Management Of Primary Varicose Veins Research Articles

Evaluation and Management of Primary Varicose Veins of Lower Limb in A Tertiary Care Centre

Introduction: Incompetent valves of deep, superficial or perforating veins lead to varicose veins. Dilated, elongated or tortuous subcutaneous veins of lower legs are a manifestation of increase in venous pressure. This increase in venous pressure results from the reflux of blood due to incompetence. The diseased Great Saphenous Vein (GSV) is removed by High Saphenous Ligation and Stripping (HLS) surgery. Aims and Objectives: To study the clinical and socio-demographic profile, precipitating factors/ risk factors, complications and clinical outcomes of management of varicose veins. Material and Methods: Data collected from 150 patients with varicose veins by appropriate history taking and clinical examination, relevant radiological and laboratory investigations and follow-up of cases to study the clinical outcome. Results: Study was conducted with 150 patients. Most common age group affected with primary varicose veins was between 41-60 yrs of age with male predominance (64.7%). Most of the cases in present study were engaged in work involving long standing hours i.e. farming (34%) and housewives (28%). Most common presenting complaints were oedema (88%), dilated veins (74%) and pain (71.3%). Conservative management was tried in all cases while Trendelenburg operation and SPJ ligation was done in 26.7% and 9.3% cases. Stripping and PERF ligation was done in 28.7% and 25.3% cases respectively. A total of 24.7% were lost to follow up. By the end of 6 month, quality of life improved in 70% cases. By the end of 6 month, symptoms improved in 72.5% cases while it disappeared in 26.5% cases. Conclusion: Males have been found to have larger incidence than females. They are mostly affected in their fourth and fifth decade of life. Ulceration and pain are the frequent findings in this condition. Compression stocking has beneficial effects if prolonged standing cannot be avoided during work hours. Trendelenburg operation with flush ligation with subfascial or extra fascial stripping is the definitive management and shows significant clinical improvement.

Endovascular Laser Therapy versus Open Surgery for the Treatment of Primary Varicose Veins of the Lower Limb

Abstract Background Venous drainage of the lower extremities is accomplished by a network of superficial veins connected to the deep veins by small perforator veins. Through a variety of pathophysiological mechanisms, weakness develops in the vein wall that results in varicosity over time. Varicosities typically form in the greater and lesser saphenous veins but also develop in branch vessels. Obstruction of the iliac veins or inferior vena cava can result in extensive varicose veins Objective s: The aim of this work is to compare the outcome of endovascular laser therapy versus open surgery in management of primary varicose veins in lower limb. Patients and Methods Type of study is a prospective, randomized, clinical study. This study was conducted on 30 patients with primary varicose veins of the lower limb, 15 patients were subjected to endovascular laser therapy for treatment of varicose veins of the lower limb (EVLA group) and 15 patients were managed by standard open surgery for treatment of varicose veins of the lower limb (surgery group). The patients were randomized selected from surgery clinic in Eldemerdash Hospital. The work was carried out in the period from June 2017 to December 2018. Results Both groups were well matched regarding age(P = 0.352) and sex (P = 0.713), type of vein diseased(P = 0.913), CEAP classification (P = 0.910) and also regarding BMI (P = 0.761). Regarding preoperative venous clinical severity score, the median(IQR) for group A (surgery group) was (5), and for group B (laser group) was (5) without statistical significant differences between both groups (P value =0.524). Many studies have shown that there was some difference in between two methods of treatment of primary varicose veins of the lower limbs open vascular surgery and endovascular laser therapy. Regarding Six weeks post-operative VCSS assessment, the VCSS score in the surgery group was statistically significantly higher (p < 0.001). However, at one and two years after the intervention The VCSS scores converged and the difference between the groups was no longer statistically significant. Conclusion The presented results show that intreatment of varicose veins with both endovascular laser ablation and open surgery there was improvement in the clinical status of the patient occur after both but EVLA was more effective early which was observed by measuring venous clinical severity score. EVLA show distinct advantages over open surgery especially in post operative pain, analgesia use and time needed to return to work.

