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Treatment of Chronic Venous Insufficiency  [PDF]
Cengiz K?ksal,Saleh Alsalehi,?zgür Kocamaz,Hasan Sunar
Ko?uyolu Kalp Dergisi , 2010,
Abstract: Chronic venous insufficiency (CVI), with its high prevalence, high cost of diagnosis and treatment, substantial loss in manpower and negative effects on quality of life, is an important health issue. A comprehensive knowledge of the anatomy and functions of venous system is a must to understand the pathophysiology of CVI. The iagnosis of CVI is made by history, physical examination and noninvasive tests. The traditional surgical strategy for CVI treatment is high ligation of saphenofemoral vein and saphenous vein stripping. In recent years, novel minimally invasive techniques such as ultrasound-guided foam sclerotherapy, endovenous laser and radiofrequency ablation have been more widely applied. Here, we have reviewed the various treatment strategies used in CVI.
Lymphedema in Chronic Venous Insufficiency and Physical Procedures
Senija Kuralic,Nedima Kapidzic-Basic
Acta Medica Saliniana , 2010, DOI: 10.5457/197
Abstract: Lymphedema is difficult, chronic, progressive, and prolonged illness with an uncertain therapeutic outcome. Lymphedema in chronic venous insufficiency (CVI), is by its ethiology a secundary illness, resulting from the dysfunction of the lymphatic and depending on the degree of CVI. This lymphedema can be transitory or persistent, acute or chronic with or without pathological changes in skin. CVI lymphedema occurs as a result of venous hypertension i.e. pathological reflux of venous blood and an increase in the mean capillary pressure in microcirculation of skin venules, which causes the venous route. The venous route impedes lymph reabsorption which upon the exhaustion of compensatory mechanisms leads to the lymph route and the occurrence of clinical lymphedema. Lymphedema therapy in CVI is directly dependent on the treatment of CVI, but to date these disorders are treated but not cured and it is correct to talk about treatment or help. Physical treatments include the application of: physical procedures such as vacusac, vasculator, magnetic, electrical, dosed kinezitherapy, laser, hyperbaric oxygen therapy (HBOT), thermomineral water of indifferent water temperature. Physical therapy contributes to the improvement and development of collateral flow and improved venous drainage with venous insufficiency. Clinically there is decrease in edema, improved trophic, reduced hyperpigmentation, reductions in dermatoflebosclerotic changes, reduced pain which ultimately improves the quality of life of these patients.
An Alternative Therapy for Recurrent Stasis Ulcers in Chronic Venous Insufficiency: Venocuff  [PDF]
Celal Yavuz,Sinan Demirtas,Orkut Guclu,Oguz Karahan,Suleyman Yazici,Ahmet Caliskan,Binali Mavitas
Case Reports in Vascular Medicine , 2012, DOI: 10.1155/2012/315147
Abstract: Chronic venous insufficiency may cause stasis ulcers that significantly impact on the quality of life. Many methods have been described for preventing or treating these ulcers. However, stasis ulcers often recur as a result of continuing venous insufficiency. Here we report a 30-year-old male patient with chronic venous insufficiency. He was admitted to the hospital owing to recurrent stasis ulcers. He had a history of various flavonoid drug usage and compression therapies over the previous six years. Venous Doppler sonography revealed combined saphenofemoral and deep femoral venous insufficiency. Venocuff was applied to the prejunctional and postjunctional parts of the femoral vein and the saphenofemoral junction. The patient was discharged on the postoperative second day, and a low-molecular-weight heparin dressing composed of calcium alginate was applied to the ulcer wound for one week after the operation. The stasis ulcer wound was totally healed after one month. The patient was followed up six months after the operation, and no postoperative complications or new ulceration was observed. Recurrent stasis ulcers are major reasons for hospitalization in patients with chronic venous insufficiency. Venocuff application for reducing venous insufficiency may be a good option for adjunctive ulcer therapy and for preventing recurrences of the problem. 1. Introduction Since early times, chronic venous insufficiency may have caused stasis ulcers that significantly impact the quality of life adversely. Many methods have been described for preventing or treating these ulcers. However, stasis ulcers have a tendency to recur owing to continuing venous leakage [1, 2]. Surgical methods such as high ligation, stripping, radiofrequency ablation, and endovenous laser therapy are widely performed. These are safe and effective procedures that, in experienced hands, can achieve good short- and long-term outcomes for most patients. However, the loss of the saphenous vein as a potential bypass graft and possible risk of continuous deep venous reflux are important disadvantages of these procedures [1–3]. Approaches that focus on providing venous valve sufficiency last for a long time. External wrapping is one of the available procedures in such cases. The main purpose of this approach is to restore the function of the venous valves that settle between saphenous and deep veins, by extraluminal wrapping of the dilated vein, thereby reducing its diameter and bringing the valve cusps together [3]. Here we report a case of chronic venous insufficiency associated with recurrent
Endovascular Therapy for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis  [PDF]
Marc A. Lazzaro,Nils Mueller-Kronast,Muhammad A. Taqi
Frontiers in Neurology , 2011, DOI: 10.3389/fneur.2011.00044
Abstract: Recent reports have emerged suggesting that multiple sclerosis (MS) may be due to abnormal venous outflow from the central nervous system, termed chronic cerebrospinal venous insufficiency (CCSVI). These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.
Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis
Bianca Weinstock-Guttman, Murali Ramanathan, Karen Marr, David Hojnack, Ralph H.B. Benedict, Charity Morgan, Eluen A Yeh, Ellen Carl, Cheryl Kennedy, Justine Reuther, Christina Brooks, Kristin Hunt, Makki Elfadil, Michelle Andrews, Robert Zivadinov
BMC Neurology , 2012, DOI: 10.1186/1471-2377-12-26
Abstract: The objective was to evaluate the clinical correlates of venous anomalies indicative of CCSVI in?patients with MS.The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other neurological disorders who underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RR-MS: n?=?181, SP-MS: n?=?80 and PP-MS: n?=?12). Disability status was evaluated by using the Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS).Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the severity of CCSVI, as measured with venous hemodynamic insufficiency severity score (VHISS). However, the severity of CCSVI was associated with the increased brainstem functional EDSS sub-score (p?=?0.002). In logistic regression analysis, progressive MS (SP-MS or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI diagnosis (p?=?0.004, OR?=?2.34, CI?=?1.3–4.2).The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has no or very limited association with clinical disability.
System analysis in optimizing the choice of treatment for patients with complicated forms of chronic venous insufficiency of the lower extremities  [PDF]
Kukolnikov E.L.
Saratov Journal of Medical Scientific Research , 2011,
Abstract: Methods: to optimize treatment of patients with complicated forms of chronic venous insufficiency of our method was applied systems analysis, proposed by Th. Saaty (1993), and was called the method of analysis of hierarchies . Results: the results indicate a direct relationship to the choice of methods for the treatment of patients with complicated forms of chronic venous insufficiency of the influence of individual actors and the goals of each. Conclusion: applying the analytic hierarchy process in selecting a method of treatment in patients with complicated forms of chronic venous insufficiency of the lower extremities can improve the quality of life of patients and reduce the frequency of disability, reduce the rate of loss of ability to self-service, as well as reduce the costs of treating both the patient and medical institution
NO and Chronic Venous Insufficiency (CVI): ImmunohistochemicalEvaluation of iNOS and eNOS Isoforms in the Venous Ulcers. Clinical and Therapeutical Possible Implications
V. Tessitore,M.L. Uzzo,G. Bonaventura,F. Carini,G. Milio,G.F. Spatola
Research Journal of Medical Sciences , 2012,
Abstract: The pathophysiologic mechanism related to pathogenesis of cutaneous trophic disorders in Chronic Venous Insufficiency (CVI) find different explanations. The increase in the number of capillaries and the subsequently stasis, the fibrin cuffs deposited around the capillaries and leucocytes migration associated at inflammatory phenomena in fact try to explain the etiology of venous ulceration. In this study, we have evaluate the immunohistochemical presence of iNOS and eNOS in cutaneous bord of venous ulcers to evaluate the role of Nitric Oxide (NO) in pathophysiology of these trophic disorders. In addition, using the image analisys method, we have evaluate the increase of capillary numbers respect to normal skin. We have studied immunohistochemical distribution of iNOS and eNOS in human normal skin and in peripheral bord of venous ulcers in 20 subject affected by CVI. The specimens have been taken during a surgical treatment. All of these are fixed in Bouin s mixture and processed with eNOS (Transduction N30020) and iNOS (Transduction N32030) antibodies. After the immunostaining procedures all specimens are studied with Nikon microscope and Lucia system of image analisys. Moderate eNOS immunoreactivity are expressed in the same way both in the endothelium of a dermic capillaries and in the spinous epithelium of the normal skin such as in the pathological specimens. iNOS immunopositivity is more expressed in the spinous epithelium and in the capillaries endothelium of a bord of venous ulcer than in a normal skin. At the image analisys the capillary numbers in the venous ulcers is remarkably higher respect the normal skin. These data provide a morphological basis to explain a possible pathogenesis in the cutaneous trophic disorders in CVI. In fact the strong iNOS immunoreactivity, expressed in this inflammatory phenomenon, may be implicated in microcirculatory stasis.
Diagnostic concordance of the dilation of the great saphenous vein in patients with chronic venous insufficiency
Reyes-Lobo Alexander,Ramos-Clason Enrique Carlos,Segovia-Fuentes Javier,Casta?o-Padilla Amaury
Revista Ciencias Biomédicas , 2012,
Abstract: Introduction: Chronic venous insufficiency (CVI) is a dysfunction of the venous systemof the inferior limbs, in which it is formed a venovenous short circuit with alteration inthe physiologic flow of the blood.Objective: To estimate the degree of diagnostic concordance between the dilation ofthe great saphenous vein and the presence of chronic venous insufficiency (CVI).Methods: Diagnostic concordance study, where were included all the patients that wentbetween the months of April and May 2011 to the service of radiology of the HospitalUniversitario del Caribe, Cartagena, Colombia to make itself a colour Doppler ultrasoundof inferior limbs because of suspicion of CIV. Data was saved and analyzed by meansof the statistical program EPI-INFO version 3.5.1. Statistical analysis was focused inthe estimation of the kappa concordance index, the diameter of the saphenous with thepresence of CVI. Moreover there were calculated the parameters of diagnostic validitylike sensibility, specificity, predictive values and probability quotient.Results: There were recruited 77 patients, 64 women and 13 men. Of the total ofpatients, 47 had ebb and of them, 41 had dilation of the great saphenous vein, for whatthe dilation of this vein per se has sensibility of 87.2% and specificity of 93,1% for thediagnosis of CVI with positive predictive value (PPV) of 95.3% and negative predictivevalue of 81.8%.Conclusion: There is good diagnostic concordance between the dilation of the greatsaphenous vein and the CVI. Rev.cienc.biomed. 2012;3(2):234-241RESUMEN:INTRODUCCIóN: la Insuficiencia Venosa Crónica (IVC) es una disfunción del sistemavenoso de los miembros inferiores, en la que se forma un corto circuito veno-venosocon alteración en el flujo fisiológico de la sangre.OBJETIVO: estimar el grado de concordancia diagnóstica entre la dilatación de la venasafena mayor y la presencia de insuficiencia venosa crónica (IVC).METODOLOGíA: estudio de concordancia diagnóstica, en el que se incluyeron todoslos pacientes que acudieron entre los meses de abril y mayo del 2011 al servicio deradiología del Hospital Universitario del Caribe, Cartagena, Colombia para practicarseecografía doppler color de miembros inferiores por sospecha de IVC. Los datos fueronalmacenados y analizados por medio del programa estadístico EPI – INFO versión 3.5.1.El análisis estadístico se centró en la estimación del índice de concordancia Kappa, deldiámetro de la safena con la presencia de IVC. Además se calcularon los parámetrosde validez diagnóstica como sensibilidad, especificidad, valores predictivos y cocientesde p
The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment  [cached]
Wies?aw Pesta,Waldemar Kurpiewski,Marek Kowalczyk,Rafa? Szynkarczuk
Videosurgery and Other Miniinvasive Techniques , 2011,
Abstract: In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatmentof advanced chronic venous insufficiency at the 5th and 6th degree of CEAP classification is still a great clinical challenge.In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternativetherapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery(SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrentvenous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascialendoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency.
Patients with Chronic Venous Insufficiency: Treatment Modalites of Venous Impairment and Its Complications during Two Years Period in Primary Care Center
Zeynep Gÿkalp Çevik
Open Access Library Journal (OALib Journal) , 2015, DOI: 10.4236/oalib.1101795
Abstract: Background: Venous disease is a common health problem in developed countries. The aim of this study was to research the medical treatment strategy, complication due to venous impairment including leg ulcer, deep and/or superficial phlebothrombosis related to chronic venous insufficiency (CVI) two years follow-up. Patients and Methods: This prospective study has been planned in our Family and Children Health Center. 196 patients who have CVI have been included for the study. The mean age of these patients was 45.0 ± 12.4 y (17 - 80 y). One hundred patients were female and the remaining 96 patients were male. The main complaints of the patients were leg pain, visible varices, skin hyperpigmentation and leg edema. Twenty-eight patients were hypertensive and 22 were diabetics. Cardiovascular specialists did recommend a mikronize flavonoid fractions, calcium dobesilat or oxerutine as a medical treatment. Also, compression bandage or stockings have been recommended additionally. Results: During two years period, leg ulcer developed in 10 patients (7 female and 3 male). Deep venous thrombosis has been detected by doppler USG in these patients who used antiaggregant and anticoagulants. We also detected deep venous thrombosis in two pregnant women. Control doppler ultrasonography showed that venous regurgitation increased from grade I to grade III or IV in 44 patients (33 female, 11 male; p < 0.05). Superficial venous thrombotic events related to CVI have been detected in nine patients. Dermatotrophyc changes and deep venous disease were common in women (OR = 0.7 for both) (p = 0.0032). Visible varicose veins were closely linked; 87.3% of legs were concordant and 13.7% discordant. The age-adjusted prevalence of edema, superficial events, and deep events were estimated as 32.2%, 19.3%, and 29.6%, respectively, compared with 1.2%, 0.3%, and 1.1% for legs visibly and functionally normal. Conclusion: Our study results showed that CVI complications and its complaints are more common in females. Complications because of CVI are more common and complaints are more severe in patients who did not use regularly pharmacologic treatment and compression stockings. Complications such as venous thrombosis and dermatotrophyc changes due to CVI are common especially in obese females. To decrease leg complaints due to venous stasis and its complication pharmacologic treatment together with compression stockings or bandage use regularly are very important factors.
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