Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia.

BACKGROUND: The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. OBJECTIVES: To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. METHODS: We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. RESULTS: In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01-7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. CONCLUSIONS: Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.

Abdominal collateral veins as an unconventional access site for hemodialysis after primary access failure.

INTRODUCTION: Vascular access dysfunction and the depletion of access pathways are complications associated with morbidity and mortality in dialysis patients. As described in the literature, catheter insertion through small collateral veins or recanalized cervical and thoracic veins is an attractive option. CASE DESCRIPTION: This article reports a case in which a collateral vein in the abdominal region was used as an access for hemodialysis. CONCLUSION: After multiple attempts with fistulas and catheters, the left abdominal wall collateral network proved to be a successful access site. Using unconventional veins can be an alternative in these patients.