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Recurrent Varicose Veins After Surgery
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Recurrent Varicose Veins After Surgery

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  • 1. Recurrent varicose veins after vein “stripping” surgery. Retreatment with endovenous laser ablation. XVII World Meeting of the International Union of Phlebology September 8-13, 2013 Hynes Convention Center Boston, Massachusetts USA Primepares G. Pal, MD, RPVI, Jacqueline S. Pal, CNP, RPhS, Rachel Isaak, BA, RVT. Minnesota Vein Center, North Oaks, Minnesota 55127 USA email: dr.p.pal@mnveincenter.com 1
  • 2. No relevant financial disclosures 2
  • 3. Recurrence of varicose veins after vein “stripping” 4% of patients evaluated had vein “stripping” after 2000 2,347 Patients Evaluated for Leg Vein Problems (2007 – 2012) (9%) Vein “stripping” surgery 219 Survey Group - 71 Patients • • Presence of varicose veins Vein “stripping” surgery after 2000 95 Limbs Patients with one limb Patients with two limbs 3
  • 4. Patient Demographics and Clinical Characteristics Patients with Varicose Veins – Despite Prior Surgery • 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 %) 95 Limbs Patients with one limb Patients with two limbs 4
  • 5. Clinical Distribution: C Classification 72% are C2 and C3 45 44 40 35 30 24 25 19 20 15 10 5 5 3 0 0 C2 C3 C 4a C4b C5 C6 5
  • 6. Presence of varicose veins despite surgery VV associated with saphenous veins, perforator veins or accessory veins Segmental or Fully Intact GSV Perforator vein(s) 61 (64%) Accessory vein reflux 28 (30%) 26 (27%) 37 segmental 24 intact 21 thigh 16 calf Small saphenous vein reflux 20 (21 %) Neovascularization/pelvic veins 12 (13 %) 6
  • 7. Treatment of patients with recurrent varicose veins 95 Limbs Patients with one limb % Patients Microphlebectomy 7% 20% Foam 73% Plus received concurrent adjunctive treatment Foam & Microphleb. Second vein treated in 23 cases Complete Treatment Received 69 Treated with EVLA Patients with two limbs 26 EVLA not possible 7% 46% Received treatment 46% 7
  • 8. Follow-up of EVLA-treated saphenous veins Majority of patients reported symptomatic improvement 80 70 69 69 60 53 53 EVLA treated 50 39 38 40 Total occlusion 30 23 23 20 14 14 10 0 2 0 1 week "Foam" other refluxing veins 3 months 6 months (Superficial venous insufficiency – excluding SV) 12 months 8
  • 9. Summary 1. EVLA is feasible in many patients with recurrent varicose veins and prior saphenous vein surgery. 2. EVLA is effective in suitable patients in the retreatment of residual saphenous veins, or refluxing saphenous veins in limbs with prior surgery. 3. The majority of EVLA-retreated patients reported symptomatic improvement. 9