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Techniques in Vascular and... Mar 2021Pelvic Venous Disease (PeVD) is characterized by pelvic varicosities and chronic pelvic pain, defined as noncyclic pelvic pain that persists for more than 6 months. Pain... (Review)
Review
Pelvic Venous Disease (PeVD) is characterized by pelvic varicosities and chronic pelvic pain, defined as noncyclic pelvic pain that persists for more than 6 months. Pain and discomfort related to PeVD typically worsen with upright positioning and occur more frequently in multiparous and premenopausal women. The most common cause of PeVD is pelvic venous insufficiency (PVI) due to incompetent valves. Noninvasive imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging, and invasive catheter-based venography can help characterize varicosities and venous insufficiency, supporting the diagnosis of PeVD. In patients with PeVD, ovarian and/or internal iliac vein embolization demonstrate excellent technical and clinical success rates with relatively low complication rates and should be considered as standard management, in conjunction with medical therapy. Appropriate diagnostic work-up and patient selection are important prior to any intervention for achieving therapeutic success, as multiparous women have a higher success rate compared to patients with dyspareunia after embolization therapy. Post-procedure follow-up is critical for assessing symptom improvement and need for repeat intervention. However, further research is needed to identify additional predictors of successful outcomes after embolization therapy. This article aims to provide an overview of patient selection, interventional technique, challenges, and outcomes of ovarian vein embolization.
Topics: Chronic Pain; Embolization, Therapeutic; Female; Humans; Ovary; Pelvic Pain; Pelvis; Radiography, Interventional; Treatment Outcome; Varicose Veins; Veins; Venous Insufficiency
PubMed: 34147199
DOI: 10.1016/j.tvir.2021.100732 -
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 -
The International Journal of Lower... Sep 2020The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or...
The purpose of this subgroup analysis is to investigate and analyze the venous leg symptoms including sense of coldness and sign of ecchymosis in patients with or without peripheral varicose veins (PVVs) from VEIN-TURKEY study population. A total of 600 patients, who were enrolled to VEIN-TURKEY study recently, were included in this subgroup analysis. Patients were examined clinically for the presence and severity of PVV and varicocele. Patients were asked to answer the VEINES-Sym questionnaire consisting of 10 parts and questions about ecchymosis and coldness in their legs. Frequency of symptoms present in the VEINES-Sym instrument, coldness (16.6%, 6.5%, = .002, respectively), and ecchymosis (16.6%, 2.7%, < .001, respectively) were significantly higher in patients with PVV compared to patients without PVV. Mean score of each symptom was significantly lower in PVV (+) patients including scores of ecchymosis and coldness. Total VEINES-Sym score was also correlated with the scores of ecchymosis ( = 0.18, < .001) and coldness ( = 0.35, < .001). Logistic regression analysis revealed that heavy legs, aching legs, night cramps, and ecchymosis are significantly and independently associated with PVV. In conclusion, sign of ecchymosis and coldness are significantly higher in patients with PVV compared to patients without PVV in a population recruited from the urology clinics. In clinical evaluation, presence or sign of ecchymosis and coldness in legs should be considered to be compatible with PVV in the absence of trauma, hematologic pathologies including antiplatelet treatment, and arterial stenosis or obstruction.
Topics: Correlation of Data; Ecchymosis; Female; Humans; Male; Middle Aged; Severity of Illness Index; Skin Temperature; Symptom Assessment; Varicocele; Varicose Veins; Venous Insufficiency
PubMed: 32356471
DOI: 10.1177/1534734620917911 -
VASA. Zeitschrift Fur Gefasskrankheiten Jul 2022
Topics: Embolization, Therapeutic; Humans; Varicose Veins; Vena Cava, Inferior
PubMed: 35786994
DOI: 10.1024/0301-1526/a001014 -
Andrologia Aug 2021The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein...
The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18 years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p < .001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p < .001). In conclusion, the results of the present study suggest that a waiting time of at least 90 min must be allowed between ejaculation and scrotal Doppler ultrasonography.
Topics: Adult; Ejaculation; Humans; Male; Ultrasonography, Doppler, Color; Varicocele; Varicose Veins; Veins
PubMed: 33913191
DOI: 10.1111/and.14090 -
Phlebology Oct 2020To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous... (Review)
Review
OBJECTIVE
To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency.
METHODS
The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength.
RESULTS
Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life.
CONCLUSIONS
Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.
Topics: Humans; Laser Therapy; Quality of Life; Saphenous Vein; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 32631172
DOI: 10.1177/0268355520937619 -
Lymphatic Research and Biology Apr 2022Treatment for patients with comorbid lymphedema and varicose veins is controversial. Surgical options for these patients are limited. The study was aimed to investigate...
