Mechanochemical ablation for great and small saphenous veins insufficiency in patients with type III shunt

Objective the aim of this study was to assess the results of mechanochemical endovenous ablation either in the primary or recurrent saphenous vein insufficiency, including only patients with veno-venous shunt type III. Methods retrospective analysis of a prospective study of patients with symptomatic chronic venous insufficiency who underwent ClariVein® technique. A total of 134 saphenous veins were included between August 2017 and August 2018. Follow-up was performed by Duplex ultrasound at 1, 6 and 12 months. Primary endpoints were technical and anatomical success. Secondary endpoints were the need for further treatment of varicose collateral veins by sclerotherapy, outcomes regarding recurrent insufficiency and clinical success. Results A total of 111 great saphenous veins and 23 small saphenous veins were treated with a technical success of 95.6%. The overall anatomical success rates at 1, 6 and 12 month were 96.2%, 88.8% and 84.4%, respectively, without differences between primary and recurrent insufficiency. Deferred sclerotherapy over varicose collaterals was carried out in 28% of the patients with anatomical success. Clinical improvement was achieved in 87.3%. Conclusions MOCA technique has proven to be an effective technique, although additional treatment over varicose collaterals could be necessary in up to one-third. Atrophy of the saphenous vein and the lack of persistent varicose collateral veins during follow-up seem to be indicators of successful therapy.

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Endovenous radiofrequency powered segmental thermal ablation (Closure FAST) of great saphenous veins

Phlebologie ◽

10.1055/s-0037-1622301 ◽

2010 ◽

Vol 39 (02) ◽

pp. 69-71 ◽

Cited By ~ 6

Author(s):

T. M. Proebstle ◽

Keyword(s):

Side Effects ◽

Thermal Ablation ◽

Clinical Success ◽

Clinical Success Rate ◽

Duplex Ultrasound ◽

Multicenter Trial ◽

Saphenous Veins ◽

Clinical Control ◽

Prospective Multicenter Trial

Summary Background: Radiofrequency powered segmental thermal ablation Closure FAST has become a globally engaged technology for ablation of incompetent great saphenous veins (GSVs). Mid-term results of slowly resolving side effects are still not described. Methods: RSTA-treated GSVs (n = 295) were followed for 24 months in a prospective multicenter trial. Clinical control visits included flow and reflux analysis by duplex-ultrasound and assessment of treatment related side effects at all times. Results: 280 of 295 treated GSVs (94.9%) were available for 24 months follow-up. According to the method of Kaplan and Meier at 24 months after the intervention 98.6% of treated legs remained free of clinically relevant axial reflux. The average VCSS score improved from 3.9 ± 2.1 at screening to 0.7 ± 1.2 at 24 months follow-up (p < 0.0001). While only 41.1% of patients were free of pain before treatment, at 24 months 99.3% reported no pain and 96.4% did not experience pain during the 12 months before. At 24 months n=3 legs showed pigmentation along the inner thigh and one leg showed study-treatment related paresthesia. Conclusion: Radiofrequency powered segmental thermal ablation Closure FAST showed a very moderate side-effect profile in conjunction with a high and durable clinical success rate.

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Outcome of 1470nm laser diode ablation for superficial venous insufficiency

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.0073 ◽

2015 ◽

Vol 14 (2) ◽

pp. 115-122

Author(s):

Gilberto do Nascimento Galego ◽

Guilherme Baumgardt Barbosa Lima ◽

Rafael Narciso Franklin ◽

Cristiano Torres Bortoluzzi ◽

Pierre Galvagni Silveira

Keyword(s):

Diode Laser ◽

Saphenous Vein ◽

Doppler Ultrasonography ◽

Venous Insufficiency ◽

Success Rates ◽

Total Occlusion ◽

Saphenous Veins ◽

Radial Fiber ◽

Superficial Venous Insufficiency

BACKGROUND: Endovenous laser ablation is a minimally invasive procedure that can be used to treat superficial venous insufficiency. We believe that using a longer wavelength will reduce the frequency of the most common adverse effects associated with the use of shorter wavelengths.OBJECTIVES: To report the results of an initial series of patients with chronic superficial venous insufficiency treated using a 1470 nanometer diode laser and to compare results using linear and radial laser fibers.METHODS: We conducted an observational cohort study. Seventy-four patients, for whom at least two postoperative Doppler ultrasonography scans were available, were recruited with a total of 121 saphenous veins treated (92 great and 29 small saphenous veins). There were 57 patients in Group A (treated with the linear fiber) and 17 in Group B (radial fiber). Follow-up ideally comprised clinical consultation and Doppler ultrasonography at 1 month, 6 months and 12 months after the procedure. Success was defined as total occlusion of the venous segment that had been treated.RESULTS: Success rates at mean follow-up of 13.4 months (range 7 - 27) were 83% for great saphenous veins and 89% for small saphenous veins. Patients treated with the radial fiber required less energy to achieve occlusion of the small saphenous vein and exhibited fewer adverse reactions, with statistical significance.CONCLUSIONS: Treatment of great and small saphenous vein insufficiency using the 1470 nm diode laser is safe and effective. The radial fiber was associated with fewer intercurrent conditions than the linear fiber, although success rates were similar.

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Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517702068 ◽

2017 ◽

Vol 32 (10) ◽

pp. 649-657 ◽

Cited By ~ 21

Author(s):

Marianne E. Witte ◽

Clark J. Zeebregts ◽

Gert Jan de Borst ◽

Michel M.P.J. Reijnen ◽

Doeke Boersma

Keyword(s):

Success Rate ◽

Saphenous Vein ◽

Literature Search ◽

Clinical Success ◽

Cochrane Library ◽

Major Complications ◽

Endovenous Ablation ◽

Anatomical Success ◽

Anatomical Success Rate

Objective To systematically review all available English literature on mechanochemical endovenous ablation and to report on the anatomical, technical, and clinical success. Methods A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on mechanochemical endovenous ablation for the treatment of insufficient great and/or small saphenous vein. Methodological quality of the included studies was evaluated using the MINORS score. The primary outcome measure was anatomical success, defined as closure of the treated vein on follow-up duplex ultrasound imaging. Secondary outcomes were technical and clinical success, and major complications defined as deep venous thrombosis, pulmonary embolisms or paresthesia. Results The literature search identified 759 records, of which 13 were included, describing 10 unique cohorts. A total of 1521 veins (1267 great saphenous vein and 254 small saphenous vein) were included, with cohort sizes ranging from 30 to 570 veins. The pooled anatomical success rate after short-term follow up was 92% (95% CI 90–94%) ( n = 1314 veins). After 6 and 12 months these numbers were 92% (95% CI 88–95%) ( n = 284) and 91% (95% CI 86–94%) ( n = 228), respectively. The long-term anatomical success rates at 2 and 3 years were 91% (95% CI 85–95%) ( n = 136) and 87% (95% CI 75–94%) ( n = 48), respectively. Major complications and especially nerve injury were very rare (≤ 0.2%). All studies were of moderate or good quality using the MINORS scoring scale. Conclusions Mechanochemical endovenous ablation using the ClariVein in combination with liquid sclerosant is associated with an anatomical success rate ranging from 87% to 92% and good clinical success. To date, no randomized controlled trials are available studying the anatomical success after mechanochemical ablation, compared to the endothermal ablation. The risk of major complications is very low after the procedure.

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Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514532455 ◽

2014 ◽

Vol 30 (6) ◽

pp. 397-404 ◽

Cited By ~ 68

Author(s):

Jose I Almeida ◽

Julian J Javier ◽

Edward G Mackay ◽

Claudia Bautista ◽

Daniel J Cher ◽

...

Keyword(s):

Saphenous Vein ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Leg Pain ◽

Compression Stockings ◽

Saphenous Veins ◽

Kaplan Meier ◽

Venous Clinical Severity Score ◽

Human Use

Objectives To evaluate the safety and effectiveness of endovenous cyanoacrylate-based embolization of incompetent great saphenous veins. Methods Incompetent great saphenous veins in 38 patients were embolized by cyanoacrylate bolus injections under ultrasound guidance without the use of perivenous tumescent anesthesia or graduated compression stockings. Follow-up was performed over a period of 24 months. Result Of 38 enrolled patients, 36 were available at 12 months and 24 were available at 24 months follow-up. Complete occlusion of the treated great saphenous vein was confirmed by duplex ultrasound in all patients except for one complete and two partial recanalizations observed at, 1, 3 and 6 months of follow-up, respectively. Kaplan-Meier analysis yielded an occlusion rate of 92.0% (95% CI 0.836–1.0) at 24 months follow-up. Venous Clinical Severity Score improved in all patients from a mean of 6.1 ± 2.7 at baseline to 1.3 ± 1.1, 1.5 ± 1.4 and 2.7 ± 2.5 at 6, 12 and 24 months, respectively ( p < .0001). Edema improved in 89% of legs (n = 34) at 48 hours follow-up. At baseline, only 13% were free from pain. At 6, 12 and 24 months, 84%, 78% and 64% were free from leg pain, respectively. Conclusions The first human use of endovenous cyanoacrylate for closure of insufficient great saphenous veins proved to be feasible, safe and effective. Clinical efficacy was maintained over a period of 24 months.

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

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515620944 ◽

2016 ◽

Vol 32 (1) ◽

pp. 13-18 ◽

Cited By ~ 6

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.

