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.

Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

1996 ◽  
Vol 11 (3) ◽  
pp. 98-101 ◽  
Author(s):  
P. Zamboni ◽  
C.V. Feo ◽  
M. G. Marcellino ◽  
G. Vasquez ◽  
C. Mari
Keyword(s):  
Saphenous Vein ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Vein Thrombosis ◽  
Long Saphenous Vein ◽  
Group A ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein ◽  
Group B

Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

The Elastic Properties of the Human Great Saphenous Vein in Relation to Primary Varicose Veins

1974 ◽  
Vol 52 (2) ◽  
pp. 153-157 ◽  
Author(s):  
J. Kenneth Booking ◽  
Margot R. Roach
Keyword(s):  
Elastic Properties ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Simultaneous Measurements ◽  
Saphenous Veins ◽  
Before And After ◽  
Laplace’S Law ◽  
Primary Varicose Veins ◽  
Laplace's Law

Simultaneous measurements of pressure and volume were made on nine great saphenous veins obtained at autopsies and nine great saphenous veins that were stripped during surgery from patients with primary varicose veins. Similar measurements were also made on six great saphenous veins obtained at autopsy before and after they were held at 100 cm H2O for 4 h. Circumferential tensions were calculated from Laplace's law (tension = pressure × radius).The great saphenous veins from patients with primary varicose veins had significantly greater radii and were more distensible than the normal great saphenous veins. After being held at 100 cm H2O for 4 h, the normal great saphenous veins became less distensible and their radii at distending pressures increased.Due to the great difference in radii, the circumferential tension on a great saphenous vein from a patient with primary varicose veins is much greater than that on a normal great saphenous vein at the same distending pressure. However, the physical stresses exerted on the great saphenous veins during the stripping operations may influence our results in some unknown way.

Venous Muscle Pump Improvement by Low Compression Elastic Stockings

1986 ◽  
Vol 1 (2) ◽  
pp. 97-103 ◽  
Author(s):  
Jan Struckmann ◽  
Søren Jesper Christensen ◽  
Axel Lendorf ◽  
Frits Mathiesen
Keyword(s):  
Venous Return ◽  
Varicose Veins ◽  
Return Time ◽  
Physiological Effect ◽  
Compression Stocking ◽  
Subjective Improvement ◽  
Muscle Pump ◽  
Before And After ◽  
Elastic Stockings ◽  
Primary Varicose Veins

The physiological effect of a graduated low compression stocking T.E.D.(R) (Kendall Co.) was evaluated by plethysmographic musculo-venous pump determination in 22 patients with primary varicose veins. A hip length T.E.D.(R) stocking was worn for a 6-week period. Efficiency of the musculo-venous pump was determined before and after treatment and a significant increase in venous return time (RT) and expelled volume (EV) was demonstrated. This was accompanied by subjective improvement. The pressure exerted by the stockings was measured in 20 legs by the Borgnis and Van den Berg method, and the pressure was in all cases below 15 mmHg. Effect of such low compression has not previously been documented for expelled volume in patients with varicose veins.

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.

scholarly journals Modification of Primary Avalvular Varicose Anomaly after endovenous radiofrequency ablation

Phlebologie ◽  
2019 ◽  
Vol 48 (06) ◽  
pp. 373-376
Author(s):  
Daniele Bissacco ◽  
Silvia Stegher ◽  
Fabio Massimo Calliari ◽  
Marco Piercarlo Viani
Keyword(s):  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Ultrasound Examination ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Invasive Procedure ◽  
Before And After ◽  
Primary Varicose Veins ◽  
Partial Thrombosis

AbstractPrimary avalvular varicose anomaly (PAVA) is a new medical concept defined as primary varicose veins resembling neovascularized tissue on ultrasound examination. PAVAs could be misdiagnosed as recurrence at the saphenofemoral or saphenopopliteal junction, but no studies have yet examined their role before and after venous invasive procedure. In this report, we describe a case of PAVA in a 39-year-old man with symptomatic varicose veins and great saphenous vein truncal incompetence. Six months after radiofrequency ablation of the great saphenous vein, duplex ultrasound revealed complete occlusion of great saphenous vein and partial thrombosis of the still incompetent PAVA.

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).

Videophlebography with Foot Venous Pressure Measurements: Description of a Technique for Diagnosing Venous Dysfunction

1997 ◽  
Vol 12 (3) ◽  
pp. 100-106 ◽  
Author(s):  
O. Björgell ◽  
O. Ekberg ◽  
H. Åkesson ◽  
R. Olsson
Keyword(s):  
Preoperative Evaluation ◽  
Venous Pressure ◽  
Video Recording ◽  
University Hospital ◽  
Pressure Measurements ◽  
Combined Approach ◽  
Venous Anatomy ◽  
Venous Valves ◽  
Venous Function ◽  
Deep Vein

Objective: To introduce phlebography with simultaneous video recording of the fluoroscopy (VIP, videophlebography), to improve phlebography performed in patients with venous dysfunction. Ambulatory foot venous pressure (AVP) was measured in the same session. Design: Descriptive study of an improved phlebographic technique. Setting: University Hospital MAS, Malmö, Sweden. Study group: Forty-one consecutive patients (50 legs) referred to phlebographic investigation. In the last 27 legs the AVP was also measured. Intervention: Phlebography with video recording and measurement of AVP. Results: In 49 out of 50 (98%) of the VIPs, information allowing a detailed description of venous function was obtained. Normal closing of venous valves, seen on the ascending VIP, combined with a normal venous pressure made it possible to exclude deep vein incompetence and avoid descending phlebography. In 16 out of 27 legs (59%) this combined approach showed that descending phlebography was unnecessary. Conclusion: VIP provides an adequate image of the venous anatomy, important in preoperative evaluation. The combination of this technique with AVP may clarify the pathophysiological abnormalities resulting from the venous dysfunction.

Druckgradient in den Beinvenen während der Betätigung der Wadenpumpe

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 187-190 ◽  
Author(s):  
Cestmir Recek ◽  
Pojer
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Venous Pressure ◽  
Standing Position ◽  
Quiet Standing ◽  
High Ligation ◽  
Long Saphenous Vein ◽  
Primary Varicose Veins ◽  
Reflux Recurrence

Background: Neovascularization is an important cause of venous reflux recurrence after high ligation of the long saphenous vein. The pathogenesis of this phenomenon is so far obscure. It is possible that a hemodynamic factor – a pressure gradient between the femoral vein and the residual long saphenous vein – could be the trigger initiating the process of neovascularization. Patients and methods: Venous pressure measurements on eight patients with primary varicose veins were performed in the erect position in the insufficient long saphenous vein on the thigh. Mean pressures in the quiet standing position and ambulatory pressures were considered. By interrupting the saphenous reflux either distally or proximally to the point of measurement the pressure conditions either in the femoral or in the crural veins were simulated. Results: With the tourniquet placed distally to the point of measurement, the venous pressure in the upper interrupted segment of the long saphenous vein (equivalent to the pressure in the femoral vein) remained uninfluenced during ambulation. In contrast, by interrupting the reflux proximally to the point of measurement, a marked decrease of the ambulatory pressure in the lower part of the long saphenous vein (equivalent to the pressure in the crural veins) was noted. Conclusions: A pressure difference occurs between the veins of the thigh and the lower leg during the activation of the muscle venous pump. This fact may explain the tendency of recurrencies of varicose veins after high ligation of the long saphenous vein as well as the initiation of reflux.

Competent and incompetent calf perforators in primary varicose veins: a resistant myth

2016 ◽  
Vol 31 (8) ◽  
pp. 532-540 ◽  
Author(s):  
Cestmir Recek
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Venous Hypertension ◽  
Flow Measurements ◽  
Posterior Tibial ◽  
Primary Varicose Veins ◽  
Bidirectional Flow

The pathophysiology of calf perforators is presented. Bidirectional flow within calf perforators with a prevailing inward, into deep veins oriented component arises during calf pump activity in varicose vein patients, as evidenced by venous pressure measurements, plethysmographic findings, duplex ultrasonography, and electromagnetic flow measurements. Reflux within calf perforators is an inward, not outward, flow; the opinion that the outward flow within calf perforators is a reflux is at odds with the reality. During calf muscle contraction, the pressure in the posterior tibial vein is higher than in the great saphenous vein; it induces the harmless outward flow within calf perforators, which runs further via great saphenous vein in the physiological direction toward the heart. Deep and superficial veins of the lower leg form conjoined vessels, as documented by nearly equal pressure curves registered simultaneously in the posterior tibial and great saphenous veins both in varicose vein patients and in healthy people. Calf perforators do not entail ambulatory venous hypertension or any other hemodynamic disorder, even if enlarged and incompetent; their ligation is needless. The diameter of calf perforators is influenced by the intensity of saphenous reflux; it enlarges with increasing intensity of saphenous reflux and diminishes after the abolition of reflux.

scholarly journals 224. Effect of Easing Overnight Restrictions on Antimicrobial Starts

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S113-S113
Author(s):  
Michael E Yarrington ◽  
Rebekah Wrenn ◽  
Justin Spivey ◽  
Christopher Shoff ◽  
Steven S Spires ◽  
...  
Keyword(s):  
Phase Shift ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Early Morning ◽  
University Hospital ◽  
Hospital Data ◽  
Process Change ◽  
Research Support ◽  
Before And After ◽  
The Hours

Abstract Background Some institutions allow administration of restricted antibiotics overnight until evaluation the following day (i.e. first dose free) to adapt to limitations in personnel resources. Whether this method results in higher number of overnight requests compared to strict 24/7 preauthorization has not been fully described. Methods In October 2019, Duke University Hospital (DUH) changed from strict preauthorization to allow initiation of two restricted agents (meropenem and micafungin) between the hours of 11pm to 7am. We performed an interrupted time series (ITS) analysis to evaluate the phase shift and change in trend in the number of new meropenem and micafungin orders per week before (Jan 2019-Oct 2019) and after (Oct 2019- Mar 2020) the process change. First antimicrobial orders for meropenem and micafungin were counted for unique patient encounters. We fit a Gaussian distribution function to the number of orders per hour of day to estimate the percent of orders initiated overnight (11p-7a) and during day/evening hours (7a-11p) before and after the process change. Results Hospital data included 1728 new meropenem and micafungin orders over a 61-week period (~28 per week). The total number of meropenem and micafungin orders was constant between Jan 2019 and October 2019 (+0.07 orders/week, 95% CI -0.13 to 0.27, Figure 1) and the phase shift during the first week of October was non-significant (-4.38 orders, 95% CI -12.34 to 3.58). The number of orders increased after October 2019 (+0.70 orders/week, 95% CI 0.13 to 1.25), however a sensitivity analysis removing the largest outlier eliminates significance. The percent of total orders between 11am to 7pm increased from 13.3% to 17.2% after the intervention (Figure 2). Overall antibiotic use remained similar through the study period. Figure 1. Estimated Approvals per Week Figure 2. Approvals by Hour of Day Conclusion There was no significant immediate change in overnight prescribing of meropenem and micafungin, however a trend towards increased number of orders appeared after removing overnight restriction requirements. Instead of “stealth dosing”, where providers wait to enter restricted antibiotic orders until evening hours, we observed a small increase in starts in early morning hours (1am-6am). Preauthorization approaches must adapt to personnel resources and quality of life for antimicrobial stewards. Disclosures Michael J. Smith, MD, MSC.E, Kentucky Medicaid (Grant/Research Support)Merck (Grant/Research Support) Rebekah W. Moehring, MD, MPH, Agency for Healthcare Quality and Research (Grant/Research Support)Centers for Disease Control and Prevention (Grant/Research Support)

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