Chronic Vein Disease Research Articles

Diosmin therapy for chronic vein diseases in outpatient settings: results of non-intervention STATUS study

Diosmin therapy for chronic vein diseases in outpatient settings: results of non-intervention STATUS study

Features of structural and functional parameters of superficial veins of lower extremities in men with arterial hypertension

The aim of the work was to assess the structural and functional parameters of the superficial veins of the lower extremities in men with arterial hypertension. A comparative analysis of the results of the angioscanning of the superficial veins of the lower extremities between 60 men with arterial hypertension and 27 men with normal blood pressure at the age of 30–50 years was performed. In hypertension, an increased rate of venous blood flow and signs of chronic vein diseases are recorded — an increased diameter and area of the lumen of the veins; abnormal venous reflux marked in 10 % of men; in 3 % — varicose veins and thrombotic masses, signs of postrombotic lesion of the superficial veins.Conclusion. For men with hypertension aged 30–50 years, there is an increased rate of venous blood flow and signs of chronic venous disease of the lower extremities: chronic venous insufficiency, varicose and postrombotic venous disease, which must be considered when stratifying cardiovascular risks and treating hypertension.

Клініка та діагностика первинного варикозного розширення вен пахових каналів як одна з форм несафенового первинного хронічного захворювання вен під час вагітності

A distinct form of chronic venous disease (CVD) which meet the obstetrician-gynecologists, surgeons and vascular surgeons on the stages of pregnancy management is the primary varicose veins of the inguinal canals named non-saphenous varicose veins. This pathology is little studied and little known but there is a rather big obstetric problem for obstetricians-gynecologists, vascular surgeons, and as a surgical problem for surgeons and clinical and cosmetic for patients. The objective: to study the primary varicose veins of the inguinal canals frequency and forms, as well as development dynamics during pregnancy. Materials and methods. Based on Rivne Regional Perinatal Center Rivne Regional Council Municipal Institution for the period from 2013 to 2019, the observation of 1,367 pregnant women with primary chronic venous disease pool of saphenous and non-saphenous veins (according to the CEAP classification as of 2002). In 285 (20.8%) of them, one of the forms of non-saphenous varicose vein the primary varicose veins of the inguinal canals was diagnosed: in isolated form 129 (45.3%) patients, in 156 (54.7%) pregnant women combined with lower extremities’ primary chronic vein disease. All pregnant women for the diagnosis of venous pathology and the venous hemodynamics study in the lower extremities veins, the iliac veins pool, inguinal canals, a study of the sources, forming the primary varicose veins of the inguinal canals, used the second diagnostic level, under the guidance of Ukrainian Consensus on the treatment of lower extremities’ varicose veins as of 2005 which included the anamnesis data, clinical examination and duplex angioscanning. For all patients, ultrasound examination was performed in the supine standing position (orthostasis) with Valsalva maneuvre using Mc Kenna D. A. and co-authors criteria (2008). Results. Among 285 (20.8%) pregnant women with the primary varicose veins of the inguinal canals, 129 (45.3%) patients were diagnosed with an isolated form; 28 (21.7%) had varicose veins within the inguinal canal, and 101 (78.3%) of the pregnant women spread through the outer inguinal ring to the external genitals, perineum, and lower limbs. 156 (54.7%) pregnant women in the primary varicose veins of the inguinal canals different forms combined with primary CVD of the lower extremities saphenous veins pool. Found that among 285 patients with the primary varicose veins of the inguinal canals sources on duplex angioscanning in 141 (49.7%) was dominated by reflux from the uterine plexus veins, 73 (25.61%) mainly from the ovaries veins, 42 (14.73%) of pregnant women primarily from the veins of the uterus + ovaries, 18 (6.32%) mainly from the veins of the uterus + ovaries + cremasteric vein, failed to clearly identify the source for 11 (3.86%) patients. This pathology progressed throughout pregnancy and during subsequent pregnancies for 285 (100%) patients. The primary varicose veins of the inguinal canals isolated form did not progress between pregnancies. At that time all the 156 pregnant women with the concomitant disease, marked by the progression of primary CVD pool of saphenous veins during pregnancy and between pregnancies. Conclusion. The use of the second level diagnosis during pregnancy which combined the data of anamnesis, clinical examination and LANWIND MIRROR 2 duplex angioscanning apparatus with 8–10 MHZ linear sensor frequency, McKenna D.A. and co-authors criteria (2008) in the supine and standing (orthostasis) with the Valsalva maneuvre in 100% is safe for both mother and fetus. The use of the inguinal canals venous pathology’s second level diagnosis among the pregnant women gave one hundred percent diagnosis of this pathology’s various forms. On duplex angioscanning the primary varicose veins of the inguinal canals found in 20.23% among pregnant women with primary chronic vein disease to 45.3% in isolated form, but more often in 54.7% in combination with lower extremities’ primary chronic vein disease. Sources of the primary varicose veins of the inguinal canals’ formation were mostly uterus venous plexuses’ reflux in 49.7% of pregnant women, the ovaries in 25.61% of the patients. Key words: D.A. McKenna and co-authors criteria (2008), duplex angioscanning, non-saphenous varicose veins, inguinal canal varicose veins.

Аспекты профилактики и консервативного ведения пациентов с хроническими заболеваниями вен нижних конечностей

Аспекты профилактики и консервативного ведения пациентов с хроническими заболеваниями вен нижних конечностей

Aescusan: pharmacology, pharmacokinetics and therapeutic characteristics

The article is devoted to Aescusan, a well-studied preparation that is traditionally used in clinical practice for the treatment of chronic diseases of veins, hemorrhoids, postoperative and post-traumatic edema. The main active substance is aescin that is contained in horse chestnut seed extract - Aesculus hippocastanum. The paper presents data of a randomized controlled study demonstrating the efficacy of Aescusan in the treatment of chronic venous diseases and chronic venous edema along with the compression therapy. A number of in vitro and in vivo experimental studies provided convincing proof of efficacy of Aescusan. In particular, they proved the anti-edema, anti-inflammatory and venotonic effect of the preparation. Aescusan improves calcium ions entry into the smooth muscle cell channels in the vascular wall, which increases the venous vascular tone. The anti-inflammatory effect of Aescusan is associated with blockade of prostaglandin F2 (PGF2) release from the venous wall, 5-hydroxytryptamine (5-HT) and histamine antagonism, decreased catabolism of tissue mucopolysaccharides. Conclusion: Aescusan has a pluripotent effect on various pathogenetic mechanisms of chronic venous diseases. It is known for its good tolerability and ease of use, which makes it possible to use the preparation in patients with chronic venous diseases, hemorrhoids, and peripheral post-traumatic edema.

Vulvar and perineal varicose veins in pregnant women

Pregnancy is an important specific risk factor for the development of chronic vein diseases in women. In addition to the superficial veins of the lower limbs, transformation often affects the pelvic veins. The management of pregnant women with vulvar and perineal varicose veins is one of the urgent problems of nowadays at the intersection of phlebology and obstetrics-gynecology. The article discusses possible options for conservative treatment of women with vulvar and perineal varicose veins during pregnancy, including the possibility and feasibility of using systemic venoactive drugs.

Efficiency of various methods of surgical treatment of chronic diseases of lower limb veins (analysis of our experience)

The article deals with classification issues, the current state of medical and surgical treatment of chronic diseases of the veins of the lower extremities, widely used in world practice, innovative domestic developments based on electrocoagulation and electric welding technologies, as well as their comparative characteristics among themselves and with laser methods based on their own experience. The aim — to compare effectiveness of open and minimally invasive surgical techniques in patients with varicose disease (VD) and post‑thrombotic disease (PTD) of the lower extremities, to assess the possibility of Ukrainian high‑tech developments using. Materials and methods. Analysis was conducted of surgical treatment of 94 patients with VD for the period from 2014 to 2017 and 81 patients with PTD (the period from 2002 to 2010) in the «Olexandrivska» clinical hospital in Kyiv. Results and discussion. The results of treatment were evaluated at 4 weeks, 3 months, and 6 months after surgery by sonographic criteria, the presence of local edema, the dynamics of the trophic changes in soft tissue of the shin. After 1 month, a slight improvement was fixed at 18 % of the patients of the main group, moderate improvement — at 74 %, significant improvement — at 8 %. In 3 months the estimated effectiveness was 2 %, 12 %, 86 %, in 6 months — 2 %, 6 %, 92 %, respectively. The average length of hospital stay for patients in the main group was 2.4 ± 0.4 days, whereas in the control group this indicator was 5.2 ± 1.2 days. Conclusions. Endovenous laser coagulation and subfascial endoscopic dissection are effective, low‑impact methods for treating lower limb varicose and post‑thrombotic diseases of the lower extremity veins and should actively supplant open methods of surgical treatment. Ukrainian developments using high‑frequency electric welding and electrocoagulation technologies could take leading positions in phlebology.

Хронические заболевания вен – острая проблема современности

Хронические заболевания вен – острая проблема современности

Method of determining disease severity in women with pelvic varicose veins

Using assessment scales in clinical and research practice is one of fundamental reference methods of evaluation in human pathological states. Pelvic vein varicosity is an independent nosological entity within the framework of chronic vein diseases. Currently, the clinical methods of assessment in the aspect of a patient-oriented approach in this type of disease are largely understudied and still not duly defined. The study was aimed at analyzing clinical outcomes of surgical treatment in the form of resection of the ovarian vein in female patients with pelvic varicose veins, based on the developed specialized scale of clinical assessment of disease severity. We carried out an open prospective study of efficacy of resection of the ovarian vein in 37 women with pelvic varicose veins. The main criterion for assessment was a clinical method of determining manifestations of the disease by means of the Pelvic Venous Clinical Severity Score. According to the Pelvic Venous Clinical Severity Score, improvement of the condition was observed in 36 (97.3%) operated female patients and 1 (2.7%) woman turned out to have negative dynamics. The median of the composite score of the severity scale decreased form 11.78±5.06 points to 5.22±3.19 (p<0.05). The total positive gradient of the score amounted to 6.57±3 .65 points. A significant decrease in manifestations of severity was observed for 9 of the 10 clinical descriptors of the disease. The use of the suggested scale in practical assessment of the results made it possible to prove high efficacy of resection of the ovarian vein in women with pelvic varicose veins in the form of decreased intensity of the disease's symptomatology. The VCSS is an easy-to-fill-in tool, taking up little time, ensuring no influence of the physician's personality on the answers, presenting quantitative expression of therapeutic results.

Pharmacotherapy of chronic vein diseases. New European guidelines

The 19th Annual Meeting of the European Venous Forum held in the city of Athens in 28-30 June 2018 presented the long-awaited updated guidelines for the diagnosis and treatment of chronic venous diseases (CVD), the full text of which can be found in the June issue of International Angiology Journal. This publication aims at acquainting practitioners with one of the key sections of the new European guidelines devoted to the pharmacotherapy of CVD.

Покази до планового хірургічного лікування вагітних при первинному симптомному хронічному захворюванню вен нижніх кінцівок, зовнішніх статевих органів, промежини або в їх поєднанні в умовах короткотермінового перебування в стаціонарі

Мета роботи: розробити і впровадити суворо індивідуальні показання до безпечного як для матері, так і дитини, ефективного патогенетичного планового хірургічного лікування вагітних із первинним симптомним хронічним захворюванням вен (ПСХЗВ) в умовах короткотермінового перебування в акушерському стаціонарі (до 72 год за термінологією IAAS).&#x0D; Матеріали і методи. На базі комунального закладу «Обласний перинатальний центр» Рівненської обласної ради за період з початку 2013р.по перший квартал 2018р. прооперовано 356 вагітних з ПСХЗВ С2s-C4s,Еp,Аs,p.Pr (basis СЕАР,2002). Показанями до планового оперативного втручання у 246 вагітних (69,1 %) – були наростання явищ хронічної венозної недостатності нижніх кінцівок, зовнішніх статевих органів, промежини не зважаючи на проведену консервативну терапію; у 84 пацієнток (23,6 %) з метою підготовки пологових шляхів до природних пологів при варикозному розширенні вен зовнішніх статевих органів та промежини, для зменшення ризиків кровотеч при можливому розриві варикозних вузлів та звужуючи покази до хірургічних пологів; у 26 хворих (7,3 %) за їх побажанням зменшення косметичних проблем, які зумовлені варикозним розширенням вен зовнішніх статевих органів і/або на відкритих частинах нижніх кінцівок. Всім оперованим вагітним виконано дуплексне сканування вен із картографуванням патологічних зон (рефлюкси, варикозні конгломерати), оцінку біофізичного профілю плода (БПП), кардіотокографію (КТГ), вивчення згортаючої системи крові, кровотік у маткових, пуповинній, середньомозковій артеріях як до, так і після операції. &#x0D; Результати досліджень та їх обговорення. Оперативні втручання виконували тільки при згоді вагітних, при відсутності протипоказань до оперативного втручання як з боку соматичного, так і акушерського статусів в умовах акушерського стаціонару. Всі оперативні втручання виконували без премедикації, для знеболення використовували тумесцентну анестезію і хірургічну методику за типом CHIVA при низхідному розвитку ПСХЗВ, а при висхідному – поєднання методик CHIVA і ASVAL. У 100 % вагітних під час оперативного втручання в післяопераційному періоді порушень соматичного статусу, тонусу матки у вагітних, серцебиття плода (дані КТГ, БПП) не зафіксовано. За суб’єктивною оцінкою вагітними, порушень кількості та якості рухів плода не зазначено, і вони у 98 % випадків вказали на позитивний клінічний результат хірургічного втручання. Оперовані у ІІ та на початку ІІІ триместрів у 85 % знаходились протягом 24 год, 10 % – на протягом 48 год в умовах стаціонару, після виписувались під спостереження акушера-гінеколога за місцем проживання, 5 % оперованих в кінці ІІІ триместру залишались в стаціонарі до пологів.

CLINICAL AND HEMODYNAMIC SPECIFICS OF LOWER EXTREMITIES VENOUS CIRCULATION IN YOUNG WOMEN WITH IDIOPATHIC SYSTEMIC HYPOTENSION

Aim. To assess clinical signs and characteristics of venous circulation disorders in lower extremities in young women with idiopathic arterial hypotension (IAH). Material and methods. The comparison was performed, of the prevalence of subjective and objective signs of the chronic vein disease (CVD), and parameters of ultrasound vessel imaging of lower extremities circulation in 105 women with IAH (SBP 98 mmHg and below) and 48 women with normal arterial pressure (SBP 120- 129 mmHg). Mean age in both groups 19 (18-22) y.o. Results. Young hypotensive women present with complaints associated with CVD: leg pain in 31%, cramps at night in 27%, knee and feet edema by the end of the day — in 12%, trophic disorder of the skin — in 4%. CVD is characterized by a high prevalence of objective early signs of chronic veins diseases — teleangioectasia/reticular varicose (30%) that 2 times more common in low blood pressure. In IAH there is a decline found of structural and functional parameters of the low extremities veins comparing to normal blood pressure: lower diameter and the area of the lumen of the veins; lower thickness of walls and lower the tone; lower velocity of flow and lower the duration and velocity of venous reflux. In IAH there are ultrasound signs of CVD: in 45% — venous failure, varicose veins in 4%. In 78% young women with hypotension and venous reflux with low tone, there are complaints on leg pain 5 times more common than in normal pressure. Conclusion. In IAH young women more commonly present with CVD that show more prominent clinical picture and venous hemodynamics disorder than in normal blood pressure.

PREVENTION OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN REPLACEMENT ARTHROPLASTY PERFORMANCE IN PATIENTS WITH ASSOCIATED CHRONIC DISEASES OF LOWER EXTREMITIES VEINS

A number of patients with problems of major joints increases every year. These patients need the replacement arthroplasty. The rate of thrombotic complications rises in given category of patients simultaneously with the increase of the number of performed operations. There weren’t well-defined instructions of management of the patients with associated chronic vein diseases at the preparation period for arthroplasty performance in spite of the presence of clinical recommendations for prevention of thromboembolic complications. The authors analyzed the experience of management of such patients and presented these data for doctors from polyclinic and hospitals in order to apply the common treatment strategy.

Персонифицированная оценка риска развития неблагоприятных сердечно-сосудистых проявлений у пациентов молодого возраста с дисплазией соединительной ткани

Adverse cardiovascular manifestations (ACVM) were registered during 7-year follow-up of young patients with undifferentiated connective tissue dysplasia (CTD). ACVM developed in 28.42% of patients. Most frequent ACVMs were extension/aneurysm of the thoracic aorta (10.75%), cerebral vascular syndrome (10.56%), and arrhythmias (9.11%). Most significant risk factors for extension/aneurysm of the aorta were pathology of vertebral arteries, common risk factors (arterial hypertension, alcohol/drugs, smoking, heavy physical work, sports activities), bicuspid aortic valve); for pathology of cerebral vessels--completely open Willis' Circle, pathology of vertebral arteries, CTD related changes of skin and spine, diagnostic CTD coefficient > 23, chronic diseases of veins; clinically significant cardiac rhythm disturbances--combined valve manifestations of CTD, myxomatous degeneration of heart valves, pathology of the aorta, male sex, metabolic changes of the myocardium, deviations of circadian index, predominance of sympathetic tone, and diastolic dysfunction. Analysis of clinical characteristics (age, symptoms and severity of CTD, QTc dispersion ≥ 50 ms) and presence of unfavorable genetic polymorphisms in β1-adrenergic receptor gene (Ser49Gly, rs1801252), transcription factor Sp4 gene (A80807T, rs1011168), genes of matrix metalloproteinases type 3 (5A/6A) and type 9 (8202 A/G) allowed to evaluate overall risk of ACVM.

Frequency of Chronic Venous Disease among Nurses

Background : Chronic vein diseases are quite common and its prevalence is also quite high in community. One of the risk factors is occupation with prolonged standing. Quality of life and work efficacy may become risk factors. This disease has not received any special consideration and response. Methods : This is a cross-sectional study performed on nurses working in Dr. Hasan Sadikin General Hospital Bandung (n=98; women=76, men=22). The study was conducted in November 2012 through collecting data on prevalence, risk factors, and clinical symptoms by using questionnaire. Chronic venous disease was observed by direct inspection in lower extremities. Diagnosis was concluded according to the Clinical Etiology Anatomy Pathophysiological criteria. Results : There was a high frequency, i.e. 86.7% (n=71), of chronic venous disease among nurses, with the age group of 20–29 years old (34.1%) as the age group that was mostly affected. Among female nurses, almost all of them experienced the disease (93.4%; n=71). Clinical symptoms felt by most nurses were heavy feeling on legs (82.3%) and cramps (55.3%). Conclusion : The frequency of chronic venous disease among nurses is high, 86.7% and almost all of the female nurses suffer from the disease. The high frequency in females could be caused by risk factors such as parity and hormonal contraception. Those who are mostly affected by the disease are within range of age 20–29 years old of age. Heavy legs and cramps are the most frequent clinical symptoms felt. Keywords : Chronic vein disease, frequency, nurses DOI : 10.15850/amj.v2n1.432

Inequalities of health insurance guidelines for the treatment of symptomatic varicose veins

The emerging model of US health-care delivery is aimed at reducing costs, standardizing care, and improving outcomes. Although it is necessary for health-care providers and insurance carriers to work together to achieve those goals, insurers have the added duty of assuring physicians and patients that they comprehend the medical evidence and, based on that understanding, construct policies. Are US insurers meeting that responsibility or are they simply creating policies to serve their own needs? The medical policies of several US health insurers were analysed. The goal was to see whether it could readily be determined if these carriers used evidence-based medicine consistently to create uniform policies for the treatment of patients with symptomatic varicose veins. The literature was also reviewed to determine whether increased insurance documentation requirements have affected cost reduction, standardization of care and/or improvement of outcomes related to chronic vein disease management. There is a dramatic lack of uniformity among the insurance policies reviewed. Insurers appear to not choose important papers to create policy but use carefully chosen articles to reinforce what they want their policies to say. In so doing, conflicting policy criteria are being created. Complicating this inconsistency, rules for medical necessity are modified frequently, raising frustration levels among vein providers and their patients. What is clear is that costs are not being lowered, care is not being standardized and little is being done to prevent potential complications resulting from chronic vein disease. Patients and physicians are increasingly ill-served by, and frustrated with, the clear lack of consistency in the medical policy criteria being created by US insurance carriers in covering the treatment of patients with symptomatic varicose veins. The contradictory coverage requirements, seemingly based on no understanding of evidence-based medicine guidelines, and total variability in reimbursement for various types of treatment options is particularly worrisome. Collaboration between venous treatment providers and insurance carriers, to create evidence-based standards of care, would be timely and beneficial in creating guidelines for optimal patient care.

Nuklearmedizinische Untersuchungsverfahren in der radiologischen Venendiagnostik. III. Indikationen und Stellenwert

Radiological diagnostic methods for the diagnosis of abnormalities of veins were discussed in the light of 1,683 contrast venograms and isotope examinations in 650 patients with acute and chronic diseases of veins. For patients with increased thrombotic risks, the 125 I-fibrinogen test is recommended as a sensitive and simple method. Where there are symptoms of venous thrombosis, radionuclide venography, together with other noninvasive methods, may be used for establishing whether there are indications for contrast venography. These may also provide evidence of previous pulmonary emboli. These methods should also be used where there is clinical suspicion of previous pulmonary emboli. Non-invasive isotope methods have proved to be sensitive techniques for preliminary examinations and for follow-up. Contrast venography is necessary if definitive treatment is planned.