Ablation Of Incompetent Perforator Veins Research Articles

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia.

The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively (t= 29.644, P= .000). In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

Complete Venous Ulceration Healing after Perforator Ablation Does Not Depend on Treatment Modality

Venous leg ulceration (VLU) represents the most advanced form of chronic venous insufficiency (CVI). Persistent VLU that fails to respond to noninvasive treatment requires a minimally invasive endovascular treatment, which may include chemical (ultrasound-guided foam sclerotherapy [UGFS]) and thermal ablation (endovenous laser therapy [EVLT] or radiofrequency ablation [RFA]) targeting incompetent veins. Current guidelines suggest ablation of incompetent perforating veins (IPVs) juxtaposed to active or healed VLU; however, the ideal treatment modality is unknown. We hypothesize that similar to incompetent superficial vein treatment options therapies, VLU healing will be equivalent across minimally invasive IPV treatment options. Using the Vascular Low Frequency Disease Consortium, adults with VLU across 11 medical centers were retrospectively reviewed (2013-2017). We included those who underwent IPV therapies. The primary outcome was complete ulcer healing over time compared with cumulative hazard curves, log-rank testing, and multivariable Cox proportional hazard regression. Secondary outcomes included number of subsequent procedures, which were compared using negative binomial regression. Of the 832 adults with VLU, 158 (19%) were exclusively treated conservatively, and 232 (28%) underwent index treatment for IPV and constitute the full and final cohort. The mean age was 60±14years, 57% were men, and the mean ulcer area was 3.0cm2 (interquartile range, 1-6 cm2). Ninety-one (39%) were treated with EVLT, 127 (55%) RFA, and 14 (6%) UGFS. Patients treated with RFA were older (RFA 62±14years; EVLT 59±14 years; UGFS 52±9 years; P=0.01), more likely to be men (RFA 68%, n=86; EVLT 41%, n=37; UGFS 64%, n=9; P<0.001), with a higher frequency of anticoagulation (RFA 36%, n=46; EVLT 18%, n=16; UGFS 14%, n=2; P=0.005). VLU did not significantly differ in size between groups (RFA 6.2±8; EVLT 4.2±5.4; UGFS 6.1±8; P<0.001). There were no differences in 1-year ulcer healing rates between groups (P=0.18). The number of subsequent procedures did not differ by treatment modality (P=0.47). This multi-institutional retrospective study does not demonstrate any association of IPV treatment modality with differing rates of VLU healing or number of subsequent procedures.

Endovenous Laser Ablation of Incompetent Perforating Veins with 1470 nm, 400 μm Radial Fiber

To evaluate the efficacy of endovenous laser ablation (EVLA) of incompetent perforating veins (IPVs) with 1470 nm laser with 400 μm radial fiber. EVLA for perforating veins can be performed with insignificant postprocedural morbidity. This allows treatment to be offered to elderly patients with comorbidities that would preclude anesthesia for surgical treatment or subfascial endoscopic perforator surgery (SEPS). A total of 24 perforating veins in 16 limbs of 13 patients were treated between July 2010 and December 2011 in our clinic. Follow-up duplex scans were performed at 1 week and 1, 3, 6, and 12 months after the procedure, to determine the treatment outcome. Of the 23 treated IPVs, 20 (86.9%) were occluded on the duplex examination at 12 months. The average energy administrated per perforating vein treated was 174 J (range 105-236 J). Four of five ulcers had healed after 8 weeks in clinical-etiology-anatomy-pathophysiology (CEAP) C6 group. Two patients reported localized paresthesia, which subsided spontaneously, but no deep venous thrombosis or skin burn was observed. All components of the Venous Clinical Severity Score (VCSS) demonstrated significant improvements at each postprocedural visit (p<0.001 for all), except for pigmentation and compression, which exhibited variation throughout the follow-up period. Especially in the case of liposclerotic or ulcerated skin in the affected region, EVLA of IPVs with 1470 nm diode laser is highly effective and safe, and appears to be feasible. Additionally, repeat treatment can easily be performed should recurrence of IPVs arise.

Randomized Clinical Trial Comparing Two Methods for Endovenous Laser Ablation of Incompetent Perforator Veins in Thigh and Great Saphenous Vein Without Evidence of Saphenofemoral Reflux

Percutaneous ablation of incompetent perforators has been introduced as a safe and efficacious alternative. To compare two methods of treating incompetent thigh perforator and great saphenous veins (GSV). Patients with varicose veins of CEAP C2 and C3 with incompetent perforating veins (IPVs) in the thigh without evidence of saphenofemoral reflux and with obvious venous reflux from IPVs into the GSV distal to IPVs were included. Endovenous laser ablation was done using two methods (IPV ablation (IPVA) versus GSV ablation: GSVA). Their technical success rate, clinical success rate, and complications were compared at 1 week, and 1, 3, 6, and 12 months. Sixty-nine consecutive patients were randomized to IPVA (n = 34) or GSVA (n = 35). Technical success was significantly lower with IPVA than GSVA (p = .002). Clinical success, defined as continued closure of treated veins, was similar with IPVA and GSVA (96.1% vs 100% at 1 week, 100% vs 97.1% at 1 month, and 100% for both at 3, 6, and 12 months, respectively). IPVA has clinical results and complications similar to those of GSVA in individuals with C2 and C3 chronic venous disease with IPVs in the thigh combined with incompetent GSV, but its higher technical failure rate makes it difficult to choose it as the primary treatment method.

Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers

Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy. Patients with nonhealing venous ulcers of >3 months' duration underwent duplex ultrasound to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Patients who had either no saphenous incompetence or persistent ulcers after saphenous ablation underwent PA of incompetent perforating veins >3 mm that demonstrated reflux; initial treatment was performed on the perforator vein adjacent to the ulcer with additional incompetent veins treated if ulcer healing failed. Seventy-five ulcers with 86 associated incompetent perforating veins were treated with PA in 45 patients with CEAP 6 recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (61%), calf (37%), and lateral ankle (2%). Initial success of PA, assessed by postprocedure duplex ultrasound, was 58%; repeat ablation was 90% successful and 71% had eventual successful perforator closure. No complications (skin necrosis, infection, or nerve injury) occurred. Failure of ulcer healing with successful perforator closure occurred in 10% and was due to intercurrent illness, patient noncompliance, and patient death due to unrelated causes. Of patients who healed their ulcers, the healing occurred at a mean of 138 days; an average PA of 1.5 incompetent veins per ulcer was required for healing. Ninety percent of ulcers healed when at least one perforator was closed; no ulcer healed without at least one perforator being closed. This experience demonstrates both the feasibility and effectiveness of PA for a selected group of patients with venous ulcers who fail conventional therapy with compression.

Endovenous Ablation of Incompetent Perforator Veins Is Effective Treatment for Recalcitrant Venous Ulcers

Objectives: Endovenous closure of incompetent saphenous veins has been reported to facilitate venous ulcer healing; however, there is little information about the effectiveness of perforator ablation (PA) in healing recalcitrant venous ulcers. We report our experience with PA with venous ulcers unresponsive to prolonged compression therapy. Methods: Patients with nonhealing venous ulcers of >3 months' duration underwent duplex ultrasound imaging to assess their lower extremity venous system for incompetence of superficial, perforating, and deep veins. Patients who had either no saphenous incompetence or persistent ulcers after saphenous ablation underwent PA of incompetent perforating veins >3 mm that demonstrated reflux; initial treatment was performed on the perforator vein adjacent to the ulcer, with additional incompetent veins treated if ulcer healing failed. Results: Fifty-six ulcers with 74 associated incompetent perforating veins were treated with PA in 44 patients with CEAP 4 (9%), 5 (6%), and 6 (85%) recalcitrant venous ulcers. Treated incompetent perforator veins were located in the medial ankle (67 %) and calf (33%). Initial success of PA, assessed by postprocedure duplex ultrasound imaging, was 55 %; reported complications of catheter site skin necrosis (0%), infection (0%), and nerve injury (0%) did not occur. In 18% of patients, more than one procedure was required for perforator closure; 73% had eventual successful perforator closure. Failure of perforator closure occurred in 27% and was associated with intercurrent illness, patient noncompliance, and patient death from unrelated causes. Of patients whose ulcers healed, the healing occurred at a mean of 2.3 months; an average PA of 1.5 incompetent veins per ulcer were required for healing. Conclusions: This experience demonstrates both the feasibility and effectiveness of PA for a selected group of patients with venous ulcers who fail conventional therapy with compression.

Innovative Treatments in Chronic Venous Insufficiency: Endovenous Laser Ablation of Perforating Veins: A Prospective Short-term Analysis of 58 Cases

Objective To evaluate the efficacy of endovenous laser ablation of incompetent perforating veins. Study design Prospective cohort study. Patients A total of 58 perforating veins in 33 limbs of 28 patients were treated between March 2008 and February 2009 in an outpatient clinic setting. The average age was 65 years (range 30–81 years); 64% female; CEAP clinical stage C4 (67%), C5 (17%) and C6 (16%) (Clinica, Etiology, Anatomy and Pathophysiology, CEAP). Methods All patients underwent a standardised clinical examination and duplex ultrasonography. Guided by duplex ultrasonography, the perforating veins were cannulated percutaneously and tumescent local anaesthesia was given. An 810-nm diode laser was used to deliver 14 W power. Mean total energy delivered was 187 (range 87–325) J. Three months post-treatment, all patients underwent a further duplex ultrasound examination, to determine the treatment outcome. Results Occlusion of the perforating veins was achieved after 3 months in 78% of the cases. In the CEAP C6 group, four of five ulcers had healed after 6 weeks. No serious complications, including deep venous thrombosis, were encountered. Conclusions Endovenous laser therapy for treating incompetent perforating veins is a safe and technically feasible technique. The initial occlusion rate is acceptable.

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device

Early success treating incompetent perforator veins (IPVs) with radiofrequency ablation (RFA) and the trend to move varicose vein surgery into a walk-in walk-out service led to the design of a specific device enabling RFA of IPVs using local anaesthesia (ClosureRFS stylet). Our aim was to assess one-year outcomes of a clinical series of patients undergoing treatment with this device. Truncal reflux, where present, was treated initially, and RFA of IPVs was performed as a secondary procedure. Duplex ultrasound examinations were performed and the presence of IPVs documented. Results were compared with preoperative scans. IPVs were classified as closed, not closed/reopened or de novo. Of the 75 patients invited for follow-up, 53 attended at a median time of 14 months (range 11-25). Sixty-seven limbs were analysed (M:F 1:2.1, median age 62, range 25-81). Of the 124 treated IPVs, 101 were closed (82%). Clinical, aetiological, anatomical and pathological clinical score was improved in 49.3% limbs. IPV closure was reduced in patients with recurrent varicose veins compared with primary varicose veins (72.3% versus 87%, P = 0.056). These results demonstrate the radiofrequency stylet device to be an effective treatment for IPVs.

Endovenous Laser Ablation of Incompetent Perforator Veins: A New Technique in Treatment of Chronic Venous Disease

The aim of this study was to assess the feasibility of endovenous laser ablation of incompetent perforator veins in a patient with incompetency of the small saphenous vein and multiple perforator veins. Two different methods were used to ablate seven perforator veins with a laser giving 50-60 J/cm energy. Total occlusion was observed in six perforators, and partial ablation in one perforator, at 1-month follow-up. To our knowledge, endovenous laser ablation of incompetent perforator veins is easy and a good therapeutic method.

Predictive factors of success following radio-frequency stylet (RFS) ablation of incompetent perforating veins (IPV)

To evaluate potential predictive factors associated with success or failure of incompetent perforating veins (IPVs) treated with radio-frequency stylet (RFS). Over the last 12 months in this observational study, 38 consecutive patients with various degrees of venous insufficiency and IPVs underwent 48 office-based radio-frequency ablation procedures (1 - C 3; 7 - C 4; 10 - C 5; 30 - C 6) in 44 limbs. There were 21 females and 17 males with a mean age of 67 +/- 17 years (38-93 years) who had a total of 93 IPVs (40 calf; 53 ankle). Eighteen patients (47%) had ipsilateral great saphenous vein (GSV) radio-frequency closures performed prior to current procedure. The venous flow pattern was classified by spectral waveform analysis as "normal" (spontaneous with respiratory phasicity) in 33 patients and "pulsatile" (with bidirectional cardiac phasicity) in five patients. Follow-up duplex scans were performed from 3 to 7 days postprocedure. Statistical analyses were performed for determining correlation between the various factors such as, age, pulsatile flow, CEAP class, prior GSV ablation, vein diameter, reflux, and patency. The mean number of ablated IPVs was 1.94 +/- 0.38 ranging from 1-3. Immediate success rate was 88% (82 cases, 32 patients). IPVs had a duplex measured mean diameter of 3.8 +/- 1.1 mm (2-6.6 mm). Eleven IPVs remained patent in six patients. There was no significant difference between the patent and the obliterated IPV groups concerning age (P = 0.75), prior GSV ablation (P = .19), IPV diameter (P = .08) and CEAP classification. Conversely, four of the five procedures (80%) performed in patients with "pulsatile" venous flow failed, while only two of the remaining 43 procedures (4.7%) in patients with "normal" venous flow failed (P < .001). These data show that a pulsatile venous flow pattern is a significant predictor of failure following RFS for IPVs.

Radiofrequency Ablation of Incompetent Perforator Veins

Chronic venous insufficiency continues to be a major source of disability and cost, with accompanying socio-economic burdens. Incompetent perforator veins play a significant role in chronic venous insufficiency. This article describes the technique of radiofrequency ablation of incompetent perforating veins for patients with chronic venous insufficiency. Patient evaluation, the evolution of the treatment technique, and details of current treatment are provided. Radiofrequency ablation of incompetent perforating veins is feasible, has promising early results, and extends the armamentarium of minimally invasive venous treatments.

Early Results and Feasibility of Incompetent Perforator Vein Ablation by Endovenous Laser Treatment

BACKGROUND Dissection of incompetent perforator veins even when using the subfascial endoscopic perforator surgery technique is associated with substantial side effects. OBJECTIVE The objective was to evaluate the feasibility of endovenous laser ablation of incompetent perforator veins. PATIENTS AND METHODS A 940-nm diode laser and a Nd:YAG laser with 1,320 nm were used with laser fibers of 600 μm diameter. Perforators were accessed by ultrasound-guided puncture using 16- and 18-gauge cannulas, respectively. Fiber tips were placed below the fascia with at least 1-cm distance from the deep vein system. After administration of perivascular local anesthesia, laser energy was delivered in a pulsed fashion using laser power in the range between 5 and 30 W. RESULTS A total of 67 perforators were treated. Except one vein, all others were occluded at Day 1 after treatment. With 1,320 nm at 10 W, a median of 250 J (range, 103–443 J) was delivered resulting in significantly reduced posttreatment diameters to a mean of 69±23% (p=.0005). With 940 nm at 30 W, a median of 290 J (range, 90–625 J) was administered, showing no significant posttreatment diameter reduction. Side effects were moderate. CONCLUSION Ultrasound-guided endovenous ablation of incompetent perforators is safe and feasible.