Current Management of Venous Diseases

 

Description:

 

This text provides an overview of venous diseases and focuses on clinical evaluation and management. It is intended to guide the treating physician by summarizing the evidence, giving technical tips, and outlining algorithms for common conditions. A unique feature of this book is clinical pearls given by experts in the field that are highlighted in each chapter. The first section of the book describes the essential anatomy and physiology/pathophysiology. It also includes evaluation of common presentations of venous diseases such as extremity edema and lower extremity ulceration with a summary for work up that includes conditions that can mimic venous diseases. The organization of the book follows the basic pathophysiology of venous disorders with chapters addressing special conditions of common interest such as pelvic congestion syndrome, thoracic outlet syndrome, and May-Thurner syndrome. There is emphasis on novel treatment modalities and emerging technologies through dedicated chapters to anticoagulant agents, emerging modalities to treat superficial venous reflux and venous stent technology. Finally, this book is a melting pot for physicians who have shown dedication and passion to the care of patients with venous disease regardless of specialty and location.The authors are an international panel of vascular experts who trained in vascular surgery, interventional radiology, interventional cardiology, hematology, pulmonology and critical care medicine. Therefore, the book will be of great value to the physicians and trainees in those specialties and to any person interested in developing in depth knowledge of the management of venous diseases.

 

Table of Contents:

 

Part I: Clinical Fundamentals

1: Venous Anatomy, Development, and Variations

Introduction

Early Vascular Development and Arterial-Venous Identity

Development of the Venous System

Vitelline Veins

Umbilical Veins

Cardinal Veins and the Venae Cavae

Venous Anomalies of Development and Clinical Correlates

Superior Vena Cava (SVC)

Inferior Vena Cava (IVC)

Renal Veins

Fetal Circulation

Venous Histology and Function

Adult Venous Anatomy

Head and Neck

Thorax

Brachiocephalic Veins

Superior Vena Cava (SVC)

Azygos and Intercostal Veins

Abdomen and Pelvis

Portal Vein

Inferior Vena Cava (IVC)

Iliac and Pelvic Veins

Upper Extremity

Subclavian Vein

Axillary Vein

Deep Veins of the Arm and Forearm

Superficial Veins of the Arm and Forearm

Lower Extremity (LE)

Superficial Veins

Deep Veins

Perforating Veins (PV)

Current Nomenclature

References

2: Venous Physiology and Pathophysiology

Venous System

Venous Valves and Valvular Function

Venous Muscle Pump Systems

The Calf Pump

Effect of Exercise on Venous Function

Deep Vein Thrombosis

Chronic Venous Disease

Varicose Veins

Deep Venous Insufficiency

Perforating Veins

Superficial Venous Insufficiency

Manifestations of Venous Hypertension

Lymphedema

References

3: Diagnostic Imaging for Veins

Ultrasound Diagnosis of Acute DVT

Diagnostic Criteria of Acute DVT

Ultrasound Diagnosis of Recurrent Thrombosis and Postthrombotic Disease

Ultrasound Diagnosis of Upper Extremity DVT

Ultrasound Diagnosis of Chronic Venous Disease

Venous Reflux

Technique

Venous Compression Syndrome

Other Imaging Modalities

Venography

Computed Tomographic Venography

Magnetic Resonance Venography

References

4: Evaluation of Edema of the Extremity

Introduction

Vascular Edema

Venous Edema

Lymphedema

Nonvascular Edema

Diagnostic Workup of Edema

Conclusion

References

5: Compression Therapy in Venous Disease

Introduction

Mechanisms of Benefit

Compression Pressure

The Role of Compression as Stand Alone Therapy

Compression after Sclerotherapy or Ablation

Compression for Venous Ulcer Disease

Prevention of Deep Vein Thrombosis

Post-thrombotic Syndrome

Compression Modalities Compared

Concurrent Peripheral Arterial Disease

Compliance Issues

Conclusion

References

Part II: Venous Insufficiency

6: Clinical Presentation of Venous Insufficiency

Introduction

Clinical Evaluation of the Patient

Risk Factors

Clinical Presentation

Symptoms

Physical Exam

CEAP Classification

C: Clinical Classification

E: Etiologic Classification

A: Anatomic Classification

P: Pathophysiologic Classification

Date of CEAP Classification

Level of Investigation

CEAP Classification Examples

Prevalence of CEAP Clinical Classifications

Clinical Assessment of Disease Severity and Quality of Life

References

7: Open Surgical Treatment of Superficial Reflux

History

Pathophysiology

Indications

Pitfalls and Danger Points

Preoperative Duplex Ultrasound Scan

Operative Procedure

Preoperative Vein Marking

Great Saphenous Vein High Ligation

GSV Stripping

Phlebectomies

Closure

Post-procedure Care

Lateral Approach of the Saphenofemoral Junction

Small Saphenous Vein Incompetence

Position

Incision

Closure

Other Surgical Approaches

Ambulatory Selective Varices Ablation Under Local Anesthesia (ASVAL) Technique

Cure Conservatrice et Hemodynamique de l’Insuffisance Veineuse en Ambulatoire (CHIVA)

