Incompetent Perforator Vein Treatment in Chronic Venous Insufficiency. Ruth L. Bush, M.D., M.P.H. Florida Vascular Society May 2013

Size: px
Start display at page:

Download "Incompetent Perforator Vein Treatment in Chronic Venous Insufficiency. Ruth L. Bush, M.D., M.P.H. Florida Vascular Society May 2013"

Transcription

1 Incompetent Perforator Vein Treatment in Chronic Venous Insufficiency Ruth L. Bush, M.D., M.P.H. Florida Vascular Society May 2013

2 Disclosures Consultant and proctor for Covidien, Inc. (VNUS) Views expressed do not necessarily reflect the position or policy of the Dept. of Veterans Affairs or the United States government

3 Treatment of Active Venous Ulcer Generally at the malleolar region Hypersensitivity Needs compression to heal (decrease edema) Antibiotic: decrease surface bacteria Slow healing, high recurrence rates

4 Conventional Treatment Layered compression dressings 70% healing at 6 months; 25% recurrence at 1 year ~ 1% of healthcare budgets, public health issue Gloviczki P, Gloviczki ML., Perspect Vasc Surg Endovasc Ther Dec;21(4):259 68

5 ESCHAR Trial Effect of Surgery and Compression on Healing and Recurrence Study 500 patients with chronic venous ulcers randomized to venous surgery or compression alone Stripping and phlebectomy 65% healing at 24 weeks Recurrence rates were decreased by ½ in surgery group Lancet 2004 ; 363: On 4 year follow up Ulcer recurrence remained significantly lower for the surgery group. 31% vs. 55% BMJ 2007:363;1854 9

6 The ESCHAR trial establishes a 1A recommendation that ligation and stripping of the GSV is associated with the prevention of ulcer recurrence. Based on the RCTs and results of studies with surrogate endpoints of restoring perforator competence, the current role of ICPV treatment can be graded as a 2B recommendation. O Donnell, Phlebology 2010;25:3 10

7 To decrease recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy. For treatment of the incompetent great saphenous vein (GSV) we recommend endovenous thermal ablation (radiofrequency or laser) over high ligation and inversion stripping of the saphenous vein to the level of the knee. We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C2), but we suggest treatment of pathologic perforating veins (outward flow 500 ms duration, vein diameter 3.5 mm) located underneath healed or active ulcers (CEAP class C5 C6).

8 CVI: Issues in General Goal is to heal ulcer Decrease venous hypertension GSV, VV, Perforators Do you need to treat all veins always? How low is low enough? Anatomic ablation vs. clinical success

9 Perforator Ablation Rationale Reduce superficial venous hypertension Alter microcellular events Leukocyte trapping Cytokine release

10 Perforator Veins Contribution to CVI somewhat controversial Generally agreed to be important in advanced CVI Sometimes important in varicosity recurrence Pattern of initial reflux important determinant of perforator contribution

11 Hemodynamic Studies Following Perforator Ablation Attempts to isolate effect of IPV treatment from that of GSV Hemodynamic effect is surrogate endpoint? Is IPV treatment complementary to GSV ablation O Donnell, Phlebology 2010;25:3 10

12 Treatment Evolution Linton Variants of open surgery >95 years ago, Homan described IPVs as important in tx venous ulcers Homans J Surg Gynecol Obstet 1916;22: Homans J Surg Gynecol Obstet 1917;23: Open surgical approach thru medial calf incision Linton RR Ann Surg 1038; 107: SEPS Subfascial Endoscopic Perforator Surgery Percutaneous Ablation of Perforators Sclerotherapy (liquid or foam)

13 SEPS 1990 s Remote incisions Endoscopic visualization Subfascial ligation clips, harmonic scalpel Outpatient Regional/General anesthesia

14 Endoscopic Instrumentation And Surgical Techniques

15 SEPS Techniques Direct Subfascial Visualization

16 SEPS Advantages vs. Linton Remote incisions low wound complications Less pain Outpatient procedure Visualize pathology Identify more incompetent perforators than pre op (2 3)

17 SEPS Disadvantages Distal perforators unreachable Tight working space Learning curve General/Regional anesthesia Operating Room setting Frustration and incomplete exploration Low adaptation rate by surgeons

18 Percutaneous Perforator Treatment: A Better Way? Percutaneous No incisions Ultrasound guided access Local anesthesia Office based Less expensive Easily repeatable Elias,S. Will SEPS be around in 5 years? IVC Apr. 2005; Miami Fl

19 SEPS Meta analysis 22 case series reviewed for safety and efficacy C5 and C6 patients Results: C6, 90% healing rate C5/6, combined low recurrence rate ~10% Complications: 1% risk DVT Limitations: Data biased by inclusion of limbs with combined GSV and IPV treatment No comparison arm Tenbrook et al. J Vasc Surg 2004:39:

20 Endothermal Ablation Minimally invasive alternative to traditional surgery Faster recovery Fewer complications Laser, radiofrequency

