Endovenous Ablation Research Articles

Clincal outcomes of two endovenous radiofrequency ablation systems in the treatment of great saphenous vein insufficiency

Clincal outcomes of two endovenous radiofrequency ablation systems in the treatment of great saphenous vein insufficiency

Retrospective review of endovenous thermic ablation alone versus combined with phlebectomy in the management of varicose veins

Background: Chronic venous disease (CVD) affects 25-30% of the adult population in developed countries, significantly impacting quality of life. Endovenous thermal ablation (EVTA) has replaced traditional saphenectomy, but the benefit of combining it with phlebectomy remains debated. This retrospective study compares varicose vein recurrence after EVTA with and without phlebectomy. Methods: A total of 155 patients from the general hospital of Mexico between 2021 and 2024, classified as CEAP C2-C6, were analyzed. Of these, 83 underwent EVTA with phlebectomy, and 72 underwent only EVTA. Demographic data were analyzed, and recurrence rates, technical success, and complications were compared using chi-square and student’s t tests (p<0.05). Results: Recurrence rates were lower in the phlebectomy group (14.5%) compared to the non-phlebectomy group (27.2%, p=0.04). The success rate was higher in the phlebectomy group (86.7%) compared to EVTA alone (65.2%, p=0.003). There were no significant differences in complications between the groups. Conclusions: EVTA with phlebectomy demonstrated better outcomes in terms of recurrence and clinical success. However, minor complications such as bruising should be considered when choosing the treatment.

Protocol-based treatment of spontaneous hemorrhage from varicose veins prevents recurrence of bleeding

BackgroundSpontaneous hemorrhage from erosion of varicose veins through the skin is a serious and occasionally fatal complication of varicose vein disease. Various treatments, both acute and delayed, have been advocated. Our two-step clinical protocol was designed to prevent further hemorrhage without delay and to provide durable freedom from recurrent bleeding. MethodsAll patients referred to our surgical vein practice with hemorrhage from varicose veins were entered into a prospective registry. On presentation, all patients underwent diagnostic duplex ultrasound for venous reflux. Immediate treatment consisted of ultrasound-guided polidocanol/CO2 foam sclerotherapy of the bleeding varicosity and adjacent veins. Subsequent endovenous ablation of underlying incompetent axial veins, with concurrent microphlebectomy when indicated, was scheduled and performed within 8 weeks. ResultsFifty-nine patients were referred with recent hemorrhage from varicose veins over a period of 4 years. Fifty-six (95%) had an ultrasound-identified tributary varicosity underlying the point of bleeding, and three had a skin-surface erosion only and no ultrasound-identified underlying tributary. Of the 59 study patients, 52 underwent prompt polidocanol/CO2 foam sclerotherapy, targeted to both the underlying tributary (when present) as well as the cutaneous bleeding varicosity. The remaining seven either declined sclerotherapy or were ineligible. Underlying incompetence of axial (great, small, or anterior saphenous) veins was found in 54 patients (92%). Of these patients with truncal vein incompetence, 48 underwent ablation—5 declined and 1 was too frail for any further intervention. There were no recurrent bleeds in the interval between immediate sclerotherapy and scheduled ablation. During a mean follow-up of 2.2 years, four patients (7%) had late, recurrent hemorrhage: one had failed to return for their scheduled ablation, two were on chronic anticoagulation, and one had severe right heart failure. All four were retreated without further recurrence. ConclusionsA two-step protocol of immediate ultrasound-guided foam sclerotherapy, followed within 8 weeks by endovenous ablation of incompetent axial veins and concurrent microphlebectomy, provided rapid and efficient treatment with durable freedom from subsequent hemorrhage.

Comparison of Long-Term Results of Endovenous Ablation Techniques and Classical Stripping Operations in the Treatment of Venous Insufficiency

Comparison of Long-Term Results of Endovenous Ablation Techniques and Classical Stripping Operations in the Treatment of Venous Insufficiency

Innovative Approaches and Future Directions in the Management and Understanding of Varicose Veins: A Systematic Review.

