Showing papers in "Phlebology in 2009"
TL;DR: EVLA of GSV and SSV with a 1470 nm diode laser is a minimally invasive, safe and efficient therapy option with a high success rate one year after treatment, however, with LEED > 100 J/cm in this study, the incidence of paresthesia rose significantly.
Abstract: Introduction: Most of the published EVLA data concern 810, 940, 980 nm diode lasers and 1064 or 1320 nm Nd:Yag laser systems. Major side effects are postoperative pain and bruising. The aim of this study was to show the outcome one year after EVLA of incompetent saphenous veins with a 1470 nm Diode laser (Ceralas E, biolitec). Patients and method: Between December 2006 and February 2007, 134 saphenous veins (108 GSV, 26 SSV) in 117 legs of 100 consecutive patients where treated by EVLA for GSV and SSV incompetence. All patients were examined clinically and with duplex by an experienced phlebologist prior to intervention, and at the follow-up visits for complications, occlusion, flow and reflux in the treated vein segment. The clinical evaluation included clinical CEAP and the presence of recurrent varicose veins. Patient satisfaction was assessed by a 0 to 4 scale. Results: After a mean follow-up period of 184 days (SD 27) 127 treated veins (102 GSV, 25 SSV) of 111 limbs in 94 patients and after 329 days (SD 14) 105 treated veins (94 GSV, 21 SSV) of 105 limbs in 83 patients were reinvestigated. Six patients were lost to follow up after six months and an additional 11 patients after one year. Up to one year follow-up all treated veins remained occluded. At six months, one new insufficient anterior accessory saphenous vein (AASV) and after 12 months, three new insufficient AASV occurred. After one year 45 patients were very satisfied with the method, 34 were satisfied, three were fairly and one was not satisfied. The mean of all answers was 0.5 (SD 0.5). In three cases phlebitic reactions after 10 days, but no severe complications such as deep vein thrombosis occured. After six months in 9.5% of the legs paresthesia was present in the treated area which reduced to 7.6% after one year. Intake of painkillers was mean 6.7 tablets (SD 3.5). When we compared GSV legs treated with LEED below or above 100 J/cm, the paresthesia rate was significantly lower in the first group with 2.3% compared to 15.5 % in the higher LEED group. The differences for number of days with analgesic intake and for the paraesthetic area were significant. Discussion: In this prospective follow-up study with 100 consecutive patients and 134 treated saphenous veins a high occlusion rate of 100% could be demonstrated one year after treatment. However, with LEED . 100 J/cm in this study, the incidence of paresthesia rose significantly. Therefore it seems adequate to stay below 100 J/cm in the future as the occlusion rate was the same below and above 100 J/cm.
142 citations
TL;DR: This study demonstrates in a large sample of patients a low rate of adverse reactions after FS of great and small saphenous trunks, however, but the eventuality of exceptional but more serious complications has to be taken into account in the management of patients.
Abstract: Objectives: Increasing interest in foam sclerotherapy (FS) for saphenous insufficiency has highlighted the need to study the side-effects and complications of this treatment. The aim of this study is to better assess their nature and incidence. Methods: A multicentre, prospective and controlled study was carried out in which patients treated with FS for great (GSV) and small saphenous veins (SSV) trunk incompetence were included. Immediate untoward events were reported. Duplex ultrasound (DUS) examination was carried out to assess all patients between the eighth and 30th day. In addition, 20% of patients were called by an external auditor. Results: In total, 818 GSVand 207 SSV were treated in 1025 patients in 20 phlebology clinics. Ninety-nine percent of patients were controlled with DUS and non-duplex-checked patients were all called. The saphenous trunk was occluded in 90.3% of patients. Twenty-seven (2.6%) side-effects were reported: migraine (n ¼ 8, 4 with visual disturbance); visual disturbance alone (n ¼ 7); chest pressure alone (n ¼ 7); and chest pressure associated with visual disturbance (n ¼ 5). Eleven thrombo-embolic events occurred: 10 deep vein thrombosis (DVT) but only five in symptomatic patients, and one pulmonary embolism that occurred 19 days following the FS without DVT identified by DUS. One transient ischaemic stroke, with complete clinical recovery in 30 minutes, and one septicaemia with satisfactory outcome were reported as well. Conclusion: Thisstudydemonstratesinalargesampleofpatientsalowrateofadversereactions after FS of great and small saphenous trunks. However, but the eventuality of exceptional but more serious complications has to be taken into account in the management of patients. A multicentre study like this one takes into account different practices and reports all possible complications, thus demonstrating the need for a common validated protocol.
136 citations
TL;DR: SF formation is greatly influenced by the choice of the gas component, the liquid-to-gas ratio, the type of syringes, while long catheters seem to represent a valid alternative especially when combined with tumescence to minimise saphenous diameter.
Abstract: Introduction: Foam sclerotherapy has gained a great popularity among phlebologists worldwide, although a major lack of homogeneity in the material used to produce sclerosant foam (SF) and to inject SF has been reported. Aims: To highlight the literature data and a few personal clinical and experimental outcomes concerning the main variables in SF production and injection. Methods: A review of the published literature and of our own 12 year clinical and experimental experience has been undertaken in order to focus on a few variables of the material and methods used to produce SF with Tessari method and to inject SF. Results: In SF production, differences in gas components, liquid to gas ratio, as well in disposable material can variably influence the resulting SF. Similarly SF injection through ultrasound guidance, with needle, or with short/long catheter may exhibit different foam behaviours according to the variable material and techniques which are employed. More recently the introduction of long catheters, possibly together with hook phlebectomy, seems to potentiate the short-mid term outcomes of foam sclerotherapy. Conclusion: SF formation is greatly influenced by the choice of the gas component, the liquidto-gas ratio, the type of syringes; also larger needles are to be preferred for injection of SF, while long catheters seem to represent a valid alternative especially when combined with tumescence to minimise saphenous diameter.
105 citations
TL;DR: The evidence for the benefit of compression hosiery for varicose veins was equivocal and the published literature was often contradictory and had methodological flaws.
Abstract: Objective: Compression hosiery is widely used in the prevention and management of symptoms related to varicose veins. However, there are still gaps and questions in relation to its benefit. This review seeks to examine the current evidence regarding the effectiveness of compression hosiery in the treatment of varicose veins. Method: Prospective, randomized controlled trials (RCTs) evaluating compression hosiery in the treatment of varicose veins were sought. Where RCTs were unavailable other evidence was included. Studies were included if they evaluated the application of compression to patients with a diagnosis of varicose veins. Twelve electronic bibliographic databases and 18 internet-based research resources were searched. Inclusion or exclusion of trials was decided by two reviewers acting independently. Results: The search strategy identified 25 studies. Eleven were RCTs or systematic reviews, 12 non-randomized studies and two guidelines. No consensus was found regarding the class of compression needed for the effective management of varicose veins. Wearing compression improved symptom management, but could be confounded by the exclusion of high number of non-compliant patients within the trials. Wearing compression to slow the progression, or prevent the reoccurrence of varicose veins could not be supported by the current published evidence. Conclusion: The evidence for the benefit of compression hosiery for varicose veins was equivocal. The published literature was often contradictory and had methodological flaws.
99 citations
TL;DR: To review published evidence concerning treatment of varicose veins using ultrasound-guided foam sclerotherapy to assess the safety and efficacy of this treatment, UGFS is reviewed.
Abstract: ObjectivesTo review published evidence concerning treatment of varicose veins using ultrasound-guided foam sclerotherapy (UGFS) to assess the safety and efficacy of this treatment.MethodsMedical li...
90 citations
TL;DR: Non-randomized series suggest that laser energy of >60 J/cm results in reliable truncal vein occlusion and that longer wavelength lasers may be associated with less post-treatment discomfort.
Abstract: ObjectiveEndovenous laser ablation (EVLA) of incompetent truncal veins has been proposed as a minimally invasive alternative to conventional surgery for varicose veins. Various strategies have been proposed for successful treatment and this study reviews the evidence for these.MethodA Medline and ‘controlled trials online database’ search was performed to identify original articles and randomized controlled trials (RCTs) reporting outcomes for EVLA. Information on patient selection, equipment, technique and outcomes were recorded.ResultsNinety-eight original studies, including five RCTs, were identified. RCT data indicate short-term outcomes (abolition of reflux, improvement in quality of life [QOL], patient satisfaction) were equivalent to those for surgery. Long-term follow-up is not available. A further RCT showed superior outcomes for ablation commencing at the lowest point of superficial venous reflux rather than at an arbitrary point (fewer residual varicosities, greater improvement in QOL).Non-rand...
69 citations
TL;DR: UGFS is a safe and effective method of treating varicose veins and the relative advantages or disadvantages of this treatment in the longer term are yet to be published.
Abstract: Objective: The objective of this study is to review the methods and outcome of ultrasoundguided foam sclerotherapy (UGFS) for the treatment of superficial venous incompetence. Method: Medical literature databases including Medline were searched for recent literature concerning UGFS. Papers describing methods and outcome have been assessed and their main findings included in this summary. A detailed description of the methods used by the author has been included as an example of how successful the treatment may be achieved. Results: A diverse range of practice is described in published literature in this field. Each group of authors used their own variation of the methods, described in the published literature, with good results. It is clear that foam sclerotherapy is far more effective than liquid sclerotherapy and that ultrasound imaging allows the treatment to be delivered accurately to affected veins. There is evidence that 3% policocanol foam is no more effective than 1% polidocanol foam. The optimum ratio of gas to liquid is 4:1, although a range of ratios is reported in published work. There is a wide variation in the volume used as well as the method by which it is injected. The use of carbon dioxide foam reduces the systemic complications, particularly visual disturbance, when compared with air foams. Very few serious adverse events have been reported in the literature despite the widespread use of this method. Rates of recanalization of saphenous trunks following UGFS are similar to those observed after endovenous laser and endovenous radiofrequency ablation of veins, as well as the residual incompetence after surgical treatment. Conclusions: UGFS is a safe and effective method of treating varicose veins. The relative advantages or disadvantages of this treatment in the longer term are yet to be published.
66 citations
TL;DR: The evidence regarding methods of closure over the ligated sapheno-femoral junction and the extent of dissection necessary in the popliteal fossa is examined as is the requirement for stripping and the use of different types of stripper.
Abstract: This article examines the practice of standard varicose vein surgery including sapheno-femoral and sapheno-popliteal ligation, perforator surgery and surgery for recurrent varicose veins. The technique of exposure of the sapheno-femoral junction and the sapheno-popliteal junction is outlined and advice given on avoidance of complications for both. The evidence regarding methods of closure over the ligated sapheno-femoral junction is examined as is the requirement for stripping and the use of different types of stripper. The requirement to strip the small saphenous vein and the extent of dissection necessary in the popliteal fossa is also examined. Complications of standard varicose vein surgery are outlined. The frequency of wound infection, nerve injury, vascular injury and venous thromboembolism are listed and strategies to avoid these complications are examined.
62 citations
TL;DR: The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms, and patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition.
Abstract: Objectives: The purpose of this study was to determine the long-term efficacy, safety and rate of recurrence for varicose veins associated with great saphenous vein (GSV) reflux treated with ultrasound-guided foam sclerotherapy (UGFS). Methods: A five-year prospective study was performed, recording the effect on the GSVand saphenofemoral junction (SFJ) diameters, and reflux in the superficial venous system over time. UGFS was the sole treatment modality used in all cases, and repeat UGFS was performed where indicated following serial annual ultrasound. Results: No serious adverse outcomes were observed ‐ specifically no thromboembolism, arterial injection, anaphylaxis or nerve damage. There was a 4% clinical recurrence rate after five years, with 100% patient acceptance of success. Serial annual duplex ultrasound demonstrated a significant reduction in GSV and SFJ diameters, maintained over time. There was ultrasound recurrence in 27% at 12 months, and in 64% at five years, including any incompetent trunkal or tributary reflux even 1 mm in diameter being recorded. Thirty percent had pure ultrasound recurrence, 17% new vessel reflux and 17% combined new and recurrent vessels on ultrasound. Of all, 16.5% required repeat UGFS treatment between 12 and 24 months, but less than 10% in subsequent years. The safety and clinical efficacy of UGFS for all clinical, aetiological, anatomical and pathological elements classes of GSV reflux was excellent. Conclusion: The popularity of this outpatient technique with patients reflects ease of treatment, lower cost, lack of downtime and elimination of venous signs and symptoms. Patients accept that UGFS can be repeated readily if required for recurrence in this common chronic condition. The subclinical ultrasound evidence of recanalization or new vein incompetence needs to be considered in this light.
