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Venous hemodynamic changes in lower limb venous disease : The UIP consensus according to scientific evidence

Lee, Byung Boong; Nicolaides, Andrew N.; Myers, Kenneth; Meissner, Mark; Kalodiki, Evi; Allegra, Claudio; Antignani, Pier Luigi; Bækgaard, Niels; Beach, Kirk and Belcaro, Giovanni, et al. (2016) In International Angiology 35(3). p.236-352
Abstract

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear... (More)

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials, intermittent compression devices, pharmacological agents and finally surgical or endovenous ablation. Chapter 8 discusses the unique hemodynamic features associated with alternative treatment techniques used by the CHIVA and ASVAL. Chapter 9 describes the hemodynamic effects following treatment to relieve pelvic reflux and obstruction. Finally, Chapter 10 demonstrates that contrary to general belief there is a moderate to good correlation between certain hemodynamic measurements and clinical severity of chronic venous disease. The authors believe that this document will be a timely asset to both clinicians and researchers alike. It is directed towards surgeons and physicians who are anxious to incorporate the conclusions of research into their daily practice. It is also directed to postgraduate trainees, vascular technologists and bioengineers, particularly to help them understand the hemodynamic background to pathophysiology, investigations and treatment of patients with venous disorders. Hopefully it will be a platform for those who would like to embark on new research in the field of venous disease..

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keywords
Association between venous clinical severity and hemodynamic abnormalities, Venous disease, Venous hemodynamic changes after treatment, Venous hemodynamics, Venous macrocirculation, Venous microcirculation
in
International Angiology
volume
35
issue
3
pages
117 pages
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Minerva Medica
external identifiers
  • Scopus:84971532167
ISSN
0392-9590
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English
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yes
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e391a15e-7f82-49fe-b3e0-662f88070b08
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2016-06-14 14:32:10
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2016-11-27 04:40:57
@misc{e391a15e-7f82-49fe-b3e0-662f88070b08,
  abstract     = {<p>There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation. They have greatly improved our understanding of the anatomical patterns of venous reflux and obstruction. However, they do not provide the physiological basis for understanding the hemodynamics of flow, pressure, compliance and resistance. Hemodynamic investigations appear to provide a better correlation with post-treatment clinical outcome and quality of life than ultrasound findings. There is a far better prospect for understanding the complete picture of the patient's disability and response to management by combining ultrasound with hemodynamic studies. Accordingly, at the instigation of Dr Angelo Scuderi, the Union Internationale de Phlebologie (UIP) executive board commissioned a large number of experts to assess all aspects of management for venous disease by evidence-based principles. These included experts from various member societies including the European Venous Forum (EVF), American Venous Forum (AVF), American College of Phlebology (ACP) and Cardiovascular Disease Educational and Research Trust (CDERT). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials, intermittent compression devices, pharmacological agents and finally surgical or endovenous ablation. Chapter 8 discusses the unique hemodynamic features associated with alternative treatment techniques used by the CHIVA and ASVAL. Chapter 9 describes the hemodynamic effects following treatment to relieve pelvic reflux and obstruction. Finally, Chapter 10 demonstrates that contrary to general belief there is a moderate to good correlation between certain hemodynamic measurements and clinical severity of chronic venous disease. The authors believe that this document will be a timely asset to both clinicians and researchers alike. It is directed towards surgeons and physicians who are anxious to incorporate the conclusions of research into their daily practice. It is also directed to postgraduate trainees, vascular technologists and bioengineers, particularly to help them understand the hemodynamic background to pathophysiology, investigations and treatment of patients with venous disorders. Hopefully it will be a platform for those who would like to embark on new research in the field of venous disease..</p>},
  author       = {Lee, Byung Boong and Nicolaides, Andrew N. and Myers, Kenneth and Meissner, Mark and Kalodiki, Evi and Allegra, Claudio and Antignani, Pier Luigi and Bækgaard, Niels and Beach, Kirk and Belcaro, Giovanni and Black, Stephen and Blomgren, Lena and Bouskela, Eliete and Cappelli, Massimo and Caprini, Joseph and Carpentier, Patrick and Cavezzi, Attilio and Chastanet, Sylvain and Christenson, Jan T. and Christopoulos, Demetris and Clarke, Heather and Davies, Alun and De Maeseneer, Marianne and Eklof, Bo and Ermini, Stefano and Fernández, Fidel and Franceschi, Claude and Gasparis, Antonios and Geroulakos, George and Gianesini, Sergio and Giannoukas, Athanasios and Gloviczki, Peter and Huang, Ying and Ibegbuna, Veronica and Kakkos, Stavros K. and Kistner, Robert and Kölbel, Tilo and Kurstjens, Ralph L M and Labropoulos, Nicos and Laredo, James and Imer, Christopher R Latt and Lugli, Marzia and Lurie, Fedor and Maleti, Oscar and Markovic, Jovan and Mendoza, Erika and Monedero, Javier L. and Moneta, Gregory and Moore, Hayley and Morrison, Nick and Mosti, Giovanni and Nelzén, Olle and Obermayer, Alfred and Ogawa, Tomohiro and Parsi, Kurosh and Sch, Hugo Part and Passariello, Fausto and Perrin, Michel R. and Pittaluga, Paul and Raju, Seshadri and Ricci, Stefano and Rosales, Antonio and Scuderi, Angelo and Slagsvold, Carl Erik and Thurin, Anders and Urbanek, Tomasz and Rij, Andre Van and Vasquez, Michael and Wittens, Cees H A and Zamboni, Paolo and Zimmet, Steven and Ezpeleta, Santiago Zubicoa},
  issn         = {0392-9590},
  keyword      = {Association between venous clinical severity and hemodynamic abnormalities,Venous disease,Venous hemodynamic changes after treatment,Venous hemodynamics,Venous macrocirculation,Venous microcirculation},
  language     = {eng},
  month        = {06},
  number       = {3},
  pages        = {236--352},
  publisher    = {ARRAY(0x8811bc0)},
  series       = {International Angiology},
  title        = {Venous hemodynamic changes in lower limb venous disease : The UIP consensus according to scientific evidence},
  volume       = {35},
  year         = {2016},
}