Management of Lower Limb Ulcers. D. NAIK MBChB FRACS DDU
|
|
|
- Norma Watkins
- 5 years ago
- Views:
Transcription
1 Management of Lower Limb Ulcers D. NAIK MBChB FRACS DDU
2 Ulcer A defect in the epithelium
3 Ulcer A failure to heal
4 Aetiology of Leg Ulcers Arterial Venous Neuropathic Vasculitic Infectious Neoplastic Lymphoedema Traumatic Fictitious D Naik MBchB FRACS DDU [Vascular]
5 D Naik MBchB FRACS DDU [Vascular]
6 History Varicose veins Deep venous thrombosis Claudication Rest pain Diabetes Injury Arthritis
7 Clinical Examination Oedema Surrounding skin Site Pain Ulcer Pulses Stigmata of venous disease Doppler indices D Naik MBchB FRACS DDU [Vascular]
8 Venous Ulcers Gaiter area Mild pain Venous ooze Shallow,irregular shape,round edges Granulating base Surrounding inflammation Stasis dermatitis D Naik MBchB FRACS DDU [Vascular]
9 D Naik MBchB FRACS DDU [Vascular]
10 Venous ulcer
11 D Naik MBchB FRACS DDU [Vascular]
12 Venous ulcer
13 Venous ulcer
14 Venous Ulcer
15
16 Marjolin s ulcer
17 Ischaemic Ulcers Occur distally and over bony prominences Severe pain Little or no bleeding Irregular edge Poor granulation tissue Absent surrounding inflammation Trophic changes Absent pulses and low ABI D Naik MBchB FRACS DDU [Vascular]
18
19 Neuropathic Ulcers Under calluses or pressure points Painless Bleeding maybe brisk Punched out,with deep sinus Surrounding inflammation Demonstrable neuropathy D Naik MBchB FRACS DDU [Vascular]
20 Neuropathic ulcer
21 Management of Ulcers History Physical examination Blood tests Pus swab Vascular imaging Biopsy D Naik MBchB FRACS DDU [Vascular]
22 Epidemiology of Venous Ulcers 0.06 and 1% Rising prevalence in elderly Peak prevalence age 70 years F:M ratio 3:1 D Naik MBchB FRACS DDU [Vascular]
23 Risk factors for Venous Ulceration Venous insufficiency Previous DVT Chronic skin changes Local trauma Aggravation by co-existing conditions D Naik MBchB FRACS DDU [Vascular]
24 Macrovascular Changes Ambulatory venous hypertension
25 Microvascular Changes Pericapillary fibrin deposition Localised microvascular ischaemia White cell adhaerence White cell activation Activity of inflammatory mediators D Naik MBchB FRACS DDU [Vascular]
26 Management of Venous Ulcers General measures Adjuvant pharmacotherapy Compression Dressings Sclerotherapy Endovenous interventions Surgery D Naik MBchB FRACS DDU [Vascular]
27 Management-General Measures Address needs of the patient as a whole Consider lifestyle,mobility,occupation Elevation of legs Prop bed up by 10-15% D Naik MBchB FRACS DDU [Vascular]
28 Management- Adjuvant Pharmacotherapy Only in addition to compression Agents include :fibrinolytic agents fibrinolysis-enhancing hydroxyrutosides pentoxifylline prostaglandin E systemic antibiotics diuretics D Naik MBchB FRACS DDU [Vascular]
29
30
31 Management - Dressings Choice is a matter of clinical judgement Insufficient clinical trials to allow recommendation D Naik MBchB FRACS DDU [Vascular]
32 The Ideal Dressing Reduce ulcer pain Allow excess exudate to escape Be non-allergenic Easy to change without discomfort Leave no dressing residue Inexpensive Easy to apply D Naik MBchB FRACS DDU [Vascular]
33 Management-Compression Ambulant patients need bandages or stockings mm Hg at ankle Graduated Sustained compression D Naik MBchB FRACS DDU [Vascular]
34 Ideal Compression Bandaging System Gradient of pressure Even pressure over anatomical contours Maintains pressure Remains in position Complements dressing functions Non-irritant and non-allergenic Comfortable Washable D Naik MBchB FRACS DDU [Vascular]
35 Venous Ulceration 50-70% of venous ulceration is secondary to primary varicose veins and is curable with relatively simple venous interventions D Naik MBchB FRACS DDU [Vascular]
36 Management of Venous Incompetence Compression Saphenous ablation chemical radiofrequency laser surgery D Naik MBchB FRACS DDU [Vascular]
37 D Naik MBchB FRACS DDU [Vascular]
38 D Naik MBchB FRACS DDU [Vascular]
39 Epidemiology Disease of Western civilisation 10-20% men and 67% of adult women have physically identifiable varicosities Varicose veins range from venectasia or telangiectasia to protuberant tortuous varicosities D Naik MBchB FRACS DDU [Vascular]
40 Primary Varicose Veins Great Saphenous Small Saphenous Perforator veins D Naik MBchB FRACS DDU [Vascular]
41 Secondary Varicose Veins A-V fistula Deep venous obstruction D Naik MBchB FRACS DDU [Vascular]
42 Investigation Duplex scan Venography CT venography D Naik MBchB FRACS DDU [Vascular]
43 Duplex Scanning Combination of ultrasound and Doppler Operator dependent Significantly improved our understanding and management of varicose veins Relatively cheap and non-invasive Mandatory prior to any major intervention D Naik MBchB FRACS DDU [Vascular]
44 D Naik MBchB FRACS DDU [Vascular]
45 Complications Bleeding Eczema Superficial thrombophlebitis Ulceration Deep vein thrombosis D Naik MBchB FRACS DDU [Vascular]
46 Every treatment has pros and cons and informed consent should include discussion about all options of management
47 Management Conservative Sclerotherapy Non-surgical saphenous ablation Chemical Radiofrequency Laser Surgery D Naik MBchB FRACS DDU [Vascular]
48 Conservative treatment Weight loss Exercise Compression hosiery D Naik MBchB FRACS DDU [Vascular]
49 Local Sclerotherapy Simple office procedure Good results in appropriately selected patients May buy time Cheapest option D Naik MBchB FRACS DDU [Vascular]
50 Ultrasound Guided Sclerotherapy [UGS] Minimally invasive Poor results in large veins Good option in selected patients Systemic effects of sclerosants unknown May require multiple treatments Phlebitis and brown staining an issue Poor long-term results D Naik MBchB FRACS DDU [Vascular]
51 D Naik MBchB FRACS DDU [Vascular]
52 D Naik MBchB FRACS DDU [Vascular]
53 Endovenous Laser Therapy First described by Bone in 1999 Diode laser forms steam bubbles in blood leading to endothelial damage,coagulative necrosis and thrombotic occlusion of vein Requires tumescent anaesthesia Deals with saphenous trunks only Requires adjunctive procedures for varices Early results favourable Day procedure D Naik MBchB FRACS DDU [Vascular]
54 D Naik MBchB FRACS DDU [Vascular]
55 Radiofrequency Ablation First described by Goldman in 2000 Heat generated by radiofrequency probe causes local heating of vein wall Requires tumescent anaesthesia Deals with saphenous trunks only Requires adjunctive procedures for varices Day procedure D Naik MBchB FRACS DDU [Vascular]
56 Management Surgical Therapy Varicose vein surgery Valvuloplasty Venous cuffs Venous bypass SSG Flaps D Naik MBchB FRACS DDU [Vascular]
57 Surgery Still regarded as the gold standard Excellent results if performed well Requires anaesthesia,cuts and more recovery Neovascularisation in less than 7% Cutaneous nerve injury and leg swelling are issues Good long-term results Everything treated in one hit D Naik MBchB FRACS DDU [Vascular]
58 D Naik MBchB FRACS DDU [Vascular]
59 D Naik MBchB FRACS DDU [Vascular]
60 D Naik MBchB FRACS DDU [Vascular]
61 Complications of Venous Interventions Complicatio EVLT RFA SURGERY ns Bruising Pain Parathesia Phlebitis Haemotom a Burns Infection 0-3 D Naik MBchB FRACS 0-20 DDU [Vascular] 2-15
62 Management of Varicose Veins UGS EVLT/RF SURGERY Invasion Cost Discomfort Recovery Recurrence +++?? + D Naik MBchB FRACS DDU [Vascular]
63
64
65 D Naik MBchB FRACS DDU [Vascular]
66 Äetiology of Arterial Occlusive Disease Atherosclerosis Emboli Arterial dissection Arteritis Aneurysms Arterial trauma Entrapment syndromes Adventitial cystic disease Vascular tumours D Naik MBchB FRACS DDU [Vascular]
67 Epidemiology of PAD Affects 12-14% of the general population Affects upto 20% of patients over 75 Coexistent coronary artery disease and cerebrovascular disease are highly prevalent in patients with PAD D Naik MBchB FRACS DDU [Vascular]
68 Natural History Relative benign % no change or improvement over 5 years 25% get worse over 5 years and require intervention Less than 12% end up with amputation D Naik MBchB FRACS DDU [Vascular]
69 History Location Duration Progress Distance Time for relief Associated rest pain D Naik MBchB FRACS DDU [Vascular]
70 Management of Arterial Ulcers Duplex scanning Arteriography Angioplasty/stent Vascular reconstruction Debridement Skin grafting D Naik MBchB FRACS DDU [Vascular]
71 Rest pain Pain felt in the distal forefoot which is exacerbated by elevation
72 Examination Arterial palpation Bruits Pallor Rubor Temperature Tissue loss Integumentary changes ABI D Naik MBchB FRACS DDU [Vascular]
