Role of ambulatory venous pressure measurement in the assessment of venous disease

2003 ◽  
Vol 18 (1) ◽  
pp. 23-29 ◽  
Author(s):  
F P Dix ◽  
C N McCollum
Keyword(s):  
Varicose Veins ◽  
Venous Pressure ◽  
Skin Condition ◽  
Venous Hypertension ◽  
Clinical Severity ◽  
Venous Disease ◽  
Duplex Imaging ◽  
Standard Assessment ◽  
Mean Pressure ◽  
Relationship Of

Objectives: The gold standard assessment of venous hypertension is ambulatory venous pressure (AVP). Aims of this study were to determine the relationship of AVP with clinical severity of venous disease and whether AVP accurately identifies sites of incompetence. Methods: 117 limbs (93 subjects) underwent classification of venous signs, duplex imaging and AVP measurement. Eleven limbs had no disease, 28 had varicose veins (VVs), 45 had chronic venous insufficiency, 15 had healed ulceration, and 18 had active ulceration. Results: Mean (standard error of the mean) pressure relief index (PRI) showed a step-wise decrease from 1794 (±317) in controls to 167 (±46) in active ulcers ( P <0.001, ANOVA). PRI correlated with clinical severity of venous disease (r = -0.60, P <0.01, Pearson). Superficial reflux alone was most common in VVs (60%), deep reflux in active ulceration (11%) and combined reflux in healed ulceration (93%). Tourniquet tests showed an increase in PRI only in combined reflux ( P <0.028, ANOVA). Conclusions: AVP correlates with skin condition but is inaccurate in identifying sites of incompetence.

Critical Buckling Pressure of Veins

2008 ◽  
Author(s):  
Ricky Martinez ◽  
Cesar A. Fierro ◽  
Hai-Chao Han
Keyword(s):  
Critical Pressure ◽  
Varicose Veins ◽  
Axial Strain ◽  
Venous Pressure ◽  
Underlying Mechanism ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Jugular Veins ◽  
Critical Buckling Pressure

Vein tortuosity is often seen as a consequence of venous hypertension and chronic venous disease. However, the underlying mechanism of vein tortuosity is unclear. The aim of this study was to test the hypothesis that hypertensive pressure causes vein buckling that leads to tortuous veins. We determined the buckling pressure of porcine jugular veins and tested the mechanical properties of these veins. Our results demonstrated that veins buckle when the transmural pressure exceeds a critical pressure that is not much higher than normal venous pressure. The critical pressure was found to be strongly related to the axial strain in the veins. Our results are useful in understanding the development of varicose veins.

scholarly journals Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management

2021 ◽  
Vol 10 (15) ◽  
pp. 3239
Author(s):  
Miguel A. Ortega ◽  
Oscar Fraile-Martínez ◽  
Cielo García-Montero ◽  
Miguel A. Álvarez-Mon ◽  
Chen Chaowen ◽  
...  
Keyword(s):  
Inflammatory Responses ◽  
Current Knowledge ◽  
Varicose Veins ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Significant Loss ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Environmental Agents

Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.

Endovenous management of varicose veins

2004 ◽  
Vol 19 (4) ◽  
pp. 163-169 ◽  
Author(s):  
S Soumian ◽  
A H Davies
Keyword(s):  
Varicose Veins ◽  
Signs And Symptoms ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Foam Sclerotherapy ◽  
High Prevalence ◽  
Promising Treatment ◽  
Developed World

Objective: Chronic venous disease has made a considerable socio-economical impact in the developed world due to its high prevalence and cost of management. Venous hypertension gives rise to significant signs and symptoms that are indications for treatment. Though the mainstay of treatment currently is surgery, it may not be the ideal choice in some cases considering the heterogeneous spectrum of venous disease. Recent alternative endovenous treatments have shown a lot of promise in successfully treating this condition. The aim of this review was to assess the long-term effectiveness of these treatments. Methods: A Medline-based review of literature was carried out. Results: Foam sclerotherapy seems to be a very promising treatment for venous disease, as short-term results have shown good results in terms of outcomes, low morbidity and cost. New endovenous techniques such as radiofrequency and laser ablation are attractive considering the absence of groin scar and subsequent neovascularization, as well as very little bruising and discomfort. Conclusions: There is no clear evidence yet regarding the long-term effectiveness of these relatively new endovenous techniques.

scholarly journals Venous ulcers of the lower limb: Where do we stand?

