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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Deep venous reflux definitions and associated clinical and physiological significance

Lim KH, Hill G, Tarr G, van Rij A. J Vasc Surg: Venous and Lym Dis.2013;1:325-332. Classification validation as well as physiopathological significance of deep venous reflux (DVR) remains debated knowing that DVR is frequently combined with superficial venous reflux (SVR). Numerous key questions need to be answered. First, does segmental deep reflux have an impact on CVD or not? Second, does segmental reflux location matter? In other words, do isolated common femoral vein reflux or popliteal vein reflux have the same physiopathological importance in terms of clinical and hemodynamic anomalies? Third, does SVR suppression abolish or improve DVR segmental…

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Chronic venous disease progression and modification of predisposing factors

Kostas TI, Ioannou CV, Drygiannakis I, Georgakarakos E, Kounos C, Tsetis D, Katsamouris AN. J Vasc Surg. 2010;51:900-907. Aim: The aim of this study was to evaluate long-term characteristics of chronic venous disease (CVD) progression and its correlation with the modification of specific risk factors. Methods: In this prospective, follow-up study, the contralateral limb of 73 patients (95% women; mean age, 48±12 years) undergoing varicose vein surgery were prospectively evaluated using physical and color duplex examination and were classified using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification. After 5 years of follow-up, the development of new sites of reflux…

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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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