Скачать с ютуб 7 Controversies in Leg Vein Treatment: BAS Meeting 2016 в хорошем качестве

7 Controversies in Leg Vein Treatment: BAS Meeting 2016

http://www.theveincarecentre.co.uk/co... Should Ultrasound Guided Foam Sclerotherapy be first choice in the treatment of varicose veins? Sclerotherapy is first choice for an impressive list of situations including recurrent varicose veins, small saphenous reflux, non-saphenous veins, perforator veins, residual veins and great saphenous veins less than 8 mm in diameter. Although endothermal ablation is suitable for saphenous veins that are relatively straight, ie they are not tortuous it is clear that sclerotherapy is far more versatile. Nearly any vein in the leg can be treated and in this respect, many specialists believe that Ultrasound Guided Foam Sclerotherapy be should be at least joint first choice in the treatment of varicose veins. How should Ultrasound Guided Foam Sclerotherapy be performed? Dr Philip Coleridge Smith provided a live demonstration of varicose vein treatment at the meeting. He emphasised the need to treat saphenous reflux, all the tributaries and all the varicose veins all together usually in one treatment session. He showed how he places multiple cannulas before administering the sclerosant. His aim is to obliterate all reflux and visible veins and as part of his protocol, he sees patients 2 weeks later, he aspirates any retained thrombus or coagulum and he retreats any veins that are persistent or refluxing. Once he has eradicated all the reflux and varicose veins, he sees patients six months after treatment and any signs of reflux or persistent varicose veins are once again retreated. His protocol gives excellent results that are very comparable to endothermal treatments. Do all patients with leg telangiectasias –thread veins – need a duplex ultrasound scan? Doctor Pavei addressed this issue. She provided a lot of evidence and in her opinion, duplex ultrasound is mandatory prior to treating leg thread veins. She pointed out that at least 25% of patients with leg telangiectasias have saphenous vein reflux. When should compression stockings be advised after sclerotherapy? Dr Martyn King tackled this difficult subject with a thorough review of the medical literature and he led a lively debate on the subject. My own impression is that wearing compression certainly offers benefit to patients after Ultrasound Guided Foam Sclerotherapy and perhaps it offers less benefit to patients after sclerotherapy for thread veins. At The VeinCare Centre we advise compression after sclerotherapy but we suggest that if the compression is uncomfortable or causing problems that it is immediately discontinued. It was acknowledged at the meeting that many specialists do not prescribe compression stocking after thread vein injections. Do all patients with phlebitis need a duplex scan. Dr Rangarajan a consultant haematologist from Basingstoke gave a thorough review of deep vein thrombosis and phlebitis. From her presentation it was clear to me that patients with phlebitis do have clots in the superficial veins and that they are also in a hypercoagulable state – that is they have sticky blood. As many as 25% of patient with phlebitis have a co-existing deep vein thrombosis and many of the rest are at high risk of developing one. It is my opinion having listened to Dr Rangarajan that everyone with phlebitis should have a duplex ultrasound scan. Can complications of sclerotherapy be avoided? Dr Philip Coleridge Smith gave a wonderfully illustrated review of complications associated with sclerotherapy many based on his role as a medical expert in cases of complaint and litigation. Based on his presentation it appears that the majority of serious complication of sclerotherapy can be avoided by careful technique, slow injection of small volumes of sclerosant and by using the correct dose and strength of sclerosant. What is the best treatment for leg thread veins? This proved to be the least controversial area. Live demonstrations of leg thread vein treatment by Claire Judge and Julie Halford as well as discussions led by Dr Pavei, Dr Stephen Tristram, Dr Martyn King and Philip Coleridge Smith confirmed that Microsclerotherapy carefully performed after a thorough assessment (which in my opinion should include a duplex ultrasound scan) certainly gives the best results.