Bos, R.R. van den

Orf-induced pemphigoid with antilaminin-332 antibodies (Article)

2012-10-01T00:00:00Z

Endovenous treatments for varicose veins (Doctoral Thesis)

2011-06-22T00:00:00Z

Endovenous treatment is currently one of the most frequently used methods for treating varicose veins in the Netherlands. Varicose veins are tortuous and enlarged veins due to weakening in the vein’s wall or valves. They are manifestations of chronic venous disease (CVD), which may lead to serious complications.

Temperature measurements for dose-finding in steam ablation (Article)

2011-05-01T00:00:00Z

Laser fibre stabs the catheter: A serious complication of endovenous laser ablation (Article)

2011-04-01T00:00:00Z

An 82-year-old woman was treated with endovenous laser ablation for insufficiency of the right great saphenous vein. Because of a very thick layer of subcutaneous fat, puncturing the vein and introducing the laser fibre was difficult. The patient reported pain after activation of the laser. Subsequently, the procedure was discontinued and the catheter was removed. Inspection of the disposables showed that the laser fibre had punctured the catheter and was therefore located outside the lumen. Fortunately, there were no harmful sequelae in this case, but as device-related complications of EVLA are serious, reporting them is important.

Proof-of-principle study of steam ablation as novel thermal therapy for saphenous varicose veins (Article)

2011-01-01T00:00:00Z

Introduction During the last decade, thermal ablation techniques such as endovenous laser ablation have been challenging the position of traditional surgery for the treatment of saphenous varicose veins. The newest method of thermal ablation is pulsated steam, which works by heating the vein with steam at 120°C. This study assessed the effectiveness of steam ablation of varicose veins in sheep and in humans. Methods The safety of the procedure in sheep was assessed by cardiovascular monitoring during treatment. We used ultrasound imaging to examine occlusion of the veins. Changes in treated veins were examined microscopically. In a pilot study, 20 veins in 19 patients with insufficiency of the great or the small saphenous vein were treated with pulsated steam ablation. Anatomic success, patient satisfaction, and complications were investigated for 6 months after the procedure. Results All veins in the sheep were occluded. No cardiovascular changes occurred during treatment. Histologic examination of treated veins showed typical changes of the vein wall, such as disappearance of the endothelial layer, fibrotic thrombosis, and major alterations in collagen fibers in the media. Steam ablation was effective in the 19 patients: 13 of 20 veins were completely closed, and 7 showed a very small segment of recanalization after 6 months of follow-up that did not seem to be clinically relevant. Nine patients had some ecchymoses at the puncture site, and one patient had a transient superficial phlebitis. A median maximal pain score of 1 (range, 0-10) was reported. No serious side effects, such as deep vein thrombosis, nerve injury, skin burns, or infections, were reported. Patients were very satisfied with the treatment, with a median satisfaction score of 9.25 (range, 0-10). Conclusions In this proof-of-principle study, pulsated steam ablation was an effective treatment for saphenous varicose veins.

The heat-pipe resembling action of boiling bubbles in endovenous laser ablation (Article)

2010-11-01T00:00:00Z

Endovenous laser ablation (EVLA) produces boiling bubbles emerging from pores within the hot fiber tip and traveling over a distal length of about 20 mm before condensing. This evaporation-condensation mechanism makes the vein act like a heat pipe, where very efficient heat transport maintains a constant temperature, the saturation temperature of 100°C, over the volume where these non-condensing bubbles exist. During EVLA the above-mentioned observations indicate that a venous cylindrical volume with a length of about 20 mm is kept at 100°C. Pullback velocities of a few mm/s then cause at least the upper part of the treated vein wall to remain close to 100°C for a time sufficient to cause irreversible injury. In conclusion, we propose that the mechanism of action of boiling bubbles during EVLA is an efficient heat-pipe resembling way of heating of the vein wall.

