Lymphatic and venous interventions - ESR Connect

Research Presentation Session

RPS 1009a - Lymphatic and venous interventions

  • 8 Lectures
  • 45 Minutes
  • 8 Speakers
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Lectures

1
RPS 1009a - The efficacy of cutaneous anaesthesia in endovenous laser ablation of the great saphenous vein.

RPS 1009a - The efficacy of cutaneous anaesthesia in endovenous laser ablation of the great saphenous vein.

06:00K. Singh, Bhopal / IN

Purpose:

To evaluate the safety and efficacy of cutaneous anaesthesia for pain control during injectable tumescent anaesthesia in endovenous laser ablation of the greater saphenous vein (GSV).

Methods and materials:

An evaluation of 35 patients (25 male, 10 female), who had undergone endovenous laser ablation for greater saphenous vein insufficiency was done. All of these patients had undergone cutaneous application of cream-based skin anaesthetics consisting of lidocaine 2. 5%W/W and prilocaine 2. 5%W/W (TOPLAP cream) along the length of GSV to be ablated. The cream was applied at least an hour before cleaning and draping the patient for the procedure. To facilitate the application of the cream, GSV was marked under USG guidance. All patients received tumescent anaesthesia. All patients were asked to record the pain or discomfort using the visual analogue score (VAS) from the start of the procedure until the end of the GSV ablation. No intravenous analgesia or sedation was used.

Results:

The mean recorded pain score was approximately 2.2 (range 1-4). Most of the patients had tolerable mild pain/discomfort with a pain score of 1-3. 4 patients complained of moderate pain with a VAS score of 4. However, the overall experience of patients was satisfactory, with patients having the ability to resume immediate ambulation and making endovenous laser ablation a walk-in walk-out procedure.

Conclusion:

Cutaneous anaesthesia is a safe, adequate, and effective option to decrease and/or eliminate the intraoperative discomfort associated with tumescent anaesthesia injections and laser ablation during endovenous laser ablation of the greater saphenous vein.

Limitations:

A limited sample size. Ethnicity and socio-economic background of the participants was not taken into consideration.

Ethics committee approval

/a

Funding:

No funding was received for this work.

2
RPS 1009a - Dynamic MR lymphangiography: a new technique for the assessment of the central lymphatic system in adults

RPS 1009a - Dynamic MR lymphangiography: a new technique for the assessment of the central lymphatic system in adults

06:15S. Katsari, Athens / GR

Purpose:

To describe the technique and utility of dynamic contrast-enhanced MR lymphangiography (DCMRL).

DCMRL enables imaging of the central lymphatic system and its relationship to anatomical structures, demonstrating flow rate, obstruction, and leakage from the lymphatic system. This provides important diagnostic information and could inform treatment such as thoracic duct embolisation or lymphovenous anastomosis.

Methods and materials:

8 adult patients with lymphatic abnormalities were examined in a tertiary lymphovascular referral centre using DCMRL. 1 patient had Noonan’s syndrome, 1 patient had chylous ascites and effusions, and 6 patients had a primary lymphatic abnormality. Bilateral ultrasound-guided access into inguinal lymph nodes was carried and ultrasound contrast injected to confirm the position. DCMRL was performed in a 3T MRI scanner by injecting gadolinium into the inguinal lymph nodes. The central lymphatic system, including the pelvis, retroperitoneal lymphatics, and thoracic duct were assessed. Patients with lymphoedema in the lower extremities were re-scanned after walking for a short period.

Results:

In 7 patients, DCMRL was successful in providing information about the central
lymphatic system. In 2 of these patients, leakage of contrast was seen into the
mediastinum and into pleural effusions. Abnormal lymphatic drainage was noted in all patients in either thoracic or abdominal lymphatics, or in both. In 1 patient, no drainage was seen into the central lymphatics, however, the contrast was seen to reflux into the scrotum and superficial tissues of the legs.

Conclusion:

DCMRL has been successfully used to provide information about central lymphatic anatomy and to identify obstruction and leakage of lymphatic fluid. This novel technique offers possibilities for both diagnoses and treatment options for patients with lymphatic abnormalities.

