MANUAL EVRF - Modern Aesthetic Solutions
Contents
1. E PRUx e SENA MEE EVA Qe bx a Sui Pubs Feud e Pe Rar 11 2 1 GENERAL CHARACTERISTICS Dhnse t the dedpe aa aa iudex banaue tecta te e etnia Carn edant did ue ein ua 11 22 EXPEANATIONOOP THE SYMBOLES uite Ca Exact te ia a eti ous andi aet tr ptt ue lad nta oin vibes oe 12 2 5 OUTPUT vendis 13 2 E Az STE Ie NR UU UU M 13 2 5 FUNCTIONING So onis Estes ERI NL E I ge 13 3 VARIG OSITIES DR 14 l INTRODUCTION 14 2 25 ANATOMY OF THE VENOUS SYSTEM 14 3 2 1 General information on vascularisation cesses 14 3 22 INC SUDCTIICION VENOUS Det WOI Kid cete idc vtero stunt tomb UM EE m 15 EL 7 Diese e ES ECEN uas uen Meu 18 3S 9 d He Vel VIS etie ten tee nS ULM RR EL d e dca i E 18 og 2 Te VO atat aeneus Re NT MEM x MR ID AME MM LL DID DLE EUR 19 3 3 3 The vascularisation and innervation of the vein 19 3A EM erect T 19 341 IDnemusculardamdyarticdlar DUITID 5 ee Dreh MORE anti Od NE cur v TOIT TER A 20 2 21 3 21 3 4 4 ADONCUTOSES of the Legs e evi ier o iR DER Urt CUORE ERAI E VR 21 3 4 5 Residual Arterial PE SSUTO eed sat tens ost e et tac tortas ohm tese udi oe rete m pM E eu2. ocon avs 7 1 Type BF apparatus 2 Name address of fabricant 3 CE number 4 Read operating manual before usage 5 0 7 Model apparatus name Serial number Technical specifications 2 5 Functioning The apparatus works in the following environment Room temperature comprised between 10 C and 40 C Relative dampness comprised between 30 and 80 condensation comprised Atmospheric pressure comprised between 700 hPa and 1060 hPa The power supply mustn t exceed a voltage of 230V 10 for the rated voltage Date 5 10 2011 Page 13 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 3 VARICOSITIES A PRACTICAL GUIDE TO THE TREATMENT OF VARICOSITIES by Dr Jean Marc CHARDONNEAU 3 1 Introduction The legs as organs used for walking and communication play a leading role in social life Superficial vein disorders in the legs are a major preoccupation for our contemporaries in particular from an aesthetic point of view Understanding how to respond to this demand is the main purpose of this guide It sets out to provide practitioners with grounding in the anatomical physiological and therapeutic elements required for a calm approach to superficial vein disorders caused by varicosities and will enable you to make effective use of the various treatments The common thread running through this guide is one of pragmatism 3 2 Anatomy of the venous system 3 2 1 Genera
3. Changed components Pen carried needle Other componDells D ED a eee Name and visa of the controller Name and visa of the customer Date 5 10 2011 Page 48 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Control of year 6 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other Components sai osse uUo EA RUFI NEED M ERE Name and visa of the controller Name and visa of the customer Control of year 7 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other componDells D ED a eee Name and visa of the controller Name and visa of the customer Date 5 10 2011 Page 49 de 49 N de r vision 06
4. e egeo e ae vega eqs ases eu aye Du Eu DIR EG 35 mu Epid xem idssdzc rpm 35 5 2 ADIUSTING THEPARAMETERS EO ARE QD ARI RUD pA Eu tA SUD ra bi tana 35 BSP RAGIMATIC APPROACH E c iC t DL 36 5 4 EVOLUTION OF THE TREATMENT oue ape Ve oM ade ve MS RE AN exa ke PERDE E PES T TAE E ES 36 ROSACEA RII TIT 37 6 DESCRIPTION OF THE APPARATUS AND THE ACCESSORIES ee 38 5 1 IFRONTIFACEOF THEE WIRE essit Eia Lois sia Stat anaes sic pude uv ducite eet este etur baa lt eue dae 38 6 2 BOTTOM SIDE OF THEE VI E S esstodecs oto 38 ACCESSORIES sae de acc Acqua ut a dd 39 5 91 OO 39 6 3 2 Needle holder pen with cable of 39 NUS ITIN RI Tm RN 39 oF OS Ci E 40 DS TInSeELIOR NC CO S choses dieto Dios eso odo 40 7 USE S 41 ZA CONFIGURATION OTDREEV RE 42 PR 42 TDN SEO Be Tid EES ea fase gt tesa mieu beum nave fase tacui tes thu 43 V2 D EndoVenbDus trediiTieltl oup aret pug 43 CRIZ2PECCRSOLCGOUIBLOTS s
5. 2 TECHNICAL CHARACTERISTICS 2 1 General characteristics Supply Voltage 110 230V 50 60Hz Power 125VA BF type apparatus Protection degree against liquid penetration IP XO Temporized fuse in glass Work in continuous Dimensions H 360 mm D 260 mm W 130 mm Weight 4 Kg Class lla apparatus Insulation class Output of the thermo coagulation HF signal Fuse reference 2x F2A 250V Switch on Switch off button Date 5 10 2011 Page 11 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 2 2 Explanation of the Symbols v Confirm x Cancel v Select TT Reduce power PI Raise power UU Reduce impuls Raise impuls a OFF Once you press this button the device is ready for use 00 00 Session timer The number of impulse per session Type BF device CE marking Read manual before use j gt Qu Allowed voltage FREQ Frequency y Maximum power Date 5 10 2011 Page 12 de 49 de r vision 06 MANUEL THERMOCOAGULATION 2 3 Output characteristics This apparatus generates some high frequencies impulses whose characteristics are frequency of the wave 4 MHz max voltage in output 400V 20 V max time of impulse 0 8 s 0 01 s continues mode 2 4 Label explanation 2 3 MADE IN BELGIUM BY C F CARE SYSTEMS Se Kontichsesteenweg 54 2830 Aartselaar 5 Model EVRF _ sin FCEVRFO000000
6. MANUAL EVRF 1639 F CARE SYSTEMS KONTICHSESTEENWEG 54 B 2630 AARTSELAAR BELGIUM TEL 32 3 451 51 45 FAX 32 3 451 51 39 WWW FCARESYSTEMS COM fcare MANUEL THERMOCOAGULATION We thank you for your confidence The PRODUCT includes a plan of two years guarantee covering All the spare parts Working hours Expenses for displacement or transport This guarantee is only applicable on the condition that the completion bond is turned over to F care systems and that all the clauses of safety measures were applied strictly For this we ask you to read the chapter SAFETY of this manual For any further information or any technical problem concerning the product we will stay fully at your disposal READ THE INSTRUCTIONS BEFORE CONNECTING THE INSTRUMENT IN SERVICE THE USE OF THIS DEVICE IS RESERVED ONLY TO PEOPLE WHO AHE HAVING THE ABILITY AND KNOWLEDGE ON THE SUBJECT OR ACTING WITH THE AUTHORITY OF A COMPETENT PERSON ALL THE INSTRUCTIONS OF THIS MANUAL MUST BE FOLLOWED STRICTLY Date 5 10 2011 Page 2 de 49 N de r vision 06 MANUEL THERMOCOAGULATION CARD INDEX OF GUARANTEE This card must be obligatory return to F care systems within 15 days after reception of the EVRF F care systems NV Kontichsesteenweg 54 B 2630 AARTSELAAR Belgium EVRF NS sumite spat iet dh received on undersigned name
7. superficial circumflex iliac vein saphenous vein medial accessory The lateral venous system under the dermis described by Albanese In difficult cases transillumination can be helpful Varicosities with cellulite Cellulite an inexhaustible subject in the popular press is much less obtrusive in medical publications Its physiopathology and definition have long been a source of controversy Currently it seems reasonable to reserve the term cellulite exclusively for the disfigurement that affects our contemporaries in a variety of ways This is a lipodystrophy in other words an increase in the number or volume of adipocytes They are found in the superficial part of the hypodermis Cellulite is dependent on vascular hormonal genetic and nutritional factors The vascular factor i e stasis leads to water retention and contributes to maintaining and aggravating the cellulite On the contrary adipocyte hypertrophy disrupts veno lymphatic return and the compression by external pressure of the superficial venous system creates upstream hyperpressure with dilation of the microvenule and the appearance of varicosities These varicosities are often isolated Date 5 10 2011 Page 25 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 3 7 Clinical examination It draws on the knowledge and experience of the doctor It expresses the nobility of our art It is irreplaceable The aim of clinical examination is
8. To assess the overall condition of the limb Physical examination of the leg shape appearance oedema varicose veins cellulite signs of cutaneous distress To identify negative factors who are generated by return of the varicose veins and try to prevent the return 3 7 1 Clinical History Reasons for consultation Aesthetic 90 of consultations The beauty of the legs is a major element of the feminine aesthetic and no phlebological lesion is acceptable from an aesthetic point of view Prevention oince venous ailments are reputed to be hereditary requests for consultation as soon as the first varicosities appear in a person with family antecedents are far from rare Is this well founded The CEAP international classification of venous disease considers it to be the first stage of venous insufficiency Do these varicosities lay the foundation for varicose veins Nothing could be less certain as this hypothesis is not confirmed by any study C Identifying Aggravating Factors on which no action can be taken The number of pregnancies The prevalence of varicose disease is proportional to the number of pregnancies Therefore after the first pregnancy the risk would be 23 with 27 for a 2 and 3 pregnancy and 3195 for the 4 Finally pregnancy very much favours the appearance of varicosities even though there is a decrease spontaneously post partum Heredity There is no denying the existence of a here
