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Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model  Claus-Georg Schmedt,

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Presentation on theme: "Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model  Claus-Georg Schmedt,"— Presentation transcript:

1 Evaluation of endovenous radiofrequency ablation and laser therapy with endoluminal optical coherence tomography in an ex vivo model  Claus-Georg Schmedt, MD, Oliver A. Meissner, MD, Kathrin Hunger, MD, Gregor Babaryka, MD, Volker Ruppert, MD, Mojtaba Sadeghi- Azandaryani, MD, Bernd Manfrred Steckmeier, MD, PhD, Ronald Sroka, PhD  Journal of Vascular Surgery  Volume 45, Issue 5, Pages (May 2007) DOI: /j.jvs Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

2 Fig 1 Cow foot model (left hind extremity) for standardized evaluation of endovenous thermal procedures. The 50-mm study vein segments of vena saphena lateralis and vena digitalis dorsalis communis II used in this experimental protocol are marked. Endovenous thermal treatment was performed after repositioning of skin flap without perivascular tumescence. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

3 Fig 2 Correlation of (A) histologic cross section (hematoxylin-eosin stain, original magnification ×40) and (B) endovascular optical coherence tomography (eOCT) cross section of a untreated control cow’s foot vein. A, In histologic cross section, circumferentially intact intima (I) with lamina elastica interna, media (M), and adventitia (A) is represented. B, In eOCT cross section intima (I) and lamina elastica interna is represented by a bright signal. Media is represented by signals with changing intensity; collagenous fibers and elastic fibers may increase signal intensity. There is a sharp boundary (marked by white arrows) between media and adventitia, which may be caused by lamina elastica externa. Owing to limited penetration depth, the transition from adventitia to perivascular tissue is less sharply defined. P, eOCT probe. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

4 Fig 3 Endoluminal optical coherence tomography (eOCT) and TapeMeasure for quantitative evaluation of thermal effects such as heat-induced collagen shrinkage with increase of media thickness and reduction of vessel lumen. A. demonstrates eOCT cross section of a nontreated cow foot vein with marked lumen-intima border and media-adventitia border for computer-based calculation of vessel lumen diameter and intima-media thickness. P, eOCT probe. B. is a schematic representation of vessel wall layers, which can be identified by eOCT and parameters calculated by TapeMeasure. L, vessel lumen; M, media; A, adventitia; L, lumen diameter; MT, media thickness. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

5 Fig 4 Endovenous radiofrequency ablation (RFA) (panels A-C). Corresponding cross sections of a cow’s foot study vein (SV2) with valve structures. A, Endoluminal optical coherence tomography (eOCT) cross section of a cow foot vein before RFA treatment representing normal intima, media and adventitia as well as valve structures. B, Corresponding eOCT cross section after RFA with reduced vessel lumen diameter and distinct media thickening of complete circumference. Valve structures seem to be thickened also. Media shows circular homogenization of signal intensity. No localized loss of tissue (ablation) is visible. C, Corresponding post RFA histologic (hematoxylin-eosin stain, original magnification ×40) cross section represents circular destruction of intima. Media appears to be thickened, comprising the complete circumference, Nuclear rarefication, loss of cell contours, and delamination with circular fissures demonstrate thermal injury of media. No areas with carbonization or transmural thermal lesions including adventitia are visible. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

6 Fig 5 Endovenous laser therapy (ELT) with paced pullback at λ = 980 nm, 5W, and linear endovenous energy density at 25 J/cm. Panels A-C, Corresponding cross sections of a cow foot study vein (SV11). A, Endoluminal optical coherence tomography (eOCT) cross section before representing normal vein wall layers. B, Corresponding post ELT cross section with circular homogenization of media signal intensity. Arrow shows localized loss of tissue (ablation) including intima and 50% of media thickness. C, Corresponding histologic cross section (hematoxylin-eosin stain, original magnification ×40) represents localized thermal injury (arrow) with carbonization and tissue ablation including intima and 50% of media thickness, which corresponds with localized increased thermal injury. Media in this quadrant of the vein circumference additionally shows delamination with circular fissures. Intima and media in other quadrants of the circumference seems to be intact. No thermal injury has occurred to the adventitia. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

7 Fig 6 Endovenous laser therapy (ELT) with paced pullback at λ = 980 nm, 7 W, and laser endovenous energy density at 35 J/cm. Panels A-C, Corresponding cross sections of a cow’s foot study vein (SV5). A, Endoluminal optical coherence tomography (eOCT) cross section before ELT. B, Corresponding eOCT cross section after ELT representing localized massive thermal alteration with loss of tissue including all vein-wall layers leading to perforation (arrow). Circular homogenization and thickening of media. C, Corresponding histologic cross section (hematoxylin-eosin stain, original magnification ×40) representing massive tissue destruction (arrow), including perivascular tissue leading to complete vessel wall perforation. Carbonization of intima, media, and adventitia is visible. Circular thermal alteration is represented by destruction of intima and repetitive delamination of media with circular fissures. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

8 Fig 7 A, Example of media thickness (MT) subject to the position of the vein length treated with radio frequency ablation (RFA) standardized TapeMeasure measurement in study vein segment SV2. B, Example of lumen diameter (LD) subject to the position of the RFA-treated vein length standardized TapeMeasure measurement in study vein-segment SV2. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

9 Fig 8 A, Example of media thickness (MT) subject to the position of the vein length treated after paced pullback treatment with endovenous laser therapy (ELT) at λ = 980 nm, laser endovenous energy density at 35 J/cm, and endovenous fluence equivalent at 26.1 J/cm2. Standardized TapeMeasure measurement in study vein-segment SV6. Thin diamond, tissue ablation, 25% to 50% of MT; thick diamond, tissue ablation >50% of MT. B, Example of lumen diameter (LD) subject to the position of the ELT-treated vein length. Standardized TapeMeasure measurement in study vein-segment SV6. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

10 Fig 9 Example of media thickness (MT) subject to the position of the vein length treated with paced pullback endovenous laser therapy (ELT) at λ = 980, laser endovenous energy density at 35 J/cm, and endovenous fluence equivalent at 40.5 J/cm2. Standardized TapeMeasure™ measurement in study vein segment SV5. Solid diamond shows the localization of complete vessel wall perforations. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

11 Fig 10 Example of media thickness (MT) subject to the position of the vein length treated with continuous pullback endovenous laser therapy (ELT) at λ = 980 nm, laser endovenous energy density at 36.5 J/cm, and endovenous fluence equivalent at 42.6 J/cm2) vein length. Standardized TapeMeasure measurement in study vein-segment SV9. Thick black line shows tissue ablation >50% of media thickness. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

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