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One-Step Approach to Treating Venous Insufficiency.

Jarjous F, Jarjous R, Nahhas G - J Clin Med Res (2015)

Bottom Line: This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure.By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively.No major or minor complications were found upon follow-up evaluation.

View Article: PubMed Central - PubMed

Affiliation: Venocure, 2881 Monroe St, Dearborn, MI 48124, USA.

ABSTRACT

Background: Patients with venous insufficiency can be treated with office-based, minimally invasive means like radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS). Traditional treatment involves ablation of the great saphenous vein (GSV) and the short saphenous vein (SSV) with RFA as a first step. The remaining refluxing tributaries are treated at a later session with UGFS or microphlebectomy. This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure. We, instead, elected to treat all the refluxing veins in one procedure which combines RFA of the truncal and perforating vein with UGFS to the accessory and tributary veins.

Methods: A controlled non-randomized clinical trial, in which a total of 72 extremities were treated for vein incompetence in 63 consecutive patients aged 26 - 78 years, was conducted. Sixty-three extremities (87.5%) received treatment for reflux in GSV, 10 extremities (13.9%) were treated for reflux in SSV, and 11 (15.3%) were treated for reflux in the perforators. Reflux duration > 1 second to increase specificity and truncal vein diameter > 5 mm were identified in the treated limbs. The treatment was performed at our office and it involved delivering radiofrequency thermal energy to the truncal and perforating vein and then using foam sclerotherapy with the guidance of ultrasound to close the tributary and accessory veins in a single procedure. The results were monitored at 1 week and 6 weeks post-operatively by venous duplex ultrasound.

Results: One hundred percent of the treated GSV and SSV and 91.7% of tributary veins were completely closed after the index procedure. Only 10 of 72 extremities (13.9%) needed a follow-up treatment to achieve closure of the perforator and accessory veins. By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively. No major or minor complications were found upon follow-up evaluation.

Conclusion: We believe that combining RFA with UGFS in a solo practice lowers the incidence of thrombophlebitis in the tributaries. Using this approach allowed us to achieve more complete resolution of venous reflux disease with lower complication rates in comparison with the popular staged strategy. This could have implications for financial savings to both the patient and the health system.

No MeSH data available.


Related in: MedlinePlus

Assessment of reflux and symptoms pre-operatively and 6 weeks post-operatively.
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Figure 1: Assessment of reflux and symptoms pre-operatively and 6 weeks post-operatively.

Mentions: Upon physical examination of patients 6 weeks after treatment, we found that edema was resolved in 46 of 60 patients (76.7%) and that ulcers healed in all three patients (100%) who had it pre-operatively. Of the 70 patients who experienced pain prior to the procedure, 64 (91.4%) reported, upon direct questioning, that their pain had vastly improved or completely resolved post-operatively. Figure 1 demonstrates a summary of these results.


One-Step Approach to Treating Venous Insufficiency.

Jarjous F, Jarjous R, Nahhas G - J Clin Med Res (2015)

Assessment of reflux and symptoms pre-operatively and 6 weeks post-operatively.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522984&req=5

Figure 1: Assessment of reflux and symptoms pre-operatively and 6 weeks post-operatively.
Mentions: Upon physical examination of patients 6 weeks after treatment, we found that edema was resolved in 46 of 60 patients (76.7%) and that ulcers healed in all three patients (100%) who had it pre-operatively. Of the 70 patients who experienced pain prior to the procedure, 64 (91.4%) reported, upon direct questioning, that their pain had vastly improved or completely resolved post-operatively. Figure 1 demonstrates a summary of these results.

Bottom Line: This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure.By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively.No major or minor complications were found upon follow-up evaluation.

View Article: PubMed Central - PubMed

Affiliation: Venocure, 2881 Monroe St, Dearborn, MI 48124, USA.

ABSTRACT

Background: Patients with venous insufficiency can be treated with office-based, minimally invasive means like radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS). Traditional treatment involves ablation of the great saphenous vein (GSV) and the short saphenous vein (SSV) with RFA as a first step. The remaining refluxing tributaries are treated at a later session with UGFS or microphlebectomy. This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure. We, instead, elected to treat all the refluxing veins in one procedure which combines RFA of the truncal and perforating vein with UGFS to the accessory and tributary veins.

Methods: A controlled non-randomized clinical trial, in which a total of 72 extremities were treated for vein incompetence in 63 consecutive patients aged 26 - 78 years, was conducted. Sixty-three extremities (87.5%) received treatment for reflux in GSV, 10 extremities (13.9%) were treated for reflux in SSV, and 11 (15.3%) were treated for reflux in the perforators. Reflux duration > 1 second to increase specificity and truncal vein diameter > 5 mm were identified in the treated limbs. The treatment was performed at our office and it involved delivering radiofrequency thermal energy to the truncal and perforating vein and then using foam sclerotherapy with the guidance of ultrasound to close the tributary and accessory veins in a single procedure. The results were monitored at 1 week and 6 weeks post-operatively by venous duplex ultrasound.

Results: One hundred percent of the treated GSV and SSV and 91.7% of tributary veins were completely closed after the index procedure. Only 10 of 72 extremities (13.9%) needed a follow-up treatment to achieve closure of the perforator and accessory veins. By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively. No major or minor complications were found upon follow-up evaluation.

Conclusion: We believe that combining RFA with UGFS in a solo practice lowers the incidence of thrombophlebitis in the tributaries. Using this approach allowed us to achieve more complete resolution of venous reflux disease with lower complication rates in comparison with the popular staged strategy. This could have implications for financial savings to both the patient and the health system.

No MeSH data available.


Related in: MedlinePlus