Phlebology最新文献

BackgroundThis study examines the role of the inguinal lymph node venous network (LNVN) in recurrent varicose veins.MethodsSeventy-five patients with recurrent varicose veins were assessed using color Doppler ultrasound and dynamic lymph node venography. Primary outcomes included LNVN reflux identification, and secondary outcomes analyzed recurrence rates and associations with venous pathology.ResultsLNVN involvement was detected in 41.3% of cases, significantly correlating with shorter recurrence-free intervals (median: 8 months vs 12 months, p = 0.04). Coexisting risk factors included neovascularization (18.2%), incomplete treatment (25%), and inadequate surgical technique (13.6%).ConclusionLNVN reflux is a significant contributor to varicose vein recurrence, with distinct imaging features that should be integrated into routine diagnostic protocols. Further research is needed to establish standardized diagnostic criteria and optimize management strategies.

ObjectiveParadoxical reflux, which is most commonly seen in the Giacomini vein, is also referred to as Rollercoaster reflux (RCR). RCR is a rare phenomenon, infrequently reported in literature and lacking standardized treatments. The aim of this study was to describe the incidence, treatment variation, and outcomes of RCR in a high-volume centre, specialized in skin and venous disease.MethodsAll patients suspected of venous incompetence who presented at Skin and Vein Clinic Oosterwal between July 2022 and July 2023 were retrospectively screened to determine if they had RCR. All eligible patients were invited to participate in the cohort study, regardless of treatment or treatment type (ultrasound-guided foam sclerotherapy [UGFS], endovenous thermal ablation [EVTA], or compression therapy). A duplex-ultrasound was performed and the VEINES-QoL/Sym questionnaire was completed. The primary outcomes were RCR incidence and type of RCR. Secondary outcomes were assessed at 1-year follow-up and included anatomical success rates, complications, quality of life (QoL) and patient-satisfaction scores.ResultsThe incidence of RCR was 1.1% (62/5.718 patients). Fifty-one limbs of 50 patients were included. Anatomical success after 1 year was 73.3% for limbs treated with UGFS and 96.6% for limbs treated with EVTA. The most common complication for UGFS was hyperpigmentation (40.0%) and for EVTA was nerve injury (10.3%). QoL improved across all treatment groups and there were no significant differences in patient satisfaction scores.ConclusionRCR is a rare phenomenon occurring in only 1.1% of patients suspected of venous incompetence. Although EVTA had a higher anatomical success rate compared to UGFS for the treatment of RCR, QoL improved across all treatment groups.

ObjectiveThe main objective of this study was to investigate the efficacy of complex decongestive therapy in patients with chronic venous insufficiency. Secondly, the suitability of manual lymphatic drainage, bandaging, and sequential pneumatic compression therapy - as key compression modalities of complex decongestive therapy - was examined.Data sourcesA search strategy was conducted in the Medline and Web of Knowledge electronic databases. The terms "chronic venous insufficiency", "chronic venous disease", "varicose veins", "kinesio taping", "pneumatic compression", "multilayer bandage", "manual lymphatic drainage", and "complex decongestive therapy" were combined with of the Boolean Operators "OR" and "AND".Study selectionTen articles exploring the efficacy of complex decongestive therapy in patients with chronic venous insufficiency were retrieved. The efficacy of the treatment and also the effectiveness of each of the maneuvers that make up the complex decongestive therapy studied separately as investigated.Data extractionTwo researchers extracted the data from each study independently and cross-checked the results to eliminate any errors. The characteristics of each study were collected, including participants, demographic characteristics, intervention measures and performance, and study design.Data synthesismanual lymphatic drainage treatment decreased the venous reflux, edema, clinical severity, symptoms, and quality of life. Kinesio taping improved peripheral venous flow, ankle function, edema, pain, quality of life, venous symptoms, venous severity disease, and mental health. Sequential pneumatic compression increased venous blood flow and quality of life, while complex decongestive therapy reduced limb volume and pain intensity and improved activities of daily living.ConclusionsThe combined use of these techniques is proposed in the symptomatic treatment of VI, just as they are used in the treatment of lymphedema. However, further studies are needed to effectively assess CDT and define its treatment parameters.

