TRLOP perforators – Veins

Which veins are suitable for TRansLuminal Occlusion of Perforators (TRLOP)?

The transluminal occlusion of perforators (TRLOP) technique is useful to close any small vein that is incompetent and is allowing blood to pass from deep to superficial. The situations where transluminal occlusion of perforators (TRLOP) is most useful are:
  • Incompetent perforating veins (IPV) of the leg and sometimes foot
  • Incompetent neovascular channels connecting deep veins with superficial veins – often at the site of previous open surgery such as high saphenous tie in the groin or small saphenous tie at the back of the knee
  • Abnormal incompetent veins connecting intramuscular veins with superficial venous abnormalities, which are found in some venous malformations
Veins that are running in the superficial fat (more or less parallel with the skin) and with at least a couple of centimetres for the device to travel through, do not need transluminal occlusion of perforators (TRLOP) and are easily treated by endovenous laser ablation (EVLA) and most of the bipolar radiofrequency ablation (RFA) techniques although it would have to be longer than 7 cm if VNUS closureFAST was to be used.
With transluminal occlusion of perforators (TRLOP), the section of vein to be treated is usually very short, and can be very close to the deep-vein – particularly around the ankle. It is therefore essential to choose an optimal device to perform the transluminal occlusion of perforators (TRLOP) procedure.
When transluminal occlusion of perforators (TRLOP) was first described, the device used was the bipolar VNUS Closure radiofrequency catheter. This had the advantage of only heating and therefore treating the vein wall that was directly in contact with the bipolar electrodes. There was little or no risk of heat travelling forwards and damaging the deep-vein or causing a deep vein thrombosis (DVT). It was pointed out that other devices could be used for transluminal occlusion of perforators (TRLOP) although concerns were expressed about any device that did not treat the vein wall accurately and locally to the end of the device. To this end, VNUS developed a device specific for the transluminal occlusion of perforators (TRLOP) procedure called the VNUS RFS (radiofrequency stylet).
Some doctors who saw the advantages of transluminal occlusion of perforators (TRLOP) started using endovenous laser ablation (EVLA) fibres. However it is important to note that the early endovenous laser ablation (EVLA) fibres pass the laser beam and hence energy forwards, which when the fibre is in the incompetent perforating vein (IPV) means that this energy can damage the deep vein or cause a deep vein thrombosis (DVT).
Therefore the inventors of the transluminal occlusion of perforators (TRLOP) technique always advised against use of end firing endovenous laser ablation (EVLA) fibres for transluminal occlusion of perforators (TRLOP). Over the last few years, a new endovenous laser ablation (EVLA) device has been developed and is now available. This is the radial firing endovenous laser catheter made by Biolitec. This catheter has the unique advantage that the laser energy does not come out of the end of the device, but at right angles, and hence directly into the vein walls at the tip of the device.
Therefore transluminal occlusion of perforators (TRLOP) can now be safely performed with endovenous laser ablation (EVLA) provided the device used is the Biolitec radial firing catheter.

Next page: How is TRLOP performed?

This website was last updated on 11/10/16.