Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy

2019 ◽  
Vol 35 (1) ◽  
pp. 46-55 ◽  
Author(s):  
Orlando Adas Saliba Júnior ◽  
Hamilton Almeida Rollo ◽  
Orlando Saliba ◽  
Marcone Lima Sobreira
Keyword(s):  
Pregnant Women ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Intervention Group ◽  
Signs And Symptoms ◽  
Lower Limbs ◽  
Control Group ◽  
Venous Disease ◽  
Compression Stockings

Objectives To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women. Method A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated. Results Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p < 0.0001) in the right leg and 0.28 cm and 0.38 cm (p < 0.0001) in the control group. CEAP classification presented worsening in the control group (p < 0.0001). The signs and symptoms in the control vs. intervention group: pain (86.67% vs. 23.33%; p < 0.0001), edema (70.00% vs. 33.33%; p = 0.0045), and leg heaviness (93.33% vs. 13.33%; p < 0.0001). Conclusions Compression stockings were effective in controlling the varicose veins related to pregnancy.

Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women

2020 ◽  
Vol 35 (10) ◽  
pp. 784-791
Author(s):  
Orlando Adas Saliba Junior ◽  
Hamilton Almeida Rollo ◽  
Orlando Saliba ◽  
Marcone Lima Sobreira
Keyword(s):  
Pregnant Women ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Intervention Group ◽  
Lower Limbs ◽  
Control Group ◽  
Venous Reflux ◽  
Compression Stockings ◽  
Reflux Time ◽  
Significant Difference

Objectives To analyze the effect of graduated compression stockings on the venous reflux in the lower limbs of pregnant women. Method A controlled randomized clinical trial was performed with sixty women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Using duplex-ultrasound, the reflux time and peak reflux velocity in the great saphenous vein and small saphenous vein were analyzed. Results Great saphenous vein reflux times in the intervention group were 0.13 s at the beginning (initial) and 0.04 s at the end of pregnancy (final) in the right leg and 0.02 s and 0.34 s (p < 0.0001) in the control group. No patient in the intervention group experienced pathological reflux at the end of the pregnancy. There was a significant difference in the reflux time measured from both the great saphenous vein and small saphenous vein and peak reflux velocity between the groups. Conclusion Compression stockings prevent increased venous reflux in lower limbs of pregnant women.

Endovenous laser ablation is an effective treatment for great saphenous vein incompetence in teenagers

2015 ◽  
Vol 31 (3) ◽  
pp. 198-202
Author(s):  
Piotr Terlecki ◽  
Stanislaw Przywara ◽  
Marek Iłżecki ◽  
Karol Terlecki ◽  
Piotr Kawecki ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Current Knowledge ◽  
Varicose Veins ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Invasive Treatment ◽  
Endovenous Laser Ablation

Objectives The current knowledge of chronic venous disease in teenagers and its treatment is very limited. The aim of the study is to present our experience and the available literature data on the treatment of varicose veins in teenagers with endovenous laser ablation of the great saphenous vein. Methods Five patients, aged 15–17 years, were qualified for surgery, based on typical signs and symptoms of chronic venous disease. Minimally invasive treatment with endovenous laser ablation of the great saphenous vein was applied. Results The technical success of surgery was achieved in all patients. Over a 2-year follow-up we did not observe any case of recanalisation of the great saphenous vein, recurrence of varicose veins, or serious complications, such as deep vein thrombosis or pulmonary embolism. One patient presented with resolving of post-operative bruising, and two cases of local numbness were transient. Conclusions Endovenous laser ablation of the great saphenous vein in the treatment of chronic venous disease in teenagers is effective and safe. The method provides excellent cosmetic effects, very short recovery time and high levels of patient satisfaction.

scholarly journals Cytokines Produced by Lymphocytes in the Incompetent Great Saphenous Vein

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ewa Grudzińska ◽  
Andrzej Lekstan ◽  
Ewelina Szliszka ◽  
Zenon P. Czuba
Keyword(s):  
Saphenous Vein ◽  
Oscillatory Flow ◽  
Great Saphenous Vein ◽  
Interleukin 1 ◽  
Lymphocyte Culture ◽  
Chronic Venous Disease ◽  
Control Group ◽  
Venous Disease ◽  
Culture Supernatants ◽  
Necrosis Factor

