Five-year Results of a Randomised Clinical Trial of Endovenous Laser Ablation of the Great Saphenous Vein with and without Ligation of the Saphenofemoral Junction

Disselhoff, B C V M; Kinderen, D.J. der; Kelder, Johannes C.; Moll, Frans L.

doi:10.1016/j.ejvs.2010.12.014

Cited by 80 publications

(53 citation statements)

References 16 publications

(16 reference statements)

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“…Recent studies have demonstrated that EVLA with SFJ ligation results in less incompetent groin tributaries and less common recanalization after the procedure. 1) Interestingly, however, the overall recurrence rate was not improved by performing SFJ ligation. 1) This finding was inconsistent with a previous finding that the presence of incompetent groin tributaries contributed to the pathogenesis of recurrent varicosities.…”

Section: S Uperficial Venous Insufficiency Is a Common Medicalmentioning

confidence: 99%

Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients

Izumi¹,

Ikeda

Yamashita

et al. 2016

Int. Heart J.

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SummaryEndovenous laser ablation (EVLA), which is a relatively new therapeutic option for saphenous varicose veins of the legs, is less invasive than conventional stripping surgery with ligation. In this study, we evaluated the safety and effectiveness of EVLA combined with ligation for severe saphenous varicose veins that were graded as ≥ C 4 by the CEAP classification. We treated 119 Japanese patients (141 limbs) between July 2005 and December 2007 utilizing a 1320-nm Nd:YAG laser. The obliteration rate of the treated veins was found to be 100% over the entire follow-up period (2.5 years). Consistent with this finding, all of the patients exhibited improved skin lesions (ie, skin pigmentation and ulceration). No major complications, including deep vein thrombosis (DVT) and nerve injury, were observed. A questionnaire survey with a reasonable response rate (66.4%) demonstrated that subjective symptoms and minor complications that were initially observed after EVLA, such as mild pain, numbness, indurations, and localized hot flashes, were remarkably improved by the end of the follow-up period. Furthermore, high levels of patient satisfaction were noted. Thus, EVLA combined with ligation constituted a safe and effective strategy for treating severe saphenous varicose veins in Japanese patients. (Int Heart J 2016; 57: 87-90) Key words: 1320-nm Nd:YAG laser, Skin lesions, High patient satisfaction S uperficial venous insufficiency is a common medical condition that increases with age. Although stripping surgery with high ligation of the saphenofemoral junction (SFJ ligation) has been the standard treatment for great saphenous varicose veins with reflux, several effective alternatives are currently available.Endovenous laser ablation (EVLA) is a minimally invasive technique that has become a common alternative in Japan. EVLA can be performed either with or without SFJ ligation, and controversy persists regarding whether performing SFJ ligation prior to EVLA is truly beneficial for decreasing the recurrence rate of varicose veins. Recent studies have demonstrated that EVLA with SFJ ligation results in less incompetent groin tributaries and less common recanalization after the procedure.1) Interestingly, however, the overall recurrence rate was not improved by performing SFJ ligation.1) This finding was inconsistent with a previous finding that the presence of incompetent groin tributaries contributed to the pathogenesis of recurrent varicosities.2) Neovascularization in the groin is one of the operative stress responses to the SFJ ligation procedure, and it acts as another principal cause of recurrence.3-7) Thus, the inconsistency noted above might be explained by the hypothesis that performing SFJ ligation not only leads to less incompetent groin tributaries but also augments neovascularization in the groin.EVLA is a relatively new technique, and it tends to be applied for mild varicose veins that have been evaluated as class C 2 or C 3 according to the CEAP classification. Therefore, although EVLA has been perfo...

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Section: S Uperficial Venous Insufficiency Is a Common Medicalmentioning

confidence: 99%

Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients

Izumi¹,

Ikeda

Yamashita

et al. 2016

Int. Heart J.

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“…31,32 This was shown by a retrospective study of Pittaluga where ligation of the GSV 2 cm below the SFJ, which preserved the proximal non-refluxing tributaries of the GSV, resulted in a very low rate of postoperative neovascularization (1.8%). 33 Additional support for this was recently published in the RCT of Casoni et al, 34 which had a follow-up of eight years.…”

Section: Lnvn and Neovascularizationmentioning

confidence: 85%

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

2015

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It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks.Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

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“…years after endovenous procedures 86,87,96,127,183,184,199 . Long-term results of randomized controlled studies are needed to provide an answer on the durability of endovenous techniques, especially for newer techniques such as MOCA and EVSA.…”

Section: Discussionmentioning

confidence: 99%

“…A recent prospective study with 1020 limbs observed failure rates with duplex ultrasound of 7.7% at 1 year, and 13.1% at 2 and 3 years 108 . In a randomized controlled trial of EVLA with or without high saphenous ligation occlusion rates at 5 years follow-up were 98% and 88% , respectively 86 . The difference between these groups was not significant.…”

Section: Outcomementioning

confidence: 99%

Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature

Eekeren

Boersma

Vries

et al. 2014

Seminars in Vascular Surgery

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Five-year Results of a Randomised Clinical Trial of Endovenous Laser Ablation of the Great Saphenous Vein with and without Ligation of the Saphenofemoral Junction

Abstract: ISRCTN60300873 (http://www.clinical-trials.com).

Cited by 80 publications

References 16 publications

Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients

Safety and Effectiveness of Endovenous Laser Ablation Combined With Ligation for Severe Saphenous Varicose Veins in Japanese Patients

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

Update of endovenous treatment modalities for insufficient saphenous veins—A review of literature

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