Duplex Ultrasound of Superficial Leg Veins
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1 Duplex Ultrasound of Superficial Leg Veins
2
3 Erika Mendoza Christopher R. Lattimer Nick Morrison Editors Duplex Ultrasound of Superficial Leg Veins
4 Editors Erika Mendoza, MD, PhD Venenpraxis Wunstorf Wunstorf Germany Christopher R. Lattimer, MD, PhD Department of Vascular Surgery Josef Pflug Vascular Laboratory Ealing Hospital and Imperial College London UK Nick Morrison, MD Morrison Vein Institute Scottsdale, AZ USA The book is supplemented with extensive on-line images and videos which can be found at German references, which were present in the original version, have been removed or replaced with English ones. They can still be found on-line or within an earlier book. ISBN ISBN (ebook) DOI / Springer Heidelberg New York Dordrecht London Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
5 Foreword Our understanding of superficial venous anatomy and its often complex haemodynamics have improved considerably during the past 20 years, mainly thanks to the introduction of the duplex ultrasound (DUS) investigation. Nowadays, venous DUS has become an indispensable tool to evaluate and treat our patients with chronic venous disorder (CVD). It is obvious that the introduction of DUS has revolutionized our phlebological practice in several ways. First, DUS has led to a refinement in the description of lower limb venous anatomy in particular, by distinguishing between the saphenous trunks within their fascial compartments and the tributaries situated subcutaneously. Second, DUS has largely improved our insight into venous haemodynamics helping us to move away from dogmatic views about causes and mechanisms of flux and reflux toward a broader insight into the (dys)functioning of the superficial venous system. Third, DUS has become our GPS (global positioning system) for efficacious and safe treatment of patients with varicose veins. Fourth, DUS is the ideal tool for postoperative follow-up after intervention in an individual patient as well as in different patient groups, obviously not as a single tool, but in addition to quality of life assessments and clinical examination of treated patients. For all practioners who are involved in the diagnosis and treatment of CVD patients, Erika Mendoza s book presents a real treasure, to be discovered little by little. The book has been composed, written and illustrated with a typical German Gründlichkeit (thoroughness). The present English edition was realized in close collaboration with Christopher Lattimer and Nick Morrison, who made an invaluable contribution to the different chapters. The book offers a very comprehensive overview of everything you might want to know about DUS of the superficial venous system. In the first 14 chapters the authors discuss all the details about ultrasound equipment, duplex anatomy, pathophysiology of superficial veins and their detailed examination with DUS during and after treatment. Ultrasound of the deep venous system, including all practical tips and tricks is also examined. The remaining three chapters are of special interest because they address many issues which you usually do not find in most textbooks. These include the examination of superficial veins in the presence of deep venous obstruction or reflux, the DUS examination of leg oedema (venous, lymphatic or lipoedema) and also some incidental, somewhat surprising, sonographic findings. In this book, illustrations are presented in a very didactic way, and these will certainly help you to recognize all the described duplex features more easily in your daily v
6 vi Foreword practice. In summary, this book is really worthwhile, from the beginning to the end, and will become your future companion in the diagnosis and treatment of patients with chronic venous disorder. Marianne De Maeseneer, MD, PhD Department of Dermatology, Section Phlebology, Erasmus Medical Centre, Rotterdam Netherlands and Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
