Ablation Of Great Saphenous Vein Research Articles

Patients with Acute Phlebitis Can be Treated Safely with Great Saphenous Vein Ablation

Patients with Acute Phlebitis Can be Treated Safely with Great Saphenous Vein Ablation

Impact of Great Saphenous Vein Ablation on Healing and Recurrence of Venous Leg Ulcers in Patients with Post-thrombotic Syndrome: A Retrospective Comparative Study

Impact of Great Saphenous Vein Ablation on Healing and Recurrence of Venous Leg Ulcers in Patients with Post-thrombotic Syndrome: A Retrospective Comparative Study

Microwave versus endovenous laser in great saphenous vein ablation: a randomized controlled clinical study

Background Due to the global burden of varicose veins (VVs) and the impact on the quality of life (QoL) of patients, it is essential to search for better treatment modalities. Objectives The main objective of this research was to compare the efficacy, safety, and impact on the QoL of endovenous microwave ablation (EMA) and endovenous laser ablation (EVLA) for the management of varicose veins of the great saphenous vein (GSV). Methods A comparative, multicenter, single-blinded, parallel randomized controlled study conducted on 340 patients confirmed to have primary VVs of the GSV who were further randomized into two groups. The study group (n=170) received EMA, and the control group (n=170) received EVLA. Results Both the study group and the control group were comparable with regard to their baseline characteristics (P values > 0.05). The study group and the control group were comparable with regard to the limb affected (P=0.184). Only 14.7% and 10.0% of the study group and the control group have both limbs affected. Both the study group and the control group were comparable with regard to CEAP classification (P=0. 068). The study group and the control group were significantly different with regard to operating time (P<0.001). The operating time is less in the study group than in the control group. The median (IQR) and the mean±SD of the operating time was 7 (4) and 8.7±4.1 min in the study (microwave) group and 9 (5) and 10±3.9 min in the control group. Also, the study group and the control group showed 100% success at the 1-week evaluation as none of the cases in both groups suffered recanalization. At 6-month evaluation, only 1 case in the study group and 2 cases of the control group experienced recanalization; however, the difference is not significant (P=0.537). At the 12-month evaluation, the study group and the control group showed 100% success as none of the cases in both groups suffered recanalization. QoL is better in the study group than the control group at 6 months Aberdeen score (P=< 0.001). The median IQR and the mean±SD of the postoperative Aberdeen score were 9 (2.7) and 9.3±1.7 in the study (microwave) group and 10.8 (3.4) and 10.8±1.8 in the control group. Moreover, the study group and the control group were comparable (P values > 0.05) with regard to adverse events except for paresthesia (P-value = 0.025). About 11.2% of the control group experienced paresthesia versus only 2.9% of the study group. Conclusion In conclusion, EMA has a lower operating time than EVLA. EMA is as effective as EVLA for treating VVS of the GSV. EMA has fewer adverse events than EVLA. EMA has better QoL than EVLA ablation. However, the choice of treatment should be based on individual patient characteristics and the expertise of the treating physician.

Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study

BackgroundThe optimal treatment approach for patients with active venous leg ulcers (VLUs) and post-thrombotic syndrome (PTS) associated with great saphenous vein (GSV) reflux remains unclear. To address this gap, we retrospectively compared the outcomes of patients with post-thrombotic VLU with an intact GSV vs those with a stripped or ablated GSV. MethodsWe retrospectively analyzed data from 48 patients with active VLUs and documented PTS, who were treated at a single center between January 2018 and December 2022. Clinical information, including ulcer photographs, was recorded in a prospectively maintained digital database at the initial and follow-up visits. Two patient groups—group A (with an intact GSV) and group B (with a stripped or ablated GSV)—were compared in terms of time to complete healing, proportion of ulcers achieving complete healing, and ulcer recurrence during the follow-up period. ResultsThere were no significant differences in age, gender, initial ulcer size, or ulcer duration between the two groups. All included patients had femoropopliteal post-thrombotic changes. Group A had significantly more completely healed ulcers (33 of 34 ulcers, 97%) compared with group B (10 of 14 ulcers, 71%) (P = .008). Group A also exhibited a significantly shorter time to complete ulcer healing (median: 42.5 days, interquartile range [IQR]: 65) compared with group B (median: 161 days, IQR: 530.5) (P = .0177), with a greater probability of ulcer healing (P = .0084). Long-term follow-up data were available for 45 of 48 patients (93.7%), with a mean duration of 39.6 months (range: 5.7-67.4 months). The proportion of ulcers that failed to heal or recurred during the follow-up period was significantly lower in group A (9 of 32 ulcers, 27%) compared with group B (11 of 13 ulcers, 85%) (P = .0009). In addition, in a subgroup analysis, patients with an intact but refluxing GSV (12 of 34) had a significantly shorter time to heal (median: 34 days, IQR: 57.25) (P = .0242), with a greater probability of ulcer healing (P = .0091) and significantly fewer recurrences (2 of 12, 16%) (P = .006) compared with group B. ConclusionsOur findings suggest that removal of the GSV through stripping or ablation in patients with post-thrombotic deep venous systems affecting the femoropopliteal segment may result in delayed ulcer healing and increased ulcer recurrence. Patients with an intact GSV had better outcomes, even when the refluxing GSV was left untreated. These findings emphasize the potential impact of GSV treatment on the management of VLUs in individuals with PTS. Further investigation is needed to validate these results and explore alternative therapeutic strategies to optimize outcomes for this patient population.

Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins

Background: Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P<0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.

Endovenous laser ablation and drug treatment of acute great saphenous vein ascending thrombophlebitis: comparison of three approaches to the treatment of patients

Aim. In patients with acute thrombophlebitis of the great saphenous vein and/or large tributaries, compare the effectiveness and safety of 1,5-month fondaparinux sodium therapy and endovenous laser ablation in the area of the saphenofemoral junction in combination with shortterm anticoagulation or without anticoagulant therapy.Material and methods. This prospective, single-center, randomized, open-label clinical trial included 105 patients with acute great saphenous vein thrombophlebitis at a distance of at least 5 cm from the saphenofemoral junction. Thirty-four patients were randomized into the group of endovenous laser ablation in the area of the saphenofemoral junction without the anticoagulant therapy. The group of endovenous laser ablation in combination with 7-day fondaparinux sodium included 35 patients, while the group of 1,5-month treatment with fondaparinux sodium — 36. In all cases, class 2 compression stockings were used for 1,5 months. Clinical manifestations of venous thrombosis and its prevalence according to compression ultrasonography were assessed in the first 45±2 days from the start of treatment.Results. The mean age of patients was 49,1±13,7 years. There were more women (73,3%). The prevalence of risk factors for the occurrence and progression of venous thrombosis was low. Previous episodes of thrombophlebitis were observed in 3 (2,9%) patients. External factors that could provoke venous thrombosis were identified in 21 (20,0%) patients. Thrombosis was located in the great saphenous vein in 97,1% of patients, while large tributaries were involved in 25,7% of cases. The median distance from the proximal thrombus to the saphenofemoral junction was 45,2 cm. Patients randomized to the pharmacotherapy group were significantly older (mean age 49,1±13,7, 45,9±13,3 and 53,8±13,2 years, respectively; p=0,032), had slightly less pain and swelling. In all patients, after endovascular laser obliteration, a stable flow cessation at the intervention site was achieved. There were no cases of progression of venous thrombosis. After 7±2 days, in all groups there was a significant decrease in the proportion of patients with clinical manifestations of venous thrombosis, as well as the severity of persistent clinical manifestations. After 45±2 days, clinical manifestations were observed in a few patients and their severity was minimal. However, in the drug treatment group, a more frequent persistence of edema was noted both after 7±2 days (26,5, 20,0 and 47,7%, respectively; p=0,036) and after 45±2 days, (0, 2,9 and 16,7%, respectively; p=0,01). Hematomas and bruises were exclusive hemorrhagic complications. Hematomas were revealed in groups with endovenous laser ablation only. All hemorrhagic complication were minor according to World Society of Thrombosis and Hemostasis (ISTH) and type 1 according to Academic Research Consortium (BARC) classifications.Conclusion. In outpatients with low risk of recurrence and mainly distal localization of acute thrombophlebitis of the great saphenous vein and/ or large inflows, endovenous laser ablation close to saphenous vein junction without anticoagulation or with 7 days of anticoagulation and medical treatment with 1,5-month anticoagulation had comparable efficacy and invasive treatment was sufficiently safe.

Laser-sclerosing foam hybrid treatment, a non-tumescent technique for insufficient great saphenous vein ablation.

We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency.

Endovenous laser ablation of great saphenous vein and pharmacotherapy of acute ascending thrombophlebitis: results of a three-month follow-up

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

May Thurner Syndrome: Diagnostic and Therapeutic Outcomes in an Institutional Setting

Introduction: May-Thurner syndrome (MTS), a chronic compression of left common iliac vein (CIV) against the lumbar vertebrae by overlying common iliac artery is an underappreciated contributor to left leg deep venous thrombosis. Even though the estimated prevalence of MTS is high in left-leg deep vein thrombosis (DVT) cases per autopsy studies, the clinical association remains low. Since the screening for MTS in patients with recurrent left-leg DVTs is not a common practice, diagnosis can either be incidental or a combination of clinical presentation and objective testing. Diagnosis is challenging via ultrasound (US) due to the deep anatomical location of iliac veins; therefore, invasive imaging including Contrast venography (CTV) is needed for confirmation. The management of MTS has been reformed over the years with the advances in minimally invasive therapeutic tools. We sought to review the management and outcomes of the MTS adult population by conducting a retrospective review to identify all adult cases of MTS at our academic safety net hospital between 2010 and 2022. Methods: Data was extracted and analyzed for baseline parameters including age, gender, ethnicity, and body mass index (BMI). Presenting symptoms, imaging used for MTS diagnosis (including US Doppler, magnetic resonance venography or CTV), and interventional approaches (catheter or systemic thrombolysis, thrombectomy, balloon angioplasty and/or stent placement) were additionally documented. SAS v9.4 (Cary, NC) was used for statistical analysis. Results: A total of 19 cases, predominantly females 68% (13/19), with a median age of 48 years and a mean BMI of 28.84 kg/m 2 diagnosed with MTS were identified. The predominant initial presentation was left lower extremity edema and pain 36% (7/19) later found to have a DVT, followed by non-healing venous ulcer 15% (3/19) and pelvic congestion syndrome 0.05 % (1/19). Whereas 42% (8/19) of the patients were diagnosed with MTS while undergoing evaluation for chronic and recurrent DVTs. All patients were diagnosed following CTV using transvenous pressures with the formation of collateral veins and a pressure gradient of more than 2 mm Hg across iliofemoral stenosis at rest. Sixteen patients (84%) underwent endovascular stent placement, while one patient underwent Balloon Angioplasty only. One patient refused any intervention for MTS however underwent great saphenous vein ablation for chronic venous wounds. In view of anticoagulation therapy, the initial choice in the most cases was low molecular weight heparin (LMWH), which was later transitioned to other choices, 81 % (10/16) were switched to direct oral anticoagulants, (apixaban= 10, rivaroxaban=3) due to ease of administration and compliance, while 19 % (3/16) were continued on LMWH for patient preference and pregnancy. Post-intervention complications consisted of stent failure in 25% (4/16) patients; related to stent thrombosis and Post-thrombotic Syndrome (PTS) in 12.5 % (2/16) patients. No bleeding complications were seen post any case of endovascular stent placement. Conclusion: This review was a highly educational experience giving us insight into this unacknowledged syndrome. Multiple factors could be contributing to this underdiagnosis, including invasive gold standard imaging for MTS, more easily recognizable risk factors for DVTs that can overshadow MTS, and a smaller number of data and studies. Some authorities have advocated a need to rule out MTS in young women with acute left lower extremity DVT, a clear female predominance was also noted (68%) in our analysis. Post-stent placement, systemic anticoagulation for 3-6 months is recommended, in our review, all patients (100%) who underwent stent placement were started on anticoagulation for at least 3 months. A small sample size, patients lost to follow-up (poor outcomes and complications could have been missed) and a single institutional review were some limitations of our study, however with a rare disease such as MTS with 2-3% prevalence it is difficult to conduct a large size, multi- institutional analysis. This study contributes to the limited literature available on MTS.

Variations and inconsistencies in venous ablation coverage policies between single-state and multistate carriers in the United States

BackgroundVein ablation is a common and effective treatment for patients with chronic venous insufficiency. The overuse of vein ablation despite the existence of evidence-based guidelines has resulted in insurance companies developing restrictive policies for coverage that create barriers to appropriate care. This study compares the insurance coverage by single-state carriers (SSCs) and multistate carriers (MSCs), highlighting the variations and inconsistencies in the various policies. MethodsThe American Venous Forum Venous Policy Navigator was reviewed for the various policies available in the United States. The policies were divided into SSCs and MSCs. The characteristics of the policies, including the anatomic and hemodynamic criteria for specific veins, duration of conservative treatment, disease severity, symptoms, and types of procedures covered, were compared between the two groups. SAS, version 9.4 (SAS Institute Inc) was used for statistical analysis. ResultsA total of 122 policies were analyzed and divided between SSCs (n = 85; 69.7%) and MSCs (n = 37; 30.3%). A significant variation was found in the size requirement for great saphenous vein ablation. Although 48% of the policies did not specify a size criterion, the remaining policies indicated a minimal size, ranging from 3 to 5.5 mm. However, no significant differences were found between SSCs and MSCs. Similar findings were encountered for the small and anterior accessory saphenous veins. MSCs were more likely to define a saphenous reflux time >500 ms compared with SSCs (81.1% vs 58.8%; P = .04). A significant difference was found between the SSCs and MSCs in the criteria for perforator ablation in terms of size and reflux time. MSCs were significantly more likely to provide coverage for mechanochemical ablation than were SSCs (24.3% vs 8.2%; P = .03). SSCs were more likely to require ≥12 weeks of compression stocking therapy than were MSCs (76.5% vs 48.7%; P = .01). No significant differences were found in the clinical indications between the two groups; however, MSCs were more likely to mention major hemorrhage than were SSCs. ConclusionsThe results of this study highlight the variations in policies for venous ablation, in particular, the striking inconsistencies in size criteria. MSCs were more likely to cover mechanochemical ablation and require a shorter duration of conservative therapy before intervention compared with SSCs. Evidence-based guidance is needed to develop more coherent policies for venous ablation coverage.

Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins: Presented at the Thirty-fifth American Venous Forum Annual Meeting, Venous 2023, San Antonio, TX, February 23-25, 2023.

Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins: Presented at the Thirty-fifth American Venous Forum Annual Meeting, Venous 2023, San Antonio, TX, February 23-25, 2023.

Black or African American patients undergo great saphenous vein ablation procedures for advanced venous disease and have the least improvement in their symptoms after these procedures

ObjectiveChronic venous insufficiency is an increasingly prevalent problem in the United States, with >25 million individuals currently affected. Previous work has shown that racial minorities and low socioeconomic status are associated with a worse clinical presentation and response to treatment. The present study aimed to determine the relationship between race, patient variables, hospital outcomes, and response to treatment for patients presenting for chronic venous insufficiency intervention. MethodsWe performed a retrospective analysis of all patients who underwent endovenous ablation (radiofrequency or laser) of the great saphenous vein to treat symptomatic, chronic venous insufficiency using Vascular Quality Initiative data from 2014 to 2020. Patient characteristics and outcomes were analyzed stratified by patient race. The χ2 test and the Kruskal-Wallis equality-of-populations rank test were used to measure the study outcomes. The primary outcomes were an improved venous clinical severity score and improvement in patient-reported outcomes. Patient characteristics, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, prior venous interventions, length of stay, and time to follow-up were compared between races. ResultsThe database consisted of 9009 predominantly female patients (n = 6041; 67.1%), with a mean age distribution of 56 years. Of the 9009 patients, 7892 are White (87.6%), 627 Hispanic (6.9%), and 490 Black or African American (18.3%). The Hispanic cohort was younger than their White and Black/African American counterparts. Black/African American patients presented with more advanced clinical stages than did the White and Hispanic groups. The clinical stage according to race was as follows: C3—Black/African American, 32.9%; Hispanic, 38.9%; White, 46%; C5—Black/African American, 4.7%; Hispanic, 2.1%; White, 2.3%; and C6—Black/African American, 12.7%; Hispanic, 3.2%; White, 6.2%. Black/African American patients were more likely to present as overweight or obese (66%; P < .001) and less likely to be taking anticoagulation medication preoperatively (11%; P < .001). Non-White race was associated with a higher probability of treatment in the hospital setting (Black/African American, 63.6%; Hispanic, 87.5%; P < .001). Black/African American patients (3.25 ± 4.4; P < .001) demonstrated lower mean improvement postoperatively in both the venous clinical severity score and patient-reported outcomes than their White (4.25 ± 4.13, P <.001) and Hispanic (4.42 ± 3.78; P < .001) counterparts. ConclusionsDifferences exist in the clinical severity and symptom presentation based on race. Black/African American patients present with more advanced chronic venous insufficiency than do their White and Hispanic counterparts. Furthermore, the postprocedural analysis showed inferior clinical and self-reported improvement in chronic venous insufficiency for the Black/African American patients. Although the Hispanic population was younger, the White and Hispanic patients experienced similar responses to treatment.

Femoral nerve blockade during endovenous laser ablation of great saphenous vein decreases pain but does not affect the use of opioids during the procedure

BackgroundEndovenous laser ablation (EVLA) using tumescent anesthesia for treatment of an insufficient great saphenous vein (GSV) can be painful and require intravenous pain management and, sometimes, sedation with propofol. Femoral nerve blockade (FNB) anesthetizes the femoral nerve distribution and is usually used for anterior thigh and knee procedures. It is easy to inject with ultrasound guidance because the nerve is easy to visualize in the groin. The aim of the present double-blind, randomized controlled trial was to determine whether FNB before tumescent anesthesia decreases the pain of GSV EVLA combined with local phlebectomy. MethodsEighty patients who underwent GSV EVLA combined with local phlebectomy under tumescent anesthesia were randomized into two groups. The placebo group (control group; 40 patients) was given placebo FNB with 0.9% saline before tumescent injection. The FNB group (intervention group; 40 patients) received 1% lidocaine with adrenaline for FNB before tumescent injection. Only the study nurse, who performed the randomization, knew which patients were in which group. The patients and operating surgeon were unaware of the randomization group. FNB was performed under ultrasound guidance. The effectiveness of anesthesia was tested 10 minutes after injection using the pin-prick test and a numeric rating scale (NRS). The NRS was completed before and during tumescent anesthesia and during EVLA ablation and local phlebectomy. The motor function of the femoral nerve was tested at the end of the procedure and 1 hour after using the Bromage method. Patients had a follow-up visit 1 month after the procedure, and their need for pain medication and the duration of sick leave were recorded. ResultsNo differences were found in the gender distribution, age, or GSV dimensions at baseline. The mean length of the treated GSV segment was 28 cm and 30 cm and the mean energy used was 1911 J and 2059 J in the placebo and FNB groups, respectively. The median NRS score for pain during tumescent injection around the GSV was 2 (interquartile range [IQR], 1-4) in the placebo group compared with 1 (IQR, 1-3) in the FNB group. Very little pain was experienced during laser ablation. The median NRS score was 0 (IQR, 0-0) and 0 (IQR, 0-0.75) in the placebo and FNB groups, respectively. The most painful stage was injection of tumescence to the local phlebectomy sites in both groups. The median NRS score was 4 (IQR, 3-7) in the placebo group and 2 (IQR, 1-4) in the FNB group (P = .01). During local phlebectomy, the NRS score was 2 (IQR, 0-4) vs 1 (IQR, 0-3) in the placebo and FNB groups, respectively. Only the difference in pain during injection of tumescence before local phlebectomy was significant. ConclusionsFNB seems to decrease pain during EVLA combined with local phlebectomy. Patients experienced the highest pain when tumescence was injected before local phlebectomy, and those in the FNB group experienced significantly less pain than the placebo group. No indication for routine use of FNB is indicated. However, it could be used to decrease the pain for patients who experience strong pain during varicose vein surgery, especially if extensive local phlebectomies are required.

Outcome Of The Compression Dressing For Two Days Vs Seven Days After Varicose Vein Surgery.

Incompetence of the great saphenous vein (GSV) is a global issue and the most prevalent cause of chronic venous disease of the leg. Clinical manifestations range from moderate to severe, including tiredness, heaviness, and irritation, as well as hyperpigmentation and leg ulcers. Significant advancements in GSV ablation employing percutaneous methods, such as endovenous laser ablation, have been made in recent years. (EVLA). The objective of the study is to compare the outcome of the compression dressing for two days vs. seven days after varicose vein surgery. This case control study was performed on the Surgical floor, Mayo Hospital, Lahore, from September 15 to March 15, 2020. We took a sum of 60 patients admitted from the outpatient department fulfilling the inclusion criteria after the approval of the ethical committee of the hospital. Group-A wore compression dressing for 2 days after surgery and Group-B wore compression dressing for seven days after surgery. Each patient received 1gm paracetamol I/V 8 hourly followed by tab. paracetamol 500mg P/O 8 hourly. Then the outcome of compression dressing was analyzed in the form of mean postoperative pain. The mean pain score was assessed in 1 week. Data were entered in SSPS v23.0 and stratification of pain score was done against age, gender, and grades of varicose veins. A comparison of the two groups was done by applying a t test. A p-value ≤0.05 was considered statistically significant. We took a sum of 60 patients with Primary varicose veins based on their eligibility for this study. Patients were divided into two groups, i.e., Group-A (Compression dressing for 2 days) and Group-B (Compression dressing for 7 days). The average ages of patients in group A were 33.4±9.6 years and in group, B was 35.4±9.9 years. A mean pain score of 4.5±1.2 was noted in patients in group-A (Compression dressing for 2 days) while 2.9±0.8 in patients in group B (Compression dressing for 7 days) with a p-value of 0.0001 which is statistically significant. When compression stockings are used for more than two days after the Trendelenburg procedure is done, it can lead to lesser pain and enhanced physical activity in the first-week post operatively.

Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins

BackgroundMicrofoam ablation (MFA) and radiofrequency ablation (RFA) are both approved by the Food and Drug Administration for treatment of proximal saphenous truncal veins. The objective of our study was to compare early postoperative outcomes between MFA and RFA following treatment of incompetent thigh saphenous veins. MethodsA retrospective review of a prospectively maintained database was conducted of patients who underwent treatment of incompetent great saphenous veins (GSVs) or anterior accessory saphenous veins (AASVs) in the thigh. All the patients underwent duplex ultrasound of the treated leg at 48 to 72 hours postoperatively. Patients were excluded from analysis if concomitant stab phlebectomy was performed. Demographic data, CEAP (clinical, etiologic, anatomic, pathophysiologic) class, venous clinical severity score (VCSS), and adverse events were recorded. ResultsBetween June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent venous closure for symptomatic reflux. A total of 200 consecutive thigh GSVs and ASVs treated within the study period using either MFA (n = 100) or RFA (n = 100) were identified. The patients were predominantly women (69%) with a mean age of 64 years. The preoperative CEAP classification was similar between the MFA and RFA groups. The mean preoperative VCSS was 9.4 ± 2.6 for the RFA patients and 9.9 ± 3.3 for the MFA patients. Among the RFA patients, the GSV was treated in 98% and the AASV in 2% compared with the GSV in 83% and the AASV in 17% in the MFA group (P < .001). The mean operative time was 42.4 ± 15.4 minutes in the RFA group and 33.8 ±16.9 minutes in the MFA group (P < .001). The median follow-up was 64 days for the study cohort. The mean postoperative VCSS declined to 7.3 ± 2.1 in the RFA group and 7.8 ± 2.9 in the MFA group. Complete closure occurred in 100% of the limbs after RFA and 90% after MFA (P = .005). Eight veins were partially closed and two remained patent following MFA. The incidence of superficial phlebitis was 6% and 15% (P = .06) after RFA and MFA, respectively. Overall, symptomatic relief was 90% following RFA and 89.5% following MFA. The complete ulcer healing rate for the entire cohort was 77.8%. Deep venous proximal thrombus extension (RFA, 1%; vs MFA, 4%; P = .37) and remote deep vein thrombosis (RFA, 0%; vs MFA, 2%; P = .5) showed a trend toward being higher following MFA but the difference did not reach statistical significance. All were asymptomatic and resolved with short-term anticoagulation therapy. ConclusionsMFA and RFA are both safe and effective for treating incompetent thigh saphenous veins, with excellent symptomatic relief and a low incidence of postprocedure adverse thrombotic events. RFA resulted in improved complete closure rates following initial treatment compared with MFA. The operative times were shorter with MFA. Both modalities can be used for patients with active venous ulcers with good healing rates. Longer term studies are required to characterize the durability of MFA closure for above knee truncal veins.

Comparison of Outcomes Following Polidocanol Microfoam Sclerotherapy and Radiofrequency Ablation of Incompetent Thigh Great and Accessory Saphenous Veins

Comparison of Outcomes Following Polidocanol Microfoam Sclerotherapy and Radiofrequency Ablation of Incompetent Thigh Great and Accessory Saphenous Veins

Safety and effectiveness of indirect radiofrequency ablation (closure FAST) of incompetent great saphenous veins with Type I aneurysms: Long-term results radiofrequency ablation for saphenous aneurysms.

Assess the safety and effectiveness of indirect radiofrequency ablation (RFA, Closure FAST) for the treatment of incompetent great saphenous veins (GSVs) with type 1 aneurysms. This was a retrospective analysis performed in three centers (2007-2021). All patients presenting with saphenous aneurysms close to the junction (within 2cm) were included. They were treated with RFA. Phlebectomies and/or sclerotherapy were performed during the same treatment session. Duplex ultrasound (DUS) was performed early after the procedure and then, more than a year later. Eight patients (11 limbs) were included between June 2007 and May 2021 with a median diameter of the GSV aneurysm 21mm (IQR 17.2-23.4). No severe adverse events occurred apart from one endovenous heat-induced thrombosis (EHIT) class III (9.1%). After more than a year (mean 7.2 ± 4.2, median 8years), none of the aneurysms was present on DUS and the truncal obliteration rate was 100%. RFA appears to be a safe and effective treatment for patients presenting with incompetent saphenous veins with the type 1 aneurysm.

Prospective randomized trial of antithrombotic strategies following great saphenous vein ablation using injectable polidocanol endovenous microfoam (Varithena)

ObjectivePostablation deep vein thrombosis (DVT) represents a potentially serious complication after Varithena polidocanol endovenous microfoam (PEM) ablation. The following primary outcomes were assessed: whether (1) adjunctive apixaban anticoagulation or (2) mechanical deep venous system (DVS) saline flushing could decrease saphenofemoral junction (SFJ) thrombus extension (postablation superficial thrombus extension [PASTE]) and/or DVT compared with compression alone, after great saphenous vein (GSV) PEM ablation. MethodsVarithena 1% PEM ablation patients were randomized to (1) SFJ compression, (2) compression and DVS saline flushing, or (3) compression, DVS saline flushing, and 5 days of postprocedural 5 mg oral apixaban anticoagulation twice daily. Duplex imaging was obtained 7 to 10 days after PEM ablation and PASTE/DVT incidence (primary end point) was compared between groups at this time point. ResultsWe treated 304 limbs in 257 patients with PEM. Overall, 103 limbs received SFJ compression (group C, 33.8%), 101 received compression and deep venous flushing (group D, 32.9%), and 100 received compression, deep flush, and anticoagulation (group A, 33.2%). Mean ultrasound follow-up time was 9.7 days (all patients) with a primary GSV closure rate of 92.4%. SFJ PASTE (II-IV) occurred in 0.9%, 1.0%, and 0% (groups C, D, and A, respectively). DVT occurred in 16.7%, 14.7%, and 1.98% (groups C, D, and A; χ2, P = .002). Patients in group A receiving apixaban anticoagulation had a significant reduction in DVT compared with patients in group C (1.98% vs 16.7%, χ2; P < .001); likewise, patients in group A had a significantly decreased DVT occurrence compared with group D (14.7% vs 1.98%; χ2, P = .00162), whereas patients in groups C and D were not statistically different (16.7% vs 14.7%; χ2, P = .60). Conclusions(1) Neither adjunctive DVS flushing nor anticoagulation decreased clinically relevant SFJ PASTE (II-IV) incidence, which remained similarly low across all groups and ranged between 0% and 1%, regardless of adjunctive DVS flushing or anticoagulation. This rate was significantly lower than prior reports (2.3%-4.1%). (2) DVS flushing had no influence on the rate of DVT. Observed PEM-induced DVT incidence using SFJ compression alone or compression with DVS flushing (16.7% and 14.7%, respectively) was significantly higher than prior reports (2.5%-9.6%). This finding may relate to the greater extent of AK/BK GSV territory treated in the present study. (3) Five days of postprocedural oral apixaban anticoagulation, 5 mg given twice daily, significantly decreased DVT occurrence to 1.98%, compared with nonanticoagulated patients (16.7%). This finding is comparable with the DVT rates reported after endovenous thermal ablation (0.7-1.7%). (4) Postprocedural apixaban anticoagulation may have a significant preventive role in decreasing DVT occurrence after PEM ablation.

Correlation between reflux time and venous clinical severity score in patients undergoing saphenous vein ablation: A prospective study

It is unclear whether reflux time independently correlates with severity of symptoms in patients with great saphenous vein reflux. Eighty patients (mean age 64+/-12.7years, 56% female) undergoing great saphenous vein (GSV) ablation for symptomatic reflux were assessed prospectively. Fifty-seven underwent ablation with radiofrequency, 23 with cyanoacrylate adhesive. Venous clinical severity score (VCSS) was assessed at, or prior to the time of ablation. The highest reflux time in the GSV was selected. VCSS values ranged from 2 to 20 (median 7). Mean reflux time was 5.3 s (+/-3.3). The Spearman rank correlation yielded a value of rs = -0.123, p (2-tailed) = .279, which was not significant. The patients with concomitant deep vein reflux had higher VCSS (p < .05). Analysis of patients with only superficial vein reflux (n = 45) also demonstrated a poor correlation between VCSS and reflux time (rs = -0.051, p (2-tailed) = .741). This prospective study did not demonstrate a correlation between reflux time and VCSS.

Non-randomized comparative study of three methods for great saphenous vein ablation associated with mini-phlebectomy; 48 months clinical and sonographic outcome

BackgroundVaricose veins are one of the earliest clinical features of superficial venous insufficiency (SVI) of the lower limbs that affects around 20–40% of the population with a lot of burden on patients’ quality of life (QoL) and health systems if left untreated. They are defined as subcutaneous veins in the lower extremities which are dilated to ≥3 mm in diameter in the upright position and retrograde flow of >0.5 s in duration. (VVs) could occur in the great saphenous vein (GSV) or small saphenous vein (SSV) and/or in any of their tributaries. MethodsA prospective non-randomized comparative study for three methods of treatment of varicose veins was conducted. All symptomatic varicose veins with Clinical, Etiological, Anatomical, Pathophysiological (CEAP) Clinical classes of 2 or greater and demonstrated venous reflux with a duration of 0.5 s or greater on duplex ultrasound imaging GSV larger than 10 mm in diameter by duplex ultrasound were included. ResultsA total of 150 patients with 183 legs in all three groups are treated. The mean age of the patients in all groups was comparable (37.32) years, and a total of 87% were women. Demographic and preoperative clinical features, presentations, and anatomic characteristics were comparable in all groups. Disfigurement was the main presenting complaint in all. All postoperative complications were significantly higher in the group of surgery over 48 months of follow up the degree of satisfaction measured by VCSS score was highest among the RFA group followed by the EVLA group. ConclusionThe results of our study suggest that the long-term results of endovenous thermal ablation methods (EVLA, RFA) are superior to open surgery for the management of varicose veins, with the RFA group showing better results in terms of improvement in QoL based on VCSS compared to the EVLA group.