Background: Endovenous laser treatment of saphenous veins offers patients a procedure with low rates of complications and an early return to occupational activities. Objective: To compare rates of formation of bruising, of paresthesia along the path of the great saphenous vein (GSV), and of GSV obliteration 30 days after thermal ablation in the thigh, performed with or without tumescence and using two different types of fiber. Methods: This was a prospective study, analyzing three groups of patients who underwent GSV thermal ablation in the thigh, using a wavelength of 1470 nm. Patients in group 1 were treated with a conventional fiber using tumescence; those in group 2 were treated with a conventional fiber without using tumescence; and patients in group 3 were treated with a double radial fiber without tumescence. After 30 days, the rates of obliteration shown by Doppler ultrasonography, of paresthesias, and of bruising were compared. Results: Comparison of the results of thermal ablation of 90 GSVs in the thigh revealed similar rates of obliteration, with no statistical differences. The rate of paresthesia along the path of the GSV in the thigh was higher in the groups without tumescence than in the group with tumescence, but the difference only attained statistical significance for the comparison with the group that was treated with the conventional fiber. There was bruising in all groups, with greater frequency in group 1 (73.33%). Conclusions: Tumescence proved useful for preventing minor neurological injuries, but didn't have any influence on the rates of bruising occurrence or of occlusion of the GSV in the thigh up to 30 days after thermal ablation.

BackgroundIn endovenous laser ablation (EVLA), the great saphenous vein (GSV) is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease.ObjectivesTo evaluate clinical and duplex ultrasound (DUS) outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins.MethodsThirty-six patients (59 GSVs) were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS) and a test group (33 GSVs with below-knee reflux). Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS), and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months.ResultsMean patient age was 45 years, and 31 patients were women (86.12%). VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month). However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year).ConclusionsThese data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

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.

Background: Electronic medical record systems may optimize future studies by improving speed, as well as data comparison and analysis. Objective: (a) To create a general database of clinical and surgical vascular diseases and select data from it to create a specific database of chronic lower limb ischemia; b) to store this database in the form of an electronic system; c) to incorporate this database into the Brazilian integrated electronic medical record system (SINPE © ); and (d) to conduct a pilot study to test the system. Methods: A general database of clinical vascular disease was created, and a specific system was developed to record the individual characteristics of the diseases that cause chronic ischemia of lower limbs. When completed, the database was incorporated into SINPE © . Results: For data collection, an authorized user enters patient data and creates a medical record for that patient. After that, chronic ischemia of lower limbs is selected in the master system to access clinical data. Aided by the autofill tool, the user selects only the data for that specific patient. Data may be retrieved for studies, to find out the number of entries that meet the chosen parameters, and to provide statistical information about them. Conclusion: (a) The theoretical database of clinical and surgical vascular diseases and the derived database of chronic lower limb ischemia were created; (b) the theoretical electronic database was created; c) the electronic medical records in both the master and the specific database were incorporated into SINPE © ; (d) the pilot study was successfully created and tested using the parser module of SINPE © .

Background: It is important to acquire technical knowledge about the power and linear endovenous energy density (LEED) settings needed to achieve the ultimate goal of endovenous laser ablation (EVLA). Objectives: To evaluate the influence of different LEEDs in terms of patency and presence of reflux and to determine clinical outcomes. Methods: Sixty great saphenous veins (GSVs) were included. Patients were randomized into 2 groups, low-power EVLA (7 W and LEED of 20-40 J/cm) and high-power EVLA (15 W and LEED of 80-100 J/cm). Patients were followedup with duplex ultrasound and calculation of venous clinical severity score (VCSS) at 3-5 days, 30 days, 180 days, and 1 year after the procedure. Results: 18 patients (29 limbs) treated with 7 W of laser power and 13 patients (23 limbs) treated with 15 W of laser power completed the study. There was no significant difference regarding age, operating time, use of analgesics, laterality, sex, or presence of comorbidities. Mean LEED was 33.54 J/cm in the 7-W group and 88.66 J/cm in the 15-W group. Both groups exhibited improvements in VCSS and significant reductions in SFJ diameters, and there were no significant difference in increase of length of the GSV stump or rates of reflux after treatment. Conclusions: The higher energy density setting was more effective for stabilizing the length of the GSV stump and was associated with a lower incidence of reflux at 6 months. Further studies with a longer follow-up period are required to substantiate this hypothesis.