Comparison of Endovasal Laser and Radiofrequency Ablation of Great Saphenous Vein in the Complex Treatment of Lower Limb Varicose Vein Disease

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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The anatomical relationship between the saphenous nerve and the great saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2010.010011 ◽

2011 ◽

Vol 26 (3) ◽

pp. 114-118 ◽

Cited By ~ 5

Author(s):

L Veverková ◽

V Jedlička ◽

P Vlček ◽

J Kalač

Keyword(s):

Radiofrequency Ablation ◽

Laser Therapy ◽

Histological Examination ◽

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Lower Leg ◽

Saphenous Nerve ◽

Endovenous Laser Therapy ◽

Anatomical Relationship

Objective Damage to the saphenous nerve (SN) has been a known complication during varicose vein surgeries. We tested whether a better knowledge of the anatomy of the SN and the great saphenous vein (GSV) can prevent such damage. Methods We conducted a morphological and histological examination on 86 limbs from 43 cadavers in order to analyse the anatomical interrelation between the SN and the GSV in the lower leg and we also measured the distance between the nerve and the vein in a sample of 42 sections from three parts of the lower leg. Results The anatomical relationship between the SN and the GSV is varied and the two structures run close to each other so a better knowledge of their anatomy in itself proved insufficient in preventing damage to the SN. Conclusion However, in the case of endovenous laser therapy and radiofrequency ablation tumescent anaesthesia decreases the risk of damage to the SN.

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Short Term Fate of Great Saphenous Vein after Radiofrequency Ablation for Varicose Veins

Kathmandu University Medical Journal ◽

10.3126/kumj.v13i3.16814 ◽

2017 ◽

Vol 13 (3) ◽

pp. 234-237

Author(s):

R.M. Karmacharya ◽

M Devbhandari ◽

Y.R. Shakya

Keyword(s):

Radiofrequency Ablation ◽

Saphenous Vein ◽

Varicose Vein ◽

Doppler Ultrasonography ◽

Distal Part ◽

Great Saphenous Vein ◽

Short Term ◽

Vein Type ◽

Saphenofemoral Junction

Background Radiofrequency ablation of varicose vein have gained popularity compared to conventional surgery due to comparable long term results in addition to definite immediate superiorities. This modality has been started in Nepal since August 2003 and the study on short term fate of ablated vein segment confirms the anatomical benefit in addition to the clinical benefit.Objective To analyze short term fate of segment of great saphenous vein that has been treated by Radiofrequency ablation in terms of occlusion of saphenofemoral junction and absence of recanalisation on Doppler ultrasonography finding done at 3-6 months postoperative period.Method Total 81 cases subjected for radiofrequency ablation of great saphenous vein in thigh segment during August 2013 – September 2014 were followed up in between 3 to 6 months by Doppler ultrasonography. The findings were classified into type 1 to 4 results based on the anatomic closure of saphenofemoral junction and absence of recanalisation on treated segments.Result There were total 81 cases with 54.3% female and 45.7% male patients. Mean short term follow up duration was 4.9 months (S.D. 1.1 months). Great Saphenous Vein was cannulated most frequently in between 5 cm above knee to 5 cm below knee. Mean number of Radio Frequency Ablation (RFA) segments were 6.6 (SD=3.1). There was complete occlusion (Type 1 results) in 51 cases (63.0%). In 24 cases (29.6%) there was competent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (GSV) (Type 2 results). In six cases (7.4%) there was incompetent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (Type 3 results). There were no cases with incompetent saphenofemoral junction with complete recanalisation in distal part of Great Saphenous Vein (Type 4 results).Conclusion Radio Frequency Ablation for varicose vein, besides making clinical improvements, is also associated with good anatomical results.

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Radiofrequency ablation of varicose veins: experience at a tertiary hospital

IMC Journal of Medical Science ◽

10.3329/imcjms.v15i1.54200 ◽

2021 ◽

Vol 15 (1) ◽

pp. 37-40

Author(s):

Farooq A Ganie ◽

Ghulam Nabi Lone ◽

Mohd Yaqoob Khan ◽

Syed Mohsin Manzoor ◽

Mudasir Hamid Bhat ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Pulmonary Thromboembolism ◽

Varicose Veins ◽

Tertiary Hospital ◽

Symptomatic Improvement ◽

Seldinger Technique ◽

One Year ◽

Vein Disease

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated by radiofrequency ablation technique was analyzed. Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated. Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately. Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation. Ibrahim Med. Coll. J. 2021; 15(1): 37-40

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The hemodynamic impact of the bidirectional flow within calf perforators and conductive veins in varicose vein disease

Journal of Theoretical and Applied Vascular Research ◽

10.24019/jtavr.101 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Cestmir Recek ◽

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Diastolic Pressure ◽

Venous Pressure ◽

Lower Leg ◽

Hemodynamic Assessment ◽

Pump Activity ◽

Bidirectional Flow ◽

Vein Disease

The hemodynamic assessment of the bidirectional flow within calf perforators and in the conductive veins in varicose vein disease is presented. The bidirectional streaming within calf perforators is induced by the changing polarity of the systolic and diastolic pressure gradients arising during calf pump activity between the deep veins and the saphenous system of the lower leg, as documented by simultaneous pressure measurements in the posterior tibial vein and the great saphenous vein. This bidirectional flow makes the deep and superficial veins of the lower leg conjoined vessels. The vector of the bidirectional streaming in varicose vein patients is oriented inward, into the deep veins. The enlarged calf perforators are the consequence of the saphenous reflux; after elimination of saphenous reflux the diameter of calf perforators diminishes significantly. Results of venous pressure, plethysmographic and electromagnetic flow measurements rebut the still prevalent opinion that the outward flow within calf perforators is a reflux. There is an up-and-down flow in the conductive veins during calf pump activity with a prevailing systolic centripetal (orthograde) flow in the popliteal/femoral axis and a diastolic centrifugal (retrograde) flow in the incompetent great saphenous vein. The popliteal vein represents actually the drain pipe of the calf muscle pump. The ambulatory venous pressure gradient arising during the diastolic phase of the calf pump activity resembles the diastolic pressure difference between the aorta and the left ventricle.

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Risk factors for endovenous heat-induced thrombosis after endovenous radiofrequency ablation of the great saphenous vein

Acta Phlebologica ◽

10.23736/s1593-232x.19.00436-3 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Raffaele Serra ◽

Nicola Ielapi ◽

Tiberio Rocca ◽

Luca Traina ◽

Stefano De Franciscis ◽

...

Keyword(s):

Risk Factors ◽

Radiofrequency Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein

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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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Surgical resection for suppurative thrombophlebitis of the great saphenous vein after radiofrequency ablation

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2019.06.005 ◽

2019 ◽

Vol 5 (4) ◽

pp. 532-534

Author(s):

Zachary Grady ◽

Matthew Aizpuru ◽

Kevin X. Farley ◽

Jaime Benarroch-Gampel ◽

Robert S. Crawford

Keyword(s):

Radiofrequency Ablation ◽

Surgical Resection ◽

Saphenous Vein ◽

Great Saphenous Vein

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Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein

Vascular ◽

10.1177/1708538119837110 ◽

2019 ◽

Vol 27 (5) ◽

pp. 537-541

Author(s):

Cemal Kemaloğlu

Keyword(s):

Risk Factor ◽

Radiofrequency Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Endovenous Laser Ablation ◽

The Third ◽

Single Risk Factor ◽

Significant Difference ◽

Vein Diameter ◽

Single Predictor

Background and aim The aim of this study was to compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) techniques for efficacy and side effects for great saphenous vein (GSV) ablation. Materials and methods Two hundred twenty-one patients and 287 extremities that underwent GSV ablation with EVLA and RFA methods were analysed retrospectively; 135 GSVs were treated with EVLA, 152 GSVs were treated with RFA. Physical examination and Ultrasound (US) records at the first week, first month and third month were evaluated. Recanalization, endothermal heat-induced thrombosis formation, presence of ecchymosis greater than 10 cm and GSV diameter parameters were statistically analyzed. Results In the RFA group, 96.7% of the GSVs that were ablated were occluded at the end of the third month. In the EVLA group, this rate was 92.6%. There was no statistically significant difference between success of ablation ( P = 0.118). In the RFA group, ecchymotic areas, that is larger than 10 cm diameter were observed in 16 extremities, whereas in the EVLA group, 66 of 135 (48.9%) limbs were found to have ecchymotic area larger than 10 cm ( P < 0.001). More recanalizations were observed in GSVs larger than 10 mm in diameter which was statistically significant ( P < 0.001). Conclusion Both EVLA and RFA methods are effective in treating GSV reflux. Compared to the EVLA, less ecchymosis occurs after RFA procedures. Regardless of the type of method used, the GSV diameter is a single predictor of recanalization.

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Inferior selective crossectomy for great saphenous vein incompetence: Our experience

Vascular ◽

10.1177/1708538120947251 ◽

2020 ◽

pp. 170853812094725

Author(s):

Maurizio Pagano ◽

Giovanna Passaro ◽

Roberto Flore ◽

Paolo Tondi

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Duplex Ultrasound ◽

Venous Disease ◽

Recurrence Rates ◽

Saphenofemoral Junction

Objective To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2–C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Results Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

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