Articles

Sclerotherapy and Scleromousse

Specific Medical Therapy is essentially represented by Sclerotherapy.
Sclerotherapy consists of the injection of a drug into a vein with the aim of determining an irritation that can lead to the drying of the vein until its disappearance.
Sclerotherapy is divided into minor and major.

»The Minore is addressed to small-caliber varices which are mostly an eminently aesthetic problem

»La Maggiore is aimed at the treatment of varicose veins of greater caliber, generally causing disturbances.
Even small varices can cause disturbances and in this case minor sclerotherapy will also have a curative value.

Since, in Major Sclerotherapy, a liquid is injected into veins located in often invisible planes, it is associated with ultrasound and is called eco-sclero-therapy or eco-sclerosis; this provides effective and safe treatment.
The injected substances can also be mixed with air in order to obtain a foam which, in certain cases, is more advantageous since it allows the injection of a smaller quantity of drug.
The problem with sclerotherapy is that it lends itself poorly to the treatment of very large veins since these, after an initial obliteration, can subsequently reopen.
In cases where this is foreseeable, surgery is preferable.

Sclerotherapy treatment, even when indicated, still requires periodic monitoring.
Sclerotherapy represents a useful integration of surgery, since it allows to reduce the surgical act to the only large varices.

Telangiectasias (capillaries)

Telangiectasias are very thin varices, of a caliber between 0, 1 and 1 mm, which can be classified into:

1) telangiectasias from venous insufficiency, generally associated with other types of varicose veins and accompanied by clinical signs of venous insufficiency. They are localized to the back of the foot, the retromalleolar region, the legs and the medial surface of the thigh.

2) telangiectasias determined by hormonal factors that are localized on the medial and anterolateral surface of the thigh. They occur spontaneously for example in menarche, during menopause, pregnancy or during contraceptive therapy.

3) very fine essential telangiectasias due to constitutional weakness of the capillary system mainly in the distal third of the leg, triggered by UV radiation, heat, cold.

4) matting telangiectasias.

5) reticular varices: in many cases they represent the nourishing veins for the districts affected by telangiectasias. The presence of reticular varices is often a sign of venous insufficiency. It is good practice to first treat the reticular veins of telangiectasias to avoid recurrence.

Endovenous Laser

It is an innovative, minimally invasive, delicate and rapid procedure for the treatment of venous insufficiency through the use of an endovascular laser fiber. The surgery is performed under local anesthesia and allows a rapid post-operative course and a prompt return home.

The Intravenous Laser, among the multiple advantages, offers:

  • Solving problems of heaviness in the legs

  • Maximum aesthetic comfort

  • Quick treatment

  • A ready return to normal daily activity

Excellent clinical and aesthetic results!

Intravenous laser treatment is very well tolerated by patients and shows excellent and convincing clinical and aesthetic results. The procedure is minimally invasive, safe and has no particular contraindications.

The intravenous laser technique allows to treat the main pathologies involving the veins of the lower limbs:

  • Large vein and small saphenous vein

  • Collateral and reticular veins

  • Vascular malformations and hemorrhoids

  • Venous ulcers

  • Telangiectasia

ADVANTAGES

Minimally invasive intravenous laser treatments have many benefits compared to other possible treatments:

With respect to the conservative approach:

  • Solves problems rather than slowing down their progression

  • It does not require the need to wear compression stockings except during the first two weeks

  • Offers aesthetic improvements in the leg

Compared to surgical treatment (venous stripping):

  • They lead to less leg trauma and fewer side effects

  • There are no postoperative scars

  • General or spinal anesthesia is not required

  • It can be performed in Day-Surgery

  • It allows a much faster recovery and with less inconvenience

Compared to other minimally invasive treatments:

  • It ensures a greater success rate in treating the great saphenous vein

  • It does not involve risks of alteration of the color of the skin (dyschromia)

  • No risk of major complications

Elastic Compression

Wearing graduated compression elastic stockings, which must always be prescribed by the doctor, reduces the symptoms related to varicose veins, prevents swelling in the legs, reduces the risk of thrombotic complications.

Couperose

Localized redness on cheekbones and cheeks, persistent heat, tingling or itching? Six out of ten women experience these symptoms.

The cause is couperose, a dilation of the capillaries and venules of the cheeks and nose which tends to accentuate especially after meals or after exposure to heat or cold. All skin types can be affected and at any age.

How and why does it manifest itself?
The term "couperose" is used to indicate a condition of intense and chronic redness of the cheeks and / or wings of the nose, with the presence of thin red or bluish little vases, well evident: it often assumes a typical arrangement, called "butterfly wings" ".

Although it is initially an aesthetic problem, it is good not to underestimate it: in some cases, in fact, couperose can develop into a dermatosis (rosacea).

Couperose can be considered the evolution of a repeated state of inflammation of the skin, following an external or internal stimulus that can turn into a stable and chronic condition.

The capillaries present in the dermis, due to the persistent congestion of the skin and the progressive loss of elasticity of the tissues, can permanently dilate and become visible and irregular.

Couperose is quite frequent in women, especially over the age of thirty, and develops mainly on dry, thin, easily irritable skin, and in subjects predisposed to capillary fragility.

The causes of its onset are complex, but can be brought back to a state of capillary, constitutional or acquired fragility.

Various basic factors also influence this basic condition: emotional, neurovegetative, hormonal, allergic, environmental, climatic.

The skin of the face, in addition to being very sensitive, is also the part most exposed to the aggression of the elements: the sudden changes in temperature, solar radiation, wind, humidity, when excessive, can trigger the process that leads to rosacea; this is the reason why it is frequently found in people who for work reasons spend a lot of time in the open air (farmers, sailors, sportsmen, etc.) or who are exposed to the prolonged action of high temperatures.

Lower limb arteropathy

The most frequent symptomatology of arteriopathies of the lower limbs is "intermittent claudication". This term refers to the onset of cramp-like pain (generally in the calf) during walking when the blood supply to the leg is reduced compared to normal.

The degree of severity of the claudication is defined by the distance (during walking) that you can travel before the pain arises. Only in cases of severe "claudication" (or if not tolerated by the patient), is there indication of a possible surgical revascularization.

Sometimes surgery is the best way to treat a steno-obstructive pathology of the arterial vessels of the lower limbs, rather than the endovascular method (balloon).

If arterial blockage affects a long stretch of artery, or if important collaterals are affected by the morbid process, surgery may be the most effective method, especially in terms of long-term results.

Arterial surgery of the lower limbs is very complex and there are a multitude of different techniques for bypassing or rebuilding damaged arterial vessels in various districts (it can involve the aorta, the iliac, femoral, popliteal and subpliteal vessels).

Without prejudice to the criterion of clinical indication, the choice of the technique to be used is mainly based on an anatomical-morphological picture of the lesions.

Limb rescue

In severe cases, the patient can experience severe pain in the lower limbs even in resting conditions or develop non-healing foot ulcers or gangrene. The picture of peripheral vascularization in these cases is seriously compromised.

Diabetic foot

Diabetic patients more easily develop ulcerative lesions of the foot. This is due to the combination of vascular and neuropathic disease that diabetes causes. Diabetes reduces the function of the nerves and blood vessels in the foot. This predisposes to develop ulcers in the bone pressure points with subsequent superinfection.

What's this?

It is a disease affecting the arteries of the foot which undergo hardening and occlusion with consequent necrosis of the sprayed tissues. Neuropathy which causes loss of sensation, paraesthesia, pain is also associated.
The diabetic patient with peripheral arterial disease must pay close attention to foot care. Doing so can minimize the risks of serious complications.

What can I do to prevent?

The vascular surgeon will give a specific treatment program according to the stage of the diabetic disease.
Here are some tips:

  • Check your feet every day. Look for wounds, blisters, cuts, redness, hot spots and bulges in the foot. If you notice something abnormal, you should notify the doctor.

  • Wash your feet daily. Wash the feet in warm water, dry especially in the interdigital spaces.

  • Apply a moisturizing lotion film to the skin. Hydration of the skin is important.

  • Beware of shoes. Footwear must be wide and soft; any constriction can cause ulcers.

  • Take care of your nails. It is preferable to get help to avoid accidentally cutting yourself.

  • Protect your feet from cold and heat. Always wear shoes and do not walk barefoot; in winter do not stay near radiators or other heat sources.

  • Working out. Flex your feet and ankles for 5 minutes 2-3 times a day. Exercises like walking, dancing, cycling are very useful for improving circulation.

Abdominal aortic aneurysm

Aneurysm is defined as a permanent and progressive dilation of an artery linked to a weakening of the structure of the arterial wall, constantly subjected to the action of blood pressure.

The natural history of abdominal aortic aneurysms is towards rupture and death from hemorrhagic shock. The risk of rupture and long-term survival of unoperated abdominal aortic aneurysm patients are directly related to the size of the aneurysm itself.

Descending thoracic aortic aneurysm

The thoracic aorta can be the site of atherosclerotic aneurysms which, although less frequently than the aneurysms of the abdominal sub-renal aorta, can affect the aortic arch, the ascending or descending thoracic aorta (in this case already visible on a standard radiograph of the Chest). In addition to the more common atherosclerotic etiology, thoracic aortic aneurysms can also be of the dissecting type (sequelae of aortic dissections treated or not treated surgically), post-traumatic (isthmic) or dysplastic (cystic medionecrosis of Erdheim).

Carotid arterial disease

Carotid endarterectomy + - PTFE patch

Intervention that we perform under regional anesthesia in the majority of cases.
A shunt (temporary bypass for blood supply to the brain during surgery) is used if necessary and is applied when a PTFE Enlargement Patch is indicated.

1) Arteriotomy and endarteriectomy
2) Carotid plaque
3) Inserting the shunt
4) Patch with shunt inserted
5) PTFE patch

Carboxytherapy

Carboxytherapy is a method, of origin from beyond the Alps, which thanks to the properties of medical CO2 (carbon dioxide), is able to re-energize the blood circulation; it is therefore effective in fighting cellulite (PEFS) and eliminating in a reasonable time once and for all pronounced abdomen, hips and abundant thighs.

Unwanted accumulation of fat, excessively protruding areas. A roll too many on hips, thighs, buttocks. Cellulite in its initial form, but difficult to eliminate despite ad hoc massages and cosmetics.

But also painful swelling in the extremities and, in general, a sense of heaviness that manifests itself in cramps, swollen ankles and widespread pain. To keep the body toned, the skin elastic and to contrast the unsightly orange peel, there is now a valid help from a new technique.


How does this method work?
It should be known that the adipose panniculi are caused by the alteration of the microcirculation, a network of small arterial, venous and lymphatic vessels that pass through the connective tissue. If these malfunction, the cells deteriorate and cause the classic orange peel or mattress skin.

Carbon dioxide, thanks to its powerful vasodilator effect, reverses this process and restores the correct flow of blood in the asphyxiated and painful areas. In this way, more oxygen reaches the tissues, toxins are disposed of and swelling is reduced.

Where is it practiced?
Carboxytherapy was born in France in the 1930s, at the Royat spa (Clermont Ferrand), where it was used for pathologies affecting the vascular system. Used in Italy for the first time in 1994, it had only a few offices, but now over 150 carboxytherapy medical centers cover the entire national territory. How does the treatment work?
The gas, delivered by a particular electronic equipment, is injected into the area to be treated by means of a very thin needle (such as that used for collagen injections).

