Additional Information
Book Details
Abstract
Sclerotherapy: Treatment of Varicose and Telangiectatic Leg Veins, by Drs. Mitchel P. Goldman, Jean-Jerome Guex, and Robert A Weiss, equips you to implement the latest cosmetic procedures for the treatment of varicose and telangiectatic leg veins. Completely revised with contributions from U.S.-based and international authorities, this classic reference is packed with everything you need to know about sclerotherapy, and provides extensive discussions of the latest techniques, solutions, and possible complications. Case studies and detailed color illustrations offer practical, step-by-step visual guidance as well as expert hints and tips for implementing the latest cosmetic procedures into your practice including foam sclerotherapy, endovenous radiofrequency (RF) and laser closure, ambulatory phlebectomy and laser treatment of spider telangiectasia. You can also access the full content and videos online at www.expertconsult.com.
- Optimize outcomes and improve your surgical, injection and laser techniques with comprehensive, visual guidance about common pitfalls and "tricks of the trade" from practically minded, technically skilled, hands-on experts.
- Implement the latest approaches with completely updated chapters reflecting the most recent advances in sclerotherapy and surgical treatment of varicose and telangiectatic leg veins.
- See how to perform a variety of key procedures demonstrating endovenous radiofrequency closure, CoolTouch endovenous ablation, cross polarization visualization, PPG digital measuring, sclerotherapy of the lateral venous system showing reflux, foam sclerotherapy, telangiectatic matting, ambulatory phlebectomy, and draining of intravascular coagulum.
- Apply the best practices and global perspectives from a newly reorganized team of U.S.-based and international authors and contributors.
- Access the complete contents from any computer at www.expertconsult.com, complete with the full text and entire image bank.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half title page | i | ||
| Sclerotherapy Expert Consult - Online and Print | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | vi | ||
| Dedication | vii | ||
| Acknowledgments | viii | ||
| 1 Anatomy | 1 | ||
| Introduction | 1 | ||
| Nomenclature | 1 | ||
| General Considerations | 2 | ||
| Deep Venous System | 3 | ||
| Anatomy of the Superficial Veins | 4 | ||
| Great saphenous vein | 4 | ||
| Small saphenous vein | 4 | ||
| Other superficial veins and collateral veins | 5 | ||
| Duplex ultrasound anatomy | 5 | ||
| Duplex Ultrasound Markers for Vein Identification | 8 | ||
| The ‘eye’ sign | 8 | ||
| The ‘alignment’ sign | 8 | ||
| The tibia-gastrocnemius angle sign | 8 | ||
| The small saphenous compartment sign | 10 | ||
| Relationship between saphenous veins and collaterals | 10 | ||
| Great Saphenous Vein | 11 | ||
| Saphenofemoral junction | 11 | ||
| Arrangement of the GSV and its subcutaneous collaterals in the thigh | 12 | ||
| Arrangement of the GSV and its subcutaneous collaterals at the knee | 13 | ||
| T vein | 14 | ||
| The anterior accessory saphenous vein | 14 | ||
| Small Saphenous Vein | 14 | ||
| Saphenopopliteal junction | 15 | ||
| Thigh extension of the SSV | 15 | ||
| Arrangement of the SSV and its collaterals | 16 | ||
| Foot Veins | 16 | ||
| Perforating veins | 17 | ||
| Venous valvular system | 18 | ||
| Nerves of the Leg of Phlebologic Interest | 18 | ||
| Histology | 19 | ||
| Vein walls | 19 | ||
| Venous valves | 20 | ||
| Vein wall variation | 20 | ||
| Venules | 21 | ||
| Telangiectasias | 21 | ||
| Innervation | 21 | ||
| References | 22 | ||
| 2 Adverse Sequelae and Complications of Venous Hypertension | 25 | ||
| Pathogenesis | 25 | ||
| Molecular Mechanisms | 25 | ||
