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Impact on venous haemodynamics after treatment of great saphenous vein incompetence using plethysmography and duplex ultrasound
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0003-1691-458X
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.ORCID iD: 0000-0002-4507-8392
Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
2020 (English)In: Phlebology, ISSN 0268-3555, E-ISSN 1758-1125, Vol. 35, no 7, p. 495-504Article in journal (Refereed) Published
Abstract [en]

Objectives

To evaluate postoperative venous haemodynamics and quality of life after treatment of great saphenous vein (GSV) incompetence.

Methods

Radiofrequency ablation and high ligation and stripping were performed in 62 patients (65 limbs) and 58 (65 limbs), respectively. Phlebectomies were performed in both modalities. Strain-gauge plethysmography on the foot combined with superficial venous occlusion was used to measure refilling time after knee bends. Strain-gauge plethysmography, duplex ultrasound and quality of life were assessed before and one month after treatment.

Results

Duplex ultrasound displayed successful intervention in all but two limbs. Refilling time increased similar in radiofrequency ablation and high ligation and stripping after treatment (p < 0.001). Postoperatively, strain-gauge plethysmography detected remaining reflux in 71% of the patients. Multivariate analysis showed that two or more incompetent calf branches were associated with remaining reflux (OR 4.82 (95% CI: 1.33–17.5), p = 0.02). No difference in quality of life was seen in patients with remaining reflux.

Conclusions

Despite successful treatment, a majority of the limbs showed remaining reflux, in which incompetent calf branches appear to play an important role.

Clinicaltials.gov: Lower Limb Venous Insufficiency and the Effect of Radiofrequency Treatment Versus Open Surgery. Nr: NCT02397226

Place, publisher, year, edition, pages
Sage Publications, 2020. Vol. 35, no 7, p. 495-504
Keywords [en]
Venous incompetence; radiofrequency ablation; high ligation; stripping; strain-gauge plethysmography; duplex ultrasound
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-163631DOI: 10.1177/0268355519898952ISI: 000508777200001PubMedID: 31959059Scopus ID: 2-s2.0-85078192873OAI: oai:DiVA.org:liu-163631DiVA, id: diva2:1393820
Note

Funding Agencies|Linkoping University Hospital Research Fund, Linkoping, Sweden; ALF Grants, Region Ostergotland, Linkoping, Sweden

Available from: 2020-02-17 Created: 2020-02-17 Last updated: 2023-12-28Bibliographically approved
In thesis
1. Lower limb venous incompetence and the effect of radiofrequency ablation versus open surgery: Focus on haemodynamics, quality of life and health economic aspects
Open this publication in new window or tab >>Lower limb venous incompetence and the effect of radiofrequency ablation versus open surgery: Focus on haemodynamics, quality of life and health economic aspects
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic venous incompetence (CVI) is a common condition, and varicose vein treatment is one of the most-common surgical procedures performed worldwide. Common symptoms of CVI are pain, cramps, itching, feeling of leg heaviness and venous claudication. Advanced CVI can lead to skin changes, eczema and venous ulcers. While the cause of the disease is un-known, it often starts with venous enlargement and valve dysfunction. The overall aims of this thesis are: 1) to develop quantitative diagnostic measurements using strain-gauge plethysmography (SGP) with standardised superficial venous occlusion and duplex ultrasound (DUS); 2) to evaluate the effects of radiofrequency ablation (RFA) and high ligation/stripping (HL/S) for patients with great saphenous vein (GSV) incompetence; and 3) to evaluate the cost-effectiveness of GSV treatment.   

The first of the four studies involved patients with GSV incompetence. For these patients, SGP with superficial venous occlusion was performed before and after GSV treatment. SGP was able to predict the haemodynamic outcome of the treatment in the majority of the limbs examined. The conclusion is that SGP with standardised superficial venous occlusion may be used for predicting the outcome of GSV treatment.   

The second study evaluated the short-term outcomes of GSV treatment using RFA and HL/S regarding haemodynamics and quality of life (QoL). Both treatments lead to significant improvements in QoL, with no signifcant differences between the treatments. Despite successful treatment, the majority of the limbs in both treatment groups had significant residual reflux located mainly in the calf (i.e., below the treated area). The residual reflux may be a risk factor for future symptom relapses and need to be examined in more-long-term studies.   

The third study examined quantitative DUS and SGP parameters in relation to clinical severity and QoL. DUS-derived volume flow and SGP re-flux time showed weak but significant correlations with clinical severity (C in CEAP). The conclusion is that the current gold standard using the qualitative DUS-derived reflux time for CVI diagnostics should be revised and replaced with a more-relevant quantitative parameter.   

The fourth study evaluated the cost-effectiveness of GSV treatment with 1 year of follow-up. Both RFA and HL/S provided significant improvements in QoL. RFA is very cost-effective and is associated with fewer days missed from work compared to HL/S. Cost-wise, both methods are well be-low the national threshold for cost-effective treatment. Due to its higher cost, HL/S should be reserved for cases that require this method.    

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. p. 52
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1846
Keywords
Chronic venous incompetence, Varicose veins, Radiofrequency ablation, High ligation/stripping Duplex ultrasound, Strain-gauge plethysmography, Quality of Life, Health economic evaluation
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-193176 (URN)10.3384/9789180751018 (DOI)9789180751001 (ISBN)9789180751018 (ISBN)
Public defence
2023-05-19, Hasselquistsalen, building 511, entrance 76, 78., Campus US, Linköping, 13:00 (Swedish)
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Supervisors
Note

2023-04-19: ISBN (PDF) has been added in the electronic version.

2023-05-12: An minor error was corrected in the electronic version of the thesis on page 27, paragraph 2. The correct scentence is: "Differences with p-values < 0.05 were considered to be statistically significant." The correction is in line with the second edition of the printed thesis. Before this date the PDF has been downloaded 38 times.

Available from: 2023-04-19 Created: 2023-04-19 Last updated: 2023-12-28Bibliographically approved

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Nelzén, OskarSkoog, JohanZachrisson, Helene

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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Thoracic and Vascular SurgeryDepartment of Clinical Physiology in LinköpingDepartment of Health, Medicine and Caring Sciences
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