Phlebectomy vs sclerotherapy ALESSANDRO FRULLINI MD FLORENCE - ITALY
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1 Phlebectomy vs sclerotherapy ALESSANDRO FRULLINI MD FLORENCE - ITALY
2 DISCLOSURE Consultant for: GloriaMed
3 Personal background General and vascular surgeon More than 3500 stripping performed 33 years of experience in sclerotherapy Echoguided saphenous sclerotherapy from 1994 (23 years) Foam sclerotherapy from 1997 (20 years)
4 ABOUT TRIBUTARIES TREATED WITH PHLEBECTOMY ACCORDING TO MULLER TECHNIQUE
5 Presently my sole treatment for saphenous and perforators incompetence is foam sclerotherapy
6 PHLEBECTOMY: ADVANTAGES MINIMAL INVASIVENESS LOCAL ANESTHESIA EASY TO LEARN LITTLE RISK
7 PHLEBECTOMY: DISADVANTAGES TREAT MOSTLY TRIBUTARIES LOCAL COMPLICATIONS SOMETIMES POOR AESTHETICS
8 MILLENIUM RESEARCH GROUP
9 MILLENIUM RESEARCH GROUP
10 Assessment of thrombotic adverse events and treatment patterns associated with varicose vein treatment T O DONNELL retrospective study was conducted with health care claims data 40 million insured lives subjects aged 18 years with a new diagnosis of varicose veins who had received at least one invasive treatment 985,632 unique subjects diagnosed with varicose veins T O DONNELL et al: J of Vasc Surgery :Venous and Lymphatic Disorders Jan 2015 Vol 3 Number 1 pag 27-34
11 DVT INCIDENCE RADIOFREQUENCY.. 4.4% LASER ABLATION. 3.1% SURGERY.. 2.4% SCLEROTHERAPY. 0.8%
12 PE INCIDENCE RADIOFREQUENCY.. 0.3% LASER ABLATION. 0.3% SURGERY.. 0.3% SCLEROTHERAPY. 0.2%
13 WHY SCLEROTHERAPY IS NOW MY PRIMARY TREATMENT?
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19 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
20 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
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24 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
25 SCLÉROTHÉRAPIE À LA MOUSSE ASSISTÉE PAR LASER (LAFOS) : UNE NOUVELLE APPROCHE POUR LE TRAITEMENT DE L INCOMPÉTENCE DES VEINES SAPHÈNES A.Frullini D. Fortuna 2013
26 CAN WE FIND ANOTHER WAY TO MANAGE VV? Laser assisted foam sclerotherapy (L.A.FO.S.): a new approach to the treatment of incompetent saphenous veins
27 L.A.FO.S VEIN DIAMETER REDUCTION BEFORE FOAM SCLEROTHERAPY USING A NEW HOLMIUM LASER OFFICE PROCEDURE PAINLESS PROCEDURE NO RISK OF PERIVENOUS DAMAGE
28 L.A.FO.S VEIN ACCESS WITH A SIMPLE CANNULA (17G) OR WITH AN INTRODUCER INSERTION OF THE LASER FIBER FIBER RETRIVAL WHILE VEIN DIAMETER IS REDUCED IMMEDIATE FOAM INJECTION IN THE SAME CANNULA
29 SCLEROLUX Ho:YAG (2,100 nm) laser (table top), ca. 20 kg Optical fiber size : 550 mm ext. 880 mm 17G or 18G thin-walled needle Short Pulse : 350 ms, Max Power : 5 W Long Pulse : 2.5 ms, Max Power : 2.5 W March 24 th, 2012 Photobiolab Research Unit - El.En. S.p.A. Dr. Damiano Fortuna, Director
30 Absorption Coeff. & l Ho:YAG March 24 th, 2012 Photobiolab Research Unit - El.En. S.p.A. Dr. Damiano Fortuna, Director
31 Ho:YAG, Not Clots Mechanism of EndoVenous Laser Treatment revealed using temperature and imaging strategies comparing Diode, Nd:YAG, Thulium and Holmium laser systems. Alex I Rem, Sander van Thoor, Rudolf M Verdaasdonk, Ben CVM Disselhoff and Daan J der Kinderen. Department of Clinical Physics, University Medical Center Utrecht, Departments of Surgery and Dermatology, Mesos Medical Center Utrecht, The Netherlands March 24 th, 2012 Photobiolab Research Unit - El.En. S.p.A. Dr. Damiano Fortuna, Director
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34 T C Endothelium Time T C Tunica media Avg. T Time
35 Recovery of vein diameter without intimal damaging Intima Intima 74.5 Media Media Adventitia Adventitia 44 37
36 H.&E. Stain HISTOLOGY Short Pulse (350 ms) Tunica intima Tunica media Untreated, healthy Tunica adventitia Treated, IHC Fact. VIII March 24 th, 2012 Treated, H&E Photobiolab Research Unit - El.En. S.p.A. Dr. Damiano Fortuna, Director
37 L.A.FO.S IS POSSIBLE AS HOLMIUM LASER DOESN T AFFECT TUNICA INTIMA AND INTIMA INTEGRITY IS A PREREQUISITE FOR GOOD SCLEROSIS
38 DUE TO REDUCED VEIN DIAMETER LESS FOAM VOLUME IS NEEDED
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47 Pre-treatment
48 Post-treatment
49 Pre-treatment
50 Post-treatment
51 LAFOS FROM VEINS TREATED 93 GSV mean diameter 14,54mm 17 SSV mean diameter 9,35 mm
52 LAFOS GSV LAFOS SSV mean diameter 14,04 mm Mean energy 300 mj Mean foam volume 4,0 POL concentration 3% Mean diameter 11,64mm Mean energy 200 mj Mean foam volume 2,1 POL concentration 2,5%
53 LAFOS IMMEDIATE RESULTS ON 110 LAFOS 106 IMMEDIATE SUCCESS 96,4% 2 VEINS OCCLUDED AT REPEATED LAFOS 1 VEIN OPEN DUE TO THERMAL OVERTREATMENT 1 VEIN DUE TO DIFFICULT ACCESS
54 LAFOS FOLLOW UP DATA FROM 51 VEINS (46.36%) months 96.07% GOOD RESULTS 3.92% RECANALIZATION
55 Pre-holmium Post-holmium
56 AT THIS MOMENT WE HAVE NOT ENOUGH DATA ON THE LATE OUTCOME OF FOAM SCLEROTHERAPY AFTER HOLMIUM LASER REDUCTION OF VEIN DIAMETER BUT ENHANCEMENT OF FOAM SCLEROTHERAPY SEEMS REASONABLE
57 IN MY EXPERIENCE VEINS RESISTENT TO FOAM SCLEROTHERAPY ARE SUCCESSFULLY TREATED WITH LAFOS
58 Courtesy of dr JL Gillet
59 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
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64 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
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66 THE KEY TO AVOID PHLEBITIS IS ADEQUATE COMPRESSION PREFER CLASS 2 AND AVOID MICROFIBER
67 SCLEROTHERAPY FALSE MYTHS SEVERAL SESSIONS ARE NECESSARY MULTIPLE INJECTIONS ARE NECESSARY NOT POSSIBLE FOR LARGE DIAMETER HIGH INCIDENCE OF PIGMENTATION HIGH INCIDENCE OF PHLEBITIS POOR OUTCOME
68 CVD IS A CHRONIC DISEASE THAT WE CAN ONLY CONTROL IT IS VIRTUALLY IMPOSSIBLE NOT TO OBTAIN VEIN OCCLUSION WITH REPEATED SESSIONS RECURRENCE OR REAPPEARANCE OF AN INCOMPETENT VEIN IS ONLY ONE MORE INJECTION AFFAIR
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75 CONCLUSIONS SCLEROTHERAPY IS THE MOST SUITABLE TOOL TO CONTROL VARICOSE VEINS WITH LESS INVASIVENESS, LESS COST AND THE BEST BENEFIT/RISK RATIO CAUTION MUST BE TAKEN IN COMPARING DIFFERENT EXPERIENCES AS DIFFERENT FOAMS OR DIFFERENT TREATMENT STATEGIES MAY PRODUCE DIFFERENT OUTCOMES
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