Abstract
Endovascular treatment for iliac vein compression syndrome with or without lower extremity deep vein thrombosis: A retrospective study on mid-term in-stent patency from a single center
WY Shi, JP Gu, CJ Liu, et al.
Eur J Radiol 2016; 85: 7–14
The purpose of this study was to evaluate mid-term patency of iliac vein following endovascular treatment for iliac vein compression syndrome (IVCS) with or without deep venous thrombosis (DVT). Two hundred and thirty-three consecutive patients with IVCS were treated with endovascular treatment and followed up. The therapeutic strategies and complications were recorded. Cumulative patency was assessed with Kaplan–Meier curves. Independent predictors of in-stent obstruction were calculated with the Cox regression model. Endovascular treatment was technically successful in 225 of the 233 patients (96.6%). All of 225 patients were treated with percutaneous transluminal angioplasty and stent placement. No severe procedure-related complications occurred. The cumulative 1-, 3- and 5-year primary patency rates over a median follow-up time of 34 months (range, 0.3–82 months) were 93.2%, 84.3% and 74.5%, respectively. Independent predictors for in-stent obstruction included the use of multiple stents and irregular stocking wearing. The cumulative 1-, 3- and 5-year secondary patency rates were 100%, 93.3% and 92%, respectively. Endovascular treatment could achieve favorable mid-term patency in patients with IVCS with or without DVT.
Venous hemodynamic improvement after endovenous radiofrequency ablation of saphenous varicose veins
T Nishibe, M Mnishibe, S Suzuki, et al.
Int Angiol Epub ahead of print, 12 February 2016
The authors studied the hemodynamic changes before and after radiofrequency venous ablation utilizing air plethysmography and duplex. One hundred and twenty-one limbs were analyzed who underwent endovenous radiofrequency ablation (RFA) for varicose veins measuring the venous filling index (VFI) as a measure of reflux. Duplex scanning was performed to evaluate saphenous vein occlusion, deep venous thrombus and endovenous heat-induced thrombosis (EHIT). The VFI were significantly reduced from 4.1 ± 3.1 preoperatively to 1.4 ± 1.0, 1.3 ± 0.8 and 1.4 ± 1.2 at one week, one month and four months postoperatively, respectively. The percentage of the VFI > 2 ml/s was 77% preoperatively, while it significantly decreased to 17 %, 16% and 18% at one week, one month and four months postoperatively, respectively. Duplex scanning showed 100% of saphenous vein occlusion and no significant EHIT II-IV.
The authors conclude that RFA is a safe and hemodynamically effective treatment for varicose veins.
Comparison of 1470 nm laser and radial 2ring fiber with 980 nm laser and bare-tip fiber in endovenous laser ablation of saphenous varicose veins: A multicenter, prospective, randomized, non-blind study
M Hirokawa, T Ogawa, H Sugawara, et al.
Ann Vasc Dis 2015; 8: 282–289
From January 2007 to December 2011, 113 patients (113 limbs) with primary varicose veins were randomized into two groups. They were treated with radial 2ring fiber and 1470 nm laser in Group I (57 limbs) and bare-tip fiber and 980 nm laser in Group E (56 limbs); laser power setting of 10 W, while pulling back the fiber manually to achieve a linear endovenous energy density of 70 to 85 J/cm. Vein occlusion rates at 12 weeks and pain in treated region were recorded as primary end point. Visual analogue scale (VAS) for assessment of pain, rates of bruising, complications and equipment failure were recorded as secondary endpoint of safety. Occlusion rates at 12 weeks were 100% in both groups. Rates of pain (0% vs. 25.0%) and bruising (7.0% vs. 57.1%) were significantly lower in Group I (p < 0.0001). VAS of pain was significantly lower on postoperative day 1, day 5 and second week in Group I. Treatment of saphenous varicose veins by EVLA using a 1470-nm laser and a radial 2ring fiber resulted in comparable occlusion rates at 12 weeks and less postoperative pain and bruising than EVLA with a 980-nm laser and a bare-tip fiber.
Factors impacting on patient perception of procedural success and satisfaction following treatment for varicose veins
S Onida, J Shalhoub, HM Moore, et al.
Br J Surg Epub ahead of print, 1 February 2016
The authors studied retrospectively patient-reported outcome measures (PROMs) from a cohort of varicose vein patients over two-year period from the National Health Service Registry. The aim of the study was to examine PROMs for varicose vein interventions, characterizing factors that might predict patient-reported perception of procedural success and satisfaction. Data for 35,039 patient episodes (62.8% women) were available for analysis. 23.4% of patients reported anxiety or depression before treatment; a formal diagnosis of depression was present in 7.8 %. Quality of life, measured by generic EQ-5D-3 L™ index and the Aberdeen Varicose Vein Questionnaire improved after intervention by 11.7 % and 40.1 %, respectively. No significant improvement was found in EQ-5D™ visual analogue scale scores. There was a significant improvement in self-perceived anxiety or depression after the intervention. Both preoperative and postoperative depression or anxiety had a statistically significant relationship with self-reported success and satisfaction.
