Development of chronic venous disease.

INTRODUCTION: Chronic venous disease is known to gradually worsen in the course of years. However, little clinical data is available. The patient group and methods: We used the set of our patients with completed clinical examination, duplex sonography and photoplethysmography and selected 160 patients examined at our office after 10 and more years. Females represented 79% in the group. The mean age was 54 years (range 18-82 years). Venous varices in lower limbs in the family were reported by 49% patients. Venous sclerotization had been undergone by 6.3% and venous surgery by 10.6% patients. The mean body mass index was 27. We used CEAP classification. The clinical class C1 included 50 patients, C2 included 81, C3 included 15 and C4 included 14 patients. Regurgitation in superficial veins was found in 43%. The mean venous return time after physical activity was 24.5 s. RESULTS: The last examination was performed after 13 years on average (range 10-28 years). Deterioration of the clinical condition and progression to a higher class were observed in 36% patients in class C1, in 23.5% patients in C2, in 13% patients in C3 and in 7% patients in C4. We did not demonstrate any statistically significant effect of the followed parameters on the progression of the disease. CONCLUSION: The progression rate of the disease in our patient group followed at the vascular office for 10 and more years is lower compared to population studies.

Does the time from symptoms onset to treatment impact further development of vein thrombosis in the leg?

INTRODUCTION: It is unknown how many days pass from the symptom onset to anticoagulation therapy of vein thrombosis (VT) in the leg in our country and whether this time has an impact on further development of the disease. METHODS: Among patients treated at our department in recent years for deep vein thrombosis in the leg, we selected 50 patients with the required data available. In each case the diagnosis was confirmed by duplex sonography. The mean age was 51 years and the group included 31 males and 19 females. Proximal VT was found in 72 % of the patients. Idiopathic VT was found in 38 % of the patients. The patients were followed for 3-6 months. RESULTS: The mean time to initiation of VT therapy was 10 days, range 1-42 days, median 7 days. Two thirds of the patients were treated with novel oral anticoagulants. Residual VT (incomplete recanalization) was present after 1-2 months of the therapy in 40.9 %, and after 3-6 months in 25 % of the patients. The positive relationship between the time to treatment and residual VT was significant both after 1-2 months of therapy (p < 0.05) and after 3-6 months of therapy (p < 0.01). CONCLUSION: The time to VT treatment is clearly longer in our country compared to other countries. Delayed onset of treatment reduces the success rate of the therapy as assessed by an increased risk of residual thrombosis in the affected veins in subsequent months. Key words: delayed diagnosis - residual vein thrombosis - vein thrombosis.

[Does body height affect the severity of chronic venous disease in lower extremities?]. / Má telesná výska vliv na závaznost chronického zilního onemocnení na dolních koncetinách?

INTRODUCTION: The effect of obesity on chronic venous disease has been known. The effect of body height has not been studied until now, although venous pressure is clearly influenced by hydrostatic pressure in the vertical position. METHODS: We have examined 1026 lower extremities in 124 men and 392 women with suspected chronic venous disease. Their clinical condition was evaluated using CEAP classification. Duplex sonography was used to exclude deep venous occlusion and to evaluate any present reflux. Venous functions were evaluated based on venous pump performance during exercise and according to venous refilling time. RESULTS: We confirmed the known, statistically highly significant relationship between age and weight, and severity of clinical condition and presence of reflux. We provided evidence of significant relationships between the clinical condition and plethysmographic parameters. We did not demonstrate a statistically significant relationship between body weight and clinical condition, venous refilling time after exercise and presence of reflux, and only a weak relationship with respect to the performance of venous muscle pump in the right lower extremities. CONCLUSION: We did not demonstrate an effect of body height on the severity of chronic venous disease.

Popliteal vein compression with the limb extended.

