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Judges D, Liu C, Onida S, Lane TRA, Davies AH. Left common iliac vein diameter in patients referred for lower limb venous duplex ultrasound. Vascular 2024; 32:705-709. [PMID: 36688495 PMCID: PMC11129520 DOI: 10.1177/17085381231153540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Evidence regarding ultrasound assessment of left common iliac vein diameter (LCIV) is limited. Extensive work is currently being undertaken worldwide on non-thrombotic iliac vein lesions to identify patients who may benefit from intervention to alleviate symptoms of chronic venous obstruction. Interventions include long-term stent implantation to improve vein diameter stenosis. This study aimed to assess a cohort of symptomatic venous patients and the diameter of the LCIV in these patients. METHODS : Retrospective medical records review of all patients attending a tertiary vascular surgery centre who underwent a venous duplex ultrasound assessment between April 2017 and February 2018 were analysed for assessment of LCIV. Medical records of those patients with documented LCIV diameter were assessed over 18 months of follow-up. RESULTS : A total of 672 (271 males, 401 females) LCIV diameter measurements were collected. The age of the patients ranged from 21 to 95 years (mean = 56.38). Median LCIV diameter overall was 7.64 mm (IQR 5.80mm-9.00 mm). 40 patients (6%) were reported to have a LCIV diameter measurement of < 4 mm, 8 (20%) male and 32 female (80%). 17 of these 40 patients (47.5%) were treated conservatively. Median LCIV diameter was 3.4 mm (IQR 2.5-3.7). 21 of these 40 patients (52.5%) underwent superficial venous intervention only, with a median LCIV diameter of 3.5 mm (IQR 3.2-3.7) and 2 out of these 40 patients (5%) underwent deep venous stenting (2/2 female - 100%), with a median LCIV diameter of 2.9 (IQR 2.9-2.9). No patients underwent both superficial and deep venous treatment in this 40 patient cohort. In those undergoing superficial venous intervention, 4 (19%) underwent repeat treatment. The two deep venous stenting patients underwent magnetic resonance venogram and venogram with intravascular ultrasound to allow stent placement, which confirmed a narrowed left common iliac vein. Primary stent patency at 18 months was 100%. CONCLUSION In this large study cohort of venous duplex assessments the median vein diameter was 7.64 mm and 40 patients out of 672 had a vein diameter smaller than 4 mm. 2 patients underwent deep venous stenting with primary patency of 100%.
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Affiliation(s)
- Damon Judges
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Chen Liu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarah Onida
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tristan Robert Alexander Lane
- Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge, UK
| | - Alun Huw Davies
- Department of Surgery and Cancer, Imperial College London, London, UK
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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 2023 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 II: Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine. J Vasc Surg Venous Lymphat Disord 2024; 12:101670. [PMID: 37652254 DOI: 10.1016/j.jvsv.2023.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
The Society for Vascular Surgery, the American Venous Forum, and the American Vein and Lymphatic Society recently published Part I of the 2022 clinical practice guidelines on varicose veins. Recommendations were based on the latest scientific evidence researched following an independent systematic review and meta-analysis of five critical issues affecting the management of patients with lower extremity varicose veins, using the patients, interventions, comparators, and outcome system to answer critical questions. Part I discussed the role of duplex ultrasound scanning in the evaluation of varicose veins and treatment of superficial truncal reflux. Part II focuses on evidence supporting the prevention and management of varicose vein patients with compression, on treatment with drugs and nutritional supplements, on evaluation and treatment of varicose tributaries, on superficial venous aneurysms, and on the management of complications of varicose veins and their treatment. All guidelines were based on systematic reviews, and they were graded according to the level of evidence and the strength of recommendations, using the GRADE method. All ungraded Consensus Statements were supported by an extensive literature review and the unanimous agreement of an expert, multidisciplinary panel. Ungraded Good Practice Statements are recommendations that are supported only by indirect evidence. The topic, however, is usually noncontroversial and agreed upon by most stakeholders. The Implementation Remarks contain technical information that supports the implementation of specific recommendations. This comprehensive document includes a list of all recommendations (Parts I-II), ungraded consensus statements, implementation remarks, and best practice statements to aid practitioners with appropriate, up-to-date management of patients with lower extremity varicose 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, CA
