scholarly journals Heparin prophylaxis in major sclerotherapy (the Prosclep study)

2021 ◽  
Vol 6 (3) ◽  
Author(s):  
Alessandro Frullini ◽  
Piero Giannetta ◽  
Demetrio Guarnaccia ◽  
Oronzo Walter Loparco ◽  
Edy Pablo Lucca ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Lower Limbs ◽  
Low Molecular Weight ◽  
Simple Extension ◽  
Thrombotic Complication ◽  
Thrombotic Complications ◽  
Significant Figures ◽  
Heparin Prophylaxis

Objective To study the incidence and the possibility of preventing thrombotic complications during major sclerotherapy for venous insufficiency of lower limbs. Methods A total of 2489 sclerotherapy sessions were performed on 2010 patients. 1087 sessions (43.7%) were carried out without heparin prophylaxis while in 1402 sessions (56.3%) a prophylaxis with low molecular weight (LMWH) was used. Thrombotic complications were divided into a) post sclerotherapy transient extension (POSTE) if they consisted of a simple extension of sclerotherapy, and b) deep venous thrombosis (DVT) when the complication occurred in a location separate from that of sclerosis. Results The overall incidence of a thrombotic complication was 0.52%. Out of 2489 sessions, 8 cases of POSTE (0.32%) and 5 thromboses of a gastrocnemius vein (0.2%) were diagnosed The most significant figures were reached in the great saphenous vein (GSV) subgroup, where the incidence of complications was 1.91% without prophylaxis and 0.31% (p = 0.009) with prophylactic heparin. Conclusions In this study prophylaxis with LMWH significantly reduced the incidence of thrombotic complications when sclerotherapy of the great saphenous vein was performed.

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.

Morphometric characteristics of competent proximal valves of the great saphenous vein and superficial femoral vein in vivo according to ultrasound angioscanning data

2019 ◽  
Vol 18 (3) ◽  
pp. 16-22
Author(s):  
E. K. Gavrilov ◽  
H. L. Bolotokov ◽  
E. A. Babinets
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Lower Boundary ◽  
Average Diameter ◽  
Lower Limbs ◽  
Functional Test ◽  
Natural Form ◽  
Superficial Femoral Vein ◽  
Venous Diameter

Introduction. It seems relevant to study the ultrasound anatomy and physiology of the proximal valve segments of the superficial femoral vein (SFV) and the great saphenous vein (GSV) to develop effective reconstructive surgical interventions on venous valves in chronic vein diseases.The aim of the survey was to study the ultrasound anatomy of the venous wall, the size and shape of the proximal SFV and GSV valves are normal at rest and during the functional test Valsalva.Material and methods. Proximal valve SFV studies were performed in 144 lower limbs in 115 people (mean age 51.1 ± 14.4 years, 60 women and 55 men), proximal GSV valves studies - in 82 lower limbs in 67 persons (average age 45, 1 ± 13.3 years, 33 women, 34 men). A longitudinal and transverse ultrasound scanning of the femoral vein bifurcation and safenofemoral junction areas were performed, the structures of the proximal SFV and GSV valves were visualized, the valve shape was measured and the diameter of the veins was measured at the level valves at the base of the valves (inlet diameter), at the point of maximum ectasia (diameter of ectasia), at the upper border of the valve (diameter of the outlet), as well as measuring the length of the valve a (length to ectasia, the total length of the valve). The degree of ectasia over the valve was judged by calculating the relative venous diameter change (RVDC).Results. the average diameter of the SFV at the level of the lower boundary of its first valve was 10.01 ± 1.44 mm. The average diameter of the SFV at the level of the maximum ectasia of its first valve was 13,1±2 mm. The average value of the index of RVDC for SFV was 31%±10,4%. An increase in the diameter of the vein in the zone of supravalvular ectasia up to 20% corresponded to the spindle-shaped valve, more than 20% - to the clavate form, which was noted in the majority of the examined. The change in the relative venous diameter of the SFV on the Valsalva test was 38,2%±12,4%. The average diameter of the GSV at the base of the first valves was 6,07±1,25 mm. The average diameter of the GSV at the level of the maximum ectasia of the osteal valve was 9,44±1,69 mm. The average RVDC for GSV was 58%±24%.Conclusion. the natural form of proximal SFV and GSV valves is clavate with presence of the significant supravalvular ectasia, which was noted in the majority of the subjects alone and in all during the performance of the Valsalva functional test.

scholarly journals The superficial venous pump

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Konstantin Mazayshvili
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Lower Limbs ◽  
Superficial Fascia ◽  
Step Cycle ◽  
Cross Sectional ◽  
Blood Flows ◽  
Active Function ◽  
Vein Segment ◽  
The Relationship

The present study has revealed the relationship between the cross sectional area of the great saphenous vein and the degree of tension in the superficial fascia of the thigh. We conducted an ultrasound examination with 27 patients (54 lower limbs) in both standing and walking positions. With an increase and decrease in the degree of tension of the superficial fascia, the blood is pushed to the sapheno-femoral junction. Nearly 200 mm3 of blood flows in, and is pushed out of, a 100-mm great saphenous vein segment in the thigh, towards the sapheno-femoral junction during a step cycle. As a result, the active function of the fascial compartment of the great saphenous vein has been found. We have called this mechanism the superficial venous pump.

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 ULTRASTRUCTURAL CHANGES IN THE WALL OF THE GREAT SAPHENOUS VEIN AT THE VARICOSE DISEASE OF VEINS OF LOWER LIMBS DEPENDING ON AGE AND ILLNESS DURATION

2018 ◽  
Vol 26 (2) ◽  
pp. 26-31
Author(s):  
I. A. Chekmareva ◽  
Kh. A. Abduvosidov ◽  
O. V. Paklina ◽  
E. A. Makeeva ◽  
L. L. Kolesnikov
Keyword(s):  
Endothelial Dysfunction ◽  
Young People ◽  
Connective Tissue ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Lower Limbs ◽  
Ultrastructural Changes ◽  
Middle Aged ◽  
Aged People ◽  
Varicose Disease

The aim of the study was features of ultrastructural changes in cellular elements and connective tissue carcass of the great saphenous vein (GSV) at varicose disease in depending on the duration of the disease in persons of different ages. An examination by light microscopy of 133 fragments of BPV, excised during phlebectomy in 19 patients, and an electron microscopic examination of 532 preparations were performed. Depending on the age of the patients, four age groups was distinguished: 18-44 years old (young people); 45-59 years (middle-aged people); 60-74 years old (the elderly), 75-90 years old (persons of senile age). In the wall of the GSV of young people with a small duration of the disease, there were poorly expressed pathomorphological changes characterized by moderately expressed endothelial dysfunction and minor hypertrophy of smooth muscle cells (SMC) of the middle shell. In the group of middle-aged people, in addition to age-related changes in the structure of the wall of varicose dilated GSV, pathological changes are noted that are characteristic of the long course of the disease with the development of endothelial dysfunction. The phenotypic heterogeneity of the SMC in the middle shell intensifies, and the communication links between them is altered. Disorganization of connective tissue leads to a decrease in the strength of the connective tissue vein skeleton. Hypertrophy of SMC, as a universal compensatory-adaptive response of cells, develops in response to an increase in functional load with hemodynamic disturbances in the veins of the lower limbs and to compensate for the quantitative deficiency of SMC as a result of their death. In elderly and senile age the duration of varicose disease is more than 10 years, on average - up to 25-30 years. The number of destructively altered SMC is increasing, degenerative processes and sclerotic changes are progressing. The ultrastructural analysis of biopsies showed that at the initial stage of development of varicose disease in young people with a small duration of varicose disease, morphological changes in the structure of the GSV wall are poorly expressed. With the increase in the age of the patient and the duration of the disease, changes in GSV are progressed. Involute degenerative-dystrophic changes are most pronounced in patients over 60 years of age and are an aggravating factor during varicose transformation of the GSV wall. In elderly and senile age, the compensatory possibilities of the cells decrease, the sclerotic degenerative changes in the wall of the GSV are progressed.

scholarly journals Non-invasive pressure measurement of the great saphenous vein in healthy controls and patients with venous insufficiency

2013 ◽  
Vol 54 (3) ◽  
pp. 325-332 ◽  
Author(s):  
M. Koster ◽  
B.R. Amann-Vesti ◽  
M. Husmann ◽  
V. Jacomella ◽  
T.O. Meier ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Pressure Measurement ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Healthy Controls ◽  
Non Invasive

Penile Mondor’s Syndrome after endovenous treatment of the great saphenous vein with 1470 nm diode laser

2013 ◽  
Vol 30 (3) ◽  
pp. 217-219 ◽  
Author(s):  
Christof Zerweck ◽  
Matthias Knittel ◽  
Thomas Zeller ◽  
Thomas Schwarz
Keyword(s):  
Diode Laser ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Diclofenac Sodium ◽  
Low Molecular Weight ◽  
Therapeutic Dosage ◽  
Foam Sclerotherapy ◽  
Endovenous Laser Ablation ◽  
Patient Reported ◽  
Endovenous Treatment

We report a penile Mondor's disease after endovenous laser ablation with a 1470 nm diode laser of the great saphenous vein with additional foam sclerotherapy of distal tributaries. We administered body-weight adjusted full dose of low-molecular weight heparin (enoxaparin) in a therapeutic dosage for 10 days. In addition, anti-inflammatory therapy with diclofenac-sodium 75 mg twice a day for the following five days was initiated. One month later, the patient reported no further discomfort or pain and the thrombophlebitis of the superficial dorsal penile vein had sonographically disappeared completely.

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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