Endovenous Ablation of Varicose Veins. Treat painful varicose veins by Laser / RFA / Sclerotherapy...
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Transcript of Endovenous Ablation of Varicose Veins. Treat painful varicose veins by Laser / RFA / Sclerotherapy...
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ENDOVENOUS ABLATION OF VARICOSE VEINS
Dr.Saurabh Joshi, MD, FNVIR
www.veincenter.in
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ABNORMAL FLOW = VENOUS REFLUX
• Superficial vein disease always starts with abnormal valves and interruption to normal flow called venous reflux
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PATHOGENESIS OF CVI• Changes in the vein wall destruction of valves
• Thrombosis
• Extra-vascular factors (failure of muscle pump, limited movement in joints, connective tissue disease)
• Congenital venous malformations
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INTRODUCTION
Lower limb varicose veins are one of the most common vascular problems encountered in practice.
The most common site for reflux is great saphenous vein (GSV) .
The standard intervention for GSV reflux is Sapheno Femoral junction (SFJ) ligation with GSV stripping.
Radiofrequency ablation (RFA),minimally invasive technique, as an alternative to conventional surgery in varicose vein treatment. RFA operates by resistive heating of the vein wall.
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DIAGNOSIS OF VENOUS DISEASE
Physical examAppearanceTrendelenburg testPalpation
Duplex ExaminationR/O DVTSize of veinsMap out superficial veinsLocate the site of refluxReflux 0.5 sec in GSV
1 sec in deep system
Find refluxing perforators
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CEAP SCORE
CATEGORY
CLNICAL FEATURES
O No visible or palpable signs of venous disease
I Telangiectases, reticular veins, malleolar flare
II Varicose veins III Edema
IV Skin changes ascribed to venous disease
V Skin changes in conjunction with healed ulceration
VI Skin changes in conjunction with active ulceration TYPE IV
TYPE II TYPE VTYPE VI
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SUBJECTS AND METHODS:
Patient selection criteria: Doppler evidence of incompetent SFJ and reflux into GSV for more than 0.5 seconds were included for treatment.
Exclusion criteria:
1.Deep venous thrombosis,
2.Deep vein reflux
3.Extremely tortuous GSV identified during pre procedure USG,
4.Inability to ambulate
5.Pregnancy.
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Power: 20 -250 watts
Application Time
Impedance control
CelonLab POWER radiofrequency generator unit Celon AG Medical
instruments,Teltow,Germany
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• Diameter: 2 mm
• Active length: 15 mm
• Flexible shaft: 115 cm
• semispherical tip
Bipolar RFITT applicator CelonProCurve 1200-S15
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Vein ablation steps
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VEIN ACCESS
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GUIDE WIRE INSERTION
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PLACEMENT OF SHEATH
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POSITION OF SHEATH CONFIRMATION
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PERIVENOUS TUMENESCENSE
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RF ABLATION
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POST PROCEDURE
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PROCEDURE DETAILS
• PUNCTURE SITE :
• ENERGY : 0.53 – 3.3 KJ. (Average – 1.7KJ)
• POWER LEVEL : 20 WATTS
• TIME TAKEN : 0.55 – 6.90 min .(Average – 3.30 min)
• After ablation single dose of LMWH 40 given SC
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RESULTS:
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• CEAP SCORE :
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RESULTS : 1 WK F/U
• Out of 65 veins , follow up at 1 week – 65 veins
Thrombosis of ablated segment – 65
Complications : Thrombus prolapsing into FV- 1
Thrombophlebitis – 1
Segmented fluid collection in vein – 1
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RESULTS : 3 WK F/U
• Follow up at 3 weeks – 56 veins
• All had thrombosed GSV
• Perforators were as they were – mostly below knee
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LATER F/U
Follow up at 90 days – 39 veinsNo recanalizations
Follow up at 180 days – 30 veinsNo recanalizations
One patient for whom the short saphenous vein was ablated, had complete recanalization at 12 months
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Presentation
3 weeks
90 days
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Presentation
3 weeks
90 days
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CONCLUSION:
• Endovenous ablation is a safe, effective and preferred alternative to the surgical procedures in the treatment of the varicose veins.
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• Contact :
• Dr.Saurabh Joshi : +919967368256 ( Mon – Sat, 9:00 – 19:00, India Standard Time)