Predictors of Venous Symptoms Improvement in Chronic Venous Disease Patients on Compression Therapy

The purpose of this study was to explore the characteristics of hemodynamic parameters of iliac vein of patients with chronic venous disease (CVD) using two-dimensional (2D)-phase contrasted (PC) and four-dimensional (4D)-Flow magnetic resonance imaging (MRI) and to test the diagnostic and grading efficiency of 2D-PC and 4D-Flow MRI in CVD and iliac vein compression syndrome (IVCS). Consecutive patients with CVD diagnosed in the outpatient department from 2023 to 2024 were enrolled in this study. Demographic data and medical records of the patients were also collected. The CEAP classification, Villalta score, and Venous Clinical Severity Score (VCSS) were used to evaluate the severity of lower limb symptoms. After computational tomography venography (CTV) scans to verify iliac vein compression, every patient underwent 2D-PC and 4D-Flow MRI scanning. Circle CVI42 software was used to perform data post processing. The inferior vena cava (IVC), common iliac vein (CIV), and common femoral vein (CFV) were chosen to acquire hemodynamic parameters by MRI. The hemodynamic parameter included flow rate (FR) per cardiac cycle, FR per minute, peak flow velocity (FV) and minimum FV measured by 2D-PC MRI and FR per cardiac cycle, peak FV and pressure gradient measured by 4D-Flow MRI. We analyzed the consistency of hemodynamic parameters between 2D-PC and 4D-Flow MRI, the differences in hemodynamic parameters between symptomatic and asymptomatic limbs and limbs with and without iliac vein compression, and the correlation between parameters and severity of symptoms. A total of 34 individuals, including three healthy volunteers, 15 patients with CVD and iliac vein compression, and 16 patients with CVD without IVCS, were enrolled in this study. Hemodynamic parameters measured by 2D-PC and 4D-Flow MRI complied with the flow rate conservation and maintained consistency (P < .01). There was a statistically significant difference in the FR of the CIV and FR difference between the CIV and CFV measured by 2D-PC and 4D-Flow MRI between symptomatic and asymptomatic limbs (2D-PC MRI: FR of CIV: 6.0 ± 3.1 vs 8.5 ± 5.1; P = .01; FR difference: 1.6 ± 2.1 vs 3.6 ± 4.3; P = .01) (4D-Flow MRI: FR of CIV: 6.9 ± 2.8 vs 8.7 ± 4.2; P = .04; FR difference: 3.0 ± 2.8 vs 4.8 ± 3.5; P = .05), and limbs with and without iliac vein compression (2D-PC MRI: FR of CIV: 5.3 ± 3.0 vs 7.6 ± 4.4; P = .03; FR difference: 1.3 ± 2.7 vs 2.8 ± 3.4; P = .04) (4D-Flow MRI FR of CIV: 6.1 ± 2.6 vs 8.2 ± 3.7; P < .01; FR difference: 2.1 ± 3.7 vs 4.6 ± 3.1; P = .04). The FR of the CIV and the FR difference between the CIV and CFV were negatively correlated with symptom severity in all affected limbs (2D-PC MRI: FR of CIV: P < .01; r = -0.3; FR difference: P = .03; r = -0.3). There was a potential negative correlation between the FR of the CIV in limbs with iliac vein compression and the severity of symptoms (2D-PC MRI: FR of CIV: P = .07; r = -0.4). In conclusion, hemodynamic parameters provided by 2D-PC and 4D-Flow MRI possess the potential clinical value of evaluating CVD and iliac vein compression.

We hypothesize that heterogeneity in RBC rheology can be attributed not only to the aging process but also to various disease states. The present study aims at investigating the rheological properties of young and old RBC in chronic venous disease (CVD) patients. RBC were separated on the basis of their density. RBC rheology was assessed with Laser Optical Rotational Cell Analyzer. For medium and high shear stress elongation index (EI) of young RBC from CVD patients was significantly higher than of young cells from controls. The same was observed for the old cells. Threshold shear rate (THR) of young RBC from CVD patients was significantly higher than of young cells from controls indicating a decreased tendency towards the formation of aggregates and of their stability in CVD patients. The same situation was observed for the old cells. To sum up, the present study demonstrated that heterogeneity in RBC rheology is both affected by age and CVD. Additionally, CVD-induced changes in RBC rheology occur to different degrees among the subpopulations of young and old RBC. CVD patients subpopulations of RBC had higher deformability and increased tendency towards aggregates formation and of their stability when compared to appropriate subpopulations of controls.

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

IntroductionManual lymphatic drainage (MLD) is an adjunctive method of chronic venous disease (CVD) therapy. Evaluation of the change at the clinical stage, hemodynamic parameters and quality of life (QoL) following venous system surgery in CVD patients undergoing MLD preoperatively are the most interesting aspects of the study.Material and methodsThe CVD patients qualified for elective surgery of the venous system were randomly divided into 2 groups: the MLD group (n = 38) and the control group (n = 32). In the preoperative period, the MLD group underwent a series of MLD through a period of 2 weeks. The control group did not undergo MLD preoperatively. Both groups were evaluated for CVD staging on the day of qualification for surgery and between 25 and 30 days post-operatively. Additionally, the MLD group was evaluated after the series of MLD. The CVD staging was evaluated in both groups with a QoL questionnaire (CIVIQ), CEAP classification, foot volumetry (FV) and venous refilling time (VRT).ResultsParameter values obtained in the MLD group (before treatment/after MLD/after surgery): CEAP 2.23/2.15/2.10, VRT 15/13/15.6, FV 3625/3472/3418, CIVIQ-complaints: 54.4/43.8/38.2 and CIVIQ-meaning: 57.3/49.3/43.1. Parameter values obtained in control group (before surgery/after surgery): CEAP 2.4/2.12, VRT 13/14.9, FV 3581/3559, CIVIQ-complaints: 51.9/38.7 and CIVIQ-meaning: 53.7/40.6. The CVD patients statistically improved in CEAP staging, FV and QoL in both groups (p < 0.05).ConclusionsThe MLD alone significantly reduced FV in patients with CVD, also improving their QoL. The MLD applied in CVD patients at the preoperative stage results in better surgical outcome, which is demonstrated by reduced disease progression, FV reduction and improvement in the QoL.

The objective of this study is to evaluate whether and which 'venous' symptoms are characteristic for patients affected with chronic venous disease compared to patients with other diseases of the lower limbs (e.g. arthrosis, peripheral arterial disease, spinal disc herniation). A cross-sectional study was performed to compare the frequency of venous symptoms among 76 patients with chronic venous disease and reflux and 74 patients with other diseases of the legs without reflux. The VEINES-Sym of the VEINES-QOL/Sym questionnaire was used to evaluate the frequency of symptoms. Demographic, clinical classification and ultrasound findings were also noted. A total of 122 patients were included for analysis (response rate of 87%). Presence of venous symptoms was slightly more often reported in the chronic venous disease group than in the non-chronic venous disease group, but differences were small and statistically non-significant. Severity of chronic venous disease as classified by the CEAP classification was not associated with higher proportions of patients reporting symptoms than in non-chronic venous disease patients, except for swelling (p = .016) and itching (p = .007) in C3-C6 patients. The largest difference between the chronic venous disease and non-chronic venous disease group was observed for the time of the day at which symptoms were most intense; patients with chronic venous disease were more likely to experience symptoms at the end of the day (p < .001). The small differences in prevalence of reported 'venous' symptoms between chronic venous disease patients and patients with other diseases of the legs suggest that these symptoms may be less specific for patients with chronic venous disease and refluxing veins than is usually assumed.

The lower limb venous system is responsible for the return of the blood from the leg toward the heart. Chronic venous disease occurs by a deficiency in the blood return due to structural or functional abnormalities of the veins of the lower limbs. Insufficient venous return leads to the accumulation of blood in the lower limbs and to varying degrees of venous hypertension, presenting a wide spectrum of clinical manifestations, ranging from simple telangiectasies and varicose veins to advanced forms. Chronic venous disease has a large prevalence in the world population and has significant impact on health services for high demand due to disease symptoms, activity limitation and aesthetic concern. Common symptoms are pain, cramps, heaviness, edema, and lower limb ulcer. The presence of tortuous and dilated veins must be noted, as well as telangiectasies, angiomatous formation, edema, and trophic skin alterations. CEAP classification has been proposed in order to standardize the scientific publications about varicose veins and therapeutic indications. Chronic venous disease treatment involves no interventionist actions to control symptoms and improve the quality of life with physical activity, compression therapy, phlebotropic agents, and interventional treatment such as sclerotherapy, transdermal laser, or surgery. Today, we have the minimally invasive methods as an alternative of surgery: endovenous ablation with laser or radiofrequency and foam sclerotherapy.

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

Chronic Venous Insufficiency

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

The influence of venous thromboembolism on quality of life and severity of chronic venous disease

Background: Elastic compression therapy (CT) in patients with peripheral artery disease (PAD) and chronic venous insufficiency (CVI) may compromise arterial perfusion. We evaluated the feasibility of a toe-flexion test, which quantifies dynamic foot perfusion by near-infrared spectroscopy (NIRS), for the assessment of hemodynamic sustainability of CT in PAD patients with CVI. Patients and methods: In this prospective observational study, PAD patients aged 50-85 with combined CVI at CEAP stages II-IV were studied. The ankle-brachial index (ABI) was measured, and foot perfusion was determined after 10 consecutive toe-flexion movements with NIRS sensors placed on the dorsum of each foot. Knee-high open-toe compression stockings were applied, and the degree of compression was measured. Toflex-area was determined by calculating the area under the curve of the oxygenated hemoglobin track recorded by NIRS. A toflex-area reduction >20% following CT was arbitrarily defined to identify limbs of patients with improved foot perfusion. These subjects received CT to be worn and a diary to report adherence and symptoms. Results: Forty-seven PAD patients (74±9 years; ABI 0.67±0.24) with CVI were enrolled. For all legs, superimposable toflex-areas were observed for the first two attempts (ICC 0.92). Following application of CT (17±2 mmHg), the toflex-area improved (from -162±110 a.u. to -112±104 a.u.; p<.001). Sixty-two limbs (n=32 patients) exhibited improved foot perfusion after CT, with a mean variation of 80±47 a.u., while 32 limbs (n=23 patients) showed stable or worsened values. In a regression model, favorable variations in toflex-area after CT were linked to a worse baseline toflex-area (R2=0.18; p<0.001; rpartial=-0.42) while the percentage improvement directly correlated with CEAP class (p=0.033). Conclusions: The NIRS-assisted test, which is feasible in a laboratory context, objectively discriminates the hemodynamic tolerability of the treatment and identifies subjects with combined PAD and CVI with improved perfusion after CT, in spite of the presence of PAD.

Getting Ready for Wound Certification: Assessing and Managing Lower Extremity Venous Disease.

Randomized Double-Blinded Study Comparing Clinical Versus Endovascular Treatment of Iliac Vein Obstruction.

Chronic venous disease (CVeD) has a remarkable prevalence, with an estimated annual incidence of 2%. It has been demonstrated how the loss of homeostatic mechanisms in the vein wall can take part in the physiopathology of CVeD. In this regard, it has been described how different axis, such as IGF-1/PAPP-A/STC-2 axis, may play an essential role in tissue homeostasis. The aim of this research is to study both genetic and protein expressions of the IGF-1/PAPP-A/STC-2 axis in CVeD patients. It is a cross-sectional study in which genetic (RT-qPCR) and protein (immunohistochemistry) expression analysis techniques were accomplished in saphenous veins from CVeD patients (n = 35) in comparison to individuals without vascular pathology (HV). Results show a significant increase in both genetic and protein expressions of PAPP-A and IGF-1, and a decrement STC-2 expression at the same time in CVeD patients. Our study is a pioneer for demonstrating that the expression of the different components of the IGF-1/PAPP-A/STC-2 axis is altered in CVeD patients. This fact can be a part of the loss of homeostatic mechanisms of the venous tissue. Further research should be destined to deepen into alterations of this axis, as well as to evaluate the usage of these components as therapeutic targets for CVeD.

BackgroundAlthough compression therapy is well established for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD), considerable variation exists in its organization in clinical practice which may impact patient outcomes. The current study aims to deepen our understanding of the main drivers of the complex care organization for compression therapy and to identify targets for improvement.MethodsThis realist evaluation includes a mixed-method design consisting of semi-structured interviews with patients and health care professionals involved in compression therapy (n = 30), stakeholder meetings (n = 2) and surveys (n = 114). Data were collected to create the content of context-mechanism-outcome-configurations (CMOcs) important in compression therapy. Based on these CMOcs, targets for improvement to optimize the organization of compression care were identified.ResultsWe identified overarching context factors and mechanisms targeting four optimal outcomes for the organization of compression therapy: selecting initial compression therapy types that support patient’s self-reliance (1), evidence based selection of elastic compression stocking type and class (2), patient-based selection of assistive devices (3), individualizing treatment duration for DVT patients (4a) and providing follow-up for CVD patients (4b). We found that increasing health care professionals’ knowledge of compression therapy, the availability of unambiguous protocols and guidelines, increasing patient involvement (and if applicable their informal care giver) in the decision making process, the accessible availability of resources, and increasing interdisciplinary consultation enhanced desirable outcomes. These targets triggered mechanisms such as increased health care professionals’ willingness, confidence and motivation to provide patient-based care and increased patients’ self-confidence and self-efficacy.ConclusionsThis study provides a detailed insight into what needs to be in place to optimize compression care and identified five main targets for improvement.