Compression Use in COVID-19...significantly improving circulation in the ulcer area. Tissue culture: the use of topical substances allow to promote granulation tissue, achieving to

The 40th Annual Scientific Meeting of the Japanese Society of PhlebologyThe 40th JSP-vWIN International Session

Compression Use in COVID-19

Chi Yung Wei Professor of Medicine University of California, Davis Vascular Center, Sacramento, CA

COVID-19 has become the quintessential term that defines our worse nightmare. One major complication of COVID

is its effect on the vascular system, particularly the veins. The high VTE rate despite of adequate pharmacological

prophylaxis have led to the renewed interest in compression therapy in the prevention of VTE. Based on meta-

analysis and prospective trials on the subject, results have been mixed. Although no conclusion could be made on

the effect of compression in VTE prevention, given the high rate of VTE in COVID, as healthcare providers, we

should provide all available tools to our patients to avert such devastating complication.

Curriculum Vitae

Dr. Chi is an internationally recognized expert in vascular medicine and intervention with special interest in phlebology and wearable device innovation. He is a Professor of Medicine at the University of California, Davis, Vascular Center. He is widely published in the field of venous and lymphatic disease with a H-index of 14, and lectures globally. He sits on the editorial board of Phlebology, Vascular Medicine and the Chinese Medical Journal. Dr. Chi’s recent research have been funded by the University of California Science and Innovation Grant as well as the American Vein and Lymphatic Society. He holds patents in various healthcare wearable device innovations.


ANA LORENA GRILLO CHINCHILLA CURRICULUM VITAE 2017

Passport of Costa Rica: 1-0966-0492

Mobile: +506 8991-3777

Mail: [email protected], [email protected] College of Doctors and Surgeons of Costa Rica CMC 5948 University degrees Bachelor's degree in Medicine – UCIMED 1999 Doctorate degree in Medicine -UCIMED 2000 Specialty in General Surgery - University of Costa Rica -2005 Specialty in Peripheral Vascular Surgery – University of Costa Rica - 2008 Vascular Ultrasound Course – Gulfcoast Ultrasound Institute – Tampa, USA - 2010 University teaching experience: Peripheral Vascular Surgery Course – Medicine – UNIBE 2008-2015 Peripheral Vascular Surgery Course – University of Costa Rica 2009-2015 Peripheral Vascular Surgery Post Graduate Education - University of Costa Rica – 2010 to date General Surgery Course - vascular surgery rotation – Medicine - U Latina -2017 to date Clinical and hospital pharmacology Rotation -Pharmacy -Hospital de Alajuela- UCIMED-2017~ Surgery Internship Tutor – UCIMED- Hospital de Alajuela – 2018 to date Professional experience: Company medical care at Sony Music, Cormar, Casa Phillips, Mercedes Benz, Matra, Continex,

Cail Heredia and Cail San José – 2000 to 2001

Minor Surgery Unit Passant - Hospital Calderón Guardia 120 hrs – Oct 2000

Oncology Unit Passant - Hospital Calderón Guardia 120 hrs – Nov 2000

General Surgery Resident – Hospital San Juan de Dios - 2001-2003

General Surgery Resident – Center for Gastric Cancer Detection- 2004

General Surgery Resident- Hospital Calderón Guardia -2004 to 2005


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Courses, seminars, congresses and others Panamerican Trauma Congress Participant – Lima, Perú - November 2003

Pan American Trauma Congress Participant- Miami Beach - November 2004

Veith Symposium Participant – New York, USA - November 2005

Annual Congress Vascular Surgery Society Participant – Philadelphia, USA - June 2006

Annual Congress Vascular Surgery Society Participant – Baltimore, USA - June 2007

International Endovascular Therapy Symposium (ISET) Participant–Hollywood Beach- Jan 2008

Diabetic Limb Salvage Participant – Washington DC - September 2008

National Medical Congress Speaker and Participant – Costa Rica-November 2008

National Medical Congress Speaker and Participant – Costa Rica- November 2009

Advanced Wound Management Symposium Participant (SAWC) – Orlando, USA -January 2010

PanAmerican Phlebolinphology Congress Participant – Guayaquil, Ecuador -October 2010

Diabetic Foot Conference (DFCON) Participant- USA - March 2011

UIP World Phlebology Congress Participant– Prague, Czech Republic -September 2011

Advanced Sclerotherapy Course – Florence, Italy - September 2011

Congress Of The International Society Of Vascular Surgery Participant-Miami- March 2012

New Cardiovascular Horizons Participant- Costa Rica - April 2012

Diabetic Foot Course speaker, Organizer and Participant- Costa Rica- 2013

New Cardiovascular Horizons Participant – Costa Rica - March 2013

Annual Congress Of The Vascular Surgery Society Participant- San Francisco, USA- May 2013

Congress Of The International Union Of Phlebology Participant – Boston- September 2013

New Cardiovascular Horizons Participant – Bogota, Colombia – 2014

Surgical Management Update Of The Diabetic Foot Participant and Organizer – CRC -2015

Meeting Of Experts In Venous Disease Speker and Participant- Colombia- August 2016

Latin American Venous Forum Participant - Bogotá- August 2016

Amputation Prevention Meeting (AMP 2016) Participant- Chicago, USA - August 2016


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AMP arterial distal access workshop, embolization workshop, atherectomy workshop

Vascular August Ultrasound Workshop Participant and Organizer – Costa Rica- 2016

Meeting Of Experts In Venous Disease Speaker and Participant- Panama- December 2016

Meeting Of Experts In Venous Disease Speaker and Participant – Panama- January 2017

