Treatment Of Varicose Veins Research Articles

Comparative study between great saphenous vein endovenous laser ablation (EVLA) and modified haemodynamic correction (CHIVA) as a treatment for varicose veins

Varicose veins (VV) could be a handicapping condition which may lead to limb swelling, pain and venous stasis ulcer. Prevalence of VV could present from 1% to 73% and from 2% to 56% at women and men respectively. CHIVA has been developed through the last two decades and is currently the second most common surgical procedure for the operative management of VV. Endovenous laser treatment of GSV was approved by FDA in 2002 and SSV was approved in 2003. EVLT allows delivery of Laser energy directly into the blood vessel lumen. EVLT with a 1470-nm diode Laser system is clinically safe, feasible and well-tolerated technique without scar and allows people to return to their normal daily activities rapidly. In a prospective comparative study between January 2018 and January 2020, 40 patients from those attended the outpatient departments complaining from VV were assessed according to the CEAP classification and ultrasonic duplex and arranged into group I (CHIVA) and group II (EVLA). Both CHIVA operation and EVLA were performed under local anesthesia. Cases were reviewed regularly at the outpatient clinic for 6 months for recurrence and complications. The recurrence occurred at 2/20 and 0/20 at CHIVA and EVLA respectively.

One-year duplex ultrasound-assessed closure outcomes of percutaneous endovenous microwave ablation for the treatment of varicose veins of the lower limbs.

This study aims to investigate the safety and efficacy of a new device using microwave technology for the endovenous ablation of the great saphenous vein (GSV) causing symptomatic lower limb varicose veins (LLVV). This prospective, single-arm, single-center, cohort study investigated the safety and effectiveness of endovenous microwave ablation for the treatment of symptomatic LLVV. Enrollment period was set between January and December 2020. Primary safety endpoint was the occurrence of procedure-related complications and primary efficacy endpoint was anatomical success defined as the duplex ultrasound (DUS)-proven GSV occlusion at 1year follow-up. Secondary endpoints included 1-year clinical success (CEAP classification improvement), repeat procedures rate due to GSV recanalization, and pain assessment at 24h post treatment. In total, 50 patients (42 female; mean age: 62 ± 12years) with 64 limbs were treated. No procedure-related complications were noted. Technical success was 95.3% (61/64 GSVs), as three cases of GSV recanalization were detected. Clinical success was 100%, as in all cases symptoms improvement by at least one grade according to CEAP classification, was achieved. Mean CEAP grade significantly improved from 3.3 ± 0.72 (median: 3) at baseline to 1.8 ± 0.85 (median: 2) at 1-year (p < 0.0001). There were no repeat procedures due to GSC recanalization. The median 24-h VAS value was 2 (mean: 1.9 ± 1.4). Endovenous microwave ablation was safe and effective for the treatment of varicose veins, achieving high 1-year GSV occlusion rates.

UNVEILING THE PHYTOCHEMICAL PROFILE, SECONDARY METABOLITE QUANTIFICATION AND ANTIOXIDANT ACTIVITY OF CLEMATIS WIGHTIANA WALL. EX WIGHT and ARN.

Traditionally, the leaves of Clematis wightiana have been used in the treatment of rheumatism, indigestion, headaches, varicose veins, bone problems, nasal congestion and sinus. The present study was conducted to evaluate the phytochemical profile, quantification of secondary metabolites and free radical scavenging capacity of C. wightiana leaf. The total phenolic, tannin and flavanoid content of C. wightiana leaves were quantified and were found to be higher in the ethyl acetate extract. Subsequently, the extracts were subjected to appraise their antioxidant capacity by availing various in vitro antioxidant assays namely DPPH radical scavenging assay, ABTS assay, Phosphomolybedenum assay, Ferric Reducing assay, Superoxide Radical Scavenging assay and Reducing power assay. The results of the antioxidant assays revealed that the ethyl acetate extract of C. wightiana leaves possess better free radical scavenging activity than other solvent extracts. Thus, the finding of the study elucidates the perception on phytochemical and bioactivity of C. wightiana which could be used in development of phytotherapeutics to enchance human health. Keywords: Clematis wightiana, Antioxidant, Superoxide radical scavenging, In vitro antioxidant assay, DPPH, Ethnomedicine.

Treatment Of Non-aesthetic Facial Veins: A Case Study Of The Combined Method Of Laser With Polidocanol Foam

Background: The veins in the frontal region of the face, Right Supratrochlear Vein, and Left Supratrochlear Vein can become exaggeratedly dilated in situations of emotion (crying or smiling), stress, physical exertion, lowering the head and other situations that can cause great embarrassment. Nd:Yag 1064nm is the most versatile LASER for the treatment of facial vessels, and can be used in telangiectasias and reticular veins. It’s different spot size and pulse duration settings allow the most suitable parameterization for different types of veins. Due to its ease, practicality of use and for delivering good results, sclerotherapy is still the gold standard technique for sclerosis of varicose veins and telangiectasias. The 1064 nm Nd:YAG LASER is also efficient. Its limit is more restricted in veins of larger caliber (&gt;3mm) and faster flow and, for physical reasons, the distance from the varicose vein to the skin should not exceed 3.5mm to 4mm. The pain at high fluences, the higher cost and the occurrence of relapses when used alone, make us opt for combined therapies in some situations. Case: Patient P.B.C, female, 43 years old, dancer, without previous comorbidities. She looked for an outpatient doctor with vascular care in February/2022 with a complaint of discomfort due to the forehead, with significant vessel dilation after physical exercise. Physical examination showed a dilated right and left supratrochlear veins. The treatment of sclerotherapy with polidocanol foam associated with the QS Nd:YAG 1064nm laser was indicated. Conclusion: Sclerotherapy associated with selective and immediate photo thermolysis, using the long-pulse Nd:YAG 1064 LASER increases the efficiency of the treatment of varicose veins, reducing possible complications when any of the techniques are used in isolation.

S2k guidelines: diagnosis and treatment of varicose veins.

2 Abstract2.1 Participating professional associations and organisationsThese guidelines for the diagnosis and treatment of varicose veins were prepared under the guidance of the Deutsche Gesellschaft für Phlebologie e. V. (DGP) in cooperation with the Deutsche Gesellschaft für Gefäßchirurgie und Gefäßmedizin—Gesellschaft für operative, endovaskuläre und präventive Gefäßmedizin e. V. (DGG), the Deutschen Gesellschaft für Angiologie, Gesellschaft für Gefäßmedizin e. V. (DGA), the Deutsche Dermatologischen Gesellschaft (DDG), the Deutsche Gesellschaft für Dermatochirurgie e. V. (DGDC), the Berufsverband der Phlebologen e. V. (BVP), and the Arbeitsgemeinschaft der niedergelassenen Gefäßchirurgen Deutschlands e. V. (ANG). This updated 2018/2019 version is based on the guidelines agreed and drafted by the same associations in 2004 and 2009, and it was adopted by the Boards of the participating professional associations on 30 April 2019.2.2 Development stage of the guidelinesThese guidelines are based on a structured consensus process, drawing on published data to create consensus-based guidelines at development stage S2k.2.3 Delegates of the professional associationsSee: https://www.awmf.org/uploads/tx_szleitlinien/037-018l_S2k_Varikose_Diagnostik-Therapie_2019-07.pdf.2.4 Selected literatureThe recommendations are based on the same publications used in previous versions and a systematic literature review carried out on 21 July 2016 in the German Institute for Vascular Public Health Research (DIGG). The review included randomised studies, meta-analyses, and controlled studies. The literature search was carried out in the Medline and PubMed databases with the following search fields in German and/or English: sclerotherapy, endovenous thermal ablation, mechanochemical ablation, cyanoacrylate glue, surgical procedures (stripping), and diagnosis, prognosis, and postoperative care of varicose veins. A manual search was carried out for later publications up to December 2018.2.5 RecommendationsThe strengths of the consensus-based recommendations are based on the recommendations of the AWMF. The following levels are used: Shall/shall not: strong recommendation Should/should not: recommendation Can be considered/can be omitted: open recommendation

Study of Subfascial Endoscopic Perforator Surgery Combined with Endovenous Laser Treatment in the Treatment of Great Saphenous Varicose Veins.

