Chronic Venous Disease CME presentation.pptx

Chronic Venous Disease CME.pptx
Chronic Venous Disease CME.pptx

1. Chronic Venous Disease European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines

2. Risk factors Age DVT Obesity Prolonged standing Smoking Pregnancy Sedentary lifestyle

3. Signs & Symptoms Heaviness in lower limb Lower limb oedema Itching of skin Nocturnal cramps Hyperpigmentation Venous dermatitis Atrophie blanche Ulceration

4. Investigations Duplex ultrasound DVT Presence of reflux (upright position) 1s for reflux in CFV, FV and POPV; 0.5s for superficial veins Course of reflux Length of refluxing trunk Saphenous trunk diameter

5. Normal deep and superficial veins of lower extremity :

6. Refluxing deep veins

7. CTV Deep venous pathology when DUS is inadequate MRV Deep vein obstruction, fibrotic scarring, collaterals Endovenous mapping

8. Management Conservative Exercise Weight loss Elevate legs at rest Compression Elastic compression stockings Elastic and in-elastic bandages Adjustable compression garments Intermittent pneumatic compression Neuromuscular electrical stimulation (promotes calf muscle contraction)

9. When to intervene ? C2 and symptomatic (Class IB) C3 : to rule out other non-venous causes of oedema before intervene (Class IIa , C) C4-C6 (Class IC)

10. Types of saphenous ablation Thermal Endovenous laser ablation Radiofrequency ablation Most commonly used Heats target vein segments of 7cm (or shorter) at temperature of 120 degree celcius In a multicentre European cohort study showed GSV occlusion rate of 92% and reflux free rate of 95% at 5 years Endovenous steam ablation Endovenous microwave ablation

11. Complications of endovenous thermal ablation Endothermal heat induced thrombosis GSV EVTA was complicated by EHIT in 1.7% class II, III, or IV in 1.4% DVT in 0.3% PE in 0.1% Hyperpigmentation Parasthesia Haematoma Thermal skin injury

12. Non-thermal ablation Cyanoacrylate glue ablation Comparable occlusion rate to RFA Less pain and shorter recovery time Complication : DVT (0% - 3.5%) hyperpigmentation (1.6%-3%) access site infection or cellulitis (1.4%-3%) haematoma (1.4%-1.6%) nerve injury or paresthesia (0%-2%)

13. Foam sclerotherapy Polidocanol (POL) and sodium tetradecyl sulphate (STS) Less effective than EVLA/RFA Complication : transient hyperpigmentation (10%-15%) telangiectatic matting (< 10%) SVT (5.9%-13.7%) neurological events (< 1%), such as visual disturbance, dysaesthesia , headache, and migraine

14. High ligation and stripping A meta-analysis looked at pooled long term outcome data (five years) of Marianne G. De Maeseneer et al. two RCTs and 10 follow up studies of RCTs on treatment of GSV incompetence Recurrent reflux rates at the SFJ were statistically significantly lower after HLS than after EVLA (12% vs. 22%) The r-VCSS scores were also pooled for HLS and EVLA and showed similar improvements. When comparing complications after HLS with those after EVLA, bleeding and haematoma (4.8% vs. 1.3%), wound infection (1.9% vs. 0.3%), and paraesthesia (11.3% vs. 6.7%) were more frequent after HLS

15. Treatment for varicose tributary Phlebectomies Sclerotherapy Treatment for Perforating veins Ligation Ablation Treatment for reticular veins and telangiectasias Sclerotherapy (POL/STS) Transcutaneous lasers

16. Management of deep venous obstruction

17. Management of venous ulceration Antibiotics and antiseptics Routine use of systemic antimicrobials and topical antibiotics not beneficial Mobilisation Wound care Debridement Dressing Compression therapy multilayer or inelastic bandages or adjustable compression garments, exerting a target pressure of at least 40 mmHg at the ankle Avoid if ABSI <0.6