Sclerotherapy Complications and Contra-Indications
|
|
|
- Brandon Sims
- 6 years ago
- Views:
Transcription
1 Sclerotherapy Complications and Contra-Indications Dr Paul Thibault Phlebologist Newcastle NSW
2 Sclerotherapy Complications and Contraindications Not everything that needs to be known can be taught
3 Sclerotherapy Complications and Contraindications World-wide clinical experience has proved beyond all possible doubt that embolism is a complication not to be feared and its interest is almost purely theoretical. Properly conducted, the injection treatment of varicose veins can be carried out without the slightest risk, and if reasonable care be exercised, ulceration at the site of injection becomes a complication of extreme rarity Dr Victor Coppleson 1929
4 Absolute Patient Selection (Contraindications) Acute deep venous thrombosis Allergy to sclerosant
5 Relative Patient Selection (Contraindications) Predisposition to thrombosis Past history of thrombosis/pe FH venous thrombo-embolism Hypercoagulable state eg polycythaemia rubra vera Long-distance travel Known Thrombophilia Bedrest and inability to ambulate Pregnancy 1st and 3rd generation Ocs
6 Sclerotherapy and Thrombosis World-wide clinical experience has proved beyond all possible doubt that embolism is a complication not to be feared and its interest is almost purely theoretical. Dr Victor Coppleson 1929 The reported incidence has been less than seen in the general population Dr Craig Feied Semin Dermatol 1993 Anecdotal reports that asymptomatic DVTs are more common than recognised Parsi and Myers
7 Sclerotherapy and Thrombosis Large veins are probably at no greater risk than small veins STS and POL are anticoagulants at concentrations>0.3% There is no evidence that patients with known thrombophilia are more predisposed to postsclerotherapy VTE than others Medico-Legal Indication for Prophylactic Clexane Significant thrombophilia Past History DVT or PE if no significant contributary cause
8 Sclerotherapy and Thrombosis Diagnosis Asymptomatic Painful swollen leg Pulmonary embolus (chest pain, dyspnoea)
9 Sclerotherapy and Thrombosis Complications Death Anaphylactoid Urticaria Rash Migraine Deep vein thrombosis STS N=2, (0.15%) 2 (0.07%) POL N=16, (0.07%) (0.02%)
10 Sclerosant Effects on Clotting Tests (Parsi) STS prolongs all clotting tests at concentrations higher than 0.3% demonstrating potent anticoagulant activity. STS shortens XACT and NAPTT at concentrations less than 0.3% demonstrating pro-coagulant activity. STS behaves as a procoagulant phospholipid at concentrations lower than 0.3%.
11 Sclerosant Effects on Clotting Tests (Parsi) STS prolongs all clotting tests at concentrations higher than 0.3% demonstrating potent anticoagulant activity. STS shortens XACT and NAPTT at concentrations less than 0.3% demonstrating pro-coagulant activity. STS behaves as a procoagulant phospholipid at concentrations lower than 0.3%.
12 Sclerosant Effects on Clotting Tests (K Parsi) POL has less dramatic effect on clotting time POL has more procoagulant activity at low concentrations when compared with STS with increased exposure time. STS is a more potent anticoagulant at high concentrations when compared with POL.
13 Sclerotherapy and Thrombosis Prevention Selection of patients Post-treatment graduated compression stocking 3-4 days day and night days during day Walk immediately after treatment minutes Daily walking 45 minutes Prophylactic Clexane for high-risk patients
14 Relative Patient Selection (Contraindications) Predisposition to thrombosis Defer or avoid Rx or consider prophylactic LMWH Past history of thrombosis/pe FH venous thrombo-embolism Hypercoagulable state eg polycythaemia rubra vera Long-distance travel Known Thrombophilia Bedrest and inability to ambulate Pregnancy 1st and 3rd generation Ocs
15 Allergy and Anaphylactic Reactions Complications Death Anaphylactoid Urticaria Rash Migraine Deep vein thrombosis STS N=2, (0.15%) 2 (0.07%) POL N=16, (0.07%) (0.02%)
16 Allergy and Anaphylactic Reactions More likely with STS More likely with stronger solutions (>1%) Most commonly pseudoanaphylactic (anaphylactoid) Anaphylactic reactions can occur also
17 Anaphylactic Reactions Type 1 hypersensitivity reaction Requires previous exposure always caused directly by degranulation of mast cells or basophils mediated by IgE Time of onset varies from minutes to hours after exposure Biphasic anaphylaxis (relapse within 72 hrs) occurs in 1 20% of cases
18 Anaphylaxis - Symptoms Skin involvement including generalized hives, itchiness, flushing, and swelling of the lips, tongue or throat. (90%) Respiratory symptoms may include shortness of breath, wheezes or stridor, and low oxygen. (70%) Gastrointestinal symptoms may include crampy abdominal pain, diarrhea, and vomiting (45%) Cardiovascular Hypotension can cause fainting & LOC. Due to histamine release, coronary artery spasm may occur with subsequent myocardial infarction or dysrhythmia (45%) CNS - loss of bladder control and muscle tone - feeling of anxiety and impending doom
19 Pseudoanaphylaxis (Anaphylactoid) does not involve an allergic reaction but is due to direct mast cell degranulation most common trigger for this mechanism is an intravenous infusion of an iodine-containing radiological contrast medium exact mechanism with sclerosants is unknown but may be related to degranulation (release of mediators) from endothelial cells occurs on 1st exposure to sclerosant and within minutes of injection
20 Allergy and Anaphylactic Reactions Management Awareness and early detection Adrenaline (sc or im) I-V line and airway (O2) corticosteroids?admission to hospital Avoidance Use foam rather than 1-3% STS solution as direct degranulation is dose/time -related
21 Relative Patient Selection (Contraindications) Current other systemic disease Lymphoedema Deep venous obstruction (only about 10% of cases) Patent foramen ovale - avoid foam
22 Local Complications Postsclerotherapy pigmentation Telangiectatic Matting Cutaneous Ulceration Superficial Thrombophlebitis and Acute Chemical Phlebitis Infection Hypertrichosis Skin reactions to tape, compression pads and stockings
23 Skin Reactions Allergy to tape Friction (cleavage) reaction to compression pads Allergy to stocking fibres
24 Postsclerotherapy Pigmentation and Telangiectatic Matting Most common adverse sequelae Commonly occur together Probably have common aetiology disruption of endothelium thrombus formation inflammation
25 Post-sclerotherapy Pigmentation: What is it? Perl s stain Haemosiderin found around dermal vessels
26
27 Postsclerotherapy Pigmentation: Aetiologic Factors Proportional to quantity of haem (Fe) in tissues Inversely proportional to rate of removal of Fe from tissues
28 Postsclerotherapy Pigmentation: Aetiologic Factors Sclerosing solution type and concentration Sclerotherapy technique Persistent proximal venous incompetence Vessel fragility (age) Vessel diameter Total body iron stores/transport mechanism Post-sclerotherapy management (compression)
29 Post-sclerotherapy Pigmentation: Causes Solution Type and Concentration Excessive endothelial destruction predisposes to pigmentation Potent sclerosants (eg STS,POL,Iodide) Less with weak sclerosants (HS and chromated glycerin) Concentration dependent (STS and POL)
30 Local Complications Complication Ulceration Significant or severe pigmentation STS N=2,686 4 (0.15%) POL N=16, (0.2%) 5 (0.2%) 30 (0.2%) Telangiectatic matting 4 (0.15%) 7 (0.04%) Superficial thrombophlebitis 14 (0.08%) 3 (0.1%)
31 Excessive Sclerosant Concentration
32 Postsclerotherapy Pigmentation: Aetiologic Factors Sclerosing solution type and concentration Technique
33 Postsclerotherapy Pigmentation: Technique Failure to treat proximal point of reflux first incompetent junctions incompetent trunks larger varices reticular veins Excessive injection pressure 2-3ml syringes therefore better than 1ml
34 Failure to treat proximal reflux
35 Postsclerotherapy Pigmentation: Aetiologic Factors Sclerosing solution type and concentration Technique Predisposition to pigmentation
36 Size of Vein and Sclerosant Concentration
37 Postsclerotherapy Pigmentation: Predisposition to pigmentation Unrelated to skin or hair colour Increased vessel fragility post-menopausal menstruation Minomycin - blue-grey Total body iron stores
38 Minomycin staining
39 Post Sclerotherapy Pigmentation The role of Fe Prospective study JDSO Oct 1994 (Thibault & Wlodarczyk) 233 patients Serum Ferritin taken prior to treatment Followed at 3, 6, 12 months for PSP
40
41
42
43
44
45
46 Post Sclerotherapy Pigmentation The role of Fe CONCLUSION: The higher the serum ferritin level, the greater the risk of persistent post-sclerotherapy pigmentation
47 How to remove Fe from the Skin?
48 How to remove Fe from the Skin?
49 Postsclerotherapy Pigmentation: Prevention Avoid iron supplements before, during and for 3 months after treatment Meticulous technique Avoid excessive injection pressures Select appropriate solution and strength Treat proximal to distal Evacuation of retained blood and microthrombi Adequate postsclerotherapy compression
50 Compression Bandaging Vs Graduated Compression Stockings Graduated compression stockings ٣٥-٤٠mmHg Elastocrepe bandages no. treated ١٥٦ ١٤٧ no. success ١٤٤ ١١٧ p < ٠.٠٠١ (Scurr JH, Coleridge-Smith P, 1985) Superficial thrombophlebitis less in GCS Pigmentation less in GCS
51 Compression in Treatment of Leg Telangiectasia Pigmentation Compression Non - Compression ٢٨.٥٠% ٤٠.٥٠% Study by Goldman, Marley, Butie et al. Patients with symetrical disease. One leg compressed for 72hrs with Class 2 stocking Ankle and calf oedema also reduced No increase in effectiveness for vessels<0.5mm diam No increase in effectiveness in thigh
52 Post-sclerotherapy Compression Study of Duration Weiss, Sadick, Goldman - Dermatologic Surgery 1999 Class 1 GCS during daytime only Reticular and spider veins Effectiveness at 6, 12, and 24 weeks Side effects Post-sclerotherapy pigmentation Telangiectatic matting Oedema Ulceration
53 Post-sclerotherapy Compression Study of Duration - Conclusions Effectiveness AT 6 WEEKS 3 weeks > 1 week > 3 days > None (p<0.004) AT 24 WEEKS 3 weeks > 1 week > (3 days, None) (p<0.006) Side Effects POST-SCLEROTHERAPY PIGMENTATION (None, 3 days) > 1 week > 3 weeks TELANGIECTATIC MATTING, ULCERATION, OEDEMA Not significant
54 Postsclerotherapy Pigmentation: Treatment Chemical exfoliants - non specific trichloroacetic acid, glycolic acid Physical exfoliants CO2, liquid nitrogen Chelating agents - topical EDTA Laser treatment
55 Laser Therapy
56 Laser Therapy
57 Chronotherapy or Flashbulb Therapy
58 Telangiectatic Matting New vessels < 0.2 mm in diameter Post-sclerotherapy Post-surgical Thigh affected > calf?age related?f > M
59 Telangiectatic Matting Incidence 5% - 75% (Goldman) Say 18% 6% will get better spontaneously (inflammatory) 6% will get better with further treatment (related to venous hypertension) 6% is permanent (Duffy)
60 Telangiectatic Matting
61 Telangiectatic Matting Aetiology Patient predisposition Extensive telangiectasias Obesity Oestrogen hormones Technique
62 Telangiectatic Matting: Aetiologic factors Angiogenesis - release of angiogenic factors from: damaged endothelial cells (disruption of endothelium) peri-vascular mast cells (peri-vascular inflammation) Arterio-venous anastomoses Persistence of proximal sources of reflux
63 Telangiectatic Matting Technique Failure to control proximal sources of reflux Excessive thrombosis in superficial veins (Interleukin- 8)
64 Telangiectatic Matting Failure to control proximal sources of reflux
65 Telangiectatic Matting Failure to control proximal sources of reflux
66 Telangiectatic Matting Management As for post-sclerotherapy pigmentation Look for untreated proximal sources of reflux Chronotherapy Review and retreat cautiously every 3 months and progress will be made
67 Telangiectatic Matting: Prevention and Treatment Treat all proximal sources of reflux including reticular veins Use compression Withdraw oestrogen therapy if not essential chronotherapy - review every 3 months Daily walking or other exercise to improve muscle tone
68 Post Sclerotherapy Cutaneous Necrosis
69 Cutaneous Necrosis Most common with hypertonic saline (extravascular injection) Less common with detergents a variety of mechanisms all ischaemic
70
71 Cutaneous Necrosis Direct intra-arterial injection Stellate necrosis causing necrosis of large area of skin High risk sites Popliteal fossa Medial distal calf (PTPVs) Groin
72 Veno-arterio Reflex Most common cause with detergents High venous pressure or sclerosant concentration causes reflex arteriolar spasm Cigarette smokers may be at greater risk
73 Veno-arteriolar Reflex Stellate purpura postsclerotherapy of intersaphenous vein complicated by VAR vasospasm of small saphenous artery
74 Treatment of Cutaneous Necrosis Awareness and early detection Local vasodilator (2% nitroglycerin ointment) Compression Clexane or aspirin
75 Treatment of Cutaneous Necrosis
76 Treatment of Cutaneous Necrosis
77 Treatment of Cutaneous Necrosis
78 Treatment of Cutaneous Necrosis
79 Superficial Thrombophlebitis and Chemical Phlebitis Common Factors Excessive sclerosant concentration Not controlling proximal reflux
80 Superficial Thrombophlebitis and Chemical Phlebitis Treatment Compression Walking NSAIDs Look for proximal reflux and treat
81 Hypertrichosis?Rare Transient STS and iodine Release of angiogenic cytokines
82 Infection Rare May be unusual bacteria such as Pseudomonas
83 Infection Differential Diagnosis Thrombophlebitis Intra-arterial injection Treatment Appropriate oral or systemic antibiotic
PACKAGE LEAFLET: INFORMATION FOR THE USER. Fibrovein 3%, 1%, 0.5% and 0.2% Solution for Injection Sodium tetradecyl sulphate
PACKAGE LEAFLET: INFORMATION FOR THE USER Fibrovein 3%, 1%, 0.5% and 0.2% Solution for Injection Sodium tetradecyl sulphate Read all of this leaflet carefully before you start using this medicine. Keep
Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:
E S Insurance: 2 nd Insurance: Wait time: Date: A. Venous Health History Form Patient please complete questions 1-12 Patient Name: SSN#: Date of Birth: Primary Care Physician: What is the reason for your
Chronic Venous Insufficiency Compression and Beyond
Disclosure of Conflict of Interest Chronic Venous Insufficiency Compression and Beyond Shawn Amyot, MD, CCFP Fellow of the Canadian Society of Phlebology Ottawa Vein Centre I do not have relevant financial
Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:
E S Insurance: 2 nd Insurance: Wait time: Date: A. Venous Health History Form Patient please complete questions 1-12 Patient Name: SSN#: Date of Birth: Primary Care Physician: What is the reason for your
Dr Paul Thibault. Phlebologist & Assistant Editor Phlebology (International Journal) Australasian College of Phlebology
Dr Paul Thibault Phlebologist & Assistant Editor Phlebology (International Journal) Australasian College of Phlebology Prescribing Effective Compression and PTS Dr Paul Thibault Phlebologist, Newcastle,
Appendix 1 to Direct Vision Sclerotherapy AUSTRALASIAN COLLEGE OF PHLEBOLOGY CLINICAL PROCEDURES. CP Direct Vision Sclerotherapy Clinical procedure
Appendix 1 to Direct Vision Sclerotherapy AUSTRALASIAN COLLEGE OF PHLEBOLOGY CLINICAL PROCEDURES CP Direct Vision Sclerotherapy Clinical procedure 1 PURPOSE This procedure summarises the actions required
Priorities Forum Statement
Priorities Forum Statement Number 9 Subject Varicose Vein Surgery Date of decision September 2014 Date refreshed March 2017 Date of review September 2018 Relevant OPCS codes: L841-46, L848-49, L851-53,
Last literature review version 19.3: Fri Sep 30 00:00:00 GMT 2011 This topic last updated: Thu Sep 30 00:00:00 GMT 2010 (More)
19.3 Liquid and foam sclerotherapy techniques for the treatment of lower extremity veins Authors Deborah L Greenberg, MD, FACP Sherry Scovell, MD, FACS Section Editors John F Eidt, MD Joseph L Mills, Sr,
[Kreussler Studies] FDA. multicenter GCP. controlled. randomized. prospective. blinded SUMMARY OF PIVOTAL STUDIES ON SCLEROTHERAPY OF VARICOSE VEINS
![[Kreussler Studies] FDA. multicenter GCP. controlled. randomized. prospective. blinded SUMMARY OF PIVOTAL STUDIES ON SCLEROTHERAPY OF VARICOSE VEINS](/thumbs/80/82187788.jpg "[Kreussler Studies] FDA. multicenter GCP. controlled. randomized. prospective. blinded SUMMARY OF PIVOTAL STUDIES ON SCLEROTHERAPY OF VARICOSE VEINS")
[Kreussler Studies] SUMMARY OF PIVOTAL STUDIES ON SCLEROTHERAPY OF VARICOSE VEINS FDA randomized controlled GCP blinded prospective multicenter [Sclerotherapy of Varices] Healthy legs with microfoam Chemische
DVT - initial management NSCCG
Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis
Love your legs again Varicose Veins
Love your legs again Varicose Veins Veins are the vessels that return blood to the heart once it has circulated through the body (as opposed to arteries, which carry oxygen-rich blood from the heart to
How to manage complications after sclerotherapy?
How to manage complications after sclerotherapy? Dra. Lourdes Reina Vascular Department. Hospital Cruz Roja Madrid Disclosure Dra. Lourdes Reina I have the following potential conflicts of interest to
AVOIDING COMPLICATIONS IN LIQUID SCLEROTHERAPY. Steven E. Zimmet, MD RPVI RVT FACPh
AVOIDING COMPLICATIONS IN LIQUID SCLEROTHERAPY Steven E. Zimmet, MD RPVI RVT FACPh Disclosures No conflicts of interest Overview Hyperpigmentation Matting Ulceration Thrombosis Anaphylaxis Neurological
Jordan M. Garrison, MD FACS, FASMBS
Jordan M. Garrison, MD FACS, FASMBS Peripheral Arterial Disease (PAD) Near or Complete obstruction of > 1 Peripheral Artery Peripheral Venous reflux Disease Varicose Veins Chronic Venous Stasis Ulcer Disease
Which place for liquid sclerotherapy? Eberhard Rabe Department of Dermatology University of Bonn Germany
Which place for liquid sclerotherapy? Eberhard Rabe Department of Dermatology University of Bonn Germany Liquid Foam or GSV, foam / liquid sclerosant n diameter[mm] Follow up effectivity Hamel Desnos 2003
PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE
PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE VARICOSE VEINS OF SUPERFICIAL VENOUS SYSTEM OF LOWER LIMBS A SYMPTOM NOT A DISEASE INITIAL,MILD CASES and severe cases with contraindication
Clinical comparison of sodium tetradecyl sulfate 0.25% versus polidocanol 0.75% in sclerotherapy of lower extremity telangiectasia
ORIGINAL ARTICLE Clinical comparison of sodium tetradecyl sulfate 0.25% versus polidocanol 0.75% in sclerotherapy of lower extremity telangiectasia Wafaa M Ramadan, MD, Khaled H El-Hoshy, MD, Dalia M Shaaban,
Varicose Veins What Are They? Sclerotherapy in the Treatment of Venous Disease Zachary C. Schmittling, MD, FACS May 4, 2018
Sclerotherapy in the Treatment of Venous Disease Zachary C. Schmittling, MD, FACS May 4, 2018 Sclerotherapy for Venous Disease: Overview 1 in 5 Americans Approximately 25% of women have some type of lower
Deep vein thrombosis (DVT) and pulmonary embolism (PE) advice for ophthalmic surgery patients
Deep vein thrombosis (DVT) and pulmonary embolism (PE) advice for ophthalmic surgery patients What is a deep vein thrombosis (DVT)? A DVT is a blood clot that forms within a vein deep in the leg but can
Tibbs DJ. Varicose veins and related disorders. Oxford: Butterworth-Heinemann; ISBN
1 PURPOSE This procedure summarises the actions required to diagnose venous disease using clinical examination and Duplex/Doppler ultrasound, and to treat superficial venous incompetence using Endovenous
VACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis IERHA Immunization Program September 2016 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever, lymphadenopathy
This information is intended as a general guide only. Please ask if you have any questions relating to this information.
Foam Sclerotherapy (Varicose vein injections) Vascular Surgery This information is intended as a general guide only. Please ask if you have any questions relating to this information. Varicose Veins Veins
Deep Vein Thrombosis
Deep Vein Thrombosis from NHS (UK) guidelines Introduction Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. Blood clots that develop in a vein are also known as venous thrombosis.
Graduated compression stockings are universally
Efficacy of Graduated Compression Stockings for an Additional 3 Weeks after Sclerotherapy Treatment of Reticular and Telangiectatic Leg Veins PAVAN K. NOOTHETI, MD, KRISTIAN M. CADAG, BS, ANGELA MAGPANTAY,
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
Venous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
VACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis Public Health Immunization Program June 2018 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever,
DISORDERS OF VENOUS SYSTEM
DISORDERS OF VENOUS SYSTEM Varicose Veins Any dilated, elongated and tortuous vein irrespective of size Varicose veins are common in the superficial veins of the leg which are subject to high pressure
Latmedical, LLC is the exclusive Caribbean distributor
No-Varix Graduated Compression Hosiery is manufactured by TEXPON S.A., the only Latin- American company certified with the norm ISO 9001:00 with scope of manufacture of graduate compression hosiery for
Tessari L. Nouvelle technique d'obtention de la sclero-mousse. Phlebologie 2000;53:129.
Appendix 1 to Microsclerotherapy Standard AUSTRALASIAN COLLEGE OF PHLEBOLOGY CLINICAL PROCEDURES CP - Microsclerotherapy - Clinical procedure 1 PURPOSE This procedure summarises the actions required to
A A U
PVD Venous AUC Rating Sheet 2nd Round 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Median I NI MADM Rating Agree Disagree Upper Extremity Venous Evaluation Table 1. Venous Duplex of the Upper Extremities for Patency
Reducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge
Reducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge What is a venous thromboembolism (VTE)? This is a medical term that describes a blood clot that develops in a deep vein
Deep Vein Thrombosis and Pulmonary Embolism: Patient Information
Deep Vein Thrombosis and Pulmonary Embolism: Patient Information A Deep Vein Thrombosis (DVT) and a Pulmonary Embolism (PE) are both disorders of unwanted blood clotting. Unwanted blood clots can occur
Vein & Body Specialists at The Bellevue Hospital Spider Vein and Varicose Vein Treatments
1 Vein & Body Specialists at The Bellevue Hospital Spider Vein and Varicose Vein Treatments What are spider veins? Spider veins are dilated, small blood vessels that have a red or bluish color. They appear
DVT and Pulmonary Embolus. Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre
DVT and Pulmonary Embolus Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre Overview Structure of deep and superficial venous system of upper
Venous Thrombo-Embolism (VTE)
Venous Thrombo-Embolism (VTE) Information for service users and carers RDaSH leading the way with care Older People s Mental Health Services Reducing risk of unwanted blood clots whilst in hospital About
SCLEROTHERAPY. Cosmetic purposes to improve the appearance of varicose and spider veins
SCLEROTHERAPY Sclerotherapy effectively treats varicose and spider veins. It's often considered the treatment of choice for small varicose veins. Sclerotherapy involves injecting a solution directly into
Management of Post-Thrombotic Syndrome
Management of Post-Thrombotic Syndrome Thanainit Chotanaphuti Phramongkutklao College of Medicine Bangkok, Thailand President of CAOS Asia President of Thai Hip & Knee Society President of ASEAN Arthroplasty
medical history Questionnaire
Surname: medical history Questionnaire Please take a few minutes to answer the following questions carefully as this assists us in preparing for your assessment. The information from this Questionaire
Venous Insufficiency Ulcers. Patient Assessment: Superficial varicosities. Evidence of healed ulcers. Dermatitis. Normal ABI.
Venous Insufficiency Ulcers Patient Assessment: Superficial varicosities Evidence of healed ulcers Dermatitis Normal ABI Edema Eczematous skin changes 1. Scaling 2. Pruritus 3. Erythema 4. Vesicles Lipodermatosclerosis
Segmental GSV reflux
Segmental GSV reflux History of presentation A 43 year old female presented with right lower extremity varicose veins and swelling. She had symptoms of aching, heaviness and tiredness in the right leg.
Who Should Be Premediciated for Contrast-Enhanced Exams?
Who Should Be Premediciated for Contrast-Enhanced Exams? Jeffrey C. Weinreb, MD,FACR Yale University School of Medicine jeffrey.weinreb@yale.edu Types of Intravenous Contrast Media Iodinated Contrast Agents
Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range
Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range Suspect a DVT? Complete a Two-level DVT Wells score on ICE system (see page
Healthy Legs For Life! Prevention is better then cure
Healthy Legs For Life! Prevention is better then cure Ellie Lindsay Independent Specialist Practitioner Associate Lecturer, CRICP, London Visiting Fellow, Queensland University of Technology Occurrence
All you need to know about. Varicose Veins. & its treatments. in 10 mins
All you need to know about Varicose Veins & its treatments in 10 mins Contents Symptoms and Causes...04 Risk Factors...05 Relief: The Top Five Tips...06 Compression Stockings or Bandages...08 New Surgery
Evaluation of lidocaine as an analgesic when added to hypertonic saline for sclerotherapy
Evaluation of lidocaine as an analgesic when added to hypertonic saline for sclerotherapy Rizwan H. Bukhari, MD, Joann M. Lohr, MD, Douglas S. Paget, MD, Andrew T. Hearn, MD, and Robert D. Cranley, MD,
NOTE: Deep Vein Thrombosis (DVT) Risk Factors
Deep Vein Thrombosis (DVT) Deep Vein Thrombosis (DVT) is the formation of a blood clot, known as a thrombus, in the deep leg vein. It is a very serious condition that can cause permanent damage to the
Patient Name: Date: Address: Primary Care Physician: Online Website On TV In print On the radio
927 W. Myrtle St. Boise, ID 83702 (208) 947-0100 NEW PATIENT INTAKE Patient Name: Date: Email Address: Primary Care Physician: How did you hear about AVT? (Please mark all that apply) Online Website On
Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
Dr Peter Chapman-Smith
Dr Peter Chapman-Smith Phlebologist NZ Stem Cell Treatment Centre, Whangarei 12:00-12:30 Healing Those Heartsink Leg Ulcers Healing Those Heartsink Leg Ulcers Practice Nurses Presentation GPCME Christchurch
CHAPTER 2 VENOUS THROMBOEMBOLISM
CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology
Vein Disease Treatment
MP9241 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated in 2.0, 3.0, 4.0 and 5.0 Additional Information: None Prevea360 Health Plan Medical Policy: Vein disease
Mabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
Determine the patients relative risk of thrombosis. Be confident that you have had a meaningful discussion with the patient.
Patient Assessment :Venous History, Examination and Introduction to Doppler and PPG Dr Louis Loizou The 11 th Annual Scientific Meeting and Workshops of the Australasian College of Phlebology Tuesday 18
Lower Limb Venous Ultrasound. Colin P. Griffin MSc, BSc (Hons)
Lower Limb Venous Ultrasound Colin P. Griffin MSc, BSc (Hons) Peripheral Vessels Lower Limb Peripheral Vessels Lower Limb Venous Deep System Common Iliac External/Internal Iliac Common Femoral Femoral
Management of an immediate adverse event following immunisation
Management of an immediate adverse event following immunisation The vaccinated person should remain under observation for a short interval to ensure that they do not experience an immediate adverse event.
How varicose veins occur
Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from groin to ankle. Spider veins are smaller, flatter, red or purple veins closer
Cardiovascular and Respiratory Disorders
Cardiovascular and Respiratory Disorders Blood Pressure Normal blood pressure is 120/80 mmhg (millimeters of mercury) Hypertension is when the resting blood pressure is too high Systolic BP is 140 mmhg
Varicose Veins. These are abnormal veins in the legs that appear as unsightly or cause other problems.
Varicose Veins What are varicose veins? These are abnormal veins in the legs that appear as unsightly or cause other problems. They develop due to abnormal valve function that allows the blood to travel
Sclerotherapy: treatment for thread veins on the legs
Sclerotherapy: treatment for thread veins on the legs What causes thread veins and varicose veins? 50% of the population will develop problems with their leg veins during their life. In most cases there
COMMISSIONING POLICY
Ref No. 1a7.5 COMMISSIONING POLICY Surgery for venous disease of the leg (Varicosities of the Long Saphenous Vein) April 2011 CONTENTS Section Page Summary 2 1. Background 2 2. Criteria for eligibility
Cover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/19768 holds various files of this Leiden University dissertation. Author: Langevelde, Kirsten van Title: Are pulmonary embolism and deep-vein thrombosis
High Level Overview: Venous Anatomy of Lower Extremities. Anatomy of a Vein 5/11/2015. Barbara Deusterman, RN
High Level Overview: Venous Anatomy of Lower Extremities Barbara Deusterman, RN What does this anatomy lecture have to do with visually guided sclerotherapy (VGS)? May 11, 2015 2 Anatomy of a Vein Almeida,
Inferior Vena Cava Filter for DVT
Inferior Vena Cava Filter for DVT Deep Vein Thrombosis A deep vein thrombosis (DVT) is a blood clot that forms in a deep vein. This is a serious condition that occurs more often than you might think. If
Terms What is Anaphylaxis? Causes Signs & Symptoms Management Education Pictures Citations. Anaphylaxis; LBodak
Leslie Bodak, EMT-P Terms What is Anaphylaxis? Causes Signs & Symptoms Management Education Pictures Citations Allergic Reaction: an abnormal immune response the body develops when a person has been previously
FIND RELIEF FROM VARICOSE VEINS. VenaSeal Closure System
FIND RELIEF FROM VARICOSE VEINS VenaSeal Closure System UNDERSTAND Varicose veins may be a sign of something more severe venous reflux disease Your doctor can help you understand if you have this condition.
Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust
MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital
Deep Vein Thrombosis
Deep Vein Thrombosis Introduction Deep vein thrombosis (DVT) is a blood clot in a vein. This condition can affect men and women of any age and race. DVT is a potentially serious condition. If not treated,
Varicose Vein Information Sheet
Neil Goldstein, MD Joseph Hewett, MD Board- Certified Physicians in Interventional, Diagnostic, and Vascular Radiology, Surgery, Vascular Surgery and Phlebology Varicose Vein Information Sheet PREVALENCE
Introduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 22.1 Define key terms introduced in this chapter. Slides 10, 14, 19, 37, 39 22.2 Differentiate between the signs and symptoms of an allergic reaction
Varicose Vein Surgery
What are varicose veins? Varicose veins are enlarged and twisted veins in your leg. Varicose veins are common, affecting up to 3 in 10 people. Varicose veins tend to run in families and are made worse
Thrombolysis in PE. Outline. Disclosure. Overview on Pulmonary Embolism. Hot Topics in Emergency Medicine 2012 Midyear Clinical Meeting
Disclosure Thrombolysis in PE Daniel P. Hays, PharmD, BCPS, FASHP reports no relevant financial relationships. Daniel P. Hays, PharmD, BCPS, FASHP Outline 55 YOF presents to ED with SOB PMH of DVT + noncompliance
PE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP
PE and DVT Dr Anzo William Adiga WatsApp or Call +256777363201 Medical Officer/RHEMA MEDICAL GROUP OBJECTIVES DEFINE DVT AND P.E PATHOPHYSIOLOGY OF DVT CLINICAL PRESENTATION OF DVT/PE INVESTIGATE DVT MANAGEMENT
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN.
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN Surgeon Dr G Mark Malouf Sydney Australia Following History and Physical examination
Clinical/Duplex Evaluation of Varicose Veins: Who to Treat?
Clinical/Duplex Evaluation of Varicose Veins: Who to Treat? Sanjoy Kundu MD, FASA, FCIRSE, FSIR The Vein Institute of Toronto Scarborough Vascular Group Scarborough Vascular Ultrasound Scarborough Vascular
POLIDOCANOL VS STS FOR SPIDER VEINS. Steven E. Zimmet, MD RPVI RVT FACPh
POLIDOCANOL VS STS FOR SPIDER VEINS Steven E. Zimmet, MD RPVI RVT FACPh Disclosures/COI No COI Off-label use Lipid bilayer with membrane proteins Lipid bilayers are the basic structures that make up cell
PATIENT INFORMATION LEAFLET
Aterosklerol 1% Injectable Ampoule For administration by IV injection only. Sterile PATIENT INFORMATION LEAFLET Active Ingredient: 20 mg Lauromacrogol 400 per ampoule (2 ml) Excipients: Ethanol 96%, Potassium
THE RESULTS OF THE SURGICAL TREATMENT OF SUPERFICIAL VENOUS THROMBOSIS
Journal of Experimental Medical & Surgical Research Cercetãri Experimentale & Medico-Chirurgicale Year XVII Nr.2/2010 Pag. 81-86 JOURNAL Experimental Medical of Surgical R E S E A R C H THE RESULTS OF
Additional Information S-55
Additional Information S-55 Network providers are encouraged, but not required to participate in the on-line American Venous Forum Registry (AVR) - The First National Registry for the Treatment of Varicose
Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine
Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality
Varicose Veins are a Symptom of Vein Disease. Now you can treat the source of your varicose veins with non-surgical endovenous laser treatment.
Varicose Veins are a Symptom of Vein Disease. Now you can treat the source of your varicose veins with non-surgical endovenous laser treatment. Approximately 1 in 5 adult Americans suffer from superficial
Patient Information. Venous Insufficiency and Varicose Veins
Patient Information Venous Insufficiency and Varicose Veins What is a Varicose Vein? Gitter Vein Institute-revised 3/8/2016 2 Frequently Asked Questions What is the difference between varicose and spider
Endovenous Laser Therapy INFORMATION & TREATMENT INSTRUCTIONS
1324 Princess Street Kingston, ON K7M 3E2 Website: www.ucosmetic.com Email: nuyu@ucosmetic.com Phone: (613) 536-LASR (5277) Fax: (613) 536-5108 Dr. Kim Meathrel, MD, FRCSC, Plastic Surgeon, Associate Professor
Management of ANAPHYLAXIS in the School Setting. Updated September 2010
Management of ANAPHYLAXIS in the School Setting Updated September 2010 What is an Allergy? Allergies occur when the immune system becomes unusually sensitive and over reacts to common substance that are
Anaphylaxis: The Atypical Varieties
Anaphylaxis: The Atypical Varieties John Johnson, D.O., PGY-4 Allergy/Immunology Fellow University Hospitals of Cleveland Case Western Reserve University School of Medicine Disclosures: None What is Anaphylaxis?
PHLEBOLOGY. Venous Insufficiency. Presentation Use Information
Disclosure of Conflict of Interest THE BASICS OF VENOUS INSUFFICIENCY: What You Should Know. An Introductory Lecture Donald Ives, MD, RVT, RPVI Board Certified Family Physician Diplomate of the American
How long to continue anticoagulation after DVT?
How long to continue anticoagulation after DVT? Dr. Nihar Ranjan Pradhan M.S., DNB (Vascular Surgery), FVES(UK) Consultant Vascular Surgeon Apollo Hospital, Jubilee Hills, Hyderabad (Formerly Faculty in
Preventing Blood Clots in Adult Patients
Manchester Royal Eye Hospital Surgical Services Information for Patients Preventing Blood Clots in Adult Patients This leaflet will give you information on how to reduce the risk of developing blood clots
Please describe, in detail, when the symptoms began:
161 East Mallard Drive, Suite 130, Boise, ID 83706 (208) 947-0100 New Patient Intake Patient Name: Primary Care Physician: Date: Email address: How did you hear about AVT (mark all that apply) Online On
Interactive Learning Session
Chronic Venous Disease - Part I Interactive Learning Session 2011 Ali Sabbour Prof of Vascular Surgery http://mic.shams.edu.eg/moodle6 Login as a guest Surgery 2 Ali Sabbour - Chronic Venous Disease Intended
1. What is fulvestrant?
Talk to our breast care nurses 0808 800 6000 1. What is fulvestrant? 2. How does fulvestrant work? 3. When might fulvestrant be prescribed? 4. How is fulvestrant given? 5. How long will I be given fulvestrant
V11 Endovenous Ablation
For the personal patients of Bruce Braithwaite V11 Endovenous Ablation What are varicose veins? Varicose veins are enlarged and twisted veins in the leg. They are common, affecting up to 3 in 10 people.
ANAPHYLAXIS Following Vaccination. A Severe Adverse Event. Developed for the Grampians Infection Control Group (GRICG) Version 2.
ANAPHYLAXIS Following Vaccination A Severe Adverse Event Developed for the Grampians Infection Control Group () Version 2.0:2014 Adverse Event Following Immunisation Adverse event following immunisation
Patient Information. Preventing and treating blood clots
Patient Information Preventing and treating blood clots 1_Clexane_Patient_Booklet_AW05.indd 1 8/04/2016 11:26 a The information provided in this document is for patients prescribed CLEXANE, and should
An allergic reaction is an exaggerated response by the immune system to a foreign substance
ALLERGIC REACTION An allergic reaction is an exaggerated response by the immune system to a foreign substance Anaphylaxis is an unusual or exaggerated allergic reaction; is a life threatening emergency
Urticaria Moderate Allergic Reaction Mild signs/symptoms with any of following: Dyspnea, possibly with wheezes Angioneurotic edema Systemic, not local
Allergic Reactions & Anaphylaxis Incidence In USA - 400 to 800 deaths/year Parenterally administered penicillin accounts for 100 to 500 deaths per year Hymenoptera stings account for 40 to 100 deaths per
Risk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD
Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
Venous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD
Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
All WALES LYMPHOEDEMA GUIDANCE:
All WALES LYMPHOEDEMA GUIDANCE: Lymphoedema Vascular Assessment Policy (Toe Brachial Pressure Index / TBPI) April 2013 Created by the All Wales Lymphoedema Service Leads 1 Background The presence of peripheral
Venous Thromboembolic Events (VTEs)
Venous Thromboembolic Events (VTEs) This Infosheet explains what a VTE is, what the causes and risk factors for VTEs are, the symptoms of a VTE, how they can be treated and some tips for self-management.