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Vein Ablation

Vein Ablation Procedure Prep

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Ep 111 Underutilization of Foam Sclerotherapy with Dr. Chris Pittman
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Pre-Procedure Prep

Indications

• Symptomatic varicose veins with proven reflux (CEAP 2)
• Symptomatic Venous Insufficiency with edema, skin changes and/or ulcerations (CEAP 3, 4, 5, 6)
• Symptoms include: aching pain, leg heaviness, leg fatigue, superficial thrombophlebitis, external bleeding, edema, ankle hyperpigmentation, skin changes, venous ulcer

Contraindications

• Significant deep venous reflux and/or DVT
• Central venous obstruction
• Severe uncorrectable coagulopathy
• Pregnant
• Inability to ambulate after the procedure

Things to Check

• History and physical exam- CEAP classification
• Preprocedure photographs to document skin changes, ulcerations etc.
• Doppler ultrasound evaluation of the lower extremity deep and superficial vein mapping, to evaluate patency and test for reflux.

Vein Ablation Podcasts

Listen to leading physicians discuss vein ablation on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #111

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We talk with Dr. Chris Pittman, founder of Vein911 and LinkedIn Foam Sclerotherapy Experts, about Foam Sclerotherapy for the treatment of superficial venous disease, including technique, patient workup, and some of the reasons why foam is underutilized.

Episode #33

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Dr. Brooke Spencer gets into the pearls and pitfalls of building a comprehensive vein practice, including a detailed discussion on the treatment of May-Thurner and Pelvic Congestion syndrome.

Episode #6

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Episode 6 with Dr. Aaron Shiloh, MD FSIR discussing pearls and pitfalls of starting an outpatient vein clinic, including the importance of marketing.

Procedure Steps

Endovenous Radiofrequency Ablation

• Draw the course of the greater saphenous vein (GSV) to be treated, including branch varicosities and perforators.
• The leg is sterilely prepped and draped.

Access

• Ultrasound guided access into the small or great saphenous vein
• Micropuncture needle and 0.018" wire.
• For RFA the GSV accessed just below the knee to avoid nerve injury to the saphenous nerve
• Small saphenous vein is accessed at the inferior aspect of the gastrocnemius muscle to avoid injury to the sural nerve.
• Place vascular sheath

Ablation

• The ablation catheter is advance with its tip approximately 3 cm distal/peripheral to the saphenofemoral junction under ultrasound guidance.
• Dilute local anesthetic is then infiltrated along the course of the vein in the perivenous sheath and surrounding subcutaneous tissue under US guidance using the tumescent pump.
• Tumescent works in 3 ways: (1) anesthesia for patient comfort; (2) buffer to protect adjacent tissues from injury during thermal ablation; (3) compress the vein around the ablation device for improved vein wall apposition
• Once adequate anesthesia has been achieved, the catheter is activated and withdrawn through the vein to ablate
• For RFA, the vein is usually heated in 7 cm segments with 20 second treatment cycles
• Catheter is then withdrawn and sheath is removed.
• Manual pressure for hemostasis, usually within 5-10 min.

Small branch varicosities can be treated at the time of ablation with US guided foam sclerotherapy, or at follow up.

Vein Ablation Articles

Read our exclusive BackTable VI Articles for quick insights on vein ablation, provided by physicians for physicians.

Medical image of a deep vein treated in a comprehensive vein practice

Building a vein practice requires knowledge and skills beyond the treatment of venous disease. Vein expert Dr. Spencer discusses where to start when treating patients with venous disease, when to take charge as a diagnostician, and why interventional radiologists need to start managing their patients perioperatively.

Post-Procedure

Post-Procedure Care

At the completion of the procedure, US evaluation of the saphenofemoral junction or saphenopopliteal junction is performed to rule out DVT.
The treated leg is immediately wrapped with ACE wrap for compression, to be worn for at least 24 hours, followed by compression stocking for 2 weeks.
Ambulation is initiated immediately and should be encouraged during post-procedure use of compression stockings.

Follow-Up

Follow up US is typically performed within 3-4 days to rule out post procedure DVT or endothermal heat-induced thrombosis (EHIT)

Complications

Follow up US is typically performed within 3-4 days to rule out post procedure DVT or endothermal heat-induced thrombosis (EHIT)

Vein Ablation Demos

Watch video walkthroughs of vein ablation on the BackTable VI expanded content network.

Instructional Foam Sclerotherapy

Varicose vein treatment with foam sclerotherapy.

Tessari Method for Foam Sclerosant by Dr. Peter Bream

Using the Tessari Method for foam sclerosant creation is quick and simple. A foam sclerosant is used in treating varicose veins. In this demo by Dr. Peter Bream, we show you how to perform the Tessari Method. Read on!

Ultrasound Guided Foam Sclerotherapy at Vein 911 Tampa Vein Treatment Center

Dr. Chris Pittman, VEIN911 Medical Director, demonstrates ultrasound guided sclerotherapy of varicose veins.

Vein Ablation From Start To Finish

Dr. Aaron Shiloh showing how a vein ablation is done.

References

[1] Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019;34(2):269‐283. doi:10.3904/kjim.2018.230
[2] Aziz F, Diaz J, Blebea J, Lurie F; American Venous Forum. Practice patterns of endovenous ablation therapy for the treatment of venous reflux disease. J Vasc Surg Venous Lymphat Disord. 2017;5(1):75‐81.e1. doi:10.1016/j.jvsv.2016.08.006
[2] Kayssi A, Pope M, Vucemilo I, Werneck C. Endovenous radiofrequency ablation for the treatment of varicose veins. Can J Surg. 2015;58(2):85‐86. doi:10.1503/cjs.014914
[4] Hardman RL, Rochon PJ. Role of interventional radiologists in the management of lower extremity venous insufficiency. Semin Intervent Radiol. 2013;30(4):388‐393. doi:10.1055/s-0033-1359733
[5] Gloviczki P, Gloviczki ML. Guidelines for the management of varicose veins. Phlebology. 2012;27 Suppl 1:2‐9. doi:10.1258/phleb.2012.012s28
[6] Eklöf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg. 2004;40(6):1248‐1252. doi:10.1016/j.jvs.2004.09.027

Disclaimer: The Materials available on https://www.BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Podcasts

Underutilization of Foam Sclerotherapy with Dr. Chris Pittman on the BackTable VI Podcast)
Building a Comprehensive Vein Practice with Dr. Brooke Spencer and Dr. Isabel Newton on the BackTable VI Podcast)
Setting Up a Vein Clinic with Dr. Aaron Shiloh and Dr. Aaron Fritts on the BackTable VI Podcast)
Treating Above the Knee Calcium with Dr. Bryan Fisher and Dr. Sabeen Dhand on the BackTable VI Podcast)

Articles

Medical image of a deep vein treated in a comprehensive vein practice

Building a Comprehensive Vein Practice

Contributors

Dr. Chris Pittman on the BackTable VI Podcast

Dr. Chris Pittman

Dr. Aaron Shiloh on the BackTable VI Podcast

Dr. Aaron Shiloh

Dr. Brooke Spencer on the BackTable VI Podcast

Dr. Brooke Spencer

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