Correlation of CEAP Clinical Class, Venous Clinical Severity Scores, Vein Diameter, and Reflux Time in the Great Saphenous Vein in Patients with Superficial Venous Insufficiency

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

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Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514526588 ◽

2014 ◽

Vol 30 (5) ◽

pp. 325-330 ◽

Cited By ~ 23

Author(s):

S Sufian ◽

A Arnez ◽

N Labropoulos ◽

S Lakhanpal

Keyword(s):

Risk Factors ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Severity Scores ◽

Class 1 ◽

Vein Diameter ◽

Saphenofemoral Junction

Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2–3 days postoperatively. Results Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis ( p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients ( p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm ( p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis ( p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2–4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 ( p = .003) at one month. Conclusion Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2–4 weeks in most patients but it may worsen in few.

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Can Great Saphenous Vein Diameter Be Correlated with Clinical Severity Scores and Quality of Life in Indian Population?

Indian Journal of Surgery ◽

10.1007/s12262-020-02284-x ◽

2020 ◽

Author(s):

Arunjeet KK ◽

Manoj Kumar

Keyword(s):

Quality Of Life ◽

Saphenous Vein ◽

Indian Population ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Severity Scores ◽

Vein Diameter

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Cryosclerosis. Az elfelejtett endovénás cryoablatio a vena saphena magna elégtelenségének kezelésében. Egy prospektív összehasonlító vizsgálat középtávú eredményei

Orvosi Hetilap ◽

10.1556/650.2016.30625 ◽

2016 ◽

Vol 157 (50) ◽

pp. 1994-2001

Author(s):

István Bence Bálint ◽

Ákos Farics ◽

László Vizsy ◽

Eszter Vargovics ◽

Renáta Bálint ◽

...

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Secondary Outcome ◽

Rank Test ◽

Clinical Failure ◽

Severity Scores ◽

Significant Difference ◽

Vena Saphena Magna ◽

Occlusion Rate

Introduction: Cryosclerosis was introduced by Milleret and Le Pivert in the 1980s. Method: A prospective non-randomized comparative study has been performed on initial 96 patients. 48 patients were treated by cryosclerosis and the others received conventional stripping. 52 cases were analyzed for 2-years. The primary end-point of the study was to determine the occlusion rate of cryosclerosis. The clinical failure, the improvement in the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores were analyzed as secondary outcome. Results: Total recanalization of the great saphenous vein causing clinical failure was observed in one case (4%). The reopening of the great saphenous vein was observed in 4 limbs (15%) that did not cause the incompetence of the trunk. The occlusion rate was 81%. Recurrent varicosity was observed by 35% and 42% of the patients in the cryosclerosis and stripping groups respectively. There was no significant difference between the groups (log rank test, p = 0.391). There was significant improvement in both the Clinical Etiologic Anatomic Pathophysiologic classification and Venous Clinical Severity Scores in each group without remarkable differences observed between the groups either at baseline or on the mid-term. Conclusions: Cryosclerosis seems to be effective in the remodeling of the great saphenous vein. The method has no remarkable mid-term clinical advantages over classical stripping so far. Orv. Hetil., 2016, 157(50), 1994–2001.

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Radiofrequency ablation of the great saphenous vein, comparing one versus two treatment cycles for the proximal vein segment

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514556142 ◽

2014 ◽

Vol 30 (10) ◽

pp. 724-728 ◽

Cited By ~ 2

Author(s):

S Sufian ◽

A Arnez ◽

N Labropoulos ◽

K Nguyen ◽

V Satwah ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Treatment Group ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Demographic Data ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Severity Scores ◽

Vein Segment ◽

Ceap Classification

Objective To evaluate the results of radiofrequency ablation (RFA) of the great saphenous vein (GSV) using one versus two 20 s energy cycle treatment in the proximal 7 cm segment of the GSV. Methods All patients who underwent RFA of the GSV from 1 May 2013 to 30 September 2013 in eight of our vein centers were included. Duplex ultrasound scans (DUSs) were performed prior to treatment on all patients and 2–3 days, and 1 month after procedure. Demographic data, GSV diameters, and other relevant data were recorded. Clinical, Etiologic, Anatomic, Pathologic (CEAP) classification and Venous Clinical Severity Scores (VCSSs) were determined prior to ablation and one month later. Patients who developed endovenous heat induced thrombosis (EHIT) were followed till resolution. Results A total of 205 patients had one cycle treatment (group A) and 204 had two cycle treatment (group B). The two groups were comparable in their demography, CEAP classification, and VCSS scores. The rate of failure of ablation and incidence of EHIT were also not significantly different. The incidence of complications was low, <5% in both groups and all were minor. Conclusion Two cycle treatment of the proximal GSV for vein ablation does not improve the success rate of vein closure in the short term, compared to one cycle treatment. It also does not increase the risks of DVT, EHIT, major bleeding, and other complications. However, we do not know at what diameter two cycles may be superior to one cycle.

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The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1258/026835507782101654 ◽

2007 ◽

Vol 22 (5) ◽

pp. 207-213 ◽

Cited By ~ 15

Author(s):

A Mdez-Herrero ◽

J Gutiérrez ◽

L Camblor ◽

J Carreño ◽

J Llaneza ◽

...

Keyword(s):

Surgical Approach ◽

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Clinical State ◽

Control Group ◽

Superficial Venous Insufficiency ◽

Saphenofemoral Junction

Objective: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration. Methods: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group. Results: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive. Conclusions: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.

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A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516658592 ◽

2016 ◽

Vol 32 (6) ◽

pp. 415-424 ◽

Cited By ~ 16

Author(s):

Malcolm Sydnor ◽

John Mavropoulos ◽

Natalia Slobodnik ◽

Luke Wolfe ◽

Brian Strife ◽

...

Keyword(s):

Patient Satisfaction ◽

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

Superficial Venous Insufficiency

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

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Clinical, ultrasonographic and histological findings in varicose vein surgery

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.08.729 ◽

2018 ◽

Vol 64 (8) ◽

pp. 729-735

Author(s):

Moacir de Mello Porciunculla ◽

Dafne Braga Diamante Leiderman ◽

Rodrigo Altenfeder ◽

Celina Siqueira Barbosa Pereira ◽

Alexandre Fioranelli ◽

...

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Lower Limb ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Clinical Classification ◽

Histopathological Changes

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease’s clinical severity or reflux in the SFJ on a Doppler ultrasound.

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Venous Function after Restoring Valve Competence of the Great Saphenous Vein

Journal of Endovascular Therapy ◽

10.1177/152660280301000228 ◽

2003 ◽

Vol 10 (2) ◽

pp. 350-355 ◽

Cited By ~ 3

Author(s):

Gudmundur Danielsson ◽

Christel Jungbeck ◽

Karin Peterson ◽

Lars Norgren

Keyword(s):

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Prospective Clinical Study ◽

Entry Site ◽

Vein Diameter ◽

Venous Function ◽

Saphenofemoral Junction ◽

Vein Reflux

Purpose: To measure changes in venous function after elimination of great saphenous vein reflux using endovenously-applied heat with a specially designed catheter. Methods: In a prospective clinical study, 13 patients (8 women; mean age 39 years, range 25–59) with symptomatic chronic venous insufficiency were treated for reflux at the saphenofemoral junction. A radiofrequency catheter (Restore) with expandable electrodes that shrinks the vein by controlled constriction of subendothelial collagen was used to restore valve competence. Extirpation of local varicosities was performed simultaneously. Main outcome was change in venous function as measured by plethysmography (foot volumetry) and change in diameter and reflux time at the saphenofemoral junction after 6 and 12 months. Results: Reflux in the greater saphenous vein was eliminated or reduced to below 0.5 seconds in all patients. The venous function was significantly improved after 6 months' follow-up, with decreased refilling rate/expelled volume related to foot volume (p=0.019). The patients were clinically improved, although only 7 (54%) were entirely free from reflux. Three (21%) patients had thrombus in the vein the day after the treatment, 2 at the treatment site and 1 at the entry site of the introducer. After 1 year, the patients are still satisfied with the results, although venous function is no longer significantly improved compared to baseline. Conclusions: It is possible to safely restore valvular competence by means of internally shrinking the vein diameter. The venous function is improved, although the vein has a tendency to increase in width with time; limited reflux reappears, with deterioration of venous function.

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