Page 11 - vascular professional 01_2021_eMagazine

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

08 09