Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization.

Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.

Comparison Between Duplex Ultrasound and Multigate Quality Doppler Profile Software in the Assessment of Lower Limb Perforating Vein Direction.

OBJECTIVES: The aim was to assess more accurately the net flow of the lower limb perforating veins (PVs). MATERIAL AND METHODS: This was an observational prospective study. Two hundred and twenty one limbs with chronic venous disease (C1-6EpAs,pPr) of 193 patients underwent a duplex ultrasound (DUS). All identified PVs were scanned also by means of quality Doppler profile (QDP) multigate analysis in order to determine their net inward and outward flow direction. A comparison between the traditional pulsed wave Doppler analysis and QDP was performed to detect potential discrepancy between the traditional definition of PV incompetence and a net outward flow. RESULTS: The DUS investigation identified 774 PVs. Only 7.7% of the PVs showed an outward flow lasting more than 500 ms. Among the PVs showing a longer than 500 ms outward flow, QDP assessment revealed net outward flow in only 84% of the PVs along the thigh and in 28.6% along the lower leg. Among the PVs showing a shorter than 500 ms outward flow, QDP assessment reported a net outward flow in 2.4% of the PVs along the thigh and in 47.3% of those along the lower leg. The sensitivity of an outward flow lasting more than 500 ms in detecting an actual net outward flow was 13.9% (9-20.1%). The specificity of an outward flow lasting less than 500 ms in detecting a net inward flow was 96.4% (93.2-98.3%). CONCLUSIONS: A lack of overlap exists between the finding of a PV outward flow lasting more than 500 ms and the net outward flow of the same vessel. The traditional definition of PV incompetence is challenged by the reported data and further investigations are required to identify a gold standard assessment.

Postoperative Venous Insufficiency in Microsurgical Lower Extremity Reconstruction and Deep Vein Thrombosis Potential as Assessed by a Caprini Risk Assessment Model.

BACKGROUND: Individual potential to develop deep vein thrombosis shares a similar pathophysiologic mechanism with intravascular thrombosis formation in the lower extremity venous system, but has not yet been studied in relation to venous insufficiency following free flap procedures. The aim of this study was to investigate the association between potential for deep vein thrombosis as measured by the Caprini Risk Assessment Model and venous insufficiency in microsurgical lower extremity reconstruction. METHODS: The authors conducted a retrospective review of all free flap procedures performed on the lower extremities at their institution between January of 2005 and April of 2014. Patients were divided into two groups consisting of those with or without venous insufficiency, and the association between venous insufficiency and Caprini score was analyzed. Receiver operating characteristic curve analysis was used to estimate the cutoff Caprini point that best discriminated between the two groups. RESULTS: Of a total 170 flaps with 24 cases of venous insufficiency, the difference in median Caprini score between the two groups was statistically significant (p = 0.03). These results were consistent with those of subgroup analysis in the deep vein recipient group. Receiver operating characteristic analysis revealed that patients with Caprini scores of 7 or higher had significantly increased odds ratios for venous insufficiency. History of sepsis (<1 month) and immobilization were significantly associated with venous insufficiency according to a multivariate regression model. CONCLUSION: The authors detected a strong association between individual deep vein thrombosis potential as measured by the Caprini Risk Assessment Model and venous insufficiency following microsurgical lower extremity reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

[Ultrasound assessment of alterations in venous haemodynamics in patients with post-thrombotic disease permanently taking phlebotonics].

OBJECTIVE: The study was aimed at using ultrasound duplex scanning for determining the sequence and terms of formation of venous haemodynamics impairments in the affected lower extremity in patients after endured acute thrombosis of deep veins and assessing the effect of phlebotonic drugs on the course of these processes. MATERIAL AND METHODS: We examined and treated a total of 66 patients presenting with newly onset acute thrombosis of deep veins of lower limbs without concomitant varicose disease. Group I patients (n = 22) received the standard course of angiotropic and metabolic infusion therapy, direct and indirect anticoagulants, as well as used elastic compression. Group II patients (n = 22) in addition to the similar course of treatment received a phlebotonic drug (Venarus) according to the standard regimen: 1,000 mg daily for two months every half year. Group III patients (n = 22) additionally to the same standard treatment regimen were also given VenarusR at a dose of 1,000 mg daily but taken uninterruptedly and constantly during the whole period of follow up. All patients were subjected to ultrasound duplex scanning of deep veins of lower limbs initially at admission, then 3 weeks, 3, 6, 12 and 18 months after making the diagnosis of acute thrombosis. RESULTS: Group II and III patients additionally taking the phlebotonic were found to have acceleration of processes of recanalization averagely by 15-20% as compared with Group I patients. Group III patients taking the phlebotonic agent permanently demonstrated deceleration of the processes of formation of horizontal and vertical veno-venous refluxes on the background of more adequate recanalization by the end of the follow-up period. CONCLUSION: Permanent taking of phlebotonics increases the rate and scope of recanalization of the thrombosed deep veins of lower limbs, as well as dramatically decreases the development of the horizontal and vertical reflux, decreasing clinical manifestations of chronic venous insufficiency.

