Vein Occlusion Rates Research Articles

Comparison of one-year outcomes and quality of life between radiofrequency ablation and microwave ablation in the treatment of lower extremity varicose veins: A retrospective cohort study.

This study compared the outcomes of radiofrequency ablation (RFA) and microwave ablation (EMA) for treating lower limb varicose veins. Patients who underwent RFA (n = 240) or EMA (n = 209) at our institute from December 2020 to August 2022 were included in this retrospective investigation. Follow-up outcomes included active vein occlusion rate, Venous Clinical Severity Score (VCSS), the Aberdeen Varicose Vein Questionnaire (AVVQ), and Chronic Insufficiency Venous Quality of Life questionnaire-14 (CIVIQ-14)score. There was no significant difference in the active vein occlusion rate between the two groups after the operation (p > .05). Compared to pre-surgery scores, both groups showed substantial improvement in VCSS, AVVQ, and CIVIQ-14 scores(p < .05), there was no significant difference in these scores in either group (p > .05). Intravenous radiofrequency and microwave ablation effectively improve the quality of life for patients with lower limb varicose veins, with low post-operative complication and recurrence rates.

Longer term follow-up of a randomized controlled trial on the role of compression after radiofrequency ablation of varicose veins

ObjectiveSeveral studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term. MethodsAll 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities. ResultsThirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (P = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), −7.3 to 1.1; P = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, −1.1 to 0.7; P = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, −0.22 to 1.17; P = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, −7.7 to 6.2; P = .83]). ConclusionsThis study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.

Effect of short-term compression therapy after thermal ablation for varicose veins: study protocol for a prospective, multicenter, non-inferiority, randomized controlled trial

BackgroundFor patients with varicose veins, the goal is to relieve pain and swelling, reduce the severity of edema, improve skin changes, and heal ulcers associated with venous disease. Compression therapy is the cornerstone of their management. Several studies have shown that wearing an elastic bandage for the first 24 h and then a compression stocking for a week can effectively reduce the pain after thermal ablation. However, in clinical practice, patient compliance with this treatment could be better, considering difficulties in pulling up and removing the compression stocking, tightness, and skin irritation because these must be worn for a prolonged period. A potential solution to battling these barriers is short-term compression therapy. Besides, the effect and necessity of wearing compression stockings after thermal ablation have been questioned. Based on current clinical experience and limited evidence, although some scholars have suggested that compression therapy may be an unnecessary adjunctive therapy after thermal ablation, there is still a great deal of uncertainty in the absence of compression therapy after thermal ablation compared to compression therapy. Therefore, we advocate further research to evaluate the clinical effect of short-term postoperative compression therapy. Furthermore, well-designed randomized controlled trials are needed.MethodsA prospective, multicenter, non-inferiority randomized controlled trial is designed to evaluate the non-inferiority of target vein occlusion rate at 3 months. Three hundred and sixty patients will be randomly assigned in a 1:1 ratio to one of the following treatments: (A) 3 M™ Coban™ elastic bandage for 48 h or (B) 3 M™ Coban™ elastic bandage for the first 24 h and then a class II compression full-length stocking (23–32 mm Hg) for 1 week. The two groups will be compared on several variables, including target vein occlusion rate at 3 months (primary outcome indicator), pain, quality of life, clinical severity of varicose veins, postoperative complications, time to return to regular work, and compliance.DiscussionSuppose the effect of the 3 M™ Coban™ elastic bandage for 48 h proves to be non-inferior to long-term compression therapy. In that case, this short-term treatment may contribute to a future update of clinical guidelines for compression therapy after thermal ablation of varicose veins, resulting in higher patient compliance and better postoperative quality of life.Trial registrationClinical Trials NCT05840991. Registered on May 2023.

