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Journal articles on the topic 'Varicose veins'
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1
Nüllen, H., and T. Noppeney. "REVAT (Recurrent Varices After Treatment)." Phlebologie 38, no. 06 (2009): 271–74. http://dx.doi.org/10.1055/s-0037-1622280.
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SummaryThe term “recurrent varicose veins” covers various entities. In the first instance, recurrent varicose veins may be the progression of the underlying disease, as there is a hereditary disposition to the condition, but we also find the phenomenon of neovascularisation, and lastly we repeatedly see recurrent varices as a result of technical or strategic surgical errors and the failure of endovenous procedures. No differentiation between these different types of recurrent varicose veins has previously been made in the literature, so that the numbers given vary between 6% and 60%. Up to the present time, few data on the progression of the underlying disease are to be found in the literature. Our own studies, on average 36 months postoperatively, demonstrated new varicose side branches that could be interpreted as progression of the underlying disease in 56.8% of the patients followed up.Several recent publications demonstrate neovascularisation as a cause of recurrence. While some authors give a figure of 24% for recurrence due to neovascularisation in patients who have had surgery, other publications regard neovascularisation as the main cause of postoperative recurrence.The data on technical or strategic surgical errors and recanalisation after endovenous procedures are also very varied. Numbers for technical errors as the cause of recurrent varicose veins following surgery range from 10.7% to more than 70%. Published recanalisation rates after endovenous laser therapy vary between 0% and 36%; the average recanalisation rate in the available prospective randomised studies on radiofrequency obliteration was 12.9%. Foam sclerotherapy has recanalisation rates between 69% and 86%, with a mean follow-up of 32.2 months.Given the different possible causes, it is extremely important, that recurrent varicose veins should be classified. The authors have developed a simple classification that can be used in routine daily practice. Recurrent varicose veins are given the acronym REVAT (recurrent varices after treatment). Generally speaking, on the one hand there is progression of the underlying disease (progression of disease = PD) and, on the other hand, varicosities after treatment as a result of technical error or failure of the method used (recurrence after treatment = RT). Progression of the underlying disease can be further subdivided into neovascularisation at the saphenofemoral or popliteal junction (progression of disease at the junction = PD-J) and new varices arising in the treated vascular territory (progression of disease at the limb = PD-L).In the case of recurrent varices after treatment we distinguish between a persisting or a new reflux at the saphenofemoral or the popliteal junction (recurrence after treatment at the junction = RT-J), untreated segments of the great or small saphenous veins or recanalisation of the trunk (recurrence after treatment at the trunk = RT-T) and untreated side branches or perforating veins (recurrence after treatment at side branches = RT-S). With the help of these abbreviations a simple formula can be generated to describe the recurrent varices, e.g. recanalisation of the left great saphenous vein (GSV) after endovenous treatment and a new varicosis in the vascular territory of the left great saphenous vein resulting from progression of the underlying disease: vascular territory left great saphenous vein = GSV-L, technical or tactical error due to recanalisation of the GSV = RT-T, progression of the underlying disease in the vascular territory of the GSV = PD-L. This generates the formula: GSV-L : RT-T, PD-L.Since there are no exact figures on the incidence of the individual causes of recurrent varicosis, a classification of recurrent varicosis is indispensable to ensure clarity in the future.
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Kirsch, Delia, Dienes, Küchle, Duschner, Wahl, Böttger, and Junginger. "Veränderungen der extrazellulären Matrix in der Venenwand – Ursache der primären Varikosis?" Vasa 29, no. 3 (August 1, 2000): 173–77. http://dx.doi.org/10.1024/0301-1526.29.3.173.
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Background: Conflicting theories on the development of primary varicosis have led to the molecular biological investigation of the vein wall or, more accurately, of the extracellular matrix. It was the aim of this study to quantify matrix expression and to compare pathological changes in the vein wall with valve-orientated staging of varicosis, in order to determine indicators of the primary cause of varicosis. Materials and methods: Three hundred seventy-two tissue specimens of greater saphenous veins were obtained from 17 patients with varicosities and categorised according to Hach stage and procurement site. The specimens were compared with 36 specimens collected from six patients without varicosities, incubated with fluorescence-stained antibodies for collagen 4, laminin, fibronectin and tenascin prior to being assessed with confocal laser scan microscopy. In addition, 22 vein specimens (16 varicose, 6 normal veins) serving as negative controls were investigated. Results: Image analysis and statistical evaluation showed that compared with normal veins, varicose veins are associated with a significant increase in matrix protein expression for collagen 4, laminin and tenascin. A trend towards an increase in matrix expression was further observed for fibronectin. There was, however, no difference between varicose veins and clinically healthy vein segments inferior to a varicose segment. Conclusion: If the findings of the present investigation can be confirmed by other studies, alterations in the vein wall may be regarded as the primary cause of varicosis and valvular insufficiency as the result of these changes.
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Lawson, James A., and Irwin M. Toonder. "A review of a new Dutch guideline for management of recurrent varicose veins." Phlebology: The Journal of Venous Disease 31, no. 1_suppl (February 25, 2016): 114–24. http://dx.doi.org/10.1177/0268355516631683.
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In 2013, the new Dutch guideline for “Venous Pathology” was published. The guideline was a revision and update from the guideline “Diagnostics and Treatment of Varicose Veins” from 2009 and the guideline “Venous Ulcer” from 2005. A guideline for “Deep Venous Pathology” and one for “Compression Therapy” was added to the overall guideline “Venous Pathology.” The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term “recidief varices” or the French “récidive de varices” should be used analogous to the English term “recurrent varicose veins.” The DCOP Guideline Development Group Neovarices concluded that “recidief” in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term “neovarices.” In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.
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Yasim, Alptekin, Erdinc Eroglu, Orhan Bozoglan, Bulent Mese, Mehmet Acipayam, and Hakan Kara. "A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)." Phlebology: The Journal of Venous Disease 32, no. 3 (July 9, 2016): 194–99. http://dx.doi.org/10.1177/0268355516638577.
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Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.
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Rabe, E., and F. Pannier. "Embolization is not essential in the treatment of leg varices due to pelvic venous insufficiency." Phlebology: The Journal of Venous Disease 30, no. 1_suppl (February 28, 2015): 86–88. http://dx.doi.org/10.1177/0268355515569412.
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Aim To consider if it is essential to perform embolization in the treatment of leg varices due to pelvic venous insufficiency. Methods Review of the current literature concerning treatment options of leg varicose veins of pelvic origin. Results Pelvic venous insufficiency, vulvar and pudendal varicose veins as well as pelvic congestive syndrome are under diagnosed entities. Embolization of ovarian and pelvic veins is well established in patients with pelvic congestive syndrome. In varicose veins of pelvic origin but without pelvic congestive syndrome, comparative studies comparing the outcome of embolization or treatment of varicose veins by sclerotherapy or phlebectomy alone are missing. Foam sclerotherapy or phlebectomy shows good results in patients with varicose veins of pelvic origin. Conclusions Embolization is not essential in the treatment of leg varices of pelvic origin without pelvic congestive syndrome. Foam sclerotherapy or phlebectomy shows good results in patients with vulvar or pudendal varicose veins. Randomized comparative studies using embolization of incompetent pelvic veins or sclerotherapy of varicose veins with pelvic origin should be performed.
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Zulfiquar, Muhammad Kamil, Muhammad Awais, Sundas Javeed Javeed, Saulat Naeem, Ayesha Waheed, Rizwan Khan, and Rooh-Ul Ain. "To Assess Short Term Outcomes of Ambulatory Selective Varices Ablation Under Local Anesthesia in Primary Varicose Veins." Pakistan Journal of Medical and Health Sciences 16, no. 4 (April 29, 2022): 139–41. http://dx.doi.org/10.53350/pjmhs22164139.
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Background: Varicose veins are superficial veins that have become enlarged and twisted. A vein that is confined within fascial planes or is buried beneath subcutaneous tissue can carry massive amounts of high-pressure reflux without being visible at all. Aim: To assess the short-term outcomes of Ambulatory Selective Varices Ablation under Local anesthesia in primary varicose veins disease Methods: this is a descriptive case series conducted at department of surgery, Services Institute of Medical Sciences, from December 2018 to June 2019. After fulfill the inclusion criteria, 181 patients were enrolled. Preoperatively, all varicose veins marked but the patient is in standing position as it’s difficult or impossible to identify during recumbent position. A micro incision or puncture is made near the vein after the anesthetic has been administered into the peri-venous tissues. After removing a segment, the surgeon moved along the vein for roughly the similar distance, makes a second incision, then the procedure is repeated until all sections of the varix have been removed, reducing the risk of an inflammatory response from the residual segment thrombosis. Results: In this study the mean age of the patients was 35.03±5.25 years. C2 CEAP classification was noted in 52(28.7%) patients, c3 CEAP classification found in 101(55.8%) patients. The reflux found in 54(29.8%) patients and recurrence noted in 33(18.23%) patients. Conclusion: The conclusion of this study that Ambulatory Selective Varices Ablation under Local anesthesia is a feasible and reliable technique with lower rate of recurrence in patients presented with in primary varicose veins disease. Keywords: Varicose vein, varices, local anaesthesia
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Myers, K. A., G. H. Zeng, R. W. Ziegenbein, and P. G. Matthews. "Duplex Ultrasound Scanning for Chronic Venous Disease: Recurrent Varicose Veins in the Thigh after Surgery to the Long Saphenous Vein." Phlebology: The Journal of Venous Disease 11, no. 3 (September 1996): 125–31. http://dx.doi.org/10.1177/026835559601100312.
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Objective: To use duplex ultrasound scanning to compare limbs with recurrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laboratory in Melbourne, Australia. Patients: A study of 779 limbs with recurrent varicose veins previously treated by ligation or stripping of the long saphenous vein and 1521 limbs with primary varicose veins. Main outcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward flow in perforators as demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous reflux alone in 14.7% or outward flow in calf perforators without saphenous reflux in 5.2%, while no source was detected in 8.3%. Limbs with recurrent veins in the long saphenous territory were compared with limbs with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward flow in calf perforators (56.8% vs. 53.1%). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller proximal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major tributaries in 28.7% or to other varices in 37.6%. Limbs known to have been treated by long saphenous ligation alone were compared with those known to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs. 39.9%) and the destination was more likely to be an intact long saphenous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex ultrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping the long saphenous vein was more likely to be due to multiple small connections passing to scattered varices and this may allow more simple treatment by injection sclerotherapy rather than repeat surgery.
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Kazi, Wasim, Jigna Patel, Varsha Sharma, and Sonal Panchal. "Role of Jalokaavacharana in the Management of Varicose Veins (Sirajgranthi)- A Case Study." Asian Journal of Pharmaceutical Research and Development 11, no. 4 (August 13, 2023): 52–55. http://dx.doi.org/10.22270/ajprd.v11i4.1305.
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When a vein becomes dilated, elongated and tortuous, the veins is said varicose. The common sight of varicosity are superficial venous system of lower limb effecting either long or short saphenous veins, oesophageal varices, varicosity of haemorrhoidal veins, varicosity of spermatic veins. Generally varicose veins are compared with sirajgranthi according to Ayurveda. Acharya Sushruta had described various types of granthi and its various treatment modalities among them jalaukaavacharana is one of them. Sushruta had given special chapter related to jalauka in which he had described the types, nomenclature, specific qualities of each types of jalauka, their method to apply and detach and how to do vamana of jalauka. Acharya charak also described jalauka as best amongst all anushashtras. Jalaukapossesessheet guna in nature and on the basis of sign and symptoms varicose veins can be correlated with sirajgranthi. In this case study a 36- year old woman of bilateral varicose veins was treated successfully and found symptomatic relief.
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Travers, J. P., C. M. Dalton, D. M. Baker, and G. S. Makin. "Biochemical and Histological Analysis of Collagen and Elastin Content and Smooth Muscle Density in Normal and Varicose Veins." Phlebology: The Journal of Venous Disease 7, no. 3 (September 1992): 97–100. http://dx.doi.org/10.1177/026835559200700303.
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Objective: Determination of the ratio of collagen and elastin to protein content of varicose/non-varicose veins from calf and determination of collagen, elastin and smooth muscle density of varicose/non-varicose vein walls. Design: Prospective study; control vein samples obtained from amputees for ischaemic vascular disease and varicose vein samples obtained from an equivalent Position following surgical stripping. Setting: Departments of Human Morphology and Vascular Surgery, Queen's Medical Centre, University of Nottingham, UK. Patients: Seven patients with no evidence of venous disease treated by amputation of the lower limb for vascular disease and 12 patients treated for varicose veins by ligation and stripping of the long saphenous vein. Interventions: Vein sections were examined biochemically and histologically using stereological techniques. Main outcome measures: Biochemical quanitfication of collagen, elastin and protein and stereological analysis of collagen, elastin and smooth muscle density of varicose and non-varicose veins. Results: There was no difference between the collagen/Protein or elastin/protein ratio in varicose and normal veins but there was a significant increase in muscle density with corresponding decrease in collagen and elastin density in the walls of varicose veins compared with non-varicose vein controls. Conclusions: There were no differences in the collagen or elastin content of varicose veins when compared with non-varicose veins. Smooth muscle hypertrophy occurs in varicose veins, which appears to disrupt the collagen/elastin lattice of the vein wall.
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Smith, P. Coleridge. "Debate: Should persistent incompetent truncal veins be treated immediately? The case in support of the statement." Phlebology: The Journal of Venous Disease 30, no. 1_suppl (February 28, 2015): 107–10. http://dx.doi.org/10.1177/0268355515569432.
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Background Debate continues as to the best method of treating patients with varicose veins and which will lead to durable clinical outcomes. Many modern techniques of treating varicose veins rely on ablation of the saphenous vein alone or in combination with phlebectomy or sclerotherapy of varices. However, it has been suggested that methods which leave the saphenous trunk untreated may result in similar outcomes. Methods A search of medical databases was made for literature which compared the outcomes of saphenous vein stripping, sclerotherapy and modern methods of vein ablation. Synthesis Surgical methods which have been used range from simple phlebectomy, ligation of the saphenous trunk to stripping of the saphenous vein. Systematic comparison of striping of the saphenous vein in addition to ligation of the sapheno-femoral junction appears to improve the outcome of varicose veins surgery compared to saphenous ligation alone. The 21st century endovenous treatments for varicose veins all rely on ablating the saphenous trunk. Duplex ultrasound studies show some variation in the efficacy of saphenous ablation with these methods. However, a randomised clinical trial shows similar patient reported outcomes with all endovenous techniques and surgical stripping of the saphenous vein. A clinical series shows that after endovenous thermal ablation recurrent varices arise in residual sections of saphenous trunk, accessory veins and residual tributaries. Conclusions Studies based on clinical criteria require follow-up of about six years to yield reliable data. Before this time varices may be forming but cannot be detected clinically and over-optimistic results of treatment are reported. Data from surgical and endovenous treatment studies suggest that the more extensive and effective the ablation of saphenous trunks, accessory veins and tributaries, the better the long-term outcome that is achieved.
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K. Kotteeswaran, Pradeep kumar S, and Poojasree B. "Study on the Prevalence Rate of Varicose Veins among School Teachers." International Journal of Physiotherapy and Research 10, no. 5 (October 11, 2022): 4337–41. http://dx.doi.org/10.16965/ijpr.2022.110.
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Background: The teachers are the biggest asset of the society as they are the source of knowledge and teaches about morals to the children.They face many problems which mainly affect their quality of life. One of the problem is varicose veins which shows various symptoms like itching and ulceration. Aim: The aim of the study is to find the prevalence rate of varicose veins among school teachers. Objective: To determine the prevalence rate of varicose veins among school teachers using VEINES-symptoms questionnaire.To determine which gender has higher prevalence rate of Varicose veins. Materials: VEINES (venous insufficiency epidemiological and economic study). Results: The statistical analysis shows that the 40% of the school teachers were affected by varicose veins by using VEINES-symptoms questionnaire. Conclusion:Based on the present study findings,it was concluded that the school teachers are more prone to Varicose veins.The present study states that female school teachers has higher prevalence rate of Varicose veins than male teachers.Among the school teachers prolonged standing considered as the significant risk factors KEY WORDS: Varicose veins, School teachers, VEINES-symptoms questionnaire, Prevalence rate, Itching, Ulceration.
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Moreira, Ricardo C. Rocha, Márcio Miyamotto, Ramzi Abdallah El-Hosni Jr., and Barbara D’Agnoluzzo Moreira. "The role of transillumination phleboscopy in the planning of cosmetic operations for varicose veins." Jornal Vascular Brasileiro 8, no. 4 (December 2009): 313–17. http://dx.doi.org/10.1590/s1677-54492009000400006.
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Background: The cosmetic treatment of varicose veins is the main activity of most vascular surgeons in Brazil. In order to obtain satisfactory cosmetic results, careful planning of varicose vein operations is necessary. Objective: Marking (or "mapping") the varicose veins with indelible ink is an essential step in planning cosmetic surgeries for lower limb varicose veins. In the present study, the role of transcutaneous phleboscopy (TcPh) in planning varicose vein operations is evaluated. Methods: A series of 100 consecutive patients, all female, were evaluated with TcPH as part of their varicose vein operations planning. A total of 171 limbs with varicose veins (71 bilateral and 29 unilateral) were evaluated. The process of marking the varicose veins followed the same protocol in all cases. Firstly, the varicose veins were marked by inspection and palpation, with the patient standing, using an indelible black ink pen. Secondly, with the patients resting in supine and prone positions, the varicose veins detected with TcPh were marked again with red or blue ink. The marks made by the two methods were then compared. Results: In 41 patients, for a total of 80 limbs (46.8%), the marks were altered after use of TcPh. Reasons for such changes were: 1) identification of other varicose veins; 2) identification of reticular veins draining complex telangiectasias; and 3) changes in the position of the marks placed with the patient standing. Conclusions: TcPh has altered the planning of varicose vein surgeries in 46.8% of all limbs evaluated, especially when the patients had complex telangiectasias, associated with reticular varicose veins.
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Beresford, T., J. J. Smith, L. Brown, R. M. Greenhalgh, and A. H. Davies. "A comparison of health-related quality of life of patients with primary and recurrent varicose veins." Phlebology: The Journal of Venous Disease 18, no. 1 (March 1, 2003): 35–37. http://dx.doi.org/10.1258/026835503321236885.
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Aim: To determine whether recurrent varicose veins affect patient quality of life. The health-related quality of life (HRQL) scores of patients with recurrent varicose veins were compared with those of patients presenting with primary varicose vein disease. Methods: HRQL among patients attending outpatient appointments for recurrent and primary varicose veins was measured using the Aberdeen Varicose Vein Questionnaire (AVVQ) and the Short Form-36 General Health Survey (SF-36). Results: Questionnaires were given to 211 patients (150 primary, 61 recurrent), and 194 (133 primary, 61 recurrent) completed them. For the AVVQ, patients with recurrent varicose veins had significantly worse symptom scores compared with those with primary disease (24.87 ± 12.28 vs 17.77 ± 9.68, Mann-Whitney, P <0.01). The SF-36 recorded significantly worse HRQL (Mann-Whitney, P <0.05) for patients with recurrent varicose veins compared with those with primary varicose veins in all but one of the eight domains (role limitation attributed to emotional problems, RE, P = 0.073). Conclusion: Varicose vein recurrence is associated with a significantly worse HRQL than is found among patients with primary varicose veins.
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Dabbs, Emma B., Scott J. Dos Santos, Irenie Shiangoli, Judith M. Holdstock, David Beckett, and Mark S. Whiteley. "Pelvic venous reflux in males with varicose veins and recurrent varicose veins." Phlebology: The Journal of Venous Disease 33, no. 6 (August 31, 2017): 382–87. http://dx.doi.org/10.1177/0268355517728667.
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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.
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de Haan, M. W., J. C. J. M. Veraart, H. A. M. Neumann, and P. A. F. A. van Neer. "Recurrent varicose veins below the knee after varicose vein surgery." Phlebologie 36, no. 03 (2007): 132–36. http://dx.doi.org/10.1055/s-0037-1622175.
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SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.
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Belcaro, G., A. N. Nicolaides, G. Laurora, M. R. Cesarone, M. T. De Sanctis, L. Incande, and A. Ricci. "Laser Doppler Flux in the Venous Wall." Phlebology: The Journal of Venous Disease 11, no. 2 (June 1996): 68–72. http://dx.doi.org/10.1177/026835559601100208.
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Objectives: To evaluate in vivo the perfusion of the venous wall in normal veins, varicose veins and in femoral veins of post-phlebitic limbs recording wall flux with laser Doppler flowmetry. As there is some evidence that both structure and microcirculatory dynamic responses are altered in the abnormal vein wall, we also aimed to study the response of vein wall perfusion to locally induced vasodilatation following papaverine infusion. Design: Open prospective study in patients with venous insufficiency and in patients undergoing coronary revascularization with a normal venous system. Setting: Cardiovascular Institute, Chieti University, Pierangeli Clinic, Italy and Irvine Laboratory, St Mary's Hospital, London, UK. Patients: Twenty-four normal long saphenous veins and 11 common femoral veins (35 normal veins, 35 subjects) and 42 varicose veins (42 patients). Measurements: Venous wall flux was measured on the external surface of normal long saphenous veins and common femoral veins. Measurements were also made on varicose veins before ligation of the sapheno-femoral junction. All measurements were made when at least three-quarters of the adventitia and periadventitia tissue were still intact for a length of 3 cm. Results: Flux in the normal vein wall was higher ( t = 5.88; p<0.05) than in varicose veins and in veins of post-phlebitic limbs. There was no difference in flux between varicose veins and post-phlebitic veins. After intravenous papaverine injection in a subgroup of eight normal and eight varicose veins, in the wall of normal veins there was a significant increase in flux (from 8.5 (SD 5.1) units to 13.2 (SD 3.8) units; p<0.05) which was not observed in varicose veins. Conclusions: A higher vein wall perfusion was observed in normal veins compared with varicose veins and post-phlebitic limb veins. Greater vascular reactivity to intraluminal papaverine injection was observed in normal veins.
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Tseng, Yuan-Hsi, Chien-Wei Chen, Min-Yi Wong, Teng-Yao Yang, Yu-Hui Lin, Bor-Shyh Lin, and Yao-Kuang Huang. "Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data." Diagnostics 12, no. 1 (January 5, 2022): 118. http://dx.doi.org/10.3390/diagnostics12010118.
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The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.
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Girish D Dahikar, Dipika D Giradkar, Shagufta A Khan, and Rajendra O Ganjiwale. "A review on remedies used in treatment of varicose veins and varicocele." GSC Biological and Pharmaceutical Sciences 18, no. 2 (February 28, 2022): 244–52. http://dx.doi.org/10.30574/gscbps.2022.18.2.0078.
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Varicose vein is clinical class of the (CVD) i.e. chronic venous disease, also called as the varicosities. Varicose veins are enlarged, swollen and twisting veins often appearing blue or dark purple. When valves in the veins do not work properly, the blood does not flow effectively. The expansion of varicose veins is often caused by a weakening of valves and walls. Generally varicose vein is found in females especially in case of pregnancy. Varicose veins generally found in lower extremity, leg and the epididymis. Epididymis is the highly convoluted duct behind the testis along which sperm passes to the vas deferens. A varicocele is an enlargement of the veins within the loose bag of skin that holds your testicles or scrotum. A varicocele is similar to a varicose vein you might see in your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. The aim of writing this review is to provide information about the varicose vein and varicocele the remedy to be used in its treatment and different tests available for its diagnosis.
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Schadeck, M. "Sclerotherapy of varicose veins." Phlebologie 46, no. 02 (March 2017): 55–59. http://dx.doi.org/10.12687/phleb2358-2-2017.
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SummaryHistorically, sclerotherapy is quite old, however, nowadays it is a common treatment in varicose therapy. It is a good and effective alternative to surgical and thermic treatment options regarding larger varicose veins and applicable for all forms of varices. With about 14,000 treatments per day, sclerotherapy is the most employed and cost effective technique worldwide.
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Farrah, J., and S. K. Shami. "Patterns of Incompetence in Patients with Recurrent Varicose Veins: A Duplex Ultrasound Study." Phlebology: The Journal of Venous Disease 16, no. 1 (March 2001): 34–37. http://dx.doi.org/10.1177/026835550101600109.
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Objectives: To identify the patterns of venous incompetence in patients with recurrent varicose veins using duplex ultrasound scanning. Setting: Oldchurch District General Hospital, Southeast England. Patients and methods: 836 patients (581 women, median age 51 years (range 22–86 years) and 255 men, median age 53 years (range 23–28 years) referred to the vascular laboratory for the assessment of recurrent varicose veins. Duplex ultrasonography was undertaken by an experienced operator to evaluate the venous system in the lower limbs. A total of 1254 limbs with recurrent varicose veins were studied. Results: Recurrent reflux was found at the sapheno-femoral (SFJ) or saphenopopliteal junction (SPJ) in 43% of cases. The source of recurrent varices was an unoperated SFJ or SPJ in 386 (31%) limbs. Thigh perforators accounted for varices in 16% of limbs. Conclusion: Nearly half of recurrences were attributable to inadequate surgical treatment at the initial operation or possible angiogenesis. Nearly a third of recurrences originated at previously unoperated sites, confirming a need for objective venous assessment before recurrent varicose vein surgery.
