Efficacy of Endovenous Laser Ablation and Ultrasound-Guided Foam Sclerotherapy in Patients with Great Saphenous Vein and Perforating Vein Insufficiency
Abstract
Aim: In this study, we aimed to investigate the efficacy of endovenous laser ablation (EVLA) and EVLA combined with ultrasound-guided foam sclerotherapy (UGFS) and outcomes of treatments in patients with great saphenous vein (GSV) and perforating vein (PV) insufficiency.
Material and Method: Patients underwent EVLA and EVLA+UGFS at the Interventional Radiology Department of a tertiary referral hospital over a 2-year period were retrospectively analysed. Lower limbs of patients were divided into 2 groups according to the treatment method: lower limbs underwent EVLA (group 1) and EVLA+UGFS (group 2). Before and after the procedures, GSVs and incompetent PVs were assessed by colour Doppler ultrasound. Chronic venous insufficiency symptoms (CVIS): pain, heaviness, night cramps, fatigue, itching, burning sensation, swelling, numbness, tingling and visual analogue scale (VAS) scores were assessed before and at 6 months after treatment.
Results: The study group included 29 female (69.1%) and 13 male (30.9%) patients with a mean age of 49.8±12.5 years (range, 24-73 years). All treated GSVs and IPVs were occluded at 6 months after procedures. Improvement in one or more CVIS was observed in all limbs. Full recovery in CVIS was 11/38 (28.9%) in group 1 and 2/9 (22.2%) in group 2. No significant difference was found between the two groups in the comparison of the percentage reduction in the rate of full recovery of symptoms (p>0.05). The VAS scores were significantly decreased after procedures in group 1 and 2 (p=0.0001 and 0.007, respectively). The difference in the percentage decrease in VAS scores in the 6th month compared to before treatment was not statistically different between the two groups (p>0.05).
Conclusion: EVLA and UGFS are highly effective and reliable treatments for GSV and PV insufficiency. EVLA+UGFS treatments provide similar improvements in CVIS in lower limbs with GSV and PV insufficiency. Patients with lower clinical severity, treatment only for GSV insufficiency may be considered instead of concomitant treatment of GSV insufficiency and PVI.
Keywords
Endovenous laser ablation ultrasound-guided foam sclerotherapy great saphenous vein varicose vein perforating vein insufficiency
Ethical Statement
The present study was approved by the Ethics Committee of the Faculty of Medicine at Pamukkale University (approval number: 2013/10; date of approval: 05/08/2013). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients during their period of hospitalisation.
Supporting Institution
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Thanks
This article is based on the specialisation thesis of the corresponding author, Tuğberk Baştürk, and we would like to thank Ali Koçyiğit for his contribution to data collection.
References
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- Ontario Health (Quality). Nonthermal endovenous procedures for varicose veins: a health technology assessment. Ont Health Technol Assess Ser. 2021;21:1-188.
- Azar J, Rao A, Oropallo A. Chronic venous insufficiency: a comprehensive review of management. J Wound Care. 2022;31:510-9.
- Whiteley MS. Current Best Practice in the Management of varicose veins. Clin Cosmet Investig Dermatol. 2022;15:567-83.
- Hager ES, Washington C, Steinmetz A, et al. Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy. J Vasc Surg Venous Lymphat Disord. 2016;4:51-6.
- Masuda EM, Kessler DM, Lurie F, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006;43:551-7.
- Dillavou ED, Harlander-Locke M, Labropoulos N, et al. Current state of the treatment of perforating veins. J Vasc Surg Venous Lymphat Disord. 2016;4:131-5.
- Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023;11:231-61. Erratum in: J Vasc Surg Venous Lymphat Disord. 2024;12:101719.
- Fukaya E, Flores AM, Lindholm D, et al. Clinical and genetic determinants of varicose veins. Circulation. 2018;138:2869-80.
- Piazza G. Varicose veins. Circulation. 2014;130:582-7.
