Thermal Techniques: Outcomes and Complications

Size: px
Start display at page:

Download "Thermal Techniques: Outcomes and Complications"

Transcription

1 Thermal Techniques: Outcomes and Complications Meet The Experts: Thermal and Non-Thermal Ablation Techniques Joseph D. Raffetto MD VA Boston HCS, West Roxbury, MA, Harvard Medical School, Boston, MA; Brigham and Women s Hospital ACP Meeting Austin, TX

2 Disclosures No financial disclosures or conflicts of interest

3 Endovenous Ablations Thermal -EVLT (Angiod, Dornier, Biolitec, Sharplan, CoolTouch) -RFA (ClosureFast, Medtronic) -steam and cryotherapy (uncommon will not discuss) Non-thermal -foam non-proprietary -mechanical occlusive chemical ablation (MOCA, ClariVein) -cyanoacrylate glue (Sapheon Venaseal, Medtronic) -UGFS -proprietary microfoam (Varithena, BTG) Liquid sclerotherapy Bootun R et al Phlebology 2016;31:5-14.

4 EVLT Lower wavelength target Hbg (810, 940, 980, and 1064 nm) Higher wavelength target water (1320, 1470, and 1920 nm) As the wavelength increase tissue penetration decreases Radial fibers vs. bare fibers Jacketed fibers

5 Clinical Outcomes and Wavelength 1470 nm (radial) vs. 980 nm (bare tip) -less pain and lower VCSS at 1 mo with 1470 nm 1920 nm vs nm -closure rates lower 1920 nm, less pain bruising, similar VCSS 1320 nm vs. 940 nm -less pain and ecchymosis with 1320 nm Doganci S et al Eur J Vasc Endovasc Surg 2010;40: Mendes-Pinto D et al Int Angiol 2016;35: Proebstle TM et al Dermatol Surg 2005;31:

6 RFA 20 seconds per cycle 120 C Requires tumescent

7 Clinical Outcomes Following Interventions Success of the operation -technical success -durability Improvement in hemodynamics Clinical outcomes (VCSS) Quality of life Recurrences Complications

8 500 patients (580 limbs) Sx VV and GSVi RCT to EVLA, RFA, Foam, Surgery GSV tx and phlebectomy C2-4, primary, SVI, reflux 3 year follow up results Primary endpoint closed or absent GSV Secondary endpoints: recurrences, VCSS, QoL Rasmussen L et al J Vasc Surg: Venous and Lym Dis 2013;1:349-56

9 Patent GSV EVLA 6.8% RFA 7% L&S 6.5% UGFS 26.4% (P 0.01) Rasmussen L et al J Vasc Surg: Venous and Lym Dis 2013;1:349-56

10 Clinical VV Recurrences EVLA 20% RFA 14.9% L&S 20.2% UGFS 19.1% (P=n.s.) Reinterventions EVLA 12.5% RFA 11.1% L&S 15.5% UGFS 31.6% (P 0.01) All Tx groups improved VCSS and QoL Rasmussen L et al J Vasc Surg: Venous and Lym Dis 2013;1:349-56

11 798 patients with CVD (C2-6) 11 UK centers RCT: Surgery, EVLT, Foam All patients with GSV L&S +/- SP All patients with EVLT or Foam, VV foam at 6 wks Primary outcome QoL disease specific and generic at 6 wks and 6 mo Brittenden J et al N Engl J Med 2014;371:

12 Outcomes At 6 Months Primary (QoL) -The AVVQ was worse for foam vs. surgery (P=0.006) -The SF36 mental component worse for foam vs. EVLT (P=0.048) -No differences in physical component of generic QoL Secondary -No differences in VCSS -Complete ablation of GSV better in surgery (78%) and EVLT (82%) vs. foam (43%, P 0.01) Complications (skin lumps and staining) Higher for foam than surgery Brittenden J et al N Engl J Med 2014;371:

13 Evaluates the English literature Most common complications related to EVLT by country -superficial burns -nerve injury -arterio-venous fistulae -deep venous thrombosis -endothermal heat-induced thrombosis (EHIT) -pain -bruising Dexter D et al Phlebology 2012;27 Suppl 1:40-45.

14 EVLT Complications Reported in 12 Countries Dexter D et al Phlebology 2012;27 Suppl 1:40-45.

15 Endothermal Heat Induced Thrombosis (EHIT) EHIT defined as propagated thrombus in the deep system pts tx with RFA (n=2120) or EVLA (n=350) -0.28% EHIT II-IV pts tx with EVLA or RFA 74 (2.4%) EHIT II -EVLA 1.9% -RFA 2.6% (P=0.31) Optimal visualization Increase distance to cm EHIT II LMWH 2 weeks EHIT III-IV treat with AC 3 months VTE 0%-5.7%, generally 1% 1 Marsh P et al Eur J Vasc Endovasc Surg 2010;40: Sadek M. et al J Vasc Surg Venous Lymphat Disord 2013;1:

16 69 patients 87 limbs 90% C2 RCT to ClosureFAST RFA or 980-nm laser of GSV Follow up at 1 and 2 wks and 1 month Primary outcome pain and ecchymosis, AE Secondary outcome VCSS and QoL Almeida JI et al J Vasc Interv Radiol 2009;20:752-9.

