Phlebology: The Journal of Venous Disease

The objective of this review is to describe the diagnosis of neck vein obstruction and the possible role of chronic persistent Chlamydophila pneumoniae infection in producing the syndrome of chronic cerebrospinal venous obstruction.

The normal patterns of flow in the neck veins are described and guidelines for interpretation of the quantitative duplex ultrasound examination of the extracranial neck veins are developed.

An infective cause of neck vein obstruction is proposed and from a literature search of the role of the obligate intracellular bacterium Chlamydophila pneumoniae in vascular and chronic diseases, a diagnostic protocol for confirming chronic persistent Chlamydophila pneumoniae infection, which includes the quantitative duplex ultrasound examination and specific blood tests are suggested.

Further research to validate this diagnostic protocol is required.

To evaluate the 36-month efficacy and safety of cyanoacrylate closure for the treatment of incompetent great saphenous veins in comparison with radiofrequency ablation.

In this multicenter, prospective, randomized controlled trial, 222 symptomatic subjects with incompetent great saphenous veins were assigned to either cyanoacrylate closure or radiofrequency ablation. The primary endpoint, complete closure of the target great saphenous vein, was determined using duplex ultrasound examination starting from three-month visit.

At month 36, the great saphenous vein closure rates were 94.4% for the cyanoacrylate closure group and 91.9% for the radiofrequency ablation group. Stable improvement in symptoms and quality of life was observed in both groups. Adverse event rates between the 24- and 36-month visits were similar between the groups as were serious adverse events which were infrequent and judged unrelated to either the device or the procedure in both groups.

This trial continues to demonstrate the safety and efficacy of cyanoacrylate closure for the treatment of great saphenous vein incompetence with great saphenous vein closure rate at 36 months similar to that of radiofrequency ablation, indicating non-inferiority of cyanoacrylate closure to radiofrequency ablation. The improvement in quality of life outcomes were also sustained and similar between the two treatment groups.

To evaluate the effect of endovenous ablation in patients presenting with leg swelling.

We identified Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class 3 (C3) patients undergoing endovenous ablation from 21 January 2005 to 19 March 2015 with an 810-nm or 1470-nm laser. Patients were surveyed regarding the degree of edema, use of compression stockings, and satisfaction with the procedure.

A total of 1634 limbs were treated by endovenous ablation for incompetent saphenous veins with or without adjunctive segmental varicose vein microphlebectomy. Of these, 528 limbs were treated for CEAP C3. The average time period from the procedure date until the survey date was 1494 days (range, 562–2795 days). Ninety-two respondents accounted for 130 ablations in 128 limbs with an average venous segmental disease score of 2.7. Ninety-seven limbs (75.8%) had reduced or resolved swelling, 29 limbs (22.6%) were unchanged, and 2 limbs (1.6%) had increased swelling. The vast majority (81%) were satisfied with their decision to have the procedure.

Endovenous ablation for edema secondary to superficial venous insufficiency is effective and has high patient satisfaction. Further investigation is needed regarding risk factors for immediate failure and delayed recurrence of edema.

To investigate the efficacy of a novel low-molecular-weight heparin injection technique compared to the standard technique relative to bruising incidence, bruise size, and pain.

A randomized controlled trial was conducted in 44 patients with acute deep vein thrombosis. Patients who were randomized into the control group received a 10-s duration injection with immediate needle withdrawal, whereas study group patients received a 30-s duration injection with a 10-s pause before needle withdrawal. Two injection sites were assessed for pain and bruising between 48 and 60 h after injection.

Bruises occurred in 50.0% and 18.2% of control and study group patients, respectively (p = 0.03). Mean bruise size between 48 and 60 h after injection was 172.73 ± 372.60 mm² and 28.18 ± 70.01 mm² in the control group and study group, respectively (p = 0.026). Pain scores were comparable between groups.

A 30-s duration injection with a 10-s pause before needle withdrawal resulted in significantly fewer and smaller bruises.

Etiology of the varicose veins is still partly known. It has been proposed that varicose veins formation might be a cause of the oxidative stress and/or cause from genetical reasons.

The levels of antioxidant defense system enzymes, superoxide dismutase, catalase, glutathione peroxidase, glutathione S-transferase, and an oxidative stress indicator, malondialdehyde, were measured in saphenous vein samples of varicose veins patients. Additionally, genetical polymorphism of glutathione S-transferase theta-1 has been studied.

In this study, measurements revealed significant increase in catalase and malondialdehyde levels in the patient group, whereas superoxide dismutase and glutathione peroxidase and glutathione S-transferase enzyme activity and comparison of the null mutation frequency in the glutathione S-transferase theta-1 gene did not show a statistically significant difference.

We propose that the increase in catalase and malondialdehyde activities in our patient group may be related to each other. Increase in catalase levels, an antioxidant enzyme might be a compensatory response to the increase in malondialdehyde levels, an oxidative molecule.

To evaluate the practice patterns and interests of vascular surgeons in Canada in the treatment of chronic venous disorder.

A web-based 19-question survey was sent to 155 active members of the Canadian Society for Vascular Surgery. Questions assessed training background, interest in venous disease, practice site, venous treatments offered, and obstacles to therapy.

A total of 64 responses (41%) were acquired. Respondents were roughly equal from academic (55%) and community (45%) sites with an even distribution of years in practice. Only 43% offered full range of therapy, which includes compression stockings, sclerotherapy, vein surgery, and endovenous ablation. The main challenges hindering venous practice include lack of time due to overwhelming arterial pathologies (67%), equipment cost/office space limitations (53%), and lack of knowledge or skills in contemporary procedures (28%). The majority of surgeons felt that their residency and fellowship did not prepare them for an active venous practice (69%). Fifty-four percent of the respondents perceived barriers in getting venous ultrasound imaging for their patients. Only 19% of the surgeons find venous disease interesting. Characteristics of these interested surgeons were analyzed and found to be very different from surgeons who did not expressed interest. An overwhelming 92% of all respondents believe that vascular surgeons should be leaders in delivering care for venous disease.

The treatment of chronic venous disorder has advanced over the last few decades but significant obstacles exist for Canadian surgeons to deliver venous therapy in accordance with current guidelines.

The prevalence of toenail alterations in chronic venous disease has only rarely been studied. We aimed to establish the frequency and clinical characteristics of toenail onychomycosis in chronic venous disease.

We included 80 adult patients, in all stages of chronic venous disease. Onychomycosis was confirmed by mycological examination. The clinical type of onychomycosis and the onychomycosis severity index were determined. Clinical characteristics of non-fungal nail changes were also analyzed.

We included 58 women and 22 men, with a mean age of 67.0 years. Pathological toenail changes were observed in 83.8% of patients. Onychomycosis was confirmed in 33.8% of all patients and was more frequent in higher clinical stages of chronic venous disease (p = 0.009). Trichophyton rubrum was the leading causative pathogen. Disto-lateral onychomycosis was most commonly present. Average onychomycosis severity index was 23.1.

Onychomycosis accounted for 40% of all toenail alterations. Patients with chronic venous disease often have severe and difficult to treat toenail onychomycosis.