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Dermatologic Therapy Feb 2022Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from... (Review)
Review
Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from teleangiectasias to venous leg ulcers (VLUs). We examined the currently available data in order to provide an updated, comprehensive review on treatment options of CVD. We searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey databases for relevant articles in English published until November 2020. Compression treatment is the mainstay of conservative treatment. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. Transcutaneous Lacer treatment (TCL) is a safe and effective alternative option to sclerotherapy for treatment of C1 stage. High ligation and stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS), endovenous thermal ablation (EVTA) systems and non thermal non tumescent ablation (NTNT) systems are safe and efficacious first-line options for treatment of saphenous insufficiency. Interventional treatment of co-existing incompetent perforator veins (IPVs) is not supported by contemporary evidence. Regarding deep venous insufficiency (DVI), treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting has produced encouraging results.
Topics: Humans; Laser Therapy; Saphenous Vein; Sclerotherapy; Treatment Outcome; Varicose Veins; Venous Insufficiency
PubMed: 34859549
DOI: 10.1111/dth.15238 -
Acta Chirurgica Belgica Dec 2023Dawali (varicose veins) is the disease of chronic dilation of veins. The veins of the legs become dilated and blue due to excessive accumulation of blood. This disease... (Review)
Review
INTRODUCTION
Dawali (varicose veins) is the disease of chronic dilation of veins. The veins of the legs become dilated and blue due to excessive accumulation of blood. This disease and the effort to identify and treat it has a very long history. The condition may have first been described in the Ebers Papyrus more than 3500 years ago. The present study deals with the turning points and progress of varicose vein surgery since ancient times, emphasizing the innovations of the scholars of the Islamic period.
METHODS
The present study is based on searching library documents and database data such as PubMed, Scopus, Science Direct, and search engines such as Google Scholar. In the end, the Prisma flow chart was drawn.
RESULTS
Besides diagnosing different varicose veins (legs, thighs, abdomen, uterus, and testes), the scholars of the Islamic period were well-versed in their prevention, etiology, and treatment. In treating varicose veins, these physicians used methods such as cleansing, phlebotomy, compression, leech therapy, and surgery, and some of them were the founders of new treatments.
CONCLUSION
The surgical treatment of varicose veins in the past was similar to modern surgical therapies. What distinguishes yesterday's varicose vein surgery from today's surgery is a more advanced tool. There is no denying the remarkable progress in using health principles, treatment techniques, and surgical instruments to facilitate surgery and reduce the disease's complications and recurrence. However, the treatment framework and foundation, such as phlebectomy and compression, were all invented and introduced in the distant past.
Topics: Female; Humans; Vascular Surgical Procedures; Varicose Veins; Leg; Treatment Outcome
PubMed: 37671628
DOI: 10.1080/00015458.2023.2254603 -
Nigerian Journal of Clinical Practice Mar 2022In this study, the densities of collagen 1 and collagen 4, which are an effective vascular component in the remodelling of varicose veins, were investigated.
AIMS AND BACKGROUND
In this study, the densities of collagen 1 and collagen 4, which are an effective vascular component in the remodelling of varicose veins, were investigated.
MATERIALS AND METHODS
The study included primary varicose vein samples of 20 patients and vein samples of 20 healthy controls. Immunohistochemical staining was performed using collagen 1 and collagen 4 antibodies. Histochemical staining was performed using Masson Trichrome.
RESULTS
In the immunohistochemical analysis of varicose samples, collagen 1 immunostaining was negative in 17 cases (85%) and positive in 3 cases (15%). In healthy venous tissue samples, collagen 1 immunostaining was negative in 12 cases (60%) and positive in 8 cases (40%). There was no statistically significant difference between both groups concerning collagen 1 immunostaining (p > 0.05). In varicose samples, collagen 4 immunostaining was negative in 4 cases (20%) and positive in 16 cases (80%). In healthy venous tissue samples, collagen 4 immunostaining was negative in 13 cases (65%) and positive in 7 cases (35%). Statistical comparison of healthy veins and varicose veins concerning collagen 4 immunostaining showed a significant difference (p = 0.03). In the histochemical analysis of varicose samples, Masson Trichrome staining was negative in 4 cases (20%) and positive in 16 cases (80%). In healthy venous tissue samples, Masson Trichrome staining was negative in 18 cases (90%) and positive in 2 cases (10%). Statistical comparison of healthy veins and varicose veins concerning collagen 4 immunostaining showed a significant difference (p = 0.01).
CONCLUSION
The change in the density of collagen types plays an important role in vein wall remodeling.
Topics: Collagen Type I; Collagen Type IV; Humans; Saphenous Vein; Varicose Veins
PubMed: 35295053
DOI: 10.4103/njcp.njcp_1505_21 -
International Angiology : a Journal of... Aug 2022Venous thromboembolism (VTE) is a possible complication after varicose vein surgery, reported after both open and endovascular interventions. Nonetheless, there are no...
