Treatment of varicose veins using the Cryo laser after foam technique.

Sclerotherapy is the treatment of choice for telangiectasias and reticular veins. The most common side effects of this procedure are hyperpigmentation and matting, which are feared owing to their aesthetic damage and difficulty of treatment. Combined treatments with laser and hypertonic glucose sclerotherapy have been described with excellent results, but limited to treatment of veins of ≤2 mm in diameter. Cryo laser after foam sclerotherapy is a procedure to treat reticular veins in the lower extremities that utilizes first foam sclerotherapy with polidocanol than immediately followed by transdermal Nd:YAG 1064 laser treatment and we can treat veins ≤5 mm. This report presents a successful case of varicose vein treatment using combined transdermal laser and sclerotherapy with foam sclerotherapy with polidocanol to treat veins >2.5 mm in diameter.

Effects of lower limb muscle strengthening on interface pressure in older adults undergoing inelastic compression: Randomized controlled clinical trial.

OBJECTIVE: To analyze the effects of lower limb muscle strengthening on interface pressure (IP), static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) in older adults undergoing inelastic compression therapy. METHOD: Forty-three healthy older adults of both sexes (Age: 66.2 ± 4.4 years) met the eligibility criteria and completed all stages of the study (Resistance Training - RT: N = 20; Control - CONT: N = 23). Body composition, strength and functional mobility of lower limbs, IP, SSI, DSI, and WPA were evaluated before and after intervention. RESULTS: The two-way ANOVA with repeated measures demonstrated a significant time-group interaction effect on muscular strength for 1-RM [F (1, 41) = 21.091; p ≤ 0.001], IP in the orthostatic position [F (1, 41) = 5.124; p ≤ 0.05], minimum WPA [F (1, 41) = 10.999; p ≤ 0.05], maximum WPA [F (1, 41) = 8.315; p ≤ 0.05], DSI minimum (F (1, 41) = 4.608; p ≤ 0.05), DSI maximum (F (1, 41) = 8.926; p ≤ 0.05), and on the delta DSI (F (1, 41) = 7.891; p ≤ 0.05). CONCLUSIONS: In RT group, the increase in lower limb muscle strength was accompanied by an increase in IP in foot dorsiflexion and plantar flexion maneuvers, both in the standing position (DSI) and during gait (WPA).

Impact of Ultrasound-Guided Foam Sclerotherapy for Pain Control in Patients with Chronic Venous Disease and Great Saphenous Vein Reflux.

Chronic venous disease (CVD) associated with great saphenous vein (GSV) reflux has a higher prevalence of pain in the lower limbs. This study evaluates the impact of ultrasound-guided foam sclerotherapy (UGFS) for GSV and symptom control, accessed by the visual analogue scale (VAS). Patients with CVD who underwent GSV-UGFS were included in this retrospective cohort (417 limbs). The pain was measured before and after the treatment. The scale alteration was assessed as a function of age, sex, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classes, total of sclerotherapy sessions, GSV occlusion patterns, and ulcer healing. Majority of patients were female (59.2%), and the mean age was 56 ± 11.5 years. In the total sample, 78.2% of the GSVs were fully occluded, 19.7% had partial occlusion, 2.2% remained open, and 3.2 ± 1.9 (median = 3.0) sessions were performed. The reduction of symptoms occurred in 88.3% of participants (VAS drop median = 4.8). Patients younger than 50 years and females had the greatest VAS decreases. When comparing the outcomes of complete occlusion versus partial occlusion, there was no significant difference in VAS pain reduction ( p = 0.14). The comparison between CEAP clinical classes also did not show statistically significant differences in delta VAS ( p = 0.71). GSV-UGFS was effective for pain control. However, this improvement does not appear to be related to the pattern of occlusion, indicating that in the short term, the outcomes of total and partial occlusion suggest successful management of symptoms. Other aspects such as gender, age, pretreatment pain intensity, and CEAP classes seem to play a role in the clinical outcome.

