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Kienzl P, Deinsberger J, Weber B. Chronic Venous Disease: Pathophysiological Aspects, Risk Factors, and Diagnosis. Hamostaseologie 2024; 44:277-286. [PMID: 38991541 DOI: 10.1055/a-2315-6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Chronic venous disease (CVD) is highly prevalent in the general population and encompasses a range of pathological and hemodynamic changes in the veins of the lower extremities. These alterations give rise to a variety of symptoms, with more severe forms resulting in venous ulceration, which causes morbidity and high socioeconomic burden. The origins and underlying mechanisms of CVD are intricate and multifaceted, involving environmental factors, genetics, hormonal factors, and immunological factors that bring about structural and functional alterations in the venous system. This review offers the latest insights into the epidemiology, pathophysiology, and risk factors of CVD, aiming to provide a comprehensive overview of the current state of knowledge. Furthermore, the diagnostic approach for CVD is highlighted and current diagnostic tools are described.
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Affiliation(s)
- Philip Kienzl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Tsai CK, Nfor ON, Tantoh DM, Lu WY, Liaw YP. The association between vegetarian diet and varicose veins might be more prominent in men than in women. Front Nutr 2023; 10:1046158. [PMID: 37324727 PMCID: PMC10267867 DOI: 10.3389/fnut.2023.1046158] [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: 11/24/2022] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Background Varicose veins (VVs), a common vascular disease is associated with a huge medical burden. The prevalence in women surpasses that in men. The role of vegetarian diets in the pathogenesis of the disease remains inconclusive. In this study, we examined the risk of VVs in vegetarian and non-vegetarian men and women. Methods The study involved 9905 adults whose data were obtained from Taiwan Biobank between 2008 and 2020. Information on VVs, sex, and vegetarian diets was obtained from participants' self-responses to the Taiwan Biobank questionnaires. Results The study subjects consisted of 4,142 men and 5,763 women. About 12% of men and 35% of women had VVs. Study participants were predominantly non-vegetarians (91.84% were men and 88.24% were women). Women had a higher risk of VVs than men. The odds ratio (OR); 95% confidence interval (CI) was 3.414; 2.995-3.891. There was a significant interaction between sex and vegetarian diets (p = 0.0034). Women were at higher risk of VVs than men both in the vegetarian (OR = 1.877, 95% CI = 1.270-2.774) and non-vegetarian (OR = 3.674, 95% CI = 3.197-4.223) groups. Based on vegetarian diets, only vegetarian men had a higher risk of VVs (OR = 1.453, 95% CI = 1.069 to 1.976). Based on the sex-stratified model, the risk of VVs was significantly higher in vegetarian men (OR = 1.457, 95% CI = 1.072-1.979), and in vegetarian and non-vegetarian women with corresponding ORs (95% CI) of 3.101 (2.528-3.803) and 3.599 (3.140-4.124), respectively. Conclusion Women were more susceptible to varicose veins compared to men, regardless of diet. However, in terms of diet, only men who followed a vegetarian diet were at greater risk for developing VVs.
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Affiliation(s)
- Cheng-Ken Tsai
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Disline Manli Tantoh
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Yu Lu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Gloviczki P, Lawrence PF, Wasan SM, Meissner MH, Almeida J, Brown KR, Bush RL, Di Iorio M, Fish J, Fukaya E, Gloviczki ML, Hingorani A, Jayaraj A, Kolluri R, Murad MH, Obi AT, Ozsvath KJ, Singh MJ, Vayuvegula S, Welch HJ. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord 2023; 11:231-261.e6. [PMID: 36326210 DOI: 10.1016/j.jvsv.2022.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
The Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society collaborated to update the 2011 Society for Vascular Surgery/American Venous Forum clinical practice guidelines and provide new evidence-based recommendations on critical issues affecting the care of patients with varicose veins. Each recommendation is based on a recent, independent systematic review and meta-analysis of the diagnostic tests and treatments options for patients with lower extremity varicose veins. Part I of the guidelines includes evidence-based recommendations for the evaluation of patients with CEAP (Clinical Class, Etiology, Anatomy, Pathology) class 2 varicose vein using duplex ultrasound scanning and other diagnostic tests, open surgical treatment (ligation and stripping) vs endovenous ablation techniques, thermal vs nonthermal ablation of the superficial truncal veins, and management of incompetent perforating veins in CEAP class 2 disease. We have also made recommendations on the concomitant vs staged treatment of varicose tributaries using phlebectomy or liquid or foam sclerotherapy (with physician-compounded foam or commercially prepared polidocanol endovenous microfoam) for patients undergoing ablation of incompetent superficial truncal veins.
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Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
| | - Peter F Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, and Rex Vascular Specialists, UNC Health, Raleigh, NC
| | | | - Jose Almeida
- Miller School of Medicine, University of Miami, Miami, FL
| | | | - Ruth L Bush
- Central Texas Veterans Affairs Healthcare System and Texas A&M University College of Medicine, Temple, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | | | | | - Arjun Jayaraj
- RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Raghu Kolluri
- Heart and Vascular Service, OhioHealth Riverside Methodist Hospital, Columbus, OH
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Kachare M, Jaisinghani P, Kulkarni S. Evaluation of anomalies of major veins of the superficial venous system of lower limb in adults on color doppler: An observational study. Phlebology 2022; 37:662-669. [DOI: 10.1177/02683555221114545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the incidence of anomalies in the superficial venous system in lower limb. Method Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. Result (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. Conclusion Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research.
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Affiliation(s)
- Manohar Kachare
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, India
| | - Pooja Jaisinghani
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, India
| | - Sanjay Kulkarni
- Department of Surgery, Bharati Vidyapeeth Deemed University, Sangli, India
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Pannier F, Noppeney T, Alm J, Breu FX, Bruning G, Flessenkämper I, Gerlach H, Hartmann K, Kahle B, Kluess H, Mendoza E, Mühlberger D, Mumme A, Nüllen H, Rass K, Reich-Schupke S, Stenger D, Stücker M, Schmedt CG, Schwarz T, Tesmann J, Teßarek J, Werth S, Valesky E. S2k guidelines: diagnosis and treatment of varicose veins. DER HAUTARZT 2022; 73:1-44. [PMID: 35438355 PMCID: PMC9358954 DOI: 10.1007/s00105-022-04977-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- F Pannier
- Praxis für Dermatologie und Phlebologie, Helmholtzstr. 4-6, 53123, Bonn, Germany.
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Tenezaca-Sari X, García-Reyes M, Escribano-Ferrer JM, Marrero C, Bellmunt-Montoya S. The CHIVA strategy applied to large-diameter saphenous veins. INT ANGIOL 2022; 41:332-337. [PMID: 35373939 DOI: 10.23736/s0392-9590.22.04831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND CHIVA is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified twostage strategy is used in patients with a great saphenous vein (GSV) diameter ≥ 9 mm with the goal to decrease the risk of symptomatic superficial vein thrombosis (SVT), as the risk of complications is higher when first and second stage simultaneously is performed. METHODS We conducted a retrospective observational study of 111 patients with CVD and a GVS diameter ≥ 9 mm treated with two possible stages of the CHIVA strategy, between January 2010 and December 2019. The goal of the first stage is to interrupt the main reflux escape point (incompetent saphenofemoral junction), thereby lowering the venous pressure and achieving a sufficient reduction in GSV diameter to enable, if necessary, a second stage that consist of disconnection of secondary reflux exit point (incompetent saphenous tributaries), with a lower risk of symptomatic SVT when patients do not show significant clinical improvement. Reductions in GSV diameter, postoperative complications and clinical improvement were analyzed. RESULTS There were 60 men (54.1%) and 51 women (45.9%) with a mean age of 57±11.9 years. All patients undergone first surgical stage, and this interruption of the saphenofemoral junction was the single procedure in 77.5% of cases (86 patients). Mean follow-up time was 19.8 months. The second stage was performed in 25 patients (22.5%). Mean preoperative GSV diameter was 10.2±1.1 mm and this decreased to 7.1±1.5 mm after the first surgery (mean reduction, 3±1.5 mm, p<0.001). Six patients (5.4%) experienced recurrence due to recanalization of the reflux point and 16 patients (14.4%) developed SVT, which was symptomatic in 12 cases (10.8%). CONCLUSIONS Interruption of the main reflux escape point as a single procedure in patients with a GSV diameter ≥ 9 mm led to a significant reduction in diameter and sufficient clinical improvement in almost 80% of cases.
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Affiliation(s)
- Xavier Tenezaca-Sari
- Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain - .,Departament de Cirurgia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain -
| | - Marvin García-Reyes
- Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - José María Escribano-Ferrer
- Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Carlos Marrero
- Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Sergi Bellmunt-Montoya
- Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.,Departament de Cirurgia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
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Naleini F, hassani M, Bagherhosseini N, Sobhiyeh M. Ultrasonographic measurement of saphenous vein diameter compared to CEAP classification in patients with varicose veins. JOURNAL OF VASCULAR NURSING 2022; 40:43-46. [DOI: 10.1016/j.jvn.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/08/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
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Choi JY, Lee JH, Kwon OJ. Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins. PLoS One 2022; 17:e0263513. [PMID: 35167584 PMCID: PMC8846520 DOI: 10.1371/journal.pone.0263513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.
