- Email: [email protected]
Significance of Patent Saphenous Vein Stump Length After Endothermal Ablation
JOURNAL OF VASCULAR SURGERY: VENOUS AND LYMPHATIC DISORDERS Volume 2, Number 1
Abstracts 105
Fig. VVSymQ treatment effect at Week 8 (last observation carried forward) by subgroup: difference from placebo with 95% confidence intervals. BMI, Body mass index; ETA, endovenous thermal ablation; GSV, great saphenous vein; PEM, polidocanol endovenous microfoam; RX, treatment; VCSS, Venous Clinical Severity Score. Predictive Value of a Preoperative Test for the Reversibility of the Reflux After Phlebectomy with Preservation of the Great Saphenous Vein P. Pittaluga, S. Chastanet. Riviera Veine Institut, Monte Carlo, Monaco Background: Evaluation of the value of a test of reversibility (TR) of the reflux of the great saphenous vein (GSV) in order to forecast the result of phlebectomy with preservation of a refluxing GSV according to the principles of the Ambulatory Selective Ablation of Varices under Local anesthesia (ASVAL). Methods: We have prospectively included the patients operated on by ASVAL for unilateral varicose veins with a reflux of the GSV and for whom a TR was feasible. The TR was considered as positive if the reflux of the GSV was completely abolished by compression of a varicose tributary at the moment of the sudden release of manual compression on the calf, during a duplex ultrasound examination performed with the patient standing upright. The presence of a reflux of the GSV, symptom relief, and cosmetic improvement were evaluated at 1 and 2 years of follow-up (FU). Results: A total of 293 lower limbs (LLs) in 249 patients have been included. The TR was positive in 165 LLs (56.3%). At 1 and 2 years of FU after ASVAL, a reflux of the GSV was less frequently observed in LLs for which the TR was positive preoperatively (respectively, 4.3% vs 11.2%; P ¼ .04 and 5.3% vs 14.1%; P ¼ .02). On the other hand, at 1 and 2 years of FU, the preoperative positivity of the TR did not have any correlation with symptom relief (12.9% vs 15.3%; P ¼ .59 and 13.6% vs 20.7%; P ¼ .16) or the cosmetic improvement (5.7% vs 9.2%; P ¼ .30 and 6.8% vs 10.9%; P ¼ .28) after treatment. The positive predictive value of the TR for the abolition of reflux of the GSV was 95.7% and 94.7% at 1 and 2 years of FU. Conclusions: The preoperative positivity of the test of reversibility of the GSV reflux was correlated with an hemodynamic improvement of the GSV at 1 and 2 years of FU after ASVAL, with a high positive predictive value. Significance of Patent Saphenous Vein Stump Length After Endothermal Ablation J.E. Genut, W.A. Marston, A.E. Kouri. University of North Carolina, Chapel Hill, NC Background: Endothermal ablation (ETA) of the great saphenous vein (GSV) carries a small but real risk of endovenous heat-induced thrombus (EHIT). There remains debate over the optimal positioning of
the ablation device within the GSV. Our research aims to determine whether the length of patent proximal GSV after ETA affects hemodynamic improvement, symptomatic relief, or midterm durability of ETA. Methods: We retrospectively reviewed a database of 922 ablation procedures performed from 2003 to 2012 to identify patients with a patent proximal great saphenous vein stump of 4 cm or greater on initial evaluation within 1 month of ETA. These patients comprised the long saphenous stump (LSS) group, which was compared with the short saphenous stump (SSS) group, consisting of those with a patent saphenous stump <4 cm. All patients were evaluated with preoperative and postoperative duplex ultrasound and air plethosmogrophy (APG) measurements of venous filling index (VFI). All LSS patients were monitored for symptom recurrence with a mean follow up of 20.5 months (range, 0.3-84 months). Results: Thirty-nine patients were identified with a LSS after ETA. The length of GSV patency from the SFJ in the LSS group varied from 4 cm to 15 cm (mean, 7.1 cm). There was no correlation in the LSS group between percent reduction in VFI and distance of patent proximal GSV (r2 ¼ 0.0073). A t-test was utilized to compare hemodynamic improvement in patients in the SSS group with those in the LSS group. There was no significant difference in the improvement of VFI after ETA in the LSS group compared with the SSS group (P < .001). Recurrence occurred in six of 39 limbs (15%) in the LSS group at an average of 27 months after ETA (range, 1-84 months). Conclusions: In this patient cohort, the length of patent GSV stump did not correlate with degree of hemodynamic improvement or durability of symptom relief after ETA at midterm follow-up. Recurrence occurred in 15% of patients in the LSS group, consistent with published recurrence rates for ETA. These results suggest the placement of the ablation device may be positioned farther away from the SFJ than is currently recommended with acceptable results. Longer term follow-up is still required to determine the optimum location for the ablation device within the saphenous vein. Twelve-Month Follow-up of the European Multicenter Study on Cyanoacrylate Embolization of Incompetent Great Saphenous Veins T.M. Proebstle1, J. Alm2, S. Dimitri3, L. Rasmussen4, M. Whiteley5, J. Lawson6, A. Davies7. 1University of Mainz, Mainz, Germany; 2Dermatoligikum, Hamburg, Germany; 3The Countess of Chester Hospital, Chester, United Kingdom; 4Danish Vein Centers, Naestved, Denmark; 5The Whiteley Clinic, Guildford, United Kingdom; 6Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands; 7Imperial College, London, United Kingdom