Treatment for patients with comorbid lymphedema and varicose veins is controversial. Surgical options for these patients are limited. The study was aimed to investigate the validity of combined lymphovenous anastomosis (LVA) and great saphenous vein stripping (GSVS) for comorbid lymphedema and varicose veins. Thirteen patients were involved in the study, and the detail was 21 edematous lower limbs (with coexisting varicose veins and lymphedema; the varicose vein and lymphedema [VL] group) who underwent combined GSVS and LVA therapy. Fifteen patients (with 30 edematous lower limbs and lymphedema only; the lymphedema [L] group) who underwent LVA only were included as a control group. GSVS was performed before LVA in the VL group. No significant differences were seen between the groups at baseline. There were no cases indocyanine green (ICG) lymphography pattern deteriorated after GSVS. No significant difference was seen in lymphatic detection rate; 129.71% ± 58.27% (67%-333%) in the VL group and 122.27% ± 39.47% (50%-250%) in the L group ( = 0.59 > 0.05), respective lymphatic diameters 0.66 ± 0.13 (0.45-0.9) mm and 0.75 ± 0.17 (0.45-1.0) mm ( = 0.07 > 0.05), and respective lymphedema improvement rate 12.17% ± 7.35% (0%-27.4%) and 12.65% ± 7.43% (3.7%-22.3%) ( = 0.86 > 0.05). In this study, stripping surgery does not cause lymphatic impairment, at least to the extent that would impede the success of an LVA procedure. Comorbid varicose veins and lymphedema can be treated surgically by a combination of LVA and GSVS.
Topics: Anastomosis, Surgical; Humans; Lymphatic Vessels; Lymphedema; Saphenous Vein; Varicose Veins
PubMed: 33794104
DOI: 10.1089/lrb.2019.0076 -
Journal of Vascular Surgery. Venous and... Nov 2021Intermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Intermittent pneumatic compression (IPC) is an established treatment option to remove tissue fluid from patients with lymphedema and chronic venous disease. The effects of IPC applied directly after varicose vein surgery performed with high volumes of tumescent local anesthesia have not been investigated. The aim of the present study was to evaluate the use of postoperative IPC concerning its effects on the leg volume and patient comfort after surgery.
METHODS
We performed an investigator-initiated, single-center, open-label randomized controlled trial. A total of 186 patients indicated for saphenofemoral junction ligation and great saphenous vein or anterior accessory saphenous vein stripping or great saphenous vein redo surgery were randomly assigned 1:1 to the intervention or control group. The patients in the intervention group were treated with IPC at 40 mm Hg for 45 minutes directly after surgery. The outcome measures were the leg volume changes calculated using an optical three-dimensional scanning system (primary objective), quality of life (QoL; Freiburg Life Quality Assessment for chronic venous disease, short form), pain, and extent of ecchymosis with follow-up examinations on days 1 and 7 after surgery.
RESULTS
The patients in both groups had comparable mean leg volume reductions from baseline to day 1 (IPC group, 58.8 mL; control group, 37.4 mL; P = .967) and to day 7 (63.1 mL and 57.0 mL, respectively; P = .546). We also did not observe significant differences between the two groups in QoL and pain. The patients in the IPC group had developed larger areas of ecchymosis compared with the control group (16% vs 13.3% of leg surface, respectively; P = .046), with a tendency toward an increase in pain at 7 days after surgery compared with no IPC application.
CONCLUSIONS
The present randomized controlled trial was designed to evaluate the decongestive effects of a single postoperative session of IPC and its effect on QoL, pain, and ecchymosis in patients who had undergone varicose vein surgery under tumescent local anesthesia. Because no evidence for a benefit from IPC could be found in the present study and increased ecchymosis was found, its standard use after varicose vein surgery cannot be recommended.
Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Vein; Humans; Intermittent Pneumatic Compression Devices; Ligation; Male; Middle Aged; Postoperative Care; Prospective Studies; Saphenous Vein; Varicose Veins
PubMed: 33667741
DOI: 10.1016/j.jvsv.2021.02.011 -
Vestnik Oftalmologii 2022Varix of the vortex vein ampulla is a rare benign condition that has clinical similarities to more concerning choroidal lesions that pose a threat to vision, in... (Review)
Review
Varix of the vortex vein ampulla is a rare benign condition that has clinical similarities to more concerning choroidal lesions that pose a threat to vision, in particular choroidal melanoma. The article describes two clinical cases, one of which is unique due to the combination of bilateral lesion and the presence of multiple varices in one eye. A brief review of the literature on this condition is also provided.
Topics: Choroid; Choroid Neoplasms; Diagnosis, Differential; Humans; Melanoma; Varicose Veins
PubMed: 36004595
DOI: 10.17116/oftalma202213804181