17 Post-Operative Pain: VAS Almeida JI et al J Vasc Interv Radiol 2009;20:752-9.

18 Outcomes Significantly less tenderness for RFA (up to 2 wks) Significantly less ecchymosis for RFA (up to 1 mo) No phlebitis or VTE in RFA group VCSS lower for RFA up to 2 wks QoL better for pain and physical for RFA at 2 wks Almeida JI et al J Vasc Interv Radiol 2009;20:752-9.

19 International Endovenous Laser Working Group (IEWG), multicenter, registry 810 and 980 nm diode laser Overall complications 3.3% No motor nerve damage No PE Complications One case of third-degree skin burn (0.1%) Six cases of DVT (0.6%) -five at the SFJ/SPJ (0.5%) -one in a gastrocnemius vein 27 cases of sensory nerve involvement (2.7%) Spreafico G et al Ann Vasc Surg 2011; 25: 71-78

20 67 RFA 64 EVLT EVLT 980 nm All patients given paracetamol (acetominophen, qid) and ibuprofen (tid) Take only as required Shepherd AC et al Br J Surg 2010;97:

21 RFA Requires Fewer Analgesics At 3 days 8 8(9 5) tablets after RFA vs. 14 2(10 7) tablets after EVLA (P = 0 003) At 10 days 20 4(22 6) vs. 35 9(29 4) tablets (P = 0 001) Shepherd AC et al Br J Surg 2010;97:

22 EHIT 0.4% in 2470 limbs treated with RFA EHIT 0% in 252 limbs treated with RFA Anwar MA et al Phlebology 2012;27 Suppl 1: Marsh P et al Eur J Vasc Endovasc Surg 2010;40: Probstle TM et al J Vasc Surg 2008;47:151-6.

23 Conclusions Thermal ablation methods are safe and effective RFA and EVLT both effective at 3 years (VCSS, QoL) EVLT wavelengths with similar long term outcomes, less pain/ecchymosis higher Less pain and ecchymosis with RFA Complications usually are mild and self limiting EHIT and DVT are very low with thermal ablation

Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA

Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA DISCLOSURES Kathleen Gibson, MD Consultant/Advisory Board: BTG, Medtronic Speakers

More information

Endovenous Thermal vs. Endovenous Chemical Ablation What is the Best for the Patient

Endovenous Thermal vs. Endovenous Chemical Ablation What is the Best for the Patient Endovenous Thermal vs. Endovenous Chemical Ablation What is the Best for the Patient T. Noppeney, J. Noppeney Center for Vascular Diseases: Outpatient Dept. Obere Turnstrasse, Dept. for Vascular Surgery

More information

MOCA and GLUE: results and analyses of the RCTs

MOCA and GLUE: results and analyses of the RCTs MOCA and GLUE: results and analyses of the RCTs Faculty disclosure Research Grant Medtronic Educational Grant mediusa Speakers Bureau Medtronic Pierre Fabre mediusa Medical Director Morrison Vein/Training

More information

Sadie Ahanchi, MD Sentara Vascular Specialists April 27,2018. Debate 1: Why Is Tumescent-Based Therapy The Gold Standard?

Sadie Ahanchi, MD Sentara Vascular Specialists April 27,2018. Debate 1: Why Is Tumescent-Based Therapy The Gold Standard? Sadie Ahanchi, MD Sentara Vascular Specialists April 27,2018 Debate 1: Why Is Tumescent-Based Therapy The Gold Standard? Tumescent based venous therapy: Fight! Introduction Tumescent anesthesia Administration

More information

Complications of endovenous lasers

Complications of endovenous lasers Review article Complications of endovenous lasers D Dexter, L Kabnick, T Berland, G Jacobowitz, P Lamparello, T Maldonado, F Mussa, C Rockman, M Sadek, L E Giammaria and M Adelman New York University Medical

More information

Epidemiology: Prevalence

Epidemiology: Prevalence Epidemiology: Prevalence More than 30 million Americans suffer from varicose veins or a more serious form of venous disease called Chronic Venous Insufficiency (CVI). 1 Of the over 30 million Americans

More information

Why Tumescent-Free Therapy Will Replace RF and Laser

Why Tumescent-Free Therapy Will Replace RF and Laser C SCOTT MCENROE Medical Director Vein Center of Virginia Sentara Medical Group April 27, 2018 Why Tumescent-Free Therapy Will Replace RF and Laser History of Venous Surgery 1950 s GSV/SSV stripping became

More information

What might bring a new wavelength for endovenous laser? Lowell S. Kabnick, MD, RPhS, FACS

What might bring a new wavelength for endovenous laser? Lowell S. Kabnick, MD, RPhS, FACS What might bring a new wavelength for endovenous laser? Lowell S. Kabnick, MD, RPhS, FACS Division of Vascular and Endovascular Surgery Faculty disclosure Lowell Kabnick, MD NOTHING TO DISCLOSE IS 1950nm

