Ambulatory Varicosity avUlsion Later or Synchronized (AVULS)

Abstract

Mini AbstractA randomised clinical trial comparing simultaneous endovenous ablation and phlebectomy with endovenous ablation and delayed phlebectomy successfully recruited and treated 101 patients. Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced rate of need for further procedures, in addition to early Quality of Life improvements. MethodsPatients undergoing local anaesthetic endovenous thermal ablation were randomised to either simultaneous phlebectomy or delayed varicosity treatment. Patients were reviewed at 6 weeks, 6 months and 1 year with clinical and quality of life scores completed, and were assessed at 6 weeks for need for further varicosity intervention, which was completed with either ultrasound guided foam sclerotherapy or local anaesthetic phlebectomy. Duplex ultrasound assessment of the treated trunk was completed at 6 months. ConclusionCombined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures, as well as early quality of life improvements.

Cost-Effectiveness of Current and Emerging Treatments of Varicose Veins

“…This leads some practitioners not to treat these during the index procedure, but instead to "wait and see." Nevertheless, the Ambulatory Varicosity avUlsion Later or Synchronized (AVULS) study found that the most effective course of action (in terms of overall patient quality of life) is to treat the varicosities alongside the truncal treatment during the index procedure [5]. It is assumed in our model that concomitant phlebectomy or foam will be used to treat nontruncal varicosities as needed alongside all the surgical treatment options, except in UGFS because it does not use appropriate anesthetics to allow this strategy to be followed.…”

“…Once wound healing was accomplished, over the longer term, HRQOL would be impaired by recurrent symptoms of varicose veins or varicosities. The Ambulatory Varicosity avUlsion Later or Synchronized study found that patients needing further treatment had a significantly worse general HRQOL at 6 weeks, measured on the EQ-5D index: 0.719 versus 0.846, mean difference 0.127 (standard error [SE] 0.054), two-tailed P value of 0.018 [5]. This difference was not seen at 6 months or 12 months, because patients with poor quality of life at 6 weeks were successfully re-treated by 6 months.…”

“…An RCT carried out in UK hospitals found that 36% (18 of 50) of patients following a strategy of delayed phlebectomy required re-treatment at the 6-week follow-up assessment, compared with 2% (1 of 51) in patients who underwent concomitant phlebectomy (OR 0.04; 95% CI 0.00-0.28) [5], with significantly better HRQOL in the concomitant group. It was assumed in the model that HL/S, EVLA, MOCA, RFA, and CAE applied a strategy of concomitant ablation of the varicosities, whereas UGFS used delayed ablation when required.…”

“…If symptoms do recur, re-intervention may be considered. Residual varicosities may in some cases also be treated during the index treatment or alternatively in a follow-up session [5].…”

Long-term Treatment of Proximal Deep Vein Thrombosis with Micronized Purified Flavonoid Fraction Additionally to Oral Rivaroxaban Improves Clinical and Ultrasound Outcomes

“…Introduction -Concomitant treatment of tributary varicosities during axial endovenous ablation has been shown in randomised trials to be the best management option, with improvement in quality of life and clinical severity 1,2 . Non thermal, non tumescent methods of ablation aim to reduce the discomfort of treatment, but the optimal management of varicose tributaries with these techniques is unknown and may have an important impact on whether these techniques carry any benefit over endothermal technologies.…”