Chronic Venous Insufficiency Research Articles

Preparation and Preliminary Analysis of Several Nanoformulations Based on Plant Extracts and Biodegradable Polymers as a Possible Application for Chronic Venous Disease Therapy

Nanotechnology is one of the newest directions for plant-based therapies. Chronic venous disease often predisposes to long-term and invasive treatment. This research focused on the inclusion of vegetal extracts from Sophorae flos (SE), Calendulae flos (CE), and Ginkgo bilobae folium (GE) in formulations with PHB and PLGA polymers and their physicochemical characterization as a preliminary stage for possible use in the development of a complex therapeutic product. The samples were prepared by an oil–water emulsification and solvent evaporation technique, resulting in suspensions with high spreadability and a pH of 5.5. ATR-FTIR analysis revealed bands for stretching vibrations (O-H, C=O, and C-H in symmetric and asymmetric methyl and methylene) in the same regions as the base components, but switched to high or low wavenumbers and absorbance, highlighting the formation of adducts/complexes between the extracts and polymers. The obtained formulations were in the amorphous phase, as confirmed by XRD analysis. AFM analysis emphasized the morphological peculiarities of the extract–polymer nanoformulations. It could be noticed that, in the case of SE-based formulations, the dominant characteristics for SE-PHB and SE-PLGA composition were the formation of random large (SE-PHB) and smaller uniform (SE-PLGA) particles; further on, these particles tended to aggregate in the case of SE-PHB-PLGA. For the CE- and GE-based formulations, the dominant surface morphology was their porosity, generally with small pores, but larger cavities were observed in some cases (CE- and GE-PHB). The highest roughness values at the (8 µm × 8 μm) scale were found for the following samples and succession: CE-PHB < SE-PLGA < SE-PHB-PLGA. In addition, by thermogravimetric analysis, impregnation in the matrix of compression stockings was evaluated, which varied in the following order: CE-polymer > SE-polymer > GE-polymer. In conclusion, nine vegetal extract–polymer nanoformulations were prepared and preliminarily characterized (by advanced physicochemical methods) as a starting point for further optimization, stability studies, and possible use in complex pharmaceutical products.

Comorbidities, Treatment and Survival Rates of Chronic Thromboembolic Pulmonary Hypertension in a Regional Centre

Background/Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by a multitude of underlying causes, treatment modalities and prognostic outcomes. Our aim was to evaluate the underlying causes, comorbidities and survival rates of CTEPH patients. Methods: A retrospective analysis was conducted regarding the evolution of CTEPH patients confirmed by right heart catheterization under treatment with specific vasodilator medication in our centre between 2008 and 2023. Results: We treated 14 CTEPH patients, 78.57% female, 52.79 ± 13.64 years at inclusion, representing 11.29% of our pulmonary arterial hypertension registry. Initially, the distribution of patients’ NYHA class was II-14.28%, III-71.42% and IV-14.28%. In total, 71.42% of these patients were technically operable due to the central location of the thrombus, but 42.85% presented severe comorbidities and 28.57% refused the surgery or it was financially inaccessible. Only four patients were operated on by pulmonary endarterectomy (PEA). Unfortunately, all the post-PEA patients had persistent pulmonary hypertension and had to continue vasodilator treatment. Overall, 64.28% of patients had monotherapy, 21.42% double therapy and 14.28% triple therapy. Regarding underlying causes and comorbidities, we found the following incidences: 78.57% chronic venous insufficiency, 42.85% obesity, 35.71% thyroid disease, hypertension and hyperuricemia, 21.42% thrombophilia and ischemic heart disease, 14.28% atrial fibrillation, vasculitis and lung disease, and 14.28% neoplastic history and diabetes. Seven patients died (50%), six of whom were unoperated and one of whom was lost (abandoned the program). The survival rates at 1, 3, 5 and 7 years for unoperated patients were 100%, 58.3%, 29.2% and 29.2% versus 100%, 75%, 75% and 75% in post-PEA patients. Conclusions: CTEPH, marked by delayed diagnosis, multiple comorbidities and limited intervention options, requires proactive screening and comprehensive multimodal therapies, including PEA, to improve survival rates.

The effectiveness of minimally invasive surgical techniques for treating patients with chronic venous insufficiency in the stage of trophic disorders: comparative study

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux.Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Pycnogenol® French maritime pine bark extract in randomized, double-blind, placebo-controlled human clinical studies

Pycnogenol® French maritime pine bark extract is a well-known and thoroughly studied patented extract from the bark of Pinus pinaster Ait. ssp. Atlantica. In 39 randomized double-blind, placebo-controlled (RDP) human clinical trials including 2,009 subjects, Pycnogenol® French maritime pine bark extract supplementation for two weeks to six months has been shown to beneficially affect cardiovascular health, chronic venous insufficiency, cognition, joint health, skin health, eye health, women’s health, respiratory health and allergies, oral health and sports performance. The mechanisms of action that can explain the respective effects on different conditions in the human body are discussed as well. As investigated in several in vitro, in vivo and in clinical studies, Pycnogenol® French maritime pine bark extract showed antioxidative effects, anti-inflammatory abilities, beneficial effects on endothelial function and reinforcing effects on the extracellular matrix. The present review aims to give a comprehensive overview of currently available “gold standard” RDP trials of Pycnogenol®’s benefits across various health domains compared to placebo. In addition, some of the processes on which the presented effects of Pycnogenol® French maritime pine bark extract are based will be elucidated and discussed. This broad overview of RDP studies on Pycnogenol® in different health domains can be used as a basis for further research on applications and mechanisms of this unique French maritime pine bark extract.

VEIN STEP Mexico: A Prospective, Observational, International Study to Assess Effectiveness of Conservative Treatments in Chronic Venous Disease

VEIN STEP Mexico: A Prospective, Observational, International Study to Assess Effectiveness of Conservative Treatments in Chronic Venous Disease

Not Entirely in Vein: Predictors of Progressive Chronic Venous Insufficiency and Mediators of Successful Endovenous Laser Ablation

Not Entirely in Vein: Predictors of Progressive Chronic Venous Insufficiency and Mediators of Successful Endovenous Laser Ablation

What you need to know about common skin problems in older adults.

Skin ageing is a multifaceted process impacted by both intrinsic and extrinsic factors. Drier and less elastic skin with declining sebum levels in older age makes ageing skin more vulnerable to various skin conditions, including infections, inflammatory dermatoses, and cancers. Skin problems are common among older adults due to the effects of ageing, polypharmacy and multimorbidity impacting not only physical health but wellbeing and quality of life. In the UK, older adults in geriatric medicine wards may present with various skin conditions. Hospitalised older individuals may have undiagnosed skin problems unrelated to their admission, making hospitalisation an opportunity to manage unmet needs. Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders clinicians encounter in the geriatric medicine wards. This article outlines the importance of performing comprehensive skin assessments to help diagnose and commence management for these common conditions.

Varicose veins: A systematic review of the diagnosis and treatment of varicose veins

VARICOSE VEINS is clinical class of chronic venous disease. Varicose veins also known as varicosities. Varicose veins are tortuous, twisted, enlarged veins, dilated veins most commonly located on the lower extremities. The diseases also show various associated symptoms which worsens the condition of the varicose veins. The ascendancy of varicose veins vary. This review articles deals with brief introduction regarding the etiopathogesis of varicose veins associated with key word cause symptoms, treatment, risks factors, management, complications, conclusion and reference. Varicose veins in the lower limb are affect at least a third (30%) of the population. such a condition that increases pressure on the legs veins such as obese, lack of exercise, pregnancy, hormonal fluctuation, smoking etc. Researchers report that a mild care of varicose veins does not usually require a doctor care, discomfort can be relieved with at home treatment and various alternative remedies, such as color therapy, diet and supplements, herbal therapy exercises, yoga, homeopathy and hydro therapy etc.

Sex and the veins. A cross-sectional analysis on sexual dysfunction in patients with Chronic Venous Disease

BackgroundThis study aimed to investigate the presence of sexual dysfunction (SD) in patients with Chronic Venous Disease (CVD) and if CVD treatments may have an impact on SD evolution in these patients. MethodsInclusion criteria were patients of both sexes and genders, with minimum age of 18, with first diagnosis of CVD. Exclusion criteria were presence of known sexual dysfunction of organic origin, arterial system diseases, malignancies and endocrine system diseases. Included patients were administered the ASEX (Arizona Sexual Experience) questionnaire that was administered at the moment of study inclusion (T0), and for patients that resulted affected from sexual dysfunction, were administered also, after CVD treatments at 6 months (T1) and after 12 months (T2). ResultsA total of 649 patients with CVD were recruited. After the administration of the ASEX questionnaire, 122 patients (18.8 %) resulted affected from SD. Female sex, C3–C6 clinical stages, and the presence of Coronary Artery Disease (CAD), hypertension, and hyperlipidemia were more associated with the presence of SD. SD improved in all patients’ population, especially after CVD treatment at T2. ConclusionsCVD patients may experience SD, especially in female sex, in more advanced disease stages. SD in CVD patients appears to improve after adequate CVD treatment.

Vein segmentation and visualization of upper and lower extremities using convolution neural network.

The study focused on developing a reliable real-time venous localization, identification, and visualization framework based upon deep learning (DL) self-parametrized Convolution Neural Network (CNN) algorithm for segmentation of the venous map for both lower and upper limb dataset acquired under unconstrained conditions using near-infrared (NIR) imaging setup, specifically to assist vascular surgeons during venipuncture, vascular surgeries, or Chronic Venous Disease (CVD) treatments. A portable image acquisition setup has been designed to collect venous data (upper and lower extremities) from 72 subjects. A manually annotated image dataset was used to train and compare the performance of existing well-known CNN-based architectures such as ResNet and VGGNet with self-parameterized U-Net, improving automated vein segmentation and visualization. Experimental results indicated that self-parameterized U-Net performs better at segmenting the unconstrained dataset in comparison with conventional CNN feature-based learning models, with a Dice score of 0.58 and displaying 96.7 % accuracy for real-time vein visualization, making it appropriate to locate veins in real-time under unconstrained conditions. Self-parameterized U-Net for vein segmentation and visualization has the potential to reduce risks associated with traditional venipuncture or CVD treatments by outperforming conventional CNN architectures, providing vascular assistance, and improving patient care and treatment outcomes.

Endovenous Microwave Ablation Versus Laser Ablation for Small Saphenous Vein Varicosis.

Laser and radiofrequency ablation are two thermal ablation methods currently widely used to treat lower limb venous insufficiency. However, very few studies have been conducted on the use of microwaves, a form of thermal ablation, for the treatment of small saphenous vein (SSV) insufficiency. This study aimed to examine the efficacy and safety of endovenous microwave ablation (EMA) for the treatment of SSV insufficiency. The clinical data of 126 patients (126 lower limbs) with SSV insufficiency (SSV trunk reflux time ≥ 500ms on lower limb color Doppler ultrasound) treated at the Surgery Department of The Sixth People's Hospital of Zhuji from January 2020 to June 2022 were analyzed retrospectively; 64 patients underwent EMA and 62 underwent endovenous laser ablation (EVLA). The perioperative marker data [duration of surgery, duration of hospitalization, length of thermal ablation, duration of thermal ablation, number of incisions, and numerical pain rating scale (NPRS)], complication data [skin ecchymosis, skin burns, surgical site infection, paresthesia, deep vein thrombosis (DVT), and heat-induced thrombosis (EHIT)], venous clinical severity score (VCSS), chronic venous disease quality of life questionnaire (CIVIQ-20) before and 1, 3, 12months after surgery, and SSV trunk occlusion rate at 12months after surgery were compared between the two groups. No significant differences in the surgery or hospitalization durations were observed between the two groups. There were no significant differences in the length of the SSV that required thermal ablation between the two groups; however, the thermal ablation time was shorter in the EMA group than that in the EVLA group (6.14 ± 1.47min vs 7.05 ± 1.16min, P < 0.001). There were no statistical differences in the number of incisions, volume of tumescent solution used, or quantity of sclerosing foam used. The NPRS scores of the EMA group at 24h and 72h after surgery were significantly greater than those of the EVLA group (4.03 ± 0.98 vs 3.52 ± 1.28, P = 0.013; 3.78 ± 1.06 vs 3.15 ± 1.03, P = 0.001). Moreover, the two groups showed no significant difference in the NPRS score at 1month (1.14 ± 0.84 vs 1.07 ± 0.75, P = 0.623). The EMA and EVLA group patients experienced similar postoperative complications. The VCSS and CIVIQ-20 score significantly improved at 1, 3, and 12months after surgery. The VCSS and CIVIQ-20 scores were compared between the two groups at 12months after surgery, and there were no significant differences (1.44 ± 0.63 vs 1.56 ± 0.56, P = 0.261; 24.24 ± 4.96 vs 25.19 ± 5.36, P = 0.304). There was no significant difference in the incidence of SSV trunk occlusion at 12months after surgery between the two groups (95.31% vs 96.77%, OR 1.475; 95%CI 0.238-9.146, P = 1.000). EMA and EVLA are equally effective treatment methods for SSV insufficiency. EMA is associated with higher NPRS scores in the early postoperative period.

Single-cell multiomics guided mechanistic understanding of Fontan-associated liver disease.

The Fontan operation is the current standard of care for single-ventricle congenital heart disease. Individuals with a Fontan circulation (FC) exhibit central venous hypertension and face life-threatening complications of hepatic fibrosis, known as Fontan-associated liver disease (FALD). The fundamental biology and mechanisms of FALD are little understood. Here, we generated a transcriptomic and epigenomic atlas of human FALD at single-cell resolution using multiomic snRNA-ATAC-seq. We found profound cell type-specific transcriptomic and epigenomic changes in FC livers. Central hepatocytes (cHep) exhibited the most substantial changes, featuring profound metabolic reprogramming. These cHep changes preceded substantial activation of hepatic stellate cells and liver fibrosis, suggesting cHep as a potential first "responder" in the pathogenesis of FALD. We also identified a network of ligand-receptor pairs that transmit signals from cHep to hepatic stellate cells, which may promote their activation and liver fibrosis. We further experimentally demonstrated that activins A and B promote fibrotic activation in vitro and identified mechanisms of activin A's transcriptional activation in FALD. Together, our single-cell transcriptomic and epigenomic atlas revealed mechanistic insights into the pathogenesis of FALD and may aid identification of potential therapeutic targets.

Is Kinesio taping acutely effective for peripheral tissue perfusion in women with mild to moderate chronic venous insufficiency? A randomized controlled trial

Objective To evaluate the acute effect of Kinesio Taping® (KT) on peripheral tissue perfusion in women with chronic venous insufficiency (CVI). Methods: This randomized, double-blind controlled trial included 59 women with mild to moderate CVI. They were randomized to a control group (n = 23; 54.08 ± 9.04 years) and KT group (n = 36; 55.87 ± 9.97 years). Near-infrared spectroscopy was positioned in the medial gastrocnemius muscle for assessment of resting tissue perfusion 48 h after the first day of evaluation and after placement of the Kinesio Taping® tape. The evaluation also consisted of performing movements of the plethysmography examination. To verify the comparisons of pre- and post-Kinesio Taping® data, the variation delta was used for analysis. Mann–Whitney U test was performed an an alpha of 5% was considered statistically significant. Results: There wasn't a significant difference between groups regarding the peripheral tissue perfusion evaluation variables Peripheral Oxygen Saturation Difference – DELTA_SPO2: (KT Group 3.21 (0.84–3.62); Control 2.21 (1.59–4.83), p = 0.219) and Difference in deoxygenate hemoglobin values – DELTA_HHB (units) KT Group -0.62 (-2.14–0.67); Control Group -0.07 (-2.15–2.62) p = 0.238). Despite the lack of statistical significance, the KT group had a 785.7% greater drop in HHB values than the control group. Conclusions: Acute use of Kinesio Taping® in women with CVI did not significantly alter tissue perfusion of calf muscles. However, it was possible to observe percentage differences in venous retention to be considered from a clinical point of view

Inflammatory Cells in Adipose Tissue and Skeletal Muscle of Patients with Peripheral Arterial Disease or Chronic Venous Disease: A Prospective, Observational, and Histological Study.

The main goal of this study was to assess whether the presence of peripheral arterial disease (PAD) correlates with increased inflammatory cell infiltration. An observational, single-centre, and prospective study was conducted from January 2018 to July 2022. Clinical characteristics and anthropometric measures were registered. Consecutive PAD patients with surgical indications for a common femoral artery approach and patients with varicose veins with an indication for surgical ligation of the saphenofemoral junction were included. In both groups, samples of sartorius skeletal muscle, subcutaneous adipose tissue (SAT), and perivascular adipose tissue (PVAT) were collected from the femoral region. We analysed the characteristics of adipocytes and the presence of haemorrhage and inflammatory cells in the samples of PVAT and SAT via haematoxylin-eosin staining. We found that patients with PAD had significantly more inflammatory cells in PVAT [16 (43.24%) vs. 0 (0%) p = 0.008]. Analysing SAT histology, we observed that patients with PAD had significantly more CD45+ leucocytes upon immunohistochemical staining [32 (72.73%) vs. 3 (27.27%) p = 0.005]. Upon analysing skeletal muscle histology with haematoxylin-eosin staining, we evaluated skeletal fibre preservation, as well as the presence of trauma, haemorrhage, and inflammatory cells. We registered a significantly higher number of inflammatory cells in patients with PAD [well-preserved skeletal fibres: PAD = 26 (63.41%) vs. varicose veins = 3 (37.50%) p = 0.173; trauma: PAD = 4 (9.76%) vs. varicose veins = 2 (25.00%) p = 0.229; haemorrhage: PAD = 6 (14.63%) vs. varicose veins = 0 (0%) p = 0.248; inflammatory cells: PAD = 18 (43.90%) vs. varicose veins = 0 (0%) p = 0.018]. Patients with PAD had a higher number of inflammatory cells in skeletal muscle and adipose tissue (PVAT and SAT) when compared with those with varicose veins, emphasizing the role of inflammation in this group of patients.

The characteristics of arterial risk factors and ankle-brachial index in patients with lower extremity chronic venous diseases: results from the BEST study.

The aim of our study was to explore the characteristics of the arterial risk factors and ankle-brachial index (ABI) in patients with lower extremity chronic venous disease (LECVD). A total of 2642 subjects were employed in our study. The lifestyle and clinical data were collected. The history of vascular diseases contained coronary artery disease, stroke, hypertension, and diabetes. ABI low than 0.9 was considered as lower extremity artery disease (LEAD). A series of blood indicators were measured. Patients with ABI low than 0.9 belonged to the group of LEAD. Age, smoking, drinking, hypertension, diabetes mellitus, lipid-lowering drug, antidiabetic, total protein, total protein, triglyceride, low-density lipoprotein cholesterol, glycosylated hemoglobin and homocysteine were the common risk factors shared by LEAD and LECVD (P<0.05). The prevalence of LEAD in patients with LECVD was higher than those without LECVD (P<0.05). In Pearson correlation analysis, LECVD was related to LEAD (P<0.05). Before and after adjusted shared factors, as the performance of the logistic regression models, LEAD was an independent risk factor for the prevalence of LECVD (OR=2.937, 95% CI: [1.956, 4.411], P<0.001). Our study demonstrated that an ABI lower than 0.9 is an independent risk factor for LECVD.

Understanding CEAP Classification: Insights from an Italian Survey on Corona Phlebectatica and Recurrent Active Venous Ulcers by Vascular Specialists.

Background and Objectives: The clinical relevance of "corona phlebectatica" and the management of risk factors for recurrence of venous ulcers in patients with chronic venous disease may be variable based on vascular specialists in different geographical areas of Italy. The aim of the present survey is to evaluate the management of patients with chronic venous disease by vascular specialists in different areas of the national territory. In particular, this involves ascertaining the clinical/prognostic relevance attributed to the presence of the "corona phlebectatica" as well as to the management of risk factors related to recurrence of venous ulcers. Materials and Methods: The web-based survey aimed at vascular medicine specialists with particular interest in venous disease. A questionnaire was developed, based on 12 questions, in relation to clinical assessment, risk factor management, and therapy in patients with chronic venous disease. Results: Almost all of the specialists involved actively participated in the survey, declaring that they personally manage chronic venous disease overall. There was a strong agreement in the prognostic consideration attributed to the presence of "corona phlebectatica" and to the management of risk factors for venous ulcer recurrence, regardless of the different geographical areas of interest. Conclusions: Accordingly with the results of this self-assessment survey, the skills and experience of the specialists involved appear to be of a good standard, both in the clinical evaluation and in the management of the progression of chronic venous disease. However, the need to reach more cultural insights into the correlations between chronic venous disease and risk factors correlated with disease progression emerges. Moreover, there was the need for a greater and tighter overall clinical control of a patient with chronic venous disease, also in relation to the presence of comorbidities.

Engineering tools for stimulating wound healing

Wound healing is the complex physiological process of restoring the skin's integrity, structure, and function after damage caused by external conditions. The wound healing cascade may be altered due to the progression of certain diseases, such as diabetes, venous hypertension, or peripheral arterial disease, resulting in non-healing chronic wounds. Chronic wounds can be characterized by a wide variety of pathologies including increased reactive oxygen species, ineffective neutrophil activity, overabundance of pro-inflammatory cytokines, and chronic hypoxia. Medical intervention is crucial to heal chronic wounds. This review explores current research to engineer improved chronic wound treatment devices, dressings, and constructs to facilitate tissue regeneration and wound closure. This review first covers different physical stimulation therapies, then, local therapeutic delivery systems, and finally three-dimensional (bio)printing techniques for the fabrication of skin grafts and wound dressings. Additionally, the review discusses the regulatory process for bringing cutting-edge wound healing technologies to market and highlights currently approved products for wound treatment. At the end, the unmet need and future directions that the field should expand are discussed.

Addressing the Impact of Deep Venous Stenting on the Management of Venous Ulcer

IntroductionVenous ulcers are a late and severe form of CVI and account for 70% of all etiologies that cause leg ulcers in the lower limb and they account for 20% of the 2.5 million cases complaining of chronic venous disease. Our study aims to investigate the effect of venous stenting of the deep veins on the healing of the venous ulcer. MethodsThis is a single-center, retrospective study conducted on prospectively recorded medical records of 78 patients with chronic deep venous diseases – C6 (either non-occlusive iliac venous lesion or post-thrombotic syndrome). Our lesion involved May-Thurner lesions, occlusions, insufficiencies, or stenoses owing to an affection of the venous outflow segment. All our patients underwent endovascular management, and those who did not respond successfully were transitioned to compression therapy. We then compared the outcomes of both groups in terms of ulcer healing and quality of life. ResultsA total of 78 patients (78 limbs), with a mean age of 39.6 ± 8.06 (range; 22-60) years, were treated. 54 patients (67.9%) were males, and 24 (32.1%) were female. The etiology was primary non-occlusive iliac venous lesion (NIVL) in 12 limbs (16.2%) and secondary (post-thrombotic) PTS in 66 (83.7%). Follow-up of the ulcer with compliance to compression therapy and standard care of the ulcer, sustained ulcer healing (reduction in ulcer area) was achieved in 60% of limbs, and most of non-occlusive the healing occurred within the first 3 months (p<0.01) ConclusionsOur results show that deep venous stenting is associated with high wound healing rates. This rate reaches a statistically significant difference in 3 months but this difference doesn't reach statistical significance at six months, with less recurrence, and improved quality of life with a high cumulative patency rate and that compression therapy is the mainstay of the conservative management of venous ulceration.

Asociación entre sistemas venosos insuficientes y manifestaciones clínicas en enfermedad venosa crónica de miembros inferiores

Introduction: The clinical, etiological, anatomical, and pathophysiological classification (CEAP) standardizes the manifestations of lower limb venous disease. Objective: To investigate the association between insufficient venous systems and the clinical classification of CEAP. Methods: A quantitative, cross-sectional, analytical, correlational study was conducted. Sampling was non-probabilistic and convenience-based. The sample size was 136 lower limbs from 71 patients. Chi-square, Monte Carlo and Odd ratio (OR) statistical tests were used with 95% confidence intervals through bivariate logistic regression (p&lt;0.05). Results: 71.8% of the subjects were female, with an average age of 66.1 years. The most frequent insufficient venous system was the superficial system, present in 61.7% of cases. 100% of the dilated great saphenous veins (GSV) had insufficiency. The most common CEAP clinical class was C2 (44.9%); 35.1% of C1 (telangiectasia) cases had an insufficient venous system; 50% of C2 cases had GSV insufficiency (p=0.227). There was an association between the insufficiency of both superficial and deep venous systems and the CEAP clinical classification (p=&lt;0.001). The deep venous system was associated with severe chronic venous disease of the lower limbs, OR (6.04) with a 95% CI (1.02-35.73) and p=0.047. Conclusions: The study demonstrated an association between the insufficiency of both superficial and deep venous systems and the CEAP clinical classification. One third of the lower limbs with C1 (telangiectasias) had an insufficient venous system.

Application of the ankle pump method in a sitting position to evaluate calf perforating veins by color Doppler ultrasonography

To investigate the feasibility and efficacy of assessing the calf perforating veins using the ankle pump method in a sitting position by color Doppler ultrasonography. We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf perforating veins were assessed by three different methods, namely manual compression in a standing position, manual compression in a sitting position, and ankle pump in a sitting position. The reflux durations and detection rate of the incompetent perforating veins were compared among the three methods. The number and diameter of calf perforating veins and the distribution of incompetent perforating veins were analyzed. A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The median number of perforating veins per calf was higher in the diseased calves (7.0, interquartile range 6.0-8.0) than the healthy calves (5.0, 3.0-6.0) (p < 0.001). The diameter of incompetent perforating veins (2.3, 2.0-3.1 mm) was larger than that of competent ones (1.4, 1.2-1.7 mm). Most of the incompetent perforating veins (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the ankle pump method was greater than that induced by the manual compression methods (p < 0.001). Although the ankle pump method had a higher detection rate (92.0%) of incompetent perforating veins than the manual compression methods (71.7% and 74.3% for standing and sitting positions, respectively) (p < 0.001), especially in the distal lower leg, the manual compression methods revealed the incompetent perforating veins that were not shown by the ankle pump method. The diseased calves with chronic venous disease have more perforating veins than the healthy calves. Incompetent calf perforating veins are commonly larger than competent perforating veins, with the majority of the incompetent calf perforating veins being located in the medial and the posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf perforating veins, especially those located in the distal calf, as an alternative or complementary to traditional manual compression, which is valuable in the daily practice of sonographers.