Evaluation of Endovenous Laser Ablation in Management of Varicose Veins

Abstract Background There have been tremendous changes to the treatment of varicose veins over the years. High ligation of the SFJ and stripping of the GSV have been considered as standard treatments for GSV insufficiency for more than one century and it is still adopted as the preferred method in the majority of the surgical centers. Aim of the Work To discuss the advances in the treatment of varicose veins and their advantages over traditional methods in an attempt to choose the best method of treatment with least complications and highest success rate of cure and to review the recently advanced endovenous laser ablation as a promising line of management of primary varicose veins. Patients and Methods This observational prospective was conducted on 30 patients 30 patients with varicose veins in multiple centers carrying out endovenous laser ablation.during the period from October 2017 till March 2018. Results After the EVL ablation +/- sclerotherapy, no major complications occurred, minor complication however, was quite common and included bruising (33.3%), ecchymosis (16.6%), postoperative pain (66%) that require analgesic, superficial thrombophlebitis (16.6%) and skin burn (3.3%). Conclusion EVLA is continuing to be an outstanding minimal invasive method for treatment of varicose veins with minimal complications and a very short recovery period which sounds appealing to the patients.

PMD11 - Great Saphenous Vein Radiofrequency Ablation Versus Standard Stripping in The Management of Primary Varicose Veins: Economic Evaluation Into the Mexican Context

PMD11 - Great Saphenous Vein Radiofrequency Ablation Versus Standard Stripping in The Management of Primary Varicose Veins: Economic Evaluation Into the Mexican Context

Duplex Guided Foam Sclerotherapy Versus Surgery in Management of Primary Varicose Veins

Background: Varicose veins is a major problem among adult population. It has a major effect on life quality as well as healthcare system resources, we aim in this study to compare ultrasound guided foam sclerotherapy (UGFS) with surgery in management of primary varicose veins patients and to measure patients’ satisfaction with either modalities. Methods: 100 lower limbs of 100 patients with great saphenous vein (GSV) incompetence were prospectively randomized to undergo either surgical treatment or foam sclerotherapy. Clinical, etiological, anatomical and pathophysiological (CEAP) Classification and the Venous Clinical Severity Score (VCSS) were completed and investigated with a follow-up period of 1 year. Results: Total occlusion of great saphenous vein (GSV) was 88% in foam group as well as in the surgery group, recurrence rate in the foam group was 6% as well as in surgery group. Patient satisfaction at 1 year was 94% in foam group while in surgery group it was 90%. There were no statistical significant differences in follow up regarding VCSS, recurrence, patient satisfaction between both groups at 1 month, 6 months and 1 year (p value>0.001). Conclusion: Surgical treatment and UGFS achieved elevated rates of total occlusion of GSV incompetence with no significant difference. Both treatments led to significant improvements in VCSS, demonstrating improvements in clinical outcomes. UGFS is a valid noninvasive modality in management of great saphenous vein incompetence and is comparable to surgery.

Crossectomy and foam: has it got a role in the contemporary management of primary varicose veins?

Crossectomy and foam: has it got a role in the contemporary management of primary varicose veins?

Management of Primary Varicose Veins with the Assistance of Endoscopic Surgery: Its Role in the Treatment of Venous Ulceration

Purpose: Primary varicose veins have been treated using endoscopic surgery and achieved an encouraging result, with very low incidence of recurrence. In this study, the result of endoscope-assisted operation for primary varicose veins with venous ulceration was evaluated. Materials and Methods: From February 1997 to December 2006, 103 legs in 91 patients of primary varicose veins with skin ulceration (C5 and/or C6 lesions) were treated with the assistance of endoscopic surgery. The mean age of these patients at the time of operation was 58.1 (range 28-87) years. The numbers of C5 and C6 lesions were 55 and 48 respectively. A total of 97 legs in 87 patients received complete follow-up. The follow-up period ranged from 2 to 104 months. The results for the rate of ulcer healing and recurrence were analyzed with the Kaplan-Meier survival analysis. Results: Among the 97 legs receiving complete follow-up, initial ulcer healing was achieved in 95 legs (97.9%), including 50 legs in the C5 group and 45 legs in the C6 group. The mean time for ulcer healing was 11.3 and 15.2 weeks in C5 and C6 groups respectively. The total number of recurrences was 5 and the mean time of recurrence was 35.8 months. The 5-year ulcer recurrence rate was 7.3%. Only two legs in two patients did not heal completely after the operation in this series. This study revealed that there were always clustered varicose veins with variable incompetent perforating vessels running immediately beneath the ulcerated skin and/or at the base of the ulcer. To achieve a complete and non-recurrent ulcer healing, radical excision of these varicose veins was mandatory. Conclusion: In the treatment of primary varicose veins with ulceration, surgery with assistance of the endoscope achieved an excellent ulcer healing rate with low recurrence of ulcerations. Besides, with the advantages of the endoscope providing a magnified monitoring view with good illumination, the relationship between varicose veins and the venous ulcer was also established. This is a good alternative for the treatment of venous ulceration.