| | - Suman M Wasan
- Department of Medicine, University of North Carolina, Chapel Hill, Rex Vascular Specialists, UNC Health, Raleigh, NC
| | - Mark H Meissner
- Division of Vascular Surgery, University of Washington, Seattle, WA
| | - Jose Almeida
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | | | - Ruth L Bush
- John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - John Fish
- Department of Medicine, Jobst Vascular Institute, University of Toledo, Toledo, OH
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Stanford, CA
| | - Monika L Gloviczki
- Department of Internal Medicine and Gonda Vascular Center, Rochester, MN
| | | | - 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 Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Béliard S, Ferreira D, Thomas H, Mourot L, Tordi N. High Physical Activity Volume Is Associated With an Increase in the Calibre of the Lower Limb Veins Without Impact on Functional Discomfort: the VARISPORT Study. Eur J Vasc Endovasc Surg 2023; 66:856-863. [PMID: 37562761 DOI: 10.1016/j.ejvs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The relationship between physical activity and lower limb veins is complex. If a sedentary lifestyle is considered to be negative on lower limb veins, specific information on physical activity varicose vein volume is sparse, especially the effect of high physical activity volume. The main objective of the VARISPORT study was to evaluate lower limb veins (clinically, morphologically, and haemodynamically) and chronic venous disease symptoms in subjects exposed to high physical activity volume compared with a group of non-exposed subjects. METHODS A cross sectional study compared a group of high exercise training volume volunteers (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months: high physical activity volume group, HPAV group) with a volunteer control group matched for age, sex, and body mass index. Clinical examination was performed to determine the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of each subject and the Carpentier score was used to assess symptoms related to possible chronic venous disease. Duplex ultrasonography was used to assess vein diameters and reflux in the deep and superficial veins. RESULTS One hundred and nineteen subjects were included in each group. The lower limb veins (deep and superficial) were significantly more dilated in the HPAV group. More reflux was found in the great saphenous veins and non-saphenous veins in the HPAV group. High physical activity volume was associated with a higher frequency of visible varicose veins (stage C2 of the CEAP classification), odds ratio 3.37 (95% confidence interval 1.66 - 7.25) without impact on functional discomfort (44 subjects with a Carpentier score ≥ 1 in each group). CONCLUSION The VARISPORT study reported an increase in the calibre of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.
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Affiliation(s)
- Samuel Béliard
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France; Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France.
| | - David Ferreira
- Anaesthetics and Intensive Care Department, CHU Besançon, Besançon, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Franche-Comté, Besançon, France
| | - Hélène Thomas
- Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France
| | - Laurent Mourot
- EA3920 Marqueurs Pronostiques et Facteurs de Régulations des Pathologies Cardiaques et Vasculaires, Platform Exercise Performance Health Innovation (EPHI Université de Franche-Comté, Besançon, France
| | - Nicolas Tordi
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France
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Bai H, Storch JB, Gokani V, Kibrik P, Chen J, Ting W. Identifying venous clinical severity score thresholds for Clinical-Etiology-Anatomy-Pathophysiology classifications of venous edema and higher. Vascular 2023:17085381231193510. [PMID: 37541989 DOI: 10.1177/17085381231193510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Venous Clinical Severity Score (VCSS) is a widely used standard for assessing and grading the severity of chronic venous disease (CVD). Prior research highlighted its high validity in detecting and quantifying venous disease. However, there is little, if any, known about the precise thresholds at which VCSS discriminates important stages of deep venous disease. This study sought to elucidate the diagnostic accuracy, thresholds, and correlation at which VCSS detects salient CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classes in deep venous disease progression. METHODS A registry of 840 patients who presented with chronic proximal venous outflow obstruction (PVOO) secondary to non-thrombotic iliac vein lesions from August 2011 to June 2021 was retrospectively analyzed. VCSS and CEAP classifications were used to evaluate preoperative symptoms. VCSS was compared to CEAP classes to determine the precise VCSS composite values at which the instrument was able to detect CEAP C3 and higher, C4 and higher, and C5 and higher. Receiver operative characteristic (ROC) curve and area under the curve (AUC) were used to evaluate VCSS for its ability to discriminate disease at these stages of CEAP classification. Spearman's rank coefficient was used to determine the correlation between CEAP VCSS composite as well as individual VCSS components (pain, varicose vein, edema, pigmentation, inflammation, induration, ulcer number, ulcer size, ulcer duration, compression). RESULTS VCSS composite was able to detect venous edema (C3) and higher at a sensitivity of 68.9% and a specificity of 54.8% at an optimized threshold of 8.5 (AUC = 0.648; 95% C.I. = 0.575-0.721). To detect changes in skin and subcutaneous tissue from CVD (C4) and higher, an optimal threshold of 11.5 was found with a sensitivity of 51.7% and specificity of 76.5% (AUC = 0.694; 95% C.I. = 0.656-0.731). Healed venous ulcer (C4) and higher was detectable at an optimized threshold of 13.5 at a sensitivity of 67.7% and a specificity of 88.9% (AUC = 0.819; 95% C.I. = 0.766-0.873). The correlation between VCSS composites and CEAP was weak (ρ = 0.372; p < .001). Attributes of VCSS that reflect more severe venous disease correlated more closely with CEAP classes, namely pigmentation (ρ = 0.444; p < .001), inflammation (ρ = 0.348; p < .001), induration (ρ = 0.352; p < .001), number of active ulcers (ρ = 0.497; p < .001), active ulcer size (ρ = 0.485; p < .001), and ulcer duration (ρ = 0.497; p < .001). The correlation between CEAP class and the other four components of VCSS were not statistically significant. CONCLUSION VCSS composite thresholds of 8.5, 11.5, and 13.5 are threshold values for detecting CEAP classification C3 and higher, C4 and higher, and C5 and higher, respectively. Consistent with prior work, VCSS appears to have a better ability to discriminate CVD at more severe CEAP classifications. In this registry, the correlation between VCSS and CEAP was found to be weak while components of VCSS that suggest more advanced disease exhibited the strongest correlation with CEAP.
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Affiliation(s)
- Halbert Bai
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason B Storch
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Gokani
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pavel Kibrik
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jenny Chen
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Scheerders ERY, van der Velden SK, Goossens LMA, Hamann SAS, de Maeseneer MGR, Malskat WSJ, de Mik L, Nijsten TEC, van den Bos RR, Hamann SAS, Malskat WSJ, Maeseneer de MGR, Bos van den RR, Velden van der SK, Mik de L, Gaastra MTW, Koppen S, Roos De KP, Shadid NH, Wolff O. A randomized clinical trial of isolated ambulatory phlebectomy versus saphenous thermal ablation with concomitant phlebectomy (SAPTAP Trial). Br J Surg 2023; 110:333-342. [PMID: 36464887 PMCID: PMC10364515 DOI: 10.1093/bjs/znac388] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/31/2022] [Accepted: 10/23/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Current treatment of patients with saphenous trunk and tributary incompetence consists of truncal ablation with concomitant, delayed or no treatment of the tributary. However, reflux of the saphenous trunk may be reversible after treatment of the incompetent tributary. The aim of this study was to determine whether single ambulatory phlebectomy with or without delayed endovenous truncal ablation (SAP) is non-inferior to thermal endovenous ablation with concomitant phlebectomy (TAP), and whether SAP is a cost-effective alternative to TAP. METHODS A multicentre, non-inferiority RCT was conducted in patients with an incompetent great saphenous vein or anterior accessory saphenous vein with one or more incompetent tributaries. Participants were randomized to receive SAP or TAP. After 9 months, additional truncal treatment was considered for SAP patients with remaining symptoms. The primary outcome was VEnous INsufficiency Epidemiological and Economic Study Quality of Life/Symptoms (VEINES-QOL/Sym score) after 12 months. Secondary outcomes were, among others, cost-effectiveness, perceived improvement of symptoms, and anatomical success. RESULTS Some 464 patients received the allocated treatment (SAP 227, TAP 237). VEINES-QOL scores were 52.7 (95 per cent c.i. 51.9 to 53.9) for SAP and 53.8 (53.3 to 55.1) for TAP; VEINES-Sym scores were 53.5 (52.6 to 54.4) and 54.2 (54.0 to 55.6) respectively. Fifty-eight patients (25.6 per cent) in the SAP group received additional truncal ablation. Treatment with SAP was less costly than treatment with TAP. CONCLUSION One year after treatment, participants who underwent SAP had non-inferior health-related quality of life compared with those who had TAP. Treatment with SAP was a cost-effective alternative to TAP at 12 months. REGISTRATION NUMBER NTR 4821 (www.trialregister.nl).
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Affiliation(s)
- Eveline R Y Scheerders
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | - Lucas M A Goossens
- Erasmus School for Health, Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sterre A S Hamann
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Marianne G R de Maeseneer
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Wendy S J Malskat
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Linda de Mik
- Department of Dermatology, Isala Zwolle, Zwolle, the Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Renate R van den Bos
- Department of Dermatology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Bissacco D, Malloggi C, Lomazzi C, Domanin M, Odero A, Trimarchi S, Casana R. Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization. Phlebology 2022; 37:223-225. [DOI: 10.1177/02683555211060622] [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
Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.
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Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Malloggi
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Lomazzi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Andrea Odero
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Renato Casana
- Laboratory of Research in Vascular Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Vascular Surgery Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
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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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Gawas M, Bains A, Janghu S, Kamat P, Chawla P. A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments. J Am Coll Nutr 2021; 41:499-510. [PMID: 34242131 DOI: 10.1080/07315724.2021.1909510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents.Key teaching pointsChronic venous disease is a pathological state of vein circulatory systems of the lower limbsProlonged standing and obesity are the major reason for varicose vein diseaseEndovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veinsVenoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disordersPhlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiencyFood rich in phytoconstituents are more effective in varicose veins.
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Affiliation(s)
- Mandar Gawas
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Aarti Bains
- Department of Biotechnology, Chandigarh group of Colleges Landran, Mohali, Punjab, India
| | - Sandeep Janghu
- Indian Institute of Food Processing Technology, Thanjavur, Tamilnadu, India
| | - Pranali Kamat
- Department of Pharmacy, Goa College of Pharmacy, Panaji, Goa, India
| | - Prince Chawla
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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Poschinger-Figueiredo D, Virgini-Magalhães CE, Porto LC, Amorim CS, de Araujo Gomes CF, Riguetti-Pinto CR, Mayall MR, de Castro LS, Fagundes FB. Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins. Vasc Health Risk Manag 2021; 17:379-387. [PMID: 34239304 PMCID: PMC8259833 DOI: 10.2147/vhrm.s313282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). DESIGN Prospective, single-centre, analytical cohort. MATERIALS AND METHODS Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. RESULTS The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. CONCLUSION Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.
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Affiliation(s)
- Douglas Poschinger-Figueiredo
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Carlos Eduardo Virgini-Magalhães
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
- Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Luís Cristóvão Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
- Roberto Alcantara Gomes Biology Institute (IBRAG), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Claudia Salvador Amorim
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Cristiane Ferreira de Araujo Gomes
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Cristina Ribeiro Riguetti-Pinto
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
- Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Monica Rochedo Mayall
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Leonardo Silveira de Castro
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
| | - Felipe Borges Fagundes
- Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil
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Mühlberger D, Brenner E, Frings N, Geier B, Mumme A, Reich-Schupke S, Steffen HP, Stenger D, Stücker M, Hummel T. Functional repair of the great saphenous vein by external valvuloplasty reduces the vein's diameter: 6-month results of a multicentre study. J Int Med Res 2021; 49:3000605211014364. [PMID: 33990156 PMCID: PMC8127796 DOI: 10.1177/03000605211014364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives External valvuloplasty (eVP) is a reconstructive surgical method to repair the function of the terminal and preterminal valves. We evaluated the 6-month outcomes of eVP regarding the diameter of the great saphenous vein (GSV). Methods Patients from five vein centres were included in this observational study. Follow-up involved detailed duplex sonography of the GSV. The venous clinical severity score (VCSS) and the C class of the clinical, aetiologic, anatomic and pathophysiologic (CEAP) classification were recorded. Results We enrolled 210 patients, with a follow-up rate of 58%; eVP was sufficient in 95.24% of the patients. The GSV diameters decreased significantly from 4.4 mm (standard deviation (SD): 1.39) to 3.9 (SD: 1.12), 4 cm distal to the saphenofemoral junction (SFJ); from 3.7 mm (SD: 1.10) to 3.5 mm (SD: 1.02) at the mid-thigh; from 3.6 mm (SD: 1.14) to 3.3 mm (SD: 0.94) at the knee and from 3.1 mm (SD: 0.99) to 2.9 mm (SD: 0.78) at the mid-calf. VCSS decreased significantly from 4.76 (SD: 2.13) preoperatively to 1.77 (SD: 1.57) 6 months postoperatively. Conclusions GSV function can be restored by eVP; diameters over the total length of the GSV decreased significantly.
