Diagnosing Chronic Venous Insufficiency Khusrow Niazi MD FACC

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Diagnosing Chronic Venous Insufficiency Khusrow Niazi, MD, FACC, FSCAI Director Peripheral Vascular Interventions Emory

Diagnosing Chronic Venous Insufficiency Khusrow Niazi, MD, FACC, FSCAI Director Peripheral Vascular Interventions Emory University Atlanta, Georgia

Disclosures: Khusrow Niazi, MD Research Grants: Trireme Surmodics Medtronic Phillips

Disclosures: Khusrow Niazi, MD Research Grants: Trireme Surmodics Medtronic Phillips

How many of us have our patients take off their shoes/socks?

How many of us have our patients take off their shoes/socks?

Annual Incidence and Prevalence Venous reflux disease is 2 x more prevalent than coronary

Annual Incidence and Prevalence Venous reflux disease is 2 x more prevalent than coronary heart disease (CHD) and 5 x more prevalent than peripheral arterial disease (PAD)1 Venous Reflux Disease Coronary Heart Disease Peripheral Arterial Disease Congestive Heart Failure Stroke Cardiac Arrhythmias Heart Valve Disease -5 5 15 25

Risk factors - Heredity - Age - Female sex - Obesity - Pregnancy -

Risk factors - Heredity - Age - Female sex - Obesity - Pregnancy - Prolonged standing - Greater height

SPECTRUM OF VARICOSE VEINS • Leg Pain or Aching or Heaviness • Leg Cramps

SPECTRUM OF VARICOSE VEINS • Leg Pain or Aching or Heaviness • Leg Cramps or Tingling • Leg Swelling or feeling of swelling • Itching • Restless Legs • Varicose veins • Spider Veins • Blood Clots • Bleeding • Ulcers

Location of Ulcer J Vasc Surg 2007; 45: S 5 -S 67

Location of Ulcer J Vasc Surg 2007; 45: S 5 -S 67

External Iliac v. Common Femoral v. Deep Femoral v. Popliteal v. Gastrocnemius vv. Soleal

External Iliac v. Common Femoral v. Deep Femoral v. Popliteal v. Gastrocnemius vv. Soleal v. Post Tibial vv

Femoral v. Ant accessory great saphenous v. Great saphenous v. Post accessory great saphenous

Femoral v. Ant accessory great saphenous v. Great saphenous v. Post accessory great saphenous v.

Intersaphenous v. Cranial extension of the small saphenous v. Popliteal v. Small saphenous v.

Intersaphenous v. Cranial extension of the small saphenous v. Popliteal v. Small saphenous v. Dorsal venous arch

Reflux via incompetent valves Venous HTN Venous outflow obstruction Failure of calfmuscle pump

Reflux via incompetent valves Venous HTN Venous outflow obstruction Failure of calfmuscle pump

Ultrasound Diagnostic Study � Required in order to determine the source of reflux �

Ultrasound Diagnostic Study � Required in order to determine the source of reflux � Evaluate for venous occlusion or thrombus � Map the course of the incompetent superficial veins

Patient position Erect, semi-erect or reverse Trendelenburg Proximal compression (or Valsalva) to elicit reflux

Patient position Erect, semi-erect or reverse Trendelenburg Proximal compression (or Valsalva) to elicit reflux for thigh veins Calf compression of distal veins Flow reversal duration

On Ultrasound: Grey scale , color and Doppler Compressibility Phasic flow Augmentation Perforators Reflux

On Ultrasound: Grey scale , color and Doppler Compressibility Phasic flow Augmentation Perforators Reflux and its duration Vein diameters

Diagnostic testing for Venous insufficiency CVI Venous Doppler *technique* S. V. reflux >3 secs

Diagnostic testing for Venous insufficiency CVI Venous Doppler *technique* S. V. reflux >3 secs Stasis ulcer Stasis dermatitis S. V. reflux >3 secs Deep vein reflux No reflux Vein diameter Symptoms Compression stockings Ablation

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