Advanced Wound Management Symposium (SAWC) Participant– San Diego- April 2017

European Venous Forum Participant – Porto, Portugal – USA - June 2017

Amputation Prevention Meeting (AMP 2017) – Chicago, USA- August 2017

Meeting Of Experts In Venous Disease Participant and Speaker – Panama- August 2017

Panamerican Phlebology meeting- Speaker and Participant- El Salvador -2018

SAFENA meeting Participant- Cartagena, Colombia- Oct 2018

ORBIS Vascular Meeting Participant- Uruguay – Dic 2018

v-Win International Meeting in Phlebology, Lymphology & Aesthetics’s, Cortina d’Ampezzo- Jan

2019

Workshop in pharmaco- mechanical thrombolysis- Mexico- 2019

Basic Cardiac Support- Costa Rica- Jun 2019

Congreso Sociedad Dominicana de Cirugía Vascular Speaker and Participant- Jul 2019

Meeting Of Experts In Venous Disease Participant and Speaker- Dom Republic Jul 2019

v-Win Humanitarian Education v-HELP – Dom Republic Jul 2019

Experts in Anticoagulation Meeting – Speaker and Participant- Panama 2019

UIP Krakow Meeting – Speaker and Participant- Poland- August 2019

II IETH Meeting Participant- Athens, Greece – Nov 2019

AVLS Meeting Speaker and Participant- Phoenix, AZ, USA- Nov 2019

Languages: English advanced, Italian Beginner, Spanish (native)


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Memberships:

Panamerican Trauma Society since 2003

International Society of Vascular Surgery sin 2007

Society of Advanced Wound Care since 2010

Association of Peropheral Vascular Surgeons of Costa Rica since 2008, board member since

2012

American College of Phlebology in 2013

Society of Vascular and Endovascular Surgery of Central America and Caribbean, founding

member and board member since 2018

UIP – Costa Rica since 2019

AVLS since 2019

Others:

IOS and windows

Office

THESIS DEVELOPMENT OF PHLEBO SOFTWARE, CLINICAL STATISCAL REGISTRY


Foam sclerotherapy treatment in venous ulcers

M.D, PhD L.R Arias Villarroel1,2,3, Dr. J. Arias-Villarroel 1,3, Dr. L.R Arias – RuÍz1,3

1Arias Medical Clinic International2Comunidad Científica de Bolivia de Flebología y Linfología, Bolivia.3Instituto Científico de Educación Superior, México.

Abstract

Advanced-stage venous insufficiency is characterized by the presence of varicose ulcers, these can develop for

months and persist for several years, many of the patients who have them are resigned to lead a life full of

limitations and with an unlikely possibility to recover.

For years pharmacological as well as surgical procedures have been developed with the aim of recovering tissue

continuity in these ulcers.

However while venous insufficiency persists, it is difficult to achieve full recovery.

Currently, the use of sclerotherapy has been shown to allow recovery in less time for patients who are cured of

varicose ulcers with topical medications.

Sclerotherapy involves applying a sclerosing agent in the lumen of the varicose vein causing it to secrete fibrin,

achieving a definitive collapse and closure of it.

Objective:

To check the relationship between the use of

sclerotherapy and the closure of varicose ulcers

Methods:

A series of cases is presented, including 46 patients

with venous ulcers who received healing every third

day and application of foam sclerotherapy once a week

during 4 months. (February to May of the year 2019)

Sclerotherapy was applied using the technique

described by Dr. Lorenzo Tessari using Tetradecyl-

Sodium Sulfate

At Arias Medical Clinic, the healing of varicose ulcers

is divided into 3 periods.

• Eliminate the infectious process: by using

antibiotics that can be oral, intramuscular and

sometimes topical.

• Restoring adequate circulation (use of foam

sclerotherapy): the use of foam sclerotherapy

allows to completely close the varicose veins that

are located on the periphery of the ulcer and in most

cases, piercing and communicating

These veins cause the accumulation of waste products in

the área weaken muscle tissue and promote a favorable

environment for the development of ulcerative bed

infections. For this these abnormal veins must be sealed.

The use of sclerotherapy eliminates reflux points,

significantly improving circulation in the ulcer area.

Tissue culture: the use of topical substances allow to

promote granulation tissue, achieving to renew muscle

and epithelial tissue as the case may be (pH control),

in addition to the use of the compressive bandage

decreases edema and helps the process of chemical

fibrosis caused by sclerotherapy, eliminating varicose

veins.

Results:

• Currently, the use of sclerotherapy has been shown

to allow recovery in less time for patients who are

cured of varicose ulcers with topical medications.


• A 72% scarring cup (in 33 patients) was achieved,

proving that the use of sclerotherapy in these patients

promotes positive evolution .In addition, alone

9% (4 patients) relapses, related to other factors

identified (use of bandage, hygiene,etc.) in 50% (23

patients) show improvements in the aesthetic aspect

managing to reduce areas with lipodermatosclerosis

on the periphery of the varicose ulcer.

Below we present two of the most significant cases

of our study.

Case 1

74 years old female, over 10 years of evolution of a

persistent ulcer (name C. S).

Case 2

42 years old female, 3 years of evolution of a persistent

(name C. D.)

Conclusions

The use of sclerotherapy allows to completely close the

varicose veins that are located on the periphery of the

ulcer and in most cases, piercing and communicating

veins are sealed that cause the accumulation of

waste products and bad oxigen quality in the área.

These weaken muscle tissue and promote a favorable

environment for the development of ulcerative bed

infections.

