chronic venous disease patrik tosenovsky. issues severity of cvd severity of cvd appropriate...
TRANSCRIPT
IssuesIssues
• Severity of CVDSeverity of CVD
• Appropriate referralAppropriate referral
• Benefit, side effects and cost of the Benefit, side effects and cost of the treatmenttreatment
CVD – Chronic Venous CVD – Chronic Venous DisordersDisorders
• Include s spectrum of clinical Include s spectrum of clinical presentations ranging from presentations ranging from teleangiectasias to venous ulceration.teleangiectasias to venous ulceration.
• Primary vs SecondaryPrimary vs Secondary
Chronic Venous Chronic Venous InsufficiencyInsufficiency
• Usually refers more specifically to Usually refers more specifically to the spectrum of skin changes the spectrum of skin changes associated with venous hypertensionassociated with venous hypertension
Primary CVD vs Secondary Primary CVD vs Secondary CVDCVD
• Primary - The cause is unknown Primary - The cause is unknown (varicose veins etc) --- varicose (varicose veins etc) --- varicose veins/swelling/skin changesveins/swelling/skin changes
• Secondary – usually following DVT --- Secondary – usually following DVT --- obstruction +/- reflux ---venous obstruction +/- reflux ---venous hypertension --- varicose hypertension --- varicose veins/swelling/skin changesveins/swelling/skin changes
ANATOMYANATOMY
Obstruction – Reflux – or bothObstruction – Reflux – or both
OBSTRUCTION
REFLUX or OBSTRUCTION or both
Competent valve and Competent valve and obstruction free lumen is the obstruction free lumen is the key for functionkey for function
Great Great SaphenousSaphenous Vein Valve Vein Valve ––magnified magnified
Classification of CVDClassification of CVD
• CEAP classification CEAP classification
• C – Clinical signs (1-6 i.e. retic.v.- C – Clinical signs (1-6 i.e. retic.v.- ulcer)ulcer)
• E – ethiology (cong., E – ethiology (cong., primaryprimary, , secondsecond.).)
• A – anatomy (deep, perf., superf)A – anatomy (deep, perf., superf)
• P – pathophysiology (reflux, P – pathophysiology (reflux, obstruction, both)obstruction, both)
Severity of CVDSeverity of CVD
• Venous Clinical Severity Score Venous Clinical Severity Score (VCSS) – more for research (VCSS) – more for research purposes and databasespurposes and databases
• Clinically more practical:Clinically more practical:1.1. Active ulcer, previous ulcer, Active ulcer, previous ulcer,
lipodermatosclerosislipodermatosclerosis2.2. Symptomatic - any stage of CVDSymptomatic - any stage of CVD3.3. Other (incl. vv’s, spider veins etc) Other (incl. vv’s, spider veins etc)
Severity of Acute venous Severity of Acute venous diseasedisease
• DVT – 2 weeks of durationDVT – 2 weeks of duration
• Severity:Severity:
1.1. Iliofemoral DVT + Iliofemoral DVT + swelling/discolorationswelling/discoloration
2.2. Other DVT (femoropopliteal, tibial, Other DVT (femoropopliteal, tibial, gastrocn., soleus veins)gastrocn., soleus veins)
Treatment optionsTreatment options
• Non-surgical – compression (venous Non-surgical – compression (venous hypertension)hypertension)
• Sclerotherapy – both for cosmetic vv’s and Sclerotherapy – both for cosmetic vv’s and synptomatic onessynptomatic ones
• Surgical – phlebectomy/strippingSurgical – phlebectomy/stripping• Percutaneous – RFA, Laser, angioplasty/stentPercutaneous – RFA, Laser, angioplasty/stent• Deep vein reconstructionDeep vein reconstruction• CombinedCombined
How effective is the How effective is the treatmenttreatment
• PercutaenousPercutaenous and and open surgicalopen surgical – up – up to 98% success rate (no difference)to 98% success rate (no difference)
• Sclerotherapy – good for small veins Sclerotherapy – good for small veins
• Angioplasty – up to 99% success rate Angioplasty – up to 99% success rate for iliac veinsfor iliac veins
• Deep vein reconstruction – 60 % Deep vein reconstruction – 60 % successsuccess
Axillary vein transplantAxillary vein transplant
Transplantace Transplantace axillárníaxillární žílyžíly