Recurrent Varicose Veins Research Articles

Inferior selective crossectomy for great saphenous vein incompetence: Our experience.

To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence.Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2-C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%.Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

Minor tributary veins of the common femoral vein near the saphenofemoral junction - A postmortem study.

Recurrent varicose veins after surgery are a frequent burden and the saphenofemoral junction is the most common source of reflux. Pre-existing branches of the common femoral vein near the saphenofemoral junction, which may increase due to haemodynamic or other reasons, could play a role in the development of recurrent varices. There exist only a few anatomical data about the prevalence of these minor venous tributaries of the common femoral vein near the saphenofemoral junction. Therefore, this study aimed to elucidate their frequency and distribution. A total of 59 veins from 35 anatomical donors were dissected. The common femoral vein with the adherent parts of the profunda femoris vein and the great saphenous vein was exposed and analysed ex situ. The number of minor tributaries to the common femoral vein was counted and their distances to the saphenofemoral junction as well their diameters were measured. We could identify up to 10 minor tributaries of the common femoral vein below the level of the great saphenous vein as far as 6 cm distally and up to four veins above the level as far as 5 cm proximally. The mean diameters of these vessels ranged from 0.5 to 11.7 mm. Most of these vessels were located near the saphenofemoral junction and 3 cm distally. Directly opposite to the opening of the great saphenous vein we could find at least one minor tributary of the common femoral vein in 57%. There exist a vast number of minor tributaries of the common femoral vein and they are mainly located near the saphenofemoral junction. Nevertheless, their role in the development of recurrent varices is still unclear and further studies are necessary.

Feasibility and technique of endovenous laser ablation (EVLA) of recurrent varicose veins deriving from the sapheno-femoral junction-A case series of 35 consecutive procedures.

To assess the feasibility and technical success of endovenous laser ablation (EVLA) of recurrent varicose veins arising from the former sapheno-femoral junction (SFJ). We retrospectively analyzed all EVLA procedures treated in our institution by one surgeon between March 2019 and April 2020 and selected all consecutive cases with SFJ recurrence occuring after surgical high ligation and stripping or endovenous thermal ablation for incompetence of the great saphenous vein (GSV) in superficial venous insufficiency. The feasibility, technical success as determined by duplex ultrasound on the postoperative visit, complications and rate of endothermal heat-induced thrombosis (EHIT) were recorded. A subgroup definition was performed based on sonographic morphology of the recurrence and resulting strategy of ablation. Thirty-five limbs with SFJ recurrence in 34 patients were treated with EVLA in order to shut down the highest refluxing point. In 22 interventions, it was required to switch off a short stump or a neovascularization by direct puncture (Subgroup 1). In 13 treatments, the presence of residual GSV segments, or persistent, varicose transformed major tributaries like the anterior accessory great saphenous vein, enabled cannulation and advancing the laser fiber from distal to the former SFJ (Subgroup 2). The EVLA procedures could be successfully carried out in all 35 cases. There were no major complications, no thromboembolism or EHIT, and no local groin complications. In one case, the patient developed a phlebitic response that required temporary medication. Technical success was achieved with 34/35 treatments (97.1%). When comparing the subgroups, the morphological pattern of the SFJ recurrence and the resulting technique of puncture, cannulation and ablation did not influence the result. The results of this case series suggest that SFJ recurrences can also be successfully treated in situations where there are tortuous or short stumps that require direct puncture and ablation.

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.

Comparison of stripping/ligation and embolization with cyanoacrylate in venous insufficiency treatment

