Chap 57-58 CVI Treatment Flashcards
What are compression indications?
symptomatic VV (20-30)
healing ulcers
against as primary for VV for those who are candidates for SV ablation
What is recommendation for surgery?
EVLT > surgery
What are recommendation for treatment of incompetent GSV?
high ligation and inversion stripping to level of knee
What perforators are the most important? what are they?
medial perforators
medial thigh posteromedial popliteal fossa medial gastroc post tib medial ankle medial foot parartibial
What are surgical techniques for reflux?
high ligation of the GSV
divide tributaries
resect 5-10cm portion of gsv
GSV stripping
Name the six tributaries of the saphenofemoral junction.
inferior epigastric superficial circumflex lateral accessory saphenous deep external pudendal superficial external pudendal medial accessory saphenous
What are adjuncts for stripping?
US guidance Tumescent anesthesia compressive dressing and elevation leg elevation before and after proximal tourniquet (massive varices)
What were the results of the ESCHAR trial?
RCT C5-6
No difference in healing, recurrence reduce with sx at one year 12 vs 28
Sx better QoL (LT no diff)
EVLT less peri-procedural morbidity
When to consider Sx >EVLT in environment where EVLT is recommended over sx?
sperficial saphenous tributary GSV dilation/aneurysm Chrinic thrombophleb excessive tortuosity acute superficial thrombosis economic
How does sclerotherapy work?
sclerosants destroy endothelium
veins transformed into fibrous cord
What are different sclerosants?
Hypertonic salin Sclerodex Chromated glycerin Nonchromated glycerin Polidocanol Sodium tetradecyl sulfate
What are indications for EVLT?
saphenous VV perforating veins reticular VV telangiectasia residual
What are CI for EVLT?
known allergy
acute DVT/PE
local infection
r-l shunt for sclerosant
relative
pregnancy
breast feeding
severe PAD
