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Endothermal ablation

Shekeeb Sufian, Alejandro Arnez, Nicos Labropoulos, Sanjiv Lakhanpal
BACKGROUND: The purpose of this study was to evaluate the risks of bleeding, deep venous thrombosis (DVT), endovenous heat induced thrombosis (EHIT) and failure of ablation on patients who undergo ablation while on oral anticoagulation. METHODS: We compared 378 (3.4%) out of 11252 patients (Group A) who had undergone 724 endovenous ablation of the saphenous veins from January 1, 2011 to September 30, 2014 while on oral anticoagulation to a randomly selected 375 patients (Group B) who underwent 641 endovenous ablation in the same time period but were not on anticoagulation...
September 6, 2016: International Angiology: a Journal of the International Union of Angiology
Diego Ayo, Sheila N Blumberg, Caron R Rockman, Mikel Sadek, Neal Cayne, Mark Adelman, Lowell Kabnick, Thomas Maldonado, Todd Berland
OBJECTIVE: The goal of this study is to determine if compression therapy after endovenous ablation (EVA) of the great saphenous vein (GSV) improves efficacy and patient reported outcomes of pain, ecchymosis and quality of life. METHODS: This was a prospective randomized controlled trial from 2009 to 2013 comparing the use of thigh-high 30-40mmHg compression therapy for 7 days vs no compression therapy following endovenous ablation of the GSV. Severity of venous disease was measured by CEAP scale and the venous clinical severity score (VCSS)...
August 20, 2016: Annals of Vascular Surgery
Fumitaka Mafuné, Yuki Tawaraya, Satoshi Kudoh
Adsorption and desorption of N2 molecules onto cationic Ta and Rh clusters in the gas phase were investigated in the temperature range of 300-1000 K by using thermal desorption spectrometry in combination with density functional theory (DFT) calculations. For Ta6(+), the first N2 molecule was found to adsorb dissociatively, and it remained adsorbed when Ta6(+)N2 was heated to 1000 K. In contrast, the second and the subsequent N2 molecules adsorbed weakly as a molecular form and were released into the gas phase when heated to 600 K...
June 23, 2016: Journal of Physical Chemistry. A
Raghu Kolluri
Minimally invasive endothermal treatments have replaced surgical ligation and stripping in the management of chronic venous insufficiency (CVI) and are now considered the standard of care. Newer techniques have emerged in the last few years in an attempt to further minimize the procedural discomfort associated with endothermal procedures. These new techniques are designed to avoid tumescent anesthesia (TA). These new non-thermal, tumescentless techniques are well tolerated and are shown to result in equivalent outcomes when compared to the thermal ablations...
July 2016: Current Treatment Options in Cardiovascular Medicine
Thomas M Proebstle, Thomas Möhler
OBJECTIVE: Endothermal ablation has become a commonly used technology for occlusion of refluxing great saphenous veins (GSVs). However, the risk for primarily untreated accessory saphenous veins (ASVs) to develop reflux during follow-up has not yet been defined. Here, the prevalence and risk of ASV reflux is explored. METHODS: During a prospective multicenter cohort study on radiofrequency segmental thermal ablation of refluxing GSVs, the presence and reflux status of ASVs were monitored in 93 legs in a single center...
July 2015: Journal of Vascular Surgery. Venous and Lymphatic Disorders
William P Shutze, Katherine Kane, Tammy Fisher, Yahya Doud, Grace Lassiter, Richard Leuking, Elizabeth Nguyen, William P Shutze
OBJECTIVE: We hypothesized that the incidence of endothermal heat-induced thrombosis (EHIT) depends on the laser wavelength used in endovenous laser ablation (EVLA) of the saphenous veins. METHODS: We identified patients undergoing EVLA in our office from 2005 to 2014 with an 810-nm (hemoglobin-specific) or 1470-nm (water-specific) laser. We reviewed the records for age, sex, body mass index, Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) class, vein diameter, vein(s) treated, adjunctive phlebectomy, energy delivered, laser pullback times, and EHIT (closure level ≥3) development...
January 2016: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Evan J Ryer, James R Elmore, Robert P Garvin, Matthew C Cindric, James T Dove, Stephanie Kekulawela, David P Franklin
OBJECTIVE: Endothermal ablation (ETA) of the great saphenous vein (GSV) is associated with a small but definite risk of endothermal heat-induced thrombosis (EHIT) extending into the common femoral vein. Follow-up duplex ultrasound imaging to detect EHIT after ETA is considered standard of care, although the exact timing of duplex ultrasound imaging to detect EHIT after ETA remains unclear. We hypothesized that an additional duplex ultrasound assessment 1 week after ETA would not identify a significant number of patients with EHIT and would significantly increase health care costs...
February 20, 2016: Journal of Vascular Surgery
Pamela S Kim, Muath Bishawi, David Draughn, Marab Boter, Charles Gould, John Koziarski, Rick Bernstein, Richard Hamilton
BACKGROUND: Several studies have shown comparable early efficacy of mechanochemical ablation to endothermal techniques. The goal of this report was to show if early efficacy is maintained at 24 months. METHODS: This was a two-year analysis on the efficacy of mechanochemical ablation in patients with symptomatic C2 or more advanced chronic venous disease. Patients with reflux in the great saphenous vein involving the sapheno-femoral junction and no previous venous interventions were included...
January 24, 2016: Phlebology
Patrick A Coughlin, David C Berridge
Despite recent NICE guidance there remains a definite role for surgery in the management of varicose veins. A lot of the available evidence that has driven the transformation of care towards endovenous treatments is of good quality yet published by enthusiasts. No endovenous studies have reported long term results as far out from intervention as the open studies, yet in the meta-analysis from Murad et al, the authors suggested from their results that when surgery was compared with all endoluminal ablation therapies, surgery was associated with a non-significant reduction in the risk of varicose vein recurrence (RR0...
November 2015: Phlebology
Mark S Whiteley
In July 2013, the National Institute of Health and Clinical Excellence (NICE) recommended "endothermal" ablation (meaning endovenous thermal ablation) is the first line treatment for truncal venous reflux in varicose veins. The initial endovenous thermoablation devices were radiofrequency ablation and endovenous laser ablation. More recently, Glue (cyanoacrylate), endovenous steam and Clarivein (mechanochemical ablation or MOCA) have entered the market as new endovenous techniques for the treatment of varicose veins...
November 2015: Phlebology
Huw Ob Davies, Matthew Popplewell, Gareth Bate, Lisa Kelly, Katy Darvall, Andrew W Bradbury
OBJECTIVE: Although varicose veins are a common cause of morbidity, the UK National Health Service and private medical insurers have previously sought to ration their treatment in a non-evidence based manner in order to limit health-care expenditure and reimbursement. In July 2013, the UK National Institute for Health and Care Excellence published new national Clinical Guidelines (CG168) to promote evidence-based commissioning and management of varicose veins. The aim of this study was to evaluate the impact of CG168 on the referral and management of varicose veins at the Heart of England NHS Foundation Trust, Birmingham, UK...
October 2016: Phlebology
Huw Ob Davies, Matthew Popplewell, Katy Darvall, Gareth Bate, Andrew W Bradbury
OBJECTIVE: The last 10 years have seen the introduction into everyday clinical practice of a wide range of novel non-surgical treatments for varicose veins. In July 2013, the UK National Institute for Health and Care Excellence recommended the following treatment hierarchy for varicose veins: endothermal ablation, ultrasound-guided foam sclerotherapy, surgery and compression hosiery. The aim of this paper is to review the randomised controlled trials that have compared endothermal ablation and ultrasound-guided foam sclerotherapy to determine if the level 1 evidence base still supports an "endothermal ablation first" strategy for the treatment of varicose veins...
May 2016: Phlebology
Marianne E Witte, Michel M P J Reijnen, Jean-Paul de Vries, Clark J Zeebregts
INTRODUCTION: In the last decade, minimally invasive endothermal ablation techniques have replaced surgery for the treatment of superficial venous insufficiency to reduce postoperative complications and recovery time and to improve quality of life. To avoid the risks of nerve damage and need for tumescent anesthesia to improve patient comfort, an alternative heatless technique has been introduced recently. METHODS: Endovenous mechanochemical occlusion using the ClariVein® catheter (Vascular Insights LLC, Quincy, MA) is a new technique combining mechanical injury to the venous endothelium coupled with simultaneous catheter-guided infusion of a liquid sclerosant...
