The VEIN Handbook
A Layman's Version of Venous Disorders

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 heart?  Which 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
     thrombosis?
 •  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
     surgery?
 •  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
     that?

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
     leg?
 •  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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