Abstract
Extracorporeal treatment with high intensity focused ultrasound of an incompetent perforating vein in a patient with active venous ulcers
Obermayer A, Aubry JF, Barnat.
N EJVES 2021; 50: 1–5. https://doi.org/10.1016/j.ejvsvf.2020.11.005.
The authors, in this case report, focused on High Intensity Focused Ultrasound (HIFU) as an alternative option of treatment to occlude incompetent veins. A 95 year old man presented with painful recurrent ulcers in his left medial calf. Ultrasound revealed a refluxing posterior tibial perforating vein measuring 2.7 mm in diameter at the level of the fascia. Extracorporeal HIFU pulses were delivered to this vein with the Sonovein device. The patient was followed up for three months post-treatment and occlusion was evaluated by duplex ultrasound. There were no complications during treatment or follow up. Reflux was abolished and the two initially active ulcers had healed three months after the treatment.
The authors concluded that although this is an early report, HIFU can be successful in ablation of incompetent perforator veins in the treatment of venous leg ulcers.
Sensitivity and specificity of thermal imaging when used to detect superficial venous reflux as compared to duplex ultrasound
Soffer AD, Caine M, Eng C, Hardigan PC, Geffin R, Young E, Diener J, Wright DDI.
Vasc Dis Manage 2021; 18: 275–279.
In this retrospective study, the authors compared Thermal Imaging (TI) with Duplex Ultrasound Scanning DUS) as an alternative to detect venous insufficiency in 101 patients (202 legs). DUS is time consuming and requires highly skilled technologists to perform contact intensive and often laborious examinations to achieve complete venous mapping. Recently, the non-contact imaging modality of TI has become widely available, it is mobile, quick to perform and inexpensive to use with little operator technical skill requirements. The authors found 95.2% sensitivity and 100% specificity; the positive predictive value was 100% and negative predictive value 88.5% and overall accuracy 98.5%.
The authors concluded that TI is an excellent pre-screening tool which may help identify those likely to benefit from further investigation of leg symptoms and superficial vein treatment.
Great saphenous vein diameter at different regions and its relation to reflux
El Mallah SI, Al-Khateep YM, Hady K.
Vasc Surg 2021; 4: 90–103. doi: 10.4103/jmisr.JMISR_59_19.
In this study the authors analyzed the diameter and reflux of the greater saphenous vein (GSV) at various points. The GSV diameter was measured at the saphenofemoral junction (SFJ), proximal thigh, distal thigh, knee, proximal leg, and distal leg. Analysis was performed to find at which diameter size the reflux is expected to occur. The sample involved 100 limbs from outpatient vascular clinic. GSV diameter was measured at the SFJ, the proximal thigh, the distal thigh, below the knee, and mid-leg and correlated with reflux. Reflux in the SFJ (group I) occurred at 7.16 ± 2.30 mm, proximal thigh (group II) at 6.60 ± 1.89 mm, distal thigh (group III a) at 6.12 ± 1.63 mm, knee (group III b) at 5.78 ± 1.60 mm, proximal leg (group IV) at 4.61.24 mm, and mid leg (group V) at 3.59 ± 1.16 mm.
The authors concluded that the measurement at six sites revealed higher sensitivity and specificity to predict reflux and that GSV diameter correlates with reflux.
The number of pregnancies and deliveries and their association with selected morphological and hemodynamic parameters of the pelvic and abdominal venous system
Szary C, Wilczko J, Plucinska D, Pachuta A, Napierala M, Bdziony A, Zadawi M, Grzela T.
J Clin Med 2021; 10:736–740. https://doi.org/10.3390/jcm10040736.
The aim of the authors in this study was to assess the relationship between the number of pregnancies in women with venous disease and the selected parameters of their venous systems. They studied 518 patients who were subjected to the diagnostics of the venous system in the lower limbs and the abdomen/pelvis using ultrasound scan and magnetic resonance or computed tomography. They found that the occurrence of pelvic venous symptoms increases proportionally to the number of pregnancies and is correlated with ovarian and parauterine vein dilatation/incompetence (13.5% of nulliparous women reported pelvic pain, and reflux in left ovarian veins was detected in 21.4% of the patients from that group, whereas in women after two pregnancies, pain and reflux concerned 22.8% and 90.6% of patients, respectively).
The authors concluded that the number of pregnancies is correlated with the incidence of pelvic vein insufficiency.
Therapeutic potential of flavonoids in the treatment of chronic venous insufficiency
Casili G, Lanza M, Campolo M, Messina S, Scuderi S, Ardizzone A, Filippone A, Paterniti I, Cuzzocrea S, Esposito E.
Vascul Pharmacol 2021; 137: 106625. doi: 10.1016/j.vph.2020.106825.
The authors studied the effect of a flavonoid compound containing troxerutin, diosmin, and horse chestnut extract on in vitro model HUVECs cells and in vivo model of chronic venous insufficiency (CVI)-induced by saphene vein ligation. They studied the flavonoid compound capacity of extensibility and compatibility with peripheral veins through a tissue block culture study. They degree of absorption, the contractile venous activity, the histological analysis, the immunoistochemical and immunofluorescence evaluation for VEGF and CD 34 were performed.
The authors concluded that a therapeutic potential of a flavonoid enriched compound may reduce varicose vein pathology and regularize venous tone.
Concomitant chronic venous insufficiency in patients with peripheral artery disease: Insights from MR angiography
Ammermann F, Meinel F, Beller E, Busse A, Strechenbach F, Teichert C, Weinrich M, Neumann A, Weber MA, Heller T.
Eur Radiol 2020; 30: 3908–3914. doi: 10.1007/s0030-020-06696-x.
The authors analyzed 180 patients undergoing MR angiography (MRA) for suspected or known peripheral vascular disease (PAD). Evidence of chronic venous insufficiency (CVI) was found in 21% of the patients. Only seven of the 38 patients with CVI on MRA had documented CVI in their medical records. Patients with CVI and PAD were more likely to be obese and diabetic. They were also more likely to have Stage IV PAD (57% vs 34% who had no CVI).
The authors concluded that patients with CVI may have symptoms contributing to PAD, and should be reported.
Cerebral venous thrombosis associated with COVID-19
Cavalcanti DD, Raz E, Shapiro M, Dehkharghani S, Yaghi S, Lilemoe K, Nossek E, Torres J, Jain R, Riina HA, Radmanesh A, Nelson PK.
AJNR Am J Neuroradiol 2020; 41: 1370–1376. doi: 10.3174/ajnr.A6644.
The authors reported a series of three patients presenting with acute cerebral venous thrombosis presenting within 2-7 days of onset of COVID-19 infection symptoms. Two were treated with hydroxychloroquine and azithromycin. The other was treated with lopinavir-ritonavir. All three had fatal outcomes.
The authors urge awareness of the atypical manifestation of COVID infection.
Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA trial)
Bootun R, Belramman A, Bolton-Saghdaour L, Lane TRA, Riga C, Davies AH.
Ann Surg 2021; 273: 232–239. doi: 10.1097/SLA.0000000000003626.
The authors undertook a randomized study to investigate the effects of wearing compression stockings after varicose vein treatment. Two hundred and six patients were randomized to compression (49%) for 7 days post procedure vs no compression. The authors found that the pain score in the compression group was significantly less the first week post procedure (ablation with or without concurrent phlebectomy). Occlusion rates and the presence of eccymosis, were similar in the two groups. Quality of life and time to return to activities was similar as well.
The authors concluded that compression management helps diminish pain scores in the first week post procedure.