Presence Of Varicose Veins Research Articles

Varicose Veins as Model for Apportionment among Risk Factors for Compensation Purposes.

To demonstrate a method which is being used to apportion between risk factors for occupationally related disease and compensate individuals with multiple risk factors. The application to individuals will be demonstrated for varicose veins. The National Insurance Institute (NII) is tasked with compensating work related injuries and illness in Israel. Population attributable fraction (PAF) has been utilized in order to estimate the amount of disease that can potentially be eliminated in a population through the elimination of individual risk factors. PAF is based on relative risks and the prevalence of these risks. A review of the medical literature consisting of epidemiological studies of varicose veins and its multiple risk factors was conducted, with special attention to prolonged occupational standing. Summary, weighted, relative risks were calculated for eight different risk factors. The proposed formula then allowed for apportioning among those risk factors in the individual. The findings of the current study indicate that prolonged standing may be associated with the presence of varicose veins, however in light of the multiple other risk factors associated, its overall contribution is generally minor. Apportionment among multiple risk factors for varicose veins can be accomplished mathematically in individuals. This application is being applied successfully for other diseases as well.

Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis.

Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger's disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno-femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.

Association of varicose veins with incidence risk of atrial fibrillation: a population-based cohort study.

Varicose veins (VV) were once considered benign and common ailments; however, recent research suggests a potential link between VV and cardiovascular diseases or mortality. VV share common risk factors and pathophysiology with cardiovascular disease, potentially influencing the vascular system. Therefore, the authors aimed to investigate the association between VV and the incidence risk of atrial fibrillation (AF) using a population-based cohort. Our retrospective cohort study included 2680971 individuals who underwent examination through the Korean National Health Screening Service from 2010 to 2011. VV was defined by two or more claims with the International Classification of Diseases 10th Revision diagnostic codes: I83.0, I83.1, I83.2 (VV of lower extremities with ulcer or inflammation, severe VV), and I83.9 (asymptomatic VV of lower extremities, mild VV). The 1:3 propensity score matching (PSM) was used to assess the risk of newly developed AF, identified via insurance claims coded as I48. The mean age of all participants was 48.5±14.2 years, with 51.4% being male. Among the population, 24557 (0.91%) had VV, including 3684 (0.14%) of severe VV and 20873 (0.77%) of mild VV. During a median follow-up of 10.06 years, 24557 (0.92%) cases of AF occurred. Participants with VV exhibited an increased incidence risk of AF compared to those without it before (HR: 1.13, 95% CI: 1.06-1.21, P <0.001) and after PSM (HR: 1.17, 95% CI: 1.08-1.27, P <0.001). This positive association was consistently observed in severe VV both before (HR: 1.19, 95% CI [1.09-1.28], P =0.002) and after PSM (HR: 1.20, 95% CI [1.10-1.30], P =0.003) and mild VV also before (HR: 1.10, 95% CI [1.04-1.16], P =0.003) and after PSM (HR: 1.13, 95% CI [1.03-1.-20], P <0.001). These findings suggest that VV may be associated with an increased risk of AF. Hence, the presence of VV should be considered as an association factor for AF occurrence.

Pelvic congestion syndrome and its treatment: topic review

Pelvic congestion syndrome (PCS) is a pathology characterized by pain in the pelvic region that occurs chronically and is usually associated with the presence of varicose veins in the genital, vulvar or perineal region as a consequence of venous reflux of gonadal, gluteal or peri uterine veins, as well as compression syndromes in the left renal veins or iliac segments, which can lead to a spectrum of clinical symptoms ranging from dysuria, pain when standing, dyspareunia and intense dysmenorrhea, or equally psychological symptoms such as mood disorders or depression, which affect the quality of life of patients. Despite its high prevalence, this disease continues to be underdiagnosed and mistreated. The etiology varies involving factors in mechanics, hemodynamics, anatomical defects, anomalies of venous return, multiparity, including hormonal factors, obesity, or sedentary lifestyle, which favor blood stasis and consequent venous dilation. The diagnosis is made with an appropriate clinical examination, and confirmed with imaging studies, phlebography being the gold standard due to its diagnostic and therapeutic usefulness. There is currently a wide variety in the treatment of PCS, however endovascular management with sclerotherapy and embolization is the one that has shown the best results with clinical improvement and quality of life. This article seeks to review the literature on pelvic congestion syndrome with the aim of understanding a frequently overlooked disease and the diagnostic and therapeutic alternatives to treat these patients.

