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Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries.
J Vasc Surg. 2013 Jul; 58(1):166-72.JV

Abstract

OBJECTIVE

To examine outcomes following 1000 consecutive endovenous radiofrequency ablation (RFA) closures of saphenous veins and 500 ambulatory phlebectomy procedures for chronic venous insufficiency. Based on the outcomes in this patient cohort, we aim to determine whether concomitant or staged phlebectomy is preferred and examine the rate and optimal treatment of complications using a dedicated treatment algorithm based on our classification system for level of closure following these procedures.

METHODS

Between 2004 and 2012, patients with symptomatic superficial venous incompetence who underwent endovenous RFA of incompetent saphenous veins were identified as well as patients with concomitant or staged microphlebectomy. Demographics, risk factors, procedural success rate, concurrent procedures, complications, and symptom relief were recorded.

RESULTS

One thousand radiofrequency ablations (95.5% great saphenous vein and accessory great saphenous veins, 4.5% small saphenous vein) were performed in the ambulatory setting (patients = 735, limbs = 916); 355 limbs with large (>3 mm) symptomatic incompetent tributaries underwent concomitant phlebectomy. Additionally, 145 limbs required phlebectomy at a later setting for persistent symptoms following saphenous RFA. Indications for treatment included lifestyle-limiting pain (94.8%), swelling (66%), lipodermatosclerosis (5.3%), ulceration (9.4%), and/or bleeding (1.4%). All patients (100%) underwent a follow-up ultrasound 24 to 72 hours following the procedure to assess for successful closure and to rule out deep venous thrombosis. The majority of patients (86.7%) had relief of their symptoms at a mean follow-up of 9 months. No patients developed postoperative deep venous thrombosis; however, saphenous closure extended partially into the common femoral vein wall in 18 patients (1.8%) and flush with the saphenofemoral junction in 47 (4.7%). One patient developed a pulmonary embolus despite a normal postoperative ultrasound. No other patients required hospital admission and no deaths occurred during the follow-up period.

CONCLUSIONS

The majority of patients with symptomatic chronic venous insufficiency benefit from endovenous RFA of incompetent saphenous veins with comparable results to published surgical outcomes for endovenous closure. The great majority of patients with refluxing tributary veins greater than 3 mm in diameter required phlebectomy in addition to saphenous ablation. These patients may benefit from concomitant phlebectomy along with endovenous saphenous closure.

Authors+Show Affiliations

Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23571079

Citation

Harlander-Locke, Michael, et al. "Endovenous Ablation With Concomitant Phlebectomy Is a Safe and Effective Method of Treatment for Symptomatic Patients With Axial Reflux and Large Incompetent Tributaries." Journal of Vascular Surgery, vol. 58, no. 1, 2013, pp. 166-72.
Harlander-Locke M, Jimenez JC, Lawrence PF, et al. Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. J Vasc Surg. 2013;58(1):166-72.
Harlander-Locke, M., Jimenez, J. C., Lawrence, P. F., Derubertis, B. G., Rigberg, D. A., & Gelabert, H. A. (2013). Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. Journal of Vascular Surgery, 58(1), 166-72. https://doi.org/10.1016/j.jvs.2012.12.054
Harlander-Locke M, et al. Endovenous Ablation With Concomitant Phlebectomy Is a Safe and Effective Method of Treatment for Symptomatic Patients With Axial Reflux and Large Incompetent Tributaries. J Vasc Surg. 2013;58(1):166-72. PubMed PMID: 23571079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. AU - Harlander-Locke,Michael, AU - Jimenez,Juan Carlos, AU - Lawrence,Peter F, AU - Derubertis,Brian G, AU - Rigberg,David A, AU - Gelabert,Hugh A, Y1 - 2013/04/06/ PY - 2012/08/31/received PY - 2012/11/19/revised PY - 2012/12/15/accepted PY - 2013/4/11/entrez PY - 2013/4/11/pubmed PY - 2013/9/10/medline SP - 166 EP - 72 JF - Journal of vascular surgery JO - J Vasc Surg VL - 58 IS - 1 N2 - OBJECTIVE: To examine outcomes following 1000 consecutive endovenous radiofrequency ablation (RFA) closures of saphenous veins and 500 ambulatory phlebectomy procedures for chronic venous insufficiency. Based on the outcomes in this patient cohort, we aim to determine whether concomitant or staged phlebectomy is preferred and examine the rate and optimal treatment of complications using a dedicated treatment algorithm based on our classification system for level of closure following these procedures. METHODS: Between 2004 and 2012, patients with symptomatic superficial venous incompetence who underwent endovenous RFA of incompetent saphenous veins were identified as well as patients with concomitant or staged microphlebectomy. Demographics, risk factors, procedural success rate, concurrent procedures, complications, and symptom relief were recorded. RESULTS: One thousand radiofrequency ablations (95.5% great saphenous vein and accessory great saphenous veins, 4.5% small saphenous vein) were performed in the ambulatory setting (patients = 735, limbs = 916); 355 limbs with large (>3 mm) symptomatic incompetent tributaries underwent concomitant phlebectomy. Additionally, 145 limbs required phlebectomy at a later setting for persistent symptoms following saphenous RFA. Indications for treatment included lifestyle-limiting pain (94.8%), swelling (66%), lipodermatosclerosis (5.3%), ulceration (9.4%), and/or bleeding (1.4%). All patients (100%) underwent a follow-up ultrasound 24 to 72 hours following the procedure to assess for successful closure and to rule out deep venous thrombosis. The majority of patients (86.7%) had relief of their symptoms at a mean follow-up of 9 months. No patients developed postoperative deep venous thrombosis; however, saphenous closure extended partially into the common femoral vein wall in 18 patients (1.8%) and flush with the saphenofemoral junction in 47 (4.7%). One patient developed a pulmonary embolus despite a normal postoperative ultrasound. No other patients required hospital admission and no deaths occurred during the follow-up period. CONCLUSIONS: The majority of patients with symptomatic chronic venous insufficiency benefit from endovenous RFA of incompetent saphenous veins with comparable results to published surgical outcomes for endovenous closure. The great majority of patients with refluxing tributary veins greater than 3 mm in diameter required phlebectomy in addition to saphenous ablation. These patients may benefit from concomitant phlebectomy along with endovenous saphenous closure. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23571079/Endovenous_ablation_with_concomitant_phlebectomy_is_a_safe_and_effective_method_of_treatment_for_symptomatic_patients_with_axial_reflux_and_large_incompetent_tributaries_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(13)00061-X DB - PRIME DP - Unbound Medicine ER -