Venous disorders are divided into acute thromboembolic events or chronic stasis.
Chronic includes varicose veins venous incompetence (superficial and deep).
Primary varicose veins can be treated for cure.
Chronic is treatable but not curable
Varicosities are a symptom of venous disease not just a cosmetic problem.
½ adult men 2/3 adult women have them.
Severe chronic insufficiency seen in 20 of working men and women.
Varicosities can range in severity from venectasias to protuberant tortuous varicosities with associated dermatitis ulcers severe pigmentation.
4 (No Transcript) 5 Causes
Linked to genetics changes in hormonal milieu.
Appearance in childhood rare although some adolescents with FHX of it have valves that are incompetent.
Primary varicose vein in young adult are common cause difficult to pinpoint.
Primary varicosities are elongated tortuous superficial veins that are protuberant and contain incompetent valves.
Mild swelling heaviness easy fatigue.
Skin should be normal edema when present is mild.
Primary varicosities merge into more severe chronic venous insufficiency. Swelling is moderate to severe increasing heaviness with larger varicosities pigment changes induration liposclerosis
When severe marked swelling calf pain after standing sitting or ambulation.
Heavy pigmentation laterally medially
8 Female Hormones
Progesterone (2nd phase menstruation) and principle hormone of pregnancy causes passive dilatation of varicosities.
Women will find that the achiness heaviness is worse in the 2nd 14 days of the cycle than the first.
Exacerbation of symptoms with pregnancy also may be noted.
9 (No Transcript) 10 Pathogenesis
Deficiencies in elastin and collagen
Gandhi found that there is an increase in collagen and decrease in elastin of varicose veins.
No difference in proteolytic activity however so no degradation.
11 (No Transcript) 12 Pathogenesis
Anatomic differences in the location of superficial veins of the lower extremities may contribute to pathogenesis.
For example the main saphenous trunk is not always affected by varicosities because it has a well developed medial fibromuscular layer and is supported by connective tissue to the deep fascia.
In contrast the tributaries to it are less supported in the sub Q fat have less muscle mass in their walls. Add an incompetent valve here and the tributary will dilate from the pressure of the greater saphenous vein.
Failure of the protective valve is the mechanism for development of the varicosities here.
Communicating veins connecting the deep with the superficial system may have valve failure as well.
13 Venous Hypertension
Gravitational and Dynamic
Gravitational is hydrostatic and caused by the weight of the column of blood from the right atrium. The highest pressure is noted from this at the foot and ankle.
Dynamic is caused by forceful muscular contractions (150-200mmHg). If perforating vein fails high pressures elicited by the contractions are transmitted to the superficial system causing dilation of superficial veins. Progressive valvular failure may occur down the line.
14 Venous Hypertension
If proximal valves become incompetent at saphenofemoral junction muscular contraction pressure is supplemented by the weight of the static column of blood from the heart. This column becomes a barrier. Blood flowing from the femoral vein spills into the saphenous vein and flow distally.
As it refluxes distally thru progressively incompetent valves it is returned through the perforators to the deep veins from where it goes back to the femoral vein and starts over again.
Changes also occur at the cellular level.
Capillary proliferation is seen extensive capillary permeability as a result of widening of interendothelial cell pores.
Transcapillary leakage principally fibrinogen.
There is also some diminished fibrinolytic activity in chronic venous stasis allowing the extravascular fibrin to remain.
16 Diagnostic Evaluation
Physical Examination and History
Hand-held doppler probe
17 Vein Stripping 18 Treatment
Conservative and Surgical Measures
Graduated compression stockings.
Phlebectomy for veins4mm (stab avulsion stripping.
Endovenous Laser Therapy Use of lasers has become an accepted alternative to surgical stripping to treat varicose veins.
A thin laser fiber is inserted into the diseased vein through a small puncture in the leg above where the visual symptoms appear. The physician then delivers laser energy through the fiber which causes the vein to close as the fiber is gradually removed. Endovenous laser therapy can be performed in a physicians office in less than one hour and the patient is encouraged to walk immediately following the procedure.
Endoscopic therapy (SEPS)
Venous Reconstruction (still experimental)
21 (No Transcript) 22 (No Transcript) 23 Saphenofemoral Ligation 24 (No Transcript) 25 (No Transcript) 26 (No Transcript) 27 (No Transcript) 28 (No Transcript) 29 (No Transcript) 30 (No Transcript)
PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use.
You can use PowerShow.com to find and download example online PowerPoint ppt presentations on just about any topic you can imagine so you can learn how to improve your own slides and presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!
For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!