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 USA email : [email protected]1 Endovenous laser ablation in the treatment of recurrent varicose veins.
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Endovenous Laser Ablation in the Treatment of Recurrent Varicose Veins
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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: [email protected]
1
Endovenous laser ablation in the treatment of recurrent varicose veins.
2
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.
3
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
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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%).