Katie Kozlowski
Sally et al (2020) investigated VenaSeal™ closure techniques to induce endovenous closure in the great saphenous vein. The instructions for use (IFU) antegrade technique (insertion of the introducer wire in a cranial manner), conventionally used for VenaSeal™ procedures can make passage of the wire to the groin difficult when the great saphenous vein is 1) small, 2) below the knee, 3) deep, or 4) traversing lower leg fascia. The authors investigated the efficacy of retrograde great saphenous vein puncture in mitigating access problems while maintaining effectiveness and patient outcomes. In this case, retrograde passage of the catheter means in a direction of placement “towards the foot”.
Fourteen patients underwent VenaSeal™ ablation of the great saphenous vein via a retrograde puncture technique, introducing the VenaSeal™ catheter in a cranial-caudal manner. All patients underwent the treatment for great saphenous vein incompetence. Patients were reviewed at one week, three, six, and 12-months post-procedure to assess patient outcomes, complications, and satisfaction.
Results of the study show 100% technical success and 100% Duplex-occlusion rate at all post-procedure follow-ups. While more studies with longer follow-up periods are required to validate long-term outcomes of the retrograde puncture technique, the authors concluded that it is “a safe and effective manner for ablation of the great saphenous vein with no additional average operative time and minimal complications”.
Dr Karamanoukian’s comment; I believe that if the vein is too small, the likelihood of significant reflux should be questioned and the need to ablate the vein in an antegrade or retrograde manner can be questioned.
Sally S, Tang TY, Chong TT, Choke EC and Ty HT. Retrograde technique for great saphenous vein ablation using the VenaSeal closure system – ideal approach for deep seated or small below the knee refluxing truncal veins. Phlebology 2020; 35: 102-109.