Correlation Between Great Saphenous Vein Diameter, Length of Treatment Zone With Improvement in Symptoms after Ablation

Background and aim The aim of this study was to compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) techniques for efficacy and side effects for great saphenous vein (GSV) ablation. Materials and methods Two hundred twenty-one patients and 287 extremities that underwent GSV ablation with EVLA and RFA methods were analysed retrospectively; 135 GSVs were treated with EVLA, 152 GSVs were treated with RFA. Physical examination and Ultrasound (US) records at the first week, first month and third month were evaluated. Recanalization, endothermal heat-induced thrombosis formation, presence of ecchymosis greater than 10 cm and GSV diameter parameters were statistically analyzed. Results In the RFA group, 96.7% of the GSVs that were ablated were occluded at the end of the third month. In the EVLA group, this rate was 92.6%. There was no statistically significant difference between success of ablation ( P = 0.118). In the RFA group, ecchymotic areas, that is larger than 10 cm diameter were observed in 16 extremities, whereas in the EVLA group, 66 of 135 (48.9%) limbs were found to have ecchymotic area larger than 10 cm ( P < 0.001). More recanalizations were observed in GSVs larger than 10 mm in diameter which was statistically significant ( P < 0.001). Conclusion Both EVLA and RFA methods are effective in treating GSV reflux. Compared to the EVLA, less ecchymosis occurs after RFA procedures. Regardless of the type of method used, the GSV diameter is a single predictor of recanalization.

Download Full-text

A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517734480 ◽

2017 ◽

Vol 33 (8) ◽

pp. 534-539 ◽

Cited By ~ 3

Author(s):

Emma B Dabbs ◽

Laurensius E Mainsiouw ◽

Judith M Holdstock ◽

Barrie A Price ◽

Mark S Whiteley

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Large Diameter ◽

Diameter Distribution ◽

Short Term ◽

Endovenous Laser Ablation ◽

Saphenous Veins ◽

Vein Diameter

Aims To report on great saphenous vein diameter distribution of patients undergoing endovenous laser ablation for lower limb varicose veins and the ablation technique for large diameter veins. Methods We collected retrospective data of 1929 (943 left leg and 986 right leg) clinically incompetent great saphenous vein diameters treated with endovenous laser ablation over five years and six months. The technical success of procedure, complications and occlusion rate at short-term follow-up are reported. Upon compression, larger diameter veins may constrict asymmetrically rather than concentrically around the laser fibre (the ‘smile sign’), requiring multiple passes of the laser into each dilated segment to achieve complete ablation. Results Of 1929 great saphenous veins, 334 (17.31%) had a diameter equal to or over 15 mm, which has been recommended as the upper limit for endovenous laser ablation by some clinicians. All were successfully treated and occluded upon short-term follow-up. Conclusion We suggest that incompetent great saphenous veins that need treatment can always be treated with endovenous laser ablation, and open surgery should never be recommended on vein diameter alone.

Download Full-text

Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal Thigh as Parameters of Venous Disease Class

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2012.10.014 ◽

2013 ◽

Vol 45 (1) ◽

pp. 76-83 ◽

Cited By ~ 47

Author(s):

E. Mendoza ◽

W. Blättler ◽

F. Amsler

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Venous Disease ◽

Disease Class ◽

Vein Diameter ◽

Proximal Thigh ◽

Saphenofemoral Junction

Download Full-text

What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches

Acta Chirurgica Belgica ◽

10.1080/00015458.2019.1684008 ◽

2019 ◽

pp. 1-8

Author(s):

Emre Kubat ◽

Celal Selçuk Ünal ◽

Onur Geldi ◽

Erdem Çetin ◽

Aydın Keskin

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Optimal Treatment ◽

Treatment Technique ◽

Vein Diameter

Download Full-text

Faculty Opinions recommendation of Great saphenous vein diameter does not correlate with worsening quality of life scores in patients with great saphenous vein incompetence.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717698036.793153147 ◽

2012 ◽

Author(s):

Milos Pavlovic

Keyword(s):

Quality Of Life ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Vein Diameter

Download Full-text

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516638577 ◽

2016 ◽

Vol 32 (3) ◽

pp. 194-199 ◽

Cited By ~ 20

Author(s):

Alptekin Yasim ◽

Erdinc Eroglu ◽

Orhan Bozoglan ◽

Bulent Mese ◽

Mehmet Acipayam ◽

...

