Ablation Of Varicose Veins Research Articles

Randomized Controlled Trial of Compression After Endovenous Thermal Ablation of Varicose Veins (COMETA Trial)

Background The 21st century has witnessed a rise in the use of endovenous thermal ablation. Being highly clinically and cost-effective and improving the quality of life of patients, they are now considered to be the gold-standard treatment for varicose veins. Post-intervention management, especially in terms of postoperative compression, however, remains unclear. As a result, a randomized study was undertaken to investigate the effects of wearing compression stockings after varicose vein treatment. Method Patients with saphenous vein reflux undergoing treatment with endothermal ablation (with or without concurrent phlebectomies) were randomized to receive either 7 days of compression stockings or no stockings. The primary outcome measure for this study was the pain score over the first 10 postoperative days. The pain scores, clinical score, time to return to normal activities, and ecchymosis were assessed. Patients were followed-up at 2 weeks and 6 months post-ablation. Results In total, 206 patients were randomized, 49% of them to the compression group. The mean age was 49.7 (±16) years and approximately 51% of the population was male. The median pain score in the compression group using a visual analog scale was significantly lower on days 2-5, compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores on days 1-3, day 5, and day 7. Improvement in the median venous clinical severity score was noted at 6-month follow-up, but this was not significant. No difference in the generic- or disease-specific quality of life was observed and the time to return to activities was similar. There were no differences in the degree of ecchymosis between the 2 groups and both groups had similar occlusion rates. Conclusions These results indicate that wearing compression stockings after endothermal ablation is advantageous in the first few days after treatment and is especially beneficial for those having concurrent phlebectomies.

Endovenous microwave ablation of varicose veins: early Egyptian experience

Endovenous microwave ablation of varicose veins: early Egyptian experience

Editor's Choice - Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

This randomized controlled trial of 100 consecutive patients with symptomatic venous insufficiency underwent RFA for mostly C3 to C4 disease. Randomization was done at the end of the procedures, 80% had RFA of saphenous veins, with patients opening a sealed envelope. Patients who wore compression stockings following radiofrequency ablation (RFA) did not have better outcomes than those who did not wear compression. Class 2 (23-32 mm Hg) compression was applied to the compression cohort who wore the hose for 2 weeks. Multiple satisfaction questionnaires were completed by all participants. At 12 weeks, there were no differences in occlusion rates (98% both groups), mean Aberdeen Varicose Vein Severity Scores and Revised Venous Clinical Severity Scores, satisfaction and pain scores, and deep venous thrombosis events. Although this relatively small clinical trial showed that there was no added benefit to compression following RFA for venous insufficiency, it is interesting that compression was only worn for 2 weeks. It is good to know that patients who cannot tolerate compression or in whom lighter compression is used will not have decreased occlusion rates as a result. But we also know that recanalization is not always accompanied by recurrent symptoms. My take home message is not to decline treatment to a patient who cannot tolerate long-term compression.

A Novel Venous Puncture Method for Endovenous Laser Ablation of Varicose Veins in the Lower Limbs Using Smaller Diameter Optical Fiber

A Novel Venous Puncture Method for Endovenous Laser Ablation of Varicose Veins in the Lower Limbs Using Smaller Diameter Optical Fiber

Chemical and mechanochemical catheter-directed sclerotherapy in varicose vein ablation

Background Varicose vein, as well as the accompanied venous insufficiency, is a frequent disorder, affecting ∼30% of the Western population. Chronic venous insufficiency has a major effect on patients’ health-related quality of life, similar to different chronic disorders, including diabetes mellitus as well as cardiovascular diseases. Aim The aim of this study was to assess and compare the applicability, technique, and results of catheter-directed foam sclerotherapy in the management of varicose vein with and without mechanical injury to the vein wall. Patients and methods The study was conducted on 104 patients with primary varicose vein between November 2017 to October 2019. All patients were admitted to Vascular Surgery Department in Mansoura University hospitals. They were divided into two groups: group A (chemical ablation) included 79 patients, and group B (mechanochemical ablation) included 25 patients. Technique In chemical ablation group, catheter-directed foam sclerotherapy of great saphenous vein was done using Aethoxysklerol 3% by ureteric catheter. In mechanochemical ablation group, catheter-directed foam sclerotherapy of the great saphenous vein was done using Aethoxysklerol 3% through Flebogrif catheter. This was a nonrandomized prospective comparative study. Results Complete occlusion was reported at 3 months for all cases of group A (100%) and 19 (76%) of cases in group B, and after 6-month follow-up, occlusion occurred in 43 (54.43%) cases among group A and 22 (88%) of cases among group B and long-segment recanalization in 36 (45.56%) of cases among group A and three (12%) of cases among group B. Complications developed in 22 cases in group A and five cases in group B. In group A, 20 cases developed painful thrombophlebitis, one case reported DVT, and only one case reported respiratory distress. However, in group B, four cases developed painful thrombophlebitis and one case reported hyperpigmentation along the course of the vein. Patients in group B were more satisfied than group A patients, with significant difference, and also group B patients has less pain sensation than group A patients, with significant difference. Conclusions Catheter-directed foam sclerotherapy is accepted in the treatment of primary varicose vein with short-term and mid-term success in varicose vein ablation and has a low incidence of complications. Mechanochemical occlusion is preferred than catheter-directed foam sclerotherapy, with better results and fewer complications.

Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity?

This review suggests that there is a critical need to renew understanding of adverse events and complications within interventional radiology and to redefine a robust commitment to patient safety a...

Interesting Scenarios during Radiofrequency Ablation of Varicose Veins at University Hospital of Nepal.

A varicose vein is a common venous condition which affects the great saphenous vein and small saphenous vein causing symptoms of pain, edema, itchiness, pigmentation, and ulceration. There are various modalities of the treatment of varicose veins; however, radiofrequency ablation is among the tested and proven treatments for varicose veins. With every case, there can be some unexpected or interesting scenarios which can pose both technical and surgical difficulties. The main objective of this paper is to introduce these scenarios which can occur despite following the standard protocol and methods both preoperatively and intraoperatively. In these scenarios, the surgeon quickly need to decide how to deal with the aberrations. Based on extensive literature and consensus of a team of three vascular surgeons, lists of interesting scenarios were prepared along with their definition. Any occurrences of such scenarios were noted in the operation theatre note. Here, we describe 39 (6.38%) interesting cases among 611 cases of radiofrequency ablation that was performed in Dhulikhel Hospital, Kathmandu University Hospital, from January 2014 until December 2019. Despite following the proper protocol, we can face many unexpected challenges preoperatively, peroperatively, and postoperatively. From this article, we concluded that vigilance of all the factors and proper Doppler ultrasonography can help in identifying most of these scenarios and aid in making proper surgical planning.

Mechanochemical Endovenous Ablation of Varicose Veins in Pediatric Patients with Klippel-Trénaunay Syndrome: Feasibility, Safety, and Initial Results

PurposeTo evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS). Materials and MethodsThirteen MOCA procedures were performed in 11 patients (age range, 4–16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6–25 months). ResultsTechnical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period. ConclusionsMOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.

Endovenous Laser Ablation of Varicose Veins Using Radial Slim Fibers

直径5 mm以上の側枝静脈瘤を有する大伏在静脈弁不全の患者44名に対して，細径ファイバー（ELVeS radial 2ring slim fiber, 直径1.27 mm）を用いて血管内レーザー焼灼を行い，さらに16 G静脈留置針で静脈瘤を穿刺し内腔へファイバーを挿入，出力5 Wでレーザー焼灼を行った．93%の症例で9割以上の瘤消失が確認され，血栓性静脈炎や皮膚熱傷などの有害事象はみられなかった．

Endovenous Laser Ablation of Saphenous Veins Larger than 2 cm: a Prospective Study

Background. The current catheters and fibres used for endovenous laser and radiofrequency ablation of varicose veins have a radial energy emission. This gives an opportunity to treat veins of a large diameter which was previously considered to be challenging. The majority of studies categorise veins of more than 1 cm in diameter as large (Chaar C.I., et al. 2011; Florescu C., et al. 2014). Many patients have saphenous veins 1–2 cm in diameter, which can be occluded in almost 100% of cases. Treating veins more than 2 cm in diameter with tumescent anaesthesia may be associated with formation of a “blind pocket”. This means that a part of the vein does not have appropriate contact with the fibre. This can be one of the reasons for recanalisation. The aim of this study was to investigate the results of endovenous laser ablation (EVLA) of saphenous veins larger than 2 cm in diameter. Methods. This was a prospective non-comparative study that included 231 patients who underwent 261 EVLA of the great saphenous vein (GSV) between November 2014 and June 2019. EVLA was performed using 1470 nm laser, radial fibres, and an automatic pull back device. All procedures were performed under tumescent anaesthesia. The average diameter of the veins at the saphenofemoral junction was 24 ± 6 mm (range 21–43 mm). EVLA was administered at the average power of 8–10 W. The linear endovenous energy density in dilated segments was 83–147 J/cm. The follow up period was 178 ± 67 days (range 61–540 days). Duplex ultrasound was performed on days one and seven, and months two and six after the treatment. Results. Two hundred and thirty (88%) veins were occluded the day after EVLA. In 31 (12%) cases there were non-occluded segments of dilated parts of the saphenous vein on the day after the procedure. These segments were found to be occluded in 21 of 31 patients at seven days. In 11 (4%) cases, ultrasound guided foam sclerotherapy (UGFS) was performed. Short stumps of GSV (19 ± 6 mm) were found in 12 (5%) patients at six month follow up, with no reflux in these stumps. Recanalisation of a long segment of the GSV with reflux was found in two (0.8%) cases, which was treated by EVLA and UGFS. Conclusion. EVLA using radial fibres is effective for a GSV more than 2 cm with a 99% occlusion rate in the early follow up period.

The proximity of the superficial epigastric vein to the saphenofemoral junction is associated with endovenous heat-induced thrombosis after radiofrequency ablation for varicose veins

ObjectiveTo elucidate the risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins in association with the superficial epigastric vein (SEV) position to the saphenofemoral junction (SFJ). MethodsWe examined 125 legs from 218 patients (mean age, 67 years; 80 female legs) with great saphenous veins (GSVs) in association with the SEV proximity to the SFJ using the duplex ultrasound test. According to the Clinical, Etiology, Anatomy and Pathophysiology classification (CEAP; C1-C6), there were 62, 38, and 25 legs in the C2, C3, and C4-C6 categories, respectively. The postoperative duplex ultrasound tests, focused on EHIT, were conducted on days 1, 7, 30, and 90 after RFA. The EHIT analysis was based on Kabnick's classification (class 1-4). We compared the GSV diameter and the SEV-SFJ distance between the EHIT positive (n = 32) and negative groups (n = 93) using the Student t-test. The risk factors (age >75, male sex, ≥C3 classification, adjunctive phlebectomy, prior venous surgery history, GSV diameter of >7.5 mm, and short SEV-SFJ distance [<4 mm]) were examined using univariate and multiple logistic regression analyses. ResultsThe EHIT ratio after RFA was 25.6% (24, five, three, and no legs in classes 1, 2, 3, and 4, respectively). In the EHIT positive group, the mean GSV diameter and the SEV-SFJ distance were larger (8.0 ± 2.3 vs 6.4 ± 2.0 mm; P < .001) and shorter (5.2 ± 4.0 vs 6.8 ± 3.7 mm; P = .05) than the negative group. Using univariate analysis, the risk factors of EHIT after RFA were as follows: ≥C3 classification (odds ratio [OR], 4.15; P = .002), GSV diameter >7.5 mm (OR, 3.50; P = .003), and short SEV-SFJ distance (OR, 2.92; P = .01). Multiple logistic regression analysis showed that a classification of ≥C3 (OR, 3.39; 95% confidence interval [CI], 1.30-8.86; P = .013), GSV of >7.5 mm (OR, 3.32; 95% CI, 1.33-8.25; P = .010), and short SEV-SFJ distance (OR, 2.71; 95% CI, 1.09-6.71; P = .032) were also significant risk factors. ConclusionsRFA treatment for patients with varicose veins should be considered postoperatively in combination with a classification of ≥C3, GSV diameter of >7.5 mm, and a history of deep venous thrombosis and concomitant procedures, because it is related with greater chances of EHIT development.

