Endovenous Ablation Procedures Research Articles

Incidence and Clinical Impact of Endovenous Glue-Induced Hypersensitivity Among Patients Who Underwent Endovenous Cyanoacrylate Ablation Procedures: A Registry-Based Cohort Study.

The characteristics of endovenous glue-induced hypersensitivity (EGIH) remain unclear. To assess the clinical impacts on patients with EGIH after endovenous cyanoacrylate-glue ablation (CA). A prospectively designed endovenous CA-specific registry was created, and a total of 335 limbs from 173 patients who underwent endovenous CA were enrolled for a cohort study. Symptomatic EGIH was observed in 55 (31.8%) patients. Beyond the target vein area, systemic side effects were noted in 5.8% of the treated patients after CA. The median onset time was 13 postoperative days (range: 1-35 days). The median duration was 7 days, but about 10.9% of the affected patients experienced symptoms lasting longer than 4 weeks. In the EGIH and non-EGIH groups, significant improvements in venous clinical severity score and Chronic Venous Insufficiency Quality of Life Questionnaire-14 scores were observed 3 months postoperatively. The development of EGIH did not affect the postoperative patient-reported satisfaction scores ( p = .524). EGIH is observed in a substantial proportion of patients. The side effects do not affect the clinical outcomes and patient-reported outcome measures. Further studies are required on the detailed pathogenesis and definition of EGIH.

Outcomes of a single-center experience in eliminating routine postoperative duplex ultrasound screening after endovenous ablation

ObjectivesThe current guidelines recommend routine postoperative duplex ultrasound (DUS) screening after endovenous ablation (EVA). This is a grade 2C recommendation, and several contemporary reports have called for revision of this recommendation as there is insufficient evidence to support universal DUS screening after EVA. There are currently no studies that evaluate outcomes among EVA patients who did not have DUS screening. The aim of our study is to present outcomes from our single-center experience among patients who did not have DUS routinely performed after EVA. MethodsWe performed a single-center, prospective cohort study that included consecutive patients who underwent EVA of the great saphenous vein at our institution between September 30, 2021, and March 15, 2022. At 30 days after the procedure, electronic medical records were queried to identify patients who may have presented for the evaluation of venous thromboembolism (VTE) symptoms. ResultsOver the study period, a total of 80 lower extremity EVA procedures (71 endovenous laser ablation and 9 radiofrequency ablation) were performed among 76 patients. Postoperative DUS was performed on 24 patients, of whom none were identified as having endovenous heat-induced thrombosis. Of the 54 patients who did not have DUS, a 30-day postprocedure chart review revealed that none of these patients were seen for symptoms of VTE. We estimate total cost savings of $14,289 by eliminating routine DUS without impact to clinical outcomes after EVA. ConclusionsPostoperative DUS assessment after EVA comes with associated health care cost and has low yield given that the incidence of clinically significant endovenous heat-induced thrombosis (3 and 4) is rare. In our experience, eliminating routine DUS had no impact on clinical outcomes, improved vascular lab access, and had a positive financial impact in our organization. Limiting DUS screening to EVA patients who exhibit symptoms of VTE can be a cost-effective approach that limits unnecessary imaging, time, and resources with no potential change in clinical outcomes based on our data. Further research is required, and a randomized controlled trial would be ideal to answer this question.

An Analysis of Endovenous Ablation Procedures by Provider Type, Including Advanced Practice Providers: A Study Using the Medicare Fee-for-service Database

An Analysis of Endovenous Ablation Procedures by Provider Type, Including Advanced Practice Providers: A Study Using the Medicare Fee-for-service Database

Effectiveness of Post-operative Single-dose Anticoagulant with Compression Therapy in Preventing Deep Vein Thrombosis after Thermal Ablation of Varicose Veins

Abstract Introduction: Deep vein thrombosis (DVT) and pulmonary embolism are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. It is not clear whether patients undergoing varicose vein surgeries should receive a thromboprophylaxis. Furthermore, there is no consensus amongst surgeons with regard to the prevention of venous thromboembolism in patients undergoing surgical treatment for varicose veins. The objective of our study was to assess the effectiveness of post-operative single-dose anticoagulant with 48 h of compression therapy in preventing DVT after thermal ablation for varicose veins under spinal anaesthesia. Materials and Methods: A prospective observational study was conducted amongst 115 patients undergoing endovenous thermal ablation procedure for varicose veins in the Department of General Surgery, Trivandrum. After obtaining detailed history, all patients were assessed clinically for symptoms and signs of varicose veins and graded according to CEAP grading. The patients underwent pre-operative ultrasound Doppler study as per hospital protocol. Thermal ablation (radiofrequency/laser) was done in all selected patients after getting informed consent. Endovenous thermal ablation of veins was done using radiofrequency probe/laser catheter inserted inside the vein under ultrasound guidance after giving tumescence around the vein with normal saline. Phlebectomy of superficial varicosities was done. After thermal ablation of veins and phlebectomy, compression bandaging was given for the limb and continued for 48 h. Single-dose injection enoxaparin 0.4 ml subcutaneous was given after 8 h of procedure. The patient was encouraged for ambulation after recovery from anaesthesia. The patient was examined for swelling, pain, difference in circumference of limb, haematoma formation and appearance of skin and if indicated Doppler study to detect any presence of DVT at post-operative day (POD) 3, 2nd week and 6th week. Then, the proportion of patients developing DVT was taken as a primary outcome. Results: None of the patients in the study group was detected to have DVT of the lower limb during pre-operative venous Doppler study and none of the patients enrolled showed symptoms or signs of DVT during the clinical assessment at POD 3, 2nd week and 6th week after the procedure and a low incidence of DVT is found after thermal ablation procedures. Conclusion: Our study concludes that the use of post-operative single-dose anticoagulant and 48 h of compression therapy and early ambulation as prophylaxis measures prevents DVT.

Women benefit from endovenous ablation with fewer complications: Analysis of the Vascular Quality Initiative Varicose Vein Registry

ObjectiveTo evaluate the association between gender and long-term clinician-reported and patient-reported outcomes after endovenous ablation procedures. MethodsThis retrospective cohort study of prospectively collected data from the Vascular Quality Initiative’s Varicose Vein Registry included patients undergoing endovenous ablation procedures on truncal veins with or without treatment of perforating veins between 2015 and 2019. A univariate analysis included comparisons of preprocedural, postprocedural, and periprocedural change in Venous Clinical Severity Score (VCSS) and total symptom score by gender. Rates of complications including deep vein thrombosis, endovenous heat-induced thrombosis, leg pigmentation, blistering, paresthesia, incisional infection, and any postprocedural complications were reported by gender. Multivariable analysis leveraged linear regression to examine how gender affected the relationships between patient characteristics, complication rates, and periprocedural change in VCSS score and total symptom score. ResultsOf 9743 patients who met the inclusion criteria, 3090 (31.7%) were men and 6653 (68.2%) were women. The perioperative change in VCSS score was greater for men than women (average –4.46 for men vs –4.13 for women; P < .0001). Perioperative change in total symptom score was greater for women than for men (average –10.64 for women vs –9.64 for men; P < .0001). Women had lower incidence of any leg complication (6.1% vs 8.6%; P = .001) endovenous heat-induced thrombosis (1.1% vs 2.2%; P = .002), and infection (0.4% vs 0.7%; P = .001). In multivariable analysis, among patients with a body mass index of more than 40, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2, women had a greater periprocedural change in VCSS score than men. ConclusionsWomen benefited from endovenous ablation similarly as men, with a lower incidence of postprocedural complications. Gender may be useful for patient selection and counseling for endovenous ablation, with particular usefulness among patients with a high body mass index, presence of deep reflux, and preoperative Clinical, Etiologic, Anatomic, and Physiologic classification of 2.

Ambulatory outpatient venous surgery service: An examination of patient satisfaction and experiences.

