A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments.

The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents.Key teaching pointsChronic venous disease is a pathological state of vein circulatory systems of the lower limbsProlonged standing and obesity are the major reason for varicose vein diseaseEndovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veinsVenoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disordersPhlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiencyFood rich in phytoconstituents are more effective in varicose veins.

Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes / Positive perception and efficacy of compression stockings for prevention of lower limb edema in pregnant women

Resumo Contexto A gravidez é caracterizada por mudanças fisiológicas que podem contribuir para o desenvolvimento de varizes, insuficiência venosa e edema das pernas. Objetivos Avaliar o efeito das meias de compressão em edema de membros inferiores e a percepção sobre o uso por gestantes. Métodos Trata-se de um ensaio clínico randomizado, controlado, prospectivo, paralelo e cego realizado com 60 mulheres grávidas distribuídas aleatoriamente em dois grupos: grupo intervenção (n = 30), que usou meias de compressão, e grupo controle (n = 30). Foram realizadas medições padronizadas de tornozelo e panturrilha, empregando-se fita métrica, em todos os 120 membros inferiores. No final do estudo, foi aplicado também um questionário para verificação das dificuldades e vantagens percebidas com relação ao uso das meias de compressão. Resultados As gestantes do grupo intervenção apresentaram aumento significativamente menor (p < 0,05) nos diâmetros de panturrilha e tornozelo em relação ao grupo controle. As diferenças médias, no início e no final da gestação, nos diâmetros de panturrilha direita, panturrilha esquerda, tornozelo direito e tornozelo esquerdo foram de, respectivamente, 0,30 cm, 0,30 cm, 0,15 cm e 0,15 cm no grupo intervenção e 1,95 cm, 1,95 cm, 1,73 cm e 1,87 cm no grupo controle. A maioria das gestantes não teve dificuldade para utilizar as meias de compressão, e todas relataram que sentiram diferença nos sintomas das pernas e que usariam as meias novamente. Conclusões As meias de compressão foram eficazes na prevenção de edema em membros inferiores de gestantes, as quais apresentaram percepção positiva quanto à sua utilização.

Abstract Background Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema. Objectives To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them. Methods This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings. Results Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again. Conclusions Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.

Feasibility and potential significance of prophylactic ablation of the major ascending tributaries in endovenous laser ablation (EVLA) of the great saphenous vein: A case series.

BACKGROUND: Recurrent varicosities after endovascular laser ablation (EVLA) of the great saphenous vein (GSV) are frequently due to varicose transformed, initially unsealed major ascending tributaries of the saphenofemoral junction (SFJ). Preventive ablation of these veins, especially the anterior accessory saphenous vein, is discussed as an option, along with flush occlusion of the GSV. However, few related data exist to date. METHODS: A consecutive case series of 278 EVLA procedures of the GSV for primary varicosis in 213 patients between May and December 2019 was retrospectively reviewed. The ablations were performed with a 1470 nm dual-ring radial laser and always included flush occlusion of the GSV, and concomitant ablation of its highest ascending tributaries by additional cannulation and ablation when this seemed anatomically appropriate. The initial technical success, comprising occlusion of the GSV and its major tributaries, was set as the primary endpoint. Possible determinants were explored using downstream multiple logistic regression analysis. RESULTS: The early technical success was 92.8%, with the GSV occluded in 99.6% and the highest ascending SFJ tributary, if present, in 92.4%. Additional ablations of ascending tributaries were performed in 171 cases (61.5%), the latter being associated with success (OR 10.39; 95% CI [3.420-36.15]; p < 0.0001). Presence of anterior as opposed to posterior accessory saphenous vein was another positive predictor (OR 3.959; 95% CI [1.142-13,73]; p = 0.027), while a confluence of the tributary in the immediate proximity to the SFJ had a negative impact (OR 0.2253; 95% CI [0.05456-0.7681]; p = 0.0253). An endothermal heat-induced thrombosis (EHIT) ≥ grade 2 was observed in three cases (1.1%). CONCLUSIONS: A co-treatment of the tributaries is feasible and could improve the technical success of EVLA if a prophylactic closure of these veins is desired, especially if their distance to the SFJ is short. Its effect on the recurrence rate needs further research.

