Minimally invasive techniques in the treatment of saphenous varicose veins

Nijsten, Tamar; Bos, R.R. van den; Goldman, Mitchel P.; Kockaert, Michaël; Proebstle, Thomas M.; Rabe, Eberhard; Sadick, Neil S.; Weiß, Robert; Neumann, Martino

doi:10.1016/j.jaad.2008.07.046

Cited by 81 publications

(67 citation statements)

References 72 publications

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“…Electrodes at the end of the catheter omit high radiofrequency energy, which heats tissue at the site, causing collagen shrinkage, denudation of endothelium (the cells that line the blood vessels) and obliteration of the venous lumen (space inside the vein). 38 This includes techniques such as VNUS Closure, ® VNUS ClosureFast ® (VNUS Medical Technologies, Inc., San Jose, CA) 54 and Olympus RFiTT ® (Olympus Surgical Technologies Europe, Hamburg, Germany). 55 Patients with either GSV or SSV incompetence might receive this intervention.…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Carroll

Hummel²,

Leaviss³

et al. 2013

Health Technology Assessment

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Section: Radiofrequency Ablationmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Carroll

Hummel²,

Leaviss³

et al. 2013

Health Technology Assessment

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“…Recurrence rates after surgery are about 25% and 50% at 5 years for the GSV and SSV, respectively [1] and 20% of all varicose vein operations are for recurrence [4].…”

Section: Introductionmentioning

confidence: 99%

“…Half of the adult population has stigmata of minor venous disease and about 25% of the population has lower extremity varicose veins. More than 25% of people with varicose veins have insufficiency of the truncal veins of the legs [1].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of varicose veins reduces the symptoms and complications of chronic venous insufficiency and improves HRQOL of patients [1].…”

Section: Introductionmentioning

confidence: 99%

“…Failure after surgery may be due to neovascularization, double saphenous vein system, technical and tactical failure (up to 30%), and/or incomplete procedure [1].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

Rass

Frings²,

Glowacki³

et al. 2012

Arch Dermatol

124

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Objective: To compare the clinical efficacy and safety of endovenous laser treatment (EVLT) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) insufficiency. Design: Two-center randomized controlled trial with 2-year follow-up. Setting: Interventions were performed on ambulatory and hospitalized patients at 2 vein centers, a university dermatology department (EVLT-treated group), and a specialized vein clinic (HLS-treated group). Patients: Random sample of 400 patients with GSV insufficiency. Interventions: Patients were assigned (1:1) to EVLT or HLS of the GSV from September 2004 through March 2007; 185 and 161 patients (limbs), respectively, were treated per protocol. Main Outcome Measures: Clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), duplex-detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), hemodynamics (venous refilling time), quality of life (Chronic Venous Insufficiency Questionnaire 2), adverse effects, and visual analog scalebased evaluations of patients' satisfaction. Results: Clinically recurrent varicose veins after surgery were similarly observed in both groups: 16.2% (EVLTtreated group) vs 23.1% (HLS-treated group); P=.15. Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT (17.8% vs 1.3%; PϽ.001). Both treatments equally improved medical condition (Homburg Varicose Vein Severity Score) and diseaserelated quality of life. Endovenous laser treatment caused more adverse effects (phlebitic reaction, tightness, dyspigmentation) but revealed advantages concerning hemodynamics, recovery, and cosmetic outcome. Conclusions: Both EVLT and HLS are comparably safe and effective procedures to treat GSV incompetence. The significantly higher rate and the course of duplexdetected saphenofemoral recurrences after EVLT remain a matter of further investigations.

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Minimally invasive techniques in the treatment of saphenous varicose veins

Cited by 81 publications

References 72 publications

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

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

Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein

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