"varicose veins" AND management

recent advances management varicose veins 2024 2025 treatment guidelines

https://pmc.ncbi.nlm.nih.gov/articles/PMC12462076

PMID: 37652254

mkdir -p /home/daytona/workspace/varicose-veins-ppt && ls /home/daytona/workspac…

~/varicose-veins-ppt/create_pptx.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Education";
pres.title = "Recent Advances in Management of Varicose Veins";

// ─── COLOR PALETTE ───────────────────────────────────────────────
const DARK_BG    = "0D1B2A";   // deep navy
const MID_BG     = "1B3A5C";   // medium blue
const ACCENT1    = "4FC3F7";   // sky blue
const ACCENT2    = "00BFA5";   // teal
const ACCENT3    = "FF7043";   // warm orange
const WHITE      = "FFFFFF";
const LIGHT_GRAY = "E8F4FD";
const TEXT_DARK  = "1A2E40";
const SUBTITLE   = "B0C4DE";
const BOX_BG     = "132538";

// ─── HELPER: section header bar ──────────────────────────────────
function addSectionBar(slide, label, color) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.65,
    fill: { color: color || MID_BG },
    line: { color: color || MID_BG }
  });
  slide.addText(label, {
    x: 0.3, y: 0, w: 9.4, h: 0.65,
    fontSize: 13, bold: true, color: WHITE, valign: "middle", margin: 0
  });
}

function addBottomBar(slide) {
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 5.3, w: 10, h: 0.325,
    fill: { color: DARK_BG }, line: { color: DARK_BG }
  });
  slide.addText("Recent Advances in Management of Varicose Veins", {
    x: 0.2, y: 5.3, w: 9.6, h: 0.325,
    fontSize: 8, color: SUBTITLE, valign: "middle", margin: 0
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };

  // decorative top stripe
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: ACCENT1 }, line: { color: ACCENT1 } });
  // accent left bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0.18, w: 0.08, h: 5.445, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });

  s.addText("RECENT ADVANCES IN", {
    x: 0.3, y: 0.8, w: 9.4, h: 0.6,
    fontSize: 22, bold: true, color: ACCENT1, align: "center",
    charSpacing: 4
  });
  s.addText("Management of\nVaricose Veins", {
    x: 0.3, y: 1.4, w: 9.4, h: 1.6,
    fontSize: 42, bold: true, color: WHITE, align: "center"
  });
  s.addShape(pres.ShapeType.rect, { x: 2.5, y: 3.05, w: 5, h: 0.06, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });
  s.addText("Evidence-Based Approaches  |  Minimally Invasive Techniques  |  2025 Guidelines", {
    x: 0.5, y: 3.2, w: 9, h: 0.45,
    fontSize: 13, color: SUBTITLE, align: "center", italic: true
  });
  s.addText("Based on SVS/AVF/AVLS 2023-24 Guidelines • 2025 SCAI Guidelines • Bailey & Love 28th Ed. • Schwartz's Surgery 11th Ed.", {
    x: 0.5, y: 4.9, w: 9, h: 0.4,
    fontSize: 9, color: SUBTITLE, align: "center"
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 2 — TABLE OF CONTENTS
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "OVERVIEW", MID_BG);
  addBottomBar(s);

  s.addText("Presentation Outline", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: WHITE
  });

  const topics = [
    ["01", "Epidemiology & Classification (CEAP)", ACCENT1],
    ["02", "Pathophysiology & Risk Factors", ACCENT2],
    ["03", "Diagnosis: Duplex Ultrasound & Imaging", ACCENT1],
    ["04", "Conservative Management", ACCENT2],
    ["05", "Endovenous Thermal Ablation (EVLA & RFA)", ACCENT1],
    ["06", "Non-Thermal, Non-Tumescent (NTNT) Techniques", ACCENT2],
    ["07", "Sclerotherapy: Foam & VeinGogh", ACCENT1],
    ["08", "Surgical Approaches & Phlebectomy", ACCENT2],
    ["09", "2023-2025 Clinical Practice Guidelines", ACCENT1],
    ["10", "Emerging Technologies & Future Directions", ACCENT2],
  ];

  topics.forEach(([num, text, col], i) => {
    const col2 = i < 5 ? 0.35 : 5.15;
    const row = i < 5 ? i : i - 5;
    const y = 1.45 + row * 0.7;
    s.addShape(pres.ShapeType.rect, {
      x: col2, y, w: 0.48, h: 0.48,
      fill: { color: col }, line: { color: col }
    });
    s.addText(num, {
      x: col2, y, w: 0.48, h: 0.48,
      fontSize: 14, bold: true, color: DARK_BG, align: "center", valign: "middle", margin: 0
    });
    s.addText(text, {
      x: col2 + 0.55, y: y + 0.05, w: 4.2, h: 0.38,
      fontSize: 11.5, color: WHITE, valign: "middle", margin: 0
    });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 3 — EPIDEMIOLOGY & CEAP
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "01  |  EPIDEMIOLOGY & CLASSIFICATION", ACCENT1.replace("4FC3F7","2a7fa8") && "1B6CA8");
  addBottomBar(s);

