1
|
Özhan A, Günaydın F. Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds. J Vasc Surg Venous Lymphat Disord 2024; 12:101849. [PMID: 38350496 DOI: 10.1016/j.jvsv.2024.101849] [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: 07/17/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.
Collapse
Affiliation(s)
- Abdulkerim Özhan
- Department of Cardiovascular Surgery, Göztepe Prof Dr Süleyman Yalçın State Hospital, İstanbul, Turkey
| | - Fatih Günaydın
- Department of Orthopaedic Surgery, Mersin Training and Research State Hospital, Mersin, Turkey.
| |
Collapse
|
2
|
Almutiri BM, Alshammari AM, Alharbi SB, Alamri LM, Alsuhaibani AN, Alenazi RS, Alfarhan GK. Evaluating the Prevalence and Risk Factors of Varicose Veins in Surgeons and Operating Room Staff at Buraidah Center Hospital. Cureus 2024; 16:e51706. [PMID: 38187031 PMCID: PMC10768938 DOI: 10.7759/cureus.51706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
Background Varicose veins (VVs), which are characterized by visible, convoluted veins in the lower limbs, are a prevalent disorder that afflicts a substantial portion of the population. The purpose of this cross-sectional study was to look at the prevalence and risk factors for VVs among surgeons and operating room personnel at Buraidah Central Hospital in Saudi Arabia. They usually become worse over time once they develop, which highlights the importance of early intervention and preventive actions. Methodology Data from 91 participants were collected from diverse healthcare professionals between August 2023 and September 2023 via an online questionnaire covering demographics, health, and occupational factors. The chi-square and Fisher's exact tests were employed to examine the correlation between these variables and the occurrence of VVs. Results The data analysis revealed that several specific factors displayed notable associations. Occupations as Surgical Physicians, OR Staff, or Nurse (p=0.009), the number of days worked in the operating room (p=0.040), the role in the operating room, especially those mainly standing (p=0.001), contraceptive pill usage (p=0.000), and vaginal delivery (p=0.037) displayed statistically significant relationships with VVs. In contrast, factors like gender, age group, ethnicity, family history of VVs, social status, smoking habits, exercise frequency, BMI, lifting heavy objects, and years in the field did not reveal substantial associations with VVs, as indicated by p-values exceeding 0.05. Conclusion The study identified a low VV diagnosis prevalence, with an equal distribution among male and female respondents. Key factors that contribute to the risk of developing VVs include the number of days worked in the operating room, the role in the operating room, a family history of VVs, contraceptive pill usage, and the method of delivery.
Collapse
Affiliation(s)
| | - Ahmed M Alshammari
- General Surgery, Saudi Commission for Health Specialties, Buraidah Central Hospital, Buraidah, SAU
| | | | | | | | | | | |
Collapse
|
3
|
Xiang Y, Zhou Q, Wu Z, Gou J. Chronic Venous Insufficiency in A Selected Nurse Population: A Cross-Sectional Study. Angiology 2024; 75:29-35. [PMID: 36172846 DOI: 10.1177/00033197221130571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic venous insufficiency (CVI) causes severe symptoms and complications in the general population, but the prevalence, related risk factors, and treatment of CVI are unknown among nurses. The demographics and occupational factors of nurses from a university hospital were collected by questionnaires, and the presentation of CVI was confirmed by the specialist vascular surgeons. A total of 1606 participants were enrolled, and the prevalence of CVI was 7.5%. After multivariate adjustment, CVI was positively related to deep venous thrombosis history (OR 6.44, 95% CI 2.73-15.22), increased standing time (OR 2.21, 95% CI 1.20-4.10), and increased time in night shift rotation (OR 2.01, 95% CI 1.29-3.14). CVI was negatively related to oral contraceptives (OR .43, 95% CI .21-.87). Of the participants, 72.5% with CVI received compression therapy. For them, wearing compression stockings with a pressure of >20 mmHg or for >4 h/day significantly increased the rate of symptom relief, while the length of compression stockings made no difference. Thus, it was beneficial for nurses to spend less time standing and shorten their time in night shift rotation. Wearing compression stockings with sufficient pressure and for enough time was recommended for CVI symptom relief.
Collapse
Affiliation(s)
- Yuwei Xiang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Zhou
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhoupeng Wu
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juxiang Gou
- Department of Thyroid & Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Babaei M, Afrooghe A, Rafati A, Mohebbi B, Moosavi J, Ghadri N, Koohestani BM, Rahimi S, Baay M, Alemzadeh-Ansari MJ, Hosseini Z, Boudagh S, Khalilipur E, Ghaemmaghami Z, Pasebani Y, Firoozbakhsh P, Pouraliakbar H, Bakhshandeh H, Sadeghipour P. Prevalence and associated factors of chronic venous disease among the modern Iranian urban population. J Vasc Surg Venous Lymphat Disord 2023; 11:1098-1106.e10. [PMID: 37690625 DOI: 10.1016/j.jvsv.2023.06.005] [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: 01/12/2023] [Revised: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Chronic venous disease (CVD) of the lower extremities is one of the common venous diseases in different populations, with a wide range of clinical manifestations and undetermined exact prevalence owing to different population characteristics and measurement methods. This study aimed to estimate the prevalence of CVD among the modern Iranian urban population and determine its associated risk factors. METHODS The Heart Assessment and Monitoring in Rajaie Hospital study, a longitudinal population-based cohort, aims to investigate the baseline prevalence and the 10-year incidence of cardiovascular diseases and associated risk factors in the adult population aged 30 to 75 years with no overt cardiovascular diseases in Tehran. Two instructed interventional cardiologists performed CVD evaluation using the Clinical-Etiology-Anatomy-Pathophysiology classification. CVD was graded as C1 to C6, and chronic venous insufficiency (CVI) as C3 to C6. A multivariable regression model was used to analyze the association between CVD and prespecified covariates of age, sex, body mass index (≥30 kg/m2), smoking, hypertension, diabetes mellitus, physical activity, dyslipidemia, and delivery method. RESULTS CVD prevalence among 1176 participants was 36.5% (95% confidence interval [CI], 33.8-39.3) and was higher in women than men (44.2% vs 23.5%). CVI prevalence was only 0.7% (95% CI, 0.3-1.3). Multivariable analysis showed that advanced age (odds ratio [OR], 1.06; 95% CI, 1.04-1.08), female sex (OR, 2.98; 95% CI, 2.14-4.14), and body mass index of ≥30 (OR, 1.36; 95% CI, 1.03-1.81) were independently associated with CVD. Physical activity (OR, 0.77; 95% CI, 0.58-1.02) was nearly protective, whereas other factors, including traditional cardiovascular risk factors, had no meaningful association with CVD. CONCLUSIONS Our findings showed that CVD was prevalent in the modern Iranian urban population. However, considering the very low prevalence of the higher stages of the disease, the benefit of mass screening is debatable, and better risk discriminators should be investigated.
Collapse
Affiliation(s)
- Mohammadreza Babaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Afrooghe
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rafati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Ghadri
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Mohajer Koohestani
- Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Rahimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Baay
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Boudagh
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ehsan Khalilipur
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghaemmaghami
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Pasebani
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Firoozbakhsh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Stanek A, Mosti G, Nematillaevich TS, Valesky EM, Planinšek Ručigaj T, Boucelma M, Marakomichelakis G, Liew A, Fazeli B, Catalano M, Patel M. No More Venous Ulcers-What More Can We Do? J Clin Med 2023; 12:6153. [PMID: 37834797 PMCID: PMC10573394 DOI: 10.3390/jcm12196153] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most severe complication caused by the progression of chronic venous insufficiency. They account for approximately 70-90% of all chronic leg ulcers (CLUs). A total of 1% of the Western population will suffer at some time in their lives from a VLU. Furthermore, most CLUs are VLUs, defined as chronic leg wounds that show no tendency to heal after three months of appropriate treatment or are still not fully healed at 12 months. The essential feature of VLUs is their recurrence. VLUs also significantly impact quality of life and could cause social isolation and depression. They also have a significant avoidable economic burden. It is estimated that the treatment of venous ulceration accounts for around 3% of the total expenditure on healthcare. A VLU-free world is a highly desirable aim but could be challenging to achieve with the current knowledge of the pathophysiology and diagnostic and therapeutical protocols. To decrease the incidence of VLUs, the long-term goal must be to identify high-risk patients at an early stage of chronic venous disease and initiate appropriate preventive measures. This review discusses the epidemiology, socioeconomic burden, pathophysiology, diagnosis, modes of conservative and invasive treatment, and prevention of VLUs.
Collapse
Affiliation(s)
- Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
| | - Giovanni Mosti
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Angiology Department, MD Barbantini Clinic, Via del Calcio 2, 55100 Lucca, Italy
| | - Temirov Surat Nematillaevich
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Specialized Surgery, Central Hospital of Ministry of Internal Affairs, Chimboy St. 2 A, Almazar District, Tashkent 100095, Uzbekistan
| | - Eva Maria Valesky
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Tanja Planinšek Ručigaj
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Dermatovenereological Clinic, University Medical Centre Ljubljana, Gradiskova 10 Street, 1000 Ljubljana, Slovenia
| | - Malika Boucelma
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Internal Medicine, University of Algiers, Bachir Mentouri Hospital, Algiers 16208, Algeria
| | - George Marakomichelakis
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- 4th Department of Internal Medicine, General Hospital of Evangelismos, 16676 Athens, Greece
| | - Aaron Liew
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Medicine, Portiuncula University Hospital, University of Galway, H91 TK33 Galway, Ireland
| | - Bahar Fazeli
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Mariella Catalano
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Biomedical, Clinical Sciences L Sacco Hospital, Inter-University Research Center on Vascular Disease, University of Milan, 20157 Milan, Italy
| | - Malay Patel
- Vascular Independent Research and Education, European Foundation, 20157 Milan, Italy; (G.M.); (A.L.); (B.F.); (M.C.); (M.P.)
- VAS-International Consortium—International No More Venous Ulcers Strategic Network, 20157 Milan, Italy; (G.M.); (T.S.N.); (E.M.V.); (T.P.R.); (M.B.)
- Department of Vascular Surgery, Apollo CVHF, Heart Institute, Ahmedabad 380059, India
| |
Collapse
|
6
|
Kiguchi MM, Fallentine J, Oh JH, Cutler B, Yan Y, Patel HR, Shao MY, Agrawal N, Carmona E, Hager ES, Ali A, Kochubey M, O'Banion LA. Race, sex, and socioeconomic disparities affect the clinical stage of patients presenting for treatment of superficial venous disease. J Vasc Surg Venous Lymphat Disord 2023; 11:897-903. [PMID: 37343787 DOI: 10.1016/j.jvsv.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Superficial venous disease has a U.S. prevalence of nearly 30%, with advanced disease contributing to a significant healthcare burden. Although the risk factors for venous disease are well known, the correlation between race, sex, socioeconomic status, and disease severity on presentation is not well established. The area deprivation index (ADI) is a validated metric with respect to regional geography, social determinants of health, and degree of socioeconomic disadvantage. In the present study, we aimed to identify the disparities and the effect that the ADI, in addition to race and sex, has among patients associated with an advanced venous disease presentation. METHODS A retrospective review between 2012 and 2022 was performed at four tertiary U.S. institutions to identify patients who underwent endovenous closure of their saphenous veins. Patient demographics, state ADI, comorbidities, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, and periprocedural outcomes were included. Pearson's correlation was performed between the CEAP classification and ADI. Poisson regression analysis was performed to identify factors predicting for an increasing CEAP classification at presentation. Variables with P < .05 were deemed significant. RESULTS A total of 2346 patients underwent endovenous saphenous vein closure during the study period, of whom 7 were excluded because of a lack of follow-up data. The mean age was 60.4 ± 14.9 years, 65.9% were women, and 55.4% were White. Of the 2339 patients, 73.3% presented with an advanced CEAP class (≥3). The mean state ADI for the entire cohort was 4.9 ± 3.1. The percent change in the CEAP classification is an increase of 2% and 1% for every level increase in the state ADI for unadjusted (incidence rate ratio [IRR] = 1.02; P < .001) and adjusted (IRR = 1.01; P < .001) models, respectively. Black race has a 12% increased risk of a higher CEAP class on presentation compared with White race (IRR = 1.12; P = .005). Female sex had a 16% lower risk of a higher CEAP presentation compared with male sex (IRR = 0.84; P < .01). CONCLUSIONS Low socioeconomic status, Black race, and male sex are predictive of an advanced CEAP classification on initial presentation. These findings highlight the opportunity for improved mechanisms for identification of venous disease and at-risk patients before advanced disease progression in known disadvantaged patient populations.
Collapse
Affiliation(s)
- Misaki M Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC.
| | | | - Jae Hak Oh
- Georgetown University School of Medicine, Washington, DC
| | - Bianca Cutler
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC
| | - Yueqi Yan
- Biostatistics and Data Support Center, University of California, Merced, Merced, CA
| | - Harik R Patel
- St. George's University of London, London, United Kingdom
| | - Michael Y Shao
- Division of Vascular Surgery, NorthShore University Health System, Chicago, IL
| | - Nishant Agrawal
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Emely Carmona
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric S Hager
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amna Ali
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
| | - Mariya Kochubey
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
| | - Leigh Ann O'Banion
- Division of Vascular Surgery, University of California, San Francisco, Fresno, CA
| |
Collapse
|
7
|
Merli GJ, Yenser H, Orapallo D. Approach to the Patient with Non-cardiac Leg Swelling. Med Clin North Am 2023; 107:945-961. [PMID: 37541718 DOI: 10.1016/j.mcna.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
One of the most common reasons for patient visits in the outpatient practice is lower extremity swelling. Non-cardiac etiologies are the most frequent reason for these encounters. The approach to this patient population will focus on the 7 key questions to initiate the gathering of historical information on the etiology of leg swelling. Figures and tables will complement the text for diagnosing lower extremity swelling. In this article, the common non-cardiac etiologies will be reviewed which include medications, chronic venous insufficiency, lymphatic disease, lipedema, venous thrombosis, and musculoskeletal etiologies.
Collapse
Affiliation(s)
- Geno J Merli
- Division Vascular Medicine, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA.
| | - Heather Yenser
- Division of Vascular Medicine, Department of Surgery, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Dina Orapallo
- Division of Vascular Medicine, Department of Surgery, Jefferson Vascular Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Suite 6210, Gibbon Building, 111 South 11th Street, Philadelphia, PA 19107, USA
| |
Collapse
|
8
|
Mayrovitz HN, Aoki KC, Colon J. Chronic Venous Insufficiency With Emphasis on the Geriatric Population. Cureus 2023; 15:e40687. [PMID: 37485203 PMCID: PMC10358300 DOI: 10.7759/cureus.40687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023] Open
Abstract
The underpinning of Chronic Venous Insufficiency (CVI) is valvular dysfunction, which manifests on a spectrum depending on the severity of insufficiency and duration of the disease. The mainstay of treatment relies on compression therapy of a proper type and intensity. In older adults, special consideration must be taken during the patient encounter to account for age-related factors. This review discusses the clinical presentation, diagnosis, and mimicking of CVI, focusing mainly on older adults. The epidemiology, risk factors, disease burden, and grave complications -- such as thrombosis and ulceration, are reviewed. The physiological impacts of CVI are described, providing the background for treatment strategies, including non-invasive, medical, and surgical therapies. The findings show advanced age to be an important risk factor contributing to CVI and that other age-related factors add to the risk of severe complications. Clinical assessments combined with objective measurements that assess localized skin water using tissue dielectric constant values or whole limb assessments may aid in the differential diagnosis. Furthermore, understanding the mechanism of action of compression therapy, the mainstay of CVI treatment, and its physiological impacts, allows for its informed use in geriatric patients with increased risks of potential compression-related side effects.
Collapse
Affiliation(s)
- Harvey N Mayrovitz
- Medical Education and Simulation, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | - Kawaiola C Aoki
- Medicine, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Jessica Colon
- Medicine, Nova Southeastern University's Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| |
Collapse
|
9
|
Menegatti E, Mandini S, Pagani A, Mandini B, Zerbini V, Piva T, Raisi A, Fabbri M, Fogli M, Mazzoni G, Zamboni P, Gianesini S. The Effect of Active Stretching Training in Patients with Chronic Venous Insufficiency Monitored by Raster-Stereography. SENSORS (BASEL, SWITZERLAND) 2022; 22:8509. [PMID: 36366206 PMCID: PMC9657419 DOI: 10.3390/s22218509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Musculoskeletal disorders can be associated with advanced clinical stages of chronic venous insufficiency (CVI). The aim of the study is to investigate the effect of active stretching (AS) training on lower limb venous function and quality of life in patients affected by CVI. (2) Methods: A prospective two-armed pilot randomized controlled was conducted. Twenty (20) CVI patients were randomly assigned to an AS training or to a control group (C) who did not receive any exercise indication. At baseline and after three months all the participants were tested for leg volumetry (LV), air plethysmography (APG), and quality of life (QoL) measured by a disease specific validated questionnaire (VVSymQ), ankle range of motion (ROM), and postural deformities using an optoelectronic body posture machine. (3) Results: At the end of the training in the AS group a significant leg volume reduction was detected (from 2340 ± 239 mL to 2239 ± 237 mL (4.3%); p < 0.0001), whereas in the C group no significant volume changes were found. The ejection fraction rate (EF%) increased significantly from 49.3 ± 9.3 to 61.1 ± 14.5, p < 0.005. A moderate-strong linear correlation with EF% and ankle ROM variation was found (R2 = 0.6790; p < 0.0034). Several postural outcomes such as pelvic tilt, pelvic torsion, and lordotic angle significantly improved in the AS group (p < 0.01, p < 0.04, p < 0.01 respectively). (4) Conclusion: The AS training impacts on the APG parameters related to the musculoskeletal pump efficiency, opening a further possibility in the management of CVI patients by means of an appropriate adapted physical exercise program.
Collapse
Affiliation(s)
- Erica Menegatti
- Department of Environmental and Prevention Sciences, University of Ferrara, 44123 Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Anselmo Pagani
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Beatrice Mandini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Valentina Zerbini
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Tommaso Piva
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marinella Fabbri
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Marco Fogli
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, 44123 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
10
|
Tuladhar AS, Pradhan S, Shrestha A, Shah S, Shrestha R. Increased Great Saphenous Vein Diameter at the Level of Knee among Patients with Varicose Veins in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:718-722. [PMID: 36705219 PMCID: PMC9446489 DOI: 10.31729/jnma.7543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023] Open
Abstract
Introduction Colour Doppler ultrasonography plays an important role in determining the morphological and hemodynamic information of the venous system. This study aimed to find out the prevalence of increased great saphenous vein diameter at the level of the knee among patients with varicose veins in a tertiary care centre. Methods A descriptive cross-sectional study was carried out in the Department of Radiology at a tertiary care centre from 30 October 2021 to 31 March 2022 after taking ethical approval from the Institutional Review Committee (Reference number: 028-077/078). A convenience sampling technique was used for the study. The study group consisted of patients over 18 years, coming for ultrasonography examination of the lower limb with the clinical symptoms and signs of varicose veins. The great saphenous vein diameter was measured at the level of the medial femoral condyle of the knee using the software in the ultrasonography unit. B mode, colour Doppler and spectral analysis were done. A cut-off value of 5 mm for the diameter of the great saphenous vein was taken to indicate the presence or absence of varicosity and saphenofemoral reflux. Point estimate and 90% Confidence Interval were calculated. Results Among 72 patients with varicose veins, the diameter of the great saphenous vein was increased in 59 (81.94%) (74.50-89.38, 90% Confidence Interval) patients. Conclusions The mean diameter of the great saphenous vein in our study was similar when compared to other studies conducted in similar settings. Keywords saphenous vein; ultrasonography; varicose veins.
Collapse
Affiliation(s)
- Abhushan Siddhi Tuladhar
- Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal,Correspondence: Dr Abhushan Siddhi Tuladhar, Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal. , Phone: +977-9841203441
| | - Sunil Pradhan
- Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Amit Shrestha
- Department of Radiology, Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Simant Shah
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| | - Rahul Shrestha
- Nepal Medical College and Teaching Hospital, Jorpati, Kathmandu, Nepal
| |
Collapse
|
11
|
Ali SA, Najmi WK, Hakami FM, Almubarak AA, Alhassan RA, Maafa SH, Al-Amer MA, Dighriri IM. Prevalence of Varicose Veins Among Nurses in Different Departments in Jazan Public Hospitals, Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e24462. [PMID: 35637826 PMCID: PMC9131706 DOI: 10.7759/cureus.24462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Varicose veins (VV) in the lower limbs are the most prevalent vascular condition in humans. They can cause significant signs and symptoms and, in extreme cases, death. This study aims to investigate the prevalence and identify the risk factors for varicose veins among nurses working in multiple departments at Jazan King Fahd Central Hospital and Prince Muhammad bin Nasser Hospital. A cross-sectional study was conducted by sending a questionnaire to female and male nurses in these hospitals. This study included 482 nurses, 415 (86.1%) of whom were female and 67 (13.9%) male. The prevalence of varicose veins among the nurses of both hospitals was 76 (15.8%), compared with 406 (84.2%) not diagnosed with varicose veins. The prevalence of varicose veins was 67 (88.2%) in female nurses, compared with 9 (11.8%) in male nurses. The risk factors associated with varicose veins were ethnicity (p = 0.007), carrying heavy items (p = 0.001), lack of exercise (p = 0.031), family history (p = 0.001), use of hormonal therapy (p = 0.001), use of contraceptive pills (p = 0.0035), type of delivery (p = 0.002), number of children (p = 0.004), and hours sitting per shift (p = 0.002). The comorbidities associated with varicose veins were deep vein thrombosis (p = 0.001), hypertension (p = 0.002), chronic constipation (p = 0.006), diabetes (p = 0.001), kidney disease (p = 0.001), rheumatoid arthritis (p = 0.001), coronary artery disease, and severe occupational injury to the lower extremities (p = 0.001). Nurses are responsible for most of the health system's services. Increasing the number of nursing workers for patient care, encouraging physical exercise, and lowering the pension age appear to be required to avoid the occurrence and development of varicose veins among nurses.
Collapse
Affiliation(s)
- Suhaila A Ali
- Family and Community Medicine Department, Jazan University, Jazan, SAU
| | - Waad K Najmi
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Shahad H Maafa
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | | | | |
Collapse
|
12
|
Menegatti E, Mandini S, Chi YW, Mazzoni G, Pagani A, Malagoni AM, Tessari M, Costa AL, Avruscio G, Zamboni P, Gianesini S. Physical fitness changes induced by thermal aquatic standardized exercise in chronic venous disease patients. Phlebology 2021; 37:134-142. [PMID: 34633888 DOI: 10.1177/02683555211051962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of physical activity represents a risk factor for both cardiovascular and chronic venous diseases (CVD), nevertheless a specific exercise protocol for CVD patient is still missing. This investigation was aimed to assess the impact of a standardized exercise protocol in a thermal water environment on physical fitness and quality-of-life (QoL) in CVD patients. METHODS Sixteen (16) CVD patients performed 5 standardized exercise sessions in a thermal water pool. Before starting the exercise protocol, the cohort filled International Physical Activity Questionnaire (IPAQ) to determine their physical activity level. At baseline and at the end of the exercise program, leg volume, QoL, musculoskeletal and cardiovascular physical fitness were assessed by means of water plethysmography, validated questionnaire and functional test, blood pressure and heart rate at rest were also reported. RESULTS All the patients were categorized as physically inactive: average activity time 235.6 (155.2) MET-minutes per week. At the end of the study, a significant leg volume reduction was found (-16%; p < .002). Significant improvement in lower limb strength (p < .0001), endurance (p < .006), rapidity and balance (p < .05) together with decrease in resting heart rate (-1.8%, p < .0001) and systolic blood pressure (-1.1%, p < .04) were reported, significant improvement in bodily pain (p < .0005) and social function (p < .002) QoL items were observed. CONCLUSIONS The proposed exercise protocol in thermal aquatic environment demonstrated to be an effective treatment modality improving both cardiovascular and musculoskeletal outcomes and QoL in sedentary CVD patients. Aquatic environment investigations require proper analysis of the various factors involved, in a standardized and reproducible way. The herein report can be a reference for further studies on different health related conditions.
Collapse
Affiliation(s)
- Erica Menegatti
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Yung-Wei Chi
- Division of Cardiovascular Medicine, Vascular Center, University of California Davis, Davis, CA, USA
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Anselmo Pagani
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Anna Maria Malagoni
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Mirko Tessari
- Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Alfio Luca Costa
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Giampiero Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Paolo Zamboni
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy
| | - Sergio Gianesini
- Vascular Diseases Center, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Mini-invasive Venous Surgery Unit, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Ferrara, Italy.,Department of Surgery, 1685Uniformed Services University of the Health Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
13
|
Ortega MA, Fraile-Martínez O, García-Montero C, Álvarez-Mon MA, Chaowen C, Ruiz-Grande F, Pekarek L, Monserrat J, Asúnsolo A, García-Honduvilla N, Álvarez-Mon M, Bujan J. Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management. J Clin Med 2021; 10:3239. [PMID: 34362022 PMCID: PMC8348673 DOI: 10.3390/jcm10153239] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 01/19/2023] Open
Abstract
Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.
Collapse
Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Miguel A. Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Chen Chaowen
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
| | - Fernando Ruiz-Grande
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Vascular Surgery, Príncipe de Asturias Hospital, 28801 Alcalá de Henares, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Angel Asúnsolo
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain;
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY 10027, USA
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
- Immune System Diseases—Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain
| | - Julia Bujan
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, 28801 Alcalá de Henares, Spain; (M.A.O.); (O.F.-M.); (C.G.-M.); (C.C.); (L.P.); (J.M.); (N.G.-H.); (M.Á.-M.); (J.B.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain;
| |
Collapse
|
14
|
Raffetto JD, Khalil RA. Mechanisms of Lower Extremity Vein Dysfunction in Chronic Venous Disease and Implications in Management of Varicose Veins. VESSEL PLUS 2021; 5. [PMID: 34250453 DOI: 10.20517/2574-1209.2021.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Chronic venous disease (CVD) is a common venous disorder of the lower extremities. CVD can be manifested as varicose veins (VVs), with dilated and tortuous veins, dysfunctional valves and venous reflux. If not adequately treated, VVs could progress to chronic venous insufficiency (CVI) and lead to venous leg ulcer (VLU). Predisposing familial and genetic factors have been implicated in CVD. Additional environmental, behavioral and dietary factors including sedentary lifestyle and obesity may also contribute to CVD. Alterations in the mRNA expression, protein levels and proteolytic activity of matrix metalloproteinases (MMPs) have been detected in VVs and VLU. MMP expression/activity can be modulated by venous hydrostatic pressure, hypoxia, tissue metabolites, and inflammation. MMPs in turn increase proteolysis of different protein substrates in the extracellular matrix particularly collagen and elastin, leading to weakening of the vein wall. MMPs could also promote venous dilation by increasing the release of endothelium-derived vasodilators and activating potassium channels, leading to smooth muscle hyperpolarization and relaxation. Depending on VVs severity, management usually includes compression stockings, sclerotherapy and surgical removal. Venotonics have also been promoted to decrease the progression of VVs. Sulodexide has also shown benefits in VLU and CVI, and recent data suggest that it could improve venous smooth muscle contraction. Other lines of treatment including induction of endogenous tissue inhibitors of metalloproteinases (TIMPs) and administration of exogenous synthetic inhibitors of MMPs are being explored, and could provide alternative strategies in the treatment of CVD.
