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Initial experiences in endovenous treatment of saphenous vein reflux
Johannes E M Sybrandy1, Cees H A Wittens
1Department of Vascular Surgery, Sint Franciscus Hospital, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
Introduction:
The most common site of venous reflux is the long saphenous vein (LSV). The preferred treatment for reflux in the LSV is surgical stripping of the LSV. However, the complications of surgical stripping are well documented and undesirable. The constant search for treatment options with less morbidity, which are also cosmetically more acceptable, has resulted in the endovenous treatment for primary varicose veins, developed by VNUS Medical Technologies, Inc (Sunnyvale, Calif). We hereby present our first treatment experiences and propose refinements to the procedure.
Methods:
Two types of heat-generating endovenous catheters were used to treat incompetence of the LSV with a diameter of up to 12 mm. The procedure was performed on a blood-empty limb.
Results:
Twenty-six limbs, in 26 patients, were treated, and the follow-up period was 1 year. The mean preoperative CEAP score was 4, and the postoperative score was 1.26, which was statistically significantly less (P <.0001, with Wilcoxon nonparametric matched pair test). Five patients had postoperative paresthesia of the saphenous nerve, and one patient had a burn from the procedure. The overall complication rate was 23%. All complications occurred in the first half of the studied population (P =.015, with Fisher exact test), indicating the learning curve effect. In one patient (3.8%), was total recanalization of the treated segment occurred, one patient (3.8%) could not be treated at all (technical failure), and one patient (3.8%) had partial recanalization of the LSV. Eight patients (30.8%) had closure of the entire LSV but with persisting reflux in the saphenofemoral junction (SFJ). Two patients had a competent SFJ with occlusion of the LSV. In 13 patients (50%), closure of both the LSV and the SFJ was seen. The LSV was successfully occluded in 88% of the patients.
Conclusion:
The endovenous catheter should not be used more than 5 to 10 cm below the knee to prevent saphenous nerve damage. Performance of the procedure with bloodlessness is preferable. A result of 88% of successfully treated LSV segments indicates a promising alternative for surgical stripping of the LSV.