Metformin reduces risk of varicose veins in patients with type 2 diabetes.

AIM: This population-based retrospective cohort study compared the incidence of varicose veins in an unmatched cohort and a cohort of 1:1 propensity score (PS)-matched pairs of ever and never users of metformin in type 2 diabetes patients. METHODS: Patients with new-onset type 2 diabetes during 1999 to 2005 were enrolled from Taiwan's National Health Insurance and followed until December 31, 2011. Analyses were conducted in an unmatched cohort of 123 710 ever users and 15 095 never users and in 15 088 PS-matched pairs of ever users and never users. Hazard ratios were estimated by Cox proportional hazards model incorporated with the inverse probability of treatment weighting using the PS. RESULTS: New-onset varicose veins were diagnosed in 126 never users and 633 ever users in the unmatched cohort and in 126 never users and 80 ever users in the matched cohort. The respective incidences were 191.36 and 110.04 per 100 000 person-years in the unmatched cohort and 191.41 and 115.81 per 100 000 person-years in the matched cohort. The hazard ratio for ever versus never users in the unmatched cohort was 0.57 (95% confidence interval, 0.47-0.69) and was 0.60 (0.45-0.80) for the matched cohort. In the unmatched cohort, the hazard ratios for the first, second, and third tertiles of cumulative duration were 1.03 (0.83-1.28), 0.55 (0.44-0.69), and 0.29 (0.23-0.37), respectively. The respective hazard ratios in the matched cohort were 0.97 (0.65-1.43), 0.79 (0.55-1.15), and 0.24 (0.13-0.42). CONCLUSION: Metformin use is associated with a lower risk of varicose veins in patients with type 2 diabetes.

J-curve association between alcohol intake and varicose veins in Japan: The Shimane CoHRE Study.

The effect of alcohol intake on varicose veins (VV) has not been determined by its consumption level. The aim of this study was to investigate the association between alcohol intake and VV in an elderly general population. Using a cross-sectional approach, the Shimane CoHRE Study data, comprising a total of 1060 participants, were analyzed. By multivariate regression analysis adjusted with basic characteristics, past work history, lifestyle-related factors and medical history, compared with non-drinkers, mild drinkers (<20.0 g/day) showed a significantly lower adjusted odds ratio (aOR) of VV (aOR = 0.64, P = 0.036). In a similar way, regular drinkers (1-5 days/week) showed a significantly lower aOR of VV when compared with occasional drinkers (aOR = 0.57, P = 0.032). VV and alcohol intake showed J-curve relationships. In a stratified analysis by alcohol consumption levels, the association of smoking and VV were also observed in moderate to heavy drinkers and habitual drinkers. These findings can provide better understanding of pathophysiological mechanism and be used for evidence-based patient education.

[Prophylaxis of Recurrent Venous Leg Ulcer]. / Rezidivprophylaxe des Ulcus cruris venosum.

Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.

[Transitory (evening) venous reflux in patients with intracutaneous varicosity and medicamentous correction thereof].

The authors carried out a study aimed at revealing transitory refluxes along the great saphenous vein (GSV) in patients with intracutaneous varicosity, and at investigating the possibility of removing them by means of preparations of micronized purified flavonoid fraction (MPFF). The study included a total of one hundred and forty-seven 21-to-47-year-old (mean age 31±4.4 years) women presenting with cutaneous varicosity (class C1s). The duration of skin manifestations amounted to 9.4±3.9 years (varying from 4 to 24 years). Telangiectasias were present in 69 (46.9%) women, 36 (24.5%) women had reticular varicosity, and 42 (28.6%) a combination thereof. An author-devised test was used with prolonged orthostatic load consisting in carrying ultrasound duplex scanning twice: in the evening after 6 p. m. and in the morning before 10 a.m., assessing the evening and morning parameters of the GSV, as well as the increment of the diameter of the vein at evening measurement as compared with the morning indices. Women with transitory refluxes along the GSV (n=59) underwent treatment with MPFF preparations (Detralex, Servier) during 60 days at a daily dose of 1,000 mg. The morning examination showed that there was no reflux along the GSV. The evening examination revealed refluxes along the GSV of various pattern and extent in 59 (40.1 %). All the 59 patients with evening refluxes presented complaints for increased fatigability, heaviness in the lower limbs by the end of the day. After 2 months of treatment, of the 59 women with initial reflux, 38 (64.4%) patients had no reflux and in 21 (35.6%) the extent of reflux decreased more than twofold. The evening diameter of the GSV decreased from 5.7 mm (95% CI 4.0-7.1) to 5.2 mm (95% CI 5.5-6.5) and the orthostatic gradient decreased from 0.9 mm (95% CD 0.6-1.3) to 0.6 mm (95% CI 0.4-0.8), p=0.000001. The initial complaints for heaviness in the legs after treatment disappeared in 76.6% of patients (50 of 59 subjects); in 9 women intensity of complaints decreased. The quality of life index decreased from 42 (95% CI 28-55) to 31 (95% CI 15-52) points (p=00001). Conclusions were drawn that in intracutaneous reflux in 40.1% of cases there appear transitory evening refluxes along the GSV revealed in the day-time orthostatic test. Taking MPFFs at a dose of 1,000 mg daily during 2 months removes evening transitory reflexes in 64.4% of cases and in 35.6% of cases decrease them, thus promoting contributing to decreased intensity of venous complaints and an increase in quality of life.

Varicose Remodeling of Veins Is Suppressed by 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors.

BACKGROUND: Despite the high prevalence of chronic venous insufficiency and varicose veins in the Western world, suitable pharmaceutical therapies for these venous diseases have not been explored to date. In this context, we recently reported that a chronic increase in venous wall stress or biomechanical stretch is sufficient to cause development of varicose veins through the activation of the transcription factor activator protein 1. METHODS AND RESULTS: We investigated whether deleterious venous remodeling is suppressed by the pleiotropic effects of statins. In vitro, activator protein 1 activity was inhibited by two 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, rosuvastatin and atorvastatin, in stretch-stimulated human venous smooth muscle cells. Correspondingly, both statins inhibited venous smooth muscle cell proliferation as well as mRNA expression of the activator protein 1 target gene monocyte chemotactic protein 1 (MCP1). In isolated mouse veins exposed to an increased level of intraluminal pressure, statin treatment diminished proliferation of venous smooth muscle cells and protein abundance of MCP1 while suppressing the development of varicose veins in a corresponding animal model by almost 80%. Further analyses of human varicose vein samples from patients chronically treated with statins indicated a decrease in venous smooth muscle cell proliferation and MCP1 abundance compared with samples from untreated patients. CONCLUSIONS: Our findings imply that both atorvastatin and rosuvastatin effectively inhibit the development of varicose veins, at least partially, by interfering with wall stress-mediated activator protein 1 activity in venous smooth muscle cells. For the first time, this study reveals a potential pharmacological treatment option that may be suitable to prevent growth of varicose veins and to limit formation of recurrence after varicose vein surgery.

A review of a new Dutch guideline for management of recurrent varicose veins.

In 2013, the new Dutch guideline for "Venous Pathology" was published. The guideline was a revision and update from the guideline "Diagnostics and Treatment of Varicose Veins" from 2009 and the guideline "Venous Ulcer" from 2005. A guideline for "Deep Venous Pathology" and one for "Compression Therapy" was added to the overall guideline "Venous Pathology." The chapter about treatment of recurrent varicose veins after initial intervention was recently updated in 2015 and is reviewed here. The Dutch term "recidief varices" or the French "récidive de varices" should be used analogous to the English term "recurrent varicose veins." The DCOP Guideline Development Group Neovarices concluded that "recidief" in Dutch actually suggests recurrence after apparent successful treatment and ignores the natural progression of venous disease in its own right. So the group opted to use the term "neovarices." In the Dutch guideline, neovarices is meant to be an all embracing term for recurrent varicose veins caused by technical or tactical failure, evolvement from residual refluxing veins or natural progression of varicose vein disease at different locations of the treated leg after intervention. This report reviews the most important issues in the treatment of varicose vein recurrence, and discusses conclusions and recommendations of the Dutch Neovarices Guideline Committee.

Interventions for varicose veins and leg oedema in pregnancy.

BACKGROUND: Pregnancy is presumed to be a major contributory factor in the increased incidence of varicose veins in women, which can in turn lead to venous insufficiency and leg oedema. The most common symptom of varicose veins and oedema is the substantial pain experienced, as well as night cramps, numbness, tingling, the legs may feel heavy, achy, and possibly be unsightly. Treatments for varicose veins are usually divided into three main groups: surgery, pharmacological and non-pharmacological treatments. Treatments of leg oedema comprise mostly symptom reduction rather than cure and use of pharmacological and non-pharmacological approaches. OBJECTIVES: To assess any form of intervention used to relieve the symptoms associated with varicose veins and leg oedema in pregnancy. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised trials of treatments for varicose veins or leg oedema, or both, in pregnancy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. MAIN RESULTS: We included seven trials (involving 326 women). The trials were largely unclear for selection bias and high risk for performance and detection bias.Two studies were placebo-controlled trials. The first one compared a phlebotonic (rutoside) with placebo for the reduction in symptoms of varicose veins; the second study evaluated the efficacy of troxerutin in comparison to placebo among 30 pregnant women in their second trimester with symptomatic vulvar varicosities and venous insufficiency in their lower extremities. Data from this study were not in useable format, so were not included in the analysis. Two trials compared either compression stockings with resting in left lateral position or reflexology with rest for 15 minutes for the reduction of leg oedema. One trial compared standing water immersion for 20 minutes with sitting upright in a chair with legs elevated for 20 minutes. Women standing in water were allowed to stand or walk in place. One trial compared 20 minutes of daily foot massage for five consecutive days and usual prenatal care versus usual prenatal care. The final trial compared three treatment groups for treating leg oedema in pregnancy. The first group was assigned to lateral supine bed rest at room temperature, women in the second group were asked to sit in a bathtub of waist-deep water at 32 ± 0.5 C with their legs horizontal and the third group included the women who were randomised to sitting immersed in shoulder-deep water at 32 ± 0.5 C with legs extended downward. We did not include this study in the analysis as outcomes reported in the paper were not pre-specified outcomes of this review.We planned to use GRADE methods to assess outcomes for two different comparisons and assign a quality rating. However, only two out of three outcomes for one comparison were reported and could be assessed. Evidence from one trial (rutoside versus placebo) for the outcomes of reduction in symptoms and incidence of complications associated with varicose veins and oedema was assessed as of moderate quality. Rutoside versus placeboOne trial involving 69 women, reported that rutoside significantly reduced the symptoms associated with varicose veins (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.11 to 3.22; moderate quality evidence). The incidence of complications (deep vein thrombosis) did not differ significantly between the two groups (risk ratio (RR) 0.17, 95% CI 0.01 to 3.49; moderate quality evidence). There were no significant differences in side-effects (RR 1.30, 95% CI 0.23 to 7.28). Women's perception of pain was not reported in this trial. External pneumatic intermittent compression versus restOne trial, involving 35 women, reported no significant difference in lower leg volume when compression stockings were compared against rest (mean difference (MD) -258.80, 95% CI -566.91 to 49.31). Reflexology versus restingAnother trial, involving 55 women, compared reflexology with rest. Reflexology significantly reduced the symptoms associated with oedema (reduction in symptoms: RR 9.09, 95% CI 1.41 to 58.54). The same study showed a trend towards satisfaction and acceptability with the intervention (RR 6.00, 95% CI 0.92 to 39.11). Water immersion versus leg elevationThere was evidence from one trial, involving 32 women, to suggest that water immersion for 20 minutes in a swimming pool reduces leg volume (RR 0.43, 95% CI 0.22 to 0.83). Foot massage versus routine careOne trial, involving 80 women reported no significant difference in lower leg circumference when foot massage was compared against routine care (MD -0.11, 95% CI -1.02 to 0.80).No other primary or secondary outcomes were reported in the trials. AUTHORS' CONCLUSIONS: There is moderate quality evidence to suggest that rutosides appear to help relieve the symptoms of varicose veins in late pregnancy. However, this finding is based on one study (69 women) and there are not enough data presented in the study to assess its safety in pregnancy. Reflexology or water immersion appears to help improve symptoms for women with leg oedema, but again this is based on two small studies (43 and 32 women, respectively).

[Combined endovascular and surgical therapy for chronic pelvic venous closure accompanied by massive prepubic and limbs varices]. / Kombinovaná endovaskulární a chirurgická terapie u chronického pánevního zilního uzáveru provázeného masivními prepubickými a koncetinovými varixy.

We report a successful surgical and endovascular procedure in a patient with increasing chronic varicose veins resulting from a chronic post-traumatic closure of the left pelvic vein. The endovascular intervention involves an effective and fast part of the procedure dealing with the primary cause of the patients pathology with subsequent surgical treatment, which radically eliminates the secondary developing pathology of massive prepubic and convoluted varicose veins in limbs.

Looking after your health. 3. Avoiding varicose veins.

This article is to summarise key concepts for the health of the midwife with particular focus on standing for prolonged periods. One of the resultant factors relating to standing postures is the slow but avoidable progression of varicose veins. There is a strong genetic bias to these veins, which can be distressing, but here we will highlight awareness and current research.

Intervenciones de enfermería para la prevención y detección oportuna de venas varicosas de miembros inferiores en el primero, segundo y tercer nivel de atención / Nursing interventiions for prevention and early detection of varicose veins of the lower limbs in the first, second and third level of care / As intervenções de enfermagem para a prevenção e detecção precoce de varizes dos membros inferiores no primeiro, segundo e terceiro nível de cuidados

Introducción. El termino de Enfermedad Venosa Crónico, se refiere a toda anomalía venosa incluyendo las venas dilatadas intradérmicas y vénulas entre 1 a 3 mm de diámetro, mientras que, el termino Insuficiencia Venosa Crónica, se utiliza para las enfermedad venosa crónica avanzada, que son las anormalidades del sistema venoso, el cual producen edema, cambios de piel o ulceras venosas. Método. Para la elaboración de esta Guía de Práctica Clínica, se unificaron términos fisiológicos, clínicos, los cuales se reunieron a través de la búsqueda, síntesis y análisis de la mejor evidencia científica. Utilizando algunos buscadores como: Tribdatabase, Cochrane, Pubmed, Biblioteca Virtual de Salud, por citar algunos. Se utilizó el Programa CASpe para el análisis de los textos y evaluación del rigor metodológico. La transparencia de la calidad de las guías se revisó con el Instrumento para la Evaluación de Guías de Práctica Clínica (AGREE II). Con base a las escalas GRADE y Sheklle, se realizó la evaluación de las recomendaciones de la literatura. Resultados. Se encontraron 128 artículos científicos y 7 (GPC), de los cuales se ocuparon 20 artículos: 2 caso de control, descriptivo, cualitativo y 16 revisiones sistemáticas, así como 4 GPC. Por lo que se pudo encontrar evidencia necesaria para fortalecer la calidad del manejo de las Venas Varicosas. Conclusiones. La presente GPCE pretende estandarizar las intervenciones de enfermería, para el manejo de Venas Varicosas de miembros inferiores, en los tres niveles de atención

