Phlebolymphology N°84

1. Generalities

Evolution of chronic venous disorders (CVD) from 18 to 88 years according to parental heredity. About 21 318 patients. V. Crébassa Data from a large French prospective, observational, multicentric study that involved 21 318 consecutive adult patients were presented. Some of the conclusions drawn from the data are unexpected. The odds ratio of chronic venous disease (CVD) is 8.6 if the patient has paternal heredity, while it is 5.0 when it is a maternal. CVD was also shown to be more frequent and symptomatic for women. Chronic venous disease: Inherited or acquired? P-L. Antignani, N. Labropoulos, E. Bouskela Despite being…

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8. Other

Duplex scanning is not mandatory after treatment for saphenous reflux. L. Kabnick The goal of routinely performing a postoperative duplex scan after endothermal ablation of the saphenous, veins is to detect endovenous heat-induced thrombosis and to evaluate the treatment’s efficacy. In the USA, greater than 300 000 endovenous procedures are performed annually. The overall incidence of endothermal heat-induced thrombosis is 3% to 4% and if we exclude thrombosis class 1, which are out of clinical significance, the overall rate falls to 1% to 2%. The majority of these thrombi will disappear within 7 to 10 days with no additional sequelae….

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7. CX Office-based Vein Practice Course

The CX Office-based Vein Practice Course was led by Ian Franklin (Imperial College, London, UK) and it covered a wide range of techniques and procedures. Over the two days, the course welcomed more than 700 participants. We were granted the unique opportunity to view demonstrations and try office-based venous devices and procedures with the guidance of experienced tutors. The course was set up in a very flexible format so we could go to the training stations we were interested in (we could have one-on-one or small group interactions with world experts). The Day 1 practice course strongly emphasized practical skills…

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6. Sclerotherapy

Catheter-directed foam with tumescence. A. Cavezzi Using foam sclerotherapy on larger saphenous diameters results in a higher recanalization rate. Larger veins require higher doses, which increases the deep vein thrombosis rate and the risk of cerebral complications. Moreover, stagnating and inflowing blood within veins neutralizes foam in a few seconds. To reduce the diameter of the vein and the blood inflow, the author describes a new foam sclerotherapy approach using a perisaphenous tumescence infiltration with an intrasaphenous flushing with saline solution through a long catheter. After using this technique for refluxing great saphenous veins (GSV) with concomitant phlebectomies on varicose…

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5. Glue

Glue. K. Gibson There are many opportunities to improve current treatments for varicose veins: eliminate need for tumescent anesthesia, eliminate the need for compression stockings, significantly reduce postprocedure pain and bruising, and improve current treatment closure rates to >90%. The VenaSeal Sapheon Closure system is a new device using cyanoacrylate adhesive to embolize the saphenous veins safely and effectively through a catheter and a dispenser gun. The catheter is engineered to be inert to adhesive and to not stick, and the dispenser gun is designed to deliver a precise amount of glue into the vein. A feasibility study, a European…

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4. Mechanoablation

CLARIVEIN. M. Reijnen Mechanicochemical ablation (MOCA) is a new technique for saphenous vein treatment. It combines mechanical endothelial damage using a rotating wire with the infusion of a liquid sclerosant. Heating the vein and tumescent anesthesia are not required, only local anesthesia is used at the insertion site. As MOCA generates no heat, it is related to a very low incidence of major complications. It is a fast and safe technique for both great saphenous vein (GSV) and small saphenous vein (SSV) insufficiency. The early results are promising with acceptable closure rates (88% at 1 year with three partial recanalizations…

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3. Thermal ablation

Is all heat the same and does catheter design matter? M. S. Whiteley Endothermal ablation is less invasive than traditional surgery with reduced side effects and a faster recovery period. Many different devices have been developed by different companies, but questions remain regarding whether the heat produced differs between different devices and how the catheter design influences the energy distribution to the vein wall. The linear endovenous energy density (LEED) is a measure of the heat energy delivered to the vein wall in Joules (J)/cm of vein treated. The power of the device is measured in watts (W) and one…

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2. Pelvic and vulvar varicose veins

Debate: Pelvic vein reflux must be treated before addressing leg veins For the motion. J. Brookes In males, varicocele of the gonadal veins is a relatively common occurrence that is easily recognized by clinical examination. The same occurs in the gonadal veins of women, but the deep ovaries hide the presence of varicosities to external examination. The deep iliac veins have three fields of drainage and may be incompetent alone or in combination with gonadal veins. They may drain to the leg directly or via pudendal tributaries. Diagnosis of pelvic venous insufficiency is clinical and is confirmed with imaging. Dynamic…

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1. Guidelines

NICE guidelines and comparative effectiveness in the treatment of chronic venous disease. A. Davies The National Institute for Health and Care Excellence (NICE) in the UK analyzes and assesses the treatment for varicose veins. In 2010, it was shown that day-case procedures were all cost-effective with surgery being the most cost-effective, but the guidelines have also shown that despite modern advances and day-case surgery, patients expect an extended period off work! The progression of the disease is still poorly understood. Body mass index, female sex, and increased age were associated with increased rates of disease progression and a weaker association…

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