This document compares the CHIVA method and ASVAL treatment for varicose veins. It discusses their differing physiopathologic assessments and strategies.
The ASVAL method is based on the ascending theory, which posits that reflux begins in the tributaries and causes dilation of the saphenous vein. Its strategy is to perform an extensive phlebectomy of any incompetent thigh tributary found on compression testing. Reflux persisting after this would be treated with saphenous trunk stripping or ablation.
The CHIVA method considers multiple theories of pathogenesis. Its strategy is tailored to the identified shunt type and systolic cartography. It never performs saphenous trunk ablation, seeking to preserve the deep
Abdominal Aortic and Thoracic AneurysmsOmar Haqqani
Authored by Dr. Andris Kazmers, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Abdominal Aortic and Thoracic AneurysmsOmar Haqqani
Authored by Dr. Andris Kazmers, MD. Presented at the First Annual Omar P. Haqqani MD Vascular Symposium, November 10, 2016, Midland Country Club, Midland, MI.
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
Transcatheter closure of atrial septal defect in symptomatic childrenRamachandra Barik
Atrial septal defect (ASD) constitutes 8%–10% of the
congenital heart defects in children. The secundum
ASD accounts for nearly 75% of all ASDs. Since
the introduction of transcatheter device closure for
secundum ASDs in 1976 by King et al., there has been
a paradigm shift in their management. Over the years,
the procedure has evolved significantly to become a
treatment of choice in many institutions. The Amplatzer
septal occluder (ASO) is the most widely used device
owing to its user-friendliness and high success rate.
Various studies have reported transcatheter closure
to be as effective, and with lower complication rate, as
compared to surgical closure.[4,5] However, most of these
studies have included bigger children, adolescents, and
adults. Although a few studies have demonstrated
the feasibility and reasonable safety of transcatheter
ASD device closure in very young children,[7-10] none of
them have addressed important issues like how large
a defect is too large for device closure, how to select
the size of the device, does the length of the interatrial
septum (IAS) matter in the device selection, and is
there a need for using modified techniques to achieve
successful deployment of the device in this subset of
patients which is characterized by relatively large defects
in small hearts.
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
Transcatheter closure of atrial septal defect in symptomatic childrenRamachandra Barik
Atrial septal defect (ASD) constitutes 8%–10% of the
congenital heart defects in children. The secundum
ASD accounts for nearly 75% of all ASDs. Since
the introduction of transcatheter device closure for
secundum ASDs in 1976 by King et al., there has been
a paradigm shift in their management. Over the years,
the procedure has evolved significantly to become a
treatment of choice in many institutions. The Amplatzer
septal occluder (ASO) is the most widely used device
owing to its user-friendliness and high success rate.
Various studies have reported transcatheter closure
to be as effective, and with lower complication rate, as
compared to surgical closure.[4,5] However, most of these
studies have included bigger children, adolescents, and
adults. Although a few studies have demonstrated
the feasibility and reasonable safety of transcatheter
ASD device closure in very young children,[7-10] none of
them have addressed important issues like how large
a defect is too large for device closure, how to select
the size of the device, does the length of the interatrial
septum (IAS) matter in the device selection, and is
there a need for using modified techniques to achieve
successful deployment of the device in this subset of
patients which is characterized by relatively large defects
in small hearts.
Detecting Deep Venous Disease with Duplex UltrasoundVein Global
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
By: Joseph Zygmunt, Jr., RVT, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The Vertebral Artery Test
Luc Peeters, MSc.Ost. & Grégoire Lason, MSc.Ost.
The International Academy of Osteopathy
http://www.osteopathie.eu/en
http://www.osteopathie.eu/en/publications
info@osteopathy.eu
La gamba gonfia - conferenza destinata ad un pubblico laicoStefano Ermini
Le gambe gonfie possono avere cause molteplici ed essere dovute a malfunzionamento di:
sistema venoso superficiale
sistema venoso profondo
vasi linfatici
sistema nervoso
sistema osteoarticolare
sistema endocrino
conseguenza di traumi
Giacomini varicose veins, hemodynamic patterns and strategy terapyStefano Ermini
Describes all venous hemodynamics patterns of Giacomini varicose veins and introduces the principles of hemodynamic treatment. Clearly explains that no classical demolitive treatment is possible in these situations.
