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.

1. Endovenous laser ablation in the treatment of recurrent
varicose veins.
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 USA
email: dr.p.pal@mnveincenter.com
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2. No relevant financial disclosures
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3. Endovenous laser ablation in the treatment of recurrent
varicose veins.
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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4. 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)
369
Had Prior Intervention
9%
219
150
Surgery
EVA
Primarily
vein “stripping”
Endovenous
Thermal Ablation
6%
Survey Group – 71 Patients
• Presence of varicose veins
• Vein “stripping” surgery after 2000
• Excluded phlebectomies
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5. Presence of varicose veins despite prior Vein “Stripping”
2,347
Patients Evaluated for Leg Vein Problems (2007 – 2012)
369
Had Prior Intervention
219
150
Surgery
EVA
Primarily
vein “stripping”
Endovenous
Thermal Ablation
9%
6%
Survey Group – 71 Patients
95 Limbs
Patients with
one limb
Patients with
two limbs
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6. 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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7. 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
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8. 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 %)
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9. Limbs (%) with prior vein “stripping”
VV associated with saphenous veins, perforator veins or accessory veins
80
64
60
40
20
30
27
20
13
0
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10. Treatment of patients with recurrent varicose veins
95 Limbs
Patients with
one limb
(CoolTouch CTEV™ 1320mm)
% 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%
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11. 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
GSV intact
SSV
Accessory vein
Second vein ablated
23
24
13
9
–––
69
GSV segmental
SSV
Accessory vein
1
7
15
–––
23
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12. Saphenous veins treated with EVLA
Treated vein
mean (SD, range)
GSV segmental (n=23)
GSV intact (n=24)
SSV (n=20
Accessory (n=24)
21.2 cm (
41.9 cm (
16.3 cm (
14.4 cm (
6.1; 12-35)
8.1; 25-58)
4.1;; 9-25)
4.4; 6-22)
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13. 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
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14. 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.
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