scholarly journals Foam Sclerotherapy and Laser Ablation of Varicose Veins: Newer Option in Bangladesh Perspective

2018 ◽  
Vol 10 (2) ◽  
pp. 140-144
Author(s):  
Motiur Rahman Sarkar ◽  
Nazmul Hosain ◽  
Fazle Maruf ◽  
MA Quaiyum Chowdhury ◽  
Anisuzzaman ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Adult Population ◽  
Leg Pain ◽  
High Ligation ◽  
Foam Sclerotherapy ◽  
Effective Treatment Option

Background: Varicose vein is one of the most common vascular conditions in the adult population. These are conventionally treated with surgical high ligation of Sapheno-femoral junction and stripping of Great Saphenous Vein (GSV) with multiple phlebectomy. The aim of this study was to highlight the technical considerations in performing endovenous laser ablation of varicose vein, understanding the importance and role of Duplex Machine and Tumescent anesthesia with evaluation of outcome.Methods: In this retrospective study we examined the records of 297 limbs of 220 patients operated at Vascular Care Centre at Dhaka, Bangladesh between October 2013 and October 2015. Among them 1 year follow up was performed in 118 patients. Patients were contacted through telephone calls and mobile SMSs with requests for follow up.Results: Vast majority of the patients had a smooth recovery. Significant pain was present in only 10% of patients for 1week after laser therapy and 3% of patients noted bruising in thigh for 2 weeks. Among the 118 patients who reported for follow up at 12 months, 113 (96%) showed effective persistent occlusion of GSV.Conclusion: EVLA of varicose vein is gaining popularity day by day in Bangladesh. It has become established as a safe and effective treatment option for varicosities caused by GSV incompetence. Foam sclerotherapy with Sodium tetradecyl sulphate replacing the multiple phlebectomy may be a suitable adjunct. Quick return to normal activities, fewer wound infections, less leg pain and leg bruising are strongly associated with these endovenous techniques compared with Saphenous vein stripping.Cardiovasc. j. 2018; 10(2): 140-144

scholarly journals Evaluation of healing of varicose ulcers after endovenous laser ablation of great saphenous vein

2020 ◽  
Vol 7 (6) ◽  
pp. 1707
Author(s):  
Hatem Hussein Mohamed ◽  
Beshoy Magdy Alshahat ◽  
Mamdouh Mohamed Almezaien
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
P Value ◽  
University Hospitals ◽  
Endovenous Laser Ablation ◽  
A Prospective Study

Background: Varicose veins are permanently swollen, tortuous and elongated while standing due to back flow of blood caused by incompetent valve closure which result in venous congestion .they are of two types primary and secondary varicosities .The main symptoms are tingling, itching, pain, fatigue, a heavy feeling in the legs especially if one has to stand for a long time. Ulcers and thrombophlebitis are possible complications. The aim of this study is to assess the outcome of laser ablation of great saphenous vein on healing of varicose ulcers.Methods: A prospective study conducted at Suez Canal University Hospitals and Nasser Institute Hospital in Cairo on 20 patients complaining varicose ulcers due to incompetent saphenous femoral junction.Results: All patients had improvement in Abrdeen Varicose vein questionnaire after endovenous laser ablation (EVLA) during the first, second and third follow up visits when compared with preoperative scores. The Aberdeen Varicose vein questionnaire ranged from 8 to 18 before the procedure, with a mean of 12.11, ranged from 3 to 11 at the first follow up visit with a mean of 7.07, ranged from 2 to 10 at the second follow up visit with a mean of 4.89 and ranged from 2 to 10 at the third follow up visit with a mean of 3.85, p value is less than 0.001 compared to the pre-operative data. During the assessment of the patients of our study after 6 months of continuous follow up, we found that the healing rate of the patients who underwent laser ablation of great saphenous vein were (91.67) (p=0.769).Conclusions: EVLA of great saphenous vein leads to better wound healing rates in treating patients with varicose ulcers.

scholarly journals ClariVein® – Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins

2016 ◽  
Vol 32 (1) ◽  
pp. 6-12 ◽  
Author(s):  
TY Tang ◽  
JW Kam ◽  
ME Gaunt
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Single Centre ◽  
Foam Sclerotherapy ◽  
Early Results ◽  
Endovenous Ablation ◽  
The Uk

Objectives This study assessed the effectiveness and patient experience of the ClariVein® endovenous occlusion catheter for varicose veins from a large single-centre series in the UK. Methods A total of 300 patients (371 legs) underwent ClariVein® treatment for their varicose veins; 184 for great saphenous vein (GSV) incompetence, 62 bilateral GSV, 23 short saphenous vein (SSV), 6 bilateral SSV and 25 combined unilateral great saphenous vein and SSV. Patients were reviewed at an interval of two months post procedure and underwent Duplex ultrasound assessment. Postoperative complications were recorded along with patient satisfaction. Results All 393 procedures were completed successfully under local anaesthetic. Complete occlusion of the treated vein was initially achieved in all the patients, but at eight weeks’ follow-up, there was only partial obliteration in 13/393 (3.3%) veins. These were all successfully treated with ultrasound-guided foam sclerotherapy. Procedures were well tolerated with a mean pain score of 0.8 (0–10). No significant complications were reported. Conclusions ClariVein® can be used to ablate long and short saphenous varicose veins on a walk-in–walk-out basis. Bilateral procedures can be successfully performed, and these are well tolerated as can multiple veins in the same leg. Early results are promising but further evaluation and longer term follow-up are required.

Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials

Phlebologie ◽  
2016 ◽  
Vol 45 (04) ◽  
pp. 201-206 ◽  
Author(s):  
K. Rass
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Term Treatment ◽  
High Ligation ◽  
Control Group ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Treatment Approaches ◽  
Long Term Treatment

SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.

SHORTTERM FOLLOW UP OF EVLA: COMPLICATIONS AND MANAGEMENTS, A SINGLE CENTER EXPERIENCE OF BANGLADESH

2020 ◽  
pp. 10
Author(s):  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Large Population ◽  
Venous Disease ◽  
Ablation Therapy ◽  
Single Center Experience ◽  
Below The Knee ◽  
Pregnancy And Delivery

Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency.” [1] Varicose veins constitute a progressive disease, remission of the disease does not occur, except after pregnancy and delivery. [2] The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. [3]Greek philosopher Hippocrates (460-377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Giovanni Rima (1777-1843) introduced mid thigh ligation of the saphenous vein. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916. [2] The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. The final technologic leap was introduction of the intraluminal stripper by Babcock. [2] In the era of minimally invasive surgery, the first documented case of Endovenous Laser Ablasion was published in 1999 using 810 nm Diode Laser. Since then several wavelengths were introduced; 810, 940, 980, 1064, 1320, 1470 and newly introduced 1940 nm. [4, 5] It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men. [6] During the 1930s to 1960s, several large studies reported the prevalence of varicose veins to roughly average 2% in the general population. [7] However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women. [8] Vein ablation is the most modern treatment option for superficial venous disease. Several endovenous modalities are getting popular for the treatment of varicose vein. Endovenous laser ablation therapy is the first endovenous procedure that had made the revolution in the treatment of varicose vein. [9] In Bangladesh, Laser ablation was first started at another center with 980 nm bare fiber and a good number of cases were done. We introduced ELVeSᴿ Radialᴿ fiber for the first time in the country using biolitecᴿ LEONARDOᴿ Mini 1470 nm during last week of March, 2018.

