Background: The 21st century has witnessed a rise in the use of endovenous thermal ablation. Being highly clinically and cost-effective and improving the quality of life of patients, they are now considered to be the ''gold-standard'' treatment for varicose veins. Postintervention management, especially in terms of postoperative compression; however, remains unclear. As a result, a randomized study was undertaken to investigate the effects of wearing compression stockings after varicose vein treatment. Method: Patients with saphenous vein reflux undergoing treatment with endothermal ablation (with or without concurrent phlebectomies) were randomized to receive either 7 days of compression stockings or no stockings. The primary outcome measure for this study was the pain score over the first 10 postoperative days. The pain scores, clinical score, time to return to normal activities, and ecchymosis were assessed. Patients were followed-up at 2 weeks and 6 months post-ablation. Results: In total, 206 patients were randomized, 49% of them to the compression group. The mean age was 49.7 (AE16) years and approximately 51% of the population was male. The median pain score in the compression group using a visual analog scale was significantly lower on days 2-5, compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores on days 1-3, day 5, and day 7. Improvement in the median venous clinical severity score was noted at 6-month follow-up, but this was not significant. No difference in the generic-or disease-specific quality of life was observed and the time to return to activities was similar. There were no differences in the degree of ecchymosis between the 2 groups and both groups had similar occlusion rates. Conclusions: These results indicate that wearing compression stockings after endothermal ablation is advantageous in the first few days after treatment and is especially beneficial for those having concurrent phlebectomies.
Abstract:Varicose veins are a very common condition and have been the subject of a recent proliferation of treatment modalities. The advent of the endovenous treatment era has led to a confusing array of different techniques which can be daunting when making the transition from traditional surgery. All modalities offer excellent results in the right situation and each has their own treatment profile. Thermal ablation techniques have matured and have a reassuring and reliable outcome, but the arrival of non-thermal techniques has delivered further options for both patient and surgeon. This article provides an overview of the different treatment devices and modalities available to the modern superficial vein surgeon and details the currently available evidence and summation analysis to help surgeons to make an appropriate treatment choice for their patients. Keywords:Endovenous ablation, varicose veins, venous disease, radiofrequency, sclerotherapy, cyanoacrylate Page 1 of 24 http://mc.manuscriptcentral.com/ang Angiology 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 IntroductionVaricose veins are a common condition affecting up to one-third of the population, with detrimental effects on the quality of life (QoL). 1-2Until the past decade, the traditional technique of saphenofemoral or saphenopopliteal ligation with or without vein stripping has been the gold standard treatment of truncal saphenous incompetence. This usually necessitates either general or regional anaesthesia. 3 Although surgery provides good outcomes, it is associated with ecchymosis, hematoma, tenderness, 4 infection, nerve injury, delayed return to normal activity 3-5 and routinely necessitates narcotic analgesia. 3In response to the need for less invasive treatment, endovenous treatments, namely radio-frequency ablation (RFA) and endovenous laser ablation (EVLA) have been developed. These have led to a reduction in morbidity compared with open surgery, 4-6 by reducing postoperative pain, providing faster recovery time, improving QoL and lowering complication rates. 7-8More recently, new non-thermal, non-tumescent (NTNTs) treatments have been developed to overcome the shortcomings associated with thermal ablation. Both thermal and non-thermal treatments are discussed in this review. Thermal-Tumescent Ablative ManagementSince 1999, endovenous thermal ablation, in the form of RFA and EVLA have been developed. More recently, endovenous microwave ablation (EMA) and steam vein sclerosis (SVS) have also been introduced. Their mechanism of action involves using heat to cause thermal damage to the venous wall. Radio-frequency ablation (RFA)The practice of RFA utilizes radio-frequency waves to produce thermal energy (85-120°C) resulting in endothelial damage and sealing of the incompetent vein ( Figure 1). In 1999, the U.S. Food and Drug Administration (FDA) approved RFA for...
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