Endovenous Laser Treatment Research Articles

A prospective safety and effectiveness study using endovenous laser ablation with a 400-μm optical fiber for the treatment of pathologic perforator veins in patients with advanced venous disease (SeCure trial)

BackgroundTreatment of pathologic perforator veins (PPVs) can shorten time to healing and reduce recurrence of ulcers in patients with advanced venous disease. Because of limited clinical evidence and device options, widespread adoption of PPV treatment is controversial. The objective of this study was to evaluate the safety and efficacy of endovenous laser therapy using a 400-μm optical fiber to treat PPVs. MethodsThis study was a single-arm, prospective, seven-center, nonblinded clinical study examining patients with advanced skin changes or healed or active ulceration (Clinical, Etiology, Anatomy, and Pathophysiology clinical class C4b, C5, and C6). Patients received treatment with a 1470-nm laser. Procedural technical success and 10-day primary closure were evaluated. All device-related adverse events were reported. Follow-up of patients was continued for 12 months after initial ablation. ResultsThe primary PPV closure (at 10-day visit) rate was 76.9% (95% confidence interval, 70.3%-82.4%). Successful primary closure rates of 75.7%, 70.3%, 62.1%, 68.8%, and 71.3% of PPVs were achieved at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. Statistically significant improvements (P < .05) were seen in patients' quality of life at 1 month, 3 months, 6 months, 9 months, and 12 months compared with screening. The percentage of patients with ulcers (22.9% at screening, 14.1% at 1 month, 13.7% at 3 months, 10.1% at 6 months, 12.3% at 9 months, and 11.1% at 12 months) displayed improvement during the course of the study. Tibial deep venous thrombosis and procedural pain were the only device-related adverse events observed. ConclusionsEndovenous laser therapy for PPV using the 400-μm optical fiber with the 1470-nm laser yielded safe and effective outcomes with no major adverse sequelae.

Risk Factors of Saphenous Vein Insufficiency in Female Patients in Riyadh, Saudi Arabia.

Background: Venous reflux most frequently occurs in the great saphenous vein (GSV), which is the most commonly diseased vein and is associated with venous insufficiency and varicose veins.Objective: We aimed, in this study, to determine risk factors for saphenous vein insufficiency in female patients in Riyadh, Saudi Arabia.Methods: This was a retrospective cohort study. Data were collected from the medical records of adult female patients who developed saphenous vein insufficiency at King Abdulaziz Medical City, between 2015 and 2017.Results: A total of 97 subjects participated in the study, 53 patients had saphenous vein reflux while 44 patients did not have reflux. Leg swelling was the only symptom that showed a significant difference between the two groups (p<0.001); patients with reflux had significantly higher rates of endovenous laser therapy (p=0.021). While the same patient group showed significantly lower rates of sclerotherapy compared to patients without reflux (p=0.006). The proportion of hypertension patients without reflux (22.7%) was significantly larger than that of hypertension patients with reflux (1.9%) (p= 0.001).Conclusion: More research is encouraged to provide better understanding and management of saphenous vein insufficiency in the Saudi population, especially in females who are at high risk.

EVLT and Foam-form Sclerotherapy as a C6 Stage Varicose Treatment.

