Escolar Documentos
Profissional Documentos
Cultura Documentos
Disease:
High prevalence but low
awareness to
diagnose and manage CVD
patients
Dr Shahzad Alam
Shah
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2
Chronic Venous Disease:
A highly prevalent disease
5
Superficial veins & deep veins,
saphenous veins
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Saphenous veins
Great saphenous vein (GSV)
Anterior accessory
Saphenous vein of the thigh
(AASV)
Adhesion and infiltration of the leukocytes into the venous valves and walls
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Chronic venous disease symptoms
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Symptom frequency VEIN CONSULT PROGR
in the
Example of the results in France48.9%
40.9%
37.4%
28.3%
13.4%
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14.4% %
When:
Not aggravated by walking except after deep thrombosis in
the case of a postthrombotic syndrome (venous claudication).
Aggravated at night, by heat and prolonged standing, in the
summer, or during menstration.
Calmed by walking, walking on a cold floor, taking a cold
shower, elevating the legs, and playing water sports.
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Signs of chronic venous
disease
Visible by an examiner
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3. Clinical stages
of CEAP
classification
&
Clinical cases
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Stages of CEAP classification
C0s C1 C2 C3 C4 C5-C6
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Signs of the CEAP
Dilatation
C0 C1 C2
C4
C3 C4 C5 C6
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Stage C0
24-year-old female:
Pain
Heaviness
Nighttime leg cramps
C0s (symptomatic)
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Stage C0
C0s
Doppler
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Stage C1
43-year-old female
No symptoms!
Tributary veins:
C1as (asymptomatic) <3 mm
Telangiectasia
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Stage C1: Corona Phlebectatica
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Stage C2
55-year-old mother:
Three daughters
Nighttime leg cramps
"My mother has the C2 Varicose vein >3
same !
mm
C2s
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Stage C2: Hemorrhagic bubbles (1/2)
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Stage C2: Hemorrhagic bubbles (2/2)
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Stage C3: Edema and bucket sign
(1/2)
39-year-old female:
Time of the exam: 11 AM
Ankle sprain when she was
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Exercises infrequently
Cramps are preventing
sleep
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Stage C3: Edema and bucket sign
(2/2)
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Digital pressure method
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When the venous disease
worsens,
the skin suffers C4, C5 and C6
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Stage C4
C4a---Dermatitis-Eczema-
Hypodermatitis
C4bDermatosclerosis
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4a
dermatitis - Eczema -
hypodermatitis
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Stage C4b: Dermatosclerosis
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Edema is not fatal
Pretreatment 1 month
posttretreatment
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Inflammation is not fatal
1 month 3 months 1 year
Pretreatment posttretreatm posttretreatm posttretreatmen
ent ent t
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Stage C4b: White skin atrophy
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Stage C5 and C6: Healed or active
ulcer
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Treatment Options
Life Style Modification
Venoactive Drugs
Compression Therapy
Foam Injection Sclerotherapy
Endovascular Procedures
Endovenous Laser Ablation
Radiofrequency Ablation
Surgery
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Treatment Options
SURGERY
Ligation of Incompetent Saphenopopliteal
and Saphenofemoral Juntions
LSV Stripping
Phelebectomies
Perforator Ligation
ENDOSCOPIC
Subfascial Endoscopic Perforator Surgery
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Treatement with
Venoactive Drugs
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Pathophysiological process of chronic
venous disease: leukocyte activation
Adhesion and infiltration of the leukocytes into the venous valves and walls
Leucocyte VLA-4
DAFLON
L-selectin
Venous wall
endothelium
VCAM-1 E-selectin ICAM-1
Adapted from Shoab SS et al. Endothelial activation response to oral Micronized Flavonoid therapy in patients with 43
chronic venous disease a prospective study. Eur J Vasc Endovasc Surg. 1999;17:313-318.
Accentuation of the inflammatory
process and impact on all the
elements of venous disease
MACROcirculation MICROcirculation
Venous
ulcer (C5,6)
Inflammation
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Adapted from Bergan JJ et al. N Engl J Med. 2006;355:488-498 and from Eberhardt RT et al. Circulation. 2005;111:2398-2409.
Daflon reduces leukocyte infiltration into
the venous valves
Fluorescent leukocytes
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Pascarella L et al. Mechanisms in experimental venous valve failure and their modifications by Daflon 500 mg. Eur J Vasc Endovasc Surg. 2008;3
Daflon preserves the valves structure
1
2
1. Valve diameter
2. Valve height
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Pascarella L et al. Mechanisms in experimental venous valve failure and their modifications by Daflon 500 mg. Eur J Vasc Endovasc Surg. 2008;3
Daflon 500 mg relieves patients
symptoms
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2 Lishov D et al. Patients seeking treatment for chronic venous disorders: Russian results from the Vein Act Program. Phlebolymphology. 2016;
Dose of Venoactive
Drugs (Daflon 500)
in Chronic Venous
2 tab./day
diseasefor 6
months
DAFLON 500
in patients undergoing
Surgery
or
Endovosavcular
procedures
Complicated CVD
DAFLON 500
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Can Daflon 500 improve
outcomes of
lower extremity varicose vein
endovenous treatment?
Results from the DECISION study
Results from the DECISION study
DEFANCE
(Daflon 500 mg assEssment of eFficacy
ANd safety for
Combined phlEbectomy)
Subfascial Endoscopic Perforator
Surgery
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Q&A Session
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