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Varicose veins typically occur in the lower limbs, caused by valvular insufficiency leading to the swelling and tortuosity of subcutaneous veins. Although rare in the upper limbs, they can be successfully diagnosed and treated. Rare causes include congenital vascular anomalies like Klippel-Trenaunay syndrome and Parkes Weber syndrome, characterised by Arteriovenous (AV) fistulae. Subclavian vein thrombosis-induced venous outflow obstruction is another uncommon cause. Diagnosis involves a thorough history taking with clinical examination, often supplemented by investigations. Invasive procedures are rarely necessary but may be used in unique cases to define the pathology further. Treatment for upper limb varicose veins closely mirrors lower limb approaches. The stab-avulsion technique combined with stripping of lengthier sections yields outstanding cosmetic and functional results. Surgical ligation with stripping effectively eliminates varicosities with a low risk of recurrence. Sclerosing agents like Sodium Tetradecyl Sulphate and Polidocanol are substitutes for surgery. In cases of varicosities resulting from upper limb arteriovenous fistulae, surgical intervention involving ligation of the distal venous limb or division of the fistula is the standard approach. In summary, while upper limb varicose veins are exceptionally rare, they can be accurately diagnosed and effectively treated with surgical interventions similar to lower limb varicose veins. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the efficacy and safety of the combination of minimally invasive methods for the treatment of incompetent great saphenous vein and perforating veins. Methods: Between December 2019 and October 2020, F-care radiofrequency ablation combined with ultrasound-guided foam sclerotherapy and residual perforator ligation and concomitant microphlebectomy were adopted for all eligible patients. The clinical symptoms scores, complications, and quality of life were recorded. Results: 49 patients (64 limbs) with a mean age of 63.29 ± 10.14 years, and 60.9% 4 were male. The 1-year truncal closure rate was 63/64 (98.4%). 1 A significant improvement in the Venous Disability Score, the Venous Segmental Disease Score, the Venous Clinical Severity Score and Chronic Venous Disease Quality of Life Questionnaire Score, at 12 months after the combination of minimally invasive treatment, were observed in the study. One patient developed intermuscular vein thrombosis that was successfully managed with rivaroxaban. Conclusions: The combination of minimally invasive methods is a safe and effective method for the treatment of lower extremity varicose veins. Further large-scale, prospective, multi-center studies are needed to further verify the findings of this study. [ABSTRACT FROM AUTHOR]

Background: Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P<0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group. [ABSTRACT FROM AUTHOR]

The article discusses the indications and safe volumes for sclerotherapy in the treatment of chronic venous disease, emphasizing the need for careful patient selection and tailored treatment approaches. Topics include contraindications for sclerotherapy, diagnostic evaluation using duplex ultrasound, and recommendations for sclerosant type and concentration based on target vessel characteristics.

Thermoablative techniques currently represent, in accordance with international guidelines, the most used methods in the treatment of varicose veins. From some years, lasers with a wavelength greater than 1900 nm have been introduced for EndoVenous Laser Ablation (EVLA) treatment. However, currently, few clinical studies regarding this new technology are reported in the medical literature. The aim of this study is to evaluate outcomes at a 2-year follow-up (mid-term) of EVLA of varicose veins of the lower limbs using a 1940-nm laser and a new cylindric monoring fiber. This clinical trial was conducted as a multicenter, retrospective, non-randomized, non-blind clinical study. Ninety-three patients were enrolled for a total of one hundred consecutive procedures performed in the period between January 2021 and May 2021 in two Italian facilities. The primary efficacy endpoint was the occlusion rate of the treated vein immediately after surgery and at the follow-up (24 months). The secondary efficacy endpoint was the evaluation of the parameters of energy delivered during the procedure (power and linear energy density or LEED). The primary safety endpoints were the incidence of pain (1 day and 7 days after surgery) and the rate of intraoperative and postoperative complications. The precepted pain was evaluated with the visual analog scale (VAS). The secondary safety endpoint was the evaluation of the improvement of the patient's symptoms related to venous disease. This evaluation was conducted by recording the changes in clinical, etiologic, anatomic, and pathophysiologic (CEAP) classification. All procedures were carried out regularly on an outpatient basis, and no intraoperative complications occurred. The occlusion rate of the target veins was 100% at 7- and 30-day controls. At follow-up controls, performed at 6 months, 1 and 2 years carried out showed an occlusion rate respectively of 99% (97 to 100), 96.9% (93.6 to 100), and 95.9% (92.1 to 99.9). The secondary efficacy endpoint was the evaluation of the parameters of energy delivered during the procedure (power watt and linear energy density): As regards the power parameters, we report an average of watts of 4.5 ± 0.8 [2.5 to 6] and linear energy density delivered (LEED) of 41.2 ± 8.6 [(21.1 to 66.7)]. The pain reported (with VAS scale) on 1 day of the procedure was 2 [1; 3] and 1 [0 to 4] at 7 days. All patients showed improved symptoms related to venous disease, with reduction of the individual CEAP class to which they belong. This study demonstrates that EndoVascular Laser Ablation (EVLA) treatment of varicose veins with a wavelength > 1900 nm is safe and effective. The overall occlusion rate was high. The reported results suggest that using lower parameters, such as output power (watts) and LEED (linear energy density), do not reduce the success rate of the treatment when used over 35 J/cm. [ABSTRACT FROM AUTHOR]

Introduction. This study investigates the long-term effectiveness and safety of endovenous laser treatment (EVLT) for chronic venous insufficiency (CVI), a condition commonly caused by dysfunctional valves in the venous circulation system. Materials and Methods. In this retrospective cohort study, patients underwent EVLT and were followed up for successive short intervals and one last time after a median duration of 9-year postprocedural. Pre- and postprocedure duplex ultrasound was used to assess changes in the great saphenous vein (GSV) diameter, reflux, and saphenofemoral junction incompetence. Quality of life was evaluated using the SF-36 and Aberdeen Varicose Vein Questionnaire (AVVQ). Results. Sixty-eight patients with a mean age of 52.4 ± 12.4 years were enrolled in the study. The mean follow-up time was 8.9 ± 2.1 years, ranging from 5 to 12 years. The mean GSV diameter significantly decreased in all patients (whole group) across proximal (from 5.8 ± 2.3 mm to 4.2 ± 2.1 mm), middle (from 4.7 ± 1.6 mm to 2.8 ± 2.2 mm), and distal (from 4.5 ± 2.3 mm to 2.2 ± 2.2 mm) segments, with P < 0.001. A disease recurrence rate of 33.8% was noted, predominantly in male patients and those with larger middle GSV diameters (OR = 5.2 (95 % CI = 1.3 -20.4) and OR = 1.5 (95 % CI = 1 -2.1), respectively). The average follow-up time for patients without recurrence was 8.8 ± 2.1 years. Almost half of the patients without recurrence were followed up for 10 years or more (49%). Conclusion. The efficacy of EVLT in managing varicose veins is demonstrated by its relatively low recurrence rate over a 10-year follow-up period, highlighting EVLT as a viable long-term treatment strategy. [ABSTRACT FROM AUTHOR]

