Vein Stripping Research Articles

Investigating microstructure evolution of lithium metal during plating and stripping via operando X-ray tomographic microscopy

Efficient lithium metal stripping and plating operation capable of maintaining electronic and ionic conductivity is crucial to develop safe lithium metal batteries. However, monitoring lithium metal microstructure evolution during cell cycling is challenging. Here, we report the development of an operando synchrotron X-ray tomographic microscopy method capable of probing in real-time the formation, growth, and dissolution of Li microstructures during the cycling of a Li||Cu cell containing a standard non-aqueous liquid electrolyte solution. The analyses of the operando X-ray tomographic microscopy measurements enable tracking the evolution of deposited Li metal as a function of time and applied current density and distinguishing the formation of electrochemically inactive Li from the active bulk of Li microstructures. Furthermore, in-depth analyses of the Li microstructures shed some light on the structural connectivity of deposited Li at different current densities as well as the formation mechanism of fast-growing fractal Li microstructures, which are ultimately responsible for cell failure.

Application of femoral nerve block combined with modified swelling anesthesia in high ligation and stripping of great saphenous vein.

To analyze and explore the clinical efficacy of ultrasound guided femoral nerve block combined with modified swelling anesthetic solution in high ligation and stripping of the great saphenous vein. 90 patients with varicose great saphenous vein of lower limbs undergoing high ligation and stripping of great saphenous vein were randomly divided into group A (femoral nerve block combined with modified swelling anesthesia), group B (simple swelling anesthesia) and group C (epidural anesthesia), with 30 patients in each group. The serum CRP level, operation duration, intraoperative blood loss, postoperative hospitalization time, total hospitalization cost, postoperative VAS score, preoperative and postoperative VCSS score, intraoperative mean arterial pressure and heart rate, postoperative related complications, and patients, satisfaction with diagnosis and treatment were compared among the three groups. There was no significant difference in operation duration, intraoperative blood loss, postoperative complications, and preoperative and postoperative VCSS scores among the three groups (P > 0.05). The postoperative hospitalization time, postoperative VAS score and total hospitalization cost of patients in group A and B were lower than those in group C, and the postoperative hospitalization time and postoperative VAS score in group A were more significant (P < 0.05). Compared with group B, the fluctuation range of intraoperative mean arterial pressure and heart rate, and postoperative serum CRP level in group A and C were lower, especially in group A (P < 0.05). The three groups of patients were followed up regularly after surgery. The results showed that the number of postoperative complications in group A was lower than that in the other two groups (P < 0.05), and the postoperative complications of the three groups were effectively relieved after symptomatic treatment (dressing change, anti-infection, taking drugs to improve circulation, etc.). The satisfaction of patients in group A was significantly higher than that in groups B and C (P < 0.05). Ultrasound guided femoral nerve block combined with modified swelling anesthetic solution applied in high ligation and stripping of the great saphenous vein can significantly improve postoperative inflammatory stress reaction of patients, effectively ensure the safety and reliability of surgical progress, help to improve analgesia effect and accelerate physical rehabilitation, and has short hospitalization time, low medical cost, and high satisfaction of patients' diagnosis and treatment, which is worthy of widespread clinical promotion and reference.

National trend of the treatment for chronic venous diseases in Korea between 2010 and 2020.

Limited data are available on the nationwide trend of treatments for chronic venous disease (CVD). The aim of the present study was to identify the nationwide trends of CVD treatments in Korea. A serial, cross-sectional study was conducted with the use of time trends to analyze patients with CVD between 2010 and 2020. The trends in the number of patients and procedures were analyzed including sclerotherapy, open surgery, and endovenous thermal ablation (ETA). Health Insurance Review and Assessment Service data were used to analyze the trends. For the statistical analysis, MedCalc Statistical software was used. P < 0.05 was considered statistically significant. A total of 1,867,307 patients with CVD were managed in Korea between 2010 and 2020. The annual number of patients with CVD increased from 143,108 in 2010 to 219,319 in 2020 (risk ratio [RR], 1.53; P < 0.001). The percentage of patients with CVD who had venous ulcer gradually decreased from 3.1% in 2010 to 1.7% in 2020 (RR, 0.86; P < 0.001). The number of conventional surgeries including stripping and local resection of varicose veins decreased from 32,384 in 2010 to 21,792 in 2020 (RR, 0.67; P < 0.001). The number of ETAs performed increased, from 290 in 2011 to 12,126 procedures in 2020 (RR, 41.81; P < 0.001). The total number of patients with CVD increased during the last 11 years. The number of conventional open surgery and sclerotherapy procedures decreased. On the contrary, the number of ETAs significantly increased in Korea.

