Complications of Sclerotherapy - Angiogenesis Following Sclerotherapy
Improved Sclerotherapy by Transillumination · Veinlite® transillumination in the pediatric...
Transcript of Improved Sclerotherapy by Transillumination · Veinlite® transillumination in the pediatric...
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Rüdiger Damisch M.D.General Surgeon
European boarded Pediatric SurgeonCertified Vascular Specialist
Institute of Vein- and Lasertherapy
A-5020 Salzburg-Ö[email protected]
damisch.org
Improved Sclerotherapy by Transillumination
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Spider veins
Standard techniqueformer „state of the art“
The Idea behind
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Spider veins – reticular veinsStandard techniqueformer „state of the art“
The Idea behind
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Spider veins – reticular veins
Feeder vein
- Visualized byTrans illumination
The Idea behind
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About the System
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Veinlite LEDX - portable with LED‘s
Device
1993
Inner diameter: 30,7mm
opening for access:16,5mm
10,2 x 6,5 x 2,1 cm
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higher luminosity and brightness, higher contrast
32 LED 24 orange superficial veins 605 nm
8 red deeper veins 660 nm
darker skin
Coloured diodes are switchable separately or combined Rechargeable battery (Lithium-Ion)
Veinlite LEDX®
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Beam angle ~45°
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subcutaneous veins appear clearly visible
skin surface
bright light source bright light source
viewer
deeper veins
are visualized
surface
virtual light
source
2-dimensional image
on the surface
based on experience
3-dimensional image
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For visualisation of all intra/subcutaneousvenous structures, esp. Feeder Veins
also mind:
jammed veins all
around and below
an ulcer
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N. Mullani et al., ACP 2010
Infection Control During Sclerotherapy
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1. „Find“ Easy and precise detection of veins, spider veins and
reticular veins down to 1 cm depth (>1 cm: ultrasound guided punkture)
for liquid and micro/foam sclerotherapy* (bubbles are very well seen)
2. Push down to compress blood-flow with the C-shaped ring
3. Pull back to stretch skin = makes vein puncture easier( taboret, tambour frame)
*
„3 step procedure“
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Punction and Obliteration of the „trunk“ („very point method“)
control of optimal amount of sclerosant fluid
(Äthoxysklerol ≙ Polidocanol ≙ Lauromacrogol 400)
guide the fluid or the bubbles through the vein
Patient can rest in supine position
(gently to cardiovascular system; take advantage of local effect = higher and
longer lasting concentration on site » longer interaction with vessel intima)
By the way: direction of blood flow can be determined by
wiping out and can be used for diagnostic purposes
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Light should be dimmed down to
benefit from higher contrast
Important notice
Illuminance: 40 – 80 lx
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Prior to Operations(in particular for Mini-Phlebectomy with Várady-Hooks)
Mapping of veins prior to operation
with legs positioned exactly as it will beafter skin prepped and legs draped
faster accurate position for incision
(veins shift cm‘s from upright standingto lie)
Further Applications
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• Veinlite guides your way totrapped blood
• stabilized through the ring
•Stab puncture with 18 gauge
needle (1,2mm), blood lancetor microscalpell
• Evacuate („blackberry jam“)
avoid discoloration
Advantages following sclerotherapy
•(Technique „sewing machine“) Occasionally blood becomes trapped in
treated veins: painful, annoying, discomforting to patients and causes skindiscoloration (hyperpigmentation)
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Every venous structure can be visualizede.g.:
i.v. lines (see video on YouTube and homepage)
Tourniquet-free injection
Visualise veins prior to estetic intervention/plastic surgery to
avoid perforation and cause hematomas
Difficult on-site procedures (first aid, pediatric, paramedics, oncology, …)
Congenital Vascular Malformations
(neonates, infants)
To establish a differential diagnosis:
hematomas, foreign bodies
and …
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Precaution:
Over-treatment
concentration %
the amount which is needed ml „Quantum satis“
inject slowly v
low pressure p
fractional / intermittent ~
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Surface illumination
Transillumination-technique
Notice: all pictures withoutany postprocessing!
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Incident light
Transillumination-technique
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Sklerotherapie mit dem Veinlite System
Incident light
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Sklerotherapie mit dem Veinlite System
with transillumination much higher contrast
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Frankfurt, 11. 03. 201123w/o filter
Trans illumination withwhite light
Trans illumination withorange light / LED
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Multiple unsuccessful sclerotherapies by severaldoctors, due to Transillumination the feeder vein
becomes visible
right knee, inner side
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exact localisation of vein puncture „where“
optimum amount of fluid „how much“ *
Patient Satisfaction and excellent Patient Care→ Doctor‘s Satisfaction „happy to go to work every day“
better „Compliance“ according to this principle: „WYSIWYG“
Patient understands circulation
Patient understands the logic principle („rationale“)
• behind treating reticular veins
• simplifies education and clarification (re-calling)
• easier to explain treatment target (operation / sclerotherapy)
Hand-held device
*Attention: „blanching“ of the skin ( skin necrosis)
WYSIWYG is the abbreviation for "What You See Is What You Get"
Consequent Benefits
Improved Sclerotherapy by Transillumination
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Randomized Clinical Trials Show That Veinlite® Is Better Than AccuVein® and VeinViewer® for Venous Access
Randomized Clinical Trials are the gold standard for assessing how a device compares to standard of care (current method of vein access). Several clinical trials have now been done to assess whether vein finder devices help improve vein access in children and adults. These devices include the Veinlite®, AccuVein®, VeinViewer® and VeinLuminator™.The results show that the Veinlite® clearly improves vein access in children, while near infrared devices, such as AccuVein® and VeinViewer®, are NO better than standard of care.A full abstract of the publication can be obtained from the National Library of Medicine or from the web site www.pubmed.gov.
Randomized Clinical Trials
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Veinlite® transillumination in the pediatric emergency department: a therapeutic interventional trial.(10)
A randomized clinical trial was carried out in 240 patients with hard to find vein in a pediatric emergency department
RESULTS – The study showed that Veinlite® improved cannulation success rate within two attempts in comparison to standard care.
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„Gold Standard“ for
Visualizing of Veins
and to
Improve considerably theSuccess rate of Sclerotherapy
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Further Information and Videos
find at:
veinlite.com