This document discusses varicose veins, including definitions, anatomy, causes, symptoms, examination techniques, and treatment options. Some key points:
- Varicose veins are dilated, tortuous veins, usually in the legs, caused by incompetent valves that allow blood to flow in the wrong direction.
- Annual incidence is about 2% and lifetime prevalence is around 40%, being more common in women.
- Symptoms can include pain, swelling, heaviness, and skin changes like pigmentation.
- Examination involves inspection, palpation, auscultation, and Doppler ultrasound to map veins and locate sites of reflux.
- Treatment options include conservative compression therapy, sclerotherapy
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Detailed presentation on Varicose veins, examination and management
Detailed presentation on Deep Vein Thrombosis, categories, staging and scoring systems and management.
Management also includes Endovascular and Surgical techniques.
Short notes made on IVC filters
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Polidocanol Endovenous Microfoam: Where Are We?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Polidocanol Endovenous Microfoam: Where Are We?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Does All Saphenous Reflux Need Ablation?Vein Global
By: Paul M. McNeill, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
2 Things New! 1290nm Laser & New Saphenous Vein Closure DeviceVein Global
By: Lowell S. Kabnick, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Mark Meissner, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Outcomes of Venous Interventions in C5-6 DiseaseVein Global
By: Mark H. Meissner, MD
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
When is MR Venography Useful? What makes it so Operator Dependent?Vein Global
By: Constantino S.Peña
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
The Important Nerves During Venous AblationVein Global
By: John Mauriello, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Mark J. Garcia MD, MS, FSIR
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Choosing the Appropriate Truncal Vein Closure DeviceVein Global
By: Steve Elias, MD, FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Thigh, Calf & Ankle Perforators: Are They Different?Vein Global
By: Nicos Labropoulos, PhD, RVT
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
How do Laser Wavelengths & Fibers Differ Clinically?Vein Global
By: Thomas M. Proebstle, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
By: Steve Elias MD FACS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Venous Leg Ulcers: Wound Preparation & Adjuvants to HealingVein Global
By: William Marston, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Endovenous treatment for varicose veins – the first choice (laser, radiofre...Michał Molski
There are different methods of treatment of varicose veins. Is there one "best method for all"? I believe there are different options for different patients. The key to sucess is surgeon's experience in handling different methods, and availability of those methods in specific medical center.
Varicose Veins are dilated, tortuous, elongated veins in the leg.
There is reversal of blood flow through its faulty valves.
It is permanently elongated, dilated vein/veins with tortuous path causing pathological circulation.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Varicose Veins
1. Varicose veins and treatment
• Jeannouel van Leeuwen ,
surgeon
• Chirurgen Maatschap
Emma Care
• Courtesy of Servier
• 25 january 2012
2. What we‟ll cover
• Some Definitions
• Anatomy
• What are you looking for?
• Examination techniques
• Treatment options
3. Incidence
• annual incidence of varicose veins is
about 2%
• life-time prevalence of varicose veins
approaches 40%
• Varicosities are more common in women
(about 2-3 times as prevalent in women
than in men)
• 10-20% actually are symptomatic enough
to complain about their lower leg varicose
veins and seek treatment.
4. What is a varicose vein?
• Long, tortuous and dilated vein of the
superficial varicose system
• Commonly legs but where else?
• Abdominal Wall
• Anus
• Vulva
• Oesophagus
• Scrotum
5. Why do they happen?
• increased pressure in the
superficial venous
system
• normally blood flows from
superficial system to deep
• if the valves protecting the
superficial veins become
incompetent there is
higher pressure in the
superficial veins and they
become varicose
6. Normal venous flow in the Leg
Normal Flow
• Superficial veins drain into the deep veins
•From the foot up to the heart
Superficial vein disease always starts with abnormal
valves and interruption to normal flow called venous
reflux
7.
