Abstract
Poster 1
Peter Chapman-Smith and Angela Browne
Skin and Vein Clinic, 67 Maunu Road, Maunu, Whangarei 0179, New Zealand
Presented by: Peter Chapman-Smith
Objectives: To observe the efficacy and safety of 1320 nm endovenous laser ablation (EVLA) combined with ultrasound guided foam sclerotherapy (UGS) for refluxing leg veins classified clinical, aetiological, anatomical and pathological elements (CEAP) 1-6. Adverse events, vein size, competence, and clinical or US recurrence are measured.
Methods: Two hundred and eighty vessels were treated with EVLA. After duplex mapping and Seldinger vein access, the laser fibre was placed 2 cm distal to the saphenous junction, then withdrawn mechanically. A Cooltouch 1320 nm Nd:YAG laser with tumescent anaesthesia was used. Foam UGS closed proximal leashes, distal trunks and tributaries. With immediate ambulation, class 2 compression hose were worn for 10 days. Serial duplex US and annual subjective questionnaires were recorded.
Results: All refluxing veins were closed with no serious adverse outcomes:
Transient hypoaesthesia, minor bruising, access site haemorrhage, pain and superficial thrombophlebitis were rare. Pre-opulcers healed. Most venous symptoms ceased within 24 h. All junctions reduced in size; >90% became competent or were closed.
Conclusions: EVLA with 1320 nm is very safe, popular and combined with foam UGS is an effective non-surgical treatment for refluxing leg veins of all sizes in the medium term.
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Poster 2
Roger Hogue*, Marlin Schul†, Boyd Erdman‡ and Carl Dando*
*Hogue Vein Institute, 3115 University Drive, Suite 1, Fargo 58103, Maple Grove, MN; †Lafayette Regional Vein Center, Lafayette, IN; ‡Madison Vein and Laser Institute, Middleton, WI, USA
Presented by: Carl Dando
Objectives: To assess the effect of topically-applied nitro-glycerin (NTG) ointment (2%) on preoperative venous access site great saphenous vein (GSV) diameter in patients undergoing endovenous laser treatment (ELT).
Methods: In this patient blinded randomized allocation consecutive enrolment study, (75) patients received either (a) treadmill ambulation only, (b) topically-applied NTG ointment only or (c) topically-applied NTG ointment and treadmill ambulation. Vein diameters were measured before therapeutic intervention and then repeated after approximately 30 min. Presence of venos-pasm and the number of ultrasound-guided venous access attempts during each ELT procedure were assessed during the study.
Results: The mean pre-treatment vein diameter was 2.6 mm (range 0.9–4.9 mm). The post-treatment percentage change in vein diameter for Group A (treadmill ambulation only) was + 2.7 % (P-value = 0.403), whereas Group B (NTG only) and Group C (NTG and treadmill ambulation) demonstrated significant venodilatation of + 69.0 % (P-value <0.001) and + 51.7% (P-value <0.001), respectively. Statistical analysis of variances and multivariate linear regression model revealed topically-applied NTG ointment and advanced stages of CVI were each significant predictors for venodilatation percentage change (P-values <0.001 and = 0.028, respectively).
Conclusions: Pretreatment with topically-applied NTG ointment (2%) produced a statistically significant, as well as subjective clinically significant, venodilatation change in the venous access site diameter of patients undergoing ELT of the GSV in this study.
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Poster 3
Stanley Hirsch
University of Pittsburgh School of Medicine, UPP Vascular Surgery, 5200 Centre Avenue, Suite 307, Pittsburgh, PA, USA
Presented by: Stanley A Hirsch
Objectives: To determine the safety and effectiveness of using endovenous laser therapy to treat the superficial accessory saphenous vein (SASV).
Methods: It has been stated that using endovenous laser therapy in a superficial vein will cause skin damage. Often a refluxing branch emerges from the great saphenous vein (GSV) in the thigh that exits the superficial fascia to the subcutaneous position and then parallels the course of the GSV. We have termed this SASV. The more distal GSV is reflux free. From 15 October 2006 to 1 June 2007, we performed 175 endovenous laser treatments of the saphenous vein. In 21 patients, the SASV was involved. There were 15 women and 3 men with ages ranging from 30–74 years (average, 52). One patient was clinical, aetiological, anatomical and pathological elements (CEAP) clinical class V, two were class IV, one was class III and two were class II.
Results: Other than transient erythema there were no skin complications. A full 100% of the veins were closed.
Conclusions: Endovenous laser therapy of the SASV is safe and effective.
