Phlebology: The Journal of Venous Disease

To compare the extent of thigh haematoma formation after perforation-invagination (PIN) stripping with that occurring after standard plication stripping of the long saphenous vein.

Prospective, within-case, randomised study with analysis on an intention-to-treat basis.

The radioisotope department of a university teaching hospital.

Fourteen patients undergoing bilateral varicose vein surgery.

Red blood cell labelling in vivo with ⁹⁹Tc^m. Preoperative imaging of the long saphenous vein using a gamma camera. Randomisation of one leg to PIN stripping and the other to standard stripping of the long saphenous vein to the knee. Patients were reimaged 6 h postoperatively.

The extent of thigh haematoma formation.

There was no significant difference with respect to the severity of varicosities in the long saphenous vein in the thigh between the limbs assigned to each group (n = 11) on the preoperative images (T = 25, 0.5>p>0.1, Wilcoxon signed rank test). Thigh haematoma in the limbs that had undergone PIN stripping of the long saphenous vein was significantly less than that in the limbs that had undergone standard stripping (T = 10, 0.05>p>0.01, Wilcoxon signed rank test).

PIN stripping of the long saphenous vein results in significantly decreased haematoma formation compared with standard stripping.

To evaluate the efficacy of three different interventional radiological procedures for the treatment of venous reflux in symptomatic male varicocele.

Prospective study with a 48-month colour duplex ultrasound (CD) follow-up.

Department of Radiology, Tor Vergata University of Rome.

From January 1991 to December 1993, 45 symptomatic patients with third- to fourth-degree varicocele, according to Sarteschi's CD classification, were randomly divided into three equal groups (15 patients each).

The first group received sclerotherapy (Athoxysclerol), the second underwent embolisation (Gianturco coils), while the third group received combined sclero–embolisation therapy (Athoxysclerol and Gianturco coils).

The frequency of recurrence for each procedure.

Two recurrences (13%) after 1 and 2 years occurred in patients who underwent sclerotherapy. In the embolisation group, two patients showed residual varices (13%). Neither recurrence nor residue was seen in the third group, who received combined therapy.

Sclerotherapy provides good immediate results but drug dilution may cause a relapse shortly after treatment. Embolisation has a lower immediate success but better long-term success. Combined treatment provides the highest long-term success rate.

To evaluate the pathway of reflux in incompetent long saphenous veins (LSVs), paying particular attention to the role of longitudinal saphenous tributaries in the thigh (accessory saphenous veins, ASVs).

Prospective study in a group of patients with primary varices. Comparison with the anatomical patterns in a group of normal subjects.

Private phlebology practice.

Sixty-seven patients with primary varices (100 limbs) and 66 subjects without varices and with competent saphenous veins (120 limbs).

Duplex ultrasound evaluation of the saphenous system in the thigh of patients and healthy subjects. The ‘eye’ ultrasonographic sign was used as the marker to distinguish the LSV from the longitudinal tributary veins of the thigh.

In 57% of limbs in patients with varices, reflux followed the saphenous vein, while in 43% the reflux spilled outside the LSV into an ASV (h or S types). When reflux followed the saphenous vein, no large calibre ASVs could be observed. In 30% of limbs in control subjects a parallel tributary vein with a similar calibre was found joining the LSV.

Clinically visible varices in the thigh rarely comprise the LSV itself, but are usually dilated ASVs, the reflux stream passing from the proximal LSV into a more superficial ASV. The distal LSV running parallel beneath is often competent. In subjects with healthy LSVs, a large competent tributary vein is already present in the thigh in 30% of cases. This suggests that superficial deviation of reflux flow into an ASV in patients with varices may not arise from haemodynamically acquired changes, but could have a congenital origin. This could even be a predisposing factor in the development of varices.

The incidence of reduplication of the long saphenous vein (LSV) reported in the literature is highly variable, perhaps due to the lack of a clear definition.

To use ultrasonography to re-evaluate the incidence of LSV reduplication in healthy subjects and Patients with varicose veins on the basis of a new definition of this anatomical aspect.

The presence of two parallel superficial venous channels in the lower limb was sought in a series of 610 duplex ultrasound examinations. The LSV was identified, by the ‘eye’ sign, running deeply in the hypodermis, closely ensheathed by two hyperechogenic laminae (the saphenous compartment). Tributary veins were identified by their more superficial course, lying outside the compartment. True LSV reduplication was considered to be present when two venous channels were Present within the saphenous compartment.

True reduplication of the LSV is extremely rare (1%) and only affects a segment of vein. Large tributaries running parallel to the LSV do not comprise true reduplication, but may act as a ‘functional double vein’. Better understanding of the anatomy of the LSV may improve operative treatment for varicose veins and improve the use of saphenous veins as arterial grafts.

The non-penetrating Vascular Clip System (VCS) was tested experimentally and compared with the conventional suture method on the venous system.

In five pigs, 30 transverse venotomies were carried out in the jugular and renal veins, and vena cava. Fifteen venotomies were reconstructed using autosuture clips and 15 using the standard needle and suture method. Eight weeks later, following phlebography, the specimens were examined macro- and microscopically.

For both methods, the veins remained patent; however, significant stenosis of 8.9% (95% CI: 0.6–17.1) for the renal vein and 8.5% (95% CI: 1.2–15.7) for the vena cava occurred when the suture technique was used. The intima to media height ratio remained the same. The anastomosis time with the clips was significantly shorter (p<0.05), while the endothelium remained intact without any hyperplasia or inflammatory changes, which are usual findings of the suture technique.

Early and mid-term results show that the VCS clipped anastomotic technique seems to be effective and acceptable for venous reconstructions.

To quantify the influence of posture and exercise on the interface pressure obtained under elastic stockings with compression pads.

Interface pressure measurement and plethysmographic evaluation of elastic stockings with and without compression pads.

Department of Surgery, Aichi Prefectural College of Nursing, Nagoya, Japan.

Pressure measurements in 24 volunteers were obtained beneath elastic stockings, elastic bandages and short-stretch bandages during supine resting, standing, tip-toe exercise and walking, and the effect of elastic stockings on the muscle pump of the leg was evaluated by strain-gauge plethysmography in 40 limbs with varicose veins.

Without compression pads, only short-stretch bandages showed a significant increase in pressure during standing and exercise. When pads were used, however, elastic stockings and bandages also showed a significant increase. With pads, significant improvement in the expelled volume during exercise was observed by strain-gauge plethysmography.

Interface pressure under elastic materials during posture and exercise is similar to that under short-stretch bandages when compression pads are used, and pads effectively augment the muscle pump.

To investigate the clinical significance of corona phlebectatica.

Clinical and plethysmographic evaluation of corona phlebectatica associated with primary varicose veins.

Department of Surgery, Aichi Prefectural College of Nursing, Nagoya, Japan.

In 411 limbs with greater saphenous incompetence, including 101 with skin changes and 310 without skin changes, clinical analysis and plethysmographic evaluation using the photoplethysmographic technique were carried out.

In 204 of 411 limbs, corona phlebectatica was observed, including 75 coloured red and 129 coloured blue. Blue coronas were observed significantly more often then red coronas in limbs with skin changes. The half refilling time in limbs with skin changes was significantly shorter than that in limbs without skin changes. In limbs without skin changes, limbs with blue coronas showed a significantly shortened half refilling time than those with red coronas.

Blue coronas are a strong indicator of the presence of prolonged venous hypertension in varicose veins.

The severity of varicose vein symptoms is no more than a subjective assessment of the underlying disease. The aim of this study was to use an objective method for assessing the severity of the condition.

We describe a test based on measuring the venous reflux time (VRT) using hand-held Doppler (HHD). To evaluate the efficiency of this test, a prospective study of 61 consecutive primary varicose vein patients with sapheno-femoral incompetence was carried out. Patients were scored preoperatively by a self-assessment questionnaire. The score was compared with the VRT of the same patients. Six months after surgery, a similar self-assessment questionnaire was sent to all patients.

The VRT was found to have a highly significant relationship to the preoperative score (ρ = 0.73, p=<0.001). It was also found that most of the patients with a low score of ≤ 3 had a VRT of ≤ 13 s whilst most with a high score of >3 had a VRT of >13 s (sensitivity 78%, specificity 100%, accuracy 84%, p=<0.0001). Only 41 patients responded to the postoperative questionnaire, giving symptom scores of 0 in 40 patients and a score of 1 in one patient.

VRT is a simple, objective, non-invasive method of assessment of varicose veins, which relates strongly to the magnitude of the patients' symptoms.