Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein

Pittaluga, Paul; Chastanet, S.; Rea, B.; Barbe, Rémy

doi:10.1016/j.jvs.2008.12.067

Cited by 107 publications

(100 citation statements)

References 37 publications

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“…The hemodynamic results were remarkably stable after three years of follow-up, with a significant improvement in GSV hemodynamics in 90% of cases compared with preoperative values. The varicose vein recurrence rate after three years was 15.7%, which was similar to the results obtained after radiofrequency treatment or traditional stripping (28). Although our study presents only shortterm results of eASVAL with one-year follow-up, they are similar to the results of surgical ASVAL treatment.…”

Section: Discussionsupporting

confidence: 86%

The endovenous ASVAL method: principles and preliminary results

Atasoy

Oğuzkurt²

2015

Diagn Interv Radiol

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A mbulatory selective varicose vein ablation under local anesthesia (ASVAL) is a surgical treatment for varicose veins based on the ascending hypothesis that venous insufficiency progresses in an ascending manner, from the superficial tributaries to the saphenous vein (SV) and then to the sapheno-femoral junction (SFJ). Recent scientific data based on precise and detailed duplex scanning support this hypothesis (1-6). The ASVAL method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests the surgical removal (phlebectomy) of the superficial varicose reservoir (SVR) as a primary treatment. The major argument in favor of preserving the GSV is the essential physiologic role that the GSV could play in superficial drainage and, to a lesser extent, its availability as revascularization material. Although the original ASVAL method is performed using simple phlebectomies, many patients refuse to have this treatment because they regard it as a surgical operation that would likely yield poor cosmetic results. Thermal endovenous techniques and foam sclerotherapy are less aggressive and are reported to be as effective as traditional surgical treatments (7). The question arises as to whether the ASVAL approach can be performed using endovenous techniques. To the best of our knowledge, this research will be a preliminary study describing the endovenous technique for the ASVAL approach.The purpose of this study was to investigate the feasibility and safety of endovenous ASVAL (eASVAL) technique and to present the short-term results with one-year ultrasonography (US) follow-up in a selected group of patients. PURPOSEWe aimed to investigate the feasibility and safety of the endovenous ambulatory selective varicose vein ablation under local anesthesia (eASVAL) method in a selected group of pa tients with varicose disease and present the short-term results of one-year ultrasonographic follow-up. METHODSThree hundred and ninety-five consecutive patients with varicose veins who had been treated with endovenous laser ablation (EVLA) were retrospectively reviewed over a period of two years. From this group, 41 patients who were treated using the eASVAL technique and had the great saphenous vein (GSV) preserved were included in the study. These patients had only limited segmental GSV reflux accompanied by a competent terminal valve. The eASVAL technique can be defined as EVLA of the proximal straight segments of the major tributaries connecting the symptomatic varicose veins with the GSV, followed by ultrasound-guided foam sclerotherapy of the superficial varicose veins themselves. The patients were assessed before and after the treatment by duplex scan findings and clinical assessment scores. RESULTSThe GSVs were successfully preserved in all 41 cases, and all patients showed significant clinical improvement using the eASVAL approach (P < 0.001). Segmental reflux was no longer present in 75.3% of patients. The mean diameters of the GSVs were significantly reduced at...

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Section: Discussionsupporting

confidence: 86%

The endovenous ASVAL method: principles and preliminary results

Atasoy

Oğuzkurt²

2015

Diagn Interv Radiol

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“…Эти данные подтверждают выводы P. Рittaluga и соавт. [7] и M. Biemans и соавт. [9], которые в 69,9 и 50% случаев соответственно отметили отсутствие рефлюкса через 12 мес.…”

Section: Discussionunclassified

“…В последние два десятилетия в литературе ак тивно обсуждают и другие теории развития варикоз ной болезни [1,[4][5][6][7]. В частности, восходящая тео рия предполагает, что, по крайней мере, во многих случаях первым шагом служат не рефлюкс в боль шой или малой подкожных венах, а варикозная трансформация и расширение их притоков.…”

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Isolated Phlebectomy Leads to Disappearance of Great Saphenous Vein Reflux

Золотухин¹,

Селиверстов²,

Захарова³

et al. 2016

Flebol.

