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vascular professional | issue 01 · 2021                                                                                                                                                                 original article









            EVLT has also been shown to be suitable for veins with a   Risk factors for EHIT stated by Dr. Žernovický in his pre-   Prof. h.c. Dr. Alexander Flor started off his presenta-  Dr. Sánchez Nicolat has performed 682 procedures,
            diameter larger than 2.5cm.                        sentation are 810nm laserwavelength, higher CEAP class,             tion on endolaser and miniphlebectomy in a clinical set-  79.7% of which were done on female patients, 20.3% on
               Complications when treating extrafascial parts of the   simultaneous phlebectomy, vein diameters greater than       ting by citing the NICE guidelines. According to those,   males at an average age of 52 years, using a laserwave-
            GSV occur rarely and are reversible.               7.5mm and also the surgeon’s level of skill.                        endovenous ablation should be the first line of therapy,   length of 1470nm. Most frequent CEAP stage was C2, the
               When it comes to tumescence, Dr. Borsuk stated in    General considerations to avoid complications accord-          ultrasound guided sclerotherapy for patients not suitable   vein most frequently affected was the GSV (92%). 83%
            his presentation that a local anesthetic compound is   ing to Dr. Žernovický are evaluation of the patients pre-       for endovenous ablation whereas conventional surgery   of patients were treated by miniphlebectomy in combina-
            not obligatory and cold saline solution has been applied    operatively by the surgeon personally by performing an     should be considered only for patients not suitable for   tion with EVLT.
            successfully even in patients treated without sedation.  ultrasound in both supine and vertical position. Diameter     either procedure above.                               The diameter of GSV ranged from 6 to 25 mm. The fi-
               A  complication  that,  according  to  Dr.  Borsuk,  occurs   of the varicose vein should be measured in Trendelenburg   According to Prof. Dr. Flor, ultrasound examination   bers Dr. Sánchez Nicolat used were radial 800micron fi-
            albeit reversible relatively often to various  degrees  is   position. Patient comfort is not only important for patient   prior to the operation is of great importance and should   bers for GSV and linear for SSV and accessory vein.
            damage  of  subcutaneous  nerves  at  40.4%  of  patients.    satisfaction but also prevents vasospasm when it comes   be done by the surgeon.                               The energy applied to the treated areas was 60-100J /cm
            However, only 4.6% of patients report reduced QOL.   to temperature, easy puncture when it comes to fluid in-             Prof. Dr. Flor performs surgery on both awake and se-  at 8-9 W at the SFJ and thigh and 5-6W below.
            Puncture below knee level was stated as a risk factor for   take and prevention of vasovagal reactions when it comes   dated patients, according to their preference. A pullback   Among all patients treated by Dr. Sánchez Nicolat she
            nerve damage, the high number of occurrence might also   to mental comfort.                                            device used during the procedure greatly shortens opera-  reported a total of 9.9% complications.
            be due to inflammation after EVLT as well.            The optimal device should be selected according to               ting time because tumescence can be applied during pull-  Occlusion rates were 92 to 95% at a 10-year follow-
               Complications and the prevention of such was dis-  experience, anatomical conditions, comorbidities, age,           back. Miniphlebectomy is done after endovenous oblite-  up, recurrences occurred in the first 3 months and were
            cussed in the next presentation held by  Dr. František   patient preference and economic conditions.                   ration. To prevent bleeding, the procedure is done whilst   resolved either by laser or sclerotherapy.
