Groin Soft Tissue Leiomyosarcoma or Femoral Vein Leiomyosarcoma?

Chronic Venous Insufficiency

Venous appropriate use criteria are an important step in improving the quality of chronic venous disease care

Objective: To establish a possible relationship between the Giacomini vein and osteoarticular pathology of the lower extremities in chronic venous diseases (CVD).Materials and methods. In 115 examined patients (out of 321), we identified the Giacomini vein (92 women, 23 men). The average age of men was 44.82 ± 1.62 years; women – 45.36 ± 3.31 years. All patients were divided into 3 groups by anatomical randomization. The first group was without pathology, the second group of patients had only CVD, and the third group included patients with CVD and osteoarticular pathology. The criteria for inclusion in the groups were: the presence of Giacomini vein in patients, chronic venous disease and osteoarticular pathology on one or both lower extremities. Exclusion criteria: age of patients less than 18 years, the presence of CVD C5-C6 according to the CEAP classification, post-traumatic changes in the osteoarticular system, post-thrombotic transformation of the veins of the lower extremities. Using triplex angioscanning, the anatomical features of the structure of the venous system of the lower extremities were assessed. The study of the condition of the foot was carried out using the Friedland method.Results. Group I with an absolute norm of the venous and osteoarticular systems included 30 people (26 %). The second group consisted of 45 patients (39.22 %) with CVD C0-C4 according to CEAP, and the third group consisted of 40 patients (34.78 %) who, in addition to venous, osteoarticular pathology. Chronic venous diseases in patients of groups II and III were distributed as follows: C0 – 25.6 %; C1 – 16.4 %; C2 – 49.4 %; C3 – 4.3 %; C4 – 4.3 % on the CEAP scale. Among the osteoarticular pathology, the most numerous group consisted of changes in the configuration of the foot, non-traumatic deformities – 32 (27.81 %) cases. To confirm the relationship between venous and osteoarticular pathology, we used the Pearson criterion. We found a significant correlation in the presence of nontraumatic deformities of the foot in the group of patients with CVD (Pearson's criterion 0.749642; p < 0.22). A strong correlation was established between the age of patients and changes in the venous and osteoarticular systems of the lower extremities (Pearson's criterion 0.7677696; p < 0.22), which confirms the relationship between the development of nontraumatic changes in the foot and CVD in patients with Giacomini vein with age.Conclusion. It was found that the presence of an altered Giacomini vein leads to an aggravation of venous stasis in the lower extremities, which in turn increases the likelihood of developing venous pathology. Chronic diseases of the veins of the lower extremities contribute to dystrophic changes in soft tissues, most pronounced in the distal part of the extremity and, as a consequence, predispose to the development of osteoarticular pathology.

Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology

The relationship between increased body mass index and primary venous disease severity and concomitant deep primary venous reflux.

Varicose disease and other age-related vascular illnesses are extremely prevalent among the adult population. Despite this, research devoted to involutive changes in the veins of the lower extremities is rare and fragmented. Complex morphological evaluation of the wall of the vein related to age and varicose disease can add valuable data to fundamental geriatric and vascular medicine. Objectives: The study was designed to determine the age-related changes in the muscular component of the great saphenous vein and changes associated with varicose disease. Materials and Methods: A morphological study of a specimen of the great saphenous vein was conducted on 55 deceased individuals and 80 patients with varicose disease. Four age subgroups were identified: young, middle-aged, elderly, and senile. A total of 135 fragments of the great saphenous vein were evaluated. Histological, morphometric, and electron microscopic studies were performed. A quantitative analysis of the volumetric fraction of muscular components was calculated using the Shapiro–Wilk test, Kruskal–Wallis (ANOVA) and Mann–Whitney methods with Bonferroni correction. Results: Our study showed that the amount of connective tissue elements between bundles of smooth muscle cells increased with age. In patients with varicose disease, we observed an appearance of connective tissue fibers among smooth muscle cells, more pronounced with the disease progression. The structure of smooth muscle cell changes. Thus, we observed hypertrophy and phenotypic heterogeneity of cells with subsequent destruction of communicative contacts. The values of subintimal longitudinally arranged smooth muscle cells reached their maximum in middle age in both normal and varicose veins, while significant decrease occurred in elderly and senile patients. Quantitative indicators of circularly arranged smooth muscle cells of the middle layer did not change with age but significantly decreased in varicose disease. Age-related changes are characterized by an increase in the proportion of smooth muscle cells in the outer layer. In varicose veins, in young and middle-aged patients, the content of bundles of longitudinally arranged smooth muscle cells in the outer layer was higher compared to the age norm, with a significant decrease in senile age. Conclusions: The age norm of the muscular component of the great saphenous vein wall is characterized by an increase in the volumetric fraction of subintimal longitudinally arranged smooth muscle cells in middle age, the volumetric fraction of circularly arranged smooth muscle cells of the middle layer remains unchanged, and the volumetric fraction of bundles of longitudinally arranged myocytes of the outer layer increases. With age in varicose disease, sclerotic changes progress in the structure of the great saphenous vein at the tissue, cellular, and intracellular levels, leading to a decrease in the volumetric fraction of all muscular components of the great saphenous vein structure.

Introduction. Varicose veins disease of the lower extremities is often accompanied by edema, which persists even after the elimination of the causes of venous insufficiency. Clinically, the etiopathogenesis of edema in such patients is not always possible to differentiate. Objective. To determine the role of the lower limb lymphatic vasculature stucture variants in the development of chronic venous edema in patients with varicose veins disease. Materials and methods. A retrospective analysis of the results of X-ray contrast lymphography and radionuclide lymphoscintigraphy of 257 patients with different stages of chronic venous insufficiency (CVI). Results. Pathognomonic patterns of the lymphatic vasculature structure at various stages of lymphedema in patients with C3-C5 CVI were discovered. We found that the increasing number of cases of persistent oedema could be associated with the lower limb lymphatic vasculature hypoplasia and higher classes of CVI: 43.95 % among the patients with C4 CVI and 88 % with C5 CVI. The majority (94,1 %) of patients with C3 CVI with a normal-like lymphatic system presented with transitory oedema. With CVI C5, the capacity of the groin lymph nodes was impaired in 64 %. In C4 CVI, weak contrasting was observed in 45.1 %. With C3 – in 35.1 % of cases. Conclusions. The progressing degree of chronic venous oedema could be associated with the lymphatic vasculature hypoplasia and the malfunction of the groin lymph nodes.

Molecular characterization of post-thrombotic syndrome

The study was completed according to ICH GCP criteria and included 127 patients with varicose disease admitted to Ryazan Regional Clinical Cardiological Dispensary in order to undergo surgical treatment. The patients were divided into three groups: the first (control) group included 14 healthy volunteers with no signs of varicose veins of lower extremities, the second group included 112 patients with varicose disease divided into three subgroups according to the CEAP classification clinical class of chronic venous insufficiency (CVI): 1 st - C2, 2 nd - C3-C4, 3 rd - C5-C6. All patients underwent a comprehensive analysis of functional state of endothelium (FSE) according to the level of its main metabolites: nitric oxide II (NO), endothelin 1-21, adhesion molecules sICAM- 1, sICAM-2, sICAM-3, and their topographic distribution. The level of endothelial dysfunction markers was studied in 15 patients with unilateral varicose disease in both healthy and affected extremity, which allowed for including them into the third group of patients. The results of the study suggest that the manifestation of endothelial dysfunction has the direct relationship with clinical classes of CVI. NO metabolites, endothelin 1-21, sICAM-1 had the highest sensitivity. The higher the CVI class, the higher the hypofunction of endothelium of varicose veins.

Alternant Approach to Manage Patent AVF With Untreatable Venous Hypertension from Central Stenosis

Background: Venoplasty and stenting is a minimally invasive therapy that can be used for patients with deep venous insufficiency in the lower extremities. This study aimed at investigating the effect of venoplasty and venous stenting in patients with chronic venous insufficiency in the lower limbs.Methods: This prospective case-series study recruited patients with chronic deep venous insufficiency in the lower limbs candidated for venoplasty in the Vascular Clinic of Sina Hospital in Tehran, Iran. Venoplasty and stenting was done if the deep venous system in the lower extremities had stenosis or obstruction on venography. The patients were visited 1, 3, and 6 months after venoplasty to assess their symptoms, venous clinical severity, and venous disability. Primary and secondary patency was evaluated with Doppler ultrasound.Results: Seventy-three patients were included in the study. The follow-up of the patients’ clinical symptoms showed significant improvement rates of about 90%, 88.7%, 92.5%, and 100% in claudication, edema, pain, and ulcers-respectively- only 1 month after the procedure. The stent patency rates were 93.2, 91.5, and 92.4 in the 1st, 2nd, 3rd, and 6th postprocedural months, correspondingly. The venous clinical severity score and the venous disability score before the procedure were 14.2 and 2.73, respectively, which were decreased to 5 and 1.1, correspondingly, at 6 months’ follow-up (p value < 0.001). Conclusion: Venoplasty and stenting in our patients with chronic deep venous insufficiency in the lower extremities conferred a significant improvement in clinical symptoms and a high percentage of patency.

Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease

Varicose disease is the most prevalent vascular disorder affecting lower extremities. Chronic venous insufficiency (CVI) is common in subjects with incompetent superficial and perforator veins. Major attention in pathogenesis of CVI is paid to horizontal venous reflux, while pathological blood flow in the superficial veins may sometimes be regarded as a postural reaction. At the same time cardiac pathology may also attribute to the development of CVI. The article presents a case report describing a female patient with combination of the right heart pathology and varicose disease associated with tricuspid regurgitation leading to constant venous reflux in the lower extremity superficial veins with further development of trophic changes.

ABSTRACTIntroduction: The ankle–brachial pressure index (ABI) is the ratio of the systolic blood pressure of the dorsalis pedis or posterior tibial arteries to the upper arm.The study attempted to identify factors which determine the ABI measurement results.Materials and methods: The research subject was the measurement of the ankle–brachial pressure index by means of continuous Doppler (cwD) and BOSO ABI-SYSTEM 100 apparatus (ABIs) in patients suffering from chronic venous insufficiency, lower extremity ischemia and diabetes. 100 outpatients participated in the study, which was conducted in the Chronic Injury Clinic of No. 1 Ludwik Rydygier University Hospital in Bydgoszcz between 28th June 2016 and 6th April 2017.Results: The average ABI value among all the examined patients was: right extremity – 0.999 (cwD), 0.954 (ABIs); left extremity – 0.980 (cwD), 0.945 (ABIs); with standard deviation of 32.9% (cwD) and 30.1% (ABIs) for the right extremity, and 34.2% (cwD) and 32.1% (ABIs) for the left extremity, which shows a considerable result differentiation. On average, the diabetes patients had the highest index – 1.163 (cwD) for the right extremity and 1.196 (cwD) for the left extremity – while the arteriosclerosis patients had the lowest index – 0.750 for the right extremity and 0.684 for the left extremity (cwD).Conclusions: The ABI values measured by continuous Doppler and BOSO ABI-SYSTEM 100 apparatus did not differ in a statistically significant way mainly in the case of the patients with chronic venous insufficiency and lower extremity arteriosclerosis. However, the values differed at the lower right and left extremities. The patients’ sex, age, education and clinical analysis partly determined the ABI test results. The patients aged 61–70 and the oldest patients had the lowest ABI values.

Animal Models for the Study of Lower Extremity Chronic Venous Disease: Lessons Learned and Future Needs