Sclerotherapy controls the points of reflux by causing

blood to pick up the right path; combing this with cures

and topical medications prevents recurrence and allows

shortening the time of scarring

It is important to emphasize that the use of topical

substances is determined by pH control in the ulcerative

bed and the use of compressive bandage is mandatory

for the patient after the application of sclerotherapy to

obtain favorable results.

Curriculum Vitae

Dr. Luis René Arias VillarroelArias Medical Clinic, MEXICOMedical surgeon graduated from the Veracruzana University Director of ARIAS MEDICAL CLINIC in Mexico and Bolivia President of the BOLIVIAN SCIENTIFIC COMMUNITY OF FLEBOLOGY AND LYMPHOLOGY Rector of the SCIENTIFIC INSTITUTE OF HIGHER EDUCATION


Percutaneous Aspiration Thrombectomy with Intelligent Blood Sparing Technology for Deep Venous Thrombosis and Pulmonary Embolism.

Patrick E. Muck MD, RVT, FACSChief – Vascular SurgeryProgram Director – Vascular Fellowship & Integrated ResidencyGood Samaritan HospitalCincinnati, OH, USA

Venous Thromboembolism(VTE) is a worldwide concern and the third leading cause of death. October 16th is

World Thrombosis Day, in recognition of Dr. Virchow and his accomplishments in the VTE space. Percutaneous

mechanical thrombectomy is an increasingly used therapy for patients with Deep Venous Thrombosis(DVT) and

Pulmonary Embolism(PE). One potential drawback of venous interventions is blood loss. The Indigo System

Lightning 12(Penumbra Inc.) is an intelligent aspiration system powered by the Penumbra Engine. The Lightning

system utilized a unique mechanism of action to help optimize thrombus removal procedures by differentiating

between thrombus and blood. Lightning enables clot detection so the interventionalist knows when the catheter

is in thrombus and when it is in a patent vessel. This technology demonstrated an 18:1 potential blood loss

savings during bench top testing when used versus the traditional dynamic aspiration tubing. Lightning Intelligent

Aspiration comes packaged with CAT-8 or the newest CAT-12 aspiration catheters. The medium bore 12 French,

CAT-12 with the Lightning Intelligent has become the next generation in thrombus removal.

Early results with this technology have mimicked the bench top testing with a decrease in the blood loss for both

DVT and PE interventions.

Curriculum Vitae

Dr. Patrick Muck completed his vascular fellowship at Good Samaritan Hospital in Cincinnati, Ohio. He currently is the Program Director of the vascular fellowship and integrated vascular residency at Good Samaritan Hospital in Cincinnati, Ohio. Dr. Muck is also the Chief of the Section of Vascular Surgery at Good Samaritan Hospital. He is the Site Director for multiple FDA trials at GSH. Dr. Muck has been a speaker and/or moderator at many international meetings. He has written and published articles in peer reviewed journals and currently is a member of the editorial board for the Journal of Vascular Surgery – Venous & Lymphatic. He serves on the Executive Committee for the Midwestern Vascular Surgery Society. He is also a member of American Venous Forum’s Board of Directors.


29 years of experience in the training of specialists in Phlebology

Daniel R. ONORATI, Bárbara DE BONYTornú Headquarters of the Career of Specialist in Phlebology and Lymphology

The training as a specialist in Phlebology presents some special characteristics. Phlebology is not considered a

specialty in itself, applicants to practice it may come from different branches of medicine and training centers need

to meet certain qualities. On the other hand, those responsible for teaching do not always have identical training

themselves and the pathology presents multiple forms of presentation and varied treatments.

In this work we have made a journey through 29 years in the teaching of the specialty, recognizing that the

conclusions will necessarily be subjective, something that we believe to minimize with an analysis of all the

factors involved in the process: the student, the teacher, the specialty and the training place.

Curriculum Vitae

ACADEMIC TRAINING• Graduated from the Faculty of Medicine of the University of Buenos Aires in

December 1980.• Concurrent physician of the general surgery service, Hospital Bernardo Houssay,

Vicente López, BA, 1981.• Former Resident Physician of the “J.M. Ramos Mejía ”of the City of Buenos Aires in

the specialties of general surgery and cardiovascular surgery.• Former Chief of Residents of cardiovascular surgery at the “J.M. Ramos Mejía”

from the City of Buenos Aires.• Physician assistant to the Phlebology Service of Prof. Paul Ouvry, Dieppe, France,

in 1987.• Assistant physician to the Phlebology Service of the Rouen hospital, Prof. André

Davy's service, 1987.• Former Instructor of Surgery Residents Hospital E. Tornú, CABA.• Specialist in General Surgery (Argentine Society of Surgery).• Specialist in Cardiovascular Surgery (Ministry of Health, CABA).• Doctor specialized in Angiology, Argentine Medical Association.• Medical specialist in Vascular Surgery with Phlebology orientation, Argentine

Medical Association.• Member of the board of directors of the Argentine Society of Phlebology and

Lymphology of the AMA (Member, Scientific Secretary, General Secretary, Vice President).

• President of the Argentine Society of Phlebology and Lymphology, 2018-2019 biennium.

ASISTENCIAL ACTIVITY• Student Guard Practitioner at the Raúl Larcade Hospital, San Miguel, BA. Period

1978-79• Surgeon on duty at E. Tornú Hospital, period 1989, '90 and '91.• Doctor in charge of the Vascular Surgery service of Hospital “E. Tornú ”of the City

of Buenos Aires from 1992 to date.• Vascular echodopplerist at the E. Tornú hospital, GCBA,• Phlebologist at the Hospital "Saturnino Unzué", May 25, Province of Buenos Aires,

period 2005-2013.• Former chief in charge of the General Surgery Hospital “E. Tornú ”, years 2008-

2009.• Former head in charge of the Department of Surgery Hospital “E. Tornú ”, year

2009 and 2016• Former Director of the “Foundation for the Study of Circulatory Diseases” (FUNDEC).• Phlebologist and vascular echodopplerist at the Sanatorio Modelo de Caseros, from

2011 to date.• Private practice in office.Student Guard Practitioner at the Raúl Larcade Hospital,

San Miguel, BA. Period 1978-79

ACADEMIC ACTIVITY• Doctor of Medicine in the specialty of General Surgery.• Former President of the Argentine Society of Microcirculation and Hemorrheology.• Titular Member of the Argentine Medical Association.• Free teacher of the annual Phlebology postgraduate course UBA years 1994 and

1995.• Director of the annual Course of Updates in Phlebology of the Faculty of Medicine of the University of Buenos Aires in 1995 and 1996.

• Visiting Professor at the University “J.F. Kennedy ”in the chair of Phlebology and Lymphology.

• Guest of the Phlebology course at the Universidad del Salvador.• Director of the Higher Course in Phlebology at the Graduate School of the Argentine

Medical Association from 2012 to 2016.• President of the 1st International Congress of Microcirculation and

Hemorrheology, Buenos Aires, October 1999, AMA headquarters.• Author of 27 papers published in national and international magazines.• Creditor of eleven national and international awards.• Full Member, lecturer and panelist of multiple round tables and national and

international symposia.• Approved the course on "Administration of health services" of the Association of

Municipal Doctors of the GCBA year 2004.• Authorized Professor of General Surgery of the Faculty of Medicine of the U.B.A.

since 1987 (Teaching career)• Head of General Surgery Teaching at the UDH E. Tornú of the UBA.• Author of the book "Varicose veins and blood circulation", Ed. Medrano, 2008• President of the "XXIII Congress of the Argentine Society of Phlebology and

Lymphology", CABA, May 2017.• Former President of the Argentine Society of Phlebology and Lymphology

AWARDS1993: "Rehabilitation in severe chronic venous disease", SAFyL Award, presented at

the X Congress of Phlebology and Lymphology ". Collaboration Dr. G. Rossi and Lic. E. Risoli. From May 19 to 22 in San M. de Tucumán, Argentina.

1997: "Prize of the Argentine Society of Phlebology and Lymphology 1996-1997". "Epidemiological analysis of venous ulcers in different social strata" authors: Daniel Onorati, Guillermo Rossi, A. Ferrari, C. Felicia, E. Intriago. (0.5)

1999: Award: "Argentine Society of Phlebology and Lymphology" for the work: "Chronic venous insufficiency: evaluation by ecoDoppler of reflux patents" authors: Guillermo G. Rossi, Onorati Daniel, Felizia Cristina. In the XIII Argentine Congress of Phlebology and Lymphology. May 19-22, H.M. from Tucumán. Argentina. (0.5)

2001: Prize for the best scientific work in the clinical area for the presentation of the poster "Presentation of a protocol for therapeutic hemodilution in microcirculation disorders". I work in collaboration. (0.15)

2001 Servier Prize of the World Congress of Phlebology, Rome for the work "Parietal fibrinolytics and elastocompression", co-author.

2003: Prize for Scientific Research awarded by the Scientific Society Hospital “.E. Tornú, GCBA, October 2003 for the work "Presentation of a therapeutic hemodilution protocol in microcirculation alterations". Co-author. (1.5)

2008: Third Prize Research Work XIII Pan American Congress of Phlebology and Lymphology, October 20-22, Recife, Brazil. "Measurement of venous output and parietal elasticity in HRV and VP as hemodynamic parameters of value in echo Doppler". D. Onorati, C. Kang, E. Intriago Giller and Lic. Est. María T. Carabajal,

2009: Stimulus Award of the XVII Argentine Congress of Phlebology and Lymphology for the work "Study of ambulatory venous pressure in subjects with varicose veins", co-author.

2014: Prize "Tucuman Society of Phlebology" within the Pan American Congress of Phlebology, "Measurement of the volume of venous reflux as a parameter of the insufficiency of the internal saphenous vein", author.


One-year follow-up results of concomitant cranial saphenofemoral junction tributary ablation with laser great saphenous vein crossectomy

Tsuyoshi Shimizu1,3, Yoshio Kasuga2, Takeshi Shimizu3

1Department of Cardiovascular Surgery, Nagano Matsushiro General Hospital2Department of Surgery, Nagano Matsushiro General Hospital3Cosmos Nagano Clinic, Nagano, Japan

Backgrounds: Anterior accessory saphenous vein (AASV) insufficiency is one of the most common causes of

recurrent varicose veins after endovenous laser ablation (EVLA)1)2).

Laser crossectomy (LC) is a promising approach, however, flush occlusion or AASV occlusion rates after LC are

not always satisfactory. Flow recanalization in the AASV develops either subsequent to or simultaneously with

flow restoration in the cranial saphenofemoral junction (SFJ) tributaries, such as the superficial circumflex iliac

vein or the superficial epigastric vein. The purpose of this study was to investigate whether concomitant cranial

SFJ tributary ablation (CTA) with LC of the GSV, would achieve higher occlusion rates of the AASV after EVLA

or not.

Methods: We retrospectively analyzed 136 limbs in 126 patients undergoing EVLA aiming LC with 1470nm

diode laser between 2017 and 2018. CTA was commenced in 2018. Treated limbs were divided into two groups;

LC only in 2017 (control group, 76 limbs), LC with CTA in 2018 (CTA group, 37 limbs). Follow-up examinations

using duplex ultrasound performed for 1 year after EVLA were reviewed. Results were compared between control

and CTA group.

Results: The CTA was performed in 62% of LC procedures in 2018 for anatomical reasons. The AASV occlusion

rate (61% vs 97%) and the flush GSV occlusion rate (21% vs 60%) at 1 year were significantly (p<0.001) better in

the CTA group. No major adverse events were observed in both groups.

Conclusions: Concomitant cranial SFJ tributary ablation during LC of the GSV is safe and effective approach to

achieve better AASV occlusion rates after EVLA. It is occasionally technically demanding but can be a feasible

option. Further investigation is needed to confirm long-term efficacy of this technique.

References:1. Gauw SA, et al. J Vasc Surg. 2016;63:420-428.2. Disselhoff BC, et al. Eur J Vasc Endovasc Surg. 2011;41:685-690


Risk Factors for Major Bleeding during Prolonged Anticoagulation Therapy in Cancer-associated Venous Thromboembolisms: From the COMMAND VTE Registry

Yuji Nishimoto1, Yugo Yamashita2

1Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.2Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: Patients with cancer-associated venous thromboembolism (VTE) are at a high risk for recurrent

VTE and are recommended to receive prolonged anticoagulation therapy if they are at a low risk for bleeding.

However, there are no established risk factors for bleeding during anticoagulation therapy.

Methods: The COMMAND VTE Registry is a multicenter registry that enrolled 3027 consecutive patients

with acute symptomatic VTE in Japan between January 2010 and August 2014. The present study population

consisted of 592 cancer-associated VTE patients with anticoagulation therapy. We constructed a multivariable Cox

proportional hazard model to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) of the potential

risk factors for major bleeding.

Results: During a median follow-up period of 199 days, major bleeding occurred in 72 patients. The cumulative

incidence of major bleeding was 5.8% at 3-months and 13.8% at 1-year. The most frequent major bleeding site was

gastrointestinal (47%). Terminal cancer (adjusted HR, 4.17; 95% CI, 2.22-7.85, P<0.001), chronic kidney disease

(adjusted HR, 1.89; 95% CI 1.06-3.37, P=0.031), and gastrointestinal cancer (adjusted HR, 1.78; 95% CI, 1.04-

3.04, P=0.037) were independently associated with an increased risk of major bleeding.

Discussion: The present study revealed that major bleeding events were common during anticoagulation therapy

in cancer-associated VTE, and some characteristics were the independent risk factors for major bleeding. Previous

studies reported that metastatic cancer was an independent risk factor for major bleeding during anticoagulation

therapy1-3. In line with these reports, the present study showed that terminal cancer was a strong independent risk

factor for major bleeding, suggesting that more advanced cancers have an especially higher risk. Clinicians should

obtain a good risk-benefit balance with prolonged anticoagulation therapy in patients with advanced cancers. A

further study would be warranted to clarify the treatment strategies of anticoagulation therapy for patients with a

terminal stage.

References1. Trujillo-Santos J, Nieto JA, Tiberio G, Piccioli A, Di Micco P, Prandoni P, et al. Predicting recurrences or major bleeding in cancer

patients with venous thromboembolism: Findings from the RIETE registry. Thromb Haemost 2008; 100: 435–439.2. Prandoni P, Trujillo-Santos J, Surico T, Valle FD, Piccioli A, Monreal M. Recurrent thromboembolism and major bleeding during

oral anticoagulant therapy in patients with solid cancer: Findings from the RIETE registry. Haematologica 2008; 93: 1432–1434.3. Angelini DE, Radivoyevitch T, McCrae KR, Khorana AA. Bleeding incidence and risk factors among cancer patients treated with

anticoagulation. Am J Hematol 2019; 94: 780-785.


Investigation of D-dimer levels after treatment of perioperative venous thromboembolism in orthopedic patients What does an elevated D-dimer level after improvement in venous thromboembolism indicate?

Kensuke TakeuchiVascular Surgery, Fukuoka Rehabilitation Hospital, Fukuoka, Japan

[Background]

D-dimer is generally used to predict the effect of venous thromboembolism (VTE) treatment. However, in the

perioperative period, D-dimer levels are elevated and thereby cannot be used as an indicator. On the other hand,

D-dimer levels occasionally remain high even after VTE disappearance by anticoagulation therapy (AC), and we

experience difficulty in determining the significance. In this study, we assessed D-dimer levels after discontinuation

of AC in terms of arteriosclerosis.

[Method]

The subjects were 84 VTE patients. Ultrasonography and D-dimer testing were performed 1 month after

discontinuation of AC. Using a D-dimer level of 1.5 μg/mL as a cut-off, the patients were divided into two groups

to compare VTE recurrence rates and pulse wave velocity (PWV).

[Result]

Proximal-type VTE was identified in 1 patient, and no cases of pulmonary thromboembolism. After excluding 2

patients, AC with direct oral anticoagulants (DOACs) was administered to the remaining patients, resulting in VTE

disappearance (89.3%). The mean duration of AC was 54.5 days. Comparisons between the high D-dimer and

low groups after discontinuation of AC found that patients in the former were older, included a lower percentage

of women, and had higher D-dimer levels after surgery. The VTE recurrence rate was 35.5% in the high group,

which was significantly higher than 13.2% in the low group (p=0.0262). The PWV was 1907 in the high group,

higher than 1693 in the low group. These results showed a correlation between D-dimer levels and PWV (p=0.023,

R=0.237).

