Optimizing EVTA: Importance of VWT and Device Size

Catheter-based endovenous thermal ablation (EVTA) under tumescent anesthesia is the standard treatment for truncal venous reflux. However, a new mathematical model suggests that doctors may need to consider more than just vein diameter when selecting treatment settings and protocols.

The study, conducted by Timothy J Fernandez-Hart, Scott J Dos Santos, and Mark Steven Whiteley, constructed a mathematical model to predict vein wall thickness (VWT) during EVTA of veins of different diameters, initial wall thicknesses, and device diameters.

The researchers applied a set of representative vein diameters and thicknesses, and common device diameters to the model. They found that vein walls would thicken when constricted compared to their initial state. Veins that initially had thicker walls and larger diameters had thicker walls when constricted than thin-walled or small-diameter veins, using the same size EVTA devices.

Interestingly, the study found that, for each vein, as the diameter of the device decreased, the constricted VWT increased. This suggests that initial VWT followed by the size of the EVTA device are more important variables than vein diameter alone when selecting treatment parameters.

The findings challenge the current trend of making EVTA devices thinner, as this may be disadvantageous for patients. Thinner devices may increase the constricted VWT at treatment, making adequate thermal penetration harder to achieve.

The study’s authors conclude that their model provides essential insights into optimizing EVTA treatments for a range of vein sizes and wall thicknesses. Doctors may need to consider both vein diameter and initial VWT when selecting treatment parameters, and thicker EVTA devices may be necessary for adequate thermal penetration in thicker-walled veins.

In summary, this new mathematical model sheds light on how to optimize EVTA treatments, highlighting the importance of considering more than just vein diameter when selecting treatment parameters. The study suggests that thicker EVTA devices may be necessary for adequate thermal penetration in thicker-walled veins, challenging the current trend of making EVTA devices thinner.