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Venous Disorders
Current Concepts
Ajay K. Khanna
Ravul Jindal
Editors
123
Venous Disorders
Ajay K. Khanna · Ravul Jindal
Editors
Venous Disorders
Current Concepts
Editors
Ajay K. Khanna
Department of General Surgery
Institute of Medical Sciences
Banaras Hindu University
Varanasi
India
Ravul Jindal
Vascular and Endovascular Surgery
Fortis Hospital
Mohali
India
ISBN 978-981-13-1107-9 ISBN 978-981-13-1108-6 (eBook)
https://doi.org/10.1007/978-981-13-1108-6
Library of Congress Control Number: 2018954830
© Springer Nature Singapore Pte Ltd. 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms 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.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore
189721, Singapore
Preface
https://t.me/med1917
It has been estimated that more than 25 million people in the USA have
supercial venous reux in their legs, and perhaps 7million exhibit serious
complications such as chronic edema, skin changes, and ulceration. Perhaps
in excess of 500,000 Americans suffer from debilitating chronic venous
ulcers. Though exact gures for Indian scenario is not available but as of the
large population in India, the number of cases are exorbitant. Such ulcers are
notoriously difcult to heal using usual wound management measures. Over
the past several years, much has been learned about the pathophysiology of
venous insufciency, and in the last few years new and exciting treatment
modalities have been developed. These new methods of resolving venous
hypertension in the supercial veins of the lower extremities are safe and
offer better patient outcomes with signicantly less patient inconvenience
than prior surgical remedies. Today varicose veins can be treated with new
and promising treatment modalities which include venous ablation procedures using radiofrequency, laser, and foam and glue sclerotherapy. While
these procedures have been available only in the last few years, a growing
body of data supports their effectiveness. Most patients require a combination
of treatment methods depending on the point of highest venous reux, the
presence of bulging varicosities, the presence of incompetent perforator
veins, and the depth of subcutaneous tissue overlying the muscle fascia.
Radiofrequency or laser ablation in combination with microphlebectomy and
foam sclerotherapy and the recent ones such as mechanochemical treatment
and glue treatment has been shown to achieve excellent clinical and cosmetic
outcomes.
Venous ulcers are debilitating and notoriously difcult to heal by usual
wound management measures. Over the past several years, much has been
learned about the pathophysiology of venous insufciency, and in the last few
years new and exciting treatment modalities have been developed. Though
compression remains the sheet anchor of the treatment of venous ulcer, many
new and different modalities are available for this difcult problem. These
new methods of resolving venous hypertension are safe and offer better
patient outcomes with signicantly less patient inconvenience.
For DVT, traditional treatment regimens including anticoagulation, venous
compression stockings, and leg elevation often are insufcient for patients
with signicant pain and swelling from extensive venous thrombosis. Recent
breakthroughs in minimally invasive interventional radiology techniques,
however, are improving the prognosis of DVT.Catheter-directed thrombolysis
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is an emerging treatment alternative for selected patients with extensive,
symptomatic DVT.Primary and recurrent venous thromboembolic disease
(VTE, deep venous thrombosis, and pulmonary embolism) remains a signicant source of morbidity and mortality in the hospitalized patient. Nonspecic
subjective complaints and lack of specic objective ndings related to acute
deep venous thrombosis (DVT) and pulmonary embolism (PE) complicate
the diagnosis. There remains no single serum marker available to exclusively
conrm the diagnosis of VTE.While D-dimer is highly sensitive and useful
for diagnostic exclusion, it lacks the specicity necessary for diagnostic conrmation resulting in the need for a variety of additional studies (i.e., duplex
ultrasound, venography, V/Q scanning, helical thoracic and pelvic CT scans,
and pulmonary angiography). There is evolving research supporting the utility of various plasma markers as novel “biomarkers” for VTE including
selectins, microparticles, interleukin-10, and other cytokines.
This book discusses various aspects of supercial veins and deep veins
and has chapters on hemodynamics of venous circulation in lower limb, deep
venous reux novel biomarkers in deep vein thrombosis, infra-popliteal DVT,
relevance of wave length in laser treatment in varicose veins, pelvic congestion syndrome, May-Thurner syndrome, nutcracker syndrome, endothermal
heat-induced thrombosis, recurrent varicose veins, venous trauma, one stop
vein clinic, alternatives for venous ulcer treatment, venous anatomy, therapeutic options in lymphedema, nerve damage during endovenous thermal
ablation, newer oral anticoagulants, compression therapy for venous ulcer,
sclerotherapy for varicose veins , thrombolysis for DVT, post-thrombotic
syndrome, etc. All chapters have been written by experts in this eld who
have extensive knowledge in this subject. It is not possible to cover everything related to venous problem in the book but whatever the best available
are incorporated in this book.
This book will be a rewarding experience for postgraduates and practicing
vein physicians and surgeons and is written by experts in various elds. This
book contains many gures and the readers will really enjoy reading the various chapters. Both the editors (AK, RJ) have been engaged in vascular practice for a long period and have treated many patients with venous disorders
with the newly available Gazettes in the armamentarium of treatment of
venous disorders.
I acknowledge the help of Dr. Naren Agarwal of Springer, India, for
accepting my proposal readily and in bringing this book to fruition. It is a
pleasure working with Dr. Naren Agarwal and this is my second exposition
with him. First was when we brought out a book on Ulcers of the Lower
Extremity by Springer in 2016, which came out beautifully and was taken as
one of the important additions to the literature in this eld.
I am indebted to my family Dr. Anuradha, Dr. Divya, and Dr. Soumya who
provided me all the moral support and will forgive me for any negligence
which was unavoidable. I am really thankful to my Coeditor Dr. Ravul Jindal
who is now the president of the Venous Association of India and remained as
a source of inspiration in bringing out this book.