[Discussion]

Many of the patients whose D-dimer remained high after improvement in VTE had a high VTE recurrence rate.

Therefore, these patients need to be followed up carefully even after VTE disappearance. In addition, D-dimer

tended to be high in patients with advanced arteriosclerosis, suggesting that not only VTE but also arteriosclerotic

disease should be meticulously followed up.


Time course of leg edema after endovenous radiofrequency ablation for saphenous varicose veins

Toshiya Nishibe1,2, Masayasu Nishibe1, Shinobu Akiyama2, Saori Nukaga2, Hitoshi Ogino2

1Department of Surgery, Eniwa Midorino Clinic, Eniwa, Japan2Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan

Background. To quantitatively evaluate leg edema in patients undergoing endovenous radiofrequency ablation

(RFA) for saphenous varicose veins using bioelectrical impedance analysis (BIA), and to elucidate the time course

of leg edema after RFA.

Methods. The data of 87 patients with 128 limbs undergoing RFA for saphenous varicose veins in Eniwa Midorino

Clinic From April 2018 to November 2019 were retrospectively analyzed. Before and 1 week and 1 month after

RFA, extracellular water/total body water (ECW/TBW) was measured as an index of leg edema with BIA. ECW/

TBW ≥ 0.400 was defined as having significant (moderate to severe) leg edema, while ECW/TBW < 0.400 was

defined as having mild or no leg edema.

Results. The body composition analyzer revealed that, before RFA, 26 legs (20.3%) had significant edema and

102 legs (79.7%) had mild or no leg edema. The patients with significant leg edema were significantly increased

at 1 week (p < 0.05) and decreased at 1 month (p < 0.01), when compared to preoperatively (Fig. 1). The value

of ECW/TBW significantly increased from preoperatively (0.393 ± 0.008) to at 1 week postoperatively (0.394 ±

0.008, p < 0.05), whereas it significantly decreased from preoperatively or at 1 week postoperatively to 1 month

postoperatively (0.391 ±0.008, p < 0.05)

Conclusions. This study quantitatively revealed the time course of leg edema after RFA. Although leg edema

temporarily worsens in the early postoperative period, it is improved as the heat-induced injury of the target vein

and surrounding tissues is recovered.

Fig. 1. Percentage of leg edema at each follow-up interval compared with preoperative measurement. ECW/TBW,

extracellular water/total body water.


COVID-19 and Venous Thromboembolism in Japan: From the Joint Questionnaire Surveillance Results

Yugo Yamashita1, Norikazu Yamada2, Mo Makoto3

1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan2Department of Cardiology, Kuwana City Medical Center, Kuwana, Japan3Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Kanagawa, Japan

Background: Several studies reported a high prevalence of venous thromboembolism (VTE), including pulmonary

embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19)1,2. However, there is a scarcity

of data on current status of VTE in patients with COVID-19 in Japan.

Methods: In a collaborative effort with Japanese Society of Phlebology (JSP) and Japanese Society of Pulmonary

Embolism Research (JaSPER), a questionnaire surveillance for COVID-19 and VTE has been conducted. In July

2020, a questionnaire regarding management strategies for anticoagulation, the number of patients hospitalized

for COVID-19, and the number of patients who developed VTE after diagnosis of COVID-19 from March 2020

to June 2020 was distributed among members of JSP and JaSPER.

Results: A total of 837 institutions were included, and the total response rate was 9.2% (77/837), which included

32% of university hospital (25/77) and 42% of certificated institutions for infectious diseases (32/77). Among 77

institutions, only 16 institutions had specific recommendations for prevention of VTE with anticoagulation, and the

rest of vast majority of institutions (79%) did not have specific recommendations. In the questionnaire surveillance,

a total of 1243 patients with COVID-19 among 77 institutions were evaluated, and 7 patients experienced VTE

occurrence, which consisted of 5 PE occurrence. The incidence rate of VTE was 0.6% (7/1243), and that of PE

was 0.4% (5/1243).

Discussion: The current questionnaire surveillance has suggested that management strategies for the prevention of

VTE by anticoagulation in COVID-19 could be varied widely according to institutions, and the number of patients

diagnosed as VTE in COVID-19 in Japan was quite small compared with reports from other countries than Japan.

It has been unknown whether these results suggest the under-diagnosis of VTE in COVID-19 in Japan or actual

lower prevalence of VTE in Japan. Further studies are warranted to confirm these results.

Reference1. Cui S, Chen S, Li X, Liu S and Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus

pneumonia. J Thromb Haemost. 2020;18:1421-1424.2. Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M and Merouani K. High incidence of venous

thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;18:1743-1746.


Combined segmentary endovenous laser treatment (EVLT) and liquid sclerotherapy of varicose veins for decrease postoperative pain and paresthesia

Jorge Flores, Rodriguez G, Godoy RSurgery at the National University of Medicine, Asuncion, Paraguay

Objective: To decrease the postoperative pain of patients who underwent surgery of theirs varicose veins.

Methods: Our series included 59 patients and 84 limbs with superficial venous insufficiency, treated by EVLT of

greater saphenous vein (GSV) and/or lesser saphenous vein, combined with liquid sclerotherapy with polidocanol

for tributaries varicose veins. EVLT of the GSV were carried out from the saphenofemoral junction to the proximal

1/3 of the calf to avoid damage to the saphenous nerve. The patients comprised 20 males and 39 females. Control

Duplex ultrasound were carried out on second postoperative day and 2 month after the operation, as well as, focal

pain experienced by the patients was evaluated using de visual analog scale (VAS) on the second postoperative

day and then, 2 months later.

Results: The preoperative VSA diminished from 32.2 ± 6.8 millimeters on the second postoperative day to 1.3 ±

1.9 millimeters 2 months later. The GSV occlusion rate by 2 month was 100%.

Conclusion: Combined EVLT with liquid sclerotherapy is a reasonable alternative for management of postoperative

focal pain after varicose veins operations.

Key words: Laser therapy, Varicose veins, Postoperative pain

Curriculum Vitae

Prof. Jorge Flores, MD, PhD.- Professor of Surgery at the National University of Medicine, Asuncion, Paraguay.- Coordinator of the Pediatric Kidney Transplant Team of the Hospital of the National University of Medicine, Asuncion, Paraguay.- Vascular Surgeon at the Baptist Medical Center, Asuncion, Paraguay.


Viscous biomatrix sclerofoam –a new therapy for large recurrent varices

Johann Christof RaggFounder & CEO of angioclinic Vein centers, Berlin, Germany

Purpose: Recurrent varicosities are a very common and complex phenomenon after leg vein surgery. Usually,

surgical therapy is again chosen, although the targets are much more difficult due to irregular shape, deep sources

and scar tissue. A novel catheter-deployed viscous microfoam using a biomatrix based on denatured autologous

blood proteins is currently in evaluation for these targets.

Material/Methods: For a prospective pilot study, 85 patients (56 f, 29 m, 31 – 78 y.) with large and tortuous

recurrent varices (5 – 15 mm Ø, mean 8.2 mm; 291 targets) were selected in bail-out situations to receive

biomatrix sclerofoam (BSF, prototype, Venartis, laboratory-prepared) instead of standards. BSF consisting of 40%

Aethoxysklerol 2%, 20% biomatrix and 40% filtrated air was deployed via catheter (PhleboCath, 2.0 – 2.3 mm Ø,

or Microcaths 1.6 mm Ø). Follow-up ultrasound was performed after 2 weeks, 2 months and one year.

Results: Primary total occlusion of all segments intended to treat was obtained in 280/291 cases (96.9%). 11/291

targets (3.8%) required a second foam application (GSV: n = 3, SSV n = 2, tributaries: n = 2, perforators: n = 3,

superficial recurrences n = 1). There were no complications, in particular no DVT. After one year, partial and focal

reperfusion was observed: SFJ: 3/65 (4.3%), GSV: 4/65 (6.2%), SPJ: 2/20 (10.0%), SSV: 2/31 (6.4%), tributaries:

6/64 (9.4%), perforators: 4/43 (9.3%), superficial varicosities: 4/61 (6.5%). None of the cases had any related

symptoms.

Conclusions: Viscous biomatrix sclerofoam seems to be safe and effective for use in large recurrent varices, with

good options for future interventional therapy.


Curriculum Vitae

Johann Christof Ragg, MD

Personal Information Date of birth: 14.2.1957 Place of birth: Bad Wildungen/Hessen, Germany Marital Status: married, Mrs. Birgit Marquardt – Ragg Children: 4 children 19 - 28 y. Profession: Clinical and interventional Phlebology Career 2020 President of the German Workgroup on Prevention in Phlebology 2019 Organizer of "Berlin Workshops for Future Phlebology" Honorary Fellow, ACP, Australasian College of Phlebology CX London, Certificate of Merit: 6 stages of vein valve insufficiency 2018 Hiroshi Miyake Award Winner, “Hyaluronan in Phlebology” EVF Poster Prize (Adjunctive hyaluronan instead of tumescence) Lecturer for Vascular Ultrasound, University Clinic Charité Berlin 2017 AVF, New Orleans: Servier Travel Award winner (High-resolution ultrasound for

vein valves) ACP, Austin: Presentation prize (Valve damage in children), poster prize (EHIT)

2016 CX Symposium London: Certificate of Merit for presentation “Percutaneous valvuloplasty – a new way to vein restoration” German Society for Phlebology, First Poster Prize (Biomatrix sclerofoam)

2015 ACP, Orlando: Platinum Award – Percutaneous Valvuloplasty: Minimal-Invasive Restoration of Vein Valve Function Using Cross-Linked Hyaluronan

2000-14 Foundation of angioclinic® vein centers Berlin, Munich, Zurich 1990-97 Charité University Clinic, Berlin

Berlin, 26.8.2020 ………………………………………………………

Johann Christof Ragg

Founder and CEO of angioclinic® Vein Centers

Bayreuther Straße 36

10789 Berlin

Germany

Business Phone Number: +49 (0)171 3717 424

Email: [email protected]

Fax: +49 (0)30 21 28 04 10


AVOIDING COMPLICATIONS IN FOAM SCLEROTHERAPY

MALAY PATELAhmedabad, INDIA

Background

Foam sclerotherapy has emerged as a reliable and economical way of eliminating superficial venous reflux by

sclerosis.

Aim

Complications of sclerosants are very rare and anecdotal and can be avoided.

Methods

The complications of foam sclerotherapy can be avoided by using sclerosants manufactured using Good

Manufacturing Practices and use of physiological gases.

Injections of foam should be made under ultrasound guidance and at multiple sites spread out over multiple

sessions. Use of low silicone syringes and low injection pressure should be used to avoid retrograde movement

into an arteriole and cause tissue necrosis. An upper limit of injecting foam ranges from 10-20 cc.

Extravasation of small amounts (0.1 to 0.2 ml) of foam into subcutaneous tissue happens frequently and is safe.

Systemic predisposing factors were co-related with cerebrovascular symptoms are a patent foramen ovale and

migraine and release of histamine and endothelin.

