Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy

Abstract

Objectives

Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated.

Methods

In this retrospective study, treatment and clinical outcomes of patients’ who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed.

Results

A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation.

Conclusion

Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

Keywords

Near infrared light residual varicose vein varicose veins surgery foam sclerotherapy

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References

Robertson

Evans

Fowkes

. Epidemiology of chronic venous disease. Phlebology 2008; 23: 103–111.

Beebe-Dimmer

Pfeifer

Engle

, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15: 175–184.

Allaf

Welch

. Recurrent varicose veins: inadequate surgery remains a problem. Phlebology 2005; 20: 138–140.

Geier

Olbrich

Barbera

, et al. Validity of the macroscopic identification of neovascularization at the saphenofemoral junction by the operating surgeon. J Vasc Surg 2005; 41: 64–68.

Kahraman

Özsin

. Ultrasound-guided catheter-directed foam sclerotherapy can be safely applied for the treatment of great saphenous varicose veins in elderly patients. Vascular 2020; 28(5): 597–603.

Kahraman

Demir

. Efficacy of foam sclerotherapy accompanied by near infrared light and duplex ultrasonography in treatment of symptomatic recurrent varicose veins: A retrospective cohort study. J Surg Med 2019; 3(1): 82–87.

Allegra

Antignani

Carlizza

. Recurrent varicose veins following surgical treatment: our experience with five years follow-up. Eur J Vasc Endovasc Surg 2007; 33: 751–756.

Kostas

Ioannou

Touloupakis

, et al. Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg 2004; 27: 275–282.

Brake

Lim

Shepherd

, et al. Pathogenesis and etiology of recurrent varicose veins. J Vasc Surg 2013; 57(3): 860–868. DOI: 10.1016/j.jvs.2012.10.102.

10.

Ebner

Taurino

, et al. Recurrent residual or progressive varicose veins: postoperative long term follow-up of 353 patients. Ann Ital Chir 2017; 88: 526–533.

11.

Iwamoto

Ikeda

Kawasaki

, et al. Treatment of varicose veins: an assessment of intraoperative and postoperative compression sclerotherapy. Ann Vasc Surg 2003; 17(3): 290–295. DOI: 10.1007/s10016-001-0256-8.

12.

Blomgren

. Residual incompetent tributaries after varicose vein surgery increased the need for reintervention after 8 years. J Vasc Surg Venous Lymphat Disord 2020; 8(3): 378–382. DOI: 10.1016/j.jvsv.2019.11.012.e1

13.

Schanzer

. Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure? Vasc Endovascular Surg 2010; 44(7): 545–549.

14.

Gloviczki

. Guidelines for the management of varicose veins. Phlebology 2012; 27(1): 2–9.

15.

Frullini

Cavezzi

. Sclerosing foam in the treatment of varicose veins and telangiectases: history and analysis of safety and complications. Dermatol Surg 2002; 28(1): 11–15.

16.

Masuda

Kessler

Lurie

, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006; 43: 551–557.