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Presence of Varicose Veins Despite Prior Endovenous Thermal
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
1
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
3
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
4
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 %)
5
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
6
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
7
8. Presence of varicose veins despite prior endovenous
thermal ablation of saphenous veins
Majority initially had GSV treatment
156
6
162 (82%)
108 (67%) had
EVA - VV
Adjunctive Treatment
•
•
•
Treatment:
Phlebectomy
Foam
Combination
Great Saphenous Small Saphenous
Vein Ablation
Vein Ablation
12
Concurrent
Treatment
8
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
9
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
11
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.
12
Notes de l'éditeur
In box with 150 we should only have EVA under the 150
Have following POINT to pop in after last pop in on this slide VV associated with recanalizedsaphenous veins, perforator veins or accessory veins
7/17/2013 CHANGES Note: {1st 3 columns light blue, the ‘no VV’ have no values, please add: Recanalized (no VV = 6 [light blue column] Perforator (no VV = 6) Accessory Vein (no VV = 6) }Add additional columns between Distal saphenous reflux and Neovasc/pelvic column to read:deNovosaphenous reflux VV 10, no VV17a.) Title with columns of VV (dark blue columns) appears on this slide initially.b.) Then pop in of No VV (light blue columns) nextc.)Then note in rectangle (‘where had no varicose veins had…DSR) comes in. (the way you have it)d.) Then have POINT (below) pop in VV associated with recanalizedsaphenous veins, perforator veins or accessory veins (Add this as POINT under title)