Lower Extremity Venous Insufficiency Research Articles

Adult-Onset Eccrine Angiomatous Hamartoma Associated with Lower Extremity Venous Insufficiency: A Case Report

Introduction: Eccrine angiomatous hamartoma (EAH) is a benign tumor characterized by the proliferation of eccrine glands and vascular structures. It can be congenital or appear during childhood, with rare cases arising in adults. EAH typically presents as a solitary purplish plaque or nodule but a multifocal presentation in a blaschkoid or segmental distribution has been described. Case Presentation: We report the case of an extensive EAH following the territory of the superficial veins of the lower limbs, arising in an adult diagnosed with venous insufficiency at a young age and that worsened after saphenectomy. Conclusion: The histopathological and ultrasonographic characteristics suggest that this case may represent a new instance of EAH associated with arteriovenous malformation. We hypothesize that there might be common molecular pathways linking both conditions and that, in predisposed patients, saphenectomy can exacerbate EAH.

Biomedical therapeutic compression textiles: Physical-mechanical property analysis to precise pressure management

Biomedical therapeutic compression textiles (TCTs) have been extensively applied in the prevention and treatment of chronic venous insufficiency of lower extremities. An efficiency and operable development strategy to achieve the morphologic control and pressure fitness of TCTs needs to be proposed to improve the medical precision and patient adherence. Therefore, the present study qualitatively explored the influencing mechanisms of each knitting variable on physical-mechanical properties and pressure behaviors of TCTs. Then constructed the quantitative models to digitalize the knitting variables for determination of yarn-machinery setting design values. The results revealed that the feeding velocity of elastic inlay yarn materials and loop size settings impacted the pressure values owing to the diversities of fabric dimensions and mechanical tensile properties, respectively. Simultaneously, the derivation ratios of proposed circumferential and pressure models evaluated by experimental validated trials were approximately 1.1% and 10.8%, respectively. This study provided the fundamental references for the design, manufacturing, and property controlling of compression textiles to improve the biomedical therapeutic effectiveness for targeted users.

CVINet: A deep learning based model for the diagnosis of chronic venous insufficiency in lower extremity using infrared thermal images

AbstractChronic venous insufficiency (CVI) is a venous disorder characterized by impaired blood flow from the lower extremities back to the heart, leading to various symptoms and complications. Accurate and timely diagnosis of CVI is critical for effective management and prevention of further complications. Deep learning (DL) models have shown results that are promising in the field of medical image analysis tasks over the past few years. This article presents CVINet, a enhanced DL‐based convolutional neural network (CNN) model that has been developed specifically for the purpose of diagnosing CVI utilizing thermal imaging data. The proposed CNN model extracts relevant features from input images using a multi‐layered architecture with convolutional layers and pooling layers. Following feature extraction, data are directed to fully connected layers for performing classification task. To enhance the performance of this model, we employ techniques such as dropout regularization and batch normalization. This model utilizes its ability to automatically learn discriminative features from raw thermal images. A large set of thermal images from both CVI patients and healthy individuals was acquired for training and testing of the model. A comparison between few conventional pre‐trained models was conducted, and the best performing model for classification was examined. Pre‐trained VGG‐16, EfficientNet‐B0, and ResNet‐152 models produced classification accuracies of 94.7%, 95.3%, and 95.8%, respectively. The Proposed CVINet model attained a classification accuracy of 96.8% on binary classification, demonstrating high performance compared with other state‐of‐the‐art networks. Overall, our proposed CNN model offers a promising solution for accurately classifying CVI and normal subjects based on thermal images which outperforms the diagnosis by clinician. The potential benefits include early detection of CVI and personalized treatment strategies that can improve patient outcomes. They improve the accuracy of patient diagnosis, reducing radiologist workload and providing them with a tool that can automatically assess the condition of the lower limb venous condition, lowering the risk of misdiagnosis. Furthermore, improving healthcare service quality and early detection can alter the course of the disease and reduce the morbidity and mortality rate of the disease.

Association between lower extremity venous insufficiency and increased choroidal thickness

The goal of this study is to investigate the association between the choroid and lower extremity venous insufficiency (LEVI). This prospective cross-sectional study includes 56 patients with LEVI and 50 age/sex-similar control subjects. Choroidal thickness (CT) measurements from 5 different points were captured from all participants by optical coherence tomography. In the group with LEVI on physical examination, reflux at the saphenofemoral junction, and the diameter of the great and small saphenous veins were evaluated via color Doppler ultrasonography. The mean subfoveal CT was higher in the varicose group than in the control group (363.04±99.75μm vs. 320.30±73.46μm, P=0.013). In addition, the CTs at the temporal 3mm, temporal 1mm, nasal 1mm, and nasal 3mm distance from the fovea were higher in the LEVI group compared to the controls (for all, P<0.05). There was no correlation between CT and diameter of the great and small saphenous vein in patients with LEVI (for all, P>0.05). However, the great and small saphenous veins of patients with CT above 400μm were observed to be wider in patients with LEVI (P=0.027 and P=0.007, respectively). Varicose veins can be a feature of systemic venous pathology. Another component of systemic venous disease may be increased CT. Patients with high CT should be investigated for susceptibility to LEVI.

Patients with active venous leg ulcers at the time of iliac vein stenting require more reoperations

ObjectiveAn active venous leg ulcer (VLU) caused by lower extremity venous insufficiency is challenging to treat and will often recur after initially healing. In the present study, we compared the symptomatic outcomes and need for reoperation after iliac vein stenting (IVS) in patients with an active VLU (VLU+) and those without an active VLU (VLU−). MethodsA single-institution database of patients with chronic venous outflow obstruction who underwent IVS from August 2011 to June 2021 was analyzed. Symptoms were quantified using the venous clinical severity score. The patients were divided into two cohorts: those with (VLU+) and without (VLU−) VLUs. ResultsA total of 872 patients (71 VLU+ and 801 VLU−) were identified. Many of the demographics and comorbidities differed between the two cohorts, and these variables were included in the multivariable analysis. On univariate analysis, the VLU+ cohort was more likely to need a major reoperation (odds ratio, 1.94; 95% confidence interval, 1.01-3.52; P = .036). However, on multivariable analysis, the difference was not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.55-2.40; P = .667). Additionally, the VLU+ cohort required a significantly greater mean total of reoperations (1.4 vs 1.0; P = .006) than the VLU− cohort. Comparatively, for patients who underwent at least one reoperation, the difference in the mean total number of reoperations was even greater for the VLU+ cohort (2.6 vs 1.8; P = .001). The results from the Kaplan-Meier log-rank test revealed no differences in the reintervention-free survival time (P = .980). Both cohorts experienced a durable mean reduction in the venous clinical severity score. The ulcer healing rates for the VLU+ cohort at 6, 12, 24, and 36 months were 38%, 47%, 52%, and 59%, respectively. The ulcer recurrence rates for the VLU+ cohort were 4%, 10%, 19%, and 30% at 6, 12, 24, and 36 months, respectively, with a median time to recurrence of 1.2 years. ConclusionsPatients with active VLUs who underwent a first reintervention after initial IVS, on average, required an additional reintervention.

The association between varicocele and other vascular diseases: A systematic review and meta-analysis.

This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses. We searched Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science for studies that reported varicocele and other vascular diseases published before 30 June 2021. The meta-analysis was performed by Revman V.5.2 to calculate the pooled odds ratios and corresponding 95% confidence intervals. Subsequently, the impact of publication bias was evaluated, and sensitivity analysis as performed to assess our results' robustness. In total, seven case-control studies, including 803 varicocele cases and 727 controls, were included. Our meta-analysis results showed that the varicocele patients had a higher risk of saphenofemoral insufficiency when compared with the control group (odds ratio [OR]: 2.80; 95% confidence intervals [CIs]: 2.03, 3.84; p < 0.00001). Additionally, varicocele patients also had a higher risk of lower extremity venous insufficiency when compared with the control group (OR: 2.34; 95% CI: 1.58, 3.47; p < 0.0001). However, there was no statistical difference in hemorrhoid risk between both groups (OR: 1.13; 95% CI: 0.28, 4.59; p = 0.87). Our study demonstrated that varicocele patients have higher risk of saphenofemoral and lower extremity venous insufficiencies but not the risk of hemorrhoids.

Patients With Active Venous Leg Ulcers at Iliac Vein Stenting Required More Reoperations

Active venous leg ulcers (VLUs) caused by lower extremity venous insufficiency indicate a high disease burden and risk of infection. Our objective was to compare the clinical outcomes and need for reoperation after iliac vein stenting for patients with VLU vs those without VLU (non-VLU).

Laser technologies in the diagnostics and care of patients with decompensated forms of chronic venous insufficiency in the lower extremities

Purpose. To assess the degree of disorders in regional microcirculation in patients with decompensated forms of chronic venous insufficiency of lower extremities and potentials for their correction with low-level laser therapy (LLLT).Material and methods. The authors analyzed results of examination and treatment of 66 patients with decompensated forms of chronic venous insufficiency in their lower extremities. 34 (51.5 %) patients, in addition to traditional therapy, had laser stimulation of microcirculation. For laser irradiation, infrared laser device “Mustang” (wavelength – 0.89 μm, frequency – 80 Hz, power – 10 W, exposure – 2 min per zone) was used. In laser course, there were 10 sessions. The state of microcirculation in tissues was examined with a computerized capillaroscope, a laser analyzer of capillary blood flow and a gas analyzer.Results. Microcirculation in patients with chronic venous insufficiency C6 has its specific features which, by findings of computerized capillaroscope, are manifested with deep suppression of tissue blood flow: namely, expressed polymorphism of capillary structures, violation of sizeratio of capillary sections, increased venous section, decreased density of the capillary network by 1.8 times, increased pericapillary zone by 1.47 times , decreased speed of capillary blood flow in the arterial section by 10.5 times and in the venous section by 11.5 times.Conclusion. Patients with decompensated forms of chronic venous insufficiency in lower extremities were observed to have significant morphological and functional changes in microcirculation, including structural changes in microvessels, decreased density of capillary network, increased prevascular zone, decreased speed of capillary blood flow. As a result, these changes cause disorders in tissue trophism, progressive decrease in TcpO2 and development of trophic ulcers. Low-level laser stimulation of microcirculation in the complex treatment of patients with decompensated forms of chronic venous insufficiency activates transcapillary metabolism, helps to restore structures and functions of microvasculature by increasing the myogenic activity of smooth muscle cells of arterioles and precapillaries as well as by normalizing arterio-venous relationships what accelerates tissue granulation and ulcer epithelialization.

Association Between Lower Extremity Venous Insufficiency and Intrapartum Fetal Compromise: A Nationwide Cross-Sectional Study.

Introduction: Chronic venous disorder (CVeD) has a high prevalence, being commonly diagnosed by the presence of varicose veins. In fact, the development of varicose veins in lower extremities and/or pelvic venous insufficiency (LEPVI) is frequent. However, its potential impact on fetal health has not been investigated. This study aimed to examine whether the presence of varicose veins in women's LEPVI is related to an intrapartum fetal compromise event.Materials: A cross-sectional, national study was conducted using medical administrative records (CMBD) of all vaginal births (n = 256,531) recorded in 2015 in Spain. The independent variable was defined as the presence of varicose veins in the legs, vulva, and perineum or hemorrhoids. A logistic regression model was used to assess the association of interest.Results: Among women with vaginal deliveries, those with varicose veins in their LEPVI have a significantly greater odds of intrapartum fetal compromise (OR = 1.30, 99.55%CI = 1.08–1.54) than their counterparts without varicose veins. After adjustment, this association remained significant (OR = 1.25, 99.5%CI = 1.05–1.50).Conclusions: Our findings of an association between varicose veins in women's lower extremities and/or pelvis and intrapartum fetal compromise suggest that varicose veins may be a novel and important clinical risk factor for fetal well-being and health.

Chronic Venous Insufficiency of Lower Extremity

Chronic Venous Insufficiency of Lower Extremity

Hemodynamic interpretation of chronic venous insufficiency of lower extremity based on Guytonian equation: is it valid for the clinical implication?

article: Hemodynamic interpretation of chronic venous insufficiency of lower extremity based on Guytonian equation: is it valid for the clinical implication? - Acta Phlebologica 2021 April;22(1):6-8 - Minerva Medica - Journals

Association between lower extremity venous insufficiency and duration of atrial fibrillation.

Physiologic studies have shown that atrium has an active role in venous blood return from lower extremity. In this context we investigated the association between AF and chronic venous disease (CVD). In this observational study we included 392 AF patients which were divided into two groups (chronic AF, 218 (56%)) and non-chronic. AF, 174 (44%)). These two groups were compared in terms of CVD after matching conventional risk factors for CVD. CEAP classification was different between chronic and non-chronic patients (C0-C2: 72% vs 47%; C3-C6: 28% vs 53% <0.001). Chronic AF patients had also higher rate of venous reflux on Doppler ultrasound (38% vs 16% P < 0.05). There was a correlation between AF duration, right atrial volume index and CEAP classification respectively (rho:0.314 p < 0.001), (rho:0.258, p < 0.001). Prevalence of CVD is higher in patients with chronic AF. In addition, atrial volume is directly correlated with CVD.

Pelvic Congestion Syndrome

Pelvic congestion syndrome (PCS) is often an underdiagnosed cause of chronic pelvic pain in female patients with radiology detection of gonadal vein dilatation and parauterine varices. It may occur either alone or in combination with vulvar varicosities and/or lower extremity venous insufficiency. Although transcatheter venography represent the gold standard for PCS diagnosis, it is performed after inconclusive noninvasive imaging such as Doppler Ultrasound, CT scan, and MRI. Once diagnosis has been confirmed, management of PCS include medical, surgical, and endovascular therapy. Medical and surgical treatments have been shown to be less effective than transcatheter pelvic vein embolization. This latter has been proven to be a safe, effective, and durable therapy for the treatment of PCS. Numerous studies have shown their results in PCS endovascular treatment, but neither of them has been subjected to an adequate randomized controlled trial. A well-designed randomized controlled trial is urgently needed to assess transcatheter embolization clinical success.

3:36 PM Abstract No. 179 Predictors for patient outcomes following endovascular varicose vein treatment

Lower extremity venous insufficiency is one of the most common vascular disorders in adults.1 Several minimally invasive treatment modalities have been developed for the treatment of venous varicosities. While serious postoperative complications are rare following treatment, this study attempts to identify preoperative patient risk factors for acute postprocedural adverse outcomes. This was a retrospective analysis of the National Surgical Quality Improvement Program (ACS-NSQIP) database between 2014-2017 for patients undergoing endovascular venous insufficiency treatment. Patients were included based on CPT codes. Descriptive analysis was performed. Multivariate logistic regression models were employed to identify risk factors for adverse patient outcomes. 9,704 patients met the inclusion criteria for the study. 6,262 (64.5%) were female, 7,019 (76.9%) white, 1,182 (12.2%) were morbidly obese, 4,662 (48%) age >55 years, 1,039 (10.7%) diabetic, 1,092 (11.3%) smoked, 267 (2.8%) reported dyspnea, 200 (2.1%) had pulmonary comorbidities, 3,375 (34.8%) had cardiac comorbidities, 26 (0.3%) had renal comorbidities, 601 (6.2%) had an open wound, 189 (1.9%) reported chronic steroid use, 10 (0.1%) reported recent weight loss, 361 (3.7%) reported bleeding disorder, 6,832 (70.4%) were ASA class 1-2, and 4,692 (48.4%) had procedure time >53 min. Postoperatively, 295 (3%) had hospital LOS >0 days, 139 (1.4%) had DVT, and 134 (1.4%) had a readmission. Other adverse postoperative outcomes were rare. Multivariate logistic regression found patients who identify as Black (OR = 3.007, 2.022-4.470), age >55 years (OR = 1.332, 1.012-1.753, P = 0.041), open wound (OR = 4.306, 3.121-5.940), bleeding disorder (OR = 1.877, 1.215-2.900, P = 0.005), ASA class 3-5 (OR = 2.024, 1.515-2.703), and prolonged procedure time (OR = 2.669, 2.017-3.530) as risk factors for prolonged hospital LOS. P <0.001 unless otherwise noted. While adverse events following endovascular venous insufficiency treatment are rare, several important risk factors have been identified and can be used for risk stratification preprocedurally.

Alt Ekstremite Venöz Yetmezliğinde Transkutan Radyofrekans Uygulanan Hastaların Sonuçları: Tek Merkezli Karşılaştırmalı Çalışma

Amaç: Kronik venöz hastalık (KVH), günlük yaşamı etkileyen, tanı ve tedavi maliyetinin yüksek olduğu bir sağlık sorunudur. Bu çalışmada, KVH tanısına sahip klinik, etiyolojik, anatomik, patofizyolojik [clinical-etiological-anatomical-pathophysiological (CEAP)] sınıflamasına göre C1s/a olan hastalarda, radyofrekans (RF)ın tedavideki etkinliğinin tespit edilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu çalışma, KVH nedeniyle 2018-2019 yılları arasında Erciyes Varis Tedavi Merkezine başvuran, CEAP sınıflamasına göre C1s/a olan hastalar dâhil edilerek yapılmıştır. Hastalar, uygulanan tedavi yöntemlerine göre 2 gruba ayrıldı. Grup 1'deki hastalara; 27.12-MHz RF tedavisi, venoaktif ilaç [venoactive drug (VAD)] tedavisi (kalsiyum dobesilat), işlem sonrası kompresyon tedavisi ve antistaz egzersiz tedavileri uygulanmıştır. Grup 2'deki hastalara ise VAD tedavisi (kalsiyum dobesilat), kompresyon tedavisi (Class 1) ve antistaz egzersiz tedavileri uygulandı. Bulgular: Çalışmaya, medyan yaşı 41 (35,25-46) olan 61 (%50,8)'i kadın ve 59 (%49,16)'u erkek, toplamda 120 hasta dâhil edildi. Grup 1'deki hastaların yaşlarının medyan değeri 40 (33,25-44), Grup 2'deki hastaların ise 42 (37-49,5) olarak bulundu. Hastalar, semptomatik olma durumuna göre incelendiğinde 96 (%80) hastanın asemptomatik, 24 (%20) hastanın ise semptomatik olduğu tespit edildi. Semptomlarda ise en sık ağrı (%25) ve bacak şişliği (%15) görüldü. Sonuç: KVH'nin primer tedavisi, hastaların eğitimi ve yaşam tarzı değişiklikleridir. KVH'de kompresyon çorapları ve medikal tedavinin yanında RF, hastaların klinikleri üzerine olumlu etki gösterebilecek alternatif bir tedavi yöntemi olarak düşünülebilir.

Upregulation of VEGF and PEDF in Placentas of Women with Lower Extremity Venous Insufficiency during Pregnancy and Its Implication in Villous Calcification.

Pregnancy is a period in a woman's life in which changes can occur that affect different physiological processes. Common conditions during this period include vascular changes, such as lower extremity venous insufficiency (VI). This is an observational, analytical, and prospective cohort study in which 114 pregnant women were analyzed, of which 62 were clinically diagnosed with VI. In parallel, 52 control patients without VI (HC) were studied. The aim of this study was to observe changes in angiogenesis and inflammation markers as well as the presence of calcium deposits. The expression of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and pigment epithelium-derived factor (PEDF) was analyzed by immunohistochemistry and RT-qPCR. The presence of calcium deposits was revealed using the von Kossa method. In the placentas of mothers with VI, gene expression of VEGF (34.575 [32.380–36.720] VI vs 32.965 [30.580–36.320] HC) and PEDF (25.417 [24.459–27.675] VI vs 24.400 [23.102–30.223] HC) significantly increased, as was protein expression in the placental villi. An increase in calcium deposits was observed in the placentas of women with VI (72.58% VI/53.84% HC). This study revealed the existence of cellular damage in the placental villi of mothers with VI with tissue implications such as increased calcification.

Women with Venous Insufficiency in Lower Extremity During Pregnancy Show Damage in Placenta: Evidence of Hypoxia and Oxidative Cellular Stress

Women with Venous Insufficiency in Lower Extremity During Pregnancy Show Damage in Placenta: Evidence of Hypoxia and Oxidative Cellular Stress

Mid and Long Term Results in Patients with Endovenous Radiofrequancy Ablation in Lower Extremity Venous Insufficiency

Introduction: Lower extremity venous insufficiency is a condition in which the flow of venous blood returns to the heart and the normal one-way rotation of the venous blood is reversed. As an alternative to open surgery in varicose veins, non-surgical endovascular procedures and hybrid endovascular procedures have emerged in the last decade. In this study, we aimed to evaluate the mid and long term results of endovenous radiofrequency ablation(RF) as an endovascular method. Material And Method: Between March 2015 and January 2017, 150 patients who underwent RF with the diagnosis of venous insufficiency were included in our study. 82 patients were female(54.7%), 68 were male(45.3%). The age range was 21-68. Spinal anesthesia was performed in 139 patients and general anesthesia was performed in 11 patients. The RF ablation catheter was inserted into the Great Saphenous Vein(GSV) Under the guidance of Doppler USG guided at the appropriate level below the knee. RF ablation was performed after approximately 1 cm distal of the superficial epigastric vein and then a flabectomy was performed. Result: Postoperative 1st 10th day, 1st 6th month and 1st 2nd year controls were performed. In control doppler USG performed in sixth month, 135 patients(%90) had BSV complete occlusion and in 15 patients(%10) 40% recanalization. 6 patients had deep venous insufficiency and 1 patient had perforating venous insufficiency. This patient developed varicose vein stockings in the medial malleolus and venous ulceration(C6) despite intensive medical therapy. Doppler USG performed in the first year of follow-up was 134 patients with GSV full occlusion and 16 patients with 40% recanalization. In the 2 year follow-up, there was no difference in the GSV patency rate between the first year and Doppler USG controls. Conclusion: We evaluated the mid and long term results of radiofrequency ablation in a single center, retrospectively in the treatment of venous insufficiency and varicose veins, which are common in the community. When applied with appropriate indication, radiofrequency ablation success rate is high, complication rate is low and it is also successful in terms of cosmetic results.

Current Therapeutic Interventions in Lower Extremity Venous Insufficiency: a Comprehensive Review.

Chronic venous disease (CVD), although affecting up to 40% of the US population, is often underdiagnosed by healthcare professionals due to an incomplete understanding of the presenting symptoms. CVD is a common cause of lower extremity pain and discomfort, including aching, cramping, tingling, burning, swelling, heaviness, restlessness, and fatigue, and may lead to significant morbidity if left untreated. The negative impact of CVD on quality of life is well established and the optimization of management strategies is an important area of evolving research. Management of CVD has rapidly evolved over the last two decades with the development of minimally invasive endovenous ablative techniques, now the mainstay of treatment. We discuss the data supporting various methods of CVD treatment with an emphasis on the impact on patient comfort and quality of life. Both radiofrequency ablation (RFA) and endovenous laser therapy (EVLA) are excellent options for treatment of lower extremity venous disease, but RFA is associated with less post-procedure discomfort. Ultrasound-guided foam therapy is best reserved for the adjuvant setting or for patients ineligible for RFA or EVLA.

Evaluation of chronic inflammation in the aetiology of venous insufficiency by investigating cytomegalovirus DNA.

IntroductionLower extremity venous insufficiency is a significant health problem with economic and sociological consequences, lowering the quality of life, and sometimes leading to serious complications. The aim of this study is to evaluate the cytomegalovirus (CMV) effect on chronic inflammation in the aetiology of chronic venous insufficiency.Material and methodsBetween November 2017 and August 2018, 468 patients who underwent radio-frequency ablation therapy and phlebectomy were included in the study. PCR analyses for CMV DNA were performed on the venous tissue samples. Patients with post-thrombotic syndrome were excluded from the study. After ethical approval, the relationship between the presence of CMV DNA, gender, body mass index, and bilaterality of chronic venous insufficiency were investigated.ResultsWhen the relationship between CMV DNA and gender or body mass index was examined, a significant relationship was not detected. But when the patients with bilateral chronic venous insufficiency and patients with unilateral chronic venous insufficiency were compared regarding CMV DNA positivity, the patients with bilateral chronic venous insufficiency had significantly higher CMV DNA positivity (p = 0.002). Also, the incidence of venous ulcers in the CMV DNA exposed group was significantly higher.ConclusionsIn the literature there are many studies showing that CMV triggers atherosclerosis, but there is no study in which CMV directly produces chronic venous insufficiency. The high rates of positivity suggest that CMV, which is the basis of chronic inflammation, may be a significant factor in the aetiology of chronic venous insufficiency.