Great Saphenous Vein Reflux Research Articles

Evaluatıng the Impact of Great Saphenous Veın Reflux Pattern on Clınıcal Severıty and Treatment Modalıty

Objectives: This research aimed to determine the impact of reflux patterns in patients with great saphenous vein (GSV) insufficiency on clinical severity and management. Methods: We evaluated 771 lower extremities of 452 patients having GSV insufficiency with Doppler Ultrasound. We characterized the reflux patterns like previously done in the literature: type 1, GSV reflux without the involvement of perimalleolar region or saphenofemoral junction (SFJ); type 2, GSV reflux involving perimalleolar region; type 3, GSV reflux involving SFJ; type 4, GSV reflux involving both perimalleolar region and SFJ. Then we conducted a study to evaluate the relationship between GSV reflux type and age, gender, venous clinical severity score (VCSS), clinical, etiological, anatomical and pathophysiological elements (CEAP), body mass index (BMI) and gave an effort to compare the groups by therapeutic strategies. Results: The mean age was 44±11 years. The male-to-female ratio was 0.49. The most commonly observed reflux pattern was type 3 (48%) in patients with GSV insufficiency and varicose veins. Patients with type 1 reflux were younger, had lower BMI, and had a better clinical situation (p=0.002). VCSS was associated with perimalleolar region involvement, as increased in type 2 reflux than type 1, and higher VCSS was related to SFJ involvement as defined in type 3 reflux. Type 4 reflux patients had the highest VCSS that means the most severe clinical presentation. Sclerotherapy was the most common treatment modality in type 1 reflux (p<0.001). Also, in type 2 and type 4 reflux, sclerotherapy was more preferred than type 3 (p<0.001). Type 4 reflux pattern required mostly radiofrequency ablation, compared with type 3 (28.2% vs 20.5%; p<0.05) after initial diagnosis. Cyanoacrylate glue embolization was the appropriate therapeutic option in only 3.2% of type 4 reflux patients, which was significantly lower than type 3. Conclusion: According to the reflux pattern classification system based on SFJ and malleolar region involvement as practiced in this study, we described a correlation between VCSS, CEAP, BMI, and the extent of venous insufficiency. This correlation with consideration of cosmetic reasons and vein diameter measurements can suggest further treatment modality. Advances in knowledge: We investigated a practical, clinically applicable, and widely accepted standard method for classifying GSV insufficiency. Mapping venous insufficiency with such a system is essential to determine the clinical severity and the most appropriate treatment modality.

Comparing the Effects of Radial and Jacketed Laser Tip Fibers on Outcome of Endovenous Laser Ablation of Lower Limb Truncal Venous Reflux

Saphenous vein reflux is one of the leading causes of cosmetic and functional disabilities.The recent ESVS guidelines recommend endovenous thermal ablation over surgery or sclerotherapy for the treatment of great saphenous vein (GSV) reflux in patients with chronic venous disease.The aim of this study is to compare different laser fiber tip configurations to outcome regarding technical success and incidence of complications. A retrospective analysis conducted on patients with documented GSV reflux from 2020 to 2022, comparing baseline parameters and outcome between 2 groups of laser tip fibers used; radial tip and jacketed tip. Primary end point was technical success. Secondary endpoints included incidence of complications in each group, and VCSS score difference in both groups. Inclusion criteria entailed patients with primary varicose veins over the age of 18 years, free from malignancy, hematological disorders, and having documented GSV reflux of more than 0.5 seconds. All patients had endovenous laser ablation (EVLA) of the, with complementary foam sclerotherapy or ambulatory phlebectomies as required. A total of 74 patients underwent EVLA (85 limbs). 54 were done using the radial laser fibers, and 32 using jacketed fibers. Technical success was achieved in 78 limbs (92.9%), 6 limbs (7.1%) had recanalization of the proximal 3cm GSV at 1 month, 2 patients experienced hematomas, and 5 patients had superficial vein thrombosis.There was no significant association between postoperative pain, bruising, recanalization, hematoma, and superficial vein thrombosis, with different laser fiber tip configurations (p-value .95, .6, .18, 1, & 1 respectively), nor was there any significant difference in VCSS between them (p-value .14).Technical success was 90% in the jacketed fibers and 94.1% in the radial fibers group (p-value 0.18). Neither does laser fiber tip configuration nor its make have a significance on outcome of EVLA of GSV reflux. Both radial and jacketed laser fiber tips exhibit similar safety and efficacy in EVLA.

Evaluation of Versatility of Mechanochemical Ablation (MOCA) in the Management of Great Saphenous Vein Reflux: A Day-case Intervention with Good Outcomes

Evaluation of Versatility of Mechanochemical Ablation (MOCA) in the Management of Great Saphenous Vein Reflux: A Day-case Intervention with Good Outcomes

Correlation between reflux time and venous clinical severity score in patients undergoing saphenous vein ablation: A prospective study

It is unclear whether reflux time independently correlates with severity of symptoms in patients with great saphenous vein reflux. Eighty patients (mean age 64+/-12.7years, 56% female) undergoing great saphenous vein (GSV) ablation for symptomatic reflux were assessed prospectively. Fifty-seven underwent ablation with radiofrequency, 23 with cyanoacrylate adhesive. Venous clinical severity score (VCSS) was assessed at, or prior to the time of ablation. The highest reflux time in the GSV was selected. VCSS values ranged from 2 to 20 (median 7). Mean reflux time was 5.3 s (+/-3.3). The Spearman rank correlation yielded a value of rs = -0.123, p (2-tailed) = .279, which was not significant. The patients with concomitant deep vein reflux had higher VCSS (p < .05). Analysis of patients with only superficial vein reflux (n = 45) also demonstrated a poor correlation between VCSS and reflux time (rs = -0.051, p (2-tailed) = .741). This prospective study did not demonstrate a correlation between reflux time and VCSS.

Characteristics of venous leg ulcer patients at a tertiary wound care center

ObjectiveThe objective of this study was to assess patient, wound, care, and reflux characteristics of venous leg ulcers (VLUs) to update and improve knowledge of disease etiology, identify barriers to healing, and improve treatment. MethodsPatients diagnosed with VLUs treated at the Stanford Advanced Wound Care Center between 2018 and 2019 were identified from the Healogics iHeal database. We identified 327 VLU entries, of which 133 were patients who had multiple or recurring wounds. An additional 27 patients were labeled as misdiagnosis, resulting in a final patient sample of 167. Patient demographics, wound, care, and ultrasound data for these patients were extracted from the Stanford electronic medical records regarding characteristics. The initial data analysis suggested possible differences in VLU characteristics depending on patient age and body mass index (BMI), which was then further analyzed. ResultsOf the 167 VLU patients assessed, 53.9% were male and 46.1% were female. The mean age was 74.7 years, and the average BMI was 30.2 kg/m2, including 41.1% of patients with a BMI over 30 kg/m2. Approximately 50% of wounds were presented in multiples, had cellulitis, or were recurring, and 39.5% were caused by trauma. Most common venous reflux patterns on duplex ultrasound examination were below-knee great saphenous vein reflux and calf perforator reflux, which was identified in 37.7% and 29.3% of the patients, respectively. Axial great saphenous vein reflux was detected in 14.4% of patients. When looking at the patient sample under 60 years of age, 67.7% were male, 61.3% presented with venous skin changes, and 51.6% had diabetes. In the patients older than 60, only 51.9% were male, 37.6% presented with venous skin changes, and 31.6% had diabetes. BMI was greater in the patients under age 60, with an average of 39.2 kg/m2, compared with 28.2 kg/m2 in those above 60. Of the patients with a BMI ≥30 kg/m2, 64.3% had multiple wounds, 61.4% had recurring wounds, and 56.5% had venous skin changes. In contrast, in patients with BMI <30 kg/m2, 47.4% had multiple wounds, 39.2% had recurring wounds, and 32.0% had venous skin changes. ConclusionsVLU pathology appears to differ depending on patient demographics and characteristics. Different drivers may influence disease cause, progression, and prognosis, making a standard approach to VLUs difficult. Our findings suggest that identifying different subtypes of VLUs and adapting an algorithm of care with a personalized treatment may help optimize management of these patients.

