December 12, 2008

SIMULTANEOUS ENDOCHEMICAL AND ENDOVENOUS THERMAL ABLATION

Julianne Stoughton, MD, Nancy L. Cantelmo, MD, Sherry Scovell, MD.
VeinSolutions, Stoneham, MA, USA.

OBJECTIVE: Endothermal ablation (ETA) has been highly successful in treating truncal veins, while sources of secondary reflux, especially with complex anatomy, are not always addressed during initial treatment. Our objective was to determine if a combination ETA for refluxing truncal veins with endochemical ablation (ECA) for complex secondary veins is effective and safe.
METHODS: Retrospective review of 605 ETAs with a mean follow up of 12 months (3-27). The 605 ETAs consisted of 131 radiofrequency ablations (RFA) and 474 endovenous lasar ablations (EVL). Combination ECA was performed in 39 limbs (6.4%) using 1.0% sodium tetradecyl sulfate, with an average volume of 2.8 cc. The Tessari method was used to transform the liquid sclerosant into foam. Simultaneous ECA was performed for the following indications: proximal neovascularization 36% , adjacent perforators or tributaries 28%, remote perforators or tributaries 51%, or recanalized vessels 13%. Duplex ultrasound was routinely performed to assess vein ablation.
RESULTS: Those limbs treated with ETA and ECA had a higher CEAP classification than those treated with ETA alone. All veins treated with ETA resulted in 100% ablation, while the vessels concomitantly treated with ECA resulted in 70% ablation. Of the 39 cases with simultaneous ETA and ECA, 82% remained asymptomatic. The symptomatic patients requiring secondary ECA demonstrated persistant proximal neovascularization or pelvic sources of reflux. Two patients with venous ulcers and simultaneous treatment healed their ulcers with 18 month followup. Rare complications consisted of 2 cases of Endovenous Heat Induced Thrombosis after EVL and ECA with higher than average volumes of sclerosant (5-6 cc) into proximal groin neovascularization. Both resolved spontaneously with close observation and without further complication.
CONCLUSIONS: ECA in conjunction with ETA appears to be safe and effective, when small volumes of sclerosant are used. ECA treatment along with ETA appears to have the benefit of reducing secondary sources of reflux, and reducing the need for further treatment. Prospective trials with long term followup are needed.

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