open access

Vol 22, No 1-2 (2020)
Review paper
Published online: 2022-01-18
Get Citation

Staged or simultaneous varicose vein treatment after saphenous vein ablation

Maciej Wołkowski1, Bartosz Kończyk1, Tomasz Urbanek2
·
Chirurgia Polska 2020;22(1-2):7-13.
Affiliations
  1. Doctoral School, Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
  2. Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland

open access

Vol 22, No 1-2 (2020)
Review articles
Published online: 2022-01-18

Abstract

Chronic venous disease (CVD) is a progressive condition that affects a significant percentage of the
population. Clinical manifestation of CVD differs between the patients: from asymptomatic patients with
esthetic problems only to the very severe stages (including venous leg ulcer) that significantly decrease
the quality of life (Qol). Although the varicose vein patients can be asymptomatic and they decide for
treatment only for cosmetic reasons, many of them present the symptoms and/or signs of CVD, including
pain, heaviness, itching, cramps, swelling, trophic changes or ulcerations. Therapeutic management of
varicose veins includes surgery, minimally invasive procedures (involving saphenous ablation or sclerotherapy), compression therapy and pharmacological treatment. Traditional surgical treatment has been a leading method in invasive VV management for many years. Nonetheless, minimally invasive treatment thrived in the 21st century and overtook open surgery regarding VVS and more advanced stages of CVD. Another commonly used minimally invasive method in the treatment of VV is foam sclerotherapy. The efficacy of EVLA in the treatment of VV can be improved by performing adjunctive foam sclerotherapy
(FS) of the tributaries. The combination of EVLA and FS is an effective method of reducing the rate of
reinterventions in VV patients with saphenous vein incompetence. In the patients undergoing saphenous
ablation, VV treatment (FS or mini phlebectomy) can be performed within the same procedure or as the
delayed treatment. The argument for delayed treatment is the potential possibility of the VV regression
(partial or complete) after saphenous vein ablation. On the other hand, saphenous ablation and varicose
vein treatment within the same session result in fast and complete varicose vein removal without the need
for additional procedures. Nevertheless, there is no consensus regarding the optimal timing of performing
FS after EVLA of the GSV trunk and because of many diversified scientific reports there are still different
approaches to this problem in phlebological centres around the world. Since the timing of adjunctive
FS after EVLA procedure in the treatment of VV associated with GSV incompetence is a topic of open
debate among surgeons, this study is a review that compares concomitant and staged treatments of VV.

Abstract

Chronic venous disease (CVD) is a progressive condition that affects a significant percentage of the
population. Clinical manifestation of CVD differs between the patients: from asymptomatic patients with
esthetic problems only to the very severe stages (including venous leg ulcer) that significantly decrease
the quality of life (Qol). Although the varicose vein patients can be asymptomatic and they decide for
treatment only for cosmetic reasons, many of them present the symptoms and/or signs of CVD, including
pain, heaviness, itching, cramps, swelling, trophic changes or ulcerations. Therapeutic management of
varicose veins includes surgery, minimally invasive procedures (involving saphenous ablation or sclerotherapy), compression therapy and pharmacological treatment. Traditional surgical treatment has been a leading method in invasive VV management for many years. Nonetheless, minimally invasive treatment thrived in the 21st century and overtook open surgery regarding VVS and more advanced stages of CVD. Another commonly used minimally invasive method in the treatment of VV is foam sclerotherapy. The efficacy of EVLA in the treatment of VV can be improved by performing adjunctive foam sclerotherapy
(FS) of the tributaries. The combination of EVLA and FS is an effective method of reducing the rate of
reinterventions in VV patients with saphenous vein incompetence. In the patients undergoing saphenous
ablation, VV treatment (FS or mini phlebectomy) can be performed within the same procedure or as the
delayed treatment. The argument for delayed treatment is the potential possibility of the VV regression
(partial or complete) after saphenous vein ablation. On the other hand, saphenous ablation and varicose
vein treatment within the same session result in fast and complete varicose vein removal without the need
for additional procedures. Nevertheless, there is no consensus regarding the optimal timing of performing
FS after EVLA of the GSV trunk and because of many diversified scientific reports there are still different
approaches to this problem in phlebological centres around the world. Since the timing of adjunctive
FS after EVLA procedure in the treatment of VV associated with GSV incompetence is a topic of open
debate among surgeons, this study is a review that compares concomitant and staged treatments of VV.

