Tumescent Anesthesia Research Articles

Sclerotherapy and Vein Gluing Combined as a Single-Catheter Procedure for Saphenous Veins

Gluing of veins is discussed as being superior to thermo-occlusive methods or sclerotherapy as it may achieve immediate and permanent vein closure without any symptoms during vein regression. Furthermore, no tumescent anesthesia is required. However, approved gluing methods use continuous placement of larger amounts of aggressive and hardly resorbable cyanoacrylate (VenaSeal [Medtronic, Santa Rosa, Calif], VariClose [Biolas Inc, Ankara, Turkey], VenaBlock [Invamed, Ankara, Turkey]). The effect depends on external manual compression. Segmental glue application is preferred by some investigators to save glue and to accelerate the procedure, but this leaves native endothelium and thus a source of relapse. These drawbacks could be overcome by a new modality that combines segmental or point-wise gluing and catheter sclerotherapy (ScleroGlue project). Twenty-four patients (16 women, 8 men; 42-69 years) with great saphenous vein insufficiency and diameters of 8 to 24 mm (mean, 9.4 mm) underwent combined sclerotherapy (Aethoxysklerol 1%, 1+4 with air) and gluing by a double-catheter access including the VariClose gluing system. Besides the great saphenous vein, additional associated targets (refluxive side branches >6 mm in diameter [n = 22] and perforator veins >6 mm in diameter [n = 12]) were included in the treatment plan. First sclerofoam was applied with a polytetrafluoroethylene catheter (PhleboCath, 1.9/2.3 mm in diameter) during withdrawal, and then cyanoacrylate glue was injected during the spasm phase of the target vein while continuously withdrawing the gluing catheter (1.2/1.6 mm in diameter). No manual compression was applied. There were no external compression media (stockings, bandages) used after the treatment. All cases (24/24) showed immediate saphenous occlusion and elimination of reflux. All auxiliary targets (39/39) were successfully reached by microfoam and occluded. The amount of glue used for saphenous veins was 10 to 33 mg (mean, 16.1 mg) per centimeter of vein. Procedural time from first puncture to patient mobilization was 11 to 23 minutes (mean, 15.1). The ScleroGlue combines reliable endothelium denaturation by catheter-delivered sclerofoam with initial and permanent lumen minimization by point-wise gluing, achieved without any external compression and using low quantities of glue. The procedure is fast and requires no anesthesia except for the puncture site. Further studies will be started in December 2016 also including nonacrylate glues.

Catheter-based endovenous laser ablation of saphenous veins in the treatment of symptomatic venous reflux: Early results

IntroductionCatheter-based endovenous laser ablation (EVLA) is a widely used alternative to surgery and is slowly becoming a state of the art method in the treatment of varicose veins. In this observational study we sought to determine whether the method is safe and feasible in an unselected population of patients and if it can be used on more vein segments during one procedure. Methods and resultsFrom February 2010 to March 2016 EVLA was performed in 1209 venous segments in 1117 consecutive patients (74% women) with venous reflux. Mean diameter of ablated segments was 9.3 mm (range 5–25mm). All procedures were performed on an out-patient basis using local tumescent anesthesia. Intraoperative sonographic guidance was mandatory. Early closure was successful in 98.8% of treated venous segments. Early non-closure occurred in 9 patients (15 treated segments) and all were successfully resolved by early re-EVLA. The causes of incomplete closure were mainly of technical character due to the learning period – low energy, non-closure of proximal tributaries, non-complete emptying of the vein during procedure. Non-closure was not related to diameter of the vein. In 6 patients the prolapse of the thrombus into the lumen of deep femoral vein was noted. The thrombus resolved after one week treatment with low molecular weight heparin. Low-risk pulmonary embolism was observed in one non-compliant patient. ConclusionEVLA of the greater saphenous vein, small saphenous vein and large tributaries in the treatment of symptomatic reflux is a flexible, safe, effective and reproducible method. The closure of venous segments was performed without limitation in venous diameter and amount of segments.

Varicose vein therapy and nerve lesions.

Treating varicose veins using endovenous thermal techniques - especially laser and radio frequency ablation - has emerged as an effective alternative to open surgery with stripping and high ligation. Even though these methods are very gentle and patient-friendly, they are nevertheless accompanied by risks and side effects. Compared to open surgical therapy, the risk of damage to peripheral and motor nerves is reduced; however, it still exists as a result of heat exposure and tumescent anaesthesia. Non-thermal methods that can be applied without tumescent anaesthesia have been introduced to the market. They pose a considerably lower risk of nerve lesions while proving to be much more effective. This paper investigates data on postoperative nerve damage and paraesthesia using internet research (PubMed). It analyses the current state of knowledge regarding non-thermal treatment methods and takes into account the latest developments in the use of cyanoacrylate to close insufficient saphenous veins.

МОЖЛИВОСТІ ХІРУРГІЧНОГО ЛІКУВАННЯ ТРОФІЧНИХ ВИРАЗОК ВЕНОЗНОГО ГЕНЕЗУ НИЖНІХ КІНЦІВОК У ПАЦІЄНТІВ ПОХИЛОГО І СТАРЕЧОГО ВІКУ В АМБУЛАТОРНИХ УМОВАХ

Запропоновано комплекс: оперативну техніку, що “консервує стовбури сафенових вен”, міні-флебектомію за Мюллером, тумесцентну анестезію для хірургічного лікування в амбулаторних умовах геронтологічних пацієнтів із варикозній хворобі нижніх кінцівок функціонального класу С5-6 Sep. As 2.3.4, p17.18 Pr за класифікацією СЕАР з трофічними виразками нижніх кінцівок площею до 10 см2 в один етап, що дозволило отримати через 6 місяців у всіх 78 оперованих пацієнтів позитивний результат: у 56 (71,8 %) хворих – добрий, а в 22 (28,8 %) – задовільний.

Тумесцентна анестезія як різновид місцевої анестезії в акушерстві при виконанні неакушерських операцій під час вагітності

У статті дано оцінку тумесцентній анестезії (різновиду місцевої анестезії), яка дала можливість безпечного виконання хірургічного втручання на підшкірних венах нижніх кінцівок і промежини під час вагітності, з метою запобігання прогресуванню варикозної хвороби нижніх кінцівок, статевих губ і промежини у вагітних у ІІ або в ІІІ триместрі вагітності. Хірургічне лікування проведено 114 вагітним. Виконано 154 операційні втручання. Використали для знеболювання у 90,8 % прооперованих вагітних тумесцентну анестезію. Впливу на перебіг вагітності, пологів, на плід не виявлено.

Hydrodisplacement of sural nerve for safety and efficacy of endovenous thermal ablation for small saphenous vein incompetence.

Background Endovenous radio frequency ablation for small saphenous vein incompetence by and large appears to be superior and safer than conventional open surgery. Small saphenous vein ablation from approximately mid-calf to the point proximally where the small saphenous vein dives into the popliteal fossa is considered to be safe, as the sural nerve is in most cases separated from this segment of the small saphenous vein by the deep fascia. The outcome of the distal incompetent small saphenous vein remains unclear. Efficacy of the endovenous radio frequency ablation can be enhanced by increasing the length of the ablatable small saphenous vein segment. Methodology To optimise endovenous radio frequency ablation outcome, the distal small saphenous vein may be made amenable to ablation if safety of the sural nerve can be assured. The sural nerve was successfully located using duplex ultrasound in 100% of our cohort in this study. The standard entry point for venous access was just above the lateral malleolus. After introduction of the introducer sheath, the radio frequency catheter was advanced proximally; the sural nerve was displaced from the small saphenous vein by approximately 1 cm with the administration of tumescent anaesthesia ( hydrodisplacement). A total of 118 patients underwent extended endovenous radio frequency ablation of 124 incompetent small saphenous vein trunks using the method described. Results Successful extended ablation of the small saphenous vein was achieved in 100% of cases and it was confirmed by duplex scanning at one and six weeks. Two neurological events were recorded during the study: 1. One patient with temporary foot drop lasting for less than 6 h with complete recovery. 2. A second patient with a sural nerve sensory deficit reported by the patient at day 2-3, which remains current at six weeks. Conclusions Extended endovenous radio frequency ablation of the small saphenous vein to optimise length of the ablatable vein segment is feasible with careful identification and hydrodisplacement of the sural nerve. This method is shown to be associated with fewer neurological complications than other methods reported in the literature.

On Beyond Lidocaine: Reconsidering Local Anesthetics in Tumescent Liposuction-A Critical Review.

The use of tumescent solution in liposuction is now considered standard of care; however, much debate still exists regarding its ideal components, especially surrounding the inclusion of local anesthetics. This article reviews the discussion regarding the use of local anesthetics in tumescent liposuction and how it may evolve in the future. The need for local anesthetic additives in tumescent liposuction has been questioned, and the use of longer-acting agents discouraged; however, increasing number of reports in recent years have described the increasingly widespread use of tumescent anesthesia where a wetting solution is infiltrated to achieve anesthesia in an operative field for procedures other than liposuction. More high-level evidence, such as randomized controlled clinical trials, will be required; however, it should be possible to develop a useful standardized algorithm that can guide surgeons to optimize patient safety as well as patient experience.

Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins

Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis. This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose® FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered. Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5cm. Subtotal recanalization was defined as great saphenous vein flow containing 5-10cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital. Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.

The effect of distraction on pain perception during an endovenous thermal ablation procedure.

To determine whether audio and visual distraction can affect the pain perception of a patient undergoing endovenous thermal ablation under tumescent anesthesia. Patients underwent an endovenous thermal ablation procedure and were randomized into two groups: non-distraction (AVD-) and with distraction (AVD+). Visual analogue scale pain score and hospital anxiety depression scale scores were used to measure outcome. The recruited patients were asked to submit an anticipated visual analogue scale pain score prior to treatment as well as the actual experienced post-operative visual analogue scale pain score. There was no significant difference between the AVD- and AVD+ groups post-operative pain score 2.85 (SD 1.7) versus 2.60 (SD 2.3), p = 0.68. Pain score in women with distraction (AVD+) decreased from 3.81 to 2.42. The pain score in men with distraction (AVD+) increases from 1.88 to 2.82. In the AVD- group, a significant difference was found between men and women (p = 0.014). Disregarding gender, a significant difference was found between the anticipated pain score and the actual pain score in both the AVD- group (p = 0.009) and AVD+ group (p = 0.021). There was a correlation between depression and the pain score, which was not seen between pain and anxiety score. The results suggested that audiovisual distraction has no influence on the visual analogue scale pain score during endovenous thermal ablation under tumescent anesthesia. Despite this, patients appreciate and evaluate audio and visual distraction as pleasant to extremely pleasant when applied.

Off-label use of tumescent local anaesthesia in endovascular and surgical techniques

SummaryTumescent local anaesthesia (TLA)has increasingly established itself as the anaesthesia method for operations on varicose veins and has become the standard method in the case of endovascular techniques. However, Off-label use occurs due to the reduced concentration of the local anaesthetic, the incorporation of additives together with a high quantity of LA which exceed the manufacturer’s recommended maximum dosage. In spite of a lack of significant complications arising from the approved use of the TLA and unambiguous positive evaluations of this anaesthesia method by international medical professional associations, the operating phlebologist should inform the patient of this Offlabel use both in the case of operative procedures and endovascular techniques in order to avoid any legal problems.

Endoluminal thermal ablation of the great saphenous vein (GSV) insufficiency

SummaryTo evaluate and compare the fiveyear outcome after treatment of a varicose GSV by endovenous thermal laser ablation (EVLA) and radiofrequency ablation (RFA).In this non-randomized, prospective study, patients treated in 2007 and 2008 for complete varicosis of the GSV (CEAP: C2–C6) were divided according to the treatment technique used into three groups: RFA (VNUS ClosureFast™), EVLA 980 nm (ELVeS 980™) and EVLA 1470 nm (ELVeS 1470™). Ultrasound-guided follow-up consultations were conducted 3 days, 3 months, 1 year and 5 years after treatment.589 patients with 643 GSVs (223 RFA, 185 EVLA 980, 235 EVLA 1470) were treated under tumescent local anaesthesia. No major complications occurred and minor complications were rare (4.7–12.2 %, p=0.135).66 % (RFA), 15 % (EVLA 980) and 32 % (EVLA 1470) of the patients were pain-free without post-operative analgesics. After 5 years, 86 % (RFA), 90 % (EVLA 980) and 93 % (EVLA 1470) of the veins were occluded (p=0.096). Ultrasound imaging revealed reflux in treated GSVs in 5–8 % of cases (p=0.73). A second ablation of the previously treated GSV was required in 5 % (RFA), 2 % (EVLA 980) and 2 % (EVLA 1470) of the patients (p=0.28).Endoluminal thermal ablation is an easy, safe and well tolerated method for the treatment of varicosis. Radiofrequency ablation is less painful than EVLA. RFA and EVLA 1470 are equally effective for vein closure.

Interventions for Varicose Veins: Beyond Ablation.

Minimally invasive endothermal treatments have replaced surgical ligation and stripping in the management of chronic venous insufficiency (CVI) and are now considered the standard of care. Newer techniques have emerged in the last few years in an attempt to further minimize the procedural discomfort associated with endothermal procedures. These new techniques are designed to avoid tumescent anesthesia (TA). These new non-thermal, tumescentless techniques are well tolerated and are shown to result in equivalent outcomes when compared to the thermal ablations. Since there is no data to support the argument that one of these therapies is truly superior to another, selection of a particular thermal or non-thermal technique is dependent on patient and physician preferences. Adoption of a particular non-thermal procedure is also dependent on other factors such as the learning curve, initial setup costs, overall cost-effectiveness and reimbursement. Once the reimbursement issues are resolved and durability is confirmed, these techniques have the potential to become the new standard of care for the management of CVI.

On the question of improving the efficiency and safety of surgical treatment of patients with chronic venous insufficiency

Background: For today there is no reliable method of determination of allergy to the local anesthetics in vitro.Materials and methods: In this research authors evaluated the safety and efficiency of the choice of the solution for tumescent anesthesia. The choice depended on the result of “index of neutrophils lesion” that was evaluated in pre-surgical period. At 182 (83,5 %) interventions in 157 (83,1 %) patients with case anesthesia (CA) was used the Klein solution. In 36 (16,5 %) cases in 32 (16,9 %) patients for tumescence was used the original medicinal composition.Results: the mean volume of administered anesthetic for the one patients at the one intervention is 366±92 ml (p<0,05) at the use of Klein solution and 540±167 ml (p<0,001) at the use of the offered medicinal composition. Allergic reactions were not revealed.Conclusions: Evaluation of the “index of neutrophils lesion” in pre-surgical period allows orient in the choice of solution for tumescent anesthesia and, as the result, increases the safety of patient

Treatment Outcomes and Lessons Learned From Transilluminated Powered Phlebectomy for Varicose Veins in 1034 Patients.

Transilluminated powered phlebectomy (TIPP) is a minimally invasive technique of varicose vein removal, which combines irrigated illumination with tumescent anesthesia for ablation of superficial varicosities and endoscopic-powered venous resection. The objective of this study was to analyze treatment outcomes of this treatment modality. A retrospective evaluation of prospectively collected data from all patients undergoing TIPP procedure for symptomatic varicose veins during a recent 12-year period was performed. Pertinent patient demographics, disease classification, perioperative complications, quality of life, and treatment outcomes were collected and analyzed. A total of 1167 limbs in 1034 patients (mean age, 52.4 years) were treated during the study period. The mean procedure time was 18.4 ± 8.9 minutes (range, 6.0-82.0 minutes). The mean number of incisions for TIPP procedure was 6.3 ± 3.6. All TIPP procedures were technically successful, and no patient required conversion to hook stab phlebectomy. Fifteen (1.5%) patients developed residual or recurrent varicosities, which were treated with sclerotherapy during the follow-up period. Postoperative complications included hematoma at 2 weeks (5.8%), ecchymosis at 2 weeks (32.9%), saphenous neuropathy (0.3%), cellulitis (1.0%), and skin pigmentation (1.9%). There was no postoperative deep vein thrombosis or mortality. Transilluminated powered phlebectomy is an effective method for varicose vein removal and is associated with high clinical success and excellent cosmetic results. Meticulous technical steps are critical in achieving successful outcomes while minimizing complications. Technical considerations and lessons learned from our experiences are discussed in this report.

Efficacy of topical local anaesthesia to reduce perioperative pain for endovenous laser ablation of varicose veins: a double-blind randomized controlled trial.

