Endovenous ablation of varicose veins − current status and overview of methods
Authors:
R. Vlachovský 1,2; T. Novotný 1; R. Staffa 1; Z. Bednařík 3
Authors‘ workplace:
II. chirurgická klinika, Centrum cévních onemocnění, Fakultní nemocnice u sv. Anny v Brně a Lékařská fakulta Masarykovy univerzity, Brno
1; VASCUMED centrum žilní chirurgie, Brno
2; I. ústav patologie Fakultní nemocnice u sv. Anny v Brně a Lékařská fakulta, Masarykova univerzita, Brno
3
Published in:
Rozhl. Chir., 2022, roč. 101, č. 5, s. 200-210.
Category:
Review
doi:
https://doi.org/10.33699/PIS.2022.101.5.200–210
Overview
During the last two decades, superficial venous surgery has experienced an unprecedented boom. Traditional surgical procedures (crossectomy and stripping) are now being replaced to a greater or lesser extent by new less invasive endovenous methods. Our aim is to provide an up-todate review of all available endovenous techniques (laser, radiofrequency, steam, mechanochemical ablation and venous glue) describing the indications, the technique and mechanism of action, and the results. In experienced hands, all endovenous techniques are safe and effective, with long-term results comparable to conventional surgical procedures.
Keywords:
radiofrequency ablation – varicose veins – ablation – laser ablation
Sources
1. Bergan JJ, Kumins NH, Owens EL, et al. Surgical and endovascular treatment of lower extremity venous insufficiency. J Vasc Interv Radiol. 2002;13:563–568. doi:10.1016/s1051-0443(07)61648-0.
2. Vuylsteke ME, Klitfod L, Mansilha A. Endovenous ablation. Int Angiol. 2019;38(1):22−38. doi:10.23736/S0392- 9590.18.04047-6.
3. Rautio T, Ohinmaa A, Perälä J, et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg. 2002;35:958–965. doi:10.1067/mva.2002.123096.
4. 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;10:1–196, iii–iv. doi:10.3310/ hta10130.
5. Campbell WB, Vijay Kumar A, Collin TW, et al. Randomised and economic analysis of conservative and therapeutic interventions for varicose veins study. The outcome of varicose vein surgery at 10 years: clinical findings, symptoms and patient satisfaction. Ann R Coll Surg Engl. 2003;85:52–57. doi:10.1308/003588403321001462.
6. Hejhal L, Firt P, Livora D. Endovascular electrocoagulation of superficial varices of leg. Rozhl Chir. 1959 Jun;38:418−425.
7. Wittens C, Davies AH, Bækgaard N, et al. ESVS Guidelines Committee. 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;49:678–737. doi:10.1016/j. ejvs.2015.02.007.
8. 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(Suppl): 2S–48S. doi:10.1016/j.jvs.2011.01.079.
9. Hamann SA, Giang J, De Maeseneer MG, et al. Editor’s choice – five year results of great saphenous vein treatment: A meta-analysis. Eur J Vasc Endovasc Surg. 2017;54:760–770. doi: 10.1016/j. ejvs.2017.08.034.
10. Argyriou C, Papasideris C, Antoniou GA, et al. The effectiveness of various interventions versus standard stripping in patients with varicose veins in terms of quality of life. Phlebology 2018;33:439– 450. doi:10.1177/0268355517720307.
11. Siribumrungwong B, Noorit P, Wilasrusmee C, et al. A systematic review and meta-analysis of randomised controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vasc Endovasc Surg 2012;44:214–223. doi:10.1016/j. ejvs.2012.05.017.
12. Karetová D, Vojtíšková J, Seifert B, et al. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Chronická žilní onemocnění. Centrum doporučených postupů, Společnost všeobecného lékařství ČLS JEP, Praha 2021.
13. De Maeseneer M, Pichot O, Cavezzi, et al. Union Internationale de Phlebologie. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins − UIP consensus document. Eur J Vasc Endovasc Surg. 2011;42: 89–102. doi:10.1016/j.ejvs.2011.03.013.
14. Zhang R, Verkruysse W, Aguilar G, et al. Comparison of diffusion approximation and Monte Carlo based finite element models for simulating thermal responses to laser irradiation in discrete vessels. Phys Med Biol. 2005;50:4075–4086. doi:10.1088/0031-9155/50/17/011.
15. Bush RG, Shamma HN, Hammond K. Histological changes occurring after endoluminal ablation with two diode lasers (940 and 1319 nm) from acute changes to 4 months. Lasers Surg Med. 2008;40:676– 679. doi:10.1002/lsm.20722.
16. Proebstle TM, Sandhofer M, Kargl A, et al. Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood. Dermatol Surg. 2002;28:596–600. doi:10.1046/j.1524-4725.2002.01309.x.
17. Desmyttere J, Grard C, Mordon SA. 2 years follow-up study of endovenous 980 nm laser treatment of the great saphenous vein: role of the blood content in the GSV. Med Laser Appl. 2005;20:283–289. doi:10.1016/j.mla.2005.08.003.
