Causes of Leg Swelling. How good is CT for DVT? Direct CT Venography. Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography

Size: px
Start display at page:

Download "Causes of Leg Swelling. How good is CT for DVT? Direct CT Venography. Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography"

Transcription

1 Lower Extremity Venous Thrombosis and Leg Swelling: The Role of CT Venography Bart Dolmatch, MD Professor of Radiology UTSW Medical Center Dallas, TX Causes of Leg Swelling Venous thrombosis Venous stenosis Other causes Venous reflux Hypoproteinemia CHF Lymphedema Arteriovenous Fistulae Femoropopliteal Venous Thrombosis How good is CT for DVT? % sensitive % specific 1 92% Positive Predictive 2 100% Negative Predictive 2 Comparable to duplex ultrasound 1 Various refs. See Kanne JP and Lalani TA. Circulation. 2004;109[suppl 1]:I-15-I-21 2 Begemann PGC et a;. JCAT (3): CT venography for DVT Sensitive and accurate Often part of another exam Not viable except in rare situations Radiation exposure Cost Direct CT Venography Pedal IV 50-60mgI/ml (1/4 th -1/5 th dilution 300mgI/ml 3ml/sec with ankle tourniquet 3ml/sec with ankle tourniquet Delay seconds Scan foot to pelvis Collimation mm with 20-25% overlap CT Symposium 1

2 Tourniquet IV Deep Vei ns Superficial Veins Direct CT Venography Deep Femoral Vein Tributaries/Collaterals Chronically occluded Right Superficial Femoral Vein --Saphenous Vein Superficial calf vein tributaries/collaterals Applications for CT Venography Understanding Venous Disease all starts with Virchow Iliac Venous Stenosis and Thrombosis 1. May-Thurner Syndrome 2. Cockett s Syndrome Virchow observed that iliofemoral DVT 5x more likely in left leg than right McMurrich 1957: May and Thurner May R, Thurner J "The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins". Angiology (1957); 8 (5): McMurrich first described left iliac vein compression CT Symposium 2

3 May and Thurner 430 autopsies 22% of had fibrous bands ( spurs ) in the lumen of the left illiac vein. The spurs occurred at the site where the right iliac artery crosses over the left iliac vein. Hypothesized to be due to chronic compression of L iliac vein between R common iliac artery and 5 th lumbar vertebrae. May-Thurner Syndrome Women (70%), young to middle age Acute: Often due to iliofemoral DVT Chronic: Venous insufficiency and venous hypertension Lower extremity pain, venous claudication Swelling Varicose veins Venous stasis skin changes Iliofemoral DVT: Cockett s Syndrome 1967 Cockett reported first clinical series of 57 pts with acute iliofemoral DVT secondary to iliac vein compression. M-T Synd + Acute DVT = Cockett s Synd. Diagnosis of M-T and Cockett s S Ultrasound T h i ll diffi lt t i li ili i (d Technically difficult to visualize iliac veins (deep in the pelvis behind fat, bladder and bowel) 2-5% of all lower extremity DVT CT Symposium 3

4 CT Diagnosis of M-T and Cockett s S 45 of 56 patients had a detectable abnormality that was at least partly responsible for acute DVT 1 27 of 44 patients with acute iliofemoral DVT had findings of May-Thurner detectable on CT 1 1 Chung JW et al. J Vasc Interv Rad. 2004;15: C CIA (white arrow) L CIV (black arrow) VRT shows vascular anatomy. Extrinsic impression of R CIA on L CIV Don t a lot of normal people have findings of May-Thurner? Yes, often incidental and asymptomatic But in acute iliofemoral vein thrombosis It is extremely common It is permissive at least partly attributable Treatment with thrombolytics and stents relieves or improves symptoms in 75% 1 of symptomatic patients suggesting an important role in pts w/ Sx s transpelvic collateral veins 1 Raju S et al. J Vasc Surg 2006;44: Treatment of May-Thurner Open surgical bypass Repair requires major surgery with laparotomy or retroperitoneal iliac exposure Endovascular treatments Angioplasty Stenting Angioplasty or Stenting? 15 of 16 pts (follow-up 10 mos) for stenting. 3 of 3 patients with only angioplasty rethrombosed. (Kim JY, 2006) 100% stent patency after 3 years in 8 patients (Binkert et al.) 13 of 15 (87%) stent patency (follow-up 16 mo) Lamont et al. Venous stenting: The current standard of care CT Symposium 4

5 Indirect CT: Just OK! Direct CT Venography: Superior Other uses for Direct CTV: Consider when duplex isn t diagnostic and a venogram is requested Clot from SVT entering Popliteal Vein 29 yo woman Left calf pain and swelling Protein S deficiency CT Symposium 5

