1. Presence of varicose veins despite prior
endovenous thermal ablation of saphenous veins.
XVII World Meeting of the International Union of Phlebology
September 8-13, 2013
Hynes Convention Center
Boston, Massachusetts
USA
Primepares G. Pal, MD, RPVI, Jacqueline S. Pal, CNP, RPhS, Rachel Isaak, BA, RVT.
Minnesota Vein Center, North Oaks, Minnesota 55127 USA
email: dr.p.pal@mnveincenter.com
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2. No relevant financial disclosures
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3. Presence of varicose veins despite prior surgical or
endovenous intervention
6% of patients evaluated had EVA
2,347
Patients Evaluated for Leg Vein Problems (2007 – 2012)
369
Had Prior Intervention
150
219
EVA
Surgery
Endovenous
Thermal Ablation
Primarily
vein “stripping”
6%
9%
Survey Group
197 Limbs
with EVA
Patients with
one limb
Patients with
two limbs
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4. Presence of varicose veins in limbs with prior endovenous
thermal ablation (EVA)
82% of patients with history of EVA and Varicose Veins
197 Limbs
162 (82%)
EVA - VV
35 EVA
No VV
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5. Patient Demographics and Clinical Characteristics
Patients with EVA – VV – Despite Prior Treatment
162 (82%)
EVA - VV
• 54.1 years (range, 22-88)
• 85% female
• Median time to presentation:
36 months (range, 6-96)
• Deep venous insufficiency:
12/162 limbs (7.4 %)
• Prior DVT: 2/162 limbs (1.2 %)
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6. Clinical Distribution EVA – VV: C Classification
80% are C2 and C3
90
85
80
70
60
50
44
40
30
30
20
10
3
0
C2
C3
C4
C5
0
C6
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7. Presence of varicose veins despite prior endovenous
thermal ablation of saphenous veins
156
6
162 (82%)
EVA - VV
Treatment:
Great Saphenous
Vein Ablation
Small Saphenous
Vein Ablation
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8. Presence of varicose veins despite prior endovenous
thermal ablation of saphenous veins
Majority initially had GSV treatment
156
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162 (82%)
108 (67%) had
EVA - VV
Adjunctive Treatment
•
•
•
Treatment:
Phlebectomy
Foam
Combination
Great Saphenous Small Saphenous
Vein Ablation
Vein Ablation
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Concurrent
Treatment
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9. Presence of varicose veins despite prior endovenous
thermal ablation of saphenous veins
Majority initially had Laser treatment
162 (82%)
EVA - VV
61
Treatment:
101
RF
Laser
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10. Presence of varicose veins despite prior endovenous
thermal ablation of saphenous veins
VV associated with recanalized saphenous veins, perforator veins or accessory veins
Recanalized
saphenous vein
58 (36%)
Perforator vein(s)
Accessory vein reflux
50 (31%)
48 (30%)
17 complete
41 segmental
34 RF
24 laser
20 thigh
30 calf
Untreated distal saphenous vein reflux
20 (12 %)
deNovo saphenous vein reflux
17 (10 %)
Neovascularization/pelvic veins
11 ( 7 %)
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11. Limbs (%) with prior endovenous thermal ablation
VV associated with recanalized saphenous veins, perforator veins
or accessory veins
100
Where had no varicose
veins had high
percentage with DSR
80
80
60
40
20
0
36
31
6
30
6
6
12
10
17
7 7
VV
No VV
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12. Summary
1. Presence of varicose veins despite prior intervention
with endovenous thermal ablation occurred in about
5-6% of patients.
2. Patients presented about 3 years after their initial
endovenous intervention.
3. Recanalization, perforator vein pathology, and new
accessory vein reflux are associated with most of the
recurrence.
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