Chronic Venous Disease Treatment - Part II Vein closure and rerouting of blood through normal veins with Ultrasound Guided Foam Sclerotherapy S. Lakhanpal MD, FACS President & CEO Center for Vein Restoration
Transcript
Slide 1
Chronic Venous Disease Treatment - Part II Vein closure and
rerouting of blood through normal veins with Ultrasound Guided Foam
Sclerotherapy S. Lakhanpal MD, FACS President & CEO Center for
Vein Restoration
Slide 2
Ultrasound Guided Foam Sclerotherapy (USGFS)
Slide 3
CVR, in following the SVS guidelines, believes that USGFS is an
adjunct to thermal ablations. Indications Treatment for extensive
networks of symptomatic varicose veins. Varicose Vein treatment for
patients on coumadin or blood thinners. Treatment for tortuous,
superficial or small segments of refluxing tributaries of the
saphenous vein not amendable to laser or RF treatment.
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Ultrasound Guided Foam Sclerotherapy (USGFS) Indications
(Contd) Treatment for refluxing vessels in the distal calf,
neovascularization and microvasculature associated with non healing
ulcers. Insurance mandated treatment modality becoming more
common.
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Ultrasound Guided Foam Sclerotherapy (USGFS) History Injections
to treat varicose veins date back 150 years. Using foam
preparations of solutions date back 60 years. Techniques evolved in
the late 1980s with the aid of duplex ultrasonography. Prior to
2004, USGFS was the main modality of treatment for diseased vessels
outside of vein stripping.
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Ultrasound Guided Foam Sclerotherapy (USGFS) Sclerosing Agents
Sotradecol Sodium tetradecyl sulfate (STS) Received FDA approval in
2004 Aslcera-Polidocanol (POL) Received FDA approval in 2010
Different strengths of sclerosant are used for different sized
veins. Foam is made at bedside- Tessari method is most common.
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Ultrasound Guided Foam Sclerotherapy (USGFS) Procedure Office
based, takes 30 minutes or less. Requires little or no local
anesthesia. More than one vein may be treated during the same
session. If any vein is incompletely treated, further injections
may be given in the same or subsequent session.
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Ultrasound Guided Foam Sclerotherapy (USGFS) Closure Rates Foam
Sclerotherapy 77% closure rate at 22 months Barret J, Allen B,
Ockelford A, Goldman M. Microfoam ultrasound-guided sclerotherapy
of varicose veins in 100 legs. Dermatol Surg 2004;30:6-12
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Ultrasound Guided Foam Sclerotherapy (USGFS) Post Procedure
Immediate return to normal activity Walking encouraged Limit
vigorous exercise for 1-2 weeks Recommend compression stockings for
1-2 weeks
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Ultrasound Guided Foam Sclerotherapy (USGFS) Contraindications
Known allergy to the sclerosant Acute deep vein thrombosis Known
patent foramen ovale Pregnancy Breast Feeding
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Ultrasound Guided Foam Sclerotherapy (USGFS) Adverse Reactions
Blood Trapping- 30% Staining and matting of the skin- 30% Due to
hemosiderin in the skin as a result of extravasation of red blood
cells. Resolves spontaneously in 80% of patients within a year.
Occurs more commonly with Fitzpatrick skin types IV, V, and VI.
Headaches and transient vasospastic reactions- 2%
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Ultrasound Guided Foam Sclerotherapy (USGFS) Adverse Reactions
(contd) DVT- 1% to 3% Allergy to compound- very rare POL estimated
1 in 10,000 STS allergy risk 0.15%-0.30% 5 deaths due to
anaphylaxis published to date Ulceration of the skin- very rare
Typically does not occur with low concentrations, 0.1% to 0.5%
STS
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Ultrasound Guided Foam Sclerotherapy (USGFS) Adverse Reactions
(contd) Stroke- 0.01% 15 case reports since 1947 13 case reports
since 1994 (9 with foam and 4 with liquid sclerosant) 3 patients
with irreversible deficits
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Ultrasound Guided Foam Sclerotherapy (USGFS) Summary Minimally
invasive procedure No incisions No heavy anesthesia No extended
recovery times involved Immediately return to your daily life Low
Risk Economical High Utility of Use