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The need for a holisticThe need for a holistic
aproach to patient care inaproach to patient care in
Chronic Venous DiseaseChronic Venous Disease
Alexandru ANDRITOIU, MD, MPhAlexandru ANDRITOIU, MD, MPh
Emergency Military HospitalEmergency Military Hospital
CraiovaCraiova
CVD definitionCVD definition
• Morphological and functional abnormalities of the
venous system of long duration manifested either
by symptoms and/or signs indicating the need for
investigation and/or care.
• It is caused by venous valvular incompetence
with or without associated venous outflow
obstruction, which may affect the superficial
venous system, the deep venous system, or both.
• Venous dysfunction may result from either a
congenital or an acquired disorder.
• CVD is the consequence of venous hypertension.
Eklof B, Perrin M, Delis KT, et al. Updated terminology of chronic venous disorders:the Vein Term Transatlantic interdisciplinary
Consensus Document. J Vasc Surg. 2009;49:498-501.
Venous anatomic segment classification
Superficial and perforating veinsSuperficial and perforating veins
Anatomical distribution of venous systemAnatomical distribution of venous system
1. Tegument
2. Fascia superficiala
3. Fascia musculara
4. Compartimentul profund
5. Compartimentul v. safene (interfascial)
6. Compartimentul subcutanat (vv colaterale sau tributare)
Venous haemodynamicsVenous haemodynamics
• About 75% of circulating blood in the
body is moving through the venous
system.
• Understanding the mechanisms by which
venous return to the heart is crucial to
understanding the physiology of the
vascular system.
Physiology of venous blood flowPhysiology of venous blood flow
Venous retourn from legs is governed by
• Arterial pressure
• Calf musculovenous pump
• Gravity
• Thoracic pump
• Valves in veins
Pathophysiology of CVIPathophysiology of CVI
• Muscle pump failure (primary)
• Venous obstruction
• Venous valvular incompetence
1. perforator incompetence
2. superf veins incompetence
3. deep vein incompetence
Phlebology 2008;23:85–98
John BERGAN, MD
The Vein Institute of La Jolla
Department of Surgery
UCSD School of Medicine La Jolla, CA, USA
MEDICOGRAPHIA, VOL 30, No. 2, 2008
Types of valvesTypes of valves
A). unicuspid B) bicuspid C) tricuspid D) quaricuspid
Classification of valvular lesions
• Functional valve lesions (type I)
• Traumatic organic valve lesions (type II)
• Inflammatory organic lesions (type III)
• Valvular vestiges (type IV)
Venous valvesVenous valves
Normal vein Varicose vein
VVenoenouuss RefluxReflux
Valvular incompetence
- Valsalva maneuver
- Calf compression
Competent VeinCompetent Vein
Start
Valsalva End Valsalva
Competent vein
Symptomatic varicose veinsSymptomatic varicose veins
• pain
• aching
• discomfort
• swelling
• heaviness
• itching
that are thought to be due to the effects of
superficial venous reflux and for which no
other more likely cause is apparent.
MEDICOGRAPHIA, Vol 33, No. 3, 2011
GuidelinesGuidelines
The ,,common language,,The ,,common language,,
1994). The American Venous Forum (AVF) has created the
CEAP (Clinical-Etiological-Anatomical-Pathophysiological)
classification.
1998). REVAS (REcurrence after VAricose vein Surgery)
2000). The Venous Clinical Severity Score (VCSS)
2004). Several consensus documents from the Union
Internationale de Phlébologie (UIP) led to the revision of
the CEAP classification system.
2009). The latest update of terminology for CVD-
VEINTERM consensus document.
All these efforts have led to the creation of a common
language in CVD, which is essential for the establishment
of clinical practice guidelines.
