Endovascular Ablation Techniques with Ambulatory Phlebectomy for Varicose Veins

Question 1

Failure to treat proximal incompetence results in vein recurrence.

Answer 1

T

Question 2

Endoluminal radiofrequency or infrared laser energy can effectively seal and eliminate abnormal saphenous veins.

Answer 2

T

Question 3

Ambulatory phlebectomy may be performed on distal or branch varicose veins in combination with endovenous techniques.

Answer 3

T

Question 4

Tumescent anaesthesia is not required for ambulatory phlebectomy or endoluminal radiofrequency or laser closure.

Answer 4

F Tumescent anaesthesia is necessary.

Question 5

For maximal improvement in abnormal venous haemodynamics and resolution of symptoms, complete removal of the great saphenous vein from the saphenofemoral junction (SFJ) to the knee is required after ligating the SFJ.

Answer 5

T

Question 6

Patients cannot return to work for up to 6 weeks after endovenous techniques.

Answer 6

F 1-72 hrs.

Question 7

Sclerotherapy can be used as an adjunctive treatment to eliminate branch varicosities that don’t resolve with closure of the great saphenous vein alone.

Answer 7

T

Question 8

Doppler units utilise frequencies for 4-5 MHz for examining superficial vessels (1-2 cm below the skin), while deeper vessels require a higher frequency of 8-10MHz.

Answer 8

F 8-10 MHz for superficial, 4-5 MHz for deep.

Question 9

Using Doppler ultrasound, a long flow sound is audible when valves are incompetent.

Answer 9

T

Question 10

Doppler examination of the superficial venous system should be performed when the patient is lying down.

Answer 10

F Standing or sitting  gravitational hydrostatic pressure enhances vol and velocity of flow.

Question 11

Using a Doppler ultrasound, flow that is heard during proximal compression or immediately after the release of distal compression is normal.

Answer 11

F This is retrograde flow – a sign of incompetent valves.

Question 12

Duplex ultrasound consists of a dual-mode device that allows a timed pulse echo to be superimposed with the continuous-wave Doppler.

Answer 12

T

Question 13

Doppler shows venous reflux more precisely than a Duplex ultrasound.

Answer 13

F Reflux shown visually and more precisely with Duplex.

Question 14

The site of origin of reflux can be pinpointed with Duplex ultrasound.

Answer 14

T

Question 15

Retrograde flow of duration >1second is considered pathologic reflux, and reflux that lasts >2 seconds is haemodynamically significant.

Answer 15

T

Question 16

Once incompetence of the great saphenous vein has been demonstrated with reverse flow, the patient is a candidate for an endovenous ablation technique.

Answer 16

T

Question 17

To shrink vessels, endovenous placement is used to direct radiofrequency energy to heat a catheter which then heat damages vein walls.

Answer 17

T

Question 18

All endovenous techniques heat the vessel at an optimal temperature of 70-90 degrees Celsius.

Answer 18

F 120 degrees or beyond.

Question 19

With radiofrequency techniques, the temperature increase remains localised in a narrow rim around the active electrode.

Answer 19

T

Question 20

Tumescent anaesthesia and immediate ambulation are not important factors in minimising the side effects of radiofrequency closure.

Answer 20

F These are the most important factors.

Question 21

It is advisable to limit radiofrequency treatment to the great saphenous vein to below the knee to minimise the risk of paraesthesia resulting from injury to the saphenous nerve.

Answer 21

F Above the knee.

Question 22

With radiofrequency ablation, a 7cm long metal core is heated to 120 degrees and allowed to transmit head to the treated vessel for 20 seconds, which shrinks a vein 7cm at a time.

Answer 22

T

Question 23

Endovascular radiofrequency ablation techniques have higher rates of side effects of DVT and nerve injury compared to traditional ligation and stripping.

Answer 23

F Lower.

Question 24

With endovascular radiofrequency ablation, results observed at 6 months are indicative of the long-term results.

Answer 24

T

Question 25

The superior epigastric vein is typically ablated using endovascular techniques.

Answer 25

F Endovenous techniques are designed to preserve this vein.

Question 26

Ambulatory phlebectomy cannot be used in combination with radiofrequency endovenous ablation techniques.

Answer 26

F

Question 27

Regarding radiofrequency closure with ambulatory phlebectomy, most physicians use the technique of duplex-guided puncture and cannulation.

Answer 27

T

Question 28

The amount of tumescent anaesthesia fluid used for ambulatory phlebectomy ranges from 1L – 1.2L.

Answer 28

F 500-800mL with typical lignocaine dose of 4-8mg/kg.

Question 29

The incisions made during ambulatory phlebectomy are sutured closed following the procedure.

Answer 29

F Kept open to allow for anaesthesia drainage, minimising swelling and bruising

Question 30

There is no need for compression following radiofrequency closure with ambulatory phlebectomy.

Answer 30

F Compression bandage applied immed after procedure and removed next day.

Question 31

Patients with reflux in the great or small saphenous vein are candidates for the technique of closure using single puncture under duplex guidance.

Answer 31

T

Question 32

For the technique of closure using single puncture under duplex guidance, it’s best if the vein size does not exceed 1mm.

Answer 32

F 1.6mm

Question 33

For the technique of closure using single puncture under duplex guidance, the entry point is usually just above or below the knee along the course of the great saphenous vein.

Answer 33

T

Question 34

For the technique of closure using single puncture under duplex guidance, it is important that the patient experiences no pain during cannulation.

Answer 34

T The perception of pain will cause immediate and rapid contraction of the saphenous vein.

Question 35

For the technique of closure using single puncture under duplex guidance, monitoring of the anaesthesia injection is not required.

Answer 35

F It’s essential.

Question 36

For the technique of closure using single puncture under duplex guidance, tumescent anaesthesia is injected into the perivenous space.

Answer 36

T

Question 37

With the technique of closure using single puncture under duplex guidance, the starting temperature when the catheter is in position should be 37 degrees Celsius.

Answer 37

F It should be 25-28 degrees if tumescent anaesthesia has been properly placed.

Question 38

At the conclusion of the procedure of closure using single puncture under duplex guidance, the duplex ultrasound of the saphenofemoral junction should reveal no flow except for the superficial epigastric emptying into the common femoral vein.

Answer 38

T

Question 39

At the conclusion of the technique of closure using single puncture under duplex guidance, the greater saphenous vein should be less echogenic with thinner-appearing walls.

Answer 39

F More echogenic, thicker-appearing walls.

Question 40

Class 2 compression hosiery should be worn for 3 days with the percutaneous closure technique.

Answer 40

T

Question 41

Class 2 compression hosiery should be worn for 14 days with the closure plus phlebectomy technique.

Answer 41

F 7 days.

Question 42

Anaesthesia of the treated portion of the leg may persist for 8-24 hours following endovenous radiofrequency ablation with tumescent anaesthesia.

Answer 42

T

Question 43

Symptom relief following endovenous radiofrequency ablation is usually not seen until 6 weeks after the procedure.

Answer 43

F Usually rapid (some within 3 days).

Question 44

Clinical improvement in the appearance of varicosities following endovenous radiofrequency ablation is typically seen within 6 weeks.

Answer 44

T

Question 45

Destruction of the great saphenous vein with laser is a function of thermal destruction.

Answer 45

T

Question 46

Using endovenous laser ablation, the incidence of postoperative pain and ecchymosis is highest in water-dependent wavelength (1320nm).

Answer 46

F Haemoglobin-dependent wavelengths (810, 940, 980, 1064nm).

Question 47

Pulsed 810nm diode laser treatment decreases risk for perforation of the vein compared to continuous treatment.

Answer 47

F Increased risk with pulsed treatment.

Question 48

Regarding endovascular laser ablation, longer wavelengths (eg. 940nm) penetrate deeper into the vein wall with resulting increased efficacy.

Answer 48

T

Question 49

When compared to the 940nm diode laser, the 1320nm Nd:YAG laser causes fewer side effects in the endovenous treatment of the great saphenous vein.

Answer 49

T

Question 50

Endoluminal laser ablation utilises a helium-neon aiming beam that is continuously illuminated to ensure that the laser fibre is in the superficial venous system.

Answer 50

T

Question 51

Lymphocoele is an very uncommon adverse event of endovenous ablation.

Answer 51

F Most common.

Question 52

Complications of endovenous laser and radiofrequency treatment and ambulatory phlebectomy include: temporary pigmentation over the treated vein, temporary nerve damage, haematoma, and localised superficial thrombophlebitis.

Answer 52

T