Conference: “Terra incognita of surgical phlebology: from CHIVA to valvuloplasty”, Moscow, 05-06.04.2019. 1 Day.
On 5 and 6 on April 2019 of the year in GKB No.24 a scientific-practical conference and a master class with international participation were held: “Terra Incognita” of surgical phlebology: from CHIVA to valvuloplasty.
The event was attended by the employees of the Medical Innovative Phlebological Center: the head of the MIFC clinic, Ph.D., Artyom Yurievich Semyonov, phlebologists of the MIFC Alexei Mikhailovich Malakhov, Evgenia Sergeevna Svishcheva and the head of the MIFC branch in Tver Andrey Alekseevich Prutensky.
Leading phlebologists "MIFC" A.A. Prutensky and Malakhov A.M. at the conference
The first day of the conference was opened by Leonid Aleksandrovich Laberko, Doctor of Medical Sciences, Professor of the Russian National Research Medical University named after N.I. Pirogov (Russian Federation, Moscow) with the message: "Methods for the treatment of CVD that everyone has heard about, but no one has seen." Leonid Aleksandrovich told about current, and not only, trends in the world of modern phlebology.
Dr. Sergio Gianesini, Professor at the University of Ferrara (Italy), Professor - USUHS University (Bethesda, USA), Vice President of the International Union of Phlebologists (Ferrara, Italy) made a statement: "CHIVA: vision and evidence base."
Sergio Gianesini is ready to demonstrate the CHIVA technique
Dr. Sergio Gianesini (Italy) is the developer and chief practitioner of this technique. Its essence is the preservation of the main saphenous vein, surgical shutdown of certain reflux points using adequate pathways for draining blood into the deep venous system. Technically, the vein trunks are ligated without removing them. Sergio presented the theoretical aspects and results of the practical application of the method. The CHIVA technique from the author and the clinics that use it is declared as minimally traumatic and minimally invasive. It is quite difficult to agree with this, since the manipulations are carried out using open surgery techniques, incisions and suture material. The obligatory wearing of compression hosiery after the operation is increased several times in comparison with the same thermal obliteration. It is from these moments that modern phlebology has departed and seeks to go even further. For mass practical application, CHIVA is unlikely to find a large number of supporters, but for the study of pathological venous hemodynamics (in the hands of enthusiastic phlebologists), the technique has clearly not exhausted its potential.
As part of the master class, Dr. Gianesini demonstrated the practical implementation of CHIVA in the operating room, describing in detail the main technical points.
Dr. Sergio Gianesini (Italy) performs surgery CHIVA
Victor Evgenievich Barinov, Professor, Central State Medical Academy of the Presidential Administration, (Russian Federation, Moscow), presented the message: "Endothelial dysfunction in the pathogenesis of CVD and the possibility of its pharmacological correction." Dr. Barinov described in detail the role of pathological changes in the vascular endothelium and noted the special importance of the drug sulodexide in the treatment of venous and arterial pathology.
Evgeny Igorevich Seliverstov, Ph.D., Russian National Research Medical University named after N.I. Pirogov, (RF, Moscow), made a presentation: "What is ASVAL?"
Reported by Ph.D. Seliverstov E.I. (Moscow)
Evgeny Igorevich presented an extensive evidence base of the effectiveness of the methodology and shared his own experience. In one form or another, ASVAL is used by the vast majority of phlebologists. More often, another name appears, namely, isolated miniflebectomy (according to Varadi, Ash). Here one can suspect the author of the report of a certain substitution of concepts, but the essence of the issue will not change radically from this.
In the practical part of the event, Dr. Seliverstov demonstrated the ASVAL technique in the operating hospital No. 24.
Dr. Seliverstov E.I. performs operation ASVAL
Afina Vyacheslavovna Vorontsova, surgeon-phlebologist at the Medswiss clinic, (Russian Federation, Moscow) presented the message: "Is there a sclero-ASVAL?"
Reports Vorontsova A.V. (Moscow)
Athena Vyacheslavovna shared the results of a rather interesting practical study of the use of foam sclerotherapy for beginning reflux along the trunk of a large saphenous vein. The completely expected inappropriate occlusion of superficial and deep veins, albeit with a favorable course, limits the possibilities of this technique.
Ivan Gennadievich Makarov, lymphologist, head of the medical and educational department at the SPC "Lymph" (Russian Federation, Moscow), made a presentation: "Epidemiology of lymphedema in the world and in Russia."
Reported by Dr. Makarov I.G. (Moscow)
Ivan Gennadevich presented modern data on the incidence of lymphedema and shared the nuances of its treatment.
Marina Yuryevna Demekhova, phlebologist, lymphologist, head of the lymphology department at the Reaclinic network of clinics, (Russian Federation, St. Petersburg), presented a number of reports.
In the first one dedicated to the topic: “When to send to a lymphologist? A little about the differential diagnosis ”, Marina Yurievna told about the diagnosis and treatment of pathologies accompanied by edema syndrome. Dr. Demekhova even touched upon very rare nosoologies like CLOVES syndrome, kaposiform hemangioendothelioma and many others.
Reported by lymphologist Demekhova M.Yu. (St. Petersburg)
In the next message: “Surgical treatment of lymphedema. Is there a place for him in practice? " Marina Yurievna turned to a rather complex topic. Despite its long history of more than one decade, it is worth recognizing that surgery of the lymphatic system is only at the beginning of its journey. Today, conservative techniques remain the main treatment for lymph edema.
Alexandra Vadimovna Rovnaya, lymphologist, rehabilitation therapist, specialist in CPPT, European trainer in CDT, (RF, St. Petersburg), presented the message: "The" gold standard "of lymphedema therapy. Alexandra Vadimovna described the modern principles of the treatment of pathology of the lymphatic system, highlighted in detail the main practical mistakes. Also, Dr. Rovnaya highlighted the role and place of the intermittent pneumatic compression technique in the treatment process.
Dmitry Vladimirovich Bondarchuk, radiologist, Medical Institute. Sergei Berezin, (RF, St. Petersburg), presented the message: “What tests should be performed on a patient and why? Questions of instrumental diagnosis of lymphedema. Dmitry Vladimirovich noted the safety and high diagnostic capabilities of single-photon emission computed tomography and MR lymphography.
Johann Christopher Ragg, phlebologist, chairman of the board of Venartis Innovations, founder and chief physician of Angioclinic Vein Centers, (Zurich, Switzerland), made a speech: "Why does a phlebologist need hyaluronic acid?"
Reported by Dr. Johann Christopher Rugg (Switzerland)
Dr. Rugg introduced a technique for correcting the valve apparatus of the superficial veins using perivenous hyaluronic acid. The latter is well known as a good and safe filler, firmly staking its place in the world of modern cosmetology. The effect of hemodynamic correction in a particular category of patients, achieved through manipulation, is undeniable. What difficulties await in the practical implementation of the methodology?
- Rather stringent criteria for patient selection.
- Serious equipment requirements, Dr. Rugg uses high-resolution ultrasound equipment (16 - 32 MHz).
- High manipulative skills of the operator (hyaluronic acid must not enter vessels and nerve trunks).
- Temporary effect of the procedure (from 6 to 12 months in most cases).
- High cost (high-quality hyaluronic acid preparations can not be cheap).
The advantages of the technology include minimal invasiveness, the complete absence of a rehabilitation period and, perhaps most importantly, the implementation of the patient's request for "the vein should not be removed."
Dr. Johann Christopher Rugg (Switzerland) performs extravasal valvuloplasty
Dr. Rugg's master class in extravasal valvuloplasty with live broadcast from the operating room completed the first day of the event.