Does varicose veins surgery have a future?
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1 Hom e Par ticipant inform at ion Scient ific program Call for abstract s Dear Friends Coll Does varicose veins surgery have a future? We are looking forwa Nice, on the occasion P. Pittaluga, S. Chastanet View M EET 2014 abstracts book here
2 Increasingly competitive techniques in front of High-ligation stripping Endovenous thermal ablation : Radiofrequency Endovenous Laser
3 Increasingly competitive techniques in front of High-ligation stripping Endovenous thermal ablation : Radiofrequency Endovenous Laser Similar midterm results
4 Increasingly competitive techniques in front of High-ligation stripping Endovenous thermal ablation : Radiofrequency Endovenous Laser Similar midterm results Less side effects
5 Increasingly competitive techniques in front of High-ligation stripping Endovenous thermal ablation : Radiofrequency Endovenous Laser Similar midterm results Less side effects High-ligation stripping should not be considered as the gold stard nowadays
6 Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
7 Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
8 Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
9 Evolution in France
10 : - 20% stripping RF + EVLT Evolution in France Despite the absence of reimbursement for endovenous techniques
11 : - 20% stripping RF + EVLT Evolution in France Despite the absence of reimbursement for endovenous techniques VNUS other vein stripping Evolution in USA Evolution in Netherl
12 This evolution is felt as a serious threat by vascular surgeons
13 This evolution is felt as a serious threat by vascular surgeons 18% vasc surg US Physicians specialties performing varicose veins treatment in 2011
14 Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
15 Endovenous techniques: New deal
16 Endovenous techniques: New deal New strategy of treatment (new pathophysiol. approach) New hling (new technical approach)
17 Endovenous techniques: New deal New strategy of treatment (new pathophysiol. approach) New hling (new technical approach) Must force surgery to make its revolution
18 What did we learn from endothermal ablations? 1) New physiopathological approach
19 Endothermal ablation: no high-ligation preservation of the junction Pittaluga P, Chastanet S. Incontinence of the GSV: hemodynamic concepts their therapeutiic consequences. In Becquemin JP ed. Updates controversies in vacular surgery. Torino: Minerva medica 2010,
20 Endothermal ablation: no high-ligation preservation of the junction Pittaluga P, Chastanet S. Incontinence of the GSV: hemodynamic concepts their therapeutiic consequences. In Becquemin JP ed. Updates controversies in vacular surgery. Torino: Minerva medica 2010, High-ligation is not necessary for the abolition of the reflux at the junction
21 Endothermal ablations: recurrence / saphenous obliteration Saphenous reflux VVs recurrence 27.4% 22.8% 19.0% 14.3% 7.8% 7.6% 6.0% 9.6% M erchant (5 y) Pichot (2 y) Lurie (2y) Nicolini (3 y)
22 Endothermal ablations: recurrence / saphenous obliteration Saphenous reflux VVs recurrence 27.4% 22.8% 19.0% 14.3% 7.8% 7.6% 6.0% 9.6% M erchant (5 y) Pichot (2 y) Lurie (2y) Nicolini (3 y) 50% of the recurrence appeared despite the abolition of the saphenous reflux
23 High-ligation is not necessary for the abolition of the reflux at the junction Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links 50% of the recurrence appeared despite the abolition of the saphenous reflux?
24 Increasing evidences for the ascending evolution theory Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
25 New strategy for the surgical treatment More targeted surgery : Calling into question the systematic high-ligation Calling into question the systematic saphenous ablation
26 Preservation of the junction during stripping Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links 2 years : SFJ reflux 1.8% Ing. neovascul 0.9% VVs recurrence 6.8%
27 Preservation of the junction during stripping Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links 2 years : SFJ reflux 1.8% Ing. neovascul 0.9% VVs recurrence 6.8% 8 years : No high-lig. > high-lig. VVs recurrence : 9.8% vs 29% (p=0.014)
28 Preservation of the saphenous vein: Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Ambulatory Selective Varices Ablation under Local anesthesia ASVAL Varices are the cause of the hemodynamic trouble
29 Preservation of the saphenous vein: Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Ambulatory Selective Varices Ablation under Local anesthesia
30 Preservation of the saphenous vein: Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Ambulatory Selective Varices Ablation under Local anesthesia 1 year :Abolition reflux 50% Abolition symptoms 66% (unselected population)
31 More targeted surgery : «à la carte»
32 What did we learn from endovenous techniques? 2) New technical approach
33 Local anesthesia Tumescence: reduces disadvantages of LA
34 Local anesthesia Tumescence: reduces disadvantages of LA Almost no limit for the surface treated Dilution of the lidocaine (< limit dose 7 mg/kg) Possibility of use of large volumes
35 Local anesthesia Tumescence: reduces disadvantages of LA Almost no limit for the surface treated Dilution of the lidocaine (< limit dose 7 mg/kg) Possibility of use of large volumes Patient comfort Use of bicarbonate +++ : reduces acidity injection pain Increases non-dissociated active lidocaine +++ Excellent quality anesthesia
36 Local anesthesia Tumescence: reduces disadvantages of LA Almost no limit for the surface treated Dilution of the lidocaine (< limit dose 7 mg/kg) Possibility of use of large volumes Patient comfort Use of bicarbonate +++ : reduces acidity injection pain Increases non-dissociated active lidocaine +++ Excellent quality anesthesia Surgeon comfort Excellent quality/duration anesthesia Reduction bleeding +++
37 Modern mini-invasive «open» surgery Atraumatic phlebectomy Micro-incisions Precise skin marking Bloodless surgery
38 Modern mini-invasive «open» surgery No stiches adhesive tapes Immediate walking Very quick discharge (1h)
39 Modern mini-invasive «open» surgery Very limited side effects J Vasc Surg: Venous Lym Dis 2013;1:385-91
40 Modern mini-invasive «open» surgery Very limited side effects J Vasc Surg: Venous Lym Dis 2013;1:385-91
41 Modern mini-invasive «open» surgery Very limited side effects J Vasc Surg: Venous Lym Dis 2013;1:385-91
42 Treatment of varicose tributaries (reservoir) +++ Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links
43 Treatment of varicose tributaries (reservoir) +++ Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Mini-invasive surgery should be the best option
44 Treatment of varicose tributaries (reservoir) +++ Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Mini-invasive surgery should be the best option RF EVLT treat only the saphenous vein
45 Treatment of varicose tributaries (reservoir) +++ Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links Mini-invasive surgery should be the best option RF EVLT treat only the saphenous vein Mini-invasive surgery > foam +++ : Treatment more durable Treatment more extensive Treatment more selective Less inflammation Less pigmentation Better esthetic result
46 Mini-invasive surgery > foam +++ Preop D8
47 TAKE HOME MESSAGE Home Participant information Scientific program Call for abstracts Exhibitors / Sponsors Links 1) Traditional We are looking forward to welcoming you in a few days at the Radisson Blu surgery Hotel in is over Endovenous techniques: at least as much efficient than stripping Endovenous techniques: less side effects 2) Surgery should change New strategy of treatment: more targeted more tailored New mini-invasive technical approach: TLA, microphlebectomy, ambulation 3) New surgery takes advantages from this evolution Efficiency / durability / selectivity / safety Very limited side effects 4) New surgery will take market shares From the endovenous techniques: saphenous sparing From the foam +++: better results, better control
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