Last week, I attended the British Association of Sclerotherapists annual conference in Basingstoke. This meeting reviews the latest developments in venous disease and leg vein treatment. Seven main areas of controversy were reviewed and in this tutorial, I will discuss them with you. The first controversy was Should Ultrasound Guided Foam Sclerotherapy be first choice in the treatment of varicose veins As I have stated in previous blogs, surgery such as stripping under general anaesthetic is no longer appropriate for varicose veins. The National Institute for Health and Care Excellence has recognised this and has indicated.
That surgery is now third choice for varicose varicose veins. NICE has in fact recommended that endothermal ablation is first choice and that Ultrasound Guided Foam Sclerotherapy is second choice. Many at the BAS meeting in Basingstoke felt this is an unfair assessment. At the meeting Dr Patrizia Pavei a phlebologist from Italy discussed the indications for Foam Sclerotherapy. In her opinion, sclerotherapy is first choice for an impressive list of situations including recurrent varicose veins, small saphenous reflux, nonsaphenous veins, perforator veins, residual veins and great saphenous veins less than 8 mm in diameter.
Although endothermal ablation is suitable for saphenous veins that are relatively straight, ie they are not tortuous it is clear that sclerotherapy is far more versatile. Nearly any vein in the leg can be treated and in this respect, many specialists believe that Ultrasound Guided Foam Sclerotherapy be should be at least joint first choice in the treatment of varicose veins. The second area of controversy is How should Ultrasound Guided Foam Sclerotherapy be performed Dr Philip Coleridge Smith provided a live demonstration of varicose vein treatment at the meeting. He emphasised the need to treat saphenous reflux, all the tributaries and.
7 Controversies in Leg Vein Treatment BAS Meeting 2016
All the varicose veins all together usually in one treatment session. He showed how he places multiple cannulas before administering the sclerosant. His aim is to obliterate all reflux and visible veins and as part of his protocol, he sees patients 2 weeks later, he aspirates any retained thrombus or coagulum and he retreats any veins that are persistent or refluxing. Once he has eradicated all the reflux and varicose veins, he sees patients six months after treatment and any signs of reflux or persistent varicose veins are once again retreated. His protocol gives excellent results that are very comparable to endothermal.
Treatments. The third area of controversy is Do all patients with leg telangiectasias thread veins need a duplex ultrasound scan Doctor Pavei addressed this issue. She provided a lot of evidence and in her opinion, duplex ultrasound is mandatory prior to treating leg thread veins. She pointed out that at least 25 of patients with leg telangiectasias have saphenous vein reflux. Not all specialists at the meeting agreed. Many use duplex ultrasound selectively and they would request a scan in some patients after a careful clinical assessment and perhaps a hand held Doppler examination. It was acknowledged however that the trend is for more and more.
Specialists to regard a full colour duplex scan as an essential assessment prior to leg thread vein treatment. The fourth area of controversy is When should compression stockings be advised after sclerotherapy Dr Martyn King tackled this difficult subject with a thorough review of the medical literature and he led a lively debate on the subject. My own impression is that wearing compression certainly offers benefit to patients after Ultrasound Guided Foam Sclerotherapy and perhaps it offers less benefit to patients after sclerotherapy for thread veins. At The VeinCare Centre we.
Advise compression after sclerotherapy but we suggest that if the compression is uncomfortable or causing problems that it is immediately discontinued. It was acknowledged at the meeting that many specialists do not prescribe compression stocking after thread vein injections. Controversy number 5 Do all patients with phlebitis need a duplex scan. Dr Rangarajan a consultant haematologist from Basingstoke gave a thorough review of deep vein thrombosis and phlebitis. From her presentation it was clear to me that patients with phlebitis do have clots in the superficial veins and that they are also in a hypercoagulable state that.
Is they have sticky blood. As many as 25 of patient with phlebitis have a coexisting deep vein thrombosis and many of the rest are at high risk of developing one. It is my opinion having listened to Dr Rangarajan that everyone with phlebitis should have a duplex ultrasound scan. The sixth area of controversy was Can complications of sclerotherapy be avoided Dr Philip Coleridge Smith gave a wonderfully illustrated review of complications associated with sclerotherapy many based on his role as a medical expert in cases of complaint and litigation. Based.
On his presentation it appears that the majority of serious complication of sclerotherapy can be avoided by careful technique, slow injection of small volumes of sclerosant and by using the correct dose and strength of sclerosant. Controversy number 7 was What is the best treatment for leg thread veins This proved to be the least controversial area. Live demonstrations of leg thread vein treatment by Claire Judge and Julie Halford as well as discussions led by Dr Pavei, Dr Stephen Tristram, Dr Martyn King and Philip Coleridge Smith confirmed that Microsclerotherapy carefully performed.