| Topics and
Case Presentations for Discussion |
| 1. Techniques of Endovenous Thermal Ablation |
a. Laser ablation, which wave-lengths and why.
b. Fibers, various types = standard, radial, sapphire.
c. Radiio-frequency, re VNUS Closure and ClosureFast.
d. Access methods, needle, micro-puncture, needle size, guidewire size and length, catheters, location of access on the patient’s leg,
e. Tumescent Anesthesia = solution content, method of infusion, pump or hand inject.
f. Rate of pullback, hand or pullback device.
g. Simultaneous phlebectomy and sclerotherapy vs delayed.
h. Simultaneous great and small and accessory saphenous veins treated or delayed one at a time.
i. High ligation, never, sometimes, frequently.
j. Conscious sedation, no sedation, pills pre and post-op.
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2. Selection of Patients, Diagnosis of Venous Insufficiency
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a. Ultrasound criteria.
b. Patient symptoms and signs which justify treatment.
c. The vein in spasm, diagnosis and treatment.
d. Methods to assure the ultrasound diagnosis is accurate.
e. Age criteria or limits.
f. Obesity criteria or limits.
g. Urgency of treatment, ulcers, bleeding, phlebitis.
h. Is any symptomatic patient not a candidate.
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3. Adjuvant vein treatments |
a. Micro-phlebectomy techniques, re hooks, clamps, which veins are to be removed, pre-op planning, day of surgery planning.
b. Delayed micro-phlebectomy vs simultaneous, which veins should be removed and when.
c. Sclerotherapy, which solutions and how much each treatment.
d. Transillumination vein light, ultrasound guided sclerotherapy, what is indicated and how much.
e. Pin stripping with the device or catheter technique.
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4. Complications of a Phlebology practice, prevention and
management
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a. Endovenous ablation: failure to close the treated vein, DVT and PE, infection, numbness, sural or saphenous nerve injury, laser fiber fracture, the post-op swollen leg, failure to access, other.
b. Micro-phlebectomy: bleeding, the anti-coagulated patient, nerve injuries, ankle and foot unique problems, too many or too few, residual varicosities at follow-up, post Rx phlebitis, recanalization due to tributary flow, other.
c. Sclerotherapy: hyperpigmentation, ulceration, proper solutions for each patient, dose, management of poor outcomes.
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5. Unique situations in phlebology |
a. Pre-op superficial thrombophlebitis.
b. Deep venous thrombosis and superficial venous incompetence.
c. Management of deep venous thrombosis.
d. New anticoagulants to replace coumadin.
e. Recurrences after definitive treatment, cause and methods to treat.
f. New modalities of treatment, including glue.
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6. The business of phlebology
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a. Projected safety for continued reimbursement.
b. Active role to lobby insurance and the consultant provider panels.
c. Marketing programs, what is best in which locations.
d. The internet and web sites.
e. Electronic medical records – the efficient office.
f. Strategies for success, short and long term.
g. Strategies to build value in the business.
h. The office based vs surgicenter vs hospital for vein treatments.
i. The Accredited office.
j. The staff, assistants and nurses and PA’s or NP’s, the front office.
Please bring any topic of interest which you would like discussed by the attendees. This is a comprehensive agenda, most of which will be touched upon during our time together.
Thank you!
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