Publications
146 results found
Onida S, Lane TRA, Davies AH, 2017, Clinical presentation and assessment of patients with venous disease, Handbook of Venous and Lymphatic Disorders: Guidelines of the American Venous Forum: Fourth Edition, Pages: 361-370, ISBN: 9781498724401
Lane T, Bootun R, Dharmarajah B, et al., 2017, 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, Vol: 32, Pages: 89-98, ISSN: 0268-3555
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- Citations: 63
Ravikumar R, Williams KJ, Babber A, et al., 2016, Randomised Controlled Trial: Potential Benefit of a Footplate Neuromuscular Electrical Stimulation Device in Patients with Chronic Venous Disease, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 53, Pages: 114-121, ISSN: 1078-5884
Williams KJ, Ravikumar R, Gaweesh AS, et al., 2016, A Review of the Evidence to Support Neuromuscular Electrical Stimulation in the Prevention and Management of Venous Disease, Advances in Experimental Medicine and Biology, Vol: 906, Pages: 377-386, ISSN: 0065-2598
INTRODUCTION: The prevention and management of venous disease is a therapeutic challenge. Movement of blood through the venous system is augmented by the action of muscles on the deep veins, and can be achieved through the application of electrical current. The efficacy of currently available clinical devices for this purpose is unknown, and is investigated here. METHODS: A literature search of the EMBASE and Medline databases was performed, and studies were included if they were full text articles, written in english, pertaining to venous disease and neuromuscular electrical stimulation (NMES). RESULTS: NMES devices increase venous haemodynamic parameters such as peak velocity and volume flow. Studies report them to be non-inferior to intermittent pneumatic compression. They are effective in the prevention of venous thromboembolism, though inferior to low molecular weight heparin. NMES can reduce symptoms of chronic venous disease. DISCUSSION: NMES is an important tool in the prevention and management of venous disease, and avoids the significant risks associated with heparin administration. Data explored here is heterogenous in device, protocol, and reported end-points, therefore should be interpreted with care. Long term effects of treatment with NMES have not been explored.
Moon KH, Dharmarajah B, Bootun R, et al., 2016, Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins, Phlebology, Vol: 32, Pages: 425-432, ISSN: 0268-3555
ObjectiveMechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion.MethodsPatients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines.ResultsFrom 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups (p=0.8065).ConclusionA comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.
Ravikumar R, Williams KJ, Babber A, et al., 2016, Neuromuscular Electrical Stimulation For Venous Thromboprophylaxis, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 21-21, ISSN: 0007-1323
Lane T, Parsepour S, Naji Y, et al., 2016, Regional experience with Lombard Aorfix graft for severe neck angulation, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 24-24, ISSN: 0007-1323
Lane T, Vimalesvaran S, Patatas K, 2016, Experience using covered heparin-bonded stents for infra-inguinal disease, Vascular-Societies Annual Scientific Meeting, Publisher: WILEY-BLACKWELL, Pages: 27-28, ISSN: 0007-1323
Varatharajan L, Thapar A, Lane T, et al., 2016, Pharmacological adjuncts for chronic venous ulcer healing: a systematic review, Phlebology, Vol: 31, Pages: 356-365, ISSN: 1433-3031
Background The aim of this study was to systematically review the current evidence and determine whether there is a clinical benefit for using pharmacological agents as adjunctive treatment for chronic venous ulcers.Method A systematic review of the MEDLINE and EMBASE (from 1 January 1947 through 15 August 2013) and Cochrane databases (from inception through 15 August 2013) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all randomised controlled trials investigating pharmacological adjuncts for the treatment of venous ulcers with a minimum sample size of 20 patients for each treatment arm.Results Ten relevant articles were identified; one pilot randomised controlled trial and four Cochrane reviews were included. Pentoxifylline, aspirin, sulodexide, mesoglycan, flavonoids, thromboxane A2 antagonist (ifetroban), zinc, prostaglandin and prostacyclin analogues were the drugs reviewed. Pentoxifylline was found to be more effective than placebo in terms of complete ulcer healing or in causing a significant improvement (greater than 60% reduction in ulcer size) (RR 1.70, 95% CI 1.30 to 2.24). Aspirin and flavonoids show potential to be effective adjuncts but methodological shortcomings and issues with bias limit the validity of results from trials involving each of these drugs, respectively. There was no significant difference between placebo and Ifetroban and likewise pooled results from trials investigating sulodexide and zinc showed no benefit in comparison to placebo.Conclusion Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.
