Understanding the Causes of Venous Pressure


Developing an effective treatment plan for patients with venous disease hinges on an thorough clinical evaluation and a keen understanding of venous anatomy and physiology, both of which will be the focus of the Thursday morning session, “Venous Clinical Examination and Hemodynamics.”

“Less invasive treatments are now available because of the advent of new technologies,” said co-moderator Dr. Jose I. Almeida, director of the Miami Vein Center and voluntary professor of surgery at the University of Miami School of Medicine. “However, the proper treatment of patients with advanced venous disease has little to do with the new toys available on the shelf. Rather, it depends on a proper understanding of the fundamental problem: What causes increased venous pressure?”

Dr. Jose Almeida

Presentations will focus on answering that question. “Without an accurate physician assessment, one cannot apply an effective treatment plan for a patient with venous disease,” said Dr. Almeida. Session co-moderators include Dr. Lowell S. Kabnick, director of the New York University Vein Center, and Dr. Thomas W. Wakefield, vascular surgery section head at the University of Michigan Cardiovascular Center.

“The session begins with identifying symptoms and signs of venous disease, scoring the disease severity with a validated tool, and classifying the severity on a scale of one to six,” said Dr. Almeida, who starts off the session with his own review of the CEAP classification for venous disease – Clinical, Etiologic, Anatomic and Pathophysiologic – and the Venous Clinical Severity Score system. “Patient reported outcomes are now increasingly important to all stakeholders in venous disease space, and these principles will be summarized,” he said.

The session then moves into the anatomy and physiology of venous disorders. “Proper treatment hinges on the understanding of superficial reflux pathways and how to identify them with the ultrasound imaging,” said Dr. Almeida “Venous hypertension can also be caused by obstruction. The hemodynamics from the perspective of our European colleagues will be presented – and the controversial treatments used based on these hemodynamic principles will be reviewed.”

Dr. Bo G. Eklof of the University of Lund will provide the European perspective with an update on the Venous Symposium Consensus (SYMVein), a collaboration of the European Venous Forum and International Working Group to develop a consensus on venous symptoms.

Dr. Lowell S. Kabnick

Dr. Kabnick will then explore outcome assessment of central venous disease, and Dr. Wakefield will review the evidence on the pathophysiology of varicose veins. Dr. Seshadri Raju, vascular surgeon at St. Dominic Hospital will explore emerging concepts in venous flow and pressure.

“This will be the talk that ties in the concepts of flow and pressure and how each contributes to the final common pathway of venous disease—namely, venous hypertension,” Dr. Almeida said of Dr. Raju’s presentation.

In keeping with a deeper dive into venous anatomy, Dr. Neil M. Khilnani, associate professor of radiology at Weill Medical College of Cornell University, will discuss the role of duplex ultrasound in identifying reflux pathways, and Dr. Brajesh K. Lal, professor at University of Maryland School of Medicine, will present the latest evidence on venous return pathology. Then Dr. Byung-Boong Lee, professor of surgery at George Washington School of Medicine, will provide an update on the International Union of Phlebology consensus on chronic venous disease

Dr. Thomas Wakefield

Two presenters from the Riviera Vein Institute in the Principality of Monaco will close out the session. Research chair Dr. Sylvain Chastanet will present 10-year results of the ASVAL – the French acronym for selective ablation of varicose veins under local anesthesia – method for treating varicose veins. And Dr. Paul Pittaluga will wrap things up by analyzing the role of the saphenofemoral junction in planning treatment for varicose veins.

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