Disclosure. Lowell Kabnick, M.D., FACS, FACPh. I disclose the following financial relationship(s):

Transcription

1 Disclosure Lowell Kabnick, M.D., FACS, FACPh I disclose the following financial relationship(s): Research Grant: BTG; Ownership Interest: AngioDynamics, Vascular Insights; Consultant/Advisory Board: AngioDynamics, BSN Jobst, Vascular Insights

2 Sclerotherapy and lasers for spider veins: What works best? Lowell S. Kabnick, MD, FACS, FACPh New York University

3 Before I answer the question of what works best

4 Meetings AVF,ACP,VEITH,IVC

5 Sclerotherapy Skleros Gr. hard or indurated, especially in an organ or tissue due to excessive growth of fibrous tissue. Hyman I. Biegeleisen, MD coined the word "sclerotherapy" to describe the treatment. TELANGIECTASIA ASSOCIATED WITH VARICOSE VEINS: TREATMENT BY A MICRO-INJECTION TECHNIC J Am Med Assoc, Jun 1934;

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7 House Keeping

8 OFF LABEL and/or NON-FDA APPROVED DRUGS Foam Sclerotherapy has not been approved for use by the Federal Drug Administration. Hypertonic Saline, Hypertonic Dextrose & Glycerin are for OFF LABEL DRUG USE.

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10 How I Do It

11 This is Not Magic or Illusions

12 But

13 INDICATIONS Surface Veins Varicose branches(< 8mm ) Reticular veins (2-4 mm ) Telangiectasias (0.1-2mm) Recurrent varicosities Unsightly normal superficial veins

14 PATIENT SELECTION Start with a thorough HISTORY and PHYSICAL EXAM. Evaluate results of Vascular testing. Discuss results and expectations.

15 Obtain informed consent Take photographs (Patients tend to forget) Document each treatment session,chart location of veins,number of injections,concentration and amount of the solution used (form)

16 TECHNIQUE OF INJECTION Use appropriate size needle for vein Use gauge needles ½ inch long. Inject volume until blood disappears and before blanching (size of vein matters) Avoid forceful pressure

17 TECHNIQUE OF INJECTION(cont.) Do not inject more than a few centimeters away from the puncture site. Apply pressure after injection. Apply compression stockings (controversial)

18 Sclerotherapy Concentrations STS AS spiders % reticular % varicose % not approv.

19 First: Inject Reticular Vein

20 Sclerotherapy of Telangiectasias: Technique Where Do You Start?

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26 Complications of Sclerotherapy: An Update J. GUEX ,173 sclero sessions (French Registry) Complications and side effects of sclerotherapy are uncommon; the method has demonstrated its safety, with 0.22% of complications per session with liquid sclerosant

27 J. GUEX 2010 The most frequent side effects were visual disturbances (n=14), and the most severe were muscular vein thrombosis (n=8). The onset of side effects was mostly observed directly after sclerotherapy

28 . Treatment of varicose and telangiectatic leg veins: doubleblind prospective comparative trial between aethoxyskerol and sotradecol. Goldman MP. Dermatol Surg Jan;28(1):52-5 All129 patients had an average of 70% improvement. There was no significant difference in adverse effects between each group

29 Injection sclerotherapy for varicose veins. Tisi PV, Beverley C, Rees A Cochrane Database Syst Rev Oct 18;(4):CD Evidence from 17 RCTs suggests that the choice of sclerosant, dose, formulation (foam versus liquid), local pressure dressing, degree and length of compression have no significant effect on the efficacy of sclerotherapy for varicose veins. The evidence supports the current place of sclerotherapy in modern clinical practice, which is usually limited to treatment of recurrent varicose veins following surgery and thread veins.

30 Lasers-transdermal Fiber Laser beam Hand piece Skin cooling device

31 Surface Lasers 532nm Red spider veins 1064nm 50% efficacy Expensive Blue spider and reticular veins Variable Expensive Sclerotherapy > Laser LKabnick,MD

32 Clinical Comparison of Sclerotherapy Versus Long-Pulsed Nd:YAG Laser Treatment for Lower Extremity Telangiectases Jason R. Lupton MD, Dermatologic Surgery,, August 2002 Leg telangiectases responded best to sclerotherapy in fewer treatment sessions than to long-pulsed 1064 nm Nd:YAG laser. Laser leg vein treatment appears to be most beneficial in telangiectatic matting, needle phobia sclerosant allergy.

33 VeinGogh VeinWave

34 Conclusion Treatment of choice for telangiectasia (leg) Sclerotherapy Treatment of choice for telangiectasia (face) Laser 1064nm/VeinWave;VeinGogh