Impact of Dexamethasone-Enriched Tumescent Anesthesia for Radiofrequency Ablation of GSV insufficiency: A Double-Blind Randomized Clinical Trial.

Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

Objectives: This research aimed to determine the impact of reflux patterns in patients with great saphenous vein (GSV) insufficiency on clinical severity and management. Methods: We evaluated 771 lower extremities of 452 patients having GSV insufficiency with Doppler Ultrasound. We characterized the reflux patterns like previously done in the literature: type 1, GSV reflux without the involvement of perimalleolar region or saphenofemoral junction (SFJ); type 2, GSV reflux involving perimalleolar region; type 3, GSV reflux involving SFJ; type 4, GSV reflux involving both perimalleolar region and SFJ. Then we conducted a study to evaluate the relationship between GSV reflux type and age, gender, venous clinical severity score (VCSS), clinical, etiological, anatomical and pathophysiological elements (CEAP), body mass index (BMI) and gave an effort to compare the groups by therapeutic strategies. Results: The mean age was 44±11 years. The male-to-female ratio was 0.49. The most commonly observed reflux pattern was type 3 (48%) in patients with GSV insufficiency and varicose veins. Patients with type 1 reflux were younger, had lower BMI, and had a better clinical situation (p=0.002). VCSS was associated with perimalleolar region involvement, as increased in type 2 reflux than type 1, and higher VCSS was related to SFJ involvement as defined in type 3 reflux. Type 4 reflux patients had the highest VCSS that means the most severe clinical presentation. Sclerotherapy was the most common treatment modality in type 1 reflux (p<0.001). Also, in type 2 and type 4 reflux, sclerotherapy was more preferred than type 3 (p<0.001). Type 4 reflux pattern required mostly radiofrequency ablation, compared with type 3 (28.2% vs 20.5%; p<0.05) after initial diagnosis. Cyanoacrylate glue embolization was the appropriate therapeutic option in only 3.2% of type 4 reflux patients, which was significantly lower than type 3. Conclusion: According to the reflux pattern classification system based on SFJ and malleolar region involvement as practiced in this study, we described a correlation between VCSS, CEAP, BMI, and the extent of venous insufficiency. This correlation with consideration of cosmetic reasons and vein diameter measurements can suggest further treatment modality. Advances in knowledge: We investigated a practical, clinically applicable, and widely accepted standard method for classifying GSV insufficiency. Mapping venous insufficiency with such a system is essential to determine the clinical severity and the most appropriate treatment modality.

Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: Short-term results

Mechanochemical Ablation Vs. Thermal Ablation in GSV Insufficiency: Results of a RCT after 3-Year Follow-up

In this study, we present our early outcomes of cyanoacrylate ablation (CA) versus endovenous laser ablation (EVLA) for the treatment of great saphenous vein (GSV) insufficiency in the Chinese mainland population. We retrospectively analyzed 108 patients (53 patients in the CA group and 55 patients in the EVLA group) with GSV insufficiency who were treated with CA and EVLA between May 2020 and May 2021. The Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were used to assess clinical symptoms and quality of life, respectively. Total closure rates and procedure-related adverse events were also recorded in both groups. There was no significant difference between patients treated with CA or EVLA in terms of demographic and clinical characteristics. The average procedure time was 17min in the CA group and 35min in the EVLA group (p < 0.001). The CA group had lower pain scores during the procedure and 3days afterward than the EVLA group (p < 0.001). At month 12, the CA group had a 90.4% closure rate, while the EVLA group had an 83.0% closure rate, with no significant difference between the two groups (p > 0.05). There was no significant difference in the Venous Clinical Severity Score or Aberdeen Varicose Vein Questionnaire score between the groups (p > 0.05). During follow-up, neither group experienced any significant adverse events, such as pulmonary embolism or deep venous thrombosis. The incidence of ecchymosis and paresthesia was significantly lower in the CA group than in the EVLA group (p < 0.05). Cyanoacrylate ablation has a high feasibility profile and is an effective approach to accomplish complete GSV target vein closure at early follow-up in the Chinese patients. Compared to EVLA, the improvement in quality-of-life outcomes is also sustained and similar, with less pain and fewer complications due to the absence of tumescence anesthesia and postprocedural compression stockings.