Comparison of Peroperative Venous Grafts Number and Distribution of Distal Venous Grafts

Introduction: Coronary artery bypass grafting effectively relieves signs and symptoms of myocardial ischemia. Coronary artery bypass grafting (CABG) surgery aims to restore adequate blood supply to the ischemic heart and the success of the operation depends mainly upon the patency of the grafts. A major contributing factor to the early atherosclerotic process is damage to the vessel wall, specially endothelial injury that occurs during the conventional harvesting of the vein, using high-pressure distension. Objective: To determine the comparison of peroperative venous grafts number and distribution of distal venous grafts. Materials and Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in National Heart Foundation Hospital &amp; Research Institute. The period of study was from January, 2019 to September, 2020 and purposive sampling method was applied for this study. The study population was 80, with two groups having 40 patients each. Grouping of patients were done by purposive sampling method and all patients underwent elective coronary artery bypass graft in 2015. These groups of patients again investigated through coronary computed tomography angiogram in 2020 for evaluation of saphenous vein patency and occlusion rate. Data was collected by using a standardized semi-structured questionnaire, face to face interview and hospital records. Results: Among the study population mean age in group A was 59.38±7.43 years and in group B was 58.70±8.27 years. The difference in age between two groups was not statistically significant (p=0.702). There was no statistical significance of gender in between the two study groups (p=0.762). The comparison of the presence of Chest pain (p=0.799), Dyspnea (p=0.262), Palpitation (p=0.633) in group A and B patients were statistically not significant (p&gt;0.05). The number of venous grafts of group A was 3.65±0.74 &amp; group B was 3.58±0.55 where the finding was statistically ............

Clinical outcomes following mechanochemical ablation of superficial venous incompetence compared with endothermal ablation: meta-analysis.

Mechanochemical ablation (MOCA) is an alternative method to endovenous thermal ablation (EVTA) for the treatment of superficial venous incompetence that does not require tumescent anaesthesia. The aim of this study was to compare the outcomes from RCTs of MOCA versus EVTA. A search was conducted in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Meta-analysis inclusion was restricted to RCTs comparing MOCA against EVTA. Outcomes included anatomical occlusion rate, disease-specific quality of life using the Aberdeen Varicose Vein Questionnaire, procedural and postprocedural pain, and rates of venous thromboembolism. Four RCTs were included in the meta-analysis comprising 654 patients. The anatomical occlusion rate at 1 year was lower after MOCA than EVTA (risk ratio 0.85, 95 per cent c.i. 0.78 to 0.91; P < 0.001). No significant differences were detected in procedural pain (mean difference -3.25, -14.25 to 7.74; P = 0.560) or postprocedural pain (mean difference -0.63, -2.15 to 0.89; P = 0.420). There were no significant differences in Aberdeen Varicose Vein Questionnaire score at 1 year (mean difference 0.06, -0.50 to 0.62; P = 0.830) or in incidence of venous thromboembolism (risk ratio 0.72, 95 per cent c.i. 0.14 to 3.61; P = 0.690). The rate of successful anatomical occlusion after MOCA is significantly lower than that after EVTA, but there is no difference in procedural and postprocedural pain between the two interventions. Long-term data are required to assess the impact of the reduced vein occlusion rate on clinical outcomes such as quality of life and reintervention.

Optical coherence tomography angiography evaluation of retinal and optic disc microvascular morphological characteristics in retinal vein occlusion.

To evaluate microvascular morphological characteristics of the retina and optic disc (OD) in retinal vein occlusion (RVO) patients using optical coherence tomography angiography (OCTA), compare the results to age- and gender-matched healthy subjects, and determine correlations between OCTA parameters and best-corrected visual acuity (BCVA) and age. In this retrospective study, right eyes of 53 RVO patients and 51 healthy subjects were compared regarding BCVA, as well as superficial and deep capillary plexus (SCP and DCP) vessel densities (VDs), foveal avascular zone (FAZ) parameters, outer retinal and choriocapillaris flow areas, OD whole and peripapillary VDs, and retinal nerve fiber layer thickness (RNFLT). Retinal vein occlusion patients were further divided into subgroups based on therapy and risk factors, and OCTA parameters were compared. Retinal vein occlusion rate or OCTA parameters did not differ significantly by gender (p>0.05). Retinal vein occlusion patients had significantly decreased BCVA, whole, parafoveal and perifoveal SCP and DCP VDs, as well as VDs 300µm area around FAZ (FD-300) than healthy subjects (p<0.001). Their choriocapillaris flow area, RNFLT, whole and peripapillary VDs were also affected. However, FAZ area did not differ significantly between groups. Superior RNFLT (p=0.016) and whole peripapillary VD (p<0.001) differed significantly between laser photocoagulation-treated and non-treated patients. The remaining OCTA parameters revealed no significant differences CONCLUSIONS: The RVO and its therapeutic alternatives may affect both OD and retinal VDs. Given its numerous benefits, it seems that OCTA will be used more frequently in clinics for RVO diagnosis, monitoring, and therapeutic response evaluation.

