Read the 5* review of our latest book on Amazon

Advances in Phlebology and Venous Surgery Volume 1 is our latest educational publication covering many of the most interesting areas of Phlebology.  The book’s chapters have been written by international experts in their own fields and include contributions from Ian J Franklin, Judy Holdstock, Seshadri Raju, Thomas M Proebstle, Rameshi K Tripathi and our very own Mark S Whiteley.

Don’t forget to order your copy whilst you are there!

https://www.amazon.co.uk/Advances-Phlebology-Venous-Surgery-1/dp/1908586044/ref=sr_1_1?s=books&ie=UTF8&qid=1524646703&sr=1-1&keywords=advances+in+venous+phlebology&dpID=41bhTyN-WGL&preST=_SX218_BO1,204,203,200_QL40_&dpSrc=srch#customerReviews

 

 

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CoPIVM 2020: COVID-19 Notice

With the excitement of hosting one of our best conferences, featuring the latest devices and protocols, we’ve had to make the unfortunate decision to cancel the International Veins Meeting 2020.

Across the world the news and extremities of COVID-19 has prompted us to take the safety and health of our guests, staff and community very seriously.

We urge everyone to follow the guidelines and protocols put forth by public health officials.

We will release the 2021 dates within the next month. All purchases for the 2020 dates will be honoured for the rescheduled 2021 dates.

We would like to thank guest speakers and delegates for the continued support, and we look forward to seeing you in London in 2021.

For more information please email

IVM2020@collegeofphlebology.com

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Professor Whiteley to present at The 18th Annual Leg Club Conference in Worcester on 26th & 27th September 2018

As an associate organisation of the Leg Club Foundation we are delighted to announce that Professor Mark Whiteley will be joining a host of expert wound care professionals at The 18th Annual Leg Club Conference in Worcester on 26th & 27th September 2018 for an exciting two day conference and exhibition for all practitioners involved in wounds and lower limb in primary and secondary care.

The annual Leg Club conference is a platform for networking and sharing important knowledge

At the Leg Club conference, you will meet new-thinkers in wound management who question old thoughts and have courage to try new things. To find new solutions, we need to look at the existing problems with new eyes.

The 2018 Leg Club conference will look at today’s current challenges in practice, the latest strategy and thinking and how they can be applied in everyday clinical situations. The annual Leg Club conference offers a unique opportunity for delegates to learn from others and forge new partnerships. The agenda on day one has been designed to be interactive as well as informative and, in the true spirit of the conference, has been designed around previous attendee feedback and training needs.

As usual the conference will feature inspiring speakers on the latest developments in wound management and it will be a fantastic opportunity to share best practice and work together to improve services.

Click here for more information.

To book please contact:

Lynn Bullock for details:
Tel: 01473 749565 
Email: lynn.bullock@legclubfoundation.com

We look forward to seeing you there!

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Spotlight on… Dr Seshadri Raju

The College of Phlebology is delighted to be joined at the 2018 International Veins Meeting by Vascular Surgeon, Dr Seshadri Raju from the Rane Center in Jackson, Mississippi.

Dr Raju is a leading specialist in venous and lymphatic diseases, and has been widely recognised for his work on hemodynamics, diagnosis, and treatment for venous disease. In addition to this, Dr Raju is known to be a pioneer in venous stenting techniques.

Alongside this revolutionary work, Dr Raju is also a founding member, previous president, and Distinguished Fellow of the American Venous Forum, and a Distinguished Fellow of the Society of Vascular Surgery.

Throughout his career to date, Dr Raju has had 75 book chapters, 2 books and over 200 peer-reviewed publications published covering the topics of immunology, vascular surgery, transplantation surgery and venous disease.

At the 2018 International Veins Meeting, Dr Raju will be sharing his expertise on using IVUS as a decision maker, a placement guide and a quality control when stenting veins; and will be participating in/chairing a number of sessions, including speaking on the following topics:

  • Modelling Lower Limb Haemodynamics (Friday 16th March, 8.45-9am, Science, Practicals & Aesthetics)
  • Role of Air-Plethysmography & Ambulatory Venous Pressure in Chronic Venous Disease (Thursday 15th March, 9.40-10am, Science, Practicals & Aesthetics)

 

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CoP President Professor Mark Whiteley, welcomes Delegates and Faculty members to the 2nd International Veins Meeting

With just a couple days to go, I am delighted to be welcoming our Faculty, Speakers and Delegates to what we hope will be a fascinating three days of Phlebology.

The study of venous diseases (Phlebology), used to be thought of as mainly “just varicose veins and thread veins”. However, over the last two to three decades, several new technologies and approaches have coalesced to making Phlebology a fascinating subject covering a huge number of different subjects and conditions.

One of the most important changes in the venous world has been the realisation that leg ulcers are often the result of curable venous disease, whether it be reflux, stasis or obstruction. A subject we’ll cover in depth during Wednesday 14th March.

We’ll be discussing the apparent disconnect between those providing diagnostic and treatment services for venous disease and those treating leg ulcers, plus how patients who could be cured are not receiving this treatment. Of course there are some patients who are not curable with endovenous surgery, and these require the expert nursing care that specialist ulcer nurses provide for example the Lindsay Leg Clubs founded by Ellie Lindsay OBE who will also be presenting at this meeting.

Advances in Venous Duplex Ultrasonography allowed us to understand venous flows and took us away from venography and other static imaging techniques. We learnt that we could not rely on diameter of veins but had to look at the flows. Now we are having to reapply that learning to pelvic varicose veins and pelvic vein reflux. On Thursday 15th March, we’ll be sharing this learning and the gold standards for diagnosis and treatment.

On Friday 16th March, we’ll be looking into the latest techniques for venous surgery for best patient results. We’ll be discussing how endovenous ablations have been revolutionary and now techniques not requiring tumescence such as MOCA and glue have transformed superficial venous surgery. We’ll discuss how Foam sclerotherapy continues to split opinion on if it’s the solution to superficial venous problems or if it should be used in conjunction with endovenous surgery.

In the main auditorium keynote lectures and live cases showing transvaginal duplex ultrasonography and leg vein duplex ultrasonography, endovenous thermal ablation, pelvic vein embolisation under local anaesthetic, TRLOP closure of perforators including the hedgehog technique for recurrent varicose veins and non-tumescent procedures, will all be shown live. Delegates will be able to ask questions throughout the procedure to get tricks and tips from the experts performing the procedures.

In satellite rooms, specialist nurses, doctors and scientists involved in the understanding and treatment of patients with leg ulcers will have sessions involving the diagnosis and treatment of patients, how to assess patients with leg ulcers fully and what options patients should be given for the best possible treatment. The sessions will be led by our guest of honour, Ellie Lindsay OBE, president of the Lindsay Leg Clubs and leading light in the world of leg ulcers combining both the nursing conservative approach and the surgical treatment approach for the benefit of patients.

Also in other satellite rooms, those interested in the science of how different endovenous techniques actually work at the cellular and tissue level will be discussed, including basic science relating to laser, radiofrequency, sclerotherapy, MOCA as well as other basic science subjects such as haemodynamics and how the microcirculation actually works. Although these are often overlooked by those involved in treating patients, it is only by the understanding of these basic scientific knowledge that we can keep developing our treatments for patients to give them the best possible results.

Throughout the meeting, world experts in Phlebology will be available for Q&A sessions so that Delegates can ask questions, allowing them to get the most out of their visit to the College of Phlebology International Veins Meeting. Questions can be asked in an open forum or, if delegates have questions that they wish to ask privately, individual Q&A sessions can be arranged either formally or informally through the downloadable online App from Crowd Compass Attendee Hub.

The College of Phlebology International Veins Meeting should provide practical information for everyone involved in diagnosing and treating patients with venous conditions. Whether these be varicose veins, thread veins, pelvic congestion syndrome, venous leg ulcers or indeed practitioners treating aesthetic veins of the face, arms, hands, breasts or elsewhere on the body.

I’m looking forward to welcoming you and will be delighted to talk to, or answer questions from any Delegate.

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Less than a week to go until 2nd International Veins Meeting! Register now!

There are only six days until the 2nd International Veins Meeting!  We have 3 days of exciting and educational sessions planned which include:

  • Live interactive scanning and operating focusing on extending Transvaginal duplex for pelvic vein reflux and obstruction, Pelvic vein embolization, Thermoablation and Non-Thermal Ablation of Venous Trunks, TRLOP closure of perforators, Ultrasound Foam sclerotherapy, Ambulatory Phlebectomy, Phlebectomy of facial / forehead veins.
  • Scientific discussions related to all aspects of venous diagnosis and interventions.
  • A leg ulcer stream to find out the very latest investigations and treatments for venous leg ulcers.
  • Hands-on scanning and skills stations combined with basic science talks related to phlebological practice.
  • Meet the expert sessions where attendees get the opportunity to ask their questions to the vascular experts in an informal setting over coffee.

There are only six days until the 2nd International Veins Meeting and we have 3 days of exciting and educational sessions planned, which include:

  • Live interactive scanning and operating focusing on extending TransVaginal duplex for pelvic vein reflux and obstruction, pelvic vein embolization, Thermoablation and Non-Thermal Ablation of Venous Trunks, TRLOP closure of perforators, Ultrasound Foam sclerotherapy, Ambulatory Phlebectomy
  • Scientific discussions related to all aspects of venous diagnosis and interventions.
  • A leg ulcer stream to find out the very latest investigations and treatments for venous leg ulcers.
  • Hands-on scanning and skills stations combined with basic science talks related to phlebological practice.
  • Meet the expert sessions where attendees get the opportunity to ask their questions to the vascular experts in an informal setting over coffee.

We have a fantastic faculty team joining us too for the Veins Meeting including Seshardri Raju, Sergio Gianesini and CoP President Professor Mark Whiteley.  Attendees will get the opportunity to meet the internationally renowned Venous Experts and ask their questions. Also the live sessions will be interactive and the audience will have the opportunity to ask their questions directly to the surgeon or clinical scientist. 

Learn – each subject or technique will start off with presentations on the basics – why we do it, who is suitable, what devices are used, how did this subject or technique develop. This will enable delegates with little or no experience in the area to get to grips with the subject or technique.

Understand – these subjects and techniques will then be analysed further – with presentations of the latest studies, devices and the relevant basic science, to deepen understanding and to help delegates understand how to improve their own practice.

Watch – there will then be live links to ultrasound suites, operating theatres and radiology rooms where live cases will be performed by recognised experts in the field. Depending on the subject or technique being explored, the live cases may be both diagnostic and treatment. Delegates will be able to ask the specialists questions during the procedures, mediated through the session chairman. Delegates will not only see the latest procedures, but will be able to clear up any specific points of interest or technique immediately.

Ask – finally, each subject or technique will be opened up for questions from any of the delegates attending, to make sure they have a chance to express their views or ask questions.

 

The 2nd International Veins Meeting is set to be packed full of educational information and give attendees the opportunity to ask their questions. Delegates will also receive abstracts within the proceedings booklet on a USB.

 

 

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Highlights of the Venous Programme at Controversies & Updates in Vascular Surgery (CACVS)

