Classification of Chronic Venous Insufficiency: A Review

Angiology ◽  
2001 ◽  
Vol 52 (1_suppl) ◽  
pp. S17-S26 ◽  
Author(s):  
Pier Luigi Antignani
Keyword(s):  
Chronic Venous Insufficiency ◽  
Clinical Studies ◽  
Venous Insufficiency ◽  
Clinical Settings ◽  
European Working ◽  
Current Therapies ◽  
Ceap Classification ◽  
Set Up ◽  
Classi Fication

Chronic venous insufficiency (CVI) is a very variable and complex entity that has stimulated different attempts at classification. Several proposals have been made in recent years, based on objective and anatomical criteria, most of them incomplete and unsatisfactory. Finally the CEAP classification was presented in 1994. This certainly is the most nearly complete classi fication, since it takes into consideration not only the main aspects of CVI: Clinical, Etiological, Anatomical, and Pathophysiological, but also the degrees of severity, reported in the form of scores. It is now accepted internationally although it still has some flaws (such as the absence of the corona phlebectactica sign) and inaccuracies (above all in the clinical part and the scoring). Recently, some members of the Promoting Committee proposed a substantial modi fication of the part on scores, coming closest to the clinical reality, instrumental diagnosis, and current therapies. The characteristics of CEAP enable us to affirm that this represents the most original and useful classification, not only for clinical studies, but also in the assessment of therapeutic results and in patient follow-up. Like all classifications, CEAP also needs to be validated by means of clinical studies in order to demonstrate its applicability. For this purpose, a European Working Group was set up in 1997. The first interesting results of 872 dossiers collected by means of a computerized program (European Phlebological File) were presented at several international congresses and concentrated on the consistency and reproducibility of the clinical part of the CEAP classification in different clinical settings.

scholarly journals Association of great saphenous vein diameter and clinical severity score after treatment of severe chronic venous insufficiency with foam sclerotherapy

2021 ◽  
Vol 11 (4) ◽  
pp. 102-107
Author(s):  
Melissa Andreia De Moraes Silva ◽  
Luiz Henrique Silva de Sordi ◽  
Lara Camargo Rezende Grillo ◽  
Elisa de Paula Garcia ◽  
Luisa Resende Silva ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Ulcer Healing ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Healing Rate ◽  
Clinical Severity ◽  
Foam Sclerotherapy ◽  
Ulcer Healing Rate ◽  
Ceap Classification

Objectives: to evaluate the association of the greater saphenous vein (GSV) diameter in the treatment of patients with severe chronic venous insufficiency (C6 CEAP classification) with ultrasound-guided polidocanol foam sclerotherapy (UGFS).  Methods: A prospective, descriptive and analytical study of 28 patients (30 limbs) that underwent UGFS. Patients were divided into 2 subgroups by GSV diameter (< 8 mm and ≥ 8 mm). Variables analyzed were ulcer healing, clinical intercurrences, clinical CEAP classification, Venous Clinical Severity Score (VCSS), diameter of the treated vein and presence of occlusion or recanalization by Doppler ultrasound. Patients were analyzed at the 1st, 3rd, and 6th months post-treatment. Results: The average age was 68.7 ± 10.5 years, 23 (82,1%) were women, and the average body mass index was 29.2 kg/m2. Although an improvement in VCSS score was observed during follow-up, no significant intergroup difference was noted. Seventeen (56%) limbs presented occlusion of the treated vein at the 1st month, 11 (36%) at the 3rd month, and 9 (30%) at the 6th month of follow-up. The ulcer healing rate was 56,6%. The average ulcer healing time was 90 days. Three (10%) patients presented with ulcer recurrence at the 6th month.  Survival analysis showed no significant difference in ulcer healing rate between subgroups after one year of follow-up (log-rank, p = 0,178). Conclusion: There was no difference between the subgroups of large and small VSM diameter in terms of symptom severity. However, significant reduction of VCSS and pain relief was observed after foam sclerotherapy.

scholarly journals Chronic Venous Insufficiency (CVI) - A Study of 100 Cases

1970 ◽  
Vol 9 (1) ◽  
pp. 20-26
Author(s):  
MM Shahin-Ul-Islam ◽  
Md Zahirul Haque ◽  
Saki Md Jakiul Alam ◽  
Mesbahuddin Noman ◽  
FM Siddiqui
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Leg Pain ◽  
Advanced Stage ◽  
College Hospital ◽  
Prolonged Standing ◽  
Burning Pain ◽  
Significant Difference ◽  
Ceap Classification ◽  
Relationship Of

