Imagination has not limits , only humans beings have it . Which is your choice? Health or profits? isrst the patient , 2nd the patient and at least ......the patient i was one Dr Ferracani Ristenpart supported by SOS ( Save Our Saphenas ) Dr Samson concept : don t destroy ,please try to recover anatomic patient capital .

1. The concept of Area reduction
applied to superficial venous
insuffiency .
Enrique Ferracani Ristenpart MD

2. PILLARS OF THE TECHNIQUE
* SPARING THE GREAT SAPHENOUS VEIN.
2ND CONDUIT IN ARTERIAL CRITICAL RECONSTRUCTION
* VENOUS AREA REDUCTION.
RESISTANCE INCREASE = REDUCTION OF REFLOW: Q =
P/R
*ABLATION OF EXTRAFASCIAL
TRIBUTARIES.
REDUCTION OF VOLUME ANDPRESSURE (BERNOULLI
ECUATION )
Objectives.

3. Physical principles of method of reduction area with serial
capacity resistors by 1470 LASER nm
(EVLAR).
Pouiselle Law

4. Internal carotid artery with an ATC obstruccion
Flow reduction
The same happens in the venous system with diameter reduction (annular resistors)
Resistance
increase
Flow

5. Pressure drop = P1-P2
Flow rate
Lenght
Diameter
Viscosity
Resistance
Discharge rate
P1 P2

6. Q (flow) =
Pressure/Resistance
VALSALVA pressure 37mmHg
P (k) 37mmhg /R = RQ(reflux)
By reducing diameters could be obtained an increase in resistance index.
Reduction of area and creation of capacity serial resistors (via Pouiselle law) ,
reduces the reflux front line in the vein.

7. Images of 1470nm emission, in gray, on the wall of the
vein.
Area reduction = Annular serial resistors

8. Sonographic evaluation of venous reflux.
Takashi Yamaki M.D Tokyo Women’s Medical University.
Diagnosis of reflux
・ Reflux times > 0.5s
Duplex-derived parameters
・ Reflux times (RT: s)
・ Peak reflux velocity (PRV: cm/s)
・ Mean reflux velocity
(MRV:cm/s)
・ Refluxed volume=MRV x Area
(r2) x RT (TRV:ml)
“TRV= reflux severity “
Reflux time
Peak reflux velocity
Vein diameter
.
Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal
Thigh as Parameters of Venous Disease ClassE. Mendoza . European Journal of
Vascular & Endovascular Surgery.Volume 45, Issue 1 , Pages 76-83, January 2013

9. Ultra sound guided Seldinger with 6
Fr sheat introducer.

10. ILV: sub-valvular LASER beam
with 1mm optical fiber.
Sub-valvular level at the SF junction
valve

11. EVLAR
Remodeling the saphenous vein ,1470 nm
LASER , radial fiber . Shots 2-4 W x 4” at selected
points .
Initial area 0.16cm2 Final area 0.09cm2

12. Sagittal view.
Initial area 0.55cm2 Area obtained 0.22cm2

13. Ultra sound ControlPre-procedure
measurement
Post-procedure
measurement
Cualitative reflux * Diagnosis of reflux ・ Reflux times > 0.5 seconds
Cuantitative reflux * Total Refluxed Volume = MRV x Area (r2)x Time= cm3/sec
Takashi Yamaki M.D

14. Reflux reduction by resistance increase .
TRV 20 cm3/” TRV 5.27 cm3/”
PREOP LAST CONTROL

15. Reflux reduction by resistance increase .

16. Reflux reduction by resistance increase .
PRE-OP POST-OP

17. Reflux reduction by resistance increase .
PRE
PROCEDURE
LAST CONTROL

18. One year follow up .
1,2CM3/” ( PRE TRV 52CM3/”)
AREA =0.16cm2( 3,14 x 0.23x 0.23)

19. Two years follow up .
TRV 6.32 CM3/” (PRE TRV 75CM3/”)

20. Reduction values obtained in Area and Total
Reflux volume

21. Area reduction (cm2)

22. Total reflux volume reduction
(cc/seg.)
The median pre TRV is 41.64 and TRV post 2.26, being statistically significant (z = 2.934,
p = 0.0033, Wilcoxon signed-rank test)

23. Conclusions
• It is more important in the SVI the total reflux volume supported by
the vein than the time in seconds and it depends on diameter,
medium peak flow and time ( TRV)
• The diameter could be reduced by 1470 laser emition under US
control.
• The reflux could be reduced creating annular rings of resistance
that consume the reflux pressure.
• The reduction of venous tributary influx reduces the energy
supported by the vein , the lateral stress too and diminishes the
inflamatory cascade efects over the valves and venous wall.
• The EVLAR is a safe method without complications , as a new tool
to be included in our armamentarium .

24. Enrique Ferracani Ristenpart MD.
“I let this challenge
approach, open to be
answered, with new data by
commitment researchers “

25. Thank you