<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\nMilleret\u00a0Rene MD<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”4_4″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″]<\/p>\n
Steam ablation of small saphenous vein and popliteal perforators<\/span>
\n AUTHOR:\u00a0Rene Milleret<\/span><\/p>\nIntroduction: We have been using since 2008 a thermal technique based on the heat generated when water vapor condensates back to liquid: The Steam method. The ability of pressurized steam to flush through bends and tortuosity is a significant advantage over more rigid fibers or catheters.
\nMaterial and methods: The steam device comprises a generator, a heating hand-piece and a dedicated catheter. Steam temperature is 110 \u00b0C.
\nSurgical technique is similar to other thermal methods.
\nUltra sound guided vein entrance is obtained by puncture with a 16 G, 48 mm Venflon\u00ae. When treating a Small Saphenous trunk the entry point is just above the medial posterior perforator to avoid heating the gastro cnemian vein
\nThe catheter can be safely pushed up to 2 cm from the sapheno popliteal junction. If a common trunk with the gastro cnemian vein is found, we place the tip 1 cm from the junction of the two veins.
\nTumescence is then applied around the vein under echo-guidance using Klein\u2019s solution (1). A gaze soaked in cold saline is applied around the catheter at the entry point to cool down the skin and avoid any burn.
\n300 Joules are delivered on each of the first centimeter\u2019s marks. Then the energy delivered In the vein depends on its pre-operative diameter measured on the patient standing.
\nTreating recurrences and Popliteal Fossa perforators may imply several punctions as it is usually not possible to negotiate sharp tortuosities.
\nPost operative care: All patients are treated for at least 1 week with a Low Molecular Weight heparin , expect those who are already under anti coagulation .If this is the case the treatment is not discontinued .
\nPatients with a personal and\/or family history of thrombo-embolic disease are treated for 20 days. Venous trunks which have presented with a superficial venous thrombosis are not a contra-indication for the treatment but we wait for 18 months before ablating the vein with steam.
\nResults: We have treated 670 Small Saphenous Veins and 243 Popliteal Fossa Perforators between 2010 and 2016.
\n98 % of the patients have been controlled at 3\/6 weeks to detect complications and check that the vein was closed. All the vein were closed on Duplex examination.
\nComplications were few:
\n— 3 cases of Deep Vein Thrombosis localized to a calf vein without pulmonary embolism,
\n— Paresthesia of the sural nerve was detected in 3,5% of the patients, it was long lasting in only 0,5% (still present at the 1 year control).
\n— No infection was reported.
\n— Skin burns at the entry point were seen in 2% of the patients but were superficial and healed spontaneously in 2 or 3 months.
\nLong term closure rates are: 94% at 1 year, going down to 88% at 3 years, 65% of patients
\nbeing followed up at this delay.
\nIn Conclusion; Steam Ablation spares the patient and the surgeon the incision and dissection
\nof the Popliteal Fossa, which can be challenging in case of Redo Surgery.<\/p>\n
SHORT CV<\/span><\/p>\nDr. Milleret is a vascular surgeon with a training in electronics .
\nHe built his own Doppler machines since 1971 and used them to develop new techniques in Phlebology.
\nHe performed the first deep vein valvuloplasty in Europe (1978), introduced Cryo-fibrosis and Cryo-stripping for ablation of Saphenous trunks. When endovenous surgery appeared he devised a Steam Ablation technique which allows thermal ablation of tributary veins\u00a0 perforators.
\nHis current research is focused on Transcutaneous Ultrasonic methods to treat refluxing veins Non invasively, and on Prosthetic venous valves for deep venous insufficiency .<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” saved_tabs=”all” global_module=”516″][et_pb_row custom_padding=”61px|0px|69px|0px|false|false” _builder_version=”3.18.9″][et_pb_column type=”3_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop” header_font=”||||||||” background_layout=”dark”]<\/p>\n
Contact PDI 2019’s PCO<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro” submit_button_text=”Send” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”E-mail address” field_type=”email” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Message” field_type=”text” fullwidth_field=”on” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
PCO of PDI 2019<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”3.19.4″ text_font=”||||||||”]<\/p>\n
![\"\"](\"https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/eventer_logo_150px.png\")
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAddress: A. Panu St. no. 13, Iasi<\/span>
Tel.: +40 332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
[et_pb_section fb_built=”1″ fullwidth=”on” disabled_on=”on|off|off” _builder_version=”3.19.4″ custom_margin=”||” custom_padding=”15px||29px” top_divider_style=”waves2″ top_divider_color=”#f0622a” top_divider_flip=”horizontal|vertical” bottom_divider_style=”waves2″ bottom_divider_color=”#fcdedb” bottom_divider_height=”105px” bottom_divider_flip=”vertical” collapsed=”off”][et_pb_fullwidth_header title=”{%22dynamic%22:true,%22content%22:%22post_title%22,%22settings%22:{%22before%22:%22%22,%22after%22:%22 MD%22}}” text_orientation=”right” header_image_url=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/Primaderma2019_logo_300px.png” disabled_on=”on|on|off” _builder_version=”3.19.4″ _dynamic_attributes=”title” title_font=”Kaushan Script||||||||” title_text_align=”right” title_text_color=”#f0622a” title_font_size=”50px” content_font=”|600||on|||||” content_text_align=”center” content_text_color=”#686766″ content_font_size=”15px” content_font_size_phone=”15px” content_font_size_last_edited=”on|desktop” subhead_font=”||||||||” background_color=”rgba(239,145,107,0.54)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back.jpg” background_layout=”light” custom_margin=”0px||8px” custom_padding=”40px||40px||true”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”1_2″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_image border_radii=”on|100px|100px|100px|100px” max_width=”36%” src=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/03\/ren\u00e9-Milleret_1.jpg” _builder_version=”3.19.4″][\/et_pb_image][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″] […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163"}],"collection":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/comments?post=5163"}],"version-history":[{"count":4,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163\/revisions"}],"predecessor-version":[{"id":5169,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163\/revisions\/5169"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/media?parent=5163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\n<\/span><\/strong><\/h4>\nMilleret\u00a0Rene MD<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”4_4″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″]<\/p>\n
Steam ablation of small saphenous vein and popliteal perforators<\/span>
\n AUTHOR:\u00a0Rene Milleret<\/span><\/p>\nIntroduction: We have been using since 2008 a thermal technique based on the heat generated when water vapor condensates back to liquid: The Steam method. The ability of pressurized steam to flush through bends and tortuosity is a significant advantage over more rigid fibers or catheters.
\nMaterial and methods: The steam device comprises a generator, a heating hand-piece and a dedicated catheter. Steam temperature is 110 \u00b0C.
\nSurgical technique is similar to other thermal methods.
\nUltra sound guided vein entrance is obtained by puncture with a 16 G, 48 mm Venflon\u00ae. When treating a Small Saphenous trunk the entry point is just above the medial posterior perforator to avoid heating the gastro cnemian vein
\nThe catheter can be safely pushed up to 2 cm from the sapheno popliteal junction. If a common trunk with the gastro cnemian vein is found, we place the tip 1 cm from the junction of the two veins.
\nTumescence is then applied around the vein under echo-guidance using Klein\u2019s solution (1). A gaze soaked in cold saline is applied around the catheter at the entry point to cool down the skin and avoid any burn.
\n300 Joules are delivered on each of the first centimeter\u2019s marks. Then the energy delivered In the vein depends on its pre-operative diameter measured on the patient standing.
\nTreating recurrences and Popliteal Fossa perforators may imply several punctions as it is usually not possible to negotiate sharp tortuosities.
\nPost operative care: All patients are treated for at least 1 week with a Low Molecular Weight heparin , expect those who are already under anti coagulation .If this is the case the treatment is not discontinued .
\nPatients with a personal and\/or family history of thrombo-embolic disease are treated for 20 days. Venous trunks which have presented with a superficial venous thrombosis are not a contra-indication for the treatment but we wait for 18 months before ablating the vein with steam.
\nResults: We have treated 670 Small Saphenous Veins and 243 Popliteal Fossa Perforators between 2010 and 2016.
\n98 % of the patients have been controlled at 3\/6 weeks to detect complications and check that the vein was closed. All the vein were closed on Duplex examination.
\nComplications were few:
\n— 3 cases of Deep Vein Thrombosis localized to a calf vein without pulmonary embolism,
\n— Paresthesia of the sural nerve was detected in 3,5% of the patients, it was long lasting in only 0,5% (still present at the 1 year control).
\n— No infection was reported.
\n— Skin burns at the entry point were seen in 2% of the patients but were superficial and healed spontaneously in 2 or 3 months.
\nLong term closure rates are: 94% at 1 year, going down to 88% at 3 years, 65% of patients
\nbeing followed up at this delay.
\nIn Conclusion; Steam Ablation spares the patient and the surgeon the incision and dissection
\nof the Popliteal Fossa, which can be challenging in case of Redo Surgery.<\/p>\n
SHORT CV<\/span><\/p>\nDr. Milleret is a vascular surgeon with a training in electronics .
\nHe built his own Doppler machines since 1971 and used them to develop new techniques in Phlebology.
\nHe performed the first deep vein valvuloplasty in Europe (1978), introduced Cryo-fibrosis and Cryo-stripping for ablation of Saphenous trunks. When endovenous surgery appeared he devised a Steam Ablation technique which allows thermal ablation of tributary veins\u00a0 perforators.
\nHis current research is focused on Transcutaneous Ultrasonic methods to treat refluxing veins Non invasively, and on Prosthetic venous valves for deep venous insufficiency .<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” saved_tabs=”all” global_module=”516″][et_pb_row custom_padding=”61px|0px|69px|0px|false|false” _builder_version=”3.18.9″][et_pb_column type=”3_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop” header_font=”||||||||” background_layout=”dark”]<\/p>\n
Contact PDI 2019’s PCO<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro” submit_button_text=”Send” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”E-mail address” field_type=”email” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Message” field_type=”text” fullwidth_field=”on” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
PCO of PDI 2019<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”3.19.4″ text_font=”||||||||”]<\/p>\n
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAddress: A. Panu St. no. 13, Iasi<\/span>
Tel.: +40 332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
[et_pb_section fb_built=”1″ fullwidth=”on” disabled_on=”on|off|off” _builder_version=”3.19.4″ custom_margin=”||” custom_padding=”15px||29px” top_divider_style=”waves2″ top_divider_color=”#f0622a” top_divider_flip=”horizontal|vertical” bottom_divider_style=”waves2″ bottom_divider_color=”#fcdedb” bottom_divider_height=”105px” bottom_divider_flip=”vertical” collapsed=”off”][et_pb_fullwidth_header title=”{%22dynamic%22:true,%22content%22:%22post_title%22,%22settings%22:{%22before%22:%22%22,%22after%22:%22 MD%22}}” text_orientation=”right” header_image_url=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/Primaderma2019_logo_300px.png” disabled_on=”on|on|off” _builder_version=”3.19.4″ _dynamic_attributes=”title” title_font=”Kaushan Script||||||||” title_text_align=”right” title_text_color=”#f0622a” title_font_size=”50px” content_font=”|600||on|||||” content_text_align=”center” content_text_color=”#686766″ content_font_size=”15px” content_font_size_phone=”15px” content_font_size_last_edited=”on|desktop” subhead_font=”||||||||” background_color=”rgba(239,145,107,0.54)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back.jpg” background_layout=”light” custom_margin=”0px||8px” custom_padding=”40px||40px||true”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”1_2″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_image border_radii=”on|100px|100px|100px|100px” max_width=”36%” src=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/03\/ren\u00e9-Milleret_1.jpg” _builder_version=”3.19.4″][\/et_pb_image][\/et_pb_column][et_pb_column type=”1_2″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″] […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163"}],"collection":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/comments?post=5163"}],"version-history":[{"count":4,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163\/revisions"}],"predecessor-version":[{"id":5169,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5163\/revisions\/5169"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/media?parent=5163"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/span><\/strong><\/h4>\nMilleret\u00a0Rene MD<\/span><\/strong><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”4_4″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″]<\/p>\n
Steam ablation of small saphenous vein and popliteal perforators<\/span>
\n AUTHOR:\u00a0Rene Milleret<\/span><\/p>\nIntroduction: We have been using since 2008 a thermal technique based on the heat generated when water vapor condensates back to liquid: The Steam method. The ability of pressurized steam to flush through bends and tortuosity is a significant advantage over more rigid fibers or catheters.
\nMaterial and methods: The steam device comprises a generator, a heating hand-piece and a dedicated catheter. Steam temperature is 110 \u00b0C.
\nSurgical technique is similar to other thermal methods.
\nUltra sound guided vein entrance is obtained by puncture with a 16 G, 48 mm Venflon\u00ae. When treating a Small Saphenous trunk the entry point is just above the medial posterior perforator to avoid heating the gastro cnemian vein
\nThe catheter can be safely pushed up to 2 cm from the sapheno popliteal junction. If a common trunk with the gastro cnemian vein is found, we place the tip 1 cm from the junction of the two veins.
\nTumescence is then applied around the vein under echo-guidance using Klein\u2019s solution (1). A gaze soaked in cold saline is applied around the catheter at the entry point to cool down the skin and avoid any burn.
\n300 Joules are delivered on each of the first centimeter\u2019s marks. Then the energy delivered In the vein depends on its pre-operative diameter measured on the patient standing.
\nTreating recurrences and Popliteal Fossa perforators may imply several punctions as it is usually not possible to negotiate sharp tortuosities.
\nPost operative care: All patients are treated for at least 1 week with a Low Molecular Weight heparin , expect those who are already under anti coagulation .If this is the case the treatment is not discontinued .
\nPatients with a personal and\/or family history of thrombo-embolic disease are treated for 20 days. Venous trunks which have presented with a superficial venous thrombosis are not a contra-indication for the treatment but we wait for 18 months before ablating the vein with steam.
\nResults: We have treated 670 Small Saphenous Veins and 243 Popliteal Fossa Perforators between 2010 and 2016.
\n98 % of the patients have been controlled at 3\/6 weeks to detect complications and check that the vein was closed. All the vein were closed on Duplex examination.
\nComplications were few:
\n— 3 cases of Deep Vein Thrombosis localized to a calf vein without pulmonary embolism,
\n— Paresthesia of the sural nerve was detected in 3,5% of the patients, it was long lasting in only 0,5% (still present at the 1 year control).
\n— No infection was reported.
\n— Skin burns at the entry point were seen in 2% of the patients but were superficial and healed spontaneously in 2 or 3 months.
\nLong term closure rates are: 94% at 1 year, going down to 88% at 3 years, 65% of patients
\nbeing followed up at this delay.
\nIn Conclusion; Steam Ablation spares the patient and the surgeon the incision and dissection
\nof the Popliteal Fossa, which can be challenging in case of Redo Surgery.<\/p>\n
SHORT CV<\/span><\/p>\nDr. Milleret is a vascular surgeon with a training in electronics .
\nHe built his own Doppler machines since 1971 and used them to develop new techniques in Phlebology.
\nHe performed the first deep vein valvuloplasty in Europe (1978), introduced Cryo-fibrosis and Cryo-stripping for ablation of Saphenous trunks. When endovenous surgery appeared he devised a Steam Ablation technique which allows thermal ablation of tributary veins\u00a0 perforators.
\nHis current research is focused on Transcutaneous Ultrasonic methods to treat refluxing veins Non invasively, and on Prosthetic venous valves for deep venous insufficiency .<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” saved_tabs=”all” global_module=”516″][et_pb_row custom_padding=”61px|0px|69px|0px|false|false” _builder_version=”3.18.9″][et_pb_column type=”3_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop” header_font=”||||||||” background_layout=”dark”]<\/p>\n
Contact PDI 2019’s PCO<\/p>\n
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PCO of PDI 2019<\/p>\n
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<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAddress: A. Panu St. no. 13, Iasi<\/span>
Tel.: +40 332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
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[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.19.4″][et_pb_column type=”4_4″ _builder_version=”3.19.4″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″]<\/p>\n
Steam ablation of small saphenous vein and popliteal perforators<\/span> Introduction: We have been using since 2008 a thermal technique based on the heat generated when water vapor condensates back to liquid: The Steam method. The ability of pressurized steam to flush through bends and tortuosity is a significant advantage over more rigid fibers or catheters. SHORT CV<\/span><\/p>\n Dr. Milleret is a vascular surgeon with a training in electronics . [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” saved_tabs=”all” global_module=”516″][et_pb_row custom_padding=”61px|0px|69px|0px|false|false” _builder_version=”3.18.9″][et_pb_column type=”3_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop” header_font=”||||||||” background_layout=”dark”]<\/p>\n Contact PDI 2019’s PCO<\/p>\n [\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro” submit_button_text=”Send” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”E-mail address” field_type=”email” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Message” field_type=”text” fullwidth_field=”on” _builder_version=”3.19.4″ border_radii=”on||||” button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.18.9″ parallax=”off” parallax_method=”on”][et_pb_text _builder_version=”3.19.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n PCO of PDI 2019<\/p>\n [\/et_pb_text][et_pb_text _builder_version=”3.19.4″ text_font=”||||||||”]<\/p>\n <\/span><\/p>\n <\/span><\/p>\n Address: A. 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\n AUTHOR:\u00a0Rene Milleret<\/span><\/p>\n
\nMaterial and methods: The steam device comprises a generator, a heating hand-piece and a dedicated catheter. Steam temperature is 110 \u00b0C.
\nSurgical technique is similar to other thermal methods.
\nUltra sound guided vein entrance is obtained by puncture with a 16 G, 48 mm Venflon\u00ae. When treating a Small Saphenous trunk the entry point is just above the medial posterior perforator to avoid heating the gastro cnemian vein
\nThe catheter can be safely pushed up to 2 cm from the sapheno popliteal junction. If a common trunk with the gastro cnemian vein is found, we place the tip 1 cm from the junction of the two veins.
\nTumescence is then applied around the vein under echo-guidance using Klein\u2019s solution (1). A gaze soaked in cold saline is applied around the catheter at the entry point to cool down the skin and avoid any burn.
\n300 Joules are delivered on each of the first centimeter\u2019s marks. Then the energy delivered In the vein depends on its pre-operative diameter measured on the patient standing.
\nTreating recurrences and Popliteal Fossa perforators may imply several punctions as it is usually not possible to negotiate sharp tortuosities.
\nPost operative care: All patients are treated for at least 1 week with a Low Molecular Weight heparin , expect those who are already under anti coagulation .If this is the case the treatment is not discontinued .
\nPatients with a personal and\/or family history of thrombo-embolic disease are treated for 20 days. Venous trunks which have presented with a superficial venous thrombosis are not a contra-indication for the treatment but we wait for 18 months before ablating the vein with steam.
\nResults: We have treated 670 Small Saphenous Veins and 243 Popliteal Fossa Perforators between 2010 and 2016.
\n98 % of the patients have been controlled at 3\/6 weeks to detect complications and check that the vein was closed. All the vein were closed on Duplex examination.
\nComplications were few:
\n— 3 cases of Deep Vein Thrombosis localized to a calf vein without pulmonary embolism,
\n— Paresthesia of the sural nerve was detected in 3,5% of the patients, it was long lasting in only 0,5% (still present at the 1 year control).
\n— No infection was reported.
\n— Skin burns at the entry point were seen in 2% of the patients but were superficial and healed spontaneously in 2 or 3 months.
\nLong term closure rates are: 94% at 1 year, going down to 88% at 3 years, 65% of patients
\nbeing followed up at this delay.
\nIn Conclusion; Steam Ablation spares the patient and the surgeon the incision and dissection
\nof the Popliteal Fossa, which can be challenging in case of Redo Surgery.<\/p>\n
\nHe built his own Doppler machines since 1971 and used them to develop new techniques in Phlebology.
\nHe performed the first deep vein valvuloplasty in Europe (1978), introduced Cryo-fibrosis and Cryo-stripping for ablation of Saphenous trunks. When endovenous surgery appeared he devised a Steam Ablation technique which allows thermal ablation of tributary veins\u00a0 perforators.
\nHis current research is focused on Transcutaneous Ultrasonic methods to treat refluxing veins Non invasively, and on Prosthetic venous valves for deep venous insufficiency .<\/p>\n<\/span><\/p>\n
Tel.: +40 332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n