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Lee, A. J., C. J. Evans, C. M. Hau, P. L. Allan, and F. G. R. Fowkes. "Pregnancy, Oral Contraception, Hormone Replacement Therapy and the Occurrence of Varicose Veins: Edinburgh Vein Study." Phlebology: The Journal of Venous Disease 14, no. 3 (September 1999): 111–17. http://dx.doi.org/10.1177/026835559901400305.
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Objective: To determine the relationship between varicose veins and duration of menstrual life, age of menopause, pregnancy, oral contraceptive use and hormone replacement therapy (HRT). Design: Cross-sectional study. Setting: City of Edinburgh, UK. Participants: Eight hundred and sixty-seven women aged 18–64 years randomly selected from 12 general practices. Methods: After completing a questionnaire, which included questions on reproductive history, the women underwent a comprehensive clinical examination including the assessment of varicose veins (trunk, hyphenweb and reticular varices), followed by duplex scanning of their legs. Results: Women who had been pregnant at least once were more likely to have minor hyphenweb or reticular varices than women who had never been pregnant ( p ≤ 0.05). Women aged 35–54 years who were current users or ex-users of the oral contraceptive pill had a lower prevalence of trunk varicose veins than women who had never taken the pill ( p ≤ 0.10). HRT was also associated with a lower prevalence of trunk varices ( p ≤ 0.05). Conclusions: These results suggest that alterations in the balance of the sex hormones may have a role in the aetiology of varicose veins.
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Gradman, W. S. "Roller coaster reflux: definition and clinical significance." Phlebology: The Journal of Venous Disease 19, no. 3 (September 1, 2004): 143–44. http://dx.doi.org/10.1258/0268355041753399.
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Objective: Duplex scanning readily identifies typical proximal venous reflux that descends directly to varices. Occasionally, reflux may first descend in a saphenous or deep vein, and then reverse direction to ascend 10 cm or more in a tributary or varicose vein before descending again to clinically evident varicose veins. This pattern, here defined as roller coaster reflux (RCR), can be difficult to establish, since no immediate superior source of reflux feeds the uppermost varices. This study reviews recent clinical experience with RCR and illustrates the phenomenon in two patients. Methods: Over a two-year period in a solo phlebology practice, duplex ultrasound was used on patients with varicose veins to identify the initial descending reflux and the point of reversal where flow began to ascend. A Trendelenburg manoeuvre with direct compression over the point of reversal was used to prove whether the source of venous distention lay 10 cm or more below the most superior varices. Results: A total of 12 patients showed evidence of RCR with flow ascending 10-23 cm to feed the uppermost varices. The sources of descending reflux were the femoral (3), popliteal (2), great saphenous (4), short saphenous (2) and tibial (1) veins. The ascending veins were the great saphenous (3), Giacomini (2) or varices (7). Elimination of the source of reflux along with the varices routinely resulted in clinical success. Conclusions: Roller coaster reflux should be sought in individuals whose reflux does not appear to arise from a superior source.
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Lv, W., X.-J. Wu, M. Collins, Z.-L. Han, and X. Jin. "Analysis of a Series of Patients with Varicose Vein Recurrence." Journal of International Medical Research 40, no. 3 (June 2012): 1156–65. http://dx.doi.org/10.1177/147323001204000336.
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OBJECTIVE: Varicose veins of the lower extremities is a common clinical condition. Although surgical treatment is often successful, the recurrence rate remains high. This retrospective study evaluated the reasons for postoperative recurrence of varicose veins by analysing ultrasonography and venography findings in patients with recurrent disease. METHODS: A series of consecutive cases of recurrent varicose veins of the lower limbs was reviewed. Data collected included clinical characteristics, symptoms and vascular imaging. RESULTS: The study included 109 legs with recurrent varicose veins (92 patients): 101/109 legs (92.7%) showed perforating vein insufficiency and 86/109 (78.9%) showed reflux of the superficial femoral vein, of varying degrees of severity. Residual saphenous vein was recorded for 82 legs (75.2%), while 19 (17.4%) had blocked iliac veins due to post-thrombotic syndrome. CONCLUSIONS: Several factors that may contribute to varicose vein recurrence have been identified. These include failure to ligate perforating veins and initial failure to perform the appropriate surgical intervention. Prevention of varicose vein recurrence after surgical correction requires a more extensive use of preoperative imaging, to tailor surgical intervention to suit individual patients.
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de Zeeuw, R., H. J. Noordmans, R. M. Verdaasdonk, and C. H. A. Wittens. "Objective non-invasive technique for quantification of superficial varicose veins." Phlebology: The Journal of Venous Disease 20, no. 2 (June 1, 2005): 60–62. http://dx.doi.org/10.1258/0268355054069197.
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Introduction: Non-invasive methods for imaging varicose veins allow quantification and evaluation of venous diseases. This paper will describe a technique to visualize superficial (subdermal) varicose veins using digital infrared imaging and analysis with special software. Method: After image acquisition, the pictures were analysed with special software that segmented the varicose veins and calculated the surface area (per gridblock) occupied by varicose veins. By comparing the surfaces occupied by varices before and after a specific treatment, one can establish which treatment method performs the best. Aim for the future: Validation of this technique and quantification of the effects of treatment modalities for superficial (subdermal) varicose veins. We also investigate the use of this technique for the other clinical CEAP stages and the potential resemblance with duplex scanning.
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Laurikka, J., T. Sisto, J. P. Salenius, M. Tarkka, and O. Auvinen. "Long Saphenous Vein Stripping in the Treatment of Varicose Veins: Self- and Surgeon-Assessed Results after 10 Years." Phlebology: The Journal of Venous Disease 9, no. 1 (March 1994): 13–16. http://dx.doi.org/10.1177/026835559400900104.
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Objective: To establish the 10-year results of long saphenous vein stripping in the treatment of varicose veins. Design: Single patient group study of patients who received surgical treatment for varicose veins 10 years earlier. Setting: Department of Surgery, University Hospital of Tampere, Finland. Patients: All men and a randomly picked sample of women were invited to attend for a follow-up examination; 81% (52 men, 74 women) participated. Intervention: Long saphenous vein stripping in all Patients. Main outcome measures: The presence of visible varicose veins as graded in four categories by clinical examination. Results: Seventy per cent of the operated legs in women free of varicosities or showed only minor varicose veins compared with 51% in men; 28% of the patients required further treatment (mostly sclerotherapy) for varicose veins. Conclusions: Long saphenous vein stripping combined with additional procedures results in a relatively low rate of severe recurrent varicose veins in 10 years.
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Kun, Li, Li Ying, Wang Lei, Zhao Jianhua, Xu Yongbo, Wang Tao, Tang Jinyuan, and Chu Haibo. "Dysregulated apoptosis of the venous wall in chronic venous disease and portal hypertension." Phlebology: The Journal of Venous Disease 31, no. 10 (July 9, 2016): 729–36. http://dx.doi.org/10.1177/0268355515610237.
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Introduction The etiology of varicose veins remains elusive. We hypothesized that abnormal cell cycle events in the vein wall may contribute to changes in the structural integrity, thus predisposing to the development of varicosities. The present study was designed to determine whether or not the same molecular apoptotic pathway exists between great saphenous and splenic veins. Methods Thirty-six samples of diseased splenic veins and varicose great saphenous veins were collected. Twenty-five samples of control splenic and great saphenous veins were also collected. The apoptotic cell proteins expression was immunohistochemically stained with antibodies (anti-Bax and anti-Bcl-xl). Apoptosis was evaluated by the terminal deoxynucleotidyl transferase-mediated nick-end labeling (TUNEL) assay and immunofluorescence staining. The morphology of apoptotic cells was observed with an electron microscope. Results The apoptotic ratio in walls (intima and media) of diseased splenic vein and varicose great saphenous vein groups were significantly lower than the corresponding regions in the splenic vein and great saphenous vein groups ( p < 0.01), respectively. A significant difference was not noted in the ratio change of apoptotic cells between the diseased splenic vein and varicose great saphenous vein groups ( p > 0.05). The high positive expression of Bcl-xl proteins was detected in the diseased splenic vein and varicose great saphenous vein groups, respectively. While the high positive expression of Bax proteins was also observed in the splenic vein and great saphenous vein groups, respectively. Electron microscopic observations confirmed that endothelial and smooth muscle cells in diseased splenic vein, varicose great saphenous vein, splenic vein, and great saphenous vein walls exhibited apoptotic morphologic features, such as fuzzy mitochondrial cristae, medullary changes, and margination of the nuclear chromatin. Conclusions Our results showed the same dysregulation of apoptosis via the intrinsic pathway in diseased splenic veins and varicose great saphenous veins. This observational study suggests that apoptotic down-regulation in the veins wall is a cause of diseased splenic veins and varicose great saphenous veins, but does not exclude the possibility that other mechanisms are involved.
