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Association between duplex ultrasonography findings and severity of chronic venous disease in Thai patients. Asian J Surg 2022:S1015-9584(22)01437-3. [DOI: 10.1016/j.asjsur.2022.09.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/21/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
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Hong KP. Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease. J Chest Surg 2022; 55:233-238. [PMID: 35478179 PMCID: PMC9178300 DOI: 10.5090/jcs.22.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/20/2022] [Accepted: 04/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background This study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification. Methods In total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020. Results There were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11). Conclusion Duplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.
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Affiliation(s)
- Ki Pyo Hong
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, 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: 224] [Impact Index Per Article: 112.0] [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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Rodriguez-Acevedo O, Elstner KE, Martinic K, Zea A, Diaz J, Martins RT, Arduini F, Hodgkinson A, Ibrahim N. Hydrodisplacement of sural nerve for safety and efficacy of endovenous thermal ablation for small saphenous vein incompetence. Phlebology 2016; 32:482-487. [DOI: 10.1177/0268355516671233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endovenous radio frequency ablation for small saphenous vein incompetence by and large appears to be superior and safer than conventional open surgery. Small saphenous vein ablation from approximately mid-calf to the point proximally where the small saphenous vein dives into the popliteal fossa is considered to be safe, as the sural nerve is in most cases separated from this segment of the small saphenous vein by the deep fascia. The outcome of the distal incompetent small saphenous vein remains unclear. Efficacy of the endovenous radio frequency ablation can be enhanced by increasing the length of the ablatable small saphenous vein segment. Methodology To optimise endovenous radio frequency ablation outcome, the distal small saphenous vein may be made amenable to ablation if safety of the sural nerve can be assured. The sural nerve was successfully located using duplex ultrasound in 100% of our cohort in this study. The standard entry point for venous access was just above the lateral malleolus. After introduction of the introducer sheath, the radio frequency catheter was advanced proximally; the sural nerve was displaced from the small saphenous vein by approximately 1 cm with the administration of tumescent anaesthesia ( hydrodisplacement). A total of 118 patients underwent extended endovenous radio frequency ablation of 124 incompetent small saphenous vein trunks using the method described. Results Successful extended ablation of the small saphenous vein was achieved in 100% of cases and it was confirmed by duplex scanning at one and six weeks. Two neurological events were recorded during the study: 1. One patient with temporary foot drop lasting for less than 6 h with complete recovery. 2. A second patient with a sural nerve sensory deficit reported by the patient at day 2–3, which remains current at six weeks. Conclusions Extended endovenous radio frequency ablation of the small saphenous vein to optimise length of the ablatable vein segment is feasible with careful identification and hydrodisplacement of the sural nerve. This method is shown to be associated with fewer neurological complications than other methods reported in the literature.
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Affiliation(s)
| | - Kristen E Elstner
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Kui Martinic
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Aaron Zea
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Jenny Diaz
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Rodrigo T Martins
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Fernando Arduini
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Alexandra Hodgkinson
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
| | - Nabeel Ibrahim
- Australian Laser Vein Clinic & Sydney Centre for Venous Disease, Sydney, Australia
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Konoeda H, Yamaki T, Hamahata A, Ochi M, Sakurai H. Quantification of superficial venous reflux by duplex ultrasound-role of reflux velocity in the assessment the clinical stage of chronic venous insufficiency. Ann Vasc Dis 2014; 7:376-82. [PMID: 25593622 DOI: 10.3400/avd.oa.14-00047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/07/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study we compare the duplex-derived parameters of reflux in patients with early and advanced superficial venous insufficiency (SVI) to identify parameters reflecting this. METHODS Two thousand and one hundred sixty limbs with primary reflux, categorized according to the CEAP (clinical, etiologic, anatomic and pathophysiologic) classification, and the patients were divided into two groups (group I [C1-3, Ep, As, Pr]; group II [C4-6, Ep, As, Pr]) were studied. The vein diameter, reflux duration(s), mean reflux velocity (MRV; cm/s), peak reflux velocity (PRV; cm/s), and total reflux volume (TRV; ml/s) were determined at the sapheno-femoral junction (SFJ), great saphenous vein (GSV) and sapheno-popliteal junction (SPJ). RESULTS Age and the proportion of males were greater in group II. MRV, PRV and TRV were greater in group II at the SFJ, SPJ and in GSV (p <0.01 for all), although the duration of SPJ reflux was non-discriminatory (p = 0.78). From receiver operating characteristic (ROC) curve, optimal cut-off points of 27.8, 47.8, and 36.2 cm/s for the PRV at the SFJ (p <0.01), GSV (p <0.01), and SPJ (p <0.01) discriminated between the two groups. CONCLUSION PRV and MRV improved discrimination between early and advanced SVI compared to reflux duration.
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Affiliation(s)
- Hisato Konoeda
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Yamaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Ochi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Jibiki M, Inoue Y, Terasaki H, Igari K, Uchiyama H, Miyai M, Kagayama T. The effect of short saphenous vein stripping in patients with deep venous reflux. Ann Vasc Dis 2013; 6:612-6. [PMID: 24130617 DOI: 10.3400/avd.oa.13-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/01/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECT We assessed whether or not deep venous reflux (DVR) improved after short saphenous vein (SSV) stripping was performed in patients with SSV reflux and DVR. MATERIALS AND METHODS Sixty-eight patients with SSV reflux who underwent SSV striping every Monday between 2008 and 2011 at Ryougoku Ashino Clinic were enrolled in this study. Forty-six of the 68 patients were selected for the analysis because they underwent duplex ultrasound examinations before and after the operation. The DVR was classified into four categories: type 0, no reflux; type I, reflux in popliteal vein; type II, reflux from popliteal vein to the middle of the superficial femoral vein (SFV) and type III, reflux from the popliteal vein to the SFV. RESULTS There were 23, 13, 2 and 8 patients with type 0, I, II, III before operation, respectively. There were 33, 8, 1, 4 patients with type 0, I, II, III after operation, respectively. There were no changes in 29 patients, improvement in 15 and new DVR in three (type 0 to I). CONCLUSION SSV stripping is feasible in patients with DVR and the DVR might not be deteriorated even though that is performed.
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Affiliation(s)
- Masatoshi Jibiki
- Department of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan ; Department of Vascular Surgery, Ryougoku Ashino Clinic, Tokyo, Japan
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Gillet JL, Lausecker M, Sica M, Guedes JM, Allaert FA. Is the treatment of the small saphenous veins with foam sclerotherapy at risk of deep vein thrombosis? Phlebology 2013; 29:600-7. [DOI: 10.1177/0268355513497362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess the deep vein thrombosis risk of the treatment of the small saphenous veins depending on the anatomical pattern of the veins. Method A multicenter, prospective and controlled study was carried out in which small saphenous vein trunks were treated with ultrasound-guided foam sclerotherapy. The anatomical pattern (saphenopopliteal junction, perforators) was assessed by Duplex ultrasound before the treatment. All patients were systematically checked by Duplex ultrasound 8 to 30 days after the procedure to identify a potential deep vein thrombosis. Results Three hundred and thirty-one small saphenous veins were treated in 22 phlebology clinics. No proximal deep vein thrombosis occurred. Two (0.6%) medial gastrocnemius veins thrombosis occurred in symptomatic patients. Five medial gastrocnemius veins thrombosis and four cases of extension of the small saphenous vein sclerosis into the popliteal vein, which all occurred when the small saphenous vein connected directly into the popliteal vein, were identified by systematic Duplex ultrasound examination in asymptomatic patients. Medial gastrocnemius veins thrombosis were more frequent ( p = 0.02) in patients with medial gastrocnemius veins perforator. A common outlet or channel between the small saphenous vein and the medial gastrocnemius veins did not increase the risk of deep vein thrombosis. Conclusion Deep vein thrombosis after foam sclerotherapy of the small saphenous vein are very rare. Only 0.6% medial gastrocnemius veins thrombosis occurred in symptomatic patients. However, the anatomical pattern of the small saphenous vein should be taken into account and patients with medial gastrocnemius veins perforators and the small saphenous vein connected directly into the popliteal vein should be checked by Duplex ultrasound one or two weeks after the procedure. Recommendations based on our everyday practice and the findings of this study are suggested to prevent and treat deep vein thrombosis.
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Affiliation(s)
- JL Gillet
- 51 bis Avenue Professeur Tixier, Bourgoin-Jallieu, France
| | | | - M Sica
- 5 rue de Crussol, Paris, France
| | - JM Guedes
- 31 rue Amiral Gourbeyre, Riom, France
| | - FA Allaert
- Chaire d’Evaluation Médicale Ceren ESC &Cenbiotech /dim CHU du Bocage, 21000 Dijon, France
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, García JAA, Arranz MAG, García DL, González-González E, Puerta CV. Reflux patterns and risk factors of primary varicose veins’ clinical severity. Phlebology 2013; 28:153-61. [DOI: 10.1258/phleb.2011.011114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Primarily, to determine the association between the clinical severity of primary varicose veins and different reflux patterns in an anatomic and haemodynamic clinical study using duplex ultrasonography (DU). Secondly, to analyse the association of clinical severity with other aspects, such as risk factors for chronic venous insufficiency (CVI) and other concurrent diseases. Method A total of 2036 limbs were evaluated using DU. Clinical status was characterized by the CEAP (clinical, aetiological, anatomical and pathological elements) classification. The degree of clinical severity was grouped into two categories, mild to moderate CVI (C1–C3) and severe CVI, characterized by the presence of skin changes (C4–C6). We analysed the association of the different reflux patterns with CEAP status. Results Saphenofemoral junction (SFJ) reflux of the great saphenous vein (GSV) was associated with the most severe form of the disease (odds ratio [OR] = 2.96; confidence interval [CI] 95%: 2.2–3.8), whereas competent SFJ of the GSV with reflux from proximal veins (OR = 2; CI 95%: 1.4 –2.7) and the pure non-saphenous reflux (OR = 4.1; CI 95%: 1.8–9.0) were associated with mild to moderate CVI. Obesity increased the frequency of severe CVI 2.7 times (OR = 2.7; CI 95%: 1.6–4.6); being a woman also increased the frequency of more severe disease 1.3 times (OR = 1.3; CI 95%: 1.0–1.7). Conclusion Anatomical and haemodynamic studies by DU are postulated as a useful diagnostic tool that allow, by identifying the pattern of venous reflux of varicose pathology, characterization of the probable association to CVI clinical severity.
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Affiliation(s)
- M García-Gimeno
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | | | - S Tagarro-Villalba
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - E Ramalle-Gomara
- Department of Epidemiology, La Rioja Regional Authority, La Rioja
| | | | - M A González Arranz
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - D López García
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - E González-González
- Department of Angiology and Vascular/Endovascular Surgery, Hospital San Pedro, Logroño
| | - C Vaquero Puerta
- Department of Angiology and Vascular/Endovascular Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Kim SY, Park EA, Shin YC, Min SI, Lee W, Ha J, Kim SJ, Min SK. Preoperative determination of anatomic variations of the small saphenous vein for varicose vein surgery by three-dimensional computed tomography venography. Phlebology 2011; 27:235-41. [DOI: 10.1258/phleb.2011.011023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To define the anatomical variations of small saphenous vein (SSV) for varicose vein (VV) surgery by three-dimensional computed tomography venography (3D-CTV) and to analyse the impact of this preoperative evaluation on surgical outcomes. Methods A total of 120 consecutive limbs with SSV insufficiency having undergone VV surgery from January 2005 until December 2007 were enrolled. The medical records and images were analysed retrospectively. Results The relationship between SSV and gastrocnemial vein (GNV) were categorized into two: (a) SSV and GNV drained to popliteal vein (PV) separately (100 limbs, 87%) and (b) SSV and GNV made common channel which drained to PV (15 limbs, 13%). Saphenopopliteal junction morphology was normal (75 limbs), severe tortuosity near PV (19 limbs), ampullary ectasia (4 limbs) and duplicated drainage to PV (2 limbs). No recurrence of VV was noted. Conclusions CTV can provide thorough preoperative anatomic information of the SSV variations and reduce the recurrence of VV.
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Affiliation(s)
| | - E-A Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - W Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, Ajona J, González Arranz M, López García D, González-González E, Vaquero Puerta C. Reflux or not reflux? Reflexiones sobre la publicación anglosajona del término en las varices primarias de los miembros inferiores en relación con nuestro entorno. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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García-Gimeno M, Rodríguez-Camarero S, Tagarro-Villalba S, Ramalle-Gomara E, González-González E, Arranz MAG, García DL, Puerta CV. Duplex mapping of 2036 primary varicose veins. J Vasc Surg 2009; 49:681-9. [DOI: 10.1016/j.jvs.2008.09.062] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 09/26/2008] [Accepted: 09/29/2008] [Indexed: 10/21/2022]
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Caggiati A, Bergan JJ, Gloviczki P, Eklof B, Allegra C, Partsch H. Nomenclature of the veins of the lower limb: Extensions, refinements, and clinical application. J Vasc Surg 2005; 41:719-24. [DOI: 10.1016/j.jvs.2005.01.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tagarro-Villalba S, González-González M, García-Gimeno M, Vicente-Santiago M, Rodríguez-Camarero S. Insuficiencia venosa superficial de miembros inferiores. ¿Cuál es el punto de fuga? ANGIOLOGIA 2005. [DOI: 10.1016/s0003-3170(05)74927-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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