Saphenous Trunk Research Articles

First registry of patients treated with foam sclerotherapy using a new automated microfoam preparation device (2021-2022).

Objectives: To present results for the use of an automated microfoam preparation system (AMPS) in the treatment of varicose veins in a real-world setting.Method: We performed a descriptive study based on a prospective database of patients treated with foam sclerotherapy between February 2021 and December 2022. Polidocanol foam was prepared using a capsule containing sterile air or a low-nitrogen mix. We recorded volume per session, percentage of sclerosing drug, number of sessions, release of thrombus entrapment, complications, and adverse events. A univariate descriptive analysis was performed using Stata V.16.Results: Over a 23-month period, 185 patients (84.9% women, 15.1% men) underwent 685 sessions. Median age was 51.6 years (range, 16-79 years). Thread veins were the condition treated in 68.9% of sessions, tributaries in 7.2%, and truncal veins in 22.6%. The average volume per session was as follows: thread veins, 8mL; great saphenous vein (GSV), 6.9mL; and small saphenous vein (SSV), 4.3mL. The average drug concentration was as follows: thread veins, 0.18%; GSV, 1.49%; and SSV, 1.63%. The average number of sessions was 3.4 for thread veins, 2 for tributaries, 2.7 for the GSV, and 2.9 for the SSV. The occlusion rate at 15 months was 93.2% (41/43) for the great saphenous vein and 86% (13/15) for the small saphenous vein. We recorded a total of 21 complications (3.1% of sessions), 14 of which were minor complications (2% sessions), and 7 moderate adverse events (1% of sessions).Conclusions: This new device is highly versatile and can be used for preparing foam at all concentrations. It contributes to a high rate of occlusion in saphenous trunks, with a minimal number of sessions required for thread veins indicating that the system is a favorable option in the treatment of venous diseases. Additionally, the low frequency of residual pigmentation may be attributed to the system's ability to tailor the foam concentration to the individual case, thus supporting optimal outcomes.

Comparison of staged versus one shot varicose veins treatment: Depending on tributaries diameter.

One of the most debatable phlebology community's issue is the choice of the optimal tactics for endovenous varicose tributaries correction after truncal ablation. Which tactic will be most effective? There is practically no data concerning treatment tactics' choice for varicose tributary depending on its diameter. Therefore, the comparison of staged versus one-stage treatment of varicose veins is relevant problem in modern phlebology. Research on this topic will make possible determination of advantages and potential disadvantages of the proposed tactics. The study included a prospective analysis of the combined treatment of 295 patients with primary varicose veins who underwent outpatient treatment. Simultaneous EVLA of saphenous trunks and ligation (gentle phlebectomy) of visible large-diameter tributaries (6mm or more) with staged sclerotherapy after a month, has significant potential benefits. The use of staged varicose veins treatment minimizes the traumatic intervention and discomfort for the patient, while achieving satisfactory treatment results without affecting the quality of life.

Development and External Validation of a Prediction Model for Patients with Varicose Veins Suitable for Isolated Ambulatory Phlebectomy