Role of Open Procedures in the Endovenous Era: Treatment Algorithm

References

8: Laser Ablation for Venous Reflux

Introduction

Mechanism of Action

Pre-procedural Planning

EVLA Procedure

Procedural Variables

Laser Wavelength

Fiber Tip

Technique Variables

EVLA Complications

Endothermal Heat-Induced Thrombosis (EHIT)

EVLA Outcomes

Conclusion

References

9: Radiofrequency Ablation for Lower Extremity Venous Reflux

Introduction

Radiofrequency Ablation Therapy

Indications and Limitations

Technique

Outcomes

Complications

Treatment for Perforator Veins

Comparison to Other Methods

Conclusions

References

10: Mechanochemical Ablation of Superficial Veins

Introduction

Mechanism of Action

ClariVein® Device and Technique

Device

Technique

Post-procedural Care

Clinical Outcomes

Complications

Conclusion

References

11: Endovenous Sealing of Superficial Veins

Introduction

What is Cyanoacrylate?

Vein Sealing Devices and Technique Used

VenaSeal™ Closure System

VariClose® Vein Sealing System

Cyanoacrylate in the Treatment of Varicose Vein Disease

Animal Studies

Human Studies

VenaSeal™ Closure System

VariClose® Vein Sealing System

Complications of Cyanoacrylate

Conclusion

References

12: Sclerotherapy

Overview

History

Sclerosants

Liquid vs. Foam Sclerotherapy

Physician-Compounded Foam

Proprietary Foam

Patient Workup Prior to Sclerotherapy

Techniques

Telangiectasias

Superficial Venous Insufficiency

PEM

Side Effects and Complications

Conclusions

References

13: Treatment of Incompetent Perforating Veins

Background

Medical Treatment

Percutaneous Thermal Ablation Techniques

Ultrasound-Guided Foam Sclerotherapy

Current Data

Complications

Conclusions

References

14: Cosmetic Approach to Varicose Veins: The ASVAL Technique

Introduction

The Concept of ASVAL

Pathophysiology of Varicose Veins

Practical Application

Selection of Patients Eligible for ASVAL

Extent of the Varicosities

Ultrasound Duplex Preoperative Assessment

Phlebectomy Reflux Elimination Success Test (PREST) Prediction Model

Other Criteria

Technique

Skin Marking

Anesthesia

Microsurgery

Postoperative Management

Results

Conclusion

References

15: Strategies to Treat Venous Reflux Disease

Introduction

Clinical Exam and Imaging

Ultrasound

Plethysmography

Venography

Classification Systems

Nonoperative Management

Operative Management

High Ligation and Stripping (HL/S)

Divided Saphenectomy (DS)

ASVAL

CHIVA

Endovascular Treatments

Thermal Ablation

Nonthermal Ablation

Common Venous Reflux Controversies

Recurrent Varicose Veins (REVAS)

Complete Occlusion (CO) and Near Complete Occlusion (NCO) Following Ablation

Which Device?

All at Once or Ablate and Wait?

Deep Reflux

Saphenous Reflux and Deep Obstruction

Perforator Veins

Vulvar Varices

Klippel–Trénaunay Syndrome

Common Issues in Patients Evaluated for Second Opinion

Previous Phlebectomy Without GSV Stripping

Previous Thermal Ablation Without Phlebectomy

Previous GSV Ablation with No Improvement

Conclusion

References

16: Complications of the Treatment of Venous Insufficiency

Introduction

Venous Thrombosis

Superficial Venous Thrombosis (SVT)

Signs and Symptoms of SVT

Prevention of SVT

Diagnosis of SVT

Treatment of SVT

EHIT

Diagnosis of EHIT

Duplex Ultrasound

Classification of EHIT

Natural History of EHIT

Deep Vein Thrombosis (DVT)

