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International Wound Journal Nov 2023Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain,... (Review)
Review
Chronic venous disease (CVD) occurs because of structural or functional disturbances to the venous system of the lower limbs. Signs and symptoms include leg pain, swelling, varicose veins, and skin changes, with venous ulceration ultimately occurring in severe disease. To assess the prevalence of CVD among health care workers, a scoping review of existing publications exploring the prevalence of CVD among health care workers was conducted in July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. A total of 15 papers met the inclusion criteria and these formed the basis of the review. Among health care workers, the mean prevalence of CVD was 58.5% and the mean prevalence for varicose veins was 22.1%. There is an increased prevalence of CVD in health care workers when compared with the general population. Therefore, there is a need for early diagnosis and the use of preventative measures to protect health care workers from CVD and varicose vein development.
Topics: Humans; Venous Insufficiency; Prevalence; Varicose Veins; Varicose Ulcer; Chronic Disease; Health Personnel
PubMed: 37139850
DOI: 10.1111/iwj.14222 -
Vascular Pharmacology Aug 2022We examined quantitative (in terms of mtDNA/nuclear DNA) and structural (in terms of common deletions in the MT-ND4 gene region) characteristics of mitochondrial DNA...
OBJECTIVE
We examined quantitative (in terms of mtDNA/nuclear DNA) and structural (in terms of common deletions in the MT-ND4 gene region) characteristics of mitochondrial DNA (mtDNA) in varicose veins (VVs) and venous wall layers by comparing mitochondrial genome parameters, as well as mitochondrial function (in terms of mitochondrial membrane potential (MtMP)), in varicose vein (VV) vs. non-varicose vein (NV) tissue samples.
METHODS
We analyzed paired great saphenous vein samples (VV vs. NV segments from each patient left after venous surgery) harvested from patients with VVs. Relative mtDNA level and the proportion of no-deletion mtDNA were determined by a multiplex quantitative PCR (qPCR), confirming the latter with a more sensitive method - droplet digital PCR (ddPCR). Mitochondria's functional state in VVs was assessed using fluorescent (dependent on MtMP) live-staining of mitochondria in venous tissues.
RESULTS
Total mtDNA level was lower in VV than in NV samples (predominantly in the t. media layer). ddPCR analysis showed lower proportion of no-deletion mtDNA in VVs. Because of the decrease in relative MtMP in VVs, our results suggest a possible reduction of mitochondrial function in VVs.
CONCLUSION
Quantitative and structural changes (copy number and integrity) of mtDNA are plausibly involved in VV pathogenesis. Future clinical studies implementing the mitochondrial targeting may be eventually fostered after auxiliary mechanistic studies.
Topics: DNA, Mitochondrial; Humans; Mitochondria; Real-Time Polymerase Chain Reaction; Saphenous Vein; Varicose Veins
PubMed: 35690235
DOI: 10.1016/j.vph.2022.107021 -
Microvascular Research May 2017Varicose veins (VV) are enlarged veins of the subcutaneous tissue, usually caused by faulty or damaged venous valves leading to impaired blood flow. Blood stasis,...
Varicose veins (VV) are enlarged veins of the subcutaneous tissue, usually caused by faulty or damaged venous valves leading to impaired blood flow. Blood stasis, excessive clotting disorder and alterations in the vein walls are symptoms of Virchow's triad which may affect the morphotic elements of blood, including erythrocytes. The aim of this study was to investigate alterations in the properties of the erythrocytes taken from varicose veins in comparison to those from antecubital vein of patients with chronic venous disease. The investigation was conducted on whole erythrocytes using spin labeling method in EPR spectroscopy and flow cytometry. The internal viscosity of cells was determined by Tempamine. The conformation state of internal proteins, mainly hemoglobin and membrane proteins was determined by maleimide spin label (MSL, 4-maleimido-2,2,6,6-tetramethylpiperidine-1-oxyl). The plasma membrane fluidity was measured using two spin labeled fatty acids (5- and 16-doxylstearic acid), while conformational state of membrane protein was measured using two covalently bound spin labels MSL and ISL [4-(2-iodoacetamido)-2,2,6,6-tetramethylpiperidine-1-oxyl]. The osmotic fragility and the shape and size of the erythrocytes were also determined. A decrease in internal viscosity of the erythrocytes from varicose vein was observed. A significant decrease in lipid membrane fluidity indicated by 5-DS, which is located at the polar region of lipid layer was found in the erythrocytes from varicose vein in comparison to normal vein. A significant decrease in the motion of MSL and ISL attached to erythrocyte membrane proteins from varicose vein was found. Changes in the plasma membrane of the erythrocytes from varicose vein were also confirmed by measuring osmotic fragility. These cells were more sensitive to hemolysis than red blood cells from the peripheral blood vein. Meanwhile, no significant differences in size and shape were observed between the erythrocytes taken from varicose veins and those from peripheral veins. In conclusion, the erythrocytes from varicose veins exhibited decreased intracellular viscosity and decreased plasma membrane fluidity. At the same time, conformational changes of membrane proteins and higher osmotic fragility of these cells were found in comparison to the erythrocytes obtained from peripheral veins in the same patients with chronic venous disease. Our findings strongly suggest that presented abnormalities in the erythrocyte plasma membrane may have significant pathophysiological implications, including shortened cell survival and alterations in the hemorheology of the varicose vein blood.
Topics: Adult; Aged; Blood Viscosity; Cytoskeleton; Electron Spin Resonance Spectroscopy; Erythrocyte Deformability; Erythrocyte Indices; Erythrocyte Membrane; Erythrocytes; Fatty Acids; Female; Flow Cytometry; Hemoglobins; Hemolysis; Hemorheology; Humans; Male; Membrane Fluidity; Membrane Lipids; Membrane Proteins; Middle Aged; Osmotic Fragility; Varicose Veins
PubMed: 28012884
DOI: 10.1016/j.mvr.2016.12.005 -
Phlebology Sep 2016The pathophysiology of calf perforators is presented. Bidirectional flow within calf perforators with a prevailing inward, into deep veins oriented component arises... (Review)
Review
The pathophysiology of calf perforators is presented. Bidirectional flow within calf perforators with a prevailing inward, into deep veins oriented component arises during calf pump activity in varicose vein patients, as evidenced by venous pressure measurements, plethysmographic findings, duplex ultrasonography, and electromagnetic flow measurements. Reflux within calf perforators is an inward, not outward, flow; the opinion that the outward flow within calf perforators is a reflux is at odds with the reality. During calf muscle contraction, the pressure in the posterior tibial vein is higher than in the great saphenous vein; it induces the harmless outward flow within calf perforators, which runs further via great saphenous vein in the physiological direction toward the heart. Deep and superficial veins of the lower leg form conjoined vessels, as documented by nearly equal pressure curves registered simultaneously in the posterior tibial and great saphenous veins both in varicose vein patients and in healthy people. Calf perforators do not entail ambulatory venous hypertension or any other hemodynamic disorder, even if enlarged and incompetent; their ligation is needless. The diameter of calf perforators is influenced by the intensity of saphenous reflux; it enlarges with increasing intensity of saphenous reflux and diminishes after the abolition of reflux.
Topics: Blood Pressure; Humans; Saphenous Vein; Varicose Veins
PubMed: 26450850
DOI: 10.1177/0268355515610041 -
VASA. Zeitschrift Fur Gefasskrankheiten 2016Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome... (Review)
Review
Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.
Topics: Constriction, Pathologic; Humans; Pelvic Pain; Pelvis; Regional Blood Flow; Renal Veins; Syndrome; Varicose Veins; Veins; Venous Insufficiency
PubMed: 27428495
DOI: 10.1024/0301-1526/a000538 -
JPMA. the Journal of the Pakistan... Feb 2022To assess the types and effectiveness of simulators present for open varicose vein surgery.
OBJECTIVE
To assess the types and effectiveness of simulators present for open varicose vein surgery.
METHODS
The systematic review was conducted at The Aga Khan University Hospital Karachi and comprised studies published from 1st January 2000 to 30th June 2020 related to open varicose vein surgical procedures done on simulators. Databases searched were PubMed, Medline, Google Scholar, Cochrane and Scopus using appropriate key words. The primary outcome of the review was to assess the effectiveness of different types of simulators used for varicose vein surgery.
RESULTS
Of the 286 articles found, 6(2%) were included. A variety of simulators ranging from animal models, homemade simulators and commercially designed models with high fidelity options had been used. Technical competence was the major domain assessed in most of the studies 5(83.3%), while 1(16.6%) study focussed on self-assessment. Blinding was done in 4(66.6%) studies for assessment purpose, and videorecording of the trainees' performance was done in 5(83.3%) studies. Most studies 4(66.6%) found the use of simulation to be an effective tool in achieving technical competence.
CONCLUSION
The use of simulation in the training of surgical residents for open varicose vein surgery was found to be beneficial, but most studies were heterogeneous in terms of design, simulator types and study participants. This makes it difficult to establish the superiority of any one type of simulator over the rest. Further research is needed to develop and validate simulators in open varicose vein surgery procedures.
Topics: Animals; Clinical Competence; Humans; Pakistan; Simulation Training; Varicose Veins; Vascular Surgical Procedures
PubMed: 35202370
DOI: 10.47391/JPMA.AKU-10 -
Phlebology Mar 2016Management of varicose vein disease has changed drastically over the past decades. Since its introduction in vein practice, surgery has gone through several stages of... (Review)
Review
Management of varicose vein disease has changed drastically over the past decades. Since its introduction in vein practice, surgery has gone through several stages of evolution until the method of ligation with stripping eventually became and remained the standard for a long time. It was found to be effective at treating the condition and, indications of its beneficial impact on patients' quality of life soon also became evident. However, being associated with significant morbidity, surgery gradually fell out of favour, especially, once the newer endovenous techniques were launched around the turn of the century. These endothermal methods allowed procedures to be carried out under local anaesthetic as day case interventions, often with a similar or even better effect on occlusion rates and quality of life. In addition, there is mounting evidence that these newer techniques might be more cost-effective. This review evaluates surgical treatment of varicose veins compared to endovenous methods and also assesses its place in current phlebological practice.
Topics: Follow-Up Studies; Humans; Hyperthermia, Induced; Quality of Life; Time Factors; Varicose Veins
PubMed: 26916779
DOI: 10.1177/0268355516632438 -
Minerva Surgery Apr 2024The aim of this registry supplement study was to evaluate the effects of the oral supplement Pycnogenol on possible skin discolorations or other minor skin changes after...
BACKGROUND
The aim of this registry supplement study was to evaluate the effects of the oral supplement Pycnogenol on possible skin discolorations or other minor skin changes after varicose vein sclerotherapy in comparison with a standard management (SM).
METHODS
One hundred sixty-one subjects completed the study. 84 took Pycnogenol from the day before sclerotherapy for 12 weeks and followed SM. 77 followed SM only and served as controls. 420 injection sites were followed-up in the Pycnogenol group and 431 in the control group. The number of injected veins (using only Aetoxysklerol) was on average 4-8 veins/patient. No side effects were observed for the SM or for supplementation. Pycnogenol supplementation showed a good tolerability. The two management groups were comparable for age, sex and veins distribution at inclusion.
RESULTS
After 12 weeks, skin discoloration assessed by a skin staining score was generally significantly lower and less frequent (P<0.05) with Pycnogenol with a score of 0.4±0.2 compared to controls (with a score of 2.1±0.4). In addition, the number of stains per treated vein was significantly lower in the Pycnogenol group than the control group.
CONCLUSIONS
Varicose vein sclerotherapy is a minimally invasive procedure almost without complications. Pycnogenol intake appears to improve healing and prevent skin discolorations after injection of the sclerosing agent. To verify this effect of Pycnogenol, more studies for a longer period are needed.
