Improvement of dynamic venous function after thermal ablation with steam vein occlusion – 6-weeks and 1-year follow-up after 167 treatments

BACKGROUND: In this paper, the method of steam vein occlusion for the treatment of the great/small saphenous vein (GSV/SSV) was analyzed in terms of a therapeutic influence on the dynamic parameters of global vein function, its effects on subjective symptoms based on chronic venous insufficiency (CVI) and the side effects of the steam vein sclerosis (SVS). It has been questioned whether the effects of this method lead to a recommendation for routine clinical practice. METHODS: The venous drainage and the venous refilling time (T0) of the leg treated were determined by photoplethysmography (Elcat, Wolfratshausen, Germany) before, six weeks and one year after the intervention to examine the effects on global venous function. Further changes of clinical symptoms and findings were assessed by the Venous Clinical Severity Score (VCSS), preoperatively and after one year, and the complication rate at 6-week follow-up was monitored. RESULTS: The SVS was performed on 167 veins (GSV: 124; SSV: 43) in a total of 156 patients. Eight patients (5.1%) did not attend the 6-week follow-up, while 29 patients (18.6%) were lost in the 1-year follow-up. Patients were suffering from symptoms such as leg pain and leg edema, which resulted in a VCSS of 9.4 (cumulated mean score of all patients) preoperatively. The T0 was reduced to mean values of 20.6 s (GSV cohort) and 21 s (SSV cohort). The VCSS improved to 6.0 after one year. This correlated with the hemodynamic parameters. The T0 increased in the GSV cohort after six weeks to 31.8 s, p < 0.001, and showed a nonsignificant improvement to 32.2 s, p = 0.509, in the 1-year check. The T0 also increased in the SSV cohort significantly after 6 weeks to 30.1 s, p < 0.001, and showed a nonsignificant reduction after one year, p = 0.289. A total of 71%of the GSV and 69.8%of the SSV of the patients involved no complications following the treatment. Light complications (grade 1) occurred (reddening, hematoma, hyperpigmentation) in the majority: 24.2%of the GSV and 18.6%of the SSV. We noticed one grade 3 complication with thrombosis in the SSV cohort, which led to a pulmonary embolism. Forty-seven complete questionnaires were analyzed (responder rate: 28.1%); 40.4%of the patients had light complaints after the treatment, such as pain, warmth or local pressure sensations (Fig. 7); 63%of those patients noticed only slight pain at a maximum of 3 out of 10. The majority (91%) would recommend this procedure. CONCLUSION: The SVS revealed endoluminal catheter-based intervention to abolish venous reflux of the G/SSV as safe. As one therapeutic target is to eliminate venous reflux, effectiveness of a method cannot be based on sonographic data alone; one must further assess patients’ symptoms and dynamic venous function. This data shows an improvement of patients’ symptoms which correlated well with the improvement of the venous function in digital photoplethysmography. The SVS can be recommended as a catheter-based treatment in the future.

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Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514532455 ◽

2014 ◽

Vol 30 (6) ◽

pp. 397-404 ◽

Cited By ~ 68

Author(s):

Jose I Almeida ◽

Julian J Javier ◽

Edward G Mackay ◽

Claudia Bautista ◽

Daniel J Cher ◽

...

Keyword(s):

Saphenous Vein ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Leg Pain ◽

Compression Stockings ◽

Saphenous Veins ◽

Kaplan Meier ◽

Venous Clinical Severity Score ◽

Human Use

Objectives To evaluate the safety and effectiveness of endovenous cyanoacrylate-based embolization of incompetent great saphenous veins. Methods Incompetent great saphenous veins in 38 patients were embolized by cyanoacrylate bolus injections under ultrasound guidance without the use of perivenous tumescent anesthesia or graduated compression stockings. Follow-up was performed over a period of 24 months. Result Of 38 enrolled patients, 36 were available at 12 months and 24 were available at 24 months follow-up. Complete occlusion of the treated great saphenous vein was confirmed by duplex ultrasound in all patients except for one complete and two partial recanalizations observed at, 1, 3 and 6 months of follow-up, respectively. Kaplan-Meier analysis yielded an occlusion rate of 92.0% (95% CI 0.836–1.0) at 24 months follow-up. Venous Clinical Severity Score improved in all patients from a mean of 6.1 ± 2.7 at baseline to 1.3 ± 1.1, 1.5 ± 1.4 and 2.7 ± 2.5 at 6, 12 and 24 months, respectively ( p < .0001). Edema improved in 89% of legs (n = 34) at 48 hours follow-up. At baseline, only 13% were free from pain. At 6, 12 and 24 months, 84%, 78% and 64% were free from leg pain, respectively. Conclusions The first human use of endovenous cyanoacrylate for closure of insufficient great saphenous veins proved to be feasible, safe and effective. Clinical efficacy was maintained over a period of 24 months.

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Mechanochemical ablation for symptomatic great saphenous vein reflux: A two-year follow-up

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515627260 ◽

2016 ◽

Vol 32 (1) ◽

pp. 43-48 ◽

Cited By ~ 17

Author(s):

Pamela S Kim ◽

Muath Bishawi ◽

David Draughn ◽

Marab Boter ◽

Charles Gould ◽

...

Keyword(s):

Clinical Improvement ◽

Saphenous Vein ◽

Severity Score ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Mechanochemical Ablation ◽

Venous Clinical Severity Score ◽

Occlusion Rate ◽

The Mean

Background Several studies have shown comparable early efficacy of mechanochemical ablation to endothermal techniques. The goal of this report was to show if early efficacy is maintained at 24 months. Methods This was a two-year analysis on the efficacy of mechanochemical ablation in patients with symptomatic C2 or more advanced chronic venous disease. Patients with reflux in the great saphenous vein involving the sapheno-femoral junction and no previous venous interventions were included. Demographic information, clinical, and procedural data were collected. The occlusion rate of treated veins was assessed with duplex ultrasound. Patient clinical improvement was assessed by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class and venous clinical severity score. Results Of the initial 126 patients, there were 65 patients with 24 month follow-up. Of these 65 patients, 70% were female, with a mean age of 70 ± 14 years and an average body mass index (BMI) of BMI of 30.5 ± 6. The mean great saphenous vein diameter in the upper thigh was 7.6 mm and the mean treatment length was 39 cm. Adjunctive treatment of the varicosities was performed in 14% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, 95% at 12 months, and 92% at 24 months. There was one patient with complete and four with partial recanalization ranging from 7 to 12 cm (mean length 9 cm). There was significant improvement in CEAP and venous clinical severity score (P < .001) for all time intervals. Conclusion Early high occlusion rate with mechanochemical ablation is associated with significant clinical improvement which is maintained at 24 months, making it a very good option for the treatment of great saphenous vein incompetence.

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Five-year outcomes of mechano-chemical ablation of primary great saphenous vein incompetence

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519861464 ◽

2019 ◽

Vol 35 (4) ◽

pp. 255-261

Author(s):

Naomi DE Thierens ◽

Suzanne Holewijn ◽

Wynand HPM Vissers ◽

Debbie AB Werson ◽

Jean Paul PM de Vries ◽

...

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Clinical Severity ◽

Long Term Results ◽

Venous Clinical Severity Score ◽

Ceap Classification ◽

Chemical Ablation ◽

Anatomical Success

Objective The aim of the study is to report long-term results after mechano-chemical ablation for the treatment of great saphenous vein incompetence. Methods Mechano-chemical ablation was performed using the ClariVein device with polidocanol as the sclerosant. Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification, Venous-Clinical-Severity-Score (VCSS), anatomical-success, RAND-SF36 and the Aberdeen-Varicose-Vein-Questionnaire (AVVQ) were obtained by clinical examination, questionnaires and duplex ultrasonography through five years’ follow-up (Clinicaltrials.gov, NCT01459263). Results Ninety-four patients (113 great saphenous veins) were included in the study. Five-year follow-up data were available for 75 limbs (66.4%). Freedom from anatomical failure was 78.7% (N = 45) with 64.6% (N = 42) having an improvement in the VCSS ≥1. A total of five reinterventions were performed through five years with a median time to reintervention of 38 months. The VCSS at five years was 2 (IQR 1; 4) and was still significantly improved compared to baseline (p < 0.001). A deterioration of the VCSS was observed in 21.5%. Conclusion Through five-year follow-up, there are a significant number of anatomical and clinical failures in this series, mainly driven by partial recanalizations.