Chronic venous disease cases at the Iasi dermatology clinic.

UNLABELLED: Chronic venous disease (CVD) is defined as a disturbance of blood return to the deep venous system, superficial venous system, and communicating (perforating) veins. Once present, CVD persists throughout life, so like heart failure it is nowadays considered "a condition for life". Severe CVD of the lower limbs is one of the most common medical problems, affecting up to 25% of the general adult population of industrialized countries. AIM: to determine the incidence of CVD among the cases admitted to the Dermatology Clinic of the' "Sf. Spiridon" Emergency Clinical Hospital Iasi, CVD incidence by sex, age, area of residence and the main pathogens incriminated in super infection of ulcerative lesions. MATERIAL AND METHODS: We did a retrospective study of patients admitted to the Dermatology Clinic of the Iasi "Sf. Spiridon" Emergency Hospital over a five years period. RESULTS: Of the total number of patients admitted to our clinic (9375), 57% were diagnosed with CVD and 26.61% of them were with CEAP 6 class chronic venous insufficiency. There was an approximately equal sex distribution and most patients (44%) were older than 65 years. CONCLUSIONS: We did a large epidemiological study of venous disease, based on revised CEAP classification, showing again that it is not only a very important medical problem, with various clinical manifestation and multidisciplinary approach, but also an important issue for health insurance system.

Endovascular diagnosis and management of chronic cerebrospinal venous insufficiency: retrospective analysis of 30-day morbidity and mortality in 95 consecutive patients.

OBJECTIVE: The purpose of this study is to report the 30-day morbidity and mortality associated with the endovascular diagnosis and management of chronic cerebrospinal venous insufficiency. MATERIALS AND METHODS: The medical records of 95 consecutive patients (60 women and 35 men) with a mean age of 48 years (age range, 25-66 years) who underwent diagnostic endovascular evaluation and intervention for chronic cerebrospinal venous insufficiency between June 2010 and September 2011 were reviewed retrospectively. All patients had a diagnosis of multiple sclerosis by McDonald criteria. Endovascular evaluation of the internal jugular and azygos veins was performed with digital subtraction venography and intravascular ultrasound. Indications for percutaneous transluminal angioplasty (PTA) were venographic findings of a greater than 50% diameter stenosis, the presence of reflux on digital subtraction venography, greater than 50% cross-sectional area stenosis by intravascular ultra-sound, or a finding of abnormal thick valves or webs by either method. The primary endpoint of this study was the 30-day mortality, and the secondary endpoint was the presence of major complications. Results are presented as means and percentages. RESULTS: A total of 107 procedures were performed in 95 patients. Endovascular evaluation showed venous lesions requiring intervention in 90 of 95 patients (94.7%) and was negative in five of 95 patients (5.3%). A total of 193 venous lesions were treated; angioplasty was technically successful in 188 of 193 (97.4%) lesions. Internal jugular vein thrombosis after PTA was identified in three of 95 (3.2%) of the treated patients. Bleeding at the puncture site not requiring transfusion occurred in four of 95 patients (4.2%). There were no reported procedure-related deaths. CONCLUSION: The results of the current study suggest that endovascular evaluation and management of chronic cerebrospinal venous insufficiency is safe, with low morbidity and no procedure-related mortality.

Ultrasound-guided foam sclerotherapy of the great saphenous vein with sapheno-femoral ligation compared to standard stripping: a prospective clinical study.