This study was carried out in the out patient department of Dhaka Medical College Hospital. 100 patients presented with chronic venous insufficiency during the period of January 2005 to June 2005 were studied to find out the various modes of presentation, risk factors and relationship of symptoms with age, sex and Body Mass Index of the patients. It was found that, maximum patients presented with heaviness in the leg (87%), followed by aching leg pain (75%), leg swelling (70%), cramping leg pain (68%), tiredness (48%), burning pain (43%), engorged leg vein (39%), restless leg at night (21%), throbbing leg pain (18%), itching (13%), various skin changes without active ulceration (7%) and active leg ulceration only 3% of cases. Increasing age of the patients, obesity, increasing number of pregnancy, prolonged standing and sitting position at work were found to be positively correlated with CVI. Advanced age is associated with more advanced stage of CVI according to clinical CEAP classification. There is almost equal sex distribution among the stages of CVI except in advanced stage, in stage C4, C5 and C6 there is 10 patients out of them 9 are male and only 1 is female. Relationship of symptoms with BMI of the patients were also sort out and found that, in C3 group of CEAP classification out of 61 patients 46 are obese according to BMI, of which 32 are female and 14 are male and only 17 patients have BMI within normal range, but in other group there is no significant difference in incidence between two groups.   DOI = 10.3329/jom.v9i1.1421 J MEDICINE 2008; 9 : 20-26

scholarly journals Klippel–Trénaunay Syndrome – A Very Rare and Interesting Syndrome

2015 ◽  
Vol 9 ◽  
pp. CCRPM.S21645 ◽  
Author(s):  
Deepak Sharma ◽  
Sachin Lamba ◽  
Aakash Pandita ◽  
Sweta Shastri
Keyword(s):  
Soft Tissue ◽  
Vascular Malformation ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Port Wine ◽  
Bone Deformity ◽  
Klippel Trenaunay Syndrome

Klippel–Trénaunay syndrome (KTS or KT) is an infrequently seen dermatological syndrome, which is often viewed as a triad of vascular malformation (capillary malformations or port-wine brands), venous varicosity, and soft tissue and/or bony hypertrophy. We report a case of a 12-year-old male who presented to us with the symptoms of varicose plaques over both lower limbs and was diagnosed as a case of KTS. Management is normally conservative and includes stockings for compression of the branches to reduce edema because of chronic venous insufficiency; modern devices that cause on and off pneumatic compression; and rarely, surgical correction of varicose veins with lifelong follow-up. The orthopedic abnormalities are treated with epiphysiodesis in order to prevent (stop) overgrowing of limb and correction of bone deformity.

scholarly journals Pattern of Presentation of Chronic Venous Insufficiency in CVI Clinic of CMCH

2018 ◽  
Vol 30 (1) ◽  
pp. 26-29
Author(s):  
Md Salim ◽  
GM Zakir Hossain ◽  
Mahmudur Rahman ◽  
Md Monirul Alam ◽  
Muallem Al Farukh Khan ◽  
...  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Prospective Observational Study ◽  
Venous Insufficiency ◽  
Medical College ◽  
Advanced Stages ◽  
Ceap Classification ◽  
Male Patients ◽  
Common Sign ◽  
The Impact ◽  
Chronic Ulceration

Chronic venous insufficiency (CVI) is a common but often ignored problem in primary health care, sign and symptoms may ranges from mild leg heaviness or aching, dilated or unsightly veins, or troublesome odema to fibroses subcutaneous panniculitis associated with recurrent cellulitis and chronic ulceration. The prospective observational study was carried out department of surgery, Chittagong Medical College & Hospital, Chittagong. The primary purpose of the present study was to evaluate the impact of the diagnostic approach on patient of chronic venous insufficiency, varicose vein to difference primary and secondary venous insufficiency. Most common sign flebedema found in 56 (65.12%) patients was followed by dermo-hypodermatitis in 15(17.44) patients, stasis eczema in 09(10.47) patients and thrombophlebitis in 06(6.98) patients. Most frequent lower leg symptoms are heaviness 82 (95.35%) & the lowest is Throbbing 55(63.95%). The others are according to order of frequency cramps 66 (70.0%), Itching (73.26%), burning 61(70.93%), tiredness (80.23%), restless leg (82.55%), pain aching 76 (88.37%). CVI (chronic venous insufficiency) studied 04 (4.65%) were in C1, 54(62.79%) were in C2, 03(3.49%) were in C3, 11(12.79%) were in C4, 6 (6.98%) were in C5 and 8(9.30%) were in C6 according to clinical CEAP classification. Majority of patients presented with the complains of heaviness of leg and unexplained leg swelling, sex predilection is almost same for male and female but advanced stages are more common in male patients. Increasing age is associated with more advanced stage of the disease.Medicine Today 2018 Vol.30(1): 26-29

