Microcirculatory disorders in chronic venous diseases and fundamentals of their systemic pharmacological correction

Olga Ya POREMBSKAYA, MD, PhD Mechnikov North-Western State Medical University, Saint Petersburg, Russia and Institute of Experimental Medicine, Saint Petersburg, Russia Abstract This article reviews the literature on microcirculatory disorders underlying the development of chronic venous diseases (CVD) across all the CEAP (Clinical-Etiology- Anatomy-Pathophysiology) clinical classes from C0s to C6 and the fundamentals of their systemic pharmacological correction particularly with micronized purified flavonoid fraction (MPFF). Anatomical and functional changes specifically in the vessels of the microvasculature are the main pathogenetic mechanism for the development of most vein-specific symptoms and determine CVD progression. The altered vessels of the microvasculature are characterized…

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Dialogue on venous hemodynamics

Oscar MALETI,1 MD: Fedor LURIE,2 MD, PhD; Giorgio BERGAMO,3 BSc; Sara GUERZONI,4 BSc; Marzia LUGLI,1 MD 1Vascular Surgery, Hesperia Hospital, Modena, Italy 2Jobst Vascular Institute and the Division of Vascular Surgery at the University of Michigan, Ann Arbor, Michigan, USA 3Microlab Elettronica Sas. Padova, Italy 4Fleboxan Vein Clinic, Modena, Italy Abstract Hemodynamics of the venous system of the lower limbs is very complex, its explanation typically evoking formulas and concepts that can be daunting for those new to the subject. Here, we approach the task from a more conversational angle, introducing a dialogue between expert and student as they discuss…

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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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Course duration for venoactive-drug treatment in chronic venous disease

Roman KALININ, MD, PhD, DMedSc; Igor SUCHKOV, MD, PhD, DMedSc; Aleksey KAMAEV, MD, PhD; Nina MZHAVANADZE, MD, PhD. MD Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russia Abstract Chronic venous disease (CVD) is currently the most common vascular disorder of the lower extremities. The gradual progression of CVD has a negative impact on patients and also leads to high economic costs of medical care, especially for the advanced forms of chronic venous insufficiency (CVI). Conservative management of CVD includes the use of compression stockings and pharmacological therapy. Despite the efficacy of compression therapy,…

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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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