Lower Limb Varicose Veins Research Articles

Progress and Current Status of Treatment for Lower Limb Varicose Veins

Varicose veins of lower extremities are common venous diseases of lower extremities in clinic [1]. The total number of patients with varicose veins of lower extremities in China has exceeded 100 million, and the incidence rate is about 15% [2]. Therefore, there is a huge number of illnesses and a demand for surgical treatment. At present, the main treatment options for lower limb varicose veins include conservative treatment and surgical treatment. Surgical treatment methods include traditional surgery and minimally invasive surgery. The high ligation and stripping of the great saphenous vein has always been the gold standard for the treatment of lower limb varicose veins. This method is technically mature and clinically effective, but it is a destructive surgery that uses a stripping device to forcefully pull. Therefore, the intraoperative trauma is large, the amount of bleeding is high, and a series of postoperative complications such as hidden nerve damage, subcutaneous congestion, incision bleeding, deep vein thrombosis, etc. are prone to occur. With the increasing demand for skin aesthetics and reducing postoperative complications, minimally invasive surgery has gradually been applied to the treatment of lower limb varicose veins, such as intracavitary laser ablation, intracavitary radiofrequency ablation, Tri Vex minimally invasive rotary cutting, hemodynamic correction, etc. [3]. This article provides a review of the current main treatment methods for lower limb varicose veins, in order to further understand and master the principles and application scope of each treatment method, and to better select personalized treatment plans for varicose vein patients in the future.

Enhancing diabetic foot ulcer prediction with machine learning: A focus on Localized examinations

Backgrounddiabetices foot ulcer (DFU) are serious complications. It is crucial to detect and diagnose DFU early in order to provide timely treatment, improve patient quality of life, and avoid the social and economic consequences. Machine learning techniques can help identify risk factors associated with DFU development. ObjectiveThe aim of this study was to establish correlations between clinical and biochemical risk factors of DFU through local foot examinations based on the construction of predictive models using automated machine learning techniques. MethodsThe input dataset consisted of 566 diabetes cases and 50 DFU risk factors, including 9 local foot examinations. 340 patients with Class 0 labeling (low-risk DFU), 226 patients with Class 1 labeling (high-risk DFU). To divide the training group (consisting of 453 cases) and the validation group (consisting of 113 cases), as well as preprocess the data and develop a prediction model, a Monte Carlo cross-validation approach was employed. Furthermore, potential high-risk factors were analyzed using various algorithms, including Bayesian BYS, Multi-Gaussian Weighted Classifier (MGWC), Support Vector Machine (SVM), and Random Forest Classifier (RF). A three-layer machine learning training was constructed, and model performance was estimated using a Confusion Matrix. The top 30 ranking feature variables were ultimately determined. To reinforce the robustness and generalizability of the predictive model, an independent dataset comprising 248 cases was employed for external validation. This validation process evaluated the model's applicability and reliability across diverse populations and clinical settings. Importantly, the external dataset required no additional tuning or adjustment of parameters, enabling an unbiased assessment of the model's generalizability and its capacity to predict the risk of DFU. ResultsThe ensemble learning method outperformed individual classifiers in various performance evaluation metrics. Based on the ROC analysis, the AUC of the AutoML model for assessing diabetic foot risk was 88.48 % (74.44–97.83 %). Other results were found to be as follows: 87.23 % (63.33 %–100.00 %) for sensitivity, 87.43 % (70.00 %–100.00 %) for specificity, 87.33 % (76.66 %–95.00 %) for accuracy, 87.69 % (75.00 %–100.00 %) for positive predictive value, and 87.70 % (71.79 %–100.00 %) for negative predictive value. In addition to traditional DFU risk factors such as cardiovascular disorders, peripheral artery disease, and neurological damage, we identified new risk factors such as lower limb varicose veins, history of cerebral infarction, blood urea nitrogen, GFR (Glomerular Filtration Rate), and type of diabetes that may be related to the development of DFU. In the external validation set of 158 samples, originating from an initial 248 with exclusions due to missing labels or features, the model still exhibited strong predictive accuracy. The AUC score of 0.762 indicated a strong discriminatory capability of the model. Furthermore, the Sensitivity and Specificity values provided insights into the model's ability to correctly identify both DFU cases and non-cases, respectively. ConclusionThe predictive model, developed through AutoML and grounded in local foot examinations, has proven to be a robust and practical instrument for the screening, prediction, and diagnosis of DFU risk. This model not only aids medical practitioners in the identification of potential DFU cases but also plays a pivotal role in mitigating the progression towards adverse outcomes. And the recent successful external validation of our DFU risk prediction model marks a crucial advancement, indicating its readiness for clinical application. This validation reinforces the model's efficacy as an accessible and reliable tool for early DFU risk assessment, thereby facilitating prompt intervention strategies and enhancing overall patient outcomes.

