R.R. van den Bos

Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins

A variety of techniques exist for the treatment of patients with great saphenous vein (GSV) varicosities. Few data exist on the long‐term outcomes of these interventions.

Endovenous Simulated Laser Experiments at 940 nm and 1470 nm Suggest Wavelength-Independent Temperature Profiles

BACKGROUND EVLA has proven to be very successful, but the optimum methods for energy delivery have still not been clarified. A better understanding of the mechanism of action may contribute to achieving a consensus on the best laser method and the most effective use of laser parameters, resulting in optimal clinical outcomes, maintaining high success rates with minimal adverse events. The aim of this study is to assess the impact of wavelength, pullback speed and power level on the endovenous temperature profile in an experimental setting. METHODS In an experimental setting, temperature measurements were performed using thermocouples. The experimental set-up consisted of a transparent box in which a glass tube was fixed. Different laser parameters (wavelength and power) and 2 different pullback speeds (2 and 5 mm/s) were used. Thermocouples were placed at different distances from the fiber tip. Validity of the experimental setting was assessed by performing the same temperature measurements using a stripped varicose vein. The maximal temperature rise and the time span that the temperature was above collagen denaturation temperature were measured. RESULTS The experiments showed that decreasing the pullback speed (2 mm/s) and increasing the power (up to 14 W) both cause higher maximal temperature and a longer time above the temperature for collagen denaturation. The use of different laser wavelengths (940 or 1470 nm) did not influence the temperature profile. CONCLUSION The results of our experiments show that wavelength on its own has not been demonstrated to be an important parameter to influence the temperature profile.

Treatment of incompetent perforating veins using the radiofrequency ablation stylet: a pilot study

Background Although the role of incompetent perforating veins (IPV) in chronic venous insufficiency remains controversial, they are often treated by surgical or by minimal invasive techniques. Objectives To describe the procedure of radiofrequency ablation (RFA) of IPV and to evaluate its short-term effectiveness and safety. Methods In a clinical pilot study, 14 IPV in 12 patients were treated with a radiofrequency stylet. After three months, ultrasound (US) examination was used to assess anatomical success rate and exclude deep venous thrombosis. Also, self-reported side-effects were investigated. Results Of the 14 treated IPV, nine (64%) were obliterated on US examination and the others showed remaining reflux. Two patients reported localized paresthesia, but no deep venous thrombosis was recorded. Conclusion RFA of IPV may be a promising procedure, but patient and incompetent perforator vein selection is important and further standardization of the procedure is required. Comparative clinical trials between RFA and other therapies are warranted.

Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins

The aim was to compare endovenous laser ablation (EVLA) and endovenous steam ablation (EVSA) for great saphenous varicose veins in a non‐inferiority study.

A New Gold Standard for Varicose Vein Treatment

The current principles of surgical treatment of varicose veins were established at the beginning of the 20th century by Perthes, Keller, Mayo, Bacbock and others. They include ligation of the incompetent sapheno-femoral or saphenopopliteal junction, stripping of the refluxing saphenous vein and phlebectomy of varicose branches. These principles have been increasingly challenged since the advent of thermal ablation by laser or radio-frequency around the turn of the millennium. Furthermore, sclerotherapy has gained renewed interest due to improved results by ultrasound guidance and the use of foam instead of liquid agents. Two randomised controlled trials (RCTs) comparing endovenous laser ablation (EVLA) of refluxing saphenous veins with surgical high ligation and stripping were published by Rasmussen et al. and by Darwood et al. Furthermore, Disselhoff et al. published an RCT comparing EVLA with cryosurgery. All studies used laser light with a wavelength of 980 nm. In all trials, abolition of reflux was marginally superior after EVLA, but the differences were not significant. Improvement of symptoms according to AVVSS (the Aberdeen Varicose Vein Symptom Severity Score) or VCSS (the Venous Clinical Severity Score) was similar after EVLA and surgery. Return to normal activities was earlier after EVLA than after surgery, according to the Darwood and Disselhof trials, but not in the Rasmussen study. However, all trials found a tendency towards less pain and bruising after EVLA. Early in 2009, Van den Bos et al. published a large meta-analysis of results of all current treatment modalities. EVLA, radio-frequency ablation (RFA) and ultrasoundguided foam sclerotherapy (UGFS) were compared with surgical high ligation plus stripping. As many as 64 clinical trials that used ultrasound examination as an outcome measure with a total of 12 320 limbs and an average followup of 32.2 months were included. After 3 years, the estimated pooled success rate was highest after EVLA with 94%, followed by RFA (84%), surgery (78%) and foam sclerotherapy (77%). After adjusting for the duration of follow-up, endovenous laser therapy was significantly superior to all other treatments in terms of abolition of saphenous reflux. Foam

Laser fibre stabs the catheter: a serious complication of endovenous laser ablation.

An 82-year-old woman was treated with endovenous laser ablation for insufficiency of the right great saphenous vein. Because of a very thick layer of subcutaneous fat, puncturing the vein and introducing the laser fibre was difficult. The patient reported pain after activation of the laser. Subsequently, the procedure was discontinued and the catheter was removed. Inspection of the disposables showed that the laser fibre had punctured the catheter and was therefore located outside the lumen. Fortunately, there were no harmful sequelae in this case, but as device-related complications of EVLA are serious, reporting them is important.

Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis

In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.

Randomized clinical trial of 940- versus 1470-nm endovenous laser ablation for great saphenous vein incompetence

The independent effect of wavelength used for endovenous laser ablation (EVLA) on patient‐reported outcomes, health‐related quality of life (HRQoL), treatment success and complications has not yet been established in a randomized clinical trial. The aim was to compare two different wavelengths, with identical energy level and laser fibres, in patients undergoing EVLA.

Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis

Results: Themedian age of stented patients was 46 (range 15e86 years), 80% were female (301/376). Following left CIV stent placement, 10 patients later presented with a right (contralateral) iliac deep venous thrombosis (DVT) resulting in a cumulative incidence of contralateral DVT of 4% according to Kaplan-Meier analysis. Acute DVT (P = .001), non-compliance with the prescribed 6 months anticoagulation (P = 0.05), pre-operative contralateral internal iliac vein (IIV) thrombosis (P = 0.001), and pre-existing IVC filter placement (P = 0.003) were all statistically significantly associated with contralateral DVT. All patients with symptomatic contralateral iliac DVT underwent clot removal in the acute phase. The primary patency of these limbs was 100% at 3 years. Conclusion: Stent placement across the iliocaval confluence from the left CIV is associated with a low but definite rate of contralateral iliac vein thrombosis. Acute DVT, pre-operative contralateral IIV thrombosis, pre-existing IVC filters, and anticoagulation non-compliance are significant risk factors.

Orf-induced pemphigoid with antilaminin-332 antibodies

than one false-negative patient developed distant metastases. These results indicate that the number of involved LNs may be an important factor for survival and that early detection of LN metastasis may contribute to a favourable prognosis. The indication of SLNB for EMPD is difficult to determine. SLNB should be applied regardless of the LN swelling because it is often difficult to determine clinically whether the swollen LNs are metastases or inflammation. Our study also indicated no statistical correlation between swollen LNs and pathological metastasis. Regarding the invasion level, elective lymphadenectomy was advocated for invasive EMPD other than the microinvasive type. However, in our study, the rate of positive SLNs was higher in patients with microinvasion. Microinvasive EMPDs with LN metastases have also been reported. As for CIS, EMPD usually presents as a large macule, and accurate confirmation of the invasion level based on the biopsy is impossible. Indeed, in our study, in 30% of patients initially diagnosed as having CIS based on the biopsy, invasive EMPD was subsequently confirmed after surgery. As SLNB has low morbidity, it may be applied in almost all cases of EMPD regardless of the invasion level. However, the therapeutic value of SLNB remained uncertain in this study, and collection of more data is necessary.