Publications
146 results found
Benson RA, 2020, Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services, British Journal of Surgery, Vol: 107, Pages: 1396-1400, ISSN: 0007-1323
This online structured survey has demonstrated the global impact of the COVID‐19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons.
Encarnacion S N, Onida S, Lane TR, et al., 2020, Do we need another modality for truncal vein ablation?, Phlebology, Vol: 35, Pages: 644-646, ISSN: 0268-3555
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Reducing the risk of venous thromboembolism following superficial endovenous treatment: a UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 706-714, ISSN: 0268-3555
ObjectivesVenous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus.MethodsA 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively.ResultsForty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements.ConclusionsThe main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.
Goodall R, Langridge B, Lane T, et al., 2020, A narrative review of the use of neuromuscular electrical stimulation in individuals with diabetic foot ulceration, International Journal of Lower Extremity Wounds, Vol: 19, Pages: 242-250, ISSN: 1534-7346
This review aims to summarise the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU).A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, seven met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use, however in each study, only three of the included participants had DFU and subgroup analyses based on ulcer aetiology was omitted. The remaining five studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in non-diabetic wounds of a similar grade (Healing rate: 70.0±32.3% in DFU vs. 38.4±22.3% in non diabetic ulcers (p<0.01)). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data supports a potential role for NMES in individuals with DFU, however the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
Langridge BJ, Onida S, Weir J, et al., 2020, Cyanoacrylate glue embolisation for varicose veins - A novel complication, Phlebology, Vol: 35, Pages: 520-523, ISSN: 0268-3555
BackgroundNon-thermal non-tumescent methods for varicose vein treatment have rapidly gained popularity in recent years due to clinical efficacy comparable to other endovenous methods, but with a superior safety and tolerability profile. Cyanoacrylate is an adhesive that rapidly polymerises during endovenous treatment to cause rapid occlusion of veins and initiate vein fibrosis.MethodCyanoacrylate glue treatment is known to cause complications such as phlebitis, cellulitis and deep vein thrombosis in rare instances. We present the first reported case of cyanoacrylate extravasation with chronic foreign body reaction in a patient nine months after initial treatment.ResultsWe discuss the aetiology of this complication, its treatment, patient outcome and its significance to both clinicians and patients.ConclusionCyanoacrylate glue embolisation can, in rare instances, lead to extravasation and chronic foreign body reaction, necessitating surgical intervention. The relative novelty of cyanoacrylate glue embolisation in the treatment of varicose veins requires clinicians to monitor for rare complications during its use in clinical practice. Patients should be aware of the rare risk of glue extravasation and foreign body reaction for fully informed consent prior to treatment.
Dattani N, Shalhoub J, Nandhra S, et al., 2020, Corrigendum to Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study, Phlebology, Vol: 35, Pages: 844-844, ISSN: 0268-3555
Goodall R, Langridge B, Onida S, et al., 2020, Median arcuate ligament syndrome, Journal of Vascular Surgery, Vol: 71, Pages: 2170-2176, ISSN: 0741-5214
BACKGROUND: Median arcuate ligament syndrome (MALS) describes the clinical presentation associated with direct compression of the celiac artery by the median arcuate ligament. The poorly understood pathophysiologic mechanism, variable symptom severity, and unpredictable response to treatment make MALS a controversial diagnosis. METHODS: This review summarizes the literature pertaining to the pathophysiologic mechanism, presentation, diagnosis, and management of MALS. A suggested diagnostic workup and treatment algorithm are presented. RESULTS: Individuals with MALS present with signs and symptoms of foregut ischemia, including exercise-induced or postprandial epigastric pain, nausea, vomiting, and weight loss. Consideration of MALS in patients' diagnostic workup is typically delayed. Currently, no group consensus agreement as to the diagnostic criteria for MALS exists; duplex ultrasound, angiography, and gastric exercise tonometry are used in different combinations and with varying diagnostic values throughout the literature. Surgical management involves decompression of the median arcuate ligament's constriction of the celiac artery; robotic, laparoscopic, endoscopic retroperitoneal, and open surgical intervention can provide effective symptom relief, but long-term follow-up data (>5 years) are lacking. Patients treated nonoperatively appear to have worse outcomes. CONCLUSIONS: MALS is an important clinical entity with significant impact on affected individuals. Presenting symptoms, patient demographics, and radiologic signs are generally consistent, as is the short-to medium-term (<5 years) response to surgical intervention. Future prospective studies should directly compare long-term symptomatic and quality of life outcomes after nonoperative management with outcomes after open, laparoscopic, endoscopic retroperitoneal, and robotic celiac artery decompression to enable the development of evidence-based guidelines for the management of MALS.
