Retrograde Endovenous Microfoam Chemical Ablation of Varicose Veins and Venous Valvular Reflux in CEAP 6 Ulcers Steven T Deak, MD, PhD, FACS VEITHsymposium.

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Presentation transcript:

Retrograde Endovenous Microfoam Chemical Ablation of Varicose Veins and Venous Valvular Reflux in CEAP 6 Ulcers Steven T Deak, MD, PhD, FACS VEITHsymposium New York, NY November 18, 2016

Varicose Veins: Indications for Intervention General appearance Aching pain Leg heavines Easy leg fatigue Superficial thrombophlebitis External bleeding Ankle hyperpigmentation Lipodermatosclerosis Atrophic blanche Venous ulcer

The treatment of large superficial varicose veins requires a two step approach: The incompetent greater saphenous vein is closed with endovenous thermal ablation Followed by ambulatory phlebectomy of the residual varicose veins, either at the same time or at a later date This study outlines an improved technique for treating the incompetent greater saphenous vein and the associated varicose vein tributaries at the same time with a single access site using endovenous chemical ablation with 1% polidocanol injectable foam

The GSV is accessed with 5 Fr micropunture catheter in distal thigh, leg 45* the GSV is thrombosed polidocanol1% SFJ compressed to protect the deep system 2nd injection is administered through the same catheter and directed distally in retrograde fashion thhrough the incompetent vv to the calf dorsiflex foot to prot. deep

38 year old male presents with varicose veins for many years with heavy feeling in both legs. Severe reflux in the greater saphenous vein 500 msecons in duration GSV measures 11 mm in diameter Varicosities at the knee 8 to 11 mm The GSV was thrombosed with 3 mLs of polidocanol injectable foam 1% The remaining varicosities in the distal leg were then treated with an additional 5 mL of polidocanol injectable foam 1% through the same micropuncture catheter in the distal thigh for a total foam volume of 8 mL

Pre-Op 2 Weeks Post-Op

1% Polidocanol Injectable Foam Physician Compounded Foam

Retrograde Microfoam Chemical Ablation Treatment of Venous Valvular Hypertension and Venous Valvular Reflux in CEAP 6 Ulcers SEPS Retrograde Microfoam Chemical Ablation

Retrograde Ablation of Venous Valvular Reflux in the Treatment of CEAP 6 Ulcers with 1% Polidocanol Injectable Foam