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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 -
PloS One 2022Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in... (Observational Study)
Observational Study
Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.
Topics: Adult; Aged; Female; Humans; Laser Therapy; Male; Middle Aged; Phlebography; Preoperative Period; Retrospective Studies; Saphenous Vein; Tomography, X-Ray Computed; Ultrasonography, Doppler; Varicose Veins
PubMed: 35167584
DOI: 10.1371/journal.pone.0263513 -
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 -
BJOG : An International Journal of... Oct 2023To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices.
OBJECTIVE
To investigate the association between chronic pelvic pain (CPP) and pelvic vein incompetence (PVI) or pelvic varices.
DESIGN
Case-control study.
SETTING
Gynaecology and vascular surgery services in two teaching hospitals in north-west England.
SAMPLE
A total of 328 premenopausal women (aged 18-54 years), comprising 164 women with CPP and 164 matched controls with no history of CPP.
METHODS
Symptom and quality-of-life questionnaires and transvaginal duplex ultrasound for PVI and pelvic varices.
MAIN OUTCOME MEASURES
Venous reflux of >0.7 s in the ovarian or internal iliac veins (primary outcome) and presence of pelvic varices (secondary outcome). Statistical analysis compared the prevalence of PVI between women with and without CPP using the two-sided chi-square test. Logistic regression was used to compare the odds of having PVI and pelvic varices between women with and without CPP.
RESULTS
Pelvic vein incompetence was found on transvaginal duplex ultrasound in 101/162 (62%) women with CPP, compared with 30/164 (19%) asymptomatic controls (OR 6.79, 95% CI 4.11-11.47, p < 0.001). Forty-three of 164 (27%) women with CPP had pelvic varices compared with three of 164 (2%) asymptomatic women (OR 18.9, 95% CI 5.73-62.7, p < 0.001).
CONCLUSIONS
There was a significant association between PVI, as detected by transvaginal duplex imaging, and CPP. Pelvic varices were strongly associated with CPP and were infrequently seen in control patients. These results justify further evaluation of PVI and its treatment in well-designed research.
Topics: Humans; Female; Male; Case-Control Studies; Venous Insufficiency; Pelvic Pain; Varicose Veins; Iliac Vein; Chronic Pain
PubMed: 37095613
DOI: 10.1111/1471-0528.17485 -
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 -
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 -
Rozhledy V Chirurgii : Mesicnik... 2022During the last two decades, superficial venous surgery has experienced an unprecedented boom. Traditional surgical procedures (crossectomy and stripping) are now being... (Review)
Review
During the last two decades, superficial venous surgery has experienced an unprecedented boom. Traditional surgical procedures (crossectomy and stripping) are now being replaced to a greater or lesser extent by new less invasive endovenous methods. Our aim is to provide an up-todate review of all available endovenous techniques (laser, radiofrequency, steam, mechanochemical ablation and venous glue) describing the indications, the technique and mechanism of action, and the results. In experienced hands, all endovenous techniques are safe and effective, with long-term results comparable to conventional surgical procedures.
Topics: Catheter Ablation; Humans; Laser Therapy; Saphenous Vein; Treatment Outcome; Varicose Veins
PubMed: 35667870
DOI: 10.33699/PIS.2022.101.5.200-210 -
Polski Przeglad Chirurgiczny Apr 2022To investigate the influence of iliac vein stenosis on clinical course and recurrence of primary varicose veins after surgeryMaterials and methods: Thirty-three patients...
INTRODUCTION
To investigate the influence of iliac vein stenosis on clinical course and recurrence of primary varicose veins after surgeryMaterials and methods: Thirty-three patients with primary varicose veins qualified for great saphenous vein stripping were analysed. The stenosis of common (CIV) and external (EIV) iliac vein was measured by IVUS and defined in three categories as minimal lumen area <90 mm2 for CIV and <75 mm2 for EIV, minimal lumen diameter <10 mm for CIV and <7.5 mm for EIV and area reduction >50%. The patients were assessed clinically and by Duplex ultrasound 48 to 72 months after the procedure. Any recurrence, the recurrence in the saphenofemoral junction (SFJ), change in Venous Clinical Severity Score ( VCSS), were analyzed in relation to the stenosis in the CIV and EIV.
RESULTS
The follow-up was completed in 27 patients. Any recurrence and the recurrence in the SFJ were observed in 70% and 18.5% of patients, respectively. There were no statistically significant differences in any recurrence, the recurrence in the SFJ and VCSS in relation to CIV and EIV stenosis in any category.
CONCLUSIONS
Iliac vein stenosis does not influence the clinical course and recurrence of primary varicose veins after surgery.
Topics: Humans; Iliac Vein; Constriction, Pathologic; Recurrence; Varicose Veins; Disease Progression; Treatment Outcome
PubMed: 36807090
DOI: 10.5604/01.3001.0015.8210