Medicographia. 2011;33:245-252
VEIN-TERMVEIN-TERM
Chronic venous disorders
Chronic venous disease
Chronic venous insufficiency (C3*-C6):
Venous symptoms
Venous aneurysm
Venous valvular incompetence
Venous reflux (primary, secondary)
Axial reflux (superficial, deep, combined)
Segmental reflux
Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM
transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
VEIN TERM (contin…)VEIN TERM (contin…)
• Perforator incompetence
• Venous occlusion, obstruction
• Venous compression
• Recanalization
Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM
transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
VEIN TERM (surgery)VEIN TERM (surgery)
• High ligation and division
• Stripping
• Venous ablation
• Perforating vein interruption-ligation-ablation
• Miniphlebectomy
• Sclerotherapy
• Endophlebectomy
Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM
transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
CEAPCEAP
Telangiectasias (C1)Telangiectasias (C1)
• Confluence of dilated
intradermal venules less
than 1 mm in caliber.
• Synonym-spider veins.
Corona phlebectaticaCorona phlebectatica
Fan-shaped
pattern of
numerous small
intradermal veins
on medial or lateral
aspects of ankle
and foot.
Varicose veins (C2)Varicose veins (C2)
Subcutaneous dilated
vein 3 mm in diameter or
larger, measured in
upright position, may
involve saphenous veins,
saphenous tributaries,
or nonsaphenous
superficial leg veins.
Edema (C3)Edema (C3)
Perceptible increase in
volume of fluid in skin
and subcutaneous tissue,
which is
characteristically
indented with pressure.
Venous edema usually
occurs in the ankle
region, but may extend
to the leg and foot.
PigmentationPigmentation
Brownish darkening of
skin, resulting from
extravasated blood.
Usually occurs in the
ankle region, but may
extend to the leg and
foot
LipodermatosclerosisLipodermatosclerosis
LDS is a localized chronic
inflammation and fibrosis of
the skin and subcutaneous
tissues of the lower leg,
sometimes associated with
scarring or contracture of
the Achilles tendon.
LDS is a sign of severe CVD
White atrophy (C4b)White atrophy (C4b)
Localized, often circular
whitish and atrophic skin
areas surrounded by
dilated capillaries and
sometimes
hyperpigmentation.
Sign of severe CVD, and
not to be confused with
healed ulcer scars.
Venous eczema and ulcerationVenous eczema and ulceration
Healed ulcer (C5)Healed ulcer (C5)
Active venous ulcer (C6)Active venous ulcer (C6)
Full-thickness defect of
skin, most frequently in
the ankle region, that fails
to heal spontaneously and
is sustained by CVD
Degree of CVIDegree of CVI
Varicosity – Progression to be observedVaricosity – Progression to be observed
The Team involved in CVDThe Team involved in CVD
• GP
• Surgery/vascular surgery
• Radiologyt (CDUS, venography)
• Interventional radiology
• Cardiology
• Dermatologyy
• Angiology-Phlebology
Vascular serviceVascular service
NICE Guideline 2013
Diagnosis of CVDDiagnosis of CVD
• Physical exam.Physical exam.
• Noninvasive TestingNoninvasive Testing
Venous Dupplex
Photoplethysmography
Airplethysmography
CT-MRI Venography
• Invasive TestingInvasive Testing
Contrast Venography
Intravascular US
Ambulatory venous pressure (AVP)
Circulation 2005;111:2398-2409
VenographyVenography
Functional venous diagnosis:Functional venous diagnosis:
Ambulatory venous pressuresAmbulatory venous pressures
Venous Insufficiency, RefluxVenous Insufficiency, Reflux
J Vasc Surg 2005;41:645-51
Patterns of SSV refluxPatterns of SSV reflux
Engelhorn C et al. J Vasc Surg 2005;41:645-51
Treatment of CVDTreatment of CVD
• Conservative
• Interventional
• Surgical
Circulation. 2005;111:2398-2409
Conservative TreatmentConservative Treatment
• compression
• wound and skin care
• pharmacological (venoactive drugs)
• exercise
• loss weight
Elastic compression stockingElastic compression stocking
• Reduces symptoms
of aching, fatigue,
pain,and swelling
• Increases fibrinolytic
activity
• Mainstay of treatment
for venous ulcers
Must be graduated
What degree of compression – When?What degree of compression – When?
