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.

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.

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.

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.

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.

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.

Successful liver allograft inflow reconstruction with the right gastroepiploic vein

Portal vein thrombosis is a common complica- tion in cirrhotic patients. When portal vein thrombectomy is not a suitable option, a large collateral vessel can be used for allograft venous inflow reconstruction. We describe an unusu- al case of successful portal revascularization using the right gastroepiploic vein. The patient underwent a cadaveric or- thotropic liver transplantation with end-to-end anastomosis of the portal vein to the right gastroepiploic vein. Six months after liver transplantation the patient is well with good liver function. The use of the right gastroepiploic vein for allograft venous reconstruction is feasible and safe, with a great advan- tage of avoiding the need of venous jump graft.

VNUS Closure^®FAST Radiofrequency of the Great Saphenous Vein for Superficial Venous Insufficiency: Experience of the CH of Cholet in France

Background:The objective of this work was to evaluate the first results of the radio ablation of the great saphenous vein in the processing of chronic venous insufficiency. Method: This is a monocentric retrospective study of radio ablation of the great saphenous vein using VNUS Closure® FAST for superficial venous insufficiency of the great saphenous vein, between January 2012 and December 2014. Results: 42 patients (57 limbs) were operated on with this technology. There were 33 women and 9 men (mean age: 46.5 years). Thirty-nine patients (92. 8%) were symptomatic. Thirty-two patients (76.1%) were classified CEAP 2. The average diameter of the saphenous vein was 8.5 ± 1.5 mm. Three patients (7.1%) had a percutaneous approach. A perfect occlusion of the saphenous vein was observed in all patients. No incident or undesirable event was observed during the procedure. One case of delayed deep-vein thrombosis was observed. At one month of follow-up, six patients (14.2%) had induration opposite to the occluded vein. Forty-three percent of the patients stated they were very satisfied with the procedure. Conclusion: The effectiveness, security and simplicity of the closure method are real. More studies are necessary to assess the long-term results of this procedure.

Occlusion Effect of a Long-pulsed 532nm Laser on Veins

Laser treatment represents an attractive option to other methods of vessel diseases especially varicose veins. A long pulse (30-50ms) 532nm laser was used in our experiments, with the pulse duration matching the thermal relaxation time of the vessels and the green laser matching the absorption spectrum peak of the blood.Laser irradiates nude vein vessels directly or exterior skin to finish operation faster and to acquire the practical data for upper enteron varicose vein treatment in several animal experiments performed in vivo. The 5Jenergy pulse allows us to finely occlude rabbit or dog's vein vessels up to 2 mm in diameter when irradiating them off external skin. Blood vessels are occluded at once, and later biopsy specimens show the immediate and long-term lasting occlusion effect. While vessels are irradiated directly, they are usually irradiated to perforate, detailed causes are still under investigation. Animal experiments showed that the long pulse green laser therapy is a safe and effective solution to the vein's occlusion, which promises such laser with high energy of each pulse and 30-50 ms duration is an ideal candidate for vessel diseases treatment.

预防性抗凝对大隐静脉射频闭合术后症状性静脉血栓栓塞的影响

目的探讨大隐静脉射频闭合术后使用预防性抗凝药物对症状性静脉血栓栓塞(VTE)的影响。方法回顾性选取2022年1至12月在浙江省人民医院血管外科行大隐静脉射频闭合术的1074例患者为研究对象,其中未接受口服预防性抗凝药物组(未接受抗凝治疗组)106例、接受利伐沙班10 mg抗凝治疗5 d组(预防性抗凝5 d组)762例、接受利伐沙班10 mg抗凝治疗10 d组(预防性抗凝10 d组)206例。比较3组患者术后1个月内VTE发生率和出血性事件发生率。结果未接受抗凝治疗组术后1个月内未发生VTE,预防性抗凝5 d组和预防性抗凝10 d组术后1个月内VTE发生率分别为0.52%(4/762)和0.49%(1/206),3组患者术后1个月内VTE发生率比较差异无统计学意义(P=0.593)。未接受抗凝治疗组和预防性抗凝5 d组术后1个月内未发生出血性事件;预防性抗凝10 d组术后出现血尿1例,发生率为0.49%(1/206),3组患者术后1个月内出血性事件发生率比较差异无统计学意义(P=0.191)。结论大隐静脉射频闭合术后预防性抗凝使用利伐沙班未能明显降低VTE发生率,但也不会增加出血风险。

正念减压疗法在大隐静脉曲张伴睡眠障碍患者围术期中的应用效果

目的探究正念减压疗法在大隐静脉曲张伴睡眠障碍患者围术期中的应用效果。方法选取2020年1月—2022年6月收治的90例大隐静脉曲张伴睡眠障碍,采用随机数字表法随机将其分为试验组和对照组2组各45例。试验组围术期在常规治疗基础上给予正念减压疗法,对照组围术期给予常规治疗。比较2组入院当天和出院当天应对方式(采用简易应对方式问卷评估)、心理状态[采用焦虑自评量表(SAS)及抑郁自评量表(SDS)评估]和睡眠质量[采用匹兹堡睡眠质量指数量表(PSQI)评估],以及出院当天住院满意度。结果出院当天,2组积极应对评分、消极应对评分、SAS评分、SDS评分和PSQI评分均优于入院当天;试验组积极应对评分、消极应对评分、SAS评分、SDS评分、PSQI评分和住院满意度均优于对照组(P<0.05)。结论围术期实施正念减压疗法有助于改善大隐静脉曲张伴睡眠障碍患者应对方式、心理状态、睡眠质量,且患者住院满意度较高。

