1st VENOUS ENDO—INTERVENTION (VEIN) SYMPOSIUM

Quezon City - The first Venous Endo – Intervention (VEIN) Symposium was held last January 27, 2018, at the SEDA Vertis North Hotel in Quezon City.  It aims to become the leading forum educating specific group of physicians interested in management of patients with venous disorders.  The forum was very well – received by the Vascular community.   A total of ninety – three (93) attendees took part in the said symposium.  The participants were affiliated to over 40 hospitals all over the country and practicing various sub – specialties.  Of the 93 participants, fifty – eight (58) were already consultants while thirty – one (31) were trainees.  They included cardiologists, vascular internists, general, peripheral vascular, transplant, cardio – thoracic surgeons and general practitioners.

Dr. E. T. Ona

The symposium was opened by the Former Department of Health Secretary, Dr. Enrique  T. Ona who was also the former president and founder of the Philippine Society for Vascular  Surgery.    He delivered a very inspiring message that recollected milestones in the Philippine vascular landscape, specifically in the field of management of venous diseases.  In 1981, he founded of the Venous Forum of the Philippines.  He recalled that the forum was created to become a venue for a special group of physicians who were interested in the treatment of venous disease. The Venous Forum was inclusive, that its members were not limited to surgeons alone, but rather also involved internists, cardiologists, and anyone who had interest in management in venous disorders.  The Venous Forum was inclusive, that its members were not limited to surgeons alone, but rather also involved internists, cardiologists, and anyone who had interest in management in venous disorders.  In his speech, he sadly expressed that the forum lost its luster over time, but with the rapid advances and better understanding of the flow and venous physiology, instrumentation and wound care, the resurgence of interest in said diseases had pushed organizations, like PSVES to create an avenue of discussion about them.  In the end, he also challenged the society to become more proactive, relevant and significant in the management of other vascular diseases like carotid arterial disease, aneurysm and peripheral arterial diseases.

Dr. Maria Rosa Abad and Dr. Ricardo Quintos II

Dr. Maria Rosa C. Abad, one of the distinguished members of the Department of Health   - Health Facilities and Services Regulatory Bureau, spoke about regulatory requirements in setting – up ambulatory vein clinics.  She emphasized that there is an existing unit in the Department of Health that is the Health Facilities and Services Regulatory Bureau.  With safety and efficacy of health care delivery, its functions encompass dissemination of regulatory policies and standards for information and compliance of the ambulatory facility; issuance of permits to construct, license to operate and certificate of accreditation; monitoring of health facilities and services to ensure sustainability of health facilities compliance with regulatory standards, among others.

Dr. Joy M. Gali and Dr. Ricardo T. Quintos II

Mastery of the use of ultrasound is another requirement for anyone who wants to start vein practice or set – up an ambulatory vein clinic.  Dr. Joy M. Gali of the National Kidney and Transplant Institute discussed the merits of personally doing the diagnostic or venous imaging and accessing of vessels under ultrasound guidance when doing the intervention.  She gave a concise lecture of the role of ultrasonography in venous disorders.  She also stressed the existence of Philippine Society of Ultrasound in Surgery (PSUS), the sole certifying society for use of ultrasound in surgery.  She mentioned the requirements for being a fellow in the said society.  The said organization is an affiliate of the Philippine College of Surgeons.

Dr. Michael dela Cruz and Dr. Ricardo Quintos

Dr. Michael  Anthony A. dela Cruz, a young Interventional Cardiologist from Cardinal Santos Medical Center discussed principles of medical management of venous insufficiency.  He discussed venous insufficiency as primary and secondary manifestation of venous hypertension transmitted to the microcirculation.  He highlighted that pharmacotherapy in venous insufficiency is directed to prevents inflammation and inhibits disease – related complication.  He also stressed that these vasoactive medications that increase the tone of the diseased vessels via the nor-adrenalergic pathway thru vasoconstriction.  However, these medications are only adjunct to the use of compression stockings, which is the mainstay in the management of venous insufficiency.

Dr. Charlton S. Sibal

Another Vascular surgeon, Dr. Charlton S. Sibal, from The Lung Center of the Philippines, discussed the adjuvant therapies for venous ulceration.  He presented venous ulcer as the end – point of venous insufficiency.  He discussed the its pathophysiology with emphasis on venous hypertension and venous microangiography leads to eventual destruction of the endothelial lining of the vein and then to venous ulceration.  He presented different ways to management of these venous ulcers, mentioning regimens of leg elevations, structured exercise and compression therapy.  He also showed the role of hyperbaric therapy in patients with venous ulcers by presenting cases their institution has managed using the said modality.    

Dr. S. Simangan, D. V. Martires, Dr. R. Quintos II

Dr. Vicente C. Martires, Jr, one of the most prominent anesthesiologist from Cardinal Santos Medical Center, demonstrated the different types of anesthesia given to patients undergoing surgical intervention for venous diseases.  He displayed the benefits of subjecting patient to tumescent anesthesia, emphasizing the role of hydro – dissection thru tumescence.  This inexpensive mode of anesthesia delivery, with corollary effect of decreased bleeding in minimally invasive venous surgeries, decreased incidence of skin burns, avoidance of use of strong opiods result to shorter recovery time for the patient.

Dr. Leoncio L. Kaw

From University of the Philippines – Philippine General Hospital, Dr. Leoncio L. Kaw Jr. reviewed why open surgery remained to be the gold standard in the care of patients with varicose veins.  With the advent of improved endovenous technology, he mentioned that the role of open surgery in venous diseases is increasingly being questioned.  He presented arguments comparing open surgery techniques like high ligation, vein stripping, stab phlebectomy to the modalities like radio frequency ablation, LASER therapy in management of varicose veins.  Recently published papers still showed that open surgery maintains to its superiority in management of varicose veins in terms of prevention of recurrence rate of varicosities, patients’ satisfaction and costs. Accordingly, open surgery, particularly vein stripping remains to be a durable and effective procedure in management of varicose veins.

Dr, Josefino I. Sanchez and Dr. Servando Simangan

Several industry – sponsored lectures were delivered.  Dr. Josefino I. Sanchez from the University of Sto. Tomas Hospital talked about post – endoveous LASER treatment edema and the role of medications, particularly micronized purified flavonoid fraction in its management .  The action of the said medication is lies in its ability to improve venous tone and its ability to reduce the harmful effects induced by the inflammatory mediators in venous hypertension of lower extremity veins during venous insufficiency.  These medications are also known to improve the lymph flow and increase the number of lymphatics and aids further absorption of excess fluid in the interstitium during post—endovenous treatment – related edema.  However, these medications will work well, as a useful adjunct to conventional therapy like compression stockings and surgery.

Dr. Quintos II, Dr. Chong Tze Tec & Dr. Simangan

Another industry – sponsored lecture was on the pharmaco – chemical ablation using endoluminal sealant (VenaSeal) by Dr. Chong Tze Tec from Singapore General Hospital.  This new modality utilizes cyanoacrylate as the occlusive chemical that seals the areas where it is endovenously injected into. Its property of being able to quickly polymerize, it has the ability to maintain adhesion of the intimal surfaces and prevents embolization to other areas. Accordingly, it is described to be a modality that is that does not use tumescence, that does not utilize heat and sclerosing agent to close the incompetent veins.  Cases of patients with which the modality was used were also presented.  It was shown that this new technique is comparable to radio frequency ablation, endovenous LASER ablation.

Dr. Quintos II, Dr. Tan Kia Lean and Dr. Simangan

A lecture was delivered by Dr. Tan Kia Lean from Ara Damansara Medical Center in  Malaysia.  He talked about the modality of percutaneous endoluminal endovenous mechanico – chemical ablation of varicose veins.  He described this technique as novel technique which combined mechanical injury of the endothelium with simultaneous infusion of physician – choice of liquid sclerosant for the treatment of great saphenous vein and small saphenous vein incompetence.  It was also shown that this new technique is safe, and an equivalent to other endovenous ablation techniques.

Dr. Quintos II, Dr. Rainan Gloria and Dr. Simangan

Dr. Rainan G. Gloria of the National Kidney and Transplant Institute, on the other hand discussed the merits of radio – frequency ablation therapy in incompetent superficial veins.  He differentiated RFA from other endovenous therapy for varicose veins by emphasizing that it uses radio – frequency currents which heats up and destroys the venous endothelium at the site of direct contact.  This results to shrinkage of collagen and endothelium denudation with later results to obliteration of the venous lumen.  

Mr. Wendell Madriaga and Dr. Quintos II

Mr. Wendell Madriaga of MEDEV Medical Devices Corporation delivered a lecture on the role of endovenous LASER ablation (using Biolitech EVLA) in venous insufficiency.  He explained that this modality delivers LASER energy with temperature over 100 C close to the fiber tip of the catheter.  This will produce heat bubbles in the endothelial cells of the veins that will eventually lead to its damage.  This again will result to contraction of the vessel with resultant fibrosis of the vein.  Delivery of energy is adjusted according to the diameter of vessel involved and emphasis in the intra – operative sizing of the veins was stressed.

Dr. Quintos II, Dr. Jeffery Chua and Dr. Simangan

Dr. Jeffery L. Chua of Makati Medical Center talked about the ins and outs of sclerotherapy.  He displayed sclerotherapy as an endovenous chemical ablation by injection of liquids and foamed sclerosing agent into intradermal, subcutaneous and transfascial varicosed/incompetent veins.  He demonstrated the sclerosing agent causes damage of the endothelium of the vein, resulting fibrosis of the said vein. He emphasized that ultrasonography plays an important role in execution of the technique since ultrasound aids in guiding the operator to selectively inject the sclerosant into the vein, avoiding exsanguination of the agent out of the vein but into the surrounding tissues.

Dr. Ricardo Jose T. Quintos II

Dr. Ricardo Jose DT. Quintos II of the Cardinal Santos Medical Center delivered two very engaging lectures.  The first one was the complications of sclerotherapy and the second was basics of the non – contact LASER therapy.  In his first lecture, he recognized that while the outcomes of sclerotherapy are numerous, it is not free of complications, if not efficiently performed.  These complications included thrombophlebitis, anaphylaxis, deep vein thrombosis, cutaneous necrosis and hyperpigmentation of the skin.  Good documentation of pre – procedural and post – procedural venous status was also stressed.  In his second lecture, he discussed the physics of light amplification by simulated emission of radiation (LASER) and its role in treatment of telangiectasia and spider veins.  He emphasized that LASER treatment works on the principle of selective photo - thermolysis where light is electively absorbed by oxyhemoglobin of the leg veins, at suitable energies and pulse durations and that cooling of the skin plays a very important role in minimizing the thermal injuries to skin by the treatment itself.

Dr. L. Baloloy, Dr. Quintos II, Dr. Simangan

The success of the first VEIN Symposium was also because of the generous support from our 7 industry partners, namely Serveir, MEDEV, Somotec, Corbridge, Medtronic, Getz Healthcare and RG Meditron.

Delegates, VEIN Symposium 2018

Industry Partners with Dr. E. Ona, Dr. R. Quintos and Dr. S. Simangan, VEIN Symposium 2018