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Acknowledgments

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We would like to thank MPG’s two Academy of Cosmetic Surgery Fellows, Monika Kiripolsky, MD and Jennifer Peterson, MD, who both worked hard to add most of the additional references to this updated volume. They also performed a variety of research studies which are included in many of the chapters. Sabrina Fabi, MD helped with proofreading the ﬁnal copy of this text. We would also like to thank the editors and production team at Elsevier for their

tireless work and dedication to this project. Their combined effort allowed this text to be turned over from submission to production in less than six months: Acquisitions Editor, Russell Gabbedy (previously Claire Bonnett); Deputy Head of Development, Joanne Scott; and Design Manager, Stewart Larking.

M.P.G., J-J.G. & R.A.W.

viii

Index

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Abdominal intravenous pressure, 52, 54 Aberdeen varicose vein questionnaire, 31 ABO blood group system, 64 Actinic neovascularization, 82, 82f Acuderm needle, 379 Adrenaline, 207, 287 Adult respiratory distress syndrome (ARDS), 207 Adventitia, vein walls, 20 Adverse sequelae, 180–199

compression therapy, 147 epidermal dehydration, 194, 195f hyperpigmentation see Hyperpigmentation localized hypertrichosis, 199 morpheas, 194–195 pain, 191–192, 192f recurrence, 195–196, 196f–197f skin suntan fading, 194, 195f stress-related symptoms, 196–198 tape compression blister, 193–194, 194f tape compression folliculitis, 194, 194f telangiectatic matting, 188–191, 189f–190f temporary swelling, 188 underlying medical disease, 198 urticaria, 198–199

localized, 192–193, 193f vasovagal reﬂex, 196–198 venous hypertension/insufﬁciency, 25–48 see also Complications

Age factors, 31, 64, 260 Air embolism, 223 Air plethysmography (APG), 107–108,

107t–108t, 108f

Air-bolus injection, 249, 264–265, 265f,

320–321

Alexandrite long-pulse laser, 187, 339t–341t,

351–352 ‘Alignment’ sign, Duplex ultrasound, 8, 9f Allergic reactions

compression stockings, 137, 137f as contraindication to sclerotherapy, 259 major, 206–207 minor, 206 to sclerosing agents

chromated glycerin/glycerin, 210–211 ethanolamine oleate, 207–208 heparin, in hypertonic saline, 211 hypertonic saline, 211 lidocaine, in hypertonic saline or

glycerin, 211–212

polidocanol, 209–210 polyiodinated iodine, 211 sodium morrhuate, 207 sodium salicylate, 211 sodium tetradecyl sulfate, 208–209

NB: Page numbers followed by f indicate ﬁgures; t indicate tables; b indicate boxes. These are included where they appear separate from associated text.

Alpha-benzopyrones, 369 Ambulatory inability, as contraindication to

sclerotherapy, 259

Ambulatory phlebectomy, 285, 287f, 292

technique for closure with, 304–305 Ambulatory venous pressure (AVP), 104–105 American College of Phlebology (ACP),

378–379 Amlodipine, 33 Anaphylaxis, 206–207, 378

polidocanol, 209 Anatomical Terminology, 1 Anatomy, vein, 1–24

deep venous system, 2–4, 3f–4f

Duplex ultrasound, 5–8, 7f–8f

markers for vein identiﬁcation, 8–11,

8f–10f general considerations, 2–3, 3f histology, 19–21 nomenclature, 1, 2t superﬁcial veins, 4–8 ultrasound imaging, 1, 2t

Anesthesia, 211, 287 Angina, 198 Angiodysplasias, 75 Angioedema, 206 Angiogenesis, 190–191, 190f Angioma serpiginosum, 76–77 Angioscopy, 55 Angiotensin II, 50 Ankle edema, 31–32 Ankle-brachial index (ABI), 125–126 Anterior accessory saphenous vein (AASV), 8, 9f,

14, 14f

Anteroexternal compartment veins, 4 Anthrombin III deﬁciency, 221 Antihistamines, 206–207 Antiplatelet agents, 223 Antiseptic, 388 L-arginine, 223 Argon laser, 338–342, 341f–342f Arterial injection, complications, 214–217, 216f Arterial spasm, 202f, 203–204, 204f, 243 Arteriolar injection, 202–203, 203f Arteriovenous anastomosis (AVAs), 21, 56–58,

