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Choosing the Appropriate Truncal Vein Closure Device
The document discusses the selection of truncal vein closure devices, emphasizing that the choice should depend on factors like the device's effectiveness, familiarity, cost, patient characteristics, and specific conditions. It categorizes available technologies into thermal (tumescent) and non-thermal (non-tumescent) options, presenting their performance metrics and suitable scenarios. Ultimately, it concludes that a tailored approach is necessary, utilizing both types of techniques based on individual patient and clinical situations.
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Choosing the Appropriate Truncal Vein Closure Device
- 1. CHOOSING THE APPROPRIATETRUNCAL VEIN CLOSURE DEVICE Steve Elias MD FACS Director, Center for Vein Disease Director, Wound Care Center Englewood Hospital and Medical Center NJ
- 2. THE ANSWER: • Theone that works • The one you are familiar with • The one you own • The least expensive • None of the above
- 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. Choices: 2014 • 810nm • 940 nm • 980 nm • 1320 nm • 1470 nm • Radiofrequency • Polidocanol Endovenous Microfoam • Mechanochemical – MOCA • Cyanoacrylate glue • Steam • V Block
- 5. Occlusion Devices: TwoCategories* • TT (Thermal, Tumescent) • NTNT (Non Thermal, Non Tumescent) *Elias S. Emerging Endovenous Technologies. Endovasc Today. March 2014.
- 6. Thermal Tumescent: TT •Laser – HSLW, WSLW, radial/jacketed, etc • Radiofrequency • Steam – not in US
- 7. Non Thermal, NonTumescent: NTNT • Mechanochemical • Cyanoacrylate glue • Polidocanol Endovenous Microfoam • V Block
- 8. Modern Era ofEndovenous 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. SIZE • Big (>12mm)– TT • Small – NTNT or TT • Really big – TT, SFJ/SPJ ligation? • Really small – NTNT or “should I do this?”
- 10. LENGTH • Short segment– RF 3 cm, laser, foam, MOCA • Short – maybe not CAG (cost?) • Long - anything
- 11. LOCATION • AK –anything • BK GSV and SSV – NTNT before TT • Suprafascial – MOCA, TT but consider skin/ cord, hyperpig
- 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. PATIENT TYPE • Fat– TT over NTNT • Thin – NTNT over TT • Anxious, Nervous – NTNT over TT
- 14. ANTICOAGULATION • INR 2.0– 2.5 – anything • INR > 2.5 - TT
- 15. SPECIAL SCENARIOS • MDor 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. CONCLUSIONS • Need oneTT and one NTNT • Tailor the technique to the situation • All veins are not the same