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Practical Approach to the Management
and Treatment of Venous Disorders
Neil S. Sadick • Neil Khilnani
Nick Morrison
Editors
Practical Approach to
the Management and
Treatment of Venous
Disorders
ISBN 978-1-4471-2890-8 ISBN 978-1-4471-2891-5 (eBook)
DOI 10.1007/978-1-4471-2891-5
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2012948090
© Springer-Verlag London 2013
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on micro fi 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 speci fi 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 speci fi 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)
Editors
Neil S. Sadick, M.D.
Clinical Professor of Dermatology –
Weill Cornell Medical College
New York, NY
USA
Nick Morrison, M.D.
Morrison Vein Institute
Scottsdale, AZ
USA
Neil Khilnani, M.D.
Cornell University
New York
USA
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v
The last twenty- fi ve years has seen a dramatic awakening of interest and
enthusiasm for the management of acute and chronic venous disorders. Many
advances in medicine, including the liberal use of duplex ultrasound, have
enabled physicians to better understand the anatomy, pathogenesis, and natu-
ral history of many common venous disorders. Advances in hematology,
pharmacology, and interventional techniques have signi fi cantly impacted our
understanding of how to prevent and treat thromboembolic disease.
Application and validation of new minimally invasive treatment strategies to
eliminate truncal re fl ux has revolutionized the care of chronic venous disor-
ders moving it out of the operating room and into less intimidating outpatient
of fi ces. These and other contributions have allowed venous care to become
more targeted to the type and extent of venous disease optimizing clinical
outcomes and minimizing morbidity, recovery, and side effects.
This text evolved as a response to numerous requests to present a simpli fi ed
approach to the diagnosis and management of most of the common aspects of
both cosmetic and medical venous disorders. The authors, representing expe-
rienced phlebologists from several different primary disciplines, have
attempted to present simplistic paradigm-oriented approaches on how to
thoughtfully evaluate and manage common vein issues with contemporary
solutions. Several areas of phlebology were not addressed in this text. The
management of vascular malformations is beyond the scope of this text and
was not covered in detail. Although indications for the appropriate use of IVC
fi lters are discussed, the details about the speci fi c devices and their placement
and removal are also beyond the scope of this text. Deep venous obstruction
from prior thrombosis, venous compression by arteries such as the compres-
sion of the left common iliac vein by the right common iliac artery, and pelvic
venous insuf fi ciency can now be managed with minimally invasive image
guided treatments; the technical aspects of such treatments are complex and
not discussed in detail in this handbook.
It is hoped that the present volume will increase the therapeutic skill of the
practicing phlebologist and thus increase the quality of care for patients faced
with problems related to venous disorders.
New York, USA Neil S. Sadick, M.D.
New York, USA Neil M. Khilnani, M.D.
Arizona, USA Nick Morrison, M.D.
Preface
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1 Phlebology: History and Epidemiology . . . . . . . . . . . . . . . . . . . . . 1
John Bergan
2 Setting Up Sclerotherapy in a Phlebology Practice . . . . . . . . . . . 7
Nick Morrison
3 Venous Anatomy of the Lower Extremity . . . . . . . . . . . . . . . . . . 13
Neil M. Khilnani
4 Pathophysiology of Venous Disease . . . . . . . . . . . . . . . . . . . . . . . 19
John Bergan
5 Clinical Evaluation of Patients with Chronic
Lower Extremity Venous Disorder. . . . . . . . . . . . . . . . . . . . . . . . 25
Neil M. Khilnani and Nick Morrison
6 Venous Duplex Ultrasound in Patients with Chronic
Venous Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Neil M. Khilnani
7 Elimination of Truncal Vein Re fl ux: Surgery,
Thermal Ablation, and Chemical Ablation
for Chronic Venous Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Nick Morrison and Neil M. Khilnani
8 Sclerotherapy and Alternatives . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Neil S. Sadick
9 Foam Sclerotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Nick Morrison
10 Ambulatory Phlebectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Lowell S. Kabnick
11 Treatment of Incompetent Perforating Veins . . . . . . . . . . . . . . 107
Steve Elias
12 Tributary Treatment Strategies: Treatment
of Varicose Veins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Neil M. Khilnani
13 Genetic Thrombophilias: When to Consider
and What to Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Edith A. Nutescu , Jessica B. Michaud, and Joseph A. Caprini
Contents
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viii
Contents
14 Deep Vein Thrombosis: What to Do. . . . . . . . . . . . . . . . . . . . . . 135
Karun Sharma and Suresh Vedantham
15 Superficial Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Joseph A. Caprini and Michael J. Verta
16 Treatment of Hand Veins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Neil S. Sadick
17 Compression Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Hugo Partsch
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
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John Bergan , M.D. 9850 Genesee , Suite 410 , La Jolla , CA , USA
Joseph A. Caprini , M.D., M.S., FACS, RVT Louis W. Biegler
Professor of Surgery and Bioengineering,
Department of Surgery , Evanston Northwestern Healthcare ,
Evanston , IL , USA
Northwestern University Feinberg School of Medicine ,
Chicago , IL , USA
Robert R. McCormick School of Engineering and Applied Sciences ,
Evanston , IL , USA
The University of Chicago Pritzker School of Medicine ,
Chicago , IL , USA
Division of Vascular Surgery, Department of Surgery ,
NorthShore University Health System , Evanston , IL , USA
Steve Elias , M.D. Dep of Surgery, Division of Vascular Surgery
Vein Programs , Columbia University , New York , NY , USA
NY Presbyterian – Columbia University Medical Center ,
New York , NY , USA
Lowell S. Kabnick , M.D., FACS, FACPh New Jersey Medical
School – UMDNJ, Morristown Memorial Hospital ,
Morristown , NJ , USA
New York University Langone Medical Center ,
New York , NY , USA
Vein Institute of New Jersey , Morristown , NJ , USA
Neil M. Khilnani , M.D. Weill Cornell Vascular and the Division
of Interventional Radiology, New York Presbyterian Hospital-Weill
Cornell Medical Center ,
New York , NY , USA
Weill Cornell Vascular, Weill Medical College of Cornell University ,
New York , NY , USA
Contributors
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