Treatment Options

Retrograde Injection Technique for Endovenous Chemical Ablation of Vacisose Veins, A Case Study

Steven T. Deak, MD, PhD, FACS Rutgers Medical School, New Brunswick, NJ

Introduction & Objectives

The treatment of large superficial varicose veins requires a two step approach. First the incompetent greater saphenous vein is closed with endovenous thermal ablation followed by ambulatory phlebectomy of the residual varicose veins, either at the same time or at a later date. This study outlines an improved technique for treating the incompetent greater saphenous vein and the associated varicose vein tributaries at the same time with a single access site using endovenous chemical ablation with polidocanol injectable foam 1%.

Materials & Methods

The greater saphenous vein is accessed with a 5 French micropuncture catheter in the distal thigh. The leg is eleveted 45 degrees to empty the varicose veins of blood. Under ultrasound guidance, the greater saphenous vein is thrombosed with polidocanol injectable foam 1% while the saphenofemoral junction is compressed to protect the deep system.

Treatment Options

Next, a second injection is administered through the same catheter allowing the polidocanol foam to flow distally in a retrograde fashion through the incompetent varicose veins to the calf. The patient is asked to dorsiflex his foot to close patent perforators.

Results

38 year old male presents with varicose veins for many years with heavy feeling in both legs. severe reflux in greater saphenous vein 500 ms in duration was noted and the right greater saphenous vein measured 11 mm in diameter with 8 to 11mm varicosities at the knee. [Figure1]. The greater saphenous vein was thrombosed with 3mL's of polidocanol injectable foam1%. The remaning varicosities in the distal leg were then treated with an additional 5mL of polidocanol injectable foam 1% through the same micropuncture catheter in the distal thigh for a total foam volume of 8mL. [Figure3: 2 weeks post op].

Treatment Options

Conclusions

An improved technique for simultaneous treatment of the GSV and associated varicose veins in the distal leg through a single access site is described.

References

Gloviczki, et al. JVS May Suppl. 2011, Todd et. al,. Phlebology. 2014; 608-618

Retrograde Endovenous Microfoam Ablation of Venous Valvular Reflux in the Treatment of CEAP 6 Ulcers: A Case Study

Steven T. Deak, MD, PhD, FACS Deak Vein NJ Clinic Somerset, NJ

Introduction & Objectives

Ligating incompetent perforators, subfacial endoscopic perforator vein surgery (SEPS) and ultrasound guided sclerotherapy of perforating veins have been employed to decrease ambulatory venous hypertension and promote healing of chronic venous insufficiency ulcers.

The objective of this study is to present a retrograde injection technique for endovenous microfoam ablation of venous valvular reflux of the greater saphenous vein and its below knee varicose tributaries from a single remote access site. This technique allows for a less invasive approach to treating venous hypertension above the knee, while correcting the saphenous reflux that leads to skin changes below the knee and ultimately leading to a more rapid healing of venous leg ulcers.

Materials & Methods

Treatment Options

The greater saphenous vein is accessed with a 5 French micropuncture catheter in the distal thigh. The leg is elevated 45 degrees in order to empty the varicose veins of blood. Under ultrasound guidance, the greater saphenous vein is thrombosed with polidocanol injectable foam 1% while the saphenofemoral junction is compressed to protect the deep system. Next a second injection is administered through the same catheter directing the polidocanol foam to flow distally in a retrograde fashion through the incompetent varicose veins to the calf and ankle. The patient is asked to dorsiflex the foot to close patent perforators.

Results

A 65 year old female present with a venous ulcer for 6 months despise compression theraphy. The ulcer measured for cm in diameter. The greater saphenous vein and its accesory branch is 6.2 mm and 5.4 mm in diameter and the venous valvular reflux measures 1.02 sec. The GSV was thrombosed with 5mL of polidocanol injectable foam 1%. The remaining varicosities in the distal leg were treated with an additional 4mL of polidocanol injectable foam 1% through the same micropuncture site in the distal thigh for a total foam volume of 9mL. The ulcer healed in 4weeks (27 days) and remained healed at 2 weeks post procedure.

Treatment Options

Conclusions

An improved technique for endovenous chemical ablation of venous valvular reflux of the GSV and its varicose tributaries below the knee is described. This technique decreases the ambulatory venous hypertension contributing to the formation of chronic venous ulcers from a single remote site. This results in shorter ulcer healing time as compared to thermal ablation of GSV with or without adjuct surgical procedures.

References

Gloviczki, et al. JVS May Suppl. 2011, Todd et. al,. Phlebology. 2014; 608-618

Call 732-873-0200 to schedule an appointment.

Treatment Options
Treatment Options