Preface
Preface
https://t.me/med1917
vii
We dedicate this book to our patients who really has taught us the practical
principles of management of their disease.
This book will be really useful to all clinicians dealing with venous disorders and also to postgraduate residents being trained in surgical residency.
This book will provide a fertile seed for ongoing basic and clinical research.
Varanasi, India AjayK.Khanna
Mohali, India RavulJindal
Contents
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1 Anatomy oftheVenous System oftheLower Limbs � � � � � � � � � 1
Jean-François Uhl and Claude Gillot
2 Hemodynamic Aspects ofChronic Venous Disease � � � � � � � � � � 21
Seshadri Raju
3 Deep Venous Reflux � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 29
Arjun Jayaraj
4 Recurrent Varicose Veins � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 39
Mark S. Whiteley
5 Relevance ofWavelength inLaser Treatment
ofVaricose Veins � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 51
Harinder Singh Bedi and Yudhishtar Singh Bedi
6 Sclerotherapy forVaricose Veins � � � � � � � � � � � � � � � � � � � � � � � � � 63
Tarun Grover
7 Nerve Injury duetoEndovenous Thermal Ablation
forVaricose Veins � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 71
Shoaib F. Padaria
8 Endothermal Heat-Induced Thrombosis � � � � � � � � � � � � � � � � � � 83
Vijay Thakore, Hiral Varnami, and Karan Thakore
9 Deep Vein Thrombosis: TheDisease � � � � � � � � � � � � � � � � � � � � � � 89
Devendra Dekiwadia
10 Post-Thrombotic Syndrome � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 105
Devendra Dekiwadia, Birju Patel, and Dilip Vaghasia
11 Isolated Infrapopliteal Deep Venous Thrombosis � � � � � � � � � � � 117
Madhuri Gore
12 Novel Biomarkers inDeep Vein Thrombosis � � � � � � � � � � � � � � � 129
Ajay K. Khanna, Manbendra Vaidya, and Soumya Khanna
13 Newer Oral Anticoagulants � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 137
Ravul Jindal and Piyush Chaudhary
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14 Therapeutic Alternatives forVenous Ulcer� � � � � � � � � � � � � � � � � 147
Fernando VegaRasgado
15 Compression Therapy forVenous Ulcer � � � � � � � � � � � � � � � � � � � 159
Giovanni Mosti
16 Pelvic Congestion Syndrome � � � � � � � � � � � � � � � � � � � � � � � � � � � � 171
Devendra Dekiwadia, Birju Patel, and Dilip Vaghasia
17 May-Thurner Syndrome � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 183
Soumya Khanna and Ajay K. Khanna
18 Nutcracker Syndrome � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 191
Ajay Savlania and Shivanesan Pitchai
19 Venous Trauma � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 201
Arvind Kohli and Gurjit Singh
20 Therapeutic Options inLymphedema � � � � � � � � � � � � � � � � � � � � 205
Waldemer Lech Olszewski and Marzanna Teresa Zaleska
21 One-Stop Vein Clinic: TheIdeal Option � � � � � � � � � � � � � � � � � � � 225
R. Bootun, T. R. A. Lane, and A. H. Davies
Contents
About the Editors
https://t.me/med1917
Ajay K� Khanna MS, FAMS, FACS,
FICS, FACRSI, MNAMS, MBA, DSc,
FRSTMH, FAIS, FUICC, FUWAI, FFIM,
FMAS PDCR is professor of surgery and
former Head of the Department of General
Surgery at the Institute of Medical
Sciences, Banaras Hindu University,
Varanasi. The author has a teaching experience of more than 35years and has been
awarded Young Outstanding Teacher and
Eminent Surgical Teacher awards. He
served as president of Varanasi Surgical
Society, president of Uttar Pradesh chap-
ter of the Association of Surgeons of India
(ASI), Governing Council member of ASI, vice president of ACRSI, and
executive member of ASI, AMASI, VAI, ATVSI, IASO. He has delivered
more than 15 orations: Dr. S.P.Srivastava Memorial Oncology Oration, UP
Chapter of ASI; Dr. S.N.Mathur Oration of UP Chapter of ASI; Roshan Lal
Subharti Oration of UP ASI; S.C.Misra Memorial Oration of UP Chapter
ASI; Dr. A.K.Mehrotra Oration of UP ASI; T P Banerjee Symposium Orator
of UP ASI; Prof. P.N. Chuttani Oration of National Academy of Medical
Sciences; Dr. R.Prasad Oration of Jharkhand ASI; Dr. S.P.Srivastava Oration
of UP IMA; S P S Memorial Oration of NIMA; R M Tewari Oration of
Jharkhand ASI; P K Sen Memorial Oration of ASI; Karnik Memorial Lecture
of ICS; Khubchandani Oration of ASI (ACRSI); N L Bordia Oration of
ATCVSI; P C Dubey Oration of Lucknow Surgeons Club. He received various fellowship awards, viz. Clinical Research Fellowship and Registrar at the
Department of Surgery, University of Wales College of Medicine, Cardiff,
Wales, UK; Metrogyl Travelling Fellowship by Gastrointestinal Research
Society; Commonwealth Scholarship; Indo-Czechoslovakian Cultural
Exchange Program; Best Poster award at the World Congress of Collegium
Internationale Chirurgiae Digestivae; Fellowship of Matsumae International
Foundation, Japan; Fellow UICC International Cancer Technology Transfer
Fellowship, USA; Best Paper award at U.P.Chapter of the Indian Society Of
Gastroenterology; R M Kasliwal award of National Academy of Medical
Sciences; Indo-Italian Cultural Exchange Fellowship; International
Collaboration/Exchange Programme of INSA, Young Outstanding Surgical
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