Cyanoacrylate ablation for chronic venous disease: a review and future applications

Kathleen Ozsvath, MD, FACS Chief of Surgery, Samaritan Hospital, Troy, New York; Vascular Associates, St Peters Health Partners, Albany, New York; Professor of Surgery, Albany Medical Center, Albany, New York, USA ABSTRACT Many endovenous procedural modalities exist today, including endovenous thermal ablation (laser ablation, [EVLT] and radiofrequency ablation [RFA]), nonthermal nontumescent ablation, and ultrasound-guided sclerotherapy (UGS) and chemical ablation. Recently, cyanoacrylate has been used for the treatment of axial insufficiency. The most studied preparation of N-butyl cyanoacrylate is VenaSeal (Medtronic), which has been compared with the other ablative techniques. These studies have shown excellent results with patient satisfaction, outcomes, and…

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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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Progress in the management of venous disease during our five decades as surgeons

Peter NEGLÉN, MD, PhD1, Bo EKLÖF, MD, PhD2 1Trimiklini, Cyprus; 2Råå, Sweden Abstract The authors’ experience spans 5 decades of development in the management of venous disease. They describe their journey through the open surgery era; the transforming introduction of duplex ultrasound scanning; the establishment of consensus-driven classification, terminology, and investigatory planning, hugely important for research and patient care; and the emergence of minimally invasive endovascular procedures during the 21st century with greater acceptability by patients, minimal morbidity/ mortality, and wider application than open surgery. The management of patients with venous disease has progressed immensely since the 1960s. Introduction At…

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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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CHIVA versus ablation

Claude FRANCESCHI, MD Angiologist, Consultant with Groupe Hospitalier Paris Saint Joseph, Paris, France Abstract CHIVA is the French acronym for Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire, ie, Conservative and Hemodynamic Treatment of Venous Insufficiency in outpatients. Ablation is not conservative, and CHIVA is based on a different hemodynamic approach. It is counterintuitive because it is difficult to imagine that the varicose veins could disappear without ablation either by extraction or by endovenous destruction. This treatment raises scientific questions that require us to revisit our understanding of classical venous pathophysiology in light of what echo-Doppler has contributed to our…

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Management of venous ulceration (interventional treatments) with perspectives from a recent meta-analysis and recommendations

Nicolas NEAUME, MD Clinique Pasteur, Toulouse, France Abstract Venous leg ulcers still affect about 1% of the adult population despite recent advances in chronic venous insufficiency treatment, and they represent a significant public health cost, estimated at between 1% and 2% of the annual health budget of Western European countries. Venous leg ulcers may be treated conservatively, with compression bandaging and wound care, medically, surgically, or with a combination of approaches, depending on the severity of the ulcer and available resources. The randomized trial of early endovenous ablation in venous ulceration demonstrated that early removal of a superficial venous reflux…

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Anticoagulation and interventional treatment of varicose veins

Matthieu JOSNIN, MD Saint Charles Clinic, Interventional Phlebology Unit, La Roche-sur-Yon, France Abstract Venous thromboembolic risk is very low after varicose vein procedures. This risk is often cited as less than 1%; however, studies also show the risk to be highly variable. Overall, literature in the field does not typically conclude thromboprophylaxis to be necessary in low-risk patients, owing to the low incidence of the event studied and the often-insufficient number of patients included. Despite the low incidence, venous thromboembolic risk is important in terms of mortality and morbidity. Varicose veins affect an average of 1 in 3 individuals, and…

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