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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What is the best method of imaging in iliofemoral venous obstruction?

Gerard J. O’SULLIVAN MB, BCh, BAO, FRCR National University of Ireland, Galway, Ireland Abstract Iliofemoral venous obstruction is increasingly recognized as a major cause of post-thrombotic syndrome. Patients can be left with significant symptoms after just one episode of iliofemoral deep-vein thrombosis; ranging from milder problems, such as varicose veins, to itching, leg swelling, and even venous ulceration. With the advent of endovascular techniques to reconstruct the iliofemoral segment has come an understanding that accurate recognition and diagnosis form a central part of the puzzle. Clinical evaluation is limited, and imaging has assumed a central role. This article looks at…

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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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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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A quality of life tool kit in chronic venous disorders

A quality of life tool kit in chronic venous disorders Robert Launois REES France, 48, rue d’Assas, 75006, Paris, France Abstract Individual preferences are now at the center of the medical decision-making process. Different experimental methods are used to determine preferences. Psychometricians use direct observation of a subject’s reaction in a particular pathological situation: patients are asked to arrange the intensity of the impacts on numerical ordinal scales, but an actual metrical measure is not yet available. Traditionally, economists believe that in a market, only the consumer’s choices enable us to estimate his or her level of satisfaction. In the…

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Endovenous management of venous leg ulcers

Raju S, Kirk OK, Jones TL. J Vasc Surg Venous Lymphat Disord. 2013;1:165-173. Reviewed by: Ramesh K Tripathi and Himanshu Verma Narayana Institute of Vascular Sciences, Bangalore, India This is an important paper highlighting the various modalities of treatment that come into play in the treatment of venous leg ulceration due to chronic venous insufficiency. The authors apparently were able to follow-up on 192 limbs that had failed conservative therapy and then underwent endovascular treatment that included 39 endovenous laser ablation (ELVA ) of superficial axial veins, 99 iliac vein stents and 59 using both procedures in combination. The numbers…

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Operative treatment in postthrombotic syndrome: an update

Oscar MALETI1, Marzia LUGLI2, Michel PERRIN3 1. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy Interuniversity Center of Phlebolymphology. 2. Department of Cardiovascular Surgery, Hesperia Hospital Modena, Italy. 3. Associate Professor of Surgery Grenoble and for Institution Unité de Pathologie Vasculaire Jean Kunlin, Clinique du Grand Large, Chassieu, Lyon, France. ABSTRACT Postthrombotic deep vein obstruction and/or incompetence can lead to severe chronic venous insufficiency in a significant number of cases. Postthrombotic lesions are essentially of two types: (i) obstruction of various degrees; and (ii) valve destruction with subsequent reflux. These two elements are variously present at different levels. The most…

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Prevalence of venous leg ulcer: the importance of the data collection method

Olle NELZEN Skaraborg Leg Ulcer Centre & Dept of Vascular Surgery Skaraborg Hospital/KSS Skövde, Sweden ABSTRACT Many epidemiological studies have been performed to assess leg ulcer prevalence, but not all have given reliable results due to weaknesses in the methodology. A proper prevalence assessment is not easily done and requires time and effort. Most studies have just focused on prevalence of leg ulcers of all causes and only a few have really validated the leg ulcer diagnosis objectively by use of hand-held Doppler, color Doppler ultrasound, or plethysmography. There are many pitfalls in performing a prevalence study of venous leg…

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