Is it safe to discontinue anticoagulant after surgical treatment of varicose vein disease, which caused pulmonary embolism?

Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.

Risk factors for venous thromboembolism after primary total joint arthroplasty: An analysis of 7511 Taiwanese patients.

The need for thromboprophylaxis in Asian patients after primary total joint arthroplasty (TJA) remains inconclusive. We aimed to identify the risk factors for venous thromboembolism (VTE) events following primary TJA in a Taiwanese population. From January 2010 to December 2019, we studied 7511 patients receiving primary TJA from a single surgeon. We validated the incidence and risk factors for 30- and 90-day symptomatic VTE events, including age, sex, body mass index (BMI), smoking, medical comorbidities, VTE history, presence of varicose veins, total knee arthroplasty (TKA) vs total hip arthroplasty (THA), unilateral vs bilateral procedure and receipt of VTE prophylaxis, transfusion, and length of stay. The incidence of 30- and 90-day symptomatic VTE events was 0.33% and 0.44%, respectively. Multivariate regression analysis showed that BMI ≥30 (adjusted odds ratio (aOR): 4.862, 95% CI, 1.776-13.313), bilateral TJA procedure (aOR: 2.665, 95% CI, 1.000-7.104), and presence of varicose veins (aOR: 9.946, 95% CI, 1.099-90.024) were associated with increased odds of 30-day symptomatic VTE events. Age ≥77 years (aOR, 2.358, 95% CI, 1.034-5.381) and BMI ≥30 (aOR: 2.832, 95% CI, 1.039-7.721) were associated with increased odds of 90-day symptomatic VTE events. Age ≥77 years, BMI ≥30, bilateral TJA procedure, or presence of varicose veins may require pharmacological thromboprophylaxis because such patients have a higher risk of VTE after primary TJA.

Development and validation of a clinical prediction model for 90-day venous thromboembolism risk following total hip and total knee arthroplasty: a multinational study

BackgroundThe risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is 1.0% to 1.5%, despite uniform thromboprophylaxis. ObjectivesTo develop and validate a prediction model for 90-day VTE risk. MethodsA multinational cohort study was performed. For model development, records were used from the Oxford Royal College of General Practitioners Research and Surveillance Centre linked to Hospital Episode Statistics and Office of National Statistics UK routine data. For external validation, data were used from the Danish Hip and Knee Arthroplasty Registry, the National Patient Registry, and the National Prescription Registry. Binary multivariable logistic regression techniques were used for development. ResultsIn the UK data set, 64 032 THA/TKA procedures were performed and 1.4% developed VTE. The prediction model consisted of age, body mass index, sex, cystitis within 1 year before surgery, history of phlebitis, history of VTE, presence of varicose veins, presence of asthma, history of transient ischemic attack, history of myocardial infarction, presence of hypertension and THA or TKA. The area under the curve of the model was 0.65 (95% CI, 0.63-0.67). Furthermore, 36 169 procedures were performed in the Danish cohort, of whom 1.0% developed VTE. Here, the area under the curve was 0.64 (95% CI, 0.61-0.67). The calibration slope was 0.92 in the validation study and 1.00 in the development study. ConclusionThis clinical prediction model for 90-day VTE risk following THA and TKA performed well in both development and validation data. This model can be used to estimate an individual’s risk for VTE following THA/TKA.

