Andrew Nickinson and Aminder Singh discuss what trainees should know about venous disease with Mr. Manj Gohel. This podcast is aimed at preparing UK vascular trainees for the Fellowship of Royal College (FRCS) vascular examination, but should apply to any vascular surgery examination.
Mr Manj Gohel MD FRCS FEBVS (@ManjGohel) is a consultant vascular and endovascular surgeon at Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. He is also an Honorary Senior Lecturer at Imperial College, London and the honorary secretary of the Royal Society of Medicine’s Venous Forum.
Mr Gohel has a specialist interest in venous disease and has been actively involved in venous research for over 15 years, speaking regularly at national and international conferences. He spearheaded the landmark EVRA and ESCHAR trials and has recently co-chaired the European Society of Vascular Surgery Venous Thrombosis Guidelines.
Hosts:
- Mr Andrew Nickinson (@AndrewNickinson)is a vascular speciality trainee in the Wessex deanery and the SAC representative for the Rouleaux Club.
- Mr Aminder Singh (@AminderASingh)is an NIHR Academic Clinical Fellow in Vascular Surgery at the University of Cambridge, Vascular trainee in East of England and European/Venous representative for the Rouleaux Club.
Episode Outline:
- Chronic lower limb venous insufficiency
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- 02:55 - What is chronic venous insufficiency?
- 10:09 - Approach to managing superficial venous reflux
- 20:47 - The role of surgery in superficial venous reflux
- 27:31 - What is superficial venous thrombosis?
- Deep venous thrombosis
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- 34:38 - Screening for malignancy and thrombophilias in patients with DVT
- 40:33 - The role of compression in proximal DVTs
- 42:17 - What is post thrombotic syndrome?
- 46:42 - The evidence for catheter directed clot burden reduction in proximal DVT
- 52:17 - Management of phelgmasia
- Proximal deep venous outflow obstruction
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- 54:04 - The basics of proximal deep venous outflow obstruction
- 57:30 - When to consider imaging the proximal deep veins in patients with symptoms of venous disease
- 1:08:07 - Pelvic congestion syndrome
- 1:11:15 - Training and service provision in venous interventions
Selected papers:
- Gohel et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial BMJ 2007; 335(7618)
- Gohel et al; EVRA Trial Investigators. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. NEJM. 2018; 378(22):2105-2114.
- Kakkos et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. EJVES. 2021 Jan;61(1):9-82.
- Vedantham et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. NEJM. 2017;377(23):2240-2252.
- Brittenden et al. A randomized trial comparing treatments for varicose veins. NEJM. 2014;371(13):1218-27.
Authors: Andrew Nickinson, Aminder Singh
Editor: Leanna Erete
Reviewers: Adam Johnson, Rachael Forsythe