  s.addText("Epidemiology & CEAP Classification", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  // Epi box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.4, w: 4.3, h: 3.7, fill: { color: BOX_BG }, line: { color: ACCENT1, width: 1.5 } });
  s.addText("Epidemiology", { x: 0.3, y: 1.4, w: 4.3, h: 0.45, fontSize: 13, bold: true, color: ACCENT1, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "• 30-50% ", options: { bold: true, color: ACCENT2 } },
    { text: "adult prevalence of visible varicose veins\n", options: { color: WHITE } },
    { text: "• More common in women; rises sharply with age\n", options: { color: WHITE } },
    { text: "• Edinburgh Vein Study: ", options: { bold: true, color: ACCENT1 } },
    { text: "55.7% prevalence in 55-64 yr age group\n", options: { color: WHITE } },
    { text: "• Risk factors: ", options: { bold: true, color: ACCENT1 } },
    { text: "obesity, pregnancy, prolonged standing, family history, female sex\n", options: { color: WHITE } },
    { text: "• Venous disease causes ", options: { color: WHITE } },
    { text: "~85% ", options: { bold: true, color: ACCENT2 } },
    { text: "of all chronic lower limb ulcers\n", options: { color: WHITE } },
    { text: "• Dressings for venous ulcers = ", options: { color: WHITE } },
    { text: "1-3% of western healthcare spend", options: { bold: true, color: ACCENT3 } },
  ], { x: 0.45, y: 1.9, w: 4.0, h: 3.1, fontSize: 10.5, valign: "top" });

  // CEAP box
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 1.4, w: 4.7, h: 3.7, fill: { color: BOX_BG }, line: { color: ACCENT2, width: 1.5 } });
  s.addText("CEAP Classification", { x: 5.0, y: 1.4, w: 4.7, h: 0.45, fontSize: 13, bold: true, color: ACCENT2, align: "center", valign: "middle", margin: 0 });
  const ceap = [
    ["C0", "No visible/palpable signs"],
    ["C1", "Telangiectasias / reticular veins"],
    ["C2", "Varicose veins"],
    ["C3", "Edema"],
    ["C4a", "Pigmentation / eczema"],
    ["C4b", "Lipodermatosclerosis / atrophie blanche"],
    ["C5", "Healed venous ulcer"],
    ["C6", "Active venous ulcer"],
  ];
  ceap.forEach(([c, desc], i) => {
    s.addShape(pres.ShapeType.rect, {
      x: 5.15, y: 1.9 + i * 0.41, w: 0.55, h: 0.34,
      fill: { color: i < 3 ? "1B6CA8" : i < 6 ? "B85C00" : "7B1818" },
      line: { color: "00000000" }
    });
    s.addText(c, { x: 5.15, y: 1.9 + i * 0.41, w: 0.55, h: 0.34, fontSize: 9.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
    s.addText(desc, { x: 5.78, y: 1.9 + i * 0.41, w: 3.7, h: 0.34, fontSize: 9.5, color: WHITE, valign: "middle", margin: 0 });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 4 — PATHOPHYSIOLOGY
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "02  |  PATHOPHYSIOLOGY & RISK FACTORS", "1B6CA8");
  addBottomBar(s);

  s.addText("Pathophysiology of Varicose Veins", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  const boxes = [
    { x: 0.3, y: 1.45, w: 2.9, h: 3.6, title: "Valve Failure", col: ACCENT1, pts: [
      "Valvular incompetence → retrograde blood flow",
      "Venous hypertension in superficial system",
      "GSV reflux: 60% of cases",
      "SSV reflux: 20% of cases",
    ]},
    { x: 3.35, y: 1.45, w: 2.9, h: 3.6, title: "Wall Changes", col: ACCENT2, pts: [
      "Smooth muscle hypertrophy and atrophy",
      "Altered collagen/elastin ratio",
      "MMP activation → matrix degradation",
      "Chronic inflammatory infiltrate",
    ]},
    { x: 6.4, y: 1.45, w: 3.3, h: 3.6, title: "Complications", col: ACCENT3, pts: [
      "Superficial vein thrombosis (thrombophlebitis)",
      "Lipodermatosclerosis",
      "Venous eczema / pigmentation",
      "Healed or active venous ulcer (C5/C6)",
      "Haemorrhage from attenuated veins",
    ]},
  ];

  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: BOX_BG }, line: { color: b.col, width: 1.5 } });
    s.addText(b.title, { x: b.x, y: b.y, w: b.w, h: 0.42, fontSize: 12, bold: true, color: b.col, align: "center", valign: "middle", margin: 0 });
    b.pts.forEach((pt, i) => {
      s.addText("▸  " + pt, { x: b.x + 0.12, y: b.y + 0.52 + i * 0.65, w: b.w - 0.2, h: 0.58, fontSize: 10, color: WHITE, valign: "top" });
    });
  });

  s.addText("Primary varicose veins: intrinsic wall/valve defect  |  Secondary varicose veins: post-DVT or pelvic obstruction", {
    x: 0.3, y: 5.07, w: 9.4, h: 0.25, fontSize: 9, color: SUBTITLE, align: "center"
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 5 — DIAGNOSIS
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "03  |  DIAGNOSIS: DUPLEX ULTRASOUND & IMAGING", "1B6CA8");
  addBottomBar(s);

