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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; ZEITSCHRIFT FUR DERMATOLOGIE, VENEROLOGIE, UND VERWANDTE GEBIETE 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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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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Gianesini S, Menegatti E, Occhionorelli S, Grazia Sibilla M, Mucignat M, Zamboni P. Segmental saphenous ablation for chronic venous disease treatment. Phlebology 2020; 36:63-69. [PMID: 32746725 DOI: 10.1177/0268355520946238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovenous thermal ablation for chronic venous disease treatment is recommended over traditional surgery. The present investigation compares endovenous laser ablation (EVLA) with radiofrequency (RF) for segmental endovenous sapheno-femoral junction ablation. METHODS This is a retrospective study in which 79 patients underwent a 6 cm great saphenous vein ablation by RF or by EVLA.Primary outcome was occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score, peri-procedural pain, aesthetic satisfaction. RESULTS At 12 ± 1 months recanalization of shrunk tract was recorded in 5/85 (5.8%) cases (2 RF, 3 EVLA) [OR: 1.6; 95%CI: 0.2-10.4; P = 0.6689]. Two cases (1/44 RF group and 1/38 EVLA group) also showed reflux recurrence [OR: 1.0; 95%CI: 0.06-17.8; P = 1.0000]. No significant differences between groups were found in AVVQ, VCSS, peri-procedural pain, or aesthetic satisfaction. CONCLUSION Saphenous sparing is feasible and effective by means of both EVLA and RF, representing a possible alternative to surgery.
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Affiliation(s)
- Sergio Gianesini
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Erica Menegatti
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Savino Occhionorelli
- General and Emergency Surgery Unit, Sant'Anna University-Hospital, Ferrara, Italy
| | - Maria Grazia Sibilla
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy.,General and Emergency Surgery Unit, Sant'Anna University-Hospital, Ferrara, Italy
| | - Marianna Mucignat
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center-Mini-invasive Venous Surgery Unit, University of Ferrara, Ferrara, Italy
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Santler B, Goerge T. Die chronische venöse Insuffizienz - Eine Zusammenfassung der Pathophysiologie, Diagnostik und Therapie. J Dtsch Dermatol Ges 2018; 15:538-557. [PMID: 28485867 DOI: 10.1111/ddg.13242_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/11/2017] [Indexed: 01/06/2023]
Abstract
Die chronische Venenerkrankung ist eine weit verbreitete Krankheit, die in späteren Stadien mit einer Vielzahl an Symptomen, aber auch Komplikationen wie dem Ulcus cruris, einhergeht. Dies wiederum hat weitreichende Auswirkungen auf die Lebensqualität der Patienten wie auch auf das Gesundheitssystem. Für die Diagnostik der chronischen Venenerkrankungen steht eine Auswahl an Verfahren zur Verfügung, wobei sich die farbkodierte Duplexsonographie als Goldstandard etabliert hat. Im Bereich der Therapie kam es in den letzten Jahrzehnten zu großen Fortschritten, sodass heute auch Alternativen zum klassischen Stripping durch die endoluminalen Verfahren zur Verfügung stehen. Die Wahl der Therapieoption ist jedoch weiterhin stark abhängig von mehreren Faktoren, unter anderem von den anatomischen Gegebenheiten und dem Krankheitsstadium. Im folgenden Artikel werden die Anatomie und Pathophysiologie, sowie die aktuellen Standards der Diagnostik und Therapie zusammengefasst.
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Affiliation(s)
- Bettina Santler
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
| | - Tobias Goerge
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
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Santler B, Goerge T. Chronic venous insufficiency - a review of pathophysiology, diagnosis, and treatment. J Dtsch Dermatol Ges 2018; 15:538-556. [PMID: 28485865 DOI: 10.1111/ddg.13242] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/11/2017] [Indexed: 01/20/2023]
Abstract
Chronic venous disease is a common disorder associated with a variety of symptoms in later disease stages but also with complications such as venous leg ulcer. This, in turn, has substantial socioeconomic effects and significantly impacts patients' quality of life. While there are a number of diagnostic procedures available, color-flow duplex ultrasound has become the gold standard. As regards therapeutic options, major advances have been made in recent decades. Today, there are alternatives to saphenofemoral ligation and stripping of the great saphenous vein, including endovenous thermal ablation techniques. However, treatment selection continues to depend on many factors such as individual anatomical circumstances and disease stage. The following article provides an overview of the anatomy and pathophysiology as well as current diagnostic and therapeutic standards.
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Affiliation(s)
- Bettina Santler
- Department of Dermatology and Venereology, University Hospital Münster, Münster, Germany
| | - Tobias Goerge
- Department of Dermatology and Venereology, University Hospital Münster, Münster, Germany
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Abstract
SummaryIntroduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.
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Abstract
ZusammenfassungAnders als bei den Arterien reicht der spontane Fluss in den Beinvenen nicht für eine gute Diagnostik aus. Daher werden Provokationsmanöver zu Hilfe genommen, um einen Blutfluss zu verursachen. Klassisch kommen die Atmung und das Valsalva-Manöver zum Einsatz. In den letzten Jahren wurden dynamische und dem physiologischen Ablauf nähere Manöver entwickelt, wie das Paraná-Manöver, bei dem der Patient leicht nach vorne geschoben wird, um die Gastrocnemius-Muskulatur zu aktivieren, das Wunstorfer Manöver, bei dem der Vorfuß angehoben wird oder das Orthostase-Manöver, bei dem der Patient hingelegt und wieder aufgestellt wird, um die Schließfähigkeit der Klappen zu testen. All diese Verfahren werden vorgestellt und miteinander verglichen.
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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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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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Gianesini S, Occhionorelli S, Menegatti E, Zuolo M, Tessari M, Spath P, Ascanelli S, Zamboni P. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology 2014; 30:157-71. [PMID: 24755924 DOI: 10.1177/0268355514531953] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Along the years, scientific clinical data have been collected concerning the possible saphenous flow restoration without any ablation and according with the CHIVA strategy. Moreover, in 2013 a Cochrane review highlighted the smaller recurrence risk following a CHIVA strategy rather than a saphenous stripping. Nevertheless, the saphenous sparing strategy surely remains a not-so-worldwide-spread and accepted therapeutic option, also because considered not so immediate and easy to perform. Aim of this paper is to provide an easily accessible guide to an everyday use of a saphenous sparing strategy for chronic venous disease, highlighting how even apparently too complicated reflux patterns classifications can be fastly and successfully managed and exploited for a hemodynamic correction.
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Affiliation(s)
- S Gianesini
- Vascular Disease Center, University of Ferrara, Italy
| | | | - E Menegatti
- Vascular Disease Center, University of Ferrara, Italy
| | - M Zuolo
- Vascular Disease Center, University of Ferrara, Italy
| | - M Tessari
- Vascular Disease Center, University of Ferrara, Italy
| | - P Spath
- Vascular Disease Center, University of Ferrara, Italy
| | - S Ascanelli
- Vascular Disease Center, University of Ferrara, Italy
| | - P Zamboni
- Vascular Disease Center, University of Ferrara, Italy
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