Renowned as the essential reference for all venous specialists, phlebologists, vascular surgeons and vascular medicine physicians, the 5th edition of the Handbook of Venous and Lymphatic Disorders: Guidelines of the American Venous Forum covers the investigation, prevention, evaluation, and treatment of venous and lymphatic disorders.


The full spectrum of acute and chronic venous disorders, chronic lymphedema and chylous complications are included. New or entirely revised chapters discuss in detail basic considerations, diagnostic evaluation, management of acute venous thrombosis and chronic venous disorders, including deep venous disease and venous ulcers. Medicaltreatments,including compression therapy, veno-active compounds and new oral antithrombotic medications are discussed. Minimally invasive endovascular techniques to treat deep vein thrombosis and pulmonary embolism with catheter-directed thrombolysis, pharmaco-mechanical, mechanicalthrombectomy, and venousstenting are presented.


Few areas in medicine have progressed as fast as minimally invasive outpatient treatment of chronic venous disease. Endo-venous therapies include laser and radiofrequency ablation, liquid and foam sclerotherapy, minimally invasive surgery, cyanoacrylate embolization, mechanico-chemical or ultrasonic ablations, among others.


Written by the world's foremost venous experts, leaders of the American Venous Forum, and international authorities, the Handbook has become the most important reference for both day-to-day management and investigation of venous and lymphatic disorders.


Edited by


Peter Gloviczki MD PhD FACS


Joe M. and Ruth Roberts Professor of Surgery and Chair, Emeritus, Division of Vascular and Endovascular Surgery, Director, Emeritus, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA



Associate Editors:



Michael C. Dalsing MD FACS

Dale and Susan E. Habegger Professor of Surgery and Chair, Emeritus, Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA



Monika L. Gloviczki MD PhD

Research Fellow, Emeritus, Department of Internal Medicine and Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA



Fedor Lurie MD PhD

Adjunct Research Professor, University of Michigan, Ann Arbor, Michigan, and Associate Director, Jobst Vascular Institute, Toledo, Ohio, USA



Gregory L. Moneta MD FACS

Professor of Surgery, Division of Vascular Surgery, Oregon Health & Science University. Portland, Oregon, USA



Cynthia K. Shortell MD FACS

Professor of Vascular and Endovascular Surgery, Executive Vice Chair, Department of Surgery, Duke University Medal Center, Durham, North Carolina, USA



Thomas W. Wakefield MD FACS

Professor Emeritus of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan, USA



Contents, Foreword, Preface, Contributors, Evidence-based guidelines, List of abbreviation used, Part 1. BASIC CONSIDERATIONS OF VENOUS DISORDERS, EDITED BY MICHAEL C. DALSING, 1. A historical review of venous and lymphatic disease, Thomas F. O'Donnell, Jr., 2. Development and anatomy of the venous system, Peter Gloviczki, 3. Physiology and hemodynamics of the normal venous circulation, Frank T. Padberg, Jr, 4. Epidemiology, genetics and risk factors of acute venous thrombosis, Samuel Jessula and Anahita Dua, 5. Pathogenesis and new insights into acute and chronic venous thrombosis, Andrea T. Obi, Thomas W. Wakefield, Peter K. Henke, 6. Epidemiology, genetics and risk factors of chronic venous disease, Eri Fukaya, 7. Pathogenesis and hemodynamics of varicose veins and chronic venous insufficiency of the lower limb, John Blebea, 8. Venous ulcer formation and healing at cellular levels Joseph D. Raffetto and Raouf A. Khalil, 9. Classification of chronic venous disorders of the lower limbs, Fedor Lurie and Patrick Sullivan, Part 2. DIAGNOSTIC EVALUATIONS AND VENOUS IMAGING STUDIES, EDITED BY FEDOR LURIE, 10. Evaluation of hypercoagulable states and molecular markers of acute venous thrombosis, Iva Minga, Alfonso J. Tafur Joseph A. Caprini, 11. Duplex ultrasound scanning for acute venous disease, Rhusheet Patel and Timothy K. Liem, 12. Duplex ultrasound scanning for chronic venous obstruction and valvular incompetence, Pedro J. Furtado Neves, Rafael D. Malgor, Nicos Labropoulos, 13. Evaluation of venous function by indirect noninvasive testing (plethysmography), Kate Gates, Fedor Lurie, Thom W Rooke, 14. Direct contrast venography, Haraldur Bjarnason, 15. Intravascular ultrasound (IVUS), Paul J. Gagne, 16. Computed tomography and magnetic resonance imaging in venous disease, Thanila Macedo, Terri J. Vrtiska, James F. Glockner, Part 3. MANAGEMENT OF ACUTE THROMBOSIS, EDITED BY THOMAS W. WAKEFIELD, 17. Clinical presentation and the natural history of acute venous thrombosis, Jake F. Hemingway and Mark H Meissner, 18. Diagnostic algorithms for acute deep venous thrombosis and pulmonary embolism, Joann Lohr, 19. Medical treatment of acute deep venous thrombosis and pulmonary embolism, Henry Han and Geoffrey D. Barnes, 20. Catheter directed thrombolysis for acute iliofemoral deep vein thrombosis, Brian G. de Rubertis and Rowza T. Rumma, 21. Percutaneous mechanical thrombectomy for treatment of acute iliofemoral deep vein thrombosis, Kayla J. Krause, Ahsan Zil-E-Ali, Faisal Aziz, Peter Gloviczki, 22. Open and hybrid surgical interventions for the treatment of acute iliofemoral deep vein thrombosis, Ahsan Zil-E-Ali, Kayla J. Krause, Faisal Aziz, Peter Gloviczki, 23. Endovascular and open surgical treatment of acute pulmonary embolism, Armin Farazdaghi and Randall R. DeMartino, 24. Treatment algorithms for acute venous thromboembolism, Salim G. Habib and Rabih A. Chaer, 25. Prevention of deep venous thrombosis, Jeffrey J. Siracuse and David B. McAneny, 26. Management of venous thoracic outlet syndrome, Chandu Vemuri, 27. Acute central venous thrombosis in the setting of central lines, pace-maker wires and dialysis catheters, Justin M. Robbins, Anil Hingorani, Enrico Ascher, 28. Indications, techniques, and results of inferior vena cava filters, Courtney E. Morgan and John E Rectenwal, 29. Superficial thrombophlebitis, Suman M. Vasan, 30. Mesenteric vein thrombosis, Elizabeth A. Andraska and Mohammed Reza Zarisfi, , Part 4. MANAGEMENT OF CHRONIC VENOUS DISORDERS , A. General Considerations, EDITED BY MICHAEL DALSING, 31. Clinical presentation and assessment of patients with venous disease, Sarah Onida, Tristan R. A. Lane, Alun H. Davies, 32. Diagnostic algorithm for chronic venous disorders, Amani D. Politano and Robert B. McLafferty, 33. Compression therapy for chronic venous disorders, Sergio Gianesini, Leo Daab, Erica Menegatti, Yung-Wei Chi, Hugo Partsch, Gregory L. Moneta, 34. Drug treatment for chronic venous disease, Monika L. Gloviczki and Joseph D. Raffetto, B. Superficial and perforating veins, EDITED BY CYNTHIA K. SHORTELL, 35. Liquid sclerotherapy for telangiectasia and varicose veins, Edward G. MacKay, 36. Percutaneous laser therapy for telangiectasia and varicose veins, Thomas M. Proebstle, 37. Physician generated foam sclerotherapy for ablation of superficial truncal veins and varicose tributaries, Claudine Hamel-Desnos and Peter Gloviczki, 38. Endovenous microfoam sclerotherapy for ablation of superficial truncal veins and varicose tributaries, Juan C. Jimenez and Peter F. Lawrence, 39. Phlebectomy, Mikel Sadek and Lowell S. Kabnick, 40. Open surgical treatment for superficial truncal incompetence, Michael C. Dalsing, 41. Saphenous preserving surgical interventions: CHIVA, ASVAL, Tristan R.A. Lane, Sarah