Vein Handbook
The Layman’s Handbook of Venous Disorders
Adapted from the Handbook of Venous Disorders; Guidelines of the American Venous Forum, Third Edition (Hodder Arnold, London 2009), Editor: Dr. Peter Gloviczki, MD, Associate Editors: Dr. Michael C. Dalsing, MD, Dr. Bo G. Eklof, MD, Dr. Gregory L. Moneta, MD and Dr. Thomas W. Wakefield, MD.
An on-line book, The Layman’s Handbook of Venous Disorders, designed to assist you with terms, treatment options, and answers to frequently asked questions about venous diseases.
The text of one of the most comprehensive textbooks on venous disorders has been adapted and rewritten in 20 chapters in Layman’s terms for easy understanding. The Editors of the Web-based publication, Dr. Michael C. Dalsing and Dr. Gary W. Lemmon, had two goals in mind: increase awareness of venous disease and educate the American public and our patients with acute and chronic venous disorders.The publication provides essential information on the cause, presentation and up-to-date management of venous diseases. Considerable new data are available on prevention and treatment of blood clots, leg swelling, varicose veins and venous ulcers.
The chapters, designed specifically for the web, are concise, easy to read, provide clear images, and each includes a section for frequently asked questions. Scan the Index or enter a key word, such as “varicose,” in the search box above to instantly find answers to your questions.
The illustrations were graciously provided by Dr. Stephen Gale.
Chapters:
- Index of chapters and authors
- Chapter 1: Normal Venous Circulation
- Chapter 2: Risk Factors for Venous Thrombosis
- Chapter 3: Clotting Disorders
- Chapter 4: Deep Venous Thrombosis Prevention
- Chapter 5: Superficial Venous Thrombosis
- Chapter 6: Clinical Presentation of Venous Thrombosis “Clots”: Deep Venous Thrombosis and Pulmonary Embolus
- Chapter 7: Medical treatment of Deep Vein Thrombosis and Pulmonary Embolus
- Chapter 8: Surgical/Interventional Treatment of Acute Deep Venous Thrombosis
- Chapter 9: Indications for Inferior Vena Cava Interruption
- Chapter 10: Axillary/Subclavian Vein Thrombosis (clot) and its Treatment
- Chapter 11: Physiology of Venous Insufficiency
- Chapter 12: Chronic Venous Insufficiency Presentation
- Chapter 13: Compression Therapy for Venous Disorders and Venous Ulceration
- Chapter 14: Spider Veins/Telangiectasias Therapy
- Chapter 15: Sclerotherapy for Venous Disease
- Chapter 16: Surgical Therapy for Chronic Venous Insufficiency
- Chapter 17: Surgical Therapy for Deep Valve Incompetence
- Chapter 18: Iliac and Vena Cava Obstructive Venous Disease Therapy
- Chapter 19: Vascular Malformations
- Chapter 20: Lymphedema Diagnosis and Therapy
Index of chapters and authors
- Normal Venous Circulation: Adapted from Chapter 3 of the “Handbook of Venous Disorders”.
Original author: Frank Padberg. Abstracted by Teresa L. Carman. - Risk Factors for Venous Thrombosis: Adapted from Chapters 8 and 9 of the “Handbook of Venous Disorders”. Original authors: for Chapter 8 – ThomasW. Wakefield and Peter K. Henke, for Chapter 9 – Mark H. Meissner. Abstracted by Kellie R. Brown.
- Clotting Disorders: Adapted from Chapter 11 of the “Handbook of Venous Disorders”. Original authors: Edith A. Nutescu, Jessica B. Michaud, Joseph A. Caprini, Louis W. Biegler, and Robert R. McCormick. Abstracted by Kellie R. Brown.
- DVT Prevention: Adapted from Chapter 23 of the “Handbook of Venous Disorders”. Original authors: Robert D. McBane and John A. Heit. Abstracted by Kellie R. Brown.
- Superficial Venous Thrombosis:Adapted from Chapter 26 of the “Handbook of Venous Disorders”. Original authors: Anil Hingorani and Enrico Ascher. Abstracted by Gary W. Lemmon.
