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

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

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.

Comparison of 1470 nm Radial Fiber Laser Ablation and Radiofrequency Ablation in Endovascular Treatment of Venous Insufficiency

Background: In this study, we aimed to compare the results of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in patients with lower extremity venous insufficiency due to great saphenous vein (GSV) reflux on efficiency, patient comfort and postoperative morbidity. Methods: Endovascular approach in treatment of GSV insufficiency was performed in 283 patients between 2011 and 2014 at our clinic. In group 1, EVLA was performed on 149 patients (42 male, 107 female;mean age 46.90 ± 11.43) and in group 2, RFA was performed on 134 patients (41 male, 93 female;mean age 47.02 ± 12.58). The results were compared in terms of local pain, ecchymosis, paresthesia, venous clinic severity score (VCSS), length of GSV that process performed, efficiency and Clinical Etiology Anatomy Pathophysiology (CEAP) classification data. Results: GSV diameter at saphenofemoral junction level was 10.65 ± 3.72 mm and 11.29 ± 3.78 mm in group 1 and 2, respectively. Length of GSV that process performed was 38.97 ± 6.88 cm in group 1 and 41.83 ± 4.82 cm in group 2. Postoperatively burn, pulmonary embolism (PE) and deep venous thrombosis (DVT) were not observed in both groups. Postoperative complications in group 1 were hematoma formation in 2 (1.3%) patients, ecchymosis in 13 (8.7%) patients, edema in 21 (14.1%) patients and paresthesia in 10 (6.7%) patients. Postoperative complications in group 2 were hematoma formation in 1 (0.7%) patient, ecchymosis in 8 (6%) patients, edema in 12 (9%) patients and paresthesia in 6 (4.5%) patients. The efficiency of the process was 96.6% in EVLA group and 98.5% in RFA group. Conclusion: We conclude that both RFA and 1470 nm radial fiber EVLA procedures are effective and reliable techniques in treatment of GSV insufficiency. No significant difference was found between two techniques in terms of efficiency and postoperative morbidity.

PATHOLOGIC CHANGES OF MUSCLE IN VENOUS INSUFFICIENCY

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Case Report of a Chronic Wound Due to Venous Insufficiency Following a Traumatic Arteriovenous Fistula

Chronic lower limb wounds are common. They can be of arterial or venous origin. In this article, we will present a clinical case of a 30-year-old patient with a chronic injury to the right medial malleolus. In his history, we can note a gunshot wound to the right leg. Ultrasonography and CT angiography helped in the diagnosis of traumatic arteriovenous fistula. The patient underwent a fistula embolization which allowed the wound to heal. The clinical presentation, additional examinations and the latest treatment recommendations will be discussed in this article.

Application of the preventive treatment theory of traditional Chinese medicine in the prevention and treatment of chronic venous insufficiency of lower extremity

Chronic venous insufficiency is characterized by high incidence,difficult treatment and high recurrence rate.Traditional Chinese Medicine Preventive Treatment Theory is one of the important core contents in the theory of TCM.By using the theory of Traditional Chinese Medicine Preventive Treatment,using the theory of“prevention before illness,prevention the disease continues to change and prevention repeated when the disease has been cured”,can reduce the incidence rate effectively,improve the effect of clinical treatment,it is also to enrich and develop the theory of Traditional Chinese Medicine Preventive Treatment.

Cryotherapy and ankle motion in chronic venous disorders

This study compared ankle range of motion (AROM) including dorsiflexion, plantar flexion, inversion and eversion, and venous refill time (VRT) in leg skin inflamed by venous disorders, before and after a new cryotherapy ulcer prevention treatment. Fifty-seven individuals participated in the randomized clinical trial;28 in the experimental group and 29 received usual care only. Results revealed no statistically significant differences between the experimental and usual care groups although AROM measures in the experimental group showed a consistent, non-clinically relevant decrease compared to the usual care group except for dorsiflexion. Within treatment group comparisons of VRT results showed a statistically significant increase in both dorsiflexion and plantar flexion for patients with severe VRT in the experimental group (6.9 ± 6.8;p = 0.002 and 5.8 ± 12.6;p = 0.02, respectively). Cryotherapy did not further restrict already compromised AROM, and in some cases, there were minor improvements.

