Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of the study is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological) classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp., Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, along with one individual having deep vein involvement and a few participants (n=35, 62.5%) having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

Identification of biological significance of different stages of varicose vein development based on mRNA sequencing.

Normal veins could develop to varicose vein (VV) by some risk factors, and might further progress to shallow vein thrombosis (SVT). However, the molecular mechanism of key genes associated with the progression and regression of VV are still not thorough enough. In this study, the healthy control (HC), VV, and SVT vascular samples were collected for transcriptome sequencing. The differentially expressed genes (DEGs) were screened by "DESeq2", including DEGs1 (HC vs. VV), DEGs2 (HC vs. SVT) and DEGs3 (VV vs. SVT). And their functional enrichment analyses were conducted by "ClusterProfiler". The receiver operating characteristic (ROC) curve was used to obtain the key genes (KGs) of the pathogenesis of VV and SVT. The qRT-PCR assay was performed to validate the expressions of KGs. Immune cell infiltration analyses were conducted based on ssGSEA method. The competitive endogenous RNAs (ceRNAs) regulatory network was constructed. The target drugs of KGs were predicted using DrugBank database. The biofunctions of DACT3 were further investigated through a series of experiments in vitro. All of these DEGs were associated with inflammation and immunity related functions. Immune cell infiltration was significantly different between VV and SVT. Six key genes including PLP2, DACT3, LRRC25, PILRA, MSX1 and APOD that were associated with the progression and regression of VV were screened. The expression of LRRC25 and PILRA was significantly negatively associated with central memory T cell, and significantly positively associated with B cell. Besides, XIST was the critical regulator of multiple KGs. Cimetidine was potential drug for VV and SVT therapy. Overexpression of DACT3 significantly inhibited the proliferation and migration of vascular smooth muscle cells (VSMCs), and affected their cell cycle and phenotypic transition. This study identified six key genes associated with the progression and regression of VV. Among them, DACT3 was proved to hinder VV progression. These findings may help to deepen understanding its underlying mechanisms.

Clinical Efficiency and Safety of Radiofrequency Ablation for Treating Incompetent Great Saphenous Veins in Aged Patients.

INTRODUCTION: Few studies have focused on the safety and efficacy of radiofrequency ablation (RFA) in treating incompetent great saphenous vein (GSV) in aged population. This study was designed to investigate the clinical efficacy of RFA in treating incompetent GSV in the aged patients. METHODS: In this retrospective study, we included 138 consecutive patients (involving 194 limbs) with a mean age of 63.0 years who underwent RFA and microphlebectomy or sclerotherapy due to symptomatic incompetent GSV with saphenofemoral junction reflux. Based on their ages, patients were classified into young group and aged group. Then we compared the preoperative and postoperative Clinical, Etiology, Anatomic, Pathophysiology (CEAP) classification, venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire 14 (CIVIQ-14) score between the 2 groups. RESULTS: In both the young and aged groups, patients underwent RFA showed significant decrease in the CEAP and VCSS at month 1, 3 and 6 compared with immediately after RFA (month 0) (all P < .001). In addition, in both groups, significant increase was seen in the CIVIQ-14 score at month 1, 3 and 6 compared with month 0 (all P < .001). Compared with the young group, the post-RFA CEAP, VCSS and CIVIQ-14 scores showed no statistical differences in the aged group at the designated time points, respectively (all P > .05). CONCLUSIONS: RFA of GSV was effective for treating GSV in the aged population, which improved the CEAP, VCSS and CIVIQ-14.

Giacomini's vein - a report on the invaluable importance of an anomalous short saphenous vein.

Variations in the drainage (termination) and course of the lower limb veins are not uncommon. When dissecting the left lower limb of the adult male cadaver in the vascular case described herein, a unique kind of unilateral short saphenous vein (SSV) termination was observed. It was found that the SSV had normal origin and course in the dorsum of the foot and the back of the leg, respectively. Most often the SSV terminates in the popliteal vein at the popliteal fossa. In this case, it extended upward into the back of the thigh, passing behind the sciatic nerve and then deep to it and the biceps femoris, and finally ended in the veins of the thigh. The SSV did not penetrate any structures along its course to the end, so this unusual vein appears unlikely to be associated with SSV varicose veins. For general, plastic, cardiothoracic, and vascular surgeons, our case would be of significant value.

