Combined Endovenous Laser Therapy and Pinhole High Ligation in the Treatment of Symptomatic Great Saphenous Varicose Veins

Zhu, Huipeng; Zhou, Yifei; Zhang, Xin; Yan, Jinlin; Xu, Zhong-You; Wang, Hui; Zhao, Qingxin; Jing, Zaiping

doi:10.1016/j.avsg.2013.04.015

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…Two recently published papers 31,32 describe a GSV interruption technique by passing a tread below the GSV by US assistance, as a complement of endovenous laser ablation, with the purpose of avoiding risk of thrombosis and recurrence keeping the thermal energy away from the saphenofemoral junction. These authors simply apply a tread to close the vein in association to the Laser treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a better visualization of the vein is accomplished avoiding the risk of femoral vein involvement. 32 Finally, GSV PTI could perfectly fit the office based CHIVA (conservative hemodynamic correction of venous insufficiency) protocol 33 or similar 34 where the GSV interruption is done in the perspective of GSV stem sparing strategy. Compared to the other GSV interruption options (laser, RF, steam, glue) the PTI technique seems simpler, cheaper (no technology is needed) and, in particular, more precise in terms of anatomical positioning.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound assisted great saphenous vein ligation and division: an office procedure

Ricci

Moro

Incalzi

2014

Veins and Lymphatics

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The aim of this proof of concept study is to describe an ultrasound (US) assisted simplified surgical procedure for pre-terminal great saphenous vein (GSV) high ligation/division avoiding groin dissection and tributary interruption, in an office setting, in association to varices phlebectomy and saphenous vein foam occlusion treatment. Inclusion criteria: primary GSV reflux due to terminal valve, vein diameter >6 mm. By ultrasonography in standing position, the point GSV passing over the adductor longus muscle (about 3 cm from the junction) is identified. This E (easy) point, relatively superficial, free from tributaries and other structures, allows an easy grasping and extraction of the GSV vein through a 3 mm stab incision provided an ultrasonography assistance. The vein is divided/ligated about 2 cm distal from the ostium, the distal stump is cannulated and foam is injected on the distal segment from the E-point incision in a retrograde fashion, varices are avulsed by phlebectomy. Twenty procedures in 18 patients (venous clinical severity score: mean 3.15 -GSV diameter: mean 7.34) were performed, all the cases without inconveniences, with a duration not exceeding 10 min in addition to the phlebectomy procedure time. No complications as hemorrhage, infection, nerve lesion, lymphatic leak or thrombosis have been registered. At one month the residual saphenous stump length was in average 2.16 cm with complete closure of GSV in all. Three patients have been controlled at 6 months showing GSV complete closure. The procedure described is a simple office US assisted method for GSV ligationdivision, leaving the 2 last cm of the saphenofemoral junction. It could be associated to most of the procedures in use with limited additional time and resources required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound assisted great saphenous vein ligation and division: an office procedure

Ricci

Moro

Incalzi

2014

Veins and Lymphatics

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“…Moreover, with respect to follow-up, no significant difference was found in incidence of DVT, SNI, wound infection, and recurrence between DS and IS groups. It is known that recurrence in 12 months, [10] short period after surgery was closely associated inadequate surgery representing surgical effectiveness. Supposed that surgeons did not removed varices completely, recurrence leaded by residual vein intended to happen in short period.…”

Section: Resultsmentioning

confidence: 99%

Day surgery is effective and safe for patients with great saphenous vein varices who meet American Society of Anesthesiologists I-II grading

Xiong

Wang

et al. 2016

Niger J Clin Pract

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“…DUS is considered the gold standard for preoperative evaluation of varicose veins, because it can provide both anatomical and functional assessment of the venous system [ 3 , 4 , 6 , 10 , 11 ]. SFJ or SPJ ligation and stripping constitutes standard treatment as reported by randomized trials that have shown good long-term results associated with this approach [ 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins

Choi

Kwon

2022

PLoS ONE

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Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.

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Combined Endovenous Laser Therapy and Pinhole High Ligation in the Treatment of Symptomatic Great Saphenous Varicose Veins

Cited by 11 publications

References 23 publications

Ultrasound assisted great saphenous vein ligation and division: an office procedure

Ultrasound assisted great saphenous vein ligation and division: an office procedure

Day surgery is effective and safe for patients with great saphenous vein varices who meet American Society of Anesthesiologists I-II grading

Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins

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