Abbreviated method of determining vein volume in balloon-controlled vein ablation

2007 ◽  
Vol 22 (1) ◽  
pp. 40-44 ◽  
Author(s):  
J K Raines ◽  
W Garcia de Quevedo ◽  
S Jahrmarkt ◽  
E Mackay ◽  
N Morrison ◽  
...  
Keyword(s):  
Clinical Study ◽  
Minimally Invasive ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Treatment Length ◽  
Surgical Ligation ◽  
Standardized Protocol ◽  
Volume Calculations ◽  
Endovenous Ablation ◽  
Vein Diameter

Traditional surgical ligation and stripping for the treatment of saphenous vein incompetence has been replaced by minimally invasive alternative treatments during the last five years. Endovenous ablation with radiofrequency (RP) and laser (EVL) have proven to be safe, durable, and widely accepted by patients. Catheter-delivered sclerotherapy (CDS) with foam and liquid for ablation of the great saphenous vein is also under investigation. In this technique, vein volume must be measured accurately by ultrasound just prior to the procedure and can require up to 11 diameter measurements. The purpose of this study was to identify an abbreviated method of determining vein volume to expedite associated endovenous procedures. Seventy-five veins were treated in 55 subjects with catheter-directed sclerotherapy in a three-center clinical study using a standardized protocol. Vein volume was carefully calculated by determining vein diameter over the Treatment Length in 4 cm intervals. These measurements were compared to vein volume calculations where only three measurements were taken. Our results suggest that the abbreviated method is capable of significantly reducing the number of diameter measurements without sacrificing accuracy. We found the method produced a vein volume that fell within 1 mL or 15% of the actual vein volume in 80% of cases. The abbreviated method cannot be used with accuracy in veins that are Erratic.

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)

2016 ◽  
Vol 32 (3) ◽  
pp. 194-199 ◽  
Author(s):  
Alptekin Yasim ◽  
Erdinc Eroglu ◽  
Orhan Bozoglan ◽  
Bulent Mese ◽  
Mehmet Acipayam ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Long Term Results ◽  
Early Results ◽  
Severity Scores ◽  
Endovenous Ablation ◽  
Vein Diameter

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

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.

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.

A randomised controlled trial of perivenous tumescent anaesthesia in addition to general anaesthesia for surgical ligation and stripping of the great saphenous vein

2019 ◽  
Vol 35 (5) ◽  
pp. 305-315 ◽  
Author(s):  
Sandip Nandhra ◽  
Tom Wallace ◽  
Joseph El-Sheikha ◽  
Daniel Carradice ◽  
Ian Chetter
Keyword(s):  
Quality Of Life ◽  
General Anaesthesia ◽  
Saphenous Vein ◽  
Primary Outcome ◽  
Great Saphenous Vein ◽  
Bodily Pain ◽  
Secondary Outcome ◽  
Surgical Ligation ◽  
Significant Difference

Introduction Open surgical ligation and stripping of the great saphenous vein is a highly cost-effective treatment when compared with conservative management and foam sclerotherapy but has limitations including post-operative morbidity and pain. This study aims to identify if the addition of tumescent anaesthesia could improve patient outcomes following treatment. Methods Patients with primary superficial venous incompetence undergoing open surgical ligation and stripping of the great saphenous vein were randomised to either General Anaesthesia (GA) alone (GA) procedure or the addition of tumescent (G + T). The primary outcome was bodily pain (within SF-36) at one week. Additional outcomes included post-procedural pain score (100 mm visual analogue scale), complications and quality of life. Results A total of 90 patients were randomised for inclusion. There was no significant difference in primary outcome; bodily pain at one week. Secondary outcome of 4-h post-procedural scores were significantly lower in the G + T group (32 (20–54) mm vs. (GA alone) 56 (24–70) mm (P = 0.016)). Complications were minor and equivalent. Both groups saw a significant increase (worsening) in Aberdeen Varicose Vein Questionnaire scores at week 1 with the G + T group faring worse at six weeks (10.0 (Interquartile Range [IQR] 5.6–17.9) vs. 4.3 (IQR 2.7–7.9) P = 0.004). Conclusion The G + T group did not demonstrate a significant difference in the one-week bodily pain domain. The addition of tumescent anaesthesia does improve immediate post-operative pain but appears to negatively impact on six-week quality of life. EudraCT Number: 2011-005574-39

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.

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