great saphenous vein thermal ablation
DESCRIPTION
By: Thomas M. Proebstle, M.D. Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.TRANSCRIPT
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Great Saphenous Vein Thermal Ablation
Thomas M Proebstle
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Disclosure
Thomas M. Proebstle, M.D. I disclose the following financial relationship(s):
•Consultant/Advisory Board: Sapheon
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Background
for Thermal Ablation of Great Saphenous Veins
- High ligation and Stripping was a brilliant idea
more than 100 years ago
- Today, numerous prospective randomized trials
comparing thermal ablation to surgery show at
least non-inferiority for procedural success and
clinical results, but improved periprocedural QoL
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Background
for Thermal Ablation of Great Saphenous Veins
- High ligation and Stripping was a brilliant idea
more than 100 years ago
- Today, numerous prospective randomized trials
comparing thermal ablation to surgery show at
least non-inferiority for procedural success and
clinical results, but improved periprocedural QoL
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Advantages (personal selection)
of Thermal Ablation of Great Saphenous Veins
- Totally Outpatient
- No sutures to be removed
- Infections only sporadically reported
- No lymphatic damage in the groin
- Even Coumadin can stay at an INR of 2.0 – 2.5
- Immediate return to normal Life
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Checkpoints
for Thermal Ablation of Great Saphenous Veins
- Indication
- Appropriate Outpatient Setting
- Ultrasound Technology available throughout
intervention
- Catheter and Local Anesthesia Placement Skills
- Heat Delivery Technology and Technique
- Post Tx Care, LMWH, Stockings as required
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Indication
for Thermal Ablation
of Great Saphenous Veins
Pathological reflux in the GSV
linked to Venous Disease related
Clinical Signs or Complains
CEAP / VCSS
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Thermal Ablation of
Great Saphenous Veins
Appropriate Outpatient Setting
- Minor OR providing Air Condition
- Tilt Table for Trendelenburg and reverse position
- Laser Safety if necessary
- Dimmable Lights for Ultrasound exams
- Organized Office staff, on-call phone numbers
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Thermal Ablation
of Great Saphenous Veins
Ultrasound Technology must be
available during intervention
- 8 to 12 MHz or more Linear Scanner
- Color Duplex and PW-Mode
- Sterile Drapings for Probe and Ultrasound-Keyboard
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Thermal Ablation of
Great Saphenous Veins
Catheter and Local Anesthesia Placement Skills
all injections to be performed ultrasound-directed
- Puncture Skills !!!
- placement of catheter or laser fiber at the SFJ not too
ambitious, today 2 cm distance recommended !!
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Thermal Ablation of
Great Saphenous Veins
Tumescent Local Anesthesia
Saline with 0.05% Lidocaine
1 mg epinephrine per 1000 cc, 10cc bicarbonate 8.4%
- Pain Control
- Collapsing the GSV around the heat source
- Thermal insulation of the surrounding tissue
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Rule #1
for Thermal Ablation of Saphenous Veins
durable success is linked to
sufficient dosing of Heat Energy
to the Vein Wall
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Recanalization 12 months after thermal ablation
of the GSV with respect to the administered EFE 940 nm laser – bare fiber
Proebstle TM et al: Reduced recanalization rates of the great saphenous vein after
endovenous laser treatment with increased energy dosing: definition of a threshold for
the endovenous fluence equivalent. J Vasc Surg (2006) 44:834-9.
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Question #1
for Thermal Ablation of Saphenous veins
How gentle can Heat Energy
be delivered to the Vein Wall ?
Which is the best System ?
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Thermal Ablation of
Great Saphenous Veins
Heat Delivery Technology and Technique
> 10 years: RF old style
810, 940, 980 nm diode lasers
1064, 1320 nm Nd:YAG lasers
< 5 years: RF-Segmental
1470 nm diode lasers
pressurized overheated steam
New Fiber Tips: spherical, covered, radial
Hb H2O
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8 W, 1 mm/s control 5 W, 0.5 mm/s
20 mm 13 mm 8 mm
control 15 W 30 W
940 nm 1320 nm
Thermal Ablation of Great Saphenous Veins
Water versus Hemoglobin absorbed Laser Wavelengths
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Covered Fiber Tips ceramics bare fiber tip
metal
radial
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RA Weiss, Dermatol Surg (2002) 28:56
RFA 1st generation versus 810 nm Diode Laser
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Thermal Ablation of Great Saphenous Veins
Prospective Randomized Trials on Patients´ Recovery
Almeida JI et al. Radiofrequency endovenous ClosureFAST versus
laser ablation for the treatment of great saphenous reflux: a
multicenter, single-blinded, randomized study (RECOVERY study).
J Vasc Interv Radiol. 2009;20:752-9.
Shepherd AC et al. Randomized clinical trial of VNUS ClosureFAST
radiofrequency ablation versus laser for varicose veins.
Br J Surg 2010;97:810-8.
Segmental Thermal Ablation shows faster recovery
compared to 980 nm bare fiber ablation proven by
VCSS and QoL instruments
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Disclosure
Standard Error below 1% at all times
95.7%
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Disclosure
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future Questions
for thermal Ablation of the Great Saphenous Vein
How does Segmental Ablation compare to
- water absorbed laser wavelengths ?
- Latest laser fiber tip technology ?
There are new concepts arriving:
is the end of the Age of Heat already in sight?
Will we turn to become gluers instead of burners?