Steam return to the future
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Transcript of Steam return to the future
• How does it work ?
• How to treat patients ?
• What are the results ?
• R.Milleret – Montpellier - France
Steam : Return to the future ?
Generation of Endo Venous Steam
• Water is pumped under high pressure through a microtube of 100 µ internal diameter.
• Electrical current heats the microtube.• Steam is emitted at a temperature of 150° At the tip of the catheter it decreases to
120°C120
Large trunks
• Steam allows treatment of very large trunks
• At one year they have shrinked even if they were more than 2 cm diameter
Obliterating Perforators
• Easy : just puncture on 1 or 2 cm under echo-guidance ,
• Inject a small quantity of tumescent solution
• Send repeated pulses into the perforator .
• In the deep veins , only droplets of hot water , no harm done .
Steam Phlebectomy
• Large Tributaries and Perforators can be treated .
• Several punctures are made along the vein.
• The catheter is not retracted , repeated pulses are sent : steam can thus travel up to
8/10 cm
* No tumescence needed if under general anesthesia . Skin cooling by gel .
Results
• Multi center French study GSV ,
1 year follow up .
• Randomized study for superficial veins
Multi-Center Trial
• CHU Besançon : Pr G.Camelot , Dr Mazen , Dr A. Lopinnet
• Clinique du Grand Large Lyon : Dr P.Nicolini
• Vein Center Montpellier : Dr R.Milleret
• Clinique Ambroise Paré Nancy : Dr D.Creton
Material
• 80 patients included
1 year results for 73 patients are available .
• Criteria :GSV only , 4/12 mm at mid-tigh .
• Each center was free to use General or Local , tumescent anesthesia .
• Median diameter mid tigh : 8 mm
• Length treated : 42 cm
Post-operative course
• Pain at 8 days : 0,75 median value
• Pain at 1 month : 0,60 median value
• No DVT , No PE No infection.
• 1 paresthesia at 8 days , 1 at 1 month .
• 0 pigmentation.
Abnormal Duplex findings
• At 8 days :
1 protrusion of thrombus in the femoral vein (less than 1 cm).
1 patient with non occluded vein segments (10 and 13 cm) at lower part of tight without reflux = technical fault (introducer not removed !) Treated with Foam injection .
Vein Resorption
• Evolution of the diameter :
8 days 1 month 12 months
Junction 9,84 7.15 4.65
Tigh 7,27 5.14 1,90
Obliteration at 1 year
• 73 patients followed up ,
• 72 with obliteration at thigh level.
NB . 6 had a more than 3 cm long stump under the junction ,they’ll be followed to check evolution .
Aim of the study
• To compare efficiency , complications and patient’s satisfaction between two obliterative techniques :
*** Foam – Chemical obliteration
*** Steam – Thermal obliteration
Material
• 2 groups of 20 patients each,randomized .
• Location of varices : Anterior Accessory ,
Internal Calf
Posterior Calf
* Diameter of varices : 3 to 10 , mean 6 mm .
Methods
• Foam : 1% Polidocanol ,
Tessari tourbillon technique,
6 to 10 cc in one session (Tegernsee)
• Steam : 3 to 6 pulses/location
3 to 6 18G / 20 G infusion catheters
* Eccentric compression .
Results at 6 months
Foam Steam
Pigmentation 4/18 2/19
Cosmetic result 10/18 15/19
(patient’s evaluation
Good/very good)
Steam : a less invasive heating technique
• Heat transfer is very quick : less than 1/2 s as compared with 20 s sequential heating with Closure Fast®
• Wall thickening is maximal , thus clot in the lumen minimal , reducing inflammatory reactions and post-op pain . .
• No perforation of the vein wall .
• Less heating of peri-venous structures.
So , I use steam ... But not exclusively .
• The power of heating techniques ,• The versatility of foam ,• Safety on top .
• Steam will not replace foam , especially for small vessels , but will complement it for larger veins which may lead to inflammatory reactions and pigmentation after foam injection .leaand pigmentation
Foam technique
• Tessari Tourbillon technique
• 2% Polidocanol
• Desilet F5 introducer
• Cook Royal Flush F5 catheter
• Tumescence to compress the junction and the localized dilatations
• Banding of the limb before injection