Epidemiological study on chronic venous disease in Belgium and Luxembourg: prevalence, risk factors, and symptomatology.

OBJECTIVE: This epidemiological study measured the prevalence of chronic venous disease (CVD) in Belgium and Luxembourg. Possible risk factors and the symptomatology were evaluated. MATERIAL AND METHODS: A survey was carried out in Belgium and Luxembourg between May and September 2013. Patient recruitment was carried out by 406 general practitioners (GPs). Each GP screened 10-20 consecutive patients older than 18 years, and in total 6009 patients were included. Patient characteristics, prevalence of risk factors, symptomatology, and C-classification were noted. The GPs diagnosed CVD and measured the need for treatment. Patients with diagnosed CVD completed a questionnaire about their history of leg problems and a quality of life score (CIVIQ-14). These data were converted into a CIVIQ Global Index Score (GIS). RESULTS: The mean age of the patients was 53.4 years, and they were predominantly female (67.5%). Among the 3889 symptomatic patients, heavy legs, pain, and sensation of leg swelling were the most common complaints. Among the included patients, 61.3% of patients were classified within C1-C6; however, only 45.9% of these patients were considered by the GPs to be suffering CVD. Treatment was offered to 49.5% of patients. Age and female gender correlate with a higher C-class (p < .001). Patients with a higher C-class (C3-C6) have significantly more pain, sensation of swelling and burning, night cramps, itching, and the sensation of "pins and needles" in the legs. Patients taking regular exercise and without a family history had a lower C-class. Higher BMI, age, female gender, family history, history of thrombophlebitis, and a higher C-class correlated with a lower GIS (p < .001). Of the patients with CVD, 10.4% had lost days of work because of their venous leg problems. CONCLUSION: CVD is a very common disease, which is underestimated. The prevalence increases with age, generates incapacity to work, and worsens the patients' quality of life.

Treatment of chronic venous disease with flavonoids: recommendations for treatment and further studies.

OBJECTIVES: A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used. METHOD: A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment. The discussion was based on a literature search in the current databases. The goals of this paper are recommendations for further studies on the use of flavonoids in the treatment of CVD. RESULTS: There is good evidence to recommend the use of flavonoids in the treatment of CVD. However, because of the poor quality of some older clinical trials, inadequate reporting, and insufficient information, much work is still needed to firmly establish their clinical efficacy and to determine when and how they should be employed. In particular, long-term randomized, placebo-controlled, double-blind studies are needed to establish the efficacy and safety of flavonoids. Additional studies are also needed to establish their mechanism of action, pharmacokinetics, toxicity, and cost-effectiveness. CONCLUSIONS: Aside from good evidence for the use of flavonoids in CVD further studies are indicated to establish long term treatment in this indication.

The surgical history of the amputated limb according to the indication for revascularization: diabetic foot, acute ischaemia, aneurysmal disease, chronic arterial occlusive disease.

BACKGROUND: To investigate whether the indication for the first revascularization (diabetic foot, acute ischaemia, aneurysmal disease, chronic occlusive disease) determines the surgical history and survival time in amputated limbs. METHODS: The surgical history of lower extremities amputated between 2002 and 2009 was reviewed for the number of (endo)vascular procedures, minor amputations, wound debridements, complications requiring surgery (acute ischaemia, bleeding, graft infection) and limb survival time (LST). RESULTS: 100 limbs were included in the study. The four groups underwent a similar number of surgical procedures (mean 4.1). Diabetic foot limbs had fewer revascularizations (mean 1.3, p = 0.003) and complications (mean 0.1, p = 0.005), but more minor amputations and wound debridements (mean 1.3, p = 0.002), in a significantly shorter LST (mean 555 days, p = 0.003). Acute ischaemic limbs showed the shortest LST (mean 179 days, p = 0.003) and significantly more complications (mean 0.8, p = 0.005). Limbs initially treated for aneurysmal disease or chronic occlusive disease had the highest number of revascularizations (mean resp. 2.7 and 2.6) and the longest LST (mean resp. 1669 and 1459 days, p = 0.001). Limbs with advanced chronic occlusive disease (rest pain or gangrene) presented with fewer revascularisations (mean resp. 2.5 and 1.8, p = 0.01) and a shorter LST (mean resp. 1284 and 794 days, p = 0.004) compared to claudicants. CONCLUSIONS: Our study suggests that the surgical history and limb survival in amputated limbs is disease and stage specific, and determined by the indication of the first revascularisation.

Programme for detecting chronic venous insufficiency in Belgium.

OBJECTIVE: Epidemiological study related to the detection of chronic venous disease (CVD) in a Belgian population and gathering of a maximum amount of epidemiological data on CVD. METHOD: Survey based on a questionnaire completed by a general practitioner during consultation. RESULTS: In total 3813 files of patients with CVD were completed and analysed. Of these patients suffering from CVD, 70% were women with a mean body mass index of 26.2 and a clinical, aetiological, anatomical and pathological elements classification as follows: C0 = 10%; C1 = 19%; C2 = 29%; C3 = 19%; C4 = 16%; C5 = 4%; C6 = 3%. Risk factors, clinical signs, complications and therapeutic approach are analysed and described. CONCLUSION: High level of statistically analysable data could be obtained within a reasonable period. The study confirms the socioeconomic importance of CVD. For example, an industrial disablement of an average duration of 23.6 days is found in 6% of patients.

Intra-arterial thrombolysis followed by elective surgery for thrombo-embolic popliteal aneurysms.

Two patients with acute limb-threatening lower extremity ischaemia as a result of a thrombosed and embolizing popliteal artery aneurysm are described. Both patients were successfully treated with intra-arterial thrombolysis and subsequent elective vascular reconstruction. Thrombolysis might be an effective method to identify the underlying cause of limb ischaemia and to recanalize the run-off vessels leading to better bypass patency rates. However, this management is only indicated in selected cases of acute limb ischaemia without motor or sensory deficit.

Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach.

BACKGROUND: Patients considered for arterial surgery, have been shown to have a high incidence of coexistent cardiac, vascular and other diseases, affecting operative risk and survival. We developed a systematic workup strategy for detecting these coexistent diseases in our vascular surgical patients, mainly based on non-invasive diagnostic techniques. METHODS: We evaluated 200 consecutive patients, admitted to the department of vascular surgery in an academic teaching hospital, in order to establish the total incidence of relevant concomitant disorders, the extent to which this screening yielded previously unknown diagnostic information, and the impact on short-term (one year) survival. RESULTS: Coronary artery disease was present in 46% of the patients; 22% had active ischaemia, newly diagnosed in 5.5%. Impaired cardiac function was found in 37%: severely impaired in 12%, newly diagnosed in 27%. Carotid artery disease was present in 32%: critical stenoses were found in 9%; new diagnoses in 29.9%. Aortic aneurysms were present in 7%, newly diagnosed in 5%. Severe renal artery stenosis was present in 5%, newly diagnosed in 3.5%. Sixteen % of the patients had chronic obstructive pulmonary disease, newly diagnosed in 3.5%, and 4.5% had unexpected disorders, which were all new diagnoses. Overall, new diagnoses were reached in 64.5% of the population, affecting therapeutic strategy immediately in 21% of the patients. The presence of coronary artery disease and of cardiac failure were clearly related to one year survival. CONCLUSIONS: We conclude that a systematic screening strategy, mainly based on noninvasive techniques, can detect the presence of concomitant diseases in the vascular surgical patient. Most important seem the newly diagnosed diseases altering surgical management in one out of every five patients; they also have important implications for patient prognosis.

[Complications in reoperations in the popliteal fossa]. / Complications des reprises dans la fosse poplité.

