Dreaming Music Video Treatment _ Project & Portfolio III
Current status of endovenous ablation for the treatment of venous insufficiency
1. A. KURSAT BOZKURT, MDA. KURSAT BOZKURT, MD
University of IstanbulUniversity of Istanbul
Cerrahpasa Medical FacultyCerrahpasa Medical Faculty
20112011
Current status of endovenous ablation
for the treatment of venous
insufficiency
2. Candidates of varicose vein treatmentCandidates of varicose vein treatment
2 billion people > 30 years old2 billion people > 30 years old
20% x 2 billion= 400 million20% x 2 billion= 400 million
1% x 400 million = 4 million1% x 400 million = 4 million
3. New Fibres in Laser ablation. J-L Gerard. In: ControversiesNew Fibres in Laser ablation. J-L Gerard. In: Controversies
and updates in vascular surgery 2009and updates in vascular surgery 2009
In FranceIn France
Cataract operation: 300 000/yearCataract operation: 300 000/year
High ligation+stripping and/orHigh ligation+stripping and/or
phlebectomy: 200 000/yearphlebectomy: 200 000/year
5. Surgery!Surgery!
NoNott PerfectPerfect SolutionSolution
Surgical stripping and ligationSurgical stripping and ligation
LongLong ConvalescenceConvalescence
Spinal or gSpinal or general anesthesiaeneral anesthesia
• HospitalizationHospitalization
• CosmesisCosmesis
6. Is Surgery More Curative?Is Surgery More Curative?
Success of Vein Stripping & LigationSuccess of Vein Stripping & Ligation
% of patients with no% of patients with no
reflux after treatment:reflux after treatment:
91% at 1 year91% at 1 year
87% at 2 years87% at 2 years
71% at 5 years71% at 5 years
91% 87%
71%
0%
20%
40%
60%
80%
100%
1 2 5
Years
7. US Varicose Vein Procedures (000)US Varicose Vein Procedures (000)
0
50
100
150
200
250
300
350
2003 2004 2005 2006 2007 2008 2009 2010
Surgery
RF
Laser
Sources: Millennium Research Group, Nov 2005 & MedTech Insight, Oct 7, 2005
8. Clinical and technical outcomes from a randomized clinical trial of endovenousClinical and technical outcomes from a randomized clinical trial of endovenous
laser ablation compared with conventional surgery for great saphenouslaser ablation compared with conventional surgery for great saphenous
varicose veins Carradice D,varicose veins Carradice D, Academic Vascular Surgical UnitAcademic Vascular Surgical Unit,, Hull, UKHull, UK. Br J. Br J
Surg. 2011, 98(8):1117-23Surg. 2011, 98(8):1117-23
280 patients were randomized equally280 patients were randomized equally
using sealed opaque envelopes to twousing sealed opaque envelopes to two
parallel groups: surgery and EVLAparallel groups: surgery and EVLA
The clinical recurrence rate at 1 year wasThe clinical recurrence rate at 1 year was
lower after EVLA: 4.0 versus 20.4 per centlower after EVLA: 4.0 versus 20.4 per cent
(P < 0.001)(P < 0.001)
9. Rasmussen LH. Br J Surg. 2011;98(8):1079-87Rasmussen LH. Br J Surg. 2011;98(8):1079-87
Randomized clinical trial comparing endovenous laser ablation,Randomized clinical trial comparing endovenous laser ablation,
radiofrequency ablation, foam sclerotherapy and surgical stripping forradiofrequency ablation, foam sclerotherapy and surgical stripping for
great saphenous varicose veins.great saphenous varicose veins.
500 consecutive patients (580 legs)500 consecutive patients (580 legs)
EVLA (980 and 1470 nm, bare fibre), RFEVLA (980 and 1470 nm, bare fibre), RF
ablation, US-guided foam sclerotherapy orablation, US-guided foam sclerotherapy or
surgical strippingsurgical stripping
The technical failure rate was highest afterThe technical failure rate was highest after
foam sclerotherapy. Both RF and foamfoam sclerotherapy. Both RF and foam
were associated with a faster recovery andwere associated with a faster recovery and
less postoperative pain than EVLA andless postoperative pain than EVLA and
strippingstripping
11. Radiofrequency Endovenous ClosureFAST
versus Laser Ablation for the Treatment of
Great Saphenous Reflux: A Multicenter,
Single-blinded, Randomized Study
(RECOVERY Study)
Jose I. Almeida, et al. Vasc Interv Radiol 2009; 20:752–759
From March through December 2007
87 veins in 69 patients
the ClosureFAST RF catheter or 980-
nm Laser
Prospective, randomized, single
blinded
Five American sites and one
European site.
12. EVL group was treated with a 980-
nm wavelength in the continuous
mode at 12 W of power with a linear
endovenous energy density of 80
J/cm.
13.
14.
15.
16. Vein occlusion and elimination of
truncal reflux were achieved in 100%
of limbs irrespective of treatment
modality at 1 month
17. Proebstle TMProebstle TM ,, J Vasc Surg. 2011;54(1):146-52J Vasc Surg. 2011;54(1):146-52
Three-year European follow-up of endovenous radiofrequency-Three-year European follow-up of endovenous radiofrequency-
powered segmental thermal ablation of the great saphenous vein withpowered segmental thermal ablation of the great saphenous vein with
or without treatment of calf varicosities.or without treatment of calf varicosities.
A total of 256 of 295 treated GSVsA total of 256 of 295 treated GSVs
(86.4%) were available for 36 months of(86.4%) were available for 36 months of
follow-up.follow-up.
OOcclusion was 92.6% and the no refluxcclusion was 92.6% and the no reflux
was 95.7%, and 96.9% of legs remainedwas 95.7%, and 96.9% of legs remained
free of clinically relevant axial reflux.free of clinically relevant axial reflux.
The average VCSS score improved fromThe average VCSS score improved from
3.9 ± 2.1 before treatment to 0.9 ± 1.5 at3.9 ± 2.1 before treatment to 0.9 ± 1.5 at
3 months (P < .0001) and stayed at an3 months (P < .0001) and stayed at an
average <1.0 during the complete 36average <1.0 during the complete 36
months of follow-up.months of follow-up.
18. Proebstle TMProebstle TM ,, J Vasc Surg. 2011;54(1):146-52J Vasc Surg. 2011;54(1):146-52
At 36 months, 189 of 255 legsAt 36 months, 189 of 255 legs
(74.1%) showed an improvement in(74.1%) showed an improvement in
CEAP class compared with the clinicalCEAP class compared with the clinical
assessment before treatment (P < .assessment before treatment (P < .
001).001).
CONCLUSION: RSTA showed a highCONCLUSION: RSTA showed a high
and durable success rate in veinand durable success rate in vein
ablation in conjunction withablation in conjunction with
sustained clinical efficacy.sustained clinical efficacy.
19. Our experienceOur experience
In the last 7 years we performedIn the last 7 years we performed
2420 EVTA procedures in the 20122420 EVTA procedures in the 2012
patients under tumescentpatients under tumescent
anesthesia.anesthesia.
Only ClosureFAST radiofrequencyOnly ClosureFAST radiofrequency
and endovenous 980-nm laserand endovenous 980-nm laser
ablation were carried out.ablation were carried out.
20. Occlusion rate at 6 months was achievedOcclusion rate at 6 months was achieved
in 99.4% with no recanalisationin 99.4% with no recanalisation andand werewere
not statistical significant different betweennot statistical significant different between
laser and RFlaser and RF groupsgroups
The complete occlusion rates atThe complete occlusion rates at 2424 monthsmonths
werewere 95.5% for95.5% for RFRF and 93.1% for 980and 93.1% for 980
nm). Most of the non-occluded veins had anm). Most of the non-occluded veins had a
filiform internal lumen and did not showfiliform internal lumen and did not show
reflux.reflux.
