Efficacy of varicose vein surgery with preservation of the great safenous vein

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001). CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

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Varicose Vein Surgery

10.2310/vasc.2113 ◽

2011 ◽

Author(s):

Jovan N. Markovic ◽

Cynthia K. Shortell

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Significant Proportion ◽

The United States ◽

Clinical Severity ◽

Treatment Modalities ◽

Venous Disease ◽

Varicose Vein Surgery

Chronic venous insufficiency (CVI) is a common vascular disorder that affects a significant proportion of the population in the United States and other developed countries. In its advanced stages, CVI significantly reduces patients’ quality of life and imposes a high economic burden on society due to increased direct health care costs and reduced productivity. Favorable clinical results associated with endovascular ablation techniques and patient preference for minimally invasive procedures has led to a shift in which treatment of vein disease is moving from the hospital to the office, allowing a more diverse group of physicians to enter a field that had typically been the domain of surgeons. This chapter reviews the terminology associated with venous disease, indications for varicose vein surgery, preoperative evaluation, procedural planning, endovenous procedures (endovenous laser ablation, radiofrequency ablation), surgical vein stripping techniques, and foam sclerotherapy. Tables include Clinical severity, Etiology or Cause, Anatomy, Pathophysiology classification; summary of nomenclature changes for the lower extremity venous system; indications for varicose vein surgery; interrogation points in the venous reflux examination; complications associated with treatment modalities used in the management of CVI; and methods of variceal ablation. Figures show an ultrasonographic image of a saphenous eye, placement of a quartz fiber for laser ablation of the great saphenous vein, a typical saphenofemoral junction, surgical stripping of the great saphenous vein, and microfoam sclerotherapy. This review contains 9 figures, 6 tables and 73 references.

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Varicose Vein Surgery

DeckerMed Surgery ◽

10.2310/surg.2113 ◽

2014 ◽

Author(s):

Jovan N. Markovic ◽

Cynthia K. Shortell

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Significant Proportion ◽

The United States ◽

Clinical Severity ◽

Treatment Modalities ◽

Venous Disease ◽

Varicose Vein Surgery

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Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517733339 ◽

2017 ◽

Vol 33 (8) ◽

pp. 547-557 ◽

Cited By ~ 2

Author(s):

Krishna Prasad Bellam Premnath ◽

Binu Joy ◽

Vijayakumar Akondi Raghavendra ◽

Ajith Toms ◽

Teena Sleeba

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Cyanoacrylate Glue ◽

Cyanoacrylate Adhesive ◽

Venous Clinical Severity Score ◽

Primary Varicose Veins ◽

Vein Reflux

Various treatment methods are available for the treatment of varicose veins, and there has been a recent surge in the usage of cyanoacrylate glue for treating varicose veins. Purpose To investigate the technical possibility, efficiency and safety of cyanoacrylate adhesive embolization and sclerotherapy using commonly available n-butyl cyanoacrylate glue for the treatment of primary varicose veins due to great saphenous vein reflux with or without incompetent perforators. Materials and Methods One hundred forty-five limbs of 124 patients with varicose veins due to great saphenous vein reflux were subjected to cyanoacrylate adhesive embolization and sclerotherapy – adhesive embolization of great saphenous vein in the thigh and perforators using cyanoacrylate followed by sclerotherapy of any residual varicose veins in the leg. Procedural success, venous closure rates and clinical improvement were assessed. Follow-up for 1, 3, 6, 9 and 12 months was obtained. Results Technical success rate was 100%. Saphenous vein closure rate was 96.5% at one year. There was no femoral venous extension of cyanoacrylate in any of the patients. Posterior tibial vein extension of cyanoacrylate was seen in three patients (2.6%) without untoward clinical effect.Significant improvement was found in venous clinical severity score (VCSS) from a baseline mean of 7.98 ± 4.42 to 4.74 ± 3, 1.36 ± 1.65 and 0.79 ± 1.19 at 1, 6 and 12 months’ follow-up. Ulcer healing rate was 100%. Conclusion Cyanoacrylate adhesive embolization and sclerotherapy for the treatment of primary varicose veins is efficacious and can be performed as an outpatient procedure, but has a guarded safety profile due to its propensity to cause deep venous occlusion if not handled carefully.

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Clinical, ultrasonographic and histological findings in varicose vein surgery

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.64.08.729 ◽

2018 ◽

Vol 64 (8) ◽

pp. 729-735

Author(s):

Moacir de Mello Porciunculla ◽

Dafne Braga Diamante Leiderman ◽

Rodrigo Altenfeder ◽

Celina Siqueira Barbosa Pereira ◽

Alexandre Fioranelli ◽

...

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Lower Limb ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Clinical Classification ◽

Histopathological Changes

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease’s clinical severity or reflux in the SFJ on a Doppler ultrasound.

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Need for adjunctive procedures following cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of postprocedure compression: Three-month data from a postmarket evaluation of the VenaSeal System (the WAVES Study)

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518801641 ◽

2018 ◽

Vol 34 (4) ◽

pp. 231-237 ◽

Cited By ~ 8

Author(s):

Kathleen Gibson ◽

Renee Minjarez ◽

Krissa Gunderson ◽

Brian Ferris

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Severity Score ◽

Rating Scale ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Compression Stockings ◽

Saphenous Veins ◽

Clinical Severity Score ◽

Venous Clinical Severity Score

Purpose Studies examining cyanoacrylate closure of saphenous veins with the VenaSeal™ System have not allowed concomitant procedures for tributaries at the time of the index procedure. Outside of clinical trials, however, concomitant procedures are frequently performed in conjunction with endovenous ablation. We report on the frequency of need for saphenous tributary treatment three months after cyanoacrylate closure of the treatment of great saphenous vein, small saphenous vein, and/or accessory saphenous vein. Methods Fifty subjects with symptomatic great saphenous vein, small saphenous vein, and/or accessory saphenous vein incompetence were treated with no postprocedure compression stockings. Concomitant procedures were not allowed. Treating physicians predicted the type and nature of any concomitant procedures that they would usually perform at the time of ablation, if not limited by the constraints of the study. Evaluations were performed at one week, one and three months and included duplex ultrasound, numeric pain rating scale, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire, and time to return to work and normal activities. At the three-month visit, the need for and type of adjunctive procedures were recorded. Results Complete closure at three months was achieved in 70 (99%) of the treated veins (48 great saphenous veins, 14 accessory saphenous veins, eight small saphenous veins). Revised venous clinical severity score improved from 6.4 ± 2.2 to 1.8 ± 1.5 (P < .001) and Aberdeen Varicose Vein Questionnaire from 17.3 ± 7.9 to 6.5 ± 7.2 (P < .0001). Sixty-six percent of patients underwent tributary treatment at three months. The percentage of patients who required adjunctive treatments at three months was lower than had been predicted by the treating physicians (65% versus 96%, p=.0002). Conclusions Closure rates were high in the absence of the use of compression stockings or side branch treatment. Improvement in quality of life was significant, and the need for and extent of concomitant procedures was significantly less than had been predicted by the treating physicians.

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Great saphenous vein sparing versus stripping in Trendelenburg operation for primary varicose veins: a prospective study

Polish Journal of Surgery ◽

10.5604/01.3001.0014.6219 ◽

2020 ◽

Vol 93 (1) ◽

pp. 34-39

Author(s):

Ashikesh Kundal ◽

Navin Kumar ◽

Deepak Rajput ◽

Udit Chauhan

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Randomized Study ◽

Duplex Ultrasound ◽

Operative Management ◽

Clinical Severity ◽

Below The Knee ◽

Venous Clinical Severity Score ◽

Significant Difference

Objective: The purpose of this study was to compare the outcome of the great saphenous vein (GSV) sparing versus stripping during Trendelenburg operation for varicose veins. Methods: This was a prospective randomized study of primary varicose vein patients who underwent Trendelenburg operation. Data of patients operated on over a period of 16 months was collected, including: below knee GSV diameter by Duplex Ultrasound and revised venous clinical severity score (rVCSS), calculated preoperatively and postoperatively at 2nd, 4th, and 8th week. Results: A total of 36 patients undergoing Trendelenburg operation were included in the study. Nineteen patients underwent GSV sparing while 17 underwent stripping of GSV till just below the knee after juxtafemoral flush ligation of the great saphenous vein. There was a significant decrease in the below-knee GSV diameter (19% after 2 months) and rVCSS (60.8%) in the sparing group. The stripping group also showed an almost similar decrease in below-knee GSV diameter (19.6% after 2 months) and rVCSS (66.3%). However, no significant difference was found between the two groups in terms of change in GSV diameter (P = 0.467) and rVCSS (P = 0.781). Conclusion: Trendelenburg procedure with sparing of GSV can be done routinely for operative management of varicose veins, where surgery is needed.

