Endovenous Laser Treatment Research Articles

Application of Endovenous Laser Treatment Combined with Foam Sclerotherapy for the Minimally Invasive Treatment of Great Saphenous Vein Varicosity

Objective: To evaluate the efficacy of endovenous laser treatment (EVLT) combined with foam sclerotherapy (FS) in the treatment of great saphenous vein varicosity (GSVV). Methods: A total of 50 patients with GSVV, treated between March 2021 and March 2024, were selected and randomly divided into two groups using a random number table. The combination group (25 cases) underwent EVLT combined with FS, while the conventional group (25 cases) underwent EVLT alone. The total effective rate, complication rate, disease severity score, and serological indicators were compared between the two groups. Results: The total effective rate in the combination group was higher, and the complication rate was lower compared to the conventional group (P < 0.05). One week after surgery, the disease severity score in the combination group was lower, coagulation function indicators were better, and inflammatory factor levels were lower compared to the conventional group (P < 0.05). Conclusion: EVLT combined with FS can improve the clinical efficacy in GSVV patients, prevent postoperative complications, reduce disease severity, protect patients’ coagulation function, and alleviate postoperative inflammatory responses, showing significant advantages in combined surgery.

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Analytical solutions in the modeling of the endovenous laser ablation

We modeled the operative treatment of incompetent truncal veins using endovenous laser ablation (EVLA). The main concern regarding the thermoablative technique is tissue damage, which is correlated with (1) the energy provided by the laser power and (2) temperature distribution. Our objective was to accurate the two functions, namely the fluence rate and the temperature, depending on the thermoablative technique and the endovenous laser treatment (ELT). First, we considered three differential equations: diffusion, heat, and bioheat equations in the endovenous-perivenous multidomain to describe the lumen, the vein wall, the tissue pad, and the skin. Second, we examined the power source according to the Beer-Lambert law in the incident beam irradiance and the heat source as the so-called absorbed optical power density. Third, we checked out the heat transfer at the skin boundary according to Newton’s law of cooling, which stands for a Robin boundary condition. For this new model, we proposed exact solutions: applying differential equations techniques, we solved (1) a diffusion approximation of the radiative transfer equation under the considered power source, and (2) the coupled heat and bioheat equations under the considered heat source accomplished with the Robin boundary condition. Then, we graphically illustrated the fluence rate profile and discussed its time dependence and steady state. Besides, we discuss thermal damage to the vein-tissue system and present open problems.

Effects of high ligation plus endovenous laser therapy in patients with varicosis of great saphenous vein and type 2 diabetes.

To analyze the effects of high ligation plus endovenous laser therapy on intraoperative blood loss, postoperative visual analogue scale (VAS) score, and complications in patients with varicosis of great saphenous vein and type 2 diabetes. About 61 patients with varicosis of great saphenous vein and type 2 diabetes treated at our hospital were included. About 32 patients (37 affected limbs) receiving conventional surgery were included in control group, while 29 patients (34 affected limbs) receiving high ligation plus endovenous laser therapy were included in study group. The intraoperative blood loss, operation time, length of postoperative hospital stay, postoperative VAS scores, blood glucose levels, Venous Clinical Severity Score (VCSS), and incidence of complications were compared between the two groups. Compared with the control group, there were less intraoperative blood loss (P < .05), shorter operation time (P < .05), and shorter length of postoperative hospital stay in the study group (P < .05). Besides, there was also lower VAS scores at different time points after surgery in the study group than in the control group (P < .05). Blood glucose levels were decreased in both groups after surgery (P < .05). Moreover, VCSS was decreased in either group at 3 months after surgery (P < .05). Blood glucose levels of patients in the study group were lower than those of the control group after surgery (P < .05). The VCSS was also lower in the study group at 3 months after surgery than in the control group (P < .05). High ligation with endovenous laser therapy for varicosis of great saphenous vein in patients with type 2 diabetes was safe and feasible.

