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Lisii C, Heckenkamp J. [Varicosis-Current treatment concepts]. Chirurgie (Heidelb) 2024; 95:415-426. [PMID: 38597983 DOI: 10.1007/s00104-024-02063-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
Varicosis is a chronic progressive disease characterized by varicose veins of the lower extremities. Pain, swelling and heaviness of the legs are typical symptoms. These symptoms are caused by a pathological venous reflux, arising from a weakness of the vein wall and progressive venous insufficiency. The indications for invasive surgery are the symptomatic clinical, etiological, anatomical, pathophysiological (CEAP) stages C2s-C6. Compression therapy and venoactive drugs can be recommended for conservative therapy. When it comes to surgical treatment conventional open vein surgery is associated with the best long-term results. Endovenous thermal ablation is associated with few postoperative complications and favors earlier mobilization of the patient. Sclerotherapy has become established with good clinical results for the ablation of reticular and telangiectatic veins, for recurrences and complicated vein anatomy.
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Affiliation(s)
- C Lisii
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Marienhospital Osnabrück, Niel-Stensen Kliniken, Bischofstraße, 49074, Osnabrück, Deutschland.
| | - J Heckenkamp
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Marienhospital Osnabrück, Niel-Stensen Kliniken, Bischofstraße, 49074, Osnabrück, Deutschland
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2
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Yin C, Tang F, Lao J, Yang Y, Li M, Cao J, Song R, Wu P, Wang Y. Risk factors for venous ulceration in patients with varicose veins of lower extremities. Wound Repair Regen 2024; 32:47-54. [PMID: 38087425 DOI: 10.1111/wrr.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
The aim of this case-control study was to explore the potential risk factors for venous ulceration in patients with varicose veins of lower extremities and to establish a simplified diagnostic score model. Seventy subjects with varicose veins of lower extremities and venous ulceration were compared with 1164 controls with varicose veins of lower extremities and no history of venous ulceration. Stepwise multivariate logistic regression analysis was used to identify the risk factors for venous ulceration. The steps in developing the diagnostic score model were based on the Framingham Heart study. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic ability of the diagnostic score model. Multivariate analysis showed that men, overweight, obesity, longer duration varicose veins, deep venous valve insufficiency, low lymphocyte counts, and high fibrinogen content were independently associated with an increased risk of venous ulceration. The AUC for the diagnostic score model was 0.75, which indicated good discriminatory ability. Special attention should be paid to the high-risk group of patients with lower extremity varicose veins. The diagnostic score model might be a useful screening tool for clinicians, policy makers, and patients.
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Affiliation(s)
- Chaonan Yin
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Fang Tang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahui Lao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yang Yang
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jia Cao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ru Song
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
| | - Peng Wu
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
| | - Yibing Wang
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Fresa M, Rieder W, Vial Y, Keller S, Porceddu E, Mazzolai L. [Pelvic congestion syndrome : from diagnosis to treatment]. Rev Med Suisse 2023; 19:2310-2315. [PMID: 38063450 DOI: 10.53738/revmed.2023.19.853.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pelvic congestion syndrome is a debilitating condition that is often under-diagnosed and under-treated, defined by chronic pelvic pain in the presence of pelvic varicose veins in women or, more rarely, in men. The differential diagnosis of chronic abdominal pain is vast and often leads to lengthy and costly diagnostic procedures. Conservative treatment is often insufficient, and embolization of pelvic varices is the treatment of choice to improve symptoms. A multidisciplinary management algorithm is proposed to facilitate the clinical path for these patients.
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Affiliation(s)
- Marco Fresa
- Service d'angiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Wawrzysiniec Rieder
- Service de gynécologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Yvan Vial
- Service de gynécologie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Sanjiv Keller
- Service d'angiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Enrica Porceddu
- Service d'angiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Lucia Mazzolai
- Service d'angiologie, Département cœur-vaisseaux, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Béliard S, Ferreira D, Thomas H, Mourot L, Tordi N. High Physical Activity Volume Is Associated With an Increase in the Calibre of the Lower Limb Veins Without Impact on Functional Discomfort: the VARISPORT Study. Eur J Vasc Endovasc Surg 2023; 66:856-863. [PMID: 37562761 DOI: 10.1016/j.ejvs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The relationship between physical activity and lower limb veins is complex. If a sedentary lifestyle is considered to be negative on lower limb veins, specific information on physical activity varicose vein volume is sparse, especially the effect of high physical activity volume. The main objective of the VARISPORT study was to evaluate lower limb veins (clinically, morphologically, and haemodynamically) and chronic venous disease symptoms in subjects exposed to high physical activity volume compared with a group of non-exposed subjects. METHODS A cross sectional study compared a group of high exercise training volume volunteers (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months: high physical activity volume group, HPAV group) with a volunteer control group matched for age, sex, and body mass index. Clinical examination was performed to determine the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of each subject and the Carpentier score was used to assess symptoms related to possible chronic venous disease. Duplex ultrasonography was used to assess vein diameters and reflux in the deep and superficial veins. RESULTS One hundred and nineteen subjects were included in each group. The lower limb veins (deep and superficial) were significantly more dilated in the HPAV group. More reflux was found in the great saphenous veins and non-saphenous veins in the HPAV group. High physical activity volume was associated with a higher frequency of visible varicose veins (stage C2 of the CEAP classification), odds ratio 3.37 (95% confidence interval 1.66 - 7.25) without impact on functional discomfort (44 subjects with a Carpentier score ≥ 1 in each group). CONCLUSION The VARISPORT study reported an increase in the calibre of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.
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Affiliation(s)
- Samuel Béliard
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France; Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France.
| | - David Ferreira
- Anaesthetics and Intensive Care Department, CHU Besançon, Besançon, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Franche-Comté, Besançon, France
| | - Hélène Thomas
- Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France
| | - Laurent Mourot
- EA3920 Marqueurs Pronostiques et Facteurs de Régulations des Pathologies Cardiaques et Vasculaires, Platform Exercise Performance Health Innovation (EPHI Université de Franche-Comté, Besançon, France
| | - Nicolas Tordi
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France
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Cheng CY. Risk of osteoporosis among individuals with varicose veins: a multi-institution cohort study. Arch Osteoporos 2023; 18:141. [PMID: 38008860 DOI: 10.1007/s11657-023-01351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
The present study showed a significant association between varicose veins and the development of osteoporosis, especially women and patients older than 50 years. Physicians should be alerted to this issue and consider screening for osteoporosis in patients with varicose veins. PURPOSE Osteoporosis might be associated with many skin diseases. However, only a paucity of data addressing the association between varicose veins and subsequent osteoporosis development. The study was aimed to evaluate whether there is an increased risk of osteoporosis among patients with varicose veins. METHODS This multi-institution database study was based on Chang Gung Research Database from January 1, 2003, to December 31, 2015. Patients aged 20 years and older with varicose veins were enrolled. Participants in the control group were selected by matching in a 4:1 ratio by sex, age, index date, and comorbidities. The hazard ratios associated with osteoporosis were estimated using Cox regression analysis with competitive risk model. Incidence rate of osteoporosis was assessed in individuals with and without varicose veins. RESULTS A total of 11,959 patients with varicose veins and 47,633 matched controls were enrolled in the study. The varicose veins group had higher incidence rates than the control group for osteoporosis (46.40 vs 31.92 per 10,000 person-years; adjusted HR 1.481 [95%CI, 1.314-1.669; P < 0.001]). Compared with matched controls, varicose veins patients with or without venous ulcers had 1.711- and 1.443-times increased risk of developing osteoporosis, respectively. Subgroup analysis showed varicose veins were associated with osteoporosis in women and patients older than 50 years. CONCLUSION The present study demonstrated individuals with varicose veins had an increased risk of osteoporosis. Physicians should be alerted to this issue and consider screening for osteoporosis in patients with varicose veins, especially among women and patients older than 50 years.
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Affiliation(s)
- Chun-Yu Cheng
- Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
- Center of Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Chang Gung Memorial Hospital, 199, Tun-Hwa North Road, Taipei, 105, Taiwan.
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Tranah TH, Nayagam JS, Gregory S, Hughes S, Patch D, Tripathi D, Shawcross DL, Joshi D. Diagnosis and management of ectopic varices in portal hypertension. Lancet Gastroenterol Hepatol 2023; 8:1046-1056. [PMID: 37683687 DOI: 10.1016/s2468-1253(23)00209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 09/10/2023]
Abstract
Ectopic variceal bleeding is a rare cause of gastrointestinal bleeding that can occur in settings of cirrhotic and non-cirrhotic portal hypertension and is characterised by its development at locations remote from the oesophagus and stomach. Ectopic varices can be difficult to identify and access, and, although a relatively uncommon cause of portal hypertensive bleeding, can represent a difficult diagnostic and therapeutic challenge associated with considerable mortality. Low incidence and variance in variceal anatomy preclude large randomised controlled trials, and clinical practice is based on experience from case reports, case series, and specialist centre expertise. Optimisation of survival outcomes relies on understanding a patient's portal venous anatomy and functional hepatic reserve to guide timely and targeted endoscopic and endovascular interventions to facilitate the rapid control of ectopic variceal bleeding.
