A Reassessment of the Role of Perforating Veins in Chronic Venous Insufficiency

1990 ◽  
Vol 5 (2) ◽  
pp. 85-94 ◽  
Author(s):  
G.M. McMullin ◽  
H.J. Scott ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Reverse Flow ◽  
Venous Pressure ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Perforating Veins ◽  
Clinically Normal

Ambulatory venous hypertension is closely associated with the signs and symptoms of venous disease. It has been shown that reverse flow of blood in the superficial and deep veins is responsible. The pressure derangement caused by incompetence of perforating veins has not been established. The present study documents the pressure disturbances caused by incompetence in each of the three compartments of the venous system, the deep, the superficial and the perforating veins. In total 90 limbs of 49 patients with chronic venous insufficiency were examined and classified by duplex scanning and ascending venography. Ambulatory venous pressure measurements were performed on all 90 limbs and a venous sufficiency index (VSI) for each limb calculated from the percentage drop in pressure and refilling time. VSI was lowest in the group with deep vein incompetence (median 0.9, range 0–36.9), intermediate in the groups with superficial vein incompetence (median 7.6, range 0.4–59) and with incompetent perforating veins (median 14.6, range 0.4–35.7) and highest in the group with normal veins (median 41.7, range 3.5–87.5). The association of symptoms and VSI was also examined. The lower the VSI the more severe were the clinical symptoms and all ulcerated limbs had a VSI < 20. However a number of clinically normal limbs were also found to have low values of VSI.

Chronic Venous Insufficiency and the Therapeutic Effects of Daflon 500 mg

Angiology ◽  
2005 ◽  
Vol 56 (6_suppl) ◽  
pp. S21-S24 ◽  
Author(s):  
John J. Bergan
Keyword(s):  
Shear Stress ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Vena Cava ◽  
Venous Hypertension ◽  
Therapeutic Effects ◽  
Inflammatory Cascade ◽  
Perforating Veins ◽  
Days Of Therapy

Chronic venous insufficiency is linked to venous hypertension and forces of shear stress on the endothelium. Venous hypertension depends upon two forces: the weight of a column of blood from the right atrium transmitted through the valveless vena cava and iliac veins to the femoral vein, and pressure generated by contracting skeletal muscles of the leg transmitted through failed perforating veins. When valve failure occurs in superficial axial veins and perforating veins, the venous pressure in the veins and venules of the skin and subcutaneous tissue is raised. The skin changes in chronic venous insufficiency are directly related to the severity of the venous hypertension. Also, pathologic changes in the valves are linked to venous hypertension and leukocyte infiltration and activation. It is hypothesized that acute venous pressure elevations cause a shift in the venous hemodynamics with changes in wall shear stress. This initiates the inflammatory cascade. Daflon 500 mg ameliorates the effects of chronic inflammation. In randomized trials, 60 days of therapy with Daflon at a dosage of 500 mg 2 tablets daily was effective, in addition to elastic compression, in accelerating venous ulcer healing. Because venous insufficiency is linked to venous hypertension and an inflammatory reaction, it appears that Daflon 500 mg 2 tablets daily shows a great potential for accomplishing blockade of the inflammatory cascade.

Characteristics of venous insufficiency in western Turkey: VEYT-I study

2012 ◽  
Vol 27 (7) ◽  
pp. 374-377 ◽  
Author(s):  
B Akbulut ◽  
H İ UÇAr ◽  
M Öç ◽  
M İKizler ◽  
C Yorgancoğlu ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Demographic Data ◽  
Adult Population ◽  
Signs And Symptoms ◽  
Turkish Population ◽  
Venous Hypertension ◽  
Venous Disease ◽  
Health Care Centre ◽  
Western Turkey ◽  
Study Population

Objectives Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. Method Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. Results A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. Conclusion The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

Chronic venous insufficiency and post-thrombotic syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2817-2822
Author(s):  
Robert T. Eberhardt ◽  
Joseph D. Raffetto
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Surgical Techniques ◽  
Duplex Ultrasound ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Severity Of Disease ◽  
Venous Valves ◽  
Venous Function

Chronic venous disease is a common problem with a significant impact upon both afflicted individuals and the healthcare system. Normal venous function requires patency of the axial veins with a series of venous valves, and muscle pumps. Dysfunction of any of the normal structures may lead to venous hypertension and development of chronic venous insufficiency. There is a spectrum of manifestations of chronic venous insufficiency including skin changes and venous leg ulcers. Venous duplex ultrasound may be used to confirm the diagnosis and provide anatomical detail. The treatment of chronic venous insufficiency will be based on the severity of disease and guided by anatomical and pathophysiological considerations. Compressive garments have been a mainstay in treatment. Interventional methods have replaced many traditional surgical techniques but are still typically reserved for unsatisfactory response to conservative measures.

scholarly journals Therapeutic approach in patients with chronic venous insufficiency

2017 ◽  
Vol 12 (2) ◽  
pp. 28-32
Author(s):  
Marilena SPIRIDON ◽  
◽  
Dana CORDUNEANU ◽  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thrombus Formation ◽  
Venous Pressure ◽  
External Pressure ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stockings ◽  
Venous Valve ◽  
Severe Stage

Chronic venous insufficiency (CVI), frequent cause of lower limb edema, represents a severe consequence of the dysfunction of the venous valve, which results from the venous hypertension together with the degenerative processes at this level. CVI defines only the severe stages of the chronic venous disease (CVD), accompanied by morphological and functional damage, with significant alteration in quality of life. The treatment of CVI involves, depending on the severity of the case, a combination of general nonpharmacologic, pharmacologic, and surgical measures. Non-pharmacologic measures involve the use of a continuous and controlled external pressure represented by compression stockings which can significantly improve the venous return and lead to a major symptoms improvement. Pharmacologic treatment aims on one hand to alleviate hemodinamics by lowering blood viscosity, decreasing venous pressure and preventing intravascular thrombus formation and, on the other hand, restoring thevascular glycocalyx/endothelium, reducing parietal inflammation and increasing the venous wall tone. Within this pathology, sulodexide represents an innovative biological product with polypharmacological actions targeting more sites involved in the pathogenesis of CVD/CVI that alleviate hemodynamics and restore vascular structure which lead to a significant symptoms improvement and a slow disease progression. Surgery remains the procedure of choice in patients initially treated conservatively in whom symptoms persist or worsen, but also in case of those who already come to doctor in a severe stage of the disease.

Skin Blood Flow in Chronic Venous Insufficiency

1993 ◽  
Vol 8 (2) ◽  
pp. 72-76 ◽  
Author(s):  
S. K. Shami ◽  
S. J. Chittenden ◽  
J. H. Scurr ◽  
P. D. Coleridge Smith
Keyword(s):  
Blood Flow ◽  
Skin Temperature ◽  
Skin Blood Flow ◽  
Chronic Venous Insufficiency ◽  
Blood Cells ◽  
Venous Insufficiency ◽  
Normal Skin ◽  
Venous Disease ◽  
Clinically Normal ◽  
Normal Controls

Objective: To evaluate the skin temperature, laser Doppler flux (LDF), concentration of moving blood cells (CMBC) and speed of blood cells (SBC) in the liposclerotic and clinically normal skin of patients with chronic venous insufficiency. Design: Parallel groups study comparing patients with chronic venous insufficiency with control subjects. Setting: Vascular laboratory, Middlesex Hospital, University College and Middlesex School of Medicine, London, UK. Participants: Twenty patients with lipodermatosclerosis and chronic venous insufficiency comprised the disease group, and 15 subjects without venous disease comprised the control group. Main outcome measures: The skin temperature, LDF, CMBC and SBC were assessed in the gaiter area and on the dorsum of the foot. Results: A higher LDF (median LDF and interquartile range (IQR) = 132 (66–289), p = 0.001 (Mann-Whitney) and skin temperature (Median temperature and IQR = 31.1 (29.6–32.4), p = 0.001) was found in the liposclerotic skin of patients with chronic venous insufficiency compared with normal controls (median LDF and IQR = 49 (32–58); median temperature and IQR = 28 (27–30.3)). Similarly the LDF on the dorsum of the foot (median LDF and IQR = 73 (59–127), p = 0.03) and skin temperature on the dorsum of the foot (median temperature and IQR = 31.1 (30.4–32.1), p = 0.002) was significantly higher in the patients with chronic venous insufficiency compared with normal controls (median LDF and IQR = 55 (36–66), median temperature and IQR = 29.5 (26.7–30.7)). Conclusions: This study demonstrates that there is increased skin blood flow in both liposclerotic skin and clinically normal skin in patients with chronic venous insufficiency.

Does the Correction of Insufficient Superficial and Perforating Veins Improve Venous Function in Patients with Deep Venous Insufficiency?

