Referat CVI

8/19/2019 Referat CVI

1/34

REFERAT

CHRONIC VENOUS INSUFFICIENCY

DISUSUN OLEH:

AMANDA ULFAH DEMILI

NIM 030.11.020

PEMBIMBING:

Dr. AGNES INDARTI, SPB(KV

KEPANITRAAN KLINIK ILMU BEDAH

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

RUMAH SAKIT TNI AL Dr. MINTOHARD!O


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DAFTAR ISI

HALAMAN

DAFTAR ISI..............................................................................................................i

KATA PENGANTAR.................................................................................................iii

BAB I PENDAHULUAN..........................................................................................1

BAB II PEMBAHASAN...........................................................................................2

2.1. DEFINISI............................................................................................................2

2.2. EPIDEMIOLOGI................................................................................................2

2.3. FAKTOR RISIKO...............................................................................................2

2.4. ETIOLOGI..........................................................................................................2

2.4.1. KONGENITAL.........................................................................................2

2.4.2. PRIMER....................................................................................................2

2.4.3. SEKUNDER.............................................................................................3

2.5. PATOFISIOLOGI................................................................................................3

2.6. MANIFESTASI KLINIS.....................................................................................6

2.7. DIAGNOSIS.......................................................................................................8

2.8. DIAGNOSIS BANDING....................................................................................11

2.9. PEMERIKSAAN PENUNJANG........................................................................11

2.9.1. NONIN!ASI!E TEST............................................................................11

2.9.2. IN!ASI!E TEST......................................................................................13

2.1". PENATALAKSANAAN...................................................................................15

2.11. KOMPLIKASI..................................................................................................18

2.12. PROGNOSIS.....................................................................................................18

BAB III ANATOMI DAN FISIOLOGI.....................................................................19

3.1. SISTEM SIRKULASI.........................................................................................19

3.2. !ENA..................................................................................................................21

3.2.1. ANATOMI !ENA....................................................................................21

1


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3.2.2. FISIOLOGI !ENA..................................................................................25

BAB I! KESIMPULAN............................................................................................29

BAB ! DAFTAR PUSTAKA....................................................................................3"

2


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KATA PENGANTAR

P#$i %'#( )*+#,i% #-)'+ '*/0i( T#/+ + M/ E% % %*, ,i)/+ (/

%*( '(#+iN& %*/i+ )*+#,i% 0) *+&*,*%i'+ (**( 0*++ $#0#, /(+i-!*+#% I+%#i-i*+-&:. P*+&*,*%i'+ (**( i+i i0' *(,*)% 0(i ;+#+ 0(i ;*(;i

)i/' #+#' i# )*+#,i% *+#-)'+ *(i'%i/ '*)0 <

1 0(. A+*% I+0(i S)B=K>! &+ *,/ *;i;i+ 0+ *;+# )*+#,i% 0,

*+&*,*%i'+ )*+%#++ (**( i+i.

2 S*,#(#/ 0'*( )*;i;i+ %%* ;*0/ 0i RSU TNI AL Mi+/($ &+ *,/

*;+# )*+#,i% %*, )*+&*,*%i+ (**( i+i.3 S*,#(#/ (*'+(*'+ A%%i%+ %%* B*0/ )*(i0* A#%#%O';*( 2"15 &+

*,/ *;+# )*+#,i% 0, *+&*,*%i'+ (**( i+i.

4 S*# )i/' &+ *;+# )*+#,i%+ (**( i+i.

P*+#,i% *+&0(i ;/? 0, )*+#,i%+ 0+ )*+%#++ (**( i+i %i/ *i,i'i

;+&' '*'#(++ ' 0(i i# '(ii' 0+ %(+ &+ *;+#+ %+ )*+#,i% /()'+.

J'( S*)*;*( 2"15

3


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BAB I

PENDAHULUAN

/(+i- @*+#% i+%#i-i*+-& =!I> )0 #+'i ;?/ 0i0*i+i%i'+ %*;i

'*,i++ 0*++ /i)*(*+%i @*+ &+ 0i%*;;'+ ,*/ )*(#;/+ ;+(, )0 %(#'#(

0+ #+%i @*+ ;i' i# @*+ *)i 0+ # @*+ 0, *(%#' @(i%*% 0+ '),i'%i+&.

G*$, &+ %*(i+ 0i$#)i 0,/ +&*(i (% ;*( , ;*+'' )*,*;(+ @*+ *)i

&+ *+-,' 0+ )*(#;/+ ?(+ '#,i.

Hi)*(*+%i @*+ 0+ /i)*(@,#* &+ *++# 0i+0i+ @*+ ;*%( %*( ')i,*(

'+ *+'i;'+ )*(#;/+ (,i 0+ #+%i. B*('#(++& ')i,*( )0 %0i#

,+$# !I 0+ 0+& i'((;%i% @*+ '+ *+#(+i %#),i '* '#,i 0+ #+'i+

*+'i;'+ #,'#% @*+. D, /, i+i $*,% 0+& )*(++ ))%i% *+0*, 0+

(#%'+& (i'% *'%(%*,#,*(.

T*(%#' +0+0 &+ *(,i/ 0,/ *,+i*'%i% @*+ (*i'#,*( # @(i%*%

@*+ *0* 0+ '*,i++ '#,i %*)*(i )i+*%i ,i)0*(%',*(%i% *-* 0+

#,%*(%i. !I ),i+ %*(i+ 0i%*;;'+ ,*/ )*(#;/+ )(i*( )0 0i+0i+ @*+ 0+ '#)

'#)+& 0+ %*'#+0*( 0i%*;;'+ ,*/ (;%i% %*;*,#+& 0+ '*#0i+ *+'i;'+

(*,#'% ;%(#'%i # '*0#+&. K(*+ ++*%i% 0+ )**(i'%+ ',i+i% i0' %*,,#

0) *+#+$#'+ %i %*( ,#%+& '*,i++ ' *,/ 0i'*;+'+ ;*;*() )*+*,ii+

0i+%i' #+#' *;*0'+ 0i%#+%i )) 0(i ;*(+& '*,i++ #+%i 0+

+i 'i; ;%(#'%i 0+ (*,#'%.

1


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BAB II

PEMBAHASAN

2.1. D*i+i%i<

K+0i%i 0i+0i+ # '#) )0 @*+ #+'i i0' ;*'*($ %*-( **'i %*/i+

*($0i '*0+ i+%#i%i*+%i 0+ *+i;#,'+ /i)*(*+%i @*+ #+'i. K+0i%i /i)*(*+%i

@*+ #+'i 0) *+&*;;'+ ;*(;i *$, %*)*(i +&*(i *0* #,%*(%i 0+

)*(#;/+ )0 '#,i.

2.2. E)i0*i,i<

P(*@,*+%i !I *+i+' %*i(i+ 0*++ )*(;/+ #%i. !*+ @(i'% *($0i )0

5 %)i 3" 0(i ))#,%i 0*?% 0+ ?+i ;*(;+0i+ )(i 0,/ 3 ;+0i+ 1.

P(*@,*+%i !I $# ,*;i/ i+i )0 ))#,%i E() 0i;+0i+ A%i # N*(.

2.3. F'( (i%i'< U%i

J*+i% '*,i+

Ri?& '*,#(

P/,*;ii%

Ri?& i+$#(i )0 #+'i

O;*%i%

K*/i,+

K*;i%+ %*)*(i ;*(0i(i , # )%#( % 0#0#'

2.4. Ei,i<

2.4.1. K+*+i,

B*+#' !I '+*+i, 0,/ &+ )' % ,/i( 0+ *+#+$#'+

'*,i++ )*('*;++ %(#'#( # +i 0(i @*+ *'%(*i% &+ *($0i %

)*('*;++ *#%. K*,i++ i+i ;i% *($0i )0 %(#'#( 0i+0i+ @*+ i0'

0+& '#) # '*,i++ ,'%i 0(i @*+. S,/ %#+& 0,/ &+ *($0i )0

%i+0( K,i))*,T(*+#+& 0i+ )0 %i+0( i+i +' ,/i( 0*++ +*@#%

i)%i,*(, &+ ++i+& '+ ;*('*;+ *+$0i @*+ @(i'% 0+ +#+

)*('*;++ )0 #+'i &+ *('*+.

2.4.2. !I P(i*( P*+&*;; !I )(i*( %i/ ;*,# 0) 0i*+#'+ 0+ *(#)'+ )*+&*;;

*(;+&' 0(i !I. D) 0i)*(i;+'+ %*;i +#+ )*('*;++ &+

;*(%i )((*%i. G+#+ i+i ;*(#, 0(i 0+& 0i,%i 0i+0i+ @*+ 0+

i+')**+ '#) @*+ &+ ++i+& '+ *+i;#,'+ ;*(;i *$,. B*+#'

&+ ),i+ )' %*-( ',i+i% 0,/ @*+ @(i'%. P0 %(#'#( '#) @*+

)' (i )((*%i )0 @*+ %)/*+.

2.4.3. !I S*'#+0*(

P0 !I %*'#+0*( *($0i %**,/ 0+& (;%i% )0 @*+. P(%*%

),i 0i#,i 0*++ ',#%i &+ *)*+(#/i ;*;*() 0i%(i;#%i '* %**+

2


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%**+ *'%(*i%. P0 '*0+ i+i %*;#/ )(%*% 0i+i% 0i+ (;#% #(

0+ *($0i (*('%i 0(i 0i+0i+ @*+ 0+ 0+& +*@%'#,(i%%i. S*,+ ;*;*()

?'# (;#% 0) 0i+i'+ ,*/ $,#( &+ )*+. H, i+i *+'i;'+

*($0i+& ;#++ +( ;%(#'%i 0*++ (*,#'% '(*+ (*'+,i%%i @*+ i0'

*i,i'i @*+ &+ #+%i+, 0+ (*'+,i%%i *+i+,'+ $(i++ %'( %i+*'i

0+ % )0 ,#*+. H, i+i 0) *($0i )0 P%/(;i- S&+0(* =PTS>

%*;i 'i; 0(i D!T 0+ (i% !i(-/? =%%i% @*+ /i)*('#,%i 0+ (#

*+0*,>.

2.5. Pi%i,i

P0 ;*;*() '%#% /i)*(*+%i @*+ 0i%*;;'+ ,*/ '#) &+ i+')**+

*)i ;*;*() '%#% ,i+ 0i'i;'+ ,*/ ;%(#'%i ,i(+ @*+ 0+ '*,+ ))

'i; ;*%i% # i;i,i% #+'i. T*'++ )0 @*+ #+'i 0i*+#'+ ,*/

0# ')+*+< ')+*+ /i0(%i' ;*(/#;#++ 0*++ ;*( ',# 0(/ 0(i

(i# '++ '* #+'i ''i 0+ ')+*+ /i0(0i+i' &+ ;*(/#;#++ 0*++

*'++ ,*/ '+('%i %'*,* #+'i 0+ *'++ 0, ')i,*(. K*0# ')+*+

i+i 0i)*+(#/i ,*/ '#) @*+. K#)'#) )0 @*+ 0) *+,*(+%i *'++

i+i )0 ;% *(*+# *)i '*i' *($0i 0, ?'# &+ , 0+ *+i+0#'%i

3


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*($0i+& (*0*,i+ '#) 0+ (*,#'% 0) *($0i &+ *+'i;'+ *'++ i+i

)0 0i+0i+ @*+. P*(#;/+ ),i% &+ *($0i )0 '#) @*+ &i# *(*+

(;*' 0*%i +( 0#+ '#).

K*i' '#) )0 @*+ )*(( i+')**+ )*+i+'+ *'++ )0 @*+

0, &+ 0i)i-# ,*/ '+('%i 0) 0i(+%i%i'+ '* %i%* @*+ %#)*(i%i,

0+ i'(%i('#,%i )0 '#,i. O,*/ '(*+ i# +0 ',i+i% 0(i !I 0(i 'i; *'++

@*+ %)i ,*;i/ 0(i +(, 0) *($0i 0, ?'# &+ )+$+. D(/ &+

*()#+ -#'#) , *+&*;;'+ 0i%*+%i )0 @*+ #+'i 0+ 0i%(%i )0 '#)

@*+.

P*(#;/+ %(#'#( )0 0i+0i+ @*+ 0,/ 0+& /i)*((i 0i+0i+ @*+ 0+

0+& )*+i+'+ ',*+ ;*(%+ 0*++ +#+ %(#'#( )0 ),% 0+

%*( *,%i+ 'i;+& 0,/ )*(;*0+ +( 0i+0i+ @*+. I(*#,(i% )0 0i+0i+@*+ *i-# *($0i+& +#+ ,i(+ &+ #(;#,*+ 0+ *+&*;;'+ +#+

shear stress. T)'+& )(%*% i+,%i *+i'#%*('+ i+*('%i *+0*,i,,*'%i

0+ 0+& i+i,(%i '( 0+ +%i '* 0#+ '#) 0+ 0i+0i+ @*+. H, i+i

*i-# *($0i+& +#+ ,i(+ &+ )*+i+ #+#' *+&*;;'+ )*(#;/+ 0i+0i+

0+ '#) @*+.

4


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P0 % i+,%i *($0i ' '+ *($0i )*+i+'+ )*(*;i,i% )0

')i,*( &+ *+'i;'+ *($0i+& *0* 0+ *'%(@%%i %*, 0(/ *(/ &+

*+i+''+ $#,/ *(ii+ 0+ i+ *(i 0i '#,i &+ *('*+.

!(i'%i% @*+ *(#)'+ +i*%%i &+ ),i+ %*(i+ )0 !I '+&

0i%*;;'+ ,*/ 0& *,%i%i% &+ ;+(, )0 $(i++ i' 0i+0i+ @*+ %*(

'#)+&. !(i%*% )(i*( *(;*+#' 'i; 0i,%i @*+ +) (;%i% %*;*,#+&

%*0+'+ @(i%*% %*'#+0*( 0i%*;;'+ ,*/ '*(#%'+ '#) %**,/ D!T 0+

(*'+,i%%i &+ '*#0i+ *+&*;;'+ @*+ 0, 0+ )*(( *+$0i

i+')**+. A'i;+& 0,/ 0(i+%* @*+ &+ ;*('#(+ %*( /i)*(*+%i @*+ &+

*+i+i'+ *'++ (+%#(, )0 )*;#,#/ '/i( ')i,*( 0*++ 'i; '*(#%'+

')i,*( '#,i *'%#0%i -i(+ *0* 0+ ,+#(i%i $(i++ &+ )0 i,i(++&

*+#+0+ i+,%i i+*'%i (;%i% 0+ +*'(%i% $(i++ 0*++

,i)0*(%',*(%i% 0+ '/i(+& #,%*(%i. G+#+ )0 i'(%i('#,%i i+i *(#)'+

%%(+ *('/i( )0 /i)*(*+%i @*+.

M*+i+'+& *'++ )0 @*+ #$#+ i'(%i('#,%i '+ -*+0*(#+ *+#(#+'

*'++ )*(#%i 0+ *i+''+ *'++ i+(')i,*(. P0 )%i*+ 0*++ ##( ,+$#

&+ ;i%+& 0i%*(i 0*++ )*+&'i (*(i )*(;*0+ *'++ %*)+$+ ')i,*( '+

*(#% ;*(;/. Mi'(%i('#,%i &+ ;+(, '+ *+'i;'+ ,0i%(i;#%i ,i(+

0(/ 0+ '(*++& '+ *(;*+#' 0*(/ i%'*i'.

S*, /i)*(*+%i @*+ ;*(,+%#+ ')i,*( '+ *,*;( 0+ '*-*)+ ,i(+

'+ ;*('#(+. K;i+%i %*# '( i+i '+ *+#(#+'+ 0& ,i(+ 0,

i'(%i('#,%i &+ *#0/'+ *($0i+& )*+i+'+ ,*#'%i &+ '*#0i+ '+

*+&*;;'+ )*(,*+'*+ &+ *+*) 0(i ,*#'%i )0 *+0*, @*+. L

'*,+ ,*#'%i i+i '+ *+$0i 'i 0+ *+*,#('+ (0i', ;*;% %*( *+i

)(*,ii' 0+ 0*++ 0*i'i+ *(#%' *+0*, 0+ i'(%i('#,%i.

A'i; *'++ @*+ &+ *+i+i )0 i'(%i('#,%i *'%(*i% &+ *(,i;

*+&*;;'+ ;*(;i )*(#;+ (,i' *(%#' '*,i++ #+%i /*(*,i'*+i+'+& )*(*;i,i% ')i,*( %*( '*,i++ *;,i%* i;(i+*+ %)i

*($*;'+& %*, ,*#'%i. D) 0i%i)#,'+ ;/? %*# *$, 0+ '),i'%i 0(i

!I 0i%*;;'+ ,*/ '+%*'#*+%i i'(%i('#,%i 0+ /i)*(*+%i @*+. P*(#;/+

i'(%i('#,%i &+ *($0i+& 0,/ 0+& )*(*;i,i% ')i,*( &+ *+i+i

)*(#;/+ /*(,i' ,',. P*(;*0+ 0, i+' !I 0i*+#'+ ,*/

'*%*i;++ &+ 0i0) +( *'++ i'(/*0i+i' 0(i ')i,*( 0(/ ,i*

0+ $(i++ i+*(ii,.

2.6. M+i*%%i K,i+i%

5


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!I *)*(,i/'+ *$, 0*++ %)*'(# &+ ,#% #,i 0(i *,+i*'%i%

%)i '* i;(%i% '#,i 0+ #,%*(%i. P*(,# 0ii+ ;/? *$, ',i+i% &+ % 0)

*($0i 'i; ;*;*() *'+i%* %*)*(i '#) &+ i+')**+ %$ ;%(#'%i @*+

%$ 0+ 0i%#+%i )) # ';i+%i.

M+i*%%i ',i+i% # )0 !I 0,/ 0i,%i @*+ *0* +&*(i #+'i 0+

)*(#;/+ )0 '#,i. !*+ @(i'% 0,/ @*+ %#)*(i%i, &+ *+,i 0i,%i 0+

%*-( )((*%i *;*%( 0+ ;*(;*,' 0i%*(i 0i%*+%i (+%@*(% &+ *+&*;;'+

)*;*+0#++ &+ *(,i/ 0+ 0) 0i),)%i. E0* ;*(#, 0i 0*(/ )*(i,,*,(

0+ %*'i+ '*% *(+#+ 0(i '##,%i -i(+. N&*(i #+'i 0i0*%'(i)%i'+

%*;i #+'i &+ *(% ;*( # +&*(i %**,/ ;*(0i(i , 0+ *+/i,+ %**,/

#+'i 0ii+i'+. O;%(#'%i @*+ 0, *+&*;;'+ -,#0i-i @*+ # '(

)0 #+'i &+ *($0i 0*++ )*(*('+. P*(#;/+ )0 '#,i &+ *($0i 0,/

/i)*()i*+%i 'i; 0*)%i%i /*%i0*(i+ 0+ 0*(ii% *'%*#%. Fi;(%i%

#+'i+ *($0i )0 '#,i 0+ %#;'#+ =,i)0*(%-,*(%i%>. T*(0) )*+i+'+

(i%i' *($0i+& %*,#,ii% #,%*(%i #+'i 0+ )*+&*;#/+ ,#' &+ ,;.

M+i*%%i ',i+i% !I 0) 0i,i/ )0 ',%ii'%i ',i+i%. K,%ii'%i EAP

=Clinical, Etiology, Anatomic, Pathophysiology> 0i'*;+'+ ,*/ '+%*+%#%

i+*(+%i+, #+#' %*;i ;%i% 0i+%i% 0+ )*+;+ !I.

K,%ii'%i ',i+i' => ;*(0%('+ +0+0 ',i+i% & ;$*'i 0i;/

0*++ /%i, )*+*#+ 0*++ =A> #+#' %i)i' i%,+& "6A # #+#'

#+'i %i)i' "6S. T*(%#' '*0, *$, &+ *+(/ '*)0

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0i%#+%i @*+ 0,/ )*, +&*(i ',#%i i(i%i '#,i 0+ '( . K,%ii'%i ',i+i%

i+i 0i'*+, %*;i )*+&'i &+ 0i(%'+ %*'i+ , %*'i+ ;*(. T*()i 0)

*+;i +0 0+ *$, ',i+i% 0i+ /(#% 0i0'+ (*',%ii'%i.

T*,+i*'%i% 0,/ @*+#, &+ *,*;( %)i '#(+ 0(i 1

%*0+'+ @*+ (*i'#,*( *+&*(+ @*+ %*+ + # )(@ &+ ##+&

'*-i, 0+ ;*('*,' /*;. !(i%*% @*+ '+ *(; $*,% 0+ *,*;( ,*;i/ 0(i 4 .

T*,+i*'%i% 0+ @*+ (*i'#,*( 0i;*0'+ 0(i @(i%*% @*+ 0, ',%ii'%i i+i

'(*+ *,+i*'%i% 0i+) i0' '+ *+$0i #,'#% %*0+'+ )0 @*+

(*i'#,*( '*#+'i++ #,'#% 0) *($0i.

K,%ii'%i *i,i =E> 0i'*+, %*;i 0i%#+%i @*+ 0, i ;*+#'

'+*+i, )(i*( 0+ %*'#+0*(. U+#' '+*+i, +i*%%i ',i+i% 0) *(,i/

$*,% %**,/ ,/i( # ;(# 0i'*/#i '*#0i+. U+#' )(i*( i0' 0 )*+&*;;

&+ $*,% %*0+'+ %*'#+0*( '+0i%i ),i% %*)*(i (;%i% *;*(i'+

;(+ &+ '/%.

K,%ii'%i +i =A> *+;('+ ,#% +i &+ *(,i; )0

)*+&'i @*+ )'/ %i%* @*+ %#)*(i%i, =A%> 0, =A0> 0+ )*(( =A)>

&+ *(,i; 0) %# 0# # '*i %i%* @*+.

K,%ii'%i )i%i,i =P>. T+0+0 0+ *$, ',i+i% @*+ #+'i+0i%*;;'+ ,*/ (*,#'% =PR > ;%(#'%i =P> # '*0#+& =PR>.

2.7. Di+%i%

. A++*%i%<

U+#' *+*+#'+ '( (i%i' 0+ )*('*;++ )*+&'i

;. P**(i'%+ i%i'<

I+%)*'%i< *+#+'+ ',%ii'%i EAP

7


12/34

P,)%i<

E0*< )ii+ 0+ ;(+ brawny

P**(i'%+ '/#%#%<

P**(i'%+ T#(+iC* =T(*+0*,*+;*(>< )**(i'%+ 0i,'#'+ 0*++ -(

)%i*+ ;*(;(i+ #+#' *+%+'+ i%i @*+ #+'i. S**,/ i# )%i*+

0i)%i%i'+ *' # 0i,'#'+ )*+*'++ +#,. Bi, @*+ %**( *(i%i 0(i

)('%i, '* 0i%, ;*((i *($0i i+%#i%i*+%i '#) @*+ %*+*(, #)#+

'#) 0i 0, @*+ %*+ + #)#+ @*+ %*+ )(@.

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P**(i'%+ P*(/*% *(#)'+ )*+#$i+ *(/0) %i%* @*+ 0,. Ji'

*(0) @(i%*%. P0 '*0+ ;*(0i(i % @(i%*% )*+#/ ,i) )/ 0ii' %*/i+

@*+ %*+ + *(##). S*,+$#+& )*+0*(i 0ii+ ;*($,+ 0i *)

%*/i+ #+%i )) ;i'. Ji' @(i%*% ;*(+%#(+%#( /i,+ (i+& %i%*

@*+ *0i.

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E@,#%i )*( )0 )%i*+ 0*++ !I *(0i(i 0(i )*+*+#+ 0 i0'+& (*,#'%

;%(#'%i # '*0#+&. D*++ )*(,++ #,(%#+0 0)),*( %*0*(/+ 0i0)'+

i+(%i 0+& (*,#'% )0 *) )*(*#+ %*+*(, 0*(/ )),i* 0+ @*+

*)i %*( ;%(#'%i )0 %**+ *()),i*, # i,**(, =%)i 8"9" 0(i

$#,/ )%i*+>. ( %*0*(/+ 0, *i,i/ )**(i'%+ &+ *) 0,/ 0*++

*;i i+@*%i%i 0i+%i% 0, 3 i+'<

3. Ti+' 1< *,i)#i )**(i'%+ ',i+i% =++*%i% )**(i'%+ i%i' &i# *@,#%i

%i('#,%i (*(i %*( )**(i'%+ @*+ 0*++ 0)),*( %*0*(/+>

4. Ti+' 2< *,i)#i )**(i'%+ ++i+@%i =0#),* %-++i+ ),*i%(i>

5. Ti+' 3< *,i)#i )**(i'%+ i+%i =%-*+0i+ 0+ 0*%-*+0i+ phlebography

)*+#'#(+ *'++>

K*i i+' i+i 0) 0i+'+ )0 )*+*+#+ ',%ii'%i ',i+i% 0(i EAP

i%,+&< '*,% "1 (i+& i0' *(,i/ # *(; )*+&'i @*+ *,+i*'%i% # @*+

(*i'#,(. D, /, i+i )**(i'%+ i+' 1 ;i%+& %#0/ -#'#). K*,% 2 0i+ 0i0)

@(i%*% @*+ +) *0* # )*(#;/+ '#,i #+#' @(i%*% @*+ %*+ + -#'#)

0*++ i+' 1 )i ,*;i/ ;i' 0*++ 0i,'#'+ )**(i'%+ #+'i. H)i( %*#

@(i%*% )(i*( *(%#' '*,)' i+i. P%i*+ 0*++ @(i%*% @*+ &+ ';#/ 0+#

)*(+/ *+0*(i D!T %*;i'+& 0i,'#'+ 0#),* %-++i+ 0+ ;i, /%i,+& *+#+$#'+

10


15/34

(*,#'% # ;%(#'%i )0 %i%* @*+ 0, ' %*;i'+& 0i,'#'+ i+@*%i%i )0

i+' 3. K*,% 3 ;i, *0* 0*++ # +) @(i%*% @*+ 0+ i0' 0 )*(#;/+ '#,i.

I+@*%i%i i+' 2 0i)*(,#'+ #+#' *+*+#'+ 0 i0'+& (*,#'% # ;%(#'%i

)*+&*;; *0*.

2.8. Di+%i% B+0i+

Di;*0'+ 0*++ %#;+ (*(i *+/#+

S#;+ (*(i *+/#+ S#;+ @*+ *+/#+

U,'#% i%'*i #,i 0(i #$#+ $(i '*(/

#i

U,'#% %%i% 0i 0*(/ ,*#,#% *0i,i%

D%( #,'#% )#- D%( #,'#% *(/

L*;i/ +&*(i )0 ,/ /(i ;i, ''i

0ii+i'+

L*;i/ +&*(i ;i, #+'i 0i+#+

E0* $(+ 0 E0* *(#)'+ *$, # )0 %i+

/(i

D*+ +0i '*-i, i0' 0 D*+ +0i 0

P*(#;/+ ?(+ '#,i *(+#+ )%i%i P*(#;/+ ?(+ '#,i i0' *(+#+

)%i%i

K,#0i'%i i+*(i*+ N&*(i ;i, ;*(0i(i , ;*('#(+ ;i,

;*($,+

Di;*0'+ 0*++ )*+&*;; *0* &+ ,i+. 'i; )*+&'i %i%*i' %*)*(i , $+#+ %i+0( +*(i' %i(%i% /*)i%

;. 'i; )*+#++ ; %*)*i B NSAID

Di;*0'+ 0*++ D!T # ;%(#'%i @*+ ,i++&

Di;*0'+ 0*++ '*,i++ ,', ,i+

R#)#( 'i% )),i* (;*'+ %('+*i#% ,&)/*0*

2.9. P**(i'%+ P*+#+$+

2.9.1. Non-invasive test:

a. D#),* %-++i+

T*'+i' i+i 0i#+'+ #+#' *+'+i(%i 0i+%i% !I %*(

*+*/#i *i,i 0+ i+' '*)(/+&. M*+';i+%i'+ B0*

ii+ 0(i @*+ %#)*(i%i, 0+ 0, 0*++ )**(i'%+ 0)),*(.

P**(i'%+ i+i 0) *;*(i'+ i+(%i 0i ;i+ + %i%* @*+

%#)*(i%i, 0, %*( )*(( &+ *('*+. P**(i'%+ 0#),* @*+ %+0(

0,/ #+#' *+&i+'i('+ D!T # ;%(#'%i @*+ ,i++&. K)(*%i;i,i%

@*+ &+ 0i,i/ 0*++ ,i(+ 0,/ '#+-i #+#' *+&i+'i('+ (;%i%.

A(/ ,i(+ 0i)*(i'% 0, )%i%i 3" (*@*(%* T(*+0*,*+;*( % 0i,'#'+

+#@*( )(@'i %*)*(i @,%@ +#@*( # %**,/ )*+*'++ )0

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#+'i. P*+#++ i+,%i0*,%i -# 0i+ 0i,'#'+ 0*,%i -# %*-(

-*) )0 )%i%i ;*(0i(i 0) *+i+0#'%i *($0i+& (*,#'%.

A0+& (*,#'% 0) 0i+i,i 0*++ (/ 0(i ,i(+ '(*+ ,i(+ %i+ii'+

'* (/ ''i *+i+0i'%i'+ 0+& (*,#'%. D#(%i 0(i (*,#'% 0i'*+, 0*++

rel!" time. #el!" time "51 0*i' *+&'+ 0+& (*,#'% %*'i+ ,

0#(%i (*,#'% ' %*'i+ ;*( )*+&'i *(%*;#. T*)i 0 /#;#++ &+

,*/ +( '*)(/+ )*+&'i 0*++ 0#),* %-++i+ ;i' %*-( 0i)*(i'%

0*++ ,*i%(i # 0i,i/ )0 +i*%%i ',i+i%.

,#)#+ 0+& '*'#(++ i+i *)i 0#),* %-++i+ 0) *+*+#'+

)0 @*+ &+ + &+ *($0i '*,i++ '#) %*/i+ 0) %*;i

)*0+ 0, *()i.

b. Air plethysmography

M)# *+#'#( i ')+*+ =(*,# ;%(#'%i 0+ '*,i++ #+%i

)) > &+ %-*( ;*(% *+&*;;'+ /i)*(*+%i @*+ %*;i 'i;

0(i (#% ;,i' @*+ &+ *(+#. A, i+i *(0i(i % '(#+ i+ ;*(;*+#'

)i) &+ *+*,i,i+i %*,#(#/ #+'i %*)+$+ 35 -.

K(#+ +i+ 0ii%i #0( %)i 6 H 0+ 0i/#;#+'+ 0*++ %##

, ',i;(%i. I%i @,#* @*+ )0 #+'i +(, 0,/ 8"15" ,. + ;i%

+i' /i++ 4"" , )0 !I. Air plethysmography *;*(i'+ i+(%i &+

0i0) 0(i %*,#(#/ #+'i %*-( '*%*,#(#/+ 0i0)'+ '*%+ ;/?

;*(+& (*,#'% ;*(/#;#++ 0*++ 0*($ )*+&'i+&. D*++ *'+i' ',#%i

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)0 !I *(0) /i)*(*i &+ '+ *+i+' %*%#i 0*++ ;*(+&

)*+&'i.

2.9.2. $nvasive test

. Amb!latory veno!s press!re =A!P>

A0,/ -( *(;i' #+#' *+#'#( /i)*(*+%i @*+. P0 ;%*(@%i *'++

@*+ 0i ''i ;*('#(+ )0 % ;*($,+ '*#0i ;*(+%#(+%#( '*;,i '*

+i,i +(, );i, ;*(/*+i. T*'+i' i+i 0i,'#'+ 0*++ *+#%#'+ $(# '*

@*+ )*0i% 0+ 0i%;#+'+ 0*++ (+%0#%*( &+ *;*(i'+ *'++.

T*'++ $# 0i+i( %*;*,# 0+ %*%#0/ )*%++ c! )0 )*(*,++

''i #+#' *;*0'+ (*,#'% @*+ 0, # @*+ %#)*(i%i,. A;+

*'++ A!P =+(,+& 0,/ 2" %)i 3" H> 0+ ?'# )*+i%i+

=+(,+& 0,/ 182" 0*i'>.

b. Phlebography

Phlebography # @*+(i *(0i(i 0(i ascen%ing 0+ %escen%ing.

Ascen%ing phlebography

P**(i'%+ i+i )*(,# 0i,'#'+ )0 @(i%*% &+ ';#/ )%-

)*(%i )%i*+ 0*++ @(i%*% #+i,*(, 0+ # )%i*+ &+ ;*(##(

2" /#+ %*( )0 '*#+'i++ D!T #+#' *+i,i @*+ )*(( 0i

0*(/ '+,i% /#+*( 0i *#(. G;(+ ,*;( 0i 0) %**,/

*+#%#'+ %,/ %# @*+ 0i''i 0+ *++i'+ '+(% '*0,+&

%*0+'+ #+#' *)*('+ @(i%*% # i+%#i%i*+%i %i%* @*+

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0, 0i,'#'+ )*+*'++ 0i 0*(/ ,*,#%. P**(i'%+ i+i #+#'

*)*(,i/'+ @*+ &+ +(, *+*%'+ +i 0+

*;*0'+ )*+&'i+& )'/ )(i*( # %*'#+0*(.

&escen%ing phlebography

T#$#+ )**(i'%+ i+i 0,/ #+#' *)*(,i/'+ (*,#'% )0

@*+ *)i # @*+ 0, %*( #+#' *+*+#'+ ii' '*;-(+ 0(i

)+#, '* #+'i ;?/ 0+ 0(i @*+ 0, '* @*+ *)i #

%#)*(i%i,. J# 0i#+'+ #+#' *+0)'+ i+(%i *+*+i

,',i%%i +i 0+ (,i '#) @*+ *+'%i( ,#%+& (*,#'%*+;('+ +i@*+ )0 '%#% &+ %#'( 0+ *;*0'+

)*+&'i @*+ )(i*( 0*++ %*'#+0*(.

A0 5 ,++ (*,#'% ,*;(i 0i,#'i%'+ %*;i ;*(i'#<

o G,++ "< i0' 0 (*,#'% 0i ;?/ )*(*#+ @*+

*(,i% %#)*(i%i, 0+ )(#+0

o G,++ 1< (*,#'% '* 0, @*+ *(,i% %#)*(i%i, )i

i0' 0i ;?/ %**+/ )/

o G,++ 2< (*,#'% '* 0, @*+ *(,i% %#)*(i%i, )i

i0' %)i @*+ )),i* ='#) @*+ )),i* ')**+>

o G,++ 3< (*,#'% %)i )*(%i% 0i;?/ ,## ='#) @*+ 0i

#+'i ;?/ ')**+>

o G,++ 4< (*,#'% %)i '* #i =0(i *(, )),i*

#+'i ;?/>

2.1". P*+,'%++

T*()i ?, )0 !I 0,/ '+%*(@i #+#' *+#(+i *$, 0+ *+-*/

)*('*;++ '),i'%i 0+ )((*%i )*+&'i. P0 !I *'+i%* &+ ),i+

*++$, 0,/ ;*('#(++& @,#* ,i(+ 0(/ %*( ;*(;/+& $#,/ ,i(+

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@,#* ' *()i 0i(/'+ '*)0 )*+#(++ *'++ /i0(0i+i' +( ')i,*(

&i# 0*++ *,*@%i #+'i )*+;/+ *'++ +( %*, 0*++ ')(*%i

)*+;/+ *'++ %i' +( ')i,*( 0*++ )*+#++ ; 0i#(*i'. S##

';i+%i 0(i 0# # %*# -( *(%*;# *(#)'+ *()i 0%( ;i ''i &+

;*+'' 0, %*, ;*+#'.

T,'%+ &+ %)*%ii' *(+#+ )0 '*)(/+ )*+&'i ',%ii'%i ',i+i%

EAP i+' 4 %)i 6 %*(i+ *;##/'+ )*+,'%++ &+ i+@%i. P%i*+

)0 i+' i+i );i, i0' *('(*'%i ;*(i%i' #+#' *($0i+& #,%*(%i #,%*(%i &+

(*'#(*+ 0+ #,'#% @*+ &+ i0' %*;#/ 0*++ i+*'%i &+ )((*%i 0+

,&)/*0*.

Elastic compression stoc'ing *(#)'+ *()i ?, #+#' %*# ',%ii'%i ',i+i%

EAP. U'#(+ &+ *) %+ )*+i+ 0, '*;*(/%i,+ )*(?+.P*+#'#(+ /(#% *+-+#'+ i+(%i *+*+i *'++ )+$+ 0+

0i**(. P*+#'#(+ *'++ ;*(0%('+ '*)(/+ ',i+i% *'++ 2"3" H #+#'

EAP '*,% 23 *'++ 3"4" H #+#' EAP '*,% 46 0+ *'++ 4"5" H

#+#' #,'#% @*+ &+ (*'#(*+. U'#(+ )+$+ &+ ,*;i/ %*(i+ 0i#+'+ 0,/

%*i+i ,## '(*+ '*)#/+ )%i*+ ,*;i/ ;*%( 0+ 0*'# 0, *(i++'+

*$,. P*+#++ %*i+i )/ # )i++ #+'i+ 0i)*(,#'+ #+#' *0* &+

,*;i/ i+i 0(i ,## *)i stoc'ing i+i ,*;i/ %#,i #+#' 0i#+'+. P*+#'#(+

0i**( 0i,'#'+ '*i' ''i i0' 0, '*0+ ;*+''.

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P*(?+ '#,i 0+ ,#' 0i,'#'+ '(*+ )*('*;++ )*+&'i !I 0)

;*(#$#+ )0 +#+ i+*(i% '#,i ,*/ '(*+ i# )*+i+ #+#' *;# (*

&+ *('*+ *) ,*;) #+#' *+#(+i (i%i' '*(#%'+ '#,i 0+ '*#+'i++

i+*'%i. P0 %%i% 0*(ii% 0) 0i;*(i'+ %*(i0 )i',. U+#' #,'#% @*+ 0)

0i;*(i'+ 0(*%%i+ 0*++ /i0(',i0 #+#' *++(, 0(i+%* -i(+ )0 ,#'.

S',*(*()i 0) 0i*()'+ )0 ;*;*() ;*+#' EAP. T*()i i+i 0)

0i;*(i'+ %*;i *()i )(i*( # 0i';i+%i'+ 0*++ )(%*0#( )*;*0/+ #+#'

*+(*'%i !I. B*;*() *+ %',*(%i% 0,/ %0i# ',(i0 &+ /i)*(+i% 0i+

%',*(+ i+i *+&*;;'+ 0*/i0(%i )0 %*, (* 0*++ -( (0i*+ *'++ %i'

&+ ,*;i/ ;*%( *+'i;'+ i( ,*;i/ -*) #+#' *,*?i *;(+

%*i)*(*;*,. S',*(+ ,i+ %*)*(i %0i# *(0*-&, %#,* ),i0-+, 0+ %0i#

((/#* ;*(#+%i %*)*(i 0**(*+. A*+*+ %',*(+ i+i *;*+#' %',*(%i% #

)*+*(%+ )0 %*, (* %*/i+ %*, *(%*;# *+,i 0*%(#'%i 0i+ )0 @*+

&+ *+,i @(i'% # *,+i*'%i% @*+ *(%*;# *(0*%(#'%i %*/i+ ,i(+

0(/ *,*?i $,#( @*+ &+ ,*;i/ %*/.

Ablative therapy with en%oveno!s ra%iore(!ency an% laser 0,/ *()i 0*++

*+*(i *(, &+ ;*(%, 0(i (0i(*'#*+%i # ,%*( #+#' ;,i*(%i @*+. T*'+i' i+i

%*(i+ 0i*()'+ )0 (*,#'% @*+ %*+ + 0+ *(#)'+ ,*(+i 0(i *'+i'

;*0/ stripping. E+*(i )+% *i-# i+$#(i *(, )0 0i+0i+ @*+ &+ '*#0i+

*($0i (;%i% 0+ i;(%i%. K),i'%i 0(i *'+i' i+i 0,/ i+$#(i +*(@#% %*+#%

0+ D!T. T*'+i' i+i 0i,'#'+ 0*++ +*%*%i #+#' *+-*/ *($0i+& ,#' ;'(

)0 '#,i 0+ *+#(+i +&*(i.

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T*()i *+0@%'#,( 0i,'#'+ #+#' *+*;,i'+ ,i(+ @*+ 0+ *+#(+i

;%(#'%i 0*++ *,'#' %*+ )0 @*+.

T*'+i' ;*0/ /+& 0i,'#'+ )0 ''i ;*+'' &+ '*0++& ;#(#' %*',i

0+ *(#)'+ %## *()i &+ *(i++'+ %*)*(i )0 )%i*+ &+ %)i

*+,i 0i%;i,i% # #,'#% @*+ &+ i0' *+&*;#/ ?,#)#+ 0*++

)*+;+ '%i,. T#$#+ )*;*0/+ ;#'+ #+#' *++i *()i '+%*(@i

)i #+#' *;#+& ,*;i/ *i%i*+.

Li%i %(i))i+ 0+ ,*;*'i 0) 0i,'#'+ )0 %*# i+'+ ',%ii'%i

',i+i% EAP 0*++ (*,#'% @*+ %#)*(i%i, 0+ *()i i+i *+#+$#'+ )*('*;++

;i' )0 /*0i+i' 0+ *+#(+i *$, %*( *;+# )*+&*;#/+ #,'#%

@*+. D*++ 0i,'#'+ ,i%i i+i )0 saphenoemoral )!nction 0+ 0i,'#'+

,*;*'i )0 @*+ @(i'% &+ ;*(/#;#++ 0*++ @*+ %*+ &+ i+')**+.*!bascial en%oscopic perorator s!rgery +*EP* 0i,'#'+ 0*++ *,i%i @*+

)*(( *)i 0) ;*('i; *($0i+& *'++ i+i )0 @*+ %#)*(i%i,. O,*/

'(*+ i# ,i%i )0 @*+ )*(( &+ i+')**+ 0i,'#'+ 0*++ '%*% @*+

&+ $#/ 0(i 0*(/ &+ *+,i ,i)0*(%',*(%i% # #,'#% @*+.

R*'+%(#'%i '#) @*+ # @,@#,),%i *,/ *+#+$#'+ )*(;i'+ )0

i+')*+ '#) %*'i( 59 0+ ?'# ;*;% (*'#(*+%i #,'#% 0, 3" ;#,+ %*;+&'

63. K),i'%i 0(i @,@#,)%i 0,/ )*(0(/+ '(*+ )%i*+ *) 0i;*(i'+

+i'#,+ D!T *;,i )(# 0+ i+*'%i )0 ,#'.E0#'%i )0 )%i*+ %#)& *()i *(%*;# 0) ;*(/%i, %*-( )i, %*)*(i

*+i+i'+ *'%(*i% ;?/ % ;*(i%i(/ *+#(+i ;*(0i(i # 0#0#' ,

0+ *+#(+i ;*( ;0+.

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2.11. K),i'%i

D**) !*i+ T/(;%i%

E;,i )(#

M*#0/'+ *($0i+& i+*'%i

2.12. P(+%i%

A0 @i< 0 ;+

A0 #+-i+< 0#;i 0 ;+

A0 %+i+< 0#;i 0 ;+

BAB III

ANATOMI DAN FISIOLOGI

3.1. Si%* %i('#,%i # %i%* '(0i@%'#,( *++('+ +#(i*+ 0+ '%i*+ '* %*,#(#/

#;#/. T*(0i(i 0(i i ')+*+ 0%( &i#<

1. J+#+ %*;i )) &+ *,'#'+ *'++ *(/0) 0(/ #+#' *+i;#,'+

(0i*+ *'++ &+ 0i)*(,#'+ ( 0(/ 0) *+,i( '* $(i++. D(/

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%*)*(i -i(+ ,i+ *+,i( 0(i 0*(/ ;*(*'++ ,*;i/ i+i '* 0*(/ ;*(*'++

,*;i/ (*+0/ %*%#i )*+#(#++ (0i*+ *'++.

2. P*;#,#/ 0(/ ;*(#+%i %*;i %,#(+ #+#' *+(/'+ 0+ *+0i%(i;#%i'+

0(/ 0(i $+#+ '* %*# ;i+ #;#/ 0+ '*#0i+ *+*;,i'++& '*

$+#+.

3. D(/ ;*(#+%i %*;i *0i# (+%)(%i *) ;/+;/+ &+ 0i%,#('+

0i,(#'+ # 0i*+0)'+.

D(/ ;*($,+ %*-( '+i+# *,,#i %i%* %i('#,%i '* 0+ 0(i $+#+ *,,#i 0#

,*+'#+ @%'#,( *()i%/ '*0#+& ;*(?, 0+ ;*('/i( 0i $+#+. T*(0i(i 0(i %i('#,%i

)(# 0+ %i('#,%i %i%*i' 0i+ %i('#,%i )(# *(0i(i 0(i ,*+'#+ *(##) @%'#,( &+

*++'# 0(/ +( $+#+ 0+ )(# %*0+'+ %i('#,%i %i%*i' *(0i(i 0(i @%'#,(

&+ *++'# 0(/ +( $+#+ 0+ %i%* (+.

D(/ &+ '*;,i 0(i %i('#,%i %i%*i' %#' '* (i# '++ *,,#i @*+ -@.

D(/ &+ %#' '* (i# *(%*;# '*;,i 0(i $(i++ #;#/ 0+ *,/ *($0i )*(#'(+

O2 '* %*, 0+ O2 '* 0(/. D(/ &+ *,/ *+,i 0*'%i*+%i *(%*;# *+,( 0(i

(i# '++ '* @*+(i'*, '++ &+ *)+& '*,#( *,,#i (*(i )#,+,i% '*

)(#. Di 0, )(# *($0i '%i*+%i 0+ '*/i,++ O2 '*#0i+ 0i ,i('+ '* (i#

'i(i *,,#i @*+ )#,+,i%. D(/ '& '%i*+ i+i ,,# %#' '* @*+(i'*, 'i(i 0+

'*#0i+ 0i))'+ '* %*# %i%* 0i #;#/ '*-#,i )(#. D(/ &+ 0i)) ,*/ %i%i

'i(i $+#+ 0i;i;i 0, ;*(;i )*(;+0i++ '* (+(+ %i%*i' 0,

;*(;i )*(;+0i++ '* (+(+ %i%*i' *,,#i )*;#,#/)*;#,#/ 0(/ &+

*(%#%#+ %*-( )(,*, 0+ ;*(-;+ 0(i (.

Si('#,%i %i%*i' 0+ )(# %i+%i+ *(0i(i 0(i %i%* )*;#,#/ 0(/ &+

*(##). A(*(i &+ *++'# 0(/ 0(i $+#+ '* $(i++ ;*(-;+-;+ *+$0i

)*;#,#/)*;#,#/ 0(/ &+ %*'i+ '*-i, 0*++ ;*(;i -;+ *+&,#('+ 0(/

'* ;*(;i ;i+ #;#/. S*?'# (*(i '*-i, *+-)i (+ &+ 0i)*(0(/i+& (*(i

*(%*;# ;*(-;+-;+ *+$0i ;+&' (*(i,. Di 0, (+ (*(i, ;*(-;+

-;+ *+$0i ')i,*( *) %*# )*(#'(+ +( 0(/ 0+ %*,%*, %*'i(+& *($0i.

K)i,*(')i,*( '*;,i *+&# #+#' *;*+#' @*+#, &+ *(#% ;*(;#+

*;*+#' @*+ '*-i, &+ '*,#( 0(i (+. !*+@*+ '*-i, '*#0i+ ;*(%# *;*+#'

@*+ &+ ,*;i/ ;*%( &+ '/i(+& *+,i('+ 0(/ '* $+#+.

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3.2. !ENA

D(/ *+i+,'+ ')i,*( *%#'i %i%* @*+ #+#' 0i;? '*;,i '* $+#+. !*+

*i,i'i 0i+0i+ &+ $#/ ,*;i/ i)i% 0*++ ),% &+ ,*;i/ %*0i'i 0i;+0i+ (*(i

%*/i+ %+ #0/ *(*+ 0+ (?+ ',)%.

3.2.1. ANATOMI !ENA

T#+i' i+i @*+ *(%#%#+ 0(i *+0*,i# nonthrombogenic 0*++ 0%(+&

0,/ *;(+ ;%,i% 0+ ,i+ *,%i'. E+0*, *)(0#'%i '( (*,'%+ %*)*(i

+i(i '%i0 0+ )(%%i',i+ 0i+ *)*(/+'+ '*0+ nonthrombogenic )0

)*(#'+ *+0*, 0*++ -( *+i+/i;i%i (*%i ),*,*. E,%i+ 0+ ),% &+

*(,*' 0i #+i' *0i *;*(i'+ '*%*)+ #+#' @*+ 0) *(#;/ ',i;*(+&

0*++ )*(#;/+ *'++ i+i,. T#+i' 0@*+ii *(0i(i 0i ',*+ %*( *,%i+ 0+

i(;(;,%. L*;i/ ;+&' )0 @*+@*+ ;*%(.

!*+ *i,i'i '#)'#) &+ $#,/+& ,*;i/ ;+&' 0i *'%(*i% 0i%,

0i;+0i+ 0*++ )('%i,. P0 @*+ -@ i+*(i( @*+ i,i' '#+i% @*+ )( 0+

%i+#%%i+#% '(+i,i% @*+@*+ *(%*;# i0' *i,i'i '#). S*i) '#) *(0i(i 0(i 0#

0#+ '#) &+ *(%#%#+ 0(i $(i++ i' 0+ 0i##)i ,*/ *+0*,i#.

!*+ E'%(*i% B?/

!*+ )0 *'%(*i% ;?/ 0i;i *+$0i %#)*(i%i, 0, 0+ )*((.

!*+ %#)*(i%i, *(,*' 0i% ,)i%+ %i &+ ),i+ % 0(i #+'i 0+ )/

0+ *(0i(i 0(i @*+ %)/*+ + 0+ @*+ %)/*+ )(@. !*+ %)/*+ +

;*(%, 0(i ('#% @*+ 0(%# )*0i% '* +*(i( ,*,#% *0i,i% %#' '* @*+

*(,i% '#+i% 4 - i+*(i( 0+ ,*(, 0(i #;*('*, )#;i%. !*+ %)/*+ )(@

;*(%, 0(i ,*(, ('#% 0(%# )*0i% '* ;i )%*(i(. S*(i+ ',i @*+ i+i

*+*;#% %% )),i* 0i+( ,*(, 0+ *0i, #%'#,#% %(-+*i#% 0+ ;*(;#+ 0*++ @*+ )),i*. T*) ;*(/*+i @*+ %)/*+ )(@ ;*(@(i%i

*)i ,*;i/ %*(i+ ;*(/#;#++ 0*++ @*+ %)/*+ + # @*+ *(,i%

)(#+0#%.

!*+ &+ ,*;i/ 0, *+i'#i $,#( (*(i 0i *'%(*i%. P0 #+'i

;?/ *(0) @*+ &+ ;*()%++ &+ )(,*, 0*++ (*(i i;i,i% +*(i(

(**(i i;i,i% )%*(i( 0+ (*(i )*(+*#% #+#' ;*(;#+ 0i %% )),i*

*;*+#' @*+ )),i*. !*+ )),i* ;*(,+$# *,*?i 0#'( /i#% 0+

*+$0i @*+ *(,i%. P0 #+'i % @*+ *(,i% ;*(% @*+ *(,i%

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)(#+0#% *;*+#' @*+ *(,i% '#+i% 0+ *+$0i @*+ i,i' *'%*(+ )0

,i*+# i+#i+,i%.

!*+@*+ )*(( *+/#;#+'+ @*+ %#)*(i%i, 0+ 0,. !*+

)*(( &+ )*+i+ 0, ',i+i% 0,/ @*+ --'* 0+ ;&0. !*+ --'*

*+/#;#+'+ ('#% @*+ &+ ;*(%, 0(i @*+ %)/*+ + 0+ @*+ i;i,i%

)%*(i(. !*+ ;&0 *+/#;#+'+ @*+ %)/*+ + 0*++ @*+ 0,

'#(+ ,*;i/ 1" - 0i;?/ ,## 0+ 12 - *0i, 0(i i;i. !*+@*+ )*((

i+i *+$0i @(i-*% # i+%#i%i*+%i )0 '*0+ @*+ &+ i+%#i%i*+%i.

Si+#% @*+%#% ;*(0i+0i+ i)i% 0+ ;*(,'%i 0i +( #%-#,#% %,*#% 0+

%(-+*i#%. Si+#%%i+#% i+i i0' *i,i'i '#) 0+ 0i/#;#+'+ 0*++ @*+

&+ '*-i, 0+ ;*('#) #+#' *-*/ (*,#'%. D(/ 0, $#,/ ;*%( 0)

0i%i)+ 0i %i+#% @*+%#%. D*++ '+('%i (+' 0(/ 0i))'+ '* @*+# 0+ 0i,i('+ *+#$# $+#+.

!*+ E'%(*i% A%

Di;i *+$0i @*+ 0, 0+ %#)*(i%i,. !*+ 0, )0 *'%(*i% %

;*()%++ 0+ *+i'#i 0(i (*(i+&. !*+ %#)*(i%i, *(0i(i 0(i @*+ %*,i'

0+ ;%i,i'. !*+ %*,i' ;*(%, 0(i ,*(, )*(*,++ ++ )*(#'+ 0*)+

0(i ,*++ ;?/. P0 ,*++ % @*+ %*,i' ;*('/i( 0i %% i+(-,@i-#,(

*+*;#% %i -,@i)*-(, #+#' *+%+'+ 0i @*+ '%i,(i%. !*+ ;%i,i'

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;*($,+ *0i, 0(i ,*++ ;?/ 0+ *+*;#% %i 0, '*#0i+ ;*(;#+

;*(% @*+ ;('i,i% #+#' *+$0i @*+ '%i,(i%. !*+ -#;ii *0i ;*(;#+

0*++ @*+ %*,i' 0+ ;%i,i' 0i )*(#'+ 0*)+ 0(i %i'#.

!*+ '%i,(i% *+$0i @*+ %#;',@i )0 ,*(, 0(i ;% i )*(.

P0 ;% *0i, 0(i #%'#,#% %-,*+#% +*(i( @*+ %#;-,@i ;*(;#+0*++

@*+ $##,(i% i+*(+ #+#' *+$0i @*+ ;('i%*,i'. !*+ ;('i%*,i' '++

0+ 'i(i ;*(;#+ *+$0i @*+ -@ %#)*(i( &+ ++i '+ *+%+'+ i%i+&

0i (i# '++.

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3.2.2. FISIOLOGI !ENA

S(#'#( i+i *+0#'#+ #+%i # 0(i @*+ &i# *+*;,i'+ 0(/ '*

$+#+ 0+ (*%*(@i( #+#' *+-*/ '*,*;i/+ @,#* i+(@%'#,(. H, i+i 0i*+#'+

,*/ ')%i% 0+ ,i(+ ;,i' @*+.

K)%i% @*+ 0,/ @,#* 0(/ &+ 0) 0i)#+ ,*/ @*+. H, i+i

;*(+#+ )0 0i%*+%i;i,i% 0i+0i+ @*+. P0 @,#* 0(/ &+ '+%+ %*i(i+

0*++ )*+i+'+ ')%i% @*+ %*'i+ ;+&' 0(/ &+ *+*) 0i @*+ 0+ i0'

0i'*;,i'+ '* $+#+. %*/i++ @*+ 0) ;*(#+%i %*;i (*%*(@i( 0(/ &i#

);i, '*;##/+ 0(/ (*+0/ @*+@*+ 0) *+&i)+ 0(/ *'%( %*;i -0++

'(*+ %i @*+ &+ #0/ 0i(*+'+.

A,i(+ ;,i' @*+ *+-# '*)0 @,#* 0(/ &+ %#' i)i) (i# )*(

*+i 0(i @*+. B*%(+& # ,$# ,i(+ *,,#i %## )*;#,#/ ;*(;+0i+ ,#(#% 0*++

(0i*+ *'++. S*;i+ ;*%( & )*+0(+ &+ 0ii;#,'+ $+#+ )0 0(/ *,/

/i,+ )0 % 0(/ *+-)i %i%* @*+ '(*+ 0+& (i'%i 0i %*)+$+ )*($,++

0(/ *(# '*i' 0(/ *,,#i (*(i, &+ *i,i'i (*%i%*+%i i+i. P0 % 0(/

*%#'i %i%* @*+ *'++ 0(/ (( /+& 17H. N#+ '(*+ *'++

(i# *+0*'i " H %i/ *(0) & &+ '*-i, *)i 0*'# #+#' *+0(+

0(/ *+,i( *,,#i %i%* @*+. Ji' *'++ (i# *+i+' %*-( ),i% (0i*+

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*'++ @*+ '* (i# '+ ;*('#(+ %*/i+ ,i(+ ;,i' @*+ '+ ;*('#(+ 0+ 0(/

*(;*+0#+ 0i %i%* @*+.

D, '*0+ i%i(/ @*+@*+ *++0#+ ,*;i/ 0(i 6" @,#* 0(/ ,.

A);i, %i)++ *(%*;# 0i;##/'+ '('( *'%(i+%i' *+0(+ 0(/ 0(i @*+ '*

$+#+ %*/i+ 0) 0i )) '* $(i++. F'('( *'%(i+%i' *(%*;# 0,/<

1. E*' %i)i% )0 ,i(+ ;,i' @*+

Si#,%i %i)i% *+i;#,'+ @%'+%(i'%i @*+ &+ -#'#) *+i+''+

(0i*+ *'++ #+#' *+0(+ ,*;i/ ;+&' 0(/ 0(i @*+ '* $+#+.

@%'+%(i'%i @*+ *+i+''+ ,i(+ ;,i' @*+ 0*++ *+#(+i ')%i%

)*+i%i+ @*+ ,*/ '(*+ )*+&*)i+ @*+ **(% '* ,#( ,*;i/ ;+&' 0(/

&+ %#0/ *(0) 0i @*+ %*/i+ ,i(+ 0(/ *,,#i @*+ *+i+'.

2. E*' 'i@i% (+' )0 ,i(+ ;,i' @*+

P) (+' 0,/ %,/ %# -( *+,i('+ #+#' *+,i('+ %i)+

0(/ 0i @*+ '* $+#+ %*?'# ;*(*('. P*+i+'+ ,i@i% *+0(+

,*;i/ ;+&' 0(/ '*,#( 0(i @*+ #+#' %#' '* $+#+. P) (+' $#

*,?+ **' (@i%i )0 %i%* @*+.

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3. E*' '#) @*+ )0 ,i(+ ;,i' @*+

K#)'#) i+i *#+'i+'+ 0(/ ;*(*(' '* 0*)+ '* (/ $+#+ 0+

*+-*/ 0(/ *+,i( '*;,i '* $(i++. K#)'#) i+i $# ;*()*(+

*,?+ **' (@i%i &+ 0ii;#,'+ ,*/ )%i%i ;*(0i(i.

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4. E*' 'i@i% )*(+)%+

A'i; 'i@i% )*(+)%+ *'++ 0i 0, (+ 00 (( 5 H 0i

;?/ *'++ %*(. K(*+ %i%* @*+ 0i #+'i 0+ ;0*+ *+0)

*'++ %*( +(, *($0i (0i*+ *'++ *'%*(+, +( @*+@*+ ;?/

0*++ @*+ &+ 0 0i 00. P*(;*0+ *'++ i+i *) 0(/ 0(i @*+@+

;i+ ;?/ *+#$# @*+@*+ 00 %*/i+ ,i(+ ;,i' @*+ *+i+'.

M*'+i%* %i,i% ,i(+ ;,i' @*+ i+i 0i'*+, %*;i )) (*%)i(%i '(*+

*($0i 'i; 'i@i% )*(+)%+.

5. E*' )*+/i%)+ $+#+

S*, '+('%i @*+(i'*, '#)'#) (i@*+(i'#,*( =A!> *((i' '* ;?/

%*/i+ (+ (i# *;*%(. A'i;+& *'++ (# %*-( #(#+ 0i ;?/ "

H *+&*;;'+ )*+i+'+ (0i*+ *'++ @*+ '* (i# 0+ ,i(+ ;,i'

@*+. S*,i+ i# *'%)+%i -*) (+ @*+(i'*, %*, (*,'%%i @*+(i'*,

*+-i)'+ *'++ +*i %**+( 0i @*+(i'*, %*/i+ 0(/ *(%*0 0(i

(i# 0+ @*+ *'++ @*+(i'*, &+ +*i *+i+''+ (0i*+ *'++ @*+

(i#@*+(i'*, 0+ *+i+''+ ,i(+ ;,i' @*+.

27


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28


33/34

BAB IV

KESIMPULAN

/(+i- !*+#% I+%#i-i*+-& 0,/ '+0i%i 0i+0i+ # '#) )0 @*+ #+'i

i0' ;*'*($ %*-( **'i %*/i+ *($0i '*0+ i+%#i%i*+%i 0+ *+i;#,'+

/i)*(*+%i @*+ #+'i. K+0i%i /i)*(*+%i @*+ #+'i 0) *+&*;;'+ ;*(;i

*$, %*)*(i +&*(i *0* #,%*(%i 0+ )*(#;/+ )0 '#,i.

M+i*%%i ',i+i% !I 0) 0i,i/ )0 ',%ii'%i ',i+i%. K,%ii'%i EAP

=Clinical, Etiology, Anatomic, Pathophysiology> 0i'*;+'+ ,*/ '+%*+%#%

i+*(+%i+, #+#' %*;i ;%i% 0i+%i% 0+ )*+;+ !I.

T*()i ?, )0 !I 0,/ '+%*(@i #+#' *+#(+i *$, 0+ *+-*/

)*('*;++ '),i'%i 0+ )((*%i )*+&'i. P0 !I *'+i%* &+ ),i+

*++$, 0,/ ;*('#(++& @,#* ,i(+ 0(/ %*( ;*(;/+& $#,/ ,i(+

@,#* ' *()i 0i(/'+ '*)0 )*+#(++ *'++ /i0(0i+i' +( ')i,*(

&i# 0*++ *,*@%i #+'i )*+;/+ *'++ +( %*, 0*++ ')(*%i

)*+;/+ *'++ %i' +( ')i,*( 0*++ )*+#++ ; 0i#(*i'. S##

';i+%i 0(i 0# # %*# -( *(%*;# *(#)'+ *()i 0%( ;i ''i &+

;*+'' 0, %*, ;*+#'.

T*'+i' ;*0/ /+& 0i,'#'+ )0 ''i ;*+'' &+ '*0++& ;#(#' %*',i

0+ *(#)'+ %## *()i &+ *(i++'+ %*)*(i )0 )%i*+ &+ %)i

*+,i 0i%;i,i% # #,'#% @*+ &+ i0' *+&*;#/ ?,#)#+ 0*++

)*+;+ '%i,. T#$#+ )*;*0/+ ;#'+ #+#' *++i *()i '+%*(@i

)i #+#' *;#+& ,*;i/ *i%i*+.

E0#'%i )0 )%i*+ %#)& *()i *(%*;# 0) ;*(/%i, %*-( )i, %*)*(i

*+i+i'+ *'%(*i% ;?/ % ;*(i%i(/ *+#(+i ;*(0i(i # 0#0#' ,

0+ *+#(+i ;*( ;0+.

29


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BAB V

DAFTAR PUSTAKA

1. J#%i D. I+%#i%i*+%i !*+ K(+i'. D%(D%( I,# B*0/ !%'#,(. 5/ *0. J'(<

B,i P*+*(;i FKUI 2"1"< 25674.

2. S$%#/i0$ R K(+0i/(0$ P(%*&+ T R#0i+ R *0i(%. B#'# A$(

I,# B*0/ S$%#/i0$D* J+. 3(0 *0. J'(< P*+*(;i B#'# K*0'*(+ EG

2"13< 5824.

3. S/*(?0 L. P*;#,#/ 0(/ 0+ *'++ 0(/. Fi%i,i M+#%i< D(i S*, K*

Si%* 2% *0. J'(< P*+*(;i B#'# K*0'*(+ EG 2""1< 297326.

4. N**(. L?*( Li;. I+< H+%*+ JT *0i(. N**(% ,i+i-, A+&. P/i,0*,)/i<

E,%*@i*( 2"1"< 2278.

5. J#+0 JP Li* TK M+* GL. !*+#% +0 L&)/i- Di%*%*. I+ B(#+i-(0i F

*0i(. S-/?(% P(i+-i),* 0 S#(*(&. 1"/ *0. N*? ('< M- G(? Hi,, 2"1"< 915

8.

6. /i*% R M(+* EM Li+i !,+* M S-/**( E P*(i+i O. /(+i- @*+#%

i+%#i-i*+-& i+ I,&< /* 24-ii*% -/( %#0&. E!r asc En%ovasc *!rg . 2""5 O-.

3"=4>

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Referat CVI