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Affiliation(s)
- Ji Yoon Choi
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
- * E-mail:
| | - Ju-Hee Lee
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
| | - Oh Jung Kwon
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
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De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, Giannoukas A, Gohel M, de Graaf R, Hamel-Desnos C, Jawien A, Jaworucka-Kaczorowska A, Lattimer CR, Mosti G, Noppeney T, van Rijn MJ, Stansby G, Esvs Guidelines Committee, Kolh P, Bastos Goncalves F, Chakfé N, Coscas R, de Borst GJ, Dias NV, Hinchliffe RJ, Koncar IB, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Wanhainen A, Document Reviewers, Björck M, Labropoulos N, Lurie F, Mansilha A, Nyamekye IK, Ramirez Ortega M, Ulloa JH, Urbanek T, van Rij AM, Vuylsteke ME. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg 2022; 63:184-267. [PMID: 35027279 DOI: 10.1016/j.ejvs.2021.12.024] [Citation(s) in RCA: 251] [Impact Index Per Article: 125.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/12/2023]
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RELATIONSHIP BETWEEN ULTRASONOGRAPHIC CRITERIA, CLINICAL MANIFESTATIONS AND LIFE QUALITY PARAMETERS IN PATIENTS WITH LOWER EXTREMITY VARICOSE VEIN DISEASE. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-2-80-13-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jha M, Mukherji R, Mopagar V, Kumari K. Quantification of Hemodynamic Parameters in Primary Great Saphenous Reflux using Colour Doppler in Clinical Settings and Effect of GSV Ablation on the Venous Arterial Flow Index. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mendoza E. Anatomie der V. saphena magna und parva. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1287-6932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungIn der Phlebologie ist die Varikose die häufigste Erkrankung. Dabei sind die V. saphena magna und V. saphena parva meist in die pathologische Rezirkulation involviert. Ihre Anatomie ist relativ konstant, bis auf Feinheiten im Mündungsbereich und Verlauf, die jedoch in einer Zeit, in der es verschiedene Techniken und Strategien zur Behandlung der Varikose gibt, mit ins Kalkül gezogen werden müssen. Somit kann man es erlauben, den Patienten den möglichst nebenwirkungsarmen Eingriff mit der geringsten Rezidivhäufigkeit anzubieten. Der Ultraschall ist heute der Goldstandard in der Untersuchung der Beinvenen; daher muss die Anatomie der Venen immer auch im Ultraschall verstanden werden. Der Artikel beleuchtet schematisch die Anatomie und ergänzt die Beschreibung mit typischen Schallbildern zur V. saphena magna und parva.
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Aurshina A, Cardella J, Sumpio B, Zhuo H, Zhang Y, Dardik A, Ochoa Chaar CI. Location of reflux in the saphenous vein does not affect outcomes of vein ablation. J Vasc Surg Venous Lymphat Disord 2020; 9:932-937. [PMID: 33249108 DOI: 10.1016/j.jvsv.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Varicose veins are commonly caused by valvular reflux in the saphenous vein. Most insurance companies will approve venous ablation (VA) for the treatment of junctional reflux only and will deny coverage for symptomatic patients with significant nonjunctional reflux of the saphenous vein at the deep system. The present study compared the outcomes of VA for patients with junctional reflux and patients with nonjunctional reflux. METHODS A retrospective, single-center review of consecutive patients who had undergone VA using radiofrequency in an outpatient office was performed from 2012 to 2016. The patients' electronic medical records were reviewed for the characteristics, imaging findings, and outcomes. A telephone survey inquiring about the intensity of symptoms using a numeric rating scale of 0 to 10 before and after treatment was also conducted, with higher number correlating with increasing symptom severity. Patients were grouped according to the location of reflux, either at the saphenofemoral-saphenopopliteal junction or below the junction (nonjunctional). The patient characteristics and outcomes were compared between the two groups. Clinical success was defined by symptom improvement or resolution. Technical success was defined by vein closure on duplex ultrasonography. RESULTS A total of 265 patients (224 with junctional reflux [84.5%] and 41 with nonjunctional reflux [15.5%]) had undergone VA of 343 veins. The mean patient age was 58.8 ± 15 years. No differences in age, sex, or race were present between the two groups. Patients with junctional reflux were significantly more likely to have undergone bilateral treatment (33.3% vs 12.2%; P = .006). No difference was found in CEAP (clinical, etiologic, anatomic, pathophysiologic) class, laterality, or type of vein treated. On ultrasonography, the veins with junctional reflux had significantly larger diameters (5.8 ± 2.1 mm vs 4.8 ± 1.8 mm; P = .004). However, the veins with nonjunctional reflux had a longer reflux time (5.5 ± 0.6 seconds vs 4 ± 1.7 seconds; P < .0001). The clinical success rates, technical success rates, and incidence of complications were not different between patients with junctional reflux and those with nonjunctional reflux. The telephone survey was completed by 217 patients after a mean follow-up of 24.9 ± 11.3 months. The survey results demonstrated no differences in improvement in pain or swelling or recurrence of pain or swelling after 2 years. CONCLUSIONS Junctional reflux in the saphenous vein is more likely to be bilateral compared with nonjunctional reflux. The location of reflux did not affect patient presentation or outcomes after VA.
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Affiliation(s)
- Afsha Aurshina
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Jonathan Cardella
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Bauer Sumpio
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Haoran Zhuo
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Yawei Zhang
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Alan Dardik
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
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Mestre S, Triboulet J, Demattei C, Veye F, Nou M, Pérez-Martin A, Dauzat M, Quéré I. Noninvasive measurement of venous wall deformation induced by changes in transmural pressure shows altered viscoelasticity in patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2020; 9:987-997.e2. [PMID: 33227457 DOI: 10.1016/j.jvsv.2020.11.010] [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: 08/07/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The noninvasive measurement of venous wall deformation induced by changes in transmural pressure could allow for the assessment of viscoelasticity and differentiating normal from diseased veins. METHODS In 57 patients with limbs in the C1s (telangiectasia or reticular veins and symptoms), C3 (edema), or C5 (healed venous ulcer) CEAP (clinical, etiologic, anatomic, pathophysiologic) category of chronic venous disease and 54 matched healthy controls, we measured the changes in the cross-sectional area of the small saphenous vein and a deep calf vein in the supine and standing positions and under compression with an ultrasound probe using ultrasonography. RESULTS The small saphenous vein, but not the deep calf vein, cross-sectional area was smaller in the limbs of the controls than in the limbs with C3 or C5 disease but was not different from that in C1s limbs. When changing from the supine to the standing position, a greater force was required to collapse the leg veins. Their cross-sectional area increased in most subjects but decreased in 31.5% of them as for the small saphenous veins and 40.5% for the deep calf vein. The small saphenous vein area vs compression force function followed a hysteresis loop, demonstrating viscoelastic features. Its area, which represents the viscosity component, was greater (P < .001) in the pooled C3 and C5 limbs (median, 2.40 N⋅mm2; lower quartile [Q1] to upper quartile [Q3], 1.65-3.88 N⋅mm2) than in the controls (median, 1.24 N⋅mm2; Q1-Q3, 0.64-2.14 N⋅mm2) and C1s limbs (median, 1.15 N⋅mm2; Q1-Q3, 0.71-2.97 N⋅mm2). The area increased (P < .0001) in the standing position in all groups. CONCLUSIONS Postural changes in the cross-sectional area of the leg veins were highly diverse among patients with chronic venous disease and among healthy subjects and appear unsuitable for pathophysiologic characterization. In contrast, small saphenous vein viscoelasticity increased consistently in the standing position and the viscosity was greater in limbs with C3 and C5 CEAP disease than in controls.
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Affiliation(s)
- Sandrine Mestre
- Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France; University Research Unit # EA2992 (Female Characteristics of Dysfunctions of Cardiovascular Interfaces), Montpellier University, Montpellier, France.
| | - Jean Triboulet
- Computer Science, Robotics, and Microelectronics Laboratory of Montpellier, Montpellier University, Montpellier, France
| | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, Nimes, France
| | - Florent Veye
- Computer Science, Robotics, and Microelectronics Laboratory of Montpellier, Montpellier University, Montpellier, France
| | - Monira Nou
- Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France
| | - Antonia Pérez-Martin
- University Research Unit # EA2992 (Female Characteristics of Dysfunctions of Cardiovascular Interfaces), Montpellier University, Montpellier, France; Department of Vascular Medicine, Nimes University Hospital, Nimes, France
| | - Michel Dauzat
- University Research Unit # EA2992 (Female Characteristics of Dysfunctions of Cardiovascular Interfaces), Montpellier University, Montpellier, France; Department of Vascular Medicine, Nimes University Hospital, Nimes, France
| | - Isabelle Quéré
- Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France; University Research Unit # EA2992 (Female Characteristics of Dysfunctions of Cardiovascular Interfaces), Montpellier University, Montpellier, France
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Huang H, Chen PY, Huang CC. 40-MHz high-frequency vector Doppler imaging for superficial venous valve flow estimation. Med Phys 2020; 47:4020-4031. [PMID: 32609885 DOI: 10.1002/mp.14362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Doppler ultrasound imaging has been used widely for diagnosing vascular diseases. Recently, vector Doppler imaging (VDI) has been proposed for visualizing the blood flow in all directions to yield more detailed information for estimating flow conditions. Increasing the resolution of VDI is important for the structural mapping of superficial vessels with microstructure. However, VDI that operates under a high-frequency ultrasound (HFUS; >30 MHz) is rare. In this study, a 40-MHz high-frequency VDI (HFVDI) based on ultrafast ultrasound imaging was developed to obtain the vector information of blood flow around the superficial venous valve. METHODS The use of HFUS imaging system causes an overload of data acquisition easily. In order to provide sufficient recording time, the frame rate should be reduced. Because the aliasing problem worsens due to a low frame rate when operating Doppler imaging, phase-unwrapping processing methods based on spatial and temporal continuities were applied. Flow phantom experiments were performed to validate the accuracy. In vivo experiments were performed on the valve of superficial veins of healthy volunteers. RESULTS The experimental results from the phantom study indicated that the error of velocity estimation was <10% in most cases. Dynamic changes of valve movements and flow conditions (including velocity profiles and vector) were observed. Because of the high resolution of HFVDI, the jet and vortex phenomena were observed between the leaflets and in the sinus pocket, respectively. CONCLUSIONS Flow velocities ranging from 2 to 15 mm/s were measured at different locations around the venous valve during the opening and closing phases. All the results indicated that HFVDI has the potential to be a useful tool for vessel duplex scanning.
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Affiliation(s)
- Hsin Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Yu Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
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Kalinin RE, Suchkov IA, Laut MV, Mzhavanadze ND, Shanaev IN. Varicose Veins: A Local or Systemic Hemodynamic Disorder? JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020; 36:328-334. [DOI: 10.1177/8756479320912683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Objective: To determine the capabilities of a sonographic examination to evaluate local and systemic hemodynamic disorders in patients with varicose disease. Materials and Methods: This study included 583 patients with varicose veins, among whom 348 had trophic disorders. All subjects underwent lower limb duplex sonography and superficial, perforator, and deep venous diameter measurements, as well as had a calculated velocity for antegrade and reflux flow. Peripheral resistive index (RI) in the arteries, accompanying perforator veins (PVs), was analyzed. In addition, echocardiography was performed on 46 of the participants. Results: A statistically significant difference in the diameter of the great saphenous vein was obtained between class C2 and C4 varicose veins ( P < .05). Similar findings were obtained for the diameter of the PVs and the velocity reflux flow through PVs. Arteries in the perforator bundles demonstrated low RI, which may be attributed to the presence of arteriovenous shunts. Varicose veins were associated with an increased incidence of nonrestrictive type of blood flow through the tricuspid valve. Conclusions: Sonography demonstrated that additional factors rather than hemodynamics may be attributable to the development of venous ulcers. The most informative parameters of cardiac function, in a patient with varicose veins, are the indicators of diastolic function in both ventricles.
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Affiliation(s)
| | | | - Marina V. Laut
- Ryazan Regional Clinical Cardiologic Dispensary, Ryazan, Russia
| | | | - Ivan N. Shanaev
- Ryazan State Medical University, Ryazan, Russia
- Ryazan Regional Clinical Cardiologic Dispensary, Ryazan, Russia
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Effect of endovenous ablation assessment stratified by great saphenous vein size, gender, clinical severity, and patient-reported outcomes. J Vasc Surg Venous Lymphat Disord 2020; 9:128-136. [PMID: 32353593 DOI: 10.1016/j.jvsv.2020.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The policies of insurance carriers have used the truncal vein size as a criterion for coverage. The objective of the present study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on patient presentation and clinical outcomes. METHODS Patients in a national cohort were prospectively captured in the Vascular Quality Initiative Varicose Vein Registry. From January 2015 to October 2017, the Vascular Quality Initiative Varicose Vein Registry database was queried for all patients who had undergone varicose vein procedures. The CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, Venous Clinical Severity Score, and patient-reported outcomes were compared by GSV size (<5 mm, group 1; ≥5 mm, group 2) before and after the procedures. A 2-sample Wilcoxon test was performed to assess the differences between the 2 groups stratified by GSV size. To assess for postoperative improvement, a matched-pairs Wilcoxon signed rank test was performed for each group separately. RESULTS During the study period, 5757 vein ablation procedures had been performed for GSV: 770 for GSV size <5 mm and 4987 for GSV size ≥5 mm. Patients in group 1 were more likely to be women (81.7% vs 68.4%; P = .001) and older (56.8 vs 55.6 years; P = .012). The CEAP clinical class was more advanced in group 2 than in group 1 (P = .001). The maximal GSV diameter in group 2 was significantly greater than in group 1 (8.32 vs 3.86 mm; P = .001); 64% of group 2 and 59.2% of group 1 had undergone radiofrequency thermal ablation (P = .001). No mortalities occurred in either group. Group 2 had more complications postoperatively (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%, P = .001), developed partial recanalization (0.8% vs 0.3%; P = .001), and missed more work days (2.32 vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but group 1 had a higher rate of paresthesia. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, itching) score. The degree of symptomatic improvement between the 2 groups was similar. CONCLUSIONS All patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation, regardless of GSV size. Patients with a preoperative GSV size ≥5 mm experienced similar improvement in symptoms but an increased complication rate. Patients with a smaller vein size should not be denied intervention or coverage by vein size.
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Hwang JH, Kim KH, Yang WY, Park SW, Hwang JJ, Lee SA. Reply. J Vasc Surg Venous Lymphat Disord 2019; 7:768-769. [PMID: 31421841 DOI: 10.1016/j.jvsv.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Ki Hyun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Woo Young Yang
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae Joon Hwang
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Song Am Lee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Kim MJ, Park PJ, Koo BH, Lee SG, Byun GY, Lee SR. Association between venous reflux and diameter of great saphenous vein in lower thigh. J Vasc Surg Venous Lymphat Disord 2019; 8:100-105. [PMID: 31402294 DOI: 10.1016/j.jvsv.2019.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/20/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Venous reflux may occur in all parts of the great saphenous vein (GSV). The GSV diameter generally increases when venous reflux occurs, and the extent of venous dilation may be altered on the basis of size and location of the reflux within the GSV. We examined which part of the GSV is the most sensitive and dilated in association with venous reflux. METHODS We retrospectively evaluated the data of 99 patients (198 limbs) with signs and symptoms of venous insufficiency of both lower limbs from January 2016 to December 2016. We performed ultrasound to examine the venous reflux and to measure the diameter of the GSV. The GSV was divided into four locations: saphenofemoral junction, midthigh, lower thigh (LT), and below the knee. The patients were divided into two groups according to the presence or absence of reflux. RESULTS There were 87 limbs that had venous reflux and 111 limbs that had no reflux. The diameter of the GSV with reflux was significantly larger than that of GSVs without reflux only at the LT (4.7 mm vs 4.2 mm; P < .001), and the highest area under the receiver operating characteristic curve was 0.642 at the LT. The cutoff value of the LT diameter for association with reflux was 5 mm (P = .025). CONCLUSIONS The cutoff diameter of the LT was 5 mm. We recommend treatment of symptomatic reflux, and LT diameter may be useful for follow-up before and after treatment.
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Affiliation(s)
- Myoung Jin Kim
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
| | - Pyeong Jae Park
- Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
| | - Seung Geun Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
| | - Geon Young Byun
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea.
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Tan MK, Sutanto SA, Onida S, Davies AH. The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review. Eur J Vasc Endovasc Surg 2019; 57:851-857. [DOI: 10.1016/j.ejvs.2019.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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21
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Dos Santos JB, Júnior WC, Porta RM, Puggina J, da Silva DF, Puech-Leão P, de Luccia N, da Silva ES. Catheter-directed foam sclerotherapy with tumescence of the great saphenous vein versus ultrasound-guided foam sclerotherapy: A randomized controlled trial. Phlebology 2019; 35:84-91. [PMID: 31117882 DOI: 10.1177/0268355519850651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To compare the effectiveness of two foam sclerotherapy techniques of the great saphenous vein. Methods Fifty subjects with varicose veins, edema, and great saphenous vein incompetence (diameter 6–10 mm) were randomly categorized into two equal groups and were treated with different foam sclerotherapy techniques: A (usual ultrasound-guided) and B (catheter-directed with tumescence). Concomitant phlebectomy was performed in all patients. Patients were seen on days 7 and 28, and at six and 12 months. The primary outcomes were the full success rate of the treated great saphenous vein and the number of patients who required retreatment sessions performed at 28-day follow-up. The secondary-assisted outcomes were the full success rates of the treated great saphenous vein after the retreatment sessions at six- and 12-month follow-up. Secondary outcomes were changes in quality of life and side effects and complications of the intervention. In case of reflux, retreatment sessions were performed at 28 days and six months in both groups. Results Full success rate of the treated great saphenous vein was 36% in group A vs. 80% in group B ( p = 0.012) and the number of patients who required retreatment sessions were n = 14 in group A vs. n = 3 in group B at 28-day follow-up ( p = 0.002). Both were statistically significant. At six and 12 months, the success rates were not statistically significant between the groups. Complication rates were similar between the groups. Quality of life improved in both groups with statistical difference ( p < 0.001). Conclusions Catheter-directed foam sclerotherapy with tumescence was better than usual ultrasound-guided foam sclerotherapy as it reached higher full success rate of the treated great saphenous vein and as a lower number of patients required retreatment sessions in the short-term. Both methods proved to be safe and improved the quality of life.
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Affiliation(s)
- Jorgete B Dos Santos
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Walter Campos Júnior
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Rina Mp Porta
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Puggina
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Ft da Silva
- Postgraduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho/UNINOVE, São Paulo, Brazil
| | - Pedro Puech-Leão
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Nelson de Luccia
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
| | - Erasmo S da Silva
- Department of Surgery, Vascular and Endovascular Division, Universidade de São Paulo, São Paulo, Brazil
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Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency. Eur J Vasc Endovasc Surg 2019; 57:570-577. [PMID: 30898493 DOI: 10.1016/j.ejvs.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. MATERIALS AND METHODS This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. RESULTS The clinical part of the CEAP classification was: C0 = 3, C1 = 4, C2 = 5, C3 = 1, C4a = 1, C4b = 6, C5 = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p < .0005), VFI (p = .001), and PDC (p = .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r = .532, p = .015), VFI (r = .489, p = .025) and PDC (r = -.474, p = .030); RCI vs. VFI (r = .446, p = .043) and PDC (r = -.527, p = .014). CONCLUSIONS Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.
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Ultrasound-based topographic analysis of tributary vein connection with the saphenous vein during ambulatory conservative hemodynamic correction of chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2019; 7:356-363. [PMID: 30777672 DOI: 10.1016/j.jvsv.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Preoperative mapping of great saphenous vein (GSV) escape points to tributary veins (TVs) and targeted intervention of escape points may reduce recurrence rates of varicose veins (VVs) after endovascular treatment of saphenous veins and prevent saphenous nerve complications. The aim of this study was to perform an analysis of cartography after Doppler ultrasound mapping of escape points in patients with VVs and to suggest one point that may prevent recurrence and nerve complications. METHODS Ultrasound assessment of VVs was performed from March 4, 2016, to July 15, 2016, specifically focusing on the locations of escape points from the saphenous vein to TVs. The collected data were reviewed retrospectively. The topographic distribution of escape points was as follows: from inguinal ligament to midthigh; from midthigh to knee; from knee to midcalf; and from midcalf to heel. RESULTS Thirty patients (41 legs) with VVs underwent ultrasound examination. All VVs were characterized by reflux at the GSV. Topographic analysis revealed a total of 79 escape points in all patients. The most common location for escape points was the third part of the leg (from knee to midcalf), where 65.8% of escape points were located; 82.3% of all escape points were located below the knee. The mean diameter of the GSV at 3 cm and 15 cm from the saphenofemoral junction was 6.8 ± 1.6 cm and 5.5 ± 1.5 cm, respectively. Mean diameter of TVs was 5.1 ± 1.9 cm. The diameter was not significantly different between saphenous veins and TVs. The mean number of escape points in each leg was 1.9 ± 1.0. CONCLUSIONS Most escape points (65.8%) are located from knee to midcalf (third part of the leg), and 82.3% of all escape points are located below the knee. The diameter of TVs near the escape point is about 90% of that of the GSV. Thermal ablations of below-knee saphenous vein have potential nerve damage. Ablation of saphenous veins above the knee alone may result in residual shunting and formation of persistent reservoirs in TVs. These persistent reservoirs may be removed effectively with sclerotherapy or miniphlebectomy, especially trying to remove TVs near the escape point. Direct ligation of a TV near the escape point from the saphenous vein, just like saphenofemoral junction ligation, could be performed. These approaches may be able to prevent residual shunting and may reduce recurrence rates and nerve injury.
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Ochi M, Yamaki T, Hamahata A, Konoeda H, Osada A, Hasegawa Y, Sakurai H. Comparison of duplex-derived parameters in patients with chronic venous insufficiency with special reference to early symptoms. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.23736/s1824-4777.18.01356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Great Saphenous Vein Diameters in Phlebological Practice in France: A Report of the DIAGRAVES Study by the French Society of Phlebology. Eur J Vasc Endovasc Surg 2018; 58:96-103. [PMID: 30343991 DOI: 10.1016/j.ejvs.2018.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim was to evaluate the distribution of the diameter of the great saphenous vein (GSV) at mid-thigh level and to investigate its association with clinical class, symptoms, and proximal extent of reflux. METHODS Vascular physicians, members of the French Society of Phlebology, were invited to participate in a consecutive observational study in patients presenting with symptoms and/or signs of uni- or bilateral chronic venous disorders (CVDs) in previously untreated limbs (clinical class of the CEAP classification C0s - C6). Patients were included between January and March 2015. They completed a specially designed venous symptoms questionnaire. Duplex ultrasound of the included limbs was performed with the patient standing to detect reflux in the GSV and to measure the GSV inner diameter at mid-thigh. RESULTS Between January and March 2015, 35 physicians examined 1245 patients (2450 limbs after excluding 40 limbs): 77% were female, mean age 52 ± 14; 69% of the patients had venous symptoms in one or both legs. The most frequent symptoms were feeling of heaviness, feeling of swelling and aching. Predominant CEAP clinical classes were C2 (38% of limbs) and C1 (35%). In case of GSV reflux (40% of limbs), the average diameter was 5.6 ± 2 mm and the distribution was 62% < 6 mm, 30% between 6 and 8 mm, and 8% > 8 mm. The study showed a clear association between clinical class and GSV diameter (the higher the clinical class, the larger the diameter; p < .0001), between venous symptoms and diameter (the larger the diameter, the higher the intensity of symptoms, p < .0001 for overall discomfort) and between proximal extent of reflux and diameter (the more proximal the extent of reflux, the larger the diameter, p < .0001). CONCLUSION The DIAGRAVES study demonstrated that in France for patients consulting with CVDs, more than half of the incompetent GSVs had a diameter < 6 mm, while large diameters were relatively infrequent. This should be kept in mind when considering management strategies in patients with CVDs.
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Abstract
ZusammenfassungEinleitung: Die Durchmesser der V. saphena magna (VSM) und der V. femoralis communis (VFC) gelten als Hinweis auf den Schwere-grad der Venenerkrankung. Eine Kaliberreduktion 8 Wochen nach Operation nach CHIVA wurde bereits belegt (3), offen blieb die Langzeitwirkung.Methode: Bei 43 Patienten wurde 5 Jahre nach einem Eingriff nach CHIVA an den Stammvenen der Durchmesser der VSM und der VFC, das C(CEAP) und die Wiederauffüllzeit im Vergleich zum präoperativen Wert erfasst.Ergebnis: 43 Patienten (Durchschnittsalter 52,7 Jahre) stellten sich im Mittel 5,36 Jahre nach Operation nach CHIVA vor. Der Durchmesser der VFC verringerte sich von präoperativ 15,39 ± 2,93 mm über 15,11 ± 2,73 mm nach 8 Wochen auf 14,18 ± 2,56 mm (p<0,05), bei Behandlung der VSM verringerte sich der Durchmesser der VFC von 16,07 ± 2,65 mm über 15,29 ± 2,41 mm nach 8 Wochen auf 14,30 ± 2,81 mm (p<0,001). Der Durchmesser der VSM verringerte sich von präoperativ 7,13 ± 2,05 mm über 4,98 ± 1,49 mm nach 8 Wochen auf 4,38 ± 1,44 mm nach 5 Jahren (p<0,001). Das C reduzierte sich von präoperativ 2,77 ± 0,81 mm über 1,51 ± 1,19 mm nach 8 Wochen auf 1,72 ± 1,10 mm nach 5 Jahren (p = 0,007). Die Wiederauffüllzeit verlängert sich von präop. 15,24 ± 6,18 ± s über 17,9 ± 6,47 s nach 8 Wochen auf 21,61 ± 9,2 s nach 5 Jahren (p = 0,022).Fazit: Auch in der Langzeitstudie nach CHIVA konnte keine Belastung der tiefen Beinvenen nachgewiesen werden.
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Stapler SJ, Zurales K, Mazurek A, Otemuyiwa B, Knol M, Wakefield TW, Coleman DM. A pilot study of venous duplex ultrasound parameters in healthy children. J Vasc Surg Venous Lymphat Disord 2018; 6:347-350. [PMID: 29292113 DOI: 10.1016/j.jvsv.2017.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The spectrum of chronic venous disease (CVD) in adults is well documented, whereas there is a paucity of data published commenting on pediatric CVD. We previously identified that there is often venous reflux present in cases of pediatric lower extremity edema despite an alternative confirmed diagnosis. To further assess the clinical significance of this venous reflux, this study aimed to elicit venous parameters in healthy pediatric controls. METHODS Healthy pediatric volunteers aged 5 to 17 years were recruited for venous reflux study. A comprehensive venous reflux study was performed with the patient standing. Vein diameter, patterns of valvular reflux, and accessory venous anatomy were examined in the deep and superficial venous systems. RESULTS Eighteen children including 10 boys and 8 girls were studied. Five volunteers were aged 5 to 8 years, six volunteers were aged 9 to 12 years, and seven volunteers were aged 13 to 17 years. Great saphenous vein (GSV) diameter at the saphenofemoral junction significantly increased with age. Deep vein valve closure time (VCT) did not differ significantly between groups, whereas GSV VCT was significantly higher in the 9- to 12-year age group. Incidental venous insufficiency was identified in 60% of children aged 5 to 8 years (n = 3), 50% of children aged 9 to 12 years (n = 3), and 57% of children aged 13 to 17 years (n = 4). All superficial venous reflux was confined to the GSV; there were no cases of isolated deep venous reflux. Reflux was identified at multiple GSV stations in 60% of children. There was no significant difference in incompetent GSV VCT in comparing children with and without deep venous reflux. Accessory superficial veins were identified in 20% of children aged 5 to 8 years (n = 1), 50% of children aged 9 to 12 years (n = 3), and 43% of children aged 13 to 17 years (n = 3). The presence of an accessory saphenous vein was not associated with deep venous reflux in any patient, and only 29% of those with accessory saphenous venous anatomy had evidence of superficial venous (GSV) reflux. CONCLUSIONS The GSV continues to grow in diameter through the teenage years. Incidental valvular incompetence and GSV reflux are common. The presence of accessory saphenous veins is similarly common and not associated with venous reflux. The clinical significance and natural history of this incidental venous reflux remain unclear. Future research should determine whether these changes seen in the pediatric age group lead to CVD during later years of life.
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Affiliation(s)
| | - Katie Zurales
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Alyssa Mazurek
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Meghan Knol
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Dawn M Coleman
- Department of Surgery, University of Michigan, Ann Arbor, Mich.