60 citations
TL;DR: Catheter directed sclerotherapy ensures a safe intraluminal delivery of the sclerosing agent into the trunk of the saphenous veins using a single access point, and remains a safe alternative for the treatment ofsaphenous incompetence and venous malformations.
Abstract: BackgroundCatheter directed sclerotherapy (CDS) involves the use of a long catheter to deliver a sclerosing agent into a target vessel (saphenous trunks or venous malformations) under ultrasound guidance.Aims and MethodsThis article reviews the history, current techniques and devices and the evidence as it relates to these procedures.ResultsCDS was developed to increase the safety and efficacy of ultrasound-guided sclerotherapy (UGS). With the advent of foam sclerosants and tumescent anaesthesia, the procedure has enjoyed a higher primary success rate. CDS has a better safety profile when compared with UGS with virtually no risk of intra-arterial injection or sclerosant extravasation. Compared with endovenous laser (EVLA) and radiofrequency ablation (RFA), CDS is a quicker procedure with less associated pain. Some balloon catheters, however, have been found to force the sclerosant down the perforators causing femoral vein occlusion. Based on the current level of evidence, no firm conclusion regarding the ...
59 citations
TL;DR: Preliminary treatment of a fistulous AVM with coil embolization is essential in order to minimize associated morbidity and to alter the lesion haemodynamics from a high- flow lesion to a low-flow lesion that is more amenable to subsequent, definitive management with ethanol or NBCA glue embolo/sclerotherapy.
Abstract: Arterio-venous malformation (AVM) is a congenital vascular malformation that is neither a venous malformation nor a haemangioma. An AVM is a potentially life-threatening and limb-threatening lesion, especially the 'fistulous' truncular form due to its unique embryological and haemodynamic characteristics. AVM treatment requires an early aggressive approach, one that is careful and based on a thorough assessment of the risks and benefits associated with the treatment plan. A successful treatment strategy requires an accurate assessment of the AVM taking into account the extent, severity and progression of the lesion. This is critical in order to minimize the morbidity associated with the currently available therapies. A multidisiciplinary approach that integrates endovascular and surgical therapy can substantially improve the treatment results seen in patients with AVMs. Preliminary treatment of a fistulous AVM with coil embolization is essential in order to minimize associated morbidity and to alter the lesion haemodynamics from a high-flow lesion to a low-flow lesion that is more amenable to subsequent, definitive management with ethanol or NBCA glue embolo/sclerotherapy.
TL;DR: The ELT of veins produces an unevenly distributed damage and the cell necrosis is far more extensive than expected, which can lead to recanalization.
Abstract: ObjectivesThe destruction induced during endovenous laser treatment (ELT) of the saphenous vein and the perivenous tissue in an animal model (goats) was analysed. Differences in vein wall destructi...
TL;DR: This technique of eccentric compression greatly reduces the intensity of postoperative pain after ELA of the GSV.
Abstract: ObjectivesTo evaluate the effect of eccentric compression applied by a new crossed-tape technique on procedure-related pain occurrence after endovenous laser ablation (ELA) of the great saphenous vein (GSV).MethodsFrom April 2005 to June 2006, 200 consecutive ELA procedures were randomized to receive (group A: 100) or not (group B: 100) an eccentric compression applied in the medial aspect of the thigh. Patients were scheduled for a seven-day examination to assess the level of pain experienced. Pain intensity was measured using a visual analogue scale giving a numerical grade from 0 (no pain) to 10 (worst pain ever).ResultsThe intensity of postoperative pain was significantly reduced (P < 0.001) in the eccentric compression group as compared with the non-compression one.ConclusionsThis technique of eccentric compression greatly reduces the intensity of postoperative pain after ELA of the GSV.
TL;DR: In the treatment of varices of the lower limbs, F shows much greater efficacy compared to L, and the side-effects reported in all the available comparative trials do not differ between F and L forms, even if visual disturbances seem to be more common with F.
Abstract: ObjectivesA systematic review to compare efficacy and safety of foam (F) sclerotherapy versus liquid (L) sclerotherapy for primary varicose veins of the lower limbs.MethodsSystematic searches of electronic databases were conducted in April 2009 to identify relevant published studies. Database searches were augmented with abstracts from conference proceedings and electronic and hand searching of journals not consistently indexed in the major databases.ResultsFor treatment of saphenous veins, six trials (four randomized controlled trials) were considered. Despite containing much less sclerosing agent, F was markedly more effective compared with L, the difference being put at between 20% and 50%. Four studies were included in a meta-analysis showing efficacy of F at 76.8% (95% confidence interval [CI] 71–82) versus L at 39.5% (95% CI 33–46), χ2 = 60.9740; P ≤ 0.0001.For reticular veins and telangiectases, only two comparative trials were found and do not at present provide any conclusive evidence to support ...
TL;DR: It is found TRLOP to be an effective treatment for IPVs, and the closure rates described are comparable with the published clinical series data for subfascial endoscopic perforator surgery.
Abstract: In 2000, we developed a percutaneous method of treating incompetent perforator veins (IPV) using ultrasound-guided radiofrequency ablation (RFA), which we termed TRansluminal Occlusion of Perforato...
TL;DR: Describing and report incidence and frequency of side-effects and complications of sclerotherapy with foamed sclerosing agents to explain their pathophysiology and to indicate possible manoeuvres and techniques to limit them.
Abstract: AimsTo describe and report incidence and frequency of side-effects and complications of sclerotherapy with foamed sclerosing agents. To explain, when possible, their pathophysiology and to indicate...
TL;DR: The available evidence for clinical effectiveness, quality of life and cost gains following endovenous RFA is summarized and the scientific principles behind RFA and technical procedural considerations are discussed and standards of care for the delivery of endovenously RFA are proposed.
Abstract: In recent years, minimally invasive endovenous treatments have gained popularity in the treatment of superficial venous reflux. The perceived advantages of endovenous therapy include reduced pain, high vein occlusion rates, and early return to work and normal activities. Endovenous radiofrequency ablation (RFA) involves the delivery of thermal energy from a bipolar catheter to the venous segment to be treated. This technique has been available since 1998 and numerous devices and catheters are now produced. Numerous prospective and randomized studies have compared the effectiveness of RFA with traditional and endovenous procedures. In this article, the available evidence for clinical effectiveness, quality of life and cost gains following endovenous RFA is summarized. The scientific principles behind RFA and technical procedural considerations are discussed and standards of care for the delivery of endovenous RFA are proposed.
TL;DR: One in five women presenting with varicose veins have reflux of non-saphenous origin, and one in six has associated pelvic vein reflux, in specialist and non-specialist units.
Abstract: ObjectivesMounting evidence suggests that pelvic vein reflux is an important contributing factor to recurrent varicose veins. We compared the incidence in our specialist private unit (Unit A) with ...
TL;DR: SEPS, used as a part of a treatment regimen for severe CVI, benefits most patients in the short term regarding ulcer healing and the prevention of ulcer recurrence, but further prospective randomized trials are required to define the long-term benefits of SEPS.
Abstract: ObjectivesThe degree of benefits and risks, and the role of subfascial endoscopic perforator vein surgery (SEPS) in the management for chronic venous insufficiency (CVI) remains uncertain.MethodsA multiple health database search was performed including Medline, Embase, Ovid, Cochrane Database of Systematic Reviews, and Cochrane Database of Abstracts of Reviews of Effectiveness, on all studies published between 1985 and 2008 that reported on health outcomes in patients with CVI treated with SEPS and comparing this therapy with the conventional Linton procedure. Three studies, which compared SEPS with conventional surgery, were included in the present meta-analysis.ResultsBetween SEPS and Linton groups, there was a significant lower rate of wound infections for SEPS (odds ratio [OR] 0.06 [95% confidence interval (CI) 0.02 to 0.25]) and a significantly reduced hospital stay for SEPS (OR –8.96 [95% CI –11.62 to –6.30]). In addition, SEPS was associated with a significant reduced rate of recurrent ulcers (mean...
TL;DR: Short-stretch bandages can be expected to have more pronounced benefits for augmenting muscle pump than long-st stretch bandages and short-Stretch stockings.
Abstract: ObjectivesTo compare the interface pressure during posture changes and exercise between elastic stockings and bandages.MethodsUsing a pressure transducer (air pack-type analyzer), the interface pressures associated with three different elastic stockings and three different elastic bandages were measured during supine resting, standing and exercise in 15 healthy volunteers.ResultsShort-stretch bandages showed a significantly higher static stiffness index value, which is defined as the pressure difference between lying and standing, than long-stretch bandages and short-stretch stockings (P < 0.001). Furthermore, short-stretch bandages showed a significantly greater pressure difference between muscle contraction and relaxation in both tip-toe and knee-bending exercises than long-stretch bandages and short-stretch stockings (P < 0.001).ConclusionShort-stretch bandages can be expected to have more pronounced benefits for augmenting muscle pump than long-stretch bandages and short-stretch stockings.
TL;DR: The presence of a PFO was detected in most patients reporting AEs after undergoing UGFS, and high sensitivity and specificity for cTCD when compared with contrast transesophageal echocardiography (cTEE).
Abstract: ObjectivesTo prospectively study the association between patent foramen ovale (PFO) detected by contrast transcranial Doppler (cTCD) and adverse events (AEs) reported by patients after ultrasound-g...
TL;DR: Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD, higher than patient reports of adverse events.
Abstract: OBJECTIVES To investigate and review collected and reported transcutaneous ultrasound, transthoracic echocardiography (TTE) and transcranial Doppler (TCD) data obtained during ultrasound-guided foam sclerotherapy (USGFS) of incompetent saphenous, tributary and perforating veins of the lower extremities. METHODS TTE and/or middle cerebral artery TCD were performed during USGFS. Ultrasound (US) findings and adverse events were recorded. Existing literature was reviewed. RESULTS Ultrasound detected emboli circulating in superficial, perforating, communicating and deep veins and into the central circulation. TTE detected bright echoes in the right heart after every injection and in the left heart in up to 65% of selected patients. TCD high-intensity transient signals (HITS) were detected in 14-42% of the patients. Incidence of HITS was higher than patient reports of adverse events. Incidence of HITS was independent of foam volumes injected. CONCLUSION Echogenic signals were detected in non-treated veins, in heart chambers and in the cerebral circulation by transcutaneous US, TTE and TCD. Pathological consequences of such findings remain to be investigated.
TL;DR: This study suggests that in the three most common forms of thrombophilia, sclerotherapy, in combination withThromboprophylaxis, can be performed safely, and prophylaxis with LMWH is easier to use than warfarin.
Abstract: ObjectivesThe aim of this study was to assess thrombotic complications following sclerotherapy in thrombophilic patients in combination with thromboprophylaxis, in two randomized arms using low molecular weight heparin (LMWH) or warfarin.Patients and methodsThis study received approval from the Ethics Committee. A total of 105 patients (81 females, 24 males) ranging in age from 20 to 82 years (mean 50) were selected: 75 with Factor V Leiden mutation, 18 with prothrombin 20210A mutation, 7 with high level of Factor VIII, 5 combinations of these. After randomization, 51 and 54 patients received warfarin and LMWH, respectively. A total of 199 sclerotherapy sessions were performed. Foam was used in 160 treatments.ResultsNo episodes of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) occurred; no instances of DVT were revealed by ultrasound-monitoring.ConclusionsThis study suggests that in the three most common forms of thrombophilia, sclerotherapy, in combination with thromboprophylaxis, can ...
TL;DR: RFA of IPV may be a promising procedure, but patient and incompetent perforator vein selection is important and further standardization of the procedure is required and Comparative clinical trials between RFA and other therapies are warranted.
Abstract: BackgroundAlthough the role of incompetent perforating veins (IPV) in chronic venous insufficiency remains controversial, they are often treated by surgical or by minimal invasive techniquesObjectivesTo describe the procedure of radiofrequency ablation (RFA) of IPV and to evaluate its short-term effectiveness and safetyMethodsIn a clinical pilot study, 14 IPV in 12 patients were treated with a radiofrequency stylet After three months, ultrasound (US) examination was used to assess anatomical success rate and exclude deep venous thrombosis Also, self-reported side-effects were investigatedResultsOf the 14 treated IPV, nine (64%) were obliterated on US examination and the others showed remaining reflux Two patients reported localized paresthesia, but no deep venous thrombosis was recordedConclusionRFA of IPV may be a promising procedure, but patient and incompetent perforator vein selection is important and further standardization of the procedure is required Comparative clinical trials between RFA
TL;DR: To gain better patient outcomes, the range of treatments focusing on areas other than the venous system, and to be aware of their strengths and limitations, it is important to know and understand the basics of the physiology of the lymphatic system and the pathological changes that chronic venous insufficiency may cause.
