More Treatments after Endothermal Ablation Justified??

Yes, but what methods can we use and what guidelines should be used and will Insurance companies allow necessary follow up?

Phlebology Doctors Ask :  Should we use Surgery? Foam Sclerotherapy?  or Heat?  When should we use compression?

heat-foam-chemical

Most patients need secondary treatments after ablation because of their disease process: some of the refluxing veins are too small or tortuous, they have bulging skin veins that would result in hard sclerosed coagulum after cosmetic injections and lead to matting and staining which is a real problem for patients at least in the short term of their life.

There are real needs for perforating veins to be treated if they result in unhealed ulcer patients, but most post ablation patients do not need normal perforators closed to be efficiently treated.

ONE TRIAL showed why perforators were closed:

University of Pittsburgh group (Dillavou) in a Retrospective Review, looked at 73 ulcers (avg 28 mos duration), all with perforator incompetence, w/o superficial incompetence

  • ~ 1/3 from post deep vein thrombosis( DVT), 1/3 had Deep Vein Incompetence( Reflux)
  • They used STS/Poli foam + foam pads from STD pharmacy plus compression wraps
  • Multiple injection sessions of ultrasound guided injections into the damaged,         refluxing perforating veins.
  • Mean follow up 30 months: 32 (52%) healed; 30 (48%) non-healed
  • Kiguchi M, et al. J. Vascular Surg 2014;59:1368-76

Other methods of closing perforators are with Closure Fast (RF), Varithena, and VenaSeal ( Cyanoacrylate adhesive) 2 studies below:

Cyanoacrylate adhesive was shown to be effective in a European Multi-center Trial with 70 patients because they preferred no tumescent anesthesia and no post procedure compression garments. 93% of patients were “recanalization  free” at one year: Proebstle, et al JVS Vand L 2014, 2, 1: 105-106 and a VeClose study in the USA of 222 patients where they compared Radiofrequency to Cyanoacrylate adhesive and they were similar 96% vs 99% Study in JVS 2015 with Morrison, N and  Gibson, K

Compression garments and compression bandages come in all shapes and sizes. Insurance companies require use of compression and other conservative treatment modalities sometimes for months before allowing surgery or endovenous procedures but they won’t often reimburse. Compression is level 1 standard of care for ulcers but with proper use may prevent these ulcers in the first place. To be continued…..

We will talk in future blogs more about compression but for most post op procedures (except VenaSeal glue), compression wraps, stockings, socks or elastic velcro wraps properly fitted and applied help the healing process and limit the inflammatory processes that can lead to matting, staining and phlebitis.

Come talk to us @Morrison Vein Institute  480-775-8460  Sudies compliments of Dr. Nick Morrison’s slides for lecture in 2015.

 

 

 

New Modalities in Varicose Vein Care

Morrison Vein Institute has been at the cutting edge of new modalities. We also have been principal investigators during FDA trials so we get a head start on our competition.

Dr. Nick Morrison, MD FACS, FACPh, has been the president of the American College of Phlebology ( Veins and Lymphatics now), National Veins and Lymphatics Foundation and currently the president of the world organizaion of Phlebology specialists called UIP.

Presented here in bullet form so you have insight on the various treatments and then come in for a venous duplex ultrasound to find out which one is right for you. Each blog will then cover these in more depth:

Tumescentless, NO Lidocaine anesthesia needed means less injections to the patient

Ablation techniques to treat venous disease, saphenous veins and tributaries with reflux disease:

  • Non- Thermal, non tumescence Ultrasound-guided foam sclerotherapy:
  • Meaning no laser or radiofrequency which would have required the anesthetic called tumescent anesthesia
  • Cyanoacrylate adhesive called VenaSeal, which likened to an implantable glue requiring no anesthesia and no support stockings after procedurescreenshot-2016-medtronic_edited
  • MOCA ( Mecanical Occlusion Chemically Assisted), ClariVein®OC is a specialty infusion catheter for the occlusion of incompetent veins in patients with superficial venous reflux.
  • Thermal, Non- tumescence: Homium Laser plus the use of foam sclerotherapy using Asclera or STS ( Sodium Tetradechol Sulfate)
  • Varithena, manufactured foam, 1% Polidocanol with co2/o2 Gas FDA approved 2014

Traditional surgical methods, newer  surgical modifications, radio frequency, laser, and  tumescentless endovenous ablation are generally safe.

mens veins.jpg

Intraoperative and postoperative  complications are infrequent and  generally are less frequently seen with endovenous ablation procedures than with more traditional   surgical procedures, like stripping or Trivex invasive procedures needing long convalescence and usually performed in an operating room with much bigger costs.

Morrison Vein Institute is committed to careful follow up and adjunctive treatments, like ultrasound guided foam sclerotherapy, phlebectomy for large bulging varicose veins on the skin and cosmetic sclerotherapy to prevent imminent phlebitis, vein rupture, itching, restless leg, cramping still possible with a myriad of skin veins left on the skin after medical ablations.

Call Morrison Vein Institute: 480-775-8460 for a consult, Compression stocking fitting and after the Venous Ultrasound meet with our Doctors for your unique vein mapping and treatment protocol. Thank You, Terri Morrison RN BS and Nick Morrison MD for this excerpt from his national presentation.