21 RFS Catheter configuration

22

23 Visualize Perforator

24 Duplex Criteria for IPV Enlarged IPV at fascia, 3.5 mm diameter Evidence of high volume, prolonged reversal of flow

25

26 Post Treatment Duplex

27 Benefits of Surgically Correcting CVI Faster healing 140 RFA procedures were (74 superficial; 66 perforators) performed on 110 venous ulcers in 88 limbs Venous ulcers had been present for an average of 71 months Closure success rate of perforators 81% 76.3% of patients ulcers healed at 6 months following RF ablation Harlander Locke et al. The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates, J Vasc Surg 2012;55:458 64

28 Benefits of Surgically Correcting CVI Reduce recurrence 28 RFA procedures (19 superficial; 9 perforators) were performed on 20 patients (21 limbs) 95% of patients previously wore compression stockings for a mean time of 23.3 months Ulcer recurrence rates were 0% at 6 months and 4.8% at 12 months Author compares these recurrence rates to prior studies showing an ulcer recurrence rate up to 67% at 12 months with compression therapy alone Harlander Locke et al. Combined treatment with compression therapy and ablation of incompetent superficial and perforating veins reduces ulcer recurrence in patients with CEAP 5 venous disease, J Vasc Surg 2012;55:446 50

29 356 patients over 2.5 year period 412 venous operations; 56 with bilateral disease) Cohort of 75 patients (21.1%) with severe CVI (C5, C6) Data collected: Body mass index (BMI) History of deep vein thrombosis (DVT) Prior vein surgery Complications Type of procedure: GSV ablation (GSV)or GSV and perforator ablation (GSVP) Primary Endpoints: Ulcer healing time Recurrent ulcerations

30 Treatment Ablation site: GSV GSV + perforator Perforator alone Follow up: Ultrasound 1 week, 6 mos

31 Results: Results 72% had GSV ablated alone; 28% had GSV + perforator C5: 96.2% ulcer free C6: 83.9% ulcer healing in 2.1 ±2.9 mos

32 Results: C5/C6 Comparison C5 n=52 C6 n=31 P value Age (years) 62.0 ± ± 12.9 NS BMI (kg/m 2 ) 33.5 ± ±7.3 NS Gender (M/F) 11/32 13/ GSV/GSVP 31/12 16/9 NS Recurrent or nonhealing ulcer Conclusion: Unclear whether addition of perforator ablation improved healing rates over GSV ablation alone

33 Limitations Small sample size Single center data Low number of perforators procedures Technical expertise with perforator identification was a steep learning curve

34 64 patients with IPV interruption for C5/C6 disease: SEPS n=41 RFA n=23 (plus GSV ablation) 37 month follow up Demographics and risk factors equivalent (BMI, SEPS 29 vs. RFA 31) No significant arterial disease present

35 Results Healing rates (C6 patients) SEPS 88% (n=23) in 5.2 mos RFA 100% (n=12) in 4.4 mos Ulcer recurrence SEPS 17% (n=7) RFA 23% (n=6) p=ns p=ns Complications: no difference, mostly minor Except SEPS: 2 major amputations non healing ulcer, 1 DVT

36 Conclusions

37 Probstle Dermatol Surg 2007;33: (C2 patients) Marks Perspect Vasc Endovasc Surg Endovasc Ther 2008;20: Bacon Phlebology 2009;24:74 78 Van den Bos Phlebology 2009;24: Hingorani J Vasc Surg 2009:50: O Donnell, Phlebology 2010;25:3 10

38 Results Summary % early closure 3 6 months Access with experience 100% Minimal morbidity (2%) Ulcer healing rates acceptable Symptom improvement almost 100%

39 Conclusions Severe chronic venous insufficiency (C5/C6) is common. Endovenous ablation (including perforators) allows for excellent healing rates and acceptable recurrent ulcer rates. Unclear whether the addition of perforator ablation is of benefit in improving venous hemodynamics and ulcer healing rates May want to reserve IPV ablation for recalcitrant or recurrent ulcers.

Minimally Invasive treatment options for Venous Insufficiency

Minimally Invasive treatment options for Venous Insufficiency Minimally Invasive treatment options for Venous Insufficiency Do we have a new Gold Standard and a cure for Venous Leg Ulcers? Dr Claire Campbell MBBS FRACS (Vasc) Vascular and Endovascular Surgeon Epworth

More information

Effective Date: March 2, 2016

Effective Date: March 2, 2016 Medical Review Criteria Varicose Vein Procedures Effective Date: March 2, 2016 Treatmetn Subject: Varicose Vein Procedures VeinTreatment of Varicose Policy: Veins HPHC covers specific non-experimental

More information

LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND:

LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND: LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND: Chronic Venous Insufficiency Phillip J Bendick, PhD William Beaumont Hospital Royal Oak, Michigan Prevalence: Carotid ASO ~ 3M Peripheral Arterial Dz ~ 5M + CAD

More information

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required.

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required. Page 1 of 5 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your

More information

Treatment of Varicose Veins

Treatment of Varicose Veins Treatment of Varicose Veins Policy Number: Original Effective Date: MM.06.016 04/15/2005 Line(s) of Business: Current Effective Date: PPO; HMO 07/01/2012 Section: Surgery Place(s) of Service: Outpatient

More information

Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities

Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency,

More information

Clinical Medical Policy Varicose Vein Treatment

Clinical Medical Policy Varicose Vein Treatment Benefit Coverage Covered Benefit for lines of business including: Health Benefits Exchange (HBE), Rite Care (MED), Children with Special Needs (CSN), Substitute Care (SUB), Rhody Health Partners (RHP),

More information

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required.

