The Experts below are selected from a list of 540 Experts worldwide ranked by ideXlab platform
Stefano Ricci - One of the best experts on this subject based on the ideXlab platform.
-
dilution of a mepivacaine adrenaline solution in isotonic sodium bicarbonate for reducing subcutaneous infiltration pain in ambulatory Phlebectomy procedures a randomized double blind controlled trial
Journal of The American Academy of Dermatology, 2014Co-Authors: Leo Moro, Stefano Ricci, Francescomaria Serino, Gloria Abbruzzese, Raffaele AntonelliincalziAbstract:Background Varicose veins are treated under local infiltration anesthesia. Literature shows that adding sodium bicarbonate reduces the pain associated with local infiltration anesthesia. Nonetheless, sodium bicarbonate is underused. Objective We sought to assess if the use of a solution of mepivacaine 2% plus adrenaline with sodium bicarbonate 1.4% results in less pain associated with local infiltration anesthesia preceding ambulatory phlebectomies, compared with standard preparation diluted with normal saline. Methods In all, 100 adult patients undergoing scheduled ambulatory Phlebectomy were randomized to receive either a solution of mepivacaine chlorhydrate 2% plus adrenaline in sodium bicarbonate 1.4% or a similar solution diluted in normal saline 0.9%. Results Median pain scores associated with local infiltration anesthesia reported in the intervention and control groups were 2 (SD = 1.6) and 5 (SD = 2.0) ( P Limitations Patients were not asked to distinguish the pain of the needle stick from the pain of the infiltration. Moreover, a complete clinical study of sensitivity on the infiltrated area was not conducted. Conclusions Data obtained from this study may contribute to improve local infiltration anesthesia in ambulatory Phlebectomy and other phlebologic procedures.
-
Ultrasound assisted great saphenous vein ligation and division: an office procedure
PAGEPress Publications, 2014Co-Authors: Stefano Ricci, Leo Moro, Raffaele Antonelli IncalziAbstract:The aim of this proof of concept study is to describe an ultrasound (US) assisted simplified surgical procedure for pre-terminal great saphenous vein (GSV) high ligation/division avoiding groin dissection and tributary interruption, in an office setting, in association to varices Phlebectomy and saphenous vein foam occlusion treatment. Inclusion criteria: primary GSV reflux due to terminal valve, vein diameter >6 mm. By ultrasonography in standing position, the point GSV passing over the adductor longus muscle (about 3 cm from the junction) is identified. This E (easy) point, relatively superficial, free from tributaries and other structures, allows an easy grasping and extraction of the GSV vein through a 3 mm stab incision provided an ultrasonography assistance. The vein is divided/ligated about 2 cm distal from the ostium, the distal stump is cannulated and foam is injected on the distal segment from the E-point incision in a retrograde fashion, varices are avulsed by Phlebectomy. Twenty procedures in 18 patients (venous clinical severity score: mean 3.15 - GSV diameter: mean 7.34) were performed, all the cases without inconveniences, with a duration not exceeding 10 min in addition to the Phlebectomy procedure time. No complications as hemorrhage, infection, nerve lesion, lymphatic leak or thrombosis have been registered. At one month the residual saphenous stump length was in average 2.16 cm with complete closure of GSV in all. Three patients have been controlled at 6 months showing GSV complete closure. The procedure described is a simple office US assisted method for GSV ligationdivision, leaving the 2 last cm of the saphenofemoral junction. It could be associated to most of the procedures in use with limited additional time and resources required
-
Comment to: Drop foot, a rare complication following Müller’s Phlebectomy, by Otters EFM, van Neer PAFA. Phlebology 2012;27:1-2.
