scholarly journals THE RESULTS OF THE APPLICATION OF LOW-INVASIVE METHODS FOR TREATMENT OF VARICOSE DISEASE

2019 ◽  
Vol 85 (4) ◽  
pp. 83-87
Author(s):  
E.G. Cherkasheninov ◽  
A.S. Kalmykova
Keyword(s):  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Laser Coagulation ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Severity Of The Disease ◽  
Light Guides

From 2015 to 2019, we performed surgical treatment of 136 patients for varicose veins of the lower extremities, of whom 74 patients were operated on by endovenous laser coagulation, 62 patients were operated on by radiofrequency ablation. The international classification of chronic venous insufficiency (CEAP) was used to distribute patients according to the severity of the disease. The indication for minimally invasive techniques was the presence of vertical reflux along the major and/or minor saphenous vein in combination with horizontal venous reflux in 95 % of cases. To perform radiofrequency ablation, the VNUS ClosureFast technique was used, and to perform endovasal laser obliteration, the «Lika-Hirurg» apparatus generating a wavelength of 1470 nm and radial (circular) light guides. To assess the results and quality of treatment, all patients underwent examination by a doctor with USDG of the operated lower extremity 1, 6 and 12 months after the treatment. Patients completed the Chronic Venous Insufficiency Questionnaire (CIVIQ 20) before surgery and 6 months after treatment. In all 136 patients, pathological venous reflux was not observed. In 2 patients, 6 months after EVLK, when performing ultrasound control in the trunks of the great saphenous vein, segmental recanalization without pathological reflux was determined. The use of radiofrequency ablation and endovasal laser coagulation of veins in the treatment of varicose veins shows positive results, and in most cases better than in classical surgical interventions, which is primarily due to the low trauma. One of the factors is the short duration of the patient's stay in the clinic and its activation immediately after the operation, which allows maintaining the routine of daily life.

Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency—Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System

2019 ◽  
Vol 34 (8) ◽  
pp. 543-551 ◽  
Author(s):  
Tjun Y Tang ◽  
Harsha P Rathnaweera ◽  
Jia W Kam ◽  
Tze T Chong ◽  
Edward C Choke ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Asian Population ◽  
Closure System ◽  
Cyanoacrylate Glue ◽  
Catheter Technique

Objectives The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required.

scholarly journals Ways to improve outpatient phlebological care with “one day” technology

2021 ◽  
Vol 18 (1) ◽  
pp. 30-39
Author(s):  
A. V. Pelevin ◽  
O. N. Guzhkov ◽  
D. L. Mushnikov
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Health Sector ◽  
Laser Coagulation ◽  
Personalized Approach

Introduction. Chronic venous insufficiency is one of the most common diseases, so finding the best treatment options is one of the most urgent tasks of surgery. One of the methods of implementing this direction is to apply a personalized approach. The aim of the study is to improve surgical care for patients with VVPC by introducing a personalized approach.Materials and methods. The study was based on clinical observations and special studies in 428 patients with uBVNC in outpatient settings. All of those surveyed were women. The average age of the patients was 42.3 ± 15.5 years. All patients were operated on — endovasal laser coagulation (EVLk) was performed in the traditional way. Clinical examination of patients, as well as special methods of research was carried out. A questionnaire was used to assess the quality of life of patients. The peculiarity of the study was the use of social and hygienic methods: survey, psychological testing, expert. Statistical analysis and mathematical processing of results were carried out with the help of modern computer technologies based on the Statisticala 6 application package.Results. It has been established that over the past five years in the Ivanovo region there has been an increase in the incidence of vessels of the lower extremities. The frequency of varicose veins exceeds 47 per 100 patients examined. The desire to perform surgery in the nonstate health sector is observed in 9.8 cases. In 85.0% of patients with VBNC, received for surgical treatment, have a lack of preparedness. Their information, clinical and psychological level is 65.0–89.0% of the due and direct influence on the formation of an unfavorable result.Conclusion. Thus, the implementation of a personalized approach to the surgical treatment of patients with chronic venous insufficiency by laser coagulation provides on a par with the reliable obliteration of altered veins the fastest clinical recovery of patients, improvement of their quality of life, satisfaction with results, good hemodynamic and cosmetic effects.

scholarly journals Clinical, ultrasonographic and histological findings in varicose vein surgery

2018 ◽  
Vol 64 (8) ◽  
pp. 729-735
Author(s):  
Moacir de Mello Porciunculla ◽  
Dafne Braga Diamante Leiderman ◽  
Rodrigo Altenfeder ◽  
Celina Siqueira Barbosa Pereira ◽  
Alexandre Fioranelli ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Clinical Classification ◽  
Histopathological Changes

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.

scholarly journals Implication of the PI3K/Akt/mTOR Pathway in the Process of Incompetent Valves in Patients with Chronic Venous Insufficiency and the Relationship with Aging

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Miguel A. Ortega ◽  
Ángel Asúnsolo ◽  
Javier Leal ◽  
Beatriz Romero ◽  
María J. Alvarez-Rocha ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Young Patients ◽  
Venous Hypertension ◽  
Mtor Pathway ◽  
Venous Reflux ◽  
Vein Wall ◽  
Tissue Samples ◽  
Pathway Expression

Chronic venous insufficiency (CVI) is a multifactorial disease, commonly caused by valvular incompetence (clinically diagnosed by venous reflux) and venous hypertension. The incidence of these factors clearly increases with patient age, and aging is one of the risk factors involved. The activity of the PI3K/Akt/mTOR pathway is considered fundamental in vascular pathologies, and understanding its involvement would help in the development of possible therapeutic targets. This is an observational, analytical, and prospective cohort study that reviewed 110 patients with CVI scheduled to undergo stratified saphenectomy. They were distributed according to the presence (R=81) or absence (NR=29) of valvular incompetence (venous reflux) diagnosed clinically. Each of the groups was further divided according to age, with a cutoff point of 50 years (NR<50=13, NR≥50=16, R<50=32, and R≥50=49). The involvement of the PI3K/Akt/mTOR pathway, as well as that of HIF-1α and HIF-2α and of CD4+, CD8+, and CD19+ cells and mastocytes, was assessed. Saphenous vein tissue samples obtained during surgery were processed for RT-qPCR and immunohistochemistry. Patients with venous reflux showed a significant increase in mRNA and protein expression levels for PI3K/mTOR and HIF-1α/HIF-2α. The number of mast cells was significantly elevated in the R group. In distribution by age, PI3K/Akt/mTOR and HIF-1α were significantly higher in R<50 patients. Furthermore, these patients had a significant increase in the number of CD4+, CD8+, and CD19+ cells and mastocytes in the saphenous vein wall. These findings provide a basis for the possible existence of changes in PI3K/Akt/mTOR pathway expression in young patients, with potential accelerated asynchronous aging that is enhanced by CVI.

scholarly journals QUANTITATIVE EVALUATION OF SYMPTOMS OF CHRONIC VENOUS INSUFFICIENCY AFTER SURGICAL TREATMENT OF ACUTE VARICO-THROMBOPHLEBITISIN THE GREAT SAPHENOUS VEIN BASIN

2021 ◽  
pp. 112-116
Author(s):  
S. S. Filip ◽  
I. I. Hadzheha
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
High Efficiency ◽  
Great Saphenous Vein ◽  
Clinical Score ◽  
Long Term Results ◽  
Results Of Treatment ◽  
Severity Of The Disease

Summary. Objective. Toquantify the symptoms of chronic venous insufficiency after surgical treatment of AVTF in the basin of the great saphenous vein. Materials and methods. The results of treatment of 355 patients with AVTF in the basin of the great saphenous vein were quantified. Of these, 234 (65.9 %) patients underwent surgical treatment of AVTF. Depending on the location and method of treatment, patients were divided into seven groups. Results. The overall clinical score before surgery ranged from (11.71±1.87) to (19.78±5.74) points, and 12 months after surgery it was highest in patients of group VII and amounted to (9.75 ± 2.89)points. Restriction of physical activity before surgery in patients with AVTF ranged from (1.13±0.21) to (2.82±0.38) points, and after 12 months — from (0.43±0.19) to (1.05±0.22) points . Assessing the severity of the disease on three components, the following results were obtained: in patients before surgery, the clinical score ranged from (10.21±2.55) to (20.51±6.43,6) months after it — from (5.27±0.78) to (13.44 ± 3.21), and after 12 months — from (2.59±0.76) to (8.24±2.17) points. Conclusions. The obtained quantitative results of the assessment of symptoms of chronic venous insufficiency convincingly demonstrate the high efficiency and expediency of surgical treatment of AVTF in large subcutaneous vein pools in comparison with isolated conservative treatment, which allows to obtain good early and long-term results in most patients.

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

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.

scholarly journals SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC VENOUS INSUFFICIENCY IN LOWER LIMBS (REVIEW ARTICLE)

2020 ◽  
Vol 20 (4) ◽  
pp. 209-215
Author(s):  
V. І. Liakhovskyi ◽  
R. M. Riabushko ◽  
А. V. Sydorenko
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Integrated Treatment ◽  
Lower Limbs ◽  
Venous Blood Flow ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Cosmetic Effect

Venous diseases of the lower limbs that are accompanied by the development of trophic ulcers are among the medical and social challenges. The vast number of patients is in working age, from 30 to 65 years old. Severe forms of the disease are registered in 27% of the cases; active or healed trophic ulcers are diagnosed in 12.9 % of cases. At present special attention is being paid to the effective surgical treatment of the pathology, to the introduction of the latest surgical interventions, which provide complete radicalism about the causes of trophic ulcers of venous genesis and ensure the maximum cosmetic effect. The aim of this work is to analyze the scientific literature on using the latest surgical techniques in the treatment of venous pathology in patients with trophic ulcers of lower extremities to promote improving the existing and elaborate new surgical interventions in terms of this pathology. Nowadays surgical treatment of patients with chronic venous insufficiency of the lower extremities, especially in case of trophic leg ulcers can be considered as the stage of the integrated treatment of venous trophic disorders. Modern surgical interventions differ in the methods, techniques and tools used, but provide the maximum cosmetic effect and complete radicalism regarding the causes of chronic venous insufficiency. Correction of pathological venous-venous reflux is the main method of eliminating venous hypertension, which underlies the progression of chronic venous insufficiency and promotes the development of trophic disorders, including the ulcers formation. The etiological cause of venous trophic ulcer is the appearance of pathological reflux, which occurs in the superficial, deep and perforating veins and, accordingly, the place of surgery should be those venous segments in which the pathological process is diagnosed. The operation can be performed simultaneously or in two stages: first, the vertical venous-venous reflux is eliminated, followed by the correction of the horizontal reflux. When using modern minimally invasive technologies, adequate and complete correction of venous blood flow in the affected limb is performed simultaneously producing no serious tissue damages to avoid cosmetic effect and to lessen postoperative period. Thus, the analysis of the scientific literatures has shown the unity of views on the strategy of surgical treatment of varicose trophic ulcers that involves the elimination of vertical and horizontal reflux, but the absence of views unity on tactical approaches in solving these issues.

Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation

2009 ◽  
Vol 24 (2) ◽  
pp. 79-81 ◽  
Author(s):  
D Casian ◽  
E Gutsu ◽  
V Culiuc
Keyword(s):  
Surgical Treatment ◽  
Tricuspid Regurgitation ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Venous Leg Ulcer ◽  
Venous Bleeding ◽  
Subfascial Endoscopic Perforator Surgery

A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.

scholarly journals Using radiofrequency ablation for the treatment of lower limb varicose veins

2020 ◽  
Vol 28 ◽  
pp. 82-91
Author(s):  
Nguyen Van Viet Thanh ◽  
Nguyen Hoai Nam
Keyword(s):  
Radiofrequency Ablation ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Lower Extremities ◽  
Endovascular Interventions ◽  
Medication Intervention ◽  
Superficial Venous Insufficiency

Lower limb chronic venous insufficiency is a commonly seen disease which accounted for 40.5% of people over the age of 50 years old with females having 4.25 higher prevalence compared with males [23]. The lesions could be observed in superficial, perforating, deep veins or all three venous systems in the lower extremities [2]. Superficial veins in particular could be classified in 3 groups: chronic venous insufficiency, varicose veins, and thrombophlebitis. The treatment options of lower limb chronic venous insufficiency in general and chronic venous insufficiency – varicose veins are grouped in two major categories: medication/intervention and surgery. Since 1980s-1990s, endovascular interventions for the treatment of superficial venous insufficiency – varicose veins were introduced and were the new advancement in the treatment of lower limb venous insufficiency disorders [3, 7, 11, 12, 16] .

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