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Frequency of refluxive tributaries of the junction region in the groin in patients with recurrent varicose veins of the thigh. PHLEBOLOGIE 2017. [DOI: 10.12687/phleb2300-2-2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryBackground A long stump and neovascularisation are commonly discussed reasons for recurrence of varicosis in the groin after “disconnection” of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV). A third possible reason for recurrence with non femoral reflux emerging from tributaries of the junction region, is often underrated. The aim of the study was to report on the source of reflux for recurrent varicose veins of the thigh in patients who already had a history of disconnection of the SFJ and stripping of the GSV.Methods In this two-centre study, consecutive patients with a history of disconnection of the SFJ, stripping of the GSV and visible or palpable varicose veins of the thigh region were included. Their data and venous diagnostics (DPPG, duplex scan) were recorded and evaluated by a standardised protocol.Results 101 legs were included. In 58.4 % there was a long stump of the GSV as a source for variose veins of the thigh. In the other legs (42,6 %) the source for the reflux was not a long stump with contact to the femoral vein but residual tributaries of the SFJ, e.g. the superficial epigastric vein or the superficial circumflex iliac vein.Conclusions Residual refluxive tributaries of the SFJ seem to be an important source for recurrent varicose veins of the thigh. Further prospective studies should focus on suitable therapeutic options.
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Abstract
Summary
Background Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Stratification of venous disease severity is still difficult. This study aims to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS).
Methods Legs without GSV reflux (Control legs, Group 1) and legs with untreated isolated GSV reflux and varicose veins limited to the GSV territory (Group 2) were studied clinically and with duplex ultrasound in a prospective study. The GSV diameters were measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to the C of CEAP and VCSS.
Results The control legs-group 1 were: n=33, 6 male, mean age 53, mean BMI 26.The legs with reflux-group 2 were: n=78, 16 male, mean age 54, mean BMI 27.The mean diameters for the SFJ ( ± SD) for groups 1 and 2 were 6.4 ± 1.8 and 9.9 ± 3.4. For PT they were 3.6 ± 0.9 and 5.9 ± 1.8 respectively. In legs with reflux the SFJ diameter correlates strongly with the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively. The PT diameter correlates slightly better with the C of CEAP and VCSS than the SFJ diameter (0.55 and 0.57). The mean values of VCSS for groups 1 and 2 were 0.70. and 4.69. The C of CEAP and VCSS show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample.
Conclusion The GSV diameters next to the SFJ and particularly at the PT in patients having reflux correlate strongly with both the C of CEAP and VCSS. Recording the GSV diameters at the SFJ and PT in a standardized way may improve comparison of published data and contribute to choice of treatment in the future.
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Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, Pruneti C, Passeri G, Ventura M, Di Nuzzo S, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis 2017; 27:473-503. [PMID: 28434807 DOI: 10.1016/j.numecd.2017.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The high number of negative opinions from the European Food Safety Authority (EFSA) to the requests for authorization of health claims is largely due to the design of human intervention studies, including the inappropriate choice of outcome variables (OVs) and of their methods of measurement (MMs). The present manuscript reports the results of an investigation aimed to collect, collate and critically analyse the information in relation to claimed effects, OVs and MMs, in the context of protection against oxidative damage and cardiovascular health compliant with Regulation 1924/2006. METHODS AND RESULTS Claimed effects, OVs and the related MMs were collected from EFSA Guidance documents and applications for authorization of health claims under Articles 13.5 and 14. The OVs and their MMs were evaluated only if the claimed effect was sufficiently defined and was considered beneficial by EFSA. The collection, collation and critical analysis of the relevant scientific literature consisted in the definition of the keywords, the PubMed search strategies and the creation of databases of references. The critical analysis of the OVs and their MMs was performed on the basis of the literature review and was aimed at defining the appropriateness of OVs and MMs in the context of the specific claimed effects. CONCLUSIONS The information provided in this document could serve to EFSA for the development of further guidance on the scientific requirements for health claims, as well as to the stakeholders for the proper design of human intervention studies aimed to substantiate such health claims.
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Affiliation(s)
- D Martini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - S Rossi
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - B Biasini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - I Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - M Musci
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy
| | - G Passeri
- Department of Medicine and Surgery, Building Clinica Medica Generale, University of Parma, Parma, Italy
| | - M Ventura
- Department of Chemistry, Life Sciences and Environmental Sustainability, Laboratory of Probiogenomics, University of Parma, Parma, Italy
| | - S Di Nuzzo
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - D Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - P Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - M Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - A Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - R C Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - D Del Rio
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy.
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Kim H, Kim H, Park JH, Kim YH, Oh SJ, Suh BJ, Park JK. Alcohol Consumption, High-Density Lipoprotein Cholesterol, Antithrombin III, and Body Mass Index Are Associated with Great Saphenous Vein Reflux in the Thigh. Ann Vasc Surg 2017; 44:307-316. [PMID: 28501660 DOI: 10.1016/j.avsg.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh. METHODS We studied 139 consecutive patients (278 legs) who underwent Doppler ultrasonography at our hospital between March 2015 and February 2016 for leg discomfort with visible varicosities, edema, skin changes, or venous ulcer in the legs. Continuous variables included age, body mass index (BMI), hematological and blood chemistry parameters, smoking (pack-years), and alcohol consumption (days). Nominal variables included sex, comorbidities, smoking status, alcohol drinking status, and specific antibodies. The relationship of GSV reflux with pregnancy and number of children was investigated in 184 legs of 92 patients among 96 female patients. RESULTS On logistic regression analysis, independent factors determining GSV reflux were BMI (B = 0.126, P = 0.012), high-density lipoprotein (HDL) cholesterol level (B = 0.029, P = 0.025), duration of alcohol consumption (B = 1.237 E-4, P = 0.016), and antithrombin III level (B = -0.036, P = 0.011). CONCLUSIONS In this study, the factors determining GSV reflux were higher HDL cholesterol level, longer duration of alcohol consumption, lower antithrombin III level, and higher BMI.
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Affiliation(s)
- Hyeonseung Kim
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Hyangkyoung Kim
- Department of Surgery, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Je Hoon Park
- Department of Surgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Yong Han Kim
- Department of Anesthesiology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jong Kwon Park
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
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Engelhorn CA, Engelhorn AL, Ritter C, de Lima GFI, Lopes JGP, Cabrini LG. Identificação pela ultrassonografia vascular dos diâmetros das veias safenas magnas sem refluxo em mulheres. J Vasc Bras 2017; 16:92-97. [PMID: 29930632 PMCID: PMC5915856 DOI: 10.1590/1677-5449.008016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Contexto A ultrassonografia vascular (UV) é o exame de escolha para estudar o sistema venoso superficial dos membros inferiores e mensurar o diâmetro das veias safenas, podendo ser utilizada como parâmetro para o planejamento cirúrgico. Objetivos Identificar pela UV os diâmetros de veias safenas magnas sem refluxo em mulheres e sua relação com a idade, altura, Classificação Clínica, Etiologia, Anatomia e Fisiopatologia (CEAP) e índice de massa corporal (IMC). Métodos Estudo transversal em mulheres com sintomas de IVC primária (C0, 1 ou 2), sem cirurgia prévia de varizes e sem refluxo detectado pela UV, nas quais foram mensurados os diâmetros da veia safena magna (VSM) na crossa, coxa e perna, que foram comparados com a idade, altura, classe clínica CEAP e IMC. Resultados Foram avaliadas 353 mulheres, das quais 146 foram incluídas no estudo sendo 88 avaliadas unilateralmente e 58 bilateralmente. Os diâmetros encontrados para a VSM sem refluxo foram de aproximadamente 6,5 mm na crossa, 4,0 mm na coxa proximal, 3.0 mm na coxa médio-distal e joelho e 2,5 mm na perna. Em todos os segmentos mensurados houve diferença estatisticamente significativa (p < 0,05) na correlação dos diâmetros com IMC. Não houve diferença estatística na correlação da medida dos diâmetros com classe CEAP, altura e idade das pacientes. Conclusões Observou-se que os diâmetros de veias safenas magnas sem refluxo independem da classe clínica CEAP 0 ou 1 e 2; da idade e da altura das pacientes. Entretanto, os diâmetros da VSM se relacionam significativamente com o IMC das pacientes.
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Affiliation(s)
| | - Ana Luiza Engelhorn
- Pontifícia Universidade Católica do Paraná - PUC-PR, Cirurgia Vascular, Curitiba, PR, Brasil
| | - Camila Ritter
- Pontifícia Universidade Católica do Paraná - PUC-PR, Cirurgia Vascular, Curitiba, PR, Brasil
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Ricci S, Moro L, Ferrini A, Rossi Bartoli I, Antonelli Incalzi R. The E point: a new echographic great saphenous identification sign in specific anatomical variants and applications. Phlebology 2017; 32:120-124. [PMID: 26908639 DOI: 10.1177/0268355516633381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To describe a new ultrasound marker of the Great Saphenous Vein at the groin. Method An ultrasound marker of the Great Saphenous Vein was identified as follows: the Great Saphenous Vein was tracked in cross-sectionally starting from the Sapheno Femoral Junction and optimally visualized where it crosses the Adductor Longus muscle, i.e., 3-5 cm below the junction. This marker, corresponding to a very superficial position of Great Saphenous Vein, was named "E Point," where E means easy to find. The search for the E point was performed on 230 limbs of 126 subjects with or without chronic venous insufficiency (training population) and the method was validated in 58 subjects (testing population). Results The E point was successfully recorded in 128/144 (89%) pathologic and in 85/86 (99%) healthy limbs. Being free from other structures, at the E point the Great Saphenous Vein was always easily calibrated. In 17 cases, the E point could not be identified due to an hypoplasic Great Saphenous Vein; in such instances, the Anterior Accessory Saphenous Vein was well evident and substituted for the Great Saphenous Vein as the main draining vein at the groin. Conclusion The E point identifies the Great Saphenous Vein in healthy and varicose patients. Failure to identify the E point indicates Anterior Accessory Saphenous Vein dominance over a hypoplasic Great Saphenous Vein.
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Affiliation(s)
- Stefano Ricci
- Centro di Flebologia, Area di Geriatria, Università Campus Bio-medico di Roma, Italy
| | - Leo Moro
- Centro di Flebologia, Area di Geriatria, Università Campus Bio-medico di Roma, Italy
| | - Alessandro Ferrini
- Centro di Flebologia, Area di Geriatria, Università Campus Bio-medico di Roma, Italy
| | - Isaura Rossi Bartoli
- Centro di Flebologia, Area di Geriatria, Università Campus Bio-medico di Roma, Italy
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Jones RW, Parkerson GR, Ottinger M, Rodriguez E, Park B. A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency. SAGE Open Med Case Rep 2017; 5:2050313X17692937. [PMID: 28255445 PMCID: PMC5315365 DOI: 10.1177/2050313x17692937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/10/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. METHODS A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. RESULTS Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. CONCLUSION Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.
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Affiliation(s)
- Roy Wesley Jones
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | | | - Mary Ottinger
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Eduardo Rodriguez
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Brian Park
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
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Seidel AC, Campos MB, Campos RB, Harada DS, Rossi RM, Cavalari P, Miranda F. Associação entre sintomas, veias varicosas e refluxo na veia safena magna ao eco-Doppler. J Vasc Bras 2017; 16:4-10. [PMID: 29930616 PMCID: PMC5829685 DOI: 10.1590/1677-5449.005216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/17/2017] [Indexed: 11/29/2022] Open
Abstract
Contexto A doença venosa crônica requer avaliação clínica, quantificação dos efeitos hemodinâmicos e definição da distribuição anatômica para decisão diagnóstica e tratamento. Métodos Estudo prospectivo realizado em 2015 com amostra de 1.384 pacientes (2.669 membros) com idade entre 17 e 85 anos, sendo 1.227 do sexo feminino. Nas respostas do questionário aplicado, os sintomas pesquisados eram dor, cansaço, sensação de peso, queimação, câimbras e formigamento. Para a formação dos grupos, foi considerado o número de membros, distribuídos em relação ao gênero, ao índice de massa corporal e à idade. Após a definição grupos e a realização do eco-Doppler para estudo da veia safena magna (VSM), os pacientes foram distribuídos em três grupos (I: sintomas presentes e varizes ausentes, II: sintomas ausentes e varizes presentes e III: sintomas presentes e varizes presentes). A análise estatística utilizou o teste qui-quadrado ou exato de Fisher para verificar a homogeneidade entre os grupos. Em caso de associação com significância de 5%, foi calculada a razão de chances. Resultados Para ambos os gêneros, foi observada chance de insuficiência da VSM 11,2 vezes maior no grupo III. Por sua vez, os casos de obesidade mórbida ocorreram 9,1 vezes mais no mesmo grupo. Além disso, pacientes na faixa etária entre 30 e 50 anos desse grupo apresentaram chance de insuficiência da VSM 43,1 vezes maior. Conclusões A insuficiência da VSM foi significantemente mais frequente no grupo III, tanto globalmente como considerando apenas os casos de obesidade mórbida e a faixa etária mais elevada.
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Affiliation(s)
| | - Mariana Baldini Campos
- Universidade Estadual de Maringá – UEM, Departamento de Medicina, Maringá, PR, Brasil.
- Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil.
| | - Raquel Baldini Campos
- Universidade Estadual de Maringá – UEM, Departamento de Medicina, Maringá, PR, Brasil.
- Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil.
| | - Dérica Sayuri Harada
- Universidade Estadual de Maringá – UEM, Departamento de Medicina, Maringá, PR, Brasil.
- Universidade de São Paulo – USP, São Paulo, SP, Brasil.
| | - Robson Marcelo Rossi
- Universidade Estadual de Maringá – UEM, Departamento de Cirurgia, Maringá, PR, Brasil.
| | - Pedro Cavalari
- Universidade Estadual de Maringá – UEM, Departamento de Cirurgia, Maringá, PR, Brasil.
| | - Fausto Miranda
- Universidade Federal de São Paulo – UNIFESP, Escola Paulista de Medicina, Departamento de Cirurgia, São Paulo, SP, Brasil.
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Lattimer CR, Mendoza E. Reappraisal of the Utility of the Tilt-table in the Investigation of Venous Disease †. Eur J Vasc Endovasc Surg 2016; 52:854-861. [PMID: 27789144 DOI: 10.1016/j.ejvs.2016.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/23/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Without gravity opposing drainage, most venous diseases would not exist. Therefore, manoeuvres that assess venous function should include gravity. The aim was to "dose" gravity in subjects using static positions and dynamic angulations on a tilt-table and to assess its effects with air plethysmography (APG) and duplex ultrasound over the femoral vein. METHODS Three groups (providing n = 11 legs each) were compared. (a) A control group, without clinical or duplex evidence of venous disease. (b) An obstruction group, with past iliofemoral deep vein thrombosis. (3) A reflux group, with primary varicose veins. A manually operated tilt-table ranging from -70° to 40° in the Trendelenburg position provided rapid tilting (<3 s). The changes in calf volume at -70° (almost standing), -45° (reclining), and 40° (legs-up) were recorded with APG, as well as the rate and duration of the changes. The minor diameter of the femoral vein was recorded at the three tilt positions. RESULTS The results were expressed as median (interquartile range). The total working venous volume (mL) in the reflux group was significantly increased: 202 (180-240) mL versus the controls at 138 (119-198) mL, p = .008, and versus the legs with obstruction at 117 (80-154) mL, p < .0005. The venous drainage index (VDI) in mL/second in the obstructed group was significantly reduced: 7 (6-9.6) mL/second, versus the controls at 17.4 (13.9-27.2) mL/second, p < .0005, and versus the legs with varicose veins at 28.1 (25.4-34.4) mL/second, p < .0005. The venous filling index (VFI) in mL/second in the reflux group was significantly increased: 8.1 (4.2-10) mL/second versus the controls at 1.8 (1-2.1) mL/second, p < .0005. The VDI cut-off point discriminating obstruction was ≤10.8 mL/second and the VFI discriminating reflux was ≥ 2.9 mL/second. The femoral vein diameter was reduced significantly with increasing leg elevation. CONCLUSIONS Manoeuvres using APG on a tilt-table have the potential to quantify the contributions of global obstruction and reflux (mL/second) in patients with venous disease.
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Affiliation(s)
- C R Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK; Department of Surgery and Cancer, Imperial College, London, UK; West London Vascular & Interventional Centre, Northwick Park Hospital, Harrow, UK.
| | - E Mendoza
- Venenpraxis-Wunstorf, Wunstorf, Germany
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Versteeg MPT, Macfarlane J, Hill GB, van Rij AM. The natural history of ultrasound-detected recurrence in the groin following saphenofemoral treatment for varicose veins. J Vasc Surg Venous Lymphat Disord 2016; 4:293-300.e2. [PMID: 27318048 DOI: 10.1016/j.jvsv.2016.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This prospective study sought to track the natural history of duplex ultrasound (DUS) detected varicose vein recurrence in the groin after surgical intervention during a 5-year period. METHODS Patients were recruited from a previous prospective trial investigating outcomes after high ligation and stripping with and without patch saphenoplasty. Follow-up examinations of the lower limb venous systems using DUS, air plethysmography, and clinical assessment were carried out at 1, 6, 12, and 36 months. At 60 months, an additional detailed DUS scan of the groin was performed on those with recurrence, including vessel numbers, diameter, and reflux velocity, to characterize the state of this groin recurrence. RESULTS In the 130 limbs at 5 years, ultrasound groin recurrence was detected in 82%, and visible varicose veins occurred in 83% (108 limbs). In contrast, recurrence with severe varices occurred in 47% (61 limbs) as clinical recurrence (Venous Clinical Severity Score less the stocking component >3) in 22% (29 limbs) and functional recurrence (venous filling index >2 mL/s) in 34% (43/125 limbs). The DUS pattern was junctional in 29 limbs (22%), nonjunctional in 37 limbs (29%), and mixed pattern in 40 limbs (31%). Compared with the 24 (19%) with no ultrasound-detected recurrence, severe visible varicose veins were significantly more common with each of these patterns and especially with multiple connecting vessels (odds ratio, 5.4; confidence interval, 1.5-19.5). The diameter and velocity of reflux through recurrent vessels in the groin did not correlate with disease severity, and no DUS feature in the groin was predictive of Venous Clinical Severity Score >3 or a venous filling index >2 mL/s. The appearance of DUS recurrence within the first year and other features, including residual lower leg reflux, body mass index, gender, and previous treatment, were more consistent predictors. CONCLUSIONS Early ultrasound recurrence is predominantly evidence of neovascularization and some small-vessel remodeling at the site of treatment. When it occurs, some visible varicose veins are inevitable. However, these appearances alone are not good predictors of severe clinical recurrence.