Lane T, Onida S, Davies A, 2020, Comment on: Strength of public preferences for endovascular or open aortic aneurysm repair, BRITISH JOURNAL OF SURGERY, Vol: 107, Pages: 613-613, ISSN: 0007-1323
Babber A, Ravikumar R, Onida S, et al., 2020, Effect of footplate neuromuscular electrical stimulation on functional and quality‐of‐life parameters in patients with peripheral artery disease: pilot, and subsequent randomized clinical trial, British Journal of Surgery, Vol: 107, Pages: 355-363, ISSN: 0007-1323
BackgroundSupervised exercise programmes for intermittent claudication have poor access and limited compliance. Neuromuscular electrical stimulation (NMES) may be an effective alternative. A proof‐of‐concept study and RCT were conducted.MethodsIn study 1, eligible patients underwent baseline assessment; treadmill testing for initial (ICD) and maximum (MCD) claudication distance; EuroQoL Five Dimensions five‐level instrument (EQ‐5D‐5L™) and Intermittent Claudication Questionnaire (ICQ) assessment; and measurement of ultrasound haemodynamics of the superficial femoral artery. After familiarization with the NMES device, participants underwent a 30‐min session of stimulation with concomitant recording of haemodynamic measures at 15 min, and after device cessation. Measurements were repeated after 6 weeks of daily use of NMES. In study 2, consecutive patients underwent baseline assessment before online randomization to a supervised exercise programme only, or adjunctive NMES treatment for 6 weeks, followed by repeat measurements.ResultsStudy 1 (20 patients) showed a significant improvement in MCD (46 per cent; P < 0·001) and ICD (71 per cent; P < 0·001). The RCT (42 patients) showed a significant adjunctive benefit of NMES in ICD (46 per cent; P = 0·014). Improvements were seen in the ICQ (9 points; P = 0·009) and EQ‐5D‐5L™ (P = 0·007) in study 1, and there was a significant adjunctive benefit of NMES on the ICQ score in patients who did supervised exercise (11·2 points; P = 0·031). Blood volume flow and time‐adjusted mean velocity increased significantly with the device on (P < 0·050). Overall, NMES compliance exceeded 95 per cent.ConclusionFootplate NMES significantly improved walking distance in patients with intermittent claudication when used independently and also as an ad
Saratzis A, Joshi S, Benson RA, et al., 2019, Acute Kidney Injury (AKI) in Aortic Intervention: Findings From the Midlands Aortic Renal Injury (MARI) Cohort Study, European Journal of Vascular and Endovascular Surgery, ISSN: 1078-5884
Belramman A, Bootun R, Onida S, et al., 2019, ClariVein®, mechanochemical endovenous ablation: patient selection and perspective, Journal of Vascular Diagnostics and Interventions, Vol: 7, Pages: 1-8, ISSN: 2463-5618
The American Venous Forum and the National Institute for Health and Care Excellence recommend endothermal ablation (ETA) techniques as the first line treatment for superficial venous incompetence. However, these techniques require the use of tumescent anaesthesia prior to energy delivery, which may be a source of discomfort for the patient and can prolong procedure time. Recently, nonthermal, nontumescent (NTNTs) techniques such as mechanochemical ablation (MOCA) have been developed to address some of the negative aspects associated with ETA. This article reviews this technique from a patient selection and perspective point view.