Great saphenous varicose vein (GSVV) is a venous reflux disease of the lower extremity. In order to explore the clinical effect of subfascial endoscopic perforator surgery (SEPS) with endovenous laser treatment (EVLT) in the treatment of GSVV, 80 patients who underwent unilateral saphenous varicose surgery are analyzed. The operation results show that the patients who used SEPS + EVLT have less operation time and mean blood loss, shorter postoperative active time and hospitalization stay, better curative effect, and higher notch aesthetics (P < 0.05). SEPS combined with EVLT has a remarkable curative effect in the treatment of saphenous varicose veins of lower extremity, which can significantly shorten the hospitalization time of patients and improve the coagulation index and stress index.

Campaign for the optimal treatment of varicose veins: welcoming the declaration of the Code of Ethics issued by the Korean Society for Phlebology

Background: Varicose veins (VV) is a common chronic venous disorder that is often left untreated due to its minor symptoms. However, recent developments in minimal invasive surgery has resulted in a rapid increase of VV treatment cases. Unfortunately, there have been some ethical issues regarding the high cost of intervention and non-professional treatment administered for VV at some private clinics.Current Concepts: Most endovenous therapies for VV are not reimbursed by the national health insurance but are only covered by personal health insurance plans in Korea. Rapid increase in the coverage costs for VV treatment has led to conflicts between the insurance companies and doctors in several cases. Recently, the Korean Society for Phlebology declared the Code of Ethics to support evidence-based treatment and warn against unethical practices related to interventions for VV.Discussion and Conclusion: The Korean Society for Vascular Surgery and Korean Society for Phlebology have just launched a campaign for the optimal treatment of VV on their YouTube channel, which shares accurate information regarding VV treatment to inform patients and doctors. To strengthen doctor-patient relationship and to avoid falling prey to unethical practitioners, it is critical to educate and update patients and healthcare service providers regarding the options available for VV treatment.

Myths and truths about varicose veins

Background: Varicose veins are a common chronic venous disorder that leads to a significantly reduced quality of life and high healthcare resource burden. There is a large amount of research-based data and opinions regarding varicose veins. There are also some common myths and misconceptions about the treatment options.Current Concepts: Management options include compression therapy, open venous surgery, and endovenous therapy. An appropriate treatment option must be selected on a case-by-case basis based on the symptoms, severity, and duplex ultrasonography findings. Venous intervention should be considered if the condition is symptomatic and often, there is no need for urgent surgery or endovenous therapy because the symptoms usually progress slowly and severe cardiac problems are rare. According to previous studies, there is no difference between the endovenous therapy modalities and the traditional surgical method (i.e., high ligation and stripping) in terms of recurrence rates. Therefore, case-specific factors, such as anatomy and economic factors, should be considered. When compression therapy is considered, graduated compression stocking with suitable pressure should be prescribed. Venoactive drugs can be suggested in addition to compression therapy for symptomatic varicose veins or venous ulcers.Discussion and Conclusion:. Correct information regarding treatment for varicose veins based on the best available evidence must be provided to patients. The treatment options for varicose veins should be selected on a case-by-case basis considering the patient`s symptoms, anatomy and economic factors.