Introduction: Chronic lower limb venous insufficiency is becoming common worldwide. The location and distribution of venous insufficiency correlates with clinical features and contributes to determining treatment strategy. Methods: Descriptive cross-sectional study, performed at Dong Nai General Hospital from May 2023 to May 2024. The research subjects were cases of venous insufficiency diagnosed with Doppler ultrasound. The reflux patterns of great saphenous vein insufficiency are classified into 4 types as follows: type 1, reflux in both the ankle and saphenofemoral junction; type 2, ankle reflux, preserved saphenofemoral junction; type 3, reflux at the saphenofemoral junction, preserved ankle area; type 4, total great saphenous vein reflux Results: There were 130 patients participating in the study. Average age is 59 ± 11 years, female/male ratio = 2.2. The rate of great saphenous, lesser saphenous, and deep vein insufficiency is 91.0, 15.8 and 15.0%, respectively. The majority of patients are in stage C2 with 37.6%. The most common locations for great saphenous vein reflux are mid-thigh, above the knee and below the knee (&gt;70%). 96.7% of cases have reflux in the middle of the thigh and/or below the knee. The rates of reflux types 1, 2, 3, and 4 of the great saphenous vein are 34.2; 24.3; 23.7 and 17.8%. CEAP 4 has the highest incidence in types 3 and 4 and the lowest in type 1. VCSS scores in types 1 and 2 are significantly smaller than those in types 3 and 4. Conclusion: Great saphenous vein insufficiency is most common in patients with venous insufficiency. Terminal valve regurgitation (types 3 and 4) is associated with clinical severity. Checking for reflux at the mid-thigh and below-the-knee locations may increase the likelihood of detecting great saphenous vein insufficiency.

Aim: In this study, we aimed to investigate the efficacy of endovenous laser ablation (EVLA) and EVLA combined with ultrasound-guided foam sclerotherapy (UGFS) and outcomes of treatments in patients with great saphenous vein (GSV) and perforating vein (PV) insufficiency. Material and Method: Patients underwent EVLA and EVLA+UGFS at the Interventional Radiology Department of a tertiary referral hospital over a 2-year period were retrospectively analysed. Lower limbs of patients were divided into 2 groups according to the treatment method: lower limbs underwent EVLA (group 1) and EVLA+UGFS (group 2). Before and after the procedures, GSVs and incompetent PVs were assessed by colour Doppler ultrasound. Chronic venous insufficiency symptoms (CVIS): pain, heaviness, night cramps, fatigue, itching, burning sensation, swelling, numbness, tingling and visual analogue scale (VAS) scores were assessed before and at 6 months after treatment. Results: The study group included 29 female (69.1%) and 13 male (30.9%) patients with a mean age of 49.8±12.5 years (range, 24-73 years). All treated GSVs and IPVs were occluded at 6 months after procedures. Improvement in one or more CVIS was observed in all limbs. Full recovery in CVIS was 11/38 (28.9%) in group 1 and 2/9 (22.2%) in group 2. No significant difference was found between the two groups in the comparison of the percentage reduction in the rate of full recovery of symptoms (p&gt;0.05). The VAS scores were significantly decreased after procedures in group 1 and 2 (p=0.0001 and 0.007, respectively). The difference in the percentage decrease in VAS scores in the 6th month compared to before treatment was not statistically different between the two groups (p&gt;0.05). Conclusion: EVLA and UGFS are highly effective and reliable treatments for GSV and PV insufficiency. EVLA+UGFS treatments provide similar improvements in CVIS in lower limbs with GSV and PV insufficiency. Patients with lower clinical severity, treatment only for GSV insufficiency may be considered instead of concomitant treatment of GSV insufficiency and PVI.

Aim: Our aim was to evaluate the two-year results of radiofrequency ablation (RFA) in the treatment of great saphenous vein (GSV) insufficiency. Methods: A total number of 217 patients who underwent RFA (52.5 % male, mean age 42.7±11.4) were included in the study. RFA was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score (VCSS) was calculated pre- and post-intervention. Results: The mean follow-up period of the patients was 22.2 ± 5.1 months. Cumulative survival rate (Kaplan–Meier) of 24-month follow-up was 84.3%. Complete occlusion rate for GSV was 100%, 98.6% ,97.6%, 97.6% and 97.6% for 1, 6, 12, 18 and 24 months follow up, respectively. VCSS was significantly different before RFA and 4 weeks after RFA (p &amp;lt; 0.001). No major complications were observed in the study. Conclusion: In the treatment of GSV insufficiency, RFA is a safely applied method with high occlusion rates and obvious VCSS score decrease.

Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins

Objective: This study aimed to compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein (GSV) insufficiency between diameters of 12 and 16 mm. Methods: This single-center retrospective study was conducted with 142 patients who underwent endovenous treatment with RFA (Group A; n=71) or CAC (Group B; n=71) for GSV insufficiency between June 2015 and June 2021. The patients who were followed for at least two years were included in the study. Patients who had a 12- to 16-mm target vessel diameter and two with grade 3 or 4 reflux were included. During follow-up, patients were evaluated with duplex ultrasonography and the Venous Clinical Severity Score (VCSS) at 1, 6, 12, and 24 months. Results: The mean GSV diameter was 13.21±1.00 for Group A and 13.51±0.97 for Group B. The groups did not differ in terms of age, sex, body mass index, clinical, etiological, anatomic, and pathophysiologic classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-h pain status, and postoperative 14-day patient satisfaction scale. The procedure time was significantly shorter in Group B. At one and six months, duplex ultrasonography revealed partial closure, and patency rates in Group B were significantly higher than those in Group A. At 12 and 24 months, closure rates did not show a statistically significant difference between the groups. Preoperative and one-month VCSS measurements did not show a statistically significant difference between groups. The 6-, 12-, and 24-month VCSS measurements of Group A were significantly higher than those in Group B. Conclusion: The complication rates were similar between the two techniques. Cyanoacrylate closure had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.

ObjectiveThis study aimed to compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein (GSV) insufficiency between diameters of 12 and 16 mm.MethodsThis single-center retrospective study was conducted with 142 patients who underwent endovenous treatment with RFA (Group A; n=71) or CAC (Group B; n=71) for GSV insufficiency between June 2015 and June 2021. The patients who were followed for at least two years were included in the study. Patients who had a 12- to 16-mm target vessel diameter and two with grade 3 or 4 reflux were included. During follow-up, patients were evaluated with duplex ultrasonography and the Venous Clinical Severity Score (VCSS) at 1, 6, 12, and 24 months.ResultsThe mean GSV diameter was 13.21±1.00 for Group A and 13.51±0.97 for Group B. The groups did not differ in terms of age, sex, body mass index, clinical, etiological, anatomic, and pathophysiologic classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-h pain status, and postoperative 14-day patient satisfaction scale. The procedure time was significantly shorter in Group B. At one and six months, duplex ultrasonography revealed partial closure, and patency rates in Group B were significantly higher than those in Group A. At 12 and 24 months, closure rates did not show a statistically significant difference between the groups. Preoperative and one-month VCSS measurements did not show a statistically significant difference between groups. The 6-, 12-, and 24-month VCSS measurements of Group A were significantly higher than those in Group B.ConclusionThe complication rates were similar between the two techniques. Cyanoacrylate closure had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.

Venous Compliance in Great Saphenous Vein Incompetence: Pre- and Post-interventional Changes

Single-center retrospective review of early outcomes of radiofrequency ablation versus cyanoacrylate ablation of isolated great saphenous vein insufficiency

This study aims to establish a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency and to evaluate the relationship between this classification, the demographics, and severity of clinical findings. This is a retrospective study from prospectively collected data of 503 patients who had the complaint of varicose vein. All patients had complete physical examination and their medical history was recorded. Lower limbs of all patients were examined with Doppler ultrasonography. A total of 787 limbs with great saphenous vein insufficiency were included in the analysis. The reflux patterns of great saphenous vein insufficiency were classified into 4 types as: type 1, great saphenous vein reflux without involvement of malleolar region and saphenofemoral junction (SFJ); type 2, reflux involving malleolar region with competent SFJ; type 3, reflux involving SFJ with competent malleolar region; and type 4, reflux involving both the SFJ and the malleolar region. We evaluated the association between the classification of great saphenous vein insufficiency and age, sex, body mass index (BMI), disease duration, clinical, etiological, anatomical and pathophysiological elements (CEAP) classification and venous clinical severity score (VCSS). The mean age of the patients was 45.3±11.7 years, with a male-to-female ratio of 2:3. The most common reflux pattern in patients with great saphenous vein insufficiency was type 3 (48.9%), while 14.8% of patients had type 1, 10.4% had type 2, and 25.7% had type 4. Patients with type I reflux pattern were younger in age (p = 0.002), had lower BMI (p = 0.002), fewer number of children (p = 0.008), as well as milder clinical severity score (p = 0.002) compared to other reflux types. Duration of disease symptoms was not significantly correlated with the reflux patterns, but VCSS increased with the involvement of malleolar region as in type 2 compared to type 1 (2.82±1.67 vs. 2.74±2.31), and further increased with the involvement of SFJ as in type 3 (4.13±2.92 vs. 2.82±1.67). Patients with diffuse reflux pattern (type 4) had the most severe clinical presentation (4.59±2.9). We developed a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency based on the involvement of malleolar region and/or SFJ. We showed an association between weight, BMI, VCSS, CEAP classification and the extent of insufficiency.

Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up.