Classification of theClassification of the
main venoactive drugsmain venoactive drugs
Nicolaides et al. Int Angiol. 2008;27:1-59.
InterventionalInterventional
• Sclerotherapy (chemical ablation)
• Ablative therapy (cold, heat)
-RF, laser, steam
• Endovascular (stent)
Guided by CDUS
Sclerotherapy of Telangiectasias:Sclerotherapy of Telangiectasias:
TechniqueTechnique
damage to endothelium
leads to fibrosis of vein
Ultrasound-guided sclerotherapyUltrasound-guided sclerotherapy
foamed solutions
Foam sclerotherapy
Compression after sclerotherapy improves results (less thrombus formation, fewer inflammatory reactions, less pigmentation)
Washout Foam sclerotherapyWashout Foam sclerotherapy
Dr. Khalil Fattah-60,000 sclerotherapy sessions experience
The foam sclerotherapy is associated with risk of DVT, pulmonary embolism, distant side effects
such as vision disturbances and vascular headaches, etc. By removing the injected foam, as suggested
by Dr. Khalil Fattahi, side effects can be minimized and treatment can be more selective in choosing
the exact segment and extent of varicose veins to be treated by foam sclerotherapy (smart Foam
Sclerotherapy).
Vein Specialty Medical ClinicVein Specialty Medical Clinic
Campbell, CACampbell, CA
Dr. Khalil Fattah colection
RF-ablationRF-ablation
The Venefit procedureThe Venefit procedure
Radiofrequency ablationRadiofrequency ablation
Closure FAST™ Catheter.
The circular heating element of the catheter measures 7 cm in length which makes
it possible to treat an equivalent length of vein in a few seconds.
GSV Ablation by LaserGSV Ablation by Laser
Pre-Treatment Post-TreatmentPre-Treatment Post-Treatment
René MILLERET
Vein Center
Clinique Pasteur
3 Rue Pasteur
34120 Pézenas
France
Phlebolymphology. 2011;19(4):174-181
Obliteration of Varicose Veins with Superheated Steam
VenaSeal Sapheon Closure SystemVenaSeal Sapheon Closure System
Cyanoacrylate
SurgicalSurgical
• Ligation
• Stripping
• Miniphlebectomy
• Subfascial Endoscopic Perforator Surgery
• Valve Reconstruction
Ligation & stripping techniqueLigation & stripping technique
Surgical Treatment of VaricoseSurgical Treatment of Varicose
Veins: PhlebectomyVeins: Phlebectomy
The CHIVA procedureThe CHIVA procedure
hemodynamic preservation in venous
insufficiency in ambulatory practice
• Is designed to create new hemodynamic
conditions by dividing the pressure column in the
varicose veins by disconnecting some venous
anastomoses and by redirecting the reflux from
the diseased superficial veins into the deep
venous system
• The incompetent saphenous trunk is left in place
1988-Franceschi (France)
C Conservatrice
H Hemodinamique
I Inssufisance
V Veinose
A Ambulatoire
CIVA methodCIVA method
The ASVAL TechniqueThe ASVAL Technique
The ASVAL method recommends
preserving the great saphenous vein,
unless there is a serious terminal
valve insufficiency, and suggests the
surgical removal of the superficial
varicose reservoir as a primary
treatment.
Pittaluga P, Marionneau N, Creton D et al. Traitement chirurgical des varices des membres inferierus: approche moderne.
Phlebologie 2004; 57:301–307.
Pittaluga P, Rea B, Barbe R. Methode ASVAL (Ablation Selective des Varices sous Anesthesie Locale): principes et resultats
preliminaries. Phlebologie 2005; 2:175–181.
Ablation Selective des Varices sous Anesthesie Locale
A Ablation
S Selective
V Varices
A Anestesie
L Locale
The endovenous ASVAL method is feasible and
has very good technical success rates and
clinical results for treating varicose vein disease
in patients with segmental GSV reflux and a
competent terminal valve.
Subfascial endoscopic perforator surgerySubfascial endoscopic perforator surgery
The perforating vein The perforating vein
after sectioning between the 2 clips
Valvular reconstructionValvular reconstruction
• The principle consists in restoring
valvular competence by using different
procedures to eliminate reflux through
these valves: valvular repair (L. Corcos,
Italy 1997), and exo-stent repair of the
junction to reduce the diameter of the
vein (S. Camilli, Italy 2002, J.R. Lane,
Australia 2002).
Venous valvuloplastyVenous valvuloplasty
• Internal valvuloplasy
• External valvuloplasty
Internal valvuloplastyInternal valvuloplasty
External valvuloplastyExternal valvuloplasty
 the placement of sutures decreases the diameter of the venous wall but keeps the
valve cusps from harm’s way. The sutures lie outside the vein lumen in this approach.
External valvularExternal valvular
stentingstenting
PRP-External valvuloplastyPRP-External valvuloplasty
PRP in venous ulcerPRP in venous ulcer
(a) a patient of venous ulcer of duration 3 months, (b) after one sitting of platelet rich plasma, (c) ulcer at 4th week and (d) ulcer being healed at 6th week
J Cutan Aesthet Surg. 2013;6(2): 97–99
Echipa Sp. Clinic Militar Craiova
Dr Silosi Cristian
Dr Alexandru Andritoiu
Ablatia prin RF a vv safene
Reporter: A i afirmat căț Angio-Center (Tg. Mures)
este un centru unic la nivel na ional pentru solu iileț ț
aduse bolilor vasculare periferice. Despre ce este
vorba?
Conf. Dr. Puskás Attila: Este vorba despre o viziune
holistică pe domeniul vascular, pentru că această
categorie de bolnavi sunt lăsa i undeva la periferiaț
actului medical, şi  nu numai în ara noastrăț .
28 oct 2014
Medic primar Medicina interna
Masterat Angiologie-Milano
Societatea Română de Angiologie i Chirurgieș
Vasculară (SRACV), după 25 de ani de la înfiin area saț
oficială i 10 manifestări tiinţifice organizate,ș ș
continuă să reprezinte o societate tiin ifică deș ț
interes general, cu caracter tiin ific i educa ional.ș ț ș ț
The need for Vein Care CentersThe need for Vein Care Centers
• Phlebology/Angiology: a distinct medical
speciality
• The need for Interventional Phlebology
• The role of the Team (holistic aproach)
• The need for combination therapies at
the same patient

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Abordarea holistica in patologia venoasa

  • 1. The need for a holisticThe need for a holistic aproach to patient care inaproach to patient care in Chronic Venous DiseaseChronic Venous Disease Alexandru ANDRITOIU, MD, MPhAlexandru ANDRITOIU, MD, MPh Emergency Military HospitalEmergency Military Hospital CraiovaCraiova
  • 2. CVD definitionCVD definition • Morphological and functional abnormalities of the venous system of long duration manifested either by symptoms and/or signs indicating the need for investigation and/or care. • It is caused by venous valvular incompetence with or without associated venous outflow obstruction, which may affect the superficial venous system, the deep venous system, or both. • Venous dysfunction may result from either a congenital or an acquired disorder. • CVD is the consequence of venous hypertension. Eklof B, Perrin M, Delis KT, et al. Updated terminology of chronic venous disorders:the Vein Term Transatlantic interdisciplinary Consensus Document. J Vasc Surg. 2009;49:498-501.
  • 3. Venous anatomic segment classification
  • 4. Superficial and perforating veinsSuperficial and perforating veins
  • 5. Anatomical distribution of venous systemAnatomical distribution of venous system 1. Tegument 2. Fascia superficiala 3. Fascia musculara 4. Compartimentul profund 5. Compartimentul v. safene (interfascial) 6. Compartimentul subcutanat (vv colaterale sau tributare)
  • 6. Venous haemodynamicsVenous haemodynamics • About 75% of circulating blood in the body is moving through the venous system. • Understanding the mechanisms by which venous return to the heart is crucial to understanding the physiology of the vascular system.
