From the Guidelines
Endovenous Ablation Therapy (EVAT) is indicated for this patient due to the presence of segmental incompetent valves throughout the great saphenous vein (GSV) with a reflux time of 1.4 seconds and a vein diameter of 4mm, which represents a significant venous insufficiency that would benefit from EVAT. The patient's findings, including the patent and competent sapheno-femoral junction and short saphenous vein, do not preclude the use of EVAT, as the procedure targets the specific segments of incompetence while preserving normal venous function elsewhere 1.
The procedure involves using thermal energy (laser or radiofrequency) to close the incompetent vein segments, redirecting blood flow to healthier veins, and is a minimally invasive approach that offers quicker recovery compared to traditional vein stripping, with most patients returning to normal activities within 1-2 days while wearing compression stockings for 1-2 weeks post-procedure to optimize outcomes 1.
Some key points to consider in the management of varicose veins include:
- The use of compression stockings as a first-line treatment is not supported by strong evidence, and EVAT is recommended as a first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux 1
- The CEAP classification system is used to categorize venous disease of the legs according to the severity, cause, site, and specific abnormality, and can help guide treatment decisions 1
- Treatment options for varicose veins include conservative measures, lifestyle modifications, phlebotonics, and interventional procedures such as thermal ablation, endovenous sclerotherapy, and surgery 1
Overall, the patient's findings and the current evidence support the use of EVAT as a safe and effective treatment option for this patient's venous insufficiency.
From the Research
Findings Indicated for EVAT
The provided findings indicate that the patient has a patent and competent sapheno-femoral junction, a patent great saphenous vein (GSV) with segmental incompetent valves throughout, and a patent and competent short saphenous vein. The diameter of the GSV is 4mm with a reflux time of 1.4sec.
Eligibility for EVAT
Based on the studies, the patient may be eligible for endovenous thermal ablation (EVAT) treatment, which includes endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). The studies suggest that EVAT is effective in treating great saphenous vein reflux, with high occlusion rates and improvement in symptoms 2, 3, 4, 5.
Key Points to Consider
- The patient's GSV diameter and reflux time are within the range that can be treated with EVAT 2, 3.
- The presence of segmental incompetent valves throughout the GSV may require a tailored approach to treatment 2, 4.
- The patient's short saphenous vein is patent and competent, which may not require treatment 2, 3.
Treatment Options
- Endovenous laser ablation (EVLA) with a 1470-nm radial fiber may be a suitable option for the patient, given its effectiveness in treating GSV reflux and improving symptoms 2, 4.
- Radiofrequency ablation (RFA) may also be considered, given its similar effectiveness to EVLA in treating GSV reflux 2, 5.