- Clinical Presentation of Venous Thrombosis “Clots”: Deep Venous Thrombosis and Pulmonary Embolus: Adapted from Chapters 17 and 18 of the “Handbook of Venous Disorders”. Original authors: for Chapter 17 – Mark H. Meissner and for Chapter 18 – Joann Lohr, Daniel Kim and Kellie Krallman. Abstracted by Kellie R. Brown.
- Medical Treatment of DVT and PE: Adapted from Chapters 19 and 22 of the “Handbook of Venous Disorders”. Original authors: for Chapter 19 – Russell D. Hull and Graham F. Pineo and for Chapter 22 – Thomas W. Wakefield. Abstracted by Kellie R. Brown.
- Surgical/Interventional Treatment of Acute Deep Venous Thrombosis: Adapted from Chapter 20 and 21 of the “Handbook of venous Disorders”. Original authors: for Chapter 20 – Anthony Comerota and Jorge L. Martinez Trabal and for Chapter 21 – Bo Eklof and Robert B. McLafferty. Abstracted by Michael C. Dalsing.
- Indications for Inferior Vena Cava Interruption: Adapted from Chapter 25 of the “Handbook of Venous Disorders”.Original authors: Lazar J.Greenfield, Venkataramu N. Krishnamurthy, Mary C. Proctor and John E. Rectenwald. Abstracted by Gary W. Lemmon.
- Axillary/Subclavian Vein Thrombosis (Clot) and Its Treatment: Adapted from Chapter 24 of the “Handbook of Venous Disorders”. Original authors: Richard M. Green and Robert Rosen. Abstracted by Gary W. Lemmon.
- Physiology of Venous Insufficiency:Adapted from Chapter 5 of the “Handbook of Venous Disorders”. Original authors: Kevin G. Burnand and Ashar Wadoodi. Abstracted by Teresa L. Carman.
- Chronic Venous Insufficiency Presentation: Adapted form Chapter 28 & 29 of the “Handbook of Venous Disorders”. Original authors: for Chapter 28 – Andrew W. Bradbury and C. Vaughan Ruckley and for Chapter 29 – Robert B. McLafferty and Andrew D. Lambert. Abstracted by Teresa L. Carman.
- Compression Therapy for Venous Disorders and Venous Ulceration: Adapted from Chapter 30 of the “Handbook of Venous Disorders”.Original authors: Gregory L. Moneta and Hugo Partsch. Abstracted by Teresa L. Carman.
- Spider Veins/Telangiectasias Therapy: Adapted from Chapter 34 and 39 of the “Handbook of Venous Disorders”. Original authors: for Chapter 34 – Thomas M. Proebstle and for Chapter 39 – Jose I. Almeida and Jeffrey K. Raines. Abstracted by Michael C. Dalsing.
- Sclerotherapy for Venous Disease: Adapted from Chapter 32 and 33 of the “Handbook of Venous Disorders”. Original authors: for Chapter 32 – J. Leonel Villavicencio and for Chapter 33 – Joshua I. Greenberg, Niren Angle and John J. Bergan. Abstracted by Teresa L. Carman.
- Surgical Therapy for Superficial ChronicVenous Insufficiency: Adapted from Chapters 35, 36, 37 and 38 of the “Handbook of Venous Disorders”. Original authors: for Chapter 35 – Adam Howard, Dominic P.J. Howard and Alun H. Davies; for Chapter 36 – Robert F. Merchant and Robert L. Kistner; for Chapter37 – Nick Morrison and for Chapter 38 -Lowell S. Kabnick. Abstracted by Gary W. Lemmon.
- Surgical Therapy for Deep Valve Incompetence: Adapted from Chapter 42 of the “Handbook of Venous Disorders”. Original author: Seshadri Raju. Abstracted by Gary W. Lemmon.
- Iliac and Vena Cava Obstructive Venous Disease Therapy: Adapted from Chapter 44 of the “Handbook of Venous Disorders”. Original author: Peter Neglén. Abstracted by Gary W. Lemmon.
- Vascular Malformations: Adapted from Chapters 53, 54 and 55 of the “Handbook of Venous Disorders”. Original authors: for Chapter 53 – Byung Boong Lee, James Loredo, David H. Deaton, Richard F. Neville; for Chapter 54 and 55 – Heron E. Rodriguez and William H. Pearce. Abstracted by Raghu Motaganahalli.