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Bruczko-Goralewska, Marta, Lech Romanowicz, Justyna Bączyk, Małgorzata Wolańska, Krzysztof Sobolewski, and Radosław Kowalewski. "Peptide growth factors and their receptors in the vein wall." Journal of Investigative Medicine 67, no. 8 (August 19, 2019): 1149–54. http://dx.doi.org/10.1136/jim-2019-001075.
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The varicose vein wall remodeling is a very complex process, which is controlled by numerous factors, including peptide growth factors. The aim of the study was to assess a/b FGF, IGF-1, TGF-β1, VEGF-A and their receptors in the vein wall. Varicose vein samples were taken from 24 patients undergoing varicose vein surgery. The control material consisted of vein specimens collected from 12 patients with chronic limb ischemia. Contents of aFGF, bFGF, IGF-I, TGF-β1, VEGF, IGF-1R, VEGF R1 and VEGF R2 were assessed with ELISA method. Protein expression of FGF R1 and TGF-β RII were evaluated with western blot. Increased contents of aFGF, IGF-1 and VEGF-A were found in varicose veins in comparison with normal ones (p<0.05). In contrast, a significant decrease in TGF-β content was demonstrated in varicose veins (p<0.05). Furthermore, there was no difference in bFGF content in both groups (p>0.05). IGF-1 R content was significantly increased in varicose veins (p<0.05). There was no difference in VEGF R1 content between varicose and normal veins (p>0.05), whereas VEGF R2 content was significantly increased in varicose veins (p<0.05). Western blot demonstrated increased expression of TGF-β RII in varicose veins (p<0.05) and similar expression of FGF R1 in both groups (p>0.05). Demonstrated changes in peptide growth factors and their receptors may disturb metabolism of extracellular matrix in the varicose vein wall and contribute to the development of the disease to its more advanced stages.
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Gwozdzinski, Lukasz, Anna Pieniazek, Joanna Bernasinska-Slomczewska, Pawel Hikisz, and Krzysztof Gwozdzinski. "Alterations in the Plasma and Red Blood Cell Properties in Patients with Varicose Vein: A Pilot Study." Cardiology Research and Practice 2021 (June 30, 2021): 1–10. http://dx.doi.org/10.1155/2021/5569961.
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The varicose vein results from the inefficient functioning of the valves in the lower limb veins, making the blood flow slow down and leading to blood stasis and hypoxia. This type of vein dysfunction might be a result of the development of oxidative stress. We compared oxidative stress markers in the plasma and erythrocytes obtained from peripheral veins and varicose veins in the same patients (glutathione, nonenzymatic antioxidant capacity (NEAC), catalase (CAT) and acetylcholinesterase (AChE) activity, thiols, thiobarbituric acid-reactive substance (TBARS), and protein carbonyls). We found a decrease in NEAC in the plasma obtained from the varicose veins compared to the peripheral veins. We detected a decrease in thiols in the plasma, hemolysate, and plasma membranes and increase in protein carbonyl compounds and TBARS levels in the varicose veins. These changes were accompanied by a decrease in CAT and AChE activity. For the first time, our results show changes in the plasma, erythrocyte membrane, and hemolysate protein properties in varicose vein blood in contrast to the plasma and erythrocytes in peripheral vein blood from the same patients. The increased oxidative stress accompanying varicose vein disease might result from the local inefficiency of the antioxidant defense system.
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Akhmetzianov, Rustem V., Roman A. Bredikhin, Elena E. Fomina, and Elena F. Konovalova. "MORPHOLOGICAL PARALLELS OF THE STRUCTURE OF VESSEL’S WALL AT VARICOSE EXTENSION OF THE VEINS OF PELVIS AND LOWER EXTREMITIES." Morphological newsletter 28, no. 2 (August 12, 2020): 24–31. http://dx.doi.org/10.20340/mv-mn.2020.28(2):24-31.
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The histological differences in the structure of the ovarian vein and saphenous veins of the lower extremities during their varicose transformation have been insufficiently studied in the modern literature. The study aims to determine the morphological parallels of the structure of varicose veins in varicose veins of the pelvis and varicose veins of the lower extremities. Fifty histological biopsy specimens of removed veins were examined in women. Of these, 25 large saphenous veins were obtained from patients with varicose veins of the lower extremities and 25 preparations of a resected ovarian vein from 25 women with varicose veins of the pelvis. The preparation was stained with hematoxylin-eosin and by the Van Gieson method, studied by light microscopy. In the study of the preparations, significant structural changes were noted in all layers of the venous wall, both in varicose veins of the pelvis and in varicose veins of the lower extremities in the form of a combination of atrophic, fibroplastic and hypertrophic processes leading to the loss of its functional properties. Depending on the decompensation of pathological processes, 3 morphological forms of lesions of the venous wall structure were revealed. The hypertrophic form was found in 17 (34%) surgery perform women, fibrous - in 13 (26%), atrophic - in 20 (40%). In the group of patients with varicose veins of the pelvis compared with the group of patients with varicose veins of the lower extremities, the prevalence of initial forms of lesion was revealed. There was a correlation between the severity of venous vascular lesions with the duration of the disease and the patient's age, the number of risk predictors and a high body mass index, which was the determining factor in the occurrence of this phenomenon. The results of this study indicate the similarity of the pathological picture of venous lesions, both in varicose veins of the pelvis and in varicose veins of the lower extremities.
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Iqbal, Arshid, Afroza Jan, Adil Rashid, and Syed Anayat. "Leech therapy: a non-surgical management for varicose vein." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 11, no. 3 (February 25, 2022): 904. http://dx.doi.org/10.18203/2320-1770.ijrcog20220576.
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Varicosity refers to multiple, dilated, tortuous, and elongated veins that have permanently lost their valvular efficiency, such as haemorrhoids, varicocele, and esophageal varices. Varicose veins are twisted and enlarged veins that are commonly found in the legs. When veins become varicose, the valves stop working properly, allowing blood to flow backwards and the veins to engorge. Varicose veins are most common in the superficial veins of the legs, with the veins engorging and ulcerating as a result of standing under high pressure. The purpose of this case series is to evaluate the efficacy of Hirudotherapy in the treatment of varicose veins in the lower legs. Hirudotherapy was carried out scientifically by employing appropriate hygienic measures, and 8 to 10 leeches were used locally to suck the blood and transmit important bioactive enzymes that could aid in the treatment of varicose veins of the lower legs. Hirudotherapy was given every ten days for 60 days, and patients were monitored for a year. Leech therapy was found to significantly reduce venous engorgement by resolving edema, inflammation, and venous congestion.
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Pfisterer, Larissa, Gerd König, Markus Hecker, and Thomas Korff. "Pathogenesis of varicose veins - lessons from biomechanics." Vasa 43, no. 2 (March 1, 2014): 88–99. http://dx.doi.org/10.1024/0301-1526/a000335.
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The development of varicose veins or chronic venous insufficiency is preceded by and associated with the pathophysiological remodelling of the venous wall. Recent work suggests that an increase in venous filling pressure is sufficient to promote varicose remodelling of veins by augmenting wall stress and activating venous endothelial and smooth muscle cells. In line with this, known risk factors such as prolonged standing or an obesity-induced increase in venous filling pressure may contribute to varicosis. This review focuses on biomechanically mediated mechanisms such as an increase in wall stress caused by venous hypertension or alterations in blood flow, which may be involved in the onset of varicose vein development. Finally, possible therapeutic options to counteract or delay the progress of this venous disease are discussed.
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Kim, Mi-Hyeong, and Chanjoong Choi. "Second-generation treatment of varicose veins: endovenous thermal ablation by laser or radiofrequency ablation." Journal of the Korean Medical Association 65, no. 4 (April 10, 2022): 209–16. http://dx.doi.org/10.5124/jkma.2022.65.4.209.
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Background: Endovenous thermal ablation (EVTA) is the second-generation treatment of varicose veins in the lower extremities. It has overcome the shortcomings of the first-generation treatment of high ligation and stripping. Further, it is the basis for the development of the third-generation treatment with endovenous glue ablation. It is currently recommended as the first-line treatment for varicose veins accompanied by great saphenous vein incompetence.Current Concepts: EVTA involves obliterating the varicosed veins by applying thermal energy to blood or vein wall. It can be performed by laser or radiofrequency ablation methods, under local anesthesia. The treatment results are excellent and show lesser pain and faster recovery compared to the first-generation treatment. However, complications include endovenous heat-induced thrombosis, deep vein thrombosis, ecchymosis, and phlebitis.Discussion and Conclusion: To enhance the therapeutic effect and reduce the complications of EVTA, sufficient tumescent anesthesia, a controlled number of firing in radiofrequency ablation, and use of the novel highwavelength laser and a radial catheter tip in endovenous laser ablation are recommended. In addition, proficiency in other generations of varicose vein treatments could help in various situations.
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Kim, Mi-Hyeong, and Chanjoong Choi. "Second-generation treatment of varicose veins: endovenous thermal ablation by laser or radiofrequency ablation." Journal of the Korean Medical Association 65, no. 4 (April 10, 2022): 209–16. http://dx.doi.org/10.5124/jkma.2022.65.4.209.
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Background: Endovenous thermal ablation (EVTA) is the second-generation treatment of varicose veins in the lower extremities. It has overcome the shortcomings of the first-generation treatment of high ligation and stripping. Further, it is the basis for the development of the third-generation treatment with endovenous glue ablation. It is currently recommended as the first-line treatment for varicose veins accompanied by great saphenous vein incompetence.Current Concepts: EVTA involves obliterating the varicosed veins by applying thermal energy to blood or vein wall. It can be performed by laser or radiofrequency ablation methods, under local anesthesia. The treatment results are excellent and show lesser pain and faster recovery compared to the first-generation treatment. However, complications include endovenous heat-induced thrombosis, deep vein thrombosis, ecchymosis, and phlebitis.Discussion and Conclusion: To enhance the therapeutic effect and reduce the complications of EVTA, sufficient tumescent anesthesia, a controlled number of firing in radiofrequency ablation, and use of the novel highwavelength laser and a radial catheter tip in endovenous laser ablation are recommended. In addition, proficiency in other generations of varicose vein treatments could help in various situations.
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Yan, Li, Jinyuan Tang, Xiaoxuan Hu, Yongbo Xu, Kun Li, Hongyan Liu, Zhengui Nie, Haibo Chu, and Yuxu Zhong. "Imbalance in matrix metalloproteinases and tissue inhibitor of metalloproteinases from splenic veins and great saphenous veins under high hemodynamics." Phlebology: The Journal of Venous Disease 35, no. 1 (April 24, 2019): 18–26. http://dx.doi.org/10.1177/0268355519842432.
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Objectives Varicose vein is a common disorder involving extensive venous dilation and remodeling, yet the underlying mechanism is unclear. Studies have shown increased expression of matrix metalloproteinases in human varicose veins and animal models of venous hypertension. We investigated the differences in matrix metalloproteinases and tissue inhibitor of metalloproteinases from human splenic veins and great saphenous veins under high hemodynamics. Methods Seventy-two human diseased splenic vein, splenic vein, varicose great saphenous vein, and great saphenous vein specimens were collected. The mRNA and protein expression of matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 were determined. Results The mRNA expression and protein positive expression ratio of matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and tissue inhibitor of metalloproteinase-2 as well as the content of relative-protein expression were significantly increased in the diseased splenic veins and varicose great saphenous veins compared with the splenic veins and great saphenous veins ( P < 0.05). The varicose great saphenous vein-to-great saphenous vein ratio in the protein positive expression ratio and mRNA expression were significantly increased compared with the diseased splenic vein-to-saphenous vein ratio ( P < 0.05). There was no significant change in the content of relative-protein expression of the varicose great saphenous vein-to-great saphenous vein and diseased splenic vein-to-splenic vein ratios analyzed by Western blot ( P>0.05). Conclusion Under high hemodynamics, dysequilibrium of matrix metalloproteinases and tissue inhibitor of metalloproteinases from human splenic veins and great saphenous veins may be one of the molecular mechanisms underlying vascular remodeling.
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Parihar, Shweta, ,. Sarswati, ,. Chattarpal, and Devender Sharma. "A Brief Review on Herbs Used in the Treatment of Varicose Veins." Journal of Drug Delivery and Therapeutics 12, no. 1 (January 15, 2022): 158–62. http://dx.doi.org/10.22270/jddt.v12i1.5161.
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A weakening of the venous valves and walls is a common cause of varicose veins. Blood might flow back and pool in veins due to damaged valves, causing them to enlarge. Weakened vein walls are longer, broader, and less elastic than normal, causing valve flaps to split, resulting in increased blood pooling and twisted veins. Primary varicose veins are characterised by valvular incompetence and reflux, which have long been assumed to be the cause. Recent research, on the other hand, reveals that valve dysfunction may be preceded by alterations in the vein wall. This condition is referred to as "Siragranthi" in Ayurvedic literature (ie.Varicose vein). As a result, the current review critically assesses the possible utility of herbal medications in the treatment of varicose veins.
Keywords- Herbal Plants, Varicose veins, Types, Pathophysiology
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Smith, P. Coleridge. "The Outcome of Treatment for Pelvic Congestion Syndrome." Phlebology: The Journal of Venous Disease 27, no. 1_suppl (March 2012): 74–77. http://dx.doi.org/10.1258/phleb.2011.012s01.
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Pelvic congestion syndrome is one of many causes of chronic pelvic pain. It is generally accepted that this is attributable to ovarian and pelvic vein incompetence which may result in varices in the lower limb leading to presentation in varicose vein clinics. However, far more patients have pelvic varices associated with varicose veins in the lower limb than have pelvic congestion syndrome. Magnetic resonance imaging and computed tomographic venography are usually used in the diagnosis of this condition and criteria have been established to identify pelvic varices. Many different treatments have been used to manage the symptoms of pelvic congestion. Hysterectomy combined with oophrectomy open surgical ligation of ovarian veins and laparoscopic vein ligation have been used in the past. The most common treatments used currently involve embolization of pelvic and ovarian veins. The results of this treatment have been published in a limited number of clinical series, usually with fairly short follow-up periods. These treatments may be complicated by migration of embolization of coils used to occlude veins. The longest duration of follow-up currently reported is five years. Limited clinical evidence supports the use of embolotherapy in the management of pelvic congestion syndrome.
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Campos, Camila Teixeira, Romulo Teixeira de Oliveira, Wanderley De Paula, and Ygor Minassa Alves. "Tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico: relato de caso / Surgical treatment of lower limb varicose veins in a hemophiliac patient: case report." Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo 64, no. 3 (October 30, 2019): 258. http://dx.doi.org/10.26432/10.26432/1809-3019.2019.64.3.258.
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Objetivo: Relatar uma situação rara na especialidade cirúrgica vascular, aparentemente ainda sem documentação de experiência semelhante e que consiste no tratamento cirúrgico de varizes de membros inferiores em paciente hemofílico e com sintomatologia venosa. Relato de caso: Procedimento cirúrgico realizado no Hospital Evangélico de Vila Velha, no setor de Cirurgia Vascular no ano de 2018, em paciente hemofílico e portador de veias varicosas primárias sintomáticas em membros inferiores. Realizado intervenção cirúrgica convencional com safenectomia bilateral e ressecção de varizes tronculares com infusão endovenosa de fator VIII no pré-operatório e nos 10 dias subsequentes. Necessitou de acompanhamento multidisciplinar incluindo hematologista e apresentou evolução satisfatória, sem intercorrências hemorrágicas. O paciente retornou no 14º de pós-operatório sem complicações. Concluímos que é perfeitamente possível a realização de cirurgia venosa de varizes com técnica convencional em paciente portador de doença hemofílica, bastando para isso a recomendada infusão de fator VIII.Descritores: Hemofilia A, Varizes, Procedimentos cirúrgicos vascularesAbstractObjective: To report a rare situation in the vascular surgical specialty, apparently still without documentation of similar experience, which consists in the surgical treatment of lower limb varicose veins in a hemophiliac patient with venous symptomatology. Case report: Surgical procedure performed at the Evangelical Hospital of Vila Velha, in the Vascular Surgery sector in 2018, in a hemophilic patient with symptomatic primary varicose veins in the lower limbs. Conventional surgical intervention was performed with bilateral saphenous vein resection and trunk varicose vein resection with intravenous factor VIII infusion preoperatively and in the 10 subsequent days. It was required multidisciplinary follow-up including hematologist and presented satisfactory evolution, without hemorrhagic complications. The patient returned in the 14th postoperative period without complications. It was concluded that to perform varicose vein surgery with conventional technique in a patient with hemophilic disease is perfectly possible with the recommended factor VIII infusion.Keywords: Hemophilia A, Varicose veins, Vascular surgery procedures
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Zolotukhin, Igor A., Olga Ya Porembskaya, Mariya A. Smetanina, Aleksandr V. Sazhin, Maksim L. Filipenko, and Aleksandr I. Kirienko. "Varicose veins: on the verge of discovering the cause?" Annals of the Russian academy of medical sciences 75, no. 1 (March 30, 2020): 36–45. http://dx.doi.org/10.15690/vramn1213.