Aim: Stripping/ligation (S/L) is the gold standard method used in the treatment of varicose veins. Saphenous vein ablation with cyanoacrylate (CA) is a new minimally invasive treatment method that forces this throne. Our aim is to compare these two methods in terms of patient satisfaction. Methods: In this cross-sectional study, voluntary patients who had superficial venous insufficiency and varicose vein were divided into two groups as S/L and CA. CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic-clinical score) and VAS (Visual Analogue Scale ) were evaluated on the 1st, 3rd, 7th, 14th, 30th postoperative days and at the outpatient follow-up visits 1 year later. SF-36 (Short Form-36) questionnaire was applied at the first month. VCSS (Venous Clinical Severity Score) of patients were compared at 6 months after surgery. Control, color doppler ultrasonography was performed on patients with recurrent varicose veins or those who were symptomatic. SPSS 22.0 program was used for data analysis. Results: The preoperative and postoperative VCSS scores were lower in the CA group than in the S/L group (P<0.001). In both groups, postoperative VCSS score was lower compared to preoperative conditions (P<0.001). The VAS score of S/L group was higher than the CA group, during anesthesia, on the 1st, and 3rd postoperative days (P<0.001). However, during the procedure, on the 7th (P<0.001) and 14th days (P=0.033), VAS scores were lower in the S/L group than the CA group. In short form -36, viability score was better in the S/L group (P<0.001). CA group scored higher in the other parameters (such as physical functioning, role limitations, bodily pain, general mental health, social functioning, role limitations due to emotional problems and general health perceptions) (P˂0.001 for all). Conclusion: Although the S/L method is the gold standard for varicose vein treatment, saphenous vein ablation with CA scored higher in terms of patient satisfaction.

Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases.

Objectives: Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. Methods: An observational study with retrospective data analysis. Materials: Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. Results: In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen’s kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. Conclusions: TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.

DETERMINANTS OF RECURRENCE RATE DURING MIDTERM FOLLOW-UP OF PATIENTS AFTER ENDOVENOUS LASER ABLATION OF PRIMARY LOWER LIMB VARICOSE VEINS

Background: The goal of this prospective cohort study was to study the different determinants impacting primary varicose vein recurrence rates and patterns after endo venous laser ablation (EVLA) for primary lower limb varicose veins.Patients and Methods: 127 symptomatic patients (127 limbs) with great saphenous vein reflux (>0.5 seconds), GSV diameter> 3mm and pre-operative incompetent perforators were followed up within two years for recurrence after EVLA.Outcomes: Recurrence was defined clinically by venous clinical severity score (VCSS) and CEAP classification and radiologically by patterns of reflux on duplex ultrasound examination. Assessment was done at 1, 6, 12 and 24 months after the procedure. Results: Two-year life table analysis showed varicose vein recurrence in 9 (7.1%) of limbs. Varicose vein recurrence was mostly seen owed to due to BMI more than 30.5 kg/m2 in 77.8 % (p <0.001, 95% CI 1.105 to 1.590) of recurrence patients, refluxing anterior accessory saphenous vein in 77.8% of patients (p <0.001, 95% CI 3.2 to 1669.1) and postoperative incompetent perforators in 77.8% of patients (p <0.001, 95% CI 2.7 to 69.3). Age, gender and pre-operative GSV diameter ≥ 5.5 mm were statistically insignificant in determination of recurrence. Conclusion: BMI, refluxing anterior accessory saphenous vein and postoperative incompetent perforators are the most importantdeterminants of recurrence after EVLA with a statistically significant impact in comparison with age, gender and preoperative dilated GSV diameter ≥5.5 mm.

The 2020 update of the CEAP classification system and reporting standards

The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier “r” for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.

Recommendation of Ultrasound-guided Foam Sclerotherapy for Residual or Recurrent Varicose Veins after Endovascular Thermal Ablation or Surgery

Recommendation of Ultrasound-guided Foam Sclerotherapy for Residual or Recurrent Varicose Veins after Endovascular Thermal Ablation or Surgery

A Study of Re-operation for Recurrent Varicose Veins

A Study of Re-operation for Recurrent Varicose Veins

Anterior accessory saphenous vein confluence anatomy at the sapheno-femoral junction as risk factor for varicose veins recurrence after great saphenous vein radiofrequency thermal ablation.

