Endovenous management of saphenous vein reflux

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Endovenous management of saphenous vein reflux Stefano Manfrini, MDa, Vincenzo Gasbarro, MDa, Gudmundur Danielsson, MDb, Lars Norgren, MDb, James G. Chandler, MDc, Andrew F. Lennox, MBBS, FRACSd, Zaki A. Zarka, MDd, Andrew N. Nicolaides, MS, FRCSd Journal of Vascular Surgery Volume 32, Issue 2, Pages 330-342 (August 2000) DOI: 10.1067/mva.2000.107573 Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Hematoxylin and eosin–stained cross sections of lateral saphenous veins, taken at mid thigh from similarly sized goats (all at 10× original magnification). A, Untreated. B, Closed by thermal collagen-denaturation contraction, seen at 3 days. C, Closed by thermal collagen-denaturation contraction, seen at 6 weeks. Note 60% contraction and vein wall thickness doubling with glassy hyalinization at 3 days, and note thrombus maturation with fibrosis and vaso vasorum ingrowth at 6 weeks. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Masson trichrome–stained cross sections of lateral saphenous veins contracted to predetermined diameter (both sections were taken at mid thigh from similarly sized sheep and photographed at 10× original magnification). A, Seen at 3 days. B, Seen at 3 weeks. Note apparent wall relaxation at 3 weeks. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Closure catheters (note cupped, uninsulated electrode tips). B, Restore catheter (note central 9-mm uninsulated electrode areas). Arrows indicate microthermocouples. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Symptom prevalence (%) in 53 Closure patients followed up for 6 months or more. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Box-and-whisker plots of valve diameters of 31 Restore patients followed up for 6 months or more (P values vs pretreatment diameter). Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Box-and-whisker plots of reflux duration for 31 Restore patients followed up for 6 months or more (P values vs pretreatment reflux duration). Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Symptom prevalence (%) in 31 Restore patients followed up for 6 months or more. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 8 Reflux and symptom absence as functions of valve diameter change at 6 months (circles ; n = 14) and 12 months (triangles ; n = 17); black symbols indicate symptom-free patients. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 9 Closure catheter positioning near saphenofemoral junction (SFJ). A, Compression wrap around thigh and electrodes expanded just below superficial epigastric vein (SE) orifice. B, Treatment in progress (wrap omitted to show undistorted treatment anatomy). C and D, Comparable views show catheter positioned as close to SFJ as possible; in D, note cul-de-sac (arrow) and lack of superficial epigastric vein washout. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 10 Acute reduction (%) in valve diameters and catheter dwell times associated with vein patency and early thrombosis after Restore treatment. Journal of Vascular Surgery 2000 32, 330-342DOI: (10.1067/mva.2000.107573) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions