New treatment in varicose veins
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Transcript of New treatment in varicose veins
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RECENT ADVANCES IN THE MANAGEMENT OF VARICOSE VEINS
DR. JOEL ARUDCHELVAMCONSULTANT VASCULAR AND TRANSPLANT SURGEON
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HISTORY OF PROCEDURES 1550 B.C.- Erbers papyrus - not to treat
varicose veins Hippocrates - compression
Celcus (25 BC – AD 14) described the ligation
Galen (AD 131 – 201) – Phlebectomies
1850’s injections of veins (Joseph Pierre Pétrequin)
(930–1313 AD), Arab surgeon Albucacis - vein stripping
1890 - Friedrich Trendelenburg - ligation of the GSV
2000’s – Thermal ablation (Radiofrequency / laser)
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Advantages and Disadvantages Surgery
Needs anaesthesia Takes time Admission Trauma Complications
Thermal ablation Local Quick Day procedure Less trauma Less complications
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LASER
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“LASERS” Characteristics
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Types of LASERs
CO2 lasers Diode lasers Dye lasers Other Gas lasers Etc
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Varicose vein LASERS
810 nm (AngioDynamics Queensbury, NY)
940 nm (Dornier MedTech Americas, Inc)
980 nm (Biolitec, Inc, East Longmeadow)
1064 nm (Sharplan, Inc., NJ)
1320 nm (CoolTouch, Roseville, Calif)
1470 nm (Biolitec, neoLaser)
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Equipment
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Technique
Pre procedural USS and mark Tumescent solution
Lignoocaine (400 mg/l = 0.04%) epinephrine (1 mg/l = 1:1,000,000) sodium bicarbonate (10 mEq/l) in saline
solution Reverse Trendelenburg
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Technique
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70 – 80 j / cm
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USS Guided tumescent injection (perivenous)
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LASER Actvation and ablation
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Complications
Ecchymosis Superficial phlebitis Neurologic injuries – saphenous, sural Skin burns DVT
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Outcome
No significant difference in initial technical success rate within 2 years
fewer complications in EVLA bleeding and haematoma (1.28% versus
4.83%) wound infection (0.33% versus 1.91%) paraesthesia (6.73% versus 11.27%
Phlebology. 2014 Mar;29(2):109-19.
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Radiofrequency Ablation
Same principal of EVLA Special heater probe - 85 -120 c Probe directly comes in contact with
vein wall
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Thank you