Varicose veins recurrence rate remained almost unchanged despite the constant technological advancement in its treatment. The aim of this study is to evaluate the variable accessory saphenous vein (ASV) anatomy at the sapheno-femoral junction (SFJ) as a possible risk factor for recurrent varicose vein (RVV) after great saphenous vein (GSV) radiofrequency thermal ablation (RTA). Two-hundred consecutive patients affected by chronic venous disease (mean age 52.4±10.3 years; 187 women; CEAP C2-C6; 25.2±1.4), underwent to RTA from 2014 to 2016, at our Institute. Preoperatively all patients underwent duplex-ultrasound scanning, reporting the anatomical site, extension of reflux and the ASV anatomy at the SFJ. Duplex ultrasound and physical examination was performed postoperatively at 1, 6 and 12 months, and yearly thereafter. Patients were divided in two groups based on the anatomical site of reflux: group A (N.=187) including GSV and SFJ, group B (N.=82) including SFJ reflux. There was no preoperative statistical difference between the two groups. At a mean follow-up of 29.7±2.4 months, a freedom from recurrent varicose vein and GSV recanalization was: 100% and 100% at 1 month, 95.9% and 99.1% at 1 year, 93.7% and 96.7% at 3 years, respectively. A higher rate of RVV was documented for patients in group A at 3-year of follow-up (P=0.042). Cox regression analysis found, among five potential predictors of outcome, that direct confluence of ASV in SFJ (HR=1.561; 95% CI: 1.0-7.04; P=0.032) was a negative predictors of 1-year RVV. Sapheno-femoral junction morphology may affect recurrent varicose veins formation. In particular, a concomitant incompetence of the accessory saphenous vein or its directly confluence into the SFJ could represent an indication to simultaneous treatment by non-surgical techniques (RTA or laser) and avoid surgical ligation.

Advanced Stages of Chronic Venous Disease: Evolution of Surgical Techniques and Advantages of Associated Medical Treatment.

Contemporary interventional treatment of primary chronic venous disease (CVD) is mainly focused on the treatment of venous reflux. The long-term results of endovenous ablation (EVA) and high ligation and stripping are not different with respect to varicose vein recurrence, and this recurrence appears to be a manifestation of disease progression. Since inflammation is one of the key mechanisms of CVD development and progression, efforts to minimize inflammation and angiogenic potential in endovenous and surgical procedures are worthwhile. As techniques continue to be refined, surgery remains a valid option; in particular, the techniques that minimize trauma can be beneficial regarding recurrence. Medical treatment with venoactive drug therapy such as micronized purified flavonoid fraction (MPFF; Daflon®), which has proven clinical benefits in patients with CVD, can be used before and after EVA or surgery to minimize inflammation, pain, hemorrhage, and reduce CVD symptoms.

Elastic Compression Stockings and Varicose Veins Recurrence

Elastic Compression Stockings and Varicose Veins Recurrence

Impacts of endovenous laser ablation on neovascularization in treatment of chronic venous insufficiency (CVI)

Objectives: The aim of this experimental study is to contribute to the elucidation of the etiopathogenesis of recurrence and to investigate the effect of thermal energy on neovascularization in Sapheno-Femoral Junction (SFJ) divisions. Methods: Seven adult wistar rats have been used for each group. The left legs of the same rats without any attemp were accepted as the control group. The other groups were named surgical and Endovascular laser ablasyon (EVLA) group respectively, after right femoral venous binding, with scissor divide and directly with cotter divide. After routine light microscopic tissue processing; tissue samples were stained by Hemotoxylin-Eosin and VEGF. In light microscopic sections, capillaries were counted with 10 different field x20 lens magnification, and the average was taken and H-Scores were determined. For the statistical analysis, the Spousal T Test was applied and the groups were compared according to the result. Kolmogorov-Simirnov Test was applied to individual distributions of each group. Results: In statistical analysis; the Kolmogorov-Simirnov test was normally distributed separately (p>0,05). In VEGF immunostaining; while there was statistically significant difference between Control and Surgery group (p: 0,001), between Surgery and EVLA group (p: 0,039) and there was no statistically significant difference between Control and EVLA group (P: 0,199). Conclusions: In our study, it was observed that the use of thermal ablation in EVLA application of varicose vein surgery in SFJ reduced neovascularization emerging in varicose vein recurrence. EVLA may be an easily applicable, minimally invasive and alternative way of preventing varicose venous recurrences.

PATHOPHYSIOLOGICAL AND PATHOMORPHOLOGICAL ASPECTS OF RELAPSE OF VARICOSE VEINS AFTER ENDOVASCULAR LASER VEIN COAGULATION

The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC. Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed. Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria. Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.

Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool

Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool

Prevention of recurrent bleeding from varicose veins of the esophagus and stomach among patients with decompensated liver cirrhosis

Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis. Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups. Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only. Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.

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.

Risk Factors of Severe Post-Thrombotic Syndrome in Young Patients from the North-West of Russia

Introduction - Sever post-thrombotic syndrome (PTS) (CEAP4-6) is a complication of deep venous thrombosis leading to decreased quality of life. Вut what kind of predictors associated with the development of severe PTS is not fully identified. Methods - We retrospectively studied 120 young patients after acute DVT up to 45 years old (men − 57, women − 63, middle age − 37.4). For grading PTS, we used the clinical scale of chronic venous insufficiency (CEAP0-6). Sixty seven (55.8%) patients were genotyped for nine polymorphisms: factor I (FI) –455 G/A, FI Thr312Ala, FII 20210 G/A, FV 1691 G/A, FXII 46 C/T, FXIII Val34Leu, PAI-1 –675 4G/5G, TPA 311 bp I/D, EPCR Ser219Gly, that were discriminated by PCR-RFLP method. All results were analyzed with the SPSS software version 17.0 (SPSS Inc, Chicago, IL, USA). The differences in genotype distributions were estimated by Fisher’s exact test with calculating odds ratios (OR), their 95% confidence intervals (CI) and p-value. The discriminant analysis was used to define the predictors of severe PTS. Results - Severe PTS (CEAP4-6) was registered in 15 out of 67 genotyped patients (22.4%). The risk of severe PTS was increased dramatically in patients with established genetic risk factors, in particular, G20210A mutation (OR=4.3; 95%СI: 1.3-14.1; p=0.01), FV Leiden variant (OR=2.6; 95%СI: 0.9-7.1; p=0.05) and the homozygous FXIII 34Leu/Leu genotype (OR=6.9; 95%СI: 0.7-67.5; p=0.057). However, the discriminant analysis with inclusion of additional criteria (clinical and acquired) had shown that ipsilateral recurrence of DVT (p=0.05), obesity (p=0.002), varicose veins (p=0.07) and short courses of anticoagulant therapy (less than 3 months) (p=0.030) were associated with the risk of the sever PTS. None of studied DNA variations played a significant role in the outcome of DVT: FV 1691GA (p=0.160), FII 20210GA (p=0.501), FXIII 34Leu/Leu (p=0.141). Conclusion - Short courses of anticoagulant therapy is one of the most important risk factors of severe PTS in young patients.

Application of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity

PurposeThe aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy (FS). MethodsA total of 64 patients (35 females, 29 males; mean age, 57 ± 11 years [range, 29–79 years]) with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019. The maximum diameter of the vein branches was >20 mm, which appeared to be cystic dilatation and forms large-scale in the crus or the thigh. All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia. The surgical time, pain/phlebitis, number of incisions, amount of bleeding, recurrence of varicose vein, incidence of surgical site infections (SSIs), satisfaction score, and improvement in clinical symptoms were evaluated respectively with the patients in two groups: Group A, with patients who underwent treatment with the Trivex system, and Group B, patients who underwent treatment by point-form-stripping combined with FS. ResultsAll procedures were performed successfully. The average operative time in Group A was 56 ± 11 min, whereas that of Group B was 90 ± 33 min, which was a significant difference (p < 0.05). Group A patients felt little pain after surgery, whereas in Group B the level of pain peaked on postoperative day 30, mostly due to thrombophlebitis after FS. There was no recurrence of varicose vein was observed in any patient, however, there were some residual effects in Group B, including the amount of bleeding volume, in-hospital stays, pain/phlebitis, and number of incisions (P < 0.05). There were no significant differences with respect to SSIs, improvement in clinical symptoms, and satisfaction scores observed (p>0.05). ConclusionsThis study shows that patients benefited from both treatment options. However, primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy (FS). In summary, the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy (FS) for those who demand a high level of appearance, and especially for young patients, the Trivex system is recommended.