21. There was significant difference in theThere was significant difference in the
postoperative appearance of ecchymosispostoperative appearance of ecchymosis in favorin favor
of RFof RF (P=0.09).(P=0.09).
Patients treated withPatients treated with RFRF had less indurationhad less induration
around the treated vein (P=0.00around the treated vein (P=0.001818), less need to), less need to
take analgetics (1.take analgetics (1.44 days versus 2.days versus 2.88 days) anddays) and
had a better postoperative quality of lifehad a better postoperative quality of life
(P=0.018).(P=0.018).
The Venous Clinical Severity Score wasThe Venous Clinical Severity Score was
significantly improved at 6significantly improved at 6 and 24and 24 monthsmonths
compared with the baseline onecompared with the baseline one, but not different, but not different
between laser and RFbetween laser and RF..
22. No serious adverse events exceptNo serious adverse events except
one mild pulmonary embolusone mild pulmonary embolus in laserin laser
groupgroup were detected.were detected.
Patients treated with thePatients treated with the
ClosureFAST catheter experiencedClosureFAST catheter experienced
significantly less post-proceduresignificantly less post-procedure
pain, bruising and tenderness whenpain, bruising and tenderness when
compared to laser ablationcompared to laser ablation
23. Personel viewPersonel view
LSV + SSV + PerforatorsLSV + SSV + Perforators
Catheter thermoablation replacedCatheter thermoablation replaced
open surgeryopen surgery
Personel experience > 2000Personel experience > 2000
patients!patients!
Foam is a good optionFoam is a good option →→ needs toneeds to
prove safety and >5 years efficacyprove safety and >5 years efficacy
? for routine usage (Neurogical? for routine usage (Neurogical
complications?)complications?)
24.
25.
26.
27.
28. Peter GloviczkiPeter Gloviczki et al. Jet al. J Vasc Surg. 2011Vasc Surg. 2011
May;53(5 Suppl):2S-48SMay;53(5 Suppl):2S-48S
The care of patients withThe care of patients with
varicose veins and associatedvaricose veins and associated
chronic venous diseases:chronic venous diseases:
Clinical practice guidelines ofClinical practice guidelines of
the Society for Vascularthe Society for Vascular
Surgery and the AmericanSurgery and the American
Venous ForumVenous Forum
29. For treatment of the incompetent greatFor treatment of the incompetent great
saphenous vein (GSV), we recommendsaphenous vein (GSV), we recommend
endovenous thermal ablationendovenous thermal ablation
(radiofrequency or laser) rather than high(radiofrequency or laser) rather than high
ligation and inversion stripping of theligation and inversion stripping of the
saphenous vein to the level of the kneesaphenous vein to the level of the knee
(GRADE 1B).(GRADE 1B).
FFoam sclerotherapy as an option for theoam sclerotherapy as an option for the
treatment of the incompetent saphenoustreatment of the incompetent saphenous
vein (GRADE 2C).vein (GRADE 2C).
30. To decrease the recurrence of venousTo decrease the recurrence of venous
ulcers, we recommend ablation ofulcers, we recommend ablation of
the incompetent superficial veins inthe incompetent superficial veins in
addition to compression therapyaddition to compression therapy
(GRADE 1A).(GRADE 1A).
We recommend phlebectomy orWe recommend phlebectomy or
sclerotherapy to treat varicosesclerotherapy to treat varicose
tributaries (GRADE 1B)tributaries (GRADE 1B)
31. We recommend against selectiveWe recommend against selective
treatment of perforating veintreatment of perforating vein
incompetence in patients with simpleincompetence in patients with simple
varicose veins (CEAP class C2; GRADEvaricose veins (CEAP class C2; GRADE
1B),1B),
WWe suggest treatment of pathologice suggest treatment of pathologic
perforating veins (outward flow durationperforating veins (outward flow duration
≥500 ms, vein diameter ≥3.5 mm)≥500 ms, vein diameter ≥3.5 mm)
located underneath healed or active ulcerslocated underneath healed or active ulcers
(CEAP class C5-C6; GRADE 2B).(CEAP class C5-C6; GRADE 2B).
