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 molecular weight heparin different from the more familiar unfractionated heparin?

Chapter 5:   Catheter-directed Thrombolysis for Acute Deep Venous Thrombosis

• What is thrombolysis?
• 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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