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Journal of Vascular Surgery. Venous and... Mar 2022To analyze the effectiveness and cost effectiveness of technologies for treatment of varicose veins over 5 years-conservative care, surgery (high ligation and...
OBJECTIVE
To analyze the effectiveness and cost effectiveness of technologies for treatment of varicose veins over 5 years-conservative care, surgery (high ligation and stripping), ultrasound-guided foam sclerotherapy (UGFS), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), mechanochemical ablation (MOCA), and cyanoacrylate glue occlusion (CAE).
METHODS
A systematic review was updated and used to construct a Markov decision model. Outcomes were reintervention on the truncal vein, retreatment of residual varicosities and quality-adjusted life years (QALY) and costs over 5 years.
RESULTS
UGFS has a significantly greater reintervention rate than other procedures; there is no significant difference between the other procedures. The cost per QALY of EVLA vs UGFS in our base-case model is £16,966 ($23,700) per QALY, which is considered cost effective in the UK. RFA, MOCA, and CAE have greater procedure costs than EVLA with no evidence of greater benefit for patients.
CONCLUSIONS
EVLA is the most cost-effective therapeutic option, with RFA a close second, in adult patients requiring treatment in the upper leg for incompetence of the GSV. MOCA, UGFS, CAE, conservative care, and high ligation and stripping are not cost effective at current prices in the UK National Health Service. MOCA and CAE seem to be promising, but further evidence on the effectiveness, reinterventions, and health-related quality of life is needed, as well as how cost effectiveness may vary across settings and reimbursement systems.
Topics: Clinical Decision-Making; Cost-Benefit Analysis; Decision Support Techniques; Health Care Costs; Humans; Markov Chains; Models, Economic; Quality of Life; Quality-Adjusted Life Years; Time Factors; Treatment Outcome; Varicose Veins
PubMed: 34450353
DOI: 10.1016/j.jvsv.2021.05.014 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2020The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the...
OBJECTIVE
The aim: With the help of biochemical and morphological methods of investigation to identify the causes of a false postoperative recurrence of varicose veins after the EVLC.
PATIENTS AND METHODS
Materials and methods: In 173 patients with varicose veins of the lower extremities, the level of markers of endothelial dysfunction was determined: P-selectin, E-selectin, tissue plasminogen activator, endothelin-1, adhesion molecules of type 1 vascular endothelium (sVCAM-1-soluble vascularcellularmolecula), circulating endothelial cells (CEC) before surgery (EVLC), on the 10th and 60th day of the postoperative period.At the same time, a morphological and electron microscopic examination of the state of the deep venous system in 31 patients with varicose vein disease of the lower extremities who died from acute heart failure, was performed.
RESULTS
Results: Increased values of markers of endothelial dysfunction in patients with varicose veins of the lower extremitiesbefore surgery of EVLC were established. We found that, despite the operation, the parameters of endothelial dysfunction decrease, but in the remote postoperative period do not come to the norm. Morphological and electron microscopic studies of the deep vein wall revealed pathomorphological changes in all of their layers, especially the endothelial layer. At the heart of the development of endothelial dysfunction in the postoperative period, the leading role belongs to changes in mitochondria.
CONCLUSION
Conclusions: 1. Based on our research, we can state that there are significant pathomorphological and pathophysiological changes in the deep venous system of the lower extremities in conditions of varicose vein disease. 2. The initiator of postoperative relapse of varicose veins are structural changes in the wall of deep veins with a violation of the integrity of the endothelial lining, contributing to the absorption of plasma and leukocyte contents from the blood stream in the interstitium, with the following pathological changes in the layers of deep veins.Such changes are the basis for the manifestations of endothelial dysfunction in the postoperative period.
Topics: Endothelial Cells; Humans; Lasers; Recurrence; Tissue Plasminogen Activator; Varicose Veins
PubMed: 33454685
DOI: No ID Found -
Journal of Vascular Surgery. Venous and... Jul 2022Pregnancy is a known risk factor for developing varicose veins (VV). However, pregnancy is often considered a homogeneous entity and few studies have examined if...
BACKGROUND
Pregnancy is a known risk factor for developing varicose veins (VV). However, pregnancy is often considered a homogeneous entity and few studies have examined if specific characteristics and complications of pregnancy may influence VV formation. This study sought to identify which pregnancy-specific factors are associated with the development of VV.
METHODS
All women who gave birth (live or still) between 1998 and 2020 within a multicenter health care system were identified retrospectively and followed through all hospital encounters (inpatient and outpatient). The primary outcome was VV, defined as any encounter with a primary diagnosis code for VV or a procedure for VV. The study period for each woman was the time from the first to last encounter. Extended Cox regression modeling evaluated the association between VV and pregnancy-related factors as a time-varying covariates while controlling for patient comorbidities.
