Phlebology: The Journal of Venous Disease

To quantify venous reflux by a standard duplex ultrasound technique and correlate the data obtained with clinical grades of severity of venous disease.

A prospective study in a single group of patients with venous insufficiency.

Private practice in secondary and tertiary care.

133 inpatients undergoing investigation for venous disease. Patients with known venous obstruction, arterio-venous malformations or lymphoedema were excluded from the study.

Duplex ultrasound scanning was performed to measure the cross-sectional area, severity and duration of venous reflux following calf compression using a standardized technique.

Clinical classification assigned to each limb correlated with the presence of venous reflux, but not the quantity, velocity or duration of reflux in the veins studied. Presence of reflux and diameter of the vein studied correlated (p<0.001) in all the veins except the popliteal vein (p > 0.03).

Quantification of venous reflux obtained by cuff deflation does not correlate with clinical severity of venous stasis, but does detect reflux accurately. This allowed greater saphenous sparing in nine limbs in 41 patients but proved the need for saphenous removal in seven limbs not previously suspected clinically of requiring this procedure.

To compare physical examination (PE) and continuous-wave hand-held Doppler (CWD) examination with colour flow duplex scanning as a gold standard for greater saphenous vein (GSV) reflux.

Prospective performance of PE and CWD by two clinical examiners and subsequent duplex scanning by two vascular laboratory technicians unaware of the results of the PE and CWD examinations. Tapes were then reviewed; results of the duplex scanning were compared with physical and CWD findings.

Thirty-one women and nine men, aged 27–64 years, with symptomatic class I primary varicosities in distribution of the GSV. Eighty limbs were evaluated Prospectively in 40 consecutive patients, including 22 limbs in 14 patients with a history of prior GSV stripping.

GSV ligation and stripping in 50 limbs when duplex demonstrated saphenofemoral or truncal reflux; 30 limbs were treated by stab avulsion, cluster excision and sclerotherapy.

Demonstration of saphenofemoral reflux by duplex was confirmed by operative findings. Sensitivity, specificity and positive and negative predictive values of PE and CWD were calculated in comparison to duplex scans.

For PE, sensitivity ad specificity were 48% and 73%; positive predictive and negative predictive values were 75% and 46%. For CWD, sensitivity and specificity were 48% and 83%; positive predictive and negative predictive values were 83% and 44%. CWD was falsely positive for saphenofemoral reflux in 10 instances. The GSV was spared in these 10 limbs and in 20 other limbs based on negative colour flow duplex examinations. At 12–18 months clinical results were similar in 50 limbs treated by ligation and GSV stripping as compared with 30 treated by stab avulsion, cluster and sclerotherapy.

Sensitivity and negative predictive values for PE and CWD were low while specificity and postitive predictive values were high. CWD false postitives were due to insonation of veins close to the bulb or upper superficial femoral vein reflux subsequently detected by duplex scans. Colour flow duplex scanning is recommended prior to intervention for primary saphenous varicosities; exceptions occur in slender subjects where PE and CWD are more specific and predictive for reflux.

To demonstrate a significant correlation between the Doppler waveform and blood flow volume in the assessment of valve efficiency. In particular the objective was to ratify use of the ‘area index’ of the wave form.

Pearson's correlation and zero line assessment were used. Using a phantom, multiple tests were performed so that a wide spectrum of flow volumes could be compared with corresponding Doppler waves.

Private diagnostic imaging clinic with vascular surgical association.

The hypothesis was that there should be a significant correlation between the Doppler wave and the blood flow volume and, in particular, the Doppler area.

The Doppler wave index EI_d demonstrated the highest correlation coefficient (r = 0.97, p<0.01) when compared with the volume index EI_V.

While there is a strong correlation between EI_d and flow volume, additional study is needed to determine its place in the clinical setting.

A methodological report of duplex ultrasound examination of the venous system, with Particular consideration of the best position for examining the patient.

Single patient group, comparison of duplex ultrasound imaging with phlebography.

Teaching hospital vascular laboratory.

Patients referred for assessment of their venous system.

