Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results

Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-termina...

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Veröffentlicht in:	Phlebology 2018-06, Vol.33 (5), p.321-329
Hauptverfasser:	Leo, Moro, Stefano, Ricci, Raffaele, Antonelli Incalzi
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Sprache:	eng
Schlagworte:	Adult Aged Female Femoral Vein Follow-Up Studies Humans Laser Therapy Male Middle Aged Postoperative Period Saphenous Vein - physiopathology Sclerosing Solutions - therapeutic use Sclerotherapy Severity of Illness Index Surveys and Questionnaires Treatment Outcome Ultrasonography, Interventional Varicose Veins - therapy Venous Insufficiency - therapy
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description	Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 (p
doi_str_mv	10.1177/0268355517702818
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However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 (p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 (p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 (p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy.</description><identifier>ISSN: 0268-3555</identifier><identifier>EISSN: 1758-1125</identifier><identifier>DOI: 10.1177/0268355517702818</identifier><identifier>PMID: 28440727</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Postoperative Period ; Saphenous Vein - physiopathology ; Sclerosing Solutions - therapeutic use ; Sclerotherapy ; Severity of Illness Index ; Surveys and Questionnaires ; Treatment Outcome ; Ultrasonography, Interventional ; Varicose Veins - therapy ; Venous Insufficiency - therapy</subject><ispartof>Phlebology, 2018-06, Vol.33 (5), p.321-329</ispartof><rights>The Author(s) 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-f5f078cbaf163413d2bc8d3d99f1318ac1dc4454f1feeebd7e5a41924f7f05d73</citedby><cites>FETCH-LOGICAL-c337t-f5f078cbaf163413d2bc8d3d99f1318ac1dc4454f1feeebd7e5a41924f7f05d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0268355517702818$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0268355517702818$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28440727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leo, Moro</creatorcontrib><creatorcontrib>Stefano, Ricci</creatorcontrib><creatorcontrib>Raffaele, Antonelli Incalzi</creatorcontrib><title>Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results</title><title>Phlebology</title><addtitle>Phlebology</addtitle><description>Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 (p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 (p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 (p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy.</description><subject>Adult</subject><subject>Aged</subject><subject>Female</subject><subject>Femoral Vein</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Laser Therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Period</subject><subject>Saphenous Vein - physiopathology</subject><subject>Sclerosing Solutions - therapeutic use</subject><subject>Sclerotherapy</subject><subject>Severity of Illness Index</subject><subject>Surveys and Questionnaires</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Interventional</subject><subject>Varicose Veins - therapy</subject><subject>Venous Insufficiency - therapy</subject><issn>0268-3555</issn><issn>1758-1125</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kN1KxDAQhYMouv7ceyV5gWiSNqbrnYirguKNXpc0mexm6TYl0yo-jy9q1lURQRiYYeY7Z-AQciz4qRBan3F5XhVKqTxzWYlqi0yEVhUTQqptMlmf2fq-R_YRl5xzqbXeJXuyKkuupZ6Q91k0K4q2hRSHBSTTv9HoaR7pPIEZKJp-AV0ckb5A6GgugxhtMEOIHX0Nw4L2CdgAaRU60_7il2NnP6E2zD_pMxdeAq43Bqnp8h8fLLDGILhsEi24McEFFZI9xC4bJ8CxHfCQ7HjTIhx99QPyPLt-urpl9483d1eX98wWhR6YV57ryjbGi_OiFIWTja1c4aZTLwpRGSucLUtVeuEBoHEalCnFVJZee66cLg4I3_jaFBET-LpPYWXSWy14vc67_pt3lpxsJP3YrMD9CL4DzgDbAGjmUC_jmHJI-L_hB-qWjJg</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Leo, Moro</creator><creator>Stefano, Ricci</creator><creator>Raffaele, Antonelli Incalzi</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>201806</creationdate><title>Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results</title><author>Leo, Moro ; Stefano, Ricci ; Raffaele, Antonelli Incalzi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-f5f078cbaf163413d2bc8d3d99f1318ac1dc4454f1feeebd7e5a41924f7f05d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Female</topic><topic>Femoral Vein</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Laser Therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Period</topic><topic>Saphenous Vein - physiopathology</topic><topic>Sclerosing Solutions - therapeutic use</topic><topic>Sclerotherapy</topic><topic>Severity of Illness Index</topic><topic>Surveys and Questionnaires</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Interventional</topic><topic>Varicose Veins - therapy</topic><topic>Venous Insufficiency - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leo, Moro</creatorcontrib><creatorcontrib>Stefano, Ricci</creatorcontrib><creatorcontrib>Raffaele, Antonelli Incalzi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Phlebology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leo, Moro</au><au>Stefano, Ricci</au><au>Raffaele, Antonelli Incalzi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results</atitle><jtitle>Phlebology</jtitle><addtitle>Phlebology</addtitle><date>2018-06</date><risdate>2018</risdate><volume>33</volume><issue>5</issue><spage>321</spage><epage>329</epage><pages>321-329</pages><issn>0268-3555</issn><eissn>1758-1125</eissn><abstract>Objective Ultrasound-guided foam sclerotherapy (UGFS) – one of the most frequently recommended methods for treating great saphenous vein incompetence – is easy and inexpensive. However, it achieves a lower occlusion rate compared to endovenous thermal ablation. The application of UGFS to pre-terminal great saphenous vein interruption, eliminating the saphenous stem wash out effect, enhances the short-term occlusion rate. This study explores the results of this technique at 12 months. Method Thirty great saphenous veins (28 patients) with junction incompetence, with calibres >6 mm and >30 cm reflux stem length were submitted to echo-guided pre-terminal great saphenous vein interruption and foam great saphenous vein occlusion. Participants were subjected to a 12-month post-operative review by ultrasound assessment of great saphenous vein occlusion and terminal stump stability. Comparisons were made between pre-operative and 12-month Validation of Venous Clinical Severity Score (VCSS), photopletismography, Aberdeen questionnaire and complications. Results After 12 months, 28/30 great saphenous veins remained occluded (93%). One complete and one partial recanalization did not require retreatment. Four saphenous stumps showed a reflux during Valsalva (one due to recanalization, one limited to the stump, two with reflux in the anterior accessory saphenous vein). VCSS improved from 3.33 ± 1.64 to 0.67 ± 1.21 (p < 0.05). Aberdeen questionnaire scores decreased from 9.44 ± 6.18 to 2.47 ± 3.77 (p < 0.05). For photopletismographic examination, the mean venous refilling time (normal value: > 25 s) improved from 17.94 ± 11.97 to 31.4 ± 11.99 (p < 0.05). Conclusion Applying pre-terminal great saphenous vein interruption to UGFS of the saphenous stem achieved an occlusion rate at one year similar to that of endovenous thermal ablation. The procedure is simple, effective, office based, and may be used as a 10-min prolongation to a phlebectomy.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>28440727</pmid><doi>10.1177/0268355517702818</doi><tpages>9</tpages></addata></record>
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subjects	Adult Aged Female Femoral Vein Follow-Up Studies Humans Laser Therapy Male Middle Aged Postoperative Period Saphenous Vein - physiopathology Sclerosing Solutions - therapeutic use Sclerotherapy Severity of Illness Index Surveys and Questionnaires Treatment Outcome Ultrasonography, Interventional Varicose Veins - therapy Venous Insufficiency - therapy
title	Foam sclerotherapy of the great saphenous vein in association with pre-terminal saphenous junction ligation/division as an office-based procedure: 12-Month results
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