Lower Limb Varicose Veins Research Articles

Ultrasound Guided Foam Sclerotherapy of Lower Limb Varicose Veins: Outcome and Patient Satisfaction

Ultrasound Guided Foam Sclerotherapy of Lower Limb Varicose Veins: Outcome and Patient Satisfaction

Prevalence of foot varicose veins in hairdressers and some related factors in Gonabad

Introduction: Physical postures at work and occupational conditions are among the important risk factors that increase the prevalence of varicose veins. These include prolonged standing and tedious postures that are unavoidable in the hairdressing profession. This study aimed to investigate the relationship between the prevalence of foot varicose veins and occupational and demographic factors in hairdressers. Materials and Methods: This cross-sectional-correlational study was conducted on 90 hairdressers in Gonabad in 2015. The participants were selected using a random method. After completing the demographic information questionnaire, the samples were examined according to CEAP criteria (clinical findings, etiology, anatomical findings, and pathophysiology). The collected data were analyzed using Chi-square, Fisher, and independent t-tests using SPSS software version 20 at a significance level of p <0.05. Results: Out of 90 patients, 45 were male, and 45 were female, and (77.8%) had an average working time of more than 6 hours. Most of the men (51.1%) and women (53.3%) had varicose veins of the lower extremities of both limbs. The relationship between varicose veins of hairdressers and education (P = 0.031), work experience (P = 0.043), regular exercise (p = 0.012), smoking (P = 0.009) was significant. Conclusion: The present study results indicate the high prevalence of lower limb varicose veins in hairdressers. This disorder causes many mental and physical disorders and ultimately affects the individual's work efficiency, so controlling risk factors and preventing this complication in hairdressers seems necessary.

Prospective Clinical Study of Varicose Vein

Context: The varicose vein is a common chronic peripheral vascular disease affecting the lower limbs. They have significant impact on the quality of life. Even though considerable advances in understanding venous pathophysiology and modern imaging techniques have revolutionized the lower limb varicosity management, whether these inferences hold good for our population is a pertinent question. Aims: To evaluate the clinical presentation and surgical outcome of management of varicose vein. Settings and Design: Prospective observational study. Methods and Material: Prospectively patients with symptoms and signs of varicose vein are evaluated. Precise proforma used to collect patient's demographic details, clinical features, and investigation reports; during the study from August 2016 to November 2018. Statistical analysis used: univariate analysis, percentages. Results: This study includes 132 patients, seventytwo (54.54%) are males, and sixty (45.45%) are females. In this study, varicose veins are commonly seen in the 40–50yr's age, and the right limb was affected in 51.38% than the left limb 88 (48.62%). The incompetence of the Saphenofemoral junction valve is seen in 24 (13.26%) patients, saphenopopliteal Valve incompetent in 17 (9.39%) patients & below knee perforator in 32 (17.67%) patients. Twenty-one out (15.90 %) of one thirty-two had a complication in our study; the commonest was surgical site infection in twelve (7.2%) patients. Conclusions: The varicose veins of lower limbs are a disease of the all-age adult group, common in fourth and fifth decades of life. Patients usually presents with complications rather than the disease itself. The wound infection is the common postoperative complication. Keywords: Flush Ligation; Saphenofemoral junction; Perforators; Varicose vein; Venous disease. Key Messages: Management of varicose vein is technology driven, Good results can be achieved by proper selection of patients and appropriate procedures.

