Phlebology: The Journal of Venous Disease

To investigate leucocyte activation in normal volunteers subjected to short-term venous hypertension by measuring the cell surface expression of the integrin CD11b and the selectin CD62L on neutrophils and monocytes before and after short-term venous hypertension. Plasma levels of L-selectin, which is shed by leucocytes upon activation, were also measured.

Prospective study, measuring white cell count, neutrophil and monocyte surface CD11b and L-selectin expression in whole blood using a fluorescent-labelled monoclonal antibody in a flow cytometer, and plasma L-selectin by a commercially available ELISA.

The Middlesex Hospital Vascular Laboratory, a referral centre for the investigation of venous diseases.

Twenty-five normal volunteers without any history or clinical finding of venous disease.

There was a significant fall in the white cell: red cell ratio (p = 0.03, Wilcoxon) in response to venous hypertension, followed by a significant increase (p < 0.001, Wilcoxon) when the venous hypertension was reversed. Neutrophil and monocyte CD11b levels fell significantly (p < 0.001 and p < 0.001, Wilcoxon) in response to venous hypertension. On reversing the venous hypertension a significant increase of CD11b expression was noted in both neutrophils and monocytes (p < 0.001 and p < 0.01, Wilcoxon). Surface L-selectin expression, however, showed a significant sustained fall in both neutrophils and monocytes (neutrophils, p = 0.05 and p = 0.02; monocytes, p = 0.04 and p = n.s., Wilcoxon) throughout the experiment. There was a significant rise in soluble L-selectin in the plasma following venous hypertension (p < 0.001, Wilcoxon).

This study demonstrates both neutrophil and monocyte activation in the microcirculation of normal volunteers in response to short-term venous hypertension.

To describe the methods required to conduct a large epidemiological study of venous disease in the general population, and the resulting response.

Cross-sectional study.

University of Edinburgh.

Men and women aged 18–64 years, randomly selected from general practice registers.

Subjects were invited for the following procedures: questionnaire, height and weight measurement, classification of varices and chronic venous insufficiency, duplex measurement of duration of venous reflux and venous blood sampling. A questionnaire survey of non-responders was carried out.

A total of 1566 subjects attended, a final response rate of 53.8%. The response rate increased with age. The distribution of ethnic origin and social class of attenders was similar to that of the general Edinburgh population. Study participants were generally older, from more affluent areas and more often female than non-responders (p ≤ 0.001).

Large epidemiological studies of venous disease in the community are feasible but the level of response illustrates the importance of obtaining information on the disease status of non-responders.

To report on the surgical treatment of varicose veins by angioscopic valvuloplasty to preserve the long saphenous vein (LSV) and the efficacy of this method compared with conventional stripping and high ligation.

A total of 306 limbs in 187 patients with reflux at the sapheno-femoral junction to below knee level were operated on using intraoperative angioscopy to diagnose valve insufficiency. Angioscopic external valvuloplasty was attempted for the subterminal valves in the LSV by three techniques: total plication of the dilated annulus by running polypropylene sutures (technique 1), plication by autogenous femorofascial sleeve or Dacron-reinforced silicone (technique 2), and plication of the commissure with shortening of the cusps from outside the vein wall (technique 3). Partial stripping or segmental ligation was performed for varicose veins below knee level and the incompetent perforating veins were treated simultaneously by suprafascial ligation.

The subterminal valves were classified as follows: valves with elongated and atrophic cusps – type I, 136 (44%); valves with expanded and depressed commissures with cusp changes – type II, 108 (35%); valves that had cusps with other deformities – type III, 38 (13%); and absence of valves between the saphenofemoral junction and mid-thigh level, 24 limbs (8%). Valvuloplasty of the LSV was successfully performed in 62 limbs (20%). There were two cases with occlusion of the LSV (3%) and four with recurrence of varicose veins (6%) at 2–89 (mean 55, SD 21) months follow-up.

Angioscopic external valvuloplasty is effective in the treatment of varicose veins to preserve the LSV. Further data are needed for complete evaluation of this procedure.

Patients with chronic venous insufficiency (CVI) benefit subjectively from treatment with graduated compression stockings. Usually, class II compression is used in patients with CVI grade II. The present study investigates possible differences between graduated compression of classes I and II.

Randomized study.

Department of Vascular Surgery and Vascular Laboratory, University Hospital, Lund.

Thirty-one patients, nine male and 22 female (59 legs), all with grade II CVI. Foot volumetry and a visual analogue scale (VAS) were used to assess symptoms. Patients were randomized to either class I or class II graduated compression, and the examinations were repeated after 8 weeks of treatment.

The VAS assessment showed that all patients benefited to the same extent and there were no differences between the two compression classes. An increase of the expelled volume with compression was recorded, to a significant degree with class I compression. Reflux values were not significantly influenced by either grade of compression.

Class I graduated compression did not show any difference in subjective effect or objective parameters compared with Class II. Class I compression can be recommended instead of class II compression, especially in patients who find that the higher pressure on the leg causes discomfort.

To evaluate women who have been treated by venous thrombectomy in pregnancy because of iliofemoral venous thrombosis, reporting the outcome of their pregnancy and frequency of objectively measured venous insufficiency.

A retrospective study. The patients were assessed by questionnaire, clinical examination, tests of venous function and ultrasonography.

Department of Vascular Surgery, Gentofte Hospital, University of Copenhagen.

Nineteen women treated previously by venous thrombectomy during pregnancy, with a subsequent pregnancy.

None of the women had complications during subsequent pregnancies or deliveries, 47% had an occluded iliac segment and 53% had dilated or varicose veins. None had ulcers or skin changes. None of the women showed signs of of re-thrombosis.

Women who have been treated for deep venous thrombosis in pregnancy by thrombectomy and arteriovenous fistula followed by anticoagulant therapy may undergo further pregnancies with a very low risk of obstetric complications and a low risk of developing re-thrombosis or chronic venous insufficiency.