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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3786_Библиотеки_им_академика_М_И_Перельмана

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Phlebology, Vein Surgery and Ultrasonography
Diagnosis and Management of Venous Disease
Eric Mowatt-Larssen Sapan S. Desai Anahita Dua Cynthia E. K. Shortell
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Phlebology, Vein Surgery and Ultrasonography
Eric Mowatt-Larssen • Sapan S. Desai Anahita Dua • Cynthia E.K. Shortell
Editors
Phlebology, Vein Surgery and Ultrasonography
Diagnosis and Management of Venous Disease
Editors
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Eric Mowatt-Larssen Vein Specialists of Monterey Monterey, CA USA
Sapan S. Desai Department of Surgery Duke University Medical Center Durham, NC USA
Department of Cardiothoracic and Vascular Surgery University of Texas at Houston Medical School Houston, TX USA
Anahita Dua MSB 5.030 University of Texas-Houston Houston, TX USA
Cynthia E.K. Shortell Department of Vascular Surgery Duke University Medical Center Durham, NC USA
ISBN 978-3-319-01811-9 ISBN 978-3-319-01812-6 (eBook) DOI 10.1007/978-3-319-01812-6 Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2013956742
© Springer International Publishing Switzerland 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (
www.springer.com)
F o r e w o r d
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The latter half of the twentieth century saw very little advancement or innovation in the diagnosis and treatment modalities of venous disease. The standard diagnostic testing for deep venous disease, whether for acute or chronic thrombosis or for insuffi ciency, consisted primarily of venography, with treatment options limited to compression, leg elevation, anticoagulation, and occasionally open surgical intervention. For superfi cial venous disease, diagnostic testing at that time was limited even more to physical examination, with treatment being standard surgical high ligation and stripping with avulsion phlebectomy and perforator ligation.
Venous disease diagnostics were dramatically improved late in the twentieth century by advances in imaging modalities. The fi rst and most important among these was duplex ultrasound, followed by computerized tomography (CT) and magnetic resonance imaging (MRI). More recently, diagnostic vascular enhancement techniques have made CT and MRI even more useful. We have also been reaping further diagnostic benefi ts from advancements in ultrasound testing, using intravascular ultrasound (IVUS), for example, to diagnose deep venous disease. While not perfect, duplex ultrasound has become the gold standard for at least the initial diagnostic maneuver for most venous disorders, even including those related to lymph­edema and vascular malformations.
These diagnostic advancements have allowed scientifi c investigators worldwide to gain a clearer understanding of venous disorders and have resulted in truly dramatic changes in the therapeutic realm. We are moving rapidly toward evermore minimally invasive treatments for both deep and superfi cial venous disorders. An international explosion of interest in venous disease is bringing a wide spectrum of expertise to bear upon our understand­ing of venous pathophysiology. This has allowed the fi eld to move from one mostly dominated by art and anecdotal science to one based on rigorous investigation and scientifi c principles. Hugo Partsch describes this as a transi­tion from “eminence-based medicine” to “evidence-based medicine.” Such advancements must be very gratifying to the venous practitioners working in the fi eld for the past half century. They certainly are stimulating to those entering the fi eld from other disciplines.
Phlebology, Vein Surgery and Ultrasonography is an excellent description of current thinking regarding venous disorders, but I think of this text as sim­ply a progress report on the journey to greater understanding of venous disor­ders. By reading this book, you will, I hope, be stimulated to add to this fund
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of knowledge with scientifi c investigations of your own or in support of oth­ers, with the goal of producing high-quality reports to help us care for the vast number of patients with venous disorders.
