Early morning oedema in patients with primary varicose veins without trophic changes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 491-495 ◽  
Author(s):  
Didier Rastel ◽  
François-André Allaert
Keyword(s):  
Varicose Veins ◽  
Clinical Signs ◽  
Time Lapse ◽  
Early Morning ◽  
Epidemiological Studies ◽  
Control Group ◽  
Trophic Changes ◽  
Primary Varicose Veins ◽  
Ceap Classification ◽  
Consultation Time

Abstract. Background: Chronic lower limb oedema is one of the complications of superficial or deep chronic venous disorders. It is ranked as “C3”on the CEAP classification. In epidemiological studies, the recognition of oedema is mainly based on clinical signs, and oedema is more easily detected in the second part of the day when it becomes evident. We addressed the question whether oedema is already present in the morning in patients suffering of primary varicose veins without trophic changes. Patients and methods: In total, 101 patients with primary varicose veins (C2 and/or C3 stage of the CEAP classification) and 122 controls were enrolled as they appeared in our centre. The consultation time was no later than 6 hours after the patient had woken up. Oedema was detected by pitting test and ultrasound. Results: The mean consultation time lapse was 3.7 ± 1.2 hours after waking-up. Oedema was more frequent in the group of primary varicose veins without trophic changes (36 % compared to 14 % in the control group; p < 0.01). Oedema was mainly detected by ultrasound and far less so by the pitting test. Conclusions: Patients with varicose veins have morning oedema more frequently than patients without varicosis and at a higher rate than in epidemiological studies.

Is arteriovenous shunting involved in the development of varicosities? A study of the intraluminal pressure and oxygen content in varicose veins

2008 ◽  
Vol 23 (3) ◽  
pp. 137-141 ◽  
Author(s):  
M A Murphy ◽  
L Hands
Keyword(s):  
Oxygen Content ◽  
Supine Position ◽  
Varicose Veins ◽  
Causative Factor ◽  
Intraluminal Pressure ◽  
Control Group ◽  
Venous Disease ◽  
Control Subjects ◽  
Pulsatile Pressure ◽  
Primary Varicose Veins

Objectives Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting. Methods Thirty-nine patients with varicose veins underwent cannulation of varicosities. The pressure and the blood oxygen content within varicosities were measured in different positions and during exercise. Similar measurements were made in the long saphenous veins of 10 control subjects without venous disease. Results Mean pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6 mmHg). Control subjects had similar pressures measured in the long saphenous vein. No pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66 mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity from the heart. Pressure reduction in varicosities after exercise was significantly less than that in control subjects. Recovery time (RT 90) was also significantly shorter than in the control group. Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa (SD 0.9) on standing; these values were not significantly different to samples from control subjects. Conclusions AV shunting is unlikely to be a causative factor in the development of primary varicose veins.

scholarly journals Pre- and Postoperative Evaluation by Photoplethysmography in Patients Receiving Surgery for Lower-Limb Varicose Veins

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Orlando Adas Saliba Júnior ◽  
Mariangela Giannini ◽  
Ana Paula Mórbio ◽  
Orlando Saliba ◽  
Hamilton Almeida Rollo
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Varicose Vein Surgery ◽  
Postoperative Evaluation ◽  
Perforating Veins ◽  
Primary Varicose Veins ◽  
Ceap Classification ◽  
The Mean ◽  
Deep Vein

Objective. To evaluate the effectiveness of surgery in treating primary varicose veins in the lower limbs by photoplethysmography (PPG) and duplex mapping (DM).Method. Forty-eight lower limbs were clinically evaluated according to the CEAP classification system and subjected to PPG and DM exams. Each limb had a venous refill time (VRT) of <20 seconds and a normal deep vein system (DVS) by DM.Results. The mean pre- and postoperative VRTs were 13.79 and 26.43 seconds, respectively (P<0.0001). After surgery, 42 limbs (87.50%) had normal results by PPG (VRT > 20 seconds). Four limbs (8.33%) showed improved VRTs, but the VRTs did not reach 20 seconds. In the 2 limbs (4.17%) that maintained their original VRTs, the DM exams showed the presence of insufficient perforating veins.Conclusion. In most cases, PPG allows for a satisfactory evaluation of the outcome of varicose vein surgery.

