Phlebology Préface :
A.-A. RAMELET
Reliure :
Broché
Nbr de pages :
566
ISBN 10 :
2842999452
ISBN 13 :
9782842999452
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Quel est le sujet du livre "Phlebology" Completely restructured, with more illustrations, and rewritten by a new team of authors, this fifth edition presents a critical review of phlebology in light of the most recent data from evidence-based medicine. Although a frequent reason for office visite and hospitalization, venous diseases are paradoxically only rarely taught in medical schools. They nevertheless have heavy consequences for both the patient and Society: suffering, disability, mortality, overall socioeconomic costs, etc. This fifth edition offers a multidisciplinary and exhaustive approach to phlebology:
everyday practice (clinicat, diagnostic, therapeutic, etc.) has been emphasized: particular attention has been devoted to certain subjects that are not well known: cutaneous manifestations, differential diagnosis, functional investigations, drag therapy, endoscopic techniques, new approaches to leg inters, and clinicat tare and treatment of acute venous disease (superficial thrombophlebitis, deep vein thromboses); a detailed index allows the reader to quickly find the desired information. Audience This book will interest medical students, angiotogists, surgeons, dermatologiste, internists, and phlebologists, but it will also be of interest to all those who are confronted with the diagnosis and treatment of venous diseases.
The authors The multidisciplined approach of the book also stems from the specialties and training of its authors.
Albert-Adrien Ramelet is a dermatologist and angiologist in Lausanne and Bern. Michel Perrin is a vascular surgeon in Lyon.
Philippe Kern is an internist and angiologist in Vevey.
Henri Bounameaux is an internist and angiologist in Geneva.
En suivant ce lien, retrouvez tous les livres dans la spécialité Médecine vasculaire.
Sommaire Sommaire et contenu du livre "Phlebology" Contents
Abbreviations V
Foreword VII
1.
BASIC KNOWLEDGE
1 Definitions -classifications 3
Chron? venous disorders -Definitions 3
Chronic venous disorders and chronic venous disease 3
Venous insufllciency 3
Posr-rhromboric syndrome 4
Varicose veins 4
Telangiecrasias 5
Trophic changes 5
Leg ulcer 5
New CEAP definirions (2004) 5
Classificarions of CVD 6
Widmer Classificarion 7
CEAP c1assificarion 7
Superficial Thrombophlebitis (STP) -Definition Il
Deep Vein Thrombosis (DVT) -Definition 12
2 Anatomy and pathology of the limb veins 15
Anatomy of the limb veins 15
Structure of rhe venous wall 15
Valve srructure 15
Descriptive anaromy 16
Pathologica1 anatomy 32
Telangiecrasias 33
Varicose veins 33
Perforaring veins 38
Primary deep valvular insufficiency (PDYl) 40
Deep vein compression 40
Free edge of the leaRers' valve sinus 40
Posr-rhromboric syndrome 43
Thoraco-brachial ourler syndrome 43
Superior vena cava (SVe) syndrome 43
Venous aneurysms 44
Congeniral venous malformarions 44
Vein tumours 46
Sequelae oflimb vein trauma 46
Venous lesions in rhe pelvic syndrome 47
Microangioparhy of chronic venous insufficiency (CYl) 47
3 Venous physiology 49
Venous physiology of the lower Iimb 49
Veins 49
Blood pressure and velociry in rhe venous and capillary companmenr 51
Venous relUrn 54
amers mechanisms 56
Environmenral facrors 58
Venous physiology of the upper Iimb . 58
4 Pathophysiology of chronic venous disease 61
Venous pathophysiology of the lower Iimb 61
Pamophysiological mechanisms 61
Consequences 70
Aggravaring facrors 74
Consequences of cIuonic LL venous disease 79
Venous pathophysiology of the upper Iimb 79
Pathophysiology of tdangiectasias 79
Walilesions 80
Aneriovenous anasromoses 80
Hormones 80
5 Epidemiology and costs 83
Prevalence and incidence ofvenous disorders 83
Venous symproms in lhe absence of dinical signs (Cos) or
analomo-pamophysiological abnormaliries (~ and PN) of CVD 83
C" Telangiecrasias and rericuiar varicose veins 83
C• Varicose veins 84
2
C3 • Oedema 85
C,.
