Chronic Venous Insufficiency Research Articles

Stasis Dermatitis: The Burden of Disease, Diagnosis, and Treatment.

Stasis dermatitis (SD), an inflammatory dermatosis occurring on the lower extremities, is a cutaneous manifestation of chronic venous insufficiency (CVI). SD is associated with a significant burden of disease. Symptoms such as pain, swelling, and itching can be debilitating for patients, leading to poor sleep, loss of mobility, and the inability to perform daily activities, and can interfere with work and leisure activities. Moreover, SD is a progressive disease with serious secondary complications such as ulcerations, which increase the patients' morbidity, reduce their quality of life, and increase health care burden. Challenges in diagnosing patients may have both short- and long-term sequalae for the patients due to unnecessary treatment and management. In addition, misdiagnosis may result in hospitalizations, placing additional burden on health care professionals in terms of time and financial burden on the health care system. Compression therapy and leg elevation represent the mainstay of treatment for CVI; however, it is also difficult to self-manage, which places a substantial burden on patients and caregivers. Moreover, compression therapy may cause discomfort and exacerbate itching. Subsequent nonadherence may result in disease progression that places additional burden on the physicians who manage these patients and the health care system in terms of resources required and costs incurred. A large proportion of patients with SD develop allergic contact dermatitis because of innate immune signals and altered skin barrier predisposing to sensitization to topical prescriptions, over-the-counter medications, and compression devices used to treat SD. Other than topical corticosteroids, there are no approved pharmacological options to treat inflammation in SD.

A Prospective Comparison of Outcomes of Brachiocephalic Versus Brachiobasilic Fistulas for Hemodialysis

Background Brachiocephalic fistula (BCF) and brachiobasilic fistula (BBF) are autogenous fistulas created in the arm for hemodialysis access. However, despite the differences in anatomy and surgical technique, the existing literature shows no significant statistical difference between the maturation, patency, or complications. We analyzed the outcomes of these two types of arteriovenous fistulas in our subgroup of the Indian population. Materials and Methods A prospective observational cohort study was performed at a tertiary hospital from August 2019 to August 2021 between patients who underwent BCF and BBF. The time to maturation, 1-year primary patency, and postoperative complications were studied. Results Among the 236 patients, 137 and 99 underwent BCF and BBF, respectively. 53 (39%) and 37 (37.4%) patients were lost to follow-up at the end of 12 months in each arm, respectively. Each group comprised predominantly of males. There was no significant difference in age, diabetes, coronary artery disease, or peripheral arterial disease between the groups. The time to maturation within 6 weeks, more than 6 weeks, and non-maturation was 51.88% and 58.1% (p = 0.58), 38.67% and 32.55% (p = 0.04), and 9.43% and 9.3% (p = 0.74) in BCF and BBF groups, respectively. The 1-year primary patency, primary-assisted patency, and secondary patency were 69.04% and 53.22% (p <0.001), 78.3% and 59.6%, and 79.5% and 62.9% in BCF and BBF groups, respectively. Apart from venous hypertension (BCF:2(1.5%) vs BBF:7(7.1%), p = 0.026), there were no significant differences in the postoperative complications between the groups. Conclusion BCFs take longer to mature but have greater primary patency than BBF. Both of these fistulas had similar postoperative complications. Larger randomized trials are needed to confirm our findings.

613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment

613 Utilisation of Off-Site Theatre Capacity to Reduce the Waiting Time for NHS Patients with Chronic Deep Venous Disease in the Post Covid-19 Pandemic Environment

Single-center clinical experience of cyanoacrylate embolization method for incompetent perforating veins in treating CEAP-6 patients

ObjectiveThe most severe form of chronic venous insufficiency includes venous leg ulcers in the CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at the CEAP-6 stage. MethodsA total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months after the procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver operating characteristic analysis was used to estimate the probability of postoperative nonocclusion of the perforating vein based on the preoperative ulcers’ diameters and the perforating veins’ mean diameters. Univariate and multivariate binary logistic regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein. ResultsAt the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20 ± 3.48 cm2 to 0.28 ± 0.77 cm2 after the procedure (P < .001). On average, 3.5 ± 1.01 perforating veins were treated, with a diameter of 4.09 ± 0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85 ± 3.06 to 8.03 ± 3.53 postoperatively (P < .001). Patients with nonoccluded perforating veins had larger preoperative ulcer diameters (13.77 ± 1.78 cm2) than those with occluded perforating veins (6.24 ± 2.47 cm2; P < .001). The mean perforating vein diameter was also larger in nonoccluded perforating veins patients (4.45 ± 0.41 mm) than in occluded perforating veins patients (4.04 ± 0.38 mm; P < .001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cutoff point of 11.25 cm2 for the possibility of postoperative nonocclusion of perforating veins were 100% each. In contrast, those for the preoperative mean perforating vein diameter cutoff point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. The presence of diabetes mellitus increased the likelihood of incompetent perforator veins, remaining open by 3.4 times (95% confidence interval: 1.11-10.44; P = .032), whereas a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% confidence interval: 3.47-25.29; P < .001). ConclusionsThis study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.

Comparison of the effect of combination therapies in the treatment of large varicose ulcers: A real-world cohort study.

The primary treatment for varicose ulcers is to address the underlying cause of venous hypertension, additionally, split-thickness skin transplantation (ST) is an effective option for large ulcers. The aim of this study was to compare the efficacy of venous surgery with or without split-thickness ST in the management of varicose ulcers (diameter ≥6 cm). Patients with varicose ulcers between 2013 and 2023 were included in the real-world retrospective cohort study. The endovenous microwave ablation/endovenous laser ablation-high ligation-foam sclerotherapy-compression therapy + ST group (EMA/EVLA-CT-HL-FS + ST) consisted of 32 patients, while the EMA/EVLA-CT-HL-FS group consisted of 48 patients. A difference in ulcer healing time was found between the two groups (the hazard ratio [HR] was 4.4, 95% CI [2.3-8.2], P < 0.0001). However, the healing rate did not differ between the two groups at 6 and 12 months postoperatively. ST has been shown to expedite ulcer healing and ameliorate the symptoms of VVs in the early stages of treatment, while its intermediate to long-term efficacy for ulcer healing and overall patient quality of life may be limited.

Sarcopenic obesity and severity of chronic venous disease in postmenopausal women

Sarcopenic obesity (SO) is a functional and clinical condition that is characterised by the simultaneous existence of sarcopenia and excess adipose tissue. This condition may be one of the pathogenetic factors for chronic venous disease (CVD) of the lower extremities and chronic venous insufficiency (CVI), due to impaired muscle venous pump function. Furthermore, obesity is considered a risk factor for these conditions. Objective — to investigate the association of sarcopenia and sarcopenic obesity with the severity of chronic venous disease in postmenopausal women. Materials and methods. The study included 117 postmenopausal women who were divided into two groups: Group I — 87 (74.4%) women with CVD, and Group II—30 (25.6%) women without any signs of CVD. Within Group I, two subgroups were distinguished based on the class of CVD as defined by the CEAP classification system. Subgroup IA consisted of 45 women (51.7%) with CVD classes 1 and 2, which correspond to compensated chronic venous insufficiency (CVI). Subgroup IB included 42 women (48.3%) with CVD classes 3, 4, and 5, indicating subcompensated or decompensated CVI. The measurement of fat and lean mass was conducted using dual‑energy X‑ray absorptiometry with the Hologic device (Discovery WI, USA, 2015). The presence of sarcopenia was determined by the skeletal muscle assessment index ASM/height2, where ASM is the total appendicular skeletal muscle mass of the legs and arms. Sarcopenia was diagnosed when the value of ASM/height2 was &lt;6.0 kg/m2. The diagnosis of SO was made in patients with sarcopenia and a body mass index &gt;25 kg/m2. Results. The mean age of women was 67.32±9.12 years (46—86 years), the mean body mass index was 29.1±6.0 kg/m2 (18.4—50.1 kg/m2), and BMI/height2 was 6.72±0.864 kg/m2. Women in Group I had lower values of BMI/height2 (6.63±0.72 kg/m2) than women in Group II (6.97±1.0 kg/m2, p=0.056). Sarcopenia was detected in 27 (23.1%) women, and SO in 17 (14.5%). There was no statistically significant difference between the groups in the frequency of sarcopenia: in Group I, 5 (16.7%) women had sarcopenia, in Group II — 22 (25.3%), (p=0.334). The proportion of patients with SO in Group I was statistically significantly larger compared to Group II — 18.4 and 3.3% (p=0.044). There was an increase in the proportion of women with sarcopenia and SO with increasing severity of CVI: 8 (17.8%) patients in subgroup IA and 14 (33.3%) in subgroup IB had sarcopenia (p=0.095), and 4 (8.94%) and 12 (28.6%) had SO, respectively (p=0.018). Conclusions. Postmenopausal women with CVD were more likely to have SO (18.4%) compared to patients without CVD (3.3%, p=0.044). Postmenopausal women with subcompensated and decompensated CVI were more likely to have SO (12 (28.6%)) than women with compensated CVI (4 (8.94%, p=0.018, odds ratio 6.54, 95% confidence interval 0.83—51.58). Menopausal women with CVD were more likely to have sarcopenia and had a higher incidence of subcompensated and decompensated CVI compared to women without sarcopenia, but the difference was not statistically significant.

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Evaluation of Outcomes Following Endovenous Laser Therapy (EVLT) for Chronic Venous Insufficiency (CVI) on a Daycare Basis in a Tertiary Healthcare Centre of Northern India: A Prospective Cohort Study

Extended Management of the Great Saphenous Vein Insufficiency Below the Knee

Extended Management of the Great Saphenous Vein Insufficiency Below the Knee

Chronic venous disease and psoriasis - a random association?

Chronic venous disease and psoriasis - a random association?

Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.

Minimaly Invasive Interventions in Acute Tributary Varicothrombophlebitis of the Lower Extremities

Background. One of the formidable complications of varicose veins of the lower extremities is thrombophlebitis. The risk of developing venous thromboembolic complications remains high even when taking anticoagulants. Most authors do not even consider surgical elimination of the manifestations of acute superficial thrombophlebitis. The aim. To evaluate the effectiveness of minimally invasive surgical treatment of acute tributary varicose veins of the lower extremities. Materials and methods. The surgical treatment of 78 patients with acute varicothrombophlebitis of the tributaries of the great saphenous vein was analyzed. Depending on the treatment performed, patients were divided into two groups: group I including 56 (71.8%) patients who underwent inpatient surgery for thrombotic lesions of varicose veins of the tributaries of the great saphenous vein; group II including 22 (28.2%) patients who received conservative outpatient treatment. Results. The choice of the volume of surgical intervention in patients of group I depended on the condition of thegreat saphenous vein. In the absence of thrombotic and varicose veins in 29 (51.8%) patients, the latter was preserved. With varicose changes in the great saphenous vein, 16 (28.6%) patients underwent radiofrequency ablation after ligationof the thrombosed tributary duct and miniphlebectomy or phlebocentesis with foam-form sclerotherapy. In 11 (19.6%) cases of thrombotic lesions of the great saphenous vein, crossectomy, long/short stripping or phlebocentesis with stem sclerotherapy after ligation of its tributaries and isolation of the latter distal to the thrombotic occlusion was performed. The surgical intervention was supplemented with miniphlebectomy of other varicose veins and ligation of failed perforator veins. In patients of group II, treatment was prescribed similarly to the treatment of deep vein thrombosis. Surgical treatment of patients in group I effectively prevented venous thromboembolic complications and reduced the manifestations of chronic venous insufficiency in 72.9% of cases. Conclusions. Minimally invasive surgical intervention for acute thrombophlebitis of the tributaries of the great saphenous vein allows, on an outpatient basis or in a one-day hospital, to eliminate thrombotic lesions of varicose super-ficial veins and prevent venous thromboembolic complications, reduce or eliminate manifestations of chronic venous insufficiency, prevent recurrence of thrombosis, and reduce the patient’s disability.

Personalized compression therapeutic textiles: digital design, development, and biomechanical evaluation.

Physical-based external compression medical modalities could provide sustainable interfacial pressure dosages for daily healthcare prophylaxis and clinic treatment of chronic venous disease (CVD). However, conventional ready-made compression therapeutic textiles (CTs) with improper morphologies and ill-fitting of pressure exertions frequently limit patient compliance in practical application. Therefore, the present study fabricated the personalized CTs for various subjects through the proposed comprehensive manufacturing system. The individual geometric dimensions and morphologic profiles of lower extremities were characterized according to three-dimensional (3D) body scanning and reverse engineering technologies. Through body anthropometric analysis and pressure optimization, the knitting yarn and machinery variables were determined as the digital design strategies for 3D seamless fabrication of CTs. Next, to visually simulate the generated pressure mappings of developed CTs, the subject-specific 3D finite element (FE) CT-leg modelings with high accuracy and acceptability (pressure prediction error ratio: 11.00% ± 7.78%) were established based on the constructed lower limb models and determined tissue stiffness. Moreover, through the actual in vivo trials, the prepared customized CTs efficiently (Sig. <0.05; ρ = 0.97) distributed the expected pressure requirements referring to the prescribed compression magnitudes (pressure error ratio: 10.08% ± 7.75%). Furthermore, the movement abilities and comfortable perceptions were evaluated subjectively for the ergonomic wearing comfort (EWC) assessments. Thus, this study promotes the precise pressure management and clinical efficacy for targeted users and leads an operable development approach for related medical biomaterials in compression therapy.

Management of traumatic recurrent arteriovenous fistula of the lower extremity: Open versus endoscopic repair

Background: Traumatic Arteriovenous Fistula (TAVF) and traumatic artery aneurysms are the late complications of vascular injuries. Complications arise from neglected or undetected cases of TAVF, hence the need to promptly diagnose and manage them. Aims/Objective: this is to highlight the principles and challenges of managing traumatic recurrent AVF of the lower extremities in a low-income setting like ours. We present a 43- year man with traumatic recurrent AVF of the lower extremity, associated with chronic venous disease and ankle ulcer dating 17 years, who underwent successful treatment via open repair, in our facility, through the combined efforts of a multidisciplinary team involving vascular and plastic surgeons as well as a physiotherapist.

Chronic venous disease of lower limbs in young men at high-altitude: A cross-sectional survey.

The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention measures. The convenient sampling method was used to conduct a questionnaire survey among males aged 18 to 40 above an altitude of 3000meters in Xizang in April 2023. The contents of the questionnaire included basic information, symptoms of CVD of lower limbs, protection status and training needs. Multivariate logistic regression model was calculated to evaluate the risk factors for CVD. A total of 350 survey questionnaires were received, and 326 valid samples were collected. The prevalence of CVD of lower limbs (C1-C6) was 37.42% (95%CI: 32.17%-42.68%), the ratio of C0 to C5 were 62.58%, 27.30%, 3.07%, 4.60%, 2.15% and 0.31%, respectively, no one reached C6. The top three symptoms of CVD were lower limb fatigue (18.10%), heaviness (15.34%) and pain (13.19%). 46.01% of respondents were unaware of CVD, and 12.88% of respondents did not have any protective measures of CVD. Multivariate logistic regression showed that age (OR = 1.076, 95%CI: 1.018-1.137, p = .009), preference for spicy food (OR = 1.747, 95%CI: 1.083-2.818, p = .022), unbalanced diet (OR = 1.877, 95%CI: 1.049-3.358, p = .034) and physical exercise (OR 0.610, 95%CI: 0.377-0.986, p = .044) were the independent risk factors for CVD. This study provided data on the prevalence of CVD in young men at high-altitude and the risk factors for CVD. The findings of this study may facilitate the development of individualized clinical assessments and targeted prevention programs.

Chronic venous disease: What if everything started with early care? A discussion with experts.

Chronic venous disease (CVD) is an umbrella term for a group of morphological and functional disorders of the venous system. Clinical signs of CVD may range from telangiectasia and reticular veins to active venous ulcers; therefore, earlier diagnosis and management of CVD may delay disease progression and reduce the burden of CVD on patients, caregivers, and healthcare systems. In this podcast discussion, Professor Andrew Nicolaides, Professor Stavros Kakkos, and Dr Gerardo Estrada-Guerrero share the key highlights from their symposium at the 2023 European Venous Forum. This symposium, titled "Chronic venous disease: what if everything started with early care?", discussed the clinical significance of "functional CVD," evidence and risk factors for CVD progression, and real-world strategies to facilitate earlier diagnosis and management of CVD. Together, these topics highlight the importance of early care to improve long-term outcomes for people with CVD.

Key Regulators of Angiogenesis and Inflammation Are Dysregulated in Patients with Varicose Veins.

Varicose veins (VVs) are the most common manifestation of chronic venous disease (CVD) and appear as abnormally enlarged and tortuous superficial veins. VVs result from functional abnormalities in the venous circulation of the lower extremities, such as venous hypertension, venous valve incompetence, and venous reflux. Previous studies indicate that enhanced angiogenesis and inflammation contribute to the progression and onset of VVs; however, dysregulations in signaling pathways associated with these processes in VVs patients are poorly understood. Therefore, in our study, we aimed to identify key regulators of angiogenesis and inflammation that are dysregulated in patients with VVs. Expression levels of 18 genes were analyzed in peripheral blood mononuclear cells (PBMC) using real-time PCR, as well as plasma levels of 6 proteins were investigated using ELISA. Higher levels of CCL5, PDGFA, VEGFC, TGF-alpha, TGF-beta 1, and VEGF-A, as well as lower levels of VEGFB and VEGF-C, were found to be statistically significant in the VV group compared to the control subjects without VVs. None of the analyzed factors was associated with the venous localization of the varicosities. The presented study identified dysregulations in key angiogenesis- and inflammation-related factors in PBMC and plasma from VVs patients, providing new insight into molecular mechanisms that could contribute to the development of VVs and point out promising candidates for circulatory biomarkers of this disease.

Quantitative evaluation of lower limb varicose veins using photoacoustic imaging

PurposeVaricose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively.MethodsNine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins.ResultsThe obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins.ConclusionPAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.

Treatment of varicose great saphenous vein with endovenous laser alone or combined with eco-guided foam sclerotherapy: A randomized controlled trial.

Objectives: This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Methods: Sixty patients were randomly allocated to EVLA or EVLA-UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Results: Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, p = 0.11). Nervous injury (NI) was rarer in EVLA-UGFS (3.4% vs. 23.1%, p = 0.04). No significant difference in other complication rates (p > 0.05). QoL improved in both groups (p < 0.001). EVLA-UGFS required more subsequent procedures (24.1% vs. 7.7%, p = 0.03). Conclusions: EVLA and EVLA-UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures.

Pulmonary hypertension and chronic kidney disease: prevalence, pathophysiology and outcomes.

Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) or kidney failure, with an estimated prevalence of up to 78% in those referred for right-heart catheterization. PH is independently associated with adverse outcomes in CKD, raising the possibility that early detection and appropriate management of PH might improve outcomes in at-risk patients. Among patients with PH, the prevalence of CKD stages 3 and 4 is estimated to be as high as 36%, and CKD is also independently associated with adverse outcomes. However, the complex, heterogenous pathophysiology and clinical profile of CKD-PH requires further characterization. CKD is often associated with elevated left ventricular filling pressure and volume overload, which presumably leads to pulmonary vascular stiffening and post-capillary PH. By contrast, a distinct subgroup of patientsat high risk is characterized by elevated pulmonary vascular resistance and right ventricular dysfunction in the absence of pulmonary venous hypertension, which may represent a right-sided cardiorenal syndrome defined in principle by hypervolaemia, salt avidity, low cardiac output and normal left ventricular function. Current understanding of CKD-PH is limited, despite its potentially important ramifications for clinical decision making. In particular, whether PH should be considered when determining the suitability and timing of kidney replacement therapy or kidney transplantation is unclear. More research is urgently needed to address these knowledge gaps and improve the outcomes of patients with or at risk of CKD-PH.

Effects of a Dietary Supplement Composed of Baicalin, Bromelain and Escin for Venous Chronic Insufficiency Treatment: Insights from a Retrospective Observational Study.

Chronic venous insufficiency (CVI) represents a risk factor for cardiovascular events. The first-line treatment includes the use of compression stockings and lifestyle changes. Natural products, such as flavonoids, could be used to improve the effects of compression therapy due to their anti-inflammatory and anti-oxidant properties. This study aims to evaluate the effects of a dietary supplement containing baicalin, bromeline and escin in CVI patients. A retrospective cohort study was performed by using the medical records of CVI affected outpatients. Patients treated with the dietary supplement were defined as "users". A modified Venous Clinical Severity Score (VCSS) was calculated, including pain, inflammation, vessels induration and skin pigmentation. All clinical variables were evaluated at baseline (T0), after 30 (T1) and 90(T2) days in "users" and "non-users". Out of 62 patients, 30 (48.4%) were "users". No difference was observed between groups at baseline. A lower VCSS value was recorded in "users" than that observed in "non-users" at T2 (7.0 (4.0-9.0) vs. 9.0 (5.0-10.0); p = 0.025). Vessels' induration and pain significantly reduced in 53.3% and 43.3% of "users" and in 18.8% and 9.4% of "non-users". Only "users" (33.3%) showed a reduction of the inflammatory signs as well as a decrease in malleolar circumference, from 29.0 (26.5-30.0) to 27.5 (26.0-28.5) (p < 000.1). A reduction of C-reactive Protein levels was found in "users" compared to "non-users" at T2 (1.0 (0.9-1.2) vs. 1.3 (1.0-1.5); p = 0.006). These findings suggest that implementation of a dietary supplement could improve the clinical outcomes of CVI patients.