- Lymphedema Diagnosis and Therapy: Adapted from Chapters 57, 59 & 60 of the “Handbook of Venous Disorders”. Original authors: for Chapter 57 -Thom W. Rooke, Cindy Felty; for Chapter 59 – Gail L. Gamble, Audrea Cheville, David Strick; and for Chapter 60 – Peter Gloviczki. Abstracted by Raghu Motaganahalli.
Chapter 1: Normal Venous Circulation
Original author: Frank Padberg
Abstracted by Teresa L.Carman
Content:
- Introduction
- Physiology/Hemodynamics
- Conclusion
- Commonly asked questions:
- Why do my legs swell?
- What if my swelling is only in one leg?
- What causes the veins to not work well?
- What can I do about my swelling?
Summary:
This chapter will tell you how blood flow circulates in the blood vessels called arteries from heart to the legs and back to the heart through the veins, blood vessels that return the nutritionally depleted blood. You will learn about normal venous return and abnormal venous function, which may result in swelling or edema and skin damage such a discoloration, darkening, thickening and ulceration.
Chapter 2: Risk Factors for Venous Thrombosis
Original authors: Peter K. Henke, Mark H. Meissner and Thomas
W.Wakefield
Abstracted by Kellie R. Brown
Content:
- Introduction
- How common are Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?
- What causes DVT and PE (venous thromboembolism -VTE)?
- What are the risk factors for VTE?
- Age, Gender and Race
- Surgery
- Trauma
- Medical Illness
- Immobilization or Travel
- Primary Blood Clotting Disorders
- Oral Contraceptives and Hormonal Therapy
- Pregnancy
- How does clot affect the vein?
- Does the vein return to normal after the clot resolves?
- Conclusion
Summary:
This chapter will discuss the common risk factors for Deep Vein Thrombosis (DVT: blood clots forming in the deep veins often of the leg, pelvic or abdomen but can also occur in the arm veins), the changes that occur in a vein after a clot has formed, and what happens to the clot over time. Among patients with DVT, one third of them are diagnosed due to a pulmonary embolus (PE), a blood clot traveling in the blood vessels to the lung, causing shortness of breath and chest pain. The long-term effects of DVT, called post-thrombotic syndrome (PTS), can be associated with skin discoloration, ulceration and other skin changes in the legs.
Chapter 3: Clotting Disorders
Original authors: Edith A. Nutescu, Jessica B. Michaud, Joseph A. Caprini, Louis W. Biegler, and Robert R. McCormick
Abstracted by Kellie R. Brown
Content:
- Introduction
- What is a D-Dimer Level?
- Clotting Disorders
- Hereditary Clotting Disorders
- Group 1: A lack of anti-clotting factors in the blood
- Antithrombin Deficiency
- Protein C Deficiency
- Protein S Deficiency
- Group 2: An increased amount of pro-clotting factors in the blood
- Activated Protein C Resistance/Factor V LeidenMutation
- Prothrombin Defects; Prothrombin Gene 20210A Mutation
- Factor Elevations: Elevations in the levels of different proteins in the blood that participate in the clotting process
- Hyperhomocysteinemia
- Other Inherited Clotting Disorders
- AntiPhospholipidantibody Syndrome (APS)
- How common is it?
- How and when do you test for this?
- What is the risk of VTE in people with APS?
- How do you treat APS?
- Heparin Induced Thrombocytopenia
- Heparin induced thrombocytopenia (HIT)
- How common is HIT?
- How and when do you test for HIT?
- What is the risk of VTE in a person with HIT?
- How do you treat HIT?
- Cancer
- Conclusion
Summary:
The normal balance between clot formation and breakdown can be changed by the presence of certain genetic or acquired defects leading to abnormal clot formation. In this chapter you will learn about different factors that can increase the risk of VTE. These conditions should be looked for in any person who has a VTE, unless the cause is already known.
Chapter 4: Deep Venous Thrombosis Prevention
Original authors: Robert D. McBane and John A. Heit
Abstracted by Kellie R. Brown
Content:
- Introduction
- Risk Factors
- Prevention of DVT and PE : “Mechanical” and”pharmacologic” prevention
- Who should get preventative treatment
- Low Risk Patients
- Moderate Risk Patients
- High Risk Patients
- Very High Risk Patients
- Non-Surgical High Risk Patients
- Are there special circumstances that change the risk of DVT?
