Clinical value of color Doppler ultrasound in the diagnosis of lower extremity varicosis of great saphenous vein in patients with deep vein structure and hemodynamic status / 中国基层医药

Objective To investigate the clinical value of color Doppler ultrasound in the diagnosis of lower extremity varicosis of great saphenous vein in patients with deep vein structure and hemodynamic status.Methods 79 patients with 96 deep lower extremity varicosis were detected deep venous wall and valve echo,lumen morphology,reflux time,reflux velocity and spectrum Doppler imaging by using color Doppler ultrasound,and the results were compared with intravenous X-line angiography,while the patients with normal deep vein were selected as the control group.Results Color Doppler ultrasonography compared with angiography,the completely normal diagnostic accuracy of deep vein was 98.3％,the diagnosis accuracy of simple deep venous valve insufficiency was 91.7％,the diagnostic accuracy of sequela of deep vein thrombosis was 100.0％,the diagnosis accuracy of arteriovenous fistula was 100.0％.The sonographic appearance of 60 deep veins was similar to those of the control group.In the stripping surgery of 60 great saphenous vein,there was no postoperative lower limb swelling,review of ultrasound had no deep venous reflux phenomenon.96 suffered limbs were measured in different parts,different levels of venous reflux.The reflux time of superficial femoral vein valve was the longest,which was (5.92 ± 1.83) s,the reflux rate was (50.28 ± 19.48) cm/s,and the lower leg traffic vein reflux time was the shortest,which was (2.37 ± 1.92) s,the reflux rate was (27.92 ± 17.28) cm/s.Conclusion Color Doppler ultrasound has important clinical value for the evaluation of lower extremity varicosis of great saphenous vein in patients with deep vein structure and blood flow.

Endovenous laser obliteration versus traditional surgical ligation for the treatment of varicosis of lower extremity: a comparative study / 介入放射学杂志

Objective To compare the effectiveness and the influence on life quality of endovenous laser obliteration with those of traditional surgical ligation in treating varicosis of lower extremity.Methods By using numerical random grouping method,40 patients with varicosis of lower extremity were divided into traditional surgical ligation group (high ligation plus stripping,traditional group,n=20) and endovenous laser obliteration group (laser group,n=20).The curative effect and complications were compared between the two groups.According to the brief health survey (SF-36) scale,the influences of the two treatments on the life quality were evaluated.Results During the follow-up period,the differences in the curative effect and complications between two groups were not significant (P＞0.05).The life quality assessed by SF-36 scores in the laser group was better than that in the traditional group,the difference between the two groups was statistically significant (P＜0.05).Conclusion For the treatment of varicosis of lower extremity,endovenous laser obliteration is safe and effective,it carries less influence on the patient's life quality when compared with traditional surgical ligation therapy.

Foam sclerotherapy of lauromacrogol for the treatment of lower extremity varicose veins：comparison study of two different injection ways Z / 介入放射学杂志

Objective To compare the clinical efficacy of two different injection ways in treating lower extremity varicose veins with foam sclerotherapy of lauromacrogol. Methods During the period from Dec. 2010 to Dec. 2012 a total of 80 patients with clinically-proved lower extremity varicosis were admitted to authors’ hospital. The patients were randomly and equally divided into two groups:anterograde group (n=40) and retrograde group (n=40). For patients of anterograde group, under fluoroscopy guidance the needle was directly punctured into the distal end of the varicose vein with subsequent injection of 1%lauromacrogol foam sclerosing agent, while for patients of retrograde group the opposite femoral vein was punctured by using Seldinger technique, then a catheter was inserted into the proximal part of the great saphenous vein of the diseased side, and 1%lauromacrogol foam sclerosing agent was injected into the varicose vein. The operation time, recovery time, the dosage of the sclerosing agent used, the incidence of complications and the use of additional treatment were recorded, and the results were statistically analyzed. All the patients were followed up for 3 - 6 months. Results No significant difference in the overall effective rate existed between the two groups at 3-6 months after the treatment (P>0.05). The preoperative and postoperative CEAP scores of the anterograde group were 3.70 ± 0.63 and 0.88 ± 1.18 respectively, while the preoperative and postoperative CEAP scores of the retrograde group were 3.73 ± 0.59 and 0.88 ± 1.27 respectively. The difference in CEAP score between preoperative values and postoperative ones was statistically significant in both anterograde group and retrograde group (P < 0.05). Besides, the differences in the operation time, recovery time, the dosage of the sclerosing agent used, the incidence of complications and the use of additional treatment between the two groups were also statistically significant. Conclusion In treating lower extremity varicose veins with foam sclerotherapy of lauromacrogol, the overall effectiveness of anterograde injection and retrograde injection is quite the same. As each injection way has its own advantages and disadvantages, the therapeutic scheme should be individualized for each patient.

