Rutherford's 158: Chronic Venous Insufficiency: Treatment of Perforator Vein Incompetence скачать в хорошем качестве

Rutherford's 158: Chronic Venous Insufficiency: Treatment of Perforator Vein Incompetence

#PerforatingVeins #IPV #CVI #VaricoseVeins #LegUlcers #RutherfordVascularSurgery #VeinTreatment #PAPS #EndovenousAblation #Sclerotherapy This video, drawing on Rutherford's Vascular Surgery, delves into perforating veins (PVs) – critical links connecting superficial and deep leg veins. Their primary function is one-way blood flow from surface to deep, maintained by valves and calf muscle pump action. Incompetent perforating veins (IPVs) occur when these valves fail, disrupting flow. IPVs are common in chronic venous disease (CVD), affecting 40-60% of legs with primary CVD and more frequent after deep vein thrombosis (DVT). They rarely occur in isolation, usually alongside superficial or deep vein issues. Strong superficial reflux, especially in the great saphenous vein, can contribute to IPVs. Historical understanding of IPVs evolved from anatomical description to recognition of their role in venous ulcers. Treatment progressed from extensive open surgery (Linton procedure) to less invasive subfascial endoscopic perforator surgery (SEPS), and most recently, to percutaneous ultrasound-guided ablation techniques (PAPS). Diagnosis relies heavily on Duplex ultrasound, assessing vein size (over 2-4mm potentially problematic) and reflux duration (over 0.3-0.5 seconds typically signifies incompetence). Current guidelines favour minimally invasive PAPS (thermal ablation or sclerotherapy) over open surgery or SEPS when treating problematic IPVs. Treatment is considered for healing/preventing ulcers near skin changes, but not for isolated varicose veins without advanced disease. Evidence for treating IPVs alone to heal ulcers is inconclusive from large trials. Treating main superficial reflux can sometimes improve IPV function. PAPS procedures involve ultrasound-guided access, tumescent anesthesia (for thermal), and confirmation of closure. While generally safe, complications can occur. Post-procedure ultrasound checks are vital. Treatment decisions are highly individualised based on anatomy, symptoms, and guidelines.