Endovenous cyanoacrylate glue to treat varicose veins and chronic venous insufficiency—Experience gained from our first 100+ truncal venous ablations in a multi-ethnic Asian population using the Medtronic VenaSeal™ Closure System

2019 ◽  
Vol 34 (8) ◽  
pp. 543-551 ◽  
Author(s):  
Tjun Y Tang ◽  
Harsha P Rathnaweera ◽  
Jia W Kam ◽  
Tze T Chong ◽  
Edward C Choke ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Asian Population ◽  
Closure System ◽  
Cyanoacrylate Glue ◽  
Catheter Technique

Objectives The aim of this prospective single-centre study is to assess the effectiveness and patient experience of the VenaSeal™ Closure System, a novel non-thermal, non-tumescent catheter technique, which uses cyanoacrylate glue to occlude the refluxing truncal superficial veins to treat varicose veins and chronic venous insufficiency, in a multi-ethnic Asian population from Singapore. Methods Seventy-seven patients (93 legs; 103 procedures) underwent VenaSeal™ Closure System ablation. Forty-nine (63.6%) for great saphenous vein incompetence, 16 (20.8%) bilateral great saphenous vein, 2 (2.6%) small saphenous vein and 10 (13.0%) combined unilateral great saphenous vein and small saphenous vein/anterior thigh vein reflux. In addition, 65/93 legs (69.9%) had C4–C6 disease. Patients were reviewed at 2 weeks, 3, 6 and 12 months post-procedure. Results There was 100% technical success. 28/77 (36.4%) underwent concomitant phlebectomies. All procedures were well tolerated with a mean post-operative pain score of 3.0 (range: 0–5). After three months, median patient satisfaction was 9.0 (interquartile range: 7.0–10.0). At two-week follow-up, the great saphenous vein was completely occluded in 88/88 (100%) veins and small saphenous vein completely closed in 11/11 (100%) veins. At three-month follow-up, the great saphenous vein was occluded in 51/53 (96.2%) veins and small saphenous vein completely closed in 5/5 (100%) veins. At six-month follow-up, the great saphenous vein was completely occluded in 42/45 (93.3%) veins and small saphenous vein completely closed in 5/7 (71.4%) veins. At one year, great saphenous vein and small saphenous vein occlusion rates were 54/59 (91.5%) and 5/8 (62.5%), respectively. There was one deep vein thrombosis. Transient superficial phlebitis was reported in 10/93 (10.8%) legs, which were all self-limiting. There were 9/103 (8.7%) anatomical recurrences, but no patients required re-intervention as they were asymptomatic. Conclusions Cyanoacrylate glue is a safe and efficacious modality to ablate refluxing saphenous veins in Asian patients in the short term. There is a high satisfaction rate and peri-procedural pain is low. Early results are promising but further evaluation and longer term follow-up are required.

scholarly journals VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

2013 ◽  
Vol 50 (3) ◽  
pp. 191-195 ◽  
Author(s):  
Bonno van BELLEN ◽  
Ivan de Barros GODOY ◽  
Andrea Almeida REIS ◽  
Pedro BERTEVELLO
Keyword(s):  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Venous Thrombosis ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thromboembolic Disease ◽  
Lower Limbs ◽  
Abdominal Circumference ◽  
Morbidly Obese ◽  
Ceap Classification

Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.

Telangiectases in Venous Insufficiency: Point of Reflux and Treatment Strategy

2000 ◽  
Vol 15 (1) ◽  
pp. 38-42 ◽  
Author(s):  
F. Mariani ◽  
V. Bianchi ◽  
S. Mancini ◽  
S. Mancini
Keyword(s):  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Average Diameter ◽  
Venous System ◽  
Lower Limbs ◽  
Perforating Veins ◽  
Ceap Classification

