Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein

Theivacumar, N.S.; Dellagrammaticas, D.; Beale, R.J.; Mavor, A. I. D.; Gough, Michael

doi:10.1002/bjs.5804

Cited by 53 publications

(53 citation statements)

References 8 publications

(9 reference statements)

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“…This has been observed previously 46 , although some claim that such tributaries are insignificant 47 . It is difficult to suggest how this can be prevented and it seems likely that, alongside neoreflux in the saphenopopliteal junction, perforators and non-axial branches, it represents natural background disease progression.…”

Section: Discussionmentioning

confidence: 62%

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Carradice

Mekako

Mazari

et al. 2011

British Journal of Surgery

107

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Section: Discussionmentioning

confidence: 62%

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Carradice

Mekako

Mazari

et al. 2011

British Journal of Surgery

107

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“…14 In our study, the incidence of subsequent thigh vein perforators that were varicose at 14 months was under 2% and only one of them was present on initial ultrasonography. However, non-refluxing tributaries can remain untreated 14 and can be reassessed if the patient develops further reflux. The majority of recurrences occur within 18 months.…”

Section: Discussionmentioning

confidence: 99%

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Alder

Rahi

2014

annals

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INTRODUCTION Endovenous ablation of saphenous varicose veins has decreased morbidity and recovery time compared with open surgery. This study assessed the outcome and mid-term patient satisfaction of single-visit endovenous laser treatment (EVLT) alone, EVLT combined with phlebectomies and endovenous chemical ablation. METHODS A retrospective review was conducted of all patients (n=91) in 2008-2009 who underwent single-visit day-case EVLT using local anaesthesia under a single surgeon. Postoperative venous ultrasonography at 2 and 14 months was reviewed. A telephone questionnaire was carried out to assess recurrence of symptoms and quality of life at 42 months. RESULTS Overall, 124 limbs underwent day-case EVLT under local anaesthesia using an 810nm diode laser at a continuous setting of 14W. Forty-eight of these underwent EVLT alone while fifty underwent EVLT with phlebectomies and twenty-six underwent EVLT with endovenous chemical ablation. Ninety-one per cent of limbs underwent two-month postoperative imaging. All had satisfactory great saphenous vein (GSV) ablation (anterior thigh vein patency: n=1). The majority (84%) of limbs underwent 14-month imaging with a 98% GSV ablation rate. Three per cent had anterior thigh vein and saphenofemoral junction incompetence. Recurrence of GSV patency and reflux was <1%. The response rate to the questionnaire was 60%: 95% of respondents confirmed improvement following treatment, 62% remained symptom free at 42 months while 65% of patients with a return of symptoms deemed them mild. The questionnaire was scored out of 56 for symptoms and quality of life. Those with symptoms scored significantly higher. CONCLUSIONS At 42 months, the majority of limbs remained asymptomatic. The short-term GSV ablation rates were excellent. Overall mid-term review of patients has shown a well received single-visit service with concomitant phlebectomy or endovenous ablation, and good ablation and patient satisfaction rates.

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“…Early results seem promising with laser or radiofrequency but not with sclerosants, whether liquid or foam. [32][33][34] This study is the largest and most thorough of its kind, and these results at 3 years show that use of a polytetrafluoroethylene patch of suitable size is an effective mechanical suppressant of neovascularization at the SFJ and can be safely used to improve long-term outcome of varicose vein surgery. Use of a polytetrafluoroethylene patch is therefore the only method thus far proven clinically in a large randomized trial to improve neovascular SFJ recurrence as an outcome of varicose vein surgery.…”

Section: Van Rij Et Al Mechanical Inhibition Of Angiogenesismentioning

confidence: 82%

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

et al. 2008

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Background-Saphenofemoral junction (SFJ) ligation has been a major component of surgical intervention for varicose veins; however, recurrence occurs in as many as 40%. Neovascularization with reconnection of the venous channels at the transected SFJ has been identified as the major cause of this recurrence. This randomized controlled study sought to evaluate mechanical suppression of neovascularization at the SFJ, with the use of a synthetic patch, to prevent recurrence after ligation surgery. Methods and Results-A total of 389 limbs (from 292 patients) were randomized into either control (SFJ ligation surgery) or patch (SFJ ligation with polytetrafluoroethylene patch of the transected SFJ) groups. All patients underwent clinical assessment, duplex imaging, and air plethysmography studies preoperatively and at 1, 6, 12, and 36 months postoperatively. The patch consistently halved the recurrence rate to 3 years postoperatively in all clinical subgroups. In those patched SFJs that still developed recurrence, evidence of neovascularization circumventing the polytetrafluoroethylene patch was observed by both ultrasound and histology. Conclusions-This study demonstrates that use of a polytetrafluoroethylene patch is an effective mechanical suppressant of neovasculogenesis at the SFJ and can be safely used as a strategy to improve long-term outcome of varicose vein surgery. (Circulation. 2008;118:66-74.)

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Fate and clinical significance of saphenofemoral junction tributaries following endovenous laser ablation of great saphenous vein

Abstract: Persistent non-refluxing GSV tributaries at the SFJ did not appear to have an adverse impact on clinical outcome 1 year after successful EVLA of the GSV.

Cited by 53 publications

References 8 publications

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins

Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins

Mechanical Inhibition of Angiogenesis at the Saphenofemoral Junction in the Surgical Treatment of Varicose Veins

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