[Linee guida flebo-linfologiche SIF-SICVE 2016 della Società Italiana di Flebologia e della Società Italiana di Chirurgia Vascolare ed Endovascolare].

Phlebology is not a specialty for its own in Italy. Phlebological patients are treated by vascular and general surgeons, dermatologists, phlebologists, angiologists, internists and even general practitioners. Even tough guidelines present a series of recommendations based on evidence-based medicine, guidelines may also be a tool to unify the diagnostic and therapeutic approach in a vast medical field like phlebology. Since vascular surgeons and phlebologists are particularly involved in phlebology-related pathologies the scientific societies of the Italian Society of Phlebology (SIF) and the Italian Society for Vascular and Endovascular Surgery (SICVE) decided to cooperate for the preparation of phlebo-lymphological guidelines. These guidelines comprehend also an important chapter dealing with the lymphology of the lower extremities; phlebological active physicians are often faced with lymphatic pathologies and a good differential diagnosis can be sometimes very helpful. Sclerotherapy and Surgery as the major therapeutical alternatives are extensively analyzed, but also the compression therapy, the medical and physical therapy are presented under the critical view of evidence based analyses. Separate chapters deal with the treatment alternatives for superficial and deep venous thromboses and the recommendations for the treatment of venous ulcers. The current scientific evidences were confronted with the experiences of Italian specialists and the particular practice and reality in Italy. They represent therefore the actual valid positions and recommendations in Italy which shall be updated regularly.

Development of primary superficial venous insufficiency: the ascending theory. Observational and hemodynamic data from a 9-year experience.

BACKGROUND: Hemodynamic principles suggest that primary venous insufficiency follows the hydrostatic column of venous pressure of the limbs, and therefore, venous reflux begins at the lower points and rises upwards. To test the hypothesis of an "ascending development" of reflux, we carried an observational study to analyze the natural evolution of lower limb venous insufficiency. METHODS: During 9-year period patients with primary superficial venous disease who refused treatment were followed prospectively with 6-month scheduled clinical and duplex ultrasound examinations. Localization, stage, and evolution of the venous patterns were compared. RESULTS: A total of 104 limbs in 99 patients were analyzed (12 males, 92 female; mean age 48.7 years). Prevalence of reflux was (p < 0.001) more frequent along great-saphenous and its tributaries (78/104, 75%) than nonsaphenous veins. The time of re-examination ranged from 1 to 13 years (mean 4 +/- 3.1 years). With the exception of six remaining stable, all the veins showed a progression of insufficiency (94%); 47 involved deep circulation. In all the worsened refluxes, an extension to reach one or more venous segments at an upper level, uninvolved before, was found. There was no downward oriented pattern of progression. There was no significant difference in age, gender, and type of vein between the stable and progressive diseases. CONCLUSIONS: Natural history of primary venous insufficiency is that of a progressive disease, which begins at lower levels of the limbs and develops in an antegrade manner as venous stasis is higher where force of gravity is higher. This data do not support the aggressive and widespread treatment of terminal valve as first approach, but need to be supported by larger studies.

Guidelines for venous thromboembolism and clinical practice in Italy: a nationwide survey.

Venous thromboembolism (VTE) is a common health problem for today's society, and considering the role that it plays in surgical patients (general surgery, gynecology, and orthopedics), new advances in our understanding of the procedures and trauma characteristics are relevant and necessary. The most important and recently published guidelines concerning this problem have been taken into consideration, leading to articulate investigations and data evaluation. This project has proposed a data-survey framework available as a questionnaire in order to investigate application of the guidelines for VTE throughout the national territory. Of the total 714 Italian centers, a random sample of 214 were contacted and asked to take part in this study; of these, 146 replied (20.4% of total and 68.2% of the sample): 48 departments of general surgery, 46 departments of gynecology, and 52 departments of orthopedics. About 70% of the centers has appropriate information about surgery as a risk factor for VTE. The answers have provided evidence of an adequate knowledge of the instrumental and laboratory diagnostic pathways, useful to confirm the diagnosis of TE (80%). Data waiting compared with morbidity and mortality rates related to deep vein thrombosis and pulmonary embolism showed an increase of mortality associated with the diagnostic data timing of supply, with an exponential trend linked to the data acquisition delay. Both risk stratification and adequate application of prophylaxis together with treatment devices represent a real tool to control morbidity and mortality for VTE. Moreover, diagnostic data waiting significantly influences adequate prophylaxis. In Italy, only 40% of the centers are ready to provide diagnostic data within 12 hr.

Echo-sclerosis hemodynamic conservative: a new technique for varicose vein treatment.

Treatment of venous insufficiency has been revolutionized by introduction of various less invasive procedures. The echo-sclerosis hemodynamic conservative (ESEC) technique is a completely new treatment of varicose veins that combines ultrasound-monitored sclerosis, innovative sclerotherapy findings, and hemodynamic principles. The objective of venous stasis suppression is achieved by the ESEC technique through a conservative and functional approach that preserves venous drainage and saphenous vessel integrity. The technique is efficient, simple, safe, in-office manageable, and easily repeatable, although it obviously requires training and skill. It may be considered as the primary treatment for most varicose patients. Evaluation of long-term results, with regard to comparison with other techniques, should assess cost efficacy from a lifelong point of view.