Cryoperforator Surgery: A New Treatment of Incompetent Perforating Veins

Abstract

This study was conducted to determine the feasibility of cryoperforator surgery in the treatment of incompetent perforating veins. Fifteen patients with C2-C4 varicose disease (according to the Clinical-Etiology-Anatomy-Pathophysiology classification) were enrolled in this study. Under local anesthesia, incompetent perforating veins were treated with a duplex-guided cryoprobe. Duplex scans were performed 2 and 4 weeks after treatment. Fifteen patients with 28 incompetent perforating veins were treated with cryoperforator surgery. Distribution of the incompetent perforating veins was as follows: posterior tibial perforator, 12; paratibial perforator, 11; intergemellar perforator, 1; lateral leg perforator, 4 (range = 1-5 incompetent perforating veins per patient). Follow-up showed successful treatment of 12 incompetent perforating veins (43%). This study showed that cryoperforator surgery is feasible for treatment of incompetent perforating veins. Higher success rates could be obtained with our modified diamond-dust coated cryoprobe. Major advantages are the treatment in an outpatient setting and the possibility of treating all incompetent perforating veins, intraluminal or extraluminal.

Predictive factors of success following radio-frequency stylet (RFS) ablation of incompetent perforating veins (IPV)

“…While we expected that tricuspid regurgitation may play a significant role in the pulsatile flow that we noted, only two of the six echocardiograms performed in patients with pulsatile flow demonstrated mild tricuspid insufficiency. 13,14,15 A key limitation in this study is the small number cases. Because the number of cases in the failed group is only six, compared with that in the occluded group (42), we also conducted stepwise multiple logistic regression analyses.…”

Early Results of Cryosurgery in Varicose Veins in Korea: Safety and Feasibility

“…We were unable to find randomized clinical studies regarding the differences in costs between radiofrequency ablation therapy and cryosurgery, but the former is expected to be more expensive because of the use of ablation catheters and power sources. Cryosurgery has also proved to have advantages over other therapeutic techniques for treating incompetent perforating veins [13]. …”

Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity

“…Some patients have enlarged incompetent PVs and severe limb symptoms, including ulceration. In the treatment of venous ulcers that are located above the ankle, it is recommended to include treatment of incompetent PV in combination with SVI therapy [19,25]. In patients with a combination of SVI and PVI, routine PVI treatment is recommended by some authors, along with SVI treatment because of the risk of recurrence [6,[25][26][27].…”

“…In the treatment of venous ulcers that are located above the ankle, it is recommended to include treatment of incompetent PV in combination with SVI therapy [19,25]. In patients with a combination of SVI and PVI, routine PVI treatment is recommended by some authors, along with SVI treatment because of the risk of recurrence [6,[25][26][27]. Incompetent PVs can be treated with surgical ligation, US-guided sclerotherapy, endovascular thermal, laser therapy, or radiofrequency ablation [24].…”