Elimination of saphenous reflux after tributary sclerotherapy: report of two cases / Abolição do refluxo de safena após escleroterapia de colaterais: relato de dois casos

Abstract Most patients with chronic venous disease (CVD) and reflux in the saphenous vein are treated with saphenous stripping or ablation. The venous hemodynamics approach offers the possibility of treating saphenous reflux without eliminating the saphenous vein. We present 2 cases in which venous reflux was eliminated while preserving the great saphenous vein, after treatment with hemodynamic sclerotherapy using a protocol of synergic use of Dextrose and long pulse Nd YAG 1064 laser. These cases show that treating the tributaries responsible for saphenous reflux can correct hemodynamic imbalances and restore normal flow in the great saphenous vein with improvements in symptoms and esthetics. Long-term results are still uncertain.

Resumo A maioria dos pacientes com insuficiência venosa crônica e refluxo na veia safena é tratada com retirada ou ablação da safena. A hemodinâmica venosa traz a possibilidade de tratar esses pacientes sem eliminar a veia safena. Nós apresentamos dois casos de refluxo parcial de veia safena magna resolvidos com escleroterapia hemodinâmica. Usamos um protocolo de uso sinergístico de glicose 75% e Nd-YAG laser 1064. Os casos nos mostram que o tratamento das tributárias pode corrigir o refluxo da veia safena e obter melhora clínica e cosmética. Os resultados de longo prazo ainda são incertos.

Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

<p><b>INTRODUCTION</b>The pattern of venous reflux in Thai patients with chronic venous insufficiency (CVI) was studied in correlation with clinical manifestations.</p><p><b>METHODS</b>Ultrasonography findings and clinical data were prospectively collected and retrospectively reviewed.</p><p><b>RESULTS</b>CVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR. For lateral ulceration, 46.7% had SSVR and 33.3% had isolated GSVR. Pulsatile venous signal was found in 3.3% of legs. In 17 legs with ulceration after previous surgical treatment, calf vein reflux (residual calf great saphenous vein or small saphenous vein) was found in 13 (76.5%) legs.</p><p><b>CONCLUSION</b>Calf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.</p>

Associação entre sintomas, veias varicosas e refluxo na veia safena magna ao eco-Doppler / Associations between symptoms and varicose veins and great saphenous vein reflux seen on Doppler ultrasonography

Resumo Contexto A doença venosa crônica requer avaliação clínica, quantificação dos efeitos hemodinâmicos e definição da distribuição anatômica para decisão diagnóstica e tratamento. Métodos Estudo prospectivo realizado em 2015 com amostra de 1.384 pacientes (2.669 membros) com idade entre 17 e 85 anos, sendo 1.227 do sexo feminino. Nas respostas do questionário aplicado, os sintomas pesquisados eram dor, cansaço, sensação de peso, queimação, câimbras e formigamento. Para a formação dos grupos, foi considerado o número de membros, distribuídos em relação ao gênero, ao índice de massa corporal e à idade. Após a definição grupos e a realização do eco-Doppler para estudo da veia safena magna (VSM), os pacientes foram distribuídos em três grupos (I: sintomas presentes e varizes ausentes, II: sintomas ausentes e varizes presentes e III: sintomas presentes e varizes presentes). A análise estatística utilizou o teste qui-quadrado ou exato de Fisher para verificar a homogeneidade entre os grupos. Em caso de associação com significância de 5%, foi calculada a razão de chances. Resultados Para ambos os gêneros, foi observada chance de insuficiência da VSM 11,2 vezes maior no grupo III. Por sua vez, os casos de obesidade mórbida ocorreram 9,1 vezes mais no mesmo grupo. Além disso, pacientes na faixa etária entre 30 e 50 anos desse grupo apresentaram chance de insuficiência da VSM 43,1 vezes maior. Conclusões A insuficiência da VSM foi significantemente mais frequente no grupo III, tanto globalmente como considerando apenas os casos de obesidade mórbida e a faixa etária mais elevada.

Abstract Background Chronic venous disease demands clinical assessment, quantification of hemodynamic effects, and definition of anatomic distribution before diagnostic and treatment decisions can be made. Methods This is a prospective study conducted in 2015 with a sample of 1,384 patients (2,669 limbs) aged from 17 to 85 years, 1,227 of whom were female. The most common symptoms reported in response to the questionnaire were pain, tiredness, feelings of heaviness, burning, cramps, and tingling. Subsets were formed on the basis of number of limbs distributed by sex, body mass index, and age. After definition of subsets, Doppler ultrasonography was used to conduct examinations of the great saphenous vein (GSV) and patients were distributed into three clinical groups (I: symptoms present and varicose veins absent, II: symptoms absent and varicose veins present and III: symptoms present and varicose veins present). Statistical analysis employed the chi-square test or Fisher’s exact test to test for homogeneity between groups. When associations significant to 5% were detected, odds ratios were calculated. Results For both sexes, the chance of GSV insufficiency was 11.2 times greater in group III. Among cases with morbid obesity, the chance was 9.1 times greater in the same group. Additionally, patients in this group with ages ranging from 30 to 50 years exhibited a 43.1 times greater chance of GSV insufficiency. Conclusions Insufficiency of the GSV was significantly more frequent in group III, both overall and when considering only cases with morbid obesity, or cases in older age groups.

Cortical versus Pial Venous Drainage in Dural Arteriovenous Fistula / 신경중재치료의학

No abstract available.

Spontaneous Aggressive Conversion of Venous Drainage Pattern in Dural Arteriovenous Fistula Treated with Onyx Embolization

We report a case of dural arteriovenous fistula (DAVF) that showed spontaneous conversion of venous drainage pattern from Borden type II to type III within a four month period of follow-up. Upon admission, the patient presented with aggravated neurologic status and newly developed seizure. After admission, endovascular embolization was performed through the middle meningeal artery with Onyx®. Complete obliteration of dural arteriovenous shunt was confirmed by angiography, and the patient's clinical symptoms improved. Although most cases of DAVF show benign clinical course and conversion pattern, close follow-up is required to detect potential aggravation.

Associação entre aplasia segmentar de veia safena magna e varizes em membros inferiores avaliada pelo ecocolor Doppler / Association between segmental aplasia of great saphenous vein and varicose veins of lower limbs, evaluated using color Doppler ultrasonography

Há diferenças individuais no diâmetro da veia safena magna (VSM) em membros normais e doentes; sendo possível a identificação dessas alterações pelo ecocolor Doppler.ObjetivoAvaliar a associação da aplasia segmentar da VSM com a presença de varizes e/ou insuficiência da mesma em membros inferiores, usando o ecocolor Doppler em pacientes com clínica de doença venosa crônica (DVC).Métodos1.408 pacientes com queixas compatíveis de DVC de membros inferiores, sendo 1.286 do sexo feminino, com idade entre 17 e 85 anos, examinados com ecocolor Doppler. Foram incluídos aqueles com classificação CEAP clínica C0 a C4. Pela avaliação clínica, a amostra foi distribuída em grupo A, pacientes com varizes, e grupo B, aqueles sem varizes. O ecocolor Doppler determinou se havia aplasia da VSM pela análise do seu trajeto no compartimento safeno e presença de veias varicosas nos diferentes sítios. Para estatística, foram considerados os testes Qui-quadrado ou Exato de Fisher e uma análise de resíduos em tabelas, com nível de significância de 5%.ResultadosNo grupo A houve 479 (83,9%) de VSM insuficientes, 169 (38,2%) com aplasia e 71 (80,7%) com insuficiência e aplasia associadas. No grupo B, houve 92 (16,1%) de VSM insuficientes, 273 (61,8%) com aplasia e 17 (19,3%) com insuficiência e aplasia associadas.ConclusãoA aplasia segmentar da VSM ocorre mais em membros inferiores que não apresentam varizes e/ou insuficiência da mesma, mas considerando-se a presença da associação de aplasia e insuficiência, houve maior incidência no grupo de membros que apresentavam varizes.

There are individual differences in the diameter of the great saphenous vein (GSV) in both normal and non-functional limbs and it is possible to identify these differences using color Doppler ultrasonography.ObjectivesTo assess the association between segmental GSV aplasia and the presence of varicose veins and/or GSV insufficiency in lower limbs using color Doppler ultrasonography, in patients with chronic venous disease (CVD).MethodsA total of 1,408 patients with complaints compatible with CVD of lower limbs were examined using color Doppler ultrasonography. The age range of the sample was from 17 to 85 and 1,286 of the patients were female. People with clinical classifications (CEAP) ranging from C0 to C4 were included. On the basis of clinical examination, the sample was subdivided as follows: group A patients had varicose veins and group B patients were free from varicose veins. Color Doppler ultrasonography was used to determine whether there was GSV aplasia, by analysis of its route into the saphenous compartment, and the presence of varicose veins in different sites. Statistical analysis was conducted using the chi-square test or Fisher’s exact tests followed by an analysis of residuals in tables, with a 5% significance level.ResultsIn group A, there were 479 (83.9%) patients with GSV insufficiency, 169 (38.2%) with aplasia and 71 (80.7%) with both insufficiency and aplasia. In group B, there were 92 (16.1%) patients with GSV insufficiency, 273 (61.8%) with aplasia and 17 (19.3%) with both insufficiency and aplasia.ConclusionSegmental GSV aplasia was more common in lower limbs with no varicose veins and/or insufficiency, but there was a higher incidence of patients with both aplasia and insufficiency in the group with varicose veins.

