Facilitated by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC; Moira Sykstus. MHA, CPCO, RRT, CHT
At the competition of this activity, participants should be able to:
Chronic Venous Insufficiency (CVI) affects millions of people in the United States. Late stage CVI (CEAP stages 3-6) is associated with lymphatic dysfunction that may be worsened by a genetic component. Unrecognized and treated improperly, the protein deposition and significant chronic interstitial fluid pressure can compromise micro arterial perfusion (rarefaction), resulting in chronic subcritical dermal ischemia and development of skin pathologic changes and ulceration. This program will emphasize how to diagnose and treat venous insufficiency and associated lymphedema of venous etiology (phlebolymphedema).
Technological diagnostic advances has shed light on the nanostructure and function of the endothelial luminal gel lining, now recognized as the glycocalyx. The functional purpose of the glycocalyx is mechanacotransduction of vessel luminal shear resulting in Endothelial cell production of various cytokines and nitric oxide (NO), a Permeability layer, to quench Inflammation, and to mitigate against Coagulation development (glycocalyx functions are EPIC). Glycocalyx “shedding,” caused by hyperglycemia, hypertension, hyperlipidemia, trauma, sepsis, tobacco, chemotherapy, may contribute to interstial edema development due to hyperpermeability of the microvasculature, which overwhelms the lymphatic capacity to transport fluid to the central lymphatic vessels and central venous system. An overwhelmed lymphatic system results in an inability to control interstitial edema and a resulting compromise in the local /regional immune function. Interstial edema may be the result of various etiologies (venous thromboses, trauma, medications, ischemia reperfusion). An understanding of the possible causes provide for improved recognition and treatment. This program will emphasize diagnosis and management of lower extremity edema and lymphedema.