Endovascular Laser Therapy versus Open Surgery for the Treatment of Primary Varicose Veins of the Lower Limb

Background Venous drainage of the lower extremities is accomplished by a network of superficial veins connected to the deep veins by small perforator veins. Through a variety of pathophysiological mechanisms, weakness develops in the vein wall that results in varicosity over time. Varicosities typically form in the greater and lesser saphenous veins but also develop in branch vessels. Obstruction of the iliac veins or inferior vena cava can result in extensive varicose veins Objective s: The aim of this work is to compare the outcome of endovascular laser therapy versus open surgery in management of primary varicose veins in lower limb. Patients and Methods Type of study is a prospective, randomized, clinical study. This study was conducted on 30 patients with primary varicose veins of the lower limb, 15 patients were subjected to endovascular laser therapy for treatment of varicose veins of the lower limb (EVLA group) and 15 patients were managed by standard open surgery for treatment of varicose veins of the lower limb (surgery group). The patients were randomized selected from surgery clinic in Eldemerdash Hospital. The work was carried out in the period from June 2017 to December 2018. Results Both groups were well matched regarding age(P = 0.352) and sex (P = 0.713), type of vein diseased(P = 0.913), CEAP classification (P = 0.910) and also regarding BMI (P = 0.761). Regarding preoperative venous clinical severity score, the median(IQR) for group A (surgery group) was (5), and for group B (laser group) was (5) without statistical significant differences between both groups (P value =0.524). Many studies have shown that there was some difference in between two methods of treatment of primary varicose veins of the lower limbs open vascular surgery and endovascular laser therapy. Regarding Six weeks post-operative VCSS assessment, the VCSS score in the surgery group was statistically significantly higher (p < 0.001). However, at one and two years after the intervention The VCSS scores converged and the difference between the groups was no longer statistically significant. Conclusion The presented results show that intreatment of varicose veins with both endovascular laser ablation and open surgery there was improvement in the clinical status of the patient occur after both but EVLA was more effective early which was observed by measuring venous clinical severity score. EVLA show distinct advantages over open surgery especially in post operative pain, analgesia use and time needed to return to work.

The efficacy of Hamamelis 30 in the management of varicose veins and its complications using revised venous clinical severity score tool and peripheral venous Doppler study

Objectives: The homoeopathic remedy, Hamamelis, has been extensively used to treat varicose veins. However, scientific research conclusively proving its utility is lacking. This study was performed to ascertain the remedy’s therapeutic utility and efficacy in treating varicose veins and its complications using the revised venous clinical severity score (VCSS) tool and Doppler studies. Materials and Methods: A prospective uncontrolled experimental study with purposive sampling was performed; the subjects were selected from the outpatient department. A total of 32 cases, fulfilling the inclusion and exclusion criteria were clinically examined. The VCSS and Doppler test before and after treatment with Hamamelis 30 were performed. Results: The Wilcoxon signed-rank test was applied and the change in the median VCSS was found to be statistically significant. P-value of the pre score was 5.53 ± 4.15 and that of the post score was 3.45 ± 2.36 with a mean change of 2.09 ± 2.87 and 37.69% improvement with P-value of 0.000 < 0.01. The Doppler study showed no significant change or improvement. Conclusion: This study revealed that the homoeopathic remedy Hamamelis 30 is effective in the management of varicose veins and its complications by ameliorating symptoms and improving the VCSS. However, the Doppler study reports showed no changes or improvement perhaps due to the short period of treatment.

Σύγκριση της αποτελεσματικότητας της χειρουργικής επέμβασης της σαφηνεκτομής και τοπικών εκριζώσεων στην αντιμετώπιση των συμπτωμάτων σε ασθενείς με χρόνια φλεβική νόσο

Στόχος: Ο στόχος της μελέτης είναι η επικύρωση του 3D εργαλείου βαθμολόγησης – αξιολόγησης για τη χρόνια φλεβική νόσο, όπως προτάθηκε στο SYM VEIN consensus. Μέθοδος: Η παρούσα κλινική μελέτη είναι μία προοπτική μελέτη κοόρτης που περιλαμβάνει συνολικά τριάντα πέντε (35) ασθενείς, κατόπιν συναίνεσης, με χρόνια φλεβική νόσο. Οι ασθενείς αυτοί που θα υποβάλλονταν σε σαφηνεκτομή εκτιμήθηκαν με το αναθεωρημένο Venous Clinical Severity Sore (r-VCSS), με το CIVIQ-20 ερωτηματολόγιο για την ποιότητα ζωής και με το 3D σύστημα βαθμονόμησης του SYM VEIN consensus, προεγχειρητικά και τέσσερεις εβδομάδες μετά την επέμβαση. Το συνολικό αποτελέσματα του 3D εργαλείου αξιολόγησης ελέγχθηκε για την ανταπόκρισή του, για την αξιοπιστία του και για τη δομική του εγκυρότητα.Αποτελέσματα: Το συνολικό αποτέλεσμα του 3D εργαλείου αξιολόγησης αποδείχθηκε καλής αξιοπιστίας και εσωτερικής συνοχής (Cronbach’s alpha 0,85). Η πρωταρχική ανάλυση των καταληκτικών σημείων ταυτοποίησε τρεις ομάδες συμπτωμάτων (παραισθησία, καυστικό άλγος, κνησμός vs αίσθημα βάρους, αίσθημα οιδήματος, κνησμός vs σύνδρομο ανήσυχων ποδιών, πάλλων πόνος) αποδεικνύοντας μία υψηλή συσχέτιση των συμπτωμάτων που περιλαμβάνονται στην ίδια ομάδα και πιθανώς μοιράζονται κοινή παθοφυσιολογία, ενδεικτικό της επαρκούς δομικής εγκυρότητας του εργαλείου αξιολόγησης. Το συνολικό αποτέλεσμα του 3D εργαλείου αξιολόγησης είχε σημαντική συσχέτιση με το r-VCSS και το αποτέλεσμα του CIVIQ-20 (rho 0,46, p = 0,005 and rho 0,65, p < 0,001, αντίστοιχα), ενδεικτικό της επαρκούς συγκλίνουσας εγκυρότητας. Μετά τη σαφηνεκτομή, παρατηρήθηκαν στατιστικώς σημαντικές μειώσεις (p < 0,001) του συνολικού αποτελέσματος του 3D εργαλείου αξιολόγησης, αλλά και των επιμέρους αποτελεσμάτων του 3D εργαλείου για όλα τα φλεβικά συμπτώματα εκτός από δύο, ενδεικτικό της εξαιρετικής ανταπόκρισης του εργαλείου στη θεραπεία. Η διάμεση τιμή της συνολικής βαθμολογίας του 3D εργαλείου αξιολόγησης μειώθηκε από το 31 στο 6 (83,8% μείωση, p < 0,001), η διάμεση τιμή του r-VCSS μειώθηκε από το 6 στο 0 (100% μείωση, p < 0,001), και η μέση τιμή της βαθμολογίας του CIVIQ-20 μειώθηκε από το 24 στο 14 (40% μείωση, p < 0,001). Η διαφορά της ποσοστιαίας αλλαγής της διάμεσης τιμής των αποτελεσμάτων μεταξύ των r-VCSS και του CIVIQ-20 σε σύγκριση με τη συνολική βαθμολογία του 3D εργαλείου αξιολόγησης ήταν στατιστικώς σημαντική (p = 0,005 and p < 0,001, αντίστοιχα).Συμπέρασμα: Το συνολικό αποτέλεσμα του 3D SYM VEIN εργαλείου αξιολόγησης έχει καλή αξιοπιστία, δομική εγκυρότητα και εξαιρετική ανταπόκριση στη θεραπεία, παρά του ότι είναι λιγότερο επιρρεπές στην αλλαγή μετά τη σαφηνεκτομή, σε σύγκριση με την αναθεωρημένη μορφή του Venous Clinical Severity Score (r-VCSS).

Comparison of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up

Objective To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers. Methods One hundred ninety-five ( n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) ( n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded. Results For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group ( p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group ( p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years ( p = 0.011). No significant difference was found between groups for the five-year recovery rates ( p > 0.05). Conclusion Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.

Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa

Resumo Contexto Pacientes com doença venosa crônica avançada são mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda não está estabelecido se a gravidade da insuficiência venosa é um fator que influencia a taxa de oclusão de veias safenas tratadas por endolaser. Objetivos Analisar a taxa de oclusão dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificação Clínica-Etiológica-Anatômica-Patológica (CEAP) dos pacientes. Métodos Análise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a março/2020. Foram realizadas estatística descritiva e curva de sobrevida de Kaplan-Meier com regressão de Cox para grupos de VCSS e CEAP. Resultados Foram analisados 170 pacientes e 180 segmentos venosos; a idade média foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia média utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicações foram dor no trajeto da safena (12,2%) e parestesias após 6 meses (17,2%). Não houve diferença na taxa de oclusão venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusão menor em relação ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confiança (IC) 1,85, 5,61; p = 0,001]. Conclusões As taxas de oclusão de segmentos venosos tratados com endolaser foram menores na presença de classificações CEAP avançadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

Bronchial Clearance Physiotherapy in Pediatrics. A Controlled, Randomized, Multicenter Study of the Short-Term Effects on Respiration during Outpatient Care for Infants with Acute Bronchiolitis

Objectives The use of chest physiotherapy (CP) has not, to date, been shown to be effective in the care of infants hospitalized for bronchiolitis. However, it has not yet been studied in outpatient settings. The aim of our study was to examine the short-term benefit of CP with the increased exhalation technique (IET) on the respiratory conditions of nonhospitalized infants. Methods Our research consisted of a multicenter, randomized, controlled, single-blind study of infants under 1 year old. A decrease in the severity score of the infants' respiratory condition was compared between two groups: one receiving CP and one without CP. Eighty-two infants were randomized: 41 in the CP group and 41 in the control group. Blinded assessors determined the Wang Clinical Severity Score at inclusion (T0) and 30 minutes later (T1) for each group. Results Improvement in the severity score was observed for 29 infants (70.7%) in the group receiving CP, compared with 4 infants (9.76%) in the control group (p < 0.001). The mean decrease in the Wang Clinical Severity Score was −2 (±1.32) in the group receiving physiotherapy compared with −0.22 (±0.99) in the control group (p < 0.001). Conclusion For outpatient care of infants with bronchiolitis, the results of this study suggest that CP with IET leads to a short-term improvement of mucus airway obstruction parameters.

Vai trò của hội chứng May – Thurner trong bệnh lý huyết khối tĩnh mạch sâu chi dưới

Nhóm I: Hồi cứu hồ sơ và khảo sát lại CT Scan, chúng tôi ghi nhận 30 trường hợp huyết khối tĩnh mạch sâu chi dưới (HKTMSCD) được can thiệp lấy huyết khối bằng Fogarty, trong đó có 9/30 trường hợp được xác định HC May – Thurner. Tuổi trung bình là 44,4, tỷ lệ nam/nữ là 1/8. Tỷ lệ tái huyết khối sớm cao là 89% và điểm số VCSS (Venous Clinical Severity Score) trung bình là 7,625. Can thiệp sửa chữa tổn thương giải phẫu của HC May-Thurner chỉ thành công về mặt kỹ thuật ở 01 trường hợp. Nhóm II: Can thiệp điều trị lấy huyết khối cho 60 trường hợp, chụp khảo sát trong mổ kết hợp với hình ảnh CT cản quang thì tĩnh mạch, ghi nhận được 37/60 (61,6%) trường hợp có HC May-Thurner. Can thiệp sửa chữa tổn thương bằng nong bóng – stent thành công về mặt kỹ thuật là 35/37 (94,6%). Tỷ lệ tái huyết khối sớm cải thiện hơn rõ so với nhóm I 21,6% (8/37) và điểm số VCSS trung bình cũng cải thiện hơn là 5,025. HKTMSCD do HC May-Thurner là bệnh cảnh thường gặp trên lâm sàng. Cần lưu ý hướng đến chẩn đoán này khi người bệnh có biểu hiện sưng phù 1 bên chân Trái. Phương tiện chẩn đoán xác định dựa vào hình ảnh học với vai trò của chụp CT Venography. Điều trị theo phác đồ hiện nay là lấy huyết khối với tiêu sợi huyết tại chỗ và sửa chữa thương tổn giải phẫu bằng nong bóng và stent

Associations of Hyper-filtration and Proteinuria with Clinical Severity Score among Adult Sudanese Sickle anemia patients

Background: Sickle Cell Anemia (SCA) is an autosomal recessive haemoglobinopathy with high morbidity and mortality. Global survival of sickle patients is increased and subsequently, prevalence of chronic complications including renal manifestations due to advances in management. Therefore, early detection and management of these complications become mandatory. This study aimed to investigate the estimated Glomerular Filtration Rate (eGFR), proteinuria and serum uric acid as markers of renal involvement in Sudanese sickle adults and association between these parameters and clinical severity score of sickle cell disease. Methods: Cross-sectional hospital-based study included thirty-two adult Sudanese patients diagnosed with SCA and twenty-three controls. Written informed consent was obtained. Blood and urine samples were collected. Severity score was calculated using Bios online calculator and eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula without adjustment for ethnicity. Results: Protein/Creatinine Ratio (PCR) was significantly higher (p-value < 0.001) in sickle cell anaemia group compared to controls. Hyper-filtration and Hyperuricemia were manifested in 75% and 6.3% of SCA group respectively. There was no association between the severity score and renal manifestations in the SCA group. Conclusions: Hyper-filtration and proteinuria were the most prevalent renal manifestations in SCA group. Further studies are recommended to determine the predictors of renal complications and early management of them.