桃红四物汤联合射频消融治疗下肢静脉曲张合并血栓性静脉炎临床研究

[目的]探究桃红四物汤联合射频消融治疗下肢静脉曲张合并血栓性静脉炎患者的临床疗效。[方法]选择2020年1月至2022年1月于医院治疗的下肢静脉曲张合并血栓性静脉炎患者100例,采用随机数字表法分为射频消融组与桃红四物汤联合组各50例,射频消融组给予患者射频消融治疗,桃红四物汤联合组给予患者桃红四物汤联合射频消融治疗,治疗前、后检测两组患者可溶性血管细胞黏附分子-1(sVCAM-1)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、D-二聚体、一氧化氮(NO)、血栓素B2(TXB2)、内皮素-1(ET-1)、血管性血友病因子(vWF)、6-酮-前列腺素F1α(6-Keto-PGF1α)、纤维蛋白原、血细胞比容、血浆黏度水平,给予患者皮肤温度、肿胀程度、皮肤颜色、疼痛程度评价,比较两组临床疗效。[结果]治疗后,桃红四物汤联合组TNF-α、sVCAM-1、IL-1β、D-二聚体、TXB2、6-Keto-PGF1α、ET-1、vWF、纤维蛋白原、血细胞比容、血浆黏度水平及皮肤温度、肿胀程度、皮肤颜色、疼痛程度评分低于射频消融组(P<0.05);桃红四物汤联合组NO水平、总有效率较射频消融组高(P<0.05)。[结论]给予下肢静脉曲张合并血栓性静脉炎患者桃红四物汤联合射频消融治疗,可抑制炎症,减少血管内皮损伤,改善血液流变学及微循环,缓解患者临床症状,提升患者临床疗效。

膈下逐瘀汤联合地奥司明对大隐静脉曲张术后凝血机制的影响

目的探讨大隐静脉曲张手术患者应用膈下逐瘀汤联合地奥司明治疗对凝血机制的影响。方法选取2019年1月至2022年4月于绍兴市中医院接受大隐静脉曲张手术的60例患者,根据随机数字表法将纳入患者分为对照组和观察组,每组各30例,对照组患者予地奥司明治疗,观察组患者予地奥司明+膈下逐瘀汤治疗。比较两组患者的凝血指标、血管内皮功能、炎症因子水平。结果治疗后,观察组患者的Krüppel样转录因子、活化部分凝血活酶时间、凝血酶时间、凝血酶原时间、一氧化氮、白细胞介素(interleukin,IL)-10均显著高于对照组,纤溶酶原激活物抑制剂1型、血管性血友病因子、内皮素-1、超敏C反应蛋白、IL-2、IL-6均显著低于对照组(P<0.05)。结论膈下逐瘀汤联合地奥司明用于大隐静脉曲张术后患者可改善机体高凝状态和血管内皮功能,降低机体炎症因子水平,值得临床推广应用。

思维导图联合清单式管理在原发性下肢静脉曲张围术期病人中的应用

目的:探讨思维导图联合清单式管理在原发性下肢静脉曲张围术期病人中的应用效果。方法:选取2022年4月—12月某三级甲等医院血管外科原发性下肢静脉曲张行手术治疗的124例病人作为研究对象,采用随机数字表法将病人分为观察组和对照组各62例;对照组实施下肢静脉曲张常规护理,观察组病人采用思维导图联合清单式管理进行专科护理及健康宣教;两组病人均于术后12周填写护理满意度调查问卷、慢性静脉功能不全病人生活质量问卷(CIVIQ-14),比较两组病人术后12周护理满意度及生活质量的变化。结果:术后12周观察组病人护理满意度高于对照组(P=0.008),疼痛、身体体能、心理维度及生活质量总分均高于对照组(P<0.01)。结论:思维导图联合清单式管理在原发性下肢静脉曲张围术期病人中应用有良好的效果,能有效提升病人满意度及术后生活质量。

射频及激光消融术治疗大隐静脉曲张的疗效研究

目的探讨射频及激光消融术治疗大隐静脉曲张的疗效。方法选取2018年1月至2021年1月就诊于北京中医药大学附属护国寺中医医院血管外科行手术治疗的大隐静脉曲张患者280例为研究对象,根据手术方法不同分为射频组及激光组,射频组采用大隐静脉射频消融术(radiofrequency ablation,RFA)+泡沫硬化剂注射术+点式剥脱术,共140例患者,140条患肢;激光组采用大隐静脉高位结扎+主干激光消融术+泡沫硬化剂注射术+点式剥脱术,共140例患者,140条患肢。对比2组患者手术时间、术中出血量、住院时间、血小板(platelet,PLT)、D⁃二聚体(D⁃dimer,D⁃D)、视觉模拟量表(visual ana⁃logue scale,VAS)评分、静脉临床严重程度量表(venous clinical severity scale,VCSS)评分、并发症发生率、大隐静脉闭合及复发情况。结果射频组患者手术时间、住院时间短于激光组患者,术中出血量少于激光组患者,差异均有统计学意义(P<0.05)。2组患者治疗后D⁃D水平均低于治疗前,射频组治疗后PLT水平降低,激光组治疗后PLT水平升高,射频组治疗后PLT和D⁃D水平低于激光组治疗后,差异均有统计学意义(P<0.05)。射频组患者术后6 h及48 h VAS评分均低于激光组,差异有统计学意义(P<0.05)。2组患者术前VCSS评分比较差异无统计学意义(P>0.05);射频组患者术后1个月VCSS评分低于激光组患者,差异有统计学意义(P<0.05)。2组患者术后闭合及复发情况比较差异无统计学意义(P>0.05)。术后射频组患者并发症发生率低于激光组,差异有统计学意义(P<0.05)。结论采用RFA治疗大隐静脉曲张,能降低患者术后PLT、D⁃D水平,有效控制静脉严重程度,减少并发症发生率,且无需高位结扎大隐静脉,更具微创性。

Combined subfascial endoscopic perforator surgery and endovenous laser treatment without impact on the great saphenous vein for management of lower-extremity varicose veins

Background Conventional high ligation and stripping of the great saphenous vein （GSV） has a good curative effect but is highly traumatic with a considerable relapse rate. Subfascial endoscopic perforator surgery （SEPS） plus endovenous laser treatment （EVLT） could be applied as individual therapy. This study aimed to evaluate the feasibility of performing combined SEPS and EVLT without impacting GSV in the management of valvular insufficiency of the lower-limb venous perforators. Methods Placement of lower-limb venous perforator insufficiency was marked by ascending phlebography in 83 affected limbs from September 2010 to June 2011. After randomization, SEPS was performed on 41 limbs to address the insufficiency of the venous perforators under the deep fascia, in combination with EVLT to close the superficial varicose veins without impacting the GSV. The remaining 42 limbs were treated using traditional GSV phlebectomy as controls. Results Postoperatively, all varicose veins were resolved, with lightening of the pigmentation and healing of the ulcer. Within a follow-up period of 5-11 months, no symptoms had recurred. Compared with the control group, the operation time, the number of incisions sutured, and the in-hospital time decreased on average by 1.5 hours, 4.7, and 6.8 days, respectively （P 〈0.01 in all cases）. Conclusion Combined SEPS and EVLT for treatment of valvular insufficiency of the lower-limb venous perforators offer the advantages of microtrauma and rapid cure.

血府逐瘀汤联合腔内激光闭合术对下肢静脉曲张患者的临床疗效

目的探讨血府逐瘀汤联合腔内激光闭合术对下肢静脉曲张患者的临床疗效。方法选取2021年2月至2022年3月于河北工程大学附属医院及邯郸市中医院就诊的140例下肢静脉曲张患者,按照入院顺序编号随机分组法分为对照组(n=70,行大隐静脉高位结扎+腔内激光闭合术)与治疗组(n=70,在对照组基础上予血府逐瘀汤治疗)。比较两组患者的临床疗效,术后瘀斑、肢体疼痛、肿胀消失时间,治疗满意度及并发症发生情况。结果治疗组患者总有效率高于对照组患者,差异有统计学意义(P<0.05)。治疗组患者术后瘀斑、肢体疼痛、肢体肿胀消失时间均明显短于对照组患者,差异均有统计学意义(P<0.01)。治疗组患者治疗满意度高于对照组患者,差异有统计学意义(P<0.05)。治疗组患者并发症总发生率低于对照组患者,差异有统计学意义(P<0.05)。结论血府逐瘀汤联合腔内激光闭合术治疗下肢静脉曲张患者能够明显改善患者术后瘀斑、肢体疼痛、肿胀等症状,降低并发症发生率,提高患者的治疗满意度,临床疗效较好。

静脉曲张合并May-Thurner综合征的相关治疗方案

May-Thurner综合征也称为髂静脉压迫综合征(IVCS)或Cockett综合征,是一组与静脉回流障碍相关的症状,其发生率为14.0%~55.6%,临床相关表现包括静脉曲张、腿部色素沉着、静脉溃疡等。目前,临床上对静脉曲张合并May-Thurner综合征患者的治疗方案包括静脉曲张热消融手术、髂静脉支架置入术、髂静脉支架置入术联合静脉曲张热消融手术、压力治疗等,但尚未形成统一标准,本综述对以上4种治疗方式的相关内容进行分析,以期在保证患者疗效的同时获得更好的预后。