J Vasc Surg Venous Lymphat Disord. 2023 Aug 1:S2213-333X(23)00307-4. doi: 10.1016/j.jvsv.2023.07.009. Online ahead of print.
ABSTRACT
OBJECTIVES: After foam sclerotherapy in the truncal saphenous vein, the clinical impact of additional eccentric compression has not been explored.
METHODS: Between April 2020 and February 2021, we enrolled 42 patients (84 limbs) who underwent bilateral endovenous combined therapy for great saphenous vein (GSV) reflux. Each patient received the same type of endovenous ablation in both above-the-knee GSVs (Laser, Radiofrequency, Cyanoacrylate glue) and combined foam sclerotherapy was performed on both below-knee GSVs. Subsequently, we conducted a prospective randomized, single-blind, within-person study in which each subject’s bilateral truncal saphenous vein of the calves underwent two different compression therapy: regular class II compression stocking on one side (RC group) and additional eccentric compression on the other side (AC group). The primary endpoint was the occlusion range (0-10) of the BK truncal GSV after foam sclerotherapy. The secondary outcomes were the pain score (visual analog scale, VAS, 0-10) of the paired limb, the required numbers of additional foam sclerotherapy, compliance to compression therapy, and procedure-related complications.
RESULTS: For the above-the-knee GSV, endovenous laser treatment (n=44), endovenous radiofrequency ablation (n=14), and endovenous cyanoacrylate procedure (n=26) were performed. The mean sub-compression pressure of the medial calf in the supine and standing position were 16.7± 2.34 and 24.5±6.6 mmHg in the RC group and 38.5±5.5 and 45.3±8.2 mmHg in the AC group, respectively (p=0.000). Secondary outcomes of pain score, numbers of additional UGFS, and pigmentation were not statistically different between the two groups. Patient-reported satisfaction scores on compression (0-10) at postoperative 24 hours were 8.03±1.9 in the AC group and 7.98±1.9 in the RC group (p=0.317, Wilcoxon Signed Ranks Test). In both groups, the closure rate of AK GSV at the post-operative one month was 100%. Regarding procedure-related complications within one month, DVT, numbness, or skin necrosis requiring additional medical attention was not identified.
CONCLUSION: The 24 hours of additional eccentric compression on truncal GSV, compared to the conventional knee-level stocking only, did not yield any clinical advantages in terms of occlusion range, postoperative pain, the need for additional sclerotherapy, and skin pigmentation after foam sclerotherapy. The decision on whether types of compression therapy to perform after foam sclerotherapy in the truncal vein should be comprehensively determined. (https://cris.nih.go.kr/, Clinical Trial Number: KCT 0005605).
PMID:37536560 | DOI:10.1016/j.jvsv.2023.07.009