1990 ◽  
Vol 5 (2) ◽  
pp. 113-123 ◽  
Author(s):  
H. Åkesson ◽  
L. Brudin ◽  
W. Cwikiel ◽  
P. Ohlin ◽  
G. Plate
Keyword(s):  
Venous Insufficiency ◽  
Venous Pressure ◽  
Clinical Results ◽  
Return Time ◽  
Venous Hypertension ◽  
Venous Reflux ◽  
Perforating Veins ◽  
Venous Circulation ◽  
Recurrent Ulcers ◽  
Superficial Venous Insufficiency

Thirty limbs in 25 patients with chronic deep venous insufficiency and recurrent ulceration were examined by ascending and descending contrast phlebography, occlusion plethysmography, foot volumetry and ambulatory venous pressure. Superficial venous insufficiency was surgically corrected by stripping of the saphenous vein and local excision of the varicosities (op1) in 12 limbs. Perforating venous insufficiency was then corrected by extensive subfascial ligation of perforating veins (op2) in all limbs. Venous outflow capacity, measured by occlusion plethysmography, and muscle pump function, measured by foot volumetry, were not affected by either procedure. Venous reflux, measured by foot volumetry, (Q/EVrel) and by venous pressure return time (RT90) improved significantly with op1 but no change was seen after op2. Venous hypertension decreased significantly with op1 but did not change after op2, and 59% of the limbs still had severe venous hypertension (> 60 mmHg) after both procedures. Initial clinical results were good, ulcers persisting in only three limbs, but recurrences occurred in an additional six limbs within 27 months. The limbs with persistent or recurrent ulcers had severe phlebographic reflux and severe venous hypertension. These results demonstrate that improvement in venous reflux and hypertension may be achieved by correction of superficial venous insufficiency, but the addition of ligation of perforating veins seems to be of less benefit to the venous circulation.

scholarly journals Diagnosis and treatment of varicose veins and chronic venous insufficiency

2020 ◽  
Vol 63 (12) ◽  
pp. 756-763
Author(s):  
Shin-Seok Yang
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Symptom Relief ◽  
Venous Pressure ◽  
Chronic Venous Disease ◽  
High Ligation ◽  
Venous Disease

This study aimed to review the pathophysiology of varicose veins and chronic venous insufficiency and the recent surgical treatment trend. Varicose veins are tortuous, twisted, or lengthened veins in the lower extremities. It is part of the spectrum of chronic venous disease. Primary pathogenesis is increased chronic venous hypertension caused by valvular insufficiency, venous outflow obstruction, and calf muscle pump failure. Some patients complain of no symptoms, except report cosmetic concerns. If the varicose vein progresses to chronic venous insufficiency, it may cause edema of the lower limb. The skin lesion can present as hyperpigmentation of the median part of the ankle, congestive dermatitis, and even a skin ulcer. The varicose vein can be diagnosed easily by visual inspection after identifying the skin lesions. For non-surgical treatment, elastic stocking, Unna boots, and pneumatic compression devices are recommended to reduce venous pressure. High ligation with stripping has been the standard treatment for varicose veins to achieve symptom relief and improve cosmetic effects. Endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, and the VenaSeal closure system have been introduced as surgical treatment methods. Recently, endovenous thermal/non-thermal ablations are recommended for treatment because both are less invasive techniques. The appropriate therapy should be selected after considering the patients’ symptoms and signs, anatomical structure, and economic burden of the treatment.

Prevalence, presentation and occupational risk factors of chronic venous disease in nurses

2015 ◽  
Vol 31 (2) ◽  
pp. 111-117 ◽  
Author(s):  
AI Diken ◽  
A Yalçınkaya ◽  
E Aksoy ◽  
S Yılmaz ◽  
K Özşen ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Working Conditions ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Occupational Risk Factors ◽  
Duration Of Hospital Stay ◽  
Work Burden

Objective In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. Methods Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. Results Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical–Etiology–Anatomy–Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left–right ankles and the mean duration of hospital stay. Conclusions Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency.

Venous Pressure Gradients in Patients with Chronic Venous Disease

1986 ◽  
Vol 1 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Einer Stranden ◽  
Per Øgreid ◽  
Egil Seem
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Pressure Gradients ◽  
Venous Valves ◽  
The Mean ◽  
The Difference ◽  
Pressure Changes

Venous pressure was measured simultaneously in a vein of the calf and the foot in five healthy controls and 10 patients with superficial chronic venous insufficiency (CVI). In both groups ambulatory venous pressure decreased more in the foot veins than in the calf veins. In patients with CVI the mean difference in foot and calf ambulatory venous pressure reduction (AVPR) was 25.5 mmHg, as was found in the controls (24.6 mmHg). During compression of superficial veins the difference in AVPR was reduced in patients but not in controls (11.6 vs 27.0 mmHg, respectively). About 50% of this difference in AVPR could be ascribed to the difference in cannulation height (except for the meaurement with superficial compression in patients where the whole difference in AVPR could be ascribed to the difference in cannulation height). Pressure changes during ambulation in the dorsal foot vein and calf veins may differ considerably, dependent on the existance of a specific foot vein pump and sufficiency of venous valves at the level of the ankle. Therefore, veins proximal to the ankle should be used for pressure recordings in the evaluation of chronic venous insufficiency in the calf.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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