lipodermatosclerosis standards of medical practitioners and the quality of patient care related to the treatment of venous disorders.

Transcription

1 Chattanooga s premiere VEIN CENTER Update on Venous Insufficiency, Varicose and Spider Veins 2016 Vincent W. Gardner, MD, FACS, RPVI Fellow, American College of Surgeons Board Certified, American Board of Surgery Diplomate, American Board of Venous &Lymphatic Medicine Diplomate, American Board of Cosmetic Surgery After Before PHLEBOLOGY The medical specialty devoted to the diagnosis and treatment of patients with venous disorders ABVLM The American Board of Venous & Lymphatic Medicine was established in 2007 to improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders. IMPORTANCE OF CHRONIC VENOUS DISEASE 1 in 22 or 4.5% or 12.2 million people in the USA are affected by varicose veins Incidence increases with age and is more common in women with over 40% of women in their 50 s suffering from some sort of venous disorder Across all ages and gender, 60% of Americans suffer from venous disease and its sequelae National Heart Lung and Blood Institute (NHLBI) American College of Phlebology THE SPECTRUM OF CHRONIC VENOUS DISEASE telangiectasias thrombophlebitis varicose veins Venous ulcer lipodermatosclerosis Prevalence of Varicose Veins Vein problems are most common chronic condition in North America Varicose Veins most common vein disorder 40 million Americans have varicose veins 1 15% men; 25% women More people lose work time from vein disorders than from arterial disease 2 1 Society for Vascular Surgery 2 Vascular Disease Foundation Newsletter, Spring 2005; Vol 5. ACP

2 Presenting Symptoms of Chronic Venous Disease Pain Aching, throbbing, burning, stabbing, cramping. Swelling (peripheral edema) Varicosities Varicose, telangiectasia(spider), reticular. Restless legs Numbness Fatigue, heaviness in legs Itching Bleeding Skin changes...ulcer. Anatomy & Physiology The Circulatory System The Heart is the main pump to get oxygenated blood to tissues via the arteries The Calf muscle is the main pump to get blood back to the heart via the veins Venous vs. Arterial INTERNAL STRUCTURE Vein Artery Adventitia Layer Media Layer Intima Layer The Significance of Veins The venous system contains Most of the blood Veins 60-70% Lungs 10-12% most of the blood as it moves through the circulatory system. 40% in the legs!!! The rest of the blood Heart 8-11% Arteries 10-12% Capillaries 4-5% Source: Hole s Human Anatomy and Physiology, 7 th Edition, 1996, ACP. Three Systems of Veins Think of a Roadmap! Deep Superficial Perforating/ communicator

3 Veins of the Superficial System Great Saphenous Vein & Tributaries Small Saphenous Vein S Normal Valve Function VEIN ANATOMY Valve Open Blood flows toward heart Valve Closed Prevents blood from reverse flow 1 5 Venous Pressure at the Ankle Normal vs. Defective Difference mmhg Ambulatory Venous Hypertension

4 Great Saphenous Vein Deep Vein Perforating Veins Small Saphenous Vein Atlas of Vascular Surgery, Linton, Pathophysiology Vein Disease Chronic venous disease (Chronic) Venous insufficiency Venous reflux Venous (valvular) incompetence (Ambulatory) Venous hypertension Venous stasis disease Epidemiology: Who develops venous disease? Why do we have vein problems? Genetics Gender Aging Occupation Medical conditions Venous Disease is a Hereditary Disorder 134 families were examined The risk of developing varicose veins was: 89% if both parents had varicose veins 47% if one parent had varicose veins 20% if neither parent had varicose veins Cornu-Thenard, A, J DermatolSurg Oncol 1994 May; 20(5): ACP The beginnings of venous disease may be found as early as childhood 740 pts y/o 518 pts y/o 459 pts y/o Diagnosable Vein disease 2.5% 12.3% 19.8% Actual Varicose Veins 0 1.7% 3.3% Phlebologie Nov-Dec;43(4): Weindorf N, Schultz-Ehrenburg U, ACP.

5 Inactivity aggravates venous disease 2854 patients with varicose veins, working in a factory 64.5% had jobs standing in one place 29.2% had jobs requiring prolonged periods of sitting 6.3% had jobs allowing frequent walking during their shift Santler, R Hautarzt 1956; 10:460, ACP Varicose Veins are 3 times more common in women than men Varicose veins." The Mayo Clinic. January ACP. Each pregnancy worsens the condition 405 women with varicose veins 13% had one pregnancy 30% had two pregnancies 57% had three pregnancies Brand FN, et al The epidemiology of varicose veins: the Framingham Study Am J Prev Med 1988; 4:96-101, ACP. Restless Leg Syndrome 35 pts with RLS/CVI. Post treatment -53% alleviated symptoms. -31% complete relief.

6 Notes from this Presentation:

7