OBJECTIVETo evaluate the curative effect of the combination of endovenous laser treatment of varicose saphenous vein (ELVS) and classic ligation and stripping treatment.

METHODSWe retrospectively analyzed the clinical data of 21 patients with varicose saphenous vein (VS) who were treated with ELVS alone or combined with ligation and stripping in our hospital.

RESULTSAll the patients got good therapy result. The early symptom relief rate was 82.4%, while the late symptom relief rate was 100%. No infections, haematoma of wound, and any other major complications were reported. The common complications included pain induced by remains of the thrombosis phlebitis (n = 2, 11.7%), minor skin burn (n = 1, 5.9%), residue vein varicose (n = 1, 5.9%), numbness of the calf (n = 1, 5.9%), and mild peri-phlebitis (n = 1, 5.9%). All the complications were resolved after proper management. The 1-year follow-up showed no recurrence.

CONCLUSIONThe combination of ELVS and classic ligation and stripping is safe and effective in the treatment of varicose saphenous.

Adult ; Aged ; Female ; Humans ; Laser Therapy ; Ligation ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Varicose Veins ; surgery

BACKGROUNDConventional high ligation and stripping of the great saphenous vein (GSV) has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery (SEPS) plus endovenous laser treatment (EVLT) could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators.

METHODSPlacement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls.

RESULTSPostoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5 - 11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively (P < 0.01 in all cases).

CONCLUSIONCombined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.

Adult ; Aged ; Endovascular Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Varicose Ulcer ; surgery ; Varicose Veins ; surgery ; Vascular Surgical Procedures ; methods

OBJECTIVE: To observe the effect of subfascial endoscopic perforator vein surgery (SEPS) in the treatment of chronic venous ulceration of the legs. METHODS: Chronic venous ulceration for 91 patients with 102 limbs was treated by SEPS from January 2005 to July 2008. The effect of SEPS on chronic venous ulceration of the leg, the symptoms during and after the operation, and the durations of hospital treatment were analyzed. RESULTS: The symptoms of the 102 legs conducted by SEPS operation, except the pigmentation, were obviously improved (P<0.01). Its cicatrisation rate, the recrudesce rate, and the cut infection rate were 93.1%, 1.96%, and 1.0%, respectively. The time of the operation was short and the hemorrhage was small during the surgery. The durations of hospitalization and the cicatrisation time of ulceration were (6.5+/-3.4) d and (12.2+/-13.7) d, respectively. CONCLUSION SEPS is simple and effective in treating chronic venous ulceration of the leg, and particularly effective for patients classified into C5 and C6 in clinical-etiological-anatomical-pathophysiology (CEAP).
Aged ; Angioscopy ; methods ; Fasciotomy ; Female ; Humans ; Male ; Middle Aged ; Varicose Ulcer ; surgery ; Varicose Veins ; surgery ; Vascular Surgical Procedures ; Venous Insufficiency ; complications ; surgery

OBJECTIVETo retrospectively analyze the experiences and results of the treatment on 62 patients with primary varicose of lower extremities with endovenous laser.

METHODSAll patients were treated with endovenous laser. The laser treatment could begin when the fiber withdraw with 1 cm/2 s. The laser power was 10 - 12 w with the laser pulse duration and the interval 1 second respectively.

RESULTSThe duration of follow-up varied from 2 months to 8 months. After endovenous treatment, the varicose veins and edema disappeared in all cases. The itching and uncomfortable feeling was dissipated. No morphine-like analgesic has been used and no serious complications occurred.

CONCLUSIONEndovenous laser treatment of primary varicose of lower extremities is a safe and effective technique.

Female ; Follow-Up Studies ; Humans ; Laser Coagulation ; methods ; Male ; Retrospective Studies ; Treatment Outcome ; Varicose Veins ; surgery

OBJECTIVE: To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. METHODS: Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT^® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. RESULTS: After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. CONCLUSION The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT^® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.
Catheter Ablation ; Humans ; Lower Extremity/diagnostic imaging* ; Phlebography ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Varicose Veins/surgery*

Varicose vein can cause embarrassment in life not only for pathophysiological reasons but also for aesthetic reasons, especially when wearing shorts or swimming suits. The main traditional therapy has been the surgical obliteration or stripping of greater or lesser saphenous veins. However, as the varicose veins are not bothersome in life, many patients can not easily decide to receive such painful operations. In Europe, the sclerotherapy has been applied since several decades ago with good results, which can obliterate these veins by the simple injection of a sclerosing solution into the vessel. From 1995 to 1999, We conducted the sclerotherapy of varicose veins in 549 patients (765 cases). Selected sclerosing agent was Fibrovein (sodium tetradecyl sulfate) which has the safest, painless and excellent effect. Due to the above mentioned benefits, this agent has been used popularly by phlebologist in the world. The results were excellent, average treatment sessions were 3 times and average follow up period was 1 year (3 months - 5 years). Most of the patients were satisfied with the results and no severe complications were observed. Recurrence were recognized in 69 cases (9%) within the first year. We did not experience any life threatening allergic reaction nor severe complications. The pain elicited by needle injection could be minimized using small caliber. In conclusion, compression sclerotherapy is simple, safe, excellent treatment for varicose veins and it would be applicable in the field of plastic surgery.
Europe ; Follow-Up Studies ; Humans ; Hypersensitivity ; Lower Extremity* ; Needles ; Recurrence ; Saphenous Vein ; Sclerotherapy* ; Surgery, Plastic ; Swimming ; Varicose Veins* ; Veins

OBJECTIVETo explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation.

