-
Journal of Vascular Surgery. Venous and... Nov 2023
Topics: Humans; Varicose Veins; Ultrasonography, Doppler, Duplex; Saphenous Vein; Recurrence
PubMed: 37863553
DOI: 10.1016/j.jvsv.2023.06.004 -
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 -
Annals of Vascular Surgery Apr 2010Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical... (Review)
Review
Varicose veins are as old as Hippocrates. Varicose vein treatments come and go. Surgery for varicose vein disease is one of the commonest elective general surgical procedures. The history of varicose vein surgery has been traced. We note the first descriptions of varicose veins, and we particularly focus on the ligation of the saphenofemoral junction, stripping of the great saphenous veins, phlebectomy, and perforant vein surgery. We end with the rapid rise of minimally invasive procedures, such as foam sclerotherapy, radiofrequency ablation, and endovenous lasertherapy. Within 10 years, the advantages of minimal invasiveness for these procedures, combined with claims of equivalent short-term outcomes and even better long-term results, have already influenced our everyday practice. At present, the gold standard treatment of varicose veins still is surgical ligation and stripping of the insufficient vein. Concomitantly or sequentially with the treatment of truncal insufficiency, residual varicosities can be treated by phlebectomy. New minimally invasive techniques, however, have changed the clinical landscape for varicose vein surgery tremendously. The dramatic changes of the last decade are probably the precursors of the next generation.
Topics: Femoral Vein; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Ligation; Minimally Invasive Surgical Procedures; Saphenous Vein; Treatment Outcome; Ultrasonography, Doppler, Duplex; Varicose Veins; Vascular Surgical Procedures
PubMed: 20144527
DOI: 10.1016/j.avsg.2009.07.035 -
The British Journal of Surgery Jan 2023Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins....
BACKGROUND
Standardization of access to treatment and compliance with clinical guidelines are important to ensure the delivery of high-quality care to people with varicose veins. In the National Health Service (NHS) in England, commissioning of care for people with varicose veins is performed by Clinical Commissioning Groups (CCGs) and clinical guidelines have been developed by the National Institute for Health and Care Excellence (NICE CG168). The Evidence-Based Intervention (EBI) programme was introduced in the NHS with the aim of improving care quality and supporting implementation of NICE CG168. The aim of this study was to assess access to varicose vein treatments in the NHS and the impact of EBI.
METHODS
CCG policies for the delivery of varicose vein treatments in the NHS in England were obtained from 2017 (before EBI introduction) and 2019 (after EBI introduction) and categorized by two independent reviewers into levels of compliance with NICE CG168. Hospital Episode Statistics data were compared with the NICE commissioning model predictions. A quality-adjusted life-year was valued at £20 000 (Euro 23 000 15 November 2022).
RESULTS
Despite the introduction of the EBI programme, CCG compliance with NICE CG168 fell from 34.0 per cent (64 of 191) to 29.0 per cent (55 of 191). Some 33.0 per cent of CCG policies (63 of 191) became less compliant and only 7.3 per cent (14 of 191) changed to become fully compliant. Overall, 66.5 per cent of CCGs (127 of 191) provided less than the recommended intervention rate before EBI and this increased to 73.3 per cent (140 of191) after EBI. The overall proportion of patients estimated to require treatment annually who received treatment fell from 44.0 to 37.0 per cent. The associated estimated loss in net health benefit was between £164 and 174 million (Euro 188 million and 199 million 15 November 2022) over 3 years. A compliant policy was associated with a higher intervention rate; however, commissioning policy was associated with only 16.8 per cent of the variation in intervention rate (R2 = 0.168, P < 0.001).
CONCLUSION
Many local varicose vein commissioning policies in the NHS are not compliant with NICE CG168. More than half of patients who should be offered varicose vein treatment are not receiving it, and there is widespread geographical variation. The EBI programme has not been associated with any improvement in commissioning or access to varicose vein treatment.
Topics: Humans; State Medicine; England; Varicose Veins; Surveys and Questionnaires; Quality of Health Care
PubMed: 36448204
DOI: 10.1093/bjs/znac392 -
Revista Da Associacao Medica Brasileira... 2022The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo.
OBJECTIVES
The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo.
METHODS
Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil.
RESULTS
Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in São Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure.
CONCLUSION
Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).
Topics: Adult; Humans; Male; Female; Middle Aged; Brazil; Hospitals, Public; Patient Discharge; Vascular Surgical Procedures; Varicose Veins
PubMed: 36449789
DOI: 10.1590/1806-9282.20220565 -
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 -
Lakartidningen May 2021The aim of this study was to estimate the number of treatments for varicose veins (VV) performed in Sweden annually and the proportion of these unknown to the National...
The aim of this study was to estimate the number of treatments for varicose veins (VV) performed in Sweden annually and the proportion of these unknown to the National Board of Health and Welfare or to the Swedish National Registry for Vascular Surgery, Swedvasc. Aggregated data was collected from the National Patient Registry (NPR), Swedvasc and inquiries sent to hospitals and private clinics for the years 2016-2018, the calculated volumes from these three sources were comparable with extrapolated volumes obtained from a coverage control between NPR and Swedvasc for treatments of the great saphenous vein. The approximated volumes of VV interventions annually were 8 650, 10 750 and 12 250, the proportion not registered in NPR 29%, 51% and 58% respectively, the corresponding figures for Swedvasc 56%, 33% and 20%. Interventions for VV are thus underreported in Sweden and this has implications for allocation of resources and quality control.
Topics: Humans; Registries; Saphenous Vein; Sweden; Varicose Veins; Vascular Surgical Procedures
PubMed: 35343574
DOI: No ID Found -
Phlebology Jul 2021
Topics: Humans; Saphenous Vein; Varicose Veins
PubMed: 34106014
DOI: 10.1177/02683555211006550 -
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 -
Phlebology 2007
Topics: Humans; Incidence; Risk Factors; Varicose Veins; Venous Thrombosis
PubMed: 18265546
DOI: 10.1258/026835507779700590