Collapse
Affiliation(s)
- Joseph D Raffetto
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
Kim Y, Png CYM, Sumpio BJ, DeCarlo CS, Dua A. Defining the human and health care costs of chronic venous insufficiency. Semin Vasc Surg 2021; 34:59-64. [PMID: 33757637 DOI: 10.1053/j.semvascsurg.2021.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic venous insufficiency (CVI) affects more than 25 million adults in the United States alone, and more 6 million with advanced stages of venous disease. The high incidence of CVI and the increasing costs of care, place a heavy financial burden on the US health care system. Recent studies estimate the total cost of care at more than $3 billion per year. These staggering numbers highlight the importance of timely diagnosis, treatment, and prevention of CVI. In this article, we review the epidemiology and prevalence of CVI, and its financial impact on national health care budget. Racial disparities in CVI and the impact of socioeconomic status on access to care are also discussed. Finally, we discuss CVI-related screening programs and the importance of preventative measures in venous disease.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Charles S DeCarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114.
| |
Collapse
|
16
|
Shah P, Patel J, Gandhi F. A study of chronic venous insufficiency in relation with body mass index and diameter of saphenofemoral junction and great saphenous vein. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_50_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
DOĞDUŞ M, KOÇ A. Kronik venöz yetmezlik patofizyolojisinde yüksek serum Endokan seviyeleri yer alır. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.834331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
18
|
Abou-ElWafa HS, El-Metwaly AAM, El-Gilany AH. Lower Limb Varicose Veins among Nurses: A Single Center Cross-Sectional Study in Mansoura, Egypt. Indian J Occup Environ Med 2020; 24:172-177. [PMID: 33746431 PMCID: PMC7962502 DOI: 10.4103/ijoem.ijoem_264_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 11/24/2019] [Accepted: 04/29/2020] [Indexed: 11/04/2022] Open
Abstract
Background Lower limb varicose veins are common among nurses due to occupational and nonoccupational risk factors. Aims To estimate the prevalence of lower limbs varicosity and its associated risk factors. Settings and Design A cross-sectional descriptive study was carried out among 201 nurses at Mansoura University Hospital from January 1st to May 31st, 2018. Methods A questionnaire was used to collect sociodemographic data, risk factors for varicose veins, and occupational details. Varicose veins were diagnosed by Doppler ultrasound. Statistical Analysis Univariate and logistic regression analyses were done. Results The prevalence of varicose veins was 18.4%. Significant independent predictors are being ≥25 years old, working in emergency rooms and ICU/operative rooms, and using oral contraceptives with adjusted odds ratios [95% Confidence Interval (CI)] of [8.7 (2.6-28.4)], [10.8 (2.6-45.9)], [16.2 (3.9-67.4)], and [4.2 (1.3-13.2)], respectively. Conclusions Independent predictors, other than age, are modifiable and those with highest AOR are occupationally related.
Collapse
Affiliation(s)
- Hala S Abou-ElWafa
- Occupational Health and Industrial Medicine, Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Aml A M El-Metwaly
- Medical Surgical Nursing, Department of Medical Surgical Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Abdel-Hady El-Gilany
- Public Health and Preventive Medicine, Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
19
|
Urbanek T, Juśko M, Kuczmik WB. Compression therapy for leg oedema in patients with heart failure. ESC Heart Fail 2020; 7:2012-2020. [PMID: 32710511 PMCID: PMC7524111 DOI: 10.1002/ehf2.12848] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 06/02/2020] [Indexed: 01/24/2023] Open
Abstract
The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF‐related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non‐randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF‐related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.
Collapse
Affiliation(s)
- Tomasz Urbanek
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Maciej Juśko
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Wacław B Kuczmik
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
20
|
Azhdari M, Zilaee M, Karandish M, Hosseini SA, Mansoori A, Zendehdel M, Khodarahpour S. Red vine leaf extract (AS 195) can improve some signs and symptoms of chronic venous insufficiency, a systematic review. Phytother Res 2020; 34:2577-2585. [PMID: 32314844 DOI: 10.1002/ptr.6705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Abstract
AIM Chronic venous insufficiency (CVI) is common in adults. Some complications include skin changes, edema, heavy legs, muscle cramps, pain, and varicose veins. In traditional medicine, red vine leaf extract (AS 195) has been used to cure the symptoms of CVI. This systematic review was aimed to assess the effects of AS 195 in patients with CVI. MATERIAL AND METHODS A systematic literature search was performed to identify trials that reported the impact of red vine leaf extract on CVI. The primary outcomes investigated were Leg (limb) volume, calf circumference, ankle circumference, tired and heavy legs, a sensation of tension, tingling sensation, and pain. RESULTS From the 56 studies, 5 trials were selected according to our inclusion criteria. Red vine leaf extract significantly improved numbers of outcomes (lower leg volume, calf and ankle circumference, tired, heavy legs, tingling sensation, pain, the sensation of tension in the legs, cutaneous microcirculation, and transcutaneous oxygen pressure) in only some trials. The tolerability for red vine leaf extract was reported good or satisfactory. CONCLUSIONS Red vine leaf extract had a beneficial therapeutic role in patients with CVI. Further high-quality trials are required to be carried out to provide strong evidence.
Collapse
Affiliation(s)
- Maryam Azhdari
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Nutrition Department, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzie Zilaee
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Nutrition Department, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Ahmad Hosseini
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Nutrition Department, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Anahita Mansoori
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohadeseh Zendehdel
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Khodarahpour
- Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
21
|
AlGhofili HH, Aljasser AA, Alyahya IA, Almohsen HA, Alwabel SA, Alhumaid AA, Iqbal K, Altuwaijri TA, Altoijry A. Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience. Semin Vasc Surg 2020; 32:89-93. [DOI: 10.1053/j.semvascsurg.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
22
|
Kawanabe T, Tanigawa M, Kakizaki S, Kamarudin ND, Mi X, Hanawa T, Odaguchi H. Correlation between tongue body colour, as quantified by machine learning, and clinical indices. ADVANCES IN INTEGRATIVE MEDICINE 2020. [DOI: 10.1016/j.aimed.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
23
|
Alwahbi A, Alamri A, Alotaibi W. Risk Factors of Saphenous Vein Insufficiency in Female Patients in Riyadh, Saudi Arabia. Cureus 2020; 12:e6643. [PMID: 31966948 PMCID: PMC6961556 DOI: 10.7759/cureus.6643] [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: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Venous reflux most frequently occurs in the great saphenous vein (GSV), which is the most commonly diseased vein and is associated with venous insufficiency and varicose veins. OBJECTIVE We aimed, in this study, to determine risk factors for saphenous vein insufficiency in female patients in Riyadh, Saudi Arabia. METHODS This was a retrospective cohort study. Data were collected from the medical records of adult female patients who developed saphenous vein insufficiency at King Abdulaziz Medical City, between 2015 and 2017. RESULTS A total of 97 subjects participated in the study, 53 patients had saphenous vein reflux while 44 patients did not have reflux. Leg swelling was the only symptom that showed a significant difference between the two groups (p<0.001); patients with reflux had significantly higher rates of endovenous laser therapy (p=0.021). While the same patient group showed significantly lower rates of sclerotherapy compared to patients without reflux (p=0.006). The proportion of hypertension patients without reflux (22.7%) was significantly larger than that of hypertension patients with reflux (1.9%) (p= 0.001). CONCLUSION More research is encouraged to provide better understanding and management of saphenous vein insufficiency in the Saudi population, especially in females who are at high risk.
Collapse
Affiliation(s)
- Abdullah Alwahbi
- Vascular Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Amal Alamri
- Vascular Surgery, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Wafa Alotaibi
- Vascular Surgery, King Saud Bin Abdulaziz University for Health Sciences (ksau-Hs), Riyadh, Saudi Arabia, Riyadh, SAU
| |
Collapse
|
24
|
Biranvand AS, Khosravi M, Esfandiari G, Poursaleh A, Hosseini-Fard SR, Amirfarhangi A, Najafi M. Associations between miR-661, miR-1202, lncRNA-HOTAIR, lncRNA-GAS5 and MMP9 in differentiated M2-macrophages of patients with varicose veins. INT ANGIOL 2019; 37:451-456. [PMID: 30558403 DOI: 10.23736/s0392-9590.18.04022-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The venous hypertension is suggested as the main cause of varicose disease. Some mediators and growth factors are known as the responsible of cellular events for the progression of venous perturbations. The aim of this study was to investigate non-coding (nc) RNA and MMP9 expression levels in macrophages differentiated from monocytes of patients with varicose veins. METHODS The monocytes were isolated from the whole blood samples by RosetteSep kit and were differentiated to macrophages M2 using M-CSF factor. The based on ncRNA-gene network, lncRNA-GAS5, lncRNA-HOTAIR, miRNA-661, miRNA-1202, and MMP9 were selected. The gene expression levels were measured by RT-qPCR technique. RESULTS Data showed that the MMP9 gene expression increased (P=0.003) while the GAS5, miRNA-661, and miRNA-1202 expression levels reduced significantly in the differentiated macrophages of patients (P=0.035, P=0.009, and P=0.015, respectively). Furthermore, the MMP9 gene expression levels were conversely related to the GAS5, HOTAIR, miRNA-661 and miRNA-1202 expression levels. CONCLUSIONS The results suggested that the lncRNA-GAS5, miRNA-661, miRNA-1202 and MMP9 are involved in varicose disease.
Collapse
Affiliation(s)
- Azin S Biranvand
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khosravi
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Golnaz Esfandiari
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Adeleh Poursaleh
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | - Sayed R Hosseini-Fard
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Najafi
- Cellular and Molecular Research Center, Biochemistry Department, Iran University of Medical Sciences, Tehran, Iran - .,Firoozabadi Hospital, Tehran, Iran
| |
Collapse
|
25
|
Molnar C, Opincariu D, Benedek T, Toma M, Nicolescu C. Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency. ACTA ACUST UNITED AC 2019; 52:e8330. [PMID: 30970086 PMCID: PMC6459463 DOI: 10.1590/1414-431x20198330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
Abstract
We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.
Collapse
Affiliation(s)
- C Molnar
- 1st Surgery Clinic, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.,TopMed Medical Center, Tîrgu Mureş, Romania
| | - D Opincariu
- Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania
| | - T Benedek
- Clinic of Cardiology, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania.,Center of Advanced Research in Multimodality Cardiovascular Imaging, CardioMed Medical Center, Tîrgu Mureş, Romania
| | - M Toma
- Faculty of Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania
| | - C Nicolescu
- TopMed Medical Center, Tîrgu Mureş, Romania.,Department of Anatomy, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş, Romania
| |
Collapse
|
26
|
Ulloa JH. Micronized Purified Flavonoid Fraction (MPFF) for Patients Suffering from Chronic Venous Disease: A Review of New Evidence. Adv Ther 2019; 36:20-25. [PMID: 30758743 PMCID: PMC6824339 DOI: 10.1007/s12325-019-0884-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 01/02/2023]
Abstract
Chronic venous disease (CVD) is both prevalent and unavoidable in many people as a result of persistent or unalterable risk factors, the most important of which are advanced age, excess body weight, and family history. Given this inevitability, medical treatment is required to alleviate symptoms and slow disease progression. Venoactive drug therapy is emerging as a valuable treatment option for many CVD patients and micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available. Recent evidence from animal models of venous hypertension and from clinical trials, as well as from systematic reviews, shows that MPFF is effective at alleviating many of the most common symptoms of CVD including leg pain, leg heaviness, sensations of swelling, cramps, and functional discomfort. In addition, MPFF improves the clinical signs of redness, skin changes, and edema, and improves quality of life. Collectively, these findings support the strong recommendation for MPFF treatment found in the 2018 international guidelines for the management of CVD.Funding: Servier.
Collapse
Affiliation(s)
- Jorge H Ulloa
- Fundación Santa Fe de Bogotá, Universidad de Los Andes, Bogotá, Colombia.
| |
Collapse
|
27
|
Chemokines and Growth Factors Produced by Lymphocytes in the Incompetent Great Saphenous Vein. Mediators Inflamm 2019; 2019:7057303. [PMID: 30733642 PMCID: PMC6348837 DOI: 10.1155/2019/7057303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/20/2018] [Accepted: 11/28/2018] [Indexed: 01/21/2023] Open
Abstract
The role of cytokines in the pathogenesis of chronic venous disease (CVD) remains obscure. It has been postulated that oscillatory flow present in incompetent veins causes proinflammatory changes. Our earlier study confirmed this hypothesis. This study is aimed at assessing chemokines and growth factors (GFs) released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting reflux in GSV, blood was derived from the cubital vein and from the incompetent saphenofemoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Eotaxin, interleukin 8 (IL-8), macrophage inflammatory protein 1 A and 1B (MIP-1A and MIP-1B), interferon gamma-induced protein (IP-10), monocyte chemoattractant protein-1 (MCP-1), interleukin 5 (IL-5), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), platelet-derived growth factor-BB (PDGF-BB), and vascular endothelial growth factor (VEGF) were assessed in culture supernatants by a Bio-Plex assay. Higher concentrations of eotaxin and G-CSF were revealed in the incompetent GSV, compared with the concentrations in the patients' upper limbs. The concentrations of MIP-1A and MIP-1B were higher in the CVD group while the concentration of VEGF was lower. In the stimulated cultures, the concentration of G-CSF proved higher in the incompetent GSV, as compared with the patients' upper limbs. Between the groups, the concentration of eotaxin was higher in the CVD group, while the IL-5 and MCP-1 concentrations were lower. IL-8, IP-10, FGF, GM-CSF, and PDGF-BB did not reveal any significant differences in concentrations between the samples. These observations suggest that the concentrations of chemokines and GFs are different in the blood of CVD patients. The oscillatory flow present in incompetent veins may play a role in these changes. However, the role of cytokines in CVD requires further study.
Collapse
|
28
|
Duyur Cakıt B, Pervane Vural S, Ayhan FF. Complex Decongestive Therapy in Breast Cancer-Related Lymphedema: Does Obesity Affect the Outcome Negatively? Lymphat Res Biol 2019; 17:45-50. [DOI: 10.1089/lrb.2017.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Burcu Duyur Cakıt
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Secil Pervane Vural
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - F. Figen Ayhan
- Division of Oncologic Rehabilitation and Lymphedema, Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
29
|
Mahapatra S, Ramakrishna P, Gupta B, Anusha A, Para MA. Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study. Indian J Med Res 2018; 147:471-476. [PMID: 30082571 PMCID: PMC6094506 DOI: 10.4103/ijmr.ijmr_1844_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.
Collapse
Affiliation(s)
- Sandeep Mahapatra
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Pinjala Ramakrishna
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Bhumika Gupta
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Arumalla Anusha
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Muneer Ahmad Para
- Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
| |
Collapse
|
30
|
Branisteanu DE, Feodor T, Baila S, Mitea IA, Vittos O. Impact of chronic venous disease on quality of life: Results of vein alarm study. Exp Ther Med 2018; 17:1091-1096. [PMID: 30679979 DOI: 10.3892/etm.2018.7054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 11/06/2022] Open
Abstract
Chronic venous disease (CVD) affects millions of people and negatively impacting the patient's quality of life (QoL) and most of the patients are diagnosed with CVD in advanced stages. The impact of newly diagnosed CVD on QoL has not been evaluated by other studies in Romania. The aim of this study was to assess the QoL for adult patients newly diagnosed with CVD addressing to the General Practitioner's (GP) office in Romania between June to August 2016. Patients included in the study were adult, signing the inform consent form, newly diagnosed with CVD or patients diagnosed with CVD, without CVD treatment the past 6 months. Data on demographic distribution, risk factors, clinical profiles, CVD symptomatology, QoL parameters, as well as pharmacological management practice were collected. The study included 1,893 patients (79.08% females) with 50.4% of patients in the age group 51-70 years. The most frequent CVD symptoms reported, were heavy leg sensation (85.74%), swelling of the feet (77.28%) and pain (73.11%). The most frequent CVD signs were telangiectasia and reticular veins (79.19%), varicose veins (65.77%) and edema (53.35%). The clinical, aetiological, anatomical and pathophysiological (CEAP) classification placed most of the patients in C3 class (31.85%), followed by C2 class (28.00%), C1 class (21.02%) and C4a (8.87%). Most of the patients reported 'low' or 'moderate' intensity of the CVD symptoms. QoL was affected for most of the patients at 'a mild' or 'moderate' degree, being noticed as a significant negative impact on physical, psychological, and social functioning components of QoL, correlated with CEAP class (P<0.001). Data regarding correlation of CEAP class, CVD symptoms and impact on QoL identified a significant correlation between all analyzed components (P<0.001). Study results prove that CVD diagnosis was established with relative delay and CVD is negatively affecting patients' QoL. Additional research will be needed to identify the long-term impact of CVD on QoL of the affected patients and their families.
Collapse
Affiliation(s)
| | - Toni Feodor
- Medical Center for Diagnosis, Ambulatory Treatment and Medical Prevention, Surgery Clinic 'Sf. Nicolae', 011796 Bucharest, Romania
| | - Sorin Baila
- Department of Vascular Surgery, 'C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | | | | |
Collapse
|
31
|
Compression Garments for Medical Therapy and Sports. Polymers (Basel) 2018; 10:polym10060663. [PMID: 30966697 PMCID: PMC6404358 DOI: 10.3390/polym10060663] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 12/02/2022] Open
Abstract
Compression garments are elastic clothing with an engineered compression gradient that can be worn on limbs, upper, lower, or full body to use for therapy and sports. This article presents an overview and review on the compression garments and concentrates on the design of compression garments with an appropriate pressure for specific applications. It covers the types of compression garments, fibers and yarns, knitted fabric construction, garment design, an evaluation system, and pressure measurement and modeling. The material properties, fabric properties, pressure modeling, and the garment design system presents the prediction, design, and fabrication of the compression garments. Lastly, the research status and directions are discussed.
Collapse
|
32
|
Mansilha A, Sousa J. Pathophysiological Mechanisms of Chronic Venous Disease and Implications for Venoactive Drug Therapy. Int J Mol Sci 2018; 19:ijms19061669. [PMID: 29874834 PMCID: PMC6032391 DOI: 10.3390/ijms19061669] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022] Open
Abstract
Chronic venous disease (CVD) is a common pathology, with significant physical and psychological impacts for patients and high economic costs for national healthcare systems. Throughout the last decades, several risk factors for this condition have been identified, but only recently, have the roles of inflammation and endothelial dysfunction been properly assessed. Although still incompletely understood, current knowledge of the pathophysiological mechanisms of CVD reveals several potential targets and strategies for therapeutic intervention, some of which are addressable by currently available venoactive drugs. The roles of these drugs in the clinical improvement of venous tone and contractility, reduction of edema and inflammation, as well as in improved microcirculation and venous ulcer healing have been studied extensively, with favorable results reported in the literature. Here, we aim to review these pathophysiological mechanisms and their implications regarding currently available venoactive drug therapies.
Collapse
Affiliation(s)
- Armando Mansilha
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
| | - Joel Sousa
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal.
- Departamento de Angiologia e Cirurgia Vascular, Hospital CUF Porto, 4100-180 Porto, Portugal.
| |
Collapse
|
33
|
Latest Innovations in the Treatment of Venous Disease. J Clin Med 2018; 7:jcm7040077. [PMID: 29641492 PMCID: PMC5920451 DOI: 10.3390/jcm7040077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 12/16/2022] Open
Abstract
Venous disease is more common than peripheral arterial disease. Pathophysiologically, venous disease can be associated with obstruction, reflux, or both. A common feature in chronic venous disease is ambulatory venous hypertension. Inflammatory and pro-thrombotic mechanisms can be activated. The current therapies, including compression, ablation, and recanalization are discussed.
Collapse
|
34
|
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.
Collapse
Affiliation(s)
- Bettina Santler
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
| | - Tobias Goerge
- Klinik für Hautkrankheiten - Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Coenen P, Parry S, Willenberg L, Shi JW, Romero L, Blackwood DM, Healy GN, Dunstan DW, Straker LM. Associations of prolonged standing with musculoskeletal symptoms-A systematic review of laboratory studies. Gait Posture 2017; 58:310-318. [PMID: 28863296 DOI: 10.1016/j.gaitpost.2017.08.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 02/02/2023]
Abstract
While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms. Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100). We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms. Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.
Collapse
Affiliation(s)
- Pieter Coenen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands; School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Sharon Parry
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Lisa Willenberg
- Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Joyce W Shi
- Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.
| | - Lorena Romero
- Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia.
| | - Diana M Blackwood
- Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Genevieve N Healy
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; The University of Queensland, School of Public Health, Corner of Herston Road and Wyndham Street, Brisbane, QLD 4006, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - David W Dunstan
- The University of Queensland, School of Public Health, Corner of Herston Road and Wyndham Street, Brisbane, QLD 4006, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3800, Australia; School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, VIC 3220, Australia; Department of Medicine, Monash University, Melbourne, Victoria 3800, Australia; School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, VIC 3000, Australia.
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| |
Collapse
|
37
|
Harris C, Duong R, Vanderheyden G, Byrnes B, Cattryse R, Orr A, Keast D. Evaluation of a muscle pump-activating device for non-healing venous leg ulcers. Int Wound J 2017; 14:1189-1198. [PMID: 28770561 PMCID: PMC7949827 DOI: 10.1111/iwj.12784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022] Open
Abstract
This evaluation involves an innovative muscle pump‐activating device (geko™) as an adjunctive therapy with best practices for non‐healing venous leg ulcers (VLUs). Stimulating the common peroneal nerve (at the fibular head), the geko™ device creates a response that acts as foot and calf muscle pumps, increasing venous, arterial and microcirculatory flow. The aim was to evaluate and determine if the geko™ is effective in this population and if it should be added to the medical supply formulary. In all, 12 patients with 18 recalcitrant VLUs (defined as less than 30% reduction in wound size in 30 days with best practices) in two community settings in Ontario consented to the evaluation and were treated with the geko™ for up to 20 weeks. A total of 44% of wounds healed, and 39% decreased in size. One patient non‐adherent with the geko™ and best practices had deterioration in his or her wounds. With the patients as their own control, the mean weekly healing rate with the geko™ was 9·35% (±SD 0·10) compared to 0·06% (±SD 0·10) prior to baseline, which was statistically significant (P < 0·01). Three patients not in optimal therapy increased compression due to decreased pain, further enabling healing. This study was not a randomised investigation, although the patients acted as their own controls. A pragmatic evaluation reflects the reality of the community sector; in spite of best practices or evidence‐based care, therapy is not uniformly applied, with some participants unable to tolerate or indeed comply with optimal compression therapy. Rash occurred under the devices in 7 of 12 (58%) patients. One patient stopped the device due to rash, while another had to take breaks from using the device. Subsequently, the manufacturer (FirstKind Ltd) has developed a new device and protocol specific to the requirements of wound therapy to minimise this response. This small case series demonstrated the highly significant effectiveness of the geko™ device in these hard‐to‐heal VLUs. Further evaluations to determine dose and patient selection criteria are underway.
Collapse
Affiliation(s)
- Connie Harris
- CarePartners (formerly), Perfuse Medtec Inc., London, ON Canada.,Hamilton Niagara Haldimand Brant (HNHB) Community Care Access Centre, Hamilton, ON Canada
| | - Rochelle Duong
- Mississauga Halton Community Care Access Centre, Mississauga, ON Canada
| | | | - Beth Byrnes
- CarePartners, South West Division, Tillsonburg, ON Canada
| | - Renee Cattryse
- CarePartners, South West Division, Tillsonburg, ON Canada
| | - Ava Orr
- CarePartners, Mississauga Halton Division, Mississauga, ON Canada
| | - David Keast
- Parkwood Institute, Western University, London, ON Canada
| |
Collapse
|
38
|
Kim H, Kim H, Park JH, Kim YH, Oh SJ, Suh BJ, Park JK. Alcohol Consumption, High-Density Lipoprotein Cholesterol, Antithrombin III, and Body Mass Index Are Associated with Great Saphenous Vein Reflux in the Thigh. Ann Vasc Surg 2017; 44:307-316. [PMID: 28501660 DOI: 10.1016/j.avsg.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Venous valvular reflux is the main cause of chronic venous dysfunction. However, the etiology of valvular reflux is not completely understood. We conducted this study to investigate new risk factors for venous reflux of the great saphenous vein (GSV) in the thigh. METHODS We studied 139 consecutive patients (278 legs) who underwent Doppler ultrasonography at our hospital between March 2015 and February 2016 for leg discomfort with visible varicosities, edema, skin changes, or venous ulcer in the legs. Continuous variables included age, body mass index (BMI), hematological and blood chemistry parameters, smoking (pack-years), and alcohol consumption (days). Nominal variables included sex, comorbidities, smoking status, alcohol drinking status, and specific antibodies. The relationship of GSV reflux with pregnancy and number of children was investigated in 184 legs of 92 patients among 96 female patients. RESULTS On logistic regression analysis, independent factors determining GSV reflux were BMI (B = 0.126, P = 0.012), high-density lipoprotein (HDL) cholesterol level (B = 0.029, P = 0.025), duration of alcohol consumption (B = 1.237 E-4, P = 0.016), and antithrombin III level (B = -0.036, P = 0.011). CONCLUSIONS In this study, the factors determining GSV reflux were higher HDL cholesterol level, longer duration of alcohol consumption, lower antithrombin III level, and higher BMI.
Collapse
Affiliation(s)
- Hyeonseung Kim
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Hyangkyoung Kim
- Department of Surgery, College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Je Hoon Park
- Department of Surgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Republic of Korea
| | - Yong Han Kim
- Department of Anesthesiology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jong Kwon Park
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
| |
Collapse
|
39
|
Bush R, Comerota A, Meissner M, Raffetto JD, Hahn SR, Freeman K. Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF). Phlebology 2017; 32:3-19. [PMID: 28211296 DOI: 10.1177/0268355517692221] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema. An initial search of Medline, Cochrane Database for Systematic Reviews and Google Scholar databases was conducted. The references of articles obtained in the primary search, including a Cochrane review of phlebotonics for venous insufficiency, were reviewed for additional studies. Studies were included if patients had a diagnosis of chronic venous disease documented with Doppler and Impedance Plethysmography. Studies excluded were those that had patients with arterial insufficiency (Ankle Brachial Index < .6), comorbidity of diabetes, obesity, rheumatological diseases, or if other causes of edema were present (congestive heart failure, renal, hepatic or lymphatic cause), or if the patient population had recent surgery or deep vein thrombosis, or had been using diuretics (in studies of edema). Other elements of the study design were to note specifically the type of compression therapy used in conjunction with Micronized Purified Flavonoid Fraction. Results The literature review yielded 250 abstracts, 65 of which met criteria for further review and 10 papers were selected for consideration in the systematic review. Conclusion In summary, the general level of evidence supports the recommendation that the use of medical therapy with Micronized Purified Flavonoid Fraction has beneficial outcomes without serious adverse events. In the United States, diosmiplex is the only available prescription formulation of Micronized Purified Flavonoid Fraction. It is derived from the rinds of oranges and is categorized as a medical food and not as a drug; and may be a particularly attractive therapy for many chronic venous disease patients because of its favorable safety profile. The Working Group for chronic venous disease concurs with previous guidance by the International European Society for Vascular Surgery in 2015 which recommended the use of Micronized Purified Flavonoid Fraction for the healing of venous ulcers, alone and adjunctive to compression therapy, and for the reduction in symptoms of chronic venous disease such as edema.
Collapse
|
40
|
Chen Y, Peng W, Raffetto JD, Khalil RA. Matrix Metalloproteinases in Remodeling of Lower Extremity Veins and Chronic Venous Disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 147:267-299. [PMID: 28413031 DOI: 10.1016/bs.pmbts.2017.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The veins of the lower extremity are equipped with efficient wall, contractile vascular smooth muscle (VSM), and competent valves in order to withstand the high venous hydrostatic pressure in the lower limb and allow unidirectional movement of deoxygenated blood toward the heart. The vein wall structure and function are in part regulated by matrix metalloproteinases (MMPs). MMPs are zinc-dependent endopeptidases that are secreted as inactive pro-MMPs by different cells in the venous wall including fibroblasts, VSM, and leukocytes. Pro-MMPs are activated by other MMPs, proteinases, and other endogenous and exogenous activators. MMPs degrade various extracellular matrix (ECM) proteins including collagen and elastin, and could affect other cellular processes including endothelium-mediated dilation, VSM cell migration, and proliferation as well as modulation of Ca2+ signaling and contraction in VSM. It is thought that increased lower limb venous hydrostatic pressure increases hypoxia-inducible factors and other MMP inducers such as extracellular matrix metalloproteinase inducer, leading to increased MMP expression/activity, ECM protein degradation, vein wall relaxation, and venous dilation. Vein wall inflammation and leukocyte infiltration cause additional increases in MMPs, and further vein wall dilation and valve degradation, that could lead to chronic venous disease and varicose veins (VVs). VVs are often presented as vein wall dilation and tortuosity, incompetent venous valves, and venous reflux. Different regions of VVs show different MMP levels and ECM proteins with atrophic regions showing high MMP levels/activity and little ECM compared to hypertrophic regions with little or inactive MMPs and abundant ECM. Treatment of VVs includes compression stockings, venotonics, sclerotherapy, or surgical removal. However, these approaches do not treat the cause of VVs, and other lines of treatment may be needed. Modulation of endogenous tissue inhibitors of metalloproteinases (TIMPs), and exogenous synthetic MMP inhibitors may provide new approaches in the management of VVs.
Collapse
Affiliation(s)
- Yunfei Chen
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Wei Peng
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joseph D Raffetto
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
41
|
Huang HK, Weng SF, Su SB, Wang JJ, Guo HR, Hsu CC, Huang CC, Lin HJ. Standing Posture at Work Does Not Increase the Risk of Varicose Veins among Health Care Providers in Taiwan. Med Princ Pract 2017; 26:266-272. [PMID: 28249260 PMCID: PMC5588414 DOI: 10.1159/000466696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/28/2017] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study compared the risk of varicose veins (VV) among physicians, nonphysician health care providers (HCP), and the general population. SUBJECTS AND METHODS The Taiwan National Health Insurance Research Database was used to identify 28,844 physicians and 26,099 nonphysician HCP and an identical number of age- and sex-matched patients from the general population. Using logistic regression analyses, VV risks between physicians and the general population, nonphysician HCP and the general population, and physicians and nonphysician HCP, and among physician specialists were compared by tracing their medical histories between 2007 and 2011. RESULTS Physicians and nonphysician HCP had cumulative VV incidences of 0.12% (34/28,844) and 0.13% (33/26,099), respectively, during the 5-year period, compared to that of the general population within the same 5-year period. Physicians and nonphysician HCP did not have a higher VV risk than the general population after adjusting for deep vein thrombosis (DVT) history (adjusted odds ratio [AOR] 0.86; 95% confidence interval [CI] 0.53-1.40, and AOR 1.43; 95% CI 0.82-2.50, respectively). Physicians did not a have higher VV risk than nonphysician HCP (AOR 0.80; 95% CI 0.43-1.51) after adjusting for age, sex, and DVT history. Surgery had the highest incidence (0.22%) while pediatrics and emergency medicine had the lowest incidence (0%) of VV risk among physician specialists; however, the difference was not significant (all p values >0.05). CONCLUSION In this study, VV risk did not differ among physicians, nonphysician HCP, and the general population.
Collapse
Affiliation(s)
- Hsin-Kai Huang
- Holistic Care Unit, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Leisure, Recreation, and Tourism Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- *Chien-Cheng Huang, MD, Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan 710 (Taiwan), E-Mail
| | - Chien-Cheng Huang
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
42
|
Familial Transmission of Hospital-Treated Varicose Veins in Adoptees: A Swedish Family Study. J Am Coll Surg 2016; 223:452-60. [DOI: 10.1016/j.jamcollsurg.2016.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/24/2016] [Accepted: 06/13/2016] [Indexed: 11/23/2022]
|
43
|
Marola S, Ferrarese A, Solej M, Enrico S, Nano M, Martino V. Management of venous ulcers: State of the art. Int J Surg 2016; 33 Suppl 1:S132-4. [PMID: 27353850 DOI: 10.1016/j.ijsu.2016.06.015] [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: 10/21/2022]
Abstract
Venous ulceration is a complex and serious problem that affects 1-2% of the global elderly population (>65 years), and its incidence is constantly increasing. The population group with higher risk of development of venous ulceration is the elderly. These lesions have a significant negative impact on patients' quality of life. Our aim was to analyze the state of the art, starting with the medical literature review. The evidence supports that managing chronic wounds with a multidisciplinary wound care team significantly increases wound healing and reduces the severity of wound-associated pain and the required daily wound treatments compared with persons who are not managed by such a team.
Collapse
Affiliation(s)
- Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Mario Nano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
| |
Collapse
|
44
|
Screening for lower extremity venous disease. Clin Imaging 2016; 40:325-9. [DOI: 10.1016/j.clinimag.2015.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
|
45
|
Radak DJ, Tanaskovic SZ, Vlajinac HD, Marinkovic JM, Maksimovic MZ. Relationship Between Pain and CEAP C Categories of Chronic Venous Disease. Angiology 2015; 67:670-5. [PMID: 26483571 DOI: 10.1177/0003319715613179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we investigated whether the occurrence and intensity of leg pain are related to C class of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification for chronic venous disease (CVeD). This cross-sectional study, conducted in Serbia, included 2841 patients: 2027 (71.3%) women and 814 (28.7%) men with CVeD diagnosed by general practitioners. For the first time, the Numeric Rating Scale of 0 to 5 units was used to assess the intensity of pain. For the analysis, univariate and multivariate logistic and linear regressions were applied. Pain in the legs was reported by 90.5% of the patients. The occurrence of pain significantly (P < .001) increased with increasing C class. Of the patients who reported pain in the legs, 42.0% had moderate pain, 23.7% had moderate to severe pain, 22.8% had light pain, 11.2% had severe pain, and 0.3% had very severe pain. Severity of pain differed significantly (P < .001) according to C class. Light and moderate pain gradually decreased and severe pain gradually increased from C0 to C6 class. These associations remained significant after adjustment for age, body mass index, and family history of CVeD.
Collapse
Affiliation(s)
- D J Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Z Tanaskovic
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - H D Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - J M Marinkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - M Z Maksimovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
46
|
MacColl E, Khalil RA. Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease. J Pharmacol Exp Ther 2015; 355:410-28. [PMID: 26319699 DOI: 10.1124/jpet.115.227330] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/27/2015] [Indexed: 12/24/2022] Open
Abstract
Lower-extremity veins have efficient wall structure and function and competent valves that permit upward movement of deoxygenated blood toward the heart against hydrostatic venous pressure. Matrix metalloproteinases (MMPs) play an important role in maintaining vein wall structure and function. MMPs are zinc-binding endopeptidases secreted as inactive pro-MMPs by fibroblasts, vascular smooth muscle (VSM), and leukocytes. Pro-MMPs are activated by various activators including other MMPs and proteinases. MMPs cause degradation of extracellular matrix (ECM) proteins such as collagen and elastin, and could have additional effects on the endothelium, as well as VSM cell migration, proliferation, Ca(2+) signaling, and contraction. Increased lower-extremity hydrostatic venous pressure is thought to induce hypoxia-inducible factors and other MMP inducers/activators such as extracellular matrix metalloproteinase inducer, prostanoids, chymase, and hormones, leading to increased MMP expression/activity, ECM degradation, VSM relaxation, and venous dilation. Leukocyte infiltration and inflammation of the vein wall cause further increases in MMPs, vein wall dilation, valve degradation, and different clinical stages of chronic venous disease (CVD), including varicose veins (VVs). VVs are characterized by ECM imbalance, incompetent valves, venous reflux, wall dilation, and tortuosity. VVs often show increased MMP levels, but may show no change or decreased levels, depending on the VV region (atrophic regions with little ECM versus hypertrophic regions with abundant ECM) and MMP form (inactive pro-MMP versus active MMP). Management of VVs includes compression stockings, venotonics, and surgical obliteration or removal. Because these approaches do not treat the causes of VVs, alternative methods are being developed. In addition to endogenous tissue inhibitors of MMPs, synthetic MMP inhibitors have been developed, and their effects in the treatment of VVs need to be examined.
Collapse
Affiliation(s)
- Elisabeth MacColl
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
47
|
Vuylsteke ME, Colman R, Thomis S, Guillaume G, Degrande E, Staelens I. The influence of age and gender on venous symptomatology. An epidemiological survey in Belgium and Luxembourg. Phlebology 2015; 31:325-33. [DOI: 10.1177/0268355515589224] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim The aim of this study is to measure the incidence of the symptoms in patients with chronic venous disease (CVD) and to look for the influence of age on the severity of symptoms for both genders. Materials and methods A survey was carried out in Belgium and Luxembourg between May and September 2013. Patient recruitment was done by 406 general practitioners (GPs). Each GP screened 10–20 consecutive patients older than 18 years. Inquiries were made regarding the presence of symptoms and possible signs of CVD. Patients with diagnosed CVD filled out a questionnaire including a quality of life score (CIVIQ-14). These data were converted into a CIVIQ Global Index Score (GIS). Statistical analysis was performed in order to calculate the effect of age and gender on the number of symptoms and the estimated probabilities of having CVD. Results Totally 6009 patients were included in this survey. The mean age was 53.4 years. Of all, 61.3% of the patients have CVD (C1-C6). Of all, 64.7% of patients were symptomatic. Age and female gender were major risk factors for developing CVD. Most common symptoms were ‘heavy legs’ (70.4%), pain (54.0%), and sensation of swelling (52.7%). The number of symptoms increases with age ( p < 0.001). Female patients have significantly more symptoms in comparison with male patients in all age groups. In both females and males, age is negatively correlated with GIS score ( p < 0.001). The estimated probability of having CVD was significantly higher for woman compared to men and increases with age for both gender. Conclusion CVD is a very common progressive disease with age as a major risk factor. Increasing age results in a higher C-classification, more symptoms, and a lower GIS score (quality of life). Female gender interacts significantly with age and results in a more advanced stage of CVD.
Collapse
Affiliation(s)
- Marc E Vuylsteke
- Department of Vascular Surgery, Sint-Andries Ziekenhuis, Tielt, Belgium
| | - Roos Colman
- Department of Public Health, Biostatistics unit, University of Ghent, Ghent, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, University Hospitals Leuven, Belgium
| | - Geneviève Guillaume
- Department of Cardiovascular and Thoracic Surgery, University Hospital Mont-Godinne, Mont-Godinne, Belgium
| | - Evy Degrande
- Department of Internal Medicine, Sint-Andriesziekenhuis, Tielt, Belgium
| | - Ivan Staelens
- Department of Vascular Surgery, UZ Brussels, Brussels, Belgium
| |
Collapse
|
48
|
Azma K, Mottaghi P, Hosseini A, Salek S, Bina R. Venous insufficiency after prolonged standing: Is joint hypermobility an important risk factor? Adv Biomed Res 2015; 4:98. [PMID: 26015924 PMCID: PMC4434442 DOI: 10.4103/2277-9175.156666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 01/31/2015] [Indexed: 12/03/2022] Open
Abstract
Background: Varicose veins are extremely common disease which is due to elevated superficial venous pressures. We aimed to know that if joint hypermobility causes the venous insufficiency following the prolonged standing. Materials and Methods: This prospective cohort study conducted on the soldiers of training periods in a military base of Iran Army in Isfahan in 2013. The active-duty soldiers were first examined by a physician and their Beighton scores (BSs) were obtained. At the onset of the training period, the presence of chronic venous insufficiency was clinically evaluated according to the C class of clinical, etiological, anatomical, and pathological classification. After 3 months, soldiers with and without joint hypermobility were reexamined for manifestations of venous insufficiency based on clinical examination. Results: Of 718 soldiers, 211 subjects were diagnosed for joint hypermobility syndrome (29.3%). The mean BS was significantly higher in hypermobility soldiers (5.5 ± 1.5) than the healthy ones (1.2 ± 1.1). Before the training period, the prevalence of spider and varicose veins in soldiers with joint hypermobility was significantly higher than healthy subjects (P > 0.001). After the training period, the prevalence of venous insufficiency significantly increased in soldiers with joint hypermobility (P > 0.001) while there was no significant difference in healthy group before and after the period of training (P = 0.25). Conclusion: Hypermobility could be considered as a risk factor for the development of venous insufficiency, so it seems necessary to evaluate the population who need to be standing for a long time for evidence of joint hypermobility.
Collapse
Affiliation(s)
- Kamran Azma
- Department of Physical Medicine and Rehabilitation, Clinical Biomechanical and Rehabilitation Engineering Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Peyman Mottaghi
- Department of Internal medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Hosseini
- Department of Orthopedic Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Salek
- Department of Pediatrics, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Bina
- Department of Internal medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
49
|
Kuna VK, Rosales A, Hisdal J, Osnes EK, Sundhagen JO, Bäckdahl H, Sumitran-Holgersson S, Jørgensen JJ. Successful tissue engineering of competent allogeneic venous valves. J Vasc Surg Venous Lymphat Disord 2015; 3:421-430.e1. [PMID: 26992620 DOI: 10.1016/j.jvsv.2014.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate whether tissue-engineered human allogeneic vein valves have a normal closure time (competency) and tolerate reflux pressure in vitro. METHODS Fifteen human allogeneic femoral vein segments containing valves were harvested from cadavers. Valve closure time and resistance to reflux pressure (100 mm Hg) were assessed in an in vitro model to verify competency of the vein valves. The segments were tissue engineered using the technology of decellularization (DC) and recellularization (RC). The decellularized and recellularized vein segments were characterized biochemically, immunohistochemically, and biomechanically. RESULTS Four of 15 veins with valves were found to be incompetent immediately after harvest. In total, 2 of 4 segments with incompetent valves and 10 of 11 segments with competent valves were further decellularized using detergents and DNAse. DC resulted in significant decrease in host DNA compared with controls. DC scaffolds, however, retained major extracellular matrix proteins and mechanical integrity. RC resulted in successful repopulation of the lumen and valves of the scaffold with endothelial and smooth muscle cells. Valve mechanical parameters were similar to the native tissue even after DC. Eight of 10 veins with competent valves remained competent even after DC and RC, whereas the two incompetent valves remained incompetent even after DC and RC. The valve closure time to reflux pressure of the tissue-engineered veins was <0.5 second. CONCLUSIONS Tissue-engineered veins with valves provide a valid template for future preclinical studies and eventual clinical applications. This technique may enable replacement of diseased incompetent or damaged deep veins to treat axial reflux and thus reduce ambulatory venous hypertension.
Collapse
Affiliation(s)
- Vijay Kumar Kuna
- Laboratory for Transplantation and Regenerative Medicine, Department of Surgery, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Antonio Rosales
- Department of Vascular Surgery, Oslo Vascular Centre, Oslo University Hospital, Aker, Norway
| | - Jonny Hisdal
- Department of Vascular Surgery, Oslo Vascular Centre, Oslo University Hospital, Aker, Norway
| | - Eivind K Osnes
- Department of Vascular Surgery, Oslo Vascular Centre, Oslo University Hospital, Aker, Norway
| | - Jon O Sundhagen
- Department of Vascular Surgery, Oslo Vascular Centre, Oslo University Hospital, Aker, Norway
| | - Henrik Bäckdahl
- Department of Chemistry, Materials, and Surfaces, SP Technical Research Institute of Sweden, Borås, Sweden
| | - Suchitra Sumitran-Holgersson
- Laboratory for Transplantation and Regenerative Medicine, Department of Surgery, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Jørgen J Jørgensen
- Department of Vascular Surgery, Oslo Vascular Centre, Oslo University Hospital, Aker, Norway; Vascular Department, University of Oslo, Oslo, Norway
| |
Collapse
|
50
|
Diken AI, Yalçınkaya A, Aksoy E, Yılmaz S, Özşen K, Sarak T, Çağlı K. Prevalence, presentation and occupational risk factors of chronic venous disease in nurses. Phlebology 2015; 31:111-7. [PMID: 25577573 DOI: 10.1177/0268355514567491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. METHODS Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. RESULTS Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical-Etiology-Anatomy-Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left-right ankles and the mean duration of hospital stay. CONCLUSIONS Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency.
Collapse
Affiliation(s)
- A I Diken
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| | - A Yalçınkaya
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| | - E Aksoy
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| | - S Yılmaz
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| | - K Özşen
- Faculty of Medicine, Cardiovascular Surgery Nursery, Hitit University, Corum, Turkey
| | - T Sarak
- Faculty of Medicine, Department of Cardiology, Hitit University, Corum, Turkey
| | - K Çağlı
- Faculty of Medicine, Department of Cardiovascular Surgery, Hitit University, Corum, Turkey
| |
Collapse
|