Hello Charles, and thank you so much for your response to my earlier questions.
I have listed below studies that appear to meet your criteria. When I
was in doubt, I opted for inclusion, rather than omission. For
instance, a number of studies (e.g. Chang and Chua, below, or the two
Zamboni studies) mentioned duplex or ultrasound, but not necessarily
in the context of guided sclerotherapy. However, I included them just
the same, given the likliehood that they might be of interest to you.
If you find you need them stripped out of the list, let me know, and I
can do some additional fine-tuning of the list.
The listings are all from the PubMed database, and I've included more
detail about my search strategy at PubMed at the end of this listing.
I hope you find this listing fully satisfactory. However, since this
is your first time using Google Answers, let me remind you that you
are welcome to ask for clarifications or additional information if
anything about the answer below is unclear, or falls short in any way
of what you expected. I am happy to continue working with you on
this, until you have all the information you need.
pafalafa-ga
=====
Angiol Sosud Khir. 2003;9(2):73-9.
[Diagnosis and treatment of postoperative recurrences of varicosity]
[Article in Russian]
Ignat'ev IM, Bredikhin RA, Safiullina LI, Obukhova TN.
Interregional Clinicodiagnostic Centre, Kazan, Russia.
The aim of the present work was to study the causes of post-operative
recurrences of varicosity and to define approaches to their optimal
correction. Duplex scanning (DS) with Color Doppler Imaging of the
blood flow was used to examine 126 patients (136 extremities) with
recurrences of varicosity. The patients were distributed according to
the CEAP clinical classification. Altogether 76 patients (78)
extremities with recurrences of varicosity were operated on. 27
persons received different variants of sclerotherapy including
echoscleroobliteration. According to the DS data, the most frequently
obtained finding in patients with recurrences of varicosity was
identification of the perforating veins with valvular insufficiency,
namely in 120 (or in 88.2%) extremities. The long stump of the greater
saphenous vein (CSV) was discovered in 86 (63.2%) extremities, the
long stump of the lesser saphenous vein (LSV) in 6 (4.4%), ectasia of
LSV trunk was recognised in 20 (14.5%), incompetence of the valves of
the sural veins in 12 (8.8%) extremities. Incompetence of the valves
of the deep veins was present in 73 (53.6%) patients. No sources of
pathological veno-venous runoff were identified in 12 (8.1%) cases. A
good agreement was established between the incidence of valvular
incompetence of the deep veins and the disease severity. The
indications for surgical correction of valvular insufficiency were
worked out. It has been demonstrated that sclero-obliteration is the
method of choice in the treatment of the recurrences of varices. The
long-term results of operations for recurrences of varicosity were
followed up in 62 patients over the period of one to 15 years. Good
and satisfactory results were obtained in 60 (96.8%) cases. The
authors believe that the majority of varicosity recurrences arise from
an inadequate assessment of the status of lower extremity venous bed
as well as from technical and methodological faults of the operating
surgeon. DS in an indispensable component of preoperative examination
of patients with varicosity recurrences.
PMID: 12811378 [NOTE: the PMID is the PubMed identification number]
=====
Ned Tijdschr Geneeskd. 2003 Jan 18;147(3):117-20.
[Favorable results with duplex-guided compression sclerotherapy for
varices of the small saphenous vein; a retrospective study]
[Article in Dutch]
Bullens-Goessens YI, Heij JF, Veraart JC.
Academisch Ziekenhuis, afd. Dermatologie, Postbus 5800, 6202 AZ Maastricht.
OBJECTIVE: Assessment of the efficacy of duplex-guided compression
sclerotherapy in patients with varices of the small saphenous vein
(SSV).
DESIGN: Retrospective. METHOD: Data were collected from 109 patients
(14% male and 86% female; average age 51.4 years (SD: 10.6)) with 121
SSV varices which were sclerosed under duplex guidance with
polidocanol 3% during the period 1 December 1998-31 May 2001 in the
Dermatology department at Maastricht University Hospital, the
Netherlands. After-care consisted of a compression bandage for 1 week
and a therapeutic elastic stocking for 6 weeks. Check-ups took place
after 3-6 months and after 12 months. Sclerosis was repeated if the
procedure had failed. Success was defined as occlusion or by the
absence of reflux and a reduction in the complaints.
RESULTS: After 3-6 months the treatment was successful in 88/113
varices (78%) for which data were available, and after 12 months
treatment was successful in 46/57 (81%).
CONCLUSION: Sclerosis of the SSV under duplex guidance, with repeat
treatment if required, gave favourable results.
PMID: 12577772
=====
Lasers Surg Med. 2002;31(4):257-62.
Endovenous laser photocoagulation (EVLP) for varicose veins.
Chang CJ, Chua JJ.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial
Hospital, Chang Gung University, Taipei, Taiwan.
chengjen@adm.cgmh.org.tw
BACKGROUND AND OBJECTIVES: Untreated varicose veins have significant
morbidity and potential mortality. Treatment aims to relieve symptoms,
improve appearance, and to prevent deterioration. Current therapeutic
options include graduated compression stockings, sclerotherapy,
ambulatory phlebectomy, surgical ligation, and stripping. Results of
laser photocoagulation of vascular anomalies have been encouraging.
Applying these concepts of laser-tissue interactions, we developed a
new method of treatment for varicose veins of the lower extremities.
STUDY DESIGN/MATERIALS AND METHODS: One hundred and forty-nine
patients with 252 varicose greater saphenous veins underwent
endovenous laser photocoagulation (EVLP) from January 1996 to January
2000. Subject's age ranged between 23 years 9 months and 80 years 7
months with a mean age of 50 years 8 months. There were 122 females
and 27 males. Only patients with primary varicose veins and
saphenofemoral reflux documented by Duplex ultrasound were treated.
All patients received surgical ligation of the saphenofemoral junction
(SFJ). EVLP was performed using the neodymium:yttrium-aluminium-garnet
(Nd:YAG) (1,064 nm) laser, delivered with a 600 microm optical fiber.
Laser power was set at 10 or 15 W, delivered with a pulse duration of
10 seconds. The outcome was compared before and after EVLP, based on
the score of severity of the varicose veins by Hach's classification.
