Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.

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Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins

Journal of Vascular Surgery ◽

10.1016/j.jvs.2006.06.003 ◽

2006 ◽

Vol 44 (3) ◽

pp. 601-605 ◽

Cited By ~ 64

Author(s):

Harold J. Welch

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Endovenous Ablation

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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.

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Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials

Journal of Vascular Surgery Venous and Lymphatic Disorders ◽

10.1016/j.jvsv.2014.11.004 ◽

2016 ◽

Vol 4 (1) ◽

pp. 97-105 ◽

Cited By ~ 45

Author(s):

Thomas F. O'Donnell ◽

Ethan M. Balk ◽

Meghan Dermody ◽

Erica Tangney ◽

Mark D. Iafrati

Keyword(s):

Saphenous Vein ◽

Randomized Trials ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Endovenous Ablation

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Anatomical and clinical factors favoring the performance of saphenous ablation and microphlebectomy or sclerotherapy as a single-stage procedure

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514554023 ◽

2014 ◽

Vol 30 (9) ◽

pp. 627-631 ◽

Cited By ~ 2

Author(s):

AA Kokkosis ◽

H Schanzer

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Class I ◽

Chronic Venous Disease ◽

Venous Disease ◽

Class Iii ◽

Endovenous Ablation ◽

Secondary Procedures ◽

Extensive Class

Objective To identify the anatomical and clinical parameters that predict lack of regression of superficial varicosities after ablation of the great saphenous vein. Methods Symptomatic patients treated with endovenous ablation from August 2006 to July 2013, by a single surgeon, were included. Recorded parameters included age, sex, size, and extent of varicosities (class I–IV) (patient standing), and diameter and length (patient supine) of treated great saphenous vein. Varicose vein classification was defined as: class I ≤6 mm and localized to thigh or leg, class II ≤6 mm and present in the thigh and leg (extensive), class III >6 mm and localized to the thigh or leg, and class IV >6 mm and extensive. “Excellent” results were defined as complete resolution of varicosities, “good” results as incomplete resolution, and “poor” results as no improvement. Results A total of 267 patients and 302 consecutive limbs were included in the study. There were 175 females (65.5%), and the mean age was 54 years old (22–92). The CEAP classification was as follows: C2 (81.5%), C3 (6.3%), C4 (7.9%), C5 (2.0%), and C6 (2.3%). Great saphenous vein diameters was significantly larger in patients with C3–C6 (proximal 0.84 ± 0.25 versus 0.65 ± 0.21, p = < 0.0001, distal 0.58 ± 0.18 versus 0.44 ± 0.13, p < 0.0001) or class III–IV varicose veins (proximal 0.85 ± 0.25 versus 0.75 ± 0.27, p = 0.012, distal 0.62 ± 0.62 versus 0.50 ± 0.17, p < 0.0001). Class III–IV limbs had a “good/poor” result 69.8% of the time, as compared to 51.9% of the limbs class I–II varicose veins (p = 0.002). Conclusions Advanced chronic venous disease (C3–C6) patients have larger diameter great saphenous veins, reflecting the progressive nature of the disease. Patients with more severe varicosities regardless of CEAP class were more likely to require a secondary procedure. The severity of the varicosities may not correlate with the degree of venous disease, but it is an indication of which patients should undergo secondary procedures, possibly with a one-stage approach.

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Re: “Catheter Foam Sclerotherapy of the Great Saphenous Vein, with Peri-saphenous Tumescence Infiltration and Saphenous Irrigation”—Is Modified Catheter Foam Sclerotherapy a Step Back in the Evolution of Endovenous Ablation for Varicose Veins?

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2017.10.016 ◽

2018 ◽

Vol 55 (2) ◽

pp. 290-291

Author(s):

Alok Tiwari ◽

Tze Tec Chong ◽

Tjun Y. Tang

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Foam Sclerotherapy ◽

Endovenous Ablation

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Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽

10.1024/0301-1526.35.3.157 ◽

2006 ◽

Vol 35 (3) ◽

pp. 157-166 ◽

Cited By ~ 7

Author(s):

Hach-Wunderle ◽

Hach

Keyword(s):

Minimally Invasive ◽

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Venous Pressure ◽

Stage Iii ◽

High Ligation ◽

Surgical Trauma ◽

Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

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Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.008080 ◽

2009 ◽

Vol 24 (4) ◽

pp. 183-188 ◽

Cited By ~ 45

Author(s):

P Chapman-Smith ◽

A Browne

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Adverse Outcomes ◽

Patient Acceptance ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Clinical Recurrence ◽

Over Time

Objectives The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

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