So Vein: A Course and Hands-On Workshop on Sclerotherapy
One of the many invasive procedures that dermatologists perform in the clinics is sclerotherapy. It is undeniable that times have changed and people opt to have this procedure done for cosmetic purposes besides its therapeutic uses. Because of this, the demand for this procedure outweighs the number of trained dermatologists who are capable to perform the said procedure. To address this emerging concern, the Dermatologic Surgery Core Team in cooperation with the Department of Dermatology of the Jose R. Reyes Memorial Medical Center (JRRMMC) and the Skin Research of Foundation of the Philippines, offered its very first sclerotherapy workshop entitled “So Vein: A Course and Hands-On Workshop on Sclerotherapy” last July 27, 2019 at the JRRMMC Dermatology Conference Room. The event was hosted by Dr. Ma. Criscelda Rescober-Valencia.
The organizers of the workshop ensured the comprehensiveness of the said course and included lectures that tackled the basic and essential knowledge that should be acquired to be able to safely perform sclerotherapy. These same lecturers who have expertise in treating vascular malformations also did demonstrations of various techniques. Complications of sclerotherapy were also discussed to properly address them in case of any unfortunate event.
The head of the Dermatologic Surgery of the JRRMMC Department of Dermatology – Dr. Agnes Epinoza-Thaebtharm, formally opened the event. This was followed by lectures, live demonstrations and hand-on experience. The first lecturer, Dr. Riza Milante, refreshed the attendees regarding the relevant anatomy and physiology of veins in treating chronic venous diseases. A talk regarding treatment and avoidance of adverse events in sclerotherapy was given next by Dr. Agnes Espinoza-Thaebtharm. Dr. Zharlah Gulmatico-Flores elaborated the uses of vascular laser, endovenous ablation, and surgery and ambulatory phlebectomy in chronic venous diseases. Dr. Teresita Ferrariz further discussed the various sclerosing agents that are currently being used in practice.
Ms. Genevieve Salem – who is an experienced trainer of a well-known laser company in the Philippines, had a live demonstration of vascular laser. Dr. Flores and Dr. Thaebtharm performed liquid and foam sclerotherapy respectively. Afterwards, Dr. Ricardo Quintos did a comprehensive lecture and a live demonstration of vascular ultrasound and duplex scan.
In the afternoon, the delegates who availed of the hands-on workshop were taught how to safely and properly perform skin ultrasound, vascular laser and liquid and foam sclerotherapy. Small groups of 5-6 delegates were formed and each group was given a good 40 minutes in every station. The event was formally ended thereafter.
PEARLS THAT THE AUDIENCE DERIVED FROM THE CME:
- Deliver a minimum volume and concentration of sclerosant.
- Leave adjacent normal vessels unaffected.
- Determine whether the cause of varicose veins is primary or secondary thru proper history and physical examination.
- Clinical, Etiologic, Anatomic and Pathophysiologic (CEAP) classification of chronic venous disease can be utilized to guide clinicians in the evaluation and management of venous disorders of the lower extremities.
- Doppler ultrasound, skin ultrasound and duplex scan are current diagnostic tests that may guide the clinician in the assessment of varicose veins, and can be utilized during administration of sclerosing agents.
- The goals of treatment of varicose veins are alleviation of pain, reduction of edema, healing of ulcers, prevention of recurrence or progression of varicose veins, and cosmetic/aesthetic concerns of the patient.
- Treatment options include elastic compression stockings, sclerotherapy, vascular laser therapy, and invasive procedures such as endovenous thermal ablation and ambulatory phlebectomy.
- Most adverse effects of sclerotherapy including local injection site pain, urticaria, itching, erythema, bruising, cutaneous hyperpigmentation and telangiectatic matting, are relatively self-limiting. Major complications include systemic life-threatening reactions and anaphylaxis, deep venous thrombosis, tissue necrosis, and nerve damage rarely occurs. Therefore, emergency protocols, procedures and medications should be available when these adverse reactions occur.