Menu Expand
Atlas of Endovascular Venous Surgery E-Book

Atlas of Endovascular Venous Surgery E-Book

Jose Almeida

(2018)

Additional Information

Book Details

Abstract

Highly visual and packed with useful, practical information, Atlas of Endovascular Venous Surgery, 2nd Edition, provides real-world instruction on the evaluation, diagnostic imaging, and medical and endovascular surgical management of acute and chronic venous diseases. Dr. Jose Almeida, pioneering expert in the field and host of the annual International Vein Congress, along with other highly regarded practitioners, offers an authoritative understanding of what causes increased venous pressure and solutions for reducing venous hypertension. Detailed, full-color intraoperative illustrations capture key teaching moments, helping you better understand the nuances of surgery and improve your ability to perform cutting-edge procedures.


Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Atlas of Endovascular Venous Surgery i
Copyright Page iv
Dedication v
Contributors vii
Foreword xi
Preface xiii
Table Of Contents xv
Video Contents xvii
1 Venous Anatomy 1
Abstract 1.e1
Keywords 1.e1
Historical Background 1
Perforating Veins 8
Deep Veins 10
Upper Extremity Veins 12
Lower Extremity Nerves 14
Etiology and Natural History of Disease 19
Pearls and Pitfalls 19
References 19
2 Venous Hemodynamics 21
Abstract 21.e1
Keywords 21.e1
Volume-Pressure Curve 21
Effect of Poor Compliance 23
The Geometric Factor in Venous Flow 24
Venous Pressure and Flow 24
Postural Changes 25
Calf Pump Mechanics 26
Perforators 28
Reflux 30
Obstruction 32
Venous Flow Through the Abdomen 34
References 35
3 Venous Pathophysiology 37
Abstract 37.e1
Keywords 37.e1
Etiology and Natural History of Disease 37
Primary Venous Disease 37
Secondary Venous Disease 50
Congenital 53
Natural History 54
Pearls and Pitfalls 56
Obesity 57
Effects of Superficial Vein Reflux on the Deep Veins 58
Five Salient References 60
References 60
4 Venous Diagnostic Tools 63
Abstract 63.e1
Keywords 63.e1
Historical Background 63
Etiology and Natural History of Disease 64
Instrumentation 68
Plethysmography 68
Impedance Plethysmograph 68
Straingauge Plethysmograph 68
Photoplethysmograph 69
Air Plethysmograph 69
Plethysmography for Venous Insufficiency 70
Venous Filling Index 72
Ejection Fraction 72
Residual Volume Fraction 72
Deep Venous Thrombosis by Plethysmography 73
Duplex Ultrasound 74
Panoramic Imaging 77
Chroma Imaging 78
Color Power Angio 79
Three-Dimensional Imaging 80
Deep Venous System 82
Acute Thrombosis 86
Chronic Thrombosis 88
Superficial Venous System 90
Image Optimization 96
Ultrasound Artifacts 104
Color Flow Imaging 104
Pulsed Wave Doppler 110
Venography 116
Intravascular Ultrasound 117
Cross-Sectional Imaging 117
Computed Tomography Venography 117
Magnetic Resonance Venography 117
References 119
5 Endovenous Thermal Ablation of Saphenous Reflux 121
Abstract 121.e1
Keywords 121.e1
Historical Background 121
Etiology and Natural History of Disease 122
Patient Selection 122
Endovascular Instrumentation 124
Endovascular Laser 124
Radiofrequency 124
Tumescent Anesthesia Delivery 126
Imaging 126
Access and Closure 128
Hemostasis and Anticoagulation 134
Operative Steps 134
Placement of Perivenous Tumescent Anesthesia 144
Laser 147
The Pullback 150
Laser 150
Radiofrequency Ablation 156
Small Saphenous Vein Ablation 166
Treating Accessory and Circumflex Veins (Figs. 5.35–5.37) 176
Popliteal Fossa Vein 181
Laser-Assisted Distal Saphenectomy 184
Multiple Veins and Hybrid Procedures 196
Case Examples 202
Conclusion 213
References 213