Clinical Features and Surgical Management of Varicose veins of Lower limbs

Introduction: Varicose veins are a common clinical condition affecting the lower limbs. Usually patient comes for a cosmetic problem, it can cause complications giving rise to significant morbidity if not treated in time. Different options are available for surgical management. The present study has been carried out to study demographic factors, evaluate clinical presentation and outcome of various modalities of management of varicose veins of lower limb. Material and Methods: This is a prospective, descriptive and observational study conducted at Department of General Surgery, Pt. Jawahar Lal Nehru Government Medical College and Hospital Chamba Himachal Pradesh. Seventy cases admitted and operated from all the surgical units during the period of 2018 April to September 2019 were studied. All the patients presenting with varicose veins of lower limb, which met the inclusion and exclusion criteria were selected for this study. Results: In our study, maximum number of patients were in 18-30 years and predominant were male. In this series, 37 patients had varicosity in the left lower limb and 29 had varicosity in the right lower limb and the remaining 4 had bilateral limb involvement. Among them prominent veins and pain were the main complain in 56 (80%) patients. Itching and pigmentation were present in 6 (8.5%) patients. Ankle edema was present in 5 (7.1%) patients. Pain and ulceration of lower leg were present in 3 (4.2%) patients. Out of 70 cases studied, 32 (45.7%) had only long saphenous vein, 10 (14.3%) had short saphenous vein and in 9 (12.8%) cases both short and long saphenous were involved. In addition to long saphenous vein, incompetent perforators were present in 19 (27.2%) cases. Conclusion: Varicose veins are commonly seen in males, maximum in the age group of 18-30 years. Most common presenting symptom is visible dilated veins over lower limb but more than half of the patients present with one or more complications. Most commonly venous system involved is great saphenous vein system and most commonly involved perforators are below knee perforators. If cases are selected properly with good operative technique the complications are negligible. This surgical procedure followed enable the patients to lead almost a normal life.

Long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose

Objective: To examine the long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose. Methods: The clinic data of 185 patients with varicose veins of lower limbs treated with radiofrequency closure admitted at Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University from July 2016 to January 2017 was analyzed retrospectively. A total of 203 limbs were treated by radiofrequency closure. The long-term efficacy of radiofrequency closure was evaluated by analyzing the closure rate, clinical-etiology- anatomy-pathophysiology (CEAP) grading, venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ) score, and complications, using repeated measures analysis of variance. Results: All procedures were successful. The closure rate was 98.0% (199/203) at one year and two years postoperative, which was still maintained at 97.5% (198/203) at 3 years of follow-up. Postoperative CEAP grading was significantly downgraded compared with that before the operation. Totally 88.4% (76/86) of C5 to C6 grade patients downgraded to C2 to C4 grade at 6 months, and 95.3% (82/86) downgraded to C0 to C2 garde at 3 years postoperative. VCSS and CIVIQ score in both groups significantly improved at all follow-up time points compared to preoperative scores (VCSS: F=1 064.7, P=0.003; CIVIQ score: F=2 984.3, P=0.001). The most common complication was subcutaneous blood stasis (10.8%), most of which disappeared within 1 month after the surgery. Other complications included pigmentation and thrombophlebitis (5.9% and 3.9%, respectively). Conclusion: The long-term efficacy of radiofrequency closure of the great saphenous vein is satisfactory.

Nonnegligible causes of symptoms of acute lower extremities\u2014\u20143 cases of May-Thurner syndrome with deep vein thrombosis

BackgroundMay-Thurner syndrome is a kind of disease caused by the compression of the left common iliac vein. It is one of the causes of incomplete venous valves and superficial varicose veins in lower limbs, and is also a potential factor of acute deep vein thrombosis (DVT).MethodHere 3 cases are diagnosed as May-Thurner syndrome at different ages.Case presentations1. A 35-year-old female patient was hospitalized with swelling of the left lower limb for 1 week. Computed tomography (CT) showed compression of the left common iliac vein with thrombosis. May-Thurner syndrome was diagnosed and catheter-directed thrombolysis was performed. 2. A 37-year-old male patient came to our hospital due to sudden swelling of the right lower extremity and pain for 3 days. Computed tomography showed compression of the left common iliac vein and deep venous thrombosis (DVT) of the right iliac vein. May-Thurner syndrome was diagnosed. The patient was performed with inferior vena cava (IVC) filter implantation, catheter-directed thrombolysis and balloon angioplasty for right iliac vein. And the patient recovered well; 3. A 55-year-old female patient came to our hospital with swelling and discomfort in the left lower extremity for 3 days. Computed tomography showed stenosis of the left common iliac vein with deep vein thrombosis. May-Thurner syndrome was diagnosed, balloon dilation and stent implantation were performed. During 3 years of follow-up, there was no swelling or new thrombosis in her lower limbs.ConclusionWhen encountering unexplained deep vein thrombosis, iliac vein compression syndrome should be considered and treated in time to prevent the recurrence of thrombosis. Catheter-directed thrombolysis can relieve symptoms and stenting placement is the optimal way to relieve stenosis, supplemented by long-term anticoagulation therapy and graduated compression stockings.

