CEAP Classification Research Articles

Coronary Artery Disease Does Not Influence Outcomes of Iliac Vein Stenting

Although coronary artery disease (CAD) is a well-known prognosticator for worse outcomes of peripheral artery revascularization, the influence of CAD on the outcomes of lower extremity venous intervention is unknown. Our objective was to determine the impact of CAD on patient symptoms and reintervention rates after iliac vein stenting. We analyzed patients at a large tertiary care institution undergoing iliac vein stenting from August 2011 to June 2021. The venous clinical severity score was used to quantify symptoms. We stratified patients into two cohorts: those with CAD at the time of index procedure (CAD+) and those without (CAD−). Major reoperation was defined as any procedure using venography and minor reoperation as endovenous sclerotherapy or laser ablation. The two cohorts were compared with the 1-tailed independent samples t test for continuous variables and χ2 tests for categorical variables. Univariate and multivariate odds ratios (OR) of minor and major reintervention were determined using logistic regression models. Kaplan-Meier log-rank analysis was used to assess reintervention-free survival. Among 634 patients, we identified 76 (12.0%) CAD+ and 558 (88.0%) CAD−. The CAD+ group was significantly older, had a larger mean body mass index, and a larger mean CEAP class (Table). In addition, CAD+ patients had significantly higher rates of diabetes, hypertension, smoking history, and cancer (Table). CAD+ patients were also more likely to have an active venous leg ulcer at the time of iliac vein stent. The OR for a patient needing major reintervention was significantly higher for the CAD+ cohort on univariate analysis (OR: 1.93 [95% confidence interval [CI]: 1.06-3.39], P = .025), but only trended toward significance on multivariate analysis (OR: 1.79 [95% CI: 0.93-3.35], P = .072). The OR for any reoperation, major or minor, did not differ significantly between cohorts on univariate (OR: 1.12 [95% CI: 0.66-1.94], P = .686) or multivariate analysis (OR: 1.51 [95% CI: 0.85-2.74], P = .166). The CAD+ cohort had a larger mean number of reoperations, but the difference was not significant (2.1 vs 1.8, P = .128). The change in venous clinical severity score from the time of the index vein stent procedure did not significantly differ between the two cohorts at any follow-up time point in the 6 years after iliac vein stent (Table). Although CAD has a detrimental effect on the outcomes of peripheral artery disease interventions, this study indicates that CAD has no such impact on the outcomes of iliac vein stents.TablePreoperative characteristics, perioperative details, and postoperative outcomes of coronary artery disease (CAD)+ vs CAD− cohortsVariableCAD− (n = 558)CAD+ (n = 76)P valueDemographics and comorbidities Age (SD)60.3 (13.4)67.8 (10.7)<.001 Sex: male219 (39.4%)35 (46.7%).28 Diabetes105 (18.8%)38 (50.0%)<.001 HTN63 (82.9%)63 (82.9%)<.001 BMI (SD)26.2 (5.1)29.4 (7.5)<.001 Smoking Hx104 (18.6%)23 (30.3%).026 Cancer Hx51 (9.1%)20 (26.3%)<.001Perioperative details VCSS composite (SD)10.7 (3.7)11.4 (5.1).164 CEAP class mean (SD)3.5 (1.0)3.8 (1.4).037 Stent positionUnilateral224 (40.1%)33 (43.4%).673Bilateral334 (59.9%)43 (56.6%) Number of stents placed (SD)2.2 (1.0)2.1 (1.0).32Postoperative outcomes Days of follow-up (SD)770.8 (676.9)1001.1 (865.7).012 Number of total reoperations (SD)1.1 (1.3)1.4 (1.5).078 Number of reoperations in patients w/ ≥1 reoperation (SD)1.8 (1.2)2.1 (1.4).128 Univariate OR major reoperation1.93 [95% CI: 1.06-3.39].025 Multivariate OR major reoperation1.79 [95% CI: 0.93-3.35].072 Univariate OR any reoperation1.12 [95% CI: 0.66-1.94].686 Multivariate OR any reoperation1.51 [95% CI: 0.85-2.74].166 ΔVCSS 1st postoperative visit (SD)3.6 (4.4)3.3 (4.4).509 ΔVCSS 1-year follow-up (SD)6.4 (5.4)5.7 (6.9).289 ΔVCSS 2-year follow-up (SD)7.4 (5.6)7.7 (6.3).7 ΔVCSS 3-year follow-up (SD)8.2 (5.3)7.7 (5.7).406 ΔVCSS 4-year follow-up (SD)8.8 (4.9)8.5 (5.9).538 ΔVCSS 5-year follow-up (SD)9.1 (4.8)9.0 (5.4).839 ΔVCSS 6-year follow-up (SD)9.4 (4.7)9.1 (6.2).61BMI, Body mass index; CEAP, Clinical, Etiology, Anatomic, Pathophysiology; CI, confidence interval; HTN, hypertension; OR, odds ratio; SD, standard deviation; VCSS, venous clinical severity score. Open table in a new tab

