Indication for procedure:

Procedure including risks and benefits was explained to patient. Informed consent obtained. Procedure was done under sterile technique and local anesthesia.

Procedure:
Duplex ultrasound was used to map out the insufficient saphenous vein, and access was determined and marked on the overlying skin. The patient was placed supine on the procedure table and the leg was prepped and draped using sterile technique.

Ultrasound guidance was again used to localize the access site. 1% lidocaine was injected as a local anesthetic in the subcutaneous tissues at the target location in the GSV in the lower leg. Using ultrasound guidance, access was gained at this location with the 19 gauge thin walled access needle and followed by introduction of a short guidewire, location confirmed with ultrasound. A small, 3 mm incision was made at the access site to allow for introduction and placement of the 7 Fr x7cm introducer/dilator. The dilator and guidewire were removed. The 0.035 guidewire from the Venaseal kit was then introduced and positioned at the saphenofemoral junction using ultrasound guidance. The 80 cm 7 Fr introducer sheath/dilator was positioned 5cm from the saphenofemoral junction. The guidewire and dilator were removed, and the remaining sheath was flushed with sterile saline, with the syringe remaining in place prior to the next steps.

The cyanoacrylate adhesive was precisely primed into the 5 F delivery catheter and this catheter/syringe combination was attached within the dispenser gun. This “assembly” was introduced through the 7 F sheath and positioned 5 cm caudal of the saphenofemoral junction under ultrasound guidance. The steps from the IFU were followed for dispensing amounts, locations and compression times, e.g 2 aliquots proximally with 3 minutes of compression, and 1 aliquot every 3cm distally with 30 sec of compression along the course of the vessel. Following the last injection and compression sequence, the catheter and introducer sheath were pulled out from the access site. Hemostasis was achieved with manual compression and an adhesive bandage was applied to the incision. Ultrasound confirmed complete coaptation and closure of the treated segments of the GSV, and the absence of any DVT at the saphenofemoral junction.

Treatment time was approximately _____ minutes and the vein length treated was _______cm.
The drapes were removed and the patient cleaned and prepared for discharge.

Impression:
Successful vein ablation of the _____ great saphenous vein using Venaseal.
Post ablation ultrasound demonstrated complete occlusion of the GSV and patency of the deep venous system (femoral vein).