Duplex ultrasound scanning of the lower limb, ascending phlebography.

Our results of duplex ultrasound scanning in the diagnosis of deep vein thrombosis as compared with Phlebography show a sensitivity of 94% and a specificity of 91%.

We found it advantageous to examine the Patient standing during proximal vein imaging and sitting for distal venous examination. Veins dilated as a result of gravitational effects are visualized more easily. The examiner, by resting the elbow on his/her distal Thigh, has a more stable hand, facilitating the test. The Patient, by resting the heel on the edge of the examiner's chair, relaxes the calf muscles, thus simplifying the augmentation manoeuvre. The inflation of a tourniquet applied to the distal thigh dilates the calf veins.

To compare the long-term results following radical surgery or compression sclerotherapy (CST) of primary varicose veins.

Prospective, randomized study of 164 patients. The patients were assessed with clinical tests and foot volumetry, before the 6 months, 1, 3 and 5 years after treatment.

Department of Surgery, University of Lund, Sweden.

164 patients referred to the clinic for treatment of symptomatic primary varicose veins. Eighty patients were randomized to surgery and 84 to CST.

Sclerotherapy was applied using the ‘empty vein’ technique followed by compression bandage for 6 weeks. The extent of surgery was determined by each patient's disease and included flush ligation of the long or short saphenous veins and subsequent stripping, ligation of incompetent perforating veins and resection of local varicosities.

The recurrence rate of varicose veins and incompetence of perforators and saphenous veins.

Good results were achieved in both treatment groups immediately after the procedure, but the failures appeared earlier in the CST group and the number was higher compared with the surgery group. After 5 years only 10% of the operated patients were considered as treatment failures compared with 74% of the patients treated with CST. The clinical results were supported by the foot volumetry measurements.

This study clearly indicates that patients with primary varicose veins and incompetent saphenous veins should be treated with surgery, and CST should be confined to local varicosities, isolated insufficient perforators or recurrences after adequate surgery.

To demonstrate the efficacy of the use of a large contoured thigh cuff to distend varicose veins, with the patient in a horizontal position, prior to needle insertion for sclerotherapy.

Prospective study in varicose vein patients treated by injection-compression sclerotherapy.

Outpatient Surgery Clinic, University of California San Diego, La Jolla, California.

Patients presenting with varicose veins on the lower thigh and below.

Patients underwent injection-compression sclerotherapy. Needles insertion was done with the patient in a horizontal position after veins were distended using a large contoured thigh cuff.

Successful vein distension and needle insertion.

Ninety-five percent of patients had adequate vein distension for needle insertion.

Vein distension, prior to needle insertion for sclerotherapy can be achieved by using a large contoured thigh cuff.

To assess the efficacy of locoregional anaesthesia and non-opiate analgesia in controlling pain after varicose vein surgery. To examine patient attitudes to day case surgery for this condition.

Prospective single patient group study (22 consecutive patients).

University College Hospital (Teaching Hospital).

Locoregional and general anaesthesia. Non-opiate analgesia. Surgical treatment for varicose

Patient interview, pain scores, analgesia requirement.

Post operative Pain was absent in 36% during the first 24 hours. Oral analgesia was given to 36% as inpatients but only 18% after discharge. Before surgery, 95% would have preferred DCS but only 24% at six months. The after-effects of general anaesthesia was the main reason for this change in attitude.

Patients would like day case surgery for varicose veins but anaesthesia and analgesia must be satisfactory.

To describe a modification of the standard stripping technique that facilitates varicose vein surgery, avoiding unsightly scars and damage to the venous nerve.

Long saphenous vein stripping using a modified standard stripping device.

The modified stripper provides a satisfactory method of removing the long saphenous vein without resulting in large scars.

To report three cases of Marjolin's ulcer and review the literature on the subject.

Case report.

Edgware General Hospital, Edgware, Middlesex.

Three patients presenting with Marjolin's ulcer.

Amputation (2 cases) and excision with skin grafting (1 case).

Disease control.

Satisfactory control of disease in all three.