Stab Avulsion Research Articles

Case Report: Successful results of direct varicose vein ablation with EVLA in chronic venous insufficiency patient in Indonesia

Background: Varicose veins are considered a chronic venous disease. Delaying treatment might cause several late complications that contribute to a high burden on healthcare systems. It may be treated with endovenous laser ablation (EVLA) and stab avulsion as additional procedures. Varicose direct ablation has been promoted to replace stab avulsion in certain conditions. Here we report the case of a 71-year-old female who presented with chronic venous insufficiency managed by an endovascular therapeutic approach using direct varix ablation for the first time in National Cardiovascular Center – Harapan Kita, Jakarta, Indonesia. Case report: A 71-year-old female came to the outpatient clinic with a large bulging vein in her leg. Duplex ultrasound showed that the great saphenous vein (GSV) was incompetent with a varicose vein in the medial part of proximal GSV below the knee. The patient underwent EVLA with direct varicose ablation using Utoh’s technique. Duplex sonography evaluation showed the right GSV was utterly obliterated, including the varicose vein. The patient was discharged two days after the procedure without significant complaints nor pain medication. Conclusions: Direct varicose ablation was proposed as a better alternative than stab avulsion. The varicose vein can be managed with EVLA without a scalpel, incision, avulsion, or phlebectomy. In this case presentation, the endovascular therapeutical approach with Utoh’s ablation technique showed promising results, and no complication was found in the patient.

Endovenous Laser Ablation of Tributary Varicose Veins:From Stab Avulsion to Varicose Ablation

血管内レーザー焼灼術の新しい治療プロトコールを作成し，手術を施行した伏在型静脈瘤963例について報告する．波長1470 nmのBiolitec社製レーザー装置に，直径1.27 mmの細径ファイバーを接続し，伏在静脈および側枝静脈瘤を焼灼した．小伏在静脈あるいは膝上の大伏在静脈（GSV）は出力7 W（LEED 50–70 J/cm）で焼灼し，膝下GSVにも逆流を認める場合には同部を5 W（LEED 20–25 J/cm）で焼灼した．さらに側枝静脈瘤を5 W（LEED 30 J/cm）で焼灼した．GSV焼灼後の神経障害は認められず，瘤焼灼に伴う皮膚熱傷や神経障害も認めなかった．皮下出血やリンパ管損傷などの瘤切除に起因すると思われる有害事象の発生はなく，整容性にも優れた根治的治療が可能であった．静脈瘤の穿刺焼灼法はスタブアバルジョン法の弱点を補完する有益な代替手段になることが期待される．

Conversion of open varicose veins surgery unit into a modern one-stop shop endo-venous unit: strategies and cost-effectiveness

Purpose to provide a road map for converting varicose veins service to endovenous ablation and assess its process and outcome on patients with varicose veins. Patients and methods Retrospective assessment of prospectively recorded data for converting vein unit which exclusively did open varicose veins surgery (OS) (39 patients from September 2019 to February 2020) to endovenous radiofrequency ablation (ERFA) service (44 patients from March 2020 to January 2021). Results There was no statistical difference in theatre time between both interventions despite dealing with more complex cases in the ERFA group with more truncal veins (χ2 =11.950*, P<0.001*) and a higher number of stab avulsions (V number) (χ2 =217.889, P<0.001*). On the other hand, the overall cost was significantly lower in open group compared to ERFA (Mean±SD 1261±386 US$ and 1519.2±392 US$ respectively, P<0.001*. This statistical difference was reduced to P=0.041 when subgroup analysis only included cases with higher number of avulsions. In multivariate analysis, cost was associated with surgical duration and using ERFA however, less complications were recorded in ERFA group (χ2=4.419* P=0.036*) and recovery time was significantly longer in open group (8.90±2.44) than in ERFA group (6.0±1.06), P<0.001* Conclusion Converting varicose veins service to a modern ERFA is safe and effective when properly planned. ERFA is associated with shorter recovery and less theatre time and complications despite higher cost which becomes more cost-effective in cases with more truncal veins and avulsion sites.