57f, 79, 338

Ascending venography, 116, 116f Aspirin, 223 ASVAL (varices phlebectomy), 285 Ataxia telangiectasia, 76 Atrophie blanche, 34–35, 35f Augmentation, Doppler ultrasound, 97–100 Axial veins, foot, 3

Bacillary angiomatosis, 83 Backﬂow, venous, 2–4 Bandages see Compression bandages Becton-Dickinson Precision Glide needle, 379 Benzarone, 371 Benzopyrones, 369–371

Benzoyl peroxide, 206 Betamethasone valerate lotion, 81–82 Binocular loupes, 380–382, 381f–382f

simple, 382–383, 383f Biopsy, 21, 32–33, 33f Blister, tape compression, 193–194, 194f Blood ﬂow

compression therapy, 125–126

and exercise, 21, 54

stasis of, 39–40

uterine veins, through, 59–60

valvular incompetence, 55

venous valves, 20 Blood groups, 64 Blood pressure, 51, 76

see also Hypertension Blue linear telangiectasias, 71 B-mode echography, 205 Bochum I, II and III studies, 29–30 Bockenheimer’s syndrome (diffuse genuine

phlebectasia), 77–78 Breast cancer, 220–222 Brodie-Trendelenburg test, 92–93, 94f–95f

Bracey variation, 93, 96f Bronchospasm, 206–207 Bubble size, foam sclerotherapy, 244–245

Cabrera’s technique, foam sclerotherapy, 243,

255 Calcium dobesilate, 371 Calf muscle pump, 3–4 Calibratable PPG (C-PPG), 106 Camper’s fascia, 7 Cancer see Malignant disease Carbitol, 198–199 Carbon dioxide

foam sclerotherapy, 245

laser, 338, 341f Carcinomas, 37 Case histories

telangiectasias, 325–327, 327f–332f,

329–330, 332–333

varicose veins, 255, 260–274, 261f–271f,

273f–275f CD11b (integrin), 25 CEAP classiﬁcation, chronic venous disease, 28,

88–90, 89t

surgical indications, 296 Centella asiatica, 371 Centers for Medicare & Medicaid Services

(CMS), 389–390 CFV see Common femoral vein (CFV) Chemical irritants, 159

chromated glycerin/glycerin, 163–164,

167–168, 190–191, 210–211

ethanol, 168 Cherry hemangiomas, case history, 327, 329f Chest pain, transient, 207 CHIVA method, 285–286, 288f–289f, 294–295 Chromated glycerin/glycerin, 163–164, 167–168

advantages/disadvantages, 168

393

allergic reaction to, 210–211

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clinical use, 190–191

Chronic venous disease (CVD), 25–27, 79

CEAP classiﬁcation, 28, 88–90, 89t

Chronic venous insufﬁciency (CVI), 25, 31

Index

compression therapy, 123, 125, 141–142

localized hypertrichosis, 199 Chronotherapy, 188 Classiﬁcation of venous disease, 28–29 Clinical testing, 92–95, 93f–96f, 94t Closed Shunts Type III, CHIVA method,

285–286 Closure catheter system, 301–302 ClosureFAST catheter, 304 Clothing, tight-ﬁtting, 54 Clotting factor abnormalities/thrombophilia,

221 Coagula, postsclerotherapy, 184–185 Collagen, 21, 49–50 Collateral veins, 5, 6f

distal, 11 and GSV, 12–13, 13f medial, 11 proximal, 11 and saphenous veins, 10–11, 11f

and SSV, 16, 16f Commissural space, 55 Common femoral vein (CFV), 4, 116 Communicating veins, 1 Compartmental syndromes, 214–215 Complications, 199–224, 200t, 337

allergic reactions

to sclerosing agents, 207–212

systematic, 206–207 arterial injection, 214–217 cosmetic, 290 cutaneous necrosis see Cutaneous necrosis deep vein thrombosis see Deep vein

thrombosis (DVT)

embolism

air, 223

pulmonary, 217–223

without pulmonary involvement,

217 foam sclerotherapy, 248 hematoma, 290 local infectious, 290 lymphatic, 290 membranous fat necrosis, 224 migraine, 224 nerve damage/paresthesia, 223 neurologic, 290 perioperative, 290 postoperative, 290 scintillating scotomata, 223 superﬁcial thrombophlebitis, 212–214,

212f–214f systematic allergic reaction or toxicity,

206–207 varicose vein disease, 91 venous hypertension/insufﬁciency, 25–48 venous thromboembolic, 290 visual, 211, 223–224 see also Adverse sequelae

Compression

excessive localized, 204–205, 205f following sclerotherapy, 258 inappropriate, and DVT, 219

Compression bandages, 130–136

elastic, long-stretch, 133 historical use, 123, 124f inelastic and short-stretch, 132–133 interface pressure, 131–132, 132t multilayer, 133–134 practical characteristics, 136, 137t standards for, 130–132, 137t

394

stockings contrasted, 135–136 training in application of, 134–135,

135f–136f

Compression material, 130–141, 131t

bandages see Compression bandages categories, 130, 131t classiﬁcation, 130, 131t types of device, 130

Compression pressure

interface, on leg, 128–129, 129f laboratory measurements, 127–128, 128f,

129t

and Laplace’s law, 126–127, 127f

practical consequences, 127 resting and working, 126, 129, 131f stiffness, 129–130, 131f venous system, 124

Compression stockings

allergic reactions, 137, 137f, 198–199 bandages contrasted, 135–136 care of, 141 characteristics of, 137 custom-made, 138 development, 123 Donning Medical, 139, 140f graduated, 123, 125, 136, 315–316, 346,

388, 389f heaviness, 148 hyperpigmentation, 186 latex-free, 123 lengths, 138 lightweight, 148 patient compliance, 141 prescription, 138 pressure gradient, 132f, 138–139 proper ﬁt and position, 139 ready-made, 137–138 uses for, 136–141 venous system, 124–125

Compression therapy, 123–155

Bockenheimer’s syndrome, 77–78 clinical indications

compression alone in prevention of

varicose and telangiectatic leg veins,

142

DVT prevention and treatment, 149 edema, 148–149, 148f following endovenous catheter

procedures, 147

lymphedema, 150 post-thrombotic syndrome, prevention

and treatment, 149

pregnancy, 147–148 small veins, sclerotherapy of, 144–147,

146f, 147t

varicose vein sclerotherapy, 142–144 venous ulcers, 149–150 following venous surgery, 147

dangers, complications and

contraindications, 141–142 Doppler ultrasound, 97 drug treatment combined with, 373 historical development, 123, 124f material see Compression material mechanism of action, 123–126

arterial ﬂow, 125–126 edema, 123 lymph drainage, 123–124 microcirculation, 125

venous system, 124–125, 125f postoperative elastic, 288–290 pressure see Compression pressure principles of compression, 126–130,

127f–129f, 129t–130t, 131f telangiectasias, 323 terminology, 126

Congenital disorders see Genetic factors/

congenital disorders

Congenital poikiloderma (Rothmund−

Thomson syndrome), 78

Conservative treatment, 290

vs conventional, 291

Contraindications, consideration of

age factors, 260 allergic reactions, 259 ambulatory inability, 259 disulﬁram, 259 DVT, history of, 259 hormone replacement therapy, 259 pregnancy, 258–259 tamoxifen, 259 thrombophlebitis, history of, 259 travel, 259

weather, 259–260 Contrast phlebography, 1 Contrast transcranial Doppler (cTCD), 217 Contusion, 82 CoolGlide laser, 359–360, 361f Cooling, epidermal (laser therapy), 337,

357–358 CoolTouch Varia laser, 359–360, 360f Copper bromide laser, 344 Corona phlebectatica, 79 Coronary disease, and varicose veins, 296 Corticosteroid preparations, topical, and

telangiectasias, 81–82 Cosmetic complications, 290 Cotton wool, compression therapy, 144 Cough test, 92, 100, 112–113 Crosse, 4 Crossectomie see Isolated ﬂush ligation/limited

resection of SFJ and/or SPJ Cryostripping, 283–284, 284f, 291 Current good manufacturing practices (CGMP),

199 Cutaneous necrosis

and blistering, 194 etiology, 200–205, 201f–203f

arteriolar injection, 202–203, 203f excessive localized compression,

204–205, 205f

extravasation, 200–202, 201f–203f hypercoagulable state, 205 lymphatic injection, 204 pyoderma gangrenosum, 205 subcutaneous injection, 204, 204f

vasospasm, 202f, 203–204, 204f prevention, 205 treatment, 205–206, 206f

Cutis marmorata telangectatica congenita, 78 CVD see Chronic venous disease (CVD)

