Description
Beyond the Basics: Managing Perforator Vein Insufficiency delves into advanced strategies for diagnosing and treating this key contributor to chronic venous disease. While often overlooked, incompetent perforator veins can significantly worsen symptoms like leg swelling, skin changes, and venous ulcers. This session explores the role of detailed duplex ultrasound evaluation, patient selection, and evolving minimally invasive treatments such as endovenous thermal ablation and perforator ligation. Emphasis is placed on individualized care plans to improve long-term outcomes and prevent recurrence.
Summary Listen
- Dr. Jan Stupanski presented a webinar on managing perforator vein insufficiency, emphasizing their clinical importance in connecting superficial and deep venous systems. Incompetent perforators contribute to venous hypertension, swelling, skin changes, and ulcers, often being an underestimated source of venous leaks. Closing these incompetent perforators via techniques like EBLA, RFA, CCR, and sclerotherapy has closure rates averaging 60-80%, but early intervention is crucial to manage venous disease.
- Diagnosis strategies should begin with a duplex ultrasound performed while the patient is standing to identify reflux of over 0.5 seconds in perforators wider than 3.5mm. While ESDS guidelines limit ablation indications, Dr. Stupanski believes expanding them to symptomatic C3 grade patients with a family history should be considered. Treatment options include ablation and indication, with ablation techniques using microwave, laser, radio frequency, and steam devices.
- The procedure involves detailed duplex ultrasound mapping, operating field preparation, IPV puncture under ultrasound guidance, catheter insertion, and laser fiber placement. Energy delivery is monitored via ultrasound, and post-procedure care includes compression therapy, ambulation, and follow-up duplex ultrasound to confirm occlusion. Addressing significant reflux improves ulcer healing, reduces recurrence, and achieves high closure rates.
- Key takeaways include mastering Doppler ultrasound, addressing perforators in advanced disease, and avoiding procedures without proper imaging. Technical competence and patient selection are paramount, with a practical skills-focused approach to venous care. Dr. Stupanski shared a QR code linking to a video demonstrating perforator ablation and thanked participants for their engagement.
Sample Certificate
About the Speakers
Dr. Jan Szczepanski
CEO and Co-Founder, Melius Clinic, Poland
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