By: Nick Morrison, MD, FACS, FACPh, 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.
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
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.
2 Things New! 1290nm Laser & New Saphenous Vein Closure DeviceVein Global
By: Lowell S. Kabnick, MD
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.
Future of RF Ablation: Continuous or Segmental?Vein Global
By: Alan M. Dietzek, MD, RVT, RPVI, FACS
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.
Choosing the Appropriate Truncal Vein Closure DeviceVein Global
By: Steve Elias, MD, FACS
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.
Review of Randomized Controlled Trials Comparing Endovenous Thermal and Chemi...Vein Global
By: Edward G. Mackay, MD
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.
Endovenous ablation new methods where do we go from hereuvcd
New endovenous ablation methods fall into two categories: thermal tumescent (TT) and non-thermal non-tumescent (NTNT). TT methods like laser, radiofrequency, and steam ablation require tumescent anesthesia while NTNT methods like cyanoacrylate glue, mechanochemical ablation, polidocanol microfoam, and V Block ligation do not. Clinical trials show high occlusion rates of 90-95% at one year for various NTNT techniques with benefits of reduced pain, faster recovery, and ability to treat veins all the way to the ankle without tumescence. NTNT techniques are positioned to become the future standard for treating saphenous vein insufficiency.
The document discusses VNUS ClosureFast, a procedure for treating venous reflux disease. It describes how ClosureFast uses radiofrequency ablation to seal veins, diverting blood flow to deep veins. The procedure is simple, with segmental ablation allowing consistent treatment. Patients experience fast recovery with minimal pain and bruising. Long-term results show high occlusion rates, making ClosureFast an effective and cost-efficient option for treating varicose veins.
This document discusses thermal ablation as an alternative to surgery for treating great saphenous veins. It notes that randomized trials show thermal ablation is at least non-inferior to surgery for procedural success and clinical outcomes, with improved patient quality of life. The advantages of thermal ablation are outlined as being totally outpatient, avoiding sutures and reducing risks of infection, lymphatic damage, and limitations from anticoagulation. Key steps for performing thermal ablation are described, including patient selection, setting, ultrasound use, catheter placement skills, tumescent anesthesia, and ensuring sufficient heat delivery to the vein wall for durable success. Various technologies for heat delivery are mentioned, and segmental ablation is noted to allow faster patient recovery compared
Future of Non Thermal Ablation: Is the Future of Endovenous AblationVein Global
By: Steve Elias, MD, FACS
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.
2 Things New! 1290nm Laser & New Saphenous Vein Closure DeviceVein Global
By: Lowell S. Kabnick, MD
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.
Future of RF Ablation: Continuous or Segmental?Vein Global
By: Alan M. Dietzek, MD, RVT, RPVI, FACS
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.
Choosing the Appropriate Truncal Vein Closure DeviceVein Global
By: Steve Elias, MD, FACS
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.
Review of Randomized Controlled Trials Comparing Endovenous Thermal and Chemi...Vein Global
By: Edward G. Mackay, MD
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.
Endovenous ablation new methods where do we go from hereuvcd
New endovenous ablation methods fall into two categories: thermal tumescent (TT) and non-thermal non-tumescent (NTNT). TT methods like laser, radiofrequency, and steam ablation require tumescent anesthesia while NTNT methods like cyanoacrylate glue, mechanochemical ablation, polidocanol microfoam, and V Block ligation do not. Clinical trials show high occlusion rates of 90-95% at one year for various NTNT techniques with benefits of reduced pain, faster recovery, and ability to treat veins all the way to the ankle without tumescence. NTNT techniques are positioned to become the future standard for treating saphenous vein insufficiency.
The document discusses VNUS ClosureFast, a procedure for treating venous reflux disease. It describes how ClosureFast uses radiofrequency ablation to seal veins, diverting blood flow to deep veins. The procedure is simple, with segmental ablation allowing consistent treatment. Patients experience fast recovery with minimal pain and bruising. Long-term results show high occlusion rates, making ClosureFast an effective and cost-efficient option for treating varicose veins.
This document discusses thermal ablation as an alternative to surgery for treating great saphenous veins. It notes that randomized trials show thermal ablation is at least non-inferior to surgery for procedural success and clinical outcomes, with improved patient quality of life. The advantages of thermal ablation are outlined as being totally outpatient, avoiding sutures and reducing risks of infection, lymphatic damage, and limitations from anticoagulation. Key steps for performing thermal ablation are described, including patient selection, setting, ultrasound use, catheter placement skills, tumescent anesthesia, and ensuring sufficient heat delivery to the vein wall for durable success. Various technologies for heat delivery are mentioned, and segmental ablation is noted to allow faster patient recovery compared
This document discusses considerations for treating bifurcation lesions in the radial artery. It covers classifying the type of lesion, the importance of operator experience, and choosing an appropriate guide catheter and guide wires. The document recommends letting the operator do what they are comfortable with and planning treatment for the main vessel and side branch at the beginning. It describes the British Bifurcation Study approach of pretreating vessels and stenting the main vessel with or without protecting the side branch. The document shows examples of complex bifurcation cases and techniques for treatment including stenting the side branch and main vessel, using kissing balloons, and potential long-term outcomes.
New technology new technique radiofrequency results 5 yearsuvcd
Radiofrequency ablation (RFA) has proven to be a highly effective treatment for varicose veins over 5 years, with occlusion rates similar to carotid endarterectomy. RFA results in minimal complications and excellent improvement in quality of life outcomes based on randomized controlled trials. Technological advances like segmental ablation catheters and consistent energy delivery have simplified the technique and led to more reliable results compared to earlier radiofrequency and other endovenous ablation methods.
TAVI is now an accepted treatment option for low-risk patients with aortic stenosis based on evidence from the NOTION trial. Risk calculators can help evaluate surgical and interventional risk for individual patients. Younger patient age, valve durability, and risk of permanent pacemaker are factors to consider when choosing between TAVI and surgical replacement. The choice between TAVI and surgery should involve shared decision making between doctors and informed patients, considering individual preferences and long-term management. TAVI is now a competitive strategy even in low-risk patients when treatment is customized to each patient.
