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.

Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up

2020 ◽  
pp. 026835552093974
Author(s):  
Boutros Karam ◽  
Moustafa Moussally ◽  
Hussein Nassar ◽  
Karim Ataya ◽  
Rola Jaafar ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Clinical Severity ◽  
Long Term Results ◽  
Endovenous Laser Ablation ◽  
Saphenous Veins ◽  
Venous Clinical Severity Score ◽  
Vein Reflux

Introduction Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. Methods This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. Results Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. Conclusion EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

Is catheter-directed foam sclerotherapy more effective than the usual foam sclerotherapy for treatment of the great saphenous vein?

2018 ◽  
Vol 33 (9) ◽  
pp. 646-652 ◽  
Author(s):  
Orsini Camillo
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Statistical Significance ◽  
Long Term Results ◽  
Complication Rates ◽  
Foam Sclerotherapy ◽  
Occlusion Rate ◽  
Long Term Experience

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.

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.

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

2013 ◽  
Vol 29 (2) ◽  
pp. 765-771 ◽  
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

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

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 649-657 ◽  
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.

Endovenous laser ablation of the great saphenous vein – Varying energy may not affect outcome

2016 ◽  
Vol 32 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Carlos S Nejm ◽  
Jorge RR Timi ◽  
Walter Boim de Araújo ◽  
Filipe C Caron
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Endovenous Laser Ablation ◽  
Vein Occlusion ◽  
Saphenous Veins ◽  
Occlusion Rate

Objectives To determine great saphenous vein occlusion rate after endovenous laser ablation using the 1470-nm bare-fiber diode laser to supply either 7 W or 15 W and evaluate procedure-related complications. Method Patients with varicose veins of the lower extremities (CEAP class C2–C6) were randomly assigned to undergo either 7-W (18 patients, 30 limbs) or 15-W (18 patients, 30 limbs) endovenous laser ablation. Duplex ultrasound follow-up was at 3–5 days, 1, 6, and 12 months postoperatively. Results Occlusion rate was 100% in both groups at 3–5 days and 1 month and 86.7% in 7-W and 100% in 15-W patients at both 6 and 12 months, with no difference between groups ( p > 0.05). Four (13.3%) 15-W and 3 (10%) 7-W patients had paresthesia at 3–5 days, with no difference between groups ( p > 0.05). Conclusions These preliminary data suggest that both techniques are similarly effective in the treatment of varicose great saphenous veins.

Detection of varicose vein recurrence by duplex ultrasound: intra- and interobserver reproducibility

2013 ◽  
Vol 28 (2) ◽  
pp. 109-111
Author(s):  
S A Gauw ◽  
P Pronk ◽  
M C Mooij ◽  
M T W Gaastra ◽  
J A Lawson ◽  
...  
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Interobserver Reproducibility ◽  
Endovenous Laser Ablation ◽  
Follow Up Study ◽  
Kappa Test ◽  
Long Term Follow Up

In a long-term follow-up study comparing saphenofemoral ligation and stripping with endovenous laser ablation, the groin is examined yearly by duplex ultrasound (DUS) to detect postoperative varicose vein recurrence. Clear criteria are needed for the uniformity of DUS observations. Physicians taking care of the follow-up were evaluated by an intra- and interobserver analysis. DUS films of 22 patients with no recurrence and 22 patients with recurrence of varicose veins were twice interpreted in two sessions. Observations were analysed by a kappa test. Interpretations of DUS by experienced observers show a kappa >7. Improved kappa results were measured over time in our physician in training. In conclusion, the reproducibility of DUS studies performed by the experienced observers of the study is excellent.

scholarly journals Endovascular Treatment of Anterior Circulation Aneurysms With the p64 Flow Modulation Device: Mid- and Long-Term Results in 617 Aneurysms From a Single Center

2021 ◽  
Author(s):  
Marta Aguilar Pérez ◽  
Elina Henkes ◽  
Victoria Hellstern ◽  
Carmen Serna Candel ◽  
Christina Wendl ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
High Rate ◽  
Long Term Results ◽  
Effective Treatment Option ◽  
Anterior Circulation ◽  
Acute Hemorrhage ◽  
Unruptured Aneurysms ◽  
Long Term Follow Up

Abstract BACKGROUND Flow diverters have become an important tool in the treatment of intracranial aneurysms, especially when dealing with difficult-to-treat or complex aneurysms. The p64 is the only fully resheathable and mechanically detachable flow diverter available for clinical use. OBJECTIVE To evaluate the safety and effectiveness of p64 for the treatment of intracranial saccular unruptured aneurysms arising from the anterior circulation over a long-term follow-up period. METHODS We retrospectively reviewed our prospectively maintained database to identify all patients who underwent treatment for an intracranial saccular (unruptured or beyond the acute hemorrhage phase) aneurysm arising from the anterior circulation with ≥1 p64 between December 2011 and December 2019. Fusiform aneurysms and dissections were excluded. Aneurysms with prior or concomitant saccular treatment (eg, coiling and clipping) were included. Aneurysms with parent vessel implants other than p64 were excluded. Anatomic features, intraprocedural complications, clinical outcome, as well as clinical and angiographic follow-ups were all recorded. RESULTS In total, 530 patients (388 females; median age 55.9 yr) with 617 intracranial aneurysms met the inclusion criteria. The average number of devices used per aneurysm was 1.1 (range 1-3). Mean aneurysm dome size was 4.8 mm (range 1-27 mm). Treatment-related morbimortality was 2.4%. Early, mid-term, and long-term angiographic follow-up showed complete or near-complete aneurysm occlusion in 76.8%, 89.7%, and 94.5%, respectively. CONCLUSION Treatment of intracranial saccular unruptured aneurysms of the anterior circulation using p64 is a safe and effective treatment option with high rate of occlusion at long-term follow-up and low morbimortality.

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