Tumescent local anaesthesia via multiple injections in the perivenous space leads to intraoperative and postoperative pain during endovenous laser ablation (EVLA). We considered whether the application of topical local anaesthesia reduces pain caused by these injections. Eligible patients undergoing local anaesthetic EVLA were recruited and randomized to either application of topical local anaesthesia or water-based gel (placebo) to the inner thigh over the marked great saphenous vein. Varicose vein severity was classified using the American venous forum clinical etiological anatomical pathological (CEAP) classification score for chronic venous disorders and the Aberdeen varicose vein questionnaire (AVVQ) score. Visual analogue pain scores attributable to the varicose veins or tumescent injections were recorded before the procedure, immediately postprocedure and prior to discharge. Secondary outcome measures were extra analgesia requirement during or immediately postoperatively. Analysis was performed using the unpaired Student's t test and Wilcoxon signed-rank test. A total of 52 patients underwent the procedure. Eight patients were excluded from analysis due to failure to complete the procedure or incomplete data. In the remaining 44 patients (24 local anaesthesia, 20 placebo), no statistical difference was noted in age, gender distribution or the severity of varicose veins assessed preoperatively by the clinician (CEAP classification score, median = 2 in both groups) and patient (AVVQ, mean placebo = 21.59, local anaesthesia = 17.53, p = 0.264) between the two groups. There was no statistical difference in pain scores between the placebo and topical local anaesthetic group at baseline (23.0 versus 20.44, p = 0.57), immediately postoperatively (23.35 versus. 19.75, p = 0.44) or predischarge (20.9 versus 13.75, p = 0.68). Topical local anaesthesia is of no benefit in EVLA of varicose vein to reduce patient experience of perioperative pain.

Excision of Large Lipomas Using Tumescent Local Anesthesia.

Many large lipomas are removed under general anesthesia, because more local anesthesia than is safe to inject may be required for complete excision of such large tumors. The authors performed total excision using tumescent local anesthesia in an outpatient clinic for 23 patients with solitary large lipomas. The longest diameter of the lesions on magnetic resonance imaging ranged from 10 to 22 cm. Mean length of the skin incision was 4.8 cm, and 56 mL of the tumescent solution on average was used for each patient. The postoperative courses of all patients, except for 1 patient who developed a hematoma, were uneventful. With judicious patient selection after physical examination and magnetic resonance imaging findings, total excision of large lipomas under tumescent local anesthesia can be performed safely in an outpatient setting.

The Outcome of Primary Subglandular Breast Augmentation Using Tumescent Local Anesthesia.

Tumescent local anesthesia (TLA) technique to obtain regional anesthesia and vasoconstriction of the skin and subcutaneous tissues is routinely adopted for several plastic surgery procedures. Here, we describe the use of TLA in primary subglandular breast augmentation. This series evaluates advantages and disadvantages of TLA in elective augmentation breast surgery as well as patients' response to this procedure. Between December 2008 and November 2011, 150 patients underwent bilateral primary subglandular breast augmentation under TLA and conscious sedation in the presence of a board-certified anesthesiologist. Midazolam 0.05 mg/kg IV and ranitidine 100 mg IV were given as premedication. Tumescent local anesthesia was composed of 25 mL of lidocaine 2%, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% NS. The solution was delivered between the pectoral fascia and the mammary gland via a spinal needle. After infiltration, 45 minutes were allowed before surgery for local anesthetic effects to take place. The mean age of the patients was 34.3 years. The average amount of tumescent solution infiltrated was 1150 mL, with a maximal dose of 17 mg/kg of lidocaine used. Operating time was 45 minutes and recovery room time averaged 125 minutes. Minor complications were found in a total of 9 (5.3%) patients, with no main surgery-related complications such as hematoma or seroma formation. Breast augmentation under TLA and conscious sedation proved to be safe in the presence of a board-certified anesthesiologist and when performed with meticulous surgical technique.

Effect of the wide-spread use of endovenous laser ablation on the treatment of varicose veins in Japan: a large-scale, single institute study.

Background and aims: In Japan, stripping under general anesthesia, lumbar anesthesia and tumescent local anesthesia has been used in the treatment of primary varicose veins due to saphenous vein insufficiency. However endovenous laser ablation (EVLA) using a 980 nm diode laser has received National Health Insurance (NHI) coverage in 2011, while EVLA using a 1470 nm diode laser with a radial 2-ring fiber has received coverage in 2014. As a result, the use of EVLA has become widespread in Japan. We herein report on the results of varicose veins treatment at our hospital. Subjects and methods: Two hundred eighty-nine patients with saphenous vein reflux who received treatment between October 2013 and December 2015 were included in the present study. The surgical results (operating time, complications, ablation rate, linear endovenous energy density [LEED], and the incidence of surgical site infections [SSI]) were retrospectively assessed and compared among the patients who underwent stripping (group A) and those who underwent EVLA (group B) according to the Japan Guidelines for EVLA. Results: Group A and group B included 49 patients and 240 patients, respectively. Group B comprised 20 patients who underwent EVLA using a 980 nm laser (group B1) and 240 patients who underwent EVLA using a 1470 nm laser (group B2). The operative time in group A was 48 ± 16 minutes, whereas that in group B was 28 ± 10 minutes. The operative time, the length of the treated vein and LEED in groups B1 and B2 were 40 ± 11 and 27 ± 10 minutes, 36 ± 10 and 33 ± 10 cm and 84 ± 10 and 77 ± 18 J/cm2, respectively. Furthermore, the mean operative time in group B1 (with no phlebectomy) was 31 ± 9 minutes, whereas that in group B2 (with no phlebectomy) was 22 ±7 minutes, which was statistically significant (p<0.05). The level of pain peak was day 1 in group A patients and on days 3-7 in group B1 patients; the group B2 patients felt little pain. Surgical site infection at the phlebectomy site was observed in two group B2 patients. EVLA resulted in an occlusion rate of 99.6% at approximately two years after surgery. Conclusions: This study showed that EVLA using the 1470-nm laser caused less pain and bruising than EVLA using the 980-nm laser. The operative time of EVLA was approximately 9 minutes shorter than that of stripping. Therefore, EVLA using the 1470-nm laser might be the first treatment of choice for patients with saphenous vein reflux. However conventional surgery remains important because EVLA is not suitable in cases in which the diameter of the saphenous veins is >20 mm or in patients with highly tortuous veins.

Treatment of Primary Varicose Veins in Japan: Japanese Vein Study XVII.

Purpose: This study aimed at clarifying the changes in treatments for primary varicose veins in Japan. Methods: A questionnaire was mailed to the members of the Japanese Society of Phlebology. The contents of the survey covered the treatment and treatment strategy of varicose vein cases in 2013. The results were examined and compared with the results of previous surveys conducted by the aforesaid society in 1998, 2004 and 2009. Results: Of 36078 patients, 43958 limbs were reported from 201 institutions. Saphenous type was the most common type of varicose veins that developed in patients aged 70-79 years. The C4-6 cases according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification occurred significantly more in males than in females (p <0.01). For the treatments of saphenous type and of segment type (dilatation of peripheral branch), endovenous laser ablation (EVLA) was performed most frequently (51%), while the frequency of stripping and of high ligation decreased. EVLA was performed with tumescent local anesthesia, which required one day of hospitalization. Conclusion: In our study, the number of patients with varicose veins increased especially in the elderly. Surgical treatments were selected for a number of patients, and EVLA was the most commonly adopted method of treatment in Japan. (This article is a translation of Jpn J Phlebol 2016: 27; 249-57.).

Management of Rhinophyma

ABSTRACT Rhinophyma is a condition that can cause significant disfigurement as well as functional impairment of the nose. It results from hypertrophy and hyperplasia of the sebaceous glands and can be a manifestation of advanced staged rosacea. If left untreated, not only can it cause disfigurement, rhinophyma can also result in nasal airway obstruction by marked ptosis and collapse of the external nasal valve. Surgical excision is the definitive treatment as rhinophyma does not spontaneously regress. Though various surgical techniques are available for the treatment of rhinophyma, a specific technique using tumescent anesthesia, sharp dissection, and argon beam coagulation has been found to be most efficacious. This technique and its advantages are described. How to cite this article Lian TS, Thompson RW. Management of Rhinophyma. Int J Head Neck Surg 2016;7(3):188-191.