Abstract: In order to better understand phlebolymphoedemas and the impact of a dysfunctional venous system and an overloaded lymphatic system on them, it is necessary first to understand the major anatomical features of the lymphatic system. To gain better patient outcomes, the range of treatments focusing on areas other than the venous system, and to be aware of their strengths and limitations, it is important to know and understand the basics of the physiology of the lymphatic system and the pathological changes that chronic venous insufficiency may cause. It is important to be aware that the deep and superficial lymphatic systems (but particularly the superficial) are divided into a series of drainage areas called lymphatic territories, which are separated from each other by boundaries called watersheds. Often, anatomoses (which can be closed or open) cross these boundaries and between major lymph collectors within each territory. Each lymphatic territory is drained by a greater or lesser number of larger lymph vessels called lymph collectors. Usually, these drain directly to lymph nodes where up to an estimated 30% of the lymph fluid is re-absorbed. Due to proximity relationships between the lymphatic and venous systems, there are frequent lymphovenous anastomoses, which at varying times may be open but which seem to often require external intervention to maintain their patency. The lymphatic system normally is concerned with four major roles: (1) maintenance of tissue fluid and physiological homeostasis, though its role in absorption and removal of fluids and their contents; (2) body defense (those patients with a poorly functioning lymphatic system are more susceptible to infection); (3) absorbance of long-chain fats from the mesenteric area; and (4) overall control of the immune response, although the breadth of these roles is not always recognized. There are many occasions when the lymphatic system is structurally and functionally normal and can manage a large additional load of fluids and their contents as might occur when there is a compromised venous system; however, continuing excessive loads above the maximum transport capacity of an otherwise normal lymphatic system can lead to its failure to remove them. This is termed a ‘dynamic insufficiency’. Other than chronic venous insufficiency, the main reasons are right ventricular failure, inflammation and kidney disease. If, in addition, the lymphatic system has some form of structural impairment such as that which occurs when the lymphatic system is malformed (congenital forms of lymphoedema), or following surgery, radiotherapy, inflammation or trauma, then the transport capacity can be significantly reduced. A similar situation of reduced transport Correspondence: N Piller PhD, Flinders Medical Centre, Department of Surgery, School of Medicine. Email: neil.piller@flinders.edu.au
TL;DR: This large retrospective study of laser procedures performed outside the operating theatre did not reveal any significant specific complications as regards the environment required and the efficacy results were equivalent to those found in the literature.
Abstract: Objectives: To assess the feasibility of saphenous veins ablation by laser in a clinic room. To study immediate and short term (1 to 6 months) complications and to pinpoint those that could be directly linked to this environment. Efficacy of the technique should also be documented. Methods: Retrospective study (22 centres) carried out in France and Switzerland. Patients with insufficiency of great saphenous vein (GSV) or small saphenous vein (SSV). Clinical stages of clinical, aetiological, anatomical and pathophysiological classification (CEAP) were C2 to C6. Endovenous laser procedures were performed outside an operating theatre, under local anaesthesia and without high ligation. Efficacy criteria: occlusion of the vein and disappearance of the pathological reflux (duplex scan assessment). The side effects and complications were studied. Results: A total of 1703 procedures (1422 patients) were performed; 74% of the patients were women. The mean age of the patients was 57. A total of 1394 GSV and 309 SSV were treated (mean diameters 7.2 mm and 6.4 mm, respectively). Overall success level was 97% and mean length of veins treated was 40 cm for GSVand 21 cm for SSV. Energy applied in joules percentimeter was homogenous (mean and median 64 for GSV and 65 for SSV). Complications were rare and ‘simple’ apart from one pulmonary embolism which occurred 10 days after a GSV procedure, although no deep vein thrombus was found. A total of two infections were observed: onewas an infection localized at the site of access and the other was erysipelas. Conclusion: Except 2 limited infections (0.1%), this large retrospective study of laser procedures performed outside the operating theatre did not reveal any significant specific complications as regards the environment required. The efficacy results were equivalent to those found in the literature. Regarding cost and constraints induced by operating theatre environment, the clinic room should be able to offer an easier and economic alternative option for saphenous veins ablation with laser.
