The comparison of pain intensity in the patients undergoing thermal and non-thermal ablation of lower extremity veins for chronic venous insufficiency with visual analogue scale

Year 2023, , 161 - 166, 23.03.2023

İlker İnce

https://doi.org/10.18663/tjcl.1244838

Abstract

Aim
To compare the procedural pain intensity measured with VAS in patients undergoing thermal or non-thermal ablation of lower extremity veins for chronic venous insufficiency (CVI).
Material and Method
Patients who underwent a venous procedure, either thermal or non-thermal, in our clinic between June 2022 and December 2022 evaluated for inclusion to this retrospective study. The patients with available complete medical records in the database of the health center were included. Patients who had a history of deep venous thrombosis, thrombophlebitis, a venous intervention or who underwent open surgical venous procedure were excluded. Patients were asked to draw a line representing the intensity of the procedural pain on visual analogue scale (VAS).
Results
A total of 183 patients were evaluated and 60 (100%) patients whom complete medical records were available were included. The non-thermal ablation group included 30 (50%), the thermal ablation group included 30 (50%) patients. There were 14 (46.67%) males in non-thermal ablation group, 12 (40.00%) in thermal ablation group (P=0.602). The mean age in the non-thermal ablation group was 47.10 ± 9.84 years, 44.70 ± 8.84 years in the thermal ablation group (P=0.324). The procedure duration was significantly longer in thermal ablation group (22.70 ± 4.45 min in non-thermal ablation group vs 33.10 ± 3.64 min in thermal ablation group, P<0.001). VAS score was significantly higher in thermal ablation group (46.63 ± 15.76 in non-thermal ablation group vs 61.13 ± 10.65 thermal ablation group, P=0.001).
Conclusion
The endovenous non-thermal ablation of vena saphena magna (VSM) with cyanoacrylate is a more comfortable and less painful alternative for the thermal ablation technique for the patients with CVI.
Keywords: Chronic venous insufficiency; cyanoacrylate; radiofrequency; vena saphena magna; thermal ablation.

The Comparison of Pain intensity in the Patients Undergoing Thermal and Non-Thermal Ablation of Lower Extremity Veins for Chronic Venous Insufficiency with Visual Analogue Scale

Abstract

Aim
To compare the procedural pain intensity measured with VAS in patients undergoing thermal or non-thermal ablation of lower extremity veins for chronic venous insufficiency (CVI).
Material and Method
Patients who underwent a venous procedure, either thermal or non-thermal, in our clinic between June 2022 and December 2022 evaluated for inclusion to this retrospective study. The patients with available complete medical records in the database of the health center were included. Patients who had a history of deep venous thrombosis, thrombophlebitis, a venous intervention or who underwent open surgical venous procedure were excluded. Patients were asked to draw a line representing the intensity of the procedural pain on visual analogue scale (VAS).
Results
A total of 183 patients were evaluated and 60 (100%) patients whom complete medical records were available were included. The non-thermal ablation group included 30 (50%), the thermal ablation group included 30 (50%) patients. There were 14 (46.67%) males in non-thermal ablation group, 12 (40.00%) in thermal ablation group (P=0.602). The mean age in the non-thermal ablation group was 47.10 ± 9.84 years, 44.70 ± 8.84 years in the thermal ablation group (P=0.324). The procedure duration was significantly longer in thermal ablation group (22.70 ± 4.45 min in non-thermal ablation group vs 33.10 ± 3.64 min in thermal ablation group, P<0.001). VAS score was significantly higher in thermal ablation group (46.63 ± 15.76 in non-thermal ablation group vs 61.13 ± 10.65 thermal ablation group, P=0.001).
Conclusion
The endovenous non-thermal ablation of vena saphena magna (VSM) with cyanoacrylate is a more comfortable and less painful alternative for the thermal ablation technique for the patients with CVI.
Keywords: Chronic venous insufficiency; cyanoacrylate; radiofrequency; vena saphena magna; thermal ablation.

Keywords

Chronic Venous Insufficiency, cyanoacrylate, radiofrequency, vena saphena magna

References

• 1. Rabe E, Pannier F, Ko A, Berboth G, Hoffmann B, Hertel S. Incidence of Varicose Veins, Chronic Venous Insufficiency, and Progression of the Disease in the Bonn Vein Study II. J Vasc Surg. 2010; 51: 791.
• 2. Luebke T, Brunkwall J. Cost-effectiveness of endovenous laser ablation of the great saphenous vein in patients with uncomplicated primary varicosis. BMC Cardiovasc Disord. 2015; 15: 138.
• 3. Matić M, Matić A, Gajinov Z, Golušin Z, Prćić S, Jeremić B. Major risk factors for chronic venous disease development in women: is childbirth among them? Women Health. 59: 1118–27.
• 4. Branisteanu D-E, Feodor T, Baila S, Mitea I-A, Vittos O. Impact of chronic venous disease on quality of life: Results of vein alarm study. Exp Ther Med. 2019; 17: 1091–6.
• 5. Roh Y-N. The mechanism and clinical evidence of venoactive drugs. Ann Phlebol. 2019; 17: 18–22.
• 6. Yao P, Mukhdomi T. Varicose Vein Endovenous Laser Therapy [Internet]. Florida: StatPearls Publishing; 2022.
• 7. Almeida JI, Javier JJ, Mackay EG, Bautista C, Cher DJ, Proebstle TM. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology. 2015; 30: 397–404.
• 8. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, 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.
• 9. Yamamoto T, Sakata M. Influence of fibers and wavelengths on the mechanism of action of endovenous laser ablation. J Vasc surgery Venous Lymphat Disord. 2014; 2: 61–9.
• 10. Witte ME, Reijnen MMPJ, de Vries J-P, Zeebregts CJ. Mechanochemical Endovenous Occlusion of Varicose Veins Using the ClariVein® Device. Surg Technol Int. 2015; 26: 219–25.
• 11. Lawson JA, Gauw SA, van Vlijmen CJ, Pronk P, Gaastra MTW, Tangelder MJ, et al. Prospective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc surgery Venous Lymphat Disord. 2018; 6: 31–40.
• 12. Flynn D, van Schaik P, van Wersch A. A Comparison of Multi-Item Likert and Visual Analogue Scales for the Assessment of Transactionally Defined Coping Function1. Eur J Psychol Assess. 2004; 20: 49–58.
• 13. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review. J Pain Symptom Manage. 2011; 41: 1073–93.
• 14. Acipayam M, Zor MH, Altinay L, Uncu H, Kara I, Halici Ü. A comparison of axillary blockage and local anesthesia techniques on autologous arteriovenous fistula flow rates and patient comfort in chronic hemodialysis patients. Turkish J Thorac Cardiovasc Surg. 2013; 21.
• 15. Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Editor’s Choice – Management of Chronic Venous Disease. Eur J Vasc Endovasc Surg. 2015; 49: 678–737.
• 16. Disselhoff BCVM, der Kinderen DJ, Kelder JC, Moll FL. Randomized clinical trial comparing endovenous laser with cryostripping for great saphenous varicose veins. Br J Surg. 2008; 95: 1232–8.
• 17. Carradice D, Mekako AI, Hatfield J, Chetter IC. A randomised trial of EVLT versus surgery for varicose veins. Br J Surg. 2009; 96: 14–14.
• 18. Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC. Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg. 2011; 98: 501–10.
• 19. Darwood RJ, Theivacumar N, Dellagrammaticas D, Mavor AID, Gough MJ. Randomized clinical trial comparing endovenous laser ablation with surgery for the treatment of primary great saphenous varicose veins. Br J Surg. 2008; 95: 294–301.
• 20. Bozkurt AK, Yılmaz MF. A prospective comparison of a new cyanoacrylate glue and laser ablation for the treatment of venous insufficiency. Phlebol J Venous Dis. 2016; 31: 106–13.
• 21. WANG YM, CHENG LF, LI N. Histopathological study of vascular changes after intra-arterial and intravenous injection of N-butyl-2-cyanoacrylate. Chin J Dig Dis. 2006; 7: 175–9.
• 22. Proebstle T. Status of cyanoacrylate glue for saphenous ablation. In: Presented at the 10th International Vein Congress,. Miami, Florida, USA; 2012.
• 23. Morrison N, Gibson K, McEnroe S, Goldman M, King T, Weiss R, et al. Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 2015; 61: 985–94.
• 24. Almeida JI, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency Endovenous ClosureFAST versus Laser Ablation for the Treatment of Great Saphenous Reflux: A Multicenter, Single-blinded, Randomized Study (RECOVERY Study). J Vasc Interv Radiol. 2009; 20: 752–9.
• 25. Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH. Randomized clinical trial of VNUS® ClosureFASTTM radiofrequency ablation versus laser for varicose veins. Br J Surg. 2010; 97: 810–8.
• 26. Nyamekye IK. A practical approach to tumescent local anaesthesia in ambulatory endovenous thermal ablation. Phlebol J Venous Dis. 2019; 34: 238–45.
• 27. Arun O, Oc B, Duman A, Yildirim S, Simsek M, Farsak B, et al. Endovenous Laser Ablation under General Anesthesia for Day Surgery: Feasibility and Outcomes of the 300 Patients. Ann Thorac Cardiovasc Surg. 2014; 20: 55–60.
• 28. Lafçı A, Budak AB. Spinal anesthesia versus general anesthesia with a laryngeal mask airway in patients undergoing radiofrequency ablation for varicose veins. Turkish J Thorac Cardiovasc Surg. 2017; 25: 388–93.