WORKSHOP OBJECTIVES
General Objectives
To educate, train and update learners (the delegates) in the current clinical management of patients with venous disease by close informal interaction with venous experts during lectures, case discussions and hands-on activities in small groups.
At the end of this course the learner (delegate) should be able to:
1. Identify venous disease in patients
2. Apply appropriate venous investigations
3. Construct a plan for management
4. Understand different interventional procedures
5. Successfully incorporate treatment of venous patients in his/her practice
6. Realize when to refer a patient for expert care
WORKSHOP OUTLINES
Station 1. Radio Frequency Ablation
Faculty: Jose Maria Hipola Ulecia.
The ClosureFast™ Endovenous Radiofrequency Catheter, its unique attributes and placement will be briefly introduced. The participants will learn how to accurately place the catheter tip at the sapheno-femoral confluence and to sequentially withdraw the catheter in a leg simulator. Tips and tricks to achieve successful ablation in different situations will be pointed out.
Objectives: The learner should be able
1. to cannulate a vein under ultrasound guidance.
2. to appropriately place the ClosureFAST® catheter at the sapheno-femoral confluence using ultrasound.
3. to infiltrate an adequate tumescent anesthesia.
4. to perform a saphenous ablation with the ClosureFAST® catheter.
Station 2. Venous Stent
Faculty: Stephen Black
The venous stent station will offer a hands on workshop where participants will deploy the Abre™ venous stent in a venous anatomy model. Participants will also engage in a discussion on why venous stenting is important for the treatment of venous outflow obstruction in the iliofemoral veins and inferior vena cava. Participants will learn about the key requirements in Abre’s™ stent design, such as strength, flexibility, endurance, and precision.
Objectives: The learner should:
1. Learn about the possibilities of venous stenting for the treatment of chronic venous obstruction/occlusion.
2. Learn about specific features of the ABRE stent and its applicability.
3. Learn how to deploy an ABRE stent.
Station 3. Medical adhesive Ablation
Faculty: Tahir Hussain
The VenaSeal™ procedure, its unique attributes and placement will be briefly introduced. The VenaSeal™ Closure System is a non-tumescent, non- thermal, non-sclerosant procedure that uses a proprietary medical adhesive delivered endovenously to close the vein. The VenaSeal™ Closure System was shown to be effective in several clinical studies, with demonstrated safety and high closure rates. Tips and tricks to achieve a successful procedure will be pointed out.
Objectives: The learner should be able
1. to appropriately place the VenaSeal™ catheter at the sapheno-femoral confluence using ultrasound
2. to perform all procedural steps to treat the veins utilizing the VenaSeal system
3. to understand the key clinical benefits of the VenaSeal system
Station 4. Varicose Vein Surgery
Faculty: Olle Nelzen
The participants will obtain information about the techniques of modern surgical treatment of superficial vein incompetence. The methods as well as their indications will be discussed. The principles of high ligation, surgical stripping, mini-phlebectomy and other open surgical procedures will be presented and discussed. The cases of the varicose vein surgical treatment will be discussed with the workshop participants.
The workshop participants should be able to:
- Understand different surgical procedures including high ligation, striping, phlebectomy as well as saphenous saving surgery.
- Choose the proper kind of the surgical treatment adjusted to the pathology reported in the particular patient.
- Know the indications and contraindications of modern surgical treatment
- Know the principles of mini-phlebectomy of the tributaries as the part of the surgical or hybrid treatment
Station 5. Compression Therapy
Faculty: Karin van der Wegen
This workshop aims to highlight treatment of venous leg ulcers by the use of ulcer debridement and compression therapy – the medi therapy chain. A simple effective debridement by sampling a debridement cloth and measurement and fitting of a Velcro device will be demonstrated. The learners will then practice the use of the debridement cloth and apply an effective and measurable compression on each other. Case studies will be available on the website, which illustrate the results obtained by this method.
Objectives: The learners should be able
1. to understand the medi therapy chain.
2. to use a pre-moistened debridement cloth.
3. to measure, cut and apply a measurable, re-adjustable compression device.
Station 6. Venoactive Drugs
Faculty: Joana Ferreira
Participants will obtain more information about working mechanism, indications and potential benefits of veno-active drugs in patients with chronic venous disease. They will discuss the different symptoms, for which veno-active drugs are most effective. They will also look at the various clinical scenarios, in which veno-active drugs may be useful as primary treatment or adjunctive therapy.
Objectives: The learner should be able
1. to understand how veno-active drugs act on the underlying pathophysiology of chronic venous disease
2. to know when to prescribe veno-active drugs for different symptoms and for the different C-classes
3. to evaluate effectiveness of veno-active drugs
Station 7.Pelvic Embolisation
Faculty: Suat Doganci
The participants will obtain the knowledge and indications for pelvic vein embolization.
