bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echo-Anatomy of Long Saphenous Vein in the Knee Region: Proposal for a Classification in Five Anatomical Patterns
Authors: Ricci S. , Cavezzi A. 
Published: January 2017

Objective: Ultrasonography of the anatomical course of the long saphenous vein (LSV) and its tributaries to produce and verify an anatomical classification (five types). Methods: Four hundred and ninety-three limbs (293 healthy; 200 with varicose veins, VV) were investigated by ultrasonic duplex imaging by the two authors independently, identifying the LSV as the vessel in the (ultrasonic) saphenous fascial ‘eye’ compartment (SFEC), in the thigh, and within two fascial layers between tibia and medial gastrocnemius muscle, below the knee. Results: Type A: LSV runs entirely in the SFEC without relevant tributaries: overall (O) 112 (23%), limbs with vv (V) 13, normal limbs (N) 99. Type B: LSV runs in the SFEC with one or more relevant tributaries below the knee: O 133 (27%), V 70, N 63. Type C: LSV runs in the SFEC with a relevant tributary above the knee: O 89 (18%), V 28, N 61. Type D: LSV runs in the SFEC from the foot upwards, continuing at the middle third of the leg in a large side vein with the calibre and role of the LSV but in a more superficial location. LSV stem is absent (or hypoplasic) in the para-tibial position. At the thigh level the tributary re-enters the true LSV: O 72 (14.5%), V 42, N 30. type E: similar to type D but the LSV is absent only at the knee level: O 72 (14.5%), V 38, N 34. Unclassified: O 15 (3%), V 9, N 6. Conclusions: We found a good reproducibility and clinical utility of the suggested classification. Remarks: (a) the absence (or hypoplasia) of LSV at the knee level with prevalence of a tributary in almost 30% of the limbs is of importance for arterial bypass and saphenous sparing management; (b) there is a low rate of LSV complete incompetence (6%); (c) there is a correlation between absent LSV (or presence of a relevant tributary) and the incidence of VV.
Primary Cutaneous Granulomatous Phlebitis of the External Jugular Vein
Authors: Shetty S. , Gupta S. , Makhija P. , Hasan S. 
Published: January 2017

Design: Case report. Setting: Department of Otolaryngology and Head and Neck Surgery, St. John's Medical College Hospital, India. Patient: A 22-year-old man with a cord-like neck mass of 6 months' duration. Investigations and intervention: Investigations included Doppler ultrasound of the neck, which showed thrombosis of the right external jugular vein. Wedge biopsy revealed a granulomatous inflammation with focal necrosis completely replacing the vessel. Serological testing for vasculitides was negative. Transcervical excision of the vein was carried out after identifying normal vessel distally and proximally. Histopathological examination of the vein proved the lesion consistent with primary cutaneous granulomatous phlebitis (PCGP). Conclusion: Isolated venous inflammatory diseases with neither identifiable active vasculitis nor arteritis are rarely seen. PCGP is distinctly unusual. We report a case of PCGP of the external jugular vein presenting as an elongated cord-like nodular lesion in the lateral neck of insidious onset.
Surgical Enhancement of Skin Oxygenation in Patients with Venous Lipodermatosclerosis
Authors: Travers James P. , Berridge David C. , Makin Geoffrey S. 
Published: January 2017

Lipodermatosclerosis and venous ulceration may result from ***long-standing venous hypertension. Furthermore, venous ulceration is associated with reduced transcutaneous oxygen tension, (Tc Po2). This study investigates the effect of surgical removal of varicose veins upon skin oxygenation postoperatively, thereby influencing any subsequent venous ulceration. Patients with unilateral long saphenous vein incompetence, were studied consisting of 10 males and nine females, (mean overall age = 50 ± 3 years). Tc Po2 measurements at rest and using 100% oxygen stress testing were performed 24 h preoperatively under standard test conditions, with the contralateral limb serving as control. Patients with lipodermatosclerosis were confirmed to have an oxygen diffusion block preoperatively in the affected limb, ( P = 0.02). Surgical correction of venous hypertension produced significant improvement in oxygen diffusion after stress testing ( P = 0.003) compared to control limbs or patients with uncomplicated varicose veins. Surgical correction of incompetent varicose veins in patients with lipodermatosclerosis resulted in the improvement of Tc Po2 which may delay or prevent subsequent venous ulceration.
The Treatment of Long-Standing Venous Ulcers with an Extract of Early Placenta – a Pilot Study
Authors: Beaconsfield Tina , Genbačev Olga , Taylor R.S. 
Published: January 2017

The human placenta and its membranes have been used intermittently as wound dressings for more than 70 years. Term placenta is known to contain a number of growth factors essential to the healing process. The intense physiological activity of early placenta suggested that it should have similar attributes and we tested this hypothesis on one of the most refractory of all wounds – ulcers caused by chronic venous insufficiency. The cytosol fraction of 6–8 week placenta was incorporated under sterile conditions into an inactive cream vehicle and applied daily to the ulcer. The preparation and quality control of this extract are described. Eighteen patients were treated in this pilot study. The chronicity of the ulcers varied from 12 weeks to 30 years, and all had previously received conventional therapy. Ten patients with bilateral ulcers had treatment with the test preparation on one side only thereby serving as their own controls. Granulation tissue appeared between the 7th and 17th day after starting treatment, and epithelialization began within 2 weeks thereafter. The preparation produced complete healing in all cases and took 12 to 24 weeks, depending on ulcer size. None of the untreated ulcers were closed at the end of the trial. No breakdown has been seen so far on follow-up. The healing effect suggests that trophoblast might supply the missing factor(s) normally operative in surgical wounds and uninfected traumatic wounds.
Venous Valves and Tributary Veins
Authors: Van Cleef J. F. , Griton Ph. , Cloarec M. , Ribreau C. , Lemaire R. 
Published: January 2017

Our work on the four-stroke dynamic model of the muscular pump of the calf and our video films on venous ambulatory endoscopy allow us to set forth the following concept: there are always one or more openings of tributary veins close to a venous valve. A vein has a preferential axis of flattening, and its cross-sectional configuration can be defined as: an internal wall, an external wall, two borders and two extremities. The bicuspid valves' cornua are situated on the borders of the vein. Close to the valves we distinguish the commissural tributaries on the vein's borders from the sinusal tributaries on the internal or external walls of the vein. This configuration has consequences on the local dynamics of the blood; the valve by its protusion into the vein lumen alters the blood flow.
Lothian and Forth Valley Leg Ulcer Healing Trial, Part 2: Knitted Viscose Dressing versus a Hydrocellular Dressing in the Treatment of Chronic Leg Ulceration
Authors: Callam M. J. , Harper D. R. , Dale J. J. , Brown D. , Gibson B. , Prescott R. J. , Ruckley C. V. 
Published: January 2017

Objective: To compare a new ‘advanced’ hydrocellular Polyurethane dressing (HPD) (Allevyn) with a traditional simple non-adherent knitted viscose dressing (KDV) (Tricotex) in the treatment of chronic venous leg ulcers. Design: A randomized trial of factorial design, with interaction testing, to allow the evaluation of two different therapeutic components (dressing and bandages) within a single trial. The treatment period was 12 weeks or until healing, whichever occurred sooner. Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland. Patients: 132 patients with chronic venous leg ulcers were randomized, 66 to HPD and 66 to KVD. Principal exclusions were patients with diabetes, rheumatoid disease or Doppler ankle/brachial pressure indices of less than 0.8. There were 28 withdrawals (15 KVD, 13 HPD). These were considered as treatment failures. Interventions: Dressings and bandaging were applied by specialist leg ulcer nurses using standard techniques throughout, the bandaging being randomized to either elastic or non-elastic multilayer systems. Main outcome measure: The principal end-point was ulcer healing. Also monitored were healing rates, pain and the frequency of dressing changes. Results: Pain relief was significantly better in the HPD group ( p=0.01). Thirty-one (47%) of the HPD patients healed within 12 weeks compared with only 23 (35%) of the those treated with KVD (95% confidence limits for difference, −5% to +29%). The higest healing rates (61% for all ulcers and 74% for those less than 10 cm2) were observed in the subgroup in which HPD was used in combination with an elastic bandaging system. Conclusion: Patients treated with HPD did significantly better in terms of pain relief, although the higher healing rates observed in this group failed to reach significance at the 5% level.
Hydrotherapy for Varicose Veins: A Randomized, Controlled Trial
Authors: Ernst E. , Saradeth T. , Resch K. L. 
Published: January 2017

Objective: To assess the effectiveness of regular hydrotherapy in primary varicose veins. Design: Randomized, single blind, prospective, controlled trial. Setting: Social security system related rehabilitation center for employees (nationwide assignment of inpatients). Patients: 122 patients with primary varicose veins. Interventions: Group A (n=60) received daily treatments during 24 days that consisted of external application of alternating cold and warm water to both lower extremities. Group B (n=62) served as controls and was not treated with hydrotherapy. Both groups were comparable in terms of concomitant diseases and treatments. Main outcome measures: Foot volume, ankle circumference and venous re-fill time, using light reflex rheo-graphy, served as objective variables, while a number of typical symptoms were recorded as subjective parameters. Results: A more pronounced improvement in all objective signs in group A compared to B was observed. Four out of seven subjective symptoms improved more frequently in group A than in B. Conclusions: Hydrotherapy is effective in treating primary varicose veins. It can be considered as an adjunct measure to compression therapy and other conservative treatments.
Popliteal Valvular Construction Using a Silastic Sling (Technique II) for Deep Venous Insufficiency of the Lower Limb
Authors: Psathakis D. , Psathakis N. 
Published: January 2017

Objective: To establish the safety and efficacy of a silastic sling procedure for reconstructing popliteal vein. Design: Prospective survey of patients undergoing surgical treatment for popliteal vein reflux. Setting: Department of Surgery, County Hospital, Bad Karlshafen, Germany. Patients: 209 patients undergoing surgery for popliteal vein incompetence. Interventions: Silastic sling procedure (Technique II) for correction of popliteal vein incompetence. Main outcome measures: Continuous wave Doppler ultrasound examination of popliteal vein, ambulatory foot vein pressure measurements, lower limb venography. Results: One week following surgery 202 patients (of 209) reported relief of pain and reduction of limb oedema. 77 patients with ulcers (of 85) healed following the surgical procedure. Ambulatory venous pressure improved from 71 SD 11 mmHg to 36 SD 17 mmHg. There was prolongation of the venous refilling time from 9 SD 5 seconds to 27 SD 17 seconds. Postoperative phlebography in 92 patients was performed on the tenth post-operative day and in no patient was deep vein thrombosis observed. In 82 of these patients phlebography demonstrated that the constructed popliteal valve was patent. Conclusions: Construction of a popliteal valve using the author's silastic sling technique is a satisfactory method for managing patients with otherwise uncontrolled popliteal vein reflux due to either primary valvular failure or previous deep vein thrombosis.
Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study
Authors: Leu A. J. , Yanar A. , Geiger M. , Franzeck U. K. , Bollinger A. 
Published: January 2017

Objective: To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy. Design: Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®). Setting: Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland. Patients, participants: 15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years). Results: Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant. Conclusions: Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.
Long-Term Clinical Results following Correction of Incompetent Superficial and Perforating Veins in Patients with Deep Venous Incompetence and Ulcers
Authors: Åkesson H. 
Published: January 2017

Objectives: To assess the presence of venous ulcers following stripping of the saphenous vein and ligation of perforating veins in patients with deep venous incompetence. Design: Retrospective follow-up after a median of 41 months following surgery. Patients: Thirty operated limbs in 25 patients with venous ulcers, originally entering a prospective study of physiological changes following surgery for venous insufficiency. Interventions: An interview regarding absence of ulcers, expressed as a percentage of the follow-up time after surgery – the ‘ulcer-free period’. Correlation with ambulatory venous pressure (AVP) and foot volumetric measures following surgery. Main outcome measures: The presence or absence of venous ulcers. Results: The ulcer-free period for the whole group was 76%. There was a significant (p<0.05) difference in the ulcer-free period in limbs with an AVP below 60 mmHg (89%) compared with limbs with a higher AVP (70%). Conclusion: Failure to normalize AVP with surgery results in persistent high venous pressure and an increased risk of venous ulceration recurrences.
Venoscopy in Varicose Vein Surgery: Initial Experience
Authors: Gradman W. S. , Segalowitz J. , Grundfest W. 
Published: January 2017

Objective: To determine the number and function of valves and the location of perforators and tributaries in patients with varicose veins as a result of saphenofemoral or saphenopopliteal reflux. Design: Prospective endovascular evaluation of greater and lesser saphenous veins during varicose vein surgery. Setting: Cedars-Sinai Medical Center, Los Angeles, California, USA. Patients: Thirty-one limbs in 25 patients undergoing varicose vein surgery. Intervention: Patients underwent retrograde passage of a 2.3 mm angioscope from the junction of the saphenous and deep vein distally to the first competent valve. Main outcome measures: Based on intraoperative findings, the greater saphenous vein was preserved in eight out of 25 cases. Preoperative assessment of lesser saphenous reflux was incorrect in three out of six cases. Results: An incompetent subterminal valve was found in 16 out of 25 greater saphenous veins. In 13 out of 25 limbs, no other valves were seen to the knee. Four patients had competent thigh valves. Conclusions: Retrograde venoscopy may be of benefit in varicose vein surgery.
Lower Limb Neutrophil Oxygen Radical Production is Increased in Venous Hypertension
Authors: Whiston R. J. , Hallet M. B. , Lane I. F. , Harding K. G. 
Published: January 2017

Objective: To investigate neutrophil free radical production in patients with venous hypertension. Patients: Thirteen legs in patients with venous ulceration were compared with seven legs in patients suffering from lipodermatosclerosis (LDS) only and nine normal controls. Design: Leg and arm venous blood samples were obtained from each patient after a period of 30 min of leg dependency followed by elevation to the horizontal for a further 5 min. Neutrophils were isolated and free radical production assessed by luminol-dependen t chemiluminescence following stimulation with the chemotactic peptide FMLP. Results: The ratio of leg to arm luminescence was significantly higher in patients with venous ulceration (median 1.61; 95% confidence interval (CI) 1.20–3.05; p=0.0002) and those with LDS (median 1.36; 95% CI 1.05–2.01; p=0.0036) when compared with the controls (median 0.97; 95% CI 0.70–1.12). Conclusions: Neutrophil free radical production is increased in the legs of patients with venous hypertension and may be implicated in the underlying pathogenesis of this disease.
Extravascular Masses Masquerading as Deep Venous Thrombosis
Authors: Thulesius O. , Thurin A. 
Published: January 2017

Objective: To determine the incidence and characteristics of extravascular masses (EVM) giving rise to symptoms and signs of deep venous thrombosis (DVT). Design and technique: Routine ultrasound colour duplex scanning during a 6-month period. Patients: Three hundred and two inpatients and outpatients investigated on suspicion of DVT. Setting: Department of Clinical Physiology, which is the central non-invasive diagnostic unit of the county. Results: A diagnostis of DVT was made in 33%. EVM were detected in 14 patients (5%). In most cases the characteristic appearance on scanning was spindle-shaped (like a ‘mouse’) and mostly confined to the upper calf. These EVM were regarded as intramuscular haematoma or ruptured popliteal cysts. Conclusion: EVM of the leg are (1) a frequent cause of ‘pseudothrombosis' and can positively be identified by duplex ultrasound scanning: (2) most frequently found in the medial aspect of the right calf; and (3) often detected in patients with rheumatoid arthritis or patients on anticoagulant therapy and may give rise to signs and symptoms identical to DVT.
The Role of External Banding Valvuloplasty in the Surgical Management of Chronic Deep Venous Disease
Authors: Schanzer H. , Skladany M. , Peirce E. C. 
Published: January 2017

Objective: Correction of venous reflux by perivalvular banding in patients suffering from chronic venous stasis secondary to primary valvular incompetence. Design: Prospective study in a group of patients with severe venous insufficiency. One patient (one extremity) was lost to follow-up. Setting: Tertiary care teaching hospital. Patients: Twelve patients (13 extremities) with severe or moderate venous insufficiency. Interventions: Correction of valvular incompetence by narrowing a valvular ring with an external band. Twenty-seven bands were fitted to incompetent valves of 13 extremities. Main outcome measures: Abolition of reflux and improvement of muscle pump measured by clinical, plethysmographic and venographic criteria. Results: Symptomatic improvement was found in 10 extremities (77%) and complete correction of reflux on venography in eight extremities (67%). Plethysmographically measured reflux improved in 6 extremities (50%) and muscle pump function improved in 7 extremities (58%). No correlation was found between plethysmographic and clinical or venographic outcome. Conclusion: Perivalvular banding can correct reflux and alleviate clinical symptoms of chronic venous stasis in patients with primary valvular incompetence. Selection of patients, valves to be corrected, necessary degree of valvular ring narrowing and need for additional interventions should be further investigated.
Investigation of Popliteal Fossa Venous Reflux
Authors: Cheatle T. R. , Perrin M. , Hiltbrand B. , Bayon J. M. , Genevois A. , Michel C. 
Published: January 2017

Objective: To assess the relative diagnostic merits of duplex scanning (DS) and dynamic popliteal phlebography (DPP) in the investigation of popliteal fossa venous reflux. Design: Prospective single patient study. Setting: Departments of Vascular Surgery, Radiology and Angiology, Jean Kunlin Unit of Vascular Pathology, Clinique du Grand-Large, Declines Charpieu, France. Patients: Eighteen consecutive patients with venous reflux in the popliteal fossa as demonstrated by hand-held Doppler insonation. Interventions: All limbs were investigated by DS and DPP before undergoing surgical exploration of the Popliteal fossa. Main outcome measures: The findings of the two modes of investigation were compared with the operative findings. Results: Both tests showed good specificity (98% DPP, 96% DS), but only moderate sensitivity (83% DPP, 87.5% DS). Both tests were wrong in two limbs. Conclusion: Phlebography can be reserved for cases where duplex scanning is inconclusive. Unsuspected anomalies will occasionally be found at operation despite exhaustive investigation.
Objective Evaluation of Compression Therapy for Deep Vein Thrombosis by Ambulatory Strain-Gauge Plethysmography
Authors: Ohgi S. , Kanaoka Y. , Mori T. 
Published: January 2017

Objective: To evaluate objectively the effect of compression therapy in patients with different degrees of calf muscle pump impairment following deep vein thrombosis. Design: Prospective study. Setting: Second Department of Surgery, Tottori University School of Medicine, Yonago, Japan. Patients: Twenty-one lower extremities in 16 patients and 23 lower extremities in 13 healthy control subjects. Intervention: Application of standard compression elastic stockings (30–40 mmHg compression at the ankle) and high compression elastic stockings (40–50 mmHg at the ankle) (Sigvaris, Sweden). Main outcome measures: Comparison of expelled volume measured by ambulatory strain-gauge plethysmography. Results: Calf pump function after deep vein thrombosis was classified into three grades (normal, compensated and failed) by the expelled volume. The expelled volume increased from 0.4 ml/dl (SD 0.2) to 0.9 ml/dl (SD 0.5) following the application of strong compression. Conclusion: Compression therapy is haemodynamically effective only when using strong compression (40–50 mmHg) in patients with post-thrombotic syndrome.