Hemorragia fatal de una ulcera venosa crónica: Reporte de un caso / Fatal bleeding from a chronic venous ulcer: case report

Resumen La enfermedad venosa crónica es un trastorno común que se manifiesta con una amplia gama de signos. En casos en los que la enfermedad adquiere gravedad se le denomina insuficiencia venosa crónica y esta puede llevar al desarrollo de una úlcera venosa. Un trauma directo o la erosión de una vena varicosa pueden llevar a una hemorragia que, aunado a enfermedades crónicas concomitantes, factores toxicológicos, sociales o primeros auxilios inadecuados pueden llevar a la muerte en pocos minutos y en un escenario del crimen que puede ser confuso a primera vista para el equipo forense. Se reporta un caso valorado en la Sección de Patología Forense del Departamento de Medicina Legal del Poder Judicial de Costa Rica en el que se realizó una autopsia completa. Dentro de los hallazgos más importantes a nivel macróscopico se evidenció una úlcera cónica de características venosas en la pierna derecha en la cual, mediante la disección por planos y la inyección de colorante en la vena safena magna, se observó la salida de este por una vena varicosa relacionada con la úlcera.

Abstract Chronic venous disease is a common disorder that shows a large spectrum of signs. In cases in which the disease acquires severity it is named chronic venous insufficiency, and it can cause the development of a venous ulcer. Direct trauma to or erosion of a varicose vein can lead to a hemorrhage that, in combination with coexistent conditions, toxicologic or social factors, or inadequate first aid can produce death in few minutes and a crime scene which might be confusing at first sight to the forensics team. We present a case handled by the Forensic Pathology Section of the Department of Legal Medicine of the Judicial Power of Costa Rica in which a complete autopsy was performed. Among the most relevant macroscopic findings was evidence of a chronic ulcer with venous characteristics on the right leg, in which dissection by planes and dye injection into the great saphenous vein showed leakage of this dye out of a varicose vein related to the ulcer.

Oclusión de la vena safena con cianocrilato, una alternativa para el tratamiento de insuficiencia venosa crónica. Experiencia inicial en el Instituto Guatemalteco de Seguridad Social ­ IGSS / Occlusion of the saphenous vein with cyanoacrylate, an alternative for the treatment of chronic venous insufficiency. Initial experience at the Guatemalan Social Security Institute - IGSS

Las técnicas de termo ablación han revolucionado el tratamiento de la insuficiencia venosa crónica, siendo actualmente el estándar de tratamiento. Con el avance tecnológico han surgido nuevas técnicas quirúrgicas, no térmicas, no tumescentes; como el uso de cianocrilato para la oclusión venosa, el cual ha demostrado ser seguro y eficaz en el tratamiento, y tener menos complicaciones posoperatorias. Objetivo: Describir la experiencia en nuestro hospital con el uso de cianocrilato para la oclusión de vena safena mayor para el tratamiento de insuficiencia venosa crónica. Describir la eficacia a corto y mediano plazo del cierre, las complicaciones y la mejoría de la sintomatología utilizando el cuestionario CIVIQ-20 y EVA. Material y métodos: Estudio retrospectivo observacional. Entre enero y diciembre de 2019 que incluye a pacientes con insuficiencia de unión safeno femoral, sintomáticos. Con diagnóstico mediante clasificación CEAP y ultrasonido Doppler. Seguimiento clínico y ecográfico valorando oclusión de los segmentos tratados y presencia de venas varicosas a los 3 y 6 meses. Se trataron 5 pacientes con oclusión venosa con cianocrilato (100% mujeres). Valoramos la calidad de vida mediante cuestionario CIVIQ-20 y EVA (Escala Analógica Visual) previo y un mes después del procedimiento. También se describe la tasa de éxito y complicaciones inmediatas y tardías. Resultados: La totalidad de los procedimientos se realizaron con anestesia local, siendo bien tolerados. Con un éxito inmediato del 100 % sin necesidad de conversión. Solo se presentó como complicación urticaria en un paciente en el trayecto de la vena tratada con cianocrilato, la cual se trató con esteroides y resolvió. El CIVIQ-20 mostró mejoría global pasando de 35 a 29 puntos en promedio; siendo el parámetro de actividad física el que mostró una mejoría mayor. EVA demostró que la pesadez (principal síntoma) se redujo un 67%. Durante el seguimiento, ningún caso presento repermeabilización o recanalizaciones segmentarias. Conclusiones: El tratamiento endovenoso de la insuficiencia venosa crónica con las nuevas técnicas no térmicas, no tumescentes es seguro y efectivo. A corto-mediano plazo ofrecen resultados similares a las técnicas termoablativas obviando el inconveniente de la tumescencia y el uso de medias compresivas en el posoperatorio, evitando lesiones térmicas y observándose mejoría en la sintomatología. (AU)

