Varicose Vein Surgery Guidelines

1. Royle J, Somjen GM. Varicose veins: Hippocrates to Jerry Moore. ANZ J Surg. 2007 Dec. 77 (12):1120-7. [Medline].

2. Shami SK, Sarin S, Cheatle TR, Scurr JH, Smith PD. Venous ulcers and the superficial venous system. J Vasc Surg. 1993 Mar. 17 (3):487-90. [Medline].

3. Recek C. Conception of the venous hemodynamics in the lower extremity. Angiology. 2006 Oct-Nov. 57 (5):556-63. [Medline].

4. Weiss RA, Feied CF, Weiss MA. Vein Diagnosis & Treatment: A Comprehensive Approach. New York: McGraw-Hill; 2001.

5. Dawson DL, Ronningen E. Vascular laboratory: venous duplex scanning. Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia: Elsevier; 2019. 246-64.

6. Sales CM, Bilof ML, Petrillo KA, Luka NL. Correction of lower extremity deep venous incompetence by ablation of superficial venous reflux. Ann Vasc Surg. 1996 Mar. 10 (2):186-9. [Medline].

7. Coon WW, Willis PW 3rd, Keller JB. Venous thromboembolism and other venous disease in the Tecumseh community health study. Circulation. 1973 Oct. 48 (4):839-46. [Medline].

8. Callam MJ. Epidemiology of varicose veins. Br J Surg. 1994 Feb. 81 (2):167-73. [Medline].

9. Carpentier PH, Maricq HR, Biro C, Ponçot-Makinen CO, Franco A. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg. 2004 Oct. 40 (4):650-9. [Medline].

10. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003 Aug. 38 (2):207-14. [Medline].

11. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005 Jan. 29 (1):67-73. [Medline].

12. Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 2007 Aug. 46 (2):308-15. [Medline].

13. Carradice D, Mekako AI, Mazari FA, Samuel N, Hatfield J, Chetter IC. Clinical and technical outcomes from a randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg. 2011 Aug. 98 (8):1117-23. [Medline].

14. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug. 98 (8):1079-87. [Medline].

15. Wright D, Gobin JP, Bradbury AW, Coleridge-Smith P, Spoelstra H, Berridge D, et al. Varisolve® polidocanol microfoam compared with surgery or sclerotherapy in the management of varicose veins in the presence of trunk vein incompetence: European randomized controlled trial. Phlebology. 2006. 21:180-90. [Full Text].

16. Obi AT, Reames BN, Rook TJ, Mouch SO, Zarinsefat A, Stabler C, et al. Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities. Phlebology. 2016 Oct. 31 (9):618-24. [Medline].

17. Rass K, Frings N, Glowacki P, Gräber S, Tilgen W, Vogt T. Same Site Recurrence is More Frequent After Endovenous Laser Ablation Compared with High Ligation and Stripping of the Great Saphenous Vein: 5 year Results of a Randomized Clinical Trial (RELACS Study). Eur J Vasc Endovasc Surg. 2015 Nov. 50 (5):648-56. [Medline].

18. van der Velden SK, Biemans AA, De Maeseneer MG, Kockaert MA, Cuypers PW, Hollestein LM, et al. Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins. Br J Surg. 2015 Sep. 102 (10):1184-94. [Medline].

19. Nesbitt C, Bedenis R, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus open surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2014 Jul 30. CD005624. [Medline].

20. Paravastu SC, Horne M, Dodd PD. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016 Nov 29. 11:CD010878. [Medline].

21. Wallace T, El-Sheikha J, Nandhra S, Leung C, Mohamed A, Harwood A, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018 Dec. 105 (13):1759-1767. [Medline].

22. Brittenden J, Cooper D, Dimitrova M, Scotland G, Cotton SC, Elders A, et al. Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. N Engl J Med. 2019 Sep 5. 381 (10):912-922. [Medline].

23. Mohammadi Tofigh A, Tahmasebi H, Zebarjadi J. Comparing the Success Rate and Side Effects of Endovenous Laser Ablation and Radiofrequency Ablation to Treat Varicose Veins in the Lower Limbs: A Randomized Clinical Trial. J Lasers Med Sci. 2020 Fall. 11 (Suppl 1):S43-S48. [Medline]. [Full Text].

24. Hafner J, Ramelet AA, Schmeller W, Brunner UV, eds. Management of Leg Ulcers. New York: Karger; 1999.

25. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004 Dec. 40 (6):1248-52. [Medline].

26. Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020 May. 8 (3):342-352. [Medline].

27. Naoum JJ, Hunter GC. Pathogenesis of varicose veins and implications for clinical management. Vascular. 2007 Sep-Oct. 15 (5):242-9. [Medline].

28. Biemans AA, Kockaert M, Akkersdijk GP, van den Bos RR, de Maeseneer MG, Cuypers P, et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. J Vasc Surg. 2013 Sep. 58 (3):727-34.e1. [Medline].

29. Kalra M, Gloviczki P. Surgical treatment of venous ulcers: role of subfascial endoscopic perforator vein ligation. Surg Clin North Am. 2003 Jun. 83 (3):671-705. [Medline].

30. Caggiati A, Allegra C. Historical introduction. Bergan JJ, Bunke-Paquette N, eds. The Vein Book. 2nd ed. New York: Oxford University Press; 2014. 3-16.

31. Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg. 1999 Apr. 29 (4):589-92. [Medline].

32. Recek C. The hemodynamic paradox as a phenomenon triggering recurrent reflux in varicose vein disease. Int J Angiol. 2012 Sep. 21 (3):181-6. [Medline]. [Full Text].

33. Johnson CM, McLafferty RB. Endovenous laser ablation of varicose veins: review of current technologies and clinical outcome. Vascular. 2007 Sep-Oct. 15 (5):250-4. [Medline].

34. Subramonia S, Lees T. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg. 2010 Mar. 97 (3):328-36. [Medline].

35. Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular. 2017 Apr. 25 (2):149-156. [Medline].

36. Eroglu E, Yasim A, Ari M, Ekerbicer H, Kocarslan A, Kabalci M, et al. Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate. Phlebology. 2017 Dec. 32 (10):665-669. [Medline].

37. Linn YL, Yap C, Soon S, Chan SL, Khoo V, Chong TT, et al. Registry to investigate the efficacy and safety of the VenaBlock^© VeIn SEaling system for VaRicose veins in SingApore - Six months results of the RIVIERA trial. Phlebology. 2021 Jun 21. 2683555211025181. [Medline].

38. Rabe E, Otto J, Schliephake D, Pannier F. Efficacy and safety of great saphenous vein sclerotherapy using standardised polidocanol foam (ESAF): a randomised controlled multicentre clinical trial. Eur J Vasc Endovasc Surg. 2008 Feb. 35 (2):238-45. [Medline].

39. Varithena [prescribing information]. US Food and Drug Administration. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/205098s000lbl.pdf. November 2013; Accessed: August 4, 2021.

40. O'Hare JL, Stephens J, Parkin D, Earnshaw JJ. Randomized clinical trial of different bandage regimens after foam sclerotherapy for varicose veins. Br J Surg. 2010 May. 97 (5):650-6. [Medline]. [Full Text].

41. [Guideline] Lurie F, Lal BK, Antignani PL, Blebea J, Bush R, Caprini J, et al. Compression therapy after invasive treatment of superficial veins of the lower extremities: Clinical practice guidelines of the American Venous Forum, Society for Vascular Surgery, American College of Phlebology, Society for Vascular Medicine, and International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2019 Jan. 7 (1):17-28. [Medline].

Wesley K Lew, MD Fellow, Department of Vascular Surgery, University of California, Los Angeles

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Integrated Vascular Surgery Residency and Fellowship, Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society

Disclosure: Nothing to disclose.

Fred A Weaver, MD, MMM Professor of Surgery, Chief, Division of Vascular Surgery and Endovascular Therapy, Co-Director USC CardioVascular Thoracic Institute; Keck School of Medicine, University of Southern California

Fred A Weaver, MD, MMM is a member of the following medical societies: Alpha Omega Alpha, American Association for the Surgery of Trauma, American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Phi Beta Kappa, Society for Vascular Surgery, Society of University Surgeons, Western Surgical Association, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery

Disclosure: Received consulting fee from CVRx for review panel membership.

Craig F Feied, MD, FACEP, FAAEM, FACPh Professor of Emergency Medicine, Georgetown University School of Medicine; General Manager, Microsoft Enterprise Health Solutions Group

Craig F Feied, MD, FACEP, FAAEM, FACPh is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Phlebology, American College of Physicians, American Medical Association, American Medical Informatics Association, American Venous Forum, Medical Society of the District of Columbia, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

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