Severe Varicose Veins Research Articles

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.

Longer term follow-up of a randomized controlled trial on the role of compression after radiofrequency ablation of varicose veins

ObjectiveSeveral studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term. MethodsAll 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities. ResultsThirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (P = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), −7.3 to 1.1; P = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, −1.1 to 0.7; P = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, −0.22 to 1.17; P = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, −7.7 to 6.2; P = .83]). ConclusionsThis study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.

Clinical efficacy of sodium aescinate administration following endovenous laser ablation for varicose veins.

Endovenous interventions and minimally invasive procedures are effective in the management of varicose veins. However, they can cause postoperative discomfort. To evaluate the clinical efficacy of sodium aescinate (SA) in improving edema, pain, vein-specific symptoms, and quality of life in patients following endovenous laser ablation (EVLA) for varicose veins. In this single-center randomized controlled trial (RCT), patients were allocated into two groups: in Group A, 60mg SA was administered twice daily for 20days, and in Group B (control), no venoactive drug was prescribed. The Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification system for chronic venous disorders was used to assess the varicose veins. The circumferences of the calf and ankle were recorded for evaluating edema. The 10-point Visual Analog Scale (VAS), Venous Clinical Severity Score (VCSS), and Aberdeen Varicose Veins Questionnaire (AVVQ) were used to measure the pain intensity, overall varicose vein severity, and patient's quality of life, respectively. The study included 87 patients (mean age, 59.9 ± 10.7years; 54 men) with CEAP class C2-C5 varicose veins who underwent EVLA and phlebectomy or foam sclerotherapy. The calf circumference recovered quicker in Group A than in Group B by days 10, 21, and 30 (difference from baseline was 1.04 ± 0.35 vs 2.39 ± 1.15 [p < .001], 0.48 ± 0.42 vs1.73 ± 1.00 [p < .001], and 0.18 ± 0.64 vs 0.82 ± 0.96 [p < .001], respectively). The ankle circumference recovered quicker in Group A than in Group B by days 10 and 21 (the difference from baseline was 1.37 ± 0.52 vs 2.36 ± 0.93 [p < .001] and 0.58 ± 0.60 vs 1.14 ± 0.88 [p = .002], respectively). Pain relief was achieved quicker in Group A than in Group B (0.257 ± 1.097 [p = .0863] vs 0.506 ± 1.250 [p = .0168] by day 21). There were no significant differences in the VCSS and AVVQ scores between both groups. There were no drug-related adverse effects. SA, in combination with compression therapy, can relieve edema and alleviate pain in patients following EVLA for varicose veins.

Unusual origins of cardiac insufficiency: a case of iliac arteriovenous fistula post-spinal disc surgery

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions.

Enhanced Diagnostics Based on Deep Learning for Varicose Vein Detection

Varicose veins, a prevalent vascular condition affecting a significant portion of the population, necessitate early detection for optimal intervention and improved patient outcomes. This study introduces a novel diagnostic approach for varicose vein detection, leveraging the capabilities of deep learning. Varicose veins represent a prevalent vascular condition that can lead to discomfort and complications if not identified and treated promptly. This research introduces an advanced diagnostic methodology for varicose vein detection, utilizing deep learning techniques. Our approach harnesses the capabilities of deep neural networks, specifically employing a convolution neural network (CNN) architecture. Trained on a diverse dataset of vascular images, the model demonstrates a high proficiency in identifying varicose veins by capturing nuanced patterns and subtle features. Fine-tuning through transfer learning ensures adaptability to variations in patient demographics and imaging conditions. To enhance diagnostic precision, our system incorporates advanced image processing techniques and feature extraction methods. The integration of image segmentation algorithms and anatomical feature analysis provides detailed insights into the extent and severity of varicose veins. Furthermore, the model is designed to accommodate multi-modal imaging data, incorporating information from various imaging modalities to enhance diagnostic accuracy. Validation of our approach is conducted on a comprehensive dataset encompassing a spectrum of varicose vein cases, including varying degrees of severity. The results underscore the superior performance of our deep learning-based diagnostic system, achieving notable sensitivity and specificity in varicose vein detection. This proposed enhanced diagnostic tool holds promise for healthcare professionals, streamlining the diagnostic process and facilitating early and accurate identification of varicose veins. The potential implications include improved patient outcomes through timely intervention and the development of personalized treatment strategies. As we continue refining and expanding our model, its integration into clinical practice could contribute to a more efficient and effective management of varicose vein disorders.

Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study.

Studies on varicose veins have focused its effects on physical function; however, whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear. Moreover, the differences in such functions between individuals with varicose veins and healthy individuals remain unclear. To investigate changes in physical function and the quality of life (QOL) following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity. We enrolled 37 participants (those with varicose veins, n = 17; healthy individuals, n = 20). We performed the following measurements pre- and post-nonsurgical treatment in the varicose vein patients and healthy individuals: Calf muscle oxygenation during the two-minute step test, open eyes one-leg stance, 30 s sit-to-stand test, visual analog scale (VAS) for pain, Pittsburgh sleep quality index, physical activity assessment, and QOL assessment. Varicose veins patients and healthy individuals differ in most variables (physical function, sleep quality, and QOL). Varicose veins patients showed significant differences between pre- and post-nonsurgical treatment- results in the 30 sit-to-stand test [14.41 (2.45) to 16.35 (4.11), P = 0.018), two-minute step test [162.29 (25.98) to 170.65 (23.80), P = 0.037], VAS for pain [5.35 (1.90) to 3.88 (1.73), P = 0.004], and QOL [39.34 (19.98) to 26.69 (17.02), P = 0.005]; however, no significant difference was observed for muscle oxygenation. Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients, bringing their condition close to that of healthy individuals. Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.

Assessing postoperative wound infection rates in ultrasound-guided microwave ablation versus conventional surgery for varicose veins.

Varicose veins are the prevalent vascular disorder that has conventionally been managed via risky postoperative wound infections and conventional surgery. While ultrasound-guided microwave ablation (UMA) has gained attention as a minimally invasive alternative, there is still a lack of research examining its comparative effectiveness. A prospective comparative investigation was undertaken in the Zhejiang region of China from January to November 2023, involving 140 patients who had received the diagnosis of primary varicose veins. An equal number of 70 patients underwent UMA and conventional surgery. Exclusion criteria for the study encompassed adult patients aged 18-65, with the exception of those who had undergone prior venous surgery, deep vein thrombosis or peripheral arterial disease. The demographical characteristics, procedural details and complication profiles of patients who developed postoperative wound infections within 30 days were analysed statistically. The outcomes demonstrated that postoperative wound infections were significantly diminished (5.7%) with UMA in comparison to conventional surgery (17.1%). In addition, the average duration of procedures and length of hospital stay for UMA patients were both reduced, although neither of these differences was found to be statistically significant (p > 0.05). Infection management, age and gender distribution of varicose veins were comparable between the two groups (p > 0.05). A significant inverse correlation was observed between the severity of varicose veins and postoperative outcomes, as determined by the regression analysis (p < 0.05). Using UMA to treat varicose veins showed promise as an alternative to conventional surgery, specifically in minimizing the incidence of postoperative wound infections. Additional research and clinical consideration are needed regarding the potential transition toward minimally invasive techniques in treatment of varicose veins, as suggested by these results.

Effect of short-term compression therapy after thermal ablation for varicose veins: study protocol for a prospective, multicenter, non-inferiority, randomized controlled trial

BackgroundFor patients with varicose veins, the goal is to relieve pain and swelling, reduce the severity of edema, improve skin changes, and heal ulcers associated with venous disease. Compression therapy is the cornerstone of their management. Several studies have shown that wearing an elastic bandage for the first 24 h and then a compression stocking for a week can effectively reduce the pain after thermal ablation. However, in clinical practice, patient compliance with this treatment could be better, considering difficulties in pulling up and removing the compression stocking, tightness, and skin irritation because these must be worn for a prolonged period. A potential solution to battling these barriers is short-term compression therapy. Besides, the effect and necessity of wearing compression stockings after thermal ablation have been questioned. Based on current clinical experience and limited evidence, although some scholars have suggested that compression therapy may be an unnecessary adjunctive therapy after thermal ablation, there is still a great deal of uncertainty in the absence of compression therapy after thermal ablation compared to compression therapy. Therefore, we advocate further research to evaluate the clinical effect of short-term postoperative compression therapy. Furthermore, well-designed randomized controlled trials are needed.MethodsA prospective, multicenter, non-inferiority randomized controlled trial is designed to evaluate the non-inferiority of target vein occlusion rate at 3 months. Three hundred and sixty patients will be randomly assigned in a 1:1 ratio to one of the following treatments: (A) 3 M™ Coban™ elastic bandage for 48 h or (B) 3 M™ Coban™ elastic bandage for the first 24 h and then a class II compression full-length stocking (23–32 mm Hg) for 1 week. The two groups will be compared on several variables, including target vein occlusion rate at 3 months (primary outcome indicator), pain, quality of life, clinical severity of varicose veins, postoperative complications, time to return to regular work, and compliance.DiscussionSuppose the effect of the 3 M™ Coban™ elastic bandage for 48 h proves to be non-inferior to long-term compression therapy. In that case, this short-term treatment may contribute to a future update of clinical guidelines for compression therapy after thermal ablation of varicose veins, resulting in higher patient compliance and better postoperative quality of life.Trial registrationClinical Trials NCT05840991. Registered on May 2023.

Risk factors analysis of endoscopy and TIPS in the treatment of secondary esophagogastric varicose bleeding with cirrhosis.

To analyse the risk factors of secondary hemorrhage and survival rate in cirrhotic patients with esophagogastric variceal rupture and to compare the efficacy and safety of endoscopic hemostasis and TIPS (transjugular intrahepatic portosystemic shunt). A total of 120 patients with secondary bleeding after endoscopic treatment of esophagogastric varicose bleeding with cirrhosis in our hospital during the past 3 years were retrospectively analysed. There were 65 males and 55 females, ranging in age from 49 to 74 years old, with an average of (59.5 ± 8.4) years old. The etiology, degree of varicose veins, bleeding location, hemostasis method, Infection, ascites, portal vein thrombosis or cancer thrombus, albumin, platelets, prothrombin activity, Child Pugh (Child-Pugh classification is a diagnostic criterion for liver reserve function) grade were compared in each group. The risk factors of treatment failure and analyse the survival time was analysed. There were statistically significant differences in varicosis degree, infection, ascites, portal vein thrombosis or cancer thrombus, child Pugh grade, albumin and prothrombin activity between the failed Endoscopy group and the successful hemostasis group (P< 0.05). There were statistically significant differences in child Pugh grade, albumin and prothrombin activity between the failed TIPS treatment group and successful hemostasis group (P< 0.05). There was no significant difference in 1-year survival between the endoscopy group and the TIPS group. Severe varicose veins, infection, ascites, portal vein thrombosis or cancer thrombus, child pugh classification, albumin, and prothrombin activity were the major risk factors for failed secondary endoscopic therapy, child Pugh classification, albumin and prothrombin activity were the main risk factors for failure TIPS treatment. There is no significant difference in long-term survival between the two methods.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Pro- and Anti-Inflammatory Blood Cytokines Levels in Women with Moderate and Severe Pelvic Venous Insufficiency

The aim of this study was to determine the blood levels of pro- and anti-inflammatory cytokines in patients with moderate and severe pelvic venous insufficiency (PVI). Methods and Results: One hundred and four women with PVI and 30 healthy women (control group [CG]) of reproductive age were examined. The patients with PVI (main group [MG]) were divided into 2 subgroups according to the severity of the disease: MG-moderate (n=63) and MG-severe (n=41). The concentration of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8), and anti-inflammatory interleukins IL-4 and IL-10 were assessed by enzyme immunoassay using monoclonal antibody panels. Measurements were performed on a microplate photometer. Data analysis showed higher values of pro-inflammatory factors (IL-1β, IL-6, and IL-8) in the MG-moderate than in the CG. The MG-severe, compared with the CG, had high levels of IL-1β, IL-2, IL-6, IL-8, and low IL-10 concentration. In addition, patients of the MG-severe had higher levels of IL-2 than patients of the MG-moderate (P=0.045). The IL-6/IL-10 ratio was characterized by higher values in the MG-moderate and MG-severe than in the CG (P&lt;0.0001). The patients of the MG-severe also had higher levels of the IL-6/IL-10 ratio than patients of the MG-moderate (P=0.020). Conclusion: In patients with PVI with increasing severity of varicose veins, the pro- and anti-inflammatory cytokine balance is progressively disturbed toward the dominance of pro-inflammatory components. The control of these changes in patients is an important component of the design of therapeutic measures and prevention of morphofunctional disorders occurring with the progression of the disease.

Machine Learning-Based Technique for the Severity Classification of Sublingual Varices according to Traditional Chinese Medicine.

Tongue diagnosis, a noninvasive examination, is an essential step for syndrome differentiation and treatment in traditional Chinese medicine (TCM). Sublingual vein (SV) is examined to determine the presence of blood stasis and blood stasis syndrome. Many studies have shown that the degree of SV stasis positively correlates with disease severity. However, the diagnoses of SV examination are often subjective because they are influenced by factors such as physicians' experience and color perception, resulting in different interpretations. Therefore, objective and scientific diagnostic approaches are required to determine the severity of sublingual varices. This study aims at developing a computer-assisted system based on machine learning (ML) techniques for diagnosing the severity of sublingual varicose veins. We conducted a comparative study of the performance of several supervised ML models, including the support vendor machine, K-neighbor, decision tree, linear regression, and Ridge classifier and their variants. The main task was to differentiate sublingual varices into mild and severe by using images of patients' SVs. To improve diagnostic accuracy and to accelerate the training process, we proposed using two model reduction techniques, namely, the principal component analysis in conjunction with the slice inverse regression and the convolution neural network (CNN), to extract valuable features during the preprocessing of data. Our results showed that these two extraction methods can reduce the training time for the ML methods, and the Ridge-CNN method can achieve an accuracy rate as high as 87.5%, which is similar to that of experienced TCM physicians. This computer-aided tool can be used for reference clinical diagnosis. Furthermore, it can be employed by junior physicians to learn and to use in clinical settings.

Effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors

Objective: To investigate the effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors. Methods: 127 cases with liver cirrhosis accompanied with esophageal and gastric varices without bleeding history were included in the endoscopic and non-endoscopic treatment group, respectively. Informed consent was obtained from both groups. Gastric varices (Lgf) and esophageal varices (Leg) were diagnosed according to LDRf classification criteria, and the corresponding treatment scheme was selected according to the recommended principle of this method.The incidence rate of bleeding from ruptured esophageal varices were observed at 3, 6 months, and 1, and 2 years in the treated and the untreated group, and the patients with different Child-Pugh scores were followed-up for 2 years. Gender, age, etiology, varicose degree, Child-Pugh grade, platelet count, prothrombin activity, portal vein thrombosis, collateral circulation, portal vein width and other factors affecting the bleeding rate were assessed. Measurement data were described as mean ± standard deviation (x¯±s), and qualitative data of categorical variables were expressed as percentage (%), and χ2 test was used. Results: 127 cases were followed up for 2 years. There were 55 cases in the endoscopic treatment group (18 cases underwent band ligation, 2 cases underwent band ligation combined with tissue adhesive embolization, 28 cases underwent sclerotherapy, and 7 cases underwent sclerotherapy combined with tissue adhesive embolization). Recurrent bleeding and hemorrhage was occurred in 5 (9.1%) and 28 cases (38.9%), respectively (P<0.05). In addition, there were 72 cases in the untreated group (P<0.05). Severe varicose veins proportions in treated and untreated group were 91.1% and 85.1%, respectively (P>0.05). There was no statistically significant difference in liver cirrhosis-related medication and β-blocker therapy between the treated and untreated group (P>0.05). There was no statistically significant difference in the bleeding rate between the different treated groups (P>0.05). The bleeding rates at 3, 6 months, 1, and 2 years in endoscopic treated and untreated group were 2.00% vs. 2.59% (P>0.05), 2.30% vs. 5.88% (P>0.05), 3.10% vs. 7.55% (P>0.05) and 4.00% vs. 21.62% (P<0.05), respectively. All patients with Child-Pugh grade A, B and C in the treated and the untreated group were followed-up for 2 years, and the bleeding rates were 1.8% vs. 8.1% (P<0.05), 1.1% vs. 9.4% (P<0.05) and 9.1% vs. 10.1% (P>0.05), respectively. There were statistically significant differences in the rupture and bleeding of esophageal and gastric varices, varices degree, Child-Pugh grade and presence or absence of thrombosis formation in portal vein (P<0.05); however, no statistically significant differences in gender, age, etiology, platelet count, prothrombin activity, collateral circulation and portal vein width (P>0.05). There was no intraoperative bleeding and postoperative related serious complications in the treated group. Conclusion: The risk of initial episodes of bleeding from esophageal and gastric varices is significantly correlated with the varices degree, Child-Pugh grade, and portal vein thrombosis. Primary preventive treatment under endoscope is safe and effective for reducing the long-term variceal bleeding risk from esophageal and gastric varices.

Factors associated with chronic venous disease: study in 1,136 patients treated for varicose veins of the lower limbs in a specialized clinic.

Varicose veins are a highly prevalent condition in the general population, generating variable reasons for consultation that can alter the patient's quality of life, with prevalence and associated factors that vary in different series. To describe the epidemiological profile of patients who consulted for varicose veins by evaluating main symptoms and associated variables. Between 2019 and 2020, 1,136 patients attending vascular surgery consultation in a specialized outpatient center were evaluated. Demographic variables, presented symptoms, complications, and associated factors, such as body mass index, parity and family history, were recorded. A total of 1136 patients were evaluated (79.8% women and 20.2% men), with a mean age of 53.51 years. The presence of symptoms was similar in men and women; the most frequent complications were ulcer, varicorrhage, and superficial venous thrombosis. Most patients showed CEAP 1, 2 and 3 (n = 909) and more than half were overweight or obese (n = 679) with a predominance of those classified as C4. Sixty-nine per cent had a positive family history of varicose veins. There was no difference between severity of varicose veins and time working in the standing or sitting position, but there was a greater presence of C5 or C6 ulcer among patients standing for more than 4 hours. Describing the characteristics of patients with varicose veins helps to understand the disease and to focus efforts towards those who are more susceptible. The results of this research are similar to those found in other populations.

Epidemiologia das doenças venosas crônicas: um estudo de 1136 pacientes tratados por varizes de membros inferiores em uma clínica especializada na Colômbia

BackgroundVaricose veins are a highly prevalent condition in the general population, generating variable reasons for consultation that can alter the patient’s quality of life, with prevalence and associated factors that vary in different series.ObjectivesTo describe the epidemiological profile of patients who consulted for varicose veins by evaluating main symptoms and associated variables.MethodsBetween 2019 and 2020, 1,136 patients attending vascular surgery consultation in a specialized outpatient center were evaluated. Demographic variables, presented symptoms, complications, and associated factors, such as body mass index, parity and family history, were recorded.ResultsA total of 1136 patients were evaluated (79.8% women and 20.2% men), with a mean age of 53.51 years. The presence of symptoms was similar in men and women; the most frequent complications were ulcer, varicorrhage, and superficial venous thrombosis. Most patients showed CEAP 1, 2 and 3 (n = 909) and more than half were overweight or obese (n = 679) with a predominance of those classified as C4. Sixty-nine per cent had a positive family history of varicose veins. There was no difference between severity of varicose veins and time working in the standing or sitting position, but there was a greater presence of C5 or C6 ulcer among patients standing for more than 4 hours.ConclusionsDescribing the characteristics of patients with varicose veins helps to understand the disease and to focus efforts towards those who are more susceptible. The results of this research are similar to those found in other populations.

Role of physiotherapy interventions in treating varicose veins

The lower limb venous system is responsible for returning blood from the foot, leg, and thigh toward the heart. Chronic venous disease occurs by an inability of the blood to completely return due to structural or functional abnormalities of the veins of the lower limbs. Varicose veins are enlarged veins that have become tortious and abnormally swollen. This study was taken to evaluate, diagnose, and rehabilitate varicose veins by physiotherapy interventions. The patient presented at our outpatient department with severe varicose veins. She was assessed, and a patient-specific 2-month rehabilitation program was formulated. This study helps us to understand various aspects involved in the condition, its prognosis, and management by physiotherapy interventions.

Ultrasonographic measurement of saphenous vein diameter compared to CEAP classification in patients with varicose veins

Introduction and ObjectiveUltrasound of the saphenous vein and measurement of the vein diameter may have a role in determining the severity of varicose veins. This study aimed to compare the saphenous vein diameter with the CEAP classification, as the reference standard in determining the severity of chronic venous diseases, in patients with lower limbs varicose veins free from saphenous vein reflux. MethodsIn this cross-sectional study, 100 patients with lower limbs varicose veins (saphenous vein) and free from saphenous vein reflux were enrolled. Demographic data (age, gender, body mass index (BMI)) were collected using a checklist. The severity of varicose veins was determined using the standard CEAP classification. The saphenous vein diameter was measured using ultrasonography. ResultsMean age of the patients was 43 years and there were 68 female patients. According to the CEAP classification, 13 patients had no varicose veins (CEAP class C0). However, 87 patients had varicose veins (65 patients with class C1, one patient with class C2, and 21 patients with class C3). Mean saphenous vein diameter in the whole sample was 6.7 mm. There was no significant relationship between the severity of varicose veins determined by CEAP classification and mean saphenous vein diameter measured by ultrasound. Mean saphenous vein diameter in C0, C1, C2, and C3 groups were respectively 1.7 mm, 6.7 mm, 8 mm, and 8.7 mm (P= 0.71). On the other hand, mean saphenous vein diameter was higher significantly in those with higher body mass index (BMI) and among older patients. ConclusionThe results of this study showed that saphenous vein diameter did not differ significantly between CEAP C0 through C4 classes. However, the severity of varicose vein was more prominent in older patients and those with higher BMI.

Effect of Lifestyle and Symptom Intensity Factors on the Severity of Lower Limbs Veins of Varicose Among Nurses in North Khorasan Hospitals, Iran

Introduction: Few data were reported the risk factors for lower limb varicose veins (VVs) among Iranian nurses. The current research aims to study the social, life style, and occupational factors associated with development of VVs in a sample of Iranian nurses. Materials and Methods: In this cross sectional study 235 volunteered nurses filled the consent forms and then examined by a vascular specialist. Varicose veins of the patient nurses were graded by CEAP criteria. The patients then filled out lifestyle questionnaire (LQ). Results: In this study, there were 163 (69.4%), 64 (27.2%) and 8 (3.4%) of cases with mild, moderate and severe VVs. Relation of age, laboring times, abortion times and BMI with VVs severity was statistically significant (P<0.005). found physical activity (OR=4.038), weight control and nutrition (OR=3.76) significantly effected on VVs intensity.Conclusion: This study highlighted lifestyle risk factors of varicose veins, which can considered in improving of lifestyle and quality of life of nurses in the long-time.Keyword: Varicose vein, Lifestyle, Quality of life, Physical activity, weight control

A One-Year Audit of Varicose Vein Surgery at a Vascular Surgical Unit with a Long-Term Duplex and Quality of Life Follow-Up

Objective: With the introduction of endovenous treatments, open varicose veins surgery was discarded due to a claimed high risk of neovascularisation. A one-year audit was set up to look at results from performing mainly open surgery. Methods: All varicose vein interventions were registered and prospectively followed with colour Duplex assessments after 4-6 weeks, 1 and &gt;5 years. In addition, Aberdeen Varicose Vein Questionnaire (AVVQ) was used in addition to Varicose Vein Severity Score (VCSS) to assess patients’ quality of life (QoL) and the disease severity. Results: During the year, 236 patients/252 legs were operated and 28% were re-do procedures. Median age was 55 years (16-87) and 70% were females. Duplex at 4-6 weeks showed a primary success rate of 91%. Neovascularisation was noted in 8% one year after primary surgery. The long-term assessment was done after a median of 69 months (39-75) and 67% of all legs were examined. After primary surgery 16% showed neovascularisation compared with and 27% after re-do procedures. VCSS improved significantly from 6 (range 1-22) to 2 at the long-term follow-up (p&lt;0.001). The AVVQ score improved from 20 (range 3-55) down to 10 (p&lt;0.001). Conclusion: The risk for neovascularisation seems to have been overestimated and good long-term results can be achieved following modern open surgery. The major problem is to avoid varicose vein recurrence since results from re-do procedures seem less favourable long term.

Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report.

IntroductionCirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis.Presentation of caseA 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein.DiscussionThere have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely.ConclusionHybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.