Lymphedema praecox is a rare lymphatic vascular anomaly diagnosed before the age of 35, presenting with unilateral involvement of the lower extremities. Paget's Disease of Bone (PDB) is also a rare osteometabolic disorder characterized by an accelerated rate of bone remodeling, and diagnosis of the disease is challenging. Here, we report a 49-year-old woman with primary lymphedema since the age of 33, who presented with pain and swelling in her right leg. Although the volume of the extremity diminished after complete decongestive therapy, the pain continued. Further evaluation with X-ray, bone scan, and biochemical markers supported the diagnosis of PDB. Following the zoledronic acid infusion, the pain score improved. However, there is no published association between these two diseases. Both lymphedema and PDB are associated with vascular disease and have a genetic background. This is the first case reporting the coexistence of lymphedema and PDB in the same extremity.
前发性淋巴水肿是一种罕见的淋巴管异常，35 岁以前确诊，表现为单侧下肢受累。帕吉特骨病（Paget's Disease of Bone，PDB）也是一种罕见的骨代谢疾病，其特点是骨重塑速度加快，该病的诊断具有挑战性。在此，我们报告了一名自 33 岁起就患有原发性淋巴水肿的 49 岁女性，她出现右腿疼痛和肿胀。虽然在完全消肿治疗后肢体肿胀有所减轻，但疼痛仍在持续。通过X光、骨扫描和生化指标的进一步评估，她被确诊为原发性淋巴水肿。输注唑来膦酸后，疼痛评分有所改善。然而，这两种疾病之间并没有公开的关联。淋巴水肿和PDB都与血管疾病有关，并有遗传背景。这是首例报告在同一肢体同时存在淋巴水肿和PDB的病例。
{"title":"Lymphedema and Paget’s Disease: beyond the nipple","authors":"S. Tuzun, Aslinur Keles, Narmin Ahmadli","doi":"10.4081/vl.2024.12352","DOIUrl":"https://doi.org/10.4081/vl.2024.12352","url":null,"abstract":"Lymphedema praecox is a rare lymphatic vascular anomaly diagnosed before the age of 35, presenting with unilateral involvement of the lower extremities. Paget's Disease of Bone (PDB) is also a rare osteometabolic disorder characterized by an accelerated rate of bone remodeling, and diagnosis of the disease is challenging. Here, we report a 49-year-old woman with primary lymphedema since the age of 33, who presented with pain and swelling in her right leg. Although the volume of the extremity diminished after complete decongestive therapy, the pain continued. Further evaluation with X-ray, bone scan, and biochemical markers supported the diagnosis of PDB. Following the zoledronic acid infusion, the pain score improved. However, there is no published association between these two diseases. Both lymphedema and PDB are associated with vascular disease and have a genetic background. This is the first case reporting the coexistence of lymphedema and PDB in the same extremity.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"105 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140740588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eugenio Martelli, Laura Capoccia, G. Sotgiu, L. Saderi, M. Puci, Piero Modugno, Sergio Furgiuele, Vincenzo Aversano, Salvatore De Vivo, Luca Iorio, A. R. Martelli, Stefano Ricci
Double‑blind/multicenter/randomized trial protocol. Eligibility criteria: age 18-70 yrs; C2-C5 leg varices secondary to the Great Saphenous Vein (GSV) incontinence; GSV size 6-10mm, at 10cm from the Saphenous-Femoral Junction (SFJ); ostial reflux lasting >0.5 sec at duplex ultrasound; negative reflux elimination test; acceptance of the GSV sparing treatment plus partial/total varicose veins removal. Exclusion criteria: non-isolated GSV reflux; district already treated; pregnancy/lactation; impaired walking ability; deep vein thrombosis/insufficiency; severe comorbidities. Participants recruited from 7 Italian tertiary referral centres. Interventions: crossotomy (no SFJ’s tributaries ligation) vs crossectomy. The study aimed to verify if GSV drainage through the SFJ’s tributaries reduces groin/peripheral recurrences. Primary endpoint: 1-year GSV reflux recurrence, positive to the Valsalva maneuver, originating from the SF. Participants equally randomized. Participants, care givers, and those assessing the outcomes blinded to group assignment.
{"title":"Crossotomy vs crossectomy for saphenous vein sparing surgery in patients with varicose veins due to ostial incontinence: protocol for double blind, multicenter, randomized trial","authors":"Eugenio Martelli, Laura Capoccia, G. Sotgiu, L. Saderi, M. Puci, Piero Modugno, Sergio Furgiuele, Vincenzo Aversano, Salvatore De Vivo, Luca Iorio, A. R. Martelli, Stefano Ricci","doi":"10.4081/vl.2024.12146","DOIUrl":"https://doi.org/10.4081/vl.2024.12146","url":null,"abstract":"Double‑blind/multicenter/randomized trial protocol. Eligibility criteria: age 18-70 yrs; C2-C5 leg varices secondary to the Great Saphenous Vein (GSV) incontinence; GSV size 6-10mm, at 10cm from the Saphenous-Femoral Junction (SFJ); ostial reflux lasting >0.5 sec at duplex ultrasound; negative reflux elimination test; acceptance of the GSV sparing treatment plus partial/total varicose veins removal. Exclusion criteria: non-isolated GSV reflux; district already treated; pregnancy/lactation; impaired walking ability; deep vein thrombosis/insufficiency; severe comorbidities. Participants recruited from 7 Italian tertiary referral centres. Interventions: crossotomy (no SFJ’s tributaries ligation) vs crossectomy. The study aimed to verify if GSV drainage through the SFJ’s tributaries reduces groin/peripheral recurrences. Primary endpoint: 1-year GSV reflux recurrence, positive to the Valsalva maneuver, originating from the SF. Participants equally randomized. Participants, care givers, and those assessing the outcomes blinded to group assignment.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"19 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139597400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Sica, F. De Nigris, F. Minelli, Alessandro Cina, G. Tinelli, Y. Tshomba
Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. These lesions may present with a wide range of signs and symptoms, including hypertension and hematuria. We report a case of a 71-year-old woman with incidentally diagnosis of asymptomatic right renal AVM.
{"title":"Extensive congenital asymptomatic renal arteriovenous malformation","authors":"S. Sica, F. De Nigris, F. Minelli, Alessandro Cina, G. Tinelli, Y. Tshomba","doi":"10.4081/vl.2023.11695","DOIUrl":"https://doi.org/10.4081/vl.2023.11695","url":null,"abstract":"Renal arteriovenous malformations (AVM) are abnormal communications between the intrarenal arterial and venous systems. These lesions may present with a wide range of signs and symptoms, including hypertension and hematuria. We report a case of a 71-year-old woman with incidentally diagnosis of asymptomatic right renal AVM.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131882331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biagio Sassone, Enrico Bertagnin, Giuseppe Simeti, S. Virzì
While ultrasound assistance for accessing the axillary vein has been established as a reliable method for cardiac pacemaker and cardioverter-defibrillator leads implantation, there is a lack of information regarding the utilization of portable handheld ultrasound devices within this context. We describe our experience with the systematic use of a pocket-sized handheld ultrasound device during the implantation of transvenous cardiovascular implantable electronic devices.
{"title":"Handheld ultrasound device-guided axillary vein access for pacemaker and defibrillator implantation","authors":"Biagio Sassone, Enrico Bertagnin, Giuseppe Simeti, S. Virzì","doi":"10.4081/vl.2023.11641","DOIUrl":"https://doi.org/10.4081/vl.2023.11641","url":null,"abstract":"While ultrasound assistance for accessing the axillary vein has been established as a reliable method for cardiac pacemaker and cardioverter-defibrillator leads implantation, there is a lack of information regarding the utilization of portable handheld ultrasound devices within this context. We describe our experience with the systematic use of a pocket-sized handheld ultrasound device during the implantation of transvenous cardiovascular implantable electronic devices.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123989291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Eretta, Elisa Tridoni, Serena Isaia, Arianna Pigoni, Azzurra Vatteroni, Laura Impieri, C. Bianchi
Lymphedema is a chronic and worsening disease due to an abnormal accumulation of liquids, with a high protein content in the interstitial space. The disease is characterized by an insufficient flow of lymphatic fluid, which manifests as edema, inflammation, and fibrosis, all the way up to the stiffening of the affected tissues. Because it's a chronic and increasing disease, the treatment is highly complex. The literature shows that the treatment must be multidisciplinary and it is necessary to combine multiple techniques, such as manual lymphatic drainage, mechanical lymphatic drainage, elasto-compressive bandages and other complementary techniques up to surgical treatment in the most advanced forms which are not responsive to physical therapy. Furthermore, the disease is characterized by episodes of cellulitis, that may lead to infectious complications because the lymphatic function becomes insufficient. A condition of local immunodeficiency is created due to the crucial role that the lymphatic system covers with immune defenses, therefore creates a fertile ground for infections caused by small skin wounds, insect bites, animal scratches, nail fungus, blood draws. Therefore, particular attention is paid to skin folds and interdigital spaces for which hygiene is necessary using neutral detergents, drying by dabbing, and applying emollient creams for skin hydration. Unfortunately, such practices of prevention and care are often underestimated. We provide education of the patient on self-care, such as the self-bandage and the correct application of the elasto-compressed stoking. For wrapping the bandage, it is advisable to wear a glove or a special sock. The multilayer bandages are used in the first decongestant phase while over time the elastic stocking is the best aid for the management of lymphedema. Our clinic is a referral center for diagnosis, treatment and surgical therapy, where patients come for surgical evaluation. Since 2016 we have systematically collected clinical data and volume evaluation of more than 600 cases affected by lymphedema and lipoedema of all stages. They have been treated with complex decongestive therapy for 4 hours a day, 15 consecutive days, subsequently a maintenance of once a week for 3 months, then once a month for 6 months. Of more than 600 patients treated, only 150 were submitted to surgery (lymphatic venous anastomosis, fasciotomy or liposuction, chylothorax and chyloperitoneal shunt, reconstructive plastic of external genitalia). Complex decongestive interdisciplinary therapy, when properly performed can stabilize the lymphedema patient situation, reducing the stage and ensuring a good quality of life.
{"title":"Complex decongestive therapy in lymphedema: report from an Interdisciplinary Center","authors":"C. Eretta, Elisa Tridoni, Serena Isaia, Arianna Pigoni, Azzurra Vatteroni, Laura Impieri, C. Bianchi","doi":"10.4081/vl.2023.11551","DOIUrl":"https://doi.org/10.4081/vl.2023.11551","url":null,"abstract":"Lymphedema is a chronic and worsening disease due to an abnormal accumulation of liquids, with a high protein content in the interstitial space. The disease is characterized by an insufficient flow of lymphatic fluid, which manifests as edema, inflammation, and fibrosis, all the way up to the stiffening of the affected tissues. Because it's a chronic and increasing disease, the treatment is highly complex. The literature shows that the treatment must be multidisciplinary and it is necessary to combine multiple techniques, such as manual lymphatic drainage, mechanical lymphatic drainage, elasto-compressive bandages and other complementary techniques up to surgical treatment in the most advanced forms which are not responsive to physical therapy. Furthermore, the disease is characterized by episodes of cellulitis, that may lead to infectious complications because the lymphatic function becomes insufficient. A condition of local immunodeficiency is created due to the crucial role that the lymphatic system covers with immune defenses, therefore creates a fertile ground for infections caused by small skin wounds, insect bites, animal scratches, nail fungus, blood draws. Therefore, particular attention is paid to skin folds and interdigital spaces for which hygiene is necessary using neutral detergents, drying by dabbing, and applying emollient creams for skin hydration. Unfortunately, such practices of prevention and care are often underestimated. We provide education of the patient on self-care, such as the self-bandage and the correct application of the elasto-compressed stoking. For wrapping the bandage, it is advisable to wear a glove or a special sock. The multilayer bandages are used in the first decongestant phase while over time the elastic stocking is the best aid for the management of lymphedema. Our clinic is a referral center for diagnosis, treatment and surgical therapy, where patients come for surgical evaluation. Since 2016 we have systematically collected clinical data and volume evaluation of more than 600 cases affected by lymphedema and lipoedema of all stages. They have been treated with complex decongestive therapy for 4 hours a day, 15 consecutive days, subsequently a maintenance of once a week for 3 months, then once a month for 6 months. Of more than 600 patients treated, only 150 were submitted to surgery (lymphatic venous anastomosis, fasciotomy or liposuction, chylothorax and chyloperitoneal shunt, reconstructive plastic of external genitalia). Complex decongestive interdisciplinary therapy, when properly performed can stabilize the lymphedema patient situation, reducing the stage and ensuring a good quality of life.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134045901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cerebral venous outflow abnormalities and inner ear: an underestimated piece of the puzzle?","authors":"Andrea Migliorelli, A. Ciorba","doi":"10.4081/vl.2023.11585","DOIUrl":"https://doi.org/10.4081/vl.2023.11585","url":null,"abstract":"Not available.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128517784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianping Deng, Xiaoyin Zhu, Xin Du, Lei Su, Yijian Gu, Qiang Zhang
Pelvic Leak Points (PLPs) are a possible cause of varicose veins of the lower limbs even in men, and can be easily overlooked without a thorough assessment, or leading to incorrect treatment with high recurrence rate. CHIVA is a minimally invasive approach by recorrecting hemodynamic changes, preserving the venous drainage network in lower extremity. In this study, we present two cases of male patients with symptomatic varicose veins related to PLPs that were successfully treated with the CHIVA method. With proper venous hemodynamic assessment and strategic support, CHIVA could be a safe and effective way to treat PLPs in men.
{"title":"CHIVA treatment for pelvic leak points in men","authors":"Jianping Deng, Xiaoyin Zhu, Xin Du, Lei Su, Yijian Gu, Qiang Zhang","doi":"10.4081/vl.2023.11271","DOIUrl":"https://doi.org/10.4081/vl.2023.11271","url":null,"abstract":"Pelvic Leak Points (PLPs) are a possible cause of varicose veins of the lower limbs even in men, and can be easily overlooked without a thorough assessment, or leading to incorrect treatment with high recurrence rate. CHIVA is a minimally invasive approach by recorrecting hemodynamic changes, preserving the venous drainage network in lower extremity. In this study, we present two cases of male patients with symptomatic varicose veins related to PLPs that were successfully treated with the CHIVA method. With proper venous hemodynamic assessment and strategic support, CHIVA could be a safe and effective way to treat PLPs in men.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129735793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"In memory of Prof. Hugo Partsch","authors":"Giovanni Mosti","doi":"10.4081/vl.2022.11219","DOIUrl":"https://doi.org/10.4081/vl.2022.11219","url":null,"abstract":"Not available","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128292951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic venous insufficiency (CVI) resulting from incompetent perforators due to varicose veins is a common surgical condition present in at least 10% of the general population. This study was planned to evaluate stab avulsion vs subfascial endoscopic perforator surgery in the management of incompetent perforators resulting in CVI. Forty patients of CVI resulting from primary varicose veins, falling into class 4 to 6 as per the clinical part of CEAP classification, along with Duplex assessment with proven incompetent perforators of lower extremity, irrespective of the status of saphenousfemoral or saphenous-popliteal junction status, were included in the study. All the patients were randomized into two groups, A and B, by a computer-generated draw. Group A patients underwent stab avulsion, and group B patients underwent SEPS for incompetent perforators. The following parameters were evaluated: (i) pain score using a visual analog scale at 1 hour, 12 hours and 24 hours after surgery, (ii) ulcer healing 1 month and 3 months after surgery, (iii) reversal of skin changes after 1 month and 3 months of surgery during follow-up, and (iv) wound-related complications. Early relief of symptoms in terms of ulcer healing, reversal of skin changes, and decreased incidence of wound complications was found to be better in the subfascial endoscopic perforators surgery (SEPS) group.
{"title":"Evaluation of stab avulsion versus subfascial endoscopic perforator surgery in the management of chronic venous insufficiency resulting from incompetent leg perforators in primary varicose veins","authors":"Sudhir Kumar Jain, Vaishali Shirale (Saxena), Maneesha Jain, Ritu Saxena","doi":"10.4081/vl.2022.10690","DOIUrl":"https://doi.org/10.4081/vl.2022.10690","url":null,"abstract":"Chronic venous insufficiency (CVI) resulting from incompetent perforators due to varicose veins is a common surgical condition present in at least 10% of the general population. This study was planned to evaluate stab avulsion vs subfascial endoscopic perforator surgery in the management of incompetent perforators resulting in CVI. Forty patients of CVI resulting from primary varicose veins, falling into class 4 to 6 as per the clinical part of CEAP classification, along with Duplex assessment with proven incompetent perforators of lower extremity, irrespective of the status of saphenousfemoral or saphenous-popliteal junction status, were included in the study. All the patients were randomized into two groups, A and B, by a computer-generated draw. Group A patients underwent stab avulsion, and group B patients underwent SEPS for incompetent perforators. The following parameters were evaluated: (i) pain score using a visual analog scale at 1 hour, 12 hours and 24 hours after surgery, (ii) ulcer healing 1 month and 3 months after surgery, (iii) reversal of skin changes after 1 month and 3 months of surgery during follow-up, and (iv) wound-related complications. Early relief of symptoms in terms of ulcer healing, reversal of skin changes, and decreased incidence of wound complications was found to be better in the subfascial endoscopic perforators surgery (SEPS) group.","PeriodicalId":421508,"journal":{"name":"Veins and Lymphatics","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115737332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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