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Uh uh uh Hi. I'm happy to introduce uh my uh the, the next speaker, my dear friend, Doctor Hamad Far. Uh He was uh give us uh an illustration about what I have learned from high training course. 2024. Uh Thank you very much, Professor Mosad. And thank you much for the kind invitation of doctor had. It's a pleasure and honor uh to give a lecture today. And it's always very difficult to present after Professor Mosatil man. And I always like uh and fascinated this picture, the lecture I'm going to summarize to you a trip that I have made last month and this is what I have learned from and I will try to be very quick not to waste your time. Uh This is a hau machine which is about 300,000 U dollar a new machine in the army of the uh vascular tools. So the course was in uh Guildford which is a part of London. Uh not, not very near to central London. It was for two days organized by a Phlebology College which is college made by Mark Whiteley, which is a, is a very good private venture really. Um And the presented five life cases was in one day. This is the Gilford and this is the, the place that uh Whitely Clinic settles in the ground floor is all clinics and the upper second floor is all operating theater and duplex scan and the third floor is for lunch and sitting. It's a beautiful place. It's private, all private practice, nothing to do with NHS National Health System. And immediately on his world is Nuffield College. Nuffield College is a big, very big NHS center for arterial and venous disease. And he's always fully booked and he's always booked the three months ahead. Well, before I go to the course, I read about high, I know that it is made by a French company called the and this company has started to read by what is called Eco thera. And now they are treating thyroid and they are going to also treat breast as well. The machine for the vein is called so vein and the machine for thyroid and breast is called op pulse. Both of them have a Ce mark and found in Europe. Now, this is a new era when I start to read about it. Well, it's a beauty really. You don't take the patient to theater, you do it in, in, in not theater facility and there is non invasive. You don't need any puncture. There is no incision, no surgery needed, uh no needle phobia and that's it. It looks pretty attractive. And uh when I went to the course, I was really very excited to attend discourse. Now this is a machine which is equal $300,000. Um I hope you can see the machine is robotic arm, which is this arm. This arm is is moved by computer artificial intelligence. And this is the tip where it has the ultrasound beam and this is the ultrasound beam come from a small slit and you make like maybe 50 DX scanner have one beam directed to certain tissue. So you have beams going like this. And because this generate a lot of heat, you got a beautiful um uh what is cooling system and this is expensive cooling system. That's why the machine is too big. It's only big for the cooling system. And this is a dux machine that you do live um live seeing DX scan. So this is the hy machine how it work. It works by directing high intensity focused ultrasound beam direct into the vein causing high temperature up to 40 that will cause degeneration of tissues. These are the other area of arteries. And I'm sure in the near future, it will play a role in the breast adenomas as well. In the beginning, they took about 2 to 3 hours to do the procedure. You can see here two hours because they were having the pulse for eight seconds, eight second pulse wave. Now they tried well let us make it four seconds. This makes operation 1.5, 1 hour. And then they were hoping in 2026 which is next year to make the operation in 30 minutes because you have tried 0.02 of a second intensive pulse. It seemed to work as good as well. So they are moving into very short duration. What happened to the vein? There is a lot of pathology study, but I will just give you the name, it's called hyalinosis process. Because when you direct heat from inside the vein out, it is different from directing the heat outside in. It's not the same pathology at all. But this is a big story. We don't need to go into detail, but it works by coagulative necrosis and highly noses. The advantage obviously is there is no wound, outpatient patient goes home, no age restriction, no need to stop aspirin or anticoagulation, no age restriction. Some people were 99 doing this procedure, no compression. So it's maximum beauty really and back to normal life on the same day. So what happened with this intense beam in the initially they get eight seconds time and you get area of the tissue five millimeter long by 3.5 millimeter wide, this will be ablated. So if you have a nerve in that area, nerve is gone, so you must be very careful when you direct the machine. And this is a slit that will make all the power of the duplex scan and I will get you at the end of my presentation very quick case that he done by Mark Whiteley. So now they are doing four seconds and this is the amount of tissue that will be ablated. Now, this is the video uh and this video if you can, I think you can run it from your mouse. Uh you can run the video from your mouse because uh this is Mark Whitely. There was five live cases. If you press on it, we did check it. It was working, it's not working. It's PTX, it is incorporated and I tested before. But anyway, no problem because this is not an important video. Well, the video is patient. Come in. Hello, there is no there is no you don't need to have any a sit down have the hyper robotic machine. Actually Mark Whitely is not the one which should do the case. What does the case is the nerve? So the nurse will just mark by this point you do firing every one centimeter and you can go 20 centimeter, you can do 30 centimeter, you can do the you do everything. But here you see my shortest summary to you which took me really a lot. It took me really a lot to learn this lesson. The machine does not attack any varicose vein in the three millimeter under the skin. The dubs cannot. So all the telangiectasia is out, you can't deal with transect easy. You can't deal with any vein one millimeter below below the skin. And this will not tell you in the advert. Secondly, no high power will be more than 2.23 millimeters below the skin because we don't have the technology to do that. So if you have like our nice Egyptian ladies and the vein is maybe about 50 millimeters down, it's out of high range. OK. So these two really will limit. So if someone say, well, let me buy one high, I think it's about 46 million, put it in my clinic and earn a lot of money. It will not happen. You cannot build a clinic just on. Oh, here is the video it was working. So it was mine wasn't my mistake. So this is a high machine. It's a feno femoral junction. OK? Let us ablate this. Mark Whiteley will tell the nurse give me ablation to this. OK? Fine. It will do the adjustment and here is the uh do a little bit of pressure a around the vein. OK? And you will see suddenly this is the ultrasound machine of the hi a machine. Suddenly you will get, this is the intensity, this is the heat that is being bombarded. If the vein is in this area, you cannot, you cannot kill it. OK? No one will tell you that up to three millimeter. And if it is more than 23 millimeters, you can do it. So this is a beautiful smaller spot. Um Can you make it run? Uh I think this mic is OK. Uh Anyway, so this is the ablation, this is the beam. And um let me, yeah. Now yes. The same any vein you can ablate. No question. Accessory vein, Jamin vein, small SUFA vein, you have to be sure there is no nerve number one and you have to be sure it is within the target area, three millimeter under the skin, 23 millimeter down any vein you can ablate immediately and the result is immediate and patient doesn't wear a gown. Patient come with the jeans, money wise, he more quietly deal with them like it in the laser. Obviously, the company is not very happy. It wanted to have three times the price of laser. But he said, well, I have a waiting list. Let me give this option because he's one of the biggest centers in Europe. And now they have two center with Hiu machine, one in the United States and one in China. Anyway, let me take you to the final conclusion. I concluded that no single answer for varicose vein. So definitely exo Laer and and foam are here to stay sure. So will play a big part in our future and probably you will deal with CID and breast breast benign disease as well. Cost. Sure is an issue. No question about it, but I'm sure China will come with an high equivalent rather than the one that we see in Europe. And thank you very much uh and many advanced technologies that we should know about. Uh but on the other hand, we don't have to rush to the uh uh containing it because it's very expensive for a disease that you have pointed out that it's a uh a disease that would ma maintain with you for life. We cannot say that there is an absolute management of the varicose veins, a disease that needs multiple uh attacks in different ways with multiple methods of intervention. So you are have to custom your uh uh choice of intervention according to what you have in your box. Yes. The other thing I need to comment about, I need to know the sponsor of this course uh to host. Yes, I will tell you about outside the mic. It uh any other questions for doctor, er, thank you doctor er, for uh your uh very uh uh excellent presentation as usual. Uh The next uh uh speaker will be uh uh Doctor Ahmed. Bua. Doctor Ahmed will talk about the bailout utilization of five for acute thrombosis. This uh thrashing during peripheral endovascular interventions. Mm.