Clinical, ultrasonographic and histological findings in varicose vein surgery

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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Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency—Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519826008 ◽

2019 ◽

Vol 34 (8) ◽

pp. 543-551 ◽

Cited By ~ 8

Author(s):

Tjun Y Tang ◽

Harsha P Rathnaweera ◽

Jia W Kam ◽

Tze T Chong ◽

Edward C Choke ◽

...

Keyword(s):

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Asian Population ◽

Closure System ◽

Cyanoacrylate Glue ◽

Catheter Technique

Objectives The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required.

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Registry to investigate the efficacy and safety of the VenaBlock© VeIn SEaling system for VaRicose veins in SingApore – Six months results of the RIVIERA trial

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211025181 ◽

2021 ◽

pp. 026835552110251

Author(s):

YL Linn ◽

CJQ Yap ◽

SXY Soon ◽

SL Chan ◽

VBX Khoo ◽

...

Keyword(s):

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Venous Occlusion ◽

Clinical Severity ◽

Puncture Site ◽

Venous Clinical Severity Score

Background The Venablock© Venous Closure System (Invamed, Ankara, Turkey) is a novel cyanoacrylate-based non-thermal non-tumescent embolization device to block refluxing truncal veins for chronic venous insufficiency and varicose veins. The aim was to prospectively evaluate the safety and 6 months efficacy of Venablock© for the treatment of primary great saphenous vein (GSV) and small saphenous vein (SSV) incompetency in a multi-ethnic cohort from Singapore. Methods This was a single arm, single investigator prospective study of 29 patients (39 limbs, 39 truncal veins) recruited over a 5-month period (August 2019 to February 2020), who were treated with the Venablock© device at a tertiary vascular unit in Singapore. Patients with symptomatic varicose veins (C2–6) and had truncal reflux > 0.5 second on venous Duplex ultrasound were included. Follow-up occurred at 2 weeks, 3 and 6 months with dedicated quality of life questionnaires and a targeted Duplex ultrasound performed to check for continued venous occlusion. Result Mean age was 61.4 (±11.0) years and mean BMI was 26.2 (±5.7) kg/m2. 11/29 (37.9%) were males. Most common CEAP class treated was 2 (12/29, 41.3%). Mean diameter of treated GSV was 5.7 (±2.0) mm, 4.8 (±1.7) mm and 4.2 (±1.3) mm for the proximal, mid and distal above knee segments respectively. Mean time from access puncture to sheath removal was 23.4 (±10.0) mins. Vein occlusion at 2 weeks, 3 and 6 months was 39/39 (100%), 39/39 (100%) and 36/37 (97.2%) respectively. 5/29 (17.2%) developed puncture site infections, of which 3/29 (7.7%) required formal surgical drainage. 3/29 (7.7%) developed phlebitis. At 6 months, revised Venous Clinical Severity Score improved from 5.2 (±3.5) to 2.1 (±2.9; p < .001); EuroQol-5 Dimension score, from 7.4 (±2.1) to 5.7 (±1.4; p < .001); Aberdeen Varicose Vein Questionnaire score, from 18.1 (±15.5) to 7.9 (±8.9; p = .007); and Chronic Venous Insufficiency Questionnaire, from 18.6 (±16.2) to 4.5 (±6.3; p < .001). Conclusion Venablock© is a safe and efficacious option of treating truncal venous insufficiency in a multi-ethnic Asian cohort from Singapore in the short term. There is a significant improvement in QoL. Longer follow-up is required to assess the durability of this technique, in particular the higher puncture site infection rates observed compared to other glue-based therapies.

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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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Symptoms, clinical disability scores and reflux in complicated and uncomplicated primary varicose veins

Phlebology The Journal of Venous Disease ◽

10.1258/026835503321895370 ◽

2003 ◽

Vol 18 (2) ◽

pp. 73-77 ◽

Cited By ~ 7

Author(s):

J Saarinen ◽

M Heikkinen ◽

V Suominen ◽

J Virkkunen ◽

R Zeitlin ◽

...

