Mild Chronic Venous Insufficiency Research Articles

Chronic venous insufficiency, could it be one of the missing pieces in the puzzle of treating pain?

Pain is a common complaint among patients seeking medical care. If left untreated, pain can become chronic, significantly affecting patients' quality of life. An accurate diagnosis of the underlying cause of pain is crucial for effective treatment. Chronic venous insufficiency (CVI) is frequently overlooked by pain physicians. Moreover, many pain physicians lack sufficient knowledge about CVI. CVI is a common condition resulting from malfunctioning or damaged valves in lower limb veins. Symptoms of CVI, ranging from mild to severe, include pain, heaviness, fatigue, itching, swelling, skin color changes, and ulcers in the lower limbs. Recently, it has become more widely known that these symptoms can be attributed to CVI. Even slight or mild CVI can cause related symptoms. Pain physicians primarily consider neuromusculoskeletal disorders when assessing patients with leg pain, and often neglect the possibility of CVI. In clinical practice, when pain physicians encounter patients with unresolved leg pain, they must assess whether the patients exhibit symptoms of CVI and conduct tests to differentiate CVI from other potential causes.

The impact of exercise training on calf pump function, muscle strength, ankle range of motion, and health-related quality of life in patients with chronic venous insufficiency at different stages of severity: a systematic review.

Exercise training (ET) is an important tool in the management of patients with chronic venous insufficiency (CVI). The objective of this article was to discuss the effects of ET on the calf pump, functional parameters, and quality of life of patients with mild and advanced CVI. A systematic review was conducted and eleven studies were included. In patients with mild CVI, ET was effective for improving venous reflux, muscle strength, ankle range of motion, and quality of life. In advanced CVI patients, ET increased ejection fraction, reduced residual volume fraction, and improved muscle strength and ankle range of motion, but did not change venous reflux indices or quality of life. It is concluded that ET is effective for improving calf pump function, muscle strength, and ankle range of motion in CVI. In patients with mild CVI, additional benefits were observed in quality of life.

ANALYSIS OF EFFICIENCY OF DIFFERENT METHODS OF TREATMENT OF PATIENTS WITH ACUTE THROMBOSIS IN THE INFERIOR VENA CAVA

Summary. Research aim. To estimate efficiency of thromboclasis and anticoagulating therapy for patients with DVT of pelvis and lower limbs and to determine the severity of CVI caused by PTD in the long term.
 Material and methods. 138 patients with thrombosis in the system of the inferior vena cava were examined and treated.
 Results and discussion. Thrombolytic therapy (TLT) as a basic method of treatment was used in 52 (37.7 %) patients. 20 (14.5 %) patients undergone catheter-controlled thrombolysis(CCT) and 32 (23.2 %) patients had systemic thrombolytic therapy. 86 (62.3 %) patients in the basic treatment had anticoagulant therapy (ACT). In the long-term results of TLT significantly exceed the results of ACT. 70 % of these patients had signs of postthrombotic disease (PTD) with mild chronic venous insufficiency(CVI), and 100 % of patients with ACT had more severe forms of PTD.
 Conclusions. Application of TLT for patients from with DVT of the pelvis and lower limbs resulted in rapid regress or complete removal of basic clinical signs of venous thrombosis. Instrumental methods of research, such as Doppler ultrasonography and color duplex scanning, as well as X-ray contrast phlebography are the only informative methods for assessing the process of dissolution of blood clots, the functional state of deep veins of the pelvis and lower limbs during CCT.

Effect of a Mixed Kinesio Taping–Compression Technique on Quality of Life and Clinical and Gait Parameters in Postmenopausal Women With Chronic Venous Insufficiency: Double-Blinded, Randomized Controlled Trial

ObjectiveTo investigate the short-term effect of a mixed Kinesio taping (KT) model on range of ankle motion (ROAM), gait, pain, perimeter of lower limbs, and quality of life in postmenopausal women with chronic venous insufficiency (CVI). DesignDouble-blinded, randomized controlled trial. SettingClinical setting. ParticipantsConsecutive postmenopausal women (N=130; mean age ± SD, 65.44±14.7y) with mild CVI. No participant withdrew because of adverse effects. InterventionParticipants were randomly assigned to either (1) an experimental group to receive a mixed KT-compression treatment following KT recommendations for gastrocnemius muscle enhancement and functional correction of the ankle, and adding 2 tapes to simulate traditional compression bandages (no KT guidelines); or (2) a placebo control group for sham KT. Both interventions were performed 3 times a week during a 4-week period. Main Outcome MeasuresROAM, gait, pain, perimeter of right and left lower limb, and quality of life were assessed at baseline and 48 hours posttreatment. ResultsQuality of life was better in the intervention group by a mean of 8.76 points (95% confidence interval [CI], 4.96–12.55). The experimental group also showed significant pre-/posttreatment improvements in both lower limbs in gait dorsiflexion ROAM (95% CI, 1.02–2.49), cadence (95% CI, 3.45–1.47), stride length (95% CI, 21.48–10.83), step length (95% CI, 1.68–6.61), stance phase (95% CI, 61–107), and foot (95% CI, .56–.92) and malleolus (95% CI, 1.15–1.63) circumference. None of these variables were significantly modified in the placebo group. Both groups reported a significant reduction in pain. ConclusionsAnkle dorsiflexion during gait, walking parameters, peripheral edema, venous pain, and quality of life remain improved in patients with CVI at 1 month after mixed KT-compression therapy. KT may have a placebo effect on pain perception.

Neuropathy and Ankle Mobility Abnormalities in Patients With Chronic Venous Disease

How complications associated with chronic venous insufficiency (CVI) develop is not clear. The central source of the complications is likely a dysfunction of the calf muscle pump, which includes veins and their valves, the gastrocnemius and other lower leg and foot muscles as well as the nerves supplying the muscles, and ankle mobility limitations. The least well-studied source of complications is the relationship between range of ankle movement (ROAM), neuropathy, and the clinical severity of the disease. To study sensory neuropathic changes and ankle mobility in patients with CVI to help elucidate the pathophysiologic development of venous ulcers. A cross-sectional study took place from August 2011 to August 2012 at the outpatient wound clinic and the wound healing research clinic at the University of Miami Hospital. Sixty-four limbs from 42 individuals were evaluated and individually classified according to the clinical aspect of the clinical-etiology-anatomy-pathophysiology classification for CVI. Range of ankle movement was measured using goniometry, measuring active ankle combined plantarflexion and dorsiflexion and combined inversion and eversion. Peripheral neuropathy was measured subjectively through the Neuropathy Symptom Score and objectively through the Neuropathy Disability Score scales. More patients with severe CVI had reduced plantarflexion-dorsiflexion ROAM compared with patients with mild CVI (25 [89%] vs 11 [31%]; P < .001) and reduced inversion-eversion ROAM (22 [79%] vs 4 [11%]; P < .001). Patients with worse CVI had significantly worse neuropathy with higher Neuropathy Symptom Score and Neuropathy Disability Score values compared with patients with less severe CVI. We found a relationship between reduced ROAM and worse neuropathy with increased severity of CVI. Management in patients with CVI should include testing for neuropathy and improving ankle mobility.

Effects of Kinesio Taping on Venous Symptoms, Bioelectrical Activity of the Gastrocnemius Muscle, Range of Ankle Motion, and Quality of Life in Postmenopausal Women With Chronic Venous Insufficiency: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of Kinesio taping (KT) on venous symptoms, quality of life, severity, pain, edema, range of ankle motion (ROAM), and peripheral muscle myoelectrical activity in lower limbs of postmenopausal women with mild chronic venous insufficiency (CVI). DesignDouble-blinded randomized controlled trial with concealed allocation. SettingClinical setting. ParticipantsConsecutive postmenopausal women (N=123; age range, 62–67y) with early-stage CVI. None of the participants withdrew because of adverse effects. InterventionParticipants were randomly assigned to an experimental group for standardized KT application for external gastrocnemius (EG) and internal gastrocnemius (IG) muscle enhancement and ankle function correction or a placebo control group for sham KT application. Both interventions were performed 3 times a week during a 4-week period. Main Outcome MeasuresVenous symptoms, CVI severity, pain, leg volume, gastrocnemius electromyographic data, ROAM, and quality of life were recorded at baseline and after treatment. ResultsThe experimental group evidenced significant improvements in pain distribution, venous claudication, swelling, heaviness, muscle cramps, pruritus, and CVI severity score (P≤.042). Both groups reported significant reductions in pain (experimental group: 95% confidence interval [CI], 1.6 to 2.1; control group: 95% CI, −0.2 to 0.3). There were no significant changes in either group in quality of life, leg volume, or ROAM. The experimental group showed significant improvements in root mean square signals (right leg: EG 95% CI, 2.99–5.84; IG 95% CI, 1.02–3.42; left leg: EG 95% CI, 3.00–6.25; IG 95% CI, 3.29–5.3) and peak maximum contraction (right leg: EG 95% CI, 4.8–22.7; IG 95% CI, 2.67–24.62; left leg: EG 95% CI, 2.37–20.44; IG 95% CI, 2.55–25.53), which were not changed in controls. ConclusionsKT may reduce venous symptoms, pain, and their severity and enhance gastrocnemius muscle activity, but its effects on quality of life, edema, and ROAM remain uncertain. KT may have a placebo effect on venous pain.

A randomized controlled trial of a mixed Kinesio taping–compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency

Objectives: To investigate the effect of a mixed Kinesio taping treatment in women with chronic venous insufficiency. Design: A double-blinded randomized clinical trial. Setting: Clinical setting. Participants: One hundred and twenty postmenopausal women with mild–moderate chronic venous insufficiency were randomly assigned to an experimental group receiving standardized Kinesio taping treatment for gastrocnemius muscle enhancement and ankle functional correction, or to a placebo control group for simulated Kinesio taping. Main outcomes variables: Venous symptoms, pain, photoplethysmographic measurements, bioelectrical impedance, temperature, severity and overall health were recorded at baseline and after four weeks of treatment. Results: The 2 × 2 mixed model ANCOVA with repeated measurements showed statistically significant group * time interaction for heaviness (F = 22.99, p = 0.002), claudication (F = 8.57, p = 0.004), swelling (F = 22.58, p = 0.001), muscle cramps (F = 7.14, p = 0.008), venous refill time (right: F = 9.45, p = 0.023; left: F = 14.86, p = 0.001), venous pump function (right: F = 35.55, p = 0.004; left: F = 17.39 p = 0.001), extracellular water (right: F = 35.55, p = 0.004; left: F = 23.84, p = 0.001), severity (F = 18.47, p = 0.001), physical function (F = 9.15, p = 0.003) and body pain (F = 3.36, p = 0.043). Both groups reported significant reduction in pain. Conclusion: Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency. Kinesio taping may have a placebo effect on pain.

Exercise with compression stockings improves reflux in patients with mild chronic venous insufficiency

Purpose: This study evaluates the effectiveness of calf muscle strengthening with compression stockings on the haemodynamics in patients with venous disease. Method: Patients were assigned to a protocol of aggressive management of their chronic venous insufficiency (CVI) including compression stockings (Jobst knee high, 30–40 mmHg ankle), intermittent leg elevation, and a supervised calf muscle strengthening programme. Patients underwent baseline air plethysmography (APG) with and without stockings (T1) and SF-12, Aberdeen varicose vein questionnaire and venous severity score. Exercise sessions included a total of 18, 1 h supervised sessions, 2–3 times per week, consisting of 15 min on treadmill, 10 min on a Stairmaster, 10 min on a Nustep, and 5 min on an airdyne bicycle and lower body strength training. The sessions were supervised by an exercise physiologist. At completion, patients underwent a second APG (T2) and a third (T3) one month later, as well as answering questionnaires. A final venous severity score was assigned. Results: Eleven patients (7M, 4F), 22 limbs, 14 with CVI and eight without CVI, mean age 60, made up this study. Only two patients suffered from postphlebitic syndrome. In all, 10/11 subjects completed the entire protocol. Although no significant differences were noted in any of the APG parameters between T1 and T2 or T2 and T3, there were significant differences when segregating into C2 ( n = 6 patients with eight involved limbs) and C4, 5 ( n = 5 patients with six involved limbs). Concerning the affected extremities, statistically significant decreases in venous volume (VV) with stockings on between T1 and T2, which reverted back to baseline at T3, and in venous filling index (VFI) between T2 and T3 without stockings were noted ( P&lt;0.05) in C2 limbs. Similar findings were not observed in the C4, C5 limbs, with actual increases in these parameters. Greater increases in ejection fraction were noted in C2 limbs than in C4, C5 limbs. Despite the decrease in reflux in C2 limbs, residual volume fraction (RVF) increased in C2 limbs at T2 both with ( P&lt;0.05) and without stockings, while it decreased in C4, C5 limbs with stockings in place. Finally, outflow fraction (OF) increased only in C2 limbs without stockings in place. Regarding the other parameters, all patients noted improvement in swelling by Aberdeen questionnaire, physical health was improved by SF-12 and patients lost a mean of 3.8 lb of weight. Conclusions: An exercise programme along with compression stockings resulted in a decrease in reflux, especially during the supervised exercise programme, in patients with mild (C2) chronic venous disease. For more extensive disease (C4, C5), the programme tended to decrease RVF.

Urine hemosiderin: a novel marker to assess the severity of chronic venous disease.

Impaired venous drainage in severe chronic venous insufficiency (CVI) leads to microcirculatory overload, characterized by erythrocyte diapedesis and subsequent extravascular hemolysis, resulting in typical dermal hemosiderin deposition. We hypothesized that hemosiderin, normally absent, could be present in the urine in CVI. The three-phase study included 117 patients with CVI and 12 healthy control subjects, all of whom had undergone clinical examination and duplex scanning. In phase 1, current methods were used to test urine for hemosiderin in 61 persons: 12 healthy control subjects, 24 patients with mild CVI (clinical class C1 to C3), and 25 patients with severe CVI (clinical class C4 to C6). In phase 2, the concentration of urinary hemosiderin was determined in 45 consecutive patients with CVI, CEAP class 1 to 6. A score of 0 was assigned when typical hemosiderin granules were absent at microscopic examination, a score of 1 when one to three granules per field were detected; 2 when four to six granules were detected; and 3 when more than six granules were observed. Phase 3 included 23 patients with CVI (clinical class 2 to 6). Hemosiderin concentration was determined and a score assigned before patients underwent surgical procedures to correct primary CVI. Both hemosiderin testing and duplex scanning were repeated after 6 months. Phase 1: Urine hemosiderin testing to determine presence or absence of CVI in patients with reflux detectable at duplex scanning yielded the following values: positive predictive value, 96% (95% confidence interval [CI], 86% to 100%); negative predictive value, 88% (CI, 68% to 97%); sensitivity, 94% (CI, 72% to 99%); specificity, 91% (CI, 83% to 99%); and diagnostic accuracy, 95% (CI, 86% to 99%). Phase 2: Hemosiderinuria score enabled classification of clinical severity of CVI. Mean scores, respectively, were clinical class 1, 0.18 +/- 0.12; class 2, 0.75 +/- 0.47; class 3, 1.67 +/- 0.21; class 4, 1.86 +/- 0.26; class 5, 2.50 +/- 0.28; and class 6, 1.92 +/- 0.21 (P <.001). Phase 3: At 6-month follow-up, hemosiderin score was improved, from 2.48 +/- 0.12 preoperatively to 0.78 +/- 0.18 postoperatively (P <.0001). A score of 0 or 1 was associated with successful surgery, whereas a score of 2 or 3 reflected persistence of reflux. Determination of presence of hemosiderin in the urine is a new, sensitive, cost-effective, noninvasive, and repeatable test that enables detection of substantial microcirculatory overload in patients with CVI.

Air plethysmography in chronic venous insufficiency: clinical diagnosis and quantitative assessment.

To define the role of air plethysmography (APG) in the clinical diagnosis and quantitative assessment of chronic venous insufficiency (CVI), APG studies were performed on 582 limbs in 291 patients with signs and symptoms of CVI. One hundred and thirty-one limbs were classified into group I (no evidence of CVI), 291 into group II (mild CVI), and 160 into group III (advanced CVI). On APG, the mean venous filling index (VFI) was 1.45 mL/s, 3.90 mL/s, and 5.25 mL/s in groups I, II, and III respectively (p<0.05). The mean ejection fraction (EF) and mean residual volume fraction (RVF) also showed significant differences between the limbs with CVI and the contralateral normal limbs, but the values were similar for the different severities of CVI limbs. The amount of overlap in VFI, EF, and RVF values among the clinical groups was considerable. Discrimination analysis derived a VFI value of 2.67 mL/s as a cutoff point between normal limbs and limbs with CVI, with a positive predictive value of 96%. In conclusion, APG is a simple and noninvasive test for quantitative assessment of the different components of CVI, valvular reflux, and calf muscle pump function. However, only VFI correlated significantly with the severity of CVI. VFI, with its high positive predictive value, may be useful in diagnosis of CVI, and it may serve as an objective quantitative measurement for monitoring the effect of treatment.

Ambulatory Venous Pressure and Leg Volume Measurements before and after Surgery for Primary Varicose Veins

Objective: To compare clinical disability, ambulatory venous pressure (AVP) and leg volume before and after venous surgery, and to relate the changes to those observed after one night preoperative in-hospital rest. Design: Prospective study. Setting: Department of Vascular Surgery, University Hospital, Paris, France. Subjects: Nineteen patients with primary varicose veins and mild chronic venous insufficiency (CVI), scheduled for venous surgery. Main outcome measures: Clinical disability recorded by the analogue scale method, and leg volume and AVP measurements. These evaluations were repeated three times: on the day before surgery, in the afternoon; in the early morning on the day of surgery; and 2 months after surgery, in the afternoon. Results: Varicose vein surgery improved disability ( p = 0.001) and two AVP parameters: recovery time (RT, p = 0.0049) and the calf muscle pump index (CMPI), which rose by 345% (95% confidence intervals: 29, 659). Preoperative supine rest for one night improved disability ( p = 0.0016) and reduced leg volume ( p = 0.0002). The improvements induced by surgery correlated with the changes induced by rest, for disability ( p = 0.016), RT ( p = 0.006) and CMPI ( p = 0.033). Conclusion: Surgery improves venous function in patients with primary varicose veins. AVP remains a standard method of evaluating CVI. Combined with volumetry, it allows sensitive comparisons between different treatments. Because venous function varies greatly with daily activity, it is imperative to standardize the times at which venous function is evaluated.

A new method for the assessment of venous insufficiency in primary varicose veins using near-infrared spectroscopy.

Patients with chronic venous insufficiency (CVI) were evaluated from the aspect of ambulatory venous function using near-infrared spectroscopy (NIRS). Seventy-two primary varicose veins of 59 patients (varicose group) and 20 normal limbs of 13 volunteers (normal group) were studied. The affected limbs of the patients were divided into three groups according to the classification advocated by an International Consensus Committee in 1995: mild CVI with class 2 or 3 (50 limbs); moderate CVI with class 4 (11 limbs); and severe CVI with class 5 or 6 (11 limbs). All of the patients underwent a treadmill walking test, during which NIRS was applied. Oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoHb) were continuously measured by NIRS during exercise. The ambulatory venous retention index (AVRI) obtained from serial changes in DeoHb was assessed comparatively in the four groups (normal and mild to severe CVI). In addition, 19 limbs in 13 patients were evaluated with air plethysmography for comparison with the data obtained by NIRS. Two distinct patterns of DeoHb change were observed. During exercise, the DeoHb level decreased in the normal group as a result of calf muscle contraction, whereas in the varicose group the DeoHb level rose because of an apparent venous reflux into the calf muscles. AVRI studies demonstrated a significant difference (p < 0.0001) among groups. Although there was no apparent relationship between AVRI and ejection fraction, AVRI showed a significant correlation with the venous filling index (r = 0.61) and a weak correlation with the residual volume fraction (r = 0.41). NIRS is useful for accurately assessing ambulatory venous dysfunction in patients with primary varicose veins.