does varicose veins surgery have a future - meet...

P. Pittaluga, S. Chastanet

Does varicose veins surgery

have a future ?

FREE WEBCAST OF THE WHOLE CONGRESS

June 8 - 1 0 , 2 0 1 4 - N ice, France

Dear Friends and Colleagues,

We are looking forward to welcoming you in a few days at the Radisson Blu Hotel inNice, on the occasion of the MEET 2014 that will be coming back to its roots in France.

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If you cannot attend, you can watch the full congress online. Click here to view the sessions.

See you soon in Nice to build endovascular synergies with us.

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The MEET 2014 from 08/06/2014 to 10/06/2014 in Nice, France is COMPLIANT with the Eucomed Code of EthicalBusiness Practice. More information here.

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Endovenous thermal ablation :

• Radiofrequency

• Endovenous Laser

High-ligation and stripping

Increasingly competitive techniques in front of


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Similar midterm results


• Radiofrequency





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• Radiofrequency


Less side effects




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High-ligation and stripping should not be

considered as the gold standard nowadays



• Radiofrequency


Less side effects




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Evolution in France


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Evolution in France

2007-2012 :

• - 20% stripping

• + 12 000 RF + EVLT

Despite the absence of

reimbursement for

endovenous techniques FREE WEBCAST OF THE WHOLE CONGRESS

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Evolution in France

other VNUS vein stripping

Evolution in USA Evolution in Netherland

2007-2012 :

• - 20% stripping

• + 12 000 RF + EVLT

Despite the absence of

reimbursement for

endovenous techniques FREE WEBCAST OF THE WHOLE CONGRESS

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This evolution is felt as a serious threat

by vascular surgeons


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18% vasc surg

US Physicians specialties performing varicose

veins treatment in 2011

This evolution is felt as a serious threat

by vascular surgeons


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Endovenous techniques: New deal FREE WEBCAST OF THE WHOLE CONGRESS

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Endovenous techniques: New deal

New strategy of treatment (new pathophysiol. approach)

New handling (new technical approach)


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Must force surgery to

make its revolution

Endovenous techniques: New deal

New strategy of treatment (new pathophysiol. approach)

New handling (new technical approach)


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1) New physiopathological approach

What did we learn from endothermal ablations?


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Pittaluga P, Chastanet S. Incontinence of the GSV: hemodynamic concepts and their therapeutiic consequences. In Becquemin

JP ed. Updates and controversies in vacular surgery. Torino: Minerva medica 2010, 401-408

Endothermal ablation: no high-ligation preservation of the junction


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Pittaluga P, Chastanet S. Incontinence of the GSV: hemodynamic concepts and their therapeutiic consequences. In Becquemin

JP ed. Updates and controversies in vacular surgery. Torino: Minerva medica 2010, 401-408

High-ligation is not necessary for the abolition

of the reflux at the junction

Endothermal ablation: no high-ligation preservation of the junction


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7.8%

27.4%

7.6%

19.0%

6.0%

14.3%

9.6%

22.8%

Merchant (5 y) Pichot (2 y) Lurie (2y) Nicolini (3 y)

Saphenous reflux

VVs recurrence

Endothermal ablations: recurrence / saphenous obliteration


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50% of the recurrence appeared despite the

abolition of the saphenous reflux

7.8%

27.4%

7.6%

19.0%

6.0%

14.3%

9.6%

22.8%

Merchant (5 y) Pichot (2 y) Lurie (2y) Nicolini (3 y)

Saphenous reflux

VVs recurrence

Endothermal ablations: recurrence / saphenous obliteration


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High-ligation is not necessary for the abolition

of the reflux at the junction

50% of the recurrence appeared despite the

abolition of the saphenous reflux

?


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Increasing evidences for the ascending evolution theory


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New strategy for the surgical treatment

More targeted surgery :

• Calling into question the

systematic high-ligation

• Calling into question the

systematic saphenous ablation


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Preservation of the junction during stripping

2 years :

SFJ reflux 1.8%

Ing. neovascul 0.9%

VVs recurrence 6.8%


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2 years :

SFJ reflux 1.8%

Ing. neovascul 0.9%

VVs recurrence 6.8%

8 years :

No high-lig. > high-lig.

VVs recurrence :

9.8% vs 29% (p=0.014)

Preservation of the junction during stripping


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ASVAL

Varices are the cause of the

hemodynamic trouble

Preservation of the saphenous vein: Ambulatory Selective Varices Ablation under Local anesthesia


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1 year :Abolition reflux 50%

Abolition symptoms 66% (unselected population)



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More targeted surgery : « à la carte »


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What did we learn from endovenous techniques ?

2) New technical approach


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Local anesthesia

Tumescence: reduces disadvantages of LA


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Local anesthesia


Almost no limit for the surface treated • Dilution of the lidocaine (< limit dose 7 mg/kg)

• Possibility of use of large volumes


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Patient comfort • Use of bicarbonate +++ : reduces acidity and injection pain

• Increases non-dissociated and active lidocaine +++

• Excellent quality anesthesia

Local anesthesia





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Patient comfort • Use of bicarbonate +++ : reduces acidity and injection pain

• Increases non-dissociated and active lidocaine +++

• Excellent quality anesthesia

Surgeon comfort • Excellent quality/duration anesthesia

• Reduction bleeding +++

Local anesthesia





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Modern mini-invasive « open » surgery

Atraumatic phlebectomy

Micro-incisions

Precise skin marking

Bloodless surgery


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No stiches – adhesive tapes

Immediate walking

Very quick discharge (1h)



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Very limited side effects


J Vasc Surg: Venous and Lym Dis 2013;1:385-91


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Treatment of varicose tributaries (reservoir) +++


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Hom e Part icipant inform at ion Scient ific program Call for abstracts Exhibit ors / Sponsors LinksTreatment of varicose tributaries (reservoir) +++

Mini-invasive surgery should be the best option


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RF and EVLT treat only the saphenous vein



Mini-invasive surgery > foam +++ :

Treatment more durable

Treatment more extensive

Better esthetic result

Less pigmentation

Treatment more selective

Less inflammation

RF and EVLT treat only the saphenous vein




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Mini-invasive surgery > foam +++

D8

Preop


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TAKE HOME MESSAGE

1) Traditional surgery is over

• Endovenous techniques: at least as much efficient than stripping

• Endovenous techniques: less side effects

2) Surgery should change

• New strategy of treatment: more targeted and more tailored

• New mini-invasive technical approach: TLA, microphlebectomy, ambulation

3) “New surgery” takes advantages from this evolution

• Efficiency / durability / selectivity / safety

• Very limited side effects

4) “New surgery” will take market shares

• From the endovenous techniques: saphenous sparing

• From the foam +++: better results, better control


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