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Alastair Lewis: Powerful TIRS Outcomes in Venous Ulcer Prevention
Alastair Lewis/LinkedIn
Nov 28, 2025, 16:20

Alastair Lewis: Powerful TIRS Outcomes in Venous Ulcer Prevention

Alastair Lewis, Vascular Surgeon at Fitzwilliam Health Clinic, posted on LinkedIn:

”Terminal Interruption of Reflux Source (TIRS) in pre-ulceration.
54-year-old male, 6-month history of progressive swelling, itch, and evolving skin change,s and 3-4 week active flare-up of LDS in the right pre-tibial area. History of EVLT and healed venous ulcer, left leg in 2022.

Duplex findings

  • Great saphenous vein 8mm in thigh, 5mm in calf.
  • 4-5mm varicosities arising from GSV tributaries.
  • Extensive venous plexus underlying LDS

Treatment

  • Single session of ultrasound-guided foam sclerotherapy performed in a peripheral-to-proximal manner.
  • 8mls 0.2% Varixio STS foam to sub-LDS plexus
  • 8mls 0.5% Varixio STS foam to the varicose veins and calf segment of GSV
  • 4mls 3% STS foam, physician-compounded, thigh GSV
  • Class 2 compression stockings for 2 weeks

Outcome

  • Immediate relief of itch and swelling 24 hours following treatment.
  • 8 week review – duplex confirms occlusion of GSV, varicose veins, and sub-LDS plexus
  • Clinically – almost complete resolution of swelling, inactive skin changes remain
  • This experience underscores the value of early intervention for venous disease complications and highlights the effectiveness of targeting peripheral venous plexuses in patients at risk of ulceration.”
  • Alastair Lewis: Powerful TIRS Outcomes in Venous Ulcer Prevention Ulcer

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Alastair Lewis Fitzwilliam Health Clinic Health Hematology Hemostasis Hemostasis Today Medicine sclerotherapy Terminal Interruption of Reflux Source thrombosis TIRS Ulcer Ulcer Prevention Vascular Surgery Venous Disease Venous Ulcer Prevention
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