Symptoms Of Chronic Venous Insufficiency Research Articles

Improvements in edema and microcirculation in chronic venous insufficiency with Pycnogenol® or elastic compression.

Chronic venous insufficiency (CVI) is the consequence of venous valve reflux and/or venous flow obstruction and resulting venous hypertension in the lower extremities. The aim of this prospective supplement registry study was to evaluate the efficacy of compression stockings or Pycnogenol® in controlling symptoms and edema in CVI and their efficacy on microcirculatory parameters. Two comparable groups of 30 subjects with CVI were observed for 4 months. Elastic compression was less tolerated than Pycnogenol® with 12 subjects being unable to follow the compression routine. No side effects due to supplementation were observed; tolerability of the supplementation was optimal. Ambulatory venous pressure (AVP) and refilling time (RT) at inclusion indicated a significant increase in venous pressure and reflux (refilling time <16 seconds). AVP and RT did not change after 4 months. Microcirculatory and clinical measurements were comparable at inclusion between the 2 groups. After 4 months, skin resting flux (RF) and skin PO<inf>2</inf>-PCO<inf>2</inf> were significantly improved with Pycnogenol® compared to compression (P<0.05). The significant increase in skin PO<inf>2</inf> and the decrease in PCO<inf>2</inf> after Pycnogenol® intake were ascribed to the decrease in the abnormally high skin resting flux, a sign of better perfusion and skin nutritional supply. Pycnogenol® reduced leg volume, on average by 18.3% in the evening compared to 4.4% of reduction with compression (P<0.05) showing an important effect on edema. The venous Clinical Severity Score (VCSS) and the composite symptom score (CSS) decreased significantly in the Pycnogenol® group compared to compression, indicating a better improvement in microcirculatory perfusion and nutritional supply produced by the supplementation of Pycnogenol® in comparison with compression. Pycnogenol® significantly improved microcirculation and clinical symptoms in comparison with compression. The decrease in local oxidative stress (OS) at the distal perimalleolar region with Pycnogenol® was significant in comparison with compression (P<0.05). A lower local OS is an important metabolic indication of a better capillary perfusion with better nutritional exchanges. At the end of the registry study, four small ulcerations and skin breaks in four limbs (between 3 and 5 mm of maximum diameters) were observed in the compression group. No ulcerations or skin breaks were observed in the Pycnogenol® group. Pycnogenol® relieved edema, improved microcirculation in CVI patients and reduced stationary, interstitial fluid in comparison with compression. Most symptoms of CVI are associated with interstitial water retention; the presence of extra fluid in limb tissues alters perfusion and nutrient supply. Pycnogenol® supplementation reduced water and fluid accumulation in CVI limbs and improved microcirculation and local oxidative stress thus showing important anti-edema effects.

The sex prevalence of lower limb varicose vein networks

ObjectiveTo determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination. MethodsWe scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis. ResultsOverall, 1072 patients—252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)—were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV−) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV− was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244). ConclusionsThe analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV− was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common.

Effect of Yoga in Industrial Workers with Chronic Venous Insufficiency: A Randomized Controlled Trial.

Background and objective: Prolonged standing is one of the significant contributors to chronic venous insufficiency (CVI) in industry workers. Yoga is proven to be an effective therapy in treating occupational hazards. The current study aimed to investigate the effect of yoga on CVI among industry workers. Methodology: Male workers (n = 100) from machinery manufacturing industries in Bangalore meeting the inclusion and exclusion criteria were recruited for the study. The yoga group received a specifically designed yoga module for 6 days a week for 12 weeks, and the control group was offered lifestyle suggestions. Plasma homocysteine was used as the primary outcome variable, whereas Venous Clinical Severity Score, ankle brachial pressure index (ABPI), ankle and calf circumference, CVI questionnaire, and Chalder fatigue scale were assessed as secondary variables at baseline and the end of 12 weeks of intervention. Results: Eighty-eight participants (yoga = 43, control = 45) completed the study. A one-way analysis of covariates (ANCOVA) was used to determine the significant differences between groups in the post-values. A significant difference was found between groups in plasma homocysteine (partial eta squared = 0.34, p < 0.001). All variables, except for ABPI, calf circumference, and ankle circumference, had shown statistically significant differences between the yoga and control groups after 12 weeks of intervention, with moderate to high effect sizes. There were no significant adverse events associated with the intervention. Conclusions: Yoga practices can reduce the symptoms of CVI along with vascular inflammation as indicated by reduced plasma homocysteine. Overall, yoga practices are found to be safe and efficacious for managing CVI. IEC Reference Number: RES/IEC-SVYASA/184/2021 Trial Registration Number (If Clinical Trial): CTRI/2021/02/030944.

Effect of intermittent pneumatic compression therapy and short-stretch bandaging use on the symptoms of chronic venous insufficiency

Effect of intermittent pneumatic compression therapy and short-stretch bandaging use on the symptoms of chronic venous insufficiency

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

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

Effect of junctional reflux on the venous clinical severity score in patients with insufficiency of the great saphenous vein (JURY study)

ObjectiveEffective treatment options are available for chronic venous insufficiency associated with superficial venous reflux. Although many patients with C2 and C3 disease based on the CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification have combined great saphenous vein (GSV) and saphenofemoral junction (SFJ) reflux, some may not have concomitant SFJ reflux. Several payors have determined that symptom severity in patients without SFJ reflux does not warrant treatment. In patients planned for venous ablation, we tested whether Venous Clinical Severity Scores (VCSS) are equivalent in those with GSV reflux alone compared with those with both GSV and SFJ reflux. MethodsThis cross-sectional study was conducted at 10 centers. Inclusion criteria were: candidate for endovenous ablation as determined by treating physician; 18 to 80 years of age; GSV reflux with or without SFJ reflux on ultrasound; and C2 or C3 disease. Exclusion criteria were prior deep vein thrombosis; prior vein ablation on the index limb; ilio-caval obstruction; and renal, hepatic, or heart failure requiring prior hospitalization. An a priori sample size was calculated. We used multiple linear regression (adjusted for patient characteristics) to compare differences in VCSS scores of the two groups at baseline, and to test whether scores were equivalent using a priori equivalence boundaries of +1 and −1. In secondary analyses, we tested differences in VCSS scores in patients with C2 and C3 disease separately. ResultsA total of 352 patients were enrolled; 64.2% (n = 226) had SFJ reflux, and 35.8% (n = 126) did not. The two groups did not differ by major clinical characteristics. The mean age of the cohort was 53.9 ± 14.3 years; women comprised 74.2%; White patients 85.8%; and body mass index was 27.8 ± 6.1 kg/m2. The VCSS scores in patients with and without SFJ reflux were found to be equivalent; SFJ reflux was not a significant predictor of VCSS score; and mean VCSS scores did not differ significantly (6.4 vs 6.6, respectively, P = .40). In secondary subset analyses, VCSS scores were equivalent between C2 patients with and without SFJ reflux, and VCSS scores of C3 patients with SFJ reflux were lower than those without SFJ reflux. ConclusionsSymptom severity is equivalent in patients with GSV reflux with or without SFJ reflux. The absence of SFJ reflux alone should not determine the treatment paradigm in patients with symptomatic chronic venous insufficiency. Patients with GSV reflux who meet clinical criteria for treatment should have equivalent treatment regardless of whether or not they have SFJ reflux.

THE EFFECTIVENESS OF 120-140 J/CM ENERGY DENSITY FOR THE ENDOVENOUS LASER ABLATION IN PATIENTS WITH DIABETES MELLITUS

The aim of this study is to analyze the impact of the 120-140 J/cm energy for EVLA in patients with diabetes. Material and methods. The outcomes of 40 patients with varicose disease and diabetes mellitus as a comorbid condition were analyzed. Forty patients with varicose disease and diabetes mellitus were enrolled in the investigation. There were 27 women (67.5%) and 13 men (32.5%). The average age of the patients was 59.5±1.18 years, ranging from 44 to 74 years. The blood glucose level was 184.5±11.6 mmol/l, and the concentration of glycohemoglobin was equal to 8.5±0.25%. The average duration of the diabetes history was 10.6±0.91 years. Biolitec ELVeS Radial 2 Ring Fiber diode device and laser with 1470 nm wavelength and 120 – 140 J/cm energy were used for EVLA. VCSS results and recurrence rates were subjected to analysis in 1 week, 1 month, 6 months, and 1 year following the treatment. Results. The outcomes of the EVLA with high power energy for the treatment of varicose disease in patients with diabetes were not enough highlighted. The total VCSS score was for the right lower extremity: 4.75±0.725 - 1 week after EVLA; 1.93±0.547 - 1 month later; 0.79±0.306 - 6 months after; 0.36±0.151 - 1 year after; respectively for the left lower limb 5.37±0.806 - 1 week; 2.6±0.643 - after 1 month; 1.06±0.351 - after 6 months; 0.62±0.034 - after 1 year. 1 week after EVLA, there was an intense decrease in the pain index in the right lower limb, and after 1 month, almost 90% of the patients had no pain at all. In the 6-month and 1-year follow-ups, the pain had completely disappeared, and only 1 person reported having episodic pain. This trend is also reflected in the left leg. The intensity of pain in the left leg decreased significantly after 1 week of EVLA. During all observations, the intensity of pain was statistically significantly less than in the previous examinations (p&lt;0.05). In the short term after EVLA the rapid reduction of the intensity of pain and oedema, and the disappearance of chronic venous insufficiency symptoms ensured earlier rehabilitation of patients. The recurrence was observed in 1 case (2.5%). Conclusion. 120-140 J/cm of energy was approved as an optimal density for the EVLA in patients with varicose and diabetes mellitus.

Horse Chestnut Seed Extract: An Opportunity for Creating Evidencebased New Natural Products

For centuries, herbal remedies have been used to prevent and treat disease. Horse chestnut seeds are an abundant source of phytoconstituents containing triterpenoid saponins, with thirty molecules isolated and characterized. Escin, which is a combination of acylated triterpene glycosides composed of α- and β-escin, is the major biologically active component of horse chestnut seed extract. Escin is the most researched veno-active compound with anti-inflammatory, anti-oedematous, and antioxidant properties. Due to their unique three pharmacological actions, escin is a well-established molecule for the management of venous diseases such as chronic venous insufficiency (CVI) and hemorrhoids. The available treatments for CVI have some disadvantages, including severe side effects, expensive surgical options, long duration of treatment, and limited accessibility to allopathic drugs. As a result, phytoconstituents and lifestyle changes can be seen as safe and effective therapy options for CVI management because they have no major side effects and can simultaneously function on several targets. This review article focuses on the chemical components of horse chestnut extract, particularly the phytoconstituents escin, and proanthocyanidins, which have been extensively studied in preclinical and clinical studies. The review article provides a comprehensive overview of their potential therapeutic benefits in managing symptoms of CVI and their regulatory status.

Physical exercise for the treatment of non-ulcerated chronic venous insufficiency.

Physical exercise for the treatment of non-ulcerated chronic venous insufficiency.

Effect of passive ankle movement in the sitting position on the symptoms of chronic venous insufficiency with long-term observation.

Chronic venous insufficiency (CVI) is the most common vascular disease. One major risk factor for its development is either long-term sitting or standing in the same position and the nature of the work performed. This study aims to assess the effectiveness of passive ankle movement in the sitting position performed using the Bella Vena robot for the symptoms of CVI with long-term observation. A group of 58 patients (mean age: 59.69 ±14.59 years) with CVI in CEAP (Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)) classification categories 2 and 3, and a group of 37 (mean age: 51.49 ±14.86 years) healthy volunteers performing sedentary work for at least 6 h during the working day were enrolled into the study. The total duration of observation lasted 8 months (8 visits), during which the following parameters were assessed at the beginning and end of this period: pain intensity (according to the visual analogue scale (VAS)), level of saturation on the toe, pulse rate, and lower limb Doppler ultrasound evaluation of reflux parameters. The exercises used in people with CVI resulted in a significant reduction (p ≤ 0.01) in the occurrence of symptoms. Among all respondents, after 8 months of exercise, a significant reduction in pain level according to the VAS of the lower limbs, an improvement in saturation at the toe level, and a reduction in venous reflux was recorded (p ≤ 0.05). Home exercises with the use of an automatic exercise rehabilitation device alleviated significant symptoms in patients with CVI and improved the calf muscle pump.

Two-Year Results of a First-In-Human Study in Patients Surgically Implanted With a Bioprosthetic Venous Valve, the VenoValve in Patients With Severe Chronic Venous Insufficiency.

Two-year follow-up results from a first-in-human study of patients implanted with the VenoValve are evaluated for supporting the long-term clinical safety and performance of the device. Chronic Venous Insufficiency (CVI) involves improper functioning of lower limb vein valves and inability of these valves to move blood back towards the heart. CVI symptoms include swelling, varicose veins, pain, and leg ulcers. Currently, there is no cure for this condition and treatment options are limited. This study provides 2-year outcomes for 8 patients who were implanted with the bioprosthetic VenoValve for treating severe CVI with deep venous reflux measured at the mid-popliteal vein. The 6-month and 1-year results were previously published. Eleven patients with C5 & C6 CVI were implanted with VenoValve into the midthigh femoral vein and followed for 2 years. Assessed clinical outcomes include device-related adverse events, reflux time, disease severity, and pain scores. All 11 implant procedures were successful. Two-year follow-up data was obtained for 8 subjects: 1 patient died of non-device related causes, 1 was lost to follow-up, and 1 refused to follow-up due to the COVID-19 pandemic. No device-related adverse events occurred between the first and second years of follow-up. Reported 2-year clinical performance outcomes included significant decreases in mean reflux times of the mid-popliteal vein (61%), and significant improvements in mean scores for disease severity rVCSS (56%) and VAS pain (87%). Results from this study support long-term safety and effectiveness of the VenoValve for improving CVI severity by reducing reflux and thereby venous pressures in the lower extremities. With limited treatments for valvular incompetence involved in severe, deep venous CVI, the device may be considered as a novel therapy. A pivotal trial in the United States is currently being conducted to assess the device in a larger number of patients.

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

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

Race differences in iliofemoral vein stenting for chronic venous insufficiency.

Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.

Ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency: initial tertiary experience from southwestern Greece

article: Ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency: initial tertiary experience from southwestern Greece - Acta Phlebologica 2022 August;23(2):93-4 - Minerva Medica - Journals

Abstract No. 158 Re-intervention rate of adhesive versus laser ablation for greater saphenous vein closure

Endovascular ablation of the greater saphenous vein (GSV) for symptomatic chronic venous insufficiency (CVI) has been shown to durably treat the majority of patients1. However, a subset of patients develop recurrent symptoms requiring additional unplanned ablation on the treated GSV, new varicosities, or both2. Laser ablation is an effective technique for GSV closure. The newer VenaSeal adhesive appears to be non-inferior in terms of short-term outcomes3, with suggestion of improved initial closure rates and less complications4.

Initial US experience with the BlueLeaf Endovenous Valve Formation System

Chronic venous insufficiency (CVI), owing to deep vein reflux (DVR) and venous obstruction, is widespread and associated with significant morbidity. The BlueLeaf System has been designed to treat patients with symptomatic CVI with evidence of DVR. The BlueLeaf device is intended to form autogenous tissue leaflets from vein walls without the use of a permanent vascular implant. This report describes the early outcomes of the initial 6 patients treated in the United States.

Bioactivity Potential of Aesculus hippocastanum L. Flower: Phytochemical Profile, Antiradical Capacity and Protective Effects on Human Plasma Components under Oxidative/Nitrative Stress In Vitro.

Horse chestnut (Aesculus hippocastanum) flower is a traditional medicine applied to alleviate symptoms of chronic venous insufficiency (CVI). However, its flavonoid-based composition has not been sufficiently recognized, and the data supporting its traditional application are lacking. In the work, 43 constituents were detected by UHPLC–PDA–ESI–TQ–MS/MS (flavonoids, phenolic acids, flavanols, and coumarins), including 31 reported in the flower for the first time. The quantitative HPLC–PDA study (developed and validated for quality control purposes) indicated the fractionated extraction as an efficient method for enhancing the total polyphenol content (TPHC) in the extracts (up to 414.06 mg/g) and kaempferol glycosides as their dominant constituents (75.05–82.14% TPHC). The activity studies showed significant scavenging properties of the extracts and their constituents towards reactive oxygen species (especially against highly reactive hydroxyl radical, with capacities up to 7.85 mmol ascorbic acid equivalents/g). Moreover, the analytes relevantly protected human plasma biomolecules from peroxynitrite-induced oxidative/nitrative damage; at 1–50 µg/mL, they hindered the protein nitration and lipid peroxidation, decreasing the levels of 3-nitrotyrosine (by up to 50%) and thiobarbituric acid reactive substances (by up to 70%), respectively. The extracts also averted the depletion of plasma thiols (by up to 67%) and improved the non-enzymatic antioxidant capacity of plasma. The demonstrated mechanisms might be partly responsible for the efficacy of the flower in CVI. Additionally, the anti-aggregatory and anticoagulant properties of the extracts were found only mild or negligible, which suggests that they may be safely applied with drugs impacting the coagulation process.

Chronic venous insufficiency after COVID-19: management of edema and pain syndromes

Introduction. COVID-19 infection raises many questions regarding the health condition of patients after they have had COVID-19. The aim of this study is to examine the characteristic symptoms of chronic venous insufficiency in the postcovid period.Materials and methods. The materials that were used for work included the results of studying the medical aid appealability, characteristic symptoms, diagnosis and treatment of symptoms of chronic venous insufficiency in persons who have had the coronavirus infection. 47 patients presented with complaints about deterioration of their condition after they had had COVID-19 over March to September 2021 period. Methods: general clinical examiniation, ultrasound angioscanning of veins of the lower extremities, laboratory coagulation tests.Results and discussion. Before deterioration, calf circumference was measured 22–24 cm at a typical measurement site in most patients (89%), after covid infection it reached 26–27 cm. Varicose veins remained soft, without intravascular formations, edema was often bilateral, asymmetric, pain was described as constant (5–6 VAS scores), patients had prominent signs of lymphostasis. 35 out of 47 people received diosmin-based venotonic drug of Russian manufacture at a dose of 1000 mg/day (one tablet twice a day), the course of treatment lasted one to two months. After that period, the edema subsided in 85% of patients, the severity of pain syndrome significantly reduced (up to 2–3 VAS scores). With regard to chronic venous insufficiency in patients with chronic diseases of lower extremity veins (mostly varicose and post-thrombotic diseases), the significant progress of disease was observed in almost 94% of follow-up cases. Diosmin is the main drug that is prescribed to treat chronic venous insufficiency. The drug has an angioprotective and venotonic effect, reduces the vein wall elasticity, increases venous tone, and decreases venous stasis, reduces capillary permeability and fragility, and increases their resistance, improves microcirculation and lymphatic drainage.Сonclusions. In the postcovid period, clinical symptoms of some chronic diseases occur/worsen, including clinical manifestations of chronic venous insufficiency. The use of Russian diosmin-based drug for the management of edema and pain syndrome is very promising.

Chronic venous insufficiency symptoms and its potential causes: Are we doing it right?

Chronic venous insufficiency symptoms and its potential causes: Are we doing it right?

Cutaneous findings in patients with chronic venous insufficiency

Venous hypertension causes many different cutaneous findings such as varicosities, telangiectasia, edema, and pigmentation, dermatitis, and venous ulcers on the skin. This study aims to investigate the cutaneous signs and symptoms of chronic venous insufficiency (CVI) and to examine their contribution to early diagnosis. A total of 150 patients were included in the study who applied to the dermatology outpatient clinic and were diagnosed with skin disease related to CVI or had skin findings. Patient's age, gender, complaints, occupation, additional diseases, drug usage, history of prolonged standing and travel, smoking habit, number of pregnancies, history of varicose veins in the family, dermatological diagnosis/findings, and venous Doppler ultrasonography reports were examined retrospectively. 56% of patients were women. Mean age was 56.69±13.6years. Overall, 82.7% of total patients had at least one skin finding. The most frequent skin findings except varicose veins were insufficiency dermatitis accounted for 32.7% of patients, telangiectasia, and pigmentation which were comprised 25.3%, 19.3% of the total number of patients respectively. In addition to this, 48.7% of patients had itching problems and 32.7% had pain. Moreover, 46% of patients presented superficial vein insufficiency, while 8.7% had deep vein insufficiency. For 47.3% of patients, vein diameter dilation was observed and 11.3% suffered from perforating vein insufficiency. In terms of Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification, scores of 52% of the patients were C3 and lower, while scores of 48% of total patients were C4a and higher. Early diagnosis and treatment of chronic venous insufficiency could prevent further chronic processes such as venous ulceration which is an advanced CVI finding. Thus, assessing the early skin findings might be important to identify the underlying venous insufficiency disease.