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Laser treatment of the incompetent saphenous vein
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Lower extremity varicose vein disorders are most often associated with truncal venous insufficiency involving the saphenous system: the great saphenous vein (GSV), the small saphenous vein (SSV), and/or incompetent major tributaries or perforator veins. Varicose vein disorders have historically been treated with stripping of the saphenous vein and interruption/ligation and removal of the major tributary and perforator veins.1 Since 1999, endovenous thermal ablation procedures have been found to be safe and effective methods of eliminating the proximal portion of the GSV, the SSV, and even tributary and perforating veins from the venous circulation, with faster recovery and better cosmetic results than stripping.2,3 The currently available methods most commonly used to achieve thermal ablation of these incompetent veins are: the Venefit procedure using a radiofrequency (RF) catheter and generator (Medtronic, Minneapolis, MN); the RF-induced thermotherapy procedure using a bipolar RF system (Celon AF Medical Instruments, Teltow, Germany); the endovenous laser ablation procedure using a laser fiber and generator (various manufacturers); and the steam vein sclerosis procedure using heated vaporized water (CERMA SA, Archamps, France). The first three systems use electromagnetic energy, whereas the last utilizes steam. As with a stripping procedure, following these endovenous thermal ablation procedures, it is also necessary to treat any remaining incompetent portion of the GSV and/or SSV, perforating veins, and varicose tributaries, typically with either sclerotherapy and/or phlebectomy.4 This chapter will primarily concern itself with endovenous laser ablation.
US budget impact of increased payer adoption of the Flexitouch advanced pneumatic compression device in lymphedema patients with advanced chronic venous insufficiency and multiple infections
Published in Journal of Medical Economics, 2018
Adam Cohen, Julia A. Gaebler, Jessica Izhakoff, Laura Gullett, Timothy Niecko, Thomas O’Donnell
Three case-matched cohorts were developed from the BHI claims dataset to control for differences in patient characteristics while evaluating the cost of treating patients with CONS + FLX vs each of the other three treatment modalities (CONS, CONS + SPCD, CONS + Other APCD). A stepwise propensity score matching approach was used to account for differences in clinical and demographic characteristics of the study cohorts. Cohorts were matched on Elixhauser comorbidity index components, age, gender, region of country, insurance type, and dummy indicators for the following clinical conditions: breast cancer, melanoma, uterine cancer, ovarian cancer, prostate cancer, cervical cancer, vaginal cancer, vulvar cancer, lymphoma, soft tissue sarcoma, congestive heart failure, CVI, venous leg ulcers, diabetes, iliac vein disorders, pulmonary hypertension, and postphlebitic syndrome. These case-matched comparisons were performed for both the CVI and recurrent infections sub-populations.