Search

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 results from recent RCTs in sclerotherapy are reviewed. [ABSTRACT FROM AUTHOR]

Chronic venous disease (CVD) is one of the most common diseases in our population. Aside from venous symptoms like heaviness and pain, which are present in about 50% of the general population, signs of CVD include varicose veins (VVs), oedema, eczema, venous eczema, hyperpigmentation, white atrophy, lipodermatosclerosis and venous ulcers. The aim of this paper is to review current literature for the relevance of natural history of VVs in refunded care. Available papers on VVs, progression of the disease and complications were reviewed. Prevalence of VVs is high with more than 20% in the general population. Information on progression of uncomplicated VV to chronic venous insufficiency (CVI) is rare. However, most venous ulcers have a primary venous origin. The progression rate of VV to higher clinical stages reaches 4% per year. Among the risk factors are obesity and higher age. Quality of life (QOL) is also reduced in uncomplicated VV in C2 patients. In conclusion, there is evidence from the literature that a high proportion of patients with uncomplicated VVs in the clinical, aetiological, anatomical and pathophysiological classification (CEAP Clinical Class 2) will progress to CVI if untreated. VVs have a negative impact on QOL and clinical symptoms. VV patients with CVI (C3-C6) as well as those C2 patients with severe clinical symptoms and impaired QOL due to CVD should be treated with ablation of the VVs in a refunded care system. [ABSTRACT FROM AUTHOR]

Background: Endovenous laser ablation (EVLA) is an efficient method to treat insufficient great saphenous veins (GSV) with high occlusion rates. Most studies used 810, 940 or 980 nm diode lasers and a bare fibre. Moderate postoperative pain and bruising are frequent findings. Laser systems with higher wavelengths like 1470 nm with a higher absorption in water show less pain and bruising after the procedure. A newly developed fibre (radial fibre, Biolitec) emits the laser energy radially around the tip directly into the venous wall contrary to the bare fibre. The aim of this study was to demonstrate the outcome and side-effects after EVLA of GSV with a 1470 nm diode laser (Ceralas E, Biolitec) by using the radial fibre. Methods: Non-randomized, prospective study including 50 unselected limbs of 50 patients with a duplex sonographically verified incompetent GSV. EVLA was performed with a 1470 nm diode laser (Ceralas E, Biolitec) and a radial fibre. In the same session all insufficient tributaries were treated by phlebectomy. Tumescent local anaesthesia with 0.05% lidocaine was applied perivenously. Laser treatment was carried out in a continuous mode with a power of 15W. Compression stockings (30 mmHg) were applied for one month. Postinterventional checkups took place one, 10, 30 days and six months after the procedure. Results: Three patients were lost to follow-up. The average linear endovenous energy density (LEED) was 90.8 J/cm vein (SD 35.3). At the six month follow-up all treated veins remained occluded and no new reflux in the treated segments occurred. No recurrent varicose veins had occurred so far. No severe complications such as deep venous thrombosis could be detected. In four patients at 30 days and three patients at six months local paresthesia occurred in the region of EVLA. Forty-four percent of patients did not have any pain after the treatment and 50% did not take any analgesic tablets at any time after the procedure. Postoperative ecchymoses in the track of the treated GSV was rare. In 80% of the limbs, no ecchymoses was observed after the treatment. Conclusion: EVLA of GSV with a radially emitting laser fibre by using a 1470 nmdiode laser is a safe and efficient treatment option. [ABSTRACT FROM AUTHOR]