Varicose veins are common disorders that affect the quality of life of sufferers due to the symptoms they cause. The efficacy of different varicose vein treatments has been studied extensively, with varying success rates. Less invasive treatments, such as sclerotherapy, can be mentioned among the proposed therapies. This study investigates the efficacy of ultrasound-guided foam sclerotherapy (UGFS) for treating varicose veins. In this study, the results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) protocol. By searching in 11 databases as well as the Google Scholar search engine using the keywords "varicose vein," "foam sclerotherapy," "occlusion," "success," "Duplex-guided foam sclerotherapy," "efficacy," and "Ultrasound-Guided Foam Sclerotherapy," randomized clinical trial (RCT) and cohort articles published until July 2022 were collected. The required information was extracted and analyzed using Comprehensive Meta-analysis (CMA) software version 2. Data analysis of 35 randomized clinical trial articles showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 78% (95% CI: 73–83; P value < 0.001) (I2 = 89.11, P value < 0.001). The subgroup analysis showed that the success of this method is more in the form of sodium tetradecyl sulfate and polidocanol 2% foam and in a period of fewer than 3 months from the start of treatment and in the Asian race. Also, the analysis of 8 cohort studies showed that the success rate of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is 81% (95% CI: 65–91; P value < 0.001). The most prevalent complications of this method in the treatment of varicose veins were induration, thrombophlebitis, bruising, dyspigmentation, hematoma, pain, and phlebitis. Present study illustrated that the effectiveness of ultrasound-guided foam sclerotherapy in the treatment of varicose veins is high. However, it was significantly less successful than published meta-analyses on other less invasive methods such as radiofrequency ablation (RFA) and endovenous laser ablation (EVLA). Also, this method showed more major complications than our previous study on the effect of endovenous laser ablation in the treatment of varicose veins. Factors such as foam type, follow-up duration, and racial differences can affect the study's results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Varicose vein entity includes a vast majority of clinical and pathological manifestations. However, there are very few standardized methods to assess the clinical severity and predict the outcomes of surgery in such patients. Hence, this current study evaluated the role of on Clinical Assessment of varicose veins by clinical scores and correlating the outcomes of surgery in such patients. METHODS AND MATERIALS: This analytical study group consisted of 60 patients above 18 years. They were assessed for severity of varicose veins by documenting a detailed history, clinical examination findings, imaging studieson a prestructured case sheet and the result of surgery. It wasfound that majority of the patients were =60 yrs.and the left lowerlimb was predominantly affected in both sexes. RESULTS: In our study 50 % (n=30) patients had Severe grade of Venous Reflux (VRS). We found that majority had undergone the SFJ Flush ligation and multiple perforator ligation 50.0% (n=30). We also analyzed the postoperative outcome, which revealed majority had uneventful periods 66.67 % (n=40). We also found that the clinical features assessed correlated well with the venous reflux on the Duplex scan, as well as surgical outcomes and complications (Pearson correlation coefficient=0.171, P value-0.032). CONCLUSION- A statistically significant result was found for the clinical assessment scores and also correlated with the surgical outcome. [ABSTRACT FROM AUTHOR]

The article focuses on the management of bleeding varicose veins, highlighting the potential risks and urgent need for medical attention. Topics discussed include first aid measures for patients experiencing bleeding, immediate clinical management in healthcare facilities, and the importance of timely referral to vascular specialists to prevent recurrence and ensure patient safety.

In surgical diseases, obesity is a significant risk factor for wound infection, more surgical blood loss and a longer post-operative time and increased risk of venous thromboembolism due to impairment of cardiac, pulmonary, and immunological functions. Underweight patients are at more risk for post-operative complications, including long term mortality. We obtained data prospectively from 1540 patients attending General surgery OPD from October 2022-December 2022 in Victoria hospital. Height, weight, BMI was calculated after Detailed history and clinical examination is noted. we found that hernias and varicose veins were more common with the patients with more weight. Obese patients more tend to have hernias than normal weight patients. Most patients with breast lumps belong to obese grade 2 class. In developing countries like india, where there is a stage of nutritional transition particularly in urban areas, the problems of undernutrition and over-nutrition should be addressed. [ABSTRACT FROM AUTHOR]

Background: endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. Methods: all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions. Results: 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively. Conclusions: EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients. [ABSTRACT FROM AUTHOR]

Introduction: Even though EVLA is increasingly popular and together with other minimally-invasive techniques is rapidly replacing surgical stripping, surgical treatment is still widely used. Our study aimed to compare the clinical outcomes and the quality of life following either endovenous laser ablation (EVLA) or conventional surgery for varicose veins of the lower limbs. Aim and Objective of the study: the present study is aimed to compare the clinical outcomes and the quality of life in varicose veins patients who had undergone endovenous laser ablation or open surgery. Materials and Methods: It is a prospective randomised study. A total of 268 patients were treated for symptomatic varicose veins since the previous year, among them 130 patients underwent open surgery and 138 patients received endovenous laser ablation. Results: Disease-specific quality of life at six weeks was significantly better in the EVLA group. Similarly, VCSS and AVVQ scores at six weeks were also better in the EVLA group. Patients in the EVLA group experienced less postoperative pain and therefore needed fewer supplementary analgesic drugs. In addition, patients in the EVLA group managed to return to work and normal activities sooner than those in the surgery group. However no statistically significant differences were found between groups for clinical recurrence, overall satisfaction, rate of complications and secondary procedures at the end of one year. Discussion and Conclusion: Both techniques -- EVLA and surgery -- yielded similar results in terms of efficacy, clinical recurrence rates and overall patient satisfaction. Although in the present study we did not find EVLA to be superior to surgical stripping in the long term, a significant difference was seen in the immediate post operative period in terms of post operative pain and the duration of time required to return to work. Therefore, we assume that EVLA should be recommended over surgical stripping, especially for patients who need to resume to work in post-operative period. [ABSTRACT FROM AUTHOR]

Background: The prevalent issue of varicose veins in the lower extremities necessitates exploring effective and efficient treatment methods. This study aims to evaluate the efficacy of foam sclerotherapy, focusing on improvements in the venous clinical severity score and the swift return to work posttreatment. Through this research, we intend to ascertain whether foam sclerotherapy can serve as a cost-effective, safe, and satisfactory alternative to traditional treatments. Methodology: A universal sampling method was implemented to select the sample size for the study. The study cohort consisted of 31 patients who visited the outpatient department and met the established inclusion criteria. These patients underwent comprehensive history evaluation and physical examinations. Subsequent to the preliminary evaluations, the patients were subjected to necessary hematological and biochemical analyses along with appropriate radiological investigations, including USG venous Doppler studies, dictated by clinical suspicions. All participants underwent USG-guided foam sclerotherapy and their progress was monitored based on predefined outcomes. Results: The study predominantly involved males aged between 30 and 60 years. A significant enhancement in patient satisfaction was documented, with notable reductions in ulcer size in 3 out of the 31 patients who initially presented with ulcers. Moreover, the therapy ensured a 100% reduction in reported pain and swelling, with no hospital stays extending beyond one day. Remarkably, 28 out of the 32 patients managed to resume their work within a span of less than 7 days, showcasing no side effects from the treatment. Conclusion: The data gleaned from the study underscore the considerable patient satisfaction derived from foam sclerotherapy, especially concerning alleviation in pain, swelling, and enhanced ulcer healing. Furthermore, patients reported a significant reduction in lower limb pigmentation following the therapy. Not only is foam sclerotherapy cost-effective and safe, but it also facilitates a quicker return to work coupled with shorter hospital stays, establishing itself as a potent alternative in managing symptomatic varicose veins. [ABSTRACT FROM AUTHOR]

Background: Varicose vein is a common surgical disease. Diagnosis and management of the same has significantly improved since the advent of Duplex Ultrasonography. This study was undertaken to evaluate the clinical outcomes in patients with varicose veins treated with Endovenous Laser Ablation (EVLA). Materials and Methods: This retrospective and on-going prospective observational study was carried out in a tertiary care centre for a period of 18 months. Study included total 80 patients who underwent EVLA for varicose veins fulfilling inclusion and exclusion criteria. Demographic data (age, gender), clinical signs and symptoms, USG doppler findings, operative findings, and post-operative complications were recorded. Results: In this study, mean age of study patients was was 44.66 ± 14.33 years with a range from 21 to 69 years, and male preponderance (81.2%). Standing for long duration was reported in 85% of study patients, and in 80% of patient duration of disease was less than from 1 to 5 years. Dilated veins were common clinical presentation seen in 80% patients. In most of patients, hospital stay was ≤4 days. Nerve injury (27.5%) and anesthetic complications (27.5%) were the most common complications seen in this study. Conclusion: EVLA is a safe and reliable minimally invasive procedure to treat varicose vein diseases with minimal post-operative complications. [ABSTRACT FROM AUTHOR]

Introduction: The Venous Clinical Severity Score (VCSS) was designed to give more strength to CEAP classification and to provide a method for serial assessment particularly to CEAP clinical class 4 and class 6. Even though the VCSS has been very useful, several areas of deficiency are also noted over time. VCSS was again revised by American Venous Forum with an intention to improve the VCSS, and also by preserving its strengths Aim of the Study: To Compare VSS system with CEAP system postoperatively in assessing the outcome of varicose veins surgery. Methodology: A Prospective Longitudinal Clinical Study done in 30 patients from November 2019 to June 2021in the Department of General Surgery, Narayana Medical College and Hospital, Nellore. Duplex ultrasound for each patient to assess the following CEAP clinical class, CEAP 18-point clinical score, VCSS, VDS. Patients were followed up in the post-operative period for 6 weeks and 6 months and CEAP class, CEAP score, VCSS score and VDS will be recorded to assess the venous outcome at 6 weeks, 6 months. Results & Conclusion: CEAP score and VCSS percentage reductions at 6 weeks and 6 months follow-up were almost similar, VCSS showed slightly higher reduction compared to CEAP score, implying almost equally good sensitivity in measuring outcomes compared to CEAP clinical class. Venous Disability Score (VDS) reduced to 100% by 6 months follow-up and found superior compared to other scores. Thus, reflecting that VCSS along with CEAP class has more use in determining overall severity of venous disease and its outcomes post-surgical intervention, when compared to other venous assessment tools. [ABSTRACT FROM AUTHOR]

Our objective was to investigate the indications, effectiveness, and safety of Amplatzer™ Vascular Plugs (AVPs) in clinical practice. To retrospectively identify patients managed with AVPs at the Dijon University Hospital between January 2011 and April 2021, we searched materials vigilance registries and procedure reports. The 110 identified patients underwent 111 procedures with delivery of 202 AVPs into 118 vessels; 84% of the procedures were performed by radiologists with over 10 years' experience and 67% were scheduled. Varicocele, haemostasis, pelvic varicose veins, and arterio-venous dialysis fistulas accounted for 69% of procedures. The technical and clinical success rates were 99% and 97%, respectively. The single major complication was AVP migration in a high-flow internal iliac vein, with no residual abnormalities after successful device retrieval. Several AVPs and/or concomitant injection of coils or liquid agents were used in 80% of cases. The use of AVPs alone occurred chiefly for splenic artery embolisation in trauma patients and for collateral vein occlusion in dysfunctional arterio-venous dialysis fistulas. No cases of recanalisation occurred during the 19 ± 29 month follow-ups. Based on their good safety and effectiveness profile, AVPs deserve to be part of the therapeutic armamentarium of every interventional radiologist. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the outcome of hybrid endovenous laser ablation (EVLA, 1470 nm) and radiofrequency ablation (RFA) procedures for varicose veins (VVs). Material and methods: We retrospectively analysed the clinical data of patients from July 2019 to December 2020. Eighty-four patients (121 limbs) underwent a hybrid EVLA procedure, and 108 patients (151 limbs) underwent an RFA procedure. The outcomes, venous clinical severity score (VCSS), chronic venous disease quality-of-life questionnaire (CIVIQ-20) score, and recurrence at 1, 6, and 12 months were collected. Results: No differences in complications or 24-h pain scores were noted between the 2 procedures, but a lower dosage of foam sclerosant was used in the EVLA procedure than in the RFA procedure (p < 0.02). The postoperative VCSS and CIVIQ-20 scores in the 2 groups were significantly decreased compared with the scores before the procedure, and no differences in scores were noted between the 2 procedures at 1 month. However, the VCSS and CIVIQ-20 scores for the EVLA procedure were significantly better than those for the RFA procedure at 6 and 12 months (p < 0.05). Both procedures showed a similar great saphenous vein closure rate at 12 months. The EVLA procedure showed lower rates of overall recurrence (4.96% vs. 14.57%, OR = 3.27, 95% CI: 1.33-8.00, p = 0.01) and recurrence below the knee (4.13% vs. 11.92%, OR = 3.14; 95% CI: 1.18-8.35, p = 0.02). Moreover, the patient satisfaction score was greater for the EVLA procedure than for the RFA procedure (p < 0.02). Conclusions: The hybrid EVLA (1470 nm) procedure reduces VV recurrence below the knee and results in better quality-of-life scores. [ABSTRACT FROM AUTHOR]

Objective To compare the effects of traditional open surgery and laser therapy combined with foam sclerotherapy on immune system in patients with primary saphenous varicose veins. Methods A total of 104 patients who underwent elective varicose vein surgery were divided into the laser therapy combined with foam sclerotherapy group (MIS group，n=53) and traditional open surgery group (OS group, n=51) according to the surgical method.Venous blood sample was collected before and 24 h after operation for the measurement of superoxide dismutase (SOD), interleukin (IL) -1β, IL-6 and IL-8, IL-10, tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) levels. The changes in the proportion of T cell subsets and NK cells were detected by flow cytometry. The expression levels of differentially-expressed genes (DEGs) of immune cells in peripheral blood were determined by single-cell RNA sequence (scRNA-seq) technology. Results In the MIS group, no significant differences were observed in the levels of SOD, IL-6, IL-10, TNF-α and IFN-γ before and after operation (all P > 0.05) except that IL-1β and IL-8 levels were increased after operation (both P < 0.05) . In the OS group, significant differences were noted in the above indicators before and after operation (all P < 0.05) . No significant differences were found in the proportion of T lymphocyte subsets and NK cells before and after surgery in the MIS group (both P > 0.05), while the proportion of CD8+T cells was increased at postoperative 24 h, and that of NK cells was significantly reduced in the OS group (both P < 0.05) . Functional enrichment analysis of the DEGs in peripheral blood immune cells at postoperative 24 h indicated that postoperative hypoxia response, IFN response, and NF-κB inflammatory signaling pathways in the OS group were significantly up-regulated compared with those in the MIS group. Conclusion Laser treatment combined with foam sclerotherapy exerts slight effect on the immune inflammation and hypoxic response of the body system in patients with primary saphenous varicose veins. MIS can better maintain the body’s immune balance and preserve the capability of original immune system to resist microbial invasion to a greater extent compared with traditional OS. [ABSTRACT FROM AUTHOR]

Endovenous laser ablation (EVLA) is a common minimally invasive technique used to treat varicose veins. The most commonly used laser wavelengths for EVLA/EVLT of varicose veins are 810 nm and 1470 nm. The laser pulse frequency is typically set to continuous wave (CW) mode, with a pulse duration of a few milliseconds (ms) delivered in a radial mode. The energy delivered per pulse is typically set between 40 and 120 Joules, with a power setting of 10 to 30 watts and an intensity setting of 40 to 120 J/cm2. The controversy exists regarding the benefits of performing saphenofemoral junction (SFJ) ligation prior to EVLA to decrease the recurrence rate of varicose veins. This meta-analysis aims to investigate the effectiveness of combining EVLA with high ligation versus using EVLA alone in treating lower extremity varicose veins. We conducted a systematic search of four databases from their inception until July 1, 2022, for randomized controlled trials and prospective controlled trials evaluating the advantages and disadvantages of EVLA with or without high ligation for the treatment of lower extremity varicose veins. In analyzing binary data, rate difference (RD) is used, while odds ratio (OR) is used for evaluating the confidence interval (CI) of binary data. A P value of less than 0.05 is deemed statistically significant. Heterogeneity is assessed using the chi-square test. If the I2 statistic, which reflects statistical heterogeneity, is greater than 50%, a random-effects model should be used. In the absence of significant statistical heterogeneity, a fixed-effects model should be used if I2 is less than 50%. We used the Cochrane risk-of-bias tool to assess the quality of the studies and Review Manager 5.4 for the primary and secondary outcome analysis. The meta-analysis was conducted in accordance with the Cochrane Handbook. There were no significant differences in the rate of major complications (RR = 1.63; 95% CI, 0.40–6.69; P = 0.50) or in the frequency of minor complications (RR = 1.07, 95% CI, 0.87–1.31; P = 0.52) between the EVLA with high ligation (EVLA/HL) group and the EVLA group. However, the rate of vein occlusion was significantly lower in the EVLA group than in the EVLA/HL group (RR = 1.06; 95% CI, 1.03–1.09; P = 0.0004). Our meta-analysis indicates that combining EVLA with high ligation provides stable long-term clinical efficacy in treating varicose veins of the lower extremities, although it increases the invasiveness of the surgery. The use of EVLA alone may be less effective in preventing vein occlusion. [ABSTRACT FROM AUTHOR]

Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin. [ABSTRACT FROM AUTHOR]

Labial varices are commonly seen in women with varicose veins of the pelvis. Initial management is conservative management since labial varies typically resolve, particularly in pregnant patients following delivery. Varices can be seen also in association with pelvic varices in the pelvic venous disease spectrum. Sclerotherapy is often the management. This article reviews the presentation and treatment of patients with labial varices, with a focus on interventional radiologic management. [ABSTRACT FROM AUTHOR]

Background Incompetence at the saphenofemoral junction (SF) is the most common cause (70%) of varicose veins. Endovenous laser ablation (EVLA) uses laser energy to ablate incompetent axial veins selectively and was originally described for the treatment of GSV reflux and its related varicosities. The venous system is a network of interconnected vessels; any preserved inflow of the saphenous-femoral mouth can cause postoperative recurrence. However, according to the literature, the greatest risk of recurrence is associated with the stump of the GSV of venous tributaries, including great venous trunks parallel to the GSV in the thigh. Aim of the work Comparison of the standard endovenous laser ablation technique (1.5–2 cm from SFJ) versus crossectomy ablation for the treatment of varicose veins regarding recurrence of reflux and incidence of endovenous heat-induced thrombus (EHIT) in the first week. Patients and methods In all, 80 patients admitted to Ain Shams University Hospitals and Alexandria Armed Forces Hospital from Jan. 1st, 2021 to Jan. 30th, 2023 participated in the study. The patients were divided evenly into two groups: Participants were randomly assigned to one of the trial groups using the sealed envelope method.Group A was treated by ablation of the great saphenous vein at the saphenofemoral junction (0 cm from SFJ) using 1470 nm radial double-ring diode laser fibers (ELVeS Radial 2ring™ fiber) and Biolitec Ceralas E1470/15 W laser machine. Group B was treated by ablation of the great saphenous vein at 1.5–2 cm from the saphenofemoral junction using the same laser fiber and machine. Ablation was done after putting an appropriate amount of tumescent anesthesia (500 mg lidocaine, 1 mg of epinephrine, and 12.5 mEq sodium bicarbonate added to a 1-liter solution of 0.9% normal saline). The ultrasound machine was used for the accurate placement of the laser fiber. Postoperative duplex was done on day 1, 1 week, and at 6, 12, and 18 months. Results Mean age: 39.28+/– 12.27 years in both groups; M/F: 23/17 in the first group, 20/20 in the second group. Postoperative duplex showed the absence of reflux in both groups after 1 day, after 6 months. One patient (2.5%) in group A and four patients (10%) in group B showed recurrent reflux, while recurrent refluxes were observed in one case (2.5%) in group A and five cases (12.5%) in the other group after 12 and 18 months of follow-up. One patient (2.5%) developed superficial thrombophlebitis along the course of the ablated great saphenous vein in both groups while extension to the deep veins was not detected in both groups. Conclusion Crossectomy (ablation at 0 cm at SFJ) ablation of varicose veins with 1470 radial double rings and nm diode laser with an appropriate amount of tumescent showed better results with less recurrence rate due to neovascularization or tributaries left than the standard technique of endovenous laser ablation of varicose veins (1.5–2 CM from SFJ). Along with showing a lesser incidence of thermal propagation into the deep system (EHIT) both crossectomy and standard techniques showed the same complication rate regarding venous thrombosis. [ABSTRACT FROM AUTHOR]

