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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Combination therapy in the treatment of varices

Nicholas H. OSBORNE MD, MS1*; Craig BROWN MD, MS1; Christopher O. AUDU MD, PhD1; Danielle C. SUTZKO MD, MS2; Andrea T. OBI MD1; Thomas W. WAKEFIELD MD1 1Section of Vascular Surgery, Department of Surgery, Michigan Medicine; 2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham Abstract Background: There is significant variation in the treatment of combined truncal-vein reflux and symptomatic varicosities. We sought to use the Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR) to explore the contemporary real-world experience of combined ablation and phlebectomy versus ablation alone. Methods: Using the VQI/VVR database, patients…

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Effectiveness of micronized purified flavonoid fraction–based conservative treatment in chronic venous edema

Vadim Yu BOGACHEV, MD, PhD On behalf of the VAP-PRO-C3 study investigators group. Department of Faculty Surgery No. 2, Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia Abstract Aim: This study assessed the effectiveness of micronized purified flavonoid fraction (MPFF)-based conservative treatment in patients with chronic venous edema (CVE) as part of an observational program that evaluated the management of patients with CVE caused by the primary forms of chronic venous disease (CVD) in real clinical practice. Materials and methods. The VAP-C3 (Vein Act Prolonged-C3; NCT03722836) prospective, single-arm, observational study was conducted in Russia in adult outpatients with CVD…

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Small saphenous vein interventional treatment

Jean-Luc GERARD Vascular medicine, CHU Henri Mondor Hospital, Paris XII University, Créteil, France Abstract Evidence-based medicine can provide some clues about options for treating varicose veins, but there is no consensus on the best option. Even though the majority of practitioners have discarded several of the newer techniques available after having used them, they can nonetheless remain good options for others. However, the best procedure would be easily reproducible by the majority and for the majority. The adoption of these new and less invasive techniques, such as chemical ablation (foam sclerotherapy) and endovenous thermal ablation, could allow for treatment at…

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An update on operative treatments of primary superficial vein incompetence: part 2.

An update on operative treatments of primary superficial vein incompetence: part I. Michel Perrin, MD Vascular Surgery, Unité de Pathologie Vasculaire Jean Kunlin Chassieu, France Abstract In part 2 of “An update on operative treatment of primary superficial vein incompetence,” all randomized controlled trials (RCTs) published since 1990 on operative treatments of varicose veins were collected and the references were gathered in tables according to either the procedure used or the patient’s clinical status. Case series and meta-analyses were taken into account in this review when RCTs were not available. For more details regarding clinical or instrumental outcomes of the…

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