Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.643451
Title: Optimising outcomes in the treatment of superficial venous insufficiency
Author: Wallace, Tom
ISNI:       0000 0004 5354 2700
Awarding Body: University of Hull and the University of York
Current Institution: University of Hull
Date of Award: 2014
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Abstract:
The traditional “gold-standard” treatment for symptomatic SVI affecting the GSV is conventional open surgery and stripping under general anaesthesia. Despite improved QoL and cost-effectiveness when compared to conservative management, conventional surgery is not without drawbacks. Endovenous ablative treatments have been developed, which seek to address some of these limitations. Randomised clinical trial (RCT) data has demonstrated the superiority of endovenous laser ablation (EVLA) over surgery in the short term. Attention is now focused on evaluating its mid- and long-term outcomes, and to further evolve the technique to improve patient outcomes. In this thesis, five studies were conceived to address two main objectives. Firstly, two-year follow-up of the HELP-1 RCT of EVLA versus conventional surgery was performed to assess clinical, QoL and duplex ultrasound (DUS) outcomes and identify potential for EVLA technique evolution. Four further studies were performed, aimed at improvement of patient outcomes by modification of the EVLA technique via i) pH buffering of tumescent anaesthesia, ii) concomitant treatment of varicosities, and iii) endovenous energy delivery via longer wavelength laser. Two-year outcomes from the HELP-1 RCT demonstrated continued superiority of EVLA over conventional surgery in terms of lower clinical recurrence rates, with maintained improvements in clinical and QoL outcomes. DUS outcomes identified patterns of clinical recurrence that can be addressed by simple modifications of the EVLA technique. Buffering of tumescent anaesthesia resulted in significantly reduced patient-reported periprocedural pain. Concomitant treatment of varicosities with ambulatory phlebectomy under tumescent anaesthesia demonstrated significant benefits in clinical severity and disease-specific QoL over foam sclerotherapy. Use of longer laser wavelength (1470nm) resulted in significantly reduced postprocedural pain in comparison to shorter (810nm) wavelength. EVLA is demonstrated to have significant short- and medium-term benefits over conventional surgery. Further evolution of the technique, including the modifications described, should provide additional benefit in terms of patient outcomes.
Supervisor: Chetter, Ian Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.643451  DOI: Not available
Keywords: Medicine
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