8. Abnormal flow = Venous Reflux
Damaged Valves
1. Blood flows to the skin
2. Blood is pushed distally and
proximally
3. Close loop recirculation
4. Blood is retained in the leg
• Increased volume of blood
(heaviness Fatigue)
• Increased venous pressure
• Veins Dilate (varicose veins)
9. Taking the history
Presenting Complaint: Varicosities, abdominal/groin
lump – saphena varix
Symptoms
Localized discomfort in the leg, Pain, Swelling, Venous
claudication, Itching
“Risk” factors
Female, age, ethnicity, occupation, pregnancy, obesity, sm
oking
ASK about history of abdominal
complaints/cancer, DVT, previous & other venous
complaints
10. So the examination
• Inspection
• Auscultation
• Palpation
• cough test
• tap test
• Tourniquet Tests
• Trendelenberg
• Tourniquet test
• Perthes
• Doppler
• Sapheno-femoral junction
• Sapheno-popliteal junction
11. Diagnosis of venous disease
• Physical exam
• Appearance
• Trendelenburg test
• Palpation
• Hand Doppler
• Duplex Examination
• R/O DVT
• Size of veins
• Map out superficial veins
• Locate the site of reflux
• Reflux 0.5 sec in GSV and 1 sec in
deep system
• Find refluxing perforators
12. Clinical picture - symptoms
• Cosmetic disfigurement
• Pain and discomfort
• Night cramps
• Mild swelling at night
• Pigmentation
• Itching
• Ulceration
13. Anatomy
• Superficial System arises from foot and ends at Sapheno- femoral
junction (spiderhead)
• Long saphenous vein- medial leg up to SFJ
• Short saphenous vein- lateral malleolus , up calf to meet popliteal
vein behind knee
• Sapheno- femoral junction- 4 cm lateral and 4cm below the pubic
tubercle
• Communication veins: connecting deep and superficial system
through piercing deep fascia, with valves to direct blood from
superficial to deep viens.
• Perforator veins: there are 3 perforators on the medial side and 1
on the lateral side of the leg
14.
15. Inspection- other features
1. Spider Veins- blueish vessels that distend above
the skin surface
2. Thrombophlebitis- superficial red painfull lump
3. Brown pigmentation- haemosiderin
deposition
4. Venous Eczema
5. Venous Ulcers- over medial ankle
6. Lipodermatosclerosis-progressive sclerosis
of cutaneous fat- ankle becomes thin and hard- area
above becomes oedematous
7. Scars from previous surgery
16.
17. Atrophy blanche
Ulceration: active and healed
Inspection Leaves a white patch
Venous ulcers/eczema
Pitting oedema
Spider veins
18. Inspection
Lipodermatosclerosis
Literally "scarring of the skin and fat“
A slow process that occurs over a number of years
and has 2 phases:
1. Acute
Venous pooling →chronic venous hypertension
RBC forced into surrounding tissue
Haemoglobin broken down into brown
haemosiderin
2. Chronic
Chronic haemosiderin formation leads to fibrin
deposition
Skin becomes thickened and shiny
Skin around ankle constricts and the inverted
champagne-bottle shape is seen
19. Stages of chronic venous
insufficiency
(Expert meeting in Moscow, 2000.)
• 0 - no symptoms;
• 1 - heavy feet syndrome;
• 2 - intermittent edema;
• 3 - persistent edema, hyper- or
hypopigmentation, lipodermatosc
lerosis, eczema;
• 4 - venous ulcer.
20.
21. Causes
Primary
• Theories of Aetiology:
• Weak wall theory
• Congenital valvular incompetence
• Aggravating factors:
• Female sex
• High parity
• Occupation requiring prolonged standing
• Marked obesity
• Constricting clothes
• Estrogen intake
• Deep venous thrombosis
22. Secondary
Anything that raises intra-abdominal pressure or
raises pressure in superficial/deep venous system
so…:
•Pregnancy
•Abdominal/pelvic mass
•Ascites
•obesity
•constipation
•thrombosis of leg veins (DVT)
•AV fistula
•Vena cava thrombose
•Large liver cysts
24. Palpation
• Palpate the veins to confirm they are infact veins-
will refill if if gently pressed and released
• Next- find the sapheno-femoral junction (SFJ)
• Find Pubic Tubercle just lateral to pubic symphisis
• 4 cm lateral then 4cm below
• Palpate for a sapheno varix- localised distension of the
long saphenous vein in the groin
• Cough Test- Fingers over SFJ, ask patient to cough
can you feel a thrill, if yes suggest incompetence
• Tap Test- tap over the SFJ and feel further down
long saphenous vein for any transmitted sounds, if
yes suggest incompetence
25. Trendelenberg/Tourniquet tests
Aim- to localise the valve/s that are
incompetent
Trendelenberg
• Lie patient down and raise leg attempting
to drain varicosities of blood.
• Using either a tourniquet or fingers put
pressure over SFJ to occlude it
• Ask patient to stand
If varicosities DO NOT refill indicates SFJ
incompetence
If DO refill the leaky valve is lower down
„I will now try and locate the incompetent
perforator using the tourniquet test‟
26. Tourniquet test continued
• Same as before- lie down, raise and drain
leg
• Place tourniquet approximately over area
of each perforator( mid thigh, sapheno
popliteal, calf perforators)
• If varicosities DO NOT refill that perforator
is incompetent
• If varicosities DO refill continue down leg
27. To complete my examination I
would like to…
• Perform a full Abdominal Examination
• Scrotal examination ( on males!)
• Arterial Examination
Investigations
• Duplex Ultrasonography- maps valve
incompetence
• Phlebography not done anymore
28. Spider Veins
The proper term is Telangiectasia
•These are non raised dilated veins located in the
Dermis (deep layer of the skin)
•Single layer endothelium, minimal muscle
•Can be Red or Blue in color depending on the origin
•Do not cause major medical complications
•Appears earlier than varicose veins (4% of teenagers ,
and 13 % in 18 to 20 year olds
•More common in females
•Reticular Veins are lager feeding veins
30. Venous Stasis Ulcers
• Differential Diagnosis
1. Venous ulcerations 50% on non healing ulcers
2. Arterial ulcers in about 10%
3. Malignancy : basal and squamous cell, lymphoma
4. Infections: HIV, fungal
5. Collagen vascular disorders: Lupus ec.
6. Lymphatic obstruction
• Affects over 1 million people in the US
• 100,000 are disabled from this
• More common in elderly population
33. Management
Surgical
Conservative/Medical
• Ankle-to-groin saphenous vein
Graded compression stripping (with stab avulsion)
bandaging, Compression • Segmental saphenous vein stripping
hosiery (with stab avulsion)
• Saphenous vein ligation:
Paste Gauze (Unna) Boots
high, low, or both
Diuretics? Zinc? • Saphenous vein ligation and
Phlebotrophic/Hemorheologi sclerotherapy
c agents? Aspirin/NSAIDs etc • Saphenous vein ligation (with stab
avulsion)
• Stab avulsion of varices without
saphenous vein stripping
(phlebectomy)
• Endoluminal occlusion of the
saphenous vein by radiofrequency
(RF) or laser energy
34. Surgical ligation and Stripping
• Standard treatment
for a century
• General anesthesia
• Pain
• Long recovery
• Some complications
• Good cosmetic
results
35. Surgical treatment
• Crossectomy or/and
vein stripping till
below knee better
than compressive
therapy alone
• Other techniques :
Endovas.burning or
foam injection
36. Vein Ablation
• Laser Ablation (EVLA )
• Uses light to heat the vein
• Radio Frequency (VNUS Procedure)
• Uses radio frequency to heat the vein
• Office based procedure
• Done under local anesthesia
• One needle puncture at the level of the
knee
• Takes about 1 hour
• Patient resumes normal activity same
day
37. EVLA Results
Images from
http://venacure-evlt.com/
38. Sclerotherapy
• Cumulate vein with needle
• Inject Sclerosing Solution
• Ethoxysclerol
• Hyper tonic Saline
• Foam (Mix STS with air and make
bubbles)
• Intravenous injection causes intima
inflammation and thrombus
formation
39. Sclerotherapy Use
• Neovascularization
• Perforators
• Clean up after Phlebectomies
• Spider veins
• Reticular veins
• GSV: can closure the, but has
high recurrence rate
41. UNNA boot
result
• Weekly change with
UNNA boot bandage
gives nice result
42. • Compressive
bandages first choice
with simple small vein
ulcer
43. • Skin grafting can be
put on a non infected
granulating skin
defect of a venous
ulcer
44. Treatment complications
• Major complications following VV surgery are relatively rare
• Up to 20% morbidity
• Infection
• Hematoma
• Pain
• Nerve damage
• Saphenous nerve (LSV surgery)
• Sural, peroneal nerve (SSV surgery)
• Lymphatic leak - Venous thrombosis - Vascular injury
• Recurrence
45. Oral medication
• Effect on edema , hematocrit , augmentation
capillary permeability , inflammation , less fibrinolysis
, leukocyte function en erythrocytes
• No evidence for monotherapy only in addition effect
on ulcer healing
• Daflon , Trental , Aspirine