Objective: To verify the role of sources of non-saphenous reflux in the appearance of reticular varices and telangiectases in areas other than the lateral venous system of Albanese. Setting: Institute of General Surgery and Surgical Specialisations, Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, University of Siena. Patients and methods: The study was carried out on 106 women aged 18–65 years who were affected by chronic venous insufficiency (CVI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients had telangiectases (200 telangiectactic areas) and reticular varices of the lower limbs of type II and III of the classification of Weiss, with competent saphenous trunks and a normal deep venous system. Sclerotherapy was therefore performed, after clinical and duplex ultrasound examination. The records of 185 telangiectactic area treated 3 years earlier were reviewed. Results: In all cases reticular varices was found together with the telangiectases. In 73.5% (147/200 areas) one or more incompetent perforating veins was found (average diameter 1.6 mm) and in 83.6% (123/147 areas) it was possible to establish that the main source of reflux was in the base of the telangiectasia. Complete elimination of microvarices was achieved in 88% of cases (176/200 areas; average sessions: 3.5). The complications were haemosiderin pigmentation (1.5%, 3/200 areas) and matting (1%, 2/200 areas). In 24 areas resistant to the therapy it was not possible to demonstrate the presence of reflux, while in 24.5% of cases (49/200 areas, average surface 15.4 cm2) two sessions of sclerotherapy were sufficient eventually to obtain (about 4 weeks later) the disappearance of the micro-varices. Follow-up after 3 years revealed the appearance of new telangiectases in 58.9% of cases (109/185 check-ups). Of these 95.4% (104/109) arose in areas other than those treated and therefore only 4.6% (5/109) recurred in the area where the sclerosing treatment had been carried out. Conclusion: In CVI all telangiectases are accompanied by reticular varices, even when not visible on clinical examination; in most cases the sources of reflux are distinguishable as incompetent perforating veins and are situated beneath telangiectactic efflorescences.

Chronic venous insufficiency (CVI)

2018 ◽  
pp. 469-478
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Oxygen Transport ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Leg Ulcers ◽  
Skin Changes ◽  
Lymphatic Flow ◽  
Compression Bandages ◽  
Ceap Classification

Chronic venous insufficiency (CVI) can result in varicose veins or, if severe, may develop skin changes and leg ulcerations. This chapter details the classification and presentation of varicose veins and venous leg ulcers (CEAP classification). It outlines the recommended investigations for CVI such as handheld Doppler scan and venous duplex ultrasound scans. The management of CVI is to improve the venous and lymphatic flow thereby improving the skin oxygen transport through reducing oedema. This can be performed by graduated compression bandages.

scholarly journals Establishing an oncocardiology service

Herz ◽  
2020 ◽  
Vol 45 (7) ◽  
pp. 626-631
Author(s):  
L. H. Lehmann ◽  
M. Totzeck
Keyword(s):  
Cancer Patients ◽  
Clinical Studies ◽  
Ethical Issues ◽  
Diagnostic Tools ◽  
Evidence Based ◽  
Therapeutic Approaches ◽  
Patient Centered ◽  
Set Up ◽  
Integrate Research

Abstract Oncocardiology is an emerging field in cardiovascular healthcare. Besides establishing surveillance and follow-up strategies for cancer patients, it will be essential to set up specialized oncocardiology services. However, there is a lack of clinical studies to give evidence-based recommendations regarding cardiological diagnostic and therapeutic approaches for cancer patients. An oncocardiology service is a patient-centered structure that aims to integrate research and interdisciplinary patient care to bridge this gap. We discuss the current challenges in developing an oncocardiology service and review the literature on this topic. We further provide an overview of the essential diagnostic tools and upcoming ethical issues to be considered in the management of oncology patients.

Popliteal venous aneurysm: a report on three cases presenting with chronic venous insufficiency without embolic events

2007 ◽  
Vol 22 (2) ◽  
pp. 56-59 ◽  
Author(s):  
J T Christenson
Keyword(s):  
Pulmonary Embolism ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Anticoagulation Therapy ◽  
Duplex Scanning ◽  
Venous Aneurysm ◽  
Safe Procedure ◽  
The Mean ◽  
Superficial Venous Insufficiency

Objectives: Popliteal venous aneurysms (PVA) are rare, but represent a significant potential source of thromboembolus. Most often the patients present with pulmonary embolism, which can also be detected in patients presenting with chronic venous insufficiency. Methods: Three patients without any clinical evidence of pulmonary emboli were diagnosed by venous duplex scanning during workup for superficial venous insufficiency. None of the PVAs contained thrombus. The mean diameter of the aneurysm was 30 mm. Surgery included tangential aneurysmectomy and lateral venorrhaphy. Results: None of the patients had evidence of pulmonary embolism, and there were no postoperative deep venous thromboses diagnosed. All patients received anticoagulation therapy for three months postoperatively, and patency was confirmed by duplex scanning during follow-up four, nine and 12 months after surgery. Conclusions: It is recommended that PVAs should be ruled out in patients undergoing workup for chronic venous insufficiency, even in the absence of embolic events. A good quality venous duplex scanning is sufficient for diagnosis and treatment. Surgical treatment of PVAs is advocated. Tangential aneurysmectomy with lateral venorrhaphy is the surgical technique of choice. It is a safe procedure with a low complication rate.

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