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Title: The role of endovenous thermal ablation in the treatment of varicose veins
Author: Shepherd, Amanda Claire
ISNI:       0000 0004 2709 4879
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2011
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Varicose veins are a common problem affecting approximately 30% of the Western population. The majority of patients present to secondary care complaining of a number of commonly experienced symptoms, however, some present with severe complications of venous disease including venous ulceration. For hundreds of years varicose veins have been treated with compression and surgery. In the last decade, technological advances have lead to the introduction of minimally invasive therapies for varicose veins, with the aim of providing rapid treatment with minimum discomfort to the patient at acceptable cost to the healthcare provider. This study examined the current use of endovenous ablation procedures in the United Kingdom amongst consultant vascular surgeons using an online questionnaire and also explored the patient’s views regarding treatment of varicose veins and potential therapeutic options. Prior to conducting a randomised clinical trial comparing early outcomes following laser and radiofrequency ablation in patients with primary varicose veins, an observational pilot study was carried out in the department. In parallel, the use of disease specific quality of life tools were compared to clinical, anatomical and haemodynamic outcome measures in this cohort of patients. The findings of the study have shown that although endovenous ablation procedures appear to be increasing in popularity, traditional surgery remains the most frequently performed procedure. Overall, patients overall have little knowledge of potential treatment options and the majority would be in favour of a single treatment under a local anaesthetic. However, most would be strongly influenced by the advice and opinion of the surgeon to whom they were referred. Results from the pilot study and a randomised clinical trial showed that radiofrequency ablation is significantly less painful than laser ablation for up to 10 days post procedure. Clinical improvements and gains in quality of life were significantly improved at 6 weeks and 6 months post intervention compared with baseline scores and were comparable between the groups. No significant difference was observed in anatomical outcomes between the two treatments. Although radiofrequency may be less painful than laser ablation, both endovenous thermal ablation treatments result in significant improvements in quality of life and are likely to become increasingly popular in the future.
Supervisor: Davies, Alun ; Gohel, Manjit Sponsor: Mason Medical Research Group ; Royal Society of Medicine
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral