scholarly journals The approach to the management of a patient with chronic venous insufficiency in a specialized vascular center ‒ a combination of world guidelines and personal experience

2021 ◽  
Vol 36 (2) ◽  
pp. 60-72
Author(s):  
O.M. Voloshyn ◽  
O.V. Suzdalenko ◽  
V.O. Gubka ◽  
S.M. Machuskyi ◽  
O.G. Popova ◽  
...  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Patient Adherence ◽  
Individual Characteristics ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Comprehensive Treatment ◽  
Main Task ◽  
Minimal Risk ◽  
Vascular Surgeon

A lot of recommendations has been published regarding the treatment of chronic venous disease. At the same time, none of these documents reflects the complete «path» of the patient from the stage of the initial visit (diagnosis) to the choice of the optimal treatment option. Therefore, the creation of a protocol that would take into account on the one hand the most modern and proven effective approaches to diagnosis and treatment, and on the other hand, the individual characteristics of each clinical case is an urgent task.The main task of the publication is to create a practice-oriented instruction for the diagnosis, comprehensive treatment and prevention of chronic venous insufficiency. The management of a patient with chronic venous insufficiency is presented in the form of «AngioLife Venous Protocol®», a set of clear practical recommendations for vascular surgeon and phlebologist. This protocol is based on our own practical experience, existing protocols and guidelines for the treatment of patients with chronic venous insufficiency. The venous protocol includes four stages of a set of medical measures, the purpose of which is to form a clear program of further examination and treatment of the patient. Adherence to all the recommendations specified in the protocol allows to obtain satisfactory functional and cosmetic results of treatment of patients with chronic venous insufficiency with minimal risk of recurrence.

scholarly journals Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Mustafa Dogdus ◽  
Onur Akhan ◽  
Mehmet Ozyasar ◽  
Ahmet Yilmaz ◽  
Mehmet Sait Altintas
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
High Morbidity

Background and Objectives. Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. Methods. Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. Results. The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. Conclusions. PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

Endocrine mechanisms in the pathogenesis of primary varicosis

Phlebologie ◽  
2013 ◽  
Vol 42 (01) ◽  
pp. 13-18 ◽  
Author(s):  
S. Schnabl ◽  
A. Strölin ◽  
Ch. Busch
Keyword(s):  
Chronic Venous Insufficiency ◽  
Regulatory Networks ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Extensive Literature ◽  
Vein Wall ◽  
Extensive Literature Search ◽  
Relaxin 2

SummaryIntroduction: Varicose veins affect up to 40 % of men and up to 51 % of women. The patho-physiology of primary varicosis (chronic venous insufficiency, CVI) is poorly understood. Here, the available data on possible endocrine mechanisms in healthy and varicose veins are reviewed.Methods: An extensive literature search was conducted in PubMed using the following key words: Chronic venous insufficiency, CVI, chronic venous disease, CVD, varicosis, saphenous vein, pathogenesis, hormone.Results: Several theories ranging from incompetence of the valves to functional, biological or morphologic changes in different layers of the vein wall have been proposed. However, an increasing body of evidence suggests that endocrine mechanisms might be involved in the pathogenesis of primary varicosis. In this respect a growing number of hormones (e.g. estrogen, progesterone, relaxin-2, and oxytocin) and their receptors have been linked to primary varicosis in experimental, pharmacological and histological studies.Conclusion: In summary, endocrine-based mechanisms seem to play a role in the pathogenesis of primary varicosis. This opens up the perspective for pharmacological treatments targeting the various described endocrine regulatory networks.

scholarly journals Circaid adjustable inelastic compression wraps for the treatment of lower limb edema in the venous system pathology

2019 ◽  
pp. 12-16
Author(s):  
A. Yu. Semenov ◽  
A. M. Malakhov
Keyword(s):  
Chronic Venous Insufficiency ◽  
Western Europe ◽  
Venous Insufficiency ◽  
Medical Science ◽  
Compression Therapy ◽  
European Population ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Garments ◽  
The Usa

Symptoms of chronic venous insufficiency have been known since antiquity. The prevalence of chronic venous insufficiency in Western Europe and the USA has been reported within the range from from 1 to 40% in women and from 1 to 17% in men [1]. As reported by the European authors, the average prevalence of chronic venous insufficiency with class C2-C6 (according to the CEAP classification) among the European population reaches 30% [2]. Edema syndrome remains one of the leading manifestations of chronic venous disease. Compression therapy is one of the main ways to combat edema. The arsenal of devices for the treatment of edematous syndrome is steadily expanding with the development of medical science. Today, in addition to inelastic compression wrap and elastic compression garments, brand-new compression products, circaid adjustable inelastic compression wraps are available.

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

Chronic venous insufficiency and post-thrombotic syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2817-2822
Author(s):  
Robert T. Eberhardt ◽  
Joseph D. Raffetto
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Surgical Techniques ◽  
Duplex Ultrasound ◽  
Venous Hypertension ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Severity Of Disease ◽  
Venous Valves ◽  
Venous Function

Chronic venous disease is a common problem with a significant impact upon both afflicted individuals and the healthcare system. Normal venous function requires patency of the axial veins with a series of venous valves, and muscle pumps. Dysfunction of any of the normal structures may lead to venous hypertension and development of chronic venous insufficiency. There is a spectrum of manifestations of chronic venous insufficiency including skin changes and venous leg ulcers. Venous duplex ultrasound may be used to confirm the diagnosis and provide anatomical detail. The treatment of chronic venous insufficiency will be based on the severity of disease and guided by anatomical and pathophysiological considerations. Compressive garments have been a mainstay in treatment. Interventional methods have replaced many traditional surgical techniques but are still typically reserved for unsatisfactory response to conservative measures.

Epidemiology and classification of venous disease

ESC CardioMed ◽  
2018 ◽  
pp. 2805-2806
Author(s):  
Eberhard Rabe ◽  
Felizitas Pannier
Keyword(s):  
Risk Factors ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Adult Population ◽  
Clinical Signs ◽  
Advanced Age ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
General Adult Population

Chronic venous diseases are frequent pathologies in the general population. The most common chronic venous pathologies are varicose veins and chronic venous insufficiency including post-thrombotic syndrome. In the general adult population, varicose veins are present in up to 25% of people with an increasing prevalence with age. Risk factors include advanced age, genetic predisposition, female sex, and multiparity. The term chronic venous insufficiency summarizes the clinical signs of chronic venous disease with oedema, skin changes, or venous ulcers. More than 15% of the population is affected by chronic venous insufficiency. Risk factors include advanced age, obesity, and prolonged sitting.

Quantification of early cutaneous manifestations of chronic venous insufficiency by automated analysis of photographic images: Feasibility and technical considerations

2017 ◽  
Vol 33 (5) ◽  
pp. 309-314 ◽  
Author(s):  
François Becker ◽  
Patrice Fourgeau ◽  
Patrick H. Carpentier ◽  
Amina Ouchène
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Region Of Interest ◽  
Automated Analysis ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Short Term ◽  
Cutaneous Manifestations ◽  
Digital Photo ◽  
Early Markers

Summary We postulate that blue telangiectasia and brownish pigmentation at ankle level, early markers of chronic venous insufficiency, can be quantified for longitudinal studies of chronic venous disease in Caucasian people. Objectives and methods To describe a photographic technique specially developed for this purpose. The pictures were acquired using a dedicated photo stand to position the foot in a reproducible way, with a normalized lighting and acquisition protocol. The image analysis was performed with a tool developed using algorithms optimized to detect and quantify blue telangiectasia and brownish pigmentation and their relative surface in the region of interest. To test the short-term reproducibility of the measures. Results The quantification of the blue telangiectasia and of the brownish pigmentation using an automated digital photo analysis is feasible. The short-term reproducibility is good for blue telangiectasia quantification. It is a less accurate for the brownish pigmentation. Conclusion The blue telangiectasia of the corona phlebectatica and the ankle flare can be assessed using a clinimetric approach based on the automated digital photo analysis.

scholarly journals Therapeutic approach in patients with chronic venous insufficiency

2017 ◽  
Vol 12 (2) ◽  
pp. 28-32
Author(s):  
Marilena SPIRIDON ◽  
◽  
Dana CORDUNEANU ◽  
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Thrombus Formation ◽  
Venous Pressure ◽  
External Pressure ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Compression Stockings ◽  
Venous Valve ◽  
Severe Stage

Chronic venous insufficiency (CVI), frequent cause of lower limb edema, represents a severe consequence of the dysfunction of the venous valve, which results from the venous hypertension together with the degenerative processes at this level. CVI defines only the severe stages of the chronic venous disease (CVD), accompanied by morphological and functional damage, with significant alteration in quality of life. The treatment of CVI involves, depending on the severity of the case, a combination of general nonpharmacologic, pharmacologic, and surgical measures. Non-pharmacologic measures involve the use of a continuous and controlled external pressure represented by compression stockings which can significantly improve the venous return and lead to a major symptoms improvement. Pharmacologic treatment aims on one hand to alleviate hemodinamics by lowering blood viscosity, decreasing venous pressure and preventing intravascular thrombus formation and, on the other hand, restoring thevascular glycocalyx/endothelium, reducing parietal inflammation and increasing the venous wall tone. Within this pathology, sulodexide represents an innovative biological product with polypharmacological actions targeting more sites involved in the pathogenesis of CVD/CVI that alleviate hemodynamics and restore vascular structure which lead to a significant symptoms improvement and a slow disease progression. Surgery remains the procedure of choice in patients initially treated conservatively in whom symptoms persist or worsen, but also in case of those who already come to doctor in a severe stage of the disease.

Progression in venous pathology

2015 ◽  
Vol 30 (1_suppl) ◽  
pp. 95-97 ◽  
Author(s):  
F Pannier ◽  
E Rabe
Keyword(s):  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Leg Ulcers ◽  
Skin Changes ◽  
Venous Leg Ulcers

Aim To review epidemiologic data on progression of venous pathology in varicose veins and from varicose veins towards chronic venous insufficiency. Methods We searched Medline and PubMed for epidemiologic studies concerning progression of venous pathology. Results The data suggest that reflux progression may develop from segmental to multisegmental superficial reflux. In younger age, reflux in tributaries and non-saphenous veins is more frequent. In older age, more saphenous reflux develops and more proximal sites seem to be affected. A high proportion of uncomplicated varicose vein (C2) develops skin changes and chronic venous insufficiency (C3–C6). Significant risk factors for the progression of varicose vein towards venous leg ulcers are skin changes, corona phlebectatica, higher body mass index and popliteal vein reflux. During a 13.4-year follow-up period, 57.8% (4.3%/year) of all chronic venous disease patients showed progression of the disease. Summary Studies on the progression of venous pathology show a high progression rate of chronic venous disease. More follow-up studies are still needed to get better information about the risk of varicose vein patients for progression to venous leg ulcers and to answer the question which patients may benefit from early varicose vein interventions.

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.

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