Two-Year Results of a First-In-Human Study in Patients Surgically Implanted With a Bioprosthetic Venous Valve, the VenoValve in Patients With Severe Chronic Venous Insufficiency.

OBJECTIVE: Two-year follow-up results from a first-in-human study of patients implanted with the VenoValve are evaluated for supporting the long-term clinical safety and performance of the device. BACKGROUND: Chronic Venous Insufficiency (CVI) involves improper functioning of lower limb vein valves and inability of these valves to move blood back towards the heart. CVI symptoms include swelling, varicose veins, pain, and leg ulcers. Currently, there is no cure for this condition and treatment options are limited. This study provides 2-year outcomes for 8 patients who were implanted with the bioprosthetic VenoValve for treating severe CVI with deep venous reflux measured at the mid-popliteal vein. The 6-month and 1-year results were previously published. METHODS: Eleven patients with C5 & C6 CVI were implanted with VenoValve into the midthigh femoral vein and followed for 2 years. Assessed clinical outcomes include device-related adverse events, reflux time, disease severity, and pain scores. RESULTS: All 11 implant procedures were successful. Two-year follow-up data was obtained for 8 subjects: 1 patient died of non-device related causes, 1 was lost to follow-up, and 1 refused to follow-up due to the COVID-19 pandemic. No device-related adverse events occurred between the first and second years of follow-up. Reported 2-year clinical performance outcomes included significant decreases in mean reflux times of the mid-popliteal vein (61%), and significant improvements in mean scores for disease severity rVCSS (56%) and VAS pain (87%). CONCLUSIONS: Results from this study support long-term safety and effectiveness of the VenoValve for improving CVI severity by reducing reflux and thereby venous pressures in the lower extremities. With limited treatments for valvular incompetence involved in severe, deep venous CVI, the device may be considered as a novel therapy. A pivotal trial in the United States is currently being conducted to assess the device in a larger number of patients.

Nd:Yag laser combined with injection sclerotherapy in the treatment of reticular veins and telangiectasias (CLaCS method): A triple-blind randomized clinical trial comparing two sclerosing agents associated with same laser patterns.

BACKGROUND: Cryo-Laser & Cryo-Sclerotherapy (CLaCS) is a technique which combines thermal sclerotherapy and injection sclerotherapy. Telangiectasias and small varicosities are targeted by a transdermal laser and right after receive injection sclerotherapy. A cooling device blows -20°C air onto the skin and needle in a pre-, parallel-, and post-fashion. OBJECTIVE: Our objective was to establish if there is a difference in result and complications by varying the sclerosing agent but keeping the same ND:Yag long pulse laser parameters in the treatment of small varicosities. METHODS: Fifty five patients were enrolled prospectively and randomized to two groups; in the group 1 dextrose 75% was the sclerosing agent used in combination with the ND:Yag long pulse laser and, in the group 2, the same laser technique was used but the sclerosing agent was polidocanol 0.3% and dextrose 67%. RESULTS: The results were evaluated 30 days after the treatment by the patients and for blinded evaluators using before and after standardized photos with and without augmented reality. In the patient's perspective and in the blinded evaluation of the regular photos, no differences between the groups were found. Both groups had low rates of hyperpigmentation and bruising with no statistical difference. Patients treated with polidocanol had less pain after the treatment and a better clearance rate in the photos with augmented reality. No major complications were found. CONCLUSION: The treatment of small varicosities with CLaCS using Dextrose 75% or polidocanol 0.3% and Dextrose 67.5% is a safe and effective procedure and both sclerosing agents can be used with similar results. Possibly, in the polidocanol group more nonvisible reticular veins were cleared, but the implication of this find is not clear.

The impact of lower limb chronic venous disease on quality of life: patient and physician perspectives.

Aim: This research compared patient and physician perceptions of quality of life (QoL) in C0-4 chronic venous disease (CVD). Methods: Qualitative standardized phone interviews were conducted with 100 patients and 60 specialists from Brazil, China, the Czech Republic, Italy and Russia. Results: In addition to the impact of physical symptoms on QoL, patient interviews revealed a high aesthetic and emotional burden of C0-4 CVD that contributes to social isolation and affects relationships. Physicians were aware of the physical impact but underestimated the other implications of CVD on their patients' QoL. Conclusion: Healthcare professional awareness of the overall impact of CVD on QoL needs improvement. All aspects of QoL should be assessed in order to manage CVD effectively.

Chronic venous disease (CVD) is a progressive condition that occurs when the functioning of the veins, which are blood vessels that move blood back to the heart, is compromised, leading to swelling and other physical changes in the legs. CVD can be debilitating to those who suffer from it, so the authors surveyed 100 people with CVD as well as 60 physicians who treat them to understand more about the impact of this disease. The authors found that CVD affects people not only physically but also aesthetically and emotionally, which impacts on relationships and leads to social isolation. Physicians are aware of the physical impact of CVD but often underestimate other burdens their patients might experience, so the authors suggest that physicians consult their patients on these aspects when treating them.

One-Year First-in-Human Success for VenoValve in Treating Patients With Severe Deep Venous Insufficiency.

OBJECTIVE: The clinical outcomes of this first-in-human (FIH) study provide safety and performance results 1 year after implantation of the VenoValve. BACKGROUND: Chronic venous insufficiency (CVI) is most often caused by valve failure in the venous system, which circulates blood from the lower limbs back to the heart and lungs. Severe diseases significantly influence quality of life, and current treatment options are limited. This study provides 1-year patient outcomes from 11 patients implanted with the VenoValve for treatment of severe deep venous CVI in C5 and C6 patients. Earlier results from 6-month follow-ups were previously published. METHODS: This prospective FIH study assessed the safety and performance of the VenoValve surgically implanted in 11 patients with C5 and C6 disease. All patients were followed up for at least 1 year. Assessments for adverse events, reflux time, disease severity, pain scores, and quality of life were reported. RESULTS: Implantation of VenoValve into the deep femoral vein was successful in all patients. Adverse events included 1 hematoma, 3 superficial wound infections, and 1 bleeding complication due to over-anticoagulation. One VenoValve became occluded due to patient non-compliance with anticoagulation medication. One-year clinical outcomes included significant decreases in mean reflux times (54%), and significant improvements in mean disease severity revised venous clinical severity score (56%), mean visual analog scale pain scores (76%), and Venous Insufficiency Epidemiologic and Economic Study QOL/sym scores. CONCLUSIONS: The promising results from this FIH study demonstrate sustained safety and effectiveness of the VenoValve at 1 year post-implantation, and support further study for its use as a novel treatment for severe, deep venous CVI caused by valvular incompetence. A pivotal, prospective, non-blinded, single-arm, multi-center study in the United States with seventy-five (75) patients is in progress to assess the safety and effectiveness of VenoValve in these patients through 30 days and 6 months. The clinical trial is registered on ClinicalTrials.gov under identifier: NCT04943172 (https://clinicaltrials.gov/ct2/show/NCT04943172?term=hancock+jaffe&draw=2&rank=1).

Association between obesity and the aggravation of limited range of ankle mobility in chronic venous disease.

AIM: The aim of the present study was to show that an increase in weight leads to the aggravation of limited joint mobility. METHOD: One hundred sixteen patients with varicose veins of the lower limbs and body mass index (BMI) higher than 30 kg/m2 were evaluated at the Belczak Clinic in Maringá, Brazil. All patients were evaluated by the same physician, and the goniometric readings were performed on all patients by a physiotherapist. The participants were then divided into three groups based on BMI: Group I-BMI between 30 and 40. Group II-BMI between 40 and 50, and Group III-BMI > 50. RESULTS: There is a significant difference between the groups detected. CONCLUSION: The present findings show that an increased BMI in obese individuals with chronic venous disease is associated with a progressive limitation of ankle mobility.

Differences in health-related quality of life in patients with mild and severe chronic venous insufficiency: A systematic review and meta-analysis.