More information

VeClose trial Cyanoacylate closure vs. RF ablation 36-month results

VeClose trial Cyanoacylate closure vs. RF ablation 36-month results VeClose trial Cyanoacylate closure vs. RF ablation 36-month results LINC 2018, Leipzig 31 st Jan 2018 Tobias Hirsch, Halle, Germany www.gefaessmedizin-hirsch.de Disclosure Tobias Hirsch I have the following

More information

Conflict of Interest. None

Conflict of Interest. None Conflict of Interest None American Venous Forum Guidelines on Superficial Venous Disease TOP 10 GUIDELINES 10. We recommend using the CEAP classification to describe chronic venous disorders. (GRADE 1B)

More information

Closurefast radiofrequency ablation for the treatment of GSV: Technique and outcome results

Closurefast radiofrequency ablation for the treatment of GSV: Technique and outcome results Closurefast radiofrequency ablation for the treatment of GSV: Technique and outcome results Stephen Black Consultant Vascular Surgeon Clinical Lead for Venous and Lymphoedema Surgery Guy s and St Thomas

More information

Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous vein

Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous vein Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous vein Raghu Kolluri, MD, Director Vascular Medicine OhioHealth Riverside Methodist Hospital

More information

Le varici recidive Recurrent varices: how to manage them?

Le varici recidive Recurrent varices: how to manage them? Le varici recidive Recurrent varices: how to manage them? Marianne De Maeseneer MD PhD, Vascular Surgeon Department of Dermatology, Rotterdam, Netherlands & Faculty of Medicine and Health Sciences University

More information

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure

More information

Catheter-based treatments for varicose veins: evidence and practice.

Catheter-based treatments for varicose veins: evidence and practice. imeet May 2018, Nice France Catheter-based treatments for varicose veins: evidence and practice. Marc Vuylsteke MD PhD Vascular Surgeon Sint-Andriesziekenhuis Tielt Belgium Venous Disease C0: 38.5% C1:

More information

Venous Disease and Leg Ulcers. Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL

Venous Disease and Leg Ulcers. Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL Venous Disease and Leg Ulcers Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL Disclosures Stocks Endoshape Sapheon Medical Advisory Board BTG, Boston Scientific Venous Leg Ulcer Most common

More information

Understanding venous disease and treatment options for your patients. Christopher Wulff, MD

Understanding venous disease and treatment options for your patients. Christopher Wulff, MD Understanding venous disease and treatment options for your patients Christopher Wulff, MD Understanding Chronic venous insufficiency (CVI) Important Statistics About CVI Affects all age groups 1 Is ten

More information

Srovnání 2 typů radiálních laserových vláken (1-ringových a 2-ringových) v nitrožilní léčbě křečových žil pomocí laseru o vlnové délce 1470 nm

Srovnání 2 typů radiálních laserových vláken (1-ringových a 2-ringových) v nitrožilní léčbě křečových žil pomocí laseru o vlnové délce 1470 nm Srovnání 2 typů radiálních laserových vláken (1-ringových a 2-ringových) v nitrožilní léčbě křečových žil pomocí laseru o vlnové délce 1470 nm Robert Vlachovský, Robert Staffa, Ernest Biroš II. chirurgická

More information

6/1/2017. Mechanico-Chemical Ablation MOCA? Disclaimer

6/1/2017. Mechanico-Chemical Ablation MOCA? Disclaimer Cox Health Venous Symposium June 2-3, 207 Mechanico-Chemical Ablation Non-thermal, Non-tumescent Venous Ablation Therapy ROBERT W. VORHIES, M.D., F.A.C.S. VASCULAR AND ENDOVASCULAR SURGERY ENDOVENOUS THERAPY

More information

Thermal Ablation 101: Basics of RF and Laser

Thermal Ablation 101: Basics of RF and Laser 1:48-2:00 Now 11 min flying Thermal ablation indications, contraindications, results, complications (30 min) Thermal Ablation 101: Basics of RF and Laser Nick Morrison, MD, FACPh, FACS, RPhS President,

More information

Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015

Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015 Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015 Anatomy of Perforating veins Cadaveric studies 1 have shown >60 vein perforating veins from superficial to deep Normal

More information

Table XI. Reference Abstracts corresponding to references can be found using the listing RCTs by alphabetical order or RCTs by topic.

