The VEIN Handbook
A Layman's Version of Venous Disorders
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Chapter 1: Normal Venous Circulation
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The VEIN Handbook
A Layman's Version of Venous Disorders

Frequently Asked Questions Index

Chapter 1:  Normal Venous Circulation
 "  What is the main function of the deep venous circulation?
 "  What characteristics do veins have that enable them to return blood to the heart?
 "  At what three sites does a peripheral pump mechanism contribute to the return flow of blood from the
     extremity toward the heartWhich is the main contributor?
 "  How much of the blood contained within the deep veins of the calf is expelled by calf contraction?

Chapter 2:  Acute Deep Venous Thrombosis and Its Complications
 "  What is deep venous thrombosis?
 "  What causes a deep venous thrombosis?
   What is deep venous thrombosis?
   What are the major complications of deep venous thrombosis?
   How is a deep venous thrombosis treated?

Chapter 3:  Hypercoagulable States in Venous Disease
   What is a hypercoagulable state?
 "  What is heparin-induced thrombocytopenia?
   What is factor V Leiden (or activated protein C deficiency)?
   What is hyperhomocysteinemia?
   What is protein C deficiency?

Chapter 4:  Medical Treatment of Acute Deep Venous Thrombosis
   What is deep venous thrombosis (DVT)?
   Why is my doctor concerned with the occurrence of DVT?
   What is the usual treatment for DVT?
   What are the possible risks of taking anticoagulants for the treatment of DVT?
   How is treatment for DVT with low molecualr weight heparin different from the more familiar
     unfractionated heparin?

Chapter 5:   Catheter-directed Thrombolysis for Acute Deep Venous Thrombosis
   What is thrombolysis?FAQs\hbk05q.html
   Which patients derive the most benefit from catheter-directed thrombolysis?
   What are the objectives of thrombolysis?
   Are there other benefits of catheter-directed thrombolysis?
   What are the complications of thrombolysis?
   Are there alternatives to catheter-directed thrombolysis for extensive venous thrombosis?

Chapter 6:  Surgery for Acute Iliofemoral Deep Venous Thrombosis
   What are the symptoms of acute iliofemoral deep vein thrombosis?
   Which is the most important objective when treating iliofemoral deep vein thrombosis?
   What is the first choice for the treatment of iliofemoral deep vein thrombosis?
   Why is a venous thrombectomy performed after a deep vein clot has been discovered?
   Why is an arteriovenous fistula created after a vein thrombectomy is performed?
   Are long-term results after thrombectomy better than that obtained with anticoagulation use alone?

Chapter 7: Superficial Venous Thrombophlebitis
   What is superficial thrombophlebitis?
   What is the usual treatment for superficial thrombophlebitis caused by a minor trauma?
   Can superficial thrombophlebitis lead to deep venous thrombosis and its potential health risks?
   How do I know that I have a superficial thrombophlebitis?
   I have had a hard and tender knot appear in my arm where an IV had been in place and used to put me
    asleep for a minor surgery. Is this something to worry about?

Chapter 8: Treatment of Acute Axillary-Subclavian Venous Thrombosis
   I was building my weightlifting repetitions over the weekend and woke up with a swollen and painful
     right arm. It has not resolved with rest; what should I do?
   What are the risks of ignoring the symptoms of effort vein thrombosis?
   What is needed to confirm that I do or do not have a clot in my upper arm and shoulder veins?
   What needs to be done to minimize the problems that can be associated with upper arm deep vein
   I am an active construction worker and have just experienced a clot of my right arm deep shoulder veins.
     If simple anticoagulation may not provide me with full arm function within a short period of time, what
     might be needed?

Chapter 9:  Pulmonary Embolism
   What is a pulmonary embolism?
   How serious is a pulmonary embolism?
   Who is likely to have a pulmonary embolism?
   How can I protect myself against a pulmonary embolism?
   How will I know if I have a pulmonary embolism?

Chapter 10:  Prevention of Deep Venous Thrombosis
   My doctor has recommended intermittent external pneumatic leg compression as a preventive measure
     for deep vein thrombosis. How does this work?
   Why is my doctor so concerned about preventing clots from developing in my deep leg veins during my
     upcoming surgery?
   What methods are available to prevent deep leg vein clots from occurring during my planned cancer
   I am going to have my hip replaced next week. I know that cancer increases the chances of clot formation
     in my legs during an operation, but does this non-cancer operation hold the same risk?
   I am a healthy 55-year-old man who needs an operation for gastroesophageal reflux due to unrelenting
     heartburn symptoms. What are my options for preventing deep venous thrombosis during my operation?

Chapter 11:  Indications and Techniques of Inferior Vena Cava Interruption
   Will I be able to feel the filter or tell that I have it?
   Does the filter ever have to be changed?
   Do I need to avoid sports or change my usual activities because of the filter?
   Will I need to take anticoagulants for life?
   Can I still have an MRI scan with a filter?

Chapter 12:  Sclerotherapy
   Is sclerotherapy the best treatment for large varicose veins (larger than 5 mm)?
   Can spider veins be treated by surgery?
   Are there any treatment methods for varicose veins other than sclerotherapy and surgery?
   Who should treat my varicose veins?
   What kind of elastic garments should I get?

Chapter 13:  Complications of Sclerotherapy
   My doctor is considering sclerotherapy for the discolored, protruding veins in my leg. I have heard that
     the veins or area around them may be a brownish rather than blue color after the injections. Is this
     common and does it last forever?
   A friend has had multiple sclerotherapy injections for varicose veins with good results. However, the last
     injection resulted in a small skin ulcer. Is this common, and what will be the long-term result?
   The agents used to inject veins during sclerotherapy are drugs, can one have an allergic reaction while
     having these injections?
   During sclerotherapy, can the injected drug escape the superficial veins and cause damage or clots to
     occur in my deep veins?
   Can my arteries be damaged during venous sclerotherapy injections for my varicose veins?

Chapter 14:  Surgery for Varicose Veins
   I have had surgery for varicose veins, and I have a purple patch on my thigh. Will this go away?
   I have had vein surgery, and the entire inside of my leg is numb from nearly the knee to the ankle.
     The surgery was done 10 days ago.
   I had vein surgery 15 years ago and I have most of my veins back. What do I do now?
   I have had large varicose veins for many years, and they do not bother me at all. Should anything be
     done about them?
   I have varicose veins and I have had phlebitis in these veins several times. What can be done about

Chapter 15:  Compression Treatment for Chronic Venous Insufficiency
   What causes chronic venous insufficiency?
   Can elastic stockings cut off the circulation to my legs?
   Once my ulcer is healed, why do I continue to need to wear elastic stockings?
   Can't I have an operation to correct my venous insufficiency and thereby avoid needing to use stockings?
   How do I know if my compression stockings are helping me?

Chapter 16:  Surgical Repair of Incompetent Venous Valves
   What is venous insufficiency of the lower leg?
   My doctor tells me that I have primary deep venous insufficiency, which is causing the recurrent ulcer on
     my leg. What does this mean?
   How can my doctor be sure that I have primary deep venous insufficiency causing the recurrent ulcer on
     my leg?
   Is the only treatment for primary deep venous insufficiency compression stockings and elevation of my
   Who is a candidate for surgical treatment of primary deep venous insufficiency?

Chapter 17:  Venous Valve Transplantation and Vein Segment Transfer for Valvular Incompetence of Deep Veins
   How long will I be out of work after a reconstruction of the deep veins of my leg?
   Will my arm swell on the side where a vein valve was removed to donate to the leg?
   Will I be required to do anything else after surgery?
   Besides promoting ulcer healing and preventing its recurrence, will the skin and fatty tissue of my
     affected leg improve?
   What is the chance that I will require another deep venous transplantation or transposition operation in
     the next 2-3 years?

Chapter 18:  Endovascular Reconstruction for Chronic Iliac Vein and Inferior Vena Cava Obstruction
   I have swelling and discomfort in my left leg when I exercise. My doctor says I have the May-Thurner
     syndrome. What is this syndrome?
   What can be done to relieve my symptoms associated with the May-Thurner syndrome?
   Can a totally occluded iliac vein or inferior vena cava (the large abdominal vein that directs all lower body
     blood back to the heart) be reopened?
   What complications can occur when trying to open an occluded vein by minimally invasive methods?

Chapter 19:  Subfascial Endoscopic Perforating Vein Surgery
   Where are the important perforating veins located?
   What is the cause of perforator incompetence?
   What is the best test to confirm incompetent perforators?
   What is the best surgical technique to interrupt incompetent perforators?
   What can you expect after the SEPS procedure?

Chapter 20:  Lymphedema
   Does the lymphatic system transport blood back to the heart?
   Does lymphedema involve the accumulation of blood in the extremities?
   How is lymphedema diagnosed?
   I have been diagnosed with lymphedema. What is the treatment for it?
   Can lymphedema be prevented?

Chapter 21:  Treatment of Lymphedema
   I have swelling in my leg that even involves my foot; it appeared without an apparent cause. My doctor
     has told me that I have primary lymphedema since no other cause can be found. What other problems
     could cause leg swelling?
   Is there a cure for primary lymphedema?
   How can I decrease the unsightly leg swelling associated with lymphedema?
   What can be used to keep the swelling (lymphedema) from coming back in my legs?
   Do I have other health risks I should know about because of my chronic lymphedema?


Read Chapter 1: Normal Venous Circulation

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