Conference "Laser phlebology 2018", 24.05.2018., St. Petersburg (Russian speakers)
24 May 2018 year in St. Petersburg under the auspices of the "St. Petersburg Association of Phlebologists" held a scientific and practical conference with international participation "Laser phlebology 2018", which was devoted to the fundamental and practical aspects of the application of new methods of treatment in phlebological practice.
The report on the theme: "Synergy of techniques in the treatment of small forms of chronic venous diseases: application of neodyma laser, sclerotherapy and cold" was made by the head of the phlebological direction of the State Clinical Hospital named after. A.K. Yeramishantsev and MC "GarantKlinik", Ph.D. Manjikyan Hovsep Petrosovich
Reported by the surgeon-phlebologist Manjikian О.P. (Moscow)
In the message, Ovsep Petrosovich presented his own version of the ClaCS therapy, where 75-0,2% polydocanol solution was used in addition to the 0,3% glucose solution and shared the experience of this procedure.
Semenov Artyom Yurievich - founder and head of the center of phlebology "MIFTS" (Moscow), made a report "Sclerotherapy of unaesthetic veins in the arms."
Reported by phlebologist, Ph.D. Semenov A.Yu. (Moscow)
The superficial veins of the hands are an important aesthetic component. In the age of the heyday of cosmetology and plastic surgery, it is often by the appearance of a woman's hand that one can judge her age. Not so long ago, rather modest reports about correction of veins on hands began to appear. In Europe, Professor Alexander Flor, MD (Austria) was the first to seriously address this issue. In Moscow, the pioneer of the technique was Artem Yuryevich Semyonov. What are the causes of non-aesthetic veins on the hands?
- Age changes in the skin.
- Heavy loads.
- Congenital vascular abnormalities (malformations).
Artem Yurevich presented data on the anatomy of the vessels of the hand, described in detail possible contraindications to this procedure. Also, Dr. Semyonov shared the technical aspects of sclerotherapy on the hands, the criteria for choosing the drug and its form for manipulation. Based on the world-wide and own experience of the procedure, Artem Yuryevich made the following conclusions:
- Sclerotherapy on the hands is an exclusively aesthetic procedure.
- Does not contain a "curative" component, but it is not harmful to health and limb function.
- The minimum percentage of complications with respect to technology.
- There are no scars, scars, stitches.
- There are no restrictions for the procedure, there is no rehabilitation period.
- High cosmeticity with minimal tissue trauma.
- Selective occlusion of the target venous segment (there is the possibility of preserving the cubital veins).
Any aesthetic problem sooner or later leads to psychoemotional discomfort and the question of whether to solve it or not, only the patient will answer.
Ilyukhin Evgeniy Arkadevich - head of the phlebology department of the Reaclinic network of medical centers, the chief physician of the Medalp clinic, Ph.D., a member of the Russian phlebology association (AFF), the European venous forum (EVF), the vice-president of the St. Petersburg Phlebology Association (St. , Russia), made an interesting report on the evolution of endovasal laser obliteration of veins in Russia.
Reports Ilyukhin EA (St. Petersburg)
Evgeniy Arkadevich presented the analysis of the most significant clinical studies and experimental scientific works in the field of endovenous laser surgery. A number of conclusions are drawn. The main factors that determine the result of EVLO:
- The wavelength of the laser radiation (longer waves contribute to deeper processing of the venous wall and less energy is required to achieve the result).
- Radiation power (the optimal parameters of this parameter should be adhered to, since this achieves a better frequency of closure with minimal side effects).
- The extraction speed of the fiber will depend on the installed power. A reduction in speed with a parallel reduction in power or an increase in both parameters for the best result is the subject of discussion.
- Radiation area (power density).
- The nature of the emission is unquestionably the radial type of emission leading in everything, except for the price of the device.
- Presence of residual blood - qualitative tumescent anesthesia is an important criterion of success.
- The material of the light guide flange ensures the reliability and safety of the procedure and when working with high power.
- The diameter of the vein in the vast majority of cases does not matter when working with a radial laser light guide, the optimal choice of parameters and competent tumescence.
At the moment, EVLO and RFO are the best methods for eliminating insolvent venous veins, and the exchange of experience to eliminate personal errors is more effective than scientific research, since the principal issues are resolved.
The next speaker, Dmitry A. Rosukhovskiy, a vascular surgeon, phlebologist, Ph.D. (St. Petersburg, Russia), Secretary of the St. Petersburg Phlebology Association, presented the message "One year of the laser sclerotherapy and cryotherapy application in St. Petersburg".
Reports Rosukhovsky DA (St. Petersburg)
Dmitry Alexandrovich introduced the Eraser technique, which includes:
- The effect of a transcutaneous laser (Nd: YAG with a wavelength of 1064 nm).
