Stratification of pelvic venous reflux in patients with pelvic varicose veins.

OBJECTIVE: We investigated the association between the pattern and duration of pelvic venous reflux (PVR) and pelvic pain severity in patients with pelvic varicose veins (PVVs). METHODS: The present retrospective study included 600 female patients with PVVs. Of the 600 patients, 453 had had PVVs and pelvic congestion syndrome (group 1) and 147 had had an asymptomatic disease course (group 2). Pelvic venous pain (PVP) was assessed using a visual analog scale. All the patients had undergone duplex ultrasound of the left and right renal veins, external, internal, and common iliac veins, and parametrial, uterine, gonadal, and vulvar veins (PV, UV, GV, and VV, respectively), with an assessment of their patency and diameter and the presence and duration of reflux. Reflux in the pelvic veins was considered pathologic if it lasted for >1 second. RESULTS: In group 1, PVR type I (1-2 seconds), II (3-5 seconds), and III (>5 seconds or spontaneous reflux in the absence of a loading test) was found in 31%, 58%, and 11% of the patients, respectively. Moderate and severe reflux (types II and III) was associated with severe PVP (mean score, 8.3 ± 0.5) in 69% of the group 1 patients. A combination of reflux in the GV, PV, UV, and internal iliac vein was associated with severe PVP (mean score, 8.1 ± 0.3) in 51% of these patients. A combination of reflux in the PVs, UVs, and VVs was associated with moderate pain (mean score, 5.3 ± 0.2) in 49.2% of group 1. In group 2, PVR type I, II, and III was present in 95%, 4%, and 1% of the patients, respectively, and was observed in the PV only in patients with type I; in the GVs, PVs, UVs, and internal iliac veins in those with type II; and in the PVs and GVs in the patients with type III reflux. Reflux in the GVs and UVs was significantly more prevalent in group 1 than in group 2 (GVs, 51% vs 6%; P = .0001; UVs, 57% vs 7%; P = .0001). A combination of reflux in the GVs and UVs was a predictor of severe PVVs (odds ratio, 19.7; 95% confidence interval, 11.3-34.6). CONCLUSIONS: In patients with PVVs, the presence and severity of pelvic pain will be determined by the type of PVR and its distribution in the pelvic veins. The combination of moderate to severe reflux (types II and III) in the PVs, UVs, and GVs was a predictor of severe PVP. Patients with asymptomatic PVVs were characterized by mild reflux (type I) in the PVs, with rare involvement of the GVs and UVs.

The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders.

As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the May-Thurner, pelvic congestion, and nutcracker syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based on a perceived need, the American Vein and Lymphatic Society convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the Symptoms-Varices-Pathophysiology ("SVP") classification for PeVD, includes three domains-Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVPA,H,E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with the Clinical-Etiologic-Anatomic-Physiologic (CEAP) classification. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.

The 2020 update of the CEAP classification system and reporting standards.

The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.

Patient outcomes after radiofrequency ablation stratified by Clinical, Etiology, Anatomy, and Pathophysiology classification.

OBJECTIVE: Venous insufficiency is a prevalent and potentially debilitating disease. Treatment guidelines and techniques such as radiofrequency ablation (RFA) developed in the United States and Europe have been shown to provide significant improvements in quality of life; however, these have not been clearly assessed in the populations of developing nations. This study examined quality of life outcomes after RFA of patients treated at a single Jamaican vein center. METHODS: In this study, 100 patients who underwent RFA from 2007 to 2012 were evaluated. Patients answered the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) questionnaire assessing quality of life before and after RFA. Improvements in specific categories, such as venous symptoms, work limitations, social limitations, and cosmetic concerns, were evaluated. Cumulative VEINES-Sym and VEINES-QOL scores were also assessed. RESULTS: Patients' quality of life responses were significantly improved in every individual VEINES question. Average cumulative VEINES-Sym t score improved 9.96 points (P < .01), and VEINES-QOL t score improved 11.15 points (P < .01). For patients with Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) C5 and C6 disease, the only questions that did not show significant improvement were limitations to daily workplace activity and impact on clothing after RFA. However, in this subset, the average VEINES-Sym t score improved 11.83 points (P < .01), and the VEINES-QOL t score improved 11.96 points (P < .01) after RFA. CONCLUSIONS: Venous disease is often overlooked, and access to treatment can be limited in developing nations. This study demonstrated that venous treatment guidelines and RFA techniques developed in the United States and Europe could be successfully applied to a Jamaican population, resulting in significant improvements in quality of life.

Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population.

BACKGROUND: The objective of this study was to evaluate the association between the clinical classification of chronic venous insufficiency and duplex ultrasound findings. METHODS: A total of 1010 limbs with clinically suspected chronic venous insufficiency were stratified according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification and underwent duplex ultrasound evaluation consecutively between January 2012 and June 2015. Venous thrombosis, venous reflux, and anatomic distribution of the deep and superficial venous systems were investigated across the CEAP clinical classes. RESULTS: There were 259 male limbs (25.6%) and 751 female limbs (74.4%) in clinical class C0 (24 limbs [2.4%]), C1 (130 limbs [13.1%]), C2 (452 limbs [44.8%]), C3 (183 limbs [18.1%]), C4 (163 limbs [16.1%]), C5 (31 limbs [3.1%]), and C6 (27 limbs [2.7%]). The mean age in clinical class C4-C6 (60.77 ± 14.67 years) was statistically significantly higher than in C0-C3 (55.73 ± 18.85 years; P < .001). Male limbs were shown to have a predilection for presenting with clinical class C4-C6 over female limbs (36.3% vs 16.9%; odds ratio, 2.8; 95% confidence interval, 2.0-3.8). Positive findings were predominantly displayed in clinical class C4-C6 compared with C0-C3 (deep venous thrombosis, 3.2% vs 1.3%; deep venous reflux, 30.8% vs 26.9%; superficial vein thrombosis, 2.7% vs 2.0%; superficial venous reflux, 56.6% vs 47.6%; perforator vein reflux, 12.7% vs 8.2% [P = .049]). A low prevalence of small saphenous vein and perforator vein reflux in C1 limbs (0.3% and 4.6%) and C3 limbs (3.8 and 6.6%) was discovered. CONCLUSIONS: The prevalence of CEAP class C0-C3 was found to be higher than C4-C6. However, men were shown to have a predilection for presenting in clinical class C4-C6 over women. The mean age of patients with clinical class C4-C6 limbs was statistically significantly higher than of those with clinical class C0-C3 limbs. The prevalence of deep venous reflux, superficial venous reflux, and coincident deep and superficial venous reflux in clinical class C4-C6 limbs was higher than in clinical class C0-C3 limbs. Detection of incompetent perforator veins was shown to have a statistically significant correlation with clinical class C4-C6 limbs.

[Surgery of varicose vein insufficiency]. / Operative Therapie der Varikose.

The basis of surgery of great saphenous vein insufficiency is the concept of "privat circulation" coined by Trendelenburg in 1891. It was only logical that the dissection of the insuffcient vein or it's partial or complete resection could bring about healing. Over the years varicose vein stripping was modified to finally result in the highly effectiv concept of crossectomy and stripping. For decades this was the Goldstandard in surgery of varicose vein insufficiency. All the other minimally invasive therapeutic techniques which have been developed in the last decades had to compete with crossectomy and stripping. Thanks to progress in technical development the classic stripping procedure has been replaced by highly effectiv, minimally invasiv procedures, at least in the western industrialisied countries. For a minority of patients with specific anatomical pathologies as well as countries with limited health resources vein stripping remains a surgical standard procedure.

Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density / Avaliação da taxa de obliteração da veia safena magna e da evolução clínica de pacientes submetidos a termoablação com laser 1470 nm, fibra linear e baixa densidade de energia endovenosa linear

Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV) occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs) underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS), and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%). Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