BACKGROUND: The aim of this study was to assess the haemodynamic significance of popliteal vein compression by full knee extension. PATIENTS AND METHODS: We examined patients without a history of previous deep vein thrombosis with the knee slightly flexed and then fully extended. The popliteal vein diameters and venous pressures in 61 subjects (116 limbs) were examined using duplex ultrasonography and photoplethysmography. The venous outflow in 50 patients was assessed using photoplethysmography. RESULTS: The diameter of the popliteal vein in semiflexion was 7.7 (+ 1,5) mm, in extension it was reduced to 4.3 (+ 1,7) mm (p < 0.001). Venous pressure in the big toe rose from 12.3 (+ 6,1) mmHg to 15.5 (+ 7,4) (p < 0.001). We have demonstrated the reduction of maximum venous outflow in 50 patients from 65.8 (+ 24) %/min to 60.1 (+ 23) %/min (p < 0.01) immediately after loosening the 2-minute venous occlusion, as well as outflow reduction during subsequent seconds. CONCLUSIONS: Our results provide evidence of haemodynamically significant popliteal vein compression in full extension of the limb. Clinically, the compression may play a role as a risk factor for venous thrombosis in immobilized patients, particularly during operations.

The inverse association of elevated serum bilirubin levels with subclinical carotid atherosclerosis.

BACKGROUND: Serum bilirubin is negatively associated with the development of coronary heart disease. In the present study, we have focused on the analysis of intima-media thickness (IMT) of the common carotid artery in hyper- and normobilirubinemic subjects. METHODS: The study was performed on 111 men without manifested atherosclerosis. In all subjects, complete biochemical tests were determined along with the examination of IMT by carotid ultrasound. RESULTS: The mean IMT in hyperbilirubinemic subjects as compared with controls was substantially lower (p=0.017), and hyperbilirubinemic men also had very low age-adjusted prevalence odds ratios for having IMT above the 50th percentiles of controls, even after adjustment for selected vascular risk factors (p=0.034). CONCLUSIONS: In the present study, we demonstrate the inverse relationship between serum bilirubin and IMT in healthy men.

Recurrent peripheral arterial embolism from metastatic lung choriocarcinoma--a case report.

A patient with choriocarcinoma, most likely of ovarian origin, with lung metastasis is presented. The disease manifested itself by recurrent embolism into the peripheral arteries. Literature on this topic is reviewed.

Intima-media thickness of the common carotid artery is the significant predictor of angiographically proven coronary artery disease.

BACKGROUND: Previous studies have shown a relationship between intima-media thickness (IMT) of the common carotid artery and coronary artery disease (CAD). The role of IMT in the prediction of significant CAD has not been established. OBJECTIVES: To investigate the diagnostic accuracy of IMT measurement and the detection of carotid plaques in relation to cardiovascular risk factors in the prediction of significant CAD. PATIENTS AND METHODS: One hundred and seventy patients (121 men and 49 women; average age 58 +/- 11 years) undergoing selective coronary angiography were examined by carotid ultrasound. IMT was measured. Plasma lipid concentrations and other risk factors were determined. RESULTS: Angiographically proven significant CAD was found in 138 (81%) of all patients. Carotid plaques were detected in 98 (58%) of all patients. Presence of carotid plaques in common carotid artery (P<0.001) and male sex (P<0.005) were found to be categorical risk factors for significant CAD but in multiple regression analysis only age (P=0.15), IMT (P<0.01), high density lipoprotein (HDL) cholesterol (P=0.02) and, less significantly, total cholesterol (P=0.09) were found to be independent parameters for the prediction of significant CAD. IMT of 0.75 mm was determined as a cut-off point for the detection of significant CAD (sensitivity 78%, specificity 79%, positive predictive value 95%, negative predictive value 41%, odds ratio 12.9, 95% CI 3.5 to 47.6). CONCLUSION: The increase in IMT is the significant positive predictor of angiographically proven CAD; other predictors are high age, low HDL cholesterol and, less significantly, high total cholesterol. Presence of carotid plaques and male sex do not add any new information for the prediction of CAD once the predictors are considered.

The ankle-brachial blood pressure index as a risk indicator of generalized atherosclerosis.

Contemporary methods of assessment of possible cardiovascular disease based on traditional risk factors are not perfect. Therefore new ways are sought. Simple and inexpensive methods include assessment of the blood pressure on the lower extremities above the ankles. The finding of a reduced ratio of the ankle-brachial blood pressure index (ABI) indicates atherosclerosis of the lower extremity arteries. ABI values of 0.9 or less are associated with a significantly increased risk of cardiovascular diseases (in particular myocardial infarction and stroke) that is independent of other risk factors. ABI assessment is a simple clinical examination and should be performed in middle-aged and elderly subjects with a medium and high cardiovascular risk in order to define more accurately their health status. Patients with reduced ABI of 0.9 or less are candidates for secondary preventive treatment for cardiovascular disease.