21-01 11-25 nicolini

VARICOSE VEIN
OPERATIVE TREATMENT
SHOULD BE DONE ONLY BY
VASCULAR SURGEONS
Philippe NICOLINI, M.D.
Clinique du PARC
LYON 6ème
FRANCE
Faculty Disclosure
Philippe NICOLINI, M.D.
I disclose the following financial relationships:
VASCULAR SURGEON
Consultant and employee of the SELARL of Philippe NICOLINI, vascular surgeon
Before last general secretary of the French Society of Vascular Surgery
Paid speaker for SELARL of Philippe NICOLINI
Founder member of the GDVSAOVS (group of defense of the vascular surgeons against
all the others vascular specialists)
I have a lot of relationships with all Vascular surgeons.
Je déclare les informations suivantes : je suis Chirurgien Vasculaire, consultant
et employé de la SELARL du Dr Philippe NICOLINI, dont je suis le principal
actionnaire, je reçois des fonds de la CNAM pour opérer les patients/Je suis
l’avant dernier secrétaire de la Société de Chirurgie Vasculaire et membre de
son Conseil d’administration, je suis fondateur du GDCVCSV (Groupe de
Défense des Chirurgiens Vasculaires contre tous les autres spécialistes
vasculaires, j’ai des relations permanentes avec les autres chirurgiens
vasculaires.
Actual situation in France
160 000 Varicose vein surgery/year (PMSI 2009)
– 30 000 since 2005
5 000 000 sclerotherapy procedures estimated
(CNAM 2010)
560 Vascular surgeons (2/3 private activity, 1/3
public activity)
1200 angiologists
Actual situation in France
80 % of varicose vein surgery are made in
private institute (CNAM 2009) = 370 vascular
surgeons make 128000 procedures/year,
average 350/year by surgeon
10-15 % of angiologists perform foam
echosclerotherapy: Quantification/year ???
No coding
VV Surgery
2007
2008
2009
Stripping
RF
Laser
Total
-
-
-
87470
(157)
(599)
(86970)
71053
304
1059
(121898)
(264)
(488)
74889
3488
1018
(117317)
(NC)
(NC)
72416
79395
5
Situation in UK
NHS
2006
2007
2008
2009
25280
23895
20742
17655
64
454
1589
5000
LASER
1980
3986
5162
7062
Foam
3824
5495
6235
8474
TOTAL
31148
33830
33729
38191
Crossectomy +
stripping
RF
Situation in USA
Millenium research group
1999
2002
2005
2008
2009
155 000
152 520
140 000
25 000
27 000
RF
0
9840
60 000
130 000
185 000
LASER
0
1640
120 000
340 000
305 000
TOTAL
155 000
164 000
320 000
495 000
517 000
Crossectomy
+ stripping
Actual situation in France
• These accounts are invalid because problem of
the re imbursement of endovenous
techniques.
• We can however consider that 80 % of
varicose veins can benefit from an
endovenous treatment
• For information, in Germany 85 % of varicose
veins (including open surgery) are performed
by dermatologists with a different training
than angiologists in France
Ideal criteriae of realization
•
•
•
•
•
•
•
Mastery of the peroperative echography:
Echoguided puncture
Precise location at the JSF
Mastery of the tumescent anesthesia
Mastery of the endovascular navigation
Catheterization
Guide's use
Ideal criteriae of realization
One shot treatment of all VV
Endovenous treatment + extensive phlebectomies
Endovenous treatment + pelvic embolisation
Endovenous treatment + Perforating vein ligation
Endovenous treatment + redux of the SFJ in case of
recurrence with big diameter or macroscopic
neovasculogenesis
Conclusions
• ONLY THE VASCULAR SURGEON can claim to answer
all these criteria (if he perform per operative dupplex
scan)
• At once:
Of the vocational training
cultural: maximal treatment in the same operative
time
Possibility to perform open surgery at place or
associated in case of problems
Cover Insurance
Conclusions
• Angiologists can do only sclerotherapy or
endovenous techniques
They had to select the patients or propose an
inadapted treatment.
• Vascular Surgeon can adapt his technique
according to the importance and the grade of
the venous disease: large diameter, tortuosity,
aneurysm, thinness of the patients, …
Conclusions
• Of more the Vascular Surgeon can easily
propose at a single time a bilateral treatment
with different possibility of anesthesia
(locoregionale or general)
• He can take care more easily in an
environment adapted by the patients with
associated co-morbidity (postoperative
supervision)
Conclusions
TO SUPPORT the GDVSAOVS (group of defense
of the vascular suckers against all the others
vascular specialists)
SEND YOUR DONATION
to
Philippe NICOLINI.com