Conference: “From varicose veins to post-thrombotic syndrome”, Moscow, September 21, September 2019.
On September 21, 2019, a phlebological conference "A patient with venous pathology at a surgical appointment: from varicose veins to post-thrombotic syndrome" was held at the Kremlin in Izmailovo Business Center.
The event was actively attended by employees of the Medical Innovation Phlebological Center. Presentations were made by the head of the IIFC, candidate of medical sciences, Artyom Yuryevich Semenov, leading employees of the IIFC, candidates of medical sciences, Dmitry Anatolyevich Fedorov and Vladimir Vyacheslavovich Raskin.
Conference speakers, surgeons phlebologists "MIFTS" Semenov A.Yu., Raskin V.V. and Fedorov D.A.
The conference was also attended by leading phlebologists of the Medical Innovation Phlebological Center: Alexei Mikhailovich Malakhov, Evgenia Sergeevna Svishcheva and Alexei Nikolaevich Voloshkin.
Phlebologists "MIFC" Malakhov A.M., Svishcheva E.S and Voloshkin A.N. at the conference
The president of the conference, Khachatur Mikhailovich Kurginyan, made an opening speech. He spoke about further plans for promoting the conference in the cities of the Russian Federation.
Opening remarks by the conference organizer Khachatur Mikhailovich Kurginyan
Vadim Yuryevich Bogachev, Doctor of Medical Sciences, Professor, Scientific Director of the First Phlebological Center, (Moscow), made a report: “Medical correction of CVD. Self-deception or necessity? "
Professor reports, MD Bogachev V.Yu. (Moscow)
He spoke about the undeniable evidence of the effectiveness of the micronized purified bioflavonoid fraction in the treatment of chronic venous insufficiency.
Sergey Vladimirovich Maksimov, surgeon, phlebologist, candidate of medical sciences, head of "Nord Clinic" (Dmitrov), presented the message: "Is mechanochemical obliteration an expensive alternative to stem sclerotherapy?"
The head of "Nord Clinic", Ph.D. S.V. Maksimov (Dmitrov city)
Sergey Vladimirovich shared his own experience of using the Flebogrif mechanochemical obliteration technique. Largely anticipated report in light of the active promotion of non-tumescent technologies. Despite the rather limited number of patients, it is difficult to talk about the bias of Dr. Maksimov. Indeed, even according to these data, it is quite possible to judge the immediate prospects of the technology, at least in Russia. It should be noted that Sergey Vladimirovich is an experienced endovascular surgeon, a recognized expert in modern techniques used in phlebology. The data obtained by Dr. Maksimov indicate a high percentage of recanalization of target veins, which required both more careful observation and additional manipulations. Including, endovenous laser obliteration of the recanalized varicose vein trunk. The economic benefits of using the technology, both for the patient and the doctor, are rather dubious. But reputational risks can be great, it is impossible to give a 100% guarantee on the result of treatment. Either laser obliteration is so good, or non-tumescent techniques are not yet so perfect, it is obvious that there is no need to talk about any direct competition between them today. When can we consider mechanochemistry as a method of treating varicose veins?
- Lack of equipment for thermobliteration in the clinic.
- Individual preferences of the patient, categorical rejection of tumescent anesthesia.
- Elderly and debilitated patients, ready for additional manipulations in the future.
Evgeny Arkadievich Ilyukhin, Ph.D., head of phlebology REACLINIC, member of the Association of Phlebologists of Russia, member of EVF, (St. Petersburg) presented two reports. In the first of them, Evgeny Arkadyevich turned to the topic: "Compression knitwear - do we really need it?"
Reported by Ph.D. Ilyukhin E.A. (Saint Petersburg)
Compression therapy today is an integral part of modern treatment, practically, of any pathology of the venous or lymphatic systems of the body. The necessity and expediency of using which is beyond doubt. At the same time, only the competent application of compression therapy will have the necessary therapeutic effect. Dr. Ilyukhin devoted the next post to the evolution and limitations of endovenous laser obliteration. The technology of endovenous laser obliteration has passed a rather serious and difficult path for 20 years of its existence. Not all clinical and basic research has been perfect. In many respects, the changes took place and were maintained thanks to large-scale clinical practice, when the obviousness of the advantages of new wavelengths, fiber generations, operating modes did not need special advertising. Has EVLK with a wavelength of 1,5 micrometers and a radial light guide reached its perfection, is it necessary to go further or develop alternative directions for the treatment of varicose veins?
Artyom Yurievich Semyonov, Ph.D. Head of the Moscow Innovative Phlebological Center, (Moscow), in the message: “Endovascular methods of treating varicose veins. Is there a way further? " continued the theme of Evgeny Arkadievich.