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Affiliation(s)
- Dominic Mühlberger
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum Department of the Ruhr University Bochum, Bochum, Germany.,Vein Centre of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Erich Brenner
- Institute for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Austria
| | - Norbert Frings
- Vein Centre Capio Bad Bertrich GmbH, Bad Bertrich, Germany
| | - Bruno Geier
- Department of Vascular Surgery, Krankenhaus Bethanien Moers, Germany
| | - Achim Mumme
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum Department of the Ruhr University Bochum, Bochum, Germany.,Vein Centre of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Stefanie Reich-Schupke
- Vein Centre of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | | | | | - Markus Stücker
- Vein Centre of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany.,Department of Dermatology, St. Josef Hospital Bochum, Katholisches Klinikum Bochum, Department of the Ruhr University Bochum, Bochum, Germany
| | - Thomas Hummel
- Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum Department of the Ruhr University Bochum, Bochum, Germany.,Vein Centre of the Departments of Dermatology and Vascular Surgery, Katholisches Klinikum Bochum, Bochum, Germany
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11
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Silva APP, Pinto DM, Milagres VAMV, Bez LG, Maciel JCA, Lopes CDS. Results of venous reflux treatment with 1,470 nm endolaser and correlation with degree of venous insufficiency. J Vasc Bras 2021; 20:e20200172. [PMID: 34093690 PMCID: PMC8147881 DOI: 10.1590/1677-5449.200172] [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] [Indexed: 11/21/2022] Open
Abstract
Background Patients with advanced chronic venous disease are more likely to need additional procedures for relapsed varicose veins. It has not yet been established whether severity of venous insufficiency is a factor that influences the occlusion rate of saphenous veins treated with endolasers. Objectives To analyze occlusion rate of venous segments treated with endolaser and correlate it with patients’ Venous Clinical Severity Score (VCSS) and Clinical-Etiological-Anatomical-Pathological (CEAP) classification. Methods Retrospective analysis of a cohort of patients operated using a 1,470 nm endolaser from November 2012 to March 2020. Descriptive statistics were calculated and Kaplan-Meier survival curves were plotted with Cox regression for groups stratified by VCSS and CEAP. Results A total of 180 venous segments were analyzed in 170 patients. Mean age was 44.3 ± 9.2 and the majority of patients were female (71%). Mean energy density used in the great saphenous vein was 49.2 ± 8.3 J/cm. The most common complications were pain along the course of the saphenous vein (12.2%) and paresthesias at 6 months (17.2%). There was no difference in venous occlusion rate between groups with VCSS ≤ 7 and VCSS > 7 (p = 0.067). A group of patients classified as CEAP classes C4, C5, or C6 had a lower occlusion rate than a group at classes C2 or C3 (hazard ratio [HR] = 3.22; confidence interval [CI] 1.85, 5.61; p = 0.001]. Conclusions The occlusion rates of venous segments treated with endolaser were lower in patients with higher CEAP classes. It is probably necessary to use more energy in these patients to achieve effective treatment of saphenous veins.
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Affiliation(s)
- Ana Paula Pires Silva
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
| | - Daniel Mendes Pinto
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil.,Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Leonardo Ghizoni Bez
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
| | | | - Caetano de Souza Lopes
- Hospital Felício Rocho, equipe de Angiologia e Cirurgia Vascular, Belo Horizonte, MG, Brasil
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12
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Shrestha P, Karmacharya RM, Dahal S, Dhakal P, Bhandari N, Bade S. Patient literacy on varicose veins in cases presenting at university hospital of Nepal subjected for surgical management of varicose veins. JOURNAL OF VASCULAR NURSING 2021; 39:2-5. [PMID: 33894950 DOI: 10.1016/j.jvn.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
Varicose veins are prominent dilated veins usually present in the lower limbs leading to complications if not managed well. Knowledge regarding varicose vein among the patients in Nepal is not yet known. We aim to examine the knowledge regarding varicose vein diagnosis and treatment among patients to better understand the barriers to care. This is a descriptive cross-sectional study adopting census sampling method. We collected data from the surgical ward where patients were admitted for surgery of varicose veins. Self-developed tool "Dhulikhel Hospital Patient Perception Questionnaire on Varicose Vein" was used for data collection after validation (Kuder-Richardson Reliability Coefficient was 0.75). Collected data were analyzed using software SPSS 23.0. Descriptive statistics was performed to present sociodemographic variables and varicose veins literacy scores. Independent sample t-test was performed for dichotomous variables and one-way ANOVA with post hoc analysis were performed for variables with multiple groups. Total 80 participants were included in the study of which 60% were men. The mean age was 45.66 years with SD 13.27. Varicose veins literacy score was high among 52.4% (more than 50% score) and low (less than 50% score) among 47.6%. There was significant mean difference (P < .01) among male and female sex, different educational groups, and different occupational groups. Patients admitted for varicose vein surgery had less than 50% knowledge in different components of varicose vein. Regular educational intervention is recommended to ensure better care of these patients.
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Affiliation(s)
- Prabha Shrestha
- Department of Nursing, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Robin Man Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal.
| | - Sushil Dahal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Prasesh Dhakal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Niroj Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
| | - Sohail Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchowk, Nepal
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13
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Richards T, Anwar M, Beshr M, Davies AH, Onida S. Systematic review of ambulatory selective variceal ablation under local anesthetic technique for the treatment of symptomatic varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:525-535. [PMID: 33137495 DOI: 10.1016/j.jvsv.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The ambulatory selective variceal ablation under local anesthesia (ASVAL) technique subscribes to the "ascending" theory of varicose vein etiology, which recommends primary ambulatory phlebectomy as a treatment for tributary varicosities and truncal vein incompetence. This systematic review explores the efficacy and safety of the ASVAL technique for the treatment of symptomatic varicose veins. METHODS A comprehensive search of the Medline and Embase databases and the Cochrane Register of Controlled Trials in May 2019 revealed 11 original articles that were qualitatively reviewed. The primary outcome was the absence from recurrent varicose veins at 1-year follow-up. Secondary outcomes were resolution of great saphenous vein (GSV) reflux on duplex ultrasound, change in GSV diameter, objective and subjective clinical improvement in chronic venous disease, and patient-reported outcome measures. RESULTS A total of 2106 limbs underwent intervention in 1734 patients reported in two randomized controlled trials, one case control study, three cohort studies, and five case series. Varicosity recurrence at 1 year ranged from 0.5% to 13.5% in patients. Of 1622 limbs with diagnosed GSV incompetence before intervention, 1114 were competent at 1 year (mean, 68.2% [±12.62%]). All studies measuring GSV diameter reported statistically significant reductions in vein size. CONCLUSIONS ASVAL may be considered as a minimally invasive treatment for early stages of chronic venous disease in the presence of truncal reflux. The evidence base should be strengthened by prospective randomized controlled trials that follow standardized procedures and report according to recognized measures of quality of life alongside clinical and hemodynamic data.
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Affiliation(s)
- Thomas Richards
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Muzaffar Anwar
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Mostafa Beshr
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sarah Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
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14
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Yang Q, Zhao Y, Chen X, Tang P, Li L, Zhao J, Han Y, Wu D, An L, Zhang B, Zhou X, Liu L, Chi YW. Association between vein diameters, reflux characteristics, and clinical severity in patients with chronic venous insufficiency in Northwest China. J Vasc Surg Venous Lymphat Disord 2020; 9:401-408.e1. [PMID: 32730997 DOI: 10.1016/j.jvsv.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/09/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our goal was to summarize the relationship between vein diameters, reflux characteristics, and clinical severity in consecutive patients with chronic venous insufficiency (CVI) in Northwest China. METHODS We evaluated 531 consecutive patients with CVI (249 women) who presented to the Department of Ultrasound of Xijing Hospital from September 2017 to July 2019. Reflux times and the mean diameters of the great saphenous, the small saphenous, and the calf perforator veins based on duplex ultrasound scans obtained in the standing position were recorded. Venous-specific assessment tools-the Heaviness, Achiness, Swelling, Throbbing, Itching (HASTI) score, the Venous Clinical Severity Score (VCSS), and the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) class-were analyzed. Regression analysis was used to investigate the relationship between the clinical scores, vein diameters, and reflux times. A P value of less than .05 was considered statistically significant. RESULTS We analyzed 531 consecutive patients with 728 limbs. The mean age was 55.24 ± 11.38 years; the mean body mass index (BMI) was 24.75 ± 3.49 kg/m2. Three hundred thirty-four patients (62.9%) presented with unilateral limb findings and 197 (37.1%), with bilateral limb involvement. No significant changes were noted in age and BMI across CEAP classes (F = 2.322 and F = 3.917, respectively; P > .05 for both). Both the HASTI score (r2 = 0.8741; P < .001) and the VCSS (r2 = 0.9257; P < .001) correlated with the CEAP class. The HASTI score strongly correlated with the mean diameters of the great saphenous and small saphenous veins (r2 = 0.9252, r2 = 0.6304, respectively; P < .001 for both) similarly to VCSS (r2 = 0.9396, r2 = 0.7195, respectively; P < .001 for both). The HASTI score and VCSS correlated equally with the mean diameters of the calf perforator veins (r = 0.7773 and r = 0.7781, respectively; P < .001 for both). In those with C6, both great saphenous vein (F = 4.608; P < .001) and small saphenous vein reflux times (F = 14.97; P < .001) were significantly higher than those in C1. Both the HASTI score and VCSS strongly associated with the reflux times of the great saphenous (r2 = 0.7706 and r2 = 0.8181, respectively; P < .001 for both) and small saphenous veins (r2 = 0.6470 and r2 = 0.7865, respectively; P < .001 for both). CONCLUSIONS This analysis is one of the few epidemiologic studies of patients with CVI in Northwest China. Age and BMI did not correlate with CEAP class. Both the HASTI score and VCSS correlated strongly with the CEAP classification; vein diameters and reflux time in both the great saphenous vein and the small saphenous vein, indicating the validity of these outcome tools to venous hemodynamics and to CVI in general.
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Affiliation(s)
- Qian Yang
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yongfeng Zhao
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Xi Chen
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Peng Tang
- Department of Orthopedics, China Rehabilitation Research Center, Beijing Charity Hospital, Beijing, China
| | - Lamei Li
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Junfeng Zhao
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yongfeng Han
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Dangjie Wu
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Li An
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Binqing Zhang
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Xiaodong Zhou
- Department of Ultrasonic Diagnosis and Treatment Center, Xian International Medical Center Hospital, Xian, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital of the Forth Military Medical University, Xian, China
| | - Yung-Wei Chi
- University of California, Davis, Vascular Center, Sacramento, Calif.
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15
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Rocha FA, Lins EM, de Almeida CC, Dias RC, da Silva PAL, Gameleira CA, Falcão MGDMG, Barros JWDS. Quality of life assessment before and after surgery for lower limb varicose veins. J Vasc Bras 2020; 19:e20190108. [PMID: 34178063 PMCID: PMC8202207 DOI: 10.1590/1677-5449.190108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Lower limb varicose veins are one of the most prevalent diseases in the global
population. The disease is chronic and has a great impact on patients’ quality of
life, limiting daily activities and functional performance. Several authors have
emphasized the importance of including quality of life assessment in management of
patients with chronic venous disease. Objectives To evaluate quality of life before and after surgical treatment of patients with
varicose veins. Methods A before and after study design was employed. Ninety-two people with varicose
veins of the lower limbs were treated surgically. Patients were divided into
subsets according to age and CEAP clinical classification. Quality of life was
assessed using the VEINES QOL/SYM questionnaire, administered during the
preoperative period and 60 days after the operation. Results The sample comprised 92 subjects, 82.6% (76) of whom were women and mean age was
45.7±12.11 years. CEAP class 2 was the most frequent clinical classification, in
57.6% of patients. There was a significant difference in scores before and after
surgery among patients aged from 30 to 40 years. There was no difference between
preoperative and postoperative scores between different CEAP groups. Conclusions No difference in quality of life was observed after surgery in most of the
patients in the present study.
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Affiliation(s)
| | - Esdras Marques Lins
- Universidade Federal de Pernambuco - UFPE, Disciplina de Cirurgia Vascular, Recife, PE, Brasil
| | - Catarina Coelho de Almeida
- Universidade Federal de Pernambuco - UFPE, Hospital das Clínicas, Serviço de Cirurgia Vascular, Recife, PE, Brasil
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16
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Comparison of hand-held acoustic Doppler with point-of-care portable color Doppler ultrasound in the assessment of venous reflux disease. J Vasc Surg Venous Lymphat Disord 2020; 8:831-839.e2. [PMID: 32184080 DOI: 10.1016/j.jvsv.2019.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/23/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Diagnostic-quality portable color Doppler ultrasound (PCD) offers convenient point-of-care venous reflux disease (VRD) diagnosis. Philips Lumify (Philips N.V., Best, The Netherlands), a high-fidelity broadband linear array transducer (4-12 MHz frequency), connects through a web-enabled smartphone or tablet to cloud software and offers B-mode and color Doppler imaging without pulsed wave Doppler capability. The aims of the study were to compare hand-held acoustic Doppler (HHD) vs PCD diagnostic performance using conventional duplex ultrasound (DUP) as the "gold standard" for VRD assessment, to assess effects of body mass index (BMI) and disease severity on diagnostic performance of HHD and PCD, and to determine whether PCD offers any diagnostic improvement over HHD in VRD assessment. METHODS There were 241 patients (65 male, 176 female; mean age, 55.5 ± 15.5 years; mean BMI, 32.2 ± 7.9 kg/m2). DUP (447 legs), PCD (262 legs), and HHD (217 legs) studied the great saphenous vein at above-knee (AK) and below-knee (BK) levels. A phlebologist performed HHD, whereas PCD and DUP were performed sequentially (PCD first) by an experienced technologist and interpreted independently. PCD was done blinded to DUP results. DUP findings were analyzed blinded to HHD and PCD results. Venous reflux was dichotomously assessed as <2 seconds and >2 seconds. RESULTS HHD improves from moderate to good sensitivity from AK level (68%) to BK level (94%) but suffers poor specificity that declines significantly from AK level (50%) to BK level (12%; P < .05). HHD positive predictive value exceeds its negative predictive value (NPV) and remains unchanged from AK level (71%) to BK level (72%). HHD NPV remains consistently poor at AK (48%) and BK (42%) levels. PCD has similar sensitivity from AK level (69%) to BK level (74%), better AK level (79%) vs BK level (58%) specificity (P < .05), similar positive predictive value for AK (76%) and BK levels (78%), and better NPV for AK level (72%) vs BK level (53%; P < .05). BMI range (<30 kg/m2 vs ≥ 30 kg/m2) did not influence diagnostic performance of HHD and PCD significantly. HHD and PCD specificity was higher for Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class <4 compared with CEAP class ≥4 (P < .05). CONCLUSIONS The relative diagnostic performance of HHD and PCD is highly dependent on insonation level. PCD advantages compared with HHD are marginally greater specificity at AK and BK levels and better NPV at AK level. Compared with HHD, PCD's disadvantage is lower sensitivity at BK level. Both HHD and PCD have higher specificity at AK level than at BK level. Overall, PCD offers only moderate sensitivity and specificity, making it inadequate for exclusion of significant venous reflux. Neither obesity nor CEAP class significantly influenced the general diagnostic performance of PCD or HHD.
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17
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Response to Commentary on "The Relationship Between Vein Diameters, Clinical Severity, and Quality of Life: A Systematic Review". Eur J Vasc Endovasc Surg 2019; 59:325. [PMID: 31337583 DOI: 10.1016/j.ejvs.2019.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/15/2019] [Indexed: 11/21/2022]
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18
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Vein diameter and vein surgery. Eur J Vasc Endovasc Surg 2019; 57:858. [PMID: 30902605 DOI: 10.1016/j.ejvs.2019.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/22/2022]
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