The frequency and clinical significance of nontarget superficial and deep vein occlusion after physician compounded foam sclerotherapy of varicose tributaries

2020 ◽  
Vol 35 (6) ◽  
pp. 430-439 ◽  
Author(s):  
Kirill Lobastov ◽  
Athena Vorontsova ◽  
Astanda Bargandzhiya ◽  
Sergey Tsaplin ◽  
Ilya Schastlivtsev ◽  
...  
Keyword(s):  
Medical Records ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Lower Limbs ◽  
Foam Sclerotherapy ◽  
Vein Occlusion ◽  
Deep Vein ◽  
Observation Period ◽  
Time Point

Objective To evaluate the incidence and clinical relevance of silent nontarget occlusion (NTO) of superficial and deep veins occurring after ultrasound-guided foam sclerotherapy (UGFS) that can be detected by serial duplex ultrasound scan (DUS). Methods This retrospective analysis evaluated the medical records of patients treated with UGFS at a private clinic in Moscow, Russia from 2015 to 2017. All patients underwent serial DUS at 1 to 2 weeks and 1, 3, 6, and 12 months after UGFS. Results During the observation period, 268 patients were treated with UGFS, using physician compounded polidocanol foam 257 lower limbs of 196 patients (73%) with varicose veins who underwent DUS at 1 to 2 weeks after the last session of UGFS (inclusion time-point): 139 women and 57 men (mean age: 44.2 ± 12.2 years) with the following CEAP clinical class distribution: C2, 74.0%; C3, 20.0%; C4, 4.5%; and C5, 1.5%. NTO at the inclusion time-point occurred in 60 limbs (23.3%) of 57 patients (28.5%) and was symptomatic only in three limbs (1.2%). Most occlusions were localized in the untreated great saphenous vein trunk ( n = 28) and the calf muscle veins ( n = 23). Overall, 72%, 44%, 29%, and 10% of all limbs and 77%, 45%, 28%, and 12% of limbs with NTO were followed up by DUS at 1, 3, 6, and 12 months, respectively. There were no cases of thrombus progression or symptomatic venous thromboembolism (VTE). At six months, no deep vein occlusions persisted. Conclusions The frequency of nontarget vein occlusion after UGFS revealed by serial DUS may be as high as 23.3%. These occlusions tend to resolve within six months and are not associated with symptomatic VTE.

Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux

2009 ◽  
Vol 24 (4) ◽  
pp. 183-188 ◽  
Author(s):  
P Chapman-Smith ◽  
A Browne
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Adverse Outcomes ◽  
Patient Acceptance ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Clinical Recurrence ◽  
Over Time

Objectives The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods A five-year prospective study was performed, recording the effect on the GSV and saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results No serious adverse outcomes were observed – specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.

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.

scholarly journals In the era of endo-venous ablation of varicose veins, is surgery still competitive?

2018 ◽  
Vol 5 (12) ◽  
pp. 3904
Author(s):  
Ahmed S. Elmallah ◽  
Yehia M. Alkhateeb ◽  
Said I. Elmallah
Keyword(s):  
Minimally Invasive ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Early Recurrence ◽  
Lower Limbs ◽  
Foam Sclerotherapy ◽  
High Tie ◽  
Venous Ulcers ◽  
Group A ◽  
Group B

Background: There are different evolving minimally invasive surgical options for varicose veins (VV) treatment. This study compared Endo-venous Laser Ablation (EVLA) and foam sclerotherapy Vs high tie and multiple phlebectomy / ligation without vein stripping.Methods: 185 lower limbs with primary VV and sapheno-femoral junction (SFJ)incompetence were included. Patients were divided into two groups. Group A: 85 limbs in 78 patients (4 had chronic venous ulcers) were treated by EVLA & foam sclerotherapy under tumescent anesthesia. Group B: 100 limbs in 100 patients (5 had chronic venous ulcers) were treated by high tie and multiple phlebectomy/ ligation under local anesthesia. All patients had duplex ultrasound preoperative and 4 weeks and 1 year postoperatively. Postoperative outpatient follow-up was 4 weeks, 3, 6 and 12 months.Results: All procedures were successful. Early postoperative recurrence in 3 limbs (3.52%) in EVLA and no early recurrence in group B. Patients with venous ulcers healed within 3-5 weeks in both groups. Postoperative pigmentation was higher in group B. Mean time of procedure was 60-90 min and 60-150 min respectively. Significant pain in first week was more in group A (40 patients) than group B (22 patients) p<0.05. No DVT, wound infection, permanent nerve affection nor skin burn was recorded in both groups. Return to normal activities was quicker in Group B compared to group A but mean cost per limb was higher in Group B (1000 -1500 US $) versus Group A (500-750 US$).Conclusions: Both procedures are effective and safe in treating varicose veins. Minimally invasive surgery was less costly, more postoperative pain and was associated with longer operative time. EVLA was associated with more postoperative pigmentation and 1 year VV recurrence.

scholarly journals ULTRASOUND GUIDED FOAM SCLEROTHERAPY AS A PREFERRED TREATMENT OPTION FOR VARICOSE VEINS IN TERMS OF SAFETY, EFFICACY AND COST EFFECTIVENESS

2021 ◽  
Vol 71 (4) ◽  
pp. 1332-35
Author(s):  
Muhammad Jamil ◽  
Rashid Usman ◽  
Muhammad Irfan Khan ◽  
Muhammad Afzal Randhawa ◽  
Aaiza Aman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Military Hospital ◽  
Venous Reflux ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Vein Thrombosis ◽  
Ceap Classification ◽  
Deep Vein

Objective: To assess the safety, efficacy and cost effectiveness of ultrasound-guided foam sclerotherapy in superficial venous reflux in Clinical, Etiological, Anatomical and Pathological (CEAP) classification grade 2-6 disease. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2018 to Feb 2020. Methodology: One thousand and sixty-seven patients (1312 legs) with varicose veins were treated by ultrasound-guided foam sclerotherapy using 3% sodium tetradecyl sulphate for truncal veins and 1% for smaller veins in 1:4 ratio with air. After 7 days, leg was assessed clinically and radiologically with Duplex ultrasound for occlusion of veins and complications. Second, third and fourth sclerotherapy sessions were performed for residual/recurrence/new varicosities. Compression bandage was used for at least 3 months after treatment. Results: The overall eradication of superficial venous reflux and healing of ulcers, was seen in 92.1% (1208 legs). It was 83.5% (1095 legs) after 1st session of UGFS. Second, 3rd and 4th session of UGFS further increases this percentage of benefitted patients Deep vein thrombosis developed post procedure in 2 (0.18%) patients and pulmonary embolus in one patient. Three (0.28%) patients had transient visual disturbances within half an hour of treatment. Retreatment was required due to formation of new superficial venous reflux in 39 (2.9%) legs and recurrence in 93 (7.1%) legs. Conclusion: Ultrasound guided foam sclerotherapy is a better option of treatment in varicose veins in terms of safety, efficacy and cost effectiveness.

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

2016 ◽  
Vol 32 (1) ◽  
pp. 13-18 ◽  
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.

scholarly journals Endovenous Ablation of Varicose Veins Experience at Tertiary Neurological Center

2018 ◽  
Vol 1 (2) ◽  
pp. 94-96
Author(s):  
Sandeep Raj Pandey ◽  
George Bush Jung Katwal ◽  
Sharad Hari Gajuryal
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Normal Activity ◽  
Vein Thrombosis ◽  
Long Term Follow Up ◽  
Endovenous Thermal Ablation

Introduction: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein.Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction.Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3.Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required.  Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.

Can foam sclerotherapy be used to safely treat bilateral varicose veins?

2011 ◽  
Vol 27 (1) ◽  
pp. 19-24 ◽  
Author(s):  
R H Bhogal ◽  
C E Moffat ◽  
P Coney ◽  
I K Nyamekye
Keyword(s):  
Varicose Veins ◽  
Visual Disturbance ◽  
Complication Rates ◽  
Treatment Episode ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Systemic Complications ◽  
Complete Occlusion ◽  
Vein Occlusion ◽  
Significant Difference

Objective We assessed the use of ultrasound guided foam sclerotherapy (UGFS) to treat bilateral varicose veins either as synchronous or interval procedures. We specifically assessed total foam volume usage and its influence on early outcome and complications. Methods We reviewed our prospectively compiled computerised database of patients with bilateral varicose veins who have undergone UGFS. Duplex findings, foam volumes used and clinical outcome were assessed. Results One hundred and twelve patients had undergone UGFS for bilateral varicose veins. Sixty-one had bilateral UGFS (122 legs) and 51 had interval UGFS (102 legs). Seventy-eight percent bilateral and 60% interval procedures were for single trunk disease. Median foam volumes per treatment episode were: 17.5 mls bilateral, and 10 mls interval FS. At two weeks 81% of legs had complete occlusion after bilateral UGFS compared to 70% after interval UGFS. One patient in the bilateral UGFS developed transient visual disturbance. There was no systemic complications in the interval UGFS. Conclusions Bilateral foam sclerotherapy treatment did not adversly affect vein occlusion rates and there was no significant difference in complication rates between the two groups. Bilateral UGFS can be safely performed in selected patient presenting with bilateral varicose veins.

scholarly journals Management of Varicose Veins: A Survey of Current Practice by Members of the Vascular Society of Great Britain and Ireland

2009 ◽  
Vol 91 (1) ◽  
pp. 77-80 ◽  
Author(s):  
AG Edwards ◽  
S Baynham ◽  
T Lees ◽  
DC Mitchell
Keyword(s):  
Great Britain ◽  
Private Practice ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Clinical Excellence ◽  
Foam Sclerotherapy ◽  
Ultrasound Assessment ◽  
Primary Varicose Veins ◽  
The Uk ◽  
E Mail

INTRODUCTION In 1999, a survey was published detailing the management of varicose veins by members of the then Vascular Surgical Society (VSS). Since then, newer methods for treating varicose veins have been developed and far more explicit rationing has been introduced in the NHS. SUBJECTS AND METHODS In order to examine whether there had been a significant change in established practice in the UK, a questionnaire was sent to all Vascular Society of Great Britain and Ireland (VSGBI) members in the 2004 yearbook by E-mail or post. RESULTS Of the 426 questionnaires distributed, a 69% response rate was achieved. Of respondents, 97% treated varicose veins in their NHS practice, whilst 88% did so in private practice. Some 73% used hand-held Doppler assessment in the clinic and 96% used duplex ultrasound assessment selectively. Despite UK National Institute for Health and Clinical Excellence (NICE) guidelines, only 68% said that their primary care trusts funded treatment of symptomatic varicose veins, while 93% did so for complications. In either NHS or private practice, respectively, 83% or 72% of responders offered surgery as preferred treatment for primary varicose veins, while 14% or 20% preferred endovascular treatments (endovascular laser treatment, radiofrequency ablation and foam sclerotherapy). Of responders, 17% did not follow-up patients after treatment. CONCLUSIONS This survey suggests that there is rationing of access to care for symptomatic varicose veins. Despite publicity for endovenous techniques, surgery remains the preferred treatment for varicose veins in the UK.

scholarly journals Pre- and Postoperative Evaluation by Photoplethysmography in Patients Receiving Surgery for Lower-Limb Varicose Veins

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Orlando Adas Saliba Júnior ◽  
Mariangela Giannini ◽  
Ana Paula Mórbio ◽  
Orlando Saliba ◽  
Hamilton Almeida Rollo
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Varicose Vein Surgery ◽  
Postoperative Evaluation ◽  
Perforating Veins ◽  
Primary Varicose Veins ◽  
Ceap Classification ◽  
The Mean ◽  
Deep Vein

Objective. To evaluate the effectiveness of surgery in treating primary varicose veins in the lower limbs by photoplethysmography (PPG) and duplex mapping (DM).Method. Forty-eight lower limbs were clinically evaluated according to the CEAP classification system and subjected to PPG and DM exams. Each limb had a venous refill time (VRT) of <20 seconds and a normal deep vein system (DVS) by DM.Results. The mean pre- and postoperative VRTs were 13.79 and 26.43 seconds, respectively (P<0.0001). After surgery, 42 limbs (87.50%) had normal results by PPG (VRT > 20 seconds). Four limbs (8.33%) showed improved VRTs, but the VRTs did not reach 20 seconds. In the 2 limbs (4.17%) that maintained their original VRTs, the DM exams showed the presence of insufficient perforating veins.Conclusion. In most cases, PPG allows for a satisfactory evaluation of the outcome of varicose vein surgery.

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