- Kiguchi MM, Hager ES, Winger DG, et al. Factors that influence perforator thrombosis and predict healing with perforator sclerotherapy for venous ulceration without axial reflux. J Vasc Surg 2014; 59:1368-76.
- Gao RD, Qian SY, Wang HH, et al. Strategies and challenges in treatment of varicose veins and venous insufficiency. World J Clin Cases. 2022;10:5946-56.
- Pavei P, Spreafico G, Bernardi E, et al. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021;9:352-60.
- Malskat WS, Engels LK, Hollestein LM, et al. Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2019;58:230-42.
- Theivacumar NS, Dellagrammaticas D, Darwood RJ, et al. Fate of the great saphenous vein following endovenous laser ablation: does re- canalisation mean recurrence?. Eur J Vasc Endovasc Surg. 2008;36:211-5.
- Khilnani NM, Grassi CJ, Kundu S, et al; Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Society of Interventional Radiology Standards of Practice Committees. Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol. 2010; 21:14- 31.
- Van den Bos RR, Neumann M, De Roos KP, et al. Endoyenous laser ablation induced complications: review of the literature and new cases. Dermatol Surg. 2009;35:1206-14.
- Vaz C, Matos A, de Pereira MSC, et al. Iatrogenic complications following laser ablation of varicose Veins: In Rutherford´s Vascular Surgery. Philadelphia: Sauders Elsevier 2010:871-88.
- Sanioglu S, Yerebakan H, Ozgen A, et al. Mid-calf level as a puncture site is not safe enough for thermal ablation of the small saphenous vein. SAGE Open Med. 2017;5:2050312117731474.
- Bush RG, Bush P, Flanagan J, et al. Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study. Scientific World J. 2014;2014:505843.
- Shi H, Liu X, Lu M, et al. The effect of endovenous laser ablation of incompetent perforating veins and the great saphenous vein in patients with primary venous disease. Eur J Vasc Endovasc Surg. 2015;49:574-80.
- Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27:46-51.
- Bossart S, Daneluzzi C, Cazzaniga S, et al. Skin hyperpigmentation after sclerotherapy with polidocanol: a systematic review. J Eur Acad Dermatol Venereol 2023;37:274-83.
- Yilmaz S, Ceken K, Alparslan A, et al. Endovenous laser ablation for saphenous vein insufficiency: immediate and short-term results of our first 60 procedures. Diagn Interv Radiol. 2007;13:156-63.
- Vourliotakis G, Sahsamanis G, Evagelidis P, et al. Endovascular laser treatment of incompetent saphenous veins using the 1470 nm diode laser and radial fiber. Ann Med Surg. 2018;25:12-6.
- Yie K. Symptom improvement after cyanoacrylate glue adhesion and endovenous laser ablation in low-grade CEAP clinical classes. J Vasc Surg Venous Lymphat Disord. 2022;10:360-9.e2.
- Oğuzkurt L. Ultrasonographic anatomy of the lower extremity superficial veins. Diagn Interv Radiol. 2012;18:423-30.
Abstract
References
- Fayyaz F, Vaghani V, Ekhator C, et al. Advancements in varicose vein treatment: anatomy, pathophysiology, minimally invasive techniques, sclerotherapy, patient satisfaction, and future directions. Cureus. 2024;16:e51990.
- Ontario Health (Quality). Nonthermal endovenous procedures for varicose veins: a health technology assessment. Ont Health Technol Assess Ser. 2021;21:1-188.
- Azar J, Rao A, Oropallo A. Chronic venous insufficiency: a comprehensive review of management. J Wound Care. 2022;31:510-9.
- Whiteley MS. Current Best Practice in the Management of varicose veins. Clin Cosmet Investig Dermatol. 2022;15:567-83.
- Hager ES, Washington C, Steinmetz A, et al. Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy. J Vasc Surg Venous Lymphat Disord. 2016;4:51-6.
- Masuda EM, Kessler DM, Lurie F, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006;43:551-7.
- Dillavou ED, Harlander-Locke M, Labropoulos N, et al. Current state of the treatment of perforating veins. J Vasc Surg Venous Lymphat Disord. 2016;4:131-5.
- Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023;11:231-61. Erratum in: J Vasc Surg Venous Lymphat Disord. 2024;12:101719.
- Fukaya E, Flores AM, Lindholm D, et al. Clinical and genetic determinants of varicose veins. Circulation. 2018;138:2869-80.
- Piazza G. Varicose veins. Circulation. 2014;130:582-7.
- Kiguchi MM, Hager ES, Winger DG, et al. Factors that influence perforator thrombosis and predict healing with perforator sclerotherapy for venous ulceration without axial reflux. J Vasc Surg 2014; 59:1368-76.
- Gao RD, Qian SY, Wang HH, et al. Strategies and challenges in treatment of varicose veins and venous insufficiency. World J Clin Cases. 2022;10:5946-56.
- Pavei P, Spreafico G, Bernardi E, et al. Favorable long-term results of endovenous laser ablation of great and small saphenous vein incompetence with a 1470-nm laser and radial fiber. J Vasc Surg Venous Lymphat Disord. 2021;9:352-60.
- Malskat WS, Engels LK, Hollestein LM, et al. Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2019;58:230-42.
- Theivacumar NS, Dellagrammaticas D, Darwood RJ, et al. Fate of the great saphenous vein following endovenous laser ablation: does re- canalisation mean recurrence?. Eur J Vasc Endovasc Surg. 2008;36:211-5.
- Khilnani NM, Grassi CJ, Kundu S, et al; Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Society of Interventional Radiology Standards of Practice Committees. Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol. 2010; 21:14- 31.
- Van den Bos RR, Neumann M, De Roos KP, et al. Endoyenous laser ablation induced complications: review of the literature and new cases. Dermatol Surg. 2009;35:1206-14.
- Vaz C, Matos A, de Pereira MSC, et al. Iatrogenic complications following laser ablation of varicose Veins: In Rutherford´s Vascular Surgery. Philadelphia: Sauders Elsevier 2010:871-88.
- Sanioglu S, Yerebakan H, Ozgen A, et al. Mid-calf level as a puncture site is not safe enough for thermal ablation of the small saphenous vein. SAGE Open Med. 2017;5:2050312117731474.
- Bush RG, Bush P, Flanagan J, et al. Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study. Scientific World J. 2014;2014:505843.
- Shi H, Liu X, Lu M, et al. The effect of endovenous laser ablation of incompetent perforating veins and the great saphenous vein in patients with primary venous disease. Eur J Vasc Endovasc Surg. 2015;49:574-80.
- Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27:46-51.
- Bossart S, Daneluzzi C, Cazzaniga S, et al. Skin hyperpigmentation after sclerotherapy with polidocanol: a systematic review. J Eur Acad Dermatol Venereol 2023;37:274-83.
- Yilmaz S, Ceken K, Alparslan A, et al. Endovenous laser ablation for saphenous vein insufficiency: immediate and short-term results of our first 60 procedures. Diagn Interv Radiol. 2007;13:156-63.
- Vourliotakis G, Sahsamanis G, Evagelidis P, et al. Endovascular laser treatment of incompetent saphenous veins using the 1470 nm diode laser and radial fiber. Ann Med Surg. 2018;25:12-6.
- Yie K. Symptom improvement after cyanoacrylate glue adhesion and endovenous laser ablation in low-grade CEAP clinical classes. J Vasc Surg Venous Lymphat Disord. 2022;10:360-9.e2.
- Oğuzkurt L. Ultrasonographic anatomy of the lower extremity superficial veins. Diagn Interv Radiol. 2012;18:423-30.
Details
| Primary Language | English |
|---|---|
| Subjects | Radiology and Organ Imaging |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | May 9, 2025 |
| Submission Date | March 16, 2025 |
| Acceptance Date | April 24, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
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