Radiofrequency-induced thermal therapy: results of a European multicentre study of resistive ablation of incompetent truncal varicose veins.

OBJECTIVES: To investigate the effectiveness of bipolar radiofrequency-induced thermal therapy (RFITT) in a multicentre non-randomized study. METHODS: Some 672 incompetent saphenous veins (85% great saphenous varicose vein, 15% short saphenous vein) in 462 patients (56.5% CEAP [clinical, aetiological, anatomical and pathological elements] class 3 or worse) were treated in eight European centres. Patients were assessed between 180 and 360 days postoperatively. Occlusion rates were determined by duplex ultrasound and compared with the power used for treatment, pull back rate and experience of the operating surgeon. RESULTS: Complete occlusion rates of 98.4% were achieved when treatments were performed by an experienced operator (more than 20 cases), when the maximum power setting on the RFITT generator was between 18 and 20 W and the applicator was withdrawn at a rate slower than 1.5 second/cm CONCLUSIONS: RFITT is efficacious, well tolerated by patients and has a low incidence of procedure-related post-operative complications.

[Endolumninal catheter-guided laser therapy of varicosities]. / Endoluminale kathetergestützte Lasertherapie der Stammveneninsuffizienz.

Chronic venous insufficiency is one of the most common diseases with a high socio-economic importance. The most common operation is vein stripping to remove the greater or lesser saphenous vein eliminating venous reflux. In comparison to classical vein stripping, endoluminal laser therapy is a minimally invasive and effective alternative with few complications and a shorter convalescent period. Varicosities can also be treated with the laser, using local anesthesia and sonographic monitoring. The recurrence rate is around 2%, comparable to surgical methods. This article reviews the practical aspects of endoluminal laser therapy, concentrating on the two most widely available systems, reviews the current literature and considers other endoluminal approaches.

[Stripping the Giacomini vein--pathophysiologic necessity or phlebosurgical games?]. / Stripping der Giacominivene--pathophysiologische Notwendigkeit oder phlebochirurgische Spielerei?

The Giacomini vein is present in 2.5%-10% of all patients having a phlebography because of varicosis. In a patient analysis of the last 5 years 129 patients were detected with a Giacomini vein (2.5%) out of a total of 5132 patients with varicosis. This vein was found in a significantly higher number of patients with a combined insufficiency of the long and short saphenous vein (p = 0.0001). An analysis of the different insufficiency patterns showed a Giacomini vein in 80% of insufficiency of grade I of the long and short saphenous vein. Likewise, this vein could be detected in more than half of the cases with complete insufficiency of both venous trunks (51%) as well as in 55% of the patients with a short saphenous vein insufficiency of grade III and an incomplete insufficiency of the long saphenous vein. On the other hand, there was no connection between insufficiency of the long saphenous vein, incomplete insufficiency of the short saphenous vein and the presence of the Giacomini vein. From these results we draw the conclusion that the Giacomini vein is a pathophysiologic connection between the two providing areas and thus transfers the insufficiency from one vascular system to the other. It hereby enhances the combined varicosis of both trunks as well as the formation of relapses. Therefore the Giacomini vein should always be stripped or removed by exeresis.