  s.addText("Diagnosis & Assessment", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  // Left column
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.42, w: 5.5, h: 3.65, fill: { color: BOX_BG }, line: { color: ACCENT1, width: 1.5 } });
  s.addText("Duplex Ultrasound (Gold Standard)", { x: 0.3, y: 1.42, w: 5.5, h: 0.42, fontSize: 12.5, bold: true, color: ACCENT1, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "• Performed in standing position", options: { breakLine: true } },
    { text: "• Pneumatic cuff deflation test: reflux >0.5 sec = pathological", options: { breakLine: true } },
    { text: "• Evaluates: common femoral, femoral, popliteal, posterior tibial, GSV & SSV", options: { breakLine: true } },
    { text: "• Identifies: reflux site, perforator incompetence, deep vein obstruction", options: { breakLine: true } },
    { text: "• Essential for treatment planning and ablation guidance", options: { breakLine: true } },
    { text: "• SVS/AVF 2023 Guideline: ", options: { bold: true, color: ACCENT2, breakLine: false } },
    { text: "mandatory pre-intervention duplex in all patients", options: { breakLine: false } },
  ], { x: 0.45, y: 1.9, w: 5.2, h: 3.0, fontSize: 10.5, color: WHITE, valign: "top" });

  // Right column
  s.addShape(pres.ShapeType.rect, { x: 6.05, y: 1.42, w: 3.65, h: 3.65, fill: { color: BOX_BG }, line: { color: ACCENT2, width: 1.5 } });
  s.addText("Other Modalities", { x: 6.05, y: 1.42, w: 3.65, h: 0.42, fontSize: 12.5, bold: true, color: ACCENT2, align: "center", valign: "middle", margin: 0 });
  const modalities = [
    ["CT Venography", "Pelvic/iliac obstruction, May-Thurner syndrome"],
    ["MR Venography", "Complex anatomy, pelvic congestion syndrome"],
    ["IVUS", "Deep vein stenting planning"],
    ["Air Plethysmography", "Functional venous reserve assessment"],
    ["VeinViewer / Near-IR", "Superficial vein mapping pre-procedure"],
  ];
  modalities.forEach(([mod, desc], i) => {
    s.addText(mod, { x: 6.2, y: 1.9 + i * 0.62, w: 1.5, h: 0.5, fontSize: 9.5, bold: true, color: ACCENT1, valign: "middle", margin: 0 });
    s.addText(desc, { x: 7.72, y: 1.9 + i * 0.62, w: 1.8, h: 0.5, fontSize: 9, color: WHITE, valign: "middle", margin: 0 });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 6 — CONSERVATIVE MANAGEMENT
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "04  |  CONSERVATIVE MANAGEMENT", "1B6CA8");
  addBottomBar(s);

  s.addText("Conservative & Medical Management", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  const cards = [
    {
      x: 0.3, y: 1.42, w: 2.9, h: 3.65, title: "Compression Therapy", col: ACCENT1,
      pts: [
        "First-line for all symptomatic CVD",
        "20-30 mmHg: mild symptoms",
        "30-40 mmHg: moderate-severe / ulcers",
        "40-50 mmHg: lymphoedema",
        "Knee-high to waist-high depending on distribution",
        "Unna's boot / multilayer wraps for ulcers",
        "Pneumatic compression devices for refractory cases",
      ]
    },
    {
      x: 3.4, y: 1.42, w: 2.9, h: 3.65, title: "Venoactive Drugs", col: ACCENT2,
      pts: [
        "Micronized purified flavonoid fraction (Daflon 500/1000)",
        "Reduces venous hypertension & capillary leakage",
        "Indicated for C2-C4 symptoms",
        "Horse chestnut seed extract (Escin)",
        "Calcium dobesilate: reduces capillary permeability",
        "2023 SVS/AVF: grade 1B evidence for symptom relief",
        "Adjunct - not a substitute for intervention",
      ]
    },
    {
      x: 6.5, y: 1.42, w: 3.2, h: 3.65, title: "Lifestyle & Prevention", col: ACCENT3,
      pts: [
        "Weight reduction (BMI-linked risk)",
        "Leg elevation above heart level",
        "Regular walking / calf muscle pump activation",
        "Avoid prolonged standing",
        "Anti-inflammatory diet",
        "Screen for DVT in acute thrombophlebitis",
      ]
    },
  ];

  cards.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: BOX_BG }, line: { color: b.col, width: 1.5 } });
    s.addText(b.title, { x: b.x, y: b.y, w: b.w, h: 0.42, fontSize: 11.5, bold: true, color: b.col, align: "center", valign: "middle", margin: 0 });
    b.pts.forEach((pt, i) => {
      s.addText("• " + pt, { x: b.x + 0.12, y: b.y + 0.5 + i * 0.44, w: b.w - 0.2, h: 0.42, fontSize: 9.8, color: WHITE, valign: "top" });
    });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 7 — ENDOVENOUS THERMAL ABLATION
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "05  |  ENDOVENOUS THERMAL ABLATION", "1B6CA8");
  addBottomBar(s);

  s.addText("Endovenous Thermal Ablation (ETA)", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  // EVLA box
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.38, w: 4.5, h: 3.72, fill: { color: BOX_BG }, line: { color: ACCENT1, width: 1.8 } });
  s.addText("Endovenous Laser Ablation (EVLA)", { x: 0.3, y: 1.38, w: 4.5, h: 0.42, fontSize: 12, bold: true, color: ACCENT1, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "Wavelengths:\n", options: { bold: true, color: ACCENT2, breakLine: false } },
    { text: "810–1470 nm; longer wavelengths (1470 nm water-absorbing) cause less pain & bruising\n\n", options: { color: WHITE } },
    { text: "VenaCure EVLT 2.0 (2025):\n", options: { bold: true, color: ACCENT2, breakLine: false } },
    { text: "Dual-wavelength system for high-throughput ambulatory settings\n\n", options: { color: WHITE } },
    { text: "Mechanism:\n", options: { bold: true, color: ACCENT2, breakLine: false } },
    { text: "Thermal destruction of endothelium via laser energy delivered by fibre-optic catheter under tumescent anaesthesia\n\n", options: { color: WHITE } },
    { text: "Meta-analysis 2024 (PMID 38316290):\n", options: { bold: true, color: ACCENT3, breakLine: false } },
    { text: "RFA and EVLA have comparable occlusion rates; RFA has lower pain scores and fewer bruising events", options: { color: WHITE } },
  ], { x: 0.45, y: 1.85, w: 4.2, h: 3.1, fontSize: 10, color: WHITE, valign: "top" });

  // RFA box
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 1.38, w: 4.65, h: 3.72, fill: { color: BOX_BG }, line: { color: ACCENT2, width: 1.8 } });
  s.addText("Radiofrequency Ablation (RFA)", { x: 5.05, y: 1.38, w: 4.65, h: 0.42, fontSize: 12, bold: true, color: ACCENT2, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "ClosureFast System:\n", options: { bold: true, color: ACCENT1, breakLine: false } },
    { text: "Segmental heating catheter — 7 cm segments at 120°C for 20 sec\n\n", options: { color: WHITE } },
    { text: "ClosureFast Next-Gen (Medtronic, FDA 2024):\n", options: { bold: true, color: ACCENT1, breakLine: false } },
    { text: "Integrated impedance-feedback guidance for real-time treatment optimization\n\n", options: { color: WHITE } },
    { text: "Advantages:\n", options: { bold: true, color: ACCENT1, breakLine: false } },
    { text: "Less post-procedural pain/bruising vs EVLA; office-based; local anaesthesia\n\n", options: { color: WHITE } },
    { text: "2023 SVS/AVF Guideline (Grade 1B):\n", options: { bold: true, color: ACCENT3, breakLine: false } },
    { text: "Endovenous thermal ablation preferred over open surgery for GSV/SSV reflux", options: { color: WHITE } },
  ], { x: 5.2, y: 1.85, w: 4.3, h: 3.1, fontSize: 10, color: WHITE, valign: "top" });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 8 — NON-THERMAL NON-TUMESCENT (NTNT)
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "06  |  NON-THERMAL, NON-TUMESCENT (NTNT) TECHNIQUES", "1B6CA8");
  addBottomBar(s);

  s.addText("NTNT Ablation: The New Frontier", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  s.addText("Advantages over ETA: No tumescent anaesthesia • No thermal nerve damage risk • Suitable for tortuous veins • Office-based", {
    x: 0.3, y: 1.35, w: 9.4, h: 0.4, fontSize: 10.5, color: ACCENT2, align: "center", italic: true
  });

  const ntnt = [
    {
      x: 0.3, y: 1.82, w: 3.1, h: 3.3, title: "Cyanoacrylate Closure\n(VenaSeal™)", col: ACCENT1,
      pts: [
        "Medical-grade cyanoacrylate glue injected via catheter",
        "No tumescent anaesthesia needed",
        "Single access point; no compression hosiery required post-op",
        "2-year occlusion rates ~94%",
        "Risk: hypersensitivity/foreign body granuloma (~2%)",
      ]
    },
    {
      x: 3.55, y: 1.82, w: 3.1, h: 3.3, title: "Mechanochemical Ablation\n(MOCA - ClariVein®)", col: ACCENT2,
      pts: [
        "Rotating wire tip creates endothelial damage",
        "Simultaneously infuses sclerosant (polidocanol)",
        "No tumescent; low pain",
        "MARADONA trial: non-inferior to EVLA at 1 year",
        "Best for medium-diameter veins (5-12 mm)",
      ]
    },
    {
      x: 6.8, y: 1.82, w: 2.9, h: 3.3, title: "Steam Ablation\n(SVS)", col: ACCENT3,
      pts: [
        "Superheated steam (120°C) pulses delivered via catheter",
        "No tumescent required",
        "Good for small/tortuous veins inaccessible to other catheters",
        "Early studies show comparable occlusion rates",
      ]
    },
  ];