OBJECTIVE: Chronic venous insufficiency (CVI) has a broad spectrum of clinical expression, ranging from mild to severe cases, which negatively impacts the health-related quality of life (HRQoL). However, the comparison in HRQoL between mild and severe CVI has not yet been systematically discussed, which could assist in the adoption of preventive strategies METHODS: A systematic review and meta-analysis was conducted (protocol register https://osf.io/mr4aj/) following a search of the MEDLINE, CINAHL, Web of Science, LILACS, and Scopus databases, using the terms related to CVI and HRQoL. Observational studies that assessed the HRQoL in individuals with CVI in different degrees of severity were included, without date restriction RESULTS: We retrieved 4750 titles and abstracts and 9 were included in this review. The HRQoL was worse in patients with severe CVI compared to mild patients at Short-form of Health Survey (SF-36) (mean difference 11.02, 95% CI from 8.62 to 13.43; p<0.001), Chronic Venous Insufficiency Quality Of Life Questionnaire (CIVIQ-14) (mean difference 13.07; 95% CI from 11.33 to 14.82; p<0.001) and Aberdeen Varicose Veins Questionnaire (mean difference 7.7; 95% CI: -12.82 to -2.58; p=0.003), especially in the physical domains. There was no difference in the HRQoL between severe and mild patients at CIVIQ-20 (p=0.09) CONCLUSION: The HRQoL was worse in the physical domains in patients with severe CVI when compared to mild patients. However, the heterogeneity of the results was high and the data should be interpreted with caution.

Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia.

BACKGROUND: The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. OBJECTIVES: To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. METHODS: We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. RESULTS: In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01-7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. CONCLUSIONS: Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.

Hemorragia fatal de una ulcera venosa crónica: Reporte de un caso / Fatal bleeding from a chronic venous ulcer: case report

Resumen La enfermedad venosa crónica es un trastorno común que se manifiesta con una amplia gama de signos. En casos en los que la enfermedad adquiere gravedad se le denomina insuficiencia venosa crónica y esta puede llevar al desarrollo de una úlcera venosa. Un trauma directo o la erosión de una vena varicosa pueden llevar a una hemorragia que, aunado a enfermedades crónicas concomitantes, factores toxicológicos, sociales o primeros auxilios inadecuados pueden llevar a la muerte en pocos minutos y en un escenario del crimen que puede ser confuso a primera vista para el equipo forense. Se reporta un caso valorado en la Sección de Patología Forense del Departamento de Medicina Legal del Poder Judicial de Costa Rica en el que se realizó una autopsia completa. Dentro de los hallazgos más importantes a nivel macróscopico se evidenció una úlcera cónica de características venosas en la pierna derecha en la cual, mediante la disección por planos y la inyección de colorante en la vena safena magna, se observó la salida de este por una vena varicosa relacionada con la úlcera.

Abstract Chronic venous disease is a common disorder that shows a large spectrum of signs. In cases in which the disease acquires severity it is named chronic venous insufficiency, and it can cause the development of a venous ulcer. Direct trauma to or erosion of a varicose vein can lead to a hemorrhage that, in combination with coexistent conditions, toxicologic or social factors, or inadequate first aid can produce death in few minutes and a crime scene which might be confusing at first sight to the forensics team. We present a case handled by the Forensic Pathology Section of the Department of Legal Medicine of the Judicial Power of Costa Rica in which a complete autopsy was performed. Among the most relevant macroscopic findings was evidence of a chronic ulcer with venous characteristics on the right leg, in which dissection by planes and dye injection into the great saphenous vein showed leakage of this dye out of a varicose vein related to the ulcer.

