Coil embolization for the treatment of peripheral veins:

Beneficial treatment options for incompetent saphenous veins, including endovenous thermal ablation, ultrasound-guided foam sclerotherapy, and traditional surgery, have been established by rigorous randomized clinical trials and recommended by several international evidence-based guidelines. 1 National Institute for Health and Care ExcellenceVaricose veins in the legs: the diagnosis and management of varicose veins. Clinical guideline [CG168]. NICE, London2013 Google Scholar , 2 Gloviczki P. Comerota A.J. Dalsing M.C. Eklof B.G. Gillespie D.L. Gloviczki M.L. et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011; 53: 2S-48S Abstract Full Text Full Text PDF PubMed Scopus (862) Google Scholar , 3 Gloviczki P. Gloviczki M.L. Guidelines for the management of varicose veins. Phlebology. 2012; 27: 2-9 Crossref PubMed Scopus (63) Google Scholar , 4 Wittens C. Davies A.H. Baekgaard N. Broholm R. Cavezzi A. Chastanet S. et al. Editor's choice—management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015; 49: 678-737 Abstract Full Text Full Text PDF PubMed Scopus (463) Google Scholar There is currently no high-quality evidence to support the use of physical embolic agents, a This statement applies to physical embolic agents only and is not applicable to cyanoacrylate adhesives and other liquid embolic agents. aThis statement applies to physical embolic agents only and is not applicable to cyanoacrylate adhesives and other liquid embolic agents. such as coils, to treat axial venous reflux. Accordingly, we recommend against the use of such approaches for the treatment of saphenous incompetence outside of the clinical trial settings (Grade 2C against; Table). TablePublished English-language literature on the experience with coils in the treatment of varicose veins 1 Authors M.K. Barsoum, H. Bjarnason, T.W. Rooke, F.L. Cindy, J.C. Andrews, T.M. Petterson, M. Aslam, J.A. Heit Title Saphenous Vein Ablation Using Catheter-Directed Coil Embolization and Sclerotherapy Journal Journal of Vascular and Interventional Radiology 2009;20(Suppl):S11-2 Methods Retrospective cohort study of symptomatic patients with GSV varicositiesCoil occlusion and alcohol ablation treatment for symptomatic GSV with saphenofemoral junction incompetence. Results N = 176; 85% women; 230 legsAt follow-up duplex ultrasound (n = 140 legs; median 10 weeks after treatment), the GSV was occluded in 100 legs and partially and completely recanalized in 25 and 15 legs, respectively. Symptoms (pain, edema, skin changes, and ulcer) resolved completely in 191 legs (90%) and partially in 3 legs. Complications Inappropriate coil placement requiring repositioning (n = 4), a small arteriovenous fistula (n = 1), influenza-like symptoms (n = 2), and superficial phlebitis (n=7). One patient developed deep venous thrombosis and was treated with warfarin for 3 months. 2 Authors Ahmed Kayssi, George Oreopoulos, Kong T. Tan, Jeffrey Jaskolka Title Combined Coil Embolization and Foam Sclerotherapy for the Management of Varicose VeinsAnnals of Vascular Surgery 2017;38:293-7 Journal Annals of Vascular Surgery 2017;38:293-7 Methods Retrospective case series analysisFluoroscopically guided coil embolization of the GSV and foam sclerotherapy of the GSV and below-knee varices at a single Canadian center. Results N = 22; 23 legsMost patients (78.3%) presented for follow-up 57.2 ± 21.9 days postoperatively. Doppler studies demonstrated complete GSV occlusion in all patients. Complications Three patients (13.6%) noted skin discoloration overlying the treated varicose veins; none complained of pain on follow-up or developed leg numbness, deep venous thrombosis, or pulmonary emboli. 3 Authors Michel Barsoum, Thom Rooke, Haraldur Bjarnason Title Do We Really Need a New Varicose Vein Technique? Journal Endovascular Today, April 2008 Methods Retrospective studyFluoroscopically guided embolization coil (Nester Embolization Coil; Cook Medical, Bloomington, Ind) is placed into the tributary for anchoring and then curled up in the GSV. Subsequently, 5 to 10 mL of absolute alcohol is injected into the vein peripheral to the coils as the catheter is pulled to the introducer sheath. Results N = 125 patients; 161 legs with 36 bilateral proceduresBased on duplex ultrasound of 106 legs, the GSV remained occluded in 77 legs; minimal recanalization was noted in 6 legs. After coil embolization with alcohol sclerosis, symptoms resolved completely in 62 legs and partially resolved in 3 legs (one patient was lost to follow-up). The three venous ulcers healed, and leg edema was resolved in all cases. Complications One small nonocclusive deep venous thrombosis; three episodes of coil displacement. All episodes occurred early in our experience, before starting to anchor the first coil into a tributary vein. One of the patients had transient fever and myalgia immediately after the procedure.Symptomatic superficial vein thrombosis was noticed in two of the patients. There were no episodes of pulmonary embolism and no deaths. 4 Authors Marco Viani, Giacomo Viani, Jessiva Sergenti Title One-Shot Scleroembolization: A New Technique for the Treatment of Varicose Veins Disease of Lower Extremities. Preliminary Results Journal Phlebology 2014;29:694-7 Methods Prospective case seriesStandard platinum coil (0.035-inch fibered platinum coil; Boston Scientific, Marlborough, Mass) 1 mm wider than the caliber of saphenofemoral junction in standing position, under echographic controlWith scleroembolization of the great saphenous vein with lauromacrogol 2% foam. Results N = 9; 2 women, 7 men; mean age, 63.5 yearsOcclusion of the GSV trunk was immediately obtained in all patients.Painless. Symptoms of varicose veins resolved in all patients perioperatively.At 3 months, complete occlusion of the great saphenous vein was maintained in eight of nine cases. Complications Recanalization of the saphenous shaft in one patient 1 week after treatment, and this was successfully treated with a foam injection.No instances of coil migration or compression of the common femoral vein at 3 months of follow-up using ultrasound.No deep venous thromboses were observed. GSV, Great saphenous vein. Open table in a new tab GSV, Great saphenous vein.

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