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SCLEROTHERAPY WORKSHOPDIRECTOR: MARGARET MANN MDFACULTY:

CATHERINE BURDGE APRNMICHAEL DI IORIOMARK FORRESTAL MDTERRI HARPER, MSN, APRN, FNP-C

AMERICAN VEIN AND LYMPHATIC SOCIETYSATURDAY, FEB 8, 2020

Faculty Members

Nurse Practitioner and Center Manager of Connecticut Image Guided Surgery

Master of Science degree in nursing and post masters certificate for the specialty of acute care nurse practitioner from Yale University in New Haven, Connecticut.

Has served as the Nursing Section Chair and as Program Chair for the Nursing Section for ACP's Annual Congresses.

Catherine Burdge, APRNVascular & Interventiional RadiologyConnecticut Image Guided Surgery

Fairfield, CT

Faculty Members Founder and Medical Director Board Certified in Vascular, Interventional

Radiology and Diagnostic Radiology Diplomate of the ABVLM Board of Directors, Foundation for Venous and

Lymphatic Medicine

Michael Di Iorio, MD, RPVI, RVT, RPhsSouth Austin Vein Center

Austin, TX

Faculty Members

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Faculty Members

Board certified in internal medicine Exclusively treated patients with vein disorders in

an outpatient setting for over 30 years. Instrumental in the development of the field of

venous and lymphatic medicine in the United States.

Served as President of AVLS 2015-16

Mark Forrestal, MD, FACPhNorthwest Vein Care

Arlington, IL

Aesthetic nurse practitioner Served as Section Chair and Program Chair for

the Allied Health Section of the AVLS 2016 Graduate of the ACP Leadership

AcademyTerri Harper, APRN, NP-CVein Specialists of the South

Macon, GA

Faculty Members

Agenda

8:00 AM 8:15 AM Welcome Margaret Mann, MD, FACPh

8:15 AM 8:30 AM Venous Anatomy for Sclerotherapy Mark Forestal, MD

8:30 AM 8:45 AM Sclerosants ‐ How They Work Catherine Burdge, APRN

8:45 AM 9:00 AMChoosing the Right Sclerosant ‐ Type, Concentration, Volume Mark Forestal, MD

9:00 AM 9:15 AM Injection Techniques: Tips and Tricks Terri Harper, MSN, APRN, FNP‐C

9:15 AM 9:30 AMPatient Education: Pre‐ and  Post‐Treatment  Catherine Burdge, APRN

9:30 AM 9:45 AM Consent and Legal Issues Michael Di lorio, MD

9:45 AM 10:00 AM Question & Answer All Faculty

10:00 AM 10:15 AM Break

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10:15 AM 10:30 AM Ultrasound Guided Liquid and Foam Sclerotherapy Michael Di lorio, MD

10:30 AM 10:45 AM When Sclerotherapy is Not Enough Mark Forestal, MD

10:45 AM 11:00 AM Avoiding Complications Terri Harper, MSN, APRN, FNP‐C

11:00 AM 11:15 AM Managing Disasters‐ skin ulcers and beyond Michael Di lorio, MD

11:15 AM 11:30 AM Is There a Role for Lasers?Margaret Mann, MD, FACPh

11:30 AM 11:45 AM Compression ‐What's the EvidenceCatherine Burdge, APRN

11:45 AM 12:00 PM Question & Answer All Faculty

1:00 PM 1:30 PM Case Studies: Video DemonstrationsMargaret Mann, MD, FACPh

1:30 AM 1:45 AMRound Table Discussion: Variations in Treatments ‐How We Do It All Faculty

1:45 PM 3:30 PM Hands‐On Workshop & VR Immersion Lab All Faculty

3:30 PM 3:45 PM Sclerotherapy: Distinguish Your PracticeTerri Harper, MSN, APRN, FNP‐C

3:45 PM 4:00 PMRound Table Discussion: Team‐Based Care ‐ How We Do It All Faculty

Variations in Treatments -How We Do It

Round Table Discussion:

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Margaret Mann, MD, FAAD, FACPh

Preparing Solution

Final Solution 3% STS Normal Saline

Final Amount

0.1% 1 cc 29 cc 30 cc

0.2% 2 cc 28 cc 30 cc

Final Solution 1% POL

Normal Saline

Final Amount

0.25% 2 cc 6 cc 8 cc

0.5% 2 cc 2 cc 4 cc

•Sodium Tetradecyl Sulfate – 3% solution, 2cc per vial •Polidocanol – 0.5% and 1% solution, 2 cc per vial

Margaret Mann, MD, FAAD, FACPh

STS- FFF Enterprise Terumo Syringes- Low silicone

content for foam–MedVetInternationalhttps://www.shopmedvet.com

Margaret Mann, MD, FAAD, FACPh

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Mark Forrestal, MD, FACPH

Mark Forrestal, MD, FACPH

Catherine Burdge, APRN

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Catherine Burdge, APRN

Terri Harper, MSN, APRN, FNP-C

Michael Graves, MD, FAAD

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Vineet Mishra, MD, FAAD, FACPH

Jessica Ochs, PA-C

Daniel Friedmann, MD FAAD

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Daniel Friedmann, MD FAAD

Todd Cartee, MD, FAAD

How we do It- Panel Discussion

General Principles but lots of variations in techniquesUnderstand spider veins are part of an

interconnected network of veinsRemember “Patterns” of venous insufficencyFor patients with venous insufficiency, comprehensive

treatment offers the best resultsPOL and STS offer better efficacy and fewer side

effects than hypertonic saline

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General Principles but Lots of variations in techniques

Reticular veins - Favorite sclerosant, concentration, syringe size, needle gauge

Spider veins - Favorite sclerosant, concentration, syringe size, needle gauge

How do you prepare solutions?When do you use lasers?

Foam Sclerotherapy - What type of vessels? Sclerosant preference? STS vs POLConcentration of Sclerosant?Ratio of liquid to air?Room air vs other? Two way connector vs stopcock?Needle gauge? Butterfly needle?What do you do if pt has history of migraines

Compression- cotton balls? How long?

Visualization device?

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Realistic Expectation

Managing Patient Expectations

Multiple treatments are required Final results takes weeks to months Look for improvement…not perfection I can make their veins better, but I cannot eliminate their genetic tendency to form more TAKE PHOTOS

Dr. M Mann 1/12/17 Dr. M Mann 3/17/17 Dr. M Mann 4/6/17

Dr. M Mann 11/28/16 Dr. M Mann 4/21/17Dr. M Mann 2/10/17 Dr. M Mann 3/17/17

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