O laser de diodo 1470 nm, com comprimento de onda específico para água, tendo como alvo a água intersticial da parede venosa, poderia causar ablação venosa a densidades de energia menores e com menos efeitos colaterais. Objetivos Determinar a taxa de obliteração da veia safena magna (VSM) após termoablação com laser 1470 nm utilizando 7 W de potência e avaliar a evolução clínica e as complicações. Métodos Dezenove pacientes (31 VSMs) foram submetidos a termoablação e reexaminados através de ecodoppler, avaliação clínica utilizando o Venous Clinical Severity Score (VCSS) e avaliação das complicações do procedimento entre 3 e 5 dias e aos 30 e 180 dias de pós-operatório. Resultados A média de idade dos pacientes foi de 46 anos; 17 eram mulheres (89,47%). De acordo com a classificação de Clinical-Etiology-Anatomy-Physiopathology (CEAP), 2 dos 31 membros tratados eram C2, 19 eram C3, 9 eram C4 e 1 membro era C5. A densidade de energia linear endovenosa média foi de 33,53 J/cm. A taxa de obliteração da VSM foi de 93,5% no pós-operatório imediato, de 100% entre 3 e 5 dias e aos 30 dias, e de 87,1% aos 180 dias. Houve uma redução significativa dos valores de VCSS em todos os momentos de avaliação. Conclusões Os dados deste estudo apoiam a possibilidade de que, utilizando baixa densidade de energia, podemos reduzir a incidência de complicações sem afetar significativamente o resultado clínico. No entanto, isso parece ocorrer às custas da diminuição da eficácia em termos de taxa de obliteração da VSM.

Use of the Clinical, Etiologic, Anatomic, and Pathophysiologic classification and Venous Clinical Severity Score to establish a treatment plan for chronic venous disorders.

To be useful in clinical practice and in the evaluation of clinical therapies for chronic venous disorders, a measurement instrument should be objective, inclusive of all severities of venous disease, and rapidly performed by clinicians. The Clinical, Etiologic, Anatomic, and Pathophysiologic classification helps us identify the etiology, whether it is congenital, nonthrombotic, or post-thrombotic; anatomic segments involved, whether deep, superficial, or perforators; and pathophysiologic data, such as reflux or obstruction. The Venous Clinical Severity Score can be used to observe patients longitudinally, especially after interventions, although the total score is biased with regard to advanced disease, such as C4 through C6. To be able to predict progression of disease, more patient-validated instruments are needed. Physician-reported outcomes (the Venous Clinical Severity Score and the Clinical, Etiologic, Anatomic, and Pathophysiologic classification) in association with a patient-reported outcome may be the solution for the development of an ideal treatment plan.

Peripheral vascular insufficiency impairs functional capacity in patients with heart failure / Insuficiência vascular periférica compromete a capacidade funcional no paciente com insuficiência cardíaca

INTRODUCTION: Heart failure (HF) is a complex syndrome in which effort limitation is associated with deterioration of peripheral musculature. Improving survival rates among these patients have led to the appearance of cases in which other pathologies are associated with HF, such as peripheral vascular insufficiency (PVI). The combination of these two pathologies is common, with significant repercussions for affected patients. OBJECTIVE: To compare functional limitations and quality of life between patients with HF in isolation or HF + PVI. METHOD: Twelve patients with HF+PVI were paired to 12 patients with HF in isolation. All had ejection fraction <40%. The following were conducted: 6 minute walk test (6MWT), chair test (CT), step test (ST), one repetition maximum test (1RM) and quality of life questionnaire. RESULTS: The results for the 6MWT (311±27 vs. 447±29), ST (49±3 vs. 81±10) and CT (17±1 vs. 21±1) were lower in the HF+PVI group than in the HF group (p<0.05). The HF+PVI group exhibited a reduction in the number of steps taken from the first to the second minute of the ST, in relation to the HF group. The HF group exhibited better HR recovery than the HF+PVI group (50±4 vs. 26±3; p<0.05). No differences were found in results for the Borg scale, the peripheral muscle strength test (1RM) or the questionnaires (p>0.05). CONCLUSIONS: The study participants who had mixed disease exhibited a greater degree of functional impairment than the group with HF, without reporting worsened quality of life...

