Evaluation of the Superficial Venous System and When to Treat

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Presentation transcript:

Evaluation of the Superficial Venous System and When to Treat American College of Phleboloty 2016 30th Annual Congress Daniel L. Monahan, M.D., F.A.C.S Roseville, California

No Disclosures

Venous Reflux is a Surrogate Our job is to treat varicose veins, not ultrasound findings.

Anatomy of the Superficial Venous System

Remember the G’s Take a History

The G’s of Varicose Veins 1. Genetics 2. Gender 3. Gestation 4. Gravity 5. Geriatrics 6. Gluttony 7. Job and Activities – not a “G”, so not so important The G’s of Varicose Veins

Physical Examination

Varicose Veins – Location, Distribution, Size, Extent Swelling, Ankle findings – signs of neglected disease CEAP Physical examination

CEAP Classification C – Clinical – C0 to C6 Etiologic Anatomic Pathologic CEAP Classification

CEAP C0 – no visible or palpable signs C1 – telangiectasias or reticular veins C2 – varicose veins C3 – edema C4a – pigmentation and/or eczema C4b – atrophie blanche/lipodermatosclerosis C5 – healed venous ulcer C6 – active venous ulcer S: symptomatic A: asymptomatic CEAP

(REVISED) Venous Clinical Severity Score VCSS

VCSS Pain Varicose Veins Venous Edema Skin Pigmentation Inflammation Induration Active Ulcer number Active Ulcer duration VCSS

“Conservative Measures” Leg Elevation Use of NSAIDS Use of Compression, and Duration Documentation of Disability

High resolution color flow venous duplex Scanning Everybody gets an ultrasound High resolution color flow venous duplex Scanning

Ultrasound Exam Deep System Superficial truncal veins Perforators Lateral thigh Pelvic Veins Prior phlebitis Acute superficial phlebitis Ultrasound Exam

Ultrasound Exam What is reflux? 0.5 – 1.0 sec (500 to 100 msec) defines normal, not abnormal Ultrasound Exam

When to Treat And When Not To

What you CAN do What you SHOULD do When to treat

We are not looking for opportunities to do ablations We are not looking for opportunities to do ablations. We are looking for opportunities to help patients with their varicose veins.

When not to treat

The preference for conservatism

Thank you