Ultrasound-guided foam sclero -therapy of the small saphenous vein

Phlebologie ◽  
2017 ◽  
Vol 46 (02) ◽  
pp. 60-62 ◽  
Author(s):  
R. D. Murena-Schmidt
Keyword(s):  
Saphenous Vein ◽  
Clinical Investigation ◽  
Varicose Veins ◽  
Age Groups ◽  
Cost Effective ◽  
Ultrasound Guided ◽  
Patient’S Satisfaction ◽  
Cost Effective Treatment

SummaryUltrasound guided sclerotherapy (UGFS) of varicose veins is a worldwide spread method, in many countries recognized by guidelines. Important for the outcome is the patients history, clinical investigation and a detailed colour coded ultrasound mapping previous to UGFS.In previous studies varicose small saphenous vein (SSV) treatment with UGFS were reported to have worse results compared to GSV. Other studies report good outcome after UGFS of SSV varicose veins up to 12 months follow up.In my experience UGFS of insufficient SSV is safe and effective with high patient‘s satisfaction, good longterm results and improvement in quality of life. UGFS can be used in all age groups. UGFS has the additional benefit that repeated treatments are easy to perform if needed and that this method is very cost effective. Treatment sessions last 20 to 30 minutes so that patients do not need significant time off work.

What is effective care for varicose veins?

2016 ◽  
Vol 31 (1_suppl) ◽  
pp. 80-87 ◽  
Author(s):  
Mark H Meissner
Keyword(s):  
Quality Of Life ◽  
Effective Treatment ◽  
Varicose Veins ◽  
Treatment Options ◽  
Cost Effective ◽  
Symptom Improvement ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Cyanoacrylate Glue

Varicose veins affect one-quarter to one-third of Western adult populations and consume an increasing amount of health care resources. Much of this increased utilization has been driven by the advent of minimally invasive technology including endovenous thermal ablation, foam sclerotherapy, and more recently mechanicochemical and cyanoacrylate glue ablation. This has largely been driven by patient and physician preferences in the absence of robust evidence that one therapy is truly superior to another. This partially arises from misunderstandings about appropriate outcomes measures and what truly constitutes effective treatment of varicose veins. Technical outcomes, such as saphenous closure rates, have frequently been used as surrogates for effective treatment but are poorly correlated with symptom improvement, quality of life, and risk of recurrence. Although there does appear to be a trend towards higher recurrence with ultrasound-guided foam sclerotherapy, the data are occasionally conflicting and there does not appear to be substantial differences between the various modalities. Similarly, there do not appear to be major differences in late quality of life measures between these treatment options. As long-term differences in recurrence and quality of life are small, overall cost effectiveness is driven primarily by initial treatment costs and ultrasound-guided foam sclerotherapy is the most cost-effective strategy in many models. However, there continues to be substantial uncertainty surrounding cost estimates and other factors of importance to the patient may ultimately drive treatment decisions. The benefits of some adjuncts to the treatment of axial superficial reflux, such as the concurrent versus staged management of tributary varicosities, remain ill-defined while that of others, such as routine post-procedural ultrasound surveillance and compression, need critical re-evaluation.

scholarly journals Results of endovenous ClosureFast treatment for varicose veins in an outpatient setting

2011 ◽  
Vol 27 (3) ◽  
pp. 118-123 ◽  
Author(s):  
U Bisang ◽  
T O Meier ◽  
M Enzler ◽  
C Thalhammer ◽  
M Husmann ◽  
...  
Keyword(s):  
Complication Rate ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Outpatient Setting ◽  
Fast Recovery ◽  
Patient’S Satisfaction ◽  
Day Range ◽  
Saphenous Veins

Objective Endovenous methods are increasingly used to treat varicose veins. We evaluated the outcome of patients treated with the new radiofrequency ablation (RFA)-ClosureFast catheter in an outpatient setting. Method Retrospective analysis of postinterventional duplex ultrasound (DUS), complication rate and quality of life of patients treated for incompetent saphenous veins. Results Between 2007 and 2009, 155 patients had been treated with ClosureFast. DUS was available from 73 (47%) patients (102 great [GSV] and 16 small [SSV] saphenous veins). After a mean follow-up of 12.2 months (range 1–29 months), DUS showed six (5.9%) open GSV and an occlusion of all treated SSV. One pulmonary embolism had occurred. Mean patient's satisfaction was 8.7 (10 = very satisfied), pain after one week 2.0 (no pain = 0, maximal = 10) and absence of work was 0.9 day (range 0–14 days). Conclusion RFA for incompetent saphenous veins can safely be performed in an outpatient setting with a low complication rate, minimal pain and fast recovery.

scholarly journals Management of Melasma through Panchakama- A case study

2020 ◽  
Vol 6 (3) ◽  
pp. 135-138
Author(s):  
Poonam Verma ◽  
◽  
Latika ◽  
D Prasanth ◽  
Santoshkumar Bhatted ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Cost Effective ◽  
Medical Treatments ◽  
Cost Effective Treatment ◽  
Negative Impacts ◽  
New Treatments

