Even though the treatment strategy for rhythm control offers only a limited cure rate, with some antiarrhythmics having a recurrence of AF at one year of around 50%, it is important to consider the long-term effects of the treatment. An editorialist noted that the brief follow-up of subjects assigned to surgery may result in an underestimation of the costs and an exaggeration of the benefits of surgery (van Rij, 200). By the third year, only 40% of the Michaels et al study subjects assigned to surgery were evaluated. However, the editorialist noted that most recurrences are diagnosed after 3 years of age.
Focusing on the short term can lead to underestimating the cost and overestimating the benefit. The editorialist stated that prospective comparisons of durability of up to 5 years or more are rare, and yet at this time the recurrence rate can reach 50%. Sadick (2000) has pointed out that new, less invasive technologies for the treatment of varicose veins must be evaluated with caution. Long-term studies using other technologies should be compared to incompetent SFJ (saphenofemoral junction) surgical ligation. Six-month and five-year follow-ups are two different endpoints.
The latter is a more precise time interval of therapeutic efficacy. Kendler et al. (2000) noted that (r), recently, the use of foam sclerotherapy has had a revival. Several studies have documented the effectiveness of foam sclerotherapy in selected patients. The possibility of treating patients on an outpatient basis, with low costs and speed, makes foam sclerotherapy very attractive compared to invasive and minimally invasive methods.
However, long-term follow-up is needed in properly controlled randomized trials before foam sclerotherapy can be recommended as a routine procedure. Toonder et al. (201) pointed out that percutaneous thermoablation techniques are still in use today and appear to be more effective than non-thermal techniques. However, thermal techniques require anesthesia and can cause inadvertent damage to surrounding tissues, such as nerves. Cyanoacrylate adhesive has a proven track record, but not for treating chronic leg vein disease.
Innovation has led to the development of the VenaSeal Sapheon closure system, which has been designed to use modified cyanoacrylate glue as a new therapy for trunk vein incompetence. These researchers examined the feasibility of ultrasonically guided cyanoacrylate adhesive perforant embolization (CAPE). The authors stated that the results of this feasibility study showed an occlusion rate of 76% of incompetent perforating veins without serious complications; further research with a specific delivery device is necessary in a larger patient population. In a retrospective, single-center comparative study, Zierau (201) reported 5-year results with the Venasea-Closure system in 2,085 veins (1,515 GSV, 570 SSV) versus ablation with RF-induced thermotherapy (RFITT) in 282 veins (181 GSV, 101 SSV). This study compared the advantages and disadvantages of both methods and presented the findings from 5 years of the author's single-center study.
The author recommended sealing the veins in the trunk varices typical of GSV, SSV or VSAA (anterior accessory saphenous vein). This is a single-center retrospective study; it should be noted that the author is the founder and CEO of Saphenion. The authors stated that the comparatively low closure rate observed in the eScope study can be attributed to the inherent limitations of this study, such as the small sample size, which had a high statistical impact of treatment failure in a single patient on GSV closure rates. Another notable factor would be the fact that this device was being used by doctors with no previous experience in cyanoacrylate occlusion, who were selected to participate in this study because of their experience in thermal ablation. Although the analysis of the initial phase of the VeClose trial indicated that the learning curve of using the device was relatively short and that its impact on clinical outcomes was negligible, it was essential to remember that the eScope study began long before the VeClose trial and that almost all of the doctors who participated in the eScope study had no previous contact with cyanoacrylate closure technology.
Prasad et al. (201) noted that recurrent venous insufficiency of the lower extremities is often a challenge in clinical practice and is most commonly due to incompetent drillers. Many of these patients do not have adequate symptom relief with compression and require some type of treatment for incompetent interruption of the perforator. A number of methods have been tried with varying efficiencies. These researchers evaluated the feasibility, safety, and efficacy of combined ambulatory cyanoacrylate and sodium tetradecyl sulfate adhesion sclerotherapy for the treatment of patients with symptoms of persistent or recurrent venous insufficiency of the lower extremities secondary to incompetent perforators.
A total of 83 members of 69 patients with symptoms of persistent or recurrent venous insufficiency of the lower limbs secondary to incompetent perforators were treated with cyanoacrylate, embolization of incompetent perforators and sclerotherapy of dilated collateral veins (varices of the superficial branches).The technical success, pain associated with procedure, perforating occlusion rate, venous occlusion rate, clinical improvement and ulcer healing were evaluated. Follow-up was done 3 and 6 months after procedure. The procedure was successfully performed on all patients; a total 191 perforators were treated. The occlusion rate for both perforating and varicose veins was 100%.
Deep vein expansion due to cyanoacrylate occurred in 4 (4.8%) patients without any adverse clinical results. The clinical venous severity score improved from a baseline value 8.18 ± 3.60 to 4.30 ± 2.48 after 3 months follow-up and 2.42 ± 1.52 after 6 months (p).Radak and colleagues (201) observed that over past 20 years varicose vein surgery underwent great turbulence and several innovations. A number new techniques have been introduced with aim increasing success rates, reducing perioperative complications and improving patients' quality life. The last innovation being CAE technique threatens shake up currently well-established endovenous methods. These researchers analyzed all previous studies by searching Medline database using PubMed.
Although using NBCA glue for medical purposes wasn't new idea but first in vivo and animal experiments with NBCA for vein closure were carried out just at beginning. In St Louis Missouri radiofrequency ablation treatment for vein diseases has been proven effective over time as evidenced by various studies conducted over time which have shown high success rates ranging from 40%, 50%, 76%, up to 100%. This treatment method has been found to be safe when performed by experienced professionals as well as being cost effective when compared to other treatments available for vein diseases. Radiofrequency ablation treatment for vein diseases is an effective way to treat chronic leg vein disease as well as other vein diseases such as varicose veins or venous insufficiency due to incompetent drillers or perforators. This method has been found to be safe when performed by experienced professionals as well as being cost effective when compared to other treatments available for vein diseases. The success rate for radiofrequency ablation treatment for vein diseases in St Louis Missouri is high due to its effectiveness in treating chronic leg vein disease as well as other vein diseases such as varicose veins or venous insufficiency due to incompetent drillers or perforators. In conclusion radiofrequency ablation treatment for vein diseases is an effective way to treat chronic leg vein disease as well as other vein diseases such as varicose veins or venous insufficiency due to incompetent drillers or perforators in St Louis Missouri due its high success rates ranging from 40%, 50%, 76%, up to 100%. This method has been found to be safe when performed by experienced professionals as well as being cost effective when compared to other treatments available for vein diseases.
