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    Julian Juli
    Varicose veins and chronic venous insufficiency affect millions of Americans each year. Proper functioning of the venous valves is essential for returning blood from the legs back to the heart. When the valves become incompetent, venous hypertension develops which can lead to varicose veins, deep vein thrombosis, and in severe cases, venous stasis ulcers. Treatment options range from compression stockings and sclerotherapy for milder cases to endovenous ablation procedures like radiofrequency ablation for more severe reflux. Endovenous ablation has high success rates for treating reflux with minimal complications.

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    Lembar Konfirmasi

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    Julian Juli
    51 views36 pages
    Varicose veins and chronic venous insufficiency affect millions of Americans each year. Proper functioning of the venous valves is essential for returning blood from the legs back to the heart. When the valves become incompetent, venous hypertension develops which can lead to varicose veins, deep vein thrombosis, and in severe cases, venous stasis ulcers. Treatment options range from compression stockings and sclerotherapy for milder cases to endovenous ablation procedures like radiofrequency ablation for more severe reflux. Endovenous ablation has high success rates for treating reflux with minimal complications.

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    Varicose veins and chronic venous insufficiency affect millions of Americans each year. Proper functioning of the venous valves is essential for returning blood from the legs back to the heart. When the valves become incompetent, venous hypertension develops which can lead to varicose veins, deep vein thrombosis, and in severe cases, venous stasis ulcers. Treatment options range from compression stockings and sclerotherapy for milder cases to endovenous ablation procedures like radiofrequency ablation for more severe reflux. Endovenous ablation has high success rates for treating reflux with minimal complications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views36 pages

    Lembar Konfirmasi

    Uploaded by

    Julian Juli
    Varicose veins and chronic venous insufficiency affect millions of Americans each year. Proper functioning of the venous valves is essential for returning blood from the legs back to the heart. When the valves become incompetent, venous hypertension develops which can lead to varicose veins, deep vein thrombosis, and in severe cases, venous stasis ulcers. Treatment options range from compression stockings and sclerotherapy for milder cases to endovenous ablation procedures like radiofrequency ablation for more severe reflux. Endovenous ablation has high success rates for treating reflux with minimal complications.

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    of 36

    VARISES

    DIAGNOSA, PENATALAKSANAAN
    KONVENSIONAL SAMPAI TERKINI
    dr. Londung Brisman Sitorus SpB KV
    Bedah Vaskular dan Endovaskular
    RS EMC TANGERANG
    Incidence/Prevelance

    • It is estimated that more than 80 million Americans suffer from some form of venous disorder.
    • Up to 13 million people in the U.S. suffer from CVI
    • Peak incidence occurs in women aged 40-9 and men aged 70-79 years
    • Statistics show one in three Americans over the age of 45 is affected by vein disease, and of those, only 4% are
    being treated.
    • Annual health care cost in the US to treat CVI is about $3billion; about 2 million workdays are lost per year due to venous
    ulcers

    Varicose Veins
    • More than 24 million Americans have varicose veins
    • Up to 50% of women have varicose veins while 24% of men aged 30-40 and 43% of men over 70 have varicose veins

    DVT / PTS
    • There are over 200,000 new cases of DVT each year in the U.S.
    • The incidence of pulmonary embolism in patients with DVT ranges from 5 – 20% and can be fatal
    • After an episode of DVT, 20 – 50% of patients develop Post Thrombotic Syndrome within the first 2 years

    Venous Stasis Ulcers


    • Affect 2.5 million people in the U.S.
    • An estimated 500,000 persons are newly diagnosed each year
    Function
     Transport blood back to the heart

     Prevent intravascular volume overload


    Anatomy
    Valves
    Lower Extremity
    Venous Hypertension

     Hydrostatic pressure vs Mechanical/muscular pressure


     A. K. Tassiopoulos et al.
     1153 cases of ulcerated legs and venous disease
     Reflux in superficial, deep, and perforating veins
     Incompetent valves
    Risk Factors

     Genetic
     More in females
     Hormones
     Progesterone, estrogen
     Pregnancy
     Age: >50
     Greater height
     Prolonged standing
     Obesity
    Signs and Symptoms

     Telangiectasias  Aching
     Reticular veins  Heaviness
     Varicosity  Early fatigue
     Thrombophlebitis  Edema
     Hyperpigmentation  Itching
     Bleeding from  Restless legs
    clusters  Cramps
     Ulceration
    Clinical Examination

    Feel for saphena varix


    (1cm medial to the
    femoral a.) & a
    transmitted cough Dilated short saph v. Indurated tender veins
    impulse suggestive of saph-pop suggestive of
    incompetence thrombophlebitis
    Test for incompetence

    Brodie –Trendelenburg test

    Empty the
    veins &
    apply a mid
    thigh
    tourniquet

    Let the patient stand

    If the veins remain empty, but fill after If the veins fill before removal of
    removal of tourniquet, the tourniquet, the incompetence must
    incompetence must be above the be below the tourniquet
    tourniquet
    Perthes’ walking test

    Place a tourniquet around the


    thigh while the patient is
    standing (note that the vv are
    full)
    Let the patient walk in place

    If the veins empty with


    walking, then the tourniquet is
    preventing superficial reflux
    from an incompetent valve
    above, while deep veins are
    patent with intact valves.
    Classification: CEAP
    *Eklof et al. J of Vasc Surg 2004

    Clinical classification
     C0: no visible or palpable signs of venous disease
     C1: telangiectasies or reticular veins
     C2: varicose veins
     C3: edema
     C4a: pigmentation or eczema
     C4b: lipodermatosclerosis or atrophie blanche
     C5: healed venous ulcer
     C6: active venous ulcer
     S: symptomatic, including ache, pain, tightness, skin
     irritation, heaviness, and muscle cramps, and other
     complaints attributable to venous dysfunction
     A: asymptomatic
    C1
    C2
    C3
    CEAP Etiologic classification
     Ec: congenital
     Ep: primary
     Es: secondary (post-thrombotic)
     En: no venous cause identified

    Anatomic classification
     As: superficial veins
     Ap: perforator veins
     Ad: deep veins
     An: no venous location identified

    Pathophysiologic classification

     Basic CEAP
     Pr: reflux
     Po: obstruction
     Pr,o: reflux and obstruction
     Pn: no venous pathophysiology identifiable
    Treatment

     Compression Therapy
     Stocking

     Drug Therapy

     Surgery
    Compression Stockings

     Worn during the day  Operator dependent


     Elastic stockings with  Difficult to put on
    adjustments in  Physical
    pressure impediments/Co-
    morbidities
     Lower pressure
    stockings (20-30mm
    Hg) for edema and DVT  50% of patients were
    prophylaxis unable to them on
     Higher pressure (30- alone
    40+mm Hg) for ulcers
    and significant venous
    disease  30-65% noncompliance
    noted in clinical trials
    in venous centers
    Compression Therapy:
    Indications
    Efficacy of Compression Therapy

    1. 22 trials comparing healing of venous ulcers using


    compression stockings
     Compressive therapy more effective than non-compression
     Higher pressure were more effective than lower
     Multilayer compression was better than single layer bandaging
    2. 466 patients with a healed ulcer
     Continued use of compression stocking reduced reoccurrence
    within 3-5 year
    3. ESCHAR study: 500 limb trial that compares surgery and
    compression vs. compression alone for ulcer treatment
     Combination therapy had lower rates of reoccurrence of ulcer
    at year 4 (24% vs. 52%)
    More invasive

     Sclerotherapy
     0.2% sodium tetradecyl injected directly into spider angiomas and smaller
    superficial varicosities
     Complications (<5%): allergic reaction, hypo/hyper-pigmentation, local skin necrosis

     Surgical excision of veins ( Stripping)


     Endovenous laser ablation of saphenous vein (EVLT), Radio Frequency
    ablation ( RFA)
    Sclerotherapy
    Efficacy

     Meta-analysis of 64 studies (12,320 legs)


     Anaylzed ablation via Duplex US
     Follow upto 5 years
     Success rate of EVLT highest after 5 years
     Complications: DVT (<3%), local bruising and pain, paresthesias, foam emboli,
    stroke
    THANK YOU

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