Diabetes, Hypertension, and Smoking Do Not Affect Outcomes of Iliofemoral Vein Stenting for Proximal Venous Outflow Obstruction

Diabetes, hypertension, and smoking are well-recognized risk factors for peripheral artery disease, but little is known of their impact on chronic venous insufficiency (CVI). The aim of this study was to evaluate these factors in CVI patients undergoing iliac vein stent placement for chronic iliofemoral venous outflow obstruction. A clinical registry of 708 patients who underwent iliac vein stenting from August 2011 to June 2021 at a single institution was analyzed. Symptoms were quantified using Venous Clinical Severity Score and CEAP class. Both major (any intervention that included venography) and minor (superficial vein ablation) reinterventions after the initial iliac vein stenting were recorded. Univariate differences were analyzed using χ2 or Fisher exact tests for categorical variables and one-way analysis of variance for continuous variables. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. A Log-rank test was used to assess differences in reintervention-free survival. Among patients with CVI undergoing vein stent placement, the prevalence of diabetes was 23.0% (n = 163), hypertension was 51.1% (n = 362), and smoking was 22.2% (n = 157). Patients with diabetes (3.6 vs 3.4; P = .062), hypertension (3.6 vs 3.3; P < .001), and smoking (3.7 vs 3.4; P = .003) had higher CEAP scores than those without diabetes, hypertension, and smoking, respectively. Improvement in venous clinical severity score composite scores after vein stenting showed no differences postoperatively (diabetes: P = .513; hypertension: P = .053; smoking: P = .608), at 1-year follow-up (diabetes: P = .666; hypertension: P = .681; smoking: P = .745), or at 5-year follow-up (diabetes: P = .525; hypertension: P = .953; smoking: P = .146) (Table I). Diabetes (OR, 0.80; 95% CI, 0.45-1.43), smoking (OR, 1.34; 95% CI, –0.73 to 2.51), and hypertension (OR, 1.11; 95% CI, 0.63-1.95) were not associated with increased risk of major reintervention after iliac vein stent placement in the multivariate regression models (Table II). Log-rank test similarly showed no differences in reintervention-free survival for major or minor reoperations between those with and without diabetes (P = .79), hypertension (P = .14), and smoking (P = .80). Unlike in peripheral artery disease, diabetes, hypertension, and smoking have little to no impact on long-term outcomes or reinterventions after iliac vein stent placement for CVI.Table IComparison of patients with and without smoking history, diabetes, and hypertension preoperatively and postoperatively.VariablesSmoking historyP valueNo (n = 551)Yes (n = 157)PreoperativeVCSS composite10.5 (4.0)10.5 (4.3).894CEAP class3.4 (1.0)3.7 (1.1).003PostoperativeVCSS composite6.4 (3.6)6.7 (3.7).586Change in VCSS composite postoperative to preoperative3.5 (3.3)3.7 (3.3).608Reintervention1.8 (1.2)2.0 (1.6).091DiabetesP valueNo (n = 545)Yes (n = 163)PreoperativeVCSS composite10.6 (3.9)10.3 (4.5).478CEAP class3.4 (1.0)3.6 (1.2).062PostoperativeVCSS composite6.5 (3.5)6.4 (4.0).827Change in VCSS composite postoperative to preoperative3.6 (3.3)3.4 (3.2).513Reintervention1.8 (1.3)1.9 (1.2).709HypertensionP valueNo (n = 346)Yes (n = 362)PreoperativeVCSS composite10.4 (3.6)10.6 (4.5).594CEAP class3.3 (0.9)3.6 (1.2)<.001PostoperativeVCSS composite6.6 (3.5)6.4 (3.7).727Change in VCSS composite postoperative to preoperative3.9 (5.3)4.6 (5.3).053Reintervention1.8 (1.2)1.9 (1.3).174VCSS, Venous Clinical Severity Score. Open table in a new tab Table IIAdjusted and unadjusted odds of any minor and major reinterventionComparisonModelORP value95% CISmoking historyUnadjusted1.120.595(0.75-1.70)Adjusted1.340.355(0.73-2.51)DiabetesUnadjusted0.640.022(0.43-0.94)Adjusted0.80.454(0.45-1.43)HypertensionUnadjusted0.730.071(0.52-1.03)Adjusted1.110.727(0.63-1.95)CI, Confidence interval; OR, odds ratio. Open table in a new tab

Comparative study between great saphenous vein endovenous laser ablation (EVLA) and modified haemodynamic correction (CHIVA) as a treatment for varicose veins

Varicose veins (VV) could be a handicapping condition which may lead to limb swelling, pain and venous stasis ulcer. Prevalence of VV could present from 1% to 73% and from 2% to 56% at women and men respectively. CHIVA has been developed through the last two decades and is currently the second most common surgical procedure for the operative management of VV. Endovenous laser treatment of GSV was approved by FDA in 2002 and SSV was approved in 2003. EVLT allows delivery of Laser energy directly into the blood vessel lumen. EVLT with a 1470-nm diode Laser system is clinically safe, feasible and well-tolerated technique without scar and allows people to return to their normal daily activities rapidly. In a prospective comparative study between January 2018 and January 2020, 40 patients from those attended the outpatient departments complaining from VV were assessed according to the CEAP classification and ultrasonic duplex and arranged into group I (CHIVA) and group II (EVLA). Both CHIVA operation and EVLA were performed under local anesthesia. Cases were reviewed regularly at the outpatient clinic for 6 months for recurrence and complications. The recurrence occurred at 2/20 and 0/20 at CHIVA and EVLA respectively.

Relationship between clinical severity and hemodynamic impact of great saphenous vein incompetence using strain gauge plethysmography and duplex ultrasound.

To evaluate the relation of quantitative Duplex ultrasound (DUS) and strain gauge plethysmography (SGP) parameters with clinical severity and quality of life in patients with superficial venous incompetence. DUS volume flow and distal SGP refilling times (T50 and T90) were evaluated in 152 patients (164 Limbs) with superficial incompetence. Clinical severity and quality of life were evaluated with C of the CEAP classification, venous clinical severity score (VCSS), Aberdeen varicose vein questionnaire (AVVQ), and EuroQol 5D-3L. Higher DUS volume flow was associated with higher C in CEAP scores. Volume flow was also related to T50 and T90. Shorter T50 and T90 were associated with higher C in CEAP and VCSS. T50 was also associated with EQ-5DVAS. Reflux extension to the foot wase associated with shorter T50 and T90 and higher DUS volume flow. DUS volume flow and SGP refilling times are related with clinical severity and provide quantitative information regarding venous function in patients with superficial incompetence.

One-year duplex ultrasound-assessed closure outcomes of percutaneous endovenous microwave ablation for the treatment of varicose veins of the lower limbs.

This study aims to investigate the safety and efficacy of a new device using microwave technology for the endovenous ablation of the great saphenous vein (GSV) causing symptomatic lower limb varicose veins (LLVV). This prospective, single-arm, single-center, cohort study investigated the safety and effectiveness of endovenous microwave ablation for the treatment of symptomatic LLVV. Enrollment period was set between January and December 2020. Primary safety endpoint was the occurrence of procedure-related complications and primary efficacy endpoint was anatomical success defined as the duplex ultrasound (DUS)-proven GSV occlusion at 1year follow-up. Secondary endpoints included 1-year clinical success (CEAP classification improvement), repeat procedures rate due to GSV recanalization, and pain assessment at 24h post treatment. In total, 50 patients (42 female; mean age: 62 ± 12years) with 64 limbs were treated. No procedure-related complications were noted. Technical success was 95.3% (61/64 GSVs), as three cases of GSV recanalization were detected. Clinical success was 100%, as in all cases symptoms improvement by at least one grade according to CEAP classification, was achieved. Mean CEAP grade significantly improved from 3.3 ± 0.72 (median: 3) at baseline to 1.8 ± 0.85 (median: 2) at 1-year (p < 0.0001). There were no repeat procedures due to GSC recanalization. The median 24-h VAS value was 2 (mean: 1.9 ± 1.4). Endovenous microwave ablation was safe and effective for the treatment of varicose veins, achieving high 1-year GSV occlusion rates.

Comparison of intravascular ultrasound and magnetic resonance venography in the diagnosis of chronic iliac venous disease

BackgroundThe diagnosis of chronic iliofemoral venous obstruction (CIVO) can be made with several different modalities. Intravascular ultrasound (IVUS) examination is the gold standard in the diagnosis of CIVO. However, being invasive, it should not be the initial examination to screen patients with CIVO. The aim of this report is to compare the performance of magnetic resonance venography (MRV) with IVUS examination in the diagnosis of CIVO. MethodsFrom January 2016 to December 2020, the records of all patients who underwent preoperative MRV and then IVUS in the evaluation of CIVO were analyzed retrospectively. ResultsThere were 505 patients who were evaluated by any modality for CIVO. Of these patients, 15% (78) were evaluated by MRV. Patients who had failed a trial of conservative therapy for at least 3 to 6 months and who had disabling and lifestyle-limiting symptoms of CIVO were selected to undergo further evaluation with MRV at the treating physician’s discretion. For inclusion in analysis, technically satisfactory IVUS examination and MRV data were mandatory. Data was available for 60 common iliac vein (CIV) segments and 61 external iliac vein (EIV) segments for comparative analysis after appropriate exclusions. The mean age of the patients was 56 ± 15 years. The male to female ratio was 1:2. The distribution of patients across different CEAP classes was as follows: CEAP 3, 28%; CEAP 4, 62%; CEAP 5, 2%; and CEAP 6, 8%. Bland-Altman plots of the mean difference in area between IVUS examination and MRI were 74.1% for CIV and 56.9% for EIV. The sensitivity of MRV was 93% and 100%, and the specificity was 0% and 50% for CIV and EIV, respectively. The positive predictive value was 93% and 86%; the negative predictive value was 0 and 50% for CIV and EIV, respectively. Improvement was noted in clinical parameters (Venous Clinical Severity Score, visual analog pain scale, and grade of swelling) after IVUS examination and stenting after MRV. For the Venous Clinical Severity Score, the score improved from 6.0 ± 2.7 (before the procedure) to 4 ± 2.7 (after the procedure) (P = .0001). ConclusionsThere is dimensional disparity between MRV and IVUS examination in the diagnosis of symptomatic CIVO. MRV has a high sensitivity but low specificity when compared with IVUS examination and overestimates the severity of the stenosis in both the EIV and CIV. MRV is not a reliable diagnostic tool for iliac vein stenosis and should not be used for the definitive disposition of patients with CIVO.

Vein ablation is an effective treatment for patients with bleeding varicose veins

BackgroundBleeding is a rare but potentially life-threatening complication of varicose veins. There is paucity of literature about patients with varicose veins that present with bleeding and the effectiveness of vein ablation as therapy to prevent recurrent bleeding. This study compares patients treated with vein ablation for bleeding varicose veins with patients treated for venous symptoms other than bleeding. We hypothesize that vein ablation is safe and effective in preventing recurrence of bleeding from varicose veins. MethodsA retrospective single-centre review of consecutive patients undergoing vein ablation using radiofrequency in an outpatient office was performed. Patients presenting with bleeding were identified. A random (3:1) group of patients undergoing vein ablation for other venous symptoms and no bleeding was selected as a comparative group (control). The medical records were reviewed for patient characteristics and outcomes. A telephone survey inquiring about intensity of symptoms on a numeric rating scale of 0 to 10 prior and after treatment as well as recurrence of bleeding was also conducted. Patient characteristics and outcomes were compared between the two groups. ResultsThe incidence of patients with bleeding varicose veins was 3.6% (13/362) of all patients undergoing vein ablation at our center. A total of 26 ablations and 60 ablations were performed in patients with bleeding (n = 13) and controls (n = 39), respectively. There was no difference in age and race, but there was a trend for bleeding to occur more commonly in male patients (61.5% vs 33.3%; P = .073). Patients with bleeding from varicose veins were more likely to have congestive heart failure (P = .013) and present with more advanced venous disease based on CEAP classification (P = .005) compared with the control group. There was no difference between the 2 groups in vein closure (P = .246) or complications (P = .299) after vein ablation. With mean follow-up of 2.26 ± 1.17 years, 85% of patients (n = 11) remained free from bleeding episodes. One patient with recurrent bleeding required additional vein ablation and the second patient had a concomitant ulcer that was treated with compression therapy. ConclusionsBleeding from varicose veins is rare and more common in patients with congestive heart failure. Bleeding affects patients with higher CEAP scores. Vein ablation is a safe and effective treatment to prevent the recurrence of bleeding.

Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial.

Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p < .01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p < .01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins.

To Assess Short Term Outcomes of Ambulatory Selective Varices Ablation Under Local Anesthesia in Primary Varicose Veins

Background: Varicose veins are superficial veins that have become enlarged and twisted. A vein that is confined within fascial planes or is buried beneath subcutaneous tissue can carry massive amounts of high-pressure reflux without being visible at all. Aim: To assess the short-term outcomes of Ambulatory Selective Varices Ablation under Local anesthesia in primary varicose veins disease Methods: this is a descriptive case series conducted at department of surgery, Services Institute of Medical Sciences, from December 2018 to June 2019. After fulfill the inclusion criteria, 181 patients were enrolled. Preoperatively, all varicose veins marked but the patient is in standing position as it’s difficult or impossible to identify during recumbent position. A micro incision or puncture is made near the vein after the anesthetic has been administered into the peri-venous tissues. After removing a segment, the surgeon moved along the vein for roughly the similar distance, makes a second incision, then the procedure is repeated until all sections of the varix have been removed, reducing the risk of an inflammatory response from the residual segment thrombosis. Results: In this study the mean age of the patients was 35.03±5.25 years. C2 CEAP classification was noted in 52(28.7%) patients, c3 CEAP classification found in 101(55.8%) patients. The reflux found in 54(29.8%) patients and recurrence noted in 33(18.23%) patients. Conclusion: The conclusion of this study that Ambulatory Selective Varices Ablation under Local anesthesia is a feasible and reliable technique with lower rate of recurrence in patients presented with in primary varicose veins disease. Keywords: Varicose vein, varices, local anaesthesia

Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease

BackgroundThis study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification.MethodsIn total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020.ResultsThere were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11).ConclusionDuplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.

Anterior accessory great saphenous vein as a cause of postoperative recurrence of veins after radiofrequency ablation.

There are problems of postoperative relapse of veins after radiofrequency ablation (RFA). The study aims to analyze the causes of postoperative recurrence of veins after RFA. 928 patients with varicose veins of the lower extremities, clinical classes C2-C4 according to the CEAP classification, were treated in the ambulatory surgery centers using RFA. The causes of varicose recurrence showed that it was caused by: a) high fusion of the anterior accessory great saphenous vein (AAGSV) with great saphenous vein (GSV) directly in the saphenofemoral junction (SFJ), which was not revealed by preoperative ultrasound (1.7%); a long stump of the GSV after the RFA (7.8%); progression of varicose disease with the small saphenous vein (SSV) and formation of new reflux associated with insufficiency of the saphenopopliteal junction (SPJ) (4.7%); d) insufficiency of perforating veins of the tibioperoneal group (Sherman, Boyd), as well as Gunter (3.8%); e) neovascularization with dilation of small vessels in the area of the saphenofemoral junction (0.97%). A comparative assessment of the quality of life (QL) after different surgery methods 3 years after implementation was carried out. Thus, QL in all patients who underwent surgery significantly improved than before surgery. However, after the RFA GSV+AAGSV, the patients had better QL by all scales than those who underwent only RFA GSV. Operations performed simultaneously on GSV and AAGSV have better functionality than GSV-only RFA.

On the peculiarities of preparation of patients with venous trophic ulcer in outpatient conditions for the performance of radiofrequency ablation of veins

Annotation. The number of patients with venous trophic ulcer is constantly growing. At the same time, there is no effective method of their treatment in outpatient conditions. This issue is of fundamental importance for reducing the period of preparation of patients for radiofrequency ablation (RFA)of varicose veins. The aim of the study. The purpose of the study was: to give a clinical justification for the use of ultrasound debridement, PRP and PRF therapy to stimulate the regeneration process in venous ulcers in outpatient settings, for the aim of prepare patients for the implementation of RFA varicose veins. Under observation were 75 patients with varicose veins of the lower extremities in the stage of decompensation (C6 according to the CEAP classification). There were 49 women, 26 men, 55±4.6 years old. The duration of existence of venous ulcers was 2.1±06 years. The average size of ulcers is 4.5±1.7 cm. Ultrasound debridement was used to purify venous ulcers from necrotic masses, followed by stimulation of the regeneration process in them through PRP and PRF therapy. Thanks to the use of ultrasound debridement, it was possible to translate the chronic inflammatory process into an acute one. So, after the first session of ultrasound debridement, the wounds are regenerative and inflammatory in nature, which is confirmed by their cytological examination. Further use of PRP and PRF as a local factor in stimulating the regeneration process in venous ulcer caused the transition of regenerative-inflammatory to regenerative type of ulcer healing. Thanks to this approach to the treatment of venous ulcers, it was possible to reduce the time for surgical training of patients by 1.87 times. Treatment of venous ulcers, including ultrasound debridement – stimulation of the wound process PRP and PRF followed by operations aimed at eliminating the causes of decompensated chronic insufficiency is a promising direction in the treatment of varicose veins in outpatient settings.

Quantification of Hemodynamic Parameters in Primary Great Saphenous Reflux using Colour Doppler in Clinical Settings and Effect of GSV Ablation on the Venous Arterial Flow Index

Purpose: The aim of our study was to quantify venous reflux in outpatient settings using color Doppler and document objective improvement in hemodynamic parameters post ablation. Methods: Venous reflux was measured using color Doppler using venous-arterial flow index (VAFI), recirculation index (RCI), and percentage diameter change (PDC) (n = 30) and compared with healthy volunteers (n = 30), adjusted for age, sex, and body mass index (BMI). Patients with concomitant peripheral arterial disease (PAD), past history of deep venous thrombosis, chronic venous insufficiency, and venous ulcers were excluded from the study. Patients with reflux underwent RFA and VAFI was measured 6 months after treatment. Data were analyzed using IBM SPSS statistics software version 25. Tests of normality were applied before choosing statistical tests. Box-and-whisker plots with outliers were used to illustrate the difference between case and control groups. VAFI scores were compared pre- and postoperatively and Wilcoxon signed-rank test was applied for the comparison. P &lt; 0.05 defined statistical significance. Results: Thirty patients with primary GSV reflux along with 30 healthy volunteers were adjusted for age, sex, and BMI. Clinical part of CEAP classification was C0 = 2, C1 = 6, C2 = 16, and C3 = 6 in reflux group and C0 = 26 and C1 = 4 in (n = 30) in healthy volunteers. There was a statistical difference in RCI, PDC, and VAFI across both groups (P &lt; 0.5). In addition, VAFI decreased significantly after treatment at 6 months (1.38 preoperative to 0.95 postoperative, SD P &lt; 0.5). Of the 30 patients, 21 had pain as the primary presenting symptom; 81% (17) reported a significant decrease in pain scores associated with hemodynamic improvement. Conclusion: RCI, PDC, and VAFI are accurate quantitative measurements of reflux in outpatient settings. VAFI is useful in objectifying the results of treatment. Symptomatic improvement in terms of pain score can be used to supplement the hemodynamic improvement though further substantiation of the above would be required in a larger cohort.

Symptom Relief and Reintervention after Iliac Vein Stenting: Long-term Outcomes Based on CEAP Classification

Long-term studies with large sample sizes of iliac vein stenting (IVS) outcomes are lacking. We sought to evaluate symptom relief and reintervention rates after IVS in patients with chronic venous disease.

Assessment of Anatomical Changes in Advanced Chronic Venous Insufficiency Using Artificial Intelligence ) and Machine Learning Techniques

Advanced chronic venous insufficiency (CVI) is characterized by significant and unique morphological changes in the legs such as swelling, discoloration, loss of subcutaneous and muscle tissue in the lower part of the leg (inverted Champaign bottle appearance) and ulceration. These changes are not uniform and do not progress linearly with time. Widely used reporting tools like CEAP classification are descriptive. Currently, there are no reliable and objective methods to assess and monitor these soft tissue changes with time and after therapy.

A systematic review of current trends in pharmacologic management after stent placement in nonthrombotic iliac vein lesions.

Stenting of the iliac vein is increasingly recognized as a treatment for chronic venous insufficiency (CVI). However, the pharmacologic management after stent placement is unclear. This review was conducted to illustrate recent trends in anticoagulation and antiplatelet regimens following stent placement for nonthrombotic iliac vein lesions (NIVL). The MEDLINE database was searched using the term "iliac vein stent." Retrieval of articles was limited to studies conducted on humans and published in English between 2010 and 2020. Studies were included that described iliac vein stent placement. Studies were excluded that contained fewer than 25 patients, performed procedures other than stent placement, did not specify the postoperative anticoagulant used, or treated lesions of thrombotic origin. 12 articles were included in this review, yielding a total of 2782 patients with a male-to-female ratio of 0.77. The predominant CEAP classification encountered was C3. The most common stent used in the included studies was the Wallstent (9/12), and the most common pharmacologic regimen was 3 months of clopidogrel (6/12). Warfarin, aspirin, cilostazol, and rivaroxaban were among other agents used. Primary stent patency ranged from 63.1 to 98.3%. There was no apparent correlation between pharmacologic agent used and stent patency or subjective patient outcomes. Multiple different approaches are being taken to pharmacologically manage patients following stent placement for NIVL. There is no consensus on which agent is best, nor is there a formal algorithmic approach for making this decision. Additionally, the findings in this study call into question whether anticoagulation following stenting for NIVL is necessary at all, given the similar outcomes among the different agents utilized. This review underscores the potential value of undertaking a multi-institutional prospective study to determine what is the best pharmacologic therapy following venous stent placement for NIVL.

Prevalence of Chronic Venous Disease in primary care centers in Azerbaijan: the VEINSCOPE study

Aim: CVD is a chronic disorder that substantially changes the quality of life for the patient since the first symptomatic stages. The effect of CVD in the general population is often undervalued and not well detected by health systems. The aim of this study was to update the information on the prevalence of CVD and its stages in accordance with CEAP classification and evaluate the treatment status of CVD patients and the tactics and steps of GPs undertaken in order to manage these patients. Material and Methods: This cross-sectional multicenter study was performed in primary care centers in which sequential patients searching medical help, regardless of reason, were enrolled. The study included 3249 patients. Data were collected by the use of a questionnaire and clinical examination. Results: The prevalence of CVD (CEAP categories C0s–C6) was 48.5%. Only 26.9% of the patients had advised with their physicians because of their venous problems in the lower extremities. 30.8% of the patients had received either oral treatment or combination of oral and topical treatments for the given symptoms. Only 5.4% of the cases were redirected to the specialist. Conclusion: Chronic venous disease is extremely prevalent among patients examined at primary care clinics in Azerbaijan particularly in women and elderly patients. Redirection to a specialist is uncommon.

COMPLICATIONS AND EVALUATION OF QUALITY OF LIFE IN PATIENTS AFTER LESS-INVASIVE TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES.

The aim: To analyze the occurrence of complications and evaluate the quality of life in patients who got less-invasive treatment methods using endovenous laser ablation of varicose veins of the lower extremities in the early and late postoperative periods. Materials and methods: The study was conducted with the participation of 100 patients treated in 2019-2020 by one team of surgeons for varicose veins of the lower extremities with symptoms of chronic venous insufficiency C2-C4 (CEAP classification). Depending on the performance of endovenous surgical interventions, all patients were divided into two study groups. Results: In assessing the quality of life associated with health, according to the CIVIQ 2 questionnaire, it was found that in the presence of varicose veins in the superficial veins of the lower extremities, indicators decrease both in general and on all studied scales (pain, physical, psychological and social). However, when using endovenous laser ablation without miniphlebectomy, after 6 months of observation, recurrence of varicose veins of the lower extremities was noted, which was not observed in patients of the first group. Conclusions: The use of less-invasive interventions with ultrasound guidance positively affects patients' quality of life with varicose veins of the lower extremities, both in the early and prolonged postoperative periods.

Effectiveness of Vascular Balneotherapy in the Treatment of Chronic Venous Disease (CVD)

Aim: Inside the “Antica Querciolaia” Thermal Station, located in the municipality of Rapolano Terme (Siena), there is a well, called “Well 5 – Cold Bath”, from which gushes a homeothermic alkaline bicarbonate-sulphate mineral water, considered suitable for thermal use with venous vascular address. The main endpoint of the study was to demonstrate the effects of vascular balneotherapy with thermal mineral water on classical symptoms, such as edema and quality of life of patients with chronic venous disease in the lower limbs, while the secondary endpoint was to verify the efficacy and tolerability of vascular balneotherapy carried out in predefined vascular paths and with a standardized protocol. Materials and Methods: In the double-blind, randomized controlled study, 60 patients with chronic venous disease of the lower limbs were enrolled in the first three stages of the CEAP classification. The patients were divided into two equivalent groups: “Balneotherapy Group”, treated with baths in thermal mineral water from “Well 5 – Cold Bath” and venoactive drug therapy and “Control Group” which only took drug therapy in an equivalent dose and duration. Results: The results of the study show a clear improvement of the “Balneotherapy Group” compared to the “Control Group” in the treatment of chronic venous disease of the lower limbs, concerning both the primary and secondary endpoints set by the study. Conclusions: Our findings show the undoubted efficacy and excellent tolerability of vascular balneotherapy in the treatment of chronic venous disease of the lower limbs.

ЭПИДЕМИОЛОГИЯ ГОСПИТАЛИЗИРОВАННОЙ ЗАБОЛЕВАЕМОСТИ ВАРИКОЗНОЙ БОЛЕЗНЬЮ В МЕГАПОЛИСЕ

Chronic venous insufficiency of the lower extremities is currently one of the most common pathologies of the human vascular system and represents an important socio-economic problem for developed countries both due to its high prevalence and due to the cost of diagnosis and treatment. In the medical literature, the analysis of treated patients in a hospital is limited only to a certain contingent of patients in a given hospital or to the study of specific degrees of chronic venous insufficiency. We did not find data on the hospitalized morbidity of varicose veins, which would indicate its structure, in the literature available to us. We studied 10326 statistical maps and case histories of patients with varicose veins with venous insufficiency C2-C6 according to CEAP classification, treated from 2010 to 2019 in the city vascular center operating on the basis of the city clinical hospital of Minsk, all patients underwent various surgical procedures. interference. The structure of hospitalized morbidity, its growth over the years, the influence of the age of men and women on the development of chronic venous insufficiency are shown. The main reasons for the development of chronic venous insufficiency have been analyzed.