73 Interpreting Doppler Readings >1 Normal arterial flow 0.9 Mild degree of arterial involvement 0.8 Lowest level at which compression can be safely applied 0.7 Significant arterial disease is present and full compression should not be used 0.5 Limb is at risk and urgent vascular opinion should be sought D Naik MBchB FRACS DDU [Vascular]
74 Non-invasive Vascular Tests Exercise ABI Pressure studies Duplex scanning Ultrasound Doppler Spectral analysis D Naik MBchB FRACS DDU [Vascular]
75 ABI Right Leg Left Leg Exe rcis e Per iod Rest Minutes Post Exercise D Naik MBchB FRACS DDU [Vascular]
76 D Naik MBchB FRACS DDU [Vascular]
77 Invasive studies CT angiography MR angiography Digital subtraction angiography D Naik MBchB FRACS DDU [Vascular]
78
79
80 D Naik MBchB FRACS DDU [Vascular]
81 D Naik MBchB FRACS DDU [Vascular]
82 D Naik MBchB FRACS DDU [Vascular]
83 D Naik MBchB FRACS DDU [Vascular]
84 Best Medical Therapy Smoking Antiplatelet therapy Hypertension Diabetes Hyperlipidaemia Statin Cilastozol,Trental Exercise D Naik MBchB FRACS DDU [Vascular]
85 Endovascular Treatment Angioplasty Stenting Atherectomy Thombolysis D Naik MBchB FRACS DDU [Vascular]
86 D Naik MBchB FRACS DDU [Vascular]
87 Angioplasty Best in big arteries with short stenoses Results below inguinal ligament best in focal lesions Short occlusions Myointimal hyperplasia affects results Greater role in high risk patients D Naik MBchB FRACS DDU [Vascular]
88 D Naik MBchB FRACS DDU [Vascular]
89 Stenting Good long term results in iliac arteries Results below the inguinal ligament less durable Stent fracture an issue in mobile arteries Myointimal hyperplasia and in stent restenosis affect durability D Naik MBchB FRACS DDU [Vascular]
90 Surgical Treatment Aortoiliofemoral interventions Femoropopliteal reconstructions Distal arterial reconstruction Sympathectomy Amputation D Naik MBchB FRACS DDU [Vascular]
91 Surgical outcomes Improved outcomes with better peri-operative care and surgical techniques Operative mortality about 2-3 % Synthetic grafts work well in the aorta and iliacs but autologous grafts preferred below the infra-inguinal ligament 5 year patency rates about 70-80% and limb salvage rates 80-90% Appropriate work up prior to surgery essential D Naik MBchB FRACS DDU [Vascular]
92 Endovascular or Surgery? BASIL trial Life expectancy greater than 2 years limb salvage greater and mortality lower in surgery patients Role of stenting still undefined but long-term patency and cost effectiveness remain an issue D Naik MBchB FRACS DDU [Vascular]
93 D Naik MBchB FRACS DDU [Vascular]
94 D Naik MBchB FRACS DDU [Vascular]
95 D Naik MBchB FRACS DDU [Vascular]
96 D Naik MBchB FRACS DDU [Vascular]
97 D Naik MBchB FRACS DDU [Vascular]
98 D Naik MBchB FRACS DDU [Vascular]
99 D Naik MBchB FRACS DDU [Vascular]
100 D Naik MBchB FRACS DDU [Vascular]
101 D Naik MBchB FRACS DDU [Vascular]
102 Ulcers When to refer Pain Infection Absent pulses ABI < 0.8 Refractory ulcers Cellulitis Deteriorating ulcers D Naik MBchB FRACS DDU [Vascular]
103 Conclusion Aetiology of lower limb ulcers is often multifactorial Management of leg ulcers should include an assessment and management of aetiological factors Current management of vascular patients involves tailoring intervention according to the clinical and risk profile of the patient
Management of Lower Limb Ulcers. D. NAIK MBChB FRACS DDU
Management of Lower Limb Ulcers D. NAIK MBChB FRACS DDU Ulcer A defect in the epithelium A failure to heal Ulcer Aetiology of Leg Ulcers Venous insufficiency Macrovascular arterial insufficiency Infectious
How to manage leg ulcers in the elderly
How to manage leg ulcers in the elderly David Riding Clinical Research Fellow / Specialty Registrar in Vascular Surgery University of Manchester / MFT British Geriatric Society Trainees Meeting 2018 Objectives
VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT
VASCULAR WOUNDS PATHOPHYSIOLOGY AND MANAGEMENT Lucy Stopher, A/CNS Vascular Surgery ...it is best to think of a wound not as a disease, but rather as a manifestation of disease. Joe McCulloch In order
Chronic Venous Insufficiency Compression and Beyond
Disclosure of Conflict of Interest Chronic Venous Insufficiency Compression and Beyond Shawn Amyot, MD, CCFP Fellow of the Canadian Society of Phlebology Ottawa Vein Centre I do not have relevant financial
Priorities Forum Statement
Priorities Forum Statement Number 9 Subject Varicose Vein Surgery Date of decision September 2014 Date refreshed March 2017 Date of review September 2018 Relevant OPCS codes: L841-46, L848-49, L851-53,
