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Braz J Med Biol Res. 2019 Apr 8;52(4):e8330. doi: 10.1590/1414-431X20198330.

Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency.

Author information

1
1st Surgery Clinic, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
2
TopMed Medical Center, Tîrgu Mureş, Romania.
3
Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
4
Center of Advanced Research in Multimodality Cardiovascular Imaging, CardioMed Medical Center, Tîrgu Mureş, Romania.
5
Faculty of Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.
6
Department of Anatomy, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.

Abstract

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.

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