Reporting by the Head of the phlebology center "MIFC", phlebologist surgeon, Ph.D. Semenov A.Yu. (Moscow)
It is indisputable that laser technologies, practically, at the very beginning of their journey, made it possible to effectively coagulate a vein. Thermal ablation modes, the specifics of laser fibers operation, a number of already forgotten, but existing complications are a thing of the past with the modernization of technology. Now it is difficult to imagine how to work with an end-face fiber on a laser with a wavelength of 810 nm. Yes, with the right approach, the vein will be obliterated. But the energy regime, which we will use in this case, will bring a number of not the most pleasant nostalgic sensations. This is what evolution is for. So do we need a new wavelength, and why? In modern practice, there are already a number of specialists working in parallel on lasers of 1470 and 1940 Nm. Yes, the 1470nm laser wave is familiar, comfortable and effective for removing varicose veins. At the same time, the 1940 Nm laser equipment offers a softer, and at the same time no less effective mode of operation, which gives additional opportunities. As an example, laser removal of suprafascial vein tributaries is associated with much fewer side effects. The new wavelength is definitely better than the familiar 1470 Nm. Considering that technologies that are trying to compete, in the form of non-tumescent techniques, show themselves to be a rather weak alternative, the "dead-end branch" of phlebology development in the face of laser obliteration will dominate in the coming years, at least.
Dmitry Anatolyevich Fedorov, Ph.D. Leading phlebologist of the Moscow Innovation Phlebological Center, (Moscow), in his report revealed the physics of the process of venous coagulation.
Leading employee of "MIFC", phlebologist surgeon, Ph.D. Fedorov D.A. (Moscow)
A study was presented to the public demonstrating how laser radiation affects the aquatic environment. There are not so many works of this kind in domestic and world practice, therefore this study deserves special attention. Dmitry Anatolyevich clearly demonstrated what processes occur in a vein during laser exposure. In the report of Dr. Fedorov, it was shown that an effective effect on the vein wall can be provided by a one and a half and two micron laser, using an end and radial light guide. Also, the study demonstrated how much more targeted and selective a two-micron laser with a radial fiber operates, due to which the energy regime is reduced without loss of efficiency.
Alexander Flor, professor, vascular surgeon specializing in the treatment of venous pathology of the upper and lower extremities, member of the American College of Phlebology, (Vienna, Austria), presented the message: "Sclerotherapy of the veins of the hand".
Reported by Professor Alexander Flor (Vienna, Austria)
Dr. Flor spoke about the aesthetic correction of veins in the hands of the following groups of patients (the overwhelming majority of women seeking help):
- Age changes.
- Athletes with hypertrophic veins.
- Venous malformations.
Alexander Flor spoke about vein removal tactics on virtually all anatomical segments of the upper extremities: on the hands, arms, and shoulders. A doctor from Switzerland uses all modern technologies to remove veins in his hands:
- Laser ablation
The vast majority of interventions are foam sclerotherapy (about 80% of procedures). Dr. Flor spoke in detail about the nuances of his own procedures, the management of patients after interventions.
Joint photo for memory of Alexander Flor with phlebologists "MIFC"
Vladimir Vyacheslavovich Raskin, Ph.D. leading phlebologist of the Moscow Innovative Phlebological Center, (Moscow), presented the message: "Prevention of relapses after EVLO."
Leading phlebologist "MIFC", Ph.D. Raskin V.V.
In the modern interpretation, the recurrence of varicose veins refers to the appearance of varicose veins in the lower limb at any time after treatment using an invasive technique. Why, then, does the disease recur even after the application of innovative treatment technologies?
Factors contributing to relapse:
- Relapse as a result of inadequate or incomplete treatment:
a - tactical errors - problems in assessing the initial pathology,
b - technical errors associated with the difficulties of performing the planned treatment,
c - incomplete treatment.
- Relapse as a result of disease progression.
The factors listed in the first paragraph, we can influence by:
- A competent diagnosis, taking into account not only the anatomy of varicose veins, but also the source and distribution of pathological blood reflux.
- Compliance with the protocol of the procedure and the elimination of technical errors.
- Mandatory observation in the postoperative period with ultrasound.
With paragraph No. 2, everything is somewhat more complicated. To date, there is no scientific data that clearly describes the mechanisms of progression of varicose veins. Clinical observations suggest a certain list of factors that accelerate the process of progression. Namely:
- hormonal status, including the use of hormonal contraceptives, hormone replacement therapy,
- professional activity,
- some sports
- nutrition features
- congenital malformations
- deep vein reflux.
