Minimally invasive techniques in the treatment of saphenous varicose veins.

Lower extremity venous insufficiency is common and increases with age. In addition to classical symptoms, it may result in skin changes and venous ulcers. Chronic venous insufficiency has a great impact on patients' health-related quality of life and is associated with considerable health care costs. Surgical ligation Of the junction with or without stripping has been the standard of care in the treatment of insufficient great and small saphenous veins. However, the recurrence rates are relatively high and surgery may be associated with serious adverse events and considerable down time; it is also cosmetically Suboptimal. To improve efficacy, patients' health-related quality of life and tre…

Gravimetrically Controlled Efficacy of Subcorial Curettage: A Prospective Study for Treatment of Axillary Hyperhidrosis

Botulinum toxin A (BTX-A) proved to be effective for the treatment of axillary hyperhidrosis by means of gravimetry. Quantitatively controlled studies for surgical treatment are lacking so far.To prospectively test the efficacy of subcorial axillary curettage by gravimetric evaluation of pre- and postsurgical sweat rates.Conservatively pretreated patients received subcorial curettage under tumescent local anesthesia using a sharp spoon. Sweat rates of each axilla were determined gravimetrically before and 4-8 weeks after surgery. Evaluation was performed with respect to baseline sweat rates greater than 50 mg/min (group A), greater than 25 and less than 50 mg/min (group B), and less than 25…

Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients

BACKGROUND The value of ultrasound B-scan for routine follow-up of melanoma patients still is not generally accepted. Therefore, the authors compared the efficacy of physical examination (PE) with ultrasound B-scan (UBS) for detection of regional tumor recurrence in melanoma patients. The aim of the current study was to evaluate whether early detection of metastases improves relapse-free and overall survival. METHODS For a period of 4 years, 829 consecutive melanoma patients were followed prospectively. Physical examination of 3011 patients and concomitant UBS of in-transit routes and regional lymph node basins were performed. Suspicious lesions were diagnosed by fine-needle aspiration cyto…

The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins

ObjectiveCyanoacrylate (CA) embolization of refluxing great saphenous veins (GSVs) has been previously described. The outcomes from a multicenter study are still lacking.MethodsA prospective multicenter study was conducted in seven centers in four European countries to abolish GSV reflux by endovenous CA embolization. Neither tumescent anesthesia nor postinterventional compression stockings were used. Varicose tributaries remained untreated until at least 3 months after the index treatment. Clinical examination, quality of life assessment, and duplex ultrasound evaluation were performed at 2 days and after 1, 3, 6, and 12 months.ResultsIn 70 patients, of whom 68 (97.1%) were available for 1…

Ultrasound in Varicose Vein Treatment

Diagnosis is a prerequisite for all treatment strategies. Duplex ultrasound is the best diagnostic tool for varicose veins for all expressions of the disease (Nicolaides Circulation 102:126–163, 2000). All types of intervention on varicose veins have their own special demands on ultrasound. Ultrasound-guided vein mapping on the skin is very helpful prior to saphenous stripping (See Sect. 12.1), and it is absolutely indispensible for CHIVA (See Sect. 12.2). In endovascular thermal therapies (See Sect. 12.3) or foam sclerotherapy of trunk veins (See Sect. 12.4), ultrasound is an essential part of the treatment process. The actual procedures will only be explained here in relation to ultrasoun…

Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins

AbstractBackgroundThis was a prospective study of radiofrequency segmental thermal ablation (RFA) for the treatment of incompetent varicose great saphenous veins (GSVs). The present report describes long-term follow-up at 5 years.MethodsThe 5-year follow-up of this multicentre European study included assessment of the Venous Clinical Severity Score (VCSS), and GSV occlusion and reflux on duplex imaging.ResultsA total of 225 patients had 295 GSVs treated by RFA, achieving an initial vein occlusion rate of 100 per cent. With 80·0 per cent compliance, Kaplan–Meier analyses showed a GSV occlusion rate of 91·9 per cent and a reflux-free rate of 94·9 per cent at 5 years. Among the 15 GSVs noted w…

Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities

BackgroundRadiofrequency segmental thermal ablation (RSTA) has become a commonly used technology for occlusion of incompetent great saphenous veins (GSVs). Midterm results and data on clinical parameters are still lacking.MethodsA prospective multicenteral trial monitored 295 RSTA-treated GSVs for 36 months. Clinical control visits included flow and reflux analysis by duplex ultrasound imaging and assessment of clinical parameters according to the CEAP classification and Venous Clinical Severity Score (VCSS).ResultsA total of 256 of 295 treated GSVs (86.4%) were available for 36 months of follow-up. At 36 months, Kaplan-Meier survival analysis showed the probability of occlusion was 92.6% a…

Presurgical Ultrasound-Guided Anchor-Wire Marking of Soft Tissue Metastases in Stage III Melanoma Patients

Background. Due to increased sensitivity of diagnostic procedures, soft tissue metastases in melanoma patients are frequently detected very early. However, small sizes, deep location, or position close to vulnerable structures could render subsequent surgery quite difficult. Objective. To test the feasibility and effectiveness of presurgical ultrasound-guided anchor-wire marking of melanoma metastases. Methods. We selected melanoma patients with cytologically proven metastases in clinical stage III which were either unfavorably located or which have failed removal by previous surgery. Anchor-wire marking was performed ultrasound guided and free-hand style without the use of local anesthesia…

A two-cohort feasibility study on polyglycolic acid yarn implantation for abolition of saphenous vein reflux

The objective of this study was to evaluate the feasibility and safety of a polyglycolic acid (PGA) yarn implant for nonthermal ablation of saphenous vein reflux.In two consecutive cohort studies (TAHOE I and TAHOE II), the feasibility of abolition of great saphenous vein (GSV) reflux by implantation of a PGA yarn was tested under ultrasound guidance in 51 and 30 patients, respectively. The use of tumescent local anesthesia was not required. Graduated compression stockings and thrombosis prophylaxis with low-molecular-weight heparin were used for 2 weeks after intervention in the first study only.Of 81 enrolled patients, 77 (95%) were available at 6-month follow-up. Complete occlusion of th…

A longitudinal single-center cohort study on the prevalence and risk of accessory saphenous vein reflux after radiofrequency segmental thermal ablation of great saphenous veins

Objective Endothermal ablation has become a commonly used technology for occlusion of refluxing great saphenous veins (GSVs). However, the risk for primarily untreated accessory saphenous veins (ASVs) to develop reflux during follow-up has not yet been defined. Here, the prevalence and risk of ASV reflux is explored. Methods During a prospective multicenter cohort study on radiofrequency segmental thermal ablation of refluxing GSVs, the presence and reflux status of ASVs were monitored in 93 legs in a single center. Control examinations were performed after 1 week and at 12, 24, 36, and 48 months. Life-table and multiple regression analyses were used to describe frequency and risk factors f…

Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent

Background. Parameters influencing failure and recanalization rates of endovenous laser treatment (ELT) of the great saphenous vein (GSV) are still to be determined. Objective. To evaluate treatment-related parameters of ELT with respect to early failure of occlusion or recanalization of GSVs. Methods. A series of 77 consecutive patients received ELT of 106 GSVs with continuous pullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks, and 3 months after the procedure. Clinical patient and vessel characteristics as well as technical parameters of the ELT procedure were evaluated via multiple logistic regression analysis. Results. A median vein length of 60 cm (range of…

Subfascial Endoscopic Perforator Surgery With Tumescent Local Anesthesia

background. Subfascial endoscopic perforator surgery (SEPS) has become an established procedure. objective. To evaluate SEPS with tumescent local anesthesia (TLA) using an single-port device originally designed for that purpose. methods. Patients selected for SEPS received subcutaneous infiltration of TLA into the medial aspect of the calf 20 minutes before surgery. Bipolar coagulation and dissection were used to treat incompetent perforators. results. Fifty-one patients with 67 legs of CEAP stages C3–C6 underwent SEPS with TLA. In 40 patients or 53 legs (79.1%) TLA alone allowed successful completion of the SEPS procedure. Five patients with 7 legs (10.4%) required additional intravenous a…

Endovenous ablation of refluxing saphenous and perforating veins.

Abstract. Since the end of the nineties endovenous thermal ablation and more recently non-thermal, non-tumescent techniques have been developed and improved. Until now, because of their favourable side effect profile in conjunction to sustained efficacy, in many countries they already replaced high ligation and stripping in the treatment of refluxing saphenous veins as well as for treatment of perforators and selected tributaries. Now, studies and comparative trials are available with long-term follow-ups for most of the techniques, providing valid data on occlusion and reflux rates, side effect profiles, and health related quality of life.

Die endoskopische Fasziotomie mit und ohne Perforansdiszision bei chronischem Ulcus cruris venosum

Lange bestehende venose Unterschenkelgeschwure erweisen sich haufig gegenuber modernen konservativen Therapiemodalitaten als refraktar. Nach operativer Sanierung des oberflachlichen Venensystems bieten endoskopische Methoden die Moglichkeit, pathophysiologisch relevante Perforansinsuffizienzen zu beseitigen und chronisch funktionelle Kompartmentsyndrome durch paratibiale Fasziotomie kausal anzugehen. Wir berichten uber 13 endoskopisch durchgefuhrte paratibiale Fasziotomien mit und ohne Ausschaltung inkompetenter Perforansvenen (Endoscopic subfascial division of perforators = ESDP) bei Patienten mit Ulcus cruris venosum einer Bestandsdauer von im Median 15 Jahren. Neben sofortiger Reduzierun…

Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood.

background. Despite the clinical efficacy of endovenous laser treatment (EVLT), its mode of action is incompletely understood. objective. To evaluate the role of intravascular blood for the effective transfer of thermal damage to the vein wall through absorption of laser energy. methods. Laser energy (15 J/pulse, 940 nm) was endovenously administered to explanted greater saphenous vein (GSV) segments filled with blood (n = 5) or normal saline (n = 5) in addition to GSVs under in vivo conditions immediately prior to stripping. Histopathology was performed on serial sections to examine specific patterns of damage. Furthermore, in vitro generation of steam bubbles by different diode lasers (81…

Ultrasound-guided fine-needle aspiration cytology in the early detection of melanoma metastases.

BACKGROUND. The early detection and treatment of tumor recurrences in melanoma patients is dependent on reliable, sensitive, and specific techniques to verify suspected tumor metastases. As of now, fine-needle aspiration cytology (FNAC) has yet to establish itself in the routine follow-up of melanoma patients. METHODS. FNAC procedures were performed in melanoma patients with palpable tumors or nonpalpable, ultrasonically suspicious lesions. Cytodiagnostic evaluation of fine-needle samples obtained from suspicious lesions was performed morphologically. Findings were validated either by histopathologic diagnosis or prolonged clinical follow-up. RESULTS. The cytologic examination of 739 FNACs …

Infrequent early recanalization of greater saphenous vein after endovenous laser treatment

Abstract Objective The frequency of recanalization of the greater saphenous vein (GSV) after endovenous laser treatment (ELT) is unclear. This study was undertaken to establish the incidence of early recanalization after ELT and to study the histopathologic features of reperfused and excised GSV. Methods One hundred nine GSV in 85 consecutive patients with clinical stage C 2-6 E P,S A S,P,D P R disease were treated with ELT. Twelve months of follow-up with duplex scanning at regular intervals was possible in 104 treated veins (95.4%) in 82 patients (96.5%). Recanalized vessels were removed surgically and examined at histopathology. Results ELT-induced occlusion proved permanent at duplex sc…

Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles.

Abstract Purpose: Despite a rapid spread of the technique, very little is known about the laser-tissue interaction in endovenous laser treatment (EVLT). We evaluated EVLT of the incompetent greater saphenous vein (GSV) for efficacy, treatment-related adverse effects, and putative mechanisms of action. Methods: Twenty-six patients with 31 limbs of clinical stages C 2-6 , E P , A S,P , P R with incompetent GSV proven by means of duplex scanning were selected for EVLT in an outpatient setting. A 600-μm fiber was entered into the GSV via an 18-gauge needle below the knee and proceeded to the saphenofemoral junction (SFJ). After infiltration of tumescent local anesthesia, multiple laser pulses o…

Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins.

Abstract Objective Cyanoacrylate closure of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of a prospective, multicenter, nonrandomized cohort study. Methods A total of 70 patients were enrolled in a prospective, multicenter study conducted at seven centers in four European countries and underwent treatment of a solitary refluxing great saphenous vein with endovenous cyanoacrylate embolization without the use of tumescent anesthesia or postprocedure compression stockings. The primary effectiveness end point was freedom from recanalization (closure rate) of the grea…

Sonographie bei der Therapie der Varikose

Die Diagnostik ist die Grundlage der Therapieentscheidung. Bei der Varikose ist die Duplexsonographie in allen Auspragungen der Krankheit das beste diagnostische Mittel (Nicolaides et al 2000). Im unmittelbaren Zusammenhang mit der Operation stellt jede Therapieform der Varikose eigene Anforderungen an die Sonographie: Beim Strippingverfahren ist das ultraschallgesteuerte Mapping auf der Haut sehr hilfreich (Abschn. 12.1), bei CHIVA gar unverzichtbar (Abschn. 12.2). Bei endovasalen thermischen Therapien (Abschn. 12.3) oder der Schaumverodung der Stammvenen (Abschn. 12.4) gehort die Sonographie zum Behandlungsablauf notwendigerweise dazu. Die Verfahren selbst sollen hier nur insoweit erklart…

The European Multicenter Study on Cyanoacrylate Embolization of Refluxing Great Saphenous Veins without Tumescent Anesthesia and without Compression Therapy.

Twelve-Month Follow-up of the European Multicenter Study on Cyanoacrylate Embolization of Incompetent Great Saphenous Veins.