Concept: Dorsal venous arch of the foot
INTRODUCTION:: No randomized clinical trial comparing treatment options for small saphenous vein (SSV) incompetence exists, and there is no clear evidence that this axis behaves the same as the great saphenous vein after treatment. This means that the existing literature base, centered on the treatment of great saphenous vein incompetence cannot simply be extrapolated to inform the management of SSV insufficiency. This trial compares the gold standard of conventional surgery and endovenous laser ablation (EVLA) in the management of SSV incompetence. METHODS:: Patients with unilateral, primary saphenopopliteal junction incompetence and SSV reflux were randomized equally into parallel groups receiving either surgery or EVLA. Patients were assessed at baseline and weeks 1, 6, 12, and 52. Outcomes included successful abolition of axial reflux on duplex, visual analog pain scores, recovery time, complication rates, Venous Clinical Severity Score, and quality of life profiling. RESULTS:: A total of 106 patients were recruited and randomized to surgery (n = 53) or EVLA (n = 53). Abolition of SSV reflux was significantly higher after EVLA (96.2%) than surgery (71.7%) (P < 0.001). Postoperative pain was significantly lower after EVLA (P < 0.05), allowing an earlier return to work and normal function (P < 0.001). Minor sensory disturbance was significantly lower in the EVLA group (7.5%) than in surgery (26.4%) (P = 0.009). Both groups demonstrated similar improvements in Venous Clinical Severity Score and quality of life. CONCLUSION:: EVLA produced the same clinical benefits as conventional surgery but was more effective in addressing the underlying pathophysiology and was associated with less periprocedural morbidity allowing a faster recovery. (Registration number: NCT00841178.).
Cyanoacrylate closure of the great saphenous vein with the VenaSeal™ Closure System is a relatively new modality. Studies have been limited to moderate-sized great saphenous veins and some have mandated postoperative compression stockings. We report the results of a prospective study of cyanoacrylate closure for the treatment of great saphenous vein, small saphenous veins, and/or accessory saphenous veins up to 20 mm in diameter.
We investigated the effectiveness of shear wave elastography (SWE) in patients with lower extremity superficial venous insufficiency (VI). A total of 138 symptomatic patients, 51 asymptomatic volunteers, and a total of 359 lower extremities (257 symptomatic, 102 asymptomatic) were examined. All participants underwent Doppler ultrasound (US) evaluation to determine VI and SWE measurements performed by manually drawing vein wall and perivenous tissue with free region of interest at the great saphenous vein (GSV) and small saphenous vein (SSV). The GSV, SSV diameter, VI, and volume flow of reflux were compared with the SWE values. The SWE values of the symptomatic group for GSV and SSV were significantly higher than those of the asymptomatic control group regardless of whether VI was detected by Doppler US (P < 0.001). There was a statistically significant increase in SWE values for the symptomatic group who were diagnosed as having reflux in GSV and SSV (P < 0.001). A significant positive correlation between increased GSV, SSV diameter, and SWE values was seen (P < 0.001). Venous insufficiency can be diagnosed with a 84.7% sensitivity and 84.2% specificity when 2655 m/s was designated as cutoff value, and with a 85.4% sensitivity and 84.2% specificity when 22,350 kPa was designated as the cutoff value in GSV. Venous insufficiency can be diagnosed with a 84.3% sensitivity and 82.4% specificity when 2845 m/s was designated as cutoff value, and with a 85.7% sensitivity and 84.4% specificity when 27,100 kPa was designated as the cutoff value in SSV. Shear wave elastography may be used effectively in addition to conventional Doppler US examination in diagnosing and following VI.
Clinical correlation of success and acute thrombotic complications of lower extremity endovenous thermal ablation
- Journal of vascular surgery. Venous and lymphatic disorders
- Published almost 2 years ago
Endovenous thermal ablation has become the primary modality of treatment for patients with venous insufficiency. Previous literature has provided reviews of radiofrequency ablation (RFA) or endovenous laser ablation (EVLA) that mostly focus on the great saphenous vein (GSV) and small saphenous vein (SSV). Data with an extended review including the anterior accessory saphenous vein (ASV) and perforator veins (PVs) have been limited. This study examines the treatment of venous insufficiency with RFA and EVLA of these multiple veins to identify clinical and demographic predictors of both the early success and thrombotic complications of endovenous thermal ablation.