Zappadu S, Onida S, Davies AH, et al., 2016, The role of quality of life tools in superficial venous disease, Reviews in Vascular Medicine, Vol: 4-5, Pages: 17-22, ISSN: 2212-0211
Superficial venous disease (SVD) is a common condition in the Western world, with recognized, negative effects on mood and quality of life (QoL) in those affected. Numerous tools exist to assess QoL in patients with SVD. The aim of this article is to review the literature on the role of QoL assessment tools in this disease group, describing the most commonly used instruments and their relevance, assessing the relationship between clinical and functional assessment tools, delineating the correlation among physician and patient reports and discussing the importance of translation.
Bootun R, Lane TRA, Davies AH, 2016, A comparison of thermal and non-thermal ablation, Reviews in Vascular Medicine, Vol: 4-5, Pages: 1-8, ISSN: 2212-0211
Varicose vein disease is common and has an adverse effect on patients. Treatment of the condition has been demonstrated to improve patients' physical well-being and quality of life. Surgical treatment has for a long time been the ‘gold standard’ method until the launch of endovenous thermal ablation towards end of the twentieth century. Indeed, being less invasive and offering the possibility of day-case local anaesthetic procedures, they have gradually become the mainstay of contemporary varicose vein treatment. Vein ablation using steam and microwave are new additions to thermal methods, but there is currently insufficient evidence as to their effectiveness and place in the management of varicose veins. The superiority of thermal ablation is now being challenged by endovenous non-thermal methods. Foam sclerotherapy, until recently the only endovenous non-thermal technique available, has been joined by mechanochemical ablation and cyanoacrylate glue as viable alternatives to thermal ablation. It is believed that these new non-thermal methods will be able to offer additional benefits to patients. This review of thermal and non-thermal ablation techniques assesses their respective merit in the management of varicose veins.
Bootun R, Onida S, Lane TRA, et al., 2016, Varicose veins and their management, Surgery (United Kingdom), Vol: 34, Pages: 165-171, ISSN: 0263-9319
All rights reserved.Varicose veins are a common condition, affecting up to a quarter of the UK population. They have been shown to negatively impact on patients' quality of life and are an important cause of morbidity. The treatment of varicose veins has, in turn, been shown to improve the quality of life of patients. Traditional techniques of saphenofemoral and saphenopopliteal junction ligation with or without vein stripping have been the mainstay of treatment for a long time. However, over the past 15 years, day-case minimally invasive endovascular interventions carried out under local anaesthetic have gradually replaced surgical methods. Nowadays, the majority of procedures are carried out using one of the endothermal ablation techniques (radiofrequency ablation [RFA] or endovenous laser ablation [EVLA]). However, these endothermal methods are often associated with discomfort as well as complications due to the use of heat energy. Recently, newer non-thermal, non-tumescent (NTNT) ablation techniques have been launched with the promise of similar effectiveness, but with less pain. This article discusses epidemiology, diagnosis and management of varicose veins, including the latest endovascular and targeted open surgical techniques.
Onida S, Shalhoub J, Moore HM, et al., 2016, Factors impacting on patient perception of procedural success and satisfaction following treatment for varicose veins, British Journal of Surgery, Vol: 103, Pages: 382-390, ISSN: 1365-2168
BackgroundPatient-reported outcome measures (PROMs) have been collected from patients undergoing varicose vein treatments in the National Health Service since 2009. The aim of this retrospective cohort study was to examine PROMs for varicose vein interventions, characterizing factors that might predict patient-reported perception of procedural success and satisfaction.MethodsCentrally compiled PROMs data for varicose vein procedures carried out from 2009 to 2011 were obtained from the Hospital Episode Statistics data warehouse for England. As data were not distributed normally, non-parametric statistical tests were employed.ResultsData for 35 039 patient episodes (62·8 per cent women) were available for analysis. Some 23·4 per cent of patients reported a degree of anxiety or depression before treatment; a formal diagnosis of depression was present in 7·8 per cent. Quality of life, measured by generic EQ-5D-3L™ index and the Aberdeen Varicose Vein Questionnaire (AVVQ) improved after intervention by 11·7 per cent (0·77 to 0·86) and 40·1 per cent (18·95 to 11·36) respectively. No significant improvement was found in EQ-5D™ visual analogue scale scores. There was a significant improvement in self-perceived anxiety or depression after the intervention (P < 0·001, McNemar–Bowker test). Both preoperative and postoperative depression or anxiety had a statistically significant relationship with self-reported success and satisfaction (both P < 0·001, χ2 test).ConclusionThis analysis of PROMs is evidence that treatment of varicose veins improves quality of life, and anxiety or depression. Preoperative and postoperative anxiety or depression scores impact on patient-perceived success and satisfaction rates.