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required. Page 1 of 5 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your

More information

Current Trends in Varicose Vein Surgery

Current Trends in Varicose Vein Surgery Current Trends in Varicose Vein Surgery In Czech Republic.. Šlais M, Dvořáček L. Department of Vascular Surgery Na Homolce Hospital, Prague, Czech Republic XXV. World Congress of the International Union

More information

Medical Coverage Policy Treatment for Varicose Veins-PREAUTH

Medical Coverage Policy Treatment for Varicose Veins-PREAUTH Medical Coverage Policy Treatment for Varicose Veins-PREAUTH Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2001 Policy Last Updated: 12/20/2011 Prospective review is recommended/required.

More information

Non-surgical treatment of severe varicose veins

Non-surgical treatment of severe varicose veins Non-surgical treatment of severe varicose veins Yasu Harasaki UCHSC Department of Surgery General Surgery Grand Rounds March 19, 2007 Definition Dilated, palpable, subcutaneous veins generally >3mm in

More information

Clinical Review Criteria

Clinical Review Criteria Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure

More information

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Surgical Options for Venous Disease Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Chronic Venous Disease Approximately 23% of adults in the US have varicose veins Estimated 22 million women

More information

Yes when meets criteria below

Yes when meets criteria below Vein Disease Treatment MP9241 Covered Service: Prior Authorization Required: Additional Information: Medicare Policy: BadgerCare Plus Policy: Yes when meets criteria below Yes None Dean Health Plan covers

More information

Treatment of Venous Disease

Treatment of Venous Disease Treatment of Venous Disease Tim Gardner MD, FACC Bryan Heart Boy, Have I missed The Boat These are NOT the legs I work with! 1 My World Venous Ulcer due to Chronic Venous Insufficency, CVI Venous Disease

More information

Endovenous Radiofrequency Ablation of the Saphenous Vein The VNUS Closure Procedure

Endovenous Radiofrequency Ablation of the Saphenous Vein The VNUS Closure Procedure Endovenous Radiofrequency Ablation of the Saphenous Vein The VNUS Closure Procedure VN20-86-E 4/09 25 Million people suffer from venous reflux disease, the underlying cause for most varicose veins VNUS

More information

Venous Reflux Disease and Current Treatments VN20-87-A 01/06

Venous Reflux Disease and Current Treatments VN20-87-A 01/06 Venous Reflux Disease and Current Treatments Leg Vein Anatomy Your legs are made up of a network of veins and vessels that carry blood back to the heart The venous system is comprised of: Deep veins Veins

More information

Venous leg ulcers. Venous Ulcers. Treat the source, not just the symptom

Venous leg ulcers. Venous Ulcers. Treat the source, not just the symptom Venous leg ulcers Venous Ulcers Treat the source, not just the symptom Topics What causes venous ulcers (VU) Treating the source, not just the symptom Diagnosis with venous duplex ultrasound scan Treatment

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Origination Date: June 1, 1993 Review Date: July 20, 2016 Next Review: July, 2018 Medicare C/D Medical Coverage Policy DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins of the

More information

MEDICAL COVERAGE POLICY SERVICE: Varicose Veins of the Lower Extremities. SERVICE: Treatment of Varicose Veins of the Lower Extremities

MEDICAL COVERAGE POLICY SERVICE: Varicose Veins of the Lower Extremities. SERVICE: Treatment of Varicose Veins of the Lower Extremities Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit

More information

OHTAC Recommendation: Endovascular Ablation for Varicose Veins Ontario Health Technology Advisory Committee

OHTAC Recommendation: Endovascular Ablation for Varicose Veins Ontario Health Technology Advisory Committee OHTAC Recommendation: Endovascular Ablation for Varicose Veins Ontario Health Technology Advisory Committee July 2013 Background Health Quality Ontario (HQO) reviewed Endovascular Laser Therapy for Varicose

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Medicare C/D Medical Coverage Policy Origination Date: June 1, 1993 Review Date: September 16, 2015 Next Review: September, 2017 DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins

More information

DEBATE ON Management of primary Varicose Veins SURGERY. Adel Husseiny, Kamhawy Vascular Surgery Unit Tanta University

DEBATE ON Management of primary Varicose Veins SURGERY. Adel Husseiny, Kamhawy Vascular Surgery Unit Tanta University DEBATE ON Management of primary Varicose Veins SURGERY Adel Husseiny, Kamhawy Vascular Surgery Unit Tanta University Efficacy of treatment alternatives Durability of results Cosmetically acceptable results

More information

Following articles prove that superficial venous insufficiency leads to deep venous insufficiency and treatment of superficial venous pathology

Following articles prove that superficial venous insufficiency leads to deep venous insufficiency and treatment of superficial venous pathology Following articles prove that superficial venous insufficiency leads to deep venous insufficiency and treatment of superficial venous pathology improves and recovers the deep venous insufficiency Ann Vasc

More information

Varicose Vein Surgery: What we will cover

Varicose Vein Surgery: What we will cover Varicose Vein Surgery 2010 For Coders Andy Bonin, MD Varicose Vein Surgery: What we will cover Anatomy review Duplex US Procedure review CPT coding review 1 Anatomy: The Circulatory System We are only