Background: Varicose veins could be a complicated condition, which may lead to limb swelling, pain, and venous ulcer. Conservative hemodynamic correction of venous insufficiency (CHIVA) has been developed over the past two decades and is currently the second most common surgical procedure for the operative treatment of varicose veins. Endovenous laser treatment of great saphenous vein was approved by FDA in 2002 and short saphenous vein (SSV) was approved in 2003. Endovenous laser ablation (EVLA) is a clinically safe, feasible, and welltolerated technique without scar and allows people to return to their normal daily activities rapidly. Aims And Objectives: To study the surgical management (great saphenous vein [GSV] stripping and perforator ligation) and its outcome and compare the outcome of GSV stripping in case of saphenofemoral junction incompetence and perforator ligation in case of perforator incompetence with the results of endoscopic and endovenous procedurespublished in the literature. Results: The patients with varicose veins were treated with high ligation with stripping followed by foam sclerotherapy and RFA. None of the patients undergoing high ligation with stripping had DVT and recurrence which favors the procedure selection for management. However, high ligation with stripping was associated with tenderness followed by infection. complications were less prevalent and only two patients had tenderness. Similarly, in radiofrequency ablation (RFA), one patient each had recurrences, skin color changes, and tenderness. None of the patients undergoing HL/S and foam sclerotherapy had recurrences. It was found that the duration of hospital days was more with HL/S; the majority had 6 to 8 days duration of hospital days whereas 13 patients had it for 4 days. In RFA, the majority had a duration of hospital days of 2 to 3 days only. Conclusion: open surgical management remains important in the treatment of varicose veins and is usually preferable to endovenous procedures and associated with less morbidity if carried out correctly. [ABSTRACT FROM AUTHOR]

Aim: To investigate the influence of iliac vein stenosis on the clinical course and recurrence of primary varicose veins after surgery. Materials and methods: Thirty-three patients with primary varicose veins qualified for great saphenous vein stripping were analysed. The stenosis of the common (CIV) and external (EIV) iliac vein was measured by IVUS and defined in three categories as minimal lumen area <90 mm² for CIV and <75 mm² for EIV, minimal lumen diameter <10 mm for CIV and <7.5 mm for EIV and area reduction >50%. The patients were assessed clinically and by duplex ultrasound 48 to 72 months after the procedure. Any recurrence, recurrence in the saphenofemoral junction (SFJ), change in Venous Clinical Severity Score (Δ VCSS), were analyzed in relation to the stenosis in CIV and EIV. Results: The follow-up was completed in 27 patients. Any recurrence and recurrence in SFJ were observed in 70% and 18.5% of patients, respectively. There were no statistically significant differences in any recurrence, recurrence in SFJ and Δ VCSS in relation to CIV and EIV stenosis in any category. Conclusions: Iliac vein stenosis does not influence the clinical course or recurrence of primary varicose veins after surgery [ABSTRACT FROM AUTHOR]

Telangiectasias is most prevalent on the lower limbs and has been estimated to manifest in 40%–90% of the population. Treatments for telangiectasias include sclerotherapy, laser therapy, intense pulsed light treatment, microphlebectomy, and thermocoagulation. Cryo‐Laser & Cryo‐Sclerotherapy (CLaCS) effectively combines thermal and injection sclerotherapy. In this treatment, unwanted veins are targeted by a transdermal laser and immediately receive injection sclerotherapy. During the whole procedure, an air‐cooling device (Cryo) blows onto the surrounding skin and tissue to prevent skin burn. Here, we present a case report of a challenging telangiectasias treated with ClaCS. [ABSTRACT FROM AUTHOR]

Introduction: Vascular lesions of the lower extremities and face, such as varicose veins and telangiectasias, are a common dilemma for the dermatologist. In recent years, laser therapy has emerged as a viable treatment option for these vascular anomalies. Materials and Methods: Although there are several types of lasers, the 1064‐nm Nd:YAG in particular is popularly selected for its safety profile and versatility. The longer 1064 nm wavelength penetrates deeper into the skin while also being less absorbed by hemoglobin and melanin, thus resulting in minimized damage to surrounding structures and less pigmentation changes. The new LP1064 applicator on the Harmony XL Pro Device is one such laser. Results: Numerous publications have corroborated the efficacy of 1064 nm Nd:YAG lasers. These studies cite at least over 75% of patients experiencing significant improvement in common vascular lesions. Efficacy of this laser is also seen for other vascular lesions such as port wine stains, hemangiomas, venous lakes, poikiloderma of Civatte, and angiokeratomas. Overall, the reported studies also show a low incidence of adverse events. Conclusion: The 1064 nm Nd:YAG laser, such as the Harmony LP1064 applicator, is a safe and effective tool to treat vein anomalies of the face and leg. Although commonly used for vein ablation, it has demonstrated a robust response in other indications as well. [ABSTRACT FROM AUTHOR]

BACKGROUND Recurrent varicose veins with neovascularization are a common clinical problem. Although endovenous laser ablation (EVLA) has become the standard treatment modality to treat truncal veins, additional sclerotherapy is required to treat newly formed tortuous veins. A novel laser fiber with an injection channel (nLF) allows for such simultaneous proximal sclerotherapy and offers a potentially more effective treatment option. OBJECTIVE The aim of this study was to present our experience using the nLF for combined EVLA and sclerotherapy treatment of symptomatic recurrent varicose veins. MATERIALS AND METHODS A retrospective single-center cohort study analyzed the outcomes of all patients with symptomatic recurrent varicose veins, treated with an nLF between September 2020 and August 2022. RESULTS In total, 28 combined EVLA/sclerotherapy procedures performed with the nLF in 26 patients were analyzed. In all cases, neovascularizations were treated by sclerotherapy through the nLF catheter, followed by laser ablation of the remaining truncal veins. All follow-up ultrasound examinations showed persistent complete occlusion of the treated truncal veins and neovascularizations. No clinically relevant complications were observed. CONCLUSION Combining proximal foam sclerotherapy and distal EVLA using an nLF for the treatment of symptomatic recurrent varicose veins is safe and effective. [ABSTRACT FROM AUTHOR]

