Primary Great Saphenous Varicose Veins Research Articles

Comparative study between radiofrequency ablation and endovenous laser ablation in the management of primary great saphenous varicose veins

Comparative study between radiofrequency ablation and endovenous laser ablation in the management of primary great saphenous varicose veins

LASER Versus Mechanochemical Ablation in Treatment of Primary Varicose Vein of Lower Limb

Background: Endovenous thermal techniques, such as endovenous laser ablation [EVLA], are the recommended treatment for varicose veins. Non-thermal techniques such as Mechanochemical ablation [MOCA] have potential benefits. Aim of the work: To compare EVLA with MOCA in the treatment of primary varicose vein of the lower limb. Patients and Methods: 40 patients who had primary great saphenous varicose veins [VV] admitted at the Vascular Surgery Department, Al-Azhar University Hospital, New Damietta, Egypt. They randomized into two equal groups each one included 20 patients group [1] treated by EVLA and group [2] treated by MOCA. Results: The time of operation of studied patients ranged from 22 to 44 minutes, and there a statistically significant decrease in time of group 2 compared to group 1. [25.36±1.80 vs. 37.30±2.47 respectively]. Postoperative pain in studied patients ranged from 0 [no pain] to 7 [severe pain], there statistically significant decrease in pain of group 2 compared to group 1. As regard to induration, it was reported in 4 patients, representing 20% of group 1 [4] patients, were significant differences between groups 1 and 2 [20% vs. 0% respectively]. At the end of the sixth month postoperatively, as regard complete occlusion of the great saphenous vein [GSV] vein, there was statistically no significant difference between group 2 when compared to group 1 [92.5% vs. 95% respectively]. Conclusions: MOCA was associated with better results on short-term follow-up.

Mechanochemical ablation versus thermal ablation as a management modality for primary great saphenous varicose veins

Background Chronic venous insufficiency is one of the most common conditions in the world. The WHO defines varicose veins (VV) of the lower limbs as dilated superficial veins presenting as baggy or cylindrical in shape and possessing damaged valves. In 70% of cases saphenous veins are affected. Objective This is a comparative, prospective study to compare thermal ablation versus maechanochemical ablation in the management of VV. Patients and methods This study was conducted on 40 patients who had primary great saphenous VV in the form of incompetence of saphenofemoral junction and/or great saphenous presented to the Vascular Department of Ain Shams University Hospitals, El-Sahel Teaching Hospitals (and other authorized hospitals under supervision of thesis supervisors). The study is a prospective, clinical trial (interventional comparative analytical study). Results This study compares between mechanochemical ablation (MOCA) versus radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) as the new managing modality for treatment of VV. This study shows no statistically difference in age and sex between the three groups. It shows statistically difference in obesity. There is statistical difference between three groups in great saphenous vein length preintervention. Most of the patients are C3 and C4. Conclusion MOCA is associated with less postoperative pain and faster recovery and work resumption compared with RFA and EVLA in the treatment of primary great saphenous VV. But recanalization was more in MOCA compared with RFA and EVLA.

Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein

New minimally invasive treatment modalities, such as ultrasound-guided foam sclerotherapy (UGFS), are becoming more popular. In a multicentre randomized controlled non-inferiority trial, the effectiveness and costs of UGFS and surgery for treatment of the incompetent great saphenous vein (GSV) were compared. Patients with primary great saphenous varicose veins were assigned randomly to either UGFS or surgical stripping with high ligation. Recurrence, defined as reflux combined with venous symptoms, was determined on colour duplex scans at baseline, 3 months, 1 year and 2 years after initial treatment. Secondary outcomes were presence of recurrent reflux (irrespective of symptoms), reduction of symptoms, health-related quality of life (EQ-5D(™)), adverse events and direct hospital costs. Two hundred and thirty patients were treated by UGFS and 200 underwent GSV stripping. The 2-year probability of recurrence was similar in the UGFS and surgery groups: 11·3 per cent (24 of 213) and 9·0 per cent (16 of 177) respectively (P = 0·407). At 2 years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35·0 per cent) than in the surgery group (21·0 per cent) (P = 0·003). Mean(s.d.) hospital costs per patient over 2 years were €774(344) per patient for UGFS and €1824(141) for stripping. At 2-year follow-up, UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest. UGFS has the potential to be a cost-effective approach to a common health problem. Registration numbers: NCT01103258 (http://www.clinicaltrials.gov) and NTR654 (http://www.trialregister.nl).

Cost-effectiveness of traditional and endovenous treatments for varicose veins

The aim of this study was to evaluate the cost-effectiveness of traditional and endovenous treatments for patients with primary great saphenous varicose veins. A Markov model was constructed to compare costs and quality-adjusted life years (QALYs) for great saphenous vein (GSV) reflux. Eight popular treatment strategies were compared up to 5 years. Estimates for the effectiveness of treatments were obtained from published randomized studies and cost values were obtained from published National Health Service (NHS) healthcare resource group tariffs and device manufacturers. Parameter uncertainty was tested using sensitivity analysis and Monte Carlo simulation. Ultrasound-guided foam sclerotherapy (UGFS) had the lowest initial cost, but a higher requirement for further interventions. Day-case surgery (with concomitant treatment of varicosities), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) performed in an outpatient or office setting (with staged treatment of varicosities) were likely to be cost-effective treatment strategies. The incremental cost-effectiveness ratio (ICER) for UGFS (versus conservative care), EVLA (versus UGFS) and RFA (versus EVLA) were £1366, £5799 and £17 350 per QALY respectively. The ICER for traditional surgery (performed on a day-case basis) was £19 012 compared with RFA. Other strategies were not cost-effective using the NHS threshold of £20 000 per QALY. Day-case surgery or endovenous ablation using EVLA or RFA performed as an outpatient are likely to be cost-effective treatment strategies for patients with primary unilateral GSV reflux requiring treatment.

Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up

Endovenous laser therapy (EVLT) for ablation of the great saphenous vein (GSV) is thought to minimize postoperative morbidity compared with high ligation and stripping (HL/S). Only a few randomized trials have reported early results. This prospective randomized trial compared EVLT (980 nm) and HL/S results at 1 and 2 years after the intervention. Patients with symptomatic varicose veins due to GSV insufficiency were randomized to HL/S (100 limbs) or EVLT (104 limbs). Four EVLT procedures failed primarily and were excluded. Phlebectomy and ligature of incompetent perforators were performed whenever indicated in both groups. Patients were re-examined clinically and by duplex ultrasound imaging preoperatively and at 12 days and at 1 and 2 years after treatment. Closure rate, complication rate, time to return to normal activity, the Aberdeen Varicose Vein Symptom Severity Score (AVVSS), the Varicose Venous Clinical Severity Score (VVCSS), and the Medical Outcome Study Short Form-36 scores were also recorded. There were no differences in patient demographics, CEAP class, Widmer class, or severity scores between the groups. Simultaneous interventions did not differ between the groups. Similar times for the return to normal activity and scores for postoperative pain were reported. No major complications after treatment were recorded. HL/S limbs had significantly more postoperative hematomas than EVLT limbs, and EVLT patients reported more bruising. Follow-up at 1 year was 100% for HL/S and 99% for EVLT. Two GSVs in the EVLT group reopened and three partially reopened. No open GSVs occurred in HL/S limbs. Ninety-eight percent of the limbs in both groups were free of symptoms. VCSS, AVVSS, and Short Form-36 scores did not reveal any group differences. At 2 years, no differences compared with 1-year results were observed, except that two more GSVs in the EVLT group were partially reopened. Abolition of GSV reflux and improvement in quality of life was similar after HL/S and EVLT. After EVLT, however, two GSVs were found completely reopened and five were partially reopened, which was significantly higher than after HL/S. A prolonged follow-up is ongoing.

Duplex Ultrasound Outcomes Following Ultrasound-Guided Foam Sclerotherapy of Symptomatic Primary Great Saphenous Varicose Veins

Objectives To describe duplex ultrasound (DUS) outcomes 12 months following ultrasound-guided foam sclerotherapy (UGFS) of primary great saphenous varicose veins (GSVV). Methods A consecutive series of UK National Health Service patients underwent serial DUS examinations following UGFS with 3% sodium tetradecyl sulphate for symptomatic primary GSVV. Results 344 treated legs (CEAP C 2/3 237, C 4 72, C 5 14, C 6 21) belonging to 278 patients (103 male) of median age 57 (range 21–89) years were enrolled between November 2004 and May 2007. The median volume of foam used was 10 (range 2–16) ml. Above-knee (AK) and below-knee (BK) GSV reflux was present in 333 (96.8%) and 308 (89.5%) legs respectively prior to treatment. AK and BK-GSV reflux was completely eradicated by a single session of UGFS in 323 (97.0%) and 294 (95.5%) legs respectively; and by two sessions of UGFS in 329 (98.8%) and 304 (98.7%) legs respectively. In those legs where GSV reflux had been eradicated, recanalisation occurred in 18/286 (6.3%) AK and 23/259 (8.9%) BK-GSV segments after 12 months follow-up. Conclusions A single session of UGFS can eradicate reflux in the AK and BK-GSV in over 95% of patients with symptomatic primary GSVV. Recanalisation at 12 months is superior to that reported after surgery and similar to that observed following other minimally invasive techniques.

