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Frontiers in Dentistry 2024Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with...
Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with sublingual varices. Due to the convenience in examining the sublingual area, the present study aimed to assess the relationship between sublingual varices and hypertension. In this descriptive-analytic study, 500 patients were categorized into two groups: those with sublingual varices and those without. Two oral medicine specialists assessed the lesions, and the blood pressure of all patients was measured while they were in a relaxed sitting position. Age and gender data were recorded for all participants. Statistical analysis included t-test, chi-square, and logistic regression, with significance set at P<0.05. The frequency of sublingual varices was 21.8%. Mean systolic blood pressure was 139.68±19.01mmHg in patients with sublingual varices and 118.09±13.78mmHg in patients without the lesions (P=0.561). Mean diastolic blood pressure was 100.45±17.81mmHg and 80.31±12.08mmHg in patients with and without sublingual varices, respectively (P<0.001). Smoking was significantly more prevalent among patients who had the lesions (P<0.05). Gender (P=0.686) and age (P=0.875) showed no significant relationship with sublingual varices, while smoking and blood pressure levels were significantly associated with these varices (P<0.001). It is advisable to monitor and manage blood pressure in patients with sublingual varices who may not be aware of their blood pressure status. Our results showed that smoking could be one of the predictive factors for sublingual varices.
PubMed: 38571901
DOI: 10.18502/fid.v21i7.14888 -
Journal of Vascular Surgery. Venous and... Jul 2024Insurance companies have adopted variable and inconsistent approval criteria for chronic venous disease (CVD) treatment. Although vein ablation (VA) is accepted as the...
BACKGROUND
Insurance companies have adopted variable and inconsistent approval criteria for chronic venous disease (CVD) treatment. Although vein ablation (VA) is accepted as the standard of care for venous ulcers, the treatment criteria for patients with milder forms of CVD remain controversial. This study aims to identify factors associated with a lack of clinical improvement (LCI) in patients with less severe CVD without ulceration undergoing VA to improve patient selection for treatment.
METHODS
We performed a retrospective analysis of patients undergoing VA for CEAP C2 to C4 disease in the Vascular Quality Initiative varicose veins database from 2014 to 2023. Patients who required intervention in multiple veins, had undergone prior interventions, or presented with CEAP C5 to C6 disease were excluded. The difference (Δ) in venous clinical severity score (VCSS; VCSS before minus after the procedure) was used to categorize the patients. Patients with a ΔVCSS of ≤0 were defined as having LCI after VA, and patients with ≥1 point decrease in the VCSS after VA (ΔVCSS ≥1) as having some benefit from the procedure and, therefore, "clinical improvement." The characteristics of both groups were compared, and multivariable regression analysis was performed to identify factors independently associated with LCI. A second analysis was performed based on the VVSymQ instrument, which measures patient-reported outcomes using five specific symptoms (ie, heaviness, achiness, swelling, throbbing pain, and itching). Patients with LCI showed no improvement in any of the five symptoms, and those with clinical improvement had a decrease in severity of at least one symptom.
RESULTS
A total of 3544 patients underwent initial treatment of CVD with a single VA. Of the 3544 patients, 2607 had VCSSs available before and after VA, and 420 (16.1%) had LCI based on the ΔVCSS. Patients with LCI were more likely to be significantly older and African American and have CEAP C2 disease compared with patients with clinical improvement. Patients with clinical improvement were more likely to have reported using compression stockings before treatment. The vein diameters were not different between the two groups. The incidence of complications was overall low, with minor differences between the two groups. However, the patients with LCI were significantly more likely to have symptoms after intervention than those with improvement. Patients with LCI were more likely to have technical failure, defined as vein recanalization. On multivariable regression, age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02) and obesity (OR, 1.47; 95% CI, 1.09-2.00) were independently associated with LCI, as was treatment of less severe disease (CEAP C2; OR, 1.82; 95% CI, 1.30-2.56) compared with more advanced disease (C4). The lack of compression therapy before intervention was also associated with LCI (OR, 6.05; 95% CI, 4.30-8.56). The analysis based on the VVSymQ showed similar results.
CONCLUSIONS
LCI after VA is associated with treating patients with a lower CEAP class (C2 vs C4) and a lack of compression therapy before intervention. Importantly, no significant association between vein size and clinical improvement was observed.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Aged; Treatment Outcome; Risk Factors; Ablation Techniques; Varicose Veins; Databases, Factual; Severity of Illness Index; Chronic Disease; Adult; Patient Selection; Time Factors; Risk Assessment
PubMed: 38552954
DOI: 10.1016/j.jvsv.2024.101884 -
Journal of Vascular Surgery. Venous and... May 2024The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage.
The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology.
OBJECTIVE
The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage.
METHODS
A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated.
RESULTS
Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein.
CONCLUSIONS
Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
Topics: Humans; United States; Saphenous Vein; Cross-Sectional Studies; Varicose Veins; Femoral Vein; Sclerotherapy; Venous Insufficiency; Treatment Outcome
PubMed: 38551528
DOI: 10.1016/j.jvsv.2024.101856 -
Journal of Vascular Surgery. Venous and... May 2024The term Anterior Accessory of the Great Saphenous Vein suggests this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A... (Review)
Review
The anterior saphenous vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology.
BACKGROUND
The term Anterior Accessory of the Great Saphenous Vein suggests this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the anterior saphenous vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs.
METHODS
The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities.
RESULTS
The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature.
CONCLUSIONS
The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.
Topics: Humans; United States; Saphenous Vein; Varicose Veins; Femoral Vein; Popliteal Vein; Ultrasonography, Doppler, Duplex; Venous Insufficiency; Treatment Outcome
PubMed: 38551527
DOI: 10.1016/j.jvsv.2024.101855 -
Journal of Vascular Surgery. Venous and... May 2024The decision to treat a refluxing anterior saphenous vein (ASV) should be a clinical decision based on the assessment on the ASV's contribution to patient's signs and...
The anterior saphenous vein. Part 4. Clinical and technical considerations in treatment. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology.
BACKGROUND
The decision to treat a refluxing anterior saphenous vein (ASV) should be a clinical decision based on the assessment on the ASV's contribution to patient's signs and symptoms. Once the decision to treat has been made, there are anatomic, clinical, and technical considerations in treatment planning.
METHODS
Clinical scenarios were discussed by a panel of experts and common anatomic, clinical, and technical considerations were identified.
RESULTS
There are unique clinical considerations such as whether both the great saphenous vein (GSV) and ASV should be concomitantly treated, if a normal ASV should be treated when treating a refluxing GSV and when and how to treat the associated tributary varicose tributaries. Being aware of the anatomic, clinical, and technical considerations allows development of a treatment plan that optimizes long-term outcomes in patients with ASV reflux.
CONCLUSIONS
Ultimately the treatment plan should be tailored to address these types of variables in a patient-centered discussion.
Topics: Humans; United States; Saphenous Vein; Varicose Veins; Venous Insufficiency; Treatment Outcome; Femoral Vein
PubMed: 38551526
DOI: 10.1016/j.jvsv.2024.101857 -
Biomedicines Mar 2024Chronic venous insufficiency (CVI) is a common medical condition characterized by impaired functioning of the venous system in the lower extremities. It leads to various...
