RECENT ADVANCES IN THE MANAGEMENT OF VARICOSE VEINS

DR. JOEL ARUDCHELVAMCONSULTANT VASCULAR AND TRANSPLANT SURGEON

HISTORY OF PROCEDURES 1550 B.C.- Erbers papyrus - not to treat

varicose veins Hippocrates - compression

Celcus (25 BC – AD 14) described the ligation

Galen (AD 131 – 201) – Phlebectomies

1850’s injections of veins (Joseph Pierre Pétrequin)

(930–1313 AD), Arab surgeon Albucacis - vein stripping

1890 - Friedrich Trendelenburg - ligation of the GSV

2000’s – Thermal ablation (Radiofrequency / laser)

Advantages and Disadvantages Surgery

Needs anaesthesia Takes time Admission Trauma Complications

Thermal ablation Local Quick Day procedure Less trauma Less complications

LASER

“LASERS” Characteristics

Types of LASERs

CO2 lasers Diode lasers Dye lasers Other Gas lasers Etc

Varicose vein LASERS

810 nm (AngioDynamics Queensbury, NY)

940 nm (Dornier MedTech Americas, Inc)

980 nm (Biolitec, Inc, East Longmeadow)

1064 nm (Sharplan, Inc., NJ)

1320 nm (CoolTouch, Roseville, Calif)

1470 nm (Biolitec, neoLaser)

Equipment

Technique

Pre procedural USS and mark Tumescent   solution

Lignoocaine (400 mg/l = 0.04%) epinephrine (1 mg/l = 1:1,000,000) sodium bicarbonate (10 mEq/l) in saline

solution Reverse Trendelenburg

Technique

70 – 80 j / cm

USS Guided tumescent injection (perivenous)

LASER Actvation and ablation

Complications

Ecchymosis Superficial phlebitis Neurologic injuries – saphenous, sural Skin burns DVT

Outcome

No significant difference in initial technical success rate within 2 years

fewer complications in EVLA bleeding and haematoma (1.28% versus

4.83%) wound infection (0.33% versus 1.91%) paraesthesia (6.73% versus 11.27%

Phlebology. 2014 Mar;29(2):109-19.

Radiofrequency Ablation

Same principal of EVLA Special heater probe - 85 -120 c Probe directly comes in contact with

vein wall

Thank you