Diagnosis and Follow-up of Varicose Veins with Duplex Ultrasound: How and Why?

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 10-15 ◽  
Author(s):  
R D Malgor ◽  
N Labropoulos
Keyword(s):  
Varicose Veins ◽  
Financial Burden ◽  
Disease Process ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Non Invasive ◽  
Work Up

Chronic venous disease (CVD) is very prevalent and causes a significant financial burden in Western societies. Accurate diagnosis is mandatory to define the anatomy and pathophysiology involved in the disease process. Duplex ultrasound (DU) is a well-established non-invasive tool used for varicose veins work-up that, most recently, has also been utilized for follow-up after endovenous procedures such as endovenous laser or radiofrequency ablation and foam sclerotherapy. Insightful information on how DU is performed during varicose veins work-up and the rationale of DU utilization for endovenous procedures are discussed.

Duplex Ultrasound Scanning for Chronic Venous Disease: I. Techniques for Examination of the Crural Veins

1994 ◽  
Vol 9 (3) ◽  
pp. 108-113 ◽  
Author(s):  
R. W. Ziegenbein ◽  
K. A. Myers ◽  
P. G. Matthews ◽  
G. H. Zeng
Keyword(s):  
Venous Insufficiency ◽  
Outcome Measure ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Ultrasound Scanning ◽  
Diagnostic Laboratory ◽  
Non Invasive ◽  
Anterior Tibial

Objective: To describe a practical technique to reliably find and study crural veins by duplex ultrasound scanning. Design: Prospective scanning of patients referred for evaluation of possible chronic deep venous insufficiency. Setting: A non-invasive vascular diagnostic laboratory in Melbourne, Australia. Patients: A study of 1340 legs in 917 consecutive patients referred with primary or recurrent varicose veins, or for evaluation of possible deep venous disease causing aching or swelling in the legs. Interventions: Examination of the crural veins by duplex ultrasound scanning. Main outcome measure: Identification of all three sets of crural veins. Results: Rates for detecting the posterior tibial, anterior tibial and peroneal veins were 97%, 92% and 91% respectively and all three were observed in 91%. If the last 1227 legs studied by colour-Doppler duplex ultrasound are considered, the rates for detection were 98%, 96% and 96% respectively. Conclusion: Examination of the crural veins can be a part of routine duplex ultrasound scanning in patients referred with suspected venous disease.

Echo-guided foam sclerotherapy treatment of venous malformation involving the sciatic nerve

2009 ◽  
Vol 24 (1) ◽  
pp. 46-47 ◽  
Author(s):  
S Gianesini ◽  
E Menegatti ◽  
G Tacconi ◽  
F Scognamillo ◽  
A Liboni ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Minimally Invasive ◽  
Varicose Veins ◽  
Venous Malformation ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Invasive Treatment ◽  
Entire Cohort

Primary sciatic nerve varices (SNV) lie within the sciatic nerve possibly causing chronic venous disease and sciatic pain as well. We report a series of 12 consecutive patients affected by symptomatic SNV. All of them were treated by echo-guided Tessari foam sclerotherapy (EGFSCL). Mean follow up lasted two years. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared in the entire cohort and only minor complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment.

Endovenous management of varicose veins

2004 ◽  
Vol 19 (4) ◽  
pp. 163-169 ◽  
Author(s):  
S Soumian ◽  
A H Davies
Keyword(s):  
Varicose Veins ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
High Prevalence ◽  
Promising Treatment ◽  
Developed World

Objective: Chronic venous disease has made a considerable socio-economical impact in the developed world due to its high prevalence and cost of management. Venous hypertension gives rise to significant signs and symptoms that are indications for treatment. Though the mainstay of treatment currently is surgery, it may not be the ideal choice in some cases considering the heterogeneous spectrum of venous disease. Recent alternative endovenous treatments have shown a lot of promise in successfully treating this condition. The aim of this review was to assess the long-term effectiveness of these treatments. Methods: A Medline-based review of literature was carried out. Results: Foam sclerotherapy seems to be a very promising treatment for venous disease, as short-term results have shown good results in terms of outcomes, low morbidity and cost. New endovenous techniques such as radiofrequency and laser ablation are attractive considering the absence of groin scar and subsequent neovascularization, as well as very little bruising and discomfort. Conclusions: There is no clear evidence yet regarding the long-term effectiveness of these relatively new endovenous techniques.