Limitations:

/a

Ethics committee approval

/a

Funding:

No funding was received for this work.

3
RPS 1009a - An alternative method for traditional surgical suturing in port catheter placement: glue

RPS 1009a - An alternative method for traditional surgical suturing in port catheter placement: glue

02:17M. Asik, Istanbul / TR

Purpose:

A port catheter (PC) is a medical device that is used for long-term or short-term access to veins in patients having chemotherapy who require continuous medication. Our aim is to evaluate the efficacy and advantages of using glue for tissue adhesion in the closure of the skin incision for the reservoir when placing the PC.

Methods and materials:

In all cases, except for 3 cases of the brand port catheter, a port reservoir was placed under the skin in the anterior wall of the chest. The subcutaneous fat tissue was covered with an absorbable suture to cover the reservoir. The skin tissue of the bioglue (Cryolife / Georgia-USA), which is ready in its injector, was closed by thinning.

Results:

39 patients (20 males, 19 females, mean age 57.1) who were scheduled to receive port catheter chemotherapy between January 2017 and December 2017 were included in the study. During the process, BioGlue was preferred for port closure of the skin tissue on the reservoir as tissue adhesion instead of surgical sutures. After the procedure, the patients were kept under observation for 1 hour to monitor for possible complications.

Conclusion:

There are many complications, such as infection and especially bleeding, when placing a PC. The incidence of these complications increases with the traditional surgical suture closure of the skin. The vast majority of patients with PCs are immunosuppressed patients, where suture can cause opportunistic infections. Pain caused by skin closure with conventional surgical suture may also cause the procedure to be prolonged. Using glue instead of conventional suturing of the tissue is a cheaper and advantageous alternative.

Limitations:

A retrospective, single-institutional, small-sample-sized study.

Ethics committee approval

Ethics committee approval obtained.

Funding:

No funding was received for this work.

4
RPS 1009a - Assessment of the effectiveness of pelvic vein embolisation: a single-centre experience

RPS 1009a - Assessment of the effectiveness of pelvic vein embolisation: a single-centre experience

05:31C. Leonard, Dublin / IE

Purpose:

Pelvic congestion syndrome can arise from incompetent valves, typically in gonadal veins, resulting in pain. Pelvic vein embolisation is a minimally invasive treatment for pelvic congestion syndrome by embolising incompetent pelvic veins. The purpose of this retrospective study was to assess the efficacy of pelvic vein embolisation in the treatment of pelvic congestion syndrome.

Methods and materials:

All patients treated with pelvic vein embolisation for pelvic congestion syndrome were analysed (2011-2019) in a university teaching hospital. A standardised questionnaire using a 0-10 numeric rating scale was used to assess pain scores and the impact on activities of daily living (ADLs), including work, socialising, exercise, and sleeping, before and after embolisation.

Results:

28 embolisation procedures were performed in 23 women. 5 patients underwent repeat embolisation for ongoing symptoms. The technical success of the procedure was 100% and there were only minor complications in 2 patients. 74% (17/23) response rate. The median pre-procedural pain score was 8 (IQR 7-8). This significantly reduced at 1-months to 5 (IQR 2.5-7.5) and at 12-months to 5 (IQR 0-8). 35% (n=6) of patients reported complete resolution of pain at 1 year. Improvement in the impact on ADLs was demonstrated across all domains and significantly in the impact on the exercise median before 8 (IQR 1-9) to 5 (IQR 6-9) after p=0.00694.

Conclusion:

Pelvic vein embolisation results in reduced pain scores compared to their pre-operative values. Given that 4 had repeat venography without embolisation suggests a multifactorial component to the symptoms. Improvement in the impact on ADLs is demonstrated across all domains, particularly exercise. Information from this study will allow clinicians to convey the potential improvements in symptom parameters for patients undergoing embolisation for pelvic congestion.

Limitations:

The sample size.

Ethics committee approval

Ethical approval received.

Funding:

No funding was received for this work.

5
RPS 1009a - Assessment and treatment of low-flow venous malformations

RPS 1009a - Assessment and treatment of low-flow venous malformations

05:09R. Mousa, Zagazig / EG

Purpose:

To outline the diagnostic features of LFVM and describe the efficacy of percutaneous sclerotherapy in their management.