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS
VASCULAR DISEASE: THREE THINGS YOU SHOULD KNOW JAMES A.M. SMITH, D.O. KANSAS VASCULAR MEDICINE, P.A. WICHITA, KANSAS KANSAS ASSOCIATION OF OSTEOPATHIC MEDICINE ANNUAL CME CONVENTION APRIL 13, 2018 THREE
The role of ultrasound duplex in endovenous procedures
The role of ultrasound duplex in endovenous procedures Neophytos A. Zambas MD, PhD Vascular Surgeon Polyclinic Ygia, Limassol, Cyprus ΚΕΑΕΧ ΚΥΠΡΙΑΚΗ ΕΤΑΙΡΕΙΑ ΑΓΓΕΙΑΚΗΣ ΚΑΙ ΕΝΔΑΓΓΕΙΑΚΗΣ ΧΕΙΡΟΥΡΓΙΚΗΣ Pre
PROVIDER POLICIES & PROCEDURES
PROVIDER POLICIES & PROCEDURES TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES STAB PHLEBECTOMY AND SCLEROTHERAPY TREATMENT The primary purpose of this document is to assist providers enrolled in
Vein Disease Treatment
MP9241 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated in 2.0, 3.0, 4.0 and 5.0 Additional Information: None Prevea360 Health Plan Medical Policy: Vein disease
Chapter 4 Section 9.1
Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33200-37186, 37195-37785, 92950-93272, 93303-93581,
BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8
BC Vascular Day Contents Abdominal Aortic Aneurysm 2 3 November 3, 2018 Peripheral Arterial Disease 4 6 Deep Venous Thrombosis 7 8 Abdominal Aortic Aneurysm Conservative Management Risk factor modification
Venous Insufficiency Ulcers. Patient Assessment: Superficial varicosities. Evidence of healed ulcers. Dermatitis. Normal ABI.
Venous Insufficiency Ulcers Patient Assessment: Superficial varicosities Evidence of healed ulcers Dermatitis Normal ABI Edema Eczematous skin changes 1. Scaling 2. Pruritus 3. Erythema 4. Vesicles Lipodermatosclerosis
Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:
E S Insurance: 2 nd Insurance: Wait time: Date: A. Venous Health History Form Patient please complete questions 1-12 Patient Name: SSN#: Date of Birth: Primary Care Physician: What is the reason for your
New Guideline in venous ulcer treatment: dressing, medication, intervention
New Guideline in venous ulcer treatment: dressing, medication, intervention Kittipan Rerkasem, FRCS(T), PhD Department of Surgery Faculty of Medicine Chiang Mai University Topic Overview venous ulcer treatment
Jordan M. Garrison, MD FACS, FASMBS
Jordan M. Garrison, MD FACS, FASMBS Peripheral Arterial Disease (PAD) Near or Complete obstruction of > 1 Peripheral Artery Peripheral Venous reflux Disease Varicose Veins Chronic Venous Stasis Ulcer Disease
Introduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
Chapter 4 Section 9.1
Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33361-33369, 33200-37186, 37195-37785, 92950-93272,
TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY
TREATMENT OPTIONS FOR CHRONIC VENOUS INSUFFICIENCY TL LUK Consultant Vascular Surgeon Sarawak General Hospital HKL Vascular Conference 19/06/2013 PREVALENCE OF LOWER LIMB VENOUS DISEASE Affects half of
The Use of Adjunctive Venography and Endovascular Manoeuvres In The Treatment of Saphenous Vein Insufficiency. A Prospective, Multi-centre Study
The Use of Adjunctive Venography and Endovascular Manoeuvres In The Treatment of Saphenous Vein Insufficiency A Prospective, Multi-centre Study Ramon L. Varcoe, MBBS, MS, FRACS, PhD Associate Professor
OHTAC Recommendation. Endovascular Laser Treatment for Varicose Veins. Presented to the Ontario Health Technology Advisory Committee in November 2009
OHTAC Recommendation Endovascular Laser Treatment for Varicose Veins Presented to the Ontario Health Technology Advisory Committee in November 2009 April 2010 Issue Background The Ontario Health Technology
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: MP.066.MH Last Review Date: 11/08/2018 Effective Date: 01/01/2019
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL This policy applies to the following lines of business: MedStar Employee (Select) MedStar CareFirst PPO MedStar Health considers the treatment of Varicose
Leg ulcer assessment and management
Leg ulceration The views expressed in this presentation are solely those of the presenter and do not necessarily represent the views of Smith & Nephew. Smith & Nephew does not guarantee the accuracy or
Role of free tissue transfer in management of chronic venous ulcer
Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI?
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Peter F. Lawrence, M.D. Gonda Vascular Center Division of Vascular Surgery
Promoting best practice in leg ulcer management
Promoting best practice in leg ulcer management Sylvie Hampton MA BSc (Hons) DpSN RGN Independent Tissue Viability Consultant Nurse Leg Ulcers - What are the causes? Chronic leg ulcers are defined as those
Varicose Vein Surgery
What are varicose veins? Varicose veins are enlarged and twisted veins in your leg. Varicose veins are common, affecting up to 3 in 10 people. Varicose veins tend to run in families and are made worse
ULCERS 1/12/ million diabetics in the US (2012) Reamputation Rate 26.7% at 1 year 48.3% at 3 years 60.7% at 5 years
Jay Christensen D.P.M Advanced Foot and Ankle of Wisconsin 2-4% of the population at any given time will have ulcers 0.06-0.20% of the total population Average age of patients 70 years increased as more
Starting with deep venous treatment
Starting with deep venous treatment Carsten Arnoldussen, MD Interventional Radiologist Maastricht University Medical Centre, Maastricht VieCuri Medical Centre, Venlo The Netherlands Background Maastricht
Additional Information S-55
Additional Information S-55 Network providers are encouraged, but not required to participate in the on-line American Venous Forum Registry (AVR) - The First National Registry for the Treatment of Varicose
Date: A. Venous Health History Form. Patient please complete questions Primary Care Physician:
E S Insurance: 2 nd Insurance: Wait time: Date: A. Venous Health History Form Patient please complete questions 1-12 Patient Name: SSN#: Date of Birth: Primary Care Physician: What is the reason for your
RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY
RECOGNITION AND ENDOVASCULAR TREATMENT OF CHRONIC VENOUS INSUFFICIENCY Paul Kramer, MD, FACC, FSCAI Liberty Cardiovascular Specialists Liberty Regional Heart and Vascular Center DISCLOSURES NONE Venous
BC Vascular Surgery Day
BC Vascular Surgery Day November 4, 2017 1 Table of Contents Abdominal Aortic Aneurysm 3 4 Acute DVT 5 6 Peripheral Arterial Disease 7 9 Varicose Veins 10 11 Diabetic Foot Ulcers 12 13 Carotid Stenosis
Prevention and Management of Leg Ulcers
EWMA Educational Development Programme Curriculum Development Project Education Module: Prevention and Management of Leg Ulcers Latest revision: October 2015 ABOUT THE EWMA EDUCATIONAL DEVELOPMENT PROGRAMME
PRODIGY Quick Reference Guide
PRODIGY Quick Venous leg ulcer infected How do I assess a venous leg ulcer? Chronic venous insufficiency and venous hypertension result from damage to the valves in the veins of the leg and inadequate
COMMISSIONING POLICY
Ref No. 1a7.5 COMMISSIONING POLICY Surgery for venous disease of the leg (Varicosities of the Long Saphenous Vein) April 2011 CONTENTS Section Page Summary 2 1. Background 2 2. Criteria for eligibility
Will it heal? How to assess the probability of wound healing
Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male
Features compression after open and endovascular operation in vascular malformation
Features compression after open and endovascular operation in vascular malformation Sapelkin Sergey Institute of Surgery named A.V. Vishnevsky, Moscow, Russia 21.10.2017 CIRC Meeting, Grassau AV-malformations:
Surgical Options for revascularisation P E T E R S U B R A M A N I A M
Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation
Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia
Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia Albeir Mousa, MD., FACS.,MPH., MBA Professor of Vascular and Endovascular Surgery West Virginia University Disclosure None What you
Criteria For Medicare Members. Kaiser Foundation Health Plan of Washington
Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure
Peripheral Arterial Disease: Who has it and what to do about it?
Peripheral Arterial Disease: Who has it and what to do about it? Seth Krauss, M.D. Alaska Annual Nurse Practitioner Conference September 16, 2011 Scope of the Problem Incidence: 20%
All WALES LYMPHOEDEMA GUIDANCE:
All WALES LYMPHOEDEMA GUIDANCE: Lymphoedema Vascular Assessment Policy (Toe Brachial Pressure Index / TBPI) April 2013 Created by the All Wales Lymphoedema Service Leads 1 Background The presence of peripheral
How varicose veins occur
Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from groin to ankle. Spider veins are smaller, flatter, red or purple veins closer
Recommendations for Follow-up After Vascular Surgery Arterial Procedures SVS Practice Guidelines
Recommendations for Follow-up After Vascular Surgery Arterial Procedures 2018 SVS Practice Guidelines vsweb.org/svsguidelines About the guidelines Published in the July 2018 issue of Journal of Vascular
Current Management of Varicose Veins
Current Management of Varicose Veins Michael J. Heidenreich, MD St. Joseph Mercy Hospital Ann Arbor, MI March 23, 2013 Nothing to disclose History Prevalence Anatomy Risk factors Clinical manifestations
PUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
Medicare C/D Medical Coverage Policy
Varicose Vein Treatment Medicare C/D Medical Coverage Policy Origination Date: June 1, 1993 Review Date: February 15, 2017 Next Review: February, 2019 DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins
Objectives. Abdominal Aortic Aneuryms 11/16/2017. The Vascular Patient: Diagnosis and Conservative Treatment
The Vascular Patient: Diagnosis and Conservative Treatment Ferrell-Duncan Clinic Zachary C. Schmittling, M.D., F.A.C.S. Vascular and General Surgery Ferrell-Duncan Clinic Cox Health Systems Objectives
Introduction to Saphenous Vein Ablations: When/Why/How?
John Ligush, MD SMJH Vascular and Vein Center Introduction to Saphenous Vein Ablations: When/Why/How? Saphenous Vein Ablations: When/Why/How? Venous disease is easy Treatment is straightforward The patients
Lower Limb Venous Ultrasound. Colin P. Griffin MSc, BSc (Hons)
Lower Limb Venous Ultrasound Colin P. Griffin MSc, BSc (Hons) Peripheral Vessels Lower Limb Peripheral Vessels Lower Limb Venous Deep System Common Iliac External/Internal Iliac Common Femoral Femoral
Chapter 4 Section 9.1
Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33361-33369, 33200-37186, 37195-37785, 92950-93272,
Peripheral Arterial Disease Extremity
Peripheral Arterial Disease Lower Extremity 05 Contributor Dr Steven Chong Advisors Dr Ashish Anil Dr Tay Jam Chin Introduction Risk Factors Clinical Presentation Classification History PHYSICAL examination
When general causes such as cardiac or renal failure and hypoproteinaemia (which tend to affect both legs) have
Part One: Assessment and Diagnosis THE REDISTRIBUTION OF FLUID FROM THE ARTERIAL END OF THE CAPILLARY TO THE VENOUS END (STARLING'S LAW) IS THE MECHANISM UNDERLYING ALMOST ALL CASES OF LIMB OEDEMA. This
Reality TV Managing patients in the real world. Wounds UK Harrogate 2009
Reality TV Managing patients in the real world Wounds UK Harrogate 2009 Reality TV Managing patients in the real world Brenda M King Nurse Consultant Tissue Viability Sheffield PCT Harrogate 2009 Familiar
AWMA MODULE ACCREDITATION. Module Three: Assessment and Management of Lower Leg Ulceration
AWMA MODULE ACCREDITATION Module Three: Assessment and Management of Lower Leg Ulceration Introduction - The Australian Wound Management Association Education & Professional Development Sub Committee-(AWMA
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
Chronic Iliocaval Venous Occlusive Disease
none Chronic Iliocaval Venous Occlusive Disease David Rigberg, M.D. Clinical Professor of Surgery Division of Vascular Surgery University of California Los Angeles Chronic Venous Occlusive Disease Chronic
Wound Classification. Overview
Overview Jeffrey A. Niezgoda, MD FACHM, MAPWCA, CHWS Review of Initial Wound Care Consultation Rational for Classification Wound Appearance Wound Etiology Management Algorithms Initial Wound Care Consult
Case study: A targeted approach to healing complex wounds using the geko device.
Case study: A targeted approach to healing complex wounds using the geko device. Authors: Mr Sameh Dimitri Consultant Vascular and Endovascular Surgeon MSc FRCS (Eng Edin) Nikki Pavey Physiotherapist at
Conflict of Interest. None
Conflict of Interest None American Venous Forum Guidelines on Superficial Venous Disease TOP 10 GUIDELINES 10. We recommend using the CEAP classification to describe chronic venous disorders. (GRADE 1B)
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN.
How to choose which treatment method(s) to use for a particular varicose veins patient ESTABLISHING A TREATMENT PLAN Surgeon Dr G Mark Malouf Sydney Australia Following History and Physical examination
Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins
Vascular Surgery Vascular surgery is a specialty that deals with diseases of the vascular system (i.e. arteries, veins and lymphatics). These are managed by medical therapy, interventional procedures,
National Vascular Registry
National Vascular Registry Angioplasty Patient Details Patient Consent* 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s) or
Imaging Strategy For Claudication
Who are the Debators? Imaging Strategy For Claudication Duplex Ultrasound Alone is Adequate to Select Patients for Endovascular Intervention - Pro: Dennis Bandyk MD No Disclosures PRO - Vascular Surgeon
A A U
PVD Venous AUC Rating Sheet 2nd Round 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Median I NI MADM Rating Agree Disagree Upper Extremity Venous Evaluation Table 1. Venous Duplex of the Upper Extremities for Patency
Identification and recommended management of leg ulcers Jill Robson RGN and Gerard Stansby MA, MChir, FRCS
Identification and recommended management of leg ulcers Jill Robson RGN and Gerard Stansby MA, MChir, FRCS thickened skin, lipodermatosclerosis skin stained haemosiderin shallow ulcer irregular shape Our
Patient Brochure. Clearstream Technologies, Ltd. Moyne Upper Enniscorthy Co. Wexford, Ireland. PK Rev. 0 05/17
Patient Brochure Clearstream Technologies, Ltd. Moyne Upper Enniscorthy Co. Wexford, Ireland PK1411100 Rev. 0 05/17 LIFESTREAM Patient Brochure If you or a member of your family has been diagnosed with
Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach.
Management of Venous Disease: an evidence based approach Disclosures Ed Boyle, MD Andrew Jones, MD Dr. Ed Boyle and Dr. Andrew Jones disclose Grants/research support: Medtronic, BTG International, Clearflow,
Venous Disease and Leg Ulcers. Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL
Venous Disease and Leg Ulcers Edward G Mackay MD St. Petersburg, FL NCVH 2015 Orlando, FL Disclosures Stocks Endoshape Sapheon Medical Advisory Board BTG, Boston Scientific Venous Leg Ulcer Most common
Arterial & Venous Ulcers. A Comprehensive Review Assessment & Management
Arterial & Venous Ulcers A Comprehensive Review Assessment & Management 1 Objectives Understand Arterial & Venous disease Understand the etiology of lower extremities ulcers Understand assessment of lower
Dr Peter Chapman-Smith
Dr Peter Chapman-Smith Phlebologist NZ Stem Cell Treatment Centre, Whangarei 12:00-12:30 Healing Those Heartsink Leg Ulcers Healing Those Heartsink Leg Ulcers Practice Nurses Presentation GPCME Christchurch
Varicose Veins. These are abnormal veins in the legs that appear as unsightly or cause other problems.
Varicose Veins What are varicose veins? These are abnormal veins in the legs that appear as unsightly or cause other problems. They develop due to abnormal valve function that allows the blood to travel
Varicose veins. Information for patients Sheffield Vascular Institute
Varicose veins Information for patients Sheffield Vascular Institute You have been diagnosed as having varicose veins. This leaflet explains more about varicose veins and answers some of the most frequently
Selection and work up for the right patients suspected of deep venous disease
Selection and work up for the right patients suspected of deep venous disease R A G H U K O L L U R I, M S, M D, R V T S Y S T E M M E D I C A L D I R E C T O R V A S C U L A R M E D I C I N E / V A S
Varicose Veins What Are They? Sclerotherapy in the Treatment of Venous Disease Zachary C. Schmittling, MD, FACS May 4, 2018
Sclerotherapy in the Treatment of Venous Disease Zachary C. Schmittling, MD, FACS May 4, 2018 Sclerotherapy for Venous Disease: Overview 1 in 5 Americans Approximately 25% of women have some type of lower
Venous Leg Ulcers. Care for Patients in All Settings
Venous Leg Ulcers Care for Patients in All Settings Summary This quality standard focuses on care for people who have developed or are at risk of developing a venous leg ulcer. The scope of the standard
DISORDERS OF VENOUS SYSTEM
DISORDERS OF VENOUS SYSTEM Varicose Veins Any dilated, elongated and tortuous vein irrespective of size Varicose veins are common in the superficial veins of the leg which are subject to high pressure
Endothermal Ablation for Venous Insufficiency. Dr. S. Kundu Medical Director The Vein Institute of Toronto
Endothermal Ablation for Venous Insufficiency Dr. S. Kundu Medical Director The Vein Institute of Toronto Objective: remove the GSV from the circulation 1. Surgical - HL & stripping 2. Chemical sclerotherapy
Intervention for Lower Extremity PAD: When, why and what?! Robert F Cuff, MD FACS RVT RPVI
Intervention for Lower Extremity PAD: When, why and what?! Robert F Cuff, MD FACS RVT RPVI 1 Disclosures I have no financial disclosures related to this talk Objectives 1. Discuss indications for intervention
SVS AVF Clinical Practice Guidelines Venous Ulcer
Venous Ulcer SVS AVF Venous Ulcer Clinical Practice Guidelines Task Force Multispecialty committee members Thomas F. O Donnell, Jr., MD (Chair), Marc A. Passman, MD (Vice Chair), William A. Marston, MD,
Varicose Vein Cyanoacrylate Glue treatment
The South West s premier independent healthcare and cosmetic clinic Varicose Vein Cyanoacrylate Glue treatment Varicose veins are a sign of underlying venous insufficiency and affect 20 30% of adults.
Vascular Surgery Rotation Objectives for Junior Residents (PGY-1 and 2)
Vascular Surgery Rotation Objectives for Junior Residents (PGY-1 and 2) Definition Vascular surgery is the specialty concerned with the diagnosis and management of congenital and acquired diseases of the
Determine the patients relative risk of thrombosis. Be confident that you have had a meaningful discussion with the patient.
Patient Assessment :Venous History, Examination and Introduction to Doppler and PPG Dr Louis Loizou The 11 th Annual Scientific Meeting and Workshops of the Australasian College of Phlebology Tuesday 18
PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE
PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE VARICOSE VEINS OF SUPERFICIAL VENOUS SYSTEM OF LOWER LIMBS A SYMPTOM NOT A DISEASE INITIAL,MILD CASES and severe cases with contraindication
2017 Florida Vascular Society
Current Management of Venous Leg Ulcers: How to Identify Patients with Correctable Venous Disease and Interventional Procedures to Heal and Prevent Recurrence 2017 Florida Vascular Society Bill Marston
Practical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
Boca Raton Regional Hospital Grand Rounds September 13, 2016
Boca Raton Regional Hospital Grand Rounds September 13, 2016 W. Anthony Lee, MD, FACS Chief, BocaCare Vascular Surgery Christine E. Lynn Heart and Vascular Institute Boca Raton, Florida Disclosures No
STEPHAN MOSTOWY BSc, MD, FRCS (C) Endovascular/Vascular Surgeon Kelowna General Hospital
STEPHAN MOSTOWY BSc, MD, FRCS (C) Endovascular/Vascular Surgeon Kelowna General Hospital Faculty/Presenter Disclosure Faculty: Dr. Stephan Mostowy Relationships with financial sponsors: NONE From head
Appendix 1 to Direct Vision Sclerotherapy AUSTRALASIAN COLLEGE OF PHLEBOLOGY CLINICAL PROCEDURES. CP Direct Vision Sclerotherapy Clinical procedure
Appendix 1 to Direct Vision Sclerotherapy AUSTRALASIAN COLLEGE OF PHLEBOLOGY CLINICAL PROCEDURES CP Direct Vision Sclerotherapy Clinical procedure 1 PURPOSE This procedure summarises the actions required
Intercepting PAD. Playbook for Cardiovascular Care 2018 February 24, Jonathan D Woody, MD, FACS. University Surgical Vascular
Intercepting PAD Playbook for Cardiovascular Care 2018 February 24, 2018 Jonathan D Woody, MD, FACS University Surgical Vascular Attending Vascular Surgeon - Piedmont Athens Regional Adjunct Clinical Associate
Current Vascular and Endovascular Management in Diabetic Vasculopathy
Current Vascular and Endovascular Management in Diabetic Vasculopathy Yang-Jin Park Associate professor Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Peripheral artery
The Struggle to Manage Stroke, Aneurysm and PAD
The Struggle to Manage Stroke, Aneurysm and PAD In this article, Dr. Salvian examines the management of peripheral arterial disease, aortic aneurysmal disease and cerebrovascular disease from symptomatology
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists
EVALUATION OF THE VASCULAR STATUS OF DIABETIC WOUNDS Travis Littman, MD NorthWest Surgical Specialists Nothing To Disclosure DISCLOSURES I have no outside conflicts of interest, financial incentives, or
Wound Care Medicine. Gaston Dana D.O.
Wound Care Medicine Gaston Dana D.O. Financial Disclosures Siemens Healthcare Toshiba Medical Systems Inc. Philips Healthcare Carestream Health GE Healthcare Shimadzu Corporation Global Health Corporation
Varicose Veins Operation. Patient Information Leaflet
Varicose Veins Operation Patient Information Leaflet April 2017 1 WHAT IS VARICOSE VEIN SURGERY (HIGH LIGATION AND MULTIPLE AVULSIONS) The operation varies from case to case, depending on where the leaky
Schedule of Benefits. for Professional Fees Vascular Procedures
Schedule of Benefits for Professional Fees 2018 Vascular Procedures ANASTOMOSIS RULES 820 Arteriovenous anastomosis in arm 1453 Arteriovenous anastomosis, open by basilic vein transposition 1465 Splenorenal
Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue)
Treatment of Venous ulcers utilizing n-butyl Cyanoacrylate (Super Glue) Awais Siddique MD Endovascular Radiologist AZH WAVE CENTERS Milwaukee WI Venous disease Etiology Are the result of Venous valvular
Indications: following: embolization. artery that has diseases 5. The evaluation. of suspected. such entities. a cold hand. biopsy
Peripheral Arterial Ultrasound Protocol Using Color and Spectral Doppler Reviewed by: Mark Yuhasz, MD Last Review Date: January 2015 Contact: (866) 761 4200, Option 1 Indications: The indications for peripheral
Venous interventions in DVT
Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute