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Barbagianni MS, Georgiou SG, Gouletsou PG, Galatos AD, Valasi I, Pappa E, Karatrantos AT, Giannoukas A. Imaging of experimental venous thrombus by means of Doppler and CEUS techniques in dogs. J Ultrasound 2024:10.1007/s40477-024-00935-3. [PMID: 39106001 DOI: 10.1007/s40477-024-00935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/10/2024] [Indexed: 08/07/2024] Open
Abstract
Venous thrombosis has been widely studied in humans, but not in dogs. This study was designed to evaluate a venous thrombus in dogs, from creation to solution, by means of various ultrasonographic techniques. Nine healthy Beagle dogs were included in the study. The venous thrombus was formatted by puncturing the lumen of the external jugular veins and then, the veins were examined with B-mode, color Doppler, pulsed-wave Doppler, and contrast-enhanced ultrasound (CEUS) techniques, at regular intervals, within 210-270 min after venipuncture. Haemodynamic parameters were calculated at two different locations, before and after the site of the thrombus formation. The existence of a thrombus was confirmed by CEUS technique. Thrombus volume and echogenicity were evaluated. The results showed that the visualization of the venous thrombus by color Doppler modality was not feasible in some veins. The blood volume was the parameter that could more precisely indicate the presence or absence of a thrombus. In cases where thrombus volume was less than 0.001 cm3, it was impossible to detect its presence using haemodynamic parameters. The CEUS imaging depicted accurately the size and shape of an anechoic venous thrombus, even when its volume was 0.001cm3.
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Affiliation(s)
- Mariana S Barbagianni
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece.
| | - Stefanos G Georgiou
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Pagona G Gouletsou
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Apostolos D Galatos
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Irene Valasi
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Elena Pappa
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
| | - Anargyros T Karatrantos
- Faculty of Veterinary Medicine, University of Thessaly, Trikallon 224, 43100, Karditsa, Greece
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Liu P, Huang J, Zhang X, Yang R, Yang S, Chen L, Gao Y. Application of the ankle pump method in a sitting position to evaluate calf perforating veins by color Doppler ultrasound. J Vasc Surg Venous Lymphat Disord 2024; 12:101897. [PMID: 38679143 DOI: 10.1016/j.jvsv.2024.101897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE We investigated the feasibility and efficacy of assessing calf perforating veins (PVs) using the ankle pump in a sitting position (AP-sit) method by color Doppler ultrasound. METHODS We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf PVs were assessed using three different methods: manual compression in a standing position, manual compression in a sitting position, and AP-sit method. The reflux durations and detection rate of incompetent PVs (IPVs) were compared among the three methods. The number and diameter of calf PVs and distribution of IPVs were analyzed. RESULTS A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The number of PVs per calf was higher in the diseased calves (median, 7.0; interquartile range [IQR], 6.0-8.0) than in the healthy calves (median, 5.0; IQR, 3.0-6.0; P < .001). The diameter of IPVs (median, 2.3 mm; IQR, 2.0-3.1 mm) was larger than that of competent PVs (median, 1.4 mm; IQR, 1.2-1.7 mm). Most of the IPVs (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the AP-sit method was greater than that induced by the manual compression methods (P < .001). Although the AP-sit method had a higher detection rate (92.0%) of IPVs than the manual compression methods (71.7% and 74.3% for standing and sitting, respectively; P < .001), especially in the distal lower leg, the manual compression methods found IPVs not found using the AP-sit method. CONCLUSIONS Diseased calves with chronic venous disease have more PVs than do healthy calves. IPVs are commonly larger than competent PVs, with most IPVs located in the medial and posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf PVs, especially those located in the distal calf, as an alternative or complementary method to traditional manual compression, which is valuable in the daily practice of sonographers.
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Affiliation(s)
- Peipei Liu
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China; Department of Ultrasound Medicine, The Peking University Third Hospital, Beijing, China
| | - Jianxing Huang
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China
| | - Xueju Zhang
- Department of Ultrasound Medicine, The Peking University Third Hospital, Beijing, China
| | - Ruolin Yang
- Department of Ultrasound Medicine, The Peking University Third Hospital, Beijing, China
| | - Shiyuan Yang
- Department of Ultrasound Medicine, The Capital International Airport Hospital of the Peking University Third Hospital, Beijing, China
| | - Lingli Chen
- Department of Ultrasound Medicine, The Capital International Airport Hospital of the Peking University Third Hospital, Beijing, China
| | - Yongyan Gao
- Department of Ultrasound, The Third Medical Center of Chinese PLA General Hospital, The Training Site for Postgraduate of Jinzhou Medical University, Beijing, China.
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Liu Y, Cao B, Wang X, Zhong J, Li Z, Peng R, Zhao D, Gu N, Yang Q. Ferumoxytol-enhanced MR venography for mapping lower-extremity venous networks and evaluating varicose veins in patients with diabetes. Eur Radiol 2024:10.1007/s00330-024-10772-x. [PMID: 38713277 DOI: 10.1007/s00330-024-10772-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES Comprehensive evaluation of lower-extremity varicose veins (VVs) in patients with diabetes is crucial for treatment strategizing. The study aims to assess the feasibility of using ferumoxytol-enhanced MR venography (FE-MRV) for lower-extremity venous mapping and the detection of VVs in patients with diabetes. MATERIALS AND METHODS As part of a phase II clinical trial of a generic brand of ferumoxytol, documented patients with diabetes were enrolled and underwent FE-MRV on a 3-Τ MRI system. Two observers assessed FE-MRV images for image quality, signal intensity ratio (SIR), perforator (PV) diameter, and luminal signal uniformity in deep-to-superficial venous networks with the assessment of intra- and inter-rater reliability. FE-MRV was used to detect lower-extremity VVs. RESULTS Eleven patients underwent FE-MRV without adverse events. The average image quality, as scored by the two observers who assessed 275 venous segments, was 3.4 ± 0.6. Two observers strongly agreed on image quality (κ = 0.90) and SIR measurements (interclass correlation coefficient [ICC]: 0.72) and had good agreement on PV diameter (ICC: 0.64). FE-MRV revealed uniform luminal signals in deep and saphenous venous networks (0.13 ± 0.05 vs 0.08 ± 0.03). Below-knee segments exhibited a significantly higher heterogeneity index than above-knee (p = 0.039) segments. Superficial VVs were observed in 55% (12/22) of legs in 64% (7/11) of patients. Calf muscle VVs were present in 64% (14/22) of legs in 9 patients. CONCLUSION FE-MRV safely and robustly mapped entire lower-extremity venous networks, enabling the detection and pre-treatment evaluation of both superficial, and deep VVs in patients with diabetes. CLINICAL RELEVANCE STATEMENT Ferumoxytol-enhanced magnetic resonance venography offers a "one-stop" imaging strategy for the detection and pre-operative evaluation of both superficial and deep VVs in diabetic patients. KEY POINTS Diabetic patients with VVs are at a higher risk of ulcer-related complications. FE-MRV allowed rapid and comprehensive visualization of the lower-limb venous networks and abdominopelvic veins in diabetic patients. This technique allowed for the detection of superficial and deep VVs in diabetic patients before the development of severe peripheral artery disease.
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Affiliation(s)
- Yuehong Liu
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Bin Cao
- Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xinyu Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiali Zhong
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Li
- Department of Radiology, Central Hospital Affiliated to Xinxiang Medical University, Xinxiang, China
| | - Ruchen Peng
- Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Dong Zhao
- Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
| | - Ning Gu
- Medical School of Nanjing University, Nanjing, China.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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Choudhary C, Kravvas G, Jones HT. What you need to know about common skin problems in older adults. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38708977 DOI: 10.12968/hmed.2023.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Skin ageing is a multifaceted process impacted by both intrinsic and extrinsic factors. Drier and less elastic skin with declining sebum levels in older age makes ageing skin more vulnerable to various skin conditions, including infections, inflammatory dermatoses, and cancers. Skin problems are common among older adults due to the effects of ageing, polypharmacy and multimorbidity impacting not only physical health but wellbeing and quality of life. In the UK, older adults in geriatric medicine wards may present with various skin conditions. Hospitalised older individuals may have undiagnosed skin problems unrelated to their admission, making hospitalisation an opportunity to manage unmet needs. Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders clinicians encounter in the geriatric medicine wards. This article outlines the importance of performing comprehensive skin assessments to help diagnose and commence management for these common conditions.
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Affiliation(s)
- Cherry Choudhary
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgios Kravvas
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Howell T Jones
- Department of Healthcare Services for Elderly People, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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Mangwani J, Roberts V, Shannak O, Divall P, Srinivasan A, Dias J. Epidemiology and Diagnosis of Post-Thrombotic Syndrome: Qualitative Synthesis with a Systematic Review. J Clin Med 2023; 12:5896. [PMID: 37762837 PMCID: PMC10532000 DOI: 10.3390/jcm12185896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/14/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Post-thrombotic syndrome (PTS) is a common and debilitating sequela of lower limb deep vein thrombosis (DVT). There is significant heterogeneity in reported PTS incidence due to lack of standardised diagnostic criteria. This review aimed to develop diagnostic criteria for PTS and subsequently refine the reported incidence and severity. Methods: PRISMA principles were followed; however, the review was not registered. The Cochrane CENTRAL database, MEDLINE, Embase, the NHS NICE Healthcare Databases Advanced Search interface, and trial registers including isrctn.com and clinicaltrials.gov were searched for studies addressing areas of interest (PTS definition, epidemiology, assessment). An experienced Clinical Librarian undertook the systematic searches, and two independent reviewers agreed on the relevance of the papers. Conflicts were resolved through panel review. Evidence quality was assessed using a modified Coleman scoring system and weighted according to their relevance to the aforementioned areas of interest. Results: A total of 339 abstracts were retrieved. A total of 33 full-text papers were included in this review. Following qualitative analysis, four criteria were proposed to define PTS: (1) a proven thrombotic event on radiological assessment; (2) a minimum 24-month follow-up period after an index DVT; (3) assessment with a validated score; and (4) evidence of progression of venous insufficiency from baseline. Four papers conformed to our PTS definition criteria, and the incidence of mild to moderate PTS ranged from 7 to 36%. On reviewing the studies which utilised the recommended Villalta scale, PTS incidence narrowed further to 23-36%. Incidence and severity reached a plateau at 24 months. Conclusions: Four diagnostic criteria were developed from qualitative synthesis. When these criteria were applied to the literature, the range of reported PTS incidence narrowed. These four criteria may standardise PTS diagnosis in future studies, facilitating the pooling of data for meta-analysis and synthesis of higher levels of evidence.
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Affiliation(s)
- Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (J.M.); (P.D.); (J.D.)
| | - Veronica Roberts
- Department of Trauma and Orthopaedics, Southern Health and Social Care Trust, Belfast BT63 5QQ, UK;
| | - Odei Shannak
- Department of Trauma and Orthopaedics, Northampton General Hospital NHS Trust, Northampton NN1 5BD, UK;
| | - Pip Divall
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (J.M.); (P.D.); (J.D.)
| | - Ananth Srinivasan
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (J.M.); (P.D.); (J.D.)
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; (J.M.); (P.D.); (J.D.)
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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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Jarošíková R, Roztočil K, Husáková J, Dubský M, Bém R, Wosková V, Fejfarová V. Chronic Venous Disease and Its Intersections With Diabetes Mellitus. Physiol Res 2023; 72:280-286. [PMID: 37449742 PMCID: PMC10668996 DOI: 10.33549/physiolres.935033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/28/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic venous disease (CVD) is a vascular disorder in which blood return is severely compromised and CVD is usually characterized by venous hypertension. Along with obesity and diabetes mellitus, CVD is one of the most common civilization diseases. In general, the estimated prevalence of CVD ranges from 60-80 %. Early diagnosis and adequate treatment are important for preventing progression to more severe stages of the disease like venous leg ulcers. Clinical manifestations of CVD in initial stages of the disease are often asymptomatic. However, as CVD progresses, symptoms begin to develop. Treatment of CVD could be divided into conservative and surgical. Conservative therapy consists of compression, pharmacological treatment and lifestyle change. In cases where conservative therapy is ineffective, surgical or endovascular treatment may be required. The intersections between diabetes mellitus (DM) and CVD are not to be underestimated. CVD and DM have often the same risk factors. Symptoms of CVD can be modified by late complications of DM, but the incidence of different CVD degrees seems to be the same as in diabetics as in non-diabetics population. We are particularly concerned in diabetics about worse compliance with treatment due to their often-poorer adherence to treatment of DM and lifestyle changes. Moreover, there exist a higher risk of CVD and peripheral arterial disease in diabetics patients. Patients with CVD should always be inspected for the presence of DM, considering its presence can have a bearing on CVD symptoms, diagnostic procedures, and therapeutic strategies.
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Affiliation(s)
- R Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Praha 4, Czech Republic.
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Bochnakova T, Kaufman C. Combined Management of Wound Ulcers With Focus on Interventional Techniques. Tech Vasc Interv Radiol 2023; 26:100896. [PMID: 37865447 DOI: 10.1016/j.tvir.2023.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This review provides a summary of current practice patterns in managing venous ulcers. The authors will describe the workup for venous ulcers, including differentiation of symptoms, physical examination, and imaging to guide the most effective treatment course for each patient. An overview of conservative management and minimally invasive treatment options for venous ulcers will be provided with a specific focus on periulcer foam sclerotherapy to aid in preventing ulcer recurrence and promoting healing. We will give interventional troubleshooting techniques for challenging patient presentations.
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Affiliation(s)
- Teodora Bochnakova
- Vascular and Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, OHSU Hospital, Portland, OR.
| | - Claire Kaufman
- Vascular and Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, OHSU Hospital, Portland, OR
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Adler C, Mousa A, Rhee A, Patel MD. Varicose Veins of the Lower Extremity: Doppler US Evaluation Protocols, Patterns, and Pitfalls. Radiographics 2022; 42:2184-2200. [PMID: 36178804 DOI: 10.1148/rg.220057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous insufficiency is a cause of substantial morbidity and medical expenditures. Diagnostic US evaluation of venous insufficiency requires a thorough understanding of the venous anatomy, including the deep, superficial, and perforator veins. The highly variable venous anatomy requires that operators use sound judgment to expand on protocol images and thus avoid missing important sources of reflux. The US examination requires specific patient positioning and use of provocative maneuvers. A basic understanding of the pathophysiology of venous insufficiency and the various treatment methods helps to identify key observations so that ineffective treatment methods are not pursued. The examination reports should have greater detail than those for the more common lower extremity deep venous thrombosis evaluation, requiring numeric and narrative descriptions of deep and superficial venous patency, reflux, diameter, and pathways. Potential pitfalls include not recognizing or detecting deep venous reflux, misidentifying common femoral vein reflux as deep venous reflux when the reflux is isolated or related to saphenofemoral insufficiency, not recognizing anterior accessory great saphenous vein (AAGSV) involvement in saphenofemoral insufficiency, not recognizing or reporting great saphenous vein or AAGSV superficialization, not suspecting central venous obstruction, and not realizing when provocative maneuvers were ineffective. With knowledge of the lower extremity venous anatomy, venous insufficiency pathophysiology, basic treatment strategies, protocol best practices, patterns of observation, and diagnostic pitfalls, those who interpret venous insufficiency US studies can perform examinations and deliver reports that help patients receive appropriate treatment. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Cameron Adler
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI (C.A.); and Department of Radiology, Mayo Clinic, Phoenix, AZ (A.M., A.R., M.D.P.)
| | - Abeer Mousa
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI (C.A.); and Department of Radiology, Mayo Clinic, Phoenix, AZ (A.M., A.R., M.D.P.)
| | - Annie Rhee
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI (C.A.); and Department of Radiology, Mayo Clinic, Phoenix, AZ (A.M., A.R., M.D.P.)
| | - Maitray D Patel
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI (C.A.); and Department of Radiology, Mayo Clinic, Phoenix, AZ (A.M., A.R., M.D.P.)
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Liu G, Clarke JL, Mohan I. A snapshot of venous ultrasound examinations in Australia and New Zealand: Implications for diagnosis and management of chronic venous disease interventions. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:236-245. [PMID: 35936961 PMCID: PMC9354182 DOI: 10.1177/1742271x211046641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/23/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Chronic venous disease is a common vascular condition, affecting up to 60% of the population worldwide. In Australia and New Zealand, chronic venous insufficiency ultrasound examinations are primarily performed by sonographers. This research aimed to explore how ultrasound examinations are being performed, providing insights into current practices and recommendations for quality improvement. METHOD A questionnaire was distributed to capture demographics, practices of ultrasound, examination techniques, the use of nomenclature and experience of the respondents. RESULTS The analysis of 97 responses showed a heterogeneity in the clinical application of ultrasound. Most sonographers performed less than two scans per day within 30-45 minutes. Deep venous incompetence was routinely excluded by all respondents. The majority used standing, sitting and reverse Trendelenburg position except for a few using supine position. Manual augmentation was the preferred provocation manoeuvre. Anatomical variations at the junctional level were not adequately evaluated. Although Giacomini's vein was assessed by 80%, 57% of those did not evaluate paradoxical reflux. Seventy-five per cent routinely assessed non-saphenous reflux; however, over 50% were unfamiliar with lymph node venous networks. A significant number of out-dated venous terms were still being used. A low participation rate in continuing professional development was identified, which might be attributable to limited education and training programs. CONCLUSION The study is a multi-faceted exploration that identified a need for standardized diagnostic and reporting guidelines. Our results could explain discrepancies in diagnostic findings and inconsistencies in the use of medical terminology, with implications for clinical decision making and assessment of surgical outcome.
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Affiliation(s)
- Gaorui Liu
- Western Sydney Vascular, Westmead, Australia
| | | | - Irwin Mohan
- Western Sydney Vascular, Westmead, Australia
- Westmead Clinical School, University of Sydney, Wentworthville, NSW, Australia
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Thomas KN, Gibbons TD, Campbell HA, Cotter JD, van Rij AM. Pulsatile flow in venous perforators of the lower limb. Am J Physiol Regul Integr Comp Physiol 2022; 323:R59-R67. [PMID: 35503236 DOI: 10.1152/ajpregu.00013.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Teaching traditionally asserts that the arterial pressure pulse is dampened across the capillary bed to the extent that pulsatility is non-existent in the venous circulation of the lower limbs. Herein, we present evidence of transmission of arterial pulsations across the capillary network into perforator veins in the lower limbs of healthy, heat-stressed humans. Perforator veins are connections from the superficial veins that drain into the deep veins. When assessed using ultrasound at rest, they infrequently demonstrate flow and a pulsatile flow waveform is not described. We investigated perforator vein pulsatility in ten young, healthy volunteers who underwent passive heating by +2 ºC deep body temperature via a hot-water-perfused suit, and five who also underwent active heating by +2 ºC via low-intensity cycling while wearing the hot-water-perfused suit. At +0.5 ºC increments in temperature, blood velocity in an ankle perforator vein was measured using duplex ultrasound. In all perforators with heating, sustained flow was demonstrated, with a pulsatile waveform that was synchronous with the cardiac cycle. The maximum velocity was 29 ± 14 cm/s with passive heating and approximately half with active heating (P=0.04). The small veins of the skin at the ankle also demonstrated increased perfusion with pulsatility, seen with low-velocity microvascular imaging technology. We consider explanations for this pulsatility and conclude that it is propagated from the arterial inflow through the skin microcirculation as a result of increased dilatation and flow volume, and that this a normal response to increased skin blood flow.
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Affiliation(s)
- Kate N Thomas
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Travis D Gibbons
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand.,Centre for Heart, Lung and Vascular Health, University of British Columbia-Okanagan, School of Health and Exercise Science, Kelowna, British Columbia, Canada
| | - Holly A Campbell
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Andre Marie van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Matei SC, Matei M, Anghel FM, Derban MD, Olariu A, Olariu S. Impact of statin treatment on patients diagnosed with chronic venous disease. Morphological analysis of the venous wall and clinical implications. Phlebology 2021; 37:188-195. [PMID: 34877912 DOI: 10.1177/02683555211053566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study evaluates the potential morphological changes that may occur in the venous wall in the case of the patients with chronic venous disease which associates treatment with statins for at least 2 years. METHODS Operated patients with chronic venous disease in the CEAP C2-C3 stage were included in the study. 215 venous fragments, collected from 50 patients within the study group and 179 venous fragments collected from 52 patients within the control group were microscopically analysed, evaluating a series of morpho-anatomical parameters. RESULTS In the study group, it was found that, venous reflux predominantly affects small veins, and also, a significant increase in collagen deposits in the adventitia and media tunics, proportional to the thickening of the venous wall. CONCLUSION Our results indicate possible effects of statins upon the venous morphology. Further studies are needed to determine the impact of these results on daily practice.
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Affiliation(s)
- Sergiu-Ciprian Matei
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO.,I'st Surgical Clinic, "Pius Brînzeu" University Clinical Hospital Timișoara, Liviu Rebreanu Boulevard, Timișoara, RO
| | - Mervat Matei
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | | | - Mihnea Dragoș Derban
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | - Andra Olariu
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO
| | - Sorin Olariu
- "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania, Timișoara, RO.,I'st Surgical Clinic, "Pius Brînzeu" University Clinical Hospital Timișoara, Liviu Rebreanu Boulevard, Timișoara, RO
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13
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Abstract
Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.
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Affiliation(s)
- Tom Alsaigh
- Division of Vascular Surgery, Vascular Medicine Section, Stanford University, 780 Welch Road, Suite CJ 350, Palo Alto, CA 94304, USA
| | - Eri Fukaya
- Division of Vascular Surgery, Vascular Medicine Section, Stanford University, 780 Welch Road, Suite CJ 350, Palo Alto, CA 94304, USA.
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14
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Varicose Veins—How to Investigate. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Pekarek L, Monserrat J, Asúnsolo A, García-Honduvilla N, Álvarez-Mon M, Bujan J. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med 2021; 10:3239. [PMID: 34362022 PMCID: PMC8348673 DOI: 10.3390/jcm10153239] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/19/2023] Open
Abstract
Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Chen Chaowen
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
| | - Fernando Ruiz-Grande
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Vascular Surgery, Príncipe de Asturias Hospital, 28801 Alcalá de Henares, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Angel Asúnsolo
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Immune System Diseases—Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
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16
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Sumpio BJ, Png CYM, Harrington A, Root D, McLaughlin R, Manchester S, Latz CA, Feldman ZM, Eagleton M, Dua A. Utility of unilateral versus bilateral venous reflux studies for venous insufficiency. J Vasc Surg Venous Lymphat Disord 2021; 9:1297-1301. [PMID: 33529718 DOI: 10.1016/j.jvsv.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Duplex ultrasonography is the reference standard for diagnosing chronic venous insufficiency. Bilateral venous reflux ultrasound studies are among the most time-consuming and physically demanding tests for vascular ultrasound technologists to perform. Furthermore, if a venous procedure is required, many insurance policies require that a diagnostic venous ultrasound scan for reflux must be performed within 1 year of the procedure. If the intervention is scheduled for >1 year after the ultrasound scan, the insurance company might require a repeat venous ultrasound scan before granting insurance authorization. Hence, ordering bilateral venous duplex ultrasound scans to evaluate for reflux when an intervention might only be performed on one limb within the year could be a waste of time and resources. The aim of the present study was to determine the utility of ordering bilateral vs unilateral studies to evaluate for reflux in patients with suspected chronic venous insufficiency and to determine whether a resource-saving potential exists for vascular laboratories through optimization of the process of ordering venous duplex ultrasound studies. METHODS A retrospective review of all patients who had undergone bilateral lower extremity ultrasound scanning to evaluate for reflux from January 1, 2016 to December 31, 2016 at the Massachusetts General Hospital vascular laboratory was performed. The demographics, indications for ultrasound scanning, comorbidities, time required to perform the ultrasound study, and interval to intervention were documented. The data were analyzed using SPSS statistical software (IBM Corp, Armonk, NY). RESULTS During the study period, 13,854 ultrasound studies had been performed in our vascular laboratory, of which 606 (4.4%) had been bilateral ultrasound scans for venous insufficiency. The time allotted for a bilateral study was 2 hours. Of the 606 studies evaluated, 152 (25.1%) showed no evidence of reflux, 284 (46.9%) showed bilateral lower extremity reflux, and 170 (28.1%) showed only venous insufficiency in one leg. Venous ablation, phlebectomy, and/or sclerotherapy were performed for 28.7% of the patients. However only 6.2% of patients had undergone venous procedures on both legs within 1 year after the ultrasound studies. Ablation was the most common procedure performed (54.6%), followed by phlebectomy (27.%) and sclerotherapy (17.9%). Overall, 94.7% of patients had not undergone a venous procedure on both legs within 1 year after the ultrasound studies and, hence, would have required a repeat duplex ultrasound scan to ensure insurance coverage for future procedures. CONCLUSIONS Most bilateral ultrasound scans for venous insufficiency will not result in an intervention. Thus, most patients (95%) could have undergone a unilateral scan before the initial intervention instead of bilateral duplex ultrasound scanning.
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Affiliation(s)
- Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anita Harrington
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Drena Root
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Robert McLaughlin
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Scott Manchester
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Zachary M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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17
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Srisuwan T, Inmutto N, Kattipathanapong T, Rerkasem A, Rerkasem K. Ultrasound Use in Diagnosis and Management of Venous Leg Ulcer. INT J LOW EXTR WOUND 2020; 19:305-314. [DOI: 10.1177/1534734620947087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Leg ulcers caused by venous diseases are effectively assessed by Doppler ultrasonography. The examination provides clear anatomical and physiological information for the diagnosis, treatment planning, and real-time guiding during the surgical treatment. Diagnostic Doppler ultrasonography assesses deep, superficial, and perforator veins, starting from patency assessment by direct visualization and simply compression test. The internal flow can be assessed by pulse wave analysis, which is used for rule out downstream flow obstruction and valvular incompetence. The venous valve function of deep, superficial, and perforator systems can be evaluated by measuring the time of the retrograde flow after flow augmentation performing in the upright position. At the end of the study, the venous map will be obtained and this map will guide clinicians to target treatment where the culprit is. The ultrasound technology has made a big shift in the treatment in the venous disease. In recent years, after the evolution and wide availability of ultrasound, newer treatment modalities have emerged for venous treatment. These include endovenous thermal ablation, endovenous adhesive closure, and ultrasound-guided foam sclerotherapy. Patients no longer require general anesthesia or hospitalization. Therefore utilization of duplex ultrasound has also surged and played an essential role in both diagnosis and therapy in venous ulcer. This article has dedicated to reviewing basic anatomy, the technique in diagnosis, and treatment.
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Affiliation(s)
- Tanop Srisuwan
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nakarin Inmutto
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Amaraporn Rerkasem
- NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand
| | - Kitttipan Rerkasem
- NCD Center of Excellence, Research Institute of Health Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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18
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Is There a Link Between Saphenofemoral Insufficiency and Varicocele: Imaging Study of Sub-Fertile Men. Nephrourol Mon 2020. [DOI: 10.5812/numonthly.99178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Doppler ultrasonographic evaluation of brachial and femoral veins, and coagulation and lipid profiles in dogs following open splenectomy. Sci Rep 2019; 9:15377. [PMID: 31653942 PMCID: PMC6814893 DOI: 10.1038/s41598-019-51924-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022] Open
Abstract
In dogs, splenectomy is mandatory as an emergency following splenic rupture with resultant hemoperitoneum and hypotensive shock. The present work aimed to evaluate the Doppler ultrasonographic parameters of brachial and femoral veins in splenectomized dogs and to investigate the effect of splenectomy on the coagulation and lipid profiles. A total number of 9 dogs underwent clinical, abdominal ultrasonographic and laboratory examinations prior to the surgical operation and kept for 60-day observation period post-splenectomy. Follow-up ultrasonography revealed no serious complications post-splenectomy. Both brachial and femoral veins were imaged medial to their corresponding arteries. Doppler ultrasonographic parameters of both veins showed no significant changes throughout the study period (P > 0.05). Haematological analysis revealed development of anemia, leukocytosis, and thrombocytosis in dogs post-splenectomy. Coagulation profile exhibited no significant variations in prothrombin and activated partial thromboplastin times (P > 0.05). In comparison with their baseline values, the mean concentrations of total cholesterol, low-density lipoprotein, and triglycerides were significantly increased 30-day post-splenectomy. In conclusion, it may seem that open splenectomy has no influence on the Doppler ultrasonographic indices of brachial and femoral veins with no evidence of deep vein thrombosis in dogs. However, persistent leukocytosis and thrombocytosis, as well as altered lipid profile may increase the risk of vascular complications with the long run. Therefore, a further long-term study may be required.
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20
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Lodzinska J, Leigh H, Parys M, Liuti T. Vascular ultrasonographic findings in canine patients with clinically diagnosed phlebitis. Vet Radiol Ultrasound 2019; 60:745-752. [PMID: 31515890 PMCID: PMC6899573 DOI: 10.1111/vru.12805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/06/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non‐pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non‐pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.
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Affiliation(s)
- Joanna Lodzinska
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Hannah Leigh
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Magdalena Parys
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
| | - Tiziana Liuti
- Royal (Dick) School of Veterinary Studies, Easter Bush Campus, The University of Edinburgh, Roslin, UK
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21
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Panpikoon T, Wedsart B, Treesit T, Chansanti O, Bua-ngam C. Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population. J Vasc Surg Venous Lymphat Disord 2019; 7:349-355. [DOI: 10.1016/j.jvsv.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/29/2018] [Indexed: 10/27/2022]
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22
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Garcia R, Labropoulos N. Duplex Ultrasound for the Diagnosis of Acute and Chronic Venous Diseases. Surg Clin North Am 2018; 98:201-218. [DOI: 10.1016/j.suc.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Gianesini S, Sisini F, Menegatti E, Di Domenico G, Gambaccini M, Occhionorelli S, Zamboni P. Altered velocity gradient in lower limb chronic venous disease. Phlebology 2018. [PMID: 29514566 DOI: 10.1177/0268355518762854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In physiology, velocity of the deep venous compartment is higher than the one in the saphenous compartment which is higher than the one in the tributaries. Considering that velocity variation is associated with changes in the pressure gradient, aim of the present study is to assess changes in venous kinetics in case of superficial chronic venous disease, so to provide further clues in venous drainage direction determination. METHODS Venous ultrasound scanning was performed on 40 lower limbs of 28 chronic venous disease patients (C2-6Ep,As,Pr). Velocities were measured in three different venous segments: great saphenous vein at 2 cm above the origin of the incompetent tributary (Group-A). great saphenous vein at 2 cm below the origin of tributary (Group-B). tributary at 2 cm from its origin from the great saphenous vein (Group-C.). RESULTS Diastolic time average velocity was higher in group-C (-21.3 ± 8.5 cm/s) than in group-A (-15.7 ± 5.2 cm/s; p = .0001) and group-B (-11.1 ± 2.9 cm/s; p = .0001), thus indicating an inversion of the physiological velocity gradient in chronic venous disease patients. DISCUSSION Chronic venous disease presents a subverted velocity gradient. These data introduce objective hemodynamics data, paving the way for further investigation in venous drainage direction determination.
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Affiliation(s)
- Sergio Gianesini
- 1 Vascular Disease Center, Unit of Translational Surgery, University of Ferrara, Ferrara, Italy
| | - Francesco Sisini
- 2 Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Erica Menegatti
- 1 Vascular Disease Center, Unit of Translational Surgery, University of Ferrara, Ferrara, Italy
| | - Giovanni Di Domenico
- 2 Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Mauro Gambaccini
- 2 Department of Physics and Earth Sciences, University of Ferrara, Ferrara, Italy
| | - Savino Occhionorelli
- 1 Vascular Disease Center, Unit of Translational Surgery, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- 1 Vascular Disease Center, Unit of Translational Surgery, University of Ferrara, Ferrara, Italy
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Abstract
The reporting roles of sonographers in Australasia vary considerably. A large number of sonographers already routinely produce formal reports, while others are moving into clinical ultrasound roles where reporting is expected. This article summarises the best practice in reporting of ultrasound examinations based on international literature and addresses key topics including report structure, clinical content, style and language. Numerous examples and sample phrases are provided and common pitfalls are discussed.
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Affiliation(s)
- Martin Necas
- Department of Ultrasound Waikato Hospital Level 1 Waiora Building Pembroke Street Hamilton New Zealand
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