Post-operative Mid-term Venous Functional Evaluation of Radio Frequency Ablation for Varicose Veins

Post-operative Mid-term Venous Functional Evaluation of Radio Frequency Ablation for Varicose Veins

The clinical outcomes of endovenous microwave and laser ablation for varicose veins: A prospective study

BackgroundThis study investigates the clinical outcomes of endovenous microwave ablation and endovenous laser ablation for varicose veins. MethodsA total of 139 patients who underwent endovenous microwave ablation and 145 patients who underwent endovenous laser ablation were included in this multicenter study. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The effect on quality of life was assessed by the Aberdeen Varicose Vein Questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire. ResultsThe endovenous microwave ablation group had a shorter procedure time than the endovenous laser ablation group (42.58 ± 15.62 minutes vs 65.46 ± 24.38 minutes, P < .01), and no significant differences were observed in the other procedure parameters. The incidences of induration (20.26% vs 31.06%) and ecchymosis (13.07% vs 22.98%, P < .05) were lower in the endovenous microwave ablation group. The rates of temporary paresthesia (9.80% vs 18.01%) and residual varicosities (8.61% vs 16.77%, P < .05) were lower in the endovenous microwave ablation group at 1 month. There were no significant differences in paresthesia or saphenous vein closure rates between the groups at 6 and 12 months. Both groups had significant improvements in their Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores post-procedure, and no significant differences in Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores were confirmed. However, local recurrence below the knee was lower in the endovenous microwave ablation group (2.34% vs 8.46%, P < .05) after 12 months. ConclusionOur results confirmed that the endovenous microwave ablation procedure demonstrated a shorter procedure time, lower complication, and local recurrence than the endovenous laser ablation procedure.

Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

Early results of an Asian prospective multicenter VenaSeal real-world postmarket evaluation to investigate the efficacy and safety of cyanoacrylate endovenous ablation for varicose veins

ObjectiveThe aim of A Singapore VenaSeal Real-World Post-Market Evaluation Study (ASVS) was to evaluate the performance of cyanoacrylate closure (CAC) for varicose veins in a prospective multiracial Singaporean Asian cohort. We report early clinical and patient satisfaction outcomes at 3 months after intervention. MethodsThere were 100 patients (151 legs; 156 truncal veins) who underwent CAC between April and December 2018. Of the 151 legs, 49 (32.5%) were treated for great saphenous vein (GSV) incompetence, 96 (63.6%) for bilateral GSV incompetence, 1 (0.7%) for small saphenous vein (SSV) incompetence, and 5 (3.3%) for combined unilateral GSV and SSV reflux. At baseline, 68 legs (45.0%) had C4 to C6 disease, and 67 legs (44.4%) had concomitant multiple stab avulsions. Patients were reviewed at 2 and 12 weeks by duplex ultrasound to check for venous recanalization (defined as ≥5 cm in length), pain score, revised Venous Clinical Severity Score, EuroQol-5 Dimension questionnaire score, Aberdeen Varicose Vein Questionnaire score, 14-item Chronic Venous Insufficiency Questionnaire (CIVIQ-14) for quality of life measures, and patient satisfaction. Time to return to work and normal activities were also recorded. ResultsThere were 59 female patients, and mean age was 60.1 ± 12.7 years. There was 100% technical success. Patients tolerated the procedure well and reported low periprocedural pain (mean pain score, 2.9 [range, 0-9]). Patient surveys at the 3-month interval showed high satisfaction rates, with 72 of 91 (79.1%) being extremely or very satisfied. By day 10, of 100 patients, 93 (93%) resumed daily activities, whereas 36 (36%) had returned to work. At 2 weeks, GSV and SSV were completely occluded in 150 of 150 (100%) and 6 of 6 (100%) veins, respectively. At 3 months, GSV and SSV occlusion rates were 140 of 141 (99.3%) and 6 of 6 (100%), respectively. Transient superficial phlebitis was reported in 27 of 151 (18 %) legs, which was self-limited. At 3 months, revised Venous Clinical Severity Score improved from 5.00 (range, 1.00-18.00) to 1.00 (0.00-10.00; P < .001); EuroQol-5 Dimension score, from 0.686 (−0.382 to 1.00) to 1.00 (0.12-1.00; P < .001); Aberdeen Varicose Vein Questionnaire score, from 17.14 (1.29-61.15) to 4.83 (0.00-57.12; P < .001); and 14-item Chronic Venous Insufficiency Questionnaire, from 19.64 (1.79-73.21) to 7.14 (0.00-51.79; P < .001). ConclusionsCAC has a high safety profile and is an effective way to block refluxing truncal veins in Asian patients at early follow-up. Patients are highly satisfied and report low postoperative pain. There is significant continued quality of life improvement at 3 months. Early results are encouraging, but we await further prospective long-term follow-up from the study.

