title: Fluoroscopic-guided approaches to radiofrequency vein ablation.
abstract: OBJECTIVE
  Ultrasound-guided antegrade access during endovenous lower-extremity vein ablation may be problematic. This study describes fluoroscopic-guided retrograde access to the target veins in cases in which antegrade access proved unfeasible.
  
  
  METHODS
  The retrograde technique was used to treat a total of 38 legs in 33 patients in whom antegrade access failed. This approach was selected because of small caliber or spasm of the proximal (ie, lower) great saphenous vein (GSV; n = 22), proximal (ie, lower) GSV spasm during access (n = 2), previous incomplete vein ablation (n = 7), skin disease over the proximal GSV (n = 6), and tortuous proximal GSV anatomy (n = 1). Thirty-two legs were treated with an ipsilateral retrograde approach and six were treated with a contralateral retrograde approach. Radiofrequency ablation with or without sclerotherapy was then performed.
  
  
  RESULTS
  The technical success rate for retrograde access and subsequent ablation was 100%. No procedural complications occurred. At 1 month, five patients with active ulcers exhibited ulcer healing (100%).
  
  
  CONCLUSIONS
  The fluoroscopic retrograde approach can be used to treat GSV reflux when traditional antegrade access is not feasible.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Yale New Haven Hospital, Saint Raphael Campus, New Haven, CT 06511, USA. nicholasperosi@gmail.com
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Perosi
authors.forename: Michael G
authors.initials: MG
authors.lastname: Johnson
authors.forename: Turgut
authors.initials: T
authors.lastname: Berkmen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods*; D015911:Sclerotherapy / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000628:therapy*