bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Management of Leg Ulcers Associated with Pulsatile Varicose Veins and Tricuspid Regurgitation
Authors: Erel E. , Wijesinghe L. D. , McCollum P. T.
Published: January 2017

Design:

Case report.

Setting:

Vascular Surgery Department, Hull Royal Infirmary, UK.

Patients:

A 79-year-old man with a history of right leg ulcer and pulsatile veins.

Investigations and interventions:

Clinical examination revealed findings of tricuspid regurgitation. Investigations included duplex scans, CT scan, arteriography and both trans-thoracic and trans-oesophageal echocardio-graphy. These all proved inconclusive. High sapheno-femoral ligation and stripping of long saphenous vein ligation procedure resulted in healing of his ulcers within six months

Conclusion:

Pulsatile veins in the leg may be due to tricuspid regurgitation or AV malformation. Echocardiogram, duplex scan and angiograms can help to differentiate between the two diagnoses. In this case, the above investigations were misleading and clinical examination here played the key role.
Leg Ulcers: Economic Aspects
Authors: Nelzèn O.
Published: January 2017

Objective:

To review what is known about the cost of leg ulcers, and venous leg ulcers in particular.

Method:

Searches of the Medline and Cochrane Library databases. Reviewing reference lists of personally gathered articles in the field of chronic leg ulcers.

Synthesis:

Most publications dealing with the economics of leg ulcers are cost studies assessing the cost of different dressings or bandages, and only a few have given estimates of the total costs of leg ulcer management. The latter, in conjunction with accurate epidemio-logical data, are essential to estimate the nationwide costs of leg ulcer management. The costs consist of direct and indirect costs for society. Direct costs are mainly staff costs for managing dressing-changes. Based on the few estimates made, approximately 1% of the total health care costs in the western world are likely to be used for management of chronic leg ulcers. To reduce the costs of leg ulcer management a reduction in the frequency of dressing-change is recommended. Improved use of high technology, such as duplex Doppler diagnostics and varicose vein surgery, is also likely to be cost-effective. On the basis of two health economic analyses leg ulcer clinics alone do not appear to reduce the costs of leg ulcer management, mainly because of an inability to prevent recurrent ulceration.

Conclusion:

The cost implications of chronic leg ulcers are insufficiently studied but there is no doubt that managing patients with leg ulcers takes a substantial proportion of the health care budget. More health economic analyses are needed to define the best treatment in order to reduce total costs.
Prophylaxis of Perioperative Venous Thrombosis: Role of Venous Compression
Authors: Silleran-Chassany J. , Safran D.
Published: January 2017

Aim:

To review the role of compression treatments in the prevention of perioperative deep venous thrombosis.

Method:

A review of current literature in the field of prevention of deep venous thrombosis following general and orthopaedic surgery has been conducted.

Synthesis:

There is a considerable risk of deep venous thrombosis following surgical treatment in hospital. This is particularly high following joint replacement in the lower limb. This may lead to fatal pulmonary embolism or chronic venous insufficiency of the lower limb with leg ulceration and disability. Perioperative deep venous thrombosis may be prevented by a number of drugs. The most frequently used is heparin or the more modern low-molecular-weight heparins (LMWH). Vitamin K antagonists are also commonly used, but have a long duration of action. Dextrans and aspirin have an effect in preventing perioperative venous thrombosis, but this is much less than heparin. Mechanical methods of prevention have the advantage of preventing venous thrombosis without increased risk of bleeding complications.

Conclusion:

Heparin and LMWH continue to be the most frequently used means of preventing peri-operative deep venous thrombosis in France. There is reliable to evidence to show that mechanical methods of prevention including graduated elastic compression and intermittent pneumatic compression of the lower limb are also effective. These may be used in combination with heparin for increased protection or as an alternative to anticoagulant drugs where there is a risk of bleeding. They are also effective when used alone.
Leg Ulcers: Biochemical Factors
Authors: Smith P. D. Coleridge
Published: January 2017

Objective:

To review the biochemical mechanisms underlying the development of skin changes leading to ulceration in patients with chronic venous disease.

Methods:

Searches of Medline and Embase medical literature databases were undertaken. Cochrane Reviews were studied for relevant articles. Hand-searching of non-indexed journals was undertaken.

Synthesis:

Increased leucocyte activation has been shown in patients with venous disease as well as increased expression of soluble endothelial adhesion molecules. Histological studies of the skin in patients with chronic venous disease show a pervascular infiltration of the capillaries of the papillary plexus (the most superficial part of the dermis) with monocytes, macrophages and connective tissue proteins including fibrin. Fibrosis of the skin and subcutaneous tissues may be initiated by increased gene expression and production of transforming growth factor-beta1. Vascular endothelial growth factor may be involved in the capillary proliferation that has been reported in the skin by a number of authors. Increased expression of several tissue metalloproteinases (MMPs) has been reported both in lipsclerotic skin and peri-ulcer skin. The tissue inhibitors of metalloproteinases (TIMPs) are also increased and the net result is unclear. Treatment of venous disease using micronised purified flavonoid fraction moderates some of the inflammatory markers, including leucocyte ligand expression and endothelial adhesion molecule shedding. These compounds have also been shown to reduce leucocyte-endothelial adhesion in animal models of ischaemia-reperfusion injury.

Conclusions:

Many inflammatory processes have now been shown to be involved in the development of the skin changes in patients with chronic venous disease. However, the precise sequence of events which leads to leg ulceration is still unclear. Pharmacological treatments aimed at moderating some of these inflammatory processes are now under investigation as potential ways of treating patients with the more advanced stages of venous disease.
First Validation of a Placebo Compression Stocking
Authors: Vayssairat M. , Houot B.
Published: January 2017

Objective:

To validate a placebo compression stocking.

Design:

Subjects were asked to identify as the same or different, placebo (P) and medical compression stockings (MCS) presented in a controlled randomised masked manner.

Setting:

A university hospital in Paris, France, and Innothera Laboratory.

Patients, participants:

One hundred and twenty-seven volunteers.

Main outcome measures:

Recognition of P versus MCS.

Results:

The false response rates in the visual test were 46.6% for physicians and 47.6% for non-physicians; in the touch test, 19.7% and 34.5% respectively, and in the wearing test, performed by non-physicians, 25.4%.

Conclusions:

P was valid in the visual part of the study but not in its touching or wearing parts. However, the large number of false responses in the non-physician group indicates that the use of a placebo stocking would be a methodological improvement compared with the usual open studies.
Compression Therapy in Aeronautic Medicine
Authors: Gourbat J. P.
Published: January 2017

Aim:

To review the influences of air and space travel on the venous side of the circulation and to assess the consequences for air and space travellers.

Method:

A review of current literature in the field of aeronautical travel has been conducted, with particular reference to the effects on the venous system and use of compression garments.

Synthesis:

The venous system is particularly sensitive to gravitational and pressure changes encountered during air and space travel due to the low pressures normally present in this part of the circulation. The symptoms experienced by air crew may be countered by the use of venous compression stockings, amongst other measures. More sophisticated techniques are required for fighter aviation and space flights. Aircraft and spacecraft travel in a hostile environment in which it is not possible for man to survive without sophisticated layers of protection. In addition, forces of acceleration generated by aircraft flight combine with those of the environment hazarding the safety and the health of navigators. Continuing technical advances allow increased performance towards ever greater speed, better acceleration, a greater range of action and longer periods of time in space.

Conclusion:

Increasingly, the limiting factor in air and space travel appears to be man, who has difficulty in tolerating the environment to which he is exposed. The immediate risk is loss of consciousness and in time there is the risk of health deterioration. The cardiovascular system as a whole is at the centre of this problem and seems to be one of the limiting factors in the design of more advanced aircraft, especially those used for military purposes.
Investigation of Venous Disease
Authors: Smith P. D. Coleridge
Published: January 2017

Aim:

To review the investigations which are performed in patients presenting with varicose veins prior to treatment.

Method:

A review of current literature in the field of the investigation of venous disease of the lower limb has been conducted using MedLine.

Synthesis:

Continuous wave (CW) Doppler is effective in detecting venous reflux in the sapheno-femoral junction and the long saphenous vein. In the popliteal fossa, for perforating veins and for the deep veins this technique has reduced accuracy. Duplex ultrasonography is widely used in the management of venous disease of the lower limb. This investigation provides reliable anatomical information but limited functional data about the veins. Phlebography and varicography are effective investigations but are being replaced by duplex ultrasonography. Plethysmographic tests assess venous function but are poor at anatomical identification of the problem. They may be used in the monitoring of venous function during treatment and in identifying the contribution of superficial venous reflux in patients with combined deep and superficial venous disease.

Conclusion:

Clinical examination is no longer sufficient to assess patients with venous disease of the lower limb prior to surgery. CW Doppler is the minimum investigation but duplex ultrasonography is the most effective non-invasive investigation. Plethysmographic tests have limited application in the management of varicose veins.
Results after Re-Operation in the Groin for Recurrent Varices of the Long Saphenous Vein
Authors: Jessen N. , Bækgaard N.
Published: January 2017

Objective:

To evaluate the outcome of re-operation in the groin for recurrent varicose veins.

Design:

Retropective follow-up study

Setting:

Department of Vascular Surgery, Gentofte University Hospital, Copenhagen, Denmark.

Methods and materials:

Thirty-two patients with 43 operated legs. Operations were performed between January 1996 and the end of April 1997 and solely as a groin dissection; no stripping was done. Follow-up consisted of a clinical examination and duplex scanning with an ATL HDI 5000 scanner.

Results:

Sixteen cured legs, 17 with reflux beginning at mid-thigh, mainly a Hunter's perforating vein, and 10 with remaining reflux at the sapheno-femoral junction.

Conclusion:

Recurrence rate in the groin is acceptable. Stripping of the long saphenous vein is mandatory to bring down the recurrence rate from mid-thigh perforating veins. This is now standard procedure in our department.
Recurrence following Varicose Vein Surgery
Authors: Wright D. D. I. , Rose K. G. , Young E. , McCollum C. N.
Published: January 2017

Objective:

To determine the site-specific rates of recurrence following varicose vein surgery.

Design:

Postal questionnaire followed up by telephone enquiries. Full clinical review, including continuous wave and duplex Doppler investigations were carried out for all patients with responses suggesting recurrence.

Setting:

Surgicare Manchester, an independent provider of specialist varicose vein treatments. All procedures were guided by Doppler ultrasound and performed by surgeons working to the same protocol.

Subjects:

A consecutive series of 250 operations on 246 Patients. Of these, 208 (85%) could be contacted for follow-up. Mean time to re-examination was 27 months.

Results:

Twelve patients returned spontaneously and 51 were recalled for examination based on questionnaire responses. Recurrences were divided into ‘site’, ‘perforator’ or ‘new site’ recurrence. Primary surgery to the sapheno-femoral junction (SFJ) had the lowest ‘site’ recurrence rate of 2.3% compared with 9.5% for SFJ re-operation. Primary surgery and re-operation of the sapheno-popliteal junction (SPJ) had higher recurrence rates of 8.3% and 7.8% respectively. New incompetence was detected in 5% and 2% of previously competent SFJ and SPJ respectively. Minor perforator incompetence was found in a further 14%.

Conclusions:

Varicose veins were progressive in some individuals, with new sites of incompetence appearing over time. However, ‘cure’ remains possible for most Patients and major recurrence can be reduced by Doppler diagnosis and precise surgery.
Effects of Compression Hosiery in Female Workers with a Standing Profession
Authors: Jungbeck C. , Peterson K. , Danielsson G. , Norgren L.
Published: January 2017

Objective:

To evaluate the effect of compression hosiery during standing work.

Design:

An open study, comparing symptoms and plethysmographic findings before and after treatment.

Setting:

University hospital, vascular surgery.

Subjects:

Forty-eight female volunteers with a standing profession.

Methods:

Visual analogue scale to evaluate symptoms and foot volumetry to study venous function before and after 4 weeks use of compression hosiery (20–30 mmHg).

Result:

All scores for symptoms were significantly reduced after treatment. Only 21% of the study subjects had minor abnormalities on foot volumetry. The expelled volume was significantly higher after work at 4 weeks than at the first measurement at inclusion, while the refilling rate was significantly lower after work at 4 weeks than at the corresponding measurement at inclusion.

Conclusion:

Symptomatic improvement was recorded after compression treatment. Limited effects were seen with the objective measurement, although the most important factor, the refilling rate, diminished significantly during the treatment period. Compression treatment reduces lower limb symptoms following standing work.
Myopathy and Venous Insufficiency
Authors: Taheri Syde A. , Heffner Reid , Pendergast David , Pisano Steven M.
Published: January 2017

Eighty patients with severe venous insufficiency, documented by history, physical examination, venography, and venous pressures, underwent gastrocnemius muscle biopsy. Muscle specimens were analysed histologically and histochemically in order to define the nature of pathological muscle changes which occur in patients with long-standing venous insufficiency. For comparison, muscle specimens from unaffected extremities were analysed. Histological analysis of muscle specimens from affected limbs showed a variety of muscle changes, including type II fibre atrophy, muscle necrosis and regeneration, and denervation atrophy. Histochemical analysis using 31P nuclear magnetic resonance revealed depletion of muscle energy stores, including creatine phosphate, ATP, and ADP.
The Effect of Elastic Compression on Tcpo2 in Limbs with Venous Stasis
Authors: Rooke Thom W. , Hollier Larry H. , Hallett John W. , Osmundson Philip J.
Published: January 2017

A low oxygen tension might contribute to the dermatological changes produced by deep venous insufficiency and venous stasis. Since elastic support is often prescribed for stasis disorders, it would be of value to know whether compression alters the oxygen tension in affected skin. We performed studies in which the transcutaneous Po2 (TcPo2) was determined for the foot or lower leg in subjects with normal veins (n = 9) or with dermatitis caused by documented deep venous insufficiency (n = 14). Measurements were made using O2-sensing electrodes placed 1–2 cm apart; surface temperature was 45°C for one electrode (producing maximal vasodilation of the underlying skin) and 42°C for the other (producing submaximal vasodilation). The vasodilation index (VI = TcPo2 at 42 °C/TcPo2 at 45°C) was used as an index of vasomotor tone. In normal limbs, TcPo2 (mmHg) and VI were affected by the subject's posture (TcPo2 = 38.8 at 42°C and 61.4 at 45°C when supine; 40.8 at 42°C and 74.6 at 45°C when upright with legs dependent; VI = 0.63 supine and 0.53 upright). In limbs with venous stasis, TcPo2 and VI were considerably lower (TcPo2 = 23.6 at 42°C and 51.5 at 45°C when supine; 20.8 at 42°C and 60.5 at 45°C when upright; VI = 0.48 supine and 0.37 upright). Following the application of an elastic wrap to the limbs with stasis, upright values for TcPo2 and VI were substantially improved (TcPo2 with compression = 28.8 at 42°C and 62.4 at 45°C; VI = 0.46). We conclude that (1) TcPo2 is reduced in regions of skin affected by stasis dermatitis, and (2) elastic compression improves TcPo2 (during upright posture) in limbs with stasis dermatitis.
Late Thrombogenicity of Grafts in the Venous System
Authors: Plate Gunnar , Hollier Larry H. , Dewanjee Mrinal K. , Kaye Michael P.
Published: January 2017

Although some previous experiments have demonstrated encouraging early results with venous vascular prosthesis, the long-term results have not been sufficiently investigated. The late thrombogenicity of 12 autogenous vein grafts and eight polytetrafluoroethylene (PTFE) grafts, three of which had been subjected to endothelial seeding, was evaluated 6 months after implantation in the canine venous system by determination of the survival time of the indium-labelled autogenous platelets and of the light and electron microscopic appearance of the graft-to-blood interface.

Twelve dogs receiving autogenous vein grafts had a platelet half-life of 64 ± 13 (mean ± s.d.) hours and a completely thrombus-free internal graft surface covered by a smooth endothelium. The platelet half-life in five dogs with non-seeded PTFE grafts was significantly ( P < 0.01) shorter (44 ± 11h). The PTFE-to-blood interface consisted of a 100- to 170-μm-thick pseudointima with a thrombus-free surface area of 25-90% and substantial endothelial coverage in only two animals. Three dogs receiving endothelial-seeded PTFE grafts had a platelet half-life of 38, 46 and 53h, respectively, a 10- to 80-μm-thick pseudointima covered with typical endothelium, and a thrombus-free surface area of 90-100%.

Our results demonstrate that PTFE grafts are still thrombogenic at 6 months following implantation in the canine venous system. Therefore, additional measures are required to maintain graft patency. Our limited experience with endothelial seeding does not allow any definite conclusions, but our findings indicate that this procedure might be beneficial.
Experimental Inferior Caval Replacement with Mesothelium
Authors: Louagie Y. , Schoevaerdts J.C. , Maldague B. , Remacle C. , Legrand-Monsieur A. , Lavenne-Pardonge E. , Ponlot R. , Lambotte L.
Published: January 2017

Thrombo-resistance of mesothelial grafts was evaluated by replacing the inferior vena cava in 16 dogs. In 10 dogs, treated by antiplatelet aggregation agents, uniform graft thrombosis happened within 15 days. In six other dogs, the addition of an arterio-venous fistula produced conditions of flow (1385 ± 178 ml/min; mean ± s.e.m.) and velocity (17.1 ± 4.5 cm/s) closer to human values and markedly improved the patency rates (four patent over six up to 6 months P < 0.02). Light microscopy and scanning electron microscopy studies performed on the patent grafts showed well preserved mesothelial cells. Mesothelial fibrinolytic activity was 1160 ± 257 tissue activator units/g tissue before and 846 ± 142 activator units/g tissue after implantation (P = n.s.). Prostaglandin synthesis by native mesothelium was respectively 252 ± 103 and 7 ± 3 pg/ml/mg wet tissue/min for 6-keto-PGF1α and TXB2. The synthesis was reduced for 6-keto-PGF1α in the patent grafts but unaltered for TXB2, This work puts forward the suggestion that mesothelium is a promising venous substitute in conditions of high flow.
Functional Evaluation of Four Different Compression Stockings in Venous Insufficiency
Authors: Sjöberg Trygve , Einarsson Eibert , Norgren Lars
Published: January 2017

In this study the compression pressure on the leg from four different ‘compression stockings’ was evaluated. A simple device for the measurement was constructed and is described. The effect of the stockings on venous function was also studied by foot-volumetry. Each of the four types of stockings was evaluated in 22 patients, all with mild to moderate insufficiency of the superficial venous system in the leg. Venous emptying from the foot and leg was significantly increased with all four stockings but with no difference between the types. The pressure measurements performed below knee and over the soft tissue area behind the tibia did not reveal the expected graduated compression. The pressure behind the medial malleolus, i.e. the venous ulcer area, was lower with all four stockings than higher up in the leg, indicating insufficient compression in this area.
A Comparison of the Histochemical Enzyme Pattern in Normal and Varicose Veins
Authors: Haardt Bernhardt
Published: January 2017

In order to study enzyme activity in the walls of healthy and diseased veins, sections were taken from the stripped varicose long saphenous veins of eight patients. These were subjected to histochemical enzyme investigations. These methods were used to determine levels and localization of lactate dehydrogenase, alkaline phosphatase, adenosine triphosphatase and the lysosomal enzymes, β-glucuronidase, non-specific esterases and acid phosphatase. The method and our findings are described. The results of these histochemical investigations demonstrate an increase in lysosomal enzyme activity in the walls of varicose veins as compared to that of normal veins. This increase is greater in the media than in the intima.

Enzymes responsible for energy metabolism demonstrated contradictory behaviour, with decline in the activity of such enzymes in the walls of varicose veins. This decline in enzyme activity was more marked in the intima than in the media and was especially noticeable in the histochemical demonstration of Ca++-adenosine triphosphatase.
The Greenfield Filter: A Five-Year Experience
Authors: Coleman Catherine , Broe P.J. , Bouchier-Hayes D.J.
Published: January 2017

During a 5-year period, 1982–1986 inclusive, 30 patients were referred for Greenfield filter placement. The indications for filter insertion were: (1) contraindications to anticoagulation (13 patients), (2) recurrent pulmonary emboli in the presence of adequate anticoagulation (14 patients), (3) complications of anticoagulant therapy (three patients).

The contraindications to anticoagulants included subarachnoid haemorrhage, duodenal ulcer, multiple trauma and afibrinogenaemia and a group of patients in whom standard methods of prophylaxis were unsuitable.

The jugular or femoral approach was used for filter placement and in two technical failures a De Weese clip was applied. One patient died from a myocardial infarction within 3 days of filter placement and the six other deaths were due to underlying malignant disease. A follow-up ultrasound study of the inferior vena cava (IVC) among 19 of 21 survivors demonstrated patency in 14, thrombus in the filter in two and an occluded IVC in two.
Iliocaval Compression Syndrome
Authors: Taheri Syde A. , Nowakowski Paul , Pendergast David , Cullen Julie , Pisano Steve , Soman Lars
Published: January 2017

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency.

The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein.

Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence.

Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis.

Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition.

To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.
Pelvic Varices and Gonadal Veins
Authors: Lechter A. , Alvarez A. , Lopez G.
Published: January 2017

A prospective study of 50 cases of pelvic varices is described. Clinical history, symptoms and signs are shown emphasizing the multiple pregnancies that enlarge the gonadal veins where a high pressure escape and retrograde flow explain the vulvar and inner and posterior thigh and leg varicosities. A surgical procedure comprising resection of the gonadal veins and ligation of communicating veins to the uterine veins combined with vulvar and leg varicectomy have given excellent and encouraging early results.
Clinical Trials in Venous Disease: With Particular Reference to Life Table Analysis
Authors: Franks P. J. , Wright D. D. I.
Published: January 2017

Over recent years surgeons have adopted an increasingly scientific approach to determine the best treatment for their patients. For venous disease there have been trials comparing surgery with sclerotherapy,1−3 the use of stockings to relieve symptoms,4 therapeutic benefits of drugs5,6 and dressings for ulcer healing.7,8

The term ‘trial’ is often used in reporting medical research, but frequently it is used inappropriately. This paper gives an overview of the considerations necessary to run a meaningful clinical trial and some of the common pitfalls in trials of venous disease.
Does the Correction of Insufficient Superficial and Perforating Veins Improve Venous Function in Patients with Deep Venous Insufficiency?
Authors: Åkesson H. , Brudin L. , Cwikiel W. , Ohlin P. , Plate G.
Published: January 2017

Thirty limbs in 25 patients with chronic deep venous insufficiency and recurrent ulceration were examined by ascending and descending contrast phlebography, occlusion plethysmography, foot volumetry and ambulatory venous pressure. Superficial venous insufficiency was surgically corrected by stripping of the saphenous vein and local excision of the varicosities (op1) in 12 limbs. Perforating venous insufficiency was then corrected by extensive subfascial ligation of perforating veins (op2) in all limbs. Venous outflow capacity, measured by occlusion plethysmography, and muscle pump function, measured by foot volumetry, were not affected by either procedure. Venous reflux, measured by foot volumetry, (Q/EVrel) and by venous pressure return time (RT90) improved significantly with op1 but no change was seen after op2. Venous hypertension decreased significantly with op1 but did not change after op2, and 59% of the limbs still had severe venous hypertension (> 60 mmHg) after both procedures. Initial clinical results were good, ulcers persisting in only three limbs, but recurrences occurred in an additional six limbs within 27 months. The limbs with persistent or recurrent ulcers had severe phlebographic reflux and severe venous hypertension. These results demonstrate that improvement in venous reflux and hypertension may be achieved by correction of superficial venous insufficiency, but the addition of ligation of perforating veins seems to be of less benefit to the venous circulation.
The Effect of the Lastosheer Stocking on Venous Insufficiency
Authors: Grønbæk Karin , Rasmussen Ann Lise , Struckmann Jan , Mathiesen F.R.
Published: January 2017

A controlled study on the effect of the newly introduced Lastosheer stocking on superficial venous insufficiency, assessed by ambulatory strain-gauge plethysmography and clinical evaluation, is presented. Seventeen patients were wearing the stockings for 6 weeks and 13 served as controls. The effect was assessed by ambulatory strain-gauge plethysmography (i.e. the venous return time and expelled volume) and by an improvement in symptoms.

In the stocking group a significant reduction in complaints of fullness, cramps and swelling was reported, whereas no improvement was reported in the control group. Moreover, the venous return time was significantly increased after 6 weeks in the stocking group, even after the stocking was removed from the leg. No significant change in expelled volume was found. In the control group no changes were noted, neither in return time nor in expelled volume.
A Venous Cavernous Haemangioma on the Arch of the Long Saphenous Vein – An Unexpected Peroperative Danger
Authors: Iellin A. , Lelcuk S. , Engelberg S. , Nass D.
Published: January 2017

The peroperative discovery of a venous cavernous haemangioma covering the sapheno–femoral junction, presents a serious problem to the unsuspecting surgeon, due to lack of preoperative preparation and an unawareness of the connections of the vascular tumour. Only an experienced vascular surgeon can handle the problem without performing further invasive investigations and, consequently, a second operation. The fact that we have not found a similar case in the medical literature, encouraged us to describe the operation performed and to point out the possible pre- and per-operative complications.
Evaluation of Acute Deep Venous Thrombosis of the Lower Limb, Using an Automated Venous Occlusion Plethysmograph
Authors: Ahlström Håkan , Nilsson Stefan , Hellers Göran
Published: January 2017

One-hundred-and-eleven consecutive patients who were referred for routine phlebography because of clinically suspected deep vein thrombosis (DVT) were also investigated with a new, simplified, computerized strain-gauge plethysmograph (Phlebotest, Eureka AB). An occlusion plethysmograph curve was obtained from each leg simultaneously. Four different numerical parameters were defined and determined from this curve. These parameters were correlated with the phlebographic diagnosis. Three of the parameters of the plethysmograph curve correlated well with the phlebographic diagnosis, which proved correct in 54 patients without DVT, including two false negative cases, and in 12 patients with thrombosis. In 45 patients, plethysmography alone was not sufficient to establish a diagnosis. The plethysmograph described is easy to handle and is suggested for use in selecting those patients, with or without thrombosis, who do not require supplementary phlebography.
Biochemical and Histological Analysis of Collagen and Elastin Content and Smooth Muscle Density in Normal and Varicose Veins
Authors: Travers J. P. , Dalton C. M. , Baker D. M. , Makin G. S.
Published: January 2017

Objective:

Determination of the ratio of collagen and elastin to protein content of varicose/non-varicose veins from calf and determination of collagen, elastin and smooth muscle density of varicose/non-varicose vein walls.

Design:

Prospective study; control vein samples obtained from amputees for ischaemic vascular disease and varicose vein samples obtained from an equivalent Position following surgical stripping.

Setting:

Departments of Human Morphology and Vascular Surgery, Queen's Medical Centre, University of Nottingham, UK.

Patients:

Seven patients with no evidence of venous disease treated by amputation of the lower limb for vascular disease and 12 patients treated for varicose veins by ligation and stripping of the long saphenous vein.

Interventions:

Vein sections were examined biochemically and histologically using stereological techniques.

Main outcome measures:

Biochemical quanitfication of collagen, elastin and protein and stereological analysis of collagen, elastin and smooth muscle density of varicose and non-varicose veins.

Results:

There was no difference between the collagen/Protein or elastin/protein ratio in varicose and normal veins but there was a significant increase in muscle density with corresponding decrease in collagen and elastin density in the walls of varicose veins compared with non-varicose vein controls.

Conclusions:

There were no differences in the collagen or elastin content of varicose veins when compared with non-varicose veins. Smooth muscle hypertrophy occurs in varicose veins, which appears to disrupt the collagen/elastin lattice of the vein wall.
A Randomized Trial of Biofilm Dressing for Venous Leg Ulcers
Authors: Smith J. M. , Doré C. J. , Charlett A. , Lewis J. D.
Published: January 2017

Objective:

Comparison of Biofilm dressing with Jelonet and Betadine in the treatment of venous leg ulcers.

Design:

Randomized parallel-group controlled trial, stratified by initial maximum ulcer diameter of 2–4 cm or >4 cm.

Setting:

Community.

Patients:

Five hundred and twenty-nine patients were assessed and 200 patients with clinical evidence of venous leg ulceration and initial ulcer diameter >2 cm were recruited to the trial. Patients with appreciable arterial disease (ratio of ankle to brachial systolic pressure <0.75) were excluded.

Interventions:

Ulcers were treated with either Biofilm (a hydrocolloid dressing) or Betadine and Jelonet in the community for 4 months or until the ulcer healed, if sooner. All patients wore standardized graduated compression.

Main outcome measures:

Time to complete healing of the ulcer, subjective assessment of pain and total cost of treatment.

Results:

Healing was more rapid in patients using Biofilm dressing (relative risk 1.16, 95% confidence interval 0.8–1.8), but not significantly so p = 0.48. Patients' subjective pain scores after 1 month of treatment indicated there was significantly less pain experienced by patients treated with Biofilm ( p = 0.02). The total cost of treatment (including dressings and nursing time) was similar for Biofilm and Betadine for small ulcers (<6 cm) but Biofilm cost three times as much for larger ulcers.

Conclusion:

Provided that standardized graduated compression was used, the primary dressing did not significantly affect the time to complete healing of the ulcer.
Compression Stockings and Venous Function in Patients with Decompensated Heart Failure
Authors: Kierkegaard A. , Norgren L.
Published: January 2017

Objective:

To measure the abnormalities of venous function in patients with decompensated heart failure.

Design:

Single group study.

Setting:

Departments of Medicine and Surgery, Lund University Hospital, Lund, Sweden.

Patient:

Forty-seven patients with decompensated heart failure due to myocardial insufficiency.

Interventions:

Conventional medical treatment for decompensated heart failure. The application of graduated compression stockings randomly applied to one leg.

Main outcome measures:

Strain gauge plethysmography assessment of venous capacitance and maximum venous outflow.

Results:

Graduated compression stockings increased venous volume significantly, but did not influence maximum venous outflow.

Conclusion:

The principal effect of compression stockings is probably a direct effect upon the veins in the leg in patients with decompensated heart failure.
A Correlation between Blood Flow Volume and Ultrasonic Doppler Wave Forms in the Study of Valve Efficiency
Authors: Beckwith T. C. , Richardson G. D. , Sheldon M. , Clarke G. H.
Published: January 2017

Objective:

To demonstrate a significant correlation between the Doppler waveform and blood flow volume in the assessment of valve efficiency. In particular the objective was to ratify use of the ‘area index’ of the wave form.

Design:

Pearson's correlation and zero line assessment were used. Using a phantom, multiple tests were performed so that a wide spectrum of flow volumes could be compared with corresponding Doppler waves.

Setting:

Private diagnostic imaging clinic with vascular surgical association.

Main outcome measures:

The hypothesis was that there should be a significant correlation between the Doppler wave and the blood flow volume and, in particular, the Doppler area.

Results:

The Doppler wave index EId demonstrated the highest correlation coefficient ( r = 0.97, p<0.01) when compared with the volume index EIV.

Conclusion:

While there is a strong correlation between EId and flow volume, additional study is needed to determine its place in the clinical setting.
The Influence of Effective Analgesia and General Anaesthesia on Patients' Acceptance of Day Case Varicose Vein Surgery
Authors: Onuma O. C. , Bearn P. E. , Khan U. , Mallucci P. , Adiseshiah M.
Published: January 2017

Objective:

To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition.

Design:

Prospective single patient group study (22 consecutive patients).

Setting:

University College Hospital (Teaching Hospital).

Intervention:

Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose

Main outcome measures:

Patient interview, pain scores, analgesia requirement.

Result:

Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude.

Conclusions:

Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.
A Modified Technique for Stripping of the Long Saphenous Vein
Authors: Bearn P. , Fox J. A.
Published: January 2017

Objective:

To describe a modification of the standard stripping technique that facilitates varicose vein surgery, avoiding unsightly scars and damage to the venous nerve.

Interventions:

Long saphenous vein stripping using a modified standard stripping device.

Conclusions:

The modified stripper provides a satisfactory method of removing the long saphenous vein without resulting in large scars.
Skin Blood Flow in Chronic Venous Insufficiency
Authors: Shami S. K. , Chittenden S. J. , Scurr J. H. , Smith P. D. Coleridge
Published: January 2017

Objective:

To evaluate the skin temperature, laser Doppler flux (LDF), concentration of moving blood cells (CMBC) and speed of blood cells (SBC) in the liposclerotic and clinically normal skin of patients with chronic venous insufficiency.

Design:

Parallel groups study comparing patients with chronic venous insufficiency with control subjects.

Setting:

Vascular laboratory, Middlesex Hospital, University College and Middlesex School of Medicine, London, UK.

Participants:

Twenty patients with lipodermatosclerosis and chronic venous insufficiency comprised the disease group, and 15 subjects without venous disease comprised the control group.

Main outcome measures:

The skin temperature, LDF, CMBC and SBC were assessed in the gaiter area and on the dorsum of the foot.

Results:

A higher LDF (median LDF and interquartile range (IQR) = 132 (66–289), p = 0.001 (Mann-Whitney) and skin temperature (Median temperature and IQR = 31.1 (29.6–32.4), p = 0.001) was found in the liposclerotic skin of patients with chronic venous insufficiency compared with normal controls (median LDF and IQR = 49 (32–58); median temperature and IQR = 28 (27–30.3)). Similarly the LDF on the dorsum of the foot (median LDF and IQR = 73 (59–127), p = 0.03) and skin temperature on the dorsum of the foot (median temperature and IQR = 31.1 (30.4–32.1), p = 0.002) was significantly higher in the patients with chronic venous insufficiency compared with normal controls (median LDF and IQR = 55 (36–66), median temperature and IQR = 29.5 (26.7–30.7)).

Conclusions:

This study demonstrates that there is increased skin blood flow in both liposclerotic skin and clinically normal skin in patients with chronic venous insufficiency.
A Double-Blind Clinical Trial of the Efficacy and Tolerability of O-(β-Hydroxyethyl)-Rutosides and Compression Stockings in the Treatment of Leg Oedema and Symptoms following Surgery for Varicose Veins
Authors: Kranendonk S. E. , Koster A. M.
Published: January 2017

Objective:

To study the efficacy and tolerability of O-(β-hydroxyethyl)-rutosides (HR) and compression stockings in the treatment of leg oedema and symptoms after varicose vein surgery.

Design:

A prospective double-blind, randomized, Parallel, placebo-controlled trial.

Setting:

Surgical department of a regional hospital.

Patients:

Forty patients undergoing venous surgery for varices associated with superficial insufficiency.

Interventions:

Saphenofemoral ligation, stripping of the entire long saphenous vein and removal of varicosities via 0.5 cm incisions. HR was given at 2 g/day (or Placebo) for 6 weeks starting on the first postoperative day. Twenty patients were randomized to each group.

Main outcome measures:

Leg volumes were measured by an automatic electronic-optic volumeter, prior to operation and again after 6 weeks and 3 months. Leg symptoms were recorded on days 1 and 10, weeks 3 and 6, and at 3 months.

Results:

There was no difference in leg volume between the two groups during the first 6 weeks when stockings Were worn, but the increase in oedema of the distal leg in the subsequent 6 weeks was significantly less in the HR group. Symptoms disappeared rapidly 3 weeks Postoperatively in both groups.

Conclusions:

Stockings are effective in controlling postoperative leg oedema and symptoms. The addition of HR can prevent subsequent oedema after removal of the stockings.
Valves in Varicose Veins and External Compression Studied by Angioscopy
Authors: Van Cleef J. F.
Published: January 2017

Aim:

To explain the mechanism of action of external compression in venous/valvular incompetence

Design:

Prospective investigation in single patient group.

Setting:

Notre Dame de Bon Secours Hospital, Paris, France.

Patients:

Four patients presenting with primary varicosities undergoing surgical treatment.

Interventions:

Dynamic saphenous vein angioscopy with application of external compression to the limb.

Main outcome measures:

Angioscopy assessment of venous valvular incompetence.

Results:

External compression failed to abolish reflux in valves where there was an intercorneal space at the valve commissure.
‘Pin-Stripping’: A Novel Method of Atraumatic Stripping
Authors: Oesch A.
Published: January 2017

Objective:

To assess the efficacy of a new technique for stripping segments of the short saphenous vein (SSV) or long saphenous vein (LSV).

Design:

Preliminary report on 83 cases.

Patients:

Seventy-five patients with incompetence of the SSV or LSV.

Interventions:

Forty-two partial Strippings and one complete stripping of the SSV; 40 Strippings of segments of the LSV.

Results:

The method described (‘Pin-stripping’) permits stripping without visualization of the distal end of the vein. Removal of the vein is possible through a stab incision and is feasible under local anaesthesia. Operation time is reduced and no postoperative complication was seen.

Conclusions:

Compared with conventional Strippings, ‘Pin-stripping’ offers several advantages in removing segments of the LSV or SSV.
Immunohistochemical Localization of Factor XIIIa in Chronic Venous Insufficiency
Authors: Vanscheidt W. , Laubert A. , Laaff H. , Weiss J. M. , Schöpf E.
Published: January 2017

Objective:

Factor XIIIa (FXIIIa) of the coagulation cascade (fibrin stabilizing factor) plays a crucial role in wound healing. Its plasma activity is significantly decreased in patients suffering from diseases accompanied with pathologically increased uptake of fibrin.

Design:

Immunohistochemical localization of FXIIIa and immunofluorescent histological labelling of fibrin in patients' biopsies and in control specimens.

Procedure:

Twenty-five biopsies were taken from granulation tissue of venous ulcers. Specimens of unimpaired wound healing ( n = 10) served as controls. Concentrations of FXIIIa and fibrin were estimated in all biopsies. Additionally, 10 biopsies from ulcer edges were stained with FXIIIa.

Results:

The fibrin uptake in ulcer tissue exceeded the amount found in control biopsies. Specimens taken from the ulcer edges contained the greatest amount of FXIIIa in both pericapillary and interstitial regions, followed by the controls. Granulation tissue taken from venous ulcers showed less FXIIIa around capillaries and in the interstitium than specimens of both other groups.

Conclusion:

Local FXIIIa deficiency in ulcer tissue may contribute to impaired wound healing. Sclerosis found in ulcer edges may be the morphological correlate of the high enzymatic concentrations found in specimens from this area.
Morphological Study of the Valvular Distribution in the Long Saphenous Vein
Authors: Ortega F. , Sarmiento L. , Mompeo B. , Centol A. , Nicolaides A. , Leon M. , Christopoulos N.
Published: January 2017

Objective:

To measure the distribution of valves in the long saphenous vein.

Design:

Morphological study of the intervalvular distance of the long saphenous vein.

Setting:

Department of Morfología, Facultad de Ciencias de la Salud (Universidad de Las Palmas de Gran Canaria, Spain) and Academic Vascular Surgery Unit, St Mary's Hospital, London, UK.

Material:

Twenty lower extremities from adult cadavers with no evidence of lower limb venous disease.

Methods:

Anatomical dissection of the long saphenous vein, with accurate measurement of valve distribution.

Results:

There were on average 8.7 valves in the long saphenous vein, with 6.3 above the knee and 2.4 below the knee.

Conclusion:

Contrary to classical anatomical texts on this subject there are more valves in the long saphenous vein in the thigh than in the calf.
Placebo Treatment for Varicosity: Don't Eat It, Rub it!
Authors: Saradeth T. , Resch K. L. , Ernst E.
Published: January 2017

Objective:

To define and compare the clinical effectiveness of two different placebo applications, oral and topical, in the management of primary varicose veins.

Design:

Prospective, controlled trial with two parallel treatment groups.

Setting:

Social security system related rehabilitation centre in Germany with nationwide assignment of inpatients.

Patients:

Sixty-one patients with the clinical diagnosis of varicose veins.

Interventions:

Group A ( n = 30) received an oral placebo, group B ( n = 31) applied a topical placebo preparation to both legs. The treatment period was 24 days; both therapies were applied daily.

Main outcome measures:

Foot volume, ankle circumference, light reflex rheography and subjective complaints.

Results:

In both groups there were significant improvements in several outcome measures concerning both objective signs and subjective symptoms. Light reflex rheography yielded significantly better results in the topically compared with the orally treated group. Other variables followed this trend without, however, reaching the level of statistical significance.

Conclusions:

Symptoms of varicose veins are highly prone to respond to placebo. There are some indications to suggest that a topical placebo induces stronger effects than an oral one.