Avaliação da termoablação com endolaser da veia safena parva com anestesia local / Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia

Resumo Contexto Na insuficiência venosa crônica (IVC), a veia safena parva (VSP) é afetada em 15% dos casos. A cirurgia convencional é a técnica padrão para o tratamento da insuficiência da VSP, sendo a lesão no nervo sural uma complicação bastante temida. O tratamento de termoablação com endolaser tende a ser um método cirúrgico que diminui complicações da terapia cirúrgica da IVC. Objetivos Avaliar os pacientes com IVC submetidos à terapia por endolaser da VSP ao menos 30 dias após o procedimento. Métodos Foram analisados 54 membros inferiores de 46 pacientes submetidos à terapia por endolaser 1470 nm, sob anestesia local, para o tratamento da IVC em um hospital terciário. Os pacientes foram avaliados no período pré-operatório, intraoperatório e pós-operatório de 30 dias, através da clínica, exame físico e achados ecográficos. Resultados Nos 54 membros inferiores submetidos ao tratamento, comparando-se o período pré-operatório e o 30º dia pós-operatório, houve diferença significativa (p < 0,003) na redução do diâmetro da VSP tratada (6,37 mm pré-operatório e 5,15 mm no 30º dia pós-operatório) (IC95% 4,58-5,72) e na melhora do escore de gravidade clínica venosa (VCSS) (média de 8,02 pré-operatório e 6,11 no 30º dia pós-operatório) (IC95% 5,01-7,21) (p < 0,02). Complicações pós-operatórias, como parestesia e flebite, estiveram presentes e foram diagnosticadas em cinco e três pacientes, respectivamente, sem significar alteração na qualidade de vida e nas atividades de rotina. Conclusões A técnica de termoablação com laser da VSP mostrou-se segura e eficaz na redução dos sintomas clínicos e na melhora da qualidade de vida.

Abstract Background The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01—7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.

Time trends and social security burden of temporary work disability due to chronic venous disease in Brazil.

BACKGROUND: Chronic venous disease (CVD) and disability are worldwide problems and have significant socioeconomic implications. This study aims to analyze the time trends and social security burden of temporary work disability due to CVD in Brazil. METHODS: An ecological time series study using the Brazilian Social Security System database was performed from 2005 to 2014. Data from all benefits granted to workers with temporary disability due to CVD were analyzed. The cases were identified using diagnosis codes I83-I83.9 of the International Classification of Diseases 10th Revision (ICD-10). The time trend analyses were performed by the Joinpoint Regression Model, with sex, age, regions, income, and category of affiliation as variables. Crude and age-standardized rates were calculated. RESULTS: A total of 429,438 benefits were granted for temporary work disability due to CVD from 2005 to 2014, with a growing trend and an age-standardized annual percent change (APC) of 3.4 (95% CI: 2.6-4.2) (p < 0.05). Social security expense increased 3.5-fold, and the number of days in benefit doubled from 2005 to 2014. In total, 27,017,818 working days were lost. The average duration of benefits was 55.3 days. The majority of workers were women (68.2%) (p < 0.001), between 30 and 59 years old, employed, had a monthly income ≤2 minimum wages (MW) (83.2%), and lived in the regions southeast (53.6%) and south (29.3%). Significantly higher APCs were observed for women than for men (APC: 4.9, 95% CI: 4.0-5.7 versus APC: 1.2, 95% CI: 0.1-2.4). All regions in Brazil had a significant growing trend, except in the north. No significant growth was observed in the age group of 60-69 years. A decreasing trend was observed in workers with monthly incomes above 2 MW (p < 0.05). CONCLUSIONS: Temporary work disability due to CVD and social security burden showed increasing trends with millions of working days lost, particularly among women and low-income workers. Preventing disability is challenging, and public policies are needed to reduce the social and economic impact of disability. Therefore, measures for promoting health at the workplace should be encouraged.

CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results.

There is considerable debate in the literature with relation to the best method to treat patients with chronic venous disease (CVD). CHIVA is an office-based treatment for varicose veins performed under local anesthesia. The aim of the technique is to lower transmural pressure in the superficial venous system and avoid destruction of veins. Recurrence of varicosities, nerve damage, bruising and suboptimal aesthetic results are common to all treatments for the disease. This paper evaluates and discusses the characteristics and results of the CHIVA technique. We conclude that CHIVA is a viable alternative to common procedures that is associated with less bruising, nerve damage, and recurrence than stripping saphenectomy. The main advantages are preservation of the saphenous vein, local anesthesia, low recurrence rates, low cost, low pain, and no nerve damage. The major disadvantages are the learning curve and the need to train the team in venous hemodynamics.