Carbonized blood deposited on fibres during 810, 940 and 1,470 nm Endovenous laser ablation: thickness and absorption by optical coherence tomography (Article)

2010-05-01T00:00:00Z

Endovenous laser ablation (EVLA) is commonly used to treat saphenous varicosities. Very high temperatures at the laser fibre tip have been reported during EVLA. We hypothesized that the laser irradiation deposits a layer of strongly absorbing carbonized blood of very high temperature on the fibre tip. We sought to prove the existence of these layers and study their properties by optical transmission, optical coherence tomography (OCT) and microscopy. We analysed 23 EVLA fibres, 8 used at 810 nm, 7 at 940 nm and 8 at 1,470 nm.We measured the transmission of these fibres in two wavelength bands (450-950 nm; 950-1,650 nm). We used 1,310 nm OCT to assess the thickness of the layers and the attenuation as a function of depth to determine the absorption coefficient. Microscopy was used to view the tip surface. All fibres showed a slightly increasing transmission with wavelength in the 450-950 nm band, and a virtually wavelength-independent transmission in the 950-1,650 nm band. OCT scans showed a thin layer deposited on all 13 fibres investigated, 6 used at 810 nm, 4 at 940 nm and 3 at 1,470 nm, some with inhomogeneities over the tip area. The average absorption coefficient of the 13 layers was 72± 16 mm-1. The average layer thickness estimated from the transmission and absorption measurements was 8.0±2.7 μm. From the OCT data, the average maximal thickness was 26± 6 μm. Microscopy of three fibre tips, one for each EVLA wavelength, showed rough, cracked and sometimes seriously damaged tip surfaces. There was no clear correlation between the properties of the layers and the EVLA parameters such as wavelength, except for a positive correlation between layer thickness and total delivered energy. In conclusion, we found strong evidence that all EVLA procedures in blood filled veins deposit a heavily absorbing hot layer of carbonized blood on the fibre tip, with concomitant tip damage. This major EVLA mechanism is unlikely to have much wavelength dependence at similar delivered energies per centimetre of vein. Optical-thermal interaction between the vein wall and the transmitted laser light depends on wavelength.

A New Gold Standard for Varicose Vein Treatment? (Article)

2010-01-01T00:00:00Z

Treatment of incompetent perforating veins using the radiofrequency ablation stylet: A pilot study (Article)

2009-10-01T00:00:00Z

Background: Although the role of incompetent perforating veins (IPV) in chronic venous insufficiency remains controversial, they are often treated by surgical or by minimal invasive techniques. Objectives: To describe the procedure of radiofrequency ablation (RFA) of IPV and to evaluate its short-term effectiveness and safety. Methods: In a clinical pilot study, 14 IPV in 12 patients were treated with a radiofrequency stylet. After three months, ultrasound (US) examination was used to assess anatomical success rate and exclude deep venous thrombosis. Also, self-reported side-effects were investigated. Results: Of the 14 treated IPV, nine (64%) were obliterated on US examination and the others showed remaining reflux. Two patients reported localized paresthesia, but no deep venous thrombosis was recorded. Conclusion: RFA of IPV may be a promising procedure, but patient and incompetent perforator vein selection is important and further standardization of the procedure is required. Comparative clinical trials between RFA and other therapies are warranted.

Endovenous laser ablation-induced complications: Review of the literature and new cases (Article)

