Varicose Veins and Related Disorders (eBook)

David J. Tibbs (Autor)

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2013 | 1. Auflage
586 Seiten
Elsevier Science (Verlag)
978-1-4831-9376-2 (ISBN)

Infos

Varicose Veins and Related Disorders focuses on the valvular incompetence in the superficial veins. It evaluates the widespread valve failure in superficial and deep veins. It addresses the congenital venous disorders and the complication of superficial vein incompetence and varicose veins. Some of the topics covered in the book are the differential diagnosis and treatment of edema of the lower limb; acute and subacute deep vein thrombosis in the lower limb; venous and other vascular disorders affecting the upper limb; and role of perforator. The book discusses vascular factors in the management of leg ulcers and the interrelationship of venous disorders with ischemia and other conditions. It also tackles the surgical treatment of superficial vein incompetence; the functional phlebography in venous disorders of the lower limbs; and valveless syndrome and weak vein syndrome. The book can provide useful information to doctors, vascular surgeons, students, and researchers.

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Preface

This book was conceived 15 years ago at a time when varicose vein surgery had changed little over the previous 20 years but during which arterial surgery had been transformed. Great enthusiasm was channelled into exploiting the new arterial techniques and, on the venous side, thromboembolism was studied intensively, but treatment of the commonplace venous disorders in the lower limbs was regarded as a routine matter suitable for delegation to the least experienced member of the surgical team. Discussion centred around perforators or the virtues of sclerotherapy, but little progress was made in understanding more fully the fundamental failures in veins, how to diagnose them and to find the best methods of treatment. Arterial surgeons, repeatedly exposing the long saphenous vein for use as arterial bypass grafts, had soon found that some well-entrenched beliefs about saphenous incompetence were not correct and the thought grew that careful study of the veins would be rewarded with a rich harvest. It was clear that the venous system, especially in its manifestations of abnormality, differed greatly from the arterial system, and the recently acquired knowledge on arteries was of no help with veins. A levelling off in the rate of new attainments in arterial surgery gave impetus to the feeling that it was time to take a fresh and critical look at the venous disorders, and to re-examine the rather confused existing beliefs. At this stage, the directional Doppler velocimeter made a timely appearance with its ability to give an extraordinary insight into patterns of flow in superficial and deep veins in the lower limbs. Soon after this the main restrictions of phlebography, reaction to contrast medium and the severe limits imposed by radiation dosage, were lifted by the introduction of low osmolar contrast media and the advent of the electronic image intensifier. The new understanding that these innovations opened out gave origin to our book. It is a product of the pooled ideas and work of a surgeon (D.J.T.) and a radiologist (E.W.L.F.); its text, apart from two chapters by invited authors, has been written by the surgeon, with the essential contribution by the radiologist expressed in the numerous functional phlebograms and varicograms appearing throughout the book. From first acquaintance with the directional Doppler flowmeter, the surgeon-author, an arterial surgeon since the pioneering mid-1950s, progressively turned towards the search for an accurate understanding of venous disorders in the lower limbs, based on the incontrovertible evidence that flowmetry and functional phlebography could provide. At an early stage a decision was made to publish eventually the findings and conclusions as a book; to this end much relevant material was collected and stored but the pressures of clinical work often caused this to be fragmentary so that meaningful statistical analysis has not been possible.

Meanwhile, other surgeons in Britain had also decided that it was time for venous surgery to have its turn and from this sprang the Venous Forum of the Royal Society of Medicine, a discussion group where surgeons, dermatologists, radiologists, nurses and any other interested groups could exchange views. An early benefit from this was the quarterly journal Phlebology, which has proved of inestimable value in promoting interest and scientific study. Continental Europe, particularly France, was well ahead of the UK in this and already had a thriving organization for venous conferences – Union de Phlebologie – and the journal Phlebologie. Strong international bonds, including USA, Japan and many other nations, have been established, each country sharing conferences with the others. In this way the mood has changed and it is realized that venous problems are full of interest, requiring special skills and individual thought, all matched by an ever expanding range of diagnostic technology. The simple Doppler flowmeter which opened the doors to an era of advancement now has its modern counterpart in imaging by ultrasound with velocity of flow measurable at any designated point and the direction of flow coded in colour. It is not hard to foresee the development of a computerized, three-dimensional display of the entire venous system in the limb of a patient exercising in the upright position, that is, the position in which problems of venous return against gravity become apparent.

The recent surge of interest in veins has not brought any unexpected revelations. Everything in the new understanding has been said before but now conflicting beliefs have given way to secure knowledge in many areas. The outstanding change has been the acquisition of an ability to demonstrate the basic manifestations of venous disorder and from this stems accurate, logical treatment. Opportunities stand waiting; surgery has always made its most rapid advances when pathogenesis by structural failure has been identified so that technical ingenuity can be turned towards finding a method of repair; now that it is known what features the diagnostic machines should be looking for, engineers can be urged to develop a further generation that will far excel the present one; for those who enjoy the search for basic knowledge the areas upon which future studies should concentrate have been defined.

It is hoped that our book illustrates how the special investigations can take diagnosis well beyond the limits of clinical examination alone. Many cases are presented and care has been taken to ensure the accuracy for each patient; all are true life examples. The views expressed are consistent with our experience and reflect the trends shown in numerous studies from all over the world. The present understanding is explained, and the opinions of international authorities are discussed, as the basis for practical guidance to surgeon, physician or nurse. The book is not intended to be read from cover to cover but rather to be dipped into, and each chapter is designed to stand alone without having to cross-refer endlessly. For similar reasons numerous coded abbreviations are avoided since they can cause tedious searches for their meaning. Perhaps it should also be explained that the direction of venous flow is described throughout the book as ‘upwards’ or ‘downwards’ because so often it is the gravitational relationship that matters rather than the anatomical and, moreover, since virtually all meaningful tests are carried out with the patient upright it is the simplest and most revealing way of expressing direction of flow.

All phlebography was carried out by Wattie Fletcher, usually with myself making ‘helpful’ suggestions alongside; in this way attention was directed to the aspects that clinical examination had indicated were most important. This book would not have been possible without Wattie’s tireless efforts and patience to obtain direct visualization on the image intensifier screen and static recordings on film, all annotated immediately afterwards. At the time of writing it looks as though it may not be too long before functional phlebography and varicography become superseded by colour-coded ultrasound imaging. But perhaps our efforts will help by showing the sort of phenomena that should be looked for. Patterns of abnormal venous flow have emerged showing an extraordinary fluidity that resembles electronics, with flow and counterflow in circuits that are within yet other circuits. Functional phlebography still has much to offer and in many respects is superior to the best of ultrasonography, but we are in a transition period where one method can complement the other, until the time eventually comes when ultrasonography is capable of excelling in all respects. Because we both believe in minimizing dosage of even low osmolar contrast medium, many of our X-ray pictures are faint. These are sufficient when the films are seen by transmitted light on the viewing screen, but do not photograph well. The cost and effort to enhance each frame for reproduction as prints would be prohibitive and we can only apologize for weak outlines; however, it is hoped that the many composite pictures, some backed by line diagrams, will compensate for this.

Inevitably, in assembling the book, a great deal of invaluable support has been freely given by many colleagues and my grateful thanks are due to Professor Peter Morris, a splendid leader of the Oxford surgical team, for giving inspiration and support from the very start, Terence Ryan, Tarik Massoud and Basil Shepstone for the sections they have written and also to David Lindsell for his advice on aspects of ultrasound. The line illustrations come from many sources, some prepared many years ago by Fay McLarty and Audrey Arnot, and special thanks are due to Sylvia Barker, whose drawings appear in many chapters, and to Gillian Lee for the excellent series on surgical technique. Many photographs are the author’s own hurried efforts but the better ones are by David Floyd who showed great skill at every step of producing a picture. There are so many other people upon whom I have been dependent, for example Jim Webb, Orthotist, from whom I learnt much, and the Ward, Vein Clinic and Technical Staff, Heather Wood, Vivienne Denton, Phyl Gardner, Peggy Wilson, Pat Franklin and Mary McDougall, Secretaries Cathy Hitchman and Jane Carlo, and many others, who were so supportive and encouraging when something new was to be introduced. It has been a great pleasure and stimulus to learn from one’s colleagues, at venous conferences and by visits, so many new ideas, but then, from student days onwards this has been one of the joys of medicine and a debt that can only be repaid to the next generation by passing on the best...

Produkt-Details

• Erscheint lt. Verlag: 22.10.2013
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie ► Krankheiten / Heilverfahren
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• ISBN-10: 1-4831-9376-4 / 1483193764
• ISBN-13: 978-1-4831-9376-2 / 9781483193762