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Long Term Results ◽

Early Results ◽

Severity Scores ◽

Endovenous Ablation ◽

Vein Diameter

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Abbreviated method of determining vein volume in balloon-controlled vein ablation

Phlebology The Journal of Venous Disease ◽

10.1258/026835507779700581 ◽

2007 ◽

Vol 22 (1) ◽

pp. 40-44 ◽

Cited By ~ 1

Author(s):

J K Raines ◽

W Garcia de Quevedo ◽

S Jahrmarkt ◽

E Mackay ◽

N Morrison ◽

...

Keyword(s):

Clinical Study ◽

Minimally Invasive ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Treatment Length ◽

Surgical Ligation ◽

Standardized Protocol ◽

Volume Calculations ◽

Endovenous Ablation ◽

Vein Diameter

Traditional surgical ligation and stripping for the treatment of saphenous vein incompetence has been replaced by minimally invasive alternative treatments during the last five years. Endovenous ablation with radiofrequency (RP) and laser (EVL) have proven to be safe, durable, and widely accepted by patients. Catheter-delivered sclerotherapy (CDS) with foam and liquid for ablation of the great saphenous vein is also under investigation. In this technique, vein volume must be measured accurately by ultrasound just prior to the procedure and can require up to 11 diameter measurements. The purpose of this study was to identify an abbreviated method of determining vein volume to expedite associated endovenous procedures. Seventy-five veins were treated in 55 subjects with catheter-directed sclerotherapy in a three-center clinical study using a standardized protocol. Vein volume was carefully calculated by determining vein diameter over the Treatment Length in 4 cm intervals. These measurements were compared to vein volume calculations where only three measurements were taken. Our results suggest that the abbreviated method is capable of significantly reducing the number of diameter measurements without sacrificing accuracy. We found the method produced a vein volume that fell within 1 mL or 15% of the actual vein volume in 80% of cases. The abbreviated method cannot be used with accuracy in veins that are Erratic.

Download Full-text

The effect of nitroglycerin ointment on great saphenous vein targeted venous access site diameter with endovenous laser treatment

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2007.007076 ◽

2008 ◽

Vol 23 (5) ◽

pp. 222-226 ◽

Cited By ~ 5

Author(s):

R S Hogue ◽

M W Schul ◽

C F Dando ◽

B E Erdman

Keyword(s):

Laser Treatment ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Venous Access ◽

Percentage Change ◽

Access Site ◽

Nitroglycerin Ointment ◽

Vein Diameter ◽

Endovenous Laser Treatment ◽

Venous Access Site

Objectives To assess the effect of topically applied nitroglycerin (NTG) ointment (2%) on preoperative targeted venous access site great saphenous vein (GSV) diameter in patients undergoing endovenous laser treatment (ELT). Methods In this double-blinded randomized study design, 75 patients received either (A) treadmill ambulation only, (B) topically applied NTG ointment only, or (C) topically applied NTG ointment + treadmill ambulation. Targeted venous access vein diameters were measured before therapeutic intervention and then repeated after approximately 30 min following pretreatment intervention. Presence of venospasm and the number of ultrasound-guided venous access attempts during each ELT procedure were assessed during the study. Results The mean pretreatment vein diameter was 2.6 mm (range 0.9–4.9 mm). The post-treatment percentage change in vein diameter for group A (treadmill ambulation only) was +2.7% ( P = 0.403), whereas group B (NTG only) and group C (NTG + treadmill ambulation) demonstrated significant venodilatation of +69.0% ( P < 0.0001) and +51.7% ( P < 0.0001), respectively. Statistical analysis of variances and multivariate linear regression model revealed topically applied NTG ointment and ‘C’ classification of clinical, aetiological, anatomical and pathological elements (CEAP) were each significant predictors for venodilatation percentage change ( P < 0.001 and = 0.028, respectively). Conclusion Pretreatment with topically applied NTG ointment (2%) produced a statistically significant, as well as subjective clinically significant venodilatation change in the targeted venous access site diameter of patients undergoing ELT of the GSV in this study.

Download Full-text