Lütfi Kirdar International Congress and Exhibition Centre Istanbul, Turkey

Primepares G. Pal, MD, RPVI, Jacqueline S. Pal, CNP, RPhS, Rachel Isaak, BA, RVT.Minnesota Vein Center, North Oaks, Minnesota 55127 USAemail: dr.p.pal@mnveincenter.com

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Endovenous laser ablation in the treatment of recurrent varicose veins.

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No relevant financial disclosures

Aims:

1. Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention.

2. Identify the site and cause of varicose veins in patients with prior surgical intervention.

3. Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.

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Endovenous laser ablation in the treatment of recurrent varicose veins.

Recurrence of varicose veins after vein “stripping”4% of patients evaluated had vein “stripping” after 2000

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2,347 Patients Evaluated for Leg Vein Problems (2007 – 2012)

369Had Prior Intervention

150EVA

Endovenous Thermal Ablation

219SurgeryPrimarily

vein “stripping”

9% 6%

Survey Group – 71 Patients

• Presence of varicose veins• Vein “stripping” surgery after 2000

• Excluded phlebectomies

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95 Limbs

Patients with one limb

Patients with two limbs

Survey Group – 71 Patients

2,347 Patients Evaluated for Leg Vein Problems (2007 – 2012)

369Had Prior Intervention

150EVA

Endovenous Thermal Ablation

219SurgeryPrimarily

vein “stripping”

9% 6%

Presence of varicose veins despite prior Vein “Stripping”

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Patient Demographics and Clinical Characteristics

Patients with Varicose Veins – Despite Prior Vein “Stripping “after Year 2000

• 49.4 years (range, 32-74)

• 84% female

• Surgery occurred median of 7 years previously (1-12 yrs)

• Deep venous insufficiency: 10/95 limbs (11 %)

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Clinical Distribution: C Classification

72% are C2 and C3

C 2 C 3 C 4a C4b C5 C60

5

10

15

20

25

30

35

40

4544

24

19

53

0

8

Perforator vein(s)

21 thigh

16 calf

28 (30%)

Presence of varicose veins despite surgery

Accessory vein reflux

26 (27%)

Small saphenous vein reflux 20 (21 %)

Neovascularization/pelvic veins 12 (13 %)

Segmental or Fully Intact GSV

61 (64%)

37 segmental24 intact

VV associated with saphenous veins, perforator veins or accessory veins

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Limbs (%) with prior vein “stripping”

Segmental/In-tact GSV

Perforator Accessory vein

SSV Neovasc/pelvic

0

20

40

60

80

64

3027

20

13

VV associated with saphenous veins, perforator veins or accessory veins

10

95 Limbs

Patients with one limb

Patients with two limbs

73%

20%

7%Microphlebectomy

Foam

Foam & Microphleb.

Treatment of patients with recurrent varicose veins

69 Treated with EVLA(CoolTouch CTEV™ 1320mm)

Plus received concurrent adjunctive treatment

26 EVLA not possible

Received treatment46

%

46%

7%

Com

plete Treatm

ent Received

% Patients

Second vein treated in 23 cases

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Saphenous veins treated with EVLA

EVLA was feasible in 69 limbs (73%). When intact GSV excluded,EVLA still feasible in 57 limbs (60%).

First vein ablated

GSV segmental 23GSV intact 24SSV 13Accessory vein 9

–––69

Second vein ablated

GSV segmental 1SSV 7Accessory vein 15

–––23

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Saphenous veins treated with EVLA

Treated vein mean (SD, range)

GSV segmental (n=23) 21.2 cm (± 6.1; 12-35)GSV intact (n=24) 41.9 cm (± 8.1; 25-58)SSV (n=20 16.3 cm (± 4.1;; 9-25)Accessory (n=24) 14.4 cm (± 4.4; 6-22)

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1 week 3 months 6 months 12 months0

10

20

30

40

50

60

70

80

69

53

39

23

69

53

38

23

0

14 14

2

EVLA treated

Total occlusion

"Foam" other reflux-ing veins

Follow-up of EVLA-treated saphenous veinsMajority of patients reported symptomatic improvement

(Superficial venous insufficiency – excluding SV)

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Summary

1. 15% of patients presenting for evaluation of leg vein problems had prior intervention. 9% had prior surgery.

2. Presence of varicose veins associated with segmental or fully intact great saphenous vein, perforator vein pathology, and accessory vein reflux.

3. Short-term, EVLA is feasible and effective in the majority of patients with varicose veins and prior saphenous vein surgery.

4. The majority of EVLA-retreated patients reported symptomatic improvement.