Venous Signs Research Articles

Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction?

Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure. Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF. Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance. Purposes: This work aims to study the prognostic value of Global the left ventricle’s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF. Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians. Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%). 63% of patients have impaired GLS (< 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study. Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF.

The Effect of Intravenous Thrombolysis on Transient Ischemic Attack and Cerebral Infarction Patients Under the Guidance of Multimodal Magnetic Resonance Imaging

Objective: To investigate the clinical effects of intravenous thrombolysis in the treatment of TIA (Transient Ischemic Attack) and cerebral infarction with multimodal MRI (magnetic resonance imaging), and to provide a reference for clinical diagnosis and treatment. Methods: Patients with acute cerebral infarction diagnosed and treated with intravenous thrombolysis were enrolled in the study. Multimodal MRI was performed to determine the location and type of cerebral infarction. Based on routine treatment and care, the rt-PA (Recombinant Tissue Plasminogen Activator) intravenous thrombolytic therapy was applied. The NIHSS (National Institutes of Health Stroke Scale) scores of patients before and after treatment were evaluated and compared to analyze the neurological prognosis. Results: The NIHSS scores after treatment were significantly lower than those before treatment, and the neurological prognosis was good. Three different forms of ACVS (asymmetric cortical venous signs) after treatment could be observed by SWI (drug-sensitive weighted imaging) images, which could help to assess the prognosis. Conclusion: Multimodal MRI could evaluate the type and severity of acute cerebral infarction. The rt-PA intravenous thrombolytic therapy could effectively promote the recovery of neurological functions in patients with cerebral infarction, which was worthy of clinical promotion.

Analysis of imaging features of age-related cerebral small vessel disease with idiopathic normal pressure hydrocephalus

Objective: To explore the imaging features in age-related cerebral small vessel disease (ArCSVD) with idiopathic normal pressure hydrocephalus (INPH). Methods: Ten cases of age-related cerebral small vessel disease (CSVD) with idiopathic normal pressure hydrocephalus admitted to the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to March 2020 were retrospective analyzed, all patients met the inclusion and exclusion criteria, and completed the head Magnetic resonance angiography plain scan, T2 fluid attenuated inversion recovery and Susceptibility Weighted Imaging sequence. Deep marrow venous signs (DMVs), INPH severity (DESH score), cortical/subcortical and deep microhemorrhages (CMBs) statistics, paraventricular and deep white matter damage (WMH) severity and CSVD imaging burden score were acquired, and correlations of DMVs and DESH scores with CMBs, WMH and Burden scores were evaluated using Spearman correlation analysis. Results: DMVs and DESH scores were significantly and positively correlated (r=0.965 9, P<0.000 1). DMVs and DESH scores were not significantly correlated with cortical/subcortical CMBs and deep CMBs. Likewise, DMVs and DESH scores were not significantly correlated with deep WMH. The WMH score of paraventricular of the 10 cases was 3 points, and the Burden score was 4 points. Conclusion: DMVs may be an indicator of the severity of ArCSVD with INPH, due to the small sample size of the current study, more cases are needed for further verification.

RIVAROXABAN IN THE PROPHYLAXIS AGAINST VENOUS THROMBOEMBOLISM AFTER TOTAL KNEE ARTHROPLASTY- A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE

Background: Venous thromboembolism (VTE) is a major healthcare problem that affects more than 1.6 million persons each year worldwide. Patients undergoing major orthopedic surgery, total knee arthroplasty (TKA), and total hip arthroplasty (THA) are at high risk for developing VTE, which can manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE), and PE can be life-threatening. It is a preventable complication of in-hospital mortality.&#x0D; The prophylaxis to prevent VTE varies from vitamin K antagonists like warfarin, low molecular weight heparin like enoxaparin, Fondaparinox sodium, direct factor Xa inhibitor like rivaroxaban and apixiban, mechanical thromboprophylaxis.&#x0D; Materials and Methods: Presented is a prospective study to see the efficacy of Oral rivaroxaban 10mg once daily dose for 14 days in the prevention of VTE in 60 elective cases total knee arthroplasty. The study was done from June 2017- October 2018 in the department of orthopaedics, Prathima institute of medical sciences, Nagunur, Karimnagar. All the operated cases were cemented with cruciate retaining prosthesis. Oral Rivaroxaban 10mg was given after 6-8 hours after wound closure and continued for 14 days. All the patients were closely monitored for signs and symptoms of DVT, PE with Wells DVT score followed by venous angiogram and signs of pulmonary embolism evaluated with modified Gurd and Wilson criteria and subsequent CT pulmonary angiogram.&#x0D; Results: In study involving 60 primary total knee replacement cases, only one patient developed deep venous thromboembolism (1.6%) with oral Rivaroxaban. No cases of bleeding manifestations or pulmonary embolism were reported.&#x0D; Conclusion: once daily oral dose of rivaroxaban 10mg for 14 days is an effective modality in preventing the number of cases of VTE after Total knee arthroplasty. The ease of administration of oral agents compared to subcutaneously given agents like Enoxaparin will lead to better patient compliance and early discharge from hospital.&#x0D; Key words: Venous thromboembolism, Total knee arthroplasty, Rivaroxaban, Deep vein thrombosis, Pulmonary embolism

Features of structural and functional parameters of superficial veins of lower extremities in men with arterial hypertension

The aim of the work was to assess the structural and functional parameters of the superficial veins of the lower extremities in men with arterial hypertension. A comparative analysis of the results of the angioscanning of the superficial veins of the lower extremities between 60 men with arterial hypertension and 27 men with normal blood pressure at the age of 30–50 years was performed. In hypertension, an increased rate of venous blood flow and signs of chronic vein diseases are recorded — an increased diameter and area of the lumen of the veins; abnormal venous reflux marked in 10 % of men; in 3 % — varicose veins and thrombotic masses, signs of postrombotic lesion of the superficial veins.Conclusion. For men with hypertension aged 30–50 years, there is an increased rate of venous blood flow and signs of chronic venous disease of the lower extremities: chronic venous insufficiency, varicose and postrombotic venous disease, which must be considered when stratifying cardiovascular risks and treating hypertension.

Abstract TP337: Multiphase CTA Improves ICH Expansion Prediction and Might Provide Additional Information on the Pathophysiology of the Spot Sign

Background: Although the spot sign is a strong predictor of hematoma expansion, there is no accepted consensus on the timing of CTA acquisition, mainly because its pathophysiologic significance is uncertain. We investigated the yield of the spot sign in the prediction of hematoma expansion and its pathophysiological underpinnings using multiphase CTA. Methods: Single-center prospective observational cohort study of 123 consecutive patients with acute (&lt;6 hours) ICH. Patients underwent multiphase CTA performed in 3 automated phases after contrast dye injection (delay of 8, 4, and 15 seconds, respectively). According to spot sign positivity in the 3 phases, patients were categorized into 1 of 4 patterns: A (+/+/-), B (+/+/+), C (-/+/+), and D (-/-/+). Outcomes included frequency of the spot sign, significant hematoma expansion at 24 hours (&gt;33% or &gt;6 mL, primary outcome), and absolute hematoma growth. Results: The frequency of the spot sign was higher the later the phase of CTA was: 29.3% in phase 1, 43.1% in 2, and 46.3% in 3 ( P &lt;0.001). The presence of the spot sign in phase 1, 2, 3, or any phase was related to significant hematoma expansion ( P &lt;0.001 for all comparisons). Predictive values varied depending on the CTA phase, with highest PPV observed in phase 1 (63%) and highest NPV in phase 2 (88.9%). Onset to imaging time was not significantly lower the more arterial the pattern of spot sign presentation was (Figure). The frequency of significant hematoma expansion was higher the earlier the pattern of spot sign presentation: A 100%, B 59.1%, C 40%, and D 0% ( P =0.013). Absolute hematoma growth analysis showed a hierarchical distribution of patterns of spot sign presentation: A &gt; B &gt; C &gt; D &gt; no spot sign ( P =0.003, Figure). Conclusions: Multiphase CTA improves hematoma expansion prediction and might provide additional information on the pathophysiology of the spot sign. Arterial spot signs may represent the point of active hemorrhage, and venous spot signs the site of resolved bleeding.

Outcome of ultrasound guided foam sclerotherapy (UGFS) treatment for varicose veins: A four years retrospective study at a tertiary care hospital in north India

Objective:The purpose of this study was to determine the outcome and rate of recurrence for varicose veins treated with ultrasound-guided foam sclerotherapy (UGFS).Methods:Data was collected from hospital records. Patients treated with UGFS for superficial venous insufficiency were included in the study. Total 361 legs in 241 patients, out of which 121 patients with unilateral limbs and 120 patients with bilateral limbs were found to be treated by this method.Results:Out of these 361 legs great saphenous vein (GSV) varicosity was found in 88 legs, short saphenous vein (SSV) in 76, GSV & SSV both in 63, others 134. 264 legs with primary varicosity while 97 were with recurrent. In 294 legs clinical CEAP was 2-3 while in 67 legs it was 4-6. Saphenofemoral junction (SFJ) incompetence was found 60 legs, saphenopopliteal junction (SPJ) incompetence in 68, only perforator’s incompetence was in 56, SFJ with perforator’s incompetence 61, SPJ with perforator’s 29 and no incompetence was noted in 87 legs.Outcome at 6 months was 96.23% while treatment failure and recurrences were noted in 2.77 % of legs. Complications which were noted at 1 week were superficial skin necrosis in 3.04%, pain at injection sites in 15.23%, superficial thrombophlebitis in 16.62%, bruising in 12.18%, skin staining in 11.08%, superficial vein thrombosis (SVT) in 9.97% while no DVT was noted in any of the treated legs.Conclusion:On conclusion it was found that UGFS is a popular office based treatment modality, safe, effective, easy and improvement in venous signs and symptoms. Even on recurrence patients easily accepts retreatment with this method. Furthermore it is associated with lesser pain, anesthesia requirements; time off work and driving gives it additional advantages.

Anti-myelin Oligodendrocyte Glycoprotein Autoantibodies in Optic Neuritis and Venous Sinus Thrombosis in a Girl

The anti-myelin oligodendrocyte glycoprotein autoantibody (anti-MOG) is recognized as a new diagnostic and prognostic markers in paediatric acquired demyelinating diseases of the central nervous system. We report a 6 years gril who developed a venous sinus thrombosis and signs of intracranial hypertension after acute otitis media. One month after this infection the patient had an episode of unilateral optic neuritis associated with anti-MOG in serum. Our patient received intravenous steroid treatment and showed a highly favourable response. This is the first case report of demyelinating disease with anti-MOG antibodies associated with thrombophilia.

Association between inflammation biomarkers, anatomic extent of deep venous thrombosis, and venous symptoms after deep venous thrombosis.

Inflammation may play a role in pathogenesis of venous thromboembolism, but the nature of this relationship is not yet understood. The objective of this study was to assess whether inflammation marker levels measured at diagnosis of deep venous thrombosis (DVT) and change in levels during the first month after DVT are associated with anatomic extent of DVT and severity of venous signs and symptoms at baseline and 1 month. The BioSOX study is a biomarker substudy of the Compression Stockings to Prevent the Post-Thrombotic Syndrome (SOX) trial, a multicenter, randomized controlled trial that included patients with a first, acute, symptomatic, proximal DVT. Blood samples were collected from participants at baseline and 1 month, and C-reactive protein (CRP), intercellular adhesion molecule 1, interleukin (IL)-6, and IL-10 were measured by established assays. Linear regression was used to assess the association between continuous log-transformed baseline biomarker levels and anatomic extent of DVT, classified as iliac or common femoral DVT vs femoral or popliteal DVT (reference). Proportional odds ordinal logistic regression models were used to analyze the association between biomarker level and Villalta score (as a measure of severity of venous signs and symptoms) at baseline and 1 month. Among 717 patients, 60.2% were male, and the mean age was 55.2 years. There was a significant association between more extensive DVT (common femoral or iliac) and levels of CRP and IL-6 at DVT diagnosis. Median (interquartile range) CRP level was 11.6 mg/L (3.84-39.5) in patients with common femoral or iliac DVT vs 6.86 mg/L (3.11-22) in patients with popliteal or femoral DVT, and median IL-6 level was 6.36 pg/mL (1.09-14.37) vs 4.40 pg/mL (2.35-8.27), respectively. These differences were statistically significant in linear regression analyses. In addition, compared with those in the lowest quartile, each higher quartile of baseline CRP concentration was associated with an odds ratio of 2.89 (1.93-4.33) for having a more severe Villalta category at baseline and 1.98 (1.28-3.08) for having a more severe Villalta category 1 month after DVT. Higher baseline levels of IL-6 were associated with Villalta severity category at baseline (odds ratio, 2.40 [1.61-3.59]). Change in biomarker levels during the first month after DVT was not strongly associated with the 1-month Villalta score. Levels of CRP and IL-6 at DVT diagnosis were associated with thrombotic disease burden, as measured by DVT extent, and severity of DVT symptoms and signs. Further studies are required to more fully elucidate the role of inflammation in DVT and its clinical course.

Predictors Of The Post-Thrombotic Syndrome In a Large Cohort Of Patients With Proximal DVT: Secondary Analysis Of The Sox Trial

Background The post-thrombotic syndrome (PTS) is a frequent complication of deep venous thrombosis (DVT). Identifying predictors of PTS is important to counsel DVT patients on their expected prognosis and to identify patients who may benefit from closer monitoring or preventive strategies. Objective In a secondary analysis of the SOX Trial, we aimed to identify predictors of developing PTS during 2 years follow-up after a first episode of proximal DVT. Methods The study cohort consisted of participants in the SOX Trial, a multicenter (24 centres in Canada and U.S.) randomized placebo controlled trial of active elastic compression stockings vs. placebo stockings worn for 2 years after a first, symptomatic proximal DVT. PTS, the primary study endpoint, was diagnosed at or after the 6 month visit based on patient-reported pain and swelling of ≥ 1 month duration that were typical in character, i.e. worse at end of day or after prolonged sitting/standing and improved after rest/leg elevation (Ginsberg criteria). Cumulative incidences of PTS were compared in subgroups defined by sex, age category, body mass index (BMI) category, anatomic extent of index DVT, type of DVT (cancer-associated, secondary risk factor-associated, unprovoked) and 1-month Villalta score category (score 0-4: none; 5-9, mild; 10-14, moderate; &gt;14, severe), using Cox regression. Losses to follow-up, withdrawals and deaths were censored as of last date of follow-up. Results are presented as cumulative incidence by 750 days follow-up and hazard ratios (HR) with 95% confidence intervals (CI). Results Among the 803 participants in the SOX Trial, 60% were male, mean age was 55.1 years, and 87% were out-patients. In analyses adjusted for intervention group (i.e. allocation to active vs. placebo stockings), iliac vein DVT (HR 2.26 [95% CI 1.12, 4.53]; reference category: popliteal DVT) and Villalta score category at 1 month after DVT (score 5-9, HR 2.74 [95% CI 1.62, 4.64]; score 10-14, HR 5.81[95% CI 2.99, 11.29]; score &gt;14, HR 7.59 [95% CI 3.31, 17.44]; reference category: score &lt;5) were significant predictors of PTS. In analyses adjusted for intervention group and all predictor variables of interest, Villalta score category at 1 month was a highly statistically significant, independent predictor of PTS (see Table). Age, sex, BMI and type of DVT did not predict development of PTS. Conclusions In a large prospective cohort of patients with proximal DVT who were participants in the SOX Trial, Villalta score category (which reflects severity of venous symptoms and signs) at 1 month after DVT was strongly predictive of development of PTS during 2 years follow-up. This confirms a similar finding that we first observed in the VETO cohort study (Kahn SR et. al., Annals Intern Med 2008). More extensive DVT was also associated with PTS. Patients with these risk factors may benefit from closer monitoring after proximal DVT, and in the case of iliac vein DVT, from more aggressive strategies to treat acute DVT. Disclosures: No relevant conflicts of interest to declare.

Satisfactory Reliability among Nursing Students using the Instrument PVC ASSESS to Evaluate Management of Peripheral Venous Catheters

Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (κ) were calculated. For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (<0.70) for two items: "adherence of inner dressing to the skin" and "PVC location." In 81% of the items, κ was between moderate and almost perfect: moderate (n=5), substantial (n=3), almost perfect (n=5). For edema at insertion site and two items on PVC dressing, κ was fair (0.21-0.40). Regarding test-retest reliability, P(A) varied between good and excellent (0.81-1) in 85%-95% of the items, and the κ ranged between moderate and almost perfect (0.41-1) in 90%-95%. PVC assess demonstrated satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.

Translation and validation of the Dutch VEINES-QOL/Sym in varicose vein patients

To translate from English to Dutch and evaluate the psychometric properties of the VEnous INsufficiency Epidemiological and Economic Studies (VEINES) questionnaire, divided in symptom (VEINES-Sym) and quality of life (VEINES-QOL) subscales. Standard forward-backward translation method was used to translate the 26 items of the VEINES-QOL/Sym. Eligible patients had to complete a standardized questionnaire. Demographic, venous disease characteristics, clinical venous signs, CEAP (clinical, aetiological, anatomical and pathological elements) classification and ultrasound findings were also noted. If item's scores were in an extreme category in more than 70% of patients a floor or ceiling effect was present. Feasibility of the individual items was considered poor if 5% or more of the responses were missing. The validity was tested by comparing the VEINES-QOL/Sym scores to the Short Form 36 (SF-36) scores and across the different 'CEAP' categories. Confirmatory factor analysis was used to assess the underlying structure of the VEINES-QOL/Sym. Sixty-six patients were included (response rate of 72%). None of the 26 items missed <10% of responses, but two showed ceiling effect. Both the VEINES-QOL and VEINES-Sym showed an excellent internal consistency (Cronbach's alpha of 0.88 and 0.81, respectively). The VEINES-QOL demonstrated a good construct validity for the physical component of the SF-36, but not for the mental component (rho = 0.62 and 0.22, respectively), as expected. The VEINES-Sym correlated poorly to both SF-36's components. According to the confirmatory principle axis factoring, only three out of 25 items did not load sufficiently on the factor. The Dutch VEINES-QOL/Sym can be used for health-related quality of life research in varicose veins patients and the evaluation of therapies.

Anatomical and physiological changes in the venous system of lower limbs in pregnant women and findings associated with the symptomatology

Quantify the volume and diameter of veins in the lower limbs of primigravidae and associate the presence of venous signs and symptoms with the vascular measurements. A cross-sectional study assessed 64 lower limbs of 32 healthy women of whom 16 were primigravidae between 22 and 36 weeks pregnant, and 16 nulligravidae. The women were submitted to physical assessment, air plethysmography and vascular ultrasound. The volumes and diameters of the main veins in the lower limbs were compared between pregnant and non-pregnant women. In the group of pregnant women, the attempt was also made to associate such measurements to the presence of vascular signs and symptoms. The average venous volume of the lower limbs (110.1 ± 30.2 and 94.7 ± 27.3 mL; p = 0.036), as well as the diameters of the common femoral (12.72 ± 2.27 and 10.14 ± 1.24 mm; p < 0.0001), saphenous (4.81 ± 1.15 and 3.55 ± 0.98 mm; p < 0.0001) and popliteal (6.87 ± 1.68 and 5.36 ± 1.07 mm; p < 0.0001) veins were, respectively, greater in the pregnant women compared with the control group. In pregnant women with venous stasis symptoms, a venous diameter of the saphenous vein compared to those without no symptoms (5.05 ± 1.19 and 4.09 ± 0.70 mm; p = 0.011) was noted. Anatomical and functional changes in the venous system during pregnancy were detected by the air plethysmography and the vascular ultrasound in primigravidae. In pregnant women, the presence of venous stasis symptoms found an anatomical and functional substrate detected in the differences in diameter of the saphenous vein.

Comparison of the Villalta post‐thrombotic syndrome score in the ipsilateral vs. contralateral leg after a first unprovoked deep vein thrombosis

Post-thrombotic syndrome (PTS) is the most frequent complication of a deep vein thrombosis (DVT). International guidelines recommend assessing PTS with the Villalta scale, a clinical measure that incorporates venous symptoms and signs in the leg ipsilateral to a DVT. However, these signs and symptoms are not specific for PTS and their prevalence and relevance in the contralateral leg have not previously been studied. Using data from the REVERSE prospective multicentre cohort study, we compared the Villalta total score and prevalence of venous signs and symptoms in the ipsilateral vs. contralateral leg in patients with a first, unilateral DVT 5 to 7 months previously. Among the 367 patients analyzed, the mean Villalta score was higher in the ipsilateral than in the contralateral leg (mean ± standard deviation [SD] 3.7 [3.4] vs. 1.9 [2.5], respectively; P<0.0001). Villalta scores in the ipsilateral and contralateral legs were strongly correlated (r=0.68; P<0.0001). Ipsilateral PTS (defined by a Villalta total score >4) was present in 31.6% (n=116) of patients. Among these, 39.7% (n=46) of patients had a Villalta score >4 in the contralateral leg, and the distribution of Villalta symptoms and signs components was similar between the legs. Villalta scores in the ipsilateral and contralateral legs are strongly correlated. Almost half of cases considered to be PTS might reflect pre-existing symptomatic chronic venous disease. Alternatively, patients with pre-existing chronic venous disease might be more prone to developing PTS after a DVT. Performing a bilateral assessment of Villalta scores at the acute phase of DVT could be of clinical interest from a diagnostic, prognostic and therapeutic point of view.

Frequency of Central Venous Thrombosis Symptoms and Signs in Patients who have History of Catheter Insertion via Internal Jugular and Subclavian Veins

Frequency of Central Venous Thrombosis Symptoms and Signs in Patients who have History of Catheter Insertion via Internal Jugular and Subclavian Veins

AGE, BODY MASS INDEX AND SEVERITY OF PRIMARY CHRONIC VENOUS DISEASE

The aim of this cross-sectional prospective study was investigate whether there is a correlation between age, BMI and severity of chronic venous disease (CVD), evaluated clinically (CEAP classification) and anatomically (extent of the epifascial venous reflux). 213 patients, 65 males (30.5%, mean age 45.1 ± 13.9 years) and 148 females (69.5%, mean age 47.5 ± 13.5 years) were divided into three age categories: 18-40 years (40.8%), 41-74 years (56.3%) and ≥75years (2.8%). BMI was classified as normal weight (18.5 - <25 kg/m(2)), overweight (25 - <30 kg/m(2)) and obesity (≥30 kg/m(2)). Clinical examination of the lower limbs assessed presence and severity of venous signs as included in the CEAP classification. BMI was calculated. Anatomical extent of CVD was described as the number of segments of the superficial and perforating veins with documented reflux by duplex imaging. Median age increased the number of insufficient venous segments (1 insufficient venous segment - median age 41.0 years, 5 insufficient venous segments - median age 51.0 years). The frequency of reflux in the superficial and perforating veins significantly increased with age (p<0.05). A statistically significant correlation was also found between age and the CEAP classification (p<0.01). This was more significant than the correlation between age and number of insufficient venous segments. In the whole group and in women the Spearman's correlation analysis revealed only a weak positive correlation between BMI and reflux in the superficial veins (r=0.145 respectively r=0.264) (p<0.05). No correlation was found in men (r=0.091). Weak positive correlation between BMI and stage of venous insufficiency (CEAP classification) was demonstrated for the whole group of patients (r=0.229, p<0.01), for women (r=0.293, p<0.05) and for men (r=0.245, p<0.01). Multiple linear regression showed age (p<0.0001) and BMI (p=0.049) as significant predictors of clinical grade according to the CEAP classification and the CEAP clinical class (p<0.0001) as a significant predictor of extent of the epifascial venous reflux. The study confirmed the relationship between age, clinical (CEAP clinical class) and pathophysiological (extent of the venous reflux) severity of CVD Older age means an increased number of insufficient venous segments and increased risk of the clinical progression of CVD from varicose veins to chronic venous insufficiency (C(3)-C(6), trophic skin changes and venous ulcers). Our results support the BMI, in term of frequency of venous reflux, as a risk factor in the whole group of patients but only in women but not in men. Multiple linear regression showed BMI together with age as significant predictors of clinical grade of CVD (p<0.05) according to the CEAP classification. As regards the influence of BMI on clinical severity/grade of CVD (CEAP), the results of our study support BMI as an important risk factor.

Comparison of the Villalta Post Thrombotic Syndrome (PTS) Score in the Ipsilateral Versus Contralateral Leg After a First Unprovoked Deep Vein Thrombosis (DVT): Results From the REVERSE Study

Abstract 1236 Background:Post thrombotic syndrome (PTS) occurs in up to 40% of persons after a proximal DVT despite optimal anticoagulant therapy. International guidelines issued by the ISTH recommend assessing PTS with the Villalta scale, a clinical measure that incorporates ratings of 5 patient-rated venous symptoms and 6 clinician-rated venous signs in the leg ipsilateral to DVT (range of scores: 0–33). However, these signs and symptoms are not specific for PTS and their presence and relevance in the contralateral leg have not been studied. The objectives of this analysis were to assess the Villalta score in the contralateral leg and its correlation with the Villalta score in the ipsilateral leg after a first DVT. Methods:Using data from the REVERSE prospective multicentre cohort study, we compared the Villalta score in the ipsilateral vs. contralateral leg in patients with a first, unprovoked, unilateral proximal DVT 5–7 months previously. As per ISTH standards, PTS was considered present if the Villalta score was >4 in the leg ipsilateral to DVT. We also compared the distribution of the Villalta scale’s signs and symptoms components in both legs in patients with PTS in the ipsilateral leg and Villalta score >4 in the contralateral leg. Results:Between October 2001 and March 2006, 664 patients with a first unprovoked venous thromboembolism (VTE) were enrolled in the REVERSE study after having received a 5–7 month course of anticoagulant therapy. The population for the present analysis consisted of the 360 REVERSE patients who had unilateral DVT as the index event, no previous secondary DVT or pulmonary embolism, and non-missing Villalta score data.Overall, mean Villalta score was higher in the ipsilateral than in the contralateral legs: 3.7 (interquartile range [IQR] 1.0 – 5.0) and 1.9 (IQR 0.0 – 3.0), respectively (paired t-test: p <0.0001).PTS was present in 31.9% (n=115) of patients. With increasing severity of venous ectasia in the contralateral leg, prevalence and severity of PTS gradually and significantly increased (both p<0.0001). Prevalence of any PTS increased from 25% (59/238) in the absence of contralateral venous ectasia to 100% (4/4) in the presence of severe contralateral venous ectasia, whereas the prevalence of severe PTS (Villalta score >15) increased from 0.9% (2/238) in patients without contralateral venous ectasia to 25% (1/4) in patients with severe contralateral venous ectasia.Villalta scores were strongly correlated in the ipsilateral and contralateral legs (r=0.68; R-Square: 0.4686; paired t-test: p<0.0001). Among the 13.9% (n=50) of patients with a Villalta score >4 in the contralateral leg, 92% (n=46) had PTS in the ipsilateral leg. Similarly, 40% (n=46) of patients with ipsilateral PTS had a Villalta score>4 in the contralateral leg. Among these 46 patients, the distribution of Villalta signs and symptoms components in both legs were similar: symptoms accounted for an average of 61% of the Villalta score in the ispsilateral leg and for 63% in the contralateral leg (paired t-test: p=0.3; 80% power to detect a paired difference of 7% using our standard deviation of 0.165 with a bilateral test at 5% alpha). Conclusions:Villalta scores in the ipsilateral and contralateral legs are strongly correlated. Almost half of patients with ipsilateral PTS had a Villalta score>4 in the contralateral leg. Among patients with Villalta score > 4 in both legs, distribution of venous signs and symptoms were similar between the two legs. This suggests that up to half of incident PTS diagnosed with the Villalta scale might in fact reflect pre-existing symptomatic chronic venous disease. Performing bilateral Villalta assessments after DVT both clinically and in PTS-related research could be of interest to distinguish PTS from previous primary venous disorders. Disclosures:Kahn:sanofi aventis: Honoraria, Research Funding; Leo Pharma: Honoraria.

Is unilateral breast enlargement always a sign of cancer?

Breast swelling is caused by many etiological factors, but should alert central vein occlusion in hemodialysis patients when the permanent vascular access is in the same arm. The swelling of the breast is caused by venous hypertension in the venous plexus draining the breast. Endovascular treatment relieves venous hypertension and related clinical signs. Additional diagnostic workup or invasive interventions such as a biopsy should be avoided in such patients, as diagnosis is straightforward with the presence of a functioning arteriovenous fistula in the same arm.

Tratamento endovascular da síndrome de compressão da veia ilíaca (May-Thurner): relato de caso

A Síndrome de May-Thurner é uma causa pouco comum de sinais e sintomas venosos relacionados ao membro inferior esquerdo. Esta síndrome é caracterizada pela compressão da veia ilíaca comum esquerda pela artéria ilíaca comum direita e, quando tal alteração anatômica causa sintomas que venham a prejudicar a qualidade de vida do paciente, existe a indicação de tratamento cirúrgico ou endovascular para correção desta alteração anatômica. Este artigo é o relato de um caso, no qual optou-se pelo tratamento endovascular com resultado satisfatório e as indicações, as nuances e os resultados esperados para esta técnica no tratamento da Síndrome de May-Thurner são discutidos. Foi concluído que, nesta síndrome, há eficácia do tratamento endovascular com melhora dos sintomas pela recanalização do sistema venoso, sem grandes riscos inerentes ao procedimento e com curto período de internação hospitalar.

Fresh look at the doppler changes in pregnancies with placental-based complications

Placental-based complications of pregnancy can be classified as acute and chronic. An example of acute placental complication is abruptio placenta. The chronic placental complications include pregnancy induced hypertension (PIH) and idiopathic Intrauterine growth restriction (IUGR). The fetus is at risk for perinatal complications in both acute and chronic conditions. Here we take a look at the natural history of the Doppler parameters in chronic conditions. The techniques used for assessing the fetal well-being include, clinical methods, biophysical tests, conventional ultrasonography, and fetal Doppler studies. Arterial Doppler studies are used to assess the well-being of the fetus and to determine the timing of delivery. However, arterial Dopplers predict only the subset of fetuses at risk of having perinatal complications. Venous Dopplers have been used to improve upon the prognostication. However, by the time the commonly used venous Doppler signs, that is, 'A' wave reversal in ductus venosus (DV) is present, the fetus is likely to be already compromised. The fetus tries to adapt to the environment of deprivation by making a series of changes in the umbilical artery circulation, cerebral circulation, and hepatic circulation. As a result of these adaptations, the fetus overcomes the state of chronic hypoxia. This article takes a look at these changes and also the effect of these adaptations. It is suggested that serial comparisons of the venous flow characteristics of the DV and inferior vena cava (IVC) can provide an early indication of the impending decompensation and can be used to predict the time the delivery.