INTRODUÇÃO: A insuficiência Cardíaca (IC) é uma síndrome complexa e a limitação ao esforço está associada à piora da musculatura periférica. Devido à melhora na sobrevida destes pacientes, observa-se o surgimento de patologias associadas à IC, como a insuficiência vascular periférica (IVP). A associação das duas patologias é comum e com grandes prejuízos aos pacientes acometidos. OBJETIVO: Comparar as limitações funcionais e a qualidade de vida em IC isolada e IC + IVP. MÉTODO: Doze pacientes com IC+IVP foram pareados a 12 pacientes com IC isolada. Todos possuíam fração de ejeção <40%. Foram realizados: teste da caminhada de seis minutos (TC6M), teste da cadeira (TCAD), teste do degrau (TD), teste de uma repetição máxima (1RM) e questionário de qualidade de vida. RESULTADOS: Os valores obtidos nos testes TC6M (311±27 vs. 447±29), TD (49±3 vs. 81±10) e TCAD (17±1 vs. 21±1) no grupo IC+IVP foram menores do que no grupo IC (p<0,05), respectivamente. O grupo IC+IVP obteve redução do número de degraus alcançados entre o primeiro e o segundo minuto do TD em relação ao grupo IC. O grupo IC apresentou melhor recuperação da FC em relação ao grupo IC+IVP (50±4 vs. 26±3; p<0,05). Não foi encontrada diferença na escala de Borg, na força muscular periférica (1RM) e nos questionários aplicados (p>0,05). CONCLUSÃO: No presente estudo, os participantes com doença mista apresentaram maior comprometimento funcional em relação ao grupo com IC, sem demonstrar piora na qualidade de vida...

[Russian observational programme SPEKTR: analysis of age-specific structure of patients with chronic venous diseases].

The authors studied the age-related structure of 864 patients with chronic venous diseases (CVD) by means of analysing the database of the Russian Programme SPEKTR (2011-2012). Most often special medical care was sought by persons of able-bodied age (31-60 years): men - 60.6%, women - 63.8%. Class C1 in women was registered at the age under 20 years in 49.5% of cases, in elder groups - from 66.4% to 76.1%. In men, it was registered 1.3-2-8 times less often in all age groups. Class C2 amounted to 75% of cases in women under 20 years; then 50% (21-30 years), increasing to 79.6% (61-70 years). Class C2 in men under 20 years was observed in 100%, then the proportion fluctuated within the bounds of 80% irrespective of the age. The maximum of registering C3 fell to the age of 41-50 years (women - 48%, men - 53.2%). The number of severe forms (C4-C6) in men was considerably more: 31-40 years - 20.2% versus 4.7% in women; 41-50 years - 59.6% versus 17.3%; 51-60 years - 46.7% versus 29.4%. Trophic ulcers were revealed in men most often at the age of 31 - 60 years - 22% in women in the analogous group - 4.9%. The anamnesis of CVD increased with age. Adequate treatment for CVD in all age groups prior to the visit to the phleblogist had been carried out very rarely.

Great saphenous vein diameter at the saphenofemoral junction and proximal thigh as parameters of venous disease class.

BACKGROUND: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standardised pre-interventional assessment is required to analyse the relative merit of treatment modalities. We weighed GSV diameter measurement at the sapheno-femoral junction (SFJ) against measurement at the proximal thigh 15 cm distal to the groin (PT), established a conversion factor and applied it to selected literature data. METHODS: Legs with untreated isolated GSV reflux and varices limited to its territory and control legs were studied clinically, with duplex ultrasound and photoplethysmography. GSV diameters were measured at both the SFJ and the PT. A conversion factor was calculated and used to compare published data. RESULTS: Of 182 legs, 60 had no GSV reflux (controls; group I), 51 had above-knee GSV reflux only (group II) and 71 had GSV reflux above and below knee (group III). GSV diameters in group I measured 7.5 mm (± 1.8) at the SFJ and 3.7 mm (± 0.9) at the PT. In groups II and III, they measured 10.9 mm (± 3.9) at the SFJ and 6.3 mm (± 1.9) at the PT (p < 0.001 each). Measurement at the PT revealed higher sensitivity and specificity to predict reflux and clinical class. Good correlation between sites of measurement (r = 0.77) allowed a conversion factor (SFJ = 1.767 * PT, PT = 0.566*SFJ) to be applied to pre-interventional data of published studies. CONCLUSIONS: GSV diameter correlates with clinical class, measurement at the PT being more sensitive and more specific than measurement at the SFJ. Applying the conversion factor to published data suggests that some studies included patients with minor disease.

