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Five-Year Data Find Foam Sclerotherapy to Be Less Effective Than Thermoablation Or Stripping for Varicose Veins

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Five-Year Data Find Foam Sclerotherapy to Be Less Effective Than Thermoablation Or Stripping for Varicose Veins Issue 2 September 2017 Manjit Gohel: Sevick-Muraca: Profile: Marianne Stent flexibility Lymphoedema De Maeseneer Page 7 Page 9 Page 12 Five-year data find foam sclerotherapy to be less effective than thermoablation or stripping for varicose veins According to a study comparing recurrence (p<0.01), and reoperation rate the five-year outcomes of four (p<0.001) between the four treatment different treatment methods groups. There were eight (5.8%) recana- for varicose veins, ultrasound- lisations in the radiofrequency ablation guided foam sclerotherapy group, eight (6.8%) in the endovenous (UGFS) is less effective for vein laser ablation group, 37 (31.5%) in the closure than thermoablation UGFS group and eight (6.3%) in the and open stripping, while stripping group. radiofrequency is less painful. Recurrent varicose veins developed in 19 (18.7%) radiofrequency ablation ars Rasmussen (Naestved, Den- cases, in 42 (38.6%) laser ablation cases, mark), presented data to delegates 28 (31.7%) UGFS cases and 38 (34.6%) L at the European Venous Forum stripping cases. (EVF; 29 June–1 July, Porto, Portugal) Within five years of initial treatment, comparing the five-year outcomes of there were 19 (17%) reoperations in endovenous radiofrequency ablation the radiofrequency ablation group, 19 (in this case ClosureFast, Medtronic), (18.7%) reoperations in the laser ablation UGFS, endovenous laser ablation and group, 43 (37.7%) reoperations in the high ligation and stripping for the treat- UGFS group, and 25 (23.4%) in the strip- ment of varicose veins. Rasmussen and Lars Rasmussen ping group. colleagues assessed each treatment based Speaking to Venous News, Rasmussen on technical efficacy, clinical recurrence examinations. Patient demographics were for endovenous laser ablation was three days said, “We saw that patients treated with and the rate of reoperation. similar across the four groups. while mean return to work time was 3.6 either radiofrequency ablation, laser abla- The study involved 500 patients Recovery time was shortest in patients days, and mean return to normal function for tion or stripping, performed better than (580 legs) with great saphenous vein treated with either radiofrequency ablation stripping was four days with mean return to the patients treated with foam.” Discuss- reflux and varicose veins, examined and or UGFS, with a mean return to normal work time of 4.3 days (p=0.0001). ing ways to improve the success of foam randomised to one of the four treatment function time of one day and a return to Over the five years of follow-up, there treatment, Rasmussen suggested, “It is methods. Follow-up of these patients work time of 2.9 days for both treatments was a difference in the rates of great clear to me, and most others, that if you included clinical and duplex ultrasound (p=0.0001). Mean return to normal function saphenous vein recanalisation (p<0.001), Continued on page 2 Questions remain over venous leg symptoms despite SYM vein consensus At the 2017 European Venous Forum (29 June–1 of these symptoms. pathology (examples: leg pain July, Porto, Portugal), a presentation given by The goal of the SYM Vein in peripheral arterial occlusive Eberhard Rabe (Bonn, Germany) questioned Consensus was to answer the disease or orthopaedic patients). whether the SYM Vein Consensus clarified all question of which of these Leg symptoms are, in them- aspects of venous symptoms. Speaking with Venous subjective symptoms are spe- selves, also not diagnostic of News, Rabe explains which questions still remain cifically attributable to venous a venous disease and deserve regarding venous leg symptoms and how the clinical dysfunction and to find a better to be assessed and treated community can best approach a difficult subject. system of quantitative and appropriately. The absence of qualitative assessment (Perrin symptoms does not exclude What was the goal of symptoms or absence of et al 2016). chronic venous disorders like of the SYM Vein symptoms, for example, C2A in asymptomatic varicose vein Consensus statement? or C5S. Symptoms include Eberhard Rabe What controversies patients. Leg symptoms might In the revised CEAP classifica- aching, pain, tightness, skin still exist with venous have a high probability of being tion it is stated, “Each clinical irritation, heaviness, muscle tion” (Bo Eklöf et al 2004). symptoms? venous, but venous dysfunc- class is further characterised cramps, and other complaints However, there are many open It is a fact that leg symptoms tion is not demonstrable like in by a subscript for the presence attributable to venous dysfunc- questions about the true origin are not specific for venous Continued on page 2 venousnews.com Facebook.com/venousnews @venousnews 2 Updates September 2017 Five-year data find foam sclerotherapy to be less effective than thermoablation or open stripping for varicose veins Continued