| Inflammation and Skin Changes | 27 | ||
| Classification of Venous Disease | 28 | ||
| Incidence | 29 | ||
| Symptoms | 30 | ||
| Signs | 31 | ||
| Edema | 31 | ||
| Pigmentation | 32 | ||
| Venous (stasis) dermatitis | 33 | ||
| Atrophie blanche | 34 | ||
| Ulceration | 35 | ||
| Malignant degeneration | 36 | ||
| Secondary complications of venous hypertension–stasis | 37 | ||
| Hemorrhage | 38 | ||
| Superficial thrombophlebitis | 39 | ||
| Deep venous thrombosis | 39 | ||
| Classification | 40 | ||
| References | 43 | ||
| 3 Pathophysiology of Varicose Veins | 49 | ||
| Histochemical Physiology of Varicose Veins | 49 | ||
| Pathophysiology | 51 | ||
| Increased Deep Venous Pressure | 53 | ||
| Proximal origin | 53 | ||
| Pelvic obstruction | 53 | ||
| Increased intra-abdominal pressure | 54 | ||
| Saphenofemoral incompetence | 54 | ||
| Distal origin | 55 | ||
| Valvular incompetence | 55 | ||
| Venous obstruction | 56 | ||
| Arteriovenous anastomosis | 56 | ||
| Primary valvular incompetence | 58 | ||
| Secondary valvular incompetence | 58 | ||
| Effects of pregnancy | 59 | ||
| Menstrual Cycle Effects | 62 | ||
| Constitutive Elements and Progression of Varicose Veins | 62 | ||
| Heredity | 63 | ||
| Aging | 64 | ||
| References | 65 | ||
| 4 Pathophysiology of Telangiectasias | 71 | ||
| Classification | 71 | ||
| Patterns | 71 | ||
| Pathogenesis | 71 | ||
| Incidence | 71 | ||
| Pathophysiology | 72 | ||
| Genetic/congenital factors | 72 | ||
| Nevus flammeus | 72 | ||
| Klippel–Trénaunay syndrome | 73 | ||
| Nevus araneus | 76 | ||
| Angioma serpiginosum | 76 | ||
| Bockenheimer’s syndrome (diffuse genuine phlebectasia) | 77 | ||
| Maffucci’s syndrome | 78 | ||
| Congenital poikiloderma | 78 | ||
| Essential progressive telangiectasia | 78 | ||
| Cutis marmorata telangiectatica congenita | 78 | ||
| Diffuse neonatal hemangiomatosis | 78 | ||
| Acquired disease with a secondary cutaneous component | 79 | ||
| Component of a primary cutaneous disease | 79 | ||
| Varicose veins | 79 | ||
| Keratosis lichenoides chronica | 80 | ||
| Other acquired primary cutaneous diseases | 80 | ||
| Hormonal factors | 80 | ||
| Pregnancy and estrogen therapy | 80 | ||
| Malignancy | 81 | ||
| Topical corticosteroid preparations | 81 | ||
| Physical factors | 82 | ||
| Actinic neovascularization and vascular dilation | 82 | ||
| Trauma | 82 | ||
| Contusion | 82 | ||
| Surgical Incisions or Lacerations | 82 | ||
| Infection | 83 | ||
| Generalized Essential Telangiectasia | 83 | ||
| Progressive Ascending Telangiectasia | 83 | ||
| Human Immunodeficiency Virus | 83 | ||
| Radiodermatitis | 83 | ||
| Erythema ab igne | 83 | ||
| References | 84 | ||
| 5 Noninvasive Examination of the Patient Before Sclerotherapy | 88 | ||
| Medical History | 88 | ||
| CEAP classification | 88 | ||
| Diagnostic approach | 90 | ||
| Prior treatment | 90 | ||
| Symptoms | 90 | ||
| Complications of varicose vein disease | 91 | ||
| Purpose of Venous Evaluation | 91 | ||
| Physical Examination | 91 | ||
| Clinical testing | 92 | ||
| Trendelenburg test | 92 | ||
| Cough test | 92 | ||
| Percussion/Schwartz test | 92 | ||
| Brodie-Trendelenburg test | 93 | ||
| Bracey Variation | 93 | ||
| Perthes’ test | 93 | ||
| Noninvasive Diagnostic Techniques | 95 | ||
| Doppler ultrasound | 95 | ||
| Characteristics of Doppler waveform | 96 | ||
| Doppler examination technique | 98 | ||
| Femoral Vein | 98 | ||
| Differentiation of femoral from saphenous veins. | 99 | ||
| Popliteal Vein | 99 | ||
| Posterior Tibial Vein | 99 | ||
| Superficial Veins | 100 | ||
| Perforating Veins | 100 | ||
| Post-treatment evaluation | 100 | ||
| Duplex ultrasound scanning | 100 | ||
| Aid to sclerotherapy | 101 | ||
| Post-treatment evaluation | 103 | ||
| Photoplethysmography | 104 | ||
