Download PDF
Semin intervent Radiol 2021; 38(02): 209-214
DOI: 10.1055/s-0041-1729155
Review Article

Choosing the Best Treatment Approach for Axial Vein Reflux: Thermal versus Nonthermal Approaches

Karen Shmelev
1   Northwestern University, Feinberg School of Medicine, Chicago, Illinois
,
Ramona Gupta
1   Northwestern University, Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Chronic venous insufficiency is a common and treatable medical condition which has a high morbidity if left untreated, progressing to lower extremity edema, skin changes of lipodermatosclerosis, and venous ulceration. Treatment options have significantly expanded over the last several decades, shifting away from the traditional surgical approach to more minimally invasive procedures such as endoluminal venous laser ablation or radiofrequency ablation. Even more recently, several techniques using nonthermal methods to ablate varicose veins have been developed, which offer the advantage of not requiring labor-intensive and painful tumescent anesthesia to protect the surrounding tissues. These techniques include mechanochemical ablation, cyanoacrylate closure, or polidocanol microfoam injection and can be offered to a wider range of patients without the need for sedation while offering similar closure rates and improved postprocedure symptom profile. Furthermore, certain patient characteristics which might preclude or complicate the use of thermal ablation methods might not pose a problem with nonthermal nontumescent methods.

Keywords

Thermal tumescent - nonthermal nontumescent - axial vein reflux - interventional radiology


Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hamdan A. Management of varicose veins and venous insufficiency. JAMA 2012; 308 (24) 2612-2621
    CrossrefPubMedGoogle Scholar
  • 2 Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 2003; 14 (08) 991-996
    CrossrefPubMedGoogle Scholar
  • 3 Lurie F, Creton D, Eklof B. et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg 2003; 38 (02) 207-214
    CrossrefPubMedGoogle Scholar
  • 4 Tang TY, Kam JW, Gaunt ME. ClariVein® - early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins. Phlebology 2017; 32 (01) 6-12
    CrossrefPubMedGoogle Scholar
  • 5 Marsden G, Perry M, Kelley K, Davies AH. Guideline Development Group. Diagnosis and management of varicose veins in the legs: summary of NICE guidance. BMJ 2013; 347: f4279-f4279
    CrossrefPubMedGoogle Scholar
  • 6 Bootun R, Lane TR, Davies AH. The advent of non-thermal, non-tumescent techniques for treatment of varicose veins. Phlebology 2016; 31 (01) 5-14
    CrossrefPubMedGoogle Scholar
  • 7 Morrison N, Gibson K, Vasquez M, Weiss R, Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 8 (06) 978-989
    CrossrefPubMedGoogle Scholar
  • 8 Kolluri R. Interventions for varicose veins: beyond ablation. Curr Treat Options Cardiovasc Med 2016; 18 (07) 43
    CrossrefPubMedGoogle Scholar
  • 9 Sevil F, Colak Jr A, Ceviz M, Kaya U, Becit N. The effectiveness of endovenous radiofrequency ablation application in varicose vein diseases of the lower extremity. Cureus 2020; 12 (04) e7640
    PubMedGoogle Scholar
  • 10 van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 2009; 49 (01) 230-239
    CrossrefPubMedGoogle Scholar
  • 11 AlGhofili HH, Aljasser AA, Alyahya IA. et al. Endothermal heat-induced thrombosis after endovenous laser ablation: a single-center experience. Semin Vasc Surg 2020; 32 (3-4): 89-93
    CrossrefPubMedGoogle Scholar
  • 12 Hartmann K. Endovenous (minimally invasive) procedures for treatment of varicose veins : the gentle and effective alternative to high ligation and stripping operations. Hautarzt 2020; 71 (Suppl. 02) 67-73
    CrossrefPubMedGoogle Scholar
  • 13 Novak CJ, Khimani N, Kaye AD, Jason Yong R, Urman RD. Current therapeutic interventions in lower extremity venous insufficiency: a comprehensive review. Curr Pain Headache Rep 2019; 23 (03) 16
    CrossrefPubMedGoogle Scholar
  • 14 Hamann SAS, Timmer-de Mik L, Fritschy WM, Kuiters GRR, Nijsten TEC, van den Bos RR. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. Br J Surg 2019; 106 (08) 998-1004
    CrossrefPubMedGoogle Scholar
  • 15 Tawfik AM, Sorour WA, El-Laboudy ME. Laser ablation versus mechanochemical ablation in the treatment of primary varicose veins: a randomized clinical trial. J Vasc Surg Venous Lymphat Disord 2020; 8 (02) 211-215
    CrossrefPubMedGoogle Scholar
  • 16 Atasoy MM. Efficacy and safety of endovenous laser ablation in very large and tortuous great saphenous veins. J Vasc Interv Radiol 2015; 26 (09) 1347-1352
    CrossrefPubMedGoogle Scholar
  • 17 Karathanos C, Spanos K, Batzalexis K. et al. Prospective comparative study of different endovenous thermal ablation systems for treatment of great saphenous vein reflux. J Vasc Surg Venous Lymphat Disord 2020; S2213-333X(20)30553-9
    PubMedGoogle Scholar
  • 18 Elias S, Raines JK. Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial. Phlebology 2012; 27 (02) 67-72
    CrossrefPubMedGoogle Scholar
  • 19 Witte ME, Holewijn S, van Eekeren RR, de Vries JP, Zeebregts CJ, Reijnen MM. Midterm outcome of mechanochemical endovenous ablation for the treatment of great saphenous vein insufficiency. J Endovasc Ther 2017; 24 (01) 149-155
    CrossrefPubMedGoogle Scholar
  • 20 Proebstle TM, Alm J, Dimitri S. et al. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg Venous Lymphat Disord 2015; 3 (01) 2-7
    CrossrefPubMedGoogle Scholar
  • 21 Almeida JI, Javier JJ, Mackay E, Bautista C, Proebstle TM. First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord 2013; 1 (02) 174-180
    CrossrefPubMedGoogle Scholar
  • 22 Almeida JI, Javier JJ, Mackay EG, Bautista C, Cher D, Proebstle TM. Three-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. J Vasc Surg Venous Lymphat Disord 2015; 3 (01) 125
    CrossrefPubMedGoogle Scholar
  • 23 Todd III KL, Wright DI. VANISH-2 Investigator Group. Durability of treatment effect with polidocanol endovenous microfoam on varicose vein symptoms and appearance (VANISH-2). J Vasc Surg Venous Lymphat Disord 2015; 3 (03) 258-264.e1
    CrossrefPubMedGoogle Scholar
  • 24 King JT, O'Byrne M, Vasquez M, Wright D. VANISH-1 Investigator Group. Treatment of truncal incompetence and varicose veins with a single administration of a new polidocanol endovenous microfoam preparation improves symptoms and appearance. Eur J Vasc Endovasc Surg 2015; 50 (06) 784-793
    CrossrefPubMedGoogle Scholar
  • 25 García-Carpintero E, Carmona M, Chalco-Orrego JP, González-Enríquez J, Imaz-Iglesia I. Systematic review and meta-analysis of endovenous cyanoacrylate adhesive ablation for incompetent saphenous veins. J Vasc Surg Venous Lymphat Disord 2020; 8 (02) 287-296
    CrossrefPubMedGoogle Scholar
  • 26 Lane T, Bootun R, Dharmarajah B. et al. A multi-centre randomised controlled trial comparing radiofrequency and mechanical occlusion chemically assisted ablation of varicose veins - final results of the Venefit versus Clarivein for varicose veins trial. Phlebology 2017; 32 (02) 89-98
    CrossrefPubMedGoogle Scholar
  • 27 Hassanin A, Aherne TM, Greene G. et al. A systematic review and meta-analysis of comparative studies comparing nonthermal versus thermal endovenous ablation in superficial venous incompetence. J Vasc Surg Venous Lymphat Disord 2019; 7 (06) 902-913.e3
    CrossrefPubMedGoogle Scholar