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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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Radiographic and clinical outcome of syringomyelia in patients treated for tethered cord syndrome without other significant imaging abnormalities

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.11.peds12251 ◽

2013 ◽

Vol 11 (3) ◽

pp. 307-312 ◽

Cited By ~ 14

Author(s):

Charles G. Kulwin ◽

Neal B. Patel ◽

Laurie L. Ackerman ◽

Jodi L. Smith ◽

Joel C. Boaz ◽

...

Keyword(s):

Clinical Symptoms ◽

Incidental Finding ◽

Tethered Cord ◽

Symptomatic Improvement ◽

Tethered Cord Syndrome ◽

High Rate ◽

Leg Pain ◽

Postoperative Mri ◽

Urodynamic Studies

Object The surgical management of patients with symptoms of tethered cord syndrome (TCS) who lack significant radiographic abnormalities is controversial. One potential MRI marker for TCS is a spinal cord syrinx or syringomyelia. Alternatively, a syrinx may be a benign and incidental finding. In this report the authors evaluated a highly selected cohort of patients with symptoms of TCS with minimal radiographic abnormalities other than syringomyelia. They analyzed clinical and radiographic outcomes after tethered cord release (TCR). Methods A retrospective review of data from 16 children who met the study inclusion criteria was performed. All patients had been surgically treated at Riley Hospital for Children in Indianapolis, Indiana, between 2006 and 2011. All children had clinical symptoms of TCS as well as available pre- and postoperative MRI data. Results The most common presentation (12 [75%] of 16 patients) was urinary dysfunction, defined as symptoms of urgency or incontinence with abnormal urodynamic studies. Clinical follow-up data were available in 11 of these 12 patients. All 11 had improvement in symptoms at an average follow-up of 17 months. Seven (87.5%) of 8 patients presenting with back or leg pain had improvement. Three patients had progressive scoliosis; 2 had stabilization of the curve or mild improvement, and 1 patient had worsening deformity. Radiographic follow-up data were obtained an average of 14.5 months after surgery. Twelve patients (75%) had stable syringomyelia after TCR. Four patients showed improvement, with 2 having complete radiographic resolution. Conclusions Highly selected patients with symptoms of TCS did very well clinically. Patients with abnormal urodynamic studies, pain, and gait disturbances showed a high rate of symptomatic improvement. However, a smaller percentage of patients had radiographic improvement of the syrinx. Therefore, the authors suggest that the decision to perform TCR should be based on clinical symptoms in this population. Symptomatic improvement was not necessarily related to radiographic resolution of the syrinx.

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Childhood maltreatment and clinical severity of treatment‐resistant depression in a French cohort of outpatients (FACE‐DR): One‐year follow‐up

Depression and Anxiety ◽

10.1002/da.22997 ◽

2020 ◽

Vol 37 (4) ◽

pp. 365-374 ◽

Cited By ~ 4

Author(s):

Antoine Yrondi ◽

Bruno Aouizerate ◽

Djamila Bennabi ◽

Raphaëlle Richieri ◽

Thierry D'Amato ◽

...

Keyword(s):

Childhood Maltreatment ◽

Clinical Severity ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Resistant Depression ◽

One Year ◽

French Cohort

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Venous Insufficiency 4 Years after an Episode of Deep Vein Thrombosis: A Clinical and Plethysmographic Investigation

Phlebology The Journal of Venous Disease ◽

10.1177/026835559801300205 ◽

1998 ◽

Vol 13 (2) ◽

pp. 53-58

Author(s):

M. Nordström ◽

B. Lindblad ◽

H. Åkesson ◽

D. Bergqvist ◽

T. Kjellström

Keyword(s):

Deep Vein Thrombosis ◽

Venous Insufficiency ◽

Outcome Measure ◽

Clinical Symptoms ◽

University Hospital ◽

Vein Thrombosis ◽

Venous Function ◽

Deep Vein ◽

Symptoms And Signs

Objective: To evaluate the frequency of venous insufficiency following deep vein thrombosis (DVT). Design: Follow-up 4 years after a verified DVT. Setting: University hospital in Malmö. Patients: Eighty-seven subjects with venographically verified DVT. Main outcome measure: To compare venous function in legs, with and without previous DVT, by venous straingauge plethysmography and its correlation with clinical symptoms and signs. Results: Fifty-two per cent of patients described general discomfort from the thrombotic leg at follow-up. Active leg ulcers were found in three patients (3%); there were no signs of venous insufficiency in 33% at clinical examination. Thirty-seven patients (75%) with ≥ 1 cm difference in calf circumference between the thrombotic and contralateral leg had suffered a proximal DVT. The refilling time T90 was pathological in 67% and the muscle pump function (RV) in 55%. In the nonthrombotic leg the corresponding figures were 53% and 40%. Nevertheless a positive correlation was found between RV of the thrombotic leg and the contralateral leg ( r = 0.33) but an even stronger correlation was found for T90 ( r = 0.74). Conclusion: Venous insufficiency was found in 60% of legs 4 years after DVT but was also found in 14% of legs without previous thrombosis. This may be caused not only by effects of the thrombosis but also by the ageing process.

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P552 Assessing adherence to objective disease monitoring and outcomes with adalimumab in a real-world IBD cohort

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.673 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S519-S519

Author(s):

Y Xiao ◽

A Al Khoury ◽

P Golovics ◽

R Kohen ◽

W Afif ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Symptoms ◽

Fecal Calprotectin ◽

Dose Optimization ◽

Early Assessment ◽

Mayo Score ◽

Objective Monitoring ◽

Kaplan Meier ◽

One Year

Abstract Background Data suggests that tight objective monitoring may improve clinical outcomes in IBD. Methods The aim of this study is to assess the adherence to serial tight objective monitoring(clinical and biomarkers) and its effect on clinical outcomes. We retrospectively reviewed the chart of 428 consecutive IBD patients started on adalimumab between January 1,2015–January 1,2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index, partial Mayo score), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) assessments were captured at treatment initiation and at 3, 6, 9, and 12 months. Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method Results Clinical evaluation was available in nearly all patients at 3(CD-UC:95-94%), 6(90-83%), 9(86-85%) and 12(96-89%) months. CRP was also available in nearly all patients but testing frequency decreased in CD patients over time. Compliance to serial FCAL testing was low. Clinical remission at one-year was higher in patients adherent to early assessment visit at 3 months (p=0.001 for CD and UC). Adherence to early follow-up resulted in earlier dose optimisation in CD and UC patients (pLogrank=0.026 for UC & p=0.09 for CD). Overall drug sustainability did not differ. Conclusion Clinical and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization, improved one-year clinical outcomes but did not change drug sustainability.

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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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Early-Term Outcomes for Treatment of Saphenous Vein Insufficiency with N-Butyl Cyanoacrylate: A Novel, Non-Thermal, and Non-Tumescent Percutaneous Embolization Technique

The Heart Surgery Forum ◽

10.1532/hsf.1496 ◽

2016 ◽

Vol 19 (3) ◽

pp. 118 ◽

Cited By ~ 16

Author(s):

Mustafa Tok ◽

Oktay Tüydeş ◽

Ahmet Yüksel ◽

Sefa Şenol ◽

Serkan Akarsu

Keyword(s):

Saphenous Vein ◽

Clinical Severity ◽

Percutaneous Embolization ◽

Early Term ◽

Technical Success Rate ◽

Venous Clinical Severity Score ◽

Occlusion Rate ◽

Vein Insufficiency

Background: The purpose of this study was to present early-term outcomes of VariClose® Vein Sealing System, which is a novel, non-thermal, and non-tumescent percutaneous embolization technique for treatment of saphenous vein insufficiency. Methods: Between March 2014 and July 2015, 189 saphenous veins in 141 patients were treated with Variclose Vein Sealing System containing n-butyl cyanoacrylate. Pre-, intra-, post-procedural, and follow-up data of patients were collected and retrospectively reviewed. Results: Mean age of patients was 42.5 ± 14.0 years, of which 53% were female. Technical success rate of intervention was 98.9%. Mean procedure time was 14.3 ± 7.5 minutes. Eighty-nine percent of patients (n = 126/141) were available at mean follow-up time of 6.7 months. Mean Venous Clinical Severity Score was significantly improved from 8.3 ± 2.2 at pre-procedure period to 3.3 ± 1.8 at follow-up. No complete recanalization was observed, but 2 patients were presented with partial recanalization during follow-up. The complete occlusion rate was 98.4%. No serious adverse event related to procedure was observed. Conclusion: Variclose Vein Sealing System appears to be safe and effective in treatment of saphenous vein insufficiency. Further randomized studies with long-term outcomes are required for determining optimal treatment modality in patients with saphenous vein insufficiency.

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