More information

RANDOMIZED CONTROL TRIALS (RCT s) on VARICOSE VEIN ENDOVENOUS TREATMENT

RANDOMIZED CONTROL TRIALS (RCT s) on VARICOSE VEIN ENDOVENOUS TREATMENT RANDOMIZED CONTROL TRIALS (RCT s) on VARICOSE VEIN ENDOVENOUS TREATMENT M. PERRIN Lyon - France CONTROVERSIES AND UPDATES IN VASCULAR SURGERY JANUARY 19-21, 2012 Paris B. Eklof Helsingborg, Sweden Thirty

More information

TREATMENT OF VARICOSE VEINS: CAN IT BE IMPROVED BY MECHANOCHEMICAL ABLATION USING THE CLARIVEIN DEVICE?

TREATMENT OF VARICOSE VEINS: CAN IT BE IMPROVED BY MECHANOCHEMICAL ABLATION USING THE CLARIVEIN DEVICE? TREATMENT OF VARICOSE VEINS: CAN IT BE IMPROVED BY MECHANOCHEMICAL ABLATION USING THE CLARIVEIN DEVICE? Michel MJP Reijnen Rijnstate Hospital, Arnhem The Netherlands mmpj.reijnen@gmail.com Disclosures

More information

Recurrent Varicose Veins. Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio

Recurrent Varicose Veins. Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio Recurrent Varicose Veins Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio Disclosures None Possible Causes of Recurrence DNA:

More information

Guidance. This guidance has been updated to take into account the NICE clinical guideline 167(1).

Guidance. This guidance has been updated to take into account the NICE clinical guideline 167(1). Bedfordshire and Hertfordshire Priorities Forum Statement Number: 9 Subject: Varicose Vein Surgery Date of decision: September 2014 Date of review: September 2017 Guidance This guidance has been updated

More information

Varicose Veins: Causes, Symptoms and Management. Andrew C. Stanley MD Section of Vascular Surgery

Varicose Veins: Causes, Symptoms and Management. Andrew C. Stanley MD Section of Vascular Surgery Varicose Veins: Causes, Symptoms and Management Andrew C. Stanley MD Section of Vascular Surgery Circulation Heart (Pump)-MI, Sudden Death Arteries (Stroke, Aneurysms, Walking dysfunction, Limb loss) Veins

More information

State-of-the-Art Laser Thermal Ablation Robert E. Foster, MD, FACC, FSCAI

State-of-the-Art Laser Thermal Ablation Robert E. Foster, MD, FACC, FSCAI State-of-the-Art Laser Thermal Ablation Robert E. Foster, MD, FACC, FSCAI Director, BHC Vein Center Birmingham Heart Clinic, PC Birmingham, Alabama Disclosures Speaker s Bureau: Abbott Stockholder: None

More information

PROVIDER POLICIES & PROCEDURES

PROVIDER POLICIES & PROCEDURES PROVIDER POLICIES & PROCEDURES SCLEROTHERAPY TREATMENT OF SUPERFICIAL VARICOSE VEINS OF THE LEGS The purpose of this document is to provide guidance to providers enrolled in the Connecticut Medical Assistance

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS COVERAGE DETERMINATION GUIDELINE SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Guideline Number: CR-A-004 Effective Date: 06/01/2012 Table of Contents Page PLAN DOCUMENT

More information

Commissioning Policy Varicose Vein Referral Guidelines. December 2010

Commissioning Policy Varicose Vein Referral Guidelines. December 2010 Commissioning Policy Varicose Vein Referral Guidelines December 2010 This commissioning policy applies to patients within: South Worcestershire Clinical Commissioning Group (CCG) Redditch & Bromsgrove

More information

Emory Healthcare s model for a PA based vein clinic

Emory Healthcare s model for a PA based vein clinic Emory Healthcare s model for a PA based vein clinic Stephen Konigsberg PA-C No relationships to disclose Society for Vascular Surgery 2011 Vascular Annual Meeting Chicago, IL June 17, 2011 Division of

More information

Venous Disease Update VN20-52-A 12/04

Venous Disease Update VN20-52-A 12/04 Venous Disease Update VN20-52-A 12/04 Prevalence Abnormal venous anatomy: 15% of males and 30% of females Familial tendency Standing vocation Associated with pregnancy (varicose veins) Leg injury or surgery

More information

Patient Information Understanding Varicose Veins

Patient Information Understanding Varicose Veins Patient Information Understanding Varicose Veins The Circulatory System Arteries carry oxygenated blood to your legs and the veins carry de-oxygenated blood away from your legs. The blood returns to the

More information

Medical Affairs Policy

Medical Affairs Policy Service: Varicose Vein Treatments PUM 250-0032 Medical Affairs Policy Implemented 04/04/14, 04/01/15, 4/1/16 Reviewed 12/12/14 Revised 12/12/14, 12/11/15 Developed Arise/WPS Policy 12/12/14, 12/11/15 Committee

More information

Modern Varicose Vein Treatments: What Every Patient Should Know

Modern Varicose Vein Treatments: What Every Patient Should Know The Skin and Vein Center Oneonta Laser Derm & Day Spa Natural Good Looks and Leg Veins Our Specialty Dr Eric Dohner, MD 41-45 Dietz St Oneonta, NY 13820 607/431-2525 www.oneontalaserderm.com Modern Varicose

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 17 SURGICAL THERAPY FOR DEEP VALVE INCOMPETENCE Original author: Seshadri Raju Abstracted by Gary W. Lemmon Introduction Deep vein valvular incompetence happens when the valves in the veins (tubes

More information

Does varicose veins surgery have a future?

