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Small Saphenous Vein Interventional Treatment How to Manage Phlebolymphology ISSN 1286-0107 Vol 24 • No. 3 • 2017 • P117-172 No. 93 Small saphenous vein interventional treatment 119 Jean-Luc GERARD (France) How to manage complications after sclerotherapy 130 Lourdes REINA, (Spain) Diagnosis and treatment of situational great 14 4 saphenous vein reflux in daily medical practice Yu. T. TSUKANOV, A. Yu. TSUKANOV (Russia) New diagnostic modalities in lymphedema 15 2 Sarah THOMIS (Belgium) Prevention and treatment of venous disorders during 160 pregnancy and the postpartum period Djordje RADAK, Slobodan TANASKOVIC (Serbia) Phlebolymphology Editorial board Marianne DE MAESENEER Oscar MALETI George RADAK Department of Dermatology Chief of Vascular Surgery Professor of Surgery Erasmus Medical Centre, BP 2040, International Center of Deep Venous School of Medicine, 3000 CA Rotterdam, The Netherlands Reconstructive Surgery University of Belgrade, Hesperia Hospital Modena, Italy Cardiovascular Institute Dedinje, Athanassios GIANNOUKAS Belgrade, Serbia Professor of Vascular Surgery Armando MANSILHA University of Thessalia Medical School Professor and Director of Unit of Lourdes REINA GUTTIEREZ Chairman of Vascular Surgery Angiology and Vascular Surgery Director of Vascular Surgery Unit Department, Faculty of Medicine, Cruz Roja Hospital, University Hospital, Larissa, Greece Alameda Prof. Hernâni Madrid, Spain Monteiro, 4200-319 Porto, Portugal Marzia LUGLI Marc VUYLSTEKE Department of Cardiovascular Surgery Vascular Surgeon Hesperia Hospital Modena, Italy Sint-Andriesziekenhuis, Krommewalstraat 11, 8700 Tielt, Belgium Editor in chief Michel PERRIN Clinique du Grand Large, Chassieu, France Aims and Scope Correspondence Indexed in EMBASE, Index Phlebolymphology is an international scientific Editorial Manager Copernicus, and Scopus. journal entirely devoted to venous and Hurrem Pelin YALTIRIK © 2017 Les Laboratoires Servier - lymphatic diseases. Servier Affaires Médicales All rights reserved throughout the world and in 35, rue de Verdun all languages. No part of this publication may The aim of Phlebolymphology is to provide 92284 Suresnes Cedex, France doctors with updated information on be reproduced, transmitted, or stored in any Tel: +33 (1) 55 72 38 98 form or by any means either mechanical or phlebology and lymphology written by well- Email: [email protected] known international specialists. electronic, including photocopying, recording, Publication Director or through an information storage and retrieval Phlebolymphology is scientifically supported by Christophe CHARPENTIER system, without the written permission of the a prestigious editorial board. Suresnes, France copyright holder. Opinions expressed do not necessarily reflect the views of the publisher, Phlebolymphology has been published four Publisher editors, or editorial board. The authors, editors, times per year since 1994, and, thanks to Les Laboratoires Servier and publisher cannot be held responsible for its high scientific level, is included in several 50, rue Carnot errors or for any consequences arising from the databases. 92284 Suresnes Cedex, France use of the information contained in this journal. Phlebolymphology comprises an editorial, Tel: +33 (1) 55 72 60 00 ISSN 1286-0107 articles on phlebology and lymphology, reviews, and news. Contents Small saphenous vein interventional treatment 119 Jean-Luc GERARD (France) How to manage complications after sclerotherapy 130 Lourdes REINA, (Spain) Diagnosis and treatment of situational great saphenous 14 4 vein reflux in daily medical practice Yu. T. TSUKANOV, A. Yu. TSUKANOV (Russia) New diagnostic modalities in lymphedema 15 2 Sarah THOMIS (Belgium) Prevention and treatment of venous disorders during 160 pregnancy and the postpartum period Djordje RADAK, Slobodan TANASKOVIC (Serbia) 117 Editorial Dear Readers, In this new issue of Phlebolymphology, Jean-Luc Gerard (France) reviews the interventional treatment methods for the small saphenous vein, which must be carried out very carefully because the vein ending is variable and it is in close proximity to the nerves. He also shares his personal experience with endovenous laser ablation, while providing clear recommendations for the optimal outcome. Sclerotherapy is an effective and safe treatment when used by trained and careful hands; however, complications can happen even to the most experienced practitioner. Lourdes Reina (Spain) focuses on the possible minor and major complications after sclerotherapy and discusses how to manage these complications efficiently. Y. T. Tsukanov and Yurii Tsukanov (Russia) analyze the potential tools and treatments to support the function of a weakened great saphenous vein. He presents his clinical experience, demonstrating the benefits of micronized