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Aims: Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention. Identify the site and cause of varicose veins in patients with prior surgical intervention. Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.
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Lütfi Kirdar International Congress and Exhibition Centre Istanbul, Turkey
Primepares G. Pal, MD, RPVI, Jacqueline S. Pal, CNP, RPhS, Rachel Isaak, BA, RVT.Minnesota Vein Center, North Oaks, Minnesota 55127 USAemail: [email protected]
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Endovenous laser ablation in the treatment of recurrent varicose veins.
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No relevant financial disclosures
Aims:
1. Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention.
2. Identify the site and cause of varicose veins in patients with prior surgical intervention.
3. Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.
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Endovenous laser ablation in the treatment of recurrent varicose veins.
Recurrence of varicose veins after vein “stripping”4% of patients evaluated had vein “stripping” after 2000
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2,347 Patients Evaluated for Leg Vein Problems (2007 – 2012)
369Had Prior Intervention
150EVA
Endovenous Thermal Ablation
219SurgeryPrimarily
vein “stripping”
9% 6%
Survey Group – 71 Patients
• Presence of varicose veins• Vein “stripping” surgery after 2000
• Excluded phlebectomies
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95 Limbs
Patients with one limb
Patients with two limbs
Survey Group – 71 Patients
2,347 Patients Evaluated for Leg Vein Problems (2007 – 2012)
369Had Prior Intervention
150EVA
Endovenous Thermal Ablation
219SurgeryPrimarily
vein “stripping”
9% 6%
Presence of varicose veins despite prior Vein “Stripping”
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Patient Demographics and Clinical Characteristics
Patients with Varicose Veins – Despite Prior Vein “Stripping “after Year 2000
• 49.4 years (range, 32-74)
• 84% female
• Surgery occurred median of 7 years previously (1-12 yrs)
• Deep venous insufficiency: 10/95 limbs (11 %)
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Clinical Distribution: C Classification
72% are C2 and C3
C 2 C 3 C 4a C4b C5 C60
5
10
15
20
25
30
35
40
4544
24
19
53
0
8
Perforator vein(s)
21 thigh
16 calf
28 (30%)
Presence of varicose veins despite surgery
Accessory vein reflux
26 (27%)
Small saphenous vein reflux 20 (21 %)
Neovascularization/pelvic veins 12 (13 %)
Segmental or Fully Intact GSV
61 (64%)
37 segmental24 intact
VV associated with saphenous veins, perforator veins or accessory veins
9
Limbs (%) with prior vein “stripping”
Segmental/In-tact GSV
Perforator Accessory vein
SSV Neovasc/pelvic
0
20
40
60
80
64
3027
20
13
VV associated with saphenous veins, perforator veins or accessory veins
10
95 Limbs
Patients with one limb
Patients with two limbs
73%
20%
7%Microphlebectomy
Foam
Foam & Microphleb.
Treatment of patients with recurrent varicose veins
69 Treated with EVLA(CoolTouch CTEV™ 1320mm)
Plus received concurrent adjunctive treatment
26 EVLA not possible
Received treatment46
%
46%
7%
Com
plete Treatm
ent Received
% Patients
Second vein treated in 23 cases
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Saphenous veins treated with EVLA
EVLA was feasible in 69 limbs (73%). When intact GSV excluded,EVLA still feasible in 57 limbs (60%).
First vein ablated
GSV segmental 23GSV intact 24SSV 13Accessory vein 9
–––69
Second vein ablated
GSV segmental 1SSV 7Accessory vein 15
–––23
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Saphenous veins treated with EVLA
Treated vein mean (SD, range)
GSV segmental (n=23) 21.2 cm (± 6.1; 12-35)GSV intact (n=24) 41.9 cm (± 8.1; 25-58)SSV (n=20 16.3 cm (± 4.1;; 9-25)Accessory (n=24) 14.4 cm (± 4.4; 6-22)
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1 week 3 months 6 months 12 months0
10
20
30
40
50
60
70
80
69
53
39
23
69
53
38
23
0
14 14
2
EVLA treated
Total occlusion
"Foam" other reflux-ing veins
Follow-up of EVLA-treated saphenous veinsMajority of patients reported symptomatic improvement
(Superficial venous insufficiency – excluding SV)
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Summary
1. 15% of patients presenting for evaluation of leg vein problems had prior intervention. 9% had prior surgery.
2. Presence of varicose veins associated with segmental or fully intact great saphenous vein, perforator vein pathology, and accessory vein reflux.
3. Short-term, EVLA is feasible and effective in the majority of patients with varicose veins and prior saphenous vein surgery.
4. The majority of EVLA-retreated patients reported symptomatic improvement.