7 Preface This book was the original idea of Erika Mendoza when it was first published in Germany in 2006 with the help of many leading experts in the discipline of chronic venous disease. It was intended as a practical everyday guide for ultrasound practitioners required to assess and diagnose the haemodynamic abnormalities behind varicose veins. The wealth of high-quality images to illustrate functional anatomy made this work reservedly the most comprehensive book at that time. The potential for internationalisation into an English version was quickly recognised by Christopher Lattimer (UK) and Nick Morrison (USA). The book was first translated into English by William Barne. It then underwent an extensive process of revision, moderation and improvement by all three authors who have incorporated their experience and accumulated knowledge directly into the book. Collectively we hope that this will maintain its position as the definitive guide on the use of duplex ultrasound in assessing superficial leg veins. We acknowledge the work of the following contributors: 1. Hans-Peter Weskott (Chaps. 1 and 17 ) 2. Alberto Caggiati (Chap. 2 ) 3. Renate Murena-Schmidt (Chap. 2 ) 4. Claude Franceschi (Chap. 3 ) 5. Birgit Kahle (Chap. 3 ) 6. Thomas M. Proebstle (Chap. 12 ) 7. Achim Mumme (Chaps. 12 and 13 ) 8. Franz Xaver Breu (Chap. 12 ) 9. Andreas Hildebrandt (Chap. 13 ) 10. Hans-Joachim Kruse (Chap. 14 ) 11. Helmut Kopf (Chap. 17 ) The book is supplemented with extensive on-line images and videos which can be found at Non english references, which were present in the original version, have been moved into the appendix foreign literature or replaced with English ones. Wunstorf, Germany London, UK Scottsdale, AZ, USA February 2014 Erika Mendoza, MD, PhD Christopher R. Lattimer, MD, PhD Nick Morrison, MD vii
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9 Acknowledgements Our gratitude is given to Sigvaris GmbH (D-87700, Memmingen, Germany) and STD Pharmaceutical (Hereford, HR4 0EL, UK) for their help in funding the translation to make this project possible. Erika Mendoza, Christopher R. Lattimer and Nick Morrison ix
10
11 Contents 1 The Ultrasound Scanner Hans-Peter Weskott, Erika Mendoza, and Christopher R. Lattimer 2 Anatomy of the Superficial Veins Alberto Caggiati, Erika Mendoza, Renate Murena-Schmidt, and Christopher R. Lattimer 3 Pathophysiology of the Superficial Venous System Erika Mendoza, Claude Franceschi, Birgit Kahle, and Christopher R. Lattimer 4 Ultrasound-Based Classifications of Varicose Veins Duplex Ultrasound Examination of Superficial Leg Veins Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 6 Flow Provocation Manoeuvres for the Diagnosis of Venous Disease Using Duplex Ultrasound Examination of the Great Saphenous Vein Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 8 Examination of the Small Saphenous Vein Perforating Veins Tributaries Superficial Vein Thrombosis Ultrasound in Varicose Vein Treatment Erika Mendoza, Thomas M. Proebstle, Achim Mumme, Franz Xaver Breu, Nick Morrison, and Christopher R. Lattimer xi
12 xii Contents 13 Ultrasound After Venous Intervention Erika Mendoza, Achim Mumme, Andreas Hildebrandt, Nick Morrison, and Christopher R. Lattimer 14 Deep Leg Veins Hans-Joachim Kruse, Erika Mendoza, Nick Morrison, and Christopher R. Lattimer 15 Examination of Superficial Veins in the Presence of Deep Venous Disease Differential Diagnosis of Leg Oedemas of Venous and Lymphatic Origin Incidental Findings During a Venous Examination of the Leg Erika Mendoza, Hans-Peter Weskott, Helmut Kopf, and Christopher R. Lattimer Appendix 1: Further Reading Appendix 2: Literature German Version Appendix 3: Abbreviations Used to Label the Figures Index
13 Contributors Franz Xaver Breu, MD Praxis für Gefäßmedizin am Tegernsee, Rottach-Egern, Germany Alberto Caggiati, MD Department of Anatomy, Universita di Roma, Rome, Italy Claude Franceschi, MD Angiologist Consultant, Hopital Saint Joseph, Paris, France Andreas Hildebrandt, MD Ullsteinhausklinik GmbH, Berlin, Germany Birgit Kahle, MD, PhD Klinik für Dermatologie, Allergologie und Venerologie, UKSH Campus Lübeck, Lübeck, Germany Helmut Kopf, MSc Institut für diagnostische und interventionelle Radiologie Wilhelminenspital Wien, Wien, Austria Hans-Joachim Kruse, MD, PhD Praxis für Gefäßmedizin, Zschopau, Germany Christopher R. Lattimer, MD, PhD Department of Vascular Surgery, Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College, London, UK Erika Mendoza, MD, PhD Venenpraxis Wunstorf, Wunstorf, Germany Nick Morrison, MD Morrison Vein Institute, Scottsdale, AZ, USA Achim Mumme, MD, PhD Klinik für Gefäßchirurgie, St. Josef-Hospital, Universitätsklinikum, Bochum, Germany Renate Murena-Schmidt, MD Praxis für Gefäßerkrankungen, Köln, Germany Thomas M. Proebstle, MD, PhD Hautklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany Hans-Peter Weskott, MD Klinikum Siloah Zentrale Sonographie, Hannover, Germany xiii
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