A Case of Pulmonary Thromboembolism after Endovenous Laser Ablation of Varicose Vein, Presenting Sudden Dyspnea and Presyncope

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

Phlebology The Journal of Venous Disease ◽

10.1177/0268355512473911 ◽

2013 ◽

Vol 29 (2) ◽

pp. 109-119 ◽

Cited By ~ 26

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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Endovenous Laser Ablation and Radiofrequency Ablation versus Conventional Surgery in Treatment of Primary Varicose Vein of the Lower Limb)Prospective Randomized Controlled Study)

QJM ◽

10.1093/qjmed/hcaa050.048 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M M Bahaaeldin ◽

M A H Rady ◽

A M E Dessouki ◽

H I Abdelhamid

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Varicose Vein ◽

Varicose Veins ◽

Current Evidence ◽

Controlled Study ◽

University Hospitals ◽

Conventional Surgery ◽

Endovenous Laser Ablation ◽

Endovenous Ablation

Abstract Background Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) of primary varicose vein are thought to minimize postoperative morbidity and reduce work loss compared with the conventional surgical procedure. Aim of the Work to determine, whether endovenous ablation (radiofrequency and laser) have any advantages or disadvantages in comparison with conventional surgery, in the treatment of primary varicose vein. Patients and Methods this is a prospective randomized study. Thirty Patients presented at Vascular Outpatient Clinic for management of chronic venous insufficiency. All patients underwent clinical examination and duplex ultrasonography. Ten (10) patients were treated with ligation and stripping of the GSV or SSV. Ten (10) patients were treated with Radiofrequency ablation. Ten (10) patients were treated with endovenous laser ablation. The study was conducted at Ain Shams University Hospitals and Helwan University Hospitals. The study took place from September 2017 to June 2018. Results Compared with conventional surgery, endovenous ablation methods reduce postoperative discomfort and pain, with a lower complication rate after treatment for avoidance of a groin incision and dissection at the saphenofemoral confluence. Cosmetic demands are also better satisfied. However, risks of EVLA and RFA remain in terms of recanalization and neoreflux via junctional tributaries. Conclusion RFA and EVLA are minimally invasive procedures. Their potential early benefits, by avoiding groin dissection and GSV stripping, have been confirmed by the findings from this trial. Current evidence based on randomized trials consistently demonstrates significant early benefits after RFA and EVLA in suitable patients with varicose veins.

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