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Varicose veins of the lower limbs are one of the most common and wide-spread pathology all around the world. What triggers the specific changes in a vein wall still remains unclear as well as what happens in the layers of the vein wall after the disease starts. The aim of the article is to analyze published data and results of researches on epidemiology, genetics, cellular and molecular mechanisms underlying varicose veins pathogenesis. It is now commonly accepted that vein wall changes in patients with varicose veins result from vein-specific inflammation. This process includes leukocytes adhesion to venous endothelium with their subsequent migration into the vein wall and surrounding tissues. Activated leukocytes express a number of molecules that lead to vein wall remodeling and dilation. Comprehensive assessment of the epidemiological data on the prevalence of varicose veins and risk factors, of the findings from genetic studies, of data on molecular-cell interactions as well as results of various surgical interventions in patients with varicose veins, shows that remodeling is a reversible process that can be stopped and reversed by different stimuli including some chemical substances. For the first time in the literature, the authors assume that varicose veins can be successfully cured pharmacologically with no surgical interventions needed.
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Dawre, Manisha Kishanrao, Snehal Shivaji Jadhav, and Divya Deepak Varma. "ANATOMICAL ASPECT OF SIRAJA-GRANTHI WITH SPECIAL REFERENCE TO VARICOSE VEINS: A REVIEW." International Journal of Research in Ayurveda and Pharmacy 12, no. 3 (July 6, 2021): 139–42. http://dx.doi.org/10.7897/2277-4343.120390.
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Varicose vein is a very common condition in surgical practice in which vein become dilated, elongated and tortuous. The changing lifestyle, occupational pattern, pregnancy, obesity are noteworthy contributing factors for the varicose veins. This condition affects lower limbs especially saphenous vein and their tributaries. In Ayurveda varicose veins can be correlated to Siraja granthi. In Siraja granthi vitiated Vata dosha enters in sira and constrict them, make them tortuous. Also decreases pulsation in the sira. In this article we have tried to evaluate the anatomical and physiological changes in Siraja granthi (Varicose veins).
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Gupta, Raunak Kumar, Dilip Kumar Acharya, and Sanjay M. Datey. "Study of the Clinical Profile of Varicose Vein Disease." International Journal of Health Sciences and Research 11, no. 8 (August 6, 2021): 6–10. http://dx.doi.org/10.52403/ijhsr.20210802.
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Introduction: Varicose veins are part of the spectrum of chronic venous diseases and include dilated, tortuous veins of lower limbs, spider telangiectasia and reticular veins. Varicose vein disease is a very common problem of the western world and mostly their patients come for treatment because of cosmetic reasons. Indian scenario is different as mostly patients from lower socioeconomic strata of the society come for complications like ulceration, dermatitis etc. of varicose veins come for treatment. This problem sometimes results in chronic absenteeism from work, economic losses and change of occupation in many individuals. Methods: This observational study was carried out from 1st January 2017 to 30th June 2018 in Sri Aurobindo Medical College and Postgraduate Institute, Indore. Clinical profile of 52 patients of varicose vein disease was studied. All the patients were thoroughly examined and the pertaining data recorded. This data was tabulated and compared with the available literature on this subject. Results: Fifty two cases of varicose vein disease were studied. The commonest age group affected with the disease was between 41 to 50 years. Male patients were more and comprised of 84.6% of total number. Sapheno femoral junction valve was incompetent in 73.1 % cases as compared to saphenopopliteal junction[34.6%].Obesity was an important factor in causation of varicose vein disease. Flush ligation at SFJ with stripping was the commonest surgical procedure carried out our center. Conclusion: It is found that varicose vein disease with its associated sequelae brings the patient for treatment in our scenario. Long saphenous vein is the commonly affected part of the superficial venous system because of incompetency of the valve at SFJ. Although various etiological factors can be attributed to varicose vein disease but occupation and obesity remain the main factors. Accurate assessment of problem and adequate surgery will prevent recurrence. Key words: Varicose veins, venous ulcers, recurrent varicose veins.
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Antoniuk-Kysil, V. M., I. Ya Dzubanovskyi, V. M. Yenikeieva, S. I. Lichner, V. M. Lypnyi, Zh M. Tymoshchuk, and N. M. Horuzha. "Clinic and diagnostics of inguinal canals primary varicose veins as one of the forms of non-saphenous primary chronic venous disease during pregnancy." HEALTH OF WOMAN, no. 7(143) (September 30, 2019): 54–62. http://dx.doi.org/10.15574/hw.2019.143.54.
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A distinct form of chronic venous disease (CVD) which meet the obstetrician-gynecologists, surgeons and vascular surgeons on the stages of pregnancy management is the primary varicose veins of the inguinal canals named non-saphenous varicose veins. This pathology is little studied and little known but there is a rather big obstetric problem for obstetricians-gynecologists, vascular surgeons, and as a surgical problem for surgeons and clinical and cosmetic for patients. The objective: to study the primary varicose veins of the inguinal canals frequency and forms, as well as development dynamics during pregnancy. Materials and methods. Based on Rivne Regional Perinatal Center Rivne Regional Council Municipal Institution for the period from 2013 to 2019, the observation of 1,367 pregnant women with primary chronic venous disease pool of saphenous and non-saphenous veins (according to the CEAP classification as of 2002). In 285 (20.8%) of them, one of the forms of non-saphenous varicose vein the primary varicose veins of the inguinal canals was diagnosed: in isolated form 129 (45.3%) patients, in 156 (54.7%) pregnant women combined with lower extremities’ primary chronic vein disease. All pregnant women for the diagnosis of venous pathology and the venous hemodynamics study in the lower extremities veins, the iliac veins pool, inguinal canals, a study of the sources, forming the primary varicose veins of the inguinal canals, used the second diagnostic level, under the guidance of Ukrainian Consensus on the treatment of lower extremities’ varicose veins as of 2005 which included the anamnesis data, clinical examination and duplex angioscanning. For all patients, ultrasound examination was performed in the supine standing position (orthostasis) with Valsalva maneuvre using Mc Kenna D. A. and co-authors criteria (2008). Results. Among 285 (20.8%) pregnant women with the primary varicose veins of the inguinal canals, 129 (45.3%) patients were diagnosed with an isolated form; 28 (21.7%) had varicose veins within the inguinal canal, and 101 (78.3%) of the pregnant women spread through the outer inguinal ring to the external genitals, perineum, and lower limbs. 156 (54.7%) pregnant women in the primary varicose veins of the inguinal canals different forms combined with primary CVD of the lower extremities saphenous veins pool. Found that among 285 patients with the primary varicose veins of the inguinal canals sources on duplex angioscanning in 141 (49.7%) was dominated by reflux from the uterine plexus veins, 73 (25.61%) mainly from the ovaries veins, 42 (14.73%) of pregnant women primarily from the veins of the uterus + ovaries, 18 (6.32%) mainly from the veins of the uterus + ovaries + cremasteric vein, failed to clearly identify the source for 11 (3.86%) patients. This pathology progressed throughout pregnancy and during subsequent pregnancies for 285 (100%) patients. The primary varicose veins of the inguinal canals isolated form did not progress between pregnancies. At that time all the 156 pregnant women with the concomitant disease, marked by the progression of primary CVD pool of saphenous veins during pregnancy and between pregnancies. Conclusion. The use of the second level diagnosis during pregnancy which combined the data of anamnesis, clinical examination and LANWIND MIRROR 2 duplex angioscanning apparatus with 8–10 MHZ linear sensor frequency, McKenna D.A. and co-authors criteria (2008) in the supine and standing (orthostasis) with the Valsalva maneuvre in 100% is safe for both mother and fetus. The use of the inguinal canals venous pathology’s second level diagnosis among the pregnant women gave one hundred percent diagnosis of this pathology’s various forms. On duplex angioscanning the primary varicose veins of the inguinal canals found in 20.23% among pregnant women with primary chronic vein disease to 45.3% in isolated form, but more often in 54.7% in combination with lower extremities’ primary chronic vein disease. Sources of the primary varicose veins of the inguinal canals’ formation were mostly uterus venous plexuses’ reflux in 49.7% of pregnant women, the ovaries in 25.61% of the patients. Key words: D.A. McKenna and co-authors criteria (2008), duplex angioscanning, non-saphenous varicose veins, inguinal canal varicose veins.
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Atta, Hussein M. "Varicose Veins: Role of Mechanotransduction of Venous Hypertension." International Journal of Vascular Medicine 2012 (2012): 1–13. http://dx.doi.org/10.1155/2012/538627.
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Varicose veins affect approximately one-third of the adult population and result in significant psychological, physical, and financial burden. Nevertheless, the molecular pathogenesis of varicose vein formation remains unidentified. Venous hypertension exerted on veins of the lower extremity is considered the principal factor in varicose vein formation. The role of mechanotransduction of the high venous pressure in the pathogenesis of varicose vein formation has not been adequately investigated despite a good progress in understanding the mechanomolecular mechanisms involved in transduction of high blood pressure in the arterial wall. Understanding the nature of the mechanical forces, the mechanosensors and mechanotransducers in the vein wall, and the downstream signaling pathways will provide new molecular targets for the prevention and treatment of varicose veins. This paper summarized the current understanding of mechano-molecular pathways involved in transduction of hemodynamic forces induced by blood pressure and tries to relate this information to setting of venous hypertension in varicose veins.
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Juhan, Claude, Serge Haupert, Gilles Miltgen, Pierre Barthelemy, and Bo Eklof. "Recurrent Varicose Veins." Phlebology: The Journal of Venous Disease 5, no. 3 (September 1990): 201–11. http://dx.doi.org/10.1177/026835559000500309.
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We report our experience of 93 patients with recurrent varicose veins. Doppler ultrasound and ascending phlebology were routinely performed, with descending or popliteal phlebography in some patients, as a means of evaluating recurrence. Early recurrence was found in a few cases due to incorrect diagnosis. Late recurrence, in the majority of cases, was due to incorrect surgery or the overlooking of gastrocnemius vein incompetence. In some cases deep reflux, soleal arch compression or left iliac vein compression was found to be a possible cause of recurrence. Extensive evaluation of the venous disorder and the ligation of every site of deep to superficial reflux are the first steps in preventing recurrence. The rules and pitfalls of surgical treatment are stressed. On recurrence, Doppler ultrasound is accurate in deep venous assessment and in demonstrating leaking perforators. Ascending phlebography is the method of choice in the investigation of the deep veins and in confirming perforating vein incompetence. We have used popliteal phlebography to demonstrate incompetence of the LSV junction, SSV junction, gastrocnemius vein and mid-thigh and popliteal fossa perforators. When necessary, surgery for recurrent varicose veins must be carefully carried out according to certain basic principles.
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Akulova, A. A., V. L. Soroka, D. V. Bondarchuk, A. E. Solomakhin, and K. V. Lobastov. "Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case." Ambulatornaya khirurgiya = Ambulatory Surgery (Russia) 20, no. 2 (November 21, 2023): 54–62. http://dx.doi.org/10.21518/akh2023-023.
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The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.
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Benyuk, V. A., V. I. Medved, I. A. Usevych, S. D. Koval, and O. S. Korzheletskyy. "The correction of hemodynamic disorders in pregnant women with varicose veins." HEALTH OF WOMAN, no. 2(118) (March 29, 2017): 69–76. http://dx.doi.org/10.15574/hw.2017.118.69.
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The objective: determining of the characteristics of hemodynamic disorders in pregnant women with varicose veins. Patients and methods. The study involved 80 pregnant women with varicose veins of the lower limbs: 42 pregnant women with varicose veins of the lower extremities (study group) suggested usage of complex therapy; 38 pregnant women (group) – traditional therapy. Performed duplex mapping dopplerometry pool pelvic vein, external iliac and ovarian veins; pool venous legs, hip and great saphenous veins. The authors suggested regimen that includes use of drug Dioflan®. Results. Analysis of the data allowed to define features and its hemodynamic disturbances in venous pools pelvis and lower extremities in pregnant women with varicose veins. The study conducted by the authors proposed estimation methods of their correction using the drug Dioflan®. Conclusion. The proposed method is statistically more effective correction of hemodynamic disorders in pregnant women with varicose veins. Key words: pregnancy, varicose veins, dopplerometry, Dioflan®.
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Joshi, Rashmi, Roshani Agrawal, and Archana Shrestha. "Knowledge regarding prevention of varicose vein among nurses." Journal of Patan Academy of Health Sciences 9, no. 2 (August 30, 2022): 77–84. http://dx.doi.org/10.3126/jpahs.v9i2.44960.
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Introduction: Varicose veins are prominent dilated veins usually present in the lower limbs. High pressures in the veins, leakiness of venous valves, weakness of the vein wall, and inflammation are the key mechanisms that lead to varicose veins. Method: A cross-sectional descriptive study was conducted to find out knowledge regarding prevention of varicose vein among nurses of Patan Hospital, Systematic random sampling technique was used for data collection. The SPSS 16 version was used to analyse. Result: Out of 211 nurses, less than half respondents 73(34.6%) had inadequate level of knowledge, nearly half respondents 101 (47.9%) had moderately adequate level of knowledge and One fifth respondents 37(17.5%) had an adequate level of knowledge regarding the prevention of varicose vein. Conclusion: Majority of the respondents 101(47.9%) had moderate adequate level of knowledge and one fifth respondents had adequate level of knowledge regarding prevention of varicose vein.
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Tandon, Atul. "Status of clinical profile and management of varicose veins in a tertiary care teaching hospital." International Surgery Journal 8, no. 10 (September 28, 2021): 3093. http://dx.doi.org/10.18203/2349-2902.isj20214001.
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Background: Varicose veins are a widespread medical condition found in at least 10 percent of the general population. Symptoms of varicose veins range from asymptomatic varicose veins to more extreme symptoms such as ulceration and bleeding.Methods: Fifty-six cases of varicose veins of lower limb were evaluated by taking detailed history and by carrying out thorough clinical examination. Patients with features of varicose veins and its complications were included in the study while patients with secondary varicose veins due to deep vein thrombosis, recurrent varicose veins, pregnancy, and venous flow obstruction were excluded from the study.Results: It was more common in left lower limb then compared to right one, 26 (46.4%) patients developed in left and 23 (41.1%) patients in right lower limb. In the present study, right limb involvement of 41.1% and left limb involvement of 46.4%. In the present study bilateral involvement is seen in four patients (12.5%).Conclusions: Distributions of varicose veins of lower limbs is greater common in center age organization of 30 to 50 years (58.9%) with male predominance, career and own family history are the opposite contributory factors.
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Lees, T. A., and J. D. Holdsworth. "Assessment and Treatment of Varicose Veins in the Northern Region." Phlebology: The Journal of Venous Disease 10, no. 2 (June 1995): 56–61. http://dx.doi.org/10.1177/026835559501000205.
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Objective: To identify the current practice of surgeons and variations between these surgeons in the investigation and treatment of varicose veins. Design: Questionnaire submitted to all surgeons treating varicose veins. Setting: All general surgeons in the Northern Region of England. Results: The response was 83% with 60 surgeons (85% of responders) treating varicose veins. Thirty-five per cent have a vascular specialist interest and treat 58% of all the varicose veins; 37% of surgeons complement initial assessment by clinical examination with hand-held Doppler examination. For long saphenous vein incompetence all surgeons perform high saphenous ligation, with 67% stripping the vein to the knee and 23% to the ankle. For short saphenous incompetence, 28% localize the saphenopopliteal junction by investigation prior to treatment, 92% perform saphenopopliteal ligation and 13% strip the vein. Conclusions: The extent of investigation and the nature of treatment of varicose veins vary considerably between consultants. Relatively few surgeons use hand-held Doppler and surgeons remain divided on the use and extent of stripping of the saphenous veins.
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Taccoen, A., C. Lebard, and F. Zuccarelli. "Laser Doppler Flux in Normal and Varicose Long Saphenous Vein Wall." Phlebology: The Journal of Venous Disease 11, no. 4 (December 1996): 146–49. http://dx.doi.org/10.1177/026835559601100404.
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Objective: To assess the wall perfusion in normal and varicose veins. Design: Observational study. Setting: Departments of vascular surgery of private and public hospitals. Patients: Twenty-seven patients undergoing vein surgery (43 long saphenous veins) and eight controls operated on for femoral-popliteal bypass. Methods: Laser Doppler flowmetry assessing long saphenous vein wall perfusion 3 cm below the saphenofemoral junction. Results: Significantly reduced wall perfusion was shown in varicose long saphenous veins compared with normal veins: 16.3 (SD 10.3) versus 45.4 (SD 14.9); p<0.001. Conclusion: Our data suggest a primary or secondary role for lower perfusion within the vein wall in varicose veins.
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Zamboni, P., C. V. Feo, M. G. Marcellino, G. Vasquez, and C. Mari. "Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?" Phlebology: The Journal of Venous Disease 11, no. 3 (September 1996): 98–101. http://dx.doi.org/10.1177/026835559601100305.
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Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences