How to Perform Ambulatory Phlebectomy: A Practical Guide for Doctors and Nurses скачать в хорошем качестве

How to Perform Ambulatory Phlebectomy: A Practical Guide for Doctors and Nurses

Ambulatory Phlebectomy (varicose vein removal) under a local anaesthetic is the best method to treat large varicose veins under the skin of the leg. It is rarely performed on its own as the only treatment for varicose veins. If present, truncal reflux in the saphenous veins (the great saphenous veins or the small saphenous veins) must be treated. Saphenous reflux can be treated by endo-thermal ablation using radio-frequency ablation (VNUS closure or RFA or EVRF) or using endo-venous laser (EVL or EVLT). Ultrasound guided foam sclerotherapy can also be used to close small to moderate sized saphenous veins. Recently, a non-thermal ablation treatment called VenaSeal (by Sapheon) has been available for the management of truncal reflux using medical superglue or cyanoacrylate. VenaSeal does not require tumescent local anesthesia or the wearing of medical stockings after treatment. Varicose veins often reduce in size after treatment of the venous reflux, but in 40-60% of treated patients, the varicose veins are still visible. Ambulatory phlebectomy provides excellent cosmetic results and it can be performed either at the same time as treatment of the reflux or at a subsequent treatment session. My own preference is to perform ambulatory phlebectomy at the time of treating the saphenous reflux. Recently in response to my video on the subject of scar-less phlebectomy, a physician has asked about the composition of my tumescent local anaesthetic, the punch biopsy method, the use of ultrasound guided foam sclerotherapy and the timing of the phlebectomy. I use 1 litre of normal saline to which I add 50ml of 2% lidocaine, 10ml of 8.4% sodium bicarbonate and 1ml of 1:1000 adrenaline. The addition of bicarbonate neutralizes the acidic pH of the solution and the injection is less painful. Also the neutral pH gives a more rapid onset of action of the local anaesthetic. The use of a 1mm biopsy punch allows excellent cosmetic outcomes with virtually no scars even after extracting very large varicose veins. Using Klein's solution results in vasoconstriction and compression of the varicose veins, so after extraction, there is virtually no blood loss. In addition, there is no extravasation of foam sclerosant when foam sclerotherapy is used at the same time that phlebectomy is performed. When treating varicose veins, I treat truncal saphenous reflux first and then I perform phlebectomy all in one session. My video is a practical guide to ambulatory phlebectomy performed under tumescent local anesthesia, answering the questions posed by a colleague in Michigan. Tel 01935 873 951 http://theveincarecentre.co.uk/ http://www.theveincarecentre.co.uk/co... [email protected]   / theveincarecentre   https://www.iwantgreatcare.org/doctor... Disclaimer: Health professionals should only provide treatments for which they have proper training and knowledge. This video serves only as a source of additional information to healthcare professionals and the public