Effect of compression stockings on cutaneous microcirculation: Evaluation based on measurements of the skin thermal conductivity.

OBJECTIVE: To study of the microcirculatory effects of elastic compression stockings. MATERIALS AND METHODS: In phlebology, laser Doppler techniques (flux or imaging) are widely used to investigate cutaneous microcirculation. It is a method used to explore microcirculation by detecting blood flow in skin capillaries. Flux and imaging instruments evaluate, non-invasively in real-time, the perfusion of cutaneous micro vessels. Such tools, well known by the vascular community, are not really suitable to our protocol which requires evaluation through the elastic compression stockings fabric. Therefore, we involve another instrument, called the Hematron (developed by Insa-Lyon, Biomedical Sensor Group, Nanotechnologies Institute of Lyon), to investigate the relationship between skin microcirculatory activities and external compression provided by elastic compression stockings. The Hematron measurement principle is based on the monitoring of the skin's thermal conductivity. This clinical study examined a group of 30 female subjects, aged 42 years ±2 years, who suffer from minor symptoms of chronic venous disease, classified as C0s, and C1s (CEAP). RESULTS: The resulting figures show, subsequent to the pressure exerted by elastic compression stockings, an improvement of microcirculatory activities observed in 83% of the subjects, and a decreased effect was detected in the remaining 17%. Among the total population, the global average increase of the skin's microcirculatory activities is evaluated at 7.63% ± 1.80% (p < 0.0001). CONCLUSION: The results from this study show that the pressure effects of elastic compression stockings has a direct influence on the skin's microcirculation within this female sample group having minor chronic venous insufficiency signs. Further investigations are required for a deeper understanding of the elastic compression stockings effects on the microcirculatory activity in venous diseases at other stages of pathology.

A French-Italian survey on the prevalence of isolated varices (C2) and complicated varices (C2+). Results of a multi-centre study conducted by the SFA and the SFP under the auspices of the European Venous Forum.

AIM: The advanced CEAP classification allows one to differentiate between isolated varicose veins (C2) and complicated varicose veins (C2, 3 - C2, 3, 4 - C2, 4 or C2, 3, 4, 5 etc) named (C2+). METHODS: The main objective of this study was to identify when using the advanced classification the prevalence of isolated varicose veins (C2) and complicated varicose veins (C2+) among patients consulting vascular specialists and to compare their symptomatic status and the data issued from the advanced CEAP including also the headings, Anatomy (A), Etiology (E) and Pathophysiology (P). RESULTS: 171 patients were evaluated, 100 in France and 71 in Italy. The prevalence of C2 and C2+ was the same in both countries: 64.4% in France and 63.3% in Italy. Also no difference was found in the prevalence of other descriptors: etiology, anatomy or pathophysiology. The time to complete the advanced form was less than 5 minutes for 65% of the investigators. CONCLUSION: The advanced CEAP is easy to use in daily pratice. We have the same prevalence of patients in France and in Italy, who consulted for isolated varicose veins or associated with other signs of chronic venous disorders.

[Recurrent varicose veins in the groin after surgery]. / Les récidives au pli de l'aine après chirurgie des varices.

Recurrence of varicose veins following surgery of the long saphenous system are common. It is important to differentiate several causes. These, in fact, dictate the therapeutic decision. Physiopathologically, there are different types of recurrences: persistent reflux from the femoral veins into the superficial varicose network due to: an incomplete long sapheno-femoral high ligation (crossectomy), a neoangiogenesis at the level of the previous sapheno-femoral junction. separate termination of an incompetent long saphenous vein (LSV) into the common femoral vein or the superficial femoral vein (antero lateral or postero medial tributaries of LSV); persistent reflux from perineal and (or) paricto-abdominal veins into the varicose network of the thigh. Dynamic popliteal phlebography was, until the advent of echo-doppler, the author's method of choice for investigation as it was easier to interpret than varicography. At the present time it is only requested on the rare occasions where doubt persists even after echo-doppler. Additionally, with this investigation, the reflux (major or minor) can be analysed at its point of origin and a map of the underlying varicose network can be drawn. Therapeutically, we make the following suggestions: in the presence of a site of major reflux (incomplete crossectomy, high flow neoangiogenesis, separate termination of the saphenous tributaries), a further operation would be justified. The removal of the site of reflux can be associated with the placing of a PTFE patch on the common femoral vein. in the presence of a site of minor reflux, sclerotherapy or, preferably, echosclerotherapy would appear to be the treatment of choice. Elimination of the site (s) of reflux must be associated with suppression of the underlying varicose network by sclerotherapy or phlebectomy.

[Pre- and postoperative contribution of Doppler ultrasonography in superficial venous surgery of the popliteal fossa]. / Apport de l'écho-Doppler pré et postopératoire dans la chirurgie veineuse superficielle de la fosse poplitée.

AIMS OF THE STUDY: Does preoperative Duplex Scan (DS) allow to determine anatomy of the ending of the short saphenous vein (SSV), gastrocnemius vein (GV) and reflux in popliteal vein (PV), SSV and GV. Postoperative DS was performed to detect deep vein thrombosis (DVT) and GV thrombosis. MATERIAL AND METHODS: From June 94 to November 95 one hundred and eighty lower limbs operated for SSV were included consecutively and prospectively. Mean age in these 154 patients was 52 yr (24-80) with a sex ratio 4F/1M. An anatomical classification was previously defined. Type A: separate termination of SSV and GV; Type B: common ostium of SSV and GV in the popliteal vein; Type C: common trunk of the SSV and GV; Type D: Others. Forty-eight limbs (26.10%) had ligation of GV: 21 (11.10%) for reflux and 27 (16%) for anatomical or surgical reasons. Ten type A with GV reflux (10/31 = 32%) were not treated. Eighty two patients (45%) received preventive low molecular weight heparin (LMWH) treatment including the 48 limbs whose GV were ligated. RESULTS: Anatomical correlation between DS and surgery findings were calculated. Positive predictive values of DS in the different types were: A, 77%; B, 68%; C, 90%; D, 79%. That gave a global predictive value of 80%. Two limited DVT were identified in group D by postoperative DS (2/10 = 1.1%). These two patients had complete recanalization of PV without reflux. In the group of limbs which had ligation of GV we identified 37.5% of GV thrombosis. In the group without ligation of GV we found 3% of GV thrombosis. CONCLUSION: Duplex scanning appears to be the investigation of choice before surgery for superficial vein incompetence in the popliteal fossa. It is a reliable investigation to determine termination patterns of SSV and GV (80%). It brings to the surgeon essential information which helps in the management of surgical procedure and particularly to ligation of gastrocnemius veins. But at this time there is no consensus on this point. The occurrence of DVT after SSV surgery including GV ligation was very low. Two questions remain: is anticoagulation necessary in all patients or selective after surgery of the SSV? is Duplex Scan mandatory during postoperative monitoring? On the basis of this study, one recommendation can be made: A routine postoperative DS is necessary after ligation of the GV or when the dissection of the popliteal fossa has been extensive (Type D).

[Understanding the poor results after surgery for superficial venous insufficiency]. / Comprendre les mauvais résultats après chirurgie de l'insuffisance veineuse superficielle.

Effectiveness and value of surgical treatment in varicose veins remains difficult to assess for many reasons. They are discussed in details in front of this general review devoted to poor results after varicose vein surgery. An other pathology is often associated with venous insufficiency and is frequently missed and responsible of poor results. Many factors contribute to make uneasy assessment of poor results. The lack of objective criteria to appreciate the natural evolution of varicose disease different from one patient to another. The difficulty to grade clinical disease severity. Results published before the use of modern preoperative investigations make their report obsolete. Precise data of surgical treatment undertaken are often not detailed. The quality of therapists (surgeon or phlebologist) is uneasy to check. The difficulty to assess results after treatment: subjective results (patient) vs objective results (audit). Duration of follow-up. Imprecise vocabulary to qualify results. Clinical assessment remains the cornerstone but supplementary investigations must be undertaken. Duplex-Scan is currently accepted as the gold standard investigation. Phlebography or (and) plethysmography can be helpful in some cases. After detailed assessment patients can be classified in different groups. This classification allows to determinate the most adequate treatment. In some selected patients redosurgery is strongly recommended. Prevention of recurrence after surgical treatment of varicose veins can not be complete. Strict respect of several rules can however reduce it. They can be summarised as follows: Respect of temporary of definitive contraindications to surgical treatment. Thorough investigation before surgery. Preoperative precise aim of what must be treated by the surgical procedure. Correct operative procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effectiveness of combined repeat surgery and sclerotherapy after failure of surgical treatment of varicose veins]. / Valeur de l'association chirurgie itérative-sclérothérapie après échec du traitement chirurgical des varices.

UNLABELLED: From January 1985 to December 1986 one hundred and five patients (145 lower limbs) have been treated by redosurgery followed by sclerotherapy. It is a selected group because redosurgery decision was taken both by surgeon and angiologists on the basis that a significant reflux between the profunda system and the superficial system was present. The aim of this retrospective study was to assess results obtained by this therapeutic association with a follow-up from 5 to 6 years. Failure mechanisms of initial treatment, symptoms, preoperative investigations, redosurgery procedures are analysed. Results were estimated both by a questionnaire and an independent audit. Patient estimation: symptoms improvement 65%; cosmetics improvement 68%. Audit estimation: SYMPTOMS: excellent or good results: 78%, fair results: 12%, poor results: 10%. Cosmetics: excellent or good results: 30%, fair results: 53%, poor results: 17%. 82% of patients plebiscited redosurgery in cooperation with sclerotherapy.

[Significance of photoplethysmography in the diagnosis of deep venous insufficiency]. / Intérêt de la photopléthysmographie dans le diagnostic de l'insuffisance veineuse profonde.

In chronic venous insufficiency, photoplethysmography, in addition to the clinical and Doppler examinations, offers important informations in the differential diagnosis between deep and superficial venous insufficiency. It is a simple, reproductible, non invasive test with data similar to venous pressure measurements. Photoplethysmography permits to set up quantitative criteria of venous insufficiency. It establishes the role of reflux in the dysfunction of the leg venous pump, and makes it possible to adjust for prescription of additional explorations, in particular popliteal or femoral dynamic phlebography. Furthermore, photoplethysmography offers a solid criterion to differentiate between various therapeutic surgeries: surgery of the superficial network, surgery of collateral veins, surgery to restore the deep venous network. Moreover, photoplethysmography is a useful tool to quantitatively appreciate the results of the venous insufficiency treatment. In conclusion, photoplethysmography appears as an additional examination necessary for functional exploration in chronic venous insufficiency. Its use in practical angiology is going to develop in view of its interesting results and its reasonable cost.