Skin Infection

Skin Necrosis

Skin Pigmentation

Neurologic Injuries

Residual Symptoms

Swelling

Recurrence

References

17: Valve Reconstruction for Deep Venous Reflux

Introduction

Deep Venous Reflux

Surgical Treatments

Surgical Treatments in Primary DVR

Internal Valvuloplasty

External Valvuloplasty

Surgical Treatments in Secondary and Congenital DVR

Vein Transposition

Transposition onto the DFV: Technical Details

Transposition onto the Saphenous Vein: Technical Details

Vein Transplant

Technical Details

Neovalve

Artificial Venous Valve

Indication for Treatment

Strategies

Outcomes

Conclusions

References

18: Pelvic Venous Insufficiency

Introduction

Epidemiology

Anatomy of the Pelvic Venous System

Pathophysiology

Clinical Findings

Diagnosis

Differential Diagnosis

Treatment

Medical Treatment

Surgery

Embolization

Treatment of PVI Due to Type 2 Lesions (Obstructive Lesions)

Conclusion

References

Part III: Acute Venous Thromboembolism

19: Presentation and Significance of Venous Thromboembolism

Epidemiology

Mechanisms Involved in Thrombosis

Risk Factors for VTE

Clinical Presentation of VTE

Deep Vein Thrombosis

Pulmonary Embolism

Other Sites of DVT

Arm/Superior Vena Cava

Inferior Vena Cava (IVC) Thrombosis

Renal Vein Thrombosis (RVT)

Splanchnic Venous Thrombosis

Thrombosis of the Liver Vasculature

Mesenteric Vein Thrombosis (MVT)

Splenic Vein Thrombosis

Cerebral Vein Thrombosis

Superficial Vein Thrombosis

Complications of VTE

VTE Recurrence

Post-thrombotic Syndrome

Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Major Bleeding While on Anticoagulation

Summary

References

20: Prevention of Venous Thromboembolism

Introduction

Risk Assessment for Both VTE and Bleeding

Mechanical Versus Pharmacological Prophylaxis

Nonsurgical Hospitalized Patients

Patients with Acute Medical Condition (Including Cancer)

Patients with Ischemic Stroke or Intracranial Hemorrhage

Non-orthopedic Surgical Patients

General Surgery Patients

Specific Surgical Patients

Orthopedic Surgery

Elective Surgery

Hip Fracture

Other Orthopedic Surgeries

Prevention of VTE in Outpatient Settings

Prevention of VTE Recurrence

Perspective and Conclusion

References

21: Overview of Anticoagulation Agents

Introduction

Parenteral Anticoagulants

Heparin

Low Molecular Weight Heparins

Fondaparinux

Heparin-Induced Thrombocytopenia

Direct Thrombin Inhibitors

Oral Anticoagulants

Warfarin

Direct Oral Anticoagulants

Switching Between Anticoagulants

Patients Undergoing Surgery or Other Invasive Procedures

Ongoing Trials and Future Directions

References

22: Superficial Thrombophlebitis

Introduction

Clinical Presentation

Etiology

Pathology

Trauma

Suppurative

Migratory

Mondor’s Disease

Small Saphenous Vein (SSV) SVT

SVT with Varicose Vein Disease

Upper Extremity SVT

Diagnosis

Treatment

References

23: Anticoagulation for Proximal Deep Vein Thrombosis

Background

The Role of Anticoagulation

Anticoagulation for Proximal DVT Due to a Strong Provoking Risk Factor

Anticoagulation for Proximal DVT Due to a Minor Provoking Risk Factor

DVT Associated with Exogenous Estrogen

DVT Associated with Pregnancy

DVT Associated with Prolonged Travel

May–Thurner Syndrome

Anticoagulation for Unprovoked DVT

Bleeding Risk

Estimating Recurrent VTE Risk

Anticoagulation in Cancer-­Associated Thrombosis

Additional Long-Term Pharmacologic Interventions to Reduce VTE Recurrence

Low-Dose VKA

Low-Dose Aspirin

Low-Dose Apixaban

References

24: Controversies in the Diagnosis and Management of Distal Deep Vein Thrombosis

Introduction

Epidemiology and Natural History of Distal DVT

Risk of Proximal Extension of Distal DVT Without Treatment

Clinical Outcomes of Patients Treated with Anticoagulants for Distal DVT

Comparison of Patients’ Outcomes Between Treated and Untreated Patients

Venous Ultrasonography for the Diagnosis of DVT

Different Protocols of Compression Ultrasound (CUS)

Proximal CUS

Single Complete (Proximal and Distal) or Whole-Leg CUS

Detailed Comparison and Respective Limitations of Ultrasound Strategies for Suspected DVT

Serial Proximal CUS in Outcome Studies

Single Complete (Proximal and Distal) CUS in Outcome Studies

Serial Proximal vs Single Complete CUS in Suspected DVT

D-Dimers in the Diagnosis of Calf DVT

Recent Trials and Recommendations for Therapeutic Management of Distal DVT

The First Randomized Trials Assessing the Need for Anticoagulant Treatment

Evolving International Recommendations for the Treatment of Distal DVT

Is It Necessary to Treat All Distal DVTs in Low-Risk Patients?

Conclusions

References

25: Endovascular Treatment of Deep Vein Thrombosis

Introduction

Rationale for Thromboreductive Strategies

Early Thrombus Removal: The Open Vein Hypothesis and Proof of Concept

Indications for Endovascular Intervention

Likelihood of Successful Catheter-­Directed Thrombolysis

Patient Selection for Catheter-­Directed Thrombolysis

Interventional Options for Acute Deep Vein Thrombosis

Catheter-Directed Thrombolysis (CDT)

Percutaneous Mechanical Thrombectomy

Pharmacomechanical Catheter-�Directed Thrombolysis (PCDT)

Complications

Outcomes

References

26: Surgical Thrombectomy for Deep Vein Thrombosis

Introduction

Patient Evaluation and Selection

Surgical Venous Thrombectomy Operative Technique

Outcomes

References

27: Upper Extremity Deep Vein Thrombosis

Introduction

Symptoms and Signs

Risk Factors

The Paget-Schroetter Syndrome

Central Venous Catheters

Cancer

Diagnosis

Treatment

Anticoagulant Therapy

Treatment Duration

Thrombolytic Therapy

Mechanical Catheter Interventions

First Rib Resection

Vena Cava Filter

Other Therapies

Prognosis

Prevention

Future Directions

References

28: Venous Thoracic Outlet Syndrome

Introduction

Etiology

Epidemiology

Clinical Presentation

Diagnosis

Maneuvers

Imaging

Treatment

First Rib Resection and Anterior Scalenectomy: Transaxillary

First Rib Resection and Anterior Scalenectomy: Supraclavicular Approach

Post-resection Venography

Results

Recent Developments and Future Research

References

29: Medical Management of Pulmonary Embolism

Impact of Pulmonary Embolism

Clinical Severity and Risk of Early Death Determine Initial Management

Management of Acute Right Heart Failure

Thrombolysis and Pharmacomechanical (Interventional) Reperfusion Therapy

Systemic Intravenous Thrombolysis

Pharmacomechanical, Catheter-�Directed Reperfusion

Impact of Thrombolysis on Late Outcomes After Pulmonary Embolism

Anticoagulation for Acute Treatment and Secondary Prophylaxis

Shift Toward New Oral Anticoagulants as the Standard of Care

Specific Patient Groups and Indications for Anticoagulation

Conclusion

References

30: Catheter-Directed Thrombolysis of Pulmonary Embolism

Introduction

Clinical Presentation and Diagnosis of PE

Risk Stratification

Treatment

Systemic Thrombolysis

Catheter-Directed Interventions

Summary of Evidence

Types and Techniques

Standard and Ultrasound-Assisted Thrombolysis

Suction Thrombectomy

Small-Bore Suction Thrombectomy Catheters

Large-Bore Suction Thrombectomy Catheters

Surgical Thrombectomy

Treatment Strategy

Inferior Vena Cava Filter

Long-Term Outcomes

Conclusions

References

31: Surgical Management of Pulmonary Embolism

History of Pulmonary Embolectomy

Epidemiology of VTE

Pathophysiology of VTE

Diagnosis of PE

Management of PE

Surgical Techniques

Paradoxical Embolization

Conclusion

References

32: Vena Cava Interruption

Introduction

Indications for Filter Placement

Absolute Indications (Requires Presence of VTE)

Relative Indications (VTE Required)

Prophylactic Indications (No VTE Required)

Types of Available Vena Cava Filters

Preprocedure Evaluation

Anatomic Variations of the IVC Affecting Filter Placement

Duplication of the IVC

Circumaortic and Retroaortic Left Renal Vein

Left IVC

Megacava

Fluoroscopically Guided Inferior Vena Cava Filter Placement

Ultrasound-Guided Inferior Vena Cava Filter Placement

Suprarenal and Superior Vena Cava Filter Placement

The PREPIC Trials

Retrievable Filters

Complications

Conclusion

References

33: Retrieval of Inferior Vena Cava Filters

Introduction

Timing of Filter Retrieval

Patient Evaluation

Standard Technique

Challenges

Advanced Endovascular Techniques

Wire Displacement Technique

Wire and Snare with Dual Access

Loop-Snare Technique

Balloon Displacement Technique

Parallel Wire Technique

Bronchoscopy Forceps

Endoscopy and Laparoscopy Forceps

Laser Sheath

Complications of Advanced Endovascular Techniques

Open Surgery for IVC Filter Retrieval

Minimally Invasive Surgery for IVC Filter Retrieval

Robotic IVC Filter Retrieval

Conclusion

References

Part IV: Chronic Venous Obstruction

34: Wound Care Management for Venous Ulcers

Introduction

Initial Assessment

Confirming Adequate Arterial Perfusion

Eliminating Edema

Treating Infection

Venous Reflux

Venous Obstruction

Reducing Impact of Host Risk Factors

Postthrombotic Syndrome

Obesity

Calf Muscle Pump Dysfunction

Smoking

Prolonged Standing

Nutrition

Wound Care Centers

Conclusion

References

35: May-Thurner Syndrome: Diagnosis and Management

Introduction

Historical Perspective

Prevalence

Pathophysiology

Clinical Presentation

Diagnostic Imaging

Treatment

Outcomes Following Iliac Vein Stenting for May-Thurner Syndrome

Conclusion

References

36: Endovascular Recanalization of Chronic Venous Obstruction

Introduction

Access Technique

Crossing Chronic Total Venous Occlusions

Advanced Methods of Crossing Chronic Total Venous Occlusions

Stenting Venous Stenoses

Treatment of Stent Thrombosis

Conclusion

References

37: The Venous Stent: Is It Primetime Yet?

Introduction

Diagnosis

Treatment

Endovascular Intervention

Chronic Total Occlusion (CTO)

Stenting Across Inferior Vena Cava Filters

Bilateral Ilio-caval Stenting

Management of Stent Complications

Stent Compression/In Stent Restenosis

Stent Occlusion

Morbidity

Venous Stents

References

38: Open Reconstruction for Chronic Venous Obstruction

Introduction

Etiology

Pathophysiology

Diagnosis

Open Reconstruction

Crossover Saphenous Vein Transposition (Palma Procedure)

Crossover Femoral Venous Prosthetic Bypass

Saphenous Vein Transposition to the Distal Femoral or Popliteal Vein (May–Husni Procedure)

Iliocaval and Femorocaval Bypass

Cavoatrial Bypass

Special Considerations

Endophlebectomy

Adjunctive Procedures

Anticoagulation

Follow-Up and Reintervention

References

39: Hybrid Reconstruction for Post-­thrombotic Iliofemoral Venous Obstruction

Introduction

Patient Selection

Preoperative Evaluation

Technical Evolution and Procedure Outcomes

Results

Histologic Characterization of Post-­thrombotic Tissue

Summary

References

40: Chronic Obstruction of the Inferior Vena Cava

Introduction

Epidemiology and Etiology

Clinical Features

Noninvasive Diagnostic Testing

Medical Management

Surgical Indications

Open and Hybrid Surgical Treatment

Endovascular Therapy: Technique

Endovascular Therapy: Results

Conclusions and Recommendations

References

41: Venous Reconstruction in Oncologic Surgery

Introduction

Inferior Vena Cava Reconstruction

Tumors Involving the IVC

Clinical Presentation and Preoperative Evaluation and Management

Surgical Approach to IVC Resection and Reconstruction

Adjunctive Extracorporeal Bypass Techniques

Perioperative and Long-Term Outcomes

Portal Vein and Superior Mesenteric Vein Reconstruction in Pancreatic Adenocarcinoma

Clinical Presentation and Preoperative Evaluation and Management

Surgical Approach to Portal Vein and Superior Mesenteric Vein Resection

Methods of Portal Vein and Superior Mesenteric Vein Reconstruction

Minimally Invasive Techniques for PV and SMV Resection and Reconstruction

Long-Term Outcomes

Iliac and Femoral Vein Reconstruction

Clinical Presentation and Preoperative Evaluation

Surgical Approach to Iliac and Femoral Vein Resection and Reconstruction

Long-Term Outcomes

Summary and Conclusions

References

42: Superior Vena Cava Syndrome

Introduction

Anatomy

Etiology

Presentation and Classification

Diagnosis and Imaging

Management

Medical Management

Endovascular Intervention

Surgical Reconstruction

Extra-Anatomic Bypass

Conclusion

References

43: Management of Chronic Thromboembolic Pulmonary Hypertension

Introduction

Symptoms

Studies

Operation

Postoperative Management

Complications

Conclusion

References

Index

 

An aparitie	20 Dec. 2017
Autor	Cassius Iyad Ochoa Chaar
Dimensiuni	18.42 x 3.18 x 26.67 cm
Editura	Springer
Format	Hardcover
ISBN	9783319652252
Limba	Engleza
Nr pag	582