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Varicose Veins

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introduction to management of varicose veins

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Varicose Veins

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

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