AIM: This study is a prospective randomized controlled trial comparing ultrasound-guided foam sclerotherapy of the great saphenous vein (GSV) combined with sapheno-femoral junction (SFJ) ligation to standard stripping surgery. Primary endpoints were patient recovery period, postoperative pain, quality of life and recurrence rate and secondary end points were frequency of complications on the two arms of the trial. METHODS: Sixty consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups of 30, treated by SFJ ligation and either ultrasound-guided foam sclerotherapy or standard stripping of the GSV. The study protocol included history, physical examination, assignment of CEAP class, assessment of the Aberdeen varicose vein questionnaire (AVVQ) and colour Duplex ultrasound. RESULTS: All treatments were completed as intended. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group as compared to standard stripping: 43 min vs. 65 min (P<0.01, Mann-Whitney). Less analgesic use postoperatively was recorded in the foam sclerotherapy group. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (3 days) compared to the surgical group (6 days) (P<0.01, Mann-Whitney). The median overall cost of the procedure in the sclerotherapy group was 3143RMB, and was 3638RMB in the conventional surgery (P=0.235, Mann-Whitney). At 3 months, median CEAP class dropped from four preoperatively to one following treatment in both groups (p<0.01, Wilcoxon test). After 6 months, in the foam sclerotherapy group five patients (20%) needed further sessions of foam sclerotherapy, resulting in a short-term closure rate of 80%. And the short-term obliteration rate was 89.5% in the conventional surgery group. CONCLUSION: Ultrasound guided sclerotherapy combined with sapheno-femoral ligation involved a shorter treatment time, less postoperative discomfort and resulted in more rapid recovery compared to conventional GSV stripping.

The Turkish validity and reliability of the venous insufficiency epidemiological and economic study-quality of life/symptoms scales.

The aim of the study was to test Turkish validity and reliability of Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) in patients with chronic venous insufficiency (CVI). A total of 118 patients with CVI hospitalized in 3 different hospitals were enrolled in this study. VEINES-QoL/Sym, translated to Turkish with a standard methodology, was applied to the patients and was evaluated for acceptability, reliability, validity, and responsiveness. Cronbach α (including if item deleted) values were used for the reliability analysis. Construct and criterion validity approaches were used for validity analysis. Cronbach α values are .86 for the VEINES-QOL and .81 for the VEINES-Sym. No problematic items were observed for the scale. The VEINES-QoL/Sym was significantly sensitive to clinical, etiology, anatomy, and pathophysiology (CEAP) classification, indicating good criterion validity. Significant correlation was found between scores of SF-36 and VEINESQoL (r = .43-.66). Turkish version of the VEINES-QOL/Sym was found reliable and valid for Turkish patients with CVI.

[Multislice computed tomographic angiography in the assessment of central veins for endovascular treatment planning: comparison with phlebography]. / Angio-TC MS nello studio dei vasi venosi centrali per la pianificazione del trattamento endovascolare: studio comparativo con la flebografia.

The dysfunction of a vascular access for hemodialysis and its loss may depend on drainage difficulties of the superficial or deep venation due to hemodynamically significant stenosis or obstruction of a central vein, which generally involve the innominate-subclavian veins or superior vena cava. These alterations are often neglected due to their central and deep location; when there is hemodynamic compensation, they may remain asymptomatic. For these reasons every suspect clinical sign for central vein stenosis (gross arm syndrome or venous hypertension in an arteriovenous fistula) must not be ignored, as timely intervention is essential for functional recovery of the vessel and for the protection of the arteriovenous fistula. The modern imaging techniques ensure thorough diagnostic assessment, while the possibilities of endovascular treatment with interventional radiology allow, in a large proportion of cases, optimal minimally invasive treatment, but above all the recovery of venation in a hemodialyzed patient. We report our experience with multislice computed tomographic angiography (MS-CTA) and reconstruction software for treatment planning of central vein stenosis or obstruction. Forty-nine patients were studied with MS-CTA (GE 16). Images were acquired in the venous phase (120-180 seconds after contrast medium injection) followed by digital vascular reconstruction (AutoBone for bone removal, vessel analysis for caliber and length measurements, thin and curved MIP, MPR). Within a week control phlebography was performed. The venous tree was divided into seven segments and analyzed in a double-blind fashion with a distinction between patent segments, 50-70% stenosis, >70% stenosis, occlusion, and collateral vascular beds. There was excellent correspondence in all the examined segments for patency, >70% stenosis, and occlusion, with high sensitivity (98%), specificity (99.3%), and diagnostic accuracy (99.1%). The binomial test demonstrated a highly significant concordance (alpha=0.99) for all patients and in all vascular segments with the exception of 70% stenoses, in which MS-CTA gave a slight overestimate. In the central venous district, color Doppler ultrasonography may not be as effective as for the peripheral study of arteriovenous fistulae, and second-level imaging techniques such as MS-CTA are more useful. We suggest that endovascular treatment must be preceded by MS-CTA. This examination shows the lesions that may benefit from endovascular treatment and recognizes ''uncrossable'' lesions, ie, the ones that will not benefit from treatment. Moreover, it allows accurate planning of endovascular treatment by showing the lesion type (stenosis or obstruction), the position and extension of the involved vessels, the vessel caliber above and below the lesion, and the possible presence of a collateral vascular bed. MS-CTA with dedicated reconstruction software, if correctly performed and accurately reconstructed, is a precious tool for diagnosis and treatment planning.