purified flavonoid fraction in the treatment of situational great saphenous vein reflux in patients with early stages of varicose veins. Lymphedema is a chronic, progressive, and debilitating disease. An early and accurate diagnosis and treatment is very important to alter the normal progression of the disease. Sarah Thomis (Belgium) provides an overview of the available noninvasive and invasive diagnostic tools for lymphedema. Pregnancy is one of the major predisposing factors for developing venous insufficiency. Djordje Radak and Slobodan Tanaskovic (Serbia) discuss the current guidelines for the diagnosis and treatment of chronic venous insufficiency during pregnancy and for the prevention of a venous thromboembolism. He also reviews the current role of low-molecular- weight heparin, warfarin, venotonic agents, and compression stockings in chronic venous disease treatment. Enjoy reading this issue! Editorial Manager Dr. H. Pelin Yaltirik 118 Phlebolymphology - Vol 24. No. 3. 2017 Small saphenous vein interventional treatment Jean-Luc GERARD Abstract Vascular medicine, CHU Henri Mondor Evidence-based medicine can provide some clues about options for treating Hospital, Paris XII University, Créteil, France varicose veins, but there is no consensus on the best option. Even though the majority of practitioners have discarded several of the newer techniques available after having used them, they can nonetheless remain good options for others. However, the best procedure would be easily reproducible by the majority and for the majority. The adoption of these new and less invasive techniques, such as chemical ablation (foam sclerotherapy) and endovenous thermal ablation, could allow for treatment at a private doctor’s surgery, thereby reducing the risk of recurrence and paresthesia that are often associated with traditional surgery under general or spinal anesthesia. Even though foam sclerotherapy is one of Keywords: the best options for treating the small saphenous vein, thermal ablation, including endovenous thermal ablation; foam endovenous laser ablation, can be more efficient for larger veins, regardless of sclerotherapy; interventional treatment; the vein anatomy. The ideal treatment for varicose veins in all cases should be saphenous vein; varicose veins an ambulatory procedure without anesthesia or only local anesthesia because this will not require the patients to stop work or need nursing care. Due to the reduced convalescence, pain, and morbidity, thermal ablation has been graded 1B according to the 2011 American guidelines, 1B according to the 2014 European Venous Forum, and recommended by the 2013 NICE guidelines as a first-choice procedure. Introduction Great saphenous vein incompetence is the most frequent cause of varicose vein Phlebolymphology. 2017;24(3):119-129 disease; however, small saphenous vein incompetence occurs in about 20% 1,2 Copyright © LLS SAS. All rights reserved of patients presenting with varicose veins. Treating the small saphenous vein www.phlebolymphology.org must be carried out very carefully, even more so than for the great saphenous vein, because the ending is variable and it is in close proximity to the nerves. 119 Phlebolymphology - Vol 24. No. 3. 2017 Jean-Luc GERARD Conventional surgery, which has been the only treatment Tricks and recommendations: personal experience for small saphenous vein incompetence, is being I began practicing endovenous laser ablation in June 2001 challenged due to the high incidence of recurrence and with a 980 nm and bare-tipped fiber, and, in June 2007, the frequently associated postoperative complications. with a 1470 nm and bare-tipped fiber, and then, in June Due to hospitalization, general or spinal anesthesia, and 2008, with a 1470 nm and radial fiber. This treatment is too many days of sick leave, traditional surgery could be designed for symptomatic patients and a small saphenous replaced with less invasive methods. vein trunk diameter >5 mm. The endovenous laser ablation procedure must be standardized in terms of the access Chemical ablation is widely accepted as a safe and effective site, positioning of the fiber tip, tumescent anesthesia treatment for the small saphenous vein and especially for (20 cc lidocaine [1% dilute in 250 or 500 cc of cooled small and medium-sized veins. However, while ultrasound- saline] without bicarbonate or epinephrine), and energy guided foam sclerotherapy is safer than conventional according to the size of the vein needs to be very precise. surgery, it may result in rare, but major complications Mapping both the vein and nerves prior to the procedure and litigation claims. During liquid or foam sclerotherapy, should become a routine practice. vascular physicians are afraid of mistakenly injecting the artery companion to the
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