EFFICACY AND RESULTS OF THERMOCOAGULATION MODALITY

IN THE TREATMENT OF RETICULAR AND TELANGIECTASIC VEINS:

10 Years Single Center Experience

Prof. Ufuk Demirkilic, MD*

* Prof. Dr. Ufuk Demirkilic Varicose Veins Center, Ankara Turkey

Disclosure

Prof. Ufuk DEMIRKILIC, MD

I do not have any potential conflict of interest

Treatment of Telangiectasias (spider veins)

Telangiectasias are small dilated blood vessels near the surface of the skin, measuring between 0,5 and 1 millimeter in diameter. They can develop anywhere on the body but are commonlyseen on the face around the nose, cheeks, and chin.They can also develop on the legs, specifically on the upperthigh, below the knee joint, and around the ankles

Thermocoagulation

• Thermocoagulation is an efficient and hopegivingtranscutaneous method for the treatment of small reticular and telangiectasic varicosities that cannot be treated effectively with microsclerosis and patients with allergies

Aim

• The aim of this study is to evaluate the efficacy of thermocoagulation method for the treatment of reticular veins and telangiectasies

Patients and Methods

• Between April 2004 and April 2014, 7560 patients treated with Viridex thermocoagulation device for the treatment of reticular and telangiectasic varicosities

• 3081 patients solely treated with thermocoagulation for telangiectasic varicosities

• Telangiectasic lesions divided into four groups:– Linear: 34,4% of lesions– Spider: 30,2% of lesions– Arborized: 23,2% of lesions– Papillary: 12,2% of lesions

Demographics and Procedure Related Data

ParametersMean Age (years)Gender (M/F)Weight (kg)BMI (kg/m2)Mean number of pulses per sessionDuration of the procedure (min)Mean Applied Power (W)Follow-up (M)

38.3±19.7188/2893

64,55±9,0423,84±4,26

758,8±158,223,1±12,6

6,4±2,512

Thermocoagulation application technique:

• Viridex thermocogualationdevice has three parts:

– Console for radiofrequency energy generator

– Isolated needle for applying energy to the lesion

– Footswitch for synchronization between generator and the needle. Applied energy and the duration can be adjusted over the generator console

Thermocoagulation-Technique

4 MHz radiofrequency wave is produced by the generator It causes a 70 °C temperature inside the vessel

There should be 1-2 mm distances between each pulse of energy. Lesser or longer distances are not approved.

• Special different sized isolated needles from Ballet and FCare Systems brands were used according to the vein diameter.

– Ballet brand: K3 0.075-0.080 mm– K5G (golden needle) 0.80-0.125 mm K6 0.150 mm], – FCare systems: R3i 0.08 mm, R6i 0.15mm]).

For telangiectasias: K3-K5G, R3i needles 20-30% energy level and duration of 0.2-0.3 second were used

For lesions bigger than 1 mm: K6, R6i 40-50% energy level and 0.4-0.5 second duration were used

For papillary lesions: 60% energy level and 0.6 second adjustments were used

Lesion become flushed and swollen immediately after the RF therapy.

These new lesions are called as oreols.

RESULTS

One day later these oreols vanished and left their places to crusts.

After a mean period of four weeks (1 to 8 weeks) these crust are peeled spontaneously and completely recovered.

Post-procedural care and follow-up:

• Topical ice packs were applied over the treated area• Patients were advised to continue to their daily social activities• There was no limitation for sun bath• Patients were seen on the second day of treatment and then

weekly until the complete recovery of crusts• During follow period second or third treatments were

performed for the residual lesions

Results

• Improvement findings of the lesions were evaluated in five improvement levels

• Improvement levels in lineer telangiectasia group were 92%• Spider, arborized telangiectasies and bluish-purple small

reticular varicosities, this improvement ratio was approximately 73%

• Forty percent of such cases needed second and 18% needed a third application of the thermocoagulation.

• After additional interventions that were performed with 3-4 weeks intervals, mean recovery levels of the patients was 4.1.

Patients’ 5 recovery levels:

Level 1: <25% recovery Level 2: 25-50% recovery Level 3: 50-75% recovery Level 4: 75-90% recovery Level 5: 90-100% recovery

Recovery Levels

Recovery Levels According to the Location

Case 1

Before Oreols

Crusts After

Case 2Before Oreols

Crusts After

Discussion

The most important factors that effect the treatment success in thermocoagulation method:Selection of:

appropriate needle size, energy level and duration

Conclusion

Thermocoagulation is a user-friendly, simple method and can be applied in big pulse numbers according to the patient’s and doctor’s patience

It can safely be used in the treatment of reticular and telangiectasias that can not be treated with microsclerotherapy.

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