Surgery of Venous System Diseases
Özet
The chapter "Surgery of Venous System Diseases" by Kadir Kaan Özsin provides an in-depth examination of chronic venous insufficiency (CVI) and deep vein thrombosis (DVT) of the lower extremities. The lower extremity venous system—comprising deep, superficial, and perforating veins—relies on bicuspid valves and the musculovenous pump to return blood against gravity. CVI arises from ambulatory venous hypertension caused by valvular incompetence, venous obstruction, or both, leading to symptoms like varicose veins, edema, and venous ulcers. Diagnosed primarily via clinical examination and color Doppler ultrasonography, CVI is classified using the updated CEAP system. Management options span from compression stockings to open surgery, such as saphenous vein stripping and high ligation, as well as modern endovenous thermal (laser, radiofrequency, steam) and non-thermal (ultrasound-guided foam, mechanochemical, cyanoacrylate) ablation techniques. Conversely, DVT, part of venous thromboembolism along with pulmonary embolism, is driven by Virchow's triad of endothelial injury, venous stasis, and hypercoagulability. While standard DVT treatment involves anticoagulants, extensive proximal cases with low bleeding risks benefit from early thrombus removal using catheter-directed thrombolysis (CDT) or pharmacomechanical thrombolysis (PMT) to prevent debilitating post-thrombotic syndrome.
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