Variações na drenagem (terminação) e curso das veias dos membros inferiores não são incomuns. No caso vascular relatado, ao dissecar o membro inferior esquerdo de um cadáver adulto do sexo masculino, foi observado um tipo único de veia safena parva (VSP) unilateral. Verificou-se que a VSP tinha origem e curso normais no dorso do pé e na traseira da perna, respectivamente. É mais comum a VSP terminar na veia poplítea, localizada na fossa poplítea. No caso relatado, ela se estendia para cima até a parte posterior da coxa, passando por trás e profundamente no nervo ciático e no músculo isquiotibial, finalizando nas veias da coxa. A VSP não penetra nenhuma estrutura no seu curso; portanto, não é provável que esta veia incomum esteja associada a veias varicosas da VSP. Para cirurgiões gerais, plásticos, cardiotorácicos e vasculares, nosso caso é de extrema importância.

Longer term follow-up of a randomized controlled trial on the role of compression after radiofrequency ablation of varicose veins.

OBJECTIVE: Several studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term. METHODS: All 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities. RESULTS: Thirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (P = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), -7.3 to 1.1; P = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, -1.1 to 0.7; P = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, -0.22 to 1.17; P = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, -7.7 to 6.2; P = .83]). CONCLUSIONS: This study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.

Transfer Learning-Based Approach for Thickness Estimation on Optical Coherence Tomography of Varicose Veins.

In-depth mechanical characterization of veins is required for promising innovations of venous substitutes and for better understanding of venous diseases. Two important physical parameters of veins are shape and thickness, which are quite challenging in soft tissues. Here, we propose the method TREE (TransfeR learning-based approach for thicknEss Estimation) to predict both the segmentation map and thickness value of the veins. This model incorporates one encoder and two decoders which are trained in a special manner to facilitate transfer learning. First, an encoder-decoder pair is trained to predict segmentation maps, then this pre-trained encoder with frozen weights is paired with a second decoder that is specifically trained to predict thickness maps. This leverages the global information gained from the segmentation model to facilitate the precise learning of the thickness model. Additionally, to improve the performance we introduce a sensitive pattern detector (SPD) module which further guides the network by extracting semantic details. The swept-source optical coherence tomography (SS-OCT) is the imaging modality for saphenous varicose vein extracted from the diseased patients. To demonstrate the performance of the model, we calculated the segmentation accuracy-0.993, mean square error in thickness (pixels) estimation-2.409 and both these metrics stand out when compared with the state-of-art methods.

Quantitative evaluation of lower limb varicose veins using photoacoustic imaging.

PURPOSE: Varicose veins in the lower extremities are dilated subcutaneous varicose veins with a diameter of ≥ 3 mm, caused by increased venous pressure resulting from backflow of blood due to venous valve insufficiency (Gloviczki in Handbook of venous disorders: guidelines of the American venous forum, Hodder Arnold, London, 2009). When diagnosing varicose veins, the shape and thickness of the blood vessels should be accurately visualized in three dimensions. In this study, we investigated a new method for numerical evaluation of vascular morphology related to varicose veins in the lower extremities, using a photoacoustic imaging (PAI) system, which can acquire high-resolution and three-dimensional images noninvasively. METHODS: Nine patients with varicose veins participated in the study, and their images were captured using an optical camera and PAI system. We visualized the vascular structure, created a blood presence density (BPD) heat map, and examined the correlation between BPD and location of varicose veins. RESULTS: The obtained photoacoustic (PA) images demonstrated the ability of this method to visualize vessels ranging from as small as 0.2 mm in diameter to large, dilated vessels in three dimensions. Furthermore, the study revealed a correlation between the high-density part of the BPD heat map generated from the PAI images and the presence of varicose veins. CONCLUSION: PAI is a promising technique for noninvasive and accurate diagnosis of varicose veins in the lower extremities. By providing valuable information on the morphology and hemodynamics of the varicose veins, PAI may facilitate their early detection and treatment.

Knowledge and Awareness of Varicose Veins and Its Risk Factors in Al-Qunfudah, Saudi Arabia.

Background Varicose veins are defined as visibly swollen and twisted veins, surrounded sometimes by patches of flooded capillaries. Varicose veins are a relatively common condition. For many people, they are a family trait. Women are at least twice as likely as men to develop them. Aim This study aims to assess the public knowledge and awareness of varicose veins in Al-Qunfudah, Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people in Al-Qunfudah, Saudi Arabia. An online questionnaire was used for data collection. The data collection sheet included socioeconomic-demographic information. Varicose vein knowledge was assessed in the second portion using three-point ratings. The final section had multiple-choice questions about risk factors and complications, including symptoms, diagnostic techniques, and risk factors for varicose veins. Results Participants were included in the study after excluding individuals aged less than 18 years old, with a majority being males (319; 79.9%). Regarding age distribution, participants aged 36-45 years constituted the largest group (132; 33.1%). Out of 399 participants, 369 (92.5%) had not been diagnosed with varicose veins. Most participants (271, 67.9%) had heard of varicose veins, with the primary sources of information being someone they knew with varicose veins (106, 39.11%). Family history was considered an important factor by 141 (35.3%) of respondents while 217 (54.4%) were unsure. Female gender and old age showed significantly higher knowledge levels (p< 0.05). Conclusion The current study concluded that while there was a fair level of public awareness of varicose veins in general, there was a noticeable lack of knowledge regarding clinical symptoms and diagnostic techniques. Younger females demonstrated noticeably greater awareness and comprehension of the illness.

Varicose vein treatment reduces edema not only in the treated legs but also in the entire body.

OBJECTIVES: We explored the connection between varicose vein and edema, by investigating extracellular water ratio (E/T) using bioelectrical impedance analysis. METHODS: In a prospective cohort study 120 patients underwent varicose vein surgery with extracellular fluid to total body water ratio (E/T) and E/T postop divided by E/Tpreop (E/T ratio) measured using a body composition analyzer. Edema was defined as E/T ≥0.390. Seventy-nine patients received unilateral treatment, while 41 underwent bilateral. p < .05 is statistically significant. RESULTS: Preoperatively, patients exhibited edema (E/T) in the treated leg (0.394 ± 0.009), untreated leg (0.392 ± 0.009), trunk (0.390 ± 0.007), and whole body (0.391 ± 0.007). Postoperatively, E/T decreased across body (p < .05). The lowest E/T ratio was observed in the treated leg (0.991 ± 0.012), followed by the untreated leg (0.994 ± 0.012), the trunk (0.995 ± 0.009), and the whole body (0.994 ± 0.009). E/T ratio of bilateral group were lower than unilateral group (p < .05). CONCLUSION: Varicose vein contributes to generalized edema, and treatment alleviates edema in the treated leg and the entire body.

Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins.

OBJECTIVE: The purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and surgical stripping (SS) for incompetent saphenous veins and to determine a suitable treatment modality for a specific clinical situation. METHODS: We retrospectively reviewed the data of patients with varicose veins who underwent RFA, CAC, MOCA, or SS from January 2012 to June 2023. The clinical outcomes, including postoperative complications and the Aberdeen Varicose Vein Questionnaire score, were assessed. RESULTS: During the study period, 2866 patients with varicose veins were treated. Among them, 1670 patients (57.9%) were women. The mean age was 55.3 ± 12.9 years. RFA, CAC, MOCA, and SS were performed in 1984 (68.7%), 732 (25.4%), 78 (2.7%), and 88 (3.0%) patients, respectively. The complete target vein closure rate after RFA, CAC, and MOCA was 94.5%, 98%, and 98%, respectively. The absence of a target vein after SS was 98%. Deep vein thrombosis developed in four patients: one in the RFA group and three in CAC group. Surgical or endovenous procedure-induced thrombosis occurred in 2.3%, 4.8%, 6.4%, and 2.3% of the patients after RFA, CAC, MOCA, and SS, respectively. Phlebitis along the target vein occurred in 0.2% and 3.8% of patients after RFA and MOCA, respectively. A hypersensitivity reaction occurred in 3.7% of patients after CAC. Readmission was required for two patients who had undergone SS. Transient nerve symptoms developed in five (0.3%), zero, one (1.3%), and two (2.3%) patients after RFA, CAC, MOCA, and SS, respectively. After treatment, the Aberdeen Varicose Vein Questionnaire score improved significantly in all groups. CONCLUSIONS: The clinical outcomes with improvement in quality of life were comparable among the different treatment modalities. The proximity of the nerve or skin to the target vein is the most important factor in selecting a suitable treatment modality.