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Persistent below-knee great saphenous vein reflux after above-knee endovenous laser ablation with 1470-nm laser: a prospective study

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.001516 ◽

2016 ◽

Vol 15 (2) ◽

pp. 113-119

Author(s):

Walter Junior Boim de Araujo ◽

Jorge Rufino Ribas Timi ◽

Carlos Seme Nejm Junior ◽

Fabiano Luiz Erzinger ◽

Filipe Carlos Caron

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Test Group ◽

Clinical Severity ◽

Control Group ◽

Venous Disease ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score

Abstract Background In endovenous laser ablation (EVLA), the great saphenous vein (GSV) is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease. Objectives To evaluate clinical and duplex ultrasound (DUS) outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins. Methods Thirty-six patients (59 GSVs) were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS) and a test group (33 GSVs with below-knee reflux). Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS), and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months. Results Mean patient age was 45 years, and 31 patients were women (86.12%). VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month). However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year). Conclusions These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

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A retrospective study of a new n-butyl-2-cyanoacrylate glue ablation catheter incorporated with application guiding light for the treatment of venous insufficiency: Twelve-month results

Vascular ◽

10.1177/1708538118770548 ◽

2018 ◽

Vol 26 (5) ◽

pp. 547-555 ◽

Cited By ~ 9

Author(s):

Turhan Yavuz ◽

Altay Nihat Acar ◽

Huseyin Aydın ◽

Evren Ekingen

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Severity Score ◽

Great Saphenous Vein ◽

Clinical Severity ◽

The Third ◽

Clinical Severity Score ◽

Venous Clinical Severity Score ◽

The Mean

Objective This study aims to present the early results of a retrospective study of the use of novel n-butyl-2-cyanoacrylate (VenaBlock)-based nontumescent endovenous ablation with a guiding light for the treatment of patients with varicose veins. Methods Patients with lower limb venous insufficiency were treated with n-butyl-2-cyanoacrylate (VenaBlock Venous Closure System) between April 2016 and July 2016. The study enrolled adults aged 21–70 years with symptomatic moderate to severe varicosities (C2–C4b) and great saphenous vein reflux lasting longer than 0.5 s with great saphenous vein diameter between 5.5 and 15 mm assessed in the standing position. No compression stockings were used after the procedure. Duplex ultrasound imaging and clinical follow-up were performed on the third day, first month, sixth month, and 12th month. Clinical, etiological, anatomical, pathophysiological classification; venous clinical severity score; and completed Aberdeen varicose vein questionnaire were recorded. Results Five hundred thirty-eight patients with great saphenous vein incompetency underwent n-butyl-2-cyanoacrylate ablation. The mean ablation length was 25.69 ± 4.8 cm, and the average amount of n-butyl-2-cyanoacrylate delivered was 0.87 ± 0.15 ml. The mean procedure time was 11.7 ± 4.9 min. Procedural success was 100%, and complete occlusion was observed after treatment and at the third-day follow-up. We observed ecchymosis in five patients (1.00%) at the entry site at the third-day follow-up. Phlebitis was encountered with six (1.20%) patients. No skin pigmentation, hematoma, paresthesia, deep vein thrombosis, or pulmonary embolism was observed. Kaplan–Meier analysis yielded an occlusion rate of 99.4% at the 12-month follow-up. All patients had significant improvement in venous clinical severity score and Aberdeen varicose vein questionnaire scores postoperatively ( p <0.0001). Venous clinical severity score scores decreased from 5.43 ± 0.87 to 0.6 ± 0.75. Aberdeen varicose vein questionnaire scores decreased from 18.32 ± 5.24 to 4.61 ± 1.42. Conclusions The procedure appears to be feasible, safe, and efficient in treating the great majority of incompetent great saphenous veins with this technique.

