Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy
- 115 Downloads
Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (κ) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo.
KeywordsOptical coherence tomography Endovenous laser therapy Endovenous radio-frequency therapy
We thank our research staff at the Ludwig Maximilians University of Munich. A substantial part of the data of this study originated from the doctoral theses of cand. med. Kathrin Hunger. The study was partially funded by the Friedrich-Bauer-Stiftung. Dr. Meissner served as a consultant for Siemens AG, Medical Solutions, during the time this study was conducted.
- 8.Meissner OA, Rieber J, Babaryka G, Oswald M, Reim S, Siebert U, Redel T, Eibel R, Mueller-Lisse U, Reiser M, Mueller-Lisse UG (2006) [Intravascular optical coherence tomography: differentiation of atherosclerotic plaques and quantification of vessel dimensions in crural arterial specimens]. Rofo 178:214–220PubMedGoogle Scholar
- 9.Feied C, Min RJ, Weiss R, Zimmet SE, Hashemiyoon R (2005) Varicose vein treatment with endovenous laser therapy. http://www. emedicine.com/derm/topic750.htm
- 14.Proebstle TM, Lehr HA, Kargl A, Espinola-Klein C, Rother W, Bethge S, Knop J (2002) Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg 35:729–736PubMedCrossRefGoogle Scholar
- 15.Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Schuller-Petrovic S, Sessa C (2003) Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg 38:207–214PubMedCrossRefGoogle Scholar
- 16.Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Sessa C, Schuller-Petrovic S (2005) Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg 29:67–73PubMedCrossRefGoogle Scholar
- 18.Perkowski P, Ravi R, Gowda RC, Olsen D, Ramaiah V, Rodriguez-Lopez JA, Diethrich EB (2004) Endovenous laser ablation of the saphenous vein for treatment of venous insufficiency and varicose veins: early results from a large single-center experience. J Endovasc Ther 11:132–138PubMedCrossRefGoogle Scholar
- 19.Rautio T, Ohinmaa A, Perala J, Ohtonen P, Heikkinen T, Wiik H, Karjalainen P, Haukipuro K, Juvonen T (2002) Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg 35:958–965PubMedCrossRefGoogle Scholar
- 21.Schmedt CG, Sroka R, Steckmeier S, Meissner OM, Babaryka G, Hunger K, Ruppert V, Sadeghi-Azandaryani M, Steckmeier BM (2006) Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insufficiency in an ex-vivo model. Eur J Vasc Endovasc Surg 32:318–325PubMedCrossRefGoogle Scholar
- 36.Jang IK, Bouma BE, Kang DH, Park SJ, Park SW, Seung KB, Choi KB, Shishkov M, Schlendorf K, Pomerantsev E, Houser SL, Aretz HT, Tearney GJ (2002) Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol 39:604–609PubMedCrossRefGoogle Scholar
- 39.Rieber J, Meissner O, Babaryka G, Reim S, Oswald M, Koenig A, Schiele TM, Shapiro M, Theisen K, Reiser MF, Klauss V, Hoffmann U (2006) Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex-vivo coronary specimens: a comparison with histology. Coron Artery Dis 17:425–430PubMedCrossRefGoogle Scholar