Introduction: The issue of treating varicose veins in C6 stages are becoming more and more significant in medical community. This condition is one of the most common lesions of peripheral vessels. Treatment of varicose veins compounds of various therapeutic measures, including: conservative therapy, surgical treatment and sclerotherapy. As of right now, the methods introduced above cannot completely rid the patient of varicose veins problems, as they do not meet all the pathogenetic principles of treatment, and therefore cannot be considered universal. Objective.To evaluate the efficiency of step-by-step treatment in patients with varicose veins at C6 stage. Methods: A prospective complex step-by-step treatment analysis of 58 patients with decompensated forms of varicose veins at stage C6. The average age of the patients was 59±5.6 years.There were 15 men and 43 women.Etiologic factor in the development of venous ulcers in 36 patients had reflux on the trunk of the great saphenous vein in 12 patients with reflux on the trunk of the SSF, and in 10 patients reflux perforating veins of the lower leg and thigh.After ultrasound duplex scanning, all patients underwent a stage of conservative treatment for 1 month, which included: constant wearing of compression stockings, Diosmin 600 mg per day, Sulodexide 250 LSU (25 mg)2 times per day, and aseptic dressings of trophic ulcers.The next stage consisted of endovenous laser treatment (EVLT) of varicose veins. After one week, sclerotherapy of separately expanded varicose inflows and perforators in induration zones was given to minimize operational injury. Results: During the step-by-step treatment, 25 (43.1%) patients managed to fully trophic ulcers epithelize before EVLT and sclerotherapy, at the stage of conservative treatment. In 50 (86,2%) patients, complete healing of ulcers was noted at the stage of EVLT (pic.1). And only in 8 (13,7%)patients, who had extensive, circular varicose ulcers, markedly complete healing in a 3-6 months after EVLT and stage sclerotherapy. It should be noted that varicose disease C6 step-by-step treatment is not only effective in the compound of treatment measures but also positively affects the patients’ emotional background. At the first stage of treatment, patients noted reduction of pain syndrome, swelling and fatigue in the legs. After EVLT, none of the patients complained about having pain in trophic ulcers area . During the step-by-step treatment of varicose at C6 stage, not a single patient experienced worsening of ulcers, erysipelas or inflammation at the sites of puncture or sclerosant introduction. Conclusion: Step-by-step treatment in patients with varicose disease at C 6 stage using compression therapy, drug treatment, EVLT and sclerotherapy, is a pathogenetically substantiated and effective treatment method achieves satisfactory results in a short period of time. Further observations are needed to compare standard surgeries and minimally invasive methods as treatment for stage C6 varicose veins.

Long-term Results of Endovenous Laser Therapy (EVLT) of Saphenous Vein Reflux: Up to 9 Years Follow-up

Long-term Results of Endovenous Laser Therapy (EVLT) of Saphenous Vein Reflux: Up to 9 Years Follow-up

Wound Care. What is new in best practice: addressing the complexities in the management of venous leg ulcers. Part 2

British Journal of Healthcare AssistantsVol. 13, No. 11 ClinicalWound Care. What is new in best practice: addressing the complexities in the management of venous leg ulcers. Part 2Menna Lloyd JonesMenna Lloyd JonesConsultant Editor, BJHCASearch for more papers by this authorMenna Lloyd JonesPublished Online:6 Nov 2019https://doi.org/10.12968/bjha.2019.13.11.540AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesBissonnette JM. Adherence: a concept analysis. J Adv Nurs. 2008; 63(6):634–43 Crossref, Google ScholarFletcher J, Atkin L, Dowsett C et al.. Best practice statement. Addressing complexities in the management of venous leg ulcers. 2019. https://www.wounds-uk.com/resources/details/best-practice-statement-addressing-complexities-management-venous-leg-ulcers (accessed 20 September 2019) Google ScholarGuest JF, Ayoub N, McIlwraith T et al.. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open. 2015 Dec 7; 5(12):e009283. doi: https://doi.org/10.1136/bmjopen-2015-009283 Crossref, Google ScholarJones ML. Wound Care. What is new in best practice: addressing the complexities in the management of venous leg ulcers. Part 1. British Journal of Healthcare Assistants. 2019; 13(10):486–491 Link, Google ScholarNational Institute for Health and Care Excellence (2018) Chronic heart failure in adults: diagnosis and management. www.nice.org.uk/ng106 (accessed 10.07.19) Google ScholarNHS Long Term Plan (2019). www.longtermplan.nhs.uk (accessed 10.07.19) Google ScholarNHS. Treatment—varicose veins. Endovenous laser treatment. 2019. https://www.nhs.uk/conditions/varicose-veins/treatment/ (accessed 20 September 2019) Google ScholarWounds UK. Best practice statement, Holistic management of venous leg ulceration. 2016. https://lohmann-rauscher.co.uk/downloads/VLU_BPS_Web.pdf (accessed 20 September 2019) Google Scholar FiguresReferencesRelatedDetails 2 November 2019Volume 13Issue 11ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 6 November 2019 Published in print 2 November 2019 Information© MA Healthcare LimitedPDF download

Safety and efficacy of endovenous ablations in octogenarians, nonagenarians, and centenarians

ObjectiveEndovenous ablation of the lower extremity veins has become the primary treatment of symptomatic venous reflux disease. Endovenous heat-induced thrombosis (EHIT) and recanalization are two well-known complications of these venous ablative procedures. Because the elderly represent the fastest growing demographic, our goal was to look at whether there is a difference of these complications and age distribution in octogenarians, nonagenarians, and centenarians vs the younger population. MethodsA retrospective study was conducted of 10,029 procedures that were performed from March 2012 to September 2018 on 8273 veins across 3218 patients who underwent endovenous ablation for lower extremity venous reflux; 6091 procedures were performed with radiofrequency ablation, and 3938 were performed with endovenous laser ablation. We reviewed charts of all patients who underwent radiofrequency ablation or endovenous laser treatment during this time. Postprocedural venous duplex ultrasound was performed at 3 to 7 days to check for EHIT and recanalization, every 3 months for the first year, and every 6 to 12 months thereafter. The χ2 test and analysis of variance were used for statistical analysis. ResultsAges ranged from 15 years to 103 years. The average age of the patients was 61.9 ± 15.2 years. Average overall follow-up for all age groups was 25.8 ± 12.9 months. Of the 3218 patients, 2700 were younger than 80 years, 380 were between 80 and 89 years, 132 were between 90 and 99 years, and 6 were 100 years or older. Of the 10,029 procedures, 8730 were performed on patients younger than 80 years; 1124, on patients 80 to 89 years; 159, on patients 90 to 99 years; and 16, on patients 100 years or older. There were 111 patients who had bilateral procedures in the accessory saphenous vein, 1878 patients who had bilateral procedures in the great saphenous vein, 99 patients who had bilateral procedures in the perforator vein, and 760 patients who had bilateral procedures in the small saphenous vein. There were statistically significant increases in EHIT rates between octogenarians and those in the age group <80 years (P = .047); between nonagenarians and those in the age group <80 years (P = .04); and between the combined group of octogenarians, nonagenarians, and centenarians and the age group <80 years (P = .012). No statistical difference was found in rates of EHIT between octogenarians and nonagenarians (P = .5). Overall age is a risk factor for the development of EHIT (odds ratio, 1.03; 95% confidence interval, 1.02-1.04; P < .00001). There were statistically significant increases in recanalization rates between octogenarians and those in the age group <80 years (P = .000013); between nonagenarians and those in the age group <80 years (P = .00022); and between the combined group of octogenarians, nonagenarians, and centenarians and the age group <80 years (P < .00001). No statistical difference was found in rates of recanalization between octogenarians and nonagenarians (P = .48). Statistical analysis of centenarians alone was not done because of zero patients available in the EHIT or recanalization category. Overall age was found to be a risk factor for recanalization (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < .00002). ConclusionsWhereas there is a relatively higher chance of EHIT and recanalization in the age group >80 years, our study shows that the majority of EHITs were class 1 and class 2. According to our study, venous ablation is safe and effective across all age groups, and age alone should not be used to deny patients venous ablations.

Mechanochemical ablation as an alternative to venous ulcer healing compared with thermal ablation

ObjectiveWe aimed to compare mechanochemical ablation (MOCA) and thermal ablation (radiofrequency ablation and endovenous laser therapy) for venous ulcer healing in patients with clinical class 6 chronic venous insufficiency. MethodsElectronic medical records were reviewed of patients with venous ulcers who underwent truncal or perforator ablation between February 2012 and November 2015. These records contained history of venous disease and ulcer history, procedures, complications, follow-up, method of wound care, and current status of the ulcer. The patients were grouped according to the method of ablation for comparison. ResultsIn 66 patients, 82 venous segments were treated, 29 with thermal methods and 53 with MOCA; 16% of patients had prior venous intervention. Before ablation, three patients in the thermal group had a history of deep venous thrombosis compared with seven in the MOCA group. On average, patients treated with MOCA were older (thermal ablation, 57.2 years; MOCA, 67.9 years; P = .0003). Ulcer duration before intervention ranged from 9.2 months for thermal ablation to 11.2 months for MOCA (P = NS). In total, 74% of patients treated with MOCA healed their ulcers compared with 35% of those treated with thermal ablation (P = .01). A healed ulcer was defined as elimination of ulcer depth and superficial skin coverage. The mean time to heal was 4.4 months in the thermal ablation group compared with 2.3 months with MOCA (P = .01). The mean length of follow-up was 12.8 months after thermal ablation and 7.9 months after MOCA (P = .02). Both age (P = .03) and treatment modality (P = .03) independently had an impact on ulcer healing on multiple logistic regression analysis. All but two patients were treated with an Unna boot after venous ablation. Complications included readmission of two patients with nonaccess-related infections, one nonocclusive deep venous thrombosis, and one late death unrelated to the procedure second to pneumonia in the setting of advanced colon cancer. There were three recurrent ulcers at 1 week, 2 months, and 7 months after MOCA that rehealed with Unna boot therapy and continued compression. ConclusionsMOCA is safe and effective in treating chronic venous ulcers and appears to provide comparable results to methods that rely on thermal ablation. Younger age and use of MOCA favored wound healing. MOCA was an independent predictor of ulcer healing. Randomized studies are necessary to further support our findings.

Radiofrequency Ablation Increases the Incidence of Endothermal Heat-Induced Thrombosis

Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) due to the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). This was a single-center, office-based, retrospective study over the course of 5years, in which 3,218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9years. At the time of each individual intervention, 24, 212, 3,620, 4,806, 200, and 1,167 patients had Clinical-Etiology-Anatomy-Pathophysiology disease 1, 2, 3, 4, 5, and 6, respectively. There was a total of 3,983 EVLT and 6,091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as type 1 as per the Kabnick classification. Endovenous ablation performed via RFA resulted in significantly more cases of EHIT than of EVLT (109 vs. 77; P=0.034; odds ratio=1.52), which was confirmed by a multivariate analysis. In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT than of EVLT.

Radiofrequency Ablation Increases the Incidence of Endothermal Heat-Induced Thrombosis

Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) because of the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). This was a single-center, office-based, retrospective study during the course of 5 years, in which 3218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9 years. At the time of each individual intervention, 24, 212, 3620, 4806, 200, and 1167 patients had Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) disease class 1, 2, 3, 4, 5, and 6, respectively. There was a total of 3983 EVLT and 6091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as type 1 per the Kabnick classification. Endovenous ablation performed by RFA resulted in significantly more cases of EHIT compared with EVLT (109 vs 77; P = .034; odds ratio, 1.52), which was confirmed by multivariate analysis. In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT compared with EVLT.

Changing Trend in Endovenous Laser Treatment of Lower Extremities—From the Viewpoint of The Japanese Committee for Endovenous Laser Treatment—

Changing Trend in Endovenous Laser Treatment of Lower Extremities—From the Viewpoint of The Japanese Committee for Endovenous Laser Treatment—

IP261. Radiofrequency Ablation Increases the Incidence of Endothermal Heat-Induced Thrombosis

Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) because of the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). This was a single-center, office-based, retrospective study during the course of 5 years, in which 3218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9 years. At the time of each individual intervention, 24, 212, 3620, 4806, 200, and 1167 patients had Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class 1, class 2, class 3, class 4, class 5, and class 6 disease, respectively. There was a total of 3983 EVLT and 6091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as class 1 per the Kabnick classification. Endovenous ablation performed by RFA resulted in significantly more cases of EHIT compared with EVLT (109 vs 77; P = .034; odds ratio, 1.52), which was confirmed by multivariate analysis. In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT compared with EVLT.

Different management options for primary varicose veins in females: A prospective study

BackgroundThe aim of this study was to evaluate the long-term follow-up results of different management modalities in treating primary uncomplicated lower limb female varicosities. MethodsA prospective study took place within a 3-year period from June 2010 until May 2012. Patients were divided into 3 groups: group I (n = 35) included those who underwent open surgical treatment. Group II (n = 25) included those who subjected to ultrasound-guided foam sclerotherapy (USGFS). While group III (n = 20) included those who treated with endovenous laser therapy (EVLT). The patients were followed up for 6 years. ResultsAll selected patients were female aged from 35-62 years with a mean of 47 ± 7.6 years. Thirty-five patients (43.75%) were treated surgically by saphenofemoral junction disconnection (SFJD), and great saphenous vein (GSV) stripping; 25 patients (31.25%) with ultrasound-guided foam sclerotherapy and the remaining 20 patients (25%) were treated with endovenous laser therapy. A significant success rate of GSV ablation was obtained for the endovenous laser therapy treated group over the ultrasound-guided foam sclerotherapy treated patients (P = .023). There was no significant difference between the surgically treated group and those group treated with endovenous laser therapy (P = .85). Recurrence was observed following long-term follow-up after 6 years in 8.5% in group I, 36% in group II, and 10% in group III, respectively. Venous clinical severity score (VCSS) and health-related quality of life score (HRQOLS) improved significantly in all treated groups. ConclusionsLong-term follow-up of patients with primary superficial varicosities among females is mandatory to elucidate the postoperative recurrence, especially those who underwent ultrasound-guided foam sclerotherapy. In addition to the observation of the development of newly formed varicosities in susceptible individuals which might develop later following long-term follow-up.

Management of primary uncomplicated varicose veins, endovenous laser ablation with sclerotherapy versus traditional surgery: which is the best option?

Aim To compare between endovenous laser treatment (EVLT) with ambulatory phlebectomy, EVLT with injection sclerotherapy, and the standard surgical procedure. Patients and methods A randomized prospective study was conducted on 60 (72 limbs) patients having primary uncomplicated varicose veins and was carried out at Minia University Hospital. Patients were divided into three groups (20 patients each), each with a different intervention for varicose veins. Group A underwent endovenous laser with injection sclerotherapy, group B underwent endovenous laser with ambulatory phlebotomy, whereas group C underwent traditional surgery. Results Operative time and hospital stay were significantly lower in group A. There was a significant decrease in complications in patients in group A (12.5%) compared with group C (37.5%). The most common complication in groups A and B was superficial thrombophlebitis, represented by 8.3 and 12.5%, respectively, and in group C was hematoma at 12.5%. After 1-month follow-up, residual varicose veins (VV) was 4.2, 16.7, and 8.3% in groups A, B, and C, respectively. Approximately 96% of patients in group A, 83.3% of patients in group B, and 66.7% of patients in group C were satisfied. Conclusion The combination technique of EVLT and injection sclerotherapy appears to be a safe and an efficient treatment method for the treatment of the great saphenous vein and small saphenous vein, achieving good short-term and long-term results.

Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review.

Chronic venous disease (CVD), although affecting up to 40% of the US population, is often underdiagnosed by healthcare professionals due to an incomplete understanding of the presenting symptoms. CVD is a common cause of lower extremity pain and discomfort, including aching, cramping, tingling, burning, swelling, heaviness, restlessness, and fatigue, and may lead to significant morbidity if left untreated. The negative impact of CVD on quality of life is well established and the optimization of management strategies is an important area of evolving research. Management of CVD has rapidly evolved over the last two decades with the development of minimally invasive endovenous ablative techniques, now the mainstay of treatment. We discuss the data supporting various methods of CVD treatment with an emphasis on the impact on patient comfort and quality of life. Both radiofrequency ablation (RFA) and endovenous laser therapy (EVLA) are excellent options for treatment of lower extremity venous disease, but RFA is associated with less post-procedure discomfort. Ultrasound-guided foam therapy is best reserved for the adjuvant setting or for patients ineligible for RFA or EVLA.

Challenges in advancing the laser fiber through the great saphenous vein during endovenous ablation and strategies to overcome them.

Objectives To determine the incidence of possible obstacles and patients’ characteristics when performing endovenous laser treatment (EVLT) and suggestions to improve the ability to overcome them. Method A prospective study with 215 limbs treated with EVLT. A sequence of maneuvers was performed to move the fiber forward when difficulty was found and if unsuccessful another entry site was punctured. Results In 29 of 215 (13.48%) limbs, resistance was encountered while navigating the fiber; 16 (55.17%) solved with lower limb extension; 13 (44.82%) needed ultrasound guided maneuvers; five (17.24%) needed a saline flush and in three patients (10.34%) another entry site was necessary. In 214 of 215 cases (99.53%), ablation was accomplished and no complications were observed. Conclusions Both obstruction and higher patients' BMI are the main obstacles during endovenous laser ablation and usually needs additional maneuvers to accomplish the procedure in our study and the use of tricks to overcome these issues is feasible.

Early and Mid-Term Results of Treatment of Superficial Venous Insufficiency of the Lower Extremity Using Endovenous Laser Therapy

Background and aim of the study: Endovenous laser ablation (ELA) has become an important procedure to treat saphenous vein reflux. In this study the early and mid-term results of endovenous laser ablation of the long or/and short saphenous veins (ELAS) will be evaluated. Patients and methods: This prospective study was conducted from March 2010 to December 2016. The study enrolled 35 symptomatic patients with unilateral or bilateral superficial venous insufficiency (CEAP; 2-6) with documented reflux in long saphenous, short saphenous, or both veins by duplex ultrasound. Results: Thirty five patients were enrolled in this study, 30 women with mean age 35.5± 8.2 years and 5 men with mean age of 32.2± 7.8 years. ELAS was performed in 52 limbs 9 of them had ulcers. Early postoperative clinical and ultrasound examination revealed complete ablation of the targeted veins (100%) with no reflux. Great saphenous alone was ablated in 76.9% of limbs, short saphenous in 13.5%, and both 9.6%. Postoperative complications were minimal, well tolerated, and completely resolved within 3-27weeks with treatment. In 88.9% of limbs with active ulceration, healing occurred after a mean of 6.6±1.6 months. Only 61.5% of legs (including all ulcer patients) were followed up for 49.5±11.3 months; recorded recanalization by duplex ultra sound was 0%, 10.3%, and 20.8% after 1, 3, and 5 years respectively. Recanalization was insignificantly higher in long than short saphenous veins. The recorded recurrence of ulcers after 1, 3, and 5 years of follow up was 0%, 12.5%, and 40% respectively. Conclusion: endovenous laser ablation of the saphenous veins is safe and has excellent early and mid-term outcomes for treatment of superficial venous insufficiency with or without ulceration of the lower extremities.

Early and Mid-Term Results of Treatment of Superficial Venous Insufficiency of the Lower Extremity Using Endovenous Laser Therapy

Background and aim of the study: Endovenous laser ablation (ELA) has become an important procedure to treat saphenous vein reflux. In this study the early and mid-term results of endovenous laser ablation of the long or/and short saphenous veins (ELAS) will be evaluated. Patients and methods: This prospective study was conducted from March 2010 to December 2016. The study enrolled 35 symptomatic patients with unilateral or bilateral superficial venous insufficiency (CEAP; 2-6) with documented reflux in long saphenous, short saphenous, or both veins by duplex ultrasound. Results: Thirty five patients were enrolled in this study, 30 women with mean age 35.5± 8.2 years and 5 men with mean age of 32.2± 7.8 years. ELAS was performed in 52 limbs 9 of them had ulcers. Early postoperative clinical and ultrasound examination revealed complete ablation of the targeted veins (100%) with no reflux. Great saphenous alone was ablated in 76.9% of limbs, short saphenous in 13.5%, and both 9.6%. Postoperative complications were minimal, well tolerated, and completely resolved within 3-27weeks with treatment. In 88.9% of limbs with active ulceration, healing occurred after a mean of 6.6±1.6 months. Only 61.5% of legs (including all ulcer patients) were followed up for 49.5±11.3 months; recorded recanalization by duplex ultra sound was 0%, 10.3%, and 20.8% after 1, 3, and 5 years respectively. Recanalization was insignificantly higher in long than short saphenous veins. The recorded recurrence of ulcers after 1, 3, and 5 years of follow up was 0%, 12.5%, and 40% respectively. Conclusion: endovenous laser ablation of the saphenous veins is safe and has excellent early and mid-term outcomes for treatment of superficial venous insufficiency with or without ulceration of the lower extremities.

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

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

Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency.

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.

Mechanochemical endovenous ablation: Latest varicose vein treatment

Superficial dilated veins known as varicose veins develop due to damaged valves. Treatment of varicose veins is very important to undertake because of its acute (bleeding and clot formation) and chronic complications (lipodermatosclerosis and venous ulcers). Various techniques have been used for their treatment in the form of endovenous laser treatment, radiofrequency ablation, steam ablation and others. Now mechanochemical endovenous ablation (MOCA) has emerged as the latest nonthermal technique for the varicose vein treatment. It can be done by two methods as follows: Clarivein (Vascular Insights, US) and Flebogrif (Balton, Poland). We have presented in this case report, efficiency of MOCA technique in a 40-year-old, very pain sensitive male with CEAP classification C3EpAsPrand no deep vein insufficiency. MOCA was done as a day care procedure under local anesthesia. Standard protocol for technique was followed. Postprocedure patient was discharged after 20 min of observation. Follow ups were done at 6 weeks, 3 months and 6 months. Skin changes settled at 6 weeks without complications. In this technique, complications which are usually seen in thermal techniques are comparatively rare. Overall MOCA technique is highly effective modality for the treatment of varicose veins with success rates reaching up to 94%.