Existe uma grande discussão na literatura sobre o tratamento da doença venosa crônica (DVC). A cura conservadora e hemodinâmica da insuficiência venosa em ambulatório (CHIVA) consiste no tratamento ambulatorial de varizes sob anestesia local. O objetivo da técnica é diminuir a pressão transmural no sistema venoso superficial para evitar a destruição das veias, incluindo as veias safenas. Recorrência de varizes, lesão de nervos, hematomas e resultado estético abaixo do ideal são uma constante em todos tratamentos de varizes. O objetivo desta revisão é avaliar e discutir a técnica CHIVA quanto a suas características e resultados. A CHIVA é uma alternativa válida frente aos outros procedimentos, apresentando menos hematomas, recorrência e lesão nervosa que a safenectomia. Preservação da veia safena, anestesia local, baixa taxa de recorrências, baixo custo, pouca dor e ausência de lesões nervosas são as principais vantagens. A longa curva de aprendizado para treinar a equipe em hemodinâmica venosa é a principal desvantagem.

Micronized Purified Flavonoid Fraction (MPFF) for Patients Suffering from Chronic Venous Disease: A Review of New Evidence.

Chronic venous disease (CVD) is both prevalent and unavoidable in many people as a result of persistent or unalterable risk factors, the most important of which are advanced age, excess body weight, and family history. Given this inevitability, medical treatment is required to alleviate symptoms and slow disease progression. Venoactive drug therapy is emerging as a valuable treatment option for many CVD patients and micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available. Recent evidence from animal models of venous hypertension and from clinical trials, as well as from systematic reviews, shows that MPFF is effective at alleviating many of the most common symptoms of CVD including leg pain, leg heaviness, sensations of swelling, cramps, and functional discomfort. In addition, MPFF improves the clinical signs of redness, skin changes, and edema, and improves quality of life. Collectively, these findings support the strong recommendation for MPFF treatment found in the 2018 international guidelines for the management of CVD.Funding: Servier.

CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results / CHIVA para tratar insuficiência de veia safena em doença venosa crônica: características e resultados

There is considerable debate in the literature with relation to the best method to treat patients with chronic venous disease (CVD). CHIVA is an office-based treatment for varicose veins performed under local anesthesia. The aim of the technique is to lower transmural pressure in the superficial venous system and avoid destruction of veins. Recurrence of varicosities, nerve damage, bruising and suboptimal aesthetic results are common to all treatments for the disease. This paper evaluates and discusses the characteristics and results of the CHIVA technique. We conclude that CHIVA is a viable alternative to common procedures that is associated with less bruising, nerve damage, and recurrence than stripping saphenectomy. The main advantages are preservation of the saphenous vein, local anesthesia, low recurrence rates, low cost, low pain, and no nerve damage. The major disadvantages are the learning curve and the need to train the team in venous hemodynamics

Existe uma grande discussão na literatura sobre o tratamento da doença venosa crônica (DVC). A cura conservadora e hemodinâmica da insuficiência venosa em ambulatório (CHIVA) consiste no tratamento ambulatorial de varizes sob anestesia local. O objetivo da técnica é diminuir a pressão transmural no sistema venoso superficial para evitar a destruição das veias, incluindo as veias safenas. Recorrência de varizes, lesão de nervos, hematomas e resultado estético abaixo do ideal são uma constante em todos tratamentos de varizes. O objetivo desta revisão é avaliar e discutir a técnica CHIVA quanto a suas características e resultados. A CHIVA é uma alternativa válida frente aos outros procedimentos, apresentando menos hematomas, recorrência e lesão nervosa que a safenectomia. Preservação da veia safena, anestesia local, baixa taxa de recorrências, baixo custo, pouca dor e ausência de lesões nervosas são as principais vantagens. A longa curva de aprendizado para treinar a equipe em hemodinâmica venosa é a principal desvantagem

Tradução e adaptação cultural do questionário ABC-V (Assessment of Burden in Chronic-Venous Disease) para o português / Portuguese translation and Brazilian cultural adaptation of the Assessment of Burden in Chronic Venous Disease questionnaire (ABC-V)

INTRODUCTION: The Assessment of Burden in Chronic Venous Disease questionnaire (ABC-V) is a valuable tool for assessing the impact that chronic venous disease (CVD) has on patients' quality of life (QL). There was a need for a translated and adapted version suitable for use in the Brazilian population. CVD is becoming a public health issue as the incidence and prevalence are high. The ABC-V can be used to collect information on patients' QL and thus the development of a Brazilian version that facilitates research into the CVD population. OBJECTIVE: To provide translation and cultural validation of the Assessment of Burden in Chronic-Venous Disease (ABC-V) questionnaire for the Portuguese language. METHODS: The ABC-V was translated into Portuguese by two bilingual translators working independently. The translators then created a consensus version, which was translated back into English by two native English speakers. Finally all the versions were analysed by a committee of with expertise in translation and the two cultures involved. The committee produced a draft Portuguese-language version which was tested in a pilot sample of between 30 and 40 people. The committee evaluated feedback from the pilot sample on the clarity and comprehensibility of the draft version RESULTS: The draft version was completed by 31 patients at the Chronic Venous Diseases Department of Padre Anchieta's Teaching Hospital. With the analysis of the questionnaires used in the pre-test, it is possible to observe that in English, unlike Portuguese, verbs are often used in the passive tense. It also emerged that there was a need to use more colloquial terms and expressions so that the question would be easier to understand, whilst preserving the meaning of the original items. Changing the tone of the questionnaire in this way should make it more suitable for use with people from a wide range of socioeconomic levels, especially those with lower social status and less education. Because the questions are qualitative rather than quantitative they are more open to interpretation and elicit more subjective responses. This creates an additional difficulty in adapting the questionnaire for the Brazilian cultural context. The data from pilot-testing of the draft version was used to develop a translated and culturally adapted version of the ABC-V. CONCLUSION: A translated and culturally adapted version of the ABC-V suitable for use in Brazil has been developed and can be used to evaluate changes in the QL of Brazilian patients with CVD.

