Venous insufficiency and perforating veins

Anatomical Distribution of Chronic Venous Insufficiency in a Chinese Population

Objective:

To study the anatomical distribution of chronic venous insufficiency (CVI) in a Chinese population by means of duplex scanning.

Procedures:

A total of 582 limbs in 291 patients with primary venous insufficiency were classified clinically into three different groups according to SVS/ISCVS criteria and evaluated prospectively with duplex scanning.

Results:

One hundred and thirty-one limbs were classified into group I (CEAP clinical class 0), 291 into group II (CEAP clinical classes 1 and 2) and 160 into group III (CEAP clinical classes 3–6). Mixed deep and superficial venous incompetence was found in 70% and 83% of limbs in groups II and III, respectively. Reflux was also demonstrated in 73% of group I limbs.

Conclusions:

Most of our patients had mixed deep and superficial venous incompetence. The prevalence of deep venous incompetence in this population, in which deep vein thrombosis is rare, suggests a pattern of venous incompetence other than postphlebitic deep vein valvular dysfunction. The prevalence of reflux in the asymptomatic contralateral limbs implies a bilateral predisposition to venous reflux and thus a possible developmental origin of CVI.

Evaluation of Compression under an Elastic Tubular Bandage Utilised as an Introduction to Compression Therapy in the Treatment of Venous Leg Ulcers

Objective:

To investigate the physical parameters of an elasticated tubular bandage (Tubigrip) on the leg and in durability studies.

Design and setting:

Cohort studies.

Participants:

Six healthy volunteers and 16 patients.

Main outcome measure:

Sub-bandage pressure.

Results:

Median pressures recorded under the Tubigrip bandage system at the lower, middle and upper calf muscle in 6 healthy volunteers, while sitting were 26, 25 and 12.5 mmHg, and for standing were 32, 40 and 16 mmHg. The median pressures recorded at the lower, middle and upper calf muscle in 16 venous leg ulcer patients while sitting were 18, 20 and 14 mmHg, and for standing were 32.5, 29.5 and 18 mmHg. Tubigrip durability studies demonstrated no decrease in sub-bandage compression over 8 days when applied to a model leg and volunteer leg. However, sub-bandage pressure decreased by more than 29% when the bandage was subjected to four wash-dry cycles.

Conclusions:

The pressures measured under Tubigrip were consistent with the ranges seen in other compression therapies. Laundering reduced the applied sub-bandage pressure.

Causes of recurrent lower limb varicose veins after surgical interventions in 141 limbs – Five-year retrospective analysis of two centers

Aim

The purpose of this study was to explore the causes of recurrent lower limb varicose veins after surgical interventions.

Methods

A retrospective five-year survey was conducted on patients who underwent second surgery due to recurrent lower limb varicose veins after surgical interventions. A total of 141 limbs (112 cases), including 72 cases of left lower limbs, 47 of right lower limbs and 22 of both limbs, were involved in the study. All patients underwent lower limb venography (141 limbs were anterograde and 28 cases were retrograde), and then examined with color-Doppler ultrasound.

Results

The major causes that urged patients to undergo second surgery are clinical changes graded above CEAP IV (93.6%), limb edema without changes on skin (5%), and single varicosity (1.4%). Up to 127 (83%) limbs exhibited perforating venous reflux, 67 (47.5%) limbs had varied degrees of deep venous insufficiency and 68 (48.2%) limbs had through or above-the-knee great saphenous vein trunk residual.

Conclusions

Preoperative venography before operation is indispensible in confirming the diagnosis and operation strategies. Patients with severe primary deep venous reflux and symptoms up to C3 may need simultaneous repair of the deep venous valves.

Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency

BACKGROUND

Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI. We investigated the effect of concomitant SEPS and SVS on deep vein reflux as well as the associated hemodynamic and clinical changes after surgery in a cohort of patients with advanced primary CVI.

METHODS

We prospectively evaluated 53 consecutive SEPSs with concomitant SVS procedures in 47 patients with advanced primary CVI. There were 25 men and 22 women with a mean age of 58 years at operation. Thirty-four procedures (64%) were performed for limbs with active venous ulcers (class 6), and the other 19 procedures were performed for 15 class 5 limbs, one class 4a limb, and three class 4b limbs, respectively. Duplex scan and air plethysmography were performed before operation, at 1 month, and at 1 year after operation. The patients were followed up regularly with clinical assessment, and the ulcer healing and recurrence rates were documented.

RESULTS

The proportion of limbs with common femoral vein incompetence decreased from 68% to 28% at 1 month and to 32% at 1 year after operation. The proportion of limbs with deep vein incompetence at more than one site also decreased from 42% to 15% at 1 month and to 12% at 1 year after concomitant SEPS and SVS. Venous hemodynamics as measured by air plethysmography improved significantly after operation. The cumulative ulcer healing was 85% at 3 months and 97% at 6 months. With a mean follow-up of 31 +/- 16 months, all ulcers healed. Only three recurrent ulcers (6%) were detected during the follow-up period.

CONCLUSION

Concomitant SEPS and SVS are effective in reducing deep vein reflux and results in hemodynamic and clinical improvements in patients with advanced primary CVI. Deep vein reconstruction procedures may not be necessary in these patients.

Randomized clinical trial of routine preoperative duplex imaging before varicose vein surgery

Background

Duplex imaging is used increasingly for preoperative evaluation of varicose veins, but its value in terms of the long-term results of surgery is not clear.

Methods

Patients with primary varicose veins were randomized to operation with or without preoperative duplex imaging. Reoperation rates, clinical and duplex findings were compared at 2 months and 2 years after surgery.

Results

Two hundred and ninety-three patients (343 legs) had varicose vein surgery after duplex imaging (group 1; 166 legs) or no imaging (group 2; 177 legs). In 44 legs (26·5 per cent), duplex examination suggested a different surgical procedure than had been considered on clinical grounds; the procedure was changed accordingly for 29 legs. At 2 months, incompetence was detected at the saphenofemoral or saphenopopliteal junction (or both) in 14 legs (8·8 per cent) in group 1 and in 44 legs (26·5 per cent) in group 2 (P < 0·001). At 2 years, two legs (1·4 per cent) had undergone or were awaiting reoperation in group 1, and 14 legs (9·5 per cent) in group 2 (P = 0·002). In the remainder, major incompetence was found in 19 legs (15·0 per cent) in group 1 and in 53 (41·1 per cent) in group 2 (P < 0·001).

Conclusion

Routine preoperative duplex examination led to an improvement in results 2 years after surgery for patients with primary varicose veins.