1st haemodynamic simposium introduction, program and information

Maggiore Policlinico Hospital of Milan - Aula Magna of the Mangiagalli Clinic

Haemodynamic aspects of physiopathology, diagnosis and therapy of the venous disease

Milan, October 15 and 16, 2015

1st International Haemodynamic Symposium on Venous Disorders

Introduction In recent decades we have witnessed a great revolution in the approach to venous diseases thanks to the increasing understanding of the phys iopathologicical mechanisms that cause the typical pathological signs of venous insufficiencies.

The introduction of non-invasive diagnostics with the continuous wave Doppler and subsequently with the Echo Color Doppler enabled us to acquire detailed inform ation on the phys iological m echanism s of venous circulation and consequentl y on the physiopathological m echanism s. This allowed for a new close examination of the events and hem odynam ic changes that trigger the onset of the clinical abnormalities characteristic of venous insufficiencies.

This development has greatly benefitted diagnosis and therapy not only of the superficial venous insufficiencies but also of the deep venous insufficiencies, which are common in post-throm bosis s yndrom e.

Scientific Board

Prof. Livio Gabrielli

Prof. Claude Franceschi

Dott. Roberto Delfrate

In the last twenty-five years, non-invasive hem odynam ic ultrasound diagnostics together with technological developments have broade ned therapeutic options. T hese include conservative hem odynam ic therapy and also the progressive development of different forms of m inim ally- invasive therapies which intend to offer alternatives to stripping that are eas ier to im plem ent.

T h e h e m o d yn a m i c C H I V A s t r a t e g y ( C o n s e r v a t r i c e e t Hem odynam ique de l' Insuffisance Veineus e en Am bulatoire) codified by C laude Fr anceschi, a pioneer who pla yed a m ajor role in the development and spreading of the Doppler ultrasound vascular investigation both in the arterial and venous districts, appeared in 1988 as an alternative to demolition therapies. It’s primary aim was to preserve saphenous veins in ever y patient for any possible further vascular use and while maintaining proper tissue drainage.

T he hem odynam ic CH IVA st rategy requir es rem ark able diagnostic skills and constant practice and perseverance in order to fully exploit the diagnostic potential of the Echo Color Doppler. Thanks to these efforts it has been possible to increase the under standing of the physiopathol ogical m echanism s of venous insufficiencies of the lower lim bs and to expand therapeutic horizons as in the case of the varicose veins of pelvic origin.

A l l t h i s a l l o w e d f o r t h e a p p l i c a t i o n o f n e w h e m o d yn a m i c knowledge to the arterial district as well, wit h several benefits for patients suffering from arterial occlusive disease arising from the development of atherosclerotic lesions and especiall y from diabetic arter iopath y. An exam ple is the possibility of measuring the arterial pressure in the vascular bed of the forefoot (Pole test) or in the tibial veins of the ank le, tak ing advantage of the basic principles of ph ysics, with an Echo Color Doppler or a simple pulse oximeter.

The definition of the concept of a shunt and the possibility of classif ying hem od ynam ic events in an y type of shunt enabled us to develop and im plem ent new hem odynam ic corrective therapies not only of the superficial vein but also of deep veins. T he aim of these therapies is to norm alize transmural pressure values in the superficial di stricts and under the fascia, standardizing the treatm ent according to the type of shunt.

As far as deep venous insufficiencies, thanks to hem odynam ic assessm ent and the contem porar y developm ent of new reconstructive and endovascular techniques, today it’s possible to face the com plex problem of deep venous i n s u f f i c i e n c i e s l i k e p o s t - t h r o m b o s i s s yn d r o m e w i t h m o r e optimism and a higher success rate.

Vascular malformation pathology has also been positively affected by the progress brought about by increasing a wareness of hem odynam ic Echo C olor Doppler diagnostics. Together with the possibility of pre -surgery assessment, the use of ultrasounds during operations has rem ark ably increased the success rates of this therap y.

