Compression regimes after endovenous ablation for superficial venous insufficiency – A survey of members of the Vascular Society of Great Britain and Ireland

2015 ◽  
Vol 31 (1) ◽  
pp. 16-22 ◽  
Author(s):  
J El-Sheikha ◽  
S Nandhra ◽  
D Carradice ◽  
C Acey ◽  
GE Smith ◽  
...  
Keyword(s):  
Great Britain ◽  
Venous Insufficiency ◽  
Current Practice ◽  
Varicose Veins ◽  
Postal Questionnaire ◽  
Compression Stockings ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Endovenous Ablation ◽  
Superficial Venous Insufficiency

Introduction The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. Methods Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. Results Valid replies were received from 41% ( n = 141) surgeons representing at least 68 (61%) vascular units. UGFS was used by 74% surgeons, RFA by 70% and EVLA by 32%, but fewer patients received UGFS (median 30) annually, than endothermal treatment (median 50) – P = 0.019. All surgeons prescribed compression: following UGFS for median seven days (range two days to three months) and after endothermal ablation for 10 days (range two days to six weeks) – P = 0.298. Seven different combinations of bandages, pads and compression stockings were reported following UGFS and four after endothermal ablation. Some surgeons advised changing from bandages to stockings from five days (range 1–14) after UGFS. Following endothermal ablation, 71% used bandages only, followed by compression stockings after two days (range 1–14). The majority of surgeons (87%) also treated varicose tributaries: 65% used phlebectomy, the majority (65%) synchronously with endothermal ablation. Concordance of compression regimes between surgeons within vascular units was uncommon. Only seven units using UGFS and six units using endothermal ablation had consistent compression regimes. Conclusion Compression regimes after treatments for varicose veins vary significantly: more evidence is needed to guide practice.

scholarly journals Treatment of Varicose Veins: The Present and the Future – A Questionnaire Survey

2008 ◽  
Vol 90 (7) ◽  
pp. 561-564 ◽  
Author(s):  
RJ Winterborn ◽  
CRR Corbett
Keyword(s):  
Great Britain ◽  
Private Practice ◽  
Questionnaire Survey ◽  
Varicose Veins ◽  
Treatment Options ◽  
Postal Questionnaire ◽  
Foam Sclerotherapy ◽  
Improved Outcomes ◽  
Change In Practice ◽  
Future Practice

INTRODUCTION The treatment options for varicose veins have increased over the last few years. Despite alack of randomised trials comparing the various modalities, many surgeons are changing their practice. The aim of this study was to assess the current practice of surgeons in Great Britain and Ireland. MATERIALS AND METHODS A postal questionnaire survey was sent to surgical members of the Vascular Society of Great Britain and Ireland and the Venous Forum of The Royal Society of Medicine. Of 561 questionnaires sent, 349 were returned completed (62%). RESULTS The types of varicose vein treatments offered by each surgeon varied widely in both NHS and private practice. The vast majority (96%) offered conventional surgery (CS) on the NHS. Foam sclerotherapy (FS) endovenous laser (EVL) and radiofrequency ablation (RF) were more likely to be offered in private practice than in NHS practice. Overall, 38% of respondents for NHS practice and 45% of respondents for private practice offered two or more modalities. Of the respondents who were not yet performing FS, EVL, or RF, 19% were considering or had undertaken training in FS, 26% in EVL and 9% in RF. When asked to consider future practice, 70% surgeons felt that surgery would remain the most commonly used treatment. This was followed by FS (17%), EVL (11%) and RF (2%). CONCLUSIONS Over one-third of respondents are now offering more than one treatment modality for the treatment of varicose veins. Whilst there is movement towards endovascular treatments, the problem of cost has yet to be solved. At present, surgery remains the most popular modality in both the NHS and private practice; however, improved outcomes and patient preference may lead to a change in practice.

Patient-reported outcomes of endovenous superficial venous ablation for lower extremity swelling

2018 ◽  
Vol 34 (6) ◽  
pp. 391-398
Author(s):  
William Shutze ◽  
Ryan Shutze ◽  
Paul Dhot ◽  
Gerald O Ogola
Keyword(s):  
Patient Reported Outcomes ◽  
Venous Insufficiency ◽  
Disease Score ◽  
Compression Stockings ◽  
High Patient Satisfaction ◽  
Saphenous Veins ◽  
Time Period ◽  
Patient Reported ◽  
Endovenous Ablation ◽  
Superficial Venous Insufficiency

Objective To evaluate the effect of endovenous ablation in patients presenting with leg swelling. Methods We identified Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class 3 (C3) patients undergoing endovenous ablation from 21 January 2005 to 19 March 2015 with an 810-nm or 1470-nm laser. Patients were surveyed regarding the degree of edema, use of compression stockings, and satisfaction with the procedure. Results A total of 1634 limbs were treated by endovenous ablation for incompetent saphenous veins with or without adjunctive segmental varicose vein microphlebectomy. Of these, 528 limbs were treated for CEAP C3. The average time period from the procedure date until the survey date was 1494 days (range, 562–2795 days). Ninety-two respondents accounted for 130 ablations in 128 limbs with an average venous segmental disease score of 2.7. Ninety-seven limbs (75.8%) had reduced or resolved swelling, 29 limbs (22.6%) were unchanged, and 2 limbs (1.6%) had increased swelling. The vast majority (81%) were satisfied with their decision to have the procedure. Conclusions Endovenous ablation for edema secondary to superficial venous insufficiency is effective and has high patient satisfaction. Further investigation is needed regarding risk factors for immediate failure and delayed recurrence of edema.

scholarly journals Exacerbation of alopecia areata: A possible complication of sodium tetradecyl sulphate foam sclerotherapy treatment for varicose veins

2017 ◽  
Vol 5 ◽  
pp. 2050313X1771264 ◽  
Author(s):  
Mark S Whiteley ◽  
Victoria C Smith
Keyword(s):  
Alopecia Areata ◽  
Varicose Veins ◽  
Clinical Score ◽  
Severe Exacerbation ◽  
Hormonal Changes ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Pelvic Vein ◽  
History Of ◽  
Sodium Tetradecyl Sulphate

A 40-year-old woman with a history of alopecia areata related to stress or hormonal changes was treated for bilateral primary symptomatic varicose veins (CEAP clinical score C2S) of pelvic origin, using a staged procedure. Her first procedure entailed pelvic vein embolisation of three pelvic veins using 14 coils and including foam sclerotherapy of the tributaries, using 3% sodium tetradecyl sulphate. Following this procedure, she had an exacerbation of alopecia areata with some moderate shedding of hair. Subsequently, she underwent endovenous laser ablation under local anaesthetic without incident. Seven months after the pelvic vein embolisation, she underwent foam sclerotherapy of leg and labial varicose veins using sodium tetradecyl sulphate. Two days following this procedure, she had a severe exacerbation of alopecia areata with gross shedding of hair. These two episodes of exacerbation of alopecia areata appear to be associated with sodium tetradecyl sulphate foam sclerotherapy of veins.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy

Vascular ◽  
2021 ◽  
pp. 170853812110514
Author(s):  
Nail Kahraman ◽  
Gündüz Yümün ◽  
Deniz Demir ◽  
Kadir K Özsin ◽  
Sadık A Sünbül ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Near Infrared ◽  
Varicose Veins ◽  
Infrared Light ◽  
Foam Sclerotherapy ◽  
Near Infrared Light ◽  
Nir Light ◽  
Male Patients

Objectives Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. Methods In this retrospective study, treatment and clinical outcomes of patients’ who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. Results A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. Conclusion Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

scholarly journals Superficial venous insufficiency from the infernal to the endothermal

2014 ◽  
Vol 96 (1) ◽  
pp. 5-10 ◽  
Author(s):  
D Carradice
Keyword(s):  
Gold Standard ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Resource Limitation ◽  
Skin Damage ◽  
The Common ◽  
Modern Treatment ◽  
The Cost ◽  
Superficial Venous Insufficiency

This review presents the common diseases associated with superficial venous insufficiency of the leg. These include varicose veins, swelling, skin damage and ulceration. The benefits and rationale behind treatment are discussed, followed by the historical advances from ancient mortality and prayer to the modern endovenous revolution. Finally, an overview of modern treatment options will discuss the evidence supporting the gold standard of endothermal ablation and the cost effectiveness of treatment at this time of challenging resource limitation.

scholarly journals Elastic compression treatment of chronic superficial venous insufficiency of the lower limbs based on Doppler venous pressure index measurements

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Leonardo Corcos ◽  
Daniele Pontello ◽  
Tommaso Spina
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Lower Limbs ◽  
Compression Stockings ◽  
Elastic Compression ◽  
Pressure Index ◽  
Counter Pressure ◽  
The Difference ◽  
Compression Treatment

Ineffectiveness or discomfort from graduated elastic compression stockings (GES) in patients with chronic venous insufficiency (CVI) and/or varicose veins of the lower limbs (VVLL) can depend of inappropriate counter pressure applied. Counter pressure was calculated by Doppler venous pressure index (VPI). The aim of this study was to verify the value VPI in the choice of GES. A total of 1212 LL of 606 patients subjected to VPI measurements VPI correlated with the various sites of reflux (R) and C of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. The difference between standing VPI the and normal values=counter pressure to be applied by GES. Questionnaire to 96 patients with CVI/VVLL wearing GES. Mean VPI values: greater saphenous (GSV)>smaller saphenous; GSV with isolated venous reflux (R) at the leg>GSV at the thigh; additional R in perforators increases VPI in all the districts; superficial R increases VPI in PT. Relation between VPI/C of CEAP: P<0.05-0.0001; 81/83/96 (97.5%) patients improved; 0 complained. R in GSV at the leg and in perforators increases VPI in deep veins. Few discrepancies VPI/CEAP can be expected. Standing VPI is highly predictive. The best choice of GES can be based on the VPI measurement.

scholarly journals ClariVein® – Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins

2016 ◽  
Vol 32 (1) ◽  
pp. 6-12 ◽  
Author(s):  
TY Tang ◽  
JW Kam ◽  
ME Gaunt
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Single Centre ◽  
Foam Sclerotherapy ◽  
Early Results ◽  
Endovenous Ablation ◽  
The Uk

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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