6 Etiology of left calf swelling? May-Thurner permissive lesion Superficial Venous Thrombosis Protein S deficiency 69yo man with Bilateral Leg Swelling and Pain Left Leg Treatment was Warfarin Right Leg Primary Adenocarcinoma of the Lung Trousseau s Syndrome Superficial thrombophlebitis Visceral Malignancy (Lung) Conclusion Indirect CT Venography Excellent for DVT diagnosis Not practical due to radiation exposure, cost Iliac venous stenosis (w/wo thrombosis) May-Thurner Syndrome Crockett s Syndrome Direct CTV is useful for eval. and follow-up When conventional Venography is needed consider direct CT Venography CT Symposium 6

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart

Surgical Options for Venous Disease. Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Surgical Options for Venous Disease Sandra C Carr MD Vascular Surgery Meriter Wisconsin Heart Chronic Venous Disease Approximately 23% of adults in the US have varicose veins Estimated 22 million women

More information

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community MINIMUM TRAINING REQUIREMENTS FOR THE PRACTICE OF MEDICAL ULTRASOUND IN EUROPE Appendix 8: Vascular Ultrasound Level 1 Training and Practice Practical training should involve at least two half day ultrasound

More information

Subtitle of other. information. Management of Chronic DVT. Presenter name Title. Date. Sid Bhende, MD. Sentara Vascular Specialists April 26 th 2014

Subtitle of other. information. Management of Chronic DVT. Presenter name Title. Date. Sid Bhende, MD. Sentara Vascular Specialists April 26 th 2014 Sid Bhende, MD Sentara Vascular Specialists April 26 th 2014 Management of Chronic DVT Outline Chronic DVT Definition Diagnosis Complication of Chronic DVT Post Thrombotic Syndrome (PTS) Management of

More information

SCREENING COMPRESSION ULTRASOUND FOR LOWER EXTREMITY DVT

SCREENING COMPRESSION ULTRASOUND FOR LOWER EXTREMITY DVT SCREENING COMPRESSION ULTRASOUND FOR LOWER EXTREMITY DVT R. Eugene Zierler, M.D. The D. E. Strandness, Jr. Vascular Laboratory University of Washington Medical Center Division of Vascular Surgery University

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 17 SURGICAL THERAPY FOR DEEP VALVE INCOMPETENCE Original author: Seshadri Raju Abstracted by Gary W. Lemmon Introduction Deep vein valvular incompetence happens when the valves in the veins (tubes

More information

Not Cardio - Vascular Coding. Caren J Swartz, CPC-I, CPC-H, CPMA

Not Cardio - Vascular Coding. Caren J Swartz, CPC-I, CPC-H, CPMA Not Cardio - Vascular Coding Caren J Swartz, CPC-I, CPC-H, CPMA caren@practiceintegrity.com Objectives Understand Anatomy for Vascular Coding Review the Rules for Vascular Procedures Review ICD-10 future

More information

LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND:

LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND: LOWER EXTREMITY VENOUS DUPLEX ULTRASOUND: Chronic Venous Insufficiency Phillip J Bendick, PhD William Beaumont Hospital Royal Oak, Michigan Prevalence: Carotid ASO ~ 3M Peripheral Arterial Dz ~ 5M + CAD

More information

Basic Emergency Vascular Ultrasound

Basic Emergency Vascular Ultrasound Basic Emergency Vascular Ultrasound Joel M. Schofer, MD, RDMS, FAAEM Lieutenant Commander, Medical Corps, United States Navy Emergency US Director, Emergency Department, Naval Medical Center Portsmouth

More information

DEEP VEIN THROMBOSIS. James St.George, M.D., RPVI, RVT, RPhS

DEEP VEIN THROMBOSIS. James St.George, M.D., RPVI, RVT, RPhS DEEP VEIN THROMBOSIS James St.George, M.D., RPVI, RVT, RPhS Originally Published In Florida Times Union March 2014 James St.George, M.D., RPVI, RVT, RPhS Dr. St. George is the Medical Director of St Johns

More information

CMS Limitations Guide - Radiology Services

CMS Limitations Guide - Radiology Services CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities

Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities Surgical And Ablative Procedures For Venous Insufficiency And Varicose Veins Of The Lower Extremities Description A variety of treatment modalities are available to treat varicose veins/venous insufficiency,

More information

Vascular Technology (VT) Content Outline Anatomy & physiology 20% Cerebrovascular Cerebrovascular normal anatomy Evaluate the cerebrovascular vessels

Vascular Technology (VT) Content Outline Anatomy & physiology 20% Cerebrovascular Cerebrovascular normal anatomy Evaluate the cerebrovascular vessels Vascular Technology (VT) Content Outline Anatomy & physiology 20% normal anatomy Evaluate the cerebrovascular vessels hemodynamics Evaluate the cerebrovascular vessels for normal perfusion normal anatomy

More information

Col league. SMMC Vascular Center Opens A PUBLICATION FOR SOUTHERN MAINE PHYSICIANS

Col league. SMMC Vascular Center Opens A PUBLICATION FOR SOUTHERN MAINE PHYSICIANS A PUBLICATION FOR SOUTHERN MAINE PHYSICIANS Col league 8 2012 SMMC Vascular Center Opens By Frank Lavoie, MD, Executive Vice President and Chief Operating Officer During the last year, Southern Maine Medical

More information

Venous Reflux Disease and Current Treatments VN20-87-A 01/06

Venous Reflux Disease and Current Treatments VN20-87-A 01/06 Venous Reflux Disease and Current Treatments Leg Vein Anatomy Your legs are made up of a network of veins and vessels that carry blood back to the heart The venous system is comprised of: Deep veins Veins

More information

Venous Stenting: Expectations and Reservations A panel of experts discusses patient selection, follow-up, and ideal technologies for the future.

Venous Stenting: Expectations and Reservations A panel of experts discusses patient selection, follow-up, and ideal technologies for the future. Venous Stenting: Expectations and Reservations A panel of experts discusses patient selection, follow-up, and ideal technologies for the future. Participants Seshadri Raju, MD, FACS The RANE Center for

More information

Ultrasound in Vascular Surgery. Torbjørn Dahl

Ultrasound in Vascular Surgery. Torbjørn Dahl Ultrasound in Vascular Surgery Torbjørn Dahl 1 The field of vascular surgery Veins dilatation and obstruction (varicose veins and valve dysfunction) Arteries dilatation and narrowing (aneurysms and atherosclerosis)

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 19 VASCULAR MALFORMATIONS Original authors: David H. Deaton, Byung Boong Lee, James Loredo, Richard F. Neville, William H. Pearce, and Heron E. Rodriguez Abstracted by Raghu Motaganahalli Introduction

More information

Invited papers. CEAP classification and implications for investigations. B. Eklöf Helsingborg, Sweden.

Invited papers. CEAP classification and implications for investigations. B. Eklöf Helsingborg, Sweden. Invited papers Acta chir belg, 2006, 106, 654-658 CEAP classification and implications for investigations B. Eklöf Helsingborg, Sweden. Key words. Chronic venous disorders ; venous disease ; reporting

More information

Confirmed Deep Vein Thrombosis (DVT)

Confirmed Deep Vein Thrombosis (DVT) Confirmed Deep Vein Thrombosis (DVT) Information for patients What is deep vein thrombosis? Blood clotting provides us with essential protection against severe loss of blood from an injury to a vein or

More information

Venous and Lymphatic Disorders

Venous and Lymphatic Disorders Venous and Lymphatic Disorders. ก. Venous and Lymphatic Disorders Varicose Veins Deep Vein Thrombosis (DVT) Lymphedema What Is Varicose Veins? Latin: Varicose = Varix = twisted Abnormal venous dilatation

More information

Information for you Treatment of venous thrombosis in pregnancy and after birth. What are the symptoms of a DVT during pregnancy?

Information for you Treatment of venous thrombosis in pregnancy and after birth. What are the symptoms of a DVT during pregnancy? Information for you Treatment of venous thrombosis in pregnancy and after birth Published in September 2011 What is venous thrombosis? Thrombosis is a blood clot in a blood vessel (a vein or an artery).

More information

CARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN

CARDIA 288 MONTH FOLLOW-UP SUPPLEMENTAL FORM (FORM B) HOSPITALIZATION CASE #: INTERVIEWER ID FY288BIVID2. Page 1 of 6 FY288BH4CN HOSPITALIZATION CASE #: 2 8 8 0 H FY288BH4CN Has the participant indicated any of the following reasons for being admitted overnight for this case? 1. Suspected or confirmed problems with the heart, circulation,

More information

Guidance. This guidance has been updated to take into account the NICE clinical guideline 167(1).

