Springer London Berlin Heidelberg New York Barcelona Budapest Hong Kong Milan Paris Santa Clara Singapore Tokyo

Transcription

1 Venous Disease

2 Springer London Berlin Heidelberg New York Barcelona Budapest Hong Kong Milan Paris Santa Clara Singapore Tokyo

3 Ruckley, Fowkes and Bradbury Venous Disease Epidemiology, Management and Delivery of Care, Springer

4 Charles Vaughan Ruckley, FRCS Ed Professor of Vascular Surgery, Vascular Surgery Office,,, Royal Infirmary of Edinburgh, Edinburgh, EH3 9YW Andrew Walter Bradbury, FRCS Ed Senior Lecturer,,, Royal Infirmary of Edinburgh, Edinburgh, EH3 9YW Francis Gerald Reid Fowkes, FRCS Ed Professor of Epidemiology, Wolfson Unit for Prevention of Peripheral Vascular Diseases, Department of Public Health Sciences,, Edinburgh, EH89AG lsbn-13: Springer-Verlag London Berlin Heidelberg British Library Cataloguing in Publication Data Venous Disease: Epidemiology, Management and Delivery of Care 1. Veins - Diseases - Epidemiology 2. Veins - Diseases - Diagnosis 3. Veins - Diseases - Treatment I. Ruckley, C.Y. (Charles Vaughan) II. Fowkes, F.G.R., III. Bradbury, Andrew Walter 616.1'4 lsbn-13: e-lsbn-13: DOl: / Library of Congress Cataloging-in-Publication Data Venous Disease: Epidemiology, Management and Delivery of Care 1 [Edited by] Ruckley, Fowkes and Bradbury. p. cm. Proceedings of a meeting sponsored by the Venous Forum of the Royal Society of Medicine, held Oct Includes bibliographical references and index. lsbn-13: Veins - Diseases - Congresses. I. Ruckley, C Vaughan. II. Fowkes, F.G.R., III. Bradbury. Andrew Walter, IY. Royal Society of Medicine (Great Britain). Venous Forum. [DNLM: 1. Vascular Diseases congresses. 2.Veins Congresses. WG 600V ] RC695.V '4-dc21 DNLM/DLC for Library of Congress Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. Springer-Verlag London Limited 1999 Softcover reprint of the hardcover 1st edition 1999 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by: The Midlands Book Typesetting Company 28/ Printed on acid-free paper

5 Contents Section I: Epidemiology and Aetiology 1 How Common Is Venous Disease in the General Population? C. ]. Evans, A. ]. Lee, C. V. Ruckley and F. G. R. Fowkes Leg Ulcer and Chronic Venous Insufficiency in the Community M. ]. Callam What Are the Risks of Thrombophilia? G. D. O. Lowe and A. Rumley Does Lifestyle Really Affect Venous Disease? A. ]. Lee, C. ]. Evans, C. V. Ruckley and F. G. R. Fowkes What Makes Veins Varicose? K. Burnand How Does a Leg Ulcerate? P. D. Coleridge-Smith Section II: Diagnosis and Measurement 7 How Should Venous Disease Be Classified? ]. ]. Bergan How Do We Select the Appropriate Tests of Venous Function? A. Nicolaides Imaging of Chronic Venous Disease P. L. Allan Venous Symptoms and Signs and the Results of Duplex Ultrasound: Do They Agree? A. W. Bradbury Section III: Clinical Management 11 Compression Therapy: Is It Worthwhile? H. Partsch What is the Place of Sclerotherapy? ]. H. Scurr Perforator Surgery: What Is Its Role? W. P. Stuart Can We Tailor Surgery to the Venous Abnormality? S. G. Darke v

6 vi Contents Section IV: Pri()rities for Treatment 15 Medical Treatment for Venous Diseases H. A. M. Neumann Telangiectasia: Is Treatment Worthwhile and Who Should Pay? A. Quaba Which Patients Should be Selected for Venous Surgery? C.R.R.Corbett NHS and Independent Provision of Varicose Vein Surgery: A Rational Basis for Case Selection D. D. I. Wright How Can Evidence on Treating Venous Disease be Rationalised? G. C. Leng, E. M. Royle and E G. R. Fowkes Section V: Delivery of Care 20 Should Every Patient with Chronic Venous Disease Have a Duplex Scan? D. C. Berridge and M. ]. Weston How To Run an Efficient Venous Service? N. ]. M. London, M. Bello and M. Scriven What Is the Scope of Day Care for Venous Surgery? I. E Lane and N. E. Bourantas Hospital or Community: How Should Leg Ulcer Care be Provided? D. A. Ellison and C. N. McCollum What Are the Costs of Treating Venous Disease? N. Bosanquet Section VI: Improving Outcomes 25 How Do We Prevent Recurrence of Varicose Veins? C. V. Ruckley and A. W. Bradbury How Can We Improve Outcomes for Leg Ulcer Patients? O. Nelzen Quality of Life for Leg Ulcer Patients P. ]. Franks Developing and Implementing Leg Ulcer Guidelines T. Gillies Index

7 Contributors Dr. P.L. Allan Senior Lecturer, Department of Medical Radiology Miss M. Bello Robert Kilpatrick Building Leicester Royal Infirmary Leicester LE2 7LX Professor John J. Bergan North Coast Surgeons 9850 Genessee Avenue Suite 560 La Jolla CA92037 USA Mr D.C. Berridge Consultant Vascular Surgeon Departments of Vascular and Endovascular Surgery and Radiology St James's and Seacroft University Hospitals Beckett Street Leeds LS9 7TF Professor Nick Bosanquet Professor of Health Policy Department of Primary Care Imperial College Norfolk Place London W2 IPG Dr. Nicholas E. Bourantas Specialist Registrar in Vascular Surgery Cardiff Vascular Unit University Hospital of Wales Cardiff CF4 4XW Mr Andrew W. Bradbury Vascular Surgery Unit University Royal Infirmary of Edinburgh Edinburgh EH3 9YW Professor K.G. Burnand St Thomas' Hospital Lambeth Palace Road London SEI 7EH Mr Michael J. Callam Consultant Surgeon Bedford General Hospital Kempston Road Bedford MK42 9DJ Mr Philip D. Coleridge-Smith University College London Medical School The Middlesex Hospital Mortimer Street London WIN IAA Mr. C.R.R.L. Corbett The Princess Royal Hospital Haywards Heath West Sussex RH16 4EX Mr Simon G. Darke Royal Bournemouth Hospital Castle Lane East Bournemouth BH7 7DW Dr Deborah Ellison Research Nurse Specialist South Manchester University Hospital Nell Lane West Didsbury Manchester M20 8LR vii

8 viii Dr. C.J. Evans Specialist Registrar in Public Health Medicine Dumfries and Galloway Health Board Grierson House The Crichton Bankend Road Dumfries DG 1 4ZG Professor F.G.R. Fowkes Professor of Epidemiology Wolfson Unit for Prevention of Peripheral Vascular Diseases Department of Public Health Sciences Dr. Peter J. Franks Co-director Centre for Research & Implementation of Clinical Practice Thames Valley University Wolfson Institute of Health Sciences Uxbridge Road London W5 2BS Dr. Tracey Gillies Specialist Registrar in Vascular Surgery Vascular Surgery Office Royal Infirmary of Edinburgh Lauriston Place EH3 9YW Mr Ian F. Lane Consultant Vascular Surgeon Cardiff Vascular Unit University Hospital of Wales Cardiff CF4 4XW Dr.A.J. Lee Research Statistician Wolfson Unit for Prevention of Peripheral Vascular Diseases Department of Public Health Sciences Dr. Gillian C. Leng Department of Public Health Sciences Professor N.J.M. London Robert Kilpatrick Building Leicester Royal Infirmary Leicester LE2 7LX Professor Gordon D.O. Lowe Professor of Vascular Medicine Uiversity Department of Medicine Royal Infirmary 10 Alexandra Parade Glasgow G312ER Professor Charles N. McCollum Professor of Sugery University South Manchester University Hospital Nell Lane West Didsbury Manchester M20 8LR Dr. Olle Nelzen Kiirnsjukhuset Skaraborg Hospital S SkOvde Sweden Professor H.A.M. Neumann Academisch Ziekenhuis Maastricht Department of Dermatology P.O. Box AZ Maastricht The Netherlands Professor Andrew Nicolaides Vascular Surgery Unit St Mary's Hospital Praed Street Paddington London W2 1NY Professor H. Partsch Dermatological Department of the Wilhelminen-Hospital A I 1 71 Vienna Austria Mr A.AQuaba Consultant Plastic Surgeon West Lothian NHS Trust St John's Hospital at Howden Howden Road West Livingston EH54 6PP Contributors

9 Contributors ix Dr. Elizabeth M. Royle Department of Public Health Sciences Professor C.Vaughan Ruddey Professor of Vascular Surgery Vascular Surgery Office Royal Infirmary of Edinburgh Lauriston Place EH3 9YW Dr. Ann Rumley Clinical Scientist University Department of Medicine Royal Infirmary 10 Alexandra Parade Glasgow G31 2ER Mr M. Scriven Robert Kilpatrick Building Leicester Royal Infirmary Leicester LE2 7LX Mr John H. Scurr Consultant Surgeon Middlesex and University College Hospital Lister House The Lister Hospital Chelsea Bridge Road London SW2W 8RE Mr Wesley P. Stuart Specialist Registrar Borders General Hospital Melrose Roxburghshire TD6 9BS Dr. M.J. Weston Consultant Radiologist Departments of Vascular and Endovascular Surgery and Radiology St James's and Seacroft University Hospitals Beckett Street Leeds LS9 7TF Mr David D.l. Wright Medical Director Surgicare Dralda House Crendon Street High Wycombe HP13 6LS