2012 ◽  
Vol 45 (02) ◽  
pp. 266-274 ◽  
Author(s):  
Chatterjee Sasanka S.
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Valsalva Maneuver ◽  
Adhesion Formation ◽  
Venous Hypertension ◽  
Long Term Results ◽  
Venous Disease ◽  
High Morbidity ◽  
Venous Ulcers ◽  
Vein Segment

ABSTRACTVenous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

Post-thrombotic syndrome: prevention is better than cure

2010 ◽  
Vol 25 (1_suppl) ◽  
pp. 14-19 ◽  
Author(s):  
M Saedon ◽  
G Stansby
Keyword(s):  
Health Care Services ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Compression Therapy ◽  
Poor Quality ◽  
Venous Hypertension ◽  
Clinical Scales ◽  
Post Thrombotic Syndrome ◽  
Care Services ◽  
Venous Valves

Post-thrombotic syndrome (PTS) can be debilitating to patients and have a major economic impact on health-care services. It arises after deep venous thrombosis (DVT) due to residual venous obstruction or valvular reflux, leading to increased venous pressure in the microcirculation. While the inflammatory process at the time of DVT may aid thrombus resolution, it may also promote destruction of venous valves. The diagnosis of PTS is principally clinical and patients typically complain of leg heaviness, swelling, pain, itching, cramps, ulcer and signs of lipodermatosclerosis. Several clinical scales or classifications have been used but it is recommended that Villalta scale is the most suitable. Risk factors for PTS include a proximal DVT and recurrent thrombosis as well as obesity and prior varicose veins. Poor quality of anticoagulation control may also be a factor. Established PTS is usually managed along the same lines as chronic venous hypertension with compression therapy and leg elevation. Surgery has only a limited role but may benefit some patients. Further trials are desperately needed to define the role of acute thrombolysis and mechanical thrombectomy, which seem to be promising treatments in the studies to date. For patients who have had a DVT more attention should be given to prescribing and using compression hosiery.

Mechanisms of varicose vein formation: valve dysfunction and wall dilation

2008 ◽  
Vol 23 (2) ◽  
pp. 85-98 ◽  
Author(s):  
J D Raffetto ◽  
R A Khalil
Keyword(s):  
Varicose Vein ◽  
Structural Integrity ◽  
Cell Injury ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Venous Disease ◽  
Vein Wall ◽  
Valve Dysfunction ◽  
Functional Changes ◽  
Vein Formation

Varicose veins are a common venous disease of the lower extremity. Although the mechanisms and determinants in the development of varicosities are not clearly defined, recent clinical studies and basic science research have cast some light on possible mechanisms of the disease. In varicose veins, there are reflux and incompetent valves as well as vein wall dilation. Primary structural changes in the valves may make them ‘leaky’, with progressive reflux causing secondary changes in the vein wall. Alternatively, or concurrently, the valves may become incompetent secondary to structural abnormalities and focal dilation in vein wall segments near the valve junctions, and the reflux ensues as an epiphenomenon. The increase in venous pressure causes structural and functional changes in the vein wall that leads to further venous dilation. Increase in vein wall tension augments the expression/activity of matrix metalloproteinases (MMPs), which induces degradation of the extracellular matrix proteins and affect the structural integrity of the vein wall. Recent evidence also suggests an effect of MMPs on the endothelium and smooth muscle components of the vein wall and thereby causing changes in the venous constriction/relaxation properties. Endothelial cell injury also triggers leukocyte infiltration, activation and inflammation, which lead to further vein wall damage. Thus, vein wall dilation appears to precede valve dysfunction, and the MMP activation and superimposed inflammation and fibrosis would then lead to chronic and progressive venous insufficiency and varicose vein formation.

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.

scholarly journals Pressure dynamics in chronic venous disease

2019 ◽  
Vol 4 (2) ◽  
Author(s):  
Taimur Saleem ◽  
Seshadri Raju
Keyword(s):  
Ex Vivo ◽  
Venous Pressure ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Abdominal Pressure ◽  
Venous Disease ◽  
Venous Obstruction ◽  
Resting Pressure ◽  
Air Plethysmography ◽  
Focal Stenosis

Peripheral venous pressure is regulated by central and peripheral mechanisms. Peripheral venous hypertension is an important pathologic component of chronic venous disease and is present in about two-third of patients with chronic venous disease. It can result from reflux, obstructive lesions or high arterial inflow. The dominant influence in patients with peripheral venous hypertension appears to be obstruction rather than reflux. Reflux can be superficial or deep or both. In about 70% of patients with reflux, valvular incompetence is present in the superficial, deep and perforator systems in some combination. In an ex vivo experimental model, conduit pressure increased with smaller native or functional caliber, focal stenosis and increased post-capillary inflow. Venous pressure in the lower limb can be measured in a variety of ways: supine resting pressure, erect resting pressure and ambulatory venous pressure. These measurements are affected by factors such as intra-abdominal pressure, intra-thoracic pressure, gravity, venoarteriolar reflux, valve reflux and venous obstruction. Venous obstruction is associated with elevated supine pressures while reflux is associated with elevated erect resting and ambulatory venous pressures. Ambulatory venous pressure reflects venous hypertension in patients with advanced venous disease. However, our investigation has shown that ambulatory venous pressure hypertension is rarely present if air plethysmography testing is negative. Consideration maybe given to the omission of the ambulatory venous pressure testing if air plethysmography testing is normal.

Endovenous laser treatment of groin and popliteal varicose veins recurrence

2017 ◽  
Vol 33 (3) ◽  
pp. 195-205 ◽  
Author(s):  
Alvise Cavallini ◽  
Daniela Marcer ◽  
Salvatore Ferrari Ruffino
Keyword(s):  
Laser Treatment ◽  
Diode Laser ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Recurrent Varicose Veins ◽  
Venous Clinical Severity Score ◽  
Effective Option ◽  
One Year

Objectives Recurrent varicose veins following surgery is a common, complex and costly problem in vascular surgery. Treatment for RVV is technically more difficult to perform and patient satisfaction is poorer than after primary interventions. Nevertheless, traditional vein surgery has largely been replaced by percutaneous office-based procedures, and the patients with recurrent varicose veins have not benefited from the same advantages. In this paper, we propose an endovascular laser treatment that allows reducing the invasiveness and complications in case of SFJ and SPJ reflux after ligation and stripping of the great and small saphenous vein. Methods 8 SFJ and 1 SPJ stumps were treated by endovascular laser treatment in out-patient clinic. Endovascular laser treatment was performed with a 1470 nm diode laser and a 400 µc radial slim™ fiber. Intraoperative ultrasoud was used to guide the fiber position and the delivery of tumescent anesthesia. The gravity of chronic venous disease was determined according to the CEAP classification and the severity of symptoms was scored according to the revised Venous Clinical Severity Score (VCSS). Results The average linear endovenous energy density was 237 J/cm. Patients return to daily activities after a mean of 1.9 days after. The VCSS improved drastically from a mean of 8 pre-interventional to 1 at day 30 and until one year. During the follow-up period (mean 8 months, range: 5–17 months), all the stumps except one were occluded. All patients were very satisfied or satisfied with the method. No severe complications occurred. Conclusions Office-based endovascular laser treatment of groin and popliteal recurrent varicose veins with 1470 nm diode laser and radial-slim fiber is a safe and highly effective option, with a high success rate in the early post-operative period.

Correlation between GSV diameter and varicose clinics

Phlebologie ◽  
2016 ◽  
Vol 45 (01) ◽  
pp. 29-35 ◽  
Author(s):  
F. Amsler ◽  
E. Kalodiki ◽  
E. Mendoza
Keyword(s):  
Varicose Veins ◽  
Clinical Severity ◽  
Venous Disease ◽  
Published Data ◽  
Mean Values ◽  
Venous Clinical Severity Score ◽  
The Mean ◽  
Group 2 ◽  
Disease Stratification ◽  
Group 1

Summary Background Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Stratification of venous disease severity is still difficult. This study aims to correlate GSV diameters with C of CEAP and the venous clinical severity score (VCSS). Methods Legs without GSV reflux (Control legs, Group 1) and legs with untreated isolated GSV reflux and varicose veins limited to the GSV territory (Group 2) were studied clinically and with duplex ultrasound in a prospective study. The GSV diameters were measured both next to the saphenofemoral junction (SFJ) and at proximal thigh (PT) and correlated to the C of CEAP and VCSS. Results The control legs-group 1 were: n=33, 6 male, mean age 53, mean BMI 26.The legs with reflux-group 2 were: n=78, 16 male, mean age 54, mean BMI 27.The mean diameters for the SFJ ( ± SD) for groups 1 and 2 were 6.4 ± 1.8 and 9.9 ± 3.4. For PT they were 3.6 ± 0.9 and 5.9 ± 1.8 respectively. In legs with reflux the SFJ diameter correlates strongly with the PT diameter (r=0.69) and moderately with the C of CEAP and VCSS; 0.42 and 0.45 respectively. The PT diameter correlates slightly better with the C of CEAP and VCSS than the SFJ diameter (0.55 and 0.57). The mean values of VCSS for groups 1 and 2 were 0.70. and 4.69. The C of CEAP and VCSS show a strong correlation among them with r=0.79 in group 2 and 0.80 in the whole sample. Conclusion The GSV diameters next to the SFJ and particularly at the PT in patients having reflux correlate strongly with both the C of CEAP and VCSS. Recording the GSV diameters at the SFJ and PT in a standardized way may improve comparison of published data and contribute to choice of treatment in the future.

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