| Light reflection rheography | 106 | ||
| Air plethysmography | 107 | ||
| Foot volumetry | 108 | ||
| Use of Noninvasive Techniques | 109 | ||
| Examination of deep veins | 110 | ||
| Examination of saphenous vein trunks | 111 | ||
| Examination of tributaries of the saphenous trunks | 112 | ||
| Examination of perforating veins | 113 | ||
| Differentiation of the relative contribution of deep and superficial reflux | 114 | ||
| Evaluation of the origin of recurrences after ligation and stripping | 115 | ||
| Evaluation of vulvar varices | 115 | ||
| Invasive Diagnostic Techniques | 115 | ||
| Venography | 115 | ||
| Ascending venography | 116 | ||
| Descending venography | 116 | ||
| Intraosseus venography | 116 | ||
| Varicography | 117 | ||
| Thermography | 117 | ||
| Future Evaluation Techniques | 118 | ||
| Near infrared imaging | 118 | ||
| References | 118 | ||
| 6 Use of Compression Therapy | 123 | ||
| Historical Development | 123 | ||
| Mechanism of Action | 123 | ||
| Edema | 123 | ||
| Lymph drainage | 123 | ||
| Venous system | 124 | ||
| Microcirculation | 125 | ||
| Arterial flow | 125 | ||
| Basic Principles of Compression | 126 | ||
| Terminology | 126 | ||
| Compression pressure and Laplace’s law | 126 | ||
| Practical consequences of Laplace’s law | 127 | ||
| Measurement of compression pressure | 127 | ||
| Laboratory measurements of compression stockings | 127 | ||
| Measurements of interface pressure on the leg | 128 | ||
| Resting and working pressure | 129 | ||
| Measurement of stiffness | 129 | ||
| Compression Material | 130 | ||
| Compression bandages | 130 | ||
| Standards for compression bandages | 130 | ||
| Inelastic and short-stretch bandages | 131 | ||
| Elastic, long-stretch bandages | 133 | ||
| Multilayer bandages | 133 | ||
| Training in the application of bandages | 134 | ||
| Compression bandages or compression stockings? | 135 | ||
| Compression stockings | 136 | ||
| Characteristics of medical graduated compression stockings | 137 | ||
| Ready-made stockings | 137 | ||
| Custom-made stockings | 137 | ||
| Prescription of a stocking | 138 | ||
| Stocking lengths | 138 | ||
| Pressure gradient | 138 | ||
| Proper fit and position | 139 | ||
| Donning medical compression stockings | 139 | ||
| Patient compliance | 139 | ||
| Care of the medical compression stocking | 141 | ||
| Dangers, Complications and Contraindications | 141 | ||
| Clinical Indications for Compression Therapy | 142 | ||
| The use of compression alone in preventing varicose and telangiectatic leg veins | 142 | ||
| Rationale for the use of compression in varicose vein sclerotherapy | 142 | ||
| How much pressure is necessary for varicose veins? | 143 | ||
| Local pads and rolls | 143 | ||
| How long should compression be maintained? | 144 | ||
| Sclerotherapy of small veins | 144 | ||
| Rationale for the use of compression in the treatment of telangiectasias | 144 | ||
| How much pressure is necessary to compress telangiectasias? | 145 | ||
| How long should compression be maintained after sclerotherapy of small veins? | 147 | ||
| Compression therapy after venous surgery and endovenous catheter procedures | 147 | ||
| Pregnancy | 147 | ||
| Edema due to sitting and standing, occupational edema | 148 | ||
| Prevention of deep vein thrombosis and post-thrombotic syndrome | 149 | ||
| Treatment of superficial phlebitis, deep vein thrombosis, and post-thrombotic syndrome | 149 | ||
| Venous ulcers | 149 | ||
| Lymphedema | 150 | ||
| Other indications | 150 | ||
| References | 150 | ||
| 7 Mechanism of Action of Sclerotherapy | 156 | ||
| General Mechanism for Producing Endothelial Damage | 156 | ||
| Categories of Sclerosing Solutions | 157 | ||
| Detergent solutions | 158 | ||
| Osmotic solutions | 159 | ||
| Chemical solutions | 159 | ||
