Endovenous steam ablation is an emerging technique for the treatment of saphenous trunks and large varicose tributaries. It acts by denaturing the collagen and proteins in the vein wall which cause it to shrink. Each pulse of steam releases only 0.08 cc of water equivalent making the amount of haemolysis insignificant. The first 2 pulses of steam are below the required temperature so it is customary to prime the device by applying 2 pulses at the top first before the working temperature is reached. Like all endo-thermal ablative (ETA) procedures, tumescence is required to protect the nerves, skin and surrounding tissues.
UĞUR BENGISUN The procedure is performed under local tumescent anaesthesia on an ambulatory basis. The method is similar to endovenous laser and radio-frequency thermal ablation. The flexible steam catheter is only 1.2 mm (5F) in diameter and can be introduced through a standard 16G infusion catheter. It has 2 side-holes at its tip where it emits the superheated steam at 120 degrees centigrade. After cannulation of the GSV, the steam ablation catheter is positioned 2-3 cm distally from the SFJ. Unlike EVLA, a graduated marking sheath is not required and guide wires are not necessary for cannulation. Ultrasound-guided tumescent anaesthesia is applied along the length of GSV to reduce the pain, to cool the peri-venous tissues and to decrease the vein diameter. The dose delivered to the vein is 3-5/pulses per centimetre as the catheter is withdrawn in 1 centimetre increments.
We started using steam in February 2013 and were the first to use this method in Turkey. We realised its potential over other endovenous methods. It has better occlusion rates than foam and operates at lower temperatures in comparison to laser, making perforation rare. Furthermore, laser protection precautions are not required. In comparison to RFA the catheter is thinner and more manoeuvrable, especially if used within smaller tortuous veins. Like all other ETA techniques our preliminary results have shown that steam ablation provides a high obliteration rate (approaching 100%). Patients are very satisfied with minimal postoperative pain and a rapid return to normal activities.