Modeling and 3D printing of veins from CT venograms

Jean-Francois UHL, MD, FacPh of the UNESCO Chair of Digital Anatomy, Paris University Abstract Digital anatomy has more and more applications in medicine and surgery, thanks to the progress in imaging and power of computer software. To evaluate patients with chronic venous disorders, in the case of complex anatomy or recurrent varices after surgery (REVAS), three-dimensional (3D) modeling of the venous system is often a great support. A global 3D depiction of the whole venous morphology will help the hemodynamical mapping achieved by color Duplex ultrasound. In addition to anatomical information, color Duplex ultrasound also provides essential hemodynamic data for…

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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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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…

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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…

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Anatomy of foot and ankle perforator veins

Jean-François UHL1 Miguel LO VUOLO2 Claude GILLOT1 1 URDIA Anatomy Research Unit EA4465, Descartes University, Paris Cité Sorbonne 2 Diagnóstico por Imágenes Junín, Santa Fe, Argentina Abstract Background: The foot venous pump is located in the plantar veins, where both its anatomy and connections with the saphenous roots and the foot perforator veins are not well known, and therefore, they are under investigated in daily practice. The aim of this paper is to describe the unique anatomy and the functional role of the foot perforator veins and emphasize their key role during the activation of the foot venous pump. Ankle…

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What is postthrombotic venous obstruction and how can it be avoided?

What is postthrombotic venous obstruction and how can it be avoided? Anthony J. COMEROTA, MD, FACS, FACC Director, Jobst Vascular Institute, The Toledo Hospital, Toledo, OH, USA; Adjunct Professor of Surgery, University of Michigan Abstract Postthrombotic venous obstruction is part of the pathophysiology of a postthrombotic syndrome. When the obstruction occurs in the iliofemoral segment, postthrombotic morbidity is often severe. In a recent study, the intraluminal contents of chronically occluded postthrombotic common femoral veins were analyzed. Approximately 80% to 90% of the tissues analyzed were composed of type I collagen, with type III collagen comprising the remainder. Vascular endothelial growth…

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Patients seeking treatment for chronic venous disorders: Russian results from the VEIN Act program

Patients seeking treatment for chronic venous disorders: Russian results from the VEIN Act program Dmitry E. LISHOV,1 Alexander I. KIRIENKO,2 Anatoly A. LARIONOV,1 Alexander I. CHERNOOKOV3 1 Center of Phlebology 2 N.I. Pirogov ’s Russian National Research Medical University 3 I.M. Sechenov First Moscow State Medical University Moscow, Russian Federation Abstract Objective: The Russian VEIN Act program (chronic VEnous dIsorders maNagement and EvaluAtion of Chronic venous disease treatment effecTiveness) was an observational, prospective survey, carried out under the auspices of the European Venous Forum that was designed to assess compliance with nonsurgical treatments (lifestyle advice, venoactive drugs, and compression therapy)…

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Controversies surrounding symptoms and signs of chronic venous disorders

Controversies surrounding symptoms and signs of chronic venous disorders Marian Simka College of Applied Sciences, Department of Nursing, Ruda Śląska, Poland Abstract Association of so-called venous symptoms (aching, itching, tingling, burning sensation, swelling, easily fatigued legs, leg heaviness, and leg restlessness) with chronic venous disease (CVD) still remains a controversial issue. Although these symptoms and a decreased quality of life are common in patients with venous incompetence, and are even more frequent in those with a history of venous thrombosis and/or recurrent and bilateral varicose veins, research has actually revealed that these complaints are poorly correlated with objective signs of…

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Changes in the diameter and valve closure time of leg veins across the menstrual cycle

Asbeutah AM, Al-Enezi M, Al-Sharifi NM, et al. J Ultrasound Med. 2014;33:803-809. This article presents an evaluation of a specific cohort of young, nulliparous women with duplex ultrasound of the lower extremities at various stages of the menstrual cycle. The study was comprised of an evaluation of 106 limbs in 53 women with homogeneity in their demographic makeup. They lacked, for the most part, any of the classic risk factors for the development of chronic venous deficiency and were all classified as class 0 (no venous disease) on the 7-point clinical, etiologic, anatomic and pathophysiologic (CEAP) scale. The study showed…

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