Objective: To explore and analyze the effect of ultrasound-guided radiofrequency ablation combined with foam sclerosis treatment on the lower limb varicose vein pain stress response, hemodynamics and coagulation function. Methods: From August 2021to May 2022, 60 cases of lower extremity varicose veins diagnosed and treated in our hospital were selected as the research objects, and the patients were divided into Joint group and foam sclerosis group with 30 cases in each group according to the simple allocation principle. The ultrasound-guided foam sclerosis combined with radiofrequency ablation therapy, and the foam sclerosis group gave ultrasound-guided foam sclerosis therapy, and the changes of pain stress response, hemodynamics and coagulation function were observed and recorded. The pain stress response, hemodynamics and coagulation function changes were observed and recorded. Results: The VAS scores of pain in the two groups at 1 d after operation were lower than those at 1d before operation (P＜0.05), and the Joint group were also lower than that in the foam sclerosis group (P＜0.05). The serum levels of bradykinin (BK) and Substance P (SP) in the two groups were lower than those in the preoperative day 1 (P＜0.05), and the joint group were also lower than the foam sclerosis group group (P＜0.05).Plasma fibrinogen (Fib) and plasminogen activator inhibitor (PAI-1) in both groups at 1 week after operation were lower than those at 1day before operation (P＜0.05). Compared with the foam sclerosis group group, the joint group also decreased (P＜0.05). The total effective rate 1 month after surgery in the joint group were 100.0 %, which were higher than that in the foam sclerosis group (86.7 %） (P＜0.05).Conclusion: Compared with foam sclerosis, ultrasound-guided radiofrequency ablation combined with foam sclerosis for lower limb varicose veins can improve the coagulation function, effectively relieve pain, improve the hemodynamic condition of patients, and improve the overall treatment effect. [ABSTRACT FROM AUTHOR]

Background: Endovascular approaches have been widely applied in patients with brain arterio-venous malformations (AVM). However, little is known regarding the risk factors for complications or predictors of procedure success. Herein, we report our experience regarding the outcomes of endovascular embolization of posterior fossa AVM, focusing on how angioarchitectural and hemodynamic characteristics of the AVM affect the post-intervention outcomes. 17 patients diagnosed with posterior cranial fossa AVM were enrolled and scheduled for endovascular interventions by Onyx or Histoacryl. Results: Most patients had a single session (58.8%), while 29.4% had two sessions, 11.7% had three sessions. Total nidus obliteration was achieved in 52.9% of cases, while 35.3% and 11.8% of them had subtotal and partial occlusion, respectively. Postprocedural hematoma was encountered in 17.6% of cases. All preprocedural demographic characteristics did not have a significant impact on occlusion outcomes. However, some angioarchitecture criteria were associated with partial occlusion including large size, superficial or mixed drainage. No significant association was noted between patients criteria and the incidence of complications. Conclusion: Endovascular interventions could be curative for brain AVM, with an accepted periprocedural morbidity rate. Proper knowledge of the angioarchitectural characteristics of these lesions could help us to predict lesions that carry high risk for complications or high chance for cure. [ABSTRACT FROM AUTHOR]

The article informs about selected phlebological research topics, including studies on combined foam sclerotherapy and endovenous laser ablation for recurrent varicose veins, epigenetic changes in venous cells under shear stress, comparison of phlebectomy techniques, genetic factors in pulmonary thromboembolism susceptibility, sirolimus treatment for pediatric vascular anomalies, fluoroscopy-guided foam sclerotherapy, and the effects of polidocanol microfoam on venous leg ulcer healing.

Background Over the years, there have been significant advancements in the treatment of varicose veins. In most surgical settings, the open procedure is still the primary approach. Yet, the popularity of less invasive procedures like EVLA and RFA has produced fantastic outcomes. Objective to assess the safest power of laser which gives maximal effect and least complications in ablation of varicose veins. Methodology A prospective observational study inducing EVLA of different laser power settings (7W & 10W) with preoperative assessment then follow up by CEAP & VCSS and duplex ultrasound measuring great saphenous vein (GSV) diameter and also postoperative complications and time to return to work. Results This study included 50 patients (52 limbs). The Patients were distributed as regard laser power used into two groups (7W, 10W) of 26 limbs for each one. As regard GSV measures changes, there was highly statistically significant decrease in GSV diameter after 1m and after 3m compared to preoperative, with P value P<0.001, among patients group. Also, there is higher number of cases with GSV>10mm in power of laser '10w' group compared to '7w; group, with P value (P<0.001); while there is no statistically significant difference between power of laser 7w versus 10w, because all patients ≤10mm after 1 month and after 3 months, with P value >0.05. Statistically there was no significant difference between 7W & 10W groups as regards time to return to work, CEAP scores and postoperative complications except the significant difference in Pain over the treated vein being less in 7W laser power group. Conclusion For endovenous laser ablation of varicose veins, both 7W and 10W laser power are indicated. They are risk-free and provide the greatest impact with the fewest difficulties for the chosen vein diameter. In our investigation, we came to the conclusion that patients with small GSV diameter required low laser power (7W), while those with large GSV diameter required high laser power (10W). [ABSTRACT FROM AUTHOR]

Background Venous leg ulcers are a considerable health problem because of their high incidence, slow healing, high recurrence rate, and high cost of treatment. Minimally invasive treatments such as endovenous thermal ablation and foam sclerotherapy proved to be safe and effective. However, there is a paucity in studies focusing on the management of postphlebitic venous ulcers using endovenous thermal ablation of the superficial system in combination with foam sclerotherapy. Objectives The aim of our study was to assess the healing time, procedure-related complications and recurrence rate in patients having a postphlebitic venous leg ulcer after being treated with EVLA associated with ultrasound-guided foam sclerotherapy to incompetent perforators with compression therapy. Subjects and methods This is a prospective observational study, conducted at Ain Shams University Hospitals and Nasser institute hospital in Cairo on 30 patients presented with postphlebitic venous leg ulcers. Results After one year, 90% of cases had a totally healed ulcers, 10% with ulcer decrease in size of more than 50%, and recurrence rate 6.7%. The adverse events of this procedure were DVT (6%), hematoma (6%), ecchymosis (43%), thrombophlebitis (6%), and pain (70%). There was significant improvement of the VCSS as regard pain, edema, inflammation, ulcer size, and number. There was highly significant (P < 0.0001) improvement in the mean (SD) VCSS (preoperative 18 [2.808] vs. postoperative 6.367 [2.3449]). Conclusion Patients with totally recanalized deep venous system post deep venous thrombosis, presenting with nonhealing venous leg ulcers, may benefit from thermal ablation of superficial varicose veins combined with ultrasound-guided foam sclerotherapy. This combined approach is a feasible, safe, and effective modality in terms of improved healing rate, low recurrence rate, low complications, and significant improvement in quality of life. [ABSTRACT FROM AUTHOR]

Purpose to provide a road map for converting varicose veins service to endovenous ablation and assess its process and outcome on patients with varicose veins. Patients and methods Retrospective assessment of prospectively recorded data for converting vein unit which exclusively did open varicose veins surgery (OS) (39 patients from September 2019 to February 2020) to endovenous radiofrequency ablation (ERFA) service (44 patients from March 2020 to January 2021). Results There was no statistical difference in theatre time between both interventions despite dealing with more complex cases in the ERFA group with more truncal veins (χ²=11.950*, P<0.001*) and a higher number of stab avulsions (V number) (χ²=217.889, P<0.001*). On the other hand, the overall cost was significantly lower in open group compared to ERFA (Mean±SD 1261±386 US$ and 1519.2±392 US$ respectively, P<0.001*. This statistical difference was reduced to P=0.041 when subgroup analysis only included cases with higher number of avulsions. In multivariate analysis, cost was associated with surgical duration and using ERFA however, less complications were recorded in ERFA group (χ2=4.419* P=0.036*) and recovery time was significantly longer in open group (8.90±2.44) than in ERFA group (6.0±1.06), P<0.001* Conclusion Converting varicose veins service to a modern ERFA is safe and effective when properly planned. ERFA is associated with shorter recovery and less theatre time and complications despite higher cost which becomes more cost-effective in cases with more truncal veins and avulsion sites. [ABSTRACT FROM AUTHOR]

Objectives This was an open-label randomized comparative two arms study to assess the efficacy and clinical outcome of endovenous thermal ablation on reticular veins and telangiectasias in patients with lower limbs varicose veins with incompetent Sapheno-femoral Junction. Patients and methods A total of 40 patients [15 (37.5%) males and 25 (62.5%) females] with reflux of the long saphenous vein were subjected to radiofrequency ablation (RFA). 20 patients had RFA alone while the other 20 patients underwent RFA and injection sclerotherapy. Then patients were followed up on 1 week after the procedure, 3 months, 6 months, and 1 year by duplex and clinically using venous clinical severity score. Results There were 37.5% males and 62.5% females. There was a statistically significant difference in both groups regarding patients' symptoms (pain, heaviness, and swelling) before and after serial times of follow-up, which was assessed by the VCSS, denoting marked improvement of patients' symptoms. Also, there was a statistically significant difference (P<0.001) concerning duplex results regards the reflux before and following RFA. Reticular veins follow-up, we found that in group A they were present among 35% of patients on 1-week follow-up. This increased to reach 70% after 1 year of follow-up, however, in group B they were absent among all patients on 1 week follow-up. They were present among 15% of patients after 1 year of follow-up. Conclusion RFA with concomitant sclerotherapy for the associated minor veins have proved to be safe, cost-effective and more patient satisfaction than RFA without concomitant sclerotherapy. [ABSTRACT FROM AUTHOR]

Background: Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows −20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. Objective: Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. Methods: Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. Results: The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. Conclusion: The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear. [ABSTRACT FROM AUTHOR]

Varicose veins are common problems and there are many ways of treatment starting from life style modification, medications, compression therapy, surgical treatment, endovenous treatment etc. One of the endovenous treatments is sclerotherapy, a method which can be applied to the telengiectasia, reticular veins, and varicose veins. In the past, it was used only for smaller veins but now with the help of ultrasound guidance, it can be used for main truncal veins as well. It destroys the vein endothelium leading to occlusion and subsequent fibrosis of the target vessel. Injection sclerotherapy has assumed a major role in the treatment of venous insufficiency, particularly in the treatment of smaller veins such as telengiectasias and spider veins and smaller diameter tributaries. This is a very important treatment for recurrent veins and it can be combined with various other treatments. In the procedure of sclerotherapy, sclerosant agent is injected in veins. It may be injected direct undiluted, diluted, or in a form of foam. Depending on the type of vein and diameter of vein, different dilutions are used. Though the recurrence with sclerotherapy is high but being a minimal invasive technique with low cost, it is a favorable technique for varicose veins. [ABSTRACT FROM AUTHOR]

Varicose veins are a common presentation, and its treatment has been a challenge for surgeons. Many studies have evaluated the efficacy of foam sclerotherapy with a high failure rate. One of the postulated reasons is inadequate obliteration of saphenofemoral junction with foam sclerotherapy. To test this hypothesis we compared whether there is a decrease in reflux with saphenofemoral junction ligation, along with foam sclerotherapy. Forty-eight patients (50 legs) with primary varicosities of the Great saphenous vein system were randomized into two groups: saphenofemoral junction ligation with foam sclerotherapy (SFJL + FS) and foam sclerotherapy alone (FS), and followed up at 2 months. There was complete disappearance of varicose veins in great saphenous vein territory in 96% of patients in SFJL + FS group, and 88% of patients in FS group. Veins ≥ 8 mm in diameter were incompletely occluded with sclerotherapy. Patient satisfaction score was comparable in both the groups. The addition of saphenofemoral junction ligation to foam sclerotherapy offers no additional patient benefit, particularly with regard to disappearance of varicose veins, relief of symptoms, recurrence, and morbidity. However, in large diameter veins (≥ 8 mm), saphenofemoral junction ligation with foam sclerotherapy gives better results. [ABSTRACT FROM AUTHOR]

Background: Established condition-specific patient-reported outcome measures for varicose veins are limited to the measurement of health status and function. A treatment satisfaction measure is needed to understand patient satisfaction with different treatment options. The aim of this study was to design a Venous Treatment Satisfaction Questionnaire (VenousTSQ) that would be ready for large-scale data collection and psychometric evaluation. Methods: Relevant items were selected from the -TSQ Item Library and new items were designed where necessary. A draft VenousTSQ was prepared using the existing AneurysmTSQ as a template. Fifteen interviews were conducted from 4 days to 16 months after the procedure. The interviews were designed to elicit important sources of satisfaction or dissatisfaction before completion of draft questionnaires. The VenousTSQ drafts were modified between sets of interviews until no further changes were required. Results: The final VenousTSQ consists of two questionnaires: VenousTSQ early (VenousTSQe) and VenousTSQ status (VenousTSQs). Items that need be asked only once are in the VenousTSQe, whereas those that can usefully be asked more than once are in the VenousTSQs. Of the 16 unique items forming the VenousTSQ, 12 were from the -TSQ Item Library. Only 1 of these 12 required significant modification. Conclusions: The VenousTSQ represents a condition-specific psychological outcome measure for varicose veins, enabling patient satisfaction or dissatisfaction with such treatments to be measured. Large-scale data collection is under way to establish optimal scoring, quantitative validity, and reliability of the VenousTSQ. [ABSTRACT FROM AUTHOR]

Background Endovenous laser ablation (EVLA) is of no standardized settings, particularly the laser power that remains under question. Objective To assess the safest power of laser with maximal effect and least complications in ablation of varicose veins. Patients and methods A prospective observational randomized study inducing EVLA of different laser power settings (7 and 10 W) with preoperative assessment, then follow-up by CEAP [classification stands for Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)] and venous clinical severity score (VCSS), and duplex ultrasound as well as postoperative complications. Results This study included 50 patients (52 limbs). Preoperative complaint was mainly in the form of pain on standing and prominent varicosities. The patients were distributed as regards laser power used into two groups (7, 10 W) of 26 limbs for each one. There was a significant difference (P<0.05) between both groups of patients as regards VCSS after 3 months being better in the 10W group. As regards great saphenous vein measure changes, there was a high significant difference (P<0.001) between those exposed to laser power 7W in comparison with those of 10W at 1- and 3 months follow-up in relation to preoperative measures showing more reduction in the 7W group. Statistically, there was no significant difference between 7 and 10W groups as regards time to return to work, CEAP [classification stands for Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)] scores, and postoperative complications, except significant differences in pain over the treated vein being less in the 7-W laser power group. Conclusion About 10-W laser power of EVLA was associated with better postoperative VCSSs, despite different power settings were not affecting time of return to work and other postoperative complications apart from less pain over treated veins with 7-W laser power. We call for further studies of large size and long follow-up due to few available related studies. [ABSTRACT FROM AUTHOR]