Evaluation of stab avulsion versus subfascial endoscopic perforator surgery in the management of chronic venous insufficiency resulting from incompetent leg perforators in primary varicose veins

Chronic venous insufficiency (CVI) resulting from incompetent perforators due to varicose veins is a common surgical condition present in at least 10% of the general population. This study was planned to evaluate stab avulsion vs subfascial endoscopic perforator surgery in the management of incompetent perforators resulting in CVI. Forty patients of CVI resulting from primary varicose veins, falling into class 4 to 6 as per the clinical part of CEAP classification, along with Duplex assessment with proven incompetent perforators of lower extremity, irrespective of the status of saphenousfemoral or saphenous-popliteal junction status, were included in the study. All the patients were randomized into two groups, A and B, by a computer-generated draw. Group A patients underwent stab avulsion, and group B patients underwent SEPS for incompetent perforators. The following parameters were evaluated: (i) pain score using a visual analog scale at 1 hour, 12 hours and 24 hours after surgery, (ii) ulcer healing 1 month and 3 months after surgery, (iii) reversal of skin changes after 1 month and 3 months of surgery during follow-up, and (iv) wound-related complications. Early relief of symptoms in terms of ulcer healing, reversal of skin changes, and decreased incidence of wound complications was found to be better in the subfascial endoscopic perforators surgery (SEPS) group.

Great saphenous vein aneurysm mimicking inguinal hernia: a case report

BackgroundDiagnosis of venous aneurysm may be difficult and can be misjudged as mass-like lesions, including hernias. Here we present the case of a patient with a great saphenous vein aneurysm misdiagnosed and operated as an inguinal hernia.Case presentationA 39-year-old Middle Eastern/Persian male presented with left inguinal bulging 15 years ago, which was misdiagnosed and operated on with a diagnosis of inguinal hernia. He was referred to our clinic, in which color Doppler sonography revealed left-sided saphenofemoral junction incompetence with severe flow reversal during the Valsalva maneuver, in favor of a great saphenous vein aneurysm. Ligation of left saphenofemoral junction and stripping of saphenous vein, and stab avulsion phlebotomy of left lower extremity varicose veins, were done. He was discharged the next day after the operation with an uneventful postoperative course or complication on follow-up.ConclusionVenous aneurysms can be misdiagnosed as other, more common, mass-like lesions, such as inguinal hernias. Therefore, our report emphasizes the consideration of thorough assessment and utilization of color duplex sonography to prevent further misdiagnosis and unnecessary intervention and operations.

Options in the treatment of superficial and deep venous disease in patients with Klippel-Trenaunay syndrome

ObjectiveKlippel-Trenaunay syndrome (KTS) is a congenital mixed mesenchymal malformation syndrome that includes varicose veins, capillary and venous malformations, lymphatic abnormalities, and hypertrophy of various connective tissue elements. The purpose of the present study was to describe the clinical characteristics and outcomes in a subset of patients with KTS in whom venous interventions, including iliofemoral venous stenting, were performed after failure of conservative therapy. MethodsA single-center retrospective data review of 34 patients with KTS who had undergone interventions for venous disease between January 2000 and December 2020 was performed. ResultsTheir mean age was 38.4 ± 17.5 years (range, 12-80 years). No gender predilection was found. Of the 34 patients, 61% had had all three features of the classic triad for KTS. Varicose veins were present in all 34 patients (100%), and 30% had had a history of bleeding varicosities. Most patients (79%) had CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) class ≥C4. Of the 34 patients, 30% had a history of deep vein thrombosis and/or pulmonary embolism. Factor VIII elevation was the most common thrombophilia condition (12%). The venous filling index was elevated at baseline (5.9 ± 5.1 mL/s) and did not normalize despite intervention (3.5 ± 2.3 mL/s; P = .04). The superficial venous interventions (n = 35) included endovenous laser therapy; stripping of the great saphenous vein, small saphenous vein, anterior thigh vein, or marginal vein; ultrasound-guided sclerotherapy; and stab avulsion of varicose veins. One coil embolization of a perforator vein was performed. Deep interventions (n = 19) included endovenous stenting (n = 15), popliteal vein release (n = 3), and valvuloplasty (n = 1). The venous clinical severity score had improved from 9.4 ± 4.5 to 6.2 ± 5.6 (P = .04). The visual analog scale for pain score had improved from 5.5 ± 2.7 to 2.5 ± 3.3 (P = .008). Healing of ulceration was noted in 75% of the patients. Significant improvements in the total pain (P = .04) and total psychological (P = .03) domains were noted in the 20-item chronic venous disease quality of life questionnaire. ConclusionsSuperficial and deep venous interventions are safe and effective in patients with KTS when conservative therapy has failed. Iliofemoral venous stenting is a newer option that should be considered in the treatment of chronic deep venous obstructive disease in patients with KTS in the appropriate clinical context. An aggressive perioperative deep vein thrombosis prophylaxis protocol should be in place to reduce thromboembolic complications in these patients.

Feasibility of incompetent perforator vein excision using stab avulsion.

ObjectivesWhether incompetent perforator veins (IPVs) require treatment remains controversial. We retrospectively evaluated the feasibility of IPV excision performed using the stab avulsion technique without ligation and sutures in patients undergoing endovenous ablation (EA).MethodsThis was a single-center, retrospective, observational cohort study. EA was performed in 1503 consecutive patients, including 33 patients with ulcers, between December 2014 and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases were included.ResultsStab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All 33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range: 13–365 days).ConclusionsIPV excision via stab avulsion may be a viable option for treating varicose veins and ulcers. This technique offers multiple advantages, including simplicity, safety, and reduced healthcare costs.

A Strategy to Enable Rapid Healing and Prevent Recurrence of Venous Ulcers

Venous ulcers are often intractable. The aim of this study was to retrospectively analyze the effectiveness of endovenous ablation, compression therapy, moist wound healing, and skin care in the management of venous ulcers. Twenty-eight consecutive patients (10 male, 18 female; mean age, 70.1 years) with Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class C6 venous ulcer underwent endovenous ablation between December 2014 and August 2020. The main treatment strategies were radiofrequency ablation and varicectomy (including stab avulsion of incompetent perforating veins), use of compression therapy until complete healing was achieved, moist wound healing (washing the ulcer site and covering it with dressings twice daily), and skin care, taking into consideration the balance of the microbiome. Active venous leg ulcers (CEAP class C6) were diagnosed in 36 patients at the first visit. In 7 of these patients, compression therapy and use of strategies to promote moist wound healing resulted in ulcer healing by the day of the planned surgery. One patient was unable to quit smoking and, therefore, could not undergo surgery. After excluding these 8 patients, the authors analyzed the data from 28 patients who underwent endovenous ablation. The mean surgical time was 38.9 minutes, and the mean number of stab avulsion incision sites was 9.7. All ulcers healed within a median of 55.5 days (range, 13-365 days). Ulcer healing was achieved by 1 year in all 28 patients (100%). No ulceration recurred as of the final follow-up (median, 24.5 months [range, 3-66 months]). Endovenous ablation, adequate varicectomy (stab avulsion [maximum number of sites in 1 patient, 43]), compression therapy, moist wound healing, and skin care are effective in treating and preventing recurrence of venous ulcers.

A Rare Encounter Compartment Syndrome after High Saphenous Vein Ligation and Multiple Stab Avulsion Surgery

A Rare Encounter Compartment Syndrome after High Saphenous Vein Ligation and Multiple Stab Avulsion Surgery

TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

Abstract Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

Clinical and Pathological Correlations in Chronic Venous Disease

Chronic Venous Disease (CVD) has a high prevalence in the western world. Varicose veins (VVs) are the main signs of this disease that is characterized by important pathological vessel wall changes. The aim of this study is to correlate the main histopathological abnormalities with related clinical issues of CVD. A cohort of patients with VVs scheduled for open surgical treatment namely stab avulsion of VVs was recruited. Subsequently, venous tissue from stab avulsion was collected in order to evaluate the following biomarkers: Vascular-Endothelial Growth Factor (VEGF), Protein Gene Product 9.5 (PGP 9.5), Fibronectin (FN), and Matrix Metalloproteinase-9 (MMP-9). The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) criteria were used to classify CVD. Fourteen tissue fragments were processed for histological and immunohistochemical studies. Of these, 43% were from CEAP C2 patients, 36% from CEAP C3 patients, and 21% from CEAP C4 patients. CEAP Class C2 had few to moderate structures positive to VEGF; occasional structures positive to Fibronectin, numerous structures positive to MMP9, few to moderate structures positive to PGP 9.5. CEAP Class C3 had moderate structures positive to VEGF; few to moderate structures positive to Fibronectin; many structures positive to MMP9; few to moderate structures positive to PGP 9.5. CEAP Class C4 had numerous structures positive to VEGF; numerous structures positive to Fibronectin; abundant structures positive to MMP-9; few structures positive to PGP 9.5. In this study, positive VEGF, FN, and MMP-9 structures were found with increasing trends in relation to the disease staging. VEGF and FN are associated with a progressive increase from C2 to C4. The MMP-9 marker has an important positivity even at early stage of the disease, being higher in CEAP C4 patients. PGP 9.5 decreases in CEAP C4 patients and this is concordant to decreased vein wall innervation.

Clinical Results 5 Years after Great Saphenous Vein Stripping.

Background: As a standard treatment for the varicose vein of the great saphenous vein (GSV) type, endovenous ablation (EVA) is the main approach. However, as a background to this, in Europe and the United States, neovascularization (Neo) following high ligation (HL) of the saphenofemoral junction (SFJ) at the time of GSV stripping has been emphasized as one of the reasons for the high rate of recurrence. However, in Japan, almost no similar mid- or long-term results of GSV stripping have been reported.Patients and Methods: From September 2011 to March 2014 when EVA was not my surgical option, 413 consecutive legs of patients underwent GSV stripping by myself using the same procedure. The patients were contacted by phone 5 years later, and recurrent varices after surgery (REVAS) and reoperation (REDO) were investigated. A total of 270 legs of the 391 living cases (69%) underwent venous ultrasonography (VUS). HL of the SFJ was performed via central flash ligation with towing and pulling out of the peripheral side branches containing the accessory saphenous veins. In principle, GSV stripping was performed using the invagination method in the range of the entire reflux region from the HL cut section to the confluent section of the side branch causing branch varicose veins. The range of stripping was to the upper thigh in 3 legs, to the middle thigh in 3 legs, to the lower thigh in 7 legs, to the knee in 46 legs, to the upper calve in 83 legs, to the middle calve in 52 legs, and over the full length in 76 legs. Stab avulsion was performed as much as possible for the side-branch varices. On VUS, the SFJ’s stump of GSV, the presence of side-branch remnants and their reflux, the presence or absence of Neo, and the recurrent lesions in other sites were evaluated. REVAS were classified as follows: Level 1, symptomatic recurrent lesion for which surgery is indicated; Level 2, asymptomatic recurrent lesion possibly requiring future surgery; and Level 3, asymptomatic recurrent lesion that is unlikely to require future surgery.Results: Of the 391 legs of patients who could be contacted, REDO was performed in 23 (6%), including 15 limbs, immediately after this investigation, and symptomatic REVAS were observed in 29 (7%). In 270 legs examined by VUS, REVAS were diagnosed as follows: 29 legs with Level 1 lesion, 40 legs with Level 2 lesion, and 27 legs with Level 3 lesion. Level 1 REVAS that occurred at the SFJ were observed only in 3 legs (1.1%), Level 1 REVAS due to incompetent perforating veins (IPVs) were observed in 14 legs (5%), and Level 1 solitary tributary varices were observed in 9 legs (3%).Conclusion: In this study, REVAS at the SFJ were significantly less than those in the past reports. It has been shown that REVAS due to IPVs or solitary tributary varices were more important than those at the SFJ. (This is a translation of Jpn J Phlebol 2019; 30(3): 259–265.)

Strategy to prevent nerve injury and deep vein thrombosis in radiofrequency segmental thermal ablation of the saphenous veins using a new objective pain scale.

ObjectiveWe evaluated the benefit of local anesthesia including tumescent anesthesia and active walking soon after surgery in preventing nerve injury and deep vein thrombosis caused during endovenous ablation.MethodsEndovenous ablation was performed in 1334 consecutive patients. Varicectomy was performed using the stab avulsion technique. After surgery, patients were encouraged to walk 100–200 m inside the ward for 3–5 times/h. The pain was evaluated objectively using the Okamura pain scale and subjectively using the numerical rating scale.ResultsStab avulsion was performed at 11.8 ± 8.0 sites and the mean operative time was 33.9 ± 15.2 min. The mean Okamura pain scale and numerical rating scale scores were 1.6 ± 1.3 and 3.0 ± 2.0, respectively. Deep vein thrombosis and pulmonary embolism were absent. The incidence of nerve injury was 0.3%.ConclusionsEndovenous ablation should be performed with the patients under local anesthesia to prevent nerve injury and deep vein thrombosis.

Early results of an Asian prospective multicenter VenaSeal real-world postmarket evaluation to investigate the efficacy and safety of cyanoacrylate endovenous ablation for varicose veins

ObjectiveThe aim of A Singapore VenaSeal Real-World Post-Market Evaluation Study (ASVS) was to evaluate the performance of cyanoacrylate closure (CAC) for varicose veins in a prospective multiracial Singaporean Asian cohort. We report early clinical and patient satisfaction outcomes at 3 months after intervention. MethodsThere were 100 patients (151 legs; 156 truncal veins) who underwent CAC between April and December 2018. Of the 151 legs, 49 (32.5%) were treated for great saphenous vein (GSV) incompetence, 96 (63.6%) for bilateral GSV incompetence, 1 (0.7%) for small saphenous vein (SSV) incompetence, and 5 (3.3%) for combined unilateral GSV and SSV reflux. At baseline, 68 legs (45.0%) had C4 to C6 disease, and 67 legs (44.4%) had concomitant multiple stab avulsions. Patients were reviewed at 2 and 12 weeks by duplex ultrasound to check for venous recanalization (defined as ≥5 cm in length), pain score, revised Venous Clinical Severity Score, EuroQol-5 Dimension questionnaire score, Aberdeen Varicose Vein Questionnaire score, 14-item Chronic Venous Insufficiency Questionnaire (CIVIQ-14) for quality of life measures, and patient satisfaction. Time to return to work and normal activities were also recorded. ResultsThere were 59 female patients, and mean age was 60.1 ± 12.7 years. There was 100% technical success. Patients tolerated the procedure well and reported low periprocedural pain (mean pain score, 2.9 [range, 0-9]). Patient surveys at the 3-month interval showed high satisfaction rates, with 72 of 91 (79.1%) being extremely or very satisfied. By day 10, of 100 patients, 93 (93%) resumed daily activities, whereas 36 (36%) had returned to work. At 2 weeks, GSV and SSV were completely occluded in 150 of 150 (100%) and 6 of 6 (100%) veins, respectively. At 3 months, GSV and SSV occlusion rates were 140 of 141 (99.3%) and 6 of 6 (100%), respectively. Transient superficial phlebitis was reported in 27 of 151 (18 %) legs, which was self-limited. At 3 months, revised Venous Clinical Severity Score improved from 5.00 (range, 1.00-18.00) to 1.00 (0.00-10.00; P < .001); EuroQol-5 Dimension score, from 0.686 (−0.382 to 1.00) to 1.00 (0.12-1.00; P < .001); Aberdeen Varicose Vein Questionnaire score, from 17.14 (1.29-61.15) to 4.83 (0.00-57.12; P < .001); and 14-item Chronic Venous Insufficiency Questionnaire, from 19.64 (1.79-73.21) to 7.14 (0.00-51.79; P < .001). ConclusionsCAC has a high safety profile and is an effective way to block refluxing truncal veins in Asian patients at early follow-up. Patients are highly satisfied and report low postoperative pain. There is significant continued quality of life improvement at 3 months. Early results are encouraging, but we await further prospective long-term follow-up from the study.

Prognosis of reflux of the below-knee great saphenous vein after surgical or endovenous treatment of reflux of the above-knee great saphenous vein

ObjectiveThis study aimed to investigate the prognosis of preoperative reflux in the below-knee great saphenous vein (BK-GSV) after surgical or endovenous treatment of reflux of the above-knee GSV (AK-GSV) with concomitant stab avulsion of tributary varicosities and correlation between the results of preoperative duplex ultrasound (DUS) and postoperative reflux status of the BK-GSV. MethodsFrom August 2015 to May 2018, there were 63 limbs (59 patients) with untreated primary varicose vein with reflux in the whole length of the GSV included in this study. The treatment methods were conventional surgery and radiofrequency ablation. Patients underwent DUS and assessment of Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Symptom Severity (AVVSS) score before treatment and at 6 and 12 months after treatment. ResultsReflux in the BK-GSV persisted in 51% (32/63) of limbs at 6 months and 51% (18/35) at 12 months after treatment of reflux of the AK-GSV combined with stab avulsion of tributary varicosities. The reflux status of the BK-GSV after treatment was independent of diameter (P = .65 at 6 months and P = .68 at 12 months) and duration of reflux of the BK-GSV (P = .76 at 6 months and P = .95 at 12 months) on preoperative DUS. The percentage improvement in the VCSS and AVVSS score, respectively, was 46% and 58% in the group of competent BK-GSV and 54% and 80% in the group of incompetent BK-GSV at 6 months (P = .52 for VCSS; P = .28 for AVVSS score) and 95% and 90% in the group of competent BK-GSV and 87% and 92% in the group of incompetent BK-GSV at 12 months (P = .15 for VCSS; P = .84 for AVVSS score). ConclusionsAlthough preoperative reflux in the BK-GSV persists in half of limbs after treatment of reflux of the AK-GSV combined with stab avulsion of tributary varicosities, clinical results and quality of life improve regardless of reflux status of the BK-GSV. The postoperative reflux status of the BK-GSV is independent of diameter and duration of reflux of the BK-GSV on preoperative DUS.

Effect of Transluminal Injection of Foam Sclerotherapy Combined with Endovenous Thermal Ablation of Varicose Veins

ObjectiveThe combination of endovenous therapies with stab avulsion or ultrasound guided foam sclerotherapy is widely performed. However, these conventional techniques tend to result in incomplete avulsions or persistent varicosities.MethodsOne hundred and thirteen legs in 97 consecutive patients who underwent 1470 nm laser ablation for great saphenous varicose veins were enrolled. The foam sclerosing agent was injected via the sheath after endovenous laser ablation (EVLA). Patients were divided into two groups: EVLA only group (Control; n = 50) and EVLA and transluminal injection of foam sclerotherapy (TLFS) group (SCL; n = 63).ResultsAt three month follow up, reflux was abolished throughout all treated great saphenous veins (GSVs) when assessed with Duplex ultrasound. Thrombophlebitis was observed in two patients in the SCL group (p = .13). Additional second stage sclerotherapy was needed in the Control group (n = 33, 66%) vs. SCL group (n = 2, 3%; p < .0001). The venous clinical severity score (VCSS) was significantly improved in the SCL group (changes of VCSS, Control −3.3 ± 1.7 and SCL -4.4 ± 1.0; p < .0001). Univariable and multivariable analyses revealed that, among age, sex, Clinical-Etiology-Anatomy-Pathophysiology classification, linear endovenous energy density, and TLFS, TLFS was the only significant factor of improved VCSS (hazard ratio = −0.96; 95% confidence interval = −1.4 to −0.58; p < .0001).ConclusionsTLFS combined with EVLA may be an easy, safe, and effective procedure with acceptable complications vs. EVLA alone and reduces additional second stage interventions.

