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 Hospital London
Disclosure Speaker name: Stephen Black I have the following potential conflicts of interest to report: Consulting : Medtronic, Cook, Optimed, Volcano, Veniti Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
System Components: ClosureFast Catheter! 3 catheter sections:! Handle! Shaft! Heating element 2. Shaft
Heating Element Thermocouple Lubricious outer jacket covers heating element and thermocouple
Closurefast Treatment Parameter Overview! 20-second treatment cycles! Generator timer counts down from 20 to 0! Energy delivery automatically stops at end of cycle! Device temperature: 120 C! Maximum power: 40 Watts! Impedance monitored internally by generator! Indicate uniformity of heating along coli! User prompted to make adjustments to external compression if necessary
ClosureFast ablation - Method of Action! Vein wall heated via! RF energy delivery to catheter heating element, resulting in:! Endothelial denaturation! Collagen contraction! Fibrotic sealing
ClosureFast segmental ablation procedure Covidien Februar 2, 2016 Confidential 7
ClosureFast full vessel wall fibrosis induction Covidien Februar 2, 2016 Confidential Goat saphenous vein 12 wks post-ablation 8
EVLA vs. ClosureFast: Continuous Pullback vs. Segmental Ablation Endovenous Laser Ablation ClosureFast Catheter Continuous Pullback! Used by endovenous lasers and some RF ablation systems (F-Care Systems)! Energy source is on throughout treatment! Energy delivery varies by pullback speed as well as other factors! Small area treated at any given time Segmental Ablation! Used by the Venefit TM procedure delivered by the ClosureFast TM catheter! Vein segment treated at one time! No energy delivered during catheter pullback! Energy delivery does not vary by pullback speed Image source: Covidien R&D dept.
Title: Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3 year follow up. Author: Rasmussen L, Lawaetz M, Serup J et al. Journal: Journal of Vascular Surgery: Venous and Lymphatic Disorders; published online August 5, 2013 RESULTS 500 patients (580 limbs) were randomized. All groups were similar in regards to baseline characteristics. Kaplan Meier estimates showing the percent of patients who were free from the following endpoints at 3 yrs *P<.0001 difference across all 4 groups RFA EVLA UGFS Stripping Reflux-free* 93% 93.2% 73.6% 93.5% Free of Recurrent Varicose Veins 85.1% 80% 80.9% 79.8% Free of Reoperations* 88.9% 87.5% 68.4% 84.5% CONCLUSIONS The author concluded that all treatment modalities were efficacious and resulted in a similar improvement in VCSS and QOL. However, more recanalization and reoperations were seen after UGFS
Title: The 5-year Final Results from the Prospective European Multicentre Cohort Study on Radiofrequency Segmental Thermal Ablation of Incompetent Great Saphenous Veins Authors: Proebstle TM, Alm BJ, Göckeritz O, Wenzel C, Noppeney T, Lebard C, Sessa C, Creton D, Pichot O Journal: British Journal of Surgery 2015 295 limbs enrolled 235 limbs @ 5 yr f/u 3 Months 6 Months 1 year 2 Year 3 Year 5 Year Vein Occlusion 99.7% 98.6% 96.3% 94.5% 92.6% 91.9% No Reflux 99.7% 99.3% 99.0% 97.2% 95.7% 94.9% Secondary Endpoints: CEAP and VCSS CEAP at 36 months Overall 74.1% (189 limbs) showed an improvement when compared to pre-treatment (P<.001) C3 & C4 C4 (skin changes) C2 8%, a reduction from 46% at pre-treatment 4%, a reduction from 15% at pre-treatment 33.3% an increase from 12.5% at 12 months This may be due to the normal course of the disease or related to the study protocol prohibiting the treatment of thigh varicosities VCSS at 60 months Pre-treatment 3.9 ± 2.1 3-60 months 1.3 ± 1.7; P<0.0001
Conclusion Safe and effective treatment Straightforward Good long term data May be challenged by the NTNT techniques
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 Hospital London