INTRODUCTION
Venous thromboembolism (VTE) is a possible complication after varicose vein surgery, reported after both open and endovascular interventions. Nonetheless, there are no internationally accepted recommendations regarding postoperative VTE prevention strategies, with some authors advocating for its use, while others recommend against it. This study aims to systematically review current evidence on the efficacy and safety of chemothromboprophylactic strategies after varicose vein surgery.
EVIDENCE ACQUISITION
A literature search was performed on the MEDLINE, Scopus, SciELO and Web of Science databases, which returned 532 studies. Ten studies were included. Data were extracted using piloted forms.
EVIDENCE SYNTHESIS
A total of 6929 patients were included for analysis, out of which 70.4% were treated by open surgery (N.=4878) and 29.6% by endovenous procedures (N.=2051; 79.1% EVLA; 20.9% RFA). VTE chemothromboprophylaxis was performed in 76.3% of the patients (N.=5284), from which 62.5% were treated by open surgery (N.=3301) and 37.5% by endovenous interventions (N.=1983). Among those treated by open surgery, reported deep venous thrombosis (DVT) rates ranged between 0-6.25%, while pulmonary embolism (PE) was reported in 0-0.07% of the cases. Regarding endovenous interventions, EHIT and DVT rates ranged between 0-2.5% and 0-0.9%, respectively, with no cases of PE described. The remaining 23.7% of the patients did not underwent VTE chemothromboprophylaxis (N.=1645), with DVT and PE rates after open surgery ranging between 0-5.17% and 0-1.48%, respectively. Only one study reported thrombotic complications after endovenous interventions in this subgroup of patients, with postoperative EHIT rates of 7.3%, and no information regarding PE or DVT. Bleeding complications were higher in patients undergoing chemothromboprophylaxis (0-10.2%) when compared to those who did not (0-0.18%), and were more frequent after endovenous interventions (0-10.2% versus 0-0.75% after open surgery).
CONCLUSIONS
VTE is a possible complication after both open and endovascular varicose vein procedures, although overall VTE complications occur less frequently after endovascular interventions. There's a clear heterogeneity regarding peri and postoperative chemoprophylaxis regimens used. Further studies are required to stratify risk factors and indications for chemothromboprophylaxis after varicose vein surgery.
Topics: Endovascular Procedures; Humans; Pulmonary Embolism; Risk Factors; Varicose Veins; Venous Thromboembolism
PubMed: 35583457
DOI: 10.23736/S0392-9590.22.04908-2 -
The Surgeon : Journal of the Royal... Dec 2022A systematic review and meta-analysis was performed to determine the role of thromboprophylaxis in the prevention of venous thromboembolism in patients undergoing... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A systematic review and meta-analysis was performed to determine the role of thromboprophylaxis in the prevention of venous thromboembolism in patients undergoing varicose vein interventions.
METHODS
PUBMED, EMBASE and Web of Science were searched for comparative studies of patients undergoing varicose vein interventions and received either thromboprophylaxis or no thromboprophylaxis. Data were collected on the number of thrombotic events including deep vein thrombosis (DVT), pulmonary embolism (PE) and endothermal heat-induced thrombosis (EHIT) as well as bleeding events. The primary outcomes for the meta-analysis were the risk of all thrombotic events, risk of DVT and risk of bleeding. Pooled risk ratios were calculated using random effects modelling.
RESULTS
Eight studies (6479 participants) were included. The use of thromboprophylaxis reduces the risk of all thrombotic events (Pooled risk ratio = 0.63, 95% Confidence interval [CI], 0.04-10.43) and the risk of DVT (Pooled risk ratio = 0.59, 95% CI, 0.08-4.60) with no increased risk of bleeding (Pooled risk ratio = 0.66, 95% CI, 0.06-7.21]. Rivaroxaban has similar efficacy in the prevention of DVT compared to Fondaparinux in patients undergoing endovenous ablation of varicose veins (Pooled risk ratio = 0.68, 95% CI, 0.06-7.41). An extended course of thromboprophylaxis reduces the risk of developing DVT compared to a short course (Pooled risk ratio = 1.40, 95% CI, 0.44-4.46). However, the two studies reporting on the duration of thromboprophylaxis did not stratify patients according to their risk of developing venous thromboembolism.
CONCLUSION
The use of thromboprophylaxis in patients undergoing varicose vein interventions reduces the risk of venous thromboembolism with no significant increase in the risk of bleeding. However, the included studies were underpowered with high to moderate risk of bias. Therefore, more randomised controlled trials with a large sample size are needed in order to provide high quality evidence for clinical practice.
