Phlebolymphedema: an up-to-date review

Jorge H. ULLOA,1 MD, FACS; Sebastian CIFUENTES,2 MD; Valentin FIGUEROA,2 MD; Emelyn Van UDEN,2 MD; Javier A. BRAVO,2 MD; Miguel AMORE,3 MD; Jairo RAMÍREZ,1 MD, FACS 1Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital; Universidad de los Andes Medical School. Bogotá, Colombia; 2Universidad de los Andes Medical School, Fundación Santa Fe de Bogotá University Hospital. Bogotá, Colombia; 3Vascular Surgery Department, Fundación Favaloro, Buenos Aires, Argentina Abstract Phlebolymphedema is a vascular condition in which there is damage of the venous and lymphatic systems in the lower limbs. It is secondary to chronic venous insufficiency, which results in venous hypertension…

Full text

The transosseous perforator veins of the knee

Jean-François UHL,1 MD; Marios VALSAMIS,2 MD; Claude GILLOT,3 MD 1Research Director, UNESCO Chair of Digital Anatomy – Paris University, Paris, France 2Phlebologist & Surgeon (private practice), Athens, Greece 3Laboratory of Anatomy – Paris University, Paris, France Abstract The perforator veins (PVs) of the knee can be responsible for reticular veins, telangiectases, and varicosities around the knee, but they are frequently underdiagnosed and missed by the phlebologists and the sonographers because of their tiny size. These PVs are frequently located around the patella and connected with transosseous perforators, well-demonstrated in the anatomical part of this work. This could explain why sclerotherapy…

Full text

VEIN STEP: Chronic VEnous dIsorders maNagement and Treatment Effectiveness Evaluation in Chronic Venous Disease, an International Observational Prospective Study. Results from Morocco

Tazi Mezalek ZOUBIDA, MD1,2 Jorge Hernando ULLOA, MD, FACS3 1Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; 2Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco; 3Fundacion Santa Fe de Bogota, Bogota, Colombia Abstract Aim: VEIN STEP is an international, observational, prospective study assessing the effectiveness of conservative treatments for the relief of chronic venous disease (CVD) symptoms and their impact on quality of life (QOL). This article presents results collected in Moroccan patients. Method: Adult outpatients consulting for symptomatic CVD were categorized via the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification system. Intensity of symptoms and their improvement…

Full text

Iliac vein compression: undervalued or overestimated?

Marc Emmanuel VUYLSTEKE, MD, PhD Vascular Surgeon & Head of Surgical Department, Sint-Andriesziekenhuis, Tielt, Belgium; Visiting professor, Department of Cardiovascular Science, University of Leuven, Belgium Abstract Iliac vein compression (IVC) is a common anatomic disorder affecting more than 20% of the adult population, especially young females. Most of those patients are asymptomatic. Some of them will develop symptoms in their left leg, such as swelling, pain, and heaviness. But progression to venous claudication, skin changes, and even venous ulceration is possible. Intolerance to exercise is an undervalued symptom. The most feared complication is the development of a deep venous thrombosis…

Full text

Micronized purified flavonoid fraction in adjunction to rivaroxaban improves outcomes of popliteal-femoral deep-vein thrombosis at 12-month follow-up

Kirill LOBASTOV,1 MD, PhD; Ilya SCHASTLIVTSEV,1,2 MD, PhD; Victor BARINOV,2 MD, PhD 1Pirogov Russian National Research Medical University, Moscow, Russian Federation; 2Clinical Hospital no.1 of the President’s Administration of the Russian Federation Abstract Aim: To assess the efficacy of the long-term use of micronized purified flavonoid fraction (MPFF) in the treatment of popliteal-femoral deep-vein thrombosis (DVT). Methods: In this pilot, comparative, open-label clinical study, patients with the first episode of popliteal-femoral DVT confirmed by duplex ultrasound scan (DUS) were allocated to two groups: the control group received standard treatment with rivaroxaban for 6 months and compression stockings for 12 months,…

Full text

Influence of age, gender, duration of illness, and symptoms on pigmentation/ulceration in varicose veins of the great saphenous system

Prasesh DHAKAL, MBBS; Robin Man KARMACHARYA, MS; Satish VAIDYA, MS; Amit Kumar SINGH, MS; Pratima THAPA, MBBS; Sushil DAHAL, MBBS; Niroj BHANDARI; Sohail BADE; Prabha SHRESTHA, MSN. Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal Abstract Background: Venous pigmentation and ulceration in varicose veins pose significant financial and psychological burdens and affect quality of life. Not all varicose veins progress to this stage (C4-C6 in CEAP classification), and knowing the predictors for progressing to pigmentation/ulceration in varicose veins helps address high-risk patients early on. Materials and methods: This is a retrospective observational study done in patients diagnosed with…

Full text

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…

Full text

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…

Full text

2020 Update to classification of chronic venous disorders

Fedor LURIE, MD, PhD Jobst Vascular Institute and the Division of Vascular Surgery at the University of Michigan, Ann Arbor, Michigan, USA. Abstract In 2017, the American Venous Forum (AVF) created a task force to determine if the CEAP classification needed a revision. An extensive literature review led the task force to conclude that there was sufficient evidence to update it to align with the newest knowledge of chronic venous disorder (CVD) and to clarify terminology. Using the modified Delphi methodology, the AVF task force concluded its 2-year project by publishing the CEAP 2020 update, which also became a reporting…

Full text

Use of air plethysmography and ambulatory venous pressure measurement in chronic venous disease

Seshadri RAJU, MD, FACS The RANE Center, St Dominic’s Memorial Hospital, Jackson, Mississippi, USA. Abstract Air plethysmography (APG) and ambulatory venous pressure (AMVP) measurement are functional tests used in chronic venous disease (CVD). We review our experience with these tests in 8456 CVD limbs seen over a 20-year period. The venous filling index (VFI90) parameter in the APG test shows progressive significant worsening as reflux and disease severity increase. Venous volume (VV) also increases—a sign of venous pooling—with reflux and disease progression. This is compensated to a large extent by a parallel increase in ejection volume to as much as…

Full text