scholarly journals Great saphenous vein remodeling using LASER with low-energy linear endovenous energy density, no tumescence, and associated surgical techniques

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Ferracani E ◽  
Bercovich J ◽  
Schulte C
Keyword(s):  
Energy Density ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Surgical Techniques ◽  
Low Energy

scholarly journals Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

2015 ◽  
Vol 14 (4) ◽  
pp. 282-289 ◽  
Author(s):  
Walter Junior Boim Araujo ◽  
Jorge Rufino Ribas Timi ◽  
Carlos Seme Nejm Júnior ◽  
Filipe Carlos Caron
Keyword(s):  
Energy Density ◽  
Clinical Outcomes ◽  
Saphenous Vein ◽  
Thermal Ablation ◽  
Lower Energy ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Venous Clinical Severity Score ◽  
Occlusion Rate ◽  
Lower Energy Density

Abstract Background Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV) occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs) underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS), and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%). Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins – A review of the clinical evidence

2016 ◽  
Vol 32 (5) ◽  
pp. 299-306 ◽  
Author(s):  
Christine A Cowpland ◽  
Amy L Cleese ◽  
Mark S Whiteley
Keyword(s):  
Laser Ablation ◽  
Energy Density ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Duplex Ultrasound ◽  
Flow Diagram ◽  
Current Evidence ◽  
Endovenous Laser Ablation ◽  
Delivery Technique ◽  
Optimal Linear

Objectives The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment. Results Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and <100 J/cm in terms of optimal closure rates with minimal side-effects and complications. Longer wavelengths targeting water might have a lower optimal LEED. A LEED <60 J/cm has reduced efficacy regardless of wavelength. The optimal LEED may vary with vein diameter and may be reduced by using specially shaped fibre tips. Laser delivery technique and type as well as the duration time of energy delivery appear to play a role in determining LEED. Conclusion The optimal LEED to ablate an incompetent great saphenous vein appears to be >80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.

scholarly journals A comparison between two different linear endovenous energy density (LEED) for great saphenous vein ablation using 1470-nm diode laser

2013 ◽  
Vol 11 (1) ◽  
pp. 103-108
Author(s):  
Sherif Essam ◽  
Ahmed Farouk ◽  
Ahmed Abolnaga ◽  
Atef Abdelhameed ◽  
Ahmed Hossny
Keyword(s):  
Energy Density ◽  
Diode Laser ◽  
Saphenous Vein ◽  
Great Saphenous Vein

CHIVA with endoluminal procedu res: Laser versus VNUS

Phlebologie ◽  
2017 ◽  
Vol 46 (01) ◽  
pp. 5-12 ◽  
Author(s):  
F. Amsler ◽  
E. Mendoza
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Surgical Techniques ◽  
Light Reflection ◽  
Common Femoral Vein ◽  
General Data ◽  
The Common ◽  
Proximal Thigh ◽  
Saphenofemoral Junction

SummaryIntroduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.

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.

Malignant tumours as a rare cause of recurrent thrombophlebitis of the great saphenous vein

Phlebologie ◽  
2008 ◽  
Vol 37 (06) ◽  
pp. 297-300
Author(s):  
N. König ◽  
H. J. Stark ◽  
P.-M. Baier
Keyword(s):  
Differential Diagnosis ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Case Reports ◽  
Malignant Tumours ◽  
Nerve Sheath Tumour ◽  
Below The Knee ◽  
Nerve Sheath ◽  
Unfavourable Prognosis ◽  
Peripheral Nerve Sheath Tumour

SummaryWe present two case reports concerning patients who had to undergone surgical treatment according tp the diagnosis of thrombophlebitis with insufficiency of the greater saphenous vein and putative encapsulated haematoma in the lower left leg area. During the operation we found tumours with urgent suspicion of malignancy. The histological examination revealed the diagnosis of mesenchymal chondrosarcoma and malignant peripheral nerve sheath tumour which are extremely malignant, but very rare neoplasmas with unfavourable prognosis. Conclusion: Since both types of tumours are often located below the knee, phlebotomists and vascular surgeons should take them into account as differential diagnosis.

Short stripping of the incompetent great saphenous vein by InvisiGrip® vein stripper

Phlebologie ◽  
2010 ◽  
Vol 39 (02) ◽  
pp. 77-81 ◽  
Author(s):  
A. G. Krasznai ◽  
E. C. M. Bollen ◽  
J. C. van der Kley ◽  
R. J. Th. J. Welten ◽  
G. M. J. M. Welten
Keyword(s):  
Success Rate ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Nerve ◽  
Preoperative Selection ◽  
Superficial Wound ◽  
Good Cosmetic ◽  
Surgical Device ◽  
Femoral Nerve Injury ◽  
Selection Of

SummaryOur aim is to describe the results of a new short stripping technique for the treatment of the incompetent great saphenous vein (GSV) using a new developed surgical device. Patients, methods: 397 patients (498 legs) were treated with the InvisiGrip® Vein Stripper, which removes the GSV through a single groin incision, endovascular cutting and antegrade stripping by inversion. We reported the surgical success rate and postprocedural complications. Results: The mean age was 51 years, 74% were women. The success rate for removal of the GSV was 95%. The 23 failures were half patient related, half device related. In 82% of the strippings, one or two attempts were needed to successfully remove the GSV, which was done by invagination in 80%. Age, gender, BMI ≥30 kg/m2 and male GSV diameter were not associated with the number of attempts. Superficial wound infection, haematoma and temporary saphenous and femoral nerve injury occurred in 6 (1.6%), 0, 3 (0.8%) and 7 (1.9%) patients, respectively. Conclusion: The InvisiGrip® is highly successful for the removal of the GSV using short inverting stripping. Furthermore, it is simple, safe, associated with good cosmetic results and no preoperative selection of patients is necessary.

Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Stage ◽  
Clinical Signs ◽  
Cost Effective ◽  
Duplex Sonography ◽  
Foam Sclerotherapy ◽  
Average Loss ◽  
One Year ◽  
The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

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