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.

CHIVA, ASVAL and related techniques – Concepts and evidence

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 42-45 ◽  
Author(s):  
Sarah Onida ◽  
Alun H Davies
Keyword(s):  
Minimally Invasive ◽  
Varicose Veins ◽  
Disease Process ◽  
Chronic Venous Disease ◽  
Treatment Modalities ◽  
Venous Disease ◽  
Invasive Treatment ◽  
Venous Circulation ◽  
Underlying Pathophysiology

Chronic venous disease (CVD) is a highly prevalent condition with significant effects on patients’ quality of life. Despite this, the underlying pathophysiology of venous disease still remains unclear. Two schools of thought exist, explaining the development and propagation of venous disease as an “ascending” and “descending” process, respectively. The descending theory, stating that CVD is secondary to proximal disease (e.g. saphenofemoral/saphenous incompetence), is the most widely accepted when planning treatment aiming to remove or destroy the junction or truncal veins. The ascending theory, describing the disease process as developing in the lower most part of the leg and propagating cranially, aims to re-route the venous circulation via minimally invasive interventions. Classically, superficial venous insufficiency has been treated with the removal of the incompetent trunk, via open surgery or, increasingly, with endovenous interventions. Minimally invasive treatment modalities aiming to preserve the saphenous trunk, such as CHIVA and ASVAL, may also play an important role in the treatment of the patient with varicose veins.

scholarly journals Ultrasound-guided foam sclerotherapy for chronic venous disease with ulcer. A prospective multiple outcome cohort study

2020 ◽  
Vol 19 ◽  
Author(s):  
Guilherme Camargo Gonçalves de Abreu ◽  
Otacílio de Camargo Jr. ◽  
Márcia Fayad Marcondes de Abreu ◽  
José Luis Braga de Aquino
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Disease Severity ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy

Abstract Background Chronic Venous Disease (CVD) is the main cause of chronic leg ulcers. Varicose veins are the most frequent cause of venous leg ulcers (VLU). 50.9% of Brazilian women have varicose veins and ulcer prevalence is as high as 4%. Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost treatment option for varicose veins. Objectives To analyze UGFS outcomes in patients with VLU. Methods Prospective consecutive single center cohort study. Patients with great saphenous vein (GSV) reflux and VLU were treated and followed-up for 180 days. The following were studied: quality of life (QoL), disease severity, healing, and elimination of GSV reflux. The Aberdeen questionnaire, a venous clinical severity score, and Duplex scanning (DS) results were analyzed. Results 22 patients aged 35 to 70 years were treated. There was improvement in quality of life, disease severity reduced, and ulcer diameter reduced (p < 0.001; ANOVA). 77.27% of VLU healed completely (95%CI: 59.76-94.78%). The dimensions of 20/22 VLU reduced (90.91%; 95%CI: 78.9-100%). GSV reflux was eliminated in 63.64% (95%CI: 43.54-83.74%). Men had greater QoL benefit and women had more complications. There were no severe complications. The VLU that had healed completely at the end of the study were smaller at baseline than those that did not completely heal. The GSV that were completely occluded at the end of the study were smaller at baseline than those that were not completely occluded (p < 0.05; Mann-Whitney). Conclusion The results suggest that most patients benefited from UGFS.