6 Radiofrequency Thermal Ablation 215
Abstract 215.e1
Keywords 215.e1
Historical Background 215
First-Generation Device 215
Second-Generation Device (VNUS ClosureFast) 216
Quality-of-Life Changes 217
Etiology and Natural History of Disease 218
Treatment Efficacy 218
Failures 218
Procedure 221
Potential Hazards and Adverse Events 224
Small Saphenous Vein and Other Veins 224
Randomized Clinical Trial Data 225
Radiofrequency Ablation Versus Open Surgery 225
Radiofrequency Ablation Versus Endovenous Laser Ablation 227
References 229
7 Laser Thermal Ablation 233
Abstract 233.e1
Keywords 233.e1
Historical Background 233
Etiology and Natural History of Disease 235
Pearls and Pitfalls 236
Dosing 236
Complications 237
Small Saphenous Vein 238
Comparative Effectiveness of Existing Treatments 239
Nonrandomized Studies 239
Summary of Randomized Controlled Trials 240
Meta-Analysis 242
Acknowledgment 242
References 242
8 Nonthermal Ablation of Saphenous Reflux 247
Abstract 247.e1
Keywords 247.e1
Mechanical Occlusion Chemically Assisted Ablation 248
Overview 248
Technique 250
Technical Pearls 250
Results 252
Summary 253
Cyanoacrylate Closure (Venaseal) 254
Overview 254
Current Technique 254
Technical Pearls 254
Results 256
Summary 257
Polidocanol Injectable Microfoam (Varithena) 258
Overview 258
Technique 258
Technical Pearls 258
Results 260
Summary 260
Discussion 260
Overall Summary 262
References 262
9 Treatment of Perforating Veins 265
Abstract 265.e1
Keywords 265.e1
Historical Background 265
Etiology and Natural History of Disease 265
Patient Selection 266
Endovascular Instrumentation 266
Operative Steps 267
Percutaneous Ablation of Perforators Technique: Chemical Ablation 267
Percutaneous Ablation of Perforators Technique Using the Radiofrequency System 268
Percutaneous Ablation of Perforators Technique Using the Laser System 269
Pearls and Pitfalls 279
Complications 279
Comparative Effectiveness of Existing Treatments 280
References 282
10 Treatment of Varicosed Tributary Veins 285
Abstract 285.e1
Keywords 285.e1
Historical Background 285
Etiology and Natural History of Disease 286
Patient Selection 286
Endovascular Instrumentation 287
Imaging 287
Hemostasis and Anticoagulation 287
Operative Steps 288
Pearls and Pitfalls 302
Complications 303
Comparative Effectiveness of Existing Treatments 303
Conclusion 304
References 306
11 Endovenous Approach to Recurrent Varicose Veins 307
Abstract 307.e1
Keywords 307.e1
Historical Background 307
Etiology and Natural History of Disease 307
Pearls and Pitfalls 308
Previous High Ligation and Stripping 308
Previous Phlebectomy Without Great Saphenous Vein Stripping 310
Previous Laser or Radiofrequency Ablation Without Phlebectomy 312
Previous Great Saphenous Vein Ablation With No Improvement 313
Comparative Effectiveness of Existing Treatments From Cochrane Database 316
References 318
12 Thromboembolic Disease 319
Abstract 319.e1
Keywords 319.e1
Historical Background and Epidemiology of Acute Venous Thromboembolic Disease 319
Etiology and Natural History of Acute Venous Thromboembolism 320
Etiology 320
Natural History 321
Diagnosis and Imaging 321
Laboratory Testing for Venous Thromboembolism 322
Testing for Thrombophilia 322
Imaging for Venous Thromboembolism 324
Antithrombotic Therapy for Venous Thromboembolism 326
Treatment for Venous Thromboembolism 326
Duration of Anticoagulation 328
Superficial Venous Thrombosis 330
Etiology and Natural History of Superficial Vein Thrombosis 330
Diagnosis and Imaging of Superficial Vein Thrombosis 330
Treatment of Superficial Vein Thrombosis 331
References 337
13 Endovenous Placement of Inferior Vena Caval Filters 339
Abstract 339.e1
Keywords 339.e1
Historical Background 339
Patient Selection 340
Imaging 342
Venous Duplex Imaging 342
Venography 342
Access and Operative Steps 343
Right Internal Jugular Approach 343
Common Femoral Vein Approach 352
Anticoagulation Management 358
Pearls and Pitfalls 358
Complications of Inferior Vena Cava Filter Insertion 358
Comparative Effectiveness 360
Retrievable Filters and Stenting of Chronically Obstructed Inferior Vena Cava Filters 360
References 361
14 Pharmacomechanical Thrombolysis 363
Abstract 363.e1
Keywords 363.e1
Historical Background 363
Etiology and Natural History 363
Treatment Options 364
Patient Selection 365
Thrombus Removal Devices 367
RAPID Lysis Technique 369
Endovascular Instruments and Equipment 369
Patient Preparation 370
Procedural Steps 370
Access 370
RAPID Lysis Pharmacomechanical Thrombolysis 370
Closure 372
Inferior Vena Cava Filters and Other Additional Procedural Points 372
Adjuvant Therapies: Angioplasty and Stenting 374
Pearls and Pitfalls 374
Single Center Registry Findings 376
RAPID-Lysis and Lytic Contraindications 376
Complications 376
Comparative Effectiveness of Existing Treatments 377
Five Salient References 378
References 378
15 New Concepts in the Management of Pulmonary Embolus 381
Abstract 381.e1
Keywords 381.e1
Historical Background 381
Demographics 381
Prognostic Factors 382
Categories of Pulmonary Embolism 382
Risk Stratification 383
Treatment Guidelines 385
Catheter Directed Therapy 386
Established Catheter Directed Treatment Modalities 386
Rheolytic Embolectomy 386
Suction Embolectomy 388
Balloon Angioplasty-Assisted Clot Disruption 388
Mechanical Embolectomy With Rotating Pigtail 388
Ultrasound-Assisted Catheter Directed Thrombolysis 389
Complications of Catheter Directed Therapies 391
On the Horizon 391
Pulmonary Embolism Response Teams 391
Extracorporeal Membrane Oxygenation 392
AngioVac 392
FlowTriever 394
References 394
16 Endothermal Heat-Induced Thrombosis 397
Abstract 397.e1
Keywords 397.e1
Historical Background 397
Definition of Endothermal Heat-Induced Thrombosis 398
Classification of Endothermal Heat-Induced Thrombosis 398
Pathophysiology 399
Epidemiology 400
Natural History/Surveillance 401
Risk Factors 402
Prevention 403
Treatment for EHIT 403
Conclusions 404
References 406
17 Postthrombotic Syndrome 409
Abstract 409.e1
Keywords 409.e1
Historical Background 409
Nonoperative Treatment 415
Interventional Treatment 416
Endovascular Horizon 422
Pearls and Pitfalls 425
Compression Therapy 425
Five Salient References 426
References 427
18 Iliocaval and Femoral Venous Occlusive Disease 431
Abstract 431.e1
Keywords 431.e1
Historical Background 431
Etiology and Natural History of Disease 433
Patient Selection 434
Operative Steps 436
Nonthrombotic Iliac Vein Lesions 439
Intravascular Ultrasonography Findings 446
Stent Deployment 446
Scientific Evidence Nonthrombotic Iliac Vein Lesion Treatment 447
Postthrombotic Iliocaval and Femoral Venous Occlusive Disease 447
Bilateral Stenting and Advanced Techniques 450
Anticoagulation 450
Scientific Evidence Postthrombotic Treatment 450
Comparative Effectiveness of Existing Treatments 452
Cases and Innovative Techniques 452
Case 1: Recanalization of Left Iliac Chronic Total Occlusion, Endovascular Reconstruction With Wallstent/Z-Stent Stack (Figs. 18.12–18.20) 452
Case 2: IVC Filter Induced Vena Cava Occlusion, Extract Filter and Stent Cava (Figs. 18.21–18.30) 460
Remove the Inferior Vena Cava Filter and Attempt to Traverse the Lesions 460
Access and Bilateral Lower Extremity Venograms 468
Intravascular Ultrasonography, Venography, and Percutaneous Transluminal Angioplasty/Stenting 468
Poststent Dilation and Completion Venography 468
Case 3: IVC Filter Induced Vena Cava Occlusion, Crush Filter and Stent Cava (Figs. 18.31–18.39) 468
Access and Initial Bilateral Lower Extremity Venography 474
Stage II Contralateral (Right) Side 475
Intravascular Ultrasonography and Percutaneous Transluminal Angioplasty/Stenting of the Right Side 475
Case 4: Caval Agenesis and Recurrent VTE-Treated With Staged Complex Reconstruction (Figs. 18.40–18.48) 476
Case 5: Femoral Vein Stenting to Add Inflow Support to Iliocaval Endovascular Reconstruction (Figs. 18.49–18.56) 484
Case 6: Infrarenal Caval Occlusion With Dissection. Treatment With Sharp Recanalization, Through-and-Through (Body Floss) Access and Endovascular Stent Reconstruction 489
Case 7: Biconical IVC Filter Caval Extraction With Loop Snare and Rigid Bronchial Forceps (Figs. 18.66–18.70) 496
Case 8: Vena Cava Atresia Presented With Acute Bilateral Iliofemoral Deep Vein Thrombosis. Treated With Catheter Directed Thrombolysis Followed by Endovascular Stenting (Figs. 18.71–18.74) 500
Case 9: Severe Thromophilia, Venous Ulceration, Failed Femoral Vein Stenting 502
Case 10: Iliac Vein Occlusion, Recanalization From Above 508
Case 11: Acute DVT Treated With “One-and-Done” Rheolytic Pharmacomechanical Thrombolysis (Figs. 18.88–18.91) 512
References 514
19 Deep Venous Incompetence and Valve Repair 517
Abstract 517.e1
Keywords 517.e1
Normal Condition: Emphasis on Lower Extremity Deep Venous Valves 518
Anatomy 518
Physiology 522
Diseased Condition: Insufficiency in the Lower Leg Venous System 522
Etiology/Pathology 522
Pathophysiology 523
The Clinical Evaluation: Clinical; Etiologic; Anatomic; Pathophysiologic 524
Typical Diagnostic Evaluation 524
Operative Intervention 526
Routine Operative Considerations 526
Operative Exposure 526
Treatment Option 1 528
External Banding 528
External Valvuloplasty 528
Internal Valvuloplasty 530
Treatment Option 2 534
Valve Transposition 535
Valve Transplantation 536
Valve Substitutes 537
Postoperative Care 538
Routine Follow-Up 538
Results 538
Early Results 538
Late Results: Option 1 539
External Banding 539
External Valvuloplasty 539
Internal Valvuloplasty 539
Late Results: Option 2 539
Valve Transposition 539
Valve Transplantation 540
Venous Valve Substitutes 540
Late Results 540
Multilevel Valve Reconstruction 540
Summary 541
References 541
20 Venous Ulcers 547
Abstract 547.e1
Keywords 547.e1
Control of Venous Hypertension 548
Compression 548
Intervention to Correct Venous Hypertension 550
Indications for Intervention 550
Superficial Venous Ablation 550
Perforator Insufficiency 552
Terminal Interruption of Reflux Source 554
Management of the Venous Ulcer to Facilitate Healing 560
Wound Bed Preparation 560
Debridement 560
Larval 561
Bacterial Colonization 562
Properties and Categories of Wound Dressings 562
Adjunctive Therapies to Accelerate Healing 563
Human Skin Equivalents 563
Summary 564
References 565
21 Pelvic Venous Disorders 567
Abstract 567.e1
Keywords 567.e1
Abdominal and Pelvic Venous Anatomy 568
Clinical Manifestations of Pelvic Venous Disorders 576
Epidemiology 580
Diagnosis of Pelvic Venous Disorders 582
The Management of Pelvic Venous Disorders 591
Primary Ovarian/Internal Iliac Venous Incompetence 591
Pelvic Origin Lower Extremity Varices 594
Primary Left Renal Vein Compression (Nutcracker Syndrome) 595
Symptomatic Internal Iliac Reflux Caused by Common Iliac Vein Compression (May-Thurner Syndrome) 598
Pitfalls in the Management of Pelvic Venous Disorders 598
Summary 599
References 599
22 Nutcracker Syndrome 601
Abstract 601.e1
Keywords 601.e1
Diagnosis 602
Duplex Ultrasonography 603
Computed Tomography/Magnetic Resonance Imaging/Intravascular Ultrasound 604
Venography 606
Patient Selection Criteria 607
Treatment 608
Open Reconstruction 608
Left Renal Vein Transposition 608
Venous Bypass Procedures 611
Other Procedures 614
Posterior Nutcracker Syndrome 615
Endovascular Treatment 615
Conclusion 617
References 617
23 Treatment of Spider Telangiectasias 619
Abstract 619.e1
Keywords 619.e1
Historical Background 619
Etiology 619
Patient Selection 620
Endovascular Instrumentation 626
Imaging 630
Sclerosants 632
Access and Closure 632
Operative Steps 634
Pearls and Pitfalls 641
Complications and Adverse Sequelae 643
Pain 643
Edema 644
Urticaria 644
Blisters and Folliculitis 644
Hyperpigmentation 645
Recurrence of Treated Vessels 646
Other Minor Conditions 646
Nerve Damage 646
Superficial Thrombophlebitis 648
Emboli and Deep Venous Thrombosis 648
Air Embolism 649
Allergic Reactions 650
Cutaneous Necrosis 650
Summary of Complications and Adverse Sequelae 652
Comparative Effectiveness 652
Laser Treatment of Spider Telangiectasias 652
Historical Perspective 652
Basic Concepts and Terminology 652
Types of Lasers 654
Operative Steps 654
Comparative Effectiveness 656
References 658
24 Endovenous Management of Central and Upper Extremity Veins 659
Abstract 659.e1
Keywords 659.e1
Primary Upper Extremity Deep Venous Thrombosis: Paget Schroetter Syndrome 659
Treatment 660
Secondary Upper Extremity Deep Venous Thrombosis 668
Dialysis Access–Related Central Venous Stenosis 669
Superior Vena Cava Syndrome 671
Crossing Upper Extremity Central Venous Occlusions 680
Suggested Readings 680
25 Venous Malformations 681
Abstract 681.e1
Keywords 681.e1
What Are Hemangiomas? Are They Arteriovenous Malfomations? 681
Vascular Malformations 683
Low-Flow Vascular Malformations—Venous Malformations 683
Low-Flow Vascular Malformations—Lymphatic Malformations 684
Low-Flow Vascular Malformations—Capillary Malformations 684
High-Flow Vascular Malformations—Arteriovenous Fistulas 685
High-Flow Vascular Malformations—Arteriovenous Malformations 685
Yakes Arteriovenous Malformation Classification 685
Treatment of Venous Malformations 686
Selected Readings 692
References 692
26 Severity Scoring and Outcomes Measurement 693
Abstract 693.e1
Keywords 693.e1
Historical Background 693
Venous Severity Assessment Tools 694
Venous Thromboembolism Risk Assessment—Caprini Score 694
Postthrombotic Syndrome—Villalta Score 696
Clinical, Etiologic, Anatomic, Pathophysiologic Classification 697
Revised Venous Clinical Severity Scoring 699
Patient-Reported Outcome Tools 699
Pearls and Pitfalls 703
Comparative Effectiveness of Existing Treatments 706
Acknowledgment 709
References 710
27 Evidence-Based Summary of Guidelines From the Society for Vascular Surgery and the American Venous Forum 713
Abstract 713.e1
Keywords 713.e1
The Evidence Pyramid 714
Grading Recommendations and Evidence 716
Clinical Practice Guidelines on Venous Disease 717
Evaluation and Classification 718
Treatment 718
Compression Therapy 720
Pharmacologic Therapy 720
Surgical Management 722
Endovenous Therapies 722
Treatment of Varicose Vein Tributaries and Recurrent Varicose Veins 724
Treatment of Pathologic Perforating Veins 726
Treatment of Venous Obstruction 726
Conclusion 726
References 728
Index 731
A 731
B 731
C 732
D 733
E 733
F 734
G 735
H 735
I 736
J 737
K 737
L 737
M 738
N 739
O 739
P 739
Q 741
R 741
S 742
T 743
U 744
V 745
W 746
Y 746
Z 746
Inside Back Cover ibc1