This document summarizes a presentation on the Tryton side-branch stent. It includes:
1) Results from the IUVANT study showing the Tryton stent achieved high rates of expansion in both the main vessel and side branch, with low late lumen loss and restenosis at 9-month follow up. Intravascular ultrasound and OCT imaging confirmed good apposition and coverage.
2) Two clinical cases demonstrating durable outcomes with the Tryton stent in complex bifurcation lesions, with unchanged results seen out to 56 months in one patient.
3) OCT from another case showed excellent strut apposition and coverage in all bifurcation segments immediately post-procedure.
4) The presenter concludes the
The Tryton Pivotal: Randomized Trial & Confirmatory Study | Philippe Généreux...trytonmedical
This document discusses the results of the TRYTON Confirmatory Study, which aimed to confirm the safety of the Tryton dedicated bifurcation stent for treating true coronary bifurcation lesions involving large side branches (≥2.25mm). The study met its primary endpoint, demonstrating a peri-procedural MI rate of 10.5% which was below the pre-specified performance goal of 17.9%. Baseline characteristics and acute angiographic outcomes were similar between the confirmatory study and pivotal trial. Additional analyses suggest the Tryton stent results in improved angiographic and procedural outcomes compared to provisional stenting for large bifurcation lesions.
Ultrasound imaging of the arm arteries prior to cardiac catheterization can help anticipate procedural failure and enhance success. In a study of over 2,000 patients, pre-procedure ultrasound identified anatomical anomalies in 9.8% of patients and helped select the largest accessible artery. This led to a procedural success rate of 98.7% and a low 1.3% crossover rate. Pre-procedure ultrasound takes on average 6 minutes and can help reduce radiation time and procedural complications by avoiding difficult arterial access.
Current indications of endovascular management of infrai̇nguinal cliuvcd
1) Endovascular therapy has become the primary treatment strategy for infrainguinal chronic limb-threatening ischemia (CLI) based on studies showing comparable effectiveness to surgery with lower complication and reintervention rates.
2) Patency and limb salvage rates are significantly higher for shorter (<5cm) femoral arterial lesions compared to longer (>10cm) lesions. Multilevel disease also has lower patency outcomes than single-level disease.
3) Runoff vessel status is an important prognostic factor, with three or more runoff vessels associated with 100% limb salvage rates at 2 years following endovascular intervention.
This document discusses radiation protection for operators performing cardiac procedures. It finds that half of brain tumors in interventional cardiologists were glioblastomas located in the left temporal region, suggesting an association with occupational radiation exposure. A randomized controlled trial found that using a pelvic lead drape reduced operator left chest radiation dose by 76%, and a novel lead-free surgical cap reduced operator head radiation exposure by 81%. Adopting measures like new equipment, lowering frames per second, lead drapes and caps can significantly reduce radiation exposure for operators.
This document discusses a study evaluating the feasibility and technical outcomes of using the Surefire Infusion System to deliver chemotherapy or radiation via a transradial (wrist) approach. The study found that the Surefire Catheter can be safely deployed through the wrist to treat liver tumors in 15 patients. Using a transradial approach with the Surefire System offers advantages over traditional techniques like fewer vascular complications and immediate patient ambulation. Pre-procedural imaging can help guide whether this approach is suitable.
1) The document discusses carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treating carotid artery disease. It reviews data from clinical trials comparing the two procedures.
2) Operator experience is an important factor for CAS outcomes, with over 100 cases associated with lower risk. New technologies like mesh-covered stents may further reduce risks of CAS.
3) Future studies like CREST-2 aim to provide more data on CAS and CEA in asymptomatic patients to help guide treatment decisions. Both procedures can effectively treat carotid artery disease when performed by experienced operators.
Early cannulation a new model in delivering hemodialysisuvcd
This document summarizes a presentation on early cannulation vascular access grafts. It discusses the guidelines recommending fistulas over catheters and grafts. Several early cannulation graft models are described, including the Vectra, AVflo, Gore Acuseal and Flixene grafts. These grafts aim to allow cannulation within 24 hours through multilayer designs. Studies show fistulas have higher primary and secondary patency rates than grafts at 6 and 18 months, but early cannulation grafts may achieve patency rates closer to fistulas. Early cannulation grafts are indicated when early access is needed to avoid catheters or for interposition when no vessels are available for a fistula.
This study compared outcomes of 140 patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts via the transradial approach versus 70 patients undergoing PCI of saphenous vein grafts via the transfemoral approach. The transradial group had a lower rate of bleeding complications compared to the transfemoral group (7% vs 21%, p<0.01), with similar rates of angiographic success (90% vs 81%, ns) and no reflow (6% vs 9%, ns). The study supports broader use of the transradial approach for saphenous vein graft intervention due to its association with fewer bleeding complications compared to the transfemoral approach.
This study evaluated the incidence of radial artery occlusion (RAO) in 339 patients who underwent a second cardiac catheterization or percutaneous coronary intervention (PCI) using the radial artery approach within 1 year of a previous radial procedure. The incidence of RAO was low at 1.5%, occurring in 5 patients. Risk factors for the cases of RAO included the use of a 6 French catheter and having undergone multiple prior radial procedures. The study concludes that contemporary techniques including slender catheters, manual bandages, and new P2Y12 inhibitors result in low rates of RAO.
P. Genereux, the tryton stent_dedicated bifurcation stent in coronary bifurca...trytonmedical
This document provides disclosure of financial interests and background on the TRYTON dedicated bifurcation stent presented by Dr. Philippe Généreux at TCT 2016. It notes that Dr. Généreux receives consulting fees and is a major shareholder in TRYTON Medical. The document then summarizes the design and deployment of the TRYTON stent, results from the pivotal RCT showing non-inferiority for the primary endpoint but superiority for the secondary angiographic endpoint of side branch diameter stenosis. It concludes by outlining the rationale and design of the TRYTON confirmatory study to further evaluate safety in large side branches.
This document discusses slender techniques for percutaneous coronary intervention (PCI) that aim to minimize trauma to arterial access sites. It describes techniques used in Europe, including the use of 5F guiding catheters and sheathless guiding catheters. A new slender approach is presented involving direct stenting via 4F diagnostic catheters using stents with integrated delivery systems. Initial experience in 22 patients found this technique was safe and feasible with short procedure and compression times and no complications at 30 days. The document concludes slender TRI techniques can reduce radial injury and complications but potential benefits require further validation.
This randomized clinical trial compared transradial catheterization performed with or without prophylactic nitroglycerin to prevent radial artery spasm. 328 patients undergoing transradial cardiac catheterization were randomly assigned to receive either intra-arterial nitroglycerin or a saline placebo after sheath insertion. The trial found no significant differences in patient pain levels, procedure duration, radiation exposure, or need for analgesics between the two groups. However, the operators' subjective impression of artery spasm was lower in the nitroglycerin group. The study concluded that prophylactic nitroglycerin does not provide clear advantages and may not be necessarily required for transradial procedures.
Gary Clifton, a director at Terumo, discusses vascular access and Terumo's product portfolio. He notes that while transradial access has clear clinical benefits over femoral access like lower bleeding risks, not all procedures can be done radially. As such, Terumo has developed products like its Slender and Pinnacle Precision micro-access tools to improve safety for alternative access points. Terumo has also developed expandable sheath technologies like SoloPath that allow removal of large bore dilators to minimize vascular complications when femoral access is needed, such as for transcatheter aortic valve replacements.
Radialists perform better femoral PCI according to a study. While radial access has benefits, not all hospitals and operators have adopted it due to challenges like a learning curve. Studies show that default radial operators in a radial center who occasionally need to use femoral access have lower rates of access site complications and mortality compared to femoral operators. Analysis of large datasets from the UK also indicate reduced access site complications and mortality with radial access compared to femoral for PCI.
Medium and long term results following evar success or disappointmentuvcd
1. EVAR was found to have a 3% reduced 30-day mortality but increased long-term reintervention rates compared to open repair in trials. However, the rate of reintervention continues to increase over time for both methods.
2. While EVAR provides an initial survival benefit for ruptured AAA, the results are inconclusive due to heterogeneity and many patients still require open repair due to anatomical limitations.
3. Open repair remains the gold standard treatment for AAA due to the increasing long-term reintervention rates with EVAR and concerns about the overuse and liberal guidelines for device usage not aligning with patient risk factors and life expectancy.
This document discusses various treatment options for varicose veins, including conservative management using compression bandages and stockings, medications to improve lymph flow and protect veins, sclerotherapy to harden problematic veins, and surgical procedures such as vein ligation and stripping. More minimally invasive options like endovenous laser ablation and radiofrequency ablation are also covered, which involve inserting a laser or radiofrequency catheter into the vein to cause thermal damage and occlusion. All treatments have potential complications like pain, bruising, bleeding, or deep vein thrombosis.
Thigh, Calf & Ankle Perforators: Are They Different?Vein Global
By: Nicos Labropoulos, PhD, RVT
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.
This document discusses considerations for treating bifurcation lesions in the radial artery. It covers classifying the type of lesion, the importance of operator experience, and choosing an appropriate guide catheter and guide wires. The document recommends letting the operator do what they are comfortable with and planning treatment for the main vessel and side branch at the beginning. It describes the British Bifurcation Study approach of pretreating vessels and stenting the main vessel with or without protecting the side branch. The document shows examples of complex bifurcation cases and techniques for treatment including stenting the side branch and main vessel, using kissing balloons, and potential long-term outcomes.
New technology new technique radiofrequency results 5 yearsuvcd
Radiofrequency ablation (RFA) has proven to be a highly effective treatment for varicose veins over 5 years, with occlusion rates similar to carotid endarterectomy. RFA results in minimal complications and excellent improvement in quality of life outcomes based on randomized controlled trials. Technological advances like segmental ablation catheters and consistent energy delivery have simplified the technique and led to more reliable results compared to earlier radiofrequency and other endovenous ablation methods.
TAVI is now an accepted treatment option for low-risk patients with aortic stenosis based on evidence from the NOTION trial. Risk calculators can help evaluate surgical and interventional risk for individual patients. Younger patient age, valve durability, and risk of permanent pacemaker are factors to consider when choosing between TAVI and surgical replacement. The choice between TAVI and surgery should involve shared decision making between doctors and informed patients, considering individual preferences and long-term management. TAVI is now a competitive strategy even in low-risk patients when treatment is customized to each patient.
This document summarizes a presentation on the Tryton side-branch stent. It includes:
1) Results from the IUVANT study showing the Tryton stent achieved high rates of expansion in both the main vessel and side branch, with low late lumen loss and restenosis at 9-month follow up. Intravascular ultrasound and OCT imaging confirmed good apposition and coverage.
2) Two clinical cases demonstrating durable outcomes with the Tryton stent in complex bifurcation lesions, with unchanged results seen out to 56 months in one patient.
3) OCT from another case showed excellent strut apposition and coverage in all bifurcation segments immediately post-procedure.
4) The presenter concludes the
The Tryton Pivotal: Randomized Trial & Confirmatory Study | Philippe Généreux...trytonmedical
This document discusses the results of the TRYTON Confirmatory Study, which aimed to confirm the safety of the Tryton dedicated bifurcation stent for treating true coronary bifurcation lesions involving large side branches (≥2.25mm). The study met its primary endpoint, demonstrating a peri-procedural MI rate of 10.5% which was below the pre-specified performance goal of 17.9%. Baseline characteristics and acute angiographic outcomes were similar between the confirmatory study and pivotal trial. Additional analyses suggest the Tryton stent results in improved angiographic and procedural outcomes compared to provisional stenting for large bifurcation lesions.
Ultrasound imaging of the arm arteries prior to cardiac catheterization can help anticipate procedural failure and enhance success. In a study of over 2,000 patients, pre-procedure ultrasound identified anatomical anomalies in 9.8% of patients and helped select the largest accessible artery. This led to a procedural success rate of 98.7% and a low 1.3% crossover rate. Pre-procedure ultrasound takes on average 6 minutes and can help reduce radiation time and procedural complications by avoiding difficult arterial access.
Current indications of endovascular management of infrai̇nguinal cliuvcd
1) Endovascular therapy has become the primary treatment strategy for infrainguinal chronic limb-threatening ischemia (CLI) based on studies showing comparable effectiveness to surgery with lower complication and reintervention rates.
2) Patency and limb salvage rates are significantly higher for shorter (<5cm) femoral arterial lesions compared to longer (>10cm) lesions. Multilevel disease also has lower patency outcomes than single-level disease.
3) Runoff vessel status is an important prognostic factor, with three or more runoff vessels associated with 100% limb salvage rates at 2 years following endovascular intervention.
This document discusses radiation protection for operators performing cardiac procedures. It finds that half of brain tumors in interventional cardiologists were glioblastomas located in the left temporal region, suggesting an association with occupational radiation exposure. A randomized controlled trial found that using a pelvic lead drape reduced operator left chest radiation dose by 76%, and a novel lead-free surgical cap reduced operator head radiation exposure by 81%. Adopting measures like new equipment, lowering frames per second, lead drapes and caps can significantly reduce radiation exposure for operators.
This document discusses a study evaluating the feasibility and technical outcomes of using the Surefire Infusion System to deliver chemotherapy or radiation via a transradial (wrist) approach. The study found that the Surefire Catheter can be safely deployed through the wrist to treat liver tumors in 15 patients. Using a transradial approach with the Surefire System offers advantages over traditional techniques like fewer vascular complications and immediate patient ambulation. Pre-procedural imaging can help guide whether this approach is suitable.
1) The document discusses carotid artery stenting (CAS) and carotid endarterectomy (CEA) for treating carotid artery disease. It reviews data from clinical trials comparing the two procedures.
2) Operator experience is an important factor for CAS outcomes, with over 100 cases associated with lower risk. New technologies like mesh-covered stents may further reduce risks of CAS.
3) Future studies like CREST-2 aim to provide more data on CAS and CEA in asymptomatic patients to help guide treatment decisions. Both procedures can effectively treat carotid artery disease when performed by experienced operators.
Early cannulation a new model in delivering hemodialysisuvcd
This document summarizes a presentation on early cannulation vascular access grafts. It discusses the guidelines recommending fistulas over catheters and grafts. Several early cannulation graft models are described, including the Vectra, AVflo, Gore Acuseal and Flixene grafts. These grafts aim to allow cannulation within 24 hours through multilayer designs. Studies show fistulas have higher primary and secondary patency rates than grafts at 6 and 18 months, but early cannulation grafts may achieve patency rates closer to fistulas. Early cannulation grafts are indicated when early access is needed to avoid catheters or for interposition when no vessels are available for a fistula.
This study compared outcomes of 140 patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts via the transradial approach versus 70 patients undergoing PCI of saphenous vein grafts via the transfemoral approach. The transradial group had a lower rate of bleeding complications compared to the transfemoral group (7% vs 21%, p<0.01), with similar rates of angiographic success (90% vs 81%, ns) and no reflow (6% vs 9%, ns). The study supports broader use of the transradial approach for saphenous vein graft intervention due to its association with fewer bleeding complications compared to the transfemoral approach.
This study evaluated the incidence of radial artery occlusion (RAO) in 339 patients who underwent a second cardiac catheterization or percutaneous coronary intervention (PCI) using the radial artery approach within 1 year of a previous radial procedure. The incidence of RAO was low at 1.5%, occurring in 5 patients. Risk factors for the cases of RAO included the use of a 6 French catheter and having undergone multiple prior radial procedures. The study concludes that contemporary techniques including slender catheters, manual bandages, and new P2Y12 inhibitors result in low rates of RAO.
P. Genereux, the tryton stent_dedicated bifurcation stent in coronary bifurca...trytonmedical
This document provides disclosure of financial interests and background on the TRYTON dedicated bifurcation stent presented by Dr. Philippe Généreux at TCT 2016. It notes that Dr. Généreux receives consulting fees and is a major shareholder in TRYTON Medical. The document then summarizes the design and deployment of the TRYTON stent, results from the pivotal RCT showing non-inferiority for the primary endpoint but superiority for the secondary angiographic endpoint of side branch diameter stenosis. It concludes by outlining the rationale and design of the TRYTON confirmatory study to further evaluate safety in large side branches.
This document discusses slender techniques for percutaneous coronary intervention (PCI) that aim to minimize trauma to arterial access sites. It describes techniques used in Europe, including the use of 5F guiding catheters and sheathless guiding catheters. A new slender approach is presented involving direct stenting via 4F diagnostic catheters using stents with integrated delivery systems. Initial experience in 22 patients found this technique was safe and feasible with short procedure and compression times and no complications at 30 days. The document concludes slender TRI techniques can reduce radial injury and complications but potential benefits require further validation.
This randomized clinical trial compared transradial catheterization performed with or without prophylactic nitroglycerin to prevent radial artery spasm. 328 patients undergoing transradial cardiac catheterization were randomly assigned to receive either intra-arterial nitroglycerin or a saline placebo after sheath insertion. The trial found no significant differences in patient pain levels, procedure duration, radiation exposure, or need for analgesics between the two groups. However, the operators' subjective impression of artery spasm was lower in the nitroglycerin group. The study concluded that prophylactic nitroglycerin does not provide clear advantages and may not be necessarily required for transradial procedures.
Gary Clifton, a director at Terumo, discusses vascular access and Terumo's product portfolio. He notes that while transradial access has clear clinical benefits over femoral access like lower bleeding risks, not all procedures can be done radially. As such, Terumo has developed products like its Slender and Pinnacle Precision micro-access tools to improve safety for alternative access points. Terumo has also developed expandable sheath technologies like SoloPath that allow removal of large bore dilators to minimize vascular complications when femoral access is needed, such as for transcatheter aortic valve replacements.
Radialists perform better femoral PCI according to a study. While radial access has benefits, not all hospitals and operators have adopted it due to challenges like a learning curve. Studies show that default radial operators in a radial center who occasionally need to use femoral access have lower rates of access site complications and mortality compared to femoral operators. Analysis of large datasets from the UK also indicate reduced access site complications and mortality with radial access compared to femoral for PCI.
Medium and long term results following evar success or disappointmentuvcd
1. EVAR was found to have a 3% reduced 30-day mortality but increased long-term reintervention rates compared to open repair in trials. However, the rate of reintervention continues to increase over time for both methods.
2. While EVAR provides an initial survival benefit for ruptured AAA, the results are inconclusive due to heterogeneity and many patients still require open repair due to anatomical limitations.
3. Open repair remains the gold standard treatment for AAA due to the increasing long-term reintervention rates with EVAR and concerns about the overuse and liberal guidelines for device usage not aligning with patient risk factors and life expectancy.
This document discusses various treatment options for varicose veins, including conservative management using compression bandages and stockings, medications to improve lymph flow and protect veins, sclerotherapy to harden problematic veins, and surgical procedures such as vein ligation and stripping. More minimally invasive options like endovenous laser ablation and radiofrequency ablation are also covered, which involve inserting a laser or radiofrequency catheter into the vein to cause thermal damage and occlusion. All treatments have potential complications like pain, bruising, bleeding, or deep vein thrombosis.
Thigh, Calf & Ankle Perforators: Are They Different?Vein Global
By: Nicos Labropoulos, PhD, RVT
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.
How do Laser Wavelengths & Fibers Differ Clinically?Vein Global
By: Thomas M. Proebstle, M.D.
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.
This document discusses endovenous laser ablation (EVLA) for treating varicose veins. It begins with definitions of different types of abnormal veins like telangiectasias, reticular veins, and varicose veins. It then discusses patient assessment, which involves medical history, physical examination, and duplex ultrasound scan. For patients with superficial venous reflux and varicose veins, treatment options discussed include conservative management, sclerotherapy, and thermal ablation techniques like EVLA. EVLA involves using laser energy to close off diseased veins. The document provides details on patient selection, procedural technique, and outcomes of EVLA for varicose vein treatment.
The document describes the venous drainage system of the lower extremity, including the long saphenous vein (LSV), short saphenous vein (SSV), deep veins, and perforating veins. It provides details on the anatomy and course of the LSV and SSV. Surgical procedures for varicose veins are discussed such as ligation and stripping, ligation of incompetent perforators, and newer minimally invasive techniques like foam sclerotherapy, endovenous laser ablation, and radiofrequency ablation. Post-operative care and potential complications are also summarized.
This document discusses varicose veins, including definitions, anatomy, causes, symptoms, examination techniques, and treatment options. Some key points:
- Varicose veins are dilated, tortuous veins, usually in the legs, caused by incompetent valves that allow blood to flow in the wrong direction.
- Annual incidence is about 2% and lifetime prevalence is around 40%, being more common in women.
- Symptoms can include pain, swelling, heaviness, and skin changes like pigmentation.
- Examination involves inspection, palpation, auscultation, and Doppler ultrasound to map veins and locate sites of reflux.
- Treatment options include conservative compression therapy, sclerotherapy
By: Steve Elias MD FACS
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.
Endovenous treatment for varicose veins – the first choice (laser, radiofre...Michał Molski
This document discusses the treatment of varicose veins, specifically endovenous ablation techniques like laser and radiofrequency ablation. It provides a brief history of varicose vein surgery techniques dating back to the early 1900s. More recent developments discussed include techniques like EVLA, RFA, sclerotherapy, steam vein sclerosis, and mechano-chemical ablation. The document also outlines the authors' hospital's experience with various treatment methods and provides their recommendations on when each technique is most appropriate based on factors like patient anatomy, vein diameter and location.
Who Needs More Testing Beyond Venous Duplex?Vein Global
By: William Marston, MD
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.
By: Mark Meissner, M.D.
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.
By: Seshadri Raju, MD, FACS
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.
Venous Leg Ulcers: Wound Preparation & Adjuvants to HealingVein Global
By: William Marston, M.D.
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.
Endovenous Laser Ablation in the Treatment of Recurrent Varicose VeinsMinnesota Vein Center
Aims:
Determine how many patients presented to a single center Vein Specialty Clinic with varicose veins despite prior surgical intervention.
Identify the site and cause of varicose veins in patients with prior surgical intervention.
Assess the role of endovenous laser ablation in the retreatment of varicose veins in patients with prior intervention.
This document discusses varicose vein surgery. It provides an overview of the indications for varicose vein surgery, including pain, swelling, skin changes, ulceration, and appearance. It describes the importance of preoperative evaluation using duplex ultrasound mapping to identify refluxing veins and develop a surgical plan. Finally, it outlines procedural considerations for varicose vein treatment, including the goals of ablating reflux from deep to superficial veins and removing all branch varicosities.
(1) 4% of patients evaluated for leg vein problems had previously undergone vein "stripping" surgery, with recurrent varicose veins present in 71 patients. (2) Recurrence was often due to residual or accessory saphenous veins, perforator veins, or neovascularization. (3) 73% of patients were treated with endovenous laser ablation (EVLA) of saphenous veins, with the majority reporting symptomatic improvement and vein closure at follow-up.
Radio Frequency Ablation (RFA Treatment ) -Modern Technology for management l...SafeMedTrip
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This presentation will be very helpful for interventional radiologist, vascualr sergeons and sonographers. We will discuss the basic concept of varicosities and then step by step their thermal ablation under US guiadance.
1. Despite prior endovenous thermal ablation of saphenous veins, varicose veins were present in 162 out of 197 limbs (82%).
2. Patients presented a median of 36 months after their initial endovenous ablation procedure. The majority were middle-aged females.
3. Recurrence of varicose veins was associated with recanalized saphenous veins in 36% of cases, perforator vein reflux in 31% of cases, and accessory vein reflux in 30% of cases.
The correct answer is C. The new H1N1 codes require specifying if the manifestation is pneumonia, other respiratory manifestations, or other manifestations.
Fecal Impaction Has New Options
Answer 2: False.
Talking point: 787.6 is deleted and replaced with more specific codes for fecal incontinence symptoms like full incontinence, incomplete defecation, smearing, and urgency.
Pain Gets 1 More Symptom
Answer 3: C.
Talking point: A new code (784.92) has been added for jaw pain.
Objectives:
By the end of this call, you will be able to:
•Describe the processes of Root-Cause Analysis (RCA) and Multi-Incident Analysis (MIA) and their role in quality improvement
•Compare and contrast the different approaches to collecting hospital-acquired VTE data
•Identify an approach suitable for improving patient safety at your institution
Ancillary Revenue Program - Are you still sending out these tests to an outside lab? UTI/STI • Vaginitis • Respiratory • ENT/Sinus • Wound • GI related infections. Find out how to CAPTURE OUTSIDE LAB REVENUE and improve patient experience and outcomes. (8) tests a day generates you over $30K in bottom-line revenue & advances patient care with a 1-hour test result that includes antibiotic resistance read-out.
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We handle ALL of the upfront capital costs, billing, staffing, and CLIA licensure/compliance at NO UPFRONT COST TO THE PRACTICE -- All that’s required is a 6-foot workspace to run the tests.
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Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
The Victoria practice participated in a program to improve management of COPD and asthma patients through a patient-centered service focusing on motivational interviewing, adherence, inhaler technique, evidence-based prescribing, and regular reviews. The pharmacist-led asthma and COPD clinic aimed to optimize prescribing through 30-minute appointments to understand patients' medication use and encourage behavior change. Results showed a reduction in respiratory prescribing costs, improved COPD and asthma control scores, and lower exacerbation rates through a medicines optimization approach.
Salon 1 14 kasim 15.30 17.00 duygu demi̇r-ingtyfngnc
This study evaluated the effects of using the AccuVein AV-400 vascular imaging device to support peripheral intravenous catheter insertion in pediatric patients. The study found that using the AccuVein device significantly reduced the time and number of attempts needed for catheter insertion compared to conventional methods. It also significantly reduced the level of pain reported by children and as assessed by observers. The success rate of catheter insertion on the first attempt was significantly higher when using the AccuVein device. The study concluded that the AccuVein device increases the success of IV catheter procedures while decreasing procedure time and pain in pediatric patients.
The document provides a summary of information from various coding and reimbursement conferences and resources. It discusses changes to CPT and ICD-9 codes for 2011 related to topics like E/M documentation, vaccine administration, physical therapy caps, and cardiac catheterization codes. It also addresses questions around coding issues including monitoring studies, endoscopy procedures, and hip arthroscopy.
Evaluating the Effectiveness of Current Pain Management StrategiesWellbe
Pain management of orthopedic surgery patients is being impacted by the changes in health care regulation and reimbursement. There is a need for safer, more effective pain management pathways that can provide opportunities for early discharge without increasing the risk of readmissions or compromising outcomes.
Current pain management strategies for joint replacements, spine surgery and outpatient knee and shoulder procedures will be examined from clinical, safety, satisfaction and cost perspectives. The process of implementing and evaluating these pathways will also be discussed.
Nina Whalen will demonstrate how she evaluated, developed and improved pain management pathways for patients. These pathways include:
– Multimodal pain management for total joint and spine
– Peripheral nerve block utilization for inpatients and outpatients
– Customized pain pathways for special populations
– The use of intraoperative tissue infiltration with medications as a primary pain management strategy in joint replacement surgery
About The Speaker:
Nina Whalen, RN, APN-C, has over 30 years of experience as a nurse practitioner in orthopedic medicine. She has been involved in every phase of patient care at both the clinic and tertiary care levels. In the 1990’s she created and worked in a nurse practitioner hospital program at Presbyterian St Luke’s hospital that provided 24 hour coverage for the needs of hospitalized orthopedic surgery patients. She has worked in research and has co-authored publications in the areas of sports medicine and total joint. She is currently the manager of clinical outcomes at OrthoIndy Hospital (formerly Indiana Orthopaedic Hospital) which is a 38 bed, physician owned, orthopedic specialty hospital in Indianapolis.
Leveraging the Growing Arsenal of Adjuvant Therapies for Early-Stage NSCLCi3 Health
3 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. Helena A. Yu, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, will provide insights into strategies for leveraging the growing arsenal of adjuvant therapies for early-stage non–small cell lung cancer (NSCLC), including treatment selection and adverse event management.
STATEMENT OF NEED
Lung cancer is the second most commonly diagnosed cancer and the leading cause of death for men and women worldwide. In the United States, non–small cell lung cancer (NSCLC) accounts for 81% of all lung cancer diagnoses (Cancer.net, 2023). Therapeutic options, survival rates, and outcomes for NSCLC are dramatically impacted by disease stage. For patients with early-stage disease, radical surgery is the mainstay of treatment; however, patients have a significant risk of relapse following surgery and local treatment. Numerous novel therapeutic approaches, including the use of molecular biomarkers and the development of targeted agents and immune checkpoint inhibitors, are under investigation for early-stage NSCLC, contributing to a growing arsenal of treatment options for this disease (Indini et al, 2020). In this visiting faculty meeting series chaired by Helena A. Yu, MD, Associate Attending Physician at Memorial Sloan Kettering Cancer Center, speakers will provide expert perspectives on diagnosis, identification of biomarkers, and efficacy and safety data of novel adjuvant therapies to improve survival outcomes for patients with early-stage NSCLC.
TARGET AUDIENCE
Medical oncologists, radiation oncologists, surgical oncologists, pulmonologists, nurse practitioners, physician assistants, oncology nurses, and other health care professionals involved in the treatment of patients with non–small cell lung cancer (NSCLC).
LEARNING OBJECTIVES
Upon completion of this activity, participants should be able to
Identify the correct tumor stage and appropriate management approach for NSCLC based on the latest evidence
Distinguish biomarkers for early-stage NSCLC that can inform individualized treatment strategies
Appraise efficacy and safety data of novel adjuvant therapies for patients with NSCLC as elucidated by recent clinical trials
Apply strategies to prevent and mitigate adverse events associated with novel adjuvant therapies for early-stage NSCLC
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Leveraging the Growing Arsenal of Adjuvant
Therapies for Early-Stage NSCLC
Helena A. Yu, MD
Associate Attending Physician
Memorial Sloan Kettering Cancer Center
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Disclosures
Advisory board/panel: AbbVie, AstraZeneca, Black Diamond,
Blueprint, C4 Therapeutics, Cullinan, Daiichi Sankyo, Janssen, Taiho,
Takeda
Grants/research support: AstraZeneca, Black Diamond, Blueprint,
Cullinan, Daiichi Sankyo, Erasca, Janssen, Novartis, Pfize
2017 02-10-slas-washington dc-combinations-sig-ht-combinations-erictangOliver Leven
- High-throughput screening of drug combinations across 240 cancer cell lines identified synergistic combinations that enhanced cell killing compared to single agents.
- Combination profiles were analyzed within and across disease types to identify opportunities for patient segmentation and indications. Challenges include the large matrix size, lack of clinical safety data, and integrating genetic biomarkers.
- Validation in patient-derived tumour cells and 3D cultures can prioritize the most synergistic combinations for driving in vivo and clinical studies to improve personalized cancer treatment.
SCIE Investor Presentation January 2017Mike Oliver
This document discusses SpectraScience's optical biopsy technology platform and commercialization plans. The technology uses light to provide faster, non-invasive cancer detection compared to physical biopsies. Clinical studies show the technology exceeds accuracy criteria for detecting colon cancer. The company plans to commercialize the technology first in Europe, where distribution agreements are in place, to take advantage of single-payer healthcare systems and proven cost savings. Future indications for bladder, esophageal, and other cancers are also discussed.
Keynote address by Brent James at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter.
Dr. Brent James describes how Intermountain Healthcare is systematically, and successfully, bringing together clinicians, patients and leaders to: establish best practices; drive out waste in their system; and ultimately deliver better, safer care. Dr. James will share insights about the structures, strategies and relationships that have been pivotal in transforming their health system.
The document discusses the International Patient Safety Goals (IPSG) which were developed by the Joint Commission International to help improve patient safety. It provides background on how the IPSG were adapted from the National Patient Safety Goals established by the Joint Commission. The document then outlines several of the IPSG, including proper patient identification, improving staff communication, reducing risks associated with medications, and preventing wrong site/procedure surgery. The goals are aimed at reducing common safety issues and medical errors in healthcare facilities.
Short and snappy topics - smbg, diabetic foot uclers, point of care testing ...PASaskatchewan
This document summarizes evidence on three topics:
1) Treatment of diabetic foot ulcers includes debridement, negative pressure wound therapy, offloading devices, and compression therapy. The evidence for different treatments varies.
2) Point-of-care INR testing is as accurate as lab testing and patient self-management is most cost-effective when feasible. Clinic-based testing requires consideration of costs.
3) For type 2 diabetics not using insulin, self-monitoring of blood glucose provides modest glycemic control benefits but no quality of life benefits. Routine monitoring is not cost-effective for these patients. Periodic monitoring may be beneficial for some high-risk patients.
Utility of primary care based TIA electronic decision support: A cluster randomised controlled trial. Presented by Anna Ranta, Department of Neurology, MidCentral DHB, at HINZ 2014, 12 November 2014, 12pm, Plenary Room
The document discusses "core measures", which are evidence-based guidelines established by CMS and the Joint Commission for treating patients with certain diagnoses. The core measure patient groups include CHF, pneumonia, AMI, surgical care improvement, psychiatry, and patient satisfaction. Hospitals must follow specific treatment protocols for these patients and are audited to ensure compliance. Identifying core measure patients early and using established protocols and tools is key to improving outcomes and quality measures.
Ablynx Financial Presentation Half Year Results 2014Ablynx ABLX
1) Ablynx reported strong financial and clinical progress in the first half of 2014, with revenues increasing 72% and a 40% reduction in net loss compared to the same period in 2013.
2) Clinically, caplacizumab achieved proof-of-concept for the treatment of acquired thrombotic thrombocytopenic purpura, and preparations were underway to start a Phase III trial in 2015. Phase I trials were also initiated for other programs.
3) Partnership wise, Merck Serono and AbbVie advanced programs in clinical trials, and a new collaboration was announced with Merck & Co. worth up to €1.7 billion in potential milestones.
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1. Polidocanol Endovenous Microfoam:
Where Are We?
Varithena™
[Previously referred to as Varisolve®
or polidocanol
endovenous microfoam (PEM)]
Thursday, April 24
2. Research GrantResearch Grant
Consultant, Research Grant - SapheonConsultant, Research Grant - Sapheon
Educational Grant, MediUSAEducational Grant, MediUSA
Consultant, MerzConsultant, Merz
Scientific Advisory Board, VenXScientific Advisory Board, VenX
Medical Director, Morrison Vein/Training InstituteMedical Director, Morrison Vein/Training Institute
Monument Valley, Arizona
4. Some previous treatment modality clinical trials used
duplex ultrasound response or GSV closure as the
primary endpoint
Ultrasound response a surrogate endpoint with no
clear relationship with patient benefit
FDA requested BTG establish clinical benefit
through use of patient-reported outcomes (PROs)
as 1° end-points
BTG developed VVSymQ instruments to measure
patient benefit in terms of…
Symptoms:
Heaviness Throbbing
Aching Itching
Swelling
Clinical Trials - Efficacy
5. 2 ° Other PRO measurement tools
Patient Self-Assessment of Appearance of Visible Varicose Veins (PA-V3
)
Noticeability Scale (0 to 4)
0 = Not at all noticeable to 4 = Extremely noticeable
Independent Panel Review of Visible Varicose Veins (IPR-V3
)
IPR-V3
score—median of 3 independent clinician reviewers
blinded to treatment and time point
3° End-points
a)Duplex ultrasound response:
Elimination of reflux at SFJ
and/or
Complete occlusion of treated truncal vein at 8 wks
b)VCSS – physician-reported outcome measurement instrument
c)VEINES-QOL – disease-specific QoL instrument
Clinical Trials - Efficacy
6. Clinical Trials - Efficacy
Phase II (pts)
UK Safety Profile 24
First US Study 40
US MRI Study 83
Compression Method 20
UK Echocardiography Study 35
Pilot Phase III 39
38 control pts
Pilot Low Conc. Microfoam 16
Phase III Pts Controls
European Phase III 437 219
VANISH-1 223 56
VANISH-2 175 57
Adjunct 79 38
All trials total pts randomized
Pts Controls
1192 408
8. 1° End-point
VVSymQ
Varithena™
superior compared to placebo (p<0.0001) at 8 weeks
*regardless of GSV diameter
2° End-points
PA-V3
Score
Varithena™
superior compared to placebo (p<0.0001) at 8 weeks
IPR-V3
Score
Varitherna™
superior compared to placebo (p<0.0001) at 8 weeks
3° Endpoints
Duplex Response
Varithena™
superior compared to placebo (p<0.0001-0.0009) at 8 weeks
VCSS
Varithena™
superior compared to placebo (p<0.0001) at 8 weeks
VEINES-QoL
Varithena™
superior compared to placebo (p<0.0001) at 8 weeks
Clinical Trials - Efficacy
(Vanish-1, Vanish-2)
9. Clinical Trials - Safety1333 patients in 12 clinical trials
437 patients in placebo-controlled clinical trials
Most common AE’s (>3%)
a) extremity pain/discomfort
b) retained coagulum
c) injection site hematoma/pain
d) SVT
e) extravasation
No anaphylaxis or life-threatening hypersensitivity
No clinically evident PE
DVT:
PASTE – 2.9%
Proximal – 1.7%
Distal – 1.1%
Muscular – 1.4% } 4.2%
10. Clinical Trials - Safety
Neurosensory events:
Incidence of neurological or visual adverse events within 1
day of treatment was 2.7% in all Varithena™
patients
and 4.0% in the placebo groups
Visual impairment
Burning sensation
Dizziness
Dysgeusia
Headache
Hypoesthesia
Migraine
Paresthesia
Presyncope
Restless legs syndrome
11. Varithena™
(polidocanol injectable foam) is
indicated for the treatment of incompetent great
saphenous veins, accessory saphenous veins and
visible varicosities of the great saphenous vein
(GSV) system above and below the knee.
Varithena™
improves the symptoms of superficial
venous incompetence and the appearance of
visible varicosities.
Clinical Indications
13. Reimbursement/Costs
Wife: I have some good news and some bad
news.
Husband: What's the good news?
Wife: The good news is I found a picture
that's worth $500,000.
Husband: Wow! That's wonderful! What's
the bad news?
Wife: The bad news is that the picture is of
you and your secretary!
14. Costs
$3195 or $71 per mL
PLUS
Administration pack – transfer unit, syringes, manometer
tubing, compression pads
Cost per Treatment:
5mL - $395 10mL - $750 15mL (max allowed) -
$1,105
Average Study Treatment Volume:
11-12mL per patient
45mL multi-treatment canister:
15. What impact will cost have?
Angiodynamics/Merz
(STS, Asclera)
Market penetration
significantly less than predicted
16. Reimbursement
Comprehensive reimbursement support services
• Provider training support
• Product information
• Benefit verification support
• Prior authorization and documentation support
• Determination of patient drug and procedure
out of pocket (OOP)
• Order and distribution support
• Insurer-specific coverage policy matching,
coding, and billing support
• Underpaid or denied claim appeals
assistance
• Claims tracking support
17. Reimbursement
Procedure:
In light of the lack of a Category I CPT code, it is recommended that
the best interim coding strategy for the FDA approved percutaneous
endovenous ablation procedure using an injectable foam
drug/device combination approach is 37799 (unlisted procedure,
vascular surgery); and that CPT codes 36475 (RF) – 36478 (EVLA) and
or 37765 (AP) may be suitable as potential crosswalks for insurers to
establish appropriate RVU levels for the Varithena™ procedure.
Varithena™
Foam (HCPCS coding)
J3490 – Unclassified drug
Medicare reimbursement - typically cost + 6%
18. Conclusions
1) The stuff seems to work pretty well
2) The stuff seems to be pretty safe in
experienced hands
Impediments to adoption
1) Cost high – over 10 x cost of homemade
2) My homemade foam works pretty
damn well
3) No reimbursement codes yet, but BTG
spending a sh**load to help
19. Thank you for your kind attention
nickmorrison2002@yahoo.com
Editor's Notes
Thank you for allowing me to present this information regarding the techniques, results, and complications of conventional surgery for small saphenous insufficiency, something that has been largely abandoned in the United States in favor of newer techniques