Great Saphenous Vein In Patients Research Articles

Nonreversed great saphenous vein grafts for vascular reconstruction after resection of lower-limb sarcoma

ObjectiveReversed great saphenous vein (GSV) graft is widely used for revascularization in limb-sparing surgery for sarcoma invading great vessels. However, a mismatch in caliber between the reverse graft and the cut end of the artery can threaten graft patency. Recently, we introduced the use of a venous valvulotome to allow non-reversed GSV graft. The purpose of this study was to evaluate the safety and versatility of this technique. DesignWe retrospectively compared long-term patency and limb salvage rates between non-reversed GSV and reversed GSV in patients undergoing limb-sparing surgery for sarcoma. MethodsThirty-seven patients were included, with 21 in the non-reversed GSV group and 16 in the reversed GSV group. Patient characteristics, surgical details, and complications were reviewed from the hospital records. The patency of reconstructed vessels was assessed by contrast-enhanced CT or MRI. Statistical analyses, including Kaplan–Meier survival analysis, were employed for comparisons. ResultsThe median follow-up was 38 months. Overall graft patency was 90.4% (19 of 21 patients) in the non-reversed GSV group and 81.2% (13 of 16) in the reversed RGSV group. In the non-reversed GSV group, there was one case of graft occlusion each in the acute phase and chronic phase, but limb circulation remained intact and all limbs were spared. ConclusionNon-reversed GSV grafting with a valvulotome offers a safe and versatile alternative to reversed GSV grafts in limb-sparing sarcoma surgery. It eliminates the need for vein reversal and minimizes diameter mismatch, potentially expanding the indication for autologous revascularization in previously ineligible cases.

Comparative outcomes of arterial bypass using the human acellular vessel and great saphenous vein in patients with chronic limb ischemia

ObjectiveThe Human Acellular Vessel (HAV) is a novel, off-the-shelf biologic conduit being evaluated for arterial reconstructions. Regulatory studies in peripheral arterial disease (PAD) to date have consisted of single-arm cohorts with no comparator groups to contrast performance against established standards. This study aimed to compare outcomes of the HAV with autologous great saphenous vein (GSV) in patients with advanced PAD undergoing infrageniculate bypass. MethodsPatients with advanced PAD and no autologous conduit who underwent bypass with the 6-mm diameter HAV (Group 1; n = 34) (March 2021-February 2024) were compared with a multicenter historical cohort who had bypass with single-segment GSV (group 2; n = 88) (January 2017-December 2022). The HAV was used under an Investigational New Drug protocol issued by the Food and Drug Administration (FDA) under the agency's Expanded Access Program. ResultsDemographics were comparable between groups (mean age 69 ± 10 years; 71% male). Group 1 had higher rates of tobacco use (37 pack-years vs 28 pack-years; P = .059), coronary artery disease (71% vs 43%; P = .007), and prior coronary artery bypass grafting (38% vs 14%; P = .003). Group 1 had more patients classified as wound, ischemia, and foot infection clinical stage 4 (56% vs 33%; P = .018) and with previous index leg revascularizations (97% vs 53%; P < .001). Both groups had a similar number of patients with chronic limb-threatening ischemia (Rutherford class 4-6) (88% vs 86%; P = .693) and Global Anatomic Staging System stage III (91% vs 96%; P = .346). Group 1 required a composite conduit (two HAV sewn together) in 85% of bypasses. The tibial vessels were the target in 79% of group 1 and 100% of group 2 (P < .001). Group 1 had a lower mean operative time (364 minutes vs 464 minutes; P < .001). At a median of 12 months, major amputation-free survival (73% vs 81%; P = .55) and overall survival (84% vs 88%; P = .20) were comparable. Group 1 had lower rates of primary patency (36% vs 50%; P = .044), primary-assisted patency (45% vs 72%; P = .002), and secondary patency (64% vs 72%; P = .003) compared with group 2. ConclusionsImplanted under Food and Drug Administration Expanded Access provisions, the HAV was more likely to be used in redo operations and cases with more advanced limb ischemia than GSV. Despite modest primary patency, the HAV demonstrated resilience in a complex cohort with no autologous conduit options, achieving good secondary patency and providing major amputation-free survival comparable with GSV at 12 months.

Low Prevalence of Adequate Single-segment Great Saphenous Vein in Patients With Severe Peripheral Arterial Disease

Low Prevalence of Adequate Single-segment Great Saphenous Vein in Patients With Severe Peripheral Arterial Disease

Comparative Outcomes of Arterial Bypass Using the Human Acellular Vessel and Great Saphenous Vein in Patients With Chronic Limb Ischemia

Comparative Outcomes of Arterial Bypass Using the Human Acellular Vessel and Great Saphenous Vein in Patients With Chronic Limb Ischemia

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.

Prevention of relapses of varicose veins in patients with true doubling of the great saphenous vein

Introduction. True doubling of great saphenous vein is observed in 1.6–2.1% of patients with varicose veins and may be one of the reasons for the development of postoperative relapse of the disease. Performing endovasal laser coagulation (EVLC) of both great saphenous vein trunks makes it possible to increase the radicality of the intervention and reduce the likelihood of a recurrence of varicose veins.Aim. Based on the study of immediate and long-term results, to substantiate the expediency of using EVLC of the main and true additional stem of great saphenous vein in patients with varicose veins.Materials and methods. From 2014 to 2020, 24 patients with a true doubling of great saphenous vein were treated. Among the applicants there were 12 women and 12 men aged 23 to 62 years with clinical class C2–C4 according to the CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic) classification. All patients under tumescent anesthesia underwent simultaneous EVLC of the main and accessory trunk of the BPV, followed by miniflebectomy or sclerobliteration of varicose tributaries.Results and discussion. The use of simultaneous coagulation of both trunks was performed by all patients, thus the technical success of the operation was observed in 100% of cases. There were no intraoperative complications. The use of such a volume of intervention is accompanied by an increase in the duration of the operation by 29.3%. Hyperpigmentation in the projection of the coagulated trunk was observed in 2 (8.3%) patients, neurological disorders – in 1 (4.2%) patient. During the examination of patients 1–2 years after the operation, no relapses of the disease were detected, and the cosmetic result of the intervention on a ten-point scale, patients on average estimated at 7.6 points.Conclusions. True doubling of the great saphenous vein is rare and may increase the likelihood of relapses of the disease. EVLC of the main and additional BPV trunks is accompanied by an increase in the duration of surgery by an average of 29.3%, and the number of patients with hyperpigmentation by 1.5 times. Simultaneous EVLC of both tables with true duplication of BPV makes it possible to reliably block a potential source of varicose disease recurrence and reduce the likelihood of recurrent veins.

COMPARISON OF THE RESULTS OF RADIOFREQUENCY ABLATION AND PHLEBECTOMY OF SUPRAFASCIAL SEGMENTS OF THE GREAT SAPHENOUS VEIN IN PATIENTS WITH VARICOSE DISEASE OF THE LOWER EXTREMITIES

Summary. Introduction. Over the past two decades, such traditional surgical procedures as crossectomy and stripping have been replaced to a greater or lesser extent by less invasive endovenous methods. Unfortunately, endovenous ablation methods do not allow to completely exclude such complications as: hyperpigmentation, paresthesias, hematomas, thermal damage to the skin.&#x0D; Purpose.To improve the tactics and improve the cosmetic effect of surgical treatment of superficially located suprafascial segments of the great saphenous vein in patients with varicose veins of the lower extremities.&#x0D; Materials and methods. An analysis of the treatment of 107 patients with VDLE at the University Clinic of ZDMU in 2019-2021 was carried out. The first (main) group – 65 (60.75 %) patients – received surgical treatment according to the proposed method – RFA, miniphlebectomy of the suprafascially located main trunk, miniphlebectomy of the tributaries along the Varada. The second (comparison) group – 42 (39.25 %) patients – received standard treatment – RFA of the GSV trunk, miniphlebectomy.&#x0D; Research results. According to the control duplex scan in all patients, the deep vein passage was occluded in 106 (99.1 %) patients.&#x0D; The overall frequency of postoperative complications in the main group was 18.4 % (12 out of 65 patients), in the comparison group – 35.7 % (15 out of 42 patients, mainly due to hyperpigmentation) and was significantly different (р ˃ 0.05).&#x0D; According to the data of CIVIQ-2, the proposed method of surgical intervention made it possible to improve the quality of life from (31.72 ± 1.56) points in patients of the comparison group to (27.49 ± 1.45) in patients of the main group.&#x0D; Conclusions. The proposed tactic of surgical correction of the varicosity of the trunk of the GSV – RFA of the intrafascial area of the GSV plus miniphlebectomy of the suprafascial segment – allows to reduce the probability of the development of hyperpigmentation, which contributes to a better cosmetic effect, subjective satisfaction of patients with the results of the operation, and a better quality of life in patients with VDLE.

Efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities

Objective: To explore the efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities. Methods: A total of 214 patients with primary varicose veins of the lower extremities in the First Affiliated Hospital of Sun Yat-sen University from January 2017 to November 2019 were included and divided into microwave ablation group (n=128) and high ligation with microwave ablation group (n=86) according to surgical approach. Further subgroups including subgroup S (diameter<10 mm) and subgroup L (diameter≥10 mm) were established. The surgical success rate, postoperative incidence and recovery of local skin numbness and ecchymosis, and the postoperative recovery of active skin ulcer were compared between the two groups and subgroups. Results: The surgical success rate was 96% (136/141) in microwave ablation group, 100% in subgroup S (116/116), and 80% in subgroup L (20/25), respectively. In addition, the surgical success rate in high ligation with microwave ablation group, subgroup S, and subgroup L was all 100% (90/90, 73/73, and 17/17). In subgroup L of microwave ablation group, the diameter of 5 great saphenous veins in patients who failed the microwave ablation was 13.0-17.1 mm. The mean follow-up time was (24±4) months in microwave ablation group and (36±6) months in high ligation with microwave ablation group, respectively. In the microwave ablation group and high ligation with microwave ablation group, the incidence of postoperative skin numbness was 15.6% and 14.4%, respectively, and the incidence of skin ecchymosis was 5.7% and 3.3%, respectively, with no statistically significant difference between the two groups (both P>0.05). The rate of active skin ulcer in the two groups was 6.4% and 15.6%, respectively, and the difference was statistically significant (P=0.020). Local skin ecchymosis in the two groups recovered within 1 month after operation. Local skin numbness in both groups recovered within the maximum 2 years of follow-up, and active skin ulcer in both groups recovered within the maximum 1 years of follow-up. Conclusion: The endovenous microwave ablation is safe and effective, especially combining with high ligation of great saphenous vein. Good follow-up results can be achieved for great saphenous vein with diameter smaller than 10 mm. However, for those with diameter greater than 10 mm, the surgical success rate of endovenous microwave ablation decreases.

Variants of Localization and Extension of Hypo- and Aplasia of the Great Saphenous Vein in Patients with Primary Varicose Great Saphenous Veins

The objective of the research was to improve the diagnostics and treatment of patients with primary varicose great saphenous veins by studying their frequency and systematizing the variants of localization and extension of great saphenous vein hypoplasia and aplasia in its trunk.&#x0D; Materials and Methods. The study included 560 patients with varicose veins of the lower limbs and pathological refluxes in different segments of the great saphenous vein. All the patients underwent triplex ultrasound scan of the lower limb venous system.&#x0D; Results. Among the patients with pathological reflux in a certain GSV segment, hypo- and aplasia of its segments were observed in 32.5% of the cases (95% CI 28.6-36.6%). Aplasia of this vein was observed twice as less frequently than hypoplasia (p&lt;0.05). In 2.3% of the cases (95% CI 1.2-3.9%), hypoplasia of a certain GSV segment evolved to aplasia, or vice versa. It was found that the GSV trunk may have several hypo- or aplastic regions separated by its normal or varicose segment – bi-level hypo- or aplasia that was observed in 3.8% of the patients with hypo- or aplasia (95% CI 1.6-7.8%). In bi-level hypo- or aplasia, 2 hypoplastic regions were detected in 85.7% of the cases (95% CI 42.1-99.6%) and 2 aplastic regions were found in 14.3% of the cases (95% CI 0.4-57.9%). There were proposed to distinguish the following variants of GSV hypo- and aplasia: 1) simple: total, proximal, segmental and distal; 2) bi-level: proximal segmental, distal segmental and bi-segmental. In addition, for every dysplastic vein segment, the type of malformation should be indicated, namely hypoplasia, aplasia, or hypo/aplasia.&#x0D; Conclusions. The study conducted allowed assessing the relationship between the variants of GSV hypo- and aplastic segment localization and extension and different variations of pathological refluxes of the GSV in its trunk for further choice of surgical tactics.

