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Purpose: To describe the technique, efficacy, and safety of Endovenous Laser Ablation (EVLA) of incompetent perforator veins (IPV) using a bare tip fiber 1470nm laser alone or in combination with microplebectomy or sclerotherapy in the management of chronic venous insufficiency (CVI) with a competent saphenous system or prior saphenous interruption. Materials and Methods: 171 IPV were ablated in 101 limbs in 87 patients. Outcomes included sonographic occlusion of IPV, subjective changes to patient symptomatology, procedure related side effects (pain, hyperpigmentation) and complications (burns, major bleeds, infections, deep vein thrombosis or paresthesias). Correlation of IPV ablation failure with clinical, perforator and treatment characteritics was assessed using univariate (ANOVA) analysis. Results: 123 IPV were seen in the setting of prior saphenous interruption (76 radiofrequency ablation, 38 surgical stripping, 10 EVLA, 3 sclerotherapy). 48 were seen in the setting of a competent saphenous system. 91 IPV ablations were combined with microphlebectomy, 25 with sclerotherapy and 55 IPV were ablated alone. At 1 and 3 months follow up, 92 and 98% of ablated IPV were sonographically occluded. 10 IPV failed ablation with statistically significant correlation with higher CEAP score (p¼.002) and history of prior GSV interruption (p¼.042). Clinically, 82% and 96% of patients noted complete resolution of insufficiency symptoms at 1 and 3 months respectively. Complications included 5 patients with new onset paresthesias and one nonocclusive DVT. No skin burns, major bleeds or infections or were encountered. Conclusion: EVLA of IPV is effective at achieving IPV closure at 3 months can can be safely perfomed alone or in combination with microphlebectomy or sclerotherapy.

Although infectious complications are rare in interventional radiology (IR), their occurrence can have serious consequences. Considerations for antibiotic prophylaxis and selection of an appropriate antibiotic agent and dosing regimen are essential components of the preprocedural evaluation of patients presenting for IR procedures. As the breadth and complexity of patients and procedures expand, it is critical for the interventional radiologist to have a thorough knowledge of the pathogenesis of infection, the rationale behind prophylaxis in specific clinical scenarios, and the appropriate use of antibiotic agents. The goal of this chapter is to provide the trainee with a comprehensive overview of antibiotic prophylaxis for the most commonly performed procedures in interventional radiology.

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