Symptoms, clinical disability scores and reflux in complicated and uncomplicated primary varicose veins

2003 ◽  
Vol 18 (2) ◽  
pp. 73-77 ◽  
Author(s):  
J Saarinen ◽  
M Heikkinen ◽  
V Suominen ◽  
J Virkkunen ◽  
R Zeitlin ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Classification ◽  
Disability Score ◽  
Duplex Imaging ◽  
Primary Varicose Veins ◽  
Varicose Disease

Objective: To evaluate the role of subjective symptoms, grade of disability and axial reflux in superficial veins in different clinical stages of varicose veins (VVs). Methods: A total of 172 legs with primary venous insufficiency from 126 patients were studied. The examination involved evaluation of the CEAP clinical class and clinical disability score (CDS), recording of any symptoms of varicose disease, and a hand-held Doppler (HHD) examination of the superficial veins. Colour-flow duplex imaging (CFDI) was also performed in 22% of the legs. Results: The rate of insufficiency of the great saphenous vein (GSV) was 83% in complicated legs (C4-6), and 68% in uncomplicated legs (C2-3), ( P > 0.05). There was a difference between complicated and uncomplicated legs in the insufficiency of the whole GSV [C4-6: n = 18 (39%) versus C2-3: n = 12 (12%), P < 0.005]. Sensation of pain was noted in 68% of the legs in class C1, 60% of those in class C2-3 and 81% of those in class C4-6. Sensation of oedema was recorded in 70% of the legs in class C1, 65% of those in class C2-3 and 86% of those in class C4-6, respectively. CDS classes 2-3 were significantly more frequent among complicated legs (C4-6: 54% versus C2-3 12%, P < 0.005). Conclusions: Leg symptoms are frequent throughout classes C1-6. Their clinical usefulness is therefore limited. CDS parallels well with the clinical classification. In complicated disease the whole saphenous vein is more frequently insufficient.

scholarly journals Clinical, ultrasonographic and histological findings in varicose vein surgery

2018 ◽  
Vol 64 (8) ◽  
pp. 729-735
Author(s):  
Moacir de Mello Porciunculla ◽  
Dafne Braga Diamante Leiderman ◽  
Rodrigo Altenfeder ◽  
Celina Siqueira Barbosa Pereira ◽  
Alexandre Fioranelli ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Varicose Vein ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Clinical Classification ◽  
Histopathological Changes

SUMMARY OBJECTIVE This study aims to correlate the demographic data, different clinical degrees of chronic venous insufficiency (CEAP), ultrasound findings of saphenofemoral junction (SFJ) reflux, and anatomopathological findings of the proximal segment of the great saphenous vein (GSV) extracted from patients with primary chronic venous insufficiency (CVI) submitted to stripping of the great saphenous vein for the treatment of lower limb varicose. METHOD This is a prospective study of 84 patients (110 limbs) who were submitted to the stripping of the great saphenous vein for the treatment of varicose veins of the lower limbs, who were evaluated for CEAP clinical classification, the presence of reflux at the SFJ with Doppler ultrasonography, and histopathological changes. We study the relationship between the histopathological findings of the proximal GSV withdrawal of patients with CVI with a normal GSV control group from cadavers. RESULTS The mean age of the patients was higher in the advanced CEAPS categories when comparing C2 (46,1 years) with C4 (55,7 years) and C5-6(66 years), as well as C3 patients (50,6 years) with C5-6 patients. The normal GSV wall thickness (mean 839,7 micrometers) was significantly lower than in the saphenous varicose vein (mean 1609,7 micrometers). The correlational analysis of reflux in SFJ with clinical classification or histopathological finding did not show statistically significant findings. CONCLUSIONS The greater the age, the greater the clinical severity of the patients. The GSV wall is thicker in patients with lower limb varicose veins, but those histopathological changes are not correlated with the disease’s clinical severity or reflux in the SFJ on a Doppler ultrasound.

scholarly journals The Profile of Leg Symptoms, Clinical Disability and Reflux in Legs with Previously Operated Varicose Disease

2005 ◽  
Vol 94 (1) ◽  
pp. 51-55 ◽  
Author(s):  
J. Saarinen ◽  
V. Suominen ◽  
M. Heikkinen ◽  
R. Saaristo ◽  
R. Zeitlin ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Disease ◽  
Consecutive Series ◽  
Disability Score ◽  
Duplex Imaging ◽  
Diagnostic Role ◽  
Prior Surgery ◽  
Varicose Disease ◽  
Short Saphenous Vein