- Sclerotherapy (a mixture of ethoxy sclerol with hypertonic glucose solution).
- Cryo-exhalation (air-lifting system).
- Augmented Reality (using a VeinViewer device).
Phlebologists Rosukhovsky DA and Shonov OA carry out the procedure "Eraser"
This method, being a combination of a number of technologies that have proven their consistency with time and practice, is designed to further improve the following indicators:
- Safety (no complications).
- Minimal dependence of the result on the experience of the operator.
- Mobility and low cost.
Markin Sergey Mikhailovich, the head of the Department of Phlebology at the Russian Academy of Sciences, made an amazing report on the topic: "One-time use of radial fiber and efficiency of laser coagulation of veins. Is it possible to compromise? "
Reported by Markin SM. (St. Petersburg)
According to Sergei Mikhailovich, the re-use of disposable devices is associated with regulatory, ethical, medical, legal and economic issues and is extremely controversial. The main goal of our work is the patient's health! Therefore, medical devices prepared for re-use must be as safe as new ones! When the fiber is reused, there is a real danger of error in the processing of the device, as well as errors in preoperative testing, or finding the patient in the "seronegative window".
Shonov Oleg Alexandrovich - surgeon-phlebologist at the Longevity Clinic, member of the Association of Phlebologists of Russia, member of the expert group for the development of Russian clinical guidelines for the diagnosis and treatment of venous diseases, member of the St. Petersburg Association of Phlebologists, presented the message: “Pathogenesis and treatment of asymptomatic forms venous disorders. "
Reported by Dr. Shonov OA. (St. Petersburg)
Oleg Aleksandrovich turned to the nuances of sclerotherapy of telangiectasias and reticular veins. Dr. Shonov noted the need to perform ultrasonic duplex scanning for all patients, as often the cause of the appearance of vascular asteroid is the existing reflux in the venous system. Oleg Alexandrovich turned to such a rare, but extremely unpleasant complication of sclerotherapy, like skin necrosis (epidermolysis). This situation is most often associated with the presence of an arteriolo-venular shunt, and this is confirmed by studies. Despite their small number, the results obtained are rather unambiguous.
Thus, sclerotherapy, being the most effective method of controlling telangiectasias and reticular veins (which is confirmed by the recommendations of the world's leading phlebological communities), is not without certain hidden dangers. In the treatment of telangiectasias, the consequence of the latter is:
- Preference for liquid form of sclerotherapy.
- A modern trend in combination therapies combining sclerotherapy and a transcutaneous laser.
Eugene Zhorzovich Sandalov, surgeon, specialist in laser therapy of wounds, author of 21 printed work, (Yekaterinburg, Russia) presented the message: "The use of erbium laser radiation in the treatment of trophic ulcers and long-term non-healing wounds (the first experience in Russia)".
Reports Sandalov E.Zh. (Ekaterinburg)
For the treatment of long-lasting non-healing wounds, Eugene Zhorzovich proposed the use of Er: YAG laser radiation (wavelength 2,94 μm) in the short-pulse mode. Space-modulated Er: YAG laser radiation was also used using the SMA module to stimulate regeneration. The principle of the latter: in response to microtraining, microcirculation, metabolism and nutrition of tissues are intensified, the regeneration process is started. Thus, the treatment consisted of two stages:
- Cleaning (debridement) - sanation of a purulent necrotic focus and removal of nonviable tissues - evaporation by instantaneous heating of the surface to 3000 ̊ C without coagulation of the underlying tissues and minimal traumatization of healthy tissues, the effect of sterilization of wound surfaces.
- Treatment with SMA-module for the purpose of stimulating repair.
A study was conducted, which included 118 patients with long-lasting non-healing wounds and ulcers of different etiologies. In most cases, a positive trend has been achieved. This allowed us to draw the following conclusions:
- The laser ablation method in combination with the stimulation of repair by the method of spatially modulated microdestruction of biological tissues (RecoSMA) is a safe and effective method of stimulating reparative tissue regeneration with long-term healing wounds and trophic ulcers, including purulent ones, in the presence of microorganisms resistant to antibiotics in the wound when other methods of rehabilitation are ineffective.
- Faster recovery of the patient's efficiency and early recovery.
- Reducing the cost of treatment through stationary substitution technologies, the lack of the need for medication, special bandages, and surgery.
Once again, the conference in St. Petersburg confirmed its highest class! And the presence of foreign speakers enriched those present with new knowledge!
Meeting fellow countrymen-phlebologists Denisova E.V. and Semenova A.Yu. at the St. Petersburg conference