In this case presentation, Dr. Jeffrey Carr demonstrates treatment of a medial ankle perforator vein using the Venclose Maven™ Perforator Catheter. This case highlights a tortuous perforator anatomy, along with an alternative access approach utilizing a 12-gauge Angiocath™ IV Catheter to support effective entry into the target vessel.
The patient is a 74-year-old male with a venous clinical severity score of 24 and a CE classification 5 clinical score. Symptoms include leg swelling, muscle cramps, leg heaviness, tiredness, and fatigue. The patient previously had the small saphenous vein ablated with radiofrequency ablation. The incompetent perforator vein is located 17 centimeters from the heel and 8 centimeters from the tibia. The diameter of the perforator is 6.4 millimeters and reflux time 570 milliseconds. The incompetent perforator vein is located here. And the fascia layer is here. Superficial tissue is above the layer, and deep tissue below. Use duplex ultrasound to obtain a clear view of the incompetent perforator vein at the level of the deep fascia and deep venous system. Line up the perf to the corner of the ultrasound screen in longitudinal view. Ensure the skin is marked where the perforator is located prior to treatment and ensure the probe is perpendicular to the skin. Administer local anesthesia to the access site. Make a skin, nick. If using an angiocah IV catheter, insert the angiocah IV catheter until flashback appears and confirm position with ultrasound. If using an introducer sheath, insert the wire and compatible introducer sheath over the wire. Verify intraluminal position in transverse view. If using an angio cath IV catheter, remove the needle and insert the Venlo Maven perforator catheter and advance the tip to the desired treatment start location under direct ultrasound visualization to ensure that the catheter is positioned appropriately. Pull back the introducer sheath or angiocath IV catheter to visualize catheter markings at the skin. Confirmed positioning of the Venclose Maven perforator catheter. Here you can visualize where the catheter is placed. It is recommended the catheter heating element is placed at or below the level of the deep fascia. Administer local anesthetic. The ultrasound technician turned the probe around to get a better view prior to treatment. Again, the physician should confirm positioning of the catheter tip. Inject tumescent anesthesia adjacent to the vein wall to create a layer of fluid around the vessel. Ensure, the distal tip of the catheter is at least 0.5 centimeters from the skin, deep system, and adjacent arteries. Ensure good vein wall apposition with the heating element by applying external compression. Deliver treatment by pressing the button on the handle or stepping on the optional foot pedal. 22nd treatment cycle at a set temperature of 130 °C begins. Multiple heating cycles can be performed at each segment based on anatomy and physician discretion. If multiple treatment segments are planned, pull the catheter back 0.5 centimeters and repeat treatment. Once treatment is complete, remove the catheter. You can see here the treated perforator vein and that it's noncompressible. No flow or occlusion is confirmed. Confirm patency of deep veins and apply external compression.
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