Purpose: It is difficult to assess the severity and location of venous insufficiency in legs with recurrent varicose disease. This present purpose was to evaluate the distribution of reflux and the diagnostic role of current classifications in a consecutive series of legs with previously operated varicose disease. Methods: A total of 90 legs in a cohort of 66 patients were included. The examination comprised CEAP clinical class, clinical disability score (CDS) and leg symptoms. Colour-flow duplex imaging (CFDI) was used to observe reflux in deep and superficial veins. Details of prior surgery were assessed. Results: The site of superficial reflux was at the groin in 58 % (recurrent or residive vein trunk or unoperated great saphenous vein), and the rate in the popliteal fossa was 11 % (unoperated short saphenous vein). In 58 % of the legs presenting superficial reflux at groin level, previous surgery at the saphenofemoral junction was noted. A sensation of pain was observed in 74 % of the legs, sensation of oedema in 64 %, itching in 26 %, and night cramps in 8%, respectively. Only itching was significantly infrequent in uncomplicated (CEAP C 2–3) legs, and in legs with local reflux was restricted to vein tributaries. Higher CDS (classes 2–3) were significantly more frequent among complicated legs (CEAP clinical class C2–3: 22% versus CEAP clinical class C4–6: 77%; p < 0.005). A similar situation was noted when legs with only local reflux were compared to those with more severe reflux (local reflux: 7 % versus severe reflux: 48 %; p < 0.005). Conclusions: Superficial reflux is frequently detected at groin level despite prior surgery. Unstructured evaluation of leg symptoms is not beneficial. Clinical disability scores associate well with the severity of the venous disease.

Invasive therapeutic options in truncal varicosity of the great saphenous vein

VASA ◽  
2006 ◽  
Vol 35 (3) ◽  
pp. 157-166 ◽  
Author(s):  
Hach-Wunderle ◽  
Hach
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Stage Iii ◽  
High Ligation ◽  
Surgical Trauma ◽  
Disease Stages

It is known from current pathophysiology that disease stages I and II of truncal varicosity of the great saphenous vein do not cause changes in venous pressure on dynamic phlebodynamometry. This is possibly also the case for mild cases of the disease in stage III. In pronounced cases of stage III and all cases of stage IV, however, venous hypertension occurs which triggers the symptoms of secondary deep venous insufficiency and all the complications of chronic venous insufficiency. From these facts the therapeutic consequence is inferred that in stages I and II and perhaps also in very mild cases of stage III disease, it is enough "merely" to remove varicose veins without expecting there to be any other serious complications in the patient’s further life caused by the varicosity. Recurrence rates are not included in this analysis. In marked cases of disease stages III and IV of the great saphenous vein, however, secondary deep venous insufficiency is to be expected sooner or later. The classical operation with saphenofemoral high ligation ("crossectomy") and stripping strictly adheres to the recognized pathophysiologic principles. It also takes into account in the greatest detail aspects of minimally invasive surgery and esthetics. In the past few years, developments have been advanced to further minimize surgical trauma and to replace the stripping maneuver using occlusion of the trunk vein which is left in place. Obliteration of the vessel is subsequently performed via transmission of energy through an inserted catheter. This includes the techniques of radiofrequency ablation and endovenous laser treatment. High ligation is not performed as a matter of principle. In a similar way, sclerotherapy using microfoam is minimally invasive in character. All these procedures may be indicated for disease stages I and II, and with reservations also in mild forms of stage III disease. Perhaps high ligation previously constituted overtreatment in some cases. Targeted studies are still needed to prove whether secondary deep venous insufficiency can be avoided in advanced stages of varicose vein disease without high ligation and thus without exclusion of the whole recirculation circuit.

Cyanoacrylate adhesive embolization and sclerotherapy for primary varicose veins

2017 ◽  
Vol 33 (8) ◽  
pp. 547-557 ◽  
Author(s):  
Krishna Prasad Bellam Premnath ◽  
Binu Joy ◽  
Vijayakumar Akondi Raghavendra ◽  
Ajith Toms ◽  
Teena Sleeba
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Severity ◽  
Cyanoacrylate Glue ◽  
Cyanoacrylate Adhesive ◽  
Venous Clinical Severity Score ◽  
Primary Varicose Veins ◽  
Vein Reflux

