Genesis, Pathophysiology and Management of Venous and Lymphatic Disorders

Genesis, Pathophysiology Management of Venous Diseases is the must-have resource on venous disease. The book bridges the gap between basic science and clinical medicine, covering the history of venous surgery, the lymphatic system and anatomy, pathophysiology of various venous disease, etiology, clinical manifestations and diagnosis, management, and medical and surgical treatment options. It also places attention on genetic studies and pharmacological analysis of various anticoagulants which are widely used in treating venous diseases and deep vein thrombosis and highlights the importance of microscopic venous valves and their pathology in both normal and disease condition.

The breadth of topics covered makes this reference suitable for a range of professionals in phlebolymphology and cardiology, including medical students, practicing clinicians, surgeons, researchers, radiologists, bioengineers, and more.

Cover image
Title page
Table of Contents
Copyright
Dedication
Epigraph
About the author
Foreword
Preface
Acknowledgments
Abbreviations
Chapter 1. The lymphovenous system
Abstract
1.1 Embryological considerations
1.2 Vascular network development in animal models
1.3 Angiogenesis
1.4 Sprouting angiogenesis
Chapter 2. Lymphangiogenesis
Abstract
2.1 Lymph vessel formation and physiology
2.2 Organization and anatomy of the lymphatic system
2.3 General initial lymphatic structure
2.4 Precollector structure
2.5 General collecting lymphatic structure
2.6 Immunological markers of lymphatic endothelium
2.7 Lymphatic networks in different organ systems
2.8 Development of lymphatic vessel networks
2.9 Origination of lymphatic endothelial cell
2.10 Specification and migration of lymphatic endothelial cells
2.11 Maturation of lymphatic vasculature and smooth muscle cell recruitment
2.12 Lymphatic valve formation
2.13 Lymphovenous valves
2.14 Lymphatic development and diseases
2.15 Lymphangiogenesis and relationships with angiogenesis during microvascular network remodeling
2.16 Lymphangiogenesis
2.17 Relationships between lymphangiogenesis and angiogenesis
2.18 Lymphangions and the lymphatic pump mechanism
2.19 Lymphatic smooth muscle
2.20 Filtration at lymph nodes
2.21 Lymphedema
2.22 Obesity, lymphatics, and lymphedema
2.23 Gastrointestinal lymphatics and inflammation
2.24 New directions: microparticles, nanoparticles, and immunotherapy
Chapter 3. Lymphatic system of the lower limb
Abstract
3.1 Importance of the lymphatic system
3.2 Structure of lymphatic vessels
3.3 Importance of the lymphatic system in maintaining fluid balance
3.4 General principles of tissue fluid formation
3.5 Generalized edema
3.6 Precipitating factors for edema
3.7 Lymphedema
Chapter 4. Diseases of the venous system
Abstract
4.1 Venous diseases of the lower limb
4.2 Anatomy
4.3 The superficial venous system
4.4 The deep venous system
4.5 Structure of microcirculation
4.6 Arterioles
4.7 Capillaries
4.8 Venules
4.9 Lymphatic vessels
4.10 Valves in veins
4.11 Comments
Chapter 5. The pathophysiology of varicose veins of the lower limb
Abstract
5.1 Biophysics
5.2 Cellular changes
5.3 Chronic venous disease: from symptoms to microcirculation
5.4 Significance of symptoms and how they influence the choice of investigation
5.5 Different microcirculatory patterns in symptomatic versus asymptomatic patients
5.6 Choosing the right veno-active drug for the right patient
5.7 From the first symptoms to the advanced stages: chronic venous disease progression
5.8 Role of TGF-β1 in vascular wall pathology
