, is reason enough to promote sclerotherapy for very large varicose veins. The author presents two enormous varices that were successfully treated with combination sclerotherapy, with a detailed description of the method utilized. </hea

Ovarian vein embolization in recurrent varicose veins - how invasive should varicose treatment be?

Treatment of varicose veins is directed towards eliminating sources of reflux causing venous hypertension in the superficial venous system. Doppler ultrasound is routinely used to localize sources of reflux prior to treatment of large varicose veins. To assess the value of Doppler ultrasound in localizing reflux in subcutaneous reticular veins associated with groups of lateral thigh telangiectases. Seven hundred patient records in which Doppler ultrasound was performed on thigh reticular veins were reviewed. Patients with reflux of the saphenofemoral junction, saphenopopliteal junction, or major saphenous system perforators were excluded. Audible reflux upon distal calf compression release was noted in thigh subcutaneous reticular veins of 618 out of 700 patients (88%). These incompetent reticular veins were associated with groups or webs of telangiectases and/or venulectases on the lateral thigh in almost all cases. Reflux was loudest just distal to the lateral femoral condyle. In 20 patients Doppler ultrasound was performed on a reticular vein while a telangiectasia associated with the reticular vein was injected with sclerosing solution. In 15 patients a clearly audible flow signal was heard in the reticular vein during injection. These findings indicate an association of telangiectatic veins with reticular veins on the thighs. Furthermore, this study underscores the value of Doppler in determining sources of reflux in smaller veins and implies that sclerotherapy of reticular veins is necessary for treatment of thigh telangiectatic webs.

Background: The main goal in the treatment of varicose veins is to reduce the symptoms and complications of chronic venous insufficiency and to improve health related quality of life (QoL) of patients. Surgery has been the standard of care in the treatment of saphenous varicose veins for more than a century. Aim of Study: The aim of this work is to compare between the outcome after UGFS, RFA & EVLA concerning the treat-ment of great saphenous vein reflux, regarding success rate, recurrence rate and complications rate. Subjects and Methods: This study was carried out at the Vascular Surgery Department, Zagazig University Hospitals during the period from August 2016 to August 2018, included a total of 51 treated lower limbs in 39 patients were divided into three different groups: Endovenous Laser Ablation (EVLA group) (n=18 legs in 13 patients; 1470nm, continuous mode, radial fiber), Radiofrequency Ablation (RFA group) (n=16 legs in 13 patients) and Ultrasound Guided Foam Sclerotherapy (UGFS group) (n=17 legs in 13 patients). All patients were subjected to complete clinical examination and laboratory investigations. Post procedure follow-up was done after one week, three month, six months & one year following treatment and all limbs were assessed clinically and by using DUS. Results: All the three treatment modalities significantly improved VCSS and QoL as reflected by significant improve-ments in VCSS and CIVIQ; with no significant differences in the outcome between the groups. The improvements per-sisted throughout the 2 years and showed that EVLA, RFA and UGFS are efficient treatments with longerterm beneficial effects in patients with GSV varicose veins. This is true even though some patients in the UGFS group developed recanal-ization of the GSV. UGFS group was significantly longer regarding duration to return to work (p < 0.01) than EVLA and RFA group which both had non-significant difference between them. Conclusion: Our study demonstrated that EVLA & RFA are efficient modalities for the treatment of GSV varicose veins in the medium term. Notinga moderate rate of recanal-ization after UGFS, it appears that EVLA & RFA are superior to UGFS regarding clinical recurrence, VCSS and QoL. Post-operative patient comfort and the outcome of EVLA & RFA in short & medium-terms are superior to those after UGFS in terms of recanalization & effective ablation.

The 3S technique: Another minimally invasive technique in the treatment of saphenous varicose veins

In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

Over the past few years, there has been a move to less invasive endoluminal methods in the treatment of lower limb varicose veins combined with a renewed interest in sclerotherapy, with the recent addition of foam sclerotherapy. The development of these new techniques has led many to question some of the more conventional teaching on the treatment of varicose veins. This review examines these new treatments for lower limb varicose veins and the current evidence for their use. An extensive search of available electronic and paper-based databases was performed to identify studies relevant to the treatment of varicose veins with particular emphasis on those published within the last 10 years. These were analysed by both reviewers independently. There is no single method of treatment appropriate for all cases. Conventional surgery is safe and effective and is still widely practised. Whilst the new treatments may be popular with both surgeons and patients, it is important that they are carefully evaluated not only for their clinical benefits and complications when compared to existing treatments but also for their cost prior to their wider acceptance into clinical practice.

Duplex ultrasound guidance of foam sclerotherapy has been established as a routine and standard treatment of varicose veins, but duplex-guided technique is not perfect because of its inherent shortcomings, and correlative complications have been reported. Moreover, not every country or region of the world can use duplex ultrasound guidance for foam sclerotherapy. To describe an original technique of using radiologically guided foam sclerotherapy for the treatment of leg varicose veins and to evaluate the technical feasibility and early results. Fifty-nine legs of 41 patients (23 male, 18 female; median age 47, range 25-75) with leg varicose veins treated using radiologically guided foam sclerotherapy were assessed. Polidocanol 1% was foamed 1:4 with air using the Tessari method. Foam sclerotherapy of the superficial varicosities and the great saphenous veins (GSVs) were performed using the filling-defects technique under radiologic guidance. Postoperative compression was maintained for 15 days. Clinical outcome was assessed according to clinical criteria. The procedure was technically successful in all 59 legs. At a median 9.0 months (range 6-12 months) of follow-up, the clinical outcome was full success in 53 legs (89.8%), and partial success in six legs (10.2%). There was no evidence of recurrence of varices or GSV reflux during follow-up. Minor complications included skin pigmentation in 27 legs (45.8%), and superficial thrombophlebitis in 18 legs (30.5%). No major complications or systemic events occurred. Radiologically guided foam sclerotherapy could be a safe, effective, and technically feasible treatment for varicose veins.

The aim of this study was to demonstrate that sclerotherapy of exceptionally large varicose veins, i.e., > 2.0 cm in diameter, is achievable, and should be the method of choice if one wishes to preserve the greater saphenous vein as a source for future bypass grafts. There is an increasing propensity toward microphlebectomy when treating varicose veins in America today. And, there is a corresponding reluctance to perform sclerotherapy, especially when dealing with the larger varices. The following are possible reasons for these decisions:

The study aims to explore the comprehensive reasons for patients' non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients' non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients' compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients' compliance with GECS therapy.

The study aims to explore the comprehensive reasons for patients’ non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients’ non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients’ compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients’ compliance with GECS therapy.

Update on Endovenous Radio-Frequency Closure Ablation of Varicose Veins

Advances in the Treatment of Varicose Veins: Ambulatory Phlebectomy, Foam Sclerotherapy, Endovascular Laser, and Radiofrequency Closure

Leg ulcer treatment