Phlebolymphology N°99

XII. Thermal tumescent (TT) ablation methods

XII. Thermal tumescent (TT) ablation methods Wavelengths, fibers or way of procedure performance for successful laser ablation? Lessons learned from 15 years of experience Uldis Maurins (Latvia) Laser energy is mainly absorbed by water in the vein wall and water content in the blood. The level of absorption of laser energy with a 1470-nm wavelength laser is 40 times higher than a 980-nm wavelength laser and 40 times lower with the new 1940-nm wavelength laser. The radial fiber, which replaced the bare fiber that heats up to 700°C to 800°C, at a linear endovenous energy density 60 J/cm, heats up…

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XI. Endovenous ablation session

XI. Endovenous ablation session Results of randomized control clinical trial of energy settings in endovenous laser ablation Denis Borsuk (Russia) In a previous study, it was demonstrated that, in endovenous laser ablation for chronic venous disease treatment, using the same linear endovenous energy density with a different power setting is associated with significantly different effects on vein wall damage and tissue depth penetration. The aim of this investigation was to analyze three energy settings for clinical effects in terms of vessel recanalization and procedural pain. Patients with chronic venous disease (C2EpAsPr) were randomized for endovenous laser ablation (n=154) at 5…

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XIII. Non thermal non tumescent (NTNT) ablation methods

XIII. Non thermal non tumescent (NTNT) ablation methods Why does the combination of sclerotherapy and mechanical vein injury works better? Mark Whiteley (UK) Thermal ablation requires transmural damage of the vein wall for fibrosis and long-term ablation. Unlike thermal ablation, sclerotherapy cannot affect deeply located layers of the venous wall, meaning that the success of great saphenous vein ablation after 1 year is no higher then 75%. The combined usage of sclerotherapy throughout the process of mechanochemical ablation (MOCA) should increase the depth of exposure to the vein wall and lead to transmural fibrosis. To prove this hypothesis, a comparison…

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X. Foam sclerotherapy: from the consensus document to the clinical practice

X. Foam sclerotherapy: from the consensus document to the clinical practice Foam sclerotherapy in C1 treatment Neil Khilnani (US) Neil Khilnani compared liquid and foam sclerotherapy and mentioned that liquid is better for small veins (>4 mm) because it dilutes and reduces the surface area of wall contact, which further dilutes the drug. According to a systematic review of more than 500 patients, the prevalence of visual disturbances is 0.09% to 2%; nearly all cases are associated with foam sclerotherapy. The frequency of visual disturbances increases after 15 mL of foam. Using CO2 improves the results of foam sclerotherapy, possibly…

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IX. Compression treatment solutions in vein and lymphatic diseases

IX. Compression treatment solutions in vein and lymphatic diseases Current indications and guidelines for medical compression st Eberhard Rabe (Germany) A review article was published in Phlebology in 2017 concerning the “indications for medical compression stockings in venous and lymphatic disorders” based on a systematic research from Pubmed, including randomized control trials, observational human studies, and reports of use of compression stockings. The recommendation was grade 1b for use of medical compression stockings to alleviate venous symptoms in chronic venous disease, to improve quality of life and venous severity in chronic venous disease, to prevent leg swelling in chronic venous…

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VIII. C0s – towards consensus on the diagnostics and therapy

VIII. C0s – towards consensus on the diagnostics and therapy Epidemiology of C0s- what do we know about? Eberhard Rabe (Germany) Recent CEAP-based studies demonstrated that the prevalence of C0 and C1 patients are around 70%, whereas it is 25% for C2 and C3 patients and 5% for C4 and C5,6 patients. According to the Bonn Vein study I, age was the main effector in the risk analysis for telangiectases, varicose veins, and chronic venous insufficiency. The Vein Consult Program showed that the epidemiology of chronic venous disease was geographically diverse, but the early stages (C0s, C1) were predominate (41.6%)….

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VII. News in the research on the chronic venous disease – pathophysiology, anatomy and symptoms

VII. News in the research on the chronic venous disease – pathophysiology, anatomy and symptoms How vein disease begins – insufficiency in children and adolescents Johann Chrisof Ragg (Germany) Recent studies on the onset of intra and epifascial venous disease show four major components: (i) congenital valve lesions; (ii) stress-induced valve decompensation, as seen in heavy workers or athletes; (iii) stasis-induced inflammatory valve degeneration; and (iv) usually secondary phlebitis. As congenital venous valve damage is the first to occur in life, it should prepare a primary pattern of an individual course of venous disease. Therefore, using high-frequency ultrasound systems (Siemens…

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VI. Innovations in phlebology

VI. Innovations in phlebology Fully percutaneously created or surgically inserted artificial vein valves in CVD treatment – research status and first clinical data Steve Elias (US) The Self Valve study analyzed the SailValve, a new self-expanding deep venous valve concept based on a single polytetrafluoroethylene cusp floating up and down in the bloodstream like a sail acting as a flow regulator and allowing minimal reflux to reduce thrombogenicity. Deployment was technically feasible in all 10 iliac veins and all were patent directly after placement. No perioperative or postoperative complications occurred. Ascending phlebograms in the follow-up animals confirmed the patency of…

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V. What is new in our understanding of the chronic venous disease?

V. What is new in our understanding of the chronic venous disease? Our current understanding of the chronic venous obstruction Christopher Lattimer (UK) Christopher Lattimer explained the different aspects of obstruction, depending on if it is in a vein (anatomical lesion), on a vein (radiological compression), concerned with venous drainage (hemodynamic), or its clinical definition (symptoms and signs). He elucidated the importance of collaterals on the symptoms and signs and emphasized that symptoms and signs are not specific for postthrombotic syndrome. Radiologically following measurements are possible, including the minor diameter, area, shape, length, tortuosity, aspect ratio. He also introduced the…

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IV. Phlebolymphology forum

IV. Phlebolymphology forum Functional relationship of the lymphatic and venous systems in clinical aspect Waldemar L. Olszewski (Poland) The blood and lymph circulation systems arise simultaneously in the embryo. The lymph sacs are formatted from the venous endothelial cells. Peripheral blood (arteries and veins) and lymphatic vessels originate from the same tissue mesenchymal cells. They differentiate into the hematological (blood vessels) or tissue fluid channel (lymphatic channels) structures. Eventually the lymphatic vessels join veins in the subclavian-jugular angle and hundreds of lymphovenous communications in the limbs and the retroperitoneal space. This order of events indicates that both systems are functionally…

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