Table XI. Reference Abstracts corresponding to references can be found using the listing RCTs by alphabetical order or RCTs by topic. Table XI. Operative procedure EVLA with different wavelengths HL+ EVLA EVLA without HL EVLA GSV ablation AK GSV ablation AK+BK Reference Abstracts corresponding to references can be found using the listing

More information

Which place for liquid sclerotherapy? Eberhard Rabe Department of Dermatology University of Bonn Germany

Which place for liquid sclerotherapy? Eberhard Rabe Department of Dermatology University of Bonn Germany Which place for liquid sclerotherapy? Eberhard Rabe Department of Dermatology University of Bonn Germany Liquid Foam or GSV, foam / liquid sclerosant n diameter[mm] Follow up effectivity Hamel Desnos 2003

More information

Clinical case. Symptomatic anterior accessory great saphenous vein (AAGSV) reflux

Clinical case. Symptomatic anterior accessory great saphenous vein (AAGSV) reflux Clinical case Symptomatic anterior accessory great saphenous vein (AAGSV) reflux A 70 year-old female presents with symptomatic varicose veins on left leg for more than 10 years. She complains of heaviness,

More information

New Technologies in Superficial Vein Treatment

New Technologies in Superficial Vein Treatment New Technologies in Superficial Vein Treatment Ariel D. Soffer, MD, FACC Associate Clinical Professor Florida International University Medical School Ariel Soffer, MD, FACC Bio Fellow of the American College

More information

How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN.

How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN. How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN Surgeon Dr G Mark Malouf Sydney Australia Following History and Physical examination

More information

UPDATE: SAPHENOUS TREATMENTS. Pauline Raymond-Martimbeau Dallas Non Invasive Vascular Laboratory Vein Institute of Texas Dallas, Texas, USA

UPDATE: SAPHENOUS TREATMENTS. Pauline Raymond-Martimbeau Dallas Non Invasive Vascular Laboratory Vein Institute of Texas Dallas, Texas, USA UPDATE: SAPHENOUS TREATMENTS Pauline Raymond-Martimbeau Dallas Non Invasive Vascular Laboratory Vein Institute of Texas Dallas, Texas, USA DISCLOSURE No financial conflicts of interest to disclose Off-label

More information

VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins

VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins VeClose trial 12-month outcomes of cyanoacrylate closure versus radiofrequency ablation for incompetent great saphenous veins Nick Morrison, MD, a Kathleen Gibson, MD, b Michael Vasquez, MD, c Robert Weiss,

More information

What can we learn from randomized trials comparing endovenous and open surgery for primary varicosis? an overview Prof. Dr. Thomas M.

What can we learn from randomized trials comparing endovenous and open surgery for primary varicosis? an overview Prof. Dr. Thomas M. What can we learn from randomized trials comparing endovenous and open surgery for primary varicosis? an overview Prof. Dr. Thomas M. Proebstle Department of Dermatology, University Medical Center Mainz,

More information

Influence of Warfarin on the Success of Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein (GSV)

Influence of Warfarin on the Success of Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein (GSV) Eur J Vasc Endovasc Surg (2009) 38, 506e510 Influence of Warfarin on the Success of Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein (GSV) N.S. Theivacumar, M.J. Gough* Leeds Vascular Institute,

More information

Long-term follow up for different varicose vein therapies: is surgery still. the best?

Long-term follow up for different varicose vein therapies: is surgery still. the best? Long-term follow up for different varicose vein therapies: is surgery still the best? Mr Roshan BOOTUN [BSc, MBBS, MRCS] Clinical Research Fellow in Vascular Surgery Professor Alun H. DAVIES [BA, BM BCh,

More information

Endovenous Laser Ablation

Endovenous Laser Ablation Endovenous Laser Ablation 132 nm Wavelength with Clear Tip Technology vs. 147 nm Wavelength Similarities and Differences 132nm and 147nm Both wavelengths are mid-infrared Water is the primary chromophore

More information

RE: Request for coverage and reimbursement for mechano-chemical venous ablation Clarivein

RE: Request for coverage and reimbursement for mechano-chemical venous ablation Clarivein October 7, 2016 Craig Haug, MD JK MAC Medical Director NHIC, Corp. Hewlett Packard Enterprise 75 William Terry Dr., Hingham, MA 02043 Dear Dr. Haug: RE: Request for coverage and reimbursement for mechano-chemical

More information

EXTERNAL VALVULOPLASTY

EXTERNAL VALVULOPLASTY Preservation of Saphenous Trunks: EXTERNAL VALVULOPLASTY Sante Camilli MD Rome, Italy sante.camilli@gmail.com Faculty disclosure Sante Camilli MD I am the proposer of the Stretching Valvuloplasty technique,

More information

Endo-Thermal Heat Induced Thrombosis (E-HIT)

Endo-Thermal Heat Induced Thrombosis (E-HIT) Endo-Thermal Heat Induced Thrombosis (E-HIT) Michael Ombrellino MD FACS The Cardiovascular Care Group Clinical Associate Professor of Surgery Rutgers School of Medicine Objectives: What is E-HIT? How do

More information

Table VIII. OS versus EVLA. New article

Table VIII. OS versus EVLA. New article Table VIII. OS EVLA. New article Operative procedure OS EVLA for for GSV or SSV incompetence Reference Abstracts corresponding to references can be found using the listing RCTs by alphabetical order or

More information

Management of Side Branches and Perforating Veins

Management of Side Branches and Perforating Veins Management of Side Branches and Perforating Veins T. Noppeney Center for Vascular Diseases: Outpatient Dept. Obere Turnstrasse, Dept. for Vascular Surgery Martha-Maria Hospital (Academic Teaching Hospital

