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Rolul US in ablatia venelorRolul US in ablatia venelor
safenesafene
Alexandru Andritoiu, Silosi Cristian
Sp. Clinic de Urgenta Militar Craiova
Ablatia vv. safeneAblatia vv. safene
Metoda termica
• RF
• EVLT
• Aburi
• Crioablatia
Metoda chimica
Spuma (foam)
Venaseal (cyanoacrilat)
Metoda mecanochimica (MOCA)
ClariVein (sotradecol)
IndicatiiIndicatii
• Boala venoasa cr.
• Reflux documentat
US in insuf. venoasaUS in insuf. venoasa
• Permeabilitatea sistemului venos profund si
superficial
• Locatia intra-compartimentala
• Refluxul in vv. safene/vv. profunde
• Calibrul safen <10 mm
• Agenezie /Hipoplazie/Duplicatie
• Sclerozari anterioare
• Vv. perforante incompetente
• Mapping venos anatomic si hemodinamic
Refluxul venosRefluxul venos
Cauza hemodinamica in b. venoasa cr.
• Spontan
• Provocat
• Axial/Segmentar
• La joctiuni S-F, S-P
• In sistemul profund (sdr. PT)
• In sistemul vv. safene
• In vv. perforante
Manevre de provocare aManevre de provocare a
refluxului venosrefluxului venos
• Valsalva (JSF)
• Compresia gambei
• Parana
• Vasculab
Reflux provocatReflux provocat
Valvular incompetence
- Valsalva maneuver
- Calf compression
Reflux venosReflux venos
Patologic
>500 ms in vv. safene
> 300 ms in vv. perforante
US interventionala in ablatia
vv. safene
• Localizarea venei safene int/ext
• Punctia venoasa eco-ghidata
• Pozitionarea cateterului RF/fibrei laser
• Raporturile cu tegumentul
• Raportul cu JSF/JSP (2 cm)
• Anestezia locala tumescenta
Ablatia prin RFAblatia prin RF
Procedeul VenefitProcedeul Venefit
Anestezia locala tumescentaAnestezia locala tumescenta
• Procedeu ghidat ecografic
• In axul lung/In ax transversal
• Pozitia cateterului min. 1 cm de tegument
• Protejarea structurilor de vecinatate (nn)
Anestezie locala
• Ser fiziologic 500 mL, Adrenalina, Lidocaina,
Bicarbonat de sodiu
• Sol. Ringer lactat
• Se prepara instantaneu
-temperatura camerei sau rece la 4 gr C
VSM in compartimentul safenVSM in compartimentul safen
Semnul ochiului egiptean
Abordul in cele 2 planuriAbordul in cele 2 planuri
Longitudinal Tranversal
Image courtesy of Carolyn
Menendez, MD
Administrarea solutiei TLA subAdministrarea solutiei TLA sub
ghidaj USghidaj US
Lidocaine 1% 1-5 f, Adrenaline 0,5 f, Na-Bicarbonate 5 mL, NaCl 0,9%-500 mL
Injectarea TLA peri-VSM distalaInjectarea TLA peri-VSM distala
Ablatia perforantelorAblatia perforantelor
• Indicatie: ulcerul venos trenant/rezistent
• Asociat abatiei trunchiului v. safene
• RF (stilet)
• Laser
• Foam (spuma)
Procedeu efectuat sub ghidaj US
RFS StyletRFS Stylet ptr.ptr. AblatAblatiaia
perforaperforantelorntelor
RFS StyletRFS Stylet
Monitorizarea US
post-procedura
• Imediat
• La 2 sapt.
• La 1-3-6-12 L
Ce se urmareste?
• Inchidere completa a v. saf
• Inchidere perforantelor
• Recanalizarea (<5%)
ConcluziiConcluzii
• US faciliteaza efectuarea cu succes a
procedurii de ablatie a vv. safene
si/sau a perforantelor