Thermo ablation techniques have revolutionized the treatment of chronic venous insufficiency, being currently the standard of treatment. With technological advancement, new non-thermal, non-tumescent surgical techniques have emerged; such as the use of cyanoacrylate for venous occlusion, which has been shown to be safe and effective in treatment, and have fewer postoperative complications. Objective: To describe the experience in our hospital with the use of cyanoacrylate for occlusion of the greater saphenous vein for the treatment of chronic venous insufficiency. Describe the shortand medium-term efficacy of closure, complications, and symptom improvement using the CIVIQ-20 questionnaire and VAS. Material and methods: Retrospective observational study. Between January and December 2019 that includes patients with symptomatic saphenous femoral junction insufficiency. With diagnosis by CEAP classification and Doppler ultrasound. Clinical and ultrasound follow-up evaluating occlusion of the treated segments and the presence of varicose veins at 3 and 6 months. 5 patients with venous occlusion were treated with cyanoacrylate (100% women). We assessed the quality of life using the CIVIQ-20 questionnaire and VAS (Visual Analogue Scale) before and one month after the procedure. The immediate and late success rate and complications are also described. Results: All the procedures were performed under local anesthesia, being well tolerated. With immediate 100% success without the need for conversion. Urticaria only presented as a complication in a patient in the path of the vein treated with cyanoacrylate, which was treated with steroids and resolved. The CIVIQ-20 showed global improvement, going from 35 to 29 points on average; being the physical activity parameter the one that showed the greatest improvement. VAS showed that heaviness (main symptom) was reduced by 67%. During follow-up, no case presented segmental recanalization or recanalization. Conclusions: Endovenous treatment of chronic venous insufficiency with new non-thermal, non-tumescent techniques is safe and effective. In the short-medium term, they offer results similar to thermoablative techniques, avoiding the inconvenience of tumescence and the use of compression stockings in the postoperative period, avoiding thermal injuries and observing improvement in symptoms. (AU)

Efeitos do fortalecimento muscular do tríceps sural na função da bomba venosa na insuficiência venosa crônica / Effects of strengthening the surae triceps muscle on venous pump function in chronic venous insufficiency

Resumo Contexto A insuficiência venosa crônica (IVC) é uma doença comum, uma disfunção da bomba muscular da panturrilha que repercute na hemodinâmica das estruturas. Objetivos Analisar os efeitos dos exercícios de fortalecimento muscular da panturrilha na hemodinâmica venosa em pacientes com IVC. Métodos O estudo contou com a participação de 13 pacientes e 25 membros inferiores com IVC, classificados entre C1 e C5 da classificação Clínica, Etiologia, Anatomia e Fisiopatologia (CEAP), oriundos do ambulatório de cirurgia vascular do Hospital Universitário Regional dos Campos Gerais. As variáveis analisadas foram dinamometria isométrica, goniometria, perimetria, adipometria no início, primeiro mês, segundo mês e final da aplicação do protocolo de exercícios. Resultados Os valores da dorsiflexão e da plantiflexão aumentaram 5º (p < 0,001). Na adipometria notou-se uma redução de 5 mm (p < 0,001). Quando separados em grupos pela CEAP, na C2 houve aumento de 5º na dorsiflexão (p = 0,02) e na plantiflexão (p < 0,001); na C3 houve aumento de 5º na dorsiflexão (p = 0,003) e redução de 1 mm na adipometria (p < 0,004); na C1 houve aumento da perimetria de 1,2 cm (p = 0,04). Conclusões A aplicação de protocolos de exercícios deveria ser considerada como uma forma de tratamento para IVC, pois impacta positivamente em fatores de risco e nas funções que estão deterioradas pela patologia.

Abstract Background Chronic venous insufficiency (CVI) is a common disease that causes calf muscle pump dysfunction and has repercussions for the hemodynamics of the structures involved. Objectives To analyze the effects on venous hemodynamics of exercises to strengthen the calf muscles in patients with CVI. Methods The study analyzed 25 lower limbs with CVI, classified from C1 to C5 according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, in 13 patients recruited from a Lymphedema and Angiodysplasia Clinic at the Hospital Universitário Regional dos Campos Gerais (Brazil). The variables analyzed were collected by isometric dynamometry, goniometry, leg circumference measurement, and adipometry at baseline, after 1 month and 2 months and at the end of the exercise protocol. Results Dorsiflexion and plantar flexion measurements increased by 5º (p < 0.001). Adipometry detected a reduction in 5 mm (p < 0.001). When grouped by CEAP class, C2 exhibited 5º increases in dorsiflexion (p = 0.02) and plantar flexion (p < 0.001); C3 exhibited a 5ºincrease in dorsiflexion (p = 0.003) and a 1mm reduction in adipometry (p < 0.004); and C1 exhibited a 1.2cm increase in leg circumference (p = 0.04). Conclusions Administration of exercise protocols should be considered as a treatment option for CVI, since it has a positive impact on risk factors and on the functions that are impaired by this pathology.

