bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of the Superficial and Perforating Veins
Authors: Gloviczki P. 
Published: January 2017

Objective: To review the techniques and results of surgical treatment of the superficial and perforating veins in patients with chronic venous insufficiency. Methods: The current techniques used at the Mayo Clinic for treatment of simple varicose veins and venous ulcers are presented. Results of subfascial endoscopic perforator vein surgery (SEPS) are discussed and data from large centres are tabulated. Results are compared with those reported following non-operative management. Synthesis: High ligation and invagination stripping of the incompetent segment of the saphenous vein, with stab avulsion of branch varicosities, is the optimal surgical technique to ablate superficial venous incompetence. SEPS is safer than open perforator vein ligation and is the technique of choice to interrupt incompetent perforating veins. A review of 12 series on SEPS, that included 361 limbs, found an ulcer recurrence rate of 10% in those 211 patients who underwent ablation of superficial reflux together with SEPS. One hundred and fifty limbs had SEPS alone, without saphenous stripping: ulcer recurrence in this group at a mean of 23 months was 12%. Results in primary valvular incompetence were significantly better than in post-thrombotic syndrome. Conclusions: Ablation of superficial reflux remains the main surgical treatment of all forms of chronic venous insufficiency. SEPS is safe and effective to interrupt medial calf perforators and results in rapid ulcer healing and low recurrence in patients with primary valvular incompetence. The treatment of post-thrombotic syndrome remains a challenge. Results of the North American Venous Ulcer Surgery (NAVUS) trial, a prospective, randomised, multicentre study, will be required to provide level 1 evidence of the effectiveness of surgical treatment over medical therapy in the treatment of venous ulcers.
Iliac Venous Obstruction: Surgical Reconstruction
Authors: Mercier F. , Cormier F. , Fichelle J. M. , Duarte F. , Cormier J. M. 
Published: January 2017

Aim: To review the investigation and treatment of iliac vein obstruction. Method: A review of current literature in the field of management of iliac venous obstruction has been conducted. Synthesis: Iliac venous obstruction results in chronic or acute symptoms in the lower limb presenting as pain, swelling, oedema and discomfort of the lower limb. Intrinsic or extrinsic obstruction of the iliac veins may be the cause. Cockett syndrome is the classic aetiology for chronic intermittent or fixed left inferior limb venous obstruction. Other causes include tumours, vascular grafts or lymph node compression and retroperitoneal fibrosis. Duplex ultrasound imaging is now the first-choice investigation. CT scanning is useful where external vein compression is suspected. Phlebography is used when an endovascular procedure is to be done. The surgical treatment of Cockett syndrome described by Cormier is transposition of the common right iliac artery in the left internal iliac artery. This is being replaced by endovascular balloon venoplasty completed by stenting of the left iliac vein. We reviewed the experience of surgical correction of Cockett syndrome with Cormier's technique in 70 patients operated on between 1976 and 1990; 55 patients had a follow-up of 12-177 months. Anatomical and functional results were perfect for all patients except when endoluminal synechiae or iliac venous thrombosis were associated with postural compression. In this case a 50% success rate was achieved. The endovascular revolution offers a less invasive technique for treatment of chronic iliac venous obstruction. Follow-up is short at present in the few publications found in the literature. Conclusions: Iliac vein obstruction results in symptoms of swelling in the lower limbs. These may be managed conservatively. Where there is an indication for venous reconstruction, investigation by duplex ultrasonography is the first step. Endovascular procedures including stenting offer significant benefit. The long-term outcome of these interventions has yet to be established.
Compression Therapy: European Regulatory Affairs
Authors: Neumann H. A. M. 
Published: January 2017