Topics: Humans; Sclerotherapy; Hyperpigmentation; Flavonoids; Varicose Veins; Plant Extracts
PubMed: 38592434
DOI: 10.23736/S2724-5691.23.10035-9 -
Cardiovascular Journal of AfricaVenous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any...
INTRODUCTION
Venous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any surgical approaches in varicose vein surgery. This study evaluated the effect of single-dose epidural anaesthesia on postoperative pain scores and length of hospitalisation after varicose vein surgery, comparing it with general anaesthesia.
METHODS
The study was conducted on a total of 100 patients, aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I-III, undergoing unilateral lower-extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçioğlu City Hospital Anesthesiology and Reanimation Service. Fifty patients with single-dose epidural anaesthesia were consecutively included in the EA group. For comparison, 50 patients who were operated on under general anesthesia were included in the GA group.
RESULTS
The groups showed statistically significant differences between the 30th-minute and first-, second-, fourth- and sixth-hour visual analogue scale (VAS) scores ( = 0.001; < 0.01). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthesia. There were statistically significant differences identified between the groups for the additional analgesia requirements of patients ( = 0.001; < 0.01). Subjects with epidural anaesthesia had lower additional analgesic requirements than those administered general anaesthesia.
CONCLUSION
Epidural anaesthesia provided adequate anaesthesia with more effective postoperative analgesia compared to patients operated on under general anaesthesia and receiving multimodal analgesia for postoperative analgesia.
Topics: Anesthesia, Epidural; Anesthesia, General; Hospitals; Humans; Pain, Postoperative; Patient Discharge; Varicose Veins
PubMed: 34851351
DOI: 10.5830/CVJA-2021-061 -
Journal of Vascular Surgery. Venous and... Sep 2022Bleeding is a rare but potentially life-threatening complication of varicose veins. There is paucity of literature about patients with varicose veins that present with...
BACKGROUND
Bleeding is a rare but potentially life-threatening complication of varicose veins. There is paucity of literature about patients with varicose veins that present with bleeding and the effectiveness of vein ablation as therapy to prevent recurrent bleeding. This study compares patients treated with vein ablation for bleeding varicose veins with patients treated for venous symptoms other than bleeding. We hypothesize that vein ablation is safe and effective in preventing recurrence of bleeding from varicose veins.
METHODS
A retrospective single-centre review of consecutive patients undergoing vein ablation using radiofrequency in an outpatient office was performed. Patients presenting with bleeding were identified. A random (3:1) group of patients undergoing vein ablation for other venous symptoms and no bleeding was selected as a comparative group (control). The medical records were reviewed for patient characteristics and outcomes. A telephone survey inquiring about intensity of symptoms on a numeric rating scale of 0 to 10 prior and after treatment as well as recurrence of bleeding was also conducted. Patient characteristics and outcomes were compared between the two groups.
RESULTS
The incidence of patients with bleeding varicose veins was 3.6% (13/362) of all patients undergoing vein ablation at our center. A total of 26 ablations and 60 ablations were performed in patients with bleeding (n = 13) and controls (n = 39), respectively. There was no difference in age and race, but there was a trend for bleeding to occur more commonly in male patients (61.5% vs 33.3%; P = .073). Patients with bleeding from varicose veins were more likely to have congestive heart failure (P = .013) and present with more advanced venous disease based on CEAP classification (P = .005) compared with the control group. There was no difference between the 2 groups in vein closure (P = .246) or complications (P = .299) after vein ablation. With mean follow-up of 2.26 ± 1.17 years, 85% of patients (n = 11) remained free from bleeding episodes. One patient with recurrent bleeding required additional vein ablation and the second patient had a concomitant ulcer that was treated with compression therapy.
CONCLUSIONS
Bleeding from varicose veins is rare and more common in patients with congestive heart failure. Bleeding affects patients with higher CEAP scores. Vein ablation is a safe and effective treatment to prevent the recurrence of bleeding.
Topics: Endovascular Procedures; Female; Hemorrhage; Humans; Male; Retrospective Studies; Treatment Outcome; Varicose Veins
PubMed: 35561970
DOI: 10.1016/j.jvsv.2022.03.015