Transcript Starting an endovascular vein program : tools, facilities

Starting an endovascular vein
program : tools, facilities and
management of patients
Jacques Bleyn
Antwerp Blood-vessel Center (ABC)
Belgium
ABC principles
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Endovascular
Percutaneous
Local anaesthesia
Day clinic
Is it necessary to do these
treatments in a clinic or can
they be done safely officebased?
Preop preparation
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No preop examinations
Mild anxiolytic drug
Shaving over the varicose veins
Antithrombotic stocking at the
controlateral limb
• Marking with echography in standing
position by the surgeon that will perform
the intervention
local anesthesia
• Under echo graphic control with isotonic
bicarbonate solution with only 20 cc
Xylocain 1%/500 cc.
• Femoral block with 30cc Lidocain 1% to
make the administration of the
tumescence painless
Isotonic bicarbonate please
Courtesy of Dr. Denis Creton
Tumescent anesthesia under
echo
Endovenous treatment
• Puncture of the Saphenous Vein at knee
level under echography or at ankle.
• Positioning of the catheter at the
Sapheno-femoral junction.
• Administration of the tumescent
anaesthesia and RF-treatment.
Puncture under echography
Surgical complement
• Müller excision of varicous side branches
in thigh and calf under local anaesthesia
with the same bicarbonate solution
• Steristrips, compression bandage and
immediate mobilisation.
• Discharge +/- 2 hours postop with elastic
stocking for 1 week.
24 hrs work incapacity.
conclusion
To start your endovenous programme,
you need:
• An endovascular mind.
• A quality Duplex scan and the necessary
skill to use it pre- and peroperatively, a
sterile sleeve and sterile gel.
• Local anaesthesia skills.
Conclusion 2
This is all easy to obtain and will make you
hate classical surgical stripping.
Thank you