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Varicose Veins

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introduction to management of varicose veins

introduction to management of varicose veins

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Varicose Veins Varicose Veins Presentation Transcript

  • Varicose Veins
    John F Eidt MD
    Vascular Surgery
  • Varicose Veins
    Venous anatomy
    Venous physiology
    Varicose veins
    Symptoms
    Treatment
  • Anatomy
    Superficial veins
    Deep veins
    Perforating veins
    Communicating veins
    View slide
  • 25 Million people suffer from venous reflux disease, the underlying cause for most varicose veins
    VNUS Closure is the minimally invasive treatment
    for the medically indicated treatment of varicose veins
    Images courtesy of Paul McNeill, MD and Rajabrata Sarkar, MD
    View slide
  • Annual U.S. Incidence
    U.S. Prevalence
    Prevalence and Etiology of Venous Insufficiency
    Venous reflux disease is 2x more prevalent than coronary heart disease (CHD) and 5x more prevalent than peripheral arterial disease (PAD)1
    Millions
  • Prevalence and Etiology of Venous Insufficiency
    Of the estimated 25 million people with symptomatic superficial venous reflux1 :
    • Only 1.7 million seek treatment annually2
    • Over 23 million go untreated
    Prevalence by Age and Gender3,4
  • Superficial Veins
    Great saphenous
    Small saphenous
    Vein of Giacomini
  • Venous System
    Deep femoral v.
    Perforating v.
    Femoral v.
    Popliteal v.
    Small saphenous v.
    Great saphenous v.
    Perforating v.
    Venous blood flows from the capillaries to the heart
    Flow occurs against gravity
    Muscular compression of the veins
    Negative intrathoracic pressure
    Calf muscle pump
    Low flow, low pressure system
    Image source: Fundamentals of Phlebology: Venous Disease for Clinicians. Illustration by Linda S. Nye. American College of Phlebology 2004.
  • Pathophysiology of Venous Insufficiency
  • Risk Factors and Symptoms of Venous Insufficiency
  • Manifestations of Venous Insufficiency
    Superficial venous reflux is progressive and if left untreated, may worsen over time.
    Below are manifestations of the disease.5
    Skin Ulcers
    Swollen Legs
    Skin Changes
    Varicose Veins
    20+ million
    2 to 6 million
    500,000
    Photos courtesy of Rajabrata Sarkar, MD, PhD.
  • CEAP Classifications
    Clinical Classifications of Venous Insufficiency (CEAP)
    Class 0 - No visible or palpable signs of venous disease
    Class 1 - Telangiectasias or reticular veins
    Class 2 - Varicose veins
    Class 3 - Edema
    Class 4 - Skin changes
    (4a) Skin changes including pigmentation or venous eczema
    (4b) Skin changes with lipodermatosclerosis
    Class 5 - Healed venous ulceration
    Class 6 - Active venous ulceration
  • Types of Varicosities
    Varicose veins
    Saphenous
    Non-saphenous
    Reticular veins
    Venulectasia
    Telangiestasia
  • Lateral Reticular Complex
  • Treatment
    Compression
    Surgery
    Stripping
    Ambulatory phlebectomy
    Radiofrequency ablation
    Sclerotherapy
    Injection
    Laser
  • Sclerotherapy
    Hypertonic saline
    Ethoxyscerol – polidocanol
    Sodium tetradecyl sulfate
  • The VNUS Closure® System
    The VNUS Closure System is a minimally invasive treatment alternative for patients with symptomatic superficial venous reflux and varicose veins
    Using a catheter-based approach, the VNUS ClosureFAST™ catheter delivers radiofrequency (RF) energy to the vein wall
    RF energy creates conductive heatingthat contracts the vein wall collagen, thereby occluding the vein
  • VNUS Closure® Procedure using the ClosureFAST™ Catheter
  • Radiofrequency AblationProcedure Video
  • Efficacy of the ClosureFAST™ Catheter
    The ClosureFAST™ catheter ablates the vein in 7cm segments with 20-second treatment cycles, resulting in vein shrinkage and occlusion.
    Interim data from a multicenter prospective study have shown 97.4% vein occlusion 1 year post-treatment.6
  • Post-Procedure Instructions
    • Ambulate frequently, a minimum of 30 minutes daily
    • Avoid heavy/strenuous exercise for a few days
    • Avoid prolonged sitting or standing
    • Wear compression stockings for up to 2 weeks
    • Patient should return for duplex scan within 72 hours
    VNUS Closure® Visual Results
    One week post-treatment*
    Pre-treatment
    *Individual results may vary
  • Perforating Veins and Reflux
    Perforator valves maintain one-way flow from superficial to deep veins
    Perforator valve failure causes:
    Higher venous pressure and GSV/branch dilation
    Increasing pressure results in GSV valve failure
    Additional vein branches become varicose
    Further GSV incompetence and dilation
  • Systemic Reflux in Venous Ulceration
    Incompetent perforators found in 63% of venous ulcer patients
    Comprehensive care treats all sources of reflux
    Photos courtesy of Steven A. Kaufman, MD.
  • VNUS ClosureRFS™
    VNUS ClosureRFS Benefits:
    Minimally invasive
    Outpatient procedure
    Quick patient recovery
    Only device cleared by the FDA for the endovenous ablation of incompetent perforator veins
    Click graphic to play video
  • Summary
    Varicose veins are common
    Due to gravity-dependent reflux
    Treatment options
    Compression
    Excision
    Ablation
    Sclerotherapy