Term
ClosureFast catheter reaches what temp? What is the tissue temperature reached? |
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Definition
120 degrees centigrade 100-110 degrees centigrade |
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Term
How do ClosureFast and ClosurePlus differ in their mechanism of action on the vein wall |
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Definition
CP uses radiofrequency energy CF uses conductive energy |
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Term
In single treating a vein segment what is the average joules/cm with closurefast Double treatment? |
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Definition
67 joules/cm 116 joules/cm |
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Term
What temperature is needed to shrink collagen in the vein wall? What temperature does laser achieve on the vein wall? |
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Definition
55 degrees centigrade 100 degrees centigrade |
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Term
| Where in the vein wall does the primary damage occur from either endovenous technique? |
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Definition
| endothelium and subendothelium |
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Term
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Definition
| light absorbing component that converts light energy to heat |
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Term
In the laser treatment of telangiectasias, why is thermal relaxation time important? On what is TRT dependent? |
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Definition
It is the time required for the object to lose 50% of its thermal energy. Photothermolysis occurs when laser exposure is equal or less than the objects thermal relaxation time TRT in veins depends on thee diameter |
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Term
| Name some contraindications to sclerotherapy |
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Definition
Lymphedema Acute febrile illness Arterial insufficiency Pregnancy/nursing Sclerosant allergy Acute DVT Hypercoagulable states Inability to ambulate |
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Term
| Name 8 side effects to foam sclerotherapy |
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Definition
Dry cough migraines chest tightness circumoral paresthesia metallic taste nausea dizziness hyperpigmentation |
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Term
| Name 7 adverse events from foam sclerotherapy |
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Definition
ocular migraine visual disturbance panic attack respiratory difficulty cutaneous necrosis DVT SVT |
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Term
| What is the incidence of duplicate femoral vein in the population |
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Definition
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Term
| Is a patent foramen ovale a contraindication to foam sclerotherapy? |
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Definition
| Relative contraindication not absolute |
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Term
| In a patient with a known patent foramen ovale, what measures can be taken to decrease the incidence of side effects (5) |
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Definition
Resting longer 8 - 30 minutes Low volumes Avoid valsalva Use liquid Leg elevation |
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Term
| Name 5 recommendations from the European Consensus on the safety of foam sclerotherapy |
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Definition
Viscous foam Avoid immediate compression over injected areas US control No movement for 2-5 minutes without valsalva and muscle activation If foam is seen in deep system, ankle dorsiflexion |
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Term
| Name 4 exclusion criteria (per Morrison) of endovenous ablation |
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Definition
restricted ambulation arteriovenous malformation known coagulopathy deep venous obstruction |
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Term
| Typical mixture of tumescent anesthesia consists of: |
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Definition
450cc of 0.9% saline 50 cc of 1% lidocain with 1:100,000 epinephrine 5cc of 8.4% sodium bicarbonate |
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Term
| In patients with the lateral subdermal plexus, what % have a communication with the deep system? |
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Definition
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Term
In the SD population study, what percent were found to have deep venous reflux? Of those what % presented with only telangiectasias |
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Definition
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Term
| Name 3 FDA approved Sclerosants |
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Definition
Na tetradecyl Sodium morruhate Ethanolamine oleate Hypertonic saline is FDA approved for other uses |
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Term
| Name the three classes of sclerosants and their mechanism of action |
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Definition
Detergents -protein theft denaturation Osmotic-cellular dehydration (osmotic) and cell membrane denaturation Ionic/irritant direct caustic destruction of endothelium |
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Term
Are detergent sclerosants more effective warm or cold? Why? |
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Definition
More effective warm When cold they are more soluble therefore less effective |
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Term
What are the maximum doses per session of the following sclerosants Polidocanol Sodium tetradecyl Chromated glycerin Hypertonic saline Sclerodex |
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Definition
Polidocanol 2mg/kg or 4cc at 3% Na tetradecyl 300mg or 10cc of 3% Chromated glycerin 5-10 cc Hypertonic saline 8cc Sclerodex 10cc
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Term
| Name 3 advantages for wearing compression after sclerotherapy |
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Definition
Increased efficacy Minimizes postop pigmentation Reduces risk of DVT |
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Term
Define size of telangiectasias venulectsias reticular veins |
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Definition
telangiectasias .1mm to 1mm venulectasias 1-2mm Reticulars 2-4 mm |
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Term
| What percent of spider vein patients have sx? (Weiss) |
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Definition