Veins and Lymphatics, 2012Co-Authors: Stefano RicciAbstract:A 43-year old woman had previously undergone bilateral surgical stripping of the great saphenous vein and the right small saphenous vein and subsequent sclerottherapy. She later presented with reticular visible asymptomatic varicose veins on the dorsolateral side of the right upper leg up to shortly below her knee. A Phlebectomy was performed by local anesthesia (non-tumescent) with approximately 15 cm3 lidocaine 1%. Immediately after Phlebectomy, the patient noticed weakness of the right foot, right foot drop, without neurological pain. The drop foot disappeared spontaneously after several hours without therapy. The sciatic nerve runs behind the femur from the buttock to the lower thigh where it divides into the common peroneal nerve (CPN) and tibial nerve. The CPN then descends along the lateral side of the popliteal fossa to the head of the fibula. It winds round the head of the fibula and divides into the superficial peroneal nerve and the deep peroneal nerve....
-
comment to drop foot a rare complication following muller s Phlebectomy by otters efm van neer pafa phlebology 2012 27 1 2
Veins and Lymphatics, 2012Co-Authors: Stefano RicciAbstract:A 43-year old woman had previously undergone bilateral surgical stripping of the great saphenous vein and the right small saphenous vein and subsequent sclerottherapy. She later presented with reticular visible asymptomatic varicose veins on the dorsolateral side of the right upper leg up to shortly below her knee. A Phlebectomy was performed by local anesthesia (non-tumescent) with approximately 15 cm3 lidocaine 1%. Immediately after Phlebectomy, the patient noticed weakness of the right foot, right foot drop, without neurological pain. The drop foot disappeared spontaneously after several hours without therapy. The sciatic nerve runs behind the femur from the buttock to the lower thigh where it divides into the common peroneal nerve (CPN) and tibial nerve. The CPN then descends along the lateral side of the popliteal fossa to the head of the fibula. It winds round the head of the fibula and divides into the superficial peroneal nerve and the deep peroneal nerve....
-
Ambulatory Phlebectomy. Principles and evolution of the method.
Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 1998Co-Authors: Stefano RicciAbstract:background. An easy, effective, inexpensive, and aesthetic method of varicose vein avulsion, in an office setting, is the aim of most phlebologists. Muller's ambulatory Phlebectomy probably comes very close to this goal. With the acceptance and diffusion of this method, imitations, deviations, and “ameliorations” are frequent but do not always represent a true evolution. objective. To describe the basic principles of the method and the evolution of some aspects (anesthesia, instruments, duplex mapping, eco-Phlebectomy, compression) leading to effective advantages. conclusion. In its 40 years in existence, ambulatory Phlebectomy has not significantly changed, and has proved to be easy and safe. The most important progress has been made in anesthetic dose and in ultrasound applications.
John J. Bergan - One of the best experts on this subject based on the ideXlab platform.
-
Treatment of varicose veins : Proximal saphenofemoral ligation comparing adjunctive varicose Phlebectomy with sclerotherapy at a military medical center
Vascular surgery, 2001Co-Authors: Stacy A. Brethauer, James D. Murray, Douglas G. Hatter, T. Roland Reeves, James R. Hemp, John J. BerganAbstract:There is no consensus as to the single best approach to the treatment of varicose veins. There has been a trend toward less invasive procedures to reduce the number of incisions and provide more selective ablation of varicosities. Ultimately, therapeutic decisions have depended on surgeon preference and the patient population. The active duty military population presents a unique challenge in the treatment of varicose veins. This mobile and active population requires a treatment method that provides maximum relief with the lowest possible morbidity and rapid recovery. The authors previously reported their experience with 104 patients who underwent saphenofemoral ligation combined with perforator point ligation and staged sclerotherapy. This group was compared to 103 patients who underwent saphenofemoral ligation, point perforator ligation, and stab avulsion Phlebectomy as a single procedure. Follow-up for the sclerotherapy group included patient satisfaction surveys and documentation of recurrent varicosities. All ambulatory Phlebectomy patients responded positively with respect to symptomatic and cosmetic results. Overall satisfaction was favorable and there was no significant difference in patient satisfaction between the ambulatory Phlebectomy and sclerotherapy groups. Twelve per cent of the sclerotherapy patients developed true recurrences or new varicosities compared to 11% in the ambulatory Phlebectomy group. The most common complication was superficial thrombophlebitis (20% ambulatory Phlebectomy, 16% sclerotherapy) which was mild in all cases. All but three patients in the ambulatory Phlebectomy group returned to work within 7 days and 75% returned to full duty within 72 hours. Completion of therapy was accomplished in a much shorter period for the ambulatory Phlebectomy group. Overall patient satisfaction was achieved for both ambulatory Phlebectomy and sclerotherapy patients. Completion of therapy was achieved in a shorter period with fewer clinic visits in the ambulatory Phlebectomy group and this has become our procedure of choice for active duty military patients.
-
outpatient varicose vein surgery with transilluminated powered Phlebectomy
Vascular Surgery, 2000Co-Authors: Gregory A Spitz, Jeffrey M Braxton, John J. BerganAbstract:The present study was done to determine the feasibility, efficacy, and safety of varicose vein removal using a minimally invasive, powered, vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compare this to a retrospective group of hook Phlebectomy operations. After preliminary development of the procedure, a prospective evaluation was done. There were 59 limbs in 56 patients (51 women, five men) treated with use of the vein extractor aided by transcutaneous illumination. Saphenous reflux was confirmed by preoperative duplex ultrasound using reflux technique and was treated by ligation of the saphenofemoral junction and stripping of the greater saphenous vein to the knee with external hooks. Surgery was performed under general anesthesia on an outpatient basis. Complications were documented. The number of incisions made was recorded and analyzed. Operative time was noted and patient satisfaction analog scores were recorded. Patients were asked to describe their pain and cosmetic results on an analog scale ranging from 1 to 10 with 1 representing no pain and 10 the worst imaginable and a similar scale for the best and worst cosmetic results. Data were analyzed by use of appropriate tests of significance and compared to historical controls of 114 hook Phlebectomy operations done over a 12-month period. The 51 women ranged in age from 23 to 66 years (mean: 46). The men were 48, 48, 54, 59, and 72 years of age, respectively. There were 58 unilateral procedures (98%) and one bilateral operation. Operative time ranged from 23 to 58 minutes (mean: 41.0 minutes). The number of incisions per limb averaged 5.6. Cellulitis, small hematoma formation, and swelling or bruising beyond that expected occurred in four limbs (6.8%). Mean postoperative pain score at 48 hours was 3.0 with a median of 3.0. Mean postoperative pain score at 7 days was 2.0 with a median of 2.0. Postoperative pain scores at 6 weeks and 3 months were zero. Mean cosmetic score at 6 weeks was 2.5 with a median of 2.0. Mean cosmetic score at 3 months was 1.0 with a median of 1.0. These results compare very favorably to a historical control group of 114 similar patients who underwent stab avulsion hook Phlebectomy to remove varicose vein clusters. Varicose, vein extraction using transilluminated powered Phlebectomy (TIPP) is safe, efficacious, and cosmetically satisfactory. The procedure decreases operating time and number of incisions required to remove varicose clusters.
Peter F. Lawrence - One of the best experts on this subject based on the ideXlab platform.
