Stephen Bird

In that case I think it is simpler,

Nobody is wanting to use the vein for anything, just get rid of it!

So tributaries matter much less as once you choke off the source they are not going to be a problem.

Perforators are also of little interest.

What matters is “can they pass the catheter down the vein to achieve the ablation?”

And the things that concern them are not perforators or varicose tributaries.

The things that do concern them are anything that will stop the free passage of the catheter. For example clot, fibrin strands and severe tortuosity.

The real gurus for this stuff are Martin Neccas and Rob McGregor.

I have seen Martin do a hand held mechanical volume of the thigh with a standard linear array and then once the volume is saved he does a “birds eye view” showing the topography of the GSV and tributaries.
It looks like aerial photo of the river Murray. Very cool.

This lets the treating Doctor see the path the catheter must take and helps to hatch a plan.

Another thing that often concerns them is when the GSV comes out of its sheath and ends up close to the skin.

If the GSV comes out of its sheath and gets close to the skin measure a vein to skin distance as they may use extra tumescence to prevent skin damage.


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