This document summarizes saphenous vein ablation using steam (SVS). SVS is described as a safe and effective technique for treating varicose veins in the great saphenous vein (GSV), small saphenous vein (SSV), and tributaries. Details are provided on the equipment, ablation procedure, guidelines and studies supporting SVS. The author's results from over 700 SVS procedures are presented, showing high occlusion rates but higher rates of partial recanalization compared to other ablation techniques. Complication rates are provided, with skin hyperpigmentation and peristhesia being most common. In conclusion, SVS is deemed an effective ablation technique comparable to other options, with good patient satisfaction but higher costs

1. Saphenous vein ablation
by steam (SVS)
is safe and efficacious
M.Molski, S.Molski,
Szpital Eskulap – Centrum Leczenia Chorób Serca i Naczyń
Osielsko

2. Conflict of interest disclosure
Nothing to declare

3. • Endovenous thermal ablation techniqe
• Allows treatment of GSV/SSV trunks
• Allows treatment of tributaries
• Allows treatment of perforating veins
ALL IN ONE PROCEDURE
Without additional techniques (miniphlebectomy or sclerotherapy)
BUT
May be combined with any of other phlebological technique
Steam Vein Sclerosis - Venosteam

4. SVS - equipment
• Generator Cerma
• Smart hand piece
• Aplicators
Flexivein – 16G, 65 cm
Tribvein – 18G, 12cm

5. 1. Vein catheterisaton
2. Tumescent anesthesia
3. Dosing of energy for venous trunks
a. 4–8 impulses onto the first vein segment
b. 2–4 impulses onto each additional 1 cm
• 2 impulses / 1 cm for vein7 mm diameter
• 3 impulses / 1 cm for vein 7–12 mm
• 4 impulses / 1cm for vein >12 mm diameter
4. Tributary ablation
a. 2–4 impulses onto each additional 1 cm
5. Compression stocking
SVS – ablation procedrue details

6. CVI guidelines

7. 1. Assesment of the efficacy and safety of steam vein sclerosis as compared to classic surgery in lower extremity
varicose vein management.
Witold Woźniak, Robert K. Mlosek, Piotr Ciostek. Videosurgery Miniinv 2015; 10 (1): 15–24.doi:
10.5114/wiitm.2015.48573 /s10103-013-1448-5
2. Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous
varicose veins.
van den Bos RR, Malskat WS, De Maeseneer MG, de Roos KP, Groeneweg DA, Kockaert MA, Neumann HA, Nijsten T. Br
J Surg. 2014; 101:1077-83. doi: 10.1002/bjs.9580
3. The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency:
own experiences.
Mlosek RK, Woźniak W, Gruszecki L, Stapa RZ. Phlebology 2014; 29:58-65. doi: 10.1258/phleb.2012.012092.
4. The state of the art of endothermal ablation.
van den Bos RR, Proebstle TM. Lasers Med Sci. 2014; 29:387-92. doi 10.1007/s10103-013-1448-5
5. Great saphenous vein ablation with steam injection: results of a multicentre study.
Milleret R, Huot L, Nicolini P, Creton D, Roux AS, Decullier E, Chapuis FR, Camelot G. Eur J Vasc Endovasc Surg 2013; 45:
391–396.
6. team ablation versus radiofrequency and laser ablation: an in vivo histological comparative trial.
Thomis S, Verbrugghe P, Milleret R, Verbeken E, Fourneau I, Herijgers P. Eur J Vasc Endovasc Surg 2013; 46: 378–382.
doi: 10.1016/j.ejvs.2013.06.004
7. Endovenous thermal ablation for varicose veins : strenghts and weaknesses.
van den Bos RR, De Maeseneer MG. Phlebolymphology 2012; 19 :163-169
8. Obliteration of varicose veins with superheated steam.
Milleret E. Phlebolymphology 2011; 19:174-181
9. Proof-of-principle study of steam ablation as novel thermal therapy for saphenous varicose veins.
van den Bos RR, Milleret R, Neumann M, Nijsten T. J Vasc Surg 2010; 53:181–186. doi: 10.1016/j.jvs.2010.06.171.
SVS – bibliography

8. 75 patients treated with obliterationa rate 96%
Minor adverse events

9. Of 107 legs 8% were partially recanalized without reflux, and 13% were or completely recanalized
with reflux.
EVSA group was more satisfied with the therapy, and had a shorter convalescence time
Complication rate was similar

10. Partial recanalization of the ablated femoral GSV segment in 1 patient out of 20 – 5%
No complications noted.

11. 52 patients in SVS arm with 1,9% long segment & 7,7% short segment recanalisation rate
Nerve injury rate 9,6% / 3,8%, skin hiperpigmentation

12. SVS – Our Results
• 730 C2-C6 patients treated since 10.2013
• 640 GSV / 84 SSV / 46 other (AASV, perforator)
• Average diameter of vein 10,2mm (3 – 25mm)
• Average lenght of GSV 45cm
• Average lenght of SSV 22cm

13. Patients qualified for SVS had more advanced disease
( CEAP, vein diameter, reccurent veins, big tributaries )
•Saphenous trunk + tributaries
•Not comparable to EVLT / RFA
• SVT
• Hiperpigmentation
• Skin burns at entry site
SVS vs EVLT vs RFA

14. S.J. Before 6 days after 100 days after
SVS - Results

15. S.J. Before 6 days after 35 days
SVS - Results

16. SVS – recanalisation
• Total – 3%
• Partial 15%

17. x SVT - 15%
x Skin hiperpigmentation – 10%
x Persthesia – 3%
x EHIT 0,5%
x DVT 0%
x Skin burns – 10%
x Infection – 1%
SVS - Complications

18. Conclusions
• SVS is an efficatious ablative technique
• Closure rate comparable with EVLT / RFA
• Cost effectivness is worse than EVLT, better than RFA
• Patient satisfacion rate better / similar to EVLT / RFA
• SVS is a safe procedure
• major complications are extremely rare
• minor complication are rare
• Complications more frequent when procedure is
performed by unexperienced in SVS operator