Saphenofemoral Insufficiency Research Articles

Varicose Veins of the Lower Extremity: Doppler US Evaluation Protocols, Patterns, and Pitfalls.

Venous insufficiency is a cause of substantial morbidity and medical expenditures. Diagnostic US evaluation of venous insufficiency requires a thorough understanding of the venous anatomy, including the deep, superficial, and perforator veins. The highly variable venous anatomy requires that operators use sound judgment to expand on protocol images and thus avoid missing important sources of reflux. The US examination requires specific patient positioning and use of provocative maneuvers. A basic understanding of the pathophysiology of venous insufficiency and the various treatment methods helps to identify key observations so that ineffective treatment methods are not pursued. The examination reports should have greater detail than those for the more common lower extremity deep venous thrombosis evaluation, requiring numeric and narrative descriptions of deep and superficial venous patency, reflux, diameter, and pathways. Potential pitfalls include not recognizing or detecting deep venous reflux, misidentifying common femoral vein reflux as deep venous reflux when the reflux is isolated or related to saphenofemoral insufficiency, not recognizing anterior accessory great saphenous vein (AAGSV) involvement in saphenofemoral insufficiency, not recognizing or reporting great saphenous vein or AAGSV superficialization, not suspecting central venous obstruction, and not realizing when provocative maneuvers were ineffective. With knowledge of the lower extremity venous anatomy, venous insufficiency pathophysiology, basic treatment strategies, protocol best practices, patterns of observation, and diagnostic pitfalls, those who interpret venous insufficiency US studies can perform examinations and deliver reports that help patients receive appropriate treatment. Online supplemental material is available for this article. ©RSNA, 2022.

The association between varicocele and other vascular diseases: A systematic review and meta-analysis.

This study is aimed to evaluate the association between varicocele and other vascular diseases through a systematic reviews and meta-analyses. We searched Cochrane Central Register of Controlled Trials, Embase, PubMed, and Web of Science for studies that reported varicocele and other vascular diseases published before 30 June 2021. The meta-analysis was performed by Revman V.5.2 to calculate the pooled odds ratios and corresponding 95% confidence intervals. Subsequently, the impact of publication bias was evaluated, and sensitivity analysis as performed to assess our results' robustness. In total, seven case-control studies, including 803 varicocele cases and 727 controls, were included. Our meta-analysis results showed that the varicocele patients had a higher risk of saphenofemoral insufficiency when compared with the control group (odds ratio [OR]: 2.80; 95% confidence intervals [CIs]: 2.03, 3.84; p < 0.00001). Additionally, varicocele patients also had a higher risk of lower extremity venous insufficiency when compared with the control group (OR: 2.34; 95% CI: 1.58, 3.47; p < 0.0001). However, there was no statistical difference in hemorrhoid risk between both groups (OR: 1.13; 95% CI: 0.28, 4.59; p = 0.87). Our study demonstrated that varicocele patients have higher risk of saphenofemoral and lower extremity venous insufficiencies but not the risk of hemorrhoids.

Is There a Link Between Saphenofemoral Insufficiency and Varicocele: Imaging Study of Sub-Fertile Men

Background: Varicocele is an important cause of infertility in men. Some studies have suggested that because of the similar pathologic processes involved in chronic venous diseases and varicocele, saphenofemoral insufficiency is an example of chronic venous disease, which causes varicose veins in the lower extremity. It is thought that there may be a relation between saphenofemoral abnormality and the emergence of varicocele, but this relation is not backed by sufficient evidence. Methods: In this prospective diagnostic study, a total of 50 patients suffering from varicocele and 50 control patients were included. Ultrasonography was performed to determine the emergence of saphenofemoral insufficiency (SFI). Results: Mean age of patients in the varicocele group and the control group was 32.4  8.44, and 34.9  6.39, respectively. Out of 50 patients being included in the study with varicocele, 8 had left sided SFI and 9 had right sided SFI, while in the control group, 4 patients were diagnosed with SFI, 2 on each side. The difference between the two groups was statistically significant. There was no relation between the time from diagnosis of varicocele, side of varicocele and the existence of saphenofemoral insufficiency. Conclusions: Saphenofemoral insufficiency was shown to be significantly related to varicocele, and can be a sign of probability of emergence or re-emergence of varicocele, and further can be used in clinical examination to guide clinicians in diagnosing varicocele.

The evaluation of saphenofemoral insufficiency in primary adult varicocele

PurposeThe aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele.Patients and methodsA total of 40 patients with the primary diagnosis of varicocele were included in the study. A total of 40 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by means of palpation and observation of each spermatic cord in standing position before and during a Valsalva maneuver. In addition, scrotal Doppler and lower extremity venous Doppler ultrasonography (US) were performed. Patients who had spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler US, a retrograde flow lasting longer than 0.5 s during normal breathing or at the Valsalva maneuver was considered to be indicative of saphenofemoral junction (SFJ) insufficiency.ResultsTwenty-five (62.5%) patients had SFJ insufficiency in the study group, whereas 11 patients (27.5%) had insufficiency in the control group. Of the 40 study participants, 10 participants had recurrent varicocele. All of them were seen to have SFJ reflux on Doppler US (100%) (P = 0.014). The patients with primary varicocele had a statistically significantly (P = 0.02) higher rate of venous insufficiency in their SFJs when compared with the control group.ConclusionThe results of the present study show that the incidence of SFJ reflux increases in individuals with varicocele, with a higher incidence in cases of recurrent varicocele. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from SFJ insufficiency.