The authors concluded from this study that varicose veins improve quality of life, and anxiety or depression. Preoperative and postoperative anxiety or depression scores impact on patient-perceived success and satisfaction rates.
The endovenous ASVAL method: Principles and preliminary results
MM Atasoy and L Oğuzkurt.
Diagn Interv Radiol 2016; 22: 59–64
We 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 patients with varicose disease and present the short-term results of one-year ultrasonographic follow-up. Three 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.
The 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 one-year follow-up (8.5 mm vs. 7.5 mm, p < 0.001). The authors concluded that eASVAL is a feasible and safe procedure in selected patients, with promising results at one-year ultrasonographic follow-up. However, prospective studies are required, comparing this approach with the standard techniques.
Clinical results of a new strategy (modified CHIVA) for surgical treatment of anterior accessory great saphenous varicose veins
N Maldonado-Fernández, JP Linares-Palomino, C López-Espada, et al.
Cir Esp Epub ahead of print, 11 January 2016
The authors studied 65 patients with anterior great saphenous venous insufficiency and its resultant varicosities using phlebectomy alone. Venous duplex was used to ascertain the state of the AGSV preoperatively, 1 month and 12 months postoperatively. The baseline CEAP clinical classification was 58% C2, 26% C3 and 15% C4–6. Postoperatively, there were seven AGSVs that were partially thrombosed (all asymptomatic) and three hematomas. There was a decrease in the average AGSV original diameter 6.4 mm to 3.4 mm postoperatively at one year (p < 0.001). At 12 months, 82% of the AGSVs were competent. All patients had improvement in their clinical symptoms. Recurrence of varicosities was identified in 8% of the patients. Cases with saphenous diameters bigger than 7.5 mm and obesity were identified as predictors of worse clinical and hemodynamic outcome.
The authors concluded that this modified surgical strategy rather than ligation and phlebectomy for anterior saphenous varicose veins results in better clinical outcomes at one year postoperatively.
In vivo evaluation of safety and performance of a nitinol venous stent in an ovine iliac venous model
WA Marston, A Chinubhai, S Kao, et al.
J Vasc Surg Venous Lym Dis 2016; 4: 73–79
Stents currently used for treatment of chronic obstruction of the iliocaval outflow tract were originally designed for arterial applications. The etiology of arterial obstruction is different from venous obstruction, and the characteristics of an optimal stent for the treatment of venous disease may be different. This study evaluated the safety and performance of a novel venous stent (NVS) designed specifically for venous applications in an in vivo venous animal model. The study evaluated vascular response and safety of the NVS compared with the Wallstent Stent (WS; Boston Scientific, Marlborough, MA) at baseline, 56, and 180 days in adult sheep. Four sheep received a single NVS in the iliac vein for acute evaluation, and eight underwent bilateral iliac vein stenting using a single NVS on one side and a single WS on the other for longer term follow-up. Fluoroscopy and intravascular ultrasound imaging were performed at implantation to identify iliac vein diameters at baseline and again at 56 and 180 days. Both iliac veins from all 56-day and 180-day animals (n = 16) underwent histologic examination. Three sections from each vessel were reviewed for intimal strut coverage, luminal thickening, thrombus and evidence of venous injury. Student t-tests were used to compare mean iliac vein diameters for the WS and the NVS. Stent placement of the NVS and WS was successful to within 5 mm of the preselected location in all animals. During follow-up, no clinical evidence of stent thrombosis or obstruction >50% occurred in any limb. Sections of the stented vein at 56 and 180 days exhibited complete or nearly complete endothelial cell coverage, no or minimal luminal thrombus, and virtually complete neointimal coverage of every strut. The WS and NVS both caused an increase in iliac vein diameters immediately after stenting. At 180 days, there was no difference in iliac vein diameter or the percentage change in diameter compared with diameters immediately after stenting as measured by venography and intravascular ultrasound. These data support clinical evaluation of this NVS in appropriately designed human clinical trials.
Investigation of endovenous laser ablation of varicose veins in vitro using 1.885 μm laser radiation
AN Belyaev, AN Chabushkin, SA Khrushchalina et al.
Lasers Med Sci Epub ahead of print, 12 February 2016
The authors studied a new wavelength solid state-crystal 1.885 µm LiYF4:Tm laser (3 W) to access its effectiveness in ablating varicose veins in vitro. The model used saline and red blood cell suspension in the venous lumen to ascertain the impact of a heated carbonized layer precipitated on the fiber end face versus the efficiency of endovenous laser ablation (EVLA).
The authors concluded from their in vitro study that the presence of heated carbonized layer on the fiber end-face increases the efficiency of EVLA.