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

An update on operative treatments of primary superficial vein incompetence: part I. This is the first of two chapters that will comprise the “Update on operative treatments of primary superficial vein incompetence.” These two chapters will be published consecutively. Michel Perrin, MD Vascular Surgery, Unité de Pathologie Vasculaire Jean Kunlin Chassieu, France Abstract For more than a century, open surgery and liquid sclerotherapy were the only options used for operatively treating primary varices. In the last 20 years, management of primary varices has dramatically changed due to ultrasound investigations and innovative techniques. Development of endovenous treatments, including thermal ablation and/or…

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Endovenous thermal ablation for varicose veins: strengths and weaknesses

Renate R. van den BOS, Marianne M.G. de MAESENEER Department of Dermatology, Erasmus MC Rotterdam, The Netherlands ABSTRACT Endovenous ablation is a frequently used method for treating varicose veins. Endovenous laser ablation is the most frequently used technique, followed by radiofrequency ablation. Endovenous thermal treatments heat the vein, leading to thrombotic occlusion and finally fibrosis of the vein wall. Endovenous steam ablation is a new technique that has not yet been extensively studied. In this article, the procedures, strengths, and weaknesses of the currently available endovenous thermal ablation treatments are discussed. INTRODUCTION Endovenous treatment is currently one of the most…

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Review and Comment of the 2011 Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53:2S-48S. Marzia LUGLI Modena, Italy Oscar MALETI Modena, Italy Michel PERRIN Lyon, France ABSTRACT The Clinical Practice Guidelines of The Society for Vascular Surgery and The American Venous Forum, published in the 2011 Journal of Vascular Surgery supplement, is the most complete document on the management of varicose veins ever published in English. It is the work of leading members of the American…

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Endovenous laser ablation

Jean-François UHL1,2 Steven E. ZIMMET2,3 Zimmet Vein and Dermatology Clinic Austin, USA ABSTRACT Endovenous laser ablation (EVLA) is a less invasive alternative to vein stripping. Outcomes seem equal to, or better than, those with stripping, with better quality of life scores in the post-operative period. EVLA has been shown to correct or significantly improve hemodynamic abnormality in patients with chronic venous insufficiency (CVI) with superficial venous reflux. Early reports suggest that endovenous ablation techniques, in contrast to surgical stripping, are associated with a low incidence of neovascularization. A variety of wavelengths are being used to perform EVLA. While the initial…

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