-
The Journal of Cardiovascular Surgery Feb 2006Crossectomy and stripping have been the standard of care for primary great saphenous varicose veins since the high failure rates of sclerotherapy became apparent in the... (Review)
Review
Crossectomy and stripping have been the standard of care for primary great saphenous varicose veins since the high failure rates of sclerotherapy became apparent in the 1970s. As the specialty of venous surgery has evolved, a number of clinical trials have established the optimal methods of surgical treatment, and the clinical benefit of routine stripping. Long-term trials, however, have uncovered a high recurrence rate after varicose vein surgery that approaches 70% after 10 years. There is much debate about whether this is the result of the dilatation of existing tributaries in the groin or the growth of new veins as a result of angiogenesis that follows surgical treatment and healing (neovascularisation). The addition of barrier technology to current crossectomy has the potential to improve the results of surgery in the future. In the meanwhile, new techniques are evolving to obliterate the great saphenous vein, including endovenous laser, radiofrequency ablation and foam sclerotherapy. Randomised clinical trials are urgently required to compare these new treatments against standard surgery, and they will need to focus on whether the short-term gains in reduced convalescence and morbidity are balanced by durable long-term results.
Topics: Health Status Indicators; History, Ancient; Humans; Minimally Invasive Surgical Procedures; Quality of Life; Randomized Controlled Trials as Topic; Saphenous Vein; Varicose Veins; Vascular Surgical Procedures
PubMed: 16434942
DOI: No ID Found -
Revista Do Colegio Brasileiro de... 2015To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein.
OBJECTIVE
To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein.
METHODS
We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics.
RESULTS
All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001).
CONCLUSION
The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.
Topics: Adult; Female; Humans; Middle Aged; Organ Sparing Treatments; Prospective Studies; Saphenous Vein; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures
PubMed: 26176677
DOI: 10.1590/0100-69912015002008 -
JPMA. the Journal of the Pakistan... Feb 2022To assess the types and effectiveness of simulators present for open varicose vein surgery.
OBJECTIVE
To assess the types and effectiveness of simulators present for open varicose vein surgery.
METHODS
The systematic review was conducted at The Aga Khan University Hospital Karachi and comprised studies published from 1st January 2000 to 30th June 2020 related to open varicose vein surgical procedures done on simulators. Databases searched were PubMed, Medline, Google Scholar, Cochrane and Scopus using appropriate key words. The primary outcome of the review was to assess the effectiveness of different types of simulators used for varicose vein surgery.
RESULTS
Of the 286 articles found, 6(2%) were included. A variety of simulators ranging from animal models, homemade simulators and commercially designed models with high fidelity options had been used. Technical competence was the major domain assessed in most of the studies 5(83.3%), while 1(16.6%) study focussed on self-assessment. Blinding was done in 4(66.6%) studies for assessment purpose, and videorecording of the trainees' performance was done in 5(83.3%) studies. Most studies 4(66.6%) found the use of simulation to be an effective tool in achieving technical competence.
CONCLUSION
The use of simulation in the training of surgical residents for open varicose vein surgery was found to be beneficial, but most studies were heterogeneous in terms of design, simulator types and study participants. This makes it difficult to establish the superiority of any one type of simulator over the rest. Further research is needed to develop and validate simulators in open varicose vein surgery procedures.
Topics: Animals; Clinical Competence; Humans; Pakistan; Simulation Training; Varicose Veins; Vascular Surgical Procedures
PubMed: 35202370
DOI: 10.47391/JPMA.AKU-10 -
EBioMedicine Feb 2015Clinical assessment and prognostic stratification of primary varicose veins have remained controversial and the molecular pathogenesis is unknown. Previous data have... (Clinical Trial)
Clinical Trial
BACKGROUND
Clinical assessment and prognostic stratification of primary varicose veins have remained controversial and the molecular pathogenesis is unknown. Previous data have suggested a contribution of the MTHFR (methylenetetrahydrofolate reductase) polymorphism c.677C>T.
METHODS
We collected blood and vein specimens from 159 consecutive patients undergoing varicose vein surgery, or autologous vein reconstruction for arterial occlusive disease as controls. We compared the frequencies of c.677C>T and another polymorphism of MTHFR, c.1298A>C, with morphology and types of complicated disease. Morphology was recorded as a trunk or perforator type and peripheral congestive complication was defined as chronic venous insufficiency (CEAP C3-6) associated with edema and skin manifestations.
FINDINGS
Multivariate analysis of genotypes for c.677C>T and c.1298A>C indicated that c.677C>T was associated significantly with the trunk phenotype (43/53 patients, 81%, p < 0.01), while c.1298A>C was associated significantly with the perforator phenotype (18/24 patients, 75%, p < 0.01) of primary varicose veins. Accordingly, when both c.677C>T and c.1298A>C displayed a heterozygous genotype, the patients were more likely to present with both phenotypes. Additionally, c.1298A>C was found to be strongly linked to the congestive complication (34/51 patients, 67%, p < 0.01).
INTERPRETATION
Both polymorphisms of MTHFR may be involved in the morphological specification of primary varicose veins and contribute to the development of complicated disease.
FUNDING
None.
Topics: Chronic Disease; Female; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Polymorphism, Genetic; Varicose Veins
PubMed: 26137554
DOI: 10.1016/j.ebiom.2015.01.006 -
VASA. Zeitschrift Fur Gefasskrankheiten Jul 2022The treatment success of catheter-based ovarian vein embolization due to peripheral varicose veins and ovarian vein reflux (OVR) should be investigated in this clinical...
The treatment success of catheter-based ovarian vein embolization due to peripheral varicose veins and ovarian vein reflux (OVR) should be investigated in this clinical investagtion. For this study, 95 female patients were identified over a 5-year period (beginning of 2006 to end of 2011) after catheter-based coil (+/- chemical) embolization of the ovarian vein due to peripheral primary or recurrent varicose veins and proven reflux in the ovarian vein. Treatment success was retrospectively assessed in 2014 by means of a structured telephone interview (n=60), clinical examination (n=56), duplex ultrasound (n=56) and magnetic resonance imaging (n=51) in patients who were willing to participate in the study. After an average of 51.9 months, 95.2% of the 60 included patients were diagnosed with recurrent varicose veins by duplex sonography and 88.1% by clinical examination. In 15.2%, a new intervention was required due to clinical symptoms. The median recurrence-free time was 47.0±5.5 months. A significant improvement by therapy was reported for all subjective symptoms in both pelvis and legs. No significant correlation between radiological findings and complaints or between radiological findings and clinical recurrence was found. The medical history of female patients with peripheral varicose veins should obligatorily include the question of symptoms in the pelvis. An appropriate diagnostic should follow in order to prevent a possible overlook of a pelvic leak point. Only then an individually adapted therapy for symptom relief is possible. Catheter-based ovarian vein embolization is one optional safe procedure that leads to significant improvement of subjective symptoms but does not necessarily prevent recurrent varicose veins.
Topics: Embolization, Therapeutic; Female; Humans; Lower Extremity; Ovary; Pelvis; Phlebography; Retrospective Studies; Treatment Outcome; Varicose Veins
PubMed: 35604333
DOI: 10.1024/0301-1526/a001008 -
Revista Da Associacao Medica Brasileira... 2022The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo.
OBJECTIVES
The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo.
METHODS
Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil.
RESULTS
Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in São Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure.
CONCLUSION
Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).
Topics: Adult; Humans; Male; Female; Middle Aged; Brazil; Hospitals, Public; Patient Discharge; Vascular Surgical Procedures; Varicose Veins
PubMed: 36449789
DOI: 10.1590/1806-9282.20220565 -
International Wound Journal Nov 2023Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain,... (Review)
Review
Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain, swelling, varicose veins, and skin changes, with venous ulceration ultimately occurring in severe disease. To assess the prevalence of CVD among health care workers, a scoping review of existing publications exploring the prevalence of CVD among health care workers was conducted in July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. A total of 15 papers met the inclusion criteria and these formed the basis of the review. Among health care workers, the mean prevalence of CVD was 58.5% and the mean prevalence for varicose veins was 22.1%. There is an increased prevalence of CVD in health care workers when compared with the general population. Therefore, there is a need for early diagnosis and the use of preventative measures to protect health care workers from CVD and varicose vein development.
Topics: Humans; Venous Insufficiency; Prevalence; Varicose Veins; Varicose Ulcer; Chronic Disease; Health Personnel
PubMed: 37139850
DOI: 10.1111/iwj.14222 -
Revista Da Associacao Medica Brasileira... Aug 2018This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction...
OBJECTIVE
This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose.
METHOD
This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers.
RESULTS
The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings.
CONCLUSIONS
The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease's clinical severity or reflux in the SFJ on a Doppler ultrasound.
Topics: Adult; Age Factors; Aged; Chronic Disease; Female; Femoral Vein; Humans; Male; Middle Aged; Prospective Studies; Saphenous Vein; Severity of Illness Index; Ultrasonography, Doppler, Color; Varicose Veins; Venous Insufficiency; Young Adult
PubMed: 30673044
DOI: 10.1590/1806-9282.64.08.729 -
Praxis Jul 2016Venous leg symptoms are frequent, but their relevance is frequently underestimated. With the introduction of effective, minimal-invasive endovenous treatment modalities... (Review)
Review
Venous leg symptoms are frequent, but their relevance is frequently underestimated. With the introduction of effective, minimal-invasive endovenous treatment modalities the treatment of varicose veins has recently made major advances. The basis of every treatment decision is a competent anamnesis, clinical investigation and duplex scan. Outpatient varicose vein treatment using endovenous methods has been proofed to be at least as effective as traditional varicose vein surgery but is associated with fewer adverse events. Accordingly, the endovenous methods are exspected to replace surgery as goldstandard treatment and endovenous thermal vein ablation (Laser/Radiofrequency) is accepted by the Swiss Federal Office of Public Health for general reimbursment since 1st january 2016. All currently available methods have their advantages and limitations, the individual selection based on the present symptoms, anatomic findings and patients’ preferences is fundamental for an optimal treatment result and maximized patient satisfaction.
Topics: Ambulatory Care; Catheter Ablation; Endovascular Procedures; Humans; Laser Therapy; Sclerotherapy; Stockings, Compression; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Varicose Veins
PubMed: 27381305
DOI: 10.1024/1661-8157/a002405 -
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