A comprehensive method of management for patients with chronic venous insufficiency and venous ulcers.
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Results for “Venous Insufficiency”
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[Surgical reconstruction in deep venous insufficiency].
Deep venous insufficiency is present clinically in post-phlebitis syndrome (PPS), above all at the stage of incompetence, after venous recanalisation, and in primary deep venous insufficiency (PDVI). Its different anatomical and pathological patterns lead to a varied management approach. Venous bypass procedures (using the techniques of Palma, Warren-Hushi, etc.) have been used in PPS at the obstructive stage but have now been virtually abandoned. In PPS at the stage of incompetence, after recanalisation, transposition of the incompetent vein to a competent vein has been suggested together with the grafting of a segment of valve-bearing vein. This is associated with many technical difficulties. In contrast, venous reconstruction surgery appears more promising in the case of PDVI. At the first stage, with a dilated vein and valve borders merely detached, it has been possible to obtain good results from external valvuloplasty by bandaging of the vein. The authors' experience at this stage involves a series of 54 operations with a follow-up of 4 to 63 months. At the late stage of PDVI, with frankly prolapsed valve borders, very useful results have been obtained form internal valvuloplasty, using various methods. Authors have recently been working on the artificial venous valve (Spiegowski, Taheri, Garcia-Rinaldi and ourselves) with uncertain results. We are currently studying a heterologous (metal and/or polymer) prosthetic device.
Adult↗
[Conservative therapy of chronic venous insufficiency].
Chronic venous insufficiency is frequent and burdened with potentially serious consequences. Its conservative treatment should include physical and pharmacological measures. Compression therapy is mandatory. In addition physical therapy offers mainly positioning, exercise and water treatments. Several oral drugs have been shown to be effective as well. Finally life style adaptation must not be forgotten.
Bandages↗
[Significance of photoplethysmography in the diagnosis of deep venous insufficiency].
In chronic venous insufficiency, photoplethysmography, in addition to the clinical and Doppler examinations, offers important informations in the differential diagnosis between deep and superficial venous insufficiency. It is a simple, reproductible, non invasive test with data similar to venous pressure measurements. Photoplethysmography permits to set up quantitative criteria of venous insufficiency. It establishes the role of reflux in the dysfunction of the leg venous pump, and makes it possible to adjust for prescription of additional explorations, in particular popliteal or femoral dynamic phlebography. Furthermore, photoplethysmography offers a solid criterion to differentiate between various therapeutic surgeries: surgery of the superficial network, surgery of collateral veins, surgery to restore the deep venous network. Moreover, photoplethysmography is a useful tool to quantitatively appreciate the results of the venous insufficiency treatment. In conclusion, photoplethysmography appears as an additional examination necessary for functional exploration in chronic venous insufficiency. Its use in practical angiology is going to develop in view of its interesting results and its reasonable cost.
Chronic Disease↗
Restoration of muscle-pump function in chronic venous insufficiency.
The direct venous pressure profile was recorded before and after treatment in 15 patients suffering from chronic venous insufficiency. Patients were treated conservatively, first by tight elastic support and walking exercises, then by eliminating the points of blood shunting by sclerotherapy of the incompetent perforators. The average venous pressure drop during tiptoeing was increased from 31.6% to 50.9% (P less tan 0.01), and the time required for return to the resting venous pressure level increased from an average 6 seconds to 12.9 seconds (P = 0.01). These values indicate a significant improvement in the functioning of the muscle pump of the calf, and are paralleled by clinical and subjective improvement. Wr recommend this method of treatment in cases of chronic venous insufficiency. We also wish to point out the importance of repeated direct venous pressure profile recording as a means of assessing the effectiveness of treatment in cases of venous disorders.
Bandages↗
The use of photoplethysmography in the assessment of venous insufficiency: a comparison to venous pressure measurements.
In an attempt to develop a noninvasive test to assess objectively the magnitude of venous valvular dysfunction in pathologic states, photoplethysmography (PPG) was compared to venous pressure in the saphenous vein at the ankle. Simultaneous venous pressure and PPG recordings were taken before, during, and after exercise with subjects in the sitting position. In a total of 338 paired measurements in 24 normal, 25 postphlebitic, and 14 varicose limbs, PPG and venous pressure tracings appeared to be identical; data points had a correlation coefficient of great significance (r = 0.898). Postexercise recovery times clearly separated the normal from the postphlebitic limbs. Varicose limbs were assessed accurately regarding results of proposed surgery using an above-knee tourniquet. It appears that the PPG evaluation provides information comparable to venous pressure studies and does so more quickly and noninvasively. The test holds promise in measuring results of direct venous reconstructive surgery as well as in venectomy procedures.
Humans↗
Ambulatory calf volume plethysmography in the assessment of venous insufficiency.
Ambulatory calf volume plethysmography has been used to study venous insufficiency in 50 lower limbs. The results demonstrate that it is possible to determine the presence of venous insufficiency and differentiate between normal limbs, limbs with superficial venous insufficiency only, limbs with deep venous insufficiency and limbs with deep venous insufficiency and occlusion by determining the ambulatory volume change and maximum venous outflow or venous volume.
Female↗
Acute and chronic venous insufficiency in the finger.
Venous hypertension with subsequent chronic venous insufficiency and its sequelae in the hand is reported as an uncommon complication of arteriovenous fistulae for hemodialysis.
Acute Disease↗
Hydroxyethylrutosides. A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders.
Hydroxyethylrutosides is a standardised mixture of semisynthetic flavonoids, mainly mono-, di-, tri-, and tetrahydroxyethylrutosides, which acts primarily on the microvascular endothelium to reduce hyperpermeability and oedema. In patients with chronic venous insufficiency or diabetes, hydroxyethylrutosides improves microvascular perfusion and microcirculation, and reduces erythrocyte aggregation. The preparation also has a possible protective effect on the vascular endothelium. In short to medium term placebo-controlled studies (up to 6 months) hydroxyethylrutosides therapy improved signs and symptoms of chronic venous insufficiency, including venous insufficiency associated with pregnancy and lymphoedema, and was well tolerated. However, the long term effects of hydroxyethylrutosides administration have yet to be demonstrated. The preparation also alleviated symptoms in patients with severe haemorrhoids, although there were no corresponding objective improvements. Hydroxyethylrutosides administration has been associated with reductions in retinal vascular permeability in patients with diabetic retinopathy but has no apparent effect on signs of retinal haemorrhage, although a reduction in oedema and haemorrhage has been reported in other patients receiving oral hydroxyethylrutosides in the acute phase of central retinal vein occlusion. There are only limited effective pharmacological treatment options for patients with chronic venous insufficiency or lymphoedema, and hydroxyethylrutosides clearly improves signs and symptoms of these disorders. While its role in diabetic retinopathy and haemorrhoids requires some clarification, hydroxyethylrutosides therapy shows promise as a useful additional option for the management of oedema and other symptoms of chronic venous insufficiency.
Animals↗
[What complementary examinations to demand in chronic venous insufficiency?].
The diagnosis of chronic venous insufficiency (CVI) is first of all a clinical diagnosis. Subsequent investigations are useful to elucidate the underlying abnormalities in the venous system and to quantify their severity. Continuous wave doppler ultrasound is the basis test. Duplex scanning is useful for the study of popliteal and tibial veins reflux. The others non invasive techniques aim to investigate patients with severe CVI. But it seems necessary to be very careful with the methodologies used with these tests, and there is a need for a test of the whole calf venous pump function. Venographic studies are performed only if it is necessary to complete the non invasive tests data, before surgical treatment of a postthrombotic syndrome or of congenital deep venous reflux, or when a rare form of CVI is suspected. Venography remains the better test for the study of the anatomy of the venous system, but it is no longer the gold standard for the investigation of CVI.
Chronic Disease↗
[Triggering of immunologic reactions by Strehler's pressure wave therapy in patients with chronic venous insufficiency].
Thirteen patients with chronic venous insufficiency of the legs, mostly with ulcerations, were treated during four weeks by pressure wave therapy following the method of Strehler. Some parameters of circulation, blood, and immunology were controlled at the beginning, at the third, tenth, twentieth and fourtieth day. There was a tendency to normalization of hypo- and hypertension, of the blood calcium and kalium, and especially, there was a significant increase of IgG and C'4 during the treatment with decrease of the IgM. Other parameters did not show specific alterations. The mobilisation of edema by pressure wave therapy seems to arise an immunologic reaction, probably by activating antigens or antigen-antibody complexes.
Complement System Proteins↗
An evaluation of Doppler ultrasound and photoplethysmography in the investigation of venous insufficiency.
Non-invasive methods of venous assessment have been developed to improve diagnostic accuracy in the assessment of venous insufficiency. Of these, continuous wave Doppler (CWD) ultrasound and photoplethysmography are the cheapest and most simple to perform. In this study duplex scanning was used to test the accuracy of these two methods. One hundred and thirty-six patients attending the venous outpatient clinic at Middlesex Hospital, London were examined by all three techniques and a diagnosis was reached using each technique. The technicians performing the examinations were unaware of the diagnoses reached by the other methods. Continuous wave Doppler ultrasound was found to be most accurate in the diagnosis of long saphenous incompetence (sensitivity 73%, specificity 85%). Due to the variability of venous anatomy at the popliteal fossa and the 'blindness' of the technique, it was inaccurate in the diagnosis of short saphenous incompetence (sensitivity 33%) and deep vein reflux (sensitivity 48%). Photoplethysmography was found to be most accurate in the diagnosis of deep vein reflux (sensitivity 79%, specificity 70%) but was inaccurate in identification of the site of superficial vein reflux. Inaccuracies may be attributed to the presence of incompetent perforating veins and variation in arterial inflow.
Humans↗
[Surgical correction of venous insufficiency following arteriovenous fistula for hemodialysis].
The percentage of venous insufficiency in the original Cimino-Brescia shunt is very low. In cases of venous insufficiency, early diagnosis is important; operative correction is then easily performed. Ligature of the distal venous limb next to the anastomosis is the treatment of choice, providing the proximal limb is still open. If the proximal limb is obstructed, the distal venous part is dissected and anastomosed to a more proximal vein. The result is an immediately functioning shunt for dialysis.
Arteriovenous Shunt, Surgical↗
[Clinical characteristics of pain in chronic venous insufficiency].
Since the report of the 1st International Conference of Phlebology at Chambéry, devoted to venous pain, the subject has scarcely attracted attention apart from the meeting of the Benelux Society of Phlebology devoted to "pain in the legs". Pain due to superficial venous insufficiency has scarcely changed in nature for 30 years and remains one of the major presenting symptoms in phlebology. Acute or chronic, punctate or diffuse, modifications in this functional symptomatology have been accentuated, or have varied in their aspects under the influence of certain fashions or certain habits of modern life, i.e.: sedentary behaviour, underfloor heating, the use of oral contraceptives or of menopausal hormone replacement therapy. However, the distribution of the various aspects of venous pain remains in the same proportions as those described by the authors cited previously. While the etiological diagnosis must essentially eliminate all other causes: arterial, neurological, muscular, articular, it is essential not to neglect deep venous insufficiency of the gemellar veins, often responsible for a wide range of symptomatology and still all too often neglected. The pathogenesis of this pain not only involves the concept of pain receptors but also the appearance of algogenic metabolites at the site of the microcirculatory unit, to which endothelial cells are particularly sensitive during stasis. In fact, pain is the expression of disorders concerning local exchanges, whether thermal, pressure, metabolic or hemorheological. It is the alarm bell of venous insufficiency and merits the attention of the phebologist who must thus undertake active treatment before problems become irreversible.
Chronic Disease↗
[Effect of 0-(beta-hydroxyethyl)-rutoside (Venoruton) on symptomatic venous insufficiency in the lower limbs].
Forty-three patients recruited from general practice with symptom-producing chronic venous insufficiency in the lower limbs participated in a randomized double-blind clinical trial with Venoruton (300 mg x 3) or a placebo for 28 days. Twenty-eight patients were treated with Venoruton and 19 with a placebo. None of the patients received other forms of treatment for chronic venous insufficiency. No differences were observed between the two groups as regards changes in symptoms (swelling, pain, heaviness, restlessness, itching and cramps) the subjective assessment of the discomfort in the extremities or the circumference of the limbs. Venoruton does not appear to have any effect on chronic venous insufficiency in the lower limbs.
Adult↗
[Classification of varices and venous insufficiency].
The problem of the classification of varicose veins is as old as phlebology itself. A number of attempts have been made to define and assess this anatomical entity, which is progressively better investigated and better treated. Chronic venous insufficiency is a more recent pathophysiological concept, which covers both superficial venous lesions and deep lesions, regardless of their cause and their expression, especially trophic, unequivocal and dominant. A brief review of the principal classifications clearly demonstrates the difficulty of reaching a consensus. The precise definition of varicose veins and chronic venous insufficiency suggests the proposal of a simple clinical classification into five stages of chronic venous insufficiency. Beyond stage II of symptomatic varicose veins, treatment is required and complementary investigations, especially functional, are justified.
Chronic Disease↗
[Venous bypass for treatment of chronic obstructive venous insufficiency of lower limbs].
About 1 to 5 percent of patients affected by chronic obstructive venous disease of the lower extremity, are eligible to surgical treatment, by veno-venous bypass, for the relief of unerely invalidating symptoms. Indications to operation include a class II to III chronic venous insufficiency of the deep venous system, failure of medical treatment continued for at least 12 months, good patency of outflow axis, a significant gradient of pressure between discared and outflow axis, a good quality saphenous vein to be utilized for bypass. The case of an aged patient, successfully treated with a femoro-femoral venous bypass, associating an artero venous fistula, is presented and indications to the operation in the older patients, together with indication to and technical details of performing the fistula are discussed.
Aged↗
Pressure-volume characteristics of foot veins in normal cases and patients with venous insufficiency.
In order to evaluate pressure-volume characteristics of foot veins in patients with venous insufficiency compared with a control group, the foot-volumetric method was utilized, combined with intravenous pressure measurements. Calculations of compliance and elastance were preformed within a fixed pressure interval, where the veins were filled or almost filled. The investigation demonstrates a lower compliance and a higher elastance in the varicose veins compared with the control cases. This is contrary to most previous investigations, in which the veins have not been fully distended, as the measurements were preformed in the lying position with rather low venous pressure. Changes of compliance and elastance were most marked in cases with advanced venous disease and skin changes of the ankle region. The observed changes of a 'greater stiffness' of the foot-vascular system can be explained by fibrotic or phlebosclerotic changes. In addition to the observations of slightly altered elasticity factors, we observed volume changes after exercise which seem to be related to capillary filtration.
Adult↗