Eficácia dos exercícios terapêuticos na qualidade de vida de pacientes com insuficiência venosa crônica: uma revisão sistemática / Effectiveness of therapeutic exercises for improving the quality of life of patients with chronic venous insufficiency: a systematic review

Resumo Os principais sinais e sintomas da insuficiência venosa crônica são dor, edema, varizes e alterações teciduais, condições que comprometem a funcionalidade e qualidade de vida. Visando amenizar esses prejuízos, o manejo da doença envolve uma ampla modalidade de intervenções; entre elas, o exercício terapêutico. Esta pesquisa apresenta as evidências existentes sobre a efetividade dos exercícios terapêuticos na qualidade de vida, dor e funcionalidade da insuficiência venosa crônica. Efetuou-se uma busca nas bases de dados CENTRAL, CINAHL, LILACS, MEDLINE, PEDro, SciELO, Science Direct, Scopus e Web of Science. Dos 2.961 resultados, quatro atenderam aos critérios de elegibilidade. Desses, apenas um estudo mostrou benefícios dos exercícios para melhora da qualidade de vida e redução da dor. Os demais apresentaram baixa qualidade metodológica. Portanto, as evidências existentes são insuficientes para indicar ou contraindicar os exercícios terapêuticos para melhoria da qualidade de vida, dor e funcionalidade em pacientes com insuficiência venosa crônica.

Abstract The main signs and symptoms of chronic venous insufficiency are pain, edema, varicose veins, and tissue changes; conditions that compromise functionality and quality of life. Management of the disease aims to mitigate these losses and involves a wide range of interventions, one of which is therapeutic exercise. This article presents the existing evidence on the effectiveness of therapeutic exercises for quality of life, pain, and functionality in chronic venous insufficiency. Searches were run on the databases CENTRAL, CINAHL, LILACS, MEDLINE, PEDro, SciELO, Science Direct, Scopus, and Web of Science. Four of the 2,961 results met the eligibility criteria. Only one of these studies showed benefits of exercise for improving quality of life and reducing pain. The others had low methodological quality. The existing evidence is therefore insufficient to indicate or contraindicate therapeutic exercises for improvement of quality of life, pain, and functionality in patients with chronic venous insufficiency.

Trends on management of superficial venous disease

Venous disease is more common in the society but less addressed than peripheral arterial disease. This is commonest in people who are sedentary workers, people standing for prolonged period, obase. Usually this group of people do not visit a doctor until it restricts him from regular work, ultimately causing a burden in the community. Early diagnosis of venous disease and its’ management is important. Understanding venous pathology, educating people about disease, conducting awareness program among target group of people are essential. Superficial venous disease includes both venous insufficiency and venous thrombosis. Management options of varicose vein and thrombophlebitis are discussed in the presentation.

Protocolo eletrônico multiprofissional de coleta de dados clínicos e cirúrgicos em insuficiência venosa crônica / Multidisciplinary electronic protocol for collection of clinical and surgical data on chronic venous insufficiency

Contexto A utilização de protocolos eletrônicos para coleta e armazenamento de dados permite a realização de pesquisas clínicas de forma dinâmica, contribuindo com a evolução da medicina. Objetivos Criar uma base eletrônica de coleta de dados clínicos e cirúrgicos referente à insuficiência venosa crônica (IVC) para auxiliar na realização de estudos científicos. Métodos Inicialmente, criou-se uma base de dados de todas as doenças vasculares e, em seguida, de IVC, por meio da revisão bibliográfica de livros-texto e de artigos científicos relevantes. A informatização desses dados foi realizada pelo programa Sistema Integrado de Protocolos Eletrônicos (SINPE©) e avaliada por um projeto piloto. Resultados O protocolo eletrônico multiprofissional de doenças vasculares abrangeu os itens anamnese, exame físico, exames complementares, tipos de tratamento e evolução. Com isso, criou-se um protocolo mestre contendo 6.145 itens, e após gerou-se um protocolo específico de IVC totalizando 2.877 itens. A funcionalidade do protocolo foi testada com um projeto piloto, coletando-se dados de prontuários. Realizou-se o cruzamento das informações coletadas, que foram demonstradas na forma de gráficos. Conclusões Foi possível criar um protocolo eletrônico para coleta de dados clínicos e cirúrgicos referente à IVC. Esse protocolo foi incorporado ao SINPE©, facilitando imensamente a realização de pesquisas científicas nessa área