Onida, Alun H. Davies, 42. Radiofrequency treatment of superficial truncal veins, Alan M. Dietzek and Emilia Krol, 43. Endovenous laser treatment of superficial truncal veins, Alessandra Puggioni, 44. Cyanoacrylate glue treatment of incompetent superficial truncal veins, Raghu Kolluri and Andrew Pollard, 45. Mechanical Occlusion Chemically Assisted (MOCA) ablations and High Intensity Focused Ultrasound (HIFU) for chronic venous disease, Ray Kennedy and Steve Elias, 46. The management of incompetent perforating veins , Mary A. Binko, Misaki M. Kiguchi, Peter F. Lawrence, Eric S. Hager, 47. Management of thrombotic complications of endovenous ablations, Peter F. Lawrence, Juan Carlos Jimenez, Kelly R. Brown, 48. Treatment algorithm for management of varicose veins, Christopher Montoya, Christopher Chow, Jose I. Almeida, 49. Etiology and management of recurrent varicose veins, Tina Koutsos, Connie Koutsos, Pamela S. Kim, Angela A. Kokkosis, Antonios P. Gasparis, C. Deep venous disease, EDITED BY GREGORY L. MONETA, 50. Surgical repair of primary and post-thrombotic valvular incompetence, Oscar Maleti and Marcia Lugli, 51. Artificial valves and endovascular techniques for treatment of venous valvular incompetence, Jorge H. Ulloa and Sebastian Cifuentes, 52. Endovascular reconstruction of primary iliac vein obstruction, Erin H. Murphy, 53. Endovascular treatment of post-thrombotic iliofemoral venous obstruction, Arjun Jayaraj and Seshadri Raju, 54. Endovascular reconstruction of iliocaval venous obstructions, Young Erben, Roberta Lozano Gonzalez, Ana Fuente, Haraldur Bjarnason, 55. Open and hybrid surgical reconstructions for non-malignant obstructions of the iliofemoral veins and the inferior vena cava, Arjun Jayaraj and Peter Gloviczki, 56. Surgical and endovenous treatment of superior vena cava syndrome, Manju Kalra, Indrani Sen, Haraldur Bjarnason, Peter Gloviczki, D. Venous Leg Ulcers, EDITED BY GREGORY L. MONETA, 57. Local treatment of venous ulcers., William A. Marston and Thomas F. O'Donnell Jr., 58. Management algorithm for patients with venous ulcers, Marc A. Passman and Thomas F. O'Donnell Jr., E. Pelvic venous disorders, EDITED BY GREGORY L. MONETA, 59. Classification and clinical presentation of pelvic venous disorders, Mark H. Meissner, 60. Evaluation and treatment of pelvic venous disorders, John V. White, Constance E. Ryjewski, Hani Ghandour, Lewis B. Schwartz, 61. Management of vulvar, perineal and pelvic origin lower extremity varicosities, Kathleen D. Gibson, 62. The management of Nutcracker syndrome Ana Fuentes, Roberta Lozano Gonzalez, Young Erben, Peter Gloviczki, PART 5. SPECIAL VENOUS PROBLEMS, EDITED BY FEDOR LURIE, 63. Management of venous trauma: civilian and military injuries, Xzabia A. Caliste and David L. Gillespie, 64. Primary and secondary tumors of the inferior vena cava and iliac veins, Richard T. Rogers, Jill J. Colglazier and Thomas C. Bower, 65. Management of arteriovenous malformations, Byung-Boong Lee, James Laredo, Anton N. Sidawy, 66. Management of venous malformations, Jovan N. Markovic and Cynthia K. Shortell, 67. The management of venous aneurysms, Victor J. Davila and Samuel R. Money, , Part 6. LYMPHEDEMA, EDITED BY MONIKA L. GLOVICZKI, 68. Pathophysiology of lymphedema, M. Mark Melin and Michael J. Davis, 69. Classification and clinical evaluation of patients with lymphedema, Thom W. Rooke and Cindy L. Felti, 70. Imaging Modalities for Diagnosis and Treatment of Lymphedema, Balazs Mohos, Chieh-Han John Tzou, Peter, Gloviczki, 71. Physical and medical therapy of lymphedema, Gillian M.E. Belnavis and Steven M. Dean, 72. Principles of surgical treatment of chronic lymphedema, Francisco R. Avila, Ricardo A. Torres-Guzman, Karla C. Maita, Antonio J. Forte, 73. Treatment of chylous disorders, Audra A. Duncan and Peter Gloviczki, Part 7. CRITICAL ISSUES IN VENOUS AND LYMPHATIC DISEASE, EDITED BY MONIKA L. GLOVICZKI, 74. Disparities in management and outcome of venous disease, Helen Potter, Linda Harris, Ruth Bush, 75. Standards of accredited office-based venous ultrasonography laboratories and vein centers, John A. Chuback and Jacqueline Sasek, 76. Coding and reimbursement for venous disease treatment, Harold J. Welch, 77. Outcomes assessment in acute venous disease, Adario Chirgwin-Dasgupta and Susan R. Kahn, 78. Outcomes assessment of treatments for chronic venous disease, Manj S. Gohel, 79. Appropriate use criteria for management of lower extremity chronic venous disease, Elna Masuda, Kathleen Ozsvath, Daniel L. Monahan, Thomas W. Wakefield, 80. Summary of Guidelines of Venous and Lymphatic Disorders of the American Venous Forum, Monika L. Gloviczki, Michael C. Dalsing, Fedor Lurie, Gregory L. Moneta, Cynthia K. Shortell, Thomas W. Wakefield, Peter Gloviczki,