May-Thurner diagnosis and management

Romulo ARMENTA-FLORES, MD; Cardiothoracic and Vascular Surgery of Central Mexico Abstract May-Thurner syndrome, known for decades as a unique pathology, has been included recently with other pelvic compression maladies in the S-V-P CEAP (symptoms-varicespathophysiology, clinical-etiology-anatomy-pathophysiology) classification sponsored by the American Venous and Lymphatic Society as part of several anatomic lesions in the abdominopelvic region that have variable clinical presentations. This classification will fully characterize and accurately describe a particular lesion; also, it will facilitate clinical interaction and precise treatment and in the long term the development of patient-reported outcome measures and clinical trials. In the interim, epidemiologic data reported so…

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Update on treatment methods for telangiectasia

Mesut ENGIN, MD, Assoc Prof; University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Turkey Abstract Telangiectasias make up a heterogeneous group of diseases that can affect various parts of the body in humans. Although generally limited to the face, telangiectasia can cover different parts of the body in various collagen tissue diseases. The appropriate treatment options for telangiectasias are sclerotherapy, laser therapy, thermocoagulation, and microphlebectomy. The purpose of sclerotherapy is to cause endothelial damage by injecting a sclerosing agent into the vascular bed. Agents such as polidocanol, sodium tetradecyl sulfate, hypertonic saline, and…

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Progress in the management of venous disease during our five decades as surgeons

Peter NEGLÉN, MD, PhD1, Bo EKLÖF, MD, PhD2 1Trimiklini, Cyprus; 2Råå, Sweden Abstract The authors’ experience spans 5 decades of development in the management of venous disease. They describe their journey through the open surgery era; the transforming introduction of duplex ultrasound scanning; the establishment of consensus-driven classification, terminology, and investigatory planning, hugely important for research and patient care; and the emergence of minimally invasive endovascular procedures during the 21st century with greater acceptability by patients, minimal morbidity/ mortality, and wider application than open surgery. The management of patients with venous disease has progressed immensely since the 1960s. Introduction At…

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CHIVA versus ablation

Claude FRANCESCHI, MD Angiologist, Consultant with Groupe Hospitalier Paris Saint Joseph, Paris, France Abstract CHIVA is the French acronym for Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire, ie, Conservative and Hemodynamic Treatment of Venous Insufficiency in outpatients. Ablation is not conservative, and CHIVA is based on a different hemodynamic approach. It is counterintuitive because it is difficult to imagine that the varicose veins could disappear without ablation either by extraction or by endovenous destruction. This treatment raises scientific questions that require us to revisit our understanding of classical venous pathophysiology in light of what echo-Doppler has contributed to our…

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Management of venous ulceration (interventional treatments) with perspectives from a recent meta-analysis and recommendations

Nicolas NEAUME, MD Clinique Pasteur, Toulouse, France Abstract Venous leg ulcers still affect about 1% of the adult population despite recent advances in chronic venous insufficiency treatment, and they represent a significant public health cost, estimated at between 1% and 2% of the annual health budget of Western European countries. Venous leg ulcers may be treated conservatively, with compression bandaging and wound care, medically, surgically, or with a combination of approaches, depending on the severity of the ulcer and available resources. The randomized trial of early endovenous ablation in venous ulceration demonstrated that early removal of a superficial venous reflux…

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Anticoagulation and interventional treatment of varicose veins

Matthieu JOSNIN, MD Saint Charles Clinic, Interventional Phlebology Unit, La Roche-sur-Yon, France Abstract Venous thromboembolic risk is very low after varicose vein procedures. This risk is often cited as less than 1%; however, studies also show the risk to be highly variable. Overall, literature in the field does not typically conclude thromboprophylaxis to be necessary in low-risk patients, owing to the low incidence of the event studied and the often-insufficient number of patients included. Despite the low incidence, venous thromboembolic risk is important in terms of mortality and morbidity. Varicose veins affect an average of 1 in 3 individuals, and…

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Combination therapy in the treatment of varices

Nicholas H. OSBORNE MD, MS1*; Craig BROWN MD, MS1; Christopher O. AUDU MD, PhD1; Danielle C. SUTZKO MD, MS2; Andrea T. OBI MD1; Thomas W. WAKEFIELD MD1 1Section of Vascular Surgery, Department of Surgery, Michigan Medicine; 2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham Abstract Background: There is significant variation in the treatment of combined truncal-vein reflux and symptomatic varicosities. We sought to use the Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR) to explore the contemporary real-world experience of combined ablation and phlebectomy versus ablation alone. Methods: Using the VQI/VVR database, patients…

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Effectiveness of micronized purified flavonoid fraction–based conservative treatment in chronic venous edema

Vadim Yu BOGACHEV, MD, PhD On behalf of the VAP-PRO-C3 study investigators group. Department of Faculty Surgery No. 2, Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia Abstract Aim: This study assessed the effectiveness of micronized purified flavonoid fraction (MPFF)-based conservative treatment in patients with chronic venous edema (CVE) as part of an observational program that evaluated the management of patients with CVE caused by the primary forms of chronic venous disease (CVD) in real clinical practice. Materials and methods. The VAP-C3 (Vein Act Prolonged-C3; NCT03722836) prospective, single-arm, observational study was conducted in Russia in adult outpatients with CVD…

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An update on operative treatments of primary superficial vein incompetence: part 2.

An update on operative treatments of primary superficial vein incompetence: part I. Michel Perrin, MD Vascular Surgery, Unité de Pathologie Vasculaire Jean Kunlin Chassieu, France Abstract In part 2 of “An update on operative treatment of primary superficial vein incompetence,” all randomized controlled trials (RCTs) published since 1990 on operative treatments of varicose veins were collected and the references were gathered in tables according to either the procedure used or the patient’s clinical status. Case series and meta-analyses were taken into account in this review when RCTs were not available. For more details regarding clinical or instrumental outcomes of the…

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Presence of varices after operative treatment: a review

Part 2: This is the second part of the review article “PREsence of Varices After operatIve Treatment (PREVAIT).” The first part was published in Phlebolymphology,  2014;21(3):158-168. Michel Perrin, MD Vascular Surgery, 26 Chemin de Decines, F-69680 Chassieu, France Abstract Background: PREsence of VArices after operatIve Treatment (PREVAIT) occurs in 13% to 65% of patients and remains a debilitating and costly problem. The second part of this review aims to provide an overview of its optimal management according to published data. Methods: A PubMed search was conducted in English and French for the years 2000-2013 by using keywords (ie, duplex scanning,…

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