By: Steve Elias, MD, FACS
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Choosing the Appropriate Truncal Vein Closure Device
1. CHOOSING THE APPROPRIATE TRUNCAL
VEIN CLOSURE DEVICE
Steve Elias MD FACS
Director, Center for Vein Disease
Director, Wound Care Center
Englewood Hospital and Medical Center NJ
2. THE ANSWER:
• The one that works
• The one you are familiar with
• The one you own
• The least expensive
• None of the above
3. CONSIDERATIONS:
• Size – big, small
• Length - short
• Location – AK, BK, Suprafascial
• Multiple veins – GSV, SSV, AAGSV
• Disease state – C5, C6, SVT
• Patient type – fat, thin, anxious, friend, foe
• Special – MD, spouse of MD, attorneys
5. Occlusion Devices: Two Categories*
• TT (Thermal, Tumescent)
• NTNT (Non Thermal, Non Tumescent)
*Elias S. Emerging Endovenous Technologies. Endovasc
Today. March 2014.
6. Thermal Tumescent: TT
• Laser – HSLW, WSLW, radial/jacketed, etc
• Radiofrequency
• Steam – not in US
7. Non Thermal, Non Tumescent: NTNT
• Mechanochemical
• Cyanoacrylate glue
• Polidocanol Endovenous Microfoam
• V Block
8. Modern Era of Endovenous Ablation: MEEVA
• Percutaneous, outpatient, local anesthesia
• TT:
• RF/Laser - >90% ablation rate @ 4yrs
• Steam - >90% at 1 year (Europe)
• NTNT :
• MOCA – 95% ablation at >2 years
• Foam – 85% at 2 years
• Glue – 95% at 1 years
• V Block – 100% at 4 months
9. SIZE
• Big (>12mm) – TT
• Small – NTNT or TT
• Really big – TT, SFJ/SPJ ligation?
• Really small – NTNT or “should I do this?”
10. LENGTH
• Short segment – RF 3 cm, laser, foam, MOCA
• Short – maybe not CAG (cost?)
• Long - anything
11. LOCATION
• AK – anything
• BK GSV and SSV – NTNT before TT
• Suprafascial – MOCA, TT but consider skin/
cord, hyperpig
12. DISEASE STATE
• C5, C6 – AK GSV & BK GSV – TT or NTNT
• C5, C6 – BK GSV residual – retrograde NTNT
and foam ulcer bed (MOCA)
tumescence an issue
• Previous SVT – TT – need more energy
13. PATIENT TYPE
• Fat – TT over NTNT
• Thin – NTNT over TT
• Anxious, Nervous – NTNT over TT