Does varicose veins surgery have a future? Hom e Par ticipant inform at ion Scient ific program Call for abstract s Dear Friends Coll Does varicose veins surgery have a future? We are looking forwa Nice, on the occasion P. Pittaluga, S. Chastanet

More information

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral NHS Devon NHS Plymouth Torbay Care Trust Peninsula Commissioning Priorities Group Commissioning Policy Varicose Vein Referral Varicose Vein Referral Guidelines 1. Description of service/treatment Most

More information

Ulcer Management Workshop

Ulcer Management Workshop Ulcer Management Workshop David Ferrar, Vascular and Endovascular Surgeon GPCME meeting, Rotorua 2008 Ulcer management Workshop Diagnosis Management How and when to measure ABI How to apply compression

More information

Medical Coverage Policy Varicose Vein Treatment sad

Medical Coverage Policy Varicose Vein Treatment sad Medical Coverage Policy Varicose Vein Treatment sad EFFECTIVE DATE: 10 28 2001 POLICY LAST UPDATED: 05 07 2013 OVERVIEW Varicose veins are large superficial veins that have become swollen. These veins

More information

THE RELATIONSHIP BETWEEN PATIENT STATUS AND RECURRENCY RATE FOLLOWING LASER SURGERY OF VARICOSE VEINS

THE RELATIONSHIP BETWEEN PATIENT STATUS AND RECURRENCY RATE FOLLOWING LASER SURGERY OF VARICOSE VEINS THE RELATIONSHIP BETWEEN PATIENT STATUS AND RECURRENCY RATE FOLLOWING LASER SURGERY OF VARICOSE VEINS Dr Imre Bihari PhD Budapest, Hungary What can influence laser surgery results? Instrument and method

More information

treatment of varicose and spider veins patient information SAMPLE a publication by advancing vein care

treatment of varicose and spider veins patient information SAMPLE a publication by advancing vein care treatment of varicose and spider veins patient information a publication by advancing vein care Since most veins lie deep to the skin s surface, vein disorders are not always visible to the naked eye.

More information

Spotlight Series: Interventional Radiology. Varicose Veins and Venous Insufficiency

Spotlight Series: Interventional Radiology. Varicose Veins and Venous Insufficiency Spotlight Series: Interventional Radiology Varicose Veins and Venous Insufficiency What is venous insufficiency? Spectrum of Disease Spider veins and telangiectasias Small reddish and purple veins near

More information

Subfascial Endoscopic Perforator Surgery in Perforator Vein Insufficiency

Subfascial Endoscopic Perforator Surgery in Perforator Vein Insufficiency 10.5005/jp-journals-10007-1127 REVIEW RTICLE WJOLS Subfascial Endoscopic Perforator Surgery in Perforator Vein Insufficiency Subfascial Endoscopic Perforator Surgery in Perforator Vein Insufficiency Ravikumar

More information

Varicose Vein Therapy: An Introduction to Surgical and Endovascular Treatment

Varicose Vein Therapy: An Introduction to Surgical and Endovascular Treatment Varicose Vein Therapy: An Introduction to Surgical and Endovascular Treatment Lower Extremity Venous Anatomy Deep, Superficial, Perforating, Reticular veins Located in two separate compartments (deep and

More information

THE ELITE LASER VEIN CENTER Los Angeles, California

THE ELITE LASER VEIN CENTER Los Angeles, California THE ELITE LASER VEIN CENTER Los Angeles, California WWW.ELITEVEIN.COM New Horizons in the Treatment of Varicose Veins Varicose Veins Bulging, twisted, blue or purple veins below the surface of the skin,

More information

LONG TERM FOLLOW-UP AFTER ENDOVENOUS LASER ABLATION

LONG TERM FOLLOW-UP AFTER ENDOVENOUS LASER ABLATION LONG TERM FOLLOW-UP AFTER ENDOVENOUS LASER ABLATION Giorgio Spreafico Centro Multidisciplinare Day Surgery Azienda Ospedaliera Università Padova - Italy Faculty Disclosure I have no financial relationships

More information

Recurrent Varicose Veins

Recurrent Varicose Veins Information for patients Recurrent Varicose Veins Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Varicose Veins that have recurred (come back). This leaflet explains

More information

Local Coverage Determination (LCD): Varicose Veins of the Lower Extremities (L31796)

Local Coverage Determination (LCD): Varicose Veins of the Lower Extremities (L31796) Local Coverage Determination (LCD): Varicose Veins of the Lower Extremities (L31796) Contractor Information Contractor Name Palmetto GBA LCD Information Document Information LCD ID L31796 LCD Title Varicose

More information

The Power Setting of Endovenous Microwave Ablation for the Treatment of Varicose Vein: In Vitro Study