            Žernovický.                                           Postoperatively, immediate mobilization is the best              having the leg in an elevated position. Steristrips are used   Total or partial recanalization occurred in 8.1% of pa-
               In accordance with the importance of esthetics red-  prevention against EHIT and thrombosis.                        in most cases, compression is applied on all patient’s legs.   tients.
            ness and discoloration has to be avoided. Both can occur   Prof. Dr. Zoltán Boehm followed with his lecture on         Postoperatively, mobilisation starts immediately by ha-  Dr. Sánchez Nicolat does follow ups at 3 days, 1 week,
            to be transient, long lasting or permanent after EVLT   miniphlebectomy according to Várady as performed in his        ving the patient walk out of the operation theatre on his   1 month, 3 months, 6 months and then annually.
            which is why Dr. Žernovický does not recommend EVLT   clinic and special indications for this procedure.               own. The legs are then elevated and ice packs are applied.  According to Dr. Sánchez Nicolat different wave-
            for superficial veins located less than 0.5cm below the    Preoperatively Prof. Dr. Boehm marks varicose veins            Check-ups are performed after one day, sonographic   lengths are equally effective, both 980nm and 1470nm
            surface. In those cases miniphlebectomy should be pre-  to be treated using dots instead of continuous lines in or-    check-up on the 3  postoperative day.              showed sufficient occlusion rates. A difference could be
                                                                                                                                                  rd
            ferred.                                            der to prevent tattoo effect at the incision points. In his            According to Prof. Dr. Flor, a combined approach when   observed in postoperative pain. Just as Dr. Dragić menti-
               Postoperative pain should rarely occur in patients un-  presentation, he also highlighted the importance of both    treating trunk veins and tributaries leads to better results   oned previously, Dr. Sánchez Nicolat stated that success
            dergoing surgery for varicose veins and, according to Dr.   Várady spatula as well as local anesthesia in order to facil-  and improves patient’s satisfaction.           of EVLT has been linked to the amount of energy (>70J/
            Žernovický, is due to ineffective tumescent anesthesia,   itate preparation of the vein and avoid an excessive num-       Finally, Dr. Nora Sánchez Nicolat presented her ex-  cm) delivered to the vessel.
            ignorance of critical zones or recommended energy dos-  ber of incisions. Prof. Dr. Boehm does however not use         periences with endolaser in combination with miniphle-
            es. Tumescent anesthesia is critical in order to prevent   adrenaline as a compound to his local anesthesia solution   bectomy in México.
            neural injuries.                                   due to making skin and tissue harder and thus preparation              Dr. Sánchez Nicolat also performs EVLT simultaneous-
               In order to prevent accidental injury of adjacent struc-  more difficult. Instead of scalpels he uses NoCore needles   ly with miniphlebectomy and/or sclerotherapy in an am-
            tures followed by complications such as hematoma or   to make the incisions and avoid unnecessary wide cuts.           bulant setting.
            rare conditions like arteriovenous fistula or lesions to   During vein extraction, “fishing” using the hook should
            the common femoral vein both ultrasound control during   be avoided in favour of pricesely detecting the vein
            operation and sufficient anatomic knowledge is of great   against the hook using a finger, thus avoiding damage of        DR. ANDREAS F. BALOGH
            importance.                                        adjacent tissue.
               To prevent aneurysmatic dilatation of the saphenous   In patients with extensive side branch varicosis Prof.           Hospital Floridsdorf, Vienna, Austria
            trunk postoperatively Dr. Žernovický also recommends la-  Dr. Boehm has also used a 2-step approach considering
            sercrossectomy, starting obliteration close to the SFJ. To   the fact that smaller side branches tend to shrink after     Dr. Andreas F. Balogh studied from 2009 until 2016
            protect the femoral vein when performing lasercrossec-  bigger ones are removed.                                          at Medical University of Vienna and is working since
            tomy a saline depot should be placed between GSV and   The low effort procedure has been proven suitable by               2017 as surgical resident at the Hospital Floridsdorf in
            CFV.                                               Prof. Dr. Boehm for unusual sites as well such as temporal             Vienna, Autstria. Since 2019 Dr. Balogh is working at
                                                               veins, the cleavage area or underam veins.                             the outpatient department of the Hospital Floridsdorf
                                                                                                                                      in the medical field of Phlebology.
                                                                                                                                         Dr. Balogh is member of the board of the Young
                                                                                                                                      Surgeons Austria (YSA), a working group under the
                                                                                                                                      organization of the Austrian Society of Surgery.  © Dr. Andreas F. Balogh





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