Superficial Venous Insufficiency Research Articles

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

Sub-ulcer Foam Sclerotherapy in Patients with Venous Leg Ulcer, Analysis and Technical Aspects of 134 Consecutive Patients.

For this retrospective study, we analyzed the sub-ulcer foam sclerotherapy technique in patients with venous leg ulcer (VLU). This study included 134 patients treated with sub-ulcer foam sclerotherapy at the Oulu University Hospital vascular outpatient clinic from January 2012 to December 2021. All included patients received sub-ulcer foam sclerotherapy as part of the treatment strategy for superficial venous insufficiency. Compression therapy and local wound care were organized for VLU treatment. A follow-up visit was scheduled for one month after the sub-ulcer foam sclerotherapy. Change in ulcer size, local (skin necrosis, infection) or systemic (deep vein thrombosis, pulmonary embolism) complications, and time to ulcer healing were monitored. The occurrence of major limb-related complications (amputation, surgical revision) was monitored for one year postoperatively. One month after sub-ulcer treatment, ulcers were smaller or completely healed in 108 (81%) patients. Ulcer healing was completed in 123 (92%) patients at one year and 131 (98%) patients at two years. Complications were recorded in four (3%) patients, three (2%) who were diagnosed with erysipelas requiring antibiotic treatment and one (1%) patient diagnosed with local dermatitis. During the one-year follow-up, no major limb-related complications (surgical revisions or amputations) arose. Sub-ulcer foam sclerotherapy may be a feasible addition to superficial vein reflux elimination in patients with VLU and a low risk for complications.

Safety and Efficacy of Endovenous Ablation in Patients with a History of Deep Venous Thrombosis

Endovenous ablation is the standard of care for patients with symptomatic superficial venous insufficiency. For patients with a history of deep venous thrombosis (DVT), there is concern for an increased risk of post-procedural complications, particularly venous thromboembolism (VTE). The objective of this study was to evaluate the safety and efficacy of endovenous thermal ablation in patients with a history of DVT. The national Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR) was queried for superficial venous procedures performed from January 2014-July 2021. Limbs treated with radiofrequency or laser ablation were compared between patients with and without a DVT history. The primary safety endpoint was incident DVT or endothermal heat-induced thrombosis (EHIT) II-IV in the treated limb at <3-month follow-up. Secondary safety endpoints included any proximal thrombus extension (i.e., EHIT I-IV), major bleeding, hematoma, pulmonary embolism (PE), and death due to the procedure. The primary efficacy endpoint was technical failure (i.e., recanalization at <1-week follow-up). Secondary efficacy endpoints included the risk of recanalization over time and the post-procedural change in quality-of-life measures. Outcomes by pre-operative use of anticoagulation (AC) were also compared among those with prior DVT. Among 33,892 endovenous thermal ablations performed on 23,572 individual patients aged 13-90, 1,698 patients (7.2%) had a history of DVT. Patients with prior DVT were older (p<0.001), of higher BMI (p<0.001), more likely to be male at birth (p<0.001) and black/African American (p<0.001), and had greater CEAP classifications (p<0.001). A history of DVT conferred higher risk of new DVT (1.4% vs. 0.8%, p=0.03), proximal thrombus extension (2.3% vs. 1.6%, p=0.045), and bleeding (0.2% vs. 0.04%, p=0.03). EHIT II-IV, PE, and hematoma risk did not differ by DVT history (p=NS). No deaths from treatment occurred in either group. Continuing pre-operative AC in patients with prior DVT did not change the risk of any complications after endovenous ablation (p=NS) but did confer increased hematoma risk among all endovenous thermal ablations and surgeries (p=0.001). Technical failure was similar between groups (2.0% vs. 1.2%, p=0.07), though a history of DVT conferred increased recanalization risk over time (HR=1.90, 95% CI [1.46, 2.46]), p<0.001). Groups had comparable improvement in post-procedural VCSS/HASTI scores (p=NS). Endovenous thermal ablation in patients with a history of DVT was effective. However, appropriate patient counseling regarding a heightened DVT risk, albeit still low, is critical. The decision to continue or withhold AC pre-operatively should be tailored on a case-by-case basis.

