The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux

Gloviczki, Péter; Lawrence, Peter F.; Wasan, Suman M.; Meissner, Mark H.; Almeida, José I.; Brown, Kellie R.; Bush, Ruth L.; Iorio, Michael Di; Fish, John; Fukaya, Eri; Gloviczki, Monika L.; Hingorani, Anil; Jayaraj, Arjun; Kolluri, Raghu; Murad, M. Hassan; Andrea, T.; Ozsvath, Kathleen J.; Singh, Michael J.; Vayuvegula, Satish; Welch, Harold J.

doi:10.1016/j.jvsv.2022.09.004

Cited by 61 publications

(57 citation statements)

References 205 publications

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“…Additionally, the patients which required phlebectomies presented venous reflux on collateral or perforating branches with apparently healthy saphenous veins, a fact that can be associated with milder symptoms. Our results are in accordance with data from the literature, supporting the idea that percutaneous phlebectomies should be considered the method of choice for side branch varicose vein removal; however, recurrences of varicose veins are frequent [ 19 , 31 ]. The main advantages of phlebectomies compared to the other classic procedures (HL&S or cryostripping) are the fact that they can be performed in an outpatient setting without the need for hospitalization [ 32 , 33 ].…”

Section: Discussionsupporting

confidence: 90%

Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment—A Comparison between Different Open Surgical Procedures

Matei

Dumitru

Radu

2022

JCM

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Chronic venous disease (CVD) is a common pathology that significantly affects the quality of life (QoL) of patients. Methods: QoL was assessed in 317 patients diagnosed with CVD who underwent surgeries, including cryostripping (n = 113), high ligation and stripping (HL&S, n = 96), and phlebectomies (n = 108). CVD symptoms and QoL were assessed before surgery and 2 weeks after surgery using the following questionnaires: CIVIQ-20, VAS, Eq-5D, PHQ-9 and GAD-9. Results. The results reveal a significant correlation (p < 0.05) between CEAP score and QoL questionnaires performed preoperatively and postoperatively in all three surgical technique groups, with a statistical improvement postoperatively. Phlebectomy had the best postoperative QoL score (r = 0.495) compared to the other two types of procedures. Conclusions: Analyzing patients’ subjective perception following conventional surgery for CVD treatment, an improved QoL is observed both in functional and psychosocial aspects, even early postoperatively. Classical surgical procedures remain an effective and feasible option in CVD treatment.

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Section: Discussionsupporting

confidence: 90%

Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment—A Comparison between Different Open Surgical Procedures

Matei

Dumitru

Radu

2022

JCM

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“…18 It is important to note that the latest guidelines from the Society for Vascular Surgery on the management of varicose veins in the lower extremities state that aneurysmal dilations of the great saphenous vein near the SFJ, and the subcutaneous location of a superficial truncal vein above the small saphenous vein, are relative anatomic contraindications for specific endovenous procedures. 26…”

Section: Discussionmentioning

confidence: 99%

Saphenous vein aneurysms characterization and treatment: A 36-year single center experience

et al. 2023

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Background Superficial vein aneurysms (SVA) are rare vascular pathologies associated with trauma, chronic venous disease, and venous malformation. Method We retrospectively reviewed cases of SVA treated from 1986 to 2022. Results Out of 2463 venous procedures, 16 patients were found with 19 GSV and 1 SSV aneurysms, with 88% presenting with a palpable mass. Varicose veins were noted in 94% of patients, 81% had concomitant reflux, 15% had thrombus within the aneurysm sac, and 19% demonstrated multiple aneurysms. All patients underwent ligation and excision. Post-procedure, 55% of patients received anticoagulants, and 85% received compression. Mean follow-up was 19.4 months, with no aneurysm recurrence. We propose a modification to the current SVA classification. Conclusion The prevalence of multiple aneurysms suggests the need for complete limb imaging in affected patients. Surgical management of SVA was effective in preventing SVA recurrence, while the proposed classification modification will aid in future SVA management.

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“…After EVLA but in the same operating room (OR) session, UGFS of VVs was carried out, according to guidelines recommendations published over the study period [1][2][3]6 using the Tessari method. Sclerosing agent (Polidocanol or Sodium Tetradecyl Sulphate [TDS]) has been used as follows:…”

Section: Methodsmentioning

confidence: 99%

“…The CDUS exam was done according to European Society of Vascular Surgery guidelines recommendation published during the study period. 2 In particular, average saphenous trunk diameter (resulting from three measurement along the thigh in case of GSV or along the leg in case of SSV) was evaluated to adapt the linear endovenous energy density (LEED) needs to EVLA maximum efficacy. 7 Average VVs diameters were also detected for adjusting UGFS percentage and amount.…”

Section: Methodsmentioning

confidence: 99%

“…1 EVLA mini-invasiveness, along with similar to better outcomes than surgery, are some of the main advantages in choosing this treatment for patients with saphenous vein disease, form CEAP class C2 to C6. 2,3 In particular, for patients experiencing more advanced disease (chronic venous insufficiency, CVI), including oedema (C3), skin changes (C4) and/or venous ulcers (C5-6), the treatments should be less invasive as possible. Indeed, skin incisions for saphenous and/or varicose veins (VVs) removal/stripping could heal later and complicate/aggravate the disease in such patients.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6)

Baraldi

Bissacco

2023

Vasc Endovascular Surg

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Background endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a “no-scalpel” procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. Methods all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions. Results 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively. Conclusions EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.

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The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux

Cited by 61 publications

References 205 publications

Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment—A Comparison between Different Open Surgical Procedures

Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment—A Comparison between Different Open Surgical Procedures

Saphenous vein aneurysms characterization and treatment: A 36-year single center experience

Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6)

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