Vascular
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Recent advances in catheter-based endovenous interventions have broadened our understanding in the pathophysiology and therapeutic strategies of chronic venous insufficiency, a condition that can be caused by abnormality of various lower extremity venous structures, including superficial or deep vein reflux or incompetent perforating veins. This article reviews the history and therapeutic principles of percutaneous ablation of perforators (PAPs). Discussions related to treatment strategies and procedural techniques of PAPs using radiofrequency ablation, laser energy, and sclerosant injection are provided. Current clinical results of PAPs with radiofrequency and laser energy ablation as a treatment modality of chronic venous insufficiency are also discussed.
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Virtual reality (VR) simulations have long been used for training in aviation and other professions. High-fidelity endovascular procedure simulators are now available, providing procedure simulations with real-time interactions; two-dimensional graphic displays of angiographic anatomy; mechanical interfaces with guidewires, sheaths, and catheters that provide some degree of haptic feedback; modeling of physiologic and pharmacology responses; and other features. ⋯ Early experience has shown that simulation is well accepted by trainees, performance on simulators improves with training and practice, and simulation prior to first performing endovascular procedures can improve clinical performance. Specific to CAS, the value of education programs using simulators appears to be tangible as trained but inexperienced CAS operators have clinical results comparable to those of physicians with extensive CAS experience.