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

Outcome of Ultrasonography-Guided Foam Sclerotherapy Versus Stab Avulsion Ambulatory Phlebectomy in the Treatment of Varicosis in Small Veins of the Leg: A Single Blinded Randomized Clinical Trial

Background: In the intervening years, a few randomized clinical trials have confirmed that foam sclerotherapy is effective in managing great vein incompetence. However, no details have been published in its efficacy in comparison with conventional methods such as stab avulsion in the treatment of varicosis in small veins. Objectives: This randomized clinical trial was conducted to compare results and outcomes of the ultrasonography-guided foam sclerotherapy and conventional stab avulsion ambulatory phlebectomy in the treatment of varicosis in small veins of the leg. Patients and Methods: In a randomized single-blinded clinical trial, patients with varicosis in the small veins of the leg were randomly assigned for treatment with ultrasonography-guided foam sclerotherapy (n = 45) or with ambulatory phlebectomy (n = 45). Follow-up visits were done in 1 week, 1 and 6 months after operation and all patients were assessed regarding postoperative pain, need for analgesics, time to return to work, and level of satisfaction. Results: Postoperative pain was significantly lower in foam sclerotherapy group by VAS (P = 0.003). There was a significant difference in the morbidity rate between the two techniques (13.3%. in foam sclerotherapy, 37.8% in ambulatory phlebectomy, P = 0.008). The main predictors of the pain incidence included ambulatory phlebectomy, female gender, and advanced age. Satisfaction was significantly higher in foam sclerotherapy group (P = 0.024). Also, this group had shorter time to return to work (P < 0.001). Conclusion: Foam sclerotherapy is more preferred to ambulatory phlebectomy for treating varicosis in small veins of the leg because of its lower morbidity, less pain, more satisfaction, and shorter time to return to work.

Utility of the Ginza forceps for superficial phlebectomy during endovenous laser ablation of the great saphenous vein.

To evaluate the efficiency of using the Ginza forceps (DVx, Tokyo, Japan), which have a long shaft and strong grip, for superficial phlebectomy with the stab avulsion technique, during simultaneous endovenous laser ablation (EVLA) of the great saphenous vein (GSV). The subjects were patients treated with EVLA performed by a single operator at one institution. All patients had a GSV diameter of 4-10mm and an EVLA length of the GSV of >20cm. We compared 59 limbs treated only with the Varady hook (Group A) with 46 limbs treated with the Ginza forceps (Group G). The mean operative times for Groups A and G were 55.4±17.1 vs. 48.5±13.5min, respectively (P=0.002), and the number of stab incisions was 5.9±2.9 (1-13) vs. 3.5±2.3 (1-11), respectively (P<0.001). The rates of nerve injury and thrombophlebitis were 1.7 vs. 0 and 3.4 vs. 0%, respectively. Performing superficial phlebectomy with the Ginza forceps reduced the operation time and the number of stab wounds. These initial results suggest that using the Ginza forceps for the procedure is safe and efficient.

The Influence of Residual Below-Knee Reflux and Incompetent Perforating Veins on Venous Function after Stripping Surgery

Persisting incompetent great saphenous vein (GSV) below the knee and residual incompetent perforating veins (IPV) are often found after selective stripping of GSV from the groin to upper calf. The aim of this study is to evaluate the venous function when the calf GSVs or calf perforating veins are incompetent after stripping surgery. One hundred-thirty-one limbs were treated by stripping from the groin to upper calf with stab avulsion or sclerotherapy of varices. One month and twelve months after surgery, the patients were examined clinically to establish the extent of persisting varices by duplex ultrasonography and air-plethysmography. Venous filling index (VFI) was a little higher in those who had residual calf GSV reflux 12 months later; it was also higher in the group with incompetent perforating veins than the group without. The chief complaints were found to have improved in all groups. The findings suggest that removal of the saphenous vein below the knee is not necessary, but it is important to take care of the incompetent perforating veins. (English Translation of Jpn J Phlebol 2011; 22: 239-244.).