Ablation Of Varicose Veins Research Articles

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

ObjectiveThe combination of endovenous therapies with stab avulsion or ultrasound guided foam sclerotherapy is widely performed. However, these conventional techniques tend to result in incomplete avulsions or persistent varicosities.MethodsOne hundred and thirteen legs in 97 consecutive patients who underwent 1470 nm laser ablation for great saphenous varicose veins were enrolled. The foam sclerosing agent was injected via the sheath after endovenous laser ablation (EVLA). Patients were divided into two groups: EVLA only group (Control; n = 50) and EVLA and transluminal injection of foam sclerotherapy (TLFS) group (SCL; n = 63).ResultsAt three month follow up, reflux was abolished throughout all treated great saphenous veins (GSVs) when assessed with Duplex ultrasound. Thrombophlebitis was observed in two patients in the SCL group (p = .13). Additional second stage sclerotherapy was needed in the Control group (n = 33, 66%) vs. SCL group (n = 2, 3%; p < .0001). The venous clinical severity score (VCSS) was significantly improved in the SCL group (changes of VCSS, Control −3.3 ± 1.7 and SCL -4.4 ± 1.0; p < .0001). Univariable and multivariable analyses revealed that, among age, sex, Clinical-Etiology-Anatomy-Pathophysiology classification, linear endovenous energy density, and TLFS, TLFS was the only significant factor of improved VCSS (hazard ratio = −0.96; 95% confidence interval = −1.4 to −0.58; p < .0001).ConclusionsTLFS combined with EVLA may be an easy, safe, and effective procedure with acceptable complications vs. EVLA alone and reduces additional second stage interventions.

”Geometry-based cannulation technique” for cannulation of great saphenous vein during radiofrequency ablation of varicose veins at a university hospital of Nepal

Background: Radiofrequency ablation is an established minimal invasive treatment modality of varicose veins. This technique involves accessing the great saphenous vein (GSV) through which radiofrequency ablation catheter is inserted. Some established puncture techniques like in-plane and out-plane techniques are also not devoid of limitations. Aims and Objectives: To know the applicability of “Geometry based cannulation technique” in terms of mean cannulation attempts and percentage of successful cannulation. Materials and Methods: We are doing “Geometry based cannulation technique” for the cannulation of GSV. For cannulation 18G needle of length 3 cm attached with 10 ml syringe (cannulating needle) partly filled with normal saline is used. Doppler ultrasonography is done with Siemen's Acuson P300 machine with linear probe of frequency 7.5–12 MHz. The depth from the skin to the upper part of vein is measured in cm and is termed as distance “A.” The tip of the cannulating needle is positioned on the middle of the probe and gently pressed down the skin to form the shadow in the Doppler. The needle is readjusted such that the shadow corresponds to the GSV. Then, the needle is moved distally to A distance. Then the needle is made rotated 45° and skin is punctured to the length (distance B) calculated from the Pythagoras theorem as square root of 2A2. Then the angle is decreased to about 30° and further 2–3 mm advancement of the cannulating needle is done such that it lies inside the target GSV. Results: From 459 cannulations in the time frame of August 2013–December 2018, we found that mean cannulation attempts were 1.4 (standard deviation 0.72, 1–3 attempts). In 429 GSVs (95.5%), there were successful cannulations, whereas in 20 GSVs (4.5%), there was failure in cannulation. The cannulation of GSV has higher success if the diameter of GSV is more than 5 mm and the depth is less than 10mm. Conclusion: “Geometry based cannulation technique” for cannulation of GSV is a novel technique and can be used with high success.

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

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. 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. 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. 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.

Patency of Anterior Accessory Saphenous Vein Following Endovenous Laser Ablation for Varicose Veins: Bare-Tip Versus Radial Fiber

