Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation

Recurrent varicose veins are considered to be caused by the recurrence of reflux but rarely may be secondary to other pathologies. A 39-year-old man complained of right lower leg skin pigmentation, pain and fatigue for several years. Duplex ultrasound revealed that the great saphenous vein diameter at the saphenofemoral junction level was 7.7 cm, and at the knee medial level was 14.4 cm. The reflux time at the proximal great saphenousvein level was 1.85 s. Endovenous laser ablation for dilated and refluxed great saphenous vein was performed. However, 1 year later, the symptoms recurred. Duplex ultrasound suspected abnormal arterial flow from the right superficial femoral artery to the recanalized segment of previously ablated great saphenous vein and anterior accessory saphenous vein. One month later, despite the successful re-endovenous laser ablation, the symptoms recurred. Computed tomography angiography showed three fistulous vessels from superficial femoral artery to anterior accessory saphenous vein. Combined treatments with endovenous laser ablation and coil embolization was performed. Ultimately, the fistulas were obliterated and the patient remained free of symptoms. Varicose veins due to the fistulas from superficial femoral artery are rare and difficult to diagnose but can be entirely treated with the percutaneous approach.

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A comparison of three tumescent delivery systems in endovenous laser ablation of the great saphenous vein

Vascular ◽

10.1177/1708538112473972 ◽

2013 ◽

Vol 21 (6) ◽

pp. 375-379 ◽

Cited By ~ 3

Author(s):

Firat H Altin ◽

Baris Kutas ◽

Tevfik Gunes ◽

Selim Aydin ◽

Bortecin Eygi

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Delivery Systems ◽

Endovenous Laser Ablation ◽

Tumescent Solution ◽

Group 3 ◽

Group 2 ◽

Group 1

Different systems for delivering tumescent solution exist in endovenous laser ablation (EVLA). This study evaluated three different tumescent delivery systems in patients with primary varicose veins due to great saphenous vein reflux who were treated with EVLA. In this prospective non-randomized study, 60 patients with isolated GSV varicose veins were divided into three groups. All patients received EVLA treatment. Three different tumescent solution delivery systems were used. Systems consisted of a needle and a syringe in Group 1, a needle connected to an infusion bag system in Group 2 and a peristaltic infiltration pump in Group 3. Tumescent delivery durations were in Group 1: 6.56 SD 1.18 minutes, Group 2: 6.05 SD 2.19 minutes and Group 3: 5.19 SD 1.15 minutes ( P = 0.014). In the outcomes of the study there were no significant difference between groups. Although peristaltic pump systems might provide shorter tumescent delivery durations without hand fatigue, shorter duration does not have any practical importance (about 1 minute and also it is not cost-effective. For delivering tumescent solutions in EVLA procedures, there was no major superiority between systems.

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The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2008.008004 ◽

2009 ◽

Vol 24 (1) ◽

pp. 17-20 ◽

Cited By ~ 14

Author(s):

N S Theivacumar ◽

R J Darwood ◽

D Dellegrammaticas ◽

A I D Mavor ◽

M J Gough

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Standard Technique ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation ◽

Residual Symptoms ◽

Severity Scores ◽

Group B

Aims The standard technique for endovenous laser ablation (EVLA) for varicose veins due to great saphenous vein (GSV) reflux involves obliteration of the above-knee (AK) GSV. This study assesses the significance of persistent below-knee (BK) GSV reflux following such therapy. Methods Sixty-nine limbs (64 patients) with varicosities and GSV reflux underwent AK-EVLA. Post treatment, GSV reflux (ultrasound: six, 12 weeks) and Aberdeen varicose vein severity scores (AVVSS, 12 weeks) were assessed, and residual varicosities treated with foam sclerotherapy (six weeks). Results The untreated BK-GSV remained patent in all limbs. Ultrasound showed normal antegrade flow in 34/69 (49%, Group A), flash reflux <1 s in 7/69 (10%, Group B) and >1 s reflux in 28/69 (41%, Group C). Although AVVSS improved in all groups ( P < 0.001): A: 14.6 (8.4–19.3) versus 2.8 (0.5–4.4), B: 13.9 (7.5–20.1) versus 3.7 (2.1–6.8), C: 15.1 (8.9–22.5) versus 8.1 (5.3–12.6) the improvement was less in Group C ( P < 0.001 versus A and B) and was associated with a greater requirement (A: 4/34 [12%]; B: 1/7 [14%]; C: 25/28 [89%]) for sclerotherapy (persisting varicosities) ( P < 0.001). Conclusion Although AK-GSV EVLA improves symptoms regardless of persisting BK reflux, the latter appears responsible for residual symptoms and a greater need for sclerotherapy for residual varicosities.

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Endovenous laser ablation is an effective treatment for great saphenous vein incompetence in teenagers

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515585436 ◽

2015 ◽

Vol 31 (3) ◽

pp. 198-202

Author(s):

Piotr Terlecki ◽

Stanislaw Przywara ◽

Marek Iłżecki ◽

Karol Terlecki ◽

Piotr Kawecki ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Current Knowledge ◽

Varicose Veins ◽

Signs And Symptoms ◽

Chronic Venous Disease ◽

Venous Disease ◽

Invasive Treatment ◽

Endovenous Laser Ablation

Objectives The current knowledge of chronic venous disease in teenagers and its treatment is very limited. The aim of the study is to present our experience and the available literature data on the treatment of varicose veins in teenagers with endovenous laser ablation of the great saphenous vein. Methods Five patients, aged 15–17 years, were qualified for surgery, based on typical signs and symptoms of chronic venous disease. Minimally invasive treatment with endovenous laser ablation of the great saphenous vein was applied. Results The technical success of surgery was achieved in all patients. Over a 2-year follow-up we did not observe any case of recanalisation of the great saphenous vein, recurrence of varicose veins, or serious complications, such as deep vein thrombosis or pulmonary embolism. One patient presented with resolving of post-operative bruising, and two cases of local numbness were transient. Conclusions Endovenous laser ablation of the great saphenous vein in the treatment of chronic venous disease in teenagers is effective and safe. The method provides excellent cosmetic effects, very short recovery time and high levels of patient satisfaction.

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Great saphenous vein mechanochemical sclerotherapy versus laser ablation in treatment of varicose vein

QJM ◽

10.1093/qjmed/hcaa050.066 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M I Ibrahim ◽

K A Nabil ◽

A M Abdalmageed ◽

G K Hussein

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Procedural Pain ◽

Procedure Time ◽

Endovenous Laser Ablation ◽

High Incidence

Abstract Background Endovenous thermal techniques, such as endovenous laser ablation (EVLA), are the recommended treatment for truncal varicose veins. But it requires the administration of tumescent anaesthesia, which can be uncomfortable. Non-thermal, non-tumescent techniques, such as mechanochemical ablation (MOCA) have some advantages such as less post-procedural pain and less procedure time . MOCA combines physical damage to endothelium using sharply terminated metal claws, with the injection of a liquid sclerosant. Introduction Chronic venous insufficiency is one of the most common medical conditions among highly developed societies. The majority of patients (70%) suffer from saphenous veins incompetency. The aim of this study was to evaluate the primary efficacy of mechanochemical sclerotherapy by phlebogriffe (flebogrif) in comparison to laser ablation in treatment of varicose vein. Methods/Design The study was conducted on 30 patients, including 16 women and 14 men divided into 2 groups. The first group (15 patients) was treated with ablation with Flebogrif (MOCA) to treat varicose veins. The second group (15 patients) was treated with ablation with Endovenous laser ablation (EVLA). All patients were qualified based on the ultrasound in a standing position confirming incompetence of the great saphenous vein or small saphenous vein. The primary outcomes are intra-procedural pain and technical efficacy at 1 year, defined as complete occlusion of target vein segment and assessed using duplex ultrasound. Secondary outcomes are post-procedural pain, analgesia use, procedure time, clinical severity, bruising, complications, satisfaction, time taken to return to daily activities and/or work, and cost-effectiveness analysis following EVLA or MOCA. Both groups will be evaluated on an intention-to-treat basis. Results The total primary obliteration rate after 3 days and 1 month was 100% with both EVLA-RTF and MOCA while after 3 months (ms) was 93.3% with both groups. After 6ms the total primary obliteration rate was 93.3% with EVLA-RTF and 86.7% with MOCA. The Venous Clinical Severity Score (VCSS) presented similar and durable improvements in both groups between 3days and 6 months. While there is significant less post procedural pain, ecchymosis and bruises with the MOCA method and so high incidence of use of analgesics in EVLA patients than in MOCA group. The median time for return to work was 1 day after both treatments. No severe adverse events were observed. Discussion The aim of the study is to evaluate whether MOCA is superior to EVLA. The two main hypotheses are that MOCA may cause less initial pain and disability allowing rapid post-operative recovery. The second hypothesis is the efficacy, which may lead to increased recurrence and affect longer term quality of life, increasing the requirement for secondary procedures. Conclusions EVLA and MOCA have similarly high great saphenous vein (GSV) obliteration rates in the long term, and the treatments are equally effective clinically. While according to post procedural pain, ecchymosis, Bruises and long procedural time. The study showed significant high incidence of occurrence in EVLA group than MOCA group. So according to these items there is significant superiority of MOCA over EVLA.

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Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: Short-term results

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.03.053 ◽

2007 ◽

Vol 46 (2) ◽

pp. 308-315 ◽

Cited By ~ 201

Author(s):

Lars H. Rasmussen ◽

Lars Bjoern ◽

Martin Lawaetz ◽

Allan Blemings ◽

Birgit Lawaetz ◽

...

Keyword(s):

Laser Ablation ◽

Randomized Trial ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

High Ligation ◽

Short Term ◽

Endovenous Laser Ablation

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Endovenous laser ablation of the great saphenous vein – Varying energy may not affect outcome

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515620944 ◽

2016 ◽

Vol 32 (1) ◽

pp. 13-18 ◽

Cited By ~ 6

Author(s):

Carlos S Nejm ◽

Jorge RR Timi ◽

Walter Boim de Araújo ◽

Filipe C Caron

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Endovenous Laser Ablation ◽

Vein Occlusion ◽

Saphenous Veins ◽

Occlusion Rate

Objectives To determine great saphenous vein occlusion rate after endovenous laser ablation using the 1470-nm bare-fiber diode laser to supply either 7 W or 15 W and evaluate procedure-related complications. Method Patients with varicose veins of the lower extremities (CEAP class C2–C6) were randomly assigned to undergo either 7-W (18 patients, 30 limbs) or 15-W (18 patients, 30 limbs) endovenous laser ablation. Duplex ultrasound follow-up was at 3–5 days, 1, 6, and 12 months postoperatively. Results Occlusion rate was 100% in both groups at 3–5 days and 1 month and 86.7% in 7-W and 100% in 15-W patients at both 6 and 12 months, with no difference between groups ( p > 0.05). Four (13.3%) 15-W and 3 (10%) 7-W patients had paresthesia at 3–5 days, with no difference between groups ( p > 0.05). Conclusions These preliminary data suggest that both techniques are similarly effective in the treatment of varicose great saphenous veins.

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Conventional surgery and endovenous laser ablation of recurrent varicose veins of the small saphenous vein: a retrospective clinical comparison and assessment of patient satisfaction

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2009.009044 ◽

2010 ◽

Vol 25 (3) ◽

pp. 151-157 ◽

Cited By ~ 16

Author(s):

L van Groenendael ◽

L Flinkenflögel ◽

J A van der Vliet ◽

E A Roovers ◽

S M M van Sterkenburg ◽

...

Keyword(s):

Patient Satisfaction ◽

Laser Ablation ◽

Saphenous Vein ◽

Sural Nerve ◽

Varicose Veins ◽

Treatment Modalities ◽

Complication Rates ◽

Endovenous Laser Ablation ◽

Recurrent Varicose Veins

Objectives Recurrences of varicosities of the small saphenous vein (SSV) are common. Surgical reintervention is associated with increased complication rates. The aim of the study was to assess the feasibility of endovenous laser ablation (EVLA) in recurrent varicose veins of the SSV and to compare this technique with surgical reintervention. Methods All case files of patients treated for SSV varicosities between May 2006 and October 2008 were evaluated and recurrences were selected. Demographics, duplex findings, clinical, aetiological, anatomical and pathological classification, perioperative and follow-up data were all registered. Additionally, a questionnaire focusing on patient satisfaction was taken. Results Two hundred and eighty-one patients were treated for varicosities of the SSV, of which 42 were for recurrences. Twenty-six of these were treated with EVLA, all under local anaesthesia, and 16 were surgically treated. Most surgically treated patients were treated under regional anaesthesia (88%). Technical success was achieved in 94% of surgically treated patients and in all EVLA-treated patients. Complications in both groups were mostly minor and self-limiting. Sural nerve neuralgia appeared to be more frequent in the surgically treated group (20% versus 9%). After correction for length of follow-up, the incidence of rerecurrences was not statistically significant between groups. Conclusion EVLA is feasible in patients with recurrent varicose veins of the SSV with possibly a lower incidence of sural nerve injury. Patient satisfaction is high for both treatment modalities. Studies with larger samples are indicated to confirm these observations.

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Evaluation of healing of varicose ulcers after endovenous laser ablation of great saphenous vein

International Surgery Journal ◽

10.18203/2349-2902.isj20202376 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1707

Author(s):

Hatem Hussein Mohamed ◽

Beshoy Magdy Alshahat ◽

Mamdouh Mohamed Almezaien

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

P Value ◽

University Hospitals ◽

Endovenous Laser Ablation ◽

A Prospective Study

Background: Varicose veins are permanently swollen, tortuous and elongated while standing due to back flow of blood caused by incompetent valve closure which result in venous congestion .they are of two types primary and secondary varicosities .The main symptoms are tingling, itching, pain, fatigue, a heavy feeling in the legs especially if one has to stand for a long time. Ulcers and thrombophlebitis are possible complications. The aim of this study is to assess the outcome of laser ablation of great saphenous vein on healing of varicose ulcers.Methods: A prospective study conducted at Suez Canal University Hospitals and Nasser Institute Hospital in Cairo on 20 patients complaining varicose ulcers due to incompetent saphenous femoral junction.Results: All patients had improvement in Abrdeen Varicose vein questionnaire after endovenous laser ablation (EVLA) during the first, second and third follow up visits when compared with preoperative scores. The Aberdeen Varicose vein questionnaire ranged from 8 to 18 before the procedure, with a mean of 12.11, ranged from 3 to 11 at the first follow up visit with a mean of 7.07, ranged from 2 to 10 at the second follow up visit with a mean of 4.89 and ranged from 2 to 10 at the third follow up visit with a mean of 3.85, p value is less than 0.001 compared to the pre-operative data. During the assessment of the patients of our study after 6 months of continuous follow up, we found that the healing rate of the patients who underwent laser ablation of great saphenous vein were (91.67) (p=0.769).Conclusions: EVLA of great saphenous vein leads to better wound healing rates in treating patients with varicose ulcers.

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