Pulsatile varicose veins: an uncommon presentation of a common condition / Varizes pulsáteis: uma apresentação incomum de uma condição comum

Abstract Varicose veins of the lower limbs are common. However, pulsatile varicose veins are unusual. They could be an indicator of a sinister underlying pathology, such as severe cardiac dysfunction. It is easy to miss these rare cases during clinical workup, which can result in futile treatment with potentially dangerous consequences. In this report, we describe 2 cases of pulsatile varicose veins that highlight different etiologies and management strategies for this condition.

Resumo Varizes dos membros inferiores são comuns. Entretanto, varizes pulsáteis são raras, podendo ser indicadoras de uma patologia subjacente sombria como disfunção cardíaca grave. É fácil deixar passar esses casos raros durante exames clínicos, o que pode resultar em tratamento fútil com consequências potencialmente perigosas. Neste relato, descrevemos dois casos de varizes pulsáteis que evidenciam as diferentes etiologias e estratégias de manejo para essa condição.

Várices yeyunales secundarias a trombosis de la vena mesentérica superior: una causa inusual de sangrado del intestino delgado / Jejunal varices secondary to superior mesenteric vein thrombosis: an unusual cause of bleeding from the small intestine

RESUMEN Las várices del intestino delgado, usualmente, están relacionadas con hipertensión portal. Las várices ectópicas secundarias a trombosis crónica aislada de la vena mesentérica superior son muy infrecuentes. El sangrado digestivo secundario a éstas representa un reto diagnóstico, dada la baja prevalencia y sospecha clínica, y terapéutico por la escasa evidencia científica existente con respecto a las opciones de tratamiento. Presentamos el caso de un hombre de 56 años, con sangrado digestivo secundario a várices yeyunales por trombosis crónica de la vena mesentérica superior, asociada a trombofilia; diagnosticadas mediante video cápsula endoscópica (VCE) y enterografía por tomografía (entero TC), sin posibilidades de manejo endoscópico ni radiológico dado el compromiso extenso, intervenido quirúrgicamente con éxito.

ABSTRACT Small bowel varices are usually associated with portal hypertension. Ectopic varices caused by isolated chronic superior mesenteric vein thrombosis are exceedingly rare. Gastrointestinal bleeding secondary to these represents a diagnostic challenge, given the low prevalence and clinical suspicion, and therapeutic dilemma due to the limited scientific evidence available regarding treatment options. We present the case of a 56-year-old man with gastrointestinal bleeding from jejunal varices due to chronic superior mesenteric vein thrombosis, associated with thrombophilia; diagnosed by video capsule endoscopic (VCE) and computed tomography enterography (CTE), with no possibility of endoscopic or radiological management given the extensive involvement, who underwent successful surgery.

Radiofrequency thermal ablation versus conventional saphenectomy / Ablação térmica por radiofrequência versus safenectomia convencional

Varicose veins of the lower limbs have a high prevalence worldwide. New treatment techniques have been developed with the objectives of improving patients' quality of life and reducing recovery times. OBJECTIVE: To evaluate patients with incompetent saphenous veins treated using conventional saphenectomy or radiofrequency ablation (RF), in terms of postoperative status. METHODS: From May 2012 to April 2013 146 varicose veins patients with saphenous insufficiency, 90 of whom were treated with conventional surgery (G1) and 56 with RF ablation (G2), were evaluated prospectively. RESULTS: In G1, 88.61% of patients complained of postoperative pain and needed to take analgesics, compared with 28.85% in G2 (p<0.05). Mean pain rating on an analog scale from 0 to 10 was 3.91±2.13 points for G1 and 1.76±3.01 points for G2 (p<0.05). Recovery periods ranged from 26.63±13.3 days to 18.26±19.37 days, for G1 and G2 respectively. Mean time taken to become totally asymptomatic was 66.78±60.9 days for G1 and 38.38±46.8 days for G2 (p<0.05). CONCLUSIONS: The RF treatment method caused less postoperative pain and resulted in earlier recovery, when compared to conventional saphenectomy...

As varizes dos membros inferiores têm elevada prevalência mundial e as técnicas convencionais de tratamento têm seus resultados bem definidos há décadas. O advento de novas tecnologias nos obriga a avaliar os resultados e compará-los com métodos tradicionais. OBJETIVO: Avaliar o tratamento de pacientes com varizes dos membros inferiores e insuficiência de safenas por safenectomia convencional (SF) ou ablação por radiofrequência (RF), quanto aos sintomas pós-operatórios. MATERIAIS E MÉTODOS: Entre maio/2011 e abril/2013, foram avaliados prospectivamente 146 pacientes com varizes dos membros inferiores e insuficiência de safenas, sendo 90 por SF (G1) e 56 por RF (G2). RESULTADOS: Quanto aos quesitos avaliados, o G1 evidenciou 88,61% dos pacientes com queixa de dor pós-operatória com necessidade do uso de analgésicos e o G2, 28,85% (p<0,05). A média da graduação da dor através da escala analógica - de 0 a 10 - foi de 3,91±2,13 pontos no G1 e de 1,76±3,01 pontos no G2 (p<0,05). O período de recuperação variou de 26,63±13,3 dias para o G1 e 18,26±19,37 dias para o G2. O tempo médio até tornar-se assintomático foi 66,78±60,9 dias para G1 e 38,38±46,8 dias para G2. CONCLUSÃO: A RF propiciou menor dor pós-operatória e recuperação mais precoce quando comparada à SF...

Neovascularization after surgical exposure of rat external jugular vein endothelium

PURPOSE: To investigate the neovascularization after exposure of the external jugular venous endothelium in an experimental model. METHODS: The sample was composed of 60 male rats of Wistar OUT B breed provided by animal colony of the Medicine College of Juazeiro do Norte, weighing 250 to 350g, aged 90-120 days. Randomized study in OUT B Wistar rats, open, with 60 days duration. The animals were distributed into three groups of 20 specimens and were subjected to the following: Group 1: neck incision with dissection, ligation and section of the external jugular vein. Group 2: neck incision with dissection and ligation of the external jugular vein. Group 3: cervicotomy without dissection of the external jugular vein without ligation or section. The animals were sacrificed, half of them in 30 days and the other half within 60 days. The material in block harvested from the operated site were sectioned and stained for immunohistochemistry with CD34 marker. RESULTS: Neovascularization occurred with level of significance when compared group 1 to group 3 at 30 days (p=0.0076) and the same occurred at 60 days (p=0.0001) (Newman-Keuls test). CONCLUSION: The group with exposure of the venous endothelium showed a significant increase of neovascularization when compared with other groups.

Beneficio del tratamiento endoscópico en pacientes con sangrado digestivo alto de etiología variceal atendidos en el Hospital Antonio Lenin Fonseca en el 2009 / Benefit of endoscopic treatment in patients with upper gastrointestinal bleeding of variceal etiology treated at the Hospital Antonio Lenin Fonseca in 2009

El presente estudio fue realizado en Hospital Antonio Lenin Fonseca, con el objetivo de conocer el beneficio del tratamiento endoscopico con ligaduras en pacientes con sangrado digestivo alto de etiologia variceal atendidos en el 2009. Es un estudio tipo descriptivo, I cohortes, prospectivo, longitudinal. Los datos más levantes concluyen que el grupo etáreo predominante fue el de mayor de 50 años con el 68.4% (39), siendo el sexo masculino el mas afectado en el 68.4% (39) de los casos. El 53.6% correspondió a várices esofágicas grado III y en el 47.4% al grado IV, siendo la etilogía de la cirrosis en el 63,2% (36) la etilica. El 19.05% (4) reingresaron por sangrado de etiología variceal, y de éstos un caso estusvo asociado a encefalopatía hepática lo que contribuyo a una mayor estancia hospitalaria. Todos los pacientes recibieron tratamiento coadyuvante con betabloqueantes. En el período en estudio no se registraron muertes por sangrado de etiología variceal...

Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? / Deve-se evitar a flebo-extração completa até o tornozelo no tratamento das varizes primárias por insuficiência da veia safena magna?

PURPOSE: The most preferred method for the treatment of primary varicose veins due to greater saphenous vein (GSV) insufficiency is saphenofemoral high ligation and thigh stripping of the GSV, and ambulatory phlebectomy. Stripping is usually ended at the knee level to prevent nerve injury in the calf. However, different surgical modalities may be used depending on the surgeon's choice and experience. METHODS: We present the results of complete stripping of the GSV to the ankle and ambulatory phlebectomies performed by a single surgeon. Ninety-six patients (102 limbs) who underwent standardized surgical procedure were participated in this study. Median follow-up time was 3.4 years. RESULTS: All complaints due to varicose veins were resolved in all extremities. Some temporary complications observed were resolved fully during follow-up. Permanent paresthesia which was the most important complication was found only in two patients (2 percent). No recurrence was observed. CONCLUSION: The risk of saphenous nerve injury in the calf should not to be considered a reason to avoid complete stripping of the GSV to the ankle. If it is applied carefully and with appropriate technique, complete stripping still seems to be a good treatment option.

OBJETIVO: O método de escolha para o tratamento das varizes primárias devido a insuficiência da veia safena magna (VSM) é a ligagura safenofemoral e a fleboextração em coxa e a flebectomia ambulatorial. A fleboextração é geralmente feita ao nível do joelho para prevenir a lesão neurológica no tornozelo. Diferentes modalidades operatórias, no entanto, podem ser utilizadas dependendo da escolha e da experiência do cirurgião. MÉTODOS: Apresentamos os resultados da fleboextração completa da VSM até o tornozelo e flebectomias ambulatoriais realizadas por um único cirurgião. Noventa e seis pacientes (102 membros) que foram submetidos a procedimento cirúrgico padrão participaram deste estudo. A mediana do tempo de seguimento foi 3,4 anos. RESULTADOS: Todas as queixas devido a varizes foram resolvidas em todos os pacientes. Algumas complicações temporárias observadas foram resolvidas totalmente durante o tempo de seguimento. Parestesia permanente que foi a complicação mais grave ocorreu apenas em dois pacientes (2 por cento). Não observamos recurrência. CONCLUSÃO: O risco da lesão do nervo safeno no tornozelo não deve ser considerada uma razão para evitar-se a fleboextração completa da VSM até o tornozelo. Se é aplicada cuidadosamente e com a técnica apropriada, fleboextração ainda parece ser uma boa opção de tratamento.

Terapia alternativa para microvarizes e telangiectasias com uso de agulha / Alternative therapy for microvarices and telangiectasias with use of needle

Contexto: O desenvolvimento de terapia alternativa à convencional para a destruição de microvarizes e telangiectasias sem o uso de produtos químicos tem como objetivo reduzir os efeitos colaterais, faz uso de agulha para lise mecânica dos vasos e tem como modelo experimental galinhas da linhagem Lohmann Brown. Objetivo: Elaborar uma nova técnica, desenvolvendo um tratamento alternativo, sem uso de produtos químicos, objetivando a redução dos efeitos colaterais. Métodos: Foram utilizadas 30 galinhas Lohmann Brown, sendo que 15 foram submetidos ao método convencional do tratamento de microvarizes e telangiectasias (grupo controle) e as outras 15 receberam o tratamento experimental proposto (grupo experimental). O grupo experimental foi tratado com agulha de lise vascular, percorrendo todo o trajeto dos vasos escolhidos em punções escalonadas até que todo o vaso ser atingido. O grupo-controle foi tratado com o oleato de monoetanolamina e glicose a 50 por cento puncionando-se o vaso com agulha 13 x 3 mm e injetando se, em média, 0,3 mL da solução de cada vaso. Resultados: Dos 50 vasos tratados no grupo experimental, dois apresentaram recidiva total, cinco apresentaram recidiva parcial, e 43 apresentaram destruição (lise) satisfatória, enquanto que, no grupo grupo-controle, dos 51 vasos tratados, quatro apresentaram recidiva total, 12 recidiva parcial, 22, destruição satisfatória, e em 13 ocorreu endurecimento de trajeto. Conclusão: O presente estudo demonstrou que o método experimental proposto, com uso de agulha de lise vascular, possuir mais eficiência no tratamento de microvarizes se comparado com o método convencional, devido à redução das recidivas e à ausência de hipercromia de trajeto endurecido.

Recurrent Lower Gastrointestinal Bleeding from Congenital Arteriovenous Malformation in the Terminal Ileum Mimicking Intestinal Varicosis: A Case Report

We report on an exceptional vascular cause of gastrointestinal hemorrhage. A 30-yr-old man was admitted because of recurrent hematochezia. Colonoscopy showed circumferential, erythematous, and nodular vascular distensions with hematocystic spots in the terminal ileum resembling varicosis and subsequent computed tomography with 3-dimensional angiographic reconstruction revealed a vascular architecture around the terminal ileum. No other potential source of bleeding was identified. The patient was treated by ileocecectomy and the final diagnosis was of an arteriovenous malformation confined to the terminal ileum. He has been followedup without a further hemorrhagic episode.

Laparoscopic control of spontaneous external hemorrhage from umbilical varix.

Spontaneous external hemorrhage from an umbilical varix is rare. We describe a 40-year-old man with cirrhosis and portal hypertension, who presented with recurrent external bleeding from an umbilical varix. The first episode was controlled by transfixation of the vein under local anesthesia. Contrast-enhanced CT scan demonstrated a hugely distended recanalized umbilical vein arising from the left branch of the portal vein and ending in the umbilical cicatrix. Recurrent bleeding necessitated laparoscopy and in-situ clipping of the bleeding vein in the falciform ligament. At six months' follow up the patient has no further bleeding.

Preminary report: initial experience of endovascular laser therapy for varicose veins due to greater saphenous vein incompetence in Thailand.

BACKGROUND: Surgical venous stripping (SVS) is a standard treatment for varicose veins (VV) due to greater saphenous vein incompetence (GSVI) but there are some disadvantages to and risks. Endovascular laser (EVL) has been introduced to overcome these disadvantages. The present study was designed to determine the effectiveness of EVL treatment for these patients. MATERIAL AND METHOD: The patients with VV due to GSVI diagnosed by duplex scan were recruited in the present study. The EVL-procedure was percutaneously approached guiding by ultrasound under monitor anesthetic care (MAC). Postoperative clinical and imaging assessment was assessed. RESULTS: There were 17 limbs with symptomatic VVs in 11 patients. Two patients were admitted for a reason not related to surgery. The others were day cases. There was no postoperative complication except a large echymosis in one case. At 3-month follow-up, no recanalization or recurrence was detected. CONCLUSION: The authors' early results demonstrated that EVL could obliterate VVs due to GSVI and further showed some benefits over SVS. More studies with a longer period of follow-up are needed to further confirm the efficacy of EVL.

Bleeding duodenal varix in splenic vein thrombosis and chronic pancreatitis.

Isolated duodenal varix is rare. We report a patient with bleeding duodenal varix with splenic vein thrombosis due to chronic pancreatitis.

Proptose intermitente associada a sinus pericranii: diagnóstico diferencial de varizes orbitrárias / Intermitent proptosis associated with sinus pericranii: diferential diagnosis of orbital varices

Um caso de Sinus Pericranii associado a uma malformação do seio sagital superior, na qual o lobo frontal apresenta sua drenagem venosa para o exterior do crânio através do próprio Sinus Pericranii, originando varizes orbitárias. O diagnóstico preciso foi obtido pelo estudo angiográfico e o tratamento foi conservador devido ao risco cirúrgico. Foi feita uma breve revisão da literatura sobre Sinus Pericranii.

prevalence of varicose veins among male workers in an engineering factory Iraq

A cross-sectional survey was conducted on 1098 male employees who had five or more years of employment in an engineering factory. The prevalence rate [PR] of varicose veins [vv] was 7.2% the highest PR of VV [17.6%] was in the age group 40-49 years and among workers employed for more than 20 years [14.3%]. This condition was also more prevalent among married workers [10.14%] and among office workers [11.0%]. A statistically significant association [P < 0.005] was found between increased body mass index [BMI] and VV. Weight reduction programs were recommended

Value of clinical evaluation and pressure study in diagnosis of varicose veins

Varicose veins of the lower extremities are one of the most important disorders of the peripheral vascular diseases. Pressure study was performed on 72 patients [43 females and 29 males]. The pressure was measured before and after exercise, before treatment and after treatment. The venous pressure and venous refill time was recorded. From this research, it was found that the pressure recording can diagnose the type of the disease but cannot tell the site of the lesion, so it cannot take the place of venography completely. However, with the aid of clinical examination and simple tourniquet tests, results equal to venography can be reached