Isolated ambulatory phlebectomy is a potential treatment option for patients with an incompetent great saphenous vein (GSV) or anterior accessory saphenous vein and one or more incompetent tributaries. Being able to determine which patients will most likely benefit from isolated phlebectomy is important. This study aimed to identify predictors for avoidance of secondary axial ablation after isolated phlebectomy and to develop and externally validate a multivariable model for predicting this outcome. For model development, data from patients included in the SAPTAP trial were used. The investigated outcome was avoidance of ablation of the saphenous trunk one year after isolated ambulatory phlebectomy. Pre-defined candidate predictors were analysed with multivariable logistic regression. Predictors were selected using Akaike information criterion backward selection. Discriminative ability was assessed by the concordance index. Bootstrapping was used to correct regression coefficients, and the C index for overfitting. The model was externally validated using a population of 94 patients, with an incompetent GSV and one or more incompetent tributaries, who underwent isolated phlebectomy. For model development, 225 patients were used, of whom 167 (74.2%) did not undergo additional ablation of the saphenous trunk one year after isolated phlebectomy. The final model consisted of three predictors for avoidance of axial ablation: tributary length (< 15 cm vs. > 30 cm: odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02 - 0.40; 15 - 30 cm vs. > 30 cm: OR 0.18, 95% CI 0.09 - 0.38); saphenofemoral junction (SFJ) reflux (absent vs. present: OR 2.53, 95% CI 0.81 - 7.87); and diameter of the saphenous trunk (per millimetre change: OR 0.63, 95% CI 0.41 - 0.96). The discriminative ability of the model was moderate (0.72 at internal validation; 0.73 at external validation). A model was developed for predicting avoidance of secondary ablation of the saphenous trunk one year after isolated ambulatory phlebectomy, which can be helpful in daily practice to determine the suitable treatment strategy in patients with an incompetent saphenous trunk and one or more incompetent tributaries. Patients having a longer tributary, smaller diameter saphenous trunk, and absence of terminal valve reflux in the SFJ are more likely to benefit from isolated phlebectomy.

ASVAL with Phlebectomy/Sclerofoam Technique: Preliminary Results.

The ambulatory selective varicose vein ablation under local anesthesia (ASVAL) method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests phlebectomy of superficial varicose reservoir as a primary treatment. To increase patient comfort, foam safety and cosmetic results, we used ASVAL with a mixed phlebectomy/foam technique on local anesthesia. Thirty consecutive patients treated with ASVAL phlebectomy-sclerofoam technique were reviewed retrospectively between December 2022 and April 2023. All patients were evaluated by clinical examination and duplex ultrasound (DUS); the main selection criteria were a minimal GSV insufficiency (main GSV < or = to 1 cm). Muller phlebectomy of tributaries at entry point in the saphenous trunk was performed; after 1 week, patients were checked for foam sclerotherapy of residual trunk. Under visual control, 0.5% polidocanol foam (from 5 to 10 cc. "Tessari Technique") was injected in visible veins and elastic compression with pad was applied for 1 week. Compression with Class I elastic stockings was prescribed, and patients were reviewed after 1 month. Postoperative complications included thigh hematoma in two patients, three thrombosis of injected trunk, and hyperpigmentation in three patients. No GSV thrombosis at DUS was recorded. In 27 patients, a satisfying cosmetic result was achieved, and in 3 patients a new foam session was needed. Phlebectomy/foam ASVAL technique is a safe, low-traumatic technique with no need of US guidance, with less risk of foam migrating in GSV, simple and inexpensive, for patients with less advanced GSV insufficiency.

Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6).

endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6months, and annually up to 4years, to assess treatment efficacy and adverse reactions. 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30days, 1 and 4years were 99.1%, 98.3% and 97.9%, respectively. EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.

High Intensity Focused Ultrasound for saphenous vein sparing

High Intensity Focused Ultrasound (HIFU) allows delivery of energy through the skin in a minimally invasive way, thus repeated treatments can be performed without too much Inconvenience for the patient. We present in this paper different options for saving refluxing Saphenous trunks using HIFU. 1 / ULTRASOUND VALVULOPLASTY. Was the first application proposed for venous insufficiency treatment. The aim was to mimic cuffing of the dilated annulus at the level of a valve insertion without any incision or puncture. 2 / ULTRASONIC CHIVA consists in closing short segments of a saphenous trunk or of a tributary by using a heating probe transcutaneously. 3 / Ultrasonic ASVAL is performed using CAVITATION. Microbubbles are generated in the blood.They implode and release mechanical energy able to ablate the endothelium of the vessel for a sclero-like effect. Cavitation does not induce a temperature rise, so the skin will not be damaged. 4 / GLOBAL SHRINKAGE of the dilated vein can be achieved. This reduces the refluxing volume,while preserving a draining saphenous trunk.

Relationship between great saphenous vein recanalization, venous symptoms reappearance, and varicose veins recurrence rates after endovenous radiofrequency ablation.

The term "recurrence" in chronic venous disease remains not yet well defined, despite numerous reports describing patterns and causes of the presence of recurrent varicose veins (RVVs). Moreover, saphenous trunk recanalization (STR) has also been documented as one of the major source of RVVs and it is widely used to indicate the "failure" of endovenous ablation. Finally, reappearance of venous symptoms (VSym) should be considered to reach a complete "recurrence" evaluation. RVVs, STR, and VSym rates and mutual co-presence after endovenous treatments are still unclear. The aim of this report is to describe and analyze these three recurrence components after 6 years in patients underwent radiofrequency ablation of the great saphenous vein.

Cyanoacrylate Adhesive Closure in the Real-World Practice: 2-Year Results of Varicose Vein Treatment

Introduction. Over the past decade, thermal tumescent (TT) ablation became the “gold standard” treatment of varicose veins. Non-thermal non-tumescent (NTNT) methods emerged in response to minimize the interventional invasion.Aim. To evaluate the two-year results of cyanoacrylate adhesive closure (CAC).Methods. Between July 2019 and July 2021, CAC was performed in 457 patients (average age 57.8 ± 15.7 years), on 634 limbs and 725 saphenous veins. Patient distribution according to CEAP was: C2 – 38%; C3 – 37%; C4 – 19%; C5 – 4%; C6 – 2%. The inclusion criteria were: incompetence of sapheno-femoral/popliteal junction and axial reflux &gt; 0.5 sec, diameter of saphenous trunk &gt; 6 mm, presence of varicosities. CAC was performed according to the protocol of the American Vein Closure System In more than 2/3 of cases (76.2%), CAC was performed selectively without tributary treatment . The pain was assessed by visual-analogue scale (VAS). The control ultrasound was performed on the 3rd day, 1, 3, 6, and 12 months post-intervention.Results. Anatomical success was achieved in 100%. The VAS pain score was &lt; 3 in 93% of patients. Partial recanalization occurred in 4 (0.6%) patients. Distal deep vein thrombosis was detected in 2 (0.3%) patients, migration of glue – in 7 (1%) patients, phlebitislike skin reaction – in 50 (11%), superficial thrombophlebitis – in 20 (4.4%) and soft tissue granuloma at the access site was diagnosed in 6 (1.3%) patients.Conclusion. CАC is a highly effective and safe treatment method with 99.4% occlusion rate in s. two-year follow-up period.

Is catheter-based foam sclerotherapy more effective than direct foam sclerotherapy when combined with high ligation for the treatment of primary great saphenous vein incompetence?

To retrospectively analyze the short-term outcomes of catheter-based versus direct foam sclerotherapy when combined with high ligation (HL) for the treatment of great saphenous vein (GSV) incompetence. From July 2018 to October 2019, a total of 82 lower limbs of 70 patients with GSV incompetence received HL combined with catheter-based foam sclerotherapy (CFS group) or direct foam sclerotherapy (DFS group) for GSV proximal trunk. Among them, 40 limbs of 36 patients were treated with CFS, and 42 limbs of 34 patients were treated with DFS. The occlusion of GSV proximal trunk was evaluated with venous duplex ultrasound examinations; Venous Clinical Severity Scores (VCSS) was used to assess clinical improvement; Aberdeen Varicose Veins Questionnaire (AVVQ) was used to assess quality-of-life scores; and Complications was used for the safety evaluation. At day 7 post-operatively, complete occlusion of proximal trunk of the GSV was achieved in 92.5% legs of the CFS group and 71.4% of the DFS group (p = 0.014). Additionally, anterograde flow was found in 7.5% legs of the CFS group and 26.2% of the DFS group (p = 0.025). No significant differences in the occurrence of complications were observed between the two groups. The median follow-up was 285.5days in the DFS group and 318days in the CFS group (p = 0.140). VCSS and AVVQ reduction were significant in both CFS group and DFS group (5.3 ± 2.5, 5.5 ± 2.4, p < 0.001 for VCSS; 15.9 ± 8.0, 16.3 ± 8.6, p < 0.001 for AVVQ), but no significant difference were observed between two groups (p = 0.655 for VCSS, p = 0.934 for AVVQ). Although the occlusion of great saphenous vein proximal trunk were different, two modalities result in similar clinical and quality-of-life improvements. DFS is a feasible alternative to CFS when combined with HL.

A nutraceutical formulation combined with sclerofoam-assisted laser treatment ameliorates chronic venous insufficiency

Chronic venous insufficiency has a high impact on the healthcare system due to its high incidence worldwide. We performed a study in 30 women with thigh and leg varices due to major saphenous vein valve incontinence with saphenous trunk reflux causing phlebo-lymphoedema to assess the efficacy of sclerofoam-assisted laser treatment combined with nutraceutical administration. The patients underwent endovascular combination sealing of the saphenous trunk with sclerofoam-assisted laser treatment technique into the major saphenous veins under low-volume tumescent anesthesia followed by intraoperative phlebectomies. Post-operatively, the patients received capsules containing Aesculus Hippocastanum, chondroitin sulphate, proanthocyanidins from Pinus pinaster Aiton, proanthocyanidins from Vitis vinifera L., hydrolysed marine collagen and carcinine dihydrochloride for 3 weeks. We evaluated the extracellular fluid volume of the lower limbs using bioimpedance spectroscopy pre- (T0) and post-surgery (T2) (impedance is a vector which is composed of two components, resistance [RES] and reactance [REA)]). In addition, we evaluated the following parameters pre- and post-surgery: pain, heaviness, paresthesia, itching, swelling, daily urine volume output and leg volume. Limb volume was significantly decreased at T2 compared to T0 (p < 0.01). RES and REA were significantly increased at T2 compared to T0 (p < 0.0001 and p < 0.01, respectively). A significant improvement in heaviness, paresthesia, pain, swelling and itch was also observed (all p < 0.0001) while no changes in terms of diuresis occurred. No adverse effects were observed. The present study shows a promising approach to the treatment of chronic venous insufficiency that warrants further clinical studies in larger cohorts of patients.

Urgent surgery versus anticoagulation for treatment of superficial vein thrombosis in patients with varicose veins.

Background: We performed a prospective observational study to compare the results of surgery and anticoagulation in patients with superficial vein thrombosis (SVT). Patients and methods: A total of 190 patients (195 limbs) with varicose veins and SVT were included and treated by anticoagulation or by surgery. Patients were followed-up during 6 months. The primary outcome for treatment efficacy was the composite rate of SVT extension/recurrence; deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE). The primary outcome for safety was the rate of wound complications and rate of bleedings. Results: Surgery was performed in 85 (44.7%) patients and 105 patients (5 with bilateral SVT) were treated conservatively. In the whole study cohort the primary outcome for treatment efficacy was registered in 15 (7.6%) cases: 9/85 (10.5%) in surgical group and 6/110 (5.4%) in anticoagulation group. Nine patients treated with surgery were diagnosed with postoperative DVT. In anticoagulation group SVT extension occurred in 3 limbs; SVT recurrence in 2 and DVT in one. There were no cases of PE or death during the follow-up. Time-to-event analysis demonstrated no significant difference between groups (HR 0.48; 95% CI 0.17-1.34). The total length of the thrombus was associated with primary efficacy outcome in surgical group (HR 1.07; 95% CI 1.02-1.11); and duration of anticoagulation (HR 0.91 per day; 95% CI 0.83-0.99) and value of Caprini score (HR 1.86; 95% CI 1.1-3.14) in anticoagulation group. Six (7%) wound complications were registered after surgery and 6 (5.71%) bleedings during anticoagulation. Conclusions: Urgent surgery is not associated with reduction of venous thromboembolism compared to anticoagulation in treatment of patients with SVT and varicose veins during 6-months follow-up. However, in patients with isolated thrombosis of varicose tributaries or with limited involvement of the saphenous trunk surgery is relatively safe.