Objective: This systematic review provides a summary and evaluation of cases of migraine aura‐like episodes elicited by sclerotherapy of veins of the lower extremities and discusses possible underlying mechanisms. Background: Sclerotherapy is a commonly used treatment for varicose veins. Symptoms resembling migraine aura have been reported during and following sclerotherapy of the lower extremities, suggesting that sclerotherapy may elicit migraine aura. Methods: We searched PubMed for articles reporting neurological complications that were transient and fully reversible following sclerotherapy treatment for varicose veins in the lower limbs. There were no restrictions regarding article language or publication date. Only original studies and case reports were included. Two authors independently reviewed included articles in detail. Data were extracted from each article, including details on symptoms, previous migraine history, sclerotherapy method, and the presence of a right‐to‐left cardiac shunt in patients. We evaluated whether episodes fulfilled modified International Classification of Headache Disorders, 3rd edition, criteria for 1.2 Migraine with aura or 1.5.2 Probable migraine with aura. Results: The search yielded 777 articles, 28 of which were included. Twenty‐six articles reported 119 episodes of transient neurological symptoms in 34,500 sclerotherapy sessions. Two additional articles reported six episodes of transient neurological symptoms with no specification of the number of sessions. Of the 125 episodes, 119 involved transient visual disturbances, and eight met the modified criteria for Probable migraine with aura. In most episodes (98%), clinical information was insufficient to determine if the criteria were fulfilled. Conclusions: Symptoms that are clinically indistinguishable from migraine with aura attacks may occur following sclerotherapy, although this likely is rare. Microembolization through a right‐to‐left shunt triggering cortical spreading depolarization is a possible mechanism. Our findings are limited by infrequent specific assessments for neurological complications and a low level of detail in the description of symptoms in the available literature. Future prospective studies are needed to determine this phenomenon's incidence and underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: To compare ambulatory phlebectomy and compression sclerotherapy for varicose veins. Material and Methods: Sixty- four cases of varicose veins of both genders were randomly divided into 2 groups of 32 each. Group I underwent ambulatory phlebectomies and group II underwent foam sclerotherapy. Parameters such as Clinical Etiology-Anatomy-Pathophysiology (CEAP), diameter of great saphenous vein, presenting primary symptoms, Grading of primary symptom relief, change in disease severity and post-procedure symptoms were compared. Results: Group I comprised of 17 males and 15 females and group II had 16 males and 16 females. Parameters CEAP C2-C3 legs was seen in 26 and 27, C4-C6 legs was seen in 6 and 5, GSV diameter was 8.6 mm and 7.5 mm, The mean procedure time was 40.2 minutes and 25.3 minutes. Primary symptoms were pain in 13 and 11, oedema in 5 and 3, night cramps in 8 and 5, bleeding in 2 and 7, ulcer in 6 and 4 and itching in 7 and 3 in group I and II respectively. Post-procedure symptoms were transient skin pigmentation in1 and 3, superficial thrombophlebitis in 0 and 2, bleeding in 1 and 3, transient loss of sensation in 0 and 1 and small ulcers in 1 and 4 in group I and II respectively. The difference was significant (P< 0.05). Good improvement (+3) was seen in 85% and 60%, moderate improvement (+2) in 10% and 20%, mild improvement (+1) in 5%and 8%, unchanged (0) in 0 and 7% and mild worsening (-1) in 0 and 5% in group I and II respectively. Conclusion: Ambulatory phlebectomy is an effective therapy for varicose veins of the leg. Primary symptom reliefare significantly higher in ambulatory phlebectomy group. [ABSTRACT FROM AUTHOR]

Sclerotherapy is among the least invasive and most commonly utilised treatment options for varicose veins. Nonetheless, it does not cure varicosities permanently and recurrence rates are of up to 64%. Although sclerosing foams have been extensively characterised with respect to their bench-top properties, such as bubble size distribution and half-life, little is known about their flow behaviour within the venous environment during treatment. Additionally, current methods of foam characterisation do not recapitulate the end-point administration conditions, hindering optimisation of therapeutic efficacy. Here, a therapeutically relevant apparatus has been used to obtain a clinically relevant rheological model of sclerosing foams. This model was then correlated with a therapeutically applicable parameter—i.e., the capability of foams to displace blood within a vein. A pipe viscometry apparatus was employed to obtain a rheological model of 1% polidocanol foams across shear rates of 6 s−1 to 400 s−1. Two different foam formulation techniques (double syringe system and Tessari) and three liquid-to-gas ratios (1:3, 1:4 and 1:5) were investigated. A power-law model was employed on the rheological data to obtain the apparent viscosity of foams. In a separate experiment, a finite volume of foam was injected into a PTFE tube to displace a blood surrogate solution (0.2% w/v carboxymethyl cellulose). The displaced blood surrogate was collected, weighed, and correlated with foam's apparent viscosity. Results showed a decreasing displacement efficacy with foam dryness and injection flowrate. Furthermore, an asymptotic model was formulated that may be used to predict the extent of blood displacement for a given foam formulation and volume. The developed model could guide clinicians in their selection of a foam formulation that exhibits the greatest blood displacement efficacy. [ABSTRACT FROM AUTHOR]

Introduction: Mondor's disease of the penis, or superficial thrombophlebitis affecting penile veins, is a rare condition. Common causes include prothombotic states, venous stasis or excessive manipulation. The literature includes one case report of Mondor's Disease after endovenous laser ablation and foam sclerotherapy and a case series after open saphenofemoral junction ligation. However, there have been no noted cases of this rare complication after mechanochemical ablation of the GSV. Case Details: A 50-year-old man with bilateral great saphenous venous incompetence had truncal mechanochemical ablation of both above-knee GSV segments with the ClariveinTM device with adjunctive 1% Fibrovein foam to varicose tributaries. Day three post-operatively he began experiencing suprapubic pain and noted tender "cord-like" veins along the penile shaft. Duplex investigation of the penis demonstrated occlusive thrombus in the superficial veins draining into the dorsal vein of the penis. The patient was treated with 75 mg oral Clopidogrel for four weeks and his symptoms resolved without functional impairment. Conclusions: Vascular surgeons should be aware that this rare albeit self-limiting thrombotic complication can occur after endovenous mechanochemical ablation of the great saphenous vein with adjunct foam sclerotherapy, particularly as this procedure is performed very frequently. Interestingly, the majority of reported cases have occurred after bilateral interventions. The patients can be reassured that their symptoms will likely settle and the use of anti-thrombotic therapy is largely at the surgeon's discretion. [ABSTRACT FROM AUTHOR]