Sl?changes ofvenous origin (pigmenrarion, eczema,
lipodermarosclerosis) 85
Cs~' Healed uicer -unhealed ulcer 85
Posr-mromboric syndrome 86
Risk factors for telangiectasias, varicose veins, CVI, u1cer
and the post-tbrombotic syndrome 87
Risk facrors for relangiecrasias. varicose veins and CYl 87
Risk facrors for rhe posr-rhromboric syndrome 90
Cast of venous disorders 90
Posr-mrombo?yndrome 91
Venous Jeg uicer 91
Conclusions 91
II.
CHRONIC VENOUS DISEASE
6 Symptoms 97
Symptoms 97
Impression of Swelling 98
Heavy Legs 98
Prurilus 98
Pain 98
Nighr Cramps 100
ResrJess Legs 100
Evaluation and quantification of the symptoms 101
Evaluation and quantification of the symptoms 102
Evaluation of disability 102
7 Signs 105
Telangiectasias 105
Definition of telangiectasias (C,) 106
Significance of telangiectasias 106
Development of telangiectasias 106
Clinical presentation 107
Topography of telangiectasias 108
Venous drainage of the skin 109
Differential diagnosis of telangiectasias III
Clinical course and recurrence III
Reticu1ar varicose veins (CI) III
Clinical appearance III
Differential diagnosis of reticular varicose veins 112
Complications 112
z
Varicose veins (C) 112
Saphenous varicose veins (truncal varicose veins) 112
Collateral saphenous varicose veins (accessory truncal varicose veins) 113
Non saphenous varicose veins 114
Varicose veins and pregnancy 114
Differential diagnosis ofvaricose veins 114
Complications 116
Œdema (C) 117
Causes of oedema 117
Venous oedema 117
Traveller's oedema 118
Lipoedema and Iymphoedema 118
Trophic changes (C4) 118
Pigmentation ("dermite ocre", purpuric and pigmented angiodermatitis
of Favre and Chaix) 119
~ma 120
Lipodermatosclerosis 124
Atrophie blanche 127
Calcification (cutaneous calcinosis) 128
Healed venous ulœr (CJ 129
Active ulœr(CJ 130
Definitions 130
Epidemiology 130
Diagnosis 131
Differential diagnosis 131
Ulcers in Practice -clinical aspects 132
Complications 139
Progression 142
Venous signs not considered in the CFAP 143
Corona phlebectatica 143
Congenital venous malformations 144
"Deœptive" signs or signs "associated" with CVD 144
Eryrhema 144
Purpura 145
Ecchymosis and haematoma 147
Infections 147
Livedo 149
Lipoedema 150
Lymphatic disotdets of CVD 152
Lymphoedema 152
Other curaneous disorders associaœd with CVD 155
Relationship berween drug injection and CVD 157
Cutaneous complications occuring during CVD and its treatment 157
Complications of local treatmems 157
Complications of systemic treatments 158
Rare complicarions foliowing surgery 159
Parricular complications following sc!erotherapy 161
J Clinical forms 167
Primary varicose veins 167
Uncomplicared varicose veins 167
Incompetence of perforating veins 171
Parricular c!inical appearances 172
Parricular anaromo-clinical forms of varicose veins and telangiectasias 172
Secondary varicose veins 180
Superficial venous insufliciency in the context of a post-thrombotic syndrome 180
Ehlers-Danlos syndrome 182
Particular venous disorders 185
Venous aneurysms 185
Background 185
Definition, pathology, parhophysiology 185
Clinical presentation and complememary investigations 185
Venous tumours 186
Background 186
Clinical presemation and complementary investigations 186
Sequelae of injury 187
Compression of deep veins in the legs 187
Chronic obstruction and compression ofveins in the arms 189
AxiJJary-subclavian venous obstructive syndrome 189
Superior vena cava syndrome 190
Pelvic congestion syndrome 190
Symproms 190
Clinical presentation 190
Diagnosis 190
Congenital venous malformations 191
KJippel-Trenaunay syndrome 191
Parlœs-Weber syndrome 192
Differentiai diagnosis of venous malformations 192
Approach -Patient association 193
Agenesis, hypoplasia and valvular dysplasia 193
Valvular agenesis 193
Hypoplasia and valvular dysplasia 193
DifferentiaI diagnosis 194
Clinicat repercussions 194
Arteriovenous fistulae 194
Symproms 194
Clinical presemation 194
Diagnosis 195
10 Quality of life and CVD
Complaints voiced
Evaluation questionnaires
Results of a few studies
Conclusions
III INVESTIGATIONS
11 History and c1inical examination
