scholarly journals A PROSPECTIVE COMPARATIVE STUDY OF RADIOFREQUENCY ABLATION VERSUS SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY FOR THE TREATMENT OF VARICOSITIES IN VARICOSE VEINS PATIENTS.

2020 ◽  
Vol 4 (12) ◽  
Author(s):  
Rana Parth Harajivandas ◽  
Firdaus A Dekhaiya ◽  
Smit Mehta
Keyword(s):  
Radiofrequency Ablation ◽  
Comparative Study ◽  
Varicose Veins ◽  
Mean Difference ◽  
Clinical Severity ◽  
Surgical Methods ◽  
Venous Clinical Severity Score ◽  
Prospective Comparative Study ◽  
The Mean ◽  
Subfascial Endoscopic Perforator Surgery

Introduction: Dilated & tortuous subcutaneous veins 3mm or more in diameter are known as varicose veins. When perforating veins become incompetent, it causes chronic venous insufficiency. Majority cases are managed conservatively. Cases with significant skin changes and ulcers, requires surgical procedures. Methods: A prospective comparative study of 30 patients of varicosities, divided into two groups, A and B according to CEAP classification were assessed for VCSS preoperatively. They underwent radiofrequency ablation (RFA) and subfascial endoscopic perforator surgery (SEPS) respectively and postoperative VCSS was calculated at follow up at 4 weeks. Collected data was assessed for the change in clinical severity of the disease and compared for the complications of both surgical methods. Results: The mean difference of pre op and post op VCSS in patient treated by RFA is 6.0 and the mean difference of pre op and post op VCSS in patient treated by SEPS is 5.4. Post RFA complications include pain (20%) and ecchymosis (13.3%). Paraesthesia and DVT was not noted. Post SEPS complications include pain (40%), ecchymosis (40%) and paresthesia (13.33%). DVT was not noted post SEPS. Only 1 case (6.66%) treated by SEPS developed recurrence post operatively. Conclusion: RFA and SEPS are two different approaches for varicosities, RFA being truncal therapy and SEPS for perforators, both are almost equally effective in context of postoperative hospital stay and improvement of VCSS; safe in terms of post op complications. Keywords: Radiofrequency ablation (RFA), Subfascial endoscopic perforator surgery (SEPS), venous clinical severity score (VCSS), varicose veins

scholarly journals Efficacy and safety of radiofrequency ablation for lower limb varicose veins

2018 ◽  
Vol 5 (11) ◽  
pp. 3676
Author(s):  
Anushtup De ◽  
Prabal Roy ◽  
Sunil Kumar
Keyword(s):  
Radiofrequency Ablation ◽  
Varicose Veins ◽  
Tertiary Care ◽  
Clinical Severity ◽  
P Value ◽  
Care Hospital ◽  
Vein Thrombosis ◽  
Venous Clinical Severity Score ◽  
The Mean ◽  
A Prospective Study

Background: Endovenous Radiofrequency Ablation (RFA) is gradually gaining widespread acceptance as a minimally invasive modality for treatment of varicose veins (VV). The objective of this study was to evaluate the efficacy based on Venous Doppler and Venous Clinical Severity Score (VCSS) and the safety of radiofrequency ablation for varicose veins.Methods: This is a prospective study of 58 consecutive patients who underwent Radiofrequency ablation of Varicose veins from January 2015 to January 2017 in a single unit of a Multispecialty Tertiary Care Hospital. The mean age was 44.10±13.74 years (19-75 years). A total of 78 limbs were treated in 58 patients. RFA was performed using Closure FastTM catheter according to the manufacturer’s recommendation. Treatment outcomes were estimated 15 days, 3 months, 6 months and 1 year after the procedure using Doppler scan and VCSS score.Results: There was 100% occlusion of the treated veins with no evidence of partial/complete recanalization. However, 2 (2.56%) patients had a GSV stump length > 3cm on Doppler at 6 months, without evidence of significant reflux. Minor complications such as ecchymosis erythema, pain and induration rapidly improved over short term. One patient (1.3%) had evidence of Deep Vein thrombosis (DVT) on follow up Venous Doppler. The mean VCSS improved from mean of 7.98 preoperatively to 2.24 after 1 year (P value <0.001).Conclusions: Radiofrequency ablation is a safe and effective procedure with minimal major complications. The minor complications were early and resolved rapidly.

scholarly journals Evaluation of liquid or foam sclerotherapy in small varicose veins (ceap c1) with venous clinical severity score

2018 ◽  
Vol 64 (12) ◽  
pp. 1117-1121 ◽  
Author(s):  
Mehmet Ali Kaygin ◽  
Umit Halici
Keyword(s):  
Severity Score ◽  
Skin Necrosis ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Foam Sclerotherapy ◽  
Clinical Severity Score ◽  
Severity Scores ◽  
Study Results ◽  
Venous Clinical Severity Score ◽  
The Mean

SUMMARY OBJECTIVE: We aimed to evaluate the efficacy of liquid or foam sclerotherapy of varicose veins using venous clinical severity scores and possible complications. METHODS: A total of 318 patients (268 females, 50 males) who were treated with liquid or foam sclerotherapy between January 2012 and December 2012 were included in this study. RESULTS: Skin necrosis was observed in only 6 patients (1. 8%), thrombophlebitis in 10 patients (3. 1%), and hyperpigmentation in 18 patients (5. 6%) in this study group. The mean venous clinical severity score was calculated as: pain score, 1. 23 ± 0.88; varicose vein score,1.85 ± 0. 8; edema score, 0.64 ± 0.77). Pain and edema decreased at the control examination, 1 month after completion of sclerotherapy sessions. Varicose veins completely disappeared after sclerotherapy. While the decrease in edema in the foam sclerotherapy group was significantly less (P<0.001), the decline in pain showed an increasing trend (P=0.069). While skin necrosis did not develop after foam sclerotherapy, rates of pigmentation and local thrombophlebitis were similar (P>0.05). CONCLUSION: In conclusion, we observed that both sclerotherapy methods are effective with a low rate of complications, alleviating the complaints of patients with small varicose veins, and providing considerable improvement in venous clinical severity scores.

Prospective comparative study evaluating the role of flavonoids after endovenous thermal ablation

2021 ◽  
pp. 026835552110023
Author(s):  
Christos S Karathanos ◽  
Konstantinos Batzalexis ◽  
Petroula Nana ◽  
Konstantinos Spanos ◽  
George Kouvelos ◽  
...  
Keyword(s):  
Comparative Study ◽  
Pain Score ◽  
Thermal Ablation ◽  
Clinical Severity ◽  
Control Group ◽  
Life Questionnaire ◽  
Venous Clinical Severity Score ◽  
Endovenous Thermal Ablation ◽  
Prospective Comparative Study

Objectives The aim of our study was to evaluate the role of flavonoids in the improvement of post-operative symptoms after endovenous thermal ablation (EVTA). Methods A prospective comparative study of 120 consecutive patients undergoing EVTA of the greater saphenous vein associated with phlebectomies was undertaken. Patients were grouped in those receiving micronized purified flavonoid fraction (MPFF- 60 patients) agent 500 mg Bid 7 days pre- and 30 days post- operatively (MPFF group) and those in the control group (60 patients) who did not. Demographics, intra-operative details, Clinical –Etiology- Anatomy- Pathophysiology (CEAP) clinical class, 10-cm Visual Analog Scale (VAS) for pain, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) were recorded. Primary outcome was the postoperative pain assessement using the VAS scale and CIVIQ pain score. Secondary outcomes included assessement of VCSS and CΙVIQ-20 scores. Results There were no significant differences between the groups regarding demographics, clinical and procedural characteristics. Patients in MPFF group reported significantly lower VAS pain levels than control group at 7- (−3.6 ± 1.2 vs −2.7 ± 1.9, p < .0001) and 30- post-operative day (−4.9 ± 0.1 vs −4.2 ± 1, p < .0001). MPFF group also showed better outcome in terms of CIVIQ pain score at 7- (−3.7 ± 1.3 vs −3.5 ± 1.8, p = .008) and 30- post-operative day (−5.3. ± 1.1 vs −4.4 ± 1, p = .017). Both groups showed a significant improvement in VAS pain score (p = .047), global CIVIQ-20 (p = .009) and VCSS (p = .008) at 7- and 30-days post-operatively. Conclusions Administration of flavonoids in patients undergoing EVTA associated with phlebectomies reduces pain by a small amount during early postoperative period.

