Great Saphenous Vein Insufficiency Research Articles

Classification of reflux patterns in patients with great saphenous vein insufficiency and correlation with clinical severity.

This study aims to establish a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency and to evaluate the relationship between this classification, the demographics, and severity of clinical findings. This is a retrospective study from prospectively collected data of 503 patients who had the complaint of varicose vein. All patients had complete physical examination and their medical history was recorded. Lower limbs of all patients were examined with Doppler ultrasonography. A total of 787 limbs with great saphenous vein insufficiency were included in the analysis. The reflux patterns of great saphenous vein insufficiency were classified into 4 types as: type 1, great saphenous vein reflux without involvement of malleolar region and saphenofemoral junction (SFJ); type 2, reflux involving malleolar region with competent SFJ; type 3, reflux involving SFJ with competent malleolar region; and type 4, reflux involving both the SFJ and the malleolar region. We evaluated the association between the classification of great saphenous vein insufficiency and age, sex, body mass index (BMI), disease duration, clinical, etiological, anatomical and pathophysiological elements (CEAP) classification and venous clinical severity score (VCSS). The mean age of the patients was 45.3±11.7 years, with a male-to-female ratio of 2:3. The most common reflux pattern in patients with great saphenous vein insufficiency was type 3 (48.9%), while 14.8% of patients had type 1, 10.4% had type 2, and 25.7% had type 4. Patients with type I reflux pattern were younger in age (p = 0.002), had lower BMI (p = 0.002), fewer number of children (p = 0.008), as well as milder clinical severity score (p = 0.002) compared to other reflux types. Duration of disease symptoms was not significantly correlated with the reflux patterns, but VCSS increased with the involvement of malleolar region as in type 2 compared to type 1 (2.82±1.67 vs. 2.74±2.31), and further increased with the involvement of SFJ as in type 3 (4.13±2.92 vs. 2.82±1.67). Patients with diffuse reflux pattern (type 4) had the most severe clinical presentation (4.59±2.9). We developed a clinically applicable classification of reflux patterns in patients with great saphenous vein insufficiency based on the involvement of malleolar region and/or SFJ. We showed an association between weight, BMI, VCSS, CEAP classification and the extent of insufficiency.

The efficacy of endovenously cyanoacrylate adhesive for the treatment of great saphenous vein insufficiency and mid-term follow-up results

The efficacy of endovenously cyanoacrylate adhesive for the treatment of great saphenous vein insufficiency and mid-term follow-up results

A comparison of cyanoacrylate closure to radiofrequency ablation techniques for treatment of truncal venous insufficiency

Aim: Cyanoacrylate closure (CAC) has become an alternative to endothermal ablative therapies for chronic venous insufficiency. In this study, we aimed to present our experience with CAC in comparison with radiofrequency ablation (RFA) and discuss the application techniques thereof.Materials and Methods: A retrospective review was performed for adult patients who underwent CAC or RFA for great saphenous vein insufficiency during two years to identify baseline patient and disease characteristics, procedural details and outcomes. The primary outcome was a complete occlusion rate. Secondary outcomes were adverse events/complications and the quality of recovery.Results: In this study, 36 patients (mean age 48.3 ± 11.2 years with 27 women) were treated with either CAC (n =19) or RFA (n = 17) during the defined period. At follow-up, after a mean duration of 8.5 ± 2.2 months, the closure rates were similar at 18/19 vs. 17/17, respectively. Apart from phlebitis and pigmentation, the incidences of bruising, skin burn and paresthesia were lower in the CAC group compared to the RFA group. The mean procedural times were shorter for CAC. In both groups, the Venous Clinical Severity Score significantly improved from baseline to last follow-up, somewhat better in the RFA group. The satisfaction level with the treatment was moderately higher among RFA patients than CAC patients, as well.Conclusion: The findings suggest that while it shortens the procedural time and does not require postoperative stockings, CAC is not a miraculous alternative for those who can duly administer tumescent anesthesia

Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips.

We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits. A total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge. There was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55). Varicose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.

Feasibility and short-term complication rate of mechanochemical ablation for epifascial tributaries of incompetent great saphenous veins

ObjectiveThe aim of the present study was to investigate the occurrence of skin complications after mechanochemical ablation with the ClariVein device (Merit Medical, South Jordan, Utah) for incompetent great saphenous veins (GSVs) and compare the results in terms of the target vein characteristics, especially in the presence of an epifascial GSV tributary. MethodsA single-center, retrospective study was performed. We reviewed 33 limbs of 32 patients with GSV insufficiency who had undergone mechanochemical ablation with the ClariVein device from December 2017 to February 2020. The 33 limbs were divided into two groups: the epifascial group, comprising 11 limbs of 11 patients, and the nonepifascial group, comprising 22 limbs of 21 patients. The patients underwent postoperative follow-up examinations at 1 week and 1, 3, 6, and 12 months. The skin complication counts and scores on a four-point scale were recorded. ResultsRegarding the baseline characteristics, the epifascial group showed a significantly lower GSV depth in the distal thigh region compared with the nonepifascial group (2.64 ± 0.5 mm vs 7.05 ± 2.57 mm; P < .001). No statistically significant difference was found between the two groups in terms of the sclerosant (sodium tetradecyl sulfate) volume (5.45 ± 2.02 mL vs 6.59 ± 1.79 mL; P = .109) or ablation length (31.82 ± 3.92 cm vs 32.95 ± 4.05 cm; P = .449). All ClariVein procedures were technically successful (33 of 33 limbs; 100%), and no major complications were reported. The hyperpigmentation score was significantly greater in the epifascial group than in the nonepifascial group (score, 0.18 ± 0.4 vs 0 ± 0; P = .0401), although the hyperpigmentation count was not significantly different between the two groups (2 of 11 limbs [18.2%] vs 0 of 22 limbs [0.0%]; P = .1042). Although marginally higher counts and scores were observed in terms of phlebitis and bruising in the epifascial group, these differences were not statistically significant. ConclusionsEndovenous treatment with the ClariVein device for incompetent GSVs can be performed safely. However, caution should be exercised when the epifascial GSV tributary is treated during the ClariVein procedure because of its predilection to result in hyperpigmentation.

Kronik venöz yetmezlik olgularında Endovenöz Radyofrekans Ablasyonun Klinik Sonuçları: İki Yıllık Takip Sonuçları

Aim: Our aim was to evaluate the two-year results of radiofrequency ablation (RFA) in the treatment of great saphenous vein (GSV) insufficiency. Methods: A total number of 217 patients who underwent RFA (52.5 % male, mean age 42.7±11.4) were included in the study. RFA was performed in patients with great saphenous vein valvular incompetence and saphenofemoral junction incompetence. Occlusion status was recorded by ultrasonography. Venous clinical severity score (VCSS) was calculated pre- and post-intervention. Results: The mean follow-up period of the patients was 22.2 ± 5.1 months. Cumulative survival rate (Kaplan–Meier) of 24-month follow-up was 84.3%. Complete occlusion rate for GSV was 100%, 98.6% ,97.6%, 97.6% and 97.6% for 1, 6, 12, 18 and 24 months follow up, respectively. VCSS was significantly different before RFA and 4 weeks after RFA (p &amp;lt; 0.001). No major complications were observed in the study. Conclusion: In the treatment of GSV insufficiency, RFA is a safely applied method with high occlusion rates and obvious VCSS score decrease.

Mechanochemical ablation for great and small saphenous veins insufficiency in patients with type III shunt.

the aim of this study was to assess the results of mechanochemical endovenous ablation either in the primary or recurrent saphenous vein insufficiency, including only patients with veno-venous shunt type III. retrospective analysis of a prospective study of patients with symptomatic chronic venous insufficiency who underwent ClariVein® technique. A total of 134 saphenous veins were included between August 2017 and August 2018. Follow-up was performed by Duplex ultrasound at 1, 6 and 12 months. Primary endpoints were technical and anatomical success. Secondary endpoints were the need for further treatment of varicose collateral veins by sclerotherapy, outcomes regarding recurrent insufficiency and clinical success. A total of 111 great saphenous veins and 23 small saphenous veins were treated with a technical success of 95.6%. The overall anatomical success rates at 1, 6 and 12 month were 96.2%, 88.8% and 84.4%, respectively, without differences between primary and recurrent insufficiency. Deferred sclerotherapy over varicose collaterals was carried out in 28% of the patients with anatomical success. Clinical improvement was achieved in 87.3%. MOCA technique has proven to be an effective technique, although additional treatment over varicose collaterals could be necessary in up to one-third. Atrophy of the saphenous vein and the lack of persistent varicose collateral veins during follow-up seem to be indicators of successful therapy.

Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins

ObjectiveMechanochemical ablation (MOCA) is a nonthermal nontumescent method of treating saphenous vein insufficiency. The feasibility and short-term results of MOCA are good, but its long-term results are unknown. A randomized study was performed to compare MOCA with endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the setting of unilateral great saphenous vein (GSV) insufficiency. MethodsVenous outpatient clinic patients with varicose veins (CEAP class C2-C4) caused by GSV insufficiency were invited to participate in the study; in total, 132 patients met the inclusion criteria and were willing to participate. Patients were randomized to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the GSV with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at 1 month, 1 year, and 3 years after the treatment. ResultsSome patients declined to continue in the study after randomization; in total, 117 patients underwent treatment. At 3 years, the occlusion rate was significantly lower with MOCA than with either EVLA or RFA (82% vs 100%; P = .005). Quality of life was similar between the groups. In the MOCA group, GSVs that were larger than 7 mm in diameter preoperatively were more likely to recanalize during the follow-up period. The partial recanalizations of proximal GSV observed at 1 year progressed during the follow-up. ConclusionsMOCA is a feasible treatment option in an outpatient setting, but its technical success rates are inferior compared with endovenous thermal ablation. Its use in large-caliber veins should be considered carefully.

Comparative efficacy and life quality effects of surgical stripping, radiofrequency ablation, and cyanoacrylate embolization in patients undergoing treatment for great saphenous vein insufficiency.

To compare traditional surgery with two minimally invasive endo-venous procedures in terms of their long-term effect on the quality of life in great saphenous vein insufficiency (GSV). This prospective observational study included 217 patients that underwent surgical stripping (n = 62), radiofrequency ablation (n = 70), or cyanoacrylate embolization (n = 85) for the treatment of GSV insufficiency. Venous Clinical Severity Score (VCSS) assessments were made, 36-item Short-Form Health Survey (SF-36) questionnaire and Chronic Venous Insufficiency quality of life Questionnaire (CIVIQ-14) were administered, before and 1 year after the treatments. Surgical stripping group had significantly higher closure rates than the other groups (p < 0.05). At 12 months, decrease in VCSS scores was less pronounced in the cyanoacrylate embolization group when compared to the other two groups (p < 0.05). Improvement in CIVIQ-14 scores was better in the radiofrequency ablation group when compared to the cyanoacrylate embolization group (p < 0.05). Surgical stripping or radiofrequency ablation groups performed better on several domains of SF-36, when compared to the cyanoacrylate embolization group. Surgical stripping and radiofrequency ablation seem to provide a better quality of life results at one year in patients undergoing treatment for GSV insufficiency.

Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber

ObjectiveScarce information is available on the long-term results of endovenous laser ablation (EVLA) for great saphenous vein (GSV) or small saphenous vein (SSV) insufficiency. We sought to provide data on the status of patients at least 9 years after EVLA. MethodsIn 2018, we undertook a cross-sectional survey of ambulatory patients who had undergone EVLA in our tertiary care center in 2008-2009. Of 240 eligible patients, 5 died of causes not related to EVLA, 20 refused to participate, and 12 were lost to follow-up. Thus, 203 patients were re-evaluated; of them, 161 (79%) had GSV insufficiency and 42 (21%) had SSV insufficiency. The mean follow-up was 114 months (standard deviation, 11 months). All included patients underwent an echocardiography-color Doppler (ECD) evaluation, a clinical visit, and a standardized medical history. We assessed the competence of the junction and of the treated and untreated saphenous trunk and the presence of recurrent varicose veins. The trunk was considered ablated if it was nonvisible on B-mode or, when visible, if it was noncompressible or without flow or reflux on color flow Doppler analysis. Any recurrent varicose vein with the leakage point located in the treated saphenous vein was considered a failure. We asked patients about the effect of EVLA on their preoperative complaints and about any new or recurrent symptoms. We also recorded any complication or additional subsequent treatment and all data necessary to calculate the clinical class (C of the Clinical, Etiology, Anatomy, and Pathophysiology [CEAP] classification) and the Venous Clinical Severity Score (VCSS). Finally, we investigated potential associations between the study outcomes and variables by multiple logistic regression techniques. ResultsSome 10 years after EVLA, we performed a single clinical and ECD evaluation in 203 patients. Only one recanalization (0.5%; 95% confidence interval, 0.0-2.7) of the treated GSV trunk was observed in an otherwise asymptomatic patient. Up to 98% of patients were asymptomatic or significantly improved after EVLA. Additional subsequent treatments occurred in 21% of patients with GSV insufficiency and 5% of patients with SSV insufficiency. Three complications were observed, two in the GSV group (varicophlebitis, saphenous nerve damage) and one (varicophlebitis) in the SSV group. The mean C class of CEAP and the mean VCSS were significantly lower at the end of follow-up, both in patients with GSV insufficiency (C class, 3.2 vs 1.5 [P = .00001]; VCSS, 6.3 vs 1.6 [P = .001]) and in patients with SSV insufficiency (C class, 2.9 vs 1.1 [P = .00001]; VCSS, 5.4 vs 0.7 [P = .001]). Only the maximum diameter of the GSV at the junction independently correlated with ECD-confirmed reflux in the treated saphenous trunk or in the anterior accessory saphenous vein (odds ratio, 1.10; 95% confidence interval, 1.01-1.21). ConclusionsEVLA using a 1470-nm diode laser with radial fibers provides stable and valuable long-term results in patients with either GSV or SSV insufficiency.

A randomized controlled noninferiority trial comparing radiofrequency with stripping and conservative hemodynamic cure for venous insufficiency technique for insufficiency of the great saphenous vein

ObjectiveThe quality of available evidence regarding new minimally invasive techniques to abolish great saphenous vein reflux is moderate. The present study assessed whether radiofrequency ablation (RFA) was noninferior to high ligation and stripping (HLS) and conservative hemodynamic cure for venous insufficiency (CHIVA) for clinical and ultrasound recurrence at 2 years in patients with primary varicose veins (VVs) due to great saphenous vein (GSV) insufficiency. MethodsWe performed a randomized, single-center, open-label, controlled, noninferiority trial to compare RFA and 2 surgical techniques for the treatment of primary VVs due to GSV insufficiency. The noninferiority margin was set at 15% for absolute differences. Patients aged >18 years with primary VVs and GSV incompetence, with or without clinical symptoms, C2 to C6 CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) clinical class, and GSV diameter >4 mm were randomized with a 1:1:1 ratio to RFA, HLS, or CHIVA. The rate of clinical recurrence at 24 months was the primary endpoint and was analyzed using a delta noninferiority margin of 15%. Ultrasound recurrence, safety, and quality of life were secondary endpoints. ResultsFrom December 2012 to June 2015, 225 limbs had been randomized to RFA, HLS, or CHIVA (n = 74, n = 75, and n = 76). Clinical follow-up and Doppler ultrasound examinations were performed at 1 week and 1, 6, 12, and 24 months postoperatively. No differences in postoperative complications or pain were observed among the three groups. RFA was noninferior to HLS and CHIVA for clinical recurrence at 24 months, with an estimated difference in recurrence of 3% (95% confidence interval [CI], −4.8% to 10.7%; noninferiority P = .002) and −7% (95% CI, −17% to 3%; P < .001), respectively. For ultrasound recurrence, RFA was noninferior to CHIVA, with an estimated difference of −34% (95% CI, −47% to −20%; noninferiority P < .001) at 24 months. However, noninferiority could not be demonstrated compared with HLS (5.9%; 95% CI, −4.1 to 15.9; P = .073). No differences were found in quality of life among the three groups. ConclusionsRFA was shown to be noninferior in terms of clinical recurrence to HLS and CHIVA in the treatment of VVs due to GSV insufficiency.

Venous Compliance in Great Saphenous Vein Incompetence: Pre- and Post-interventional Changes

ObjectiveVenous insufficiency is associated with histological changes and structural remodelling of the venous wall. The effects of these changes on global venous function remain uncertain. The aim was to evaluate venous compliance in patients with great saphenous vein (GSV) insufficiency before and after treatment by radiofrequency ablation (RFA) and in controls.MethodsEleven patients (14 limbs) underwent endovenous RFA treatment for GSV incompetence. Duplex ultrasound and strain gauge plethysmography (SGP) were performed before and after RFA. SGP time (seconds) to reach 50% of maximum venous volume (T50) with and without superficial occlusion was used to assess global venous reflux. Venous occlusion plethysmography was used to evaluate pre- and post-operative calf venous compliance. Venous compliance was also assessed in 12 age and sex matched controls.ResultsPre-operative calf venous compliance was lower in patients than in controls (p < .001). Post-operative calf venous compliance was reduced vs. pre-operative measurements (p < .002). The pre-operative reflux parameter T50 improved from 8.0 ± 2.0 seconds to 17.3 ± 1.9 seconds (p < .001) after RFA. The post-operative T50 without superficial occlusion was similar to pre-operative T50 with superficial occlusion (17.1 ± 2.5 vs. 17.3 ± 1.9 seconds, p = .84).ConclusionsCalf venous compliance is reduced in patients with GSV insufficiency. Venous reflux parameters markedly improved after RFA, whereas venous compliance displayed a further reduction vs. the pre-operative state, implicating generalised changes in the lower limb venous vessel wall.

Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency

Background: Minimally invasive Endovenous Thermal Ablation Therapy has revolutionized the treatment of varicose veins. Comparison of radiofrequency ablation (RFA) and Endovenous Laser Ablation (EVLA) needs to be more elaborated in the context of better management of patients. The objective of this study is to compare 1470-nm endovenous laser Ablation (EVLA) and radiofrequency ablation (RFA) in the treatment of patients with great saphenous vein Insufficiency. Methods: There were 100 consecutive patients presenting to our department with a great saphenous vein insufficiency treated between June 2018 and June 2019 who were included in the study. The first randomly selected 50 patients (group 1) received 1470-nm EVLA and the other 50 patients (group 2) received RFA. Patients were assessed on the second day, the first week, and the first month in terms of post-operative complications, return to routine activity and work, and postoperative pain. Results: 50 patients were allocated to each group. There was no statistically significant difference between two groups in terms of postoperative pain. Time to return to daily activity was 5.1 ± 1.12 hours in the EVLA group and 6.9 ± 0.93 hours in the RFA group (P = 0.001), whereas time to return to work was 6.7 ± 1.03 days in the EVLA group and 7.4 ± 1.07 days in the RFA group (P = 0.003). Minor complications in EVLA and RFA group were ecchymosis 26% and 32% (P = 0.509) edema 24% and 34% (P = 0.271), and induration 14% and 22% (P = 0.298), respectively. No major complication were observed in any group. Conclusion: EVLA using a 1470-nm radial fiber is an acceptable and efficacious treatment option over RFA in management of symptomatic varicose veins patients in terms of early outcome. However, long term follow up and more studies on larger populations are required to establish the superiority of either method.

Great saphenous varicose vein treatment with endovenous ablation techniques: A comparison of EVLA and RF

Aim: In this study, we compared the clinical follow-up results and complication and success rates of patients undergoing 1470 nm wavelength endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in our clinic.Material and Methods: The records of 581 patients treated in our clinic due to clinical symptoms arising from great saphenous vein insufficiency between January 2014 and September 2018 were examined retrospectively. Three hundred fifty-seven of these patients treated with EVLA or RFA and with no deficient data were included in the study. Patients with reflux in the saphenofemoral junction lasting at least 0.5 sec, with a great saphenous vein diameter of at least 7 mm, 2 cm distal to the saphenofemoral junction, and of at least 5.5 mm at knee level, and with CEAP stage C2-C5 were scheduled for endovenous ablation. The patients were randomly distributed between the established EVLA and RFA treatment groups. Data for patients’ diagnostic and therapeutic processes were recorded and evaluated in the light of information in the literature. Results: The EVLA group consisted of 86 patients (42 male, 44 female; mean age 46 years, range 26-71), and the RFA group of 271 (113 male, 158 female; mean age 43.3 years; range 20-77). The mean follow-up time was 27.2 months. No significant differences were determined in terms of patients’ demographic data, preoperative additional diagnoses, CEAP classification values, duration of reflux, or proximal and distal great saphenous vein diameter values. Thrombophlebitis developed in 14 patients and ecchymosis/hematoma in 32. No significant difference was observed between the groups in terms of complications. Great saphenous vein occlusion rates at Doppler ultrasonography six months after treatment were 91.8% in the EVLA group and 94% in the RFA group (p=0.46). Conclusion: Our results suggest that neither of the two endovenous ablation methods is superior to the other.

The Use of Two Anesthesia Techniques in Endovenous Radiofrequency Ablation of Great Saphenous Vein Insufficiency and Our Results

The Use of Two Anesthesia Techniques in Endovenous Radiofrequency Ablation of Great Saphenous Vein Insufficiency and Our Results

Mechanochemical Ablation Vs. Thermal Ablation in GSV Insufficiency: Results of a RCT after 3-Year Follow-up