  ntnt.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: BOX_BG }, line: { color: b.col, width: 1.5 } });
    s.addText(b.title, { x: b.x, y: b.y, w: b.w, h: 0.55, fontSize: 10.5, bold: true, color: b.col, align: "center", valign: "middle", margin: 0 });
    b.pts.forEach((pt, i) => {
      s.addText("• " + pt, { x: b.x + 0.1, y: b.y + 0.62 + i * 0.5, w: b.w - 0.18, h: 0.48, fontSize: 9.5, color: WHITE, valign: "top" });
    });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 9 — SCLEROTHERAPY
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "07  |  SCLEROTHERAPY: FOAM & ULTRASOUND-GUIDED", "1B6CA8");
  addBottomBar(s);

  s.addText("Sclerotherapy: Modern Approaches", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.4, w: 4.5, h: 3.68, fill: { color: BOX_BG }, line: { color: ACCENT1, width: 1.5 } });
  s.addText("Foam Sclerotherapy (UGFS)", { x: 0.3, y: 1.4, w: 4.5, h: 0.42, fontSize: 12.5, bold: true, color: ACCENT1, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "Mechanism: ", options: { bold: true, color: ACCENT2 } },
    { text: "sclerosant destroys venous endothelium → inflammatory thrombosis → fibrosis\n\n", options: { color: WHITE } },
    { text: "Agents & concentrations:\n", options: { bold: true, color: ACCENT2 } },
    { text: "• Polidocanol 1-3% (foam)\n", options: { color: WHITE } },
    { text: "• Sodium tetradecyl sulfate 1-3% (foam)\n", options: { color: WHITE } },
    { text: "• Hypertonic saline for telangiectasias\n\n", options: { color: WHITE } },
    { text: "SCAI 2025 Guideline (Rec 4.1):\n", options: { bold: true, color: ACCENT3 } },
    { text: "Foam sclerotherapy + conservative management preferred over conservative management alone for varicose veins without truncal reflux\n\n", options: { color: WHITE } },
    { text: "Complications: ", options: { bold: true, color: ACCENT2 } },
    { text: "hyperpigmentation, thrombophlebitis, DVT, skin necrosis (rare), visual disturbance", options: { color: WHITE } },
  ], { x: 0.45, y: 1.88, w: 4.2, h: 3.08, fontSize: 9.8, color: WHITE, valign: "top" });

  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 1.4, w: 4.65, h: 3.68, fill: { color: BOX_BG }, line: { color: ACCENT2, width: 1.5 } });
  s.addText("Liquid Sclerotherapy & VeinGogh", { x: 5.05, y: 1.4, w: 4.65, h: 0.42, fontSize: 12.5, bold: true, color: ACCENT2, align: "center", valign: "middle", margin: 0 });
  s.addText([
    { text: "Liquid sclerotherapy:\n", options: { bold: true, color: ACCENT1 } },
    { text: "• For telangiectasias & spider veins\n", options: { color: WHITE } },
    { text: "• Lower concentrations (0.5% polidocanol)\n", options: { color: WHITE } },
    { text: "• Compression bandaging post-injection x 3-5 days\n\n", options: { color: WHITE } },
    { text: "VeinGogh (Ohmic Thermolysis):\n", options: { bold: true, color: ACCENT1 } },
    { text: "• High-frequency microburst electrical current\n", options: { color: WHITE } },
    { text: "• Targets very fine spider veins (<1 mm)\n", options: { color: WHITE } },
    { text: "• No sclerosant agent used\n\n", options: { color: WHITE } },
    { text: "Post-procedure care:\n", options: { bold: true, color: ACCENT1 } },
    { text: "• Compression stockings minimum 2 weeks\n", options: { color: WHITE } },
    { text: "• Walking immediately encouraged\n", options: { color: WHITE } },
    { text: "• DVT prophylaxis if high-risk patient", options: { color: WHITE } },
  ], { x: 5.2, y: 1.88, w: 4.3, h: 3.08, fontSize: 9.8, color: WHITE, valign: "top" });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 10 — SURGICAL APPROACHES
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "08  |  SURGICAL APPROACHES & PHLEBECTOMY", "1B6CA8");
  addBottomBar(s);

  s.addText("Surgical Management", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  const surgical = [
    {
      title: "High Ligation & Stripping (HLS)", col: ACCENT1, x: 0.3, y: 1.42, w: 4.5, h: 1.6,
      pts: ["SFJ/SPJ flush ligation + GSV/SSV stripping", "Increasingly replaced by endovenous techniques", "Still preferred for very large veins >12 mm or failed ablation"]
    },
    {
      title: "Ambulatory Phlebectomy (Stab Avulsion)", col: ACCENT2, x: 0.3, y: 3.12, w: 4.5, h: 1.7,
      pts: [
        "Micro-incisions (2-3 mm) to hook and avulse tributary varicosities",
        "2025 SCAI Rec 5.1: Suggested for recurrent symptomatic varicose veins after truncal ablation",
        "Local anaesthesia; minimal scarring; same-day discharge"
      ]
    },
    {
      title: "CHIVA Strategy", col: ACCENT1, x: 5.1, y: 1.42, w: 4.6, h: 1.6,
      pts: [
        "Conservative & Hemodynamic Cure for Insufficiency in Out-patients",
        "Meta-analysis 2026 (PMID 41707860): Non-inferior to conventional surgery; fewer complications; lower recurrence",
        "Requires specialist duplex mapping pre-operatively"
      ]
    },
    {
      title: "Perforator Vein Ablation (SEPS/ETA)", col: ACCENT2, x: 5.1, y: 3.12, w: 4.6, h: 1.7,
      pts: [
        "Sub-fascial Endoscopic Perforator Surgery (SEPS) now largely replaced by percutaneous ultrasound-guided ablation",
        "SCAI 2025 Rec 6.1: ETA of perforator veins + conservative management for ulcer-associated perforator reflux (conditional recommendation)",
      ]
    },
  ];

  surgical.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: BOX_BG }, line: { color: b.col, width: 1.5 } });
    s.addText(b.title, { x: b.x, y: b.y, w: b.w, h: 0.38, fontSize: 11, bold: true, color: b.col, align: "center", valign: "middle", margin: 0 });
    b.pts.forEach((pt, i) => {
      s.addText("• " + pt, { x: b.x + 0.12, y: b.y + 0.42 + i * 0.4, w: b.w - 0.22, h: 0.38, fontSize: 9.2, color: WHITE, valign: "top" });
    });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 11 — GUIDELINES 2023–2025
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "09  |  2023–2025 CLINICAL PRACTICE GUIDELINES", "1B6CA8");
  addBottomBar(s);

  s.addText("Key Guideline Recommendations", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  // Source labels
  const sources = [
    { label: "SVS/AVF/AVLS 2023 (Part I+II)", col: ACCENT1, x: 0.3, y: 1.38 },
    { label: "SCAI 2025 Guidelines", col: ACCENT2, x: 5.1, y: 1.38 },
  ];
  sources.forEach(src => {
    s.addShape(pres.ShapeType.rect, { x: src.x, y: src.y, w: 4.5, h: 0.4, fill: { color: src.col.replace("4FC3F7","1B6CA8").replace("00BFA5","007A6A") }, line: { color: src.col } });
    s.addText(src.label, { x: src.x, y: src.y, w: 4.5, h: 0.4, fontSize: 11.5, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
  });

  const g1 = [
    "Duplex ultrasound: mandatory pre-intervention in all patients (Grade 1A)",
    "ETA preferred over surgery for GSV/SSV incompetence (Grade 1B)",
    "RFA and EVLA equivalent in occlusion; RFA slightly less painful (Grade 1B)",
    "Foam sclerotherapy: acceptable alternative for small/recurrent varicose veins",
    "Compression therapy for symptomatic CVI pending definitive treatment",
    "Venoactive drugs: adjunctive symptom relief (Grade 1B for MPFF/Daflon)",
    "VTE prophylaxis after ablation: individualized risk-benefit assessment",
  ];
  g1.forEach((pt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.85 + i * 0.42, w: 0.3, h: 0.3, fill: { color: ACCENT1 }, line: { color: ACCENT1 } });
    s.addText("", { x: 0.3, y: 1.85 + i * 0.42, w: 0.3, h: 0.3 });
    s.addText(pt, { x: 0.65, y: 1.85 + i * 0.42, w: 4.2, h: 0.38, fontSize: 9.5, color: WHITE, valign: "middle" });
  });

  const g2 = [
    "Compression therapy prior to ablation: conditionally suggested (low certainty)",
    "Foam sclerotherapy + conservative mgmt for varicose veins without truncal reflux (Rec 4.1)",
    "Ablation for symptomatic truncal saphenous reflux; conservative if asymptomatic (Rec 3.1/3.2)",
    "Phlebectomy for recurrent symptomatic varicosities after truncal ablation (Rec 5.1)",
    "Perforator ablation for ulcer-associated perforator reflux (Rec 6.1)",
    "Deep vein stenting for iliac vein obstruction in refractory venous ulcers (Rec 7.1)",
    "No recommendation on phlebectomy alone for venous ulcers (knowledge gap)",
  ];
  g2.forEach((pt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.85 + i * 0.42, w: 0.3, h: 0.3, fill: { color: ACCENT2 }, line: { color: ACCENT2 } });
    s.addText(pt, { x: 5.45, y: 1.85 + i * 0.42, w: 4.2, h: 0.38, fontSize: 9.5, color: WHITE, valign: "middle" });
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 12 — EMERGING TECHNOLOGIES
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "10  |  EMERGING TECHNOLOGIES & FUTURE DIRECTIONS", "1B6CA8");
  addBottomBar(s);

  s.addText("Emerging Technologies & Future Directions", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: WHITE
  });

  const emerging = [
    { title: "Focused Ultrasound Ablation", col: ACCENT1, x: 0.3, y: 1.42, w: 2.9, h: 3.65,
      pts: ["Non-invasive external energy delivery", "Phase I/II trials ongoing (2025)", "Transducer targets vein wall without skin puncture", "Potential for outpatient, truly needle-free treatment"] },
    { title: "AI-Assisted Duplex Planning", col: ACCENT2, x: 3.35, y: 1.42, w: 2.9, h: 3.65,
      pts: ["Machine learning segmentation of venous anatomy on US", "Automated reflux quantification", "Pre-procedural route planning for catheter insertion", "Reduces inter-operator variability"] },
    { title: "Microwave Ablation", col: ACCENT3, x: 6.4, y: 1.42, w: 3.3, h: 3.65,
      pts: ["915 MHz / 2.45 GHz frequency probes", "Rapid, uniform heating independent of tissue impedance", "No charring artifact; consistent vessel wall coagulation", "Early clinical studies: 94-96% occlusion at 12 months"] },
  ];

  emerging.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: BOX_BG }, line: { color: b.col, width: 1.5 } });
    s.addText(b.title, { x: b.x, y: b.y, w: b.w, h: 0.42, fontSize: 11.5, bold: true, color: b.col, align: "center", valign: "middle", margin: 0 });
    b.pts.forEach((pt, i) => {
      s.addText("▸  " + pt, { x: b.x + 0.1, y: b.y + 0.52 + i * 0.75, w: b.w - 0.18, h: 0.7, fontSize: 10, color: WHITE, valign: "top" });
    });
  });

  s.addText("Also on the horizon: Drug-eluting foam sclerotherapy • Bioabsorbable stents for deep vein obstruction • Wearable hemodynamic compression sensors", {
    x: 0.3, y: 5.08, w: 9.4, h: 0.24, fontSize: 8.5, color: ACCENT2, align: "center", italic: true
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 13 — TREATMENT ALGORITHM
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "MANAGEMENT ALGORITHM", "1B6CA8");
  addBottomBar(s);

  s.addText("Varicose Veins Management Algorithm (SCAI 2025)", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.55, fontSize: 22, bold: true, color: WHITE
  });

  // Flow chart boxes
  const flow = [
    { label: "Symptomatic Varicose Veins\n(C2-C6)", x: 3.5, y: 1.4, w: 3.0, h: 0.65, col: ACCENT1, textCol: DARK_BG },
    { label: "Duplex Ultrasound Assessment", x: 3.5, y: 2.2, w: 3.0, h: 0.55, col: ACCENT2, textCol: DARK_BG },
  ];
  flow.forEach(f => {
    s.addShape(pres.ShapeType.rect, { x: f.x, y: f.y, w: f.w, h: f.h, fill: { color: f.col }, line: { color: f.col } });
    s.addText(f.label, { x: f.x, y: f.y, w: f.w, h: f.h, fontSize: 10.5, bold: true, color: f.textCol, align: "center", valign: "middle" });
  });

  // Arrow
  s.addShape(pres.ShapeType.rect, { x: 4.92, y: 2.05, w: 0.16, h: 0.17, fill: { color: WHITE }, line: { color: WHITE } });

  // Branches
  const branches = [
    { label: "Truncal reflux\n(GSV/SSV)", x: 0.2, y: 3.0, w: 2.5, h: 0.7, col: ACCENT1, textCol: DARK_BG },
    { label: "No truncal reflux\nVaricose tributaries only", x: 3.75, y: 3.0, w: 2.5, h: 0.7, col: ACCENT2, textCol: DARK_BG },
    { label: "Perforator reflux\n(ulcer)", x: 7.3, y: 3.0, w: 2.5, h: 0.7, col: ACCENT3, textCol: WHITE },
  ];
  branches.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: b.col }, line: { color: b.col } });
    s.addText(b.label, { x: b.x, y: b.y, w: b.w, h: b.h, fontSize: 9.5, bold: true, color: b.textCol, align: "center", valign: "middle" });
  });

  // Sub-boxes
  const subs = [
    { label: "ETA (EVLA/RFA)\nor NTNT Ablation\n+ Phlebectomy if needed", x: 0.15, y: 3.9, w: 2.6, h: 1.1, col: BOX_BG, border: ACCENT1 },
    { label: "Foam Sclerotherapy\nor Phlebectomy\n+ Compression", x: 3.7, y: 3.9, w: 2.6, h: 1.1, col: BOX_BG, border: ACCENT2 },
    { label: "Perforator Ablation\n(ETA/SEPS)\n+ Compression Therapy", x: 7.25, y: 3.9, w: 2.6, h: 1.1, col: BOX_BG, border: ACCENT3 },
  ];
  subs.forEach(b => {
    s.addShape(pres.ShapeType.rect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: b.col }, line: { color: b.border, width: 1.5 } });
    s.addText(b.label, { x: b.x, y: b.y, w: b.w, h: b.h, fontSize: 10, color: WHITE, align: "center", valign: "middle" });
  });

  s.addText("All pathways include baseline conservative management (compression + venoactive drugs) unless contraindicated", {
    x: 0.3, y: 5.08, w: 9.4, h: 0.24, fontSize: 8.5, color: SUBTITLE, align: "center", italic: true
  });
}

// ───────────────────────────────────────────────────────────────────
// SLIDE 14 — SUMMARY & REFERENCES
// ───────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.background = { color: DARK_BG };
  addSectionBar(s, "SUMMARY & KEY REFERENCES", "1B6CA8");
  addBottomBar(s);

  s.addText("Key Takeaways", {
    x: 0.4, y: 0.75, w: 9.2, h: 0.5, fontSize: 24, bold: true, color: WHITE
  });

  const takeaways = [
    { num: "1", text: "Endovenous thermal ablation (EVLA/RFA) is now the first-line intervention for truncal GSV/SSV reflux — replacing open surgery.", col: ACCENT1 },
    { num: "2", text: "NTNT techniques (VenaSeal, MOCA, SVS) offer no-anaesthesia alternatives with comparable short-term outcomes.", col: ACCENT2 },
    { num: "3", text: "Foam sclerotherapy is preferred for varicose tributaries without truncal reflux per SCAI 2025 guidelines.", col: ACCENT1 },
    { num: "4", text: "Duplex ultrasound is mandatory for diagnosis, treatment planning, and post-procedure follow-up in all patients.", col: ACCENT2 },
    { num: "5", text: "Compression therapy and venoactive drugs remain the cornerstone of conservative management.", col: ACCENT1 },
    { num: "6", text: "Emerging technologies: focused ultrasound, microwave ablation, and AI-guided planning are on the horizon.", col: ACCENT2 },
  ];
  takeaways.forEach((t, i) => {
    const y = 1.38 + i * 0.54;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y, w: 0.45, h: 0.42, fill: { color: t.col }, line: { color: t.col } });
    s.addText(t.num, { x: 0.3, y, w: 0.45, h: 0.42, fontSize: 14, bold: true, color: DARK_BG, align: "center", valign: "middle", margin: 0 });
    s.addText(t.text, { x: 0.85, y: y + 0.02, w: 8.9, h: 0.4, fontSize: 10.5, color: WHITE, valign: "middle" });
  });

  s.addText([
    { text: "Key References\n", options: { bold: true, color: ACCENT2, breakLine: false } },
    { text: "• Gloviczki P et al. SVS/AVF/AVLS Guideline Part II. J Vasc Surg Venous Lymphat Disord. 2024;12(1):101670. [PMID 37652254]\n", options: { color: SUBTITLE } },
    { text: "• Attaran RR et al. 2025 SCAI Clinical Practice Guidelines for Management of Chronic Venous Disease. J Soc Cardiovasc Angiogr Interv. 2025;4(8):103729.\n", options: { color: SUBTITLE } },
    { text: "• Jiang W et al. Endovenous RFA vs EVLA: Meta-analysis. J Vasc Surg Venous Lymphat Disord. 2024. [PMID 38316290]\n", options: { color: SUBTITLE } },
    { text: "• Zhu J et al. CHIVA vs Conventional Stripping – Meta-analysis. Ann Vasc Surg. 2026. [PMID 41707860]\n", options: { color: SUBTITLE } },
    { text: "• Bailey & Love's Short Practice of Surgery, 28th Ed. | Schwartz's Principles of Surgery, 11th Ed.", options: { color: SUBTITLE } },
  ], { x: 0.3, y: 4.65, w: 9.4, h: 0.68, fontSize: 8.5, valign: "top" });
}

// WRITE FILE
pres.writeFile({ fileName: "/home/daytona/workspace/varicose-veins-ppt/Varicose_Veins_Recent_Advances.pptx" })
  .then(() => console.log("DONE: Varicose_Veins_Recent_Advances.pptx written"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/varicose-veins-ppt && node create_pptx.js

ls -lh /home/daytona/workspace/varicose-veins-ppt/Varicose_Veins_Recent_Advances…

ls -lh /home/daytona/workspace/varicose-veins-ppt/ && echo "---" && file /home/d…

cd /home/daytona/workspace/varicose-veins-ppt && node -e " const fs = require('f…

cd /home/daytona/workspace/varicose-veins-ppt && node -e " const fs = require('f…

~/varicose-veins-ppt/make_download.js

const fs = require('fs');
const data = fs.readFileSync('Varicose_Veins_Recent_Advances.pptx');
const b64 = data.toString('base64');
const mime = 'application/vnd.openxmlformats-officedocument.presentationml.presentation';

const html = [
  '<!DOCTYPE html><html>',
  '<head><title>Download Varicose Veins Presentation</title>',
  '<style>',
  'body{font-family:Arial,sans-serif;display:flex;flex-direction:column;align-items:center;justify-content:center;height:100vh;margin:0;background:#0D1B2A;color:white;}',
  'a.btn{display:inline-block;padding:18px 36px;background:#4FC3F7;color:#0D1B2A;text-decoration:none;border-radius:8px;font-size:20px;font-weight:bold;margin-top:20px;}',
  'a.btn:hover{background:#00BFA5;}',
  'p{font-size:14px;color:#B0C4DE;margin-top:12px;}',
  '</style></head>',
  '<body>',
  '<h1>Recent Advances in Management of Varicose Veins</h1>',
  '<p>14-slide professional presentation (PPTX)</p>',
  '<a class="btn" href="data:' + mime + ';base64,' + b64 + '" download="Varicose_Veins_Recent_Advances.pptx">Download PPTX</a>',
  '<p>Click the button above to save your PowerPoint file</p>',
  '</body></html>'
].join('\n');

fs.writeFileSync('download.html', html);
console.log('Done. File size: ' + html.length + ' bytes');

cd /home/daytona/workspace/varicose-veins-ppt && node make_download.js && ls -lh…