Abstract
The purpose of the present research was (I-II) to evaluate the effects of
clinical, hand-held Doppler (HHD) and duplex ultrasonographic examinations on the
planning of operative procedure for primary varicose veins, (III) to assess the
feasibility, safety and efficacy of endovenous saphenous vein obliteration with
radiofrequency-resistive heating and (IV) to compare endovenous saphenous vein
obliteration with conventional stripping operation in terms of short-term
recovery and costs.
Sixty-two legs (in 49 consecutive patients) and 142 legs (in 111
consecutive patients) with primary uncomplicated varicose veins were examined
clinically and with HHD and duplex ultrasonography for planning the subsequent
treatment. At the saphenous-femoral junction (SFJ) and at the saphenous-popliteal
junction (SPJ), sensitivity was 56-64% and 23%, specificity 93-97% and 96%,
positive predictive value 97-98% and 43% and negative predictive value 44-45% and
91%, respectively. In 9% of the cases, the treatment plan was modified on the
basis of the duplex ultrasound findings. The present study showed that, in
primary uncomplicated varicose veins, the accuracy of HHD is
unsatisfactory.
Thirty legs of 27 patients with varicose veins were treated using an
endovenous catheter (Closure® System, VNUS Medical Technologies, Inc.,
Sunnyvale,
CA), which was inserted under ultrasound guidance via a percutaneous puncture or
a skin incision. The persistence of vein occlusion and complications potentially
attributable to the endovenous treatment were assessed at 1-week, 6-week,
3-month, 6-month and 1-year follow-up visits. By the time of the last follow-up
visit, occlusion of the treated segment of the LSV had been achieved in 22
(73.3%) legs. Persisting patency or recanalization of LSV was detected in 8 legs
(26.7%). Postoperative complications included saphenous nerve paresthesia in 3
legs (10%) and thermal skin injury in one limb (3.3%).
Twenty-eight selected patients admitted for operative treatment of varicose
veins in the tributaries of the primary long saphenous were randomly assigned to
endovenous obliteration (n = 15) or stripping operation (n = 13). The patients
were followed up for 7-8 weeks postoperatively and examined by duplex
ultrasonography. The comparison of costs included both direct medical costs and
costs due to lost of productivity. All operations were successful, and the
complication rates were similar in the two groups. The sick leaves were
significantly shorter in the endovenous obliteration group [6.5 (SD 3.3) vs. 15.6
(SD 6.0), 95 % CI 5.4 to 12.9, p < 0.001, t-test]. When
the
value of the lost working days was included, the endovenous obliteration was
societally cost-saving.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-6723-0 |
| Date | 07 July 2002 |
| Creators | Rautio, T. (Tero) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2002 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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