Endovenous RF Ablation: Outcomes

The majority of subjects felt a delayed tightness peaking 4 to 7 days post-laser and lasting 3 to 10 days. This sensation described as "pulling" along the course of the treated vein was not felt in the treatment failures and may correlate with expected acute inflammation resulting in vein wall thickening and shortening as seen on duplex ultrasound. There have been no skin burns, paresthesias, DVTs or other adverse reactions. The procedure was well tolerated by all subjects using strictly local anesthesia. Discussion Readily available non-invasive diagnostic tests now allow physicians to accurately map out abnormal venous pathways and identify sources of reflux. Minimally invasive alternatives to surgical treatment of the incompetent saphenous vein have been developed with impressive results (4-11). Performing endovenous ablation of the GSV without division of each of the tributaries at the SF] goes against a fundamental rule in saphenous vein surgery; however, the combined experiences with endovenous ablation procedures have shown lower recurrence rates compared to surgical ligation and stripping. Staying out of the groin, and preserving venous drainage in normal competent tributaries while removing only the abnormal refluxing segments may not incite the neovascularization often seen following surgical treatment. Studies have shown that recurrence of varicose veins after GSV stripping occurs early (12) with 73% of limbs destined for recurrent varicosities at 5 years already having them at one year (13,14). Our results have supported this, with only rare late recanalization of veins initially closed with endovenous laser ablation. . In the first 1,000 limbs treated with 810 nm diode laser energy, there have been no heat-related complications. This may be explained by the following: 1) improved delivery and utilization of sufficient amounts of tumescent fluid in the proper tissue plane providing a protective "thermal sink" and 2) faster withdrawal rates and shallower depth of penetration of 810 nm laser energy, resulting in less damage to surrounding nontarget tissue compared to other endovenous methods utilizing heat. Endovenous laser and other modern percutaneous techniques provide patients with alternatives to ligation and stripping for treatment of truncal reflux without many of the potential complications associated with surgery. These advances have allowed more physicians, once properly trained, to offer treatment to the many people who suffer from varicose veins but are unwilling or unable to undergo surgery.

References 1. McMullin GM, Coleridge Smith PD, Scurr ]H. Objective assessment of high ligation without stripping the long saphenous vein. Br] Surg 1991; 78:1139-1142. 2. Stonebridge PA, Chalmers N, Beggs I, Bradbury AW,

P244

Ruckley CV. Recurrent varicose veins: a varicographic analysis leading to a new practical classification. Br] Surg 1995; 82:60-62. 3. Rutgers PH, Kitslaar P]EHM. Randomized trial of stripping versus high ligation combined with sclerotherapy in the treatment of incompetent greater saphenous vein. Am] Surg 1994; 168:311-315. 4. Manfrini S, Gasbarro V, Danielsson G, et al. Endovenous management of saphenous vein reflux. ] Vasc Surg 2000; 32:330-342. 5. Rautio IT, Perala ]M, Wiik HT, ]uvonen TS, Haukipuro KA. Endovenous obliteration with radiofrequency-resistive heating for greater saphenous vein insufficiency: a feasibility study. ] Vasc Interv Radiol 2002; 13:569-575. 6. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: a multicenter study. ] Vasc Surg 2002; 35:1190-1196. 7. Weiss RA and Weiss M A. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex gUidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg 2002; 28:38-42. 8. Navarro L, Min R, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins-preliminary observations using an 810 nm diode laser. Dermatol Surg 2001; 27:117-122. 9. Min R, Zimmet S, Isaacs M, Forrestal M. Endovenous laser treatment of the incompetent greater saphenous vein.] Vasc Interv Radiol 2001; 12:1167-1171. 10. Min R, Khilnani N, Zimmet S. Endovenous laser treatment of saphenous vein reflux: long-term results. ] Vasc Interv Radiol 2003; 14:991-996. 11. Sarin S, Scurr ]H, Coleridge Smith PD. Assessment of stripping of the long saphenous vein in the treatment of primary varicose veins. Br ] Surg 1992; 79:889-893. 12. Dwerryhouse S, Davies B, Harradine K, Earnshaw]). Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. ] Vasc Surg 1999; 29: 589-592. 13. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earshaw]). Neovascularization is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein. Eur] Vasc Endovasc Surg 1996; 12:442-445. http://www.nap. edu/readingroom/books/labrats/ 11:00 a.m. Endovenous RF Ablation: Outcomes Lowell Kabnick, MD Vein Institute of New jersey Morristown, New jersey

JjJ :,;

r;r

J

~ I r I i c::.

rr J

r)

j .: _r; ;~J

(j

JJ

resistive heating of the vein wall: Endothelial destruction Collagen contraction Vein lumen diameter shrinkage Fibrotic sealing of the vessel

P245

P246

Sting!e Cert1lter StudV ~Hi!1lJgolu"lJ1Jo~

DVl" • 73 limbs GSV reflux 4/03-2/04 .70/73 (97%) GSV occluded • Short term 2-30days

• 12173 (16%) DVT • No relation to ancillary procedures • Size of cath " Gender

• NO PEs Hingot...nl AP cl nl. Dl."C1' vconou'lo ttuo"'bo~i!o .1Hor '~djofH.'qu('I"ICY~bl~tlon of 9roato, ",."lphonou,," ..,,,In: A VXJrd of cilution J V.lGC Surg. 2004;40;5004

P247