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Affiliation(s)
- Thomas H Tranah
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK.
| | - Jeremy S Nayagam
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK
| | - Stephen Gregory
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Sarah Hughes
- Department of Gastroenterology and Hepatology, St George's Healthcare NHS Trust, London, UK
| | - David Patch
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital and University College London, London, UK
| | - Dhiraj Tripathi
- Department of Liver and Hepato-Pancreato-Biliary Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Debbie L Shawcross
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Institute of Liver Studies, King's College Hospital, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King's College Hospital, London, UK
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Wolosker N, Louzada ACS, Portela FSO, da Silva MFA, Schettino GDPP, Corrêa LH, Juniordata EA, Teivelis MP. Proposed public policies to improve outcomes in vascular surgery: an experts' forum. Einstein (Sao Paulo) 2023; 21:eAE0241. [PMID: 37585883 PMCID: PMC10421605 DOI: 10.31744/einstein_journal/2023ae0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/18/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. METHODS This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. RESULTS There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. CONCLUSION After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.
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Affiliation(s)
- Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | - Lucas Hernandes Corrêa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Edson Amaro Juniordata
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Kłapacz P, Maga M, Drelicharz Ł, Krężel J, Graczkowska E, Krupa K, Trąd G, Maga W, Partyka Ł, Maga P. Unsuccessful linguistic validation of the Symptom Questionnaire for assessing quality of life in Polish patients with pelvic vein disorders. Folia Med Cracov 2023; 63:65-75. [PMID: 37903380 DOI: 10.24425/fmc.2023.145914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Pelvic venous disorder (PeVD) is a prevalent chronic condition characterized by the presence of varicose veins in the pelvis, leading to the development of chronic pelvic pain. Despite the growing interest in assessing quality of life in PeVD, well-designed and validated disease-specific questionnaires are missing. The objective of this study was a linguistic and clinical validation of the Symptom Questionnaire (SQ) in a cohort of Polish females with pelvic vein incompetence. The Polish version of SQ was developed using a standardized validation process that involved a back-and- forth translation protocol. A total of 58 female patients diagnosed with pelvic varicose veins, representing diverse educational back- grounds, participated in the study. Multiple issues were observed during linguistic validation, primarily originating from disparities between the Polish and British healthcare systems, as well as differing levels of sexual health education of those two populations. Cronbach α was calculated separately for each part of the questionnaire with results exceeded 0.6 for each section. Test-retest analysis indicated most Pearson correlation coefficients surpassing 0.70. The absolute agreement consistency between pretest and post-test measures, evaluated using the Intra Class Correlation (ICC), exceeded 0.8 in three sections and 0.7 in the remaining three sections. However, the clinical validation failed due to the lack of standardized score calculation proposed by the authors of the questionnaire and inaccurately assigned values in the answer key for five questions. Consequently, the practical utility of SQ in daily clinical settings remains uncertain, highlighting the urgent need for the development of a new, user-friendly questionnaire specifically tailored to assess the quality of life in individuals with PeVD.
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Affiliation(s)
- Paulina Kłapacz
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Clinical Department of Angiology, University Hospital in Kraków, Poland.
| | - Mikołaj Maga
- Clinical Department of Angiology, University Hospital in Kraków, Poland; Department of Rehabilitation in Internal Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Drelicharz
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Clinical Department of Angiology, University Hospital in Kraków, Poland
| | - Jakub Krężel
- Clinical Department of Angiology, University Hospital in Kraków, Poland
| | - Ewa Graczkowska
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Kinga Krupa
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriela Trąd
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech Maga
- Prosthodontic and Orthodontic Department, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Łukasz Partyka
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Clinical Department of Angiology, University Hospital in Kraków, Poland
| | - Paweł Maga
- Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland; Clinical Department of Angiology, University Hospital in Kraków, Poland
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Hammoud A, Tikhomirov A, Briko A, Volkov A, Karapetyan A, Shchukin S. Evaluation of the Information Content for Determining the Vascular Tone Type of the Lower Extremities in Varicose Veins: A Case Study. Biosensors (Basel) 2023; 13:96. [PMID: 36671931 PMCID: PMC9855907 DOI: 10.3390/bios13010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The incidence of cardiovascular diseases is continuously increasing around the world. Therefore, the study of new methods for diagnosing cardiovascular diseases is very important. Early diagnosis and evaluation of the effectiveness of treatments are among the most important tasks. In this work, we study changes in vascular compliance and vascular tone of the lower extremities in a patient diagnosed with an early stage of varicose veins. The study is based on recording the bioimpedance signals of the lower extremities and their parts using the Rheo-32 multichannel device. Registration in the monitoring system takes place in two stages: the first in a state of relaxation, and the second after applying a local massage on one of the legs for five minutes. The results indicate a change in the type of vascular tone of the lower extremities after the massage, while the type of vascular tone changes and shifts on average towards the normotonic type. The method proposed in this study makes it possible to quantitatively and qualitatively assess changes in the tone of the vessels of the extremities.
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Affiliation(s)
- Ahmad Hammoud
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia
| | - Alexey Tikhomirov
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia
| | - Andrey Briko
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia
| | - Alexander Volkov
- Scientific and Educational Medical-Technological Center, Bauman Moscow State Technical University, 105005 Moscow, Russia
| | - Aida Karapetyan
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia
| | - Sergey Shchukin
- Department of Medical and Technical Information Technology, Bauman Moscow State Technical University, 105005 Moscow, Russia
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Li W, Wang J, Fu H, Liu J. Isolated sigmoid varicose vein rupture and hemorrhage: A case report. Medicine (Baltimore) 2022; 101:e30024. [PMID: 35905227 PMCID: PMC9333464 DOI: 10.1097/md.0000000000030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably. PATIENT CONCERNS A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability. DIAGNOSIS Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins. INTERVENTION Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately. OUTCOMES Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection. LESSONS Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.
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Affiliation(s)
- Weiwei Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Jianli Wang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Hua Fu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
| | - Jinlong Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
- *Correspondence: Jinlong Liu, Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China (e-mail: )
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Grigore M, Ionita-Radu F, Jinga M, Bucurica S. Transverse colon varices as a diagnostic hint for pancreatic cancer. J Gastrointestin Liver Dis 2022; 31:160. [PMID: 35694985 DOI: 10.15403/jgld-4355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Monica Grigore
- Department of Gastroenterology, Carol Davila Central Military University Emergency Hospital, Bucharest, Romania. .
| | - Florentina Ionita-Radu
- Department of Gastroenterology, Carol Davila Central Military University Emergency Hospital, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Mariana Jinga
- Department of Gastroenterology, Carol Davila Central Military University Emergency Hospital, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
| | - Sandica Bucurica
- Department of Gastroenterology, Carol Davila Central Military University Emergency Hospital, Bucharest; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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12
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Abstract
PURPOSE To describe a patient with a painful red-eye syndrome and a choroidal mass lesion that was diagnosed after multimodal imaging with a vortex vein ampulla varix induced by a nodular posterior scleritis. METHODS Retrospective case report documented with fluorescein angiography, indocyanine green angiography, b-mode ultrasound, fundus imaging, and swept-source optical coherence tomography. RESULTS A 24-year-old man presented with a painful red eye and sudden onset blurred vision. Fundus exam disclosed macular choroidal folds and a nonpigmented mass lesion at the inferior equator. Swept-source optical coherence tomography showed enlarged choroidal vessels with fluid in the suprachoroidal space under the central macula and a hyporeflective lobulated choroidal cavity in the inferior temporal retina. Multimodal imaging with contrast dyes showed a dilated vortex vein ampulla with early hyperfluorescence and a complete washout in late acquisitions on indocyanine green. The patient recovered uneventfully after a short-course administration of oral nonsteroidal anti-inflammatory drugs, disclosing irregular scleral nodules on swept-source optical coherence tomography that remained stable over a twelve-month follow-up. CONCLUSION This report suggests that nodular posterior scleritis can induce a vortex vein ampulla varix and contributes to a better understanding of the pathophysiology of this entity. We further suggest that in a diagnostic puzzling scenario the inflammatory syndrome should be treated before attempting to perform a chorioretinal biopsy.
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Affiliation(s)
- Diogo Cabral
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal ; and
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Vanda Nogueira
- Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal ; and
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13
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Spiess K, Elgohary MA. DIAGNOSIS OF VORTEX VARIX USING OPTICAL COHERENCE TOMOGRAPHY AND SCLERAL INDENTATION. Retin Cases Brief Rep 2022; 16:362-364. [PMID: 32032286 DOI: 10.1097/icb.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE We report a case of a vortex vein varix diagnosed with optical coherence tomography under globe compression. METHODS To illustrate the dynamical behavior of a vortex vein varix, optical coherence tomography was performed with and without gentle globe indentation with a cotton swab. RESULTS A 51-year-old woman was referred by her optician for an incidental finding of a nonpigmented choroidal mass in the right eye. The patient was asymptomatic with a best-corrected visual acuity of 20/16 in both eyes. On fundoscopy, a prominent smooth pink lesion at the level of the superonasal equatorial retina could be observed in the right eye. Peripheral optical coherence tomography over the area revealed dilated choroidal vessels with an overlying healthy retina. Optical coherence tomography scan was repeated applying gentle globe indentation under which the lesion completely collapsed. CONCLUSION This case illustrates that the diagnosis of a vortex vein varix can be made in clinics using noninvasive tools such as optical coherence tomography. The anatomical localization of the lesion and the pressure-evoked fluctuation of size and shape are important clues which lead to the diagnosis.
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Affiliation(s)
- Karina Spiess
- The Royal Eye Unit, Kingston Hospital, NHS Foundation Trust, Kingston Upon Thames, London, United Kingdom
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14
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Kerolus MG, Kramer DE, Turel MK, Malik R, Fessler RG, Chen M. Preoperative Transvenous Liquid Embolization for a Symptomatic Lumbar Spinal Epidural Varix Mimicking Radiculopathy. Neurol India 2022; 70:1176-1179. [PMID: 35864659 DOI: 10.4103/0028-3886.349671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Symptomatic spinal epidural veins (SEV) are a rare cause of neurologic dysfunction. Treatment is centered upon addressing the underlying venous pathology to relieve mechanical compression of the neurologic structures. However, open surgical ligation is often associated with considerable blood loss. OBJECTIVE We discuss a unique case of a large symptomatic epidural venous varix and potential treatment strategy. METHODS AND MATERIALS A 15-year-old female presented with a 1-year history of left L5 radicular pain and weakness. Lumbar MRI demonstrated a central L5/S1 herniated disc and a large extradural anomalous SEV compressing the exiting left L5 nerve root at the L5/S1 neuroformina. The SEV was treated using a transvenous liquid embolic agent providing symptomatic relief. At 16-months follow-up, she reported recurrent symptoms. She ultimately underwent a left L5/S1 MIS decompression without complication. CONCLUSION Transvenous liquid embolization of large symptomatic SEV may provide temporary neurologic relief and decrease morbidity associated with open surgical treatment options.
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Affiliation(s)
- Mena G Kerolus
- Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL, USA
| | - Dallas E Kramer
- Rush Medical College, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL, USA
| | - Mazda K Turel
- Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL, USA
| | - Rabia Malik
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1121, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL, USA
| | - Michael Chen
- Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855; Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1121, Chicago, IL, USA
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15
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Abstract
PURPOSE OF REVIEW Gastroesophageal varices are common complications of chronic liver diseases (CLDs) and portal hypertension. Small varices have the risk of progressing to larger varices, causing bleeding or even death. Thus, early detection and appropriate management of small varices are necessary. The purpose of this review is to summarize the advance in the recent 5years about diagnosing and managing the small varices in CLDs. RECENT FINDINGS The diagnosing methods of small varices in recent studies include improved endoscopic examinations, such as capsule endoscopy, and many noninvasive methods, including blood tests, ultrasound, computed tomography and magnetic resonance. For the management of small varices, though it is controversial, prevention using nonselective beta-blockers is still an essential part. SUMMARY In this review, we summarize the classification of varices, the invasive and noninvasive diagnostic methods, their performances, and the emerging progression in the management of small varices in the recent 5 years. We hope that this review provides relevant information to understand better and appropriately manage small varices.
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Affiliation(s)
- Ying Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian
| | - Hui Cheng
- Department of Infectious Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian
- Department of Gastroenterology, The Second Affiliated Hospital of Dalian Medical University, Dalian
| | - Jianyong Chen
- Department of Gastroenterology, Jiangxi Provincial People's Hospital, Nanchang
| | - Yifei Huang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hao Liu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
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16
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Baharvand M, Mortazavi H, Eshaghian M, Mirzaei H. Sublingual varicosity as a possible indicator of hypertension. Gen Dent 2022; 70:46-49. [PMID: 35225804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Oral varices are a common acquired vascular malformation that might be associated with several heart diseases. The aim of this study was to investigate whether an association exists between the severity of sublingual varices and stage of hypertension. Oral examinations were conducted, and the sublingual varicosity of 151 patients was categorized as grade 0, 1, or 2 based on severity. The blood pressure of the patients was measured and classified as normal, prehypertension, stage 1 hypertension, or stage 2 hypertension according to the guidelines of the National Heart, Lung, and Blood Institute. Pearson chi-square test, linear-by-linear association, and logistic regression were used for data analysis. Of 151 patients, 91 (60.3%) had sublingual varices, with 68 (45.0%) having grade 1 varicosity and 23 (15.2%) having grade 2. Sublingual varices were seen most frequently (84.4%) in patients older than 60 years. The frequency of hypertension (stage 1 or 2) among the sample was found to be 24.5%. The Pearson chi-square test showed a positive correlation between hypertension and sublingual varicosity (P < 0.0001; γ = 0.499). Logistic regression showed that the risk of hypertension in patients with grades 1 and 2 sublingual varicosity was 2.53 and 7.57 times greater, respectively, than that in patients with grade 0. In addition, sublingual varicosity (grade 1 or 2) was 2.32 times more frequent in men than in women (P = 0.022; 95% CI = 1.12-4.79) and 3.55 times more frequent in smokers than in nonsmokers (P = 0.003; 95% CI = 1.01-1.06). Therefore, sublingual varicosity may be a sign of hypertension.
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Musil D. Development of recommendations for the use of venoactive drugs in the treatment of chronic venous disease - where they are effective and where they are not. Vnitr Lek 2022; 68:234-239. [PMID: 36220421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The article provides an overview of the development of recommendations for indications of venoactive drugs for treating symptoms and signs associated with chronic venous disease (CVD). Venoactive drugs may be beneficial in patients with subjective problems and/or swelling of the lower limbs, after surgery for varicose veins, in chronic venous insufficiency or in microcirculatory disorders. They are not indicated in asymptomatic patients with CVD, in the prevention of varicose veins or to prevent their progression. Drugs with proven efficacy in clinical trials should be preferred.
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18
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Osmanov EM, Manyakov RR, Velichko PB, Zhabina UV, Fabrikantov OL, Nikolashin SI. [Prevalence and detection rate of senile cataract in individuals with cardiovascular diseases]. Vestn Oftalmol 2022; 138:41-47. [PMID: 36004590 DOI: 10.17116/oftalma202213804141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the prevalence of senile cataracts and its detection rate among the population at the age of 40 and older with diseases of the cardiovascular system. MATERIAL AND METHODS This observational cross-sectional study was based on the information extracted from electronic health records (EHR) of patients aged 40-99 years assigned for medical services to a city polyclinic. RESULTS Among the population with essential hypertension (EH) senile cataract occurs with the frequency of 10.4±0.3% (95% CI 9.8-10.9%) of cases, in patients with cerebrovascular diseases (CVD) - 17.1±0.2% (95% CI 16.6-17.5%) of cases, with varicose veins of the lower extremities - 19.9±0.2% (95% CI 19.4-20.3%) of cases, with ischemic heart disease (IHD) - 15.8±0.2% (95% CI 15.4-16.2%) of cases. At the same time, senile cataract is associated with an increase in the likelihood of its detection in patients with hypertension by 6.8 times (OR 6.57; 95% CI 5.89-7.74), with CVD by 5 times (OR 5.02; 95% CI 4.64-5.44), with varicose veins by 3.7 times (OR 3.70; 95% CI 3.34-4.10), with IHD by 3.5 times (OR 3.53; 95% CI 3.20-3.90). Female gender is associated with an increased likelihood of developing senile cataracts in the presence of EH by 1.4 times (OR 1.420; 95% CI 1.299-1.553), in the presence of CVD by 1.2 times (OR 1.199; 95% CI 1.066-1.348), in the presence of varicose veins by 1.4 times (OR 1.355; 95% CI 1.064-1.725), in the presence of IHD by 1.5 times (OR 1.476; 95% CI 1.298-1.679). The detection rate of senile cataract is highest at the ages of 70-79 years, amounting to 18.1% of cases with hypertension, 24.0% of cases with CVD, 29.2% of cases with varicose veins, and 33.7% of cases with ischemic heart disease. CONCLUSION Target population groups have been identified for more effective screening studies in order to detect senile cataracts among them.
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Affiliation(s)
- E M Osmanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - R R Manyakov
- Medical Unit of the Russian Ministry of Internal Affairs in the Tambov Region, Tambov, Russia
| | - P B Velichko
- Tambov Branch of S.N. Fedorov National Medical Research Center "MNTK" Eye Microsurgery", Tambov, Russia
| | - U V Zhabina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O L Fabrikantov
- Tambov Branch of S.N. Fedorov National Medical Research Center "MNTK" Eye Microsurgery", Tambov, Russia
- Derzhavin Tambov State University, Medical Institute, Tambov, Russia
| | - S I Nikolashin
- Tambov Branch of S.N. Fedorov National Medical Research Center "MNTK" Eye Microsurgery", Tambov, Russia
- Derzhavin Tambov State University, Medical Institute, Tambov, Russia
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19
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Zhigalova SB, Shertsinger AG, Manukyan GV, Malov SL, Afzalutdinova AR, Bobyleva YS, Dolgikh TS. [Ectopic duodenal varices as a cause of difficult diagnosis of bleeding in extrahepatic portal hypertension]. Khirurgiia (Mosk) 2022:106-109. [PMID: 35920230 DOI: 10.17116/hirurgia2022081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Bleeding from ectopic varicose veins is a rare life-threatening cause of upper gastrointestinal hemorrhage. Alberti first described duodenal varices in 1931. According to the literature, incidence of duodenal varicose veins in patients with portal hypertension is 1-3% of all varicose veins. Bleeding from duodenal varices makes up 17% of all bleedings from other ectopic varices. Mortality in these patients may be up to 40%. The causes are delayed diagnosis, technical difficulties in endoscopic therapeutic procedures (sclerotherapy, endoscopic ligation), as well as ineffective Blackmore tube for hemorrhage in distal stomach and bowel. We report a rare case of upper gastrointestinal bleeding from ectopic duodenal varices.
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Affiliation(s)
- S B Zhigalova
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A G Shertsinger
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Manukyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - S L Malov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | | | - Ya S Bobyleva
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - T S Dolgikh
- Petrovsky National Research Center of Surgery, Moscow, Russia
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20
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Arnaoutoglou C, Variawa RS, Zarogoulidis P, Ioannidis A, Machairiotis N. Advances of Laparoscopy for the Diagnosis of Pelvic Congestion Syndrome. Medicina (Kaunas) 2021; 57:1041. [PMID: 34684078 PMCID: PMC8539457 DOI: 10.3390/medicina57101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022]
Abstract
The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients' everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.
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Affiliation(s)
- Christos Arnaoutoglou
- 1st Department of Obstetrics & Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece
| | - Rita S. Variawa
- Independent Pharmacovigilance (Evaluation & Risk Management) Scientist, London E14 4HB, UK;
| | - Paul Zarogoulidis
- 3rd Surgery Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece;
| | - Aris Ioannidis
- Surgery Department, “Genesis” Private Clinic, 57001 Thessaloniki, Greece;
| | - Nikolaos Machairiotis
- Fellow in Endometriosis and Minimal Access Surgery, Northwick Park, Central Middlesex and Ealing Hospitals, Acton Ln, London NW10 7NS, UK;
- London North West University Healthcare NHS Trust, London HA1 3UJ, UK
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21
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Gao Y, Zhang X, Li F, Liu H, Ye Q, Wang F, Tang F, Ha F, Yan J, Lv H, Han T. Diagnosis and Treatment of Cirrhosis with Duodenal Variceal Bleeding: a Case Report. Clin Lab 2021; 66. [PMID: 33073949 DOI: 10.7754/clin.lab.2019.191130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cases of duodenal variceal hemorrhage after cirrhosis are rare, but patients have a higher mortality rate. There is currently no clinical guideline to address how such patients should choose preferred treatment. METHODS We retrospectively evaluated the clinical information of a 65-year-old male admitted to the Gastroenterology Department with gastrointestinal bleeding. RESULTS The patient was eventually diagnosed with duodenal variceal bleeding after cirrhosis. We performed TIPS on the patients after the vital signs were stable. No varicose veins were seen by endoscopy during the 2-year follow-up. CONCLUSIONS TIPS treatment is a good choice for patients with severe duodenal varices after cirrhosis.
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22
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Kuni SP, Gupta N, Cherath SK, Das A, Agrawal S, Ish P, Kumar R, Chakrabarti S. A 22-Year-Old Man With Back Pain, Dilated Veins Over Chest, and Mass in Right Atrium. Chest 2021; 158:e335-e341. [PMID: 33280779 DOI: 10.1016/j.chest.2020.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
CASE PRESENTATION A 22-year-old nonsmoker male, without any previous comorbidity, presented with 4 months' history of right upper back pain. Pain was constant dull aching type, nonpleuritic, aggravated by lying on the right lateral side and partially relieved on taking analgesics. He then developed progressive dyspnea over 2 months and noticed dilated veins over his neck and front of chest. There was associated unintentional weight loss of 6 kg. There was no history of cough, expectoration, wheeze, or hemoptysis, nor any episodes of night sweats or fever.
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Affiliation(s)
- Shamil Pannivettum Kuni
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nitesh Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Smrithi Krishna Cherath
- Pathlab-Centre for Advanced Pathology and Microbiology Services, East of Kailash, New Delhi, India
| | - Abanti Das
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sumita Agrawal
- Department of Pulmonary Medicine, Medipulse Hospital, Jodhpur, Rajasthan, India
| | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shibdas Chakrabarti
- Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Chen CW, Ting H, Chen PY, Weng JC, Hsu YC, Wang SC, Tseng YH, Huang YK. Usefulness of triggered non-contrast-enhanced magnetic resonance angiography in assessing lower extremity venous disease. Medicine (Baltimore) 2021; 100:e25809. [PMID: 34011044 PMCID: PMC8137012 DOI: 10.1097/md.0000000000025809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
Although venous duplex ultrasonography (USG) is reliable for diagnosing lower extremity venous disease (LEVD), cross-sectional imaging studies were usually required before intervention or surgery. Patients of LEVD with renal insufficiency usually restrict the use of contrast-enhanced imaging modalities. In seeking an alternative imaging solution for these patients, we explore the clinical utility of triggered angiography non-contrast-enhanced magnetic resonance imaging (TRANCE-MRI) in the assessment of LEVD.We collected data from patients presenting to a tertiary wound-care center with symptoms of LEVD from April 2017-November 2019. Each participant underwent baseline USG followed by TRANCE-MRI on a 1.5T MR scanner (Philips Ingenia, Philips Healthcare, Best, The Netherlands). Inter-rater reliability was measured using Cohen's kappa (κ).All 80 participants (mean age, 61.9 ± 14.8 years; 35 males, 45 females) were assessed and were classified into one of five disease groups, deep vein thrombosis (n = 38), venous static ulcer (n = 16), symptomatic varicose veins (n = 18), recurrent varicose veins (n = 3), and lymphoedema (n = 5). The inter-rater reliability between TRANCE-MRI and doppler USG showed substantial agreement (κ, 0.73). The sensitivity, specificity, and accuracy of TRANCE-MRI were 90.5%, 88.1%, and 88.8%, respectively. In 59 (73.8%) USG-negative patients, we were able to diagnose positive findings (deep venous thrombosis, n = 7; varicose veins, n = 15; lymphedema, n = 10; iliac vein compression with thrombosis, n = 6; external venous compression, n = 5; vena cava anomaly, n = 2; occult peripheral artery disease, n = 5; ccluded bypass graft, n = 1) by using TRANCE-MRI. Of these, 9 (15.3%) patients underwent additional vascular surgery based on positive TRANCE-MRI findings.TRANCE technique provides the limb's entire venous drainage in clear images without background contamination by associated arterial imaging. Additionally, simultaneous evaluation of bilateral lower extremities can help determine the lesion's exact site. Although TRANCE-MRI can provide MR arteriography and MR venography, we recommend performing only MR venography in symptomatic LEVD patients because the incidence of occult arterial disease is low.
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Affiliation(s)
- Chien-Wei Chen
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Physical Medicine and Rehabilitation, Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung
| | - Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Institute of Public Health, School of Medicine, National Yang-Ming University, Yuanpei University of Medical Technology, Taipei and Hsinchu
| | - Jun-Cheng Weng
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Psychiatry, Chang Gung Memorial Hospital Chiayi Branch, Department of Medical Imaging and Radiological Sciences
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan, Taiwan
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Abstract
To review the various quality of life (QoL) scales specific for chronic venous diseases (CVDs) and provide guidance and a reference for researchers to select the ideal measurement scale before studying QoL in patients with CVDs.The EBSCO, Ovid, PubMed, Wanfang, and CNKI databases were searched for the keywords "vein," "quality of life," and "scale/questionnaire," and various scales used to measure QoL in patients with CVDs. The QoL aspects were investigated and researched, and then, the search results were screened and summarized.A total of 10 major scales related to the QoL in patients with CVDs were included. The scales differed in dimension, reliability, validity, scoring method, evaluation method, and scope of application.The investigator should select the chronic venous disease QoL scale according to the research purpose and subjects, and then implement the scale to compare the specific aspects of QoL in patients with different CVDs.
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25
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Shigefuku R, Iwasa M, Yoshikawa K, Takei Y. A Rare Presentation of Intraperitoneal Ectopic Varices Rupture. Intern Med 2021; 60:959-960. [PMID: 33055487 PMCID: PMC8024947 DOI: 10.2169/internalmedicine.6012-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ryuta Shigefuku
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan
| | - Kyoko Yoshikawa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan
| | - Yoshiyuki Takei
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan
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Sayeeda S, Akhtar N, Haque AZ, Kabir MF. Pregnancy with Klippel-Trenaunay Syndrome: A Critical Case Report. Mymensingh Med J 2021; 30:238-242. [PMID: 33397882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Klippel-Trenaunay Syndrome (KTS) is a rare congenital disease characterized by a triad of cutaneous hemangioma (port-wine stain), varicose veins and bone or soft tissue hypertrophy. Cases of pregnancy complicated by KTS are rare and are associated with an increased risk of thrombo-embolic phenomena and hemorrhage. In this case, 33 years old woman, Para 1 gravida 2 (P1G2) with history of previous cesarean section and diagnosed case of KTS was presented in labour emergency of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh at 36+ weeks of gestation with labour pain. She had also a prominent hypertrophy and multiple venous varicosities on both her lower limbs; more marked on left. Her MRI done just before pregnancy revealed few prominent veins in both adnexa particularly on the left with normal caliber ovarian veins and unremarkable other pelvic structures and excludes pelvic congestion syndrome. USG done at her 35 weeks of gestation had shown numerous dilated and tortuous vessels in the parametrium, indicating pelvic congestion. Emergency caesarean section was done under spinal anesthesia. There was no postpartum hemorrhage (PPH). She was discharged along with her baby without any complication on her 4th postoperative day. Successful management of patients with KTS requires multidisciplinary team approach.
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Affiliation(s)
- S Sayeeda
- Dr Syeda Sayeeda, Associate Professor, Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh: E-mail:
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Kim HW, Yoon JS, Yu SJ, Kim TH, Seol JH, Kim D, Jung JY, Jeong PH, Kwon H, Lee HS, Lee SH, Choi JS, Park SJ, Jee SR, Lee YJ, Seol SY. Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report. Korean J Gastroenterol 2020; 76:331-336. [PMID: 33361709 DOI: 10.4166/kjg.2020.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 06/12/2023]
Abstract
Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.
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Affiliation(s)
- Hyun Woo Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Seung Jung Yu
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Tae Heon Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jae Heon Seol
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Dan Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jun Young Jung
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Pyeong Hwa Jeong
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jung Sik Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sung Jae Park
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sam Ryong Jee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Youn Jae Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sang Yong Seol
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
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Affiliation(s)
- M Adam Ali
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.
| | - Matthew Colquhoun
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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Ney B, Diserens C, Vial Y, Mazzolai L. [Pelvic congestion syndrome]. Rev Med Suisse 2020; 16:2042-2045. [PMID: 33112517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pelvic congestion syndrome is an underdiagnosed disease, defined as chronic pelvic pain lasting more than 6 months, associated with pelvic varicose veins in premenopausal women. Diagnose is based on imagery after exclusion of other causes of pelvic pains. Echography is first line diagnostic modality. Conservative treatment is often insufficient and pelvic veins embolization is required to improve symptoms.
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Affiliation(s)
- Barbara Ney
- Service d'angiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
| | - Cécile Diserens
- Service de gynécologie, Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - Yvan Vial
- Service de gynécologie, Département femme-mère-enfant, CHUV, 1011 Lausanne
| | - Lucia Mazzolai
- Service d'angiologie, Département cœur-vaisseaux, CHUV, 1011 Lausanne
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Yang HC, Chon HK. Budd-Chiari syndrome presenting with abdominal wall varices. Korean J Intern Med 2020; 35:1259-1260. [PMID: 31878770 PMCID: PMC7487289 DOI: 10.3904/kjim.2019.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hee Chan Yang
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hyung Ku Chon
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
- Correspondence to Hyung Ku Chon, M.D. Tel: +82-63-859-2564 Fax: +82-63-855-2025 E-mail:
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Hultman KH, Sinabulya H, Blomgren L. Validation of a Swedish version of a short patient-reported outcome measure for superficial venous insufficiency. J Vasc Surg Venous Lymphat Disord 2020; 9:416-422.e4. [PMID: 32736096 DOI: 10.1016/j.jvsv.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patient-reported outcome measures (PROMs) are increasingly used to measure symptoms and treatment effects, and a short PROM is more user friendly. The aim of this study was to test whether a Swedish seven-item version of the PROM used in the Vascular Quality Initiative Varicose Vein Registry can be used to measure quality of life in a Swedish cohort of patients with superficial venous insufficiency (SVI) equally well as the 26-item Swedish version of the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym-S) and measure treatment effect. METHODS Consecutive patients with SVI and Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical class ≥C2 were recruited at three private clinics and one county hospital between January 2018 and October 2019. The patients were asked to answer both the VEINES-QOL/Sym-S and the Swedish seven-item version, called VARIShort, at two assessment points, baseline (cohort 1, 252 patients) and 1 week later (cohort 2, 138 patients), and the VARIShort at baseline and 8 weeks after an endovenous procedure (cohort 3, 106 patients). The mean age was 58.3 years (range, 20-93 years), 61.4 years (range, 20-93 years), and 57.2 years (range, 20-89 years) in cohorts 1, 2, and 3, respectively; the majority were female (59%, 55%, and 64%), and most were CEAP C4 (39%, 46%, and 38%). The VARIShort was evaluated with regard to its validity, test-retest reliability, internal consistency reliability, sensitivity, and responsiveness. RESULTS There was a strong correlation between the VEINES-QOL-S and the VARIShort (rs = -0.819; P < .001). The VARIShort showed both excellent internal consistency with Cronbach's α of 0.93 and a high response to clinical change as measured with Cohen's d, overall score of 1.17. CONCLUSIONS The Swedish seven-item PROM, the VARIShort, may be used for assessment of symptoms of SVI and outcome after treatment in Swedish SVI patients. The short PROM shows degree of SVI symptom impact on quality of life in the same manner as the 26-item VEINES-QOL/Sym-S.
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Affiliation(s)
| | - Helen Sinabulya
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lena Blomgren
- Department of Cardiothoracic and Vascular Surgery, Karlskoga Vein Clinic, Örebro, Sweden; Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
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Affiliation(s)
- Eleanor Atkins
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Nadeem A Mughal
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Patrick A Coughlin
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Fokin AA, Borsuk DA, Zhdanov KO. [Possibilities of endovenous laser obliteration of subcutaneous veins with tumescence by cold saline solution]. Angiol Sosud Khir 2020; 26:56-61. [PMID: 32240137 DOI: 10.33529/angio2020110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM The purpose of the present study was to assess the possibility of carrying out endovenous laser obliteration (EVLO) with radial light guides on a laser device operating at a wavelength of 1470 nm, using for tumescence only cold normal saline solution without additional sedation or narcosis in patients with allergy to local anaesthetics. PATIENTS AND METHODS Our prospective non-comparative single-centre study consecutively included 37 patients who from November 2014 to June 2019 underwent a total of 41 isolated EVLO procedures without simultaneous miniphlebectomy or sclerotherapy of tributaries. Given the previous history of allergy to amide-group local anaesthetics and/or multiple allergic reactions to other agents, these patients received as anaesthesia and tumescence exclusively normal saline solution cooled to a temperature of +3-6ºC, without addition of local anaesthetics or any other therapeutic agents, with neither sedation nor narcosis. RESULTS The great saphenous vein was subjected to coagulation in 33 (80.5%) cases, the anterior accessory saphenous vein in 5 (12.2%), and the small saphenous vein in 3 (7.3%) cases. The median of the mean diameter of the veins at 3 cm from the saphenofemoral or saphenopopliteal junction amounted to 10 mm (1st quartile 8.2; 3rd quartile 11). The median of the mean length of the coagulated vein - 45 cm (1st quartile 22; 3rd quartile 51), the median of the average amount of the administered normal saline solution - 300 ml (1st quartile 200; 3rd quartile 450), the median of the average amount of normal saline per 1 centimetre of the venous length - 8.7 ml (1st quartile 7.5; 3rd quartile 10). All patients without exception tolerated the intervention. The process of laser obliteration was not discontinued due to pronounced perioperative pain syndrome in any case. All patients after the procedure answered the question 'Would you repeat a similar intervention if the need arises?' in the affirmative. All the 41 (100 %) veins subjected to coagulation were obliterated at early terms of follow up, with no ultrasonographic evidence of recanalization. CONCLUSION The obtained findings suggest a possibility of performing EVLO in patients with an allergy-burdened history in relation to local anaesthetics using for tumescence exclusively normal saline solution chilled to a temperature of +3-6ºC, with no additional sedation or narcosis. Such an approach makes it possible, on the one hand, not to change the organization of outpatient phlebological care and on the other hand to refuse from involving anaesthesiological support. Besides, it is absolutely safe in relation to the risk for the development of allergic reactions.
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Affiliation(s)
- A A Fokin
- Department of Surgery, Institute of Additional Professional Education, South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia
| | - D A Borsuk
- Clinic of Phlebology and Laser Surgery, Chelyabinsk, Russia
| | - K O Zhdanov
- Clinic of Phlebology and Laser Surgery, Chelyabinsk, Russia
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Tsukanov IT, Nikolaĭchuk AI, Nikolaĭchuk TV. [Efficacy of medicamentous treatment of transient premenstrual phlebopathy of lower limbs]. Angiol Sosud Khir 2020; 26:74-80. [PMID: 32240140 DOI: 10.33529/angio2020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM The purpose of the study was to examine changes of the clinical pattern and the great saphenous vein in women with premenstrual leg heaviness and distal oedema in repetitive 15-day courses of micronized purified flavonoid fraction, initiated in the second half of the menstrual cycle. PATIENTS AND METHODS A total of 39 parous women (mean age 31.3±7.9 years) with premenstrual leg heaviness were examined on days 1-4 (menstrual phase) and days 25-28 (secretory phase). The clinical pattern and the state of the veins were compared before and 3 months after 15-day courses of micronized purified flavonoid fraction. RESULTS Leg heaviness decreased from 39 (100%) cases to 4 (14.3%) and intensity according to the VAS-10 from 5.2 (95% CI: 4.7 5.7) to 0.3 (85% CI: 0.0-0.6) (p<0.0001). During the secretory phase after treatment the great saphenous vein in the groin decreased from 5.94 mm to 5.02 in the morning and from 6.56 mm to 5.43 mm in the evening. In the reflux zone during the secretory phase the great saphenous vein decreased from 6.45 mm to 5.03 mm in the morning and from 7.32 mm to 5.45 mm in the evening (p=0.00001), which became in this zone equal to its diameter in the inguinal region. As the result, in all patients there was no reflux in the morning, and the evening reflux decreased to 6 (15.4%) cases. CONCLUSION Repetitive 15-day courses of micronized purified flavonoid fraction, initiated 15 days before menstruation at a dose of 1000 mg daily ensured in 85.3% of women with premenstrual transient phlebopathy the removal of premenstrual leg heaviness, a significant decrease in swelling, normalization of the diameter of the great saphenous vein, including the reflux zone and complete elimination of morning transitory premenstrual reflux in the great saphenous vein.
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Affiliation(s)
- Iu T Tsukanov
- Department of Surgical Diseases and Urology, Omsk State Medical University of the RF Public Health Ministry, Omsk, Russia
| | - A I Nikolaĭchuk
- Department of Surgical Diseases and Urology, Omsk State Medical University of the RF Public Health Ministry, Omsk, Russia
| | - T V Nikolaĭchuk
- Department of Surgical Diseases and Urology, Omsk State Medical University of the RF Public Health Ministry, Omsk, Russia
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van Montfrans C, De Maeseneer MGR. Atrophie Blanche (C4b) Can Be Reversible After Targeted Treatment. Eur J Vasc Endovasc Surg 2019; 58:435. [PMID: 31400922 DOI: 10.1016/j.ejvs.2019.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
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Raetz J, Wilson M, Collins K. Varicose Veins: Diagnosis and Treatment. Am Fam Physician 2019; 99:682-688. [PMID: 31150188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Varicose veins are twisted, dilated veins most commonly located on the lower extremities. The exact pathophysiology is debated, but it involves a genetic predisposition, incompetent valves, weakened vascular walls, and increased intravenous pressure. Risk factors include family history of venous disease; female sex; older age; chronically increased intra-abdominal pressure due to obesity, pregnancy, chronic constipation, or a tumor; and prolonged standing. Symptoms of varicose veins include a heavy, achy feeling and an itching or burning sensation; these symptoms worsen with prolonged standing. Potential complications include infection, leg ulcers, stasis changes, and thrombosis. Conservative treatment options include external compression; lifestyle modifications, such as avoidance of prolonged standing and straining, exercise, wearing nonrestrictive clothing, modification of cardiovascular risk factors, and interventions to reduce peripheral edema; elevation of the affected leg; weight loss; and medical therapy. There is not enough evidence to determine if compression stockings are effective in the treatment of varicose veins in the absence of active or healed venous ulcers. Interventional treatments include external laser thermal ablation, endovenous thermal ablation, endovenous sclerotherapy, and surgery. Although surgery was once the standard of care, it largely has been replaced by endovenous thermal ablation, which can be performed under local anesthesia and may have better outcomes and fewer complications than other treatments. Existing evidence and clinical guidelines suggest that a trial of compression therapy is not warranted before referral for endovenous thermal ablation, although it may be necessary for insurance coverage.
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Affiliation(s)
- Jaqueline Raetz
- University of Washington Family Medicine Residency, Seattle, WA, USA
| | - Megan Wilson
- University of Washington Family Medicine Residency, Seattle, WA, USA
| | - Kimberly Collins
- University of Washington Family Medicine Residency, Seattle, WA, USA
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Jurga-Karwacka A, Karwacki GM, Schoetzau A, Zech CJ, Heinzelmann-Schwarz V, Schwab FD. A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain. PLoS One 2019; 14:e0213834. [PMID: 30939134 PMCID: PMC6445463 DOI: 10.1371/journal.pone.0213834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/03/2019] [Indexed: 02/04/2023] Open
Abstract
Objectives Pelvic congestion syndrome is defined as chronic pelvic pain due to incompetent (dilated and refluxing) pelvic veins. The aim of this study was to investigate the prevalence of this condition by examining the prevalence of dilated ovarian and para-uterine veins in pre- and postmenopausal female patients, irrespective of their symptoms. We subsequently investigated how many women with dilated veins suffered from chronic pelvic pain. Additionally, we attempted to define diagnostic criteria that may allow for early identification of affected patients. Methods We reassessed 2384 abdomino-pelvic computed tomography scans performed on women at our institution. The maximal diameters of the ovarian and para-uterine veins were measured. Patients with a pathological process in the abdomen or pelvis affecting the veins were excluded. We considered ovarian vein dilation to be 6 mm or more in the axial plane. For patients that met these criteria, we performed a retrospective chart review to evaluate the clinical presentation and/or symptoms of these patients. Results Dilated pelvic veins were present in 293/2384 (12%) patients, 118/559 premenopausal (21%) and 175/1825 postmenopausal (10%). Chronic pelvic pain of unclear etiology had been documented prior to the CT in 54/293 (18%) women with dilated veins—2% of the whole study collective (54/2384); 8% of all premenopausal (44/559) and 0.5% of all postmenopausal (10/1825). It was often accompanied by urological symptoms such as hematuria, dysuria, and urinary frequency, in the absence of infection (p<0.05). We identified a strong correlation between the presence of dilated ovarian veins and chronic pelvic pain in premenopausal parous patients with hematuria. Conclusions Pelvic congestion syndrome appears to be an underdiagnosed and undertreated disease. In our study, 8% of all premenopausal women had documented chronic pelvic pain of unclear etiology and dilated ovarian and pelvic veins on cross-sectional imaging studies. The features we identified in this study as most relevant should enable a faster identification of patients who could benefit from a specific treatment regimen for this condition.
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Affiliation(s)
- Agnieszka Jurga-Karwacka
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
| | - Grzegorz M. Karwacki
- Clinic of Radiology & Nuclear Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Christoph J. Zech
- Clinic of Radiology & Nuclear Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
- Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Fabienne D. Schwab
- Department of Gynecology and Gynecological Oncology, University Women`s Hospital of Basel, University of Basel, Basel, Switzerland
- * E-mail:
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Abstract
Risk factors for the development of progression chronic venous disease (CVD) and varicose veins are widespread and include advanced age, excess body weight, sedentary lifestyles and occupations, family history, and pregnancy. Varicose veins and CVD are associated with venous hypertension, venous reflux, dysfunctional venous valves, and vein wall inflammation, though the precise etiologies are unclear. Once venous pathology develops, it can progress through a vicious cycle of inflammation and leukocyte recruitment that leads to further deterioration of vein walls and valves, increased hypertension, and release of additional proinflammatory mediators. Early treatment of symptomatic varicose veins and CVD as well as lifestyle changes can help break the inflammatory cycle and alleviate symptoms. Physicians and patients should be aware of the risk factors for CVD, the treatments and measures available to slow disease progression, and the serious consequences of allowing the disease to progress unchecked. Funding: Servier (France).
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Affiliation(s)
- Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
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Romano J, Welden CV, Orr J, McGuire B, Shoreibah M. Case Series Regarding Parastomal Variceal Bleeding: Presentation and Management. Ann Hepatol 2019; 18:250-257. [PMID: 31113601 DOI: 10.5604/01.3001.0012.7934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/18/2018] [Indexed: 02/04/2023]
Abstract
Parastomal variceal bleeding (PVB) is a serious complication occurring in up to 27% of patients with an ostomy and concurrent cirrhosis and portal hypertension. The management of PVB is difficult and there are no clear guidelines on this matter. Transjugular intrahepatic portosystemic shunt (TIPS), sclerotherapy, and /or coil embolization are all therapies that have been shown to successfully manage PVB. We present a case series with five different patients who had a PVB at our institution. The aim of this case series is to report our experience on the management of this infrequently reported but serious condition. We also conducted a systemic literature review focusing on the treatment modalities of 163 patients with parastomal variceal bleeds. In our series, patient 1 had embolization and sclerotherapy without control of bleed and expired on the day of intervention due to hemorrhagic shock. Patient 2 had TIPS in conjunction with embolization and sclerotherapy and had no instance of rebleed 441 days after therapy. Patient 3 did not undergo any intervention due to high risk for morbidity and mortality, the bleed self-resolved and there was no further rebleed, this same patient died of sepsis 73 days later. Patient 4 had embolization and sclerotherapy and had no instance of rebleed 290 days after therapy. Patient 5 had TIPS procedure and was discharged five days post procedure without rebleed, patient has since been lost to follow-up.
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Affiliation(s)
- John Romano
- Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA.
| | - Charles V Welden
- Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jordan Orr
- Department of Medicine, Division of Gastroenterology and Hepatology, Vanderbilt University, Nashville TN, USA
| | - Brendan McGuire
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham AL, USA
| | - Mohamed Shoreibah
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham AL, USA
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40
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Ahmad S. Internal jugular phlebectasia in an adult - rare cause of neck swelling. J PAK MED ASSOC 2018; 68:1733. [PMID: 30410165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
PURPOSE To report three cases of varix of the vortex vein ampulla. METHODS Observational small case series. During 2002, three patients were examined for suspected choroidal melanoma. In all cases, the lesions were located at the equator or the periphery. RESULTS The lesions became more prominent when the eyes were positioned in the direction of the lesion, and disappeared when firm pressure by ultrasound probe was applied on the globe, while the eye was in primary position, or fundus was examined with a three-mirror Goldmann contact lens. These dynamic characteristics were also demonstrated by color Doppler imaging. CONCLUSIONS Varix of the vortex vein ampulla is an extremely rare condition. This diagnosis should be considered when an elevated choroidal lesion disappears when the fundus is examined with contact lens.
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Affiliation(s)
- J Levy
- Department of Ophthalmology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Gavrilov SG, Karalkin AV, Moskalenko EP, Savinkova KY. [State of the venous outflow from the small pelvis after surgical correction of pelvioperineal reflux]. Angiol Sosud Khir 2018; 24:90-94. [PMID: 30531775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The study was aimed at assessing the venous outflow from the small pelvis after surgical correction of pelvioperineal reflux with the use of reference methods of examination. PATIENTS AND METHODS We examines a total of 43 female patients (aged 41.5±5.2 years) presenting with pelvic varicose veins and subjected to phlebectomy on the external genitalia, perineum and lower limbs. All women had no evidence of pelvic venous plethora. All women underwent the following examinations: ultrasonographic angioscanning of pelvic and lower-limb veins, emission computed tomography of pelvic veins prior to operation, as well as 1, 6 and 12 months after surgical interventions. We evaluated efficacy of phlebectomy in elimination of pelvioperineal reflux and varicose syndrome, the frequency of detecting valvular insufficiency of pelvic and lower-limb veins, dynamics of the coefficient of pelvic congestion syndrome in the immediate and remote postoperative periods. RESULTS AND DISCUSSION No cases of relapses of valvular, perineal varicosity, repeat appearance of varicose veins on the lower extremities, occurrence of signs of pelvic venous congestion were revealed. The frequency of detecting valvular insufficiency of the parametrial, uterine, gonadal and iliac veins remained unchanged. The coefficient of pelvic congestion syndrome did not alter either (Cpcs=0.8±0.11 at baseline versus Cpcs=0.78±0.1 after 12 months). CONCLUSION The obtained results are indicative of a steady state of the venous outflow from the small pelvis in women with pelvic varicose veins and pelvioperineal reflux after surgical removal of vulvar, perineal and superficial femoral veins.
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Affiliation(s)
- S G Gavrilov
- Chair of Faculty Surgery #1, Therapeutic Department, Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
| | - A V Karalkin
- Municipal Clinical Hospital #1 named after N.I. Pirogov, Moscow, Russia
| | - E P Moskalenko
- Municipal Clinical Hospital #1 named after N.I. Pirogov, Moscow, Russia
| | - K Yu Savinkova
- Chair of Faculty Surgery #1, Therapeutic Department, Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
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Dibirov MD, Shimanko AI, Gadzhimuradov RU, Volkov AS, Tiurin DS, Magdiev AK. [Radiofrequency ablation in comprehensive surgical treatment of patients with varicose veins of lower limbs]. Angiol Sosud Khir 2018; 24:92-96. [PMID: 29688199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Analysed herein are the results of using radiofrequency ablation (RFA) in comprehensive surgical treatment of patients presenting with varicose veins of the lower extremities. The study included a series of ninety-eight 28-to-60-year-old patients (with a total of 105 operations performed) suffering from varicose veins of the lower limbs. Of these, there were 10 men (10.3%) and 88 women (89.7%). Venous disease of clinical class C2 according to the CEAP classification was diagnosed in 80 patients, that of class C3 in 17, and that of class C4a in 1 patient. The procedure of RFA was performed by means of the VNUS device model RF62. The impact was exerted in an automatic mode, maintaining the catheter's temperature at 120° C during a 20-second treatment cycle for each 7 cm of the vein's length. In all cases, each 7-cm-long venous segment to be treated was acted upon 4 times. Forty-five patients after RFA underwent ultrasonographic monitoring performed first on POD 7 and then at 3, 6, 12 and 24 months. Recanalization of the trunk of the great saphenous vein (GSV) was registered in 3 (2.8%) cases at terms up to 3 months after the operation. In 2 cases recanalization turned out to be provoked by an incompetent perforant vein in the lower third of the femur. Seven (6.6%) patients with a large diameter of the great saphenous vein were found to develop post-closure hyperpigmentation which resolved spontaneously 8 months later. The remaining patients, with strict adherence to the indications for RFA, demonstrated complete obliteration of the vessel treated, with no recanalization observed ultrasonographically 10-12 months after the procedure. An additional experimental study with a morphological analysis confirmed appropriateness of carrying out four 20-second treatment cycles of RFA in each segment of the vein. A conclusion was made that RFA used in comprehensive surgical treatment for varicose veins of the lower limbs makes it possible to attain good therapeutic and cosmetic results that persist over time, if conducted in compliance with the mentioned fundamentally essential peculiarities of performing the procedure.
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Affiliation(s)
- M D Dibirov
- Department of Surgical Pathology and Clinical Angiology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - A I Shimanko
- Department of Surgical Pathology and Clinical Angiology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - R U Gadzhimuradov
- Department of Surgical Pathology and Clinical Angiology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - A S Volkov
- Joint Hospital with Polyclinic of the Administration of the RF President's Affairs, Moscow, Russia
| | - D S Tiurin
- Department of Surgical Pathology and Clinical Angiology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - A Kh Magdiev
- Department of Surgical Pathology and Clinical Angiology, Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
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Bogachev VI, Kuznetsov MR, Lobanov VN, Turkin PI. [Cryocompression sclerotherapy of reticular veins and teleangiectasias]. Angiol Sosud Khir 2018; 24:92-97. [PMID: 30321152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Compression serves as an important component for carrying out successful and safe phlebosclerosing treatment. At the same time, the necessity of wearing compression hosiery or bandages is associated with known limitations and objections of patients, especially in a hot season. We comparatively assessed efficacy of usual compression stockings and a short-term pneumatic bandage with cryoelements while carrying out sclerosing treatment of dilated intradermal veins. Our open prospective observational study included a total of fifty 18-to-35-year-old women. After performing standardized sclerotherapy of reticular veins and telangiectasias on the symmetrical portions of the lower limbs, a pneumatic cryocompression bandage with a pressure of 50 mmHg was applied onto one of the limbs for 15 minutes, with a class 2 compression (RAL standard) medical stocking put on the other limb to be worn by the patients at daytime for 10 days. We assessed completeness of obliteration of the target veins, frequency of the development of typical undesirable events (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as the composite discomfort score according to an 11-point visual analogue scale. It was determined that using the pneumatic bandage with cryoelements as compared with the traditional compression stockings significantly decreased the frequency of the development of typical undesirable events after phlebosclerosing treatment, such as formation of ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis. Significance of differences was revealed as early as 7 days after sclerotherapy, to be increasing during further dynamic follow up. By convenience for the patients, the use of the short-term pneumatic cryobandage was four times better than wearing the compression stockings. A conclusion was drawn that while carrying out sclerotherapy of reticular veins and telangiectasias short-term pneumatic cryocompression by efficacy and safety was not inferior to the traditional medical stockings (RAL standard) and made it possible to significantly decrease the incidence of the known undesirable events after phlebosclerosing treatment.
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Affiliation(s)
- V Iu Bogachev
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia
| | - M R Kuznetsov
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia
| | - V N Lobanov
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia
| | - P Iu Turkin
- Russian National Research Medical University named after N.I. Pirogov under the RF Ministry of Public Health, Moscow, Russia
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Akhmetzianov RV, Bredikhin RA. [Clinical efficacy of Detralex in treatment of women with pelvic varicose veins]. Angiol Sosud Khir 2018; 24:93-99. [PMID: 29924779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Presented herein are the results of using Detralex in conservative treatment of women suffering from pelvic varicose veins. Our open prospective study included a total of 30 women with various forms of the course of the disease. All patients took Detralex prescribed at a daily dose of 1,000 mg for 60 days. Dynamic assessment of clinical manifestations of pelvic varicose veins in this cohort of patients was carried out with the help of a specialized quality-of-life questionnaire, an adapted clinical scale of determining disease severity, as well as a visual analogue scale for assessment of the main symptoms of the disease manifestations. The questionnaires and scales were filled in before the beginning of taking the drug and immediately after stopping it. The obtained findings objectively confirmed efficacy of conservative therapy in the majority of the responders. Reported was a decrease in the average index of quality of life from 46.77±13.25 to 36.87±8.53 points (p=0.001). The mean score of the clinical scale of disease severity regressed from 10.8±5.06 to 6.97±3.9 points (p=0.002). The average composite score for the degree of the main symptoms of the disease according to the visual analogue scale decreased from 32.9±21.26 to 19.16±16.04 points (p=0.006). We observed a dramatic decrease in severity of manifestations of the main clinical symptoms and improvement of quality of life of women on the background of taking the drug, thus suggesting its efficacy for the pathological condition concerned. The obtained results make it possible to recommend routine prescription of Detralex to all women with detected pelvic varicose veins as one of the main components of basic pharmacotherapy.
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Affiliation(s)
- R V Akhmetzianov
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Course of Cardiovascular Surgery of the Kazan State Medical University, Kazan, Russia
| | - R A Bredikhin
- Interregional Clinical and Diagnostic Centre, Kazan, Russia; Course of Cardiovascular Surgery of the Kazan State Medical University, Kazan, Russia
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Lin IC, Lee CT, Hsu YC, Tseng CM. An unusual cause of upper gastrointestinal bleeding. Dig Liver Dis 2018; 50:92. [PMID: 28822730 DOI: 10.1016/j.dld.2017.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Affiliation(s)
- I-Chang Lin
- Department of Radiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Yao-Chun Hsu
- Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chao-Ming Tseng
- Department of Internal Medicine, E-Da Cancer Hospital, I-Shou University, Kaohsiung City, Taiwan; Taiwan Association for the Study of Small Intestinal Diseases, Taiwan.
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Khorev NG, Beller AV, Kon'kova VO, Shoĭkhet IN. [Temporary tamponing of the canal while removing the great saphenous vein in elderly patients]. Angiol Sosud Khir 2018; 24:101-106. [PMID: 29924780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the study was to optimize the technique of removing the trunk of the great saphenous vein (GSV) in patients over 60 years. The study included a total of eighty-five patients aged over 60 years and presenting with primary varicose veins of the lower limbs and undergoing operations performed on the superficial venous system, including all stages of classical phlebectomy - crossectomy, stripping of the GSV, removal of tributaries and ligation of incompetent perforant veins. The patients were divided into two groups: the Study Group (n=44) patients endured removal of the GSV with the use of the technique of temporal tamponing of the canal, while in Group Two patients, composing a comparison group (n=41), the GSV was removed without the use of a tampon. The groups of the patients were comparable by the main characteristics, as well as by the CEAP class and the types of the operations performed. The results of treatment were studied clinically with the use of the Venous Clinical Severity Score (VCSS). In the Study Group patients, the average VCSS score decreased from 1.52±0.11 to 0.47±0.05 (p=0.007) and in the Comparison Group from 1.21±0.11 to 0.85±0.06 (p=0.028). In the remote terms after the operation, in the Study Group patients the average VCSS score appeared to be 2 times lower than in the control group, amounting to 0.47±0.05 and 0.85±0.06, respectively (p=0.007). A conclusion was drawn that in surgical treatment of varicose veins in elderly and aged patients while removing the grate saphenous vein, it is appropriate to use the technique of temporary tamponing of the canal, which is associated with better results in the remote period as compared to the traditional stripping.
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Affiliation(s)
- N G Khorev
- Altai State Medical University of the RF Ministry of Public Health, Barnaul, Russia; Departmental Clinical Hospital at the Barnaul Station of the Open Joint Stock Company 'Russian Railways', Barnaul, Russia
| | - A V Beller
- Departmental Clinical Hospital at the Barnaul Station of the Open Joint Stock Company 'Russian Railways', Barnaul, Russia
| | - V O Kon'kova
- Altai State Medical University of the RF Ministry of Public Health, Barnaul, Russia
| | - Ia N Shoĭkhet
- Altai State Medical University of the RF Ministry of Public Health, Barnaul, Russia
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Fokin AA, Borsuk DA, Vasiliev IS, Shaldina MV. [Damage to subcutaneous nerves in endovenous laser coagulation of the great saphenous vein]. Angiol Sosud Khir 2018; 24:81-87. [PMID: 30531774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to assess the incidence of the development of symptoms of damage to subcutaneous nerves after endovenous laser coagulation (EVLC) of the great saphenous vein (GSV), as well as to determine the effect of these symptoms on quality of life (QoL) of patients. Our retrospective study enrolled a total of 119 patients (mean age 50±13.9 years) subjected to 151 isolated EVLC of the GSV. The average volume of the injected anaesthetic per 1 cm of the vein's length amounted to 8.5±1.9 ml. Puncture of the GSV at the level of the thigh was performed in 37 (24.5%) cases, at the level of the crus in 114 (75.5%) cases. The intervention was performed at the power 5-10 W and linear density of energy approximately 70 J/cm. The median of the follow up period amounted to 264 days. The patients were interrogated by phone. The questionnaire included leading, understandable for patients questions about the presence of postoperative complaints characteristic of damage to subcutaneous nerves, as well as the question about the effect of these complaints on quality of life. The complaints characteristic of damage to subcutaneous nerves were reported for 61 (40.4%) operated limbs, with these symptoms decreasing quality of life only in 7 (4.6%) cases. All respondents noted gradual regression of the symptoms with time. The median of symptom relief amounted to 2 months. The analysis of interrelationship between the level of puncture by the thirds of the femur and crus and the damage of subcutaneous nerves demonstrated no statistically significant association (p=0.108), unlike the analysis by the femur/crus level, wherein the infragenicular puncture significantly increased the risk of traumatisation of subcutaneous nerves (p=0.022). No statistically significant differences by the frequency of damage to subcutaneous nerves depending on the power of energy were revealed (p=0.662). The obtained findings make it possible to recommend EVLC, including with puncture of the GSV below the knee, for patients with varicose veins in this basin.
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Affiliation(s)
- A A Fokin
- Department of Surgery, Institute of Additional Professional Education, South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia
| | - D A Borsuk
- Clinic of Phlebology and Laser Surgery, Chelyabinsk, Russia
| | - I S Vasiliev
- Department of Plastic Surgery and Cosmetology, South Ural State Medical University, Chelyabinsk, Russia
| | - M V Shaldina
- Department of Surgery, Institute of Additional Professional Education, South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia
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Tsukanov IT, Tsukanov AI. [Functional assessment of primary lesion of the great saphenous vein when deciding upon stripping]. Angiol Sosud Khir 2018; 24:115-120. [PMID: 29688203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the study was to examine a possibility of functional assessment of the great saphenous vein (GSV) with the help of a day orthostatic loading test for prognosis of restoration of the function of the GSV afterremoving its varicose tributaries in patients with primary varicose veins. Our prospective study included a total of sixty-five 29-to-53-year-old patients (15 men and 50 women, mean age - 36.7 years). The total number of the lower limb examined amounted to 87. All patients underwent ultrasonographic examination (duplex scanning) prior to operation, 1 and 12 months thereafter. The study was carried out using a day orthostatic loading test consisting in duplex scanning performed twice during 24 hours: in the evening after 18:00 hours and in the morning before 10:00 hours after a good night's rest. It was demonstrated that the day orthostatic loading test characterized the degree of preservation of the muscular-tonic properties of the GSV, making it possible to predict reversibility of reflux along it after removing the varicose tributaries, hence it may be used as a criterion for individualization of the choice of the scope of surgical intervention. A high orthostatic gradient prior to operation suggests preservation of the potential of the muscular-tonic function of the GSV; its decrease after surgery demonstrates reduction of the volemic loading on the GSV.
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Affiliation(s)
- Iu T Tsukanov
- Omsk State Medical University under the Ministry of Public Health of the Russian Federation, Omsk, Russia
| | - A Iu Tsukanov
- Omsk State Medical University under the Ministry of Public Health of the Russian Federation, Omsk, Russia
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Zolotukhin IA, Seliverstov EI, Shevtsov YN, Avakiants IP, Nikishkov AS, Tatarintsev AM, Kirienko AI. Prevalence and Risk Factors for Chronic Venous Disease in the General Russian Population. Eur J Vasc Endovasc Surg 2017; 54:752-758. [PMID: 29031868 DOI: 10.1016/j.ejvs.2017.08.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/18/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE/BACKGROUND The aim was to establish the prevalence of chronic venous disease (CVD) and its risk factors in the general population. METHODS This was a population based, cross sectional study. In total, 703 residents aged > 18 years from the rural community of Kryukovo (Central Russia) were enrolled. Medical history was taken and clinical examination performed, documenting venous signs/symptoms. The CEAP classification of the most affected limb was used. Duplex ultrasound was performed to register morphological changes and reflux in deep and superficial veins. RESULTS There were 63% women and 37% men (mean age 53.5 years). CVD was found in 69.3%. Of all participants 4.7% were C0S and 34.3% were C1. Chronic venous insufficiency (C3-C6) was found in 8.2% and venous ulcers (C5-C6) in 1.1%. Venous pain, heaviness, fatigue, itching, and the sensation of swelling were documented in 14.8%, 36.3%, 32.8%, 7.0% and 29.1% of patients respectively. Family history was the significant risk factor for both CVD (hazard ratio [HR] 1.3) and primary varicose vein disease (HR 1.6; p < .01). Female sex was a risk factor only for CVD (HR 1.3; p < .01) but not for varicose veins. Age was a risk factor for CVD (HR 1.01) and for varicose veins (HR 1.02; p < .01). For women, number of births (HR 1.05; p < .05) and menopause (HR 1.3; p < .01) were risk factors for CVD. Menopause was a risk factor for varicose veins (HR 2.0; p < .05). CONCLUSION This study provides data on the prevalence of CVD, venous abnormalities and risk factors in Russia. The results contribute to already established data, giving a more complete outlook on the global prevalence of CVD.
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Affiliation(s)
- Igor A Zolotukhin
- Pirogov Russian National Research Medical University, Moscow, Russia.
| | | | | | - Ilona P Avakiants
- Pirogov Russian National Research Medical University, Moscow, Russia
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