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Poster 4
Wendell Goins and Timothy Jonassen
Mid-Carolina Surgery Specialists, 1010 Woodland Drive, Medical Arts Building #3, Lancaster, SC, 29720-6251 United States
Presented by: Timothy Jonassen
Objectives: To review our experience and outcomes of 208 patients who underwent office-based endovenous ablation using either radiofrequency or the 1320 nm laser.
Methods: Details of their presenting complaints, physical examination, duplex exam, treatment and outcomes at 1 week, 3 months, 6 months and 1 year were noted.
Results: The mean age was 52.9 (range 21–85 years) and 84% were women. The clinical, aetiological, anatomical and pathological elements (CEAP) classification ranged between 2–6 (mean = 2.9). One hundred and fifteen were C3, 58 were C2 and 27 were C4. One hundred and thirteen patients underwent endovenous saphenous ablation using the 1320 nm laser and 70 patients underwent the radiofrequency method. One hundred and five patients also underwent concomitant microphlebectomy (43) or sclerotherapy (62) at the same setting. Postoperative complications included: two patients reported back to the office the same day for bleeding from the micro-phlebectomy sites; five patients developed painful hae-matomas along the great saphenous vein at aneurismal sites; three patients developed asymptomatic endovenous heat-induced thrombus; and three patients had recurrence of either reflux or varicose veins within a year of endovenous ablation. They all occurred in the thigh and occurred early in our experience.
Conclusions: The utilization of the radiofrequency or the 1320 nm laser for the purpose of endovenous ablation of incompetent saphenous veins is a safe procedure with the proper training. It can be done with local anaesthesia in an office-based setting with low morbidity.
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Poster 5
Mona Li, Michael Singh, David LoCastro, Cheryl Sura, Sandra Palmer, Marcia Johansson and Jeffrey Rhodes
University of Rochester, 150 Alpine Drive, Rochester 14618, NY, USA
Presented by: Mona Li
Objectives: Endovenous treatment of incompetent saphenous veins utilizes one of the two modalities: radiofrequency or laser ablation. The latest generation radiofrequency catheter, VNUS® ClosureFASTTM, uses a segmental ablation technique, eliminating pullback speed variation and lowering treatment times. Our initial experience with ClosureFASTTM is compared with traditional radio frequency ablation (RFA) and endovenous laser therapies (EVLT).
Methods: Retrospective analysis of consecutive office-based endovenous ablations over a ten-month period. Methods used were ClosureFASTTM (88 limbs), ClosurePlusTM (103 limbs) and endovenous laser ablation (810 or 940 nm, 95 limbs). Pre, perioperative and initial one-month variables were compared by Chi-square or ANOVA. Primary valvular incompetence was present in 99% of all limbs. Mean age was 49.8 years in 228 patients and 46% were clinical, aetiological, anatomical and pathological elements (CEAP) Class 3 or higher.
Results: Saphenous treatment times were significantly less with ClosureFAST than ClosurePlus and EVLT (P < 0.001) despite longer treatment lengths. Neither ClosureFAST nor EVLT required adjunctive measures to achieve technical success compared with 18% of ClosurePlus limbs. There was no difference in short-term closure rates among groups, 98.7% overall. There were no differences in minor complications (14%), deep vein thrombosis (DVT) (0.7%) or clot extension beyond the superficial epigastric vein (SEV) (7%).
Conclusions: ClosureFAST is a safe, efficient and rapid means to ablate saphenous reflux. This next generation catheter is superior to the previous model and is as efficient as current endovenous laser technology.
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Poster 6
Nick Morrison*, Sergio Salles-Cunha†, Diana L Neuhardt† and Terri Morrison*
*Morrison Vein Institute; †CompuDiagnostics, Inc., 8575 East Princess Drive, Suite 223, Scottsdale 85255, AZ, USA
Presented by: Nick Morrison
Objectives: To determine if diameter measurement is a useful secondary variable in the evaluation of valvular insufficiency of the great saphenous vein (GSV) in the thigh.
Methods: Evaluation for chronic valvular insufficiency of the GSV was performed in 309 extremities of women and 47 of men. The relationship between mid-thigh GSV diameter measurements and reflux longer than 1 s is reported herein.
Results: Prevalence of reflux was 100% for GSV ≥ 6 mm in extremities of women (38/38) or men (8/8). Prevalence decreased as follows as the diameter diminished: 91% (20/22) in women and 78% (7/9) in men with 5 mm GSV, 41% (19/46) in women and 50% (4/8) in men with 4 mm GSV, 19% (25/133) in women and 6% (1/16) in men with 3 mm GSV and 8% (5/62) in women and 0% (0/5) in men with 2 mm GSV. Reflux was not detected in 1 mm veins.
Conclusions: Diameter measurement can be an effective secondary measurement to establish valvular insufficiency of the GSV, particularly if a contradiction exists without reflux being detected in GSV larger than 5 mm in diameter. Presence of reflux still needs to be evaluated in veins as small as 2 mm in diameter.
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Poster 7
Nick Morrison*, Sergio Salles-Cunha†, Diana L Neuhardt† and Terri Morrison*
*Morrison Vein Institute; †CompuDiagnostics, 8575 East Princess Drive, Suite 223, Scottsdale 85255, AZ, USA
Presented by: Nick Morrison
Objectives: It seems intuitive that extremities with varicose veins in patients with more severe chronic venous disease clinical, aetiological, anatomical and pathological elements (CEAP) clinical classifications C3 to C6) should have more valvular insufficiency than extremities with oedema, skin changes and/or ulcers (C3, C4, C5-C6), but without varicose veins. Data analysis to support this concept, however, seems needed. We investigated if varicose veins affected the prevalence of venous reflux in extremities with oedema, skin changes and/or ulcers.
Methods: Presence of reflux in the great saphenous, anterior accessory saphenous and superficial tributaries of the thigh was investigated in 120 C3–C6 extremities. Varices were noted in 57 (48%) of these extremities. Reflux prevalence in C3–C6 plus C2 vs. C3–C6 extremities without varices was compared by Chi-square.
Results: Prevalence of reflux in the C3–C6 plus C2 group, 68% (39/57), was significantly higher than in the C3–C6 extremities without varicosities, 35% (22/63) (P < 0.001). Subgroup analysis revealed that prevalence of reflux was also higher in extremities with ‘end-of-the day’, intermittent, positional or occupational oedema (C3 mild) plus varicose veins, 76% (13/17), than in extremities with mild oedema, but no varicose veins, 34% (10/29) (P = 0.006).
Conclusions: Varicosities were a factor for higher prevalence of superficial venous valvular insufficiency in extremities with oedema, skin changes and/or ulcers.
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Poster 8
Aksel Nordestgaard and Christine Lamka Northwest Vein Center, 4700 Point Fosdick Dr NW, Suite 307, 7502 Ford Drive NW, Gig Harbor, WA, USA
Presented by: Aksel G Nordestgaard
Objectives: We have previously reported that only 33% of all initial incompetent perforating veins (IPV) remained incompetent following endovenous laser ablation (EVLA) of incompetent saphenous veins. This prospective study reports our experience with ultrasound guided foam sclerotherapy of persistent IPV's.
Methods: Persistent IPV's following EVLT of incompetent saphenous veins were injected 4 weeks following the EVLT procedure, using ultrasound guidance. Initial injection was done with 1% foamed sodium tetradecol (STD). Size and location of perforators were noted. Ultrasound re-evaluation was performed at 2 weeks and reinjected with 3% foamed STD if incompetence persisted.
Results: Ninety-eight limbs (77 patients) with 179 IPV's were treated with ultrasound guided foam sclerotherapy. Six patients failed follow-up, leaving 170 perforators for evaluation. At the two-week follow up ultrasound 120 (71%) were occluded, 12 (7%) competent and 38 (22%) incompetent. Of 18 significantly persistent IPV's reinjected 11 occluded, four remained patent and three patients did not return. In summary, of 167 perforators treated with foam sclerotherapy and available for follow up, 131 (78%) occluded, 13 (8%) were patent and competent, and 23 (14%) remained incompetent.
Conclusions: Ultrasound guided foam sclerotherapy of persistent IPV's following EVLT of axial reflux resulted in short-term occlusion rate of 78%.
Disclosure information was provided at the time of abstract submission.
Poster 9
Neil Sadick* and Samuel Wasser†
*Weill Cornell Medical College, 911 Park Avenue Suite 1A, NY 10021; † Lourdes Medical Center, Burlington County, NJ, USA
Presented by: Neil Sadick
Objectives: The present study examines the treatment of 90 patient limbs with saphenofemoral junction incompetence with simultaneous treatment of associated truncal varicosities by ambulatory phlebectomy.
Methods: Four-year follow-up data for recurrence rate and complication profile was ascertained for 90 patients (mean age 40 years) with saphenofemoral junction reflux associated with greater saphenous vein incompetence (4-12 mm - mean 7.8 mm) and enlargement of branch varicosities as documented by Duplex ultrasound, which were treated with a combined approach of endovascular laser obliteration of the greater saphenous vein (810 nm, Diomed S30) followed by ambulatory phlebectomy of the remaining truncal varicosities. Follow-up by Duplex ultrasound to ensure closure was carried out at week 1 and months 1, 3, 6, 12, 24, 36 and 48.
Results: A total recurrence rate r = 94 limbs of 4.3% was found in the patient cohort. All recurrences occurred within 12 months with the majority documented at month 6. Complications included ecchymoses, paresthesias and hyperpigmentation.
Conclusions: Combination endovenous laser therapies with ambulatory phlebectomy is an effective treatment modality for superficial venous incompetence in the outpatient ambulatory setting. Low recurrence rates are noted with this approach. In the present patient series most recurrences were noted within 12 months of the aforementioned procedure.
Disclosure information was provided at the time of abstract submission.
Poster 10
Sergio Salles-Cunha*, Diana L Neuhardt* and Nick Morrison†
*CompuDiagnostics, Inc; †Morrison Vein Institute, 8575 East Princess Drive, Suite 223, Scottsdale 85255, AZ, USA
Presented by: Sergio X Salles-Cunha
Objectives: To determine if colour flow, transverse-oblique imaging of superficial veins of the lower extremity can replace duplex-doppler measurements of reflux.
Methods: Saphenous, tributary and accessory veins of the thigh and calf, 1.8-14 mm in diameter, were imaged with the patient standing. An automatic cuff inflator–deflator was employed to elicit reflux. Initial US observation was the transverse imaging. Velocity scale and colour gain were optimized, and persistence was minimized. US doppler evaluation of reflux followed. A total of 100 sites were compared.
Results: All prolonged refluxes by transverse imaging (n = 50) had doppler duration longer than 2 s, with 90% lasting longer than 4 s. All but one (valve leakage) of 30 no colour transverse images had valve closure demonstrated by doppler. Short colour bursts represented delayed valve closure or wisps of reflux. Flow monitored for several seconds after valve closure demonstrated valve leakage. Transverse images demonstrated recirculating reflux while imaging multiple veins at the same time, an impossibility by doppler.
Conclusions: Colour flow transverse imaging detected reflux effectively. It is recommended, however, that for every patient and every instrument setting, at least one measurement be repeated with doppler to validate colour findings.
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Poster 11
Catherine Schell and Deborah Manjoney Wisconsin Vein Center, 1231 Georgetowne Drive, Suite G, Pewaukee, WI, USA
Presented by: Catherine Schell
Objectives: A patient's postoperative course following endovenous laser ablation (EVLA) of the great saphenous vein can be variable. The purpose of this study is to examine if a correlation exists between Joules/cm2 and the incidence of postoperative phlebitis, eccymosis or pain.
Methods: For each patient (n = 108) undergoing EVLA (940 nm) of the great saphenous vein, the saphenous segment treated was measured in centimetres from the point of access to the saphenofemoral junction. Joules per centimetre square was calculated utilizing total joules delivered along the course of the measured segment. Each patient was seen in follow-up at one week and clinically assessed for phlebitis, pain and degree of eccymosis on a scale of zero to five.
Results: Phlebitis was not demonstrated in 87% (n = 105) of the patients when an average of 66 J/cm2 was delivered. Two patients reported severe symptoms and exhibited signs of phlebitis with an average of 82 J/cm2. The majority of the patients (60%) rated their pain zero to one with an average of 65 J/cm2. A small group of patients (4.6 %), who reported their postoperative pain a four received an average of 74 J/cm2. In a majority of the patients (86 %) eccymosis was clinically assessed at a zero to two with an average of 69 J/cm2.
Conclusions: Although the postoperative course after EVLA can be variable, J/cm does not appear to predict the incidence of eccymosis or pain. However, the treatment with greater than 80 J/cm2 may increase the incidence of phlebitis.
Disclosure information was provided at time of abstract submission.
Poster 12
Takashi Yamaki*, Motohiro Nozaki*, Hiroyuki Sakurai*, Masaki Takeuchi†, Kazutaka Soejima‡ and Taro Kono*
*Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666; †Nihon University; ‡Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan
Presented by: Takashi Yamaki
Objectives: To compare the clinical outcome between duplex-guided foam sclerotherapy (DGFS) and duplex-guided liquid form sclerotherapy (DGLS) in patients with venous malformations (VM).
Methods: Eighty-nine patients with symptomatic VM were treated with duplex-guided sclerotherapy. There were 22 men and 67 women with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) and 10% ethanolamine oleate (EO). Foam sclerosing solution was provided using Tessari's method.
Results: Forty-nine patients were treated with DGFS and remaining 40 were treated with DGLS. The amount of POL was significantly smaller in patients who were treated with DGFS (P = 0.022). Similarly, there was a significant reduction in the use of EO in patients treated with EO (P = 0.005). The proportion of VM with total disappearance and partial recanalization was significant in patients treated with DGFS (P = 0.002). No major complications related to sclerotherapy were encountered in both groups.
Conclusions: These findings suggest that DGFS could have greater promise compared with DGLS in the treatment of VM.
Disclosure information was provided at the time of abstract submission.