Conference "Laser phlebology 2018", 24.05.2018., St. Petersburg (Foreign speakers)

On May 24, 2018 in St. Petersburg under the auspices of the St. Petersburg Association of Phlebologists, a scientific and practical conference with international participation "Laser phlebology 2018" was held, which was devoted to the fundamental and practical aspects of the application of new treatment methods in phlebological practice.

The Presidium of the Conference "Laser Phlebology 2018" headed by Professor E. V. Shaidakov

The Presidium of the Conference "Laser Phlebology 2018" headed by Professor E. V. Shaidakov

 

The conference was attended by leading Russian vascular surgeons, phlebologists and cosmetologists. From the invited international speakers, the leading Brazilian phlebologist Kasuo Miyake and the phlebologist-surgeon from Serbia Petar Dragic took part in the forum. The head of the phlebology clinic "MIFC" Artem Yuryevich Semenov took direct part in the conference.

Semenov A.Yu. with a professor from Brazil, Kazuo Miyaki at a conference

Semenov A.Yu. with a professor from Brazil, Kazuo Miyaki at a conference

 

The first to report was a doctor from Brazil, Kasuo Miyake. In his reports, Kasuo Miyake touched upon the development of the CLaCS technique in Brazil, told and substantiated his classification of aesthetic venous disorders and showed how he uses "Augmented Reality" cryosclerotherapy and cryosclerosclerosis during sessions.

Reported by Dr. Kasuo Miyake (Brazil)

Reported by Dr. Kasuo Miyake (Brazil)

 

Kasuo Miyake - Member of the Brazilian Society of Vascular Surgeons and Angiologists, Honorary Member of the Argentine College of Vein Surgery and Lymphology, Founder and President of the annual International Meeting on Aesthetic Phlebology (IMAP), Founder of the CLaCS (Cryo Laser and Cryo Sclerotherapy) technique ...

In his first message: “ClaCS: cryolaser and cryosclerotherapy. Why and how? " Dr. Kasuo Miyake turned to his family history. The study of the side effects of sclerotherapy was initiated by his father, Hiroshi Miyaki, in his doctoral dissertation at the University of São Paulo (1972).

Kasuo's father - Hiroshi Miyake (Brazil)

Kasuo's father - Hiroshi Miyake (Brazil)

 

"Physiopathology of ulcerative defects in sclerotherapy: an experimental study in rabbits." The animals underwent subcutaneous injections in a volume of 1 ml of several sclerosing drugs into the area of ​​the auricles under pressure of 300, 500 and 700 mm Hg.

Physiopathology of ulcerative defects in sclerotherapy: an experimental study on rabbits

The role of the injection pressure, the amount and viscosity of the sclerosant for producing ulcerative defects was investigated. In subsequent years, Hiroshi Miyake actively practiced the surgery (microflebectomy) of telangiectasias, and in 1989 actively engaged in their treatment by inserting into the vessels 75% glucose solution.

The second part of the report Kasuo Miyake devoted to the technique of ClaCS. The emergence of this technology was preceded by:

  • 1995-1999 - the emergence of medical transcutaneous lasers.
  • 1999 - the appearance of long-pulse lasers with a wavelength of 1064 nm.
  • 2000 - the beginning of the use of contact cooling.
  • 2003 - the emergence of special cooling devices.
  • 2005. - study of the Vein Viewer device to improve the visualization of blood vessels.
  • 2006. - the appearance of ClaCS cryo-laser and cryo-sclerotherapy.

The ClaCS method, in the original version, is an injection of a sclerosing 75% glucose solution followed by a long-pulse laser with a wavelength of 1064 Nm.

The first stage of CLaCS - injection of 75% glucose solution into the vessel

The first stage of CLaCS - injection of 75% glucose solution into the vessel

 

The second stage of CLaCS - exposure of the vessel to a laser with a wavelength of 1064 nm

The second stage of CLaCS - exposure of the vessel to a laser with a wavelength of 1064 nm

 

The entire procedure is performed with cooling the skin with a stream of air (-20 ̊ C). 75% glucose solution causes osmolality of the vascular endothelium, laser radiation induces thermal damage to both the intima and the medial membrane of the vessel (tunica media). The effects of laser and cold contribute to the narrowing of the vein, which, accordingly, reduces the intravascular blood clot. The latter significantly reduces the likelihood of such complications as hyperpigmentation.

