Long-term Results of Great Saphenous Vein Ligation at the Saphenofemoral Junction and Above the Knee Combined with Trunk Foam Sclerotherapy

Objective This retrospective study presents the long-term results of catheter-directed foam sclerotherapy of the great saphenous vein. Method From January 2003 to June 2017, 277 patients with varices and great saphenous vein incompetence were treated with echo-guided foam sclerotherapy. Forty-six patients were treated with long-catheters guided by foam sclerotherapy. Foaming was carried out with sodium-tetra-decyl-sulphate. Results Results were examined in the two groups: A (long-catheters) and B (other procedures). The median overall follow-up was 52.1 months. In the A-group, the complete occlusion rate was 34/46 pts (73.9%) and partial occlusion was 10/46 (21.7%). In the B-group, respectively, 130/231 (56.2%) and 90/231 (38.9%). Comparisons between groups were statistically significant (p = 0.023; p = 0.021). Failures involved, respectively, 2/46 (4.3%) and 11/231 (4.7%) with no statistical significance. The complication rates were similar in the two groups. Conclusions In this long-term experience (median follow-up exceeding four years), foam-guided sclerotherapy of the great saphenous vein with a long-catheter turned out to be more effective than the usual foam-guided sclerotherapy.

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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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Long-term results after radiofrequency ablation in 1998

Phlebologie ◽

10.12687/phleb2201-4-2014 ◽

2014 ◽

Vol 43 (04) ◽

pp. 197-200

Author(s):

A. Brunner ◽

J. Noppeney ◽

T. Noppeney

Keyword(s):

Radiofrequency Ablation ◽

Clinical Examination ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Lower Leg ◽

Entire Length ◽

Long Term Results ◽

The Mean

Summary Introduction: In 1998, radiofrequency ablation (VNUS Closure Plus™) was authorised in Germany and Europe for the treatment of superficial reflux. We participated in a clinical registry set up by the manufacturing company in 1998. The aim of this retrospective paper was to analyse the long-term results after radiofrequency ablation. Materials, methods and patients: In 1998, we operated on twelve patients (8 women, 4 men). In accordance with the concept of standard vein stripping surgery, all endovenous ablations were combined with crossectomy or ligature of the saphenopopliteal junction. Each vein was thermally ablated over its entire length and no tumescent anaesthesia was performed. The mean age of the twelve patients was 44.9 years. On ten occasions, the entire length of the great saphenous vein was treated, on one occasion the great saphenous vein at the level of the lower leg and on one occasion the entire length of the small saphenous vein. The mean duration of surgery was 80 minutes. Results: The follow-up period was 3 to 168 months, with a mean duration of 80 months. Six patients were followed up for longer than 120 months. In eight cases, the follow-up examination was performed using duplex ultrasound, in two cases using clinical examination and non-invasive testing, in one case using clinical examination and in one case via a telephone interview.The most frequent perioperative complication, occurring in six cases, was hypaesthesia at the medial malleolus or lower leg. There was one case of perioperative thrombophlebitis of a lateral branch in the lower leg and one case of a third-degree thigh burn with subsequent infection of the great saphenous vein canal. No deep vein thrombosis or pulmonary embolism occurred in any of the operated patients.Of the eleven great saphenous veins treated, one recanalised after 14 months, the others had closed or were no longer detectable on ultrasound. The small saphenous vein treated was also no longer detectable.In one patient, a major recurrence at the saphenofemoral junction with recurrent lateral branches in the thigh and lower leg were determined 168 months after surgery. No recurrent varicosis was determined in the other patients.

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Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

Clinical Interventions in Aging ◽

10.2147/cia.s60555 ◽

2014 ◽

pp. 575 ◽

Cited By ~ 1

Author(s):

Sevket Ozkaya ◽

Atilla Sarac ◽

Artan Jahollari ◽

Sureyya Talay ◽

Ertugrul Ozal

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Adult Patients ◽

Long Term Results ◽

External Valvuloplasty ◽

Vein Insufficiency

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Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results

Lasers in Medical Science ◽

10.1007/s10103-013-1389-z ◽

2013 ◽

Vol 29 (2) ◽

pp. 765-771 ◽

Cited By ~ 10

Author(s):

Mohammad Mozafar ◽

Khashayar Atqiaee ◽

Hamidreza Haghighatkhah ◽

Morteza Sanei Taheri ◽

Ali Tabatabaey ◽

...

Keyword(s):

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Long Term Results ◽

High Ligation ◽

Endovenous Laser Ablation

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Outcome four years after transcatheter foam sclerotherapy of the greater saphenous vein

Phlebologie ◽

10.1055/s-0037-1622236 ◽

2008 ◽

Vol 37 (05) ◽

pp. 237-240 ◽

Cited By ~ 3

Author(s):

T. Schulz ◽

M. Jünger ◽

M. Hahn

Keyword(s):

Saphenous Vein ◽

Clinical Symptoms ◽

Clinical Stage ◽

Clinical Signs ◽

Vessel Diameter ◽

Long Term Results ◽

Single Session ◽

Foam Sclerotherapy ◽

Clinical Recurrence

SummaryThe aim of the study was to evaluate the long-term results 4 years after a single-session, sonographically guided, transcatheter foam sclerotherapy. Patients, methods: We treated 20 patients with a total of 22 legs with varicoses of the greater saphenous vein (GSV, EpAsPr). Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. 20 legs or 91% in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm) could be followed up 4 years later. Results: During the follow up period one leg showed clinical signs of recurrence and underwent surgery, two legs received a single additional sclerotherapy during the four years period. Examination four years after showed in 6 legs clinical signs of recurrence without notice of clinical symptoms by the patients. This gives a clinical recurrence rate of 40% (8 of 20 patients). Duplex sonography showed flow in the region of the saphenofemoral junction in a total of 13 legs (65% of the reexamined GSVs) with an average vessel diameter of 3.7 ± 1.6mm (range 2 to 7 mm). Retreatments in 3 GSV of the 6 clinically relapsed GSV by a single injection of sclerosing foam showed an occlusion in 100% two weeks after. Conclusion: Transcatheter foam sclerotherapy of the GSV shows better clinical long-term results compared to known data of liquid sclerotherapy. Sonographically detected recurrency of the GSV could easily be retreated by a single session of foam sclerotherapy. Foam sclerotherapy is a promising and seriously to be taken option in the treatment of the insufficient GSV.

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

International Surgery ◽

10.9738/intsurg-d-15-00285.1 ◽

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.

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External valvuloplasty in the treatment of greater saphenous vein insufficiency: a five-year follow up

Phlebology The Journal of Venous Disease ◽

10.1258/026835503322381342 ◽

2003 ◽

Vol 18 (3) ◽

pp. 137-142 ◽

Cited By ~ 11

Author(s):

B Geier ◽

I Voigt ◽

B Marpe ◽

T Deska ◽

S El-Gammal ◽

...

Keyword(s):

Patient Satisfaction ◽

Recurrence Rate ◽

Saphenous Vein ◽

Long Term Results ◽

The Mean ◽

External Valvuloplasty ◽

Saphenofemoral Junction ◽

Vein Insufficiency

Objective: To present the results of external valvuloplasty of the saphenofemoral junction in selected patients with insufficiency of the greater saphenous vein after a mean follow up of 54 months. Methods: A total of 54 legs were prospectively studied and re-examined a mean of 54 months after the operation. The severity of the patients' symptoms and their satisfaction with the procedure were recorded. Furthermore, the venous refill time, the severity of reflux and the diameter of the greater saphenous vein were recorded preoperatively and again at follow up. Results: In 46 cases (85%) the patients were satisfied with the outcome of the procedure. At follow up, the mean severity of symptoms was significantly lower in every symptom category. The venous refill time was reduced by a mean of 5 seconds and the diameter of the greater saphenous vein was reduced by a mean of 3 mm. Reflux in the saphenofemoral junction despite the valvuloplasty was demonstrated in six legs (11.1%), and reflux in the distal saphenous trunk despite a competent valvuloplasty was seen in 18 cases (33.3%). When reflux was present at the follow-up examination, it affected a significantly shorter segment of the greater saphenous vein than preoperatively. Treatment for recurrent symptoms was necessary in 10 (18.5%) limbs. Conclusions: External valvuloplasty of the saphenofemoral junction offers good results in terms of patient satisfaction, relief of symptoms and recurrence rate. With long-term results still pending, this vein-sparing operation might be an alternative to stripping in selected patients.

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Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review

Vascular ◽

10.1177/1708538116648035 ◽

2016 ◽

Vol 24 (6) ◽

pp. 649-657 ◽

Cited By ~ 12

Author(s):

Renata Balint ◽

Akos Farics ◽

Krisztina Parti ◽

Laszlo Vizsy ◽

Jozsef Batorfi ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Success Rates ◽

Technical Success ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation

Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

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Elimination of saphenous reflux after tributary sclerotherapy: report of two cases

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.200064 ◽

2021 ◽

Vol 20 ◽

Author(s):

Felipe Puricelli Faccini ◽

Claudia Carvalho Sathler-Melo

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Chronic Venous Disease ◽

Long Term Results ◽

Venous Disease ◽

Normal Flow ◽

Venous Reflux ◽

Long Pulse

Abstract Most patients with chronic venous disease (CVD) and reflux in the saphenous vein are treated with saphenous stripping or ablation. The venous hemodynamics approach offers the possibility of treating saphenous reflux without eliminating the saphenous vein. We present 2 cases in which venous reflux was eliminated while preserving the great saphenous vein, after treatment with hemodynamic sclerotherapy using a protocol of synergic use of Dextrose and long pulse Nd YAG 1064 laser. These cases show that treating the tributaries responsible for saphenous reflux can correct hemodynamic imbalances and restore normal flow in the great saphenous vein with improvements in symptoms and esthetics. Long-term results are still uncertain.

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