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Оригинальные статьиУдаление или облитерация несостоятельного ствола большой подкожной вены (БПВ) у пациен тов с варикозной болезнью нижних конечностей представляет собой обязательный компонент любо го инвазивного лечения. Это практически постулат, основанный на традиционном объяснении этапов развития болезни: начало и дальнейшее прогресси рование варикозного расширения вен связано с формированием рефлюкса в БПВ, что вызывает трансформацию ее притоков и появление видимого варикозного расширения вен. В литературе послед них лет такое объяснение происходящих патологи Цель исследования -оценить влияние изолированной минифлебэктомии на рефлюкс в стволе большой подкожной вены (БПВ) и на его диаметр, а также определить частоту рецидива варикозной болезни после этого вмешательства. Материал и методы. В проспективное обсервационное исследование включены 66 больных (51 женщина и 15 мужчин) в возрасте от 17 лет до 71 года. у всех пациентов диагностирована варикозная болезнь с несостоятельностью ствола БПВ не ниже верхней трети голени. оперировано 76 нижних конечностей: класса С2 -в 62 (82%) случаях, класса С2-C3 -в 11 (14%) случаях, класса С2-С4 -в 3 (4%) случаях. Всем пациентам выполняли изолированную минифлебэктомию под местной анестезией, не удаляя несостоятельную БПВ. Контрольное дуплексное ангиосканирование проводили на следующий день (2-е сутки), а затем через 1 нед, 1, 3, 6, 12 мес. Во время ультразвукового исследования оценивали рефлюкс по БПВ и ее диаметр. Частоту рецидива варикозной болезни оценивали через 12 мес после вмешательства. результаты. Частота выявления рефлюкса по стволу БПВ проанализирована в подгруппе, включившей 58 нижних конечностей, со сроком наблюдения не менее 12 мес. Через год 39 (67%) БПВ были состоятельны. диаметр всех БПВ уменьшился независимо от того, исчез рефлюкс или нет. Рецидив заболевания в виде появления новых видимых варикозно-расширенных вен раз-вился на 7 (12%) из 58 нижних конечностей, осмотренных через 12 мес. Заключение. Изолированная минифлебэктомия с сохранением несостоятельного ствола БПВ приводит к исчезновению рефлюкса по нему в 67% случаев. диаметр ствола значительно уменьшается после удаления расширенных притоков. Вероятность исчезновения рефлюкса по БПВ особенно высока при протяженности несостоятельного сегмента ствола не ниже середины бедра. Aim -the aim of our study was to establish an effect of isolated phlebectomy in patients with primary varicose veins on reflux and diameter of incompetent great saphenous vein (GsV) and to assess clinical results of the procedure in terms of recurrence rate of varicose veins. Material and methods. 66 patients (51 women and 15 men) were included and prospectively followed. Age varied from 17 to 71 years. All the patients had primary varicose veins and GsV reflux not lower than the upper third of the calf. limbs were classified as C2 in 62 (82%) cases, as C2-C3 in 11 (14%) cases, and as С2-C4 in 3 (4%) cases. All the patients underwent isolated phlebectomy under local anaesthesia with preservation of incompetent GsV. All the limbs wer...

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“…UGFS on one side, and hook-phlebectomy on the other side represent mini-invasive treatments, which have undergone a growing diffusion as well. [22][23][24] In a recent meta-analysis , on the effectiveness of endovenous therapies for lower limb varices found, after 3 years, the estimated pooled success rates for stripping, UGFS, radiofrequency ablation, and laser therapy was 78%, 77%, 84% and 94% respectively. 25 Also in Rasmussen's randomized clinical trial at one year 5.8%, 4.8%, 16.3% and 4.8% of the GSVs were patent and refluxing in the laser, radiofrequency, foam and stripping groups respectively (P<0.001).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

Cavezzi

Mosti²,

Paolo

et al. 2015

Veins and Lymphatics

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A prospective comparative observational study was performed to assess the short--term efficacy and safety of the peri-saphenous infiltration of tumescence solution (PST) in great saphenous vein (GSV) long catheter foam sclerotherapy (LCFS) combined with phlebectomy of the varicose tributaries. Since November 2006 through November 2010 fifty-one consecutive patients (16 males and 35 females, mean age 51.5 years) who underwent LCFS of GSV + multiple phlebectomies were prospectively enrolled, without any pre-selection criteria, in three different groups (17 patients per group) and reviewed as to their outcomes: i) patients without additional PST; ii) with PST under visual control; iii) with ultrasound-guided PST. All procedures were performed in local anesthesia and an average of 7 mL [interquartile range (IQR) 6.5-7.5] of 3% sodiumtetradecylsulfate CO2+O2-based sclerosant foam was injected in the diseased segment of GSV (median caliber 7) (IQR 6-8) by means of a 4F long catheter. Clinical and color-duplex ultrasound (CDU) follow-up was performed at regular intervals, the last of which 14 months after the treatment.At 14 months follow-up no varicose veins were visible in 94%, 94% and 100% of the cases in group I, II and III respectively. The CDUbased outcomes were the following: 71%, 71% and 84% GSV occlusion rate in group I, II and III respectively; reflux was found in 5, 4 and 1 cases in group I, II and III respectively. Clinical and CDU morphologic and hemodynamic results were assembled and scored through an arbitrary system. The relative statistical analysis showed a significant (P<0.0001) improvement of the results for patients who received ultrasound guided PST over the other two groups. No relevant complications were recorded in all 51 cases.GSV treatment by means of LCFS + phlebectomy of varicose tributaries proved to be effective and safe in this prospective observational study. The addition of ultrasound guided PST resulted in a significant improvement of GSV occlusion rate and of varicose vein clinical resolution.

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Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein

Cited by 107 publications

References 37 publications

The endovenous ASVAL method: principles and preliminary results

The endovenous ASVAL method: principles and preliminary results

Isolated Phlebectomy Leads to Disappearance of Great Saphenous Vein Reflux

Ultrasound-guided perisaphenous tumescence infiltration improves the outcomes of long catheter foam sclerotherapy combined with phlebectomy of the varicose tributaries

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