Goodall R, Langridge B, Lane T, et al., 2019, A systematic review of the use of neuromuscular electrical stimulation in individuals with diabetic foot disease, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: Wiley, Pages: 44-44, ISSN: 0007-1323
Saratzis A, Jaspers NEM, Gwilym B, et al., 2019, Observational study of the medical management of patients with peripheral artery disease, British Journal of Surgery, Vol: 106, Pages: 1168-1177, ISSN: 0007-1323
BackgroundPrevious research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target‐based risk factor modification.MethodsThe Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal‐directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART‐REACH model, a validated cardiovascular prediction tool for patients with PAD.ResultsSome 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL‐cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high‐dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44–62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL‐cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10‐year cardiovascular risk by 29 (20–38) per cent with 6·3 (4·0–9·3) cardiovascular disease‐free years gained.ConclusionThe medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline‐based targets would confer significant patient benefit.
Llwyd Gwilym B, Saratzis A, Benson R, et al., 2019, Study protocol for the Groin wound Infection after Vascular Exposure (GIVE) audit and multicentre cohort study, International Journal of Surgery Protocols, Vol: 16, Pages: 9-13, ISSN: 2468-3574
IntroductionSurgical site infections (SSI) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units’ practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres.Methodsand analysisThis international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according as per the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer.Ethics and disseminationThis study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.
Belramman A, Bootun R, Lane TRA, et al., 2019, Foam sclerotherapy versus ambulatory phlebectomy for the treatment of varicose vein tributaries: study protocol for a randomised controlled trial, Trials, Vol: 20, ISSN: 1745-6215
BackgroundAmbulatory phlebectomies and foam sclerotherapy are two of the most common treatments for varicose vein tributaries. Many studies have been published on these treatments, but few comparative studies have attempted to determine their relative effectiveness.Methods/designThis is a prospective single-centre randomised clinical trial. Patients with primary truncal vein incompetence and varicose vein tributaries requiring treatment will be assigned randomly to either ambulatory phlebectomies or foam sclerotherapy. The primary outcome measure is the re-intervention rate for the varicose vein tributaries during the study period. The secondary outcomes include the degree of pain during the first two post-operative weeks and the time to return to usual activities or work. Improvements in clinical scores, quality of life scores, occlusion rates and cost-effectiveness for each intervention are other secondary outcomes. The re-intervention rate will be considered from the third month.DiscussionThis study compares ambulatory phlebectomies and foam sclerotherapy in the treatment of varicose vein tributaries. The re-intervention rates, safety, patient experience and the cost-effectiveness of each intervention will be assessed. This study aims to recruit 160 patients and is expected to be completed by the end of 2019.Trial registrationClinicalTrials.gov, NCT03416413. Registered on 31 January 2018.
Taha MA, Lane T, Shalhoub J, et al., 2019, Endovenous stenting in chronic venous disease secondary to iliac vein obstruction, Italian Journal of Vascular and Endovascular Surgery, Vol: 26, Pages: 89-99, ISSN: 1824-4777
Endovenous stenting has become the treatment of choice for chronic (thrombotic or non-thrombotic) venous obstructive iliac disease. This review aims to focus on the role of venous stents in the management of chronic conditions affecting the deep venous systems of the lower limbs. In addition, the review provides an overview on chronic venous outflow obstructive diseases.
Epstein DM, Gohel MS, Heatley F, et al., 2019, Cost-effectiveness analysis of a randomized clinical trial of early versus deferred endovenous ablation of superficial venous reflux in patients with venous ulceration, British Journal of Surgery, Vol: 106, Pages: 555-562, ISSN: 0007-1323
BackgroundTreatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost‐effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers.MethodsThis was a within‐trial cost‐utility analysis with a 1‐year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality‐adjusted life‐year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health‐related quality of life, and per protocol.ResultsAfter early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost‐effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost‐effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost‐effective.ConclusionEarly treatment of superficial reflux is highly likely to be cost‐effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com).
Belramman A, Bootun R, Lang TY, et al., 2019, EARLY RESULTS OF A RANDOMISED CLINICAL TRIAL OF MECHANOCHEMICAL ABLATION VERSUS CYANOACRYLATE ADHESIVE FOR THE TREATMENT OF VARICOSE VEINS (MOCCA), Joint Meeting of the Royal-Society-of-Medicine / Annual Meeting of the Society-of-Academic-and-Research-Surgery, Publisher: WILEY, Pages: 25-25, ISSN: 0007-1323
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Onida S, Lane TRA, Bootun R, et al., 2019, Varicose veins and their management, Surgery (United Kingdom), Vol: 37, Pages: 73-80, ISSN: 0263-9319
Varicose veins are common and affect a significant proportion of the UK population. They negatively impact on patients’ quality of life and are an important cause of morbidity. Treatment has been shown to improve the quality of life in those affected, and is endorsed by international clinical practice guidelines. In the UK, traditional techniques of saphenofemoral and saphenopopliteal junctional ligation with or without stripping have been largely superseded by minimally invasive, day surgery techniques under local anaesthesia. The most commonly performed include radiofrequency ablation and endovenous laser ablation, both endothermal techniques which may be associated with procedural discomfort and complications relating to the use of thermal energy. More recently, novel techniques, including mechanochemical ablation and cyanoacrylate glue, have entered the clinical arena with promising results. Saphenous sparing techniques also exist, selectively disconnecting refluxing points between the superficial and deep venous systems (CHIVA) or by removing incompetent tributaries via selective phlebectomy (ASVAL). This article discusses the epidemiology, diagnosis and management of varicose veins, including the latest endovascular and targeted open surgical techniques.
Bootun R, Lane TRA, Davies AH, 2018, One-stop vein clinic: The ideal option, Venous Disorders: Current Concepts, Pages: 225-233, ISBN: 9789811311079
Pitt J, Milanovic K, Coupland A, et al., 2018, A collective adaptive socio-technical system for remote- and self-supervised exercise in the treatment of intermittent claudication, International Symposium on Leveraging Applications of Formal Methods, Verification and Validation, Publisher: Springer Verlag, Pages: 63-78, ISSN: 0302-9743
Vascular surgeons have recognised that the condition of many patients presenting with intermittent claudication and peripheral arterial disease is better treated by physical exercise rather than endovascular or surgical intervention. Such exercise causes pain, though, before and until the health improvements are realised. Therefore, patients experiencing pain tend to stop doing that which causes it, unless they are supervised performing the necessary exercise programmes. However, supervised exercise is an extremely costly and time-consuming use of medical resources.To overcome this series of problems, we propose to develop and deploy a healthcare application which provides patient exercise programmes that are both centrally organised and remotely supervised by a health practitioner, and self-organized and self-supervised by the patients themselves. This demands that two dimensions of adaptation should be addressed: adaptation prompted by the health practitioner as the patient group improves and meets programme targets; and adaptation prompted from within the patient group enabling them to manage their own community effectively and sustainably.This position paper explores this application from the perspective of engineering a collective adaptive system for a mobile healthcare application, providing both remote- and self-supervised exercise. This requires, on the one hand, converging recent technological advances in sensors and mobile devices, audio and video connectivity, and social computing; with, on the other hand, innovative value-sensitive and user-centric design methodologies, together with formal methods for interaction and interface design and specification. The ultimate ambition is to create a ‘win-win-win’ situation in which the benefits of exercise as a treatment, the reduced costs of supervision, and the pro-social incentives to perform the exercise are all derived from computer-supported self-organised collective action.
Belramman A, Bootun R, Tang TY, et al., 2018, Mechanochemical ablation versus cyanoacrylate adhesive for the treatment of varicose veins: study protocol for a randomised controlled trial, Trials, Vol: 19, ISSN: 1745-6215
Background:Thermal ablation techniques have become the first-line treatment of truncal veins in the management of chronic venous disease (CVD). Despite excellent outcomes, these methods are often associated with pain; generally due to their use of heat and the necessity of fluid infiltration around the vein. More recently, novel non-thermal techniques, such as mechanochemical ablation (MOCA) and cyanoacrylate adhesive (CAE) have been developed to overcome these unwelcome effects. So far, the novel techniques have been found to have similar efficacy to thermal methods, yet no direct comparisons between the non-thermal treatment techniques have been conducted to date, giving rise to this study.Methods/design:This is a prospective, multicentre, randomised clinical trial, recruiting patients with truncal saphenous incompetence. Patients will be randomised to undergo either MOCA or CAE truncal ablation, followed by treatment of any varicosities. All patients will be required to wear compression stockings for 4 days post intervention. The primary outcome measure is the pain score immediately following completion of truncal ablation, measured by a 100-mm Visual Analogue Scale (VAS). The secondary outcomes are entire treatment pain scores, clinical scores, quality of life scores, occlusion rates, time to return to usual activities/work at 2 weeks, 3, 6 and 12 months. Re-intervention rate will be considered from the third month. Cost-effectiveness will be assessed for each intervention at 12 months. The study is powered to detect a mean 10-mm difference in maximum pain score. Allowing for loss to follow-up, the total target recruitment is 180 patients.Discussion:The study will be the first study to compare MOCA against CAE and is designed to determine which method causes less pain. Completion of this study is expected to be the end of 2019.Trial registration:ClinicalTrials.gov, ID: NCT03392753. Registered on 17 November 2017.
Ravikumar R, Williams KJ, Babber A, et al., 2018, Neuromuscular electrical stimulation (NMES) for the prevention of venous thromboembolism (VTE), Phlebology, Vol: 33, Pages: 367-378, ISSN: 0268-3555
ObjectiveVenous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant cause of morbidity and mortality, affecting 1 in 1000 adults per year. Neuromuscular electrical stimulation (NMES) is the transcutaneous application of electrical impulses to elicit muscle contraction, preventing venous stasis. This review aims to investigate the evidence underlying the use of NMES in thromboprophylaxis.MethodsThe Medline and Embase databases were systematically searched, adhering to PRISMA guidelines, for articles relating to electrical stimulation and thromboprophylaxis. Articles were screened according to a priori inclusion and exclusion criteria.ResultsThe search strategy identified 10 randomised controlled trials, which were used in three separate meta-analyses; 5 trials compared NMES to control, favouring NMES (odds ratio (OR) of DVT 0.29, 95%CI 0.13-0.65; P=.003); 3 trials compared NMES to heparin, favouring heparin (OR of DVT 2.00, 95%CI 1.13-3.52; P=.02); 3 trials compared NMES as an adjunct to heparin versus heparin only, demonstrating no significant difference (OR of DVT 0.33, 95%CI 0.10-1.14; P=.08).ConclusionNMES significantly reduces the risk of deep vein thrombosis compared to no prophylaxis. It is inferior to heparin in preventing DVT and there is no evidence for its use as an adjunct to heparin.
Belramman A, Bootun R, Lane TRA, et al., 2018, Endovenous management of varicose veins, Angiology, Vol: 70, Pages: 388-396, ISSN: 1940-1574
Varicose veins are a very common condition and have been the subject of a recent proliferation of treatment modalities. The advent of the endovenous treatment era has led to a confusing array of different techniques that can be daunting when making the transition from traditional surgery. All modalities offer excellent results in the right situation, and each has its own treatment profile. Thermal ablation techniques have matured and have a reassuring and reliable outcome, but the arrival of nonthermal techniques has delivered further options for both patient and surgeon. This article provides an overview of the different treatment devices and modalities available to the modern superficial vein surgeon and details the currently available evidence and summation analysis to help surgeons to make an appropriate treatment choice for their patients.
Gohel MS, Heatley F, Liu X, et al., 2018, A randomized trial of early endovenous ablation in venous ulceration, New England Journal of Medicine, Vol: 378, Pages: 2105-2114, ISSN: 0028-4793
Background: Venous disease is the most common cause of leg ulceration. Although compression therapy improves venous ulcer healing, it does not treat the underlying causes of venous hypertension. Treatment of superficial venous reflux has been shown to reduce the rate of ulcer recurrence, but the effect of early endovenous ablation of superficial venous reflux on ulcer healing remains unclear.Methods:In a trial conducted at 20 centers in the United Kingdom, we randomly assigned 450 patients with venous leg ulcers to receive compression therapy and undergo early endovenous ablation of superficial venous reflux within 2 weeks after randomization (early-intervention group) or to receive compression therapy alone, with consideration of endovenous ablation deferred until after the ulcer was healed or until 6 months after randomization if the ulcer was unhealed (deferred-intervention group). The primary outcome was the time to ulcer healing. Secondary outcomes were the rate of ulcer healing at 24 weeks, the rate of ulcer recurrence, the length of time free from ulcers (ulcer-free time) during the first year after randomization, and patient-reported health-related quality of life.Results:Patient and clinical characteristics at baseline were similar in the two treatment groups. The time to ulcer healing was shorter in the early-intervention group than in the deferred-intervention group; more patients had healed ulcers with early intervention (hazard ratio for ulcer healing, 1.38; 95% confidence interval [CI], 1.13 to 1.68; P=0.001). The median time to ulcer healing was 56 days (95% CI, 49 to 66) in the early-intervention group and 82 days (95% CI, 69 to 92) in the deferred-intervention group. The rate of ulcer healing at 24 weeks was 85.6% in the early-intervention group and 76.3% in the deferred-intervention group. The median ulcer-free time during the first year after trial enrollment was 306 days (interquartile range, 240 to 328) in the early-intervention group and 278 da
