Development Of Chronic Venous Disease Research Articles

Venous disorders as an occupational disease - a systematic review on epidemiology, pathophysiology, and modification strategies.

Forced postures are common in the workplace. Work in the primary economic sector is characterised by a high degree of physical activity and movement; however, activities in the secondary and tertiary sectors commonly require workers to stand or sit. An expansion of the tertiary sector in recent decades has meant that people in industrialised and emerging economies primarily sit or stand at work. The aim of the systematic review was to identify occupational factors relating to the presence of chronic venous disease (CVD), to place these in the context of developments in the workplace, and to determine whether measures are in place to prevent CVD. We performed a systematic literature review to analyse studies assessing work-related risk factors for CVD. We searched for publications in the PubMed database, the clinic library of BG Hospital Bergmannstrost Halle, and the registry of the German Statutory Accident Insurance. Using occupation-specific keyword combinations, we identified 27,522 publications. The publications underwent an automatic and manual filtering process according to the PRISMA guidelines and 81 publications qualified for the review. Ultimately 25 studies were included in the systematic review. All of the subjects of the studies worked in the secondary and tertiary sectors. No studies looked at the relationship between venous disorders and primary sector occupations. Standing at work for more than four hours a day, repeated heavy lifting, and cumulative time working in a sitting or standing position are risk factors for the development of CVD. Sitting is less of a risk factor than standing or walking. Occupational history and the patient's activity profile are important diagnostic tools which can help confirm a diagnosis and justify treatment when findings are inconsistent. Compression therapy is the primary form of secondary and tertiary prevention. There continues to be a lack of primary preventive measures related to workplace design.

Luminal Changes in Patients with Inferior Vena Cava Filters and Development of Chronic Venous Disease

This study aimed to analyze the luminal changes in the iliocaval veins and their effects on the development of signs and symptoms of chronic venous disease manifesting from inferior vena cava (IVC) filter placement. This was a retrospective observations study; deidentified patients with an IVC filter placed with subsequent luminal changes were included. All patients had a computerized tomography (CT) scan with or without ultrasound and those who underwent an intervention for the obstruction had also venography and intravascular ultrasound (IVUS). The diameter of IVC and iliac veins was measured from the near wall to the far wall. IVC diameters measured less than 12mm were considered to be retractions. Signs and symptoms of chronic venous disease were obtained from patient charts and were reported according to the highest CEAP class. The data were analyzed using descriptive statistics, presenting diameter changes as a mean with standard deviation and a range of diameters included. Overall, 76 patients were included in this study, of whom 66 had occlusion of the IVC or the Iliac veins. Luminal changes of the IVC were observed in all patients. A total of 58 patients presented with chronic post-thrombotic changes in both the IVC and iliac veins. There were 4 patients that had a luminal reduction with no filling defects or post-thrombotic changes. Average IVC diameter and iliac vein diameter was measured to be 8.3±1.4mm and 4.6±1.4mm, respectively. Patients most frequently presented with extremity swelling, but other signs such as venous ulceration or skin damage were observed. Permanent luminal changes of the IVC and iliac veins were observed as a result of IVC filter placement and such patients commonly present with signs and symptoms of chronic venous disease. Together, with other known filter complications, these observations add more reasons for a timely retrieval. When such changes occur, patients' appropriate symptoms can be successfully treated. The permanent changes made by filter placement in the IVC and iliac veins further support filter retrieval in a timely fashion. The luminal changes induced by filter placement should be recognized early, particularly in symptomatic patients who can be safely treated with endovenous procedures.

Development of chronic venous disease.

Chronic venous disease is known to gradually worsen in the course of years. However, little clinical data is available. The patient group and methods: We used the set of our patients with completed clinical examination, duplex sonography and photoplethysmography and selected 160 patients examined at our office after 10 and more years. Females represented 79% in the group. The mean age was 54 years (range 18-82 years). Venous varices in lower limbs in the family were reported by 49% patients. Venous sclerotization had been undergone by 6.3% and venous surgery by 10.6% patients. The mean body mass index was 27. We used CEAP classification. The clinical class C1 included 50 patients, C2 included 81, C3 included 15 and C4 included 14 patients. Regurgitation in superficial veins was found in 43%. The mean venous return time after physical activity was 24.5 s. The last examination was performed after 13 years on average (range 10-28 years). Deterioration of the clinical condition and progression to a higher class were observed in 36% patients in class C1, in 23.5% patients in C2, in 13% patients in C3 and in 7% patients in C4. We did not demonstrate any statistically significant effect of the followed parameters on the progression of the disease. The progression rate of the disease in our patient group followed at the vascular office for 10 and more years is lower compared to population studies.

