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16717 Compression Therapy

Fig. 17.4 Measurement of systolic ankle pressure

Fig. 17.5 ( a ) Patient with recurrent venous ulceration due

to massive super ﬁ cial and deep venous re ﬂ ux (postthrom-

botic syndrome). Patient had a caval ﬁ lter after sublethal

pulmonary embolism and was under oral anticoagulation.

There was no improvement with compression therapy.

( b ) Six weeks after foam sclerotherapy of the incompetent

great saphenous vein on the thigh in addition to lower leg

bandaging the ulcer was healed. Compression stockings

are worn to prevent recurrence (Courtesy Dr B Partsch)

Table 17.5 Doppler ankle brachial pressure index

(ABPI) and practical consequences

ABPI Practical consequence

1.0–1.3 No contraindication for compres-

sion (media sclerosis excluded)

0.6–1.0 Stiff/short stretch materials with

reduced pressure (15–40 mmHg)

<0.5 No sustained compression!

>1.3 Mediasclerosis, use other test (e.g.

toe pressure, acral oscillography)

Compression of Painful Swollen Leg

In the presence of a painful, swollen leg the most

important step will always be to diagnose or to

rule out acute deep vein thrombosis. Mobile

patients will bene ﬁ t immediately by a relief of

pain and swelling, including those patients in

whom no diagnosis of DVT can be made. Exact

anticoagulation with therapeutic doses of low

molecular weight heparin, in most cases overlapping

with oral vitamin k-antagonists, is obligatory if

the diagnosis of DVT is veri ﬁ ed.

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168

H. Partsch

If the exact diagnosis can not be made instantly

(e.g. during the weekend) it is advisable to inject

a therapeutic dose of low molecular weight hepa-

rin and to let mobile patients walk with a good

compression bandage before the diagnosis can be

veri ﬁ ed the next work day.

These principles of conservative manage-

ment apply both to unprovoked and to secondary

forms of DVT, e.g. after any kind of ablation pro-

cedure. While selected patients may be consid-

ered for thrombus removal, today mainly using

catheter-based thrombolytic techniques, the

majority of patients with DVT can be treated

conservatively [ 8 ] .

For extensive super ﬁ cial vein thrombosis,

treatment with prophylactic or intermediate doses

of LMWH or intermediate doses of UFH for

4–6 weeks is recommended [ 8, 9 ] . Compression

and early ambulation in addition to anticoagula-

tion does not only reduce the incidence of a post-

thrombotic syndrome but also leads to a faster

resolution of pain and swelling compared with

immobilization, and a similar lower incidence of

new PE on routine repeat lung scanning after

10 days [

8 ] .

Compression Bandages

Stiff bandages are still the ﬁ rst choice for treat-

ing venous ulcers, not only for the management

of ulcers that are large and long-standing, but

also for the management of deep vein throm-

bosis, super ﬁ cial phlebitis, postthrombotic syn-

drome, and lymphedema. Unna boot bandages

(e.g. Gelocast

+ Comprilan

) are examples of

completely not-stretchable inelastic material

(Fig. 17.7 ). The disadvantage of such bandages is

that their application is not so easy and medical

staff should be trained in the application. Multi-

component systems like Profore

, Rosidal sys

or Coban 2

act also as stiff bandages and are

easier to handle.

Double Stocking Technique

By applying two compression stockings over

each other the compression pressure will be dou-

bled and the stiffness of the ﬁ nal system will be

increased. For the patients it is easier to put on

two light stockings than one strong stocking

(Fig. 17.8 ).

Fig. 17.7 Unna boot (Varicex F

) wrapped over by a

short stretch bandage (Rosidal K

), adhesive Panelast

over the knee and adhesive Porelast

on the thigh up to the

groin in a patient with iliofemoral deep vein thrombosis.

The patient gets low molecular weight heparin in

therapeutic dose overlapped with an oral vitamin K antag-

onist and is encouraged to walk

Fig. 17.6 Application of a foam pad (Komprex

, Lohnmann

&Rauscher) to increase the local pressure behind the inner ankle

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16917 Compression Therapy

Thigh Compression After Endovenous

Procedures

In order to compress the thigh veins after treat-

ment the pressure in the upright position should

be between 30 and 60 mmHg. Such high pres-

sures can only be achieved by very strongly

applied cohesive or adhesive bandages (e.g.