- Hip or Knee Replacement Surgery
- Neurosurgery
- Trauma
- How long should preventative measures be given?
- Conclusion
Summary:
Venous thromboembolism (VTE), which is either deep vein thrombosis (DVT) or pulmonary embolus (PE), is the 4th leading cause of death in Western society. Thus, preventing VTE is very important. This chapter will discuss the main ways to prevent a DVT or PE.
Chapter 5: Superficial Venous Thrombosis
Original authors: Anil P. Hingorani and Enrico Ascher
Abstracted by Gary W. Lemon
Content:
- Clinical Presentation/Diagnosis
- Etiology
- Treatment
- Conclusion
- Commonly asked questions:
- What is superficial venous thrombosis?
- How do I know if I have superficial venous thrombosis?
- What is the treatment of superficial venous thrombosis?
Summary:
Most cases of Superficial Venous Thrombosis are not noticed or taken seriously by the patient and often get better without treatment. It is important however to make sure that the patient does not have a condition which is causing more than normal blood clotting (hypercoagulable states) or has an unknown cancer. In this chapter you will learn about the diagnostic tests and treatment’s options for the Superficial Venous Thrombosis.
Chapter 6: Clinical Presentation of Venous Thrombosis “Clots”: Deep Venous Thrombosis and Pulmonary Embolus
Original authors: Daniel Kim, Kellie Krallman, Joan Lohr, and Mark H. Meissner
Abstracted by Kellie R. Brown
Content:
- Introduction
- What are the most common signs and symptoms of a Deep Venous Thrombosis (DVT)?
- What are the most common signs and symptoms of a Pulmonary Embolus (PE)?
- How is a DVT diagnosed?
- How is a PE diagnosed?
- Conclusion
Summary:
The most common symptoms of DVT are pain and swelling, but many DVTs have no symptoms. The most common symptoms of PE are sudden onset of chest pain and shortness of breath. A low threshold to get further tests is needed in order to diagnose most DVTs because the symptoms are vague. DVT is usually diagnosed with ultrasound, and PE is usually diagnosed with CT scan, but other tests may be needed to make the diagnosis.
Chapter 7: Medical treatment of Deep Vein Thrombosis and Pulmonary Embolus
Original authors: Russell D. Hull, Graham F. Pineo, and Thomas W. Wakefield
Abstracted by Kellie R. Brown
Content:
- Introduction
- Goals of treatment (why treat a DVT or PE)?
- How is a DVT or PE treated?
- What if blood thinners can’t be used?
- Is there anything else that can be done to help the symptoms?
- What if the DVT is in the arm?
Summary:
DVT and PE are treated essentially the same. In this chapter you will discover what is the treatment’s strategy using heparin (often LMWH) and warfarin. In the case of a recurrent event, warfarin may be continued for life. If blood thinners aren’t able to be used, a filter can be placed to prevent the clot from traveling to the lungs. If symptoms are very severe, removal of the clot from the vein, usually by thrombolysis, can be undertaken.
Chapter 8: Surgical/Interventional Treatment of Acute Deep Venous Thrombosis
Original authors: Anthony Comerota, Bo Eklof, Jorge L. Martinez, and Robert B. McLafferty
Abstracted by Michael C. Dalsing
Content:
- Introduction
- Why remove acute blood clot? Goals of treatment
- Ways (method) of removing acute blood clot
- Venous narrowing (stenosis) may be seen as one cause of the blood clot
- Risks connected to removing acute blood clot
- Expected results
- Conclusion
- Commonly asked questions
- What is thrombolysis?
- Which patients derive the most benefit from catheter-directed thrombolysis?
- What are the objectives of thrombolysis or surgical thrombectomy?
- Are there other benefits of catheter-directed thrombolysis or surgical thrombectomy?
- What are the risks of using thrombolysis to remove free blood clot?
- Are there alternatives to catheter-directed thrombolysis for extensive venous thrombosis?
- Why are blood thinner used after thrombolysis or surgical thrombectomy?
Summary:
There are several interventional treatment options for acute deep venous thrombosis (DVT): catheter-directed thrombolysis with or without mechanical device use is the preferred treatment option for patients with iliofemoral deep venous thrombosis who are otherwise healthy and have no contraindication to receiving a thrombolytic drug. If thrombolysis is too high a risk, venous thrombectomy is recommended. For patients who are bedridden and those who are in very poor health, treatment with anticoagulation agents (blood-thinning agents) alone may be advisable. Successful and timely clot removal in patients with iliofemoral DVT results is less post-thrombotic symptoms and an improved health-related quality of life.