Determining venous incompetence: a report from a specialised leg ulcer clinic.

OBJECTIVE: To analyse the diagnosis, treatment and prognosis in patients attending a specialised leg ulcer clinic at a dermatology department. METHOD: In total, 345 patients were investigated and 332 registered and followed up prospectively. All patients had their arterial and venous circulation assessed with a hand-held Doppler ultrasound. RESULTS: The most frequent diagnosis was venous ulceration (153 patients, 46%) followed by hydrostatic ulceration (70 patients, 21%). Venous incompetence was classified as isolated superficial (n=86) or deep venous incompetence (n=57) in 143 out of the 153 patients. Previous deep vein thrombosis (DVT) was more frequent in patients with deep venous incompetence. Of patients with venous ulcers, 38 (25%) healed within 92 days, 77 (50%) within 155 days and 115 (75%) within 329 days. Healing time was influenced by patient age, ulcer duration and ulcer area, but not by type of venous incompetence or ankle brachial pressure index. After healing, 19% of venous patients (28/144), dominated by those with superficial disease, were subject to venous vascular surgery. CONCLUSION: Classification of venous insufficiency should be mandatory in patients with venous ulcers since it determines suitability for venous surgery.

Cost-effectiveness analysis of surgery versus conservative treatment for uncomplicated varicose veins in a randomized clinical trial.

BACKGROUND: Despite being a common procedure, the cost effectiveness of surgery for varicose veins has not been established. METHODS: Cost-effectiveness analysis was carried out alongside a randomized clinical trial at two vascular units within National Health Service (NHS) hospitals. Some 246 patients with uncomplicated varicose veins and evidence of saphenofemoral or saphenopopliteal reflux were allocated randomly to receive either conservative management or surgical treatment. Incremental cost per quality-adjusted life year (QALY) gained at 24 months following randomization was calculated. RESULTS: Total NHS costs during the 2-year study period were higher for the surgically treated group (733 UK pounds) than for those who had conservative treatment (345 UK pounds). The difference in costs was statistically significant. The mean incremental health gain from surgical treatment at 24 months was 0.083 QALYs, leading to a base-case estimate of 4682 UK pounds per QALY gained. Assuming an implicit threshold maximum willingness-to-pay value of 20 000 UK pounds for a QALY, the probability of surgical treatment for varicose veins falling below this threshold value was 70 per cent. This result was found to be robust to sensitivity analysis. CONCLUSION: For patients with uncomplicated varicose veins and evidence of saphenofemoral or saphenopopliteal reflux, surgical treatment for varicose veins offers a modest health benefit for relatively little additional NHS cost relative to conservative treatment.

Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life.

OBJECTIVE: The purpose of this study was to develop a practical and scientifically rigorous, patient-reported outcome measure to evaluate quality of life and symptoms across the range of conditions (eg, telangiectasias, varicose veins, edema, skin changes, leg ulcers) in chronic venous disorders of the leg (CVDL). METHODS: This study was a psychometric study within the VEnous INsufficiency Epidemiological and Economic Study (VEINES), an international, prospective cohort study to evaluate clinical outcomes, quality of life, costs, and use of health services in CVDL. The study was set in the 166 general practices and 116 specialist clinics in Belgium, France, Italy, and Canada (Quebec) that participated in the VEINES study plus in additional specialist clinics in Ottawa and Montreal. Field testing was carried out in three samples of patients in four countries (Belgium, France, Italy, Canada), including participants in the VEINES study (n dagger 1531) and patients recruited in additional samples of 88 English-speaking patients (Canada) and 53 French-speaking patients (Belgium, France). The reliability and validity sample (n = 615) included 527 VEINES patients and 88 patients from the supplementary English-speaking sample. The test-retest sample (n = 135) included 53 French-speaking and 82 English-speaking patients from the supplementary samples. The responsiveness sample included 1516 VEINES patients. The 26-item VEINES-QOL/Sym is a new, patient-reported questionnaire to evaluate symptoms and quality of life and is available in four language versions (English, French, Italian, French Canadian). RESULTS: Standard psychometric tests confirmed the acceptability (missing data, item endorsement frequencies, floor and ceiling effects), reliability (internal consistency, item-total, inter-item correlations) and validity (content, construct, convergent, discriminant, known groups) of the four language versions of the VEINES-QOL/Sym and the test-retest reliability of the English and French versions and provided preliminary evidence of responsiveness in a pooled language sample. CONCLUSION: The VEINES-QOL/Sym is a practical and scientifically sound, patient-reported measure of outcomes in CVDL that has been developed with rigorous methods. As the only fully validated measure of quality of life and symptoms that is appropriate for use across the full spectrum of CVDL-related conditions, that is quick and easy to administer, and that is available in four languages, the VEINES-QOL/Sym provides a rigorous tool for improving the evaluation of outcomes in clinical trials, epidemiologic studies, and audit.

The 1999 French Venous Disease Survey: epidemiology, management, and patient profiles.

A recent (1999) Sofres survey of representative samples of the adult French population aged 15 and over showed that almost half this population suffered from lower limb venous complaints and that 43% of them were untreated. Of those treated, 24.2% received venotropics, including 21.5% by prescription, while 6.0% practiced self-medication. Venous disease sufferers form a relatively underprivileged sector of the population in terms not only of age, income, work and living conditions, but also of general health and medical history. Despite its clinical efficacy and potential social utility, venotropic treatment is possible only if backed by adequate state health insurance coverage supplemented by mutual and private insurance schemes. Any restriction to such coverage will only decrease access to prescription venotropics.

[Drugs for veno-lymphatic insufficiency]. / Médicaments de l'insuffisance veinolymphatique.

Treatment of venous and lymphatic insufficiency of the lower limbs is based on 3 components: elastic support, venotonic drugs and radical treatments (surgery or sclerotherapy) of insufficient veins. Venotonic drugs have specific indications limited to functional impairment: heavy feeling in the legs, pain and impatience in the evening. There are different categories of venolymphatic drugs. Flavonoids have various pharmacological actions, most notably an increase in venous tone, reduction of capillary permeability and increase of capillary resistance. Choice of a venotonic drug is funded on knowledge of pharmacodynamics and pharmacokinetics of the molecule, critical evaluation of clinical studies, physician's personal experience and drug cost. Venotonic drugs are useful when venous insufficiency leads to functional manifestations. They are especially the treatment of heavy leg syndromes during warm seasons when elastic support is uncomfortable.

Treatment of leg ulcers with split skin grafts: early and late results.

Sixty patients (mean age 73.5 years) with 88 leg ulcers that had not responded to conservative treatment had split skin grafts applied at the Department of Plastic Surgery, Linköping, Sweden. Of 51 venous leg ulcers 45 (88%) healed after a mean of 15 days (range 5-30); and 13 (62%) of the 21 arterial ulcers healed after a mean of 18 days (range 8-30). Additional skin grafting was done on nine of the venous and on three of the arterial ulcers. Twenty-two (49%) of the healed venous ulcers recurred after a mean of four months while only two (15%) of the healed arterial ulcers recurred after a mean of 10 months. At late follow up after a mean of four years 18 of the patients were dead and 10 had had the leg in question amputated. Of the 34 patients still alive who had not had amputations, 31 were investigated at open ward or interviewed by telephone and 23 patients were examined with colour duplex scan. Seven of these patients had open leg ulcers. At duplex scan six patients had no venous or arterial insufficiency that could cause a leg ulcer. Of 16 patients with venous insufficiency 10 patients had only an inadequate superficial system. The mean cost for treating one leg ulcer by skin grafting is estimated at SEK 89000 (US$11125). We conclude that leg ulcers often heal with skin grafting but that venous ulcers often recur. To reduce the recurrence rate we suggest a better preoperative aetiological evaluation and improved postoperative treatment with a compression bandage.

Assessment of lower extremity venous function using foot venous pressure measurement.

BACKGROUND: Measurement of foot venous pressure (FVP) is useful for evaluating chronic venous insufficiency (CVI) functionally, because CVI always causes venous hypertension. In the present study, the various FVP parameters were analysed according to the new classification of venous disorders based on clinical, aetiological, anatomical and pathophysiological data (the CEAP classification). METHODS: During the past 7 years, a total of 257 legs in 196 consecutive patients with CVI have been studied. The following FVP parameters were assessed: the percentage decrease in pressure from rest with manual calf compression, the rate of increase of pressure during 4 s after compression (4SR) and the time to 50 per cent recovery of pressure (RT50) after release of compression. RESULTS: The incidence of skin changes due to venous stasis increased as the percentage pressure drop and RT50 fell. In addition, a pressure drop of less than 72 per cent and an RT50 of less than 20 s could detect legs with skin changes with a sensitivity of 76 per cent and a specificity of 62 per cent. In legs with primary varicose veins, pressure drop, 4SR and RT50 values deteriorated in proportion to the severity of the associated deep venous reflux. CONCLUSION: FVP parameters correlate well with the severity of clinical manifestations and venous reflux, and could be used quantitatively to evaluate the severity of CVI.

Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment.

PURPOSE: The efficacy of prophylactic inferior vena cava filters in selected trauma patients at high risk has come into question in relation to risk/benefit assessment. To evaluate the usefulness of prophylactic inferior vena cava filters, we reviewed our experience and overall complication rate. METHODS: From February 1991 to April 1998, the trauma registry identified 7333 admissions. One hundred eighty-seven prophylactic inferior vena cava filters were inserted. After the exclusion of 27 trauma-related deaths (none caused by thromboembolism), 160 patients were eligible for the study. The eligible patients were contacted and asked to complete a survey and return for a follow-up examination to include physical examination, Doppler scan study, vena cava duplex scanning, and fluoroscopic examination. The patients' hospital charts were reviewed in detail. The indications for prophylactic inferior vena cava filter insertion included prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. RESULTS: Of the 160 eligible patients, 127 were men, the mean age was 40.3 years, and the mean injury severity score was 26.1. The mean day of insertion was hospital day 6. Seventy-five patients (47%) returned for evaluation, with a mean follow-up period of 19.4 months after implantation (range, 7 to 60 months). On survey, patients had leg swelling (n = 27), lower extremity numbness (n = 14), shortness of breath (n = 9), chest pain (n = 7), and skin changes (n = 4). All the survey symptoms appeared to be attributable to patient injuries and not related to prophylactic inferior vena cava filter. Physical examination results revealed edema (n = 12) and skin changes (n = 2). Ten Doppler scan studies had results that were suggestive of venous insufficiency, nine of which had histories of deep vein thrombosis. With duplex scanning, 93% (70 of 75) of the vena cavas were visualized, and all were patent. Only 52% (39 of 75) of the prophylactic inferior vena cava filters were visualized with duplex scanning. All the prophylactic inferior vena cava filters were visualized with fluoroscopy, with no evidence of filter migration. Of the total 187 patients, 24 (12.8%) had deep vein thrombosis develop after prophylactic inferior vena cava filter insertion, including 10 of 75 (13.3%) in the follow-up group, and one patient had a nonfatal pulmonary embolism despite filter placement. Filter insertion complications occurred in 1.6% (three of 187) of patients and included one groin hematoma, one arteriovenous fistula, and one misplacement in the common iliac vein. CONCLUSION: This study's results show that prophylactic inferior vena cava filters can be placed safely with low morbidity and no attributable long-term disabilities. In this patient population with a high risk of pulmonary embolism, prophylactic inferior vena cava filters offered a 99.5% protection rate, with only one of 187 patients having a nonfatal pulmonary embolism.

Hemodynamic assessment of femoropopliteal venous reflux in patients with primary varicose veins.

PURPOSE: The aim of this study was to assess the anatomic distribution and extent of deep venous reflux in patients with primary varicose veins (PVVs) and to investigate its influence on venous hemodynamics. METHODS: Femoropopliteal venous reflux was examined using duplex color Doppler ultrasonography in 356 limbs with PVVs in 240 patients. Photoplethysmography (PPG) was performed using above-knee and below-knee tourniquets to determine the contributions of deep and superficial venous insufficiency. RESULTS: Of 356 limbs with PVVs, 61 (17.1%) had femoropopliteal venous reflux, 42 (11.8%) had superficial femoral venous reflux alone, and 57 (16.0%) had popliteal venous reflux alone. Femoropopliteal venous reflux was associated significantly with clinical symptoms and shortened the half venous refilling time measured by PPG, especially in the presence of incompetent perforating veins. These findings were obtained regardless of the presence of long saphenous vein reflux. CONCLUSIONS: Femoropopliteal venous reflux associated with PVVs plays an important role in the pathophysiologic mechanism of venous stasis and influences venous hemodynamics in the presence of incompetent perforating veins and short saphenous vein.