Paul Thibault
 
Paul was founding President of the Australasian College of Phlebology a position he held for 3 terms (9 years) and is currently the Assistant Editor of the international journal �Phlebology�. He has undertaken original research in venous diseases published as peer reviewed articles in international medical journals and has contributed to major textbooks on venous diseases. Paul is known for his pioneering work in the non-surgical treatment of varicose veins, in particular ultrasound guided sclerotherapy, and has published a number of other innovative treatments methods in this field.

Currently Paul holds the position of Honorary Treasurer of the Australasian College of Phlebology. His present research interest is the nature and management of cerebrospinal venous disease in Multiple Sclerosis.

 

 

Involvement of the Venous System in Multiple Sclerosis
Concurrent Workshop Repeated
Friday, 16 August 2013 Start 2:00pm Duration: 55mins Lounge 1
Start 3:05pm Duration: 55mins Lounge 1

The aetiology proposed for the development of chronic cerebrospinal venous insufficiency (CCSVI) associated with multiple sclerosis(MS) has been the presence of congenital truncular venous malformations. However this hypothesis is not consistent with the epidemiology or geographical incidence of MS and is not consistent with many of the ultrasonographic or radiographical findings of the venous disturbances found in MS patients. Never-the-less the probability of a venous aetiology of MS remains strong based on evidence accumulated from the time the disorder was first described. 

Epidemiological and geographical findings of prevalence of MS indicate the involvement of an infective agent. This presentation of the venous pathology associated with MS describes a theory that the pathogenesis of the venous disease could be initiated by a respiratory infective agent such as Chlamydophila pneumonia, which causes a specific chronic persistent phlebitis and venulitis affecting the cerebrospinal venous system. Secondary spread of the agent would initially be via the lymphatic system to specifically involve the azygos, internal jugular and vertebral veins. The theory proposes mechanisms by which an infective venous vasculitis could result in the specific neural damage, metabolic, immunological and vascular effects observed in MS. The theory presented is consistent with many of the known facts of MS pathogenesis and therefore provides a framework for further research into a venous aetiology for the disease.

If MS does result from a chronic infective venulitis rather than a syndrome involving congenital truncular venous malformations, then additional therapies to the currently used venoplasties will be required to optimize results.

This workshop will outline the principles of when venoplasty is indicated for treating stenoses of the internal jugular and azygos veins as well as describing the combined antibiotic protocol used to manage chronic persistent chlamydophila pneumonia phlebitis and venulitis affecting the cerebrospinal circulation.

Modern Management of Varicose Veins and CVI
Main Session (Workshop options scheduled)
Friday, 16 August 2013 Start 4:55pm Duration: 25mins Plenary

The management of varicose veins has progressed significantly in the past 20 years due primarily to the universal use of duplex ultrasound to assess and monitor treatment progress, and the development of advanced minimally invasive techniques that rely on new technologies such as endovenous laser and radio-frequency (RF). These are usually combined with either ultrasound-guided foam sclerotherapy or mini-phlebectomies depending on the practitioner�s training, skills, and preferences. As a result classical high ligation and saphenous stripping is rarely performed today, due to a higher incidence of adverse effects, longer recovery times and inferior long-term results.

Prescribing Effective Compression and PTS
Main Session (Workshop options scheduled)
Saturday, 17 August 2013 Start 9:50am Duration: 20mins Plenary

The classical concept of compression therapy for patients with CVI and PTS of the lower extremities recommends starting with an acute therapy phase, consisting of firm bandages, and then transferring to a maintenance phase, in which the extremity should be kept free from oedema using compression stockings.

The logic of this approach is related to the following practical problems:
1. Compression stockings prescribed for a swollen leg rapidly lose their fit and need to be newly prescribed repeatedly
2. Bandages require trained staff to apply (or provide training to a carer) and are often a single use imposing a considerable economic burden.

In practice, for prevention and treatment of oedema and less severe CVI symptoms, compression stockings are effective and usually sufficient. However for the treatment of patients with chronic venous hypertension (PTS), it is necessary to achieve interface pressures that approach the level of ambulatory venous hypertension during walking, but that are comfortably tolerated when lying down. These preconditions may be fulfilled by multilayer bandages applied with a resting pressure of 50mmHg or more.

When prescribing compression for CVI and PTS, in addition to assessment of the deep and superficial venous, it is also necessary to assess the lower extremity arterial pressures as well as the lymphatic system, as these will influence management.