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

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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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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A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516658592 ◽

2016 ◽

Vol 32 (6) ◽

pp. 415-424 ◽

Cited By ~ 16

Author(s):

Malcolm Sydnor ◽

John Mavropoulos ◽

Natalia Slobodnik ◽

Luke Wolfe ◽

Brian Strife ◽

...

Keyword(s):

Patient Satisfaction ◽

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

Superficial Venous Insufficiency

Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

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Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520939744 ◽

2020 ◽

pp. 026835552093974

Author(s):

Boutros Karam ◽

Moustafa Moussally ◽

Hussein Nassar ◽

Karim Ataya ◽

Rola Jaafar ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Clinical Severity ◽

Long Term Results ◽

Endovenous Laser Ablation ◽

Saphenous Veins ◽

Venous Clinical Severity Score ◽

Vein Reflux

Introduction Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. Methods This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. Results Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. Conclusion EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

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A new percutaneous technique: N-butyl cyanoacrylate adhesive for the treatment of giant saphenous vein insufficiency

Vascular ◽

10.1177/1708538117724647 ◽

2017 ◽

Vol 26 (2) ◽

pp. 194-197 ◽

Cited By ~ 4

Author(s):

Mehmet Senel Bademci ◽

Kaptanıderya Tayfur ◽

Gökhan Ocakoglu ◽

Serkan Yazman ◽

Muhammet Akyüz ◽

...

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Severity Score ◽

Early Period ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Tumescent Anesthesia ◽

Clinical Severity Score ◽

Venous Clinical Severity Score ◽

Vein Insufficiency

Background We have made a retrospective evaluation of the results of the cyanoacrylate ablation technique which has recently started to be used in the treatment of giant saphenous vein insufficiency today and in which tumescent anesthesia is not required. Methods Giant saphenous vein was treated in 50 patients between September 2015 and September 2016 by using endovenous cyanoacrylate ablation. In the procedure, tumescent anesthesia and varsity socks were not used. Control duplex ultrasound evaluation was performed in the post-procedural 1st, 6th and 12th months. Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores were evaluated. Results In the 50 patients who were treated, full closure was observed in giant saphenous vein in 47 (94%) patients in the 12th month control duplex ultrasound. The mean age of the patients was 46.4 (20–70) and 30 (60%) of them were female. The median Venous Clinical Severity Score scores in the 1st, 6th and 12th months were 3, 2 and 1, respectively ( p < 0.001); the median Aberdeen Varicose Vein Questionnaire scores in the 1st, 6th and 12th months were 7, 5 and 4, respectively ( p < 0.001). In the access site, two (4%) patients developed phlebitis and one (2%) developed ecchymosis. However, deep venous thrombosis, pulmonary embolism and paresthesia were not observed. Conclusion Considering the early period results in the treatment of giant saphenous vein insufficiency, cyanoacrylate ablation makes a more reliable alternative than endovenous thermal ablation methods in that it does not require tumescent anesthesia and it has a low incidence of adverse effects.

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A case of recurrent varicose veins due to the multiple fistulas from superficial femoral artery

SAGE Open Medical Case Reports ◽

10.1177/2050313x20926423 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092642

Author(s):

Satoshi Watanabe ◽

Takafumi Tsuji ◽

Shinya Fujita ◽

Soji Nishio ◽

Eisho Kyo

Keyword(s):

Laser Ablation ◽

Femoral Artery ◽

Saphenous Vein ◽

Superficial Femoral Artery ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Skin Pigmentation ◽

Duplex Ultrasound ◽

Endovenous Laser Ablation ◽

Recurrent Varicose Veins

Recurrent varicose veins are considered to be caused by the recurrence of reflux but rarely may be secondary to other pathologies. A 39-year-old man complained of right lower leg skin pigmentation, pain and fatigue for several years. Duplex ultrasound revealed that the great saphenous vein diameter at the saphenofemoral junction level was 7.7 cm, and at the knee medial level was 14.4 cm. The reflux time at the proximal great saphenousvein level was 1.85 s. Endovenous laser ablation for dilated and refluxed great saphenous vein was performed. However, 1 year later, the symptoms recurred. Duplex ultrasound suspected abnormal arterial flow from the right superficial femoral artery to the recanalized segment of previously ablated great saphenous vein and anterior accessory saphenous vein. One month later, despite the successful re-endovenous laser ablation, the symptoms recurred. Computed tomography angiography showed three fistulous vessels from superficial femoral artery to anterior accessory saphenous vein. Combined treatments with endovenous laser ablation and coil embolization was performed. Ultimately, the fistulas were obliterated and the patient remained free of symptoms. Varicose veins due to the fistulas from superficial femoral artery are rare and difficult to diagnose but can be entirely treated with the percutaneous approach.

