We usually enter the saphenous vein below the knee level and place in upwards to the saphenofemoral junction. In 2 cases of mine, who were morbid obese, I tried this method and I thought it may be helpful in some cases. Especially in patients who can not be cannulated from below the knee level due to various reasons.
Original approach! May be useful in specific situations. I never had tried this. I suppose there are some disadvantages: 1. Technically probably the puncture is more difficult and more dangerous. 2. Retrograde passage of fiber/catheter may meet valve resistance. 3. It is difficult to perform the flush ablation with no stump in such a technique. 4. There are always problems with adequate compression in the groin/upper thigh. In difficult situations I use the saphenous tributary as a route to the main trunk.
PS. Try to publish this technique.
We often use this technique for venous ulcers.
http://www.ncbi.nlm.nih.gov/pubmed/24347131
http://www.ncbi.nlm.nih.gov/pubmed/23969489
Unsure of benefit in morbidly obese - we usually find the apron to be more difficult than a thick leg. However interesting - variation of cryostripping really
Thank you Dr.Casian.
In first case, i could not push the RF catheter more than 12-15 cm from the junction. As you said it has probably attached to a valve. But very interestingly with a long valsalva maneuver and a little pull back it moved downwards easily to below the knee. There wasnt such a problem in 2nd patient.
Thanks for advice.
Best Regards..
Cemal.
I think this technique is useful in special situations in which catheterization or advancing RF or Laser probe toward SFJ from distal is difficult or impossible ( sever saphen spasm , very tortous varicosities , previous phelebitis ....) .I had 2 patients I used retrograde probe insertion . It is important that insertion point of sheath must not be longer than 20 mm from SFJ which may be difficult in obese patients.
Thanks for good question
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