Disparities in access to endovenous treatment options in chronic lower extremity superficial venous insufficiency: A national 7-year analysis

ObjectiveThe goal of this study was to analyze trends in treatment access for chronic superficial venous disease and to identify disparities in care. MethodsThis retrospective study was exempt from institutional review board approval. The American College of Surgeon National Surgical Quality Improvement Program database was used to identify patients who underwent vein stripping (VS) and endovenous procedures for treatment of chronic superficial venous disease. Endovenous options included radiofrequency ablation (RFA) and laser ablation. Data was available from 2011 to 2018 and demographic information was extracted for each patient identified by Current Procedural Terminology codes. For all racial and ethnic groups, trend lines were plotted, and the relative rate of change was determined within each specified demographic. ResultsThere were 21,025 patients included in the analysis. The overall mean age was 54.2 years, and the majority of patients were female (64.8%). In total, 27.9%, 55.2%, and 16.9% patients underwent VS, RFA, and laser ablation, respectively. Patients who received laser ablation were older (P < .001). Hispanic ethnicity was associated with significantly lower odds of receiving endovascular thermal ablation (EVTA) over VS (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.64-0.78; P < .001). American Indian/Alaska Native patients were more likely to receive EVTA over VS (OR, 4.02; 95% CI, 2.48-6.86); similarly, Native Hawaiian/Pacific Islander patients were more likely to receive EVTA over VS, although this difference was not statistically significant (OR, 1.44; 95% CI, 0.93-2.27). On multinomial regression, Hispanic patients were less likely to receive RFA over VS, whereas American Indian/Alaskan Native patients were more likely to receive RFA over VS. In all racial and ethnic groups, the percentage of endovenous procedures increased, whereas vein stripping decreased. ConclusionsBased on a hospital-based dataset, demographic indicators, including age, sex, race, and ethnicity, are associated with differences in endovenous treatments for chronic superficial venous insufficiency suggesting disparities in obtaining minimally invasive treatment options among certain patient groups.

Treatment of superficial venous insufficiency class C 6 with ultrasound-guided foam sclerotherapy

Treatment of superficial venous insufficiency class C 6 with ultrasound-guided foam sclerotherapy

Endovenous laser ablation in treating superficial venous insufficiency: initial experience from southwestern Greece

Endovenous laser ablation in treating superficial venous insufficiency: initial experience from southwestern Greece

Injection Sclerotherapy for Chronic Superficial Venous Insufficiency with Involuntary Movement of Toes.

Injection Sclerotherapy for Chronic Superficial Venous Insufficiency with Involuntary Movement of Toes.

The troubled course of the CHIVA Cure through clinical studies: a critical review

The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases.

Digital sedation: A new revolution in the management of superficial venous insufficiency

Digital sedation: A new revolution in the management of superficial venous insufficiency

Long-term results and predictors of failure after mechanochemical endovenous ablation in the treatment of primary great saphenous vein incompetence.

Mechanochemical endovenous ablation (MOCA) was introduced to treat superficial venous insufficiency of the lower leg with less pain and haematoma. Long-term outcome is still lacking. The purpose was to report long-term outcome and to analyse possible predictors for failure. The study was a retrospective pooled analysis of two prospective cohorts previously reported, but with prolonged long-term outcome up to 5-years follow-up. 163 treated legs were analysed. Mean follow-up was 5.4±0.6years, in which 33 total failures occurred. Four procedures were partially successful. VCSS improved significantly and remained stable after 1 and 2-years, but significantly rose again after 5-years. AVVQ dropped significantly, but increased after 1year to 4.3 and 6.1 at 5-years follow-up. MOCA was effective with minimal pain perioperative. However, anatomical success deteriorated after 1-year and showed even less results after 5-years, mainly due to partly recanalization, while clinical results were less affected. There were no clear clinical predictors for failure.

Safety of Ultrasound Guided Endovenous Management of Varicose Veins and How to Avoid Potential Complications

Background Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have been used to treat superficial venous insufficiency, Ablation of veins has replaced operative saphenectomy as the procedure of choice for the treatment of superficial venous insufficiency. This change has likely taken place due to the minimally invasive nature and acceptable safety of endovenous ablation while remaining as efficacious and durable as saphenous ligation and stripping. Pattern of complications had been changed over the past decade, due to shifting from surgical stripping of varicose veins to endovenous procedures. The incidence of complications vary widely based on the level of operators as ecchymosis incidence post endovenous procedure range from (52-100%), parathesia (0.5 - 41.5%), phlebitis (0.5 – 5.5%), burn (0.46%), DVT (0.27%), and pulmonary embolism in 0.02% of cases. Aim of the Work assessing the incidence of complications during endovenous procedures of varicose veins and possible preventive measures. Assessing incidence of complications during Endovenous laser ablation (EVLA), radiofrequency ablation and injection sclerotherapy. Assessing the preventive measures that could be conducted to decrease the incidence of complications of endovenous surgeries. Patients and Methods Type of study retrospective cohort study study setting the study will be conducted at Ain Shams University Hospitals, interventional radiology department study period 2 years study population patients admitted in interventional radiology department during the past 2 years and scheduled for varicose veins treatment. Results was conducted on 20 patients, 70.0% were males and 30.0% were females with mean age of the study group was 45.35 ± 11.34 years ranged from 28 to 65 years. Most patients with no known medical or surgical history 65.5%, 25.0% were diabetic and 5.0% were hypertensive. Conclusion because most of the side effects are minor, and major complications are rare, EVLA is a safe and minimally invasive procedure with excellent efficacy in the treatment of varicose veins. Because optimizing laser parameters and the EVLA procedure may reduce the incidence and severity of complications associated with EVLA, additional research is warranted.

The impact of invasive treatment of superficial venous insufficiency of the lower extremities on cardiac functions.

The aim of the study was to investigate the effect of invasive treatment for chronic venous insufficiency (CVI) on cardiac hemodynamics. Fifty three patients diagnosed with saphenofemoral junction or great saphenous vein insufficiency in a level above C3 according to Clinical-Etiology-Anatomy-Pathophysiology classification were included in the study. All the patients underwent 2D echocardiography before and 3months after the invasive treatment. In postinvasive treatment echocardiographic assessment, significant decreases in right ventricular end-diastolic diameter (p = 0.006), TAPSE (p = 0.006), tricuspid E wave velocity (p = 0.004), tricuspid E/A ratio (p < 0.001), sPAB (p = 0.017), tricuspid lateral s' wave velocity (p = 0.004), and right ventricular free wall longitudinal strain rate (p = 0.011) were observed. The invasive treatment of superficial venous insufficiency of the lower extremities may lead to reduction in the increased venous return in the supine position subclinically.

Comparison of endovenous laser ablation and cyanoacrylate embolization in the non-invasive treatment of superficial venous insufficiency in terms of patient satisfaction.

Ablation with n-butyl cyanoacrylate is a clinically newer technique than endovenous laser ablation and other interventional techniques in the treatment of chronic venous insufficiency (CVI). The aim of this study was to compare the endovenous laser ablation (EVLA) and n-butyl cyanoacrylate (NBCA) interventional techniques in terms of benefit, effectiveness, and patient satisfaction. The study was conducted at Yozgat City Hospital and Bozok University Research Hospital Cardiovascular Surgery clinics between November 2016 and February 2021. A total of 260 symptomatic patients with 130 randomized cases in each intervention group were included. NBCA patients constituted Group 1 and EVLA patients Group 2. The saphenous vein was evaluated by color Doppler ultrasonography (CDUS) of the lower extremity. Patients with saphenous veins over 5.5mm in diameter and a saphenous-femoral reflux time of 2s or longer were included in the study. The patients were asked about their satisfaction and symptoms in the first postoperative week during an outpatient clinic follow-up with CDUS investigation at the first and sixth months. Although vena saphenous magna (VSM) closure results were similar with the two methods, satisfaction rates were found to be higher with the NBCA procedure. Comparison of the new methods used in the treatment of CVI revealed similar VSM closure rates in the two methods, but the satisfaction rate was higher with the NBCA technique in this study.

A pictorial essay of ultrasound findings after endovascular procedures for superficial chronic venous disease

To date endovascular surgical techniques represent an effective and widely used choice in the treatment of superficial venous insufficiency. In recent years, tumescent ablative techniques (endovenous laser ablation, radiofrequency ablation) have been joined by non-tumescent ablative techniques (mechanical-chemical ablation and cyanoacrylate glue embolization). The Duplex ultrasound (DUS) is the survey mostly used to evaluate the outcome of these procedures. The aim of this work was to provide an updated overview of the ultrasound aspects that can be found in the follow-up of patients undergoing endovascular procedures. Specifically, the characteristic imaging pictures will be described in the immediate and short/medium term follow-up. The DUS is a fundamental element of the investigation of venous system of the lower limbs after the surgical and endovascular treatment of varicose veins. Therefore, it is necessary to update one’s knowledge regarding ultrasound patterns related to new endovascular procedures.

BMI Does Not Impact the Postoperative Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

BMI Does Not Impact the Postoperative Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

Leg Ulcer Pathway Acceleration (LUPA) study.

Leg ulcers are common, costly, and significantly impair quality of life, but their management is variable and associated with considerable delays in healing. The aim of this study was to design an accelerated leg ulcer care pathway in a community and hospital setting to improve patient outcomes. A new referral pathway was developed using a series of healthcare professional and patient interviews, focus groups, and stakeholder workshops. The referral pathway, investigation and treatment protocols were further informed by clinical guidelines to develop the Leg Ulcer Pathway Acceleration care pathway. The outcomes of a consecutive series of patients enrolled in the Leg Ulcer Pathway Acceleration care pathway were compared with the outcomes of patients from a historical leg ulcer cohort from the same community and hospital setting. A total of 110 eligible patients were enrolled and followed prospectively through the Leg Ulcer Pathway Acceleration care pathway. Their outcomes were compared with those of 183 patients with venous leg ulcers identified from existing hospital and community ulcer centres, and acting as the historical control group. The 110 patients in the Leg Ulcer Pathway Acceleration group consisted of 73 (66 per cent) men, had a mean(s.d.) age of 55.7(17.2) years, and had a median initial ulcer duration of 14.5 (i.q.r. 6-30) months. The 183 patients in the historical control group consisted of 119 (65 per cent) men, had a mean(s.d.) age of 56.4(17.2) years, and had a median initial ulcer duration of 13.5 (i.q.r. 6-47) months. Venous disease was treated in 67/110 (61 per cent) and deep venous disease was treated in 33/110 (30 per cent) of patients in the Leg Ulcer Pathway Acceleration cohort. In contrast, only 16/183 (8 per cent) of patients in the control group were treated for superficial venous insufficiency and 4/183 (2 per cent) of patients in the control group were treated for deep venous disease. Ulcer healing rates at 12 months were 80 and 20 per cent in the Leg Ulcer Pathway Acceleration group and the control group respectively (P < 0.001). Adjusted for baseline characteristics, the OR for a healed ulcer at 12 months was 21.21 (95 per cent c.i.. 11.32 to 42.46) (P < 0.001). The introduction of an accelerated leg ulcer care pathway significantly improves ulcer healing when compared with historical controls.

Comparison of Radiofrequency Ablation and Saphenous Vein Stripping for the Treatment of Recurrent Lower Extremity Venous Insufficiency.

To compare the efficiency and safety of radiofrequency ablation (RFA) and saphenous vein stripping (SVS) for the treatment of recurrent lower extremity chronic superficial venous insufficiency (CSVI). Patients who underwent SVS and RFA for recurrent lower extremity CSVI following RFA and patients who had 2-year follow-up results were enrolled into the study. Total, 37 patients who underwent a second RFA session with 2-year follow-up results were available. Then 37 patients were selected from 88 patients who underwent SVS for recurrent lower extremity CSVI to achieve a 1:1 ratio for comparison. Groups were compared based on preoperative properties, operative parameters, postoperative outcomes, complications and follow-up results. Duration of the procedure was 20.7minutes in the RFA group and 30.7minutes in the SVS group (P = .001). Postoperative pain at first hour, sixth hour and 24thhour were significantly lower in patients who underwent RF (P = .001 for each parameter). Moreover, hospitalization time (18.1hours vs 24.6hours, P = .001) and time to return to normal daily activities (1.6days and 2.5days, P = .001) were significantly shorter in the RFA group. Success of the procedure did not statistically significant at first year follow-up (P = .304). However, success was significantly higher for the SVS group at second year follow-up (73% for RFA group and 91.9% for SVS group, P = .032). We achieved significantly shorter procedure time, less postoperative hospitalization time, and a shorter time to return to daily activities with RFA. In contrast, the success rate of SVS was significantly higher at the second year follow-up, but not the first year follow-up in comparison with RFA.

Incidence of Various Types of Varicose Veins in Relation to Age and Gender Among Patients Presenting in Mayo Hospital

Amongst the most frequent illnesses in civilised nations of West is chronic venous insufficiency (CVI). It is believed that 40-50 percent of all individuals have superficial venous insufficiency of the leg, which manifests primarily as varicose veins. Individuals with varicose veins typically complain of leg pain at the conclusion of the day following extended walking. Ankle edoema, itch, hemorrhage, superficial thrombophelibitis, dermatitis, lipodermatosclerosis, and open wounds are some of the additional manifestations. Methods: In this cross sectional study, conducted at the surgical floor, Mayo Hospital, Lahore. Varicose veins were defined as dilated, tortuous, subcutaneous veins usually seen in upright posture. Any case of suspected chronic venous insufficiency was assessed on clinical examination by unbiased consultant surgeon. The severity of varicose vein was assessed by clinical grading from CEAP (Clinical-Etiological-Anatomical-Pathophysiological) system in which there are six classes. Results: Patients in our study were mostly males; male to female ratio of patients of varicose veins is 3:1, most of the male patients had class 2 or class 5; Association of class of varicose veins and gender was also insignificant (p-value calculated for the class of varicose veins and gender was 0.25). Conclusion: In our study population, male patients suffered worse than female patients. The occurrence rate was comparable between people of different ages. There was a higher prevalence of varicose veins in classes 2 and 3. To further understand the causes of varicose veins, larger-scale studies focusing on female gender-related risk factors and occupation-related risk factors are needed. Additional measures, such as patient education, can aid in lowering the frequency of varicose veins. Keywords: Varicose Veins, DVTs, Ankle edema, Thrombophelibitis, lipodermatosclerosis

Hypersensitivity Reactions after Cyanoactylate Closure for the Treatment of Incompetent Superficial Venous Insufficiency

Hypersensitivity Reactions after Cyanoactylate Closure for the Treatment of Incompetent Superficial Venous Insufficiency

Venous leg ulcers and prevalence of surgically correctable reflux disease in a national registry

BackgroundChronic venous disorders are common, with varicose veins occurring in ∼40% of the population. Venous leg ulcers affect 1% to 2% of the population, with the prevalence increasing ≤4% for those aged >65 years. Both conditions are expensive and together are responsible for ≤2% of the annual healthcare budget expenditure of Western societies. The ESCHAR (effect of surgery and compression on healing and recurrence) and EVRA (early venous reflux ablation) trials demonstrated that surgical correction of superficial venous reflux reduced ulcer recurrence, resulted in faster healing times (EVRA), and was proved cost-effective. Largescale data regarding patients with chronic venous leg ulcers presenting to venous centers with treatable superficial venous insufficiency has not been previously reported. Our study was designed to evaluate the percentage of patients with leg ulcers presenting to dedicated vein centers who were found to have surgically correctable superficial venous insufficiency. MethodsThe American Vein & Lymphatic Society Patient Reported Outcome Venous Registry began collecting data in 2014 and is one of two national registries focused on chronic venous disorders. The database was queried first for the presence of an ulcer using the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification (C6 status). These de-identified data were further correlated by crossing the number of ulcers for the same limb using the revised venous clinical severity score (rVCSS). The demographics, index duplex ultrasound details, and rVCSS features for ulcer duration and compression use were analyzed. Once the presence of an ulcer had been validated by CEAP and rVCSS, the population was divided into groups according to the ultrasound-reported anatomic pathology (eg, normal, reflux, obstruction, reflux plus obstruction). The query was directed toward all patients seeking a venous evaluation at participating centers from January 2018 through January 2022. ResultsMore than 270,000 unique patient records were reviewed. Of the 270,000 records, 163,027 (60%) had had duplex ultrasound scans available, for 1794 unique patients (1879 limbs), representing 1.1% with a leg wound. Of these patients, 55.4% were men and 44.6% were women. Group S included patients with isolated superficial pathology (n = 1291; 68.7%). Group M included patients with mixed superficial and deep pathology (n = 238; 12.7%). Group D included patients with isolated deep vein pathology (n = 58; 3.1%). Finally, group N included patients with leg wounds but no venous pathology (n = 292; 15.5%). The rVCSSs for groups S and M were significantly higher than those for group N. In group S, the dominant patterns involved the great saphenous vein (GSV) above the knee (54.8%), the small saphenous vein (30.7%), and the anterior accessory GSV (14.4%). The frequency of single, double, and triple axial vein reflux identified 1.45 vessels eligible for ablation treatment per limb. In group M, the dominant patterns involved the GSV above the knee (61.7%), the small saphenous vein (26.2%), and the anterior accessory GSV (12.1%), for 1.52 axial segments per limb. Of the 84.4% of venous ulcer patients, duplex ultrasound analysis revealed that 97% of this large subset had had surgically correctable disease. ConclusionsThe American Vein & Lymphatic Society Patient Reported Outcome Venous Registry demonstrated that 85% of the leg wounds in the present study were venous in origin and 97% possessed surgically correctable disease. Our findings support early referral to dedicated vein centers with appropriate venous reflux management as a part of the multidisciplinary team caring for patients with venous leg ulcers.