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Papers by Steven E Zimmet

International angiology : a journal of the International Union of Angiology, Jun 24, 2016

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess... more There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by comb...

Phlebology, Jun 1, 1993

Sir, I read the letter by Goren [1] with interest. Historical ~nsider~tions aside, the most signi... more Sir, I read the letter by Goren [1] with interest. Historical ~nsider~tions aside, the most significantissue relates to what IS ~ffectlve therapy f~r truncal varicosities. In his original reVl~w, Gore~ [2] rehes on personal experience and some pubhshed stud~es to c~nclude that 'sclerotherapy in any form for truncal vancose veins harbouring clear axial reflux should be dod~ed, ditched an~ di~carded from our therapeutic ar~enal. Goren had practised total sclerotherapy for varicose verns as suggested by Fegan ... [2].' Apparently all veins were treated at a single session with 0.4% Sotradecol with a large recurrence rate noted at 1 year. Goren states similar results were published by Hobbs [3], Doran and White [4], ~er~sford et al. [5]and Jacobsen [6]. Goren [2] then tried high ligation o.f the most proximal source of reflux together with compressive sclerotherapy of the tributary varicosities. Axial r~flux was.treated by retrograde sclerosis during high ligation v,ta ~ feeding tube. This too was apparently associated with significant recurrence rates. In his most recent letter (1), Gor~n quotes the study published by Bishop et al. [7] as finding sclerotherapy of the junction a total failure. He feels th~t. the study is even more noteworthy because 'the study ?ngmat~d from a vein injection clinic'. He speaks in terms of ... a ~lfect blo~ to the very heart of Toumay's teachings.' In Goren s concluding remarks he states that 'objective evidence de~on~t~ates that. scl~rotherapy is inappropriate for truncal v~n~OSltleS, res~ltlDg in a high rate of recurrence and possible Significant morbidity from thrombophlebitis'. It is difficult to feel that Goren is objective in his evaluation given the poetic Union Internationale de Phlebologie: Summary of Report of Council Meeting, Montreal, 31 August 1992

Springer eBooks, 1995

To conduct a dose-response study using hyaluronidase in the prevention of necrosis following intr... more To conduct a dose-response study using hyaluronidase in the prevention of necrosis following intradermal 23.4% sodium chloride.

Phlebology: The Journal of Venous Disease

Background Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous di... more Background Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. Objectives To categorise contraindications to sclerotherapy based on the available scientific evidence. Methods An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. Results Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh ...

Endovenous laser ablation (EVLA) is a less invasive alternative to vein stripping. Outcomes seem ... more Endovenous laser ablation (EVLA) is a less invasive alternative to vein stripping. Outcomes seem equal to, or better than, those with stripping, with better quality of life scores in the post-operative period. EVLA has been shown to correct or significantly improve hemodynamic abnormality in patients with chronic venous insufficiency (CVI) with superficial venous reflux. Early reports suggest that endovenous ablation techniques, in contrast to surgical stripping, are associated with a low incidence of neovascularization. A variety of wavelengths are being used to perform EVLA. While the initial chromophore is water or hemoglobin, depending on the wavelength used, carbon appears to be a secondary but key chromophore that is probably independent of wavelength. The application of the principles of tumescent anesthesia to venous treatments, along with the development of endovenous ablation techniques, offer the possibility of treating the vast majority of patients with varicose veins in...

Journal of The American Academy of Dermatology - J AMER ACAD DERMATOL, 1992

Dermatologic Surgery, 2008

BACKGROUND Compression bandages appear to be simple medical devices. However, there is a lack of ... more BACKGROUND Compression bandages appear to be simple medical devices. However, there is a lack of agreement over their classification and confusion over the use of important terms such as elastic, inelastic, and stiffness. OBJECTIVES The objectives were to propose terms to describe both simple and complex compression bandage systems and to offer classification based on in vivo measurements of subbandage pressure and stiffness. METHODS A consensus meeting of experts including members from medical professions and from companies producing compression products discussed a proposal that was sent out beforehand and agreed on by the authors after correction. RESULTS Pressure, layers, components, and elastic properties (P-LA-C-E) are the important characteristics of compression bandages. Based on simple in vivo measurements, pressure ranges and elastic properties of different bandage systems can be described. Descriptions of composite bandages should also report the number of layers of bandage material applied to the leg and the components that have been used to create the final bandage system. CONCLUSION Future descriptions of compression bandages should include the subbandage pressure range measured in the medial gaiter area, the number of layers, and a specification of the bandage components and of the elastic property (stiffness) of the final bandage. E. Steinlechner and M. Abel are employees of Lohmann & Rauscher, J. Hutchinson is an employee of ConvaTec, J. Schuren and K. Issberner are 3M employees. Jan Schuren has a patent application on one mentioned product. Travel expenses of the active participants were covered by the Industrial Board.

Phlebology / Venous Forum of the Royal Society of Medicine, 2014

The major venous societies in the United States share a common mission to improve the standards o... more The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content.

Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 2003

Phlebology, Jan 17, 2016

In every field of medicine, comprehensive education should be delivered at the graduate level. Cu... more In every field of medicine, comprehensive education should be delivered at the graduate level. Currently, no single specialty routinely provides a standardized comprehensive curriculum in venous and lymphatic disease. The American Board of Venous & Lymphatic Medicine formed a task force, made up of experts from the specialties of dermatology, family practice, interventional radiology, interventional cardiology, phlebology, vascular medicine, and vascular surgery, to develop a consensus document describing the program requirements for fellowship medical education in venous and lymphatic medicine. The Program Requirements for Fellowship Education in Venous and Lymphatic Medicine identify the knowledge and skills that physicians must master through the course of fellowship training in venous and lymphatic medicine. They also specify the requirements for venous and lymphatic training programs. The document is based on the Core Content for Training in Venous and Lymphatic Medicine and fo...

American Family Physician, May 1, 1994

J Vasc Interven Radiol, 2004

PURPOSE: To report long-term follow-up results of endovenous laser treatment for great saphenous ... more PURPOSE: To report long-term follow-up results of endovenous laser treatment for great saphenous vein (GSV) reflux caused by saphenofemoral junction (SFJ) incompetence. MATERIALS AND METHODS: Four hundred ninety-nine GSVs in 423 subjects with varicose veins were treated over a 3-year period with 810-nm diode laser energy delivered percutaneously into the GSV via a 600-m fiber. Tumescent anesthesia (100 -200 mL of 0.2% lidocaine) was delivered perivenously under ultrasound (US) guidance. Patients were evaluated clinically and with duplex US at 1 week, 1 month, 3 months, 6 months, 1 year, and yearly thereafter to assess treatment efficacy and adverse reactions. Compression sclerotherapy was performed in nearly all patients at follow-up for treatment of associated tributary varicose veins and secondary telangiectasia. RESULTS: Successful occlusion of the GSV, defined as absence of flow on color Doppler imaging, was noted in 490 of 499 GSVs (98.2%) after initial treatment. One hundred thirteen of 121 limbs (93.4%) followed for 2 years have remained closed, with the treated portions of the GSVs not visible on duplex imaging. Of note, all recurrences have occurred before 9 months, with the majority noted before 3 months. Bruising was noted in 24% of patients and tightness along the course of the treated vein was present in 90% of limbs. There have been no skin burns, paresthesias, or cases of deep vein thrombosis. CONCLUSIONS: Long-term results available in 499 limbs treated with endovenous laser demonstrate a recurrence rate of less than 7% at 2-year follow-up. These results are comparable or superior to those reported for the other options available for treatment of GSV reflux, including surgery, US-guided sclerotherapy, and radiofrequency ablation. Endovenous laser appears to offer these benefits with lower rates of complication and avoidance of general anesthesia. J Vasc Interv Radiol 2003; 14:991-996