Chronic Venous Insufficiency In Patients Research Articles

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.

The Relationship between Body Mass Index and Severity of Chronic Venous Insufficiency in Patients at Siloam Hospitals Lippo Village Building B

BACKGROUND: Chronic venous disease, or chronic venous insufficiency (CVI), is a condition that occurs when the venous valves, particularly in the lower extremities, fail to function properly due to venous obstruction or reflux. CVI is often referred to as a chronic venous disease, with clinical symptoms frequently presenting as varicose veins and often remaining undiagnosed accurately. CVI can occur due to various causes, including congenital, primary, secondary, and idiopathic factors. Body mass index (BMI) is a calculation used to estimate the amount of fat in the body and categorize an individual’s degree of obesity. Obesity is one of the risk factors that can contribute to the development of CVI, as it can lead to increased volume and pressure in the venous blood vessels due to an elevated BMI. OBJECTIVE: This study was conducted to investigate and understand the relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B. METHODOLOGY: This research employed a cross-sectional study design utilizing unpaired categorical comparative analytic study types. The sample was selected using consecutive sampling, with a target sample size of 115 individuals who were patients with CVI at Siloam Lippo Village Hospital Building B. Data were collected through patient interviews during Duplex ultrasound (USG Duplexs) examinations. Subsequently, the data were analyzed using the Chi-square analysis method. RESULTS: The study revealed a significant association between BMI and the severity of CVI (p < 0.001, odds ratio: 6.556, 95% confidence interval: 2.681–16,028). CONCLUSION: The research findings indicate a significant relationship between BMI and the severity of CVI in patients at Siloam Lippo Village Hospital Building B.

1024-P: Management Algorithm of Patients with Concomitant Diabetes Mellitus and Chronic Venous Insufficiency

Introduction: Diabetes mellitus (DM) and Chronic Venous Insufficiency (CVI) are significant burden in patient daily life. While the two diseases share common risk factors and pathophysiology, they are often assessed and managed as separate conditions. Aim: To develop recommendations for the identification and treatment of patients with concomitant DM and CVI. Methods: Using a modified Delphi method, a panel of experts developed 38 statements and 2 multiple choice questions. These were used to form an online survey which was disseminated through vascular and diabetes specialists across Europe, Central America, South America, and Middle East. Respondents indicated their level of agreement with each statement. The threshold for consensus was set as ≥75% of agreement. Results: A total of 238 responses were received. Most of the statements (27/38) reached >90% agreement, 9/38 attained between 75-90% agreement, and 2 failed to meet the threshold. The awareness around the impact of the two diseases was high and a gap was highlighted in the identification of patients suffering from concomitant DM and CVI. Seventy-seven (77%) respondents consider overweight (BMI >30) and leg oedema as signs for assessment of the presence of DM and diabetic microvascular complications (DmVC) in patients with CVI, while 63% agreed that three parameters (skin changes, leg burden and oedema) would be required to trigger investigation for coexistent CVI in patients with DM. Treatment of patients with DmVC and CVI should be accomplished with a combination approach, including lifestyle change, non-medical and pharmacological treatments. Venoactive drugs indicated in both DmVC and CVI were recognized as treatment option in this patient population. Conclusion: These results raised the need to consider DM and CVI as a combined therapy area. As outcome, an algorithm is proposed to help the identification of at-risk patients and to provide recommendation on the management of patients with concomitant diseases. Disclosure G.Gastaldi: Advisory Panel; Ascensia Diabetes Care, Insulet Corporation, Novo Nordisk, Lilly, Other Relationship; Abbott Diabetes, AlfaSigma, Research Support; Ypsomed AG, Speaker's Bureau; Dexcom, Inc., Medtronic, Roche Diabetes Care. A.K.Bozkurt: Advisory Panel; OM PHARMA. M.Van rijn: None. E.Bouskela: None. F.Glauser: Consultant; Servier Laboratories. E.Rabe: Consultant; Sigvaris Int., EUROCOM, Mylan, Speaker's Bureau; OM Pharma. A.Mansilha: None. H.Haller: None. J.Rosas-saucedo: None. Funding OM Pharma Ltd.

Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

Connection of perforating and intramuscular veins of the crus in varicosity

This study was undertaken to investigate the clinical anatomy of indirect perforating veins and their connection to the intramuscular venous collector of the crus by means of MSCT phlebography. From 2015 till now, MSCT phlebography was used to examine a total of 400 patients with chronic diseases of lower limb veins. According to the CEAP classification, clinical class C0-C1 was present in 108 (27%) subjects, C2-C3 - in 173 (43.3%) patients, and C4-C6 - in 119 (29.7%) patients. All examinations were performed using a 128-slice multispiral CT scanner Philips Ingenuity, followed by 3D reconstruction with the help of the IntelliSpace Portal Image Editing Software package. In the 400 extremities examined, we identified a total of 11 655 indirect perforating veins of the calf. Studying the anatomical localization of perforating veins demonstrated that 3248 veins belonged to the posterior tibial group, 1830 veins - to the lateral group, 873 veins - to the paraachillary group, 276 veins - to the intergemellary group, 4451 veins - to the medial group, and 997 perforating veins - to the lateral group. 3D imaging made it possible to trace the entire course of the perforating veins originating from the posterior arched, intersaphenous, oblique veins or other communicating branches to the subfascial and intramuscular portions to the connection with the gastrocnemius and soleus veins which as the disease progresses undergo ectasia with the formation therein of pathological segmental hypervolemia. Studying the ratio of the revealed indirect perforating veins of the determined groups and the presence of gradually developing ectasia of the intramuscular venous collectors in patients of various clinical classes from C0-C1 to C4-C6 made it possible to draw a conclusion on the involvement of perforating veins and intramuscular veins of the crus into the common pathohaemodynamic circle of the development and progression of chronic venous insufficiency in patients with varicose veins.

Accuracy of contralateral Villalta score to assess for pre‐existing chronic venous insufficiency in patients with unilateral deep vein thrombosis

BackgroundInternational guidelines recommend using the Villalta score (VS) to diagnose the postthrombotic syndrome (PTS). However, a high proportion of PTS detected with VS could just reflect the presence of preexisting primary venous insufficiency (PVI). Furthermore, it is unclear whether the contralateral VS (cl‐VS) can be used to assess for preexisting PVI. ObjectivesTo estimate whether cl‐VS can be used to assess for preexisting PVI, and to assess the proportion of PTS that could be attributable to preexisting PVI. MethodsSubanalysis of the SOX multicenter randomized trial focusing on patients with a first unilateral proximal deep vein thrombosis (DVT) followed for up to 2 years. PVI was defined as a baseline cl‐VS > 4, and PTS as VS > 4 in the leg ipsilateral to DVT starting 6 months after DVT. ResultsAmong 680 patients, mean cl‐VS remained stable over time: 1.23 (standard deviation [SD] ±2.49) at baseline and 1.17 (±2.20), 1.59 (±2.81), 1.54 (±2.50), 1.65 (±2.82), and 1.55 (±2.63) at the 1‐, 6‐, 12‐, 18‐, and 24‐month visits, respectively. Baseline cl‐VS and ipsilateral VS measured during follow‐up were mildly correlated (Pearson correlation = 0.13‐0.25). This association disappeared after subtracting the cl‐VS measured at the same visit from the ipsilateral VS. Overall, 48.8% of patients developed PTS of whom 12.8% had baseline cl‐VS > 4. ConclusionIn our study of patients with a first unilateral proximal DVT, the proportion of patients with PTS who had a cl‐VS > 4 is modest. However, cl‐VS appears to be stable over time. Its assessment could constitute a simple way of documenting preexisting PVI and help to classify patients as having PTS.

Concomitant Chronic Venous Insufficiency in Patients With Peripheral Artery Disease: Insights From MR Angiography

Both arterial and venous vascular disease processes can coexist in the same patient. Understanding the symptomatic overlap and prevalence will lead to a better diagnosis and targeted therapies. This was a retrospective observational study assessing imaging studies of patients with known peripheral arterial disease (PAD) for the presence of chronic venous insufficiency (CVI). One in five patients was found to have CVI on magnetic resonance angiography; however, not all of these patients had had documentation in the medical record of a diagnosis of CVI. Patients with coexisting PAD and CVI found on imaging studies had had a more advanced stage of PAD than those without CVI. It can be difficult to differentiate between PAD and CVI in patients with symptoms that can be common to both disease entities. Patients with more advanced stages of PAD with ulcerations or gangrene are more likely to have coexisting CVI. The clinical management of patients with mixed arterial and venous disease could need to include treatment options for both PAD and CVI for healing and/or limb salvage.

Investigation of chronic venous insufficiency in patients with sleep disorders due to restless legs syndrome.

We aimed to investigate of chronic venous insufficiency on patients with sleep disorder due to restless legs syndrome. Five hundred forty-one cases on whom polysomnography was performed due to sleep disorder were evaluated retrospectively. Forty patients with restless legs syndrome were determined. They were examined by history, physical examination, and duplex ultrasonography in terms of chronic venous insufficiency. The sleep stage rates of both groups were compared (that the rate of total sleep time in polysomnography to sleep stages is expressed as minute and percentage has been defined as sleep stage rate). Chronic venous insufficiency was identified in 20 out of 40 patients (group 1; female, 90%). In group 2, there were patients with only restless legs syndrome but with no chronic venous insufficiency (female, 80%). The mean ages of both groups were 56.4 ± 11.8 and 54.3 ± 14.7 years. Stage 1 sleep rate in group 1 was 5% ± 2.7 and in group 2 was 8% ± 3.8 (p = 0.006). Periodic limb movement index (polysomnography finding evaluating involuntary leg movements during sleep) was 11.4 ± 17.5 in group 1, and it was 29.4 ± 37.9 in group 2 (p = 0.006). We recommend that chronic venous insufficiency should be investigated in patients with primary restless legs syndrome diagnosis.

Concomitant chronic venous insufficiency in patients with peripheral artery disease: insights from MR angiography

ObjectivesThe clinical presentation of peripheral artery disease (PAD) and chronic venous insufficiency (CVI) can overlap and the conditions may co-exist. The purpose of our study was to investigate the prevalence and clinical significance of concomitant CVI in patients with PAD examined with run-off MR angiography (MRA).MethodsWe analysed 180 patients (median age 69 years, range 27 to 91) with known or suspected PAD who underwent MRA at our institution between 2012 and 2018. MRA datasets were re-evaluated for manifestations of CVI. Electronic charts were reviewed to analyse whether diagnosis of CVI was documented and to determine Fontaine stage of PAD.ResultsEvidence of possible CVI on MRA was found in 38 (21%) patients. Only seven (18%) of these patients had a documented diagnosis of CVI. Patients with co-existing PAD and CVI were more likely obese (median BMI 29.7 vs. 26.3 kg/m2, p = 0.001) and diabetic (55 vs. 35%, p = 0.039) than patients without CVI. The frequency of concomitant CVI manifestations decreased from distal to proximal with the lower leg affected in all 38 patients and the thigh in 17 patients (45%). Patients with co-existing PAD and CVI were more likely to have a clinical diagnosis of stage IV PAD than patients without co-existing CVI (57% vs. 34%, relative risk 1.68, p = 0.018).ConclusionsSigns of possible concomitant CVI can be seen in approximately one-fifth of patients with known or suspected PAD examined with run-off MRA. If present, these findings should be reported since CVI may mimic or contribute to symptoms attributed to PAD.Key Points• In total, 21% of patients with PAD patients examined with MR angiography show signs of possible co-existing CVI.• Patients with co-existing CVI were 1.7-fold more likely to have a clinical diagnosis of stage IV PAD.• Our data also showed that co-existing chronic venous insufficiency is under-diagnosed in patients with PAD.

Role of conservative treatment of chronic venous insufficiency for regression of the features of desadaptive cardiac remodeling in patients with comorbid obesity

Aim. To evaluate the influence of conservative treatment tactics for chronic venous insufficiency on the processes of cardiac remodeling in patients with comorbid obesity. 
 Methods. 32 males with obesity class 1 (BMI 32.57±2.25 kg/m2) at the age of 40.7±11.5 years and with clinical and instrumental signs of chronic venous insufficiency were divided into 2 groups: patients from group 1 (n=14) followed the recomendations to wear compression stockings and to use hesperidin + diosmin 500 mg twice a day, and the patients from group 2 (n=18) did not follow those recommendations. All patients had echocardiography performed before the treatment and 2 months after the first visit. For the evaluation of echocardiographic dynamics paired Student’s t-test was used. 
 Results. After 2 months statistically significant dynamics of the following echocardiographic findings was revealed: in group 1 index of eccentric left ventricular shape increased from 0.94±0.06 to 1.01±0.03, in group 2 - from 0.96±0.08 to 0.97±0.07 (р=0.023). In group 1 tricuspid annular plane systolic excursion decreased from 30.07±5.31 to 26.64±4.14 mm, in group 2 - from 29.6±4.72 to 29.88±6.04 mm (р=0.008), and the right atrial volume in group 1 decreased from 53.57±11.48 to 46.64±13.18 ml, in group 2 - from 52.77±11.27 to 51.38±8.54 ml (р=0.044). In group 1 statistically significant trend to decreased ratio of maximal velocity of RV early diastolic filling to maximum diastolic tricuspid valve lateral annular velocity was revealed (from 4.75±1.35 to 4.25±1.23 cm/sec) compared to group 2 (from 4.79±1.62 to 4.75±1.58 cm/sec; р=0.076). 
 Conclusion. Conservative treatment of chronic venous insufficiency in patients with obesity is associated with indirect indicators of decreasing volume overload of the heart and can influence positively on heart geometry leading to regression of spheric LV remodeling and decrease of RA volume.

Chronic venous insufficiency in patients with absence of the inferior vena cava

Up until now, knowledge of absence of the inferior vena cava (AIVC) is limited to case reports and small case series, usually reported shortly after diagnosis. To characterize long-term evolution of outcomes of patients with AIVC, weperformed a survey of current practice in Belgium, TheNetherlands, and Luxembourg (Benelux). Vascular surgeons and phlebologists in the Benelux area were asked to complete a questionnaire on medical history and treatment of each patient in follow-up at their practice with a diagnosis of AIVC. The Benelux survey yielded 35 patients with AIVC, with a follow-up ranging from 0 to 28 years. Their median age was 40 years (range, 14-65 years), and 26 (74%) were male. Diagnosis of AIVC was made in 26 patients at the time of presentation with deep vein thrombosis (DVT). DVT was bilateral in 15 patients and involved one or both iliac veins in 21 (81% of all AIVC patients with acute DVT). Computed tomography scanning was used to detect AIVC in 29 patients. Thrombophilia was present in 16 (46%). The CEAP C classification was C4-6 in 17 right legs (49%) and 15left legs (43%). Unilateral or bilateral ulceration had occurred in 11 patients in the past, and three had active ulceration. Long-term conservative treatment consisted of oral anticoagulant treatment in 28 patients and compression stockings in27. The results of this survey on AIVC illustrate the unfavorable long-term clinical evolution of these patients. They frequently present with advanced stages of chronic venous insufficiency at a relatively young age, with the development of unilateral or bilateral extensive DVT and subsequent moderate to severe post-thrombotic syndrome.

Results of complex treatment of patients with knee osteoarthritis and varicose diseases of the lower extremities

Aim. To evaluate the results of complex treatment with application of methods of correction of chronic venous insufficiency in patients with osteoarthritis of the knee joints in combination with varicose disease of the lower extremities. Methods. Examination of a cardio-vascular surgeon, orthopedist or rheumatologist, triplex scanning the veins of the lower extremities, arthrosonography and X-ray imaging of the knee joints, assessment of the severity of chronic venous insufficiency according to a CEAP scale [Clinical signs, Etiologic classification, Anatomic distribution, Pathophysiologic Dysfunction (1984)], and the degree of gonarthrosis according to the special Leken’s index and WOMAC index (Western Ontario and McMaster Universities Arthritis Index). The investigations were performed before treatment and repeatedly during the year in the course of treatment. According to the indications both conservative therapy and surgical treatment were used. Results. As a result of the complex treatment of patients achieved was a reduction in the severity of symptoms of gonarthrosis, which manifested with a decrease in the total value of the Leken’s index and the WOMAC functional index. Positive results were obtained in the group of patients who underwent surgery, and in the group of patients who received conservative treatment. Conclusion. Inclusion in the treatment of the methods aimed at eliminating manifestations of chronic venous insufficiency leads to improved results of treatment of osteoarthritis of the knee joints.

Predictive Values in the Progression of Chronic Venous Insufficiency Associated with Superficial Venous Incompetence.

The purpose of this study was to define predictive values in the progression of chronic venous insufficiency in patients with isolated superficial venous incompetence using duplex ultrasound and air plethysmography (APG). Five hundred eight legs in 371 patients with isolated superficial venous incompetence were included in this study. A color duplex scanner with a 5- to 10-MHz linear transducer was used to assess the distribution and the extent of venous reflux as well as the duration of reflux and the retrograde peak velocity at the saphenofemoral junction, greater saphenous vein in the thigh, and the saphenopopliteal junction. Venous reflux was considered to be present if the duration of reflux was greater than 0.5 s. The extent of greater saphenous vein is divided into 3 types. Type I: reflux from the groin to the ankle. Type II: reflux from the groin to the below-knee level. Type III: reflux from the groin to the above-knee level. Values obtained by APG were the venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual venous fraction (RVF). Between-group differences were analyzed using Wilcoxon's nonparametric rank sum test. Type I limbs had highest incidence of advanced chronic venous symptoms. Based on the duplex-derived duration of reflux and retrograde peak velocity in Type I limbs, there were three major groups: limbs with a retrograde peak velocity greater than 30 cm/s and a duration of reflux less than 3 s (group A), limbs with a retrograde peak velocity greater than 30 cm/s and a duration of reflux greater than 3 s (group B) and limbs with a retrograde peak velocity of less than 30 cm/s and a duration of reflux greater than 3 s (group C). Most of the class 2 and class 3 limbs belonged to Group C, whereas most of the class 4 limbs and all of the class 5 and class 6 limbs belonged to group A and group B. APG-derived VFI had significantly higher values in group A and group B compared with group C (P < 0.002). Peak velocity greater than 30 cm/s had a high positive predictive value of 75.0% with a sensitivity of 91.1%. Although duplex-derived duration of reflux is widely used to assess venous reflux, our data suggest that the peak velocity is a better predictor of the progression of chronic venous insufficiency and that it correlates well with the severity of the clinical manifestation in cases with isolated superficial venous insufficiency.

The aetiology and influence of age and gender on the development of advanced chronic venous insufficiency in the population of patients of semi-urban county outpatient vascular clinic in Poland

To determine the aetiology and influence of age and gender on the development of advanced chronic venous insufficiency in patients of semi-urban county outpatient vascular clinic. One hundred and fourteen patients with venous ulcers were divided, based on the ultrasound examination, into group 1 or group 2, with or without post-thrombotic lesions in the deep venous system, respectively. The control group consisted of 352 patients with varicose veins and without leg ulceration. The demographic data and thrombotic risk factors were compared between the groups. Group 1 patients (n = 109) were older than group 2 patients (n = 5) and control group patients, 64.7 versus 47.2 years (P = 0.016) and versus 53.8 years (P < 0.001), respectively. The percentage of women did not differ between group 1 and the control group, but was lower in group 2 (P = 0.01). The history of lower limb fracture or severe trauma increased the risk of post-thrombotic syndrome (PTS) in patients with venous ulcer. In the population studied, the venous leg ulcer develops mainly due to primary varicose veins and its risk increases with age and is equal for both sexes. PTS should be suspected in younger patients with a history of severe trauma or leg fracture.

Comparison of new continuous measurements of ambulatory venous pressure (AVP) with conventional tiptoe exercise ambulatory AVP in relation to the CEAP clinical classification of chronic venous disease

Quantitative measurements of chronic venous insufficiency (CVI) are sensitive in detecting the presence of CVI but have low specificity in differentiating clinical severities of CVI as defined by the CEAP classification. One possible reason for this is measurement techniques do not assess variables that reflect hemodynamic changes that occur during normal exercise. Our aim was to compare the association of variables determined from a new technique, continuous ambulatory venous pressure monitoring (CAVPM), and those of conventional AVP measurement with the clinical severity of chronic venous insufficiency in patients with primary venous reflux. Fifty-four limbs of 49 patients with CVI and 15 healthy controls were studied. CVI clinical severity was classified according to CEAP as C2&C3 (mild disease), C4 (moderate disease), and C5&C6 (severe disease). All participants underwent duplex ultrasound scanning to rule out the presence of reflux in the control group and to confirm it in the patient groups. Conventional AVP measurements, including 90% refilling time (RT90), were compared with the new CAVP variables of mean walking pressure (MWP) and percentage fall in walking pressure (%FWP). Data were analyzed by analysis of variance using the Kruskal-Wallis test, and comparisons between groups were performed using Mann-Whitney tests. Discriminant analysis was used to determine the ability of a test to classify limbs into clinical classes. Conventional AVP measurements could not differentiate between the control group and the presence of mild disease (P = .56) but did differentiate between controls and severe disease as well as mild and severe disease (P < .001). RT90 detected differences between controls and reflux groups (P < .001) but not between moderate (C4) and severe (C5&C6) clinical groups (P > .5). MWP and %FWP showed significant differences between all clinical severities and controls (P < .001). In the assessment of CVI, mean walking pressure and percent fall in walking pressure are more reliably associated with anatomic distribution of reflux and clinical severity of CVI than the gold standard investigations of conventional AVP and RT90.

Charakterystyka przewlekłej niewydolności żylnej u chorych na przewlekłe żylne owrzodzenia podudzi. Część I. Charakterystyka kliniczna

Charakterystyka przewlekłej niewydolności żylnej u chorych na przewlekłe żylne owrzodzenia podudzi. Część I. Charakterystyka kliniczna

Charakterystyka przewlekłej niewydolności żylnej u chorych na przewlekłe żylne owrzodzenia podudzi. Część II. Charakterystyka ultrasonograficzna i laboratoryjna

Charakterystyka przewlekłej niewydolności żylnej u chorych na przewlekłe żylne owrzodzenia podudzi. Część II. Charakterystyka ultrasonograficzna i laboratoryjna

Venoruton® vs Daflon®: Evaluation of Effects on Quality of Life in Chronic Venous Insufficiency

The aim of this independent study was to investigate differences in efficacy between oxerutins (Venoruton) and 500 mg micronized diosmin + hesperidin (D+H) (Daflon) in patients with chronic venous insufficiency (CVI), evaluating venous-related quality of life (Ve-QOL). A first group of 90 patients with severe venous hypertension (CVI, ankle swelling) was randomized to treatment with oxerutins or D+H. The oxerutins group received oral oxerutins (2 g/day); the D+H group received 3 (500 mg) tablets daily every 8 hours for 8 weeks. A second group of 122 comparable patients was included in a registry following the same study format. The 2 treatments were administered with the same methods and procedures. Clinical conditions were comparable. All patients completing 8 weeks of treatment were included in a registry. Specialists or general practitioners included patients when they considered that clinical conditions were compatible with treatment indications using 1 of the 2 treatments on the basis of their evaluation and experience. When cases were compatible with the registry, the prescribing physician communicated the case to our monitoring center. Patients were evaluated without interfering with their treatment. The main target of evaluation for this study was the change in Ve-QOL (range, 0-100) induced by treatment. A specific Ve-QOL questionnaire was used for this study. Ve-QOL score is a specific expression of the changes in QOL induced by CVI in patients between 35 and 75 years old (defined in our population studies) in which no other significant clinical disease is present (as a confounding factor affecting QOL). Two hundred twelve patients completed the 2 parts of the study. The 2 treatment groups were comparable for age and gender distribution. The mean age was 42 years (SD +/-5.5) in the oxerutins group and 41.5 (SD +/-6) in the D+H group. There were no differences in the severity of CVI between the treatment groups at inclusion. A significant decrease (46.8%, p <0.05) in Ve-QOL score; that is, improvement, was observed in the oxerutins group. The change in Ve-QOL was significantly less in the D+H group (15.5%). In conclusion, CVI, venous microangiopathy, and edema were significantly improved by the treatment with oxerutins; the improvement in QOL was significantly greater in the oxerutins group. The comparison with D+H indicates that oxerutins is comparatively more effective on Ve-QOL and on signs/symptoms of CVI.

Urine hemosiderin: a novel marker to assess the severity of chronic venous disease.

Impaired venous drainage in severe chronic venous insufficiency (CVI) leads to microcirculatory overload, characterized by erythrocyte diapedesis and subsequent extravascular hemolysis, resulting in typical dermal hemosiderin deposition. We hypothesized that hemosiderin, normally absent, could be present in the urine in CVI. The three-phase study included 117 patients with CVI and 12 healthy control subjects, all of whom had undergone clinical examination and duplex scanning. In phase 1, current methods were used to test urine for hemosiderin in 61 persons: 12 healthy control subjects, 24 patients with mild CVI (clinical class C1 to C3), and 25 patients with severe CVI (clinical class C4 to C6). In phase 2, the concentration of urinary hemosiderin was determined in 45 consecutive patients with CVI, CEAP class 1 to 6. A score of 0 was assigned when typical hemosiderin granules were absent at microscopic examination, a score of 1 when one to three granules per field were detected; 2 when four to six granules were detected; and 3 when more than six granules were observed. Phase 3 included 23 patients with CVI (clinical class 2 to 6). Hemosiderin concentration was determined and a score assigned before patients underwent surgical procedures to correct primary CVI. Both hemosiderin testing and duplex scanning were repeated after 6 months. Phase 1: Urine hemosiderin testing to determine presence or absence of CVI in patients with reflux detectable at duplex scanning yielded the following values: positive predictive value, 96% (95% confidence interval [CI], 86% to 100%); negative predictive value, 88% (CI, 68% to 97%); sensitivity, 94% (CI, 72% to 99%); specificity, 91% (CI, 83% to 99%); and diagnostic accuracy, 95% (CI, 86% to 99%). Phase 2: Hemosiderinuria score enabled classification of clinical severity of CVI. Mean scores, respectively, were clinical class 1, 0.18 +/- 0.12; class 2, 0.75 +/- 0.47; class 3, 1.67 +/- 0.21; class 4, 1.86 +/- 0.26; class 5, 2.50 +/- 0.28; and class 6, 1.92 +/- 0.21 (P <.001). Phase 3: At 6-month follow-up, hemosiderin score was improved, from 2.48 +/- 0.12 preoperatively to 0.78 +/- 0.18 postoperatively (P <.0001). A score of 0 or 1 was associated with successful surgery, whereas a score of 2 or 3 reflected persistence of reflux. Determination of presence of hemosiderin in the urine is a new, sensitive, cost-effective, noninvasive, and repeatable test that enables detection of substantial microcirculatory overload in patients with CVI.