The Power Setting of Endovenous Microwave Ablation for the Treatment of Varicose Vein: In Vitro Study The THAI Journal of SURGERY 2008; 29:64-68. Official Publication of the Royal College of Surgeons of Thailand The Power Setting of Endovenous Microwave Ablation for the Treatment of Varicose Vein: In Vitro

More information

Modern Management of Varicose Veins

Modern Management of Varicose Veins Modern Management of Varicose Veins GPCME 2008 David Ferrar Vascular and Endovascular Surgeon Vascular Ultrasound Specialist Multimodality treatment Compression stockings Sclerotherapy Ultrasound guided

More information

Advances in Percutaneous Intervention William C. Dixon IV, MD, FACC, FSCAI

Advances in Percutaneous Intervention William C. Dixon IV, MD, FACC, FSCAI Acute and Chronic Venous Disease Advances in Percutaneous Intervention William C. Dixon IV, MD, FACC, FSCAI Outline Chronic venous insufficiency Acute DVT Intervention Chronic DVT Intervention Chronic

More information

Thrombus Extensions At The SFJ After Endovenous Thermal Ablation: Should We Worry? Lowell S. Kabnick, MD, FACS, FACPh Todd L.

Thrombus Extensions At The SFJ After Endovenous Thermal Ablation: Should We Worry? Lowell S. Kabnick, MD, FACS, FACPh Todd L. 1 Endovenous ablation of the great saphenous vein (GSV) is the treatment modality of choice in the setting of symptomatic varicose veins. Endothermal Heat Induced Thrombosis (EHIT) of the GSV is an expected

More information

X-Plain Varicose Veins Reference Summary

X-Plain Varicose Veins Reference Summary X-Plain Varicose Veins Reference Summary Introduction Varicose veins are very common, in both women and men. Varicose veins can be painful and unattractive. Vein doctors use non-invasive ultrasound imaging

More information

THE VEIN CENTER. State-of-the-Art Treatment for Varicose Veins and Spider Veins

THE VEIN CENTER. State-of-the-Art Treatment for Varicose Veins and Spider Veins THE VEIN CENTER State-of-the-Art Treatment for Varicose Veins and Spider Veins Vein Disorders Nearly 50 percent of the adult population suffers from undesirable, sometimes painful vein disease. The most

More information

V03 Varicose Veins Surgery

V03 Varicose Veins Surgery V03 Varicose Veins Surgery What are varicose veins? Varicose veins are enlarged and twisted veins in the leg. They are common and affect up to 3 in 10 people. More women than men ask for treatment, with

More information

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery Ann Vasc Dis Vol. 9, No. 3; 2016; pp 188 192 Online June 27, 2016 2016 Annals of Vascular Diseases doi:10.3400/avd.oa.16-00044 Original Article Thrombosis of the Saphenous Vein Stump Varicose Vein Surgery

More information

Chronic Venous Insufficiency and Varicose Veins

Chronic Venous Insufficiency and Varicose Veins Chronic Venous Insufficiency and Varicose Veins A 52-year-old receptionist presents with an ulcer on her ankle that has persisted for a year. The use of narcotic analgesics once or twice a day and elevation

More information

Offering instruments to create network in phlebology. 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli

Offering instruments to create network in phlebology. 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli Offering instruments to create network in phlebology 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli Offering instruments to create network in phlebology 23rd-24th September 2016

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Varicose Veins Page 1 of 32 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Varicose Veins Professional Institutional Original Effective Date: January 1, 2004 Original

More information

Varicose veins: Surgery can still be considered as an option in the treatment

Varicose veins: Surgery can still be considered as an option in the treatment IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 13, Issue 12 Ver. I (Dec. 2014), PP 72-77 Varicose veins: Surgery can still be considered as an option

More information

Treatment of Varicose Veins/Venous Insufficiency

Treatment of Varicose Veins/Venous Insufficiency MEDICAL POLICY 7.01.519 Treatment of Varicose Veins/Venous Insufficiency Effective Date: Oct. 1, 2016 Last Revised: Dec. 1, 2016 Replaces: 7.01.55, 7.01.76, 7.01.515, 7.01.124 RELATED MEDICAL POLICIES:

More information

Measurement of Health-related Quality of Life with the Dutch Translated Aberdeen Varicose Vein Questionnaire before and after Treatment

Measurement of Health-related Quality of Life with the Dutch Translated Aberdeen Varicose Vein Questionnaire before and after Treatment Eur J Vasc Endovasc Surg (2009) 37, 470e476 Measurement of Health-related Quality of Life with the Dutch Translated Aberdeen Varicose Vein Questionnaire before and after Treatment T.M.A.L. Klem a, *, J.E.M.

More information

Center for Vein Restoration

Center for Vein Restoration Committed to Your Complete Vein Care Welcome! At Center for Vein Restoration we believe that the treatment of venous insufficiency is not a luxury but a necessity. We are nationally recognized as the leader

More information

Corporate Medical Policy Treatment of Varicose Veins/Venous Insufficiency. Medical Policy

Corporate Medical Policy Treatment of Varicose Veins/Venous Insufficiency. Medical Policy Corporate Medical Policy Treatment of Varicose Veins/Venous Insufficiency File name: Treatment of Varicose Veins/ Venous Insufficiency File code: UM.SURG.03 Origination: 9/01/2010 Last Review: 07/15/2010,

More information

Health Technology Assessment of Scheduled Surgical Procedures

Health Technology Assessment of Scheduled Surgical Procedures HTA of Scheduled Surgical Procedures April 2013 Health Technology Assessment of Scheduled Surgical Procedures Varicose Vein Surgery April 2013 Safer Better Care About the The (HIQA) is the independent

More information

Treatment by LASER. Understanding Varicose veins and. Dr. Rajesh Mundhada (MD. DNB) Dr. Atul Rewatkar (MD)

Treatment by LASER. Understanding Varicose veins and. Dr. Rajesh Mundhada (MD. DNB) Dr. Atul Rewatkar (MD) Understanding Varicose veins and Treatment by LASER Dr. Rajesh Mundhada (MD. DNB) Dr. Atul Rewatkar (MD) Orange city Hospital & Research Institute 19, Pandey Lay out, Veer Sawarkar Square, Nagpur 440015

More information

V03 Varicose Veins Surgery

V03 Varicose Veins Surgery V03 Varicose Veins Surgery Further information You can get more information and share your experience at www.aboutmyhealth.org If you need any advice or help please call pre-operative assessment on 01270

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: varicose_veins_treatment_for 12/2000 11/2014 11/2015 11/2014 Description of Procedure or Service A variety

More information

SEDICO Newsletter Issue 8. Varicose veins

SEDICO Newsletter Issue 8. Varicose veins SEDICO Newsletter Issue 8 Definition: Varicose veins Varicose veins are veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins occur elsewhere.

More information

Dr. Linde is an international beauty expert and an acclaimed keynote speaker at conferences all over the world. He is specialized in the treatment of

Dr. Linde is an international beauty expert and an acclaimed keynote speaker at conferences all over the world. He is specialized in the treatment of VEINS Dr. Linde is an international beauty expert and an acclaimed keynote speaker at conferences all over the world. He is specialized in the treatment of fat pads, wrinkles and transformations of the

More information

Further information You can get more information and share your experience at

Further information You can get more information and share your experience at V03 Varicose Veins Surgery Further information You can get more information and share your experience at www.aboutmyhealth.org Local information You can get information locally from:......... Taunton and

More information

When Are Prosthetic Grafts As Good As Veins?

When Are Prosthetic Grafts As Good As Veins? When Are Prosthetic Grafts As Good As Veins? Vascular Study Group of New England Jack L. Cronenwett, M.D. Dartmouth-Hitchcock Medical Center Disclosure I do not have any potential conflicts of interest.

More information

Part Two: Against the Motion. Venous Perforator Surgery is Unproven and Does not Reduce Recurrences

Part Two: Against the Motion. Venous Perforator Surgery is Unproven and Does not Reduce Recurrences 242 Trans-Atlantic Debate 17 Kianifard B, Browning L, Holdstock JM, Whiteley MS. Surgical technique and preliminary results of perforator vein closure e TRLOPS (Transluminal Occlusion of Perforators).

More information

Superficial vein ablation for the treatment of primary chronic venous ulcers

Superficial vein ablation for the treatment of primary chronic venous ulcers Superficial vein ablation for the treatment of primary chronic venous ulcers S Sufian, S Lakhanpal and J Marquez Center for Vein Restoration, 12200 Annapolis Road, Suite 255, Glenn Dale, MD 20769, USA

More information

Appropriate Use Criteria (By Rating) Table 1. Venous Duplex of the Upper Extremities for Patency and Thrombosis

Appropriate Use Criteria (By Rating) Table 1. Venous Duplex of the Upper Extremities for Patency and Thrombosis ACCF 2013 Use Criteria for Peripheral Vascular Ultrasound and Physiological Testing Part II: Testing for Venous Disease and Evaluation of Hemodialysis Access Section 1: Upper Extremity Venous Evaluation

More information

Endovenous Laser Therapy

Endovenous Laser Therapy Information for patients Endovenous Laser Therapy Northern General Hospital You have been given this leaflet because you will be having Endovenous Laser Therapy (EVLT). This leaflet explains more about

More information

A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan s method or by an operation

A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan s method or by an operation Br. J. Surg. Vol. 62 (1975) 72-76 A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan s method or by an operation F. S. A. DORAN AND MARY WHITE* SUMMARY

More information

Greater Manchester EUR Policy Statement. Title/Topic: Varicose Veins Reference: GM003 Date: January 2015

Greater Manchester EUR Policy Statement. Title/Topic: Varicose Veins Reference: GM003 Date: January 2015 Greater Manchester EUR Policy Statement Title/Topic: Varicose Veins Reference: GM003 Date: January 2015 VERSION CONTROL Version Date Details Page number 0.1 23/10/2013 Initial Draft for consideration by

More information

CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE

CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE Introduction CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE Original authors: Niren Angle, John J. Bergan, Joshua I. Greenberg, and J. Leonel Villavicencio Abstracted by Teresa L. Carman New technology has

More information

Microfoam Ultrasound-Guided Sclerotherapy of Varicose Veins in 100 Legs

Microfoam Ultrasound-Guided Sclerotherapy of Varicose Veins in 100 Legs Microfoam Ultrasound-Guided Sclerotherapy of Varicose Veins in 1 Legs JOHN M. BARRETT, FRNZCGP, n BRUCE ALLEN, FRACR, n ANNE OCKELFORD, FRNZCGP, n AND MITCHEL P. GOLDMAN, MD w n Palm Clinic, Auckland,

More information

Endovascular Radiofrequency Ablation for Varicose Veins

Endovascular Radiofrequency Ablation for Varicose Veins Ontario Health Technology Assessment Series 2011; Vol. 11, No.1 Endovascular Radiofrequency Ablation for Varicose Veins An Evidence-Based Analysis February 2011 Medical Advisory Secretariat Ministry of

More information

Suffering from varicose veins? Patient Information. ELVeS Radial Minimally invasive laser therapy of venous insufficiency

Suffering from varicose veins? Patient Information. ELVeS Radial Minimally invasive laser therapy of venous insufficiency Suffering from varicose veins? Patient Information ELVeS Radial Minimally invasive laser therapy of venous insufficiency Do you suffer from heavy legs or visible veins? This makes diseases of the veins

More information

VARICOSE VEINS - TREATMENT

VARICOSE VEINS - TREATMENT What are varicose veins? VARICOSE VEINS - TREATMENT Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood. These veins have experienced

More information

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital VARICOSE VEINS Information Leaflet Your Health. Our Priority. Page 2 of 7 Varicose Veins There are no accurate figures for the number of people with varicose veins. Some studies suggest that 3 in 100 people

More information

Verification of Participation & Certificate Request 28 th Annual Congress Phoenix, Arizona November 6 9, 2014

Verification of Participation & Certificate Request 28 th Annual Congress Phoenix, Arizona November 6 9, 2014 Complete this form in its entirety to claim the credits commensurate with your participation at the ACP s 28 th Annual Congress. You can only claim credit for one session if it runs concurrently with others.

More information

Veins. Zapping Varicose. Venous diseases affect many people and represent a major cost to the health-care system.

Veins. Zapping Varicose. Venous diseases affect many people and represent a major cost to the health-care system. Zapping Varicose Veins Improving the Quality of Life for Sufferers By Jeannette Soriano, MD Venous diseases affect many people and represent a major cost to the health-care system. Hippocrates used compression

More information

Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency

Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency William A. Marston, MD, Robert E. Carlin, MD, Marc A. Passman, MD, Mark A. Farber,

More information

Diagnostic Tools and Screening. Esther Kim, MD, MPH, RPVI Cleveland Clinic

Diagnostic Tools and Screening. Esther Kim, MD, MPH, RPVI Cleveland Clinic Diagnostic Tools and Screening Esther Kim, MD, MPH, RPVI Cleveland Clinic Disclosures: Consultant Philips US Topics Continuous wave Doppler Plethysmography Ankle Brachial Index Peripheral Arterial Evaluation

More information

Patient Informed Consent EndoVenous Laser Treatment (EVLT) Procedure

Patient Informed Consent EndoVenous Laser Treatment (EVLT) Procedure Patient Informed Consent EndoVenous Laser Treatment (EVLT) Procedure I (Patient or Guardian) authorize Dr. his associates and assistants, to perform Endovenous Laser Treatment of my right/left great/small

More information

PRACTICE GUIDELINES Superficial Venous Disease. Treatment of Superficial Venous Disease of the Lower Leg

PRACTICE GUIDELINES Superficial Venous Disease. Treatment of Superficial Venous Disease of the Lower Leg advancing vein care PRACTICE GUIDELINES Superficial Venous Disease Treatment of Superficial Venous Disease of the Lower Leg Background The diagnosis and treatment of venous disease has advanced more in

More information

Treatment of Varicose Veins

Treatment of Varicose Veins Varicose Vein Treatment of Varicose Veins JMAJ 47(3): 146 151, 2004 Osamu SATO Associate Professor, Department of Surgery, Saitama Medical Center Abstract: Varicose vein is a condition that was first described

More information

TREATMENT OF VARICOSE AND SPIDER VEINS Patient Info

TREATMENT OF VARICOSE AND SPIDER VEINS Patient Info TREATMENT OF VARICOSE AND SPIDER VEINS Patient Info www.heartofthevillages.com TIRED & ACHING LEGS? If you suffer from varicose and spider veins, you are not alone. It is estimated that there are more

More information

Developments in Endovascular and Endoscopic Surgery

Developments in Endovascular and Endoscopic Surgery Developments in Endovascular and Endoscopic Surgery Radiofrequency Ablation and Laser Ablation in the Treatment of Varicose Veins Jose I. Almeida, MD, FACS, RVT, 1,2 and Jeffrey K. Raines, PhD, RVT, 1,2

More information

Varicose Veins Operation. Patient information Leaflet

Varicose Veins Operation. Patient information Leaflet Varicose Veins Operation Patient information Leaflet 22 nd August 2014 WHAT IS VARICOSE VEIN SURGERY (HIGH LIGATION AND MULTIPLE AVULSIONS) The operation varies from case to case, depending on where the

More information

Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)

Varicose Vein Treatment (Endovenous Ablation of Varicose Veins) Scan for mobile link. Varicose Vein Treatment (Endovenous Ablation of Varicose Veins) Varicose vein treatment, also known as endovenous ablation, uses radiofrequency or laser energy to cauterize and close

More information