RESULTS
There were 156,622 women with a median follow-up of 8.3 years (interquartile range, 2.7-16.6 years) included. During this time, 225,758 deliveries occurred. The 10- and 20-year freedom from VV was 97.0% (95% CI, 96.8%-97.1%) and 92.7% (95% CI, 92.4%-93.0%), respectively, from the estimated start of first pregnancy. Overall, 4028 patients (2.57%) developed VV during the follow-up period and 1594 (1.02%) underwent a procedure for VV. After risk adjustment, increasing parity was significantly associated with VV, with each subsequent pregnancy increasing hazard of developing VV (parity = 1: hazard ratio [HR], 1.78; 95% CI, 1.55-1.99; P < .001; parity ≥6: HR, 4.83; 95% CI, 2.15-1.99-10.9; P < .001), Other significant pregnancy factors included excessive weight gain in pregnancy (HR, 1.44; 95% CI, 1.09-1.91; P = .011), post-term pregnancy (HR, 1.12; 95% CI, 1.02-1.21; P = .021), pre-eclampsia (HR, 0.79; 95% CI, 0.70-0.90; P < .001), and postpartum transfusion of platelets, plasma, or cryoprecipitate (HR, 2.05; 95% CI, 1.19-3.53; P = .001).
CONCLUSIONS
Increasing parity, excessive weight gain in pregnancy, post-term pregnancy, and pre-eclampsia affect the development of VV after pregnancy. Although VV after pregnancy are likely underreported and true incidence is unknown, women should be counseled about the impact of these factors on VV development after pregnancy.
Topics: Female; Humans; Pre-Eclampsia; Pregnancy; Retrospective Studies; Risk Factors; Varicose Veins; Weight Gain
PubMed: 35074521
DOI: 10.1016/j.jvsv.2022.01.003 -
Circulation Dec 2018Varicose veins are a common problem with no approved medical therapies. Although it is believed that varicose vein pathogenesis is multifactorial, there is limited... (Observational Study)
Observational Study
BACKGROUND
Varicose veins are a common problem with no approved medical therapies. Although it is believed that varicose vein pathogenesis is multifactorial, there is limited understanding of the genetic and environmental factors that contribute to their formation. Large-scale studies of risk factors for varicose veins may highlight important aspects of pathophysiology and identify groups at increased risk for disease.
METHODS
We applied machine learning to agnostically search for risk factors of varicose veins in 493 519 individuals in the UK Biobank. Predictors were further studied with univariable and multivariable Cox regression analyses (2441 incident events). A genome-wide association study of varicose veins was also performed among 337 536 unrelated individuals (9577 cases) of white British descent, followed by expression quantitative loci and pathway analyses. Because height emerged as a new candidate risk factor, we performed mendelian randomization analyses to assess a potential causal role for height in varicose vein development.
RESULTS
Machine learning confirmed several known (age, sex, obesity, pregnancy, history of deep vein thrombosis) and identified several new risk factors for varicose vein disease, including height. After adjustment for traditional risk factors in Cox regression, greater height remained independently associated with varicose veins (hazard ratio for upper versus lower quartile, 1.74; 95% CI, 1.51-2.01; P<0.0001). A genome-wide association study identified 30 new genome-wide significant loci, identifying pathways involved in vascular development and skeletal/limb biology. Mendelian randomization analysis provided evidence that increased height is causally related to varicose veins (inverse-variance weighted: odds ratio, 1.26; P=2.07×10).
CONCLUSIONS
Using data from nearly a half-million individuals, we present a comprehensive genetic and epidemiological study of varicose veins. We identified novel clinical and genetic risk factors that provide pathophysiological insights and could help future improvements of treatment of varicose vein disease.
Topics: Adult; Aged; Blood Vessels; Body Height; Bone and Bones; Cohort Studies; Female; Follow-Up Studies; Gene-Environment Interaction; Genetic Loci; Genome-Wide Association Study; Humans; Male; Mendelian Randomization Analysis; Middle Aged; Neovascularization, Pathologic; Proportional Hazards Models; Risk Factors; United Kingdom; Varicose Veins
PubMed: 30566020
DOI: 10.1161/CIRCULATIONAHA.118.035584 -
Annals of Vascular Surgery May 2022Varicose vein surgeries are the most commonly performed vascular procedure to treat the most prevalent vascular disease, chronic venous disease. However, nationwide...
BACKGROUND
Varicose vein surgeries are the most commonly performed vascular procedure to treat the most prevalent vascular disease, chronic venous disease. However, nationwide studies on the epidemiology of varicose vein surgeries are scarce, none in developing countries. Therefore, we designed this study to assess the total number of varicose vein surgeries performed between 2008 and 2019 in the Public Health System, which exclusively insures more than 160 million Brazilians, their trends, costs and mortality rates.