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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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A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516632652 ◽

2016 ◽

Vol 31 (1_suppl) ◽

pp. 106-113 ◽

Cited By ~ 41

Author(s):

Ahmet Kürşat Bozkurt ◽

Muhammet Fatih Yılmaz

Keyword(s):

Laser Ablation ◽

Varicose Vein ◽

Severity Score ◽

Venous Insufficiency ◽

Clinical Severity ◽

Cyanoacrylate Glue ◽

Endovenous Laser Ablation ◽

Clinical Severity Score ◽

Venous Clinical Severity Score ◽

One Year

Introduction Cyanoacrylate ablation is the newest nonthermal vein ablation technique. The one-year results of a prospective comparative study of a new cyanoacrylate glue versus endovenous laser ablation for the treatment of venous insufficiency is presented. Material and methods A total of 310 adult subjects were treated with cyanoacrylate ablation or endovenous laser ablation. The primary endpoint of this study was complete occlusion of the great saphenous vein. Secondary endpoints were procedure time, procedural pain, ecchymosis at day 3, adverse events, changes from baseline in Venous Clinical Severity Score, and Aberdeen Varicose Vein Questionnaire. Results Operative time was shorter (15 ± 2.5 versus 33.2 ± 5.7, <0.001), and periprocedural pain was less (3.1 ± 1.6 versus 6.5 ± 2.3, <0.001) in cyanoacrylate ablation group compared to the endovenous laser ablation group. Ecchymosis at the third day was also significantly less in cyanoacrylate ablation group (<0.001). Temporary or permanent paresthesia developed in seven patients in endovenous laser ablation group and none in cyanoacrylate ablation group (p = 0.015). One, three, and 12 months closure rates were 87.1, 91.7, and 92.2% for endovenous laser ablation and 96.7, 96.6, and 95.8% for cyanoacrylate ablation groups. Closure rate at first month was significantly better in cyanoacrylate ablation group (<0.001). Although there is a trend of better closure rates in cyanoacrylate ablation patients, this difference did not reach to the statistical difference at sixth and 12th month (p = 0.127 and 0.138, respectively). Both groups had significant improvement in Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire postoperatively (<0.001), but there was no significant difference in Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores between the groups at first, sixth, and 12 months. Only a slightly better well-being trend was noted in cyanoacrylate ablation group in terms of Aberdeen Varicose Vein Questionnaire scores (p = 0.062). Conclusions The efficacy and safety analysis shows that cyanoacrylate ablation is a safe, simple method which can be recommended as an effective endovenous ablation technique. The follow-up data more than one year will clarify the future role of cyanoacrylate ablation for the treatment incompetent great saphenous veins.

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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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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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Endovenous laser ablation for great saphenous varicose veins

International Surgery Journal ◽

10.18203/2349-2902.isj20195420 ◽

2019 ◽

Vol 6 (12) ◽

pp. 4502

Author(s):

Asser Abd El Hamid Goda

Keyword(s):

Laser Ablation ◽

Clinical Examination ◽

Varicose Veins ◽

Clinical Severity ◽

Safe Procedure ◽

Efficacy And Safety ◽

Main Trunk ◽

Endovenous Laser Ablation ◽

Venous Clinical Severity Score ◽

The Mean

Background: Endovenous laser ablation (EVLA) is one of the most accepted treatment options for great saphenous varicose veins. The aim of this study was to evaluate the efficacy and safety EVLA in a 12 months follow-up.Methods: Patients with symptomatic great saphenous veins (GSV) reflux were undergo EVLA. The outcome measures the efficacy and safety along the follow up period (12 months). The efficacy assessed by measuring the occlusion rate of the GSV by duplex and by measuring the improvement in the mean venous clinical severity score (VCSS) by clinical examination. The safety assessed by clinical examination to detect the complications.Results: The rate of complete occlusion in the main trunk of the great saphenous vein was 34/35 (97.1%) at 6 and 12 months. The mean VCSS scores improved significantly after the procedure at 6 and 12 months. Complications detected within 1st week as pigmentation in 3 patients, local hematoma in one patient, and paresthesia in one patient but all complications disappeared within 6 and 12 months.Conclusions: EVLA is an effective and safe procedure for the treatment of varicose great saphenous.

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