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Terminal Interruption of the Reflux Source (TIRS)

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    The author of this report discusses the inherent challenges of treating chronic venous ulcers.


    RG Bush describes a technique which he coins as terminal interruption of the reflux source (TIRS) which targets the terminal source of venous insufficiency, reducing venous hyertension and thus, allowing healing to occur.


    By ultrasound guidance, 1% Sotradecol foam is injected into a venous branch or branches in close proximity to the ulcer bed. The branch may course under the ulcer or lead directly to it. Although more than one outflow source may be localized, all targeted veins must have documentation of reflux and have continuity with the primary source. 


    The author has shown that terminal interruption of the reflux source is a safe and effective treatment to heal venous ulcers. Local reduction of venous hypertension is the underlying factor for promoting rapid healing. More studies and careful documentation will likely prove the validity of this treatment regime.


    author of study: RG Bush. 


    study title: New technique to heal venous ulcers: Terminal Interruption of the Reflux Source. 

     Journal: Perspectives Vascular Endovascular Therapies  2010 Sep;22(3):194-9.
     Dr Karamanoukian's comment: This is a good technique and a recent article has been electronically prublished which shows that it is reporducible and efficacious. I will summarize it on another page.