Steam Vein Sclerosis for Nonsaphenous varicose veins

Background

The treatment of nonsaphenous varicose veins (NSVV), including incompetent perforating veins (IPV) and recurrent varicose veins (RVV), remains challenging for many reasons, including vein tortuosity, deep location and short vein to be treated. Data and recommendations are lacking. Steam vein sclerosis (SVS) is an endothermal therapy that has been used in the treatment of incompetent saphenous veins, achieving occlusion rates similar to other thermal ablation techniques with good patient tolerance and minimal postoperative pain. We report here the results of a cohort of SVS used to treat NSVV, including RVV and IPV.

Methods

From October 2017 to March 2020, consecutive patients presenting with NSVV treated with SVS were included. Patients were followed at 3 months with both clinical and duplex scan examinations. The primary endpoint was efficacy defined as target vein occlusion at 3 months; secondary endpoints were: safety with analysis of per procedural and 3 months complications, evolution of functional stage and symptoms between inclusion and 3 months.

Results

Ninety-six patients were included in the study. Five patients were lost to follow-up. Fifty-nine percent (n = 60) were women. Lesions were recurrent (recurrent varicose vein after surgery) in 61% (n = 62). The location of the NSVV was sapheno-femoral residual stump in 8% (n = 8), inguinal neovascularization in 14% (n = 14), sapheno-popliteal residual stump in 12% (n = 12), popliteal neovascularization in 7% (n = 7), and IPV in 59% (n = 60). Complete occlusion after treatment occurred in 86% (n = 83) of patients, partial occlusion in 4% (n = 4), and complete recanalization in 10% (n = 9). The occlusion rate in the IPV group was 93%. Complications at 30 days postoperatively were 2 (2%) deep vein thrombosis, 1 (1%) hematoma, and 2 (2%) late paresthesias in the superficial peroneal nerve area.

Conclusions

The use of SVS has been shown to be effective and safe in the short-term treatment of NSVV, including IPV and RVV. Further studies are needed to evaluate its long-term effects.