LEV 9. Causes of Recurrent Varicose Vein After Endovenous Laser Ablation Therapy Confirmed by Three-Dimensional Computed Tomography Venography and Duplex Ultrasound

Objective To define the anatomical variations of small saphenous vein (SSV) for varicose vein (VV) surgery by three-dimensional computed tomography venography (3D-CTV) and to analyse the impact of this preoperative evaluation on surgical outcomes. Methods A total of 120 consecutive limbs with SSV insufficiency having undergone VV surgery from January 2005 until December 2007 were enrolled. The medical records and images were analysed retrospectively. Results The relationship between SSV and gastrocnemial vein (GNV) were categorized into two: (a) SSV and GNV drained to popliteal vein (PV) separately (100 limbs, 87%) and (b) SSV and GNV made common channel which drained to PV (15 limbs, 13%). Saphenopopliteal junction morphology was normal (75 limbs), severe tortuosity near PV (19 limbs), ampullary ectasia (4 limbs) and duplicated drainage to PV (2 limbs). No recurrence of VV was noted. Conclusions CTV can provide thorough preoperative anatomic information of the SSV variations and reduce the recurrence of VV.

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Three-dimensional modelling of the venous system by direct multislice helical computed tomography venography: technique, indications and results

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2012.012j07 ◽

2012 ◽

Vol 27 (6) ◽

pp. 270-288 ◽

Cited By ~ 17

Author(s):

J F Uhl

Keyword(s):

Computed Tomography ◽

3D Model ◽

Vascular Malformations ◽

Three Dimensional ◽

Duplex Ultrasound ◽

Anatomical Study ◽

Venous System ◽

Lower Limbs ◽

Helical Computed Tomography ◽

Computed Tomography Venography

The aim of multislice helical computed tomography venography (CTV) is to provide a precise, global and three-dimensional (3D) anatomical depiction of the venous network of the lower limbs. A multislice and multidetector spiral CT acquisition of the lower limbs with contrast injection of the dorsal foot produces about 1000 slices in 30 seconds. Dedicated volume-rendering software can compute a realistic and interactive 3D model of the venous system in realtime. This new tool furnishes an accurate 3D representation of the whole venous system of the lower limb with a realistic 3D model of the limbs, providing a road map of the varicose networks complementary to the duplex ultrasound (DUS). CTV allows a complete morphological study of the deep veins, including the detection of anatomical variations and proximal venous obstruction, not easily detectable by DUS. In the case of deep vein thrombosis, it has been shown to be a good diagnostic tool, well correlated with sonography. It also demonstrates, in some cases, haemodynamic patterns which are not available by DUS, particularly for perforator veins and congenital vascular malformations. The use of virtual reality techniques enables a complete anatomical study of both deep and superficial veins including a virtual dissection of the limbs. CTV is also a great educational tool to learn anatomy of the venous system and a powerful research tool to improve our knowledge of venous anatomy.

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Determinants and patterns of recurrence of primary varicose veins after Endovenous laser ablation

10.21203/rs.3.rs-61012/v1 ◽

2020 ◽

Author(s):

Sheref A. Elseidy ◽

M. Hatem ◽

Ahmed K. Awad ◽

Obaie Mzaik ◽

Debvarsha Mandal ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

Table Analysis ◽

Lost To Follow Up

Abstract Background: The goal of this retrospective cohort study was to determine the different recurrence patterns, sites and determinants impacting primary varicose vein recurrence after endovenous laser ablation (EVLA).Methods: 127 symptomatic patients (127 limbs) with great saphenous vein incompetence who underwent EVLA were followed up for recurrence. Twenty-seven patients were lost to follow-up, leaving 100 patients (100 limbs) for analysis. Outcomes: Recurrence defined by venous clinical severity score (VCSS) or patterns of reflux on the duplex ultrasound examination. Assessments were done at 1, 6, 12 and 24 months after the procedure.Results: Two-year life table analysis showed varicose vein recurrence in 9(7.1%) of limbs. Varicose vein recurrence was due to refluxing anterior accessory saphenous vein in 77.8% patients (p <0.001, 95% CI 3.2 to 1669.1), re-canalization (66.6%), non-truncal varicosities (55.5 %) and incompetent perforators 77.8% patients (p <0.001, 95% CI 2.7 to 69.3).Recurrence was mostly seen owed to both incompetent perforators and accessory saphenous vein, BMI more than 30.5 kg/m2 is noted in 77.8 % (p <0.001, 95% CI 1.105 to 1.590) of recurrence patients.

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