On April 09 and 10, 2021, a scientific and practical conference on modern approaches to the treatment of venous diseases was held in Novosibirsk.
Fedorov D.A. at the conference "Siberian Wave"
Yaroslav Konstantinovich Bernik, vascular surgeon, phlebologist, ultrasound doctor, (Novosibirsk), presented the message: “Sclerotherapy vs miniflebectomy. What to choose for a routine? "
In his report, Yaroslav Konstantinovich turned to a long dispute going on in the ranks of the modern phlebological community. Today, miniflebectomy and sclerotherapy techniques play a very important role in the activities of a modern phlebologist. Each of them is in demand and popular. Dr. Bernik presented his algorithm for choosing miniflebectomy and sclerotherapy, depending on specific clinical situations. The best choice would not be to abandon one technology in favor of another, but in a reasonable combination and combination.
Igor Anatolyevich Zolotukhin, surgeon, phlebologist, professor, (Moscow), presented the message: "Compression after sclerotherapy: down with everything unnecessary?"
Professor reports, MD Zolotukhin I.A.
Igor Anatolyevich presented data supporting the use of compression after sclerotherapy. The use of class 2 compression hosiery significantly improves the cosmetic result and reduces the effect of hyperpigmentation after sclerotherapy. Igor Anatolyevich devoted his next report to the topic: “Phlebotropic therapy and clinical guidelines. Genre crisis? " Igor Anatolyevich pointed out the importance of developing an independent evidence base for the effectiveness of phlebotropic drugs and the need for scientific discussions on this topic. Only in this way should phlebotropic therapy find its place in national clinical guidelines for the treatment of chronic venous diseases.
Pavel Gennadievich Madonov, Doctor of Medical Sciences, Professor, Head of the Department of Pharmacology, Clinical Pharmacology and Evidence-Based Medicine of the Federal State Budgetary Educational Institution of Higher Education NSMU (Novosibirsk), presented the message: "Subtilisins in the complex therapy of venous diseases."
Professor P.G. Madonov reports.
Pavel Gennadievich spoke about the prospect of using drugs of the subtilisin group in patients with venous pathology.
Konstantin Vitalievich Mazayshvili, Doctor of Medical Sciences, Professor (Surgut), presented the message: "Principles of treatment of venous diseases."
Reporting by professor, d.m.s. Mazayshvili K.V.
Konstantin Vitalievich shared a modern approach to the treatment of varicose veins. Today, innovative technologies make it possible to completely avoid the occurrence of complications of varicose veins with timely diagnosis, competent treatment and prevention of the disease.
Sergey Mikhailovich Markin, surgeon, phlebologist, candidate of medical sciences, (St. Petersburg), presented the message: "Evolution of medical compression hosiery".
Phlebologist S.M. Markin reports.
Sergey Mikhailovich presented a very interesting and informative excursion into the history of compression therapy of chronic venous insufficiency. The effectiveness of compression therapy has been proven empirically in ancient times. From the times of antiquity, through the Middle Ages and up to the emergence of modern principles of therapy, compression treatment has come a long way to occupy its niche in the treatment of chronic venous insufficiency today. Even in recent years, the principles of compression therapy have changed significantly, meeting the requirements of expediency and comfort.
Mikhail Yegorovich Shalamov, vascular surgeon, phlebologist, (Novosibirsk), presented the message: “Two-micron wave. First impressions. "
Dr. Shalamov shared his practical experience of endovenous laser obliteration using laser generators with a wavelength of 1470 and 1920 nm. The main conclusions made by Mikhail Egorovich about the advantages of a two-micron endovenous laser:
- Reducing the likelihood of carbonization of the fiber (reducing the effectiveness of the intervention).
- Reduced risk of damage to the light guide bulb!
- Reducing the risk of damage / burns to surrounding tissues (parasthesia, retraction, hyperpigmentation, a feeling of tightness along the vein).
Roman Aleksandrovich Razumakhin, vascular surgeon, phlebologist, candidate of medical sciences, (Novosibirsk), presented the message: "Treatment of varicose veins with compulsory medical insurance in a private clinic, is it worth it?"
Report by Dr. Razumakhin R.A. (Novosibirsk)
Roman Aleksandrovich shared his vision of the possible interaction of a commercial clinic and the state fund of compulsory health insurance. Modern treatment of varicose veins by compulsory medical insurance is possible, but it is fraught with a number of difficulties. The latter can be overcome, but is it worth it?
Nikolai Germanovich Khorev, vascular surgeon, (Barnaul), presented the message: "Practical aspects of antithrombotic therapy in special groups of patients with VTEC."
Nikolai Germanovich turned to a rather complex issue of modern medicine. In recent years, drugs of direct oral anticoagulants have become increasingly popular both among doctors and patients. Information about the effectiveness of the POAC is being accumulated. Added to this is the high compliance of patients to therapy with tablet drugs, and it becomes obvious that these drugs will play an increasing role in the therapy and prevention of venous thromboembolic complications.
Dmitry Anatolyevich Fedorov, surgeon, candidate of medical sciences, leading phlebologist of the Innovative Medical Center, (Moscow), presented the message: EVLK: Yesterday. Today!!! Tomorrow??? What do we expect from this method? "
D.A. Fedorov's report at the conference "Siberian Wave"
Dmitry Anatolyevich spoke about the evolution of endovascular laser radiation over the past two decades.
- The first laser operations began to be performed at the turn of the millennium.
- Laser generator 810 - 940 nm. "Hemoglobin-absorbed" radiation.
- 2006 the beginning of the use of "Water-absorbed" radiation of 1470 nm. - from 2009-2010 the first publications of its application appeared.
- 2009 EVLK is approved for use in Russia.
- 2013-2016 application of the 1920-1940 nm laser. for EVLK.
- 2018 the beginning of the use of the 1940 nm laser in Russia. for EVLK.
Changing the wavelength of laser radiation has resulted in a progressive decrease in the energy required for laser obliteration. In parallel, the evolution of laser light guides proceeded. Dmitry Anatolyevich clearly, with the help of a video, demonstrated the difference in the convenience and ergonomics of working with various types of laser light guides. It is indisputable that a vein can be “closed” with any laser using any type of fiber, but there is a clear difference in convenience, rehabilitation period and the risk of complications. What Dmitry Anatolyevich uses in his own practice today:
- Water-absorbing laser light
- Radial emission thin fibers (Slim, SWIFT)
- Installation through a 16-14 G brownie, without the bulky 6F introducer.
What does this give besides the convenience of performing procedures? Simultaneous execution of EVLK of varicose nodes (of the TotalEVLK type).
- EVLK of varicose nodes (of the TotalEVLK type) allows you to increase the "intravascular" component of the operation.
- This procedure allows you to significantly reduce, and with the acquisition of experience and skill to refuse, from the routine performance of phlebectomy (mini-micro-nano-…) for all patients.
- No puncture marks for ... phlebectomy.
- No mechanical vein removal. As a result, there is a decrease in surgical trauma and, possibly, the risk of thrombotic complications.
Dmitry Anatolyevich supported his statements with photo and video materials of real clinical cases from his own practice, and also described in detail the technique of total endovenous laser obliteration.
Dmitry Anatolyevich conducts a master class on Total EVLK in Novosibirsk
What can we expect from EVLK tomorrow?
- Safety, convenience and cosmetic effect of the intervention
(reduced radiation power, thin light guides and simple "delivery vehicles" ...)
- Increasing the length of the treatment of the main vein.
- Increasing the volume and efficiency of EVLK by treating varicose veins.
- The appearance of thinner, but stronger, radial fibers up to 0,7mm, suitable for installation through a 20G brownie !!!
- Possibility of routine use of EVLK on small varices and reticular veins; varicose veins of the feet, arms and hands.