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Cryotherapy for venous insufficiency:a Korean Study

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    Walid Haddad MD, Contributing author to Vein News and www.VeinsVeinsVeins.com 
    Fellow, King Abdl-Aziz University Hospital 

    Experience with Cryosurgery for Varicose Veins
    What is cryosurgery?
    Dr. Karamanoukian: The National Cancer Institute gives a good description of cryosurgery. Cryosurgery (also called cryotherapy) is the use of extreme cold produced by liquid nitrogen (or argon gas) to destroy abnormal tissue.  
    What are the common options for the treatment of of venous insufficiency?
    Dr. Karamanoukian: The endovenous ablation procedures are most commonly used today to treat venous insufficiency. This included VNUS Closure, EVLT laser and the mechanochemical version, ClariVein, Varithena and VenaSweal.  We are fortunate to have 3 modalities to treat truncal venous insufficiency at the Vein Treatment Center.  They include VenaSea, EVLT and Venefit (VNus Closure). 
    What did this study look at ? 
    Dr. Karamanoukian: This study looked at the treatment of venous insufficiency originating at the saphenofemoral junction (groin) and the role of cryosurgery in treating this condition. The study authors compared surgical vein stripping to cryosurgery assisted stripping of the great saphenous vein.  
    Are these invasive procedures and are they done in the hospital?
    Dr. Karamanoukian: The study authors achieved to discharge patients the same day and in some circumstances, kept patients in the hospital for more than a day. 
    What did they do exactly with cryosurgery?
    Dr. Karamanoukian:  The surgeons made a single incision in the groin and ligated and divided the confluence of the great saphenous vein with the femoral vein. This part of the procedure is called 'ligation' and is the 'ligation part of the ligation and stripping procedure'. The next step was to remove the great saphenous vein with a rigid cryoprobe using tumescent anesthesia. 
    How is the proximal end treated?
    Dr. Karamanoukian:  To reduce the likelihood of neovascularization (late failure) at the groin and upper thigh, the proximal stump of the ligated great saphenous vein was treated with cryotherapy.
    What were the outcomes of this study?
    Dr. Karamanoukian: The authors show that unlike convenitonal surgical ligation and stripping, cryosurgical therapy does not require additional incisions in the leg. They also believe that cryosurgey eliminates (by cold destruction of tissue) the entirety of the great saphenous vein before extraction, reducing the likelihood of neovascularization. 
    Would you say these types of procedures are applicable in the United States?
    Dr. Karamanoukian: No. As long as we have endovenous ablation procedures (EVLT, VNUS, ClariVein), are surgical ligation and stripping or cryosurgical ligation and stripping is not necessary. 
    Here is the link to the article by Eun Jue Yi et al. Korean Journal of Thoracic and Cardiovascular Surgery, volume 45, pages 155-160. 
    Learn more about Dr. Karamanoukian's procedures to treat venous insufficiency at www.VeinsVeinsVeins.com