Papers reviewed in October 2015

Posted on by Mike

E Rabe, F Pannier
Indications, contraindications and performance: European Guidelines for Sclerotherapy in Chronic Venous Disorders
Phlebology 2014, Vol. 29(1S) 26–33

Aim: Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy.
Methods: This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th–10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology.
Results: This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS). Other sclerosants are not discussed in detail. In this paper the recommendations concerning indications, contraindications, concentrations, volumes and technique of liquid and foam sclerotherapy of varicose veins and venous malformations are reviewed.

 

F Pannier and E Rabe
Results from RCTs in Sclerotherapy: European Guidelines for Sclerotherapy in Chronic Venous Disorders
Phlebology 2014, Vol. 29(1S) 39–44

Aim: Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy.
Methods: This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th–10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology.
Results: This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS).

 

Meghan Dermody, Marlin W Schul and Thomas F O’Donnell
Thromboembolic complications of endovenous thermal ablation and foam sclerotherapy in the treatment of great saphenous vein insufficiency.
Phlebology 2015, Vol. 30(5) 357–364

Objective: We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series.
Methods: Medline, Embase, Cochrane, and Clinical Trials Registry databases were searched from January 2000 through January 2013 for randomized controlled trials and large case series employing endovenous thermal ablation or foam sclerotherapy as a single modality for the treatment of great saphenous insufficiency, with concomitant postoperative duplex scanning. Pooled (stratified) incidence of venous thromboembolism with 95% confidence intervals was estimated using the DerSimonian–Laird procedure for random effects meta-analysis. A bootstrap analysis was performed to examine between-modality differences.
Results: Twelve randomized controlled trials and 19 case series investigating endovenous thermal ablation (radiofrequency ablation with VNUS/Covidien ClosureFASTTM catheter only, endovenous laser ablation, or both) were included. Data from 12 randomized controlled trials and 6 case series investigating nonproprietary foam preparations were analyzed. Estimated incidence of venous thromboembolism was low (mostly <1%) and similar across treatment modalities and study types.
Conclusions: Treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy is a common vascular intervention. The stratified incidence of venous thromboembolism appears to be low as reported in both randomized controlled trials and case series investigating these modalities. Although duplex scans were obtained postoperatively, a minority of studies specified protocols for venous thromboembolism detection.

 

Farah Jarjous, Rafi Jarjous, George Nahhas
One-Step Approach to Treating Venous Insufficiency
J Clin Med Res. 2015; 7(9): 681-684

Background: Patients with venous insufficiency can be treated with office-based, minimally invasive means like radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS). Traditional treatment involves ablation of the great saphenous vein (GSV) and the short saphenous vein (SSV) with RFA as a first step. The remaining refluxing tributaries are treated at a later session with UGFS or microphlebectomy. This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure. We, instead, elected to treat all the refluxing veins in one procedure which combines RFA of the truncal and perforating vein with UGFS to the accessory and tributary veins.
Methods: A controlled non-randomized clinical trial, in which a total of 72 extremities were treated for vein incompetence in 63 consecutive patients aged 26 – 78 years, was conducted. Sixty-three extremities (87.5%) received treatment for reflux in GSV, 10 extremities (13.9%) were treated for reflux in SSV, and 11 (15.3%) were treated for reflux in the perforators. Reflux duration > 1 second to increase specificity and truncal vein diameter > 5 mm were identified in the treated limbs. The treatment was performed at our office and it involved delivering radiofrequency thermal energy to the truncal and perforating vein and then using foam sclerotherapy with the guidance of ultrasound to close the tributary and accessory veins in a single procedure. The results were monitored at 1 week and 6 weeks postoperatively by venous duplex ultrasound.
Results: One hundred percent of the treated GSV and SSV and 91.7% of tributary veins were completely closed after the index procedure. Only 10 of 72 extremities (13.9%) needed a follow-up treatment to achieve closure of the perforator and accessory veins. By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively. No major or minor complications were found upon follow-up evaluation.
Conclusion: We believe that combining RFA with UGFS in a solo practice lowers the incidence of thrombophlebitis in the tributaries. Using this approach allowed us to achieve more complete resolution of venous reflux disease with lower complication rates in comparison with the popular staged strategy. This could have implications for financial savings to both the patient and the health system.

This entry was posted in Uncategorized. Bookmark the permalink.