Starting an endovascular vein program : tools, facilities and management of patients

1. Starting an endovascular vein program : tools, facilities and management of patients Jacques Bleyn Antwerp Blood-vessel Center (ABC) Belgium

2. ABC principles • Endovascular • Percutaneous • Local anaesthesia • Day clinic

3. Is it necessary to do these treatments in a clinic or can they be done safely office-based?

4. Preop preparation • No preop examinations • Mild anxiolytic drug • Shaving over the varicose veins • Antithrombotic stocking at the controlateral limb • Marking with echography in standing position by the surgeon that will perform the intervention

6. local anesthesia • Under echo graphic control with isotonic bicarbonate solution with only 20 cc Xylocain 1%/500 cc. • Femoral block with 30cc Lidocain 1% to make the administration of the tumescence painless

7. Isotonic bicarbonate please Courtesy of Dr. Denis Creton

9. Tumescent anesthesia under echo

10. Endovenous treatment • Puncture of the Saphenous Vein at knee level under echography or at ankle. • Positioning of the catheter at the Sapheno-femoral junction. • Administration of the tumescent anaesthesia and RF-treatment.

11. Puncture under echography

13. Surgical complement • Müller excision of varicous side branches in thigh and calf under local anaesthesia with the same bicarbonate solution • Steristrips, compression bandage and immediate mobilisation. • Discharge +/- 2 hours postop with elastic stocking for 1 week. 24 hrs work incapacity.

14. conclusion To start your endovenous programme, you need: • An endovascular mind. • A quality Duplex scan and the necessary skill to use it pre- and peroperatively, a sterile sleeve and sterile gel. • Local anaesthesia skills.

15. Conclusion 2 This is all easy to obtain and will make you hate classical surgical stripping.

16. Thank you