Factors Associated With Recurrence of Varicose Veins After Thermal Ablation: 3-Year Results of the REVATA (Recurrent Veins After Thermal Ablation) Study

Bush, Ronald G.; Bush, Peggy; Flanagan, J.J.; Fritz, Russell C.; Gueldner, T.; Koziarski, J.; McMullen, K.; Zumbro, George L.

doi:10.1016/j.jvs.2011.11.007

Cited by 3 publications

(2 citation statements)

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“…We agree with Bush et al [42] that the three most important factors associated with varicose vein recurrence included new or recurrent perforating veins; recanalized GSV and new anterior accessory great saphenous vein (AAGSV) reflux, in decreasing frequency. Technical problems such as difficult access, problems in advancing the catheter or a tortuous GSV may also lead to recurrence.…”

Section: Discussionsupporting

confidence: 91%

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Hammad¹,

Modaber²,

Aliyev³

2017

Vascul Dis Ther

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Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. Endovenous RA of VV has been established as a practical and effective alternative to conventional surgery. Segmental radiofrequency ablation provides high ablation rates in conjunction with a very moderate side effect profile. The advantages of RFA are far greater than its associated risks. There are certain points, which need to be carefully addressed during the RFA technique which was taken into consideration during gaining more experience with more number of cases which allowed to clarify our message from the study to achieve better results and avoid complications. Of most importance is an adequate Duplex scan to identify accessory channels and double superficial systems. Reconfirming the catheter tip position after leg elevation is a must. Blind positioning of the catheter must be avoided, as is the advancement of the catheter into the femoral vein to prevent unnecessary intimal damage. Tumescent anesthesia should be instilled below the saphenous fascia and above the deep muscular fascia surrounding the vein using ultrasound guidance. The purpose of tumescence is threefold; analgesia, protecting skin by displacing the vein away from it and neighboring structures against heat (heat sink effect) to displace heat radiating up to 1.5 mm beyond the vein wall, favoring the contact made between the electrode and a dry "saphenous vein" with inflow tributaries eliminated by compression is also created. The GSV should be compressed to separate it from the inflow tributaries, to maintenance an adequate probe temperature in contact with the vein wall. The avoidance of propagation of steam bubbles (or thrombus) by compression is of extreme importance. Further follow up ad studies is needed to improve the efficiency and decrease the incidence of complications of this well-established technique.

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Section: Discussionsupporting

confidence: 91%

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Hammad¹,

Modaber²,

Aliyev³

2017

Vascul Dis Ther

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“…Additionally, there is mounting evidence to support that the anterior accessory saphenous vein is an important source of recurrence after GSV ablation. 6,7 As such, we believe that a refluxing AASV warrants treatment. This expanded study truly allows for a complete determination of the venous varicosity reflux source allowing for direct source control during therapy.…”

Section: Discussionmentioning

confidence: 81%

Implications of the Expanded Venous Reflux Study

Coleman

Campbell

Shuster

et al. 2013

Journal for Vascular Ultrasound

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Background —Duplex ultrasonography remains the diagnostic modality of choice used to assess for venous reflux. Historically, our institution's practice assessed for deep venous reflux at the level of the common femoral and femoral veins, and the saphenous vein was only imaged at the saphenofemoral junction (SFJ). The American Venous Forum's Varicose Vein Venous Registry attempts to standardize the collection and analysis of clinical information on venous disease. As such, patients are subjected to a more complete study that expands on the superficial venous system. This investigation aims to identify those patients with superficial venous reflux whose diagnosis may have been missed with our previous protocol. Methods —This study reflects a retrospective review of all venous reflux studies performed with the expanded imaging protocol between October 1, 2010 and July 29, 2011, imaging the distal external iliac, common femoral, femoral, popliteal, posterior tibial, peroneal and anterior tibial veins. The great saphenous vein (GSV), small saphenous vein (SSV), anterior and posterior accessory saphenous veins (AASV and PASV), and perforator veins were evaluated for patency and reflux at multiple stations. The incidence and trends of various reflux patterns were examined. Results —A total of 1091 limbs of 593 patients were examined during this 10-month time period. Seventy-five limbs were excluded on the grounds of previous GSV harvest, stripping or ablation, limiting our analysis to 1016 limbs. Sixty-eight limbs (7%) revealed deep venous reflux without associated superficial reflux, 292 limbs (29%) revealed isolated superficial venous reflux, and 461 limbs (45%) revealed combined deep and superficial venous reflux. Of the 753 total limbs with superficial venous reflux, 528 limbs (70%) revealed “classic” reflux at the SFJ and 225 limbs (30%) revealed “accessory” superficial reflux without reflux at the SFJ. Of this “accessory” venous reflux cohort 76 limbs (34%) revealed GSV reflux caudal to the junction, 10 limbs (4%) revealed isolated AASV reflux, 20 limbs (9%) revealed isolated SSV reflux, 2 limbs (1%) revealed isolated PASV reflux, 10 limbs (4%) revealed perforator reflux exclusive of any other identified superficial venous reflux, and 106 limbs (47%) revealed a combination of accessory reflux patterns. Fifty-three of the 225 limbs with “accessory” venous reflux (24%) received surgical intervention in the form of “accessory” venous ablation or ligation, or 5% of the total patient population in this series. Conclusion —In summary, while the expanded venous reflux study requires more time and skill to perform, it reveals a cohort of patients with superficial venous insufficiency that may have previously been missed. Specifically, 225 limbs in our series (22% of the total series and 30% of limbs with superficial venous reflux) demonstrated “accessory” superficial venous reflux patterns without reflux at the SFJ which may have previously gone undiagnosed and thus untreated.

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A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency

et al. 2021

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Objective To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. Methods A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications. Results The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur. Conclusion Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.

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Factors Associated With Recurrence of Varicose Veins After Thermal Ablation: 3-Year Results of the REVATA (Recurrent Veins After Thermal Ablation) Study

Cited by 3 publications

References 0 publications

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Implications of the Expanded Venous Reflux Study

A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency

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