Endoluminal radiofrequency ablation and Endovenous laser therapy for the treatment of Varicose Veins PPT

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Indications for Endoluminal radiofrequency ablation and Endovenous laser therapy
Clinical
C0: No visible or palpable signs of venous disease
C1: telangiectases or reticular veins
C2: varicose veins
C3: edema
C4: skin changes ascribed to venous disease
 a. pigmentation or eczema     
 b. lipodermatosclerosis or atrophie blanche
C5: skin changes as defined previously with healed ulcer
C6: skin changes as defined previously with active ulcer
Etiologic: congenital, primary, secondary or none
Anatomic: superficial, perforator, deep or none
Pathophysiologic: reflux, obstruction, both or none

Endoluminal radiofrequency ablation (RFA) of the great saphenous vein: mechanism
By directing resistive radiofrequency energy through a vein, a narrow
  rim of tissue less than 1mm is heated by an electrode.

- The amount of heating is modulated using both a microprocessor and
  manual movement, resulting in controlled collagen contraction,
  thermocoagulation and absorption of the vein.

Percutaneous access to the greater saphenous vein most commonly at the level of the knee under duplex ultrasound guidance
1) A guidewire is then advanced to the saphenofemoral junction over which the closure catheter is passed
2) catheter prongs are extruded to contact the intimal lining of the vessel wall
3) radiofrequency generator allows the tip of the catheter and the prongs to attain a temperature of 85 degrees C.

Results
1) Vein occlusion at 1 week documented by venous ultrasound success rate of 98%
2) None of the treated patients developed recanalization that was not seen at 6 weeks, with a successful outcome in 90%.
3) At the 24 month follow-up, 19 of 21 patients had complete disappearance of the treated saphenous vein,for a success rate of 90%.
4) Side effects were minimal, and no skin burns or thromboses were observed

Endovenous laser therapy (EVLT): mechanism
Thermal reaction after laser exposure is essential.
- Damages endothelial, intimal internal elastic lamina, and to some
  degree the media. Adventitia is rarely affected.
- In vitro studies suggest that energy results in ‘boiling of blood’ and
  and generation of ‘steam bubbles’ that indirectly, homogenously 
  affect the varicose vein.


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