in 10 YEARS


WHAT COMES NEXT?


In 10 years, I would like to see further development of IR as a clinical,


primary specialty with dedicated subspecialty fellowships focusing on areas such as peripheral arterial disease and lymphatics. This would help us move further away from diagnostic radiology, much like radiation oncology has.


—SCOTT O. TREROTOLA, MD, FSIR


of altered flow dynamics in the post- thrombotic state is markedly limited. As learned from extensive research in the arterial literature, alteration of flow dynamics in the disease states likely contributes to failed outcomes after endovascular interventions. High-yield areas of future research on venous interventions include investigation of the association of such flow dynamic alterations with the inflammatory pathway and subsequent clinical outcomes such as stent thrombosis and in-stent stenosis. Understanding this association will provide invaluable insight for development of next-generation deep venous interventional techniques and devices with improved clinical outcomes.


Superficial venous disease Superficial venous disease management has undergone evolution over 20 years—beginning with the adoption of thermal ablation modalities to the recent advancement of nonthermal, nontumescent (NTNT) technologies (cyanoacrylate glue closure and chemical ablation), and the development of mechanicothermal techniques. Thermal ablative tools such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have proven records of being safe, effective and durable in eliminating varicose veins with reported success rates of vein obliteration in 88–100% of treated great saphenous veins (GSV) and 88–96% of treated small saphenous veins (SSV).3


The NTNT


technologies have also produced excellent results for vein obliteration and occlusion, at 94.4% at 3 years following glue closure, 87% at 3 years following mechanicothermal


2002


techniques, and 86% at 3 months for chemical ablation.4–6


These safe and


effective treatments performed in conjunction with sclerotherapy and ambulatory phlebectomy are the current standard of practice to achieve quality of life improvement in this large patient group.


Another major advance in superficial venous disease management is the improved classification of the disease and validated scoring systems to assess for changes. The Varicose Vein Symptom Questionnaire (VVSymQ) asks patients to rate heaviness, aching, swelling, throbbing and itching on a scale and produces a validated metric for assessment of the clinical impact of varicose veins and their treatment.7


The revised Clinical-Etiology-


Anatomy-Pathophysiology (CEAP) classification has also been updated in 2020 to better reflect the impact of superficial venous disease.8


Further advances in saphenous vein ablative techniques continue to occur, including endovenous microwave ablation (EMA), high intensity focused ultrasound (HIFU), endovenous steam ablation and novel sclerosant devices. EMA has shown promising results in initial comparative studies with EVLA resulting in a shorter procedure time, decreased induration and ecchymosis, and lower rates of parasthesias with successful vein closure up to 1 year.9


HIFU may be the


next disruptive technology in venous ablation due to the entirely noninvasive nature of the technique, which generates heat at a precise point via a linear ultrasound array transducer without the need for invasive tools or tumescent anesthesia.10


Endovenous steam ablation has been studied for several 2003 2004 2005 2006 2007 2008 2009


Yttrium 90 is sanctioned as a first-line therapy for colorectal metastastes.


Members vote to rename SCVIR to the Society of Interventional Radiology (SIR).


16 IRQ | SPRING 2021 SUPPLEMENT


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