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Term
| What % of spider vein patients were found to have superficial incompetence? |
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Definition
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Term
| Name some contraindications to sclerotherapy |
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Definition
Acute febrile illness allergy pregnancy lactation thromboembolic disease or DVT |
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Term
| What size reticular veins almost always show reflux? |
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Definition
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Term
| In JVasc report what veins benefit from hematoma evacuation? |
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Definition
Less than 1mm less hyperpigmentation > 1mm less pain but no difference in hyperpigmentation |
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Term
| In a study of recanalization after sclerotherapy, what was the only factor that affected recurrence rates? |
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Definition
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Term
What determines the frequency of a laser? What characteristic of a laser results in a selective target? |
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Definition
Its medium Monochromatic wavelength |
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Term
| Laser wavelength determines what two aspects of its efficacy? |
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Definition
Its chromophore and penetration |
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Term
| How is pulse duration of a laser and thermal relaxation time of a chromophore important in laser rx vessels? |
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Definition
The pulse duration must be less than the thermal relaxation time of the chromophore but more than the thermal relaxation time of competing chromophors |
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Term
| How is IPL different from laser? |
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Definition
| IPL uses multiple ranges of wavelengths and a filter to block out certain wls |
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Term
Define % of an local anesthetic eg. 1.5 % solution is how many gms/ 100cc? mg/cc |
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Definition
1.5 % solution is 1.5gm/100cc or 15mg/cc Move decimal point one space to right |
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Term
What is the order of effect on nerve fibers of a local anesthetic? Order of return? |
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Definition
Pain temperature touch touch temperature pain |
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Term
Describe the chemistry of local anesthetics |
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Definition
They consist of a lipophilic portion (benzene ring) and a hydrophilic portion (tertiary amine) connected by either a ester - CO or an amide HNC |
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Term
Give 3 examples of ester based local anesthetics What is the disadvantage of this group? |
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Definition
Cocaine/Procaine/tetracaine Greater risk of allergy |
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Term
Give 3 example of amide based local anesthetics What is their advantage? What is a pneumonic for remembering the generic names? Where are they broken down? |
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Definition
lidocaine mepivicaine bupivacaine Fewer allergic reactions If there is an "i" in the first four letters it is an amide local anesthetic Hydrolyzed in the liver |
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Term
What is the maximum dose of lidocaine both in mg/kg and total dose How does that change with tumescent anesthesia? |
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Definition
7mg/kg Up to 500mg 35mg-55mg/kg |
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Term
| Name 3 actions that are preserved in the patient with conscious sedation |
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Definition
Protective reflexes are maintained Patent airway Appropriate responses to physical or verbal command |
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Term
Lower CEAP classes are due to superficial venous disease and higher CEAP to deep venous disease True or False? |
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Definition
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Term
| Name two absolute exclusion criteria for treating superficial venous reflux |
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Definition
arteriovenous malformations Deep venous obstruction |
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Term
What % of patients with chronic venous insufficiency have SSV involvement? What % of patients with GSV involvement have SSV as well |
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Definition
10% 1/3 of patients with GSV involvement have SSV as well (comment ??) |
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Term
| In chronic venous insufficiency, what % of patients have an element of superficial reflux? |
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Definition
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Term
| In what situation should the rx of incompetent perforators be approached with caution? |
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Definition
| In deep venous obstruction an incompetent perforator may represent an outflow tract |
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Term
| Define an incompetent perforator by size and reflux time |
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Definition
Fascial diameter >3.5mm Reflux > 0.4 sec |
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Term
In RCT studies what is more effective compression alone or compression with removal of superficial reflux in healing leg ulcers? What is the advantage of compression with surgery? |
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Definition
Both have equal healing rates There were fewer recurrent ulcers withcompression with surgery also ulcers healed faster |
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Term
| Name 3 contraindications to RX of incompetent perforators |
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Definition
Severe PAD Infected ulcer Morbid obesity - failed calf muscle pump Non ambulatory or hypercoagulable patient |
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Term
| Which sclerosing agent has not been shown to cause cutaneous necrosis? |
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Definition
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