Venous Ulcer: Review Article

Venous ulceration is the most severe and debilitating outcome of chronic venous insufficiency in the lower limbs and accounts for 80 percent of lower extremity ulcerations. The morbidity caused by them has a serious impact on the quality of life. Sustained venous hypertension, caused by venous insufficiency leads to venous ulceration. The diagnosis is mainly clinical but needs to be differentiated from other causes of lower limb ulcers. Doppler ultrasound is the diagnostic investigation. Treatment options for venous ulcers include conservative management, mechanical treatment, medications, and surgical options. The goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. The achievement of good long term results depends on continuous care, ulcer care clinics, home health nursing and regular evaluation by the doctor. They have a crucial role to play for the amelioration of this common and morbid condition.

从“血不利则为水”探讨慢性下肢静脉性水肿的血脉辨证

从“血不利则为水”的角度探讨慢性下肢静脉性水肿的中医证治,认为“血瘀水停”是慢性下肢静脉性水肿的重要病机,气病尤其是脾肾阳虚是发病的根本原因。临证在重视治血、治水和治气的同时要兼顾治络,以经方为本,活用虫类药和藤类药,补气兼顾温阳,活血兼顾逐瘀,通络兼顾养络。

慢性静脉功能不全患者血栓形成风险的实验室评估模型初探

目的探讨联合血栓弹力图(thromboelastography,TEG)、凝血指标和血小板参数评估慢性静脉功能不全(chronic venous insufficiency,CVI)患者血栓形成风险的预测价值。方法回顾性纳入本院2020年11月至2022年3月共计CVI患者359名,根据是否发生静脉血栓栓塞症(venous thromboembolism,VTE)分为VTE组和非VTE组。分析2组的基线特征,以及联合血栓弹力图、凝血指标和血小板参数对CVI患者发生VTE的风险预测价值。采用单因素Logistic回归分析的方筛选风险因子,采用多因素Logistic回归构建预测模型,通过曲线下面积(AUC)、灵敏度、特异度等指标以及临床决策曲线(DCA)进行模型性能评价。结果对照组相比,血栓形成组R值降低(3.27±0.71 vs 3.87±1.16,P<0.05);凝血酶原时间(PT)降低(11.08±3.02 vs 12.86±3.48,P<0.001),纤维蛋白原(Fib)增高(3.46 vs 3.10,P<0.05),D二聚体(DD)增高(3.00 vs 1.12,P<0.001);血小板分布宽度(PDW)降低(12.01±3.87 vs 13.98±3.20,P<0.001)。以PT、DD、R值、Fib和PDW作为预测因子建立的血栓形成预测模型ROC曲线下面积为0.8422,灵敏度和特异度分别为36.78%和95.59%。临床决策曲线(DCA)判断当模型预测值为0.1~0.7时可使患者获益。结论联合TEG、凝血指标和血小板参数预测CVI患者发生VTE风险具有一定的效果。

改良股总静脉戴戒术治疗原发性下肢深静脉瓣膜功能不全下肢静脉曲张患者的临床疗效

目的探讨改良股总静脉戴戒术治疗原发性下肢深静脉瓣膜功能不全(PDVVI)下肢静脉曲张的临床疗效。方法收集2020年1月至2021年1月秦皇岛市第一医院收治的60例单侧PDVVI下肢静脉曲张患者的临床资料,按照治疗方法的不同将其分为对照组(n=30,采取传统大隐静脉高位结扎剥脱术)与研究组(n=30,在对照组基础上行改良股总静脉戴戒术)。比较两组患者术前及术后1、3、6个月的静脉临床严重程度评分(VCSS),术后3个月门诊复查双侧下肢静脉彩色多普勒超声,记录股静脉反流情况、股隐静脉残端复发率。结果研究组患者VCSS、股隐静脉残端复发率均低于对照组患者,下肢股静脉反流时间短于对照组患者,差异均有统计学意义(P<0.05)。结论改良股静脉戴戒术治疗单侧PDVVI下肢静脉曲张患者的临床效果显著,能够明显改善患肢深静脉血流动力学及瓣膜功能,缓解患者临床症状,提高其生活质量,值得在临床上进一步推广应用。

直接前侧入路对初次单侧全髋关节置换术后患者步态恢复和下肢静脉回流的影响

目的:探讨与分析直接前侧入路对初次单侧全髋关节置换术后患者步态恢复和下肢静脉回流的影响。方法:选择2021年1月—2022年11月在辽宁省健康产业集团阜新矿总医院诊治的112例初次单侧股骨颈骨折患者作为研究对象,根据随机数字表法将112例患者分为研究组(n=56)与对照组(n=56)。两组均给予全髋关节置换术治疗,研究组为直接前侧入路,对照组为后外侧入路。观察与记录患者的围手术期指标、髋关节功能、步态和下肢静脉回流障碍情况。结果:研究组手术时间、术后住院时间均短于对照组,术后引流量、术中出血量均少于对照组,差异均有统计学意义(P<0.05)。研究组髋关节功能优良率低于对照组(82.14%vs 64.29%),差异有统计学意义(P<0.05)。研究组下肢静脉回流障碍发生率为0,与对照组的10.71%比较,差异有统计学意义(P<0.05)。术后3 d,两组跨步长与步速比较,差异均无统计学意义(P>0.05);术后3个月,研究组的跨步长长于对照组,步速高于对照组,差异均有统计学意义(P<0.05)。结论:直接前侧入路初次单侧全髋关节置换术可缩短手术时间,降低出血量和下肢静脉回流障碍发生率,有利于患者髋关节功能恢复。

Intense venous reflux,quantified by a new software to analyze presurgical ultrasound,is associated with unfavorable outcomes of microsurgical varicocelectomy

The hemodynamic characteristics of venous reflux are associated with infertility in patients with varicocele;however,an effective method for quantifying the structural distribution of the reflux is lacking.This study aimed to predict surgical outcomes using a new software for venous reflux quantification.This was a retrospective cohort study of a consecutive series of 105 patients(age range:22–44 years)between July 2017 and September 2019.Venous reflux of the varicocele was obtained using the Valsalva maneuver during scrotal Doppler ultrasonography before microsurgical varicocelectomy.Using this software,the colored reflux signals were segmented,and the gray scale of the color pixels representing the reflux velocity was comprehensively quantified into the mean reflux velocity of the green layer(MRVG)and the reflux velocity standard deviation of the green layer(RVSDG).Spontaneous pregnancy and changes from baseline in the semen parameters were assessed during a 12-month follow-up period.Data were analyzed using logistic regression analysis.An association of the high MRVG group with impaired progressive motility(odds ratio[OR]=2.868,95%confidence interval[CI]:1.133–7.265)and impaired sperm concentration(OR=2.943,95%CI:1.196–7.239)was found during multivariate analysis.High MRVG(OR=2.680,95%CI:1.086–6.614)and high RVSDG(OR=2.508,95%CI:1.030–6.111)were found to be independent predictors of failure to achieve pregnancy following microsurgical repair.In summary,intense venous reflux is an independent predictor of impaired progressive motility,sperm concentration,and pregnancy outcomes after microsurgical varicocelectomy.

Immune function of erythrocytes in patients with chronic venous insufficiency of the lower extremities

Background The influence of inflammatory processes has been one of the hot topics in discussions of the etiology of chronic venous insufficiency （CVI）. Erythrocytes are very important in controlling inflammatory immunity and innate immune reactions. The purpose of this study was to analyze the correlation between the development of CVI and the change of CD35, Fy6 on erythrocytes, and interleukin-8 （IL-8） levels. Methods A group of 43 patients with CVI were studied in parallel with 8 healthy individuals serving as control subjects. Control subjects were those with normal findings on lower extremity duplex examinations. We used an erythrocyte flow cytometer to examine the expression of both CD35 and Fy6 on red blood cells, and an enzyme-linked immunosorbent assay analysis method to measure plasma IL-8 levels. We also analyzed the change of IL-8 levels under the influence of erythrocytes using a modified method of the hemaimmune reaction. Results Compared with normal control subjects, CD35 expression increased significantly among patients with CVI classified as C4 without lipodermatosclerosis, but tended to decrease and reach the lowest level among patients classified as C5-C6. Fy6 expression increased significantly among patients in the early stages of CVI, but tended to decrease remarkably among patients classified as C5-C6. The inflammatory response intensified at the C5-C6 classification, where high levels of IL-8 coexisted with a low expression of Fy6. The increase in IL-8 in the CVI group was higher than in the control group in association with the complete blood cells, regardless of the presence of erythrocytes, when inactive tumour cells were added, whereas the level of IL-8 in the CVI group was significantly lower than in the control group. Conclusions Abnormalities of erythrocyte innate immunity represents a fundamental derangement in CVI. These inadequate inflammatory responses may lead to local tissue and microvascular damage of the lower extremity.

Controlled study of conventional surgery and ultrasound guided foam sclerotherapy for the treatment of primary SVI of lower limbs

Objective:To compare conventional surgery and ultrasound guided foam sclerotherapy for primary superficial venous insufficiency(SVI)with respect to obliteration of superficial venous system,clinical outcome and cost.Methods:The study was conducted between September 2005 and March 2006,in Surgery department of Christian Medical College Hospital,Vellore.All patients with symptomatic primary venous insufficiency of lower limbs requiring definitive management were randomized to conventional surgery(n=30)or ultrasound guided foam sclerotherapy(n=30).Obliteration of superficial venous system at 3 months,clinical outcome and costs were registered.Results:Superficial venous system was obliterated in all the patients of both the groups at 3 months.Improvement in clinical scores and complication rates was similar in both the groups.The foam sclerotherapy group had less analgesic requirement,earlier return to work and lower cost.Conclusion:Foam sclerotherapy is a cheaper alternative to surgery for primary venous insufficiency with respect to early measures of clinical outcome.

新型微波导管腔内热消融术与激光导管腔内热消融术治疗慢性下肢静脉功能不全的有效性及安全性

目的探讨传统的激光导管腔内热消融术与新型微波导管腔内热消融术治疗慢性下肢静脉功能不全的有效性及安全性。方法收集2021年1—6月河北医科大学第一医院收治的56例慢性下肢静脉功能不全患者的临床资料,采用交互式网络相应系统将患者随机分为微波导管组(实施新型微波导管腔内热消融术)与激光导管组(实施激光导管腔内热消融术),各28例。观察并比较两组患者的围手术期指标(手术时间、术中出血量及住院时间),术前、术后1个月及术后3个月的静脉临床严重程度评分(VCSS)。比较两组患者术后3个月大隐静脉主干再通率、术后1周皮下淤血及皮下硬结发生率。结果两组患者的手术时间、术中出血量及住院时间比较,差异均无统计学意义(P>0.05)。两组患者术后1、3个月的VCSS均低于本组术前,差异均有统计学意义(P<0.05)。两组患者术前、术后1个月及术后3个月的VCSS比较,差异均无统计学意义(P>0.05)。两组患者术后3个月大隐静脉主干再通率以及术后1周皮下淤血、皮下硬结的发生率比较,差异均无统计学意义(P>0.05)。结论新型微波消融导管腔内热消融术与激光导管腔内热消融术治疗慢性下肢静脉功能不全的有效性及安全性均较高,值得临床应用。

人工静脉瓣膜周期变化中的力学性能研究

目的:研究各参数在人工静脉瓣膜周期变化中对力学性能的影响,为人工静脉瓣膜的设计与优化提供参考依据。方法:采用光滑粒子动力学方法进行双向流固耦合仿真,研究包含2种材料(膨化聚四氟乙烯和猪心包),3种长度(5.0、7.5和10.0 mm)和3种厚度(0.050、0.075和0.100 mm)的瓣膜共18组模型,通过对比张开孔径、最大等效应力及回流情况判断3个因素对瓣膜的影响。结果:瓣膜材料为猪心包时达到更大的张开孔径,最大值为5.90 mm,所受最大等效应力更平稳;在张开阶段当瓣膜长度为7.5 mm、厚度为0.100 mm时,最大等效应力值最小;在关闭阶段瓣膜材料为猪心包,瓣膜长度为10.0 mm、厚度为0.100 mm时,最大等效应力最小;瓣膜厚度为0.075 mm能获得最好的抗回流效果。结论:在一定范围内减小瓣膜长度和厚度,增加瓣膜材料的弹性模量,能增加人工静脉瓣膜周期运动的稳定性。

颅外静脉系统异常与中枢神经系统疾病

与动脉相比,颅外静脉系统具有复杂性、个体变异性和不对称性的特点,易受呼吸、体位改变、心功能及周围结构的影响。颅外静脉的发育异常或变异被认为可能是非病理性的,并未引起重视。然而,越来越多的证据表明,脑静脉功能不全在各种中枢神经系统疾病中确实具有重要的病理生理后果。几种中枢神经系统疾病与颈静脉反流的存在和严重程度有关。慢性脑脊髓静脉功能不全(CCSVI)是另一种基于复合超声标准的血管疾病,激发了人们对静脉回流生理学及病理学方面的兴趣。这些疾病与中枢神经系统疾病的关系尚未确定,需要进一步研究。本文章的目的是综合目前的概念和最新的发现,阐述颅外静脉系统结构特征、生理功能及颈部静脉在中枢神经系统疾病中的潜在作用。

CHIVA在下肢静脉曲张治疗中的价值分析

CHIVA是一种以多普勒超声检查为基础的局部麻醉下静脉曲张微创治疗手段,其打破了下肢静脉曲张的传统治疗理念,将血流动力学概念与血管疾病的诊断、治疗充分结合到一起,在保留浅静脉引流网络同时治疗近端反流点以移除过载血流,从而达到治疗静脉高压的目的。本文从CHIVA的原理、优势及缺点、治疗效果方面进行比较,表明CHIVA是一种可行的治疗静脉曲张的替代手术,与传统大隐静脉剥脱术相比,其主要优点包括保留隐静脉、局部麻醉、低复发率、低成本、低疼痛感、无神经损伤等。同时CHIVA的血流动力学理念可被借鉴于当前任何一种治疗方法,从而达到更精确的治疗。CHIVA主要的缺点是术前需精密的超声评估,学习曲线较长,需要培训静脉血流动力学团队。

基于数据挖掘研究陈柏楠教授治疗下肢慢性静脉功能不全的用药规律

目的总结陈柏楠教授治疗下肢慢性静脉功能不全(CVI)的用药规律。方法搜集陈柏楠教授2017年1月至2022年3月于山东中医药大学附属医院周围血管病科门诊治疗CVI的临床处方,运用频次分析、关联规则分析、拓扑数据分析、聚类分析方法,分析药物频次、性味归经、新方构建和药物组合,探讨其用药规律。结果本研究共搜集到符合纳入标准处方520首,中药152味,其中高频中药35味;高频药类为清热药、活血祛瘀药、补虚药,药性多为寒或温,味苦、辛或甘,主入肝经;分析获得强关联规则24条,构建新方1首,得到聚类组合3组。结论陈柏楠教授治疗CVI的用药规律为活血解毒,兼顾扶正,主张调畅气机,调气活血,重视湿邪,擅长灵活祛湿。