Get Citation

Keywords

saphenous ablation; varicose veins; phlebectomy; sclerotherapy; treatment

About this article
Title

Staged or simultaneous varicose vein treatment after saphenous vein ablation

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 22, No 1-2 (2020)

Article type

Review paper

Pages

7-13

Published online

2022-01-18

Page views

5601

Article views/downloads

421

DOI

10.5603/ChP.2020.0002

Bibliographic record

Chirurgia Polska 2020;22(1-2):7-13.

Keywords

saphenous ablation
varicose veins
phlebectomy
sclerotherapy
treatment

Authors

Maciej Wołkowski
Bartosz Kończyk
Tomasz Urbanek

References (50)
  1. Mannello F, Ligi D, Raffetto JD, et al. Pathophysiology of chronic venous disease. Int Angiol. 2014; 33(3): 212–221.
  2. Beebe-Dimmer JL, Pfeifer JR, Engle JS, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005; 15(3): 175–184.
  3. Davies AH. The Seriousness of Chronic Venous Disease: A Review of Real-World Evidence. Adv Ther. 2019; 36(Suppl 1): 5–12.
  4. Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019; 34(2): 269–283.
  5. McLafferty RB, Passman MA, Caprini JA, et al. Increasing awareness about venous disease: The American Venous Forum expands the National Venous Screening Program. J Vasc Surg. 2008; 48(2): 394–399.
  6. Wittens C, Davies AH, Bækgaard N, et al. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015; 49(6): 678–737.
  7. Atkins E, Mughal NA, Place F, et al. Varicose veins in primary care. BMJ. 2020; 370: m2509.
  8. Brasic N, Lopresti D, McSwain H. Endovenous laser ablation and sclerotherapy for treatment of varicose veins. Semin Cutan Med Surg. 2008; 27(4): 264–275.
  9. Köroglu M, Eris HN, Aktas AR, et al. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol. 2011; 52(3): 278–284.
  10. Evans CJ, Fowkes FG, Ruckley CV, et al. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health. 1999; 53(3): 149–153.
  11. Miguel A, Jesús V. Prevalencia de varices en adultos y factores asociados. Med Clín. 2004; 123(17): 647–651.
  12. Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994; 81(2): 167–173.
  13. Hamdan A. Management of varicose veins and venous insufficiency. JAMA. 2012; 308(24): 2612–2621.
  14. Langer RD, Ho E, Denenberg JO, et al. Relationships between symptoms and venous disease: the San Diego population study. Arch Intern Med. 2005; 165(12): 1420–1424.
  15. Nicolaides AN, Labropoulos N. Burden and Suffering in Chronic Venous Disease. Adv Ther. 2019; 36(Suppl 1): 1–4.
  16. Fukaya E, Flores AM, Lindholm D, et al. Clinical and Genetic Determinants of Varicose Veins. Circulation. 2018; 138(25): 2869–2880.
  17. Chwała M, Szczeklik W, Szczeklik M, et al. Varicose veins of lower extremities, hemodynamics and treatment methods. Adv Clin Exp Med. 2015; 24(1): 5–14.
  18. Michaels JA, Campbell WB, Brazier JE, et al. Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess. 2006; 10(13): 1–196, iii.
  19. Bone, C. "Tratamiento endoluminal de las varices con laser de diodo. Estudio preliminar. " Rev Patol Vasc. 1999: 35–46.
  20. National Clinical Guideline Centre (UK). Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins. London: National Institute for Health and Care Excellence. (UK): 2013.
  21. van den Bos RR, Kockaert MA, Neumann HAM, et al. Technical review of endovenous laser therapy for varicose veins. Eur J Vasc Endovasc Surg. 2008; 35(1): 88–95.
  22. Alder LS, Rahi MA. Single-visit endovenous laser treatment and tributary procedures for symptomatic great saphenous varicose veins. Ann R Coll Surg Engl. 2014; 96(4): 279–283.
  23. Aurshina A, Alsheekh A, Kibrik P, et al. Recanalization After Endovenous Thermal Ablation. Ann Vasc Surg. 2018; 52: 158–162.
  24. Terlecki P, Przywara S, Iłżecki M, et al. Endovenous laser ablation is an effective treatment for great saphenous vein incompetence in teenagers. Phlebology. 2016; 31(3): 198–202.
  25. Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016; 11: CD010878.
  26. Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord. 2018; 6(2): 256–270.
  27. Gibson K, Gunderson K. Liquid and Foam Sclerotherapy for Spider and Varicose Veins. Surg Clin North Am. 2018; 98(2): 415–429.
  28. Tessari, L. "Nouvelle technique d'obtention de la scléro-mousee. " Phlebologie. 2000; 53: 129.
  29. Alder G, Lees T. Foam sclerotherapy. Phlebology. 2015; 30(2 Suppl): 18–23.
  30. Watanabe S, Nishio S, Tsuji T, et al. Effect of Transluminal Injection of Foam Sclerotherapy Combined with Endovenous Thermal Ablation of Varicose Veins. EJVES Vasc Forum. 2020; 47: 83–86.
  31. Brittenden J, Cotton SC, Elders A, et al. A randomized trial comparing treatments for varicose veins. N Engl J Med. 2014; 371(13): 1218–1227.
  32. Wang JC, Li Y, Li GY, et al. A Comparison of Concomitant Tributary Laser Ablation and Foam Sclerotherapy in Patients Undergoing Truncal Endovenous Laser Ablation for Lower Limb Varicose Veins. J Vasc Interv Radiol. 2018; 29(6): 781–789.
  33. Aherne TM, Ryan ÉJ, Boland MR, et al. Concomitant vs. Staged Treatment of Varicose Tributaries as an Adjunct to Endovenous Ablation: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2020; 60(3): 430–442.
  34. El-Sheikha J, Nandhra S, Carradice D, et al. Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. Br J Surg. 2014; 101(9): 1093–1097.
  35. Yilmaz S, Ceken K, Alparslan A, et al. Endovenous laser ablation and concomitant foam sclerotherapy: experience in 504 patients. Cardiovasc Intervent Radiol. 2012; 35(6): 1403–1407.
  36. Lane TRA, Kelleher D, Shepherd AC, et al. Ambulatory varicosity avulsion later or synchronized (AVULS): a randomized clinical trial. Ann Surg. 2015; 261(4): 654–661.
  37. Mohamed A, Leung C, Hitchman L, et al. A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation. Phlebology. 2019; 34(9): 627–635.
  38. Obi AT, Reames BN, Rook TJ, et al. Michigan Vein Health Program. Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities. Phlebology. 2016; 31(9): 618–624.
  39. Brown CS, Obi AT, Cronenwett JL, et al. Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease). J Vasc Surg Venous Lymphat Disord. 2021; 9(2): 369–376.
  40. Kawai Y, Sugimoto M, Aikawa K, et al. Endovenous Laser Ablation with and Without Concomitant Phlebectomy for the Treatment of Varicose Veins: A Retrospective Analysis of 954 Limbs. Ann Vasc Surg. 2020; 66: 344–350.
  41. Monahan DL. Can phlebectomy be deferred in the treatment of varicose veins? J Vasc Surg. 2005; 42(6): 1145–1149.
  42. Welch HJ. Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins. J Vasc Surg. 2006; 44(3): 601–605.
  43. Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002; 28(1): 38–42.
  44. Onida S, Lane TRA, Davies AH. Phlebectomies: to delay or not to delay? Phlebology. 2012; 27(3): 103–104.
  45. Theivacumar NS, Dellagrammaticas D, Mavor AID, et al. Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg. 2008; 48(1): 173–178.
  46. Hicks CW, DiBrito SR, Magruder JT, et al. Radiofrequency ablation with concomitant stab phlebectomy increases risk of endovenous heat-induced thrombosis. J Vasc Surg Venous Lymphat Disord. 2017; 5(2): 200–209.
  47. Lane TRA, Onida S, Gohel MS, et al. A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation. Phlebology. 2015; 30(8): 516–524.
  48. de Ma. R, Biemans A.A.M, Pichot O. New concepts on recurrence of varicose veins according to the different treatment techniques. Phlebologie - Annales Vasculaires [Internet]. 2013Dec. ; 66(4): 54–60.
  49. Van der Velden SK, Lawaetz M, De Maeseneer MGR, et al. Members of the Predictors of Endovenous Thermal Ablation Group. Predictors of Recanalization of the Great Saphenous Vein in Randomized Controlled Trials 1 Year After Endovenous Thermal Ablation. Eur J Vasc Endovasc Surg. 2016; 52(2): 234–241.
  50. Labropoulos N, Bhatti A, Leon L, et al. Neovascularization after great saphenous vein ablation. Eur J Vasc Endovasc Surg. 2006; 31(2): 219–222.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaBy Via Medicav Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl