Techniques and Specific Treatment Modalities for the Active Non-Healing Wound. Luke Maj, MD, MHA

Size: px
Start display at page:

Download "Techniques and Specific Treatment Modalities for the Active Non-Healing Wound. Luke Maj, MD, MHA"

Transcription

1 Techniques and Specific Treatment Modalities for the Active Non-Healing Wound Luke Maj, MD, MHA Assistant Professor of Radiology University of Miami, Miller School of Medicine Director of The Vein Center at Water s Edge Dermatology, Florida

2 Disclosures None

3 OVERVIEW Deep veins Superficial veins Perforator veins

4 PERFORATOR VEINS Why are they important? Perforator damage can cause significant pathology and patient symptoms Veins (spider and varicose), skin changes, ulcers, edema, pain, other symptoms. To me perforators are the most important: They cause signs and symptoms of CVI They (at times) can be the single culprit of patients problem Many providers miss them and patients return symptomatic Treatment no longer covered by insurance (in FL) except when beneath an active or healed venous ulcer You MUST treat to completion = treating perforator veins.

5 How Do I Do It? Treat axial reflux (CVI) and Pelvic Outflow Obstruction (POO) first. I take the US myself and scan the patient. I m an old school radiologist, I want to see myself I focus on areas that I can see on the skin which demonstrate skin changes. I ask the patient to specify where the symptoms are when I scan over them THIS WILL TELL YOU WHICH PERFORATORS ARE CAUSING THE PROBLEM. The patient will actually point to the area where the symptoms are. Place probe there and look. Then I compare it to the US map by my tech and see if it was identified (PS. Good way to check how good your tech is) I close the perforator (RFA, Laser, UGS) and anything that it gives off. ****BECAREFUL Majority of the time there is an arterial branch next to the perforator CLUE: Take a moment and hold the US steady and watch for pulsating tissue That s an artery.

6 How Do I Do It? What do I use to close perforators: 1. RFA 3 or 7 cm catheter If I can get away using 3 or 7cm catheter across a T-Bone perforator that is my #1 choice. 2. RFA Stylet Bit cumbersome and closure rate for me has not been as good as catheter or laser 3. Laser I prefer this method as it is quick and good success rate. Get a IV kit ($1.50), 18 or 16 gauge and insert into perforator like you are placing an IV. Or use a regular large bore needle. Through there place the laser into the IV sheath, pull back on the IV sheath so you don t burn it off. Alternative is premeasure the length of the IV sheath and get a doohickey which holds laser fiber and screws on to IV sheath. 4. Clarivein It could be done but for me there is no reimbursement so I don t use it. 5. Venaseal Likely a great method but you have to make sure that you can compress this area for 3 mins. I don t use it on perforators at this time. 5. Foam Varithena or home made The foam will go everywhere! Into perforator and into deep space. Be cautions of DVT risk. I use this method 1% Polidochanol when the insurance wont pay for Laser or RFA or they don t meet guidelines. You may have to do it more than once. Make sure that you press with US probe to close the perforator and obtain spasm of the perforator. DO not go into the perforator further than the fascia when using laser of RFA. WATCH out for artery next to perforator it should move away when you use tumescent. When finished sclerose the tributary varicosities.

7 Case Nonhealing ulcer (10 years).

8 Massive perforator with overlying tributaries

9 Case It just wont go away. Ulceration that never completely healed and skin keeps forming a new scab for years.

10 No identifiable perforator. Only tributary veins that need to be closed. Tx: Sclero

11 Case

12 Watch out for the fascial plane depth

13 Case

14 T-BONE: Easily treated even across the perforator. Laser or 3cm RFA catheter

15 Treat up to fascial plane LEFT RIGHT

16 Case JZ Reflux: BL GSV BL SSV BL Perfs BL Tribs L Femoral L Pop R Femoral L: 2x DVT

17 Pelvic Outflow Obstruction (May Turners Syndrome)

18 LEFT

19 RIGHT

20 Case Z Refluxing L GSV Refluxing L Posterior Tibial Perf L GSV Ablated No significant change. L Posterior Tibial Perforator Closed using 1% Polidochanol Foam WHY?

21 Artery?

22

23

24 Take Away. Treat to COMPLETION (including perforators, tributaries and skin veins) I quote ($) the patient and do it during other ablation procedures if no insurance coverage Lower cost to patient, Less visits (FL must have C5 of C6 to insurance coverage) Look for perforators on patients who come back with symptoms Consider IVUS for Pelvic Outflow Obstruction in patients with CEAP 3 or higher or Hx of DVT. Watch out for ARTERIES If anyone is looking to relocate to Florida or looking for a job please see me or me lukemaj@gmail.com

25 THANK YOU

26 Techniques and Specific Treatment Modalities for the Active Non-Healing Wound Luke Maj, MD, MHA Assistant Professor of Radiology University of Miami, Miller School of Medicine Director of The Vein Center at Water s Edge Dermatology, Florida

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. 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

More information

Vein Disease Treatment

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

More information

Patient assessment and strategy making for endovenous treatment

Patient assessment and strategy making for endovenous treatment Patient assessment and strategy making for endovenous treatment Raghu Kolluri, MD Director Vascular Medicine OhioHealth Riverside Methodist Hospital Columbus, OH Disclosures Current Medtronic Consultant/

More information

Venous Disease and Leg Ulcers. Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL

Venous Disease and Leg Ulcers. Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL Venous Disease and Leg Ulcers Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL Disclosures Stocks Endoshape Sapheon Medical Advisory Board BTG, Boston Scientific Venous Leg Ulcer Most common

More information

Chronic Venous Insufficiency

Chronic Venous Insufficiency Chronic Venous Insufficiency None Disclosures Lesley Enfinger, MSN,NP-C Chronic Venous Insufficiency Over 24 Million Americans affected by Chronic Venous Insufficiency (CVI) 10 x More Americans suffer

More information

Non-Saphenous Vein Treatments. Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO

Non-Saphenous Vein Treatments. Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO Non-Saphenous Vein Treatments Jessica Ochs PA-C Albert Vein Institute Colorado Springs and Lone Tree, CO I have no financial disclosures Types of Veins Treated Perforator Veins Tributary Veins Varicose

More information

2017 Florida Vascular Society

2017 Florida Vascular Society Current Management of Venous Leg Ulcers: How to Identify Patients with Correctable Venous Disease and Interventional Procedures to Heal and Prevent Recurrence 2017 Florida Vascular Society Bill Marston

More information

Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015

Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015 Perforators: When to Treat and How Best to Do It? Eric Hager, MD September 10, 2015 Anatomy of Perforating veins Cadaveric studies 1 have shown >60 vein perforating veins from superficial to deep Normal

More information

Current Management of Varicose Veins

Current Management of Varicose Veins Current Management of Varicose Veins Michael J. Heidenreich, MD St. Joseph Mercy Hospital Ann Arbor, MI March 23, 2013 Nothing to disclose History Prevalence Anatomy Risk factors Clinical manifestations

More information

The role of ultrasound duplex in endovenous procedures

The role of ultrasound duplex in endovenous procedures The role of ultrasound duplex in endovenous procedures Neophytos A. Zambas MD, PhD Vascular Surgeon Polyclinic Ygia, Limassol, Cyprus ΚΕΑΕΧ ΚΥΠΡΙΑΚΗ ΕΤΑΙΡΕΙΑ ΑΓΓΕΙΑΚΗΣ ΚΑΙ ΕΝΔΑΓΓΕΙΑΚΗΣ ΧΕΙΡΟΥΡΓΙΚΗΣ Pre

More information

Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue)

Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue) Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue) Awais Siddique MD Endovascular Radiologist AZH WAVE CENTERS Milwaukee WI Venous disease Etiology Are the result of Venous valvular

More information

Why Tumescent-Free Therapy Will Replace RF and Laser

Why Tumescent-Free Therapy Will Replace RF and Laser C SCOTT MCENROE Medical Director Vein Center of Virginia Sentara Medical Group April 27, 2018 Why Tumescent-Free Therapy Will Replace RF and Laser History of Venous Surgery 1950 s GSV/SSV stripping became

More information

Endo-Thermal Heat Induced Thrombosis (E-HIT)

Endo-Thermal Heat Induced Thrombosis (E-HIT) Endo-Thermal Heat Induced Thrombosis (E-HIT) Michael Ombrellino MD FACS The Cardiovascular Care Group Clinical Associate Professor of Surgery Rutgers School of Medicine Objectives: What is E-HIT? How do

More information

Chronic Venous Insufficiency Compression and Beyond

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

More information

New Guideline in venous ulcer treatment: dressing, medication, intervention

New Guideline in venous ulcer treatment: dressing, medication, intervention New Guideline in venous ulcer treatment: dressing, medication, intervention Kittipan Rerkasem, FRCS(T), PhD Department of Surgery Faculty of Medicine Chiang Mai University Topic Overview venous ulcer treatment

More information

RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY

RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY Paul Kramer, MD, FACC, FSCAI Liberty Cardiovascular Specialists Liberty Regional Heart and Vascular Center DISCLOSURES NONE Venous

More information

Clinical/Duplex Evaluation of Varicose Veins: Who to Treat?

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

More information

Page 1. Ruling out deep venous obstruction prior to superficial vein treatment. Disclosures. Indications for saphenous vein ablation (SVA)

Page 1. Ruling out deep venous obstruction prior to superficial vein treatment. Disclosures. Indications for saphenous vein ablation (SVA) 1 Ruling out deep venous obstruction prior to superficial vein treatment Deepak Sudheendra, MD, RPVI Assistant Professor of Clinical Radiology & Surgery Disclosures No financial disclosures Indications

More information

Conflict of Interest. None

Conflict of Interest. None Conflict of Interest None American Venous Forum Guidelines on Superficial Venous Disease TOP 10 GUIDELINES 10. We recommend using the CEAP classification to describe chronic venous disorders. (GRADE 1B)

More information

Endothermal Ablation for Venous Insufficiency. Dr. S. Kundu Medical Director The Vein Institute of Toronto

Endothermal Ablation for Venous Insufficiency. Dr. S. Kundu Medical Director The Vein Institute of Toronto Endothermal Ablation for Venous Insufficiency Dr. S. Kundu Medical Director The Vein Institute of Toronto Objective: remove the GSV from the circulation 1. Surgical - HL & stripping 2. Chemical sclerotherapy

More information

Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA

Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA Management of Superficial Reflux: Which option, when? Kathleen Gibson, MD Lake Washington Vascular Surgeons Bellevue, WA DISCLOSURES Kathleen Gibson, MD Consultant/Advisory Board: BTG, Medtronic Speakers

More information

TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY

TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY TL LUK Consultant Vascular Surgeon Sarawak General Hospital HKL Vascular Conference 19/06/2013 PREVALENCE OF LOWER LIMB VENOUS DISEASE Affects half of

More information

UNDERSTANDING VEIN DISEASE. UC EN - For use in the U.S. only

UNDERSTANDING VEIN DISEASE. UC EN - For use in the U.S. only UNDERSTANDING VEIN DISEASE UC201706537 EN - For use in the U.S. only Do you need to sit down during your work day because your legs ache and/or swell? Do you miss out on doing the activities you love because

More information

Additional Information S-55

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

More information

OHTAC Recommendation. Endovascular Laser Treatment for Varicose Veins. Presented to the Ontario Health Technology Advisory Committee in November 2009

OHTAC Recommendation. Endovascular Laser Treatment for Varicose Veins. Presented to the Ontario Health Technology Advisory Committee in November 2009 OHTAC Recommendation Endovascular Laser Treatment for Varicose Veins Presented to the Ontario Health Technology Advisory Committee in November 2009 April 2010 Issue Background The Ontario Health Technology

More information

AMERICAN PODIATRIC MEDICAL ASSOCIATION

AMERICAN PODIATRIC MEDICAL ASSOCIATION AMERICAN PODIATRIC MEDICAL ASSOCIATION THE NATIONAL ANNUAL SCIENTIFIC MEETING Friday, July 13 th 2018 Washington, D.C. CHRONIC VENOUS INSUFFICIENCY OF THE LOWER EXTREMITIES Clinical Pearls for the Podiatrist

More information

Selection and work up for the right patients suspected of deep venous disease

Selection and work up for the right patients suspected of deep venous disease Selection and work up for the right patients suspected of deep venous disease R A G H U K O L L U R I, M S, M D, R V T S Y S T E M M E D I C A L D I R E C T O R V A S C U L A R M E D I C I N E / V A S

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Medicare C/D Medical Coverage Policy Origination Date: June 1, 1993 Review Date: February 15, 2017 Next Review: February, 2019 DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins

More information

Recurrent Varicose Veins We All See Them

Recurrent Varicose Veins We All See Them We All See Them November 4, 2017 Austin, TX Arlington Heights, IL No conflicts Terminology REVAS REcurrent Varices After Surgery PREVAIT PREsence of Varices After Interventional Treatment Recurrent varices

More information

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach.

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach. Management of Venous Disease: an evidence based approach Disclosures Ed Boyle, MD Andrew Jones, MD Dr. Ed Boyle and Dr. Andrew Jones disclose Grants/research support: Medtronic, BTG International, Clearflow,

More information

Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:

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

More information

GSV treatment with Radio Frequency EVRF device and CR45i catheter CLINICAL STUDY

GSV treatment with Radio Frequency EVRF device and CR45i catheter CLINICAL STUDY GSV treatment with Radio Frequency EVRF device and CR45i catheter CLINICAL STUDY _ BY Dr. Thomas Niesen St Louis Surgical Consultant 226 South Wood Mills Road, Suite 49 West Chesterfield, Mo 63017 Tel:

More information

LINC, Christine Teichert, MD University Medicine of Rostock, Dept. of diagnostic and interventional radiology, Germany

LINC, Christine Teichert, MD University Medicine of Rostock, Dept. of diagnostic and interventional radiology, Germany Comparison of the efficacy, safety, the primary and secondary technical success of the endovenous nonthermal, tumescensless mechanochemical ablation of varicose veins with the subjective outcome using

More information

MOCA and GLUE: results and analyses of the RCTs

MOCA and GLUE: results and analyses of the RCTs MOCA and GLUE: results and analyses of the RCTs Faculty disclosure Research Grant Medtronic Educational Grant mediusa Speakers Bureau Medtronic Pierre Fabre mediusa Medical Director Morrison Vein/Training

More information

Vein & Body Specialists at The Bellevue Hospital Spider Vein and Varicose Vein Treatments

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

More information

FIND RELIEF FROM VARICOSE VEINS. VenaSeal Sapheon Closure System

FIND RELIEF FROM VARICOSE VEINS. VenaSeal Sapheon Closure System FIND RELIEF FROM VARICOSE VEINS VenaSeal Sapheon Closure System UNDERSTAND Varicose veins may be a sign of something more severe. Your doctor can help you understand if you have this condition. may cause

More information

New Technologies in Superficial Vein Treatment

New Technologies in Superficial Vein Treatment New Technologies in Superficial Vein Treatment Ariel D. Soffer, MD, FACC Associate Clinical Professor Florida International University Medical School Ariel Soffer, MD, FACC Bio Fellow of the American College

More information

Patient Information. Venous Insufficiency and Varicose Veins

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

More information

FIND RELIEF FROM VARICOSE VEINS. VenaSeal Closure System

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.

More information

How varicose veins occur

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

More information

SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS

SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS SAFETY AND FEASIBILITY OF MECHANO-CHEMICAL ABLATION OF VARICOSE VEINS: INITIAL RESULTS Michel M.P.J. Reijnen, M.D., Ph.D. Jean-Paul P.M. de Vries, M.D., Ph.D. Rijnstate Hospital, Arnhem, The Netherlands

More information

NCVH. Ultrasongraphy: State of the Art Vein Forum 2015 A Multidisciplinary Approach to Otptimizing Venous Circulation From Wounds to WOW

NCVH. Ultrasongraphy: State of the Art Vein Forum 2015 A Multidisciplinary Approach to Otptimizing Venous Circulation From Wounds to WOW Ultrasongraphy: State of the Art 2015 NCVH New Cardiovascular Horizons Vein Forum 2015 A Multidisciplinary Approach to Otptimizing Venous Circulation From Wounds to WOW Anil K. Chagarlamudi, M.D. Cardiovascular

More information

Technique of the VenaSeal System

Technique of the VenaSeal System Technique of the VenaSeal System Indication & Contraindications VenaSeal Indication: The Sapheon VenaSeal System is intended for the permantent, complete, endovascular adhesive closure of the great saphenous

More information

RADIOFREQUENCY ABLATION. Drs PIRET V, BERGERON P MEET CANNES 2009

RADIOFREQUENCY ABLATION. Drs PIRET V, BERGERON P MEET CANNES 2009 RADIOFREQUENCY ABLATION Drs PIRET V, BERGERON P MEET CANNES 2009 Superficial Venous Disease: EPIDEMIOLOGY Touch 75% of french population at different degrees (45.10 6 ) 25% needs medical care (11.10 6

More information

LOWER EXTREMITY VENOUS COMPRESSION ULTRASOUND. CPT Stacey Good, DO Emergency Medicine Ultrasound Fellow Madigan Army Medical Center

LOWER EXTREMITY VENOUS COMPRESSION ULTRASOUND. CPT Stacey Good, DO Emergency Medicine Ultrasound Fellow Madigan Army Medical Center LOWER EXTREMITY VENOUS COMPRESSION ULTRASOUND CPT Stacey Good, DO Emergency Medicine Ultrasound Fellow Madigan Army Medical Center Learning Objectives Setup and patient positioning for optimizing success

More information

Epidemiology: Prevalence

Epidemiology: Prevalence Epidemiology: Prevalence More than 30 million Americans suffer from varicose veins or a more serious form of venous disease called Chronic Venous Insufficiency (CVI). 1 Of the over 30 million Americans

More information

Find From Varicose Veins. VenaSeal

Find From Varicose Veins. VenaSeal 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.

More information

Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:

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

More information

Deep Venous Pathology. Eberhard Rabe Department of Dermatology University of Bonn Germany

Deep Venous Pathology. Eberhard Rabe Department of Dermatology University of Bonn Germany Deep Venous Pathology Eberhard Rabe Department of Dermatology University of Bonn Germany Disclosures None for this presentation Consultant: Sigvaris, EUROCOM Speakers bureau: Bayer Vital, Aspen, Boehringer,

More information

Complete Evaluation of the Chronic Venous Patient: Recognizing deep venous obstruction. Erin H. Murphy, MD Rane Center

Complete Evaluation of the Chronic Venous Patient: Recognizing deep venous obstruction. Erin H. Murphy, MD Rane Center Complete Evaluation of the Chronic Venous Patient: Recognizing deep venous obstruction Erin H. Murphy, MD Rane Center Disclosure Speaker name: Erin H. Murphy... I have the following potential conflicts

More information

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

WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON WHAT ABOUT FOAM SCLEROTHERAPY IN REVAS? Dr O CRETON Ste FOY LES LYON Disclosure of Interest I have the following potential conflicts of interest to report: Consulting: Medtronic WHAT ABOUT REVAS? Source

More information

Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden

Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden Are there differences in guidelines for management of CVD between Europe and the US? Bo Eklöf, MD, PhD Lund University Sweden Disclosures No disclosures Five sources for comparison SVS/AVF US guidelines

More information

Medical Affairs Policy

Medical Affairs Policy Service: Varicose Vein Treatments PUM 250-0032 Medical Affairs Policy Medical Policy Committee Approval 12/01/17 Effective Date 04/01/18 Prior Authorization Needed Yes Disclaimer: This policy is for informational

More information

Protocols for the evaluation of lower extremity venous reflux: supine, sitting, or standing?

Protocols for the evaluation of lower extremity venous reflux: supine, sitting, or standing? Protocols for the evaluation of lower extremity venous reflux: supine, sitting, or standing? Susan Whitelaw RVT, RDMS PURPOSE Duplex imaging of the lower extremity veins is performed to assess the deep

More information

VeClose trial Cyanoacylate closure vs. RF ablation 36-month results

VeClose trial Cyanoacylate closure vs. RF ablation 36-month results VeClose trial Cyanoacylate closure vs. RF ablation 36-month results LINC 2018, Leipzig 31 st Jan 2018 Tobias Hirsch, Halle, Germany www.gefaessmedizin-hirsch.de Disclosure Tobias Hirsch I have the following

More information

Chronic Venous Disease: A Complex Disorder. A N Nicolaides

Chronic Venous Disease: A Complex Disorder. A N Nicolaides Chronic Venous Disease: A Complex Disorder A N Nicolaides Emeritus Professor of Vascular Surgery, Imperial College, London. Hon. Professor of Surgery, University of Nicosia Medical School, Cyprus Disclosures

More information

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. 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

More information

Features compression after open and endovascular operation in vascular malformation

Features compression after open and endovascular operation in vascular malformation Features compression after open and endovascular operation in vascular malformation Sapelkin Sergey Institute of Surgery named A.V. Vishnevsky, Moscow, Russia 21.10.2017 CIRC Meeting, Grassau AV-malformations:

More information

UNDERSTANDING VEIN PROBLEMS

UNDERSTANDING VEIN PROBLEMS UNDERSTANDING VEIN PROBLEMS Varicose Veins, Chronic Venous Insufficiency, and DVT Do You Have a Vein Problem? Have you noticed pain or swelling in your legs? Do your symptoms worsen when you re sitting

More information

Varicose Vein Information Sheet

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

More information

Complex Iliocaval Reconstruction PNEC. Seattle WA. Bill Marston MD Professor, Div of Vascular Surgery University of N.

Complex Iliocaval Reconstruction PNEC. Seattle WA. Bill Marston MD Professor, Div of Vascular Surgery University of N. Complex Iliocaval Reconstruction 2017 PNEC. Seattle WA Bill Marston MD Professor, Div of Vascular Surgery University of N. Carolina DISCLOSURES William Marston, MD Consultant/Advisory Board: Veniti, Cardinal

More information

Endovenous repair in ulcer patients: Why, when and how.

Endovenous repair in ulcer patients: Why, when and how. Endovenous repair in ulcer patients: Why, when and how. Johann Chris Ragg, MD CEO SWISS VX vein research labs CEO, Chief Physician angioclinic Vein Centers Berlin Munich - Zurich Counselor Venartis Inc.

More information

Let s Take a Look Venous Insufficiency Ultrasound Techniques

Let s Take a Look Venous Insufficiency Ultrasound Techniques Let s Take a Look Venous Insufficiency Ultrasound Techniques Brent Wilkinson RVT, RDMS Steve Schomaker RVT, RDCS, RDMS Let s take a look Differentiate between normal venous flow and venous insufficiency

More information

Phlebectomy vs sclerotherapy ALESSANDRO FRULLINI MD FLORENCE - ITALY

Phlebectomy vs sclerotherapy ALESSANDRO FRULLINI MD FLORENCE - ITALY Phlebectomy vs sclerotherapy ALESSANDRO FRULLINI MD FLORENCE - ITALY DISCLOSURE Consultant for: GloriaMed Personal background General and vascular surgeon More than 3500 stripping performed 33 years of

More information

Step by step ultrasound examination of varicose veins. Dr. Özgün Sensebat Vascular Surgeon Private Vascular Clinic Dorsten & Borken, Germany

Step by step ultrasound examination of varicose veins. Dr. Özgün Sensebat Vascular Surgeon Private Vascular Clinic Dorsten & Borken, Germany Step by step ultrasound examination of varicose Dr. Özgün Sensebat Vascular Surgeon Private Vascular Clinic Dorsten & Borken, Germany Required technical setup: B-mode vessel imaging combined with color

More information

Treatment of Varicose Veins/Venous Insufficiency

Treatment of Varicose Veins/Venous Insufficiency MEDICAL POLICY 7.01.519 Treatment of Varicose Veins/Venous Insufficiency BCBSA Ref. Policy: 7.01.124 Effective Date: March 1, 2017 Last Revised: Jan. 23, 2018 Replaces: 7.01.55, 7.01.76, 7.01.515, and

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Varicose Veins of the Lower Extremities, Treatment for File Name: Origination: Last CAP Review: Next CAP Review: Last Review: varicose_veins_of_the_lower_extremities_treatment_for

More information

The Use of Adjunctive Venography and Endovascular Manoeuvres In The Treatment of Saphenous Vein Insufficiency. A Prospective, Multi-centre Study

The Use of Adjunctive Venography and Endovascular Manoeuvres In The Treatment of Saphenous Vein Insufficiency. A Prospective, Multi-centre Study The Use of Adjunctive Venography and Endovascular Manoeuvres In The Treatment of Saphenous Vein Insufficiency A Prospective, Multi-centre Study Ramon L. Varcoe, MBBS, MS, FRACS, PhD Associate Professor

More information

Thermal Techniques: Outcomes and Complications

Thermal Techniques: Outcomes and Complications Thermal Techniques: Outcomes and Complications Meet The Experts: Thermal and Non-Thermal Ablation Techniques Joseph D. Raffetto MD VA Boston HCS, West Roxbury, MA, Harvard Medical School, Boston, MA; Brigham

More information

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington

Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure

More information

COMMISSIONING POLICY

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

More information

Case. Wounds. Fundamentals of Ulcer Care. Dr. Mark Meissner Wound Case Study. Compression and Ulcer Healing Cullum NA, Cochrane Reviews 2001

Case. Wounds. Fundamentals of Ulcer Care. Dr. Mark Meissner Wound Case Study. Compression and Ulcer Healing Cullum NA, Cochrane Reviews 2001 Case Wounds Mark H. Meissner, MD University of Washington School of Medicine 65 yr old male physician Recurrent R medial malleolar ulcer over 5 years New R lateral malleolar ulcer Intermittently wearing

More information

Medical Policy. Description/Scope. Position Statement

Medical Policy. Description/Scope. Position Statement Subject: Document #: Publish Date: 12/27/2017 Status: Revised Last Review Date: 05/04/2017 Description/Scope This document addresses various modalities (listed below) for the treatment of valvular incompetence

More information

Endovenous Radiofrequency and Laser Ablation

Endovenous Radiofrequency and Laser Ablation Endovenous Radiofrequency and Laser Ablation [For the list of services and procedures that need preauthorization, please refer to www.mcs.com.pr go to Comunicados a Proveedores, and click Cartas Circulares.]

More information

Mindful Reflections On The Management. of Venous Ulceration. Presenter name. Title Date

Mindful Reflections On The Management. of Venous Ulceration. Presenter name. Title Date C Scott McEnroe, MD, FACS Medical Director Vein Center of Virginia Sentara Vascular Specialists April 25 th, 2014 Mindful Reflections On The Management of Venous Ulceration Approximately 97 % of all statistics

More information

Venous Reflux Duplex Exam

Venous Reflux Duplex Exam Venous Reflux Duplex Exam GWENDOLYN CARMEL, RVT PHYSIOLOGIST, DEPARTMENT OF VASCULAR SURGERY NEW JERSEY VETERANS HEALTHCARE CENTER EAST ORANGE, NJ PURPOSE: To identify patterns of incompetence and which

More information

A treatment option for varicose veins. enefit" Targeted Endovenous Therapy. Formerly known as the VNUS Closure procedure E 3 COVIDIEN

A treatment option for varicose veins. enefit Targeted Endovenous Therapy. Formerly known as the VNUS Closure procedure E 3 COVIDIEN A treatment option for varicose veins. enefit" Targeted Endovenous Therapy Formerly known as the VNUS Closure procedure E 3 COVIDIEN THE VENOUS SYSTEM ANATOMY The venous system is made up of a network

More information

Starting with deep venous treatment

Starting with deep venous treatment Starting with deep venous treatment Carsten Arnoldussen, MD Interventional Radiologist Maastricht University Medical Centre, Maastricht VieCuri Medical Centre, Venlo The Netherlands Background Maastricht

More information

Chronic Swelling, Pain, and Ulceration in the Left Lower Extremity

Chronic Swelling, Pain, and Ulceration in the Left Lower Extremity WHAT WOULD YOU DO? Chronic Swelling, Pain, and Ulceration in the Left Lower Extremity MODERATOR: BROOKE SPENCER, MD, FSIR PANEL: LAWRENCE RUSTY HOFMANN, MD; MARK J. GARCIA, MD, FSIR, FACR; AND BRENT T.

More information

Anatomy. Patterns of reflux. Technique. Testing Reflux time Patient position. Difficult! Learning. NOT system optimisation. Clinical Assesment

Anatomy. Patterns of reflux. Technique. Testing Reflux time Patient position. Difficult! Learning. NOT system optimisation. Clinical Assesment Anatomy Patterns of reflux Awareness Technique Testing Reflux time Patient position Difficult! Learning NOT system optimisation Enlarged Clinical Assesment Twisted Where are the symptoms? Why they are

More information

Determine the patients relative risk of thrombosis. Be confident that you have had a meaningful discussion with the patient.

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

More information

Tessari L. Nouvelle technique d'obtention de la sclero-mousse. Phlebologie 2000;53:129.

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

More information

The Vascular Disease Almost No One Teaches But Should!!! Chronic Venous Insufficiency

The Vascular Disease Almost No One Teaches But Should!!! Chronic Venous Insufficiency The Vascular Disease Almost No One Teaches But Should!!! Chronic Venous Insufficiency Thomas E. Eidson, DO Certified Venous Disease Specialist Board Certified Family Medicine Disclosure of Conflict of

More information

Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim

Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim Published online on 15 November 2012 Phlebology, doi: 10.1258/phleb.2012.012072 Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim Christof

More information

Priorities Forum Statement

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,

More information

Clinical case. Symptomatic anterior accessory great saphenous vein (AAGSV) reflux

Clinical case. Symptomatic anterior accessory great saphenous vein (AAGSV) reflux Clinical case Symptomatic anterior accessory great saphenous vein (AAGSV) reflux A 70 year-old female presents with symptomatic varicose veins on left leg for more than 10 years. She complains of heaviness,

More information

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: MP.066.MH Last Review Date: 11/08/2018 Effective Date: 01/01/2019

MedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: MP.066.MH Last Review Date: 11/08/2018 Effective Date: 01/01/2019 MedStar Health, Inc. POLICY AND PROCEDURE MANUAL This policy applies to the following lines of business: MedStar Employee (Select) MedStar CareFirst PPO MedStar Health considers the treatment of Varicose

More information

Management of Side Branches and Perforating Veins

Management of Side Branches and Perforating Veins Management of Side Branches and Perforating Veins T. Noppeney Center for Vascular Diseases: Outpatient Dept. Obere Turnstrasse, Dept. for Vascular Surgery Martha-Maria Hospital (Academic Teaching Hospital

More information

PHLEBOLOGY. Venous Insufficiency. Presentation Use Information

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

More information

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery 2016 Annals of Vascular Diseases doi:10.300/avd.oa.16-000 Original Article Thrombosis of the Saphenous Vein Stump Varicose Vein Surgery Hiroto Rikimaru, MD, PhD We evaluated thrombus extension in the proximal

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Community Plan Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: CS117.N Effective Date: April 1, 2019 Instructions for Use Table

More information

History is Flawed. A New Paradigm for Abdominal & Pelvic Venous Disorders

History is Flawed. A New Paradigm for Abdominal & Pelvic Venous Disorders History is Flawed A New Paradigm for Abdominal & Pelvic Venous Disorders Mark H. Meissner, MD Peter Gloviczki Professor of Venous & Lymphatic Medicine University of Washington School of Medicine Disclosures

More information

As with any intervention, selection of an appropriate

As with any intervention, selection of an appropriate DVT: ccess Decisions for Interventions ssessing the advantages and disadvantages of venous access options is crucial for safe and successful DVT intervention. Y JOHN. KUFMN, MD, MS, FSIR, FH, FCIRSE, EIR

More information

Treatment of Varicose Veins/Venous Insufficiency. Description

Treatment of Varicose Veins/Venous Insufficiency. Description Page: 1 of 24 Last Review Status/Date: March 2015 Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency, including surgical approaches, thermal ablation,

More information

SCIENTIFIC PROGRAMME

SCIENTIFIC PROGRAMME 9 th EVF HOW HANDS-ON WORKSHOP on VENOUS DISEASE Grand Resort, Limassol, Cyprus, 25-27 October 2018 SCIENTIFIC PROGRAMME Thursday 25 October 2018 07.30 Welcome Chronic Venous Disease (CVD) - Basics 07.45

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Commercial Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: 2018T0447V Effective Date: March 1, 2018 Table of Contents Page INSTRUCTIONS

More information

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS

SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS UnitedHealthcare Commercial Medical Policy SURGICAL AND ABLATIVE PROCEDURES FOR VENOUS INSUFFICIENCY AND VARICOSE VEINS Policy Number: 2017T0447T Effective Date: July 1, 2017 Table of Contents Page INSTRUCTIONS

More information

Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins

Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins Eur J Vasc Endovasc Surg (2011) 41, 691e696 Endovenous Laser Ablation (EVLA) to Treat Recurrent Varicose Veins N.S. Theivacumar, M.J. Gough* Leeds Vascular Institute, The General Infirmary at Leeds, Great

More information