Long-Term Clinical and Imaging Findings in Patients with Lower Extremity Varicose Veins Treated with Endovenous Laser Treatment: A Follow-Up Study of up to 12 Years.

This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95%CI = 1.3-20.4) and OR = 1.5 (95%CI = 1-2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy.

Comparative Efficacy of Postoperative Compression Methods After EVLT for Great Saphenous Vein Insufficiency.

Introduction: The preference for endovascular techniques in treating varicose veins, particularly in the great saphenous vein (GSV), has increased due to their minimally invasive nature and reduced complications. Post-operative care, especially involving compression therapy, remains crucial to improve outcomes, prevent varicose vein recurrence, and enhance overall recovery. This study aimed to evaluate the efficacy of eccentric compression therapy compared to alternative post-operative care methods following endovenous laser treatment (EVLT) for GSV insufficiency. Methods: This prospective randomized clinical trial encompassed 88 EVLT procedures for GSV insufficiency. The participants were divided into two groups, each receiving different postoperative compression methods, and were evaluated over a specified period. The primary outcome was the pain scale after EVLT; meanwhile, the secondary outcome measured in the present study was the rate of GSV occlusion after EVLT. Results: Both groups underwent all EVLT procedures successfully without any complications. At the one-month duplex ultrasound (DUS) follow-up, the sapheno-femoral junction occlusion rates were 97% (43 out of 44) for group A (eccentric compression plus gradual compression stocking) and 95% (42 out of 44) for group B (only gradual compression stocking). Ecchymosis was observed in only 12 patients across both groups, accounting for an overall occurrence of 13.6%. Group A patients reported significantly lower analgesic usage (10%) compared to group B (18%), although this difference did not reach statistical significance. Analysis of postoperative pain data utilizing the visual analog scale (VAS) showed a median value of 5.5 in group B patients, which decreased to 3.1 with the application of eccentric compression. Moreover, there was less ecchymosis in group A observed by one week. Conclusion: This study contributes to the ongoing discourse on the efficacy of postoperative compression in varicose vein treatment. It underscores the necessity for more comprehensive, well-designed studies to yield clearer conclusions and provide better guidance for post-procedure care.

Mechanochemical Ablation: Current Status in the Management of Varicose Veins: A Comprehensive Review

Varicose veins, a common venous disorder, often lead to significant discomfort and a reduced quality of life. Over the years, numerous treatment approaches have been explored to alleviate the associated symptoms. Surgical interventions such as saphenofemoral junction ligation and Great Saphenous Vein (GSV) stripping were transformative in their time, but the emergence of endovenous techniques like Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) marked a significant shift. While these endovenous techniques have shown exceptional clinical outcomes and cost-effectiveness, they do come with the drawback of pain due to the application of heat for ablation and the necessity of infiltrating tumescent anaesthesia around the vein. In recent years, non thermal, non tumescent methods have arisen as effective alternatives that reduce patient discomfort. These methods encompass procedures such as Mechanochemical Ablation (MOCA) and endovenous cyanoacrylate glue, which minimise heat generation and eliminate the need for tumescent anaesthesia. This article provides a comprehensive overview of the current status of MOCA. It covers its mechanism of action, clinical outcomes, cost-effectiveness, and safety profiles in managing varicose veins.

Endovenous laser treatment vs conventional surgery for great saphenous vein varicosities: A propensity score matching analysis.

Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins. To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis. We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg. Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients' characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% vs 21.46%, χ2 = 11.506, P = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% vs 19.54%, P = 0.000). EVLT may not always be the best option for the treatment of great saphenous vein varicosis.

Effectiveness of iliac vein stenting combined with endovenous laser treatment of recurrent varicose veins associated with iliac vein compression.

Iliac vein compression syndrome (IVCS) is an underlying cause of varicose vein (VV) recurrence after venous surgery. However, the management of recurrent varicose veins (RVVs) combined with IVCS has rarely been reported. This study aimed to investigate the outcomes of a one-stop procedure to correct outflow obstruction and superficial reflux for patients with RVVs and IVCS. A retrospective analysis was conducted of 102 consecutive patients diagnosed with RVVs. Computed tomography venography (CTV) was performed to confirm IVCS. The cases were divided into 2 groups: the IRVVs group, including patients with RVVs and IVCS (n=48), and the RVVs group, including patients with RVVs only (n=54). The characteristics, vein reflux, and clinical, etiological, anatomical, and pathophysiological (CEAP) distribution were investigated. Then, the IRVVs group patients who underwent endovenous laser ablation (EVLA) (n=39) were divided into a further 2 groups: the EVLA + S group (n=19), who received EVLA and stenting of iliac vein, and the EVLA group (n=20), who received EVLA treatment alone. The great/small saphenous vein (GSV/SSV) trunk occlusion, VV recurrence, visual analogue scale (VAS), and venous clinical severity score (VCSS) were investigated. The prevalence rate of femoral vein reflux was 81.2% in IRVVs group and 50% in RVVs group (P<0.05). In the IRVVs group, 72.9% of patients manifested as CEAP clinical class >3, which was higher than that in RVVs group (48.1%) (P<0.05). The 12-month GSV/SSV occlusion rate in the EVLA + S and EVLA groups were 94.7% and 90.0%, respectively. Totals of 9 patients in EVLA + S group and 6 patients in EVLA group had active venous ulcers, and the ulcer healing time in EVLA + S group was significantly shorter (27.22±7.12 vs. 46.67±9.83 days, P<0.05). The reductions in the VAS and VCSS values between baseline, 1 month, and 12 months in the EVLA + S group were more obvious than those in EVLA group (P<0.05). The one-stop combination treatment of iliac venous stenting and EVLA in patients with RVVs and IVCS is safe and effective and provides prominent symptom relief, improved quality of life, and a more satisfactory ulcer healing than EVLA alone.

Stocking-only versus additional eccentric compression after below-the-knee truncal vein sclerotherapy: A SOVAECS prospective randomized within-person trial

ObjectiveAfter foam sclerotherapy in the truncal saphenous vein, the clinical effects of additional eccentric compression has not yet been explored. MethodsBetween April 2020 and February 2021, we enrolled 42 patients (84 limbs) who underwent bilateral endovenous combined therapy for great saphenous vein (GSV) reflux. Each patient received the same type of endovenous ablation in both above-the-knee GSVs (laser, radiofrequency, cyanoacrylate glue), and combined foam sclerotherapy was performed on both below-the-knee GSVs. Subsequently, we conducted a prospective randomized, single-blind, within-person study in which each patient's bilateral truncal saphenous vein of the calves underwent two different compression therapies: wearing of a regular class II compression stocking on one side (RC group) and additional eccentric compression on the other side (AC group). The primary end point was the occlusion range (score, 0-10) of the below-the-knee truncal GSV after foam sclerotherapy. The secondary outcomes were the pain score (visual analog scale score range, 0-10) of the paired limb, the required number of additional foam sclerotherapy sessions, compliance with compression therapy, and procedure-related complications. ResultsFor the above-the-knee GSV, endovenous laser treatment (n = 44), endovenous radiofrequency ablation (n = 14), and endovenous cyanoacrylate glue ablation (n = 26) were performed. The mean subcompression pressure of the medial calf in the supine and standing positions were 16.7 ± 2.34 mm Hg and 24.5 ± 6.6 mm Hg in the RC group and 38.5 ± 5.5 mm Hg and 45.3 ± 8.2 mm Hg in the AC group, respectively (P = .000). The secondary outcomes of pain score, number of additional foam sclerotherapy sessions, and pigmentation were not significantly different statistically between the two groups. The patient-reported satisfaction scores (range, 0-10) on compression at 24 hours postoperatively were 8.03 ± 1.9 for the AC group and 7.98 ± 1.9 for the RC group (P = .317; Wilcoxon signed ranks test). In both groups, the closure rate of the above-the-knee GSV at 1 month postoperatively was 100%. No procedure-related complications were identified within 1 month postoperatively, including no deep vein thrombosis, numbness, or skin necrosis requiring additional medical attention. ConclusionsThe 24 hours of additional eccentric compression on the truncal GSV compared with the use of a conventional knee-level stocking only did not yield any clinical advantages in terms of the occlusion range, postoperative pain, need for additional sclerotherapy, or skin pigmentation after foam sclerotherapy. The decision on which type of compression therapy to perform after foam sclerotherapy in the truncal vein should be comprehensively determined.