| Factors Predisposing to Thrombosis | 159 | ||
| Factors Predisposing to Endofibrosis | 160 | ||
| Experimental Evaluation of Sclerosing Solutions | 160 | ||
| Sodium tetradecyl sulfate | 161 | ||
| Sodium morrhuate | 161 | ||
| Ethanolamine oleate | 162 | ||
| Polidocanol | 162 | ||
| Polidocanol: liquid versus foam | 162 | ||
| Hypertonic saline | 163 | ||
| Hypertonic glucose/saline | 163 | ||
| Chromated glycerin and 72% glycerin | 163 | ||
| Polyiodinated iodine | 164 | ||
| Comparative efficacy in the animal model | 164 | ||
| Comparative efficacy in the human model | 164 | ||
| Clinical Use of Sclerosing Agents | 165 | ||
| Osmotic agents | 166 | ||
| Hypertonic saline | 166 | ||
| Advantages | 166 | ||
| Disadvantages | 166 | ||
| Modification of the Solution and the Technique | 166 | ||
| Hypertonic glucose–saline | 167 | ||
| Advantages | 167 | ||
| Disadvantages | 167 | ||
| Sodium salicylate | 167 | ||
| Chemical irritants | 167 | ||
| Chromated glycerin/glycerin | 167 | ||
| Advantages | 168 | ||
| Disadvantages | 168 | ||
| Ethanol | 168 | ||
| Detergent sclerosing solutions | 168 | ||
| Sodium morrhuate | 168 | ||
| Ethanolamine oleate | 169 | ||
| 8 Complications and Adverse Sequelae of Sclerotherapy | 180 | ||
| Adverse Sequelae | 180 | ||
| Postsclerotherapy hyperpigmentation | 180 | ||
| Etiologic factors | 180 | ||
| Solution Type and Concentration | 182 | ||
| Technique | 182 | ||
| Gravitational and Other Intravascular Pressures | 183 | ||
| Vessel Diameter | 183 | ||
| Predisposition to Pigmentation | 183 | ||
| Postsclerotherapy Coagula | 184 | ||
| Duration | 185 | ||
| Prevention and minimization | 185 | ||
| Treatment | 186 | ||
| Temporary swelling | 188 | ||
| Etiologic factors | 188 | ||
| Prevention and treatment | 188 | ||
| Telangiectatic matting | 188 | ||
| Etiologic factors | 189 | ||
| Angiogenesis | 190 | ||
| Prevention and treatment | 191 | ||
| Pain | 191 | ||
| Prevention | 191 | ||
| Type and Size of Needle | 192 | ||
| Technique | 192 | ||
| Type of Sclerosing Solution | 192 | ||
| Localized urticaria | 192 | ||
| Treatment | 193 | ||
| Tape compression blister | 193 | ||
| Prevention | 194 | ||
| 9 Clinical Methods for Sclerotherapy of Varicose Veins | 238 | ||
| Historical Review of Techniques | 238 | ||
| Tournay (French) technique | 238 | ||
| Sigg (Swiss) technique | 238 | ||
| Fegan technique | 239 | ||
| Treatment of reflux from the saphenofemoral junction | 239 | ||
| Injection Technique | 240 | ||
| Patient position | 240 | ||
| Standing | 240 | ||
| Standing and reclining | 241 | ||
| Leg elevation (Fegan) | 242 | ||
| Two-phase (Sigg) technique | 242 | ||
| Reclining | 243 | ||
| Foam sclerotherapy | 243 | ||
| Foam stability | 244 | ||
| Side effects | 247 | ||
| Our technique for the treatment of reticular and telangiectatic leg veins | 248 | ||
| Other applications of foam sclerotherapy | 248 | ||
| Ulcers | 248 | ||
| Venous Malformations | 248 | ||
| Combination therapy | 248 | ||
| Contraindications | 249 | ||
| Patent Foramen Ovale | 249 | ||
| Thromboembolism and Thrombophilia | 249 | ||
| Migraine | 249 | ||
| Other injection techniques | 249 | ||
| Air bolus | 249 | ||
| Use of a tourniquet | 249 | ||
| Ultrasound-guided injection | 249 | ||
| Doppler-guided injection | 251 | ||
| Endoscopic injection | 251 | ||
| Intravascular ultrasound-controlled injection | 251 | ||
| Transcatheter duplex ultrasound-guided sclerotherapy | 253 | ||
| VeinRx infusion catheter | 253 | ||
| Device Preparation | 254 | ||
| Delivery of Sclerosant | 255 | ||
| Treatment of specific problems | 255 | ||
| Treatment of large-diameter great saphenous veins | 255 | ||
| Treatment of vulvar varicosities | 255 | ||
| Treatment of venous malformations (liquid sclerosant) | 255 | ||