Endovenous laser ablation of saphenous vein – mid-term results confirm permanent closure and possibility to treat more lesions in one procedure

2020 ◽  
Vol 99 (7) ◽  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Risk Group ◽  
Varicose Veins ◽  
Outpatient Setting ◽  
Control Group ◽  
Endovenous Laser Ablation ◽  
Postoperative Course ◽  
Mid Term Results

Introduction: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. Methods: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. Results: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p<0.001). There was no difference in the incidence of complications. Ultrasonographic follow-up was performed in the risk group. Veins larger in diameter revealed complete disintegration early, but at the end of the follow-up period (mean 33±6 months) they disappeared completely. Conclusion: The study showed good mid-term results of EVLA of the saphenous vein in the outpatient setting and the feasibility of performing multiple ablations in a non-selected group of patients using local anaesthesia. Laser destruction of the vein was shown to be permanent. Perfect familiarity with the diagnostic procedure using ultrasonography and early patient follow-up are required to achieve reproducibility.

Endovenous Laser Ablation of Varicose Veins: Review of Current Technologies and Clinical Outcome

Vascular ◽  
2007 ◽  
Vol 15 (5) ◽  
pp. 250-254 ◽  
Author(s):  
Colleen M. Johnson ◽  
Robert B. McLafferty
Keyword(s):  
Saphenous Vein ◽  
Laser Energy ◽  
Varicose Veins ◽  
Adult Population ◽  
Causative Factor ◽  
Clinical Results ◽  
Effective Treatment Option ◽  
Vein Thrombosis ◽  
Saphenous Nerve Injury ◽  
Deep Vein

Symptomatic lower extremity varicose veins represent one of the most common vascular conditions in the adult population. Associated symptoms ranged from mild conditions such as fatigue, heaviness, and itching to more serious conditions such as skin discoloration and leg ulceration. The predominant causative factor of this condition is reflux of the great saphenous vein (GSV), which is traditionally treated with surgical saphenofemoral ligation and stripping of the incompetent saphenous vein. In recent years, there have been significant advances in saphenous vein ablation using percutaneous techniques, including the endovenous laser therapy (EVLT). In this article, the authors discuss the therapeutic evolution of this technology, theoretical basis of laser energy in GSV ablation, and procedural techniques of EVLT using duplex ultrasonography. Additional discussion of procedural-related complications, such as deep vein thrombosis, skin burn, saphenous nerve injury, and phletibis, and ecchymosis, are provided. Lastly, clinical results of EVLT in GSV ablation are discussed. Current literatures support EVLT as a safe and effective treatment option for varicosities caused by GSV incompetence.

Endovenous Laser Ablation for Incompetent Saphenous Vein Combined With Fluoroscopy-Guided Endovenous Foam Sclerotherapy in Varicose Tributaries: Long-Term Follow-up Results

2016 ◽  
Vol 101 (11-12) ◽  
pp. 590-597
Author(s):  
Song Am Lee ◽  
Sang Woo Park ◽  
Ik Jin Yun ◽  
Jae Joon Hwang ◽  
Jun Seok Kim ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Duplex Ultrasound ◽  
Long Term Results ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Percutaneous Sclerotherapy ◽  
Long Term Follow Up

The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.

Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis

2013 ◽  
Vol 29 (2) ◽  
pp. 109-119 ◽  
Author(s):  
Y Pan ◽  
J Zhao ◽  
J Mei ◽  
M Shao ◽  
J Zhang
Keyword(s):  
Laser Ablation ◽  
Varicose Vein ◽  
Meta Analysis ◽  
High Ligation ◽  
Success Rates ◽  
Technical Success ◽  
Conventional Surgery ◽  
Clinical Recurrence ◽  
Endovenous Laser Ablation

Objectives: To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS). Method: Prospective non-randomized studies and randomized control trials on comparison of EVLA and HLS in treating varicose vein were included in this study. A meta-analysis on the data of suitable 13 clinical trials was performed using the Mantel–Haenszel method and the risk ratio was calculated. Thirteen studies including a total of 2245 limbs were eligible for inclusion. Among them, 1128 limbs were treated with endovenous laser ablation, whereas 1117 were treated with high ligation and stripping. Primary outcome measures were technical success rates and recurrence rates at different follow-up duration and complication rates. Results: No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%). Conclusions: EVLA for varicose veins is safe and effective compared with HLS in a two-year range. More randomized controlled studies follow-up results are needed to clarify longterm recurrence (5 years).

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