Chronic Venous Insufficiency

Transcription

1 Chronic Venous Insufficiency None Disclosures Lesley Enfinger, MSN,NP-C Chronic Venous Insufficiency Over 24 Million Americans affected by Chronic Venous Insufficiency (CVI) 10 x More Americans suffer with CVI than Peripheral Artery Disease (PAD) in the USA Six Million Americans with Skin Changes associated with CVI 500,000 Americans have leg ulcers associated with CVI Over Two million work days are lost annually in the US and $1.4 Billion is spent each year on CVI Of the > 24 Millions affected, only 5% seek treatment annually Prevalence by Age and Gender AGE Female Male % 1% % 24% % 43% 1

2 Vein Walls: Anatomy of Venous System Intima - a layer of endothelial cells and fenestrated basement membrane Media - three layers of smooth muscle bundles Adventitia - thick layer of interlacing fibers of collagen Vein Valves: Thin sheets of collagen and smooth muscle covered by endothelium Overview of Venous Physiology and Pathophysiology The Deep Venous System Common Femoral Vein Femoral Vein Superficial Venous System Great Saphenous Vein Small Saphenous Vein Deep Veins of the Thigh Deep Veins of the Calf Common Femoral Vein Popliteal Vein Major pathway for the return of the blood to the heart from the lower leg Anterior tibial vein (ATV) Posterior tibial vein (PTV) Peroneal veins Superficial Venous System Pathophysiology of CVI Small Saphenous Vein (ssv) Begins at the lateral aspect of the foot Termination highly variable Most commonly terminates at popliteal fosa Great Saphenous Vein (GSV) Originates on the medial foot Saphenofemoral junction (SFJ) is the termination point of the GSV 2

3 Causes of Venous Insufficiency Heredity Gender Pregnancy Occupation Obesity Prior Injury/Surgery Sedentary Lifestyle Symptoms of Venous Insufficiency Leg pain, aching, or cramping Burning or itching of the skin Leg or ankle swelling Heavy feeling in legs Skin discoloration/texture changes Open wounds or sores Restless legs Varicose Veins Classification of Varicose Veins CEAP Classification Clinical Condition Etiology Anatomic Pathophysiology Clinical Condition (rated on a 0 6 scale) C0 = no visible venous disease C1 = telangiectatic or reticular veins C2 = varicose veins C3 = edema C4 = skin changes without ulceration C5 = skin changes with healed ulceration C6 = skin changes with active ulceration Manifestations of Venous Insufficiency Superficial venous reflux is progressive and if left untreated, may worsen over time. Below are manifestations of the disease. Skin Changes Swollen Legs Skin Ulcers. Diagnosis of Venous Insufficiency Duplex Ultrasound in the Detection of Venous Disease Duplex ultrasound is used in detecting reflux and impediment to venous outflow Duplex ultrasound is considered the gold standard in venous imaging Duplex ultrasound is utilized during the patient screening process, prior to the endovenous laser/radiofrequency therapy procedure, and after the procedure to determine reflux 3

4 Leg Elevation- above the level of the heart Compression Hose mm HG for knee high/thigh high/full panty hose Compression Dressings- D-wraps/UNNA boots Endovenous Laser Therapy-a thin laser fiber is inserted into the diseased vein through a small puncture site. It then delivers laser energy through the fiber which causes the vein to close as the fiber is gradually removed. Radiofrequency Ablations-a very small catheter is inserted into the vein delivering radiofrequency energy to the vein wall causing it to shrink, collapse, and seal shut. VNUS Closure Procedure using the ClosureFAST Catheter Phlebectomy Used to treat small veins and veins other than the Great Saphenous. Can be done immediately post endovenous laser therapy procedure, or later as an outpatient procedure A phlebectomy hook is inserted into a 1-2 mm incision in the leg and section of the vein is hooked. The vein is removed through the incision Ambulatory phlebectomy permits removal of nearly any incompetent vein below the saphenofemoral and saphenopopliteal junctions Veins that can be removed using this method include: major tributaries, perforators, and reticular veins-including small reticular veins associated with telangiectasias Overall Patient Flow Evaluation for leg pain RX for compression hose NIVLS ordered F/U after NIVLS Precertification for venous ablations Schedule 4

5 Vascular Health & Wellness PreOp with Physician/NP/CRNA Procedure room VNUS Ablation procedure (15-20 minutes) Ambulate/WC back to holding area Eat snack Home F/U venous doppler hours post op 1 Month follow up in office Vascular Health &Wellness Venous Ablation cases January-31 Venous Ablation cases Goal each week of 8-15 Venous Ablations Cost $507/per case + Labor Reimbursement $1500-$3500 References Questions and Answers 1. American Heart Association, SIR, Brand et al. The Epidemiology of Varicose Veins: The Framingham Study 2. Coon WW, Willis PW, Keller JB: Venous thromboembolism and other venous disease in the Tecumseh Community Health Study Circulation 1973; 48: Barron HC, Ross BA. Varicose Veins: A guide to prevention and treatment. NY, NY: Facts on File, Inc. [An Infobase Holdings Company]; 1995;vii 4. Vascular Disease Statistics. ( ). Retrieved 2014, from Vascular Disease Foundation. 5