Development and External Validation of a Prediction Model for Patients with Varicose Veins Suitable for Isolated Ambulatory Phlebectomy.

OBJECTIVE: Isolated ambulatory phlebectomy is a potential treatment option for patients with an incompetent great saphenous vein (GSV) or anterior accessory saphenous vein and one or more incompetent tributaries. Being able to determine which patients will most likely benefit from isolated phlebectomy is important. This study aimed to identify predictors for avoidance of secondary axial ablation after isolated phlebectomy and to develop and externally validate a multivariable model for predicting this outcome. METHODS: For model development, data from patients included in the SAPTAP trial were used. The investigated outcome was avoidance of ablation of the saphenous trunk one year after isolated ambulatory phlebectomy. Pre-defined candidate predictors were analysed with multivariable logistic regression. Predictors were selected using Akaike information criterion backward selection. Discriminative ability was assessed by the concordance index. Bootstrapping was used to correct regression coefficients, and the C index for overfitting. The model was externally validated using a population of 94 patients, with an incompetent GSV and one or more incompetent tributaries, who underwent isolated phlebectomy. RESULTS: For model development, 225 patients were used, of whom 167 (74.2%) did not undergo additional ablation of the saphenous trunk one year after isolated phlebectomy. The final model consisted of three predictors for avoidance of axial ablation: tributary length (< 15 cm vs. > 30 cm: odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02 - 0.40; 15 - 30 cm vs. > 30 cm: OR 0.18, 95% CI 0.09 - 0.38); saphenofemoral junction (SFJ) reflux (absent vs. present: OR 2.53, 95% CI 0.81 - 7.87); and diameter of the saphenous trunk (per millimetre change: OR 0.63, 95% CI 0.41 - 0.96). The discriminative ability of the model was moderate (0.72 at internal validation; 0.73 at external validation). CONCLUSION: A model was developed for predicting avoidance of secondary ablation of the saphenous trunk one year after isolated ambulatory phlebectomy, which can be helpful in daily practice to determine the suitable treatment strategy in patients with an incompetent saphenous trunk and one or more incompetent tributaries. Patients having a longer tributary, smaller diameter saphenous trunk, and absence of terminal valve reflux in the SFJ are more likely to benefit from isolated phlebectomy.

A case of vitiligo that followed the path of a varicose vein in the lower leg.

Vitiligo is an acquired chronic depigmenting disorder of the skin and is characterized by the destruction of melanocytes. One of the clinical features of vitiligo is that damage to normal skin frequently results in the formation of depigmented macules, which is known as Köebner's phenomenon (KP). Here, we presented a case of vitiligo, in which depigmented macules followed the course of a dilated varicose vein. Dilatation of blood vessels was considered to contribute to the development of the vitiliginous lesions as a trigger for KP. Any kind of skin injury can trigger KP, but this is only the second case in which a dilated blood vessel caused KP in vitiligo. J. Med. Invest. 71 : 177-178, February, 2024.

Comparative Efficacy of Postoperative Compression Methods After EVLT for Great Saphenous Vein Insufficiency.

Introduction: The preference for endovascular techniques in treating varicose veins, particularly in the great saphenous vein (GSV), has increased due to their minimally invasive nature and reduced complications. Post-operative care, especially involving compression therapy, remains crucial to improve outcomes, prevent varicose vein recurrence, and enhance overall recovery. This study aimed to evaluate the efficacy of eccentric compression therapy compared to alternative post-operative care methods following endovenous laser treatment (EVLT) for GSV insufficiency. Methods: This prospective randomized clinical trial encompassed 88 EVLT procedures for GSV insufficiency. The participants were divided into two groups, each receiving different postoperative compression methods, and were evaluated over a specified period. The primary outcome was the pain scale after EVLT; meanwhile, the secondary outcome measured in the present study was the rate of GSV occlusion after EVLT. Results: Both groups underwent all EVLT procedures successfully without any complications. At the one-month duplex ultrasound (DUS) follow-up, the sapheno-femoral junction occlusion rates were 97% (43 out of 44) for group A (eccentric compression plus gradual compression stocking) and 95% (42 out of 44) for group B (only gradual compression stocking). Ecchymosis was observed in only 12 patients across both groups, accounting for an overall occurrence of 13.6%. Group A patients reported significantly lower analgesic usage (10%) compared to group B (18%), although this difference did not reach statistical significance. Analysis of postoperative pain data utilizing the visual analog scale (VAS) showed a median value of 5.5 in group B patients, which decreased to 3.1 with the application of eccentric compression. Moreover, there was less ecchymosis in group A observed by one week. Conclusion: This study contributes to the ongoing discourse on the efficacy of postoperative compression in varicose vein treatment. It underscores the necessity for more comprehensive, well-designed studies to yield clearer conclusions and provide better guidance for post-procedure care.

3-year clinical outcomes of A Singapore VenaSeal™ real world post-market evaluation Study (ASVS) for varicose vein ablation.

INTRODUCTION: Medium-term clinical outcome data are lacking for cyanoacrylate glue (CAG) ablation for symptomatic varicose veins, especially from the Asian population. OBJECTIVES: Aim was to determine the 3-year symptomatic relief gained from using the VenaSeal™ device to close refluxing truncal veins from the Singaporean ASVS prospective registry. METHODS: The revised Venous Clinical Severity Score (rVCSS) and three quality of life (QoL) questionnaires were completed to assess clinical improvement in venous disease symptoms along with a dedicated patient satisfaction survey. 70 patients (107 limbs; 40 females; mean age of 60.9 ± 13.6 years) were included at 3 years. RESULTS: At 3 years, rVCSS showed sustained improvement from baseline (5.00 to 0.00; p < 0.001) and 51/70 (72.9%) had improvement by at least 2 or more CEAP categories. Freedom from reintervention was 90% and 85.7% patients were extremely satisfied with the treatment outcome. No further reports of further hypersensitivity reactions after one year. CONCLUSION: The 3-year follow-up results of the ASVS registry demonstrated continued and sustained clinical efficacy with few reinterventions following CAG embolization in Asian patients with chronic venous insufficiency. TRIAL REGISTRATION: ClinicalTrials.gov Registration: NCT03893201.

Serious Adverse Events with Cyanoacrylate Closure of Varicose Veins: An Initial Report from a Large-Scale National Survey in Japan.

Objective: Cyanoacrylate closure (CAC) is a minimally invasive technique for the treatment of varicose veins. A recent paper reported serious adverse events (AEs) associated with this use. This triggered an urgent survey to determine the incidence of AEs in Japan. Methods: The CAC-AE survey was sent to all 1,030 institutions authorized for CAC treatments. Cases performed between January 2020 and October 2023 were surveyed. Data on serious AEs and mortality were collected. Results: There were 623 surveys returned. There were 16 cases of proximal deep vein thrombosis, 3 cases of pulmonary embolism (PE), and 0 cases of stroke. Deep vein occlusion due to cyanoacrylate extension was observed in 1 case. Vein resection due to infection was observed in 4 cases. There were 299 cases of localized phlebitis and/or allergic reactions requiring steroid administration. Systemic allergic reactions requiring steroid administration were observed in 66 cases. There was no anaphylaxis associated with cyanoacrylate. There was one postoperative death from PE. Conclusion: This report's intent is to provide real world data on serious AEs following CAC from Japan given current concern over these events. An extensive report investigation of individual complications with analysis including causality will be provided following a full investigation separately.

The anterior saphenous vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology.

BACKGROUND: The term Anterior Accessory of the Great Saphenous Vein suggests this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the anterior saphenous vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. METHODS: The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. RESULTS: The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. CONCLUSIONS: The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.

The Anterior Saphenous Vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology.

BACKGROUND: The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. METHODS: The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. RESULTS: The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. CONCLUSIONS: The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.

Superficial Venous Thrombosis: A Comprehensive Review.

Superficial venous thrombosis (SVT), an inflammatory-thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives.

Hypersensitivity reactions following vein closure therapy with venasealTM (n-butyl- 2-cyanoacrylate).

VenaSealTM is composed of a cyanoacrylate adhesive compound often utilized for chronic venous stasis treatment. Rare case reports of hypersensitivity reactions to this compound exist. We present the first case of dermatographism and angioedema after utilization of VenaSealTM successfully treated via high dose antihistamines. We also present a case of type IV hypersensitivity to VenaSealTM, a cyanoacrylate, occurring in a patient with known meth(acrylate) allergy indicating a possible cross reactivity between these acrylate groups.