Expression of the proinflammatory marker CD34 in varicose leg veins

Phlebologie ◽  
2015 ◽  
Vol 44 (01) ◽  
pp. 19-23
Author(s):  
I.V. Samsonava ◽  
M. M. Galishevich ◽  
S. A. Sushkou
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Control Sample ◽  
Lower Limbs ◽  
Control Group ◽  
Posterior Tibial ◽  
Vena Saphena Magna ◽  
Primary Varicose Veins ◽  
Deep Vein ◽  
Cd34 Expression

Summary Objective: To study the CD34 expression in the leg veins with primary varicose veins. Material and Methods: The study included 18 patients with lower limbs varicose veins and deep vein valves insufficiency of C3 and C4 clinical classes (CEAP). To correct blood flow phlebectomy was accompanied by posterior tibial veins resection. Using immunohistochemistry, we compared the expression of CD34 in resected posterior tibial veins specimens and vena saphena magna distal fragment. Results: Posterior tibial veins wall in patients with lower limb varicosity and deep veins valves insufficiency vary the CD34 degree expression comparing with the control group. Total area of expression was significantly greater than in control sample. CD34 expression area was also significantly greater in vena saphena magna than in control group. CD34 expression comparison in the specimens from patients with varicose veins showed its significantly higher degree in the vena saphena magna than in tibial veins. Conclusion: With primary varicose veins superficial and deep leg veins develop unidirectional increase of CD34 expression, that can be assumed as a pathogenetic factors of further disease progression and involvement of deep vein valves.

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

2012 ◽  
Vol 27 (1_suppl) ◽  
pp. 114-118 ◽  
Author(s):  
E Rabe ◽  
F Pannier
Keyword(s):  
Gold Standard ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Consensus Conference ◽  
Scientific Publications ◽  
Consensus Document ◽  
Venous Diseases ◽  
Ceap Classification ◽  
Definition Of

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords ‘CEAP’ and ‘venous insufficiency’, 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

scholarly journals Homeostatic feelings – a novel explanation of vein symptoms derived from an experimental patient study

VASA ◽  
2019 ◽  
Vol 48 (6) ◽  
pp. 492-501
Author(s):  
Werner Blättler ◽  
Erika Mendoza ◽  
Christine Zollmann ◽  
John Bendix ◽  
Felix Amsler
Keyword(s):  
Rating Scale ◽  
Varicose Veins ◽  
Stress Test ◽  
Numeric Rating Scale ◽  
Lower Limbs ◽  
Venous Disease ◽  
Scale Range ◽  
Patient Groups ◽  
Primary Varicose Veins ◽  
Ceap Classification

Summary. Background: Vein symptoms (VS) entail diffuse leg discomfort and pain coinciding with a perception of weighty or swollen legs. Their traditional classification as a form of venous disease may be inaccurate as they occur in patients with no or any venous disorder. We hypothesized that VS would emerge from a primordially standing associated perturbation in the lower limbs which is not necessarily connected with a venous disorder. Patients and methods: Patients were sorted into groups according to the CEAP classification, VS only (C0s), primary varicose veins (C2p), varicose veins plus oedema (C2p and C3), and venous dermatopathy (C4). Patients completed questionnaires before and one week after they were exposed to a test of stationary standing. Results: Patients (N = 127) in the four groups differed by sex, age and body weight. The VS experienced in the preceding week scored the same in all groups at 3.1 on a numeric rating scale (range 0–10; SD 1.6). During standing, lower leg volume increased and symptoms emerged to the same extent across patient groups and were reduced similarly by compression (volume by 1.7 %, symptoms by 41.7 %). The emergence of symptoms was neither correlated with leg volume increase per se, nor with limiting this increase by compression. Symptoms recorded at baseline correlated with the symptoms provoked by the stress test with bare legs while the symptoms reported at follow-up, when stockings were worn regularly, correlated with the stress test with compression. Conclusions: VS, in terms of neuropsychology, reflect a homeostatic disturbance experienced in the presence and absence of venous disease. Thus, VS are not distinctive for the presence of venous disease insofar as they may reflect dynamic homeostatic feelings resulting from a standing-related disequilibrium in the legs’ internal environment.

CEAP-classes and symptoms in people with varicose veins

Phlebologie ◽  
2005 ◽  
Vol 34 (06) ◽  
pp. 305-309
Author(s):  
C. Ose ◽  
G. Rudofsky ◽  
J. Roesener ◽  
H. Hirche ◽  
K. Kroeger
Keyword(s):  
Odds Ratio ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Venous Disease ◽  
Muscle Cramps ◽  
Restless Legs ◽  
Class 1 ◽  
Ceap Classification ◽  
Reticular Veins

SummaryIndividual symptoms of patients with varicose veins are not considered in the CEAP-classification. Method: We analysed how far people with CEAP class 1 and 2 differ in their symptoms from people without varicose veins in the Duesseldorf/ Essen civil servants study recruiting 9935 employees. All volunteers were asked to fill out a questionnaire and were clinically examined. Primarily the clinical findings were documented adapted to the Basel Study and later modified according to the CEAP classification: 64% class 0 (no visible or palpable clinical signs of venous disease), 27% class 1 (small cutaneous veins and/or reticular veins) and 9 class 2 (varicose veins). Results: Leg swelling and muscle cramps during night were the most frequent symptoms in both classes. Statistically the frequency of symptoms in volunteers classified as CEAP class 1 respectively 2 were different from volunteers showing CEAP class 0 but were not different from each other. Grouping the symptoms restless legs, itching and cramps and calculating odds ratios for none of these showed significant results. Especially in women suffering from CEAP class 2 a significant small odds ratio of 0.5 (95%CI: 0.4–0.6) indicated that women rid of all these three symptoms had less frequently a varicosis disease. Conclusion: It can be assumed that the clinical differentiation into CEAP classes also differentiates groups of people with different symptoms.

scholarly journals Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification

2011 ◽  
Vol 26 (suppl 2) ◽  
pp. 115-119 ◽  
Author(s):  
Nei Rodrigues Alves Dezotti ◽  
Edwaldo Edner Joviliano ◽  
Takachi Moriya ◽  
Carlos Eli Piccinato
Keyword(s):  
Surgical Treatment ◽  
Varicose Veins ◽  
Disease Classification ◽  
Clinical Severity ◽  
University Hospital ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Severe Group ◽  
Primary Varicose Veins ◽  
Ceap Classification

CONTEXT: Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). PURPOSE: To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. METHODS: We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. RESULTS: There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. CONCLUSION : Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

scholarly journals THE INTENSITY OF LIPID PEROXIDATION PROCESSES IN WOMEN WITH PRIMARY VARICOSE VEINS OF THE PELVIC DEPENDING ON THE STAGE OF THE DISEASE

2018 ◽  
Vol 73 (4) ◽  
pp. 229-235 ◽  
Author(s):  
Lyubov’ I. Kolesnikova, ◽  
Andrey A. Semendyaev ◽  
Dmitriy A. Stupin ◽  
Marina A. Darenskaya ◽  
[Lyudmila A. Grebenkina ◽  
...  
Keyword(s):  
Lipid Peroxidation ◽  
Antioxidant Defense ◽  
Varicose Veins ◽  
Reproductive Age ◽  
Background Information ◽  
Control Group ◽  
Maximum Increase ◽  
Diene Conjugates ◽  
Primary Varicose Veins ◽  
Peroxidation Processes

Background: Information about involvement of general nonspecific reactions, in particular lipid peroxidation processes, in the progression of varicose veins of the pelvic (VVP) in women is still too scarce. Aims: To study the intensity of processes of lipid peroxidation and the activity of components of the antioxidant system in women with primary varicose veins of the pelvic at different stages of the disease. Materials and methods: 167 women of reproductive age were examined ― 137 with VVP and 30 made up a control group. All patients with VVP were divided into 3 groups depending on stages of the disease. Spectrophotometric and fluorometric methods of investigation were used. The study was conducted during 2012−2017. Results: It was revealed that the level of primary products of lipid peroxidation, diene conjugates, increased statistically significantly according to the stage of the disease by 1.25 times (in the 1st stage), 1.51 times (in the II stage) and 1.59 times (in the III stage) values. Changes in the content of final TBA-active products showed similar changes-an increase in the mean values for all stages of the disease relative to control (in 1.24, 1.17, and 1.77 times, respectively). Activity of glutathione peroxidase increased in stage 2 of VVP (1.19 times), with the maximum increase in stage III (1.42 times); activity of glutathione-S-transferase increased 1.18 times in the II stage of the disease. The concentration of GSH in the clinical groups was characterized by lower values with respect to the control (by 1.22 times in the 1st stage, in 1.64 times in the II stage), with the maximum decrease of this parameter in the III stage of VVP (3.67 times). The level of catalase activity increased in the I stage of VVP ― by 1.18 times and decreased in the III stage ― by 1.14 times with respect to the control. The activity of SOD showed similar changes with catalase ― in the form of increased activity at the 1st stage (1.35 times higher) and decreased values for II (1.35 times lower) and III (1.65 times lower) for the stages of VVP to the values of control. Conclusions: At progression of primary VVP in women (from the initial stage to the 3rd stage of the disease), there is an increase in imbalance in the lipid peroxidation − antioxidant defense system. Moreover, if the compensatory increase in activity of antioxidant enzymes is registered at stage 1 of the disease, then the most of the antioxidant defense factors decreases as relative to control values, and the initial stages of the disease.

scholarly journals Promotor effect of S-metolachlor generics with different hepatotoxicity in liver carcinogenesis in rats

2019 ◽  
Vol 86 (2) ◽  
pp. 5-13
Author(s):  
E.A. Bagley ◽  
N.M. Nedopytanska ◽  
V.S. Lisovska ◽  
O.V. Reshavska ◽  
L.V. Tkachenko
Keyword(s):  
Body Weight ◽  
Liver Cancer ◽  
Constitutive Androstane Receptor ◽  
Clinical Signs ◽  
Negative Control Group ◽  
Epidemiological Studies ◽  
Positive Control ◽  
Negative Control ◽  
Control Group ◽  
Species Specific

