By Jose Almeida MD PA
Extend your surgical talents with Atlas of Endovascular Venous surgical procedure, by means of Dr. Jose Almeida. This easy-to-access, hugely visible reference bargains the excellent, step by step information you want to in achieving optimum results within the surgical procedure of venous problems. unique, full-color intraoperative illustrations and top quality videos catch key educating moments, permitting you to higher comprehend the nuances of surgical procedure and equipping you to accomplish state of the art techniques and increase your perform. the newest in laser-assisted distal stripping systems, new units for the therapy of venous reflux, and an evidence-based precis of the yankee Venous discussion board directions are between many scorching issues coated. What’s extra, you could entry the absolutely searchable, entire text—along with snapshot and video libraries—online at www.expertconsult.com.
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Additional info for Atlas of Endovascular Venous Surgery
Since more patients will be presenting for therapy because of improved outcomes with endovenous techniques over traditional surgery, physiologic testing will take on increasing importance. For purposes of this chapter, physiologic testing includes the various plethysmography devices and color flow duplex imaging. The goal of these studies is to provide accurate information describing the hemodynamic or anatomic characteristics of the patient with chronic venous insufficiency, precluding the need for invasive studies2 (Fig.
In the erect position, the lower extremity venous pressure increases due to the hydrostatic column of blood extending from the right atrium to the segment of interest. Because veins are compliant, venous blood volume in the segment of interest increases. This volume increase is displayed on a graph from which measurements may be taken. First, the patient is supine, and outflow testing identifies obstruction and the degree of superficial collateralization. Next, the patient is asked to stand, and the filling rate of the veins by n Fig 2–6 Air bladder cuff Supine position C H A P T E R 2 n Noninvasive Testing Air bladder cuff Standing position Toe-up position n Fig 2–7 31 32 n ATLAS OF ENDOVASCULAR VENOUS SURGERY reflux through incompetent valves is measured.
This is known as segmental venous capacitance and represents the blood storage capacity of the segment vein. This is generally quoted in millimeters of deflection or milliliters if the system is calibrated to volume. The second measurement is the slope of the volume-time curve immediately after the pressure in the occluding cuff is released. This is known as maximum venous outflow (MVO) and represents resistance to blood flow in the deep system. This may be quoted in millimeters of deflection per second or milliliters per second if the system is calibrated to volume.