Guidance. This guidance has been updated to take into account the NICE clinical guideline 167(1). Bedfordshire and Hertfordshire Priorities Forum Statement Number: 9 Subject: Varicose Vein Surgery Date of decision: September 2014 Date of review: September 2017 Guidance This guidance has been updated

More information

Process Representation #1 : The PAD algorithm as a sequential flow thru all sections

Process Representation #1 : The PAD algorithm as a sequential flow thru all sections Process Representation #1 : The PAD algorithm as a sequential flow thru all sections An exploded version of the above scoped section flow is shown below. Notes: The flow presupposes existing services (

More information

Provided by the American Venous Forum: veinforum.org

Provided by the American Venous Forum: veinforum.org CHAPTER 1 NORMAL VENOUS CIRCULATION Original author: Frank Padberg Abstracted by Teresa L.Carman Introduction The circulatory system is responsible for circulating (moving) blood throughout the body. The

More information

X-Plain Varicose Veins Reference Summary

X-Plain Varicose Veins Reference Summary X-Plain Varicose Veins Reference Summary Introduction Varicose veins are very common, in both women and men. Varicose veins can be painful and unattractive. Vein doctors use non-invasive ultrasound imaging

More information

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral

Peninsula Commissioning Priorities Group. Commissioning Policy Varicose Vein Referral NHS Devon NHS Plymouth Torbay Care Trust Peninsula Commissioning Priorities Group Commissioning Policy Varicose Vein Referral Varicose Vein Referral Guidelines 1. Description of service/treatment Most

More information

Patient Information Understanding Varicose Veins

Patient Information Understanding Varicose Veins Patient Information Understanding Varicose Veins The Circulatory System Arteries carry oxygenated blood to your legs and the veins carry de-oxygenated blood away from your legs. The blood returns to the

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

Anatomy and Terminology Joseph A. Zygmunt., Jr. RVT, RPhS

Anatomy and Terminology Joseph A. Zygmunt., Jr. RVT, RPhS Anatomy and Terminology Joseph A. Zygmunt., Jr. RVT, RPhS Disclosure Covidien Vascular Therapies Cardiovascular Credentialing International Mis-diagnosed 2 nd Opinion?? Page 1 Venous Insufficiency, Reflux

More information

Femoral artery bypass graft (Including femoral crossover graft)

Femoral artery bypass graft (Including femoral crossover graft) Femoral artery bypass graft (Including femoral crossover graft) Why do I need the operation? You have a blockage or narrowing of the arteries supplying blood to your leg. This reduces the blood flow to

More information

WHY DO MY LEGS HURT? Veins, arteries, and other stuff.

WHY DO MY LEGS HURT? Veins, arteries, and other stuff. WHY DO MY LEGS HURT? Veins, arteries, and other stuff. Karl A. Illig, MD Professor of Surgery Chief, Division of Vascular Surgery Mitzi Ekers, ARNP April 2013 Why do my legs hurt? CONFLICTS OF INTEREST

More information

Majestic Trial 12 Month Results

Majestic Trial 12 Month Results Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.

More information

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease. Erich Minar Medical University Vienna

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease. Erich Minar Medical University Vienna ESC Guidelines on the diagnosis and treatment of peripheral artery diseases Lower extremity artery disease Erich Minar Medical University Vienna for the Task Force on the Diagnosis and Treatment of Peripheral

More information

Varicose Vein Surgery: What we will cover

Varicose Vein Surgery: What we will cover Varicose Vein Surgery 2010 For Coders Andy Bonin, MD Varicose Vein Surgery: What we will cover Anatomy review Duplex US Procedure review CPT coding review 1 Anatomy: The Circulatory System We are only

More information

Medical Coverage Policy Treatment for Varicose Veins-PREAUTH

Medical Coverage Policy Treatment for Varicose Veins-PREAUTH Medical Coverage Policy Treatment for Varicose Veins-PREAUTH Device/Equipment Drug Medical Surgery Test Other Effective Date: 9/1/2001 Policy Last Updated: 12/20/2011 Prospective review is recommended/required.

More information

Recurrent Varicose Veins

Recurrent Varicose Veins Information for patients Recurrent Varicose Veins Sheffield Vascular Institute Northern General Hospital You have been diagnosed as having Varicose Veins that have recurred (come back). This leaflet explains

More information

Non-surgical treatment of severe varicose veins

Non-surgical treatment of severe varicose veins Non-surgical treatment of severe varicose veins Yasu Harasaki UCHSC Department of Surgery General Surgery Grand Rounds March 19, 2007 Definition Dilated, palpable, subcutaneous veins generally >3mm in

More information

Clinical Review Criteria

Clinical Review Criteria Clinical Review Criteria Treatment of Varicose Veins Radiofrequency Catheter Closure Sclerotherapy Surgical Stripping Trivex System for Outpatient Varicose Vein Surgery VenaSeal Closure System VNUS Closure

More information

Yes when meets criteria below

Yes when meets criteria below Vein Disease Treatment MP9241 Covered Service: Prior Authorization Required: Additional Information: Medicare Policy: BadgerCare Plus Policy: Yes when meets criteria below Yes None Dean Health Plan covers

More information

Local Coverage Determination (LCD): Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies (L35751)

