The place of micronized purified flavonoid fraction in the management of chronic venous disease from an international guidelines’ perspective

Sergey Gennadievich GAVRILOV, MD, PhD Jorge H. ULLOA, MD1; Sebastian CIFUENTES, MD2; Antonio SOLANO, MD2; Valentin FIGUEROA, MD2 1Vascular Surgeon, Chief of Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital; Professor of Surgery, Universidad de los Andes School of Medicine, Bogotá, Colombia. 2Vascular Surgery Research Fellow, Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia. Abstract Chronic venous disease (CVD) is a highly prevalent disorder with a broad spectrum of symptoms determined by disease stage and whether there is deep or superficial venous system compromise. The treatment goal for CVD is to slow and prevent…

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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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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…

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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…

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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…

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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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Risks and contraindications of medical compression treatment

Eberhard RABE, MD1; Felizitas PANNIER, MD2 1Private practice, Helmholtzstr. 4, Bonn, Germany 2Private practice, Helmholtzstr. 4, Bonn, Germany and Department of Dermatology, University of Cologne, Germany Background Medical compression treatment with medical compression stockings (MCS), compression bandages (CB), or intermittent pneumatic compression (IPC) belongs to the basic treatment options in acute and chronic venous diseases and in lymphedema. In a recent international consensus paper, well-known experts in the field reviewed the recent literature on reported risks and recommended contraindications for elastic compression treatment. Results: Reported nonsevere adverse events (AEs) included skin irritation, allergic skin reaction, discomfort and pain, forefoot edema…

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Phlebolymphedema: is it a new concept?

Byung-Boong LEE, MD, PhD, FACS Professor of Surgery and Director, Center for the Lymphedema and Vascular Malformations, George Washington University, Washington DC, USA Abstract Venous and lymphatic systems are inseparable “dual” outflow systems with mutually complimentary function so that such mutual interdependence between these two systems causes a new condition to affect both systems simultaneously when one of the two systems should fail to provide sufficient compensation to the other system, known as “phlebolymphedema” (PLE): combined condition of chronic venous insufficiency (CVI)/chronic venous hypertension and chronic lymphatic insufficiency (CLI)/chronic lymphedema. PLE is, therefore, an unavoidable outcome of the joint failure…

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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,…

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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…

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