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Phlebology May 2024Sparing the Great Saphenous Vein capital for possible arterial substitution and recurrence decrease may be an alternative to current ablation options for Varicose Veins... (Review)
Review
BACKGROUND
Sparing the Great Saphenous Vein capital for possible arterial substitution and recurrence decrease may be an alternative to current ablation options for Varicose Veins treatment. Conservative surgery of varicose veins (CHIVA) was suggested in 1988 by Franceschi, by limited veins interruptions in strategic points. However, the method did not diffuse due to the need for high Duplex expertise to determine the procedure in every single patient.
METHOD
Evaluation of the literature regarding saphenous sparing, with special reference to CHIVA.
RESULT
It has been realized that basic Ultrasound expertise is sufficient for performing GSV conservation. Most of the time, only a few parameters are needed: a junction competence assessment and a re-entry perforator position.
CONCLUSION
For achieving the goal of saphenous conservative treatment, a limited phlebectomy and possible Junction interruption (crossotomy) may be a simplified solution.
Topics: Humans; Varicose Veins; Vascular Surgical Procedures; Saphenous Vein; Femoral Vein; Ultrasonography, Doppler, Duplex; Treatment Outcome
PubMed: 38164906
DOI: 10.1177/02683555231225788 -
Dermatologic Surgery : Official... Sep 2022Treatment of chronic venous disease and varicose veins has significant psychosocial and economic impact. The great saphenous vein is a common vein to develop... (Review)
Review
BACKGROUND
Treatment of chronic venous disease and varicose veins has significant psychosocial and economic impact. The great saphenous vein is a common vein to develop incompetence and reflux and, therefore, been the focus of therapy for many years.
OBJECTIVE
To review the published medical literature relating to large varicose vein closure and provide a guide for closure techniques' efficacy and safety.
METHODS
A comprehensive search of the English language literature was performed up to and including December 2021. All references pertaining to large varicose vein closure were reviewed.
RESULTS
There are multiple safe and effective minimally invasive methods to achieve occlusion of incompetent great saphenous vein, the most widely used of which is endovenous thermal ablation. Other nonthermal, tumescent, and nontumescent methods can also be used.
CONCLUSION
Proper knowledge of vein anatomy, ultrasound, and vein closure procedures is needed to ensure safe and effective outcomes.
Topics: Chronic Disease; Endovascular Procedures; Humans; Saphenous Vein; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 36054051
DOI: 10.1097/DSS.0000000000003517 -
Chirurgie (Heidelberg, Germany) May 2024Varicosis is a chronic progressive disease characterized by varicose veins of the lower extremities. Pain, swelling and heaviness of the legs are typical symptoms....
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.
Topics: Humans; Treatment Outcome; Varicose Veins; Sclerotherapy; Venous Insufficiency; Laser Therapy
PubMed: 38597983
DOI: 10.1007/s00104-024-02063-4 -
Annals of Vascular Surgery Aug 2024This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of... (Review)
Review
BACKGROUND
This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of venous vascular disease that predominantly affects the body's lower extremities. The most serious manifestation of this disease includes varicose veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular veins, and spider telangiectasias.
METHODS
The anatomy, pathophysiology, and risk factors of SVD were discussed during this review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep vein thrombosis. Various classification systems were listed, focusing on the most common one-the revised Clinical-Etiology-Anatomy-Pathophysiology classification. The clinical features including history and physical examination findings elicited in SVD were outlined.
RESULTS
Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but magnetic resonance imaging and computed tomography venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, nonsteroidal anti-inflammatory drugs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablationss, endovenous laser ablation, endovenous steam ablation, and endovenous microwave ablation as well as nonthermal strategies such as the Varithena (polidocanol microfoam) sclerotherapy, VenaSeal (cyanoacrylate) ablation, and Endovenous mechanochemical ablation. Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting.
CONCLUSIONS
SVDs are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared toward reducing the significant morbidity associated with SVD especially varicose veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.
Topics: Humans; Risk Factors; Treatment Outcome; Varicose Veins; Venous Insufficiency; Veins; Predictive Value of Tests
PubMed: 38583765
DOI: 10.1016/j.avsg.2024.01.009 -
AORN Journal Apr 2019
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Ligation; Male; Middle Aged; Perioperative Nursing; Practice Guidelines as Topic; Treatment Outcome; Varicose Veins
PubMed: 30919421
DOI: 10.1002/aorn.12680 -
Cardiology Clinics Nov 2021Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a... (Review)
Review
Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.
Topics: Chronic Disease; Humans; Prevalence; Varicose Veins; Venous Insufficiency
PubMed: 34686268
DOI: 10.1016/j.ccl.2021.06.009 -
Phlebology Aug 2022This study retrospectively explores the association between varicose vein and atrial fibrillation (AF).
OBJECTIVE
This study retrospectively explores the association between varicose vein and atrial fibrillation (AF).
METHODS
The data are from Taiwan National Health Insurance Research Database. The univariate and multivariable-adjusted hazard ratios (HR), with corresponding 95% confidence intervals (CI), for the occurrence of AF between the varicose vein cohort and comparison cohort were estimated using cox proportional hazards models after adjustment for age, sex, and comorbidities.
RESULTS
The incidence rates of AF in the varicose vein and the comparison cohort were 4.82 per 1000 person-years and 3.47 per 1000-person years, respectively. After controlling for all the confounding variables, subjects with varicose vein were associated with a significantly higher risk of AF (adjusted HR = 1.23, 95% CI = 1.04-1.45) compared with the comparison cohort.
CONCLUSIONS
Our study is the first to show that varicose vein correlates to AF.
Topics: Atrial Fibrillation; Humans; Incidence; Retrospective Studies; Risk Assessment; Risk Factors; Taiwan; Varicose Veins
PubMed: 35466790
DOI: 10.1177/02683555221095299 -
Biorheology 2020Foam sclerotherapy is the process of using an aqueous foam to deliver surfactant to a varicose vein to damage vein wall endothelial cells, causing the vein to spasm,...
BACKGROUND
Foam sclerotherapy is the process of using an aqueous foam to deliver surfactant to a varicose vein to damage vein wall endothelial cells, causing the vein to spasm, collapse and ultimately be re-absorbed into the body. Aqueous foams are complex fluids that can exhibit a significant yield stress and high effective viscosity which depend on their composition, particularly the bubble size and liquid fraction.
OBJECTIVE
To characterise the properties of foams used for varicose vein sclerotherapy and determine their effectiveness in the displacement of blood during sclerotherapy.
METHODS
Foams are modelled as yield stress fluids and their flow profiles in a model vein are predicted. Values of the yield stress are determined from experimental data for three different foams using the Sauter mean of the bubble size distribution. Along with the measured liquid fraction of the foams, this information is collected into a Bingham number which entirely characterises the process of sclerotherapy.
RESULTS
Polydispersity in bubble size has a strong effect on the yield stress of a foam and the Sauter mean of the size distribution better captures the effects of a few large bubbles. Reducing the polydispersity increases the yield stress, and a higher yield stress results in a larger plug region moving along the vein, which is more effective in displacing blood. The width of the plug region is proportional to the Bingham number, which also has a quadratic dependence on the liquid fraction of the foam. Assuming typical values for the rate of injection of a foam, we predict that for a vein of diameter 5 mm, the most effective foams have low liquid fraction, a narrow size distribution, and a Bingham number B ≈ 4.5.
CONCLUSIONS
The Sauter mean radius provides the most appropriate measure of the bubble size for sclerotherapy and the Bingham number then provides a simple measure of the efficacy of foam sclerotherapy in a vein of a given size, and explains the ability of different foams to remove varicose veins. Foams containing small bubbles, with a narrow size distribution, and a low liquid fraction are beneficial for sclerotherapy.
Topics: Endothelial Cells; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Varicose Veins
PubMed: 33459690
DOI: 10.3233/BIR-201004 -
International Journal of Environmental... Jan 2022The aim of our study was to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Hungarian, and to investigate the validity and reliability of the Hungarian...
PURPOSE
The aim of our study was to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Hungarian, and to investigate the validity and reliability of the Hungarian AVVQ, as well as to assess the health-related quality of life in patients with varicose veins of the leg.
METHODS
374 adults participated in this study who were divided into two groups (varicose vein, healthy). We analyzed internal consistency, convergent validity (using the 36-Item Short Form Survey, SF-36), repeatability, and intra-class correlation coefficient of the Hungarian AVVQ. Regarding discriminant validity, we determined the scores of the Hungarian AVVQ in both groups using the Mann-Whitney U-test.
RESULTS
The Cronbach-alpha value was 0.890, while the correlation coefficient was R = 1.000. According to the results of the convergent validation, the scores of pain and dysfunction moderately correlated with some scores of the SF-36. The score of cosmetic appearance had a relationship with many scores of the SF-36. We registered a significant relationship between the score of extent of varicosity and some scores of the SF-36. There was significant correlation between the score of complications and numerous scores of the SF-36 (physical functioning, role limitations due to physical health, pain and general health). The score of pain and dysfunction, cosmetic appearance, extent of varicosity, complications and total score of the Hungarian AVVQ showed a significant difference between both groups.
CONCLUSIONS
The Hungarian AVVQ was a reliable and a valid tool to assess the health-related quality of life among patients with varicose veins and was a useful tool to justify the further treatment of the patients.
Topics: Adult; Humans; Hungary; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Varicose Veins
PubMed: 35162662
DOI: 10.3390/ijerph19031639 -
VASA. Zeitschrift Fur Gefasskrankheiten Mar 2017Treating varicose veins using endovenous thermal techniques - especially laser and radio frequency ablation - has emerged as an effective alternative to open surgery...
Treating varicose veins using endovenous thermal techniques - especially laser and radio frequency ablation - has emerged as an effective alternative to open surgery with stripping and high ligation. Even though these methods are very gentle and patient-friendly, they are nevertheless accompanied by risks and side effects. Compared to open surgical therapy, the risk of damage to peripheral and motor nerves is reduced; however, it still exists as a result of heat exposure and tumescent anaesthesia. Non-thermal methods that can be applied without tumescent anaesthesia have been introduced to the market. They pose a considerably lower risk of nerve lesions while proving to be much more effective. This paper investigates data on postoperative nerve damage and paraesthesia using internet research (PubMed). It analyses the current state of knowledge regarding non-thermal treatment methods and takes into account the latest developments in the use of cyanoacrylate to close insufficient saphenous veins.
Topics: Catheter Ablation; Humans; Laser Therapy; Peripheral Nerve Injuries; Risk Assessment; Risk Factors; Saphenous Vein; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Varicose Veins
PubMed: 27981883
DOI: 10.1024/0301-1526/a000588