More information

Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden

Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden Disclosures No disclosures Five sources for comparison SVS/AVF US guidelines

More information

Randomized clinical comparison of short term outcomes following endogenous laser ablation and stripping in patients with saphenous vein insufficiency

Randomized clinical comparison of short term outcomes following endogenous laser ablation and stripping in patients with saphenous vein insufficiency Original Research 12 endogenous laser ablation and stripping in patients with saphenous vein Ozgur Bulut*, Umit Halici, Serdar Menekse Department of Cardiovascular Surgery Education and Research Hospital,

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Commercial Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: 2018T0447V Effective Date: March 1, 2018 Table of Contents Page INSTRUCTIONS

More information

Compression after sclerotherapy and endovenous ablations, the Italian point of view

Compression after sclerotherapy and endovenous ablations, the Italian point of view Compression after sclerotherapy and endovenous ablations, the Italian point of view Fabrizio Mariani Siena (Italy) General Secretary "Multidisciplinary Joint Committee in Phlebology" - UEMS (EU) General

More information

A one stop vein shop: the ideal option?

A one stop vein shop: the ideal option? A one stop vein shop: the ideal option? Professor Alun H Davies Section of Vascular Surgery Imperial College, Charing Cross & St Mary s Hospitals London Conflicts of Interest None to declare Which treatment?

More information

Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser

Comparison of Bare-Tip and Radial Fiber in Endovenous Laser Ablation with 1470 nm Diode Laser Ann Vasc Dis Vol. 7, No. 3; 2014; pp 239 245 Online Month August 30, 2014 2014 Annals of Vascular Diseases doi:10.3400/avd.oa.14-00081 Original Article Comparison of Bare-Tip and Radial Fiber in Endovenous

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Oxford Clinical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: OUTPATIENT 013.32 T2 Effective Date: February 1, 2018 Table of Contents

More information

Kathleen Gibson, MD. Lake Washington Vascular Surgeons Bellevue, WA

Kathleen Gibson, MD. Lake Washington Vascular Surgeons Bellevue, WA Cyanoacrylate Closure of Incompetent Great, Small and Accessory Saphenous Veins without the use of Post-Procedure Compression: a Post-Market Evaluation of the VenaSeal System (WAVES trial): Three Month

More information

Laser and Radiofrequency Ablation Study (LARA study): A Randomised Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810 nm)

Laser and Radiofrequency Ablation Study (LARA study): A Randomised Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810 nm) Eur J Vasc Endovasc Surg (2010) 40, 246e253 Laser and Radiofrequency Ablation Study (LARA study): A Randomised Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810 nm) S.D. Goode,

More information

Comparison of Monopolar and Segmental Radiofrequency Ablation in the Treatment of Lower Limb Chronic Venous Insufficiency

Comparison of Monopolar and Segmental Radiofrequency Ablation in the Treatment of Lower Limb Chronic Venous Insufficiency ARC Journal of Surgery Volume 4, Issue 3, 218, PP 5-1 ISSN 2455-572X DOI: http://dx.doi.org/1.2431/2455-572x.432 www.arcjournals.org Comparison of Monopolar and Segmental Radiofrequency Ablation in the

More information

Research Article Effects of Two Current Great Saphenous Vein Thermal Ablation Methods on Visual Analog Scale and Quality of Life

Research Article Effects of Two Current Great Saphenous Vein Thermal Ablation Methods on Visual Analog Scale and Quality of Life Hindawi BioMed Research International Volume 2017, Article ID 8532149, 6 pages https://doi.org/10.1155/2017/8532149 Research Article Effects of Two Current Great Saphenous Vein Thermal Ablation Methods

More information

chapter 4 Randomized clinical trial of steam ablation (LAST trial) for great saphenous varicose veins

chapter 4 Randomized clinical trial of steam ablation (LAST trial) for great saphenous varicose veins Randomized clinical trial of EVSA versus EVLA 1 http://hdl.handle.net/1765/111020 chapter 4 Randomized clinical trial of endovenous Randomized clinical laser trial ablation of endovenous versus laser ablation

More information

RADIOFREQUENCY ABLATION. Drs PIRET V, BERGERON P MEET CANNES 2009

RADIOFREQUENCY ABLATION. Drs PIRET V, BERGERON P MEET CANNES 2009 RADIOFREQUENCY ABLATION Drs PIRET V, BERGERON P MEET CANNES 2009 Superficial Venous Disease: EPIDEMIOLOGY Touch 75% of french population at different degrees (45.10 6 ) 25% needs medical care (11.10 6

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Commercial Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: 2017T0447T Effective Date: July 1, 2017 Table of Contents Page INSTRUCTIONS

More information

Al-Metwaly Ragab Ibrahim Vascular Surgery; Al-Azhar faculty of Medicine- New Damietta, Egypt.

Al-Metwaly Ragab Ibrahim Vascular Surgery; Al-Azhar faculty of Medicine- New Damietta, Egypt. International Journal of Basic and applied Sciences. Vol. 4. No. 4. 2015. Pp. 259-264 Copyright by CRDEEP Journals. All Rights Reserved Full Length Research Paper Comparative Study between Endovenous Laser

More information

Patient assessment and strategy making for endovenous treatment

Patient assessment and strategy making for endovenous treatment Patient assessment and strategy making for endovenous treatment Raghu Kolluri, MD Director Vascular Medicine OhioHealth Riverside Methodist Hospital Columbus, OH Disclosures Current Medtronic Consultant/

More information

Ramon R. J. P. van Eekeren, MD,a Doeke Boersma, MD,b Vincent Konijn, MD,a Jean Paul P. M. de Vries, MD, PhD,b Michel M. J. P. Reijnen, MP, PhD,a

Ramon R. J. P. van Eekeren, MD,a Doeke Boersma, MD,b Vincent Konijn, MD,a Jean Paul P. M. de Vries, MD, PhD,b Michel M. J. P. Reijnen, MP, PhD,a Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins Ramon R. J. P. van Eekeren, MD, a Doeke Boersma,

More information

ClariVein Õ Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins

ClariVein Õ Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins Original Article ClariVein Õ Early results from a large single-centre series of mechanochemical endovenous ablation for varicose veins Phlebology 2017, Vol. 32(1) 6 12! The Author(s) 2016 Reprints and

More information

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION. POLICY NUMBER: CATEGORY: Technology Assessment

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION. POLICY NUMBER: CATEGORY: Technology Assessment MEDICAL POLICY PAGE: 1 OF: 9 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy criteria are not applied.

More information

Endothermal Ablation for Venous Insufficiency. Dr. S. Kundu Medical Director The Vein Institute of Toronto

Endothermal Ablation for Venous Insufficiency. Dr. S. Kundu Medical Director The Vein Institute of Toronto Endothermal Ablation for Venous Insufficiency Dr. S. Kundu Medical Director The Vein Institute of Toronto Objective: remove the GSV from the circulation 1. Surgical - HL & stripping 2. Chemical sclerotherapy

More information

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach.

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach. Management of Venous Disease: an evidence based approach Disclosures Ed Boyle, MD Andrew Jones, MD Dr. Ed Boyle and Dr. Andrew Jones disclose Grants/research support: Medtronic, BTG International, Clearflow,

More information

Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon

Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon University of Groningen Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon DOI: 10.1053/j.semvascsurg.2015.02.002 10.1016/j.ejvs.2012.12.004 10.1016/j.jvsv.2014.01.001

More information

Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient

Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient Original Manuscript Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient Vascular and Endovascular Surgery 2016, Vol. 50(1) 47-51 ª The Author(s) 2016

More information

WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON

WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON Disclosure of Interest I have the following potential conflicts of interest to report: Consulting: Medtronic WHAT ABOUT REVAS? Source

More information

RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY Paul Kramer, MD, FACC, FSCAI Liberty Cardiovascular Specialists Liberty Regional Heart and Vascular Center DISCLOSURES NONE Venous

More information

Treatment of Varicose Veins/Venous Insufficiency

Treatment of Varicose Veins/Venous Insufficiency Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Current Management of Varicose Veins

Current Management of Varicose Veins Current Management of Varicose Veins Michael J. Heidenreich, MD St. Joseph Mercy Hospital Ann Arbor, MI March 23, 2013 Nothing to disclose History Prevalence Anatomy Risk factors Clinical manifestations

More information

Medical Policy. Description/Scope. Position Statement

Medical Policy. Description/Scope. Position Statement Subject: Document #: Publish Date: 12/27/2017 Status: Revised Last Review Date: 05/04/2017 Description/Scope This document addresses various modalities (listed below) for the treatment of valvular incompetence

More information

TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY

TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY TL LUK Consultant Vascular Surgeon Sarawak General Hospital HKL Vascular Conference 19/06/2013 PREVALENCE OF LOWER LIMB VENOUS DISEASE Affects half of

More information

L. H. Rasmussen, M. Lawaetz, L. Bjoern, B. Vennits, A. Blemings and B. Eklof

L. H. Rasmussen, M. Lawaetz, L. Bjoern, B. Vennits, A. Blemings and B. Eklof Randomized clinical trial Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins L. H. Rasmussen,

More information

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT PAGE: 1 OF: 12 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

Treatment of Varicose Veins/Venous Insufficiency

Treatment of Varicose Veins/Venous Insufficiency MEDICAL POLICY 7.01.519 Treatment of Varicose Veins/Venous Insufficiency BCBSA Ref. Policy: 7.01.124 Effective Date: March 1, 2017 Last Revised: Jan. 23, 2018 Replaces: 7.01.55, 7.01.76, 7.01.515, and

More information

ORIGINAL ARTICLES. Masatoshi Jibiki 1, Tetsuro Miyata 1,2, Sachiko Futatsugi 3, Mitsumasa Iso 3 and Yasutaka Sakanushi 3.

ORIGINAL ARTICLES. Masatoshi Jibiki 1, Tetsuro Miyata 1,2, Sachiko Futatsugi 3, Mitsumasa Iso 3 and Yasutaka Sakanushi 3. Effect of the wide-spread use of endovenous laser ablation on the treatment of varicose veins in Japan: a large-scale, single institute study Masatoshi Jibiki 1, Tetsuro Miyata 1,2, Sachiko Futatsugi 3,

More information

EVLT with foam sclerotherapy for varicose veins: a single unit study

EVLT with foam sclerotherapy for varicose veins: a single unit study International Surgery Journal Wasim MD et al. Int Surg J. 2018 Jul;5(7):2437-2443 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20182461

More information

UNDERSTANDING VEIN DISEASE. UC EN - For use in the U.S. only

UNDERSTANDING VEIN DISEASE. UC EN - For use in the U.S. only UNDERSTANDING VEIN DISEASE UC201706537 EN - For use in the U.S. only Do you need to sit down during your work day because your legs ache and/or swell? Do you miss out on doing the activities you love because

More information

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein Ann Vasc Dis Vol. 9, No. 4; 2016; pp 259 266 Online November 7, 2016 2016 Annals of Vascular Diseases doi:10.3400/avd.oa.16-00087 Original Article Postoperative Venous Thromboembolism in Patients Undergoing

More information

Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim

Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim Published online on 15 November 2012 Phlebology, doi: 10.1258/phleb.2012.012072 Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim Christof

More information

JOURNAL OF VASCULAR SURGERY Volume 51, Number 6 Schwarz et al 1475 (linear array 8-3 MHz [ZONARE, Mountain View, Calif]) using a standardized examinat

JOURNAL OF VASCULAR SURGERY Volume 51, Number 6 Schwarz et al 1475 (linear array 8-3 MHz [ZONARE, Mountain View, Calif]) using a standardized examinat Endovenous laser ablation of varicose veins with the 1470-nm diode laser Thomas Schwarz, MD, Eva von Hodenberg, MD, Christian Furtwängler, BS, Aljoscha Rastan, MD, Thomas Zeller, MD, and Franz-Josef Neumann,

More information

Non-Saphenous Vein Treatments. Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO

Non-Saphenous Vein Treatments. Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO Non-Saphenous Vein Treatments Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO I have no financial disclosures Types of Veins Treated Perforator Veins Tributary Veins Varicose

More information

A treatment option for varicose veins. enefit" Targeted Endovenous Therapy. Formerly known as the VNUS Closure procedure E 3 COVIDIEN

A treatment option for varicose veins. enefit Targeted Endovenous Therapy. Formerly known as the VNUS Closure procedure E 3 COVIDIEN A treatment option for varicose veins. enefit" Targeted Endovenous Therapy Formerly known as the VNUS Closure procedure E 3 COVIDIEN THE VENOUS SYSTEM ANATOMY The venous system is made up of a network

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Community Plan Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: CS117.N Effective Date: April 1, 2019 Instructions for Use Table

More information

The Management of Stasis Dermatitis and Chronic Venous Insufficiency in Patients Refractory to Conservative Therapies

The Management of Stasis Dermatitis and Chronic Venous Insufficiency in Patients Refractory to Conservative Therapies Article The Management of Stasis Dermatitis and Chronic Venous Insufficiency in Patients Refractory to Conservative Therapies Kareem Halim, 1,2, * Mark J. McElroy, 1 and John A. Lewis 3 1 Havard Medical

More information

Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon

Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon University of Groningen Mechanochemical endovenous ablation in the treatment of varicose veins van Eekeren, Ramon DOI: 10.1053/j.semvascsurg.2015.02.002 10.1016/j.ejvs.2012.12.004 10.1016/j.jvsv.2014.01.001

More information

Varicose veins that develop due to chronic venous insufficiency

Varicose veins that develop due to chronic venous insufficiency Diagn Interv Radiol 2012; 18:594 598 Turkish Society of Radiology 2012 INTERVENTIONAL RADIOLOGY ORIGINAL ARTICLE Early clinical improvement in chronic venous insufficiency symptoms after laser ablation

More information

EHIT: Incidence in a large collective after standardized endovenous laser

EHIT: Incidence in a large collective after standardized endovenous laser EHIT: Incidence in a large collective after standardized endovenous laser Johann Chris Ragg, MD angioclinic vein centers Berlin (D) Munich (D) Zurich (CH) Background The term EHIT (endothermal heat induced

More information

Quality of Life Evaluation and Chronic Venous Disease: How to carry this out during our daily practice? Armando Mansilha MD, PhD, FEBVS

Quality of Life Evaluation and Chronic Venous Disease: How to carry this out during our daily practice? Armando Mansilha MD, PhD, FEBVS Quality of Life Evaluation and Chronic Venous Disease: How to carry this out during our daily practice? Armando Mansilha MD, PhD, FEBVS Faculty Disclosure Armando Mansilha I have no financial relationships

More information

Randomized clinical trial of VNUS ClosureFAST TM radiofrequency ablation versus laser for varicose veins

Randomized clinical trial of VNUS ClosureFAST TM radiofrequency ablation versus laser for varicose veins Randomized clinical trial Randomized clinical trial of VNUS ClosureFAST TM radiofrequency ablation versus laser for varicose veins A.C.Shepherd,M.S.Gohel,L.C.Brown,M.J.Metcalfe,M.HamishandA.H.Davies Imperial

More information

Prospective evaluation of endo venous laser therapy for varicose vein; early efficacy and complications. The first report from Iran

Prospective evaluation of endo venous laser therapy for varicose vein; early efficacy and complications. The first report from Iran Iran. J. Radiat. Res., 2006; 4 (2): 87-91 Prospective evaluation of endo venous laser therapy for varicose vein; early efficacy and complications. The first report from Iran J. Salimi 1*, F.Yourdkhani

More information

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION

MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT ALTERNATIVES TO VEIN STRIPPING AND LIGATION MEDICAL POLICY SUBJECT: VARICOSITIES, TREATMENT PAGE: 1 OF: 10 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery 2016 Annals of Vascular Diseases doi:10.300/avd.oa.16-000 Original Article Thrombosis of the Saphenous Vein Stump Varicose Vein Surgery Hiroto Rikimaru, MD, PhD We evaluated thrombus extension in the proximal

More information

Treatment of Varicose Veins/Venous Insufficiency Corporate Medical Policy

Treatment of Varicose Veins/Venous Insufficiency Corporate Medical Policy Treatment of Varicose Veins/Venous Insufficiency Corporate Medical Policy File name: Treatment of Varicose Veins/Venous Insufficiency File code: UM.SURG.03 Origination: 9/01/2010 Last Review: 03/2015 Next

More information

Treatment of Varicose Veins/Venous Insufficiency. Description

Treatment of Varicose Veins/Venous Insufficiency. Description Page: 1 of 24 Last Review Status/Date: March 2015 Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgical approaches, thermal ablation,

More information

The occlusion rate and patterns of saphenous vein after radiofrequency ablation

The occlusion rate and patterns of saphenous vein after radiofrequency ablation J Korean Surg Soc 2013;84:107-113 http://dx.doi.org/10.4174/jkss.2013.84.2.107 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pissn 2233-7903 ㆍ eissn 2093-0488 The occlusion rate and patterns

More information

N.S. Theivacumar, R.J. Darwood, M.J. Gough*

N.S. Theivacumar, R.J. Darwood, M.J. Gough* Eur J Vasc Endovasc Surg (2009) 37, 477e481 Endovenous Laser Ablation (EVLA) of the Anterior Accessory Great Saphenous Vein (): Abolition of Sapheno-Femoral Reflux with Preservation of the Great Saphenous

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of endovenous mechanochemical ablation for varicose veins Varicose veins in the legs

More information

SAVE LIMBS SAVE LIVES! Endovenous Ablation for Chronic Wounds

SAVE LIMBS SAVE LIVES! Endovenous Ablation for Chronic Wounds SAVE LIMBS SAVE LIVES! Endovenous Ablation for Chronic Wounds Frank J. Tursi, DPM, FACFS Clinical Associate Professor, University of Pennsylvania/Presbyterian Foot and Ankle Consultant, Philadelphia Flyers,

More information

CHRONIC VENOUS INSUFFICIENCY of the lower extremities

CHRONIC VENOUS INSUFFICIENCY of the lower extremities Radiofrequency Ablation: Evolution of a Treatment Joann Lohr, MD, FACS, RVT, and Aaron Kulwicki, MD Superficial venous insufficiency of the lower extremities is a common affliction. There are several modalities

More information

VENASEAL CLOSURE SYSTEM

VENASEAL CLOSURE SYSTEM Sponsored by Medtronic Fall 2015 VENASEAL CLOSURE SYSTEM Is Cyanoacrylate Safe for Peripheral Venous Applications? By Nick Morrison, MD, FACPh, FACS, RPhS Clinical EvidenceBehind the VenaSeal Closure System

More information

Compression vs No Compression After Endovenous Ablation of the Great Saphenous Vein: A Randomized Controlled trial

Compression vs No Compression After Endovenous Ablation of the Great Saphenous Vein: A Randomized Controlled trial Accepted Manuscript Compression vs No Compression After Endovenous Ablation of the Great Saphenous Vein: A Randomized Controlled trial Diego Ayo, MD, Sheila N. Blumberg, MD MS, Caron R. Rockman, MD, Mikel

More information

SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS

SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS Michel M.P.J. Reijnen, M.D., Ph.D. Jean-Paul P.M. de Vries, M.D., Ph.D. Rijnstate Hospital, Arnhem, The Netherlands

More information

Cyanoacrylate vs laser ablation. Turkish experience. A. Kursat Bozkurt MD University of Istanbul

Cyanoacrylate vs laser ablation. Turkish experience. A. Kursat Bozkurt MD University of Istanbul Cyanoacrylate vs laser ablation. Turkish experience A. Kursat Bozkurt MD University of Istanbul Disclosure Speaker name: A. Kursat Bozkurt I have the following potential conflicts of interest to report:

More information