General Session VII - Superficial Venous Disease and Vascular Malformations
Efficacy and Security of Combined 1470 EVLA + Foam Sclerotherapy on the Management of C4 to C6 Patients
Tuesday, March 5, 2024
5:07 PM – 5:17 PM EST
Location: Tampa Bay Ballroom Salons 1-4
Objective: Endovenous laser ablation has become one of the standards of treatment for patients with chronic venous insufficiency due to superficial lower leg venous reflux. There have recently been multiple less invasive proposals of treatment toward patients with CEAP 4, 5, 6. Many of these patients with GSV and SSV reflux have below the knee (BTK) reflux and perforator vein insufficiency. Prevention of thermal damage to the BTK nerves and management of perforator associated incompetence has been addressed by multiple authors. The aim of this study is to present a series of patients C4-6, on which EVLA + BTK foam sclerotherapy was performed, analyzing results and security of the combined procedure.
Methods: We present a series of 287 CEAP 4-6-patients operated on from January 2018 to January 2023. All patients with GSV or SSV reflux confirmed by duplex scan. All patients operated with 1470 Diode laser with radial fiber, and complimentary Tessari Method foam UGS with 1% Polidocanol as necessary for BTK reflux and perforator incompetence. Duplex US was performed at 30, 60, and 365 days after the procedure. CIVIQ-20, AND VAS at 0, 30, 60, and 365 days was performed. Treatment efficacy and complications were assessed.
Results: We had 197 women and 90 men. 128 patients CEAP 4, 89 CEAP 5, and 70 CEAP 6. GSV reflux was found on 226 patients, 61 patients with SSV reflux. 83 Patients CEAP 5 had perforator vein insufficiency (93%) and 64 patients CEAP 6 had BTK perforator insufficiency (91%). We had no DVT after treatment, no residual paresthesia. Closure of the axials veins GSV and SSV was 98%, 94%, and 90 % at 30 days, 90, and 1 yr. Rate of ulcer closure on C5 patients was 94% at 60 days. CIVIQ 20 questionnaire improved from an average of 88 at day 0 to 42 at 1 yr. VAS on patients C5 was 7 at day 0 and decreased to 2 at 1 yr. Minor hematomas and bruises were observed on 96% of patients post intervention, minor neuropathic pain along the GSV was observed during the first 30 days PO and did not require management.
Conclusions: Combination of EVLA with foam sclerotherapy gives excellent results on axial superficial vein reflux and it allows treatment of BTK segments and perforator disease, it is a safe method to treat C4-C6 patients with minor complications and very acceptable long term closure rates. This method decreases the rate of nerve injuries and recurrences and gives good QOL to patients with this problem.