Vladimir Vyacheslavovich drew public attention to the most common variant of the development of recurrence of varicose veins when removing a large saphenous vein, varicose enlargement of the anterior lateral inflow of a large saphenous vein. With a pathological extension of this vein. up to a year after the innovative treatment, the vast majority of practicing specialists came across. The appearance of varicose expansion in the basin of the anterolateral inflow is often impossible to predict. How can we control relapse in a given vein pool as much as possible:
- Leave a minimum stump size after EVLO.
- Correct communication with patients (including after surgery that does not "suggest" a relapse).
- Observation in the mid-term period, ultrasound monitoring 1 once a year, early detection of pathological veins.
- Obliteration of the incompetent anterior accessory vein in the early stages - foam (up to 3 mm) / radial slim (4-5 mm).
Denis Aleksandrovich Borsuk, Ph.D., Chairman of the NKF Control Commission, Head of the Clinic of Phlebology and Laser Surgery, (Chelyabinsk-Yekaterinburg), presented the message: "Isolated EVLO - a necessity or an inevitability?"
Reported by Ph.D. Borsuk D.A. (Chelyabinsk)
Denis Aleksandrovich shared the results of a study of his own clinic on the efficiency and safety of performing endovenous laser obliteration without removing inflows. In the results:
- Regression of abandoned tributaries in 25% of cases.
- Reduction of the diameter of the left tributaries more than in 50% of cases.
- The development of thrombophlebitis of tributaries in 15% of cases.
Roman Alexandrovich Tauraginsky, cardiovascular surgeon, phlebologist surgeon, (Irkutsk), presented the message: "The source of reflux, from the standpoint of evidence-based medicine, experimental and mathematical modeling."
Reported by Taugarinsky R.A. (Irkutsk city)
Roman Alexandrovich presented the results of a one-center prospective study that studied the patterns of the spread of reflux in varicose veins.
Sergey Nikolaevich Yakushkin, Ph.D. cardiovascular surgeon, chief specialist of the Semeynaya Clinic, (Moscow), presented the message: “Surgery VS therapy of trophic ulcers. Medical and economic justification. Yakushkin S. N. "
Reported by Ph.D. Yakushkin S.N. (Moscow)
Sergei Nikolaevich revealed the economic aspects of the treatment of chronic venous ulcers in the modern practice of domestic medicine.
Igor Anatolyevich Zolotukhin, Professor, Chief Researcher, Department of Angiology and Vascular Surgery, Research Institute of Clinical Surgery, Russian State Medical University. (Moscow), presented the message: "Treatment of venous thromboembolic complications: the state of the problem today."
Reported by Professor Zolotukhin I.A.
Igor Anatolyevich revealed the problems of evidence-based medicine in modern domestic and world practice.
Yashkin Maxim Nikolaevich, Ph.D., surgeon, phlebologist, FGBU NMHTs named after N.I. Pirogova, (Moscow), presented the message: “Stenting of the iliac veins. What do the results look like? " Dr. Yashkin shared the data of the world's leading specialists in the field of venous stenting and observations from his own practice.
Olga Yaroslavovna Porembskaya, MD, PhD, surgeon, phlebologist, senior researcher at the laboratory of systemic and regional blood circulation, NIIEM, (St. Petersburg), presented the message: “Anticoagulant therapy for venous stenting. Possible options." Olga Yaroslavovna shared the current global trends in anticoagulation during venous stenting.
Hovsep Petrosovich Mandzhikyan, Leading Cardiovascular Surgeon, Phlebologist of the Department of Vascular Surgery at the M.K. A.K. Eramishantseva, (Moscow), presented the message: "Surgery vs conservative therapy of superficial thrombophlebitis".
Reported by O. Manjikyan.
Hovsep Petrosovich shared the current state of the art on the approach to the treatment of acute thrombophlebitis. Radical innovative treatment of varicose veins complicated by thrombophlebitis in the acute and subacute period today has a significant number of supporters. It is important that this approach in modern practice is based on a good practical basis for treating patients.
Polina Georgievna Gabai, General Director of the Faculty of Medical Law, Legal Counsel for Medical Law, (Moscow), gave a lecture: "Legal aspects of the work of a phlebologist."
Reported by Gabay P.G.
Polina Georgievna shared the most relevant information about the legal aspects of the work of a modern specialist in the field of phlebology.
Daniil Olegovich Starostin, instructor of the National Council for resuscitation, head of the department of anesthesiology and resuscitation (Moscow), presented: “Master class on cardiopulmonary resuscitation”.
Master class performed by Starostin D.O.
In the message, Daniil Olegovich shared the basic principles of emergency assistance in various conditions.
Photo of conscience for the memory of the participants and speakers of the conference "A patient with venous pathology at a surgical appointment: from varicose veins to post-thrombotic syndrome" in Moscow