Dabigatran etexilate, 223 Deep vein thrombosis (DVT), 217–223

cause, 218–222

amount of injection per site, 218–219

clotting factor abnormalities/

thrombophilia, 221

combining sclerotherapy with surgical

procedures, 219 hypercoagulable state, 219 inappropriate compression, 219 malignant disease, 222 oral contraception/estrogen replacement

therapy, 219–220 pregnancy, 221 tamoxifen, 220–221

compression therapy, 149 as contraindication to sclerotherapy,

248–249, 259

Perthes’ test, 93–94

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prevention, 222 primary valvular incompetence, 58 purpose of venous evaluation, 91 as secondary complication of venous

hypertension, 39–40, 40f and superﬁcial thrombophlebitis, 39 surgical complications, 40, 290 treatment, 222–223 see also Embolism; Thrombosis

Deep venous system

anatomy, 2–4, 3f–4f noninvasive diagnostic techniques, use of,

110, 112f

Defecatory straining, 54 Dehydration, epidermal, 194, 195f Delasco needle, 379 Dermal tissue ﬁbrosis, 27 Dermatitis

Nicolau’s livedoid dermatitis, 201–202 venous, 33–34, 34f–35f

Descending venography, 110, 116, 116f Designs for Vision binocular magniﬁers, 383 Detergents, 158

ethanolamine oleate, 162, 169, 207–208 polidocanol, 162, 163f, 171–173, 172f, 182,

190–191, 209–210, 319 sodium morrhuate, 161–162, 168, 207, 315 sodium tetradecyl sulfate, 161, 169–171,

169f, 180, 182, 204–205, 208–209,

239

Diagnostic approach, 90–91

noninvasive techniques see Noninvasive

diagnostic techniques

Dietary factors, 54 Diffuse genuine phlebectasia (Bockenheimer’s

syndrome), 77–78

Diffuse neonatal hemangiomatosis, 78 Digital cameras, 389 Digital PPG (D-PPG), 106 Diode laser, 306–309, 306f, 307t, 352–353 Diosmin, 370–371 Diphenhydramine, 206–207 Dissection anatomy, 1 Disulﬁram, as contraindication to sclerotherapy,

259

Donning Medical compression stockings, 139,

140f

Doppler ultrasound, 95–100, 97b, 101f–102f

atrophie blanche, 35 augmentation, 97–100 characteristics of Doppler waveform, 96–98,

97b, 98t color image, 103f continuous-wave, 95–96, 99, 109 contrast transcranial, 217 Duplex ultrasound compared, 101t, 103–104 examination of saphenous vein trunks,

111–112 examination technique, 98–100

femoral vein, 98–99 perforating veins, 100 popliteal vein, 99 posterior tibial vein, 99–100

superﬁcial veins, 100 injection techniques, 250 post-treatment evaluation, 100, 101t pulsed-wave, 95–96 sclerotherapy practice, 379

Doppler-guided injection, 251, 252f Dopplex devices, 379 Dorsal hand veins, treatment, 271, 271f Double-syringe method, foam sclerotherapy,

205

Drug treatment, 288

see also Small saphenous vein (SSV)

396

Headband-mounted magniﬁers, 382, 383f Heine binocular loupes, 383, 384f Hemangiomas, 255 Hematomas, 290, 306 Hematuria, 210–211 Hemoglobinuria, transient, 210 Hemorrhage, venous hypertension/insufﬁciency,

38–39, 39f

Hemosiderin, 32–33, 191

adverse sequelae/complications, 180–181

Heparin, 149, 191, 216–217

in hypertonic saline, 211

low-molecular-weight, 214, 221–222, 288 Heredity see Genetic factors High-intensity pulsed light (IPL), 345f,

353–357, 355f–356f High-output cardiac failure (HOCM), 78 Histology

innervation, 21 telangiectasias, 21, 338 vein walls, 19–20

variation, 20–21

venules, 21 Hook phlebectomy, 292, 295t–296t Hormone replacement therapy, 259 Hospitalization, 287 HS see Hypertonic saline (HS) Human immunodeﬁciency virus (HIV), 83 Hunter’s canal, 100 Hyaluronidase injection, 205 Hydrocolloid gel dressings, 206 Hydroxyzine, 206 Hypercoagulability, 187, 205, 219 Hyperpigmentation

duration, 185

etiology, 180–185, 181t, 182f

coagula, 184–185, 185f gravitational/other intravascular

pressures, 183 predisposition, 183–184 solution type and concentration, 182 technique, 182–183 vessel diameter, 183

leg telangiectasias, 343, 345, 347 linear, 181f persistent, 180 postinﬂammatory, 180 prevention and minimization, 185–186 treatment, 186–188

Hypertension

transient, 210–211 venous see Venous hypertension/

insufﬁciency

Hypertonic glucose/saline see Sclerodex (SX) Hypertonic saline (HS), 163, 164f,

166–167

advantages and disadvantages, 166 allergic reaction to, 211–212 clinical use, 165 heparin in, 211 lidocaine in, 192, 211–212 modiﬁcation of solution and technique,

166–167

Hypertrichosis, localized, 199 Hypopigmentation, 343 Hysteresis, compression principles, 126

Iatrogenic telangiectasia, 81–82 Iliac vein compression syndrome, 53–54 Immobility edema, 148–149 Incompetent tributaries phlebectomy, 284–285,

291–292

Infection

postoperative, 290

telangiectasias, 83 Inﬂammation, 27–28, 50–51 Informational brochures, 389 Infusion, slow technique, 192 Inherited clotting factor abnormalities, and DVT,

221

Injection techniques

air bolus, 249, 264–265, 265f, 320–321

amount of injection per site, and DVT,

218–219

concentration and strength of sclerosing

solutions, 322–323, 323t depth of injection, 320 Doppler-guided injection, 251, 252f Duplex ultrasound, 253, 270, 271f, 272 endoscopic injection, 251 equipment, 381 foam sclerotherapy see Foam sclerotherapy intravascular ultrasound-controlled injection,

251–253 large-diameter great saphenous veins, 255 lymphatic injection, 204 other venous conditions, 255 patient position see Position of patient preinjection procedure, 315–317, 318f preparation and visualization of vessels,

317–319 pressure, 323 quantity of sclerosing solution per site, 322f recurrences, 255–256 sequential injections, 203–204 telangiectasias, 315–323, 317f–318f, 320f,

322f, 323t tourniquet use, 249 ultrasound-guided injection, 247f, 249–251,

250f–252f VeinRx infusion catheter, 253–255, 254f,

272–274, 273f venous malformations, 255 vulvar varices, 255

Innervation, histology, 21 Insurance reimbursement, 389–390, 390b Intense pulsed light (IPL), 336 Intercellular adhesion molecule-1 (ICAM-1),

Intima, vein walls, 19 Intra-abdominal pressure, varicose veins, 52,

Intraosseus venography, 116–117 Intravascular ultrasound-controlled injection

(IVUS), 251–253

Invasive diagnostic techniques

thermography, 117–118, 118f varicography, 117, 117f venography, 115–117, 116f

IPL see High-intensity pulsed light (IPL) Ischemic ulcers, 36 Isolated ﬂush ligation/limited resection of SFJ

and/or SPJ, 284, 291

Isopropyl alcohol, 317, 319

Keeler panoramic surgical loupe, 383–384 Keratosis lichenoides chronica, 80 Ketoconazole, 83 Klippel-Trénaunay syndrome (KTS), 73–76,

74f–77f, 123, 248 case history, 274, 275f

Knee

arrangement of GSV and its subcutaneous

collaterals at, 10f, 13–14, 13f deep venous system, 4 lateral epicondyle of, 5, 6f

Krypton triphosphate laser, 339t–341t, 342–344,

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343f

KTS see Klippel-Trénaunay syndrome (KTS)

Lactation, venoactive drugs, 372 Laplace’s law, 126–127, 127f, 138, 245

practical consequences, 127

Laser therapy

alexandrite long-pulse laser, 187, 339t–341t,

351–352 argon laser, 338–342, 341f–342f atrophie blanche, 35 carbon dioxide laser, 338, 341f contact probe delivery, 342, 342b CoolGlide laser, 359–360, 361f CoolTouch Varia, 359–360, 360f copper bromide, 344 diode laser, 306–309, 306f, 307t, 352–353 endoluminal laser, 305–310, 310f–311f endovenous treatment, 244, 309 ﬁber-guided laser coagulation, 353 ﬂashlamp-pulsed dye laser, 187, 336,

