ARRS 2022 Abstracts

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E1286. Treating Superficial Venous Insufficiency: A Primer For Residents
Authors
  1. Alexandra Fairchild; LSU Health Sciences Center
  2. Allison Fladten; Medical College of Wisconsin
  3. Mona Li; Medical College of Wisconsin
  4. Andrew Ea; LSU Health Sciences Center
Background
Lower extremity venous insufficiency (also known as reflux or incompetence) is a condition caused by failure of the normal one-way valves, resulting in bidirectional flow in the veins. This can lead to local venous hypertension, venous engorgement, tissue edema, and changes in tissue perfusion. Varicose veins and venous insufficiency affect approximately 25% of women and 15% of men older than 15 years. The development of venous insufficiency is associated with age, female sex, pregnancy, heredity, body habitus, and lifestyle. Symptoms associated with superficial venous insufficiency include leg heaviness, aching, throbbing, and fatigue. Symptoms generally worsen with standing or sitting for long periods of time and improve with leg elevation. Other symptoms include itching and nocturnal cramps or restlessness.

Educational Goals / Teaching Points
We aim to provide a resident-level primer addressing the workup and management of superficial venous insufficiency. Specific teaching points include presenting symptoms, clinical history, and examination. Common findings will be outlined in the context of the American Venous Forum’s 2020 clinical-etiological-anatomical-pathophysiological (CEAP) classification for venous disease. Imaging will be reviewed, with particular focus on venous duplex ultrasound, the mainstay of noninvasive imaging for superficial venous insufficiency. Treatment techniques and goals, encompassing both conservative management and surgical/interventional procedures will be discussed. Interventions include a variety of thermal and non-thermal ablation techniques, sclerotherapy, and phlebectomy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This educational exhibit will discuss the pathophysiology of venous insufficiency and provide a brief overview of superficial venous anatomy. Clinical examples of relevant diagnostic imaging will be included, with an emphasis on venous duplex ultrasound. Finally, we will discuss the variety of interventional and surgical procedures available, including a comparison of endothermal and non-thermal ablation techniques.

Conclusion
Lower extremity venous insufficiency is a common condition of the adult population, but is largely under-appreciated, despite the potential to significantly affect quality of life. Compression remains the mainstay of conservative therapy. However, with minimally invasive techniques increasingly available, more definitive treatment is appropriate for a greater patient population. The diagnosis, classification, imaging, and management of superficial venous insufficiency are relevant and informative topics for the radiologist and radiologist-in-training, as well as interested providers, residents, and students.