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Phlebology 2018 Sep 18:268355518800191. Epub 2018 Sep 18.

The Vascular Unit, Worcestershire Royal Hospital, Worcester, UK.

Background Thermal ablation, usually performed with tumescent local anaesthesia (TLA), is the preferred method for varicose veins treatment. Tumescent local anaesthesia is always cited; however, little detail of the procedure is presented in publications. This retrospective audit of clinical tumescent local anaesthesia practice aims to provide detailed information on an important aspect of endovenous practice. Read More

Ann Surg Treat Res 2017 Aug 28;93(2):98-102. Epub 2017 Jul 28.

Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Purpose: Varicose veins with great saphenous vein (GSV) insufficiency is prevalent. Among various surgical treatments for varicose veins, cryosurgery of GSV is an alternative minimally invasive technique that could leave fewer scars and replace conventional stripping with ambulatory phlebectomy. This study sought to assess outcomes including efficacy and safety of cryosurgery for varicose veins. Read More

J Vasc Surg Venous Lymphat Disord 2017 05;5(3):312-320.e2

Section of Vascular Surgery, University of Michigan Medical School, Ann Arbor, Mich. Electronic address:

Objective: The Vascular Quality Initiative Varicose Vein Registry (VQI VVR) represents a new Patient Safety Organization database launched in January 2015 as a collaborative effort between the American Venous Forum and the Society for Vascular Surgery. This study was undertaken to identify real-world trends among treatment choices and outcomes of varicose vein patients.

Methods: Registry data prospectively captured anatomic, procedural, and outcome data for patients with C2 or more severe disease undergoing intervention for venous varicosities from January to November 2015. Read More

J Vasc Surg Venous Lymphat Disord 2017 01 26;5(1):134-137. Epub 2016 Sep 26.

Duke University Medical Center, Durham, NC.

Objective: The objective of this review was to create an evidence summary of the available literature comparing saphenous vein ablation and concomitant phlebectomy vs ablation with staged phlebectomy.

Methods: A review of the literature for ambulatory patients treated for venous insufficiency with saphenous ablation and phlebectomy was conducted. A literature search was performed using MEDLINE, Cochrane Library, Google Scholar, and PubMed with the keywords phlebectomy, endovenous ablation, staged procedures, vein stripping, superficial venous disease, and powered phlebectomy. Read More

Phlebology 2016 Mar;31(1 Suppl):114-24

Section of Phlebology and Vascular Surgery, Centrum Oosterwal, The Netherlands Department of Vascular Surgery, Maastricht University Medical Centre, The Netherlands.

In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology. Read More

Vasc Specialist Int 2014 Dec 31;30(4):105-12. Epub 2014 Dec 31.

Department of Vascular Surgery, Gachon University Gil Medical Center, Incheon, Korea.

Unlabelled: The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins.

Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Read More

Phlebology 2015 Mar;30(1 Suppl):98-106

Riviera Veine Institut, Monaco.

Background: The traditional attitude for the treatment of chronic venous disorder is to systematically treat incompetent truncal veins. We wanted to evaluate the outcomes of not treating all incompetent truncal veins with regard to our experience of focusing the treatment to the varicose tributaries.

Methods: Retrospective study on all procedures of surgical treatment consecutively performed for varicose veins by single phlebectomy with preservation of a refluxing great saphenous vein (GSV), according to the principles of the ambulatory selective varices ablation under local anesthesia (ASVAL) during four years of practice. Read More

Ann Vasc Surg 2015 Apr 13;29(3):586-93. Epub 2015 Jan 13.

Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.

Background: Ambulatory Muller phlebectomy for varicose veins can be performed under local anesthesia. However, subcutaneous injection of local tumescent anesthetics may cause discomfort because of acidity of the solution. Addition of sodium bicarbonate lowers the acidity of anesthetic solutions, which might cause less pain. Read More

J Vasc Surg Venous Lymphat Disord 2014 Oct 24;2(4):397-402. Epub 2014 May 24.

Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.

Background: Intervention on the great saphenous vein (GSV) has traditionally been limited to the above-knee (AK-GSV) segment for fear of saphenous neuralgia in spite of incompetence demonstrated in the below-knee (BK-GSV) segment. Residual symptoms and need for reintervention are reported to result in nearly half the patients if the refluxing BK-GSV is ignored. Experience with endovenous ablation of the BK-GSV at the time of AK-GSV treatment is sparsely reported in the literature. Read More

J Am Acad Dermatol 2014 Nov 10;71(5):960-3. Epub 2014 Jul 10.

Department of Geriatrics, University Campus Bio-Medico, Rome, Italy.

Background: Varicose veins are treated under local infiltration anesthesia. Literature shows that adding sodium bicarbonate reduces the pain associated with local infiltration anesthesia. Nonetheless, sodium bicarbonate is underused. Read More

Ann Surg 2015 Apr;261(4):654-61

*Academic Section of Vascular Surgery, Imperial College London †Vascular Department, Royal Oldham Hospital, Oldham, Lancashire; and ‡London Vascular Clinic, London, UK.

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. Read More

Phlebology 2014 May 19;29(1 suppl):61-65. Epub 2014 May 19.

Riviera Vein Institut, Nice, France.

Background: It is usually agreed that incompetence of the sapheno-femoral junction (SFJ) is the main indication for stripping or ablation of the great saphenous vein (GSV) in the treatment of varicose veins (VVs). We wanted to test this assumption in our surgical treatment of varicose veins.

Methods: Study design: retrospective study of the surgical procedures for VVs in our centre between January and October 2012 in patients with reflux in the GSV. Read More

Lasers Surg Med 2013 Feb;45(2):123-9

Goldman, Butterwick, Fitzpatrick, Groff & Fabi Cosmetic Laser Dermatology, San Diego, California, USA.

Background And Objectives: Endovenous laser ablation (EVLA) has been shown to be effective for the elimination of saphenous veins and associated reflux. Mechanism is known to be heat related, but precise way in which heat causes vein ablation is not completely known. This study aimed to determine the effects of various endovenous laser wavelengths and delivery modes on ex vivo human vein both macroscopically and microscopically. Read More

Skeletal Radiol 2013 Jun 26;42(6):843-7. Epub 2013 Feb 26.

Department of Radiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.

In this study, we present the case of a 74-year-old male patient who presented with a painful pretibial swelling. The patient had a history of varices of the ipsilateral leg for which he had undergone stripping and ligation. At physical examination, pretibial varices and an associated soft tissue swelling were found. Read More

Dermatol Surg 2012 May 23;38(5):748-51. Epub 2012 Jan 23.

Department of Dermatology, Inselspital, Bern, Switzerland.

Background: Some leg telangiectasias may be refractory to treatment, including sclerotherapy and lasers.

Objective: To describe the innovative Sclerotherapy in Tumescent Anesthesia of Reticular veins and Telangiectasias (START) approach to achieving good results in such patients, which also proves effective in treating reticular veins.

Method: Because compression enhances the rate of success of sclerotherapy of C1 veins (telangiectasias and reticular), Ringer solution (with or without lidocaine-epinephrine) was injected subcutaneously before, during, or immediately after sclerotherapy of therapy-refractory C1 veins. Read More

J Endovasc Ther 2011 Oct;18(5):734-8

AmeriVein Systems, Aurora, Illinois 60504, USA.

Purpose: To report a series of non-sedated patients treated with transilluminated powered phlebectomy (TIPP) under tumescent anesthesia in an office setting.

Methods: Thirty-six patients (31 women; mean age 54.8±11. Read More

Cardiovasc Intervent Radiol 2011 Jun 17;34(3):536-41. Epub 2010 Jun 17.

Warren Alpert School of Medicine, Brown University/Rhode Island Hospital, Providence, RI 02903, USA.

The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Read More

Hong Kong Med J 2009 Feb;15(1):39-43

Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

Objective: To examine the safety and efficacy of endovenous laser obliteration to treat varicose vein in a day surgery setting, using sedation and local anaesthesia.

Design: Prospective study.

Setting: Day surgery centre in a regional hospital in Hong Kong. Read More

Ann Vasc Surg 2009 Mar 5;23(2):207-11. Epub 2008 Aug 5.

Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University Medical Center, Seoul, South Korea.

Endovenous laser treatment (EVLT) is a widely used minimally invasive alternative to stripping of varicose veins involving the great and small saphenous veins. We expanded the applications to tributary varicosities and compared EVLT alone with combined EVLT and ambulatory phlebectomy. The study included 132 patients (76 males, 56 females) who were treated with EVLT and ambulatory phlebectomy. Read More

Phlebology 2008 ;23(4):172-7

Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea.

Objectives: The aim of this retrospective study is to assess the safety and effectiveness of endovenous laser treatment (EVLT) combined with ambulatory phlebectomy (AP) as a single procedure for treating saphenous vein incompetence.

Methods: The study enrolled 148 patients with saphenofemoral or saphenopopliteal junction reflux associated with saphenous vein incompetence and enlarged branch veins. Patients were treated with EVLT (135 great saphenous veins, 41 small saphenous veins) concomitantly with AP as a single procedure. Read More

Plast Reconstr Surg 2007 Dec;120(7):2017-24

Brevard Plastic Surgery and Skin Treatment Center, Melbourne, Fla. 32901, USA.

Background: Many patients express dissatisfaction with prominent and bulging hand veins. Abolishing these veins with sclerotherapy requires higher concentrations of sclerosing agents than are used for leg veins and often results in a tender, phlebitic cord. Phlebectomy is another treatment option. Read More

J Cosmet Laser Ther 2007 Mar;9(1):9-13

Weill Cornell Medical College. New York, NY, USA.

Background: Combination endovascular laser obliteration of the greater saphenous vein in conjunction with ambulatory phlebectomy has become the treatment of choice for superficial venous incompetence.

Objectives: The present study examines the treatment of saphenofemoral junction (SFJ) incompetence with simultaneous treatment of associated truncal varicosities by ambulatory phlebectomy.

Methods: Four-year follow-up data for recurrence rate and complication profile was ascertained for 90 patients (mean age 40 years) with SFJ reflux associated with greater saphenous vein (GSV) incompetence (4-12 mm; mean 7. Read More

Am J Surg 2006 Jan;191(1):33-8

Robert Wood Johnson University Hospital, Hamilton, NJ, USA.

Background: This study of patients who received either aggressive or less-aggressive treatment for superficial venous disease was undertaken to determine its effects on deep venous insufficiency (DVI).

Methods: From 1998 to 2004, we treated 1,500 consecutive patients with superficial venous disease at our outpatient care center. A total of 100 patients were available for the study; the remaining patients were not available for the complete follow-up duplex scans 6 months after therapy, irrespective of the therapeutic results. Read More

J Cosmet Laser Ther 2004 May;6(1):44-9

Weill Medical College of Cornell University, New York, NY, USA.

Objective: Non-invasive radiofrequency and endovascular technologies are becoming increasingly popular in the treatment of superficial venous incompetence. In conjunction with stab avulsion of truncal varicosities, these technologies have been able to address functional as well as cosmetic superficial venous incompetence in a non-invasive fashion. The present study presents a 2-year follow-up of 30 patients with combined axial incompetence of the greater saphenous vein (GSV) in conjunction with truncal varicosities treated with combination diode laser technology and ambulatory phlebectomy. Read More

Dermatol Surg 2003 Mar;29(3):221-6

Department of Dermatology, Bernhoven Hospital, Veghel, The Netherlands.

Background: Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or ambulatory phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and ambulatory phlebectomy.

Methods: From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to ambulatory phlebectomy. Read More

Lasers Surg Med 2002 ;31(4):257-62

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.

Background And Objectives: Untreated varicose veins have significant morbidity and potential mortality. Treatment aims to relieve symptoms, improve appearance, and to prevent deterioration. Current therapeutic options include graduated compression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation, and stripping. Read More

Dermatol Surg 2002 Jan;28(1):32-7

Department of Dermatology, Cornell-Weill Medical College, New York, New York, USA.

Background: New treatment indications and improved technique modifications have made ambulatory phlebectomy increasingly popular in the management of intermediate and large truncal varicosities.

Objective: To describe a new technique of ambulatory phlebectomy that combines a multifocal incisional and endovascular cannulation approach. This study compares this newly described technique to the previously described "pulling maneuver. Read More

Dermatol Surg 2002 Jan;28(1):29-31

Dermatology Associates of San Diego County, Inc., San Diego, California, USA.

Background: Incompetence of the saphenofemoral junction (SFJ) with reflux into the greater saphenous vein (GSV) is one cause of chronic venous hypertension that may lead to the development of varicose and telangiectatic leg veins.

Objective: To evaluate with long-term follow-up a novel method for closing the incompetent GSV at its junction with the femoral vein through an endoluminal approach.

Methods: Fifty patient legs with reflux at the SFJ into the GSV were treated with radiofrequency (RF) heating of the vein wall through an endoluminal catheter. Read More

Dermatol Surg 2000 May;26(5):452-6

Dermatology Associates of San Diego County, Inc., La Jolla, California, USA.

Background: Incompetence of the saphenofemoral junction with reflux into the greater saphenous vein is one cause of chronic venous hypertension which may lead to the development of varicose and telangiectatic leg veins. Therefore treatment is necessary.

Objective: To evaluate a novel method for closing the incompetent greater saphenous vein at its junction with the femoral vein through an endoluminal approach. Read More

Dermatol Surg 2000 Feb;26(2):155-7

Department of Dermatology, Eulji Hospital, Eulji Medical College, Seoul, Korea.

Background: Ambulatory phlebectomy (AP) is a popular outpatient procedure for the removal of varicose veins. One of the major obstacles of AP is the disappearance and shift of the veins to be removed when the patient is positioned horizontally.

Objective: We aimed to verify the usefulness of preoperative placement of intravenous cannulae. Read More

Dermatol Surg 1998 Apr;24(4):465-70

Department of Dermatology, Sint Joseph Ziekenhuis, Veghel, The Netherlands.

Background: Ambulatory phlebectomy is an accepted therapy for varicose veins. It has also been used for ankle and foot varicosities with success although the anatomy of the venous system of the foot is poorly described in the literature.

Objective: To review the relevant literature on the anatomy of the veins of the foot. Read More

Minerva Cardioangiol 1997 Apr;45(4):121-9

Divisione di Chirurgia Generale, Azienda Ospedaliera San Filippo Neri, Roma.

Outpatient varicose veins surgery, "Phlébectomie Ambulatoire" (FA) introduced by R. Muller in 1966, is now a widespread technique; modified by many authors with personal tips, FA enables most lower limb varicosities to be treated on an outpatient basis and under local anaesthesia. To achieve good functional results, an accurate preoperative diagnostic examination is mandatory; the authors present a review of the indications of FA and their personal experience. Read More

Ann Chir 1997 ;51(7):761-72

Ambulatory phlebectomy, first described by R. Muller in 1996, is now considered to be one of the major treatments of varicose veins, either alone or in combination with surgery and sclerotherapy. The first objective of this article is to recall the technique of ambulatory phlebectomy. Read More

Dermatol Surg 1995 Jul;21(7):628-30

Background: Ambulatory phlebectomy (AP) is a gratifying technique that allows one to solve problems otherwise requiring traditional surgery. However, when AP is practiced indiscriminately, results may be disappointing and can tarnish the technique, although there is always a solution to restore the situation.

Objective: To evaluate the defects of AP, their frequency, and to propose solutions for treatment and prevention. Read More

Phlebologie 1993 Oct-Dec;46(4):665-70

Echo-sclerosis and phlebectomy are complementary. Thanks to them, it is possible to treat a post-surgical saphenous branch in a single session. Echo-sclerosis deals with the origin of the varicose vein, which is often deep in the panniculus adiposus, predilection area of this technique. Read More