Indian VenaSeal™ Experience Study Extension: Outcomes of Nonthermal, Nontumescent Endovenous Ablation (VenaSeal™) for the Treatment of Truncal Reflux in Varicose Vein Disease – An Indian Perspective with 2-Year Follow-up

Background: Varicose vein disease is a common disease in nearly 37.25% of Indian population affecting 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 a 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 VCSS score. Materials and Methods: The Indian VenaSeal Experience Study was carried out a year back, which was a single-center prospective study of 50 patients over 1 year and 4 months with 3 and 6 months of follow-up, and we aimed to evaluate the outcomes of VenaSeal™ glue ablation in terms of vein occlusion rates and improvement in venous clinical severity score (VCSS). This is an extension of that study with 200 patients (378 limbs) with similar parameters for outcome evaluation. Results: The study showed the mean age of study group to be 48.6 years and majority (87%) had an early varicose vein (C2/C3) disease. The average length of vein treated per limb was 62.6 cm and the average glue used per limb was 3.05 ml. All patients showed improvement in VCSS score averaging 2.3 ± 1.6 (P &lt; 0.0001, n = 378) with target vein occlusion rate of 98% at 6 months (n = 182), 97% at 12 months (n = 126), and 95% at 2 years (n = 98). Conclusion: VenaSeal™ glue ablation procedure is a promising and effective modality for the treatment of varicose veins with excellent treatment success rates and maximum patient acceptability. However, complications such as severe phlebitis and anaphylaxis have been reported. It is a feasible option under local anesthesia, does not require tumescence, and hence an efficient outpatient department-based procedure.

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.

Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins.

ObjectiveThis study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV).DesignProspective, single-centre, analytical cohort.Materials and MethodsThirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked.ResultsThe sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14–24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10–12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time.ConclusionExclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.

Great saphenous vein occlusion rates after combined treatment with laser and foam sclerotherapy

BackgroundEndovenous laser ablation (EVLA) and foam sclerotherapy are effective and safe treatments for chronic venous disease with great saphenous vein (GSV) reflux. We report our experience combining both strategies as a merged approach to treat GSV incompetence to potentiate both methods' superiority and benefits. We aimed to determine the effectiveness of this treatment strategy. MethodsA total of 246 limbs with GSV incompetence (C2-C6) treated with EVLA and foam sclerotherapy between January 2016 and December 2019 were retrospectively analyzed. Outcomes of interest were the International Union of Phlebology (IUP) type of anatomic closure (primary, primary assisted, secondary, and therapeutic failure), identified with ultrasound in the GSV after the procedure. Clinical and ultrasound follow-up was conducted at 2 weeks, 3, 6, and 12 months after intervention. We used the Fisher exact test to determine the significance of the association between the type of anatomic closure and the clinical stage according to the Clinical-Etiology-Anatomy-Pathophysiology classification. ResultsA total of 67% of the treated limbs were C2-C4 and 33% C5-C6. IUP primary closure was achieved in 229 limbs (93%), IUP primary assisted closure in 10 limbs (4%), IUP secondary closure in 1 limb (0.4%), and therapeutic failure in 6 limbs (2%). A total of 45 limbs (18%) required microthrombectomies of tributary veins due to local induration, 7 (2.8%) developed dyschromia, 4 (1.6%) had type 1 endovenous heat-induced thrombosis, and 1 limb (0.4%) developed deep vein thrombosis, which was successfully treated with anticoagulation. ConclusionsOur results demonstrate a high occlusion rate of incompetent GSVs with combined EVLA and foam sclerotherapy with infrequent nonserious complications and one case of subclinical isolated popliteal deep vein thrombosis. Combined therapy effectiveness and safety are comparable with other endovenous treatments for chronic venous disease with GSV reflux. The use of both thermal and chemical ablation combines the benefits of both techniques.

