Chapter 106 Robert J. Min and Neil M. Khilnani Chronic venous insufficiency (CVI) is extraordinarily common, with estimates of up to 25% of women and 10% of men suffering from some form of CVI.1 Most patients with CVI have symptoms that interfere with daily living (e.g., leg aches, fatigue, throbbing, heaviness, night cramps). Severe cases can lead to skin damage resulting from chronic venous hypertension (e.g., eczema, edema, hyperpigmentation, lipodermatosclerosis). The majority of patients with leg ulceration have superficial venous insufficiency (SVI) as the primary underlying cause, with SVI being the sole factor in 20%.2 Patients with symptoms typical of CVI and clinical signs of CVI require further evaluation with duplex ultrasound (DUS).3,4 The goal of DUS evaluation is to map out all the incompetent venous pathways responsible for the patient’s condition, including the primary or highest points of reflux and the presence of obstruction.3 Such a map is necessary to determine the best treatment plan. Dr. Boné first reported on delivery of endoluminal laser energy in 1999.5 Since then, a method for treating the entire incompetent vein segment has been described by Min and Navarro.6–8 Endovenous laser treatment, which received approval by the U.S. Food and Drug Administration (FDA) in January 2002, achieves nonthrombotic vein occlusion by delivery of laser energy directly into vein walls. Lasers with wavelengths of 810, 940, 980, 1064, and 1320 nm have all been used with success. Contact between the laser fiber and vein wall is necessary to cause sufficient damage to the vein to result in acute wall thickening with eventual vein contraction and fibrosis. The equipment necessary to perform endovenous laser ablation includes but is not limited to:
Great Saphenous Vein Ablation
Equipment
Great Saphenous Vein Ablation
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