George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George...
-
Upload
bonnie-cobb -
Category
Documents
-
view
234 -
download
0
Transcript of George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George...
![Page 1: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/1.jpg)
George Sfyroeras MD, MSc, PhD, FEBVS
Vascular Surgery Department
Attikon University Hospital
George Sfyroeras MD, MSc, PhD, FEBVS
Vascular Surgery Department
Attikon University Hospital
ULTRASOUND GUIDED FOAM SCLEROTHERAPYULTRASOUND GUIDED FOAM SCLEROTHERAPY
![Page 2: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/2.jpg)
Sclerotherapy Sclerotherapy Old technology, used a new way
![Page 3: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/3.jpg)
• Ultrasound-Guided foam sclerotherapy (USGS) is a revolution in the management of varicose vein.
• Ultrasound-Guided foam sclerotherapy (USGS) is a revolution in the management of varicose vein.
![Page 4: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/4.jpg)
• In trained hands it is simple, affordable, safe, efficient and easily repeatable.
• In trained hands it is simple, affordable, safe, efficient and easily repeatable.
![Page 5: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/5.jpg)
• Ideal sclerosing must ensure appropriate concentration of the agent with integral contact to the entire venous wall.
• Ideal sclerosing must ensure appropriate concentration of the agent with integral contact to the entire venous wall.
![Page 6: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/6.jpg)
• Liquid sclerosing agent gets washed away by blood quickly when the vein diameter is over 3 mm.
• Liquid sclerosing agent gets washed away by blood quickly when the vein diameter is over 3 mm.
![Page 7: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/7.jpg)
• Injection with foam has the advantage of filling the vein and staying longer and causing spasm.
• Injection with foam has the advantage of filling the vein and staying longer and causing spasm.
![Page 8: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/8.jpg)
• In the past attempts were made to clear the blood from the vein, prior to injection by using “air block” technique, i.e.; injecting air before the sclerosant.
• In the past attempts were made to clear the blood from the vein, prior to injection by using “air block” technique, i.e.; injecting air before the sclerosant.
![Page 9: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/9.jpg)
• Cabrera introduced foamed sclerosant in 1997 using CO2.
• Tessari simplified using liquid sclerosant into foam using two syringes and a three-way stopcock in 2000.
• Cabrera introduced foamed sclerosant in 1997 using CO2.
• Tessari simplified using liquid sclerosant into foam using two syringes and a three-way stopcock in 2000.
![Page 10: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/10.jpg)
![Page 11: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/11.jpg)
• Only detergent sclerosing agents such as Sotradecol and Polidocanol can be used to foam. One part of sclerosant with four parts air is used with two 5 CC syringes. Foam can be used in different size of the veins using concentration from 0.25% to 3%.
• Only detergent sclerosing agents such as Sotradecol and Polidocanol can be used to foam. One part of sclerosant with four parts air is used with two 5 CC syringes. Foam can be used in different size of the veins using concentration from 0.25% to 3%.
![Page 12: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/12.jpg)
Foam SclerotherapyPreparationFoam SclerotherapyPreparation
![Page 13: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/13.jpg)
• Multiple, repeated treatment may be necessary and therefore results should be assessed from a life-long point of view, rather than ablation of target vein alone.
• Multiple, repeated treatment may be necessary and therefore results should be assessed from a life-long point of view, rather than ablation of target vein alone.
![Page 14: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/14.jpg)
Foam Sclerotherapy of the GSVFoam Sclerotherapy of the GSV
![Page 15: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/15.jpg)
Foam Sclerotherapy for lateral thigh branchFoam Sclerotherapy for lateral thigh branch
CannulationCannulation
![Page 16: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/16.jpg)
![Page 17: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/17.jpg)
Ultrasound GuidedUltrasound Guided
![Page 18: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/18.jpg)
![Page 19: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/19.jpg)
![Page 20: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/20.jpg)
![Page 21: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/21.jpg)
![Page 22: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/22.jpg)
Ultrasound Guided Foam Sclerotherapy for the Small Saphenous Vein
Ultrasound Guided Foam Sclerotherapy for the Small Saphenous Vein
![Page 23: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/23.jpg)
• Success of foam is attributed to its prolonged contact with the vein wall endothelium.This leads to sub endothelial layer exposure and irreversible venous fibrosis.
• Success of foam is attributed to its prolonged contact with the vein wall endothelium.This leads to sub endothelial layer exposure and irreversible venous fibrosis.
Post OpPost OpPre OpPre Op
![Page 24: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/24.jpg)
RESULTSRESULTS
• Primary occlusion is better than 80% in most published data. Initial failure can be treated with repeated injection, thus approaching over 95% success.
• Primary occlusion is better than 80% in most published data. Initial failure can be treated with repeated injection, thus approaching over 95% success.
![Page 25: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/25.jpg)
• Complications are rare, occasional DVT of the muscular veins have been reported making the incidence to be 0.03%.
• Complications are rare, occasional DVT of the muscular veins have been reported making the incidence to be 0.03%.
![Page 26: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/26.jpg)
• Ophthalmic migraine, visual disorders such as transient hemianopsia and dry cough are more common. Patients with patent foramen ovale have these occur more frequently.
• One death due to stroke has been reported.
• Ophthalmic migraine, visual disorders such as transient hemianopsia and dry cough are more common. Patients with patent foramen ovale have these occur more frequently.
• One death due to stroke has been reported.
Patent foramen ovale
Patent foramen ovale
![Page 27: George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department Attikon University Hospital George Sfyroeras MD, MSc, PhD, FEBVS Vascular Surgery Department.](https://reader036.fdocuments.net/reader036/viewer/2022062309/56649db35503460f94aa3d36/html5/thumbnails/27.jpg)
Thank YouThank You