Postoperative outcomes of patients with dural arteriovenous fistulas: An analysis of influencing factors / 第二军医大学学报

Objective To investigate the prognostic factors for poor postoperative outcomes of patients with dural arteriovenous fistulas (DAVFs). Methods The clinical data of 153 patients with DAVFs, who were treated in our institute over the past 6 years, were retrospectively analyzed. The clinical manifestations, angioarchitecture, treatment methods, neuroradiological results, and clinical outcomes were collected for Kaplan-Meier estimation and Cox regression analysis. Results The patients were followed up for a mean of (38. 1 ± 16. 3) months. Twenty-one patients showed modified Rankin scale (mRS) 3-6 during recent follow-up; 4 patients died of postoperative complications, another 8 patients died during follow-up, and 9 patients presented with permanent neurologic defects. Kaplan-Meier estimation suggested that patients with poor preoperative neurologic status (mRS≥ 3) venous sinus thrombosis, combined arteriovenous approach embolization, partial obliteration, parital obliteration with cortical venous reflux (CVR), and postoperative restriction of dominant venous sinuses tended to have poor clinical outcomes. Cox regression analysis demonstrated that poor preoperative neurologic status (mRS≥3) (P= 0. 018), partial obliteration with CVR (P = 0. 001), and postoperative restriction of dominant venous sinuses (P = 0. 000 1) were risk factors predicting poor postoperative outcomes. Conclusion Poor preoperativeneurologic status, partial obliteration with CVR, and postoperative restriction of dominant venous sinuses are the independent risk factors for poor clinical outcomes of DAVFs.

Avaliação do refluxo venoso superficial ao mapeamento dúplex em portadores de varizes primárias de membros inferiores: correlação com a gravidade clínica da classificação CEAP / Evaluation of venous reflux by color duplex scanning in patients with varicose veins of the lower limbs: correlation with clinical severity by CEAP classification

Contexto: As alterações de pele manifestadas na insuficiência venosa crônica têm como etiologia mais comum o refluxo venoso. Alguns autores relatam que o refluxo venoso superficial é responsável por 40-60 por cento das úlceras de perna nos portadores de varizes primárias. Objetivo: Correlação do refluxo venoso superficial ao mapeamento dúplex com o quadro clínico (classificação CEAP - clínica, epidemiológica, anatômica e fisiopatológica) nos portadores de varizes primárias de membros inferiores. Método: Estudo transversal e descritivo, desenvolvido em portadores de varizes primárias. As variáveis primárias foram: refluxo venoso e quadro clínico. O quadro clínico foi caracterizado por grupos: A, B e C, representados pelas categorias clínicas da CEAP. Dados complementares foram: tipos de refluxo em veias safenas magnas e parvas, conforme classificação de Engelhorn (2004). Testaram-se as hipóteses de inter-relações entre presença de refluxo e quadro clínico, utilizando-se os testes exato de Fisher e qui-quadrado no nível de 5 por cento de probabilidade. Resultados: Das 242 extremidades inferiores examinadas, 15 foram excluídas, totalizando 227 na amostra final. Noventa e nove (83,9 por cento) pacientes eram do sexo feminino. A média de idade foi de 50 anos, com mediana igual a 49 anos. Noventa e três extremidades (41 por cento) não apresentavam refluxo, e 134 (59 por cento) o apresentavam isolado e/ou associado. O refluxo isolado em veias perfurantes (p = 0,0008) e destas em associação com o refluxo em veias safenas magnas (p < 0,0001) estão significativamente relacionados à gravidade do quadro clínico. Conclusão: Há correlação entre a presença do refluxo venoso superficial ao mapeamento dúplex e a gravidade do quadro clínico nos portadores de varizes primárias de membros inferiores.

Background: Skin changes observed in chronic venous insufficiency have venous reflux as the most common etiology. Some authors have reported that reflux in the superficial venous system accounts for 40-60 percent of leg ulcers in patients with primary varicose veins. Objective: To evaluate the correlation between superficial venous reflux and clinical status (CEAP classification - clinical, etiology, anatomy and pathophysiology) in patients with primary varicose veins of the lower limbs using duplex scanning. Method: A cross-sectional and descriptive study was performed in patients with primary varicose veins. Primary variables were venous reflux and clinical status. Clinical status was characterized by groups A, B, and C, represented by CEAP clinical categories. Types of venous reflux in the great and small saphenous veins were used as complementary data, according to Engelhorn's classification (2004). Hypotheses of interrelationship between incidence and types of reflux were statistically analyzed using Fisher's exact and chi-square tests. Significance was set at 0.05 percent. Results: Of 242 lower limbs, 15 were excluded, so that the final sample was comprised of 227 lower limbs. Ninety-nine (83.9 percent) patients were female. Mean age was 50 years and median was 49 years. Reflux was absent in 93 limbs (41 percent), and 134 (59 percent) showed isolated and/or associated reflux. Isolated reflux in perforating veins (p = 0.0008) or in association with great saphenous vein reflux (p < 0.0001) was significantly related to clinical status severity. Conclusion: Duplex scan showed correlation between presence of superficial venous reflux and clinical status severity in patients with primary varicose veins of the lower limbs.

Perioperative nursing of patients with primary venous reflux disease of lower extremity / 中国实用护理杂志

Objective To discuss the perioperative nursing experience of patients with primary venous reflux disease(PVRD)of lower extremity undergoing external valvuloplasty of superficial femoral vein.Methods Patients(146 cases)with PVRD of lower extremity were given psychological nursing,observation of postoperative complications and rehabilitation exercise instruction.Results Five limbs appeared short lymphatic seepage and other limbs recovered completely.No thrombus Was seen.Venous claudication,swelling and pain disappeared in 90.4% patients.Limbs symptom alleviated in 9.6% patients.All varicos evein disappeared.The function of deep vein valve recovered in 92% patients by color doppler ultra sonoscope re-examination.Conclusions General evaluation before operation,good perioperative psycho logical nursing and attention to the complication and rehabilitation exercise instruction are significant for reduction of postoperative complication and improvement of success rate of operation.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.

The Frequency of Occurrence and Clinical Significance of the Giacomini Vein

PURPOSE: The Giacomini vein (GV) is one of branches that arising from the short saphenous vein (SSV) which extends cephalad along the posterior thigh communicating to the great saphenous vein (GSV), GSV branch or deep venous system. Despite of its common occurrence, the clinical significance of this venous structure isunknown yet. We investigated the frequency and the anatomical feature of the GV and the frequency of superficial or deep venous reflux associated GV to clarify its clinical significance. METHOD: We conductednon-invasive vascular evaluations on both legs using duplex ultrasonography in 50 patients having leg varicosity or telangiectasis. RESULT: 16 patients (32%) of 50 patients[28 limbs (28%) of 100 limbs]revealed the GV in their lower extremities. Among the patient with GV, venous refluxes of GSV, SSV or perforating vein (PV) were noted in frequencies of 16 limbs (76%), 8 limbs (38%) and 9 limbs (42%) respectively. The SSV and PV reflux were more common in the legs with GV than the legs without GV (P<0.001 respectively, McNemar test) regardless the existence of GV reflux. CONCLUSION: The SSV or PV reflux was more commonly associated with GV.

A Clinical Analysis of the Risk Factors of Varicose Veins in Korean / 대한피부과학회지

PURPOSE: Varicose veins occur commonly in the general population, however the etiology is not well established. Varicosities are frequently associated with a reflux of blood in the leg veins due to valvular incompetence. Our aim was to determine which risk factors are related to reflux in the general population, and thus could be implicated in the etiology of varicose veins. METHOD: One hundred and eighty nine patients were assessed and their clinical records from March 2001 to June 2004 were reviewed. They were all diagnosed as having primary varicose veins of the lower extremities using duplex ultrasonography. We analyzed the sex, age, symptoms, signs, duration, location and CEAP classification. Patients also completed a self-administered questionnaire, asking about their objectives of the visit, cigarette consumption, familial history, previous pregnancies, use of drugs such as oral contraceptives, hormones, and anticoagulant agents, and other associated diseases. We carried out duplex scans to measure the reflux in venous segments in each leg. RESULTS: The mean age was 46.0 years, and there were 3.3 times more females than males. The most common CEAP classification was C2sEpAsPr, followed by C2aEpAsPr and C1sEpAsPr. Venous reflux was significantly associated with females (p=0.0067), duration (p=0.0027), pregnancy (p=0.0034), smoking (p=0.0360), family history of mother (p=0.0082) and brother (p=0.0360), heaviness (p=0.0120) and stasis dermatitis or ulcer (p=0.0219). CONCLUSION: This study identified relatively strong and consistent risk factors of venous reflux that are associated with females, pregnancy, smoking, duration, family history of the mother or brother, heaviness, and stasis dermatitis or ulcers.