Short- and long-term outcomes after minimally invasive versus open spleen-saving distal pancreatectomies.

Introduction:This study aimed to compare the perioperative outcomes of patients who underwent minimally invasive spleen-preserving distal pancreatectomy (MI-SPDP) versus open surgery SPDP (O-SPDP). It also aimed to determine the long-term vascular patency after spleen-saving vessel-preserving distal pancreatectomies (SSVDPs).Methods:A retrospective review of 74 patients who underwent successful SPDP and met the study criteria was performed. Of these, 67 (90.5%) patients underwent SSVDP, of which 38 patients (21 open, 17 MIS) had adequate long-term post-operative follow-up imaging to determine vascular patency.Results:Fifty-one patients underwent open SPDP, whereas 23 patients underwent minimally invasive SPDP, out of which 10 (43.5%) were laparoscopic and 13 (56.5%) were robotic. Patients who underwent MI-SPDP had significantly longer operative time (307.5 vs. 162.5 min, P = 0.001) but shorter hospital stay (5 vs. 7 days, P = 0.021) and lower median blood loss (100 vs. 200 cc, P = 0.046) compared to that of O-SPDP. Minimally-invasive spleen-saving vessel-preserving distal pancreatectomy (MI-SSVDP) was associated with poorer long-term splenic vein patency rates compared to O-SSVDP (P = 0.048). This was particularly with respect to partial occlusion of the splenic vein, and there was no significant difference between the complete splenic vein occlusion rates between the MIS group and open group (29.4% vs. 28.6%, P = 0.954). The operative time was statistically significantly longer in patients who underwent robotic surgery versus laparoscopic surgery (330 vs. 173 min, P = 0.008).Conclusion:Adoption of MI-spleen-preserving distal pancreatectomy (SPDP) is safe and feasible. MI-SPDP is associated with a shorter hospital stay, lower blood loss but longer operation time compared to O-SPDP. In the present study, MI-SSVDP was associated with poorer long-term splenic vein patency rates compared to O-SSVDP.

A multi-institutional review of endovenous thermal ablation of the saphenous vein finds male sex and use of anticoagulation are predictors of long-term failure.

To review long-term outcomes and saphenous vein (SV) occlusion rate after endovenous ablation (EVA) for symptomatic varicose veins. A review of our EVA database (1998-2018) with at least 3-years of clinical and sonographic follow-up. The primary end point was SV closure rate. 542 limbs were evaluated. 358 limbs had radiofrequency and 323 limbs had laser ablations; 542 great saphenous veins (GSV), 106 small saphenous veins (SSV) and 33 anterior accessory saphenous veins (AASV) were treated. Follow-up was 5.6 ± 2.3 years; 508 (74.6%) veins were occluded, 53 (7.8%) partially occluded and 120 (17.6%) were patent. On multivariable Cox regression analysis, male sex (HR 1.6, 95% CI [0.46-018], p = 0.012) and use anticoagulation (HR 2.0, 95% CI [0.69-0.34], p = 0.044) were predictors of long-term failure. On Kaplan-Meier curve, we had an 86.3% occlusion rate. Our experience revealed a 5-year closure rate of 86.3%. Ablations have satisfactory occlusion rate.

Radiofrequency Endovenous Ablation: A Safe and Effective Modality for Varicose Veins Treatment

