<b>Endovenous Laser Ablation of the Saphenous Vein for Treatment of Venous Insufficiency and Varicose Veins:</b>Early Results From a Large Single-Center Experience

Perkowski, Paul E.; Ravi, Rajagopalan; Gowda, Ramesh C.N.; Olsen, Dawn; Ramaiah, Venkatesh G.; Rodriguez‐Lopez, Julio A.; Diethrich, Edward B.

doi:10.1583/03-1126.1

Cited by 94 publications

(73 citation statements)

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“…First series and controlled trials reported on high clinical efficacy of endovenous therapy with low complication rates [15][16][17][18][19]. The consequences of endovenous treatment, such as venous wall thickening, a reduction in luminal diameter, thrombus formation or obliteration are currently assessed either clinically, based on duplex ultrasound findings, or on phlebography [17,20].…”

Section: Introductionmentioning

confidence: 99%

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

et al. 2007

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Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (kappa) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.

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Section: Introductionmentioning

confidence: 99%

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

et al. 2007

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“…24,25 A study of active ulcers showed 83% healed after EVLASER. 26 Patient satisfaction is high 26 and patients return to normal activities 25 almost immediately. No study has reported on long-term QoL changes after EVLASER.…”

Section: Endovenous Laser Treatment (Evlaser)mentioning

confidence: 99%

The Treatment of Varicose Veins

Subramonia

Lees

2007

annals

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Varicose veins are a common problem and cause disfigurement, disability and impairment in the quality of life (QoL). Over 40,000 operations are performed each year for varicose veins within the NHS in England and Wales. Conservative methods like compression bandaging for ulceration can also be expensive. Varicose veins are, therefore, of significant clinical and economic importance to the health service and also have a major socio-economic impact on society. The advent of endovenous ablation techniques has expanded the surgical options for patients requiring treatment. Materials and MethodsRelevant studies were identified via the MEDLINE, PREMEDLINE, EMBASE, PubMed, Cochrane Library and Science Citation Index using Boolean search terms from their commencement to 2005. Further studies were obtained from references, reviews, specialty journals, trial registries and the internet and by hand-searching. Abstracts were searched for studies reporting safety, efficacy, technique and outcomes with emphasis on comparative studies and large case series. The authors concentrated on evidence published in the last 10 years to achieve a balance between comprehensiveness and precision. Non-English articles were excluded unless a translation could be obtained. Conference abstracts and unpublished reports were excluded. ResultsDefinitive treatment of varicose veins aimed at abolishing sources of venous reflux and removing long refluxing segments and varicose reservoirs can be achieved by conventional surgery or by endovenous ablation techniques. Transilluminated powered phlebectomy and subfascial endoscopic perforator surgery are less commonly employed.The main outcome in the selected studies is the abolition of saphenous vein reflux. However, there is wide variation in the reporting of outcomes between studies. Elimination of varicosities, recanalisation after endovenous ablation, recurrence of reflux, re-appearance of varicose veins, symptomatic improvement and re-treatment rates are not reported in all studies. Varicosities evident at follow-up are not clearly differentiated into residual, recurrent or newly incompetent veins. Some studies are affected by significant follow-up loss.

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“…O padrão-ouro para o tratamento cirúrgico de varizes devido à insuficiência da junção safeno-femoral Cirurgia de varizes -de Medeiros CAF (JSF) associada ao refluxo na VSI é a ligadura da crossa com fleboextração [35][36][37][38] .…”

Section: Conceitos Atuaisunclassified

Cirurgia de varizes: história e evolução

Medeiros¹

2006

J. vasc. bras.

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ResumoComo a safenectomia é uma cirurgia bem estabelecida, a utilização de um método pouco invasivo para obter os mesmos efeitos indica que os benefícios esperados a curto e médio prazo devem prevalecer sobre os riscos previstos. Entretanto, em se tratando de uma doença muito prevalente na população mundial, há grande preocupação por parte dos órgãos de saúde governamentais e das sociedades científicas correlacionadas sobre esse assunto, de tal forma que os argumentos sobre novas modalidades de tratamento devem estar bem fundamentados, inclusive para aceitação pelo público em geral.Com o intuito de se avaliar efetivamente novos dispositivos, devem ser conduzidos estudos em pacientes e com grupos controles que sejam bem delineados. É preciso submeter qualquer projeto de pesquisa sobre o assunto à apreciação do comitê de ética na instituição em que o trabalho será conduzido para aprovação prévia. Palavras-chave:Insuficiência venosa, tratamento, fotocoagulação a laser. AbstractSince great saphenous vein stripping is a well established surgery, the use of a minimally invasive method to obtain the same effects indicates that short and medium-term benefits should prevail over expected risks. However, because it is a very common disease in the world population, there is great concern about this subject by government health institutions and correlated scientific societies. Therefore, the arguments about new treatment modalities must be well based, including to gain acceptance by the general public.To effectively evaluate new devices, there must be well designed clinical studies with groups and controls. All projects about this matter must be submitted to the appreciation of an ethics committee at the institution where the research will be carried out for previous approval.

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Endovenous Laser Ablation of the Saphenous Vein for Treatment of Venous Insufficiency and Varicose Veins:Early Results From a Large Single-Center Experience

Abstract: ELAS for symptomatic saphenous vein incompetence and varicose veins has excellent short-term subjective and objective outcomes. This technique appears to be very successful in reducing symptoms, resolving varicose veins, and healing ulcers.

Cited by 94 publications

References 18 publications

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

The Treatment of Varicose Veins

Cirurgia de varizes: história e evolução

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