The small saphenous vein (SSV) has proved to be a valid graft option for coronary artery bypass grafting (CABG), if other grafts are absent or unsuitable. Beside the described open technique we herein present our approach to endoscopic harvesting in supine position in seven patients. Harvesting was successful in six patients. Mean skin-to-skin time was 29.8 minutes. There were no infections or neurological deficits and the intraoperatively measured graft flow was excellent according to mean flow and low pulsatility index. Therefore, endoscopic harvesting of the SSV extends surgical opportunities not only in CABG, but also in surgery of peripheral artery disease.
The optimal technique to detect venous reflux requires a patient to be standing with weight on one leg while the other leg is scanned for superficial venous reflux (standing position [SP] technique). This represents a significant hardship for a subset of patients who are unable to stand and adequately maintain their balance. This study examines the predictability of identifying venous reflux using a reverse Trendelenburg 60° (RT-60) when compared with the SP in the great saphenous vein (GSV) and small saphenous vein (SSV).
The purpose of this study was to determine the occlusion rate of incompetent great saphenous veins (GSVs) and small saphenous veins (SSVs) treated with radiofrequency ablation (RFA) and individualize variables associated with recanalization.
To achieve good long term results after bypass surgery, in addition to good inflow and outflow arteries, the bypass graft material has an important role. The best patency and limb salvage rates are achieved with autologous vein. If great saphenous vein is not available, acceptable long term results can be achieved with arm veins and lesser saphenous vein. The quality and size of the vein are important. A small-caliber vein, increased wall thickness, postphlebitic changes and varicosities are associated with a risk of early failure. Preoperative vein mapping with ultrasound reduces readmissions and postoperative surgical site infections. During the mapping, the vein to be used and its main tributaries are marked with a permanent marker pen. To reduce wound complication rates we recommend bridged incisions in vein harvesting. Endoscopic vein harvesting seems to have no benefit compared to open techniques in lower limb bypasses, and has been associated with higher risk of primary patency loss at one year. With deep tunneling of the graft the problems caused by wound infection can be avoided.
Clarivein mechanochemical ablation of the great and small saphenous vein: Early treatment outcomes of two hospitals
- Phlebology / Venous Forum of the Royal Society of Medicine
- Published over 4 years ago
Mechanochemical endovenous ablation is a novel technique for the treatment of great saphenous vein and small saphenous vein incompetence which combines mechanical injury of the endothelium with simultaneous infusion of liquid sclerosant. The main objective of this study was to evaluate early occlusion.
This is a prospective trial investigating endovenous radiofrequency ablation with the EVRF® system for the treatment of symptomatic varicose veins. Primary endpoints include one-year anatomical and clinical success and procedure-related complications. Secondary endpoints include adjunctive procedures and recanalization rates, periprocedural pain assessment, and time return to normal activities. In 60 patients with 74 limbs, 58 great saphenous vein, 11 small saphenous vein, 2 anterior accessory saphenous vein, and 3 perforators were ablated. Additional ablations for further improvement were necessary in 28.4%. Clinical success was 94.6%. Anatomical success was 96.0% at one month and 89.2% at one year. Primary ablation success was 77%. Revascularization occurred in 12.1%. Clinically driven repeat ablation rate was 4.0%. Perforator ablation due to segmental revascularization was performed in 5.4%. Complications included one puncture-site infection, three scars, two cases of transient paresthesia, and one skin pigmentation. Periprocedural mean pain score was 2.4 ± 2.6. In 27.0% cases, the patients used analgesics and mean time return was 1.2 ± 0.5 days. The EVRF® system yields satisfactory clinical and anatomical midterm outcomes with very low complication rates.