View all articles Online Tutorials
The Role of Ultrasound in Endovenous Ablation of Varicose Veins - Before, During and After Treatment
Introduction
Varicose vein disease is a common medical problem that is associated with multiple symptoms of varying degrees. Many patients seek treatment because the varicosities are cosmetically discomforting; but they also frequently admit to experiencing aching pain, night cramps, heaviness, pressure, swelling and even the chronic skin changes associated with venous insufficiency. In the past, treatment has required surgical ligation and stripping of the GSV (greater saphenous vein). Newer methods of treatment involve an endovascular approach using a tiny catheter rather than surgery. Thermal energy is applied to the vein wall through the catheter by either a laser or radiofrequency device. Both techniques result in a non-thrombotic vein occlusion by heating of the vein wall. Endovenous treatments have the advantage of being minimally invasive with fewer complications, reduced recovery time and decreased cost compared to surgery.
Although a number of options exist for imaging the venous system, ultrasound has evolved as the imaging modality of choice. In the pretreatment venous study, ultrasound is used to map the anatomy, both normal and variant as well as the refluxing pathways. Ultrasound imaging is also an integral tool during the endovenous procedure. It is used to locate the best access site, determine placement of the guidewire and guide the application of tumescent anesthesia. Post-treatment ultrasound studies are used to confirm resolution of the reflux and successful obliteration of the treated vein.
While many sonographers are quite familiar with the anatomy of the deep venous system in the lower extremity, they are often less familiar with that of the superficial venous system. Evaluation for deep vein thrombosis with ultrasound is often well understood, but the method to elicit reflux or map varicose veins is not. Therefore it is essential for sonographers and interpreting physicians to master the specific anatomy, physiology and techniques associated with evaluating venous reflux disease.
Cindy A. Owen, RDMS, RVT
Diagnostic Ultrasound Services at Baptist Memorial Hospital Desoto
Southaven, MS
Visit the full article on the GE Healthcare website!