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Great saphenous vein mechanochemical sclerotherapy versus laser ablation in treatment of varicose vein

QJM ◽

10.1093/qjmed/hcaa050.066 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M I Ibrahim ◽

K A Nabil ◽

A M Abdalmageed ◽

G K Hussein

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Procedural Pain ◽

Procedure Time ◽

Endovenous Laser Ablation ◽

High Incidence

Abstract Background Endovenous thermal techniques, such as endovenous laser ablation (EVLA), are the recommended treatment for truncal varicose veins. But it requires the administration of tumescent anaesthesia, which can be uncomfortable. Non-thermal, non-tumescent techniques, such as mechanochemical ablation (MOCA) have some advantages such as less post-procedural pain and less procedure time . MOCA combines physical damage to endothelium using sharply terminated metal claws, with the injection of a liquid sclerosant. Introduction Chronic venous insufficiency is one of the most common medical conditions among highly developed societies. The majority of patients (70%) suffer from saphenous veins incompetency. The aim of this study was to evaluate the primary efficacy of mechanochemical sclerotherapy by phlebogriffe (flebogrif) in comparison to laser ablation in treatment of varicose vein. Methods/Design The study was conducted on 30 patients, including 16 women and 14 men divided into 2 groups. The first group (15 patients) was treated with ablation with Flebogrif (MOCA) to treat varicose veins. The second group (15 patients) was treated with ablation with Endovenous laser ablation (EVLA). All patients were qualified based on the ultrasound in a standing position confirming incompetence of the great saphenous vein or small saphenous vein. The primary outcomes are intra-procedural pain and technical efficacy at 1 year, defined as complete occlusion of target vein segment and assessed using duplex ultrasound. Secondary outcomes are post-procedural pain, analgesia use, procedure time, clinical severity, bruising, complications, satisfaction, time taken to return to daily activities and/or work, and cost-effectiveness analysis following EVLA or MOCA. Both groups will be evaluated on an intention-to-treat basis. Results The total primary obliteration rate after 3 days and 1 month was 100% with both EVLA-RTF and MOCA while after 3 months (ms) was 93.3% with both groups. After 6ms the total primary obliteration rate was 93.3% with EVLA-RTF and 86.7% with MOCA. The Venous Clinical Severity Score (VCSS) presented similar and durable improvements in both groups between 3days and 6 months. While there is significant less post procedural pain, ecchymosis and bruises with the MOCA method and so high incidence of use of analgesics in EVLA patients than in MOCA group. The median time for return to work was 1 day after both treatments. No severe adverse events were observed. Discussion The aim of the study is to evaluate whether MOCA is superior to EVLA. The two main hypotheses are that MOCA may cause less initial pain and disability allowing rapid post-operative recovery. The second hypothesis is the efficacy, which may lead to increased recurrence and affect longer term quality of life, increasing the requirement for secondary procedures. Conclusions EVLA and MOCA have similarly high great saphenous vein (GSV) obliteration rates in the long term, and the treatments are equally effective clinically. While according to post procedural pain, ecchymosis, Bruises and long procedural time. The study showed significant high incidence of occurrence in EVLA group than MOCA group. So according to these items there is significant superiority of MOCA over EVLA.

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Determinants and patterns of recurrence of primary varicose veins after Endovenous laser ablation

10.21203/rs.3.rs-61012/v1 ◽

2020 ◽

Author(s):

Sheref A. Elseidy ◽

M. Hatem ◽

Ahmed K. Awad ◽

Obaie Mzaik ◽

Debvarsha Mandal ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

Table Analysis ◽

Lost To Follow Up

Abstract Background: The goal of this retrospective cohort study was to determine the different recurrence patterns, sites and determinants impacting primary varicose vein recurrence after endovenous laser ablation (EVLA).Methods: 127 symptomatic patients (127 limbs) with great saphenous vein incompetence who underwent EVLA were followed up for recurrence. Twenty-seven patients were lost to follow-up, leaving 100 patients (100 limbs) for analysis. Outcomes: Recurrence defined by venous clinical severity score (VCSS) or patterns of reflux on the duplex ultrasound examination. Assessments were done at 1, 6, 12 and 24 months after the procedure.Results: Two-year life table analysis showed varicose vein recurrence in 9(7.1%) of limbs. Varicose vein recurrence was due to refluxing anterior accessory saphenous vein in 77.8% patients (p <0.001, 95% CI 3.2 to 1669.1), re-canalization (66.6%), non-truncal varicosities (55.5 %) and incompetent perforators 77.8% patients (p <0.001, 95% CI 2.7 to 69.3).Recurrence was mostly seen owed to both incompetent perforators and accessory saphenous vein, BMI more than 30.5 kg/m2 is noted in 77.8 % (p <0.001, 95% CI 1.105 to 1.590) of recurrence patients.

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