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Affiliation(s)
- Matthew P T Versteeg
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Josie Macfarlane
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Geraldine B Hill
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - André M van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Postural Diameter Change of the Saphenous Trunk in Chronic Venous Disease. Eur J Vasc Endovasc Surg 2016; 51:831-7. [DOI: 10.1016/j.ejvs.2016.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
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Lattimer CR, Kalodiki E, Geroulakos G, Hoppensteadt D, Fareed J. Are Inflammatory Biomarkers Increased in Varicose Vein Blood? Clin Appl Thromb Hemost 2016; 22:656-64. [PMID: 27103338 DOI: 10.1177/1076029616645330] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To test for the presence of inflammatory biomarkers in blood taken from varicose veins versus antecubital blood of the same patient and compare this to levels in healthy controls. METHODS Using a multiplex biochip array method (Randox, United Kingdom), the interleukins (ILs) IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, and IL-10; vascular endothelial growth factor; interferon γ, tumor necrosis factor α ; monocyte chemotactic protein 1 (MCP-1); and epidermal growth factor were measured in citrated plasma samples drawn from the arms and legs of 24 patients with varicose veins and 24 controls. RESULTS Expressed as median (interquartile range) in pg/mL, leg samples from patients with varicose veins had significantly higher levels of IL-8 and MCP-1 compared to their own arm samples (IL-8: local 2.3 [1.71-3.3] vs systemic 2.3 [1.62-2.98], P = .023; MCP-1: local 114.42 [84.29-139.05] vs systemic 103.56 [79.75-126.42], P < .0005). This was not observed in the control group. Leg samples from both patients with varicose vein and controls had higher levels of IL-6 compared to their own arm samples (patients: local 1.67 [0.82-4.48] vs systemic 1.24 [0.58-3.26], P = .002; controls: local 1.23 [0.83-1.7] vs systemic 1.03 [1.7-1.52], P = .005). No significant differences were detected with the other biomarkers. CONCLUSIONS Blood drawn from the site of varicose veins appears to have significantly increased concentrations of IL-6, IL-8, and MCP-1 when compared to the same patient's arm blood. This supports the hypothesis that inflammation is activated from the tissues drained by the varicose veins.
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Affiliation(s)
- Christopher R Lattimer
- Faculty of Medicine, Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College, Southall, Middlesex, United Kingdom
| | - Evi Kalodiki
- Faculty of Medicine, Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College, Southall, Middlesex, United Kingdom Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA
| | - George Geroulakos
- Faculty of Medicine, Josef Pflug Vascular Laboratory, Ealing Hospital and Imperial College, Southall, Middlesex, United Kingdom
| | - Debra Hoppensteadt
- Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Maywood, IL, USA
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Seidel AC, Cavalari P, Rossi RM, Miranda F. Proposal for Classification of the Great Saphenous Vein Aplasia by the B-mode Ultrasound. Ann Vasc Surg 2015; 31:170-8. [PMID: 26616497 DOI: 10.1016/j.avsg.2015.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/20/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The lack of the great saphenous vein (GSV) in its compartment is rarely mentioned in literature, although it happens in individuals with or without insufficiency of it. With the help of the B-mode ultrasound examination this vein can be easily identified. The aim of this study was to propose a classification for the findings. METHODS Prospective study carried out for a period of 6 months in a sample of 2,665 lower limbs with ages ranging from 17 to 85, being that 1,286 patients are female. These patients underwent B-mode ultrasound examination as recommended by the literature. This evaluation determined whether there was a GSV aplasia by the analysis of its location in the saphenous compartment. RESULTS After images were taken they were classified as: type I-aplasia only along the thigh, type II-aplasia only along the calf, type III-aplasia in the distal section of the thigh and proximal calf, type IV-vein in the saphenous compartment in the thigh and aplasia in the whole calf, type V-vein in the saphenous compartment only in a short segment in the proximal thigh, and type VI-vein with short segment in the saphenous compartment in the distal calf. From the total of 2,665 limbs, aplasia was found in 442 (16.6%). CONCLUSIONS These anatomic findings attain an important role in daily practice, influencing the surgical decision, particularly with the arrival of endovascular procedures, such as the use of laser and thermoablation.
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Affiliation(s)
| | - Pedro Cavalari
- Surgery Department, State University of Maringá, Paraná, Brazil
| | - Robson M Rossi
- Statistics Department, State University of Maringá, Paraná, Brazil
| | - Fausto Miranda
- Surgery Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Lattimer CR, Kalodiki E, Mendoza E. Gravitational venous drainage is significantly faster in patients with varicose veins. Phlebology 2015; 31:546-53. [PMID: 26338842 DOI: 10.1177/0268355515604256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES It has been proposed that varicose veins may be caused by a degree of impeded proximal venous drainage (pelvic venous obstruction) in the same way that biological tubes dilate in response to an obstruction. The venous drainage index (VDI) of air-plethysmography (APG) was used to test this hypothesis. A dependency to elevation manoeuvre was used to provoke gravitational venous drainage. A rapid reduction in calf volume implied good drainage. METHODS This was a single centre, proof-of-concept study comparing gravitational venous drainage in varicose vein patients and controls. Leg filling and drainage manoeuvres (elevation to dependency and dependency to elevation) were performed three times per leg in 15 patients (7 male, 8 right) and 16 controls (3 male, 8 right). The VDI was measured in the same way the established venous filling index (VFI) is calculated to quantify filling: VDI = 90% of venous drainage volume (90VDV)/90% venous drainage time (VDT90). RESULTS The patients were significantly older at 58 (41-75) years versus the controls 47 (18-58), p = 0.001. There was no significant difference between the groups in weight, height, BMI or common femoral vein diameter. The patients were (C2 = 8; C3 = 1, C4 = 6), VCSS 4 (1-11) with a median refluxing proximal thigh saphenous diameter of 6 (5-11) mm. The median (inter-quartile range) VFI and VDI (both in mL/s) in the control tests (n = 48) were 1.3 (0.9-1.9) and 33.8 (21.5-55), respectively. The VFI and VDI in the patient tests (n = 41) were significantly faster at 6.2 (3.5-9.4), p < 0.0005, and 47.1 (36.1-66.3), p = 0.002, respectively. Adjusted to a standard mean for each leg, the reproducibility limits (×3) of the VDI was very good at 39.7 (95% CI: 36.5-42.9) in controls and 52.9 (95% CI: 49.7-56.1) in patients. CONCLUSION The VDI was significantly greater in patients with varicose veins compared to controls. It is unlikely that impeded gravitational drainage is a significant factor in the pathophysiology of varicose veins.
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Affiliation(s)
- Christopher R Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK Department of Surgery and Cancer, Imperial College, London, UK Department of Vascular Surgery, Northwick Park Hospital, Middlesex, UK
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital, Middlesex, UK Department of Surgery and Cancer, Imperial College, London, UK
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Lattimer CR, Kalodiki E, Geroulakos G, Hoppensteadt D, Fareed J. Endogenous pro-thrombotic biomarkers from the arm and leg may not have the same value. Phlebology 2015; 31:275-82. [DOI: 10.1177/0268355515589678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Assessments of endogenous pro-thrombotic biomarkers are performed invariably on arm blood. However, the commonest site for thrombosis is in the leg. A leg blood sample may reflect local pro-thrombotic processes more accurately than systemic arm blood. The aim was to determine whether pro-thrombotic biomarkers from standard venous arm samples differed significantly from leg samples. Method Concurrent blood samples were taken from an ankle/lower calf varicose vein and an ante-cubital vein in 24 patients awaiting laser treatment as well as age approximated and sex matched healthy controls without venous disease. The following assays were performed: thrombin–antithrombin (ng/ml), antithrombin (%) activity, microparticles (nM), fibrinogen (mg/dl), prothrombin fragment 1.2 (F1.2) (pM) and P-selectin (ng/ml). Results Expressed as median (inter-quartile range). Significant arm/leg differences were observed in thrombin–antithrombin, antithrombin, prothrombin fragment 1.2 and P-selectin. The legs of patients had significantly reduced antithrombin activity and P-selectin concentrations compared to their arms (leg: 101 (90–108) versus arm: 112 (99–126), P = 0.001 and leg: 42 (26–52) versus 45 (27–52), P = 0.044, respectively). Control leg samples had significantly increased thrombin–antithrombin and P-selectin compared to control arm samples (leg: 2.1 (0.9–3.2) versus arm: 0.8 (0.5–1.7), P = 0.015 and leg: 36 (24–50) versus arm: 30 (23–41), P = 0.007, respectively). However, the control legs had significantly reduced F1.2 (leg: 265 (230–333) versus arm: 299 (236–361), P = 0.028). No significant arm/leg differences were detected in the microparticle or fibrinogen levels. Conclusions These findings indicate that venous arm blood is significantly different from venous leg blood in four out of six biomarkers studied. Recognition of local venous leg sampling as a site for investigation may unravel why the leg has a greater predisposition to thrombosis and lead the way towards an arm/leg differential test.
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Affiliation(s)
- Christopher R Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Southall, UK
- Imperial College, London, UK
- Department of Vascular Surgery, Northwick Park Hospital, Harrow, UK
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital, Southall, UK
- Imperial College, London, UK
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, USA
| | - George Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital, Southall, UK
- Imperial College, London, UK
- Department of Vascular Surgery, Northwick Park Hospital, Harrow, UK
| | - Debra Hoppensteadt
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, USA
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, USA
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Lattimer CR, Mendoza E. Superficial venous reflux duration and cessation with two concurrent duplex probes. J Vasc Surg Venous Lymphat Disord 2015; 3:154-60. [DOI: 10.1016/j.jvsv.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/06/2014] [Indexed: 11/25/2022]
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van der Velden S, Pichot O, van den Bos R, Nijsten T, De Maeseneer M. Management Strategies for Patients with Varicose Veins (C2–C6): Results of a Worldwide Survey. Eur J Vasc Endovasc Surg 2015; 49:213-20. [DOI: 10.1016/j.ejvs.2014.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/07/2014] [Indexed: 11/26/2022]
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Lattimer CR, Kalodiki E, Geroulakos G, Syed D, Hoppensteadt D, Fareed J. d-Dimer Levels are Significantly Increased in Blood Taken From Varicose Veins Compared With Antecubital Blood From the Same Patient. Angiology 2015; 66:882-8. [DOI: 10.1177/0003319714565168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
d-Dimer is a prothrombotic biomarker and a very sensitive measure of endogenous fibrinolysis. It is used as a screening test for suspected deep vein thrombosis. This study investigated whether d-dimer levels were increased in the varicose veins of patients in comparison to their own arm samples. Patients, n = 24, 17 male, age 45 (25-91), C2-6, awaiting saphenous laser ablation were compared to matched controls, n = 24, 17 male, age 42 (24-89). Concurrent venous blood samples were taken from the arm and a lower calf/ankle (varicose) vein. The median (interquartile range) d-dimer (ng/mL) level was significantly greater in the ankle than in the arm blood of the same patient at 319 (164-631) versus 281 (167-562), P = .003, Wilcoxon. This did not occur in the controls at 269 (80-564) versus 262 (106-526), P = .361, Wilcoxon. The results indicate increased endogenous fibrinolysis in varicose veins compared with arm blood. This suggests there is more thrombotic activity or dissolution of formed subclinical fibrin thrombus which may explain the association of varicose veins with superficial vein thrombosis. This contrasts with earlier studies reporting a local reduction in fibrinolysis in venous disease.
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Affiliation(s)
- Christopher R. Lattimer
- Josef Pflug Vascular Laboratory, Ealing Hospital, Northwick Park Hospital & Imperial College, London, United Kingdom
| | - Evi Kalodiki
- Josef Pflug Vascular Laboratory, Ealing Hospital, Northwick Park Hospital & Imperial College, London, United Kingdom
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, IL, USA
| | - George Geroulakos
- Josef Pflug Vascular Laboratory, Ealing Hospital, Northwick Park Hospital & Imperial College, London, United Kingdom
| | - Daneyal Syed
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, IL, USA
| | - Debra Hoppensteadt
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, IL, USA
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories, Loyola University, Maywood, IL, USA
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Starodubtsev V, Lukyanenko M, Karpenko A, Ignatenko P. Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods. Phlebology 2014; 30:700-5. [DOI: 10.1177/0268355514555546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To estimate the safety and efficacy of using the laser 1560 nm wavelength for treatment of chronic venous disease in patients with wide diameters of the proximal segment of the great saphenous vein. Methods In the study 88 patients with lower limb varicose veins were included. Maximum diameter of the great saphenous vein proximal segment varied from 15 to 34 mm (22 ± 2.3) in all patients. In the 1st group in 34 cases crossektomy and endovenous laser ablation (EVLA) were performed. In the 2nd group in 30 cases EVLA regardless diameter of the great saphenous vein proximal segment was performed. In the 3rd group in 34 cases EVLA taking into account the diameter of the great saphenous vein proximal segment was performed. The laser 1560 nm wavelength was used. Linear endovenous energy density in the 1st and 2nd groups was 90 J/cm for the proximal segment and trunk of great saphenous vein. Linear endovenous energy density in the 3rd group was personalized on the size of the veins: 100 J/cm for diameter of great saphenous vein proximal segment 15–20 mm, 150 J/cm for diameter 20–30 mm, 90 J/cm for middle and distal segments of great saphenous vein. Results In the 1st group obliteration of the trunk of the great saphenous veins and accessory great saphenous veins in all cases without additional interventions was reached. In the 2nd group at four cases (13.3%) the second procedure EVLA was carried out, after which the obliteration of the trunk was achieved. In the 3rd group the obliteration of the trunk of great saphenous vein was achieved without additional interventions. Conclusion Our experience of using the laser 1560 nm wavelength for the treatment of the chronic venous disease in patients with wide diameter of the proximal segment of great saphenous vein shows the safety and efficacy of this technique. EVLA has to be personalized on the size of the segments of vein in patients with wide proximal segment of great saphenous vein.
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Affiliation(s)
- V Starodubtsev
- Novosibirsk Research Institute of Circulation Pathology named by Meshalkin, Novosibirsk, Russian Federation
| | - M Lukyanenko
- Novosibirsk Research Institute of Circulation Pathology named by Meshalkin, Novosibirsk, Russian Federation
| | - A Karpenko
- Novosibirsk Research Institute of Circulation Pathology named by Meshalkin, Novosibirsk, Russian Federation
| | - P Ignatenko
- Novosibirsk Research Institute of Circulation Pathology named by Meshalkin, Novosibirsk, Russian Federation
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Measuring diameters of great saphenous vein and common femoral vein using duplex ultrasound. PHLEBOLOGIE 2014. [DOI: 10.12687/phleb2225-5-2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
SummaryFor years, measurement of the diameter of the great saphenous vein and, occasionally, the common femoral vein has been a component of many clinical studies on varicose vein treatment. There is consensus that the measurements should be conducted with the patient in the standing position and with a transverse view through the vein, but no standardised site of measurement of the venous diameter has yet been established. The shape of the great saphenous vein varies greatly at the saphenofemoral junction. Due to the curvature of the great saphenous vein, it is difficult to find a point at which the transverse view measured is at right angles to the course of the vein. According to the available data, the optimal site for measuring the great saphenous vein diameter is the proximal thigh. When measuring the common femoral vein, a transverse view immediately distal to the junction of the great saphenous vein is suggested and studies have also confirmed this.
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Joh JH, Park HC. The cutoff value of saphenous vein diameter to predict reflux. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:169-74. [PMID: 24106683 PMCID: PMC3791359 DOI: 10.4174/jkss.2013.85.4.169] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/29/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
Purpose Increased saphenous vein diameter is a common consequence of saphenous vein reflux. Until now, there have been no reports about the correlation between diameter and reflux of saphenous vein in Korea. The aim of this study was to investigate the correlation between saphenous vein reflux and diameter changes. Methods From April 2009 to August 2012, 777 patients were sent to the vascular laboratory for evaluation of venous reflux. The diameter of the saphenous vein was measured with B-mode imaging, and reflux was quantified based on valve closure time using Doppler spectral tracings. Receiver operating characteristics curve analysis was applied to determine the best saphenous vein diameter cutoff for predicting reflux. Results The mean diameters of normal great saphenous vein (GSV) and refluxed GSV were 5.0 ± 2.4 mm and 6.4 ± 2.0 mm, respectively. The mean diameters of normal small saphenous vein (SSV) and refluxed SSV were 3.1 ± 1.3 mm and 5.2 ± 2.7 mm, respectively. The diameter differences between the normal and refluxed GSV and SSV were 1.4 mm and 2.1 mm, respectively, and these differences were statistically significant (P < 0.0001). A GSV threshold diameter of 5.05 mm had the best positive predictive value for reflux. The sensitivity and specificity at 5.05 mm were 76% and 60%, respectively. The best SSV diameter for predicting reflux was 3.55 mm. The sensitivity and specificity at 3.55 mm were 87% and 71%, respectively. Conclusion GSV diameter of ≥5.05 mm had the best positive predictive value for pathologic reflux. For pathologic reflux of SSV, the best cutoff diameter was 3.55 mm.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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dos Santos Crisóstomo RS, Candeias MS, Ribeiro AMM, da Luz Belo Martins C, Armada-da-Silva PAS. Manual lymphatic drainage in chronic venous disease: A duplex ultrasound study. Phlebology 2013; 29:667-76. [DOI: 10.1177/0268355513502787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To compare the effect of call-up and reabsorption maneuvers of manual lymphatic drainage on blood flow in femoral vein and great saphenous vein in patients with chronic venous disease and healthy controls. Methods Forty-one subjects participated in this study (mean age: 42.68(15.23)), 23 with chronic venous disease (chronic venous disease group) with clinical classification C1–5 of clinical-etiological-anatomical-pathological (CEAP) and 18 healthy subjects (control group). Call-up and reabsorption maneuvers were randomly applied in the medial aspect of the thigh. The cross-sectional areas, as well as the peak and the mean blood flow velocity at femoral vein and great saphenous vein, were assessed by Duplex ultrasound at the baseline and during maneuvers. The venous flow volume changes were calculated. Results The venous flow volume in femoral vein and great saphenous vein increased during both manual lymphatic drainage maneuvers and in both groups ( P < 0.05). The two maneuvers had a similar effect on femoral vein and great saphenous vein hemodynamics, and in both the chronic venous disease and control groups. As a result of the call-up maneuver, the flow volume augmentations, as a result of call-up maneuver, decreased with the severity of chronic venous disease in those patients measured by the clinical classification of CEAP ( r = −0.64; P = 0.03). Conclusions Manual lymphatic drainage increases the venous blood flow in the lower extremity with a magnitude that is independent from the specific maneuver employed or the presence of chronic venous disease. Therefore, manual lymphatic drainage may be an alternative strategy for the treatment and prevention of venous stasis complications in chronic venous disease.
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Affiliation(s)
- Rute Sofia dos Santos Crisóstomo
- Laboratório de Biomecânica e Morfologia Funcional (LBMF), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal
- Centro Interdisciplinar Para o Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal
- Instituto Politécnico de Castelo Branco, Escola Superior de Saúde Dr. Lopes Dias, Castelo Branco, Portugal
| | | | | | | | - Paulo AS Armada-da-Silva
- Laboratório de Biomecânica e Morfologia Funcional (LBMF), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal
- Centro Interdisciplinar Para o Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002 Lisboa, Portugal
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