Introduction - Anterior accessory saphenous vein (AASV) insufficiency is one of the most common causes of late recurrence after endovenous laser ablation (EVLA) for great saphenous vein (GSV) insufficiency1)2). Therefore, reduction of the AASV patency rate after EVLA can be associated with better long-term results. The aim of this study is to compare the patency rate of saphenofemoral junction tributaries after EVLA between bare-tip and radial fibers. Methods - We reviewed 375 limbs in 339 patients undergoing EVLA for GSV insufficiency. The bare-tip fiber with a 980-nm diode laser was used in 299 limbs (group B). The radial fiber with a 1470-nm diode laser was used in 76 limbs (group R). Concomitant ablation of AASV or high ligation of GSV was not included in this study. Patients who had previous EVLA, high ligation and stripping were excluded. Duplex ultrasound scanning was performed 3 months after EVLA to assess occlusion of the ablated GSV and patency of the saphenofemoral junction tributaries including the AASV, the posterior accessory saphenous vein (PASV) and the superficial epigastric vein (SEV) in both groups. Student-t tests and chi square tests were used to compare two groups. Results - The total occlusion rate of the ablated GSV at 3 months after EVLA was 100% in group R and 99% in group B, p = 0.999. The patent AASV was detected significantly (p = 0.004) less in group R (33 limbs, 43%) than in group B (184 limbs, 62%), whereas the PASV patency rate was similar (p = 0.815) in both groups (16% in group R, 15% in group B, p = 0.815). The SEV occlusion rate was 4% in group R and 1% in group B, p=0.101. There was no difference in age, gender, body mass index, CEAP classification and the proximal GSV diameter in both groups. Laser power was smaller in group R (8.9 +/- 0.9 W) than in group B (9.4 +/- 0.6 W), p < 0.001, however, linear endovenous energy density did not differ between the groups (79.9 +/- 13.6 J/cm in group R, 78.3 +/- 9.2 J/cm in group B, p = 0.198). The distance between the tip of the fiber and the common femoral vein was shorter in group R (9.7 +/- 2.4 mm) than in group B (17.5 +/- 4.9 mm), p < 0.001. Conclusion - EVLA using a radial fiber archived better occlusion rates of AASV. This result can be attributed to the position of the laser fiber tip closer to the saphenofemoral junction. Our study suggests that EVLA using a radial fiber will reduce the risk of late recurrence caused by AASV insufficiency in the treatment of GSV varicose veins. References1)J Vasc Surg. 2016; 63: 420-428.2)Eur J Vasc Endovasc Surg. 2011; 41: 685-690.

Short Term Outcome of Adjunct Foam Sclerotherapy for Varicose Veins in Patients Subjected to RFA at Dhulikhel Hospital, Nepal.

Background Varicose veins are dilated, tortuous, superficial veins usually seen on lower limbs. Various surgical modalities are available for varicose veins including open surgery (Trendelenburg operation), Endovenous Laser Ablation (EVLA), Radiofrequency Ablation (RFA) and Sclerotherapy. The aim of this study is to look for the outcome of adjunct sclerotherapy for varicose veins done as an adjunct with Radio Frequency Ablation. Objective To know the possible outcome regarding benefits and complications of adjunct sclerotherapy with Radio Frequency Ablation. MethodologyWe combined Radio Frequency Ablation of varicose veins with necessary phlebectomy and perforator ligation and performed adjunct sclerotherapy for residual significant varicosities with polidocanol (2%) mixed with 2 ml NS and 2 cc of air (Tessari method) to patients undergoing varicose vein surgery in between 2016 and 2017. Records on complications were enquired immediately following surgery and on 1st follow up done within 3–5 days of the procedure. ResultsAmong 256 limbs subjected to varicose veins surgery 51 limbs were given adjunct sclerotherapy. Among them, five limbs had perivenous spillage with some localized swelling while there was allergic reaction in one patient as immediate postprocedural complication. Nine limbs had painful thrombosed veins during early follow-up. ConclusionsAdjunct sclerotherapy showed complication rate of roughly one tenth and one fifth of the treated cases in immediate and early postoperative follow-up.

Venous thromboembolism complications after endovenous laser ablation for varicose veins and role of duplex ultrasound scan

ObjectiveA nationwide survey was conducted in Japan to determine the incidence of venous thromboembolism (VTE) after endovenous thermal ablation for varicose veins and to investigate its pathogenic background. MethodsThe survey targeted all cases of endovenous thermal ablation between January 2011 and December 2013. Based on this survey, a retrospective study of patients who developed endovenous heat-induced thrombosis (EHIT) of classes 2 to 4, no EHIT-related deep venous thrombosis (DVT), and pulmonary embolism (PE) was conducted. Lower extremity venous ultrasound was performed within 72 hours and at 1 to 3 months postoperatively in all institutions. We investigated factors associated with the occurrence of complications and the usefulness of postoperative ultrasound. ResultsSurvey responses were collected from 213 institutions. Endovenous laser ablation was performed for 43,203 patients (EHIT 2 in 318 patients, EHIT 3 in 50 patients, EHIT 4 in 7 patients, other DVTs in 24 patients, and PE in 3 patients). The incidence of VTE complications was 1.0% for EHIT 2, 0.11% for EHIT 3, 0.013% for EHIT 4, 0.063% for other DVTs, and 0.0067% for PE based on the adjusted population. Sex, age, obesity, origin of the varicose vein, vein diameter, and preoperative Caprini score were not strong indicators of VTE complications. Of 50 patients with EHIT 3, there were 35 patients who had EHIT 3 during the first postoperative ultrasound session. In one patient, EHIT 3 progressed to EHIT 4 despite initiation of anticoagulant therapy. Of seven patients with EHIT 4, only one patient had EHIT 4 at the first postoperative ultrasound examination. Because ultrasound performed before the occurrence of EHIT 4 revealed that three patients had EHIT 2 or EHIT 3, EHIT 4 could have possibly been predicted by ultrasound. Of three patients with PE, two developed PE before ultrasound, and EHIT was not detected by ultrasound in one of those patients before PE developed. Anticoagulant therapy was administered in most patients with EHIT 3 and all patients with EHIT 4 and PE, with favorable outcomes. ConclusionsThe incidence of VTE complications after endovenous laser ablation was low. Furthermore, the value of performing postoperative ultrasound for VTE management seems to be low because the occurrence of severe VTE complications could not be predicted by lower extremity venous ultrasound. Although the perioperative detection of VTE complications by this modality resulted in the early administration of anticoagulant therapy and may have contributed to improved prognosis, the number of those patients was limited.

Safety and Efficacy of Radiofrequency Ablation for Varicose Veins: An Initial Experience from Pakistan.

To evaluate the safety and efficacy of radiofrequency ablation (RFA) for varicose veins. Observational case series. Section of Vascular Surgery, Aga Khan University Hospital, Karachi, from September 2016 to August 2018. Data of RFA procedures performed on 40 patients were collected on a questionnaire from the medical records. It included patients' demographics, pre- and postoperative clinical, etiological, anatomical and pathological (CEAP) system score, venous clinical severity score (VCSS), procedural details and intra- or postoperative complications. Outcome measures were 'safety of the procedure, which was measured by presence of any complications; and 'efficacy of the procedure' which was measured by improvements in the CEAP and VCSS score. The mean age of the patients was 44.7±11.5 years. Twenty-one (52.5%) patients were women. Preoperative median VCSS [range] was 7 [2-15], which improved to 1 [0-3] (p <0.001). Preoperative median CEAP [range] was 3 [2-6] and improved to 1 [0-4] (p <0.001). One patient had recurrence and five patients (12.5%) had minor complications, which were treated conservatively. RFA in patients with symptomatic varicose veins can be performed with minimal complications. This modality is also effective in reducing the disease severity.

Recent Developments and Mechanism of Action of Endovenous Laser Ablation for Varicose Veins

Recent Developments and Mechanism of Action of Endovenous Laser Ablation for Varicose Veins

Compression Therapy after Endovenous Laser Ablation for Varicose Veins

Compression Therapy after Endovenous Laser Ablation for Varicose Veins

IF15. The Proximity of Superficial Epigastric Vein to Saphenofemoral Junction Is Associated With Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins

IF15. The Proximity of Superficial Epigastric Vein to Saphenofemoral Junction Is Associated With Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins

The Impact of Great Saphenous Vein Size on Gender, Clinical Severity, and Outcome of Patients Undergoing Vein Ablation for Varicose Veins

Policies of insurance carriers have used truncal vein size as a criterion for coverage. The objective of this study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on the patient’s presentation and clinical outcomes. Patients in a national cohort were prospectively captured in the Vascular Quality Initiative Varicose Vein Registry. From January 2015 to October 2017, the Vascular Quality Initiative Varicose Vein Registry database was queried for all patients undergoing varicose vein procedures. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class, Venous Clinical Severity Score, and patient-reported outcomes were compared for GSV size <5 mm (group 1) vs size ≥5 mm (group 2) before and after the procedures. Two-sample Wilcoxon test was performed to assess the difference between the two groups as defined by GSV size. To assess for improvement after the procedure in this population, a matched pairs signed rank Wilcoxon test was performed for each group separately. During the study period, 5757 vein ablation procedures were performed for GSV: 770 GSV size <5 mm and 4987 GSV size ≥5 mm. Group 1 patients were more likely to be female (81.7% vs 68.4%; P = .001) and older (56.8 years vs 55.6 years; P = .012). CEAP scores were higher in group 2 compared with group 1 (P = .001). Maximal GSV diameter in group 2 was significantly higher (8.32 mm vs 3.86 mm; P = .001); 64% of group 2 underwent radiofrequency thermal ablation compared with 59.2% of group 1 (P = .001). There were no deaths in either group. Group 2 had more complications after the procedure (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%; P = .001), developed partial recanalization rate (0.8% vs 0.3%; P = .001), and missed more work days (2.32 days vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but there was a higher rate of paresthesia in group 1. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, and itching) score. The degree of symptomatic improvement between the groups was similar (Table). All patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation regardless of size. Patients with preoperative GSV size ≥5 mm had similar improvement in symptoms but sustained an increased complication rate. Patients with smaller vein size should not be denied intervention or coverage on the basis of size criteria.TableVenous Clinical Severity Score (VCSS) and heaviness, achiness, swelling, throbbing, and itching (HASTI) improvements based on great saphenous vein (GSV) sizeGroup 1, GSV <5 mmGroup 2, GSV ≥5 mmP valueVCSS improvement2.783.16.833HASTI improvement5.615.71.719 Open table in a new tab

Clinical Response to Combination Therapy in the Treatment of Varicose Veins

Varicose vein ablation procedures are being performed with increasing frequency; however, there is a lack of consensus on the relative efficacy of combined treatment of saphenous incompetence and symptomatic varicosities vs a staged approach. In this study, we examined the impact on symptom severity when a procedure to eliminate varicosities is added to standard endovenous saphenous ablation. The American Venous Registry Varicose Vein Module was established by the American Venous Forum in 2010 and collected data from 53 physicians from 37 clinical centers during a 2-year period. Our analysis includes patients with Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class C2S disease severity and without prior treatment. Combination therapy (CT) is defined as the use of a varicosity-treating secondary procedure (stab phlebectomy or injection of sclerosant into varicosity) in combination with endovenous saphenous vein ablation. Unimodal therapy (UT) is defined as endovenous saphenous vein ablation alone (radiofrequency or laser). Symptom severity change is assessed using the pretreatment and 1-month follow-up Venous Clinical Severity Score (VCSS). Bivariate statistics are calculated comparing the CT and UT groups, with P values calculated using the Student t-test or Pearson χ2 test as appropriate. A multivariable linear regression model assesses the association of CT with the change in VCSS. There were 1031 patients included for analysis (UT, 478; CT, 553). UT patients were older (35.9% were >64 years vs 20.7%; P < .001), were more likely to be white (79.3% vs 65.5%; P < .001) and to have a higher initial VCSS (7.28 vs 6.15; P < .001), and were assessed at an earlier follow-up visit (25.9 days postoperatively vs 32.9 days; P < .001). Compared with UT, CT was associated with an additional 1-point reduction in VCSS on bivariate analysis (−3.50 points for UT vs −4.54 points for CT; P < .001; Table). Thrombotic complications were not different between the two groups (UT, 1.04%; CT, 0.72%; P = .58). On the multivariable model, after adjustment for follow-up day, age group, ethnicity, and initial VCSS, CT was associated with a reduction in VCSS of 1.07 points beyond the reduction seen in UT alone (P < .001). Invasive treatment of C2S chronic venous insufficiency improves symptom severity. Whereas treatment of venous reflux is essential to address venous symptoms, our results suggest that patients further benefit from additional direct treatment of varicosities. For select patients, combined therapy may present a more effective treatment strategy than saphenous ablation alone.TableCompared with unimodal therapy (UT), combination therapy (CT) is associated with an additional 1-point reduction in Venous Clinical Severity Score (VCSS) on bivariate analysisTotal (N = 1031)UT (n = 478)CT (n = 553)P valueDay of follow-up29.7 (8.23)25.9 (0.40)32.9 (6.20)<.001bAge, years<.001a <45253 (24.6)85 (17.9)168 (30.4) 45-55221 (21.5)103 (21.6)118 (21.4) 55-64269 (26.2)117 (24.6)152 (27.5) >64285 (27.7)171 (35.9)114 (20.7)Female733 (71.1)342 (71.6)391 (70.7).766aWhite741 (71.9)379 (79.3)362 (65.5)<.001aInitial VCSS6.68 (3.87)7.28 (4.52)6.15(3.10)<.001bVCSS change−4.06 (3.27)−3.50 (3.95)−4.54 (2.46)<.001bCategorical variables are presented as number (%). Continuous variables are presented as mean (standard deviation).aPearson χ2.bStudent t-test. Open table in a new tab

Thromboprophylaxis for varicose vein procedures - A national survey.

Background Venous thromboembolism is rare following varicose vein ablation procedures, but uncertainty about its incidence combined with a lack of evidence-based clinical guidelines regarding thromboprophylaxis has led to debate about best practice. We conducted a national survey to investigate current practice among Irish vascular surgeons. Methods An anonymous online questionnaire was emailed to all members of the Irish Association of Vascular Surgeons and the Northern Ireland Vascular Society. Results Response rate was 60%. With regard to procedure type, 36.7% of respondents use only endovenous techniques and 53% use a combination of open and endovenous. Formal duplex imaging on all patients is obtained by 53.3%. With regard to VTE prevention, 73.3% always give thromboprophylaxis. For those who give it selectively, a variety of factors were considered as risks. Pharmacological agents used are enoxaparin in 73.3% of cases or tinzaparin, and 71.4% use a single dose (either 20/40 mg or 3500/4500 IU respectively). If patients are already taking anticoagulation, this is continued by 46.7% of respondents. Routine post procedure duplex imaging is carried out by 23.1% of recipients, either by the surgeon or formally and 80% review patients clinically. Moreover, 43.3% of respondents claim to know their post-operative VTE rate and this varies from 0 to 1% with one mortality reported. Conclusions The majority of respondents use single-dose thromboprophylaxis periprocedurally for varicose vein ablation procedures. VTE rates are low but the true incidence may be unknown.

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

The 1470 radial endovenous laser ablation of the great saphenous vein larger than 12 mm: is it a good option? A single-center experience

Introduction Endovenous ablation of varicose veins has been used to treat varicose veins and has gained popularity as one of the preferred techniques to treat axial reflux. Initially the diameter recommended was less than 8 mm, then gradually surgeons starting gaining the experience to treat larger veins. Treating larger veins has been on the controversial side with some surgeons recommending surgery versus others recommending endovenous ablation. Patients and methods The patients were divided to three groups according to the great saphenous vein diameter and follow-up duplex arranged at 3, 6, and 2 months. Visual analog scale was used at 1 week and 4 weeks to assess postoperative pain. Results In our study, there was no incidence of deep venous thrombosis (DVT) or nerve injury in any of our groups. At 1 month, there was significant difference between the groups, but at 4 weeks there was no significant difference regarding postoperative pain. There was no recanalization with an occlusion percentage of 100% in the 3-month duplex scan in all the groups. There is no significant statistical difference between the groups regarding recanalization at 6 and 12 months. Conclusion Our study showed good short-term results of endovenous laser therapy in the ablation of large-diameter great saphenous vein. The use of endovenous laser therapy has to be a dynamic process where you as an endovascular surgeon can change a variety of parameters to optimize the final results of the procedure.

Mechanochemical ablation of varicose veins with N-Butyl Cyanoacrylate: Six-month follow-up

Mechanochemical ablation of varicose veins with N-Butyl Cyanoacrylate: Six-month follow-up

Retrospective analysis of results of using cyanoacrylate composition for varicose vein ablation

The method of cyanoacrylate ablation of varicose veins is currently considered as a possible alternative to traditional methods of thermal obliteration. One of significant advantages of this method is no need for performing tumescent anaesthesia. Over the period from 1995 to 2002, cyanoacrylate obliteration of varicose veins was carried out in a total of 96 patients, with clinical assessment of the complication rate and efficacy at various time intervals, with the maximum follow-up period amounting to 3 years. In addition to clinical assessment of the results, presented are the findings of histological examinations of morphological changes occurring in the venous wall and lumen after administration of cyanoacrylate on days 3, 7, 10, 14, 21, 30 and 90. The conclusion was drawn on feasibility of carrying out prospective studies on using various glue compositions of both Russian and foreign manufacture in order to determine all benefits and disadvantages of this group of chemical compounds for more successful and wider implementation of them into clinical practice of modern phlebology.

VP35 Effectiveness and Safety of Cyanoacrylate Ablation for Varicose Veins

IntroductionTreatment of varicose veins is currently performed by different interventionist alternatives that include surgical, endothermal and non-thermal ablation therapies. The main guidelines recommended endovenous thermal treatment as the first choice therapy; however present side effects related to thermal energy. Non-tumescent endovenous ablation techniques such as cyanoacrylate ablation (CA) started to develop to avoid these problems. The objective of this study is to assess the effectiveness and safety of CA for saphenous vein incompetence.MethodsA systematic review with meta-analysis was carried out. The search of scientific literature was performed in Medline, Embase, Cochrane library, CDR, WoS and Scopus databases. GRADE methodology was used to assess the quality of the evidence and Cochrane risk of bias tool to assess methodological quality of randomized control trials (RCT). Pooled risk ratio was calculated using a random effects model.ResultsTwo RCTs and one non-RCT comprising 1,077 participants were included. Additionally, 10 case series were included for safety assessment. Pooled analysis of closure rates by the two RCTs indicated there were not significant differences between CA and radiofrequency ablation (RFA) or endovenous laser ablation (EVLA). Improvements in venous clinical severity score were reported by all comparative studies without significant differences among groups. The most frequently reported adverse events were ecchymosis, phlebitis, paraesthesia, and thrombosis. The pooled analysis showed significant differences only in ecchymosis rates, with lower probability of ecchymosis in CA groups. CA treatment showed lower pain rates and shorter intervention times and recovery compared to endothermal therapies.ConclusionsThe effectiveness of CA devices in the treatment of varicose veins is comparable to EVLA and RFA, while the rates of adverse effects are lower. Despite the limitations of the evidence, CA may be a promising alternative to existing treatments, with the advantages of better patient comfort.

In the era of endo-venous ablation of varicose veins, is surgery still competitive?

Background: There are different evolving minimally invasive surgical options for varicose veins (VV) treatment. This study compared Endo-venous Laser Ablation (EVLA) and foam sclerotherapy Vs high tie and multiple phlebectomy / ligation without vein stripping.Methods: 185 lower limbs with primary VV and sapheno-femoral junction (SFJ)incompetence were included. Patients were divided into two groups. Group A: 85 limbs in 78 patients (4 had chronic venous ulcers) were treated by EVLA &amp; foam sclerotherapy under tumescent anesthesia. Group B: 100 limbs in 100 patients (5 had chronic venous ulcers) were treated by high tie and multiple phlebectomy/ ligation under local anesthesia. All patients had duplex ultrasound preoperative and 4 weeks and 1 year postoperatively. Postoperative outpatient follow-up was 4 weeks, 3, 6 and 12 months.Results: All procedures were successful. Early postoperative recurrence in 3 limbs (3.52%) in EVLA and no early recurrence in group B. Patients with venous ulcers healed within 3-5 weeks in both groups. Postoperative pigmentation was higher in group B. Mean time of procedure was 60-90 min and 60-150 min respectively. Significant pain in first week was more in group A (40 patients) than group B (22 patients) p&lt;0.05. No DVT, wound infection, permanent nerve affection nor skin burn was recorded in both groups. Return to normal activities was quicker in Group B compared to group A but mean cost per limb was higher in Group B (1000 -1500 US $) versus Group A (500-750 US$).Conclusions: Both procedures are effective and safe in treating varicose veins. Minimally invasive surgery was less costly, more postoperative pain and was associated with longer operative time. EVLA was associated with more postoperative pigmentation and 1 year VV recurrence.

Efficacy and safety of radiofrequency ablation for lower limb varicose veins

Background: Endovenous Radiofrequency Ablation (RFA) is gradually gaining widespread acceptance as a minimally invasive modality for treatment of varicose veins (VV). The objective of this study was to evaluate the efficacy based on Venous Doppler and Venous Clinical Severity Score (VCSS) and the safety of radiofrequency ablation for varicose veins.Methods: This is a prospective study of 58 consecutive patients who underwent Radiofrequency ablation of Varicose veins from January 2015 to January 2017 in a single unit of a Multispecialty Tertiary Care Hospital. The mean age was 44.10±13.74 years (19-75 years). A total of 78 limbs were treated in 58 patients. RFA was performed using Closure FastTM catheter according to the manufacturer’s recommendation. Treatment outcomes were estimated 15 days, 3 months, 6 months and 1 year after the procedure using Doppler scan and VCSS score.Results: There was 100% occlusion of the treated veins with no evidence of partial/complete recanalization. However, 2 (2.56%) patients had a GSV stump length &gt; 3cm on Doppler at 6 months, without evidence of significant reflux. Minor complications such as ecchymosis erythema, pain and induration rapidly improved over short term. One patient (1.3%) had evidence of Deep Vein thrombosis (DVT) on follow up Venous Doppler. The mean VCSS improved from mean of 7.98 preoperatively to 2.24 after 1 year (P value &lt;0.001).Conclusions: Radiofrequency ablation is a safe and effective procedure with minimal major complications. The minor complications were early and resolved rapidly.