Chronic venous disease. Part 1: pathophysiology and clinical features.

Chronic venous disease (CVD) is a commonly encountered condition in the dermatology outpatient department. If untreated, CVD may progress to chronic leg ulcer causing serious morbidity to the patient. It also affects the quality of life of the affected patient and contributes to loss of work productivity. The spectrum of clinical manifestations for CVD is myriad, ranging from asymptomatic varicose veins and pigmentation to ulceration and scarring. Awareness of spectrum of clinical presentations is required to identify, diagnose and manage CVD. Long-standing cases may develop ankle joint stiffness, fixed flexion deformity, periostitis and even Marjolin ulcer. Increased venous hypertension, thought to result from valve incompetence and failure of the calf muscle pump, is central to the pathophysiology of the development of CVD. Tissue oedema, hypoxia and subsequent fibrosis are major immediate contributing factors responsible for the clinical manifestations of CVD. Localized, chronic inflammation is now increasingly being recognized as a key player, directly responsible for stasis dermatitis and hypercoagulable state. The complete ramifications of persistent inflammation in CVD are yet to be understood and serious systemic morbidities such as arterial and cardiac disease are increasingly being recognized in association with CVD.

Popliteal vein compression, obesity, and chronic venous disease

BackgroundObesity is a known risk factor for the development of chronic venous disease (CVD). However, some obese patients with lower limb skin changes suggestive of venous disease do not demonstrate venous reflux or obstruction. Popliteal vein compression (PVC) caused by knee hyperextension during standing has been postulated by others to be more common in the obese due to the increased adipose content of the popliteal fossa. This compression may contribute to the development of venous disease. The objective was to examine the prevalence of PVC in obese and nonobese subjects, with and without venous disease. MethodsParticipants were recruited across the range of Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical classifications and body mass. Those referred for venous studies had full venous ultrasound assessments. To assess for PVC, the popliteal vein was assessed via B-mode ultrasound whilst the subject stood and performed two maneuvers: knee hyperextension and a bilateral toe stand. Video clips of each maneuver were analyzed offline. ResultsThere were 309 limbs (158 subjects), of which 131 were nonobese (body mass index [BMI]: 26 ± 3 kg/m2) and 178 obese (BMI: 43 ± 8 kg/m2). PVC with toe stand (PVC(toe stand)) was more common in obese limbs (89% vs 64%, P < .001). It occurred mainly in the distal popliteal vein, associated with contraction of the gastrocnemius muscles. PVC with knee hyperextension (PVC(lock)) was also more frequent in obese limbs (39% vs 10%, P < .0001) and was distinct as it occurred more proximally in the popliteal vein. PVC(lock) was significantly more frequent in all C classes of obese patients, most notably in the obese with C4-6 CVD (41% vs 4%, P < .0001), and was associated with more severe Venous Clinical Severity Score (median 8 [range: 0-19] vs 5 [0-21], P = .034). There were 19 limbs with skin changes (C4-6) with no venous reflux or obstruction on ultrasound, exclusively obese limbs. These limbs, designated CEAP Pn limbs, were in older, shorter participants with a higher BMI than their counterparts demonstrating reflux, and they also had more frequent PVC(lock) (63% vs 37%, P = .036). ConclusionsPVC(toe stand) and PVC(lock) are both functional effects and more common in obese limbs. PVC(toe stand) is likely associated with normal functioning of the calf muscle pump. Although PVC(lock) may contribute to CVD in some obese limbs, the demonstration of PVC(lock) alone is insufficient evidence for direct intervention.

Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management.

Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.

Abnormal proinflammatory and stressor environmental with increased the regulatory cellular IGF-1/PAPP-A/STC and Wnt-1/β-Catenin canonical pathway in placenta of women with Chronic venous Disease during Pregnancy.

Lower limbs venous insufficiency refers to a wide variety of venous disorders grouped by the term of chronic venous disease (CVD). Hemodynamic and hormonal changes related to pregnancy period, may promote the development of CVD affecting approximately 1 in 3 women. It has been shown that the presence of this condition is associated with damage and placental suffering. Thus, taking IGF-1/PAPP-A/STC-2, inflammatory cytokines production, PI3K/Akt and Wnt/ β-catenin pathways as a part of the alterations that occurs in the placenta due to CVD, the aim of this study will be to examine the main components of these pathways. Genic and protein expression of PAPP-A, STC-2, IGF-1, IRS-4 Wnt-1, β-catenin, c-myc, Cyclin D1, IL-4/IL-6 and PI3K/Akt/mTOR pathway will be analysed through RT-qPCR and immunohistochemical techniques in women with CVD (n=62) and pregnant women without this condition (HC) (n=52). PAPP-A, IGF-1, IL-4, IL-6, IRS-4, PI3K, Akt, mTOR, Wnt-1, β-catenin, c-myc and Cyclin D1 expression were found to be increased in women with CVD, whereas STC-2 were decreased in this group, compared to non-affected women. Our study has demonstrated that IGF-1/PAPP-A/STC-2 axis, PI3K/Akt and Wnt/β-catenin pathways, along with c-myc, Cyclin D1 and inflammatory cytokines are altered in placenta women with CVD. These results extent the knowledge that CVD is associated to a placenta damage with abnormal tissue environment and cellular regulation.

Comparative efficacy and safety of traditional Chinese medicine for lipodermatosclerosis: A protocol for systematic review and network meta-analysis.

Background:Lipodermatosclerosis (LDS) is a severe skin change accompanied by the development of chronic venous disease of the lower extremities. Its main clinical manifestations are erythema, induration, hyperpigmentation, and rough and thickened skin. It may also eventually lead to refractory ulcers, skin necrosis and even cancer. Conventional treatment methods mainly include the intake of oral anabolic hormones or androgen and pressure therapy. However, patients often refuse due to their drug resistance and intolerance. As a clinical irreplaceable treatment method for LDS, traditional Chinese medicine (TCM) has not been compared of the safety and effectiveness so far. Therefore, we cannot wait to use a method to compare the efficacy of TCM for LDS systematically, such as network meta-analysis (NMA).Methods:We will retrieve the relevant Chinese and English databases comprehensively. All the randomized controlled trials of TCM for LDS from January 2015 to September 2020 will be included. Under the guidance of inclusion criteria, 2 researchers will screen the literature, then assess the risk of bias and extract data. We will use Bayesian NMA to evaluate all available evidence in STATA 14.0 and WinBUGS software.Results:This study will use Bayesian NMA to evaluate the efficacy and safety of TCM for LDS.Conclusion:This study provide a reliable theoretical basis for the clinical application of TCM in the treatment of LDS, and contribute to the formulation of treatment guidelines for LDS.

Occupational leg edema-use of compression stockings.

To analyze the use of compression stockings to avoid the formation of occupational edema of the lower limbs in jobs with prolonged orthostatism. We carried out a review of the articles published in PubMed, from the 1st of January 2008 to 31st of December 2018 using the term “Occupational Leg Swelling”. Only articles that met the following criteria were selected: prospective, observational and experimental retrospectives articles written in Portuguese or English. The research resulted in 23 articles. After reading the titles and abstracts and applying the inclusion and exclusion criteria, 5 were selected. Prolonged orthostatism is considered a risk factor for the development of chronic venous disease. The use of compression stockings reduces the occupational edema of the lower limbs. Professionals exposed to prolonged orthostatism during their work activity have a higher risk of developing lower limb edema; Despite few studies demonstrated the effectiveness of wearing compression stockings to prevent occupational edema of the lower limbs, they have showed benefit in reducing edema as well as associated symptoms. The use of compression stockings should therefore be recommended to all professionals at increased risk for occupational edema of the lower limbs.

3:36 PM Abstract No. 86 Predictors of iliocaval in-stent restenosis

Chronic venous disease (CVD) occurs in 1-5% of adults. Iliocaval obstructive lesions play a significant role in the development of CVD. Iliocaval stenting is a mainstay treatment for CVD. However, in-stent restenosis (ISR) occurs in 5-23% and is related to recurrence of symptoms and possible decreased patency. We sought to evaluate risk factors associated with ISR. Patients who underwent successful iliocaval stenting were compiled from a departmental database of all lower extremity venous stents from 1996-2018. In total, 760 iliocaval stents were placed in 160 patients (47.5% female, 52.5% male), mean age 48.7 years. Median follow-up was 332 days (range, 0-5627 days). ISR was defined as >50% reduction in luminal diameter. Risk factors examined for ISR included age, gender, type of stent (Wallstent, Boston Scientific, Natick MA) vs. SMART stent (Cordis, Santa Clara, CA), diameter and length of stent, and diameter of angioplasty balloon. Veins included were the inferior vena cava (IVC), bilateral common iliac veins (CIV), and bilateral external iliac veins (EIV). Median and mean time to ISR was 177 and 422 days respectively (range, 11-3985 days). Neither age nor gender were significantly associated with ISR. Location of stent was not associated with increased risk of ISR. ISR occurred in 15.1% of IVC stents, 15.2% of CIV stents, and 18.4% of EIV stents. In both the CIV and EIV, Wallstents had a decreased risk of restenosis when compared to SMART stents (CIV: HR -3.0, P <0.005; EIV: HR -2.4, P = 0.02). Stent brand was not a risk factor for IVC ISR. Angioplasty balloon diameter following stent deployment was a significant risk factor for ISR as increased balloon diameter was associated with a decreased risk of IVC ISR (HR -2.7, P = 0.01). Balloon diameter did not affect ISR for CIV or EIV stents. Our study had clinically acceptable and similar rates of ISR for the IVC, CIV and EIV. Wallstents may decrease ISR in iliac veins but are similar to SMART stents when placed in the IVC. Some literature suggests that over dilation of stents may help long-term patency (4); however, we found that use of larger balloons decrease ISR in IVC stents only.

The effect of wearing insoles with a toe-grip bar on occupational leg swelling and lower limb muscle activity: A randomized cross-over study.

ObjectiveSitting or standing for hours decreases the blood flow in the legs and results in increased pressure on the veins, leading to the development of chronic venous disease. This study aimed to investigate the effects of insoles with a toe‐grip bar on occupational leg swelling and lower limb muscle activity.MethodsThis randomized cross‐over study enrolled 12 healthy men who work in a sitting or standing position. They were randomly divided into groups A (wore shoes with insoles with a toe‐grip bar for 8 hours each) and B (wore shoes with regular insoles for 8 hours each). After 1 week, groups A and B wore shoes with regular insoles and shoes with insoles with a toe‐grip bar, respectively, for 8 hours each. Lower leg volume was measured before and after each intervention, and lower limb muscle activity was measured at the start of each intervention.ResultsOccupational leg swelling was significantly smaller in men wearing insoles with a toe‐grip bar (P < .05). Moreover, the integrated electromyogram value of the tibialis anterior muscle and medial and lateral gastrocnemius muscles during the stance phase of walking, and tibialis anterior muscle during the swing phase of walking was significantly greater in men wearing insoles with a toe‐grip bar (all P < .05).ConclusionInsoles with a toe‐grip bar contribute to increased lower limb muscle activity, attenuating occupational leg swelling.

Pathogenetic substantiation of phlebotropic therapy for chronic venous diseases

Chronic venous disease (CVD) is the most common vascular pathology that has a significant negative effect on physical and psychological health outcomes, and requires high level of public spending on healthcare. Number of CVD risk factors has been identified in recent decades, but only recently have the experts begun to discuss the role of inflammation and endothelial dysfunction. Modern knowledge enables us to identify several priority strategies and goals aimed at managing the basic pathophysiological mechanisms of the development and progression of CVD. In particular, the use of venoactive drugs, which role in enhancing vascular tone and contractility, reducing inflammation and edema and improving microcirculation and accelerating the healing of venous leg ulcers has been carefully studied and presented with positive outcomes in various publications. This review provides various pathophysiological mechanisms of the development of CVD, which present the targets for venoactive drug therapies.

Flow cytometric characterization of the saphenous veins endothelial cells in patients with chronic venous disease and in patients undergoing bypass surgery: an exploratory study.

Recent findings have suggested that the primary factors for development of chronic venous disease (CVD), which commonly manifests as varicose veins (VV), are due to structural and biochemical modifications of the vessel wall. The aim of this exploratory study was to characterize by flow cytometry the endothelial cells (EC) mechanically extracted from the varicose saphenous veins (VSV) segments of patients submitted to VV surgery, and to compare the expression of cell surface molecules in these EC with that observed in the EC from the graft SV (GSV) of patients undergoing bypass surgery. EC were isolated from distal- (varicose trunk) and from proximal- (nearly normal) VSV segments of 30 patients submitted to VV surgery, and from proximal GSV segments of 20 patients submitted to bypass surgery (control group), using a mechanical method, and their immunophenotype was characterized by flow cytometry. EC were identified as being CD45negCD146brightCD31bright, and analyzed for expression of activation-related (CD54, CD62E, CD106), procoagulant (CD142), and cell junction (CD31, CD146) molecules, and for the scavenger receptor, CD36. The EC harvested from the SV segments of CVD patients had lower expression of all the molecules evaluated, in comparison to controls; these differences were more evident for the EC isolated from the distal-VSV. The EC extracted from the proximal- and distal-VSV segments of the CVD patients also differ from each other, the first having lower levels of CD62E, CD106, CD142 and CD36. Groups did not match for gender and controls were heterogeneous concerning the underlying pathologies, which may have a confounding effect. Our study revealed that the EC isolated from varicose (distal) and nearly normal (proximal) VSV segments of the CVD patients differ phenotypically from each other, and from the EC of the control group. The VSV segments more affected by the CVD have the lowest expression of the studied markers. We hypothesize that CVD is associated with a decrease on the EC surface molecules, causing EC dysfunctionality. Further studies with a large number of gender-matched participants are needed, to confirm the results obtained in this exploratory study.

Melatonin attenuates inflammation-related venous endothelial cells apoptosis through modulating the MST1-MIEF1 pathway.

Chronic venous disease (CVD) is a prevalent and potentially debilitating condition that affects millions of individuals. An excessive endothelial inflammatory response is reportedly involved in the development of CVD. In this study, we explored the effect and mechanism of melatonin on venous endothelial damage induced by tumor necrosis factor α (TNF-α). Our data demonstrated that inflammation injury triggered mitochondrial dysfunction, activated reactive oxygen species-related oxidative damage, inhibited mitochondrial potential and ultimately initiated caspase-involved cellular death. Interestingly, melatonin preserved inflammation-attacked mitochondrial performance and thus increased cell survival under TNF-α. Cellular experiments illustrated that inflammation injury promoted the levels of mammalian sterile 20-like kinase 1 (MST1) and mitochondrial elongation factor 1 (MIEF1); active MST1-MIEF1 pathway disturbed mitochondria-related energy production, leading to mitochondria-induced cell damage. Interestingly, melatonin effectively suppressed MST1-MIEF1 axis and thus improved cell survival ratio under TNF-α-mediated inflammation injury. Reactivation of MST1-MIEF1 pathway attenuated melatonin-related endothelial protective actions. Herein, our results illuminate that melatonin is an effective approach to attenuate inflammation-related venous endothelial cell damage through handling the MST1-MIEF1 signaling pathway.

Effect of Hand Massage on Occupational Leg Swelling and Resting-state Electroencephalographic Activity: A Randomized Cross-over Study

Background: Hand massage is recommended for leg swelling with circulatory disturbance because sitting or standing for hours leads to occupational leg swelling and increases the risk for development of chronic venous disease. Furthermore, studies have revealed that hand massage improves emotion and mood. Hence, this study aimed to investigate the effects of hand massage on occupational leg swelling and resting-state electroencephalographic (EEG) activity. Methods: This study was designed as a randomized cross-over study. Eighteen healthy women who work in a sitting or standing position were included in this study and were randomly divided into 2 groups (A and B). First, group A received hand massage to their right leg, and group B received machine massage to their right leg, for 15 minutes each. After 2 weeks, group A received machine massage to their right leg, and group B received hand massage to their right leg, for 15 minutes each. Lower leg volume, restingstate EEG activity were measured before and after each massage. Moreover, the emotion and mood states were measured after each massage. Results: Lower leg volume was significantly reduced after hand and machine massages (p < 0.05). The degree of pleasant, relaxation and refreshing was significantly higher after hand massage than after machine massage (p < 0.05). Resting-state alpha activity after hand massage significantly increased in the left anterior cingulate cortex compared with resting-state alpha activity after machine massage (p < 0.05). Conclusion: This study suggests that hand massage attenuate occupational leg swelling and increases the resting-state alpha activity in the left anterior cingulate cortex.

The calf muscle pump revisited.

Chronic venous disease (CVD) defines the spectrum of manifestations of venous disease that originate as a result of ambulatory venous hypertension. Thus far, the role of the calf muscle pump in the development and potentiation ofCVD has been overlooked and understated in the clinical setting, with much greater emphasis placed on reflux and obstruction. The aim of this review is to explore the level of significance that calf muscle pump function or dysfunction bears on the development and potentiation of CVD. EMBASE and MEDLINE databases were searched with keywords "calf" AND "muscle" AND "pump" AND "venous" AND "insufficiency" AND ("lower limb*" OR "leg*"), screened for cross-sectional and longitudinal studies relating to chronic venous insufficiency, highlighting the role of the calf muscle pump in CVD and the extent to which the calf muscle pump is impaired in these cases. This resulted in the inclusion of 10 studies. Compared with healthy subjects, patients with CVD have a reduced ejection fraction (15.9%; P< .001) and an increased venous filling index (4.66mL/s; P< .001), indicating impairment in calf muscle pump ejection ability as well as poor venous competence. Calf muscle pump dysfunction is present in 55% of patients with CVD in the literature, but this did not reach significance on meta-analysis. Isotonic exercise programs in patients with active and healed ulcers have been shown to increase calf muscle pump function but not venous competence. Calf muscle pump failure is a therapeutic target inthe treatment of CVD. Evidence suggests that isotonic exercise treatment may be an effective method of increasing the hemodynamic performance of the calf muscle pump. This review emphasizes the requirement for more attention to be placed on the treatment of calf muscle pump failure in cases of CVD by use of exercise treatment programs or other methods, which may be of clinical importance in managing symptomatic disease. To establish this in routine clinical practice, these results would need to be replicated in appropriate clinical trials. It would also be logical to look at other modifiable muscle pumps, such as thethigh and foot, and to explore the potential benefit of electrical devices acting on the leg (eg, electrical muscular orneuromuscular stimulation), especially for those patients in whom exercise capacity is limited.

Microfoam Sclerotherapy for Varicose Veins: a Retrospective Analysis of a Modified Technique

Varicose veins (VVs) are generally characterized by their elongated, twisted, bulging, superficial appearance on the lower extremities and usually present with acute or chronic venous diseases. Despite diagnostic and surgical advances in the management of VV, patients suffer from post-therapeutic complications and recurrence. We present findings from a retrospective study of a modified treatment modality in patients with varicose veins who attended St. Thomas Institute of Research on Venous Diseases, Changanassery, Kerala. The hospital caters to patients from India and outside. Out of 14,707 patients treated from 1997 till May 2013, 6,350 patients from January to March 2011 were selected for the study from the routine clinical practice (mid-segment) to facilitate follow-up. They were categorized according to Clinical Etiologic Anatomic Pathophysiologic (CEAP) clinical classification system. Baseline data were accrued using a questionnaire. Patients were treated by microfoam sclerotherapy giving a maximum importance to smaller veins, depicting a modified technique of microfoam sclerotherapy (MMFST). This is based on the significance of microscopic venous valves (MVVs) in the development of chronic venous disease (CVD). Follow-up was according to a predefined schedule, and improvements and complications were recorded. A positive family history of VVs was reported in 85.23% of patients. Half the study population belonged to CEAP clinical class IV. There were no significant complications in patients throughout the 2 to 6years of follow-up. Recurrence was rarely reported during follow-up and was corrected by repeating the procedure as required during follow-up. MMFST is an innovation in the treatment of VVs based on new principles, with the potential to control and revert the symptoms of CVD, with minimal complications.

Perfil clínico e sociodemográfico dos portadores de doença venosa crônica atendidos em centros de saúde de Maceió (AL)

CONTEXTO: A doença venosa crônica (DVC) consiste em alteração do sistema venoso causando uma incompetência valvar associada à obstrução de fluxo ou não. Acomete 10 a 20% da população mundial, tendo maior prevalência no sexo feminino. Apresenta como sintomas mais comuns dor e edema e na forma avançada, a úlcera venosa. Traz limitações funcionais e isolamento social, afetando a qualidade de vida. OBJETIVO: Traçar o perfil dos portadores de DVC, pelo levantamento de dados clínicos e sociodemográficos que indiquem características que possam contribuir para possível mudança de hábito na vida de pacientes que, por motivos de trabalho, falta de conhecimento e/ou instruções, tiveram sua rotina afetada pela doença, com consequente diminuição da sua qualidade de vida. MÉTODOS: Estudo descritivo, observacional do tipo transversal, sendo avaliados portadores de DVC atendidos em centros de saúde de Maceió (AL), aplicando um formulário para coleta de dados, como classificação CEAP, Critério de Classificação Econômica Brasil e Questionário SF-36. RESULTADOS: A amostra foi composta por 66 pacientes com DVC; 83% eram do sexo feminino e 17%, do masculino, a faixa etária predominante foi entre 50 a 60 anos; eram sedentários, assumindo ortostatismo prolongado, baixo nível de escolaridade e classe econômica, doença clínica grave (C6 sintomático) e qualidade de vida variável. CONCLUSÃO: Os resultados demonstraram predomínio da doença no sexo feminino, entre 50 a 60 anos de idade, com fatores desencadeadores e/ou agravantes para desenvolvimento da DVC como falta de atividade física, baixo nível de escolaridade e baixa renda econômica, afetando a qualidade de vida.

High prevalence of nonthrombotic iliac vein lesions in chronic venous disease: A permissive role in pathogenicity

Nonthrombotic iliac vein lesions (NIVL), such as webs and spurs described by May and Thurner, are commonly found in the asymptomatic general population. However, the clinical syndrome, variously known as May-Thurner syndrome, Cockett syndrome, or iliac vein compression syndrome, is thought to be a relatively rare contributor of chronic venous disease (CVD), predominantly affecting the left lower extremity of young women. The present study describes the much broader disease profile that has emerged with the use of intravascular ultrasound (IVUS) scanning for diagnosis and analyzes stent placement outcome in two specific NIVL subsets that may offer clues to their pathogenic role. Among 4026 patients with CVD symptoms spanning the range of CEAP clinical classes, IVUS examinations were selectively done in severely symptomatic patients for indications as described. Iliac vein obstructive lesions were found in 938 limbs of 879 patients; 53% of the limbs had NIVL, 40% were post-thrombotic, and 7% were a combination. Stents were placed in 332 limbs in 319 patients in two NIVL subsets. The subsets, one with and one without associated distal limb reflux, were compared. Reflux was left untreated in the first subset. The median age was 54 years (range, 18 to 90 years). The female-male ratio was 4:1 and the left-right ratio was 3:1. NIVL lesions in the iliac vein occurred at the iliac artery crossing (proximal lesion) and also at the hypogastric artery crossing (distal lesion), a new IVUS finding. Venography was only 66% sensitive, with 34% of venograms appearing "normal." IVUS had a diagnostic sensitivity of >90%. The cumulative results observed at 2.5 years after stent placement in the NIVL subsets with reflux and without reflux, respectively, were complete relief of pain 82% and 77%, complete relief of swelling 47% and 53%, complete stasis ulcer healing 67% and 76%, and overall clinical relief outcome 75% and 79%. These results are nearly identical between the two subsets even though distal reflux remained uncorrected in the NIVL plus reflux subset. NIVL has high prevalence and a broad demographic spectrum in patients with CVD. Similar lesions in the asymptomatic general population may be permissive of future development of CVD. Stent placement alone, without correction of associated reflux, often provides relief.

The Epidemiology of Chronic Venous Insufficiency and Varicose Veins

Chronic venous disease is a common condition presenting to physicians in Western Europe and the United States. This article provides a comprehensive review of the published literature in the English language, from 1942 to the present, and focuses on the prevalence of chronic venous insufficiency and varicose veins, as well as the involved risk factors. Prevalence estimates vary widely by geographic location, with the highest reported rates in Western countries. Reports of prevalence of chronic venous insufficiency vary from < 1% to 40% in females and from < 1% to 17% in males. Prevalence estimates for varicose veins are higher, <1% to 73% in females and 2% to 56% in males. The reported ranges in prevalence estimations presumably reflect differences in the population distribution of risk factors, accuracy in application of diagnostic criteria, and the quality and availability of medical diagnostic and treatment resources. Established risk factors include older age, female gender, pregnancy, family history of venous disease, obesity, and occupations associated with orthostasis. Yet, there are several factors that are not well documented, such as diet, physical activity and exogenous hormone use, which may be important in the development of chronic venous disease and its clinical manifestations.