Prezi

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in the manual

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

COMPLICACIONES DE LA ESCLEROTERAPIA CON ESPUMA

No description
by samira ali on 28 March 2012

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of COMPLICACIONES DE LA ESCLEROTERAPIA CON ESPUMA

COMPLICACIONES DE LA ESCLEROTERAPIA CON ESPUMA SAMIRA ALÍ CURE, M.D.
FELLOW DE CIRUGÍA GENERAL Y ANGIOLOGÍA
U EL BOSQUE - HOSPITAL DE KENNEDY MIGUEL RAMÍREZ GÓMEZ, M.D.
CIRUJANO VASCULAR Y ANGIÓLOGO
DIRECTOR PROGRAMA CIRUGÍA VASCULAR Y ANGIOLOGÍA
U EL BOSQUE - HOSPITAL DE KENNEDY According to the inscription, this tablet found on the west side of the Acropolis in Athens was dedicated to Dr Amynos by Lysimachidis of Archarnes. This represents the earliest known depiction of varicose veins from the end of the fourth century bc.
(From National Archaeological Museum of Greece.)
Segismundo Eisholtz (1623–1688)
D. Zollikofer de St. Gallen (1682)

Historical introduction of sclerosing agents

Absolute alcohol (Monteggio, Leroy D’Etiolles) 1840
Ferric chloride (Pravaz) 1851–1853
Iodo tannic liquer (Desgranges) 1855
‘Chloral’ (Negretti) 1880
5% Phenol solution (Tavel) 1904
Potassium iodo-iodine (Tavel) 1906
‘Sublime’ (Scharf) 1910
Hypertonic glucose/50–60% calorose (Kausch) 1917
30% Sodium salicylate (Sicard and Gaugier) 1919
Sodium bicarbonate (Sicard and Gaugier) 1919
1% Bichloride of mercury (Wolf) 1920
12% Quinine sulfate with 6% urethane (Genevrier) 1922
Bi-iodine of mercury (Lacroix, Bazelis) 1922
Hypertonic saline with procaine (Linser) 1926
50% Grape sugar (Doeriffel) 1927
Sodium citrate (Kern and Angel) 1929
20–30% Hypertonic saline (Kern and Angel) 1929
Sodium morrhuate (Higgins and Kittel) 1930
Chromated glycerin (Scleremo) (Jausion) 1933
Ethanolamine oleate (Biegeleisen) 1937
Sodium tetradecyl sulfate (Sotradecol) (Reiner) 1946
Phenolated mercury and ammonium (Tournay and Wallois) 1949
Stabilized polyiodinated ions (Variglobin) (Imhoff and Sigg) 1959
Polidocanol (Aethoxysklerol) (Henschel and Eichenberg) 1966
Hypertonic saline/dextrose (Sclerodex) 1969



Modified from Goldman MP, Bennett R: J Am Acad Dermatol 17:167, 1987

Orbach 1944, técnica de bloque de aire Sigg, 1949. Técnica de bloque de espuma 1956: Peter Fluckiger técnica inyección retrógrada, aspiración y de elevación de pierna Walter Gillesberger: técnica de baja presión EFECTOS ADVERSOS HIPERPIGMENTACIÓN Postsclerotherapy hyperpigmentation: treatment characteristics
Agent Patient's Race Time of Biopsy Result
POL 0.25% White 6 weeks Heme
POL 0.75% White 6 weeks Heme
POL 0.75% Hispanic 6 months Heme
POL 0.75% White 2 months Heme
SM ? White 7 years Heme
HS 18% White 8 months Heme
HS 20% White 2 months Heme
STS 0.5% White 5 months Heme
STS 0.25% Hispanic 3 months Heme

POL, Polidocanol; SM, sodium morrhuate; HS, hypertonic saline; STS, sodium tetradecyl sulfate; Heme, hemosiderin. Factores Etiológicos HEMOSIDERINA
EXTRAVASACION
POR RUPTURA O DIAPEDESIS INFLAMACIÓN GRANULOCITOS HISTAMINA CONTRACCIÓN DEL ENDOTELIO AUMENTO DE LA BRECHA INTERCELULAR FAGOCITOSIS HEMATIES HEMOGLOBINA HEMOSIDERINA Tipo de Solución y concentración
Técnica: Puntos de alimentación
PRESIÓN EDEMA TRANSITORIO Mayor en el tobillo
Gravedad
Espasmo Reflejo
Torniquete
1ml, corticoides Diámetro del vaso
0,6-1,2 MATTING TELANGIECTÁSICO 1960 Ouvry-Davy
Vasos subclínicos
F de Riesgo: Obesidad, Estrógenos (migración, proliferación celular), embarazo, historia familiar ANGIOGÉNESIS Migración cel endoteliales post disrupción

HIPOXIA
FCE, y factor angiogénico mastocitos perivasculares

ELASTOCOMPRESIÓN
TRATAMIENTO Reinyección ssn hipertónica
Vaso alimenticio
Ketotifeno, pentoxifilina, protamina
DOLOR Tipo de aguja y tamaño
Técnica
Soluciones hipertónicas
Lidocaína, acidificación,
vasoespasmo, alergia
URTICARIA Transitoria, 40%
Corticoides tópicos, clobetasol,
vasoconstricción, menos MT, FLICTENAS POST COMPRESIÓN FOLICULITIS RECURRENCIA Falta de compresión COMPLICACIONES
Complications observed in a prospective French registry of 12,173 sclerotherapy sessions*
IMMEDIATE COMPLICATIONS
Liquid (T = 12) Foam (T = 28)
Anaphylactic shock – –
Intra-arterial injections – –
Vasovagal fainting (VVF) alone 4 6
Headaches alone – –
Paresthesias alone 2 1
Nausea, vomiting alone 1 0
Visual disturbances alone 4 8
Visual disturbances associated with
one or more of: headache nausea, VVF – 8
Others 1 5
DELAYED COMPLICATIONS
Liquid (T = 0) Foam (T = 9)
Deep vein thrombosis – 1
Muscular vein thrombosis – 1
Muscular vein extension – 1
Perforating vein thrombosis – 3
Intense superficial thrombophlebitis – 3
Skin necrosis – –
Adapted from Guex J-J, Allaert F-A, Gillet J-L, Chleir F: Dermatol Surg 31:123, 2005.

T, total number of complications per type of agent form (liq or foam)

* 5434 (44.6%) with liquid, 6395 (52.5%) with foam, and 344 (2.8%) using both. NECROSIS CUTÁNEA EXTRAVASACIÓN INYECCIÓN INTRAARTERIOLAR INYECCIÓN SUBCUTÁNEA COMPRESIÓN EXCESIVA PREVENCIÓN Y TRATAMIENTO REACCIONES ALÉRGICAS Ó TOXICIDAD

MENORES: Angioedema, Broncoespasmo, Estornudos
MAYORES: Anafilaxia; Toxicidad pulmonar, cardíaca o renal
* Lidocaína TROMBOFLEBITIS SUPERFICIAL ETIOLOGÍA TRATAMIENTO ASA AINES HBPM HEPARINA TÓPICA DRENAJE INYECCIÓN INTRAARTERIAL TRATAMIENTO

Infiltración arterial y periarterial con procaina 1%
Enfriamiento con ice packs
Heparinización inmediata por 6 dias o mas
Dextran 10%, 500 mg dia por 3 dias
Considerar trombolisis directa
Prazosin , hidralazina o nifedipina por 30 dias EMBOLIA SIN COMPROMISO PULMONAR

20-30% FOP
Manifestaciones neurológicas
Eco trans esofágico Vs TCD contrastado

Elevación , HBPM TROMBOEMBOLISMO PULMONAR
TROMBOSIS VENOSA PROFUNDA CAUSAS

Daño endotelial
Estasis venosa
Alteración de coagulación

Migración del esclerosante
Trombo parcialmente adherido en SVP volumen excesivo falta de actividad perforantes mas de 0,5 ml compresión deficiente Volumen por extremidad Combinación con cirugías
Compresión inapropiada
Estados hipercoagulables Hypercoagulable states
Primary hypercoagulable states

Deficiency in inhibitors of coagulation
• Antithrombin III deficiency
• Protein C deficiency
• Protein S deficiency

Disorders of the fibrinolytic system
Plasminogen deficiency
Plasminogen activator excess
Dysfibrinogenemias
Vascular damage
• Homocystinuria

Platelet damage
• Paroxysmal nocturnal hemoglobinuria
• Lupus anticoagulant

Secondary hypercoagulable states

Abnormalities of coagulation and fibrinolysis
• Pregnancy
• Malignancy
• Nephrotic syndrome
• Oral contraceptives
• Estrogen/progestin supplementation
• Inflammatory bowel disease

Infectious diseases
• Secondary syphilis
• Psittacosis

Platelet abnormalities
• Myeloproliferative disorders
• Diabetes mellitus
• Hyperlipidemia
• Paroxysmal nocturnal hemoglobinuria
• Lupus anticoagulant
• Heparin-associated thrombocytopenia

Stasis or aberrant blood flow
• Varicose veins
• Congestive heart failure


• Immobilization
• Obesity
• Advanced age
• Perioperative state
• Polycythemia vera, sickle cell disease
• Dehydration
• Paraproteinuria

Endothelial damage
• Intravenous catheters
• Intravenous solutions
• Intravenous drug abuse
• Vasculitis
• Behçet's disease
• Thromboangiitis obliterans

Modified from Thomas JH: Am J Surg 160:547, 1990; and from Samlaska CP, James WD: J Am Acad Dermatol 23:1, 1990. PREVENCIÓN
0,5 a 1 CC
Compresión 30-40mmHg
Movimientos pantorrilla
Noche
Heparina?
Ancianos
Movilización LESIÓN NERVIOSA EMBOLIA AÉREA MANIFESTACIONES VISUALES Y MIGRAÑA Phlebology 2010;25:261–266
See the full transcript