Impact of Ultrasound-Guided Foam Sclerotherapy for Pain Control in Patients with Chronic Venous Disease and Great Saphenous Vein Reflux.

Chronic venous disease (CVD) associated with great saphenous vein (GSV) reflux has a higher prevalence of pain in the lower limbs. This study evaluates the impact of ultrasound-guided foam sclerotherapy (UGFS) for GSV and symptom control, accessed by the visual analogue scale (VAS). Patients with CVD who underwent GSV-UGFS were included in this retrospective cohort (417 limbs). The pain was measured before and after the treatment. The scale alteration was assessed as a function of age, sex, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classes, total of sclerotherapy sessions, GSV occlusion patterns, and ulcer healing. Majority of patients were female (59.2%), and the mean age was 56 ± 11.5 years. In the total sample, 78.2% of the GSVs were fully occluded, 19.7% had partial occlusion, 2.2% remained open, and 3.2 ± 1.9 (median = 3.0) sessions were performed. The reduction of symptoms occurred in 88.3% of participants (VAS drop median = 4.8). Patients younger than 50 years and females had the greatest VAS decreases. When comparing the outcomes of complete occlusion versus partial occlusion, there was no significant difference in VAS pain reduction ( p = 0.14). The comparison between CEAP clinical classes also did not show statistically significant differences in delta VAS ( p = 0.71). GSV-UGFS was effective for pain control. However, this improvement does not appear to be related to the pattern of occlusion, indicating that in the short term, the outcomes of total and partial occlusion suggest successful management of symptoms. Other aspects such as gender, age, pretreatment pain intensity, and CEAP classes seem to play a role in the clinical outcome.

Association of duplex ultrasonography findings with the severity of chronic venous disease in Thai patients

IntroductionChronic venous disease (CVD) is characterized by venous hypertension and stasis, which occur because of valvular incompetence and/or venous outflow obstruction. This study aimed to investigate the relationship between CVD clinical presentation and duplex ultrasonography findings in a Thai patient population. MethodThis cross-sectional study examined patients diagnosed with CVD at the Chulabhorn Hospital Vascular Clinic (Bangkok, Thailand) between December 1, 2018 and October 1, 2021. Patient data was obtained from the medical records and review of lower limb venous ultrasonography studies. Patients were assessed using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification of venous disorders: mild-to-moderate CVD was defined as C1 to C3 and severe CVD was defined as C4 to C6. ResultsOverall, 260 CVD patients were analyzed (60 men and 200 women). More than 75% of the patients were women and more than 80% had bilateral lower limb involvement. Factors associated with severe CVD were older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (38.8%), followed by C1 (33.85%), C4 (12.2%), C3 (9.23%), C6 (3.46%), and C5 (2.31%). Two-thirds of the patients had great saphenous vein reflux and nearly half had perforator vein reflux. Perforator reflux and small saphenous vein reflux were significantly associated with severe CVD (P < 0.001 and P = 0.028, respectively). Higher number of venous systems involved was significantly associated with severe CVD (P = 0.005). Reflux time of the great saphenous vein correlated with severe CVD and VCSS (P = 0.026 and P = 0.037, respectively). Mean diameters of the superficial vein, perforator vein, and deep vein and reflux times of the perforator and deep veins were not significantly associated with severe CVD. ConclusionThe major risk factors for severe CVD are older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (39%). Great saphenous vein reflux was the most common type of reflux in our study population. Increasing number of venous systems involved increased the risk of severe CVD. The presence of perforator vein reflux and small saphenous vein reflux also increased the risk of severe CVD. Reflux time of the great saphenous vein correlated with severe CVD and venous clinical severity score.

Pilot single-arm study to investigate the efficacy and safety of endovenous Microwave ablations for treatment of varicose veins in Singapore - one year results of the MAESTRO registry.

Aim was to report a prospective two-centre Singaporean experience using Endovenous Microwave Ablation (EMA) to treat symptomatic primary great saphenous vein reflux. We evaluated 1-year safety, efficacy and patient satisfaction. 50 patients (63 limbs; 29 females; mean age 58.0 ± 12.1years) were included. Patients were reviewed at 2-weeks, 3-, 6- and 12-months and underwent Duplex ultrasound assessment. Three quality of life (QoL) questionnaires were completed. The truncal closure rates at 2-weeks, 3-, 6- and 12-months were 63/63 (100%), 59/59 (100%), 58/58 (100%) and 59/60 (98.3%), respectively. There was 100% technical success and no serious adverse events. There were sustained improvement of QoL questionnaire scores from 2weeks to 12months. EMA is a safe and efficacious venous ablative technology at 12 months and is associated with a high rate of target vein occlusion and sustained QoL improvement.

Factors associated with delayed venous ulcer healing after endovenous intervention for superficial venous insufficiency

ObjectiveThis retrospective trial analyzed the effect of predetermined variables on venous ulcer healing after endovenous ablation of insufficient veins. MethodsA total of 259 patients presenting 273 venous leg ulcers (VLUs) at Oulu University Hospital vascular outpatient clinic between January 2010 and December 2020 were included in the study. In addition to compression therapy, all patients received endovenous ablation (endothermal ablation and/or foam sclerotherapy) to promote venous healing. The hazard ratio (HR) for an ulcer to heal was analyzed in univariate analysis of predetermined factors, including age, sex, recurrent venous ulcer, presence of great saphenous vein or small saphenous vein reflux, persistent superficial vein reflux after ablation, recanalization in treated segments, ulcer age, body mass index >35 kg/m2, history of deep vein thrombosis, history of erysipelas, ability to move, smoking, hypertension, atrial fibrillation, coronary artery disease, diabetes mellitus, and cardiac insufficiency. Logistic regression was used in a multivariate analysis to identify independent risk factors for ulcer healing. ResultsIn the univariate analysis, healing was negatively associated with persistent superficial vein reflux after ablation (HR, 0.117; 95% confidence interval [CI], 0.088-0.354), recanalization in treated segments (HR, 0.161; 95% CI, 0.060-0.433), nonambulatory patient (HR, 0.322; 95% CI, 0.130-0.800), history of deep vein thrombosis (HR, 0.518; 95% CI, 0.294-0.910), and presence of small saphenous vein reflux (HR, 0.565; 95% CI, 0.384-0.830). Independent risk factors included persistent superficial vein reflux after ablation (HR, 0.123; 95% CI, 0.0051-0.295). All the patients in the persistent superficial vein reflux group had their VLUs eventually healed after further endovenous treatment. ConclusionsWhen treating patients with VLUs, persistent superficial vein reflux after ablation was negatively associated with ulcer healing. After additional endovenous ablative treatment, ulcers with persistent reflux eventually healed.

Risk Factors for and Treatment of Chronic Venous Disease in Thai Patients.

IntroductionThe prevalence of chronic venous disease (CVD), a common health care problem, is still underestimated. A few previous epidemiologic studies have report Asian patients with this condition in western countries, but not in Asian countries. The aim of this study was to determine risk factors for CVD and its treatment in Thai individuals.MethodsIn this cross-sectional study, we collected data of patients with CVD visiting Chulabhorn Hospital Vascular Clinic from 1 December 2018–1 October 2021. We reviewed medical records for patient characteristics, comorbidities, Clinical, Etiology, Anatomy, Pathophysiology (CEAP) categories, Venous Clinical Severity Score (VCSS), ultrasound findings and treatment.ResultsThe study cohort comprised 260 CVD patients with CVD of mean age 61.92 ± 12.82 years. Almost 80% of participants were female. A history of deep vein thrombosis (DVT) was the strongest risk factor for severe CVD. Other identified risk factors comprised body–mass index (BMI) >30 kg/m2, and older age. The most common CEAP categories were C2 (39%) and C1 (33.8%). Superficial venous reflux was the most common location of venous reflux in this study, 67.32% of participants having great saphenous vein reflux and 16.99% small saphenous vein reflux. Only 4.76% of our cohort had both reflux and obstruction. Most of the participants had undergone compression therapy, approximately half of them complying well with wearing of stockings. Nineteen percent of our cohort had undergone sclerotherapy and 14% surgery, which comprised radiofrequency ablation in 97% of them.ConclusionThe major risk factors for severe CVD identified in this study were deep vein thrombosis, body mass index>30 kg/m2 and older age. The most common CEAP category was C2 (39%). GSV was the most commonly involved venous system. Involvement of numerous venous systems was a risk factor for severe CVD.

Impact of a synchronous prophylactic treatment of the anterior accessory saphenous vein on the recurrent varicose vein rate in patients undergoing thermal ablation of an insufficient great saphenous vein (SYNCHRONOUS-Study): study protocol for a prospective, multicentre, controlled observational study

IntroductionTo date, there are no prospective studies evaluating the prevention of recurrent veins by the simultaneous treatment of a sufficient anterior accessory saphenous vein (AASV) in patients undergoing endovenous laser...

Severity of disease and treatment outcomes of anterior accessory great saphenous veins compared with the great saphenous vein: Presented at the Thirty-fourth Annual Meeting of American Vein and Lymphatic Society, Washington, D.C., October 15-18, 2020.

Objective Endovenous therapies are currently the standard of care for the treatment of patients with symptomatic great saphenous vein (GSV) reflux. The effectiveness and long-term outcomes of these therapies for anterior accessory great saphenous veins (AAGSVs) are poorly defined. The objective of this investigation is to determine treatment outcomes in patients with symptomatic AAGSV reflux compared with patients with symptomatic GSV reflux.

Correlation of Clinical Class with Duplex Ultrasound Findings in Lower Limb Chronic Venous Disease

BackgroundThis study investigated the distribution of valve incompetence in patients with chronic venous disease (CVD) and its correlation with the clinical category of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification.MethodsIn total, 1,386 limbs with clinically suspected CVD were categorized according to the CEAP classification and consecutively underwent duplex ultrasonography between April 2017 and December 2020.ResultsThere were 362 limbs in male patients and 1,024 limbs in female patients. The limbs were classified as C0s–C1 (608 limbs, 43.8%), C2 (727 limbs, 52.5%), or C3–C6 (51 limbs, 3.7%). The prevalence of saphenous vein incompetence in CEAP C0s–C1 limbs was 43.6%. The saphenofemoral junction (SFJ) was competent in 37% of CEAP C2–C6 limbs. The CEAP C3–C6 category was not correlated with reflux patterns of the saphenous vein system (Cramer’s V=0.07), incompetent SFJ (Cramer’s V=0.07), deep vein reflux (Cramer’s V=0.03), or the distribution of incompetent segments in the great saphenous vein (GSV) (Cramer’s V=0.11).ConclusionDuplex ultrasonography is necessary to formulate a proper treatment plan for limbs categorized as CEAP C0s–C1. The SFJ was competent in more than one-third of CEAP C2–C6 limbs with GSV reflux; as such, flush ligation of the GSV may be unnecessary in these patients. The CEAP C3–C6 category showed no correlations with reflux patterns of the saphenous vein system, SFJ reflux, deep vein reflux, or the distribution of incompetent segments in the GSV.

Diameter-reflux relationship of the saphenous vein in the C0-C3 patients of chronic venous disease.

To evaluate the relationship between the saphenous vein's diameter and reflux and determine the cut point of the saphenous vein's diameter that indicates lack of reflux. A retrospective cohort study conducted in 807 limbs underwent the venous ultrasound for 36months. The saphenous vein's diameter in the reflux and non-reflux groups was evaluated. The receiver operating characteristics (ROC) curve was constructed to determine the saphenous vein's diameter that maximizes the summation of sensitivity and specificity for saphenous vein reflux in C0-C3 patients. The reflux group had a significantly greater diameter than a non-reflux group at four great saphenous vein (GSV) levels and two small saphenous vein (SSV) levels (p-value < 0.001). The venous reflux correlated significantly with GSV diameter at all four GSV levels and two SSV levels (p-value <0.001). The ROC area of the diameter at four GSV levels ranges from 0.59 to 0.69. The optimal cut-off diameter for GSV reflux is 3.8mm at the proximal thigh, 2.8mm at the distal thigh, 3.2mm at the proximal calf, and 2.5mm at the distal calf. The ROC area of the diameter at two SSV levels ranges from 0.66 to 0.67. The optimal cut-off diameter for SSV reflux is 2.5mm at the proximal calf and 2.3mm at the distal calf. The saphenous vein's diameter has been proved to be significantly correlated with the presence of reflux in duplex ultrasound in all lower limbs' levels. Unfortunately, the study's cut point diameter is considered poor accuracy and is not an accurate measurement to use as the screening test for the presence of reflux.

Combined Treatment of the Anterior Accessory Saphenous Vein and the Great Saphenous Vein

The anterior accessory saphenous vein (AASV) is a common source of primary and recurrent lower extremity varicose veins. Reflux in the AASV can occur independently or simultaneously with great saphenous vein (GSV) reflux. A number of published reports describe recommendations and treatment of symptomatic refluxing AASVs, but descriptions of combined treatment are sparse. Treatment options for ablation of the AASV include both thermal and non-thermal techniques, and results are equivalent to ablation of the great and small saphenous veins. Although not commonly performed, concomitant ablation of the AASV and the GSV is effective and safe, and can be accomplished with minimal additional time. Concomitant treatment is an appropriate option that should be discussed with the patient.

A prospective multicenter randomized clinical trial comparing endovenous laser ablation, using a 1470 nm diode laser in combination with a Tulip-TipTM fiber versus radiofrequency (Closure FAST™ VNUS®), in the treatment of primary varicose veins.

The treatment of chronic venous disease, has largely shifted from high ligation and stripping to endovenous thermal ablation (EVTA) techniques, because of its comparable efficacy and lack of invasiveness. This clinical trial aimed to compare the efficacy of two thermal ablation techniques, endovenous laser ablation (EVLA) 1470-nm with Tulip-TipTM fiber and radiofrequency ablation (RFA) ClosureFastTM using a non-inferiority design for occlusion rate (primary outcome). A prospective multicenter randomized clinical trial randomized 280 patients for the treatment of great saphenous vein (GSV) reflux. Primary outcome was the GSV occlusion rate, secondary outcome factors were the possible side-effects of the treatment such as pain, ecchymosis, quality of Life (CIVIQ-20), revised Venous Clinical Severity Score (r-VCSS). One-year follow-up period. The total occlusion rates at one year follow-up were 96.4% and 94.5% in the EVLA and RFA groups respectively (P=0.15). Regarding secondary outcomes, such as postoperative CIVIQ-20, r-VCSS, analgesia, absenteeism, there was no significant difference between both treatment groups. RFA and EVLA, using a 1470 nm laser with Tulip-TipTM fiber, of the GSV results in equal occlusion rates at one year, with comparable postoperative pain and improved quality of life.

FEATURES OF SUPERFICIAL VEIN THROMBOSIS IN PATIENTS WITH A LARGE DIAMETER OF GREAT SAPHENOUS VEIN

Introduction. Superficial vein thrombosis is characterized by the formation of thrombi in the superficial veins with subocclusion or occlusion of the venous lumen and its inflammatory reaction, which occurs more often in the lower extremities. Chronic venous disease in 75–88% of cases is the most important clinically identified factor in the development of superficial vein thrombosis. The great saphenous vein is affected in 60–80% of cases. A population-based study found that the chronic venous disease is a risk factor for venous thromboembolism and correlates with an increased risk of mortality in patients. Venous thromboembolism is a major burden of the disease worldwide, with approximately 10 000 000 cases per year. Objective: to assess the prevalence of superficial vein thrombosis in patients with chronic venous disease and to identify the relationship between the diameter of the great saphenous vein and superficial vein thrombosis. Materials and methods. Total of 925 chronic venous disease cases were analyzed from January 2019 to December 2021 at the Clinical Department of Surgery, Traumatology, Orthopedics, and Phthisiology of Sumy State University (Sumy Laser Clinic, LLC) for the prevalence of superficial vein thrombosis in patients with chronic venous disease who were undergoing treatment. The patients with superficial vein thrombosis were examined for the diameters of great saphenous vein and venous reflux using ultrasound 10 mm below the sapheno-femoral junction, in the upper and lower thirds of the thigh. Results: Of 925 chronic venous disease cases, superficial vein thrombosis was observed in 53 cases, which accounted for 5.73 % of the total. Women accounted for 67.9 % (36), men – for 32.1 % (17). The study included patients aged 25 to 69 years (mean age 52.62 ± 10.48 years). In 69.8 % (37) of superficial vein thrombosis cases, the diameter of great saphenous vein was ≥ 10 mm at a level 10 mm below the sapheno-femoral junction; in 49 % (26) of cases – in the upper third of the thigh; in 30.2 % (16) of cases – in the lower third of the thigh. That is, the extension of the sapheno-femoral junction trunk to the lower third of the thigh was preserved in 43.24% of cases. Conclusion. The results of the study revealed a high prevalence (5.73%) of superficial vein thrombosis. 69.8% of all cases of superficial vein thrombosis was registered in patients with a large diameter (≥ 10 mm) of great saphenous vein.

Expression of the ACTA1, PLXNA4, and SEMA3A genes in varicose veins of patients with different length of great saphenous vein reflux

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучение экспрессии связанных с ремоделированием актинового филамента генов <i>ACTA1</i>, <i>PLXNA4</i> и <i>SEMA3</i> в стенках варикозно измененных (ВВ) и неизмененных (НВ) вен у пациентов с разной протяженностью патологического рефлюкса в большой подкожной вене (БПВ). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Обследованы 26 пациентов, которых разделили на две равночисленные группы: с протяженностью патологического рефлюкса до нижней трети бедра (13 пациентов) и до нижней трети голени (13 пациентов). После выделения РНК из парных (ВВ и НВ, 26 пар) сегментов БПВ от каждого пациента методом ОТ-ПЦР в реальном времени была проведена оценка на уровне мРНК относительной экспрессии изучаемых генов. <h3>РЕЗУЛЬТАТЫ</h3> Показана разница в отношениях экспрессии (в ВВ к НВ внутри пар) гена <i>ACTA1</i> между группами пациентов с разной протяженностью рефлюкса (<i>p</i>=0,03). Выявлена дифференциальная экспрессия гена <i>PLXNA4</i> в ВВ в группе пациентов с протяженностью рефлюкса до нижней трети бедра (<i>p</i>=0,04), а также между подгруппами НВ от пациентов с протяженностью рефлюкса до нижней трети бедра и НВ от пациентов с рефлюксом до нижней трети голени (<i>p</i>=0,03). Показана дифференциальная экспрессия в ВВ (<i>p</i>=0,02) в группе пациентов с рефлюксом до нижней трети бедра для гена <i>SEMA3A</i>, продуктом которого является лиганд рецептора PLXNA4. <h3>ЗАКЛЮЧЕНИЕ</h3> Показана разница в экспрессии генов <i>ACTA1</i>, <i>PLXNA4</i> и <i>SEMA3</i>, участвующих в процессах ремоделирования цитоскелета и, как следствие, венозной стенки, в образцах вен от пациентов с разной протяженностью патологического рефлюкса в БПВ. Таким образом, протяженность патологического рефлюкса в магистральной вене, определяющая вероятность рецидива рефлюкса после процедуры ASVAL, связана с ремоделированием стенки вены. Выявленные гены могут стать перспективными терапевтическими мишенями.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ЭНДОВЕНОЗНОЙ МЕХАНОХИМИЧЕСКОЙ ОБЛИТЕРАЦИИ БОЛЬШОЙ ПОДКОЖНОЙ ВЕНЫ С ИСПОЛЬЗОВАНИЕМ ПЕНЫ ПОЛИДОКАНОЛА КОМНАТНОЙ ТЕМПЕРАТУРЫ И ОХЛАЖДЕННОЙ