Metolachlor and currently its biological active isomer S–metolachlor is one of the most widely used herbicides in the world. Chronic experiments in rats have found hepatocarcinogenic effect of metolachlor, and epidemiological studies have found positive relationship between enzyme exposure to metolachlor and prevalence of liver cancer. Possibility of the influence of harmful impurities contained in technical products on the detected effects is emphasized. Objective is to study promotor effect of S–metolachlor generics with different hepatotoxicity in carcinogenesis of liver in rats induced by nitrosodiethylamine (NDEA) and analyse possibility of its realisation in human. Materials and Methods. Experiments were performed in male Wistar Han rats on hepatocarcinogenesis model “NDEA — hepatectomy”. Two specimens of S–metolachlor generics were studied; and their ratio of S/R enantiomers was 87/13 % with different hepatotoxicity. Substances were administered intragastrically in the doses of 1.5,15 and 150 mg/kg body weight for 8 weeks. Animals of the negative control group received water, and positive control — phenobarbital. Promotor effect was evaluated by the standardised parameters of the total area and number of hepatocyte foci expressing γ-glutamyl transpeptidase (GTP). Results. No clinical signs of the toxic action of S–metolachlor on the rat body induced to carcinogenesis by NDEA were found. Increase in the number and total area of γ-GTP positive foci in the liver of animals on tumorogenic dose of both specimens of S–metolachlor as well as phenobarbital was found. Mean area of focus in the liver of rats on more toxic specimen was lower. The threshold of promotor action of S–metolachlor on hepatocarcinogenesis has been established at the level of γ 15 mg/kg body weight. Analysis of literature data on the mechanism of hepatotoxic action of metolachlor allowed to make a conclusion aboutphenobarbital-like mechanism of promotor action that is realised through constitutive androstane receptor (CAR). This mechanism is species-specific for rodents; therefore, the results of epidemiological studies on the possibility of liver cancer in human cannot be confirmed experimentally. Conclusion. Tumorogenic dose of S–metolachlor generics with different degree of hepatotoxicity shows promotor effect in NDEA induced carcinogenesis in rat liver. Hepatotoxicity of S–metolachlor inhibits growth of γ-GTP positive foci. The threshold of hepatocarcinogenesis promotion has been established at the level of γ 15 mg/kg body weight. The mechanism of the observed effect is not relevant for human. Key Words: S–metolachlor, hepatocarcinogenesis initiated by nitrosodiethylamine, Wistar Han rats, γ-glutamyltranspeptidase.

Ambulatory Venous Pressure and Leg Volume Measurements before and after Surgery for Primary Varicose Veins

1997 ◽  
Vol 12 (3) ◽  
pp. 86-90 ◽  
Author(s):  
M. Vayssairat ◽  
K. Chakkour ◽  
P. Gouny ◽  
A. Taccoen ◽  
C. Cheynel ◽  
...  
Keyword(s):  
Varicose Veins ◽  
Venous Pressure ◽  
Early Morning ◽  
University Hospital ◽  
Venous Surgery ◽  
Before And After ◽  
Volume Measurements ◽  
Primary Varicose Veins ◽  
Venous Function ◽  
The Times

Objective: To compare clinical disability, ambulatory venous pressure (AVP) and leg volume before and after venous surgery, and to relate the changes to those observed after one night preoperative in-hospital rest. Design: Prospective study. Setting: Department of Vascular Surgery, University Hospital, Paris, France. Subjects: Nineteen patients with primary varicose veins and mild chronic venous insufficiency (CVI), scheduled for venous surgery. Main outcome measures: Clinical disability recorded by the analogue scale method, and leg volume and AVP measurements. These evaluations were repeated three times: on the day before surgery, in the afternoon; in the early morning on the day of surgery; and 2 months after surgery, in the afternoon. Results: Varicose vein surgery improved disability ( p = 0.001) and two AVP parameters: recovery time (RT, p = 0.0049) and the calf muscle pump index (CMPI), which rose by 345% (95% confidence intervals: 29, 659). Preoperative supine rest for one night improved disability ( p = 0.0016) and reduced leg volume ( p = 0.0002). The improvements induced by surgery correlated with the changes induced by rest, for disability ( p = 0.016), RT ( p = 0.006) and CMPI ( p = 0.033). Conclusion: Surgery improves venous function in patients with primary varicose veins. AVP remains a standard method of evaluating CVI. Combined with volumetry, it allows sensitive comparisons between different treatments. Because venous function varies greatly with daily activity, it is imperative to standardize the times at which venous function is evaluated.

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