Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Sclerosing foam in the treatment of 
venous ulcers of lower limbs 
Dr. Maurizio Ronconi 
Dr. Edoardo Cervi 
Clinica Chirur...
Epidemiology 
> 6 million persons 
Teatment costs up to $ 2,5 billion 
2 million lost workdays 
anno 
1% of the population...
Leg’s ulcer natural history 
HHeeaalliinngg rraatteess 
6688 –– 8833%% 
Multilayer elastic compression bandaging 
Leg elev...
Leg’s ulcer and venous reflux 
Visible varicosities only in about 40% of patients with 
superficial venous reflux 
Duplex ...
Recurrence rates after healing 
Study F-up Reflux Compression 
alone 
Barweel JR 
Europ J Vasc 
Endovasc Surg 2000 
non 
r...
242 
1418 patients assessed 
550000 rraannddoommiisseedd 
compression + surgery 
258 
compression alone
Healed legs not recurred 
85% 
66% 
82% 
76% 
Ulcer healing
History of sclerosing foam 
•1944 Orbach 
•1949 Sigg 
•1956 Fluckiger Arve Ree 
•1957 Mayer/ Brucke 
• 1995 - Juan Cabrera...
2nd European Consensus Meeting on Foam 
Sclerotherapy - Tegernsee, Germany
F. X. Breu et al., Supplement 71, February 2008, 3 VASA 2008; S/71: 3–29
Conclusions 
“…Foam Sclerotherapy has become an 
established treatment option for varicosis 
and has undoubtedly improved ...
GSV 363 318 (88%) 45 
GSV > 5 mm dia 160 130 (81%) 30 
GSV <¼ 5 mm dia 203 189 (93%) 15 
GSV treated POL 39 33 (80%) 6 
GS...
 Surgery for varicose veins is widely used in the UK but 
recurrence may be expected in 25-50% of patients at 5 years 
 ...
116 consecutive patients 
Microfoam F-up 
Healing 83% 
Recurrence rate 8% 6 months 
“… This minimally invasive procedure 
...
27 patients 
CEAP C6 
Reflux: 
•SVR: 20 patients 
•SVR + DVR: 7 patients 
Median Foam: 8 ml
Ulcer healing 
93% 
70% 
Venous occlusion 
Median F-up Compression + 
foam sclerotherapy 
Healing 12 months 93% 
Recurrenc...
Conclusions 
“…eradication of superficial venous reflux (SVR) 
improves chronic venous ulcer outcome when 
compared to com...
Personal experience 
january 2006 – march 2007 
53 patients 
with leg ulcer 
personal and family history 
clinical exami...
Inclusion crtiteria 
 Open ulcer 
 Healed ulcer within preceding 6 months 
 ABPI > 0.9 
 Venous reflux (superficial an...
Patients characteristics 
CEAP 
C5 - C6 
17 
maschi 
14 
femmine 
Sex 
F : 17 
M: 14 
1 
2 
3 
5 
6 
11 
0 
2 
51-60 61-70...
JJuullyy 11,, 22000099
Methods 
Bacteriological swabs 
Wound infection: 
Staph. Aureus 
Ps. Aeruginosa 
Enterococcus 
Proteus Mirabilis 
E. Coli ...
31 patients 
19 patients 
Group 1 
Wound care 
 primary (idrocolloidi) 
 advanced (Ag ionizzato, ac. ialuronico) 
Multil...
Personal tecnique of UGFS 
Treatment required time: 30 min (median) 
Repeat venous duplex scanning prior to treatment 
...
Follow-up 
Group 1 Group 2 
Clinical examination 
Dupplex scan 
8 days after sclerofoam 
2nd Foam session 
every 8 days 
(...
Results at 12 months 
31 patients 
group 1 
16 healed 
group 2 
6 recurrence 11 healed 1 recurrence 
84% 91% 
32% 9% 
n.s....
FFeebbrruuaarryy 1122,, 22001100
Thank you for your 
kindly attention
Sclerosing foam in the treatment of venous ulcers of lower limbs
Sclerosing foam in the treatment of venous ulcers of lower limbs
Sclerosing foam in the treatment of venous ulcers of lower limbs
Upcoming SlideShare
Loading in …5
×

Sclerosing foam in the treatment of venous ulcers of lower limbs

1,041 views

Published on

Sclerotherapy 2010

Published in: Health & Medicine
  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yxufevpm } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yxufevpm } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yxufevpm } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/yxufevpm } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/yxufevpm } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/yxufevpm } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Sclerosing foam in the treatment of venous ulcers of lower limbs

  1. 1. Sclerosing foam in the treatment of venous ulcers of lower limbs Dr. Maurizio Ronconi Dr. Edoardo Cervi Clinica Chirurgia Spedali Civili di Brescia
  2. 2. Epidemiology > 6 million persons Teatment costs up to $ 2,5 billion 2 million lost workdays anno 1% of the population NHS cost £ 400-600 million 3% of total costs on health care 1% of total health ccoossttss ooff ddeevveellooppooeedd ccoouunnttrriieess anno
  3. 3. Leg’s ulcer natural history HHeeaalliinngg rraatteess 6688 –– 8833%% Multilayer elastic compression bandaging Leg elevation Medications Antibiotic therapy Stockings vveerryy sslloowwllyy hheeaalliinngg eelleevvaatteedd rreeccuurrrreennccee rraattee vveennoouuss rreefflluuxx
  4. 4. Leg’s ulcer and venous reflux Visible varicosities only in about 40% of patients with superficial venous reflux Duplex ultrasonography studies in legs with chronic ulceration show reflux: 51-53% in superficial system alone 32-44% in both systems 5-15% in deep system alone
  5. 5. Recurrence rates after healing Study F-up Reflux Compression alone Barweel JR Europ J Vasc Endovasc Surg 2000 non random 1 year superficial 28% Zamboni Europ J Vasc Endovasc Surg 2003 random 3 years superficial 38% Compression + relux surgery 14% 9%
  6. 6. 242 1418 patients assessed 550000 rraannddoommiisseedd compression + surgery 258 compression alone
  7. 7. Healed legs not recurred 85% 66% 82% 76% Ulcer healing
  8. 8. History of sclerosing foam •1944 Orbach •1949 Sigg •1956 Fluckiger Arve Ree •1957 Mayer/ Brucke • 1995 - Juan Cabrera: rotating brush technique • 1997 - Alain Monfreuax: low pressure tecnique and “Methode MUS”
  9. 9. 2nd European Consensus Meeting on Foam Sclerotherapy - Tegernsee, Germany
  10. 10. F. X. Breu et al., Supplement 71, February 2008, 3 VASA 2008; S/71: 3–29
  11. 11. Conclusions “…Foam Sclerotherapy has become an established treatment option for varicosis and has undoubtedly improved the management of varicose veins.” F. X. Breu et al., Supplement 71, February 2008, 3 VASA 2008; S/71: 3–29
  12. 12. GSV 363 318 (88%) 45 GSV > 5 mm dia 160 130 (81%) 30 GSV <¼ 5 mm dia 203 189 (93%) 15 GSV treated POL 39 33 (80%) 6 GSV treated STD 324 285 (88%) 39 GSV primary 257 220 (86%) 37 GSV recurrent 106 98 (92%) 8 SSV 141 116 (82%) SSV > 5 mm dia 62 SSV <¼ 5 mm dia 79 SSV treated POL 15 SSV treated STD 126 SSV primary 135 25 14 11 4 21 24 48 (77%) 68 (86%) 11 (73%) 105 (84%) 111 (82%) N. patients Vein status 11 months after treatment 808 occlusion reflux
  13. 13.  Surgery for varicose veins is widely used in the UK but recurrence may be expected in 25-50% of patients at 5 years  Surgery leaves scars and may result in damage to adjacent structures including nerves, lymphatics, major arteries and veins. Deep vein thrombosis and pulmonary embolism occur Conclusions “This technique is useful in the management of chronic venous disease as an alternative to surgery” Eur J Vasc Endovasc Surg Vol 32, November 2006
  14. 14. 116 consecutive patients Microfoam F-up Healing 83% Recurrence rate 8% 6 months “… This minimally invasive procedure may become the treatment of choice for venous ulcers in the future.”
  15. 15. 27 patients CEAP C6 Reflux: •SVR: 20 patients •SVR + DVR: 7 patients Median Foam: 8 ml
  16. 16. Ulcer healing 93% 70% Venous occlusion Median F-up Compression + foam sclerotherapy Healing 12 months 93% Recurrence rate 12 months 7%
  17. 17. Conclusions “…eradication of superficial venous reflux (SVR) improves chronic venous ulcer outcome when compared to compression alone…” “…UGFS appears to be at least as effective as surgery as a means of dealing with SVR…”
  18. 18. Personal experience january 2006 – march 2007 53 patients with leg ulcer personal and family history clinical examination ABPI index venous duplex scan
  19. 19. Inclusion crtiteria  Open ulcer  Healed ulcer within preceding 6 months  ABPI > 0.9  Venous reflux (superficial and/or deep) on duplex 31 patients eligible for study
  20. 20. Patients characteristics CEAP C5 - C6 17 maschi 14 femmine Sex F : 17 M: 14 1 2 3 5 6 11 0 2 51-60 61-70 71-80 81-90 Age median 66 (range 57/76)
  21. 21. JJuullyy 11,, 22000099
  22. 22. Methods Bacteriological swabs Wound infection: Staph. Aureus Ps. Aeruginosa Enterococcus Proteus Mirabilis E. Coli 11 (3344,,33%%)) Disinfection
  23. 23. 31 patients 19 patients Group 1 Wound care  primary (idrocolloidi)  advanced (Ag ionizzato, ac. ialuronico) Multilayer elastic compression bandaging II class compression stockings 12 patients Group 2 Foam sclerotherapy Polidocanolo 3% Wound care  primary (idrocolloidi)  advanced (Ag. ionizzato, ac. ialuronico) II class compression stockings
  24. 24. Personal tecnique of UGFS Treatment required time: 30 min (median) Repeat venous duplex scanning prior to treatment Patient in supine (GSV) or prone (SSV) position Saphenous trunk incanulated with a peripheral intravenous catheter 23 G under direct ultrasound guidance 1 – 2 cannulae inserted according to the extent of reflux Sclerosing foam prepared in according to Tessari’s method 3% Sodium tetradecyl sulphate or 3% Polidocanolo Median foam session: 8 ml II class compression stocking, left in place for 4 days (night included)
  25. 25. Follow-up Group 1 Group 2 Clinical examination Dupplex scan 8 days after sclerofoam 2nd Foam session every 8 days (if necessary and until reflux controll) Clinical examination Dupplex scan at 1, 6, 12 months after last foam compression bandaging every 8 days Clinical examination Dupplex scan at 1, 6, 12 months
  26. 26. Results at 12 months 31 patients group 1 16 healed group 2 6 recurrence 11 healed 1 recurrence 84% 91% 32% 9% n.s. P < 0.001
  27. 27. FFeebbrruuaarryy 1122,, 22001100
  28. 28. Thank you for your kindly attention

×