Terminal Veins Research Articles

Trans-arterial chemo-emobilization (TACE) combined with laparoscopic portal vein ligation and terminal branches portal vein embolization for hepatocellular carcinoma: a novel conversion strategy

Trans-arterial chemo-emobilization (TACE) combined with laparoscopic portal vein ligation and terminal branches portal vein embolization for hepatocellular carcinoma: a novel conversion strategy

Forensic characteristics of injuries from thermo-baric explosive device

Since the beginning of the Russian Federation's invasion of Ukraine in 2022, explosive trauma has become an extremely urgent problem, as the main source of bodily injury among both the military in the combat zone and the civilian population in cities has been the impact of explosive devices. The aim of the study is the examination of the forensic characteristics of damage to biological objects that were formed from thermal exposure and shock wave as a result of the explosion of a cumulative munition and in the conditions of an experimental explosion model. The objects of the study were the materials of two examinations on the death of Ukrainian soldiers who died in the war zone (archival "Conclusions of the medical examination" of the Kyiv City Clinical Bureau of Forensic Medical Examination in 2023). Under the conditions of the experiment, studies of pathomorphological changes in the liver and small intestine of 30 white outbred rats from the action of an artificially created air shock wave with an overpressure of 31.62±4.84 kPa were carried out. The injuries were examined macroscopically and using standard laboratory histological techniques. Microscopy of histological sections was performed using an Axio Imager 2 microscope (Zeiss, Germany) at magnifications of ×200 and ×400. Statistical processing of the obtained quantitative results was carried out using the STATISTICA 6.1 software product. Under the condition of the explosion of the ammunition with the cumulative effect of the rocket-propelled infantry flamethrower "Bumblebee" on sectional incisions of the skin and muscles of the thigh in the projection of areas of redness, a picture of a gelatinous consistency of bright red color was macroscopically determined due to abundant blood impregnation of muscles and subcutaneous fat and partial loss of muscle structure with the release of myoglobin. The bright red color of the skin of the thigh and pelvis without burning the hair may indicate the superficial thermal effect of the explosive device and the protection of the skin by clothing. Diffusely located numerous both paired and single abrasions and shallow wounds, small rounded, oblong, circular in shape, which are the result of fragments of a rocket-propelled grenade equipped with a fire mixture, were also determined. The effect of an air shock wave with an overpressure of 31.62±4.84 kPa on the liver parenchyma of rats was determined by focal hemorrhages with rupture of the terminal central vein of the hepatic lobule, edema of the parasinusoidal spaces, and sludges in the sinusoids. In the wall of the small intestine, acute hemodynamic disorders occurred in the form of vasodilation of arterial vessels, venular and capillary stasis. There was layering and swelling of the small intestine wall, rupture of veins, focal hemorrhage. Thus, the revealed characteristic pathomorphological signs of the destructive effect of overpressure as a result of a blast wave (barotrauma) are typical and common both in the areas of the human thigh and pelvis, and in biological objects of experimental animals. The obtained results are consistent with the pathomorphological manifestations of barotrauma in areas of the human body as a result of the action of an explosive device with a cumulative effect.

Coordination of hydraulic and functional traits in ten species of trees of the Sonoran Desert

Leave’s vein xylem and stomata hydraulic traits should be critically linked to modulating plant responses to drought in leaves of desert species, influencing traits at the whole-plant level and promoting adaptation. We tested for coordination among leaf vein xylem anatomical traits across different hierarchical orders (hydraulic vessel diameter, vein area, free veins per area, areolas per area, total free veins number, total areola number) and stomatal traits (stomatal size, stomatal density, stomatal index, leaf total stomatal area, leaf total stomatal number) as well as their relationship with the leaf area in ten tree species from the Sonoran Desert scrub, Mexico. Moreover, these traits were correlated with other hydraulic and functional traits associated with resource use strategies (hydroscape area, stem-specific density, leaf mass per area, and leaf phenology). Leaf total stomatal area and number were positively associated with vessel diameters at the midrib and with leaf total free terminal veins and areola number, indicating coordination between water transpiration and transport. Also, interspecific differences fit species along a physiological resource use spectrum, following an exploitative vs. conservative physiological axis. Accordingly, species with lower leaf longevity (LL) and foliage duration at the canopy (FD) displayed higher values of stomatal indices and free vein densities, higher stomata density; and anatomical traits related to higher hydraulic conductance and gas exchange in comparison to species with higher LL and FD. Therefore, in this community, species have been selected to take advantage of different temporal hydrological niches to enhance survival under unpredictable and highly seasonal water availability.