from page 1 of the treatments analysed are now with the bare fibre, and after stripping, John Bergan (professor of surgery, Uni- repeat foam injections, you will obtain a obsolete due to technological advances compared to radiofrequency ablation. We versity of California, San Diego) used to much higher success rate, but in my opin- over the lifetime of the trial, Rasmussen saw a reduced rate of recurrent varicose highlight the ease, efficacy, follow-up, ion there are some veins that are quite argued, “It is absolutely not true. In sev- veins in patients treated with ClosureFast. low cost, and increased patient comfort resistant to foam.” Speaking to his own eral European countries, stripping is still If I was to treat my wife for varicose veins, using foam. In an interview with Vas- personal approach, he said, “Our way is the most used treatment and the majority I would use radiofrequency ablation or cular News following a presentation at to do a truncal ablation with foam, with of laser fibres now used in Europe are laser with a radial fibre, but we also have the VEITHsymposium in 2006 he said: phlebectomies then added to it. This way, still bare fibres. These treatments that to consider that this may be slightly more “Foam sclerotherapy is non-invasive, you obtain the same result—at least in we have studied are still used a lot in expensive than laser with a bare fibre.” requiring only local anaesthetic and a the short term—as you do with thermal Europe and in the USA.” Pioneers of foam sclerotherapy advo- short recovery time; it is already the ablation. The patients love this approach As to the best treatment approach, cated that in the right hands this treat- therapy of choice for recurrent varicosi- because it is so easy for them.” Rasmussen concluded, “We saw a higher ment modality plays an important role in ties; and it does not have a high start-up Responding to suggestions that some degree of neovascularisation after laser the physician’s armamentarium. The late or supply costs.” Questions remain over venous leg VIDIO trial results published The VIDIO study, led by Paul Gagne, Southern symptoms despite SYM vein consensus CT Vascular Center, Darien, USA, showed that Continued from page 1 with a clear temporal and/or Sym, AVVQ ao) symptoms are intravenous ultrasound (IVUS) is more sensitive some C0 patients or in a popula- spatial association like in venous more or less included but well for assessing treatable iliofemoral vein stenosis tion with a sitting profession but claudication, phlebalgia of superfi- specified. compared with multiplanar venography and without venous pathology. cial thrombophlebitis or throbbing In the SYM Vein Consensus frequently leads to revised treatment plans and the pain associated with chronic a three-dimensional diagram is potential for improved clinical outcome. What are some of the venous ulceration. A moderate suggested with the features: factors that must be probability appears if these symp- Frequency: never=0, from he results of VIDIO 51 of 100 patients, whereas IVUS considered when look- toms may be equally attributable time to time=1, several (Venography versus identified lesions in 81 of 100 ing at symptoms of po- to other causes which need to times per week=2, and every Tintravascular ultrasound patients. Compared with IVUS, tential venous disease? be excluded like in sensation of day=3; for diagnosing and treating ili- the diameter reduction was on There are several categories heavy or swollen legs which may Daily course: never=0, only ofemoral vein obstruction) were average 11% less for venography of influencing factors. Hu- occur in the “otherwise well” in the evening=1, in the after- published in the September 2017 (p<0.001). The intraclass correla- man factors that influence how population, and also as a feature in noon=2, in the morning=3; issue of Journal of Vascular tion coefficient was 0.505 for vein both patients and practitioners those with other clinical condi- Severity: none=0, slightly=1, Surgery – Venous and Lymphatic diameter stenosis calculated with describe, interpret, express and tions such as knee osteoarthritis or moderate=2, and severe=3. Disorders. the two methods. IVUS identified use symptoms include: language plantar static disturbances. A low This score must still be According to Gagne et al, significant lesions not detected and culture; levels of tolerance probability appears in unspecific validated before using it in during a 14-month period begin- with three-view venography in to unpleasant experiences; prior symptoms like “impatient legs”, randomised controlled trials. ning July 2014, 100 patients with 26.3% of patients. Investiga- experience; duration and intensity mimicking a minor form of rest- clinical class C4 to C6 venous tors revised the treatment plan of symptoms; psychosocial gains; less legs or sensation of warm What was the take- disease and suspected iliofemoral in 57 of 100 cases after IVUS, economic gains; the belief re- feet mainly in the first ten minutes home message of your vein obstruction were enrolled most often because of failure of garding the relationship of symp- after going to bed.
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