For "redo" therapy in the popliteal space an excellent anatomical knowledge is imperative as shown by the results of the dissection of 38 cadaver legs. Dynamic phlebography is the only way to get this information. It is upon this examination that the phlebologist should make his choice either to use sclero-compression therapy or to reoperate the patient. In the case of an reoperation the external access should be chosen even if this implicates an anatomical challenge.

Chemical pleurodesis in primary spontaneous pneumothorax.

Spontaneous pneumothorax presents a high recurrence rate after conventional pleural drainage procedures. Different pleural scarifying agents are used in an attempt to prevent early and late recurrence. To investigate the effect of tetracycline and 30%-glucose, we conducted a randomized study on 20 patients with primary spontaneous pneumothorax: 10 patients were treated by pleural drainage combined with chemical pleurodesis; 10 patients were treated by pleural drainage alone. Chemical pleurodesis resulted in a statistically significant reduction (p less than 0.05) in early recurrence. The rate and magnitude of late recurrences however was unaffected by the pleurodesis treatment, although recurrence in the chemically treated group was later than in the conventional drainage group.

[Dynamic selective phlebography of veins in the calf]. / Phlébographie sélective dynamique des veines du mollet.

The authors present dynamic tests during phlebography, with which try to identify precisely the three layers of the venous circulation of the calf, consisting of the small saphenous vein, the gastrocnemius veins and the soleus veins. Mimicking the phases of walk during these manoeuvres, leads to a simultaneous morphological and functional study of the venous return. The result of these tests leads always to a specific therapeutic attitude.

[Venous stasis caused by extrinsic compression of the popliteal area]. / Stase veineuse par compression extrinsèque de la région poplitée.

The authors present three clinical cases of venous compression of the popliteal area. They are two popliteal cysts and one tibial exostosis. A relatively frequent popliteal artery aneurysm and a few iatrogenic cases, complete the list of possible differential diagnoses. Ultrasonography seems to present definite advantages concerning its use and aiding phlebography, arteriography and arthrography in detecting a popliteal "mass" causing a proximal venous stasis.

[Study of perforating veins by selective dynamic phlebography]. / Etude des perforantes par la phlébographie sélective dynamique.

Selective dynamic phlebography allows an interesting approach to the physiopathology of the gemellus and soleus veins. Moreover it specifies the part played by the posterior perforating veins in the incompetence of the short saphenous vein. Finally it alerts us against untimely surgery of this venous section which is still so unexplored.

Surgical management of spontaneous pneumothorax.

Spontaneous pneumothorax is a common surgical problem. Although the general principles of drainage of the pleural space and of prevention of recurrence seem well known, the literature shows differences in success rates concerning the treatment of a first pneumothorax and of the eventual recurrences. This is probably due to some technical factors and different views on the therapeutical strategy. In this retrospective review of 62 patients with spontaneous pneumothorax, 8 were treated by bed rest for their not enlarging and less than 20% pneumothorax, and 54 were treated by closed chest tube thoracostomy with an early success rate of 93.5% at the first admission. The simultaneous use of scarifying agents and closed chest drainage appears useful for the treatment of immediate or first recurrence. Sixteen patients were readmitted later for ipsilateral recurrence. According to the magnitude of their pneumothorax, they were treated by bed rest or tube thoracostomy with scarifying agents. Four of these patients needed thoracotomy with oversuturing of subpleural blebs and pleurodesis. The total thoracotomy rate of the initial patient population was 12.9% after an average follow up period of 24.8 months.

[Endarterectomy of the superficial femoral artery using an oscillating loop]. / Endarterectomie van de arteria femoralis superficialis door middel van een oscillerende ring.

A short series of half closed endarterectomies of superficial femoral artery with oscillating ringstripper is presented. The technique used is described, and major problems are discussed. Results are published and confrontated with the clinical events. Three criteria are withheld for indication of this procedure: the superficial femoral artery has to be completely occluded and not calcifiated; the popliteal artery has to be angiographically normal; two out of three arteries below knee have to be permeable. The authors advocate oral anticoagulation for a relatively long postoperative period.