Background Use of electronic protocols for data collection and storage enables clinical research to be conducted dynamically, contributing to medical advances. Objectives To create an electronic data base for collection of clinical and surgical data on chronic venous insufficiency (CVI), to facilitate production of scientific studies. Methods Initially, a database was constructed by means of a bibliographic review of text books and relevant scientific articles for all vascular diseases and then a database on CVI was extracted. These data were computerized using the Integrated Electronic Protocols System (SINPE©) and then assessed in a pilot project. Results The multidisciplinary electronic protocol for vascular diseases covered the following items: history taking, physical examination, work-up tests, types of treatment, and progression. Using these items, a master protocol was created containing 6,145 items, and then a CVI-specific protocol containing 2,877 items was compiled. The protocol's functionality was tested in a pilot project, collecting data from medical records. The information collected was analyzed and illustrated graphically. Conclusions It proved possible to create an electronic protocol for collection of clinical and surgical data on CVI. The protocol was incorporated into the SINPE©, greatly facilitating production of scientific research in the area

Epidemiología de los desórdenes venosos crónicos y factores asociados en amerindios nativos embera-chamí, Antioquia / Epidemiology of chronic venous disorders and associated factors in embera-chami native amerindians, Antioquia / Epidemiologia das doenças venosas crônicas e fatores associados em ameríndios nativos embera-chamí, Antioquia

Resumen Objetivo: Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa). Metodología: Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple. Resultados: La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica. Conclusiones: El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.

Abstract Objective: To analyze the prevalence of chronic venous disorders (CVD) in the embera-chamí from Cristianía (Karmata Rua), in the southwest of Antioquia, and to study possible associated factors (AF). Methodology: A cross sectional study of a random sample of 488 subjects. The diagnosis was performed through Doppler ultrasonography. Information about sociodemographic, behavioral and anthropometric AFs was collected. The most relevant AFs were selected through multiple binary logistic regression. Results: The prevalence of varicose veins was 27.5% and that of chronic venous insufficiency (cvi) was 0.8%. Superficial anatomical segments were compromised in 34.8% of individuals. Age was the most important AF, with an Odds Ratio (OR) between 3.33 and 6.30 according to the type of cvd. Being a female, parity, fat in the thigh/leg and large size were associated with telangiectasias. Age, abdominal fat and leg shape were AF of varicose veins. Superficial veins in both sexes were associated with age and abdominal fat and in women, also with a family background of varicose veins. Deep and perforator veins were associated with age and peripheral fat depletion. Conclusions: The low prevalence pattern of CVDs in embera-chamí may be a consequence of lifestyles involving daily physical activity and genetic differences shared with Amerindians. Deep and perforating disorders should be considered in differential health care programs in relation to mestizos.

Resumo Objetivo: Analisar a prevalência de doenças venosas crônicas (dvc) na Embera-Chami Christiania (KarmataRua), no sudoeste do estado de Antioquia, e conhecer seus fatores associados (AF). Metodologia: Um estudo de coorte de uma amostra aleatória de 488 indivíduos. O diagnóstico foi feito por ecoduplex venoso. Informações sobre FA sócio demográficas, comportamentais e antropométricas foram coletadas. Os FAs mais relevantes foram selecionados para múltipla regressão logística binária. Resultados: A prevalência de varizes foi de 27,5% e a de insuficiência venosa crônica (ivc) foi de 0,8%. Houve comprometimento dos segmentos anatômicos superficiais em 34,8% dos indivíduos. A idade foi a FA mais importante, com Odds Ratio (OR) entre 3,33 e 6,30 de acordo com o tipo de dvc. Sexo feminino, paridade, gordura na coxa e perna e altura foram associados a telangiectasias. Idade, gordura abdominal e formato de perna foram FA de varizes. Nas veias superficiais, em ambos os sexos, idade e gordura abdominal estavam associadas e, nas mulheres, também a história familiar de varizes. Às profundas e perfurantes foram associadas a idade e depleção de gordura periférica. Conclusões: O padrão de baixa prevalência de DVC em embera-chamí pode ser uma consequência de estilos de vida relacionados à atividade física diária e diferenças genéticas compartilhadas com ameríndios. Em programas diferenciais de atenção à saúde, distúrbios profundos e perfurantes devem ser considerados em relação aos mestiços.

National health and nutrition education survey on chronic venous insufficiency

Introduction@#Chronic venous disease is an under-recognized condition which may result in significant morbidities with considerable costs. There is scarce data on chronic venous disease in the Philippines.@*Methods@#The National Nutrition and Health Survey II was conducted to determine the national prevalence of different risk factors and clinical conditions. The primary objective of this study is to determine the prevalence of chronic venous disease in adults aged 20 years and older using the Southern Tagalog Venous Insufficiency Questionnaire (STVIQ).@*Results@#A total of 7,212 subjects, were randomly surveyed. Chronic venous disease has a crude overall prevalence rate of 52.5%, is frequently seen in females (60%) and with increasing age. About 38.6% of the population have typical venous symptoms but only 1.6% have edema, stasis pigmentation and healed venous ulcers. Prevalence of chronic venous disease is not related to urban residence and type of occupation.@*Conclusion@#Chronic venous disease in the Philippines is common, reported in approximately five out of 10 Filipinos, most of whom are asymptomatic.

Quality of life in chronic venous disease women / Qualidade de vida em mulheres com doença venosa crônica

The aim of the study was to verify the relationship between physical function and quality of life in women with chronic venous disease. Physical function was evaluated by the tests: chair stand test (lower limbs strength), arm curl (upper limbs strength), 6-minute walk (aerobic fitness), back scratch (upper limbs flexibility), sit and reach (lower limbs flexibility), and time up-and-go (agility). Quality of life was assessed by The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which is composed by physical, psychologic, social, environmental, and global do-mains. For statistical analysis, the Pearson correlation coefficient was used with an alpha of 5%. Patients evaluated were 32 (61.27 ± 7.78 years). A significant correlation was observed between the physical domain of quality of life with the chair stand test (r = 0.46; p = 0.001), arm curl (r = 0.39, p = 0.002), and 6-minute walk test (r = 0.45; p = 0.001). Also, chair stand test presented low correlation with global quality of life (r = 0.36, p = 0.004). The physical domain of quality of life measured by the WHOQOL-BREF questionnaire is related to lower and upper limbs strength and physical fitness in women with chronic venous disease but presented weak correlation with the global domain of quality of life. Thus, in women with CVD, the muscular strength of lower and upper limbs, and physical fitness is correlated with the physical domain of quality of life

O objetivo do estudo foi verificar a relação entre capacidade física e qualidade de vida em mulheres com doença venosa crônica. A capacidade física foi avaliada pelos testes: sentar e levantar (força de membros inferiores), flexão de braço (força de membros superiores), teste de caminhada de seis minutos (resistência ae-róbia), alcançar as costas (flexibilidade de membros superiores), sentar e alcançar (flexibilidade de membros inferiores) e levantar ir-e-vir (agilidade). Qualidade de vida foi avaliada pelo questionário da Organi-zação Mundial de Saúde WHOQOL-BREF composto pelos domínios físico, psicológico, social, ambiental e global. Correlação de Pearson foi usada para verificar a relação entre as variáveis. O valor de alpha foi estabelecido em 5%. Foram avaliados 32 pacientes (61.27 ± 7.78 anos). Correlações significativas foram ob-servadas entre os domínios físico de qualidade de vida com o teste de sentar e levantar (r = 0.46; p = 0.001), flexão de braço (r = 0.39; p = 0.002), e teste de seis minutos de caminhada (r = 0.45; p = 0.01). Além disso, o teste de sentar e levantar apresentou fraca correlação com o domínio qualidade de vida global (r = 0.36; p = 0.004). Conclui-se que a resistência aeróbia e força muscular de membros superiores e inferiores tem relação com o domínio físico de qualidade de vida em mulheres com doença venosa crônica

Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study

Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

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>

Úlceras flebostáticas / Phlebostatic ulcers

Las úlceras flebostáticas son las más frecuentes en los miembros inferiores y constituyen una de las complicaciones más graves de la insuficiencia venosa crónica. Se caracterizan por ser invalidantes y tener alta repercusión socioeconómica. El objetivo de este trabajo es revisar los aspectos más relevantes de la epidemiología, la clínica y del tratamiento de las úlceras flebostáticas. Para la exploración bibliográfica se realizaron búsquedas de artículos en las bases de datos informatizadas on-line Medline, Cochrane Library, artículos publicados en páginas web, revistas líderes en la publicación de estudios sobre úlceras flebostáticas, el Consenso Latinoamericano sobre Úlceras Venosas, las Guías Prácticas de la Sociedad de Cirugía Vascular y el Fórum Americano de Flebología. Las úlceras flebostáticas son las más frecuentes de los miembros inferiores, más comunes en el sexo femenino y en mayores de 60 años. Repercuten en la calidad de vida del paciente y los gastos sanitarios. No existe tratamiento único para ellas, por lo que en un paciente se usan varios tratamientos o su combinación. Las evidencias científicas apuntan hacia las terapias compresivas como de primera línea. A pesar de los avances tecnológicos realizados en el tratamiento de estas úlceras, así como la gran variedad de los mismos, donde se complementan los más modernos con los ya existentes, las úlceras flebostáticas son de difícil curación y de alta recurrencia(AU)

The phlebostatic ulcers are the most common in the lower limbs and represent the most serious complications of the chronic venous insufficiency. These ulcers are disabling and have a significant social and economic impact. The objective of this paper was to review the most outstanding aspects of the epidemiology, the clinical manifestations and the treatment of the phlebostatic ulcers. The literature search was made in Medline, Cochrane Library, articles published in different web pages, leading journals in the publication of studies about phlebostatic ulcers, Latin American Consensus on Venous Ulcers, Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. The phlebostatic ulcers are the most frequent in the lower limbs, mainly in females and in patients older than 60 years. They have an impact on the quality of life of patients and on health expenditures. There is not a unique treatment for this type of ulcers, so several therapies or a combination of them is used. The scientific evidences point to the compressive therapies as the first-line method. Despite the technological advances in the treatment of these ulcers, and their great variety, in which the already existing ones and the latest ones complement each other, these ulcers are difficult to be cured and highly recurrent(AU)

Evolución clínica y ultrasonográfica del síndrome postrombótico en su primer año de evolución / Clinical and ultrasonographic progression of posthrombotic syndrome in its first year

Introduccións: La insuficiencia venosa crónica es característica principal del síndrome postrombótico donde el estasis venoso es típico. Objetivos: Describir la evolución clínica y ultrasonográfica del síndrome postrombótico durante su primer año. Métodos: Estudio descriptivo prospectivo en 20 hombres (55,6 por ciento) y 16 mujeres (44,4 por ciento) con una edad promedio de 55,8 ± 14,2 años (IC95 por ciento : 41,6 ­ 70 años), ingresados en el Servicio de Flebolinfología del Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de trombosis venosa profunda de los miembros inferiores. Las variables estudiadas fueron: tipos de síntomas clínicos, tipo de evolución ultrasonográfica por ecodoppler, estadios clínicos del síndrome postrombótico, tiempo y porcentaje de recanalización. Resultadoss: A los seis meses de evolución predominó la sintomatología severa (47,2 por ciento); en el sector fémoro­poplíteo la clasificación de buena. Al año, fue más frecuente la clasificación de moderada (52,8 por ciento) y de muy buena en el sector poplíteo; el edema pretibial fue el signo que predominó. En los sectores ocluidos fémoro-poplíteo el porcentaje de recanalización promedio aumentó al año y fue superior (p < 0,05) al obtenido a los seis meses. Se encontró asociación significativa entre el porcentaje de recanalización y el período de evolución (X2= 41,41; p= 0,0000); y entre el estadio clínico y el porcentaje de recanalización (X2= 32,95; p= 0,0000). Conclusións: durante el primer año de presentarse el síndrome postrombótico pueden ocurrir cambios clínicos y evolución favorable en la recanalización del sistema venoso profundo(AU)

Introduction: Chronic venous insufficiency is the main characteristic of the posthrombotic syndrome where the vein stasis is typical. Objective: to describe the clinical and ultrasonographic progression of the post-thrombotic syndrome in its first year. Methods: A descriptive prospective study was conducted in 20 men (55.6 percent) and 16 women (44.4 percent), with average age of 55.8 ± 14.2 years (IC95 percent : 41.6 ­ 70 years) diagnosed as deep venous thrombosis of the lower limb patients and hospitalized in the phlebolymphology service of the National Institute of Angiology and Vascular Surgery. The studied variables were types of clinical symptoms, type of ultrasonographic progression using Echodoppler device, clinical stagings of the posthrombotic syndrome, and time and percentage of re-canalization. Results: After six months of progression, severe symptoms predominated (47.2 percent); and in the femoral-popliteal area the classification was good. After a year, the moderate classification was more frequent (52.8 percent) and extremely good in the popliteal sector; the pretibial edema was the predominant sign (50 percent). In the occluded popliteal-femoral sector, the percentage of average re-canalization increased after a year, being higher (p< 0.05) than that of six months. A significant association was found between the percentage of re-channeling and the period of progression (X2= 41.41; p= 0.0000); and between the clinical staging and the percentage of re-canalization (X2= 32.95, p= 0.0000). Conclusions: During the first year of existence of the posthrombotic syndrome, clinical changes and favorable progression may occur in the re-canalization of the deep venous system(AU)

Randomized trial of radiofrequency ablation versus conventional surgery for superficial venous insufficiency: if you don't tell, they won't know

OBJECTIVES: This study compared radiofrequency ablation versus conventional surgery in patients who had not undergone previous treatment for bilateral great saphenous vein insufficiency, with each patient serving as his own control. METHOD: This was a randomized controlled trial that included 18 patients and was carried out between November 2013 and May 2015. Each of the lower limbs of each patient was randomly assigned to undergo either radiofrequency ablation or conventional surgery. Clinical features (hyperpigmentation, hematoma, aesthetics, pain, skin burn, nerve injury, and thrombophlebitis) were evaluated at one week, one month, and six months postoperatively. Hemodynamic assessments (presence of resection or occlusion of the great saphenous vein and recurrent reflux in the sapheno-femoral junction and in the great saphenous vein) were performed at one month, six months, and 12 months postoperatively. The independent observer (a physician not involved in the original operation), patient, and duplex ultrasonographer were not made aware of the treatment done in each case. Clinicaltrials.gov: NCT02588911. RESULTS: Among the clinical variables analyzed, only the aesthetic evaluation by the physicians was significant, with radiofrequency ablation being considered better than conventional surgery (average, 0.91 points higher: standard deviation: 0.31; 95% confidence interval: -1.51, -0.30; p=0.003). However, in our study, we observed primary success rates of 80% for radiofrequency ablation and 100% for conventional surgery. CONCLUSIONS: If the physician is not required to inform the patient as to the technique being performed, the patient will not be able to identify the technique based on the signs and symptoms. Our study revealed that both techniques led to high levels of patient satisfaction, but our results favor the choice of conventional surgery over radiofrequency ablation, as patients who underwent conventional surgery had better hemodynamic assessments.

Horse chestnut – efficacy and safety in chronic venous insufficiency: an overview

ABSTRACTThe extract from horse chestnut seeds (Aesculus hippocastanumL., Sapindaceae), standardised for the content of aescin, is used as the treatment for chronic venous insufficiency. It has anti-inflammatory and anti-oedematous properties and indicates a positive effect on the venous tone, rheological properties, and blood coagulability. The mechanism of horse chestnut seed extract/aescin activity was proposed on the basis of in vitro and in vivo studies, and its effectiveness was documented with numerous randomised clinical trials. The results of the studies have proven that horse chestnut seed extract not only significantly improves subjective symptoms in patients with chronic venous insufficiency like calf spasm, leg pain, pruritus, fatigue, but it also reduced leg volume, the ankle and calf circumference. The preparations containing horse chestnut seed extract are very popular and they have similar effectiveness as compression therapy and a preparation with O-(β-hydroxyethyl)-rutosides. Moreover, horse chestnut seed extract has been proven to be safe and very well tolerated. The study was to present the results of the studies that have been conducted so far and that have confirmed the effectiveness of use of horse chestnut seed extract or aescin as the treatment for chronic venous insufficiency.

Evaluation of quality of life and photoplethysmography in patients with chronic venous insufficiency treated with foam sclerotherapy

BACKGROUND: Ultrasound-guided foam sclerotherapy plays a major role in treatment of chronic venous insufficiency, providing clinical and hemodynamic improvement to patients undergoing treatment.OBJECTIVES: To examine the relationships between venous refilling time and impact of venous disease on quality of life and between changes in venous refilling time and improvement of symptoms after ultrasound-guided foam sclerotherapy for chronic venous insufficiency. METHODS: Thirty-two patients classified as C4, C5 or C6 answered a questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy.RESULTS: Statistically significant improvements were observed in quality of life scores and in venous filling time and in the following symptoms: aching, heavy legs, restless legs, swelling, burning sensations, and throbbing (p<0.0001). A similar improvement was also seen in the work and social domains of quality of life (p<0.0001).CONCLUSIONS: As confirmed by questionnaire scores and venous refilling times, ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels and low rates of major complications.

