Surgical treatment of severe chronic venous insufficiency caused by pulsatile varicose veins in a patient with tricuspid regurgitation

2009 ◽  
Vol 24 (2) ◽  
pp. 79-81 ◽  
Author(s):  
D Casian ◽  
E Gutsu ◽  
V Culiuc
Keyword(s):  
Surgical Treatment ◽  
Tricuspid Regurgitation ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Reflux ◽  
Foam Sclerotherapy ◽  
Venous Leg Ulcer ◽  
Venous Bleeding ◽  
Subfascial Endoscopic Perforator Surgery

A case of severe chronic venous insufficiency caused by pulsatile varicose veins in a 46-year-old man with tricuspid regurgitation is presented. Active venous leg ulcer complicated with recurrent venous bleeding and inefficacy of conservative management serve as indications for surgical treatment. This case demonstrates the possibility of radical surgical correction of pathological venous reflux by means of saphenofemoral ligation, foam sclerotherapy and subfascial endoscopic perforator surgery.

Surgical Treatment of the Superficial and Perforating Veins

2000 ◽  
Vol 15 (3-4) ◽  
pp. 131-136 ◽  
Author(s):  
P. Gloviczki
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
High Ligation ◽  
Ulcer Recurrence ◽  
Perforating Veins ◽  
Post Thrombotic Syndrome ◽  
Venous Ulcers ◽  
Ulcer Surgery

Objective: To review the techniques and results of surgical treatment of the superficial and perforating veins in patients with chronic venous insufficiency. Methods: The current techniques used at the Mayo Clinic for treatment of simple varicose veins and venous ulcers are presented. Results of subfascial endoscopic perforator vein surgery (SEPS) are discussed and data from large centres are tabulated. Results are compared with those reported following non-operative management. Synthesis: High ligation and invagination stripping of the incompetent segment of the saphenous vein, with stab avulsion of branch varicosities, is the optimal surgical technique to ablate superficial venous incompetence. SEPS is safer than open perforator vein ligation and is the technique of choice to interrupt incompetent perforating veins. A review of 12 series on SEPS, that included 361 limbs, found an ulcer recurrence rate of 10% in those 211 patients who underwent ablation of superficial reflux together with SEPS. One hundred and fifty limbs had SEPS alone, without saphenous stripping: ulcer recurrence in this group at a mean of 23 months was 12%. Results in primary valvular incompetence were significantly better than in post-thrombotic syndrome. Conclusions: Ablation of superficial reflux remains the main surgical treatment of all forms of chronic venous insufficiency. SEPS is safe and effective to interrupt medial calf perforators and results in rapid ulcer healing and low recurrence in patients with primary valvular incompetence. The treatment of post-thrombotic syndrome remains a challenge. Results of the North American Venous Ulcer Surgery (NAVUS) trial, a prospective, randomised, multicentre study, will be required to provide level 1 evidence of the effectiveness of surgical treatment over medical therapy in the treatment of venous ulcers.

scholarly journals CHRONIC VENOUS INSUFFICIENCY

10.23856/3217 ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 131-136
Author(s):  
Antoni Stadnicki ◽  
Martin Rusnák ◽  
Anna Stadnicka
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Postthrombotic Syndrome ◽  
Venous Disease ◽  
Compression Stockings ◽  
Venous Leg Ulcer ◽  
Color Flow ◽  
Clinical Disorder

Chronic venous insufficiency (CVI) is a common, but underdiagnozed clinical disorder associated with a variety of signs and symptoms. The presence of leg edema in association  with varicose veins, and venous leg ulcer in later disease stages defines the disease. The pathogenesis of chronic venous disease  is based on venous reflux, obstruction, or a combination thereof.  Prior postthrombotic syndrome   is one of risk factor for CVI which may explain observed  prevalence of thrombophilia in CVI. Color flow duplex ultrasound is the gold standard for nearly all diagnostic issues related to chronic venous disease. Compression stockings are the mainstay for conservative management. Earlier use of venous ablation therapy should be considered in symptomatic patients with superficial tortuous vein

scholarly journals Ways to improve outpatient phlebological care with “one day” technology

2021 ◽  
Vol 18 (1) ◽  
pp. 30-39
Author(s):  
A. V. Pelevin ◽  
O. N. Guzhkov ◽  
D. L. Mushnikov
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Health Sector ◽  
Laser Coagulation ◽  
Personalized Approach

Introduction. Chronic venous insufficiency is one of the most common diseases, so finding the best treatment options is one of the most urgent tasks of surgery. One of the methods of implementing this direction is to apply a personalized approach. The aim of the study is to improve surgical care for patients with VVPC by introducing a personalized approach.Materials and methods. The study was based on clinical observations and special studies in 428 patients with uBVNC in outpatient settings. All of those surveyed were women. The average age of the patients was 42.3 ± 15.5 years. All patients were operated on — endovasal laser coagulation (EVLk) was performed in the traditional way. Clinical examination of patients, as well as special methods of research was carried out. A questionnaire was used to assess the quality of life of patients. The peculiarity of the study was the use of social and hygienic methods: survey, psychological testing, expert. Statistical analysis and mathematical processing of results were carried out with the help of modern computer technologies based on the Statisticala 6 application package.Results. It has been established that over the past five years in the Ivanovo region there has been an increase in the incidence of vessels of the lower extremities. The frequency of varicose veins exceeds 47 per 100 patients examined. The desire to perform surgery in the nonstate health sector is observed in 9.8 cases. In 85.0% of patients with VBNC, received for surgical treatment, have a lack of preparedness. Their information, clinical and psychological level is 65.0–89.0% of the due and direct influence on the formation of an unfavorable result.Conclusion. Thus, the implementation of a personalized approach to the surgical treatment of patients with chronic venous insufficiency by laser coagulation provides on a par with the reliable obliteration of altered veins the fastest clinical recovery of patients, improvement of their quality of life, satisfaction with results, good hemodynamic and cosmetic effects.

scholarly journals Ultrasound-guided foam sclerotherapy for severe chronic venous insufficiency

2017 ◽  
Vol 44 (5) ◽  
pp. 511-520 ◽  
Author(s):  
Guilherme Camargo Gonçalves de-Abreu ◽  
Otacílio de Camargo Júnior ◽  
Márcia Fayad Marcondes de-Abreu ◽  
José Luís Braga de-Aquino
Keyword(s):  
Minimally Invasive ◽  
Lower Limb ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Venous Hypertension ◽  
Ultrasound Guided ◽  
Foam Sclerotherapy ◽  
New Techniques

ABSTRACT Chronic venous insufficiency is characterized by cutaneous alterations caused by venous hypertension; in severe forms, it progresses to lower limb ulcers. Lower limb varicose veins are the main cause of chronic venous insufficiency, and the classic treatment includes surgery and compressive therapy. Minimally invasive alternative treatments for varicose veins include new techniques such as venous thermal ablation using laser or radiofrequency. The use of different methods depends on clinical and anatomical factors. Ultrasound-guided foam sclerotherapy is the venous injection of sclerosing foam controlled by Doppler ultrasound. Sclerotherapy is very useful to treat varicose veins, and probably, is cheaper than other methods. However, until the present, it is the less studied method.

scholarly journals THE RESULTS OF THE APPLICATION OF LOW-INVASIVE METHODS FOR TREATMENT OF VARICOSE DISEASE

2019 ◽  
Vol 85 (4) ◽  
pp. 83-87
Author(s):  
E.G. Cherkasheninov ◽  
A.S. Kalmykova
Keyword(s):  
Radiofrequency Ablation ◽  
Saphenous Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Laser Coagulation ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Severity Of The Disease ◽  
Light Guides

From 2015 to 2019, we performed surgical treatment of 136 patients for varicose veins of the lower extremities, of whom 74 patients were operated on by endovenous laser coagulation, 62 patients were operated on by radiofrequency ablation. The international classification of chronic venous insufficiency (CEAP) was used to distribute patients according to the severity of the disease. The indication for minimally invasive techniques was the presence of vertical reflux along the major and/or minor saphenous vein in combination with horizontal venous reflux in 95 % of cases. To perform radiofrequency ablation, the VNUS ClosureFast technique was used, and to perform endovasal laser obliteration, the «Lika-Hirurg» apparatus generating a wavelength of 1470 nm and radial (circular) light guides. To assess the results and quality of treatment, all patients underwent examination by a doctor with USDG of the operated lower extremity 1, 6 and 12 months after the treatment. Patients completed the Chronic Venous Insufficiency Questionnaire (CIVIQ 20) before surgery and 6 months after treatment. In all 136 patients, pathological venous reflux was not observed. In 2 patients, 6 months after EVLK, when performing ultrasound control in the trunks of the great saphenous vein, segmental recanalization without pathological reflux was determined. The use of radiofrequency ablation and endovasal laser coagulation of veins in the treatment of varicose veins shows positive results, and in most cases better than in classical surgical interventions, which is primarily due to the low trauma. One of the factors is the short duration of the patient's stay in the clinic and its activation immediately after the operation, which allows maintaining the routine of daily life.

scholarly journals Diagnosis and treatment of varicose veins and chronic venous insufficiency

2020 ◽  
Vol 63 (12) ◽  
pp. 756-763
Author(s):  
Shin-Seok Yang
Keyword(s):  
Surgical Treatment ◽  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Symptom Relief ◽  
Venous Pressure ◽  
Chronic Venous Disease ◽  
High Ligation ◽  
Venous Disease

This study aimed to review the pathophysiology of varicose veins and chronic venous insufficiency and the recent surgical treatment trend. Varicose veins are tortuous, twisted, or lengthened veins in the lower extremities. It is part of the spectrum of chronic venous disease. Primary pathogenesis is increased chronic venous hypertension caused by valvular insufficiency, venous outflow obstruction, and calf muscle pump failure. Some patients complain of no symptoms, except report cosmetic concerns. If the varicose vein progresses to chronic venous insufficiency, it may cause edema of the lower limb. The skin lesion can present as hyperpigmentation of the median part of the ankle, congestive dermatitis, and even a skin ulcer. The varicose vein can be diagnosed easily by visual inspection after identifying the skin lesions. For non-surgical treatment, elastic stocking, Unna boots, and pneumatic compression devices are recommended to reduce venous pressure. High ligation with stripping has been the standard treatment for varicose veins to achieve symptom relief and improve cosmetic effects. Endovenous laser ablation, radiofrequency ablation, mechanochemical ablation, and the VenaSeal closure system have been introduced as surgical treatment methods. Recently, endovenous thermal/non-thermal ablations are recommended for treatment because both are less invasive techniques. The appropriate therapy should be selected after considering the patients’ symptoms and signs, anatomical structure, and economic burden of the treatment.

scholarly journals SURGICAL TREATMENT OF COMPLICATED FORMS OF CHRONIC VENOUS INSUFFICIENCY IN LOWER LIMBS (REVIEW ARTICLE)

2020 ◽  
Vol 20 (4) ◽  
pp. 209-215
Author(s):  
V. І. Liakhovskyi ◽  
R. M. Riabushko ◽  
А. V. Sydorenko
Keyword(s):  
Surgical Treatment ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Lower Extremities ◽  
Integrated Treatment ◽  
Lower Limbs ◽  
Venous Blood Flow ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Cosmetic Effect

Venous diseases of the lower limbs that are accompanied by the development of trophic ulcers are among the medical and social challenges. The vast number of patients is in working age, from 30 to 65 years old. Severe forms of the disease are registered in 27% of the cases; active or healed trophic ulcers are diagnosed in 12.9 % of cases. At present special attention is being paid to the effective surgical treatment of the pathology, to the introduction of the latest surgical interventions, which provide complete radicalism about the causes of trophic ulcers of venous genesis and ensure the maximum cosmetic effect. The aim of this work is to analyze the scientific literature on using the latest surgical techniques in the treatment of venous pathology in patients with trophic ulcers of lower extremities to promote improving the existing and elaborate new surgical interventions in terms of this pathology. Nowadays surgical treatment of patients with chronic venous insufficiency of the lower extremities, especially in case of trophic leg ulcers can be considered as the stage of the integrated treatment of venous trophic disorders. Modern surgical interventions differ in the methods, techniques and tools used, but provide the maximum cosmetic effect and complete radicalism regarding the causes of chronic venous insufficiency. Correction of pathological venous-venous reflux is the main method of eliminating venous hypertension, which underlies the progression of chronic venous insufficiency and promotes the development of trophic disorders, including the ulcers formation. The etiological cause of venous trophic ulcer is the appearance of pathological reflux, which occurs in the superficial, deep and perforating veins and, accordingly, the place of surgery should be those venous segments in which the pathological process is diagnosed. The operation can be performed simultaneously or in two stages: first, the vertical venous-venous reflux is eliminated, followed by the correction of the horizontal reflux. When using modern minimally invasive technologies, adequate and complete correction of venous blood flow in the affected limb is performed simultaneously producing no serious tissue damages to avoid cosmetic effect and to lessen postoperative period. Thus, the analysis of the scientific literatures has shown the unity of views on the strategy of surgical treatment of varicose trophic ulcers that involves the elimination of vertical and horizontal reflux, but the absence of views unity on tactical approaches in solving these issues.

Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

2020 ◽  
pp. 64-75
Author(s):  
E. Burleva ◽  
O. Smirnov ◽  
S. Tyurin
Keyword(s):  
Postoperative Period ◽  
Chronic Venous Insufficiency ◽  
Thermal Ablation ◽  
Venous Insufficiency ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Statistical Processing ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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