According to the results of a clinical trial carried out in several centres in France, the experience of three years of an institution and comparative study between obliterarii technique with steam and foam injectarilor in tributarele large, steam-powered ablation has proved to be a safe and effective method to treat the saphenous vein. (GSV).
Principle of ablation uses steam steam condensate, which releases a large amount of energy in a short span, generating a therapeutic effect in a way that is safe for the health of the patient. Steam is delivered in periodic pulses, allowing the evacuation of heat between two consecutive pulses. The water pressure is high pomata through a microfuge tube containing 100 μ in diameter internally. An electric current heats microtubul and steam is emitted at a temperature of 150 ° (from atop the catheter falls to 120 ° C).
Study in multiple centers
In the study carried out in multiple centers, 80 patients were treated in four centres (University Hospital of Besançon (Prof. g. Camelot), private clinics in Lyon (Dr P Nicolini), Montpellier (Dr R Milleret) and Nancy (Dr D Chintz)). Milleret presented the results obtained in the course of a year, obtained from 73 patients.
Treatment protocol included the treatment of the GSV, only the latter having the freedom to use general anesthesia, or local tumescenta. The average length of 42 cm was treated for an average of 8 mm diameter in the Middle thigh. The immediate postoperative pain was 1.7 (mean value) and in eight days was 0.75 (average value). There were cases of venous thrombosis, pulmonary embolism or deep infections. Also there were cases of pigmentation. They have found a case of paresthesia at eight days and a month. All in one month, a patient presented with thrombosis GSV below punctiei (decreased without complications after treatment with molecular weight heparin), another patient with hematoma at level punctiei and another with the superficial level of complications femoral Canal. At six months, one patient presented hipoestezie of limb.
Partial results after a year absence look at low tide in 98.5% of the 75 patients. Quality score of life SF-12 has been improved both physically and mentally: 49.99 versus 51.27 (p = 0.049) and 46.01 versus 52.05 (p = 0.001) at six months. Improvements in symptomatology can be seen in table 1.
|Level of pain||25||12|
We present our personal experience after the treatment of 164 patients between 2007 and 2010. 117 patients were treated with the affections of the GSV and 47 with SSV. General anesthesia was used in surgeries, and 78 local anesthesia in tumescenta 76. No major complications were observed.
One patient presented deep thrombosis of the leg, vindacata after two weeks of treatment with heparin low molecular weight. Three patients have experienced minor skin burns at the level of entry, who have been healed in four to six weeks. Obliterare rates are presented in table 2.
Table 2: rates of obliterare
|Nr. patients treated||Nr. patients follow||Obliterare||Percentage|
Comparative study of steam/froth for 2.2.1
We conducted a comparative study on the obliterarii with steam injection versus foam in large rivers. The target was the comparison of chemical and thermal technology from the point of view of effectiveness, patient safety, patient satisfaction and cosmetic results. Have been treated in two groups of 20 patients. The mapping was done by the surgeon using the guidance of ecografica. Foam was obtained by method Films with 1% polidocanol for veins of over 5 mm wide and 0.5% for smaller veins. No more than 10cc were injected per session (consensus of the Tegernsee).
Steam was applied using the generator and catheters Venflon of 18 g for larger veins and 20 g for smaller veins. Three to six pulses were applied at each entry point. Patients were chasing an 8/10 days, one month and six months. One vessel has been used for postoperative pain and appreciation of the level of general satisfaction. Cosmetic results were graded “excellent” to “poor” in four steps.
The results showed that all patients have received a check from 8 days and one month ago, the three were not submitted to the control of up to six months; two of the Group of patients treated with foam and one of those treated with steam. No complications were observed. A patient group with foam had a passenger disturbance of vision. Inflammatory reactions were observed in six patients after injecting the foam without the reaction of this type to be present in patients treated by method of steam. The level of pain 8 days was 2.4 after treatment with foam and steam 0.5 after treatment.
At one month, blood has been with a 16 g needle under local anesthesia at 12 of the Group of patients treated with foam and six of the Group of treated with steam. It was found at the pigmentation in all these 12 patients and in 4 of the 6 Group of treated with steam. Also, after 6 months was still visible pigmentation in 4 patients treated with foam and 2. Cosmetic results were appreciated by patients after six months as “good” or “very good” in 10 of the 18 patients treated with foam and 15 of 19 patients after ablation. Steam method causes less pain and pigmentation due to venous wall ingrosarii, which implies a low lumen after the treatment. Steam ablation is useful especially in the case of large varicose vein relief rolled in, recurring and malformations, in which no other method can not compete with it.
In the last decade, thermal ablation techniques, have begun to challenge the traditional surgical treatment position in the treatment of varicose saphenous veins. The newest method for thermal ablation is the steam that runs through the ducted heating, vein using steam at 120 ° c. This study evaluated the efficacy of ablation of varicose veins with steam in sheep and humans.
Safety procedure for the sheep was appreciated by cardiovascular monitoring during treatment. The technique has been used for the examination of the problem concerning the vein. The treated vein changes were examined microscopically. In a pilot study, 20 patients with veins of 19 of the saphenous vein insufficiency small or large have been treated by the method of ablation with pulsed steam. Anatomically, the patient satisfaction success and complications were investigated in 6 months after the procedure.
All the veins from sheep were ocluzate. There were changes during treatment cardiovascular. Examination of veins treated histologica showed changes typical of the venous wall, such as the disappearance of fibrotica thrombosis endothelial layer, and transient alterations of collagen fibers. The ablation was effective in 19 patients: 13 of 20 veins were complete and closed 7 presented a very small segment of recanalizare after 6 months of follow-up, which don’t seem relevant clinical. Nine patients were presented at the punctiei level and bruising a patient has had an episode of superficial phlebitis passenger. It was reported an average pain score of 1 (scale 0-10). There were no reported significant side effects such as deep venous thrombosis, nerve disorders, burns or infection. Patients were very satisfied with the treatment, with an average score of 9.25 (scale 0-10).
In this study the proof-of-principle, pulsed steam ablation was an effective method of treatment for Varicose saphenous veins.
J Surg Mistletoe. 2011 Jan; 53 (1): 181-6.