WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON

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1 WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON

2 Disclosure of Interest I have the following potential conflicts of interest to report: Consulting: Medtronic

3 WHAT ABOUT REVAS? Source of reflux «Trunck»= reflux transmission Varicose veins = Low pressure tank Re-entry leg perforators THE TREATMENT HAS TO BE THE MOST COMPLETE AND THE LESS INVASIVE

4 THE ANATOMOPATHOLOGY IS SPECIFIC Neovascularization Van Rij AM et al J Vasc Surg 2004;40: Residual trunck Recanalization Perforators

5 SPECIFIC LESIONS Neovascularization Residual trunck Recanalization Perforators

6 SPECIFIC LESIONS Neovascularization Residual trunck Recanalization Perforators Munasinghe A et al. Br J Surg. 2007;94:840-3

7 SPECIFIC LESIONS Neovascularization Residual trunck Recanalization Perforators

8 SPECIFIC LESIONS CLASSIC SURGERY ALTERNATIVE Neovascularization Residual trunck Recanalization Perforators INAPPROPRIATE DIFFICULT TRAUMATIC EXTENSIVE PHLEBECTOMIES WITHOUT GROIN REDO SURGERY Pittaluga et al, J Vasc Surg, 2010 ENDOVENOUS ABLATION OF RESIDUAL TRUNCK Theivacumar et al, EJVES, 2011 ULTRASOUND GUIDED FOAM SCLEROTHERAPY

9 HOW TO PERFORM UGFS? POLIDOCANOL SULFATE TETRADECYL 1-3% FOAM PREPARATION: Tessari, 1:4 Access site: Needle, cannula, butterfly, catheter Volume: max 10ml / session Contraindications: Right to left shunt (PFO) Migraine Tessari L et al. Dermatol Surg 2001;7:58-60

10 HOW TO PERFORM UGFS? POLIDOCANOL SULFATE TETRADECYL 1-3% NEOVASCULAR NETWORK TRUNCAL RECANALIZATION PERFORATORS FOAM PREPARATION: Tessari, 1:4 Access site: Needle, cannula, butterfly, catheter Volume: max 10ml / session Contraindications: Right to left shunt (PFO) Migraine

11 HOW TO PERFORM UGFS? POLIDOCANOL SULFATE TETRADECYL TRIBUTARIES 1-3% FOAM PREPARATION: Tessari, 1:4 Access site: Needle, cannula, butterfly, catheter Volume: max 10ml / session Contraindications: Right to left shunt (PFO) Migraina

12 HOW TO PERFORM UGFS? POLIDOCANOL SULFATE TETRADECYL 1-3% RESIDUAL TRUNCK FOAM PREPARATION: Tessari, 1:4 Access site: Needle, cannula, butterfly, catheter Volume: max 10ml / session Contraindications: Right to left shunt (PFO) Migraina

13 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Injection under US guidance Compression

14 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Injection under US guidance Compression

15 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Injection under US guidance Compression

16 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Injection under US guidance Compression

17 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Injection under US guidance Compression

18 THE PROCEDURE Prior to local tumescent anesthesia Procubitus Puncture under US guidance Reflux and flux Trendelendburg Immediate walk-out LMWH Compression stocking: 1 week Duplex scan at D7 Injection under US guidance Compression

19 COMBINED SURGERY +++ UGFS + Phlebectomies

20 COMBINED SURGERY +++ UGFS + Phlebectomies UGFS + EVRF

21 COMBINED SURGERY +++ UGFS + Stump ligation UGFS + Phlebectomies UGFS + EVRF

22 THE LITERATURE? OCCLUSION? RECANALIZATION? RECURRENCE?

23 100 GSV 29 SSV Phlebectomies Combined surgery (large SF/SP residual stump) No major adverse event 2 asymptomatic DVT Occlusion rate: 92% at 40 days

24 91 legs (73 patients) Occlusion rate: 93-98% after 1 session (BK - AK) % after 2 sessions (BK - AK) Recanalisation: 9-12% at 12 months (BK- AK) Long term recanalization despite early good results

25 55% 100% 71% 83% 100% 90% (6 weeks) Early repeated UGFS is often needed to achieve complete occlusion

26 100 legs C5 and C6 Occlusion Ulcer recurrence 99% 61% 1 year 21 UGFS retreatment 2,3% 76% 2 years 5,1% Late repeated UGFS improve long term occlusion rate

27 CONCLUSION THE MOST SUITABLE TOOL FOR REVAS COMBINED PROCEDURES +++ HIGH OCCLUSION RATE: Repeated procedures RECANALIZATION: Close follow-up and re-injection NEED MORE STUDIES: Long term results Results on the different kind of revas (neovascular network, perforators ) Results on recurrences, Qol

28 THANK YOU FOR YOUR ATTENTION

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