Objective: Updating the status of the European standardisation for medical elastic compression stockings, including custom-made stockings (class 030606, EN29999), knitted from threads made of natural fibres or synthetic fibres and elastic threads. Design: Review of the literature. Setting: Department of Dermatology at the University Hospital of Maastricht (The Netherlands). Methods: Systematic review of the European regulations within the European Committee for Standardisation (CEN), by a special committee researching non-active medical devices (CEN/TC205). A special working group was set up for medical elastic compression stockings (CEN/TC205/WG2) and for anti-embolism stockings (CEN/TC205/WG2/P1) linked to the scientific background and literature on medical elastic compression stockings. Results: CEN/TC205 formalised a European prestandard (prEN12718) for medical elastic compression stockings. The pre-standard describes five compression classes, instructions for measurement, instructions for residual pressure and instructions for knitting. Still lacking is a good instrument for the comparison of laboratory measurements and a durability test. The problem of the elasticity coefficient is neglected in the standard. Conclusions: Normalisation of non-active medical devices is an important quality instrument. The medical profession should give attention to adequate compression classes, a good understanding of the elasticity coefficient and the durability of stockings.
A New Pragmatic Classification System for Varicose Veins
Authors: Michaels J. A. , Campbell W. B. , Rigby K. A. , Chan P. , Beard J. , Wood R. , Lonsdale R.J. , Sheriff S. , Palfreyman S. , Thompson J. , Allington K. , Brazier J. , Shackley P. , Niblett P. , Peters A. , Bickerton D. 
Published: January 2017

Objective: An anatomical classification system for varicose veins which has a direct and pragmatic bearing on treatment. Methods: A group of trial participants from the two vascular units involved met to design a system. A consensus on the form and content of the system was reached. This process included forming a set of ideal classification criteria, a literature review of existing classification systems and a pilot study of the proposed system. Results: The identified classification systems were felt to be unsatisfactory for a number of reasons including being difficult to understand and use, requiring special investigations and not linking through to clinical management options. The pilot study demonstrated consensus between clinicians when using our system. Conclusion: A system has been developed that is easy to learn, use and understand. It can be employed in a busy outpatient setting and produces an acceptable degree of agreement regarding the anatomical nature of varicose veins.
Ankle Motility is a Risk Factor for Healing of Chronic Venous Leg Ulcers
Authors: Barwell J. R. , Taylor M. , Deacon J. , Davies C. , Whyman M. R. , Poskitt K. R. 
Published: January 2017

Objective: To investigate the effect of ankle motility on chronic venous leg ulcer healing, and to relate this to calf pump function and muscle bulk. Methods: This was a prospective cohort study undertaken in a leg ulcer clinic. Ankle motility, calf-ankle circumference ratio and calf pump power (derived from digital photoplethysmography) were assessed as to their effect on ulcer healing rate. Thirty consecutive patients undergoing multi-layer compression bandaging for open chronic venous ulcers were included. Results: Ankle motility was an independent risk factor for ulcer healing ( p = 0.001, hazard ratio 1.08, 95% CI 1.03–1.13). Ankle motility correlated with calf-ankle circumference ratio ( r = 0.48, p<0.01). No relationship was found between photoplethysmography-derived calf pump power, ankle motility or ulcer healing rate. Conclusions Ulcers in legs with poor ankle motility are slower to heal and this may be related to reduced calf muscle bulk. Ankle exercises or physiotherapy could be considered in such patients.
Recurrent Varicose Veins in Surgical Practice
Authors: Alves C. Pereira , Neves J. , Soares T. , Pereira C.M. Alves , Negus David 
Published: January 2017

Recurrent varicose veins are often regarded as inevitable. To confirm or refute this point we have analysed the last 20 patients operated on in our vascular unit. Results have shown that majority of recurrences were due to inadequate primary treatment, with inadequate ligation of sapheno–femoral junction the most frequent cause.
Enzymatic and Isoenzymatic Study of Varicose Veins
Authors: García-Róspide V. , Peñafiel-Marfil R. , Moreno-Padilla F. , González-Ríos J. , Ramos-Bruno J.J. , Ros-Díe E. 
Published: January 2017

The activities of lactate dehydrogenase (LDH), creatinine kinase (CK) and alkaline phosphatase (AP) enzymes were assessed in the venous wall according to the methods of Bergmeyer, Szasz and Bessey, respectively, in 50 varicose veins (44.7 ± 14.06 years mean age), and 51 control veins (65.7 ± 13.4 years mean age). We also assessed the activity of venous LDH and CK isoenzyme in both groups. The most important finding was a significant decrease in LDH and CK in varicose veins, which may be of great importance in the study of varicose pathology.
Partial Versus Total Stripping of the Great Saphenous Vein Evaluated by Strain-Gauge Plethysmography
Authors: Helsted Morten , Hesselfeldt-Nielsen Jørgen , Mathiesen Frits R. 
Published: January 2017

This study was undertaken in order to assess the necessity of stripping the great saphenous vein totally or partially in the treatment of varicose veins. Thirty-four patients with varicose veins with no previous treatment were allocated to one of the two following treatments: sapheno–femoral ligation and complete stripping from the groin to the ankle with ligature of incompetent perforators and avulsion of visible varicose veins (group I); and partial stripping from the groin to 5 cm below the line of the knee joint and otherwise treated as mentioned above (group II). All patients were examined clinically before and 3 months after surgery to assess their varicose veins and the sensitivity in the saphenous nerve area. They were all investigated by strain-gauge plethysmography, recording venous return-time (RT) and expelled volume (EV). The patients scored their subjective findings on visual analogue scales (VAS) assessing discomfort, swelling and visual appearance. The Plethysmographic results of the two groups showed that RT increased by 25.5 and 22.5 s, respectively, to 53.4 and 63.6 s (median values) (normal RT > 42 s). The increment of the two groups, is significant, but a comparison does not show any significant difference. The EV-values showed nonsignificant changes. Saphenous nerve damage was found in five of 15 patients in group I and in one of 19 in group II, but this difference is not statistically significant ( P < 0.10). The VAS scores showed a significant improvement in both groups, in terms of discomfort and visible appearance, but that they did not differ in these respects. We conclude that partial stripping does not lead to a different outcome from total stripping, and that partial stripping seems to be the preferable treatment of primary varicose veins.
Leg Ulcer Patients: No Decreased Fibrinolytic Response but White Cell Trapping after Venous Occlusion of the Upper Limb
Authors: Vanscheidt W. , Kresse O. , Hach-Wunderle V. , Hasler K. , Scharrer I. , Wokalek H. , Schöpf E. 
Published: January 2017

Objective: To study changes in indicators of fibrinolytic activity and white cell trapping in response to raised venous pressure in the upper limbs of patients with chronic venous insufficiency. Design: Comparison of disease group versus control group study. Setting: Departments of Dermatology and Medicine, University of Freiburg. Patient: Thirty patients with chronic venous insufficiency and thirty control subjects of similar age with unrelated conditions. Interventions: The venous pressure was raised in one upper limb by application of a sphygmomanometer cuff around the upper arm for a period of 10 minutes. Main outcome measures: Red cell count, white cell count, plasminogen activator inhibitor, tissue plasminogen activator were measured in blood drawn from the arm subjected to raised venous pressure. Results: No significant changes were observed in the parameters of fibrinolytic activity. After 10 minutes of venous hypertension the white cell trapping in the disease group was 17.7% (interquartile range, 10.7–22), compared with 12.8% (interquartile range 4.9–16.1%) in the control group. Conclusion: The differences in white cell trapping parameters between healthy control subjects and patients with chronic venous insufficiency is probably attributable to systemic activation of white cells associated with their venous disease.
Lothian and Forth Valley Leg Ulcer Healing Trial, Part 1: Elastic versus Non-Elastic Bandaging 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 determine whether elastic or non-elastic bandaging is more effective in healing chronic venous ulcers. Design: Randomized trial with factorial design and interaction analysis, enabling independent evaluation of both bandaging and dressings within the single-trial format. The duration of treatment was 12 weeks or until ulcer-healing, whichever occurred sooner. Setting: The Leg Ulcer Clinics of Edinburgh and Falkirk and District Royal Infirmaries, Scotland. Patients: 132 patients with chronic leg ulcers and clinical evidence of chronic venous disease, and excluding those with Doppler ultrasound ankle/brachial pressure indices of less than 0.8, diabetes or rheumatoid disease. There were 28 withdrawals who were classified for analysis as treatment failures. Interventions: Elastic or non-elastic multilayer bandage systems were applied using similar application techniques by a team of trained nurse specialists. All other treatments were standardized, including the randomization of dressings to either a knitted viscose or a hydrocellular polyurethane dressing. Main outcome measure: Complete ulcer healing. Results: In the elastic group 35 out of 65 ulcers (54%) healed within 12 weeks compared with 19 out of 67 (28%) in the non-elastic group (95% confidence limits for percentage healed, 9% to 42%). Ulcer pain was also reported significantly less often in the elastic group (48% of visits versus 29%; p=0.03). Conclusion: When applied by similar multilayer bandaging techniques, elastic bandaging was significantly better than non-elastic bandaging in the treatment of chronic venous leg ulcer.
Bandaging of the Lower Leg
Authors: Gundersen J. 
Published: January 2017

Objective: To summarize the advantages of different bandaging techniques and their appropriateness in particular pathological condition. Data Sources: The author draws on his own considerable experience in the management of venous disease using bandaging techniques. Conclusion: The technique of bandaging is invaluable in the management of patients with lower limb oedema and venous disease. It should be learnt by all clinicians and nurses managing such patients.
Make it Easy: Duplex Examination of the Venous System
Authors: Kalodiki E. , Calahoras L. , Nicolaides A. N. 
Published: January 2017

Objective: A methodological report of duplex ultrasound examination of the venous system, with Particular consideration of the best position for examining the patient. Design: Single patient group, comparison of duplex ultrasound imaging with phlebography. getting: Teaching hospital vascular laboratory. Patients: Patients referred for assessment of their venous system. Main outcome measures: Duplex ultrasound scanning of the lower limb, ascending phlebography. Results: Our results of duplex ultrasound scanning in the diagnosis of deep vein thrombosis as compared with Phlebography show a sensitivity of 94% and a specificity of 91%. Conclusions: We found it advantageous to examine the Patient standing during proximal vein imaging and sitting for distal venous examination. Veins dilated as a result of gravitational effects are visualized more easily. The examiner, by resting the elbow on his/her distal Thigh, has a more stable hand, facilitating the test. The Patient, by resting the heel on the edge of the examiner's chair, relaxes the calf muscles, thus simplifying the augmentation manoeuvre. The inflation of a tourniquet applied to the distal thigh dilates the calf veins.
Calf Muscle Metabolism in Venous Insufficiency
Authors: Hands L. J. , Kemp G. J. , Zukowski A. , Nicolaides A. N. , Radda G. K. 
Published: January 2017

Objectives: To study the effect of deep venous insufficiency on calf muscle energy metabolism. Design: A paired study of affected and unaffected calf muscle in seven patients with unilateral lower limb deep venous insufficiency. Investigations: Phosphorus-31 magnetic resonance spectroscopy was used to study changes in vivo in pH, phosphocreatine and other phosphorus metabolites during and after exercise. Results: Glycolytic activity was increased in the affected muscle at the start of exercise but metabolic recovery following exercise was normal. Conclusions: Oxidative phosphorylation is impaired, at least at the start of exercise, but appears normal immediately after exercise. This may be due to inadequate blood flow, perhaps secondary to the rise in intramuscular pressure that occurs with exercise.
Recurrence and Late Sequelae after First-Time Deep Vein Thrombosis: Relationship to Initial Signs
Authors: Lagerstedt C. , Olsson C.-G. , Fagher B. , Norgren L. , Tengborn L. 
Published: January 2017

Objective: To investigate the relation between initial symptoms and long-term sequelae in first-time deep venous thrombosis (DVT). Design: Follow-up study of patients 6 years after an episode of suspected symptomatic DVT. Setting: Vascular laboratory, University Hospital of Lund. Patients: 66 patients, 19 with femoral DVT, 20 with calf DVT and 27 with normal phlebograms at initial investigation. Main outcome measures: Symptoms and signs of chronic venous insufficiency (CVI), foot volumetry and measurement of plasminogen activator inhibitor 1 (PAI-1) activity. Initial clinical signs and results at phlebography were compared with findings at follow-up. Results: Of patients with DVT, 11 (28%) had been treated for a recurrent DVT during follow-up. No relation was found between initial signs of DVT and late signs of CVI. Patients with DVT had significantly more signs of CVI but symptoms did not differ between the groups. Mean levels of PAI-1 activity were similar in the three groups, and patients with recurrent DVT did not differ. Refilling flow was related to the clinical CVI-score, and expelled volume was inversely related to the extension of DVT at phlebography. Conclusion: The recurrence rate is high in first-time DVT, but symptoms are mostly mild as long as after 6 years. There is a poor correlation between symptoms of CVI and objective findings. The late development of CVI cannot be predicted from the clinical signs in the acute phase. Levels of PAI-1 do not correlate with the degree of CVI.
Assessment of Intermittent Pneumatic Compression by Strain-Gauge Plethysmography
Authors: Abu-Own A. , Scurr J. H. , Smith P. D. Coleridge 
Published: January 2017

Objective: To compare the physiological effects of a sequential gradient pneumatic compression device (SCD) with a single-chamber pneumatic compression device (Venodyne). Design: Single patient group with treatment crossover. Setting: Department of Surgery, University College and Middlesex Hospital, London, UK. Subjects: Thirty-four limbs of 17 normal adult volunteers were studied. Interventions: Sequential gradient compression was applied to one leg and single-chamber compression to the other lower limb for 10 min. The compression devices were then swapped to the opposite leg for a further 10 min period. Outcome measures: The increase in foot volume (distal venous distension) in response to each compression, and the subsequent decrease in foot volume (distal venous emptying), were measured. The overall reduction of foot volume (net effect) during the period of compression was calculated. Results: The results indicate the net effect was a decrease in foot volume (median decrease 0.35 ml%, 95% CI: 0.21% to 0.45%) with the SCD and no change with the Venodyne (median decrease 0.09 ml%, 95% CI: −0.25% to 0.22%). Conclusion: We conclude that sequential intermittent pneumatic compression of the calf and thigh is less likely to cause distal blood trapping and foot swelling than single-chamber calf compression.
Primary Venous Aneurysms of the Popliteal Fossa
Authors: Cheatle T. R. , Perrin M. 
Published: January 2017

Objective: To report five cases of primary venous aneurysm arising in the popliteal fossa. Setting: Unite de Pathologie Vasculaire Jean Kunlin, Clinique du Grand-Large, av. Leon-Blum, Decines Charpieu, France. Patients: Five patients with radiological evidence of venous aneurysm in the popliteal fossa. Interventions: Surgical repair in all cases. Main outcome measures: Avoidance of pulmonary embolism. Results: Satisfactory postoperative recovery in all. No complications or subsequent pulmonary emboli.
The Role of Elastic Compression Stockings in Prevention of Venous Dilatation Induced by a Reverse Trendelenburg Position
Authors: Arcelus J. I. , Caprini J. A. , Traverso C. I. , Size G. , Hasty J. H. 
Published: January 2017

Objective: To evaluate the response of the deep veins of the leg to an inclination from supine (reverse Trendelenburg) and assess the influence of gradient elastic compression stockings on such response. Design: Prospective study in healthy volunteers. Setting: University affiliated community hospital, Glenview, Illinois, USA. Participants: Ten healthy volunteers. Interventions: High-resolution ultrasound imaging was carried out to study the leg veins in the supine and 45° reverse Trendelenburg position, with and without thigh-length gradient elastic compression stockings. Main outcome measures: Vein cross-sectional area changes after the use of compression stockings in the supine position and after 30 and 60 min in a reverse Trendelenburg position. Results: Significant dilatation of the leg veins was observed during the reverse Trendelenburg position. This was partially prevented by the use of gradient elastic compression stockings. Conclusion: Elastic compression of the legs significantly reduces the dilatation of the medial gastrocnemius veins of the calf that occurs in healthy volunteers as a result of inclination from supine.