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Mehra R, Patra V, Dhillan R, Sharma A, Kashyap S, Rastogi G, Gupta L, Singh R, Chopra C, Sharma V. Replication study identified EFEMP1 association with varicose vein predisposition among Indians. Eur J Med Res 2024; 29:232. [PMID: 38609985 PMCID: PMC11015598 DOI: 10.1186/s40001-024-01786-8] [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: 08/24/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Varicose vein is a chronic condition that affects the lower extremities of the human body. Several factors have been implicated in the development of this disease, viz age, gender, weight, height and prolonged standing. Recently, genome-wide studies have identified genetic biomarkers that are associated with varicose veins in different ethnic groups. Such genetic studies are lacking in South Asians specifically in Indians where the prevalence of varicose veins is high, and it is important to replicate these variants in the stated population. The study aimed to replicate the association of genetic variants associated with varicose veins in this target population, which were found to be associated with the other ethnic groups. METHODOLOGY The studied cohort is of the Indian population comprising unrelated 104 varicose veins cases and 448 non-varicose vein controls. The samples were genotyped using the Illumina Global Screening Array. Using the genomic data from UK BioBank and 23andMe studied cohorts; eight genetic variants were selected to replicate in our dataset. The allelic association was performed to identify the effective allele and risk was estimated using odds ratio and p-value as level of significance. Multifactor Dimensionality Reduction was used to estimate the cumulative effect of variants in Indians. RESULT Variant rs3791679 of EFEMP1 was found to be associated with varicose veins in Indians. After observing the association of the EFEMP1 with varicose veins, we further ensued to identify all genetic variants within EFEMP1 to uncover the additional variants associated with this trait. Interestingly, we identified six new variants of EFEMP1 gene that have shown association. Moreover, the cumulative effect of all associated variations was estimated and the risk was 2.7 times higher in cases than controls whereas independently their effect ranges from 0.37-1.58. CONCLUSION This study identifies EFEMP1 as a potential gene related to the risk of varicose veins in Indians. It also highlights that evaluating the maximum number of variants of a gene rather than focusing solely on replicating single variations offers a more comprehensive and nuanced understanding of the genetic factors contributing to a complex trait like varicose veins.
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Affiliation(s)
- Rohit Mehra
- Department of Vascular and Endovascular Surgery, Command Hospital (Southern Command), Pune, India.
| | - Vikram Patra
- Department of Vascular and Endovascular Surgery, Command Hospital (Northern Command), Udhampur, India
| | - Rishi Dhillan
- Department of Vascular and Endovascular Surgery, Army Hospital (Research and Referral), Delhi, India
| | - Anuka Sharma
- NMC Genetics India Pvt. Ltd. Gurugram, Haryana, 122001, India
| | - Sonal Kashyap
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
| | - Garima Rastogi
- NMC Genetics India Pvt. Ltd. Gurugram, Haryana, 122001, India
| | - Love Gupta
- NMC Genetics India Pvt. Ltd. Gurugram, Haryana, 122001, India
| | - Reena Singh
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
| | - Chirag Chopra
- School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, Punjab, India
| | - Varun Sharma
- NMC Genetics India Pvt. Ltd. Gurugram, Haryana, 122001, India.
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Guven H. Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up. Vascular 2024:17085381241240870. [PMID: 38509041 DOI: 10.1177/17085381241240870] [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: 03/22/2024]
Abstract
OBJECTIVE Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options. PATIENTS AND METHOD This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured. RESULTS The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26 years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup. CONCLUSION D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.
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Affiliation(s)
- Hakan Guven
- Department of Cardiovascular Surgery, Heart an Arrythmia Hospital, Bursa, Türkiye
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Choi JY, Lee JH, Kwon OJ. Association between the saphenous vein diameter and venous reflux on computed tomography venography in patients with varicose veins. PLoS One 2022; 17:e0263513. [PMID: 35167584 PMCID: PMC8846520 DOI: 10.1371/journal.pone.0263513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Three-dimensional computed tomography venography is a useful tool to identify increased saphenous vein diameter and provides a complementary road map for surgery in patients with varicose veins. In this study, we investigated the correlation between saphenous vein diameter on computed tomography venography and venous reflux detected on duplex ultraonography. We enrolled 152 patients (213 extremities) who underwent endovenous laser ablation therapy, following high ligation of the saphenofemoral junction between January 2014 and December 2019. All patients underwent preoperative computed tomography venography evaluation. The saphenous vein diameter was measured on computed tomography venography, and venous reflux was evaluated in the operating room using Doppler ultrasonography. Among the 152 patients included in the study, 61 showed varicose veins affecting the bilateral extremities. Among the 213 extremities investigated, 165 (77.5%) and 48 (22.5%) extremities showed varicosities involving the greater and lesser saphenous veins, respectively. Among all extremities, venous reflux was detected in 172 (80.8%). The mean diameter of the greater saphenous vein measured 5 cm distal to the saphenofemoral junction was 8.07±1.82 mm in patients with reflux and 5.11±1.20 mm in patients without reflux (p < .05). The small saphenous vein diameter measured 5 cm distal to the saphenopopliteal junction was 7.65±1.74 mm in patients with reflux and 5.04±1.80 mm in patients without reflux (p < .05). Based on the receiver operating characteristic curve, the greater saphenous vein threshold diameter of 5.880 mm measured 5 cm distal to the saphenofemoral junction was the optimal cut-off value to predict reflux (sensitivity 91.4%, specificity 81.8%). The lesser saphenous vein diameter of 5.285 mm measured 5 cm distal to the saphenopopliteal junction was the optimal cut-off value to predict reflux (sensitivity 94.9%, specificity 75.0%). Vein diameter cannot be used as an absolute reference for venous reflux; however, it may have predictive value in patients with varicose veins. Computed tomography venography based measurements of vein diameter may serve as a useful diagnostic tool to predict venous reflux and recommend treatment.
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Affiliation(s)
- Ji Yoon Choi
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
- * E-mail:
| | - Ju-Hee Lee
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
| | - Oh Jung Kwon
- Division of Transplantation and Vascular surgery, Department of Surgery, Hanyang University Medical Center, Seoul, Korea
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Chebl RB, Souki NE, Geha M, Majzoub I, Kaddoura R, Zgheib H. Two-point compression ultrasonography: Enough to rule out lower extremity deep venous thrombosis? World J Emerg Med 2021; 12:268-273. [PMID: 34512822 DOI: 10.5847/wjem.j.1920-8642.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) is a major cause of morbidity and is a common presenting complaint to the emergency department (ED). Point-of-care two-point compression ultrasonography has evolved as a quick and effective way of diagnosing DVT. The purpose of this study is to validate the prevalence and distribution of venous thrombi isolated to proximal lower extremity veins, other than common femoral and popliteal veins in patients with DVT. METHODS This is a single-center retrospective study that looked at patients presenting to the ED of a tertiary care hospital between January 2014 and August 2018. The clinical presentation and laboratory and imaging results were obtained using the hospital's electronic medical record. RESULTS A total of 2,507 patients underwent a lower extremity duplex ultrasound during the study period. Among them, 379 (15%) were included in the study. The percentages of isolated thrombi to the femoral vein and deep femoral vein were 7.92% and 0.53%, respectively. When the patients were stratified into the two groups of isolated DVT and two-point compression DVT, there were no statistically significant differences in the laboratory results between both groups. However, immobilized patients and patients with recent surgeries were more likely to have an isolated DVT. CONCLUSIONS Thrombi isolated to proximal lower extremity veins other than the common femoral and popliteal veins make up 8.45% of DVTs. Given this significant number of missed DVTs, the authors recommend the addition of the femoral and deep femoral veins to the two-point compression exam.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Nader El Souki
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Mirabelle Geha
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Imad Majzoub
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Rima Kaddoura
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Hady Zgheib
- Department of Emergency Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
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Sumpio BJ, Png CYM, Harrington A, Root D, McLaughlin R, Manchester S, Latz CA, Feldman ZM, Eagleton M, Dua A. Utility of unilateral versus bilateral venous reflux studies for venous insufficiency. J Vasc Surg Venous Lymphat Disord 2021; 9:1297-1301. [PMID: 33529718 DOI: 10.1016/j.jvsv.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Duplex ultrasonography is the reference standard for diagnosing chronic venous insufficiency. Bilateral venous reflux ultrasound studies are among the most time-consuming and physically demanding tests for vascular ultrasound technologists to perform. Furthermore, if a venous procedure is required, many insurance policies require that a diagnostic venous ultrasound scan for reflux must be performed within 1 year of the procedure. If the intervention is scheduled for >1 year after the ultrasound scan, the insurance company might require a repeat venous ultrasound scan before granting insurance authorization. Hence, ordering bilateral venous duplex ultrasound scans to evaluate for reflux when an intervention might only be performed on one limb within the year could be a waste of time and resources. The aim of the present study was to determine the utility of ordering bilateral vs unilateral studies to evaluate for reflux in patients with suspected chronic venous insufficiency and to determine whether a resource-saving potential exists for vascular laboratories through optimization of the process of ordering venous duplex ultrasound studies. METHODS A retrospective review of all patients who had undergone bilateral lower extremity ultrasound scanning to evaluate for reflux from January 1, 2016 to December 31, 2016 at the Massachusetts General Hospital vascular laboratory was performed. The demographics, indications for ultrasound scanning, comorbidities, time required to perform the ultrasound study, and interval to intervention were documented. The data were analyzed using SPSS statistical software (IBM Corp, Armonk, NY). RESULTS During the study period, 13,854 ultrasound studies had been performed in our vascular laboratory, of which 606 (4.4%) had been bilateral ultrasound scans for venous insufficiency. The time allotted for a bilateral study was 2 hours. Of the 606 studies evaluated, 152 (25.1%) showed no evidence of reflux, 284 (46.9%) showed bilateral lower extremity reflux, and 170 (28.1%) showed only venous insufficiency in one leg. Venous ablation, phlebectomy, and/or sclerotherapy were performed for 28.7% of the patients. However only 6.2% of patients had undergone venous procedures on both legs within 1 year after the ultrasound studies. Ablation was the most common procedure performed (54.6%), followed by phlebectomy (27.%) and sclerotherapy (17.9%). Overall, 94.7% of patients had not undergone a venous procedure on both legs within 1 year after the ultrasound studies and, hence, would have required a repeat duplex ultrasound scan to ensure insurance coverage for future procedures. CONCLUSIONS Most bilateral ultrasound scans for venous insufficiency will not result in an intervention. Thus, most patients (95%) could have undergone a unilateral scan before the initial intervention instead of bilateral duplex ultrasound scanning.
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Affiliation(s)
- Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anita Harrington
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Drena Root
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Robert McLaughlin
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Scott Manchester
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Zachary M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med 2019; 34:269-283. [PMID: 30360023 PMCID: PMC6406103 DOI: 10.3904/kjim.2018.230] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/08/2018] [Indexed: 12/15/2022] Open
Abstract
Chronic venous insufficiency (CVI) of the lower extremities manifests itself in various clinical spectrums, ranging from asymptomatic but cosmetic problems to severe symptoms, such as venous ulcer. CVI is a relatively common medical problem but is often overlooked by healthcare providers because of an underappreciation of the magnitude and impact of the problem, as well as incomplete recognition of the various presenting manifestations of primary and secondary venous disorders. The prevalence of CVI in South Korea is expected to increase, given the possible underdiagnoses of CVI, the increase in obesity and an aging population. This article reviews the pathophysiology of CVI of the lower extremities and highlights the role of duplex ultrasound in its diagnosis and radiofrequency ablation, and iliac vein stenting in its management.
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Affiliation(s)
- Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Division of Interventional Cardiology, Calhoun Cardiology Center, UConn Health, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Juyong Lee
- Division of Interventional Cardiology, Calhoun Cardiology Center, UConn Health, University of Connecticut School of Medicine, Farmington, CT, USA
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Autogenously derived regenerative cell therapy for venous leg ulcers. ACTA ACUST UNITED AC 2018; 3:e156-e163. [PMID: 30775606 PMCID: PMC6374579 DOI: 10.5114/amsad.2018.81000] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/09/2018] [Indexed: 12/23/2022]
Abstract
Introduction Venous leg ulcers (VLUs), which arise from chronic venous insufficiency in the lower limbs, are a major cause of morbidity and significantly negatively impact patients’ health-related quality of life. Treatment of venous ulcers can be either conservative or surgical. Despite appropriate treatment, VLUs can be resistant to healing. Clinical results of treatment of venous foot ulcers with adipose-derived autologous stem cells, which did not improve despite the surgical treatment of the underlying venous pathology in the following case series, are reported. Material and methods Between April 2015 and January 2016, a total of 31 patients who had undergone surgery for underlying venous pathology but the venous ulcer had not healed were included in the study. The mean venous ulcer size was 3.6–6.2 cm (range: 2 to 8 cm by 3 to 9 cm). All patients were treated with adipose-derived autologous stem cells prepared using the MyStem Regenerative Adipose-Derived Stem Cell Purification Kit (MyStem LLC, USA). The ulcer diameter was measured and recorded in the third, sixth and twelfth months. The follow-up time was 12 months after ulcer healing. Results Eighteen ulcers demonstrated complete healing at the 12th month. Thirteen ulcers exhibited serious contraction and epithelialization even though the ulcer was not completely closed. At the 12th month, the ulcer size was reduced by 96.00 ±1.74% in these patients. The reduction in the ulcer area based on the month analyzed was significant (p = 0.001; p < 0.01). After the ulcers healed, the patients were followed for recurrence for one year. Recurrent ulcers were observed at the treated sites in 3 of 31 patients (9%). No adverse events, such as infection, inflammation, or tissue reactions, were observed. Conclusions Application of cell therapy in venous leg ulcer is currently used exclusively in patients not responding to the standard treatment. Autogenously derived regenerative cell therapy for VLUs can be considered as an additional treatment to primary surgical therapy.
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Tolu I, Durmaz MS. Frequency and Significance of Perforating Venous Insufficiency in Patients with Chronic Venous Insufficiency of Lower Extremity. Eurasian J Med 2018; 50:99-104. [PMID: 30002576 PMCID: PMC6039150 DOI: 10.5152/eurasianjmed.2018.18338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/11/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE). MATERIALS AND METHODS Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI). RESULTS PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001). CONCLUSION PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.
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Affiliation(s)
- Ismet Tolu
- Department of Radiology, Health Sciences University Training and Research Hospital, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Health Sciences University Training and Research Hospital, Konya, Turkey
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Sureshkumar S, Vignesh N, Venkatachalam J, Vijayakumar C, Sudharsanan S. Clinical Tests Combined with Color Doppler Versus Color Doppler Alone in Identifying Incompetent Perforator Veins of the Lower Limb: A Prospective Analytical Study. Cureus 2018. [PMID: 29531879 PMCID: PMC5837254 DOI: 10.7759/cureus.2026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background The color Doppler, a better investigation to identify the perforators objectively has replaced the clinical examination for the same. However, this has led to a significant number of negative explorations and cosmetic disfigurement. Objective To compare the efficacy of the clinical tests combined with the color Doppler versus color Doppler alone to identify the perforator incompetence during the surgery for primary varicose veins of the lower limb. Methods This was a prospective analytical study, including 61 lower limb varicose vein patients who belonged to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class four-six, planned for the surgical treatment for perforator incompetence, excluding those requiring additional vascular or nonvascular procedure, recurrent varicose veins and those who had injection sclerotherapy prior to the surgery. The clinical tests, including Trendelenburg's test, multiple tourniquet tests and, the Fegan's tests were performed and incompetent perforators were marked on a template as 'C' to indicate the clinically positive perforator incompetence. The patients were then examined with the color Doppler ultrasound and the pathological incompetent perforators were marked as 'D'. The surgical management of the perforator incompetence was done by stab ligation. The incision was made in the color Doppler 'D' marked sites as it has been the standard protocol. The number of incompetent perforators identified during the surgical exploration were categorized as 'D' positive or 'C' and 'D' positive and were recorded in the specified proforma. Results It was found that the mean number of the perforator incompetence identified by the color Doppler alone was 8.2 whereas during the surgery, only a mean of six perforators was identified, leading to 20 unnecessary explorations per 10 patients (8.2 vs. 6; mean difference 2.229; P <0.001). The mean number of the perforator incompetence identified by the color Doppler combined with the clinical tests was 4.5 and during the surgery, a mean of four perforators was identified (4.5 vs. 4; mean difference 0.377; P <0.001). The color Doppler combined with the clinical examination lead to only four unnecessary explorations per 10 patients. Conclusion A combination of both the clinical tests and the color Doppler ultrasound has a higher accuracy in detecting perforator incompetence and can reduce the number of negative explorations by the rate of 16 unnecessary explorations per 10 patients.
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Affiliation(s)
- Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Narayan Vignesh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - J Venkatachalam
- Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sundaramurthi Sudharsanan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Lee DK, Ahn KS, Kang CH, Cho SB. Ultrasonography of the lower extremity veins: anatomy and basic approach. Ultrasonography 2017; 36:120-130. [PMID: 28260355 PMCID: PMC5381851 DOI: 10.14366/usg.17001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 11/29/2022] Open
Abstract
Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography.
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Affiliation(s)
- Dong-Kyu Lee
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Aurshina A, Ascher E, Hingorani A, Salles-Cunha SX, Marks N, Iadgarova E. Clinical Role of the “Venous” Ultrasound to Identify Lower Extremity Pathology. Ann Vasc Surg 2017; 38:274-278. [DOI: 10.1016/j.avsg.2016.05.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
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12
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Nguyen T, Bergan J, Min R, Morrison N, Zimmet S. Curriculum of the American College of Phlebology. Phlebology 2016. [DOI: 10.1258/026835506779613534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T Nguyen
- Dermatology, Mohs Micrographic & Dermatologic surgery, Procedural Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
| | - J Bergan
- Department of Surgery, UCSD School of Medicine, San Diego, CA, USA
| | - R Min
- Department of Radiology, Cornell University School of Medicine, New York, NY, USA
| | - N Morrison
- Morrison Vein Institute, Scottsdale AZ, USA
| | - S Zimmet
- Zimmet Vein and Dermatology, Austin, TX, USA
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Baliyan V, Tajmir S, Hedgire SS, Ganguli S, Prabhakar AM. Lower extremity venous reflux. Cardiovasc Diagn Ther 2016; 6:533-543. [PMID: 28123974 DOI: 10.21037/cdt.2016.11.14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous incompetence. This review is intended to provide a succinct review of the pathophysiology of venous incompetence and the current role of imaging in its management.
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Affiliation(s)
- Vinit Baliyan
- Division of Abdominal Imagingy, Massachusetts General Hospital, Boston, MA, USA
| | - Shahein Tajmir
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Massachusetts General Hospital, Boston, MA, USA
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14
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Thomson L. Sclerotherapy of telangiectasias or spider veins in the lower limb: A review. JOURNAL OF VASCULAR NURSING 2016; 34:61-2. [PMID: 27210454 DOI: 10.1016/j.jvn.2016.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lily Thomson
- Section of Vascular Surgery, Health Sciences Centre, Vascular Research Lab, Winnipeg, Manitoba, Canada; St. Boniface General Hospital, Operating Room, Winnipeg, Manitoba, Canada.
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15
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Affiliation(s)
- Martin Necas
- Waikato HospitalVascular LaboratoryHamilton; Tristram ClinicTristram Vascular Ultrasound, Hamilton and Unitec New Zealand; School of HealthPostgraduate Studies - Ultrasound, Waitakere CampusRatanui St, HendersonAucklandNew Zealand
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16
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Cooper MA, Qazi U, Bass E, Zenilman J, Lazarus G, Valle MF, Malas MB. Medical and surgical treatment of chronic venous ulcers. Semin Vasc Surg 2015; 28:160-4. [PMID: 27113282 DOI: 10.1053/j.semvascsurg.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous ulcer of the lower extremity is a common vascular condition and is associated with decreased quality of life, reduced mobility, and social isolation. Treatment of chronic venous ulcer (CVU) includes compression therapy, debridement of the ulcer when necessary, and wound care. Collagen and antimicrobial dressings can improve the proportion of ulcers healed compared with compression alone. Acellular skin equivalents are not superior to compression, but cellular human skin equivalents can promote more rapid healing, particularly in patients with longstanding ulcers. Current vascular surgical practice is to eliminate documented reflux or obstruction in patients with CVU that have failed a 3-month period of compression dressing, debridement, and local wound care. We found that surgical treatment of the superficial venous system can decrease the time to healing of CVUs compared with compression therapy alone, but does not increase the proportion of ulcers healed.
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Affiliation(s)
- Michol A Cooper
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - Umair Qazi
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - Eric Bass
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - Jonathan Zenilman
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - Gerald Lazarus
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - M Frances Valle
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224
| | - Mahmoud B Malas
- Johns Hopkins Medical Institutions, 4940 Eastern Avenue, Baltimore, MD 21224.
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17
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Atasoy MM. Efficacy and Safety of Endovenous Laser Ablation in Very Large and Tortuous Great Saphenous Veins. J Vasc Interv Radiol 2015; 26:1347-52. [DOI: 10.1016/j.jvir.2015.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 04/03/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022] Open
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18
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Hardman RL, Rochon PJ. Role of interventional radiologists in the management of lower extremity venous insufficiency. Semin Intervent Radiol 2014; 30:388-93. [PMID: 24436566 DOI: 10.1055/s-0033-1359733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lower extremity venous insufficiency affects over half of all women. Interventional radiologists should be aware of the clinical evaluation of women with venous insufficiency and classification of disease. Endovascular therapies available for treatment of lower extremity venous insufficiency include: endovenous laser ablation, radiofrequency endovascular ablation, and sclerotherapy. The interventional radiologist should be versed on which therapy to select in each clinical presentation and the procedural techniques. The authors review the role of the interventional radiologist in managing this lower extremity venous disorder.
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Affiliation(s)
- Rulon L Hardman
- Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Paul J Rochon
- Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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19
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Duplex ultrasound evaluation of patients with chronic venous disease of the lower extremities. AJR Am J Roentgenol 2014; 202:633-42. [PMID: 24555602 DOI: 10.2214/ajr.13.11465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This article will describe the elements of performing a thorough venous ultrasound evaluation of the lower extremity in patients with manifestations of chronic venous disorder. The emphasis will be on the evaluation of superficial venous reflux. Only the specific aspects of the evaluation of the deep system pertaining to chronic venous disease will be discussed. CONCLUSION Duplex ultrasound requires the examiner to solve a puzzle to explain the patient's clinical manifestations. Patients who have been treated with surgery, thermal ablation, or ultrasound-guided sclerotherapy will require duplex ultrasound after treatment to identify complications, gauge the extent of treatment success, and evaluate the cause for any recurrence.
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20
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Biomechanical comparison between mono-, bi-, and tricuspid valve architectures. J Vasc Surg Venous Lymphat Disord 2014; 2:188-193.e1. [DOI: 10.1016/j.jvsv.2013.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/10/2013] [Accepted: 08/07/2013] [Indexed: 11/21/2022]
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21
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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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22
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Varicose veins: role of mechanotransduction of venous hypertension. Int J Vasc Med 2012; 2012:538627. [PMID: 22489273 PMCID: PMC3303599 DOI: 10.1155/2012/538627] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 11/13/2011] [Indexed: 11/17/2022] Open
Abstract
Varicose veins affect approximately one-third of the adult population and result in significant psychological, physical, and financial burden. Nevertheless, the molecular pathogenesis of varicose vein formation remains unidentified. Venous hypertension exerted on veins of the lower extremity is considered the principal factor in varicose vein formation. The role of mechanotransduction of the high venous pressure in the pathogenesis of varicose vein formation has not been adequately investigated despite a good progress in understanding the mechanomolecular mechanisms involved in transduction of high blood pressure in the arterial wall. Understanding the nature of the mechanical forces, the mechanosensors and mechanotransducers in the vein wall, and the downstream signaling pathways will provide new molecular targets for the prevention and treatment of varicose veins. This paper summarized the current understanding of mechano-molecular pathways involved in transduction of hemodynamic forces induced by blood pressure and tries to relate this information to setting of venous hypertension in varicose veins.
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23
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Kockaert M, Roos KPD, Dijk LV, Nijsten T, Neumann M. Duplication of the Great Saphenous Vein: A Definition Problem and Implications for Therapy. Dermatol Surg 2012; 38:77-82. [DOI: 10.1111/j.1524-4725.2011.02154.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Abstract
Duplex ultrasonography (DUS) is an essential part of the evaluation of patients with most forms of superficial venous insufficiency. DUS has also become an important tool in directing and assessing the results of a variety of minimally invasive treatments of this disease. In this article, we review the salient aspects of performing an adequate DUS evaluation and the utility of this technique in guiding treatment.
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Affiliation(s)
- Neil M Khilnani
- Cornell Vascular, Weill Medical College of Cornell University, New York, New York
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25
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Krishnan S, Nicholls SC. Chronic venous insufficiency: clinical assessment and patient selection. Semin Intervent Radiol 2011; 22:169-77. [PMID: 21326690 DOI: 10.1055/s-2005-921961] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Chronic venous insufficiency is a complex condition, with widely varied clinical manifestations, etiologies, and underlying pathophysiology. An orderly workup is mandatory to assess the nature of a patient's underlying venous disease. This begins in the office setting with a careful medical history, physical examination, and bedside diagnostic tests. These are augmented by confirmatory diagnostic testing, including duplex ultrasonography, venography, plethysmography, and ambulatory venous pressure measurement. Based upon the results of these examinations, the patient's venous disease can be classified according to standardized classification schemes, which in turn leads to the selection of an appropriate treatment strategy. This article outlines the steps in the clinical assessment and classification of patients with chronic venous insufficiency.
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Affiliation(s)
- Shyam Krishnan
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical School, Seattle, Washington
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26
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Köroğlu M, Eriş HN, Aktaş AR, Kayan M, Yeşildağ A, Çetin M, Parlak C, Gürses C, Akhan O. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol 2011; 52:278-84. [PMID: 21498363 DOI: 10.1258/ar.2010.100356] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Superficial venous insufficiency is a common problem associated with varicose veins. Endovenous laser ablation (EVLA) and concomitant ultrasound (US)-guided foam sclerotherapy are recent treatment methods alternative to surgery in the treatment of superficial venous insufficiency. PURPOSE To compare the effectiveness of EVLA and concomitant US-guided foam sclerotherapy prospectively in two different subgroups of the disease (isolated truncal vs. truncal with perforating vein insufficiency). MATERIAL AND METHODS The study was approved by the institutional review board. Fifty-five patients with symptomatic saphenous vein insufficiency and varicose veins were included in the study. Seventy-three EVLA and concomitant foam sclerotherapy were performed for 60 lower extremities. To determine the severity of the venous disease, Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were carried out before and 6 months after the treatment. Patients were followed up clinically and with Doppler ultrasonography for 6 months after the procedures. RESULTS At the sixth month of the follow-up; the total occlusion rate for the saphenous veins was 98.64% (72/73), and re-canalization rate was 1.36% (1/73). The total occlusion rate for the perforating veins was 75% (18/24), re-canalization rate was 25% (6/24). There was no notable major complication. VCSS and VAS scores were decreased significantly following the treatment (p < 0.05). The patients who had isolated saphenous vein insufficiency (Group I: 36/60) and those who had saphenous and perforating vein reflux (Group II: 24/60) were compared. VAS scores were more prominently decreased after the treatment in the isolated saphenous vein insufficiency group (p < 0.05). VCSS were also decreased more prominently in Group I when compared to Group II. CONCLUSION EVLA and concomitant US-guided foam sclerotherapy are effective, safe, and minimally invasive treatment options, yielding good cosmetic and clinical results in both isolated truncal and truncal with perforating vein insufficiency groups. However, clinical results and satisfaction of the patients were remarkably superior in cases with isolated truncal vein insufficiency compared to truncal and perforating vein insufficiency.
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Affiliation(s)
- Mert Köroğlu
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Hüseyin Naim Eriş
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Aykut Recep Aktaş
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Mustafa Kayan
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Ahmet Yeşildağ
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Meltem Çetin
- Süleyman Demirel University, Faculty of Medicine, Department of Radiology, Isparta
| | - Cem Parlak
- Antalya Education and Research Hospital, Department of Radiation Oncology, Antalya
| | - Cemil Gürses
- Antalya Education and Research Hospital, Department of Radiology, Antalya
| | - Okan Akhan
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
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27
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Practice guideline for the performance of peripheral venous ultrasound examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:143-150. [PMID: 21193718 DOI: 10.7863/jum.2011.30.1.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Endovenous laser ablation of the small saphenous vein sparing the saphenopopliteal junction. Cardiovasc Intervent Radiol 2010; 33:766-71. [PMID: 20087734 DOI: 10.1007/s00270-010-9806-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
Abstract
To assess outcomes after endovenous laser ablation (EVLA) of the small saphenous vein (SSV). Retrospective review was performed of all consecutive EVLA procedures performed over a 39-month period at three neighboring vein practices for symptomatic, duplex ultrasound-proven incompetence of the SSV. EVLA was performed under ultrasound guidance with an 810- or 980-nm diode laser in continuous mode using the pullback method while sparing the deep, most cephalad segment of the SSV near the saphenopopliteal junction. Follow-up after EVLA included patient symptoms, physical examination, and duplex ultrasound. Pretreatment variables were similar across all three practices. EVLA was performed to treat 67 incompetent SSVs in 63 patients (86% women; mean age and 95% confidence interval, 50 +/- 3 years; range, 20-82 years). Average energy delivered was 92 J/cm. Immediate technical success and occlusion of the treated vein at 1-2 weeks was 100%. Imaging follow-up length was 243 +/- 65 days (range, 3-893 days). Clinical follow-up (243 +/- 66 days) showed symptomatic improvement in 66 (99%) of 67 patients; one patient had recanalization with recurrent reflux by ultrasound (2%). Complications included one case of paresthesias lasting beyond 1 month of follow-up (2%) and three cases of superficial phlebitis (4%), but no deep vein thrombosis, skin burns, or other complications. Although ablation involved only the superficial portion of the SSV and spared its deep segment in the popliteal fossa, SSV occlusion typically extended up to the saphenopopliteal junction or to a gastrocnemial collateral, without popliteal vein involvement. EVLA of the SSV is safe and effective when the saphenopopliteal junction and popliteal fossa are avoided. This approach may help reduce the risk of paresthesias or other complications while maintaining low recanalization rates.
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Khilnani NM, Grassi CJ, Kundu S, D'Agostino HR, Khan AA, McGraw JK, Miller DL, Millward SF, Osnis RB, Postoak D, Saiter CK, Schwartzberg MS, Swan TL, Vedantham S, Wiechmann BN, Crocetti L, Cardella JF, Min RJ. Multi-society Consensus Quality Improvement Guidelines for the Treatment of Lower-extremity Superficial Venous Insufficiency with Endovenous Thermal Ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:14-31. [DOI: 10.1016/j.jvir.2009.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 10/20/2022] Open
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30
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Multi-disciplinary Quality Improvement Guidelines for the Treatment of Lower Extremity Superficial Venous Insufficiency with Ambulatory Phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:1-13. [DOI: 10.1016/j.jvir.2009.01.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Revised: 01/13/2009] [Accepted: 01/18/2009] [Indexed: 11/22/2022] Open
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31
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Shortell CK, Markovic JN. Incorporating outpatient venous procedures into a vascular surgery practice. J Vasc Surg 2009; 50:225-30. [PMID: 19563978 DOI: 10.1016/j.jvs.2009.01.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 01/26/2009] [Accepted: 01/28/2009] [Indexed: 11/30/2022]
Abstract
The use of endovenous procedures to treat superficial venous reflux disease in an exclusively outpatient setting has been growing in popularity during the last decade. Incorporating outpatient venous procedures into an existing vascular surgery practice is a logical step and provides optimal patient care by using the combined expertise and knowledge of devoted vascular surgeons and dedicated supporting staff. This affords the opportunity to treat patients comprehensively and to streamline the evaluation and treatment process for patients with virtually all stages of chronic venous insufficiency. Successful establishment of an outpatient vein care clinic involves making well-informed decisions about workspace, staffing, acquisition of equipment, optimization of reimbursement, and patient recruitment. Separation of the venous practice from the arterial practice both geographically and temporally is critical to success because the clinical and operational needs of these two groups of patients are very different and because the vein practice in many situations may become so robust that it erodes physicians' participation in the arterial side of the vascular practice. In addition to favorable clinical results and increased patient demand, procedures performed on an outpatient basis can be expected to significantly increase revenues. With proper strategy and organization, an outpatient vein practice can round out the existing vascular practice and be a profitable adjunct to an already established vascular surgery practice.
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Affiliation(s)
- Cynthia K Shortell
- Department of Surgery, Division of Vascular Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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32
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Recommended Reporting Standards for Endovenous Ablation for the Treatment of Venous Insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Interv Radiol 2009; 20:S417-24. [DOI: 10.1016/j.jvir.2009.04.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 05/14/2007] [Indexed: 11/17/2022] Open
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33
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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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34
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Doporučení pro duplexní ultrazvukové vyšetření končetinových žil. COR ET VASA 2009. [DOI: 10.33678/cor.2009.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brasic N, Lopresti D, McSwain H. Endovenous Laser Ablation and Sclerotherapy for Treatment of Varicose Veins. ACTA ACUST UNITED AC 2008; 27:264-75. [DOI: 10.1016/j.sder.2008.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Garrison KL. Sonographic Evaluation of Venous Insufficiency and Sonography-Guided Radiofrequency Ablation of the Great Saphenous Vein. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2007. [DOI: 10.1177/8756479307305378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous insufficiency (VI) is a pathology that is underappreciated and commonly missed sonographically. When performed correctly, a sonographic evaluation lends information that can provide a minimally invasive treatment option for the patient. The purpose of this case study is to provide an overview of the essential steps in the sonographic evaluation for VI, highlighting components specific to radiofrequency ablation of the great saphenous vein.
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Kundu S, Lurie F, Millward SF, Padberg F, Vedantham S, Elias S, Khilnani NM, Marston W, Cardella JF, Meissner MH, Dalsing MC, Clark TWI, Min RJ. Recommended Reporting Standards for Endovenous Ablation for the Treatment of Venous Insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Interv Radiol 2007; 18:1073-80. [PMID: 17804767 DOI: 10.1016/j.jvir.2007.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sanjoy Kundu
- The Vein Institute of Toronto, Toronto, Ontario, Canada
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Kundu S, Lurie F, Millward SF, Padberg F, Vedantham S, Elias S, Khilnani NM, Marston W, Cardella JF, Meissner MH, Dalsing MC, Clark TWI, Min RJ. Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Surg 2007; 46:582-9. [PMID: 17826252 DOI: 10.1016/j.jvs.2007.05.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 05/14/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Sanjoy Kundu
- The Vein Institute of Toronto, Toronto, Ontario, Canada
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Ganguli S, Tham JC, Janne d'Othée BM, d'Othee BMJ. Establishing an Outpatient Clinic for Minimally Invasive Vein Care. AJR Am J Roentgenol 2007; 188:1506-11. [PMID: 17515369 DOI: 10.2214/ajr.06.0836] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Minimally invasive vein care procedures are less invasive than surgery and have a lower complication rate, are well tolerated by patients, and have good cosmetic results. Because radiologists have expertise in imaging-guided procedures, offering minimally invasive vein care is a logical step. CONCLUSION Starting an effective outpatient vein care clinic involves decisions about space, equipment, and advertising. With proper staffing and rapport with patients and referring physicians, a varicose vein practice can be a profitable adjunct to any radiology practice.
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Affiliation(s)
- Suvranu Ganguli
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02214, USA.
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40
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Abstract
Successful varicose vein surgery depends on accurate preoperative assessment and individualized treatment for various combinations of venous insufficiency. Noninvasive duplex scanning is currently the gold standard in varicose vein evaluation. Flush ligation and division of the great saphenous vein and its tributaries, inverted downward stripping to below the knee combined with stab avulsion of varicosities, have yielded excellent results for patients with great saphenous vein reflux. Additionally, identifying and correcting incompetent calf perforating veins is necessary to achieve a satisfactory outcome. Neovascularization at the saphenofemoral junction and varicose vein recurrence and their treatment remain unsolved and require further investigation.
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Affiliation(s)
- Yung-Feng Lo
- Department of General Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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41
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Min RJ. Common Clinical Patterns and Duplex Evaluation of Venous Insufficiency. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70128-7] [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] Open
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Venous Duplex Ultrasound: Beyond the DVT. J Vasc Interv Radiol 2005. [DOI: 10.1016/s1051-0443(05)70227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Post-Thrombotic Syndrome After Orthopaedic Surgery. Tech Orthop 2004. [DOI: 10.1097/01.bto.0000146861.58320.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Office Based Workup. J Vasc Interv Radiol 2004. [DOI: 10.1016/s1051-0443(04)70089-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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