Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence
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Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. / Lee, Byung B; Nicolaides, Andrew N; Myers, Kenneth; Meissner, Mark; Kalodiki, Evi; Allegra, Claudio; Antignani, Pier L; Bækgaard, Niels; Beach, Kirk; Belcaro, Giovanni; Black, Stephen; Blomgren, Lena; Bouskela, Eliete; Cappelli, Massimo; Caprini, Joseph; Carpentier, Patrick; Cavezzi, Attilio; Chastanet, Sylvain; Christenson, Jan T; Christopoulos, Demetris; Clarke, Heather; Davies, Alun; Demaeseneer, Marianne; Eklöf, Bo; Ermini, Stefano; Fernández, Fidel; Franceschi, Claude; Gasparis, Antonios; Geroulakos, George; Gianesini, Sergio; Giannoukas, Athanasios; Gloviczki, Peter; Huang, Ying; Ibegbuna, Veronica; Kakkos, Stavros K; Kistner, Robert; Kölbel, Tilo; Kurstjens, Ralph L; Labropoulos, Nicos; Laredo, James; Lattimer, Christopher R; Lugli, Marzia; Lurie, Fedor; Maleti, Oscar; Markovic, Jovan; Mendoza, Erika; Monedero, Javier L; Moneta, Gregory; Moore, Hayley; Morrison, Nick; Mosti, Giovanni; Nelzén, Olle; Obermayer, Alfred; Ogawa, Tomohiro; Parsi, Kurosh; Partsch, Hugo; Passariello, Fausto; Perrin, Michel L; Pittaluga, Paul; Raju, Seshadri; Ricci, Stefano; Rosales, Antonio; Scuderi, Angelo; Slagsvold, Carl E; Thurin, Anders; Urbanek, Tomasz; M VAN Rij, Andre; Vasquez, Michael; Wittens, Cees H; Zamboni, Paolo; Zimmet, Steven; Ezpeleta, Santiago Z.
In: INT ANGIOL, Vol. 35, No. 3, 06.2016, p. 236-352.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence
AU - Lee, Byung B
AU - Nicolaides, Andrew N
AU - Myers, Kenneth
AU - Meissner, Mark
AU - Kalodiki, Evi
AU - Allegra, Claudio
AU - Antignani, Pier L
AU - Bækgaard, Niels
AU - Beach, Kirk
AU - Belcaro, Giovanni
AU - Black, Stephen
AU - Blomgren, Lena
AU - Bouskela, Eliete
AU - Cappelli, Massimo
AU - Caprini, Joseph
AU - Carpentier, Patrick
AU - Cavezzi, Attilio
AU - Chastanet, Sylvain
AU - Christenson, Jan T
AU - Christopoulos, Demetris
AU - Clarke, Heather
AU - Davies, Alun
AU - Demaeseneer, Marianne
AU - Eklöf, Bo
AU - Ermini, Stefano
AU - Fernández, Fidel
AU - Franceschi, Claude
AU - Gasparis, Antonios
AU - Geroulakos, George
AU - Gianesini, Sergio
AU - Giannoukas, Athanasios
AU - Gloviczki, Peter
AU - Huang, Ying
AU - Ibegbuna, Veronica
AU - Kakkos, Stavros K
AU - Kistner, Robert
AU - Kölbel, Tilo
AU - Kurstjens, Ralph L
AU - Labropoulos, Nicos
AU - Laredo, James
AU - Lattimer, Christopher R
AU - Lugli, Marzia
AU - Lurie, Fedor
AU - Maleti, Oscar
AU - Markovic, Jovan
AU - Mendoza, Erika
AU - Monedero, Javier L
AU - Moneta, Gregory
AU - Moore, Hayley
AU - Morrison, Nick
AU - Mosti, Giovanni
AU - Nelzén, Olle
AU - Obermayer, Alfred
AU - Ogawa, Tomohiro
AU - Parsi, Kurosh
AU - Partsch, Hugo
AU - Passariello, Fausto
AU - Perrin, Michel L
AU - Pittaluga, Paul
AU - Raju, Seshadri
AU - Ricci, Stefano
AU - Rosales, Antonio
AU - Scuderi, Angelo
AU - Slagsvold, Carl E
AU - Thurin, Anders
AU - Urbanek, Tomasz
AU - M VAN Rij, Andre
AU - Vasquez, Michael
AU - Wittens, Cees H
AU - Zamboni, Paolo
AU - Zimmet, Steven
AU - Ezpeleta, Santiago Z
PY - 2016/6
Y1 - 2016/6
N2 - 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 treatmen 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.
AB - 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 treatmen 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.
KW - Hemodynamics/physiology
KW - Humans
KW - Lower Extremity/blood supply
KW - Regional Blood Flow/physiology
KW - Veins/diagnostic imaging
KW - Venous Insufficiency/diagnosis
M3 - SCORING: Journal article
C2 - 27013029
VL - 35
SP - 236
EP - 352
JO - INT ANGIOL
JF - INT ANGIOL
SN - 0392-9590
IS - 3
ER -