Prevalence and predictors of chronic thromboembolic pulmonary hypertension following severe forms of acute pulmonary embolism

Introduction and ObjectivesThe true prevalence of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) in the Portuguese population remains unknown. We aimed to assess the prevalence and predictors of CTEPH two years after a symptomatic high- (HR) or intermediate-high risk (IHR) PE. MethodsWe conducted a retrospective cohort study of patients admitted with PE between 2014 and 2019 to a Portuguese referral center for pulmonary hypertension. ResultsIn this single-center registry of 969 patients admitted with PE (annual incidence of 46/100000 population), 194 had HR (5.4%) and IHR (14.7%) PE. After excluding patients who died or had no follow-up in the first three months, 129 patients were included in the analysis. The overall prevalence of suspected CTEPH by clinical assessment, Doppler echocardiography and V/Q lung scan was 6.2% (eight patients). CTEPH was confirmed by right heart catheterization in four of these (3.1%). Increased pulmonary artery systolic pressure (PASP) at admission (OR 1.12; 95% CI 1.04–1.22; p=0.005) and the presence of varicose veins in the lower limbs (OR 7.47; 95% CI 1.53–36.41; p=0.013) were predictors of CTEPH. PASP >60 mmHg at admission identified patients with CTEPH at follow-up with sensitivity and specificity of 83.3% and 76.3%, respectively. All patients diagnosed with CTEPH had at least two radiological findings suggestive of CTEPH at the index event. ConclusionsIn our cohort, the prevalence of CTEPH in survivors of severe forms of acute PE was 6.2%. PASP above 60 mmHg and supporting radiological findings on the index computed tomography scan are highly suggestive of acute-on-chronic CTEPH.

Combination of enoxaparin and low-dose aspirin for thromboprophylaxis in selective patients after primary total joint arthroplasty in a Taiwanese population.

The incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total joint arthroplasty (TJA) procedures are lower in Asian populations than in Caucasian populations. Therefore, the need for thromboprophylaxis in Asian patients undergoing TJA remains inconclusive. The aim of this study was to validate the clinical outcomes of thromboprophylaxis in selective TJA patients in a Taiwanese population. We retrospectively reviewed records of patients who underwent TJA procedures performed by a single-surgeon between January 2010 through December 2019. Patients received thromboprophylaxis with a combination of enoxaparin and low-dose aspirin if they fulfilled any of the following criteria: 1) body mass index >30 (kg/m 2 ), 2) presence of varicose veins, 3) history of DVT or PE, or 4) simultaneous bilateral TJA procedure. We assessed the incidence of DVT and PE, 90-day postoperative complications, length of stay, in-hospital mortality, 30-day and 90-day readmission, and 1-year reoperation. Of the 7511 patients included in this study, 2295 (30.6%) patients received thromboprophylaxis. For patients who received thromboprophylaxis(N = 2295), the incidence of DVT and PE were 0.44% and 0%, respectively. For patients who did not receive thromboprophylaxis (N = 5216), the incidence of DVT and PE was 0.46% and 0.04%, respectively. The overall rates of 90-day postoperative complications (2.3%), 30-day (1.8%) and 90-day readmission (2.3%), and 1-year reoperation (1.1%) were low. Providing thromboprophylaxis for selective TJA patients within the Taiwanese population was effective, as indicated by the low incidence of DVT and PE. Complications, such as surgical site infection, should be carefully weighed and managed.

Fluoroscopy-guided foam sclerotherapy for varicose veins in the legs: A retrospective cohort analysis with long-term follow-up

ObjectiveTo examine the long-term effectiveness of fluoroscopy-guided foam sclerotherapy for varicose veins in the legs. MethodsThis retrospective cohort study included consecutive patients who underwent fluoroscopy-guided foam sclerotherapy for varicose veins in the legs at the authors’ center during a period from August 1, 2011, to May 31, 2016. The last follow-up was conducted by a telephone/WeChat interactive interview in May 2022. Recurrence was defined as the presence of varicose veins regardless of symptoms. ResultsThe final analysis included 94 patients (58.3 ± 7.8 years of age; 43 men; 119 legs). The median Clinical-Etiology-Anatomy-Pathophysiology (CEAP) clinical class was 3.0 (interquartile range [IQR]: 3.0, 4.0). C5 and C6 accounted for 5.0% (6/119) of the legs. The average total amount of the foam sclerosant used during the procedure was 35 ± 12 mL (range: 10-75 mL). No patients developed stroke, deep vein thrombosis, or pulmonary embolism after the treatment. At the last follow-up, the median CEAP clinical class reduction was 3.0. All 119 legs except for class 5 achieved the CEAP clinical class reduction by at least one grade. The median venous clinical severity score was 2.0 (IQR: 1.0, 5.0) at the last follow-up vs 7.0 (IQR: 5.0, 8.0) at the baseline (P < .001). The recurrence rate was 30.9% (29/94) in the overall analysis, 26.6% (25/94) for the great saphenous vein and 4.3% (4/94) for the small saphenous vein (P < .001). Five patients received subsequent surgical treatment, and the remaining patients opted to receive conservative treatments. Among the two C5 legs at the baseline, ulcer recurred in one leg at 3 months after the treatment and healed after conservative treatments. In the four C6 legs at the baseline, ulcer healed within a month in all patients. The rate of hyperpigmentation was 11.8% (14/119). ConclusionsLong-term outcomes in patients undergoing fluoroscopy-guided foam sclerotherapy are satisfying, with minimal short-term safety concerns.

The significance of minimally invasive treatment methods in the single-stage elimination of varicose vein disease of the great and small saphenous veins of the lower limbs and their branches

Introduction. This article presents a clinical case of successful and single-stage endovenous laser coagulation combined with miniphlebectomy in a patient with extensive and combined varicose lesion of all major subcutaneous veins of the lower limbs with significant symptoms of chronic venous insufficiency.Aim. To determine the possibilities of simultaneous elimination of all main subcutaneous veins and their varicose tributaries on both lower limbs using minimally invasive methods.Materials and methods. A 44-year-old female patient complained of gastrocnemius muscle cramps, swollen shins, feeling of heaviness at the end of the working day and the presence of varicose veins in both lower extremities. The severity of the chronic vein disease before the intervention according to the VCSS (Venous clinical Severity Score) was 8. As a result, patency of deep veins and condition of their valve apparatus, insufficiency of valves of the sapheno-femoral and sapheno-popliteal annexes on both sides with reflux through large and small saphenous veins and anterior accessory large saphenous vein on the right, insufficiency of perforating veins of both tibias were determined. Endovenous laser coagulation of the great and small saphenous veins on both sides and the right anterior accessory great saphenous vein, miniphlebectomy of dilated tributaries within both lower limbs was performed. The symptoms of chronic venous insufficiency decreased markedly. Swelling of the lower legs and cramps in the gastrocnemiu muscles have almost completely disappeared, and the feeling of heaviness in the legs after static loads has significantly decreased.Conclusion. Endovenous laser coagulation with miniphlebectomy should be given preference in varicose vein disease with combined affection of all great saphenous veins of both lower limbs. Their application provides an opportunity to eliminate simultaneously incompetence of all target veins and to remove varicose dilated tributaries, providing good therapeutic and cosmetic effect without hospitalization and detachment of the patient from his or her work activity.

Association Between Knowledge of Chronic Venous Insufficiency and Clinical Severity in Women

Objective: to determine the association between knowledge about chronic venous insufficiency and clinic severity in women attending a family medicine unit. Methods: cross-sectional and analytical study in 280 women with chronic venous insufficiency. The instrument Chronic Venous Insufficiency Knowledge, which evaluates theoretical knowledge about the disease, was applied. The clinical severity of the disease was determined by means of the Venous Clinical Severity Score instrument, which independently measures clinical manifestations of the disease. Spearman’s rho coefficient was used to assess the correlation between the degree of knowledge and clinical severity. Results: the overall assessment of knowledge of chronic venous insufficiency placed most of the participants at a low level (68%). A strong negative correlation was found between knowledge-presence of pain (Spearman’s rho coefficient of -0.611, p=0.000) and knowledge-presence of venous edema (Spearman’s rho coefficient of -0.648, p=0.000). When analyzing the correlation between knowledge and the presence of varicose veins, a moderate correlation was reported (Spearman’s rho coefficient -0.450, p=0.000), as well as with skin pigmentation (Spearman’s rho coefficient -0.464, p=0.000). The rest of the clinical severity topics reported a low correlation. Conclusions: low knowledge of chronic venous insufficiency is a risk factor for the severity of the disease. Therefore, it is vital to consider the implementation of educational strategies aimed at patients to improve knowledge and thus prevent disease progression.

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Venous thromboembolism (VTE) prophylaxis has been suggested for patients who underwent total join arthroplasty (TJA). However, the morbidity of surgical site complications (SSC) and periprosthetic joint infection (PJI) has not been well evaluated. We aimed to evaluate the impact of VTE prophylaxis on the risk of early postoperative SSC and PJI in a Taiwanese population. We retrospectively reviewed 7511 patients who underwent primary TJA performed by a single surgeon from 2010 through 2019. We evaluated the rates of SSC and PJI in the early postoperative period (30-day, 90-day) as well as 1-year reoperations. Multivariate regression analysis was used to identify possible risk factors associated with SSC and PJI, including age, sex, WHO classification of weight status, smoking, diabetes mellitus (DM), rheumatoid arthritis(RA), Charlson comorbidity index (CCI), history of VTE, presence of varicose veins, total knee or hip arthroplasty procedure, unilateral or bilateral procedure, or receiving VTE prophylaxis or blood transfusion. The overall 90-day rates of SSC and PJI were 1.1% (N = 80) and 0.2% (N = 16). VTE prophylaxis was a risk factor for 90-day readmission for SSC (aOR: 1.753, 95% CI 1.081–2.842), 90-day readmission for PJI (aOR: 3.267, 95% CI 1.026–10.402) and all 90-day PJI events (aOR: 3.222, 95% CI 1.200–8.656). Other risk factors included DM, underweight, obesity, bilateral TJA procedure, younger age, male sex and RA. Pharmacological thromboprophylaxis appears to be a modifiable risk factor for SSC and PJI in the early postoperative period. The increased infection risk should be carefully weighed in patients who received pharmacological VTE prophylaxis.

Prevalence and detection rate of senile cataract in individuals with cardiovascular diseases

To determine the prevalence of senile cataracts and its detection rate among the population at the age of 40 and older with diseases of the cardiovascular system. This observational cross-sectional study was based on the information extracted from electronic health records (EHR) of patients aged 40-99 years assigned for medical services to a city polyclinic. Among the population with essential hypertension (EH) senile cataract occurs with the frequency of 10.4±0.3% (95% CI 9.8-10.9%) of cases, in patients with cerebrovascular diseases (CVD) - 17.1±0.2% (95% CI 16.6-17.5%) of cases, with varicose veins of the lower extremities - 19.9±0.2% (95% CI 19.4-20.3%) of cases, with ischemic heart disease (IHD) - 15.8±0.2% (95% CI 15.4-16.2%) of cases. At the same time, senile cataract is associated with an increase in the likelihood of its detection in patients with hypertension by 6.8 times (OR 6.57; 95% CI 5.89-7.74), with CVD by 5 times (OR 5.02; 95% CI 4.64-5.44), with varicose veins by 3.7 times (OR 3.70; 95% CI 3.34-4.10), with IHD by 3.5 times (OR 3.53; 95% CI 3.20-3.90). Female gender is associated with an increased likelihood of developing senile cataracts in the presence of EH by 1.4 times (OR 1.420; 95% CI 1.299-1.553), in the presence of CVD by 1.2 times (OR 1.199; 95% CI 1.066-1.348), in the presence of varicose veins by 1.4 times (OR 1.355; 95% CI 1.064-1.725), in the presence of IHD by 1.5 times (OR 1.476; 95% CI 1.298-1.679). The detection rate of senile cataract is highest at the ages of 70-79 years, amounting to 18.1% of cases with hypertension, 24.0% of cases with CVD, 29.2% of cases with varicose veins, and 33.7% of cases with ischemic heart disease. Target population groups have been identified for more effective screening studies in order to detect senile cataracts among them.

COMPLICATIONS AND EVALUATION OF QUALITY OF LIFE IN PATIENTS AFTER LESS-INVASIVE TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES.

The aim: To analyze the occurrence of complications and evaluate the quality of life in patients who got less-invasive treatment methods using endovenous laser ablation of varicose veins of the lower extremities in the early and late postoperative periods. Materials and methods: The study was conducted with the participation of 100 patients treated in 2019-2020 by one team of surgeons for varicose veins of the lower extremities with symptoms of chronic venous insufficiency C2-C4 (CEAP classification). Depending on the performance of endovenous surgical interventions, all patients were divided into two study groups. Results: In assessing the quality of life associated with health, according to the CIVIQ 2 questionnaire, it was found that in the presence of varicose veins in the superficial veins of the lower extremities, indicators decrease both in general and on all studied scales (pain, physical, psychological and social). However, when using endovenous laser ablation without miniphlebectomy, after 6 months of observation, recurrence of varicose veins of the lower extremities was noted, which was not observed in patients of the first group. Conclusions: The use of less-invasive interventions with ultrasound guidance positively affects patients' quality of life with varicose veins of the lower extremities, both in the early and prolonged postoperative periods.

Varicose Vien (Risk Factors and Prevalence) in KSA – Questionnaier Study

The purpose of this study is to determine the relationship between different variables (namely: age group, gender, risk factors like smoking history, alcohol consumption, long duration of sitting and standing hours, family history of varicosities, history of leg trauma or surgery, frequent constipation, pregnancy more than once, and hormonal therapies including OCPs) and the presence of varicose veins. Also, the purpose is to determine the prevalence of varicose veins among the sample taken in the study, and the prevalence of the different symptoms and complication among this population.&#x0D; A significant relationship was found between the presence of varicose veins and age group, gender, alcohol consumption, long duration of sitting and standing hours, family history of varicosities, history of leg surgery, frequent constipation, pregnancy more than once, and hormonal therapies including OCPs. The results are concordant, in most parts of this study, with the previous studies in different times and regions, done for the nearly similar purposes.

The possibility of introducing a normal pregnancy and delivery in patients with established liver cirrhosis

The management of pregnant women with portal hypertension is challenging. In the second trimester, examinations are performed to identify esophageal varices. There are no clear recommendations regarding the primary prevention of bleeding in case of esophageal varices in pregnant women and management in case of bleeding. There are no recommendations on the preferred mode of delivery (vaginal or caesarean section) for portal hypertension. Since the persistent period is undesirable in the presence of varicose veins, it is recommended, if necessary, to shorten the second stage of labor by applying obstetric forceps or performing vacuum extraction of the fetus. In the presence of obstetric indications, a caesarean section is performed, which is also associated with certain risk; since cirrhosis often has varicose veins of the abdominal wall. In addition there is a tendency to bleed during childbirth, infectious complications, and slow wound healing. Because of possible medical contraindications and difficulty of prenatal management and delivery of patients with established liver cirrhosis, there are many cases of patients concealing their diagnosis when planning pregnancy and visiting a gynecologist, which, undoubtedly, can lead to concomitant complications and serious consequences that threaten the lives of patients. The clearest example of the above is the following patient case.