9. EVRF 6 3 Accessories The accessories of the EVRF are the following 6 3 1 Foot switch The footswitch permits to activate the high frequency impulses It connects the blue connector with the EVRF 6 3 2 Needle holder pen with cable of connexion Linked to the apparatus it permits to transmit the high frequency impulses through the needle 6 3 3 Needles The apparatus is delivered with a set of F Care needles The needles are in nickel type F CARE 0 075 and F CARE Keri 0 150 mm They must imperatively have the CE mark imposed by the Directive 93 A2 CEE Date 5 10 2011 Page 39 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 6 3 4 Handset The apparatus is delivered with a F Care handset including cable of connexion The handset will be used to coagulate the veins from the inside out The catheter which is scrolled out of the handset can be inserted into the vein for a maximum of 8 10cm 6 3 5 Insertion needles The insertion needles are used to make the initial insertion in the vein After the insertion has been done you pull out the needle and leave the flexible part in the vein This flexible part will guide the catheter of the handset in the vein Date 5 10 2011 Page 40 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 7 USE The use of the EVRF is very easy Connect the needle holder pen or handset to the apparatus red
10. and functiom pp state to have taken knowledge of the chapter of safety of this user s manual and engage in the name of my establishment to apply it and to make it apply NAME and SIGNATURE STAMP Date 5 10 2011 Page 3 de 49 de r vision 06 MANUEL THERMOCOAGULATION Summary WE THANK YOU FOR YOUR CONFIDENCE 5 ieieol es exu ex vkaouv ev Vus as eu ed tut ecuvVka aue dba voa colo eiua traer Ve va YR EA orc 2 THE PRODUCT INCLUDES A PLAN OF TWO YEARS GUARANTEE COVERING ee ee eee e nennen nene rennen 2 SUMMAR Y E v 4 1 SECURITY INSTRUCTIONS i555 6 ERICENESEEDRIE 6 1 2 ELECTROMAGNETIC DISRUPTION 6 2235 PROTECTION AGAINST EXPLOSION mandia sae I eno EO coset fune ria bo rae a A E 6 o MEE RASA EIE DESEE UU mm TTE 6 1 5 PEUT 7 126 CONTROL 7 7 GUARANTEE ANDHABILITIESae S edcos Ges inti ftetit cn cd raus 7 LS SCGUEANING AND SERVICING sen mien dent bn xa etti be Ova toti vasa Cota 9 1 95 IN CASE OF PROBLEMS iiu ptss cn d a a E cane vt cea O YR ORNA ER RR ERU 10 T1210 iPRACTICAILADVICES itur mom det rire aient dva inse eei aco boss es Destin du ben ei estu pU 10 2 TECHNICAL CHARACTERISTICS es zrese Pea vata va
11. attributed to them notably transporting immuno competent cells Any insufficiency or dysfunction of the lymphatic system therefore results in upsetting not only the liquid homeostasis but also the immunological homeostasis 3 2 2 The superficial venous network The superficial Greater Saphenous Vein oaphenous trunk The internal saphenous or greater saphenous vein begins in the medial marginal vein of the dorsum of the foot and before the medial malleolus running along the internal face of the tibia It is accompanied along this route by the internal saphenous nerve It traverses the medial condyle then runs alongside the sartorius muscle and the adductor muscle and flows to Scarpa s triangle via the arch in the common femoral vein Collaterals of the Medial Saphenous Vein Leonardo s vein or posterior leg vein of the medial saphenous vein anterior leg vein of the medial saphenous vein external leg vein of the external saphenous vein Tributaries of the Sarphenous Arch f rm2ra sous cutan e veire ferorals abcurninale iia sup honteuses exte JONCTION SAPHENO FEMORALE DROITE Date 5 10 2011 Page 15 de 49 de r vision 06 MANUEL THERMOCOAGULATION Abdominal subcutaneous vein Surface iliaque circumflexe vein External ashamed vein Posterior Saphenous crural Former Saphenous crural The crural veins Anterior saphenous vein antero medial situation it frequently
12. caused by the transport or by dropping it down 6 Any external interventions fire lightning flood natural disaster explosion war to many voltage etc If proved that the apparatus has been opened If the identification of the apparatus has been changed or modified lf the guarantee form has not been returned within 5 days after the delivery date incorrectly or incompletely filled in Liabilities After a period of 10 years of marketing of the device F care systems will not be held responsible for any errors and their consequences F care systems can not be blamed for any eventual consequences for the device the user or the patient for example as wrong use of the device or the accessories wrong interpretation or no use of the manual bad maintenance or repair of the device by an incompetent person not recommended by F care systems F care systems can not be blamed in case of electrical discharge cardiac sickness or allergy on a patient due to a bad manipulation bad connections due to excessive regulations or to a wrong use of the accessories Neither the manufacturer nor F care systems will be blamed in case of transmission of infections by the needles Date 5 10 2011 Page 8 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 1 8 Cleaning and servicing AS SECURITY PRECAUTION DISCONNECT THE APPARATUS FROM THE NETWORK BEFORE ANY SERVICING OR REPAIRING To assure as standing gua
13. into the vein 3 Connect the sterilized handset to the guide 5 Retract the catheter while holding down the footswitch to invoke RF signal 4 3 3 Saphena Magna treatment footswitch to invoke RF signal 2 Take the needle out and leave the guide in the vein You can see backflow if you are in the vein 4 Slide the catheter into the vein by turning the wheel of the handset 6 When you are at the end of the vein Take the needle and the guide out Insert the Argon Percutaneous 6 frenge introduction needle into the Saphena Magna Take the needle out en leave the guide in the Saphena Magna Insert the CR45i catheter with a 0 5 cm tip into to Saphena Magna Retract the CR45i catheter every 0 5 cm after 3 beeps while you press down the Retract the CR45i catheter slowly out of the Saphena Magna 6 Take the Argon Percutaneous needle out the treatment has been done Date 5 10 2011 Page 32 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 4 4 Clinical study THERMO COAGULATION OF THE VARICOSITES 6 YEARS OF RETREAT by Dr Jean Marc CHARDONNEAU The study concerned 400 patients from 25 to 70 years of age with an average age of 43 Each patient was treated in 4 to 5 sessions Protocole The sessions lasts for 10 to 15 minutes The number of pulses varies between 100 to 300 and the period between two sessions is three weeks No compression or hemostatic dressing is used Results Instantane
14. plug thanks to the cable provided on this aim Connect the foot switch to the apparatus blue plug Switch on the apparatus the welcome screen appears Afterwards the mode selection screen is shown The welcome screen is shown for 3 Seconds Afterwards the mode selection screen is shown In this menu you have the option to choose between 3 modes Transcutaneous Endovenous CR12i and CR30i catheter Endovenous CR45i catheter Saphena Changing the selection can be done by touching the button By touching X you go to the settings screen Date 5 10 2011 Page 41 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 7 1 Configuration of the EVRF After touching the X button you end up in the settings screen In this screen you have the option to alter 2 settings language and screen contrast By touching one of the buttons you will be able to change the selected option By touching X you go back to the mode selection screen 7 1 2 Language settings If the language setting option was chosen we end up in the following screen Several languages can be selected French English Italian Spanish Portuguese Norwegian Swedish Deutsch Dutch Choose the desired language with the up down arrows and touch the language you wish Touch X to cancel and return to the settings selection 7 1 3 Screen contrast If screen contrast was chosen we enter the
15. t use the apparatus near to another sensitive high frequency device Doppler Peacemaker etc 1 3 Protection against explosion The apparatus must be disconnected from the power to disinfect the place where the unit is located Don t use the apparatus at places where flammable gas or steam is present 1 4 Security by installation The apparatus can not be installed at a location with high atmospheric dampness Avoid penetration of any liquids inside the apparatus because it is not watertight Don t wet the apparatus If however a liquid had penetrated into the apparatus stop the treatment immediately and disconnect the apparatus from the mains Have the apparatus checked by a competent person Don t expose the apparatus to high temperatures gt 40 C Don t install the apparatus near a heat source central heating and never under the direct light of the sun Never cover the ventilation grate at the back of the apparatus These vents must be positioned to get always a good air circulation Don t expose the apparatus to rain The apparatus may never undergo vibrations Don t keep the apparatus in places where the temperature is lower than 10 C A G GV GY Date 5 10 2011 Page 6 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 1 5 Security during use At the end of the treatment make sure that you switch off the apparatus Immediately replace any defective
16. terminates in the medial saphenous arch but more rarely flows into the superficial circumflex iliac vein the subcutaneous abdominal vein or external pudic vein External crural arches of subcutaneous gluteal or trochanteric origin they are often sinuous and very superficial posterior crural veins of the external pudic vein or the haemorrhoidal vein Medial varices Giacomini s vein Cruveilhier s vein and the posterior crural saphenous vein The superficial lesser Saphenous Vein VUE ANTERIFURE VUE POSTERIEURE Pathway Begins opposite the posterior side of the external malleolus following the external marginal vein Hises obliquely upwards and inwards towards the medial posterior line lt is accompanied by the external saphenous nerve a branch of the external sciatic popliteal nerve It then becomes the subaponeurotic vein and flows into the popliteal vein in 6096 of cases into the collateral veins of the knee in 3096 and into the greater saphenous trunk in 10 Date 5 10 2011 Page 16 de 49 de r vision 06 MANUEL THERMOCOAGULATION Anastomotic veins These are the veins interlinking the two saphenous veins In the legs o oblique branches on the medial side o 4transversal branches on the external side Inthe crural zone o Giacomini s vein arises in the external saphenous arch rising and ending in the upper 1 3 of the medial saphenous vein o The external femoral poplitic vein rises on the pos
17. to 70 years but the adults from 30 to 50 years having the clear dye and whose skin tends to redden easily are more often affected The women are more prone there than the men but the latter are more inclined to develop a rhinophyma a disorder which is characterized by a nose red swollen and embossed and which is secondary with untreated blotches It requires a surgical correction Approximately 15 of the population is affected This type of acnea is distinguished obviously from the common acne In the case of the blotches redness and the papules also appear in a cyclic way but not in black spots or white buttons The lesions are rather red hard and of small size Adjusting the parameters power 5 8 watt pulse time 0 2 s 0 3s maximum number of pulses 300 session frequency of sessions every 3 weeks For a face 3 to 4 sessions are required Control after 8 weeks with maintenance once a year Date 5 10 2011 Page 37 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 6 DESCRIPTION OF THE APPARATUS AND THE ACCESSORIES 6 1 Front face of the EVRF Display with touch screen 2 Connexion for the needle holder pen or catheter silver 3 Connexion for the treadle blue 2 3 6 2 Bottom side of the EVRF 1 Main power supply fuse holder ON OFF switch 2 Cooling fan WWW ANNA Date 5 10 2011 Page 38 de 49 N de r vision 06 MANUEL THERMOCOAGULATION
18. E THERMOCOAGULATION A PRACTICAL GUIDE TO THE TREATMENT OF VARICOSITIES by Dr Jean Marc CHARDONNEAU The therapeutic approach to varicose disease is relatively well developed and today whatever the type of varix its location or diameter it can almost certainly be eradicated The same does not apply to varicosities This is bitterly disappointing knowing that they represent more than 7096 of the reasons for phlebology consultations The traditional therapies vary in their effectiveness Microsclerosis the reference technique even in the hands of experts can only hope to achieve good results in 6596 of cases The laser technique still has to prove itself and for the moment few studies demonstrate its usefulness in the arsenal of therapies for varicosities We therefore thought it would be interesting to study a new physical procedure called Thermocoagulation 4 1 Principe The principle is based on the use of a very high frequency wave 4 million Hertz which causes a thermal lesion This wave varies slightly over time allowing progressive burning of the tissues whilst avoiding their carbonisation These modifications allow targeted and effective use limiting the risk of cutaneous lesions It is necessary to distinguish between electrocoagulation and thermocoagulation Zone de hermocoagulation Physiologically electrocoagulation ionises NaOH separating the Na and OH and is therefore a chemical burn Th
19. Name and visa of the customer Control of year 3 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other compoDells ERR IUS ete eee Name and visa of the controller Name and visa of the customer Date 5 10 2011 Page 47 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Control of year 4 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other COMPONENTS EARR EN VU CK Name and visa of the controller Name and visa of the customer Control of year 5 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle
20. Page 45 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 8 ANNUAL CONTROL FORMS The EVRF must have an annual control to be able to claim with the maintenance of its MARKING EC This control makes it possible to check all the functions of the apparatus and particularly the safety measures This chapter relates to the notebook of maintenance of the EVRF Control of end of guarantee Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other components 0 Name and visa of the controller Name and visa of the customer Date 5 10 2011 Page 46 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Control of year 2 Date of control to carry out Date of control Checks carried out Visual monitoring and cleaning of EVRF Security s control Control functions of orders Measuring of the output signals Control of the treadle Control pen carries needle Changed components Pen carried needle Other components Name and visa of the controller
21. They are an extremely frequent reason for consultation Between January and September 1995 Professor CATTALINA a specialist in occupational medicine and SOFRES medical studied 1 823 women working in four health sectors operating theatres laundries cr ches and secretariats An analysis of the results showed that the time spent in the job was the leading factor affecting the seriousness of the ailment Then in decreasing order the number of pregnancies and obesity A high temperature in the workplace and carrying heavy weights seem to be aggravating factors for venous ailments Heredity does not seem to affect the severity of the problem Do the genes play a role in the expression of the ailment Finally 6896 of women working in the operating theatre had varicosities compared with 51 to 54 in the other sectors The SUVIMAX study in 1999 3 065 persons who were monitored for a period of four years showed that 3396 of women were diagnosed with chronic venous insufficiency and 2896 Date 5 10 2011 Page 23 de 49 N de r vision 06 MANUEL THERMOCOAGULATION declared that they had symptoms indicating venous insufficiency without a medical diagnosis The NIH study in the United States of 600 employees at the University of South California found that varicosities affect 67 of the total population and varicose veins 25 Varicosities which increase with age vary between the sexes women 8396 men 5196 and according to racial g
22. all near the valve l greater than upstream A H 3 3 3 The vascularisation and innervation of L onfieme e ott el Nin the vein wall The vasa vasorum responsible for sasl Y vascularisation of the vein wall These are fine vessels that come from the adjacent arteries apr M The alpha adrenergic sympathetic nervous system is responsible for the contraction of the pm vein wall and therefore for vasoconstriction 1 eel li wr Hg LA VALVULE VEINEUSE LN APPLT ACTIF EN A DOMMAGEABLE EN B 3 4 Physiology The physiology of return circulation is complex and still involves many unknowns It has to perform several functions returning blood to the right side of the heart cutaneous thermoregulation regulation of the cardiac flow reservoir of blood mass Date 5 10 2011 Page 19 de 49 N de r vision 06 MANUEL THERMOCOAGULATION It has to deal with difficult conditions that have been known for a long time Bipedality aggravates the hydrostatic and hydrodynamic factors that it has to combat resulting in venous hyperpressure This venous hyperpressure responsible for micro circulatory problems is the key factor in venous ailments and their potential for development Gradual functional adaptation over thousands of years with a unique venous blood propulsion system deals with the main problems posed by gravity However the effectiveness of these adaptation