Photos before and after the procedure CLaCS (Kasuo Miyake, Brazil)

Photos before and after the procedure CLaCS (Kasuo Miyake, Brazil)

 

ClaCS is conducted in Miyake clinic from 1999 year with photo documentation of all procedures. Dr. Kasuo Miyake highlighted the following advantages of the method:

  • Ability to refuse the use of compression.
  • Exposure to direct sunlight is permissible the next day after the procedure.
  • Complete absence of such complications as: skin necrosis, deep vein thrombosis and embolism, anaphylactic shock and death.
  • Hyperpigmentation of the skin occurred only in 0,67% of patients, and skin burns in 0,11%, which is significantly lower than with the isolated use of classical sclerotherapy or a transcutaneous laser.

Petar Dragic made two presentations: “Laser crossectomy - risk or reliability? "And" Three years of application of the cryolaser sclerotherapy technique. "

Reported by surgeon-phlebologist Petar Dragic (Serbia)

Reported by surgeon-phlebologist Petar Dragic (Serbia)

 

Peter Dragic, a famous European phlebologist from the city of Sombor (Serbia), the founder of the Dr Dragic clinic in Belgrade (Serbia) and the city of Banja Luka (Bosnia and Herzegovina). Peter devoted his first message to the topic “Benefits of ClaCS. Cryolaser and cryosclerotherapy. "

Dr. Dragic told about the history of his clinic - "Dr Dragic", which was founded in the city of Novi Sad (Serbia) in 2007. Subsequently, branches were opened in Belgrade (Serbia) and Banja Luka (Bosnia and Herzegovina). The clinic is distinguished by high specialization and aesthetic orientation.

In the phlebology clinic "Dr Dragic" (Serbia)

In the phlebology clinic "Dr Dragic" (Serbia)

 

Clinic "Dr Dragic" was the first in the region to start practicing endovasal laser treatment, and ClaCS-therapy was the first in Europe (in 2015). Currently, the clinic operates an educational center with the support and patronage of Biolitec and Covidien. More than 100 specialists from various regions of Europe have already been trained on this educational base. The Phlebology Center "Dr Dragic" specializes in laser vein surgery and ClaCS therapy, where more than 1000 procedures are performed annually.

In the continuation of the message, Dr. Draghic turned to ClaCS technology. The procedure consists of:

  • Percutaneous laser exposure.
  • Air cooling (up to -20 ̊ C).
  • Microinjection of glucose solution.
  • Visualization with the help of the veovisor.

Using Vein Viewer to improve the visualization of blood vessels

Using Vein Viewer to improve the visualization of blood vessels

 

All components of this method are absolutely natural, which reduces the likelihood of allergic reactions and other side effects. The only allergens are photons, chilled room air and glucose solution. This reduces the incidence of complications such as:

  • Allergic reactions.
  • Hyperpigmentation.
  • Completely avoid the appearance of necrosis and ulcers.

Doctor Dragic called reasons for the effectiveness of the method:

  • The combination of the effects of sclerotherapy, laser and cooling gives the best results.
  • The removal of feeding veins becomes a pledge of a long period without relapse.
  • The procedure allows you to remove not only telangiectases and reticular veins, but also veins that are not detected by the naked eye, located at a depth of up to 1 cm.
  • It allows you to effectively remove blood vessels in difficult areas such as the ankle and foot.

The second report by Dr. Peter Dragich was about laser crossectomy. In the clinic "Dr Dragic", a study was carried out of the prolapse of a blood clot into the lumen of the femoral vein (presence of EHIT) during laser obliteration of the trunk of the great saphenous vein.

SPS fiber tip positioning for laser crossectomy

SPS fiber tip positioning for laser crossectomy

 

The work included 100 lower limbs (50 main and 50 - control group) with a diameter of about 1 cm in the sapheno-femoral anastomosis (SPS). In the first group, the laser light guide was positioned 0,9 mm from the anastomosis, in the second - at 9,3, XNUMX mm. Results:

  • In both groups, the average prolapse of the clot was 0,9 mm.
  • When the light guide was positioned in 0,9 mm from the SPS, a retraction (shrinkage reduction) was achieved at 30%, which was not observed in the second group.
  • The denser fixation of the clot in the vein lumen was in the first group, which theoretically hinders the growth of EHIT.

The following conclusions were made:

  • The protrusion of a clot into the lumen of the femoral vein during EVLA (radial fiber) on a large saphenous vein ≤ 1 cm in diameter is not related to the level of positioning of the laser catheter.
  • The expansion of the blood clot with the formation of EHIT more significantly depends on the characteristics of the blood flow in front of the tip of the fiber than from the positioning level of the catheter in the lumen of the large saphenous vein.
  • The expansion and non-adherence of the blood clot in the second group (positioning 9,3 mm from anastomosis) may be predictors of the development of EHIT, but further research is required to confirm this.

Speech by Russian speakers in the next issue of news.