May 2015: Surgical Technology International
J El-Sheikha, S Nandhra, D Carradice, C Acey, G E Smith, B Campbell, I C Chetter
INTRODUCTION: The optimal compression regime following ultrasound guided foam sclerotherapy (UGFS), radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) for varicose veins is not known. The aim of this study was to document current practice. METHODS: Postal questionnaire sent to 348 consultant members of the Vascular Society of Great Britain and Ireland. RESULTS: Valid replies were received from 41% (n = 141) surgeons representing at least 68 (61%) vascular units...
February 2016: Phlebology
William P Shutze, Katherine Kane, Tammy Fisher, Yayha Daoud, Grace Lassiter, Richard Lueking, Elizabeth Nguyen, William Shutze, Greg Pearl, Bert Smith
No abstract text is available yet for this article.
December 2014: Journal of Vascular Surgery
Avianne P Bunnell, Shariq Zaidi, J Leigh Eidson, W Todd Bohannon, Marvin D Atkins, Ruth L Bush
BACKGROUND: Endovenous thermal ablation has emerged as an alternative therapy for the treatment of chronic superficial venous insufficiency (CVI) of the lower extremities. Recanalization, or anatomic failure, of a vein after endovenous radiofrequency ablation (RFA) has been described, albeit an infrequent occurrence. This study was performed to demonstrate risk factors associated with the efficacy of RFA and recanalization in the treatment of CVI. METHODS: Data were collected in an ongoing multicenter registry, which was retrospectively reviewed...
February 2015: Annals of Vascular Surgery
Doeke Boersma, Ramon R J P van Eekeren, Hans J C Kelder, Debora A B Werson, Suzanne Holewijn, Michiel A Schreve, Michel M P J Reijnen, Jean Paul P M de Vries
BACKGROUND: Minimally invasive endothermal techniques, for example, radiofrequency ablation (RFA), have revolutionized the treatment of insufficient truncal veins and are associated with an excellent outcome. The use of thermal energy requires the instillation of tumescent anesthesia around the vein. Mechanochemical endovenous ablation (MOCA™) combines mechanical endothelial damage, using a rotating wire, with simultaneous infusion of a liquid sclerosans. Tumescent anesthesia is not required as no heat is used...
2014: Trials
Randolph Todd C Jones, Lowell S Kabnick
Fifteen years ago, radiofrequency ablation of the saphenous vein was introduced as a new and minimally invasive modality for the treatment of superficial venous insufficiency. Three years later, it was followed by endovenous laser ablation. These procedures have revolutionized the treatment of superficial venous insufficiency and have caused a dramatic shift from a highly invasive and morbid inpatient procedure, to a minimally invasive and ambulatory office procedure. Soon after their introduction, a new clinical entity was identified: endothermal heat-induced thrombosis (EHIT)...
October 2014: Journal of Invasive Cardiology
S M McHugh, A L Leahy
BACKGROUND: Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. Newer treatments, especially non-thermal ablation have potential benefits both for patient acceptability and decreased risk of nerve injury. APPROACH: We describe the current non-thermal options available including advantages and disadvantages. Ultrasound guided foam sclerotherapy avoids the risk of nerve injury, however it is not as effective as endothermal ablation...
October 2014: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Katherine Kane, Tammy Fisher, Monica Bennett, William Shutze, Taylor Hicks, Brad Grimsley, Dennis Gable, Greg Pearl, Bert Smith, William Shutze
BACKGROUND: Endovenous laser ablation (EVLA) of the saphenous vein has become one of the preferred treatments for treating saphenous vein reflux that has resulted in symptomatic lower extremity venous insufficiency or varicose veins. This procedure was noted during initial reports to have a low incidence of postoperative thrombosis of the femoral or popliteal vein adjacent to the treated great saphenous vein (GSV) or small saphenous vein (SSV). Later clinical experience suggested that the actual incidence of this event is higher and it was subsequently termed endothermal heat-induced thrombosis (EHIT)...
October 2014: Annals of Vascular Surgery
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