Future of phlebology
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Presentation depicts current achievments in phlebology and future insights regading new technologies, new problems and opportunities
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Future of phlebology
- 1. Surgical insight into future of phlebology Michał Molski
- 2. Deep venous system - Thrombosis • New technologies allow to perform procedures in deep venous system • Treatment of deep vein thrombosis • Treatment of postthrombotic syndrome • Treatment of deep system insuficiency
- 3. Deep venous system - Thrombosis • Change in imaging standard • Compression US in not enough • Complete venous roadmap • full duplex • MRV / CTV
- 4. Deep venous system – CT venography Assesment of postthrombotic lesions in ilio-femoral veins
- 5. Deep venous system - Thrombosis • A standarized DVT classification required • Documentation of pathology • Decision based on classification • Enables research • Lower Extremity Thrombosis • LET 1 – calf veins • LET 2 – POPV, SFV, DFV • LET 3 – ilio-femoral • LET 4 - caval
- 6. Deep venous system - Thrombosis • A standarized DVT classification required • Documentation of pathology • Decision based on classification • Enables research • Lower Venous Extremity SCORE • Each segment • Post thrombotic lesions • Residual stenosis • 0% • 10-50% • 50-90% • 100% • Collaterals • External compression
- 7. Deep venous system - Thrombosis • Current DVT treatment • Thrombolysis • Systemic • CDT • Mechanical • Pharmaco-mechanical • FUTURE • No thrombolitics • <1 hour • Outpatient • Lower cost • Lower complications • Patients with malignacies • Postoperative patients
- 8. Deep venous system - Thrombosis • Local thrombolytic devices • Trellis II • Low profile devices • Lazarus – 4F • Angiodynamics 14F device • Angiovac
- 9. Deep venous system - Obstruction Current Stent problems • Radial force • Kinking • Tappering • Stent rigifity • fractures • bamboo effect FUTURE • New better stents
- 10. Deep venous system - Obstruction • Endophlebectomy of CFV • Improves inflow • Patch? • AV fistula FUTURE • Percutaneous? • Endoscopic?
- 11. Deep venous system - Insuficciency Reflux in • Internal iliac vein • gonadal veins • vulval veins Clinical presentation • Pelvic congestion • Pubic varicosieties • Reccurent leg varicosities • Hemorhoids? Treatment options • Coils • sclerotherapy
- 12. Superficial & perforating system treatment • Classical surgical approach • Endovenous • Thermoablation • Chemical ablation • Thermo-chemical ablation • Mechano-chemical ablation • Hybrid procedures
- 14. Changes in phlebology Optimal medical care will be provided in specialised venous centers • High volume of patients • Expertise in simple and difficult cases • Complex diagnosis • Ultrasound • MR • CT • Complex treatment • Endovenous superficial procedures • Endovenous deep system procedures • Surgical • Esthetic • Sclerotherapy • Lasers
- 15. Complications of „minimally ivasive procedure” performed in famous clinic but went wrong – lack of expertise Scars & Bilateral severe parestesia
- 16. Changes in phlebology - Certification • Patients require to be treated by well trained physician • Many medical specialties interested in phlebology Surgeons, angiologists, dermatologists, esthetic medicine, radiologists, cardiologists • Standards required • Education • Training • CME • Exams • National certification • Polskie Towarzystwo Flebologiczne • International certification • European College of Phlebology • …
- 17. XX century - Golden age of surgeons XXI century – Dusk of surgeons? 1989 2008 2018
- 18. Thank you