Adjuvant radiofrequency thermocoagulation improves the outcome of liquid sclerotherapy in the treatment of spider veins of the leg: A pilot study.

OBJECTIVE: This study evaluated the effect of low-energy radiofrequency thermocoagulation added to standard liquid sclerotherapy on clinical outcomes of patients with venous insufficiency. PATIENTS AND METHOD: We included 111 patients with spider veins CEAP/C1 stage. The patients were randomized into sclerotherapy (Group 1) and sclerotherapy + sclerotherapy immediately followed by low energy percutaneous RF thermocoagulation (Group 2) groups and followed up with same protocols prospectively. RESULTS: The study groups did not differ in terms of the mean age, body mass index, the number of spider veins and pre-interventional venous clinical severity scores (VCSS). Patients' self-assessed satisfaction ratings of cosmetic outcomes were found to be higher compared to the baseline (p = 0.001). While both techniques caused a significant decline in VCSS at postprocedural third month, it was observed that the type of applied intervention did not affect the VCSS (p = 0.43 and p = 0.93, respectively). There was a significant difference in hyperpigmentation and trapped blood between the two groups after the procedure (p = 0.009 and p = 0.02, respectively), there was no statistically significant difference in terms of skin necrosis (p = 0.52). A significant difference in the self-assessed cosmetic outcomes was observed in patients treated with sclerotherapy followed by low energy percutaneous RF thermocoagulation compared with patients whom sclerotherapy performed alone (p = 0.001). DISCUSSION: This study suggests that radiofrequency thermocoagulation added to the sclerotherapy provides better cosmetic outcomes with less treatment sessions and no additional complication rates.

Carotid patch and cerebrovascular event relation after carotid endarterectomy procedure.

BACKGROUND: Carotid endarterectomy (CEA) is the treatment of choice for patients with symptomatic and asymptomatic high-grade carotid stenosis. In literature there are papers advocating patch plasty for better results. But there is controversy about which patch material is optimal for use. This study compared rate of neurologic events, and perioperative death in patients undergoing CEA with primary closure versus patch closure. METHODS: We compared patch angioplasty to primary closure between August 2008 and December 2012 in 57 operations. Patients grouped according to their closure technique. Early (30-day) stroke and mortality rate were evaluated. Mean age of patients was 67.79±10.19 (range 41-85 years). 15 (26.31%) of patients were female. RESULTS: Primary closure was used in 13 operations, and patch angioplasty was used in 44 (saphenous vein: 5, Dacron: 23, Fabric: 5, Carotid: 11). There were no significant differences among groups' baseline characteristics. Primary closure was associated with significantly more postoperative major stroke compared with patch used closure (P=0.05). None of preoperative variables were associated with postoperative stroke. CONCLUSIONS: On the basis of our results, avoiding primary closure for CEA is defendable. But choice of patch material needs large trials to conclude.