The Effect of Endovenous Laser Ablation of Incompetent Perforating Veins and the Great Saphenous Vein in Patients with Primary Venous Disease

Shi, Huigang; Liu, Xinyu; Lü, Min; Lu, Xinwu; Jiang, Mier; Yin, Ming

doi:10.1016/j.ejvs.2015.01.013

Cited by 25 publications

(10 citation statements)

References 28 publications

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“…Treatment used Time of follow-up Perforator occlusion rate (%) Toonder et al 10 Cyanoacrylate glue (Sapheon) 3 months 76 Bacon et al 32 Radiofrequency ablation 5 years 81 Marsh et al 33 Radiofrequency ablation 1 year 72.3 (recurrent varicose veins) 87 (primary varicose veins) Van den Bos et al 34 Radiofrequency ablation 3 months 64 Hingorani et al 35 Radiofrequency ablation 1 month 88 Hissink et al 36 Laser ablation (810 nm) 3 months 78 Boersma et al 37 Laser ablation (810 nm) 6 weeks 63 Boersma et al 37 Laser ablation (1470 nm) 6 weeks 45 Shi et al 38 Laser ablation 1 year 81.3 Seren et al 8 Combined laser ablation and compression therapy…”

Section: Authormentioning

confidence: 99%

Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

Joy

Toms

et al. 2017

Phlebology

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Recurrent lower limb venous insufficiency is often a challenge in clinical practice and is most commonly due to incompetent perforators. Many of these patients do not have adequate symptom relief with compression and require some form of treatment for incompetent perforator interruption. Various treatment methods have been tried with different efficiencies. Objective To evaluate the feasibility, efficiency and safety of an outpatient combined cyanoacrylate adhesion-sodium tetradecyl sulphate sclerotherapy for treatment of patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators. Methods Eighty-three limbs of 69 patients with symptoms of persistent or recurrent lower limb venous insufficiency secondary to incompetent perforators were treated with cyanoacrylate embolization of incompetent perforators and sclerotherapy of dilated collateral veins (surface branch varicose veins). Technical success, procedural pain, perforator occlusion, venous occlusion, clinical improvement and ulcer healing were assessed. Follow-up was done three- and six-month post-procedure. Results Procedure could be successfully performed in all patients. One hundred and ninety-one perforators were treated in total. Perforator and varicose veins occlusion rate was 100%. Deep venous extension of cyanoacrylate occurred in four (4.8%) patients, with no adverse clinical outcome. Venous clinical severity score improved from a baseline of 8.18 ± 3.60 to 4.30 ± 2.48 on three-month follow-up and 2.42 ± 1.52 on six-month follow-up (p < 0.0001). All ulcers showed complete healing within three months. Significant prolonged thrombophlebitis occurred in 38.5% of limbs. Conclusion Combined cyanoacrylate adhesion and setrol sclerotherapy is technically easy, has a lot of advantages including being an outpatient procedure and highly efficacious but with a guarded safety profile.

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Section: Authormentioning

confidence: 99%

Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

Joy

Toms

et al. 2017

Phlebology

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“…However, when deep calf thrombi are identified on postprocedure venous ultrasound, they may still be considered EHIT if the thrombus extends into a calf vein from a treated perforator, a treated SSV directly draining into a gastrocnemius vein, or a treated below-knee GSV through a perforator. 29,30 Examples of non-EHIT DVT include a thrombus in a deep vein nonadjacent to the saphenofemoral junction after GSV ablation, a thrombus remote from the saphenopopliteal junction after SSV ablation, a remote calf vein thrombus after GSV ablation, and a DVT in the contralateral limb. Both types of DVT, EHIT and non-EHIT, may be present in the same patient.…”

Section: Introduction and Rationalementioning

confidence: 99%

Section: Introduction and Rationalementioning

confidence: 99%

Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has

et al. 2020

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The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT. One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed. Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.

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“…Evidence to ligate/obstruct perforating veins in patients with venous ulcers has been published for a variety of surgical or minimally invasive techniques. 7–34 There are, however, questions and critiques about (a) proper indications, (b) selection of perforating veins that should be excluded, and (c) contribution of perforating vein ligation in comparison to other treatments necessary for ulcer healing. 1,30–34…”

Section: Introductionmentioning

confidence: 99%

“…A pubmed.org search on “SEPS” showed a decrease in significant publications from around 10 per year in 1999–2003 to ≍4 per year from 2004 on. Decreased interest on SEPS was not really replaced by thermal ablation techniques, such as radiofrequency 16–19 or laser, 20–23 or even chemical ablation with foam sclerotherapy. 24–26 Perforating vein surgical ligation, often based on ultrasound mapping for aesthetic phlebology, has been an alternative for patients with ulcers.…”

Section: Introductionmentioning

confidence: 99%

Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution

Abreu

Salles-Cunha²

2016

Journal for Vascular Ultrasound

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Background Perforating vein ligation has been proposed for the treatment of chronic venous ulcers in the leg. Pubmed.org, however, showed a lack of increase in subfascial endoscopic perforator surgery (SEPS) publications, even before the popularization of perforating vein thermal or chemical ablation procedures. We renewed an investigation on perforating vein ligation surgery as part of venous ulcer treatment. The basic question was if ulcer size and number of notable perforating veins were related. Methods Leg perforating veins were detected by ultrasonography (US) and by clinical palpation in 118 legs of 104 subjects, mostly women (79, 76%). This group represented a sample of a mostly rural Brazilian population. Inclusion criterion was any “request for venous US at any stage of ulcer treatment.” Ulcer size in centimeters squared and number of detected perforating veins (NP) were compared using Pearson correlation coefficient p available with Excel. Results Average ulcer size was 13 ± 17 cm2 (1–100) for NP = 0–7, resulting in p = −0.18 for the 118 pairs of data. Subgroup averages were 16, 16, 11, 8, and 8 cm2 for NP = 0, 1, 2, 3, and ≥4 perforating veins detected (n = 32, 30, 29, 16, and 11, respectively), resulting in p = −0.94 for such averages and NP. Conclusion Ulcer size failed to correlate with number of detected perforating veins based on raw data but correlated inversely to such number if subgroup averages were compared. Average ulcer size was larger for subgroups of legs with lesser number of perforating veins. Arbitrary ligation of detectable perforating veins may result in ulcer size augmentation. Detailed research must continue to find criteria to indicate (a) ligation or (b) preservation of specific perforating veins either (a) detrimental or (b) contributory to venous ulcer healing.

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The Effect of Endovenous Laser Ablation of Incompetent Perforating Veins and the Great Saphenous Vein in Patients with Primary Venous Disease

Abstract: EVLA was safe and effective in reducing the number of IPVs in PVI. However, the addition of IPV EVLA had no effect on ulcer healing rate, VCSS or varicose vein recurrence at 1 year follow up.

Cited by 25 publications

References 28 publications

Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy

Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution

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