Varicose Vein Therapy: Endovenous Laser Ablation

Endovenous laser ablation (EVA) is utilized in the therapy and the management of varicose veins from chronic venous disease. The fundamental sign for this treatment is disease that is refractory to conservative treatment with compression stockings. This activity audits the treatment of varicose veins with endovenous laser treatment and features the role of the interprofessional group being taken care of by patients that go through this method.

Sonographer-rated Effort Is Superior to Examination Time as a Method of Measuring Workload in the Vascular Laboratory

Managing and equitably attributing workload in the vascular laboratory is challenging because of the wide variety of examinations that sonographers perform. We developed an effort-based method of measuring sonographer workload in the vascular laboratory. Vascular sonographers (n = 11) at an academic medical center anonymously rated the overall effort required to perform 39 different examinations for which standard protocols existed. The overall effort to perform a unilateral lower extremity venous ultrasound for DVT was selected as the reference and arbitrarily assigned an effort level of 1. Sonographers then rated all other exams relative to the reference examination using a scale of 0.2 to 5.0 (0.2 being only one-fifth the effort of the reference examination and 5.0 requiring a five-fold greater effort). Perceived effort as rated by the sonographers was then correlated with the time required to perform all examination-related activities (electronic health record time stamps for n = 9822 examinations with complete start/end time data from June 1, 2021, through May 28, 2022) as well as experience (years since RVT certification). Mean effort ratings varied considerably across the 39 examinations, ranging from 0.68 ± 0.20 (unilateral endovenous laser treatment [EVLT] follow-up) to 3.61 ± 0.85 (abdominal venous ultrasound for pelvic pain), a >5-fold difference (Table). Mean coefficient of variation for rated effort across all studies was 0.27 (range, 0.14-0.47). Mean time to perform each examination ranged from 35 ± 12 minutes (unilateral EVLT follow-up) to 88 ± 29 (EVLT guidance), a 2.5-fold difference. Mean coefficient of variation for examination time across all studies was 0.32 (range, 0.11-0.53). There was a modest correlation between sonographer-rated effort and examination time (R = 0.56) (Figure). Mean duration of RVT certification was 12.2 ± 10.1 years (range, 1-39 years). There was no correlation between duration of RVT certification and rated effort for each examination. Sonographer-rated effort is a precise measure of workload in the vascular laboratory and is independent of experience. Although effort and examination time correlated modestly (R = 0.56), effort ratings produced greater dispersion (>5-fold difference between easiest/hardest examination) than did time (2.5-fold difference between shortest/longest examination) with equal or less variation. For instance, the longest examination (EVLT guidance) received an effort rating of only 1.74 (14th), whereas the study receiving the highest effort score (abdominal venous, 3.61) required a mean of 58 minutes (24th). Sonographer-rated effort scores likely incorporate additional elements of work such as mental and/or physical effort, required expertise and documentation complexity not captured by examination time alone.TableSonographer-rated effort and time to complete 39 different vascular laboratory examinationsExaminationRated effortEffort SDEffort CoVTime, minutesTime SDTime CoVUnilateral EVLT follow-up0.680.200.2935120.35PPG fingers0.850.330.3947240.51PPG toes0.910.290.3251250.49Unilateral LE US for DVT (reference)1----45160.36Unilateral UE US for DVT1.080.180.1749150.30ABI limited1.240.590.4770300.43Bilateral LE vein map for bypass1.240.500.4060320.53Bilat LE venous US (limited)1.330.260.1948160.33Bilat UE venous US (limited)1.370.450.3344160.36Unilateral UE artery US for pseudoaneurysm1.480.310.2155140.26WBI1.560.620.4054180.33Unilateral LE artery US for pseudoaneurysm1.610.500.3147170.36Unilateral carotid US1.690.600.3550160.32Bilateral LE artery US (limited)1.710.480.2857170.30EVLT guidance1.740.750.4388290.33Bilateral LE artery US for popliteal aneurysm1.740.500.2953180.34Bilateral LE venous US for DVT1.800.300.1753150.29Bilateral carotid US1.790.500.2853150.28ABI complete (segmentals)1.930.630.3252140.27Bilateral LE artery US for pseudoaneurysm2.000.650.3356170.30Bilateral UE veins US for DVT2.010.450.2361190.31AAA screen2.030.500.2546100.22Temporary artery duplex2.080.560.276270.11Intraoperative duplex (CEA/LE bypass)2.100.600.2956190.34TOS PPG arterial (limited)2.310.610.2656140.25Bilateral LE venous comp check2.150.440.2157170.30Unilateral UE fistula map2.570.740.2960170.29Unilateral LE artery US (native)2.590.490.1968290.43AAA duplex (known)2.600.500.1953120.23Graft surveillance2.740.540.2074270.37ABI exercise2.870.670.2386230.27Bilateral radial artery map2.960.770.2655130.23Bilateral LE artery US (native)3.040.710.2375290.39Mesenteric artery US3.060.640.2153110.21Fistula surveillance US3.160.670.2163160.25Unilateral LE venous reflux mapping3.340.720.2262160.26Aortoiliac artery US (native/EVAR)3.390.790.2385320.38Renal artery US3.480.500.1462150.24Bilateral UE fistula map3.510.840.2488260.30Abdominal venous US3.610.850.2358140.24AAA, Abdominal aortic aneurysm; ABI, ankle-brachial index; CEA, carotid endarterectomy; CoV, coefficient of variation; DVT, deep vein thrombosis; EVAR, endovascular aneurysm, repair; EVLT, endovenous laser treatment; LE, lower extremity; PPG, photoplethysmogram; SD, standard deviation; TOS,; US, ultrasound; WBI, whole body imaging. Open table in a new tab

A Non-Randomised Prospective Study Comparing the Efficacy of Endovenous Laser Therapy and Trendelenburg?s Procedure for Sapheno-Femoral Junction Incompetence

A Non-Randomised Prospective Study Comparing the Efficacy of Endovenous Laser Therapy and Trendelenburg?s Procedure for Sapheno-Femoral Junction Incompetence

Comparative Analysis of Long-Term Efficacy, Safety, and Complications of Radiofrequency Ablation Versus Endovenous Laser Treatment of Varicose Veins

Comparative Analysis of Long-Term Efficacy, Safety, and Complications of Radiofrequency Ablation Versus Endovenous Laser Treatment of Varicose Veins

The origin of loud claps during endovenous laser treatments.

Optoacoustic and ultrasound methods have shown that the loud "claps" perceived by patients and medical staff during endovenous laser ablation (EVLA) are caused by volumetric blood boiling when large vapor-gas bubbles appear and collapse under the action of laser radiation, which is well absorbed in water. Acoustic effects when using lasers in the near infrared range (1.94, 1.47, and 0.97 μm) were studied in an experiment with non-deaerated water, as well as in EVLA. The nature of these acoustic signals was investigated using high-speed video recording. It turned out that the amplitude of the emerging acoustic pulses in the case of surface boiling, which prevails when using lasers with a wavelength of 0.97 μm, is two orders of magnitude smaller than in the case of volumetric boiling (1.94 and 1.47 μm). The reasons for the decrease in sound effects in this case are associated with numerous microbubbles at the tip of the laser fiber. The results obtained may be useful for further understanding of the mechanisms of EVLA.

