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Advances In Varicose Vein Treatment 2
1. Advances In Varicose Vein Treatment Louis Grella, MD, F.A.C.S. Medical Director Advanced Vein Care Louis Grella, MD F.A.C.S. www.Advancedveincare.org
2. Vascular Training Experience Stony Brook Medical Center SUNY Syracuse: MD Degree Flushing Hospital Medical Center : General Surgery SUNY Stony Brook: Vascular Surgery Fellow North Port VA: Vascular Laboratory training Jersey Coast Vascular Institute: Vascular Surgery practice Advanced Vein Care: Medical Director Louis Grella, MD F.A.C.S. www.Advancedveincare.org
17. Many unnamed branches and Tributaries Louis Grella, MD F.A.C.S. www.Advancedveincare.org
18. Venous Disease Superficial System Varicose Veins Spider Veins Venous Malformation (birth marks and others) Venous Reflux Leg Swelling Venous Ulceration
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20. Calf Muscle Pump Just like the in heart we have diastole and systole This is why stretching your legs or walking improves circulation
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22. From the foot up to the heart Superficial vein disease always starts with abnormal valves and interruption to normal flow called venous reflux
23. Abnormal flow = Venous Reflux Damaged Valves Blood flows to the skin Blood is pushed distally and proximally Close loop recirculation Blood is retained in the leg Increased volume of blood (heaviness Fatigue) Increased venous pressure Veins Dilate (varicose veins)
25. Symptoms of venous reflux Leg Fatigue Leg Heaviness Itching and pain along veins Varicose Veins Spider veins (not always 2nd to reflux) Leg swelling( think DVT 1st) Skin Discoloration (lipo dermatosclerosis) Venous ulceration
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27. Remember this is only a manifestation of the underlying disease
41. Venous Stasis Ulcers Differential Diagnosis Venous ulcerations 50% on non healing ulcers Arterial ulcers in about 10% Malignancy : basal and squamous cell, lymphoma Infections: HIV, fungal Collagen vascular disorders: Lupus ec. Lymphatic obstruction Affects over 1 million people in the US 100,000 are disabled from this More common in elderly population
42. Venous Stasis Ulcers Etiology Venous Hypertension Venous reflux DVT Varicose veins Edema Biological factors Leakage of proteins impedes diffusion O2 Aggregation of white cells Block capillary flow Release on inflammatory proteins
43. Diagnosis of venous disease Physical exam Appearance Trendelenburg test Palpation Hand Doppler Duplex Examination R/O DVT Size of veins Map out superficial veins Locate the site of reflux Reflux 0.5 sec in GSV and 1 sec in deep system Find refluxing perforators
44. Venous Duplex R/O DVT Scan deep system in cross section, look for total compression of the vein in B mode Examine from the femoral vein to the below the pop Check flow characteristics with Doppler Sharp up stroke with calf compression Small or No flow with relaxation R/O DVI This must be done with patient upright Reversal of flow of > 1 sec with Valsalva or after calf compression
45. Duplex Anatomy Locate GSV Junction(FSJ) Look for Mickey's hat Normal venous flow Look at valve Venous flow is opposite the artery
52. Anatomy of Great Saphenous Femoral junction has multiple branches Runs on medial side of leg down to ankle Found in a facial sheet Perforators connect it to deep system
67. Sclerotherapy Cumulate vein with needle Inject Sclerosing Solution Sotradecol (Sodium tetradecyl sulfate) Pilodocanol Hyper tonic Saline Foam (Mix STS with air and make bubbles) Intravenous injection causes intima inflammation and thrombus formation
68. Sclerotherapy Use Neovascularization Perforators Clean up after Phlebectomies Spider veins Reticular veins GSV: can closure the, but has high recurrence rate