Panelast

) or by using special pads that exert

eccentric compression (Medi postop kit

) [ 17 ]

(Fig. 17.9 ).

Immobile Patients

Compression is effective especially in connection

with walking. Therefore exercises are essential to

keep the venous pump active.

When a patient does not walk. e.g. due to

immobility or pain from leg ulcers, the ankle

joints will get stiff. A vicious circle will start

characterized by the following features:

Pain → no movement → stiff ankle → walking

inability → venous pumping failure → ulcer wors-

ening → more pain → etc.

Decongestive Lymphatic Therapy

in Lymphedema

The basic conservative treatment in lymphoe-

dema consists in a combination of compression,

manual lymph-drainage, skin-care and exercises

(“Decongestive lymphatic therapy”)

The most important component is compres-

sion [ 18 ] .

Fig. 17.8 Satin foot socks, foam-rubber-foot-pads and wear-

ing rubber gloves make the donning of compression garment

easier

Fig. 17.9 Compression pad for increasing the local

pressure after endovenous ablation of the great saphenous

vein. (Medi postop kit

)

Small ulcers can be effectively treated using

two stockings: a basic “liner” keeps the ulcer

dressing in place and may be also worn

during night time without discomfort. In the

morning the second stocking is donned over

the ﬁ rst, producing higher pressure in the

upright position and during walking, when

this is needed. (e.g. UlcerCare

, Jobst, Ulcer

kit

medi, Venotrain, Bauerfeind

To be effective, rubber foam pads should

be placed exactly over the treated thigh

vein, which has to be marked using Duplex

before the procedure.

Exercises to keep ankle joints active are an

important adjunct to compression therapy.

Intermittent pressure pumps (IPC) mimicking

the muscle pump action may be very helpful

especially in patients with restricted mobility.

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170

H. Partsch

“Other” Compression Devices

Stiff bandages have the disadvantage that they

lose pressure immediately after application and

that they are not easy to apply, so that special

training is needed.

Very effective stiff compression that can be

handled by the patient without assistance may be

delivered by intermittent pneumatic pumps and

by Velcro-band devices (e.g. CircAid

Main advantages of IPC machines are the main-

tenance of the pressure for selected time periods

and the independence from the walking ability of

the patient. However, such devices can only be used

in addition to conventional bandages or stockings.

Velcro-band devices (e.g. CircAid

, CircAid

Medical) can be used by the patient after brief

instruction and provide the advantages of a stiff

system which can be readjusted by the patient

according to his needs (Fig.

17.10 ).

Pitfalls

Non-compliance

Compression therapy will only work when the

compression device is worn. Non-adherence

is the most important factor limiting the

Intermittent pneumatic compression pumps

(IPC) are a useful supplementary tool for

the home-therapy of patients with lym-

phoedema, postthrombotic syndrome, and

leg-ulcers, as well as in those patients with

mixed, arterial-venous etiology [ 20 ] .

Vecro-band devices (CircAid

) can be used

by cooperative patients in the same situations

with the advantage of unrestricted mobility.

Compression in lymphoedema should start

with stiff bandages which should be changed

daily in the initial phase. The bandages

should stay over night and – at least in severe

cases – include toes or ﬁ ngers. Additional

manual lymph-drainage and intermittent

Ulcer pain

No ankle

movement,

Stiff ankle

Venous

pump

decreases

Ulcer

detiorates

More pain

pneumatic compression (IPC) is bene ﬁ cial

but may not replace compression. When no

more volume reduction of the swollen limb

can be obtained, well ﬁ tting compression

stockings (made-to-measure) should be

worn on a daily basis lifelong.

https://t.me/med1917

17117 Compression Therapy

effectiveness of compression therapy. The most

important point to overcome this problem is

adequate education and counselling of the

patient, especially when treatment is started for

the ﬁ rst time. The problem will be solved as

soon as the patient experiences the bene ﬁ ts of

compression.

Slippage of Fixed Bandages

Inelastic bandages may get loose very quickly

due to the reduction of edema. However, it could

be demonstrated that they will maintain their

hemodynamical effectivity up to 1 week after

application [ 19 ] .