Diagnosis of venous disease with duplex ultrasound

2013 ◽  
Vol 28 (1_suppl) ◽  
pp. 158-161 ◽  
Author(s):  
R D Malgor ◽  
N Labropoulos
Keyword(s):  
Low Cost ◽  
Duplex Ultrasound ◽  
Venous Disease ◽  
Venous Obstruction ◽  
Venous Reflux ◽  
Venous Anatomy ◽  
Non Invasive ◽  
Chronic Venous Obstruction ◽  
Valve Function

The advent of duplex ultrasound (DU) has changed vascular practice over the years. Venous anatomy, valve function and obstruction can be evaluated in real time using DU. It is a low cost, portable, non-invasive, safe and operator-friendly device that can be used for diagnosis, treatment guidance and follow-up. This paper defines the patterns, location and characteristics of venous reflux and also provides insightful information on acute and chronic venous obstruction.

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

2019 ◽  
Vol 34 (9) ◽  
pp. 604-610
Author(s):  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Maria Grazia Sibilla ◽  
Diana Neuhardt ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
Significant Difference ◽  
Effective Option ◽  
Procedural Time ◽  
Group A ◽  
One Year ◽  
Group B

Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.

scholarly journals Sclerofoam assisted laser therapy for saphenous refluxes: an innovative tumescence-free technique

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Francesco Zini ◽  
Lorenzo Tessari ◽  
Renato Torre
Keyword(s):  
Laser Therapy ◽  
High Volume ◽  
Mean Value ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Hybrid Technique ◽  
Foam Sclerotherapy ◽  
Tumescent Anesthesia ◽  
Primary Chronic Venous Disease

Endovenous laser (EL) and radiofrequency devices have continuously increased their appealing in the last decade. Even if miniinvasive, such procedure still requires multiple high volume injections of tumescent anesthesia: a medical act that is not totally complications- free. Aim of the present investigation is to evaluate the feasibility of a hybrid technique (so called sclerofoam assisted laser therapy, SFALT) combining foam sclerotherapy (FS) and EL in a tumescence free approach. Fourty primary chronic venous disease patients (8 males, 32 females, C2-4EpAsPr) presenting a sapheno-femoral reflux both at the Valsalva and compression/relaxation maneuver underwent a SFALT procedure. Diameters were measured at mid-thigh in supine. It consists in a EL fiber introduction into the great saphenous vein (GSV), shrinking it for a single cm at 200 J/cm. After a shrunk plug is created, keeping the fiber stuck in it, 5 cc of foam sclerotherapy [Tessari method, 1% polidocanol (POL) or 1% sodium tetradecyl sulfate (STS)] are injected through the same 6 Fr EL introducer. The consequent spasm allows a following EL mediated shrinkage by means of a significantly reduced fluence. Clinical and sonographic follow up were performed at one and three weeks. At 3 weeks follow up all the 40 cases presented a shrunk GSV, without recanalization signs. Neither major nor minor complications were reported. At the mid-thigh the standing GSV caliber decreased from a preoperative mean value of 0.6±0.2 cm to a post FS injection 0.3±0.1 cm value (P&lt;0.05), showing no statistical difference among STS and POL. SFALT approach is feasible, safe and with potentially interesting outcomes. More investigations are needed in order to define the proper fluence parameters and the chance of eliminating the even mild sedation. This technique offers the chance of a possible tumescence free GSV treatment, even in case of major calibers vessels.

Superficial Venous Disease

2018 ◽  
pp. 287-298
Author(s):  
Ronald S. Winokur ◽  
Geraldine Abbey-Mensah ◽  
Neil M. Khilnani
Keyword(s):  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Venous Ulcers ◽  
Patient Morbidity ◽  
And Performance ◽  
Superficial Venous Insufficiency

Superficial venous insufficiency (SVI) is an extremely common condition affecting up to 39% of Americans, which results in significant patient morbidity and high healthcare costs (up to $3 billion per year for treatment). In addition to patients with asymptomatic spider veins and painful varicose veins, over 2 million adults have advanced chronic venous disease (CVD), and at least 20,000 individuals develop new venous ulcers each year. Patients suffering from venous insufficiency can benefit greatly from office-based, minimally invasive treatments. Successful treatment depends on understanding of superficial venous anatomy and pathophysiology, how to conduct a targeted history and physical exam, and performance and interpretation of Duplex ultrasound (DUS), as well as knowledge and application of the available treatment options.

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