Varicose veins are dilated, tortuous superficial veins, causing aching pain, swelling, and cramps in the affected lower limb. The key behind having such a problem is venous insufficiency after valve failure in the involved dilated vein. Surgery was the standard procedure for removing these dilated veins. A new era of treatment emerged, where endovenous radiofrequency ablation is applied under local and tumescent anesthesia by the aid of Doppler ultrasound. This study aims to assess the safety and efficacy of radiofrequency ablation in treating varicose veins. Our center is the first center in Baghdad, Iraq using this technique for treating varicose veins. Forty-five patients with varicose veins were enrolled in a prospective study from October 2017, through March 2019, aged 20–56 years; females 27 (60%), and males 18 (40%). Their veins were scanned by Doppler ultrasound and were diagnosed as having venous insufficiency; a total of sixty veins were ablated by radiofrequency, fifty (83%) long saphenous veins, and only ten (17%) short saphenous veins. The patients were scored clinically using comprehensive classification system for chronic venous disorders (CEAP) clinical score, 75% of patients were C2-C4, while only 25% of patients C5-C6. The time for each limb was around 20 minutes. A 100% technical success, and an excellent vein occlusion rate postoperatively. No postoperative complications were noted. After 1-week’, 1-month’, and 6 months’ follow-up, there was an improvement in CEAP clinical score, an early post-procedure return to daily activities. Therefore, endovenous radiofrequency ablation shows excellent results in terms of safety, efficacy, and patient satisfaction.

Long-term Saphenous Vein Occlusion Rate After Endovenous Ablation

Long-term Saphenous Vein Occlusion Rate After Endovenous Ablation

Bariatric surgery might aggravate proliferative diabetic retinopathy.

This study aimed to assess the changes experienced by patients with proliferative diabetic retinopathy (PDR) after bariatric surgery (BS). This retrospective observational study includes 37 eyes of 21 patients with PDR who underwent BS at a tertiary university hospital over the period of 2014-2018. The control group (CG) comprised 37 eyes of 27 patients with PDR who attended the same research hospital for diabetes care without undergoing BS. Preoperative and postoperative glycated haemoglobin (HbA1c) levels, weight and diabetic retinopathy screening results were collected from the medical records of the patients. Patients who had undergone preoperative retinal screening and at least one postoperative retinal screening were included in the analysis. Both groups exhibited statistically significant visual acuity (VA) loss at 6months and 1year (p<0.001). At postoperative 6months the VA loss experienced by the control BS group was significantly more severe than that experienced by the CG (p=0.03). The first-year HbA1c levels of the BS group were significantly lower than those of the CG (p=0.02). The BS group had significantly higher intraocular haemorrhage (p=0.04), neovascular glaucoma (p=0.04) and retinal vein occlusion (p=0.04) rates than the CG group. All complications occurred at different patients. Patients with PDR who received BS showed more severe retinopathy than patients who were matched for age, sex, HbA1c levels and follow-up duration and who did not receive BS.

Great saphenous varicose vein treatment with endovenous ablation techniques: A comparison of EVLA and RF

Aim: In this study, we compared the clinical follow-up results and complication and success rates of patients undergoing 1470 nm wavelength endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in our clinic.Material and Methods: The records of 581 patients treated in our clinic due to clinical symptoms arising from great saphenous vein insufficiency between January 2014 and September 2018 were examined retrospectively. Three hundred fifty-seven of these patients treated with EVLA or RFA and with no deficient data were included in the study. Patients with reflux in the saphenofemoral junction lasting at least 0.5 sec, with a great saphenous vein diameter of at least 7 mm, 2 cm distal to the saphenofemoral junction, and of at least 5.5 mm at knee level, and with CEAP stage C2-C5 were scheduled for endovenous ablation. The patients were randomly distributed between the established EVLA and RFA treatment groups. Data for patients’ diagnostic and therapeutic processes were recorded and evaluated in the light of information in the literature. Results: The EVLA group consisted of 86 patients (42 male, 44 female; mean age 46 years, range 26-71), and the RFA group of 271 (113 male, 158 female; mean age 43.3 years; range 20-77). The mean follow-up time was 27.2 months. No significant differences were determined in terms of patients’ demographic data, preoperative additional diagnoses, CEAP classification values, duration of reflux, or proximal and distal great saphenous vein diameter values. Thrombophlebitis developed in 14 patients and ecchymosis/hematoma in 32. No significant difference was observed between the groups in terms of complications. Great saphenous vein occlusion rates at Doppler ultrasonography six months after treatment were 91.8% in the EVLA group and 94% in the RFA group (p=0.46). Conclusion: Our results suggest that neither of the two endovenous ablation methods is superior to the other.