Inverse Pressure Gradient

Non- ﬁ tting compression devices may cause

strangulations and skin damage. This may be

especially important in immobilized patients.

When the patient is walking a higher pressure

over the calf than over the ankle will be well tol-

erated and may even be more effective. This has

been considered by some companies in develop-

ing new compression stockings which are also

easier to put on by the patients.

Key-Points for Success

Adjust pressure and material of the compres-•

sion device

to the underlying stage and severity of the –

veno-lymphatic disease.

to the mobility of the patient and their abil- –

ity to handle the device.

Apply strong compression bandages for severe •

cases (large ulcers, massive edema – training

needed).

Keep in mind that compression has also an •

important role in acute venous disease. (According

to Virchow’s triade stasis is one of the pathoge-

netic factors of thrombosis. Compression and

exercises are the most important measures coun-

teracting stasis).

Use low pressure if the leg is small and thin. •

Tell your patients that well ﬁ tted medical com-•

pression stockings

should be put on in the morning and –

removed over night,

should be renewed after 6 months if worn daily, –

can be applied using rubber gloves and –

gliding socks much more easily,

should only be hand-washed and not ironed, –

are able to reduce edema and in ﬂ ammation, –

will relief venous symptoms, –

will achieve better effects after sclerother- –

apy and lower potential side-effects,

mmHg 100

Supine dorsiflexions Standing

Fig. 17.10 Pressure under

a CircAid

measured above

the inner ankle by a

Picopress

transducer

(Microlab, Padova).

The resting pressure in the

supine position is

42 mmHg. Seven

dorsi ﬂ exions produce

pressure peaks up to

70 mmHg. When the patient

stands up the pressure rises

to 60 mmHg. This as an

example for a stiff,

completely inelastic device

adjusting immediately to a

higher counter-pressure

when this is required in the

standing position

https://t.me/med1917

172

H. Partsch

will speed up recovery after surgery and –

endovenous procedures of varicose veins,

should be worn after deep vein thrombosis in –

order to prevent postthrombotic syndrome,

will be an obligatory maintenance therapy –

in lymphoedema and severe postthrom-

botic syndrome.

Consider Velcro-band devices for long term •

treatment if the pressure of stockings is too low.

Check the arterial circulation before any kind •

of sustained compression.

Pads and rolls may be used in order to increase •

the local pressure, e.g. after an endovenous

procedure [

21 ] .

Use intermittent pneumatic compression •

devices as adjunct therapy, especially in

patients with restricted mobility.

Give your patients advice for their life-style:•

regular exercises (walking, swimming), –

healthy weight (balanced diet), –

avoid long sitting and standing, –

leg-elevation several times a day if possible, –

avoid hot bathes. –

References

1. Partsch H, editor. Evidence based compression therapy.

VASA 2003;32(Suppl 63):1–39.

http://verlag.han-

shuber.com/ezm/index.php?ezm=VAS&la=d&ShowIs

sue=1469

2. Partsch H, Flour M, Coleridge Smith Ph, Benigni J-P,

Cornu-Thénard A, Delis K. Indications for compres-

sion therapy in venous and lymphatic disease.

Consensus based on experimental data and scienti ﬁ c

evidence. Int Angiol. 2008;27:193–219.

3. Kern P, Ramelet AA, Wütschert R, Hayoz D.

Compression after sclerotherapy for telangiectasias

and reticular leg veins: a randomized controlled study.

J Vasc Surg. 2007;45:1212–6.

4. Partsch B, Partsch H. Calf compression pressure

required to achieve venous closure from supine to

standing positions. J Vasc Surg. 2005;42:734–8.

5. Partsch H. Ambulation and compression after deep

vein thrombosis: dispelling myths. Semin Vasc Surg.

2005;18:148–52.

6. Gohel MS, Barwell JR, Earnshaw JJ, Heather BP,

Mitchell DC, Whyman MR, et al. Randomized clinical

trial of compression plus surgery versus compression

alone in chronic venous ulceration (ESCHAR study) –

haemodynamic and anatomical changes. Br J Surg.

2005;92(3):291–7.

7. Sullivan V, Denk PM, Sonnad SS, Eagleton MJ,

Wake ﬁ eld TW. Ligation versus anticoagulation: treat-

ment of above-knee super ﬁ cial thrombophlebitis non

involving the deep venous system. J Am Coll Surg.