23. aricose veins There is an increase of 29 to 39 in persons who are overweight This is mainly a risk factor of cutaneous complication in the varicose patient Height The correlation between height and the presence of varicose veins has been shown to be significant in several studies Aggravating sports Although physical activity is highly recommended to encourage good venous hemodynamics the practice of certain sports can prove harmful For all sports any excessive training is harmful for the venous system It results in venous hyperdistensibility with the risk of parietal and valvular alteration followed by venous hyperpressure and hypoxia Working position There is unquestionably a link between a standing or sitting working position and the prevalence of varicose veins It depends on the number of hours a day of sedentary activity and the time spent in the job Others factors unproven Restrictive closing Constipation Hormonal Pathology Studies give conflicting results and it appears that the oestroprogestative hormones favour varicosities and reticular venule but reduce the risk of the appearance of truncular varicose veins Date 5 10 2011 Page 27 de 49 de r vision 06 MANUEL THERMOCOAGULATION 3 7 2 Clinical procedure How to examine a leg Observation and palpation are the two main elements of leg examination In orthostatism Anterior and posterior vertical position greek statue posit
24. ates between 50 and 85 Venous blood return in the supine position is characterised by a low pressure peripheral and a shallow pressure gradient pressure at the ankle of 12 to 18 mm Hg and filling pressure of the right auricle 2 to 10 mm Hg Hence the moderate suction effect created by the heart In the sitting position venous pressure at the ankle is 56 mm Hg In orthostatism in an immobile standing position the pressure is 85 mm Hg for an average sized adult It increases by 0 8 mm Hg per additional centimetre of height When taking up a standing position the blood volume in the inferior members increases by 300 ml which is responsible for a transient diminution of the cardio respiratory blood volume and the systolic volume When walking contraction phase It varies between 85 and 95 mm Hg in the medial malleolar saphenous vein just before the heel leaves the ground and falls to 70 mm Hg when the foot is lifted Release phase the leg musculature relaxes and then the crural musculature contracts When the heel touches the ground and rests the pressure falls to 46 mm Hg Date 5 10 2011 Page 22 de 49 de r vision 06 MANUEL THERMOCOAGULATION The drop in venous pressure at the ankle to below the hydrostatic pressure occurs after 3 to 12 paces independently of the walking speed 6 Speed of Veinous Blood Circulation The speed of the venous blood flow in the vena cava is 10 cm s It varies depending on the posit
25. ave power from 16 watt to 25 watt The wave power will be decreased when you touch or it can be increased touching uut Joule This is the sum of the amount of energy generated over a period of time The Joule is the multiplication of watt x seconds Date 5 10 2011 Page 43 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 7 2 2 Transcutaneous treatment This screen indicates The value of the standard power which is for the Variculas 8 watt We can increase or decrease this power duration of the impulse width T pulse We can decrease or increase LU lil this time The time between 2 pulses T down This time can be decreased by touching Or increased by touching the left we have a clock which will indicate the operation life of the EVRF when we begin the care the left we have the drawing of a foot switch with a meter which will count the number of pulses given The OFF icon in the top left corner indicates that the EVRF is in OFF mode By touching on OFF the EVRF is changed to ON and ready to be used USE Put a needle in the needle holder pen Disinfect the area to treat Place the needle perpendicularly to the area to treat Prick so that the needle is planted in or very close to the Varicula Push the foot switch to give the high frequency wave We thermo coagulate all 2 3mm A beep indicates that the impulse is trans
26. been treated correctly and the oedema masked the result i Pigmentation always disappears 7 Ochre marks of varying shades appearing a few days or even a few weeks after the treatment These are associated with the use of non insulated needles more rarely or a technical fault the non insulated part of the needle the last millimetre is in contact with the skin often following an overdose a Transparent appearance of the skin burn pulse too superficial Dotted appearance some of the varicosities were correctly treated wait one month and then treat the remaining part 9 How to avoid this problems Lack of results Strictly follow the protocol and the delay between each stage This is often caused by a lateral insertion alongside the varicosity The great majority of cases are due to a lateral pulse alongside the vessel You must take time carry out the tests making sure you are in the vessel send the pulse and use a magnifying glass small varicose veins the capacity can be increased up to 12 watt to ensure that the vein is closed If the varicose vein has a larger diameter increase the power and the duration of the emission to 0 5 seconds 5 5 Specificity of rosacea The rosacea are a chronic and evolutionary skin trouble Causing ignition and redness in the face The cheeks and the nose are usually the first to take a red dye follow ups of the face and chin The blotches can touch any old person from 20
27. cable Itis recommended that the patient is not connected with the applied parts before the apparatus has been switched ON 6 The apparatus must only be used with accessories maintenance parts and consumption products which technical security on use has been controlled and approved by a control organism entrusted with the mission of control of the apparatus and its accessories It s important to inform the patient about the sensation he will feel during treatment with the device The treatment is not for People who are prone to diseases People who do not understand mentally what will happen orwho are not rational enough to distinguish between normal and abnormal comatose patients non intellectual people People who can t express themselves or reveal abnormal sensations infants elderly People with epilepsy heart failure pregnancy People who refuse the treatment 1 6 Technical control The user must assure the submission of the apparatus for a technical control in conformity with the medical instructions 93 42 CEE at least once a year or after each repairing This technical control is made of a A visual control b A security control C A control of all functions d Measuring the exit signals e Measuring of securities for overload current The results of this control must be collated on the control formular at the end of this manual This control must be realised by competent people w
28. ditary factor in venous insufficiency However its preponderant role has been challenged Indeed the incidence of venous insufficiency increases in industrialised countries Europe North America Japan whilst the birth rate is constantly falling In parallel certain populations Black Africa New Guinea Polynesia that are free from the disease develop the disease when they move to the industrialised countries Date 5 10 2011 Page 26 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Lifestyle seems to be more important factor than heredity in the occurrence of venous disease Finally K Hubner following a study of the unilateral and bilateral distribution of varicose veins and varicosities in 12 313 patients confirms that from a genetic standpoint saphenous varicose veins and varicosities are two different entities Traumatism Contusion accident hot wax hair removal massage gloves treatment of cellulite using certain depression massage appliances pressure therapy using high pressure multi compartment sleeves and balneotherapy with underwater jets are aggravating factors Veinous therapies Saphenous vein stripping Chiva technique phlebectomy sclerotherapy laser electrocoagulation micro phlebectomy are also aggravating factors Identifying Aggravating Factors on which action can be taken Weight The Framingham study showed a positive correlation between high body mass and the risk of v
29. e composed of three tunics The Intima or internal tunic Composed of a vascular endothelium a sub endothelial layer of mucoglycoproteins of conjunctive tissue and cells this is the seat of the endothelial cell The latter is in constant communication with the elements of the blood and its response to hypoxia is the prime mover in the biochemical cascade that leads to venous incompetence Date 5 10 2011 Page 18 de 49 N de r vision 06 MANUEL THERMOCOAGULATION The Media or middle tunic composed of smooth muscle fibres and an elastic conjunctive structure The Adventitia or external tunic the vasa vasorum vessels that nourish the vein walls are located in this conjunctive tissue They are accompanied by lymphatic vessels and sympathetic nerve endings These vasa vasorum carry oxygen and nutrients to the vein wall and a lack of perfusion can give rise to hypoxia of the median layer leading to a structural alteration of the vein wall 3 3 2 The Valves A semilunar flap of endothelial tissue the main a lt function of which is to segment the blood d g vessels and above all to prevent blood reflux thereby making it more fragile The valves have passive mobility in the lumen of the vein They are more numerous in the deep veins If they function correctly they close totally when the venous pressure downstream is p A i i j l Y This flap thins the vein w
30. ep femoral vein with the same name as the artery 6 cm from the arch Above the crural arch the external iliac vein follows on from the common femoral vein before joining the internal iliac vein to form the common iliac vein Where these two common or primitive iliac veins meet is the origin of the inferior vena cava 3 3 Histology The venous system begins at the level of micro circulation The arteries are extended by arterioles and finally by meta arterioles From these run the capillaries that branch into microvenule and in parallel the artero venous anastomoses The post capillary microvenule have a diameter of 10 to 30 uim Their walls are comprised of endothelial cells lying on a basal membrane encased in a layer composed of pericytic cells and fibroblasts This layer increases as it moves away from the capillaries The post capillary microvenule converge into collector venule with a diameter of 30 to 50 um Their walls are made up of smooth muscle cells The collector venule join up with the veins The capillary flow is regulated by a dual system the pre capillary sphincters and Masson s neurovascular glomus which forms part of the neuro vegetative system Varicosities occur in the superficial dermis There are no vessels in the epidermis The saphenous veins and the largest varicose veins are located in the deep dermis especially the hypodermis in contact with the adipous lobules 3 3 1 The Vein Walls They ar
31. ermocoagulation by heating the atoms creates a thermal burn Clinically Electrocoagulation has not always given satisfactory results Firstly it can cause depressed scars that are frequently achromatic and second the pain is difficult to bear Although thermocoagulation is certainly not painless in general it is well tolerated Finally it is never responsible for serious cutaneous lesions Lesions from thermocoagulation are influenced by the power of the wave emitted duration of application of the wave the modulation of the wave Date 5 10 2011 Page 30 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 4 2 Equipment The appliance is comprised of a generator with a programmer linked to a pedal and to a needle holder 4 3 Technique 4 3 1 Needle treatment The technique is simple but requires absolute rigour It is strongly recommended to follow the seven golden rules 1 2 3 4 QUO pi Insert the needle perpendicular to the skin The zone to be treated must be horizontal Use a magnifying glass to avoid inserting the needle outside of the vessel Clean the needle regularly with a sterile compress Pulse every 2 3 mm Work at a very superficial level Use the appropriate diameter Ballet needles Date 5 10 2011 Page 31 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 4 3 2 Perforating Collateral and Reticular vein treatment 1 Introduce the needle with the guide
32. h injected An area predisposed to varicosity is probable Biological or hemorheological factors could play a role Date 5 10 2011 Page 24 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Varicosities fed by drainage venule Major category An Australian study by Thibault showed that 2596 of symptomatic varicosities were associated with major sources of valvulary venous insufficiency These varicosities are often found in groups Hemodynamic Reflux Reflux is responsible for these varicosities which appear after the superficial venous network is subjected to pressure From a physiopathological standpoint the transmission of pressure from the reticular veins to the venule probably results in their dilation and transforms them into telangiectasis and venulectasis Thanks to micro phlebography it has been possible to determine the origin of the reflux In 30 of cases we find the deep venous network isolated In 20 the superticial venous network And in 50 of cases both networks Finding these reticular drainage veins is not always easy It requires careful examination Clinical examination must be able to find a reticular venule The inferior member should be observed in the centripetal direction It is also possible to use cartography of the drainage zones to find the root causes of telangiectases The different zones are medial saphenous vein external saphenous vein anterior crural saphenous vein
33. ho are recommended by the company F CARE SYSTEMS 1 7 Guarantee and liabilities Conditions of guarantee The guarantee takes two years on the device and seven years on the spare parts from the day of the purchase mentioned on the invoice you always have to keep with yOu Are in guarantee manufacturing defects and the repairing of hidden defaults once they have been proved Date 5 10 2011 Page 7 de 49 de r vision 06 MANUEL THERMOCOAGULATION Also falls under warranty the repairing of defective components The purchaser must inform F CARE SYSTEMS about the expiry date of the guarantee by registered letter with acknowledgement of receipt 6 compensation can be asked as a prejudice due is to the immobilization of the apparatus The pick up and return charges are for the purchaser The yearly guarantee mentioned doesn t apply for the repair of a breakdown or mistakes due to a bad use of the apparatus or of its accessories an erroneous interpretation of the manual negligence or an accident bad maintenance of the device or a repairing of the apparatus realised by an incompetent person not recommended by F care systems Not covered by warranty Incorrect operation of the device The regulations repairs or modifications effectuated by the purchaser or by a third party not recommended by F care systems Damage of the delivered device box housing display during the impact
34. ice Fuses The replacement of the fuses accessible through the fuse holder of the mains power supply must be realised with a flat screwdriver The two fuses are type F2A 250V in glass 5 mm per 20 mm Date 5 10 2011 Page 9 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Maintenance The EVRF device must be controlled annually by F care systems or a company authorised by F care systems after the warranty has expired Transport and storage The apparatus can be carried out and stored during 15 weeks maximum and in the following environment conditions Room temperature between 40 C and 70 Relative dampness between 10 and 100 Atmospheric pressure comprised between 500 hPa and 1060 hPa After 15 weeks must the device pass the test procedure again 1 9 Incase of problems The apparatus doesn t switch on Check if the power cable is well connected to the device and put the switch on I There is no output signal Check first if the pen is well connected to the apparatus If this is the case there is a problem with the pen itself so you have to take another one 1 10 Practical advices Never place the unit in direct sunlight during treatment Place the machine on a solid and flat surface Use the EVRF only at temperature between 10 C 40 Do not expose to rain and moisture Date 5 10 2011 Page 10 de 49 N de r vision 06 MANUEL THERMOCOAGULATION
35. ion fencing position In decubitus Anterior and posterior and lateral Observe in the centripetal direction foot thigh and pull on the skin in order to flatten it Examination in the centripetal direction smoothing the skin with both hands is used to find a feeder venule Palpation may reveal a small cutaneous depression indicating the presence of a hypodermic vein Search for the clinical barriers to venous and lymphatic return Plantar arches The negative impact of static plantar ailments on venous insufficiency is real enough and we therefore need to combat high arches flat feet and valgus foot deformity Condition of the ankle and knee joints The ankle articulation plays an important role in the calf muscular pump and any alteration in the mobility of the ankle joint can lead to the appearance of venous hyperpressure of the leg even in young patients The same phenomenon exists to a lesser degree at the knee Condition of the calf and abdominal muscles These two muscle groups play a primordial role Any organic or functional deficit has significant repercussions on venous return Presence of cellulite Cellulite is a lipodystrophy composed of three elements adiposis stasis fibrosis The hypertrophy of the adipose lobules clearly disrupts the venous and lymphatic return resulting in a pressure increase in the venous sector When it affects exclusively or mainly the legs it is commonly referred to by the inadequa
36. ion of the subject In dorsal decubitus the speed of circulation in the legs is 2 cm s It falls by 4096 in orthostatism It increases by 20 when walking 60 during gymnastic exercise of the toes 80 when wearing an elastic restraint 90 during gymnastic exercise of the feet 150 when the end of the bed is raised by 20 270 when the subject is lying down with the legs raised vertically and 340 peddling in the same position 3 6 Varicosities Varicosities fall within the two worlds of phlebology and aesthetics Modern phlebology is based on their co existence These are no capillaries but permanent dilations of the intradermal microvenule with a diameter that varies between 0 1 and 1 mm They differ in appearance Isolated in small branches Diffuse spider s webs Inthe form of hairlines They mostly affect certain areas internal and external knee thigh internal ankle external leg They may be spontaneous or secondary and occur after stripping or sclerosis in which case they are referred to as matting Their colour varies from bright red to dark blue and the diameter depends not only on the depth but also on the oxyhemoglobin content They are covered by various medical disciplines phlebology angiology dermatology aesthetic medicine plastic surgery vascular surgery internal medicine 3 6 1 Prevalence It is difficult to broach the subject of varicosities without referring to their prevalence
37. is stage during one month normally The result is 10095 disappearance If certain varicosities have not disappeared check that the effects of thermo coagulation are not found alongside the varicosity Stage 2 varicosities lt 0 3 located in the knees and thighs parameters identical to the first stage During 15 days only do this and await the result This procedure is a little more delicate as these varicosities are often fed by a venule However the correct technique should lead to a very positive result approaching 10096 Stage 3 After six weeks of thermo coagulation apprenticeship go on to stage 3 isolated varicosities gt 0 3 and 0 6 mm use needle K6i very good result Stage 4 Varicosities gt 0 3 grouped and fed by a reflux More difficult to tackle for the best result it is preferable to treat the reflux first by using microsclerosis for example 5 4 Evolution of the treatment Normal evolution of the treatment D0 instantaneous disappearance of the varicosity with the appearance of an erythematous micro oedema D 8 appearance of very fine micro scabs corresponding to the pulse points D 30 total disappearance Abnormal evolution of the treatment m Disappearance of the oedema followed by reappearance of the varicosity over the days that follow Date 5 10 2011 Page 36 de 49 N de r vision 06 MANUEL THERMOCOAGULATION The varicosity in reality has
38. l cavity 3 4 3 The tonus of the Vein Wall This venous tonus depends on the sympathetic nervous system The release of certain chemical substances following stimulation of the adrenergic nerves results in contraction of the vein wall These vasomotor reflexes are especially common in the superficial veins They do not exist for the muscular veins Orthostatism cold stress deep respiration physical effort and hyperventilation increase the venous tonus On the contrary rest in the decubitus position heat and the absorption of alcohol reduce it Certain medicinal products reduce the venous tonus B blockers nitroglycerine nitrate derivatives theophylline and barbiturates Finally it is increased by non compensated cardiac insufficiency 3 4 4 Aponeuroses of the Legs Their role is certainly underestimated Their resistance to variations in volume and pressure increases the effectiveness of the muscular pump It is not simply passive envelope but participates actively to the ejection of blood from the deep veins 3 4 5 Residual Arterial Pressure This is what remains of the systolic propulsive force of the left ventricle after arterial flow to the capillaries It plays only a moderate role 3 4 6 Arterial Pulsatility The rhythm of the venous flow is controlled by the satellite artery that exercises pressure on it This pressure propels the venous blood in the opposite direction to the arterial blood However it onl
39. l information on vascularisation Three types of circulation flow through the lower limbs arterial venous and lymphatic Arterial blood flows from the aorta to the common iliac 3 Sem OY artery and then the external iliac artery before 7 VS XM masse traversing the femoral canal The femoral artery divides Cows d VE iE A meses Very rapidly into the superficial femoral artery and the B M BT more secondary deep femoral artery The popliteal o A artery follows on from the superficial femoral artery v giving rise to two branches the anterior tibial artery and the tibioperoneal trunk which in turn divides into the posterior tibial artery and the peroneal artery Blood returns via two networks 1 a superficial network that drains 1 10 of the Dr blood 2 a deep or aponeurotic system that drains 9 10 of the blood and is a satellite of the arterial die sapere system These two networks are linked by communicating veins flowing under normal conditions from the superficial network to the deep network The lymphatic vessels drain the lymph which comes from the interstitial tissue Lymphangions then collectors and finally ganglions ensure circulation to the thoracic canal They traditionally transport substances VEINES SUPERFICIELLES DU MEMBREINEERIELR With a high molecular weight Date 5 10 2011 Page 14 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Other properties have recently been
40. mechanisms is being challenged by modern living conditions Even though these physiological blood return mechanisms are partly known their respective importance has not yet been properly defined Many factors are involved in venous dynamics 3 4 1 The muscular and articular pump The contraction of the calf muscles during effort compresses the veins and favours the flow of blood towards the heart The effectiveness of this contraction depends a great deal on the articular condition of the ankle and to a lesser degree of the knee Squeezing the plantar venous sole allows the blood to flow to the deep venous trunks and the saphenous veins Around 30 ml of blood is expelled each time the foot comes into contact with the ground The contraction of the calf muscles the blood mass is ejected towards the heart by the compression of the muscular veins and deep veins The deep vein valves amp 2 prevent reflux upstream and towards the superficial venous network The non extensible aponeuroses limit the dilation of the muscles Naturally the effectiveness of this muscular pump depends on the development of this muscular mass especially the gemellary and solear muscles It will be much larger in sporting than sedentary persons in men than in women The sural venous muscular pump a veritable peripheral pump reduces the distal venous pressure by 40 and the blood sequestered by orthostatism by 200 ml In an imm
41. mitted The beep stops as soon as the duration of the impulse is finished ex an impulse of 0 2 S will generate 2 sound beeps an impulse of 0 4 S will generate 4 sound beeps If after the first pulse is finished the foot switch is still activated then the T Down time starts After T Down is finished and the foot switch is still activated a new pulse will be transmitted If you don t want to use the T Down feature then you need to deactivate the pedal first before a new pulse will be transmitted The parameters of power and duration of impulse can be modified thanks to the buttons on the bottom of the screen 7 2 3 End of the care To stop the care definitively one touches the X button We return to the basic screen Date 5 10 2011 Page 44 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 7 3 EVHF Settings These tables will give a clear overview of which settings are necessary for which vein treatment EVRF settings for the transcutaneous treatment K3i needle K6i needle Power watt 8 14 Max 10 Max 16 Max 0 5s EVHRF settings for the CR12i CR30i catheter Catheter 12 CR30I mm retraction Catheter CR45i Needle 6 Frenge Introducer Continuous mode Keep footswitch pressed down Number beeps per 0 5 3 cm retraction WARNING Do not send frequency through the CR45i catheter when it is longer than one minute outside the vein This avoids damage of the device Date 5 10 2011
42. n at the back of the foot from the confluence of the deep dorsal metatarsal veins They traverse the medial part of the anterior face of the ankle and rise alongside the muscles of the anterior section of the leg At the upper edge of the interossal ligament they join the venous tibial peroneal trunk Date 5 10 2011 Page 17 de 49 N de r vision 06 MANUEL THERMOCOAGULATION The posterior tibial veins they start at the confluence of the plantar veins rise in the posterior section of the leg and in the upper 1 3 of the leg they form the tibial peroneal trunk with the peroneal veins The peroneal veins start out narrow and progressively increase in calibre from the influx of veins from the solear muscle They run across the posterior face of the leg muscle and help to form the tibial peroneal trunk At the knee all of the leg veins join near the ring of solear muscle or above the articular interline giving rise to the popliteal vein It may be double 1 3 or even triple It receives many tributaries the medial and external gemellary veins the articular veins the external saphenous vein the popliteal fossa vein At the thigh the superficial femoral vein follows on from the popliteal vein at the level of the ring of 3D adductors rises through the Hunter canal and crosses the sartorius muscle Its origin is outside of the superficial femoral artery at the rear in mid thigh and within the crural ring It receives the de
43. obile standing position the venous pressure is 90 mm Hg after 30 seconds Ihe hemodynamic repercussion is rapidly felt upstream with an increase in capillary pressure and the appearance of an edema PRESSAGE DE LA SEMELLE VRINEUSE Finally an increase in adipose tissue in the leg significantly increases the work of the muscular pump see the study by Dr Chardonneau of heaviness of the legs revue de phlebology 1999 The articular condition each articular movement pushes venous blood towards the heart It follows that articular amplitude is a key factor in the expulsion of blood Date 5 10 2011 Page 20 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 3 4 2 The diaphragm pump The rhythm of venous blood return is controlled by respiration The further we go into the large veins popliteal femoral iliac the more this phased movement is felt A Doppler reading easily confirms this in the decubitus position During inspiration the diaphragm is drawn lower into the abdominal cavity as the volume of the thorax increases Thoracic pressure falls and the intra abdominal pressure increases This effect tends to squeeze the inferior vena cava and to propel its contents towards the thorax The venous valves prevent any reflux towards the inferior members During expiration we find that the diaphragm rising into the thoracic cage is responsible for an influx of venous blood into the inferior members of the abdomina
44. oe ni dei eR Lieu n atat ea pile sS EE LE A E E IA LCS I D EET 43 2s ascutaneousredttell vu vecta TEETAN Rea TRUE T UE E UO EU TUTO EET 44 VD Bs ENO OF EMC CON cL Hc 44 TB AE RE SETTINGS oie pb ao Ot sana iota p nmm aA Sie ean 45 8 ANNUAL CONTROL FORMIS S TUE PEOFFEUEN e FERE F o ETE VES ere eds 46 Date 5 10 2011 Page 5 de 49 de r vision 06 MANUEL THERMOCOAGULATION 1 SECURITY INSTRUCTIONS 1 1 Electrical Security 6 Check if the disposals taken for the electrical security from the place where the apparatus will be set up are conform to the actual regulations before the apparatus is taken in service 9 Risk of damaging the apparatus in case of excessive points of tension or mains cut Check if the tension and the frequency indicated at the back of the apparatus are conform to the electricity mains of the region The apparatus must only be used with the cable provided together with the device It must always be connected to a ground plug conform to the local regulations for medical premises n case of extension of the power supply cable the leak currents can be increased The apparatus in this case is not conform anymore to security standards 1 2 Electromagnetic disruption The apparatus is equipped with a filter for mains suppression To avoid any eventual disruption don
45. ous disappearance of the varicosity Small erythematous papule during the minutes that follow Scratched appearance for a few days to a few weeks followed by total disappearance Complications Incidents Very few secondary effects were observed Very rare erythism and transient accentuation of the varicosity Exceptional pigmentation from overdose An overdose could come from the following events o Pulses too close together o Excessive duration of the pulse 0 8 o Power too high o Several passages in the same location Lack of results due to technical faults pulse too deep or lateral unsuitable needle Patient experiences No severe pain Easier to bear than microsclerosis Comfort absence of dressing absence of ecchymosis Date 5 10 2011 Page 33 de 49 de r vision 06 MANUEL THERMOCOAGULATION No post treatment irritation or pain Treatment possible all year round Safe 4 5 Contra indications Allergy to nickel and chromium use a gold needle Pacemaker Cutaneous infection 4 6 Advantage of Thermo coagulation easy to use instantaneous disappearance allergies exceptional no durable pigmentation no necrosis speed of treatment Session lasts a maximum of 10 to 15 minutes For 300 to 400 pulses in a single session we eradicate 80 to 100 cm of varicosities highly effective on all types of varicosities small varicosities in all locations on zones inacce
46. rantee for security and the quality of the apparatus it s totally forbidden to open the device or the accessories by an incompetent person Opening the device or its accessories for servicing or repairing is only reserved for competent people recommended by F CARE SYSTEMS Apparatus You can clean the external face of the apparatus with a soft dry rag ora damp rag Don t use aggressive products because they can damage the spare parts inside the device In case of streaks or smears use a non aggressive soapy water None liquid may penetrate into the apparatus and also dry the device carefully after cleaning Hygiene The needles and catheter used are sterile and for single use Never use the same needles and catheter for more patients and wear gloves during the treatment Waste handling Please throw the single use products in the appropriate bio medical waste bins according to national regulations End of life considerations Atthe end of its life the product is taken out of service European legislation and sometimes national laws arrange the basic principles on how to treat the product Different rules apply depending on possible contamination risks For electrical and electronic equipment the EU Directive on WEEE deals with recovery and treatment of waste at European level Recommendations The user must contact the MANUFACTURER if he is unsure what to do with the product when it is taken out of serv
47. roup higher frequency amongst Caucasians and lower amongst Blacks Varicose veins are twice as frequent in women as in men with no ethnic difference Venous pathologies affect half of the adult population and 3 4 of the elderly particularly women A survey conducted by the MEDIA Institute showed that 70 of first consultations in a phlebology practice were because of varicosities An INSEE study in 1996 stated that 7196 of menopausal patients had varicosities 3 6 2 Etiology Even though the physiopathology remains partially hypothetical we can identify four main types Red varicosities They merge into marks or zones They are fine and superficial One particular form should be noted the red sock syndrome This affects women over the age of 45 with very fine very superficial red varicosities on the legs ankles and the back of the foot No varicose veins are found The difficulty of catheterising these micro vessels limits the therapeutic options Recidivism frequently occurs Matting Small angiomatous circumscribed and congestive they are secondary to an aggression an external or iatrogenic traumatism contusion caused by Stripping From traumatising surgery From a major hematoma From the persistence of an accessory saphenous vein or an incontinent perforator From phlebectomy generally if the varicose vein is left in place From sclerosis sclerosis nearby with an excessive concentration or too muc
48. s 0 35 systematic test before each pulse Before sending the pulse you must find the correct needle position by pressing on the varicosity with the needle until a small thread of varicosity disappears confirming that you are properly positioned on the varicosity The gentle pressure of the needle should make the varicosity disappear At this moment insert the needle very gently still superficial and send the pulse Verification of effectiveness Immediately pull the skin well after treatment with both hands to see using the magnifying glass that the varicosity has disappeared if the pulse is too lateral the varicosity will reappear disappearance in itself is not a sufficient condition because it is masked by the oedema for the success of the treatment but it is a necessary condition From day8 until day 15 repeat the inspection the space between the pulses must be pink and empty indicating the disappearance of the varicosity Date 5 10 2011 Page 35 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 5 3 Pragmatic approach Practical detail that may be used as a guide 0 055 mm is the smallest diameter needle used in phlebology 13 x 0 3 if the vessel can be catheterised it is more than 0 3 mm Stage 1 red and blue varicosities 0 3 mm non catheterisable isolated external leg of ankle needle K3i power setting 5 8 watt pulse time 0 2 0 3s Hemain at th
49. s 21 CER ATECHION PUISO 21 22 3 5 GENERAL INFORMATION OF VENOUS sss sese esses esse nnn 22 COMME moli ET TIT 23 5 23 302 ED 24 So CHUNICALEXAMINA TION Peas oec ca spl I S pc I ED eames 26 ILCNA STO o RR TTE TA E E OA E A ET 26 28 4 THE THERMOGOAGULATION i EEE ENERO SERE NR A 30 Date 5 10 2011 Page 4 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 30 RE 31 A TECHNIQUE site bicis eti repa e beraten bw xe reso rr petes peu tick ma beds iden alude defe diti anat etae 31 4o Neede neono eruta 31 4 3 2 Perforating Collateral and Reticular vein tregtment 32 43 3 Saphena Magna treatment oeri t ne dade ect cide to en 32 ANGE EIS EP RR um a A 33 2 5 CONTRASINDICATIONS s 34 4 6 ADVANTAGE OF THERMO COAGULATION 34 47 CONCLUSION DISCUSSION sua RUNS 34 5 FREATMENT PROTOCOLS 3 ciet a te oaa
50. screen to change the contrast Choose the desired contrast settings with the left right arrows and touch to accept Touch to cancel and return to the mode selection Date 5 10 2011 Page 42 de 49 N de r vision 06 MANUEL THERMOCOAGULATION EVRF 7 2 Use of the EVRF When we are on the mode selection screen we have the option to choose between 3 different modes Transcutaneous Endovenous with the CR12i amp CR30i catheter and CR45i catheter Saphena 7 2 1 Endovenous treatment CR12i amp CR30i catheter In this screen we have the option to change the wave power from 1 watt to 16 watt The wave lm will be decreased when you touch or it can be increased by touching uil Joule This is the sum of the amount of energy generated over a period of time The Joule is the multiplication of watt X seconds For example when setting the EVRF at 15 watt after 4 seconds you have 15 x 4 60 joules The EVRF will give a sound beep every two seconds so you know that every beep you have generated 2 times the watt that was set on the EVRF This is the amount of joule that the EVRF generated The Pulse width cannot be changed since this is continuous mode If the machine is ON mode and you push the foot switch the wave will remain on the output for as long as you keep the foot switch pushed CR45i catheter Saphena In this screen we have the option to change the w
51. ssible to microsclerosis lt to 0 3 mm on zones of the foot can be used on all types of skin 4 7 Conclusion Discussion Microsclerosis is currently the reference treatment for varicosities but it does seem likely that phlebologists and other practitioners interested in this type of aesthetic damage will soon give preference to thermo coagulation Thermo coagulation without the least danger treats the same symptoms as microsclerosis or laser therapy but with superior results This therapy has been in use for 30 months We have observed no recidivism in the patients monitored It is very difficult to find parallel studies that demonstrate the effectiveness of microsclerosis secondary effects are virtually non existent if we follow the seven golden rules Failures are rare Date 5 10 2011 Page 34 de 49 de r vision 06 MANUEL THERMOCOAGULATION EVRF 5 TREATMENT PROTOCOLS A PRACTICAL GUIDE TO THE TREATMENT OF VARICOSITIES by Dr Jean Marc CHARDONNEAU 5 1 Type of Needles For easy penetration use Ballet needles The size varies according to the diameter of the varicosities to be treated K3i 0 075 mm for very fine varicosities of less than 0 3 mm 0 150 mm for varicosities of more than 0 3 mm 5 2 Adjusting the parameters There are two adjustable parameters the power of the wave and the emission duration In general intensity 5 8 watt duration of emission 0 2
52. te term of lipoedema Diagnosis of lipoedema is based on a rather light flexible edema its bilateral character absence of Stemmer s sign Chardonneau s sign appearance of an internal retromalleolar adipose groove when the skin is pinched characteristic of cellulitic infiltration in the ankle Date 5 10 2011 Page 28 de 49 N de r vision 06 MANUEL THERMOCOAGULATION Finding a drainage venule The physical examination must be meticulous and patient For varices mainly in orthostatism use palpation to get more elastic cutaneous Starting with the course of the saphenous veins who run vertically and for the other superficial veins who run horizontally For the venule by inspection in decubit Examine in the centripetal direction of the venous flow foot thigh from different angles with different lighting if possible drawing and smoothing the skin with both hands Transillumination has become almost indispensable for dealing with these feeder veins It uses a cold light source and fibre optic cable The end of the fibre comes into direct contact with the skin The light passing through the skin is reflected by the fascia superficialis deep dermis and the veins appear as Chinese shadows It can show the veins located on the deep side of the dermis A tortuous or looped appearance is a sign of a pathology Date 5 10 2011 Page 29 de 49 N de r vision 06 MANUEL THERMOCOAGULATION 4 TH
53. terior side of the thigh as far as the fold in the buttocks The Venule of the Poplitea Fossal They originate from an anastomosis with crural veins or a posterior crural perforator and ending in various ways in the external saphenous vein the gemellary veins the peroneal vein or the reticulum of the calf The Perforating Veins Anastomoses between the deep and superficial network with perforation of a fascia There are two types 1 direct linking directly the saphenous veins to the deep network 2 indirect linking the two networks through intermediate trunks general small in calibre They vary widely from one individual to another They are very numerous in the feet 50 to 70 in general with valves in the legs retro tibial Cockett 2 to 4 and Boyd 2 to 5 muscular solear 3 gemellary 5 to 6 perforating the popliteal fossa In the crural zone Hunter s or Dodd s perforator perforators of the deep femoral vein and the femoral vein with an accessory arch 3 2 3 The Deep Veinous System 9096 of the blood uses this return route The deep veins have valves The leg veins contain a large number 10 The popliteal vein from 0 to 4 The superficial femoral and common vein from 2 to 6 The deep femoral vein 3 The iliac veins rarely have valves In the legs the veins are satellites of the arteries of the same name In principle there are two veins for one artery The anterior tibial veins these begi
54. y makes a modest contribution Date 5 10 2011 Page 21 de 49 de r vision 06 MANUEL THERMOCOAGULATION 3 4 7 Cardiac Aspiration A moderate intra auricular systolic suction effect is produced by the downward traction of the tricuspid and mitral valves This mechanism is particularly reduced in the case of arrhythmia 3 5 General information of Venous Dynamics The anti reflux role of the valves is dependent on the integrity of the flaps 2 or 3 that float in the lumen of the vein They tolerate pressure in excess of 200 mm Hg The closing speed of the valves is less than 0 5 seconds in the event of rapid reflux Parietal Distensibility The peripheral vein walls contain little smooth muscle tissue and are fine They are easily distended They become larger with age This distensibility of the vein wall depends on the level of progesterone serum Venous capacity The lumen diameter of the vein is 20 um for venule 5 mm for average peripheral veins and cm for the vena cava Venous compliance is 24 times greater than for the corresponding artery The veins are capacious vessels 64 of the blood volume flows through the veins 1 3 of it in the major veins and the blood reservoirs spleen liver Veinous Pressure In decubitus the hydrostatic venous pressure is 20 mm Hg In the case of existing varicosity it varies between 40 and 70 mm hg and in the case of a post thrombotic syndrome it oscill
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