-
endovenous ablation with concomitant Phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries
Journal of Vascular Surgery, 2013Co-Authors: Michael P Harlanderlocke, Peter F. Lawrence, Juan Carlos Jimenez, David A Rigberg, Brian G Derubertis, Hugh A GelabertAbstract:Objective To examine outcomes following 1000 consecutive endovenous radiofrequency ablation (RFA) closures of saphenous veins and 500 ambulatory Phlebectomy procedures for chronic venous insufficiency. Based on the outcomes in this patient cohort, we aim to determine whether concomitant or staged Phlebectomy is preferred and examine the rate and optimal treatment of complications using a dedicated treatment algorithm based on our classification system for level of closure following these procedures. Methods Between 2004 and 2012, patients with symptomatic superficial venous incompetence who underwent endovenous RFA of incompetent saphenous veins were identified as well as patients with concomitant or staged microPhlebectomy. Demographics, risk factors, procedural success rate, concurrent procedures, complications, and symptom relief were recorded. Results One thousand radiofrequency ablations (95.5% great saphenous vein and accessory great saphenous veins, 4.5% small saphenous vein) were performed in the ambulatory setting (patients = 735, limbs = 916); 355 limbs with large (>3 mm) symptomatic incompetent tributaries underwent concomitant Phlebectomy. Additionally, 145 limbs required Phlebectomy at a later setting for persistent symptoms following saphenous RFA. Indications for treatment included lifestyle-limiting pain (94.8%), swelling (66%), lipodermatosclerosis (5.3%), ulceration (9.4%), and/or bleeding (1.4%). All patients (100%) underwent a follow-up ultrasound 24 to 72 hours following the procedure to assess for successful closure and to rule out deep venous thrombosis. The majority of patients (86.7%) had relief of their symptoms at a mean follow-up of 9 months. No patients developed postoperative deep venous thrombosis; however, saphenous closure extended partially into the common femoral vein wall in 18 patients (1.8%) and flush with the saphenofemoral junction in 47 (4.7%). One patient developed a pulmonary embolus despite a normal postoperative ultrasound. No other patients required hospital admission and no deaths occurred during the follow-up period. Conclusions The majority of patients with symptomatic chronic venous insufficiency benefit from endovenous RFA of incompetent saphenous veins with comparable results to published surgical outcomes for endovenous closure. The great majority of patients with refluxing tributary veins greater than 3 mm in diameter required Phlebectomy in addition to saphenous ablation. These patients may benefit from concomitant Phlebectomy along with endovenous saphenous closure.
-
light assisted stab Phlebectomy early postoperative experience
American Surgeon, 2007Co-Authors: Andrew J. Vardanian, Huynh L Cao, Peter F. LawrenceAbstract:Light-assisted stab Phlebectomy (LASP) is a technique that we have developed for treatment of lower extremity varicose veins. It combines powered and stab Phlebectomy with minimally invasive surgical instruments to optimize intraoperative visualization of varicose veins and to remove branch veins with minimal bruising, hematoma, or pain. The early experience with this technique has not been reported. We conducted a retrospective review of all patients who underwent LASP to characterize the associated perioperative experience and to identify postoperative factors that indicated a successful outcome. From 2004 to 2006, LASP was performed on 268 limbs to remove lower extremity branch veins. The majority of patients were women (75%), and the mean age was 52 years. A group of 184 patients underwent LASP in combination with another procedure, and 49 patients underwent LASP alone. Nearly all patients had conscious sedation for anesthesia (99%); operating room time averaged 44 minutes, and blood loss averaged 88 cc. Immediate postoperative complications were infrequent, occurring in 10 per cent of patients, and included unresected or missed veins, hematoma, and cellulitis. LASP provides improved visualization of branch veins and allows varicose veins to be removed with a short operating room time and minor postoperative complications.
-
Light-assisted stab Phlebectomy: Report of a technique for removal of lower extremity varicose veins
Journal of vascular surgery, 2007Co-Authors: Peter F. Lawrence, Andrew J. VardanianAbstract:We report a new technique to remove varicose veins and reduce recurrence from missed veins. A rigid cannula with a light source injects tumescent solution and transilluminates under veins. Varicose veins are removed with stab Phlebectomy using a modified crochet hook and mosquito clamp. Additional tumescent solution flushes hematomas and compresses empty vein channels, resulting in less pain, bleeding, and pigmentation. More than 200 patients have undergone light-assisted stab Phlebectomy at the Gonda Vascular Center, with high patient and surgeon satisfaction. This sutureless technique allows complete and rapid varicose branch vein removal with few missed varicose veins, little bruising, and an excellent cosmetic result.