Various treatment methods are available for the treatment of varicose veins, and there has been a recent surge in the usage of cyanoacrylate glue for treating varicose veins. Purpose To investigate the technical possibility, efficiency and safety of cyanoacrylate adhesive embolization and sclerotherapy using commonly available n-butyl cyanoacrylate glue for the treatment of primary varicose veins due to great saphenous vein reflux with or without incompetent perforators. Materials and Methods One hundred forty-five limbs of 124 patients with varicose veins due to great saphenous vein reflux were subjected to cyanoacrylate adhesive embolization and sclerotherapy – adhesive embolization of great saphenous vein in the thigh and perforators using cyanoacrylate followed by sclerotherapy of any residual varicose veins in the leg. Procedural success, venous closure rates and clinical improvement were assessed. Follow-up for 1, 3, 6, 9 and 12 months was obtained. Results Technical success rate was 100%. Saphenous vein closure rate was 96.5% at one year. There was no femoral venous extension of cyanoacrylate in any of the patients. Posterior tibial vein extension of cyanoacrylate was seen in three patients (2.6%) without untoward clinical effect.Significant improvement was found in venous clinical severity score (VCSS) from a baseline mean of 7.98 ± 4.42 to 4.74 ± 3, 1.36 ± 1.65 and 0.79 ± 1.19 at 1, 6 and 12 months’ follow-up. Ulcer healing rate was 100%. Conclusion Cyanoacrylate adhesive embolization and sclerotherapy for the treatment of primary varicose veins is efficacious and can be performed as an outpatient procedure, but has a guarded safety profile due to its propensity to cause deep venous occlusion if not handled carefully.

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.

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.

Anatomical Patterns in Varicose Vein Disease: A Duplex Scanning Study

1995 ◽  
Vol 10 (3) ◽  
pp. 94-97 ◽  
Author(s):  
J. J. Guex ◽  
B. Hiltbrand ◽  
J. M. Bayon ◽  
F. Henri ◽  
F. A. Allaert ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Previous Treatment ◽  
Lower Limbs ◽  
Duplex Scanning ◽  
Consecutive Series ◽  
Yield Data ◽  
Varicose Disease ◽  
Vein Disease

Objectives: To determine symptomatology, clinical class, and topographic patterns of varicose veins in a consecutive series of patients with venous complaints. Methods: We performed clinical examination and duplex scanning of 498 lower limbs in 317 patients with obvious varicose veins for whom no previous treatment had been undertaken. Results: Classes of chronic venous insufficiency (CVI) in 498 legs: grade 0: 117 (23.5%); gr 1: 310 (62.2%); gr 2: 47 (9.4%); gr 3: 24 (4.8%). Duplex-detected venous reflux was found in the greater saphenous vein territory (junction or trunk or related perforator or main tributary) in 423 limbs (85.3%) the sapheno-femoral junction was incompetent in only 342 legs (68.7%). Reflux was found in the lesser saphenous vein territory in 100 limbs (20.1%) and in sapheno-popliteal junction in 92 (18.5%). Strictly non saphenous origin of varicosities was found in 31 limbs (6.2%). Deep venous incompetence was found in 48 legs (9.6%). Conclusions: These findings yield data on the distribution and occurence of lower limbs venous lesions in patients with varicose disease.

Recurrent varicose veins: Sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping

VASA ◽  
2006 ◽  
Vol 35 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Hartmann ◽  
Klode ◽  
Pfister ◽  
Toussaint ◽  
Weingart ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Significant Risk ◽  
Duplex Ultrasound ◽  
Significant Risk Factor ◽  
Recurrent Varicose Veins ◽  
Surgical Errors ◽  
Duplex Imaging ◽  
A Minor

Background: The objective of this study was to assess the frequency of varicose recurrence 14 years after flush ligation of the saphenofemoral (SFJ) or saphenopopliteal (SPJ) junction with additional stripping of the incompetent saphenous vein. Patients and methods: Our study group comprised 245 extremities of 210 patients operated upon in 1990 for either great saphenous vein (GSV) or small saphenous vein (SSV) incompetence. Limbs were assessed with Duplex ultrasound by a practitioner other than the original surgeon and relevant patient data was recorded. Results: In 68.5% of re-examined limbs Duplex imaging provided no evidence for recurrent varicose veins at the former SFJ or SPJ. This included 15 legs (= 6.1%) where reflux immediately proximal to the junction but originating from adjacent veins (i.e. pudendal vein, epigastrical vein) was detected. In 31.5%, reflux from the operated SFJ or SPJ (junctional recurrence) was detected but only a minor percentage of legs (6.9%) had actually developed a clinically relevant recurrent varicosity (> 3 mm in diameter) branching out from the former junction and requiring treatment. Patients with a BMI < 30 were less likely to suffer recurrent varicose veins (no recurrence in 72.7%) than patients with a BMI ≥ 30 (no recurrence in 54.5%). Conclusions: 14 years after flush ligation of the SFJ or SPJ with stripping of the incompetent saphenous vein, junctional recurrences were found in less than one-third of re-examined extremities. In the absence of surgical errors, we must assume neovascularisation as cause for these recurrences. Duplex US determined a clinically relevant recurrence (> 3 mm in diameter) in only 7% of limbs. Post-operative varices seem to develop less often after SPJ surgery than after SFJ surgery and according to our data, obesity (BMI ≥ 30) constitutes a significant risk factor.

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