323 COMPARISONS OF RIGHT AND LEFT TESTICULAR SIZE IN BOYS WITH AND WITHOUT VARICOCELE

of 60 patients with primary diagnosis of varicocele and 20 agematched controls were included into the study. Varicocele was diagnosed by observation and palpation of each spermatic cord in standing position before and during a valsalva maneuver. All patients examine for hemorrhoids by general surgeon. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for sapheno-femoral junction insufficiency. RESULTS: Thirtyeight(63.3%)patients had hemorrhoids in the study-group whereas 5(25.0%) had hemorrhoids in the control-group. The study-group had a statistical significant higher rate of hemorrhoids than control-group. Fortysix(76.6%) patients had insufficiency in sapheno-femoral junction in the study-group whereas 6(30.0%) had insufficiency in the control-group. The patients with primary varicocele had a statistical significant higher rate of venous insufficiency in their sapheno-femoral junctions than control-group. Although the patients who have grade III varicoceles tended to have saphenofemoral insufficiency and hemorrhoids,there was no statistical significance between the grade of varicocele and the presence of saphenofemoral insufficiency or hemorrhoids. CONCLUSIONS: The rate of hemorrhoids and sapheno-femoral insufficiency has been found to be statistically higher in patients with primary varicocele compared to healthy men. Thus,we claim that varicocele formation may not always be a local disease. However,further studies in larger group of patients are certainly required to confirm the possible association between these pathological conditions.

322 IS VARICOCELE A COMPONENT OF PELVIC OR SYSTEMIC VENOUS DISEASE?

You have accessJournal of UrologyPediatrics: Andrology-Cryptorchidism & Varicoceles1 Apr 2011322 IS VARICOCELE A COMPONENT OF PELVIC OR SYSTEMIC VENOUS DISEASE? Hakan Koyuncu, Anar Ismayilov, Vugar Hasanov, Nail Ersoz, Yusuf Kibar, Hasan Cem Irkilata, and Murat Dayanc Hakan KoyuncuHakan Koyuncu Ankara, Turkey More articles by this author , Anar IsmayilovAnar Ismayilov Ankara, Turkey More articles by this author , Vugar HasanovVugar Hasanov Ankara, Turkey More articles by this author , Nail ErsozNail Ersoz Ankara, Turkey More articles by this author , Yusuf KibarYusuf Kibar Ankara, Turkey More articles by this author , Hasan Cem IrkilataHasan Cem Irkilata Ankara, Turkey More articles by this author , and Murat DayancMurat Dayanc Ankara, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.405AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to evaluate the possible relationship between varicocele and hemorrhoids and sapheno-femoral insuficiency, which are the clinicial signs of venous insufficiency, in patients diagnosed with primary varicocele. METHODS Between November-2009 and August-2010, a total of 60 patients with primary diagnosis of varicocele and 20 age-matched controls were included into the study. Varicocele was diagnosed by observation and palpation of each spermatic cord in standing position before and during a valsalva maneuver. All patients examine for hemorrhoids by general surgeon. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for sapheno-femoral junction insufficiency. RESULTS Thirtyeight(63.3%)patients had hemorrhoids in the study-group whereas 5(25.0%) had hemorrhoids in the control-group. The study-group had a statistical significant higher rate of hemorrhoids than control-group. Fortysix(76.6%) patients had insufficiency in sapheno-femoral junction in the study-group whereas 6(30.0%) had insufficiency in the control-group. The patients with primary varicocele had a statistical significant higher rate of venous insufficiency in their sapheno-femoral junctions than control-group. Although the patients who have grade III varicoceles tended to have saphenofemoral insufficiency and hemorrhoids,there was no statistical significance between the grade of varicocele and the presence of saphenofemoral insufficiency or hemorrhoids. CONCLUSIONS The rate of hemorrhoids and sapheno-femoral insufficiency has been found to be statistically higher in patients with primary varicocele compared to healthy men. Thus,we claim that varicocele formation may not always be a local disease. However,further studies in larger group of patients are certainly required to confirm the possible association between these pathological conditions. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e130-e131 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hakan Koyuncu Ankara, Turkey More articles by this author Anar Ismayilov Ankara, Turkey More articles by this author Vugar Hasanov Ankara, Turkey More articles by this author Nail Ersoz Ankara, Turkey More articles by this author Yusuf Kibar Ankara, Turkey More articles by this author Hasan Cem Irkilata Ankara, Turkey More articles by this author Murat Dayanc Ankara, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Evaluation of Saphenofemoral Insufficiency in Primary Adult Varicocele

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P = .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Endovenous Ablation of Saphenofemoral Insufficiency: Analysis of 100 Patients Using RF Closure Fast Technique

Chronic venous insufficiency is a common problem leading to varicose veins of lower limbs which was traditionally being treated with ligation and stripping. Endovenous ablation is an attractive alternative minimally invasive technique to treat such patients. We analysed the results of 100 consecutive patients treated with Radiofrequency based endovenous ablation using Closure Fast Catheter. Retrospective analysis of 100 consecutive patients with chronic venous insufficiency treated at our institution was done. All patients were classified pre and post procedure based on clinical, etiologic, anatomic and pathophyslogical classification, Venous clinical severity and Venous disablitity scores alongwith color doppler examination with follow up done at 2weeks, 3months and one year for any disease recurrence or residual symptoms. 97 of the 100 patients treated at 3months and at 1year showed good reduction of venous clinical severity and Venous disability scores to 0. Doppler showed complete closure of saphenofemoral junction and long saphenous vein at 2weeks with no recanalisation at one year. No thrombus formation was observed. Minor complications like ecchymosis was seen in 9 patients and thrombophlebitis in 4 patients. Endovenous ablation using radiofrequency with Closure Fast technique showed improved short and long term results in patients with venous insufficiency with 100% closure seen on doppler studies along with lesser complications and no thrombus formation due shortened procedure time and improved catheter design.

Venous Reflux From the Pelvis and Vulvoperineal Region as a Possible Cause of Lower Extremity Varicose Veins

The aim of this study was to demonstrate with the use of computed tomography and ultrasonography that isolated venous reflux from the pelvis and vulvoperineal region is a possible cause of lower extremity varicose veins. From a consecutive series of patients who were referred to the vascular imaging laboratory, we retrospectively selected patients who had unusual lower extremity varicose veins that arose from the pelvis and vulvoperineal region. Computed tomographic venography and ultrasonograhy were used to exclude other causes of varicose veins. We reviewed medical records to evaluate the presence of pelvic congestion syndrome. Computed tomographic findings were reviewed to locate ovarian vein dilatation. Twenty limbs of 15 female patients (age range, 33-72 years; mean age, 53.2 years) were diagnosed with varicose veins that arose from the pelvis and vulvoperineal region without any saphenofemoral insufficiency. Eleven patients (73.3%) had no history of chronic pelvic pain. Four patients (26.7%) presented with chronic pelvic pain without any other evident gynecological etiology. Dilatation of the left ovarian vein was seen in 10 patients (67%; mean dilatation, 8.6 mm; range, 7.5-9.6 mm). Five patients (33%; mean dilatation, 4.9 mm; range, 3.8-6.6 mm) showed no ovarian vein dilatation. The combined use of computed tomographic venography and ultrasonography may be a possible noninvasive method for the diagnosis of unusual lower extremity varicose veins. Venous reflux from the pelvis and vulvoperineal region as a cause of lower extremity varicose veins can manifest without evidence of pelvic congestion syndrome or ovarian vein dilatation.

Primer varikoselli olgularda safenofemoral yetmezlik Saphenofemoral insufficiency in patients with primary varicocele

Amac: Primer venoz yetmezlik ile primer varikosel arasinda patofizyolojik ve hemodinamik aci- dan siki iliski bulunmaktadir. Bu calisma ile, primer varikoseli olan ve olmayan genc erkeklerdeki safenofemoral yetmezlik sikligini renkli Doppler ultrasonografi ile degerlendirmeyi amacladik. Gerec ve yontem: Varikosel tespit edilen 42 genc erkek birey ve varikoseli olmayan 22 saglikli genc erkek birey prospektif calismaya dahil edildi. Tum bireylerdeki pampiniform pleksus venleri ve safenofemoral bileskeler yetmezlik yonunden degerlendirildi. Venoz reflunun degerlendirilmesinde renkli Doppler ultrasonografi, venoz caplarin olcumunde ise B-mod ultrasonografi kullanildi. Bulgular: Varikoseli olan olgularin pleksus veni capinin, kontrol bireylerden istatistiksel olarak anlamli oranda daha genis oldugu saptanmistir (p < 0.001). Varikosel saptanan olgularda safenofemoral yetmezligin, kontrol bireylere gore daha sik oldugu bulundu (p < 0.001). Sonuc: Primer varikoseli olan hastalarda safenofemoral yetmezlik insidansi anlamli olarak daha fazladir

Pregnancy and varicose veins.

IT IS well recognized that varicose veins of the lower extremities are a common complication of pregnancy. The purpose of this paper is to point out that, in our opinion, it is a safe and practical procedure in selected cases to carry out vein surgery in the early postpartum period. Etiology The etiology of varicose veins is related to several factors including heredity, postural strain, trauma, compression or constriction of veins, and phlebitis of the deep venous system of the legs. It is also recognized that patients who develop varicose veins do so as a result of a basic valvular defect in their veins. Varicose veins of the lower extremities are usually the result of short saphenopopliteal insufficiency, saphenofemoral insufficiency and/or incompetent perforating veins. In pregnancy the venous system of the round ligament is also often involved. The varices seen in pregnancy usually appear during the first trimester before the