This document provides an overview of chronic venous disease and phlebology. It discusses the anatomy and pathophysiology of the venous system, risk factors for venous disease including heredity and lifestyle factors, common presenting symptoms, evaluation of patients, and classification of chronic venous disease severity using the CEAP system. The key points are that venous disease is common and influenced by multiple hereditary and environmental factors, leading to reflux and obstruction in the veins.

1. THE FUNDAMENTALS OF PHLEBOLOGY: Venous Disease for Clinicians Copyright © 2009 by American College of Phlebology An Introductory Lecture

4. Copyright © 2009 by American College of Phlebology “ It is ironic that medical education does not cover three of the most common medical problems: back pain, hemorrhoids, and varicose veins.” P. Fujimura, MD Surgical Intern University of California School of Medicine

5. The medical specialty devoted to the diagnosis and treatment of patients with venous disorders Copyright © 2009 by American College of Phlebology PHLEBOLOGY

7. THE SPECTRUM OF CHRONIC VENOUS DISEASE Copyright © 2009 by American College of Phlebology lipodermatosclerosis telangiectasias varicose veins Superficial phlebitis venous ulceration

9. Copyright © 2009 by American College of Phlebology Epidemiology: Who develops venous disease?

12. The beginnings of venous disease may be found as early as childhood Copyright © 2009 by American College of Phlebology Phlebologie. 1990 Nov-Dec;43(4):573-7. Weindorf N, Schultz-Ehrenburg U. 740 pts 10-12 y/o 518 pts 14-16 y/o 459 pts 18-20 y/o Diagnosable Vein disease 2.5% 12.3% 19.8% Actual Varicose Veins 0 1.7% 3.3%

14. Varicose Veins are 3 times more common in women than men Copyright © 2009 by American College of Phlebology "Varicose veins." The Mayo Clinic. January 2007. http://www.mayoclinic.com

16. Copyright © 2009 by American College of Phlebology Anatomy and Pathophysiology

18. Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye

24. Doppler exam: Normal flow Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye

25. Doppler: Reflux Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye

26. REFLUX : its contribution to varicose veins Copyright © 2009 by American College of Phlebology Illustration by Linda S. Nye

31. Copyright © 2009 by American College of Phlebology EVALUATION OF THE PATIENT WITH VENOUS DISEASE

41. Skin changes suggestive of chronic venous insufficiency Copyright © 2009 by American College of Phlebology Corona Phlebectatica (C1) Pigmentation (C4a) Atrophie blanche (C4b) Healed ulcer (C5)

43. Venous ulceration Copyright © 2009 by American College of Phlebology Impending ulceration Lipodermatosclerosis (C4a) Venous ulceration (C6)

46. Copyright © 2009 by American College of Phlebology Conservative Treatment of Venous Disorders

51. Copyright © 2009 by American College of Phlebology * Requires a prescription Compression Strength Indications 8-15mm Leg fatigue, mild swelling, stylish 15-20mm Mild aching, swelling, stylish 20-30mm Aching, pain, swelling, mild varicose veins 30-40mm * Aching, pain, swelling, varicose veins, post-ulcer 40-50, 50-60mm * Recurrent ulceration, lymphedema

57. Copyright © 2009 by American College of Phlebology Current Approaches to the Treatment of Varicose Veins and Related

60. Sclerotherapy of Telangiectasias: Technique Copyright © 2009 by American College of Phlebology Injection of sclerosant solution causes damage to endothelium which leads to fibrosis of vein

61. Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Photos courtesy of Steven Zimmet, MD, FACPh

65. Sclerotherapy Results Copyright © 2009 by American College of Phlebology Before After Ultrasound-guided sclerotherapy of the Great Saphenous Vein and sclerotherapy of branches Photos courtesy of Steven Zimmet, MD, FACPh

70. Treatment Results Copyright © 2009 by American College of Phlebology Before After Endovenous obliteration of the Great Saphenous Vein and phlebectomy of tributaries Photos courtesy of Steven Zimmet, MD, FACPh