journal rerading

1. Journal Reading
Vascular Surgery
Division
Marlin M. Puteri P.
1806261944

3. Introduction
• Chronic venous disease (CVD) with GSV reflux  common circulatory
disorder with considerable impact on QoL
• Superficial vein reflux 21% in adult population, increased with age.
• Treatment: EVLA, radiofrequency ablation, US-guided foam
sclerotherapy  popular due to lower complication rates and costs,
shorter recovery time, minimally invasive, no vein extraction (vs SFJ
ligation and stripping GSV)

4. Foam Sclerotherapy
Saphenous tortuosities
and dilations are
frequently found in
advanced CVD, may
require more than one
access port to obliterate
the vein
Sclerosing agent acts through direct
contact with the endothelium, facilitated by
blood displacement and aided by the gas
within the foam
Promotes a broader distribution of the
sclerosant and increases the contact area
with vein lumen
Superior in larger vessels than in
telangiectasias, independent of the vessel
diameter and the sclerosing
concentration.

5. EVLA
• ablates endothelium by transferring heat to vessel wall
• Outpatient setting, under local anesthesia
• Safe and successful technique with shorter intervention time, low
perioperative pain and positive impact on QoL
• Complications: superficial laser burns, dyschromia, phlebitis and
parasthesia.

6. Complications
• Endovenous heat-induced thrombosis (E-HIT)  2-8%

7. Materials and
Methods

8. • Retrospective data
• Cohort of 246 limbs
• Both men and women with GSV insufficiency that underwent EVLA and
foam sclerotherapy
• January 2016 - December 2019
• Informed consent before the procedure + board review
• Sex, age, leg laterality, and CEAP classification were recorded.

9. Criteria
Inclusion
• Aged between 18 and 75 years
• Presence of a tortuous infragenicular GSV
with identifiable epifascial affluent veins.
• Reflux time of the GSV >0.5 sec, extending
infragenicularly.
• Clinical-Etiology-Anatomy-Pathophysiology
(CEAP) C2-C6.
• GSV with a 10 to 15 mm diameter.
Exclusion
• GSV diameter more than 15mm.
• Known history of coagulopathy

10. Methods
DUS
• Vascular laboratory did the initial duplex
• Both the technician and vascular surgeon mapped the reflux areas
Data
• Sex, age, leg laterality, and CEAP classification
• Initial, FU visit at 2 weeks, 3-6-12 months after intervention
Treatment
• Combined treatment
• USG guided catheter + endovenous laser and 0,5% polidocanol

11. USG guided cath in the
suprageniculate segment of
GSV, through a port a bare laser
fiber is inserted to ablate 15cm
distance, 3cm below SFJ
Endovenous laser fiber of
1470nm with mean liner
endovenous energy density of
107 J/cm
Tumescet saline + 12cc of 0,5%
polidocanol foam + physiologic
gas under USGguided

12. Results

13. Results
• The cross-analysis between each type of anatomic
closure and every stage of the clinical CEAP
classification showed that limbs with a higher CEAP
class are more likely to have a therapeutic failure,
whereas those with lower CEAP are more prone to
achieve IUP primary closure (P ¼ .010 in the Fisher
exact test).
• 6 months of follow-up, no changes in the occlusion
rate of the GSV were found.
• 1 year of follow-up, CEAP 4 and 5 limbs remained
with the same occlusion as the previous session,
but 31 of 35 CEAP 6 limbs (88.57%) achieved
occlusion of the GSV.

14. Discussion

15. Previous study
• Sample 262 patients wit 291 limbs with
Endoluminal Occlusion Foam of the GSV.
• Results: 82,3% primary closure; 4,71% failure at 6
months follow up
• Complications (56 events), no severe
complications during treatment and follow-up:
• Microthrombosis  microthrombectomy
• Post-sclerotherapy ulceration
• Dyschromia
• Matting
Current study
• We obtained a primary closure rate at 6 months of
93% and a failure rate of 2.4%.
• 57 adverse events associated, including
microthrombosis in 18% of the limbs and matting
corresponding to 2.8%, also one case each of
popliteal deep venous thrombosis and E-HIT.

20. Conclusions
• Thermal ablative techniques have emerged
as the primary treatment strategies because
of their effectiveness, safety, and high
occlusion rates.
• Combination of both EVLA and foam
sclerotherapy is a safe and promising
technique that achieves a high occlusion rate
of the GSV
• Combined therapy may be more effective in
C2-C4 limbs than C5-C6 limbs