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Background: Varicose veins are permanently swollen, tortuous and elongated while standing due to back flow of blood caused by incompetent valve closure which result in venous congestion .they are of two types primary and secondary varicosities .The main symptoms are tingling, itching, pain, fatigue, a heavy feeling in the legs especially if one has to stand for a long time. Ulcers and thrombophlebitis are possible complications. The aim of this study is to assess the outcome of laser ablation of great saphenous vein on healing of varicose ulcers.Methods: A prospective study conducted at Suez Canal University Hospitals and Nasser Institute Hospital in Cairo on 20 patients complaining varicose ulcers due to incompetent saphenous femoral junction.Results: All patients had improvement in Abrdeen Varicose vein questionnaire after endovenous laser ablation (EVLA) during the first, second and third follow up visits when compared with preoperative scores. The Aberdeen Varicose vein questionnaire ranged from 8 to 18 before the procedure, with a mean of 12.11, ranged from 3 to 11 at the first follow up visit with a mean of 7.07, ranged from 2 to 10 at the second follow up visit with a mean of 4.89 and ranged from 2 to 10 at the third follow up visit with a mean of 3.85, p value is less than 0.001 compared to the pre-operative data. During the assessment of the patients of our study after 6 months of continuous follow up, we found that the healing rate of the patients who underwent laser ablation of great saphenous vein were (91.67) (p=0.769).Conclusions: EVLA of great saphenous vein leads to better wound healing rates in treating patients with varicose ulcers.
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ABSTRACT BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.
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Humans , Varicose Veins , Venous Insufficiency , Saphenous Vein , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To study the effect of endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs.Methods Clinical data of 112 patients undergoing endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs from Oct 2011 to Feb 2016 was retrospectively evaluated.Results Patients had average 2-6 perforating veins in their affected lower limbs.Procedures were successful in all the patients,all the superficial varicose veins disappeared after 1 month and 1 year of ultrasound follow-up,perforating veins closed,ulcer healed,and chromatosis alleviated.Conclusion Endovenous laser ablation combined with subfascial endoscopy therapy for venous ulcer of the lower limbs is effective,safe and quick recovery.
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Objective To explore the therapeutic effects of endovenous laser ablation (EVLA) combined with percutaneous continuous circumsuture (PCCS) and EVLA in treating severe great saphena varicose. Methods A total of 60 patients with unilateral great saphenous varicose level C5-C6 were randomly divided into control group and experimental group according to the CEAP system. Control group was given EVLA surgery while experimental group was given EVLA+PCCS surgery. Data of operation time, hospital stay, intraoperative blood loss, the rate of ulcer healing, variceal recurrence rate and postoperative complication rate within 6 months after operation were compared between two groups. Results The mean operative time and intraoperative blood loss were lower in the experimental group than those in the control group ( P<0.05). There were no significant differences in hospital stay, ulcer healing rate and recurrence rate between two groups ( P>0.05). No deep venous thrombosis was found after treatment in two groups. The occurrence rates of skin burns and subcutaneous ecchymosis were significantly lower in the experimental group than those in the control group ( P<0.05). There were no significant differences in the incidence rates of other complications between two groups (P>0.05). Conclusion EVLA combined with PCCS in the treatment of severe saphenous varicose veins can significantly shorten the operation time, reduce the amount of bleeding, reduce the incidence rates of skin burns and subcutaneous ecchymosis on the premise of promising cure rate and recurrence rate. Overall, the combination therapy is superior than monotherapy.
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Objective To explore the therapeutic effects of endovenous laser ablation (EVLA) combined with percutaneous continuous circumsuture (PCCS) and EVLA in treating severe great saphena varicose. Methods A total of 60 patients with unilateral great saphenous varicose level C5-C6 were randomly divided into control group and experimental group according to the CEAP system. Control group was given EVLA surgery while experimental group was given EVLA+PCCS surgery. Data of operation time, hospital stay, intraoperative blood loss, the rate of ulcer healing, variceal recurrence rate and postoperative complication rate within 6 months after operation were compared between two groups. Results The mean operative time and intraoperative blood loss were lower in the experimental group than those in the control group ( P<0.05). There were no significant differences in hospital stay, ulcer healing rate and recurrence rate between two groups ( P>0.05). No deep venous thrombosis was found after treatment in two groups. The occurrence rates of skin burns and subcutaneous ecchymosis were significantly lower in the experimental group than those in the control group ( P<0.05). There were no significant differences in the incidence rates of other complications between two groups (P>0.05). Conclusion EVLA combined with PCCS in the treatment of severe saphenous varicose veins can significantly shorten the operation time, reduce the amount of bleeding, reduce the incidence rates of skin burns and subcutaneous ecchymosis on the premise of promising cure rate and recurrence rate. Overall, the combination therapy is superior than monotherapy.
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Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation (EVLA) is a frequently used method. A newly developed alternative, based on thermal therapy, is endovenous microwave ablation (EMA). This study evaluated the effect of the two procedures, in terms of coagulation and histological changes, in occluding lateral veins in goats. Twelve animals were randomized into two group, with 6 treated with EMA (EMA group), and the rest 6 with EVLA (EVLA group). Results of coagulation, including coagulation, fibrinolysis and platelet activation, were assessed at three or four different time points: before, immediately after, 24 h (and 48 h) after ablation. The diameter change, a measure of efficacy, was ultrasonographically measured before and 1 month after the ablation. Histological changes were grossly and microscopically evaluated immediately, 1 and 3 month(s) after the ablation. The length of the ablated vein and preoperative average diameter were comparable between the two groups. In both EMA and EVLA groups, several coagulation parameters, fibrinolysis and platelet activation parameters only underwent slight changes. Ultrasound imaging displayed that the diameter reduction of the veins treated by EMA was significantly larger than by EVLA, in consistent with the results of macroscopic examination. Microscopic examination revealed necrosis and thickening of the vein wall, and occlusion of the lumen within 3 months after ablation in both EMA and EVLA groups. It is concluded that EMA is a minimally invasive therapy, which appears to be safe and effective for treatment of lateral veins in goats.