Topics: Humans; Venous Thromboembolism; Varicose Veins; Rivaroxaban; Pulmonary Embolism
PubMed: 35589498
DOI: 10.1016/j.surge.2022.04.002 -
Phlebology Mar 2023
Topics: Humans; Atrial Fibrillation; Varicose Veins; Catheter Ablation; Treatment Outcome
PubMed: 36592347
DOI: 10.1177/02683555221148835 -
Radiologia 2022Although ultrasound-guided interventional procedures have resulted in great advances in many fields of medicine, this approach has revolutionized endovascular... (Review)
Review
Although ultrasound-guided interventional procedures have resulted in great advances in many fields of medicine, this approach has revolutionized endovascular procedures. This paper aims to review the basic principles to develop a strategy to follow in ultrasound-guided treatments of varices in the lower limbs, as well as to provide a brief overview of the main endovenous techniques available nowadays. We divide these techniques into those that use catheters to occlude straight saphenous axes (thermal / non-thermal ablation) and other options, such as foam sclerotherapy, which can be used in all types of varices, even in those originating in the pelvis.
Topics: Humans; Radiology, Interventional; Saphenous Vein; Ultrasonography, Interventional; Varicose Veins; Venous Insufficiency
PubMed: 35180992
DOI: 10.1016/j.rxeng.2020.08.003 -
The Surgeon : Journal of the Royal... Oct 2022The objective of this systematic review and meta-analysis was to evaluate rates of ulcer healing following ultrasound-guided foam sclerotherapy (UGFS). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The objective of this systematic review and meta-analysis was to evaluate rates of ulcer healing following ultrasound-guided foam sclerotherapy (UGFS).
METHODS
The MEDLINE, CENTRAL and Embase databases were used to search for relevant studies using the terms ' (sclerotherapy AND ulcer) OR (vein AND ulcer) OR (sclerotherapy AND vein)'. Heterogeneity between studies was quantified using the I statistic. A random effects model was used to calculate risk ratios where substantial heterogeneity was found.
RESULTS
The initial search yielded 8266 articles. 8 studies were included in the qualitative synthesis and 3 in the meta-analysis. Superior complete ulcer healing rates were noted in patients treated with foam sclerotherapy versus compression therapy alone (pooled OR 6.41, 95% CI = 0.3-148.2, p = 0.246, random effects method). A marked degree of heterogeneity was observed between studies (I = 81%).
CONCLUSION
A prospective, trial is warranted in order to determine the true merits of UGFS in the setting of venous ulceration.
Topics: Humans; Prospective Studies; Recurrence; Saphenous Vein; Sclerotherapy; Treatment Outcome; Ulcer; Ultrasonography, Interventional; Varicose Ulcer; Varicose Veins
PubMed: 34629303
DOI: 10.1016/j.surge.2021.08.008 -
Ophthalmology Dec 2021
Topics: Adult; Female; Humans; Orbit; Pressure; Tomography, Optical Coherence; Varicose Veins
PubMed: 34802632
DOI: 10.1016/j.ophtha.2021.04.023 -
Journal of Vascular Surgery. Venous and... May 2021Varicose veins afflict more than one in five Americans, and although varicose veins may be an asymptomatic cosmetic concern in some, many others experience symptoms of... (Review)
Review
Private payers' varicose vein policies are inaccurate, disparate, and not evidence based, which mandates a proposal for a reasonable and responsible policy for the treatment of venous disease.
Varicose veins afflict more than one in five Americans, and although varicose veins may be an asymptomatic cosmetic concern in some, many others experience symptoms of pain, aching, heaviness, itching, and swelling. More advanced venous disease can result from untreated venous insufficiency. The complications of chronic venous disease, including bleeding, thrombosis, and ulceration, are seen in up to 2 million Americans annually. Numerous reports have documented venous disease adversely affects quality of life and that treatment of venous disease can improve quality of life. It has previously been documented that private insurers, and Centers for Medicare & Medicaid Services subcontractors for that matter, have disparate policies that in many instances are self-serving, contain mistakes, use outdated evidence, and disregard evidence-based guidelines. The two leading venous medical societies, the American Venous Forum and the American Venous and Lymphatic Society, have come together to review the varicose vein coverage policies of seven major U.S. private medical insurance carriers whose policies cover more than 150 million Americans. The authors reviewed the policies for venous disease and, if significant gaps or inconsistencies are found, we hope to point them out, and, finally, to propose a thoughtful and reasonable policy based on the best available evidence.
Topics: Chronic Disease; Clinical Decision-Making; Eligibility Determination; Evidence-Based Medicine; Humans; Insurance Coverage; Insurance, Health, Reimbursement; Managed Care Programs; Policy Making; United States; Varicose Veins
PubMed: 33684590
DOI: 10.1016/j.jvsv.2020.12.076