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VASA. Zeitschrift Fur Gefasskrankheiten Jul 2014In patients with chronic venous disease (CVD) the number of venous valves and the degree of valve deterioration have not been extensively investigated and are poorly...
BACKGROUND
In patients with chronic venous disease (CVD) the number of venous valves and the degree of valve deterioration have not been extensively investigated and are poorly understood. The aim of this prospective study was to quantitatively and qualitatively investigate the venous valves in CVD patients in view of their clinical classification.
PATIENTS AND METHODS
Within two years a consecutive series of 152 patients (223 limbs) undergoing primary surgery for great saphenous vein varicose veins was investigated. In all patients the 'C' class according to the basic CEAP-classification was registered preoperatively (C2 to C6) for each limb. Both the quantity and quality of venous valves were assessed in the GSV's after removal. Qualitative evaluation of the valves was based on macroscopic appearance using a classification from 0 to 5 and described as 'valve disease class'.
RESULTS
A negative correlation between age and the number of valves was detected (p = 0.0035). There was an increase of C-class with increasing age. No significant correlation between the average number of valves per meter and the C-class was detected. For all C-classes an average of between four and five valves per meter was counted. Valve disease class was positively correlated with the C-class although the valve disease class was never higher than the C-class (p < 0.05).
CONCLUSIONS
The valve disease class of the great saphenous vein correlates with the C-class of the CEAP-classification. The number of valves did not correlate with the 'C'-class. With each increase in the CEAP class the age increased as well.
Topics: Adult; Age Factors; Aged; Female; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Saphenous Vein; Severity of Illness Index; Varicose Veins; Venous Valves
PubMed: 25007904
DOI: 10.1024/0301-1526/a000361 -
Vascular Jun 2016Varicose vein has become enlarged and twisted and, consequently, has lost its mechanical strength. As a result of the varicose saphenous vein (SV) mechanical...
OBJECTIVE
Varicose vein has become enlarged and twisted and, consequently, has lost its mechanical strength. As a result of the varicose saphenous vein (SV) mechanical alterations, the hemodynamic parameters of the blood flow, such as blood velocity as well as vein wall stress and strain, would change accordingly. However, little is known about stress and strain and there consequences under experimental conditions on blood flow and velocity within normal and varicose veins. In this study, a three-dimensional (3D) computational fluid-structure interaction (FSI) model of a human healthy and varicose SVs was established to determine the hemodynamic characterization of the blood flow as a function of vein wall mechanical properties, i.e. elastic and hyperelastic.
METHODS
The mechanical properties of the human healthy and varicose SVs were experimentally measured and implemented into the computational model. The fully coupled fluid and structure models were solved using the explicit dynamics finite element code LS-DYNA.
RESULTS
The results revealed that, regardless of healthy and varicose, the elastic walls reach to the ultimate strength of the vein wall, whereas the hyperelastic wall can tolerate more stress. The highest von Mises stress compared to the healthy ones was seen in the elastic and hyperelastic varicose SVs with 1.412 and 1.535 MPa, respectively. In addition, analysis of the resultant displacement in the vein wall indicated that the varicose SVs experienced a higher displacement compared to the healthy ones irrespective of elastic and hyperelastic material models. The highest blood velocity was also observed for the healthy hyperelastic SV wall.
CONCLUSION
The findings of this study may have implications not only for determining the role of the vein wall mechanical properties in the hemodynamic alterations of the blood, but also for employing as a null information in balloon-angioplasty and bypass surgeries.
Topics: Biomechanical Phenomena; Blood Flow Velocity; Case-Control Studies; Computer Simulation; Elasticity; Finite Element Analysis; Hemodynamics; Humans; Models, Cardiovascular; Numerical Analysis, Computer-Assisted; Regional Blood Flow; Saphenous Vein; Stress, Mechanical; Varicose Veins
PubMed: 26123058
DOI: 10.1177/1708538115594095 -
Vascular Apr 2021To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and...
OBJECTIVE
To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2-C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated.
RESULTS
Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.
Topics: Adult; Aged; Female; Hemodynamics; Humans; Ligation; Male; Middle Aged; Recurrence; Retrospective Studies; Saphenous Vein; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency
PubMed: 32772841
DOI: 10.1177/1708538120947251 -
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 -
Phlebology 2008
Topics: Humans; Treatment Outcome; Varicose Veins
PubMed: 18453478
DOI: 10.1258/phleb.2008.081000 -
Phlebology Jul 2018Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex...
Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex ultrasonography revealed significant pelvic contribution in eight males presenting with bilateral lower limb varicose veins. Testicular and internal iliac veins were examined with either one or a combination of computed tomography, magnetic resonance venography, testicular, transabdominal or transrectal duplex ultrasonography. Subsequently, all patients received pelvic vein embolisation, prior to leg varicose vein treatment. Results Pelvic vein reflux was found in 23 of the 32 truncal pelvic veins and these were treated by pelvic vein embolisation. Four patients have since completed their leg varicose vein treatment and four are undergoing leg varicose vein treatments currently. Conclusion Pelvic vein reflux contributes towards lower limb venous insufficiency in some males with leg varicose veins. Despite the challenges, we suggest that pelvic vein reflux should probably be investigated and pelvic vein embolisation considered in such patients.
Topics: Adult; Aged; Cohort Studies; Humans; Iliac Vein; Magnetic Resonance Angiography; Male; Middle Aged; Phlebography; Recurrence; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex; Varicose Veins
PubMed: 28857674
DOI: 10.1177/0268355517728667 -
Kathmandu University Medical Journal...Background Varicose vein is one of the most common venous diseases which affect superficial veins especially of lower limb. This disease is characterized by prominent...
Background Varicose vein is one of the most common venous diseases which affect superficial veins especially of lower limb. This disease is characterized by prominent dilated veins, feeling of heaviness, itchiness, pigmentation, ulceration depending upon the stage of the disease. Objective This study was conducted to know how Body Mass Index, Age and Gender influence staging of varicose veins in our context. Method This is a cross sectional hospital based study conducted at Dhulikhel Hospital, Kathmandu University Hospital from April 2018 to March 2019. Patients with signs and symptoms of varicose vein were included in the study. Informed consent was taken from each patient and data collection done by filling the proforma. Result This study comprised 135 lower limbs with varicose vein from 108 patients. Male:Female ratio was 1.4:1. Mean age of patients was 44.47±12.65 (17-81) years. Significant correlation was found between increasing age and progression in Clinical staging of Varicose vein according to Clinical classification (p<0.05). Mean Great Saphenous Vein diameter at knee was found significantly higher in patients with more than five years of symptoms Mean Body Mass Index was not very different in different Clinical stage of Varicose veins. Conclusion This study showed that the Clinical Staging of Clinical Etiological Anatomical and Pathophysiological classification of varicose vein is significantly related to age. The mean diameter of Great Saphenous Vein at the level of Knee is significantly related to the duration of symptoms. However, the influence of Body Mass Index and gender on stages of varicose vein could not be established.
Topics: Adult; Ambulatory Care Facilities; Body Mass Index; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Saphenous Vein; Varicose Veins
PubMed: 33582684
DOI: No ID Found -
The Journal of Dermatologic Surgery and... Jan 1992Varicose veins of any size (except telangiectasia) and in any site of the lower limb (except the saphenofemoral junction) can be avulsed through multiple 0.5-mm (or...
Varicose veins of any size (except telangiectasia) and in any site of the lower limb (except the saphenofemoral junction) can be avulsed through multiple 0.5-mm (or larger) incisions under local infiltration anesthesia (Müller's technique). When necessary, high ligation, division, and stripping of the proximal long saphenous vein can also be performed under local anesthesia. It is thus possible to treat even the most complex varicose cases with outpatient office-based surgery.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Humans; Methods; Postoperative Care; Postoperative Complications; Surgical Instruments; Varicose Veins
PubMed: 1740569
DOI: 10.1111/j.1524-4725.1992.tb03302.x -
British Medical Journal Jan 1976A method has been devised to allow reliable comparison of different strengths and constructions of support hosiery. Five garments were evaluated for the compression they...
A method has been devised to allow reliable comparison of different strengths and constructions of support hosiery. Five garments were evaluated for the compression they exerted on the leg and their ability to limit the distension of a model varicose vein. Stockings and tights which provide modest compression can achieve worthwhile control of vein distension.
Topics: Adolescent; Adult; Clothing; Elasticity; Female; Humans; Middle Aged; Nylons; Pressure; Varicose Veins
PubMed: 1247807
DOI: 10.1136/bmj.1.6004.254 -
Seminars in Vascular Surgery Jun 2010Based on a theoretical hemodynamic model, CHIVA (conservative hemodynamic cure for venous insufficiency) is an ultrasound-guided, minimally invasive surgical strategy... (Review)
Review
Based on a theoretical hemodynamic model, CHIVA (conservative hemodynamic cure for venous insufficiency) is an ultrasound-guided, minimally invasive surgical strategy performed under local anesthesia for the treatment of patients with varicose vein disease. After careful duplex mapping, the surgeon performs flush ligation procedures at the proximal origin of key points of reflux while meticulously maintaining superficial venous drainage to prevent varicosity recurrence. The saphenous veins are preserved. The strategy has been shown in studies to be safe and effective.
Topics: Anesthesia, Local; Clinical Competence; Hemodynamics; Humans; Ligation; Minimally Invasive Surgical Procedures; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasonography, Interventional; Varicose Veins; Vascular Surgical Procedures; Venous Insufficiency
PubMed: 20685567
DOI: 10.1053/j.semvascsurg.2010.01.008