Second-generation treatment of varicose veins: endovenous thermal ablation by laser or radiofrequency ablation

Background: Endovenous thermal ablation (EVTA) is the second-generation treatment of varicose veins in the lower extremities. It has overcome the shortcomings of the first-generation treatment of high ligation and stripping. Further, it is the basis for the development of the third-generation treatment with endovenous glue ablation. It is currently recommended as the first-line treatment for varicose veins accompanied by great saphenous vein incompetence.Current Concepts: EVTA involves obliterating the varicosed veins by applying thermal energy to blood or vein wall. It can be performed by laser or radiofrequency ablation methods, under local anesthesia. The treatment results are excellent and show lesser pain and faster recovery compared to the first-generation treatment. However, complications include endovenous heat-induced thrombosis, deep vein thrombosis, ecchymosis, and phlebitis.Discussion and Conclusion: To enhance the therapeutic effect and reduce the complications of EVTA, sufficient tumescent anesthesia, a controlled number of firing in radiofrequency ablation, and use of the novel highwavelength laser and a radial catheter tip in endovenous laser ablation are recommended. In addition, proficiency in other generations of varicose vein treatments could help in various situations.

Third-generation treatment of varicose veins: cyanoacrylate adhesive closure and mechanochemical ablation

Background: The mainstream of incompetent saphenous veins treatment has dramatically changed from the first-generation conventional high ligation and stripping surgery to the second-generation endovenous thermal ablation as a minimally invasive technique using laser or radiofrequency. The third-generation treatment of nonthermal non-tumescent techniques is already available, including cyanoacrylate adhesive closure (CAC) and mechanochemical ablation (MOCA).Current Concepts: The non-thermal non-tumescent techniques are developed to overcome the complications of thermal ablation, including nerve injury and vein perforation. The technique also reduces the need for painful tumescent anesthesia and postoperative compression. MOCA employs a dual injury using a single-catheter-based delivery system consisting of a mechanical abrasion with a rotating wire and chemical ablation with a sclerosant. CAC is executed by injecting a glue that produces a polymer with the blood and obliterates the lumen. CAC does not need tumescent anesthesia and postoperative compression. Therefore, patient recovery is fast and satisfaction is excellent. However, the new devices are expensive and not included in the medical insurance in Korea, and long-term effects of the new treatments are unproven; therefore, the cost-effectiveness is unconfirmed.Discussion and Conclusion: MOCA and CAC are newly developed minimal invasive treatments for varicose veins. They are reported to be safe and effective techniques. However, further studies are needed to evaluate the long-term outcomes and cost-effectiveness.

Hypoxia Promotes Human Umbilical Vein Smooth Muscle Cell Phenotypic Switching via the ERK 1/2/c-fos/NF-κB Signaling Pathway

Vein wall hypoxia has long been suggested as a key factor for the development of varicose veins (VVs) and accumulating evidence has revealed the phenotypic transformation of vascular smooth muscle cells (VSMCs) under hypoxic conditions. However, the underlying molecular mechanisms of this process remain poorly understood. Our previous study revealed a positive correlation between c-fos expression and VSMC functional disturbance of VVs. This study aimed to further explore the role of c-fos in the phenotypic switching of VSMCs under hypoxic conditions. Human umbilical vein smooth muscle cells (HUVSMCs) were cultured under hypoxia or normoxia. PD0325901 (10 μmol/L) and pyrrolidine dithiocarbamate (PDTC) (10 μmol/L) were used to inhibit the extracellular signal-regulated kinase 1/2 (ERK1/2) and nuclear factor-κ B (NF-κB) signaling pathways, respectively. HUVSMCs stably overexpressing c-fos were constructed to explore the underlying mechanism. The Western blot analysis was performed to detect the protein expression levels of c-fos, phosphorylated p65 (p-p65), interleukin-1β (IL-1β), cyclooxygenase-2 (COX-2), osteopontin (OPN), and α-smooth muscle actin (α-SMA). Cell proliferation and migration capacity were detected by a Cell Counting Kit 8 (CCK-8) assay and a wound-healing assay, respectively. The cell apoptotic rate was determined using the Annexin V-FITC Apoptosis Detection Kit. Hypoxic exposure increased the expression levels of indicators of the p-ERK1/2/c-fos and NF-κB signaling pathways, which was accompanied by altered levels of phenotypic biomarkers (α-SMA and OPN). Cells exposed to hypoxia were characterized by a greater proliferative and migratory ability. No significant differences were observed in the rate of cell apoptosis between the normal group and the hypoxic group. In addition, inhibition of the ERK1/2/c-fos signaling pathway by PD0325901 (10 μmol/L) reduced the expression of inflammatory cytokines and attenuated hypoxia-mediated phenotypic transformation. Furthermore, inhibition of the NF-κB signaling pathway by PDTC (10 μmol/L) downregulated the expression level of OPN and reduced the migration of HUVSMCs under hypoxia exposure. However, pretreatment with PDTC did not suppress the expression of c-fos or cell proliferation. Finally, the introduction of exogenous c-fos in HUVSMCs induced increased protein expression levels of p-p65, COX-2, and OPN, accompanied by a remarkable increase in HUVSMC proliferation and migration. Our research demonstrated that hypoxia could promote the phenotypic transformation of HUVSMCs partially through the ERK1/2/c-fos/NF-κB signaling pathway, which provided a novel insight into hypoxia-associated venous wall remodeling to furtheraid the development of a novel therapeutic target for the prevention or treatment of VVs.

On the peculiarities of preparation of patients with venous trophic ulcer in outpatient conditions for the performance of radiofrequency ablation of veins

Annotation. The number of patients with venous trophic ulcer is constantly growing. At the same time, there is no effective method of their treatment in outpatient conditions. This issue is of fundamental importance for reducing the period of preparation of patients for radiofrequency ablation (RFA)of varicose veins. The aim of the study. The purpose of the study was: to give a clinical justification for the use of ultrasound debridement, PRP and PRF therapy to stimulate the regeneration process in venous ulcers in outpatient settings, for the aim of prepare patients for the implementation of RFA varicose veins. Under observation were 75 patients with varicose veins of the lower extremities in the stage of decompensation (C6 according to the CEAP classification). There were 49 women, 26 men, 55±4.6 years old. The duration of existence of venous ulcers was 2.1±06 years. The average size of ulcers is 4.5±1.7 cm. Ultrasound debridement was used to purify venous ulcers from necrotic masses, followed by stimulation of the regeneration process in them through PRP and PRF therapy. Thanks to the use of ultrasound debridement, it was possible to translate the chronic inflammatory process into an acute one. So, after the first session of ultrasound debridement, the wounds are regenerative and inflammatory in nature, which is confirmed by their cytological examination. Further use of PRP and PRF as a local factor in stimulating the regeneration process in venous ulcer caused the transition of regenerative-inflammatory to regenerative type of ulcer healing. Thanks to this approach to the treatment of venous ulcers, it was possible to reduce the time for surgical training of patients by 1.87 times. Treatment of venous ulcers, including ultrasound debridement – stimulation of the wound process PRP and PRF followed by operations aimed at eliminating the causes of decompensated chronic insufficiency is a promising direction in the treatment of varicose veins in outpatient settings.

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.

Comparative study of ambulatory phlebectomy and foam sclerotherapy in the treatment of primary non-axial varicose veins

Comparative study of ambulatory phlebectomy and foam sclerotherapy in the treatment of primary non-axial varicose veins

Indian venaseal™ Experience study – Outcomes of nonthermal and nontumescent endovenous glue ablation for treatment of truncal reflux in varicose vein disease

Background: Varicose veins is a common disease in nearly 37.25% of the Indian population significantly affecting the quality of life. Endovenous thermal ablation has been the first-line treatment for superficial venous reflux. A new technique, available now, is nonthermal nontumescent vein sealing system (VenaSeal™), which comprises endovenous delivery of cyanoacrylate tissue adhesive into the vein causing obliteration of lumen and has shown better results in terms of safety and efficacy. Being a new modality, only handful of institutes across India perform this procedure and there is a scarcity of Indian data on its outcomes. Aims and Objectives: To evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in Venous Clinical Severity Score (VCSS). Materials and Methods: Single-centre prospective study of fifty patients over 1 year and 4 months with 3- and 6-month follow-up. Results: The study showed the mean age of the study group to be 43.8 years and the majority (90%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 89.1 cm, and the average glue used per limb was 2.95 ml. All patients showed improvement in VCSS score from preoperative average of 2.6 ± 1.4 to 0.32 ± 0.19 (P &lt; 0.0001, n = 89) with target vein occlusion rate of 100% at 3 months and 97.75% at 6 months. Conclusion: Thus, VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates, minimal complications, and maximum patient acceptability. It is a feasible Out patient department (OPD) based procedure.

A review on remedies used in treatment of varicose veins and varicocele

Varicose vein is clinical class of the (CVD) i.e. chronic venous disease, also called as the varicosities. Varicose veins are enlarged, swollen and twisting veins often appearing blue or dark purple. When valves in the veins do not work properly, the blood does not flow effectively. The expansion of varicose veins is often caused by a weakening of valves and walls. Generally varicose vein is found in females especially in case of pregnancy. Varicose veins generally found in lower extremity, leg and the epididymis. Epididymis is the highly convoluted duct behind the testis along which sperm passes to the vas deferens. A varicocele is an enlargement of the veins within the loose bag of skin that holds your testicles or scrotum. A varicocele is similar to a varicose vein you might see in your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. The aim of writing this review is to provide information about the varicose vein and varicocele the remedy to be used in its treatment and different tests available for its diagnosis.

A review on remedies used in treatment of varicose veins and varicocele

A review on remedies used in treatment of varicose veins and varicocele

Clinical Assessment of Endovenous Thermal Ablation Combined With Concomitant Phlebectomy for the Treatment of Lower Limb Varicose Veins With or Without Poor Glycemic Control

In this study of >500 patients, with 33% classified as having diabetes, varicose vein treatment with thermal ablation and stab phlebectomy was safe and effective, regardless of glycemic control. This study retrospectively evaluated 501 patients treated for unilateral symptomatic varicose veins with combined thermal ablation and stab phlebectomy. Of the cohort, 164 (33%) had had a diagnosis of type 2 diabetes mellitus. These patients were further subdivided into those with good glycemic control (hemoglobin A1c [HbA1c] <7%; n = 93) and those with poor glycemic control (HbA1c ≥7%; n = 71). All the patients were followed up for 1 year, and the venous clinical severity score was used before and after the procedure. The group demographics were comparable expect for the greater occurrence of venous ulcerations, C6 disease, in the poor glycemic control group. All the patients, with and without good glycemic control, had had good outcomes in terms of edema and pain improvement, ulcer healing, and quality of life parameters. Venous surgeons clearly must weigh the benefits and risks of performing interventions on patients with diabetes and poor glycemic control. These patients have a much higher risk of less than satisfactory outcomes, cardiac and anesthetic complications, and infection. In my practice, I would be turning cartwheels if my patients were able to maintain a HbA1c of <7%, which is not even the most desirable rate of control. For patients with venous ulcerations, any improvement in the anti-inflammatory state caused by diabetes can only aid in the healing process. I am left wondering about the measurement and accuracy of the glycemic control in this study. Were measurements of HbA1c performed, revealing changes in glycemic control that could have influenced the outcomes, or was the HbA1c only measured at the intervention? What level of HbA1c was considered prohibitive? Were the glycemic levels more difficult to control to begin with for the venous ulcer patients with diabetes as a direct result of the ulcer? Finally, was this an older group with more longstanding diabetes and the resulting inflammation and oxidative stress?

Compression following Endovenous Treatment of Incompetent Varicose Veins by Sclerotherapy (CONFETTI)

Compression following Endovenous Treatment of Incompetent Varicose Veins by Sclerotherapy (CONFETTI)

Efficacy of Endovascular Laser Ablation for the Management of Venous Leg Ulcers

Venous leg ulcers (VLUs) represent a significant disease burden worldwide owing to their high incidence, increasing prevalence, slow or nonhealing, high recurrence rate, and considerable patient and financial burden on the healthcare system. Newer, minimally invasive techniques have been widely used for the treatment of varicose veins with or without active VLUs. This is a retrospective study to evaluate the efficacy of endovenous laser ablation (EVLA) in the treatment of VLUs owing to superficial venous reflux.