344–346, 344f–349f

long-pulse, 346–351, 350f

high-intensity pulsed light, 345f, 353–357,

355f–356f krypton triphosphate, 339t–341t, 342–344,

343f leg telangiectasias, 337f, 339t–341t

alexandrite long-pulse, 339t–341t,

351–352

argon laser, 338–342, 341f–342f carbon dioxide laser, 338, 341f CoolGlide laser, 359–360, 361f CoolTouch Varia, 359–360, 360f copper bromide, 344 diode laser, 352–353 evaluation of combined laser-

sclerotherapy treatment, 361–364,

362t–363t, 364f

ﬁber-guided laser coagulation, 353 ﬂashlamp-pulsed dye laser, 336,

344–351, 344f–350f

high-intensity pulsed light, 345f,

353–357, 355f–356f

krypton triphosphate and frequency-

doubled Nd-YAG, 339t–341t,

342–344, 343f

Lyra laser, 360–361 Nd:YAG laser, 339t–341t, 342–344, 343f,

357–361, 358f

Quantel Medical Multipulse Mode, 361 SmartEpil IS, 361

Vasculite laser, 359 Lyra laser, 360–361 Nd:YAG laser, 307–308, 308f, 357–361, 358f

frequency-doubled, 339t–341t, 342–344,

343f Q-switched, 186–188 Quantel Medical Multipulse Mode, 361 SmartEpil IS, 361 thermal relaxation times, blood vessels, 341t Vasculite laser, 359

Laserscope KTP Dermastat, 342 Lateral epicondyle of knee, 5, 6f Lateral subdermal plexis, case history, 327, 330f Leg

ankle

edema, 31–32

ulceration, 266, 267f elevation of (Fegan), 242 foot

anatomy, vein, 16–18, 17f, 18t

venous pump in, 51–52

interface compression pressure on, 128–129,

129f

knee

arrangement of GSV and its

subcutaneous collaterals at, 10f,

13–14, 13f deep venous system, 4 lateral epicondyle of, 5, 6f

nerves, of phlebologic interest, 18–19,

19f–20f

telangiectasias, 336–368

compression therapy, 146 histology, 338 laser therapy see under Laser therapy location, 320 sclerosing agents, 164–165, 190–191 ‘spray’, 342 ulceration, 205 underlying disease, 80

thigh

arrangement of GSV and its

subcutaneous collaterals in, 12–13,

13f deep venous system, 4 extension of SSV, 6f, 8f, 10f, 15–16,

15f–16f telangiectasias, development on, 71

ulceration, 373 Leg crossing, 54 Leukocytes, 25 Lichen aureus, 32–33, 34f Lidocaine, 192, 211–212, 304 Ligation

evaluation of origin of recurrences following,

115 and inability to ambulate, 259 non-ﬂush, at SFJ, 283 saphenous trunk preservation, 284, 291 as sole technique for varicose veins, 301 telangiectasias, pathophysiology, 82, 83f

Light cryotherapy, 186 Light reﬂection rheography (LRR), 106, 107f Lighting, 319 Linear endovenous energy density (LEED), 305,

308–309

Lipodermatosclerosis

compression therapy, 124 telangiectasias, pathophysiology, 90 venous hypertension/insufﬁciency, 27, 32

Local anesthesia (LA), 287 Long-pulse pulsed dye laser (LPDL), 346–351 Low-molecular-weight heparin (LMWH), 149,

214, 221–222 postoperative, 288

L-selectin, 25 Lung cancer, 222 Lymphatic complications, 290 Lymphatic injection, 204 Lymphedema, 150, 296 Lyra laser, 360–361 Lytic agents, 222

Maffucci’s syndrome, 78 Magnifying glasses, 382, 382f Malignant degeneration, 36–37, 37f Malignant disease, 81, 222 Mark II Magni-Focuser, 382, 383f Matrix metalloproteinase (MMP), 50–51 Mechanism of action of sclerotherapy, 156–

179 endoﬁbrosis, predisposing factors, 160 endothelial damage, producing, 156–157,