Highlights of the Venous Programme at Controversies & Updates in Vascular Surgery (CACVS) – Saturday 19 January
By Mark S Whiteley
The venous session started with a welcome address by the course convenor, Dr Jean-Luc Gerard.
Session I: Post Thrombotic Syndrome – Atypical Varicose Veins
Peter Neglen gave us some fascinating insight into using IVUS (intra vascular ultrasound) in deep vein reconstruction. He pointed out that it does not require x-rays and is particularly useful in obese patients where other imaging might be very difficult.
He showed that IVUS:
  • Can be used to guide stents and filters
  • Is very good for assessing obstruction
  • Reveals stenosis and compression that are not seen on venogram
  • Reveals residual thrombus after clot removal
However it does not give any haemodynamic information and is not good for visualising valve leaflets.
Maria Lugli gave a fascinating talk about the on-going evolution of their neovalve technique for making new veins in the deep venous system.
She told the audience that since the year 2000, they had moved from forming a bicuspid to monocuspid valve. This allows a deep valve pocket to be formed. Also the neovalve is fixed in the semi-open position to reduce re-adhesion. She showed that in thin veins a bovine pericardial patch can be used to close the vein, and also explained that the valve formation in an area near an opening from a tributary could be selected to increase flow competition.
The neovalve technique is used in C3 – C6 disease – and she stressed that they only treat symptomatic disease.
Peter Gloviczki gave an authorative talk on incompetent perforating veins (IPV) and stated that 70% are haemodynamically significant and 45% do not go with saphenous surgery.
When it comes to which IPV need treatment, using a diameter of 3.9 mm, misses 1/3 of significant IPV.
Therefore the recommendations are to treat IPV in:
  • C5 and C6 disease
  • if there is no deep vein obstruction
  • there is outwards reflux on manual compression of >500ms
  • diameter > 3.5mm
He reported information from the North America SEPS registry showing rapid ulcer healing rates after SEPS. Also some patients had healing with SEPS alone, similar to healing with stripping and SEPS.
He showed the minimally invasive TRLOP technique, invented by Mark Whiteley and adopted by others subsequently, which shows results of IPV occlusion similar to SEPS.
Atypical Varicose Veins from Gluteal Source
Philippe Lemasle gave a fascinating talk about the origin of gluteal varicose veins. He showed the inferior gluteal vein drains the sciatic nerve, draining into the internal iliac vein.
He showed that embryologically the vein was a persistent sciatic vein and there can be veins both in the sciatic nerve sheath, or a large persistent vein might be visible on ultrasound running alongside the sciatic nerve.
He cautioned that if such veins are found, they may be associated with hypoplasia or absence of the deep veins in the leg and so the deep vein must be checked before any treatment is planned.
Milka Greiner continued the discussion about the incompetent inferior gluteal vein and pointed out that varicosities of the tributaries may form in multiparous women or may arise embryologically due to lack of valves in the inferior gluteal vein. She also pointed out the high risk of deep vein hypoplasia in such people, and also the association with the valve less inferior gluteal vein and venous anomalies such as Klippel-Trelawney Syndrome.
She suggested that when the embryological type was found in children, it should be treated before any limb length problems developed. She pointed out that coil embolisation might irritate the nerve and so suggested glue embolisation of the veins.
Annouk Bisdorff gave an account of the different types of sclerosant that can be used for venous lesions. Some of the gems that she shared included using Aethoxysclerol foam for lesions that were small ( < 2cm) and ethanol injection for larger venous malformation. For lesions draining into the brain from around the orbit, glue can be used to close the draining vein and then the superficial vein can be sclerosed using a sclerotherapy liquid.
She explained that the semi-liquid products such as glue or Onyx should only be used in deep lesions as they can form lumps. There is also a new Ethanol gel, but this has a maximum dose of only 2ml per session. In the pelvic veins she preferred glue.
Session II: Treatment of the Small Saphenous Vein.
Debate: The Safest or the Most Efficient 
Denis Creton-Nancy gave an excellent account of open surgery for the small saphenous vein (SSV), showing that in his practice stripping can be safe if performed under local anaesthetic in an outpatient setting. He showed flush ligation is not always necessary and he leaves the Giacomini vein open for venous drainage.
He also said that complete stripping of the SSV is not always needed and said that using a pin stripper meant there was a very low risk of complications.
James Lawson spoke about using radiofrequency ablation (RFA) to treat the SSV. He attested that treating the SSV is more challenging than GSV and reports of stripping the SSV showed widely varying reported incidences of nerve damage, from 1.7 – 34%.
He explained that ligation alone is not enough and quoted a paper from Samuel reporting the results of a randomised controlled trial showing that recurrence after open surgery was higher at 1 year than treatment with thermal ablation.
Manj Gohel was asked to support foam sclerotherapy for treatment of the SSV although he pointed out that he had reservations about doing this in his own practice. He showed the cost of foam sclerotherapy is low and complications reduce as the dose reduces.
Foam sclerotherapy is best for smaller veins and Bradbury has reported a long term outcome of 91 % closure at 22 months. He did point out that if foam is to be used, it is essential to aspirate any thrombus if thrombophlebitis occurs.
Jean Luc Gerard supported the use of endovenous laser ablation (EVLA) for the treatment of the SSV. He pointed out that with open surgical stripping, although some experts get good results, this is not the usual course of events. After stripping of the SSV in France, figures show the average time taken off of work is 26 days. He pointed out the large number of medico-legal claims particularly related to nerve damage following SSV stripping.
He showed that when comparing EVLA with open surgery (stripping) for the SSV, there was a higher success, earlier return to work and lower paraesthesia rate.
Session III: Competence or incompetence of the terminal and pre-terminal valve: does it change your mode of treatment? 