Retracted: Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins.

[This retracts the article DOI: 10.1155/2022/1801099.].

Safety and efficacy of endovenous laser therapy with microphlebectomy or foam sclerotherapy for varicose vein patients in outpatient clinic

Safety and efficacy of endovenous laser therapy with microphlebectomy or foam sclerotherapy for varicose vein patients in outpatient clinic

Complications and pitfalls of endovenous laser therapy for varicose veins of lower extremities.

Varicose veins of lower extremities are a common disorder affecting a significant proportion of adult population. Endovenous techniques have been used in clinical practice for more than 20 years for their radical treatment; of these, laser therapy is one of the most widely utilized options. However, this treatment modality, too, has its specific side effects and complications which can be divided into perioperative (difficult venous access, fiber or sheath damage, vasovagal reaction with a drop in blood pressure and bradycardia, cutaneous thermal injury), and postoperative (bruising and hematomas, exceptionally pain, superficial venous thrombosis (phlebitis) and fibrous cord formation or pigmentations). Paresthesias, infections, arteriovenous fistulas, deep venous thrombosis and pulmonary embolism are very rare. The introduction of new generators with higher wavelengths and fibers with radial emission of laser energy has substantially reduced the side effects and complications. Performing the surgery in the outpatient setting using tumescent local anesthesia and under perioperative ultrasound control is an essential condition of the procedure.

Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome

ObjectiveKlippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. MethodsA single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. ResultsTheir mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. ConclusionsSuperficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.

The marginal vein-Still a rare entity: case series of 16 patients

HintergrundDie Marginalvene (MV) ist eine angeborene, vorwiegend venöse Gefäßmalformation, die auf einer fehlenden Rückbildung des embryonalen Venensystems an den unteren Extremitäten beruht. Sie geht mit einer Vielzahl an Komplikationen einher. Bisher werden in der Literatur keine einheitlichen Therapieregime beschrieben.FragestellungWelche Behandlungsstrategien und Ergebnisse gibt es bei Patienten mit MV?Material und MethodenIm Zeitraum 01.01.2008 bis 31.12.2020 wurden alle am Universitätsklinikum Augsburg behandelten Patienten mit Marginalvene retrospektiv aufgearbeitet.ErgebnisseDas mediane Alter zum Diagnosezeitpunkt lag bei 14,8 Jahren (3–42 Jahre). 12/16 Patienten hatten eine Beinlängendifferenz. 75 % der Patienten (12/16) hatten bereits zur Diagnosestellung MV eine chronisch-venöse Insuffizienz (CVI). Im untersuchten Kollektiv wurden 62,5 % (10/16) der Patienten zum Zeitpunkt der Diagnosestellung mittels Kompression konservativ behandelt. Bei weiteren 31,3 % (5/16) der Patienten erfolgte primär eine offen-chirurgische Entfernung der MV und bei 1/16 Patienten wurde die MV primär mittels endovenöser Lasertherapie (EVLT) verschlossen; 15/16 Patienten wurden sekundär therapiert. 2,6 ± 2,4 (MW ± SD) Sekundärprozeduren wurden pro Patient im Follow up durchgeführt. Das mittlere Follow-up lag bei 8,1 Jahren.DiskussionZur Prävention/Vermeidung einer Progression einer CVI und Thrombembolieprophylaxe sollte nach Diagnosestellung die MV zeitnah verschlossen/entfernt werden. Die Anwendung chirurgisch-konventioneller Techniken zur Entfernung der MV scheint gegenüber der Behandlung mit minimal-invasiven Prozeduren hinsichtlich der Anzahl der erforderlichen Sekundäreingriffe von Vorteil.