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2.
Khirurgiia (Mosk) ; (1): 69-76, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395515

RESUMO

OBJECTIVE: To clarify the role of clinical anatomy of foot and ankle perforator veins (PV) in surgical treatment of varicose vein disease. MATERIAL AND METHODS: Anatomy of foot and ankle PV was assessed in 50 amputated lower extremities by anatomical dissection. RESULTS: There were 4-6 PVs at the medial surface of the foot. These veins connected medial marginal vein and vv. plantaris medialis (VPM). There were 2-3 PVs at the lateral surface of the foot. These veins connected lateral marginal vein and vv. plantaris lateralis (VPL). All PVs on the lateral surface of the foot constitute the neurovascular bundles. PVs flowing into vv. dorsalis pedis are localized on the medial surface of the medial marginal vein at the level of the ankle base. In most cases, we found an arterial branch nearby at the subfascial level. In anterior part of the plantar surface of the foot, we distinguished 4-5 small PVs (~1 mm) flowing into vv. digitales plantares through the commissural orifices of the aponeurosis. There were 6-9 vessels (~1 mm) along the fascial aponeurotic septa. These vessels connected superficial plantar venous network and plantar veins. Small arterial branch was found almost in all cases near these veins. Noteworthy is the area where the plantar veins lie on the quadratus plantae and are covered by a leaf of deep plantar fascia. This anatomy is similar to topography of posterior tibial veins. CONCLUSION: Foot perforator veins constitute the neurovascular bundles as a rule. Plantar vein topography and their relationship with PV confirm an existence of muscular-venous pump of the foot.


Assuntos
Tornozelo/irrigação sanguínea , Aponeurose , Pé/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Veia Safena/anatomia & histologia , Varizes , Tornozelo/fisiopatologia , Aponeurose/irrigação sanguínea , Dissecação , Veia Femoral/anatomia & histologia , Veia Femoral/fisiopatologia , Pé/fisiopatologia , Humanos , Veia Safena/fisiopatologia , Varizes/diagnóstico , Varizes/fisiopatologia , Varizes/cirurgia
4.
Vasc Endovascular Surg ; 54(8): 687-691, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32744168

RESUMO

BACKGROUND: To investigate the influence of superficial venous ablation on deep venous dilation and reflux in patients with saphenous varicose veins, and to elucidate the association between superficial venous reflux and deep venous morphology and hemodynamics. METHODS: The data of 154 patients with 223 limbs, who underwent endovenous radiofrequency ablation (RFA) of the great saphenous vein for primary varicose veins between September 2014 and March 2016 in Eniwa Midorino Clinic, were retrospectively analyzed. Overall venous hemodynamics of the leg, including functional venous volume (VV) and venous filling index (VFI), was assessed using air-plethysmography. Saphenous and deep vein reflux and diameter were evaluated with duplex scanning. RESULTS: Hemodynamic and morphologic changes were evaluated before and 1 month after RFA. The VV and VFI were significantly decreased in postoperative values than in preoperative values (P < .001). Limbs with deep venous reflux significantly decreased postoperatively than preoperatively (P < .001). There were significant differences in the diameter of the common femoral vein (CFV) and popliteal vein (PV) between the preoperative and postoperative values (P < .001). There were strong to moderate correlations between the VV and the diameter of the CFV or PV (CFV, r = 0.47, P < .001; PV, r = 0.35, P < .001), while there were moderate to weak correlations between the VFI and the diameter of the CFV or PV (CFV, r = 0.23, P < .001; PV, r = 0.33, P <.001). CONCLUSIONS: Superficial venous ablation significantly reduced deep venous dilation and reflux in patients with saphenous varicose veins. Significant correlations existed between the VV or VFI, which reflected superficial venous reflux, and the diameter of the deep veins. These findings reveal that volume overload due to superficial venous reflux is associated with deep venous morphology and hemodynamics.


Assuntos
Ablação por Cateter , Procedimentos Endovasculares , Veia Femoral/fisiopatologia , Hemodinâmica , Veia Poplítea/fisiopatologia , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
7.
Orv Hetil ; 161(15): 583-587, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323522

RESUMO

Introduction: Variceal bleeding is a life-threatening complication of portal hypertension with a six-week mortality rate of approximately 20%. Aim: To analyse whether the changes introduced in the treatment of variceal gastrointestinal haemorrhage in our department affected the mortality rate of these patients. Method: A retrospective method was used to compare the data of patients treated with variceal bleeding in 2014 and 2015. In 2015, two changes were made in the treatment of patients with variceal bleeding: all patients were treated in the subintensive care unit and terlipressin was administered to all patients susceptible to variceal haemorrhage. Bleeding was mitigated by means of sclerotherapy and/or ligation. Significance was calculated using Student's t-test, then we performed logistic regression to find out what treatment factors affect mortality rate. Patients: 2014 vs. 2015 figures ­ number of patients: 24 vs. 30, average age: 59.8 vs. 57.6 years, male (%): 70.8 vs. 66.7. There were no significant differences between the Child­Pugh stages of the two years, p = 0.53. For the analysis we also grouped patients based on whether irrespective of the year of treatment they were administered terlipressin or not. Number of patients: 22 vs. 32, average age: 60.4 vs. 57.4, male (%): 63.6 vs. 70.6. Results: Mortality in 2015 and 2014: 23% and 33%, respectively. Mortality of patients treated with terlipressin: 18.2 vs. 34.4, p = 0.09. Child­Pugh stages had the strongest influence on mortality (stage A vs. B p = 0.05, stage A vs. C p = 0.02). Terlipressin administered in Child­Pugh stage C reduced mortality at a rate bordering on significance (p = 0.055). Conclusion: Despite the comparatively small number of cases, the changes introduced in our department in 2015 in the treatment of variceal gastrointestinal haemorrhages resulted in a significant reduction of hospital mortality rates. Orv Hetil. 2020; 161(15): 583­587.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terlipressina/efeitos adversos , Resultado do Tratamento , Varizes/fisiopatologia , Vasoconstritores/efeitos adversos
8.
Ann Vasc Surg ; 68: 569.e1-569.e7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32283303

RESUMO

BACKGROUND: Pelvic congestion syndrome (PCS) is defined as noncyclical pelvic pain or discomfort caused by dilated parauterine, paraovarian, and vaginal veins. PCS is typically characterized by ovarian venous incompetence that may be due to pelvic venous valvular insufficiency, hormonal factors, or mechanical venous obstruction. METHODS: We describe a case of a 38-year-old multiparous female with a history of pelvic pressure, vulvar varices, and dyspareunia. She underwent left gonadal vein coil embolization in 2014 for PCS that lead to symptomatic relief of her pain. Four years later, the patient returned for recurrent symptoms. Magnetic resonance venogram demonstrated dilated pelvic varices. The previously embolized left gonadal vein remained thrombosed, and there was no evidence of right gonadal vein insufficiency. However, catheter-based venography revealed a large, dilated, and incompetent median sacral vein. RESULTS: Pelvic venography demonstrated left gonadal vein embolization without any evidence of reflux. The right gonadal vein was also nondilated without reflux. Internal iliac venography showed large cross-pelvic collaterals and retrograde flow via a large, dilated median sacral vein. Coil embolization of the median sacral vein resulted in a dramatic reduction of pelvic venous reflux and resolution of symptoms. CONCLUSIONS: Recurrence of PCS can occur after ovarian vein embolization through other tributaries in the venous network. The median sacral vein is a rare cause of PCS. We present an interesting case of a successfully treated recurrent PCS with coil embolization of an incompetent median sacral vein.


Assuntos
Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/terapia , Pelve/irrigação sanguínea , Varizes/terapia , Insuficiência Venosa/terapia , Adulto , Embolização Terapêutica/instrumentação , Feminino , Humanos , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/fisiopatologia , Recidiva , Retratamento , Síndrome , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
9.
Curr Cardiol Rev ; 16(3): 164-172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32164514

RESUMO

Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.