Relação entre biomarcadores inflamatórios, de adesão celular, de estresse oxidativo, de lesão endotelial, remodelamento tecidual e vascular e os diferentes estágios da doença venosa crônica primária (classes clínicas CEAP C0a, C2, C3, C4) / Relationship between biomarkers of inflammation, cell adhesion, oxidative stress, endothelial cell damage, vascular and tissue remodeling and the different stages of primary chronic venous disease (CEAP clinical classes C0a, C2, C3, C4)

A doença venosa crônica (DVC) é uma desordem complexa que compreende sinais e sintomas que variam das telangiectasias às úlceras ativas. A DVC é classificada de acordo com aspectos clínicos, etiológicos, anatômicos e fisiopatológicos (CEAP) em sete classes variando de C0 à C6. A principal causa da DVC é a hipertensão venosa que altera o fluxo venoso e, consequentemente, a força de cisalhamento que induz alterações fenotípicas nas células endoteliais que passam a expressar mediadores pró-inflamatórios e pró-trombóticos, que levam à adesão de leucócitos, ao aumento do estresse oxidativo, da permeabilidade vascular e do dano endotelial e ao remodelamento tecidual e vascular.Em virtude dos inúmeros mecanismos e da diversidade de moléculas envolvidas na patogênese e progressão da DVC, é essencial conhecer a interação entre elas e também saber quais são as moléculas (biomarcadores) que se correlacionam positivamente ou negativamente com a gravidade da doença. Foram avaliados os níveis de Interleucina-6 (IL-6), sL-selectina, sE-selectina, sP-selectina, molécula de adesão intercelular-1solúvel (sICAM-1), molécula de adesão das células vasculares-1 solúvel (sVCAM-1), ativador tecidual do plasminogênio (tPA), atividade do inibidor do ativador do plasminogênio-1 (PAI-1), trombomodulina solúvel (sTM), fator de von Willebrand (vWF), metaloproteinase de matriz (MMP)-2, MMP-3, MMP-9, inibidor tecidual das MMPs -1 (TIMP-1), angiopoietina-1 e -2, sTie-2 e s-Endoglina e fator de crescimento do endotélio vascular (VEGF) no sangue coletado da veia braquial de 173 mulheres com DVC primária divididas em grupos C2, C3, C4 e C4 menopausadas (C4m) e de 18 voluntárias saudáveis (grupo C0a). Foram também analisados os níveis urinários de ent-prostaglandina F2α nesses grupos. Não foram encontradas diferenças estatisticamente significativas com relação às concentrações sanguíneas e urinárias de sE-selectina, sP-selectina, sICAM-1, atividade de PAI-1, MMP-3, razão TIMP-1/MMP-3 ...

Chronic Venous Disease (CVD) is a complex disorder, which encompasses signs and symptoms that vary from telangiectasias to active ulcers. The CVD is classified according Clinical, Etiologic, Anatomical and Pathophysiological (CEAP) aspects into seven classes varying from C0 to C6. The main cause of CVD is venous hypertension, which alters venous flow and consequently, shear stress. Abnormal shear stress induces phenotypic changes in endothelial cells that start to express pro-inflammatory and pro-thrombotic mediators that lead to leukocyte adhesion, oxidative stress, increased vascular permeability and endothelial cell damage and tissue and vascular remodeling. Due to several mechanisms and the diversity of molecules involved in the pathogenesis and progression of CVD, is essential to know the interplay between them and which are the molecules (biomarkers) that correlate positively and negatively with the severity of the disease. We investigated the levels of interleukin-6 (IL-6), sL-selectin, sE-selectin, sP-selectin, soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) activity, soluble thrombomodulin (sTM), von Willebrand factor (vWf), matrix metalloproteinase (MMP)-2, MMP-3, MMP-9, tissue inhibitor of metaloproteinases-1 (TIMP-1), angiopoietin-1 and -2, sTie-2, s-Endoglin, vascular endothelial growth factor (VEGF) in the blood taken from the brachial vein of 173 patients with primary CVD divided into C2, C3, C4 and menopaused C4 (C4m) groups and 18 healthy volunteers (C0a group).We also investigated the urinary levels of ent-prostaglandin F2α in these groups. There was no statistically significant difference between groups with respect to blood or urinary levels of sE-selectin, sP-selectin, sICAM-1, PAI-1 activity, MMP-3, TIMP-1/MMP-3 ratio, angiopoietin-2, angiopoietin-1/angiopoietin-2 ratio, s-Endoglin ...

