Méthodes : Sur une série de 31 femmes présentant des varices périnéales d’origine extrasaphéniennes ayant bénéficié d’une exploration radiologique veineuse pelvienne et de l’embolisation des veines incontinentes nous avons étudié les résultats et les corrélations anatomo-clinique entre les varices et les signes cliniques de l’insuffisance veineuse pelvienne. Un sous-groupe B de 23 patientes présentant une insuffisance veineuse pelvienne et des signes cliniques a été comparé à un groupe A de 4 patientes qui ne présentaient pas d’insuffisance veineuse pelvienne à l’exploration. Nous avons choisi d’étudier 3 signes cliniques : la douleur pelvienne et la douleur des membres inférieurs survenant au début ou pendant les règles ainsi que la dyspareunie. La symptomatologie a été évaluée sur une échelle analogique de 0 à 10 et un score clinique (de 0 à 30) a été établi en ajoutant ces 3 chiffres.

http://link.springer.com/content/pdf/10.1007/BF02973687.pdf

Références bibliographiques: La fibroscopie bronchique

Objective To determine whether recurrence of leg ulcers may be prevented by surgical correction of superficial venous reflux in addition to compression. 

Design Randomised controlled trial.

Setting Specialist nurse led leg ulcer clinics in three UK vascular centres.

Participants 500 patients (500 legs) with open or recently healed leg ulcers and superficial venous reflux.

Interventions Compression alone or compression plus saphenous surgery. 

Main outcome measures Primary outcomes were ulcer healing and ulcer recurrence. The secondary outcome was ulcer free time.

Results Ulcer healing rates at three years were 89% for the compression group and 93% for the compression plus surgery group (P=0.73, log rank test). Rates of ulcer recurrence at four years were 56% for the compression group and 31% for the compression plus surgery group (P<0.01). For patients with isolated superficial reflux, recurrence rates at four years were 51% for the compression group and 27% for the compress plus surgery group (P<0.01). For patients who had superficial with segmental deep reflux, recurrence rates at three years were 52% for the compression group and 24% for the compression plus surgery group (P=0.04). For patients with superficial and total deep reflux, recurrence rates at three years were 46% for the compression group and 32% for the compression plus surgery group (P=0.33). Patients in the compression plus surgery group experienced a greater proportion of ulcer free time after three years compared with patients in the compression group (78% v 71%; P=0.007, Mann-Whitney U test).

Conclusion Surgical correction of superficial venous reflux in addition to compression bandaging does not improve ulcer healing but reduces the recurrence of ulcers at four years and results in a greater proportion of ulcer free time. 

Trial registration Current Controlled Trials ISRCTN07549334.

https://www.bmj.com/content/bmj/335/7610/83.full.pdf

Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial.

Duplex Ultrasound Investigation of the Veins of the Lower Limbs after Treatment for Varicose Veins – UIP Consensus Document

BACKGROUND In the last decade, minimally invasive techniques have been introduced in the treatment of lower extremity varicosities. Of these therapies, endovenous laser ablation is the most widely accepted and used treatment option for insufficient great and short saphenous veins. OBJECTIVE To present a review of reported common and rare and minor and major complications associated with endovenous laser ablation. METHODS A systematic review of studies and case reports on endovenous laser ablation-induced complications. The complications were classified as minor or major according to the Society of Interventional Radiology Standards of Practice Committee guidelines on reporting complications. A case-series of complications after endovenous laser ablation is presented. RESULTS Ecchymoses and pain are frequently reported side effects of endovenous laser ablation. Nerve injury, skin burns, deep vein thrombosis and pulmonary embolism seldom occur. An exceptional complication is a material or device that by accident remains inside the body after the procedure. Ecchymosis, pain, induration, skin burns, dysesthesia, superficial thrombophlebitis, and hematoma were classified as minor complications. Deep vein thrombosis and nerve injury were classified as major complications. CONCLUSION Endovenous laser ablation may be considered a safe treatment of lower extremity varicosities. The incidence of common side effects may decrease with better laser parameters.

Endovenous laser ablation-induced complications: review of the literature and new cases

Endovenous laser ablation of varicose veins with the 1470-nm diode laser

Background:
Endovenous laser treatment is a percutaneous technique used for the treatment of long saphenous vein (LSV) incompetence. This paper presents the results of an uncontrolled case series undertaken to assess the feasibility, safety and efficacy of this technique.

Methods:
Some 145 incompetent LSVs in 136 patients with saphenofemoral reflux were treated with endovenous laser. The data were evaluated prospectively. Assessment was carried out at 1 week, 3 and 12 months for LSV occlusion and symptomatic relief.

Results:
Primary procedural success was achieved in 124 (85·5 per cent) of 145 LSVs. Reasons for primary failure included failed cannulation, failure to pass the guidewire and patient discomfort. At 3 months' follow-up, 105 (89·7 per cent) of 117 veins were totally and nine (7·7 per cent) were partially occluded. At 12 months, 63 (76 per cent) of 83 veins were totally and 15 (18 per cent) were partially occluded. At this stage 73 (88 per cent) of 83 patients remained satisfied, but 26 (31 per cent) had residual or recurrent varicosities. Of these, only five required further treatment. Complications included saphenous nerve injury in one patient and superficial skin burns in a second.

Conclusion:
Endovenous laser treatment for LSV reflux is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Endovenous laser treatment for long saphenous vein incompetence

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Endovenous laser treatment for long saphenous vein incompetence