Clinical application of transarterial chemoembolization combined with terminal branches portal vein embolization in planned hepatectomy

This study aimed to investigate the clinical efficacy of transarterial chemoembolization (TACE) in conjunction with terminal branches portal vein embolization (TBPVE) in the context of planned hepatectomy. A cohort of five patients afflicted by primary hepatocellular carcinoma who were deemed unsuitable candidates for primary surgical resection was gathered from August 2019 to December 2021. Following the application of TACE in combination with TBPVE as a therapeutic intervention, we observed postoperative general reactions, alterations in tumor biomarkers, hyperplasia of future liver remnant (FLR), and subsequent surgical resection. All patients successfully underwent the combined TACE and TBPVE procedure, achieving a technical success rate of 100%. One week after TACE, alpha-fetoprotein (AFP) levels decreased from 38.52±49.21 to 25.27±37.94 μg/L, and Protein Induced by Vitamin K Absence or Antagonist (PIVKA) levels decreased from 1689.30±1663.83 to 219.03±228.10 μg/L. Two weeks post-TBPVE, FLR exhibited an increment from 350.80±41.17 to 476.00±57.91 mL. The ratio of FLR to standard liver volume (SLV) increased from 30.94%±3.63% to 42.03%±5.62%. The combined application of TACE and TBPVE not only effectively manages tumor progression but also augments the FLR, thereby affording patients with a limited future liver remnant an opportunity for surgical resection of hepatocellular carcinoma.

Clinical application of transarterial chemoembolization combined with terminal branches portal vein embolization in planned hepatectomy

This study aimed to investigate the clinical efficacy of transarterial chemoembolization (TACE) in conjunction with terminal branches portal vein embolization (TBPVE) in the context of planned hepatectomy. A cohort of five patients afflicted by primary hepatocellular carcinoma who were deemed unsuitable candidates for primary surgical resection was gathered from August 2019 to December 2021. Following the application of TACE in combination with TBPVE as a therapeutic intervention, we observed postoperative general reactions, alterations in tumor biomarkers, hyperplasia of future liver remnant (FLR), and subsequent surgical resection. All patients successfully underwent the combined TACE and TBPVE procedure, achieving a technical success rate of 100%. One week after TACE, alpha-fetoprotein (AFP) levels decreased from 38.52±49.21 to 25.27±37.94 μg/L, and Protein Induced by Vitamin K Absence or Antagonist (PIVKA) levels decreased from 1689.30±1663.83 to 219.03±228.10 μg/L. Two weeks post-TBPVE, FLR exhibited an increment from 350.80±41.17 to 476.00±57.91 mL. The ratio of FLR to standard liver volume (SLV) increased from 30.94%±3.63% to 42.03%±5.62%. The combined application of TACE and TBPVE not only effectively manages tumor progression but also augments the FLR, thereby affording patients with a limited future liver remnant an opportunity for surgical resection of hepatocellular carcinoma.

Developmental Venous Anomalies and Arteriovenous Malformations Coordinately Drained by the Internal Cerebral Vein: Clues to Pathogenesis.

An intimate understanding of dynamic angioarchitectural development of vascular malformations involving the intracranium may provide mechanistic insight into the incipient pathogenesis of these lesions. The authors report two patients harboring cerebral developmental venous anomaly (DVA) and three patients harboring sporadically developing cerebral arteriovenous malformations (AVM) in whom the internal cerebral vein (ICV) represented the chief venous egress route. Onyx embolization successfully achieved complete obliteration in all patients harboring cerebral AVMs. Two female patients presenting with a chief complaint of chronic headaches was found to harbor deeply situated DVA draining via the lateral group of direct lateral vein (DLV) egress via the ICV. Three female patients presenting with chronic headaches or intraparenchymal hemorrhage were found to possess cerebral AVMs deriving arterial feeders from the anterior cerebral arteries, with major venous drainage into the ICV via the direct lateral veins or terminal vein. Common drainage of DVAs and AVMs may indicate a common originate genesis. This pattern of venous drainage in the context of seeking to develop a cohesive and coherent model illumining our understanding of the mechanistic incipient pathogenesis of AVMs.