Endoscope-assisted management of primary varicose veins below the knee

Objective: Primary varicose veins below the knee were managed with the assistance of endoscopic surgery in 240 limbs (235 cases). Methods: Patients were classified into five clinico-anatomic types according to associated normal veins involved in the varicosities. All procedures were limited to below the knee. With the superior illumination and magnified monitor view offered by the endoscope, all the varicosities and the incompetent perforating veins were dissected, clipped, divided and removed through one or more access incisions (2.5–3.0 cm in length). However, the normal veins were preserved, including the long saphenous vein. Results: The mean number of incisions in each limb of all patients was 1.86. As there were no residual varicosities or incompetent perforating veins, there was little possibility of recurrence. In the follow-up of 218 limbs, recurrence occurred in only two limbs. Conclusion: Endoscope-assisted surgery is a good alternative for management of primary varicose veins below the knee, resulting in low recurrence and aesthetically acceptable surgical scarring.

Radiofrequency Endovenous Obliteration versus Stripping of the Long Saphenous Vein in the Management of Primary Varicose Veins: 3-Year Outcome of a Randomized Study

We evaluated the 3-year outcome of a series of patients with primary varicose veins who were randomized to radiofrequency endovenous obliteration vs. stripping of the long saphenous vein (LSV). Twenty-eight patients were included in the study: 15 were randomized to the radiofrequency endovenous obliteration procedure and 13 to LSV stripping. At 3-year follow-up, five patients (33.3%) of the endovenous group had recurrent or residual varices and in three of them a reflux in the thigh veins was detected. None of the primarily occluded LSV segments was recanalized. In the stripping group, three patients (23.1%, p = 0.68) showed varicosities at clinical and duplex examinations. In one patient, a patent duplicate LSV trunk was detected. In the remaining two patients, no reflux in the thigh region was detected. According to the present results, radiofrequency endovenous obliteration of the LSV is associated with somewhat poorer short-term results compared with the stripping operation.

Endoscope-assisted management of primary varicose veins of the long saphenous vein and its tributaries

Objective: Primary varicose veins of the long saphenous vein and its tributaries were managed in 104 limbs of 101 patients with the assistance of endoscopic surgery. Methods: Patients were divided into four clinico-anatomical types according to normal veins involved in the varicosities. With good illumination and magnified monitor viewing by means of a surgical endoscope, the varicositic trunk, varicositic tributaries, incompetent perforating veins and healthy veins could be clearly visualized and identified. Through two or more access incisions (2.5-3.0 cm in length), the varicose veins were completely dissected, divided and removed. The incompetent perforating veins were clipped and divided. In all cases, the mean number of incisions in each limb was 3.0. Results: The most common cause of morbidity was maceration of the incision wound. Transient numbness may have presented at the dissected area, but there were no signs of injury to the saphenous nerve. Conclusions: There was very little possibility of recurrence, because no residual varicosities or incompetent perforating veins remained after this operation. Recurrence presented in only one case at follow up, three months postoperatively. Patients were satisfied with the minimal surgical scarring and complete absence of disfiguring varicosities in the limb.

Gross anatomy of primary varicose veins observed in endoscopic surgery.

The gross anatomy of varicose veins is one of the most important factors in the study of varicosity. Because of wide variations in the extent of involvement and degree of severity of varicose veins, it is difficult to obtain live and intact specimens of varicose veins. With good illumination and magnified monitor viewing, the varicositic main channel, its tributaries, and the incompetent perforating veins can be dissected and visualized clearly during endoscopic surgery. Thus, the whole range of varicosities can be observed directly in situ. Characteristic features of the varicosities of 350 limbs have been recorded by video and photographs for study and classification. These features include: 1) poor contractility of varicose veins; 2) dilated and tortuous changes of varicose veins; 3) saccular or lateral bulging deformities of vein walls, or both; 4) uniformly dilated and tortuous deformities of a long vein; 5) varicositic changes of the accessory vein; 6) anatomic abnormalities of varicose veins, such as supernumerary tributaries, varicositic clusters, and a crowded relationship among the long saphenous vein, perforating vein and tributaries; 7) various conditions of the perforating veins; and 8) the close relationship among the long saphenous vein, perforating veins, and the saphenous nerve. These data provide valuable information for the study and management of primary varicose veins.

