treatment of superficial venous

1. The Brazilian Experience in
SuperficialVenous Insufficiency and
What the World Might Learn from It
Rodrigo Kikuchi
Vascular Surgeon
Venous Disease Comission - Brazilian Society of Angiology andVascular Surgery
Member SBACV, SBLMC,ABFL,AVF,ACP, SVS,AFI,ASLMS
Vascular Excellence Institute - Londrina/PR - Brazil
Vascular Excellence São Paulo - São Paulo/SP - Brazil
10 min

2. • Disclosure:
No potential conflict of interest regarding this presentation

3. ?

5. - prevalence of 50% among women, 75% if consider some type of
telangiectasia
Lower limb varicose veins and telangiectasia
95 million - Brazil
190 million legs

6. Aesthetics of market growth
128% in 2013
77% in 2014
Associação Brasileira de Higiene Pessoal, Perfumaria e Cosmeticos (ABHIPEC)
Earning 136 billion Brazilian Reais
(US$ 45 billion)

7. - 56% of women are dissatisfied with their appearance.
- 79% of women use beauty products.
- 56% of the money spent with aesthetic are with procedures, the
other 44% are with cosmetics
Sophia Mind, 2013
The aesthetics consumer
- 83% of women say they are satisfied with what they do for beauty,
but only 6% would not exchange for a new treatment;

8. Parties that most bother women
- abdomen (69%)
- breast (46%)
- buttocks and legs (26%)
Onodera, 2011
Where they perform procedures
- aesthetic clinics (34%)
- beauty salons (26%)
- physicians' offices (17%)

9. - abdomen = 58%
- hair = 40%
- buttocks = 32%
- legs = 29%
Living Beauty, pesquisa do Instituto Francês Opinião Pública, 2015
Where Brazilian women are more willing to invest their money?

10. BR$ 136 billion
US$ 45 billion
56% spending on treatments 44% spending on products
29% are willing to invest in the legs
BR$ 76.16 billion
US$ 25.22 billion
BR$ 22 billion
US$ 7.28 billion

11. In Brazil women do not pay to treat a disease…
… they pay to have their legs beautiful

12. Treatment of lower limb veins is challenging
- number of variables to be considered is too large
- injuries differ greatly
- wishes of patients differ widely
- availability of techniques differ widely between
practices
Treatment of lower limb veins in Brazil is even more
challenging…
- need of a very good cosmetic result

13. cryosclerotherapy
duplex scan
transdermal laser
air cooling
augmented reality
liquid
sclerotherapy
foam sclerotherapy
endovenous
laser
radiofrequency

14. Perspectives inVascular Surgery and Endovascular
Therap, 2011, 23(4):250–254
“à la carte” treatment
Patient motivation
- cosmetic
- symptomatic
- afraid of bad evolution
Clinical Examination
- CEAP
- Severity score
- general information
Ultrasound
- anatomy
- hemodynamic
Treatment goal
technical possibility
treatment strategy
Possible options
- advantages and disadvantages
- patient preference
- procedure availability

15. What are the techniques that a Brazilian phlebologist know?
- stripping
- thermal ablation
- foam sclerotherapy
- liquid sclerotherapy
- phlebectomy
- criosclerotherapy
- radiofrequency
- transcutaneous laser
- …

16. Phlebectomy

17. Phlebectomy

18. Cryosclerotherapy
- injection of frozen dextrose with a 24G needle (-14ºC)

19. BEFORE AFTER 04 SESSIONS
Cryosclerotherapy

20. BEFORE AFTER 02 SESSIONS
Cryosclerotherapy

21. reticular veins in the medial thigh
branch of a competent saphenous vein

22. reticular veins in the medial thigh
branch of a competent saphenous vein
Foam sclerotherapy
- concentration 0.5%
- chance of occlusion: High
- problems:
- hyperpigmentation (weak vein wall and superficial vein) - High risk
- secondary phlebitis (including the saphenous vein) - Moderate risk
- matting - Moderate risk
It would not be first personal choice

23. Transcutaneous laser associated with liquid sclerotherapy
- 75% glucose
- chance of occlusion: Low
- problems:
- hyperpigmentation - moderate risk
- matting - slight risk
It would not be first personal choice
reticular veins in the medial thigh
branch of a competent saphenous vein

24. Microphlebectomy
- ultrasound maping
- chance of "occlusion": High
- problems:
- scar - moderate risk
- matting - slight risk
Personal choice
reticular veins in the medial thigh
branch of a competent saphenous vein

25. telangiectasias and reticular leg side
transdermal laser and liquid sclerotherapy with glucose/dextrose 75%

26. radiofrequency + liquid sclerotherapy with 0.5% polidocanol
after 2 sessions

27. microsurgery + intra-op liquid sclerotherapy with glucose 50%
Transcutaneous laser + liquid sclerotherapy with 75% glucose

28. radiofrequency

29. posterolateral reticular veins
micropheblectomy?
foam?

30. posterolateral reticular veins Laser + cryosclerotherapy
2 days after session

31. grouped telangiectasias, previousVV surgery

32. perforating vein

33. foam sclerotherapy with polidocanol 1%

35. transcutaneous laser +
sclerotherapy glucose 67.5% and 0.3% polidocanol

36. EVLA + phlebectomy + transcutaneous laser + liquid sclerotherapy

37. EVLA + foam sclerotherapy+
liquid sclerotherapy

38. In conclusion…
- each technique has its positive and negative features
- to work with each technique a specific knowledge and training is
required
- the choice of techinique is based on knowledge and experience of
attending physician

39. The$Brazilian$Experience$in$Superficial$Venous$Insufficiency$
and$What$the$World$Might$Learn$from$It?
Question
1. work under the pressure for a cosmetic result
2. know as many techniques as possible
3. be creativity
4. make money with aesthetic

40. Theoretical and hand on training in
18 hours training course
individually or in doubles
individual approach
Vascular Excellence Clinic São Paulo
contato@excelenciavascular.com.br
www.excelenciavascular.com.br
area for physicians

42. kikuchi@excelenciavascular.com.br
+55 (11) 98111-9901
www.excelenciavascular.com.br
area for physicians