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Medicine Jul 2022Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of...
RATIONALE
Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.
PATIENT CONCERNS
A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.
DIAGNOSIS
Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins.
INTERVENTION
Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.
OUTCOMES
Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection.
LESSONS
Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.
Topics: Colon, Sigmoid; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Middle Aged; Portal Vein; Rupture; Varicose Veins
PubMed: 35905227
DOI: 10.1097/MD.0000000000030024 -
European Journal of Vascular and... Feb 2004
Review
Topics: Catheter Ablation; Humans; Leg; Peripheral Nervous System; Saphenous Vein; Skin; Sural Nerve; Varicose Veins; Vascular Surgical Procedures
PubMed: 14718891
DOI: 10.1016/j.ejvs.2003.11.007 -
VASA. Zeitschrift Fur Gefasskrankheiten Jul 2022
Topics: Embolization, Therapeutic; Humans; Varicose Veins; Vena Cava, Inferior
PubMed: 35786994
DOI: 10.1024/0301-1526/a001014 -
Vascular Medicine (London, England) Feb 2015
Review
Topics: Hemodynamics; Humans; Predictive Value of Tests; Regional Blood Flow; Risk Factors; Saphenous Vein; Treatment Outcome; Ultrasonography; Varicose Veins
PubMed: 25722421
DOI: 10.1177/1358863X14566224 -
Advances in Therapy Mar 2019Risk factors for the development of progression chronic venous disease (CVD) and varicose veins are widespread and include advanced age, excess body weight, sedentary... (Review)
Review
Risk factors for the development of progression chronic venous disease (CVD) and varicose veins are widespread and include advanced age, excess body weight, sedentary lifestyles and occupations, family history, and pregnancy. Varicose veins and CVD are associated with venous hypertension, venous reflux, dysfunctional venous valves, and vein wall inflammation, though the precise etiologies are unclear. Once venous pathology develops, it can progress through a vicious cycle of inflammation and leukocyte recruitment that leads to further deterioration of vein walls and valves, increased hypertension, and release of additional proinflammatory mediators. Early treatment of symptomatic varicose veins and CVD as well as lifestyle changes can help break the inflammatory cycle and alleviate symptoms. Physicians and patients should be aware of the risk factors for CVD, the treatments and measures available to slow disease progression, and the serious consequences of allowing the disease to progress unchecked.Funding: Servier (France).
Topics: Age Factors; Chronic Disease; Disease Progression; Humans; Risk Factors; Time Factors; Varicose Veins; Venous Insufficiency
PubMed: 30758741
DOI: 10.1007/s12325-019-0885-3 -
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 -
Cardiovascular Journal of AfricaVenous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any...
INTRODUCTION
Venous insufficiency caused by varicose veins, especially in the lower extremities, is widespread and can cause severe complications. Anaesthesia is essential for any surgical approaches in varicose vein surgery. This study evaluated the effect of single-dose epidural anaesthesia on postoperative pain scores and length of hospitalisation after varicose vein surgery, comparing it with general anaesthesia.
METHODS
The study was conducted on a total of 100 patients, aged 18 years and older, with the American Society of Anesthesiologists (ASA) physical status classification I-III, undergoing unilateral lower-extremity stripping due to varicose veins within a six-month period at the Prof Dr Cemil Taşçioğlu City Hospital Anesthesiology and Reanimation Service. Fifty patients with single-dose epidural anaesthesia were consecutively included in the EA group. For comparison, 50 patients who were operated on under general anesthesia were included in the GA group.
RESULTS
The groups showed statistically significant differences between the 30th-minute and first-, second-, fourth- and sixth-hour visual analogue scale (VAS) scores ( = 0.001; < 0.01). Patients with epidural anaesthesia had lower 30th-minute VAS scores compared to those administered general anaesthesia. There were statistically significant differences identified between the groups for the additional analgesia requirements of patients ( = 0.001; < 0.01). Subjects with epidural anaesthesia had lower additional analgesic requirements than those administered general anaesthesia.
CONCLUSION
Epidural anaesthesia provided adequate anaesthesia with more effective postoperative analgesia compared to patients operated on under general anaesthesia and receiving multimodal analgesia for postoperative analgesia.
Topics: Anesthesia, Epidural; Anesthesia, General; Hospitals; Humans; Pain, Postoperative; Patient Discharge; Varicose Veins
PubMed: 34851351
DOI: 10.5830/CVJA-2021-061 -
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 -
Journal of Vascular Surgery Mar 2013Recurrent varicose veins (RVV) occur in 13% to 65% of patients following treatment, and remain a debilitating and costly problem. RVV were initially thought largely to... (Review)
Review
BACKGROUND
Recurrent varicose veins (RVV) occur in 13% to 65% of patients following treatment, and remain a debilitating and costly problem. RVV were initially thought largely to be due to inadequate intervention, however, more recently neovascularization and other factors have been implicated. This review aims to provide an overview of the current understanding of the etiology and pathogenesis of RVV.
METHODS
A systematic search of the PubMed database was performed using the search terms including "recurrent," "varicose veins," and "neovascularization."
RESULTS
Three types of RVV have been reported, namely residual veins, true RVV, and new varicose veins, although the definitions varied between studies. RVV are attributable to causes including inadequate treatment, disease progression, and neovascularization. Using duplex ultrasonography, neovascularization has been observed in 25% to 94% of RVV. These new vessels appear in various size, number, and tortuosity, and they reconnect previously treated diseased veins to the lower limb venous circulation. Histologically, these vessels appear primitive with incomplete vein wall formation, decreased elastic component, and lack of valves and accompanying nerves. Although the rate of RVV following open surgery and endovenous treatment appears similar, neovascularization seems less common following endothermal ablation. Other causes of RVV following endovenous treatment include recanalization and opening of collaterals.
CONCLUSIONS
Recurrence remains poorly understood following treatment of varicose veins. Neovascularization is an established and common cause of RVV, although other factors may contribute.
Topics: Ablation Techniques; Diagnostic Imaging; Disease Progression; Endovascular Procedures; Humans; Neovascularization, Pathologic; Predictive Value of Tests; Recurrence; Risk Factors; Treatment Outcome; Varicose Veins; Vascular Surgical Procedures; Veins
PubMed: 23343668
DOI: 10.1016/j.jvs.2012.10.102 -
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