Introduction. The term of venous Chronic refers to all venous anomaly including dilated veins intradermal and venules between 1 to 3 mm in diameter, whereas the term chronic venous insufficiency, is used for advanced chronic venous disease, which are abnormalities the venous system, which produces edema, skin changes or venous ulcers. Method. For the preparation of this Guide to Clinical Practice, physiological terms, clinical, which gathered through research, synthesis and analysis of the best scientific evidence they are unified. Using some search engines such as: Tribdatabase, Cochrane, Pubmed, Virtual Health Library, to name a few. CASpe program was used for the analysis of texts and evaluation of methodological rigor. The transparency of the quality of the guidelines was revised with the Instrument for the Evaluation of Clinical Practice Guidelines (AGREE II). Based on the GRADE and Sheklle scales, evaluation of the recommendations of the literature was conducted. Results. 2 case control, descriptive, qualitative and 16 systematic reviews, as well as 4 GPC: 128 scientific articles and 7 (GPC), of which 20 items were found occupied. As it could be found, the evidence was necessary to strengthen the quality of management of varicose veins. Conclusions. This GPCE aims to standardize nursing interventions for the management of lower limb Varicose Veins in the three levels of care

Introdução. O termo Doença Venosa Crônica se refere a toda anomalia venosa incluindo as veias dilatadas intradérmicas e vênulas entre 1 a 3mm de diâmetro, enquanto que o termo Insuficiência Venosa Crônica é utilizado para a doença venosa crônica avançada, que são as anormalidades do sistema venoso, das quais produzem edema, mudanças na pele ou úlceras venosas. Método. Para a elaboração desta Guia de Prática Clínica se unificaram termos fisiológicos, clínicos, dos quais foram reunidos através da busca, síntese e análise da melhor evidencia científica. Utilizando alguns buscadores como: Tribdatabase, Cochrane, Pubmed, Biblioteca Virtual de Salud, por citar alguns. Foi utilizado o Programa CASpe para a análise dos textos e avaliação do rigor metodológico. A transparência da qualidade das guias foi revisada com o Instrumento para la Evaluación de Guías de Práctica Clínica (AGREE II). Baseado nas escalas GRADE e Sheklle realizou-se a avaliação das recomendações da literatura. Resultados. Foram encontrados 128 artigos científicos e 7 (GPC) , dos quais se ocuparam 20 artigos: 2 casos de controle, descritivo, qualitativo e 16 revisões sistemáticas, bem como 4 GPC. Destarte, foi possível encontrar evidência necessária para fortalecer a qualidade da condução das veias varicosas. Conclusões. O presente GPCE pretende estandardizar as intervenções de enfermagem para o manejo das Veias Varicosas dos membros inferiores nos três níveis de cuidado

[Which patients follow the physician's recommendation to take edema-protective agents? : A retrospective, descriptive study]. / Welche Patienten nehmen nach ärztlicher Empfehlung Ödemprotektiva ein? : Eine retrospektive, deskriptive Studie.

BACKGROUND AND OBJECTIVE: Currently little is known about patients taking edema-protective agents against symptoms due to venous diseases. In a survey approximately 7 % of the general population specified taking oral vein drugs. MATERIALS AND METHODS: In a retrospective, descriptive investigation patients of a general practitioner's office, who have orally taken red vine leaf extract (Antistax), were analyzed in terms of age, sex, body mass index (BMI), comorbidities, severity of venous disease, and the concomitant use of compression stockings. RESULTS: The majority of the 82 patients analyzed, taking red vine leaf extract, were female (73 women, 9 men). The average age was 59 years. The BMI was on average 28.3; however, 41 % of the patients had a BMI over 30 and are therefore classified as obese (at least grade I). Of the patients, 52 % were rated clinical stage C2 and 36.5 % stage C3, according to the CEAP classification. Finally, 58 of the 82 patients wore compression stockings in addition to taking their edema-protective drug. CONCLUSIONS: In the present case series edema-protective agents were mainly taken by pre-obese and obese patients in chronic venous insufficiency stages C2 and C3. Oral therapy was combined with compression stockings by 70.7 % of patients.

Sulodexide down-regulates the release of cytokines, chemokines, and leukocyte colony stimulating factors from human macrophages: role of glycosaminoglycans in inflammatory pathways of chronic venous disease.