2001;193:556–62.

8. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob

GE, Comerota AJ. Antithrombotic therapy for venous

thromboembolic disease: American College of Chest

Physicians evidence-based clinical practice guidelines

(8th edition). Chest. 2008;133:454–545.

9. Decousus H, Prandoni P, Mismetti P, Bauersachs RM,

Boda Z, Brenner B, CALISTO Study Group.

Fondaparinux for the treatment of super ﬁ cial-vein

thrombosis in the legs. N Engl J Med. 2010;

363(13):1222–32.

10. Partsch H, Kaulich M, Mayer W. Immediate mobilisa-

tion in acute vein thrombosis reduces post-thrombotic

syndrome. Int Angiol. 2004;23:206–12.

11. Partsch H. Do we still need compression bandages?

Haemodynamic effects of compression stockings and

bandages. Phlebology. 2006;21:132–8.

12. Partsch H, Clark M, Mosti G, Steinlechner E, Schuren

J, Abel M, Benigni JP, Coleridge-Smith P, Cornu-

Thénard A, Flour M, Hutchinson J, Gamble J,

Issberner K, Juenger M, Moffatt C, Neumann HA,

Rabe E, Uhl JF, Zimmet S. Classi ﬁ cation of compres-

sion bandages: practical aspects. Dermatol Surg.

2008;34:600–9.

13. Mostbeck A, Partsch H, Peschl L. Änderungen der

Blutvolumenverteilung im Ganzkörper unter physika-

lischen und pharmakologischen Maßnahmen. Vasa.

1977;6:137–41.

14. O’Meara S, Cullum NA, Nelson EA. Compression for

venous leg ulcers. Cochrane Database Syst Rev.

2009;(1):CD000265.

15. Hertzman PA, Owens R. Rapid healing of chronic

venous ulcers following ultrasound-guided foam scle-

rotherapy. Phlebology. 2007;22:34–9.

16. Obermayer A, Göstl K, Walli G, Benesch T. Chronic

venous leg ulcers bene ﬁ t from surgery, long-term

results from 173 legs. J Vasc Surg. 2006;44:572–9.

17. Partsch B, Partsch H. Which pressure do we need in

order to compress the great saphenous vein on the

thigh? Dermatol Surg. 2008;34(12):1726–8.

18. Badger C, Seers K, Preston N, Mortimer P. Physical

therapies for reducing and controlling lymphoedema

of the limbs. The Cochrane Library. 2003;(2). Oxford:

Update Software.

19. Mosti G, Partsch H. Inelastic bandages maintain their

hemodynamic effectiveness over time despite signi ﬁ cant

pressure loss. J Vasc Surg. 2010;52(4):925–31.

20. Labropoulos N, Leon Jr LR, Bhatti A, Melton S, Kang

SS, Mansour AM, Borge M. Hemodynamic effects of

intermittent pneumatic compression in patients with

critical limb ischemia. J Vasc Surg. 2005;42(4):710–6.

21. Lugli M, Cogo A, Guerzoni S, Petti A, Maleti O.

Effects of eccentric compression by a crossed-tape

technique after endovenous laser ablation of the great

saphenous vein: a randomized study. Phlebology.

2009;24(4):151–6.

https://t.me/med1917

173

N.S. Sadick et al. (eds.), Practical Approach to the Management and Treatment of Venous Disorders,

DOI 10.1007/978-1-4471-2891-5, © Springer-Verlag London 2013

Ambulatory phlebectomy

anesthesia , 97

bene ﬁ ts of , 95

clinical guidelines , 105

complication , 102, 103

compressive bandage and incisions , 93

contraindications , 95

cosmetic dimension , 104

de ﬁ nition , 94

delivering and mixing, tumescent anesthesia , 98

delivery loop , 99, 101

discharge recommendation , 100, 102

incision , 98, 100

indications , 94–95

learning curve , 93

Muller hook , 98, 99

Muller’s phlebectomy technique , 93–94

optional vein ligation , 99, 101

phleb tray , 98, 100

powered phlebectomy , 103–104

preoperative preparation , 96–97

puncture devices , 98

quickness and ef ﬁ cacy , 93

sclerotherapy , 95–96

spatula , 99, 100

staged vs. unstaged procedure , 96

surgical plan , 97

traction , 99, 101

transection , 99, 101

transillumination , 95

TriVex T system , 104

tumescent anesthesia , 97–98

Ambulatory Selective Ablation of Varices under Local

anesthesia (ASVAL) , 48

American College of Radiology , 35

Chronic lower extremity venous disorder

acute lipodermatosclerosis , 28, 31

chronic lipodermatosclerotic change , 28, 31

duplex scan , 27–28

edema , 28, 30

management of , 31

managing patient expectation , 26

medial malleolar corona phlebectasia ,

28, 29

patient risk factor , 25

physical progressive sign , 27

reticular varicosities , 28, 29

routine health information , 26

super ﬁ cial venous insuf ﬁ ciency

symptoms , 25

symptoms , 26–27

telangiectasias , 27

treatment , 25–26

varicose vein , 30

vascular-speci ﬁ c historical factor , 26

venous insuf ﬁ ciency , 28, 30

venulectasia posterior calf , 28

Chronic venous disorder

complications of , 45

endovenous chemical ablation , 55 ( see also Foam

sclerotherapy)

endovenous thermal ablation

adjunctive treatment , 54–55

compression therapy , 50

deep vein thrombosis , 53

hatched black line marking , 49

indications and contraindication , 48

intra-operative adverse event , 52

laser thermal ablation vs. RF , 54

life-table analysis , 52

nitropaste , 49

patient positioning , 49

pearls and pitfalls , 55

postoperative adverse event , 52–53

recanalization , 54

RF and laser endovenous ablation , 48

saphenous vein, adjunctive treatment , 50–51

saphenous vein-cephalad , 49–50

segmental recurrent patency , 54

segmental stenosis , 50

SPJ, groin recurrence , 53

stripping vs. RF ablation , 51–52

technical equipment , 48–49

trendelenberg positioning , 50, 51

truncal re ﬂ ux , 52

ultrasound-guided laser ﬁ ber , 50, 51

high ligation/stripping , 46

indications and contraindication , 46

Index

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174

Index

Chronic venous disorder (cont.)

SEPS

indications/contraindications , 46–47

pearls and pitfalls , 48

postoperative care , 48

recurrent varicose vein surgery , 47

saphenous sparing technique , 47–48

SPJ, re-exploration , 48

therapeutic intervention , 45

ulceration , 45

Chronic venous insuf ﬁ ciency (CVI) , 21–22

Compression therapy

arterial brachial pressure index , 164–165

bandages vs. medical compression stocking , 164, 166

clinical ef ﬁ cacy , 161

compression bandage , 162, 164, 165

contraindications , 164

CW-Doppler probe , 164

decongestive lymphatic therapy , 169–170

Doppler ABPI , 165, 167

double stocking technique , 168, 169

eccentric compression , 162

experience endorsed indications , 161

ﬁ xed bandage slippage , 172

immobile patient , 169

intravenous pressure , 162, 163

inverse pressure gradient , 172

IPC machine advantage , 170

leg compression bandage , 166

medical compression stocking , 161, 162

non-compliance , 171–172

non-phlebological indications , 163, 164

painful swollen leg , 167–168

PAOD , 166

patient life-style , 173

spider vein sclerotherapy , 161

super ﬁ cial and deep vein thrombosis ,

162–163

systolic ankle pressure , 164, 167

thigh compression , 169

unna boot bandage , 168

velcro-band device , 170, 171

venous ulceration , 166, 167

Deep vein thrombosis (DVT)

