Optimal indications for foam sclerotherapy. Breu F. X., Rottach Egern/Tegernsee,
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1 Optimal indications for foam sclerotherapy Breu F. X., Rottach Egern/Tegernsee,
2 Transparenzerklärung Dr. F. X. Breu Hiermit lege ich offen, dass ich von folgenden Firmen Honorare erhalten habe, die sich auf Vorträge und Moderationen, die Teilnahme an Advisory Boards und allgemeine Beratung beziehen: - Bayer Vital - Kreussler Pharma - Leo Pharma - Sigvaris - OmniaMed
3 European Guidelines for Sclerotherapy in Chronic Venous Disorders Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Partsch B, Ramelet AA, Tessari L, Pannier F for the Guideline Group Phlebology 2013
4 Guideliene Conference, Mainz
5 Guideliene Conference, Mainz European Phlebological Societies Antignani, P.L. Italian Society of Angiology and Vascular Medicine Bihari, I. Hungarian Venous Forum Böhler, K. Austrian Society of Phlebology and Dermatologic Angiology Breu, F. X. German Society of Phlebology Cavezzi, A. Italian College of Phlebology Ceulen, R. Benelux Society of Phlebology Coleridge Smith, P. Venous Forum of the Royal Society of Medicine Fernandez, F. Spanish Chapter of Phlebology Frullini, A. Italian Phlebological Association Gillet, J.L. French Society of Phlebology Goranova, E. Bulgarian Society of Phlebology Guex, J.J. French Society of Phlebology Guggenbichler, S. German Society of Phlebology Hamel-Desnos, C. French Society of Phlebology Islamogu, F. Turkish Society of Phlebology Kern, P. Swiss Society of Phlebology Kuzman, G. Bulgarian Society of Phlebology Larin, S. Russian Phlebological Association Maurins, U. Baltic Society of Phlebology Milic, D. Serbian Society of Phlebology, Balcan Venous Forum Pannier, F. German Society of Phlebology Partsch, B. Austrian Society of Phlebology and Dermatologic Angiology Rabe, E. German Society of Phlebology Radu, D. Romanian Society of Phlebology Ramelet, A.-A. Swiss Society of Phlebology Rasmussen, L. Scandinavian Venous Forum Schuller-Petrovic, S. Austrian Society of Phlebology and Dermatologic Angiology Sommer, A. Benelux Society of Phlebology Strejcek, J. Czech Society of Phlebology Stücker, M. German Society of Phlebology Tessari, L. Italian College of Phlebology Tüzün, H. Turkish Society of Phlebology Urbanek, T. Polish Society of Phlebology
6 Indications We recommend sclerotherapy for all types of veins, in particular: Incompetent saphenous veins (GRADE 1A) Tributary varicose veins (GRADE 1B) Incompetent perforating veins (GRADE 1B) Reticular varicose veins (GRADE 1A) Telangiectasias (spider veins) (GRADE 1A)
7 Indications Residual and recurrent varicose veins after previous interventions (GRADE 1B) Varicose veins of pelvic origin (GRADE 1B) Varicose veins (refluxing veins) in proximity of leg ulcers (GRADE 1B) Venous malformations (GRADE 1B)
8 Specific (optimal) indications for foam sclerotherapy Isolated incompetent side branches (e.g. v. saph. access. ant.), reticular veins, refractory and/or large-diameter spider veins, telangiectasias, central veins of spider veins Partial incompetence of the GSV (max diameter 8 mm) and SSV of the side branch or perforans type incompetence of opening type with working valve on the outer pelvic level (iliac veins) or in the common femoral vein (prox. the SFJ) Recurrent varicosis (REVAT) varix rupture, spontaneous varix bleeding
9 SFJ= saphenous junction SSV = suprasaphenous valve TV = terminal valve PTV = preterminal valve M.Stücker: Vasomed 2011 Congress edition: in 48% TV sufficient and PTV insufficient = good indication for endoluminal procedure
10 10
11 72y. pat. with recurrent varicous bleeding, AF, anticoagulation, rec. ulcers
12 After 4 times sclerotherapy Control after 12 weeks
13 Recurrences 47 y old female after 3 times surgery right and 2 times surg. left leg
14 Specific indications for foam sclerotherapy Isolated branch varicosis (e.g. v. saph. access. ant.), reticular veins, refractory and/or largecalibre spider veins, telangiectasias, central veins of spider veins Partial incompetence of the GSV and SSV of the side branch or perforans type (max. diameter 8 mm) GSV insufficiency of opening type with working valve on the outer pelvic level or in the common femoral vein Recurrent varicosis (REVAT) varix rupture, spontaneous varix bleeding Obesity Periulcerous varicosities (aged patient)
15 The tangle of dilated venules under the ulcer are the target of treatment in foam sclerotherapy
16 Healing and Recurrence Rates Following Ultrasoundguided Foam Sclerotherapy of Superficial Venous Reflux in Patients with Chronic Venous Ulceration Pang K H et al; Birmingham, UK; Eur J Vasc Endovasc Surg 2010; Pat., 132 Beine. CEAP: 49 C C6, mittleres Alter: 70y, mittlere Ulkusdauer: 8m, mittleres Schaumvolumen: 8 ml Med. follow up: 16m (12-32m) Heilungsrate (C6): 81% nach 6m Rezidive: 5% nach 2y (ESCHAR 2007: ca. 40% nur Kompr., ca. 20% OP+Kompr.!) --> Keine Thrombose, Sehstörung oder neurolog. Ereignis
17 Specific indications for foam sclerotherapy Isolated branch varicosis (e.g. v. saph. access. ant.), reticular veins, refractory and/or large-diameter spider veins, telangiectasias, central veins of spider veins Partial insufficiency of the Vsm and Vsp of the side branch or perforans type Magna insufficiency of opening type, possibly better results with functioning valve on the outer pelvic level or in the v. fem comm. Recurrent varicosis (REVAS) Varix rupture, spontaneous varix bleeding Obesity Periulcerous varicosities (old patient) Patient who refuses surgery or other procedure Lymphedema Rel. contraindications for surgery (eg OAK) Patients at increased risk during heparin bridging (eg. artificial heart valves) Venous malformations such as KTS Vulvar varicosis Varix convolutes and highly tortuous varicose veins (not suitable for laser and VNUS) Bone-perforators
18 Sek. lymphedema with varicose veins
19 Vulvar varices of pelvic origin
20 Knochenperforatoren mit Seitenästen We sometimes see side branches with their origin in bone perforators Thanks to A.Ramelet Phlebology 2016
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23 Thank you for your attention
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