Introduction. Skin reflects our physiology and emotions too. In present era each and every one desire to have healthy and beautiful skin. Any changes or disease of skin creates apart from physical and psychological and social negative impacts. Hyperpigmentation or melasma is one of the such raised problem in our country as it has significant impact on beauty and appearance. It is more prevalent in women, in an estimated 9:1 ratio compared to men. In addition, there are high expenditures related to medical treatments and procedures whose results do not always meet the expectations of patients. hence it is need of an hour to provide safe and cost effective treatment for the skin disease like melasma. In addition to traditional treatments for melasma, there are also promising new treatments, including topical, oral, and procedural therapies Materials & Methods: It is a Case report on 28 year old female patient diagnosed as a case of Melasama (Vyanga) managed through Ayurveda treatment like Vaman Karma and Ayurveda medication Assessment was made on the basis of significant change in MASI score and quality of life (melas Qol) Observation & Results: Observation was done before treatment after treatment and during follow up The changes computed in Masi score in which degree of pigmentation decline to 10 to 6, quality of life improve 60 to 48. Conclusion: The computed data from the present study shows that Vamana Karma along with Ayurvedic oral Ayurveda medication is effective in the treatment of melasma (Vyanga).

Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial

2019 ◽  
Vol 35 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Jorgete B dos Santos ◽  
Walter Campos Júnior ◽  
Rina MP Porta ◽  
Juliana Puggina ◽  
Daniela FT da Silva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Success Rate ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Success Rates ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
Number Of Patients

Objectives To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Methods Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6–10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. Results Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). Conclusions Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.

scholarly journals What Is Known and Unknown About Twice-Weekly Hemodialysis

2015 ◽  
Vol 40 (4) ◽  
pp. 298-305 ◽  
Author(s):  
Yoshitsugu Obi ◽  
Rieko Eriguchi ◽  
Shuo-Ming Ou ◽  
Connie M. Rhee ◽  
Kamyar Kalantar-Zadeh
Keyword(s):  
Quality Of Life ◽  
De Novo ◽  
Urine Volume ◽  
Cost Effective ◽  
Standard Of Care ◽  
Treatment Regimens ◽  
Interdialytic Weight Gain ◽  
Cost Effective Treatment ◽  
Incremental Hemodialysis

Background: The 2006 Kidney Disease Outcomes Quality Initiative guidelines suggest twice-weekly or incremental hemodialysis for patients with substantial residual kidney function (RKF). However, in most affluent nations de novo and abrupt transition to thrice-weekly hemodialysis is routinely prescribed for all dialysis-naïve patients regardless of their RKF. We review historical developments in hemodialysis therapy initiation and revisit twice-weekly hemodialysis as an individualized, incremental treatment especially upon first transitioning to hemodialysis therapy. Summary: In the 1960's, hemodialysis treatment was first offered as a life-sustaining treatment in the form of long sessions (≥10 hours) administered every 5 to 7 days. Twice- and then thrice-weekly treatment regimens were subsequently developed to prevent uremic symptoms on a long-term basis. The thrice-weekly regimen has since become the ‘standard of care' despite a lack of comparative studies. Some clinical studies have shown benefits of high hemodialysis dose by more frequent or longer treatment times mainly among patients with limited or no RKF. Conversely, in selected patients with higher levels of RKF and particularly higher urine volume, incremental or twice-weekly hemodialysis may preserve RKF and vascular access longer without compromising clinical outcomes. Proposed criteria for twice-weekly hemodialysis include urine output >500 ml/day, limited interdialytic weight gain, smaller body size relative to RKF, and favorable nutritional status, quality of life, and comorbidity profile. Key Messages: Incremental hemodialysis including twice-weekly regimens may be safe and cost-effective treatment regimens that provide better quality of life for incident dialysis patients who have substantial RKF. These proposed criteria may guide incremental hemodialysis frequency and warrant future randomized controlled trials.

scholarly journals Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases

2017 ◽  
Vol 5 (2) ◽  
pp. 129-132
Author(s):  
Disha A Rajput ◽  
Shalini M Valecha ◽  
Manisha Sarwade ◽  
Shrikant Dhumale
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Urinary Continence ◽  
Urgency Incontinence ◽  
Patient’S Satisfaction ◽  
Satisfaction Index ◽  
Genuine Stress Urinary Incontinence

ABSTRACT Introduction Urinary incontinence (UI) is more common than any other chronic disease with the prevalence of approximately 23 and 55%. Among the various forms of UI, stress incontinence (SUI) is the most common (49%), with urgency incontinence (UUI) representing 21% and mixed type (MUI) at 29%. As it affects the quality-of-life of women, the restoration of urinary continence is one of the greatest challenges. Aim To review the cases of genuine SUI treated surgically by Burch retropubic urethropexy. Results We have managed surgically eight cases of genuine SUI by Burch retropubic urethropexy. On 1-year follow-up, none of the patients had any urinary complaints. All had responded well to surgery and patient's satisfaction index was good. Conclusion Since SUI is the commonest among incontinences, it is a challenge to diagnose and treat to improve quality-of-life of patients. Burch retropubic urethropexy is the gold standard treatment for SUI, especially if other indications exist for abdominal surgery. Even in the present era of less invasive vaginal procedures, results are comparable. How to cite this article Rajput DA, Valecha SM, Sarwade M, Dhumale S. Burch Retropubic Urethropexy for Genuine Stress Urinary Incontinence: A Review of Eight Cases. J South Asian Feder Menopause Soc 2017;5(2):129-132.

