Devices, Lymphatics and the Whole Limb
Each talk in this trainee session paired a short lecture with cases, ahead of the hands on stations.
Lymphatics Are Not Optional
Two speakers made the same argument: treating reflux alone leaves phlebolymphedema patients swollen. Venous pressure sits near 80 to 90 mmHg when standing still and falls toward supine levels once the calf pump is properly engaged, so watch patients walk. Act at stage two while changes are still reversible, and refer for pneumatic compression at the same visit rather than a year later. Inelastic daytime wraps give low resting pressure and high working pressure during walking.
Choosing an Ablation
- Superficial reflux drives most chronic venous insufficiency, and close to 70 percent of ulcer patients have pure superficial disease.
- Thermal devices are durable but need tumescent anesthetic, a straight vein, and care near the saphenous and sural nerves.
- Nonthermal options suit indurated lower leg skin, tortuous veins and treatment of the plexus beneath an ulcer.
Clot Removal
Large bore aspiration has largely displaced lysis for iliofemoral clot and intermediate high risk pulmonary embolism, judged on thrombus clearance and the right to left ventricle ratio rather than perfect pictures.
