By Jose Almeida MD PA

Extend your surgical abilities with Atlas of Endovascular Venous surgical procedure, via Dr. Jose Almeida. This easy-to-access, hugely visible reference deals the excellent, step by step assistance you want to in achieving optimum results within the surgical procedure of venous issues. distinct, full-color intraoperative illustrations and high quality videos trap key educating moments, permitting you to raised comprehend the nuances of surgical procedure and equipping you to accomplish state of the art tactics and increase your perform. the most recent in laser-assisted distal stripping techniques, new units for the therapy of venous reflux, and an evidence-based precis of the yankee Venous discussion board instructions are between many sizzling subject matters lined. What’s extra, you could entry the totally searchable, entire text—along with picture and video libraries—online at

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C H A P T E R 2 Noninvasive Testing Jose I. Almeida HISTORICAL BACKGROUND Of the 25 million Americans with venous disease, approximately 7 million exhibit serious symptoms such as edema, skin changes, and venous ulcers. One million seek formal medical advice annually. Of these, 80% of venous patients are managed conservatively with observation, leg elevation, and support stockings, while the remainder are treated surgically with vein stripping or endovenous ablation. With the development of safe, less traumatic, and effective endovenous techniques for venous insufficiency, most venous surgeons acknowledge that more patients will seek treatment, and physicians will be more inclined to move from conservative therapy to surgical therapy.

Ascher E, Jacob T, Hingorani A, et al. Expression of molecular mediators of apoptosis and their role in the pathogenesis of lower-extremity varicose veins. J Vasc Surg 2001;33: 1080-1086. 12. Bouissou H, Julian M, Pieraggi MT, et al. Vein morphology. Phlebology 1988;3(suppl 1):1-11. 13. Jones GT, Solomon C, Moaveni A, et al. Venous morphology predicts class of chronic venous insufficiency. Eur J Vasc Endovasc Surg 1999;18:349-354. 14. Lowell RC, Gloviczki P, Miller VM. In vitro evaluation of endothelial and smooth muscle function of primary varicose veins.

VFI does not rely on the calf muscle pump for complete vein emptying. Ejection fraction (EF) represents the efficiency of the calf muscle pump and is analogous to left ventricular ejection fraction used in cardiology. Residual volume fraction (RVF) is proportional to the invasively measured ambulatory venous pressure, which is a global measurement related to severity of disease. It is important to recognize that VFI measures thigh-to-calf reflux only. Perforator reflux has no effect on VFI, nor does reflux isolated to either the calf or the thigh.

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