157f, 157t foam sclerosants/sclerosing agents, 175–176

sclerosing solutions see Sclerosing solutions

thrombosis, predisposing factors, 159–160 Media, vein walls, 19–20 Medical history, 88–91, 89t Membranous fat necrosis, 224 Menstrual cycle effects, 256

varicose veins, 62 Metaproterenol sulfate, 198 Methylprednisolone, 188, 207 Metrizamide, 240–241 Micelles, detergents as, 184 Microcirculation, compression therapy, 125 Microfoam sclerotherapy, in KTS, 274, 275f Microinjection, of telangiectasias, 315 MicroMaxx ultrasound system, 379 Micronized Puriﬁed Flavonoid Fraction (MPFF),

370–371

Microsclerotherapy

goal, 319

indications for, 315

poor results, 324

of spider veins, 317

see also under Telangiectasias Microthrombectomy, 324 Migraine, 224, 249 Molefoam device, compression therapy, 144 Monfreux technique, foam sclerotherapy,

245–247 Monocycline, 184 Morpheas, 194–195 Multilayer bandages, 133–134 Multilens binocular magniﬁers, 383–384,

384f–385f Muscle ﬁbers, venous valves, 20 Myelogenous leukemia cutis, 34

Naftazone, 371 Nd:YAG laser, 307–308, 308f

frequency-doubled, 339t–341t, 342–344,

343f Near infrared imaging, 118 Needles, 319, 379–380, 379f–380f

type and size, 192

Nerves

damage to, 223

leg, 18–19, 19f–20f Nervus cutaneous lateralis surae (NCLS), 18 Neurocardiogenic syncope see Vasovagal reﬂex Neurologic complications, 290 Nevi ﬂammei (port-wine stains), telangiectasias,

72–73, 73f–74f

Nevus araneus (spider telangiectasias) see Spider

telangiectasias NIAPROOF Anionic Surfactant 4 (NAS 4), 198 Nicolau’s livedoid dermatitis (NLD), 201–202 Nikon 2020 fully automatic camera, 389 940-nm diode laser, 307 980-nm diode laser, 307 Nitrates, 203 Nitric-oxide-generating gel, 203 Nitroglycerin, 198, 203 Noninvasive diagnostic techniques

air plethysmography, 107–108, 107t–108t,

108f

Doppler ultrasound, 95–100, 97b, 101f–102f

characteristics of Doppler waveform,

96–98, 97b, 98t

color image, 103f Duplex ultrasound compared, 101t examination technique, 98–100 post-treatment evaluation, 100, 101t

Duplex ultrasound scanning, 100–104,

101f–103f

aid to sclerotherapy, 101–103, 104f

Index

397

Doppler ultrasound compared, 101t

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post-treatment evaluation, 103–104,

105f foot volumetry, 108–109, 109f light reﬂection rheography, 106, 107f

Index

photoplethysmography, 104–106, 105f use of, 109–115, 111t

differentiation of relative contribution of

deep and superﬁcial reﬂux, 114

evaluation of origin of recurrences

following ligation/stripping, 115

evaluation of vulvar varices, 115, 115f examination of deep veins, 110, 112f examination of perforating veins, 114f examination of saphenous vein trunks,

111–112

examination of tributaries of saphenous

trunks, 112–113, 113f see also Examination of patient, non-invasive

Norepinephrine, 50 North American Society of Phlebology (NASP),

378

Nurse care, 378 Nutritional supplements, 371

Obesity, and varicose veins, 54, 296 Observational studies, conventional surgery

Occupational edema, 148–149, 148f Oculus loupe (N1064), 384 Oedema see Edema Oestrogen see Estrogen; Estrogen therapy 1064-nm Nd:Yag laser, 307, 357–361, 358f 1320-nm Nd:Yag laser, 307–308, 308f 1470-nm diode laser, 308 1500-nm diode laser, 308–309 Open Deviated Shunts Type II, CHIVA method,

Optiloupe attachment lens, 382 Optivisor magniﬁers, 382 Oral contraception, and DVT, 219–220 Orascoptic loupes, 384 Osmotic solutions, 159

Oxerutin, 371 Oxyhemoglobin, 336

outcome, 291

285–286

extravasation, 200 hypertonic glucose/saline, 163 hypertonic saline, 163, 164f, 165–167, 211 polyiodinated iodine, 164, 211 sodium salicylate, 167, 211

Pads and rolls, 143–144, 144f–145f, 386 Pain

chest, transient, 207 lipodermatosclerosis, 90 prevention, 191–192, 192f varicose veins, 30–31

Pantyhose, compression stockings, 139 Papular telangiectasias, 71 Paresthesia, 210, 223 Paroven, 30 Partial thromboplastin time (PTT), 184–185 Patent foramen ovale (PFO), 249

case history, 274, 275f

Patient position see Position of patient Pelvic obstruction, varicose veins, 53–54 Pentoxifylline, 206 Percussion/Schwartz test, 92, 93f, 100, 112–113 Perforating veins

anatomy, 16–18, 17f, 18t Dodd group, 4, 18

398

Doppler examination technique, 100,

101f–102f in foot, 18 and GSV, 4 Hunterian group, 4, 18 incompetence

case histories, 260–262, 261f–262f, 266,

267f–268f, 268

deep venous pressure, 56 saphenous trunk preservation, 284–285 surgical indications, 297

symptoms, 30 nomenclature, 1 noninvasive diagnostic techniques, use of,

113–114, 114f

pathophysiology, 53

Peripheral arterial occlusive disease (PAOD),

and varicose veins, 296 Peripheral heart, 3–4 Perivascular phagocytosis, of RBCs, 181 Peroneal artery, 3 Perthes’ test, 93–95, 94t, 96f, 259 Phasicity, Doppler ultrasound, 96–97 Phlebectomy

ambulatory, 285, 287f, 292, 304–305 hook or powered, 292, 295t–296t incompetent tributaries, 284–285, 291–292 instruments, 386

varices, 285, 294 Phlebitis, 212 Photography, 388–389 Photoplethysmography (PPG), 29–30, 104–106,

105f, 114 digital or calibratable, 106 sclerotherapy with, 239

Physical examination, 91–95, 93f–96f, 94t Phytotherapy, 371 Pigmentation, signs of venous hypertension,

32–33, 32f–34f

PLACE eponym, compression bandages,

131–132

Plant extracts, 371 Plethysmography, 106 PO see Polidocanol (PO) Poiseuille’s formula, non-foam sclerotherapy,

257

Polarizing magniﬁcation, 384–385, 386f Polidocanol (PO), 162, 163f, 171–173

advantages, 172–173 allergic reaction to, 209–210 clinical use, 190–191 and cutaneous necrosis, 200–201 endothelial damage, 182 injection technique, 319 liquid vs foam, 162 maximum daily dose, 172t structural formula, 172f

Polyiodinated iodine, 164 Polyoxyethylene dodecanol, 203 Popliteal area vein, 16 Popliteal vein, Doppler examination technique,

Port-wine stains see Nevi ﬂammei (port-wine

stains)

Position of patient

Doppler ultrasound, 97 leg elevation (Fegan), 242 reclining, 243 standing, 240–241 standing and reclining, 241–242 two-phase technique (Sigg), 242–243

Posterior deep compartment veins, 4 Posterior tibial artery, 3 Posterior tibial vein, Doppler examination

technique, 99–100

Postoperative care and convalescence, 288–290

Postthrombotic obstruction, 30 Post-thrombotic syndrome, prevention and

treatment, 149 Powered phlebectomy, 292, 295t–296t PPG see Photoplethysmography (PPG) Precision binocular loupe, 382–383 Pregnancy

compression therapy indicated for, 147–148 as contraindication to sclerotherapy,

258–259

and DVT, 221 indications for surgery, 296 telangiectasias, 80–81 varicose veins, 30, 59–62

venoactive drugs, 372 Premenstrual syndrome (PMS), 372 Pressure

compression see Compression pressure

increased deep venous, with varicose veins

distal origin, 55–58 proximal origin, 53–55

of injection, 323 Pressure amplitudes, 126 Pressure gradient, compression stockings, 132f,

138–139 Primary cutaneous disease, 79–80 Primary deep obstruction, 297 Primary deep reﬂux (PDR), 296 Primary valvular incompetence, varicose veins,

58, 59f Primary varices, 296–297 Prior treatment, noninvasive diagnostic

techniques, 90 Prismatic optics, 382 Progesterone, 62 Progressive ascending telangiectasia, 83 Protein C, 221–222 Protein S, 221–222 Proteus syndrome, 75–76 Prothrombin time (PT), 184–185 Provensis technique, foam sclerotherapy, 205 Proximal compression and release, Doppler

ultrasound, 97 Pulmonary edema, 207 Pulmonary embolism, 39, 217–223, 306