Effectiveness of iliac vein stenting combined with high ligation/endovenous laser treatment of the great saphenous veins in patients with Clinical, Etiology, Anatomy, Pathophysiology class 4 to 6 chronic venous disease

BackgroundLower limb chronic venous disease (CVD), resulting from iliac vein compression syndrome (IVCS), manifests as a series of symptoms ranging from varicose veins to venous ulcerations. Stent implantation has been considered an effective treatment method; however, the management of CVD has rarely been reported. In the present study, we evaluated the treatment and outcomes of patients with CVD. MethodsWe performed a retrospective cohort study of patients with severe iliac vein stenosis with lower limb CVD. The patients were divided into two groups: group 1 had received stenting alone (n = 42), and group 2 had received stenting and high ligation/endovenous laser treatment (n = 29). We evaluated the clinical outcomes using the Venous Clinical Severity Score and visual analog scale, and assessed the quality of life (QoL) using the Chronic Venous Disease QoL questionnaire at a median follow-up point of 15 months (range, 6-25 months). ResultsIn our cohort, the prevalence rate of nonthrombotic IVCS (NIVCS) was 11.7% (98 of 838 patients). The technical success rate was 100%, without severe complications. During the study period, three group 1 patients and two group 2 patients were lost to follow-up. The overall patency rate in the patients with NIVCS during a mean follow-up period of 15.0 months (range, 6-25 months) was 94.4%. For patients with a Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class of <4, all parameters showed similar improvements in the two groups, except for the disappearance of varicose veins. However, in patients with a CEAP clinical class of ≥4, the combination therapy significantly improved their QoL. The Venous Clinical Severity Score reduction was 4.64 ± 1.72 in group 1 and 11.89 ± 1.82 in group 2 (P < .01). Pain, scored using the visual analog scale, demonstrated a decrease from 4.41 to 2.52 (P < .05) in group 1 and 4.71 to 0.53 (P < .01) in group 2. The relief rate of stasis dermatitis in groups 1 and 2 was 26.9% and 90.5%, respectively (P < .05), and the venous ulceration healing rate was 16.7% and 87.5%, respectively (P < .05). ConclusionsThe prevalence of NIVCS should not be overlooked. The proposed combination treatment is an effective therapeutic strategy for patients with NIVCS and advanced CVD (CEAP clinical class, ≥4) during short-term follow-up.

Great saphenous vein stump: a risk factor for superficial/deep venous thrombosis and an indication for prophylactic anticoagulation? - a retrospective analysis

ABSTRACTBackground: Great saphenous vein (GSV) grafts are used for coronary artery bypass surgeries, but the remaining stump of the GSV may be the nidus for superficial and deep vein thrombosis. This study aims to determine the risk of thrombosis in the GSV stump in patients who developed lower extremity swelling following coronary artery bypass graft (CABG).Methods: We conducted a single-center retrospective analysis at Abington Jefferson Hospital of 100 patients who underwent CABG with GSV. Patients were monitored via follow-up for seven days for the development of saphenous vein thrombosis without any prophylactic anticoagulation for venous thrombosis. Risk factors including age, diabetes, hypertension, smoking, familial thrombophilia’s, family history of thrombosis, malignancy, and confounding factor-like early mobilization that may potentially alter the results were recorded.Results: The mean age of included patients was 70 years, and 65% of participants were men, 35% were women. Fourteen percent of the patients developed pain, swelling and edema in a leg where the graft was taken. We included patients aged >50 years with coronary artery disease who underwent CABG with SVG and developed lower extremity symptoms concerning for thrombosis. These patients underwent duplex ultrasound for possible GSV stump thrombosis. Any patients with coronary artery disease but no CABG or no lower extremity edema were excluded from the study. We found no saphenous vein thrombosis in the stump of the GSV in patients with clinical symptoms of thrombosis in their lower extremities based on duplex imaging.Conclusion: Based on our findings, the postoperative risk of developing thrombosis at the GSV stump and its extension to the deep veins is low and does not warrant prophylactic anticoagulation for venous thromboembolism. However, we recommend that further prospective studies with larger samples for an extended duration are warranted for better assessment of the risk of venous thrombosis in the GSV stump with minimal confounding factors.

Clinical value of color Doppler ultrasound in the diagnosis of lower extremity varicosis of great saphenous vein in patients with deep vein structure and hemodynamic status

Objective To investigate the clinical value of color Doppler ultrasound in the diagnosis of lower extremity varicosis of great saphenous vein in patients with deep vein structure and hemodynamic status. Methods 79 patients with 96 deep lower extremity varicosis were detected deep venous wall and valve echo, lumen morphology, reflux time, reflux velocity and spectrum Doppler imaging by using color Doppler ultrasound, and the results were compared with intravenous X-line angiography, while the patients with normal deep vein were selected as the control group. Results Color Doppler ultrasonography compared with angiography, the completely normal diagnostic accuracy of deep vein was 98.3%, the diagnosis accuracy of simple deep venous valve insufficiency was 91.7%, the diagnostic accuracy of sequela of deep vein thrombosis was 100.0%, the diagnosis accuracy of arteriovenous fistula was 100.0%.The sonographic appearance of 60 deep veins was similar to those of the control group.In the stripping surgery of 60 great saphenous vein, there was no postoperative lower limb swelling, review of ultrasound had no deep venous reflux phenomenon.96 suffered limbs were measured in different parts, different levels of venous reflux.The reflux time of superficial femoral vein valve was the longest, which was (5.92±1.83)s, the reflux rate was (50.28±19.48)cm/s, and the lower leg traffic vein reflux time was the shortest, which was (2.37±1.92)s, the reflux rate was (27.92±17.28)cm/s. Conclusion Color Doppler ultrasound has important clinical value for the evaluation of lower extremity varicosis of great saphenous vein in patients with deep vein structure and blood flow. Key words: Color Doppler ultrasound; Varicosis of great saphenous vein; Deep vein; Hemodynamics

Cost-effectiveness of endovenous laser ablation of the great saphenous vein in patients with uncomplicated primary varicosis.

BackgroundAlthough widely applied, the cost-effectiveness of endovenous laser ablation (EVLT) for varicose veins has not been established.MethodsCost-effectiveness analysis was performed on the evaluation of EVLT for the treatment of uncomplicated varicose veins by using published data from randomizd clinical trials regarding the costs and the quality of life. Incremental cost per quality-adjusted life year (QALY) gained at 6 months following treatment was calculated. Sensitivity analysis was carried out to investigate the uncertainty associated with the results of our analysis.ResultsOver the time horizon of 1–6 months, it was found that the incremental cost of EVLT compared with conventional surgery was €466.66 and the incremental effect was −0.007 QALY at 1 month, −0.0075 QALY at 3 months and 0.0 QALY at 6 months. This shows that the strategy “EVLT” was dominated by the strategy “HL/S” at any time point for the base cases analyses. The results of various alternative economic evaluations indicated that EVLT may be a potentially cost effective (i.e. incremental cost effectiveness ratio of between €12158.67 and €514721.67 per QALY, respectively) treatment option compared to conventional surgical treatment for varicose veins with a certainty between 54.9 and 98.8 %.ConclusionFor patients with uncomplicated varicose veins and evidence of saphenofemoral reflux, surgical treatment for varicose veins offers a robust health benefit for relatively less costs compared to EVLT.

The Effect of Endovenous Laser Ablation of Incompetent Perforating Veins and the Great Saphenous Vein in Patients with Primary Venous Disease

This study aimed to investigate the clinical results and fate of incompetent perforating veins (IPVs) following treatment of superficial venous insufficiency, with or without endovenous laser ablation (EVLA) of IPVs. A retrospective analysis of patients with primary venous insufficiency (PVI) was conducted in a single institution from January, 2010 to December, 2011. IPVs were found in 311 patients (376 limbs). Among these, 132 patients (156 limbs) were treated with EVLA of IPVs and varicose vein surgery, and the remaining 179 patients (220 limbs) were treated with varicose vein surgery alone and served as controls. The fate of the IPVs, complications and clinical results were evaluated. The technical success rate of EVLA of IPVs was 100%. There was no statistical difference in complications between the two groups. At 1 year follow up, 68 perforators were recanalized and still incompetent in the EVLA treated IPV group compared with 437 incompetent perforators in the untreated IPV group (18.7% vs 92.6%; P < .001). A faster median ulcer healing time (1.40 months) was found in the EVLA treated IPV group (95% confidence interval [CI] 1.15-1.66 vs 3.30 months [95% CI 2.50-4.10]; P = .001), even though no statistical difference in the 12 month ulcer healing rate was observed between the two groups (P = .584). There were no significant differences between the two groups for varicose vein recurrence rates or changes in the Venous Clinical Severity Score (VCSS). EVLA was safe and effective in reducing the number of IPVs in PVI. However, the addition of IPV EVLA had no effect on ulcer healing rate, VCSS or varicose vein recurrence at 1 year follow up.