TL;DR: The aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day, and found that the accumulation of fluids was significantly higher in the morning than in the afternoon.
Abstract: The aim of this study was to investigate the rate of occupational leg swelling depending on the time period of the working day. Volumetric variations of the legs of 70 hospital employees, enrolled in three groups, were evaluated. Group I: 35 morning shift workers; Group II: 35 afternoon shift workers; and Group III: 15 individuals randomly selected from Groups I and II, who were evaluated on the day they worked 12 hours consecutively. Volumetry was performed before and after each shift for both legs of the participants in Groups I and II. For Group III volumetry was performed early in the morning, at noon and in the evening. For statistical analysis, the Student's t-test and Mann-Whitney test were used with an alpha error of 5% being considered acceptable (P value<0.05). Significant increases in volume were recorded for the limbs in all three groups (P value<0.001). On comparing Groups I and II, the accumulation of fluids was significantly higher in the morning than in the afternoon (P value<0.003). Asymptomatic workers may present with oedema of the legs during their work with the rate of oedema being different for morning and afternoon shifts. The possibility of wearing compression stockings should be considered for this type of work.
TL;DR: All symptoms and ankle circumferences significantly improved over time, with increasing clinical, aetiological, anatomical and pathophysiological (CEAP) classes and body mass index (BMI) (P < 0.001).
Abstract: ObjectivesThe present study assessed the effect of Ruscus aculeatus-hesperidin-methyl-chalcone–ascorbic acid (HMC–AA) on the quality of life (QoL) of patients suffering from chronic venous disorders (CVDs).MethodsAn observational, multicentre and prospective study was performed with 917 Mexican patients suffering from CVD. Patients were treated with R. aculeatus–HMC–AA. After 12 weeks of treatment, the physicians then assessed the patients' symptoms and QoL using Short Form (SF-12) and Chronic Venous Insufficiency (CIVIQ) auto-questionnaires.ResultsPatients were mainly women (86.7%), overweight or obese (72.7%) or C2 (39.3%)–C3 (27.6%). All symptoms and ankle circumferences significantly improved over time, with increasing clinical, aetiological, anatomical and pathophysiological (CEAP) classes and body mass index (BMI) (P < 0.001).Concerning QoL, all dimensions of the SF-12 score significantly improved over time (P < 0.001). Moreover, the CIVIQ scores significantly improved (P < 0.001) with increasing BM...
TL;DR: The results of this study suggest that the combined therapy of LMWH with an anti-inflammatory agent is more effective than LMWH and may be an important option in the standard treatment of SVT.
Abstract: ObjectivesThe optimal treatment of superficial vein thrombosis (SVT) of the leg has not been determined yet. The aim of this study is to evaluate the efficacy of low-molecular-weight heparin (LMWH) as compared with combined therapy of LMWH with an anti-inflammatory agent in treatment of SVT.MethodsFifty patients with SVT of the greater saphenous vein were randomly assigned to be treated with Ca-nadroparin 190 IUAxa/kg in a single dose or with same dose of Ca-nadroparin and 60 mg oral acemetacine twice daily for 10 days. The efficacy of the two treatments to relieve symptoms and signs was evaluated by using visual analogue scale.ResultsSignificant improvements were achieved for both groups after the treatment in terms of all four symptoms (P < 0.001). Treatment scores were in favour of LMWH with anti-inflammatory agent treatment group to relieve all four symptoms. The most significant and remarkable results obtained were for the reduction of pain and local tenderness (P < 0.05). No patient experienced majo...
TL;DR: Little else is known about the optimal preparation of foamed sclerosants and the best technique for administering foam for sclerotherapy, so long-term studies are required to determine outcome.
Abstract: ObjectivesThe aim was to evaluate the published literature to assess what is conclusively known about optimal technique and outcome for foam sclerotherapy.MethodsA literature search was performed f...