A COMPARATIVE STUDY OF TRENDELENBURG OPERATION AND TRENDELENBURG OPERATION COMBINED WITH STRIPPING OF LONG SAPHENOUS VEIN IN THE TREATMENT OF PRIMARY VARICOSE VEINS OF LOWER LIMB

Aims And Objectives: To compare the effectiveness, incidence of complications and recurrence after Trendelenburg operation and Trendelenburg operation combined with stripping of the thigh segment of long saphenous vein in the treatment of primary varicose veins of lower limb. Study is based on analysis Material & Methods: of 100 cases of primary varicose veins of long saphenous vein with or without perforator incompetence who got treated by either simple ligation or ligation with stripping of long saphenous vein from at Department of General Surgery, Osmania General Hospital, Hyderabad Telangana. After surgery residual long Results: saphenous vein reux was present in 22% cases in the group in which ligation alone was done and residual thigh perforators were identied in 11% of cases whereas in the group which underwent ligation combined with stripping of the thigh segment of long saphenous vein residual reux was present in 6% cases and no residual thigh perforators were identied. The i Conclusion: ncidence of Residual long saphenous vein reex and residual perforator in the thigh is less after ligation and stripping of long saphenous vein compared to Ligation of Saphenofemoral junction alone. The incidence of Nerve palsy and bleeding and hematoma is also not more in the ligation + stripping group compared to ligation alone.

Construction of integral index for comprehensive assessment and analysis of risk factors for lower limb varicose veins during pregnancy

Objective. To develop a model of an integral index for complex assessment of varicose vein risk factors and estimate the influence of pregnancy on the occurrence of chronic vein diseases. Varicose veins (VV) and chronic venous insufficiency are one of the most widespread human diseases. This pathology in pregnancy has a clear picture, which is quite different from varicose veins in non-pregnant women.
 Materials and methods. Analysis of 1974 individual medical cards of pregnant women and puerperas of Maternity Hospital № 2 for the period of 20162019 was carried out. Out of them, 456 cards had a diagnosis of varicose veins of the lower limbs. The method was based on statistical analysis and integral indices.
 Results. The following risk diapasons were determined: low risk (favorable prognosis) 0.440.85; medium risk (favorable prognosis is possible) 0.861.28; high risk (unfavorable prognosis) 1.292.13. The quantity of pregnancies is not an unfavorable prognosis for women. Long statistical loads give unfavorable prognosis (1.341.43); family predisposition is an unfavorable prognosis (1.66); lifting loads depending on the quantity in grams (1000 favorable sign; 500010 000 unfavorable (1.211.870)); wearing tight clothes is not an unfavorable prognosis (0.88); hypodynamia medium risk (1.14); diet low and medium risk (0.750.95), obesity high risk (1.242.15).
 Conclusions. The obtained results permitted to detect the most significant risk factors for varicose veins during pregnancy. Medium and high-risk indices are the following: long statistical loads, family predisposition, lifting loads, hypodynamia, diet and obesity. They influence the development of varicose veins. There is a possibility to present a prospective prognosis for pregnant women and develop a complex of measures to decrease risks for chronic vein diseases taking into account individual features of patients.

Transforming growth factor-β1 and inducible nitric oxide synthase signaling were involved in effects of prostaglandin E2 on progression of lower limb varicose veins

ObjectiveThe vital pathogenesis of varicose veins includes remodeling of the extracellular matrix and decreased vascular tone. Prostaglandin E2 (PGE2), a small molecule substance and inflammatory medium that belongs to the arachidonic acid derivatives, has the capacity to influence the expression of metalloproteinase and the vascular tone of the venous wall. The purpose of the present study was to investigate the role of PGE2 in the development of varicose veins in lower limbs. MethodsThe collected venous specimens were analyzed using hematoxylin and eosin, Masson's trichrome, and immunohistochemical staining. Transforming growth factor (TGF)-β1, PGE2, CD31, and α-smooth muscle actin antibody were used to detect the expression and distribution of these proteins. The effect of PGE2 on the proliferation, migration, and tube formation capacity of human umbilical vein endothelial cells (HUVECs) was detected in vitro. The effect of TGF-β1 on the expression of PGE2 and matrix metalloproteinases (MMPs) was assessed using Western blotting. Quantitative reverse transcription polymerase chain reaction was used to evaluate the effect of PGE2 on the expression of nitric oxide synthase (NOS) and other genes. ResultsThe expression of PGE2 and TGF-β1 in varicose veins was upregulated in the media tunica and intima tunica, and a strong positive correlation was found between PGE2 and TGF-β1 expression in both varicose veins (95% confidence interval, 0.5207-0.9582; R = 0.848; P = .0005) and normal veins (95% confidence interval, 0.2530-0.8532; R = 0.643; P = .003). PGE2 promoted the migration and tube formation ability of HUVECs. Moreover, PGE2 also upregulated the expression of MMP-1 and TGF-β1 in HUVECs and increased the mRNA level of inducible NOS. ConclusionsPGE2 can affect the remodeling of the extracellular matrix and reduce the elasticity of the vascular walls by promoting the synthesis of TGF-β1 and MMP-1. PGE2 can also reduce the tension of the great saphenous vein by promoting the expression of inducible NOS, thus aggravating the blood stasis.

Endovenous radiofrequency for chronic superficial venous insufficiency: Clinical outcomes and impact in quality of life.

Endovenous treatment of lower limb varicose veins is progressively replacing conventional surgery. The authors are investigating radiofrequency (RFA) results in terms of vein occlusion, complications, patient's satisfaction and quality of life in a single centre. A retrospective analysis of medical charts with a prospective follow-up was performed on data about patients undergoing RFA for insufficiency of great saphenous vein (GSV). A total number of 135 patients (164 limbs) (63% n 85 female; 37% n 50 male; mean age of 53.9 years, range 24-85 years; mean VCSS score (Venous Clinical Severity Score) 6, range 4-22) were included. Complete obliteration of GSV was obtained in 98.2% of the cases. No device- or procedure-related adverse events occurred. No deep venous thromboses, pulmonary embolism, phlebitis, major bleeding, paraesthesia nor skin burn were detected. Patients returned to normal activities in a mean of 8 days (range 5-10). One-month postoperatively, the mean quality of life scores 6 (range 5-9) and mean satisfaction score was 6 (range 4-8) in a scale from 0 to 8. At a median follow-up of 11 months (range 2-18), mean VCSS was 3.9 (range 2-8). Radiofrequency guarantees good functional outcomes and low rate of complications. It is associated with high satisfaction rate and quality of life score.

Comparative efficacy of various methods of treatment of chronic venous oedema in real clinical practice

The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins. We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2). Due to paucity of the participants, from the subsequent analysis we excluded the groups MPFF + endovasal laser coagulation, patients not receiving MPFF (n=16) and MPFF + topical treatment. All further statistical data are shown for the remaining 687 patients. Comparing the groups of patients undergoing conservative treatment alone and those subjected to surgical intervention demonstrated no statistically significant differences in dynamics of crural oedema. In both groups at every subsequent visit there was a statistically significant decrease in the ankle volume (p<0.001). During the whole period of follow up the crural volume in patients from the group of conservative treatment totally decreased by 0.201±0.158 L and in the operated patients by 0.236±0.189 L (p=0.021). The QOL assessed by the CIVIQ-14 global index score statistically significantly improved in the unoperated patients from 31.5±19.2 to 12.0±10.1 (p<0.001). In the operated patients, the baseline and final values of the QOL of the global index score amounted to 33.4±17.8 and 7.7±9.2, respectively (p<0.001). In the groups with and without topical treatment, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 28.5±17.4 and 36.2±18.6, respectively. During the follow-up period, we observed statistically significant positive dynamics of all parameters of quality of life. The final visit demonstrated improvement of the CIVIQ-14 global index score to 9.4±9.2 in patients without topical treatment and 10.1±10.4 in those receiving topical treatment (p=0.367), with the mean value of this parameter during treatment in both groups decreased significantly (p<0.001). A statistically significant decrease in the ankle volume in both groups was registered at every visit, finally amounting to 0.223±0.166 L and 0.248±0.174 L (p=0.118) for patients not receiving and receiving topical treatment, respectively. In groups of patients not receiving and those receiving compression therapy, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 21.4±14.2 and 33.1±18.5 (p<0.001), respectively. At the final visit, these indices statistically significantly (p<0.001) decreased to 7.3±9.1 and 9.9±9.9 (p=0.106). Compared with the baseline values, the ankle volume at the final visit in groups of patients with and without compression therapy statistically significantly decreased by 0.187±0.14 L and 0.238±0.17 L respectively (p=0.204). During the study, there were no adverse events related to the administration of MPFF and use of Detragel. MPFF and Detragel appear to be effective and safe components of comprehensive conservative therapy of chronic oedema induced by primary varicose veins of lower extremities.

Ultrasound color duplex parameters of patients presenting with lower limb varicose veins at outpatient department of university hospital of Nepal

Background: Varicose vein is prominent dilated veins of lower limbs. Incomplete treatment and local recurrence are still the clinical challenge among the vascular surgeons. We aim to evaluate the range of imaging on color duplex describing the anatomy of veins, their variants, valve competencies, territories of defective venous system, demographic data, and the factors contributing among the patients referred to Vascular Outpatient Department of Kathmandu University Hospital. Objective: The aim was to know the ultrasound (US) color duplex parameters of superficial venous system in varicose vein. Materials and Methods: We included 299 patients during the study of 6 months with varicose veins for detailed US Doppler analysis. Gray-scale US was done to study the anatomy of veins followed by color duplex and color duplex spectrometry to determine the reflux of the superficial venous system. Quantification of reflux was determined by the use of Valsalva maneuver. Association of great saphenous vein (GSV) cross-sectional diameter and saphenofemoral junction incompetence was also studied. Results: Of 299 varicose vein cases, 52.50% were female. Among involved cases, the mean of GSV diameter was 5.43 mm in the right and 5.68 mm in the left. Saphenofemoral junction diameter was 7.89 mm in the right and 8.17 mm in the left. Receiver operative characteristics curve showed GSV diameter at femoral condyl of 4.5 mm as best cutoff value for the diagnosis saphenofemoral junction reflux. Conclusions: US color duplex is investigation of choice for varicose vein as a preoperative analysis tool, quantifying the superficial valve incompetency, studying and mapping the venous anatomy, and planning the surgery.

VARICOSE VEINS STAGE DOWN BEFORE SURGERY

Background: For many people, varicose veins and spider veins are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems. Objective: To evaluate the effect of staging down of the lower limb varicose veins by injection sclerotherapy before surgical treatment in comparison with the standard procedure. Patients and Methods: Included 40 patients, aged 25–42 years (Range), who were recruited from the outpatient clinic of the Department of Vascular Surgery, Al-Hussein University Hospital. All patients were followed up monthly for 6 months. The duration of the study had been from 6 to 12 months from July 2018 to July 2019. Patients were divided into 2 groups: group I: In this group patients with varicose veins were treated stage down before surgery and control group: This was an age and sex matched group of patients with the first group. The clinical and hemodynamic assessments were carried on. Duplex ultrasound was done at the end of follow up period to detect the degree of improvement. Results: Mean duration of varicose veins was 3.0 ±0.2 with a range of (1.5-5) years. Varicose veins were distributed in leg in 50% of group I and 70% of group II. Median baseline anatomical extent of varicose veins was 5 and 6 in group I and II respectively with range of 4-9. As regard symptoms, aching was present in 5% of cases,, heaviness was in 5%, itching in 10% of cases, cosmetic concerns was in 5%, swelling in 0% of cases. Regarding post intervention complications, pain was present in 15% of cases, swelling in 5%, bruising in 10% of cases, and discoloration in 0%, and pigmentation in 10% of cases. As regard comparison of the two groups regarding the patient satisfaction score, 40% of cases were highly satisfied in group one, compared with 25% of cases of group II. There was a high significant improvement of anatomical extent of varicose veins over 6 months follow up period. Conclusion: Sclerotherapy before surgical treatment provided symptomatic relief and significant improvements and patient satisfaction in patients diagnosed with uncomplicated varicose veins.

Endovenous laser ablation of lower limb varicose veins: report of results in proximal and distal routes

Amaç:Bu çalışmanın amacı izole variköz küçük safen ven tanısı alan ve endovenöz lazer ablasyon uygulanan hastalarda vasküler giriş yolunun (proksimal veya distal) postoperatif ağrı üzerine olan etkilerini değerlendirmektir. Hastalar ve Yöntem:Çalışma varisli safen ven tanış alan 49 hastanın (35 kadın, 14 erkek) tıbbi dosyaları kullanılarak yapıldı. Endovenöz lazer ablasyonu 1470 nm emisyon dalga boyunda lazer enerjisi kullanılarak gerçekleştirildi. Ağrının değerlendirilmesi görsel analog skala kullanılarak 7., 1., 3. ve 6. aylarda yapıldı. Bulgular:Kırk dokuz hastadan 30\'unda küçük safen veninin dizaltı distal kesiminden ve 19\'unda da küçük safen venin proksimalinden giriş yapıldı. Bu iki grubun sonuçları variköz venin proksimal geniş olan kısmından erişilebilmesinin, variköz venlerin endovenöz lazer ablasyon tedavisinde azalmış lokal ağrı skorları ile kolay bir yol sağladığını göstermiştir (p <0.001). Sonuç:İzole variköz küçük safen ven tanısı alan ve endovenöz lazer ablasyon uygulanan hastalarda vasküler giriş yolunun (proksimal veya distal) postoperatif ağrı üzerine anlamlı bir etkisi olmasa da, proksimal giriş yolunun daha kolay erişildiği ve bu yolla işlemin daha kısa sürdüğü görülmüştür.

Lower Limb Varicose Veins's Clinical Profile and Management

The lower limbs’ venous system has the pressure of posture, and blood has to be pushed against gravity into the heart cavity. This issue is generally approached either by a cautious approach or by surgical interference, all of which are constrained. Attempts to study different clinical manifestations of varicose veins are being made in the present study. The overall number of 50 varicose vein patients was analysed and the study results were reported. Varicosity veins of the lower limb is a fairly normal pathological entity. In the 20-50 age range, the condition is more common. The main modality of the procedure is surgery. The most common technique performed is Saphenofemoral flush ligation with stripping.

Russian register of acute pulmonary embolism SIRENA: characteristics of patients and in-hospital treatment

Aim. To assess the features of diagnosis, treatment and outcomes of pulmonary embolism (PE) in patients of Russian hospitals.Material and methods. The register included all hospitalized patients with PE identified by any diagnostic method. Duration of inclusion was 12 months. In-hospital period management was assessed. Information about the included patients was provided by 20 hospitals from 15 Russian cities.Results. For the period from April 15, 2018 to April 15, 2019, 609 patients were included in the register (women — 50,7%, mean age — 63,0±14,5 years, minimum-maximum — 19-94 years). Among the known risk factors for PE, the most common were lower limb varicose veins (31,4%), heart failure (23,3%), previous deep vein thrombosis (19,4%), cancer (17,1%). The median time from symptom onset to suspicion/confirmation of PE was 4 days (1-3 quartiles — 1-8 days). Shortness of breath, syncope/presyncope, chest pain/discomfort, cough, leg pain or lower extremity asymmetry and hemoptysis were noted in 88,7%, 30,0%, 29,8%, 17,3%, 9,4% and 8,5% of patients, respectively. Echocardiography was performed in 89,5%, and Doppler ultrasound of lower limb veins — in 85,9% of patients. Signs of venous thrombosis were found in 57,8% of patients. Computed tomographic (CT) pulmonary angiography was performed in 89,2% of patients, pulmonary scintigraphy and pulmonary angiography — 0,8% each.Conclusion. Symptoms and main risk factors for PE in Russian patients did not fundamentally differ from those previously known. There was good adherence to modern guidelines for the diagnosis of PE, but adherence to guidelines on drug therapy met requirements only in half of the cases. There was an excessive use of TLT, as well as the use of ineffective methods of administering and monitoring anticoagulant therapy.In total, imaging technologies were used in 90,6% of patients, and signs confirming PE were found in 92,7%. Thrombolytic therapy (TLT) was performed in 25,0%; 92,0% of patients received anticoagulants. At the same time, unfractionated heparin (UFH) was injected subcutaneously in 26,3% of cases, and in one third of patients the drug was injected in doses unadjusted by body weight. In 42,7% of patients received UFH, the target activated partial thromboplastin time was not achieved. With warfarin treatment, the target international normalized ratio was achieved in only 48,4% of patients. Inferior vena cava filter placement and thrombectomy were performed in 1,3% each. During hospitalization (median — 11 days), 9,9% of patients died.

Using radiofrequency ablation for the treatment of lower limb varicose veins

Lower limb chronic venous insufficiency is a commonly seen disease which accounted for 40.5% of people over the age of 50 years old with females having 4.25 higher prevalence compared with males [23]. The lesions could be observed in superficial, perforating, deep veins or all three venous systems in the lower extremities [2]. Superficial veins in particular could be classified in 3 groups: chronic venous insufficiency, varicose veins, and thrombophlebitis. The treatment options of lower limb chronic venous insufficiency in general and chronic venous insufficiency – varicose veins are grouped in two major categories: medication/intervention and surgery. Since 1980s-1990s, endovascular interventions for the treatment of superficial venous insufficiency – varicose veins were introduced and were the new advancement in the treatment of lower limb venous insufficiency disorders [3, 7, 11, 12, 16] .

LASER Versus Mechanochemical Ablation in Treatment of Primary Varicose Vein of Lower Limb

Background: Endovenous thermal techniques, such as endovenous laser ablation [EVLA], are the recommended treatment for varicose veins. Non-thermal techniques such as Mechanochemical ablation [MOCA] have potential benefits. Aim of the work: To compare EVLA with MOCA in the treatment of primary varicose vein of the lower limb. Patients and Methods: 40 patients who had primary great saphenous varicose veins [VV] admitted at the Vascular Surgery Department, Al-Azhar University Hospital, New Damietta, Egypt. They randomized into two equal groups each one included 20 patients group [1] treated by EVLA and group [2] treated by MOCA. Results: The time of operation of studied patients ranged from 22 to 44 minutes, and there a statistically significant decrease in time of group 2 compared to group 1. [25.36±1.80 vs. 37.30±2.47 respectively]. Postoperative pain in studied patients ranged from 0 [no pain] to 7 [severe pain], there statistically significant decrease in pain of group 2 compared to group 1. As regard to induration, it was reported in 4 patients, representing 20% of group 1 [4] patients, were significant differences between groups 1 and 2 [20% vs. 0% respectively]. At the end of the sixth month postoperatively, as regard complete occlusion of the great saphenous vein [GSV] vein, there was statistically no significant difference between group 2 when compared to group 1 [92.5% vs. 95% respectively]. Conclusions: MOCA was associated with better results on short-term follow-up.

Clinical features and socio-demography of varicose veins of lower limbs

Background: Varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. Objective: to study the clinical features and socio-demography of varicose veins of lower limbs. Setting: This was a prospective study involving 40 patients who presented with signs and symptoms of primary varicose veins to CG hospital and Bapuji hospital attached to J.J.M. Medical College, Davangere during June 2009 to May 2011. Result: The commonest age group of over patients was between 31 to 40 yrs (27.5 %.). 33 were male and 07 were female. Right limb was more affected 19 cases (47.5%) than left limb 17 cases (42.5%). In 4 of the cases (10%), both the limbs were involved. 5 patients had family history of similar complaints (12.5%). Our patients presented with varied symptoms, out of which dilated veins was most common 37 (92.5%) patients followed by aching pain 22 patients (55%). Long saphenous system is the most common venous system affected by varicosity (64.7%). A greater portion of the patients had combined valvular incompetence (60%). The most common was the above ankle group with 24 followed by below knee with 21 cases. Conclusion: It was concluded that varicosity of the lower limb is a fairly common clinical entity. Disease is prevalent in the young adult and middle aged individuals (21-40 years). The most common presenting symptom was dilated veins followed by aching pain.

Ultrasound-guided percutaneous injection of foam sclerotherapy in management of lower limb varicose veins (pilot study)

BackgroundMinimally invasive procedures; like ultrasound-guided percutaneous injection of foam sclerotherapy (USGFS) are being the keystone methods in managing lower limb varicose veins and its complications, being advantageable over the surgery as being minimally invasive with better postoperative comfort and immediate cosmetic effect and faster return to full socioeconomic activity. Varicose veins are common problem that affects the quality of life and have a significant cost burden on the health care system. Sclerotherapy (endovenous chemical ablation) destructs the endothelium to induce inflammation and fibrosis and then occlusion of the blood vessel lumen.ResultsThe study included 33 diseased limbs of females (64.7%) and 18 (35.3 %) limbs of males. Of the diseased limbs, 16 (31.3%) presented with disfigurement, 14 (27.4%) with pain, 11 (19.6%) with heaviness, 6 (11.7%) with edema, and 4 (7.8%) with non-healed venous ulcer. Twenty-six (50.9%) diseased limbs show competent sapheno-femoral junction (SFJ) while 25 (49.1%) limbs showed SFJ reflux of variant degrees. All patients underwent direct ultrasound-guided foam sclerotherapy either as the primary therapy in 29 (56.9%) limbs or as a complementary therapy for residual perforators and varicosities after treatment with other methods of treatment like laser ablation and phlebograph in 22 (43.1%) limbs. Nine (17.6%) limbs treated with 2% polidocanol (Pol.) and 42 (82.3%) limbs with 3% Pol. In the 2nd session Doppler follow-up, 35 (68.6%) limbs showed complete occlusion while 13 (25.5%) limbs showed partial occlusion, while in the 3rd session Doppler follow-up, 3 (5.9%) limbs still show partial occlusion while 45 (88.2%) limbs showed complete occlusion and no recanalization. Forty (78.4%) limbs addressed marked symptomatic relief while 5 (9.8%) limbs moderate relief and 3 (5.9%) cases with mild relief and the other 3 (5.9%) cases missed follow-up. Twenty-five (49%) limbs had no complications while 23 (45%) limbs had different local complications ranging from pain, hyperpigmentation, and superficial thrombophlebitis. Also, we find a statistically significant correlation between the Pol. concentration injected and the symptomatic relief and Doppler US follow-up while there is a borderline correlation between the Pol. concentration injected and the detected complications.ConclusionsThe preliminary results revealed ultrasound-guide foam sclerotherapy is an effective and safe treatment for lower limb varicose veins. The concentration of polidocanol injected could be correlated significantly with the symptoms improvement and borderline correlation to the complication rate.