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One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05333-7 ◽

2021 ◽

Author(s):

Hiroshi Yokoyama ◽

Masashi Takata ◽

Fumi Gomi

Keyword(s):

Survival Analysis ◽

Clinical Success ◽

Treatment Success ◽

Medication Use ◽

Glaucoma Surgery ◽

Success Rates ◽

Kaplan Meier ◽

One Year ◽

Ab Interno

Abstract Purpose To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group). Methods This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery. Results Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198). Conclusion S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

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Rheolytic Thrombectomy Using AngioJet ZelanteDVT Catheter or Solent Omni Catheter for Treatment of Patients with Proximal Vein Thrombosis

10.21203/rs.3.rs-1073588/v1 ◽

2021 ◽

Author(s):

Maofeng Gong ◽

Guanqi Fu ◽

Zhengli Liu ◽

Yangyi Zhou ◽

Jie Kong ◽

...

Keyword(s):

Clinical Success ◽

Successful Outcome ◽

Success Rates ◽

Technical Success ◽

Bleeding Events ◽

Vein Thrombosis ◽

Rheolytic Thrombectomy ◽

Deep Vein ◽

Clinical Characteristic

Abstract Purpose The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using AngioJet ZelanteDVT catheter or Solent Omni catheter for acute proximal deep vein thrombosis (DVT).Material and Methods We conducted a retrospective review of 40 patients who treated by AngioJet RT divided into ZelanteDVT group (n=17) and Solent group (n=23) from January 2019 to January 2021. Data of demographics, clinical characteristic, technical success, clinical success, complications, and early follow-up were analysed.Results No significant differences regarding demographics were detected (all p >.05). The technical success rates were both 100%. ZelanteDVT group had a shorter duration time of RT and a higher primary RT success than those of Solent group (all p <.05), and percentage of adjunctive CDT was 29.4% in ZelanteDVT group, significantly lower than that was 79.3% in Solent group (p =.010). The successful outcome for ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), both high in the two groups (p >.05). Except for transient macroscopic hemoglobinuria occurred in all patients at the first 24 hours post-RT, none suffered other procedure-related adverse events or major complications in both groups. Minor complications presented as bleeding events occurred in 21.7% (5/23) patients of Solent group, and one (5.9%) patient in Zelante DVT group (p >.05). At 6-month, the frequency of PTS was 5.9% (1/17) in ZelanteDVT group compared with 17.4% (4/ 23) in Solent group (p >.05).Conclusion Both catheters are safe and effective for the management of patients with proximal DVT, leading to improved clinical outcomes with low complication. Zelante-DVT catheter offered more powerful thrombectomy over Solent catheter, allowing for faster extraction of the DVT with shorter run time and lower adjunctive CDT.

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Inferior selective crossectomy for great saphenous vein incompetence: Our experience

Vascular ◽

10.1177/1708538120947251 ◽

2020 ◽

pp. 170853812094725

Author(s):

Maurizio Pagano ◽

Giovanna Passaro ◽

Roberto Flore ◽

Paolo Tondi

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Duplex Ultrasound ◽

Venous Disease ◽

Recurrence Rates ◽

Saphenofemoral Junction

Objective To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2–C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Results Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

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Five-year outcomes of mechano-chemical ablation of primary great saphenous vein incompetence

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519861464 ◽

2019 ◽

Vol 35 (4) ◽

pp. 255-261

Author(s):

Naomi DE Thierens ◽

Suzanne Holewijn ◽

Wynand HPM Vissers ◽

Debbie AB Werson ◽

Jean Paul PM de Vries ◽

...

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Long Term Results ◽

Venous Clinical Severity Score ◽

Ceap Classification ◽

Chemical Ablation ◽

Anatomical Success

Objective The aim of the study is to report long-term results after mechano-chemical ablation for the treatment of great saphenous vein incompetence. Methods Mechano-chemical ablation was performed using the ClariVein device with polidocanol as the sclerosant. Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification, Venous-Clinical-Severity-Score (VCSS), anatomical-success, RAND-SF36 and the Aberdeen-Varicose-Vein-Questionnaire (AVVQ) were obtained by clinical examination, questionnaires and duplex ultrasonography through five years’ follow-up (Clinicaltrials.gov, NCT01459263). Results Ninety-four patients (113 great saphenous veins) were included in the study. Five-year follow-up data were available for 75 limbs (66.4%). Freedom from anatomical failure was 78.7% (N = 45) with 64.6% (N = 42) having an improvement in the VCSS ≥1. A total of five reinterventions were performed through five years with a median time to reintervention of 38 months. The VCSS at five years was 2 (IQR 1; 4) and was still significantly improved compared to baseline (p < 0.001). A deterioration of the VCSS was observed in 21.5%. Conclusion Through five-year follow-up, there are a significant number of anatomical and clinical failures in this series, mainly driven by partial recanalizations.

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