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Rolul us in ablatia v

  • 1. Rolul US in ablatia venelorRolul US in ablatia venelor safenesafene Alexandru Andritoiu, Silosi Cristian Sp. Clinic de Urgenta Militar Craiova
  • 2. Ablatia vv. safeneAblatia vv. safene Metoda termica • RF • EVLT • Aburi • Crioablatia Metoda chimica Spuma (foam) Venaseal (cyanoacrilat) Metoda mecanochimica (MOCA) ClariVein (sotradecol) IndicatiiIndicatii • Boala venoasa cr. • Reflux documentat
  • 3. US in insuf. venoasaUS in insuf. venoasa • Permeabilitatea sistemului venos profund si superficial • Locatia intra-compartimentala • Refluxul in vv. safene/vv. profunde • Calibrul safen <10 mm • Agenezie /Hipoplazie/Duplicatie • Sclerozari anterioare • Vv. perforante incompetente • Mapping venos anatomic si hemodinamic
  • 4. Refluxul venosRefluxul venos Cauza hemodinamica in b. venoasa cr. • Spontan • Provocat • Axial/Segmentar • La joctiuni S-F, S-P • In sistemul profund (sdr. PT) • In sistemul vv. safene • In vv. perforante
  • 5. Manevre de provocare aManevre de provocare a refluxului venosrefluxului venos • Valsalva (JSF) • Compresia gambei • Parana • Vasculab
  • 6. Reflux provocatReflux provocat Valvular incompetence - Valsalva maneuver - Calf compression
  • 7. Reflux venosReflux venos Patologic >500 ms in vv. safene > 300 ms in vv. perforante
  • 8. US interventionala in ablatia vv. safene • Localizarea venei safene int/ext • Punctia venoasa eco-ghidata • Pozitionarea cateterului RF/fibrei laser • Raporturile cu tegumentul • Raportul cu JSF/JSP (2 cm) • Anestezia locala tumescenta
  • 9. Ablatia prin RFAblatia prin RF Procedeul VenefitProcedeul Venefit
  • 10. Anestezia locala tumescentaAnestezia locala tumescenta • Procedeu ghidat ecografic • In axul lung/In ax transversal • Pozitia cateterului min. 1 cm de tegument • Protejarea structurilor de vecinatate (nn) Anestezie locala • Ser fiziologic 500 mL, Adrenalina, Lidocaina, Bicarbonat de sodiu • Sol. Ringer lactat • Se prepara instantaneu -temperatura camerei sau rece la 4 gr C
  • 11. VSM in compartimentul safenVSM in compartimentul safen Semnul ochiului egiptean
  • 12. Abordul in cele 2 planuriAbordul in cele 2 planuri Longitudinal Tranversal Image courtesy of Carolyn Menendez, MD
  • 13. Administrarea solutiei TLA subAdministrarea solutiei TLA sub ghidaj USghidaj US Lidocaine 1% 1-5 f, Adrenaline 0,5 f, Na-Bicarbonate 5 mL, NaCl 0,9%-500 mL
  • 14. Injectarea TLA peri-VSM distalaInjectarea TLA peri-VSM distala
  • 15. Ablatia perforantelorAblatia perforantelor • Indicatie: ulcerul venos trenant/rezistent • Asociat abatiei trunchiului v. safene • RF (stilet) • Laser • Foam (spuma) Procedeu efectuat sub ghidaj US
  • 16. RFS StyletRFS Stylet ptr.ptr. AblatAblatiaia perforaperforantelorntelor
  • 18. Monitorizarea US post-procedura • Imediat • La 2 sapt. • La 1-3-6-12 L Ce se urmareste? • Inchidere completa a v. saf • Inchidere perforantelor • Recanalizarea (<5%)
  • 19. ConcluziiConcluzii • US faciliteaza efectuarea cu succes a procedurii de ablatie a vv. safene si/sau a perforantelor

Editor's Notes

  1. he ClosureRFS Stylet is the only intravascular ablation device specifically cleared by the FDA for the treatment of incompetent perforator veins. This minimally invasive outpatient treatment can be either the primary procedure or an adjunct to saphenous vein ablation with the VNUS ClosureFAST™ catheter