Correlation Between Various Definition of Superficial Venous Reflux and Clinical Presentation of Venous Disease

2018 ◽  
Vol 42 (4) ◽  
pp. 189-192
Author(s):  
Mehrdad Mac Farid ◽  
Bernardo Fernandez ◽  
Szilvia Udvari-Nagi ◽  
Suresh Kacham ◽  
Tracey Mountjoy Cross ◽  
...  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Presentation ◽  
Primary Objective ◽  
Venous Disease ◽  
Venous Reflux ◽  
Saphenous Veins ◽  
Anatomic Distribution ◽  
Definition Of ◽  
Saphenofemoral Junction

There have been various ways of reporting venous reflux in chronic venous insufficiency (CVI). Some vascular laboratories tend to describe venous reflux with categorical presence of reflux and some use grading method by measuring duration of venous reflux in seconds. The primary objective of study is to find out which method of describing venous incompetency in superficial venous system at great saphenous veins (GSV) and saphenofemoral junction (SFJ) would best correlate with clinical presentation of venous disease using CEAP (clinical manifestation, etiologic factors, anatomic distribution, pathophysiologic dysfunction) classification.

scholarly journals Clinical Presentation and Patterns of Venous Reflux in Thai Patients with Chronic Venous Insufficiency (CVI)

2010 ◽  
Vol 40 (3) ◽  
pp. 399-402 ◽  
Author(s):  
B. Kanchanabat ◽  
Y. Wongmahisorn ◽  
W. Stapanavatr ◽  
P. Kanchanasuttirak ◽  
A. Manomaiphiboon
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Presentation ◽  
Venous Reflux

Epidemiology of Chronic Venous Insufficiency

1996 ◽  
Vol 11 (1) ◽  
pp. 2-5 ◽  
Author(s):  
F. G. R. Fowkes
Keyword(s):  
General Population ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Disease ◽  
Skin Changes ◽  
Medline Search ◽  
Study Selection ◽  
Varicose Ulcer ◽  
Definition Of

Objective: To determine the prevalence of chronic venous insufficiency in the general population and its association with varicose veins. Data sources: MEDLINE search 1980–94 plus scanning of reference lists in articles obtained. Study selection: Studies on venous disease in subjects not attending health services. Data synthesis: A formal systematic review of metaanalysis was not carried out because of the heterogeneity of the few available studies. Skin changes were found to occur in over 3% of adults, more so in women than men. The prevalence was higher in subjects with varicose veins and depended on the definition of skin changes and the severity of varicose veins. Approximately 0.3% of adults had an open varicose ulcer, and around 1% had an open or healed ulcer. Prevalence was higher in women and increased with age. Conclusions: The prevalence of chronic venous insufficiency was found to be common in the general population, but more studies of distribution and aetiology are required.

Not Just a Dog Bite: Unmasking Underlying Chronic Venous Insufficiency

2020 ◽  
Vol 44 (4) ◽  
pp. 203-206
Author(s):  
Jessica Kralec
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Chronic Wound ◽  
Great Saphenous Vein ◽  
Venous Stasis ◽  
Dog Bite ◽  
Venous Reflux ◽  
Area Of Concern ◽  
The Right ◽  
Saphenofemoral Junction

An 81-year-old man sustained a dog bite to his right lateral calf. Despite antibiotics, the patient continued to have leg swelling, severe itching, and a chronic wound. He was evaluated at the Wound Center, at which time a diagnosis of chronic venous insufficiency was made, and a venous reflux examination was recommended. The patient was scanned using Intersocietal Accreditation Commission Vascular Testing venous reflux protocol. Imaging was directed to the area of concern at the lateral calf. A 1.1-mm vein branch off the proximal calf great saphenous vein (GSV) was identified under the itching/trauma area with venous reflux identified. Venous reflux examination findings identified significant venous reflux from the right saphenofemoral junction through the distal calf GSV and vein branches. An elective right GSV endothermal venous ablation and stab phlebectomy were performed. The patient returned per protocol on postoperative day 2. He reported no pain and complete resolution of itching. Physical examination demonstrated marked improvement in the excoriated area. Surveillance duplex revealed no evidence of an endovenous heat-induced thrombosis. Venous stasis dermatitis occurs when there is inflammation of the skin caused by chronic venous insufficiency. In the early stages, symptoms include swelling at the ankles, hyperpigmentation, dryness, and itching. The development of stasis dermatitis can be precipitated by trauma, thereby unmasking underlying chronic venous insufficiency. Stasis dermatitis in this patient resolved because we treated the cause: chronic venous insufficiency.

Venous Reflux Localization: Comparative Study of Venography and Duplex Scanning

1993 ◽  
Vol 8 (3) ◽  
pp. 124-127 ◽  
Author(s):  
L. I. Valentín ◽  
W. H. Valentín ◽  
S. Mercado ◽  
C. J. Rosado
Keyword(s):  
Ultrasound Imaging ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Femoral Vein ◽  
Duplex Ultrasound ◽  
Duplex Scanning ◽  
Venous Disease ◽  
Superficial Femoral Vein ◽  
Saphenous Veins ◽  
Prospective Comparison

Objective: To compare the results obtained by duplex ultrasound imaging and ascending and descending phlebography in patients with chronic venous insufficiency. Design: Prospective comparison between venography and duplex ultrasound imaging in a single patient group with chronic venous insufficiency. Setting: Private vascular clinic in Puerto Rico. Patients: Twenty-one patients presenting with clinical evidence of venous disease of the lower limb. Main outcome measures: Presence of valvular incompetence in deep and superficial veins as indicated by duplex ultrasound imaging and ascending and descending phlebography. Results: Duplex ultrasound imaging showed twice as many patients with popliteal vein incompetence (eight veins compared with four veins) and twice as many incompetent long saphenous veins (14 detected by duplex, eight detected by venography). In the proximal venous system, 13 common femoral veins were thought incompetent on venography, but only seven on duplex scanning; in the superficial femoral vein, 11 were incompetent on venography and three on duplex scanning. Conclusion: Duplex ultrasound scanning provides greater sensitivity for detection of valvular incompetence in distal veins compared with venography. Descending phlebography is poor in demonstrating distal venous valvular incompetence.

Cellular senescence at the saphenofemoral junction in patients with healthy, primary varicose and recurrent varicose veins – A pilot study

Vascular ◽  
2021 ◽  
pp. 170853812110128
Author(s):  
Dominic Mühlberger ◽  
Anne-Katrin Zumholz ◽  
Erich Brenner ◽  
Achim Mumme ◽  
Markus Stücker ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cellular Senescence ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Common Finding ◽  
Venous Disease ◽  
Venous Reflux ◽  
Recurrent Varicose Veins ◽  
Primary Varicose Veins ◽  
Saphenofemoral Junction

Objectives Cellular senescence could play a role in the development of venous disease. Superficial venous reflux at the saphenofemoral junction is a common finding in patients with primary varicose veins. Furthermore, reflux in this essential area is associated with higher clinical stages of the disease and recurrent varicose veins. Therefore, this pilot study aimed to investigate cellular senescence in the immediate area of the saphenofemoral junction in patients with healthy veins, primary varicose veins and additionally in patients with recurrent varicose veins due to a left venous stump. Methods We analyzed vein specimens of the great saphenous vein immediately at the saphenofemoral junction. Healthy veins were collected from patients who underwent arterial bypass reconstructions. Samples with superficial venous reflux derived from patients who received high ligation and stripping or redo-surgery at the groin, respectively. Sections were stained for p53, p21, and p16 as markers for cellular senescence and Ki67 as a proliferation marker. Results A total of 30 samples were examined (10 healthy, 10 primary varicose, and 10 recurrent varicose veins). We detected 2.10% p53+ nuclei in the healthy vein group, 3.12% in the primary varicose vein group and 1.53% in the recurrent varicose vein group, respectively. These differences were statistically significant ( p = 0.021). In the healthy vein group, we found 0.43% p16+ nuclei. In the primary varicose vein group, we found 0.34% p16+ nuclei, and in the recurrent varicose vein group, we found 0.74% p16+ nuclei. At the p < 0.05 level, the three groups tended to be significant without reaching statistical significance ( p = 0.085). There was no difference in respect of p21 and Ki67. Conclusion We found significantly higher expression rates of p53 in primary varicose veins at the saphenofemoral junction than in healthy veins. p16 expression tended to be increased in the recurrent varicose vein group. These preliminary findings indicate that cellular senescence may have an impact in the development of varicose veins or recurrence. Further studies addressing this issue are necessary.

scholarly journals Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Mustafa Dogdus ◽  
Onur Akhan ◽  
Mehmet Ozyasar ◽  
Ahmet Yilmaz ◽  
Mehmet Sait Altintas
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
High Morbidity

Background and Objectives. Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. Methods. Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. Results. The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. Conclusions. PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

The Epidemilogy of Chronic Venous Ulcer: Some Unanswered Questions

2000 ◽  
Vol 15 (3-4) ◽  
pp. 106-109
Author(s):  
C. V. Ruckley
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Epidemiological Studies ◽  
Therapeutic Interventions ◽  
Venous Disease ◽  
Clinical Classification ◽  
Age Related

Objective: To highlight gaps in knowledge concerning the epidemiology of chronic venous insufficiency and to indicate what future studies are required. Methods: Existing classifications are compared. Limitations of epidemiological studies are defined. Data from published series and from the Edinburgh Vein Study are presented. Synthesis: The Basle 1978 classification of chronic venous insufficiency (CVI) is a purely clinical classification in which the earliest grade is corona phlebectatica. The Porter 1988 classification of CVI attempted to correlate clinical grades with sites of venous incompe-tence. However, a consistent relationship does not exist. The CEAP classification separates the clinical grades (which do not include corona phlebectasia) from the anatomical segments. The CEAP clinical classification covers a range of venous manifestations but is not consistent. There is a need for further consideration of classifications. Published selected series of patients show that the frequency of incompetence in both deep and superficial systems increases in proportion to the severity of the clinical manifestations of venous disease. To understand the significance of these data we need to know the patterns of venous incompetence in the general population. Data from 1566 subjects between the ages of 18 and 64 years in the Edinburgh Vein Study, a randomly selected cross-section of members of the Edinburgh population, showed that the prevalence of CVI was age-related and was present in 9.2% of men and 6.6% of women. Men had a significantly higher frequency of reflux in the deep system than women. In order to direct therapeutic interventions where they are most appropriate we need to know which patients with the early stages of varicose veins progress to CVI and which patients with early CVI progress to the serious skin complications. Conclusions: Key information concerning the natural history of venous disease and its evolution in relation to haemodynamic abnormalities awaits the findings of longitudinal-cohort epidemiological studies which include the duplex scanning of large populations.

Three Tests of Microcirculatory Function in the Evaluation of Treatment for Chronic Venous Insufficiency

1990 ◽  
Vol 5 (3) ◽  
pp. 165-172 ◽  
Author(s):  
T. R. Cheatle ◽  
G. M. McMullin ◽  
J. Farrah ◽  
P. D. Coleridge Smith ◽  
J. H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Subcutaneous Fat ◽  
Intermittent Pneumatic Compression ◽  
Laser Doppler ◽  
Response To Treatment ◽  
Venous Disease ◽  
Doppler Flowmetry ◽  
Xenon Clearance ◽  
Microcirculatory Function

No investigation exists which has been shown to detect accurately microcirculatory improvement following treatment for chronic venous insufficiency. This study examines three possible techniques for doing so. Fourteen patients with chronic venous insufficiency and fourteen controls underwent measurement of transcutaneous PO2, 133xenon clearance from the skin and subcutaneous tissues and laser–Doppler flowmetry in the gaiter region. Patients with venous disease then followed a regime of intermittent pneumatic compression for 4 h each day for 4 weeks. The same measurements were then repeated. Xenon clearance from subcutaneous fat and the time taken to reach maximal laser–Doppler flow after release of a tourniquet showed a significant improvement after compression treatment. These tests may be useful as parameters in the objective monitoring of response to treatment in patients with liposclerotic skin.

Anatomical Distribution of Chronic Venous Insufficiency in a Chinese Population

1999 ◽  
Vol 14 (1) ◽  
pp. 29-32 ◽  
Author(s):  
A. C. W. Ting ◽  
S. W. K. Cheng ◽  
L. L. H. Wu ◽  
G. C. Y. Cheung
Keyword(s):  
Chronic Venous Insufficiency ◽  
Chinese Population ◽  
Venous Insufficiency ◽  
Duplex Scanning ◽  
Venous Reflux ◽  
Anatomical Distribution ◽  
Group Iii ◽  
Vein Thrombosis ◽  
Group I ◽  
Deep Vein

Objective: To study the anatomical distribution of chronic venous insufficiency (CVI) in a Chinese population by means of duplex scanning. Procedures: A total of 582 limbs in 291 patients with primary venous insufficiency were classified clinically into three different groups according to SVS/ISCVS criteria and evaluated prospectively with duplex scanning. Results: One hundred and thirty-one limbs were classified into group I (CEAP clinical class 0), 291 into group II (CEAP clinical classes 1 and 2) and 160 into group III (CEAP clinical classes 3–6). Mixed deep and superficial venous incompetence was found in 70% and 83% of limbs in groups II and III, respectively. Reflux was also demonstrated in 73% of group I limbs. Conclusions: Most of our patients had mixed deep and superficial venous incompetence. The prevalence of deep venous incompetence in this population, in which deep vein thrombosis is rare, suggests a pattern of venous incompetence other than postphlebitic deep vein valvular dysfunction. The prevalence of reflux in the asymptomatic contralateral limbs implies a bilateral predisposition to venous reflux and thus a possible developmental origin of CVI.

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