2009-08-01T00:00:00Z

BACKGROUND In the last decade, minimally invasive techniques have been introduced in the treatment of lower extremity varicosities. Of these therapies, endovenous laser ablation is the most widely accepted and used treatment option for insufficient great and short saphenous veins. OBJECTIVE To present a review of reported common and rare and minor and major complications associated with endovenous laser ablation. METHODS A systematic review of studies and case reports on endovenous laser ablation-induced complications. The complications were classified as minor or major according to the Society of Interventional Radiology Standards of Practice Committee guidelines on reporting complications. A case-series of complications after endovenous laser ablation is presented. RESULTS Ecchymoses and pain are frequently reported side effects of endovenous laser ablation. Nerve injury, skin burns, deep vein thrombosis and pulmonary embolism seldom occur. An exceptional complication is a material or device that by accident remains inside the body after the procedure. Ecchymosis, pain, induration, skin burns, dysesthesia, superficial thrombophlebitis, and hematoma were classified as minor complications. Deep vein thrombosis and nerve injury were classified as major complications. CONCLUSION Endovenous laser ablation may be considered a safe treatment of lower extremity varicosities. The incidence of common side effects may decrease with better laser parameters. The authors have indicated no significant interest with commercial supporters.

Heat conduction from the exceedingly hot fiber tip contributes to the endovenous laser ablation of varicose veins (Article)

2009-03-01T00:00:00Z

Lower-extremity venous insufficiency is a common condition, associated with considerable health care costs. Endovenous laser ablation is increasingly used as therapy, but its mechanism of action is insufficiently understood. Here, direct absorption of the laser light, collapsing steam bubbles and direct fiber-wall contact have all been mentioned as contributing mechanisms. Because fiber tips have reported temperatures of 800-1,300°C during endovenous laser ablation, we sought to assess whether heat conduction from the hot tip could cause irreversible thermal injury to the venous wall. We approximated the hot fiber tip as a sphere with diameter equal to the fiber diameter, having a steady state temperature of 800°C or 1,000°C. We computed venous wall temperatures due to heat conduction from this hot sphere, varying the pullback velocity of the fiber and the diameter of the vein. Venous wall temperatures corresponding to irreversible injury resulted for a 3 mm diameter vein and pullback velocities <3 mm/s but not for 5 mm and 1 mm/s. The highest wall temperature corresponded to the position on the wall closest to the fiber tip, hence it moves longitudinally in parallel with the moving fiber tip. We concluded that heat conduction from the hot fiber tip is a contributing mechanism in endovenous laser ablation.

Endovenous therapies of lower extremity varicosities: A meta-analysis (Article)

2009-01-01T00:00:00Z

Background: Minimally invasive techniques such as endovenous laser therapy, radiofrequency ablation, and ultrasound-guided foam sclerotherapy are widely used in the treatment of lower extremity varicosities. These therapies have not yet been compared with surgical ligation and stripping in large randomized clinical trials. Methods: A systematic review of Medline, Cochrane Library, and Cinahl was performed to identify studies on the effectiveness of the four therapies up to February 2007. All clinical studies (open, noncomparative, and randomized clinical trials) that used ultrasound examination as an outcome measure were included. Because observational and randomized clinical trial data were included, both the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Quality Of Reporting Of Meta-analyses (QUORUM) guidelines were consulted. A random effects meta-analysis was performed, and subgroup analysis and meta-regression were done to explore sources of between-study variation. Results: Of the 119 retrieved studies, 64 (53.8%) were eligible and assessed 12,320 limbs. Average follow-up was 32.2 months. After 3 years, the estimated pooled success rates (with 95% confidence intervals [CI]) for stripping, foam sclerotherapy, radiofrequency ablation, and laser therapy were about 78% (70%-84%), 77% (69%-84%), 84% (75%-90%), and 94% (87%-98%), respectively. After adjusting for follow-up, foam therapy and radiofrequency ablation were as effective as surgical stripping (adjusted odds ratio [AOR], 0.12 [95% CI, -0.61 to 0.85] and 0.43 [95% CI, -0.19 to 1.04], respectively). Endovenous laser therapy was significantly more effective compared with stripping (AOR, 1.13; 95% CI, 0.40-1.87), foam therapy (AOR, 1.02; 95% CI, 0.28-1.75), and radiofrequency ablation (AOR, 0.71; 95% CI, 0.15-1.27). Conclusion: In the absence of large, comparative randomized clinical trials, the minimally invasive techniques appear to be at least as effective as surgery in the treatment of lower extremity varicose veins.

