Endovenous laser treatment of the small saphenous vein

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Endovenous laser treatment of the small saphenous vein Dimitrios Kontothanassis, MD, Roberto Di Mitri, MD, Salvatore Ferrari Ruffino, MD, Eleonora Zambrini, MD, Giuseppe Camporese, MD, Jean Luc Gerard, MD, Nicos Labropoulos, PhD, DIC, RVT Journal of Vascular Surgery Volume 49, Issue 4, Pages 973-979.e1 (April 2009) DOI: 10.1016/j.jvs.2008.11.019 Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 1 Cross-sectional picture by ultrasound imaging shows the sural nerve (inside red circle) adjacent to the small saphenous vein. Tumescent anesthesia is given by placing the needle tangentially in both sides of the vein to separate it from the nerve. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 2 Infusion of tumescent anesthesia around the small saphenous vein (SSV). A, The SSV before tumescence has a diameter of 6.2 mm and the catheter inside the vein measures 2.7 mm. B, After the infusion of the cold tumescent fluid, the diameter of the SSV is 3.4 mm and encircles the catheter. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 3 Long view of the small saphenous vein during laser ablation. As the catheter is being pulled back, steam bubbles are seen from the heating of the blood. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 4 The ultrasound image shows the small saphenous vein immediately after the procedure is occluded. The split screen function shows the small saphenous vein on the right side is not compressible after applying pressure with the transducer. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 5 At the 1-year follow-up, a trace of the small saphenous vein (arrowheads) is barely noticeable inside the canal. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 6 Survival curves for treatment failure and development of reflux in new sites. A, Recanalized segments with and without reflux. B, Reflux in treated areas. C, Reflux in new locations. D, Recanalization, reflux in treated areas and in new locations. Journal of Vascular Surgery 2009 49, 973-979.e1DOI: (10.1016/j.jvs.2008.11.019) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions