In this case presentation, Dr. Jeffrey Carr demonstrates treatment of a mid-calf perforator vein using the Venclose Maven™ Perforator Catheter. This case features a straight perforator anatomy, allowing for a more direct procedural approach, along with access using a 12-gauge Angiocath™ IV Catheter.
The patient is a 68-year-old male with a venous clinical severity score of 37 and a CEP classification 5 clinical score. The patient has type 2 diabetes with hypertension and experiences numbness, tingling, and swelling. The incompetent perforator vein is located 29 centimeters from the heel and 10 centimeters over from the tibia. The diameter of the perforator is 3.5 millimeters and reflex time 890 milliseconds. 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 neck. 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. If using an angio cath IV catheter, remove the needle from the angio cath IV catheter. Insert the Venlose 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 angiocah IV catheter to visualize catheter markings at the skin. Here you can visualize where the catheter is placed. It is recommended the catheter heating element be placed at or below the level of the deep fascia. Administer local anesthesia. Then 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. Prior to treatment, if possible, place the catheter's heating element at or below the deep fascia for the first treatment segment. Use fluid anesthesia to protect deep veins. 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. Confirm occlusion of treated vein, and confirm patency of deep veins with ultrasound. Apply external compression.
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