Massimo Cappelli discussed “stump evolution” and “non-evolution” and Oliver Pichotdescribed the variability of tributaries and valves at the Sapheno-Femoral Junction (SFJ), saying there was a need for a protocol for investigating the SFJ with duplex ultrasound.
There were further presentations about the subject, but one question was asked that seemed most pertinent: if there was any clinical relevance when the vein was ablated. The answer was that with ablation, the pattern of valves makes little or no difference to treatment.
Session IV:  Miscellaneous
Armando Mansilha discussed patient reported outcomes and quality of life tools. He explained that he uses these as part of his patient assessment and follow up and suggested it would be something that every vein clinic could do.
Inga Vanhandenhove provided fascinating insight into how the environment of the hospital or clinic has a huge impact on patient satisfaction. She explained that evidence based design (Hamilton 2003) improved recovery and got the patient home earlier. Those in single rooms with good views had lower infection rates, and those in private rooms suffered fewer drug errors, had lower noise levels with beneficial effects on blood pressure and anxiety, as well as staff burn-out.
Michel Perrin gave a very well researched review of the randomised studies in the endovenous treatment of varicose veins. Although many of the outcomes were as expected, that the endovenous techniques have lower pain and faster return to work than stripping, he did point out that technology is moving so fast that when the longer term results are published, the techniques that they relate to have moved on and aren’t used in that form any more.
Session V: Thermal Techniques
Lars Rasmussen presented the five year results of his study comparing open surgery, endovenous laser ablation, radiofrequency ablation and foam sclerotherapy. The primary endpoint was closure of the great saphenous vein and so interestingly, in this study, a great saphenous vein reopening of 5 cm or more was regarded as a failure. As such the success rate of EVLA at five years was only 85%. Some notable findings were that in the endovenous laser group, the anterior accessory saphenous vein was more commonly the cause of recurrence. In the stripping group, incompetent perforators were commonly cause of recurrence.
Manj Gohel gave a presentation suggesting that the technique of performing the procedure, and the strategy of which order the procedures were performed in, and where the procedures are performed together, are probably at least as important if not more important than which procedure is used.
Lowell Kabnick gave an overview of his experience with endovenous laser. He showed that as the wavelength had increased from the haemoglobin absorbing wavelengths to the longer water absorbing wavelengths such as the 1470 nm, patients had experienced less pain and bruising. He also showed that moving from bare-tip fibres to jacket covered fibres also reduced perforations and hence pain and bruising.
Giorgio Spreafico also discussed his experience of the evolution of endovenous laser ablation. He pointed out that moving on from the jacket tip fibre to the radial firing endovenous laser fibre had further reduced pain by spreading the energy around the whole of the vein and not allowing concentration of energy at a single point of contact. He also suggested that this reduced carbon formation within the vein which is another potential cause of pain after endovenous laser ablation.
Thomas Proebstle then gave the first of two talks. He compared the five year results of VNUS Closure FAST with its hot end, with the original VNUS Closure catheter which although was much slower, use bipolar radiofrequency ablation. Although the older technique was much slower, the results were very similar with both techniques.
Thomas Proebstle then gave a talk about the new Venaseal “superglue” cyanoacrylate closure of veins. He reported excellent results without the need of any tumescent anaesthesia in two early multicentre studies. The talk stimulated a lot of questioning of this innovative new procedure.
Mark Whiteley presented the advantages of radial firing endovenous laser over the radiofrequency ablation techniques. He pointed out that there are several different devices under the banner of “radiofrequency ablation”: including the VNUS Closure FAST in which a 7cm or 3cm end are heated by radiofrequency but the final contact with the tissue is thermal only, without any radiofrequency current involved; the bipolar techniques such as RFiTT which induce thermal destruction in the wall (and therefore truly are radiofrequency ablation); and the new generation of monopolar radiofrequency ablation devices techniques for which there is very little research available at present.
Dr Y Alimi presented the early results of using steam to close the Great Saphenous Vein (GSV) and the tributaries. At 6 months there was a 96% closure with 92% closure at 12 months with a consequent improvement in quality of life measures. The study showed less skin pigmentation than treatment of the tributaries with foam sclerotherapy (4/20 v 12/20).
Claudine Hamel Desmos discussed her clinic’s experience with the RFiTT bipolar radiofrequency system. She explained how the technique had changed to try to increase the linear endovenous energy (LEED) passing into the vein, to try to ensure closure. She claimed that using a power of 18 – 20 Watts and a pull-back averaging >2.5 secs per cm there were no failures. However it might take several passes of the catheter to achieve this LEED.
Dr Leopardi assistant to Carlo Spatera discussed the evolution of EVLA in their department. They had instituted quite rigid exclusion criteria for veins not suitable for EVLA and so concluded that with their self-imposed restrictions on vein size, in their unit EVLA was not an alternative to stripping.
A vote was taken before and after this session, using the interactive voting system, asking the audience which of the endovenous technique they would prefer.
The results showed an initial result before the talks and then the change of audience opinion after the vote:
Technique Pre-session vote Post-session vote
Radiofrequency Ablation 38% 25%
Endovenous Laser 42% 33%
Glue Ablation 11% 29%
Steam Ablation 7% 12%
RFA and EVLA vote same about 40%
Written by Mark Whiteley, Consultant Vascular Surgeon at The Whiteley Clinic (www.thewhiteleyclinic.co.uk) in Guildford, England. Update 22/01/13
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Highlights of “Endovenous Management of Varicose Veins” at the VEITH SymposiumTM, New York

Highlights of “Endovenous Management of Varicose Veins” at the VEITH SymposiumTM, New York

Apostolos K. Tassiopoulos presented a paper “Why Treat Varicose Veins: is there evidence?” in which he pointed out that there is very good evidence to treat symptomatic C2 disease (symptomatic visible varicose veins) and C3 to C6 disease (C3 – swelling of the ankles due to venous oedema; C4 – skin damage due to venous reflux including red stains, brown stains, venous eczema and lipodermatosclerosis; C5 – healed venous leg ulcers; C6 – venous leg ulcers). Pointing out that 87% of patients with venous leg ulcers have superficial venous reflux that can be treated successfully and only 44% have deep venous reflux which may prevent successful healing after varicose vein treatment, he made a very strong argument for assessing all venous leg ulcers and treating all of those with significant superficial venous reflux. C2 disease without symptoms (varicose veins that are visible but without any symptoms) should only be treated if there is a clear risk of progression.
Michael A. Vasquez spoke about “How to use CEAP and VCSS in Clinical Practice”. Michael gave a very powerful argument to use VCSS as a tool to follow the outcome of venous surgery, as CEAP is a more static measure of venous disease.
Cess H.A. Wittens tried to persuade the audience that “Modern Day Stripping is as Good as Endovenous Thermoablation” – however, the difference between the two is the groin incision. Although many people who are new to endovenous surgery do not get adequate closure of the tributaries in the groin and also do not get a flush closure at the saphenofemoral junction, experienced professionals do, negating his argument.
Peter Gloviczki presented a very interesting comparison between the guidelines for the management of superficial venous disease between the USA and the UK. He showed that in the UK, the recommendations of many PCT’s and now private medical insurance companies is that varicose veins should be treated if they are causing: superficial thrombophlebitis, bleeding, skin damage at the ankles or ulceration. In the USA, all of these indications are covered, but in addition, varicose veins that are bulging and causing pain (C2 symptomatic) or swelling and oedema (C3) are also covered by medical insurance. Subsequent discussion did point out that although many UK private medical insurance companies are now not covering these, there are some areas where the NHS will cover this. However in the UK, provision of varicose veins services is very patchy with some areas being better at covering varicose vein surgery than others in the NHS, although all private medical insurance companies seem to be withdrawing as much as they are able to from covering this medical condition.

DEBATE:

– Alun H. Davies defended that “C2 Venous Disease is Progressive: Its Treatment Should Be A Covered Insurance Benefit” whereas
– José I. Almeida suggested that “C2 Venous Disease is Progressive: Its Treatment Should Not Be A Covered Insurance Benefit”.
This was an interesting debate from the point of view that both parties were arguing from very similar standpoints. Alun Davies made the point that those with C2 varicose veins that were progressing should be treated, whilst accepting that those with C2 which were cosmetic did not need to be covered. José Almeida made a similar point, saying that those with C2 that were cosmetic and hadn’t progressed were cosmetic and insurance money should be spent elsewhere on medical conditions.
The vote was close and appeared to be won by José Almeida.
William A. Marstom gave a fascinating talk on “Other Adjuncts to Heal Ulcers”. Concentrating on venous leg ulcers, William showed that there was some good evidence for the drug Pentoxifylline and, despite all the claims of many dressing companies, the only also dressing that has been shown to improve healing is the Apligraft. Hence there was good consensus that patients with venous leg ulcers should first of all have any superficial venous reflux treated and if this does not heal the ulcer, compression, and then should be treated with Pentoxifylline, culture if the wound is still not healing with antibiotics if required, and Apligraft.
Thomas F. O’Donnell presented a fascinating analysis into the flaws of the often quoted ESCHAR trial in his talk “Are We Really To Believe That Correction Of Saphenous Reflux Does Not Aid Ulcer Healing? Debunking The ESCHAR Trial”. This trial is often quoted as showing that superficial venous surgery has no advantage over compression bandaging in curing venous leg ulcers – but surgery is superior to compression in reducing ulcer recurrence. However Thomas F. O’Donnell exposed many problems with the trial. Amongst the most important was the fact that 30% of the participants refused surgery but were still included as having had surgery in an “intention to treat” analysis. Furthermore, those that did have surgery had to wait for 7 weeks on average for their surgery, delaying their start and giving the compression group a 7 weeks head start. When these (and other) factors are taken into account, it is highly likely that superficial surgery to correct saphenous reflux probably actually increases the speed of ulcer healing as well as reducing ulcer recurrence.

DEBATE:

– Steve Elias suggested “Perforator Ablation IS Overused” and
– Mark Whiteley asserted that “Perforator Ablation IS NOT Overused”
Steve Elias pointed out that Mark Whiteley had invented TRLOP – TransLuminal Occlusion of Perforators – which he had subsequently renamed PAPS – Perforator Ablation Procedure. He suggested that although TRLOP was the original name for the perforator ablation procedure, PAPS might be a better name.
Mark Whiteley stated that the name was irrelevant to the debate. He showed research proving that incompetent perforating veins cause venous problems (varicose veins, venous eczema, ulcers), that they are the second commonest cause of recurrent varicose veins, that they can be treated successfully by ablation, and the figures show that most venous doctors are still not treating perforators. Hence he concluded the perforator ablation is NOT overused – indeed it is underused.
The vote was overwhelmingly in favour of this position, that perforator ablation is not overused, by more than 90% of the audience.
Written by Mark Whiteley, Consultant Vascular Surgeon at The Whiteley Clinic (www.thewhiteleyclinic.co.uk) in Guildford, England. Update 15/01/13
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Masterclass of venous anatomy, Paris

Indulge an ultimate experience in venous echo-anatomy!

Participate to the 3rd Masterclass in Paris …
Faculté de Médecine – 45 rue des Saints Pères – 75006 – Paris
Thursday 17th of  January 2013  
9 AM – 6 PM    5° floor –  Farabeuf  Pavillon
Registration fee for the whole day:  80 €   (check or cash, no Visa)
Possibility of separate registration for morning or afternoon (50€)
Pleasesend a check to Mrs Annick Hamou   annick.hamou@parisdescartes.fr
More informations with Dr J.F UHL   jef.uhl@gmail.com
Morning session : Venous ECHO-ANATOMY  Dr J.F Uhl et Olivier PICHOT
8H30             Welcome to the attendees
9H – 12H30 Anatomy  and USD investigation of the GSV and SSV for the phlebologist
Afternoon session  ANATOMY with cadaver dissection  Pr C. GILLOT – Dr J.F UHL
14H Anatomy of the « achilean vein »   Pr Claude GILLOT
14H30     3D Reconstruction of the lower limbs of a fetus of 14 weeks   Dr J.F UHL
15H   Coffe break
15H30   Dissection of an injected cadaver.  Pr Claude GILLOT
Under the auspices of the Anatomical society of Paris and the University Paris Descartes
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First International Symposium on Endovenous Abolition of Saphenous Vein Reflux with Cyanoacrylate Adhesive

First International Symposium on Endovenous Abolition of Saphenous Vein Reflux with Cyanoacrylate Adhesive
Saturday, 26 January 2013
Mainz Germany
This symposium is being run by Prof. Dr. Thomas Proebstle and his colleagues and features a talk of the history of endovenous cyanoacrylate adhesive by Dr Rob Raabe (inventor of the Venaseal glue technique).
There will be a live surgery transmission to the participants in the lecture hall.
This one day meeting is free of charge and bookings can be made via the attached PDF.
Please click above to open the research paper as a PDF, or to save the file, right hand click on the logo, and click on ‘save target as’. To open PDF file you need a PDF reader installed on your computer, such as Adobe Acrobat Reader. You can download this by clicking here.
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