Treatment Of Chronic Venous Insufficiency Research Articles

Efficacy of combination of needle extract, hesperidin and vitamin C in treatment of chronic venous diseases

In Russia, physicians are virtually unaware of drugs based on needle extract. However, abroad, saponins and, in particular, a combined preparation containing needle extract, hesperidin and vitamin C is one of drugs of choice, if not the leading medication in treatment of venous oedemas and other venous symptoms. The authors conducted a systematic review of the Russian-and English-language literature using the following search terms: saponins, hesperidin, needle, ruscus, ruscogenin (and their Russian equivalents), each of which was entered in a combination with the word 'venous' or its Russian equivalent, respectively. Ruscogenin and neoruscogenin from the root of needle possess anti-inflammatory properties and induce venous wall contraction, thus making it possible to use needle extract in treatment of chronic venous insufficiency. It was experimentally determined that needle extract stimulates vein contractility, decreasing permeability of the venous wall, influencing extracellular matrix proteins, inhibiting leukocyte migration through regulation of both proteins and matrix ribonucleic acid. Analysed herein are the results of original studies of a combination of needle extract, flavonoid hesperidin methyl chalcone and ascorbic acid, also examining in detail the mechanism of action conditioned by synergism of pharmacological effects of these components. This is followed by discussing the place of saponins in the classification of phlebotropic drugs and comparing efficacy of needle root extract with that of other phlebotonics. It was experimentally determined that a combination of needle extract, hesperidin and vitamin C possesses multiple additive phlebotropic effects. According to clinical trials, it leads to relief of most symptoms and a decrease in the ankle volume (high level of evidence 1A), being not inferior by clinical efficiency and duration of action to the best-known flavonoids, whereas by the venotonizing effect, decreased permeability of the vascular wall, and inhibition of leukocytic aggression even superior thereto. Further experimental and clinical studies of efficacy of this combination for various forms of chronic venous diseases and venous thromboses are warranted.

Therapeutic potential of flavonoids in the treatment of chronic venous insufficiency

Chronic venous insufficiency (CVI) is a common disorder associated with a variety of symptoms in later disease stages; despite the high prevalence of this pathology, suitable pharmaceutical therapies have not been explored to date. In this context, it was recently reported that a chronic increase in venous wall stress or biomechanical stretch is sufficient to cause development of varicose veins. Recent evidence demonstrate that flavonoids are natural substances that convey the circulatory system functionality, playing a key role in blood flow. Particularly, troxerutin, diosmin and horse chestnut extract, appear protective for the management of vascular diseases. The aim of the present study was to evaluate the effect of a flavonoid compound, containing troxerutin, diosmin and horse chestnut extract on in vitro model on HUVECs cells, due to its production of vasculoregulatory and vasculotropic molecules, on an ex-vivo model on mesenteric vessel contraction, to regularize mesenteric microcirculation and on in vivo model of CVI-induced by saphene vein ligation. Furthermore, the flavonoid compound capacity of extensibility and compatibility with peripheral veins was investigated through a tissue block culture study.The degree of absorption, the contractile venous activity, the histological analysis, the immunoistochemical and immunofluorescence evaluation for VEGF and CD34 were performed, together with inflammatory mediators dosage. For the first time, this research revealed the therapeutic potential of a compound, enriched with flavonoids, to be a supportive treatment, suitable to reduce varicose vein pathophysiology and to regularize venous tone.

What is evidence-based in the treatment of chronic venous insufficiency?

Chronic venous diseases belong to the most frequent diseases. They can be asymptomatic, cause subjective symptoms or lead to objectif alterations, such as edema, cutaneous alterations and venous leg ulcers. This ultimately results in chronic venous insufficiency (CVI). Varicose veins are a progressive degenerative disease of the venous walls in the superficial venous system of the legs, which can decisively impair the quality of life of those affected. The classification of chronic venous diseases is carried out with the CEAP classification according to clinical, etiological, anatomical and pathophysiological criteria. Instruments, such as the venous clinical severity score, are used for assessment of the severity. The treatment of chronic venous diseases targets the improvement of the subjective complaints and objectifiable alterations. In addition, complications, such as phlebitis and formation of ulcers should be avoided. Invasive procedures, compression treatment and pharmaceutical treatment are complementary and a combination of these procedures can be meaningful. General physical measures, such as propping up the legs and frequent walking, are part of the basic measures for every patient with venous diseases. Compression therapy with medical compression stockings is the gold standard in the noninvasive treatment of symptomatic venous diseases, possibly supplemented by anti-inflammatory drugs. A varicose vein should be eliminated whenever possible. Stripping operations and the less invasive endovenous thermal ablation show comparable results for saphenous vein varicosis. Foam sclerotherapy and percutaneous phlebectomy are the methods of choice for elimination of side branch varicosis; however, recurrences of varicose veins are frequent.

FLAVONOIDS FROM THE BUDS OF THE HORSE CHESTNUT (AESCULUS HIPPOCASTANUM L.)

The buds of horse chestnut (Aesculus hippocastanum L., Hippocastanaceae family) is a new promising species of medicinal plant raw material. The prospect of studying the buds of this plant is due to the content of flavonoids in them, which have a wide range of pharmacological effects. Flavonoids are interesting for their capillary-strengthening action, which allows them to be used in the treatment of chronic venous insufficiency. This fact is consistent with the practice of using drugs from other organs of horse chestnut (seeds, leaves) as venotonic and angioprotective drugs. In addition, flavonoids are also characterized by antioxidant, anti-inflammatory, antimicrobial and antifungal activity.
 The actuality of the study of horse chestnut buds as a new type of medicinal plant material is also supported by the need to develop of the new effective and safe drugs based on the raw materials of this plant.
 The aim of this study was to determine the flavonoid composition of the buds of Aesulus hippocastanum. In the course of the work from the buds of horse chestnut by the method of column chromatography on silica gel L 100/160 was for the first time there were isolated and characterized using 1H-NMR, 13C-NMR, UV spectroscopy and mass spectrometry the flavonoid compounds rhamnocitrin (7-O-methylkaempferol), and accompanying 7,4′-dimethylkaempferol. The dominant and diagnostic significant flavonoid for the horse chestnut buds is rhamnocitrin. The results indicate the prospects for further study of the buds of the horse chestnut as a new type of medicinal plant raw materials.

Endovenous obliteration in the combined treatment of chronic venous diseases

The modern approach to the treatment of chronic venous insufficiency and varicose veins utilizes physical techniques for endovasal obliteration. It is characterized by significantly fewer side effects and opens new possibilities for the treatment of patients with varicose disease. Purpose: To evaluate the effectiveness of radiofrequency obliteration of varicose veins and puncture laser obliteration of perforant veins in the combined treatment of patients with varicose disease (VD). Material and methods. Outcomes of treatment of 528 patients with VD in the pool of the great saphenous vein (GSV) or small saphenous vein (SSV) have been analyzed. These patients had the combined treatment, which included radiofrequency obliteration of GSV and SSV trunk and / or Giacomini vein. Of these, 335 patients had also ECHO Foam-Form sclero-obliteration of GSV and SSV inflows and perforant veins on the thigh and / or ankle. In 266 patients, their treatment was combined with miniphlebectomy of GSV and SSV inflows and perforant veins on the thigh and / or ankle; and in 55 patients – with puncture laser obliteration of perforant veins. Results. The assessment of curative outcomes have has shown that postoperative pain intensity (VAS) was 3.1 + 0.5. Transient paresthesias were seen in 14 (3.4%) cases. Local ecchymoses – in 18 (4.3%) cases. Consequences of tumescent anesthesia: local ecchymoses and hyposthesia passed after 3–5 days. Skin pigmentation was noted in 1 case and lasted up to 3 months. Thrombosis was registered in 2 cases as a parietal thrombus in the great saphenous vein at the level of the middle third of the thigh; and in 2 cases as a thrombotic clot prolapse.

Exit site complications following cyanoacrylate glue endovenous ablation of incompetent truncal veins for chronic venous insufficiency.

In the last 5 years, the use of nonthermal, nontumescent endovenous ablation such as cyanoacrylate glue (CAG) for treatment of chronic venous insufficiency has gained global popularity. This case series discusses the presentation and management of delayed access sheath site infections in patients who have undergone CAG therapy. The authors believe such adverse effects are related to granuloma formation owing to a hypersensitivity reaction to CAG at the puncture exit site. The endovenous surgeon should be aware of preventing glue spillage into the subcutaneous space at the access site during treatment, to minimize the risk of this complication developing.

Correction to: Sulodexide in the Treatment of Chronic Venous Insufficiency: Results of the All-Russian Multicenter ACVEDUCT Program.

In the original article, the "Duration, Types of Therapy and Dynamics of Improvements" topic published incorrectly.

Sulodexide in the Treatment of Chronic Venous Insufficiency: Results of the All-Russian Multicenter ACVEDUCT Program

Sulodexide was a safe and effective medication in the treatment of a cohort of patients with lower extremity chronic venous insufficiency (CVI). This multicenter prospective observational Russian study enrolled 2263 patients with various stages of CVI, mainly classes C3 and C4, who were routinely prescribed sulodexide. Symptom improvement was seen in 56.4%, and 42.8% reported a decreased number of symptoms, mainly after about 2 weeks of treatment and in those aged 30 to 40 years. Sulodexide, used in many countries outside the United States, is a mixture of glycosaminoglycans extracted from porcine intestinal mucosa including low-molecular-weight heparin and dermatan sulfate. It is a lipid-lowering, antithrombotic, and anti-inflammatory agent, decreasing viscosity. It has been used for the management of venous disease and venous ulcerations and for the prevention of recurrent thromboembolism. There are reports of efficacy in advanced stages of CVI, but not routine use. This study overestimates the effectiveness of this drug, adding the results and stating that 99.2% (56.4% plus 42.8%) of patients had improvements. High-quality data are needed.

Endovenous laser ablation: A comprehensive review.

To provide an evidence-based overview of endovenous laser ablation and describe its role as an effective and durable technique for the management of superficial venous insufficiency. The published literature on the treatment of varicose veins using endovenous laser ablation was reviewed. The literature search focused on the history of endovenous laser ablation, its safety and durability, known complications, and differences in outcomes based on the iterations of fiber type and laser wavelength. Treatment safety and efficacy of endovenous laser ablation appear to be based on the amount of energy administered over a defined distance, or the linear endovenous energy density. The ideal linear endovenous energy density varies with the laser wavelength and fiber-type. Post-operative pain and bruising may be reduced by the use of higher wavelength fibers or the use of radial or jacket-tip fibers as compared to bare-tip fibers. The incidence of endothermal heat-induced thrombosis remains low and has declined with increasing experience. Reports have demonstrated a greater than 90% technical success rate with saphenous endovenous laser ablation, long-term durability of ablation, and commensurate improvement in quality of life. Endovenous laser ablation is a safe and durable treatment option for the management of incompetent superficial and perforator veins of the lower extremities. As an endothermal technology, it remains a key component of the standard of care for the treatment of chronic venous insufficiency.

Correction to: Sulodexide in the Treatment of Chronic Venous Insufficiency: Results of the All-Russian Multicenter ACVEDUCT Program

In the original article, there is some error in the Table2. The correct Table2 is given below.

Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions

ObjectiveAlthough many studies have demonstrated that endovenous therapies have comparable efficacy to crossectomy and stripping, few studies have been published regarding the classification and recurrence patterns of varicose veins after endovenous therapy. This study attempted to provide an objective scheme for the definition and classification of recurrence. Moreover, it describes the types and rates of recurrence after endovenous thermal ablation, as well as factors associated with recurrence. MethodsThis prospective cohort study comprised a cohort of 449 patients with saphenofemoral junction (SFJ) insufficiency who underwent endoluminal varicose vein treatment for the first time in the limb between October 2013 and January 2015. The treatments were performed by a team of three experienced phlebologists. For endovenous laser ablation, Biolitec ELVeS was used with bare, radial or radial slim fibers. Radiofrequency ablation was performed with VNUS ClosureFAST (Medtronic, Deggendorf, Germany). The patients were consecutively scheduled for 3-year follow-up examinations. Detailed ultrasound findings were collected by two experienced phlebologists who classified the observed duplex ultrasound recurrence into different recurrence types. ResultsClinically relevant recurrence was found in only 5.1% of cases. Examining only the recanalizations requiring reintervention resulted in a recurrence rate of 2.6%. However, if every new varicose vein that occurred postoperatively was considered a recurrence, the resultant recurrence rate was almost 54%. Preliminarily, we defined a recurrence as newly developed varicose veins within the region of the SFJ or along the course of the former treated vein distal to the SFJ. According to this definition, we obtained a clinically relevant recurrence rate of 5.3%, thus indicating that neovascular vessels were the largest recurrence type (57.7% within the region of the SFJ and 9.9% distal to the SFJ), followed by recanalization (8.9% within the region of the SFJ and 9.4% distal to the SFJ) and a refluxing anterior accessory saphenous vein (7.5%). We also developed a modified classification of progression to better understand recurrence after treatment of chronic venous insufficiency; the scheme included method failure (recanalization), neovascularizations, and disease progression (refluxing untreated vessels and new varicose veins occurring outside the treated region). The diameter of the treated vein (P = .001) and the clinical class according to CEAP classification (P = .008) were significant predictors of recurrence. ConclusionsEndoluminal therapies are efficient methods for the treatment of varicose veins, which result in low recurrence rates after 3 years. Several factors influence the development of recurrence. This study provides a practice-oriented classification and description of recurrence with clinical relevance, through making distinctions among technical error, progression of the underlying disease and actual recurrence.

Effect of obesity on chronic venous insufficiency treatment outcomes

BackgroundObesity is a known risk factor for the development and progression of chronic venous disorders (CVDs). It is currently unknown whether the treatment outcomes, after an intervention for CVDs, are affected by obesity. The purpose of the present investigation was to assess the effectiveness of various CVD treatments in obese patients and determine what level of obesity is associated with poor outcomes. MethodsData were prospectively collected in the Center for Vein Restoration electronic medical record system (NexGen Healthcare Information System, Irvine, Calif) and retrospectively analyzed. The patients and limbs were categorized by the following body mass index (BMI) categories: <25, 26 to 30, 31 to 35, 36 to 40, 41 to 45, and >46 kg/m2. The changes in the revised venous clinical severity score and Chronic Venous Insufficiency Quality of Life Questionnaire 20-item (CIVIQ-20) quality of life survey were used to determine the CVD treatment effectiveness for patients who had undergone endovenous thermal ablation (TA), phlebectomy, or ultrasound-guided foam sclerotherapy (USGFS). ResultsFrom January 2015 to December 2017, 65,329 patients (77% female; 23% male) had undergone a venous procedure. Of these patients, 25,592 (39,919 limbs) had undergone ablation alone, ablation with phlebectomy, or ablation with phlebectomy and USGFS. The number of procedures performed was as follows: TA, n = 37,781; USGFS, n = 22,964; and phlebectomy, n = 17,467. The degree of improvement at 6 months after the procedure was progressively less with an increasing BMI for the patients who had undergone TA, and the decrease was more significant for those patients with a BMI >35 kg/m2 (P ≤ .001). The outcomes improved ∼12% with the addition of phlebectomy to TA. The patients who had undergone a combination of TA, phlebectomy, and USGFS demonstrated no additional improvement. Significantly inferior outcomes were noted in patients with a BMI ≥35 kg/m2, with the poorest outcomes observed in patients with a BMI ≥46 kg/m2 (P ≤ .001). The average number of TAs per patient increased with an increasing BMI and was significantly different compared with the number for those with a BMI <30 kg/m2 (P ≤ .001). All pre- and post–CIVIQ-20 quality of life scores, within a BMI category, at 6 months were significantly different (P ≤ .01). No differences in the degree of improvement were observed in patients with a BMI ≥31 kg/m2. Finally, multivariate logistic regression analysis indicated that when controlling for BMI, diabetes, a history of cancer, female gender, and black and Hispanic race were independently associated with poorer outcomes. ConclusionsProgressive increases in BMI negatively affected CVD-related treatment outcomes as measured using the revised venous clinical severity score and CIVIQ-20. The outcomes progressively worsened with a BMI >35 kg/m2 for patients undergoing CVD treatment. The treatment outcomes for patients with a BMI ≥46 kg/m2 were so poor that weight loss management should be considered before offering CVD treatment.

A Novel Modified Technique with a Combination of Percutaneous Embolization with N-Butyl Cyanoacrylate and High Ligation of Saphenous Vein: a Preliminary Report

Chronic venous insufficiency (CVI) is defined as a condition affecting the venous system of lower extremities. Different treatment options are used for the treatment of this pathological condition, which impairs quality of life, especially in later stages. Surgical options are used in the case of failure with conservative treatment and pharmacological methods. There are numerous surgical techniques used in the treatment of venous insufficiency. Each of these techniques has its advantages and disadvantages. New hybrid methods are being developed to overcome adverse effects and possible complications such as deep vein thrombosis, phlebitis, and infections. In the present study, we aimed to present the preliminary results of a combination of percutaneous embolization of SV with n-butyl cyanoacrylate (NBCA) and high ligation, which is a novel modified method that we have developed. A total of 47 patients, aged between 28 and 62 years and diagnosed with chronic venous insufficiency, were included in the study. The patients were evaluated with a Comprehensive Classification System For Chronic Venous Disorders, and Venous Clinical Severity Score (VCSS). Patients??? demographic features such as age and gender, and clinical features such as CEAP classes, VCSSs, and vena saphena magna VSM diameters were recorded. All patients were treated with a novel modified hybrid technique including Venablock embolization system (Invamed RD, Ankara, Turkey) and surgical high ligation of the greater SV. In addition, patients??? preprocedural, intraprocedural, and postprocedural period follow-up data were recorded and retrospectively analyzed. According to the CEAP classification, 38 patients (80.8%) were classified as C3, six patients (12.8%) as C4, and three patients (6.4%) as C2. CEAP class was C3 in majority (38/47) of the patients, with 22 (46.8%) female and 22 (53.2%) male patients in C3 class. The mean preoperative VCSS of the patients was calculated as 8.83????????1.31 and the mean postoperative VCSS was calculated as 2.85????????0.71. The mean postoperative VCSS was statistically significantly lower than the mean preoperative VCSS (p???<???0.05). The technical success rate was found as 100%. None of the patients developed complications or side effects. We suggest that this novel method is efficient and safe in the treatment of chronic venous insufficiency because it eliminates the need for general anesthesia with short operation time and adhesion of all branches of the saphenous vein, thus preventing possible complications.

A Comparative Study to Evaluate Early Postoperative Complications and Short-Term Quality of Life Assessment Between Stripping and Endovenous Laser Therapy in the Treatment of Chronic Venous Insufficiency Patients: A Study From North India

Introduction: Most common cause of chronic venous insufficiency (CVI) is Great saphenous vein (GSV)followed by short saphenous vein (SSV) insufficiency. Various modalities for the treatment of CVI areEndovenous thermal (by laser or radiofrequency) ablation, Foam sclerotherapy and Ligation and strippingof GSV.Endovenous thermal therapy is costly for the patients residing in the developing country. Herewith wehave compared quality of life and early complications between ligation and stripping (L & S) of GSV andEndovenous laser therapy (EVLT).Method: Patients of CVI were diagnosed clinically and radiologically by duplex doppler USG. Fifteenpatients in group 1(L & S) and 22 patients in Group 2 (EVLT) were followed at the 6 weeks, 3 months and6 months.Early post procedural outcomes were documented at one week. Generic health was assessed by SF 36tools and Specific health was assessed by Aberdeen varicose vein questionnaires (AVVQ) at baseline(preprocedural), at 6 weeks,3 months and at 6 months.Results: Postoperative pain in group 1 and group 2 patients were in 20.0% and 04.5% patientsrespectively(p>0.05). Paresthesia was in 26.7% and 9.1% respectively (p >0.05). Skin hyperpigmentationwas 00.00% and 4.5% respectively (p 0.403). In both groups, infection was found in 20.0% and 04.5%respectively (p 0.137). Tract haematoma along GSV was in 13.3% and 0.00% respectively in both groups.Physical function, role limitation due to physical problems and emotional problems, emotional well-being,social function, pain, general health at end of 6 weeks and at end of 6 months were slightly better in EVLTpatients but was insignificant (p >0.05). DVT and recurrence were absent in both groups.Conclusion: Regarding treatment of CVI, Early post-operative complications, Short term General anddisease specific QoL is slightly better in patients having EVLT than L & S, but is statistically insignificant.

Racial disparities in the outcomes of superficial vein treatments for chronic venous insufficiency

BackgroundChronic venous disease (CVD) affects >20 million people in the United States. Despite this huge prevalence, there are few data on whether the effectiveness of current CVD therapies for symptomatic superficial vein reflux is affected by race. The goal of this investigation was to evaluate CVD treatment outcomes in various races in the United States. MethodsFrom January 2015 to December 2017, we retrospectively reviewed and prospectively collected data from 66,621 patients who presented for CVD evaluation. We divided patients into five racial groups: African American, Asian, Hispanic, other (race not recorded), and white. Presenting signs and symptoms, treatment modalities, number of procedures per patient, and preintervention and postintervention revised Venous Clinical Severity Scores (rVCSSs) were evaluated. All racial groups were stratified by Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class for subgroup analysis. ResultsThe average age of the entire cohort was 56.8 ± 14.7 years, with 51,393 women (77%) and 15,228 men (23%). Prevalence by race was 17% African American, 3% Asian, 18% Hispanic, 8% others, and 55% white. There was a higher incidence of C0 disease in whites (44%) and African Americans (31%); C1 and C2 disease in whites (46% and 55%) and Hispanics (28% and 25%); and C3, C4, C5, and C6 disease in whites (60%, 57%, 58%, and 61%) and African Americans (19%, 17%, 19%, and 21%). Pain as an initial presenting symptom was more common in African Americans, Asians, and Hispanics (29%, 29%, and 31%). Swelling was highest in African Americans (18%) and cramping in Hispanics (14%). Skin changes and venous ulcers were most common in African Americans (16% and 21%) and whites (63% and 61%). With regard to the average number of procedures performed, Hispanics (1.98 ± 1.24) and others (2.07 ± 1.25) required fewer stand-alone ablations compared with whites (2.31 ± 1.56), Asians (2.36 ± 1.58), and African Americans (2.27 ± 1.56; P ≤ .0001. With the addition of phlebectomies to ablations, Hispanics (3.78 ± 2.08) continued to require fewer procedures, and Asians required the greatest number of phlebectomies compared with all groups (P ≤ .001). When ultrasound-guided foam sclerotherapy was added to ablation and phlebectomy, African Americans required more procedures compared with all races (4.38 ± 2.59; P ≤ .01). For stand-alone ablations, Hispanics (2.18 ± 2.34) and Asians (1.91 ± 2.35) demonstrated lower postprocedure rVCSSs compared with African Americans (2.79 ± 2.88) and whites (2.8 ± 2.85; P ≤ .0001). For ablations with phlebectomies, all races demonstrated similar results except for Hispanics (2.19 ± 2.14), who did better than whites (2.85 ± 2.75; P ≤ .002). For ablations with phlebectomies and ultrasound-guided foam sclerotherapy, all races had similar results (P ≤ .0001). ConclusionsIn the United States, CVD is primarily observed in white women. There are differences in the incidence and prevalence of disease severity and symptom presentation based on race. The incidence of CVD decreases with age in all racial groups except whites. Hispanics required the fewest procedures and African Americans required the most for optimal results. Postintervention rVCSSs equalized in all races when ablations were combined with phlebectomies and ultrasound-guided foam sclerotherapy.

Contact sensitization in patients with chronic venous insufficiency and the impact of the disease duration on the risk of occurrence of contact sensitization

Background/Aim. Development of allergic contact der-matitis as a complication of treatment of chronic venous insufficiency (CVI) is well known. The aim of this study was to determine the incidence and risk of eczematous contact sensitization in patients with CVI, as well as the correlation between disease duration and contact sensitization. Methods. The study involved 266 subjects examined during three-year-period who were divided into two groups: the study group included patients with CVI referred for allergy testing due to suspected contact dermatitis, and the control group included the ones without CVI patch tested for suspected contact dermatitis. The severity of CVI was assessed by Clinical Etiology-Anatomy-Pathophysiology (CEAP) classification. Thereafter, each patient underwent patch testing. Results. The incidence of contact sensitization among patients with CVI was 49.3%. In these patients, the incidence of contact sensitization to the European standard battery of allergens was 31.55%; to the battery specific for CVI it was 28.45%. Patients with CVI had a 2.45-fold higher risk for developing contact sensitization to two or more allergens, and a 3.69-fold higher risk for developing contact sensitization to five or more allergens compared to those without CVI. The prevalence of contact sensitization in patients with CVI was not significantly different from those without CVI. There was a positive correlation between the incidence of contact sensitization and the duration of the disease. Conclusion. Patients with CVI had no statistically significantly distinct contact sensitization prevalence and had 2.45 and 3.69 times higher risk to manifest contact sensitization to two and more allergens and five and more allergens, respectively, than patients with no CVI. The positive correlation between frequency of contact sensitization and disease duration was found.

Impact of Great Saphenous Vein Foam Sclerotherapy on Quality of Life and Photoplethysmography Findings in Chronic Venous Insufficiency: One-Year Follow-up.

Ultrasound-guided foam sclerotherapy (UGFS) for treatment of chronic venous insufficiency (CVI) has been attracting significant interest over the past 20 years. It is a minimally invasive technique that comprises a safe treatment option and has yielded good results, especially in cases of advanced disease, with high rates of wound healing. To examine clinical, ultrasound, and photoplethysmography outcomes after a 1-year follow-up of UGFS for CVI. Twenty-nine legs classified as C4, C5, or C6 of the CEAP classification were included. Patients answered the VEINES questionnaire on quality of life and symptoms. and their venous filling time (VFT) was measured using photoplethysmography before and 45, 180, and 360 days after treatment of CVI with UGFS. The results showed statistically significant improvements in VEINES quality-of-life and symptom scores and in VFT measured by photoplethysmography and a reduction in great saphenous vein diameter (p < .0001) at 45, 180, and 360 days after treatment with UGFS. Ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels, confirmed by improvement in questionnaire scores, venous refilling time, and ultrasound findings.

Fluid-Structure Coupling Model and Experimental Validation of Interaction Between Pneumatic Soft Actuator and Lower Limb.

Pneumatic soft actuators (PSAs) are components that produce predesigned motion or force in different end-use devices. PSAs are lightweight, flexible, and compatible in human-machine interaction. The use of PSAs in compression therapy has proven promising in proactive pressure delivery with a wide range of dosages for treatment of chronic venous insufficiency and lymphedema. However, effective design and control of PSAs for dynamic pressure delivery have not been fully elaborated. The purpose of this study is to explore interactive working mechanisms between a PSA and lower limbs through establishing fluid-structure coupling models, an intermittent pneumatic compression (IPC) testing system, and conducting experimental validation. The developed IPC testing system consisted of a PSA unit (multichambered bladders laminated with an external textile shell), a pneumatic controller, and various real-time pressure monitoring sensors and accessory elements. The established coupling model characterized the dynamic response process with varying design parameters of the PSA unit, and demonstrated that the design of initial thickness, stiffness, and air mass flow of the PSA, as well as stiffness of limb tissues of the users, influenced PSA-lower limb interactions and resultant pressure dosages. The simulated results presented a favorable agreement with the experimental data collected by the IPC testing system. This study enhanced understanding of PSA-lower limb interactive working mechanisms and provided an evidence-based technical guidance for functional design of PSA. These results contribute to improving the efficacy of dynamic compression therapy for promotion of venous hemodynamics and user compliance in practice.

Varicose vein surgery versus foam sclereotherapy to prevent extension of venous reflux with time

In the treatment of Chronic Venous Insufficiency (CVI) High Ligation (HL) and stripping of the saphenous varicose veins, and percutaneous phlebectomy have been the main options for many years. Modern management of CVI includes treatment of the cause (reflux) and result (varicose veins). Reflux should be treated before varicosities because if the cause is not eliminated, the varicose veins will recur [1].

Dancing: More than a therapy for patients with venous insufficiency.

ObjectiveThis study aims to figure out the effects of dance therapy on patients with chronic venous insufficiency disease.MethodsForty subjects with chronic venous insufficiency were recruited to either the control group or the dance therapy group. As the severity of chronic venous insufficiency was defined with the Venous Clinical Severity Scores (VCSS), patients in control group received only medical treatment. Twenty patients with chronic venous insufficiency in dance therapy group received three times a week, for five weeks, totally 15 sessions of dance therapy in addition to medical treatment.ResultsThere was no significant difference in pre- and post-treatment results of Rivermead Index, VCSS parameters constipation complaint, assistive breath muscle activity, lower limb circumference, strength and range of motion between groups ( p &gt; 0.05). The remarkable result of this study was obtaining that the post-treatment quality of life scale’s bodily pain score was significantly higher in the dance therapy group than the control group ( p &lt; 0.05).ConclusionsIt was concluded that dance therapy has positive effects on quality of life. There were no barriers to chronic venous insufficiency patients in this form of gentle exercise, showing that it is to meliorate the cardiovascular, physical and psychological benefits of an activity that is enhancing of the self-esteem in addition to the quality of life. Treatment of chronic venous insufficiency should consist of methods that support the patient mentally, physically and psychologically, in addition to the medical treatment. Dance therapy might be a potential exercise intervention for improvements in chronic venous insufficiency patients, so clinicians focusing on them could recommend this form of gentle exercise in addition to the medical treatment.