Contrary to what it may seem, the application is not painful. During the delivery of carbon dioxide, a slight discomfort may be felt which depends on the flow rate and individual sensitivity. The only contraindications can occur in cases of severe heart failure and pregnancy.

Results
To obtain evident and lasting results over time, fifteen sessions, of about 20-30 minutes each, are sufficient weekly. But the benefits are felt after just a few sessions. The swellings subside, the legs are more agile, the panniculus more compact.

Carboxytherapy works very well for the abdomen and hips because it has the power to deflate the dense areas of liquids and fats even of long standing. In this case, the gas, always injected subcutaneously, activates the demolition processes of the fat tissue.

Ulcers: treatment

Traditional cleansing
The oldest surgical cleansing with forceps, scissors, scalpels, spoon, undoubtedly painful, coarse, makes the lesions bleed, even massively when some veiled varicose vein is concealed, hidden in the ulcerative fundus. This unpleasant event frightens patients who often refuse further courettage.
The cleansing must be combined daily with the decontamination obtained with acid, chloroxidant, surfactant or metal products, these can have toxic, dyeing and sensitizing actions. In some cases it is necessary to perform a tampon and to establish a specific therapy. Iatrogenic complications lengthen cures and inconvenience to patients.

Cleansing Photodynamic Decontamination with Laser
The cleansing-sterilization of varicose ulcers and sores in general, by means of photodynamic therapy with LASER, allows painlessly to obtain interesting results of debridement by exploiting photosensitising solutions of wide consumption activated by low energy light radiation.
Through the use of a special accessory, the laser beam activates the photosensitizing solution without coming into contact with the lesion by making 1200 rotations per minute, therefore painlessly for the patient.
The result is a cytotoxic action on bacterial films and at the same time a synergy of fibroblastic stimulus speeding up healing.
Carboxytherapy is also of great help in the treatment of ulcers.

Advantages:

  • speed of execution

  • uniformity of abrasion

  • absence of contact, sensitization, bleeding, pain, reduction of dressings and related social costs

  • outpatient intervention


The advantage of managed laser therapy is the immediate activation of lymphocytes, fibroblasts, proliferation of endothelium-collagen growth factors, and TIM cytokines inhibiting metalloproteases with speeding up inflammation, traumatic resorption and granulation of wounds.
Healing times are therefore reduced by 50% with an evident benefit in connective remodeling.

Before the laser treatment After the laser treatment

The LASER used by Dr. Baraldi allows to deliver the exact dosage of the radiation determining the photostimulant - cicatricial effects, since it manages the correct parameters on which to comply to avoid overdose phenomena that can burn, aggravate edemas, inhibit growth factors and hence the scarring.

Cellulitis - EFSP

CELLULITE - EFSP (Ediculated Fibro Sclerotic Panniculopathy)

 

PREDISPOSING FACTORS

  1. BREED: the white is more predisposed

  2. FAMILY: nutritional errors and endocrine-metabolic syndromes typical of the same family group.

  3. HORMONAL ALTERATIONS: functional hormonal alterations, intake of estrogen-progestins, intake of foods containing hormones.

  4. NUTRITIONAL DISORDERS: any nutritional problem can induce cellulite, in particular excess in the diet of sugars, fats, hormones.

  5. DIGESTION ALTERATIONS: all digestive alterations, in particular those due to enzymatic insufficiencies and those associated with intestinal dysbiosis.

  6. FOOD INTOLERANCES: it is the cause of "cellulite", both directly and causing a series of problems which in turn are the cause of "cellulite": hormonal changes, water retention, digestive changes, dysbiosis, circulatory problems, etc.

  7. CIRCULATORY PROBLEMS: - if they are of arterial origin, they lead to hypoxia of the affected areas, slowing of the microcirculation, fibrosclerosis - if they are of venous origin, both for structural and functional alterations, they lead to congestion of the lymphatic system, congestion of the connective tissue, fibrosclerosis.

  8. LIFE STYLE: it must represent the right balance between vital activities.

  9. INFECTIONS: they can cause tissue damage, in turn due to structural alterations of various types, including fibrosclerosis.

  10. SMOKING: it certainly causes vasoconstriction, slowing of the microcirculation, lack of oxygenation of the tissues, in turn the cause of fibrosclerosis. It also adds the direct effect on the circulatory system and on the circulation and hyperproduction of free radicals.

 

RELEASING FACTORS

  1. OVERWEIGHT AND OBESITY

  2. RECRUITMENT OF HORMONES

  3. ANATOMICAL AND FUNCTIONAL ALTERATIONS

  4. FOOD ERRORS AND INTESTINAL DYSBIOSIS

  5. FOOD INTOLERANCE

 

CELLULITE OR PEFS presents as a PREDISPONENT ELEMENT a venous stasis affecting the lower limbs, due to the district slowdown of the microcirculation flow. THE RELEASE ELEMENT is the recurrent edema of the adipose tissue due to the increase in capillary-venular permeability.
The histopathological evolutionary phases begin from the venous stasis and recurrent edema, leading to a complete subversion of the adipose tissue and which, for descriptive convenience, we can distinguish in four stages.

Cellulitis - EFSP

CELLULITE - EFSP (Ediculated Fibro Sclerotic Panniculopathy)

 

PREDISPOSING FACTORS

  1. BREED: the white is more predisposed

  2. FAMILY: nutritional errors and endocrine-metabolic syndromes typical of the same family group.

  3. HORMONAL ALTERATIONS: functional hormonal alterations, intake of estrogen-progestins, intake of foods containing hormones.

  4. NUTRITIONAL DISORDERS: any nutritional problem can induce cellulite, in particular excess in the diet of sugars, fats, hormones.

  5. DIGESTION ALTERATIONS: all digestive alterations, in particular those due to enzymatic insufficiencies and those associated with intestinal dysbiosis.

  6. FOOD INTOLERANCES: it is the cause of "cellulite", both directly and causing a series of problems which in turn are the cause of "cellulite": hormonal changes, water retention, digestive changes, dysbiosis, circulatory problems, etc.

  7. CIRCULATORY PROBLEMS: - if they are of arterial origin, they lead to hypoxia of the affected areas, slowing of the microcirculation, fibrosclerosis - if they are of venous origin, both for structural and functional alterations, they lead to congestion of the lymphatic system, congestion of the connective tissue, fibrosclerosis.

  8. LIFE STYLE: it must represent the right balance between vital activities.

  9. INFECTIONS: they can cause tissue damage, in turn due to structural alterations of various types, including fibrosclerosis.

  10. SMOKING: it certainly causes vasoconstriction, slowing of the microcirculation, lack of oxygenation of the tissues, in turn the cause of fibrosclerosis. It also adds the direct effect on the circulatory system and on the circulation and hyperproduction of free radicals.

 

RELEASING FACTORS

  1. OVERWEIGHT AND OBESITY

  2. RECRUITMENT OF HORMONES

  3. ANATOMICAL AND FUNCTIONAL ALTERATIONS

  4. FOOD ERRORS AND INTESTINAL DYSBIOSIS

  5. FOOD INTOLERANCE

 

CELLULITE OR PEFS presents as a PREDISPONENT ELEMENT a venous stasis affecting the lower limbs, due to the district slowdown of the microcirculation flow. THE RELEASE ELEMENT is the recurrent edema of the adipose tissue due to the increase in capillary-venular permeability.
The histopathological evolutionary phases begin from the venous stasis and recurrent edema, leading to a complete subversion of the adipose tissue and which, for descriptive convenience, we can distinguish in four stages.

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Heart Surgeon

Expert in Vascular and Endovascular Surgery

Christian Baraldi, MD

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Dr. Baraldi - Catanzaro

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Reggio Calabria

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