H Martino A Neumann - One of the best experts on this subject based on the ideXlab platform.
-
ambulatory Phlebectomy versus compression sclerotherapy results of a randomized controlled trial
Dermatologic Surgery, 2003Co-Authors: Kees-peter De Roos, Fred H M Nieman, H Martino A NeumannAbstract:BACKGROUND. Although no randomized controlled trial has assessed the effects of either compression sclerotherapy or ambulatory Phlebectomy, both techniques are used to treat varicose veins worldwide. We performed a randomized controlled trial to compare recurrence rates of varicose veins and complications after compression sclerotherapy and ambulatory Phlebectomy. METHODS. From September 1996 to October 1998, we randomly allocated 49 legs to compression sclerotherapy and 49 legs to ambulatory Phlebectomy. Our primary outcome parameters were as follows: recurrence rates at 1 and 2 years and complications related to therapy. Eighty-two patients were included, of whom 16 were included with both of their legs. The number of treated legs was therefore 98, but two patients were lost to follow-up. RESULTS. One year recurrence amounted to 1 out of 48 for Phlebectomy and 12 out of 48 for compression sclerotherapy (P<0.001); at 2 years, six additional recurrences were found, but then solely for compression sclerotherapy (P<0.001). Significant differences in complications occurring more in Phlebectomy than in compression sclerotherapy therapy were blisters, teleangiectatic matting, scar formation, and bruising from bandaging. CONCLUSION. Our results show that ambulatory Phlebectomy is an effective therapy for varicose veins of the leg. Recurrence rates are significantly lower than for compression sclerotherapy therapy. If varicose veins persist 4 weeks after compression sclerotherapy, it can be argued that to reduce the risk of future recurrence ambulatory Phlebectomy should be considered as the better treatment option.
Andrew J. Vardanian - One of the best experts on this subject based on the ideXlab platform.
-
light assisted stab Phlebectomy early postoperative experience
American Surgeon, 2007Co-Authors: Andrew J. Vardanian, Huynh L Cao, Peter F. LawrenceAbstract:Light-assisted stab Phlebectomy (LASP) is a technique that we have developed for treatment of lower extremity varicose veins. It combines powered and stab Phlebectomy with minimally invasive surgical instruments to optimize intraoperative visualization of varicose veins and to remove branch veins with minimal bruising, hematoma, or pain. The early experience with this technique has not been reported. We conducted a retrospective review of all patients who underwent LASP to characterize the associated perioperative experience and to identify postoperative factors that indicated a successful outcome. From 2004 to 2006, LASP was performed on 268 limbs to remove lower extremity branch veins. The majority of patients were women (75%), and the mean age was 52 years. A group of 184 patients underwent LASP in combination with another procedure, and 49 patients underwent LASP alone. Nearly all patients had conscious sedation for anesthesia (99%); operating room time averaged 44 minutes, and blood loss averaged 88 cc. Immediate postoperative complications were infrequent, occurring in 10 per cent of patients, and included unresected or missed veins, hematoma, and cellulitis. LASP provides improved visualization of branch veins and allows varicose veins to be removed with a short operating room time and minor postoperative complications.
-
Light-assisted stab Phlebectomy: Report of a technique for removal of lower extremity varicose veins
Journal of vascular surgery, 2007Co-Authors: Peter F. Lawrence, Andrew J. VardanianAbstract:We report a new technique to remove varicose veins and reduce recurrence from missed veins. A rigid cannula with a light source injects tumescent solution and transilluminates under veins. Varicose veins are removed with stab Phlebectomy using a modified crochet hook and mosquito clamp. Additional tumescent solution flushes hematomas and compresses empty vein channels, resulting in less pain, bleeding, and pigmentation. More than 200 patients have undergone light-assisted stab Phlebectomy at the Gonda Vascular Center, with high patient and surgeon satisfaction. This sutureless technique allows complete and rapid varicose branch vein removal with few missed varicose veins, little bruising, and an excellent cosmetic result.