INTRODUÇÃO: O questionário ABC-V (Assessment of Burden in Chronic Venous Disease) representa uma importante ferramenta na avaliação da carga que a Doença Venosa Crônica (DVC) inflige na qualidade de vida (QV) de seus portadores. No entanto, para que ele possa ser empregado no estudo da população brasileira, primeiramente deve ser submetido a um processo de tradução e adaptação. A DVC apresenta alta incidência e prevalência, se tornando uma questão relevante à saúde pública. Desta forma, o questionário ABC-V ao buscar avaliar a DVC e influência na QV dos pacientes, qualifica diferentes aspectos e cria um parâmetro para que essa população afetada possa ser melhor estudada. OBJETIVO: Prover tradução e validação cultural do questionário Assessment of Burden in Chronic-Venous Disease (ABC-V) para a língua portuguesa. MÉTODO: O questionário ABC-V passou por duas traduções independentes para o português, por dois tradutores bilíngües. Em seguida, os tradutores deram origem a uma versão consensual, que foi retrotraduzida por dois tradutores de língua nativa inglesa, sendo geradas as versões retro traduzidas. Posteriormente, todas as versões foram submetidas à análise por um comitê de profissionais especialistas em tradução e na cultura dos países da versão original e da brasileira, e os tradutores envolvidos. O comitê produziu a versão pré-final em português, para o pré-teste. Consequentemente, deu-se o teste da versão pré-final do questionário, sendo testado em um N entre 30 e 40 pessoas. Finalmente, o comitê anteriormente formado reavaliou todos os relatórios feitos durante o processo e analisou se houve dificuldade de entendimento do questionário por parte dos indivíduos nos quais foi aplicada a versão pré-final. RESULTADOS: Foram entrevistados 31 pacientes na fase de Pré-teste no ambulatório de Doenças Venosas Crônicas do Hospital de Ensino Padre Anchieta. Com a análise dos questionários empregados no Pré teste, pode-se observar o fato de que na língua inglesa usam-se muito os verbos no tempo passivo, diferentemente do que acontece na língua portuguesa. Dessa forma percebeu-se a necessidade de usar termos e expressões mais coloquiais para que houvesse melhor compreensão das perguntas, porém sem alterar o sentido do autor e também para que sua intenção fosse mantida, principalmente para que o questionário possa ser adequado a diferentes níveis socioeconômicos, sobretudo àqueles com nível social e educacional mais baixo. Pelo fato de as perguntas não serem quantitativas e sim qualitativas, elas acabam dando maior abertura a interpretações diferentes e dependem da subjetividade de cada entrevistado, sendo relacionadas muito a "o que você pensa de", "como você percebe tal coisa", e isso também se apresentou como fator de dificuldade para realizarmos a adaptação do questionário à realidade da população brasileira. Com os resultados obtidos da fase de Pré Teste foi então elaborada a versão traduzida e adaptada culturalmente do questionário ABC-V. CONCLUSÃO: O questionário ABC-V foi amplamente traduzido e adaptado culturalmente para a língua portuguesa, estando apto para ser empregado no Brasil para avaliar a melhora da qualidade de vida em pacientes portadores de doença venosa crônica.

The clinical importance of air plethysmography in the assessment of chronic venous disease / Importância clínica da pletismografia a ar na avaliação da doença venosa crônica

Abstract Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

Resumo A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.

The clinical importance of air plethysmography in the assessment of chronic venous disease.

Air plethysmography is a non-invasive test that can quantify venous reflux and obstruction by measuring volume changes in the leg. Its findings correlate with clinical and hemodynamic measures. It can quantitatively assess several components of venous hemodynamics: valvular reflux, calf muscle pump function, and venous obstruction. Although clinical uses of air plethysmography have been validated, it is used almost exclusively for medical research. Air plethysmography can be used to assess chronic venous disease, to evaluate improvement after venous surgery, to diagnose acute and past episodes of deep venous thrombosis, to evaluate compression stocking therapy, to study the physiological implications of high-heeled shoes in healthy women, and even to evaluate the probability of ulcer healing.

A pletismografia a ar é um método não invasivo que pode quantificar refluxo e obstrução venosa medindo alterações no volume das pernas. Seus achados se correlacionam com parâmetros clínicos e hemodinâmicos. Ela pode fornecer informações quantitativas dos diferentes componentes da hemodinâmica venosa: refluxo valvular, função de bomba muscular da panturrilha e obstrução venosa. Apesar de ter seu uso clínico validado, a pletismografia a ar é usada quase que exclusivamente para pesquisa. Ela pode ser usada para avaliar a doença venosa crônica, mensurar o ganho hemodinâmico após cirurgia venosa, diagnosticar trombose venosa profunda atual ou prévia, avaliar os efeitos da elastocompressão, estudar as implicações fisiológicas do uso de salto alto em mulheres e também avaliar a probabilidade de cura de uma úlcera venosa.

Use of pure diosmin 600 mg in chronic venous disease: a review of the literature / Utilização de diosmina 600 Mg na insuficiência venosa crônica: revisão da literatura

Chronic Venous Disorder (CVD) is a term used to represent all abnormal clinical changes that result from venous disease of the lower extremities, and that have a chronic pattern. This disease has a documented socioeconomic impact, involving a significant part of the western populations, and consuming 2-3% or more of societies? health budgets. This review of the literature focuses on diosmin, a benzopyrone phlebotonic, specifically mechanisms of action as well as preclinical and clinical evidence.