Endovenous laser treatment of groin and popliteal varicose veins recurrence

2017 ◽  
Vol 33 (3) ◽  
pp. 195-205 ◽  
Author(s):  
Alvise Cavallini ◽  
Daniela Marcer ◽  
Salvatore Ferrari Ruffino
Keyword(s):  
Laser Treatment ◽  
Diode Laser ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Recurrent Varicose Veins ◽  
Venous Clinical Severity Score ◽  
Effective Option ◽  
One Year

Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5–17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.

Segmental saphenous ablation for chronic venous disease treatment

2020 ◽  
pp. 026835552094623
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Savino Occhionorelli ◽  
Maria Grazia Sibilla ◽  
Marianna Mucignat ◽  
...  
Keyword(s):  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Procedural Pain ◽  
Venous Disease ◽  
Disease Treatment ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score ◽  
Endovenous Thermal Ablation ◽  
Occlusion Rate ◽  
Reflux Recurrence

Background Endovenous thermal ablation for chronic venous disease treatment is recommended over traditional surgery. The present investigation compares endovenous laser ablation (EVLA) with radiofrequency (RF) for segmental endovenous sapheno–femoral junction ablation. Methods This is a retrospective study in which 79 patients underwent a 6 cm great saphenous vein ablation by RF or by EVLA. Primary outcome was occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score, peri-procedural pain, aesthetic satisfaction. Results At 12 ± 1 months recanalization of shrunk tract was recorded in 5/85 (5.8%) cases (2 RF, 3 EVLA) [OR: 1.6; 95%CI: 0.2–10.4; P = 0.6689]. Two cases (1/44 RF group and 1/38 EVLA group) also showed reflux recurrence [OR: 1.0; 95%CI: 0.06–17.8; P = 1.0000]. No significant differences between groups were found in AVVQ, VCSS, peri-procedural pain, or aesthetic satisfaction. Conclusion Saphenous sparing is feasible and effective by means of both EVLA and RF, representing a possible alternative to surgery.

Correlation between GSV diameter and varicose clinics

Phlebologie ◽  
2016 ◽  
Vol 45 (01) ◽  
pp. 29-35 ◽  
Author(s):  
F. Amsler ◽  
E. Kalodiki ◽  
E. Mendoza
Keyword(s):  
Varicose Veins ◽  
Clinical Severity ◽  
Venous Disease ◽  
Published Data ◽  
Mean Values ◽  
Venous Clinical Severity Score ◽  
The Mean ◽  
Group 2 ◽  
Disease Stratification ◽  
Group 1

Summary Background Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Stratification of venous disease severity is still difficult. This study aims to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS). Methods Legs without GSV reflux (Control legs, Group 1) and legs with untreated isolated GSV reflux and varicose veins limited to the GSV territory (Group 2) were studied clinically and with duplex ultrasound in a prospective study. The GSV diameters were measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to the C of CEAP and VCSS. Results The control legs-group 1 were: n=33, 6 male, mean age 53, mean BMI 26.The legs with reflux-group 2 were: n=78, 16 male, mean age 54, mean BMI 27.The mean diameters for the SFJ ( ± SD) for groups 1 and 2 were 6.4 ± 1.8 and 9.9 ± 3.4. For PT they were 3.6 ± 0.9 and 5.9 ± 1.8 respectively. In legs with reflux the SFJ diameter correlates strongly with the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively. The PT diameter correlates slightly better with the C of CEAP and VCSS than the SFJ diameter (0.55 and 0.57). The mean values of VCSS for groups 1 and 2 were 0.70. and 4.69. The C of CEAP and VCSS show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample. Conclusion The GSV diameters next to the SFJ and particularly at the PT in patients having reflux correlate strongly with both the C of CEAP and VCSS. Recording the GSV diameters at the SFJ and PT in a standardized way may improve comparison of published data and contribute to choice of treatment in the future.

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

2019 ◽  
Vol 34 (9) ◽  
pp. 604-610
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Maria Grazia Sibilla ◽  
Diana Neuhardt ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Significant Difference ◽  
Effective Option ◽  
Procedural Time ◽  
Group A ◽  
One Year ◽  
Group B

Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.

scholarly journals Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification

2011 ◽  
Vol 26 (suppl 2) ◽  
pp. 115-119 ◽  
Author(s):  
Nei Rodrigues Alves Dezotti ◽  
Edwaldo Edner Joviliano ◽  
Takachi Moriya ◽  
Carlos Eli Piccinato
Keyword(s):  
Surgical Treatment ◽  
Varicose Veins ◽  
Disease Classification ◽  
Clinical Severity ◽  
University Hospital ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Severe Group ◽  
Primary Varicose Veins ◽  
Ceap Classification

CONTEXT: Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). PURPOSE: To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. METHODS: We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. RESULTS: There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. CONCLUSION : Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

scholarly journals A variant of the castor zinc finger 1 (CASZ1) gene is differentially associated with the clinical classification of chronic venous disease

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Gregory T. Jones ◽  
Judith Marsman ◽  
Luba M. Pardo ◽  
Tamar Nijsten ◽  
Marianne De Maeseneer ◽  
...  
Keyword(s):  
Zinc Finger ◽  
Varicose Vein ◽  
Risk Allele ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Enhancer Activity ◽  
Lower Severity

Abstract Recent reports have suggested a reproducible association between the rs11121615 SNP, located within an intron of the castor zinc finger 1 (CASZ1) gene, and varicose veins. This study aimed to determine if this variant is also differentially associated with the various clinical classifications of chronic venous disease (CVD). The rs11121615 SNP was genotyped in two independent cohorts from New Zealand (n = 1876 controls /1606 CVD cases) and the Netherlands (n = 1626/2966). Participants were clinically assessed using well-established CVD criteria. The association between the rs11121615 C-allele and varicose veins was validated in both cohorts. This was strongest in those with higher clinical severity classes and was not significant in those with non-varicose vein CVD. Functional analysis of the rs11121615 variant demonstrated that the risk allele was associated with increased enhancer activity. This study demonstrates that the CASZ1 gene associated C-allele of rs11121615 has a significant, reproducible, association with CVD (CEAP C ≥ 2 meta-odds ratio 1.31, 95% CI 1.27–1.34, P = 1 × 10−98, PHet = 0.25), but not with non-varicose vein (CEAP C1, telangiectasia or reticular veins) forms of venous disease. The effect size of this association therefore appears to be susceptible to influence by phenotypic heterogeneity, particularly if a cohort includes a large number of cases with lower severity CVD.

scholarly journals A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status

2020 ◽  
pp. 026835552096864
Author(s):  
Raveena Ravikumar ◽  
Tristan RA Lane ◽  
Adarsh Babber ◽  
Sarah Onida ◽  
Alun H Davies
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Clinical Severity ◽  
Percentage Change ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Severity Scores ◽  
Venous Clinical Severity Score ◽  
Group A ◽  
Randomised Controlled

Background This randomised controlled trial investigates the dosing effect of neuromuscular electrical stimulation (NMES) in patients with chronic venous disease (CVD). Methods Seventy-six patients with CEAP C3-C5 were randomised to Group A (no NMES), B (30 minutes of NMES daily) or C (60 minutes of NMES daily). Primary outcome was percentage change in Femoral Vein Time Averaged Mean Velocity (TAMV) at 6 weeks. Clinical severity scores, disease-specific and generic quality of life (QoL) were assessed. Results Seventy-six patients were recruited - mean age 60.8 (SD14.4) and 47:29 male. Six patients lost to follow-up. Percentage change in TAMV (p<0.001) was significantly increased in Groups B and C. Aberdeen Varicose Veins Questionnaire Score (-6.9, p=0.029) and Venous Clinical Severity Score (-4, p-0.003) improved in Group C, and worsened in Group A (+1, p=0.025). Conclusions Daily NMES usage increases flow parameters, with twice daily usage improving QoL and clinical severity at 6 weeks in CVD patients.

Venous leg ulcer in the context of chronic venous disease

2013 ◽  
Vol 29 (4) ◽  
pp. 220-226 ◽  
Author(s):  
F S Lozano Sánchez ◽  
J Marinel Io Roura ◽  
E Carrasco Carrasco ◽  
J R González-Porras ◽  
J R Escudero Rodríguez ◽  
...  
Keyword(s):  
Short Form ◽  
Cross Sectional Study ◽  
Leg Ulcer ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Control Group ◽  
Venous Disease ◽  
Venous Leg Ulcer ◽  
Cross Sectional ◽  
Venous Clinical Severity Score

Objectives Chronic venous disease (CVD) is a frequent disorder with a high socioeconomic impact. Little is known about the possible differences between healed ulcer (C5 group) and active ulcer (C6 group) in terms of disease severity and quality of life (QoL). Our aim was to determine the possible differences in severity disease and QoL between the C5–C6 and C1 (control) group. Methods Data from a national, multicentre, observational and cross-sectional study ( n = 1598) were used to compare three groups of CVD: C1 ( n = 243), C5 ( n = 136) and C6 ( n = 70). CVD severity was assessed with the Venous Clinical Severity Score (VCSS) and QoL with the Short Form 12 Health Survey (SF-12) and Chronic Lower Limb Venous Insufficiency Questionnaire (CIVIQ-20). Results Patients with active ulcers had a higher mean total VCSS than patients with healed ulcers ( P < 0.05). Both SF-12 and CIVIQ-20 QoL questionnaires indicated a poorer QoL in patients with ulcers than in those with C1 ( P < 0.05). Compared with the C5 group, patients with active ulcers (C6) had lower QoL scores, but the differences were not statistically significant. Conclusions Patients with venous leg ulcers (C5–C6) are associated with high severity and poor QoL. However, the healing of a leg ulcer did not contribute to improvement of QoL.

Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein

1996 ◽  
Vol 11 (3) ◽  
pp. 125-131 ◽  
Author(s):  
K. A. Myers ◽  
G. H. Zeng ◽  
R. W. Ziegenbein ◽  
P. G. Matthews
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Injection Sclerotherapy ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins

Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.

scholarly journals Efficacy of varicose vein surgery with preservation of the great safenous vein

2015 ◽  
Vol 42 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Bernardo Cunha Senra Barros ◽  
Antonio Luiz de Araujo ◽  
Carlos Eduardo Virgini Magalhães ◽  
Raimundo Luiz Senra Barros ◽  
Stenio Karlos Alvim Fiorelli ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Venous Disease ◽  
Varicose Vein Surgery ◽  
Beneficial Effects ◽  
Venous Clinical Severity Score

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001). CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

scholarly journals Laser-assisted strategy for reflux abolition in a modified CHIVA approach

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Michele Zuolo ◽  
Mirko Tessari ◽  
Paolo Spath ◽  
...  
Keyword(s):  
Severity Score ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Clinical Severity Score ◽  
Diastolic Velocity ◽  
Venous Clinical Severity Score

The aim of this study was to assess feasibility and efficacy of an endovenous laser (EL) assisted saphenous-sparing strategy in chronic venous disease (CVD). Fourteen CVD patients (C2,3,4s Ep As Pr1,2,3) underwent a saphenofemoral junction (SFJ) treatment by EL just from below the superficial epigastric vein downward for a limited tract, together with a flush ligation of the incompetent tributaries of the great saphenous vein (GSV) along the leg. The following GSV parameters were assessed 15 cm below the SFJ: reflux time, caliber, peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI). Venous clinical severity score and the Clinical, Etiological, Anatomical, and Pathophysio logical (CEAP) classification clinical classes were assessed. At 1 year follow up 3 cases were considered failures because of a GSV thrombosis, even if they presented a GSV recanalization with a laminar flow within at the 2 years follow-up. Eleven procedures succeeded because neither minor nor major peri-procedural complications were reported, apart 2 cases of self-healing bruising. In these last 11 cases the procedure led to a GSV reflux suppression (from 3.1±0.4 s to a retrograde laminar draining flow), to a GSV caliber reduction (from 9.4±0.5 to 3.1±0.2 cm, P&lt;0.001), to a PSV reduction (from 50.2±4.6 to 18.4±3.5 cm/s, P&lt;0.001), to a RI reduction (from 0.9±0.2 to 0.51±0.2, P&lt;0.005) and to an oscillatory flow suppression (EDV from -8.9±1.6 to 6.2±2.3 cm/s, P&lt;0.001). Both CEAP and venous clinical severity score improved from 3 to 1 (P&lt;0.001) and from 7±2 to 2±1 (P&lt;0.05), respectively. The GSV flow reappeared below the shrunk tract draining into the re-entry perforator. Sapheno-femoral reflux suppression can be obtained by just a GSV segmental closure. An almost 80% of success rate of the present investigation paves the way for an even wider diffusion of endovenous techniques, moreover erasing the surgical requirements for those who would like to perform a saphenoussparing strategy. In this way new devices could be used inside equally innovative strategies.

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