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

ABC principles Endovascular Percutaneous Local anaesthesia Day clinic

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

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

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

Isotonic bicarbonate please Courtesy of Dr. Denis Creton

Tumescent anesthesia under echo

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.

Puncture under echography

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.

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.

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

Thank you