Reason for the consultation Clinical history Symproms Pasr hisrory Risk facrors Furcher c1inical hisrory Prognosis Patient examination Chronic venous disease Acure venous disease Upper limbs Phlebological tests Tap sign (Schwarrz's resr, wave resr) Cough resr Trendelenburg resr Perches resr Grher resrs Validation of the clinical examination Chronic venous disease Acure venous disease
12 Ultrasonography
Doppler principle Continuous wave doppler (CWD) Duplex ultrasound (DU) B mode ulrrasound Pulsed Doppler Colour mode Doppler energy or power
B-Aow
3D 20 MHz probe Conrrasr media Ulrrasound-guided rechniques Grher ulrrasound rechniques Technique Invesrigarion Choice of probe and machine serring Parienr prepararion and complicarions DU orCWD? Conclusion
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13 Vascular investigations in venous disease exduding ultrasound techniques 241 General details 241 Non-invasive methods 241 Plerhysmography 241 Static volumetry 245 Dynamic volumetry 245 Thermography 246 Measurement of transcutaneous oxygen pressure (TcP02) 246 Laser Doppler 246 Capillaroscopy 247 Measurement of the systolic index (SI) 247 Invasive methods 248 Venous pressures 248 Phlebography 250 Other radiological techniques 254 Skin biopsy 257 Measurement of interstirial pressure 257 Endovenous ultrasound 257
14 Choice of investigations in chronic limb venous disease 259 Venous symptoms of the liwithout visible or palpable sign ofvenous disease (Cos) 259 LL pain, LL venous pain, with no visible or palpable sign of venous disease 259 Other LL venous symptoms without visible or palpable sign of venous disease 260 Cl -Presence of tdang?tasias or reticulu varicose veins 261 Telangieetasias 261 Reticu1ar varicose veins 262 Varicoseveins(C) 262 Saphenous varicose veins 262 Recurrence of varicose veins 263 Non-saphenous varicose veins 263 Venous malformations or varicose veins in the context of a congenital venous malformation 264 Secondary varicose veins 264 Oedema (C,) 264 Trophic changes (C~) 264 Active venous u1cer (CJ 265 Post-thrombotic syndrome (PTS) 265 Primary deep valvulu insufficiency 265 Venous claudication 265 Other situations 266 Venous disease of the upper Iimb 266
IV PREVENTION AND TREATMENT
15 lifestyle, physiotherapy, prevention 269 L?styte 269 Background 269 Principles and objectives of treatment 269 Princip1es and methods 269
Sports and spare rime 274 Background 274 Principles and objectives of sports rraining 274 Principles and merhods 274 Parricular aspecrs 275 Physiotherapy 276 Background 276 Principles and objecrives of rrearmenr 276 Examinarions before rrearmenr 277 Principles and merhods 277 Crenotherapy -thermalism 278 Ortheses 279 Compression 280 Prevention 280 Chronic venous disease (CVD) 280 Pregnancy 280 Prevenrion of recurrence of ulcers 280
16 Compression therapy 285
Background 285 Acrive and passive compression 285 Compression 285 SuPPOrt 286 Acrive or passive compression 286 Principles and objectives of treatment 286 Pressure 286 Pressure variations 287 Effecrs of compression 287 Objecrives of compression 288 Pre-treatment examinations 288 Principle and methods 289 Marerials 289 Elasric bandages 289 Compression srockings (medical srockings) 294 Indications 298 Contraindications 298 Results 300 Classes Cos and C" 301 Trearmenr for varicose veins (C) 301 Trearmenr for oedemas (C3) 302 Trearmenr for rrophic changes (C.) 302 Prevenrion of recurrence of ulcers (Cs) 302 Trearmenr of leg ulcers (CG) 303 Prevenrion of rhe progression of CVD 304 Prophylaxis for DVT 304 Trearmenr for superficial rhrombophlebiris 304 Trearmenr for DVT 304 Prevention and rrearment of posr-rhromboric syndromes 304 Pregnancy 305 Prevenrion of oedemas and DVT during Jong-disrance f1ighrs or long trips 305 Orher indicarions 305 Compression and sports 305 Compression and qualiry of life 305 Economy of compression 305
Complications 306 Consequences ofexcessive pressure 306 Infectious complications 306 Allergies and irrirarion 306 Injury during applicarion 306 Conclusions 306
17 Drug treatment of CVD 309 Venoactive drugs 309 Definition 309 Objecrives, mode of action and evaluarion 310 Classification and pharmacology ofVAD 311 Indications for VAD, dosage, parricular siruarions 320 Side effecrs 323 Resulrs 323 Conclusion 327 Other medicinal products 327 Quinine sulphare 327 Fibrinolyric anabolic agems 327 Non-sreroidal ami-inAarrunarory drugs 328 Diuretics 328 Plare/er ami-aggregams 328
18 Sclerotherapy 335 Background 335 Principles and objectives of treatment 335 Pre-treatment exarns 335 Principle and methods 336 Sclerosing agems 336 Techniques 338 Indications 343 Indicarions for rhe rrearmem of varicose veins and relangiecrasias 343 Advamages of sclerorherapy 344 Orher indicarions 344 Contraindications 344 Results 345 Te/angiecrasias 345 Reticular varicose veins 345 Accessory saphenous varicose veins 345 Varicose veins of rhe saphenous rrunks 345 Perforaring veins 346 Complications 346 Early complicarions 347 Lare complications 348 Conclusions 351 Information for the patient 355 Sc1erorherapy of small varicose veins and relangiecrasias 355 Before rrearmem 355 Afcer sc!erorherapy 355 Risks and complicarions 355 Resulrs 356 Information for the patient 356 Ulrrasound-guided sc1erorherapy for varicose veins 356
Advantages and drawbacks 356 Before treatment 356 After ultrasound-guided sclerotherapy 356 Risks and complications 357
19 Lasers, electro-coagulation, curetting and other treatments for telangiectasias 359 ScJerotherapy of telangiectasias 359 Lasers and flash lamps 359 Background 359 Definitions 360 Principles and objectives of the therapeutic method 361 Equipment and parameters 361 Patient examination and information 362 Indications 362 Contraindications and safety measures 362 Post-procedure care 363 Posr-procedure complications 363 Results 363 Electrocoagulation 365 Background 365 Principles of the method 365 Methods 365 Conrraindications 366 Complications 366 Results 366 Phlebectomy and curetting of telangiectasias 366 Background 366 Principles of rhe method 366 Methods 367 Follow-up and post-operative care 367 Complications 368 Results 368 ~ouflage 369 Background 369 Principles of the method 369 Methods 369 Complications 370 Results 370
20 Surgical methods for the treatment of chronic venous disease 373
21 Surgical methods for the treatment of superficial venous insufficiency 375
Ba~ound 375
Principles and objectives of varicose vein surgery 375 ln theory 375 In practice 375 Simplification of the aims of treatment 376
Principles of surgery and methods 377 Excision surgery 377 Endovenous ablation 382 So-called conservative haemodynamic techniques for saphenous rrunks 384
Anaesthesia and hospitalisation 386 Post-operative care 387 Drug treatment 387 Posr-operative elastic compression 387 Recovery 387 Complications of surgery 388 Peroperative complications 388 Postoperative complications 388 Tests before surgery for SV! 390 Results 390 Information for the patient 394 Sutgery for varicose veins in the legs 394 Varicose veins 394 Symptoms and risks of progression 394 Therapeutic possibilities 394 Surgical procedures 395 Posroperative period 395 Possible complications 396 Declaration 397
22 Surgical methods for the treatment of perforating vein insufficiency (Pel) 399 Background 399 Objective ofsurgery 399 Principles and methods 400 Point surgery on perforating veins 400 Extensive su rgery on perforating veins 400 Fasciotomy 402 Follow-up and postoperative care 402 Complications ofsurgery 402 Results 402
23 Surgical methods for the treatment of lower limb deep vein insufficiency 405 Background 405 Principles and objectives ofsurgery 405 Venous obstruction 405 Reflux 406 Principles and methods ofsurgery 406 Obstruction 406 Reflux 408 Specifie complications 412 Preoperative investigations 412 Results 412 Obstruction 412 Reflux 415
24 Particular cases: surgical methods and results 419 Venous aneurysms 419 fum of surgery 419 Preoperative investigations 419 Surgical methods 420 Results 421
Venous tumours Principle of surgery Surgical merhods Invesrigations Resu!rs SequeIae of venous trauma Aim of surgery Merhods Invesrigations Resuhs Compression of deep veins in the Iower limb Aim of surgery Investigarions Chronie obstruction and compression ofveins in the arms Axillary-subdavian vein Superior vena cava Pe1vie congestion syndromes and pelvie varicose veins Aim of surgery Invesrigarions Classification of rhe surgical merhods Resuhs ofsurgical rrearmem Congenital venous malformations Invesrigarions Merhods Resulrs
25 Treatment of venous ulcers
Introduction Aim of treatment Treatment methods Reducrion of the venous hypertension and of ifS consequences Local rrearmem of ulcers Improvemem in rhe effect?eness of rhe muscle pump Adjuvant rrearmenfS Trearment of ulcer complications Monitoring the eifectiveness of treatment Ulcer measuremem Teleconsu1rarion Praet?I approaeh Making the diagnosis Venous ulcer Refractory ulcer Prevemion of recurrences Results of the treatment of venous uleers Healing Prevemion of recurrence Specifie features of the treatment of Ieg ulcers of other causes Mixed ulcers Necrotising angiodermatitis (Martorell's ulcer) AIterial ulcers Ulcers in atrophie blanche Ulcers associated with connective tissue disease Other ulcers
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26 Therapeutic indications 481 Symptoms 481 Impression of sweJling 482 Prurirus 482 Heavy legs 483 Pain 483 Nighr cramps 483 Resrless legs 483 Sympramarology due ra rhe female hormone cycle 484 Venous LL symprams wirhour visible or palpable signs of venous disorders 484 Venous changes and complications from CVD 484 TeJangiecrasias (C,) 484 Rericular varicose veins (C,) 485 Primary varicose veins (C" Ep) 485 Secondary varicose veins (C" Es) 492 Perforaring veins 492 Posr-rhromboric syndrome 493 Signs due to or associated with CVD 494 Oedema 494 Lipoedema 494 Lymphoedema 494 Pigmenrarion 495 Srasis dermariris and conracr eczema 495 Lipodermarosclerosis 496
Atrophie blanche 496
Leg ulcer and ulcer scar 496 ?r ehronic venous disorders 496 SequeJae ofinjuries 496 Pelvic congesrive syndrome 497 Congeniral venous malformarions 497 Primary deep venous insufficiency -Valvular agenesis 497
v; ACUTE VENOUS DISEASE
27 Definitions SOI Superficial thrombophlebitis (STP) SOI Deep vein thrombosis (DVD SOI Pulmonary embolism (PE) 502 Post thrombotic syndrome (PTS) 502
28 Superficial thrombophlebitis 503 EpidemioIogy 503 Pathophysiology and aetiopathogenesis 504 Clinical presentation 504 Diagnosis 505 Superficial thrombophlebitis ofvaricose veins (varicophlebitis) 506 Superficial thrombophlebitis in a non-varieose vein 506 Specifie presentations 507 Superficial thrombophlebitis and deep vein thrombosis 508
Treaunent of superficial thrombophlebitis 508 Compression 509 Mobilisarion 509 Anri-inflammaroryagenrs 509 Thrombecromy 510 Anricoagularion 511 Plare!er anri-aggreganrs 512 Surgery 512 Prevention of recurrences 513 STP in varicose veins 513 STP in a non-varicose vein 513
29 Deep vein thrombosis 517 Epidemiology, pathophysiology and natural history 517 Epidemiology 517 Parhophysiology and aerioparhogenes? 517 Narural hisrory 519 Clinical sympthoms and signs 519 Main symproms and signs 519 Clinical examinarion 519 ClinicaJ assessmenr scores 520 Differenria! diagnosis 521 Specifie c1inical forms oflower Iimb DVf 522 Phlegmasia alba dolens and coerulea dolens 522 Trousseau's syndrome 522 DYT and pregnaney 522 DYT from a venous spur 522 Traveller's DYT 523 Upper limb DYT 523 Pulmonary embolism 524 Paraclinical diagnostic investigations 524 Ascending phlebography 525 Ulrrasound 526 D-dimer measuremenr 527 Diagnostics strategies 528 Pharmacology of anticoagulants 528 Heparins 528 Viramin K anragonisrs 530 Specifie facror Xa inhibirors 531 Specifie rhrombin inhibirors 531 Prevention ofvenous thromboembolic disease 532 Posr-operarive prevenrion 532 Prevenrion in non-surgica! deparrmenrs 533 Prevenrion of rraveller's DYT 533 Medical treatment of deep vein thrombosis 534 Therapeuric measures 534 Ambularory or hospiral rrearmenr) 537 Trearmenr of DYT in pregnaney and in rhe posr-parrum period 538 Parrial inferior vena cavaI inrerruprion 538 Antagonism of anticoagulant effeet 539
30 Thrombolysis and the surgical treatment of acute venous disorders 543 Venous thrombectomy 543 Fibrinolysis 543 Acute venous trauma 545 Surgical techniques 545 Indicarions 545
VI. CONCLUSIONS
Conclusions 549
Index 551
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