Lower Limb Dialysis Grafts

The exponential rise in diabetes in India has led to a steady rise in end-stage renal disease patients requiring renal replacement therapy (RRT). Affordability and access to centers providing RRT and maintenance of functioning upper extremity vascular access for prolonged periods remain a challenge. Frequently facing no upper extremity access situations, we decided to reassess the feasibility of lower extremity vascular access. A retrospective study was carried out evaluating data from January 2009 to March 2022 including patients with a graft tunneled in the thigh (lower superficial femoral artery end to side to terminal great saphenous vein end to end). Totally 26 cases were studied with respect to age, sex, body mass index, comorbidities, difficulty in cannulation, complications, graft dysfunction, and patency rates. Follow-up was a dynamic ongoing process without a fixed endpoint. Graft dysfunction was seen in seven of 26 patients (26.92%), with a primary patency rate of 88.46% (23/26) at 1 year. Twelve subjects died during the study period, however, all had a functioning lower limb arteriovenous graft (AVG). Lack of surgical training, fear of complications, and absence of team approach in decision-making are some reasons why lower extremity permanent dialysis access is infrequently used. However, in view of increased survival on dialysis, advancing age of the dialysis population, associated comorbidities, and multiple access failures, lower limb AVGs may be considered a feasible access modality with acceptable patency rates and minimal complications.

Abstract No. 213 Portal vein embolization using sodium tetradecyl sulfate foam sclerosant versus microsphere particle embolization: a retrospective comparative analysis

Portal vein embolization (PVE) is performed to induce future liver remnant (FLR) hypertrophy prior to resection. A variety of embolic materials have been used for PVE, though the agent to induce maximal hypertrophy remains undetermined. 3% sodium tetradecyl sulfate (STS) is foamed with ethiodized oil and air prior to injection behind balloon occlusion of the proximal right portal vein, allowing impregnation of the portal venules and sinusoids. Microsphere particle (MSP) embolization relies on flow-directed therapy to deliver particles to the terminal portal veins and is followed by particles of escalating size and concluded with coil or plug embolization of the right portal vein.

Review of Neonatal and Infant Cranial US.

Review of Neonatal and Infant Cranial US.

The clinical value of terminal branches portal vein embolization for hepatocellular carcinoma with insufficient future liver remnant

Objectives: To examine the efficacy of terminal branches portal vein embolization(TBPVE) for the increment of FLR in hepatocellular carcinoma (HCC) patients and to introduce its clinical value with transcatheter chemoembolization(TACE) in the treatment of HCC patients without surgery. Methods: One hundred and fifty HCC patients from three clinical centers of china underwent TBPVE technique from December 2016 to May 2021,including 89 males and 61 females. The average age was 51.9 years(range:18 to 79 years).One hundred and one patients were diagnosed with a background of HBV infection,including 27 patients with portal venous hypertension.TACE was performed simultaneously with TBPVE in 102 patients.Fifty-three patients underwent hepatectomy,who were subdivided into HBV positive and HBV negative groups,with TACE and without TACE groups to analyze the increment of future liver remnant (FLR), complications and survival data.These data were also analyzed in other 97 patients without hepatectomy. Results: All the patients reached adequate FLR successfully in 14 days after TBPVE including patients with portal venous hypertension.The average increment rates of FLR was 56.2% in 7 days and 57.8% in 14 days after TBPVE. There was no significant difference neither between HBV positive and HBV negative groups(7 days:(55.0±27.3)% vs.(57.8±20.9)%,t=0.885,P=0.373; 14 days:(57.3±24.6)% vs.(58.3±23.7)%;t=0.801,P=0.447),or between with TACE and without TACE groups(7 days:(62.3±26.3)% vs. (48.8±20.6)%;t=1.788,P=0.077;14 days:(64.4±25.0)% vs.(55.2±23.1)%;t=1.097,P=0.257).The morbidity and mortality rates were 20.8% and 1.9% in patients with hepatectomy.The 1-,3-year overall survival(OS) and disease-free(DFS) rates were 87.5%,64.5% and 64.7%,40.6% for patients underwent surgery.There was no significant difference of 1-,3-year OS and DFS between HBV positive and negative groups,but there were different between TACE and without TACE groups.The 1-,3-year OS for patients underwent TBPVE and TACE but without surgery were 80.1%, 53.7%. Conclusion: TBPVE is a good alternative technique for modulation of FLR for staged hepatectomy even in HBV positive HCC patients and can be applied with TACE procedure simultaneously as an option treatment for patients with no intend to surgery.

Point-of-Care Assessment of DCD Livers During Normothermic Machine Perfusion in a Nonhuman Primate Model.

Normothermic machine perfusion (NMP) provides clinicians an opportunity to assess marginal livers before transplantation. However, objective criteria and point‐of‐care (POC) biomarkers to predict risk and guide decision making are lacking. In this investigation, we characterized trends in POC biomarkers during NMP and compared primate donation after circulatory death (DCD) livers with short and prolonged warm ischemic injury. Following asystole, livers were subjected to either 5 minutes (DCD‐5min, n = 4) or 45 minutes (DCD‐45min, n = 4) of warm ischemia time. Livers were flushed with heparinized UW solution, and preserved in cold storage before NMP. During flow‐controlled NMP, circulating perfusate and tissue biopsies were collected at 0, 2, 4, 6, and 8 hours for analysis. DCD‐45min livers had greater terminal portal vein pressure (8.5 vs. 13.3 mm Hg, P = 0.027) and terminal portal vein resistance (16.3 vs. 32.4 Wood units, P = 0.005). During perfusion, DCD‐45min livers had equivalent terminal lactate clearance (93% vs. 96%, P = 0.344), greater terminal alanine aminotransferase (163 vs. 883 U/L, P = 0.002), and greater terminal perfusate gamma glutamyltransferase (GGT) (5.0 vs. 31.7 U/L, P = 0.002). DCD‐45min livers had higher circulating levels of flavin mononucleotide (FMN) at hours 2 and 4 of perfusion (136 vs. 250 ng/mL, P = 0.029; and 158 vs. 293 ng/mL, P = 0.003; respectively). DCD‐5min livers produced more bile and demonstrated progressive decline in bile lactate dehydrogenase, whereas DCD‐45min livers did not. On blinded histologic evaluation, DCD‐45min livers demonstrated greater injury and necrosis at late stages of perfusion, indicative of nonviability. Conclusion: Objective criteria are needed to define graft viability during NMP. Perfusate lactate clearance does not discriminate between viable and nonviable livers during NMP. Perfusate GGT and FMN may represent POC biomarkers predictive of liver injury during NMP.

The Most Minimally-invasive ALPPS - Using Terminal Branches Portal Vein Embolization (TBPVE) for Liver Partition (A Report of 24 Cases)

Introduction: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a minimally-invasive way to partition the liver. The intra-hepatic portal vein communication can thus be blocked between both liver. As a result, only a single surgical operation is required. This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP). Methods: From February 2016 to November 2017, 24 patients were performed with TELPP. The procedure was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5, S8 or S4. In order to avoid potential enlargement of tumor, in some cases tumor TACE were used at the same time. Standard liver volume(SLV), future liver remnant (FLR) and FLR/SLV are calculated by CT scan taken. Open or laparoscopic hepatectomy was performed in two weeks when the FLR is appropriate. Results: All the patients (most of the liver were cirrhotic;4 patients with PVTT) achieved enough FLR that had a median increase of 55.6% (from 26.2% to 120.8%) in two weeks. All of them underwent hepatectomy, most of them were extended hemihepatectomy and trisegmentectomy. No server morbidity occurred except 1 case with minor ectopic thrombus. 3 patients died respectively 15,18,7 months, all the other 21 patients are surviving. Conclusion: This study shows that TBPVE had a rapid FLR increase similar to ALPPS without it's drawback. TELPP is very promising, cause requiring only one single operation instead of two staged operations.

An Analysis of Temperature Distribution and Ablated Volume in the 3-D FEM Tissue Model with Blood Vessel during Radio-Frequency Ablation

The current treatment for a brain tumor has many methods such as surgery or chemotherapy but often the treatments may affect the patient or treatment is still limited in some aspects. A promising technique for brain tumor treatment is radio-frequency ablation. Radio-frequency ablation utilizes alternating current (AC), typically at about 500 kHz, to destroy unwanted tissues by heating to temperatures exceed 45°C to 50 °C. The objective of this research is to study the treatment of brain tumor during radio-frequency ablation with computer simulation through finite element method (FEM) for solving the problem. A three-dimensional FEM model of brain tissue with a brain tumor and blood vessel is considered. Three types of blood vessels i.e. aorta, main veins and terminal veins are studied. The electric current equation and time-dependent bioheat transfer equation coupled with time-dependent convective blood vessel heat transfer equation are solved to predict temperature distribution and ablated volume within brain tissue model. The simulation results are compared with the simulation results from previous work to verify the accuracy of the presented model. The effects of the blood vessel are included and not included in the brain tissue model, types of blood vessel and treatment time during radio-frequency ablation on the temperature distribution and ablated volume are investigated. The outcomes indicated that size of blood vessel results in heat sink effects which increase with the velocity of blood flow. The aorta causes more heat sink effects than main veins and terminal veins, respectively; thereby the ablated area and ablated volume in case of the aorta is higher than one in case of main veins and terminal veins, respectively. In addition, the temperature value increases with greater treatment time. The results from this study provide the basis for planning the radio-frequency ablation of brain tumor, leading to approaches of medical practice process improvement.

A rapid and effective optical-clearing technique for deep tissue fluorescence imaging in trees

This non-invasive clearing technique allows for deep clear imaging of plant tissue and 3D structural analysis of leaf cells. Optical-clearing technology allows the reduction of light scattering and absorption in internal biological tissues. This technology allows microscopy techniques, such as confocal laser scanning microscopy, to obtain structural information deep within the internal tissue and also allows for three-dimensional (3D) tissue analysis. However, the transparent method in plants remains to be further elucidated. In this study, we first report on a non-invasive, rapid and effective clearing technique that increases the transmission of light through plants. Importantly, we found that the leaf terminal veins of four species had different characteristics based on fluorescence imaging observations. Moreover, through the combination of transparent technology and microscopic observation, we clearly observed the three-dimensional structure of plant leaf cells. Our simple and rapid clearing method is useful for fluorescence imaging the intact internal structure. Taken together, the results of this study will provide valuable information for further microscopic experimental investigations in trees.

High intensity focused ultrasound (HIFU) ablation of porous liver: Numerical analysis of heat transfer and hemodynamics

In the present study, the influence of the liver vascular bed on heat transfer in a tumor located close to the hepatic artery and exposed to high intensity focused ultrasound (HIFU), is studied numerically. For this purpose, an acoustics-thermal-fluid coupling model based on the porous media theory under the local thermal non-equilibrium assumption is used to calculate the temperature field in the tumor, porous liver, and the hepatic artery. Different generations of the liver vasculature including arterial branches, terminal arterial branches, terminal veins and venous branches are examined at different porosities (the volume fraction of the vasculature). It is found that the liver vasculature and the porosity have a considerable cooling effect on HIFU ablation efficacy and treatment planning. Also, it is shown that the terminal arterial branches have the most cooling effect because of their high blood velocity and heat transfer surface area. It is demonstrated that this effect is significant so that some cancerous cells remain viable near the tumor surface and therefore, some approaches should be adopted to ablate the tumor completely. Finally, the results show the importance of using local thermal non-equilibrium assumption to study the heat transfer in different generations of the liver vasculature.

Evolution of ALPPS:the simpler, safer and effective one---TELPP

Background: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a way to compart the liver. This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP). Methods: The procedure of TELPP was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5,S8 or S4. CT scan was taken one or two weeks later , and standard liver volume(SLV), FLR and FLR/SLV are calculated. Two weeks later, open or laparoscopic hepatectomy is performed. Results: Patients including hepatocellular carcinoma: n =8, intrahepatic cholangiocarcinoma: n = 1, hilarcholangiocarcinoma: n =1, colorectal liver metastasis: n =1. The volume of theFLR had increased from 382ml to 578ml, representing a median volume increase of 51% (range =32.5%-86.7%). Of the 11 patients with hepatectomy, right hemihepatectomy(n=2), extended right hemihepatectomy (n=5) ,right trisecmentectomy(n=2), extended left hemihepatectomy (n=1) and left trisecmentectomy(n=1). No patient died, and no serve perioperative morbidity occurred. Conclusion: The ALPPS and all modifications need two-stage operations with a high morbidity and mortality rate. It seems that TELPP is very promising. It has the merit of ALPPS as extraordinarily rapid increasement of FLR volume, yet the morbidity and mortality is much lowe, as only single surgical operation is required.

Evolution of ALPPS:the simpler, safer and effective one---TELPP

Background: Numerous modifications have been suggested for improvement of ALPPS. We suggest Terminal Branches Portal Vein Embolization (TBPVE) as a way to compart the liver.This method is termed Terminal branches portal vein Embolization Liver Partition Planned hepatectomy (TELPP). Methods: The procedure of TELPP was that in addition to PVE, embolization agent was infused to the terminal branches of portal vein of S5,S8 or S4. CT scan was taken one or two weeks later, and standard liver volume(SLV), FLR and FLR/SLV are calculated. Two weeks later, open or laparoscopic hepatectomy is performed. Results: Patients including hepatocellular carcinoma: n =8, intrahepatic cholangiocarcinoma: n = 1, hilarcholangiocarcinoma: n =1, colorectal liver metastasis: n =1. The volume of theFLR had increased from 382ml to 578ml, representing a median volume increase of 51% (range =32.5%-86.7%). Of the 11 patients with hepatectomy, right hemihepatectomy(n=2), extended right hemihepatectomy (n=5), right trisecmentectomy(n=2), extended left hemihepatectomy (n=1) and left trisecmentectomy(n=1). No patient died, and no serve perioperative morbidity occurred. Conclusion: The ALPPS and all modifications need two-stage operations with a high morbidity and mortality rate. It seems that TELPP is very promising. It has the merit of ALPPS as extraordinarily rapid increasement of FLR volume, yet the morbidity and mortality is much lowe, as only single surgical operation is required.

A New Technique in Tamai Zone 1 Reconstruction: Reverse Dorsal Terminal Vein Flap (Hat Flap)

Introduction The aim of this study was to determine usability of the reverse dorsal terminal vein flap (hat flap) in the reconstruction of Tamai zone 1 defects.Materials and Methods A total of 31 patients with fingertip amputation in Tamai zone 1 defect in the finger operated upon between 2014 and 2016 were included in this study. Flaps were designed from the proximal end of the nail bed to the middle phalanx according to the defect size. After passing through the skin, the proximal parts of the dorsal vein and branches were knotted. The flap was harvested by preserving the paratenon and dorsal digital terminal vein. Then, the flap was rotated and the defect was closed.Results A total of 32 patients were included in this study. The average size of the defects was 2 × 2.2 cm. Loss of epidermis in five patients and partial flap loss in two patients were observed (7/32, 21.8%), but total flap loss was not observed in any patient.Conclusion The reverse flow terminal dorsal vein-based pedicle flaps can be used as a viable surgical technique in the reconstruction of Tamai zone 1 amputations.Level of Evidence This is a Level IV study.

Dilated Thoracic Duct Terminal and Chyle Withdrawal from a Central Venous Port in Innominate Vein Stenosis

Central vein stenosis is a rare complication that occurs after central venous port placement. We report a case of chyle withdrawal from a central venous port in a patient receiving chemotherapy for stage IV rectal cancer. Dilated thoracic duct terminal and innominate vein stenosis both were clearly shown in the angiography results, and innominate vein stenosis was resolved by performing percutaneous transluminal angioplasty.

Rápida cicatrización de la úlcera venosa con técnica TAPIRS-LF con láser, espuma y vendajes multicapa

IntroductionThe traditional surgical techniques are being replaced by minimally invasive procedures, such as Endovenous Laser (Thermal, Tumescent), and ultrasound foam sclerotherapy (Non-Thermal, Non-Tumescent). The aim of this study was to determine the healing time and rate of venous ulcers (VU) using a Terminal, Axial and Perforator Interruption of the Reflux Source (TAPIRS-LF) protocol. This included Endovascular Laser Treatment and endoluminal venous occlusion with ultrasound-guided foam and a multilayer bandage system until ulcer healing was achieved. Material and methodsA prospective non-controlled trial was conducted on patients with chronic venous leg ulcers (CEAP [clinical, etiological, anatomical and pathological elements] classification C6) during 2015 and 2016. A total of 27 patients aged 18 years and over, presenting with venous insufficiency, VU, and an ankle-brachial index greater than 0.8, were included, with a total of 27 extremities being analysed. All of the patients were subjected to thermal and non-thermal endoluminal occlusion, with endovenous laser treatment in axial venous system, with ultrasound-guided foam in the distal axial superficial venous system and perforator and terminal veins near to the ulcer, using the Tessari method with 3% polidocanol. Follow-up was carried out every week and a Doppler test was performed after 4, 12, and 24 weeks. ResultsThe mean age of the patients was 59.6 years. The active ulcer duration prior to treatment was 11.7 months. The mean VU diameter was 15.06 cm2, and 92.5% VU were seen to be healing at 8 weeks. ConclusionsThe minimally invasive ablation using Terminal, Axial and Perforator Reflux with compression in patients with active VU results in a faster healing during the treatment of chronic venous ulcers.