Defining the role of extended saphenofemoral junction ligation: A prospective comparative study

Objective: This study explores the added effect of extended saphenofemoral junction (SFJ) ligation when the greater saphenous vein (GSV) has been eliminated from participating in thigh reflux by means of endovenous obliteration. GSV obliteration, unlike surgical stripping, can be done with or without SFJ ligation to isolate and study SFJ ligation’s specific contribution to treatment results. Methods: Sixty limbs treated with SFJ ligation and 120 limbs treated without high ligation were selected from an ongoing, multicenter, endovenous obliteration trial on the basis of their having primary varicose veins, GSV reflux, and early treatment dates. Results: Five (8%) high-ligation limbs and seven (6%) limbs without high ligation with patent veins at 6 weeks or less were excluded as unsuccessful obliterations. Treatment significantly reduced symptoms and CEAP clinical class in both groups (P =.0001). Recurrent reflux developed in one (2%) of 49 high-ligation limbs and eight (8%) of 97 limbs without high ligation by 6 months (P =.273). New instances of reflux did not appear thereafter in 57 limbs followed to 12 months. Recurrent varicose veins occurred in three high-ligation limbs and four limbs without high ligation by 6 months and in one additional high-ligation limb and two additional limbs without high ligation by 12 months. Actuarial recurrence curves were not statistically different with or without SFJ ligation (P >.156), predicting greater than 90% freedom from recurrent reflux and varicosities at 1 year for both groups. Conclusion: These early results suggest that extended SFJ ligation may add little to effective GSV obliteration, but our findings are not sufficiently robust to warrant abandonment of SFJ ligation as currently practiced in the management of primary varicose veins associated with GSV vein reflux. (J Vasc Surg 2000;32:941-53.)

Placebo Treatment for Varicosity: Don't Eat It, Rub it!

Objective: To define and compare the clinical effectiveness of two different placebo applications, oral and topical, in the management of primary varicose veins. Design: Prospective, controlled trial with two parallel treatment groups. Setting: Social security system related rehabilitation centre in Germany with nationwide assignment of inpatients. Patients: Sixty-one patients with the clinical diagnosis of varicose veins. Interventions: Group A ( n = 30) received an oral placebo, group B ( n = 31) applied a topical placebo preparation to both legs. The treatment period was 24 days; both therapies were applied daily. Main outcome measures: Foot volume, ankle circumference, light reflex rheography and subjective complaints. Results: In both groups there were significant improvements in several outcome measures concerning both objective signs and subjective symptoms. Light reflex rheography yielded significantly better results in the topically compared with the orally treated group. Other variables followed this trend without, however, reaching the level of statistical significance. Conclusions: Symptoms of varicose veins are highly prone to respond to placebo. There are some indications to suggest that a topical placebo induces stronger effects than an oral one.

Ambulatory stab evulsion phlebectomy for truncal varicose veins

The management of primary varicose veins is evolving. Recovery time, cost, recurrence rate, and cosmesis are critical determinants. Classic “high ligation” and ankle-to-groin stripping is expensive, results in a long convalescence, and may produce unacceptable scarring and possible permanent nerve injury. This report describes the technique of stab evulsion phlebectomy performed in an outpatient setting. Under loco-regional anesthesia, and after high ligation, existing tributary and trunk varicosities are evulsed with specially designed hooks. The multiple stab incisions, 1.5- to 3-mm long, are closed with adhesive strips. Fifty-six patients, with 69 involved limbs, have been operated on during the past 9 months. Postoperative pain and complications were minimal. Convalescence was eliminated and all patients immediately resumed normal daily activities. Cosmesis was excellent. This technique is based on hemodynamically accurate principles. It effectively removes all varicosities, eliminates the proximal source of reflux, and disconnects potentially outflowing perforators, yet leaves in situ undamaged trunk veins, which may be used as potential vein grafts.

Varicography in the management of primary varicose veins

Forty-nine legs in 41 patients with primary varicose veins were investigated by varicography, (direct injection of varicose veins with contrast medium). Additional features not found at clinical examination, such as reduplication of the long saphenous vein, unusual terminations of the short saphenous vein and incompetent perforating veins, were found in over 50% of the legs examined. It is suggested that varicography should be carried out in patients with primary varicose veins in whom the clinical assessment is not conclusive.

SURGICAL MANAGEMENT OF PRIMARY VARICOSE VEINS.

SURGICAL MANAGEMENT OF PRIMARY VARICOSE VEINS.