Local Coverage Determination (LCD): Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies (L35751) Local Coverage Determination (LCD): Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies (L35751) Contractor Information Contractor Name Wisconsin Physicians Service Insurance Corporation

More information

Ultrasound - Venous (Extremities)

Ultrasound - Venous (Extremities) Scan for mobile link. Ultrasound - Venous (Extremities) Venous ultrasound uses sound waves to produce pictures of the body's veins. It is commonly used to search for blood clots, especially in the veins

More information

When Diabetic Patients Need Compression Socks

When Diabetic Patients Need Compression Socks When Diabetic Patients Need Compression Socks When Diabetic Patients Need Compression Socks As someone diagnosed with diabetes, you have been working closely with your physician, diabetic educator and

More information

MANAGEMENT OF ACUTE DEEP VEIN THROMBOSIS UPDATE? Mr Chew Loon Guan Head Dept of General & Vascular Surgery Serdang Hospital

MANAGEMENT OF ACUTE DEEP VEIN THROMBOSIS UPDATE? Mr Chew Loon Guan Head Dept of General & Vascular Surgery Serdang Hospital MANAGEMENT OF ACUTE DEEP VEIN THROMBOSIS UPDATE? Mr Chew Loon Guan Head Dept of General & Vascular Surgery Serdang Hospital Caveat The following deep vein thrombosis is in regards to the lower extremity

More information

Community Deep Vein Thrombosis (DVT)Service

Community Deep Vein Thrombosis (DVT)Service Community Deep Vein Thrombosis (DVT)Service Patient information guide Telephone: 01225 474273 Your scan will take place at: Combe down Branch Surgery Sulis Manor Rd Odd Down Bath BA2 2AL Date:. Time:.

More information

Venous Thromboembolic Treatment Guidelines

Venous Thromboembolic Treatment Guidelines Venous Thromboembolic Treatment Guidelines About the NYU Venous Thromboembolic Center (VTEC) The center s mission is to deliver advanced screening, detection, care, and management services for patients

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Origination Date: June 1, 1993 Review Date: July 20, 2016 Next Review: July, 2018 Medicare C/D Medical Coverage Policy DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins of the

More information

Medical Coverage Policy Varicose Vein Treatment sad

Medical Coverage Policy Varicose Vein Treatment sad Medical Coverage Policy Varicose Vein Treatment sad EFFECTIVE DATE: 10 28 2001 POLICY LAST UPDATED: 05 07 2013 OVERVIEW Varicose veins are large superficial veins that have become swollen. These veins

More information

Clinical Medical Policy Varicose Vein Treatment

Clinical Medical Policy Varicose Vein Treatment Benefit Coverage Covered Benefit for lines of business including: Health Benefits Exchange (HBE), Rite Care (MED), Children with Special Needs (CSN), Substitute Care (SUB), Rhody Health Partners (RHP),

More information

Compression US for DVT

Compression US for DVT Compression US for DVT 1 Anatomy Below the knee, the veins listed below are traditionally imaged to exclude DVT. This process is time consuming and requires expertise beyond the scope of this course. Anterior

More information

A-kursus i kar-radiologi: Ultralyd af arterier. Jonas Eiberg Karkirugisk afdeling

A-kursus i kar-radiologi: Ultralyd af arterier. Jonas Eiberg Karkirugisk afdeling A-kursus i kar-radiologi: Ultralyd af arterier Jonas Eiberg Karkirugisk afdeling BASIC vascular ultrasound Infrarenal aorta Screening for aorto-iliac disease by visual interpretation of the flow-curve

More information

A Patient s Guide to Antithrombotic and Thrombolytic Therapy

A Patient s Guide to Antithrombotic and Thrombolytic Therapy A Patient s Guide to Antithrombotic and Thrombolytic Therapy PATIENT EDUCATION GUIDE What is a blood clot? A blood clot is a solid mass consisting of blood cells and other material that forms inside a

More information

Venous thromboembolic disease is a common

Venous thromboembolic disease is a common One-Step Treatment of DVT With the Trellis-8 Device Preliminary data reveal a safe, effective, and expeditious treatment option. Y ZVONIMIR KRJCER, MD, ND STY REDDY TMKURI, MD Venous thromboembolic disease

More information

PROVIDER POLICIES & PROCEDURES

PROVIDER POLICIES & PROCEDURES PROVIDER POLICIES & PROCEDURES SCLEROTHERAPY TREATMENT OF SUPERFICIAL VARICOSE VEINS OF THE LEGS The purpose of this document is to provide guidance to providers enrolled in the Connecticut Medical Assistance

More information

Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment

Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment Celiac Artery & Superior Mesenteric Artery Disease, Diagnosis, and Treatment Jason Roberts DHSc, RVT Technical Director of Non-Invasive Vascular Services First Coast Cardiovascular Institute DISCLOSURES

More information

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital

VARICOSE VEINS. Information Leaflet. Your Health. Our Priority. VTE Ambulatory Clinic Stepping Hill Hospital VARICOSE VEINS Information Leaflet Your Health. Our Priority. Page 2 of 7 Varicose Veins There are no accurate figures for the number of people with varicose veins. Some studies suggest that 3 in 100 people

More information

Model Answer: Australasian College of Phlebology > Ultrasound in Phlebology > Advanced Course > Topic 4

Model Answer: Australasian College of Phlebology > Ultrasound in Phlebology > Advanced Course > Topic 4 Ques?on 1: Compression sonography (lee image) is the gold standard for the diagnosis of DVT. Are there any advantages of color Doppler ultrasound (right image) over compression sonography in the diagnosis

More information

Endovenous Laser Therapy

Endovenous Laser Therapy Information for patients Endovenous Laser Therapy Northern General Hospital You have been given this leaflet because you will be having Endovenous Laser Therapy (EVLT). This leaflet explains more about

More information

Pro: Calf Deep Venous Thrombosis Should Be Treated with Anticoagulation

Pro: Calf Deep Venous Thrombosis Should Be Treated with Anticoagulation Pro: Calf Deep Venous Thrombosis Should Be Treated with Anticoagulation Joseph A. Caprini, MD, Jennifer G. Sarayba, MD, Dejan Maksimovic, BS, Catherine J. Glase, BS, Andrew C. MacDougall, BS, Juan I. Arcelus,

More information

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA diagnosis and management Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Aortoenteric

More information

Deep Vein Thrombosis and Pulmonary Embolism

Deep Vein Thrombosis and Pulmonary Embolism P A T I E N T I N F O R M A T I O N G U I D E Deep Vein Thrombosis and Pulmonary Embolism Information for Newly Diagnosed Patients CONTENTS A. Blood clot basics a. What is a blood clot? b. What causes

More information

Ischaemic stroke 85% (85 in every 100 strokes)

Ischaemic stroke 85% (85 in every 100 strokes) UNDERSTANDING STROKE DUE TO INTRACEREBRAL HAEMORRHAGE This factsheet provides information for people who have had a stroke due to an intracerebral (bleed in the brain) and for their families and carers.

More information

THE VEIN CENTER. State-of-the-Art Treatment for Varicose Veins and Spider Veins

THE VEIN CENTER. State-of-the-Art Treatment for Varicose Veins and Spider Veins THE VEIN CENTER State-of-the-Art Treatment for Varicose Veins and Spider Veins Vein Disorders Nearly 50 percent of the adult population suffers from undesirable, sometimes painful vein disease. The most

More information

Recurrent Varicose Veins. Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio

Recurrent Varicose Veins. Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio Recurrent Varicose Veins Vineet Mishra, MD Director of Mohs Surgery and Procedural Dermatology University of Texas Health Science Center San Antonio Disclosures None Possible Causes of Recurrence DNA:

More information

Medicare C/D Medical Coverage Policy

Medicare C/D Medical Coverage Policy Varicose Vein Treatment Medicare C/D Medical Coverage Policy Origination Date: June 1, 1993 Review Date: September 16, 2015 Next Review: September, 2017 DESCRIPTION OF PROCEDURE OR SERVICE Varicose veins

More information

Information for patients who require Foam Sclerotherapy for Varicose Veins.

Information for patients who require Foam Sclerotherapy for Varicose Veins. Information for patients who require Foam Sclerotherapy for Varicose Veins. Why do I need this procedure? Everybody has two sets of veins in the legs. These include the superficial and deep veins. Their

More information

Acute pelvic pain associated with an intra-osseous lipoma. of the hip joint

Acute pelvic pain associated with an intra-osseous lipoma. of the hip joint Acute pelvic pain associated with an intra-osseous lipoma of the hip joint John Fraser Discipline of General Practice University of Newcastle, Callaghan, 2308 New South Wales, Australia. Correspondence:

More information

CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE

CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE Introduction CHAPTER 15 SCLEROTHERAPY FOR VENOUS DISEASE Original authors: Niren Angle, John J. Bergan, Joshua I. Greenberg, and J. Leonel Villavicencio Abstracted by Teresa L. Carman New technology has

More information

Guidelines for the Management of Patients Following Endoluminal Vein Dilation Procedures for the Treatment of Multiple Sclerosis

Guidelines for the Management of Patients Following Endoluminal Vein Dilation Procedures for the Treatment of Multiple Sclerosis Guidelines for the Management of Patients Following Endoluminal Vein Dilation Procedures for the Treatment of Multiple Sclerosis Report Submitted to the Minister of Health and Long-Term Care By the Ontario