The pathogenesis of chronic venous disease (CVD) remains unclear, but lately inflammation is suggested to have an important role in its development. This study is aimed at assessing cytokines released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting oscillatory flow (reflux) in GSV, blood was derived from the cubital vein and from the incompetent sapheno-femoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Interleukins (IL) 1β, 2, 4, 10, 12 (p70), and 17A; interleukin 1 receptor α (IL-1ra); tumor necrosis factor-α (TNF-α); interferon-gamma (IFN-γ); and RANTES were assessed in culture supernatants by the Bio-Plex assay. In both stimulated and unstimulated samples, in the examined group, IL-1β and IFN-γ had higher concentrations and RANTES had lower concentrations when compared to those in the control group. In the examined group, IL-4 and IL-17A had higher concentrations without stimulation and TNF-α had higher concentrations with stimulation. The GSV samples had higher IL-2, IL-4, IL-12 (p70), and IFN-γ concentrations without stimulation and lower IL-2 and TNF-α concentrations with stimulation when compared to those of the upper limb in the examined group. These observations indicate that the oscillatory flow present in incompetent veins causes changes in the cytokine production by lymphocytes, promoting a proinflammatory profile. However, the relations between immunological cells, cytokines, and the endothelium require more insight.

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

2015 ◽  
Vol 31 (5) ◽  
pp. 334-343 ◽  
Author(s):  
Jean Francois Uhl ◽  
Miguel Lo Vuolo ◽  
Nicos Labropoulos
Keyword(s):  
Lymph Node ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Normal Subjects ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Anatomical Dissection ◽  
Anatomical Finding

Objective To describe the anatomy of the lymph node venous networks of the groin and their assessment by ultrasonography. Material and methods Anatomical dissection of 400 limbs in 200 fresh cadavers following latex injection as well as analysis of 100 CT venograms. Routine ultrasound examinations were done in patients with chronic venous disease. Results Lymph node venous networks were found in either normal subjects or chronic venous disease patients with no history of operation. These networks have three main characteristics: they cross the nodes, are connected to the femoral vein by direct perforators, and join the great saphenous vein and/or anterior accessory great saphenous vein. After groin surgery, lymph node venous networks are commonly seen as a dilated and refluxing network with a dystrophic aspect. We found dilated lymph node venous networks in about 15% of the dissected cadavers. Conclusion It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks. Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

Anatomical and clinical factors favoring the performance of saphenous ablation and microphlebectomy or sclerotherapy as a single-stage procedure

2014 ◽  
Vol 30 (9) ◽  
pp. 627-631 ◽  
Author(s):  
AA Kokkosis ◽  
H Schanzer
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Class I ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Class Iii ◽  
Endovenous Ablation ◽  
Secondary Procedures ◽  
Extensive Class

Objective To identify the anatomical and clinical parameters that predict lack of regression of superficial varicosities after ablation of the great saphenous vein. Methods Symptomatic patients treated with endovenous ablation from August 2006 to July 2013, by a single surgeon, were included. Recorded parameters included age, sex, size, and extent of varicosities (class I–IV) (patient standing), and diameter and length (patient supine) of treated great saphenous vein. Varicose vein classification was defined as: class I ≤6 mm and localized to thigh or leg, class II ≤6 mm and present in the thigh and leg (extensive), class III >6 mm and localized to the thigh or leg, and class IV >6 mm and extensive. “Excellent” results were defined as complete resolution of varicosities, “good” results as incomplete resolution, and “poor” results as no improvement. Results A total of 267 patients and 302 consecutive limbs were included in the study. There were 175 females (65.5%), and the mean age was 54 years old (22–92). The CEAP classification was as follows: C2 (81.5%), C3 (6.3%), C4 (7.9%), C5 (2.0%), and C6 (2.3%). Great saphenous vein diameters was significantly larger in patients with C3–C6 (proximal 0.84 ± 0.25 versus 0.65 ± 0.21, p = < 0.0001, distal 0.58 ± 0.18 versus 0.44 ± 0.13, p < 0.0001) or class III–IV varicose veins (proximal 0.85 ± 0.25 versus 0.75 ± 0.27, p = 0.012, distal 0.62 ± 0.62 versus 0.50 ± 0.17, p < 0.0001). Class III–IV limbs had a “good/poor” result 69.8% of the time, as compared to 51.9% of the limbs class I–II varicose veins (p = 0.002). Conclusions Advanced chronic venous disease (C3–C6) patients have larger diameter great saphenous veins, reflecting the progressive nature of the disease. Patients with more severe varicosities regardless of CEAP class were more likely to require a secondary procedure. The severity of the varicosities may not correlate with the degree of venous disease, but it is an indication of which patients should undergo secondary procedures, possibly with a one-stage approach.

scholarly journals Variants of Localization and Extension of Hypo- and Aplasia of the Great Saphenous Vein in Patients with Primary Varicose Great Saphenous Veins

2019 ◽  
Vol 25 (2) ◽  
Author(s):  
Rostyslav Sabadosh
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Lower Limbs ◽  
Ultrasound Scan ◽  
Saphenous Veins ◽  
Vein Segment ◽  
Surgical Tactics ◽  
The Relationship

The objective of the research was to improve the diagnostics and treatment of patients with primary varicose great saphenous veins by studying their frequency and systematizing the variants of localization and extension of great saphenous vein hypoplasia and aplasia in its trunk. Materials and Methods. The study included 560 patients with varicose veins of the lower limbs and pathological refluxes in different segments of the great saphenous vein. All the patients underwent triplex ultrasound scan of the lower limb venous system. Results. Among the patients with pathological reflux in a certain GSV segment, hypo- and aplasia of its segments were observed in 32.5% of the cases (95% CI 28.6-36.6%). Aplasia of this vein was observed twice as less frequently than hypoplasia (p<0.05). In 2.3% of the cases (95% CI 1.2-3.9%), hypoplasia of a certain GSV segment evolved to aplasia, or vice versa. It was found that the GSV trunk may have several hypo- or aplastic regions separated by its normal or varicose segment – bi-level hypo- or aplasia that was observed in 3.8% of the patients with hypo- or aplasia (95% CI 1.6-7.8%). In bi-level hypo- or aplasia, 2 hypoplastic regions were detected in 85.7% of the cases (95% CI 42.1-99.6%) and 2 aplastic regions were found in 14.3% of the cases (95% CI 0.4-57.9%). There were proposed to distinguish the following variants of GSV hypo- and aplasia: 1) simple: total, proximal, segmental and distal; 2) bi-level: proximal segmental, distal segmental and bi-segmental. In addition, for every dysplastic vein segment, the type of malformation should be indicated, namely hypoplasia, aplasia, or hypo/aplasia. Conclusions. The study conducted allowed assessing the relationship between the variants of GSV hypo- and aplastic segment localization and extension and different variations of pathological refluxes of the GSV in its trunk for further choice of surgical tactics.

scholarly journals Persistent below-knee great saphenous vein reflux after above-knee endovenous laser ablation with 1470-nm laser: a prospective study

2016 ◽  
Vol 15 (2) ◽  
pp. 113-119
Author(s):  
Walter Junior Boim de Araujo ◽  
Jorge Rufino Ribas Timi ◽  
Carlos Seme Nejm Junior ◽  
Fabiano Luiz Erzinger ◽  
Filipe Carlos Caron
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Test Group ◽  
Clinical Severity ◽  
Control Group ◽  
Venous Disease ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score

Abstract Background In endovenous laser ablation (EVLA), the great saphenous vein (GSV) is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease. Objectives To evaluate clinical and duplex ultrasound (DUS) outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins. Methods Thirty-six patients (59 GSVs) were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS) and a test group (33 GSVs with below-knee reflux). Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS), and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months. Results Mean patient age was 45 years, and 31 patients were women (86.12%). VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month). However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year). Conclusions These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

Prevalence and Patterns of Small Saphenous Vein Reflux

2009 ◽  
Vol 33 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Diana L. Neuhardt ◽  
Sergio X. Salles–Cunha ◽  
Nick Morrison
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Signs And Symptoms ◽  
Clinical Severity ◽  
Common Pattern ◽  
Voluntary Service ◽  
Valvular Insufficiency ◽  
Vein Reflux

