Sclerotherapy as the Only Treatment for Varicose Veins

Background: Chronic venous insufficiency (CVI) is a widespread and underdiagnosed condition that affects more than 20% of the general population. The most prevalent manifestation of CVI is varicose veins (VVs), which affect up to 25% of women and 15% of males. Sclerotherapy is a minimally invasive procedure used primarily in treating telangiectasias, reticular veins, and small varicose veins. Objectives: This study aims to evaluate the efficacy and safety of various sclerotherapy techniques in treating varicose veins-related complications. Methods: We conducted a cross-sectional observational interventional study at Jordan University Hospital (JUH) from September 2022 to January 2023. The study involved patients with lower limb varicose veins, assessing their clinical response and monitoring potential treatment complications. Statistical analyses were performed using SPSS software version 21.0. Results: Of 567 patients with diagnosed VVs, 544 were female (95.94%), and 23 were male (4.06%). The primary complaints were pain and cosmetic concerns. Treatments included Foam Aethoxysklerol® 3% (polidocanol) and Micro-foam Aethoxysklerol® 1%. Improvement in symptoms was reported by 538 patients (94.89%). The most common adverse event was hyperpigmentation, reported in 120 patients (21.16%), followed by post-procedural pain in 104 patients (18.34%). Notably, one patient (0.18%) experienced deep vein thrombosis (DVT), one (0.18%) reported telangiectatic matting, and there were two cases (0.36%) of visual disturbances and one allergic reaction. Conclusion: Sclerotherapy is effective and safe for treating VVs with minimal adverse events. It is a viable standalone treatment, reducing complications linked to other methods like radiofrequency ablation and surgery.

Sclerotherapy for Varicose Veins of the Lower Limbs

Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18;72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.

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

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

Application of Endovenous Laser Treatment Combined with Foam Sclerotherapy for the Minimally Invasive Treatment of Great Saphenous Vein Varicosity

Objective:To evaluate the efficacy of endovenous laser treatment(EVLT)combined with foam sclerotherapy(FS)in the treatment of great saphenous vein varicosity(GSVV).Methods:A total of 50 patients with GSVV,treated between March 2021 and March 2024,were selected and randomly divided into two groups using a random number table.The combination group(25 cases)underwent EVLT combined with FS,while the conventional group(25 cases)underwent EVLT alone.The total effective rate,complication rate,disease severity score,and serological indicators were compared between the two groups.Results:The total effective rate in the combination group was higher,and the complication rate was lower compared to the conventional group(P<0.05).One week after surgery,the disease severity score in the combination group was lower,coagulation function indicators were better,and inflammatory factor levels were lower compared to the conventional group(P<0.05).Conclusion:EVLT combined with FS can improve the clinical efficacy in GSVV patients,prevent postoperative complications,reduce disease severity,protect patients’coagulation function,and alleviate postoperative inflammatory responses,showing significant advantages in combined surgery.

Application of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity

Purpose:The aim of this study was to evaluate the clinical effects of the Trivex system in the treatment of primary severe superficial varicose veins of the lower extremity and compare Trivex to the point-form-stripping combined with foam sclerotherapy(FS).Methods:A total of 64 patients(35 females,29 males;mean age,57?11 years[range,29–79 years])with primary severe superficial varicose veins of the lower extremity involving 64 legs were included between October 2015 and July 2019.The maximum diameter of the vein branches was>20 mm,which appeared to be cystic dilatation and forms large-scale in the crus or the thigh.All patients underwent high ligation and endovenous laser ablation or stripping of the trunk under general anesthesia.The surgical time,pain/phlebitis,number of incisions,amount of bleeding,recurrence of varicose vein,incidence of surgical site infections(SSIs),satisfaction score,and improvement in clinical symptoms were evaluated respectively with the patients in two groups:Group A,with patients who underwent treatment with the Trivex system,and Group B,patients who underwent treatment by point-form-stripping combined with FS.Results:All procedures were performed successfully.The average operative time in Group A was 56?11 min,whereas that of Group B was 90?33 min,which was a significant difference(p<0.05).Group A patients felt little pain after surgery,whereas in Group B the level of pain peaked on postoperative day 30,mostly due to thrombophlebitis after FS.There was no recurrence of varicose vein was observed in any patient,however,there were some residual effects in Group B,including the amount of bleeding volume,in-hospital stays,pain/phlebitis,and number of incisions(P<0.05).There were no significant differences with respect to SSIs,improvement in clinical symptoms,and satisfaction scores observed(p>0.05).Conclusions:This study shows that patients benefited from both treatment options.However,primary severe superficial varicose veins of the lower extremity treated with the Trivex system suffered less pain with fewer incisions than severe branches treated with the point-form-stripping combined with foam sclerotherapy(FS).In summary,the Trivex system is a suitable treatment prior to point-form-stripping combined with foam sclerotherapy(FS)for those who demand a high level of appearance,and especially for young patients,the Trivex system is recommended.

Numerical study on evolution of subharmonic varicose low-speed streaks in turbulent channel flow

The evolution of two spanwise-aligned low-speed streaks in a wall turbulent flow, triggered by the instability of the subharmonic varicose （SV） mode, is studied by a direct numerical simulation （DNS） method in a small spatial-periodic channel. The results show that the SV low-speed streaks are self-sustained at the early stage, and then transform into subharmonic sinuous （SS） low-speed streaks. Initially, the streamwise vortex sheets are formed by shearing, and then evolve into zigzag vortex sheets due to the mutual induction. As the intensification of the SV low-speed streaks becomes prominent, the tilted streamwise vortex tubes and the V-like streamwise vortex tubes can be formed simultaneously by increasing ＋~. When the SV low-speed streaks break down, new zigzag streamwise vortices will be generated, thus giving birth to the next sustaining cycle of the SV low-speed streaks. When the second breakdown happens, new secondary V-like streamwise vortices instead of zigzag streamwise vortices will be generated. Because of the sweep motion of the fluid induced by the secondary V-like streamwise vortices, each decayed low-speed streak can be divided into two parts, and each part combines with the part of another streak, finally leading to the formation of SS low-speed streaks.

Strategies and challenges in treatment of varicose veins and venous insufficiency

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences.In the recent decade,the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques.The literature was systematically searched on Medline without language restrictions.All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed.Endovenous laser ablation(EVLA)and radiofrequency ablation(RFA)both are same safe and effective in terms of occlusion rate,and time to return to normal activity.In comparison with RFA or EVLT,Cure conservatrice et Hemodynamique de l’Insufficience Veineuse en Ambulatoire(CHIVA)may cause more bruising and make little or no difference to rates of limb infection,superficial vein thrombosis,nerve injury,or hematoma.In terms of recurrence of varicose veins,there is little or no difference between CHIVA and stripping,RFA,or EVLT.Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy(FS)group(51%)during 1 year of follow-up.The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy.Although the mechanochemical endovenous ablation(MOCA)is a non-thermal,non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage,the overall success rate of MOCA is lower than those of other procedures such as EVLA,RFA,or high ligation and stripping.EVLA is the most cost-effective therapeutic option,with RFA being a close second for the treatment of patients with varicose veins.Endovenous thermal ablation(EVLA or RFA)is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins.Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures.MOCA and cyanoacrylate embolization appear promising,but evidence of their effectiveness is required.

Varicose Veins, Retinal Tears and Deep Vein Thrombosis, New Insights into the Causes from Adams Disease

Adams disease is the consequence of overly active transient receptor potential cation channels (TRP). This case report presents a patient suffering from multiple vascular problems and may provide new insights into the causes of venous problems. Endothelial and smooth muscle cells in veins contain TRP. These channels when activated excessively result in calcium accumulation, oxygen radical formation and apoptosis of endothelial and smooth muscle cells. The death of critical cells in vein valves, may lead to varicose veins. The loss of endothelial cells in venules may lead to retinal tears. Damage to vein walls may lead to a deep vein thrombosis. Transient receptor potential cation channels may be new drug targets of interest in the treatment or prevention of these conditions.

Right Inguinal Varicose Vein in Connection with Femoral Vein Following Intravenous Drug Abuse: A Rare Radiologic Finding

Varicose veins are enlarged, protuberant superficial veins that are palpable beneath the skin. The causes of such a venous pathology may be primary, secondary, or congenital. The major agents leading to the development of varicose veins include: Hereditary, prolonged standing, Increasing age, Heavy lifting, Prior superficial or deep vein clots, Female gender and Multiple pregnancies. In this manuscript, we report a case of inguinal varicose vein in connection with femoral vein, resulted from direct intravenous injection of drug. The diagnosis was made based on Doppler sonography.

Phlebosclerosis: An overlooked complication of varicose veins that affects clinical outcome: A case report

BACKGROUND Phlebosclerosis is a common age-related fibrotic degeneration of the venous wall.It is a disorder rather than a disease,which may cause venous dysfunction and even venous thrombosis.It is rarely reported in patients with varicose veins.CASE SUMMARY The present report describes the case of a 70-year-old man with varicose veins,vitiligo,and phlebosclerosis.Venous angiography revealed blood reflux in the superficial and deep veins.The patient underwent surgery to remove the saphe-nous veins.During the operation,a calcified vein resembling a wooden stick was found,which was surprisingly extracted from the thickened venous wall.A cross-section of this wooden stick-like vein revealed venous fibrosis and calcification,obvious thickening of the venous wall,extensive collagen deposition on the venous wall,hyaline degeneration,and venous sclerosis causing closure of the venous lumen.CONCLUSION This is probably the first report of a wooden stick-like structure being found in the venous wall in patients with varicose veins and venous ulcers.Phlebosclerosis can be observed in the late stage of varicose veins complicated by frequent infections and worse clinical outcomes.Therefore,it is important to be aware of this condition and address it rather than overlook it.

Multi-scale Distribution Pattern of Natural Ramet Population in the Rhizomatous Herb ,Thermopsis lanceolata

Thedistributionpatternofnaturalrametpopulationintherhizomatousherb ,Thermopsislanceolata R .Br.,at 5scales (0 .2m ,0 .4m ,0 .6m ,0 .8mand 1.0m)wasinvestigatedusinggridsamplingand spatialauto_correlationanalysis (Moran’sI)inMaowususandlandofInnerMongoliaofChina .Theresult showedthattherametpopulationhadnon_randomdistributionpatternatfourscales (0 .2m ,0 .4m ,0 .6m and 1.0m) .Themostfrequentlyobservedpatternwascontagiousatthescaleof 0 .2m .Thegenethadsym podialgrowthandnearlyphalanxarchitecture .Thebranchingangleoftherhizomeswasfrom 10°to 30° .The densityoftherametpopulationwasfrom 35to 131ramets·m- 2 .Themeanheightoframetswasbetween 11.0 cmand 2 5.9cm .Thebiomassoftherametpopulationwas 2 6 3.6 3g·m- 2 and 30 6 .19g·m- 2 inthetwo plots,respectively .33.71%and 4 4 .97%ofthebiomassallocationtorhizomeswereobservedandthe biomassallocationtorootswas 2 9.91%and 2 9.95%andthattoleaveswas 2 5.12 %and 36 .35%inthetwo plots ,respectively .Theratioofroottoshootwas 0 .4 4inbothplotswhiletheratioofbelow_toabove_ground biomasswas 2 .12and 3.59,respectively .

Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

AIM:To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis(UC)patients.METHODS:This was a prospective,multicenter,observational study.Between May 2010 and August 2012,49 steroid-refractory UC patients(55 flare-ups)were consecutively enrolled.All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1mg/kg per day.The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/m L for the first 2 wk.Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index(CAI).RESULTS:The mean CAI was 12.6±3.6 at onset.Within the first 7 d,93.5%of patients maintained high trough levels(10-15 ng/m L).The CAI significantly decreased beginning 2 d after treatment initiation.At 2wk,73.1%of patients experienced clinical responses.After tacrolimus initiation,31.4%and 75.6%of patients achieved clinical remission at 2 and 4 wk,respectively.Treatment was well tolerated.CONCLUSION:Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation.Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC.

Hybrid vs sequential therapy for eradication of Helicobacter pylori in Taiwan: a prospective randomized trial

AIM: To evaluate the efficacy of sequential vs hybrid therapy in patients with Helicobacter pylori(H. pylori) infection.METHODS: From March 2013 to May 2014,one hundred and seventy-five H. pylori infected patients who had not been treated for H. pylori before wererandomized to receive either sequential therapy(rabeprazole 20 mg and amoxicillin 1 g twice daily for 5 d,followed by rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg twice daily for 5 d) or hybrid therapy(rabeprazole 20 mg and amoxicillin 1 g for 7 d,followed by rabeprazole 20 mg,amoxicillin 1 g,clarithromycin 500 mg and metronidazole 500 mg twice daily for 7 d). H. pylori status was confirmed by positive results of both rapid urease test and histology examination or a positive result of culture. Eradication efficacy was assessed by follow-up endoscopy with rapid urease test and histological examination 8 wk after the end of anti-H. pylori therapy,or 13C-urea breath test at least 4 wk after completion of treatment. The primary outcome was H. pylori eradication by intension-to-treat(ITT) and per-protocol(PP) analyses.RESULTS: One hundred and sixty-seven patients(83 patients in the sequential group and 84 patients in the hybrid group) completed the study. The compliance rates were 97.6% and 97.7% for the two groups,respectively. The eradication rate was 78.2% for the sequential group and 92% for the hybrid group by ITT analysis(P = 0.01). The eradication rate was 81.9% for the sequential group and 96.4% for the hybrid group by PP analysis(P = 0.01). Univariate analysis for the clinical and bacterial factors did not identify any risk factors associated with treatment failure. Severe adverse events were observed in 2.3% of patients in the sequential group and 2.4% of those in the hybrid group.CONCLUSION: Due to a grade A(> 95%) success rate for H. pylori eradication by PP analysis,similar compliance and adverse events,hybrid therapy seems to be an appropriate eradication regimen in Taiwan.

Thermal Fatigue Behaviour of Co-Based Alloy Coating Obtained by Laser Surface Melt-Casting on High Temperature Alloy

A thermal fatigue behaviour of Co-based alloy coating obtained by laser surface meltcasting on the high temperature alloy GH33 was studied.The results show that after each time of thermal cycling,the final residual stress was formed in the melt-casting layer which is attributed to the thermal stress and structural stress.Through the first 50 times of thermal cycling,the morphology of coating still inherits the laser casting one,but the dendrites get bigger;After the second 50 times of thermal cycling,corrosion pits emerge from coating,and mostly in the places where coating and substrate meet.The fatigue damage type of coating belongs to stress corrosion.

SYNTHESIS AND THERMAL STABILITY OF NANOCOMPOSITE nc-TiN/a-TiB_2 THIN FILMS

Several nc-TiN/a-TiB2 thin films comprised of nanocrystalline (nc-) TiN and amor phous (a-) TiB2 phases were deposited on Si(100) at room temperature by reactive unbalanced dc magnetron sputtering, followed by vacuum annealed at 400, 600, 80 0 and 1000℃ for 1h, respectively. Effects of B content on microstructure, mecha nical behaviors and thermal microstructure stability have been investigated by X -ray diffraction (XRD), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS) and nanoindentation measurements. The results indicated that B addition greatly affected both microstructure and mechanical behavior of nc-Ti N/a-TiB2 thin films. With increasing B content the grain size decreased. A maxim um hardness value of about 33GPa was obtained at B content of about 19at.%. The improved mechanical properties of nc-TiN/a-TiB2 films with the addition of B int o TiN were attributed to their densified microstructure with development of fine grain size. Only addition of sufficient B could restrain grain growth during an nealing. High B content resulted in high microstructure stability. The crystalli zation of amorphous matrix occurred at about 800℃, forming TiB or TiB2 crystall ite, depending on B content. Before that no change in bonding configuration was found.

THERMAL DECOMPOSITION BEHAVIOR OF AMMONIUM THIO TUNGSTATE in H_2

The ther m al deco m position mechanism of a m m oniu m thiotungstate of the size of 63 ～75 μmin H2 has been investigated by D T A and X R D methods . The ther m al deco m position activationenergies and the orders of a m m oniu m thiotu ngstate were calculated by means of Kissinger , Freem an Carroll and Coast Redfern m ethods . It w as also obtained that therm al deco m posi tion is cond ucted according to four reaction equations :( N H4) 2 W S4· H2 O(s) ( N H4) 2 W S4(s) + H2 O(g) W S2(s) + 2 N H3(g) + H2(g) + 2 S(s) + H2 O(g) W S2(s) + 2 N H3(g) + 2 H2 S(g) + H2 O(g) W S2(s) + W(s) + 2 N H3(g) + 2 H2 S(g) + H2 O(g) .

CXC chemokines and chemokine receptors in gastric cancer: From basic findings towards therapeutic targeting

Gastric cancer is the fourth most common cancer,and the second-highest cause of cancer-related deaths worldwide.Despite extensive research to identify novel diagnostic and therapeutic agents,patients with advanced gastric cancer suffer from a poor quality of life and poor prognosis,and treatment is dependent mainly on conventional cytotoxic chemotherapy.To improve the quality of life and survival of gastric cancer patients,a better understanding of the underlying molecular pathologies,and their application towards the development of novel targeted therapies,is urgently needed.Chemokines are a group of small proteins associated with cytoskeletal rearrangements,the directional migration of several cell types during development and physiology,and the host immune response via interactions with G-protein coupled receptors.There is also growing evidence to suggest that chemokines not only play a role in the immune system,but are also involved in the development and progression of tumors.In gastric cancer,CXC chemokines and chemokine receptors regulate the trafficking of cells in and out of the tumor microenvironment.CXC chemokines and their receptors can also directly influence tumorigenesis by modulating tumor transformation,survival,growth,invasion and metastasis,as well as indirectly by regulating angiogenesis,and tumor-leukocyte interactions.In this review,we will focus on the roles of CXC chemokines and their receptors in the development,progression,and metastasis of gastric tumors,and discuss their therapeutic potential for gastric cancer.

Simultaneous modulated accelerated radiation therapy for esophageal cancer:A feasibility study

AIM: To establish the feasibility of simultaneous modulated accelerated radiation therapy (SMART) in esophageal cancer (EC).

Frequency and prognostic role of mucosal healing in patients with Crohn's disease and ulcerative colitis after one-year of biological therapy

AIM: To assess the endoscopic activity before and after a one-year period of biological therapy and to evaluate the frequency of relapses and need for retreatment after stopping the biologicals in patients with Crohn&#x02019;s disease (CD) and ulcerative colitis (UC).