Perfil clínico e sociodemográfico dos portadores de doença venosa crônica atendidos em centros de saúde de Maceió (AL) / Clinical and socio-demographic profile of patients with venous disease treated in health centers of Maceió (AL), Brazil

CONTEXTO: A doença venosa crônica (DVC) consiste em alteração do sistema venoso causando uma incompetência valvar associada à obstrução de fluxo ou não. Acomete 10 a 20% da população mundial, tendo maior prevalência no sexo feminino. Apresenta como sintomas mais comuns dor e edema e na forma avançada, a úlcera venosa. Traz limitações funcionais e isolamento social, afetando a qualidade de vida. OBJETIVO: Traçar o perfil dos portadores de DVC, pelo levantamento de dados clínicos e sociodemográficos que indiquem características que possam contribuir para possível mudança de hábito na vida de pacientes que, por motivos de trabalho, falta de conhecimento e/ou instruções, tiveram sua rotina afetada pela doença, com consequente diminuição da sua qualidade de vida. MÉTODOS: Estudo descritivo, observacional do tipo transversal, sendo avaliados portadores de DVC atendidos em centros de saúde de Maceió (AL), aplicando um formulário para coleta de dados, como classificação CEAP, Critério de Classificação Econômica Brasil e Questionário SF-36. RESULTADOS: A amostra foi composta por 66 pacientes com DVC; 83% eram do sexo feminino e 17%, do masculino, a faixa etária predominante foi entre 50 a 60 anos; eram sedentários, assumindo ortostatismo prolongado, baixo nível de escolaridade e classe econômica, doença clínica grave (C6 sintomático) e qualidade de vida variável. CONCLUSÃO: Os resultados demonstraram predomínio da doença no sexo feminino, entre 50 a 60 anos de idade, com fatores desencadeadores e/ou agravantes para desenvolvimento da DVC como falta de atividade física, baixo nível de escolaridade e baixa renda econômica, afetando a qualidade de vida.

BACKGROUND: Chronic venous disease (CVD) is to change the system causing a venous valvular incompetence associated with obstruction of flow or not. It affects 10 to 20% of world population, with higher prevalence in females. It presents as the most common symptoms and pain and swelling in advanced form, venous ulcer, and brings functional limitations, social isolation, affecting quality of life. OBJECTIVE: Profiling of patients with CVD, the survey data indicate that clinical and socio-demographic characteristics that may contribute to possible change of habit in the life, who for reasons of work, lack of knowledge and/or instructions had affected their routine by the disease, with consequent decline in their quality of life. METHODS: A descriptive, observational, cross-sectional study that evaluated patients with CVD treated at health centers in Maceió (AL) Brazil, applying a form for collecting data, such as CEAP, Brazil Criterion of Economic Classification Questionnaire and SF-36. RESULTS: The sample consisted of 66 patients with CVD, 83% were female and 17% male. The patients had predominantly aged between 50 and 60 years who were sedentary, assuming prolonged standing, low educational level and economic status, severe clinical disease (symptomatic C6), and quality of life variable. CONCLUSION: The results showed a predominance of females, 50 to 60 years old, with triggering factors and/or aggravating factors for development of CVD as lack of physical activity, low education and low economic income, affecting quality of life.

The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography

Introduction: Pelvic varicose veins, one of the main causes of chronic pelvic pain and dyspareunia, are an important source of reflux for lower limb varicose veins, especially in recurrent cases. Color Doppler ultrasound of the lower limbs and transvaginal ultrasound are the noninvasive diagnostic methods most commonly used to assess pelvic venous insufficiency, whereas phlebography is still considered as the gold standard. Objectives: To determine the prevalence of lower limb varicose veins originating from the pelvis in a group of female patients and to determine the agreement between results obtained via color Doppler ultrasound of the lower limbs, transvaginal ultrasound, and phlebography. Methods: The sample comprised female patients referred to a vascular laboratory for lower limb screening. Patients diagnosed with deep venous thrombosis were excluded. Data analysis included kappa coefficient of agreement, McNemar's test, sensitivity and specificity values. Results: Of a total of 1,020 patients, 124 (12.2 percent) had findings compatible with reflux of pelvic origin. Among these patients, 51 (41.2 percent) were recurrent cases. A total of 249 were submitted to transvaginal ultrasound. There was significant agreement between lower limb ultrasonographic findings and transvaginal findings. Phlebography was performed in 54 patients. The comparison between transvaginal ultrasound and phlebography was associated with a 96.2 percent sensitivity and 100 percent specificity. Conclusions: The authors draw attention to the relatively high prevalence of lower limb varicose veins originating from the pelvis, suggesting an important but underdiagnosed cause of recurrent varicose veins.

Introdução: AS VARIZES Pélvicas, uma das principais causas de dor pélvica crônica e dispareunia, são uma importante fonte de refluxo para as varizes dos membros inferiores, especialmente em casos recorrentes. O Doppler colorido dos membros inferiores e o ultrassom transvaginal são os métodos diagnósticos não-invasivos mais comumente usados para avaliar a insuficiência venosa pélvica, enquanto a flebografia ainda é considerada como o padrão-ouro. Objetivos: Determinar a prevalência de varizes dos membros inferiores originadas na pélvis em um grupo de pacientes do sexo feminino e determinar a concordância entre os resultados obtidos por Doppler colorido dos membros inferiores, ultrassom transvaginal e flebografia. Métodos: A AMOstra incluiu pacientes do sexo feminino encaminhadas para o laboratório vascular para triagem dos membros inferiores. As pacientes diagnosticadas com trombose venosa profunda foram excluídas. A análise dos dados incluiu o coeficiente de concordância kappa, o teste de McNemar e os valores de sensibilidade e especificidade. Resultados: De um total de 1.020 pacientes, 124 (12.2 por cento) tiveram achados compatíveis com refluxo de origem pélvica. Entre essas pacientes, 51 (41.2 por cento) eram casos recorrentes. Um total de 249 foram submetidas a ultrassom transvaginal. Houve concordância significativa entre os achados ultrassonográficos dos membros inferiores e os achados transvaginais. A flebografia foi realizada em 54 pacientes. A comparação entre o ultrassom transvaginal e a flebografia foi associada a 96.2 por cento de sensibilidade e 100 por cento de especificidade. Conclusões: OS AUTores chamam a atenção para a prevalência relativamente alta de varizes dos membros inferiores originadas na pélvis, sugerindo uma importante, embora subdiagnosticada, causa de varizes recorrentes.

Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document.

Non-uniform terminology in the world's venous literature has continued to pose a significant hindrance to the dissemination of knowledge regarding the management of chronic venous disorders. This VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology, focusing on terms that were identified as creating interpretive problems, with the intent of promoting the use of a common scientific language in the investigation and management of chronic venous disorders. The VEIN-TERM consensus document is intended to augment previous transatlantic/international interdisciplinary efforts in standardizing venous nomenclature which are referenced in this article.

[Clinico-histopathological correlations of venous wall modifications in chronic venous insufficiency]. / Corelatii clinico-histopatologice ale modificarilor parietale venoase in insuficienta venoasa cronica.

The interest manifested for the conjunctive tissue pathology leaded to the study of the structural disorder that appears in the varicose veins walls. The study is a prospective one initiated in March 2007 made on 11 patients with varicose disease hospitalized at Cluj-Napoca within Surgery Clinic no. II. The purpose of this study is to point out the histopathological modifications in the varicose venous wall (great saphenous vein cross, communicating veins, perforating veins), as well as the correlation of histopathological results with the evolutive stage of chronic vein insufficiency (CEAP classification) and with the clinical score at these patients. The histopathological (HP) results for 2 of the patients revealed hypertrophy of the media, intimal hyperplasia (stage II) corresponding to a CEAP 3. Six patients were integrated in HP stage III due to the partial intimal fibrosis corresponding to a CEAP 6 for one case, CEAP 4 one case, CEAP 3 four cases. One patient had HP stage I with CEAP 3 and two patients had HP stage IV corresponding to CEAP 5, respectively CEAP 6.