2 premier laser vein clinic the basics of venous disease: what you should know. dr. rajan modi m.s....
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Premier Laser Vein ClinicTHE BASICS OF
VENOUS DISEASE:What You Should Know.
Dr. Rajan ModiM.S. F.M.A.S.
An Introductory Lecture
P. Fujimura, MD
Surgical Intern
University of California School of Medicine
“It is ironic that medical education does not cover three of the most common medical problems: back pain,
hemorrhoids, and varicose veins.”
PHLEBOLOGY
The medical specialty devoted to the diagnosis and treatment of patients with venous disorders
Anatomy and physiology of the venous system
Deep venous system: the channel through which 90% of venous blood is pumped out of the legs
Superficial venous system: the collecting system of veins
Perforating veins: the conduits for blood to travel from the superficial to the deep veins
Musculovenous pump: Contraction of foot and leg muscles pumps the blood through one-way valves up and out of the legs
Venous Anatomy
Valve Failure
Prolonged dilation damages the valves, so the blood flows in the wrong direction
The resulting backpressure is termed “venous hypertension”, and this is what causes symptoms
IMPORTANCE OF CHRONIC VENOUS DISEASE
Incidence increases with age and is more common in women with over 40% of women in their 50’s suffering from some sort of venous disorder
Etiology of Venous Insufficiency Inherited genetic predisposition
Normal aging process
Hormonal changes
History of venous thrombosis
Excess pressure on leg veins Standing
Obesity
Pregnancy
Tumors
Constipation
Previous surgery
Venous Disease is a Hereditary Disorder
The risk of developing varicose veins was:
89% if both parents had varicose veins
47% if one parent had varicose veins
20% if neither parent had varicose veins
Other Factors Chronic Venous Insufficiency
Although some risk factors for venous disease such as age, family history of venous disease are immutable others can be modified, such as weight, physical activity, and cigarette smoking.
Presenting Symptoms of Chronic Venous Disease Aching 17percentCramping-14Tired legs-12 Swelling-12 Heaviness-12 Itching -6 Restless legs-6
THE SPECTRUM OF CHRONIC VENOUS DISEASE
telangiectasias
lipodermatosclerosis varicose veins
Superficial phlebitis
venous ulceration 5
Venous Disease Classification
CEAP
Clinical
Etiologic
Anatomic
Pathologic
What? How ? Where? Why?
Venous Disease Classification Clinical C0 - No visible or palpable venous disease
C1 - Telangectasias or reticular veins
C2 - Varicose veins
C3 - Edema
C4 - Skin changes (a - pigmentation b - dematosclerosis)
C5 - Healed ulcers
C6 - Active ulcers
Venous Disease Classification Etiological
C - congenital
P - primary (venous failure without other cause)
S - secondary (post-phlebitic syndrome)
Venous Disease Classification Anatomical
S - superficial
D - deep P - perforator
Venous Disease Classification Pathological
R - reflux
O - obstruction
Venous Disease Diagnosis
Physical Exam Visible veins
Swelling
Ulceration
Skin changes
Standing venous reflux exam Duplex ultrasound with compression and release
Standing venous reflux exam
Standing Venous Reflux Exam Establishes presence of reflux
Deep and/or superficial systems Results dictate treatment option
Superficial only Conservative or
interventional Deep only Conservative
Deep and superficial involvement Conservative Selective interventional
Venous Disease Treatment Options
Conservative Elevation
Compression
Interventional Stripping
Laser ablation Radio frequency ablation Micro or stab phlebectomy Sclerotherapy
Conservative Treatment Compression Therapy
Treatment of telangiectasias
Sclerotherapy most effective
Laser may be helpful Multiple treatments usually
required Reduces symptoms in 85%
of patients Improves quality of life
Surgical Treatment of Varicose Veins: Vein Stripping
Vein stripping used to
remove Great and Small saphenous veins
Crossectomie and Stripping ► Very invasive and traumatic procedure
► General anaesthesia is required
► Destroys the connective tissue
► Poor cosmetical result due to scarring
► Patients have to be hospitalised
► Recovery time 2-3 weeks
► High Recurrence Rates
Conventional Treatment
EVLT Less invasive technique: Endovenous Laser Treatment (EVLT). EVLT uses targeted laser energy to seal the vein shut
Why ELVeS™ - Advantages GSV treatment
• Gentle, moderate and yet effective method of treatment • Less traumatic • Minimal discomfort • Quick and easy to perform • No scarring • No general anaesthesia required • Excellent aesthetic results • Recurrence rates are extremely low • Outpatient Procedure • A rapid return to normal activities
ELVeS™ by biolitec
EVLT Procedure A catheter is placed in the vein through a needle utilizing ultrasound guidance
• The laser is passed through the catheter to the saphenofemoral junction which is confirmed by ultrasound
EVLT Procedure
ELVeS™ - The Procedure for the GSV
Map the Course of the Vein
ELVeS™ - The Procedure for the GSV Access to the Vein
• Anaesthesia by local intradermal injection• Entry of the needle into the vein under Ultrasound
Guidance
ELVeS™ - The Procedure for the GSV
• After the puncture the guide wire is inserted into the vein
• The entry needle is withdrawn and the introducer sheath and dilator are inserted over the guide wire and into the vein
• The guide wire is then removed and the laser fibre is inserted into the introducer sheath and advanced along its length
• The introduction of the laser fiber can be monitored by using the aiming beam
ELVeS™ by biolitec
ELVeS™ - The Procedure for the GSV
• The fibre is advanced to a position 2-3 centimeters below the sapheno-femoral junction to preserve the integrity of the femoral vein from the first pulse of laser energy
• The final position 2-3 cm below the sapheno femoral junction is controlled by ultrasound
ELVeS™ by biolitec
EVLT Advantages
Relief of chronic pain symptoms Faster return to normal activity Improves venous stasis wound healing potential Decreases wound recurrence Minimal-to-no scarring Typically is covered by insurance
EVLT Post-op Care
Dress leg with compression bandage Class II compression stocking on POD 2 Resume normal activities as tolerated Avoid hot baths Avoid vigorous gym workouts
EVLT Post-op
Mild Bruising can occur along the leg that has been treated A “tightening” sensation along the vein is reported by many patients Some mild tenderness along the vein
EVLT - Patient 1
Before EVLT
2 Months After EVLT
EVLT - Patient 2
Before EVLT
2 Months After EVLT
Before - After Pictures
ELVeS™ by biolitec
Surgical Treatment of Varicose Veins: Phlebectomy
Very esthetic method of removing varicose veins
Usually requires only local anesthetic
Especially useful for tributaries of GSV, SSV
Institute Experience n>370
0% mortality
0% major adverse events
0.9% DVT (n=3) 0% skin burns
0% major infection rate
Conclusions Venous disease is common
Venous disease is related to either reflux or obstruction
Symptoms include pain, swelling, and ulceration Duplex imaging aids diagnosis and treatment Treatment options are both conservative and
interventional
Endovenous laser treatment provides potential relief of symptoms in a minimally invasive manner
Why Refer Patients to PLVC for Venous Disease
Comprehensive care by surgeon. Member of american board of phlebology. Sterile surgical environment.Dedicated anesthesiology.
THANK YOU FOR YOUR ATTENTION
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