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The VANISH-2 Study: A Randomized, Blinded, Multicenter Study to Evaluate the Efficacy and Safety of Polidocanol Endovenous Microfoam 0.5% and 1.0% Compared with Placebo for the Treatment of Saphenofemoral Junction Incompetence
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
This trial also demonstrated excellent symptom relief and appearance following this nonthermal, nontumescent method for treating patients with incompetent, symptomatic varicose veins. Several instruments for measuring patient satisfaction and symptomatic improvement were utilized and all demonstrated a statistically and clinically significant improvement in patients with chemical ablation compared with placebo. Although already considered a “noninvasive” technique, thermal (radiofrequency and laser) ablation requires injection with a spinal of tumescent solution to the subcutaneous tissue surrounding the GSV. Chemical ablation not only eliminates the risk of thermal spread to the surrounding tissues, it does not require injection of tumescent fluid which may significantly increase the discomfort to patients undergoing radiofrequency or laser ablation.
Ventricular arrhythmias in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Jason T. Jacobson, Sei Iwai, Wilbert S. Aronow
Catheter ablation offers a minimally invasive approach with less morbidity and has largely supplanted surgical resection. The most current ablation techniques consist of extensive ablation targeting all signals that display evidence of slow conduction in the hope of interrupting all possible VT circuits. The complete elimination of all these sites, both endocardially and epicardially does show promise and does predict long term success independent of non-inducibility of VT at the end of a procedure (119,120).
Venous disorders
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Endothermal ablation technologies replaced surgical ligation and stripping as the gold standard treatment once randomised trials demonstrated that they were marginally safer, have extremely high technical efficacy, offer superior quality of life post procedure (with a rapid recovery) and equivalent improvements in quality of life in the longer term. The techniques are cost effective as they can be performed as an outpatient under local anaesthetic. The basic concept is that a treatment device is inserted into the incompetent axial vein percutaneously. The vein is surrounded by tumescent local anaesthetic solution. This compresses the vein onto the treatment device, emptying it of blood. It also hydro-dissects tissues such as nerves away from the zone of injury. Finally, it acts as a heat sink, mopping up excess thermal energy to prevent remote damage. The treatment device then produces thermal energy that destroys the structure of the vein, resulting in permanent occlusion. Two broad technologies exist: laser and radiofrequency ablation.
Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment
Published in International Journal of Hyperthermia, 2022
Yuan-Mao Lin, Reto Bale, Kristy K. Brock, Bruno C. Odisio
The role of anesthetic techniques in ablation is critical since it reduces the pain, anxiety, and patient’s movements during the procedure, therefore facilitating tumor targeting and potentially improving ablation outcomes [75]. Several anesthetic methods are used, such as general anesthesia, and sedation using fentanyl, midazolam, or propofol. General anesthesia is preferred because of controllable respiration during the procedure. Adjunctive methods such as intermittent breath-hold during probe placement, low tidal volume settings, and high-frequency jet ventilation can also be applied with that intent [16,27,76]. Precise respiratory triggering is mandatory if stereotactic techniques are used [66]. On a recent retrospective analysis by Puijk et al of 90 patients submitted to 114 ablation procedures under general anesthesia (n = 22), midazolam (n = 32), or propofol (n = 60), authors reported that sedation with propofol and general anesthesia was associated with better local tumor control than sedation with midazolam, providing local tumor progression rates of 4.3%, 5.7%, and 45.2%, respectively (p < 0.001) [77].
Microwave ablation of lung malignancies with coexisting severe emphysema: a retrospective analysis of safety and efficacy in 26 patients
Published in International Journal of Hyperthermia, 2021
Jinzhao Peng, Zhixin Bie, Yuanming Li, Bin Li, Runqi Guo, Chengen Wang, Xiaoguang Li
All patients were hospitalized for MWA and observation. A non-enhanced chest CT scan was routinely performed immediately after ablation, to assess whether the tumor was completely ablated and to check for possible complications. If the ablation was deemed complete and no urgent management of complications was needed, the patient was transferred to the inpatient ward and observed. All patients were advised absolute bed rest without special positioning maneuvers, and vital signs were monitored with electrocardiography in 8 h after ablation, including heart rate, blood pressure, and pulse oximetry. Prophylactic antibiotics were not routinely administered after MWA; only three patients were administered antibiotics after ablation owing to a diagnosis of pulmonary infection, which was established from the clinical symptoms, including high fever and radiological findings. A non-enhanced chest CT scan was then individually performed 24–48 h after the procedure to assess for changes and check for subtle complications. If no complications were requiring further treatment, the patients were usually discharged 2–3 days after the ablation procedure. After discharge from the hospital, contrast-enhanced CT follow-up imaging was performed at 1, 3, 6 and 12 months post-ablation and every 6 months thereafter. The images obtained 1-month post-ablation were considered the baseline scans, with which subsequent images were compared. Data pertaining to complications and efficacy were recorded.
Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis
Published in International Journal of Hyperthermia, 2020
Yuan Fei, Yuxuan Qiu, Dong Huang, Zhichao Xing, Zhe Li, Anping Su, Jingqiang Zhu
The ‘image-guided ablation’ has been proposed for the last two decades as treatment of benign nodules that required treatment and plays an increasingly crucial role in the management of thyroid nodules [4]. Compared with surgery, image-guided ablation has been proved to be effective and safe to relieve compressing symptoms and meet patients’ requirements for treatment without scars, especially for young or female patients [5]. The types of ablation include chemical ablation and energy-based ablation. The latter consists of radiofrequency ablation (RFA), laser ablation (LA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU), and medical centers adopt different technologies. As the number of patients treated with energy-based ablation increased, the complications, side effects, and risks have been also observed. Pain is the most common complaint. Additionally, voice changes, perithyroidal hemorrhage, hematoma, and skin burn may also occur. Therefore, full informed consent was routinely required at pre-ablation [6]. Recently, the effects of energy-based ablation on thyroid function have gained wide concern.