Optimising endovenous strategies in the management of symptomatic venous incompetence

Venous incompetence represents a significant burden of disease globally. In recent decades the emergence of endovenous ablative techniques have led to a paradigm shift in the management of venous incompetence. These modalities potentially offer significant improvements in venous perioperative and functional outcomes when compared with traditional open surgical approaches. However, despite a range of effective and safe interventional options consensus is lacking with regard to a broadly generalisable interventional strategy for venous incompetence. The aim of this thesis is to improve the endovenous treatment strategies of those undergoing interventions for venous incompetence with a view to enhancing patient outcomes. To achieve this aim the author conducted a series of experiments examining a number of key strategic components of endovenous care. The specific areas examined included the use of high ligation as an adjunct to Great Saphenous Vein ablation, concomitant tributary intervention as an adjunct to saphenous ablation and ultrasound probe orientation during the cannulation process for venous ablative procedures. With regard to the experimental outcomes firstly, the described work suggests that high ligation in addition to saphenous ablation carries no benefit with regard to disease recurrence, rates of reintervention and procedural morbidity. Secondly, concomitant tributary intervention, to saphenous ablation, is associated with a lower rate of reintervention and improvements in early quality of life and disease severity. Thirdly, longitudinal orientation of the ultrasound during venous cannulation offers significantly lower rates of patient reported pain compared to transverse orientation. Clarifications of these contentious aspects of strategy carry the potential to improve the procedural outcomes of these widely performed interventions. This is particularly important given the continued growth and demand for venous interventions. Nonetheless continued strategic development of venous care pathways is required to inform evidence-based decision-making and enhance the reliable and consistent delivery of patient care.

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NUI Galway

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University of Galway Theses (PhD Theses)