This study aimed to ascertain patients' experience of the out-patient venous service being provided,; identify the level of patient satisfaction with the service and identify areas for further improvement and development. A prospective descriptive quantitative study. A questionnaire was distributed to all patients who used the service between June 2017 and March 2018. A total of 195 questionnaires was distributed with 162 valid questionnaires returned; response rate of 83%. This study found high satisfaction levels with endovenous ablation procedures, with concomitant phlebectomy, in the ambulatory outpatient setting and patient experiences of the service are overwhelmingly positive. Study findings support the management of ambulatory outpatient varicose vein endovenous ablation procedures as a feasible alternative to day surgery theatre settings and is the blueprint for future management of varicose vein surgery in Ireland.

Trend Analysis for the Treatment of Incompetent GSV

Purpose: Chronic venous disease (CVD) has an excellent socioeconomic impact. Treatment modalities of CVD are evolving fields that could be derived from the disease's progressive nature. Materials and methods: After a wide literature search in Google Scholar (Publish and Perish software), extracted data was analyzed by VOSviewer software, creating network and overlay visualizations. Results: CVD has been investigated intensively in the literature from the beginning of the 21st century. Studies aimed to understand the mechanism of CVD in the early 2000s. Later, the focus of scientific interest was moved to novel procedures. Researchers were motivated to explore the reasons for technical failures and recurrences of endovenous thermal ablation (EVTA) procedures and open surgery to treat saphenous incompetence. Less invasive procedures replaced invasive open surgery. The search for novel tissue sealants showed a thin centralized network. Papers were dated from 2010. Therefore, this is a very recent source of evidence. There were meeting points for some components of tissue sealants. Biomaterials for novel tissue adhesion are under development and investigation. The efficacy and safe application in humans is the focus of research. Conclusion: Researchers widely investigate CVD. An evolution from invasive open surgery (stripping) through EVTA to non-thermal ablation procedures could be discovered in the literature. There could be some versatile options for replacing cyanoacrylate in the future, but there are no clear paths to reach that point in scientific literature yet.

Women Benefit From Endovenous Ablation With Fewer Complications: Analysis of the Vascular Quality Initiative Varicose Vein Registry

We evaluated the association between gender and long-term clinical outcomes after endovenous ablation procedures. Using data from the Vascular Quality Initiative from 2015 to 2019, we identified patients who had undergone endovenous ablation procedures on truncal veins with or without treatment of perforating veins. We excluded patients with preoperative CEAP (clinical, etiologic, anatomic, physiologic) class <2. We used univariate analysis to determine the preprocedure, postprocedure, and periprocedural changes in the Venous Clinical Severity Score (VCSS) stratified by gender. We also determined the rates of deep vein thrombosis, leg pigmentation, blistering, paresthesia, incisional infection, and any postprocedural complications for each gender. We then used multivariate linear regression to examine how gender affects the relationships between the periprocedural change in the VCSS, patient characteristics, and complication rates. A total of 9743 patients were included in the present study. The women had lower pre- and postprocedural VCSSs, but both genders had similar a periprocedural change in the VCSS (Table). The women had a lower incidence of any postprocedural leg complications, blistering, deep vein thrombosis, and paresthesia. The men had lower incidence of leg pigmentation. Women with deep reflux experienced greater benefit from endovenous ablation than did men with deep reflux (Fig). At the extremes of body mass index (<25 and >35 kg/m2), women experienced greater benefit from endovenous ablation than did men. Women after endovenous ablation experienced improvements similar to those of men in the VCSS but with a lower incidence of postprocedural complications. Of those with deep venous reflux and at the extremes of body mass index, women were more likely to benefit from endovenous ablation than were men. These data are useful in predicting the results after venous ablation.TablePre- and postprocedure VCSS and periprocedural change in VCSS stratified by genderVariableMen (n = 3090)Women (n = 6653)P valueVCSS Preprocedure8.84 ± 4.107.54 ± 3.11<.001 Postprocedure4.47 ± 4.093.50 ± 3.23<.001 Change−4.46 ± 3.73−4.13 ± 3.23.001Complication, % Any leg complication8.66.10.001 Leg blistering0.60.40.2 Deep vein thrombosis1.10.60.06 Paresthesia1.91.70.5 Leg pigmentation0.30.70.1 Leg infection0.70.40.07VCSS, Venous clinical severity score.Data presented as mean ± standard deviation, unless noted otherwise. Open table in a new tab

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.

