[MO-42] Concomitant treatment of axial and branch varicose veins with Endovenous Laser Ablation and catheter-directed foam sclerotherapy
Aim: Endovascular thermal ablation is the first choice to treat trunk varicose veins in lower limbs. Ambulatory phlebectomy for tributaries is strongly recommended at the same time or at a later stage. We developed endovenous laser ablation ( EVLA) and catheter-directed foam sclerotherapy ( CDFS ) via the same sheath to decrease the need of phlebectomy and 2nd--staged treatment. The effect, safety and complications were concerned.
Methods: From Jan.1st, 2018 to Jul. 31st, 2018, total 55 patients underwent EVLA + CDFS were reviewed. The 1470nm round tip diode fiber via a 4Fr. 85cm long sheath was inserted till 2cm distal to SFJ. 40-80J/cm was irradiated to thigh GSV and 20J/cm to lower leg GSV with concomitant STS foam injected 3-5 cm apart. (3 patients used 100% O2-compounded foam ) Hook phlebectomy was performed selectively in sites with bulging varicosities. The preop/intraop and post-op sonography and EVLA or CDFS-related complications were recorded.
Results: 16 males and 39 females, aged 15-82 (mean 58.8) underwent EVLA + CDFS from Jan.1st to Jul. 31st. The endothermal heat- inducted thrombosis (EHIT) or deep vein thrombosis was none but one with partial thrombosis of soleus vein. The GSV closure rate was 100%. Only 7.3% patients had severe ecchymosis and consumed more than 600mg diclofenac. There were 71% patients with remarkable pigmentation. 22% patients complained induration of thrombophlebitis and one infected. There was one paresthesia of lower shin and one matting at sclerotherapy site.
Conclusions: The EVLA+ CDFS is an easy, quick and effective method to treat trunk and branch varicose veins concomitantly. 100% O2-based foam was even safer. The closure rate is as excellent as EVLA alone, but less phlebectomy wounds were needed. The sclerotherapy-related complications such as thrombophlebitis, pigmentation and induration were common and was managed by early coagula removal and phlebectomy.
Methods: From Jan.1st, 2018 to Jul. 31st, 2018, total 55 patients underwent EVLA + CDFS were reviewed. The 1470nm round tip diode fiber via a 4Fr. 85cm long sheath was inserted till 2cm distal to SFJ. 40-80J/cm was irradiated to thigh GSV and 20J/cm to lower leg GSV with concomitant STS foam injected 3-5 cm apart. (3 patients used 100% O2-compounded foam ) Hook phlebectomy was performed selectively in sites with bulging varicosities. The preop/intraop and post-op sonography and EVLA or CDFS-related complications were recorded.
Results: 16 males and 39 females, aged 15-82 (mean 58.8) underwent EVLA + CDFS from Jan.1st to Jul. 31st. The endothermal heat- inducted thrombosis (EHIT) or deep vein thrombosis was none but one with partial thrombosis of soleus vein. The GSV closure rate was 100%. Only 7.3% patients had severe ecchymosis and consumed more than 600mg diclofenac. There were 71% patients with remarkable pigmentation. 22% patients complained induration of thrombophlebitis and one infected. There was one paresthesia of lower shin and one matting at sclerotherapy site.
Conclusions: The EVLA+ CDFS is an easy, quick and effective method to treat trunk and branch varicose veins concomitantly. 100% O2-based foam was even safer. The closure rate is as excellent as EVLA alone, but less phlebectomy wounds were needed. The sclerotherapy-related complications such as thrombophlebitis, pigmentation and induration were common and was managed by early coagula removal and phlebectomy.