ENDOVENOUS ABLATION OF VARICOSE VEINS

Dr.Saurabh Joshi, MD, FNVIR

www.veincenter.in

ABNORMAL FLOW = VENOUS REFLUX

• Superficial vein disease always starts with abnormal valves and interruption to normal flow called venous reflux

PATHOGENESIS OF CVI• Changes in the vein wall destruction of valves

• Thrombosis

• Extra-vascular factors (failure of muscle pump, limited movement in joints, connective tissue disease)

• Congenital venous malformations

INTRODUCTION

Lower limb varicose veins are one of the most common vascular problems encountered in practice.

The most common site for reflux is great saphenous vein (GSV) .

The standard intervention for GSV reflux is Sapheno Femoral junction (SFJ) ligation with GSV stripping.

Radiofrequency ablation (RFA),minimally invasive technique, as an alternative to conventional surgery in varicose vein treatment. RFA operates by resistive heating of the vein wall.

DIAGNOSIS OF VENOUS DISEASE

Physical examAppearanceTrendelenburg testPalpation

Duplex ExaminationR/O DVTSize of veinsMap out superficial veinsLocate the site of refluxReflux 0.5 sec in GSV

1 sec in deep system

Find refluxing perforators

CEAP SCORE

CATEGORY

CLNICAL FEATURES

O No visible or palpable signs of venous disease

I Telangiectases, reticular veins, malleolar flare

II  Varicose veins III Edema

IV Skin changes ascribed to venous disease

V Skin changes in conjunction with healed ulceration

VI Skin changes in conjunction with active ulceration TYPE IV

TYPE II TYPE VTYPE VI

SUBJECTS AND METHODS:

Patient selection criteria: Doppler evidence of incompetent SFJ and reflux into GSV for more than 0.5 seconds were included for treatment.

Exclusion criteria:

1.Deep venous thrombosis,

2.Deep vein reflux

3.Extremely tortuous GSV identified during pre procedure USG,

4.Inability to ambulate

5.Pregnancy.

Power: 20 -250 watts

Application Time

Impedance control

CelonLab POWER radiofrequency generator unit Celon AG Medical

instruments,Teltow,Germany

• Diameter: 2 mm

• Active length: 15 mm

• Flexible shaft: 115 cm

• semispherical tip

Bipolar RFITT applicator CelonProCurve 1200-S15

Vein ablation steps

VEIN ACCESS

GUIDE WIRE INSERTION

PLACEMENT OF SHEATH

POSITION OF SHEATH CONFIRMATION

PERIVENOUS TUMENESCENSE

RF ABLATION

POST PROCEDURE

PROCEDURE DETAILS

• PUNCTURE SITE :

• ENERGY : 0.53 – 3.3 KJ. (Average – 1.7KJ)

• POWER LEVEL : 20 WATTS

• TIME TAKEN : 0.55 – 6.90 min .(Average – 3.30 min)

• After ablation single dose of LMWH 40 given SC

RESULTS:

• CEAP SCORE :

RESULTS : 1 WK F/U

• Out of 65 veins , follow up at 1 week – 65 veins

Thrombosis of ablated segment – 65

Complications : Thrombus prolapsing into FV- 1

Thrombophlebitis – 1

Segmented fluid collection in vein – 1

RESULTS : 3 WK F/U

• Follow up at 3 weeks – 56 veins

• All had thrombosed GSV

• Perforators were as they were – mostly below knee

LATER F/U

Follow up at 90 days – 39 veinsNo recanalizations

Follow up at 180 days – 30 veinsNo recanalizations

One patient for whom the short saphenous vein was ablated, had complete recanalization at 12 months

Presentation

3 weeks

90 days

Presentation

3 weeks

90 days

CONCLUSION:

• Endovenous ablation is a safe, effective and preferred alternative to the surgical procedures in the treatment of the varicose veins.

• Contact :

• Dr.Saurabh Joshi : +919967368256 ( Mon – Sat, 9:00 – 19:00, India Standard Time)

• drsaurabhjoshi1@gmail.com