Minimally invasive techniques in the treatment of saphenous varicose veins (Article)

2009-01-01T00:00:00Z

Lower extremity venous insufficiency is common and increases with age. In addition to classical symptoms, it may result in skin changes and venous ulcers. Chronic venous insufficiency has a great impact on patients' health-related quality of life and is associated with considerable health care costs. Surgical ligation of the junction with or without stripping has been the standard of care in the treatment of insufficient great and small saphenous veins. However, the recurrence rates are relatively high and surgery may be associated with serious adverse events and considerable down time; it is also cosmetically suboptimal. To improve efficacy, patients' health-related quality of life and treatment satisfaction and to reduce serious side effects, costs, and postoperative pain, several minimally invasive techniques have been introduced in the last decade. Dermatologists have played an important role in the development of these new therapies of truncal varicose veins. Of the new therapies, ultrasound-guided foam sclerotherapy, endovenous laser therapy, and radiofrequency ablation are the most common and challenge surgery as the "gold standard" of care for patients with varicose veins. The objective of this review is to inform clinicians about these 3 therapeutic options for truncal varicose veins and to describe and compare the procedures, indications, efficacy, and safety profile.

Technical Review of Endovenous Laser Therapy for Varicose Veins (Article)

2008-01-01T00:00:00Z

Background: In the last decade, several new treatments of truncal varicose veins have been introduced. Of these new therapies, endovenous laser therapy (EVLT) is one of the most widely accepted and used treatment options for incompetent greater and lesser saphenous veins. Objective: The objective of this report is to inform clinicians about the EVLT procedure and to review its efficacy and safety in treatment of truncal varicose veins. Also, we discuss some of the underlying theoretical principles and laser parameters that affect EVLT. Methods: We carried out a literature review of EVLT`s efficacy and safety. We included reports that included 100 or more limbs with a follow-up of at least 3 months. The principals and procedure of EVLT are described. Of the laser parameters, mode of administration, wavelength, fluence, wattage and pullback speed are discussed. Conclusion: EVLT appears to be a very effective and safe option in the treatment of varicose veins but large randomized comparative studies are needed.

Persistent high-risk sexual behaviour in men who have sex with men after symptomatic lymphogranuloma venereum proctitis (Article)

2007-10-01T00:00:00Z

In this brief paper, we report persistent high-risk sexual behaviour in a group of men who have sex with men (MSM) after symptomatic lymphogranuloma venereum (LGV) proctitis. Patient records were retrospectively studied and the number of newly acquired sexually transmitted disease (STD) was investigated. It was concluded that a high number of MSM (65%) contracted an STD relatively shortly after the diagnosis of LGV proctitis.

Condoms do not cover everything: An unusual presentation of herpes simplex virus-2 infection (Article)

2007-04-01T00:00:00Z

We report on a patient who presented with an unusual manifestation of primary herpes simplex virus (HSV) infection. Furthermore, this case again shows that even the correct use of a condom has limited protecting value. We emphasize the usefulness of informing patients carefully about transmission risks of HSV.

The CHEK2 1100delC mutation identifies families with a hereditary breast and colorectal cancer phenotype (Article)

2003-01-01T00:00:00Z

Because of genetic heterogeneity, the identification of breast cancer-susceptibility genes has proven to be exceedingly difficult. Here, we define a new subset of families with breast cancer characterized by the presence of colorectal cancer cases. The 1100delC variant of the cell cycle checkpoint kinase CHEK2 gene was present in 18% of 55 families with hereditary breast and colorectal cancer (HBCC) as compared with 4% of 380 families with non-HBCC (P<.001), thus providing genetic evidence for the HBCC phenotype. The CHEK2 1100delC mutation was, however, not the major predisposing factor for the HBCC phenotype but appeared to act in synergy with another, as-yet-unknown susceptibility gene(s). The unequivocal definition of the HBCC phenotype opens new avenues to search for this putative HBCC-susceptibility gene.