Phlebology最新文献

IntroductionThe gold standard treatment for Chronic Venous Disease (CVD) is compression therapy. Current types of compression therapy often lack properties like comfort and ease of use, which makes patient compliance challenging. Recently a new pneumatic compression therapy device was developed, called Pneumasox® (PSX). The device is based on Pascal's law, using air to create pressure. This could be an interesting addition to the current treatments.MethodsWe evaluated the pressure properties of the PSX. This was investigated by examining both the pressure inside the PSX and the interface pressure. For the primary outcome, the pressure was measured for three different settings (after first inflation, after 10 dorsiflexion movements, 2 min after the movements). This was separately investigated for the anatomical B1 and C point. As a secondary outcome, we investigated the reduction of the pressure after its application. All measurements were performed on a non-moving, dangling leg.ResultsThe average pressure in the PSX after the first inflation was 31 mm Hg. The average interface pressure was 33 mm Hg. Dorsiflexion movements initially resulted in a pressure drop of 14-16 mm Hg, but after 2 min the average pressures had increased to 27 mm Hg (PSX), 30 mm Hg (interface pressure, B1 point) and 31 mm Hg (interface pressure, C point). The average decrease in pressure after 30 min was about one-third of the initial pressure, with a peak during the first minute (6-7 mm Hg).ConclusionOur study suggests a promising role for the PSX in the treatment of CVD and especially for venous leg ulcers in an outpatient setting. However, further experiments are necessary to investigate the effects during daily activities. Considering the fact that the reduction is highest during the first minute, we suggest that repressurizing should take place after 1 min.

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.

BackgroundRecurrent lower extremity venous insufficiency remains a therapeutic challenge despite advances in surgical and endovenous techniques. Emerging evidence suggests that reflux within the inguinal lymph node venous network (LNVN) may contribute significantly to recurrence. This study evaluates the safety and effectiveness of ultrasound-guided lymph node sclerotherapy as a novel treatment targeting LNVN reflux.MethodsThis prospective observational study included 75 patients with prior treatment for varicose veins who presented with symptomatic recurrence between 2022 and 2024. All patients underwent color Doppler ultrasonography and dynamic lymph node venography to detect LNVN reflux. Eligible patients received ultrasound-guided injections of 0.5% sclerosant into affected lymph nodes. Clinical outcomes were assessed using CEAP classification and duplex ultrasound at 1-year follow-up. Statistical analyses were performed using Wilcoxon signed-rank and chi-square tests.ResultsOf the 75 patients (mean age: 47.4 ± 9.4 years), 80% (n = 60) showed significant clinical improvement. Among patients classified as C3, 90% reported edema resolution. Improvement rates in C4-C6 patients ranged from 70% to 72.2%. Duplex ultrasound demonstrated complete reflux resolution in 64% and partial improvement in 20%. The reduction in reflux was statistically significant (p < .001). No major complications were reported; minor injection-site inflammation occurred in 8% of cases.ConclusionLymph node sclerotherapy appears to be a safe and effective outpatient intervention for recurrent venous insufficiency associated with LNVN dysfunction. By directly addressing a previously under-recognized source of reflux, this technique offers a minimally invasive and targeted alternative to conventional reinterventions. Further multicenter trials are warranted to confirm long-term outcomes and validate its role in standard venous treatment algorithms.

ObjectiveThe aim of this study is to present our results with an innovative extracorporeal thermal therapy using High Intensity Focused Ultrasound (HIFU) to treat Superficial Venous Insufficiency (SVI).DesignObservational retrospective study with prospective data collection.MethodsA total of 102 consecutive patients were included. All types of incompetent veins that met the HIFU-device criteria were treated. The primary endpoint of our analysis was vein occlusion rate. As secondary endpoints, shrinkage, absence of reflux, clinical improvement and complications related to the treatment were analyzed. Clinical and Ultrasound (US) follow-up was planned at 15 days, 3 months, 6 months, and 12 months. For clinical assessment, simplify CEAP classification and Venous Clinical Severity Score (VCSS) were registered.ResultsA total of 164 veins were treated: 92 saphenous trunks [65 Great Saphenous Veins (GSV), 15 Short Saphenous Veins (SSV), 12 Anterior Accessory Saphenous Veins (AASV)], 48 perforator veins and 24 other veins (15 tributaries, 4 Giacomini veins, 5 neovascularizations). For all types of veins, occlusion rates were 85% to 96% at early follow-up and from 85% to 90% twelve months after the treatment. Regarding reflux-free rate, it ranged from 85% to 96% 2 weeks after treatment, and from 85% to 93% at twelve months. Finally, shrinkage rates ranged from 96% to 97% 2 weeks after the treatment, and from 94% to 97% at twelve months. All patients showed statistically significant clinical improvement in VCSS and CEAP classification trough the different follow-ups. No major adverse events were observed.ConclusionTreatment of varicose veins with the HIFU therapy seems to be competitive with the state-of-the-art techniques and has shown to be effective and safe in our initial 102 patients' data analysis. Nevertheless, further studies are needed for stronger evidence.

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.

BackgroundVenous leg ulcers (VLUs) affect approximately 1% of the adult population and incur significant morbidity and healthcare costs. Endovenous interventions, such as endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS), have shown benefits in treating venous insufficiency in patients with VLUs. However, the effect of specifically targeting the sub-ulcer venous plexus with foam sclerotherapy remains poorly understood.ObjectiveThe FINNULCER trial is investigating the addition of sub-ulcer foam sclerotherapy to conventional endovenous treatment (EVLA + UGFS) for managing superficial venous insufficiency in patients with VLUs. The primary aim is to evaluate the effect of sub-ulcer foam sclerotherapy in promoting ulcer healing.MethodsPatients with VLUs are being screened at four vascular surgery units in Finland. Eligible participants who provide informed consent are randomized into the study group to receive sub-ulcer foam sclerotherapy + EVLA + UGFS or into the control group to receive EVLA + UGFS. The primary outcome is the time to ulcer healing during 1 year of follow-up from randomization. Secondary outcomes include quality of life assessments and procedure-related outcomes.Trial registrationClinicalTrials.gov (NCT04737941).

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.