Tratamiento híbrido endoluminal de la incompetencia de safena mayor con espuma y radiofrecuencia: experiencia inicial
Ulloa, Jorge Hernando
Revista Mexicana de Angiología, 0037-7740, Vol. 42, No. 1, 2014 p. 38-42
Sociedad Mexicana de Angiología
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Treating of greater saphenous vein (GSV) incompetence, radiofrequency (RF) and laser have been associated to neuralgia and other complications due to the extension of the thermal injury. These techniques require anesthesia and have a major disadvantage in the management of tortuous trunks due to the stiffness of the catheter. Foam sclerotherapy opened a new trend in the treatment of larger veins, painlessly reaching varicosities, but the treatment of the GSV, raises the possibility of a quick reopening of the saphenofemoral junction (SFJ). Our group developed an approach that merges the benefits of thermal injury and foam sclerotherapy. Forty-six patients classified as C2-C4 (CEAP classification), 39 female, mean age: 58.4 with incompetence and tortuosity of GSV where included in this study. Two patients were lost during follow-up. Hybrid procedure was performed using ultrasound guided percutaneous access of GSV with a new short RF catheter (VNUS Closure FAST) distal to the SFJ under local anesthesia. Thermal occlusion of the saphenofemoral junction (SFJ) and GSV subjacent segment was achieved. Just before retrieving the device, we injected 8cc of lapidium chloride foam 1% (Sklerol, ICV Pharma, Colombia), using physiologic gas (70% CO2 /30% O2); a gentle massage was done with the transducer to spread the foam distally. Duplex ultrasound was carried out to assess GSV and SFJ occlusion; follow-up completed 6 months. Forty-four patients completed the follow-up period. There were no major complications. Seven patients reported pain in the groin area immediately after the procedure. Two cases presented with superficial phlebitis in the calf due to lack of compression and required microthrombectomy. Forty-one patients had their GSV and SFJ occluded at 6 months demonstrated by duplex ultrasound and 3 required a second foam dose. This is a preliminary report of a hybrid procedure that involves use of thermal energy to completely occlude the SFJ and treat at the same time the GSV and associated varicosities, without the need for further thermal usage of the venous trunk or the use of phlebectomy. This hybrid procedure combines the best of this two techniques, minimizing their disadvantages and potentiating their advantages. The occlusion rate seems promising but further studies should evaluate it’s effectiveness in time.
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