Varicose veins, a prevalent condition that primarily affects the lower limbs, present significant hurdles in diagnosis and treatment due to their diverse causes. This study dives into the complex hormonal, environmental, and molecular elements that influence varicose vein genesis, emphasizing the need for precise diagnostic methods and changing therapy approaches to improve patient outcomes. It investigates the epidemiology and demographic distribution of varicose veins, delves into their pathophysiology, and assesses diagnostic methods such as duplex ultrasonography and the CEAP classification system. In addition, the study discusses novel therapies such as sclerotherapy and endovenous thermal ablation, as well as the effectiveness of existing diagnostic methods in detecting chronic venous illnesses. By investigating venous wall remodeling and inflammatory pathways, it gives a thorough knowledge of varicose vein formation. The study calls for future research that focuses on patient-centered methods, bioengineering advances, digital health applications, and genetic and molecular studies to improve the accuracy and effectiveness of vascular therapy. As a result, a multidisciplinary literature analysis was done, drawing on insights from vascular medicine, epidemiology, genetics, and pharmacology, to consolidate existing knowledge and identify possibilities to enhance varicose vein diagnosis, treatment, and patient care outcomes.

The Impact of Targeted Endovenous Radiofrequency Ablation versus Excluded Saphenous Vein Surgery in Management of Incompetent Giacomini Vein

The Impact of Targeted Endovenous Radiofrequency Ablation versus Excluded Saphenous Vein Surgery in Management of Incompetent Giacomini Vein

Venous stenting versus venous ablation.

The minimally invasive procedures of venous ablation and iliac vein stenting are evolving treatment options for venous insufficiency. Yet, there are no studies directly comparing the outcome of these procedures. We performed a survey on patients who had both procedures, to determine if either procedure helped more and if there is any other clinical factor related to the outcome. We collected data between Jan 2012 and Feb 2019 from 726 patients who failed to improve swelling after conservative management. The patients underwent iliac vein stenting and vein ablations. We recorded patient assessment of the leg immediately after completion of both procedures. Follow-up was performed using in-person questionnaires by asking if improvement in lower extremity swelling occurred and if so, which procedure helped more. Of the 726 patients who underwent endovenous closure and iliac vein stent placement, 254 (35%) were males. The average age of the patients was 70 (±13.7 SD, range 29-103) years. The presenting symptom (C of CEAP classification) of lower extremity limb venous disease was 34.8%, 44.6%, 5.6%, and 15% for C3-C6, respectively. Patients were asked about swelling, and they stated: swelling is better (605, 83.3%), swelling is not better (118, 16.3%), and not sure if there is any improvement in swelling (3, 0.4%). Patients stated the following completion of both procedures: both procedures equally helped (129, 18%), iliac vein stent superior (167, 23%), endovenous ablation superior (177, 24%), neither helped (112, 16%), and not sure which procedure helped more (141, 19%). After ANOVA, we concluded that older patients (average = 72.5 years) were more often not sure which procedure helped more (p = .024), and younger patients (average = 68.4years) stated that endovenous ablation helped more (p = .014). There were no significant differences between the groups regarding gender (p = .9), laterality (p = .33), or presenting symptoms scores (p = .9). There was no statistical relationship between the procedure that was performed first and the procedure that helped more (p = 0.095). In this qualitative assessment, preliminary data suggest that the comparative role of iliac vein stent versus endovenous ablation warrants further study. The data were broadly distributed, and neither procedure was superior. In addition, 16% of the patients stated that neither procedure helped. The age of patients may also play a role in their procedure preferences and their subjective assessment for improvement.

Safety and efficacy of endovenous microwave ablation for treatment of varicose veins of the lower limbs in China: A prospective registered clinical trial.

This study aimed to investigate the safety and efficacy of a new Chinese device using microwave ablation for treating symptomatic great saphenous vein (GSV) varicose veins (VVs). This prospective, single-arm, single-center, cohort study investigated the safety and efficacy of endovenous microwave ablation for the treatment of symptomatic VVs. A total of 50 patients with lower limb varicose veins were enrolled from the Hospital of Chengdu University of Traditional Chinese Medicine. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The primary outcome was the occlusion rate of GSV immediately and at 1, 6, and 12 months after the treatment. The secondary outcomes included the venous clinical severity score (VCSS), the chronic venous insufficiency questionnaire 14 items (CIVIQ-14) score, the Aberdeen varicose vein questionnaire (AVVQ) score, and the pain visual analog scale (VAS) score. This study protocol was registered at ClinicalTrials.gov (ID: NCT04645771). In total, 50 limbs from 50 patients (26 female; mean age: 53.45 ± 9.78 years) were treated. A technical success rate of 100% was achieved and no serious adverse events were recorded. During the follow-up period, the occlusion rate of the major/minor saphenous vein trunk remained 100% at 1, 6, and 12 months after surgery except one patient fell off. The median 24-h VAS value was 2 (2,3). The VCSS score, CIVIQ-14 score, and AVVQ score (p < .05) at 1, 6, and 12 months improved significantly compared with the value preoperative (p < .05). EMA was safe and effective for treating varicose veins in the lower limbs, with a high rate of venous trunk occlusion and few complications, thus improving patients' postoperative quality of life.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12mm, group B ≥12mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1month, 12months and 24months postoperatively. 118 patients with GSV diameter <12mm (group A) and 87 with GSV diameter ≥12mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12mm, 1470nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470nm EVLA and RFA techniques performed similar outcomes.

Value and limitations of postoperative duplex scans after endovenous thermal ablation

Value and limitations of postoperative duplex scans after endovenous thermal ablation

Interventions for great saphenous vein insufficiency: A systematic review and network meta-analysis.

Great saphenous vein insufficiency (GSVI) adversely affects the quality of life of affected individuals. Minimally invasive endo-venous ablation techniques have emerged as effective and safe treatments, despite the longstanding use of surgical interventions. We aim in our study to evaluate all the available interventions in the literature, either endo-venous or conventional approaches for the treatment of GSVI. A thorough search was performed across four electronic databases to identify relevant studies. A frequentist network meta-analysis (NWM) was executed on the combined data to derive network estimates pertaining to the outcomes of concern. Risk ratios (RRs) were employed as the effect size metric for binary outcomes, while mean differences (MDs) were utilized for continuous outcomes, each reported with a 95% confidence interval. The qualitative review was conducted employing the Cochrane risk of bias assessment tool 1. Our NWM included 75 studies encompassing 12,196 patients. Regarding technical success rate within the first 5years after treatment, Endo-venous Laser Ablation (EVLA) with High Ligation and Stripping (HL/S), EVLA alone, Cyanoacrylate Adhesive Injection, cryostripping, HL/S and Radiofrequency Ablation (RFA) were significantly better than Ultrasound-Guided Foam Sclerotherapy and F-care. Also, invagination stripping was inferior to all interventions. Conservative Hemodynamic Cure for Venous Insufficiency and Varicose Veins (CHIVA) demonstrated a significantly lower recurrence rate with a RR of 0.35 [0.15; 0.79] compared to RFA, but RFA was more effective in recurrence prevention than HL/S and Mechanochemical Ablation (MOCA), with a RR of 0.63 [0.41; 0.97] and 0.18 [0.03; 0.95], respectively. Endo-venous Steam Ablation (EVSA) emerged as the most effective in reducing post-intervention pain, showing a MD of -2.73 [-3.72; -1.74] compared to HL/S. In Aberdeen Varicose Vein Questionnaire outcome, our analysis favored MOCA over most studied interventions, with an MD of -6.88 [-12.43; -1.32] compared to HL/S. Safety outcomes did not significantly differ among interventions. Our findings revealed significant variations in the technical success rates, recurrence rates, and post-intervention pain levels among different interventions. CHIVA exhibited enhanced performance in terms of lower recurrence rates, while EVSA emerged as a promising choice for mitigating post-intervention pain. Additionally, our analysis underscored the significance of patient-reported outcomes, with MOCA consistently yielding favorable results in terms of enhancing quality of life and expediting the return to regular activities.

Comparing mechanochemical endovenous ablation using Flebogrif with endovenous laser ablation in the treatment of primary great saphenous vein incompetence: protocol for a multicentre, open-label, non-inferiority, observer-blinded, randomised controlled trial (REBORN trial)

IntroductionEndovenous laser ablation (EVLA) is associated with an excellent outcome in the treatment of great saphenous vein (GSV) incompetence. However, the use of thermal ablation requires tumescent anaesthesia and is...

Comparative analysis of VenaBlock and VenaSeal Systems for catheter-guided endovenous cyanoacrylate closure in treating chronic venous insufficiency of the lower extremity: effectiveness and feasibility.

Cyanoacrylate adhesive closure (CAC) systems are widely used to treat varicose veins. In terms of efficacy and safety, these nonthermal, non-tumescent methods are noninferior to endovenous thermal ablation techniques. However, no published studies have compared products that use CAC systems. VenaSeal® (Medtronic, Santa Rosa, CA, USA) and VenaBlock® (Invamed) are the most commonly used CAC-based products worldwide. This study aimed to focus on the efficacy of these two commonly used products, with little emphasis on safety. Published full-text articles on the VenaBlock® and VenaSeal® systems were searched. Data for each product were evaluated by comparing them with each other in terms of effectiveness. In total, 1882 extremities from 11 studies using VenaBlock® and 524 extremities from eight studies using VenaSeal® were included and compared. Both devices were effective, and their cumulative recanalization-free survival rates were similar (P=0.188) at the 6-, 12-, 24-, 36-, and 60-month follow-ups. Both products improved the venous clinical severity score (VCSS) and quality of life (QoL) scores. VenaBlock® and VenaSeal® are effective in terms of cumulative recanalization-free survival rates, and no significant difference was found between the two groups (P=0.188). Both significantly improve the VCSS and QoL scores. CAC is feasible for the treatment of varicose veins.

Axial Ablation versus Terminal Interruption of the Reflux Source (AAVTIRS): A Randomised Controlled Trial.

Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested. We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible. 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences. The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation.Trial registered at clinicaltrials.gov NCT04484168.

Deep vein thrombosis after sclerotherapy and endovenous laser ablation of varicose veins - an observational study.

Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.

The access and invasiveness-based classification of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery.

The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure. We performed an online search for definitions for 'non-invasive', 'non-surgical', 'minimally invasive', 'minimal access', 'pinhole' and 'keyhole'. We then searched peer-reviewed medical papers (PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal. We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both 'non-invasive' and 'minimally invasive') showing confusion in the classification of procedures. We suggested the 'AI classification' based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 - needle = <21G, 4 - cannula >21G but not a surgical trocar, 5 - surgical trocars or small incisions and 6 - incisions). The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand.

Efficacy and Safety of Radiofrequency Ablation and Trendelenburg Procedure for Varicose Vein Treatment in a Tertiary Care Hospital

Context: Varicose veins have been conventionally treated by Trendelenburg procedure, which includes below-knee phlebotomies, juxta-femoral flush ligation of saphenous veins, and below-knee vein stripping. However, radiofrequency ablation (RFA) therapy, a less invasive method that uses high-frequency alternating current to cause thermal damage to the venous tissue, has become increasingly popular due to its reduced adverse effects. This study aimed to compare these two methods regarding early ambulation, return to work, postoperative pain severity, recovery time, and complication rates. Aims: To compare the effectiveness and safety of open procedure compared to endovenous ablation. Settings and Designs: An analytical cross-sectional study was prospectively conducted at Saveetha Medical College in Chennai. Subjects and Methods: This analytical cross-sectional study, conducted prospectively from May 2020 to May 2023, involved 100 individuals diagnosed with varicose veins. Participants were followed up at 3-, 6-, and 12-month intervals. The study was carried out at Saveetha Medical College in Chennai. Fifty patients were treated using the Trendelenburg method (Group I), while 50 patients received RFA (Group II). The data on early ambulation, return to work, postoperative pain severity, recovery time, and complication rates were collected and analyzed using the Epi Info 7 version. Results: Group I did not show any significant complications, such as bleeding, hematoma, or inflammation, compared to Group II. Notably, in Group II, there was an earlier hospital discharge, faster return to daily activities and work, and faster patient mobilization. Conclusions: This study concludes RFA, compared to the Trendelenburg method, has early ambulation, early return to work, reduced postoperative pain, swift recovery, and fewer complications. Consequently, we recommend RFA as their primary surgical option for patients with varicose veins in the lower limbs.

Quantitative 2-Dimensionsal Digital Subtraction Venography for Venous Interventions: Validation in Phantom and In Vivo Porcine Models

PurposeTo determine the feasibility of using a 2-dimensional quantitative digital subtraction venography (qDSV) technique that employs a temporally modulated contrast medium injection to quantify blood velocity in phantom, normal, and stenotic porcine iliac vein models. Materials and MethodsBlood velocity was calculated using qDSV following temporally modulated pulsed injections of iodinated contrast medium and compared with Doppler ultrasound (US) measurements (phantom, in-line sensor; in vivo, diagnostic linear probe). Phantom evaluation was performed in a compliant polyethylene tube phantom with simulated venous flow. In vivo evaluation of qDSV was performed in normal (n = 7) and stenotic (n = 3) iliac vein models. Stenoses were created using endovenous radiofrequency ablation, and blood velocities were determined at baseline, after stenosis, after venoplasty, and after stent placement. ResultsIn the phantom model, qDSV-calculated blood velocities (12–50 cm/s) had very strong correlations with US-measured velocities (13–51 cm/s) across a range of baseline blood velocities and injection protocols (slope, 1.01–1.13; R2 = 0.96–0.99). qDSV velocities were similar to US velocities regardless of injection method: (a) custom injector, (b) commercial injector, or (c) hand injection. In the normal in vivo model, qDSV-calculated velocities (5–18 cm/s) had strong correlation (slope, 1.22; R2 = 0.90) with US-measured velocities (3–20 cm/s). In the stenosis model, blood velocities at baseline, after stenosis, after venoplasty, and after stent placement were similar on qDSV and US at all time points. ConclusionsVenous blood velocity was accurately quantified in a venous phantom and in vivo porcine models using qDSV. Intraprocedural changes in porcine iliac vein blood velocity were quantified with qDSV after creation of a stenosis and subsequently treating it with venoplasty and stent placement.

Comparison of two ablation procedures combined with high ligation and foam sclerotherapy and compression therapy for patients with venous leg ulcers

ABSTRACT Aim To compare the ablation techniques’ efficacy of endovenous microwave ablation (EMA) combined with high ligation (HL), foam sclerotherapy (FS) and compression therapy (CT) and endovenous laser ablation (EVLA) combined with HL-FS-CT in the treatment of VLUs. Method 301 consecutive patients with VLUs from 2013 to 2022 in a 3200-bed hospital were intervened by EMA combined with HL-FS-CT and EVLA combined with HL-FS-CT were retrospectively compared. Results One hundred thirty-four patients underwent EMA+HL-FS-CT and 167 patients underwent EVLA+HL-FS-CT. The primary outcome of the ulcer healing time was 1.45(0.75–1.5) months and 1.86(0.5–2.5) months, respectively, in the two groups (HR for ulcer healing was 1.26, 95% CI [0.96–1.66], p = 0.097). Secondary outcomes included that no significant difference was found in ulcer recurrence and GSV recanalization and complications between the two groups, and the postoperative VCSS and AVVQ were significantly lower than the baseline values in the respective groups (p = 0.0001). Conclusion EMA+HL-FS-CT and EVLA+HL-FS-CT are both effective at treating VLUs. Both of the two comprehensive treatments were beneficial to the healing of ulcers, but no evidence showed which one was superior in the ulcer healing time.

Challenging conventions: Reconsidering the indication for endovenous ablation in CEAP 2 patients.

Endovenous ablation may not always be necessary for every patient with chronic venous insufficiency who has an indication for endovenous ablation. This study investigates whether compression stockings and Daflon® can be as effective for some patients with CEAP two in chronic venous insufficiency. In this study, 137 patients who had endovenous ablation indication received plethysmographical hemodynamic tests and were divided into two groups. Group 1 had normal venous hemodynamics and received compression stockings and Daflon®. Group 2 had abnormal function and received laser ablation. All patients were reevaluated after 6 months. The study showed that there was no statistically significant difference between Groups 1 and 2 in the 6th month measurements after the treatments. As a result, we do not find it appropriate and do not recommend that every patient with complaints of chronic venous insufficiency and an indication for endovenous ablation undergo ablation without evaluating lower extremity venous hemodynamics.