anticoagulant therapy , 136

bleeding complication , 141

catheter-directed intrathrombus thrombolysis , 137

complications , 135

contraindications , 135

drugs, catheter-directed thrombolysis , 135, 136

elastic compression stocking , 141

endovascular treatment technique

diagnostic venogram , 137

drug-only approach , 137

LMWHs , 140

pearls and pitfalls , 140

pharmacomechanical thrombolytic technique , 137

PTS prevention measure , 139, 140

single-session pharmacomechanical CDT ,

137–139

ultrasound-assisted thrombolysis , 137

venography and adjuctive intervention , 139

venous access , 137

indications , 135

IVC ﬁ lter , 136

patient risk assessment , 136

patient screening , 137

pre-treatment screening evaluation , 141

venous patency restoration , 136–137

vitamin K antagonists , 136

Fegan technique , 63

Foam sclerotherapy

CEAP class , 83

detergents , 83–84

direct injection method, target vein , 84

ef ﬁ cacy and comparative study , 86

ef ﬁ cacy improvement guidelines , 86

extensive femoropopliteal thrombosis , 88

foam safety , 86–87

gas embolization , 83

liquid sclerotherapy , 83

needle insertion , 85

needle longitudinal ultrasound image , 85

occular migraine , 88

postoperative care , 89

pulmonary embolism , 87

safety improvement guidelines , 88–89

scotomas , 87

side-effects and complications, UGFS , 89

super ﬁ cial leg vein image, ultrasound , 85

super ﬁ cial thrombophlebitis , 88

three-way tap connector , 83, 84

UGFS , 83

Genetic thrombophilias

anticoagulant drug interaction , 126, 128

antithrombin de ﬁ ciency , 129

APC resistance/FVL polymorphism ,

130–131

clinical manifestations , 125, 127

coagulation cascade , 129

elevated coagulation factor , 131

Group 1 and Group 2 disorder , 125, 126

hyperhomocysteinemia , 131

laboratory test , 126, 128

prevalence , 126, 127

protein C and S de ﬁ ciency , 129–130

prothrombin G20210A polymorphism , 131

thrombophilic defect , 131

thrombosis relative risk , 125, 127

https://t.me/med1917

175Index

thrombotic-risk evaluation , 132

venous thrombosis prophylaxis , 132

Virchow’s triad , 125

VT occurrence , 125

warfarin-induced skin necrosis , 130

Hand vein

ambulatory phlebectomy , 159

combination approach , 159

dorsal venous system anatomy , 157

endovenous laser , 157, 158

Q-switched laser and RF , 159

rejuvenation , 157, 158

sclerotherapy , 157–159

skin characteristic aberration , 157

super ﬁ cial dorsal hand vein enlargement , 159

volume depletion , 159

Hobbs technique , 63–64

Hyperhomocysteinemia , 131

Incompetent perforating vein

deep venous system , 107

energy source , 110–111

GCS and GSV treatment , 112

indications , 109

life indicator , 113–114

Linton procedure , 109

liquid and foam sclerotherapy , 112, 113

management of , 114

paired veins and artery , 111, 113

PAPS , 110, 111

vs. pathologic perforating vein , 108–109

pathophysiology , 107

post PAPS , 111, 112

post SEPS, perforator clipped , 111, 112

PPV occlusion , 111, 113

re ﬂ ux , 107

SEPS , 109–110

thermal abaltion , 111

truncal vein ablation and SEPS , 111

ulceration , 108

ultrasound-guided percutaneous access , 110

varicose vein , 107–108

Intersocietal Commission for the Accreditation of

Vascular Laboratories (ICAVAL) , 35

Lower extremity venous anatomy

AAGSV , 15

cephalad termination , 16–17

femoral vein, segmental duplication , 14

foot deep venous system , 13

gastrocnemius vein , 14

GSV , 14–15

Leonardo’s Vein , 15–16

popliteal vein , 14

saphenous vein , 14

sciatic vein vs. SSV , 17

sinusoidal vein , 13

SSV , 16

super ﬁ cial venous system , 14

Phlebology

black bile theory , 1

clinical and duplex ultrasound technique , 5

De venarum ostiolis folio pamphlet , 2

foam sclerotherapy , 3–4

Harvey’s blood ﬂ ow illustration , 1

leather lace up stocking, compression

therapy , 2

minimally invasive varicose vein treatment , 3

perforating vein theory , 2–3

telangiectasias , 5

ulcer healing, bandaging , 1–2

varicose vein, surgical treatment , 2

venous insuf ﬁ ciency, epidemiology , 4–5

Phlebolymphedema , 28, 30

PIN stripping , 46

Post-phlebitic syndrome , 21–22

Sclerotherapy

antiseptics , 9

direct hands-on approach , 7–8

ergonomic position , 9–10

foam vs. liquid sclerosants , 8–9

governmental regulation, performing of , 7

limiting learning session , 8

liquid sclerosants , 8

manufacturing process , 9

minimally invasive technique , 61

offer course and practical symposia , 11

patient positioning , 10, 11

phlebologic process , 7

phlebology fellowship and preceptorship

training , 11

re ﬂ ux source , 61

reticular vein

indications , 67

MSC , 71

pearls and pitfalls , 71

post treatment compression therapy , 70

pre/post sclerotherapy , 69, 70

pretreatment , 67–68

re-treatment session , 70–71

sclerosant concentration , 68

skin traction , 69

treatment , 68–69

safety, foam sclerotherapy , 9

side effects/complications, foam sclerotherapy , 8

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176

Index

Sclerotherapy (cont.)