BackgroundThe community prevalence of chronic venous insufficiency is high while complication rates of untreated varicose veins are relatively low. This prevalence / severity disparity leads to large numbers of patients awaiting routine clinic appointments for evaluation of their venous disease. Virtual consultations may partially alleviate this issue. We aimed to determine whether there was in difference in patient outcomes between those seen in a traditional 'face-to-face' clinic model compared to those consulted remotely by telephone.MethodsA prospective multi-site cohort study involved random allocation of six hundred 'non-urgent' referrals to virtual or face to face appointments for initial consultation regarding varicose veins.ResultsInitial virtual consultations for varicose veins were as effective as face-to-face consultations with respect to patient consultation outcomes. Similar proportions, about one-third, of face-to-face and virtual patients opted for surgical intervention (p = .726), compression hosiery (p = .17) or surveillance (p = .296). Factors including pain, phlebitis, ulcers and leg swelling may influence patients' willingness to utilise virtual consultations.ConclusionsVirtual consultations provided an equally effective method of delivering initial consultations for varicose veins while facilitating patients for whom travelling long distances poses a challenge.

ObjectivesEnlarged forehead veins are common, with the supratrochlear vein being a frequent patient concern. Given the potential morbidity of sclerotherapy and phlebectomy, endovenous laser ablation (EVLA) may be a viable treatment option.MethodsWe present a patient with an enlarged right supratrochlear forehead vein treated with a single session of 1320 nm EVLA.ResultsClinical eradication was demonstrated at 3 months posttreatment with only self-limited edema and delayed ecchymosis.ConclusionsPilot preliminary evidence demonstrates that EVLA of the supratrochlear vein has a high benefit-to-risk ratio.

IntroductionLipedema is a chronic and progressive adipose tissue disorder that predominantly affects women. However, despite its high prevalence and severe negative impact on quality of life, it remains significantly underdiagnosed. The aim of this study was to assess the knowledge and awareness of medical doctors in Turkey regarding lipedema.MethodsA cross-sectional study was conducted among 508 medical doctors working in different clinical specialties in Turkey. A questionnaire was designed and validated by a panel of physical medicine and rehabilitation specialists. A total of 22 questions were asked to assess physicians' age, specialty, clinical experience, and institutional characteristics, as well as their knowledge of the clinical features, diagnostic criteria, and treatment modalities of lipedema.Results47.6% of the physicians were between 31 and 40 years of age. 29.3% of the participants had been practicing medicine for 0-5 years. 51% were familiar with the term "lipedema", but only 29.9% had seen or referred patients with lipedema. 51.4% of the participants answered "no idea" when asked about the lipoedema clinic and 50.9% answered "no idea" when asked about lipoedema treatment.ConclusionThis study identifies significant gaps in medical professionals' knowledge and awareness of lipedema in Turkey. The findings emphasize the necessity to incorporate lipedema-specific content in medical education and continuing professional development programs. Moreover, the establishment of multidisciplinary models of care, the dissemination of standardized clinical guidelines, and the promotion of public awareness campaigns are imperative to enhance early recognition and effective management of lipedema, which is often overlooked.

In the medical field, ultrasound is commonly used for diagnostic imaging due to its ability to provide real-time images. However, High-Intensity Focused Ultrasound (HIFU) is also used for other clinical purposes, such as thermal tissue ablation. In the case of varicose veins, the potential role and benefits of HIFU have been known for a long time despite in-vivo results have mostly been preliminary and experimental, particularly regarding its effect on venous wall. The aim of this brief report is to describe how HIFU acts on venous wall in human incompetent great saphenous veins.

ObjectivesChronic pelvic pain from pelvic congestion syndrome (PCS) is a complex condition disproportionately affecting women. PCS pain has been described as dull and achy, but emerging research indicates variances in the historical pain depictions. We aimed to identify the groups of pain characteristics experienced by women living with PCS using a latent class analysis and examine their predictive validity on quality of life, pain intensity, and pain management indicators.MethodsA secondary data analysis of cross-sectional survey data collected from 160 participants on a Facebook PCS support group was conducted. After evaluating the original 86 unique pain descriptors endorsed on the McGill Pain Questionnaire, descriptors endorsed by more than 30 participants were retained for analysis (n = 34).ResultsResults from the latent class analysis identified two latent classes: mild but consistent (44.4%) and intense and debilitating (55.6%). Between the two latent classes, there were clear patterns of pain endorsement to indicate that women in the two groups experience PCS pain differently. Compared to the second latent class (intense and debilitating), women in the first latent class (mild but consistent) experienced milder PCS associated pain and reported a significantly higher quality of life, satisfaction with their health, and less interference with sleep quality and sexual desire. Unfortunately, everyday activities (i.e., exercising, urinating, moving, standing, and working) were more likely to increase pain for women in the second latent class.ConclusionsDiagnosis and treatment of pelvic venous disorders are hindered by outdated evidence on the expected pain depictions. A comprehensive pain profile of PCS is needed to establish the effect on women's lifestyles, quality of life, and mental health.