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Saphenous Vein Ablation
Joseph A. Ronsivalle, DO, FSIR; Suvranu Ganguli, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Definitions

            • Endovenous thermal ablation (EVTA): Procedure involving internal thermal energy delivery to vein wall
              • Vein irreversibly occludes, eventually fibroses
              • Used to eliminate incompetent superficial truncal veins responsible for superficial venous insufficiency
              • Laser (differing wavelengths) or radiofrequency energy
            • Superficial veins: Veins of lower extremity superficial to fascia that surrounds muscular compartment
              • Includes truncal veins
                • Great saphenous vein (GSV)
                • Small saphenous vein (SSV)
              • Includes anastomoses connecting GSV/SSV
                • Vein of Giacomini: Posteromedial branch of GSV
                  • Arises at saphenofemoral junction (SFJ); connects to SSV
                • Anterior thigh tributary (ATT)
                  • Arises at SFJ; courses over anterior thigh
              • Also includes innumerable venous tributaries known as collecting veins
            • Superficial venous insufficiency: Usually caused by primary degenerative disease of superficial vein wall
              • Leads to venous reflux/chronic venous hypertension
            • Venous reflux: Retrograde flow that occurs within veins; defective valves fail to prevent flow reversal
              • Clinically significant reflux lasts for > 0.5-1.0 seconds following release of compression on muscular mass below vein
            • CEAP classification: Clinical status, etiology, anatomy, and pathophysiology
              • Summarizes disease state in chronic venous disease based on physical observations of disease severity
              • Helps report clinical success of intervention
              • Venous severity score (VSS) is additional means of grading spectrum of disease severity

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          • Postprocedure Imaging

                            OUTCOMES

                            • Problems

                              • Complications

                                • Expected Outcomes

                                  Selected References

                                  1. Morrison N et al: Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 61(4):985-94, 2015
                                  2. Todd KL 3rd et al: The VANISH-2 study: a randomized, blinded, multicenter study to evaluate the efficacy and safety of polidocanol endovenous microfoam 0.5% and 1.0% compared with placebo for the treatment of saphenofemoral junction incompetence. Phlebology. 29(9):608-18, 2014
                                  3. Kerver AL et al: The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation. J Vasc Surg. Epub ahead of print, 2012
                                  4. Lewis M et al: Advantages of blood pool contrast agents in MR angiography: A pictorial review. J Med Imaging Radiat Oncol. 56(2):187-91, 2012
                                  5. Gloviczki P et al: The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 53(5 Suppl):2S-48S, 2011
                                  6. Haqqani OP et al: Great saphenous vein patency and endovenous heat-induced thrombosis after endovenous thermal ablation with modified catheter tip positioning. J Vasc Surg. 54(6 Suppl):10S-7S, 2011
                                  7. Gale SS et al: A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg. 52(3):645-50, 2010
                                  8. Khilnani NM et al: Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from SIR, CIRSE, ACP and CIRA. J Vasc Interv Radiol. 21(1):14-31, 2010
                                  9. O'Donnell TF: The role of perforators in chronic venous insufficiency. Phlebology. 2010 Feb;25(1):3-10. Review. Erratum in: Phlebology. 25(4):214, 2010
                                  10. Almeida JI et al: Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 20(6):752-9, 2009
                                  11. Gohel MS et al: Radiofrequency ablation for uncomplicated varicose veins. Phlebology. 24 Suppl 1:42-9, 2009
                                  12. Ravi R et al: Endovenous thermal ablation of superficial venous insufficiency of the lower extremity: single-center experience with 3000 limbs treated in a 7-year period. J Endovasc Ther. 16(4):500-5, 2009
                                  13. Fan CM et al: Endovenous laser ablation: mechanism of action. Phlebology. 23(5):206-13, 2008
                                  14. Frasier K et al: Minimally invasive vein therapy and treatment options for endovenous heat-induced thrombus. J Vasc Nurs. 26(2):53-7, 2008
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Preprocedure

