A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation

2019 ◽  
Vol 34 (9) ◽  
pp. 627-635 ◽  
Author(s):  
Abduraheem Mohamed ◽  
Clement Leung ◽  
Louise Hitchman ◽  
Tom Wallace ◽  
George Smith ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Varicose Veins ◽  
Patient Choice ◽  
Clinical Severity ◽  
Concomitant Treatment ◽  
Mechanochemical Ablation ◽  
Severity Scores ◽  
Secondary Procedures ◽  
One Year

Introduction Endovenous mechanochemical ablation (MOCA) is an increasingly popular non-thermal non-tumescent technique used to treat axial reflux in patients with superficial venous incompetence. However, the optimal management of varicose tributaries following this technique is unknown and may impact on patient outcomes. This study compares MOCA with concomitant phlebectomy (MOCAP) versus ablation with sequential phlebectomy if required (MOCAS). Methods Patients with symptomatic Comprehensive Classification System for Chronic Venous Disorders (CEAP C2–C6) unilateral axial reflux were studied. Patient choice determined whether concomitant treatment of varicosities was carried out. The primary outcome was the Aberdeen Varicose Veins Questionnaire (AVVQ) at one year. Secondary outcomes included: Venous Clinical Severity Scores (VCSS), EuroQol 5-Domain quality of life scores, complications, procedure duration, procedural and post-operative pain scores and need for secondary procedures. Outcomes were assessed at baseline and then one week, six weeks, six months and one year post intervention. Results Fifty patients underwent MOCAP and 33 patients MOCAS. The two groups were comparable at baseline. MOCAP was associated with lower (better) AVVQ scores at six weeks (3.4 (0.5–6.0) vs. 6.1 (1.8–12.1); P = 0.009) and at six months (1.6 (0.0–4.5) vs. 3.34 (1.8–8.4); P = 0.009) but by one year the difference was no longer statistically significant (1.81 (0.0–4.5) vs. 3.81 (0.2–5.3); P = 0.099). MOCAP was associated with longer procedural duration (45 min (36–56) vs. 30 min (25–37); P < 0.001) and higher maximal periprocedural pain (31 (21–59) vs. 18 (7–25); P = 0.001). VCSS at all time points were lower in favour of MOCAP (0 (0–1) vs. 1 (0–3); P < 0.001). MOCAP was associated with fewer episodes of clinically significant thrombophlebitis (6 of 50 (12%) vs. 10 of 33 (30%); P = 0.039) and lower numbers of secondary procedures (2 (4%) vs. 6 (18%); P = 0.032). Conclusion Concomitant treatment of tributary varicosities following MOCA improves quality of life and clinical severity, while reducing rates of re-intervention and post-operative thrombophlebitis compared to sequential treatment. The penalty is a modest increase in procedural duration and discomfort. Further evidence from longer-term follow-up is needed.

COST-EFFECTIVENESS OF RADIOFREQUENCY ABLATION VERSUS LASER FOR VARICOSE VEINS

2015 ◽  
Vol 31 (5) ◽  
pp. 289-296 ◽  
Author(s):  
Amanda C. Shepherd ◽  
Marta Ortega-Ortega ◽  
Manj S. Gohel ◽  
David Epstein ◽  
Louise C. Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Radiofrequency Ablation ◽  
Varicose Veins ◽  
Cost Effective ◽  
Clinical Severity ◽  
Economic Implications ◽  
Severity Scores ◽  
Significant Difference

Objectives: Although the clinical benefits of endovenous thermal ablation are widely recognized, few studies have evaluated the health economic implications of different treatments. This study compares 6-month clinical outcomes and cost-effectiveness of endovenous laser ablation (EVLA) compared with radiofrequency ablation (RFA) in the setting of a randomized clinical trial.Methods: Patients with symptomatic primary varicose veins were randomized to EVLA or RFA and followed up for 6 months to evaluate clinical improvements, health related quality of life (HRQOL) and cost-effectiveness.Results: A total of 131 patients were randomized, of which 110 attended 6-month follow-up (EVLA n = 54; RFA n = 56). Improvements in quality of life (AVVQ and SF-12v2) and Venous Clinical Severity Scores (VCSS) achieved at 6 weeks were maintained at 6 months, with no significant difference detected between treatment groups. There were no differences in treatment failure rates. There were small differences in favor of EVLA in terms of costs and 6-month HRQOL but these were not statistically significant. However, RFA is associated with less pain at up to 10 days.Conclusions: EVLA and RFA result in comparable and significant gains in quality of life and clinical improvements at 6 months, compared with baseline values. EVLA is more likely to be cost-effective than RFA but absolute differences in costs and HRQOL are small.

Mechanochemical ablation for the treatment of superficial venous incompetence: A cohort study of a single centre’s early experience

2018 ◽  
Vol 34 (7) ◽  
pp. 466-473 ◽  
Author(s):  
Abduraheem H Mohamed ◽  
Clement Leung ◽  
Tom Wallace ◽  
Sean Pymer ◽  
Amy Harwood ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Clinical Severity ◽  
Health Related Quality ◽  
Mechanochemical Ablation ◽  
Venous Clinical Severity Score ◽  
Related Quality ◽  
Health Related ◽  
One Year

Background Mechanochemical ablation is an innovative non-thermal method of treating symptomatic axial superficial venous incompetence. This is a single-centre cohort study aiming to investigate the technical efficacy and clinical effectiveness at one year. Methods Patients with primary, unilateral, symptomatic axial incompetence were offered treatment with mechanochemical ablation using ClariVein® with 1.5% sodium tetradecyl sulphate. Assessments including clinical examination, duplex ultrasound and patient-reported health-related quality of life were performed at baseline and weeks 1, 6, 26 and 52. Results Thirty-two patients were recruited to the study. Complete target vein occlusion at one year was found in 21 (75%) patients. Six patients (21.4%) required secondary procedures, of which three had axial endovenous thermal ablation and three required ambulatory phlebectomy with perforator ligation. There was a significant improvement in the median (interquartile range) Venous Clinical Severity Score from baseline 6 (5–8) to a score of 1 (0–2) at one year (p < 0.001). There was also a significant improvement in health-related quality of life, both generic (p = 0.001) and disease specific (p < 0.001). One patient (3.1%) had a post-procedural non-fatal pulmonary embolus. Conclusions Mechanochemical ablation is a feasible and effective treatment for superficial venous incompetence. When using consensus definitions for anatomical closure, results for mechanochemical ablation may be less favourable than previously reported. Further studies are required to compare clinical and technical outcomes following mechanochemical ablation to other methods of endovenous ablation.

Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit™ versus ClariVein® for varicose veins trial

2014 ◽  
Vol 31 (1) ◽  
pp. 61-65 ◽  
Author(s):  
R Bootun ◽  
TRA Lane ◽  
B Dharmarajah ◽  
CS Lim ◽  
M Najem ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiofrequency Ablation ◽  
Randomised Controlled Trial ◽  
Pain Score ◽  
Varicose Veins ◽  
Controlled Trial ◽  
Early Results ◽  
Mechanochemical Ablation ◽  
Randomised Controlled

Objective Endovenous techniques are, at present, the recommended choice for truncal vein treatment. However, the thermal techniques require tumescent anaesthesia, which can be uncomfortable during administration. Non-tumescent, non-thermal techniques would, therefore, have potential benefits. This randomised controlled trial is being carried out to compare the degree of pain that patients experience while receiving mechanochemical ablation or radiofrequency ablation. The early results of this randomised controlled trial are reported here. Methods Patients attending for the treatment of primary varicose veins were randomised to receive mechanochemical ablation (ClariVein®) or radiofrequency ablation (Covidien® Venefit™). The most symptomatic limb was randomised. The primary outcome measure was intra-procedural pain using a validated visual analogue scale. The secondary outcome measures were change in quality of life and clinical scores, time to return to normal activities and work as well as the occlusion rate. Results One-hundred and nineteen patients have been randomised (60 in the mechanochemical ablation group). Baseline characteristics were similar. Maximum pain score was significantly lower in the mechanochemical ablation group (19.3 mm, standard deviation ±19 mm) compared to the radiofrequency ablation group (34.5 mm ± 23 mm; p < 0.001). Average pain score was also significantly lower in the mechanochemical ablation group (13.4 mm ± 16 mm) compared to the radiofrequency ablation group (24.4 mm ± 18 mm; p = 0.001). Sixty-six percent attended follow-up at one month, and the complete or proximal occlusion rates were 92% for both groups. At one month, the clinical and quality of life scores for both groups had similar improvements. Conclusion Early results show that the mechanochemical ablation is less painful than the radiofrequency ablation procedure. Clinical and quality of life scores were similarly improved at one month. The long-term data including occlusion rates at six months and quality of life scores are being collected.

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

2021 ◽  
pp. 1-8
Author(s):  
Olle Nelzén ◽  
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.

Levenskwaliteit een jaar na radiofrequente ablatie van de vena saphena magna

2021 ◽  
Author(s):  
L. CRAEGHS ◽  
B. BECHTER-HUGL ◽  
S. THOMIS ◽  
I. FOURNEAU
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Self Image ◽  
Patient Reported ◽  
One Year

Quality of life one year after radiofrequency ablation of the great saphenous vein Symptomatic varicose veins have a negative impact on quality of life. Radiofrequency ablation (RFA) is an endovenous technique to occlude the venous lumen. In this study, the patient satisfaction and patient-reported quality of life is investigated one to two years after RFA of the great saphenous vein (GSV). Questionnaires were sent to 200 patients who were treated with RFA of the GSV at UZ Leuven more than one year ago. Data were processed using SPSS Statistics 24. 98 of 200 patients (49%) participated in this study. 80,4% (78/97) of patients were satisfied and 95,8% (92/96) would choose it all over again. Self image improved in 58,2% (57/98) and general health improved in 29,6% (29/98) of patients compared to a year ago. 57,4% (54/94) of patients had no relapse or progression one year after RFA of the GSV. Dissatisfaction was more common in patients with a history of varicose vein treatment, in patients with recurrent varicose veins or venous symptoms and in patients with postoperative hematoma. RFA of the GSV results in patient satisfaction among the participating patients and has a positive impact on their self image and on health-related quality of life more than a year after the treatment.

scholarly journals Validation of the Italian version of the Myasthenia Gravis Impairment Index (MGII)

2021 ◽  
Author(s):  
Francesca Pasqualin ◽  
Carolina Barnett ◽  
Silvia Vittoria Guidoni ◽  
Elisa Albertini ◽  
Mario Ermani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myasthenia Gravis ◽  
The Other ◽  
Clinical Severity ◽  
Italian Version ◽  
Floor Effect ◽  
Dutch Translation ◽  
Severity Scores ◽  
Patient Reported

Abstract Objective To validate the Italian version of the Myasthenia Gravis Impairment Index (MGII). Introduction MGII is a recent promising measure developed for MG patient evaluation. It includes a clinical severity evaluation and a patient-reported questionnaire. It has been developed in English and has demonstrated feasibility, reliability, and construct validity. Recently, its Dutch translation has been validated. Methods MGII was translated to Italian with a multi-step forward process. We assessed correlations with the following scores: Istituto Nazionale Carlo Besta score for Myasthenia Gravis (INCB-MG), the MG Activities of Daily Living (MG-ADL), the Myasthenia Gravis Composite (MGC), the Quality of Life 15 for Myasthenia Gravis (QOL15-MG), and the Myasthenia Gravis Disability (MGDIS). We also assessed differences in MGII scores by disease severity with the ANOVA Kruskal–Wallis test. Results One hundred forty-one patients were enrolled. The mean MGII total score was 13.3 ± 11.9 (range 0–49), with a mean ocular subscore of 3.7 ± 4.7 and a mean MGII generalized subscore of 9.6 ± 9.0. As expected, the MGII had a good correlation with the other severity scores. The MGII had a lower floor effect (3.5%) than the other measures. Twenty-five patients were assessed in follow-up; as expected, the MGII change scores had moderate correlations with change in other MG severity measures and lower correlations with quality of life measures. Conclusions The MGII score was cross-culturally validated in an Italian cohort of MG patients. We confirmed its lower floor effect and the correlations with other MG measures including INCB-MG that was not evaluated in previous studies.

The relation between clinical scores and quality-of-life in long-term follow-up

2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 99-105 ◽  
Author(s):  
Fabio S Catarinella ◽  
Fred HM Nieman ◽  
Cees HA Wittens
Keyword(s):  
Quality Of Life ◽  
Negative Correlation ◽  
Severity Score ◽  
Clinical Severity ◽  
Venous Disease ◽  
Venous Obstruction ◽  
Clinical Severity Score ◽  
Severity Scores ◽  
Venous Clinical Severity Score

Introduction Quality-of-life and severity scores are both popular measures in medicine. For deep venous obstruction, the VEINES-QOL/Sym and venous clinical severity score (VCSS) are widely used. Combining a patient-reported outcome with a clinical severity score should give a more sensitive outcome for treatment results. To establish and compare their suitability for deep venous disease, we compared the outcomes of both scores in a group of patients who were interventionally treated for deep venous disease. Methods The venous clinical severity scores and VEINES-QOL/Sym scores of a group of patients who had received interventional treatment for deep venous obstruction more than 12 months ago were compared at T0 and T12. Results Both the Spearman’s rho and Pearson’s r show a very weak, negative correlation (statistically significant ( p ≤ 0.05)), between the venous clinical severity score and VEINES-QOL at T12 and between the venous clinical severity score and the VEINES-SYM at both T0 and T12. T0 VCSS-VSYM: rho = −0.219 ( p = 0.052), r = −0.236 ( p = 0.037), T12 VCSS-VQOL: rho = −0.459 ( p = 0.007), r = −0.379 ( p = 0.030), T12 VCSS-VSYM: rho = −0.463 ( p = 0.007), r = −0.432 ( p = 0.012). This negative correlation was not statistically ( p ≥ 0.05) confirmed for T0 VCSS-VSYM. Conclusion The physician-scored venous clinical severity score of patients treated for deep venous obstruction does not correlate well with their self-reported quality-of-life and symptom scores.

Treatment of foot varicose veins: A study of 119 consecutive patients

2017 ◽  
Vol 33 (4) ◽  
pp. 267-272
Author(s):  
Luiz Fernando Albernaz ◽  
Daiane Taís Schlindwein Albernaz ◽  
Fernanda Rita Machado Zignani ◽  
Yung-Wei Chi
Keyword(s):  
Quality Of Life ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Lymphatic Drainage ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Single Procedure ◽  
Venous Clinical Severity Score ◽  
Deep Vein

Objective To analyze the outcomes of 119 (188 feet) patients undergoing foot varicose vein phlebectomy with and without sclerotherapy between 2013 and 2015. Methods Legs and feet were treated in one single procedure. Clinical and ultrasound assessments were carried out at 7, 30, and 90 days for visualization of the sapheno-femoral and sapheno-popliteal junctions and the deep vein system. Results Mean age was 50 ± 12 years (25–79 years); 67 patients were female (56.3%). Median venous clinical severity score was 4 (range 2–5) before and 1 (range 0–2) at 90 days ( p < 0.001). Edema and transient paresthesia were the most frequent complications (13 (10.92%) and 11 (9.24%) patients, respectively). All complications were resolved at 90 days except one case of edema (resolved after 150 days with compression stockings and lymphatic drainage manual therapy). Conclusions Symptomatic foot varicose vein intervention was safe and effective. Further studies should focus on assessment of vein-specific quality of life questionnaires.

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