Yes, but what methods can we use and what guidelines should be used and will Insurance companies allow necessary follow up?
Phlebology Doctors Ask : Should we use Surgery? Foam Sclerotherapy? or Heat? When should we use compression?
Most patients need secondary treatments after ablation because of their disease process: some of the refluxing veins are too small or tortuous, they have bulging skin veins that would result in hard sclerosed coagulum after cosmetic injections and lead to matting and staining which is a real problem for patients at least in the short term of their life.
There are real needs for perforating veins to be treated if they result in unhealed ulcer patients, but most post ablation patients do not need normal perforators closed to be efficiently treated.
ONE TRIAL showed why perforators were closed:
University of Pittsburgh group (Dillavou) in a Retrospective Review, looked at 73 ulcers (avg 28 mos duration), all with perforator incompetence, w/o superficial incompetence
- ~ 1/3 from post deep vein thrombosis( DVT), 1/3 had Deep Vein Incompetence( Reflux)
- They used STS/Poli foam + foam pads from STD pharmacy plus compression wraps
- Multiple injection sessions of ultrasound guided injections into the damaged, refluxing perforating veins.
- Mean follow up 30 months: 32 (52%) healed; 30 (48%) non-healed
- Kiguchi M, et al. J. Vascular Surg 2014;59:1368-76
Other methods of closing perforators are with Closure Fast (RF), Varithena, and VenaSeal ( Cyanoacrylate adhesive) 2 studies below:
Cyanoacrylate adhesive was shown to be effective in a European Multi-center Trial with 70 patients because they preferred no tumescent anesthesia and no post procedure compression garments. 93% of patients were “recanalization free” at one year: Proebstle, et al JVS Vand L 2014, 2, 1: 105-106 and a VeClose study in the USA of 222 patients where they compared Radiofrequency to Cyanoacrylate adhesive and they were similar 96% vs 99% Study in JVS 2015 with Morrison, N and Gibson, K
Compression garments and compression bandages come in all shapes and sizes. Insurance companies require use of compression and other conservative treatment modalities sometimes for months before allowing surgery or endovenous procedures but they won’t often reimburse. Compression is level 1 standard of care for ulcers but with proper use may prevent these ulcers in the first place. To be continued…..
We will talk in future blogs more about compression but for most post op procedures (except VenaSeal glue), compression wraps, stockings, socks or elastic velcro wraps properly fitted and applied help the healing process and limit the inflammatory processes that can lead to matting, staining and phlebitis.
Come talk to us @Morrison Vein Institute 480-775-8460 Sudies compliments of Dr. Nick Morrison’s slides for lecture in 2015.