This document discusses the treatment of varicose veins, specifically endovenous ablation techniques like laser and radiofrequency ablation. It provides a brief history of varicose vein surgery techniques dating back to the early 1900s. More recent developments discussed include techniques like EVLA, RFA, sclerotherapy, steam vein sclerosis, and mechano-chemical ablation. The document also outlines the authors' hospital's experience with various treatment methods and provides their recommendations on when each technique is most appropriate based on factors like patient anatomy, vein diameter and location.

1. Endovenous treatment
for varicose veins – the first choice
(laser, radiofrequency ablation)
Michał Molski
Stanisław Molski

2. History of varicose veins surgery
• 1905 – Keller –hook ended stripper
• 1907 – Babcock – ball ended stripper
• 1916 – Homans removes SFJ collaterals
• 1953 – X-ray guided catheterisation- Seldinger
• 1956 – Dodd i Cockett – „long stripping”
• 1963 – Van der Stricht – invagination stripping
• 1998 – EVLA, RFA
• 1999 – Fluoroscopic UGS – Donnelly
EVLA + sclerotherapy
Multi-access technique
• Sclerotherapy through baloon catheters (KAVS)
• 2010 – Steam Vein Sclerosis
• 2011 – Mechano-chemical ablation
• 2011 – Cyanoacrylate ablation
• 2013 – Laser assisted foam sclerotherapy (LAFOS)
M.Molski CVS Cracow 19-10-2014

3. recommendations

4. recommendations

5. recommendations

6. recommendations

7. recommendations

8. recommendations

9. Our Hospital experience
Choice of the method depends on the patient’s
anatomy and patient’s prefference
Is it better to have
universal or dedicated
methods?
M.Molski CVS Cracow 19-10-2014

10. Our Hospital experience
Choice of the method also
depends on the experience
of vascular surgeon
M.Molski CVS Cracow 19-10-2014

11. Our Hospital experience
≈6500 cases
≈1500 cases
M.Molski CVS Cracow 19-10-2014

12. Our Hospital experience
• Staged tretment > all in one treatment
• One leg at one procedure > two legs at once
• One venous confluence at one procedure
• Endovenous thermal ablation > surgery for trunks
• Sclerotherapy for tributaries after >30 days
• LMWH for selected patiens - ≥5 pts in Caprini scale
• Compression therapy 3 days+nights, 30 days, lifelong
• NSAID for 7-10 days
M.Molski CVS Cracow 19-10-2014

13. • Surgery
Our Hospital experience
• patiens who cannot afford ablation
• patient unfit for sclerotherapy
• CEAP C3 – C5
• BMI < 25 (sometimes <30)
• truncal + perforator incompetence
• primary varicosities
• crossectomy for failed ablation
M.Molski CVS Cracow 19-10-2014

14. Our Hospital experience
• EVLT 980nm bare fiber
• CEAP C2-C6
• <8-10mm diameter
• straight trunk
• trunk in fascial compartment
• patient accepts bruising and „small” pain
• only to the level of ⅓ proximal shin for GSV
• only to the level of ½ calf for SSV
M.Molski CVS Cracow 19-10-2014

15. • RFITT Celon
Our Hospital experience
• CEAP C2-C6
• all diameters
• straight trunk
• trunk preferably in fascial compartment
• truncal + perforator incompetence
• only to the level of ⅓ proximal shin for GSV
• only to the level of ½ calf for SSV
M.Molski CVS Cracow 19-10-2014

16. • SVS
Our Hospital experience
• CEAP C4-C6, sometimes C3
• all diameters
• trunk out of fascial compartment
• big tributaries
• reccurent varicosities
• tortous varicosities
• perforators
• only to the level of ⅓ proximal shin for GSV
• only to the level of ½ calf for SSV
M.Molski CVS Cracow 19-10-2014

17. Our Hospital experience
• chemical catheter directed ablation+tummescence
• mechano-chemical ablation – only 5 cases
• CEAP C2-C6
• < 6-8mm
• trunk out of fascial compartment
• truncal incompetence in shin or thigh+shin
• rather not for perforators
M.Molski CVS Cracow 19-10-2014

18. Fot. Marzena Marczewska
Thank you
M.Molski CVS Cracow 19-10-2014