18. Vuylsteke M, Van Dorpe J, Roelens J, et al. Endovenous laser treatment: a morphological study in an animal model. Phlebology 2009;24:166–175. doi:10.1258/ phleb.2009.008070.
19. Pannier F, Rabe E, Rits J, et al. Endovenous laser ablation of great saphenous veins using a 1470 nm diode laser and the radial fibre – follow-up after six months. Phlebology 2011;26:35–39. doi:10.1258/ phleb.2010.009096.
20. Vuylsteke M, Van Dorpe J, Roelens J, et al. Intraluminal fibre-tip centring can improve endovenous laser ablation: a histological study. Eur J Vasc Endovasc Surg. 2010;40:110–116. doi:10.1016/j. ejvs.2009.09.013.
21. van den Bos RR, Milleret R, Neumann M, et al. Proof-of-principle study of steam ablation as novel thermal therapy for saphenous varicose veins. J Vasc Surg. 2011;53:181–186.
22. Thomis S, Verbrugghe P, Milleret R, et al. Steam ablation versus radiofrequency and laser ablation: an in vivo histological comparative trial. Eur J Vasc Endovasc Surg. 2013;46:378–382. doi:10.1016/j. ejvs.2013.06.004.
23. Keel D, Goldman MP. Tumescent anesthesia in ambulatory phlebectomy: addition of epinephrine. Dermatol Surg. 1999;25:371–372. doi:10.1016/j. jvs.2010.06.171.
24. Veverková L, Páč L, Kalač J, et al. Deset let endovenózní ablace varixů, úspěchy, neúspěchy a budoucnost. Rozhl Chir. 2014;93(2):57−62.
25. Caprini JA, Arcelus JI, Hasty JH, et al. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost. 1991;17 Suppl 3:304−312.
26. Rasmussen LH, Lawaetz M, Bjoern L, et al. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011;98:1079–1087. doi:10.1002/bjs.7555.
27. Honěk T, Honěk J, Horváth V, et al. Endovenózní laserová ablace vena saphena − střednědobé výsledky potvrzují trvalý uzávěr a možnost ošetřit více lézí během jednoho zákroku. Rozhl Chir. 2020;99(7):299−303. doi: 10.33699/ PIS.2020.99.7.299-303.
28. Doganci S, Yildirim V, Demirkilic U. Does puncture site affect the rate of nerve injuries following endovenous laser ablation of the small saphenous veins? Eur J Vasc Endovasc Surg. 2011;41:400–405. doi:10.1016/j.ejvs.2010.11.029. Epub 2010.
29. Elias S, Lam YL, Wittens CH. Mechanochemical ablation: status and results. Phlebology 2013;28(Suppl 1):10–4. doi:10.1177/0268355513477787.
30. Boersma D, van Eekeren RR, Werson DA, et al. Mechanochemical endovenous ablation of small saphenous vein insufficiency using the ClariVein (®) device: oneyear results of a prospective series. Eur J Vasc Endovasc Surg. 2013;45:299–303. doi:10.1016/j.ejvs.2012.12.004.
31. Vos CG, Ünlü Ç, Bosma J, et al. A systematic review and meta-analysis of two novel techniques of nonthermal endovenous ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord. 2017;5:880–896. doi:10.1016/j. jvsv.2017.05.022.
32. Whiteley MS. Glue, steam and Clarivein – best practice techniques and evidence. Phlebology 2015;30(Suppl):24–28. doi:10.1177/0268355515591447.
33. van Eekeren RR, Boersma D, Konijn V, et al. Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins. J Vasc Surg. 2013;57:445–450. doi:10.1016/j.jvs.2012.07.049.
34. Almeida JI, Min RJ, Raabe R, et al. Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovascular Surg. 2011;45:631– 635. doi:10.1177/1538574411413938.
35. Morrison N, Gibson K, McEnroe S, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015;61:985– 994. doi:10.1016/j.jvs.2014.11.071.
36. Chan YC, Law Y, Cheung GC, et al. Predictors of recanalization for incompetent great saphenous veins treated with cyanoacrylate glue. J Vasc Interv Radiol. 2017;28:665–671. doi:10.1016/j. jvir.2017.01.011.
37. Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular 2017;25:149–156. doi:10.1177/1708538116651014.
38. Almeida JI, Javier JJ, Mackay E, et al. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord. 2013;1:174–180. doi:10.1016/j. jvsv.2012.09.010.
39. Lam YL, De Maeseneer M, Lawson J, et al. Expert review on the VenaSeal® system for endovenous cyano-acrylate adhesive ablation of incompetent saphenous trunks in patients with varicose veins. Expert Rev Med Devices 2017;14:755–762. doi:10.1080/17434440.2017.1378093.
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Perspectives in Surgery
2022 Issue 5
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