Assessment of Endovenous Microwave Catheter Ablation in the Treatment of Primary Lower Limb Varicose Veins

Background: Many Adults often have varicose veins, and the CEAP classification is a widely used method of staging the condition. Surgery is the standard course of therapy, which comprises sapheno-femoral and/or sapheno-opopliteal junction disconnection, along with or without superficial axial vein stripping. The endovenous ablation treatment is now the most popular and has a 95% occlusion rate. Endovenous Microwave Ablation (EMA), an endovenous ablation method, operates by producing radio-frequency radiation. The MICROTAZE OT-110 M device produces radiofrequency radiation. Aim of the study: The aim of this study is using endovenous microwave ablation as a new technique in treating of lower limb varicose veins according to the results, advantages, disadvantages and complications. Subjects and Methods: Thirty patients with lower limb varicose veins participated in this study. It was conducted at the vascular surgery department of Al-Azhar university hospitals (Al-Hussein and sayed-Galal). Patients were exposed to a clinical assessment and a duplex ultrasound after providing written permission. Results: over weighted and patients with 30-50 years were the most. A statistically significant improvement was observed in AVVQ at different follow-up intervals. Conclusion: This prospective, single-center study found endovenous microwave ablation of the great saphenous vein to be safe and effective. There were few complications, no DVT or paresthesia, a little amount of postoperative discomfort, and positive midterm radiological and clinical data.

Assessment of open surgical outcome of patients with lower limb varicose vein disease at a tertiary care center of Eastern Nepal

Introduction: The trend of varicose vein disease seems to be rising globally and its treatment options and outcome vary from the institution by institution. Management of the disease has also changed from high ligation, stripping, avulsion, and sclerotherapy to minimally invasive endovenous thermal ablation. Methods: A retrospective observational study was carried out to find out the treatment methods and outcome of lower limb varicose vein disease at the cardiothoracic vascular surgery unit of the surgery department of B.P. Koirala Institute of Health Science from February 2019 to February 2020. The medical record of the patients was studied, relevant data entered and analyzed in statistical package for social sciences statistical software. Results: Total registered patient during the study period were 46; which included 29(63%) male and 17(37%) female with mean age 38.41±10.12. Saphenous femoral junction reflux was seen in 38(82.60%) cases, saphenous popliteal junction reflux was seen in nine (19.60%) cases while perforator reflux was seen in 37(80.40%) cases. Saphenous femoral junction ligation, saphenous popliteal junction ligation was performed in 36(78.30%) and 7(15.20%) cases respectively. Stripping of the greater saphenous vein was done in 35(76.10%) cases, and 9(19.60%) cases were managed conservatively. Only 5(10.90%) cases developed infection, and none of the cases were found with recurrence or nerve injury. All the cases remained satisfied during the management course. Conclusions: Saphenous femoral junction reflux was seen common and saphenous femoral junction ligation was performed on majority of the cases. Only 10% cases developed infection and all patients were satisfied during management course. Early surgical management of the disease overcomes complications and improves in the quality of life of the patients.

Incidence of saphenous nerve injury after total stripping of greater saphenous vein: Its severity and effect on life

Introduction: Total stripping of great saphenous vein is common practice since it reduces the need for reoperation. However, the incidence of saphenous nerve damage is higher in total stripping than in the conventional stripping. Methods: Fifty-seven patients who underwent total stripping of great saphenous vein were studied to find out the incidence of saphenous nerve damage, its severity and effect on day-to-day activities. Data was collected using an interviewer administered questionnaire and a detailed neurological examination of the leg. The questionnaire included questions on symptoms of saphenous nerve damage, its severity and its impact on their day-to-day life and Aberdeen Venous Severity Score (AVSS) to assess outcome of surgery for varicosities. Results: The age of patients ranged from 17 to 79 years with mean age of 44.7 (SD 15.80) years. Men comprised 56.1% of the sample. Fifteen out of 57 legs (26.3%) had evidence of saphenous nerve damage either by symptoms or by sensory deficit or by both. Patients with saphenous nerve damage were not significantly different in terms of age, gender, pre-operative Clinical Aetiological Anatomical and Pathophysiology (CEAP) class, post-operative CEAP class, post-operative AVSS, follow up interval or presence of recurrent varicosities when compared with those who didn’t have saphenous nerve damage. Among those who had evidence of saphenous nerve damage, only one had persistent symptoms with minimal discomfort in day-to-day activities. Thirteen (22.4%) patients had recurrent varicosities generally presenting as isolated clusters and none of them necessitated to have reoperation with median follow up of 12 months. The acceptance of the operation among patients seems to be encouraging. Conclusions: According to the findings of this study, total stripping of great saphenous vein can be safely undertaken by general surgeons with acceptable risk of saphenous nerve damage. Most of saphenous nerve damages are subclinical and transient and have negligible effect on day-to-day activities.

Application of stem cells in the treatment of trophic ulcers of venous genesis

Literary research is devoted to analyzing of literature sources on the practical application of stem cells for the treatment of trophic ulcers of venous origin. The most essential and promising source of stem cells is umbilical cord blood. The treatment of trophic ulcers of venous etiology is still debatable. Currently, none of the known methods to treat varicose veins or eliminate pathological reflux are universal. However, the issue of parallel treatment of trophic ulcers caused by varicose veins is acute. In addition, the removal of altered magistral veins does not always lead to the simultaneous disappearance of ulcers on the skin. Today the primary treatment method for this pathology is surgery, which was introduced in the 19th century. Since then, it has not changed dramatically: high ligation and stripping of large and small veins, followed by their removal. However, surgery sometimes leads to recurrence, as it is not etiological. Stem cells are already used quite successfully as the main method of treatment for chronic ischemia of the lower extremities. Intramuscular injection of bone marrow mononuclear cells into the ischemic limb is considered to help to reduce both pain and the risk of high amputations by 19%. The use of in vitro fibroblasts, a multilayer layer of keratinocytes, a skin equivalent, is a very successful and promising analog of autodermoplasty. The use of stem cells allows healing in 99.1% of patients after 16.2 days, with a recurrence of 1.25%. Mesenchymal stem cells were administered intradermally to treat radiation ulcers, stimulated the healing process, reduced pain, inflammation, which could be confirmed by a decrease in the level of C-reactive protein in the blood. After the introduction of mesenchymal stem cells perifocal and into the bottom of the wound, after 2 weeks, in more than 60% of cases, there was active growth of granulations and maturation of granulation tissue. The area of the wound defect was also significantly reduced, and the efficiency of skin autograft survival was significantly increased.Our study of sources of scientific literature on the problem of stem cell research in general and the introduction into therapeutic practice of therapy of trophic ulcers with cord blood stem cells indicates a considerable interest of scientists in this topic. This is evidenced by a large number of publications on the problem of studying the properties of stem cells. However, it is necessary to note the striking qualitative and quantitative difference between our analyzed domestic and foreign sources of scientific literature in favor of describing foreign research. We consider it appropriate to point out the insufficient number of related qualitative scientific studies on the treatment of trophic ulcers by domestic scientists.

A technology for non-mining flanks formation at deep kimberlite open pits

Research objective is to develop a technology for non-mining flanks formation at deep open pits to reduce the amount of stripping operations and increase the scope of diamond fields mining by the open-pit method. Research relevance. The non-mining flanks formation and reduction of their additional excavation from the main openings is one of the most pressing problems in the development of deep kimberlite open pits. In the deep zone of kimberlite open pits, the stable slope of the flanks can reach 75°–80°, while according to the condition of ramps placement it is 48°–60°. This results in increased overburden volumes and limits the maximum depth of open pits. Methods of research. A technology has been developed for forming non-mining flanks and giving them a convex (cissoidal) profile with a gradual increase in slope angles. The technology consists in phased transition starting from a certain depth from the traditional overburden removal method to one with steeply inclined ramps and a spiral marginal tunnel passing behind the shear zone. A method for calculating the design angles of non-mining flanks when opening deep quarries with spiral ramps is substantiated. The main regularities of opening parameters effect on the slope angle of non-mining flanks are established. The results of experimental studies of rock physical and mechanical properties are used, as well as the methods of economic and mathematical modeling and technical and economic analysis. Results. By the example of Nyurba mine of Alrosa PJSC, it was found that the proposed technology allows increasing the resulting angle of non-mining flanks from 45°–48° to 54°–63°, reducing the amount of overburden removal operations by 3–8 times and effectively mining the open pit to a depth of 750 m corresponding to the depth of explored reserves. Scope of results. The proposed technology and method for calculating the design slope angles of non-mining flanks can be used not only in kimberlite open pit development, but also in the development of non-ferrous and precious metal deposits, represented by steeply dipping rounded deposits, by the open-pit method.

Design and research of stripping tool for live-fired cable based on the distribution network

High-voltage live cables are often required to be live-fired in the transformation and maintenance of power grids. The traditional live fire connection operation is mainly manual fire connection, which has great potential safety hazards, the fire connection efficiency is low, and the fire connection quality is uneven. This paper designs and develops a peeling tool based on a 10kV live fire connection operation. In view of the problems of low fire connection efficiency and uneven connection quality of traditional live fire connection tools, hierarchical operation, intelligent control, and instantaneous dynamics simulation based on Anasys Workbench are adopted. The design and development of peeling tools are based on 10kV live connection work. Test experiments show that the live cable stripping tool can realize the live cable stripping operation of 10kV cables and has the characteristics of a high degree of automation and stable fire connection quality.

Great saphenous vein aneurysm mimicking inguinal hernia: a case report

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

Reviving Hope by Using Platelet-Rich Plasma Combined with Saphenous Vein Stripping Surgery in Patients with Refractory Venous Leg Ulcer: A Case Report

Venous ulcer is an open skin lesion that is difficult to heal and easy to recur. Although the fatality rate is low, the quality of life of patients is seriously affected, and there is the possibility of infection, deterioration and even amputation. The use of platelet rich plasma therapy has obvious effect, but the combined treatment of great saphenous vein dissection is rarely reported.

Does the healthcare system know what to cut under the pandemic emergency pressure? An observational study on geographic variation of surgical procedures in Italy

ObjectivesDuring 2020 many countries reduced the number of elective surgeries to free up beds and cope with the COVID-19 outbreak. This situation led healthcare systems to prioritise elective interventions and...

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

INCIDENTAL PULMONARY CAVITARY LESIONS AS AN UNCOMMON PRESENTATION OF LEMIERRE SYNDROME

Investigation of aqueous phase dynamics in a uranium stripping unit using radioactive tracer

Mixer-setters units are widely used in uranium purification processes. For efficient operations of mixer-settler units, it is essential to measure the hydrodynamics parameters of the different phases involved. The residence time distribution (RTD) measurement is commonly used method to estimate the hydrodynamics parameters of process reactors. In the present study, RTD of the aqueous phase was measured in different stages mixer-settler unit (mixers, settlers and mixer-settler units) used for stripping operation using Iodine-131 as a radiotracer. For the RTD measurements, radiotracer was injected as an impulse in aqueous phase feed line and its movement was monitored at different locations in the stripping unit using NaI(Tl) detectors. The mean residence times (MRTs) of the aqueous phase were estimated from measured RTD curves. For quantification of the degree of mixing, suitable flow models were proposed based on design and nature of the measured RTD curves and subsequently used for simulation. Based on the results of the RTD study, the mixing of aqueous phase was characterized and design of the stripping unit and its sub-units were validated. The optimum conditions were identified for efficient for the operation of the stripping unit.

A comparative study between Trendelenburg procedure vs radiofrequency ablation for varicose vein surgery in a tertiary care hospital Chennai- A cross-sectional study

Background, One of the most popular surgical procedures, varicose vein surgery serves as a crucial teaching technique for aspiring surgeons. The great saphenous and short saphenous systems in the lower limbs, which are tortuous and dilated, are the veins most commonly affected by varicose veins. A vessel wall disease or valvular pathology is the cause of a varicose vein. People who work all day standing up typically have long-term effects. The Trendelenburg procedure involves several phlebotomies for the dilated veins below the knee, along with the juxta femoral flush ligation of saphenous veins and vein stripping up to below the knee. The less invasive radiofrequency ablation therapy has replaced the Trendelenburg method and is growing in popularity since it has fewer drawbacks. Venous tissue is thermally damaged when a high-frequency alternating current is employed to transmit electrical energy into the tissue. More research is needed to compare the Trendelenburg and radiofrequency in the chosen group with regard to early ambulation, early return to work, the severity of postoperative pain, recovery time, and complications. Methods An analytical cross-sectional study including 100 people with varicose veins was undertaken from June 2017 to July 2019 and lasted one year and eleven months.

Assessment of endovenous microwave catheter ablation in the treatment of primary lower limb varicose veins

Background: Lower limbs varicose veins are common in the adult population, The CEAP classification is a conventional way of staging varicose vein disease.Traditional treatment is surgery, which involves disconnection of sapheno-femoral and/or sapheno-opopliteal junctions with or without stripping of the superficial axial vein. the endovenous ablation is now the most widely used procedure and approximately occlusion rate of 95%. the Endovenous ablation techniques is Endovenous Microwave Ablation (EMA) which works by generating radio-frequency energy. It generates radiofrequency energy with the MICROTAZE OT-110 M machine. Aim: The aim of this study is using endovenous microwave ablation as a new technique in treatment of lower limb varicose veins according to the results, advantages, disadvantages and complications. Subjects and Methods: This study was conducted on 30 patients with varicose veins of lower limbs. It was conducted in the department of vascular surgery, Al- Azhar University Hospitals – Cairo (Al-Hussein and and said-Galal Hospitals). After taking a written consent, patients were subjected to Clinical evaluation and Duplex Ultrasound. Results: over weighted and patients with 30-50 years were the most. A statistically significant improvement was observed in AVVQ at different follow-up intervals.

Comparative study between using of radio frequency ablation and endovenous laser ablation in the treatment of primary lower limb varicose veins

Background: Varicose veins are a frequent vascular issue. Radiofrequency ablation (RFA) and Endo-venous laser ablation (EVLA) are endo-venous treatments for varicose veins. Endo-venous therapy demonstrated superior outcomes than standard high ligation and stripping in terms of pain, quality of life, healing, and recurrence. The RFA and ELA surpass vein stripping in morbidity, outcome, and neovascularization (recurrence), which is attributed for greater recurrence rates. Aim: We aim to compare between using of radio frequency ablation and endo-venous laser ablation in the treatment of primary lower limb varicose veins as regard to complications, treatment failure,recurrence. Methods: This prospective randomized controlled study was conducted in the vascular surgery department at Al-Azhar university hospitals (Al-Hussein and Sayed Galal), in the period from September 2020 to June 2022 (20 months). The study included 50 patients, males were 22(44%) while females were 28(56%), Presented by primary varicose veins. Results: In EVLA group Recanalization of short-segment occlusion was done in 4 patients, Recanalization of long-segment occlusion was done in 2 patients and recurrent varicose veins happened in 5 patients.

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

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

Application of music-guided imagination on relief of anxiety in a patient undergoing High ligation and stripping of the greater saphenous vein

Application of music-guided imagination on relief of anxiety in a patient undergoing High ligation and stripping of the greater saphenous vein

Strategies and challenges in treatment of varicose veins and venous insufficiency.

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.