Aims and objectives
Based on theoretical considerations injectable hyaluronan gels offer three options to treat venous insufficiency: 1)Percutaneous valvuloplasty (PVP),
aiming at the restoration of local valve function in insufficient veins with still intact and mobile valvular structures (Fig.1/2).
2) Focal venoplasty (FVP),
aiming to produce a focal diameter reduction independent of valvular structures in order to reduce reflux (Fig.3/4).
3) Segmental venoplasty (SVP),determined to replace the standard saline tumescent technique by producing a long-term and long-distance diameter reduction as an adjunct to endoluminal procedures for saphenous veins...
Methods and materials
PVP was studied in 22 patients with the aim to treat insufficient terminal or preterminal GSV valves (14 f,
32 – 54 y.,
GSV diameter 7.0 – 12.0 mm),
using a prototype hyaluronan (XL type,
FVP was evaluated in 16 patients (11 f,
46 – 69 y.) for reflux reduction in GSV or sidebranch insufficiency (L-type,
SVP was investigated in 20 cases (13 f,
41 – 72 yrs.) with GSV or SSV insufficiency,...
PVP established orthograde flow in 22/22 cases without recurrencewithin the follow-up of 26 weeks.With FVP,
13/16 cases were successful (81.3%) in obtaining alternate (n = 10) or orthograde flow (n = 4) in veins previously showing distinct reflux and dilation,correlating well with clinical improvement.
technical success(> 50% lumen reduction) was obtained in all cases (20/20).
In the hyaluronan compressed segments no postinterventional complaints where notified compared to 18/20 cases (90%) after standard procedures.
All hyaluronan applications were without adverse reactions.
Perivenous injections of hyaluronic acid is a new but promising tool in the field of interventional phlebology.
PVP is effective and safe to restore valve function for the treatment of early stages of the venous insufficiency.
as atreatment optionfor reflux reduction in GSV or sidebranch insufficiency,independent of valve function showed feasibility,
effectivity and safety,
while clear indications need further studies. For both procedures it remains to be seen whether long-term necessary re-treatment will be accepted as itis already practiced in aesthetic dermatology.SVP,
Proceedings in Percutaneous Valvuloplasty JVS-VL 2017,
Continued percutaneous valvuloplasty development “is promising”.
17th November 2017
Ragg JC et al.
Novel Biomatrix Sclerofoam: Equal to or Better Than Thermo-Occlusion? Journal of Vascular Surgery: Venous and Lymphatic Disorders 2017,