NZer1 wrote:Thanks Dr.S
In my mind we are hoping for the obstruction to stay against the wall, in reality of course we are open to every possibility imaginable.
In my mind, i am hoping that the valve is opened up and will function again. But the primary goal is to keep the flow so that reflux above the valve no longer occurs. i am hoping over the years for a better solution, such as a percutaneously deployable synthetic valve replacement.
**When there are other findings such as webs, septums and membrane is there any guesses/experiences there?
webs are lacy tissue that divides the vein drainage into smaller channels. Balloon should tear them open
septums are very challenging structures. their nature makes balloon angioplasty less effective than against valves. I think greater balloon diameter may be an answer. we shall see.
I am guessing also that retreating is a mine field knowing if there is an old or previously unseen issue.
I don't look at it in that way.
I look at retreatment of patients previously treated by others as if my treatment was their first. So IVUS is very important to me. We know that venography can miss 25% of abnormalities. So why would i trust venography performed by others without IVUS?
*When I read some of your comments I get the impression that using IVUS in re-treat situations you are looking for original issues, treated issues and 'new' issues?
yes, of course. I am trying to avoid using IVUS on my own retreatments. I reload the images from the first IVUS back into the IVUS unit and work from that. Hoping to save patients $2000 on retreatments.
**Is there an actual situation we might call a new issue. Something that has happened as a result of flow improvement elsewhere in the vein or elsewhere in the collective system? Not caused by treatment in the past rather something that develops now the flow is increased where there has previously been low or less flow?
I cannot think of any
**Have you recovered, and are you looking after your self?
very kind, Nigel, thank you. I am recovering nicely. I didnt miss or reschedule any patients. I have had some delay in addressing some patient email inquiries and questions but no patient was delayed! I feel very lucky to be alive and have a renewed sense of urgency to perfect my techniques