Post procedural mobility is essential

Results and Conclusions

Ultrasound guided foam sclerotherapy is very safe when performed with attention to detail.

1. European guidelines for sclerotherapy in chronic venous disorders.Rabe E, Breu FX, Cavezzi A, Coleridge Smith P, Frullini A, Gillet JL, Guex JJ, Hamel-Desnos C, Kern P, Partsch B, Ramelet AA, Tessari L, Pannier F; Guideline Group. Phlebology. 2014 Jul;29(6):338-54. doi: 10.1177/0268355513483280. Epub 2013 May 3

2. http://www.phlebology.com.au/newsletter_docs/ACPUGSStandard2016.pdf3. Goldman MP. Sodium tetradecyl sulfate for sclerotherapy treatment of veins: Is compounding pharmacy solution safe? Dermatol

Surg 2004;30:1454-1456. 4. Robert A. Weiss, MD, Robert Voigts, MS, David J. Howell, PhD. Absence of Concentration Congruity in Six Compounded

Polidocanol Samples Obtained for Leg Sclerotherapy. Dermatol Surg 2011 Jun;37(6):812-5. doi: 10.1111/j.1524-4725.2011.01906..x.

5. Macht DI. A Pharmacological and Therapeutic Study of Benzyl Alcohol as a Local Anesthetic. J Pharmacol Exp Ther 1918 6. Tessari L. Nouvelle technique d’obtention de la scle ́ro- mousse. Phle ́bologie 2000;53:1297. Mowatt-Larssen E, Shortell CK. http://emedicine.medscape.com/article/1895467-overview8. Erkin A, Kosemehmetoglu K, Diler MS, Koksal C. Evaluation of the Minimum Effective Concentration of Foam Sclerosant in

an Ex-vivo Study. Eur J Vasc Endovasc Surg 2012; 44(6):593-79. Hamel-Desnos C ,Ouvry P ,Benigni JP, Boitelle G, Schadeck M, Desnos P, Allaert FA. Comparison of 1% and 3% polidocanol

foam in ultrasound guided sclerotherapy of the great saphenous vein: a randomised, double-blind trial with 2 year-follow-up. "The 3/1 Study” Eur J Vasc Endovasc Surg 2007; 34(6):723-9

10. Yiannakopoulou E. Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins. Pharmacology 2016;98:62-69 https://doi.org/10.1159/000445436


11. Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology 2012;27 Suppl 1:46-51. doi: 10.1258/phleb.2012.012S0912. Hayward WA, Haseler LJ, Kettwich LG, et al. Pressure generated by syringes: Implications for hydrodissection and injection

of dense connective tissue lesions. Scand J Rheumatol;40(5):379-826.13. Izafalia M, Sixou J-L. Administration of anesthetics using metal syringes. An ex vivo study. Anesth Prog. 2011

Summer;58(2):61-657.14. Claudio R, Hadzic A, Shih H et al. Injection pressures by anesthesiologists during simulated peripheral nerve block. Reg Anesth

Pain Med, 2004;29:20-20.15. Malouf GM, Conrad P, Stacey MC. The Australian Polidocanol Study – October 1991 to December 1994. Scope on Phlebology

and Lymphology. 1996; 3:8-11.16. Parsi K, Hannaford P. Intra-arterial injection of sclerosants: Report of three cases treated with systemic steroids, Phlebology

2015 DOI: 10.1177/026835551557898817. Bihari, I. and Magyar, É. (2001), Reasons for Ulceration After Injection Treatment of Telangiectasia. Dermatologic Surgery, 27:

133–136. doi:10.1046/j.1524-4725.2001.00298.x18. Miyake RK, King JT, Kikuchi R, Duarte FH, Davidson JR, Oba C. Role of injection pressure, flow and sclerosant viscosity in

causing cutaneous ulceration during sclerotherapy. Phlebology. 2012 Dec;27(8):383-9. doi: 10.1258/phleb.2011.011076. Epub 2012 Feb 8

19. Tran D, Parsi K. Veno-arteriolar reflex vasospasm of small saphenous artery complicating sclerotherapy of the small saphenous vein. ANZ J Phleb 10(1) 2007:p29-32

20. Ferrara F, Ferrara G. The chemical mediators of some sclerotherapy complications. (In French) Phlebolgie 2012, 65 p1-521. Frullini A, Felice F, Burchielli S, Di Stefano R. High production of endothelin after foam sclerotherapy: a new pathogenetic

hypothesis for neurological and visual disturbances after sclerotherapy. Phlebol/Venous Forum R Soc Med 2011;26:203-8

Curriculum Vitae

Short biography MALAY PATEL drmalaypatel.comFormer Assistant Professor of Vascular Surgery at Gujarat University, Dr. Malay Patel, now is a vascular-endovascular surgeon and phlebologist in private practice in Ahmedabad, India.He was the President of Vascular Society of India from 2003-2005 and Founding President of the Venous Association of India from 2007-2009.He was the Vice-President of the International Union of Phlebology from 2013-2017 and is now its Assistant General Secretary till 2021.His main area of interest for treating arterial insufficiency lies in distal revascularizations for critical limb ischemia and carotid endarterectomy for cerebral ischemia.His main area of interest in venous insufficiency lies in managing superficial venous reflux with ultrasound-guided foam and early treatment of deep venous thrombosis by thromboaspiration and short duration thrombolysis.He travels extensively for learning and teaching and invited speaker at conferences and workshops worldwide.He is a reviewer for the Indian Journal of Surgery, Indian Journal of Vascular and Endovascular Surgery, European Journal of Vascular and Endovascular Surgery, International Angiology, and Phlebology.

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