METHODSData of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52.6 years (ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months (ranging from 5 to 37 months). Average diameter of ulcers was 3.7 cm (ranging from 1.3 to 6.5 cm). Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70.4%), primary deep vein insufficiency in 38 limbs (46.9%), post-DVT syndrome in 16 limbs (19.8%), reflux of accessory saphenous veins in 11 limbs (13.6%) and residual/re-opened great saphenous vein in 8 limbs (9.9%). Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality.

RESULTSAll the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation. Only 3 limbs (3.7%) suffered again from recurrence 1 year after re-operation.

CONCLUSIONSIncompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.

Adult ; Aged ; Female ; Humans ; Leg ; blood supply ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Varicose Ulcer ; etiology ; surgery ; Varicose Veins ; etiology ; surgery

OBJECTIVE: To analyze the efficacy of integrated minimally invasive surgery for iliac vein compression syndrome with varicose veins of lower extremities. METHODS: From January 2017 to January 2018, 11 patients with iliac vein compression syndrome accompanied by varicose veins of lower extremities underwent left iliac vein stent implantation and radiofrequency thermal ablation of lower extremity veins in the First Affiliated Hospital of Zhejiang University School of Medicine. The left iliac vein stent was implanted through the puncture point approach of the main great saphenous vein, and then radiofrequency thermal ablation of the main saphenous vein was performed. Rivaroxaban and aspirin were administered from the day of surgery for 6 months and 12 months, respectively. After discharge, patients were followed up for more than 6 months. The lower extremity veins, iliac veins were reexamined by Doppler ultrasound or CT angiography at 2 weeks, 2 months and 6 months after surgery. RESULTS: The operations were successfully performed in 11 patients, and no complication was observed during the operation. The rates of soreness and swelling remission, pigmentation and skin quality improvement, and the iliac vein stent patency were 100%. No varicose vein recurrence, iliofemoral vein thrombosis and pulmonary embolism were found. CONCLUSIONS Integrated minimally invasive surgery is safe, effective and less invasive for iliac vein compression syndrome with varicose veins of lower extremities.
Humans ; Lower Extremity ; surgery ; May-Thurner Syndrome ; complications ; surgery ; Minimally Invasive Surgical Procedures ; standards ; Radiofrequency Ablation ; Saphenous Vein ; surgery ; Treatment Outcome ; Varicose Veins ; complications ; surgery

OBJECTIVETo investigate the surgical technique of skeletonization of the great saphenous vein (GSV) at the saphenofemoral junction (SFJ) in surgical intervention of primary varicosity and evaluate the outcomes one year after the operation.

METHODSA total of 624 cases (774 limbs) of primary varicosity of the GSV were prospectively divided into skeletonization group (265 cases, 325 limbs) and control group (359 cases, 449 limbs). In the skeletonization group, skeletonization of the GSV at the SFJ, its branches and other aberrantly joined superficial veins was performed, and in the control group, routine high ligation of the GSV was performed, after which laser-ablation of the GSV, GSV stripping, Muller's operation, mutilation of the perforators and ulcer-related operations were performed in both groups.

RESULTSTwenty cases in the skeletonization group were found to have superficial veins directly joining into the femoral vein or into the GSV in different tissue layers. In 14 cases in the control group, the superficial veins of the internal femoris or lateral femoris were mistaken for the GSV. No difference was found in the operating time between the two groups (t=0.68, P>0.05), but the skeletonization group had a significantly less bleeding volume (t=1.75, P<0.05). Statistical differences were found between the two groups in intraoperative bleeding rate in the inguinal regions, venous clinical severity scores (2.1∓0.5 vs 4.6∓0.9, t=1.96, P<0.05), and residual varicosity and recurrences (3/325 vs 13/449, V=1.25, P<0.05) at the one year follow-up.

CONCLUSIONSkeletonization of the GSV and its branches and other aberrantly joined superficial veins at the SFJ can decrease the postoperative residual varicosity and recurrence due to blood reflux.

Adult ; Aged ; Aged, 80 and over ; Female ; Groin ; blood supply ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Saphenous Vein ; pathology ; surgery ; Treatment Outcome ; Varicose Veins ; pathology ; surgery

Aged ; Anastomosis, Surgical ; Duodenum ; blood supply ; surgery ; Female ; Gastrointestinal Hemorrhage ; etiology ; surgery ; Humans ; Hypertension, Portal ; complications ; Jejunum ; surgery ; Rupture, Spontaneous ; Varicose Veins ; complications