Enfermedad venosa crónica

Chronic venous disease (CVD) is understood to be the venous return system of the lower limbs (LL) failing to work effectively, and is clinically diagnosed by the presence of varicose veins. It is a very common disease. In terms of aetiopathogenesis, two mechanisms explain the onset of CVD: primary reflux and venous obstruction. A diagnosis of CVD is based on CAP score, which is the most widely used and accepted. It assesses clinical, aetiological, anatomical, and pathophysiological aspects. Treatment of CVD aims to reduce symptoms and prevent progression to advanced clinical stages of the disease with complications and sequelae. However, once varicose veins appear, they cannot be reversed pharmacologically; there are an increasing range of technical possibilities for their removal.

Management of superficial venous thrombosis based on individual risk profiles: protocol for the development and validation of three prognostic prediction models in large primary care cohorts

BackgroundSuperficial venous thrombosis (SVT) is considered a benign thrombotic condition in most patients. However, it also can cause serious complications, such as clot progression to deep venous thrombosis (DVT) and pulmonary embolism (PE). Although most SVT patients are encountered in primary healthcare, studies on SVT nearly all were focused on patients seen in the hospital setting. This paper describes the protocol of the development and external validation of three prognostic prediction models for relevant clinical outcomes in SVT patients seen in primary care: (i) prolonged (painful) symptoms within 14 days since SVT diagnosis, (ii) for clot progression to DVT or PE within 45 days and (iii) for clot recurrence within 12 months.MethodsData will be used from four primary care routine healthcare registries from both the Netherlands and the UK; one UK registry will be used for the development of the prediction models and the remaining three will be used as external validation cohorts. The study population will consist of patients ≥18 years with a diagnosis of SVT. Selection of SVT cases will be based on a combination of ICPC/READ/Snowmed coding and free text clinical symptoms. Predictors considered are sex, age, body mass index, clinical SVT characteristics, and co-morbidities including (history of any) cardiovascular disease, diabetes, autoimmune disease, malignancy, thrombophilia, pregnancy or puerperium and presence of varicose veins. The prediction models will be developed using multivariable logistic regression analysis techniques for models i and ii, and for model iii, a Cox proportional hazards model will be used. They will be validated by internal-external cross-validation as well as external validation.DiscussionThere are currently no prediction models available for predicting the risk of serious complications for SVT patients presenting in primary care settings. We aim to develop and validate new prediction models that should help identify patients at highest risk for complications and to support clinical decision making for this understudied thrombo-embolic disorder. Challenges that we anticipate to encounter are mostly related to performing research in large, routine healthcare databases, such as patient selection, endpoint classification, data harmonisation, missing data and avoiding (predictor) measurement heterogeneity.

Association Between Lower Extremity Venous Insufficiency and Intrapartum Fetal Compromise: A Nationwide Cross-Sectional Study.

Introduction: Chronic venous disorder (CVeD) has a high prevalence, being commonly diagnosed by the presence of varicose veins. In fact, the development of varicose veins in lower extremities and/or pelvic venous insufficiency (LEPVI) is frequent. However, its potential impact on fetal health has not been investigated. This study aimed to examine whether the presence of varicose veins in women's LEPVI is related to an intrapartum fetal compromise event.Materials: A cross-sectional, national study was conducted using medical administrative records (CMBD) of all vaginal births (n = 256,531) recorded in 2015 in Spain. The independent variable was defined as the presence of varicose veins in the legs, vulva, and perineum or hemorrhoids. A logistic regression model was used to assess the association of interest.Results: Among women with vaginal deliveries, those with varicose veins in their LEPVI have a significantly greater odds of intrapartum fetal compromise (OR = 1.30, 99.55%CI = 1.08–1.54) than their counterparts without varicose veins. After adjustment, this association remained significant (OR = 1.25, 99.5%CI = 1.05–1.50).Conclusions: Our findings of an association between varicose veins in women's lower extremities and/or pelvis and intrapartum fetal compromise suggest that varicose veins may be a novel and important clinical risk factor for fetal well-being and health.