| Treatment of other venous conditions | 255 | ||
| Treatment of recurrences | 255 | ||
| Does the Menstrual Cycle Influence Sclerotherapy? | 256 | ||
| Recommended Sclerosing Solution Amounts and Concentrations for Non-Foam Sclerotherapy | 256 | ||
| Postsclerotherapy Compression | 258 | ||
| Contraindications to Treatment | 258 | ||
| Pregnancy | 258 | ||
| Inability to ambulate | 259 | ||
| History of thrombophlebitis and deep vein thrombosis | 259 | ||
| Allergic reaction | 259 | ||
| Patients taking disulfiram | 259 | ||
| Patients taking tamoxifen | 259 | ||
| Patients taking hormones | 259 | ||
| Other contraindications | 259 | ||
| Warm Weather | 259 | ||
| Travel | 259 | ||
| Age | 260 | ||
| Case Histories | 260 | ||
| Case Study 1 Incompetent perforator veins treated with Fegan’s technique | 260 | ||
| Case Study 2 Incompetent perforator vein at the midcalf treated with modified Fegan technique | 260 | ||
| Case Study 3 Reticular varicosities without perforator vein reflux treated with total-vein sclerotherapy (Sigg’s technique) | 263 | ||
| Case Study 4 Posterior thigh varicose GSV tributary associated with an incompetent SFJ treated with sclerotherapy alone using the air-bolus technique | 264 | ||
| Case Study 5 Incompetent GSV varicose tributaries treated with total-vein sclerotherapy alone | 265 | ||
| Case Study 6 Incompetent perforator vein underlying ankle ulceration | 266 | ||
| Case Study 7 Sclerotherapy of vulvar varicosities | 267 | ||
| Case Study 8 Large varicose vein from incompetent perforator veins | 268 | ||
| Case Study 9 Extensive varicosities of GSV and GSV tributaries | 268 | ||
| Case Study 10 Development of SFJ incompetence after initial successful treatment of varicose GSV and tributaries | 269 | ||
| Case Study 11 Symptomatic clinically inapparent varicose vein treated with duplex-controlled sclerotherapy | 270 | ||
| Case Study 12 Treatment of dorsal hand veins | 271 | ||
| Case Study 13 Duplex-guided injection | 272 | ||
| Case Study 14 VeinRx catheter foam sclerotherapy of the GSV | 272 | ||
| Case Study 15 Varicose veins and venous ulcers treated with sclerosant microfoam | 274 | ||
| Case Study 16 Microfoam sclerotherapy in Klippel-Trenaunay Syndrome (KTS) and a patent foramen ovale (PFO) | 274 | ||
| References | 275 | ||
| Chapter 9: Appendix | 280 | ||
| Schematic principal types of varicose networks, schematic treatments | 280 | ||
| 10 Role of Surgery in the Treatment of Varicose Veins | 282 | ||
| Background | 282 | ||
| Basis and Aim of Surgery | 282 | ||
| The Different Surgical Procedures | 282 | ||
| Surgery without saphenous trunk preservation | 282 | ||
| Principle and Controversies | 282 | ||
| Technical Information | 283 | ||
| Conventional surgery variants | 283 | ||
| Saphenous Trunk Stripping with Preservation of Saphenofemoral Confluence, with or without Incompetent Tributary Phlebectomy and/or Incompetent Perforator Interruption | 283 | ||
| Cryostripping | 283 | ||
| Surgery with saphenous trunk preservation | 284 | ||
| Isolated flush ligation or limited resection | 284 | ||
| SFJ and/or SPJ ligation plus incompetent tributary phlebectomy with or without incompetent perforator interruption | 284 | ||
| SFJ wrapping or valvuloplasty plus incompetent tributary phlebectomy with or without incompetent perforator interruption | 284 | ||
| SFJ Wrapping | 285 | ||
| Valvuloplasty or Valve Repair | 285 | ||
| Ambulatory phlebectomy | 285 | ||
| Varices phlebectomy | 285 | ||
| CHIVA method | 285 | ||
| Investigations to be Done Before VV Surgery | 286 | ||
| Patient’s Information | 286 | ||
| Anesthesia and Hospitalization | 287 | ||
| Anesthesia | 287 | ||
| Hospitalization | 287 | ||
| Postoperative Care and Convalescence | 288 | ||
| Drug treatment | 288 | ||
| Postoperative elastic compression | 288 | ||
