Lower Limb Varicose Research Articles

Preliminary experience with a 1470 nm diode ring laser with echosclerotherapy in lower limb varicose veins

Objective：To study the effect of endovenous laser ablation (EVLA) of lower limb varicose veins using a 1470 nm diode ring laser with ultrasound-guided foam sclerotherapy (UGFS), also known as echosclerotherapy. Methods：From January 2020 to December 2022, 236 patients with primary lower limb varicose veins were enrolled in the study. All patients were treated with 1470 nm diode ring laser with echosclerotherapy in our center. Under tumescent anesthesia, venipuncture of the great saphenous vein (GSV) trunk was performed, followed by 1470 nm laser therapy (80-100J/10W). Before the procedure, 1% polidocanol foam was injected into the insufficient collateral veins extending from the main trunk of the GSV. During the 3days after surgery, self-adhesive elastic bandage was used for compression therapy. After 3 days of surgery, grade II compression stockings was used for 1 month. All patients underwent a follow-up duplex Doppler ultrasound 1, 30 days after the procedure. Hospital stay time, postoperative pain, GSV occlusion rate, recurrence rateand complications, such as ecchymosis, edema, paresthesia and endovenous heat-induced thrombosis (EHIT). Results: Four patients were lost to follow up. The average hospitalization time was 2.8 days, the average admission time after operation was 1-2 days. The average operating time was 45.79 ± 8.57min. At the one month follow up all treated GSV remained occluded. There were 2 patients were treated with echosclerotherapy in outpatient because of new reflux in the treated collateral veins. Seventy-five percent of patients did not have any pain after the treatment and ninety-one point eight percent of ones did not take any analgesic tablets at any time after the procedure. No severe complications such as deep venous thrombosis could be detected. And there was no patient developed EHIT after treatment. Minor complications were ecchymosis at 15.1%, edema at 44.8%, and paresthesia around ankle at 0, respectively. All patients expressed satisfaction with the operative curative effects and cosmetic effects. Conclusion: EVLA with 1470-nm diode ring laser with echosclerotherapy in lower limb varicose veins is comfortable with less incision, hospitalization procedure and is a safe and efficient treatment option.

Diagnosis and Management of Pelvic Venous Disorders in Females.

Pelvic venous pathologies in females are responsible for chronic symptoms grouped under the term pelvic congestion syndrome, which includes chronic pelvic pain, perineal heaviness, urgency, and postcoital pain, along with vulvar, perineal, and lower limb varicose veins. These conditions are also associated with ovarian and pelvic venous reflux and venous obstruction. This review aimed to explore the clinical and imaging modalities for diagnosing pelvic congestion syndrome, pelvic venous pathologies, their therapeutic management, and their outcomes.

FEATURES OF EXPRESSION OF GROWTH MEDIATORS AND MATRIX METALLOPROTEINASES AT THE LOCAL LEVEL IN PATIENTS WITH LOWER LIMB VARICOSE VEINS, CLINICAL CLASS C4 - C6

The purpose of the research was to study the features of the expression of growth mediators and matrix metalloproteinases in patients with lower limb varicose veins, clinical classes C4-C6. The study included 98 patients. The control group consisted of 102 healthy donors. The levels of VEGF, PDGF, matrix metalloproteinases (MMP-2, MMP-9), superoxide dismutase, and prolidase were studied. The average value of VEGF in pathologically altered vein (PAV) wall samples was 40.1 ± 6.2 ng/g of protein and was statistically significantly higher - 1.7 times compared with the same value in persons from CG 2 (23.0 ± 5.9 ng/g protein, p=0.001). Patients with lower limb varicose veins (LLVV) showed an inverse correlation between VEGF levels and SOD activity in blood plasma and PAV (r=-0.52; p=0.002 and r=-0.59; p=0.001, respectively). An increase in the level of PDGF correlated with an increase in the oxidative stress index (OSI) in the blood plasma and the PAV wall (r=0.59; p=0.022 and r=0.61; p<0.001). In patients with LLVV, a high level of MMP-9 inversely correlated with the total oxidant capacity (TAC) in blood plasma and in the varicose vein wall (r=-0.48; p<0.001 and r=-0.52; p=0.012). In patients with LLVV, there were statistically significant relationships between prolidase activity and OSI and TAC values ​​in the PAV wall (r=0.62; p=0.003 and r=-0.59; p<0.001). It has been established that VEGF, PDGF, MMPs play a key role in the LLVV pathogenesis; the dynamics of these indicators can be used to predict the effectiveness of surgical treatment and the risk of recurrence.

Operative therapy of lower extremity varicose vein disease in women with pelvic congestion syndrome

Background: Approximately a third of women of fertile age suffer from chronic pelvic pain. 20% of gynecological encounters are associated with this exact problem. Within the structure of reasons of chronic pelvic pain pelvic vein incompetence (pelvic congestion syndrome) takes up to 30%, however, patients are correctly diagnosed only in 2–4% of the cases. Operative treatment helps solve the problem completely, but high disease reoccurrence and post-surgery complications rate remain relevant. Materials and Methods: 62 women with lower limb varicose vein disease aged from 22 to 48, including 20 women diagnosed with pelvic congestion, were examined and assigned into two groups (main group – 32, comparison group – 30). The main group was applied operative therapy based on the developed method of insufficient communicant vein dissection and, in case of pelvic congestion, – surgical intervention aiming at its elimination. Assessment of the result was conducted through the determination of post-surgery complications and with the varicose vein disease severity (VCSS) method. The aim: To decrease the frequency of the lower limb varicose vein disease reoccurrence after operative therapy of the pathology.

Assessment of endovenous microwave catheter ablation in the treatment of primary lower limb varicose veins

Background: Lower limbs varicose veins are common in the adult population, The CEAP classification is a conventional way of staging varicose vein disease.Traditional treatment is surgery, which involves disconnection of sapheno-femoral and/or sapheno-opopliteal junctions with or without stripping of the superficial axial vein. the endovenous ablation is now the most widely used procedure and approximately occlusion rate of 95%. the Endovenous ablation techniques is Endovenous Microwave Ablation (EMA) which works by generating radio-frequency energy. It generates radiofrequency energy with the MICROTAZE OT-110 M machine. Aim: The aim of this study is using endovenous microwave ablation as a new technique in treatment of lower limb varicose veins according to the results, advantages, disadvantages and complications. Subjects and Methods: This study was conducted on 30 patients with varicose veins of lower limbs. It was conducted in the department of vascular surgery, Al- Azhar University Hospitals – Cairo (Al-Hussein and and said-Galal Hospitals). After taking a written consent, patients were subjected to Clinical evaluation and Duplex Ultrasound. Results: over weighted and patients with 30-50 years were the most. A statistically significant improvement was observed in AVVQ at different follow-up intervals.

Comparative study between using of radio frequency ablation and endovenous laser ablation in the treatment of primary lower limb varicose veins

Background: Varicose veins are a frequent vascular issue. Radiofrequency ablation (RFA) and Endo-venous laser ablation (EVLA) are endo-venous treatments for varicose veins. Endo-venous therapy demonstrated superior outcomes than standard high ligation and stripping in terms of pain, quality of life, healing, and recurrence. The RFA and ELA surpass vein stripping in morbidity, outcome, and neovascularization (recurrence), which is attributed for greater recurrence rates. Aim: We aim to compare between using of radio frequency ablation and endo-venous laser ablation in the treatment of primary lower limb varicose veins as regard to complications, treatment failure,recurrence. Methods: This prospective randomized controlled study was conducted in the vascular surgery department at Al-Azhar university hospitals (Al-Hussein and Sayed Galal), in the period from September 2020 to June 2022 (20 months). The study included 50 patients, males were 22(44%) while females were 28(56%), Presented by primary varicose veins. Results: In EVLA group Recanalization of short-segment occlusion was done in 4 patients, Recanalization of long-segment occlusion was done in 2 patients and recurrent varicose veins happened in 5 patients.

Experimental Substantiation of the Use of HIFU Technology in the Treatment of the Lower Limb Varicose Disease

Experimental Substantiation of the Use of HIFU Technology in the Treatment of the Lower Limb Varicose Disease

Effect of undifferentiated connective tissue dysplasia on clinical course of varicose disease and thrombophlebitis of varicose veins after crossectomy

Objective: to analyze the features of clinical course of lower limb varicose vein disease and acute thrombophlebitis of varicose veins for the patients with undifferentiated connective tissue dysplasia (UCTD) after crossectomy. Materials and Methods. The prospective clinical cohort study involved 132 female patients with varicose disease who underwent crossectomy, of which 67 patients with dysplasia were included into the main group, whereas patients without dysplasia were included into the control group. Examination of patients and ultrasound scanning of leg veins were conducted in 3, 6, 12, and 36 months. The Cox regression analysis was used to assess the effect of dysplasia on the risk of developing thrombophlebitis of varicose veins. Results. The progress of varicose disease clinical manifestations of after crossectomy was detected in 57 (85.1%) female patients with dysplasia and in 14 (21.5%) without it (р=0.002), which resulted in phlebectomy. The recurrent thrombophlebitis of varicose veins was found in 22 (32.8%) female patients with dysplasia vs. 5 (7.7%) without it (р=0.002). Cox regression model Exp (B), which characterizes the predicted change of risks for dysplasia, was 4.216 (95% CI 1.595-11.147). Conclusion. The clinical course of varicose disease in patients with UCTD is characterized by the progression of clinical manifestations of chronic venous insufficiency of a lower limb. UCTD results in over 4.2-fold risk of developing the recurrent thrombophlebitis of varicose veins after crossectomy.

Comparative study between Surgical Stripping and Foam Sclerotherapy in management of lower limb varicose Veins

Comparative study between Surgical Stripping and Foam Sclerotherapy in management of lower limb varicose Veins

One-year duplex ultrasound-assessed closure outcomes of percutaneous endovenous microwave ablation for the treatment of varicose veins of the lower limbs.

This study aims to investigate the safety and efficacy of a new device using microwave technology for the endovenous ablation of the great saphenous vein (GSV) causing symptomatic lower limb varicose veins (LLVV). This prospective, single-arm, single-center, cohort study investigated the safety and effectiveness of endovenous microwave ablation for the treatment of symptomatic LLVV. Enrollment period was set between January and December 2020. Primary safety endpoint was the occurrence of procedure-related complications and primary efficacy endpoint was anatomical success defined as the duplex ultrasound (DUS)-proven GSV occlusion at 1year follow-up. Secondary endpoints included 1-year clinical success (CEAP classification improvement), repeat procedures rate due to GSV recanalization, and pain assessment at 24h post treatment. In total, 50 patients (42 female; mean age: 62 ± 12years) with 64 limbs were treated. No procedure-related complications were noted. Technical success was 95.3% (61/64 GSVs), as three cases of GSV recanalization were detected. Clinical success was 100%, as in all cases symptoms improvement by at least one grade according to CEAP classification, was achieved. Mean CEAP grade significantly improved from 3.3 ± 0.72 (median: 3) at baseline to 1.8 ± 0.85 (median: 2) at 1-year (p < 0.0001). There were no repeat procedures due to GSC recanalization. The median 24-h VAS value was 2 (mean: 1.9 ± 1.4). Endovenous microwave ablation was safe and effective for the treatment of varicose veins, achieving high 1-year GSV occlusion rates.

Fatal haemorrhage from a lower limb varicose vein rupture: two case reports

BackgroundChronic venous disease is one of the most prevalent pathologies today. In Portugal, as in other western countries, its prevalence is high, affecting around 35% of the adult population. It is a chronic and progressive condition that, despite generally benign, may course with major complications, like severe bleeding.Case presentationWe present the cases of a 47-year-old man and of an 82-year-old woman, with chronic venous disease and obesity, whose deaths occurred from lower limb varicose vein rupture. The gathered circumstantial information, the presence of large amounts of blood on the bodies’ surfaces and clothes, and malleolus ulcers agree with the fatalities reported in scientific literature.ConclusionsThese cases are peculiar, both from a forensic pathology and from a clinical perspective. We want to raise awareness among the medical community about this major complication that is linked with a disease commonly perceived as benign, but that can result in a medical emergency. We also underline the importance of educating patients to this possible outcome.

Evaluation of Efficacy of Endovenous Radio Frequency Ablation for Varicose Veins in Industrial Workers—A Prospective Study

AbstractIntroduction The disease of varicose veins is a common vascular condition affecting one out of five in world population. Although conventional surgical treatments were considered the gold standard, they were fraught with many complications. Endovenous thermal interventions like endovenous radio frequency ablation (RFA) have largely superseded traditional surgery as the gold standard treatment as it is minimally invasive. Our initial experience with this treatment modality is presented along with the review of literature.Aim Our aim was to evaluate the efficacy, safety, clinical outcomes, and health economic benefits of endovenous RFA for varicose veins in our setup.Materials and Methods It was a prospective observational study conducted by the Department of General surgery at ESIC Medical College and Hospital, Hyderabad, India, from September 2020 to February 2021. Thirty consecutive patients with primary varicose veins were evaluated by detailed history, clinical examination, and venous Doppler study of the lower limbs. The procedure was performed under spinal anesthesia and Doppler ultrasound guidance using the ClosureFast (Medtronic) radio frequency segmental ablation system. Additionally, multiple stab phlebectomies were performed to deal with tributary varices in required cases. Various intraoperative (length of vein ablated and operative time) and postoperative (complications and return to work) variables were studied. Postoperative follow-up at 1,8,24 weeks was done clinically and using Doppler ultrasound to look for the recanalization of vein. The collected data were entered in Microsoft Excel spreadsheet and analyzed using descriptive statistics.Results The mean (standard deviation) age of patients was 39.1 (8.7) years. Ten patients had C2 disease, six C3, eleven C4, and three had C6 disease. The mean postoperative visual analog scale score on day 1 was 1.4. Mean return to normal activity time was 1.3 days. Average return to work time was 2.1 days. The post-procedure total occlusion rate at 24 weeks follow-up was 96%.Conclusion Endovenous RFA is a safe and effective minimally invasive modality for treating lower limb varicose veins, providing health economic benefits to patients.

Clinical Assessment of Endovenous Thermal Ablation Combined With Concomitant Phlebectomy for the Treatment of Lower Limb Varicose Veins With or Without Poor Glycemic Control

In this study of >500 patients, with 33% classified as having diabetes, varicose vein treatment with thermal ablation and stab phlebectomy was safe and effective, regardless of glycemic control. This study retrospectively evaluated 501 patients treated for unilateral symptomatic varicose veins with combined thermal ablation and stab phlebectomy. Of the cohort, 164 (33%) had had a diagnosis of type 2 diabetes mellitus. These patients were further subdivided into those with good glycemic control (hemoglobin A1c [HbA1c] <7%; n = 93) and those with poor glycemic control (HbA1c ≥7%; n = 71). All the patients were followed up for 1 year, and the venous clinical severity score was used before and after the procedure. The group demographics were comparable expect for the greater occurrence of venous ulcerations, C6 disease, in the poor glycemic control group. All the patients, with and without good glycemic control, had had good outcomes in terms of edema and pain improvement, ulcer healing, and quality of life parameters. Venous surgeons clearly must weigh the benefits and risks of performing interventions on patients with diabetes and poor glycemic control. These patients have a much higher risk of less than satisfactory outcomes, cardiac and anesthetic complications, and infection. In my practice, I would be turning cartwheels if my patients were able to maintain a HbA1c of <7%, which is not even the most desirable rate of control. For patients with venous ulcerations, any improvement in the anti-inflammatory state caused by diabetes can only aid in the healing process. I am left wondering about the measurement and accuracy of the glycemic control in this study. Were measurements of HbA1c performed, revealing changes in glycemic control that could have influenced the outcomes, or was the HbA1c only measured at the intervention? What level of HbA1c was considered prohibitive? Were the glycemic levels more difficult to control to begin with for the venous ulcer patients with diabetes as a direct result of the ulcer? Finally, was this an older group with more longstanding diabetes and the resulting inflammation and oxidative stress?

Blood Flow Analysis of the Great Saphenous Vein in the Su-Pine Position in Clinical Manifestations of Varicose Veins of Different Severities: Application of Phase-Contrast Magnetic Resonance Imaging Data.

The progression of clinical manifestations of lower-limb varicose veins remains unclear. This study investigated changes in lower-limb venous blood flow using phase-contrast magnetic resonance angiography. Data were collected on veins from 141 legs. We compared legs with and without varicose veins and related symptoms and examined varying levels of varicose vein symptom severity. Legs without varicose veins exhibited a lower absolute stroke volume (ASV, p < 0.01) and mean flux (MF, p = 0.03) for the great saphenous vein (GSV) compared with legs with symptomatic varicose veins. Legs with asymptomatic varicose veins exhibited lower MF for the GSV (p = 0.02) compared with legs with symptomatic varicose veins. Among legs with varicose veins, asymptomatic legs exhibited lower ASV (p = 0.03) and MF (p = 0.046) for the GSV compared with legs that exhibited skin changes or ulcers; however, no significant differences were observed between legs presenting with discomfort or edema and legs with skin changes or ulcers, and between legs presenting with discomfort or edema and asymptomatic legs. In conclusion, in the supine position, increased blood flow rate and blood flow volume in the GSV were associated with symptomatic varicose veins and increased symptom severity.

Direct Fluoroscopic-Guided Sclerotherapy for Vulvoperineal Varices: An Experience in 70 Patients

Abstract Purpose The aim of this study was to assess the safety and effectiveness of percutaneous vulvoperineal varices sclerotherapy using 2% polidocanol foam under fluoroscopic guidance. Subjects and Methods This is a retrospective review of prospectively collected data of 70 patients treated between June 2020 and November 2021, with a mean age of 31 years (range: 24–42 years). All patients were not pregnant with residual vulvoperineal varices after embolization of their refluxing tributaries of the ovarian vein and/or internal iliac veins presenting with vulvoperineal heaviness/pain with or without lower limb varicosities. Technical and clinical successes together with procedural complications were assessed. Results The technical success rate was 100%. No minor or major complications have been reported. Follow-up was at 1 week, 2 weeks, 6 months, and 12 months post sclerotherapy. Clinical success was observed in all patients with improvement in their symptoms. Conclusion Direct fluoroscopic-guided sclerotherapy for vulvoperineal varices offers a safe and effective treatment option with the ability of visualization and embolization of the pelvic leak points to avoid recurrence.

Thromboprophylaxis in lower limb varicose vein surgery in Brazil.

Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.

Protocol for prophylaxis of venous thromboembolism in varicose vein surgery of the lower limbs.

Pulmonary embolism is the most feared complication of venous thromboembolism (VTE) and the third leading cause of cardiovascular mortality in the world, after acute myocardial infarction and stroke. The risk of VTE is virtually universal in hospitalized patients, especially those with reduced mobility. Although variable in incidence between clinical and surgical patients, up to 66.6% of events related to hospitalizations can occur after discharge, with this risk remaining for up to 90 days. Despite all the investment made in VTE prophylaxis in recent decades, there is still no consensus or specific guidelines for its prevention in patients undergoing conventional surgery for varicose veins of lower limbs. The adoption of a validated risk assessment model for VTE prophylaxis, based on the current literature, may help in the implementation and standardization of VTE prophylaxis in conventional lower limb varicose vein surgery, in addition to this benefit, it may lead to a reduction in the length of hospital stay and the number of readmissions.

Ultrasonic semiotics of lower limb varicose disease in railway transport workers

Ultrasonic semiotics of lower limb varicose disease in railway transport workers

Опыт применения симультанных операций у больных с варикозной болезнью и грыжами передней брюшной стенки

Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.

Estimation of enzyme catalytic activity in bioptates of lower limb varicose deformed veins depending on the severity of chronic venous insufficiency

Estimation of enzyme catalytic activity in bioptates of lower limb varicose deformed veins depending on the severity of chronic venous insufficiency