Historical Background Although the role of perforator veins (PVs) in the development of signs and symptoms remains unclear, the number of incompetent PVs and the size of both competent and incompetent PVs have been shown to increase with worsening chronic…
All endovenous technologies can be classified under two general categories: thermal tumescent (TT) or nonthermal nontumescent (NTNT). The TT technologies include radiofrequency, laser, and steam. NTNT technologies encompass: mechanical occlusion chemically assisted (MOCA), cyanoacrylate closure (CAC), and polidocanol injectable microfoam…
Historical Background Endovenous laser ablation (EVLA) therapy arose from a background of managing refluxing truncal veins using open surgical techniques, such as stripping with high ligation. The technology was first introduced in 1999, and following US Food and Drug Administration…
Historical Background Investigators in the 1960s and 1970s observed third-degree skin burns and saphenous nerve injuries after thermal ablation of the saphenous vein. Low-wattage, bipolar current, and specific electrode designs, coupled with algorithms governed by frequent sampling of wall temperature…
Historical Background Treatment of this disorder has evolved from sclerotherapy to open radical surgery and then to the use of sophisticated technology, such as thermal and nonthermal catheter-based ablation. The exact historical point in time when saphenous vein incompetence was…
Historical Background Of the 25 million Americans with venous disease, approximately 7 million exhibit serious symptoms such as edema, skin changes, and venous ulcers. One million seek formal medical advice annually. Diagnostic testing is used to identify, grade, and follow…
Etiology and Natural History of Disease Primary Venous Disease Primary venous disease affects two-thirds of patients with chronic venous disease (CVD). The most accepted theory is based on increased venous hydrostatic pressure transmitted to the vein wall, causing smooth muscle…
Volume-Pressure Curve The volume-pressure (V-P) curve is central to venous hemodynamics. Its effect is manifest in many aspects of venous function. Because veins are thin-walled collapsible tubes, the V-P curve is governed by the Tube law, which is displayed in…
Historical Background Chronic venous diseases include a spectrum of clinical findings ranging from spider telangiectasias and varicose veins to debilitating venous ulceration. Varicose veins without skin changes are present in about 20% of the general population, and they are slightly…
1 Introduction ▴ Patients presenting for elective hernia repair often possess risk factors for wound morbidity and hernia recurrence that the surgeon cannot mend. Defect size, age, multiplicity of recurrences, and the presence of an ostomy or infected prosthetic are…