Keyword(s):

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Classification ◽

Disability Score ◽

Duplex Imaging ◽

Primary Varicose Veins ◽

Varicose Disease

Objective: To evaluate the role of subjective symptoms, grade of disability and axial reflux in superficial veins in different clinical stages of varicose veins (VVs). Methods: A total of 172 legs with primary venous insufficiency from 126 patients were studied. The examination involved evaluation of the CEAP clinical class and clinical disability score (CDS), recording of any symptoms of varicose disease, and a hand-held Doppler (HHD) examination of the superficial veins. Colour-flow duplex imaging (CFDI) was also performed in 22% of the legs. Results: The rate of insufficiency of the great saphenous vein (GSV) was 83% in complicated legs (C4-6), and 68% in uncomplicated legs (C2-3), ( P > 0.05). There was a difference between complicated and uncomplicated legs in the insufficiency of the whole GSV [C4-6: n = 18 (39%) versus C2-3: n = 12 (12%), P < 0.005]. Sensation of pain was noted in 68% of the legs in class C1, 60% of those in class C2-3 and 81% of those in class C4-6. Sensation of oedema was recorded in 70% of the legs in class C1, 65% of those in class C2-3 and 86% of those in class C4-6, respectively. CDS classes 2-3 were significantly more frequent among complicated legs (C4-6: 54% versus C2-3 12%, P < 0.005). Conclusions: Leg symptoms are frequent throughout classes C1-6. Their clinical usefulness is therefore limited. CDS parallels well with the clinical classification. In complicated disease the whole saphenous vein is more frequently insufficient.

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Area-pressure relationship of lower limb main veins in man

VASA ◽

10.1024/0301-1526.35.2.59 ◽

2006 ◽

Vol 35 (2) ◽

pp. 59-66 ◽

Cited By ~ 3

Author(s):

Chauveau ◽

Bassez ◽

Tra ◽

Scherrer

Keyword(s):

Mechanical Properties ◽

Cross Section ◽

Saphenous Vein ◽

Lower Limb ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Posterior Tibial ◽

Relationship Of

Background: The mechanical properties of human veins remain incompletely known. However they play an important part in number of physiological and pathological situations, as hemodynamic adjustment to orthostasis, deep venous thrombosis (DVP) and chronic venous insufficiency (CVI). The aim of the study was to describe the pressure/volume (area) relationship of some important conduit veins of the human’s lower limb. Probands and methods: We investigated the area/pressure relationship of the femoral vein (FV) at mid thigh, the great saphenous vein (GSV) at lower third of the leg, and a deep leg vein (DLV), either the peroneal or posterior tibial vein, in fifteen healthy young men. The cross section areas were measured with B-mode ultrasound while various positive and negative venous pressures were generated by body’s tilting. Results: Over the range of pressures investigated, the area/pressure relationship was roughly linear, the classical sigmoid relation did not emerge from our data. The relative compliance of FV, GSV and DLV was 0.0312, 0.0118, and 0.0147 mmHg-1, respectively. Conclusions: The relative compliance of FV is more than two times higher than the relative compliance of both the DLV and the GSV.

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

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002008 ◽

2015 ◽

Vol 42 (2) ◽

pp. 111-115 ◽

Cited By ~ 1

Author(s):

Bernardo Cunha Senra Barros ◽

Antonio Luiz de Araujo ◽

Carlos Eduardo Virgini Magalhães ◽

Raimundo Luiz Senra Barros ◽

Stenio Karlos Alvim Fiorelli ◽

...

Keyword(s):

Surgical Treatment ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Clinical Severity ◽

Venous Disease ◽

Varicose Vein Surgery ◽

Beneficial Effects ◽

Venous Clinical Severity Score

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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Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽

10.1024/0301-1526.35.3.157 ◽

2006 ◽

Vol 35 (3) ◽

pp. 157-166 ◽

Cited By ~ 7

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.

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Outcomes of knee-groin great saphenous vein stripping in patients with chronic venous insufficiency

International Journal of Surgery Science ◽

10.33545/surgery.2019.v3.i3a.03 ◽

2019 ◽

Vol 3 (3) ◽

pp. 09-12

Author(s):

Dr. Ali Sapmaz ◽

Dr. Serhan Yilmaz ◽

Dr. Murat Özgür Kiliç ◽

Dr. Betül Keskinkılıç Yağiz ◽

Dr. Ahmet Serdar Karaca ◽

...

Keyword(s):

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein

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The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500304 ◽

2000 ◽

Vol 15 (3-4) ◽

pp. 106-109

Author(s):

C. V. Ruckley

Keyword(s):

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Varicose Veins ◽

Clinical Manifestations ◽

Epidemiological Studies ◽

Therapeutic Interventions ◽

Venous Disease ◽

Clinical Classification ◽

Age Related

Objective: To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required. Methods: Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented. Synthesis: The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications. Conclusions: Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.

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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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