High intensity focused ultrasound in treating great saphenous vein incompetence: Perioperative and 1-year outcomes.

BACKGROUND: To investigate the use of high intensity focused ultrasound (HIFU) for great saphenous vein (GSV) incompetence. MATERIAL AND METHODS: Patients with GSV incompetence underwent HIFU. The primary endpoint was the rate of GSV target segment shrinkage or closure after 1 year. RESULTS: Out of 188 limbs treated, the GSV treated segment shrinkage/closure rate at 1 week, 3 months, 6 months, and 12 months was 93.3%, 98.2%, 97.6%, and 98.3%, respectively. CONCLUSION: These preliminary results suggest that HIFU holds promise for the treatment of GSV incompetence. Further trials are needed to compare it with other techniques and assess long-term outcomes.

Ultrasound assessment is linked to histological vein wall thickness in chronic venous disease.

OBJECTIVES: Few studies compared both ultrasound and histological approaches for the same series of patients with chronic venous disease (CVD). We aimed to assess the diagnostic performances of duplex ultrasound assessment (US) of Vein Wall Thickness (VWT) among patients with CVD. METHODS: 38 adults with primary varicose veins having undergone Great Saphenous Vein thermal ablation with phlebectomy, and agreeing to biopsy of the Posterior Accessory Great Saphenous Vein (PASV) were consecutively included in a two-center prospective study. VWT assessment of the PASV was performed using both US, and microscope examination. High values for microscope-assessed VWT were defined at > 0.5 mm. RESULTS: The mean age was 53.0 ± 13.1 years, 71% were women. Maximization of US performances was obtained with a threshold of 0.6 mm: Sensitivity (Se) = 92.9%, Specificity (Sp) = 91.7%, positive (86.7%) and negative predictive value (NPV) (95.7%), positive (11.1) and negative likelihood ratio (NLR) (0.07). CONCLUSIONS: US assessment of VWT could be a non-invasive tool for diagnosis and follow-up in CVD, and an interesting in vivo parameter complementing diameter and reflux measures, with a view to optimizing treatment. It could help to determine i) the energy level necessary in case of endovenous laser ablation, and ii) the sclerosing agent concentration in case of chemical ablation.

Great saphenous vein surgery without high ligation of the saphenofemoral junction.

OBJECTIVE: The aim of this study was to evaluate whether great saphenous vein (GSV) surgery without high ligation of the saphenofemoral junction (SFJ) is beneficial in terms of varicose vein recurrence. METHODS: This was a prospective randomized trial set in a private practice. From December 2000 to May 2004, 120 patients were enrolled. Patients were randomly allocated preoperatively to two groups undergoing GSV surgery with (group A, n = 60) or without (group B, n = 60) high ligation of the SFJ. In four patients (two in each group), both limbs were operated on. Inclusion criteria were primary varicose veins with SFJ incompetence resulting in GSV reflux. Exclusion criteria were age <18 years, inability to give informed consent, associated small saphenous vein incompetence, and prior GSV surgery. Mean follow-up was 8 years and was complete in all but one patient (99.2%). The primary end point was varicose vein recurrence, defined as treated lower limbs with new thigh varices at clinical evaluation (CEAP ≥ 2) or venous reflux at the thigh or groin level, as assessed by duplex ultrasound imaging. RESULTS: The follow-up included 123 limbs. The combined clinical and ultrasound-determined recurrence rate was 24.4% (30 of 123): 32.2% (20 of 62) in group A vs 16.4% (10 of 61) in group B (P = .045). Postoperatively, recurrence of even minimal varices was observed in 24 limbs (19.5%): 18 of 62 (29.0%) in group A vs six of 61 (9.8%) in group B (P = .014). The ultrasound-detected recurrence rate was 22% (27 of 123): 32.2% (20 of 62) in group A vs 11.4% (7 of 61) in group B (P = .010). The average time to recurrence was 3.5 ± 1.2 years in group A and 4.1 ± 1.6 years in group B (P = .258). CONCLUSIONS: GSV surgery without high ligation of the SFJ is associated with low rates of clinical and ultrasound-determined recurrence of varicose veins.