Abstracts 105
Fig. VVSymQ treatment effect at Week 8 (last observation carried forward) by subgroup: difference from placebo with 95% confidence intervals. BMI, Body mass index; ETA, endovenous thermal ablation; GSV, great saphenous vein; PEM, polidocanol endovenous microfoam; RX, treatment; VCSS, Venous Clinical Severity Score. Predictive Value of a Preoperative Test for the Reversibility of the Reflux After Phlebectomy with Preservation of the Great Saphenous Vein P. Pittaluga, S. Chastanet. Riviera Veine Institut, Monte Carlo, Monaco Background: Evaluation of the value of a test of reversibility (TR) of the reflux of the great saphenous vein (GSV) in order to forecast the result of phlebectomy with preservation of a refluxing GSV according to the principles of the Ambulatory Selective Ablation of Varices under Local anesthesia (ASVAL). Methods: We have prospectively included the patients operated on by ASVAL for unilateral varicose veins with a reflux of the GSV and for whom a TR was feasible. The TR was considered as positive if the reflux of the GSV was completely abolished by compression of a varicose tributary at the moment of the sudden release of manual compression on the calf, during a duplex ultrasound examination performed with the patient standing upright. The presence of a reflux of the GSV, symptom relief, and cosmetic improvement were evaluated at 1 and 2 years of follow-up (FU). Results: A total of 293 lower limbs (LLs) in 249 patients have been included. The TR was positive in 165 LLs (56.3%). At 1 and 2 years of FU after ASVAL, a reflux of the GSV was less frequently observed in LLs for which the TR was positive preoperatively (respectively, 4.3% vs 11.2%; P ¼ .04 and 5.3% vs 14.1%; P ¼ .02). On the other hand, at 1 and 2 years of FU, the preoperative positivity of the TR did not have any correlation with symptom relief (12.9% vs 15.3%; P ¼ .59 and 13.6% vs 20.7%; P ¼ .16) or the cosmetic improvement (5.7% vs 9.2%; P ¼ .30 and 6.8% vs 10.9%; P ¼ .28) after treatment. The positive predictive value of the TR for the abolition of reflux of the GSV was 95.7% and 94.7% at 1 and 2 years of FU. Conclusions: The preoperative positivity of the test of reversibility of the GSV reflux was correlated with an hemodynamic improvement of the GSV at 1 and 2 years of FU after ASVAL, with a high positive predictive value. Significance of Patent Saphenous Vein Stump Length After Endothermal Ablation J.E. Genut, W.A. Marston, A.E. Kouri. University of North Carolina, Chapel Hill, NC Background: Endothermal ablation (ETA) of the great saphenous vein (GSV) carries a small but real risk of endovenous heat-induced thrombus (EHIT). There remains debate over the optimal positioning of
the ablation device within the GSV. Our research aims to determine whether the length of patent proximal GSV after ETA affects hemodynamic improvement, symptomatic relief, or midterm durability of ETA. Methods: We retrospectively reviewed a database of 922 ablation procedures performed from 2003 to 2012 to identify patients with a patent proximal great saphenous vein stump of 4 cm or greater on initial evaluation within 1 month of ETA. These patients comprised the long saphenous stump (LSS) group, which was compared with the short saphenous stump (SSS) group, consisting of those with a patent saphenous stump <4 cm. All patients were evaluated with preoperative and postoperative duplex ultrasound and air plethosmogrophy (APG) measurements of venous filling index (VFI). All LSS patients were monitored for symptom recurrence with a mean follow up of 20.5 months (range, 0.3-84 months). Results: Thirty-nine patients were identified with a LSS after ETA. The length of GSV patency from the SFJ in the LSS group varied from 4 cm to 15 cm (mean, 7.1 cm). There was no correlation in the LSS group between percent reduction in VFI and distance of patent proximal GSV (r2 ¼ 0.0073). A t-test was utilized to compare hemodynamic improvement in patients in the SSS group with those in the LSS group. There was no significant difference in the improvement of VFI after ETA in the LSS group compared with the SSS group (P < .001). Recurrence occurred in six of 39 limbs (15%) in the LSS group at an average of 27 months after ETA (range, 1-84 months). Conclusions: In this patient cohort, the length of patent GSV stump did not correlate with degree of hemodynamic improvement or durability of symptom relief after ETA at midterm follow-up. Recurrence occurred in 15% of patients in the LSS group, consistent with published recurrence rates for ETA. These results suggest the placement of the ablation device may be positioned farther away from the SFJ than is currently recommended with acceptable results. Longer term follow-up is still required to determine the optimum location for the ablation device within the saphenous vein. Twelve-Month Follow-up of the European Multicenter Study on Cyanoacrylate Embolization of Incompetent Great Saphenous Veins T.M. Proebstle1, J. Alm2, S. Dimitri3, L. Rasmussen4, M. Whiteley5, J. Lawson6, A. Davies7. 1University of Mainz, Mainz, Germany; 2Dermatoligikum, Hamburg, Germany; 3The Countess of Chester Hospital, Chester, United Kingdom; 4Danish Vein Centers, Naestved, Denmark; 5The Whiteley Clinic, Guildford, United Kingdom; 6Skin and Vein Clinic Oosterwal, Alkmaar, The Netherlands; 7Imperial College, London, United Kingdom