Lane TRA, Varatharajan L, Fiorentino F, et al., 2017, Truncal varicose vein diameter and patient-reported outcome measures, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 1648-1655, ISSN: 0007-1323
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Kosasih S, moore H, Lane TRA, et al., 2017, Deep Venous Reconstruction: A Case Series, Cureus, Vol: 9, ISSN: 2168-8184
ObjectivesThis study aims to review a case series of deep venous reconstruction procedures performed at one centre by a single consultant.MethodsA retrospective review of deep venous reconstruction procedures performed by a single consultant from 1994 to 2013 was carried out and all notes were reviewed for outcomes. A 58-month cumulative patency rate was calculated using Kaplan-Meier survival analysis.ResultsNineteen patients underwent deep venous reconstruction procedures including the Palma bypass, May-Husni bypass, femoral vein transposition and axillary vein transplant techniques from 1994 to 2013. Eleven patients were male and eight were female with a mean average age of 45.2 years (range 29-63). Clinical severity of disease ranged from C3 to C6, and 16 patients had a confirmed history of deep vein thrombosis. Cumulative primary patency rate for all reconstructions at 58 months was 89.5%, with two patients occluding and 17 remaining patent at last follow-up.ConclusionDeep venous reconstructions, particularly the Palma and May-Husni procedures, are feasible and can have good outcomes in patients failed by endovascular techniques and other more conservative therapies.
Roche M, Sinha S, Ozdemir B, et al., 2017, The use of 'failure-to-rescue' ('FTR') as a quality metric - systematic review of the literature and reporting recommendations, International Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY, Pages: 17-17, ISSN: 0007-1323
Bootun R, Onida S, Lane, et al., 2017, Pilot study of the use of cyanoacrylate in the treatment of varicose veins, Society for Academic and Research Surgery (SARS), Publisher: Wiley, Pages: 46-47, ISSN: 1365-2168
BackgroundThe treatment of varicose vein disease has changed significantly over the past decade. Endovenous ablation, especially using thermal methods, has become the new norm. However, it is often associated with patient discomfort during tumescent infiltration and the ablative procedure. The non-thermal, non-tumescent (NTNT) techniques are believed to be more advantageous as they eliminate these potential adverse events. In this study, the use of a new cyanoacrylate compound (Variclose vein sealing system, Biolas®, Ankara, Turkey) is assessed.MethodPatients with symptomatic varicose veins were invited to have their truncal saphenous incompetence treated using the new cyanoacrylate glue. Intraoperatively, their level of discomfort was assessed. Patients also had their clinical status and quality of life assessed at baseline and at 1 month post-operatively. ResultsSeventeen patients (20 limbs) were recruited. The mean age was 54 years. Eighty-five percent of limbs were reviewed at the 30-day follow-up. The mean baseline VCSS was 3.6 (±2.5), which improved to 2.4 (±3) at the 30-day point. Improvements were also noted in both the generic and specific quality of life scores. The median maximum pain score using a VAS was 34mm and 33mm for average pain. The complete/proximal occlusion rate at 30 days was 88%.ConclusionsThese preliminary results suggest that endovenous ablation using cyanoacrylate is safe and results in quality of life improvements similar to that seen in studies evaluating thermal techniques along with a low degree of intra-operative pain. Larger comparative studies are, however, required to confirm its effectiveness.
Bootun R, Onida S, Lane TRA, et al., 2017, Pilot study of the use of cyanoacrylate in the treatment of varicose veins, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS), Publisher: Wiley, Pages: 46-47, ISSN: 1365-2168
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