Correlation between GSV diameter and varicose clinics

Phlebologie ◽  
2016 ◽  
Vol 45 (01) ◽  
pp. 29-35 ◽  
Author(s):  
F. Amsler ◽  
E. Kalodiki ◽  
E. Mendoza
Keyword(s):  
Varicose Veins ◽  
Clinical Severity ◽  
Venous Disease ◽  
Published Data ◽  
Mean Values ◽  
Venous Clinical Severity Score ◽  
The Mean ◽  
Group 2 ◽  
Disease Stratification ◽  
Group 1

Summary Background Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Stratification of venous disease severity is still difficult. This study aims to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS). Methods Legs without GSV reflux (Control legs, Group 1) and legs with untreated isolated GSV reflux and varicose veins limited to the GSV territory (Group 2) were studied clinically and with duplex ultrasound in a prospective study. The GSV diameters were measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to the C of CEAP and VCSS. Results The control legs-group 1 were: n=33, 6 male, mean age 53, mean BMI 26.The legs with reflux-group 2 were: n=78, 16 male, mean age 54, mean BMI 27.The mean diameters for the SFJ ( ± SD) for groups 1 and 2 were 6.4 ± 1.8 and 9.9 ± 3.4. For PT they were 3.6 ± 0.9 and 5.9 ± 1.8 respectively. In legs with reflux the SFJ diameter correlates strongly with the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively. The PT diameter correlates slightly better with the C of CEAP and VCSS than the SFJ diameter (0.55 and 0.57). The mean values of VCSS for groups 1 and 2 were 0.70. and 4.69. The C of CEAP and VCSS show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample. Conclusion The GSV diameters next to the SFJ and particularly at the PT in patients having reflux correlate strongly with both the C of CEAP and VCSS. Recording the GSV diameters at the SFJ and PT in a standardized way may improve comparison of published data and contribute to choice of treatment in the future.

Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities

2016 ◽  
Vol 31 (9) ◽  
pp. 618-624 ◽  
Author(s):  
Andrea T Obi ◽  
Bradley N Reames ◽  
Trent J Rook ◽  
Sandford O Mouch ◽  
Arya Zarinsefat ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Severity Score ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Severity Scores ◽  
Venous Clinical Severity Score ◽  
Operative Complications ◽  
Thrombotic Complications ◽  
Procedure Type

Background Patients with painful varicose veins and venous insufficiency can be treated by eliminating axial reflux only or by eliminating axial reflux plus phlebectomy with transilluminated powered phlebectomy. This study was undertaken with the aim of determining and improving signs and symptoms of venous disease (measured by venous clinical severity score) and complications (by routine surveillance ultrasound and long-term post-operative follow up) for each treatment strategy. Methods We performed a retrospective evaluation of prospectively collected data from 979 limbs undergoing procedures for significant varicose veins and venous insufficiency from March 2008 until June 2014 performed at a single tertiary referral hospital. Patient demographics, Clinical Etiology Anatomy and Pathophysiology classification, venous clinical severity scores pre- and post-procedure, treatment chosen, and peri-operative complications were collected; descriptive statistics were calculated and unadjusted surgical outcomes for patients stratified by the procedure performed. Multivariable logistic regression was used to evaluate the relationship between procedure type and thrombotic complications after adjusting for patient characteristics, severity of disease, pre-operative anticoagulation, and post-operative compression. Result Venous clinical severity scores improved more with radiofrequency ablation + transilluminated powered phlebectomy as compared to radiofrequency ablation alone (3.8 ± 3.4 vs. 3.2 ± 3.1, p = 0.018). Regarding deep venous thrombosis, there was no significant difference between radiofrequency ablation + transilluminated powered phlebectomy vs. radiofrequency ablation alone. There was no statistical difference in asymptomatic endovenous heat-induced thrombosis or infection, although there were slightly more hematomas and cases of asymptomatic superficial thrombophlebitis with combined therapy. On multivariable analysis, only procedure type predicted thrombotic complications. Conclusion Ablation of axial reflux plus transilluminated powered phlebectomy produces improved outcomes as measured by venous clinical severity score, with slight increases in minor post-operative complications and should be strongly considered as initial therapy when patients present with significant symptomatic varicose veins and superficial venous insufficiency. Implementation of a standardized thromboprophylaxis protocol with individual risk assessment results in few significant thrombotic complications amongst high-risk patients, thus potentially obviating the need for routine post-operative duplex.

scholarly journals Endovenous laser ablation for great saphenous varicose veins

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. 

Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan

2018 ◽  
Vol 33 (10) ◽  
pp. 678-686 ◽  
Author(s):  
Hitoshi Kusagawa ◽  
Naoki Haruta ◽  
Ryo Shinhara ◽  
Yuji Hoshino ◽  
Atsushi Tabuchi ◽  
...  
Keyword(s):  
Ulcer Healing ◽  
Healing Rate ◽  
Clinical Results ◽  
Clinical Severity ◽  
Ulcer Recurrence ◽  
Surgical Methods ◽  
Venous Clinical Severity Score ◽  
Ulcer Healing Rate ◽  
Subfascial Endoscopic Perforator Surgery

Objectives To clarify the surgical methods and the clinical results of subfascial endoscopic perforator surgery in Japan. Methods This study included 1287 limbs of 1091 patients who underwent subfascial endoscopic perforator surgery in 14 hospitals. Simultaneous saphenous vein treatment was performed in 1079 limbs (83.8%), and 118 limbs (9.2%) had deep venous lesions. The venous clinical severity score was calculated before and 6 to 12 months after surgery. The ulcer healing rate and ulcer recurrence rate were calculated cumulatively. Results Preoperative venous clinical severity score was significantly decreased from 10.0 ± 6.6 to 3.1 ± 3.4 ( P < .0001) postoperatively. The primary ulcer healing rate was 96.2% (332/345 C6 limbs) at an average follow-up of 47.7 months, and the ulcer recurrence rate was 12.0% (49/393 C5, C6 limbs) at the average follow-up of 46.0 months after the ulcer healed. Conclusion These results indicate that subfascial endoscopic perforator surgery is an alternative to improve the long-lasting disease severity and/or clinical outcome.

Comparison of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up

Vascular ◽  
2021 ◽  
pp. 170853812110113
Author(s):  
Yusuf Kuserli ◽  
Ali Aycan Kavala ◽  
Saygin Turkyilmaz
Keyword(s):  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Severity Score ◽  
Great Saphenous Vein ◽  
Clinical Severity ◽  
Venous Ulcers ◽  
Vein Occlusion ◽  
Clinical Severity Score ◽  
Venous Clinical Severity Score ◽  
Subfascial Endoscopic Perforator Surgery

Objective To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers. Methods One hundred ninety-five ( n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) ( n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded. Results For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group ( p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group ( p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years ( p = 0.011). No significant difference was found between groups for the five-year recovery rates ( p > 0.05). Conclusion Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.

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