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      Guía de la exploración venosa de los miembros inferiores del capítulo de diagnóstico vascular de la SEACV Translated title: Guidelines on lower limb venous system vascular assessment from SEACV vascular diagnosis chapter

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          Abstract

          Resumen Las guías de práctica clínica se han posicionado como una herramienta extremadamente útil, accesible y necesaria para llevar a cabo de forma adecuada el trabajo diario. El Capítulo de Diagnóstico Vascular de la Sociedad Española de Angiología y Cirugía Vascular viene desarrollando este instrumento de difusión, consolidación y homogenización del saber en la vertiente del diagnóstico vascular, que es la que le incumbe. La insuficiencia venosa de las extremidades inferiores es uno de los campos de estudio y diagnóstico clásicos más ricos y defendidos desde el Capítulo de Diagnóstico Vascular. Esta entidad ya ha publicado dos excelentes guías sobre este tema. Aunque a un ritmo menor y con una filosofía diferente a otro tipo de guías clínicas, las guías de diagnóstico también deben actualizarse para incorporar nuevas áreas de saber, cambiar puntos de vista o, simplemente, explicar los mismos hechos desde otras perspectivas. Con este ánimo presentamos esta nueva actualización de la Guía de la exploración venosa de los miembros inferiores, teniendo muy claro que no tratamos, ni mucho menos, de sustituir las ya publicadas, sino de complementarlas y sumarles conocimientos. Desde esta perspectiva, hemos plasmado los hallazgos ecográficos que podemos constar en un estudio venoso, hemos incluido un capítulo sobre la anatomía ecográfica “normal” de las venas de las extremidades inferiores, actualizando su nomenclátor, hemos pormenorizado con todo lujo de detalles lo que sería una exploración ecográfica venosa de miembros inferiores, hemos reservado un espacio para recordar y actualizar protocolos de estudio ecográfico de la trombosis venosa y, finalmente, y como tema estrella, hemos desarrollado todo un capítulo innovador sobre el estudio de la insuficiencia venosa pélvica.

          Translated abstract

          Abstract Clinical practice guidelines have positioned themselves as an extremely useful, accessible, and necessary tool to properly carry out daily work. The Capítulo de Diagnóstico Vascular of Sociedad Española de Angiología y Cirugía Vascular has been developing this instrument of dissemination, consolidation and homogenization of knowledge in the aspect of vascular diagnosis, which is the one that concerns it. Venous insufficiency of the lower limbs is one of the richest and most defended fields of study and diagnosis since the Chapter on Vascular Diagnosis. This entity has already published two excellent guides on this subject. Although at a lower rate and with a different philosophy than other kind of clinical guidelines, diagnostic guidelines must also be updated, incorporating new areas of knowledge, changing points of view, or simply, explaining the same facts from other perspectives. With this spirit we present this new update of the “Guide to the venous exploration of the lower limbs”, being very clear that we are not trying, far from it, to replace those already published, but to complement them and add knowledge. From this perspective, we have captured the ultrasound findings that we can record in a venous study; we have included a chapter on the “normal” ultrasound anatomy of the veins of the lower extremities, updating its gazetteer; we have detailed in great detail what would be a venous ultrasound examination of the lower limbs; we have reserved a space to remember and update ultrasound study protocols of venous thrombosis; and, finally, and as a star theme, we have developed an innovative chapter on the study of pelvic venous insufficiency.

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          Most cited references25

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          Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines.

          Nutcracker syndrome (NCS) describes left renal vein compression between the superior mesenteric artery and the aorta. Although uncommon, it is an important diagnosis due to the important morbidity associated with it, including the risk of chronic kidney disease from long-term left renal vein (LRV) hypertension and the risk of LRV thrombosis.
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            The venous system is, in many respects, more complex than the arterial system and a thorough understanding of venous anatomy, pathophysiology, and available diagnostic tests is required in the management of acute and chronic venous disorders. The venous system develops through several stages, which may be associated with a number of development anomalies. A thorough knowledge of lower extremity venous anatomy, anatomic variants, and the recently updated nomenclature is required of all venous practitioners. Effective venous return from the lower extremities requires the interaction of the heart, a pressure gradient, the peripheral muscle pumps of the leg, and competent venous valves. In the absence of pathology, this system functions to reduce venous pressure from approximately 100 mm Hg to a mean of 22 mm Hg within a few steps. The severe manifestations of chronic venous insufficiency result from ambulatory venous hypertension, or a failure to reduce venous pressure with exercise. Although the precise mechanism remains unclear, venous hypertension is thought to induce the associated skin changes through a number of inflammatory mechanisms. Several diagnostic tests are available for the evaluation of acute and chronic venous disease. Although venous duplex ultrasonography has become the standard for detection of acute deep venous thrombosis, adjuvant modalities such as contrast, computed tomographic, and magnetic resonance venography have an increasing role. Duplex ultrasonography is also the most useful test for detecting and localizing chronic venous obstruction and valvular incompetence. However, it provides relatively little quantitative hemodynamic information and is often combined with measurements of hemodynamic severity determined by a number of plethysmographic methods. Finally, critical assessment of venous treatment modalities requires an understanding of the objective clinical outcome and quality of life instruments available.
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              Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document.

              Non-uniform terminology in the world's venous literature has continued to pose a significant hindrance to the dissemination of knowledge regarding the management of chronic venous disorders. This VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology, focusing on terms that were identified as creating interpretive problems, with the intent of promoting the use of a common scientific language in the investigation and management of chronic venous disorders. The VEIN-TERM consensus document is intended to augment previous transatlantic/international interdisciplinary efforts in standardizing venous nomenclature which are referenced in this article.

                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                February 2023
                : 75
                : 1
                : 25-42
                Affiliations
                [2] Málaga orgnameHospital Quirónsalud orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular España
                [4] Bilbao orgnameHospital de Basurto orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular España
                [1] L'Hospitalet de Llobregat, Barcelona orgnameHospital Universitari de Bellvitge orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular Spain
                [3] Torrelodones Madrid orgnameHospital Universitario HM Torrelodones orgdiv1Servicio de Angiología, Cirugía Vascular y Endovascular España
                Article
                S0003-31702023000100025 S0003-3170(23)07500100025
                10.20960/angiologia.00440
                642634a8-5ca6-4712-b7cb-e9dd82047e82

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 13 June 2022
                : 01 September 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 18
                Product

                SciELO Spain

                Categories
                Artículos Especiales

                Doppler ultrasound,Venous insufficiency of lower extremities,Pelvic venous insufficiency,Ecografía Doppler,Insuficiencia venosa de extremidades inferiores,Insuficiencia venosa pélvica

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