The technique of pelvic vein venography as well as pelvic vein embolization and pelvic vein disease will be presented and discussed with the participants.
The learners should be able to:
- Understand the pathology leading to the venous hypertension in the pelvic circulation
- Specify the indications to the pelvic vein embolisation
- Understand the prinicples of pelvic vein venography
- Choose the proper vascular access to the pelvic vein venography and embolisation
- Choose the proper technique of the pelvic vein embolisation
- Propose the treatment of the patients with varicose veins of pelvic origin with and without pelvic symptoms
Station 8. IVUS
Faculty: David Greenstein
The participants will familiarize themselves with the technology and functionality of the IVUS imaging technology in deep venous procedures. We will discuss the venous procedural workflow incorporating IVUS and explain the benefits over just venography.
Key image interpretation, as well as a hands on experience using the latest Core M2 mobile IVUS system form an integral part of the session.
Objectives: After the session, the learner should be able:
1. To understand the value of IVUS-guided deep venous stenting
2. to recognize and interpret key IVUS images in venous procedures
Ultrasound Workshops
The imaging ultrasound workshop will have 4 stations with 1-2 instructors each. It will demonstrate the imaging protocols for evaluating acute and chronic venous disease. The participants will perform live imaging in volunteers with different vein pathologies. The importance of positioning of the patient, use of appropriate transducers, imaging principles and optimization of the image will be emphasized. Non-venous ultrasonographic findings, which mimic the signs and symptoms of DVT of the lower limb will be discussed.
General Objectives: The learner should be able
1. to identify the ultrasound anatomy of the veins and the surrounding tissues.
2. to recognize the ultrasonographic criteria for diagnosis of acute and chronic venous disease.
3. to be acquainted with non-venous pathology that could explain the patient’s complaints.
Station 9. Recurrent varicose veins
Faculty: Joel Sousa
Objectives. The learner should be able
1. to identify anatomical sites of recurrence
2. to recognize neovascularization and lymph node venous networks
3. to detect escape points and course of recurrent reflux
Station 10. Superficial veins
Faculty: Jose Lopes
Objectives. The learner should be able
1. to detect reflux in the GSV, SSV and AASV and their tributaries.
2. to recognize the connections between the GSV and SSV
3. to find common perforator sites and what defines a pathological perforator
4. to plan the most appropriate intervention based on the clinical situation and duplex ultrasound findings
Station 11. Deep Venous Obstruction
Faculty: Rita Augusto
Objectives. The learner should be able
1. to identify iliac obstruction after previous deep vein thrombosis
2. to identify post-thrombotic lesions in deep veins below the inguinal ligament
3. to detect collateral pathways for the venous return in case of deep venous obstruction
Station 12. Abdominal and pelvic vein investigation
Faculty: Daniel Brandao
Objectives. The participants should be able
1. to identify the main deep veins from the diaphragm to the inguinal ligament.
2. to detect compression of the veins such as in cases with nutcracker and iliac vein compression syndromes.
3. to identify the ovarian veins and internal iliac veins and use different testing manoeuvres to detect reflux.
Station 13. Intermittent Compression Device
Faculty: Rupert Bauersachs
The Kendall SCD™ 700 Compression System is a non-invasive device, which provides intermittent pneumatic compression to the lower extremities. The system consists of the controller, tubing set and single patient use garments. Compression is applied through sequential, gradient, circumferential inflation at a frequency determined by the individual patient’s venous refill time.
The learners will use duplex ultrasound to demonstrate the increased volume flow and velocity achieved with intermittent pneumatic compression while observing the unique Vascular Refill Detection (VRD) technology.
The attendees will learn about the increased volume flow and velocity achieved with intermittent pneumatic compression while observing the unique Vascular Refill Detection (VRD) technology.
Objectives: The learner should be able
1. to describe the mechanisms involved in prevention of VTE using mechanical prophylaxis.
2. To apply risk assessment tools to analyse patient risk level for VTE.
3. to explain the physiologic basis for Vascular Refill Detection and impact on blood flow.
Station 14. Laser Ablation
Faculty: Lars Mueller
The learners will practice endovenous ablation of the saphenous veins using the Biolitec ELVeS® Radial 2ring™ and ELVeS Radial Slim™ fiber with a 1470 nm laser generator. The unique features of this system will be emphasized. The learners will learn to decide the dosage of energy. The learners will perform the longitudinal and transverse access to the vein and treatment under ultrasound guidance on phantom legs. Tips and tricks will be pointed out.
Objectives: The learners should be able
1. To plan the ELVeS® Radial treatment, decide on dosage of energy and adjust the generator accordingly.
2. To access the vein by micro puncture technique under ultrasound guidance and place the fiber tip correctly.
3. To perform a radial laser ablation of the saphenous vein.
Station 15. Compression stocking
Faculty: Michael Juenger
The need for different types of medical compression stockings (MCS) and what distinguishes highly elastic MCS from short stretch MCS with high working pressure will be discussed. The main focus is on a practical comparison of long and short stretch stockings. The participants will learn and practice leg measuring and how to read sizing tables. They will apply long stretch and short stretch stockings with and without a fitting aid. Using Picopress to measure the pressure of the stockings, each participant will experience differences in working pressure.
Objectives: The learner should be able
1. to measure a leg.
2. to find the appropriate stocking-size by use of tables.
3. to apply long and short stretch MCS, with and without fitting aid.
4. to differentiate between highly elastic stockings and short stretch stockings with high working pressure.
Station 16. Foam sclerotherapy
Faculty: Tomasz Urbanek
Indications for foam and liquid sclerotherapy will be discussed as well as injection techniques and the use of the various concentrations of the sclerosant. Different foam producing techniques will be demonstrated and the learners will be trained how to produce good quality foam with Aethoxysklerol®. The EasyFoam® Kit and other techniques of foam preparation will be presented and discussed. Cannulation of spider veins will be practiced using the respective phantom. The techniques of the small and large vein visualisation and puncture will be discussed (including transillumination by Veinlite LED®). Tips and tricks for optimal results will be pointed out.
Objectives: The learner should be able:
1. to plan the sclerotherapy treatment and decide on the appropriate dosage and concentration.
2. to perform sclerotherapy with the proper technique.
3. to produce microfoam, which is stable, fine-bubbled, viscous and homogenous
Station 17. Open Valve Reconstruction
Faculty: Sergio Silva
Different techniques of deep valve repairs will be demonstrated by video. Selection of patients and technical tips and tricks will be discussed.
Objectives: The learner should be able
1. to select patients considered for deep valve repair.
2. to choose what technique to apply depending on the morphological findings
3. to outline the procedural details of primary repair, external repair, transposition, axillary vein transfer and neovalve construction
Station 18: Leg Ulcer Treatment
Faculty: Dominik Heim
Venous ulcers (C6) are the late stage of chronic venous insufficiency due to venous hypertension. In treating ulcers all manœuvres of reducing venous hypertension have to be considered and later or additionally local treatment has to take place. As this is a lot to consider and to elaborate in a 30 minutes-workstation the following topics with a maintopic per day will be discussed :
Thursday : Treatment of the source of venous hypertension: Truncal insufficiency:
reference to working stations « ablation »
perforator insufficieny : phlebectomy (reference to the working station « surgery »),
foam sclerotherapy : demonstration of « Varixio
Friday : Compression
Demonstration of wraps : Compreflex and Coolflex (Sigvaris)
Saturday : Local treatment
Demonstration of Medihoney (Integra)
All subjects will be touched briefly in the introduction at the booth.
Objectives: The learners should be able
1. to localise the source of insufficiency and know how to treat it
2. to know the use of compressions wraps
3. to know one option (honey) for local treatment
Station 19. Thrombectomy
Faculty: Efthymios Avgerinos/Niels Baekgaard
The participants will be informed about indications and strategies for acute thrombus removal, mainly through mechanical thrombectomy with the Aspirex® Device. Different catheters will be discussed and demonstrated. Clinical cases will be discussed, pointing at all important details to obtain a successful treatment result. Indications for additional stent placement, post-treatment surveillance and anticoagulant treatment will all be considered.
Objectives: The learner should be able
1. to determine proper indications for acute thrombus removal
2. to understand the differences and techniques of catheter-directed thrombolysis and mechanical thrombectomy using the Aspirex® Device
3. to know when additional stent placement is required
4. to schedule post-treatment surveillance and determine the anticoagulant treatment
Station 20. Venous Stent
Faculty: Houman Jalaie/Hayley Moore
The venous stent station will offer a hands-on workshop where participants will deploy the VENOVO ® venous stent in a venous anatomy model. Participants will also engage in a discussion on why venous stenting is important for the treatment of venous outflow obstruction in the iliofemoral veins and inferior vena cava. Participants will learn about the key requirements in venous stent design, such as strength, flexibility, endurance, and precision.
Objectives: The learner should:
1. Learn about the indications of venous stenting for the treatment of chronic venous obstruction/occlusion.
2. Learn about specific features of the VENOVO® stent and its applicability.
3. Learn how to deploy a VENOVO® stent