Endovenous Laser Ablation in the Treatment of Recurrent Varicose Veins

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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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Endovenous Laser Ablation in the Treatment of Recurrent Varicose Veins

  1. 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 1
  2. 2. No relevant financial disclosures 2
  3. 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. 3
  4. 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 4
  5. 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 5
  6. 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 %) 6
  7. 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 7
  8. 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 %) 8
  9. 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 9
  10. 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% 10
  11. 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 11
  12. 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) 12
  13. 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 13
  14. 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. 14

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