Assessment of the CHIVA and the ASVAL Method.

In this article, the CHIVA and ASVAL methods are assessed from the hemodynamic point of view. The CHIVA method comprises complicated, unusual terminology and new perceptions, such as closed and open shunts, fractionation of the hydrostatic pressure, subdivision of the venous network. The principal part of the CHIVA theory is the drainage of venous blood from the thigh saphenous system into the deep lower leg veins through the preserved saphenous trunk after high ligation at the saphenofemoral junction, which is considered as a beneficial, physiological phenomenon. In reality, this is recurrent reflux producing ambulatory venous hypertension. The main impact of the CHIVA procedure is the elimination of the saphenous reflux by high ligation at the saphenofemoral junction; thus it can be presumed that the CHIVA procedure yields similar results like the crossectomy. The ASVAL procedure is de facto the modification of the old Madelung method that was the prevalent surgical procedure before the Trendelenburg era in the 19th century. The results after ASVAL were not checked by plethysmography; there is a good case to suppose that the results after the ASVAL method would comply with those after sclerotherapy.

Treatment of Recurrent Symptomatic Saphenous Trunk Reflux with Catheter Directed Foam Sclerotherapy and Tumescent Anaesthesia

ObjectiveThe aim was to assess short and midterm efficacy and safety of catheter directed foam sclerotherapy (CDFS) with tumescent anaesthesia in patients with recurrent symptomatic saphenous reflux.MethodsThis was a prospective observational study (February 2018 to February 2019) including 21 consecutive patients referred with recurrent symptomatic varicose veins. Standing duplex ultrasound (DUS) with saphenous vein diameter measurement 3 cm from the terminal valve was performed pre-operatively. All the patients were operated on under local anaesthesia. By ultrasound guided puncture a hydrophilic 0.035″ guidewire and 5F Berenstein catheter were inserted through a 5F introducer sheath. Peri-saphenous tumescent anaesthesia (PSTA) was performed under ultrasound guidance. Sclerosant foam was prepared with sodium tetradecyl sulphate 3% or polidocanol 3% using the Tessari method. Concomitant phlebectomies were performed in 52%. Clinical evaluation and DUS were performed pre- and post-operatively at one week, six months, and 12 months.ResultsThere were 11 men and 10 women (median age 52 years; interquartile range [IQR] 43 – 61). The great saphenous vein was treated in 18 patients. The median vein diameter was 6.8 mm (IQR 4.7 – 8.9). Previous procedures were Cure conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire (CHIVA), mechanochemical ablation, thermal ablation, and cyanoacrylate closure. The distribution of the clinical class (Clinical Etiology Anatomy Pathophysiology [CEAP] classification) was 16 C2, three C3, and two C4 limbs. Immediate technical success was 100%. There were no complications in the early post-operative period. The median follow up was eight months (IQR 5 – 10). The occlusion rate demonstrated by DUS was 100% (21/21) at one week, 100% (21/21) at six months, and 86% (18/21) at 12 months. The median post-procedural vein diameter at one week, six months, and 12 months was 4.8 mm (IQR 3.9 – 6), 4.3 mm (IQR 3.5 – 5.5), and 4 mm (IQR 3 – 4.9), respectively.ConclusionCombination CDFS with PSTA achieves good short and medium term venous occlusion rates, associated with few complications in patients with recurrent symptomatic saphenous reflux.

Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation.

Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period. Articles were obtained through a detailed search of the scientific journal databases (PubMed, Scopus, Web of Science) for those published between January 1, 2011 to December 31, 2020. The term "radiofrequency venous ablation" was combined with "risk factors", "recanalization" and "recurrence", to obtain the first article cluster. Risk factors analysis for saphenous vein recanalization after ablation is not a well-studied problem. Although several studies have analyzed recanalization patterns and anatomical causes of ablation failure, few and disaggregate data are available regarding clinical preoperative risk factors. BMI and saphenous trunk diameter seem to be the only two recognized characteristics that may affect short and long-term recanalization rate, though CVI status, sex, target vein treatment length and others factors may be taken into account. Physicians should consider risk factors for recanalization in patient selection and treatment recommendations, but also recognize that not all "ablation failures" are of clinical relevance.

Adjunctive techniques to minimize thrombotic complications following microfoam sclerotherapy of saphenous trunks and tributaries

ObjectiveThrombus extension into the deep venous system following superficial vein chemical ablation with Varithena polidocanol microfoam has been reported. The objective of this study was to assess the effect of intraoperative improved techniques during treatment for patients with symptomatic varicose veins and their impact on extension of thrombus into deep veins. MethodsA retrospective review of a prospectively maintained database was performed. All patients who underwent endovenous chemical ablation with polidocanol microfoam (Varithena, Boston Scientific, Marlborough, Mass) for symptomatic superficial axial and tributary vein reflux were identified. Patients had postoperative duplex (48-72 hours) scanning after the procedure; those who did not adhere to the recommended follow-up were excluded. Demographic data, CEAP Classification, Venous Clinical Severity Score, procedure details, and follow-up data were abstracted. ResultsBetween April 2018 and August 2020, 157 limbs in 122 patients were treated with Varithena microfoam; 129 limbs in 99 patients met our inclusion criteria. Veins treated included the great saphenous vein (n = 89), anterior accessory saphenous vein (n = 15), small saphenous vein (n = 14), and tributary veins (n = 56). Adjunctive techniques during treatment included intraoperative elevation of the limb to greater than 45°, ultrasound mapping and digital occlusion of large perforator veins, limitation of foam volume per session, injection of sterile saline before treatment, and compression of the limb in the elevated position. The preoperative Venous Clinical Severity Score was 11.4 and decreased after treatment to 9.7. The immediate closure rate was 95% with 81% overall symptomatic relief at last follow-up. The mean follow-up was 113.5 days for the entire cohort; two limbs (1.5%) required postoperative anticoagulation for thrombus extension into the deep venous system (common femoral vein n = 1; popliteal vein n = 1) postoperatively for a mean of 22 days. Both resolved with anticoagulation. One asymptomatic limb developed a femoral vein deep venous thrombosis and one symptomatic late deep venous thrombosis was noted 4 months after the procedure. Postoperative pain and phlebitis were reported in 15.6% and 14.8% of patients, respectively, and all had resolved at last follow-up. No pulmonary emboli were noted and no neurologic or visual adverse events were recorded. ConclusionsAdjunctive techniques during microfoam ablation decreased thrombotic complications in our series compared with those reported in earlier phase III clinical trials. Excellent early closure and symptomatic improvement were also noted. Endovenous microfoam ablation with Varithena is a safe and effective nontumescent, nonthermal alternative to laser and radiofrequency ablation.

Mid Term Results, Complications and Their Treatment After Cyanoacrylate Embolisation of Saphenous Veins

Background. The results of cyanoacrylate embolisation (CAE) of the great (GSV) and small (SSV) saphenous trunks in patients with varicose veins (VVs) of the lower limbs were evaluated. Methods. This is an ongoing prospective observational study that started in 2017 at the Hospital Neftyanik, including patients with VVs who underwent CAE of the GSV and/or SSV by VenaSeal technology. Patients are followed with clinical and ultrasound evaluation at one week, three, six, and 12 months after surgery, and then every year. Efficiency criteria are the technical success of the vein occlusion; absence of recanalisation; GSV stump length; vein involution; absence of truncal reflux; absence of reflux at the junction; no need to remove tributaries; no need for re-intervention on the trunk; clinical class by CEAP; and disease severity by VCSS. Safety criteria are the absence of adverse effects (AEs). Results. Between 2017–2019 CAE was performed on 122 limbs of 92 patients: 46 women and 46 men aged from 28 to 69 years (mean age, 45.3 ± 10.3 years) with the CEAP clinical of C2 (47.6%), C3 (35.2%), C4 (16.4%), and C5 (0.8%). The GSV trunk (diameter 4.5–18.0 mm; mean 9.0 ± 2.5) was treated in 82% and the SSV (3.7–13.0 mm; mean, 7.0 ± 2.3) in 18%. Technical success was achieved in all cases. The lengths of the GSV stump varied from 0 to 48 mm (mean, 19.0 ± 9.7). Sclerotherapy for varicose tributaries during the first three months was performed in 55 legs (45.1%). Patients were followed for three months (range one week–18 months). Additional sclerotherapy for varicose tributaries was required for 35 limbs (28.7%). Truncal recanalisation > 5 cm was found in eight limbs (6.6%) 3–12 months after intervention and required second CAE (n = 1), laser ablation (n = 1) or sclerotherapy (n = 4). Other AEs that did not require re-intervention were GSV trunk phlebitis (n = 8; 6.6%) or tributaries (n = 5; 4.1%), allergic reaction (n = 4; 3.3%), cord sensation (n = 5; 4.1%), glue propagation to the junction (n = 2; 1.6%), glue propagation out of the junction (n = 2; 1.6%), altered sensation (n = 4; 3.3%), and puncture site haematoma (n = 1; 0.8%). Conclusion. CAE is an effective method for saphenous vein ablation that is associated with an acceptable incidence of non-severe AEs with a low rate of re-interventions.

Use of a Novel Device in Reconstructive Venous Surgery: Preliminary Results.

Evaluation of the outcomes of OSES (oval-shaped external support), a novel device for external valvuloplasty of the great saphenous vein (GSV) for the conservative treatment of superficial venous insufficiency. Between 2012 and 2015, 30 patients underwent external valvuloplasty of the GSV for a total of 32 limbs. Patients were subjected to clinical and instrumental follow-up by a half-year ultrasound for a minimum of 36 months. The main endpoints were the recurrence of varicose disease, persistent or recurrent venous reflux, and venous thrombosis. Varicose recurrence was verified in six limbs on 32 (18.75%). Four limbs (12.5%) presented a recurrence of the reflux even in the absence of varicose veins. Two limbs (6.25%) underwent saphenectomy after the valvuloplasty intervention at 12 and 18 months, respectively, because of the presence of saphenofemoral reflux and varicose recurrences. No case of venous thrombosis of the saphenous trunk was observed. The external valvuloplasty of the GSV is a well-known technique that used to treat the superficial venous insufficiency. The newly introduced OSES device seems to show better midterm results, due to a better alignment of the valve flaps. In our experience, the use of this device gives better long-term results and allowed to extend the indication to patients with saphenic diameters that were considered not eligible for repair. In conclusion, although our data needs further confirmation, OSES device might represents a new interesting opportunity for reconstructive venous surgery.

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 Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency

Objectives Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. Materials and methods This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. Results The clinical part of the CEAP classification was: C0 = 3, C1 = 4, C2 = 5, C3 = 1, C4a = 1, C4b = 6, C5 = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p Conclusions Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.

Conservative treatment of anastomosing incompetent thigh perforators by selective ablation of the distal incompetent greater saphenous trunk: Feasibility and short-term Results

Isolated crural perforators are a frequent source of recurrence after varicose surgery. When the incompetent crural perforator (ICP) is connected to a greater saphenous vein (GSV), only the distal portion of the GSV located below perforator is incompetent whereas the proximal portion of the GSV is competent. Under these conditions, the selective ablation of the distal portion of the GSV makes it possible to preserve the perforator and to ensure its ascending drainage in the competent proximal trunk.