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Choosing the Appropriate Truncal Vein Closure Device

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By: Steve Elias, MD, FACS

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Choosing the Appropriate Truncal Vein Closure Device

  1. 1. CHOOSING THE APPROPRIATE TRUNCAL VEIN CLOSURE DEVICE Steve Elias MD FACS Director, Center for Vein Disease Director, Wound Care Center Englewood Hospital and Medical Center NJ
  2. 2. THE ANSWER: • The one that works • The one you are familiar with • The one you own • The least expensive • None of the above
  3. 3. CONSIDERATIONS: • Size – big, small • Length - short • Location – AK, BK, Suprafascial • Multiple veins – GSV, SSV, AAGSV • Disease state – C5, C6, SVT • Patient type – fat, thin, anxious, friend, foe • Special – MD, spouse of MD, attorneys
  4. 4. Choices: 2014 • 810 nm • 940 nm • 980 nm • 1320 nm • 1470 nm • Radiofrequency • Polidocanol Endovenous Microfoam • Mechanochemical – MOCA • Cyanoacrylate glue • Steam • V Block
  5. 5. Occlusion Devices: Two Categories* • TT (Thermal, Tumescent) • NTNT (Non Thermal, Non Tumescent) *Elias S. Emerging Endovenous Technologies. Endovasc Today. March 2014.
  6. 6. Thermal Tumescent: TT • Laser – HSLW, WSLW, radial/jacketed, etc • Radiofrequency • Steam – not in US
  7. 7. Non Thermal, Non Tumescent: NTNT • Mechanochemical • Cyanoacrylate glue • Polidocanol Endovenous Microfoam • V Block
  8. 8. Modern Era of Endovenous Ablation: MEEVA • Percutaneous, outpatient, local anesthesia • TT: • RF/Laser - >90% ablation rate @ 4yrs • Steam - >90% at 1 year (Europe) • NTNT : • MOCA – 95% ablation at >2 years • Foam – 85% at 2 years • Glue – 95% at 1 years • V Block – 100% at 4 months
  9. 9. SIZE • Big (>12mm) – TT • Small – NTNT or TT • Really big – TT, SFJ/SPJ ligation? • Really small – NTNT or “should I do this?”
  10. 10. LENGTH • Short segment – RF 3 cm, laser, foam, MOCA • Short – maybe not CAG (cost?) • Long - anything
  11. 11. LOCATION • AK – anything • BK GSV and SSV – NTNT before TT • Suprafascial – MOCA, TT but consider skin/ cord, hyperpig
  12. 12. DISEASE STATE • C5, C6 – AK GSV & BK GSV – TT or NTNT • C5, C6 – BK GSV residual – retrograde NTNT and foam ulcer bed (MOCA) tumescence an issue • Previous SVT – TT – need more energy
  13. 13. PATIENT TYPE • Fat – TT over NTNT • Thin – NTNT over TT • Anxious, Nervous – NTNT over TT
  14. 14. ANTICOAGULATION • INR 2.0 – 2.5 – anything • INR > 2.5 - TT
  15. 15. SPECIAL SCENARIOS • MD or Spouse – RF, MOCA • Friend – RF, WSLW (1470), MOCA • Foe – HSLW (810/980) or stripping • Attorney – 810/980 with 150 joules/cm and no tumescence
  16. 16. CONCLUSIONS • Need one TT and one NTNT • Tailor the technique to the situation • All veins are not the same

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