Management of grade Ⅳ portal vein thrombosis in liver transplantation (report of 6 cases) / 中华器官移植杂志

Objective To investigate the methods for reconstructing portal vein in liver transplantation patients with grade Ⅳ portal vein thrombosis.Methods Clinical data of 6 patients with grade Ⅳ portal vein thrombosis who underwent liver transplantations were analyzed retrospectively.Different portal vein reconstructing approaches were applied: 4 patients underwent portal vein anastomosis with internal organ varicosis vein (group A),and 2 patients underwent portal vein arterialization (group B). Portal venous flow was monitored by intraoperative ultrasound and postoperative liver function was tested periodically during follow-up.Results In group A,one patient died of celiac infection 2 months post-transplantation.The remaining three patients were followed up for 14-17 months,and their portal veins remained smooth without thrombosis and with mitigated esophageal varicosity.In group B,one patient,with recurrent upper gastrointestinal bleeding,died of celiac infection 47 days after liver transplantation.The patient was followed up for 33 months with satisfactory liver and kidney functions although stomach esophagus varicosity was aggravated.Portal vein blood flow in groups A and B was 1258 ± 345 and 2275 ± 247 ml/min respectively after anastomosis by intraoperative color Dopplar ultrasound monitoring. Aspertate aminotransferase (AST) in group B was significantly lower on the fourth day after liver transplantation,and alanine aminotransferase (ALT) in group B was significantly lower on the 3rd,4th,5th and 6th day after liver transplantation than in group A (all P＜0.05).Serum total bilirubin (TBIL) had no statistically significant difference during the 10 days post-operation (P＞0.05).Conclusion Patients with grade Ⅳ portal vein thrombosis may achieve a satisfactory clinical effect by reconstructing portal vein through anastomosis of donor portal vein with internal organ? varicosis vein.PVA may be associated with early recovery of graft function and may be an effective remedial measure for patients with grade Ⅳ portal vein thrombosis who undergo liver transplantation.

Congenital Angiodysplasia in a Woman Presenting with Idiopathic Jejunal Varicosis on Angiography

Angiography is a useful diagnostic tool in cases with massive gastrointestinal bleeding such as angiodysplasia and varicosis when endoscopy is not available. Angiodysplasia and varicosis have distinguishable characteristic features on angiography, such as the presence of a nidus, visible late-draining veins, and the typical vascular tuft. We recently treated a rare case of congenital angiodysplasia without the characteristic angiodysplasia features on angiography. Instead, the patient presented with a very rare case of idiopathic jejunal varicosis. A 42-year-old woman visited the emergency room with the chief complaint of melena for three days and a hemoglobin level of 5.9 g/dL. An abdominal CT angiogram showed varicosis at the jejunal mesentery. Angiography of the superior and inferior mesenteric arteries showed tortuous and dilated jejunal and ileal branches during the venous phase, suggesting a vascular malformation such as varicosis of the jejunum. Surgical exploration with intraoperative endoscopy revealed diffuse engorged veins and a 1.0-cm-diameter superficial ulcer covered with a blood clot that was 70 cm from the ligament of Treitz. A 100-cm segment of jejunum was resected. Histological examination revealed that the lesion was angiodysplasia, not varicosis. The final diagnosis was congenital angiodysplasia.

Tarsal Tunnel Syndrome secondary to the Varicosis of Posterior Tibial Vein (Two Cases Report) / 대한족부족관절학회지

Tarsal tunnel syndrome is a complex of symptoms resulting from the compression of the posterior tibial nerve or its branches. Many studies have done on etiologic agents. We reported two cases of tarsal tunnel syndrome secondary to the varicosis of posterior tibial vein. Symptoms were relieved after excision of the varicosis, neurolysis and reposition of posterior tibial nerve.

Selective mini-incision procedure for the treatment of superficial varicosis of lower limbs / 中国微创外科杂志

Objective To evaluate the feasibility and clinical efficacy of selective mini-incision procedure for superficial varicose veins of lower extremities. Methods A total of 89 patients with local superficial varicose veins (101 veins) treated in this hospital from January 1998 to July 2003 entered the study.Stetho-Doppler and finger pressure examination were performed preoperatively in all the patients to locate the malfunctioned venous valves.Ligation of communicating veins combined with saphenectomy was carried out by way of mini-incision under local anesthesia. Results The sutured wounds in all the patients healed by first intention.Out of 36 limbs with swelling and heaviness,symptoms disappeared in 29 limbs and relieved in 7 limbs.Localized subcutaneous hematoma beneath the incision occurred in 3 patients,but no skin numbness or other complications took place.Follow-up ranged from 1 month to 5 years [(30 2?18 8)months] and 65 patients were followed for more than 1 year.No recurrence of superficial varicosis of lower limbs was seen. Conclusions Selective mini-incision procedure for the treatment of varicose vein of lower extremities is feasible,simple,safe and effective.

Splenectomy combined with endoscopic varices ligation for the treatment of portal hypertension / 中国微创外科杂志

Objective To Study the effect of splenectomy plus endoscopic varices ligation (SEVL) in the treatment of portal hypertension. Methods SEVL was carried out in 38 patients with portal hypertension from January 2000 to June 2002. The authors compared hemodynamic parameters and gastric emptying time before and after the operation. The incidence of upper gastrointestinal bleeding, the disappearance rate of esophageal varicosis, the outcomes of portal hypertensive gastropathy (PHG) and the incidence of complications were recorded at postoperative 3 weeks, 6 months, 12 and 18 months, respectively. Results Postoperatively, the free portal pressure, portal flow volume and velocity were significantly reduced in all the cases ( P 0.05). Portal thrombosis was seen in 6 cases (6/38, 15.8%). Conclusions SEVL has little influence on gastric emptying and PHG, offering a high disappearance rate of varicosis and a low incidence of complications.

Comparison of Holmium Laser and Traditional Surgery for Varicosis of the Lower Limbs / 中国微创外科杂志

Objective To compare the efficacy of holmium laser and traditional surgery for the treatment of varicosis of the lower limbs.Methods From March 2005 to December 2006,226 patients with varicosis of the lower limbs(274 limbs)were treated using holmium laser(laser group,120 patients with 148 diseased limbs)or high ligation and stripping of the great saphenous vein(traditional group,106 patients with 126 diseased limbs).Results The mean operation time of the laser group was significantly shorter than that in the traditional group [(38.0?10.8)min vs(61.5?12.3)min,t=-15.294,P=0.000].None of the patients in the laser group need analgetics after the operation,while 58 patients in the traditional group received the drug after the surgery(0 vs 54.7%,?2=88.329,P=0.000).The patients in the laser group returned to activities earlier and had shorter postoperative hospital stay than those in the traditional group [(6.2?0.8)h and(3.0?0.5)d vs(22.5?1.5)h and(8.5?2.5)d;t=-105.034,P=0.000 and t=-23.632,P=0.000,respectively].The rates of complications and 1-year recurrence were similar in the two groups [16.9%(25/148)vs 18.3%(23/126),?2=0.087,P=0.768 and 3.8%(3/78)vs 3.1%(2/65),?2=0.000,P=1.000].Conclusions Holmium laser has advantages of shorter operation time and hospital stay,fewer surgical incisions,milder postoperative pain,and earlier return to activities.Closure of the great saphenous vein is the key to ensure the effect of laser therapy.High ligation of the great saphenous vein should be done simultaneously if necessary.

Minimally invasive surgery for low extremity varicosis complicated with chronic ulcers / 中国微创外科杂志

Objective To study the minimally invasive surgical treatment for lower extremity varicosis complicated with chronic ulcers. Methods The authors reviewed 58 patients with low extremity varicosis complicated with chronic ulcers characterized by the CEAP (clinical, etiologic, anatomic, pathophysiologic) classification by using duplex ultrasonography. After the location of the perforating veins producing ulcers was marked, minimally invasive operations under local anesthesia were performed. Results Postoperatively, the ulcers healed in 1 month in 49 patients whose lesion surfaces were smaller than 3 cm ? 3 cm and completely cleared up in 2 months in the rest of 9 patients who had relatively larger ulcers. Follow-up observations for 0.5~1.5 years found remarkable improvement of skin color and elasticity in patients with severe cutaneous hyperpigmentation and lipodermatosclerosis. No recurrence was seen. Conclusions Both valvular insufficiency of the great or less saphenous vein and the perforating venous incompetence should be treated simultaneously in patients with lower extremity varicosis complicated with chronic ulcers.

