The workplace ecosystem of the future 24.4.2024 Fabritius_share ii.pdf
New technology new technique radiofrequency results 5 years
1. Steve Elias MD FACS FACPh
Director, Division of Vascular Surgery
Vein Programs
Columbia University and Medical Center
NY NY USA
NEW TECHNOLOGY, NEW TECHNIQUE:
RADIOFREQUENCY RESULTS 5 YEARS
2. vein disease is an incurable disease
VEIN DISEASE IS AN INCURABLE DISEASE
3. RFA = CAROTID ENDARTERECTOMY?
• About as good as it gets
• Most studied
• Most durable
• Excellent results
• Minimal complications
• Technique/Technology matters
4. MEEVA:
MODERN ERA OF ENDOVENOUS ABLATION
• After initial learning curve – 1999 -2002
• After global learning curve – 2003 – 2007
• MEEVA – 2007 on
• Laser and RF during MEEVA – the rest is just history
5. • Segmental positioning
• Continuous temp – watts
• No char on catheter
• Short procedure
• Continuous pullback
• Bipolar heating -
impedance
• Char on catheter – stop
• Long procedure
RF: WHAT HAS CHANGED?
Before MEEVA After MEEVA
11. ENDOVENOUS ABLATION: STEPS - APET
• A - Access
• P – Position in GSV/SSV/AAGSV/BK GSV/ Anything
straight
• E – Exsanguinate – tumescence
•
• T – Treat from within (destroy)
22. RF: SPECIFIC THOUGHTS
• Operator independent – just position each segment
• Segmental treatment – eliminates pullback variability
• Delivers consistent energy – needed to overcome
• Position and device does the rest
23. META – ANALYSIS RESULTS 3 YEARS:
WHERE WE WERE (BEFORE MEEVA)
• Only literature up to 2007 (12,320 limbs)
• Did not include any of MEEVA
• EVLA – 94%
• RFA – 84% (92% MEEVA)
• USG Foam – 77%
• Stripping – 78%
• QoL – not really addressed
van den Bos, Renate et al. Endovenous therapies of lower extremity varicosities:
a meta-analysis. JVS 2009; 49: 230-39.
24. RANDOMIZED CONTROLLED TRIAL:
WHERE WE ARE - QOL
• Randomized clinical trial comparing endovenous laser
ablation, radiofrequency ablation, foam sclerotherapy and
surgical stripping for great saphenous varicose veins
• L. H. Rasmussen, M. Lawaetz, L. Bjoern, B. Vennits, A. Blemings
and B. Eklof
• British Journal Surgery 2011; 98:1079-1087
25. WHERE WE ARE: QOL
• Five hundred consecutive patients (580 legs) with GSV reflux were
randomized to endovenous laser ablation (980 and 1470 nm, bare
fibre), radiofrequency ablation, ultrasound-guided foam
sclerotherapy or surgical stripping using tumescent local
anaesthesia with light sedation. Miniphlebectomies were also
performed.
• The patients were examined with duplex imaging before surgery,
and after 3 days, 1 month and 1 year.
26. WHERE WE ARE: QOL
• Disease-specific quality-of-life and Short Form 36 (SF-36 ) scores
had improved in all groups by 1-year follow-up. In the SF-36
domains bodily pain and physical functioning, the radiofrequency
and foam groups performed better in the short term than the
others.
• All treatments were efficacious. The technical failure rate was
highest after foam sclerotherapy, but both radiofrequency ablation
and foam were associated with a faster recovery and less
postoperative pain than endovenous laser ablation and stripping.
27. SHOULD WE DO EVA?
• SVS/AVF Guidelines – 1B recommendation for EVA,
compression if not a candidate for EVA
• NICE: (National Institute for Health Care Excellence):
EVAFoamSurgeryStockings
• Good data based on: efficacy, safety and QoL
• QALY – takes everything into the equation: cost,QoL,RTW
28. QOL: MOST IMPORTANT
• Not closure rates
• Not patency rates
• QoL
• It’s about the patient, not the procedure
29. TAKE HOME MESSAGE: RF AT 5 YRS
GOOD DATA THAT IT HELPS PATIENTS
• Percutaneous
• 30 minutes - average
• Outpatient, local/sedation anesthesia
• Resume normal activities in a few days
• Improve QoL – look/feel 75-80% better
• Durable and long lasting effects
• Any age – walking, talking, functioning
30. THINGS WE’VE LEARNED: 5 YRS LATER
• Distance from SFJ/SPJ can be greater for good results
• Post activity – doesn’t matter
• Compression – maybe not
• Treat to lowest level of incompetence
• Improve technology/simplfy technique = Improve
results