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.

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

2021 ◽  
pp. 38-39
Author(s):  
Chunchesh MD Chunchesh MD ◽  
Vani Ahuja ◽  
Kiran S Mahapure
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Cost Effective Treatment ◽  
Pediatric Orthopaedics ◽  
Talipes Equinovarus ◽  
Main Factor

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

Arteriovenous Fistula Is a Rare but Significant Finding After Endovenous Thermal Ablation

2019 ◽  
Vol 43 (3) ◽  
pp. 116-122
Author(s):  
Donna M. Kelly ◽  
Deborah Sanford ◽  
Julianne Stoughton
Keyword(s):  
Saphenous Vein ◽  
Thermal Ablation ◽  
Varicose Veins ◽  
English Literature ◽  
Significant Finding ◽  
Asymptomatic Patients ◽  
Vein Segment ◽  
Endovenous Thermal Ablation

Endovenous thermal ablation (EVTA) has become the mainstay of treatment for symptomatic varicose veins in the setting of saphenous vein insufficiency. We observed 5 iatrogenic arteriovenous fistulas (AVFs) following thermal ablation of the great saphenous vein (GSV). Postprocedure duplex ultrasound (DUS) results were analyzed for the presence of AVF in any location along or adjacent to the treated saphenous veins. Cases were prospectively followed. English literature was reviewed for any other published reports of AVF after EVTA. Data were compiled using our 5 cases, 2 cases were shared with us by colleagues and 20 cases were reported in the literature. Our center has performed more than 4000 (4155) cases of EVTA over the past 15 years. Five cases of AVFs were detected, 3 were found in asymptomatic patients during routine post-EVTA surveillance. The additional 2 cases presented with signs or symptoms which prompted a DUS after ablation. Including cases in the literature, we were able to identify 2 different types of AVFs. The first type of AVF was demonstrated in 13 cases where the AVF occurred along the treated vein. All of these cases involved ablation of the GSV and 90% of these showed signs of recanalization. The second type of AVF was seen in 14 additional cases where the AVF involved a vein segment adjacent to or remote from the ablated vein. The second type occurred in the GSV in 5 cases, external iliac vein (EIV) in 3 cases, and in the popliteal vein in 5 cases. There is 1 reported case of AVF involving the sural artery after perforator vein EVTA. Three of the type 1 cases were followed and spontaneously resolved; 3 of the type 1 cases were treated with surgical ligation with unreported outcomes. Seven cases did not report any follow-up information. Seven of the type 2 cases were treated, and had spontaneous resolution and 7 were not treated. The follow-up on these cases ranged from 1 month to 6 years. Thermal ablation can result in AVF either along the length of the treated vein or adjacent to the area of ablation. Further study would help elucidate the cause and treatment algorithms.

scholarly journals A Cost-effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-herpetic Neuralgia

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Christopher F Carpenter ◽  
Annas Aljassem ◽  
Jerry Stassinopoulos ◽  
Giovanni Pisacreta ◽  
David Hutton
Keyword(s):  
Herpes Zoster ◽  
Cost Effectiveness ◽  
Subunit Vaccine ◽  
Age Groups ◽  
Cost Effective ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Published Data ◽  
Disease Epidemiology

Abstract Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals, accounting for &gt;1 million cases annually in the United States. A live attenuated HZ vaccine (LAV) is Food and Drug Administration approved for those age 50 years or older, though Advisory Committee on Immunization Practices recommendations are only for those age 60 years or older. LAV efficacy is ~70% for persons 50–59 years of age, with lower efficacy in older adults. A new 2-dose adjuvanted subunit vaccine (SUV) has &gt;95% efficacy in persons 50–69 years of age and remains ~90% efficacious in persons vaccinated at age 70 years. Methods To estimate the relative cost-effectiveness of SUV, LAV, and no vaccination (NoV) strategies, a Markov model was developed based on published data on vaccine efficacy, durability of protection, quality of life, resource utilization, costs, and disease epidemiology. The perspective was US societal, and the cycle length was 1 year with a lifelong time horizon. SUV efficacy was estimated to wane at the same rate as LAV. Outcomes evaluated included lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios (ICERs). Results For individuals vaccinated at age 50 years, the ICER for LAV vs NoV was $118 535 per quality-adjusted life-year (QALY); at age 60 years, the ICER dropped to $42 712/QALY. SUV was more expensive but had better ICERs than LAV. At age 50, the ICER was $91 156/QALY, and it dropped to $19 300/QALY at age 60. Conclusions Vaccination with SUV was more cost-effective than LAV in all age groups studied. Vaccination with SUV at age 50 years appears cost-effective, with an ICER &lt;$100 000/QALY.

Sign in / Sign up

Export Citation Format

Share Document