Nick Morrison
Foreword
Pref ace
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Phlebology is in the midst of a revolution brought on by technological advancements. Duplex ultrasound is used before treatments to map refl ux and see clots and obstructions in diagnosis, during many procedures to ensure accurate treatments, and used afterward to check technical success and avoidance of complications. Furthermore, because it allows noninvasive monitoring of venous pathology, it has acted much like the invention of the telescope and allowed paradigm-challenging observations about the natural history of refl ux. It turns out the understandings of Rima and Trendelenburg from the nineteenth century are incorrect, and refl ux often spreads proximally up the great saphenous vein over time. We have not fi gured out the implica­tions of these fi ndings.
Meanwhile, endovascular techniques have become dominant, even as surgical techniques have continued to improve and advance. Laser ablation, radiofrequency ablation, and chemical ablation (sclerotherapy) compete with high ligation with or without stripping, ambulatory phlebectomy, powered phlebectomy, and subfascial endoscopic perforator surgery. Three­dimensional venography and intravascular ultrasound allow us to diagnose and treat proximal venous problems at ilio-caval and pelvic veins few physicians even considered only 10 years ago.
All this intellectual fervor has led to two new certifi cations. Physicians who are diplomates of the American Board of Phlebology specialize in venous disease management. Physicians and ultrasonographers can attain certifi cation as a registered phlebology sonographer.
I hope the reader will sense some of the excitement of the birth of this new specialty in this book. The authors come from a wide range of specialties, consistent with the history of phlebology, which has always smartly embraced the diverse perspectives of multiple different medical fi elds. The faculty is also international, an overt acknowledgement that the work of our interna­tional colleagues has been instrumental in moving our understanding of venous disease forward. Finally, ultrasound is integrated into this text, because it is my belief that good ultrasound is essential in providing excellent care for our patients.
Although phlebology is young, venous diseases are common, and the shoulders we stand on are ancient. The high risk of refl ux in our species may well be primarily the result of bipedalism, which magnifi es the impact of gravity when venous valves fail. Compression is seen in cave paintings from our hunter-gatherer origins from over 5000 years ago. All the ancient cultures
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who left written records described vein symptoms and treatments. Recent rapid developments in our understanding were only possible through the work of several organizations, such as the International Union of Phlebology, American College of Phlebology, and American and European Venous Forums. Important textbooks were written and edited by giants in the fi eld, such as Craig Feied, Robert Weiss, Helane Fronek, Mitchell Goldman, John Bergan, JJ Guex, and Peter Gloviczki.
This volume would have been impossible without the amazing technical skills of Dr. Sapan Desai. He has already impacted the arena of medical edu­cation in profound ways and you will see the fruits of his abilities in the pages which follow. I owe many thanks also to Dr. Cynthia Shortell. Besides her contributions to the editing for this book, she has taught me a tremendous amount over our years of collaboration.
To the reader: please read, challenge, enjoy, and savor!
Monterey, CA, USA Eric Mowatt-Larssen
Preface
Contents
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Part I Basic Sciences
1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Brian S. Knipp and David L. Gillespie
2 Pathophysiology of Refl ux. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Sergio Gianesini and Paolo Zamboni
3 Presentation of Chronic Venous Disease . . . . . . . . . . . . . . . . . . 33
Michael A. Vasquez and Cary Munschauer
4 Refl ux Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Daniel F. Geersen and Eric Mowatt-Larssen
Part II Vein Testing
5 Ultrasound Physics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Frank R. Miele
6 Ultrasound for Refl ux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Joseph A. Zygmunt Jr.
7 Ultrasound for Phlebology Procedures . . . . . . . . . . . . . . . . . . . 95
Diana L. Neuhardt
8 Physiologic Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Julianne Stoughton
9 Conventional and Cross-Sectional Venography . . . . . . . . . . . . 115
Charles Y. Kim and Carlos J. Guevara
Part III Superfi cial Vein Therapy
10 Endovenous Thermal Ablation. . . . . . . . . . . . . . . . . . . . . . . . . . 135
Mark N. Isaacs
11 Chemical Superfi cial Vein Ablation . . . . . . . . . . . . . . . . . . . . . . 147
Nick Morrison
12 Surgical Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Marc A. Passman
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