Endovenous Management of Varicose Veins

Abstract

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...

A randomised controlled trial of neuromuscular stimulation in non-operative venous disease improves clinical and symptomatic status

“…24,30,31 The Society for Vascular Surgery (SVS) and the National Institute for Health and Care Excellence (NICE) recommend endovenous ablation for the treatment of SVI 32,33 and endovenous ablation and surgical ablation have success rates of greater than 90%. [32][33][34][35] The management of DVI and DVO involves preventing disease progression by reducing ambulatory venous pressure, preventing recurrent thromboembolism using antithrombotic agents or flavonoids, with surgical or endovascular options in severe cases. 6,36 Interventions for deep venous disease have promising but mixed results.…”

Effectiveness of tumescent solution combined with negative pressure wound therapy in traditional high ligation and stripping of the great saphenous vein

“…[ 1 ] Despite the recent emergence of laser, radio-frequency, foam sclerotherapy, and other novel therapeutic modalities, THLS is still the dominant option to treat varicose veins of the lower extremities. [ 2 – 4 ] However, subcutaneous ecchymosis and pain discomfort may occur in the thighs of some patients after THLS. Although subcutaneous ecchymosis can be absorbed and recovered by itself and pain can be treated with drugs, these 2 postoperative complications still exert certain side effect on patients after operation.…”

Endovenöse Radiofrequenzablation

“…Die segmentale lokale Energieabgabe mit nachfolgender Kontraktion und Denaturierung der Venenwand resultiert in einer dauerhaften Obliteration des behandelten Gefäßabschnitts. Aufgrund der Möglichkeit der Durchführung im ambulanten Setting und in Lokalanästhesie zeigt die seit 1998 zugelassene Radiofrequenzablation eine hohe Patientenakzeptanz und -zufriedenheit [3][4][5]. Vor allem bei Stammveneninsuffizienzen (V. saphena magna/parva), aber auch bei Insuffizienz der akzessorischen Venen (z.…”