CONTEXTO: A escleroterapia com espuma guiada por ultrassom (EGUS) ocupa lugar de destaque no tratamento da insuficiência venosa crônica (IVC), proporcionando melhora clínica e hemodinâmica aos pacientes submetidos ao tratamento.OBJETIVOS: Verificar a correlação entre dados obtidos por questionário de qualidade de vida e de sintomas com dados obtidos por fotopletismografia (FPG), antes e depois do tratamento por escleroterapia com espuma guiada por ultrassom (EGUS) da insuficiência venosa crônica (IVC). MÉTODOS: Um grupo de 32 pacientes, classificados como C4, C5 e C6, foi submetido à aplicação de questionário de qualidade de vida e sintomas, sendo aferido o tempo de enchimento venoso (TEV) por FPG antes e 45 dias depois do tratamento da IVC através de EGUS. O teste do sinal foi utilizado para análise estatística da melhora dos escores dos questionários e do TEV. O teste de McNemar foi utilizado para avaliação da melhora nos sintomas e do impacto do tratamento nas atividades laborais e sociais dos pacientes.RESULTADOS: Houve melhora nos escores dos questionários de qualidade de vida e no TEV, com significância estatística (p<0,0001). Houve melhora estatisticamente significativa nos sintomas: dor, cansaço, edema, queimação, pernas inquietas e latejamento (p<0,0001). Incremento na qualidade laboral e social após o tratamento apresentou melhora estatisticamente significativa (p<0,0001). Não ocorreram complicações maiores ou efeitos adversos nesta série.CONCLUSÕES: A EGUS mostrou-se eficaz, com alto índice de satisfação e baixas taxas de complicacões maiores, ratificada pelos escores dos questionários e pelos TEVs aferidos pela FPG.

Three-dimensional reconstruction and significance of arterial cast on chronic venous insufficiency of low extremity / 局解手术学杂志

Objective To evaluate the three-dimensional reconstruction and significance of arterial cast on chronic venous insufficiency of low extremity. Methods A set of specimen on chronic venous insufficiency of left lower extremity amputation residues was infused with epoxy resin-lead oxide through the femoral artery,and then casted. The CT data of the cast specimen was used to reconstruct 3D modal of ar-tery on chronic venous insufficiency of left lower extremity,using the volume rendering(VR) and maximum intensity projection(MIP). Re-sults The cast specimen and 3D reconstruction of chronic venous insufficiency of left lower extremity amputation residues could clearly dis-play distribution and run of lower extremity arteries,blood supply of lesion and local region embolism of small artery ( arteriole) . Conclusion The 3D modal of artery on chronic venous insufficiency of left lower extremity should provide morphological basis of exact etiology and perfect pathogenesis,also has a certain guiding significance of clinical diagnosis and treatment.

The clinical analysis between the endovenous radiofrequency treatment and the conventional surgery for lower limb chronic venous insufficiency / 重庆医学

Objective To compare the current therapeutic effects between endovenous radiofrequency treatment and conventional surgery for lower limb chronic venous insufficiency (CVI) ,and summarize operative skills and clinical value of endovenous radiofreq uency treatment on CVI .Methods Data of 45 limbs of 41 patients treated by endovenous radiofrequency treatment (endovenous ra-diofrequencytreatmentgroup)and20limbsof20patientsbytraditionalsurgery(traditionalsurgerygroup)wereanalyzedandcom-pared in terms of operation time ,postoperative pain ,postoperative hospitalized duration ,complications ,and one-year recurrence rate .Results Endovenous radiofrequency treatment group had less postoperative pain and shorter postoperarive hospitalized dura-tion than traditional surgery group(P0 .05) . The two groups had few complications and had no recurrence in one year .Conclusion As a minimally invasive treatment for vari-cose veins ,endovenous radiofrequency treatment has less trauma ,rapid recovery ,safe and effective ,and it is worthy to be recommen-ded .

Application status and evaluation of transilluminated powered phlebectomy in varicose vein surgery / 国际外科学杂志

Varicose veins is the main clinical manifestations of the chronic venous insufficiency.TIPP transilluminated powered phlebectomy,a new minimally invasive surgery,received much attention while surgical techniques aimed at treating varicose vein were constantly updated.In this article,TIPP in the varicose vein surgery is reviewed from its history,operating techniques and advantages,and TIPP's future is being prospected.

Acroangiodermatitis of mali: A rare vascular phenomenon.

Acroangiodermatitis (synonym pseudo-Kaposi sarcoma) is an unusual, benign condition which clinically presents as purple-colored patches, plaques or nodules, mostly on the extensor surfaces of lower extremities in patients with chronic venous insufficiency and arteriovenous malformations. It resembles aggressive conditions like Kaposi's sarcoma and requires histopathological examination for its diagnosis. We report two such cases of acroangiodermatitis. Histopathology of both the cases showed dilated capillaries in the dermis with extravasated red blood corpuscles (RBCs), hemosiderin deposits, and hyperplastic granulation tissue. Both were treated with oral antibiotics and topical steroids. The ulcers showed a good response within 2 months of treatment.