RESULTS: The range of total delivered energy is from 9,200 to 20,100
J. The entire procedure was completed in 95-175 minutes (mean 122.33
minutes) for bilateral procedures, and 65-100 minutes (mean 81.07
minutes) for unilateral procedures. The follow-up period ranged from
12 to 28 months with a mean of 19 months. One hundred and forty-one
patients with 244 legs involved (96.8%) demonstrated remarkable
improvement (P < 0.05). Common early complications of EVLP are: local
paraesthesia of the treated area in 92 legs (36.5%), ecchymosis and
dyschromia in 58 legs (23.0%), superficial burn injury in 12 legs
(4.8%), superficial phlebitis in four legs (1.6%), and localized
hematoma in two legs (0.8%) at 3 weeks post-operatively. The final
outcome showed no significant morbidity or mortality. All patients
recovered completely.
CONCLUSIONS: EVLP is a simple effective treatment modality for
varicose veins. This less invasive method can minimize the
complications of conventional surgery.
PMID: 12355571
=====
J Vasc Surg. 2002 May;35(5):958-65.
Endovenous obliteration versus conventional stripping operation in the
treatment of primary varicose veins: a randomized controlled trial
with comparison of the costs.
Rautio T, Ohinmaa A, Perala J, Ohtonen P, Heikkinen T, Wiik H,
Karjalainen P, Haukipuro K, Juvonen T.
Department of Surgery, Oulu University Hospital, Kajaanintie 50,
SF-90230 Oulu, Finland. tero.rautio@oulu.fi
OBJECTIVE: The aim of this randomized study was to compare a new
method of endovenous saphenous vein obliteration (Closure System, VNUS
Medical Technologies, Inc, Sunnyvale, Calif) with the conventional
stripping operation in terms of short-term recovery and costs.
METHODS: Twenty-eight selected patients for operative treatment of
primary greater saphenous vein tributary varicose veins were randomly
assigned to endovenous obliteration (n = 15) or stripping operation (n
= 13). Postoperative pain was daily assessed during the 1st week and
on the 14th postoperative day. The length of sick leave was
determined. The RAND-36 health survey was used to assess the patient
health-related quality of life. The patient conditions were controlled
7 to 8 weeks after surgery, and patients underwent examination with
duplex ultrasonography. The comparison of costs included both direct
medical costs and costs resulting from lost of productivity of the
patients. Costs that were similar in the study groups were not
considered in the analysis.
RESULTS: All operations were successful, and the complication rates
were similar in the two groups. Postoperative average pain was
significantly less severe in the endovenous obliteration group as
compared with the stripping group (at rest: 0.7, standard deviation
[SD] 0.5, versus 1.7, SD 1.3, P =.017; on standing: 1.3, SD 0.7,
versus 2.6, SD 1.9, P =.026; on walking: 1.8, SD 0.8, versus 3.0, SD
1.8, P =.036; with t test). The sick leaves were significantly shorter
in the endovenous obliteration group (6.5 days, SD 3.3 days, versus
15.6 days, SD 6.0 days; 95% CI, 5.4 to 12.9; P <.001, with t test).
Physical function was also restored faster in the endovenous
obliteration group. The estimated annual investment costs of the
closure operation were US $3360. The other direct medical costs of the
Closure operation were about $850, and those of the conventional
treatment were $360. With inclusion of the value of the lost working
days, the Closure treatment was cost-saving for society, and when 40%
of the patients are retired (or 60% of the productivity loss was
included), the Closure procedure became cost-saving at a level of 43
operations per year. CONCLUSION: Endovenous obliteration may offer
advantages over the conventional stripping operation in terms of
reduced postoperative pain, shorter sick leaves, and faster return to
normal activities, and it appears to be cost-saving for society,
especially among employed patients. Because the procedure is also
associated with shorter convalescence, this new method may potentially
replace conventional varicose vein surgery.
PMID: 12021712
=====
Angiology. 2000 Jul;51(7):529-34.
Endovascular sclerotherapy, surgery, and surgery plus sclerotherapy in
superficial venous incompetence: a randomized, 10-year follow-up
trial--final results.
Belcaro G, Nicolaides AN, Ricci A, Dugall M, Errichi BM, Vasdekis S,
Christopoulos D.
PAP/PEA Institute, San Valentino, Pescara, Italy. CARDRES@MIAMI.ABOL.IT
The study was planned to evaluate efficacy and costs of endovascular
sclerotherapy (ES) in comparison with surgery and surgery associated
with sclerotherapy in a prospective (10-year follow-up),
good-clinical-practice study. Patients with varicose veins and pure,
superficial venous incompetence were included. Of the patients
randomized into the three groups 39 (group A) were treated with ES, 40
(B) with surgery + sclerotherapy, and 42 with surgery only (C).
Surgery consisted of ligation of the SFJ (saphenofemoral junction) and
of incompetent veins detected with color duplex. Of the preselected
150 patients, 121 subjects entered the study; 96 completed the 10-year
follow-up (mean age 52.6 +/- 6 years; 51 men, 45 women). Dropouts were
due to nonmedical problems. At 10 years no incompetence was observed
in subjects treated with SPJ ligation (B and C). In the ES group 18.8%
of the SFJs were patent and incompetent and in 43.8% of limbs the
distal (below-knee) venous system was still incompetent [16.1% in the
surgery + sclerotherapy group (p < 0.05) and 36% in the group treated
with surgery only (p < 0.05 vs B and 0.05 vs A)]. Color duplex of the
long saphenous vein indicated atrophy or obstruction of a segment
(average 6.7 cm) after SFJ ligation (4.2 cm after ES). The cost of ES
was 68% of surgery while the cost of surgery and sclerotherapy was
122% of surgery only. Endovascular sclerotherapy is an effective,
cheaper treatment option, but surgery after 10 years is superior.
PMID: 10917577
=====
Dermatol Surg. 2000 May;26(5):410-4; discussion 413-4.
Transcatheter duplex ultrasound-guided sclerotherapy for treatment of
greater saphenous vein reflux: preliminary report.
Min RJ, Navarro L.
Weill Medical College of Cornell University, New York Presbyterian
Hospital, New York, New York, USA.
BACKGROUND: Surgical ligation and stripping of the greater saphenous
vein has been the gold standard for treatment of saphenofemoral
junction incompetence for several years. Although sclerotherapy of the
greater saphenous vein has also been advocated by some phlebologists,
the procedure can be technically challenging and has resulted in
inadvertent nontarget injection.
OBJECTIVE: The purpose of this study was to assess the effectiveness
and safety of transcatheter duplex-guided sclerotherapy for the
treatment of varicose veins due to saphenofemoral junction reflux.
METHODS: Fifty-one greater saphenous veins in 50 patients were treated
with transcatheter sclerotherapy. Using local anesthesia and
ultrasound guidance, the greater saphenous vein was entered 15-45 cm
below the saphenofemoral junction. An infusion catheter was placed
over a guidewire and positioned under ultrasound guidance, and 3%
sodium tetradecyl sulfate was administered below the saphenofemoral
junction and along the course of an "empty" greater saphenous vein via
the catheter.
RESULTS: Catheter placement and treatment was possible in all
patients, with 2-5 ml of 3% sodium tetradecyl sulfate administered per
session. At the 24-hour and 1-week follow-ups, all treated greater
saphenous vein segments were closed following initial treatment, with
no flow detectable by continuous wave or color Doppler interrogation.
No patients required re-treatment, with all veins remaining closed at
2- to 12-months follow-up. There have been no adverse reactions.
CONCLUSION: Transcatheter duplex ultrasound-guided sclerotherapy
should improve both the safety and efficacy of treatment compared to
conventional ultrasound-guided sclerotherapy and offers an alternative
to surgical ligation and stripping for those patients wishing to avoid
surgery.
PMID: 10816225
=====
Ann Chir. 1997;51(7):773-9.
[Sclerotherapy section of incompetent short saphenous veins:
indications, technique, results]
[Article in French]
Vin F, Chleir F, Allaert FA.
Hopital Notre-dame de Bons Secours, Paris.
Sclerotherapy section of the long consists of a combination of
ligations, with section and injection of the proximal and distal
segment of the long saphenous vein. This technique is performed under
local anesthesia 10 centimeters from the saphenofemoral junction and
can be performed as an outpatient procedure.
MATERIALS AND METHODS: Inclusion criteria are incompetent long
saphenous vein diameter over 9 millimeters in older patients whose
Duplex-scan examination eliminated other leaking points such as
anterior or posterior tributaries or the junction, reflux coming from
superficial iliac circonflex veins or from vulvo-pudendal varicose
veins. Our study concerned 75 patients. 78 limbs were operated, 72
were reviewed after 1 year and 65 after 3 years.
RESULTS: 66 of the 72 limbs (91.6%) had an incompressibility without
flux or reflux at the sapheno-femoral junction level after 1 year and
59 of the 65 limbs (90.8%) after 3 years. Sclerosis with
incompressibility without flux or reflux was observed in the lower
third of the thigh in 51 of the 72 limbs (70.8%) after 1 year and in
40 of the 65 limbs (61.5%) after 3 years, without any clinically
detectable underlying varicose recurrence.
DISCUSSION: This technique is ambulatory and economic and ensures
control of sapheno-femoral junction reflux. In the majority of reflux
cases, the reflux observed in the lower third of the thigh is related
to a Hunter perforanting vein that can feed an underlying varicose
network. They were treated by ultrasound-guided ossifying injection.
CONCLUSION: The indications for this technique are incompetence of the
sapheno-femoral junction in older patients with trophic disorders,
allowing effective treatment of the source of the reflux with rapid
healing of underlying trophic disorders.
PMID: 9501549
=====
Dermatol Surg. 1998 Jan;24(1):131-5.
Clinical determinants of ultrasound-guided sclerotherapy outcome. Part
I: The effects of age, gender, and vein size.
Kanter A.
Vein Center of Orange County, Irvine, CA 92604, USA.
BACKGROUND: Ablation of the incompetent saphenous vein may be
accomplished by either surgical extirpation or ultrasound-guided
sclerotherapy (UGS). Clinical guidelines for the selection of suitable
candidates for UGS have yet to be established for this relatively new
procedure.
OBJECTIVE: To assess the effects of age, gender, and vein size on the
outcome of UGS.
METHODS: UGS was performed on 116 Class C2-6EPASPR limbs with
duplex-confirmed saphenofemoral junctional incompetence using 1-mL
injectate volumes of 3% sodium tetradecyl sulphate (STS) (15-mL
maximum) and Class II compression. Treatment endpoint was persistent
vasospasm observed on duplex imaging, with clinical and duplex
ultrasound follow-up at 2 weeks, 6 months, and annually for 2 years.
RESULTS: Statistical testing showed that only vein size affected
recanalization. Age, gender, and vein size all affected the dosage
required to achieve vasospasm, but not the clinical recurrence rate.
Vein size was larger in males and correlated with age.
CONCLUSIONS: Larger doses of STS are required to induce vasospasm in
older patients, males, and those with larger veins. Regardless of
gender and age, larger veins are more likely to recanalize, but are
not necessarily associated with clinical recurrence. Although older
patients and males tend to have larger veins, their recanalization
rates are similar to younger patients and females when sufficiently
higher STS doses are used to induce vasospasm. Ambulatory patients of
all ages and either gender may be good candidates for UGS if vasospasm
is used as the treatment endpoint. Contrary to prevailing opinion,
large vein caliber is not an absolute contraindication for UGS.
PMID: 9464300
=====
Dermatol Surg. 1998 Jan;24(1):136-8; discussion 138-40.
Clinical determinants of ultrasound-guided sclerotherapy. Part II: In
search of the ideal injectate volume.
Kanter A.
Vein Center of Orange County, Irvine, CA 92604, USA.
BACKGROUND: Ablation of the incompetent saphenous vein may be
accomplished by either surgical extirpation or ultrasound-guided
sclerotherapy (UGS). Procedural guidelines for optimizing UGS outcome
have yet to be established for this relatively new procedure.
OBJECTIVE: To compare the effect of 1 vs 2 mL UGS sclerosant injectate
volumes (SIV) on immediate vasospasm and later clinical outcome after
UGS.
METHODS: UGS was performed on 56 patients with Class C2-4EPASPR venous
insufficiency and duplex-confirmed saphenous junctional incompetence
using 3% sodium tetradecyl sulphate (STS) and Class II compression.
Group 1 received 1 mL SIV, and group 2 received 2 mL SIV. Treatment
endpoint for both groups was persistent vasospasm observed on duplex
imaging (15 mL maximum), with clinical and duplex follow-up at 2
weeks, 6 months, and 12 months.
RESULTS: The number of injections per treatment to achieve vasospasm
(vasospastic dose) was unaffected by doubling the SIV. Group 2 had a
higher recanalization rate than group 1. Several patients in group 2
experienced a transient febrile response shortly after treatment.
CONCLUSIONS: Using our UGS protocol to treat saphenous junctional
incompetence, 2 mL SIV was less effective than 1 mL SIV, and was
associated a minor adverse effect. The larger SIV did not induce more
rapid vasospasm, and therefore did not lead to a reduction in the
number of injections per treatment. The maximum safe STS dose/session
is unknown, and deserves scientific study.
PMID: 9464301
=====
Tech Vasc Interv Radiol. 2003 Sep;6(3):116-20.
Sclerotherapy treatment of telangiectasias and varicose veins.
Zimmet SE.
Zimmet Vein and Dermatology Clinic, Austin, TX 78701, USA.
Telangiectasias and/or varicose veins are present in about 33% of adult women
and 15% of adult men. Although they may be only of cosmetic concern, superficial
varices often cause significant symptoms such as pain, aching, heaviness, and
pruritus. Venous ulceration is commonly caused solely by superficial venous
insufficiency. Superficial thin-walled veins may rupture and hemorrhage.
Sclerotherapy is a nonsurgical procedure that can be used to treat both small
and large varices of the superficial venous system and perforators. This
involves injecting a sclerosant intraluminally to cause fibrosis and eventual
obliteration of a vein. The most common sclerosants used in the U.S. include
sodium tetradecyl sulfate, polidocanol, 23.4% saline, and a combination of 25%
dextrose with 10% saline. Treatment generally proceeds from proximal to distal
and largest to smallest vein, based on a reflux map developed from physical
examination, Doppler, and duplex ultrasound. Sclerotherapy results can be
optimized and the risk of complications minimized by choosing the proper
sclerosant, sclerosant concentration, sclerosant volume, and injection sites for
the vein(s) being treated. Post-treatment instructions, particularly compression
and ambulation, are designed to improve the results and safety of sclerotherapy.
Adequate understanding of an appropriate history and physical, ultrasound
evaluation, anatomy, pathophysiology, knowledge of sclerosing solutions, patient
selection, and post-treatment care, as well as the ability to prevent,
recognize, and treat complications are required before embarking on treatment.
PMID: 14614695
=====
Rozhl Chir. 1999 Jul;78(7):319-22.
[Pathophysiologic aspects of chronic venous insufficiency]
[Article in Slovak]
Labas P, Ohradka B, Cambal M.
I. chirurgicka klinika LF UKo, Bratislava, Slovenska republika.
Knowledge of the pathophysiology of the venous circulation and its evaluation
before treatment determines not only the best therapeutic plan, but at the same
time makes it possible to avoid operations which are not necessary and a priori
doomed to lead to a relapse. The basic therapeutic principles in the treatment
of chronic venous insufficiency after evaluation and localization of the
functional disorder by an objective examination method (duplex sonography,
phlebography ...) are: a) compression, b) severing of pathological points of
insufficient perforators, orifices of both saphenous veins, c) antireflux
operation of the deep veins with preference of the popliteal vein. Any
therapeutic procedure which does not have the aim to reduce venous hypertension
is a priori doomed to failure and very soon a relapse develops. From this aspect
it is not important to remove chaotically and extensively superficial
varicosities (surgically or by sclerotherapy) but to severe the insufficient
perforators and the insufficient orifices of saphenous veins surgically or by
sclerotherapy.
PMID: 10596565
======
Surgery. 1996 Apr;119(4):406-9.
Recurrent varicose veins: investigation of the pattern and extent of reflux with
color flow duplex scanning.
Labropoulos N, Touloupakis E, Giannoukas AD, Leon M, Katsamouris A, Nicolaides
AN.
Academic Vascular Surgical Unit, St. Mary's Hospital Medical School, London,
U.K.
BACKGROUND: This study was conducted to investigate with color flow duplex
imaging the patterns and the extent of venous valvular incompetence in recurrent
varicose vein disease.
METHODS: One hundred thirty-four limbs of 123 unselected
patients who arrived in the outpatient clinic with residual or recurrent
varicose veins after undergoing an operation were included. Limbs with history
of compression sclerotherapy before or after the operation were excluded. The
long (LSV) and short saphenous vein (SSV) systems in all limbs were examined
with color flow duplex imaging for detection of the sites and the extent of
reflux.
RESULTS: Various patterns of recurrent valvular reflux were seen in both
the LSV and SSV systems. Reflux confined to saphenofemoral junction alone or
associated with reflux in the LSV system was seen in 29% of the limbs. Reflux in
the whole LSV system was very common after saphenofemoral junction ligation was
performed (chi-squared test, p<0.01). Most of the limbs (53%) with recurrence in
the LSV system had incompetent perforating veins. Incompetent perforators in the
thigh were more common after ligation (23%) than stripping (10%), but this
finding was not true in the calf. After saphenopopliteal junction ligation was
performed, the more common pattern was the reflux in the SSV (75%), whereas
after SSV stripping was performed, it was the reflux in the SSV tributaries
(64%).
CONCLUSIONS: Multiple patterns of reflux develop in recurrent varicose
veins. Precise mapping of the reflux and identification of the possible causes
are required to instigate appropriate treatment. Color flow duplex imaging is an
efficient noninvasive diagnostic technique to identify venous reflux.
PMID: 8644005
=====
Int Angiol. 1995 Jun;14(2):202-8.
Angiovideo-assisted hemodynamic correction of varicose veins.
Zamboni P, Feo C, Marcellino MG, Manfredini R, Vettorello GF, De Anna D.
Institute of General Surgery, University of Ferrara, Italy.
OBJECTIVE. Evaluation of the feasibility and utility of angioscopy in the
hemodynamic correction (French acronyms is CHIVA) of primary varicose veins
disease.
EXPERIMENTAL DESIGN. Prospective evaluation of 25 patients, undergoing
hemodynamic correction of primary varicose disease with intraoperative
videoangioscopic guide. Patients have been selected according to criteria
emerged from a prospective study that we had previously conducted. Follow-up
lasted 1 year (range 8-18 months).
SETTING. Department of Surgery, University of Ferrara, Italy.
Institutional practice.
One-day surgery.
PATIENTS. Their selection has been carried out in our Vascular
Laboratory. The adopted clinical
criteria of selection were: Primary varicose disease of the long saphenous vein
territory, no previous thrombophlebitis and/or sclerotherapy. Doppler cw and
Duplex criteria followed were: competent deep venous system, long saphenous vein
diameter minor than 10 mm and incompetent perforating veins diameter minor than
4 mm.
INTERVENTIONS: 25 hemodynamic corrections according to the CHIVA method
described by Franceschi. An angioscope, introduced through a distal collateral
of the long saphenous vein, permitted the precise interruption of the
venous-venous shunts and of the superficial venous system, just below the
perforators chosen as re-entry points in the deep venous system. MEASURES.
Clinical: varices and symptomatology reduction. Duplex and Doppler cw: detection
of the superficial blood flow re-entry, in the deep venous system, through the
perforators and identification of recurrences or new refluxes. Pre and
postoperative Ambulatory Venous Pressure and Refilling Time have also been
measured.
RESULTS. In 20 patients symptoms and varices relief were recorded
(80%), in 5 patients varices reduction was observed only during walking (20%).
In 2 of these latter patients there was no re-entry through the perforators,
with a recurrent sapheno-femoral reflux in 1 of them. Early complications
recorded were: 2 long saphenous vein thrombosis (8%); 7 ecchimosis (28%) when
heparine/saline solution had been used for angioscopic clearance.
CONCLUSIONS. Intraoperative angioscopy is feasible and useful when
the hemodynamic situation
is complex and the Duplex map is difficult to be interpreted by the surgeon. In
this series the second look percentage rate has been minor compared to the
percentage rates published so far by other authors.
PMID: 8609448
=====
5: Ann Ital Chir. 1995 May-Jun;66(3):379-86.
[Video-assisted venous surgery]
[Article in Italian]
Zamboni P, Murgia AP, Vasquez G, Zandi G, Mari C, Liboni A.
Istituto di Chirurgia Generale, Universita degli Studi di Ferrara.
The use of intraoperative angioscopy, till now utilized exclusively in arterial
surgery, is now used also in venous surgery. From January 1992 54 patients
underwent to video-guided venous surgery: 23 cases of external valvuloplasty of
the sapheno-femoral junction (EV-SFJ), 25 cases of hemodynamic correction of
varicose veins (French acronyms CHIVA), 5 cases of high ligation plus long
saphenous vein intraoperative sclerotherapy (HL-IS) 1 case of sub-fascial
perforators interruption (SPI), the only extraluminal videoguided procedure. We
have used 3 different video-angioscopes: a 1 mm monofibroscopy let in a 6 Fr
Fogarty catheter, a disposable 2,8 mm colangioscope and a 2,2 mm operative
angioscope. For the perforators interruption we have utilised the thoracoscope.
EV-SFJ: the angioscopy has confirmed the presence of normal valvular cusps in a
dilated vein wall in 21 cases, so excluding 2 patients from the planned
treatment. At the end of the operation the angioscope has verified the
reapproach of valvular cusps. CHIVA: the angioscopy has allowed to identify the
exact points of the superficial venous system which should be interrupted,
according to the Franceschi's theory. This procedure can avoid the technical
errors due to intraoperatory misleadings of the duplex mapping. HL-IS: consists
of a classic high ligation followed by long saphenous vein intraoperative
sclerotherapy. The angioscopy has allowed a complete deconnection of the long
saphenous vein from tributaries and perforators. Furthermore has facilitate the
proportional distribution of the sclerosing agent along the long saphenous vein.
SPI: the videoassistance have permitted the identification of the insufficient
perforating veins reducing their surgical exposures.(ABSTRACT TRUNCATED AT 250
WORDS)
PMID: 8526307
=====
Rozhl Chir. 1998 Sep;77(9):414-6.
[Compressive sclerotherapy monitored by ultrasound]
[Article in Slovak]
Labas P, Ohradka B, Stvrtinova V, Lukac L, Sabolova K.
I. chirurgicka klinika LF UKo, Bratislava, Slovenska republika.
Echosclerotherapy and sonographic control of aimed sclerotherapy resp. is a
major advance in the treatment of chronic venous insufficiency. It facilitates
not only aimed administration of highly active substances but ensures above all
prevention of serious complications. Functional examination of the venous system
helps to locate relatively accurately the sites of pathological reflux which are
in the first place responsible for the development of the whole symptomatology
and it prevents the administration of excessive amounts of sclerotizing
substances into intact portions of the venous system. Similarly as Baccaglini et
al. (1995) the authors achieved by compressive sclerotherapy with monitoring by
ultrasound occlusion of up to 90% important reflux sites such as the
saphenofemoral and saphenopopliteal orifice which are to a great extent
responsible for serious clinical symptoms.
PMID: 9828651
=====
J Mal Vasc. 1997 Dec;22(5):303-12.
[Recurrent varicose veins in the groin after surgery]
[Article in French]
Perrin M, Gobin JP, Nicolini P.
Service de Chirurgie Vasculaire, Clinique du Grand Large, Decines Charpieu.
Recurrence of varicose veins following surgery of the long saphenous system are
common. It is important to differentiate several causes. These, in fact, dictate
the therapeutic decision. Physiopathologically, there are different types of
recurrences: persistent reflux from the femoral veins into the superficial
varicose network due to: an incomplete long sapheno-femoral high ligation
(crossectomy), a neoangiogenesis at the level of the previous sapheno-femoral
junction. separate termination of an incompetent long saphenous vein (LSV) into
the common femoral vein or the superficial femoral vein (antero lateral or
postero medial tributaries of LSV); persistent reflux from perineal and (or)
paricto-abdominal veins into the varicose network of the thigh. Dynamic
popliteal phlebography was, until the advent of echo-doppler, the author's
method of choice for investigation as it was easier to interpret than
varicography. At the present time it is only requested on the rare occasions
where doubt persists even after echo-doppler. Additionally, with this
investigation, the reflux (major or minor) can be analysed at its point of
origin and a map of the underlying varicose network can be drawn.
Therapeutically, we make the following suggestions: in the presence of a site of
major reflux (incomplete crossectomy, high flow neoangiogenesis, separate
termination of the saphenous tributaries), a further operation would be
justified. The removal of the site of reflux can be associated with the placing
of a PTFE patch on the common femoral vein. in the presence of a site of minor
reflux, sclerotherapy or, preferably, echosclerotherapy would appear to be the
treatment of choice. Elimination of the site (s) of reflux must be associated
with suppression of the underlying varicose network by sclerotherapy or
phlebectomy.
PMID: 9479600
=====
Minerva Cardioangiol. 1995 May;43(5):191-7.
[Echo-sclerotherapy in the management of varices of the lower extremities]
[Article in Italian]
Baccaglini U, Pavei P, Spreafico G, Sorrentino P, Fontebasso V, Castoro C,
Gongolo A, Ancona E.
Istituto di Chirurgia Generale II, Universita degli Studi, Padova.
Sclerotherapy has been used with satisfactory results, for several years in the
treatment of varicose veins. Nevertheless sometimes sclerosis can be incomplete
because of the morphology of lower limbs or because the varicose disease is not
clinically evident. In addition, sclerotherapy can give rise to severe
complications due to intrarterial or extraluminal injections. In order to exceed
this limits, some authors suggested to use a new technique, the
echosclerotherapy, which was presented for the first time in Strasburg 1989 by
Knight and Vin. Echosclerotherapy is a good help for traditional sclerotherapy,
especially when it is applied in the sclerosis of the short saphenous veins, of
perforating veins or in unfavourable anatomical situations. From May to November
1993 at the Second Surgical Department of Padua University, 31 patients, 29
women and 3 men, have been treated by echosclerotherapy. 25 patients had great
saphenous varicose veins; 3 patients had varices due to perforating veins of the
popliteal fossa and 3 patients varices due to Hunter perforating veins. In 48.4%
of cases we obtained a complete sclerosis of the vessel; in 38.7% a stump
remained near the sapheno-femoral junction of about two centimeters; in one case
the treatment was not completed and in one case remained a stump of ten
centimeters. Only in two cases Echosclerotherapy was not able to obtain
sclerosis. None of the patients had major complications and nobody had deep vein
thrombosis. If we consider our results altogether we can say that in 87% of
cases we had good results.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 7478042
=====
Dermatol Surg. 1996 Jan;22(1):65-70.
An ambulatory treatment of varicose veins associating surgical section and
sclerotherapy of large saphenous veins (3S technique). Preliminary study with
results at one year.
Vin F, Chleir F, Allaert FA.
Service de Phlebologie, Hopital Notre Dame de Bon Secours, Paris, France.
BACKGROUND. The 3S technique enables treatment of large incontinent greater
saphenous veins in patients who, for medical or social reasons, refuse
traditional surgical methods. It associates phlebectomy with section-ligation
and injection of a sclerosing solution in the proximal and distal segments. The
3S technique is merely one stage in the treatment of the saphenous vein, aimed
at suppressing reflux, and associated with sclerosis of the junction. It must
always be combined with later sclerotherapy sessions.
METHODS. One hundred and eight patients were operated on by the 3S
technique, of which 100 had 1-year
follow-up. Each patient was checked by duplex scan examination before treatment,
and 1 month and 1 year after.
RESULTS. We obtained good results without reflux in 96% at the
sapheno-femoral junction at 1 year.
CONCLUSIONS. Superficial venous insufficiency is a chronic disease
with evolution or recurrences. To
appreciate the efficiency of 3S technique, it will be better to have 5
years worth of follow-up.
This is a preliminary study with a short follow-up.
PMID: 8556260
=====
2: Phlebologie. 1978 Apr-Jun;31(2):79-83.
[Sclerotherapy of saphenous varicose veins: some technical points]
[Article in French]
Chatard H.
This article concerns sclerotherapy techniques. It deals with varicosity of the
large or small saphenous veins and their treatment using sclerosing injections
in cases where, for various reasons, the decision not to undertake surgery is
made. The following points are successively considered: --management of the
treatment: from top to bottom, that is, from the proximal to the distal segment
of the varicose vein; --the dose of the sclerosing drug utilized and the
relation between the amount and the concentration of the injected doses; --the
position of the patient and various movements aimed at injecting the solution in
a patient when he is lying down, even if the needle is introduced when he is
standing up; --the spasm-inducing capacity of certain sclerosing drugs and the
possible utilization of provoked veinoconstriction during treatment for better
contact between sclerosing drugs and endothelium; --finally, retention with
straps: they are put in place immediately after treatment, maintained from 8 to
15 days without interruption, have little or no elasticity and are
non-detachable.
PMID: 693600
=====
J Mal Vasc. 1997 Dec;22(5):336-42.
[Ultrasonographic exploration for recurrent varicose veins in the
popliteal fossa after surgery]
[Article in French]
Franco G.
CERM, Paris.
