Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein

Vascular ◽  
2019 ◽  
Vol 27 (5) ◽  
pp. 537-541
Author(s):  
Cemal Kemaloğlu
Keyword(s):  
Risk Factor ◽  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Endovenous Laser Ablation ◽  
The Third ◽  
Single Risk Factor ◽  
Significant Difference ◽  
Vein Diameter ◽  
Single Predictor

Background and aim The aim of this study was to compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) techniques for efficacy and side effects for great saphenous vein (GSV) ablation. Materials and methods Two hundred twenty-one patients and 287 extremities that underwent GSV ablation with EVLA and RFA methods were analysed retrospectively; 135 GSVs were treated with EVLA, 152 GSVs were treated with RFA. Physical examination and Ultrasound (US) records at the first week, first month and third month were evaluated. Recanalization, endothermal heat-induced thrombosis formation, presence of ecchymosis greater than 10 cm and GSV diameter parameters were statistically analyzed. Results In the RFA group, 96.7% of the GSVs that were ablated were occluded at the end of the third month. In the EVLA group, this rate was 92.6%. There was no statistically significant difference between success of ablation ( P = 0.118). In the RFA group, ecchymotic areas, that is larger than 10 cm diameter were observed in 16 extremities, whereas in the EVLA group, 66 of 135 (48.9%) limbs were found to have ecchymotic area larger than 10 cm ( P < 0.001). More recanalizations were observed in GSVs larger than 10 mm in diameter which was statistically significant ( P < 0.001). Conclusion Both EVLA and RFA methods are effective in treating GSV reflux. Compared to the EVLA, less ecchymosis occurs after RFA procedures. Regardless of the type of method used, the GSV diameter is a single predictor of recanalization.

A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins

2017 ◽  
Vol 33 (8) ◽  
pp. 534-539 ◽  
Author(s):  
Emma B Dabbs ◽  
Laurensius E Mainsiouw ◽  
Judith M Holdstock ◽  
Barrie A Price ◽  
Mark S Whiteley
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Large Diameter ◽  
Diameter Distribution ◽  
Short Term ◽  
Endovenous Laser Ablation ◽  
Saphenous Veins ◽  
Vein Diameter

Aims To report on great saphenous vein diameter distribution of patients undergoing endovenous laser ablation for lower limb varicose veins and the ablation technique for large diameter veins. Methods We collected retrospective data of 1929 (943 left leg and 986 right leg) clinically incompetent great saphenous vein diameters treated with endovenous laser ablation over five years and six months. The technical success of procedure, complications and occlusion rate at short-term follow-up are reported. Upon compression, larger diameter veins may constrict asymmetrically rather than concentrically around the laser fibre (the ‘smile sign’), requiring multiple passes of the laser into each dilated segment to achieve complete ablation. Results Of 1929 great saphenous veins, 334 (17.31%) had a diameter equal to or over 15 mm, which has been recommended as the upper limit for endovenous laser ablation by some clinicians. All were successfully treated and occluded upon short-term follow-up. Conclusion We suggest that incompetent great saphenous veins that need treatment can always be treated with endovenous laser ablation, and open surgery should never be recommended on vein diameter alone.

scholarly journals A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein

2016 ◽  
Vol 32 (6) ◽  
pp. 415-424 ◽  
Author(s):  
Malcolm Sydnor ◽  
John Mavropoulos ◽  
Natalia Slobodnik ◽  
Luke Wolfe ◽  
Brian Strife ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score ◽  
Superficial Venous Insufficiency

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors

2014 ◽  
Vol 30 (5) ◽  
pp. 325-330 ◽  
Author(s):  
S Sufian ◽  
A Arnez ◽  
N Labropoulos ◽  
S Lakhanpal
Keyword(s):  
Risk Factors ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Endovenous Laser Ablation ◽  
Severity Scores ◽  
Class 1 ◽  
Vein Diameter ◽  
Saphenofemoral Junction

Objectives To evaluate the incidence of heat-induced thrombosis, its progression and risk factors that may contribute to its formation after endovenous laser ablation. Methods This was a prospective evaluation of all patients who had endovenous laser ablation of the great saphenous vein, accessory saphenous vein, and small saphenous vein using 1470 nm wavelength laser, from March 2010 to September 2011. All patients who developed endovenous heat-induced thrombosis at the saphenofemoral junction or at the saphenopopliteal junction were included. Demographic data, history of venous thrombosis, body mass index, vein diameter, reflux time, catheter tip position, endovenous heat-induced thrombosis progression, number of phlebectomies, and venous clinical severity scores were analyzed. Duplex ultrasound was done in all patients preoperatively, and 2–3 days postoperatively. Results Endovenous laser ablation was performed in 2168 limbs. Fifty-seven percent had great saphenous vein, 13% accessory saphenous vein, and 30% small saphenous vein ablation. Endovenous heat-induced thrombosis was developed in 18 limbs (12 at saphenofemoral junction and six at saphenopopliteal junction) for an incidence of 0.9%. Eight were class 1 and 10 were > class 2. No pulmonary embolism was reported. The percentage of men with endovenous heat-induced thrombosis was higher compared to those without (39% vs. 24%, p = .14). The median age for endovenous heat-induced thrombosis patients was 59.6 compared to non-endovenous heat-induced thrombosis ( p = .021). Great saphenous vein/accessory saphenous vein diameter for endovenous heat-induced thrombosis patients was 8.0 mm versus 6.3 mm for non-endovenous heat-induced thrombosis patients ( p = .014), and for small saphenous vein it was 5.7 mm versus 4.5 mm ( p = .16). Multiple concomitant phlebectomies were performed in 55.6% of the endovenous heat-induced thrombosis patients compared to 37% in non-endovenous heat-induced thrombosis ( p = .001). All other parameters were similar between endovenous heat-induced thrombosis and non-endovenous heat-induced thrombosis group. Endovenous heat-induced thrombosis resolution occurred in 16 cases at 2–4 but two cases progressing from class 1 to 2, before resolution. The mean VCSS score for endovenous heat-induced thrombosis patients preoperatively was 5.6 and improved to 2.8 ( p = .003) at one month. Conclusion Risk factors associated with endovenous heat-induced thrombosis formation after endovenous laser ablation include: vein size, age, and multiple phlebectomies. Endovenous heat-induced thrombosis resolves in 2–4 weeks in most patients but it may worsen in few.

Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 649-657 ◽  
Author(s):  
Renata Balint ◽  
Akos Farics ◽  
Krisztina Parti ◽  
Laszlo Vizsy ◽  
Jozsef Batorfi ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Success Rates ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation

Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFast™ procedure: Influence of BMI and CEAP class

Vascular ◽  
2018 ◽  
Vol 26 (5) ◽  
pp. 498-508 ◽  
Author(s):  
Renato Casana ◽  
Valerio Stefano Tolva ◽  
Andrea Odero ◽  
Chiara Malloggi ◽  
Gianfranco Parati
Keyword(s):  
Body Mass Index ◽  
Radiofrequency Ablation ◽  
Body Mass ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Vein Diameter ◽  
Diameter Reduction

Purpose Endovascular ablation of the great saphenous vein has been proposed as a less invasive alternative to conventional ligation and stripping of varicose veins. Outcomes of patients treated with the radiofrequency ablation ClosureFast™ system over an eight-year period from a single-center were evaluated. Methods Three-year follow-up data included duplex ultrasound scan, complication rate, and questionnaires to assess patients’ QOL, level of pain, and days off work. Results A total of 1080 consecutive patients (49.5 ± 18.6 years, 72% female, mean body mass index: 25.44 ± 4.1 kg m−2) underwent radiofrequency ablation for incompetent saphenous veins in a single institution. Occlusion of the great saphenous vein was obtained in 98.6% and 93.8% cases at the end of the procedures and within 36 months, respectively. Only three deep venous thromboses and minor complications occurred in this series throughout the first week from the procedure. A decrease of the external vein diameter, equal to 72.7% and 31.1% of the pretreatment diameter, was observed at 1 week and 36 months, respectively. The average Aberdeen Varicose Vein Questionnaire score improved from 18.06 ± 9.47 before treatment to 11.56 ± 10.23 at 12 months, with no significant differences in the subsequent follow-up. SF-36 QOL scores significantly improved after the procedure in all domains, while there were no changes over time. Patients reported a prompt return to normal daily activities (1.5 ± 0.7 days) and work (3.1 ± 1.9 days). Body mass index influenced QOL scores, while it did not affect great saphenous vein diameter reduction during the follow-up. On the contrary, Clinical Etiologic Anatomic Pathophysiologic class significantly influenced both great saphenous vein diameter reduction after the treatment and QOL scores within 36 months. Conclusion Results of this retrospective monocentric, large patients study suggest that radiofrequency ablation of the great saphenous vein may be a safe and efficient alternative to conventional surgery.

Is the temperature of tumescent anesthesia applied in the endovenous laser ablation important? Comparison of different temperatures for tumescent anesthesia applied during endovenous ablation of incompetent great saphenous vein with a 1470 nm diode laser

Vascular ◽  
2014 ◽  
Vol 22 (6) ◽  
pp. 421-426 ◽  
Author(s):  
Burcin Abud ◽  
Kemal Karaarslan ◽  
Soysal Turhan ◽  
Yücel Karaman
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Tumescent Anesthesia ◽  
Endovenous Laser Ablation ◽  
Significant Difference ◽  
Different Temperatures ◽  
Tumescent Solution ◽  
Intraoperative Pain ◽  
Group B

Introduction We aimed to investigate whether the temperature of tumescent anesthesia is important, if so, to establish an opinion about the ideal temperature. Materials and methods Endovenous laser ablations were performed in 72 patients; 35 patients (Group A) received tumescent anesthesia at +4℃, while other 37 patients (Group B) received tumescent anesthesia at room temperature. The groups were compared in terms of intraoperative pain, postoperative regional pain, ecchymosis, paresthesia, skin burns and necrosis. At month 1, great saphenous vein was evaluated for recanalization and patient satisfaction. Results The survey on intraoperative pain showed that patients receiving tumescent anesthesia at +4℃ experienced much less pain. Interestingly, statistical analysis showed that this difference was not significant ( p = 0.072). No skin burns or necrosis occurred in either group, whereas ecchymosis and paresthesia were the most frequently observed side effects in both groups, but no significant difference was found between the groups. There was no significant difference between pain levels on postoperative days and no significant difference between the groups in terms of satisfaction with endovenous laser ablation procedure and postoperative satisfaction. All venous segments treated with endovenous laser ablation in both groups were occluded. At month 1 no recanalization was observed. Conclusion We conclude that the temperature of tumescent anesthesia solution is not important, while the proper administration of tumescent solution in adequate amounts ensuring delivery of the fluid to all segments appears to be a more significant determinant for the success of the procedure.

scholarly journals Retrograde endovenous laser ablation of the great saphenous vein using the superficial inferior epigastric vein as access vessel illustrated by a case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199499
Author(s):  
Mark S Whiteley ◽  
Charlotte E Davies
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Scar Tissue ◽  
Endovenous Laser Ablation ◽  
Below The Knee ◽  
Vein Access ◽  
Endovenous Thermal Ablation ◽  
Percutaneous Cannulation ◽  
Vein Diameter

Endovenous thermal ablation is a first-line treatment for symptomatic varicose veins due to truncal vein reflux. Ablation of an incompetent great saphenous vein is usually performed from distally, with the vein access at the lowest point of reflux, or just below the knee. Occasionally there are patients in whom the great saphenous vein is difficult to access distally for reasons such as small vein diameter, scar tissue, vasospasm, difficult anatomy or multiple attempts with haematoma formation. In such cases, we access the great saphenous vein in a retrograde fashion by percutaneous cannulation of the superficial inferior epigastric vein, passing the catheter into the great saphenous vein just distal to the saphenofemoral junction and then down the vein to the required distal position. Ablation can then be performed, stopping the ablation in the great saphenous vein just distal to the junction of superficial inferior epigastric vein and great saphenous vein. We present a patient to illustrate our technique.

Risk factors for endovenous heat-induced thrombosis after endovenous radiofrequency ablation of the great saphenous vein

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Raffaele Serra ◽  
Nicola Ielapi ◽  
Tiberio Rocca ◽  
Luca Traina ◽  
Stefano De Franciscis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein
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