Manifestations Of Chronic Venous Insufficiency Research Articles

Sulodexide in clinical practice: possibilities and prospects of its use

Objective: to analyze up-to-date information about the efficiency of using sulodexide n clinical practice. Current publication on the efficacy and safety of sulodexide, as well as information on the pathogenesis and clinical manifestations of chronic venous insufficiency, microvascular angina, venous thromboembolic events, and diabetes mellitus have been sought for and analyzed Most clinical trials show that sulodexide exerts anti-inflammatory, endothelium-protective, and pleotrophic effects, by confirming its potential efficacy in the treatment of cardiovascular diseases, in particular chronic vein diseases, microvascular anginas, and venous thromboembolic events. Sulodexide as an additional therapy is used to treat type 2 diabetes mellitus.

Stasis Dermatitis: The Burden of Disease, Diagnosis, and Treatment.

Stasis dermatitis (SD), an inflammatory dermatosis occurring on the lower extremities, is a cutaneous manifestation of chronic venous insufficiency (CVI). SD is associated with a significant burden of disease. Symptoms such as pain, swelling, and itching can be debilitating for patients, leading to poor sleep, loss of mobility, and the inability to perform daily activities, and can interfere with work and leisure activities. Moreover, SD is a progressive disease with serious secondary complications such as ulcerations, which increase the patients' morbidity, reduce their quality of life, and increase health care burden. Challenges in diagnosing patients may have both short- and long-term sequalae for the patients due to unnecessary treatment and management. In addition, misdiagnosis may result in hospitalizations, placing additional burden on health care professionals in terms of time and financial burden on the health care system. Compression therapy and leg elevation represent the mainstay of treatment for CVI; however, it is also difficult to self-manage, which places a substantial burden on patients and caregivers. Moreover, compression therapy may cause discomfort and exacerbate itching. Subsequent nonadherence may result in disease progression that places additional burden on the physicians who manage these patients and the health care system in terms of resources required and costs incurred. A large proportion of patients with SD develop allergic contact dermatitis because of innate immune signals and altered skin barrier predisposing to sensitization to topical prescriptions, over-the-counter medications, and compression devices used to treat SD. Other than topical corticosteroids, there are no approved pharmacological options to treat inflammation in SD.

Surgical Prevention of Thromboembolic Complications in Transfascial Thrombosis

The aim. To evaluate the effectiveness of surgical methods of prevention of venous thromboembolic complications in transfascial thrombosis of the lower extremities.
 Materials and methods. The paper analyzes the results of examination and surgical or conservative treatment of 417 patients with transfascial thrombosis treated at the Vascular Surgery Department of the Zakarpattia Regional Clinical Hospital named after A. Novak from 1995 to March 2020 and at the Surgical Department of the Central City Clinical Hospital of Uzhhorod from September 2020 to September 2022. The main (I) group consisted of 349 (83.7%) patients who were operated for transfascial thrombosis. The control (II) group consisted of 68 (16.3%) patients with transfascial thrombosis who received conservative treatment.
 Results. In case of acute varicothrombophlebitis complicated by transfascial thrombosis, the scope of surgery should be expanded in order to surgically prevent thromboembolism of the pulmonary artery. All the patients with transfascial thrombosis were treated as for deep vein thrombosis. The approach to the removal of the small saphenous vein should be differentiated depending on the extent of thrombotic occlusion and the confluence of the sural veins. Surgical treatment of patients with transfascial thrombosis made it possible to prevent recurrence of the thrombotic process in the superficial and deep veins of the lower extremities, thromboembolism of the pulmonary artery, while with conservative treatment their frequency was 5.1%, 3.4% and 3.4%, respectively. Active surgical tactics in patients of the I group made it possible to reduce the frequency of manifestations of decompensated chronic venous insufficiency from 27.1% to 7.0%, and manifestations of postthrombotic syndrome in the deep veins of the lower extremities from 100% to 3.7%.
 Conclusions. Implementation of operative treatment of acute varicothrombophlebitis complicated by transfascial thrombosis allows to effectively prevent venous thromboembolic complications, eliminate manifestations of chronic venous insufficiency and prevent the development of post-thrombotic changes in superficial and deep veins.

Varicose Ulcers Of The Lower Legs

Disorders that are often found in the lower extremities are vascular disorders. Varicose veins are very common, especially in women due to venous insufficiency due to poor blood circulation such as reflux and obstructive and can be inherited. The chronic phase of varicose veins can manifest as venous ulcers which is the development of wound below the knee. The lesions appear irregular in shape with clear boundaries, these ulcers can be prevented as early as possible by treating the trigger factor first before referring to the chronic direction. Physical examination is a medical process that must be undertaken when diagnosing a disease. The results are recorded in the medical record which is used to make a diagnosis and plan further treatment. Physical examination will be carried out systematically, starting from head to toe which is carried out in four ways, namely inspection, palpation, auscultation, and percussion. Varicose ulcers are a manifestation of chronic venous insufficiency. Patients with varicose ulcers have a history of varicose veins which, if treated, prevent the occurrence of varicose ulcers.

Significance of elevation of foot in management of varicose veins and its sequelae

Varicose veins are a severe clinical manifestation of chronic venous insufficiency [1] , prolonged standing / sitting causes blood to pool in veins of Lower limbs, there by increases the pressure in veins, then veins stretch from Increased pressure, these may weaken the walls of veins and damage the valves. CVI associated with Impaired blood flow leads to tissue congestion oedema and eventually impairement of tissue nutrition. In advanced venous insufficiency Impaired tissue nutrition can causes statis dermatits and development of varicose ulcer. If varicose ulcer is not treated properly, then it gets Infected leads to cellulitis and gangrene, may require amputation of part of limb. The present article deals with brief introduction regarding aetiopathogenesis of varicose veins and its sequelae related symptoms. The aim of writing article is to express the significance of elevation of foot in varicose veins and its sequelae.

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.

Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Clinical and instrumental associations of knee osteoarthrosis and pathology of the veins of the lower extremities

Knee osteoarthritis (OA) and varicose disease of the lower extremities (VD) are two diseases common in middle– aged and older women. Questions about whether their combination is accidental or natural and whether VD affects the course and severity of OA, remain unresolved.The aim of the study was to look for the possible association between knee OA and lower limb vein pathology on the basis of clinical and modern instrumental investigation sand to study the effect of the VD on the clinical manifestations and severity of knee OA.Materials and methods. A case-control study was conducted in 85 women 40–60 years old with knee OA diagnosed in accordance with the criteria of ACR (1986) and 50 women of the same age without signs of knee OA. Women of both groups were evaluated for complaints and objective examination with an emphasis on diseases of the joints and veins of the lower extremities, radiography of the knee joints, ultrasound duplex scanning of the veins of the lower extremities. The severity of OA was assessed by the Lequenne indices. The clinical assessment of venous pathology was carried out according to the CEAP classification.Results. Patients with knee OA more often than their peers without joint pathology have VD (43% vs 22%; p=0.015), signs of chronic venous insufficiency (28% vs 12%; p=0.03), as well as valve failure of several lower limb veins simultaneously (53% vs 20%; p=0.0004). After correction by body mass index, the association of knee OA with detected vascular pathology remained clinically and statistically significant. The presence of VD with moderate manifestations of chronic venous insufficiency, as well as ultrasound signs of venous pathology, was not associated with the clinical signs and course of knee OA.Conclusions. Knee OA in middle-aged and older women, regardless of body mass index, is associated with VD and ultrasound signs of simultaneous valves failure of several veins. Manifestations of chronic venous insufficiency did not affect the clinical picture and severity of knee OA.

Pleiotropic therapy for the initial stages of chronic venous insufficiency in post-thrombotic disease

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

Diagnosis of arteriovenous compression in small pelvic varicose veins

The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry. Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 - 4.5%, C1 - 60.6%, C2 - 27.2%, C3 - 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May-Thurner syndrome) was confirmed in 1 case only. In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.

Review of the plethysmographic methods for studying hemodynamic disorders in patients with chronic lower extremites venous diseases

Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.

Association between heel-rise test performance and clinical severity of chronic venous insufficiency.

Peripheral pump dysfunction is important in identifying manifestations of chronic venous insufficiency. The association with disease severity may define better treatment strategies. To evaluate the association between peripheral muscular pump performance by heel-rise test, age, physical activity, use of compression stockings, and chronic venous insufficiency clinical severity. Subjects with chronic venous insufficiency were enrolled in the study (n = 172) and evaluated by clinical-etiology-anatomy-pathophysiology severity and heel-rise test. In model 1 of logistic regression, number of heel-rise test repetitions, age, and physical activity explained 47% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), physical activity contributed the most. In model 2, heel-rise test repetition rate, age, and physical activity explained 46.4% of clinical-etiology-anatomy-pathophysiology severity (p = 0.0001), repetition rate contributed the most. Conclusion: There was an inverse association between muscular pump performance and physical activity with clinical-etiology-anatomy-pathophysiology severity, muscular pump repetition rate contributed to a less severe outcome.

Concomitant chronic venous insufficiency in patients with peripheral artery disease: insights from MR angiography

ObjectivesThe clinical presentation of peripheral artery disease (PAD) and chronic venous insufficiency (CVI) can overlap and the conditions may co-exist. The purpose of our study was to investigate the prevalence and clinical significance of concomitant CVI in patients with PAD examined with run-off MR angiography (MRA).MethodsWe analysed 180 patients (median age 69 years, range 27 to 91) with known or suspected PAD who underwent MRA at our institution between 2012 and 2018. MRA datasets were re-evaluated for manifestations of CVI. Electronic charts were reviewed to analyse whether diagnosis of CVI was documented and to determine Fontaine stage of PAD.ResultsEvidence of possible CVI on MRA was found in 38 (21%) patients. Only seven (18%) of these patients had a documented diagnosis of CVI. Patients with co-existing PAD and CVI were more likely obese (median BMI 29.7 vs. 26.3 kg/m2, p = 0.001) and diabetic (55 vs. 35%, p = 0.039) than patients without CVI. The frequency of concomitant CVI manifestations decreased from distal to proximal with the lower leg affected in all 38 patients and the thigh in 17 patients (45%). Patients with co-existing PAD and CVI were more likely to have a clinical diagnosis of stage IV PAD than patients without co-existing CVI (57% vs. 34%, relative risk 1.68, p = 0.018).ConclusionsSigns of possible concomitant CVI can be seen in approximately one-fifth of patients with known or suspected PAD examined with run-off MRA. If present, these findings should be reported since CVI may mimic or contribute to symptoms attributed to PAD.Key Points• In total, 21% of patients with PAD patients examined with MR angiography show signs of possible co-existing CVI.• Patients with co-existing CVI were 1.7-fold more likely to have a clinical diagnosis of stage IV PAD.• Our data also showed that co-existing chronic venous insufficiency is under-diagnosed in patients with PAD.

Chronic Venous Insufficiency and Post-thrombotic Syndrome; Approach to Management and Health Resort Treatment

Introduction: Post- thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT), and develops in 20–50% of patients after a proximal DVT. Balneotherapy and hydrotherapy is justified in treatment of primary or post-thrombotic chronic venous insufficiency (CVI). M aterial: A review of articles was done in electronic databases Pubmed and Medline by keywords: postthrombotic syndrome, chronic venous insufficiency in conjunction with balneotherapy, hydrotherapy, kinesitherapy, coagulation. Results: Main risk of PST is considered as extensive proximal character of DVT, pre-existing CVI, older age, high body mass index, pre-existent varicosities. PTS refers to clinical manifestations of CVI, and is common cause of unilateral CVI. The thrombus itself may lead to venous valves destruction and reflux. The Villalta PTS scale may define and classify the severity of PTS Venous leg ulcers is the most advanced clinical manifestation of the disease. Prevention of PTS begins with prevention of initial and recurrent DVT includes use of compression stockings and anticoagulant medications. Treatment guidelines recommend anticoagulant therapy - five days with heparin followed by three months of oral anticoagulant after acute event, with subsequent long-term of extended therapy depending on patient’s risk of recurrence. Recent clinical trials indicate that the use of new anticoagulants (NOAS) reduces the incidence of PTS. Ultrasound compression test of the leg veins evaluates the degree of obstruction by clots. Medical therapy of CVI has still not efficient. Carbon dioxide baths and ozone baths have favorably affect hemostasis system. However there are only a few controlled studies evaluating effects of balneotherapy in primary and post-thrombotic CVI. The favorable effect of these mineral baths may result from both hydrostatic effects as well as the contribution with specific chemico-physical properties. The controlled trials (in patients with C3 -C5 stage) shown that balneohydrotherapy and kinesitherapy have decreased signs and symptoms in patients with primary and post - thrombotic CVI. Conclusions: The Health Resort treatment of patients with CVI in the mechanism of post-thrombotic syndrome should be preceded by evaluation of the venous system of the lower limb by compression ultrasound. Balneotherapy and hydroteraphy seem to be effective and safe procedures even in patients with advanced primary and post-thrombotic CVI stage.

ОЦІНКА МІНІМАЛЬНОЇ ЕФЕКТИВНОЇ КОНЦЕНТРАЦІЇ ПІННОГО СКЛЕРОЗАНТУ ПРИ СКЛЕРТЕРАПІЇ ВАРИКОЗНО РОЗШИРЕНИХ ВЕН НИЖНІХ КІНЦІВОК

Хронічна венозна недостатність є широко розповсюдженою,глобальною проблемою і безперервно прогресує зі збільшенням віку. Актуальним єпитання лікування різних класів хронічної венозної недостатності. На сьогоднішнійдень із широким впровадженням апаратних методик та хімічних агентіврозпочалась ера мініінвазивних втручань, які конкурують з класичнимивенектоміями. Золотим стандартом лікування початкових проявів хронічноївенозної недостатності є склеротерапія. Вона використовувалася для лікуванняварикозного розширення вен з початку минулого сторіччя. У хімічній склеротерапіївикористовуються різні хімічні агенти, які, в першу чергу, сприяють пошкодженню,зневодненню і руйнуванню ендотеліальних клітин, що призводить до елімінації вени.Всі склерозанти представляють собою компроміс між ефективністю ітоксичністю. В науковому світі досі ведуться дискусії та недостатньо клінічнихданих стосовно оптимального вибору склерозанту та його концентрації. Метоюданого дослідження було вивчення патогістологічних змін стінки вени, які можутьбути викликані різною концентрацією пінних склерозантів, та дослідити основнінегативні побічні явища, які виникають у пацієнтів при лікуванні данимиконцентраціями склерозуючих речовин. В наше дослідження було включено 40хворих, які перебували на стаціонарному лікуванні в період з грудня 2017 по травень2019 рр. з приводу варикозно розширених магістральних підшкірних вен в поєднанні зретикулярниим варикозом або телеангіектазіями(С2 – С4a клас варикозу за СЕАРкласифікацією), хворим планувалось виконання відкритої венектомії з наступноюповторною склеротерапією у віддаленому періоді. Пацієнтів було рандомізовано на3 основні групи по 10 осіб, яким вводили найбільш розповсюджені концентраціїполідоканолу: 0,5%, 1 % та 3%. Група порівняння склала 10 осіб з аналогічноюпатологією. Полідоканол вводили у пінній формі за добу до оперативного втручання– венектомії. В ході венектомії попередньо марковані сегменти вен обережновидалялись та відправлялись на патогістологічне дослідження. Загальну оцінкупроводили за системою, яка відображала ступінь пошкодження стінки вени вбалах. Через три тижні після венектомії усім пацієнтам виконували склеротерапіюдрібних притоків великої підшкірної вени, використовуючи склерозанти тої жеконцентрації, що до оперативного втручання. Двічі проводили клінічну оцінкупісляпроцедурних негативних явищ: на другий день та через місяць. Результатидослідження підтверджують, що найменші зміни в судинній стінці викликаютьсяпри використанні 0,5% пінного полідоканолу, а найбільш виражені та глибокі зміни -дією 3% пінного полідоканолу, що супроводжується більшою кількістю негативнихпобічних явищ у післяпроцедурному періоді. Найбільш оптимальною для склерозаціївен діаметром 5-7 мм є 1% концентрація. При застосуванні даної концентраціївиникає достатнє пошкодження вени для її подальшої облітерації, яке не супроводжується такою кількістю негативних проявів, як більш високаконцентрація. Результати проведеного дослідження можуть бути корисними длялікарів – флебологів, які використовують склеротерапію для лікування початковихпрояві хронічної венозної недостатності.

A rare case of arteriovenous fistula formation in a patient with inferior vena cava thrombosis, successfully managed with endovascular recanalisation

Inferior vena cava (IVC) filters are recommended for patients with proximal deep vein thrombosis (DVT) who are not eligible for anticoagulation. Long-dwelling filters are well-known to be associated with the development of IVC thrombosis. Chronic caval occlusion can lead to a severe post-thrombotic syndrome (PTS), with manifestations of chronic venous insufficiency in the lower extremities. Animal studies have shown that post-thrombotic inflammation can trigger the development of an arteriovenous fistula (AVF), however, there is limited evidence for this phenomenon in patients with PTS. We describe the case of a spontaneous AVF in a patient with long-standing IVC thrombosis. It was postulated that the AVF could be compounding the venous hypertension and severe swelling of his lower extremities. The case additionally demonstrates the successful results of endovascular recanalisation for an occluded filter in the presence of an AVF.

Quantification of Early Cutaneous Manifestations of Chronic Venous Insufficiency by Automated Analysis of Photographic Images: Feasibility and Technical Considerations

Through the use of automated photographic analysis, early manifestations of chronic venous insufficiency (CVI), such as hemosiderin staining and corona phlebectatica, may be able to be assessed and quantified.

Hemodynamic influence of design parameters of novel venous valve prostheses

Abstract Venous ulcers of the lower limbs are one clinical manifestation of chronic venous insufficiency. Currently, there is no venous valve prosthesis available. This study presents novel venous valve prostheses made of threedimensional electrospun fibrous nonwoven leaflets. The aim of this study was to prove the feasibility of the manufacturing process as well as to investigate design features of the venous valve prostheses from a hemodynamic point of view. An adapted pulse duplicator system (ViVitrolabs, Victoria, BC, CA) was used for characterization of the hydrodynamic performance. For eight different venous valve prototypes flow rate, effective orifice area and regurgitation fraction was investigated in vitro. In particular, tricusp valve designs showed an up to 40% higher effective orifice area as well as 15% higher maximum flowrate compared to bicusp valve designs. However, the regurgitation fraction of the bicusp valve designs is up to 86% lower compared to tricusp valve. Additionally, the hemodynamic performance of the tricuspid valves showed a high sensitivity regarding the leaflet length. Bicuspid valves are less sensitive to changes of design parameters, more sufficient and therefore highly reliable.

A GENETIC STUDY OF PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY BASED ON CLINICAL AND GENEALOGICAL METHOD

Relevance. Practically 10-15 % of the world's population has varicose veins as a manifestation of chronic venous insufficiency. The clinical and genealogical method is the method allows to identify family cases of disease in patients with chronic venous insufficiency.
 Objective: to demonstrate the role of heredity in varicose disease, to analyze family cases of varicose disease, to determine the type of disease inheritance and to give a prediction of heredity for descendants, using the clinical and genealogical method.
 Materials and methods. The study involved 72 patients, mostly women – 46 (63.9 %) persons, with different classes of varicose veins according to the CEAP classification. To determine the type of inheritance we used clinical and genealogical method of pedigrees’ study. The nature of the trait – hereditary or non-hereditary disease; type of the inheritance – autosomal-dominant, autosomal-recessive, sex-linked, were defined.
 Results. The family nature of the varicose disease was revealed in 17 (23 %) of the 72 examined patients. The autosomal-dominant type of inheritance was determined. There is direct inheritance across generations.
 Conclusions. We determined the family nature of the disease inheritance, with the autosomal-dominant type of inheritance with a high degree of gene expression. In these families there is a high risk of the birth of the children who will have chronic venous insufficiency.

A GENETIC STUDY OF PATIENTS WITH CHRONIC VENOUS INSUFFICIENCY BASED ON CLINICAL AND GENEALOGICAL METHOD

Relevance. Practically 10-15 % of the world's population has varicose veins as a manifestation of chronic venous insufficiency. The clinical and genealogical method is the method allows to identify family cases of disease in patients with chronic venous insufficiency.
 Objective: to demonstrate the role of heredity in varicose disease, to analyze family cases of varicose disease, to determine the type of disease inheritance and to give a prediction of heredity for descendants, using the clinical and genealogical method.
 Materials and methods. The study involved 72 patients, mostly women – 46 (63.9 %) persons, with different classes of varicose veins according to the CEAP classification. To determine the type of inheritance we used clinical and genealogical method of pedigrees’ study. The nature of the trait – hereditary or non-hereditary disease; type of the inheritance – autosomal-dominant, autosomal-recessive, sex-linked, were defined.
 Results. The family nature of the varicose disease was revealed in 17 (23 %) of the 72 examined patients. The autosomal-dominant type of inheritance was determined. There is direct inheritance across generations.
 Conclusions. We determined the family nature of the disease inheritance, with the autosomal-dominant type of inheritance with a high degree of gene expression. In these families there is a high risk of the birth of the children who will have chronic venous insufficiency.