Comparison of Modified Above-Knee and Conventional Surgery with the Stripping of the Great Saphenous Vein of Varicose Veins of the Lower Extremities: A Retrospective Study

Objective. To compare the clinical effects of modified above-knee and conventional surgery with the stripping of the great saphenous vein of varicose veins of the lower extremities. Methods. Clinical data of patients with a varicose vein of the lower extremity from May 2016 to May 2018 were collected. A retrospective study was conducted on the patients receiving modified above-knee and conventional surgery with the great saphenous vein stripping. The baseline characteristics and long-term follow-up data were compared between the groups. Results. There were no significant differences in baseline characteristics between the two groups ( P > 0.05 ). The surgeries were successfully performed by the same group of surgeons under local anesthesia and neuraxial anesthesia. The hospital stay, operation time, intraoperative blood loss, total length, and number of incisions in the above-knee group were comparable to those in the conventional surgery group ( P > 0.05 ). The incidence of saphenous nerve injury and subcutaneous hematoma in the above-knee group was lower than that in the conventional surgery group ( P < 0.05 ). There were no significant differences in recurrent varicose vein incidences ( P > 0.05 ). After surgery, the venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) scores of both groups were higher than those before operation ( P < 0.05 ). There was no significant difference in VCSS score or CIVIQ-14 scores between the two groups postoperation ( P > 0.05 ). At 24 months after surgery, the above-knee group (71.8%) and conventional surgery group (73.2%) resulted in changes of at least two CEAP-C clinical classes lower than baseline, respectively. Conclusion. The modified above-knee technique can ensure clinical outcomes, reduce intraoperative blood loss and complication incidences, and shorten the operative time. This gives evidence that the modified above-knee technique is worthy of clinical application.

Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data

The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.

Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization

Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.

Quercetin Relieves the Excised Great Saphenous Vein Oxidative Damage and Inflammatory Reaction

Objective. The patency and quality of transplanted great saphenous vein (GSV) can seriously influence the physical state and life quality of patients who accepted the coronary artery bypass grafting (CABG). Quercetin is known for antioxidant, antithrombotic, anti-inflammatory, and antitumor properties. In this study, we examined the protection of quercetin to the great saphenous vein from oxidative and inflammatory damage. Methods. The GSVs were collected from 15 patients undergoing CABG and cultured. Treated the veins by H2O2 and detected the NO, SOD, and MDA content by the relevant kits to explore the quercetin protection against oxidative damage. Then, for another group of GSVs, sheared them and detected the inflammatory cytokines, such as IL-6, TNFα, CCL20, PCNA, and VEGF. Collect the veins for H&E staining and PCNA and VEGF immunofluorescent staining. Results. Pretreatment by quercetin reduced the production of NO and MDA induced by H2O2, and increased SOD activity. Quercetin also supressed the mRNA expressions of IL-6, TNFα after mechanical damage and had no influence on CCL20 and VEGF. Consistent with the lower expression of PCNA treated by quercetin, the vein intima was thinner. Conclusion. These results demonstrated that quercetin protects GSVs by reducing the oxidative damage and inflammatory response and also suppresses the abnormal thickening of venous endothelium by inhibiting cell proliferation. It reminded that, to some extent, quercetin has the potential to release the great saphenous vein graft damage.

Validation of Caprini’s Saphenous Ablation Scores

Introduction: Deep Vein Thrombosis (DVT) after varicose vein surgery is well recognized. Less well documented is Endovenous Heat-Induced Thrombosis (EHIT), thrombus extension into a deep vein after superficial venous thermo ablation. There is no current agreement on the routine use of thromboprophylaxis in patients undergoing varicose vein surgery. more data on the incidence of VTE, and the need for postoperative thromboprophylaxis are necessary to formulate evidence-based clinical guidelines. Aim of the study: Comparison of the use of Caprini's Saphenous Ablation Scores versus Standard Caprini’s Score for the prophylaxis of VTE in EVLA. Patients & Methods: 60 patients admitted to Royal Vascular Center, Alexandria - Egypt. From Jan. 1st, 2021, to June 30th 2021 divided in 3 groups. - Group A) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Caprini’s Saphenous Ablation Scores Fig 1-A & B -Group B) Treated by ablation of Great saphenous vein and received VTE prophylaxis according to Standard Caprini’s Risk Assessment Score for VTE Fig 2-A&B - C) Treated by ablation of Great saphenous vein without VTE prophylaxis Ablation was done using radial 1480 YAG laser fibers and Post-operative Duplex was done one day, 3 month and one-year. Results: Age: 35.6+0.2, 34.3+0.5 and 37.6+0.09 years in the 3 groups M/F: 6/14, 8/12 and 7/13. In group A) all patients showed absent reflux post operatively and in all follow up visits. Duplex examination revealed significant reflux in the great saphenous veins in all patients and ranged from 0.7:0.9 Sec. and mean duration 0.7+0.09 Sec. Vein diameter ranged from (0.6: 0.9,X+0.76 CM.) in group A), (0.6: 0.8,X+0.7 CM.) in group B) , (0.5: 0.8,X+0.65 CM.) in group C) According to Caprini’s saphenous score 14 patients 70% were classified as low risk, 4 patients 20% were of moderate risk and 2 patients 10% of high-risk in Group A, while applying standard Caprini’s Score in group B patients revealed: 6 patients 30% were of moderate risk and 14 patients 70% of high risk in Group B ) . 3 patients developed superficial thrombophlebitis 15% and one patient 5% developed left calf DVT in Group C, while no VTE events were shown in both A&B Groups Significant drop in CVSS in patients in the three groups. Conclusion: Risk assessment of patients undergoing varicose veins ablation should be done and applying Caprini’s saphenous score as a better alternative to Standard Caprini’s score for VTE prophylaxis and is considered a safe and cost-effective tool in VTE prevention in these patients.

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

Purpose The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). Materials and methods All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. Results During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. Conclusion RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.

The Active Isoforms of MGP Are Expressed in Healthy and Varicose Veins without Calcification

Matrix Gla protein (MGP), a local inhibitor of tissue mineralization, is associated with vascular calcification. Depending on the carboxylation and phosphorylation status, MGP has active conformations, e.g., carboxylated MGP (cMGP) and phosphorylated MGP (pMGP), but also inactive conformations, e.g., uncarboxylated MGP (ucMGP) and dephosphorylated MGP (dpMGP). Our purpose was to assess the presence of all MGP conformations in healthy veins (HV) and varicose veins (VV), concurrently with the analysis of circulating total MGP (tMGP) before and after the surgical stripping of VV. We collected samples from the great saphenous vein, considered as control group, and tissue from VV, designated as VV group. Plasma levels of tMGP were significantly decreased after the surgical removal of the VV (before 59.5 ± 17.2 vs. after 38.1 ± 11.3, p < 0.001). By using immunohistochemistry staining, we identified local cMGP and pMGP in the control and VV groups, both without calcification, while ucMGP and dpMGP were absent. cMGP was observed in the nucleus and cytoplasm and pMGP in the nucleus of cells belonging to the tunica media, tunica intima and vasa vasorum. Therefore, the active conformations of MGP (cMGP and pMGP) are prevalent in HV and VV without calcification, affirming their anti-calcifying role in veins.