Long-term follow-up for different varicose vein therapies: is surgery still the best?

Management of varicose vein disease has changed drastically over the past decades. Since its introduction in vein practice, surgery has gone through several stages of evolution until the method of ligation with stripping eventually became and remained the standard for a long time. It was found to be effective at treating the condition and, indications of its beneficial impact on patients’ quality of life soon also became evident. However, being associated with significant morbidity, surgery gradually fell out of favour, especially, once the newer endovenous techniques were launched around the turn of the century. These endothermal methods allowed procedures to be carried out under local anaesthetic as day case interventions, often with a similar or even better effect on occlusion rates and quality of life. In addition, there is mounting evidence that these newer techniques might be more cost-effective. This review evaluates surgical treatment of varicose veins compared to endovenous methods and also assesses its place in current phlebological practice.

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A review on hetus of varicose veins

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v7i4.400 ◽

2019 ◽

Vol 7 (4) ◽

Author(s):

Shruti Mani ◽

M. V. Mokashi

Keyword(s):

Quality Of Life ◽

Varicose Vein ◽

Varicose Veins ◽

Early Stage ◽

Signs And Symptoms ◽

Physiological Changes ◽

Prolonged Standing ◽

Life Style Changes

The life style changes, obesity, occupational pattern of prolonged standing and pregnancy are considered to be significantly contributing to this situation known as Varicose veins wherein veins become enlarged and twisted. Incidence of varicose vein is more in people belonging to the occupation that involved prolonged standing. Varicose vein can be co-related to Sirajgranthi as described in Ayurvedic texts. Ayurved formulations are said to be effective in the management of Sirajgranthi (Varicose veins)Sirajgranthi, treated at an early stage or allows proper maintenance of signs and symptoms reduces the complications and support a better quality of life. In this article we have tried to analyse the anatomical and physiological changes due to long term standing.

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A One-Year Audit of Varicose Vein Surgery at a Vascular Surgical Unit with a Long-Term Duplex and Quality of Life Follow-Up

Surgical Case Reports ◽

10.31487/j.scr.2021.07.15 ◽

2021 ◽

pp. 1-8

Author(s):

Olle Nelzén ◽

Ingvor Fransson

Keyword(s):

Quality Of Life ◽

Varicose Vein ◽

Open Surgery ◽

Varicose Veins ◽

Long Term Results ◽

Primary Surgery ◽

One Year

Objective: With the introduction of endovenous treatments, open varicose veins surgery was discarded due to a claimed high risk of neovascularisation. A one-year audit was set up to look at results from performing mainly open surgery. Methods: All varicose vein interventions were registered and prospectively followed with colour Duplex assessments after 4-6 weeks, 1 and >5 years. In addition, Aberdeen Varicose Vein Questionnaire (AVVQ) was used in addition to Varicose Vein Severity Score (VCSS) to assess patients’ quality of life (QoL) and the disease severity. Results: During the year, 236 patients/252 legs were operated and 28% were re-do procedures. Median age was 55 years (16-87) and 70% were females. Duplex at 4-6 weeks showed a primary success rate of 91%. Neovascularisation was noted in 8% one year after primary surgery. The long-term assessment was done after a median of 69 months (39-75) and 67% of all legs were examined. After primary surgery 16% showed neovascularisation compared with and 27% after re-do procedures. VCSS improved significantly from 6 (range 1-22) to 2 at the long-term follow-up (p<0.001). The AVVQ score improved from 20 (range 3-55) down to 10 (p<0.001). Conclusion: The risk for neovascularisation seems to have been overestimated and good long-term results can be achieved following modern open surgery. The major problem is to avoid varicose vein recurrence since results from re-do procedures seem less favourable long term.