More information

Lower Extremity Venous Duplex Evaluation

Lower Extremity Venous Duplex Evaluation VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Lower Extremity Venous Duplex Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound

More information

Clinically Important Pulmonary Emboli: Does Calf Vein US Alter Outcomes? 1

Clinically Important Pulmonary Emboli: Does Calf Vein US Alter Outcomes? 1 Ultrasonography Ronald H. Gottlieb, MD Jani Widjaja, MD Sonu Mehra, MD William B. Robinette, MS, RDMS, RVT Clinically Important Pulmonary Emboli: Does Calf Vein US Alter Outcomes? 1 Index terms: Embolism,

More information

Preventing Venous Thromboembolism (VTE)

Preventing Venous Thromboembolism (VTE) Preventing Venous Thromboembolism (VTE) UHN Information about blood clots in veins, also known as Deep Vein Thrombosis and Pulmonary Embolism This brochure will help you to understand: Deep Vein Thrombosis

More information

Vascular Ultrasound. Laurence Needleman, MD

Vascular Ultrasound. Laurence Needleman, MD Laurence Needleman, MD First Impression Laurence Needleman, M.D. Where and how was signal obtained? Quality of the scan Presence of flow Direction of flow Characterization of signal Transverse Splenic

More information

Baby Your Legs! Get relief for: Heavy, tired or aching legs Swollen ankles and feet Varicose or spider veins. Managing leg health during pregnancy

Baby Your Legs! Get relief for: Heavy, tired or aching legs Swollen ankles and feet Varicose or spider veins. Managing leg health during pregnancy Baby Your Legs! Get relief for: Heavy, tired or aching legs Swollen ankles and feet Varicose or spider veins Managing leg health during pregnancy Common leg health problems during pregnancy Venous disorders

More information

REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES

REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES Effective January 1, 2015, there was a change in CPT that affects reporting specific endovascular services provided in the

More information

Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach

Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Endovascular Repair of an Axillary Artery Aneurysm: A Novel Approach Bao- Thuy D. Hoang, MD 1, Jonathan- Hien Vu, MD 2, Jerry Matteo, MD 3 1 Department of Surgery, University of Florida College of Medicine,

More information

Subclavian Steal Syndrome By Marta Thorup

Subclavian Steal Syndrome By Marta Thorup Subclavian Steal Syndrome By Marta Thorup Definition Subclavian steal syndrome (SSS), is a constellation of signs and symptoms that arise from retrograde flow of blood in the vertebral artery, due to proximal

More information

Treatment of Varicose Veins

Treatment of Varicose Veins Treatment of Varicose Veins Policy Number: Original Effective Date: MM.06.016 04/15/2005 Line(s) of Business: Current Effective Date: PPO; HMO 07/01/2012 Section: Surgery Place(s) of Service: Outpatient

More information

Workshop : Venous Thromboembolism

Workshop : Venous Thromboembolism Workshop : Venous Thromboembolism Interactive Clinical Cases Venous Thromboembolism - Treatment duration of DVT - Distal DVT - Post Thrombotic Syndrome - Myeloma - Thrombophilia - Cockett s syndrome -

More information

Center for Vein Restoration

Center for Vein Restoration Committed to Your Complete Vein Care Welcome! At Center for Vein Restoration we believe that the treatment of venous insufficiency is not a luxury but a necessity. We are nationally recognized as the leader

More information

ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014

ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014 ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014 Thromboembolism epidemiology 5 million DVT s 900,000 PE s 290,000 fatalities Heit J. Blood. 2005;106:910. 10 VTE events Since this talk began DVT

More information

Upper Extremity Vein Mapping for Placement of a Dialysis Access

Upper Extremity Vein Mapping for Placement of a Dialysis Access VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Upper Extremity Vein Mapping for Placement of a Dialysis Access This Guideline was prepared by the Professional Guidelines Subcommittee of the Society

More information

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required.

MEDICAL COVERAGE POLICY. SERVICE: Varicose Veins of the Lower Extremities. PRIOR AUTHORIZATION: Required. Page 1 of 5 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your

More information

PATIENT INFORMATION BOOKLET Thoracic Stent Grafts: A Treatment for Thoracic Aortic Aneurysms

PATIENT INFORMATION BOOKLET Thoracic Stent Grafts: A Treatment for Thoracic Aortic Aneurysms PATIENT INFORMATION BOOKLET Thoracic Stent Grafts: A Treatment for Thoracic Aortic Aneurysms TABLE OF CONTENTS Introduction 1 Glossary 2 Thoracic Aorta 3 Thoracic Aortic Aneurysm (TAA) 4 Causes 5 Symptoms

More information

X-Plain Abdominal Aortic Aneurysm Vascular Surgery Reference Summary

X-Plain Abdominal Aortic Aneurysm Vascular Surgery Reference Summary X-Plain Abdominal Aortic Aneurysm Vascular Surgery Reference Summary Ballooning of the aorta, also known as an "abdominal aortic aneurysm," can lead to life threatening bleeding. Doctors may recommend

More information

Central Venous Catheters and Upper Extremity DVT: Update, Diagnosis and Management

Central Venous Catheters and Upper Extremity DVT: Update, Diagnosis and Management Central Venous Catheters and Upper Extremity DVT: Update, Diagnosis and Management David Hahn, MD Interventional Radiology NorthShore University HealthSystem Objectives Discuss the epidemiology and clinical

More information

VFI Technology to Change the Way You Work

VFI Technology to Change the Way You Work Technology to Change the Way You Work Vascular Ultrasound Made Easier Vector Flow Imaging VFI VFI is a ground-breaking technology that can revolutionize the workflow for many Doppler ultrasound applications.

More information

Patient Information Booklet. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms

Patient Information Booklet. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms Patient Information Booklet Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms TABLE OF CONTENTS Introduction 1 Glossary 2 Abdominal Aorta 4 Abdominal Aortic Aneurysm 5 Causes 6 Symptoms

More information

Ultrasound - Vascular

Ultrasound - Vascular Scan for mobile link. Ultrasound - Vascular Vascular ultrasound uses sound waves to evaluate the body s circulatory system and help identify blockages and detect blood clots. A Doppler ultrasound study

More information

Offering instruments to create network in phlebology. 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli

Offering instruments to create network in phlebology. 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli Offering instruments to create network in phlebology 23rd-24th September 2016 Venice, Centro culturale Don Orione Artigianelli Offering instruments to create network in phlebology 23rd-24th September 2016

More information

Vascular ultrasound in aortic endoleaks

Vascular ultrasound in aortic endoleaks Vascular ultrasound in aortic endoleaks Nicos Labropoulos Professor of Surgery and Radiology Director, Vascular Laboratory Division of Vascular Surgery Stony Brook University Medical Center Stony Brook,

More information

Renovascular Disease. Renal Artery and Arteriosclerosis

Renovascular Disease. Renal Artery and Arteriosclerosis Other names: Renal Artery Stenosis (RAS) Renal Vascular Hypertension (RVH) Renal Artery Aneurysm (RAA) How does the normal kidney work? The blood passes through the kidneys to remove the body s waste.

More information

aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C

aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C aka EVH, Endo-vein, Endoscopic vessel harvesting Lisa Sand, PA-C Objectives: Understand the importance of preoperative lower extremity evaluation Ultrasound imaging to determine satisfactory venous conduit

More information

Lower Extremity Arterial Segmental Physiologic Evaluation

Lower Extremity Arterial Segmental Physiologic Evaluation VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Lower Extremity Arterial Segmental Physiologic Evaluation This Guideline was prepared by the Professional Guidelines Subcommittee of the Society

More information

Spine University s Guide to Cauda Equina Syndrome

Spine University s Guide to Cauda Equina Syndrome Spine University s Guide to Cauda Equina Syndrome 2 Introduction Your spine is a very complicated part of your body. It s made up of the bones (vertebrae) that keep it aligned, nerves that channel down

More information

Heel Pain Syndromes DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY

Heel Pain Syndromes DELLON INSTITUTES FOR PERIPHERAL NERVE SURGERY Heel Pain s 5 3333 N CALVERT ST, SUITE 370, BALTIMORE, MD 21218 T410 467 5400 F410 366 9826 delloninstitutes.com your complaints are Pain, numbness or burning in your heel. The timing of this pain and

More information

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

Spotlight Series: Interventional Radiology. Varicose Veins and Venous Insufficiency

Spotlight Series: Interventional Radiology. Varicose Veins and Venous Insufficiency Spotlight Series: Interventional Radiology Varicose Veins and Venous Insufficiency What is venous insufficiency? Spectrum of Disease Spider veins and telangiectasias Small reddish and purple veins near

More information

CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ. Charles White MD

CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ. Charles White MD CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ Charles White MD Director of Thoracic Imaging Department of Radiology University of Maryland CORONARY ARTERY BYPASS GRAFTS First performed

More information

From Experimental to the Standard of Care:

From Experimental to the Standard of Care: Long long island Island A Business & Practice Management Magazine about physicians from physicians for physicians Left to right: Richard J. Dranitzke, M.D.; Thomas E. Arnold, M.D.; Robert Pollina, M.D.,

More information