Randomized Clinical Trial Of Mechanochemical and Endovenous Thermal Ablation of Great Saphenous Varicose Veins

In this prospective, randomized, controlled trial comparing endovenous thermal ablation with mechanochemical ablation (MOCA), both endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) had higher great saphenous vein occlusion rates at 1 year with similar patient satisfaction.

A Randomised Clinical Trial Comparing N-Butyl Cyanoacrylate, Radiofrequency Ablation and Endovenous Laser Ablation for the Treatment of Superficial Venous Incompetence: Two Year Follow up Results

To compare early and two year results for N-butyl cyanoacrylate (NBCA), radiofrequency ablation (RFA), and endovenous laser ablation (EVLA) in the treatment of varicose veins. This was a randomised clinical trial. Five hundred and twenty five patients were blindly randomised into NBCA, RFA, and EVLT groups (175 patients to each group; block randomisation using sealed envelopes). Four hundred and fifty six patients were monitored for 2 years (ultrasound at 2 days, and 6, 12, and 24 months). The primary endpoint was the saphenous vein occlusion rates, and the secondary endpoints were peri- and post-procedural pain, complications, and time to return to work. No simultaneous phlebectomies were performed. The numbers of patients lost to follow up were NBCA seven, RFA 26, and EVLA 36. Occlusion rates were similar at 6, 12, and 24 months (6 months [NBCA 98.1%, RFA 94.1%, and EVLA 95.1%, p=.14], 1 year [NBCA 94.7%, RFA 92.5%, and EVLA 94.2%, p=.72], 2 years [NBCA 92.6%, RFA 90.9%, and EVLA 91.5%, p=.89]). Peri-procedural pain was significantly lower after NBCA (p<.001), but complication rates (DVT, bleeding, and phlebitis) were similar. Time to return to work was shortest after NBCA (NBCA 1.04 days, RFA 1.56 days and EVLA 1.31 days (p<.001) with 95% (NBCA), 50% (RFA) and 75% (EVLA) of patients returning to work on Day 1. Pre-procedural venous clinical severity scores (VCSSs) were the same in all groups. A decrease was observed in VCSS values in all groups at 6 months, and this persisted at 1 and 2 years. However, VCSS scores at 6 months and 2 years were significantly lower in the NBCA group (p<.001). Foam sclerotherapy was subsequently applied to varicose tributaries in 18 patients from all groups. No differences were observed in occlusion rates between the three modalities, but NBCA appeared superior with respect to peri-procedural pain, return to work and decreased VCSS.

More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application

Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810nm, but today the fibers are usually 940, 980, or 1470nm. The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470nm EVLA. Patients were followed up for 48months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08±0.6). The energy applied to the saphenous vein was 60-120J/cm (84.65±13.03) and 45-120J/cm (76.95±15.06) in Group A and Group B, respectively (P<0.001), with 15W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. Group A (980nm laser) consisted of 200 patients with a mean age of 37.84±12.2years. Group B (1470nm laser) consisted of 200 patients with a mean age of 38.38±12.1years. The mean duration of the procedure was 32.2±9.7min in Group A and 31.7±8.8min in Group B, respectively (P=0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P=0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. Both the 980 and 1470nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.

Endovenous laser ablation of the great saphenous vein - Varying energy may not affect outcome.

Objectives To determine great saphenous vein occlusion rate after endovenous laser ablation using the 1470-nm bare-fiber diode laser to supply either 7 W or 15 W and evaluate procedure-related complications. Method Patients with varicose veins of the lower extremities (CEAP class C2-C6) were randomly assigned to undergo either 7-W (18 patients, 30 limbs) or 15-W (18 patients, 30 limbs) endovenous laser ablation. Duplex ultrasound follow-up was at 3-5 days, 1, 6, and 12 months postoperatively. Results Occlusion rate was 100% in both groups at 3-5 days and 1 month and 86.7% in 7-W and 100% in 15-W patients at both 6 and 12 months, with no difference between groups ( p > 0.05). Four (13.3%) 15-W and 3 (10%) 7-W patients had paresthesia at 3-5 days, with no difference between groups ( p > 0.05). Conclusions These preliminary data suggest that both techniques are similarly effective in the treatment of varicose great saphenous veins.