METHODS
Public and open data referring to all surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the Brazilian Ministry of Health database.
RESULTS
A total of 869,220 surgeries were performed to treat chronic venous disease in Brazilian public hospitals and outpatient clinics, with an average rate of 4.5 surgeries per 10,000 inhabitants per year. Starting in 2015, we observed a slight non-significant downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 232,775,518.11. A total of 49 deaths were reported after varicose vein surgery, corresponding to a mortality rate of 0.0056%.
CONCLUSIONS
A total of 869,220 surgeries were performed to treat chronic venous disease over twelve years, with an overall rate of 4.52 procedures per 10,000 population per year. The mortality rate was very low, 0.0056%.
Topics: Brazil; Chronic Disease; Humans; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures; Veins
PubMed: 34942339
DOI: 10.1016/j.avsg.2021.11.016 -
Computational and Mathematical Methods... 2022To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities. (Comparative Study)
Comparative Study Observational Study
Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study.
OBJECTIVE
To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities.
METHODS
Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups.
RESULTS
There were no significant differences in baseline characteristics between the two groups ( > 0.05). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group ( > 0.05). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group ( < 0.05). There were no significant differences in recurrent varicose vein incidences ( > 0.05). After surgery, the venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation ( < 0.05). There was no significant difference in VCSS score or CIVIQ-14 scores between the two groups postoperation ( > 0.05). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively.
CONCLUSION
The modified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modified above-knee technique is worthy of clinical application.
Topics: Adult; Aged; Computational Biology; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Recurrence; Retrospective Studies; Saphenous Vein; Ultrasonography, Doppler, Color; Varicose Veins; Vascular Surgical Procedures
PubMed: 35069794
DOI: 10.1155/2022/7730960 -
Interactive Cardiovascular and Thoracic... Jan 2021We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2...
OBJECTIVES
We evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits.
METHODS
A total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge.
RESULTS
There was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55).
CONCLUSIONS
Varicose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.
Topics: Adult; Aged; Female; Humans; Laser Therapy; Male; Middle Aged; Recurrence; Time Factors; Treatment Outcome; Varicose Veins
PubMed: 33212479
DOI: 10.1093/icvts/ivaa219 -
Vascular and Endovascular Surgery Jan 2024endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel"...
Safety and Efficacy of Combining Saphenous Endovenous Laser Ablation and Varicose Veins Foam Sclerotherapy: An Analysis on 5500 Procedures in Patients With Advance Chronic Venous Disease (C3-C6).
BACKGROUND
endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes.
METHODS
all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions.
RESULTS
5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively.
CONCLUSIONS
EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients.
Topics: Male; Humans; Female; Middle Aged; Sclerotherapy; Treatment Outcome; Varicose Veins; Venous Insufficiency; Saphenous Vein; Laser Therapy; Chronic Disease
PubMed: 37430384
DOI: 10.1177/15385744231188804 -
Lakartidningen May 2021The aim of this study was to estimate the number of treatments for varicose veins (VV) performed in Sweden annually and the proportion of these unknown to the National...
The aim of this study was to estimate the number of treatments for varicose veins (VV) performed in Sweden annually and the proportion of these unknown to the National Board of Health and Welfare or to the Swedish National Registry for Vascular Surgery, Swedvasc. Aggregated data was collected from the National Patient Registry (NPR), Swedvasc and inquiries sent to hospitals and private clinics for the years 2016-2018, the calculated volumes from these three sources were comparable with extrapolated volumes obtained from a coverage control between NPR and Swedvasc for treatments of the great saphenous vein. The approximated volumes of VV interventions annually were 8 650, 10 750 and 12 250, the proportion not registered in NPR 29%, 51% and 58% respectively, the corresponding figures for Swedvasc 56%, 33% and 20%. Interventions for VV are thus underreported in Sweden and this has implications for allocation of resources and quality control.
Topics: Humans; Registries; Saphenous Vein; Sweden; Varicose Veins; Vascular Surgical Procedures
PubMed: 35343574
DOI: No ID Found -
Annals of Vascular Surgery Aug 2019The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive...
BACKGROUND
The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations.
METHODS
Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site.
RESULTS
Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period.
CONCLUSIONS
The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.
Topics: Aged; Endovascular Procedures; Female; Humans; Male; Middle Aged; Polidocanol; Prosthesis Design; Quality of Life; Retrospective Studies; Saphenous Vein; Sclerosing Solutions; Sclerotherapy; Stents; Surveys and Questionnaires; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Varicose Veins
PubMed: 31009711
DOI: 10.1016/j.avsg.2019.01.025