Authors' reply: Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins (Br J Surg 2008; 95: 294–301)

Authors' reply: Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins (<i>Br J Surg</i> 2008; 95: 294–301)

Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins (Br J Surg 2008; 95: 294–301)

Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins (<i>Br J Surg</i> 2008; 95: 294–301)

Randomised Trial of Flush Saphenofemoral Ligation for Primary Great Saphenous Varicose Veins

Objectives: The aim of this study was to assess different techniques of saphenofemoral ligation in the treatment of primary varicose veins. Methods: One hundred and eighty-two patients (210 legs) with primary saphenofemoral junction incompetence were randomised to standard saphenofemoral ligation (transfixion with an absorbable suture) (SSL) or flush saphenofemoral ligation (oversewing with 4/0 polypropylene) (FSL). All legs underwent additional great saphenous vein stripping and multiple phlebectomies. Patients underwent assessment preoperatively, and at 6 weeks, 1 year and 2 years postoperatively with clinical examination, duplex imaging and completion of the Aberdeen Varicose Vein Symptom Severity Score (AVVSSS). Results: A total of 148 patients (172 legs) attended follow-up at 2 years postoperatively. Recurrent varicose veins were visible in 30 legs (33 per cent) in the SSL group and 26 legs (32 per cent) in the FSL group (P = 0.90). Neovascularisation was present in 20 groins (22 per cent) in the SSL group and 15 groins (19 per cent) in the FSL group (P = 0.57). Nine cases of neovascularisation in the SSL group and five in the FSL group directly resulted in clinical recurrence (P = 0.37). Conclusions: Flush ligation of the saphenofemoral junction confers no advantage over standard ligation with respect to clinical recurrence and neovascularisation. Registration number: ISRCTN20235689 (http://www.controlled-trials.com).

Randomised Trial of Flush Saphenofemoral Ligation for Primary Great Saphenous Varicose Veins

ObjectivesThe aim of this study was to assess different techniques of saphenofemoral ligation in the treatment of primary varicose veins. MethodsOne hundred and eighty-two patients (210 legs) with primary saphenofemoral junction incompetence were randomised to standard saphenofemoral ligation (transfixion with an absorbable suture) (SSL) or flush saphenofemoral ligation (oversewing with 4/0 polypropylene) (FSL). All legs underwent additional great saphenous vein stripping and multiple phlebectomies. Patients underwent assessment preoperatively, and at 6 weeks, 1 year and 2 years postoperatively with clinical examination, duplex imaging and completion of the Aberdeen Varicose Vein Symptom Severity Score (AVVSSS). ResultsA total of 148 patients (172 legs) attended follow-up at 2 years postoperatively. Recurrent varicose veins were visible in 30 legs (33 per cent) in the SSL group and 26 legs (32 per cent) in the FSL group (P=0.90). Neovascularisation was present in 20 groins (22 per cent) in the SSL group and 15 groins (19 per cent) in the FSL group (P=0.57). Nine cases of neovascularisation in the SSL group and five in the FSL group directly resulted in clinical recurrence (P=0.37). ConclusionsFlush ligation of the saphenofemoral junction confers no advantage over standard ligation with respect to clinical recurrence and neovascularisation.Registration number: ISRCTN20235689 (http://www.controlled-trials.com).

Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins

Endovenous laser ablation (EVLA) is a minimally invasive technique for treating varicose veins due to truncal vein incompetence. This randomized trial compared EVLA with conventional surgery in patients with primary saphenofemoral and great saphenous vein (GSV) reflux. Consecutive consenting patients with symptomatic varicose veins were randomized to EVLA 1 (stepwise laser withdrawal), EVLA 2 (continuous laser withdrawal) or surgery (saphenofemoral ligation, GSV stripping, multiple phlebectomies). Principal outcome measures were abolition of GSV reflux and improvement in Aberdeen Varicose Vein Symptom Score (AVVSS) 3 months after treatment. GSV reflux was abolished in 41 of 42 legs treated with EVLA 1, 26 of 29 following EVLA 2 and 28 of 32 after surgery (P = 0.227). The median (interquartile range, i.q.r.) AVVSS improvement was similar: 9.38 (4.54-14.93) with EVLA 1, 10.26 (5.03-15.03) after EVLA 2 and 8.36 (4.54-13.21) following surgery (P = 0.694). Return to normal activity (median (i.q.r.) 2 (0-7) versus 7 (2-26) days; P = 0.001) and work (4 (2-7) versus 17 (7.25-33.25) days; P = 0.005) was quicker after EVLA by either method. Abolition of reflux and improvement in disease-specific quality of life was comparable following both EVLA and surgery. The earlier return to normal activity following EVLA may confer important socioeconomic advantages. ISRCTN99270116 (http://www.controlled-trials.com).

Primary great saphenous varicose veins revisited.

AbstractOur knowledge of the prevalence, pathogenesis, and treatment of primary great saphenous varicose veins has been reviewed. There is now evidence that potentially correctable environmental factors contribute importantly to the development of primary varicose veins, but what these factors are is not known. It is suggested that the evidence that incompetence of the venous valves at and above the saphenofemoral junction initiates the development of primary great saphenous varicose veins is scientifically weak. There are a number of questions about the treatment of primary varicose veins that have scarcely been asked, far less answered. The case is argued for microepidemiological studies of the prevalence of primary varicose veins, for studies to test more rigorously the valve hypothesis of their causation, and for more prospective, long‐term, clinical trials of treatment to be undertaken.