| Recovery and convalescence | 290 | ||
| Surgical Complications | 290 | ||
| Perioperative complications | 290 | ||
| Postoperative complications | 290 | ||
| Hematoma | 290 | ||
| Local infectious complications | 290 | ||
| Lymphatic complications | 290 | ||
| Neurologic complications | 290 | ||
| Venous thromboembolic complications | 290 | ||
| Cosmetic complications | 290 | ||
| Redo Surgery | 290 | ||
| Post Surgical Follow-up | 290 | ||
| Results from Surgery | 291 | ||
| Surgery without preservation of the saphenous trunk | 291 | ||
| Conventional surgery | 291 | ||
| Natural Evolution of the Disease Versus Conventional Surgery | 291 | ||
| Conservative Treatment Versus Conventional Surgery | 291 | ||
| Outcome of conventional surgery in observational studies | 291 | ||
| RCTs on Conventional Surgery Versus Other Operative Treatment | 291 | ||
| Classical surgery variants | 291 | ||
| Saphenous trunk stripping with preservation of the saphenofemoral confluence +/- incompetent tributaries phlebectomy +/- incompetent perforator interruption | 291 | ||
| Cryostripping | 291 | ||
| Surgery with saphenous trunk preservation | 291 | ||
| Isolated flush ligation or limited resection of the SFJ and/or SPJ | 291 | ||
| SFJ and/or SPJ ligation plus incompetent tributaries phlebectomy with or without incompetent perforator interruption | 291 | ||
| SFJ wrapping or valvuloplasty plus incompetent tributaries phlebectomy with or without incompetent perforator interruption | 292 | ||
| Ambulatory phlebectomy | 292 | ||
| Hook phlebectomy or powered phlebectomy | 292 | ||
| Varices phlebectomy with conservation of the refluxing saphenous trunk | 294 | ||
| CHIVA method | 294 | ||
| Indications for Surgery | 295 | ||
| Indications according to etiology | 295 | ||
| Indications according to the clinical presentation | 296 | ||
| Pregnancy | 296 | ||
| Association of VV with another disease | 296 | ||
| Obesity | 296 | ||
| Peripheral Arterial Occlusive Disease and Coronary Disease | 296 | ||
| Lymphedema | 296 | ||
| Indications according to the CEAP class | 296 | ||
| Indications according to anatomic and physiopathologic anomaly | 296 | ||
| Reflux at the SFJ and/or at the SPJ | 296 | ||
| Competent saphenous trunk | 296 | ||
| Combination of primary deep reflux and primary varices | 296 | ||
| Combination of primary deep obstruction and primary varices | 297 | ||
| Incompetent perforator and varices | 297 | ||
| Conclusions | 297 | ||
| References | 297 | ||
| Chapter 10: Appendix | 300 | ||
| Information for the patient | 300 | ||
| 11 Intravascular Approaches to the Treatment of Varicose Veins: | 301 | ||
| Radiofrequency Closure | 301 | ||
| ClosureFAST | 304 | ||
| Technique for closure with ambulatory phlebectomy | 304 | ||
| Endoluminal Laser | 305 | ||
| 810-nm Diode laser | 306 | ||
| 940-nm Diode laser | 307 | ||
| 980-nm Diode laser | 307 | ||
| 1064-nm Nd:YAG laser | 307 | ||
| 1320-nm Nd:YAG laser | 307 | ||
| 1470-nm Diode laser | 308 | ||
| 1500-nm Diode laser | 308 | ||
| Endovenous laser treatment of the small saphenous vein | 309 | ||
| Endovenous laser therapy for stasis ulcers | 309 | ||
| Technique for endoluminal laser ablation using a standard sharp fiberoptic | 309 | ||
| Conclusions | 310 | ||
| References | 311 | ||
| 12 Clinical Methods for Sclerotherapy of Telangiectasias | 315 | ||
| Historical Review of Techniques | 315 | ||
| Indication | 315 | ||
| Injection Technique | 315 | ||
| Preinjection procedure | 315 | ||
| Preparation and visualization of the vessels | 317 | ||
| Equipment | 319 | ||
| Needle and syringe | 319 | ||
| Table and lighting | 319 | ||
| Skin tension | 319 | ||
| Depth of injection | 320 | ||
| Air-bolus (block) or foam technique | 320 | ||
| Foam injection | 321 | ||
| Quantity of sclerosing solution per injection site | 321 | ||
| Concentration and strength of sclerosing solutions | 322 | ||
| Pressure of injection | 323 | ||
| Post-Treatment Techniques | 323 | ||
| Post-treatment compression | 323 | ||
| Microthrombectomy | 324 | ||
| Repeat Treatment Sessions | 324 | ||
| Poor Results of Microsclerotherapy: How to Analyze the Reasons | 324 | ||
| Sclerotherapy Treatment of Facial Telangiectasia | 324 | ||
| Sclerotherapy Treatment of Essential Telangiectasia | 325 | ||
| Conclusion | 325 | ||
| Case Study 1 Traumatic telangiectatic patch | 325 | ||
| Case Study 2 Unassociated telangiectasia | 326 | ||
| Case Study 3 Reticular vein unassociated with the saphenous system | 326 | ||
| Case Study 4 Mixed reticular and telangiectatic veins | 326 | ||
| Case Study 5 Extensive reticular and telangiectatic veins | 327 | ||
| Case Study 6 Treatment of cherry hemangiomas | 327 | ||
| Case Study 7 Lateral subdermal plexis | 327 | ||
| Case Study 8 Long-term follow-up of sclerotherapy treatment of telangiectasia | 329 | ||
| Case Study 9 Long-term follow-up of sclerotherapy treatment of telangiectasia | 329 | ||
| Case Study 10 Treatment of telangiectasia and resulting telangiectatic matting | 329 | ||
| Case Study 11 Treatment of facial telangiectasia | 330 | ||
| Case Study 12 Treatment of facial telangiectasia | 330 | ||
| Case Study 13 Facial telangiectasias and venous malformation | 332 | ||
| Case Study 14 Sclerotherapy of telangiectasias on venous malformation | 332 | ||
| Case Study 15 Treatment of reticular chest veins | 333 | ||
| References | 334 | ||
| 13 Treatment of Leg Telangiectasias with Laser and High-Intensity Pulsed Light | 336 | ||
| Histology of Leg Telangiectasia | 338 | ||
| Laser Treatment of Leg Telangiectasia | 338 | ||
| Carbon dioxide laser | 338 | ||
| Argon laser | 338 | ||
| Contact probe delivery | 342 | ||
| Krypton triphosphate and frequency-doubled Nd:YAG (532 nm) | 342 | ||
| Copper bromide 578 nm | 344 | ||
| Flashlamp-pulsed dye laser, 585 or 595 nm | 344 | ||
| Long-pulse flashlamp-pumped pulsed dye laser | 346 | ||
| Long-pulse alexandrite (755 nm) | 351 | ||
| Diode lasers | 352 | ||
| Fiber-guided laser coagulation | 353 | ||
| High-Intensity Pulsed Light | 353 | ||
| ND:YAG Laser, 1064 nm | 357 | ||
| Vasculite | 359 | ||
| CoolTouch varia | 359 | ||
| CoolGlide | 360 | ||
| Lyra | 360 | ||
| Quantel medical multipulse mode | 361 | ||
| SmartEpil lS | 361 | ||
| Evaluation of Combined Laser–Sclerotherapy Treatment of Leg Telangiectasia | 361 | ||
| Conclusions | 364 | ||
| References | 365 | ||
| 14 Venoactive Drugs | 369 | ||
| Introduction | 369 | ||
| Classification of VAD | 369 | ||
| Benzopyrones | 369 | ||
| Alpha-benzopyrones | 369 | ||
| Gamma-benzopyrones (flavonoids) | 369 | ||
| Diosmin and Micronized Purified Flavonoid Fraction | 370 | ||
| Rutosides and Oxerutin | 371 | ||
| Saponins | 371 | ||
| Escin | 371 | ||
| Ruscus | 371 | ||
| Other plant extracts | 371 | ||
| Phytotherapy | 371 | ||
| Nutritional supplement | 371 | ||
| Other preparations used in the past | 371 | ||
| Synthetic drugs | 371 | ||
| Calcium dobesilate | 371 | ||
| Benzarone | 371 | ||
| Naftazone | 371 | ||
| Tribenoside | 371 | ||
| Principal Mode of Action of VAD | 372 | ||
| Administration, Dosage, Limits | 372 | ||
| Duration of treatment | 372 | ||
| Premenstrual syndrome | 372 | ||
| Pregnancy and lactation | 372 | ||
| Topical application | 372 | ||
| Adverse effects | 372 | ||
| Scientifically Recognized Indications | 373 | ||
| Main indications of VAD | 373 | ||
| Leg ulcer | 373 | ||
| Other indications | 373 | ||
| Combination with compression | 373 | ||
| Results | 373 | ||
| Demonstrated therapeutic effect | 373 | ||
| Guidelines | 373 | ||
| Conclusions | 373 | ||
| References | 374 | ||
| 15 Setting Up a Sclerotherapy Practice | 378 | ||
| Providers | 378 | ||
| Facility | 379 | ||
| Equipment | 379 | ||
| Ultrasound devices | 379 | ||
| Needles | 379 | ||
| Syringes | 380 | ||
| Sclerosing solutions | 380 | ||
| Binocular loupes | 380 | ||
| Magnifying glasses | 382 | ||
| Headband-mounted simple binocular magnifiers | 382 | ||
| Simple binocular loupes | 382 | ||
| Multilens binocular magnifiers | 383 | ||
| Polarizing magnification | 384 | ||
| Transillumination | 385 | ||
| Endovenous ablation systems | 385 | ||
| Phlebectomy instruments | 386 | ||
| Foam pads | 386 | ||
| Tape dressings | 386 | ||
| Graduated compression stockings | 388 | ||
| Antiseptic | 388 | ||
| Photography | 388 | ||
| Patient Informational Brochures | 389 | ||
| Insurance Reimbursement | 389 | ||
| Additional Resources | 390 | ||
| References | 391 | ||
| Appendices | e1 | ||
| APPENDIX A Compression Hosiery, Compression Bandages, and Pressure Pads | e1 | ||
| Compression Hosiery | e1 | ||
| Activa healthcare | e1 | ||
| Bauerfeind | e1 | ||
| CircAid medical | e1 | ||
| Cizeta medicali S.p.A. | e2 | ||
| Gloria-Med | e2 | ||
| Gloria Med USA | e2 | ||
| Innothera | e2 | ||
| Jobst (a brand of BSN medical) | e2 | ||
| JuZo | e3 | ||
| International medi-surgical | e3 | ||
| Medi USA | e3 | ||
| Prenatal cradle | e4 | ||
| Sigvaris | e4 | ||
| Venosan | e4 | ||
| Compression Bandages | e4 | ||
| Medi-Rip | e5 | ||
| Tubigrip | e5 | ||
| Swisslastic compression bandages | e5 | ||
| Pressure Pads | e5 | ||
| Jobst stasis pads | e5 | ||
| JuZo-Helastic | e6 | ||
| Other Contacts | e6 | ||
| Compression stockings | e6 | ||
| Bandages | e6 | ||
| Other compression devices | e7 | ||
| Intermittent pressure pumps | e7 | ||
| Surgical appliance industries | e7 | ||
| APPENDIX B Manufacturers and Distributors of Sclerosing Solutions | e8 | ||
| Ethanolamine Oleate | e8 | ||
| Hypertonic Saline 23.4% | e8 | ||
| Polidocanol | e8 | ||
| Polyiodinated Iodine | e8 | ||
| Chromated Glycerin 72% | e8 | ||
| Glycerin 70% | e9 | ||
| Sclerodex (Dextrose/Saline) | e9 | ||
| Sodium Morrhuate | e9 | ||
| Sodium Tetradecyl Sulfate | e9 | ||
| Compounding Pharmacies | e9 | ||
| APPENDIX C Equipment Sources | e10 | ||
| Needles | e10 | ||
| Syringes | e10 | ||
| Magnifying Glasses | e11 | ||
| Headband-Mounted Simple Binocular Magnifiers | e11 | ||
| Simple Binocular Loupes | e11 | ||
| Binocular Loupes | e11 | ||
| Visual Aid System | e11 | ||
| Foam Pads | e12 | ||
| Tape Dressings | e12 | ||
| Body Adhesive | e12 | ||
| Laser Companies | e12 | ||
| Diagnostic Equipment | e13 | ||
| Photography: Digital and 35-mm Cameras | e13 | ||
| Ambulatory Phlebectomy Pump/Equipment | e14 | ||
| APPENDIX D Patient Brochures | e15 | ||
| Spider Vein, Varicose Vein Therapy | e15 | ||
| Treatment of Leg Veins | e15 | ||
| Sclerotherapy Treatment of Spider and Varicose Veins | e15 | ||
| Sclerotherapy Treatment of Leg Veins | e15 | ||
| Facts for Consumers: Varicose Vein Treatments ( | e15 | ||
| Customized Brochure on Spider and Varicose Vein Therapy | e15 | ||
| APPENDIX E Responses to Postoperative FAQs | e16 | ||
| APPENDIX F What to Tell a Patient Calling with a Varicose Hemorrhage | e17 | ||
| APPENDIX G Checklist of Questions for Your Secretary to Ask Before Passing You a Patient on the Telephone | e18 | ||
| APPENDIX H Coding and Billing Guide for Endovenous Laser Ablation | e19 | ||
| Index | 393 | ||
| A | 393 | ||
| B | 393 | ||
| C | 393 | ||
| D | 394 | ||
| E | 395 | ||
| F | 395 | ||
| G | 396 | ||
| H | 396 | ||
| I | 396 | ||
| K | 396 | ||
| L | 397 | ||
| M | 397 | ||
| N | 397 | ||
| O | 398 | ||
| P | 398 | ||
| Q | 398 | ||
| R | 398 | ||
| S | 399 | ||
| T | 400 | ||
| U | 401 | ||
| V | 401 | ||
| W | 401 | ||
| ELSEVIER DVD-ROM LICENSE AGREEMENT | IFC1 |