5.9 Role of mitogen-activated protein kinase (ERK1/2) in venous reflux in patients with chronic venous disorder
5.10 Human venous valve disease caused by mutations in FOXC2 and GJC2
5.11 FOXC2, GJC2, and GFA1 mutations in human venous valve disease
5.12 Pathophysiological mechanisms of chronic venous disease and implications for veno-active drug therapy
5.13 Pathophysiology of chronic venous disease
5.14 Genetic biases related to chronic venous ulceration
5.15 Gene expression of the epidermal wound bed
5.16 Gene expression of the dermal wound bed
5.17 Gene polymorphism in chronic venous ulcer
5.18 Epidemiology
Chapter 6. Etiology of varicose veins
Abstract
6.1 Genetic associations
6.2 Primary changes in the vein walls/valves
6.3 Normal structure of veins
6.4 Extracellular matrix degradation
6.5 Enzymatic dysregulation
6.6 Activation of endothelium
6.7 Smooth muscle cell proliferation and migration
6.8 Dysregulated SMC apoptosis
Chapter 7. Clinical manifestations
Abstract
7.1 Clinical complications
7.2 Evaluation of patients
7.3 Investigations
Chapter 8. Staging of chronic venous disease
Abstract
8.1 Development of the classification of chronic venous disease for proper evaluation
8.2 The revised CEAP classification: summary
8.3 Pathophysiologic classification
8.4 Comment
8.5 Terminology and new definitions in CVD
Chapter 9. Management
Abstract
9.1 The nature of the disease
9.2 The stage of the disease
9.3 The type of problem
9.4 Management of congenital venous disorders
9.5 Management of primary varicose veins
9.6 Conservative management
9.7 Calcium dobesilate
9.8 Micronized purified flavonoid fraction (Daflon)
9.9 Rutosides
9.10 Sulodexide
9.11 Implications for treatment
9.12 Compression bandages
9.13 Surgical management
Chapter 10. History of the surgical management of varicose veins
Abstract
10.1 Introduction
10.2 Egypt
10.3 Greece
10.4 Rome
10.5 Arabia
10.6 The era of barber surgeons
10.7 The Renaissance
10.8 The era of sclerotherapy
10.9 Back to invasive procedures
10.10 Comments
Chapter 11. Contemporary surgical procedures
Abstract
11.1 Open/operative procedures
11.2 Closed/minimally invasive/endovenous procedures
11.3 Trendenlenburg’s operation
11.4 Procedure in brief
11.5 Tributaries ligated in the procedure
11.6 Risk factors
11.7 Trendelenburg operation
11.8 Complications
11.9 Excision of the short saphenous vein
11.10 Varicose vein stripping with conventional ligation
11.11 Technique of stripping of LSV
11.12 Modified vein-stripping technique
11.13 Common side effects of vein ligation and stripping
11.14 Microphlebectomy
11.15 The basic steps of the microphlebectomy procedure
11.16 The benefits and expected results
11.17 Transilluminated powered phlebectomy
11.18 Risks
11.19 Normal results
11.20 Morbidity and mortality rates
Chapter 12. Endovenous laser treatment
Abstract
12.1 Introduction
12.2 Evolution of endovenous laser technology
12.3 Endovenous laser ablation
Chapter 13. Radiofrequency ablation
Abstract
13.1 Endovenous radiofrequency ablation for the treatment of varicose veins
13.2 Latest medical devices used in radiofrequency ablation
13.3 ClariVein
13.4 Cryostripping
13.5 The evolution of varicose vein treatment: from 19th century ligation to noninvasive therapy (cyanoacrylate glue)
13.6 Subfascial endoscopic perforator surgery in perforator vein insufficiency
Chapter 14. Sclerotherapy
Abstract
14.1 Introduction
14.2 Definition
14.3 Evolution of the methodology of sclerotherapy
14.4 Principles of sclerotherapy
14.5 Sclerosant drugs
14.6 Historical evolution of sclerosing agents
14.7 Hypertonic saline
14.8 Sodium tetradecyl sulfate
14.9 Polidocanol
14.10 Chromated glycerine (Sclermo)
14.11 Planning for surgery
14.12 Preparation of the patient
14.13 Materials for the procedure
14.14 Technique
14.15 Retreatment
14.16 Complications
14.17 Follow-up
14.18 Ultrasound-guided sclerotherapy and endovenous videoscopic sclerotherapy
14.19 Comments
14.20 Other sclerotherapy indications
Chapter 15. Modified microfoam sclerotherapy
Abstract
15.1 Acute complications related to small veins
15.2 Relevance of the size of veins in chronic venous disease
15.3 Nonreturn valves
15.4 The junctional valves and perforators
15.5 Relevance of microscopic veins
15.6 Modified microfoam sclerotherapy—principle
Chapter 16. Deep vein thrombosis
Abstract
16.1 Introduction
16.2 Epidemiology
16.3 Pathogenesis
16.4 Symptoms
16.5 Signs
16.6 Wells clinical score for deep vein thrombosis
16.7 Predisposing factors
16.8 Other provoking risk factors
16.9 Complications
16.10 Investigations
16.11 Differential diagnosis
16.12 Treatment
16.13 Anticoagulation therapy (thrombolysis)
16.14 Venous thromboembolism and management in special populations
16.15 Management of venous thromboembolism in surgical patients
16.16 Diagnosis of pulmonary embolism in pregnancy
16.17 Intrapartum management
16.18 Venous thromboembolism in cancer
16.19 Management of upper extremity deep vein thrombosis
16.20 Thrombolytic therapy for deep vein thrombosis
16.21 Surgery for deep vein thrombosis
16.22 Lifestyle
Chapter 17. Anticoagulation in the prevention and treatment of venous thromboembolism
Abstract
17.1 Introduction
17.2 Problems caused by venous thromboembolism
17.3 Pathophysiology
17.4 Role of blood vessels
17.5 Role of platelets
17.6 Role of the coagulation system
17.7 Alteration of blood flow
17.8 Anticoagulants
17.9 Selection of anticoagulant
17.10 Mechanisms of anticoagulation
17.11 Dabigatran: pharmacological analysis
17.12 Apixaban: pharmacological analysis
17.13 Deep vein thrombosis/pulmonary embolism management with rivaroxaban (Xalerto)
17.14 Precautions
17.15 Laboratory testing to be done prior to starting rivaroxaban
17.16 Rivaroxaban: an oral direct FXa inhibitor
17.17 Rivaroxaban in acute coronary syndrome
17.18 Rivaroxaban for stroke prophylaxis in nonvalvular atrial fibrillation
17.19 Rivaroxaban: and then there were three
17.20 Fondaparinux
17.21 Fondaparinux: advantages
17.22 Abdominal surgery
17.23 Edoxaban
Chapter 18. Chronic venous ulcer
Abstract
18.1 Etiopathogenesis
18.2 Harmful coexisting conditions
18.3 Management
18.4 Care of the ulcer
18.5 Leech therapy
18.6 Collaspread
18.7 Hydrogel (colloidal silver gel)
18.8 Recombinant activated platelet factor (Regranex, Plermin)
18.9 Submucosa wound matrix
18.10 Maggot therapy
18.11 Skin grafting
Chapter 19. The morbid varicose vein
Abstract
19.1 Introduction
19.2 Materials and methods
19.3 Pathogenesis of varicose veins
19.4 The venous valves and venous plethora
19.5 The different types of varicosities
19.6 Pathogenesis
19.7 Pathogenesis of varicose veins
19.8 Pathophysiology at the level of the cellular microcirculation
19.9 Conclusion
Chapter 20. Photographic presentation of venous diseases
Abstract
20.1 Congenital venous malformations
20.2 Primary varicose veins
20.3 Maggots
20.4 Recurrence after surgery
20.5 Elephantoid change
20.6 Bleeding
20.7 Thrombophlebitis
20.8 Cellulitis
20.9 Postcellulitis
20.10 Healing and healed ulceration
20.11 Immediate effects of sclerotherapy
20.12 Late effect of sclerotherapy
20.13 Lipodermatosclerosis
20.14 Atrophie blanche (livedoid vasculopathy)
20.15 Hypertrichiasis
20.16 Varicose veins in the arm
20.17 Morbid vein
References
Index

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N. Radhakrishnan