Bootun R, Lane TRA, Dharmarajah B, et al., 2016, Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit (TM) versus ClariVein (R) for varicose veins trial, PHLEBOLOGY, Vol: 31, Pages: 61-65, ISSN: 0268-3555
Bootun R, Onida S, Lane TR, et al., 2015, To compress or not to compress: the eternal question of the place of compression after endovenous procedures, Phlebology, Vol: 31, Pages: 529-531, ISSN: 1433-3031
Sounderajah V, Moore HM, Thapar A, et al., 2015, Acoustic reflectors are visible in the right heart during radiofrequency ablation of varicose veins, PHLEBOLOGY, Vol: 30, Pages: 557-563, ISSN: 0268-3555
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Bootun R, Lane TRA, Davies AH, 2015, The advent of non-thermal, non-tumescent techniques for treatment of varicose veins, Phlebology, Vol: 31, Pages: 5-14, ISSN: 0268-3555
Varicose veins are common and their management has undergone a number of changes over the years. Surgery has been the traditional treatment option, but towards the 21st century, new endovenous thermal ablation techniques, namely, radiofrequency ablation and endovenous laser ablation, were introduced which have revolutionised the way varicose veins are treated. These minimally invasive techniques are associated with earlier return to normal activity and less pain, as well as enabling procedures to be carried out as day cases. They are, however, also known to cause a number of side-effects and involve infiltration of tumescent fluid which can cause discomfort. Non-thermal, non-tumescent methods are believed to be the answer to these unwelcome effects. Ultrasound-guided foam sclerotherapy is one such non-thermal, non-tumescent method and, despite a possible lower occlusion, has been shown to improve the quality of life of patients. The early results of two recently launched non-thermal, non-tumescent methods, mechanochemical ablation and cyanoacrylate glue, are promising and are discussed.
Lane TRA, Kelleher D, Shepherd AC, et al., 2015, Ambulatory Varicosity avUlsion Later or Synchronized (AVULS): a randomized clinical trial, Annals of Surgery, Vol: 261, Pages: 654-661, ISSN: 1528-1140
Objective: A randomized clinical trial assessing the difference in quality of life and clinical outcomes between delayed and simultaneous phlebectomies in the context of endovenous truncal vein ablation.Background: Endovenous ablation has replaced open surgery as the treatment of choice for truncal varicose veins. Timing of varicosity treatment is controversial with delayed and simultaneous pathways having studies advocating their benefits. A previous small randomized study has shown improved outcomes for simultaneous treatment.Methods: Patients undergoing local anesthetic endovenous thermal ablation were randomized to either simultaneous phlebectomy or delayed varicosity treatment. Patients were reviewed at 6 weeks, 6 months, and 1 year with clinical and quality of life scores completed, and were assessed at 6 weeks for need for further varicosity intervention, which was completed with either ultrasound-guided foam sclerotherapy or local anesthetic phlebectomy. Duplex ultrasound assessment of the treated trunk was completed at 6 months.Results: 101 patients were successfully recruited and treated out of 221 suitable patients from a screened population of 393. Patients in the simultaneous group (n = 51) showed a significantly improved Venous Clinical Severity Score at all time points, 36% of the delayed group required further treatment compared with 2% of the simultaneous group (P < 0.001). There were no deep vein thromboses, with 1 superfificial venous thrombosis in each group.Conclusions: Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures, as well as early quality of life improvements.
Lane TRA, Sritharan K, Herbert JR, et al., 2015, The disparate management of superficial venous thrombosis in primary and secondary care, PHLEBOLOGY, Vol: 30, Pages: 172-179, ISSN: 0268-3555
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- Citations: 12
Dharmarajah B, Hoon K-H, Bootun R, et al., 2015, Assessment of acoustic reflectors in the right heart during mechanochemical and radiofrequency ablation of the great saphenous vein, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 10-10, ISSN: 0007-1323
Bootun R, Lane TRA, Dharmarajah B, et al., 2015, Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: the multicentre Venefittm Versus Clarivein® for Varicose Veins (VVCVV) trial, Annual Meeting of the Society-of-Academic-and-Research-Surgery (SARS(, Publisher: WILEY-BLACKWELL, Pages: 4-4, ISSN: 0007-1323
Lane TRA, Moore HM, Franklin IJ, et al., 2015, Retrograde inversion stripping as a complication of the ClariVein (R) mechanochemical venous ablation procedure, Annals of The Royal College of Surgeons of England, Vol: 97, Pages: E18-E20, ISSN: 0035-8843
The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein® device, without adverse sequelae.
Bootun R, Lane TRA, Dharmarajah B, et al., 2015, Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: the Multicentre Venefit™ versus ClariVein® for Varicose Veins (VVCVV) trial, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 2-3, ISSN: 0007-1323
Moon K-H, Dharmarajah B, Bootun R, et al., 2015, Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins, BRITISH JOURNAL OF SURGERY, Vol: 102, Pages: 18-18, ISSN: 0007-1323
Rao R, Lane TRA, Franklin IJ, et al., 2015, Open repair versus fenestrated endovascular aneurysm repair of juxtarenal aneurysms, JOURNAL OF VASCULAR SURGERY, Vol: 61, Pages: 242-U591, ISSN: 0741-5214
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- Citations: 106
Kuet M-L, Lane TRA, Anwar MA, et al., 2014, Comparison of disease-specific quality of life tools in patients with chronic venous disease, PHLEBOLOGY, Vol: 29, Pages: 648-653, ISSN: 0268-3555
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- Citations: 24
Moore HM, Lane TRA, Franklin IJ, et al., 2014, Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer, VASCULAR, Vol: 22, Pages: 375-377, ISSN: 1708-5381
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Lane TRA, Onida S, Gohel MS, et al., 2014, A systematic review and meta-analysis on the role of varicosity treatment in the context of truncal vein ablation, Phlebology, Vol: 30, Pages: 516-524, ISSN: 0268-3555
Background: With the advent of endovenous truncal ablation under local anaesthetic for the treatment of varicoseveins, the fate of varicosed tributaries has become controversial, with centres offering different timings of treatment, ifoffered at all. This study aims to review the literature assessing delayed and simultaneous varicosity treatment duringtruncal ablation.Methods: Randomised trials and cohort studies concerning varicosity treatment timing were identified through asystematic literature search. Requirements for further treatment, quality of life and rate of venous thrombotic eventswere assessed for meta-analysis.Results: Four studies were identified assessing need for further varicosity procedure, with no significant difference seenbetween simultaneous or delayed treatment (p ¼ 0.339). Two studies assessed quality of life, with simultaneous treatmentproviding significantly improved outcomes at six weeks (p ¼ 0.029) but not at 12 weeks (p ¼ 0.283). Studiesexamining venous thrombotic events showed no difference in venous thromboembolism rate between simultaneousor delayed treatment approaches (p ¼ 0.078).Conclusion: The evidence base regarding timing of varicosity treatment is sparse; however, it does show that simultaneoustreatment of varicosities leads to early gains in quality of life, with a non-significant trend for fewer furtherprocedures but more venous thrombotic events.
Rowland SP, Dharmarajah B, Moore HM, et al., 2014, Inferior Vena Cava Filters for Prevention of Venous Thromboembolism in Obese Patients Undergoing Bariatric Surgery: A Systematic Review., Annals of Surgery, ISSN: 1528-1140
Objective: The use of inferior vena cava (IVC) filters for prevention of venous thromboembolism (VTE) in bariatric surgery is a contentious issue. We aim to review the evidence for the use of IVC filters in bariatric surgical patients, describe trends in practice, and discuss challenges in developing evidence-based guidelines.Background: The incidence of VTE in modern bariatric procedures with traditional methods of thromboprophylaxis, such as sequential calf compression devices and perioperative low molecular weight heparin, is approximately 2%.Methods: A systematic review of the literature was conducted according to PRISMA guidelines. We searched Medline up until July 2013 with the terms "bariatric filter" and "gastric bypass filter." Two investigators independently screened search results according to an agreed list of eligibility criteria.Results: Eighteen studies were included. There were no randomized controlled trials. Data from controlled cohort studies suggest that those who undergo IVC filter insertion preoperatively may be at higher risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE). A small cohort of patients with multiple risk factors for VTE benefitted from reduced PE-related mortality after preoperative IVC filter insertion. Data from 12 case series reporting VTE outcomes from a total of 497 patients who underwent preoperative IVC filter insertion demonstrated DVT rates of 0% to 20.8% and PE rates ranging from 0% to 6.4%.Conclusions: Published data reporting the safety and efficacy of IVC filter use in bariatric surgical patients is highly heterogeneous. There is no evidence to suggest that the potential benefits of IVC filters outweigh the significant risks of therapy.
Dharmarajah B, Thapar A, Salem J, et al., 2014, Decision making in symptomatic moderate carotid atherosclerosis: a survey of uk vascular surgeons and stroke physicians, Annual Meeting of the Society-of-Academic-and-Research-Surgery, Publisher: WILEY-BLACKWELL, Pages: 37-38, ISSN: 0007-1323
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