  • 7. Physiology of venous blood flowPhysiology of venous blood flow Venous retourn from legs is governed by • Arterial pressure • Calf musculovenous pump • Gravity • Thoracic pump • Valves in veins
  • 8. Pathophysiology of CVIPathophysiology of CVI • Muscle pump failure (primary) • Venous obstruction • Venous valvular incompetence 1. perforator incompetence 2. superf veins incompetence 3. deep vein incompetence
  • 10. John BERGAN, MD The Vein Institute of La Jolla Department of Surgery UCSD School of Medicine La Jolla, CA, USA MEDICOGRAPHIA, VOL 30, No. 2, 2008
  • 11.
  • 12. Types of valvesTypes of valves A). unicuspid B) bicuspid C) tricuspid D) quaricuspid
  • 13. Classification of valvular lesions • Functional valve lesions (type I) • Traumatic organic valve lesions (type II) • Inflammatory organic lesions (type III) • Valvular vestiges (type IV)
  • 14. Venous valvesVenous valves Normal vein Varicose vein
  • 15. VVenoenouuss RefluxReflux Valvular incompetence - Valsalva maneuver - Calf compression
  • 16. Competent VeinCompetent Vein Start Valsalva End Valsalva Competent vein
  • 17. Symptomatic varicose veinsSymptomatic varicose veins • pain • aching • discomfort • swelling • heaviness • itching that are thought to be due to the effects of superficial venous reflux and for which no other more likely cause is apparent.
  • 18. MEDICOGRAPHIA, Vol 33, No. 3, 2011
  • 20.
  • 21.
  • 22. The ,,common language,,The ,,common language,, 1994). The American Venous Forum (AVF) has created the CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification. 1998). REVAS (REcurrence after VAricose vein Surgery) 2000). The Venous Clinical Severity Score (VCSS) 2004). Several consensus documents from the Union Internationale de Phlébologie (UIP) led to the revision of the CEAP classification system. 2009). The latest update of terminology for CVD- VEINTERM consensus document. All these efforts have led to the creation of a common language in CVD, which is essential for the establishment of clinical practice guidelines. Medicographia. 2011;33:245-252
  • 23. VEIN-TERMVEIN-TERM Chronic venous disorders Chronic venous disease Chronic venous insufficiency (C3*-C6): Venous symptoms Venous aneurysm Venous valvular incompetence Venous reflux (primary, secondary) Axial reflux (superficial, deep, combined) Segmental reflux Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
  • 24. VEIN TERM (contin…)VEIN TERM (contin…) • Perforator incompetence • Venous occlusion, obstruction • Venous compression • Recanalization Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
  • 25. VEIN TERM (surgery)VEIN TERM (surgery) • High ligation and division • Stripping • Venous ablation • Perforating vein interruption-ligation-ablation • Miniphlebectomy • Sclerotherapy • Endophlebectomy Eklöf B, Perrin M, Delis KT, Rutherford RB, Gloviczki P. Updated terminology of chronic venous disorders: The VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009:49:498-501
  • 27.
  • 28. Telangiectasias (C1)Telangiectasias (C1) • Confluence of dilated intradermal venules less than 1 mm in caliber. • Synonym-spider veins.
  • 29. Corona phlebectaticaCorona phlebectatica Fan-shaped pattern of numerous small intradermal veins on medial or lateral aspects of ankle and foot.
  • 30. Varicose veins (C2)Varicose veins (C2) Subcutaneous dilated vein 3 mm in diameter or larger, measured in upright position, may involve saphenous veins, saphenous tributaries, or nonsaphenous superficial leg veins.
  • 31. Edema (C3)Edema (C3) Perceptible increase in volume of fluid in skin and subcutaneous tissue, which is characteristically indented with pressure. Venous edema usually occurs in the ankle region, but may extend to the leg and foot.
  • 32. PigmentationPigmentation Brownish darkening of skin, resulting from extravasated blood. Usually occurs in the ankle region, but may extend to the leg and foot
  • 33. LipodermatosclerosisLipodermatosclerosis LDS is a localized chronic inflammation and fibrosis of the skin and subcutaneous tissues of the lower leg, sometimes associated with scarring or contracture of the Achilles tendon. LDS is a sign of severe CVD
  • 34. White atrophy (C4b)White atrophy (C4b) Localized, often circular whitish and atrophic skin areas surrounded by dilated capillaries and sometimes hyperpigmentation. Sign of severe CVD, and not to be confused with healed ulcer scars.
  • 35. Venous eczema and ulcerationVenous eczema and ulceration
  • 37. Active venous ulcer (C6)Active venous ulcer (C6) Full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by CVD
  • 39. Varicosity – Progression to be observedVaricosity – Progression to be observed
  • 40. The Team involved in CVDThe Team involved in CVD • GP • Surgery/vascular surgery • Radiologyt (CDUS, venography) • Interventional radiology • Cardiology • Dermatologyy • Angiology-Phlebology
  • 42. Diagnosis of CVDDiagnosis of CVD • Physical exam.Physical exam. • Noninvasive TestingNoninvasive Testing Venous Dupplex Photoplethysmography Airplethysmography CT-MRI Venography • Invasive TestingInvasive Testing Contrast Venography Intravascular US Ambulatory venous pressure (AVP) Circulation 2005;111:2398-2409
  • 44. Functional venous diagnosis:Functional venous diagnosis: Ambulatory venous pressuresAmbulatory venous pressures
  • 45. Venous Insufficiency, RefluxVenous Insufficiency, Reflux
  • 46. J Vasc Surg 2005;41:645-51
  • 47. Patterns of SSV refluxPatterns of SSV reflux Engelhorn C et al. J Vasc Surg 2005;41:645-51
  • 48. Treatment of CVDTreatment of CVD • Conservative • Interventional • Surgical
  • 50. Conservative TreatmentConservative Treatment • compression • wound and skin care • pharmacological (venoactive drugs) • exercise • loss weight
  • 51. Elastic compression stockingElastic compression stocking • Reduces symptoms of aching, fatigue, pain,and swelling • Increases fibrinolytic activity • Mainstay of treatment for venous ulcers Must be graduated
  • 52. What degree of compression – When?What degree of compression – When?
  • 53. Classification of theClassification of the main venoactive drugsmain venoactive drugs Nicolaides et al. Int Angiol. 2008;27:1-59.
  • 54.
  • 55. InterventionalInterventional • Sclerotherapy (chemical ablation) • Ablative therapy (cold, heat) -RF, laser, steam • Endovascular (stent) Guided by CDUS
  • 56. Sclerotherapy of Telangiectasias:Sclerotherapy of Telangiectasias: TechniqueTechnique damage to endothelium leads to fibrosis of vein
  • 58. Foam sclerotherapy Compression after sclerotherapy improves results (less thrombus formation, fewer inflammatory reactions, less pigmentation)
  • 59. Washout Foam sclerotherapyWashout Foam sclerotherapy Dr. Khalil Fattah-60,000 sclerotherapy sessions experience The foam sclerotherapy is associated with risk of DVT, pulmonary embolism, distant side effects such as vision disturbances and vascular headaches, etc. By removing the injected foam, as suggested by Dr. Khalil Fattahi, side effects can be minimized and treatment can be more selective in choosing the exact segment and extent of varicose veins to be treated by foam sclerotherapy (smart Foam Sclerotherapy).
  • 60. Vein Specialty Medical ClinicVein Specialty Medical Clinic Campbell, CACampbell, CA Dr. Khalil Fattah colection
  • 62. Radiofrequency ablationRadiofrequency ablation Closure FAST™ Catheter. The circular heating element of the catheter measures 7 cm in length which makes it possible to treat an equivalent length of vein in a few seconds.
  • 63. GSV Ablation by LaserGSV Ablation by Laser
  • 65. René MILLERET Vein Center Clinique Pasteur 3 Rue Pasteur 34120 Pézenas France Phlebolymphology. 2011;19(4):174-181 Obliteration of Varicose Veins with Superheated Steam
  • 66. VenaSeal Sapheon Closure SystemVenaSeal Sapheon Closure System Cyanoacrylate
  • 67. SurgicalSurgical • Ligation • Stripping • Miniphlebectomy • Subfascial Endoscopic Perforator Surgery • Valve Reconstruction
  • 68. Ligation & stripping techniqueLigation & stripping technique
  • 69. Surgical Treatment of VaricoseSurgical Treatment of Varicose Veins: PhlebectomyVeins: Phlebectomy
  • 70. The CHIVA procedureThe CHIVA procedure hemodynamic preservation in venous insufficiency in ambulatory practice • Is designed to create new hemodynamic conditions by dividing the pressure column in the varicose veins by disconnecting some venous anastomoses and by redirecting the reflux from the diseased superficial veins into the deep venous system • The incompetent saphenous trunk is left in place 1988-Franceschi (France) C Conservatrice H Hemodinamique I Inssufisance V Veinose A Ambulatoire
  • 72. The ASVAL TechniqueThe ASVAL Technique The ASVAL method recommends preserving the great saphenous vein, unless there is a serious terminal valve insufficiency, and suggests the surgical removal of the superficial varicose reservoir as a primary treatment. Pittaluga P, Marionneau N, Creton D et al. Traitement chirurgical des varices des membres inferierus: approche moderne. Phlebologie 2004; 57:301–307. Pittaluga P, Rea B, Barbe R. Methode ASVAL (Ablation Selective des Varices sous Anesthesie Locale): principes et resultats preliminaries. Phlebologie 2005; 2:175–181. Ablation Selective des Varices sous Anesthesie Locale A Ablation S Selective V Varices A Anestesie L Locale
  • 73. The endovenous ASVAL method is feasible and has very good technical success rates and clinical results for treating varicose vein disease in patients with segmental GSV reflux and a competent terminal valve.
  • 74. Subfascial endoscopic perforator surgerySubfascial endoscopic perforator surgery The perforating vein The perforating vein after sectioning between the 2 clips
  • 75. Valvular reconstructionValvular reconstruction • The principle consists in restoring valvular competence by using different procedures to eliminate reflux through these valves: valvular repair (L. Corcos, Italy 1997), and exo-stent repair of the junction to reduce the diameter of the vein (S. Camilli, Italy 2002, J.R. Lane, Australia 2002).
  • 76. Venous valvuloplastyVenous valvuloplasty • Internal valvuloplasy • External valvuloplasty
  • 78. External valvuloplastyExternal valvuloplasty  the placement of sutures decreases the diameter of the venous wall but keeps the valve cusps from harm’s way. The sutures lie outside the vein lumen in this approach.
  • 81.
  • 82.
  • 83. PRP in venous ulcerPRP in venous ulcer (a) a patient of venous ulcer of duration 3 months, (b) after one sitting of platelet rich plasma, (c) ulcer at 4th week and (d) ulcer being healed at 6th week J Cutan Aesthet Surg. 2013;6(2): 97–99
  • 84. Echipa Sp. Clinic Militar Craiova Dr Silosi Cristian Dr Alexandru Andritoiu Ablatia prin RF a vv safene
  • 85. Reporter: A i afirmat căț Angio-Center (Tg. Mures) este un centru unic la nivel na ional pentru solu iileț ț aduse bolilor vasculare periferice. Despre ce este vorba? Conf. Dr. Puskás Attila: Este vorba despre o viziune holistică pe domeniul vascular, pentru că această categorie de bolnavi sunt lăsa i undeva la periferiaț actului medical, şi  nu numai în ara noastrăț . 28 oct 2014 Medic primar Medicina interna Masterat Angiologie-Milano
  • 86. Societatea Română de Angiologie i Chirurgieș Vasculară (SRACV), după 25 de ani de la înfiin area saț oficială i 10 manifestări tiinţifice organizate,ș ș continuă să reprezinte o societate tiin ifică deș ț interes general, cu caracter tiin ific i educa ional.ș ț ș ț
  • 87.
  • 88. The need for Vein Care CentersThe need for Vein Care Centers • Phlebology/Angiology: a distinct medical speciality • The need for Interventional Phlebology • The role of the Team (holistic aproach) • The need for combination therapies at the same patient