The Efficacy of Radiofrequency Ablation for the Treatment of Symptomatic Varicose Veins of Lower Limbs.

Radiofrequency ablation (RFA) is a minimally invasive treatment for lower limb varicose veins. Studies indicate that RFA results in immediate occlusion of 90%-100% of treated long saphenous veins. Evidence suggests that post-operative scans rarely alter patient management or outcomes. The aim of this study was to assess the potential necessity of routine postoperative scanning in the treatment of varicose veins. Retrospective data were collected for the patients who had RFA under a single consultant from November 2015 to June 2018. Descriptive statistics were calculated to summarize patient demographics, procedural details, and outcome measures. A total of 124 patients underwent radiofrequency ablation (RFA). Most of the patients (n = 114, 92%) demonstrated complete ablation, indicating a high success rate for the procedure. This study suggested that routine postoperative scanning should be discontinued as this did not alter patient management in over 99% of cases. The resources currently used for postoperative scans could be redirected towards other critical areas.

Safety and efficacy of endovenous microwave ablation for treatment of varicose veins of the lower limbs in China: A prospective registered clinical trial.

This study aimed to investigate the safety and efficacy of a new Chinese device using microwave ablation for treating symptomatic great saphenous vein (GSV) varicose veins (VVs). This prospective, single-arm, single-center, cohort study investigated the safety and efficacy of endovenous microwave ablation for the treatment of symptomatic VVs. A total of 50 patients with lower limb varicose veins were enrolled from the Hospital of Chengdu University of Traditional Chinese Medicine. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The primary outcome was the occlusion rate of GSV immediately and at 1, 6, and 12 months after the treatment. The secondary outcomes included the venous clinical severity score (VCSS), the chronic venous insufficiency questionnaire 14 items (CIVIQ-14) score, the Aberdeen varicose vein questionnaire (AVVQ) score, and the pain visual analog scale (VAS) score. This study protocol was registered at ClinicalTrials.gov (ID: NCT04645771). In total, 50 limbs from 50 patients (26 female; mean age: 53.45 ± 9.78 years) were treated. A technical success rate of 100% was achieved and no serious adverse events were recorded. During the follow-up period, the occlusion rate of the major/minor saphenous vein trunk remained 100% at 1, 6, and 12 months after surgery except one patient fell off. The median 24-h VAS value was 2 (2,3). The VCSS score, CIVIQ-14 score, and AVVQ score (p < .05) at 1, 6, and 12 months improved significantly compared with the value preoperative (p < .05). EMA was safe and effective for treating varicose veins in the lower limbs, with a high rate of venous trunk occlusion and few complications, thus improving patients' postoperative quality of life.

Predictive factors for iliac vein compression syndrome in patients with varicose veins.

This study aimed to identify predictors of iliac vein compression syndrome (IVCS) in patients with varicose veins and to evaluate the necessity of routine lower extremity venography for preoperative assessment of these patients. A retrospective analysis was conducted on data from 1165 patients with lower-limb varicose veins who underwent preoperative venography at Wuhan Union Hospital, Tongji Medical College, China, between January 2019 and September 2023. Logistic regression analyses identified factors associated with concurrent IVCS, and a nomogram was constructed based on these findings. Out of 1165 patients, 75 (6.4%) had IVCS according to venography and 769 had iliac vein ultrasound and found 2 (0.17%) positives. Multivariate analysis revealed the independent predictive value of left-sided involvement (odds ratio (OR) = 3.22, 95% confidence interval (CI): 1.24-8.33, p = 0.016), history of deep vein thrombosis (DVT) in the affected limb (OR = 3.11, 95% CI: 1.21-8.00, p = 0.018), pain (OR = 2.24, 95% CI: 1.17-4.26, p = 0.014), and positive results on iliac vein ultrasound (OR = 25.56, 95% CI: 2.10-311.26, p = 0.011) for the presence of IVCS in patients with lower-limb varicose veins. A nomogram incorporating these predictors demonstrated moderate predictive ability (AUV = 0.689, 95% CI: 0.607-0.771), with good calibration upon validation. Patients with left lower extremity varicose veins, pain symptoms, history of DVT in the affected limb, and positive iliac vein ultrasound findings are at a higher risk of concurrent IVCS. Patients with varicose veins who have the aforementioned risk factors may need to undergo preoperative angiography.

Pregnancy outcomes in patients with undifferentiated connective tissue disease: An observational cohort prospective study

Background. Undifferentiated connective tissue disease is the subject of research in a large number of medical specialties, as it leads to an aggravated course of various diseases. In the presence of this pathology during pregnancy, the incidence of such complications as preeclampsia, gestational diabetes, and placental abruption increases. Failure to carry a pregnancy to term can be associated with various causes, including the activity of myocytes, while the pathology in question involves the connective tissue of the uterus. In this connection, it seems necessary to study the impact of undifferentiated connective tissue disease on pregnancy outcomes in order to administer timely treatment.Objectives. To assess how undifferentiated connective tissue disease affects the risk of failure to carry a pregnancy to term.Methods. An observational cohort prospective study was conducted among pregnant women who were under antenatal care in 2021–2022. The study was performed at the premises of the Clinical Maternity Hospital of Minsk Region (Republic of Belarus). The patients were divided into two groups: an exposed group comprising 59 patients with diagnosed undifferentiated connective tissue disease and a nonexposed group comprising 59 patients without this pathology. Both groups were divided into subgroups according to the obstetric outcome. The exposed group included a subgroup of 17 undifferentiated connective tissue disease patients who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 42 undifferentiated connective tissue disease patients with delivery at term. The nonexposed group included a subgroup of five women without undifferentiated connective tissue disease who had failed to carry pregnancy to term (miscarriage and preterm labor) and a subgroup of 54 women without undifferentiated connective tissue disease and with delivery at term. According to ICD-10, abortive outcomes occurred before 21 weeks and six days gestation; labor that occurred at 22–36 weeks and six days gestation was considered preterm, whereas in the case of delivery at term, the baby was born at 37–41 weeks and six days gestation. The obstetric, gynecological, and somatic history, as well as pregnancy outcomes, were analyzed. Statistical processing of data was performed using the following software: Statistica 12.0 (StatSoft, USA), Microsoft Excel 2016, Epi InfoTM 7.2.6.0 (USA), and MedCalc 15.8 (MedCalc Software, Belgium). In hypothesis testing, differences were considered statistically significant at p &lt; 0.05.Results. In the group of undifferentiated connective tissue disease patients, metrorrhagia was statistically significantly more common than in the patients without undifferentiated connective tissue disease: 18 out of 59 (30.5 %) and six out of 59 (10.2 %), respectively, p = 0.012. The obstetric history revealed no statistically significant intergroup differences, p &gt; 0.05. In the undifferentiated connective tissue disease patients, the following diseases were statistically significantly more common: myopia, spinal scoliosis, lower limb varicose veins, chronic tonsillitis, mitral valve prolapse, and iron deficiency anemia (p &lt; 0.05). The incidence of new cases of failure to carry a pregnancy to term in the cohort during the observation period amounted to 18.6 % for the patients in both groups. The pregnancy ended prematurely in 17 out of the 59 undifferentiated connective tissue disease patients (28.8 %) and in five out of the 59 patients without undifferentiated connective tissue disease (8.5 %), relative risk of 3.4 (95 % CI:1.3–8.6), p = 0.005.Conclusion. Undifferentiated connective tissue disease increases the risk of failure to carry a pregnancy to term by 3.4 times. Timely diagnosis and treatment of undifferentiated connective tissue disease at the stage of preconception preparation can reduce the incidence of failure to carry a pregnancy to term.

Haemodynamic study of left nonthrombotic iliac vein lesions: a preliminary report

Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (∆P) between the two ends of the stenotic segment and the velocity difference (∆V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms.

Comparison of one-year outcomes and quality of life between radiofrequency ablation and microwave ablation in the treatment of lower extremity varicose veins: A retrospective cohort study.

This study compared the outcomes of radiofrequency ablation (RFA) and microwave ablation (EMA) for treating lower limb varicose veins. Patients who underwent RFA (n = 240) or EMA (n = 209) at our institute from December 2020 to August 2022 were included in this retrospective investigation. Follow-up outcomes included active vein occlusion rate, Venous Clinical Severity Score (VCSS), the Aberdeen Varicose Vein Questionnaire (AVVQ), and Chronic Insufficiency Venous Quality of Life questionnaire-14 (CIVIQ-14)score. There was no significant difference in the active vein occlusion rate between the two groups after the operation (p > .05). Compared to pre-surgery scores, both groups showed substantial improvement in VCSS, AVVQ, and CIVIQ-14 scores(p < .05), there was no significant difference in these scores in either group (p > .05). Intravenous radiofrequency and microwave ablation effectively improve the quality of life for patients with lower limb varicose veins, with low post-operative complication and recurrence rates.

Comparative study between endovenous laser ablation (EVLA) with 1940 nm versus EVLA with 1470 nm for treatment of incompetent great saphenous vein and short saphenous vein: a randomized controlled trial

BackgroundTo date, the most commonly used endothermal ablation method is endovenous laser ablation (EVLA). The objective of this work is to assess the initial and short-term outcomes of a 1940 nm diode laser compared with 1470 nm diode laser utilization for the treatment of lower limb varicose veins. MethodsThis is a randomized controlled prospective study that included patients with varicose veins. The allocated patients were randomized according to the technique used: group I, which was treated using EVLA with a 1940 nm diode laser, and group II, which was treated using EVLA with a 1470 nm diode laser. ResultsThis study initially included 216 patients. After the exclusion of patients lost during follow-up, group I consisted of 105 patients, and group II consisted of 101 patients. There were high rates of anatomical success in the two groups with obliteration of the treated vessels at the 1-month follow-up (100% and 99%, respectively) and the 6-month follow-up (100% and 99%, respectively). A very low rate of adverse events was encountered (1%). Group II showed obviously longer median days to return for usual activities (11.5 compared with 7 days). They showed significantly higher pain scores, which was evident at the 7-day and 1-month follow-ups (P < .001). ConclusionsBoth lasers provided excellent outcomes in terms of anatomical success and low rates of adverse events. The 1940 nm diode laser was associated with lower median days to return for usual activities and significantly lower pain scores. Evidently, lower power and linear endovenous energy density were required for this laser.

The sex prevalence of lower limb varicose vein networks

ObjectiveTo determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination. MethodsWe scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, isolated perforator reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis. ResultsOverall, 1072 patients—252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)—were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). No significant sex differences regarding SSV reflux were detected. Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV−) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV− was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244). ConclusionsThe analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV− was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common.

Deep vein thrombosis after sclerotherapy and endovenous laser ablation of varicose veins - an observational study.

Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.

Quantitative evaluation of lower limb varicose veins using photoacoustic imaging

PurposeVaricose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively.MethodsNine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins.ResultsThe obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins.ConclusionPAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.

Enhancing patient comfort in varicose vein treatment through combined lidocaine and ropivacaine tumescent anesthesia.

To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities. This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance. There were no significant differences in age, body mass index, operative time, or blood loss among the three groups (P ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III (P < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III (P < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups (P ≥ 0.05). The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.

Mechanism of Bloodletting Puncture in Treating Varicose Vein of Lower Limb

Mechanism of Bloodletting Puncture in Treating Varicose Vein of Lower Limb

RISK FACTORS OF VARICOSE VEIN IN BLUE-COLLARED WORKERS OF GLODOK MAKMUR SHOPPING CENTRE JAKARTA

Varicose veins, apart from affecting daily activities such as walking, also impact aesthetics. Varicose veins are dilated veins characterized by the bulging of blood vessels. In Europe, varicose veins are experienced by 50% of the population, while in Indonesia, it is around 25-30% of the population. Although varicose veins have a low mortality rate, the discomfort, swelling, and hyperpigmentation they cause can progress to more complex health problems. This study aims to determine the risk factors for lower limbs varicose veins in blue-collar workers at the Glodok Makmur shopping centre Jakarta. A case-control design was used in this research. A total of 40 cases, namely male workers with lower limb varicose veins, and 40 controls, namely male workers without lower leg varicose veins, were selected using purposive sampling. Data from respondents were collected through questionnaires and analyzed using the Chi Square test with a significance of ? = 0.05. From the results of the analysis, it was found that lower limbs varicose veins had a significant relationship with high BMI (OR = 4.667, 95% CI = 1.507-14.455), dominant working position standing (OR = 7.071, 95% CI = 2.519-19.850), smoking habits (OR = 0.648, 95% CI = 0.503-3.018), and family history of varicose veins (OR = 6.000, 95% CI = 2.207-16.313). The results of this study indicate that high BMI, dominant working position standing, smoking habit, and family history of varicose veins are potential risk factors for the occurrence of lower leg varicose veins in blue-collar workers at the Glodok Makmur shopping centre Jakarta.

Radiofrequency ablation versus stripping of great saphenous vein in the management of varicose veins

Background: Varicose veins are defined as dilated, tortuous subdermal veins &gt;3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P&lt;0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group.

A comprehensive ultrasound approach to lower limb varicose veins and abdominal-pelvic connections

ObjectivePelvic venous reflux may be responsible for pelvic venous disorders and/or lower-limb (LL) varicose veins. Ultrasound investigation with Doppler allows a complete study of the entire infra-diaphragmatic venous reservoir. The aim of this study was to guide and standardize the investigation of the pelvic origin of venous reflux in female patients with LL varicose veins. MethodsIn this case-control study, we applied a comprehensive ultrasound investigation protocol, which involved four steps: (1) venous mapping of the lower limbs; (2) transperineal and vulvar approach; (3) transabdominal approach; and (4) transvaginal approach. ResultsForty-four patients in group 1 (patients with LL varicose veins and pelvic escape points [PEPs]) and 35 patients in group 2 (patients with LL varicose veins without PEPs [control group]) were studied, matched by age. The median age was 43 years in both groups. The calculated body mass index was lower in group 1 (23.4 kg/m2) compared with the control group (25.4 kg/m2), and this difference reached statistical significance (P < .001). The presence of pelvic varicose veins (PVs) by transvaginal ultrasound was 86% in group 1 and 31% in group 2. Perineal PEPs were the most prevalent, being found in 35 patients (79.5%), more frequent on the right (57.14%) than on the left (42.85%) and associated with bilateral PVs 65.7% of the time. In group 1, 23 patients (52%) reported recurrent varicose veins vs eight patients (23%) in the control group (P = .008). Regarding the complaint of dyspareunia, a significant difference was identified between the groups (P = .019), being reported in 10 (23%) patients in group 1 vs one patient (2.9%) in the control group. The median diameters in the transabdominal approach of the left gonadal veins were 6.70 mm for group 1 and 4.60 mm for group 2 (P < .001). In patients with PVs in group 1, the median diameter of PEPs at the trans-perineal window was 4.05 mm. In the transvaginal examination, the mean diameter of the veins in the peri uterine region was 8.71 mm on the left and 7.04 mm on the right. ConclusionsThe identification of PEPs by venous mapping demonstrates the pelvic origin of the reflux and its connections with the LL varicose veins. For a more adequate treatment plan, we suggest a complete investigation protocol based on the transabdominal and transvaginal study to rule out venous obstructions, thrombotic or not, and confirm the presence of varicose veins in the pelvic adnexal region.

Clinical Evaluation and Management of Varicose Veins of Lower Limb at a Tertiary Care Hospital in India

Objectives Varicose veins are defined as dilated, tortuous and elongated veins in the lower limbs. Being one of the most common chronic vascular disorders of the lower limb, the varicose veins affect approximately 10% of the population. If left untreated, the patient may end up with complications like ulceration. The present study is aimed at evaluating the demography, risk factors, clinical features and management of varicose vein patients attending the Department of General Surgery at a tertiary care hospital. Material and Methods This is a prospective observational study conducted at a tertiary care hospital involving patients with lower limb varicose veins. Demographic factors like age, gender, etiology, clinical features, site of incompetence, type of surgical procedure and postoperative complications were studied. Results Out of 74 patients, majority of them (47.2%) were between 41 and 50 years of age, with a predominance of males (51 cases). Analysis of the history of the patients showed that many were chronic alcoholics (72.9%) and chronic smokers (66.2%). Nearly, 91.8% of them presented with visible dilated veins and pain (60.8%) in the affected limb. The long saphenous vein was greatly involved, and majority of them were managed by saphenofemoral flush ligation + subfascial ligation of perforators (SFFL + SFLP) with minimal postoperative complications. Conclusion Varicosity of the veins of the lower limb is common in patients with long-standing jobs, chronic alcoholics and smokers. Involvement of the long saphenous vein is observed in majority of the patients. Duplex ultrasound is the most sensitive diagnostic procedure and surgery is the primary modality of the treatment.

The predictors of lower limbs varicose veins among healthcare providers.

Lower limb varicose veins (LLVVs) are a common problem that mostly occurs among healthcare professionals, especially nurses. While the direct cause of LLVVs is not known at present, its predictors have been identified in the literature. The objective of this study is to identify the predictors of LLVVs among nurses in Jordan. This cross-sectional descriptive study was carried out in Jordan in the period between August 2022 and December 2022. This study was carried out on 407 nurses. The participants were recruited in the study using convenience sampling. LLVVs and predictors were analyzed using binominal logistic regression. The percentage of having LLVVs was 30.7%. Results showed that having a family history of LLVVs and older age were significant predictors of developing LLVVs among both male and female nurses. For male nurses, longer shift hours were a significant independent predictor of developing LLVVs, where increased number of deliveries, less sitting time, and increased weight were significant independent predictors of developing LLVVs among female nurses. This study highlighted the predictors of LLVVs among nurses, which can be considered in improving the lifestyle and quality of life of nurses in the long term.

Endovenous laser ablation for saphenous veins and tributaries - the LEST technique.

Endovenous thermal ablation is now one of the most important techniques for treating chronic venous insufficiency. Technical refinements and technological innovations have made it possible to employ the method not only in the saphenous veins, but also to treat superficial veins such as varicose tributaries. We describe a technique for surgical treatment of varicose veins using endovenous laser thermal ablation employing multiple punctures and present the experience at our service with analysis of 601 cases operated using this technique. Thermoablative treatment of tributary veins with multiple puncture sites expands the applications for endolaser in treatment of lower limb varicose veins, providing, comprehensive, safe, and effective treatment.