Lower Extremity Varicose Research Articles

Anatomic-hemodynamical types of recurrence of the lower extremities varicose disease

Objective. To improve the results of treatment in patients with postoperative recurrence of varicose disease of the lower extremities with the help of studying of peculiarities of disorders in regional venous hemodynamics and determination of anatomic-hemodynamic types of the disease.
 Materials and methods. There were examined 85 patients with postoperative recurrence of varicose disease of the lower extremities. Ultrasonic duplex scanning of veins was performed on apparatus «EnVisor», manufactured by «Philips» (Holland) using a multifrequency linear sensor with the 12 - 5 MHz frequency for subcutaneous veins and a convex sensor with the 5 - 2 MHz frequency - for deep veins.
 Results. There were delineated 8 anatomic-hemodynamical types of recurrences of varicose disease of the lower extremities. The investigation conducted have permitted to systematize the causes and signs of the disease. Objective criteria for prognostication of the varicose disease of the lower extremities recurrence may be applied for optimization of volume of primary surgical intervention and prophylaxis of its complications.
 Conclusion. The main causes of the recurrence development in varicose disease of the lower extremities are tactical and technical mistakes of surgeons during performance of primary surgical interventions in patients, suffering varicose disease of the lower extremities. Studying of peculiarities in development of recurrence of varicose disease of the lower extremities permits to elaborate the practical anatomic-hemodynamical classification, which systematizes the main causes of the varicose disease recurrence and constitutes the base for the reoperations tactics elaboration.

Venous leg symptoms in patients with migraine: a potential clue on the pathophysiology of migraine (Vein-Migraine study)

Abstract Background Chronic venous disorders (CVD) that conventionally refers to disease of lower and upper extremity venous system encompass a large spectrum of abnormalities in the venous system. Recently, various venous disorders such as hemorrhoids, varicocele and lower extremity varicose veins have been gathered under the term of dilating venous disease (DVeD). So, vascular wall pathology itself has been supposed to be the underlying mechanism of DVeD in different vascular systems. Migraine is a neurovascular disorder which cerebral venous congestion might have role in pathogenesis. Both vascular and neurogenic theories have been postulated for the pathophysiology of migraine. We hypothesized that pathophysiology of migraine might related with DVeD due to vascular theory. Purpose The objective was to assess the association between venous disease and migraine by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in migraineurs and non-migraineurs. Methods The study was designed as a non-randomized, prospective cohort study and consisted of patients diagnosed with migraine. The control group included age- and sex-matched healthy subjects. All participants were examined for the presence of CVD. Presence of lower extremity venous system disease and subsequent classification has been assessed and categorized according to clinical component of clinical, etiological, anatomical and pathological (CEAP) classification. VEINES-Sym questionnaire was applied to assess venous symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was used to assess the severity of disease in migraineurs. Results Participants were classified into two groups as migraine (+) group (n=130) and migraine (−) group (n=130) (Figure 1). Migraine patients and control group were comparable in terms of clinical status and demographic parameters. The mean score of night cramps, burnings, itching, tingling and throbbing were found to be lower in migraineurs than those of non-migraineurs. In addition, the presence of venous symptoms, aching legs, night cramps, heat/burning sensation, throbbing and tingling were found to be significantly higher in patients with migraine compared with those without migraine (Figure 2). Also, total VEINES-Sym score was lower in patients with migraine compared to control group (34.4±8.7, 37.6±8.12, p=0.003, respectively). Additionally, there was a significant negative correlation between VEINES-Sym score and total MIDAS disability score (r=−0.33, p<0.001) and MIDAS severity levels (r=−0.266, p=0.003) of the migraineurs. Logistic regression analysis revealed that VEINES-Sym score is an independent and statistically significant associate of migraine (OR: 0.95, 95% CI: 0.92–0.98, p=0.001). Conclusions We have documented an independent association between migraine and VEINES-Sym score indicating possible pathophysiological link between migraine and CVD. Funding Acknowledgement Type of funding sources: None.

Regional features of the incidence of the lower extremities varicose in Kazakhstan

Diseases of the cardiovascular system remain an important medical and social problem throughout the world, since the prevalence, features of the clinical course and outcomes lead to a significant decrease in the quality of life. The study of the geographic variability of varicose veins of the lower extremities (hereinafter – VLE) can expand the understanding of this problem. Objective. To assess the regional features of the incidence of VLE in Kazakhstan for 2009-2018. Material and methods. The material for the study was the data of the Ministry of Health of the Republic of Kazakhstan – annual form No. 12, concerning VLE (ICD 10 – I83) for 2009-2018. A retrospective study using descriptive and analytical methods of biomedical statistics was used as the main method. Results and discussion. For 2009-2018 in the republic 158 151 cases of VLE were registered for the first time, of which 37 670 (23.8%) in men and 120 481 (76.2%) in women. The average annual incidence rate of VLE (both sexes) in the republic was 91.6±9.6 per 100,000 of the total population (95% CI=72.8-110.30/0000). The lowest incidence rates of VLE in the entire population were established in Aktobe region – 28.1±1.40/0000 (95% CI=25.4-30.80/0000). Very high incidence rates (both sexes) were detected in North Kazakhstan region (130.5±7.60/0000, 95% CI=115.6-145.40/0000) and in Astana city (163.0±11.00/0000, 95% CI=130.6-195.40/0000). Conclusions. The study showed a preliminary assessment of VLE incidence in the republic, identifying regions of low and high frequency, trends of VLE morbidity. In dynamics, morbidity rates tended to grow. With the equalization of the incidence rates of VLE, the average annual growth rate was Т=+12.5%. Keywords: varicose veins of the lower extremities, incidence, Kazakhstan.

Non-contrast Computed Tomography Volume Rendered Imaging in an Elderly Woman with Round Ligament Varicosity and Lower Extremity Varicose Veins

Non-contrast Computed Tomography Volume Rendered Imaging in an Elderly Woman with Round Ligament Varicosity and Lower Extremity Varicose Veins

Efficacy and mechanism of fire needling bloodletting for lower extremity varicose veins

To compare the clinical effect of lower extremity varicose veins between fire needling bloodletting and operation, and to explore the possible mechanism. A total of 60 patients were randomized into an observation group and a control group, 30 cases in each one. In the control group，the operation was adopted. The fire needling bloodletting was applied in the observation group, twice a week for 4 weeks. Before and after treatment, the venous clinical severity score (VCSS) and venous disability score (VDS) were recorded, the hemorheological indexes [blood viscosity, plasma viscosity, hematocrit, fibrinogen and erythrocyte sedimentation rate (ESR)], immune inflammatory response indexes[serum C-reactive protein (CRP), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6)], vascular endothelial cell function indexes [the number of circulatingendothelial cell (CEC), plasma endothelin (ET-1) and NO)] and apoptosis indexes (Bcl-2, Bax and Caspase-3) were detected in the two groups. Compared before treatment, the scores of VCSS and VDS, hemorheological indexes, immune inflammatory response indexes and levels of plasma NO after treatment were reduced in the two groups (P<0.05). The level of serum Bax after treatment was reduced in the observation group (P<0.05). The number of CEC and levels of plasma ET-1 after treatment were increased in the two groups (P<0.05). The levels of serum Bcl-2 and Caspase-3 after treatment were increased in the observation group (P<0.05). In the observation group, the scores of VCSS and VDS, hemorheological indexes，immune inflammatory response indexes, vascular endothelial cell function indexes and level of serum Bax after treatment were lower than the control group (P<0.05), and the levels of Bcl-2 and Caspase-3 were higher than the control group (P<0.05). Fire needling bloodletting could effectively treat lower extremity varicose veins, and the mechanism may be related to the improvement of hemorheology, downregulation of immune inflammatory response, improvement of vascular endothelial cell function and inhibition of apoptosis.

A perioperative phlebotropic therapy compliance study in patients with varicose veins

Introduction: Lower extremity varicose vein disease is one of the common problems in vascular surgery. Clinically, this disease is accompanied by a wide range of complaints and external symptoms, which eventually lead to a worse patients’ quality of life. The integrated approach is being applied to the disease treatment, which involves the use of various phlebotropic drugs as conservative therapy along with minimally invasive surgical correction and sclerotherapy.Objective: to improve the quality of phlebotropic therapy for patients with lower extremity varicose vein disease, based on the study of factors that shape the patient’s compliance with the effective treatment of clinical symptoms. The term «compliance» means the precise and informed implementation of the doctor’s recommendations during the treatment by the patient. Most often, «compliance» is assessed by the drug use index, which is the quotient of dividing the number of days on which the full dose of the drug was taken by the duration of the entire study period. Materials and methods: The analysis of 368 + 111 patients with lower extremity varicose vein disease was carried out. Of these, 111 patients turned out to be beyond the correct study of compliance (a phlebectomy was performed in a hospital). 368 patients were divided into the following groups: Group 1: the patients, who were assigned modern surgical treatment of varicose veins (endovenous laser coagulation, scleroobliteration); Group 2: the patients, who withdrew from assigned interventions. As it turned out, the different groups of patients differed in compliance.Results. The patients who were shown and performed surgical treatment – 320 (86.9%), can be considered highly compliant with the prescribed conservative therapy – the average value of the compliance index is 0.83, compared to the representatives who refused to perform the recommended surgical procedures recommended by them – 48 (13.1%), the compliance index is 0.78.In the course of the investigation, the factors shaping compliance with phlebotropic drugs were identified, a comparative assessment was carried out on the main indicators of the effectiveness of phlebotropic drugs.Conclusion. Thus, the compliance of the patients suffering from LEVVV during the treatment with phlebotropic drugs varies depending on the multiplicity and convenience of the form of the drug, on the effectiveness of the proposed phlebotropic therapy according to the influence on the complaints and symptoms, on the psychological readiness of the patient to entrust the result of the final treatment of the disease to the surgeon.

Foam sclerotherapy compared with liquid sclerotherapy for the treatment of lower extremity varicose veins: A protocol for systematic review and meta analysis.

There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.

Evaluation of quality of life in patients with varicose veins of the lower extremities

In this descriptive study, the presence of any association between risk factors and quality of life (QOL) in patients with lower extremity varicose veins was determined using a disease-specific scale. This study included 200 patients admitted to the cardiovascular surgery polyclinic of a hospital between January and December 2018 with chronic venous insufficiency and lower extremity varicose veins. The data collection form was applied to the patients who accepted the study after appropriate information was given about the research by a face-to-face interview method. The QOL was found to be higher in the 51–70 age group, with a fixed standing time of less than 7 hours a day, without constipation and with one or more chronic diseases other than varicose veins. About 83.5% of the patients had used compression stockings (CS) and 40.5% of the patients had previously used complementary treatment methods. The QOL scores of the patients with lower extremity varices were found to be low. Causes of dissatisfaction of the patients when using CS include swelling of the feet and fingers, pain and numbness, itching of the wrist, firmness, wrinkles, keeping warm, gliding down the leg and not being cosmetic.&#x0D; Keywords: Varicose veins, chronic venous insufficiency, compression stockings, quality of life, nurse’s role&#x0D; &#x0D;

Experience of application of mechanochemical scleroobliteration in treatment for recurrence of lower extremity varicose vein disease

Aim. Evaluation of the effectiveness of mechanochemical scleroobliteration in treatment for recurrent lower extremity varicose veins (VVD).&#x0D; Materials and Methods. A retrospective analysis of the results of examination and treatment of 19 patients (17 women and 2 men, average age 36.34.5 years) with recurrences of VVD, in whom mechanochemical sclerotherapy as the main method of treatment was used. In all cases, mechanochemical ablation of the superficial venous trunks was performed using Phlebogriph catheter. As a hardener, 3% sodium tetradecyl sulfate solution (fibro-vein) was used in the volume not more than 10 ml per procedure.&#x0D; Results. According to the CEAP classification, 15 patients had C2 and 4 patients had C3 class. Recurrence of VVD in one lower extremity was diagnosed in 17 (89.5%) patients, and bilateral in 2 (10.5%). In 6 (31.6%) cases, recurrence occurred in 5 or more years after the first operation, in 8 (42.1%) patients after 3-5 years, in 5 (26.3%) after 1-3 years. The diameter of varicose veins before treatment according to color duplex scanning (CDR) was 7.90.8 mm. The duration of the detected saphenofemoral reflux (n=10) with the trunk of the great saphenous vein (GSV) left on the hip was 5.71.4 s, with the length 31.231.4 mm. With the preserved зtrunk of the GSV, crossectomy was performed in combination with mechanochemical scleroobliteration. Crossectomy was also performed in two patients with repeated dilation of the trunk of the small saphenous vein (SSV) followed by mechanochemical scleroobliteration. In two cases, insufficient shin perforants were ligated from mini-incisions, and in two more cases, foam scleroobliteration of them was performed. Within 3 weeks after the procedure, a good result was recorded in 94.7% of cases in the form of complete occlusion of sclerotized veins with the absence of reflux in them. Only in one observation incomplete occlusion of the sclerotized vein on the hip was noted, which required a repeated procedure. Long-term results were studied in 19 patients, in 94.7% of who complete obliteration of sclerotized veins and improvement of the clinical course of chronic venous disease were recorded.&#x0D; Conclusion. Mechanochemical scleroobliteration has proven to be an effective method of treatment for lower extremity VVD being a minimally invasive procedure.

Sclerotherapy Induced Takotsubo Syndrome

A 66-year-old female was brought to the emergency department for acute-onset left-sided chest pain. Prior to arrival, she was at an outpatient appointment with a vascular surgeon for elective sclerotherapy treatment of her lower extremity varicose veins. After receiving an IV injection of polidocanol, she developed severe chest pain with left arm and jaw numbness for the first time in her life. Upon arrival to the ED, the patient reported that her symptoms had resolved. Electrocardiogram (ECG) on presentation was significant for T-wave inversions in leads V1-V3. An initial set of cardiac enzymes showed a troponin I level of 0.62 ng/mL, which subsequently increased to 2.26 ng/mL. Her echocardiogram was significant for mild left ventricular systolic dysfunction with apical hypokinesis (ejection fraction 50%). A repeat ECG showed new T-wave inversions compared to that from the time of admission. The patient eventually agreed to cardiac catheterization, which revealed patent vessels without coronary artery disease, supporting our diagnosis of Takotsubo syndrome and what is the first reported case of likely polidocanol-induced Takotsubo syndrome in the United States.

Effectiveness and Analysis of Applying the Principle of Myofascial Trigger Points (MTrPs) to Treat Lower Extremity Varicose Veins (LEVVs): A Prospective Clinical Therapeutic Study

Effectiveness and Analysis of Applying the Principle of Myofascial Trigger Points (MTrPs) to Treat Lower Extremity Varicose Veins (LEVVs): A Prospective Clinical Therapeutic Study

Clinical significance of antegrade lower limb venography in varicose veins of lower limbs

Objective To investigate the clinical significance of antegrade lower limb venography in varicose veins of lower limbs. Methods The data of 230 cases of varicose veins of lower limb in Department of Vascular Surgery, Xiangyang Central Hospital from June 2018 to August 2019 were examined by antegrade lower limb venography. All patients were divided into simple varicose veins group (group A, 67 cases) and secondary varicose veins group (group B, 63 cases) according to the patency of deep veins. The data of sex, limb side, swelling and ulcer were analyzed respectively. Results There was no significant difference in the results of sex between the two groups (57.5% vs 63.5%, P>0.05). The incidence of left side in group A was lower than that in group B (59.3% vs 76.2%, P<0.05). And the incidence of swelling of lower extremities and ulcer in boot area in group A was lower than that in group B (31.1% vs 49.2%, P<0.05; 18.6% vs 31.7%, P<0.05 respectively). Conclusions Combined with swelling of lower extremities, ulcer in boot area or the varicose veins in left side had a higher incidence of secondary varicose veins. Anterograde venography of lower extremities can accurately distinguish the classification of varicose veins of lower extremities and improve the diagnostic coincidence rate, which has significant clinical significance. Key words: Phlebography; Lower extremity varicose veins; May-Thurner syndrome

Elastic compression after ultrasound-guided foam sclerotherapy in overweight patients does not improve primary venous hemodynamics outcomes

ObjectiveLower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. MethodsOverweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcome measure was the absence of venous reflux in the great saphenous vein. ResultsOne hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P = .64) or the mean foam volume per procedure (P = .27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P = .16) or 3 months (25% vs 21%; P = .85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups—2 of 62 in control patients and 2 of 69 in compression patients (P = .45). Venous diameter reduction was noted in both groups during treatment (P < .05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. ConclusionsElastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.

Prevalence of Chronic Venous Diseases in Students of Ivano-Frankivsk National Medical University

The Objective of the Research was to increase the frequency of detecting chronic venous disorders in young people by surveing the students using a specially designed questionnaire with an analysis of its results for timely treatment.&#x0D; Materials and Methods. To detect lower extremity chronic venous disorders, 1,007 students of the Ivano-Frankivsk National Medical University were interviewed using questionnaire that was based on the VEIN-TERM, the Venous Clinical Severity Score, the Chronic Venous Insufficiency Quality of Life Questionnaire. In the surveyed people, there were estimated the following data: age; gender; objective symptoms of chronic venous disorders such as telangiectasia, reticular (spider) veins, varicose veins and leg swelling; 11 most common symptoms of chronic venous disorders; risk factors such as the presence of lower extremity varicose veins in parents, previous childbirth and frequent or rare use of high heels in females.&#x0D; Results. In 617 (61.3%; 95 CI, 58.2 - 64.3%) respondents, phlebopathy was detected; 63 (6.3%, 95 CI 4.8 - 7.9%) students reported lower extremity telangiectasias; 11 (1.1%; 95 CI 0.5 - 1.9%) students reported reticular veins. Varicose veins were detected in 33 (3.3%; 95 CI 2.3 - 4.6%) cases. Among them, there were 14 (1.4%, 95 CI 0.8 - 2.3%) cases of leg swelling. Only two symptoms, namely calf cramps (p=0.01) and leg pain (p=0.04) turned out to occur significantly more frequent in the respondents with varicose veins. Varicose veins were more often found in the students whose fathers suffered from varicose veins as compared to those whose mothers had varicose veins – 12.1% (95% CI 5.4 - 22.5%) versus 4.2% (95% CI 2.1 - 7.5%), respectively (p=0.008). Among females without lower extremity varicose veins, 34.1% (95% CI 29.7 - 38.3%) of the respondents indicated wearing high heels (above 5 cm) which was approximately 3 times more often as compared to female respondents with varicose veins - 11.2% (95% CI 0.0 - 21.7%) of women (p=0.001).&#x0D; Conclusions. 1. Leg pain and calf cramps can be considered as the most important subjective symptoms for early diagnosis of lower extremity varicose veins in young people. 2. The presence of lower extremity varicose veins in a father results in higher risk of detecting this pathology in the respondent than the presence of lower extremity varicose veins in a mother: 12.1% (95% CI 5.4-22.5%) versus 4.2% (95% CI 2.1 - 7.5%) (p = 0.008). 3. Early diagnostics of lower extremity varicose veins in young people with the aim of further adequate treatment to prevent their progression and the development of complications can be implemented by questioning students in different educational institutions.

Comment On "Vein Size and Disease Severity in Chronic Venous Disease" by Radhakrishnan et al: Afflicted Vein Diameter or Signs and Symptoms in Chronic Venous Disease: Which One Really Matters?

Besides being a widespread health problem, chronic venous disease (CVD) of the lower extremities is also a cosmetic and growing economic problem. CVD or lower extremity varicose veins can be classified as a subgroup of dilating venous or vascular diseases.[1] [2] [3] Spider veins, varicose veins, edema, changed skin color, and ulcerations are the main clinical signs of the disease[4] and admission complaints of patients mostly include heavy legs, aching legs, swelling, night cramps, burning sensation, restless legs, throbbing, itching and tingling.[5] In addition to these symptoms, color changes including purpuric and ecchymotic lesions of the lower extremities have been described as a significant reason for admitting to phlebology clinics in this patient group.[6] [7] [8] [9]

Retrospective Analysis of Risk Factors for Venous Thromboembolism in 283 Patients with Lung Cancer during Systemic Therapy

背景与目的肺癌患者是静脉血栓栓塞症（venous thrombo-embolism, VTE）的高危人群，合并VTE者具有较高的死亡率。本研究旨在明确接受系统性治疗肺癌患者的VTE发生情况及影响因素。方法回顾性分析2016年1月-2018年12月在北京大学第三医院肿瘤化疗与放射病科接受系统性治疗的283例肺癌患者，卡方检验分析VTE与临床特征间的关系，多因素回归分析影响VTE的高危因素。结果283例肺癌患者中，VTE发生率为12.01%（34/283）。有下肢静脉曲张组的VTE发生率为50.00%（5/10），显著高于无下肢静脉曲张组的9.89%（27/273）（P=0.001）。远处转移患者的VTE发生率为14.05%（26/185），高于带瘤但无远处转移患者的14.00%（7/50），且高于无瘤患者的2.08%（1/48）（P=0.024）。肿瘤活动组的VTE发生率为16.93%（21/124），显著高于稳定组的8.18%（3/159)（P=0.025）。首次药物治疗前白蛋白 < 35g/L组VTE发生率为22.00%（11/50），显著高于≥35 g/L组的9.87%（23/233）（P=0.017）；D-二聚体 > 0.3 μg/mL组VTE发生率为17.93%（26/145），显著高于≤0.3 μg/mL组的5.80%（8/138）（P=0.006）。接受PICC的患者上肢静脉血栓的发生率为9.71%（17/175），显著高于未行PICC组的1.85%（2/108）（P=0.010）。肺癌病理类型、白细胞、血红蛋白、血小板计数及是否接受抗血管生成药物治疗等因素与VTE的发生率无关。多因素分析显示下肢静脉曲张、低白蛋白血症、D-二聚体升高是VTE的独立影响因素。结论有无下肢静脉曲张、血白蛋白和D-二聚体水平或许是预测肺癌患者系统性治疗期间发生VTE更为有效的因子，可进一步建立新的预测模型并进行前瞻性验证。

Dynamics of endothelial dysfunction indices before and after operation in patients with varicose disease of the lower extremities

The aim of the study is to examine the correlation between the endothelial dysfunction indices and the clinical class of the disease before and after the operation in patients with varicose disease of the lower extremities.Materials and methods. In total, 69 patients with varicose disease of the lower extremities were examined, with preoperative and long-term postoperative measurements of homocysteine, nitrotyrosine and eNOS by the immunoassay analysis.Results. The results of dynamic changes in endothelial dysfunction indices in 69 patients with varicose disease of the lower extremities, examined before and after an operation, were analyzed. A significant correlation between the mean values of homocysteine, nitrotyrosine and eNOS with the clinical class of lower extremity varicose vein disease (LEVVD) has been determined.Conclusions. A significant decrease in the indices of homocysteine, nitrotyrosine and increased eNOS was observed long term following operation compared to the initial values before it. It has been established that the homocysteine values were relatively stronger correlated with the patient's age than with the LEVVD clinical class, and nitrotyrosine and eNOS were relatively higher correlated with the LEVVD class than with the patients’ age.

Pathomorphologocal aspects of the recurrence development of the lower extremities varicose veins.

Pathomorphologocal aspects of the recurrence development of the lower extremities varicose veins.

A Rare Case of Primary Upper Extremity Varicose Veins

AbstractThe incidence of varicosities of upper extremity is far most uncommon from that of lower extremity varicose veins for varied reasons even though the causes are almost the same. Here, the authors present a case of right upper limb varicose veins in a 55-year-old female who is a housewife. After ruling out all the secondary and congenital causes on clinical and Doppler study, the authors diagnosed it as a case of primary upper extremity varicose veins. They referred the case to a vascular surgeon but the patient denied the surgery, and is lost to follow-up. Hence, the authors report this case of primary upper limb varicosities as the incidence is very low when compared with lower extremity, and not much of literature is available except for a few case reports.

Risk factors for venous thromboses in patients with rheumatoid arthritis

Objective: to determine risk factors (RFs) for venous thromboembolic events (VTE) in patients with rheumatoid arthritis (RA).Subjects and methods: The investigation enrolled 374 patients (311 women and 63 men) with a reliable diagnosis of RA who met the 2010 ACR/EULAR classification criteria. The patients' mean age was 53.7±13.6 years; the disease duration was 12.1±10.7 years. All the patients were treated at the V.A. Nasonova Research Institute of Rheumatology Clinic during the period from 2014 to 2017. A standard clinical examination of the peripheral joints was performed. RA activity was measured using DAS28. A survey was made using a questionnaire including questions on traditional RFs for VTE and RFs that might be caused by RA and its therapy. Results and discussion. VTE were recorded in 45 (12%) out of the 374 patients. Group 1 included 45 patients with VTE; Group 2 consisted of 329 patients without VTE. Multidimensional analysis showed an increased risk of developing VTE in RA under the influence of the following factors: high inflammatory activity; lower extremity varicose veins; hypercholesterolemia; and hypertension. Their weighted coefficients were 1.1, 2.5, 1.0, and 0.9, respectively. According to the obtained model (p&lt;0.001), the risk of VTE in RA can be predicted by the following formula: Z = 1.1 • high RA activity (Yes = 1/No = 0) + 2.5 • lower extremity varicose veins (Yes = 1/No = 0) + 1.0 • hypercholesterolemia (Yes = 1/No = 0) + 0.9 • hypertension (Yes = 1 / No = 0).Conclusion: The increased risk for VTE in RA patients determines the need for its timely assessment, by taking into account the known risk factors as both standard ones and those caused by the disease itself and its therapy. This risk assessment is necessary for the timely adequate treatment and prevention of thrombotic events in RA.