Effect of Transluminal Injection of Foam Sclerotherapy Combined With Endovenous Thermal Ablation of Varicose Veins

Effect of Transluminal Injection of Foam Sclerotherapy Combined With Endovenous Thermal Ablation of Varicose Veins

Editor's Choice – Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial☆

Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n=47) and 98% (n=45), respectively (p=1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference-1, 95% CI-2 - 3, p=.57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI-1 - 2, p=.46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p=.72) and pain score 2.0 vs. 2.0 (p=.92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p=1.0 for above the knee and p=1.0 for below the knee). The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.

Supplement of Clinical Practice Guidelines for Endovenous Thermal Ablation for Varicose Veins: Overuse for the Inappropriate Indication

Supplement of Clinical Practice Guidelines for Endovenous Thermal Ablation for Varicose Veins: Overuse for the Inappropriate Indication

Thrombosis Following Endovenous Glue Ablation

Endovenous glue ablation for lower limb varicose veins is growing in popularity due to its safety and efficacy. Of significant concern is glue-associated thrombus extension into deep veins. We present a case of thrombus extending into the common femoral vein following endovenous glue ablation for varicose veins with the VenaSealTM closure system (VCS; Medtronic). A 63-year-old man who presented with symptomatic varicose veins had incompetence of the saphenofemoral junction. He underwent endovenous glue ablation using VCS closure. At 1 month, improvement in varicosities was mirrored by duplex ultrasound confirmation of successful long saphenous vein ablation, but ultrasound indicated thrombus extending into the common femoral vein. This was managed by surveillance duplex and serial clinical observation, with spontaneous resolution at 12 months. With increasing use of VCS for varicose veins, it is likely that thrombotic complications of the deep veins will be encountered more frequently. It is time for formulation of guideline-based management of this complication.

A comparison of choosing the best technique in endovenous ablation of varicose veins of the lower limbs

BACKGROUND: Endovenous ablation is very popular among vascular surgeons and patients especially for last ten years. Technologic development of the surgical techniques makes the demands for the lesser pain and bruising, shorter operation time, better quality of life and less time off work. METHODS: The study is set for the determination of the preferences for the endovenous therapy and planned among the patients who had the diagnosis of venous insufficiency with doppler usg of the lower limbs (CEAP 2S) and were hospitalized in the Sakarya University Research and Training Hospital cardiovascular clinic. The primary aim of this study was to determine whether Biochemical Vein Ablation systems (BVA) of the great saphaenous vein (GSV) was associated with less pain and bruising than Radiofrequency Ablation (RFA)and Endovenous Laser Ablation (EVLA). The secondary aims were to assess efficacy of vein ablation and quality of life following these procedures. In total 402 patients of chronic venous insufficiency were taken to our study. Endovenous treatment methods were compared for the peroperative and postoperative comfort for the patient and the physician. Treatment procedures for EVLA the BioLITEC (Biolitec AG, Germany) and for RFA Covidien ClosureFast Endovenous Radiofrequency Ablation (RFA) Catheter (MA, USA) and for BVA (ClariVein catheter Vascular Insights, Madison, CT, USA). Aethoxysklerol 40 mg (2%) was used as the sclerosant material (Aethoxysklerol, Kreussler Pharma, Wiesbaden, Germany) were used. Phlebectomies were performed as required. Primary endpoints were patient assessed pain and bruising measured by visual analogue scale (VAS). Secondary endpoints were patency assessed by duplex ultrasound at 6 weeks and 6 months. RESULTS: The operation was easier either to the physician and the patient in the BVA group. The pain and postoperative comfort were superior in both BVA and RFA groups in comparison to the EVLA group. There were no significant differences in mean postoperative pain, bruising and activity scores among BVA, RFA and EVLA groups. All BVA, RFA and EVLA resulted at least occlusion rates of 95% at 10 days postoperatively. CONCLUSIONS: BVA and RFA was less painful for patients than EVLA and produced less bruising in the postoperative period with comparable success rates but there was no difference in the long-term results of the study. © 2019 EDIZIONI MINERVA MEDICA