Physical Therapy Improves Venous Haemodynamics in Cases of Primary Varicosity: Results of a controlled study / 日本温泉気候物理医学会雑誌

Physical factors are known to influence haemodynamics in the veins of the lower extremities. In a controlled randomized study we investigated the effects of combined physical therapy on varicose veins.<br>Over a 24-wk period a treatment group consisting of 12 persons exercised under the activation by means of externally applied compression and cold temperature stimuli (i. e. thermosteresis). They also exercised once a day without supervision for 15min. During the same period a control group of 12 persons underwent the same measurements but no treatment. At baseline and in wk 24 the following measurements were made under standardarized conditions: venous capacity (ml/100ml of tissue) using a strain gauge plethysmograph (Periquant 3800^R, Gutman Eurasburg, FRG); and refilling time of subcutaneous veins emptied by activation of the ankle joint pump using a photoplethysmograph (Cardiopluse Analyzer^R, Fritac Zurich).<br>In the treatment group venous capacity decreased by an average of 16% from 4.9±0.3 (sd) ml/100ml tissue to 4.1±0.4 (p<0.005, U-test) while in the control group it remained practically unchanged at 4.8±0.4 vs. 5.0±0.3 Venous refilling time in the lower extremities also increased in the treatment group, half refilling rising from 7.8±1.0 to 11.3±0.9 sec (p<0.001) and total refilling time from 17.1±1.4 to 25.7±2.1 (p<0.001); these parameters remained virtually unchanged in the control group, with half refilling time dropping slightly from 7.7±1.1 to 7.1±1.3 and total refilling time from 18.3±1.7 to 16.3±1.9.<br>Patient self-rating scores obtained using a standardized questionnaire administered at baseline and at the end of wk 24 improved in the treatment group only.<br>The combined physical therapy was thus shown to be of long-term therapeutic value.<br>They improved venous function and reduced patients' symptoms. Our findings indicate that for the further development of this combined treatment regimen it would be useful to identify the individual factors contributing to its efficacy and evaluate them separately.

Subfascial endoscopic perforator surgery for the treatment of recurrent venous ulcer / 中国普通外科杂志

Objective To evaluate the effect of subfascial endoscopic perforator surgery(SEPS) for the(treatment) of recurrent venous ulcer.Methods SEPS Was preformed on 56 limbs with recurrent venous(ulcer),and ulcer healing was assessed at follow up.Results Fifty-five limb ulcers healed in 10～49 days,one limb ulcer was not healed after 90 days,but healed after ligation of lesser saphenous vein.The patients were followed up for 1 to 3 years,1 case recurred after 6 months and it healed with antibiotic treatment;2 cases recurred after 18 months,and both healed after high ligation of lesser saphenous vein.Conclusions SEPS is effective and safe in the treatment of recurrent venous ulcer.SEPS is minitraumatic with few(complications).

STUDY OF LOCAL INJECTION WITH UREA FOR VARICOSIS OF LOWER EXTRIMITY / 中国普通外科杂志

From 1988 to 1995, 148 patients with varicosis of lower extremity were treated by local i-jection with 40% urea. The results were good. The mechanism of urea injection for treating the varicosis of lower extreatment was discussed.The urea therapy is one of better methods for the varicosis of lower extremity.

Varicose veins in Siriraj Hospital: A study of 904 out–patients cases.

A clinical study of varicose veins in Thais was carried out in 904 patients diagnosed with varicosis in outpatient clinic, Siriraj Hospital, over a 3-year period from 1982-1984, using carefully clinical examination. 1. The incidence of varicose veins in outpatient clinical was a ratio of 2 per thousand and in hospital treated cases was a ratio of 3 per thousand. 2. The apparently higher prevalence in women especially with one or more children was noted. 3. Attempted analysis of occupations in varicose vein cases has shown that the incidence in occupations which involved prolonged standing and walking was twice that of sedentary jobs. 4. Evidence of deep vein thrombosis and active venous ulcer were found in 0.2% and 1.2% of the patients in this study.