Chronic Venous Disease: From Pathogenesis to Clinical Practice
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Chronic Venous Disease is a very common disease and a complex clinical condition when complicated. Hence understanding the pathogenesis involved and treatment at the early stages avoid complications that are difficult to manage.
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Chronic Venous Disease: From Pathogenesis to Clinical Practice
- 1. Dr Shahzad Alam Shah Laparoscopic and Endoscopic Surgeon Fatima Jinnah Medical University/ SGRHL Lahore Pakistan Chronic Venous Disease From Pathophysiology To Clinical Practice A Progressive Inflammatory Disease 6/6/2020 Shahzad Alam Shah WEBINAR
- 2. • Understanding the Pathogenesis • Diagnostic Implications • Why there are diversified treatment options? • And what are these options? Chronic Venous Disease; Objectives 6/6/2020 Shahzad Alam Shah WEBINAR
- 3. Risk or Predisposing Factors • Hereditary • Prolonged Standing • Obesity • History of DVT, DM, • Number of Pregnancies https://medlineplus.gov/ency/article/000203.htm 6/6/2020 Shahzad Alam Shah WEBINAR
- 4. Current challenges for the management of Chronic Venous Disease. Disease awareness low Continue to ignore at initial stages. Culture to wear the full dress Late Presentations Delay in diagnosis and treatment 6/6/2020 Shahzad Alam Shah WEBINAR
- 5. Pathophysiological process of chronic venous disease 6/6/2020 Shahzad Alam Shah WEBINAR
- 7. PATHOPHYSIOLOGY • MACROVASCULAR • MICROVASLAR 6/6/2020 Shahzad Alam Shah WEBINAR
- 8. Pathophysiological process of chronic venous disease: Leukocyte Activation Adapted from Danziger N. J Mal Vasc. 2007;32:1-7 and Bergan JJ et al. N Engl J Med. 2006;355:488-498. 6/6/2020 Shahzad Alam Shah WEBINAR
- 9. • Junctions: Saphenofemoral and Sephenopopliteal • Valves along the veins • Perforators 6/6/2020 Shahzad Alam Shah WEBINAR
- 10. Normal Valve Vs Damaged Valve Veins have problems sending blood from the legs back to the heart https://medlineplus.gov/ency/a rticle/000203.htm 6/6/2020 Shahzad Alam Shah WEBINAR
- 11. Tissue Viability Wound Healing Glucose Amino Acids Minerals Vitamin s Fatty Acids Hypoxia Oedema Fibrinogen Fibrin Cuff Leukocyte Trapping Proteolytic Enzyme Oxygen Free Radicles Damage Basement Membrane Reduced Circulation of Blood Red Cell Oxygen Hydrostatic Pressure Flow RateCirculation Dilated Vessels Increased Back Pressure because of venous hypertention Enzymetic Actiivty Removal of Waste Co2+ Hco2 Carbonic Acid Lactic Acid Ph in Tissues Removal of Waste Co2+ Hco2 Carbonic Acid Lactic Acid 6/6/2020 Shahzad Alam Shah WEBINAR
- 12. Hydrostatic Pressure Flow RateCirculation Removal of Waste Increased Back Pressure because of venous hypertention Hemosideros is Ankle Flare Varicosity Oedema Tight Swelling Lipodermosclero sis Cramps Aching Throbing Eczema Dermatitis Itching Restless Leg Pain Dilated Vessels Leukocyte Trapping Chronic Venous Insufficiency Syndrome 6/6/2020 Shahzad Alam Shah WEBINAR
- 13. C0s C1 C3 C4 C5-C6 Stages of CEAP Classification Ankle Flare Varicosity Oedema Tight Swelling Lipodermosclerosis Venous Ulcers C2 6/6/2020 Shahzad Alam Shah WEBINAR
- 14. VENOUS ULCER Complication of CVD: C4-C6 UlcerationSkin Atropy and Proximal Edema 6/6/2020 Shahzad Alam Shah WEBINAR
- 15. Management options for the Chronic Venous Disorder 6/6/2020 Shahzad Alam Shah WEBINAR
- 16. Treatment options • Life Style Modification • Venoactive Drugs • Compression Therapy • Foam Injection Sclerotherapy: sodium tetradecyl sulfate, polidocanol • Endovascular Procedures – Endovenous Laser Ablation – Radiofrequency Ablation • Surgery 6/6/2020 Shahzad Alam Shah WEBINAR
- 17. Treatment options • SURGERY – Ligation of Incompetent Saphenopopliteal and Saphenofemoral Junctions – LSV Stripping – Phelebectomies – Perforator Ligation • ENDOSCOPIC – Subfascial Endoscopic Perforator Surgery 6/6/2020 Shahzad Alam Shah WEBINAR
- 18. MPFF acts at the heart of venous inflammation in the venous valves and walls Adapted from Shoab SS et al. Endothelial activation response to oral Micronized Flavonoid therapy in patients with chronic venous disease – a prospective study. Eur J Vasc Endovasc Surg. 1999;17:313-318. Leucocyte Venous wall endothelium CD11b/CD18 VLA-4 VCAM-1 E-selectin ICAM-1 L-selectin MPFF 6/6/2020 Shahzad Alam Shah WEBINAR
- 19. Venotonic and Anti-Inflammatory Action of Drugs • MPFF improves venous tone by modulating noradrenergic signaling and reducing norepinephrine metabolism • MPFF also protects against inflammation-related valve damage by inhibiting the leukocyte-endothelium interaction, decreasing capillary permeability, improving capillary resistance, and increasing lymphatic ... 6/6/2020 Shahzad Alam Shah WEBINAR
- 20. MPFF inhibits the expression of adhesion molecules on the surface of leukocytes MPFF exerts anti-inflammatory effects by inhibiting the expression of adhesion molecules on the surface of leukocytes, thereby limiting leukocyte rolling, adhesion, and subsequently, infiltration into the venous valves and walls. Shoab SS, Porter JB, Scurr JH, Coleridge-Smith PD. Effect of oral micronized purified flavonoid fraction treatment on leukocyte adhesion molecule expression in patients with chronic venous disease: a pilot study. J Vasc Surg. 2000;31(3):456-461. MPFF significantly reduces edema Blume J, Langenbahn H, De Champvallins M. Quantification of oedema using the volometer technique: therapeutic application of Daflon 500 mg in chronic venous insufficiency. Phlebology. 1992;7:37-40. MPFF increased venous tone Barbe R, Amiel M. Pharmacodynamic properties and therapeutic efficacy of Daflon 500 mg. Phlebology.1992;7(suppl 2):41-44. MPFF significantly reduces pain, heaviness, and cramps. Tsukanov YT, Tsukanov AY, Nikolaychuk A. Great saphenous vein transitory reflux in patients with symptoms related to chronic venous disorders, but without visible signs (C0s), and its correction with MPFF treatment. Phlebolymphology. 2015;22(1):18-24. 6/6/2020 Shahzad Alam Shah WEBINAR
- 21. Injection Foam Sclerotherapy Sodium tetradecyl sulfate, polidocanol 6/6/2020 Shahzad Alam Shah WEBINAR
- 22. Compression Therapy Adaptive Compression Bandages Compression Stocking 6/6/2020 Shahzad Alam Shah WEBINAR
- 23. Compression Therapy • Multicomponent systems Intermittant Pneumetic Compreession 6/6/2020 Shahzad Alam Shah WEBINAR
- 24. Endovascular Ablations Endovenous Radio Frequency Ablation Endovenous Laser Ablation 6/6/2020 Shahzad Alam Shah WEBINAR
- 25. Sub Fascial Endoscopic Perforator Surgery SEPS 6/6/2020 Shahzad Alam Shah WEBINAR
- 27. THANK YOU Dr Shahzad Alam Shah
Editor's Notes
- it should be emphasized that all CVeD clinical pictures are connected to each other because they have a common pathophysiological biomolecular mechanism(s), in which the crucial events of hemodynamic alterations pave the way for a self-sustained vicious cycle of subsequent inflammatory and proteolytic cascades [1,3]