Introduction - Great saphenous vein (GSV) insufficiency is nowadays usually treated with endovenous techniques, the most common of them using thermal ablation to seal the vein. Presently, non-tumescent endovenous techniques have emerged, using no thermal energy and thus being even less invasive. We made a randomized controlled trial to compare the results of mechanochemical ablation (EVMCA) to endovenous laser ablation (EVLA) and radiofrequency ablation (RF) in terms of both technical success (occlusion of the GSV) and quality of life and report results up to 3-years. Methods - The study population comprised 125 patients with GSV insufficiency and varicose veins in one leg, with clinical classification of C2-C4. We randomized them to receive either mechanochemical ablation (59 patients), laser ablation (34 patients), or radiofrequency ablation (32 patients). Local phlebectomies were performed at the same operation, if necessary. The clinical status as well as duplex doppler ultrasound examination results were recorded, and the patients filled quality of life questionnaires 3 years after the initial procedure. By the end of March 2018, 59 patients (27 EVMCA, 16 EVLA and 16 RF) had completed 3-year follow-up and all patients will be finished by mid September 2018. Results - At one month, all treated GSV’s were occluded in the ultrasound examination. At one year, the most proximal 20 centimetres of the GSV was recanalized either completely or partly in seven of the EVMCA patients, but only 2 of them had reflux in recanalized part ; in EVLA and RF groups, there was no recanalization (P = 0.078). At three years, proximal 20 cm was open in 7 patients in the EVMCA group and now 5 of them had also reflux in the vein. In EVLA and RF groups, there was no recanalization after 3-years. The whole GSV was recanalized either partly or completely at one year in five patients, 3 of them having reflux, in the EVMCA group, with no recanalization in EVLA or RF groups (P = 0.20). The corresponding numbers at 3-years were 5 recanalized veins (all of them having reflux) in EVMCA-group and still no recanalizations in thermoablation groups. At 3-year follow-up visit, 7 patients wanted additional treatment due to their varicose veins: 4 patients in the EVMCA-group and 3 patients in the RF-group. All these EVMCA-patients had reflux in GSV and recurrent varicose veins. The 3 patients in the RF-group had occluded GSV but open GSV tributaries. There were no statistically significant differences in QoL measures between the groups at one- or three years. Conclusion - There seems to be more recanalizations at 3-year follow-up after EVMCA compared with thermoablation of GSV. Despite this difference the need of procedures for recurrent varicose veins at patient’s perspective is the same between the groups.

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

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

Single-center retrospective review of early outcomes of radiofrequency ablation versus cyanoacrylate ablation of isolated great saphenous vein insufficiency

ObjectiveData comparing radiofrequency ablation (RFA) with cyanoacrylate closure (CAC) treatment of isolated great saphenous vein (GSV) insufficiency are limited. In this study, we present our early outcomes of RFA vs CAC for the treatment of GSV insufficiency. MethodsBetween March 2015 and February 2017, a total of 159 patients underwent CAC (n = 75) or RFA (n = 84) for treatment of GSV insufficiency by a single surgeon. Medical data of the patients were retrieved from the institutional database and retrospectively analyzed. All patients underwent lower extremity venous color duplex ultrasound examination. The Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were used. Total closure rates of the GSV with RFA or CAC were recorded at 1 month, 6 months, and 12 months. Procedure-related adverse events and quality of life of the patients were also evaluated. ResultsThe mean age was 46.33 ± 14.40 years in the CAC group and 48.09 ± 13.25 years in the RFA group (P = .4). The mean treated saphenous vein diameter was 7 mm in the CAC group and 7.25 mm in the RFA group (P = .07). The length of treated venous segment was 30 cm in both the CAC and RFA groups (P = .66). The mean duration of operation was 25 minutes in the CAC group and 35 minutes in the RFA group (P < .001). The incidence of adverse events was higher in the RFA group (P < .05). At 1 month, 6 months, and 12 months of follow-up, there was no statistically significant difference in the total closure rates between the CAC and RFA groups. There was no significant difference in the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire score between the groups (P > .05). ConclusionsOur study results suggest that both RFA and CAC are effective in closure of the target GSV. Although the incidence of tumescent anesthesia-related and procedure-related complications is higher with the RFA technique, both techniques can be used safely with similar success rate and patient satisfaction.

Association between Insufficiency of Anterior Perforator Vein of the Knee and Great Saphenous Vein Insufficiency in Patients with Primary Varicose Veins of the Lower Limbs

Association between Insufficiency of Anterior Perforator Vein of the Knee and Great Saphenous Vein Insufficiency in Patients with Primary Varicose Veins of the Lower Limbs

LEV 5. A Comparison of 1470-nm Endovenous Laser Ablation and Radiofrequency Ablation in the Treatment of Great and Small Saphenous Vein Insufficiency

LEV 5. A Comparison of 1470-nm Endovenous Laser Ablation and Radiofrequency Ablation in the Treatment of Great and Small Saphenous Vein Insufficiency