Recurrence rate, five years after surgery is known to be high, about
50%, further reoperations amount a quarter of global venous
insufficiency surgery. True varicose veins recurrence has a very
theoretical definition which is reappearance of the disease after
initial total eradication. Early post surgical recurrence result from
an incomplete or inadequate operation. Late recurrence is known to
occur after correct surgery but with deterioration of the remaining
superficial venous system and with evolving point of reflux, or in
case of inappropriate surgery leaving communication between
superficial and deep venous systems which have evolved silently, or
even recurrence following incomplete surgery because of unrecognised
anatomical variation. This distinction is merely theoretical,
duplex-scan shows that incomplete removal of varicose veins remain the
main cause of recurrence. In presence of post-surgical varicose vein
recurrence, the aim of sonographic investigation is to identify the
main factors, more than the cause, before surgery assessment which
could serve as reference being seldom available. In practice certain
technical or and tactical errors could surely be identified in the
course of treatment, without being able to assess precisely what could
be attributed to the evolution of the varicose disease itself.
Sonographic tests enables dynamic mapping of recurrence and allows for
a better choice of further treatment, surgery, phlebectomy,
sclerotherapy, or various techniques combined, or even abstaining from
any aggressive therapy if even slightly risky. Ideally this mapping
should be followed by skin marking when further surgery is necessary
to avoid yet more incomplete treatment.
PMID: 9479605
=====
J Dermatol Surg Oncol. 1990 Jul;16(7):612-8. Related Articles, Links
Cosmetic leg veins: evaluation using duplex venous imaging.
Thibault P, Bray A, Wlodarczyk J, Lewis W.
Newcastle Laser Center, Australia.
The records of 305 consecutive patients who had presented with
cosmetic symptoms related to varicose and/or spider veins over a
12-month period were studied. Following clinical assessment, 250 (82%)
patients were referred for duplex venous imaging. A total of 500 lower
limbs were evaluated; 236 (47%) were documented to have incompetence
in the superficial venous system (long or short saphenous veins). Only
6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found
to have perforator incompetence. Short saphenous vein incompetence was
found in 59 (12%) limbs. In the long saphenous vein there was a
consistent pattern of an increasing incidence of incompetence from the
saphenofemoral junction down to the below-knee segment. The duplex
imaging findings were applied to determine the optimal treatment, ie,
whether surgery, sclerotherapy, or a combination of both would provide
the best short- and long-term results. The possible etiology and
pathophysiology of spider and varicose veins are discussed in relation
to these results.
PMID: 2193958
=====
J Dermatol Surg Oncol. 1990 Jul;16(7):612-8.
Cosmetic leg veins: evaluation using duplex venous imaging.
Thibault P, Bray A, Wlodarczyk J, Lewis W.
Newcastle Laser Center, Australia.
The records of 305 consecutive patients who had presented with
cosmetic symptoms related to varicose and/or spider veins over a
12-month period were studied. Following clinical assessment, 250 (82%)
patients were referred for duplex venous imaging. A total of 500 lower
limbs were evaluated; 236 (47%) were documented to have incompetence
in the superficial venous system (long or short saphenous veins). Only
6 (1%) limbs had deep venous incompetence and 45 (9%) limbs were found
to have perforator incompetence. Short saphenous vein incompetence was
found in 59 (12%) limbs. In the long saphenous vein there was a
consistent pattern of an increasing incidence of incompetence from the
saphenofemoral junction down to the below-knee segment. The duplex
imaging findings were applied to determine the optimal treatment, ie,
whether surgery, sclerotherapy, or a combination of both would provide
the best short- and long-term results. The possible etiology and
pathophysiology of spider and varicose veins are discussed in relation
to these results.
PMID: 2193958
=====
Here are titles of additional articles that did not meet all my search
criteria (e.g., there may have been no reference to "ultrasound" or
related terms), but which may be of interest to you just the same:
1: Min RJ, Khilnani N, Zimmet SE.
Endovenous laser treatment of saphenous vein reflux: long-term results.
J Vasc Interv Radiol. 2003 Aug;14(8):991-6.
PMID: 12902556 [PubMed - indexed for MEDLINE]
2: Labas P, Ohradka B, Cambal M, Reis R, Fillo J.
Long term results of compression sclerotherapy.
Bratisl Lek Listy. 2003;104(2):78-81.
PMID: 12839217 [PubMed - indexed for MEDLINE]
3: Bogachev VIu, Zolotukhin IA, Briushkov AIu, Zhuravleva OV.
[Phlebosclerosing treatment of lower extremity varicosity using the 'foam-form'
technique]
Angiol Sosud Khir. 2003;9(2):81-5. Russian.
PMID: 12811379 [PubMed - indexed for MEDLINE]
4: Ignat'ev IM, Bredikhin RA, Safiullina LI, Obukhova TN.
[Diagnosis and treatment of postoperative recurrences of varicosity]
Angiol Sosud Khir. 2003;9(2):73-9. Russian.
PMID: 12811378 [PubMed - indexed for MEDLINE]
5: Ramelet AA.
Phlebectomy. Technique, indications and complications.
Int Angiol. 2002 Jun;21(2 Suppl 1):46-51. Review.
PMID: 12515980 [PubMed - indexed for MEDLINE]
6: Bowes LE, Goldman MP.
Sclerotherapy of reticular and telangiectatic veins of the face, hands, and
chest.
Dermatol Surg. 2002 Jan;28(1):46-51.
PMID: 11991270 [PubMed - indexed for MEDLINE]
7: Widmer MK, Schmidli J, Carrel T.
[Minimally invasive therapy in varicose veins]
Schweiz Rundsch Med Prax. 2001 Feb 8;90(6):205-12. Review. German.
PMID: 11235641 [PubMed - indexed for MEDLINE]
8: Dagher L, Burroughs A.
Variceal bleeding and portal hypertensive gastropathy.
Eur J Gastroenterol Hepatol. 2001 Jan;13(1):81-8. Review.
PMID: 11204818 [PubMed - indexed for MEDLINE]
9: Takeda Y, Agui T, Tanaka K, Okuzawa M, Tanigawa N.
Sclerotherapy with a ligation of incompetent veins for a stasis ulcer due to
varix cruris: minimal invasive therapy for varix cruris.
Surg Today. 1999;29(11):1154-7.
PMID: 10552333 [PubMed - indexed for MEDLINE]
10: Zimmet SE.
Venous leg ulcers: modern evaluation and management.
Dermatol Surg. 1999 Mar;25(3):236-41. Review.
