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.

The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency

2007 ◽  
Vol 22 (5) ◽  
pp. 207-213 ◽  
Author(s):  
A Mdez-Herrero ◽  
J Gutiérrez ◽  
L Camblor ◽  
J Carreño ◽  
J Llaneza ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Clinical State ◽  
Control Group ◽  
Superficial Venous Insufficiency ◽  
Saphenofemoral Junction

Objective: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration. Methods: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group. Results: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive. Conclusions: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.

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 A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency

2017 ◽  
Vol 5 ◽  
pp. 2050313X1769293
Author(s):  
Roy Wesley Jones ◽  
Godfrey Ross Parkerson ◽  
Mary Ottinger ◽  
Eduardo Rodriguez ◽  
Brian Park
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Venous Aneurysm ◽  
Venous Stasis ◽  
High Ligation ◽  
Bilateral Lower Extremity ◽  
Duplex Imaging ◽  
The Right ◽  
Saphenofemoral Junction

Objective: We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. Methods: A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Results: Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Conclusion: Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

scholarly journals Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

2021 ◽  
Vol 18 (2) ◽  
pp. 151-153
Author(s):  
F. Kh. Nizamov
Keyword(s):  
Chronic Diseases ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Venous Stasis ◽  
Vein Wall ◽  
Vas Scores

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

scholarly journals Outcomes of knee-groin great saphenous vein stripping in patients with chronic venous insufficiency

2019 ◽  
Vol 3 (3) ◽  
pp. 09-12
Author(s):  
Dr. Ali Sapmaz ◽  
Dr. Serhan Yilmaz ◽  
Dr. Murat Özgür Kiliç ◽  
Dr. Betül Keskinkılıç Yağiz ◽  
Dr. Ahmet Serdar Karaca ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein

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

Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5–8 years after surgery

2014 ◽  
Vol 30 (8) ◽  
pp. 569-572 ◽  
Author(s):  
Alexandra E Ostler ◽  
Judy M Holdstock ◽  
Charmaine C Harrison ◽  
Barrie A Price ◽  
Mark S Whiteley
Keyword(s):  
Response Rate ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasonography ◽  
Venous Reflux ◽  
Primary Varicose Veins ◽  
And Inversion ◽  
Saphenofemoral Junction ◽  
Subfascial Endoscopic Perforator Surgery

Objective We have previously reported strip-tract revascularization 1 year following high saphenous ligation and inversion stripping. This study reports the 5–8 year results in the same cohort. Methods Between 2000 and 2003, 72 patients presented with primary varicose veins and had undergone high saphenous ligation and inversion stripping plus phlebectomies with or without subfascial endoscopic perforator surgery. Of the 64 patients who had attended for follow-up at 1 year, 35 patients (male:female, 16:19; 39 legs) underwent duplex ultrasonography 5–8 years after surgery (response rate 55%). Duplex ultrasonography was performed and all strip-tract revascularization and reflux and groin neovascularization was documented. Results Eighty-two percent of legs of patients showed some evidence of strip-tract revascularization and reflux. Full and partial strip-tract revascularization and reflux was seen in 12.8% and 59% of limbs of patients, respectively, and 10.2% limbs of patients had neovascularization only at the saphenofemoral junction only. Seven limbs of patients showed no revascularization. Conclusion Five to eight years after high saphenous tie and stripping, 82% of legs of patients showed some strip-tract revascularization and reflux and 12% showed total revascularization and reflux of the stripped great saphenous vein.

scholarly journals Comparison of the Hemodynamic Performance of Two Neuromuscular Electrical Stimulation Devices Applied to the Lower Limb

2020 ◽  
Vol 10 (2) ◽  
pp. 36
Author(s):  
Sahar Avazzadeh ◽  
Andrea O’Farrell ◽  
Kate Flaherty ◽  
Sandra O’Connell ◽  
Gearóid ÓLaighin ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Neuromuscular Electrical Stimulation ◽  
Venous Stasis ◽  
Western World ◽  
Neuromuscular Stimulation ◽  
Mean Velocity ◽  
Compression Bandages

Currently, 1% of the population of the Western world suffers from venous leg ulcers as a result of chronic venous insufficiency. Current treatment involves the use of moist wound healing, compression bandages, and intermittent pneumatic compression. Neuromuscular electrical stimulation is a novel potential new therapeutic method for the promotion of increased lower limb hemodynamics. The aim of this study was to measure the hemodynamic changes in the lower limb with the use of two neuromuscular electrical stimulation devices. Twelve healthy volunteers received two neuromuscular stimulation device interventions. The GekoTM and National University of Ireland (NUI) Galway neuromuscular electrical stimulation devices were randomized between dominant and non-dominant legs. Hemodynamic measurements of peak venous velocity (cm/s), the time average mean velocity (TAMEAN) (cm/s), and ejected volume (mL) of blood were recorded. Peak venous velocity was significantly increased by the GekoTM and the NUI Galway device compared to baseline blood flow (p < 0.0001), while only the voluntary contraction produced significant increases in TAMEAN and ejected volume (both p < 0.05). Neuromuscular muscular electrical stimulation can produce adequate increases in lower limb hemodynamics sufficient to prevent venous stasis. Greater use of neuromuscular stimulation devices could be considered in the treatment of conditions related to chronic venous insufficiency but requires further research.

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.

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