                                      • Procedure

                                        • Post Procedure

                                          TERMINOLOGY

                                          • Definitions

                                            • Endovenous thermal ablation (EVTA): Procedure involving internal thermal energy delivery to vein wall
                                              • Vein irreversibly occludes, eventually fibroses
                                              • Used to eliminate incompetent superficial truncal veins responsible for superficial venous insufficiency
                                              • Laser (differing wavelengths) or radiofrequency energy
                                            • Superficial veins: Veins of lower extremity superficial to fascia that surrounds muscular compartment
                                              • Includes truncal veins
                                                • Great saphenous vein (GSV)
                                                • Small saphenous vein (SSV)
                                              • Includes anastomoses connecting GSV/SSV
                                                • Vein of Giacomini: Posteromedial branch of GSV
                                                  • Arises at saphenofemoral junction (SFJ); connects to SSV
                                                • Anterior thigh tributary (ATT)
                                                  • Arises at SFJ; courses over anterior thigh
                                              • Also includes innumerable venous tributaries known as collecting veins
                                            • Superficial venous insufficiency: Usually caused by primary degenerative disease of superficial vein wall
                                              • Leads to venous reflux/chronic venous hypertension
                                            • Venous reflux: Retrograde flow that occurs within veins; defective valves fail to prevent flow reversal
                                              • Clinically significant reflux lasts for > 0.5-1.0 seconds following release of compression on muscular mass below vein
                                            • CEAP classification: Clinical status, etiology, anatomy, and pathophysiology
                                              • Summarizes disease state in chronic venous disease based on physical observations of disease severity
                                              • Helps report clinical success of intervention
                                              • Venous severity score (VSS) is additional means of grading spectrum of disease severity

                                          PREPROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Preprocedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Alternative Procedures/Therapies

                                                        POST PROCEDURE

                                                        • Things to Do

                                                          • Postprocedure Imaging

                                                            OUTCOMES

                                                            • Problems

                                                              • Complications

                                                                • Expected Outcomes

                                                                  Selected References

                                                                  1. Morrison N et al: Randomized trial comparing cyanoacrylate embolization and radiofrequency ablation for incompetent great saphenous veins (VeClose). J Vasc Surg. 61(4):985-94, 2015
                                                                  2. Todd KL 3rd et al: The VANISH-2 study: a randomized, blinded, multicenter study to evaluate the efficacy and safety of polidocanol endovenous microfoam 0.5% and 1.0% compared with placebo for the treatment of saphenofemoral junction incompetence. Phlebology. 29(9):608-18, 2014
                                                                  3. Kerver AL et al: The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation. J Vasc Surg. Epub ahead of print, 2012
                                                                  4. Lewis M et al: Advantages of blood pool contrast agents in MR angiography: A pictorial review. J Med Imaging Radiat Oncol. 56(2):187-91, 2012
                                                                  5. Gloviczki P et al: The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 53(5 Suppl):2S-48S, 2011
                                                                  6. Haqqani OP et al: Great saphenous vein patency and endovenous heat-induced thrombosis after endovenous thermal ablation with modified catheter tip positioning. J Vasc Surg. 54(6 Suppl):10S-7S, 2011
                                                                  7. Gale SS et al: A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg. 52(3):645-50, 2010
                                                                  8. Khilnani NM et al: Multi-society consensus quality improvement guidelines for the treatment of lower-extremity superficial venous insufficiency with endovenous thermal ablation from SIR, CIRSE, ACP and CIRA. J Vasc Interv Radiol. 21(1):14-31, 2010
                                                                  9. O'Donnell TF: The role of perforators in chronic venous insufficiency. Phlebology. 2010 Feb;25(1):3-10. Review. Erratum in: Phlebology. 25(4):214, 2010
                                                                  10. Almeida JI et al: Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 20(6):752-9, 2009
                                                                  11. Gohel MS et al: Radiofrequency ablation for uncomplicated varicose veins. Phlebology. 24 Suppl 1:42-9, 2009
                                                                  12. Ravi R et al: Endovenous thermal ablation of superficial venous insufficiency of the lower extremity: single-center experience with 3000 limbs treated in a 7-year period. J Endovasc Ther. 16(4):500-5, 2009
                                                                  13. Fan CM et al: Endovenous laser ablation: mechanism of action. Phlebology. 23(5):206-13, 2008
                                                                  14. Frasier K et al: Minimally invasive vein therapy and treatment options for endovenous heat-induced thrombus. J Vasc Nurs. 26(2):53-7, 2008