Analysis of the efficacy of endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in day surgery for lower extremity varicose vein

doi:10.3969/j.issn.1674-8115.2021.10.006

Abstract

Abstract: Objective

·To compare and analyze the therapeutic effect of 980 nm laser endovascular thermal ablation (EVTA) combined with foam sclerotherapy on day surgery (local anesthesia) and high ligation of great saphenous vein+810 nm laser EVTA combined with foam sclerotherapy on inpatient surgery (general anesthesia) for patients with lower extremity varicose vein.

Methods

·Data of the patients who underwent the above different surgical procedures respectively in the Department of General Surgery, The First Hospital of Xuzhou Mining Group from March 2019 to March 2020 were retrospectively analyzed, including 111 day surgery patients (980 nm group) and 107 inpatient surgery patients (810 nm group). The baseline data, postoperative data and follow-up data were collected, and the differences between the two groups were compared.

Results

·There was no significant difference between the two groups in baseline data and follow-up data. After operation, the 980 nm group was better than the 810 nm group in pain score, duration of pain, the proportion of using painkillers, the time required to resume daily life and economic cost (all P<0.05).

Conclusion

·Endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in the day surgery for lower extremity varicose vein has certain advantages in postoperative comfort, hospitalization time and cost, which will provide a new option for patients who are not suitable for general anesthesia.

Key words: 980 nm laser, lower extremity varicose vein, day surgery, foam sclerotherapy

CLC Number:

R654.6

Yong-chuan LI, Xin-wu LU, Zhi-hua ZHANG, Jin-bao QIN, Xing ZHANG. Analysis of the efficacy of endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in day surgery for lower extremity varicose vein[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(10): 1308-1312.

Figures/Tables 3

TrendMD

References 30

1	Davies AH. The seriousness of chronic venous disease: a review of real-world evidence[J]. Adv Ther, 2019, 36(): 5-12.
2	Raju S, Knight A, Lamanilao L, et al. Peripheral venous hypertension in chronic venous disease[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(5): 706-714.
3	Crawford JM, Gasparis A, Amery S, et al. Treatment pattern of consecutive patients with chronic venous disease[J]. J Vasc Surg Venous Lymphat Disord, 2019, 7(3): 344-348.
4	Hamann SAS, Giang J, De Maeseneer MGR, et al. Editor's choice-five year results of great saphenous vein treatment: a meta-analysis[J]. Eur J Vasc Endovasc Surg, 2017, 54(6): 760-770.
5	Shamimi-Noori SM, Clark TWI. Venous stents: current status and future directions[J]. Tech Vasc Interv Radiol, 2018, 21(2): 113-116.
6	Sydnor M, Mavropoulos J, Slobodnik N, et al. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein[J]. Phlebology, 2017, 32(6): 415-424.
7	Wittens C, Davies AH, Bækgaard N, et al. Editor's choice - management of chronic venous disease: clinical practice guidelines of the European society for vascular surgery (ESVS)[J]. Eur J Vasc Endovasc Surg, 2015, 49(6): 678-737.
8	Kolluri R, Chung J, Kim S, et al. Network meta-analysis to compare VenaSeal with other superficial venous therapies for chronic venous insufficiency[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(3): 472-481.e3.
9	Ligi D, Croce L, Mannello F. Chronic venous disorders: the dangerous, the good, and the diverse[J]. Int J Mol Sci, 2018, 19(9): 2544.
10	Chernykh KP, Kubachev KG, Semenov AY, et al. Treatment of patients with lower limb varicose veins disease[J]. Khirurgiia (Mosk), 2019(5): 88-93.
11	Rasmussen LH, Bjoern L, Lawaetz M, et al. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results[J]. J Vasc Surg, 2007, 46(2): 308-315.
12	杨心蕊, 陆信武. 下肢静脉曲张微创治疗进展[J]. 中国实用外科杂志, 2015, 35(12): 1352-1354.
13	朱化刚, 邵拥军, 周静, 等. 美国下肢静脉曲张及慢性静脉疾病治疗指南解读[J]. 中华普通外科杂志, 2012, 6(3): 258-259.
14	Chen JQ, Xie H, Deng HY, et al. Endovenous laser ablation of great saphenous vein with ultrasound-guided perivenous tumescence: early and midterm results[J]. Chin Med J (Engl), 2013, 126(3): 421-425.
15	Varetto G, Gibello L, Frola E, et al. Day surgery versus outpatient setting for endovenous laser ablation treatment. A prospective cohort study[J]. Int J Surg, 2018, 51: 180-183.
16	Carroll C, Hummel S, Leaviss J, et al. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation[J]. Health Technol Assess, 2013, 17(48): i-xvi, 1-141.
17	Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum[J]. J Vasc Surg, 2011, 53(5): 2S-48S.
18	Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins[J]. J Vasc Surg Venous Lymphat Disord, 2018, 6(2): 256-270.
19	Malskat WSJ, Engels LK, Hollestein LM, et al. Commonly used endovenous laser ablation (EVLA) parameters do not influence efficacy: results of a systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2019, 58(2): 230-242.
20	Ignatyev IM, Pokrovsky A, Gradusov E. Long-term results of endovascular treatment of chronic iliofemoral venous obstructive lesions[J]. Vasc Endovascular Surg, 2019, 53(5): 373-378.
21	Aktas AR, Celik O, Ozkan U, et al. Comparing 1470- and 980-nm diode lasers for endovenous ablation treatments[J]. Lasers Med Sci, 2015, 30(5): 1583-1587.
22	Bertanha M, Sobreira ML, Camargo PAB, et al. Preliminary results of severe venous insufficiency treatment with thermal ablation of the great saphenous vein by endovascular technique with laser diode 980 nm developed in Brazil, associated with sclerotherapy with polidocanol[J]. Rev Col Bras Cir, 2017, 44(3): 308-313.
23	Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review[J]. Vascular, 2016, 24(6): 649-657.
24	龚卓, 王勉镜. 980 nm和810 nm半导体激光生物热效应的比较[J]. 中国激光医学杂志, 2006, 15(3): 141-143.
25	Bi M, Li D, Chen Z, et al. Foam sclerotherapy compared with liquid sclerotherapy for the treatment of lower extremity varicose veins: a protocol for systematic review and meta analysis[J]. Medicine (Baltimore), 2020, 99(22): e20332.
26	Biemans AA, Kockaert M, Akkersdijk GP, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins[J]. J Vasc Surg, 2013, 58(3): 727-734. e1.
27	Hartmann K. Endovenous (minimally invasive) procedures for treatment of varicose veins: the gentle and effective alternative to high ligation and stripping operations[J]. Hautarzt, 2020, 71(): 67-73.
28	Liu ZX, Guo PM, Zhang LL, et al. Efficacy of endovenous laser treatment combined with sclerosing foam in treating varicose veins of the lower extremities[J]. Adv Ther, 2019, 36(9): 2463-2474.
29	Venermo M, Saarinen J, Eskelinen E, et al. Randomized clinical trial comparing surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy for the treatment of great saphenous varicose veins[J]. Br J Surg, 2016, 103(11): 1438-1444.
30	Schwein A, Georg Y, Lejay A, et al. Endovascular treatment for venous diseases: where are the venous stents? [J]. Methodist Debakey Cardiovasc J, 2018, 14(3): 208-213.

Item	810 nm group （n=107）	980 nm group （n=111）	P value
Gender （M/F）/n	58/49	49/62	0.137
Age/year	55.37±8.68	57.12±10.13	0.172
CEAP classification/n（%）
C3	31 （29.0）	28 （25.2）	0.534
C4	46 （43.0）	39 （35.1）	0.235
C5	30 （28.0）	44 （39.6）	0.071
Preoperative VCSS/score	8.48±3.74	9.19±2.75	0.113
Preoperative diameter of GSV/mm
at SFJ level	7.92±2.10	7.49±1.99	0.122
at knee level	5.63±0.67	5.78±0.59	0.081
Reflux time at SFJ level/ms	3 829.01±732.84	3 784.32±693.80	0.644

Item	810 nm group （n=107）	980 nm group （n=111）	P value
Gender （M/F）/n	58/49	49/62	0.137
Age/year	55.37±8.68	57.12±10.13	0.172
CEAP classification/n（%）
C3	31 （29.0）	28 （25.2）	0.534
C4	46 （43.0）	39 （35.1）	0.235
C5	30 （28.0）	44 （39.6）	0.071
Preoperative VCSS/score	8.48±3.74	9.19±2.75	0.113
Preoperative diameter of GSV/mm
at SFJ level	7.92±2.10	7.49±1.99	0.122
at knee level	5.63±0.67	5.78±0.59	0.081
Reflux time at SFJ level/ms	3 829.01±732.84	3 784.32±693.80	0.644

Item	810 nm group （n=107）	980 nm group （n=111）	P value
Pain score/score	3.67±1.32	2.14±0.91	0.000
Duration of pain/d	3.72±1.51	0.78±0.25	0.000
Use of painkiller/n（%）	16（15.0）	3 （2.7）	0.001
VCSS changes before and after operation/score	5.75±2.25	6.38±1.74	0.022
Time required to resume daily life/d	7.05±4.63	2.27±1.45	0.000
Economic cost/yuan	15 649.85±1 063.32	7 268.76±502.18	0.000

Item	810 nm group （n=107）	980 nm group （n=111）	P value
Pain score/score	3.67±1.32	2.14±0.91	0.000
Duration of pain/d	3.72±1.51	0.78±0.25	0.000
Use of painkiller/n（%）	16（15.0）	3 （2.7）	0.001
VCSS changes before and after operation/score	5.75±2.25	6.38±1.74	0.022
Time required to resume daily life/d	7.05±4.63	2.27±1.45	0.000
Economic cost/yuan	15 649.85±1 063.32	7 268.76±502.18	0.000

Item	810 nm group （n=107）	980 nm group （n=111）	P value
Severe complication/n（%）
lower extremity DVT	2 （1.9）	0 （0）	0.148
Others	0 （0）	0 （0）	‒
Minor complication/n（%）
Ecchymosis	31（29.0）	24 （21.6）	0.212
Edema	72 （67.3）	66 （59.5）	0.230
Paresthesia around ankle	9 （8.4）	6 （5.4）	0.381