1. Deep vein thrombosis (DVT) and pulmonary embolism
are frequent complications after major abdominal and orthopedic
procedures. The risk is further increased in patients with malignancy
and a history of venous thromboembolism. Options for DVT prophylaxis include
intermittent pneumatic compression, use of graduated compression
stockings, and administration of low-dose unfractionated heparin,
low molecular weight heparin, fondaparinux, and vitamin K antagonists.
However, prophylaxis should be stratified based on the patient’s
level of risk.
2. In patients with established DVT, unfractionated heparin, low
molecular weight heparin, and fondaparinux are options for initial antithrombotic
therapy. The duration and type of long-term anticoagulation
should be stratified based on the provoked or unprovoked nature
of the DVT, the location of the DVT, previous occurrence of DVT,
and presence of concomitant malignancy.
3. Thrombolytic therapy, surgical thrombectomy, and placement of
inferior vena cava filters are adjunctive treatments that may be
indicated in patients with extensive and complicated venous thromboembolism.
4. Saphenous vein stripping, endovenous laser treatment, and radiofrequency
ablation are effective therapies for patients with saphenous vein
valvular insufficiency. Concomitant varicose veins may be managed
with compression therapy, sclerotherapy (for smaller varices), and
5. The mainstay of treatment for chronic venous insufficiency is
compression therapy. Sclerotherapy, perforator vein ligation, and
venous reconstruction may be indicated in patients in whom conservative management
6. Lymphedema is categorized as primary (with early or delayed onset)
or secondary. The goals of treatment are to minimize edema and prevent
infection. Lymphatic massage, sequential pneumatic compression,
use of compression garments, and limb elevation are effective forms
Veins are part of a dynamic and complex system that returns venous blood
to the heart against the force of gravity in an upright individual.
Venous blood flow is dependent on multiple factors such as gravity,
venous valves, the cardiac and respiratory cycles, blood volume,
and the calf muscle pump. Alterations in the intricate balance of
these factors can result in venous pathology.
Veins are thin-walled, highly distensible, and collapsible structures. Their
structure specifically supports their two primary functions of transporting
blood toward the heart and serving as a reservoir to prevent intravascular
volume overload. The venous intima is composed of a nonthrombogenic
endothelium with an underlying basement membrane and an elastic
lamina. The endothelium produces endothelium-derived relaxing factor
and prostacyclin, which help maintain a nonthrombogenic surface
through inhibition of platelet aggregation and promotion of platelet
disaggregation.1 Circumferential rings of elastic
tissue and smooth muscle located in the media of the vein allow
for changes in vein caliber with minimal changes in venous pressure.
When an individual is upright and standing still, the veins are
maximally distended and their diameter may be several times greater
than that in the supine position.
Unidirectional blood flow is achieved with multiple venous valves. The
number of valves is greatest ...