Spontaneous hemorrhage from varicose veins: A single-center experience

ObjectiveWhereas the commonly described manifestations of venous insufficiency include telangiectasia, varicose veins (VVs), edema, skin changes, and ulcers, we have noted some patients who present with external hemorrhage from lower extremity VVs. Because there are few recent data examining this entity, we herein describe our experience. MethodsDuring 29 months, we had 32 patients present with hemorrhage from lower extremity VVs. There were 15 men and 17 women with a mean age of 60.2 years (range, 38-89 years; standard deviation [SD], ±14.9 years). Interestingly, 16 of these patients presented after coming into contact with warm water; 28 patients, 19 patients, and 1 patient presented with reflux >500 milliseconds in the great, small, and accessory saphenous veins, respectively. Eight patients and six patients had reflux >1 second in the femoral and popliteal veins, respectively. ResultsAll patients were treated with weekly Unna boots. Mean ulcer healing time was 2.12 weeks (range, 1-8 weeks; SD, ± 2.15 weeks). Patients with VV hemorrhage after contact with warm water had a mean healing time of 1.75 weeks, whereas those who bled without such exposure took an average of 3.5 weeks (P = .0426). Twenty patients underwent at least one endovenous thermal ablation procedure, with the average patient in the cohort receiving 2.16 procedures (range, 0-9; SD, ± 2.37). There was no significant difference between laterality, age, or sex between patients who bled after warm water contact and those who bled spontaneously. The ulcers recurred in three of the patients, and Unna boot treatment was reapplied until wounds healed once more. Patients had an average follow up of 7.2 months (range, 26 months; SD, ± 8.9 months), and we noted no recurrent bleeding episodes. ConclusionsSpontaneous hemorrhage of VVs, although relatively under-reported, is not a rare occurrence. Risk factors are unknown; however, half of our patient cohort reported VV hemorrhage during or directly after coming into contact with warm water. Furthermore, these patients demonstrated a significantly shorter wound healing time compared with the rest of the cohort. Basic first aid, wound care, and hemostasis control education should be provided to all patients with VVs. Further investigation surrounding the risk factors associated with VV hemorrhage is warranted.

Benefits of venoactive drug therapy in surgical or endovenous treatment for varicose veins: a systematic review.

Lower limb varicose veins can be treated effectively with endovenous ablation procedures or with minimally invasive open techniques. However, these procedures may cause pain and discomfort, and surgical stripping can be associated with long recovery times. We investigated whether venoactive drugs (VAD) used to treat chronic venous disease (CVD), provide benefits to patients recovering from a surgical or endovenous varicose vein procedure. We conducted a systematic review of the literature to identify clinical trials investigating VAD therapy before, during, or after a surgical, endovenous, or sclerotherapy procedure for varicose veins. Records retrieved from the PubMed and Embase databases were screened for relevant studies. Full-length articles in English were obtained for analysis. We identified five clinical trials investigating the effects of VAD on recovery after surgery, endovenous ablation, or sclerotherapy. Studies were conducted in Russia, Italy, and Czech Republic and varied considerably in design, but all were unblinded open-label studies. All studies reported the use of micronized purified flavonoid fraction (MPFF); in one study, sulodexide was also used. Three studies reported significantly less post-procedural pain with MPFF treatment, with one reporting no significant effect. Two studies reported significant reductions in post-procedural bleeding with MPFF treatment. Three out of four studies reported greater symptomatic improvement with MPFF treatment. Appropriate treatment with MPFF may help reduce post-procedural pain, hemorrhage, and CVD-specific symptoms. While adjunct VAD treatment seems promising, high-quality placebo-controlled studies are needed to unequivocally demonstrate its benefits.

PC184. Management of Patients Undergoing Endovenous Ablation Procedures and Treatment Outcomes Are Significantly Different in Intersocietal Accreditation Commission-Accredited and Not Accredited Vein Centers

PC184. Management of Patients Undergoing Endovenous Ablation Procedures and Treatment Outcomes Are Significantly Different in Intersocietal Accreditation Commission-Accredited and Not Accredited Vein Centers

Lidocaine safety after saphenous vein tumescent anesthesia.

Objectives For endovenous thermal ablation of the saphenous veins, tumescent lidocaine anesthesia is often used. Unfortunately, information is sparse on the pharmacokinetics of lidocaine absorption and its maximum safe dose. The aim of this study was to evaluate plasma concentration of lidocaine on 12 lead electrocardiograms (ECGs) and symptoms over time after the administration of tumescent lidocaine during endovenous thermal ablation procedures in healthy volunteers. Methods An observational study of symptoms, 12 lead ECGs, and serum lidocaine levels were obtained following the administration of either 15 mg/kg lidocaine or 35 mg/kg lidocaine in the perivenous saphenous space under ultrasound guidance. Blood was drawn at regular intervals in heparinized tubes and spun at 3000 r/min for 10 min. The plasma lidocaine levels were plotted vs. time for statistical comparisons. Results With the 35 mg/kg dose, four of 11 participants developed symptoms of lidocaine toxicity at 40 min, which resolved by 180 min. The 35 mg/kg dose resulted in a mean serum lidocaine peak of 2.55 µg/ml at 60 min. The 15 mg/kg dose did not result in any symptoms of lidocaine toxicity, and it resulted in a serum lidocaine plateau of 0.85 µg/ml at 180 min. No significant changes were seen on the 12-lead ECG after the administration of lidocaine at either dose. Conclusions The 15 mg/kg total lidocaine dose did not cause symptoms and appears to be a safe lidocaine dosage for tumescent anesthesia for saphenous endovenous thermal ablations. The 35 mg/kg lidocaine dose is associated with lidocaine toxicity. More study on the maximal safe dose of lidocaine for endovenous thermal ablations is needed.

Impact of provider characteristics on use of endovenous ablation procedures in Medicare beneficiaries

ObjectiveThe objective of this study was to assess the association between provider characteristics and intensity of endovenous therapy (EVT) utilization in the Medicare population. MethodsThe Medicare Provider Utilization and Payment Data Public Use Files (2012-2014) were queried to construct a database of providers performing EVT using laser or radiofrequency ablation techniques for treatment of lower extremity venous reflux. A utilization index (UI; EVT procedure per patient treated per year) was calculated for each provider, and median services per county were determined. Provider specialty, geographic region, and site of service (facility vs outpatient) were determined for each patient. Multivariate regression analysis was used to identify provider characteristics associated with a UI above the 75th percentile. ResultsThere were 6599 providers who performed EVT in 405,232 Medicare beneficiaries during the study period. Intensity of EVT use by providers was assessed by the calculated UI, the average number of EVT procedures performed in treated patients per year (range, 1-4). Vascular surgeons had the lowest UI among all provider specialties (1.32). By multivariate analysis, the likelihood of a provider's UI being >1.8 (top 25%) was associated with provider training in a field other than surgery, cardiology, or radiology (odds ratio [OR], 3.35; 2.74-4.09); services performed in an outpatient setting (OR, 2.62; 1.97-3.47); and providers who perform high annual volume of EVT (OR, 8.68; 7.59-9.91). A high annual volume provider was defined as one whose EVT volume was ≥75th percentile nationally. ConclusionsThere is great variation in intensity of vein ablation procedures performed on Medicare beneficiaries by geographic location and provider specialty. High-volume providers and those with a specialty not traditionally associated with the management of lower extremity chronic venous disease are more likely to perform more EVT procedures per patient.

The Outcome of Anticoagulation on Endovenous Laser Therapy for Superficial Venous Incompetence

With the growth of outpatient endovenous ablation procedures and the impetus to make the intervention experience as hassle-free as possible, examining the effect of continuous anticoagulation on outcomes is prudent. This study, albeit a small cohort, adds to the data supporting the safe continuation of anticoagulation throughout the periprocedural period, including the use of direct thrombin inhibitors.

SS19. Impact of Provider Characteristics on Use of Endovenous Ablation Procedures in Medicare Beneficiaries

SS19. Impact of Provider Characteristics on Use of Endovenous Ablation Procedures in Medicare Beneficiaries

Current Practices in Venous Disease—A Survey of Canadian Vascular Surgeons

The objective of this study was to evaluate the practice patterns of vascular surgeons in Canada in the treatment of superficial venous disease. A web-based survey was sent to 155 active members of the Canadian Society for Vascular Surgery. The survey included 19 questions investigating the venous practices of vascular surgeons. Questions assessed training background, practice site, venous treatments offered, and obstacles to therapy. Open-ended questions were also included as options for additional comments. A total of 63 responses (41%) were acquired during February and March 2017. Respondents were roughly equal from academic (54%) and community (46%) sites, with an even distribution of years in practice. Only 62% offered sclerotherapy, whereas 49% offered endovenous ablation procedures in their practice. The majority of surgeons thought that their residency and fellowship had not prepared them for an active venous practice (68%). Seventy-five percent of surgeons are interested in attending a hands-on course in venous therapy. The main challenges faced with venous therapy include lack of time due to overwhelming arterial diseases (67%), equipment cost/office space limitations (52%), and lack of knowledge or skills in contemporary procedures (27%). Sixty percent of the respondents perceived barriers in getting venous ultrasound imaging for their patients. Fifty-seven percent of surgeons believe there are gaps between published guidelines and the care of venous disease in their practices. However, 92% of respondents believe that vascular surgeons should be leaders in delivering care for venous disease. The treatment of superficial venous disease has advanced during the last few decades, but significant obstacles exist for Canadian surgeons to deliver venous therapy in accordance with current guidelines.

A Defined Protocol to Resolving Cannulation Failure during Endovenous Ablation Procedures

During endovenous ablation for the treatment of insufficient veins, failure to cannulate the entirety of the refluxing vein with the treatment catheter prevents technically successful ablation. In this technique report, we describe a defined protocol to overcome cannulation failure of axial veins for endovenous ablation. This protocol utilizes commonly available adjunctive techniques including ultrasound-guided digital compression, the use of a guidewire, the use of a guide catheter, and placement of a second puncture site in a step-wise fashion to overcome varying degrees of tortuosity or obstruction. The sequential application of these techniques as described in this report allows endovenous ablation to be applied to patients with challenging venous anatomy.

The effect of distraction on pain perception during an endovenous thermal ablation procedure.

To determine whether audio and visual distraction can affect the pain perception of a patient undergoing endovenous thermal ablation under tumescent anesthesia. Patients underwent an endovenous thermal ablation procedure and were randomized into two groups: non-distraction (AVD-) and with distraction (AVD+). Visual analogue scale pain score and hospital anxiety depression scale scores were used to measure outcome. The recruited patients were asked to submit an anticipated visual analogue scale pain score prior to treatment as well as the actual experienced post-operative visual analogue scale pain score. There was no significant difference between the AVD- and AVD+ groups post-operative pain score 2.85 (SD 1.7) versus 2.60 (SD 2.3), p = 0.68. Pain score in women with distraction (AVD+) decreased from 3.81 to 2.42. The pain score in men with distraction (AVD+) increases from 1.88 to 2.82. In the AVD- group, a significant difference was found between men and women (p = 0.014). Disregarding gender, a significant difference was found between the anticipated pain score and the actual pain score in both the AVD- group (p = 0.009) and AVD+ group (p = 0.021). There was a correlation between depression and the pain score, which was not seen between pain and anxiety score. The results suggested that audiovisual distraction has no influence on the visual analogue scale pain score during endovenous thermal ablation under tumescent anesthesia. Despite this, patients appreciate and evaluate audio and visual distraction as pleasant to extremely pleasant when applied.

Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review.

The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening (p = 0.66; OR: 0.22; 95% of CI: 0.08-0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06-0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54-18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.