Objective The small saphenous vein (SSV) often is a forgotten source of venous valvular insufficiency signs and symptoms or is a “victim” of unwillingness to treat. Either way, ultrasound (US) frequently focuses on the great saphenous vein without an equivalent thorough evaluation of the SSV. We investigated the prevalence and patterns of SSV reflux during a voluntary service to the community of Santiago de Guayaquil in Ecuador. Methods Patients were screened for SSV reflux while standing. A portable laptop scanner was used to examine the SSV at the proximal, mid, and distal calf (positions A, B, and C) in 410 legs of 205 subjects. Although all patients were C1 – C6 according to the clinical CEAP (i.e., clinical severity, etiology or cause, anatomy, and pathophysiology) classification, 14% of the legs were C0. Forward and reverse flows were noted after a variety of manual compressions. Only severe reflux lasting longer than 4 seconds is reported herein. Results The prevalence of SSV abnormalities was 17% (69/410). Reflux was noted in 54 (13%) of the extremities whereas in 15 (4%), the SSV did not have reflux but was intertwined with the pathways of varicose veins. The diameters of the refluxing veins were related to the location and extent of reflux. The most common pattern was reflux in the A, B, and C positions (n = 17) of SSV averaging 4.6 (A) to 4.4 mm (C) in diameter. Reflux was noted in the AB, A, and B positions in 10, 11, and 12 SSV, respectively; diameters of these veins averaged 4.1 (A) to 3.7 mm (B), 4.1 mm (A), and 3.4 mm (B). SSV reflux in the B and C and C only positions were least common (n = 4), noted in veins averaging 2.5 mm in diameter. Varicose veins interconnected with short SSV segments were noted in all three positions (A, B, and C) in seven legs whereas in eight legs the varicosities were segmental, most commonly in the B position (n = 6). Conclusions The prevalence of SSV abnormalities was significant. SSV reflux or connection to varicose veins was noted in close to one of five legs. The SSV should be evaluated at least at the proximal and mid calf to avoid missing significant reflux.

More great saphenous vein valves - less varicose veins?

VASA ◽  
2014 ◽  
Vol 43 (4) ◽  
pp. 260-265 ◽  
Author(s):  
Anna-Barbara Gräub ◽  
Markus Naef ◽  
Hans E. Wagner ◽  
Wolfgang G. Mouton
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Valve Disease ◽  
Venous Disease ◽  
Consecutive Series ◽  
Macroscopic Appearance ◽  
Disease Class ◽  
Venous Valves ◽  
Ceap Classification

Background: In patients with chronic venous disease (CVD) the number of venous valves and the degree of valve deterioration have not been extensively investigated and are poorly understood. The aim of this prospective study was to quantitatively and qualitatively investigate the venous valves in CVD patients in view of their clinical classification. Patients and methods: Within two years a consecutive series of 152 patients (223 limbs) undergoing primary surgery for great saphenous vein varicose veins was investigated. In all patients the ‘C’ class according to the basic CEAP-classification was registered preoperatively (C2 to C6) for each limb. Both the quantity and quality of venous valves were assessed in the GSV’s after removal. Qualitative evaluation of the valves was based on macroscopic appearance using a classification from 0 to 5 and described as ‘valve disease class’. Results: A negative correlation between age and the number of valves was detected (p = 0.0035). There was an increase of C-class with increasing age. No significant correlation between the average number of valves per meter and the C-class was detected. For all C-classes an average of between four and five valves per meter was counted. Valve disease class was positively correlated with the C-class although the valve disease class was never higher than the C-class (p < 0.05). Conclusions: The valve disease class of the great saphenous vein correlates with the C-class of the CEAP-classification. The number of valves did not correlate with the ‘C’-class. With each increase in the CEAP class the age increased as well.

scholarly journals Efficacy of varicose vein surgery with preservation of the great safenous vein

2015 ◽  
Vol 42 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Bernardo Cunha Senra Barros ◽  
Antonio Luiz de Araujo ◽  
Carlos Eduardo Virgini Magalhães ◽  
Raimundo Luiz Senra Barros ◽  
Stenio Karlos Alvim Fiorelli ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Venous Disease ◽  
Varicose Vein Surgery ◽  
Beneficial Effects ◽  
Venous Clinical Severity Score

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001). CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

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