EVF-AVF Joint Session: New Techniques and Pelvic Care

Laser Crossectomy Technique Refinement

Keeping the laser fiber tip within five millimeters of the femoral vein junction with adequate tumescence reduced early recurrence over years of practice, and long term follow up found low neovascularization and durable occlusion at both the saphenofemoral and saphenopopliteal junctions.

Emerging Superficial Technologies

A non-thermal dual syringe catheter aspirates blood while injecting sclerosant into a collapsed vein, a focused ultrasound device seals veins transcutaneously without punctures, and a thermal imaging device screens for varicosities by skin temperature before ultrasound referral.

Deep Valve Reconstruction Strategy

A proposed algorithm treats obstruction first, since two thirds of chronic venous insufficiency involves combined obstruction and reflux, reserving valve reconstruction for patients who remain symptomatic, noting ambulatory venous pressure often stays unchanged despite clinical improvement.

Pelvic and Labial Varicosities in Pregnancy

Most labial and vulvar varicosities in pregnancy resolve with compression and positioning, but ultrasound is warranted for unilateral swelling, early presentation, or phlebitis, while postpartum pelvic symptoms get venography and coiling and surface symptoms get targeted sclerotherapy.