Recurrent varices after surgery: a clinical and color-Doppler ultrasound scan analysis

Bissacco, Daniele; Castronovo, E.; Romagnoli, Silvia; Domanin, Maurizio

doi:10.23736/s0392-9590.18.03939-1

Cited by 8 publications

(3 citation statements)

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“…Furthermore, in the majority of cases, studies on GSV recanalization and/or VVs recurrence focus their description on CDUS and/or clinical patterns of recurrence, without reporting preoperative risk factors. 12,17,18 Our analysis confirms results described by Van der Velden and collaborators, 19 in which clinical class and GSV diameter were the strongest predictors of recanalization 1 year after endovenous procedures. The 5-year results further reinforce this evidence, even though classes C3, C4, and C5 are independent risk factors up to the 3-year follow-up, becoming dependent risk factors at the 5-year follow-up.…”

Section: Discussionsupporting

confidence: 89%

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

et al. 2021

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Purpose The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). Materials and methods All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. Results During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. Conclusion RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.

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Section: Discussionsupporting

confidence: 89%

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

et al. 2021

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“…Despite literature does not provide discussions regarding the fate of type A or type B patients (termed and differentiated for the first time in this paper) who underwent or not an invasive treatment, it is possible to hypothesize that these groups might differ in long-term postoperative outcomes, 4 ,5 particularly at the SFJ level, which remains the most represented source of recurrence. 6…”

Section: Discussionmentioning

confidence: 99%

Are all patients with sapheno-femoral junction incompetence the same? An ultrasound analysis to potentially predict recurrence after invasive treatments

et al. 2023

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The sapheno-femoral junction (SFJ) and the great saphenous vein (GSV) are recognized as one of the main sources of reflux in chronic venous disease. Moreover, reflux time is considered as the main parameter to characterize GSV disease. Despite this, it is well-known in the clinical practice that not all patients with SFJ/GSV reflux are similar, in terms of disease severity and degree. Some other anatomical findings, such as SFJ and GSV diameters, as well as the absence/incompetence of suprasaphenic femoral valve (SFV) might be of interest to better “quantify” the disease severity. The aim of this paper is to describe, through a duplex scan analysis, the relationship between SFJ incompetence, GSV/SFJ diameter and SFV absence/incompetence, to identify if there are patients with “severe” GSV disease and a potential higher recurrence rate after invasive treatments.

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“…However, there is evidence that the failure to treat IPVs in patients with varicose veins is associated with recurrence in the future. 10 , 26 , 27 Since the advent of the transluminal occlusion of perforator (TRLOP) technique in 2000, 28 percutaneous treatment of these veins has now become an ambulatory procedure.…”

Section: Causes Of Varicose Veinsmentioning

confidence: 99%

Current Best Practice in the Management of Varicose Veins

Whiteley¹

2022

CCID

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This article outlines the current best practice in the management of varicose veins. “Varicose veins” traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, “varicose veins” is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called “hidden varicose veins”. Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local “feeding veins” and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.

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Recurrent varices after surgery: a clinical and color-Doppler ultrasound scan analysis

Cited by 8 publications

References 0 publications

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

Are all patients with sapheno-femoral junction incompetence the same? An ultrasound analysis to potentially predict recurrence after invasive treatments

Current Best Practice in the Management of Varicose Veins

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