1. Retrograde Endovenous Microfoam Chemical Ablation of Varicose Veins and Venous Valvular Reflux in CEAP 6 Ulcers
Steven T Deak, MD, PhD, FACS
VEITHsymposium New York, NY
November 18, 2016

2. Varicose Veins: Indications for Intervention
General appearance
Aching pain
Leg heavines
Easy leg fatigue
Superficial thrombophlebitis
External bleeding
Ankle hyperpigmentation
Lipodermatosclerosis
Atrophic blanche
Venous ulcer

4. The treatment of large superficial varicose veins requires a two step approach:
The incompetent greater saphenous vein is closed with endovenous thermal ablation
Followed by ambulatory phlebectomy of the residual varicose veins, either at the same time or at a later date
This study outlines an improved technique for treating the incompetent greater saphenous vein and the associated varicose vein tributaries at the same time with a single access site using endovenous chemical ablation with 1% polidocanol injectable foam

5. The GSV is accessed with 5 Fr micropunture catheter in distal thigh, leg 45* the GSV is thrombosed polidocanol1% SFJ compressed to protect the deep system
2nd injection is administered through the same catheter and directed distally in retrograde fashion thhrough the incompetent vv to the calf dorsiflex foot to prot. deep

6. 38 year old male presents with varicose veins for many years with heavy feeling in both legs.
Severe reflux in the greater saphenous vein 500 msecons in duration
GSV measures 11 mm in diameter
Varicosities at the knee 8 to 11 mm
The GSV was thrombosed with 3 mLs of polidocanol injectable foam 1%
The remaining varicosities in the distal leg were then treated with an additional 5 mL of polidocanol injectable foam 1% through the same micropuncture catheter in the distal thigh for a total foam volume of 8 mL

7. Pre-Op
2 Weeks Post-Op

8. 1% Polidocanol Injectable Foam
Physician Compounded Foam

9. Retrograde Microfoam Chemical Ablation
Treatment of Venous Valvular Hypertension and Venous Valvular Reflux in CEAP 6 Ulcers
SEPS
Retrograde Microfoam Chemical Ablation

10. Retrograde Ablation of Venous Valvular Reflux in the Treatment of CEAP 6 Ulcers with 1% Polidocanol Injectable Foam