Methods and materials:

This study was done over two years, including 28 patients with LFVM, diagnosed with MRI and US. These patients underwent a total of 54 treatments. Management was divided into sessions, with each session consisting of multiple treatments (1 to 4) with an 8-week interval in between. Sclerotherapy procedures were done under local anaesthesia using ultrasound guidance. Compression was applied after the procedure where practicable. Subjective response to treatment was based on improvement in pain, swelling, discomfort, discolouration, and improvement of movement where applicable. The objective evaluation was based on a decrease in the size of the lesion on examination, change in the ultrasound appearances, and change in vascularity on colour Doppler evaluation.

Results:

Approximately 93% of the patients reported a significant improvement of symptoms, which correlated with changes in US appearance and a decrease in the number of cystic spaces. 2 patients reported no significant resolution of the symptoms, which were correlated with no significant changes on US; both lesions were in the extremities (wrist and leg). Most patients complained of pain and swelling which resolved within a week of the procedure. No significant post-procedural complications were reported.

Conclusion:

Treatment of LFVM with percutaneous sclerotherapy results in good outcomes for patients with a low complication rate. Accurate diagnosis of these lesions is critical to guide management.

Limitations:

/a

Ethics committee approval

Written consent was obtained from all patients.

Funding:

No funding was received for this work.

6
RPS 1009a - Hydrophilic guidewire usage in facilitating catheter advancement during the endovenous treatment of varicose veins

RPS 1009a - Hydrophilic guidewire usage in facilitating catheter advancement during the endovenous treatment of varicose veins

06:35K. Hwang, Seoul / KR

Purpose:

To investigate the use of hydrophilic guidewires for facilitating catheter advancement during varicose vein treatment using radiofrequency ablation (RFA) or cyanoacrylate closure (CAC).

Methods and materials:

From March 2016-April 2019, 463 limbs in 286 patients (126 male, mean age 53.7 years, range 21-88 years) with incompetent great saphenous vein were subjected to either RFA or CAC. Procedure records were reviewed for the use of a hydrophilic guidewire, the reason for guidewire usage, and the choice of guidewire diameter.

Results:

In total, a hydrophilic guidewire was used to facilitate catheter advancement in the treatment of 92 of 463 limbs (19.8%). For RFA, a guidewire was used in the treatment of 53 of 321 limbs (16.5%). Among them, 15 limbs were due to vasospasm, while 38 were due to venous tortuosity. A 0.025-inch guidewire was used in 42 of 53 limbs (79.2%), and a 0.018-inch guidewire in 11 of 53 limbs (20.8%). For CAC, a 0.035-inch guidewire was used in 39 of 142 limbs (27.5%). Among them, 10 limbs were due to vasospasm, 23 due to venous tortuosity, and 6 due to repeated varicose vein engagement. All varicose vein treatment sessions were technically successful. No major complications occurred.

Conclusion:

Hydrophilic guidewire usage could facilitate catheter advancement when it is hindered by vasospasm, tortuosity of the saphenous vein, or repeated engagement into varicosity. For RFA, the use of a 0.018-inch guidewire could provide better catheter advancement when a 0.025-inch guidewire passage through the radiofrequency catheter is difficult.

Limitations:

This is a retrospective study from a single institute. There is no comparison with other methods.

Ethics committee approval

/a

Funding:

This study was supported by a KSIR grant.

7
RPS1009a - Endovascular stenting of the main veins in urology

RPS1009a - Endovascular stenting of the main veins in urology

06:32O. Zhukov, Moscow / RU

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Speakers

Presenter

Anthony Cullen

Dublin, Ireland

Presenter

Oleg B. Zhukov

Moscow, Russia

Presenter

Carol Leonard

Dublin, Ireland

Presenter

Kyosoo Hwang

Seoul, South Korea

Presenter

Rola Mahmoud Mousa

Zagazig, Egypt

Presenter

Murat Aşık

Istanbul, Turkey

Presenter

Sofia Katsari

Athens, Greece

Presenter

Kamaljeet Singh

Bhopal, India