Prof. Livio Gabrielli Director of the Postgraduate course on Vascular Surgery at the University of Milan Head of the Vascular Surgery Unit of the IRCCS Cà Granda Foundation –Maggiore Policlinico Hospital

Prof. Claude Franceschi Consultant in vascular pathology, complex venous insufficiency and vascular malformations Saint Joseph Hospital, Paris Director of the diplôme d'Ecodoppler vasculaire Groupe hospitalier Pitié-Salpêtrière University of Paris VII, Paris Medical Consultant Private Clinic - Figlie di San Camillo, Cremona

Dott. Roberto Delfrate Head of the Surgery Department and of the Surgery Unit at the Private Clinic Figlie di San Camillo in Cremona

1st International Haemodynamic Symposium on Venous Disorders Hemodynamic aspects of physiopathology, diagnosis and therapy of the venous disease

T he s ym p os ium c ons is ts of t wo d a ys of i n - d ep th s tu d y d ur i n g wh i c h th e f u n d am ent a l c o nc ep ts of t h e p h ys io p at ho l o g y of t h e s up erf ic i al an d d ee p ve n ous d i s eas e a nd of v e no u s m alf orm at io n wi l l be ex p l a in e d.

Ex c ep t io n a ll y e x p er i en c ed pr of es s io n als wi l l ga t her to an a l yze th e d if f ere nt a ppr o ac hes t o t h e v en o us dis e as e , to ex am in e th e as p ec ts of p h ys i o pa t ho l o g y a nd pr o v id e i n - d e pt h, ex p er t inf orm at i o n a n d up d at es .

Lec t urers f r om d if f er e nt bac k gr o un ds wi l l t a k e t u r ns a t t he p od i um an d wi l l c om par e t he i r ex p er i enc es dur i n g t he v ar i ous s es s io ns . A l i ve ex am in a t io n wi t h Ec h o Co l or D op p l er wi l l be c a rri e d o ut on pa t ie n ts af f ec t ed b y th e v e no us d is eas e a n d th e c o nc e p ts ex pres s e d b y th e l ec tur er s wi l l b e p ut i n to pr ac t ic e .

It wi l l b e a n ex tr aor d i n ar y oc c as io n f or a n y p h ys ic i a n wh o wa nts to de v e l op an d up d at e t h e ir s k i l ls t h ank s to th e la t es t k no wl e d ge i n t h e f ie l d of v e no us dis e as es af f ec t i n g th e w es te rn p o pu l at i o n m or e a n d m ore .

T arg et aud i enc e It a li a n a nd f or e ig n p h ys ic ia ns .

Target medical disciplines: angiology, general surgery, vascular surgery, diabetology, gynecology and obstetrics, dermatology, cardiology, vulnology, emergency medicine, internal medicine, sports medicine, radiology, neurology, general medicine.

Italian and foreign resident doctors of the above -mentioned disciplines.

S ci ent if i c Bo a rd Dot t . R ob ert o De lf rat e

Cre m on a

P rof . Cl aud e Fr an c es chi

P ar is

P rof . L iv io G a br i el li

Mi l a n

Edu c at i on al obj e ctiv es: T he m ai n obj ec t i v e of t his s ym p os ium is to d is c us s t h e l at es t ad v a nc em e nts in v e no us ph ys i op a th o l og y, wh ic h in v o l v es c om pl ex hem od yn am ic c onc e p ts , a n d to p ro v i de p h ys ic i a ns wi t h t he s k il ls to per f or m ad v anc e d h e m od yn am ic d i ag n os t ic s b y im pro v i n g t h e o ver a l l s ta n dar d of t he Ec h o Co l or D op p l er ex am in at i ons . A n ot h er im por t an t a im is t o pr om ot e th e pr ac t ic e of lo ok i ng f o r th e m os t s u i ta b l e tr e atm en t, s tar t in g wi th t he pr og nos is , f o l lo we d b y t h e d e v e lo pm en t of a r at i on a l th er ap e ut ic s tr at e g y b as e d o n t he ex am in a ti on of e v i de nc e a nd k no wl ed g e of p h ys i op at h o lo g y.

