Endovenous laser ablation or radiofrequency ablation for varicose veins: a review

Sushil DAHAL, MBBS; Robin Man KARMACHARYA, MS; Satish VAIDYA, MS; Prasesh DHAKAL, MBBS; Niroj BHANDARI, MBBS; Sahil BADE, MBBS; Sohail BADE, MBBS; Selene POKHAREL, MBBS; Shreeja SHIKHRAKAR, MBBS; Prabha SHRESTHA, MSN; Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal Abstract Varicose veins are a part of chronic venous insufficiency syndrome, presenting with dilated veins, skin changes, and even ulceration in the lower limbs. Untreated, it can result in many complications and has an impact upon one’s quality of life. Management depends upon the stage and etiology of varicose veins. Conventional vein stripping surgery is now being replaced by…

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Update on treatment methods for telangiectasia

Mesut ENGIN, MD, Assoc Prof; University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Turkey Abstract Telangiectasias make up a heterogeneous group of diseases that can affect various parts of the body in humans. Although generally limited to the face, telangiectasia can cover different parts of the body in various collagen tissue diseases. The appropriate treatment options for telangiectasias are sclerotherapy, laser therapy, thermocoagulation, and microphlebectomy. The purpose of sclerotherapy is to cause endothelial damage by injecting a sclerosing agent into the vascular bed. Agents such as polidocanol, sodium tetradecyl sulfate, hypertonic saline, and…

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Is it essential to treat the AASV during thermal ablation of the GSV?

Anne-Sophie LENSEL, MD; Jean-Luc GERARD, MD; Clinique du Mont-Louis, Paris Clinique Geoffroy Saint-Hilaire, Paris Abstract Recent decades have experienced the substantial development of endovenous techniques to treat varicose veins. Such techniques are guided by ultrasound through use of increasingly efficient equipment, and operators have become better trained. This, in parallel with the study of cadaver dissections, has led to a marked improvement in the knowledge of vein anatomy in the lower limbs. The treatment of varicose veins has always been known for its risk of recurrence, which can have several origins. The most widely accepted cause right now is recurrence…

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Factors impeding venous return and their impact on the management of chronic venous disease

RAshna RAIKER, BS; Nicos LABROPOULOS, PhD2; 1Department of Surgery, Stony Brook University Medical Center, New York, USA Abstract Chronic venous disease is multifactorial. Although the main pathology of chronic venous disease is reflux and obstruction, several other factors play a role as well. These include the duration, distribution, and extent of disease, but also additional factors such as obesity, and musculoskeletal and heart failure. This is especially important for those with advanced disease, as these factors that impede venous return may be more common. In fact, there are reports where people do not have evidence of venous disease but still…

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Pharmacological correction of total venous reflux in patients with varicose veins

Nikolai KHOREV,1 MD, PhD; Darya KUZNETSOVA,2 MD, PhD 1Department of Cardiology and Cardiovascular Surgery, Altai State Medical University, Barnaul, Russia 2Department of Pathological Anatomy, Department of Pathophysiology Altai State Medical University, Barnaul, Russia Abstract The study was aimed at evaluating the efficacy of micronized purified flavonoid fraction (MPFF) in patients with primary chronic venous disease (CVD). It included 35 patients with varicose veins of the lower extremities (18 with bilateral and 7 with unilateral lesion). A total of 53 legs with varicose veins were evaluated in 3 groups based on the CEAP (Clinical, Etiology, Anatomic, Pathophysiology classification system) clinical class:…

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Cyanoacrylate closure in the treatment of varicose veins – what is the evidence?

Nick MORRISON, MD, FACS, DBVLM Center for Vein Restoration, Phoenix, Arizona, USA Abstract Introduction Cyanoacrylate ablation for incompetent saphenous veins is a recent addition to the armamentarium of venous surgeons. It does not require the instillation of tumescent anesthesia during the procedure, thus reducing patient discomfort, and neither are compression hose necessary after treatment. Early cyanoacrylate ablation trials VenaSeal™ (Medtronic, Minnesota, USA) was the first reported use of a formulation of cyanoacrylate used in the ablation of incompetent saphenous veins. Clinical series and randomized controlled clinical trials demonstrated the safety and efficacy of this ablation method. The VeClose trial compared…

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Is compression necessary after endovenous thermal ablation of varicose veins? Clarifying a (com)pressing matter

Matthew TAN, BSc, MBBS, MRCS, AFHEA; Alun H. DAVIES, MA, DM, DSc, FRCS, FHEA, FEBVS, FLSW, FACPh Section of Vascular Surgery, Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, United Kingdom Abstract Chronic venous disease (CVD) represents a significant impact on patients’ lives with negative financial, social, and health-related quality of life consequences. The gold standard for treatment of varicose veins and CVD is now considered to be endovenous thermal ablation (EVTA). Although compression is widely prescribed for patients post EVTA, there is widespread disagreement on the optimal compression regimen and if compression is even required…

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The place of micronized purified flavonoid fraction in the management of chronic venous disease from an international guidelines’ perspective

Sergey Gennadievich GAVRILOV, MD, PhD Jorge H. ULLOA, MD1; Sebastian CIFUENTES, MD2; Antonio SOLANO, MD2; Valentin FIGUEROA, MD2 1Vascular Surgeon, Chief of Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital; Professor of Surgery, Universidad de los Andes School of Medicine, Bogotá, Colombia. 2Vascular Surgery Research Fellow, Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Abstract Chronic venous disease (CVD) is a highly prevalent disorder with a broad spectrum of symptoms determined by disease stage and whether there is deep or superficial venous system compromise. The treatment goal for CVD is to slow and prevent…

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Microcirculatory disorders in chronic venous diseases and fundamentals of their systemic pharmacological correction

Olga Ya POREMBSKAYA, MD, PhD Mechnikov North-Western State Medical University, Saint Petersburg, Russia and Institute of Experimental Medicine, Saint Petersburg, Russia Abstract This article reviews the literature on microcirculatory disorders underlying the development of chronic venous diseases (CVD) across all the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) clinical classes from C0s to C6 and the fundamentals of their systemic pharmacological correction particularly with micronized purified flavonoid fraction (MPFF). Anatomical and functional changes specifically in the vessels of the microvasculature are the main pathogenetic mechanism for the development of most vein-specific symptoms and determine CVD progression. The altered vessels of the microvasculature are characterized…

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Dialogue on venous hemodynamics

Oscar MALETI,1 MD: Fedor LURIE,2 MD, PhD; Giorgio BERGAMO,3 BSc; Sara GUERZONI,4 BSc; Marzia LUGLI,1 MD 1Vascular Surgery, Hesperia Hospital, Modena, Italy 2Jobst Vascular Institute and the Division of Vascular Surgery at the University of Michigan, Ann Arbor, Michigan, USA 3Microlab Elettronica Sas. Padova, Italy 4Fleboxan Vein Clinic, Modena, Italy Abstract Hemodynamics of the venous system of the lower limbs is very complex, its explanation typically evoking formulas and concepts that can be daunting for those new to the subject. Here, we approach the task from a more conversational angle, introducing a dialogue between expert and student as they discuss…

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