Radiofrequency ablation for treatment of varicose veins of lower limbs

Catedra chirurgie 1, Universitatea Naţională de Medicină „N.Pirogov”, Vinniţa, Ucraina, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Venele varicoase ale extremităţilor inferioare sunt frecvent întîlnite în populaţia ţărilor occidentale industrial dezvoltate afectînd 10-15% de bărbaţi şi 20-25% de femei. Această prevalenţă înaltă este responsabilă pentru costuri sociale şi medicale majore. Scopul studiului a fost evaluarea rezultatului clinic al tratamentului chirurgical prin ablaţie cu radiofrecvenţă (RFA) la bolnavii cu varice ale membrelor inferioare. Material şi metode: O sută patruzeci şi doi de bolnavi cu vene varicoase au fost supuşi RFA al segmentului proximal de venă safenă magna cu ajutorul dispozitivului “VNUS Closure”™. Diametrul venei a variat între 5 şi 20 mm. Cateterul pentru RFA a fost introdus prin puncţie percutană sau o incizie cutanată minimă. Toate intervenţiile au fost realizate sub anestezia locală infiltrativă cu ghidaj ultrasonor. Au fost studiate schimbările morfologice la nivelul peretelui venei safene magna supuse tratamentului prin RFA.Rezultate: Profunzimea necrozei a fost determinată la nivelul stratului endotelial şi subendotelial cu detaşarea caracteristică a acestora, cu colabarea şi îngustarea lumenului vascular. Specificul particular reprezintă lipsa fenomenului de neoangiogeneză la nivelul joncţiunii safenofemurale şi safenopopliteale. Aşa complicaţii ca parestezii sau echimoze au fost observate doar în 5 cazuri. Merită de subliniat absenţa sindromului dolor semnificativ în grupul pacienţilor studiaţi. Toţi bolnavii au fost externaţi peste 2 ore după intervenţie. Concluzii: Metoda are următoarele avantaje: durata scurtă a incapacităţii de muncă, utilizarea anesteziei locale, rezultatul estetic bun, durata redusă a intervenţiei, rezultatele precoce şi la distanţă favorabile, posibilitatea de obliterare a venelor cu diametrul mare şi lipsa necesităţii în analgezie postoperatorie.Introduction: Varicose veins of the lower limbs are a common condition affecting 10-15% of men and 20-25% of women in the developed countries of western world. This high prevalence is responsible for high medical and social costs. The aim was to study the clinical results of surgical treatment of patients with varicose veins of lower limbs using radiofrequency ablation (RFA). Material and methods: One hundred forty two patients with varicose veins underwent RFA of the above knee great saphenous vein by “VNUS Closure”™ procedure. The vein diameters were from 5 to 20 mm. The RF catheter was inserted via percutaneous puncture or through a small skin incision. All operations were performed under local, tumescent anesthesia, with ultrasound guidance. We studied morphological changes of the wall of great saphenous vein in patients who underwent treatment with RFA. Results: The depth of necrosis was within endothelial and subendothelial layer, but detachment of endothelial and subendothelial layers was characteristic with collapse and narrowing of vessel lumen. The special feature was lack of neoangiogenesis at the level of saphenofemoral and safenopopliteal junction. Such complications as paresthesia or ecchymosis were observed only in 5 cases. It should be noted that the studied patients had no significant pain syndrome. All patients were discharged 2 h after operation. Conclusions: Advantages of the method are shorter sick leave, using of local tumescent anesthesia, good cosmetic result, shorter duration of surgery, good immediate and late results, possibility to close the veins with a large diameter and no use of postoperative analgesics

Experience of VenaSeal system using in treatment of chronic venous insufficiency

Highly Specialized Clinical Center for Cardiovascular and X-ray Vascular Surgery with an Intensive Care Unit, Vinnytsya Regional Clinical Hospital Named After M.I. Pirogov, Department of Endoscopic and Cardiovascular Surgery, National Pirogov Memorial Medical University, Vinnytsya, Ukraine, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroduction: The VenaSeal device is a disposable, single use system for administering cyanoacrylate adhesive into an incompetent truncal vein which can be used without tumescent anesthesia and without application of heat. The aim of the study was to evaluate our experience of VenaSeal system using. Methods: Our experience included 9 patients (16 lower limbs) with chronic venous insufficiency C2-C4 (CEAP). 2 patients received monoprocedures of VenaSeal, 2 patients – VenaSeal + miniflebectomy, 4 patients – VenaSeal + foam sclerotherapy, 1 patient – RFA of great saphenous vein + VenaSeal closure of perforator vein. Results: The average diameter of the treated vein area in patients of our study was 9.5±2.0 mm. Cyanoacrylate embolization was associated with low pain scores. Moreover, presumably because it does not require tumescent anesthesia, treatment resulted by the absence of ecchymosis. Our patients had no postoperative burns and pigmentation at all. Also, there was no even mild paresthesia in any patient. According to ultrasonography great saphenous veins were closed in all patients both on day 3 and on day 30. The severity and impact of venous disease on quality of life were measured with several end points in our study. Subjects treated with VenaSeal system showed significantly improving of quality of life over time. Conclusions: Using of VenaSeal is a fast and effective method of eliminating the incompetence of the saphenous veins, without the need for tumescent anesthesia, wearing compression knitwear, not accompanied by paresthesias, postoperative burns and pigmentation