Steam ablation is a new technique for treating varicose veins. It uses high pressure steam delivered through a microcatheter to thermally ablate veins. In animal and early human studies: - It can effectively treat large varicose veins over 2cm in diameter, shrinking them significantly within a year. - It causes minimal pain and few complications compared to foam sclerotherapy in early results. - A randomized trial found steam ablation resulted in less inflammation, pain, pigmentation and better cosmetic results than foam for treating superficial tributaries.

2. • How does it work ?
• How to treat patients ?
• What are the results ?
• R.Milleret – Montpellier - France
Steam : Return to the future ?

3. Generation of Endo Venous
Steam
• Water is pumped under high pressure
through a microtube of 100 µ internal
diameter.
• Electrical current heats the microtube.
• Steam is emitted at a temperature of 150°
At the tip of the catheter it decreases to
120°C120

5. Catheter and vein entrance device .

8. Microscopic study / Animal

9. Jonction Sapheno-Femorale

10. Sapheno femoral junction – control at 1 month .

11. Large trunks
• Steam allows treatment of very large trunks
• At one year they have shrinked even if they
were more than 2 cm diameter

13. Trunk at one year

14. Dilatation anevrysmale

15. Small Saphenous Trunk

20. Obliterating Perforators
• Easy : just puncture on 1 or 2 cm under
echo-guidance ,
• Inject a small quantity of tumescent solution
• Send repeated pulses into the perforator .
• In the deep veins , only droplets of hot
water , no harm done .

22. Steam Phlebectomy
• Large Tributaries and Perforators can be
treated .
• Several punctures are made along the vein.
• The catheter is not retracted , repeated
pulses are sent : steam can thus travel up to
8/10 cm
* No tumescence needed if under general
anesthesia . Skin cooling by gel .

31. 1 month result , 6 punctures

33. Results
• Multi center French study GSV ,
1 year follow up .
• Randomized study for superficial veins

34. Multi-Center Trial
• CHU Besançon : Pr G.Camelot , Dr
Mazen , Dr A. Lopinnet
• Clinique du Grand Large Lyon : Dr
P.Nicolini
• Vein Center Montpellier : Dr R.Milleret
• Clinique Ambroise Paré Nancy : Dr
D.Creton

35. Material
• 80 patients included
1 year results for 73 patients are available .
• Criteria :GSV only , 4/12 mm at mid-tigh .
• Each center was free to use General or
Local , tumescent anesthesia .
• Median diameter mid tigh : 8 mm
• Length treated : 42 cm

36. Post-operative course
• Pain at 8 days : 0,75 median value
• Pain at 1 month : 0,60 median value
• No DVT , No PE No infection.
• 1 paresthesia at 8 days , 1 at 1 month .
• 0 pigmentation.

37. Abnormal Duplex findings
• At 8 days :
1 protrusion of thrombus in the
femoral vein (less than 1 cm).
1 patient with non occluded vein
segments (10 and 13 cm) at lower part of tight
without reflux = technical fault (introducer not
removed !) Treated with Foam injection .

38. Vein Resorption
• Evolution of the diameter :
8 days 1 month 12 months
Junction 9,84 7.15 4.65
Tigh 7,27 5.14 1,90

39. Obliteration at 1 year
• 73 patients followed up ,
• 72 with obliteration at thigh level.
NB . 6 had a more than 3 cm long stump
under the junction ,they’ll be followed to
check evolution .

40. QOL results
• SF 12
inclusion 6 months P
Physical 51,27 49,99 0,049
Mental 52,05 46,01 0,001

41. Randomized study of Steam
Phlebectomy versus Foam
obliteration of superficial tributaries

42. Aim of the study
• To compare efficiency , complications and
patient’s satisfaction between two
obliterative techniques :
*** Foam – Chemical obliteration
*** Steam – Thermal obliteration

43. Material
• 2 groups of 20 patients each,randomized .
• Location of varices : Anterior Accessory ,
Internal Calf
Posterior Calf
* Diameter of varices : 3 to 10 , mean 6 mm .

44. Methods
• Foam : 1% Polidocanol ,
Tessari tourbillon technique,
6 to 10 cc in one session
(Tegernsee)
• Steam : 3 to 6 pulses/location
3 to 6 18G / 20 G infusion
catheters

45. Eccentric compression

46. Results at 8 days
Foam Steam
Inflammation 6/20 0/20
Pain 2,4 0,5

47. Results at 1 month
Foam Steam
Blood extraction 12/20 6/20
Pigmentation 12/20 4/20

48. Results at 6 months
Foam Steam
Pigmentation 4/18 2/19
Cosmetic result 10/18 15/19
(patient’s evaluation
Good/very good)

49. Venous Malformations

52. Steam : a less invasive heating
technique
• Heat transfer is very quick : less than 1/2 s
as compared with 20 s sequential heating
with Closure Fast®
• Wall thickening is maximal , thus clot in the
lumen minimal , reducing inflammatory
reactions and post-op pain . .
• No perforation of the vein wall .
• Less heating of peri-venous structures.

55. THANK YOU FOR
YOUR ATTENTION
Nicolas de Staël – Les Mouettes
VISIT US IN
MONTPELLIER !

56. So , I use steam ... But not
exclusively .
• The power of heating techniques ,
• The versatility of foam ,
• Safety on top .
• Steam will not replace foam , especially for small
vessels , but will complement it for larger veins
which may lead to inflammatory reactions and
pigmentation after foam injection .leaand
pigmentation

57. Alpha Technique
• A mbulatory
• B loodless
• C atheter
• D elivered
• E ndovenous
• F oam

58. Foam technique
• Tessari Tourbillon technique
• 2% Polidocanol
• Desilet F5 introducer
• Cook Royal Flush F5 catheter
• Tumescence to compress the junction and
the localized dilatations
• Banding of the limb before injection

70. Long term results
• 5 years
• RF Laser Alpha
• N 42 58 65
• OBL 37 41 59
• % 88 70 88

71. Is there a future for steam ?
• It’s a new method , so equipment will
improve and hopefully be cheaper.
• Reimbursement still an issue in many
countries ...
• Large bulging varicose veins, recurrences
and malformations are applications where
no other technique can compete .