The Effect of Endovenous Laser Ablation of Incompetent Perforating Veins and the Great Saphenous Vein in Patients with Primary Venous Disease

This study aimed to investigate the clinical results and fate of incompetent perforating veins (IPVs) following treatment of superficial venous insufficiency, with or without endovenous laser ablation (EVLA) of IPVs. A retrospective analysis of patients with primary venous insufficiency (PVI) was conducted in a single institution from January, 2010 to December, 2011. IPVs were found in 311 patients (376 limbs). Among these, 132 patients (156 limbs) were treated with EVLA of IPVs and varicose vein surgery, and the remaining 179 patients (220 limbs) were treated with varicose vein surgery alone and served as controls. The fate of the IPVs, complications and clinical results were evaluated. The technical success rate of EVLA of IPVs was 100%. There was no statistical difference in complications between the two groups. At 1 year follow up, 68 perforators were recanalized and still incompetent in the EVLA treated IPV group compared with 437 incompetent perforators in the untreated IPV group (18.7% vs. 92.6%; p < .001). A faster median ulcer healing time (1.40 months) was found in the EVLA treated IPV group (95% confidence interval [CI] 1.15-1.66 vs. 3.30 months [95% CI 2.50-4.10]; p = .001), even though no statistical difference in the 12 month ulcer healing rate was observed between the two groups (p = .584). There were no significant differences between the two groups for varicose vein recurrence rates or changes in the Venous Clinical Severity Score (VCSS). EVLA was safe and effective in reducing the number of IPVs in PVI. However, the addition of IPV EVLA had no effect on ulcer healing rate, VCSS or varicose vein recurrence at 1 year follow up.

Side effects and occlusion rate after tumescentless treatment of the great saphenous vein with EVLA

SummaryWe have performed a retrospective analysis of side-effect profile of endovenous laser ablation (EVLA) of great saphenous veins in patients operated on in general sedation or general/regional anesthesia with or without tumescence solution injection. The results confirmed our initial assumptions that omitting tumescence (and in addition, avoiding any external compression and cooling) may actually significantly reduce the incidence of moderate/severe postoperative pain and brusing without compromising closure rates. As these are probably caused by vessel wall perforations they seem to be more common in the tumescence cohort. The results are in line with recent basic research which showed that fiber tip centering may reduce perforations (easier to perform in vessels filled with blood), that blood itself does not either reduce or enhance laser‘s effect, and that various lasers over a wide range of wavelengths (from hemoglobin-absorbing to water-absorbing) have comparable clinical efficacy. Hence, omitting tumescence and external compression probably reduces the incidence of postoperative pain and brusing in patients treated with EVLA.

Manual lymphatic drainage in chronic venous disease: A duplex ultrasound study

To compare the effect of call-up and reabsorption maneuvers of manual lymphatic drainage on blood flow in femoral vein and great saphenous vein in patients with chronic venous disease and healthy controls. Forty-one subjects participated in this study (mean age: 42.68(15.23)), 23 with chronic venous disease (chronic venous disease group) with clinical classification C1-5 of clinical-etiological-anatomical-pathological (CEAP) and 18 healthy subjects (control group). Call-up and reabsorption maneuvers were randomly applied in the medial aspect of the thigh. The cross-sectional areas, as well as the peak and the mean blood flow velocity at femoral vein and great saphenous vein, were assessed by Duplex ultrasound at the baseline and during maneuvers. The venous flow volume changes were calculated. The venous flow volume in femoral vein and great saphenous vein increased during both manual lymphatic drainage maneuvers and in both groups (P < 0.05). The two maneuvers had a similar effect on femoral vein and great saphenous vein hemodynamics, and in both the chronic venous disease and control groups. As a result of the call-up maneuver, the flow volume augmentations, as a result of call-up maneuver, decreased with the severity of chronic venous disease in those patients measured by the clinical classification of CEAP (r = -0.64; P = 0.03). Manual lymphatic drainage increases the venous blood flow in the lower extremity with a magnitude that is independent from the specific maneuver employed or the presence of chronic venous disease. Therefore, manual lymphatic drainage may be an alternative strategy for the treatment and prevention of venous stasis complications in chronic venous disease.

Retrograde mechanico-chemical endovenous ablation of infrageniculate great saphenous vein for persistent venous stasis ulcers

To present the use of retrograde mechanico-chemical endovenous ablation for ablating the remaining below-knee great saphenous vein in patients with venous stasis ulcers persisting after above-knee great saphenous vein ablation. This small study includes six patients with persistent C6EpAsPr ulcers following above-knee great saphenous vein ablation with no incompetent perforators. They were treated using retrograde mechanico-chemical endovenous ablation approach followed by Unna therapy, followed up on post op days 3 and 30 with ultrasound, and subsequent weekly visits until the wound healed. Six patients (four men and two women), have average ulcer size of 4.1 cm(2). There was no nerve injury or other complications after mechanico-chemical endovenous ablation. These patients had an average of 28 ± 11 days healing time, compared with a mean of five months in traditional method. Mechanico-chemical endovenous ablation can be safe and effective in the treatment of patients with below-knee great saphenous vein insufficiency with venous ulcers.

Endovenous laser ablation of the great saphenous vein in patients with von Willebrand disease

Introduction. Patients with von Willebrand disease have a high risk of bleeding during the surgical treatment of varicose veins. Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is a minimally invasive treatment for saphenofemoral junction incompetence. The number of complications and relapse rate of EVLA are lower than in those of conventional surgical treatment. Case presentation. A patient with great saphenous vein insufficiency, von Willebrand disease and hypofibrinogenemia successfully underwent endovenous laser ablation. Replacement therapy with cryoprecipitate was administered preoperatively and postoperatively. The surgical procedure and postoperative course were unremarkable. Conclusion. In patients with von Willebrand disease and other coagulation disorders, endovenous laser ablation is a safe and effective treatment. The use of minimally invasive treatment, the adequate correction of haemostasis, and close cooperation between the haematologist, anaesthesiologist and endovascular surgeon reduce the risk of bleeding.

A Prospective Double-Blind Randomized Controlled Trial of Radiofrequency Versus Laser Treatment of the Great Saphenous Vein in Patients With Varicose Veins

Endovenous ablation of varicose veins using radiofrequency ablation (RFA) and endovenous laser therapy (EVLT) has reported advantages over traditional open surgical treatment. There is little evidence comparing the efficacy and patient-reported outcomes between the 2 endovenous solutions. This study compares the RFA and EVLT strategies in a prospective double-blind clinical trial. Consecutive patients with primary unilateral great saphenous vein (GSV) reflux undergoing endovenous treatment were randomized to RFA (VNUS ClosureFAST) or EVLT (810-nm diode laser). The primary outcome measure was GSV occlusion at 3 months after treatment. Secondary outcome measures were occlusion at 7 days, postoperative pain, analgesic requirement, and bruising, assessed at day 7 after surgery. Quality of life (QoL) was assessed preoperatively and 3 months after surgery using the Aberdeen Varicose Vein Questionnaire (AVVQ) and EQ-5D. A total of 159 patients were randomized to RFA (79 patients) or EVLT (80 patients). Groups were well matched for demographics, disease extent, severity, and preoperative QoL. Duplex scanning confirmed 100% vein occlusion at 1 week in both groups. At 3 months, occlusion was 97% for RFA and 96% for EVLT; P = 0.67. Median (interquartile range) percentage above-knee bruise area was greater after EVLT 3.85% (6.1) than after RFA 0.6% (2); P = 0.0001. Postoperative pain assessed at each of the first 7 postoperative days was less after RFA (P = 0.001). Changes in the AVVQ (P = 0.12) and EQ-5D (P = 0.66) at 3 months were similar in both groups. RFA and EVLT offer comparable venous occlusion rates at 3 months after treatment of primary GSV varices; with neither modality proving superior. RFA is associated with less periprocedural pain, analgesic requirement, and bruising. ISRCTN63135694 (http://www.controlled-trials.com).