PMID: 10193974 [PubMed - indexed for MEDLINE]
11: Jenkins SA, Baxter JN, Critchley M, Kingsnorth AN, Makin CA, Ellenbogen S,
Grime JS, Love JG, Sutton R.
Randomised trial of octreotide for long term management of cirrhosis after
variceal haemorrhage.
BMJ. 1997 Nov 22;315(7119):1338-41.
PMID: 9402774 [PubMed - indexed for MEDLINE]
12: Yoshida Y, Imai Y, Nishikawa M, Nakatukasa M, Kurokawa M, Shibata K,
Shimomukai H, Shimano T, Tokunaga K, Yonezawa T.
Successful endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate
following the recurrence of bleeding soon after endoscopic ligation for ruptured
duodenal varices.
Am J Gastroenterol. 1997 Jul;92(7):1227-9.
PMID: 9219810 [PubMed - indexed for MEDLINE]
13: Kanter A, Thibault P.
Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy.
Dermatol Surg. 1996 Jul;22(7):648-52.
PMID: 8680788 [PubMed - indexed for MEDLINE]
14: McCormick PA, Dick R, Burroughs AK.
Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the
treatment of portal hypertension.
Aliment Pharmacol Ther. 1994 Jun;8(3):273-82. Review.
PMID: 7918921 [PubMed - indexed for MEDLINE]
15: Priollet P.
[Comprehensive management of chronic venous insufficiency]
Presse Med. 1994 Feb 10;23(5):259-63. French.
PMID: 8177876 [PubMed - indexed for MEDLINE]
16: Acharya SK, Dasarathy S, Saksena S, Pande JN.
A prospective randomized study to evaluate propranolol in patients undergoing
long-term endoscopic sclerotherapy.
J Hepatol. 1993 Sep;19(2):291-300.
PMID: 8301064 [PubMed - indexed for MEDLINE]
17: Neglen P, Einarsson E, Eklof B.
The functional long-term value of different types of treatment for saphenous
vein incompetence.
J Cardiovasc Surg (Torino). 1993 Aug;34(4):295-301.
PMID: 8227108 [PubMed - indexed for MEDLINE]
18: Trempe J.
Long-term results of sclerotherapy and surgical treatment of the varicose short
saphenous vein.
J Dermatol Surg Oncol. 1991 Jul;17(7):597-600. No abstract available.
PMID: 1860990 [PubMed - indexed for MEDLINE]
19: Thibault P, Bray A, Wlodarczyk J, Lewis W.
Cosmetic leg veins: evaluation using duplex venous imaging.
J Dermatol Surg Oncol. 1990 Jul;16(7):612-8.
PMID: 2193958 [PubMed - indexed for MEDLINE]
20: Puissegur Lupo ML.
Sclerotherapy: review of results and complications in 200 patients.
J Dermatol Surg Oncol. 1989 Feb;15(2):214-9.
PMID: 2915088 [PubMed - indexed for MEDLINE]
21: Elewaut A, De Man M, De Vos M, Barbier F.
Endoscopic sclerotherapy: the value of balloon tamponade and the importance of
disinfection.
Endoscopy. 1988 Mar;20(2):48-51.
PMID: 3383790 [PubMed - indexed for MEDLINE]
22: Rikkers LF, Burnett DA, Volentine GD, Buchi KN, Cormier RA.
Shunt surgery versus endoscopic sclerotherapy for long-term treatment of
variceal bleeding. Early results of a randomized trial.
Ann Surg. 1987 Sep;206(3):261-71.
PMID: 3307653 [PubMed - indexed for MEDLINE]
23: Hesterberg R, Stahlknecht CD, Roher HD.
Sclerotherapy for massive enterostomy bleeding resulting from portal
hypertension.
Dis Colon Rectum. 1986 Apr;29(4):275-7.
PMID: 3485037 [PubMed - indexed for MEDLINE]
24: Wenner L.
Improvement of immediate and long-term results in sclerotherapy.
Vasa. 1986;15(2):180-3. No abstract available.
PMID: 3727769 [PubMed - indexed for MEDLINE]
25: Davy A, Ouvry P.
[Ostial incontinence: sclerosis or resection of the saphenous junction?]
Phlebologie. 1986 Jan-Mar;39(1):35-45. French.
PMID: 3703945 [PubMed - indexed for MEDLINE]
26: Andel Z.
[Current treatment of varices of the lower extremities in Czechoslovakia]
Phlebologie. 1986 Jan-Mar;39(1):157-61. French.
PMID: 3703940 [PubMed - indexed for MEDLINE]
27: Westaby D, Melia WM, Macdougall BR, Hegarty JE, Williams R.
Injection sclerotherapy for oesophageal varices: a prospective randomised trial
of different treatment schedules.
Gut. 1984 Feb;25(2):129-32.
PMID: 6363216 [PubMed - indexed for MEDLINE]
28: Westaby D, Williams R.
Follow-up study after sclerotherapy.
Scand J Gastroenterol Suppl. 1984;102:71-5.
PMID: 6591376 [PubMed - indexed for MEDLINE]
29: Beresford SA, Chant AD, Jones HO, Piachaud D, Weddell JM.
Varicose veins: A comparison of surgery and infection/compression
sclerotherapy. Five-year follow-up.
Lancet. 1978 Apr 29;1(8070):921-4.
PMID: 76857 [PubMed - indexed for MEDLINE]
30: Cloutier G.
[Scleroses of the junction of the internal and external saphenous veins. New
approach]
Phlebologie. 1976 Jul-Sep;29(3-4):227-32. French.
PMID: 1005507 [PubMed - indexed for MEDLINE]
==========
The PubMed database, operated by the National Institutes of Health in
the US, can be accessed at:
http://www.ncbi.nlm.nih.gov/PubMed/
I ran numerous searches to identify relevant articles, including searches on:
sclerotherapy
echosclerotherapy
sclerotherapy and ultrasound
aimed sclerotherapy
guided sclerotherapy
duplex sclerotherapy
sonographic sclerotherapy
I searched on these terms both alone, and in combination with other terms such as:
saphenous
perforators
long-term
outcomes |
