VariClose® vein sealing system is inferior to endovenous laser ablation for the treatment of varicose veins

Background One of the three commercially available cyanoacrylate venous glues used for the treatment of saphenous vein insufficiency is the VariClose® vein sealing system. Previous studies have documented a high rate of occlusion and minimal postoperative complications. The aim of this study was to compare occlusion rates and clinical outcomes of endovenous laser treatment with the VariClose® vein sealing system in the treatment of truncal vein insufficiency. Patients and methods Retrospective non-randomized single center study with prospectively collected data comparing endovenous laser treatment and VariClose® procedures between April 2018 and November 2019. Results VariClose® was used in 27 patients (30 veins) and endovenous laser treatment in 42 patients (51 veins). The occlusion rate at one, three, and six months were 96%, 85%, and 65% for VariClose® procedures and 100%, 100%, and 97% for endovenous laser treatment procedures ( p = 0.01), respectively. Reduction of VCSS scores before treatment and at the last postoperative follow-up visit in the VariClose® group dropped by an average of 1.8 ± 1.6 and in the endovenous laser treatment by an average of 3.3 ± 2.9 ( p = 0.01). Conclusion VariClose® vein sealing system is inferior to endovenous laser treatment as a treatment option for varicose veins as it has a higher recanalization rate.

PRELIMINARY RESULTS OF ENDOVENOUS LASER TREATMENT FOR SAPHENOUS VENOUS INSUFFICIENCY IN HUE CENTRAL HOSPITAL

Saphenous venous insufficency (VI) is more and more common. This disease is diagnosed by clinical symptoms and doppler US. In the last decade, ligation and stripping was main treatment modalities. Recently, there are many alternative methods for this disease such as sclerotherapy, thermal therapies… Laser is one of effective procedure for VI. Objective: To evaluate short-term outcomes of endovenous laser ablation for the treatment of saphenous venous insufficiency. Methods: This retrospective study included 124 patients at C2 stage and above (CEAP classification) who underwent endovenous laser ablation at Hue Central Hospital from 12/2014 to 02/2017. Results: The patients’ average median age was 52 ± 12.18. Patients with great saphenous insufficency were 98.4% (181 limbs) and only 1.6% with small saphenous disease. Most of them were treated with laser wavelength at 1470nm, power at 6-10W. There were 82 patients needed phlebectomy (Muller) and 20 patients associated with sclerotherapy. Most of cases underwent local anesthesia. The initial outcomes of the patient are excelent, there were no major complication related to the procedure. Most of patient were no pain significantly after treatment. The number of patient with mild (no need of antalgics) and severe pain (needed fort antalgics for 5 days) due to laser ablation were 4 cases and 1 case, respectively. Patients could return to daily activities at the day after. A follow – up postoperative ultrasound after 10 days: 100% of cases presented sclerosant veins and no intravenous flow, no deep venous thrombose. There were no recurrence at 3 and 6 month of medical revisit. Conclusion: Endovenous laser treatment was proven as a method of preference for chronic vein insufficiency because of its advandtages such as minimal invasive technique, high successive percentage, least of complication, high aesthetics and early to return daily activities. Key words: Saphenous venous insufficency (VI), laser, endovenous laser ablation

Challenges in advancing the laser fiber through the great saphenous vein during endovenous ablation and strategies to overcome them

Objectives To determine the incidence of possible obstacles and patients’ characteristics when performing endovenous laser treatment (EVLT) and suggestions to improve the ability to overcome them. Method A prospective study with 215 limbs treated with EVLT. A sequence of maneuvers was performed to move the fiber forward when difficulty was found and if unsuccessful another entry site was punctured. Results In 29 of 215 (13.48%) limbs, resistance was encountered while navigating the fiber; 16 (55.17%) solved with lower limb extension; 13 (44.82%) needed ultrasound guided maneuvers; five (17.24%) needed a saline flush and in three patients (10.34%) another entry site was necessary. In 214 of 215 cases (99.53%), ablation was accomplished and no complications were observed. Conclusions Both obstruction and higher patients' BMI are the main obstacles during endovenous laser ablation and usually needs additional maneuvers to accomplish the procedure in our study and the use of tricks to overcome these issues is feasible.