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Relationships between duplex findings and quality of life in long-term follow-up of patients treated for chronic venous disease

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516630868 ◽

2016 ◽

Vol 31 (1_suppl) ◽

pp. 88-98 ◽

Cited By ~ 3

Author(s):

Ying Huang ◽

Peter Gloviczki

Keyword(s):

Quality Of Life ◽

Clinical Studies ◽

Varicose Veins ◽

Long Term Results ◽

Venous Disease ◽

Venous Surgery ◽

Long Term Follow Up

Objective Relationships between duplex findings and data on health-related quality of life (QoL) to assess long-term results of treatment of varicose veins and chronic venous insufficiency (CVI) are not well known. The goal of this review was to correlate duplex findings and QoL assessments in clinical studies with long-term follow-up. Methods A review of the English language literature on PUBMED revealed 17 clinical studies, including 9 randomized controlled trials (RCTs), 6 prospective, and 2 retrospective studies that included patients with at least 5-year follow-up after endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), and traditional superficial venous surgery. Results At 5 years, great saphenous vein (GSV) occlusion rate on duplex ultrasound ranged from 66% to 82% for EVLA, from 62% to 92% for RFA, from 41% to 58% for UGFS and from 54% to 85% for surgery. Freedom from GSV reflux rates were 82% and 84%, respectively for EVLA and surgery, and ranged between 84% and 95% for RFA. Significant improvements were observed in several domains of generic QoL and in most domains of venous disease-specific QoL, irrespective of the treatment. In at least one RCT, CIVIQ scores correlated well with abnormal duplex findings in patients who underwent treatment with UGFS. In another RCT, long-term AVVQ was significantly better after surgery as compared with UGFS similar to results of duplex findings. Conclusions Analysis of the available literature confirmed that all four techniques were effective in the abolishment of reflux or obliteration of the GSV. Moreover, well-designed RCTs with large sample size are needed to produce robust long-term data on clinical outcome after treatment of varicose veins and CVI and to better understand the relationships between duplex-derived data and QoL assessments.

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Comparison of results of treatment varicose vein disease using a method of endovenous laser oblitetation with radial light guide and combined phlebectomy

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2017-16-1-16-20 ◽

2017 ◽

Vol 16 (1) ◽

pp. 16-20

Author(s):

A. N. Galileeva ◽

M. A. Parikov ◽

V. B. Karpovich ◽

A. A. Kotslova ◽

V. V. Davydenko

Keyword(s):

Quality Of Life ◽

Varicose Vein ◽

Varicose Veins ◽

Lower Extremities ◽

Term Efficacy ◽

Results Of Treatment ◽

Radial Fiber ◽

Vein Disease

We compare the short- and long-term efficacy of endovenous laser oblitetation (EVLO) using a radial fiber with radial emission versus combined phlebectomy for the surgical treatment of varicose vein disease of the lower extremities. Participated 58 patients (46 females, 12 males) with ages ranging between 24 and 75 years with varicose vein disease of the lower extremities affecting the great saphenous vein (GSV) were prospectively enrolled in this observational trial. Patients were randomized to receive either combined phlebectomy - first group - 29 patients (33 extremities) or endovenous laser obliteration using a radial fiber-second group - 29 patients (36 extremities). A total of 69 extremities with functional classes C2 - 28 (40.58 %) cases, C3 - 30 (43.48 %) cases and C4 - 11 (15.94 %) cases according to CEAP classification were treated. Post-treatment CIVIQ-2 Questionnaire and VCSS scale, physical examination, duplex angioscan was conducted at 1st day, 1 week, 12 and 36 months later. The frequency of recurrence was assessed at one and three years after the surgery. 2nd group is characterized by higher quality of life in postoperative period. 100 % ablation in group with EVLO and 93.1 % - with combined phlebectomy. The frequency of recurrence presenting with new visible varicose veins was noted through 3 year in 8 patients (9 extremities) (34 %) from first group and in 4 patients (6 extremities) (21 %) from the second of 80 % examined patients. Endovenous laser obliteration has significant advantages in short-term efficacy: lower post-procedure pain, quicker rehabilitation period, possibility to carry out in outpatient settings, higher quality of life in long-term efficacy, lower frequency of recurrence.

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