Is a patient with bilateral lower limb venous reflux, as evidenced by incompetent sapheno-femoral junction, great saphenous vein, and anterior thigh vein, a candidate for Endovenous Ablation Therapy (EVAT)?

From the Guidelines

Endovenous Ablation Therapy (EVAT) is a suitable treatment option for patients with bilateral lower limb venous reflux, including incompetent sapheno-femoral junction, great saphenous vein, and anterior thigh vein. According to recent studies, EVAT has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins, with similar efficacy, improved early quality of life, and reduced hospital recovery 1. The treatment involves the use of radiofrequency ablation (RFA) or endovenous laser ablation (EVLA), which have been shown to be at least as efficacious as surgery, with fewer rates of bleeding, hematoma, and wound infection 1.

Key Considerations for EVAT

• Tumescent anesthesia: a method by which diluted local anesthetic with or without epinephrine and/or sodium bicarbonate are injected around the target vessel to protect the surrounding tissue and collapse the vein wall extrinsically 1.
• Sclerosing agent: such as sodium tetradecyl sulfate, at a dose of 0.5-1.0% concentration, to achieve closure of the incompetent veins.
• Occlusion rates: vary from 91% to 100% within 1-year post-treatment 1.
• Complications: postprocedural thrombotic events, including deep vein thrombosis (DVT) and pulmonary embolism, occur infrequently, with rates of 0.3% and 0.1%, respectively 1.

Treatment Outcomes

• Quality of life: EVAT has been shown to improve early quality of life, with reduced rates of paresthesia compared to surgery 1.
• Recurrence rates: conflicting data, with some studies noting improved recurrence rates with EVLA at 6 weeks and 1 year, while others note no significant difference 1.
• Long-term outcomes: no statistically significant difference in long-term outcomes between conventional surgery and endovenous therapy, or between RFA and EVLA or conventional surgery 1.

Overall, EVAT is a viable treatment option for patients with bilateral lower limb venous reflux, including incompetent sapheno-femoral junction, great saphenous vein, and anterior thigh vein, with suitable treatment regimens and outcomes supported by recent studies 1.

From the Research

Patient Eligibility for Endovenous Ablation Therapy (EVAT)

The patient in question has bilateral lower limb venous reflux, with incompetence in the sapheno-femoral junction, great saphenous vein, and anterior thigh vein. To determine if this patient is a candidate for Endovenous Ablation Therapy (EVAT), we can look at the following points:

• Success of EVAT in patients with venous insufficiency: Studies have shown that EVAT is a successful treatment for patients with symptomatic venous insufficiency, with high closure rates and significant improvement in symptoms 2, 3, 4.
• Effectiveness of EVAT in patients with deep venous insufficiency: Research has found that EVAT is equally effective in patients with or without deep venous insufficiency, with no significant difference in outcomes 2.
• Treatment of incompetent tributary veins: The patient's anterior thigh vein incompetence may require concomitant phlebectomy, which has been shown to be a safe and effective method of treatment when combined with EVAT 4.
• Safety of EVAT in patients with comorbid conditions: EVAT has been found to be safe and effective in patients receiving long-term warfarin therapy, with no significant increase in complications 5.

Key Considerations

• The patient's specific anatomy and pattern of reflux should be taken into account when determining the best course of treatment.
• The presence of incompetent tributary veins, such as the anterior thigh vein, may require additional treatment, such as phlebectomy.
• The patient's overall health and any comorbid conditions should be considered when evaluating the risks and benefits of EVAT.

Relevant Findings

• EVAT has been shown to be a safe and effective treatment for patients with symptomatic venous insufficiency, with high closure rates and significant improvement in symptoms.
• The presence of deep venous insufficiency does not appear to affect the outcomes of EVAT.
• Concomitant phlebectomy can be a safe and effective method of treating incompetent tributary veins.
• EVAT can be safely performed in patients receiving long-term warfarin therapy.