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THE FUNDAMENTALS OF PHLEBOLOGY: Venous Disease for Clinicians Copyright © 2009 by American College of Phlebology An Introductory Lecture
Disclosure of Conflict of Interest ,[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Presentation Use Information ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology “ It is ironic that medical education does not cover three of the most common medical problems: back pain, hemorrhoids, and  varicose veins.” P. Fujimura, MD Surgical Intern University of California School of Medicine
The medical specialty devoted to the diagnosis and treatment of patients with venous disorders Copyright © 2009 by American College of Phlebology PHLEBOLOGY
IMPORTANCE OF CHRONIC VENOUS DISEASE ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology National Heart Lung and Blood Institute (NHLBI) http://www.nhlbi.nih.gov/
THE SPECTRUM OF CHRONIC VENOUS DISEASE Copyright © 2009 by American College of Phlebology lipodermatosclerosis telangiectasias varicose veins Superficial  phlebitis venous  ulceration
Presenting Symptoms of Chronic Venous Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology Epidemiology: Who develops venous disease?
Venous Disease is a Hereditary Disorder ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Cornu-Thenard, A,  J Dermatol Surg Oncol 1994 May; 20(5):318-26.
Heredity in Chronic Venous Insufficiency ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology J Vasc Surg. 2007 August; 46(2): 331–337
The beginnings of venous disease may be found as early as childhood Copyright © 2009 by American College of Phlebology Phlebologie. 1990 Nov-Dec;43(4):573-7. Weindorf N, Schultz-Ehrenburg U. 740 pts 10-12 y/o 518 pts 14-16 y/o 459 pts 18-20 y/o Diagnosable  Vein disease 2.5% 12.3% 19.8% Actual  Varicose Veins 0 1.7% 3.3%
Inactivity aggravates venous disease  ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Santler, R  Hautarzt 1956; 10:460
Varicose Veins are 3 times more common in women than men Copyright © 2009 by American College of Phlebology "Varicose veins." The Mayo Clinic. January 2007. http://www.mayoclinic.com
Each pregnancy worsens the condition ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Brand FN, et al The epidemiology of varicose veins: the Framingham Study Am J Prev Med 1988; 4:96-101
Copyright © 2009 by American College of Phlebology Anatomy  and  Pathophysiology
Anatomy and physiology of the venous system  in the lower extremity ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Superficial venous system  ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Superficial venous system ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Perforating veins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Musculovenous pump ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Venous Valvular Function ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Doppler exam: Normal flow Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Doppler: Reflux Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
REFLUX : its contribution to varicose veins Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
Pathophysiology:  2 components ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology The presence of both is far worse than either one alone
CEAP Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
AMBULATORY VENOUS HYPERTENSION ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Venous symptoms ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology EVALUATION  OF THE  PATIENT WITH VENOUS  DISEASE
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Physical Examination ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Telangiectasias ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology * Weiss RA and  Weiss MA  J Dermatol Surg Oncol. 1990 Apr;16(4):333-6.
Lateral Subdermic Plexus ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Reticular Veins ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Varicose Veins –  Great Saphenous Distribution ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Great Saphenous  Insufficiency ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Varicose Veins –  Small Saphenous Distribution ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Varicose Veins with  Pelvic Origins ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Skin changes suggestive of chronic venous insufficiency Copyright © 2009 by American College of Phlebology Corona Phlebectatica (C1) Pigmentation (C4a) Atrophie blanche (C4b) Healed ulcer (C5)
Venous ulceration ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology * Shami SK et al. J Vasc Surg 1993; 17:487-90
Venous ulceration Copyright © 2009 by American College of Phlebology Impending ulceration Lipodermatosclerosis (C4a) Venous ulceration (C6)
Venous vs. Arterial Ulcers ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Arterial   ulcer Photo courtesy of John Bergan, MD
Muscle fascia herniation ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology Conservative Treatment  of  Venous Disorders
Compression Therapy ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Photo courtesy of Juzo
Compression therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Elastic compression stockings ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Graduated compression is not the same as T.E.D. hose ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology * Requires a prescription Compression Strength Indications 8-15mm Leg fatigue, mild swelling, stylish  15-20mm Mild aching, swelling, stylish 20-30mm Aching, pain, swelling, mild varicose veins 30-40mm * Aching, pain, swelling, varicose veins, post-ulcer 40-50, 50-60mm * Recurrent ulceration, lymphedema
Prescribing graduated compression stockings ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Donning compression stockings:  what to advise your patients ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Inelastic compression ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Photo courtesy CircAid Medical Products, Inc.
Exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
When to treat or refer a patient with venous disease ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Copyright © 2009 by American College of Phlebology Current Approaches to the  Treatment of  Varicose Veins and Related
Some Important Consideration… ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Treatment of telangiectasias ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Weiss RA and  Weiss MA  J Dermatol Surg Oncol. 1990 Apr;16(4):333-6.
Sclerotherapy of Telangiectasias: Technique Copyright © 2009 by American College of Phlebology Injection of sclerosant solution causes damage to endothelium which leads to fibrosis of vein
Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Photos courtesy of Steven Zimmet, MD, FACPh
Treatment of Reticular Veins ,[object Object],Copyright © 2009 by American College of Phlebology ,[object Object],[object Object]
Non-surgical treatment of varicose veins ,[object Object],[object Object],Copyright © 2009 by American College of Phlebology Min R et al, J Vasc Interv Radiol 2001; 12:1167-1171  Rautio T et al,  J Vasc Surg 2002; 35(5):958-65   NEED PIC
Ultrasound-guided Sclerotherapy ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Photo courtesy of CompuDiagnostics, Inc.
Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Ultrasound-guided sclerotherapy of the Great Saphenous Vein and sclerotherapy of branches Photos courtesy of Steven Zimmet, MD, FACPh
Radiofrequency “Closure” Technique ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology NEED PIC
Endovenous Laser Ablation ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Surgical Treatment of  Varicose Veins: Vein Stripping ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Butler CM, et al Phlebology 2002. 17:59-63   Photo Photo courtesy of John Bergan, MD
Surgical Treatment of Varicose Veins: Phlebectomy ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Treatment Results Copyright © 2009 by American College of Phlebology Before After Endovenous obliteration of the Great Saphenous Vein and phlebectomy of tributaries Photos courtesy of Steven Zimmet, MD, FACPh
Venous ulceration ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Padberg FT et al J Vasc Surg 1996; 24:711-19
Superficial Thrombophlebitis:  Management ,[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology
Management of the lower extremity after Deep Venous Thrombosis: Considerations in addition to anti-coagulation ,[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Prandoni et al, Ann Intern Med 2004;141:249-256
Pelvic Congestion Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology Venbrux AC et al J Vasc Interv Radiol 2002; 13:171-178
[object Object],[object Object],[object Object],[object Object],Copyright © 2009 by American College of Phlebology AMERICAN COLLEGE OF PHLEBOLOGY 101 Callan Avenue, Suite 210  ●  San Leandro, CA  94577-4558 510.346.6800  ●  510.346.6808  Fax [email_address]   ● www.phlebology.org

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Xomed traitement varice

  • 1. THE FUNDAMENTALS OF PHLEBOLOGY: Venous Disease for Clinicians Copyright © 2009 by American College of Phlebology An Introductory Lecture
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  • 4. Copyright © 2009 by American College of Phlebology “ It is ironic that medical education does not cover three of the most common medical problems: back pain, hemorrhoids, and varicose veins.” P. Fujimura, MD Surgical Intern University of California School of Medicine
  • 5. The medical specialty devoted to the diagnosis and treatment of patients with venous disorders Copyright © 2009 by American College of Phlebology PHLEBOLOGY
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  • 7. THE SPECTRUM OF CHRONIC VENOUS DISEASE Copyright © 2009 by American College of Phlebology lipodermatosclerosis telangiectasias varicose veins Superficial phlebitis venous ulceration
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  • 9. Copyright © 2009 by American College of Phlebology Epidemiology: Who develops venous disease?
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  • 12. The beginnings of venous disease may be found as early as childhood Copyright © 2009 by American College of Phlebology Phlebologie. 1990 Nov-Dec;43(4):573-7. Weindorf N, Schultz-Ehrenburg U. 740 pts 10-12 y/o 518 pts 14-16 y/o 459 pts 18-20 y/o Diagnosable Vein disease 2.5% 12.3% 19.8% Actual Varicose Veins 0 1.7% 3.3%
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  • 14. Varicose Veins are 3 times more common in women than men Copyright © 2009 by American College of Phlebology "Varicose veins." The Mayo Clinic. January 2007. http://www.mayoclinic.com
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  • 16. Copyright © 2009 by American College of Phlebology Anatomy and Pathophysiology
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  • 18. Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
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  • 24. Doppler exam: Normal flow Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
  • 25. Doppler: Reflux Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
  • 26. REFLUX : its contribution to varicose veins Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye
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  • 31. Copyright © 2009 by American College of Phlebology EVALUATION OF THE PATIENT WITH VENOUS DISEASE
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  • 41. Skin changes suggestive of chronic venous insufficiency Copyright © 2009 by American College of Phlebology Corona Phlebectatica (C1) Pigmentation (C4a) Atrophie blanche (C4b) Healed ulcer (C5)
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  • 43. Venous ulceration Copyright © 2009 by American College of Phlebology Impending ulceration Lipodermatosclerosis (C4a) Venous ulceration (C6)
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  • 46. Copyright © 2009 by American College of Phlebology Conservative Treatment of Venous Disorders
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  • 51. Copyright © 2009 by American College of Phlebology * Requires a prescription Compression Strength Indications 8-15mm Leg fatigue, mild swelling, stylish 15-20mm Mild aching, swelling, stylish 20-30mm Aching, pain, swelling, mild varicose veins 30-40mm * Aching, pain, swelling, varicose veins, post-ulcer 40-50, 50-60mm * Recurrent ulceration, lymphedema
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  • 57. Copyright © 2009 by American College of Phlebology Current Approaches to the Treatment of Varicose Veins and Related
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  • 60. Sclerotherapy of Telangiectasias: Technique Copyright © 2009 by American College of Phlebology Injection of sclerosant solution causes damage to endothelium which leads to fibrosis of vein
  • 61. Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Photos courtesy of Steven Zimmet, MD, FACPh
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  • 65. Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Ultrasound-guided sclerotherapy of the Great Saphenous Vein and sclerotherapy of branches Photos courtesy of Steven Zimmet, MD, FACPh
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  • 70. Treatment Results Copyright © 2009 by American College of Phlebology Before After Endovenous obliteration of the Great Saphenous Vein and phlebectomy of tributaries Photos courtesy of Steven Zimmet, MD, FACPh
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