Venous And Lymphatic Diseases

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ISBN: 9780824729233 | 0824729234
Cover: Hardcover
Copyright: 5/15/2006

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With an invaluable selection of color images, this guide authoritatively covers the identification, assessment, pathophysiology, epidemiology, and treatment of disorders affecting the venous and lymphatic anatomy. Written by experts from several fields, this source considers topics including the management of deep venous thrombosis, chronic venous insufficiency, venous trauma, and surgical and pharmacologic therapies for these conditions.

Preface

iii

Contributors

xvii

SECTION A: BACKGROUND DATA

Historical Background

(8)

Alberto Caggiati

The ``Discovery'' of the Venous Draining Systems

(1)

Lymphatic Vessels

(1)

The ``Discovery'' of the Circulation of the Blood

(2)

Sclerotherapy

(1)

Surgery

(3)

Venous and Lymphatic Anatomy

(14)

Alberto Caggiati

The Roots of the Draining Systems: The Microvascular Bed

(1)

The Superficial Venous System of the Lower Limb

(5)

Deep Veins of the Lower Limb

(2)

Perforating Veins

(6)

References

(1)

Physiology of the Veins and Lymphatics

(14)

Philip D. Coleridge Smith

Introduction

(1)

The Circulation and the Venous System

(2)

The Venous Valves

(1)

Superficial Venous System

(1)

Communicating or Perforating Veins Associated with the Long Saphenous Vein

(1)

Deep Venous System

(1)

Normal Venous Physiology of the Lower Limbs

(2)

The Return of Blood to the Heart

(1)

The Calf Muscle Pump

(2)

Lower Limb Venous Pathophysiology

(1)

Valvular Reflux or Retrograde Flow

(1)

Edema

(1)

Lymphatic System

(1)

Lymphedema

(1)

References

(3)

Epidemiology of Venous Disorders

(16)

F. G. R. Fowkes

Varicose Veins: Prevalence and Incidence

(3)

Asymptomatic Venous Valve Incompetence: Prevalence

(1)

Risk Factors for Varicose Veins

(4)

Venous Skin Changes: Prevalence

(1)

Venous Ulcer: Prevalence, Incidence, and Prognosis

(2)

Risk Factors for Venous Ulcers

(2)

Conclusion

(1)

Key Points

(1)

References

(3)

Health Economics and Quality of Life---Impact of Venous Disorders

(8)

Meryl Davis

Fiona J. Tsang

Alun H. Davies

Introduction

(1)

Health Economics

(2)

Quality of Life

(3)

Conclusion

(1)

Key Points

(1)

References

(3)

Classification of Chronic Venous Disease and Outcome Assessment

(16)

Gudmundur Danielsson

Bo Eklof

Introduction

(1)

The Creation of the Ceap Classification

(1)

Other Developments Related to Ceap

(1)

Revision of Ceap

(2)

Terminology and New Definitions

(1)

Refinement of C-Classes in Ceap

(1)

Refinement of E. A. and P in Ceap

(1)

Date of Classification

(1)

Level of Investigation

(1)

Basic Ceap

(1)

Revision of Ceap: An Ongoing Process

(1)

Revision of Ceap: Summary

(2)

Outcome Assessment

(4)

Conclusion

(1)

Key Points

(1)

References

(3)

SECTION B: ASSESSMENT AND INVESTIGATION

Clinical Assessment of Venous Disease

(16)

Sriram Subramonia

Tim A. Lees

Introduction

(1)

Venous Anatomy

(3)

Venous Physiology and Pathophysiology

(1)

Risk Factors

(1)

Symptomatology

(2)

Skin Changes of Chronic Venous Insufficiency

(1)

Acute Presentations of Venous Disease

(1)

Outpatient Clinical Assessment

(4)

Classification of Venous Disease

(1)

Key Points

(1)

References

(3)

Noninvasive Evaluation of Venous Disease

(8)

Ahmad Bhatti

Nicos Labropoulos

Introduction

(1)

Physiologic Tests

(1)

Air Plethysmography

(1)

Photo Plethysmography

(1)

Light Reflection Rheography

(1)

Strain Gauge Plethysmography

(1)

Foot Volumetry

(1)

Continuous Wave Doppler

(1)

Duplex Ultrasound

(1)

Computed Tomographic Venography

(1)

Magnetic Resonance Venography

(1)

Key Points

(1)

References

(4)

Invasive Tests---Radiological and Pressure Measurements

101

(12)

Peter Neglen

Seshadri Raju

Introduction

101

(1)

Ambulatory Venous Pressure---A Global Hemodynamic Test

101

(1)

Arm-Foot Venous Pressure Differential and Reactive Hyperemia Foot Vein Pressure Elevation---A Hemodynamic Test for Global Outflow Obstruction

102

(2)

Femoral Venous Pressure---A Test for Focal Outflow Obstruction

104

(1)

Popliteal Venous Pressure---A Test for Focal Obstruction

104

(1)

Ascending Venography

105

(1)

Transfemoral Descending Venography

105

(1)

Transfemoral Ascending (Antegrade) Venography

105

(2)

Intravascular Ultrasound

107

(2)

Conclusion

109

(1)

Key Points

109

(1)

References

110

(3)

Diagnosis of Deep Vein Thrombosis

113

(18)

Luis Leon

Nicos Labropoulos

Introduction and Magnitude of the Problem

113

(1)

Pathophysiology

113

(1)

Natural History of Venous Thrombosis

114

(2)

Diagnosis

116

(9)

Key Points

125

(1)

References

126

(5)

SECTION C: MANAGEMENT OF DEEP VENOUS THROMBOSIS

The Pathophysiology of Deep Venous Thrombosis

131

(12)

Ahmad Bhatti

Nicos Labropoulos

Background

131

(1)

Stasis

131

(1)

Hypercoagulability

132

(3)

Vessel Injury

135

(1)

Other Causes

135

(1)

Natural History of DVT

136

(1)

Key Points

137

(1)

References

137

(6)

Epidemiology of Venous Thrombosis

143

(12)

Patrick Kesteven

Introduction

143

(1)

Historical Perspective

143

(1)

Pathophysiology

143

(1)

Incidence

144

(2)

Risk Factors

146

(5)

Rosendaal's Multicausal Model and Recurrences

151

(1)

Key Points

151

(1)

References

152

(3)

Venous Thromboembolism and Malignant Diseases

155

(18)

Paolo Prandoni

Andrea Piccioli

Anna Falanga

Pathogenesis of Thrombosis in Cancer

155

(2)

Epidemiology and Risk Factors of Thromboembolism in Cancer Patients

157

(3)

Thromboprophylaxis

160

(1)

Treatment of Established Venous Thromboembolism

161

(1)

Impact of Antithrombotic Drugs on Cancer Evolution and Development

162

(1)

Risk of Cancer in Patients with Venous Thromboembolism

163

(3)

Key Points

166

(1)

References

166

(7)

Venous Thrombosis Prophylaxis

173

(24)

Joseph A. Caprini

Dereck W. Wentworth

Incidence and Magnitude of the Problem

173

(3)

Risk Assessment

176

(13)

Key Points

189

(1)

References

190

(7)

Venous Thrombolysis of the Extremities

197

(8)

Ahmad Bhatti

Nicos Labropoulos

Marc Borge

Introduction

197

(1)

Indications

197

(1)

Technique

198

(1)

Flow-Directed Thrombolysis

198

(1)

Catheter-Directed Thrombolysis

198

(1)

Mechanical Thrombectomy

199

(1)

Pharmacologic Adjuncts

200

(1)

Outcome

201

(1)

Key Points

202

(1)

References

203

(2)

Role of Surgery and Endovascular Therapies in Lower Limb Deep Venous Thrombosis

205

(18)

Olivier Hartung

Yues S. Alimi

Claude Juhan

Aims of the Treatment

205

(1)

Surgical Thrombectomy

206

(8)

IVC Interruption and Filters

214

(1)

Endovascular Techniques

215

(4)

Respective Indications

219

(1)

Key Points

219

(1)

References

220

(3)

Inferior Vena Cava Filters

223

(14)

Sumaira Macdonald

The Scope of the Clinical Problem

223

(1)

Inferior Vena Cava Interruption: An Evolution

224

(1)

Filter Types and Design

225

(1)

Indications for Use

226

(3)

The Use of Caval Filters Outside of the Trauma Setting: The Evidence Base

229

(2)

Clinical Controversies Concerning Vena Cava Filters

231

(2)

Key Points

233

(1)

References

233

(4)

SECTION D: VARICOSE VEINS

Etiology and Pathophysiology of Varicose Veins

237

(8)

Jonathan Golledge

Introduction

237

(1)

Risk Factors for Varicose Veins

237

(1)

Duplex Findings in Varicose Veins

237

(1)

Pathology of Varicose Veins

238

(1)

Theories Regarding Varicose Vein Etiology

238

(1)

Valve Dysfunction in Varicose Veins

239

(1)

Primary Vein Wall Weakness and Varicose Veins

240

(1)

Arteriovenous Communications and Varicose Veins

241

(1)

Conclusion

241

(1)

Key Points

242

(1)

References

242

(3)

Indications for Treatments of Varicose Veins

245

(12)

Simon Palfreyman

Jonathan Michaels

Introduction

245

(1)

Background

245

(4)

Indications for Treatment of Varicose Veins

249

(4)

Conclusion

253

(1)

Key Points

254

(1)

References

254

(3)

Conservative Treatments: Medical/Drug Therapies

257

(20)

Stavros K. Kakkos

Michel Perrin

Keith F. Cutting

George Geroulakos

Compression

257

(4)

Intermittent Pneumatic Compression

261

(1)

Supervised Exercise

261

(1)

Skin Substitutes

261

(2)

Pharmacological Treatment of Chronic Venous Disorders

263

(6)

Key Points

269

(1)

References

270

(7)

Surgical Treatment of Varicose Veins

277

(6)

Steven S. Kang

Great Saphenous Vein Ligation and Stripping

277

(2)

Small Saphenous Ligation and Stripping

279

(1)

Stab Avulsions

280

(1)

Postoperative Care

281

(1)

Key Points

281

(2)

Assessment and Surgical Treatment of Recurrent Varicose Veins

283

(6)

James E. McCaslin

Ronald K. G. Eifell

Gerard Stansby

Introduction

283

(1)

Assessment

283

(1)

Surgical Management

284

(1)

Complications

285

(1)

Conclusion

285

(1)

Key Points

285

(1)

References

286

(3)

Surgical Treatments and New Technologies/Day Care Strategies

289

(30)

Ronald K. G. Eifell

Tim A. Lees

Introduction

289

(1)

Surgical Treatments

290

(1)

Saphenofemoral Disconnection (SFD) Combined with LSV Stripping

291

(1)

SFD Only

292

(1)

Saphenopopliteal Junction Disconnection (SPJ)

292

(1)

Saphenofemoral Junction (SFJ) Recurrence and Redo Surgery

293

(1)

Multiple Phlebectomies (Stab Avulsions)

294

(1)

Perforator Surgery

294

(1)

Open Perforator Surgery

295

(1)

Heparin Prophylaxis

295

(1)

Non-surgical procedures

295

(2)

New Technologies

297

(12)

Day Care Strategies

309

(2)

Appendix I

311

(1)

Appendix II

312

(1)

Key Points

312

(1)

References

313

(6)

Varicose Veins, Pregnancy, and Venous Disorders of the Pelvic Veins

319

(16)

Linda de Cossart

Introduction

319

(1)

Varicose Veins and Pregnancy

319

(7)

Pelvic Congestion Syndrome

326

(4)

Key Points

330

(1)

References

331

(4)

Superficial Vein Thrombosis: Natural History and Clinical Significance

335

(12)

Athanasios D. Giannoukas

Nicos Labropoulos

Demographic Characteristics

335

(1)

Varicose Veins, Location, and STP

336

(1)

Hypercoagulable States and STP

336

(1)

Pregnancy and STP

337

(1)

Malignancy and STP

337

(1)

DVT and STP

338

(1)

PE and STP

339

(1)

Diagnosis of STP

340

(2)

Management of STP

342

(1)

Final Remarks and Conclusion

342

(1)

Key Points

343

(1)

References

343

(4)

Medicolegal Aspects

347

(8)

Bruce Campbell

Introduction

347

(1)

Determining the Frequency of Medicolegal Claims

347

(1)

Varicose Veins

348

(1)

New Treatments for Varicose Veins

349

(1)

Venous Thromboembolism as a Complication of Varicose Vein Operations

349

(1)

Venous Thromboembolism Requiring Expert Opinion

350

(1)

Swollen Legs---Postphlebitic Syndrome and Lymphatic Disease

350

(1)

Communicating Risks and Benefits

350

(1)

Spotting High-Risk Cases

351

(1)

When Things Go Wrong

352

(1)

The Uncertainties of Medicolegal Decisions

352

(1)

Key Points

353

(1)

References

353

(2)

SECTION E: CHRONIC VENOUS INSUFFICIENCY

Pathophysiology of Leg Ulceration

355

(16)

Peter J. Pappas

Brajesh K. Lal

Walter N. Duran

Frank T. Padberg, Jr.

Robert W. Zickler

Introduction

355

(1)

The Venous Macrocirculation

355

(1)

Varicose Veins

356

(3)

Historical Theories of CVI

359

(7)

Conclusion

366

(1)

Key Points

366

(1)

References

367

(4)

Compression Therapy and Nursing Care for Venous Leg Ulcers

371

(12)

Jill Robson

Hany Hafez

Background

371

(1)

Assessment

372

(5)

Treatment

377

(1)

Compression

377

(4)

Key Points

381

(1)

References

381

(2)

Surgical Therapies for Chronic Venous Disease: Superficial Venous Surgery

383

(10)

Frank C. T. Smith

Introduction

383

(1)

The Role of Superficial Incompetence in Chronic Venous Insufficiency

383

(1)

Surgery for Superficial Venous Reflux

384

(6)

Key Points

390

(1)

References

391

(2)

Surgical Therapies in Chronic Venous Insufficiency: Deep Venous Surgery/Valve Transplantation/SEPS

393

(18)

Michael C. Dalsing

Introduction

393

(1)

Etiology/Pathophysiology of Valvular Damage

394

(1)

Diagnosis

395

(2)

Indications and Goals for Surgical Intervention

397

(1)

Treatment Options and Results

398

(5)

Summary

403

(1)

Key Points

403

(1)

References

404

(7)

Management of Deep Venous Obstruction of the Lower Extremity: Endovascular Intervention and Surgery

411

(16)

Peter Neglen

Seshadri Raju

Introduction

411

(1)

Venous Outflow Obstruction

411

(1)

Diagnosis and Selection of Patients

412

(1)

Open Surgical Reconstruction

413

(1)

The Cross-Over Bypass

413

(2)

The In-Line Bypass

415

(1)

Sapheno-Popliteal Bypass

416

(1)

Femoro-Ilio-Caval Stenting

416

(3)

Iliocaval Stenting Following Thrombolysis/Thrombectomy for Acute DVT

419

(1)

Stenting of Chronic Nonmalignant Obstruction

419

(2)

Endovascular Technique

421

(2)

Summary

423

(1)

Key Points

423

(1)

References

424

(3)

SECTION F: OTHER VENOUS CONDITIONS

Upper-Extremity Venous Thrombosis

427

(18)

Klaus Overbeck

Shankat N. Khan

Gerard Stansby

Nicos Labropoulos

Introduction

427

(1)

Etiology

427

(2)

Clinical Presentation

429

(1)

Assessment

430

(1)

Management

431

(5)

Natural History

436

(1)

Conclusions

436

(1)

Key Points

437

(1)

References

437

(8)

Mesenteric and Portal Vein Thrombosis

445

(16)

Klaus Overbeck

Derek Manas

Gerard Stansby

Introduction

445

(1)

Mesenteric Venous Thrombosis

445

(4)

Portal Vein Thrombosis

449

(5)

Key Points

454

(1)

References

454

(7)

Superior Vena Caval Obstruction

461

(6)

Enrico Ascher

Anil Hingorani

Etiology

461

(1)

Presentation

461

(1)

Diagnosis

462

(1)

Treatment

462

(1)

Key Points

463

(1)

References

464

(3)

Congenital Venous Malformations: Venous Tumors

467

(16)

Sachiendra V. Amaragiri

Nicos Labropoulos

Congenital Venous Malformations

467

(8)

Venous Tumors

475

(3)

Key Points

478

(1)

References

478

(5)

Popliteal Vein Entrapment

483

(6)

Seshadri Raju

Peter Neglen

Incidence

483

(1)

Clinical Features

483

(1)

Venography

484

(1)

Other Imaging Techniques

484

(1)

Functional Tests

484

(1)

Pathology

484

(2)

Operative Lysis

486

(1)

Clinical Results

486

(1)

Key Points

487

(1)

References

487

(2)

Management of Venous Trauma

489

(22)

Denis W. Harkin

Paul H. Blair

Introduction and Magnitude of Problem

489

(1)

Pathophysiology of Venous Trauma

490

(2)

Diagnosis of Venous Trauma

492

(1)

Management Principles for Venous Trauma

493

(3)

Extremity Venous Trauma

496

(5)

Neck Venous Trauma

501

(2)

Thoracic Venous Trauma

503

(2)

Abdominal Venous Trauma

505

(2)

Key Points

507

(1)

References

508

(3)

SECTION G: LYMPHATIC DISORDERS

Lymphedema: Clinical Features and Investigation

511

(16)

Alok Tiwari

George Hamilton

Introduction

511

(1)

Etiology of Lymphedema

512

(10)

Key Points

522

(1)

References

522

(5)

Lymphedema: The Role of Conservative Medical and Surgical Treatments

527

(10)

Alok Tiwari

George Hamilton

Introduction

527

(1)

Aim of Treatment

527

(1)

Conservative Treatment

527

(3)

Medical Treatment

530

(1)

Surgical Treatment

531

(1)

Limb Reduction Procedures

531

(1)

Bypass Procedures

532

(1)

Prophylactic Surgery

533

(1)

Summary

534

(1)

Key Points

534

(1)

References

534

(3)

Surgical Management of Chylous Ascites and Chylothorax

537

(12)

Ian Nichol

Chylous Ascites

537

(6)

Chylothorax

543

(1)

Key Points

544

(1)

References

545

(4)

Index

549

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Venous And Lymphatic Diseases

Summary

Table of Contents

Supplemental Materials