Descrizione/guida ad eseguire una corretta cartografia venosa. La mappatura delle vene varicose con l'eco.color-doppler richiede esperienza e può essere eseguita con diversi livelli di informazione. Questo esame è la base della chirurgia emodinamica conservativa CHIVA.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
3. ASVAL Phisiopathologic assesment
1. Ascending Theory
2. “Reservoire” effect
ASVAL Strategy
1. Tributary compression test
La Strategia CHIVA
1. Tributary compression test
2. Systolic carthography
CHIVA Phisiopathogic assesement
All theories
4. Phisiopahologic presuppositions : Ascending theory
1-Dr Pittalugua: “That is the explanation of the « aspirating effect » of the varicose
reservoir on the saphenous vein” : Vasculab 2009. He changed this explanation 4
years later in “We talk about "filling effect" rather than "aspirating effect". The
dilatation begins on the tributaries at the bottom (where the hydrostatic pressure is
higher) because of the weakness of the vein wall and the absence of protection by the
fascia”. VASCULAB Feb 2013
Aspirativ effect in 2009
Feeding tributary effect in 2013
5. What the “reservoir” effect is in Phisiology ?
Reservoire venoso:
Sistema di
ammortizzamento delle
variazioni di pressioni nel
sistema venoso grazie
alla compliance della
parete che consente un
aumento di volume
importante con aumento
di pressione debole (
almeno fino al
raggiungimento della
massima distensione).
Reservoire cardiaco:
Svolto dalle vene
muscolari
6. The “Reservoir” effect, invented from the ascending theory
followers , would be that a large varicose veins volum capacity
alone is capable of creating a “passive”aspirative effect..
Only that a liquid movement may be
created only by "active"forces, like that
of gravity or a pump.
MotionEquation of a Generic Volume
(Base of Hydrodynamics)
Force acting on the unit mass
Therefore
this concept
is contrary to
the physic
fluids law
7. ∂gh
Leukocyte adhesion in the valve sinus
M.A. Elsharawy et al. Interactive
Cardiovascula and Thoracic Surgery 6 (2007)
219-224
(ONO T. et al. J. Vasc. Surgery 1998 Jan; 27
(1):158-166)
2° Comment
8. 3° Commento
Daily practice:
Rare Finding of enlarged veins not refluxing
Frequent findings of not enlarged refluxing veins
Prospective epidemiological study on the beginning of
varicose veins.
Schultz-Ehrenburg and al. Phlebologie 2009; 38: 17–25
Longitudinal study . 740 pupils 10-12 to 18-20.
“The manifestation of a truncal VV is preceded
by a VR in the same vein (p = 0.039). “
ASVAL = Dilation precedes reflux
Studio Schulz-Ehrenburg = Reflux precedes dilation
9. 4° Comment
A DUS documentation of proximal reflux extension is possible?
Answer = NO
No Competent valves
No retrograde Flow
Incompetent
tributary
Competent
Valve
10. Strategy
ASVAL : Extensive phlebectomy of
the incomtent tributary
CHIVA : adapted to shunt type and
to systolic carthography
11. La Strategia
ASVAL strathegy : provides an extensive phlebectomy of the incompetent thigh
tributary when the compression test is positive.
If saphenous reflus reappears , ASVAL provides the saphenous trunk stripping or
Laser ablation
“Penso” che da questo è nato lo stripping senza crossectomia, per trattare la
ricomparsa del reflusso in caso di valvola terminale continente.
In conclusion ASVAL is only the new “Muller”
phlebectomy justified by the ascending theory
CHIVA Strategy : Never provides the saphenous trunk ablation
12. Note that …
The compression re-entry test has been
described by Claude Franceschi 23 years ago
and publied by Marc Bailly in 1995
J.M. Bailly
Carthographie CHIVA
EMC - Paris 1995
13. Which Kind of Hemodynamic Pattern can give origin to
this GSV thigh tributhary ?
GSV
SSV
Giacomini
Deep Veins
Competent
Incompetent
14. 1° variable aspect :
a. The escape point can exists or not
b. The escape point location
Whithout escape point Whit an escape point ( SFJ)
16. 2° variable aspect :
The saphenous axe below the tributary origin ( competent/incompetent/absent)
Competent Incompetent Absent
(US not detected)
17. With Saphenous Incompetence
With Competent GSV
below the tributary
With Incompetent GSV
below the tributary
Shunt Type 2A Shunt Type 2B Shunt Type 2C
Possibilities without escape point (negative Valsalva)
Shunt Type 2
Without Saphenous Incompetence
18. Possibilities with a refluxing SFJ - Terminal valve incompetent
(positive Valsalva)
Shunt Type 3 Shunt Type 1 + 2
20. Shunt Type 4 +II
Pelvic escape point
Shunt Type 5
21. Muscle Contractive Centripetal Flow in the Giacomini Vein that
feeds a centrifugal flow in the GSV during the relaxation phase
22. ASVAL provides the saphenous trunk
stripping or Laser ablation when the
saphenous reflux reappers after
phlebectomy
What percentage do you think ASVAL will
be a saphenous sparing surgery
treatment?
Less then 20% in shunt type 3 and
about 50% in shunt type 2/b and 5
?
23. Why do centrifugal flow reappears in a shunt type 2 after
tributary flush ligation ( including or not an extensive
phlebectomy) ?
Saphenous
trunk
Tributary
Tributary
Desappearing of diastolic
centrifugal flow
No flow is detectable A Centripetal flow persists
Saphenous
trunk
Desappearing of diastolic
centrifugal flow