B el o w is a d e ta i l ed lis t of th e s ym p os i um ’s o bj ec t i ves :  T o pr om ot e t h e d i a g nos t ic p o te nt i a l of t h e n e w u l tra - s o no gr a p h ic tec h no l og i es an d th e i m plem en ta t io n m od a l it i es of t h e di a gn os is wi th th e us e of hem o d yn am ic m an e u v ers an d c ar t ogr a p hic m aps .  T o ex am i ne th e dif f er e nt f i e l ds of a p p lic a ti o n of th e ne w h em od yn a m ic ph ys i o pa th o l og ic a l k n o wl ed g e i n d ep t h. T h e s e f ie l ds i nc lu d e:  S up er f ic i a l v e no us i ns uf f ic i e nc ies ; 

V en o us i ns uf f ic i enc i es of p el v ic or i g i n;



V as c u l ar m a lf orm at io n s ;

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De e p v en o us i ns uf f ic i e nc ies ;



V en o us u lc er s of t he l o wer l im bs ;

T o k no w a n d c om par e d if f er e nt t he r a p ies :  Sc le ro th er a p y; 

S ap h en ec tom y;



E nd o l um ina l t h er a p i es ;



CH IV A ;

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S urg ic a l t h er a p i es a n d tr e atm en t of t h e var ic os e v e ins of p e l v ic or ig i n;

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S urg ic a l th er a pi es of v as c u l ar m a lf orm at io ns ;



T he tre atm e nt of d e ep v en o us i ns uf f ic i en c i es : f r om s te nts t o v a l vu l op l as t i es a n d C HI V A c or r ec t i o ns



T he tre a tm ent of u lc er s of th e l o wer l im bs



E las t oc om pr es s i v e ve no us d is eas e t he ra p ie s



T he n e ed f or p os t- s ur ger y a n t ic oa g u la n t t h era p i es f or a br i ef or m edi um pe r i o d af t er t h e tr ea tm ent of d e e p a nd s up erf ic i a l ve n ous i ns uf f ic i enc i es



T he r o le of m ed ic a l t h er a p y t od a y

For mat : T he c o urs e is ac c r e d it ed b y t he It a li a n Ac c re d it at i on Co u nc il f or Co nt i nu i n g Me d ic a l E d uc a t io n ( E C M) a n d c o ns is ts of t wo da ys a nd 1 0 s es s i o ns , dur i n g wh ic h t he re wi l l be t wo l ec ti o ns m ag is tr a l is , a f in a l r ec a p s es s i o n an d a l i ve s es s i on f r om th e ex am in a ti o n r oom of t he H os p i ta l M ag g i ore P ol ic l i n ic o of M i l an wi t h th e u l tr as o un d ex am i na t io n of t wo p at i en ts .

E ac h s es s i o n c o ns is ts of :

 

Lecture of one member of the faculty Guided debate with one or more discussants

12 C r ed iti ECM r ef er e nc e num ber 35 1- 13 5 4 80

Condu t t o ri , Re l at o ri e Di s cus s ant

Pr of . G i o v an n i B at t is t a A g us

Mi l a n o

Full Professor of Vascular Surgery at the University of Milan Vascular Surgery and Angiology Private Practice

Pr of . Am in e B a h ni n i

Parigi

Head of the Department of Vascular Pathology of the American Hospital of Paris Associate Professor in the Phlebology track at the University Pierre et Marie Curie, Paris

Do tt .s s a V it tor i a B ar a l d in i

Mi l a n o

Surgeon specialized in Pediatric Surgery and Vascular Surgery at the Center for Child Angiomas and Vascular Malformations at the “V.Buzzi” Children’s Hospital in Milan

Pr of . S tef a n o B i anc h i

Mi l a n o

Head of the Multi-Specialty Department of Obstetrics and Gynecology and of the Maternal-Infant Department at the Hospital San Giuseppe in Milan Associate Professor in charge of the Obstetrics and Gynecology track at the University of Milan

Pr of . P i er o Bo n a de o

Tortona

Head of the Department of Day Surgery and Vascular Surgery at the Hospital of Tortona (Alessandria)

Do tt . M as s im o Br ic c h i

C r e mo n a

Assistant Medical Director of the Department of General Surgery at the Private Clinic Figlie di San Camillo in Cremona

Pr of . M as s im o C ap p el l i

F i r e n ze

Self-employed physician with Angiology and Phlebology Private Practice in Florence.

Adjunct Professor at the Clinical Research Centre of the University of Camerino

Pr of . G i ac om o C l eric i

Pavia

Head of the Centre for the Treatment of Diabetic Foot at the Istituto di Cura Città di Pavia – University of Pavia

Do tt . Ro b er t o D e lf rat e

C r e mo n a

Head of the Surgery Department and of the Surgery Unit at the Private Clinic Figlie di San Camillo in Cremona

Pr of . M aur i zi o Dom a ni n

Mi l a n o

Assistant Director of the University Department of Vascular Surgery at the IRCCS Cà Granda Maggiore Policlinico Hospital of Milan Adjunct Professor of the Postgraduate Specialty Course of Vascular Surgery at the University of Milan

Pr of . S tef a n o Er m i ni

F i r e n ze

Self-employed physician with Phlebology Private Practice in Grassina - Florence Contract Professor of Hemodynamic Phlebology at the University of Camerino.

Do tt . G u g li e lm o F or na s ar i

C r e mo n a

Vascular Surgeon, - Consultant at the Private Clinic “Figlie di San Camillo” – Cremona

Pr of . C la u de Fr anc es c h i

Parigi

Consultant of Vascular Pathology, Complex Venous Insufficiency and Vascular Malformation, Hospital Saint Joseph, Paris Director of the Echo Color Doppler Certificate Program at the University Hospital Petié-Salpêtrière University Paris VII, Paris Consultant at the Private Clinic Figlie di San Camillo in Cremona

Pr of . L i v io G abr i e l li

Mi l a n o

Director of the Postgraduate course on Vascular Surgery at the University of Milan Head of the Vascular Surgery Unit of the IRCCS Cà Granda Foundation –Maggiore Policlinico Hospital

Pr of .s s a Mi lk a G r e i n er

Parigi

Assistant Director of the Interventional Vascular Radiology Ward at the American Hospital in Paris Doctor of the Cardio-vascular and Interventional Radiology Department at the Hospital Petié-Salpêtrière in Paris Lecturer of Vascular Medicine at the University Pierre et Marie Curie, Paris

Do tt . S a l va to re L a ga n à

Salò

Assistant Director of the Department of General Surgery at the Hospital Enterprise of Desenzano del Garda – Hospital of Gavardo

Pr of . O s c ar M a l et i

Mo d e n a

Head of the Department of Vascular Surgery at Hesperia Hospital in Modena Head of research on new biomedical phlebology products at the Research Centre “Math for Technology, Medicine and Biosciences” at the University of Ferrara

Do tt . F a us t o P as s ar ie l l o

Napoli

Self-employed Vascular Surgeon at the Practice Aquarius - Naples

Do tt . R ic c ar d o P ic c io l i

C r e ma

Self-employed Surgeon in the Department of General and Vascular Surgery at the Medilaser Practice in Crema (Cremona)

Do tt . M aur o P i n e ll i

A v e zza n o

Head of the Department of Angiology and Vascular Diagnostics at the Hospital of Avezzano (L’Aquila)

Pr of . J or ge J u a n S am s ò

Barcellona

Director of the Vascular Lab of the Diagnostic unit Platón at the University Hospital of Barcelona

Do tt . G i a nn i V er c e l li o

Mi l a n o

Vascular Surgeon and Angiologist, Consultant at the Italian Diagnostic Centre of Milan.

Coordinator of the Center for Angiomas and Vascular Malformations of at Niguarda Cà Granda Hospital in Milan

Pr of . M ark W hite le y Vascular Surgeon, Director of “The Whiteley Clinic” - London External faculty member at the University of Surrey

Londra

Dat e an d v e nu e :

M aggior e Pol ic li ni co Hos pit al of M ilan A ul a M a gn a of th e M a ng i a ga l l i C l in ic V ia C om m enda , 1 2 M i l an O ct o b e r 1 5 and 16 , 2 01 5

M aximu m n umb e r of att end ee s: T he c ou r s e c a n no t b e at te n de d b y m or e t ha n 1 5 0 ph ys ic i ans Le ar nin g mat e ri al At t en d ees wi l l b e g i v e n t he f ol l o wi n g t ex ts w rit t en b y D r Rob e rto D elf r ate :

 A

n ew a pp ro ac h t o v ar i co se v ein s: ha emo dyn a mi c e va lu ati on and t re at me nt Lorena Dioni Publisher 2014 C o ve r p r i c e € 9 0 , 0 0

 Nuo vo app ro c cio di a gnost i co al le ven e v a ri co s e Lorena Dioni Publisher 2014 C o ve r p r i c e € 1 6 , 0 0 .

E xt r a c t f r o m t h e p r e f a c e s o f p r o f . L i vi o G a b r i e l l i “In Vascular Surgery training, knowledge of haemodynamics is a basic requisite for the education of residents. This knowledge is the basis of a full understanding of the clinical manifestations of both arterial and venous diseases.

In many aspects the venous system is far more complicated than the arterial system due to its anatomical network complexity, the existence of the muscle pumps that allow for the return of blood to the heart against forces of gravity and the presence of competent or incompetent valves in the vessels.”

Prof. Livio Gabrielli

Fe es Re g is tr at i o n f e e : € 3 5 0, 0 0 + V AT . I t i nc l u de s :   

A dm is s i on t o a l l s es s i ons Co urs e m at er ia l ; Da i l y “ l ig h t l unc h”

Ad m ini st r ativ e O f f i ce Lor e n a Di o n i

m edic a l s c i en t if ic p ub l ic at i ons a n d tr ai n i ng Fo lg ar i a ( T r e n to) p ho n e: 3 4 8- 76 9 1 26 8 e.m ai l : l or e n ad i o ni @ h aem o d ynam ic s de lf ra t e.c om

S ci ent ifi c O ffi c e

Ma ur i zi o Dom an i n Lor e n a Di o n i

How to r ea ch th e con f e ren c e v enu e

Clinica Mangiagalli

Program Thur sd a y, O ct ob e r 15 , 20 1 5 – Mo r ni n g S es s i on 8.30 Registration 9.00 1.

N e w b a s i c s o f v e n o u s p h ys i o p a t h o l o g y 1.1. Intra- and extra-pressure. Trans mural pressure 1.2. The physiology of venous return

1.50’ Claude Franceschi

20’

Mauro Pinelli

20’

1.3. The concept and classification of shunts

Jorge Juan Samsò

20’

1.4. Perforating veins Debate

Stefano Ermini

20’

Moderator: Livio Gabrielli Discussant: Massimo Cappelli

30’

10.50 2.

H e m o d yn a m i c d i a g n o s t i c s

1.20’

2.1. Standard Echo Color Doppler test 2.2. The choice of valvular diagnostics test and its meaning

Roberto Delfrate

10’

Stefano Ermini

20’

2.3. Hemodynamic Cartography, systolic and diastolic aspects Debate

Massimo Cappelli

20’

Moderator: Maurizio Domanin Discussants: Jorge Juan Samsò Guglielmo Fornasari

30’

12.10 3.

The inner saphenous vein, an instrument for the surgeon 3.1. The diabetic foot and diabetic arteriopathy of the lower limbs 3.2. The inner saphenous vein as a source of vascular graft: upgrade 3.3. The histological quality of the saphenous veins preserved with CHIVA treatment Debate

Ore 1.20 Light Lunch

1.10’

Giacomo Clerici

20’

Salvatore Laganà

10’

Roberto Delfrate

10’

Moderator: Livio Gabrielli Discussants: Amine Bahnini Claude Franceschi

30’

Program Thur sd a y, O ctob e r 15 , 20 1 5 – A ft er no o n S e s s i on 2.20 Lectio magistralis

Claude Franceschi

20’

Elastocompression: overview of the elastocompression therapy of the venous diseas e 2.40 4.

1.30’

Vascular malformations

4.1. Physiopathological framework and therapeutic overview 4.2. Surgical treatment of vascular malformations 4.3. Hemodynamic surgical treatment of venous malf ormations

Claude Franceschi

20’

Gianni Vercellio

20’

Roberto Delfrate

20’

Debate

Moderator:

30’

Vittoria Baraldini Discussant: Livio Gabrielli

4.10 5.

1.50’

Venous insufficiency of the pelvis

5.1. Physiopathology and diagnosis of the pelvic varicocele 5.2. Surgical treatment of the pelvic varicocele 5.3. Endovascular treat ment of the pelvic varicocele

Mark Whiteley

20’

Amine Bahnini

20’

Milka Greiner

20’

5.4. The varicose veins of the lower limbs of pelvic origin

Roberto Delfrate

20’

Debate

Moderator:

30’

Giovanni Battista Agus Discussants: Stefano Bianchi Salvatore Laganà

6.00 End of the first day

Program Fri da y , O ct ob e r 1 6, 2 01 5 – Mor n in g Ses s i o n 2.20

8.30 6.

H e m o d yn a m i c d i a g n o s t i c s a n d c a r t o g r a p h y Live from the examination rooms of the Graduate

In the doctor’s office:

School of Vascular Surgery of the University of

Roberto Delfrate

Milan

2.00’

In the conference room: Claude Franceschi

Debate

Moderator:

20’

Livio Gabrielli Discussants: Jorge Juan Samsò Guglielmo Fornasari

2.10’

10.50 7.

Pursuing the best therapeutic strateg y in primitive varicose veins of the lower limbs without an y sort of integralism

7.1. CHIVA and the reasons for preserving the saphenous vein 7.2. Hemodynamic aspects in sclerothepathy

Stefano Ermini

20’

Riccardo Piccioli

20’

7.3. Saphenectomy

Maurizio Domanin

20’

7.4. Endoluminal therapies 7.5. CHIVA-Laser: possibilities and perspectives

Giovanni Battista Agus

20’

Fausto Passariello

20’

Debate

Moderator:

30’

Livio Gabrielli Discussants: Claude Franceschi Roberto Delfrate

1.00 Light Lunch

Programma Fri da y O c tob er 16 , 2 0 15 – Af t er n o on S es s i o n 2.00 Lectio magistralis

Piero Bonadeo

20’

Medical therapy of venous insufficiencies 1.20’

2.20 8.

D e e p v e n o u s i n s u f fi c i e n c i e s : d i a g n o s i s , t r e a tm en t a n d p o s t - s u r g e r y m a n a g e m e n t o f th e p a ti en t

8.1. The physiopat hological assessment and t he benefits of the CHIVA treat ment 8.2. The treat ment of deep venous insufficiencies: from stents to valvuloplasties Debate

Claude Franceschi

30’

Oscar Maleti

30’

Moderator: Maurizio Domanin

20’

Discussants: Roberto Delfrate Mauro Pinelli

3.40 9.

Venous ulcers of the lower limbs

1,20’

9.1. Physiopathogical assessment 9.2. Therapeutic details in the venous ulcers

Massimo Bricchi

20’

Piero Bonadeo

20’

9.3. Alternatives to modern dressings in the treat ment of ulcers in the lower limbs Debate

Massimo Bricchi

20’

Moderator: Maurizio Domanin

20’

Discussant: Salvatore Laganà

5.00 10. Final Recap Session 10.1. Perspectives on the hemodynamic approach to venous diseases Debate

40’ Roberto Delfrate

20’

Moderator: Livio Gabrielli

20’

Discussants Claude Franceschi Maurizio Domanin

5.40 Closing Remarks 5.50 CM E Test

Livio Gabrielli

10’

This conference was made possible by the unconditional educational support of:

And with the support of