telangiectasias

complications , 79–80

extensive thrombosis H&E , 78, 80

feeding source abolishment , 81

glistening effect , 72

hand placement , 73

hemoglobin/deoxyhemoglogin absorption

spectrum , 77

30–40° injection angle , 72–73

IPL , 76

laser and light source treatment , 75, 77, 78

laser therapy , 78–79

light and RF technology , 78, 79

management of , 71–72

monomodal approach , 77–79

necrotic ulcerative reaction , 73–74

optimal laser parameter , 77, 78

oral contraceptive usage , 81

patient positioning , 72, 73

pearls and pitfalls , 80–81

post treatment , 74–75

pretreatment , 72

sclerosant concentration , 72

sclerosant postsclerotherapy kneading , 74, 75

treatment principle , 74

treatment resistant approach , 75

therapeutic modality , 12

ultrasound guided liquid sclerosants , 10

varicose vein

compression therapy , 64–65

diagnostic approach , 62

duplex sclerotherapy protocol , 66–67

duplex ultrasound , 65

Fegan technique-dependent cannulation , 63

Fegan variant , 63

ﬂ ow sheet , 65, 66

Hobbs technique , 63–64

patient positioning , 63

pearls and pitfalls , 67

pretreatment , 62–63

Sigg technique , 64

treatment factor , 64

type I , 62

type II , 62

type III , 62

type IV , 62

venous pathology treatment , 61

written protocol , 8

Sigg technique , 64

Subfascial endoscopic perforator surgery (SEPS)

indications/contraindications , 46–47

pearls and pitfalls , 48

postoperative care , 48

recurrent varicose vein surgery , 47

saphenous sparing technique , 47–48

SPJ, re-exploration , 48

Super ﬁ cial vein thrombosis (SVT)

anticoagulation , 150

clinical diagnosis , 145

complications , 144–145

D-dimer assay , 153

DVT incidence , 151

epidemiology and etiology , 143–144

factor Xa inhibitor fondaparinux , 153

high and low dose anticoagulant , 152

mortality , 143

NSAIDs , 145

prophylactic dose vs. body-weight-adjusted

therapeutic dose , 152

pulmonary embolism and deep vein thrombosis , 150

STENOX trial , 151

surgery disadvantages , 150–151

thrombophilic test , 152–153

thrombus extension and DVT , 151, 152

treatment , 150

treatment paradigms , 153

UFH and LMWH , 150

VTE prevention , 145–149

Tributary treatment strategy aesthetic bene ﬁ t , 117

chemical ablation , 120–122

clinical and anecdotal experience , 117

image guided chemical ablation , 122

microphlebectomy , 119–120

recurrence pattern varicose veins and symptom , 117,

118

saphenous vein ablation , 122–123

truncal re ﬂ ux elimination , 118–119

Venous disease arterial pressure , 19

arterio-venous shunt , 22

cardiac surgery , 22

clinical Duplex Doppler scanning , 23

CVI , 21–22

dysfunctional venous system , 21

hypoxia , 22

leukocyte trapping hypothesis , 22

perforating vein valve , 20

physiology and pathophysiology , 19, 20

risk factors , 21

saphenous compartment relationship , 20, 21

splanchnic venous circulation and cutaneous vein , 19

telangiectasias , 21

tissue damage and delayed healing , 23

valvular re ﬂ ux , 21

venous valve , 20

Venous duplex ultrasound

AAGSV , 36, 37

arteriovenous ﬁ stula , 42

axial DUS image, EVTA , 42, 43

calf vein evaluation , 40–41

caliber assessment , 36–37

C2-6 CVD and C1 disease treatment , 44

CD and PWD , 37

CFV, pulse wave Doppler assessment , 40, 41

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