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.”
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