Charing Cross Vascular Meeting
Treatment of varicose veins 1. Guidelines 2. Pelvic and vulvar varicose veins 3. Thermal ablation 4. Mechanoablation 5. Glue 6. Sclerotherapy 7. CX Office-based Vein Practice Course 8. Other
Phlebolymphology N°84
2.5 Thermal ablation
Endovenous therapies of saphenous veins, the evidence. R. van den Bos Endovenous thermal ablation (EVTA) techniques are commonly used and very effective for saphenous vein insufficiency and are recommended as first-choice treatments in several national guidelines (UK, USA, and Holland). The author presented the first large meta-analysis on great saphenous vein (GSV) treatment from randomized controlled trials (RCTs) only (Siribumrungwong et al. Eur J Vasc Endovasc Surg. 2012;44:214-223). This study analyzed the efficacy, complications, postoperative pain, time to return to normal activities, and QOL scores. Endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and surgery were equally effective. Ultrasound-guided foam sclerotherapy…
2.4 Sclerotherapy
Sclerotherapy treatment of telangiectasies by ultrasound guidance. C. Hamel Desnos The author started by stressing the importance of a right initial mapping to ensure the success of the treatment. To perform this mapping, according to the author, an adequate clinical examination with careful observation (frequently using cold light) and ultrasound imaging are necessary. In fact, insufficient or no treatment of the underlying reflux is the cause, in many cases, of matting. Even if it can be difficult to perform sclerotherapy treatment of small and very superficial veins under ultrasound imaging guidance, the use of an adequate technique can be the…
2.3 Venous Malformation
Vascular malformation classification: Hamburg or ISSVA classification? A. Bisdorff Bresson According to the author, the term “angioma” is often incorrectly used in literature to name both vascular tumors and vascular malformations. Vascular malformations are congenital developmental errors concerning the lymphatic, arterial, and/or venous system. They might be present at birth, but are not always seen. They can appear in childhood, adolescence, or adulthood, but will never disappear. The Hamburg classification (1993) classifies the vascular malformations according to the type of predominant vessel. This classification system is used mainly by vascular surgeons. The classification differentiates between truncular and extratruncular lesions as…
2.2 Iliofemoral vein
Acute thrombosis for iliofemoral veins: thrombolysis or pharmaco-mechanical thrombolysis? A. Camerota Acute iliofemoral deep vein thrombosis (DVT) is associated with the most severe postthrombotic morbidity when treated with anticoagulation alone. According to the author, patients submitted to thrombectomy compared with anticoagulation alone have improved latency, lower venous pressures, less leg swelling, and fewer postthrombotic symptoms. Catheter directed thrombolysis (CDT) has been shown to reduce postthrombotic morbidity, improve quality of life, and reduce recurrent DVT. The addition of external pneumatic compression devices to the leg being treated with CDT has been shown to accelerate lysis to noncompressed limbs. In conclusion, both…
1.2 Abdominal Aortic Aneurysms (AAA)
Can stent graft design influence cardiac outcome? C. Liapis Endovascular aortic repair (EVAR) is associated with lower perioperative mortality and morbidity rates compared with open surgical repair. This advantage is blunted in the long-term, mainly due to an increase in cardiovascular complications (Stather PW et al. Br J Surg. 2013;100:863-872). Arterial stiffening together with an adverse cardiac function after stent-graft implantation may explain this change in the long-term outcome. In fact, there is evidence of: (i) an increased arterial stiffness and biomarker elevation 1 year after EVAR, which is related to the endograft type (polyester more than polytetrafluoroethylene; Kadoglou NP…
1.3 Carotid stenosis
Risk stratification methods for asymptomatic carotid plaques. S. Kakkos The incidence of stroke, in patients with asymptomatic carotid artery stenosis >60% randomized to the medical arm of the ACAS (Asymptomatic Carotid Atherosclerosis Study) and ACST (Asymptomatic Carotid Surgery Trial) studies, has been shown to be 2% per year, while in the surgical arm, carotid endarterectomy, in carefully selected patients, reduces the risk of stroke to 1% per year. Therefore, 100 surgeries are needed to prevent one stroke in one year, so up to 94% of the interventions may not benefit the patient. Additionally, the improving results of the current medical…
1.4 Superficial femoral artery (SFA) and stents, visceral arteries, and leg arteries
1.4.1 Controversy: Do we really need a stent in long SFA lesions? No: Drug eluting balloons (DEB) are the answer. T. Zeller The author started by presenting recent data regarding subintimal angioplasty of transatlantic inter-society consensus II class C/D lesions (TASC II C/D lesions), stressing a primary 12-month patency of 52% to 73% (Sidhu R et al. Vasc Endovascular Surg. 2010;44:633-637; Kim SJ et al. Circ J. 2010;74:1959-1964). Then, he introduced several studies and a meta-analysis concerning the results of the drug-eluting balloon (DEB) in the superficial femoral artery (SFA), showing a clear benefit of DEB compared with standard angioplasty…
1.5 Critical limb ischemia
1.5.1 Controversy: Critical limb ischemia. Endo or open first? Endo is the first choice strategy. K. Deloose Surgical bypass has been the gold standard for revascularization in the critical limb ischemic (CLI) patient for years now. In fact, it allows a 5-year limb salvage rate >80%. However, it has a 5% mortality rate, 10% to 20% incision wound complications. In 20% to 80% of successful patent bypasses, there is a recurrent or persistent ulcer or wound at one year. It has also been shown that bypass surgery induces a 12% decline in deambulation and a 15% loss in independent living…