Chronic venous insufficiency (CVI) is a common medical condition characterized by impaired functioning of the venous system in the lower extremities. It leads to various symptoms, including varicose veins, leg edema, and skin pigmentation. It is believed that a combination of genetic and environmental factors affect the development of CVI. The gene is of particular interest in this context, as it plays a role in lipid metabolism and inflammation. The ε4 allele (rs429358) has been associated with an increased risk of Alzheimer's disease, while the ε2 allele (rs7412) has shown a protective effect against Alzheimer's disease but a strong association with cardiovascular inflammation. This research aimed to investigate the presence of gene variants in individuals with chronic venous insufficiency disease and validate the relationship between this gene and cardiovascular diseases. The study analyzed the expression of gene variants in varicose vein tissue samples from patients and a normal vein in the control group. The results indicated no significant expression of the ε4 allele in either group. However, there was a significant decrease in the expression of the ε2 allele in the patient group. Additionally, a negative correlation was observed between the two single nucleotide polymorphisms (SNPs) in vein tissue. The lower expression of the ε2 allele in patients suggests a potentially reduced risk of cardiovascular disease in these individuals. Consequently, there appears to be a weaker association between the expression of the APOE gene ε2 allele and cardiovascular diseases.
PubMed: 38540308
DOI: 10.3390/biomedicines12030695 -
Biomedicines Feb 2024Despite advancements in coronary artery bypass grafting (CABG), the optimal choice of graft material remains a subject of investigation. This study aimed to...
The Controversy of Using Insufficient Great Saphenous Veins in Coronary Artery Bypass Grafting: A Comparative Morphological Analysis of Healthy and Insufficient Veins Related to the Possibility of Using Them as a Graft.
BACKGROUND
Despite advancements in coronary artery bypass grafting (CABG), the optimal choice of graft material remains a subject of investigation. This study aimed to comprehensively analyze the morphological characteristics of varicose veins, exploring their potential utilization in CABG compared to healthy veins.
METHODS
The study included 178 patients, categorized into two groups based on healthy and varicose veins. Morphological parameters, including maximum venous diameter, wall thickness, and specific changes in tunica intima (TI), tunica media (TM), and tunica adventitia (TA), were analyzed through microscopic evaluation.
RESULTS
Varicose veins exhibited a significantly larger maximum venous diameter ( = 0.0001) and increased wall thickness ( = 0.0001) compared to healthy veins. Although varicose veins showed thickening in TI and TM, the differences were not statistically significant. Notably, disorganized smooth muscle bundles were more prevalent in varicose veins ( = 0.001), suggesting potential wall weakness. The absence of vasa vasorum in TA was significantly higher in varicose veins ( = 0.050), influencing vascularization considerations.
CONCLUSIONS
The comparative morphological microscopic analysis of the specimens of healthy and varicose veins reveals significant differences between the groups, which make the conclusion of this study to plead for avoiding the use of varicose veins as a graft.
PubMed: 38540090
DOI: 10.3390/biomedicines12030476 -
Phlebology Jun 2024The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage. (Review)
Review
The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology.
OBJECTIVE
The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage.
METHODS
A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated.
RESULTS
Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein.
CONCLUSIONS
Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
Topics: Humans; Saphenous Vein; Varicose Veins; Insurance Coverage; Venous Insufficiency; Societies, Medical; United States
PubMed: 38526968
DOI: 10.1177/02683555231223281 -
Phlebology Jun 2024The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A... (Review)
Review
The Anterior Saphenous Vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology.
BACKGROUND
The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs.
METHODS
The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities.
RESULTS
The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature.
CONCLUSIONS
The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.
Topics: Saphenous Vein; Humans; Varicose Veins; Female; Male; Middle Aged; Adult; Ultrasonography; Aged; Venous Insufficiency
PubMed: 38526958
DOI: 10.1177/02683555231223055 -
International Wound Journal Apr 2024Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment,... (Meta-Analysis)
Meta-Analysis
Chronic venous insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold-standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non-compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full-text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta-analysis. There are five main overarching themes for non-compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub-themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription.
Topics: Adult; Humans; Middle Aged; Venous Insufficiency; Chronic Disease; Lower Extremity; Patient Compliance; Research Design; Varicose Ulcer; Stockings, Compression
PubMed: 38522455
DOI: 10.1111/iwj.14833