Phlebolymphology N°99

XXIII. Keynote lectures

XXIII. Keynote lectures Chronic pelvic vein disease 2019 update: what do we know? what we do not know? Mark Meissner (US) Pelvic venous disorders in women can present as chronic pelvic pain, lower extremity and vulvar varicosities, lower extremity swelling and pain, and left-flank pain and hematuria. Multiple evidence gaps exist regarding chronic pelvic disease with the consequence that nonvascular specialists rarely consider the diagnosis. Mark Meissner started his lecture by pointing out that the term “pelvic congestion syndrome” is nonsense and it should be abandoned in favor of “chronic pelvic venous disorders.” Indeed, he highlighted that the term “syndrome”…

Full text

XXII. Diagnostics and treatment of the chronic pelvic vein disease and varicose veins of pelvic origin

XXII. Diagnostics and treatment of the chronic pelvic vein disease and varicose veins of pelvic origin Not all pelvic vein disease cases and varicose veins of pelvic origin are related to the same pathology (doubts and difficulties) Małgorzata Mielnik (Poland) Transvaginal and abdominal duplex ultrasound scanning can be used in diagnosing pelvic vein disorders, but, in most cases, transvaginal duplex ultrasound scanning is not mandatory to make the diagnosis. So far, we have been strongly focused on transvaginal scanning, but not all patients with abnormal transvaginal duplex ultrasound scanning are symptomatic. Ultrasound examination has many limitations; there are no strict…

Full text

XXI. Post-thrombotic syndrome: towards consensus on definition, scoring and effective prevention

XXI. Post-thrombotic syndrome: towards consensus on definition, scoring and effective prevention What is PTS and how we measure this? Mark Meissner (US) The clinical definition of the syndrome is the presence of pain (often described as aching, heaviness, or, in some cases, as venous claudication) with associated swelling and skin changes, which eventually leads to ulceration. In addition, there is evidence of reflux and/or obstruction due to a previous deep vein thrombosis. It has been demonstrated that, after deep vein thrombosis, thrombus organization and recanalization occurs over a period of 6 months with increasing prevalence of reflux reaching 70%. Thus,…

Full text

XX. VTE session

XIX. Focus on varicose vein recurrence The novel anticoagulants for the initial and long-term treatment of VTE: state of the art Paolo Prandoni (Italy) Direct oral anticoagulants are now recognized as the standard of treatment for the majority of patients with venous thromboembolism. Large phase 3 randomized controlled trials showed that direct oral anticoagulants were at least as effective as and safer than vitamin K antagonists. They reduced all major bleeding, particularly intracranial bleeding, which is the most feared complication of anticoagulation. Apixaban and rivaroxaban can be administered with a single-drug approach, using a loading dose for 1 or 3…

Full text

XIX. Focus on varicose vein recurrence

XIX. Focus on varicose vein recurrence What do we need: better technology or better strategy? Varicose veins after saphenous ablation and surgery: disease recurrence or disease progression? Josef Rafetto (US) Josef Rafetto presented the study showing that nonocclusion and early reopening of the great saphenous vein after endovenous laser treatment is fluence dependent, where fluence is calculated as energy (J) per surface area. Recurrence could occur due to tactical errors, as endovenous laser ablation is not a stand-alone treatment, to technical errors resulting from inadequate tumescence, inadequate injury/energy; however, neovascularization is rarely seen. Josef Rafetto explained the pattern of recurrence:…

Full text

XVIII. Chronic deep venous obstruction treatment

XVIII. Chronic deep venous obstruction treatment Chronic venous obstruction endovascular treatment – lesson leaned Michael Lichtenberg (Germany) Over the last decade, the number of endovascular interventions has increased significantly, especially as concerns venous stenting, percutaneous venoplasty, and venous thrombus removal. In Germany, approximately two-thirds of such procedures are conducted in specialized venous centers. Such a center should complete more than 100 intravascular ultrasound scans per year, have a hybrid operation room, and have vascular surgeon interventionists. The price of a case with installing one stent is worth 3193 € or 4122 € if two or more stents are installed. In…

Full text

XVII. Acute deep vein obstruction invasive treatment

XVII. Acute deep vein obstruction invasive treatment Mechanical thrombectomy in acute DVT – lessons learned Michael Lichtenberg In the ATTRACT study, after 24 months, patients receiving pharmacomechanical catheter-directed thrombolysis showed an improved result of treatment vs the patients not receiving pharmacomechanical catheter-directed thrombolysis (Vilalta score, 3.95 vs 5.54 [P=0.03]; venous clinical severity score, 1.98 vs 2.8 [P=0.018]; VEINES score, 28.63 vs 23.02 [P=0.029]). Frequency of bleeding complications in the PEARL registry was 4.5% (minor/major), in the CAVENT study 22% (minor/major), and in the Venous registry 16% minor and 11% major. A meta-analysis (review included 19 articles) of catheter-directed thrombolysis or…

Full text

XVI. Venous leg ulcer forum

XVI. Venous leg ulcer forum Venous leg ulcer treatment – do we really have consensus? Summary of the existing guidelines Giovanni Mosti (Italy) Giovanni Mosti started his talk by citing the Evidence-based clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum, an intersocietal document endorsed by the American College of Phlebology and the Union Internationale de Phlébologie. He illustrated all the steps related to the management of venous leg ulcers. Ulcer cleansing is mandatory at each dressing change with a neutral, nonirritating, nontoxic solution. The debridement is mandatory in the initial inflammatory or infected stage….

Full text

XV. Small saphenous and BTK vein treatment

XV. Small saphenous and BTK vein treatment Surgery, thermal or non-thermal treatment in the SSV treatment? Marc Vuylsteke (Belgium) Incompetence of the small saphenous vein is observed in 10% to 15% of patients with chronic venous insufficiency and 29% of patients with severe chronic venous insufficiency or truncal vein incompetence. The small saphenous vein is located near the saphenous nerve, with an average distance between them of 3 to 4 mm. There are 5 different types of saphenopopliteal junctions. Surgical treatment of small saphenous vein incompetence is characterized by low anatomical success with a high recurrence rate (30% to 50%)…

Full text

XIV. Complications and failures in phlebological treatment

XIV. Complications and failures in phlebological treatment Underuse, overuse, or misuse of the phlebological treatment? – treatment overuse or insufficiently trained operators Martin Schul (US) Martin Schul presented a clinical case and an example treatment overuse. In one patient, an ablation procedure was performed for three veins, but there was no evidence of reflux in any image. We have benchmarks of 1.6 to 1.7 ablations per patient. Overutilization is widespread and involves every specialty. Underutilization is often in patients with leg ulcers. They required on average 0.37 more ablation procedures vs nonulcer patients. On the other hand, early intervention was…

Full text