Objective. To conduct a comparative analysis of long-term (3-yars) results of varicose veins treatment by mechanochemical endovenous ablation (MOCA) with using polidocanol foam of room temperature and a chilled one. Methods. The study is based on the treatment results of 122 patients with great saphenous vein (GSV) incompetence. The patients were randomized into 2 groups. In the main group (n=60), mechano-chemical ablation was performed according to original technique, using a cooled sclerosant, 60ᵒ degrees leg elevation and a shin bandage; in the comparison group (n=62) standard technique was used. The median GSV diameter in the main group was Me (Q25; Q75) = 7.4 (5.8; 8.2) mm, in the comparison group - Me (Q25; Q75) = 7.3 (5.6; 8.3) mm (P=0.794). Results. One month after the surgery, the GSV was totally occluded in 100% cases in the main and in 96.7% cases in the comparison group (P=0.496). One year after the surgery, occlusion rates were 94.6% and 80.4% respectively (P=0.042). 3 years later, GSV occlusion was diagnosed in 92.6% cases and in 76.4% cases, respectively (P=0.0033). Hyperpigmentation was reported in 21.7% legs in the main group and 22.6% legs in the comparison group (P&gt;0,99). Transient superficial phlebitis developed in 6.7% and in 8.1% legs, respectively (P=0.744). Conclusion. Endovenous mechanochemical cryoablation is more effective than the standard MOCA technique and can be considered as the most preferable method for eliminating reflux in the GSV. What this paper adds A comparative safety and efficacy of the endovenous mechanochemical cryoablation in comparison with the standard technique to eliminate GSV reflux has been evaluated for the first time. A small number of complications and significant positive dynamics of clinical symptoms were reported in both groups. After 3 years, GSV recanalization rate was 3.2 times higher using the standard technique.

Comparative analysis of short-term outcomes after surgical treatment of varicose disease with endovasal laser obliteration and short stripping

The purpose of this study was to compare outcomes (within six months) after short stripping (SS) and endovenous laser obliteration (EVLO) in patients with varicose veins when analyzing ultrasound findings, postoperative complications, level of postoperative pain, clinical manifestations, and duration of rehabilitation after the intervention. Patients with varicose veins of lower extremities and insufficiency of large saphenous vein valves had either EVLO or SS with miniflebectomy. All patients were examined before surgery and then in 5 days, 10 days and in 1, 3 and 6 months after it. The patients also had clinical examination, ultrasound duplex scanning of their lower extremity veins; Venous Clinical Severity Score (VCSS) was also used for the trial. Pain was assessed during the first 10 days after the surgery using a 10-point pain assessment scale. 156 patients (177 lower extremities) were followed-up for 6 months. As the results of our study showed, endovenous laser obliteration and short stripping were equally effective in eliminating the reflux of the great saphenous vein (GSV). After 6 months of follow-up, the reflux along the medial inflow was noted in one case in SS group; partial GSV recanalization was noted in one case in EVLO group in 3 months, in 3 cases – in 6 months. Besides, despite LMH preventive doses one patient from EVLO group had EHIT II deep vein thrombosis. The obtained outcomes have demonstrated that EVLO and SS have similar effectiveness and safety. No difference has been found between these two types of treatment, except more pronounced postoperative pain and bruising in SS group. Performed care was equally safe and effective in eliminating GSV reflux, in relieving symptoms and eliminating varicose veins as well as in improving the quality of life. Long-term outcomes, especially the rate of relapses depending on the type of intervention, are to be investigated in future trials.