Chronic venous disease (CVeD) is a debilitating condition that affects millions of individuals worldwide. The condition can result in varicose veins, or advance to severe skin changes and venous ulceration. The fundamental basis for CVeD is inflammation within the venous circulation and that it is subjected to increased hydrostatic pressure resulting in increased ambulatory venous pressure. The inflammation involves leukocytes, in particular macrophages and monocytes, inflammatory modulators and chemokines, cytokine expression, growth factors, metalloproteinase (MMP) activity, and many regulatory pathways that perpetuate inflammation. Sulodexide (SDX) is a glycosaminoglycan with pro-fibrinolytic and anti-thrombotic properties. We have previously demonstrated that SDX inhibits the secretion of pro-zymogen MMP-9 from human leukocytes without displacing high molecular complexes of MMP-9. The anti-inflammatory properties of SDX on activated leukocytes have not been well established. We hypothesized that SDX will reduce the secretion of inflammatory mediators from lipopolysaccharide (LPS)-stimulated macrophages. Therefore, we evaluated the effects of SDX on LPS-stimulated macrophage secretion of various inflammatory and anti-inflammatory cytokines, chemokines, and colony stimulating factors. We used microplatebased multiplex immunoassays. LPS-stimulated macrophages in vitro caused a substantial increase of interleukins, tumor necrosis factor, interferon, chemokines and colony stimulating factors. The addition of SDX caused both a dose-dependent and dose-independent decrease in nearly all of the inflammatory cytokines, chemokines and colony stimulating factors. These findings suggest that SDX has a significant effect on the release of inflammatory mediators from macrophages, and may be useful in the treatment of early and advanced CVeD.

Analysis of the strain of the great saphenous vein in motion.

This research probes into the strain changes of the great saphenous vein (GSV) during step exercises. Microelectromechanical Systems (MEMS) were used to process and develop Gauge Factors (GF=4.79 ± 0.247), 5 males and 5 females with an average age of 20 ± 0.6 years were asked to engage in step exercises (with step height of 25 cm), and the strain changes of the GSV in the lower limbs of the dorsal venous arch were measured. The results show that the effect the exercise has on the vein vessel is not prominent within 0.87 min; between 0.87 and 13.71 min, the average rates of the strain changes in the GSV show a linear increase; after 13.4 ± 0.31 min, the linear curve of the increase rate is alleviated. This shows that to prevent varicose veins in the lower limbs, continuous exercise between 0.87 to 13.71 minutes has better effects in training. Exercising for over 13.71 minutes has its beneficial effects, but the effects are considerably less obvious than exercising for 0.87~13.71 min.

Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis.

BACKGROUND AND AIM: Transjugular intrahepatic portosystemic shunt (TIPS) is the mainstay treatment option for the complications of portal hypertension. Whether or not variceal embolization should be performed during TIPS procedures remains controversial. A meta-analysis to compare the incidence of shunt dysfunction, variceal rebleeding, encephalopathy, and death between patients treated with TIPS alone and those treated with TIPS combined with variceal embolization was conducted. METHODS: All relevant studies were searched via PubMed, EMBASE, and Cochrane Library databases. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled. Heterogeneity among studies and publication bias were assessed. RESULTS: Six articles were included in our study. Type of stents was covered (n = 2), bare (n = 2), mixed (n = 1), and unknown (n = 1). Varices were angiographically embolized by coils in six studies. Additional liquids agents were employed in three studies. Compared with TIPS alone group, TIPS combined with variceal embolization group had a significantly lower incidence of variceal rebleeding (OR 2.02, 95% CI 1.29-3.17, P = 0.002), but a similar incidence of shunt dysfunction (OR 1.26, 95% CI 0.76-2.08, P = 0.38), encephalopathy (OR 0.81, 95% CI 0.46-1.43, P = 0.47), and death (OR 0.90, 95% CI 0.55-1.47, P = 0.68). Neither any significant heterogeneity nor proof of publication bias among studies was found in all meta-analyses. CONCLUSIONS: Adjunctive variceal embolization during TIPS procedures might be beneficial in the prevention of variceal rebleeding. However, given the heterogeneity of type of stents, embolic agents, type of varices, and indications of variceal embolization among studies, additional well-designed randomized, controlled trials with larger sample size and use of covered stents should be warranted to confirm these findings.