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.

Double-Blind, Parallel Group Study to Compare the Clinical Effectiveness of Calcium Dobesilate 500 mg BID vs. Calcium Dobesilate LP 1 g OD, in Patients with Chronic Venous Insufficiency of the Lower Limbs

Background: Chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities due to venous hypertension (VH. The prevalence is between 5% - 30%. CVI is associated with older age, smoking, lower extremity trauma, presence of an arteriovenous shunt, and elevated estrogen levels. All patients should be initially treated with conservative management. Venoactive drugs like calcium dobesilate are useful. Objectives: The primary objective compared the clinical improvement in patients with CVI, grades 0 - 3 of the CEAP classification of chronic venous disease, produced by two formulations of calcium dobesilate: calcium dobesilate LP 1 g OD vs calcium dobesilate 500 mg BID, immediate release. The secondary objective assessed the side effects of both formulations. Method: All patients took one tablet and one capsule at 7 am, and one capsule at 7 pm, for 8 weeks. One group received dobesilate 1 g OD and the other group received dobesilate 500 md BID. They were evaluated after 15, 30 and 60 days of treatment, using the symptom evaluation scale. Results: In both groups, there was a significant decrease in the symptom score after 15 days. Four patients in the Dobesilate OD group: had adverse effects, which did not require suspension of treatment. In the BID dobesilate group, there was one therapeutic failure, and one case of gastric discomfort. Conclusions: Prolonged-release Calcium dobesilate 1 g OD is as effective as calcium dobesilate 500 mg BID for the treatment of patients with chronic venous insufficiency.

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.

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.

Prosthetic venous valves for chronic venous insufficiency:Advancements and future design directions

With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.

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.

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.

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.