Chapter 9: Indications for Inferior Vena Cava Interruption
Original authors: Lazar J. Greenfield, Venkataramu N. Krishnamurthy, Mary C. Proctor, and John E. Rectenwald
Abstracted by Gary W. Lemmon
Content:
- Introduction
- Surgical treatment advances
- Conclusion
- Commonly asked questions
- Is it safe to leave the filter in and does it has to stay there for my lifetime?
- Can the filter be placed for blood clots in the arms rather than the legs?
- With so many filter types which one is the best for me?
Summary:
Blood clots from the large veins of the legs and pelvis can produce life threatening Pulmonary Embolism (PE) if left untreated such as when standard therapy cannot be used. PE management might include placement of an inferior vena cava filter effective in preventing PE. However filter does not reduce the risk to zero nor does it treat the underlying venous clotting problem. Therefore continued anticoagulant therapy (blood thinners) should be used when possible.
Chapter 10: Axillary/Subclavian Vein Thrombosis (clot) and its Treatment
Original authors: Richard M. Green and Robert Rosen
Abstracted by Gary W. Lemmon
Content:
- Introduction
- Diagnosis
- Management
- Conclusion
- Commonly asked questions
- What is thoracic outlet syndrome and who can be affected by it?
- Can both arms be involved?
- What type of disability remains with treatment?
Summary:
Axillo-subclavian vein thrombosis occurs as a result of abnormal muscle and/or rib anomalies of the thoracic outlet at the base of the neck and ribcage. Treatment should be done rapidly and involves three steps which includes dissolving the clot, maintaining anticoagulation (stopping any new clots from forming) with a blood thinner and surgical treatment to eliminate the external compression on the subclavian vein.
Chapter 11: Physiology of Venous Insufficiency
Original authors: Kevin G. Burnand and Ashar Wadoodi
Abstracted by Teresa L. Carman
Content:
- Introduction
- Chronic Venous Insufficiency
- Chronic Vein Insufficiency Effects
- Commonly asked questions
- Why do my legs swell?
- What if my swelling just happened and is only in one leg?
- What causes the veins to not work well?
- What can I do about my swelling and what can happen if I do nothing?
Summary:
Two other major contributors to venous insufficiency are venous reflux and venous obstruction. Regardless of the cause, chronic venous insufficiency and chronic venous hypertension may result in leg swelling, skin darkening or hyperpigmentation, skin thickening or lipodermatosclerosis (fat and skin scar development), and even sores or ulcers. Your doctor can do laboratory testing and vascular testing to determine what conditions you may have.
Chapter 12: Chronic Venous Insufficiency Presentation
Original authors: Andrew W. Bradbury, Andrew D. Lambert, Robert B. McLafferty, and C. Vaughan Ruckley
Abstracted by Teresa L. Carman
Content:
- Introduction
- Incidence
- Presentation
- Diagnosis
- Conclusions
- Commonly asked questions
- Do I need to bring anything to my first appointment with the vein specialist?
- Do I need to fast or not eat before my appointment?
- Will I need a surgery for my veins?
Summary:
Evaluation of venous disease whether asymptomatic or causing severe symptoms begins with a good history and a physical examination including laboratory studies if necessary. Most venous disease is not a major problem for the patient and does not require a surgery or procedure. Patients with bothersome symptoms or recurrent ulcers may benefit from a procedure or surgery.
Chapter 13: Compression Therapy for Venous Disorders and Venous Ulceration
Original authors: Gregory L. Moneta and Hugo Partsch
Abstracted by Teresa L. Carman
Content:
- Introduction
- Physiology
- Diagnosis
- Forms of compression
- Conclusions
- Commonly asked questions
- Compression stockings are hard to get on. Do I have to wear them every day?
- How can I make the compression stockings easier to put on?
- Which stocking is the best?
Summary:
The abnormal backward flow of blood in the leg veins or blockages to the blood getting out of the leg can lead to problem including swelling, skin changes and even ulcers. Once the diagnosis is made, placing compression from the outside of the leg can correct many of the underlying problems such that the symptoms get better. Compression therapy comes in many forms and some devices are better for healing ulcers (open skin lesions) and other for maintaining a steady state within the leg.
Chapter 14: Spider Veins/Telangiectasias Therapy
Original authors: Jose I. Almeida, Thomas M. Proebstle and Jeffrey K. Raines
Abstracted by Michael C. Dalsing.
Content:
- Introduction
- Etiology and Diagnosis
- Treatment and Results
- Conclusions
- Commonly asked questions
- What are spider veins?
- What causes spider veins?
- Are there ways to get rid of my spider veins?
Summary:
Spider veins are very small blemishes within the skin. The cause of the spider veins must be sought and treated prior to taking care of the skin blemish. To eliminate the spider veins, currently two treatments are commonly used; Laser treatment uses light to heat the spider vein resulting in scarring while sclerotherapy uses drugs to damage the inside of the vein resulting in scarring. Each method has risks including a worsened cosmetic appearance for the potential benefit of eliminating the blemish.
Chapter 15: Sclerotherapy for Venous Disease
Original authors: Niren Angle, John J. Bergan, Joshua I. Greenberg, and J. Leonel Villavicencio
Abstracted by Teresa L. Carman
Content:
- Introduction
- Indications (reasons) for using sclerotherapy
- Contraindications (reasons not to use) to sclerotherapy
- How is sclerotherapy performed?
- Complications (problems) of sclerotherapy
- Foam Sclerotherapy
- Commonly asked questions
- Do I need surgery for my veins?
- Will I need only one treatment or more?
- Will my insurance pay for this therapy?
- How long will I be off work after the procedure?
Summary:
The information provided here is to serve as a guideline regarding one possible treatment (sclerotherapy) and what to expect. Therapy is very individualized to a single patient and the best treatment options for your condition should be discuss with physicians skilled in the evaluation and treatment of vein problems. Most patients will require several sclerotherapy treatments to fully treat their venous disease and may have veins return over a period of time requiring further therapy.
Chapter 16: Surgical Therapy for Chronic Venous Insufficiency
Original authors: Alun H. Davies, Adam Howard, Dominic P.J. Howard, Lowell S. Kabnick, Robert L. Kistner, Robert F. Merchant, Nick Morrison
Abstracted by Gary W. Lemmon
Content:
- Introduction
- Definitions
- Economics of Chronic Venous Insufficiency
- Presentation
- Examination
- Management
- Vein stripping
- Vein ablation
- Complications
- Conclusions
- Commonly asked questions
- I have varicose veins. Do I need these to be treated?
- Are stockings necessary to wear for CVI or varicose veins?
- Which is better, vein stripping or “laser” surgery?
- Are varicose veins hereditary?
Summary:
The superficial leg veins can allow the backward flow of blood down the veins and result in lower leg swelling, skin changes and even skin breakdown (ulcers). By removing these non-working veins, the symptoms are made better. One can remove these veins from the body by pulling them out (stripping) or by burning the inside so that they scar shut (laser or radiowave ablation, or sclerotherapy). The patient must know that there can be problems with each method of removal and must believe that the benefits are better than the risks involved.
Chapter 17: Surgical Therapy for Deep Valve Incompetence
Original authors: Seshadri Raju
Abstracted by Gary W. Lemmon
Content:
- Introduction
- Diagnosis
- Surgical options
- Complications
- Results
- Conclusions
- Commonly asked questions
- When such I ask my doctor about deep vein valve surgery?
- How long will I need to be on Warfarin treatment?
- What happens to the arm if the vein is taken from that location to be transplanted to the leg veins?
Summary:
Vein valves that do not work will cause blood to flow backward in the veins into the legs. This leads to problems with swelling, skin changes and even breakdown of the skin (ulcers). There are ways to stop this abnormal backward flow of blood by fixing the vein valves. If the valve is still present but just not meeting properly, the valve can be fixed with fine sutures. If the valve is totally damaged, one must place the refluxing system below a working valve in another part of the leg veins (transposition) or must take one from the arm as a transplant. Other techniques are being investigated but so far these are the more common ways to fix the problem.
Chapter 18: Iliac and Vena Cava Obstructive Venous Disease Therapy
Original author: Peter Neglén
Abstracted by Gary W. Lemmon
Content:
- Diagnosis
- Therapy
- Conclusions
- Commonly asked questions
- Will treating iliac vein narrowing I have heal my leg ulcer?
- What are the stents made of and can I feel them?
Summary:
Iliac vein or vena cava vein blockage or narrowing prevents blood flow from getting out of the leg(s) since these are the major exit sites for this blood to get back to the heart. Removing blockages from these veins is possible with techniques that allow one to place a dilating balloon and stent (metallic support device) inside the narrowed vein. In the rare case that this is not successful, there are surgical procedures which can help.
Chapter 19: Vascular Malformations
Original authors: David H. Deaton, Byung Boong Lee, James Loredo, Richard F. Neville, William H. Pearce, and Heron E. Rodriguez
Abstracted by Raghu Motaganahalli
Content:
- Introduction
- Hemangioma
- Congenital vascular malformations (venous malformations emphasis)
- Overview
- Vascular Malformations which stop maturing later in pregnancy
- Vascular Malformationswhich stop maturing early in pregnancy
- Complex Venous Malformations
- Maffucci syndrome
- Proteus syndrome
- Klippel-Trenaunay syndrome
- Parkes Weber syndrome
- Conclusions
- Commonly asked questions
- My child has a reddish spongy mass on the cheek, what should I do?
- My doctor thinks that my baby had a congenital venous malformation, what does this mean?
- My seven year old hasa birth mark on the left leg and back, a varicose vein that I just noticed that goes down the outside of the leg, and his leg on that side may be a little bigger than the other side. What could be the problem?
- My child has a congenital venous malformation, are we at risk for other children with the same problem?
Summary:
A hemangioma, commonly known as a “strawberry birthmark”, is the most common benign tumor of infancy. These vascular tumors grow very fast during the first year of life to the fear of the parents but then stop growing and actually get smaller very slowly during childhood so that they are usually gone by school age. Only in rare cases is any treatment needed. Congenital vascular malformations are the result of blood vessels not maturing (going to full development) while the infant is still in the mother’s womb. If this happens early, the abnormal blood vessels do not have the form usually seen with blood vessels and appears more like a spongy mass which can involve neighboring body parts. If this happens later in the pregnancy, the blood vessels look more normal but are abnormally small, abnormally large or have unusually connections with other blood vessels. As a part of congenital vascular malformations, the venous malformation is the most common and possibly the easiest to manage. Congenital vascular malformations do not go away and will require a lifetime of care.
Chapter 20: Lymphedema Diagnosis and Therapy
Original authors: Audrea Cheville, Cindy Felty, Gail L. Gamble, Peter Gloviczki, Thom W. Rooke, David Strick
Abstracted by Raghu Motaganahalli
Content:
- Introduction
- Hemangioma
- Congenital vascular malformations (venous malformations emphasis)
- Overview
- Vascular Malformations which stop maturing later in pregnancy
- Vascular Malformationswhich stop maturing early in pregnancy
- Complex Venous Malformations
- Maffucci syndrome
- Proteus syndrome
- Klippel-Trenaunay syndrome
- Parkes Weber syndrome
- Conclusions
- Commonly asked questions
- My child has a reddish spongy mass on the cheek, what should I do?
- My doctor thinks that my baby had a congenital venous malformation, what does this mean?
- My seven year old hasa birth mark on the left leg and back, a varicose vein that I just noticed that goes down the outside of the leg, and his leg on that side may be a little bigger than the other side. What could be the problem?
- My child has a congenital venous malformation, are we at risk for other children with the same problem?
Summary:
Lymphedema is swelling in the leg, arm or other parts of the body due to the body’s inability to effectively remove lymph fluid (which contains proteins, fatty acids, waste from cell feeding and bacteria that enter the body). Lymphedema can happen because the formation of the lymph vessels during maturation was less than adequate (called primary lymphedema) or damage (injury) has occurred to the normally formed lymph channels and lymph nodes during surgery, from infection, from radiation treatment or other causes. It can also occur from too much lymph fluid being made such as can happen when venous disease is present. Before treating lymphedema itself a physician has to be sure that there is no infectious or other acute medical problem that must be dealt with. The most important medical therapy used for lymphedema is external compression treatments (massage, compression pumping, compression wraps and eventually compression stockings) to decrease the swelling and to keep it down. Surgery for lymphedema is a last option for only a select group of patients.