Assuntos
Dilatação Patológica/fisiopatologia , Extremidade Inferior/patologia , Varizes/fisiopatologia , Veias/fisiopatologia , Feminino , Humanos , Masculino
10.
Int Angiol ; 39(2): 105-111, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32043339

RESUMO

BACKGROUND: Varicose veins recurrence rate remained almost unchanged despite the constant technological advancement in its treatment. The aim of this study is to evaluate the variable accessory saphenous vein (ASV) anatomy at the sapheno-femoral junction (SFJ) as a possible risk factor for recurrent varicose vein (RVV) after great saphenous vein (GSV) radiofrequency thermal ablation (RTA). METHODS: Two-hundred consecutive patients affected by chronic venous disease (mean age 52.4±10.3 years; 187 women; CEAP C2-C6; 25.2±1.4), underwent to RTA from 2014 to 2016, at our Institute. Preoperatively all patients underwent duplex-ultrasound scanning, reporting the anatomical site, extension of reflux and the ASV anatomy at the SFJ. Duplex ultrasound and physical examination was performed postoperatively at 1, 6 and 12 months, and yearly thereafter. RESULTS: Patients were divided in two groups based on the anatomical site of reflux: group A (N.=187) including GSV and SFJ, group B (N.=82) including SFJ reflux. There was no preoperative statistical difference between the two groups. At a mean follow-up of 29.7±2.4 months, a freedom from recurrent varicose vein and GSV recanalization was: 100% and 100% at 1 month, 95.9% and 99.1% at 1 year, 93.7% and 96.7% at 3 years, respectively. A higher rate of RVV was documented for patients in group A at 3-year of follow-up (P=0.042). Cox regression analysis found, among five potential predictors of outcome, that direct confluence of ASV in SFJ (HR=1.561; 95% CI: 1.0-7.04; P=0.032) was a negative predictors of 1-year RVV. CONCLUSIONS: Sapheno-femoral junction morphology may affect recurrent varicose veins formation. In particular, a concomitant incompetence of the accessory saphenous vein or its directly confluence into the SFJ could represent an indication to simultaneous treatment by non-surgical techniques (RTA or laser) and avoid surgical ligation.


Assuntos
Veia Femoral/cirurgia , Ablação por Radiofrequência , Veia Safena/cirurgia , Varizes/cirurgia , Adulto , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Grau de Desobstrução Vascular
11.
J Vasc Surg Venous Lymphat Disord ; 8(1): 110-117, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31843246

RESUMO

OBJECTIVE: Lower extremity varicose veins have a high prevalence and can be associated with significant morbidity in their more advanced presentations; overweight patients tend to present with more severe clinical symptoms and conventional surgical treatment remains challenging. Although the advent of ultrasound-guided foam sclerotherapy (UGFS) increased the treatment options for these patients, the need for elastic compression after UGFS remains controversial. METHODS: Overweight patients with lower extremity varicose veins secondary to great saphenous vein reflux were treated with UGFS and then randomized to use or no use of a 3-week treatment of elastic compression stockings. Follow-up was performed by clinical evaluation and duplex ultrasound examination. The primary outcome measure was the absence of venous reflux in the great saphenous vein. RESULTS: One hundred thirty-five lower limbs were treated; 72 limbs were randomized to elastic compression and 63 limbs to the control group. There were no statistically significant differences in the number of procedures (P = .64) or the mean foam volume per procedure (P = .27) between groups. There was no difference in the reflux rate at either 3 weeks (26% vs 35%; P = .16) or 3 months (25% vs 21%; P = .85). Major complications were venous deep thrombosis (n = 2), neurologic event (n = 1), and ischemic ulceration (n = 1); the overall rate was 3% in both groups-2 of 62 in control patients and 2 of 69 in compression patients (P = .45). Venous diameter reduction was noted in both groups during treatment (P < .05) but with greater decrease in greater saphenous vein diameter in patients treated with compression. CONCLUSIONS: Elastic compression stockings for 3 consecutive weeks after UGFS in overweight patients did not decrease great saphenous vein reflux, need for repeat procedures, or the volume of foam injected. However, UGFS was associated with a greater and uniform reduction in saphenous vein diameter at all times after the procedure.


Assuntos
Hemodinâmica , Sobrepeso/complicações , Veia Safena/fisiopatologia , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Meias de Compressão , Ultrassonografia de Intervenção , Varizes/terapia , Insuficiência Venosa/terapia , Adulto , Brasil , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/fisiopatologia , Fatores de Risco , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/etiologia , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/etiologia , Insuficiência Venosa/fisiopatologia
12.
J Cardiovasc Pharmacol ; 75(3): 211-221, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31738197

RESUMO

High pressure in the lower-limb veins is often associated with chronic venous insufficiency and varicose veins (VVs), making it important to search for the mechanisms and agents that control venous function. We have shown that protracted increases in venous stretch/wall tension reduce vein contraction and augment matrix metalloproteinase (MMP)-2 and -9. Also, MMP-2 and MMP-9 promote venodilation, a hallmark of VVs. Sulodexide (SDX) is a blend of glycosaminoglycans with efficient profibrinolysis and antithrombosis activities, but its actions on vein function and the mechanisms involved are unclear. We tested the hypothesis that SDX enhances venous contractile response by decreasing MMP expression/activity in veins subjected to protracted stretch. Rat inferior vena cava (IVC) rings were treated with SDX (0.001-1 mg/mL) or vehicle, equilibrated under control 0.5-g resting tension or protracted 2-g stretch for 18 hours, and the contractile response to 96-mM KCl and phenylephrine (Phe) in SDX-treated and nontreated veins was recorded. In IVC rings under control 0.5-g resting tension, SDX caused dose-dependent contraction, 96-mM KCl caused marked contraction (176-mg/mg tissue), and Phe caused dose-dependent contraction with a maximum (56-mg/mg tissue) at 10 M. In IVC subjected to protracted 2-g stretch, 96-mM KCl-induced contraction was reduced to 112 mg/mg and maximal Phe-induced contraction was decreased to 23 mg/mg. In IVC subjected to protracted 2-g stretch plus SDX, 96-mM KCl-induced contraction was restored to 228 mg/mg and maximal Phe-induced contraction was improved to 115 mg/mg. Gelatin zymography and Western blots revealed increases in MMP-2 and MMP-9 levels/gelatinolytic activity in veins subjected to protracted 2-g stretch and reversal to control levels in veins subjected to 2-g stretch plus SDX. Thus, SDX improves vein function and augments the contractile response in veins subjected to protracted stretch. The SDX-induced improvement of contraction and restoration of vein function appear to involve decreases in MMP-2 and MMP-9 and may contribute to the benefits of SDX in chronic venous insufficiency and VVs.


Assuntos
Glicosaminoglicanos/farmacologia , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Varizes/tratamento farmacológico , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia , Veia Cava Inferior/efeitos dos fármacos , Insuficiência Venosa/tratamento farmacológico , Animais , Regulação para Baixo , Técnicas In Vitro , Masculino , Proteólise , Ratos Sprague-Dawley , Varizes/enzimologia , Varizes/fisiopatologia , Veia Cava Inferior/enzimologia , Veia Cava Inferior/fisiopatologia , Insuficiência Venosa/enzimologia , Insuficiência Venosa/fisiopatologia
13.
Vasc Endovascular Surg ; 54(1): 47-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31581906

RESUMO

OBJECTIVES: Cyanoacrylate glue is injected for incompetent great saphenous vein (GSV) treatment 5 cm distal to the saphenofemoral junction (SFJ). Although a few reports have investigated the postprocedural remnant stump length, none have focused on the factors affecting glue extension length and the consequent remnant stump length. METHODS: Seventy-nine patients undergoing cyanoacrylate closure using the VenaSeal system at our clinic between August 2018 and November 2018 were investigated. The GSV diameter was measured just before treatment in the supine position 3 cm distal to the SFJ. Cyanoacrylate glue was injected 5 cm distal to the SFJ. RESULTS: The mean glue extension length was 1.13 ± 1.12 cm. The GSV diameter and glue extension length exhibited a significant inversely proportional relationship (P < .001). More specifically, patients with a GSV diameter ≥0.7 cm had a longer remnant stump length than those with a smaller GSV diameter (P < .001). CONCLUSIONS: An increased GSV diameter is likely associated with a decreased glue extension length and, consequently, a longer remnant stump.


Assuntos
Cianoacrilatos/administração & dosagem , Veia Safena , Adesivos Teciduais/administração & dosagem , Varizes/terapia , Adulto , Cianoacrilatos/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
14.
J Vasc Surg Venous Lymphat Disord ; 8(1): 100-105, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31402294

RESUMO

OBJECTIVE: Venous reflux may occur in all parts of the great saphenous vein (GSV). The GSV diameter generally increases when venous reflux occurs, and the extent of venous dilation may be altered on the basis of size and location of the reflux within the GSV. We examined which part of the GSV is the most sensitive and dilated in association with venous reflux. METHODS: We retrospectively evaluated the data of 99 patients (198 limbs) with signs and symptoms of venous insufficiency of both lower limbs from January 2016 to December 2016. We performed ultrasound to examine the venous reflux and to measure the diameter of the GSV. The GSV was divided into four locations: saphenofemoral junction, midthigh, lower thigh (LT), and below the knee. The patients were divided into two groups according to the presence or absence of reflux. RESULTS: There were 87 limbs that had venous reflux and 111 limbs that had no reflux. The diameter of the GSV with reflux was significantly larger than that of GSVs without reflux only at the LT (4.7 mm vs 4.2 mm; P < .001), and the highest area under the receiver operating characteristic curve was 0.642 at the LT. The cutoff value of the LT diameter for association with reflux was 5 mm (P = .025). CONCLUSIONS: The cutoff diameter of the LT was 5 mm. We recommend treatment of symptomatic reflux, and LT diameter may be useful for follow-up before and after treatment.


Assuntos
Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Coxa da Perna/irrigação sanguínea , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto , Estudos Transversais , Feminino , Humanos , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Veia Safena/cirurgia , Meias de Compressão , Resultado do Tratamento , Varizes/terapia , Insuficiência Venosa/terapia
16.
J Vasc Surg Venous Lymphat Disord ; 8(1): 74-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31699666

RESUMO

BACKGROUND: Lower limb chronic venous disease (CVD), resulting from iliac vein compression syndrome (IVCS), manifests as a series of symptoms ranging from varicose veins to venous ulcerations. Stent implantation has been considered an effective treatment method; however, the management of CVD has rarely been reported. In the present study, we evaluated the treatment and outcomes of patients with CVD. METHODS: We performed a retrospective cohort study of patients with severe iliac vein stenosis with lower limb CVD. The patients were divided into two groups: group 1 had received stenting alone (n = 42), and group 2 had received stenting and high ligation/endovenous laser treatment (n = 29). We evaluated the clinical outcomes using the Venous Clinical Severity Score and visual analog scale, and assessed the quality of life (QoL) using the Chronic Venous Disease QoL questionnaire at a median follow-up point of 15 months (range, 6-25 months). RESULTS: In our cohort, the prevalence rate of nonthrombotic IVCS (NIVCS) was 11.7% (98 of 838 patients). The technical success rate was 100%, without severe complications. During the study period, three group 1 patients and two group 2 patients were lost to follow-up. The overall patency rate in the patients with NIVCS during a mean follow-up period of 15.0 months (range, 6-25 months) was 94.4%. For patients with a Clinical, Etiology, Anatomy, Pathophysiology (CEAP) clinical class of <4, all parameters showed similar improvements in the two groups, except for the disappearance of varicose veins. However, in patients with a CEAP clinical class of ≥4, the combination therapy significantly improved their QoL. The Venous Clinical Severity Score reduction was 4.64 ± 1.72 in group 1 and 11.89 ± 1.82 in group 2 (P < .01). Pain, scored using the visual analog scale, demonstrated a decrease from 4.41 to 2.52 (P < .05) in group 1 and 4.71 to 0.53 (P < .01) in group 2. The relief rate of stasis dermatitis in groups 1 and 2 was 26.9% and 90.5%, respectively (P < .05), and the venous ulceration healing rate was 16.7% and 87.5%, respectively (P < .05). CONCLUSIONS: The prevalence of NIVCS should not be overlooked. The proposed combination treatment is an effective therapeutic strategy for patients with NIVCS and advanced CVD (CEAP clinical class, ≥4) during short-term follow-up.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Terapia a Laser , Síndrome de May-Thurner/terapia , Veia Safena/cirurgia , Stents , Varizes/cirurgia , Idoso , Doença Crônica , Terapia Combinada , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Terapia a Laser/efeitos adversos , Ligadura , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Cicatrização
19.
Eur J Obstet Gynecol Reprod Biol ; 243: 83-86, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31675634

RESUMO

OBJECTIVE: The study was aimed at assessing the influence of pelvic congestion syndrome (PCS) on the clinical manifestations of chronic venous disease (CVD) of the lower extremities in patients with concomitant varicose veins of the pelvis and lower extremities. STUDY DESIGN: We examined clinically and with duplex ultrasound 30 women with varicose veins of the lower extremity only (VVLE) and another 45 women with VVLE and concomitant varicose veins of the pelvis (VVP) causing symptoms of the pelvic congestion syndrome (PCS). All patients had chronic venous disease (CVD) of class C2 (n = 47) or C3 (n = 28) according to the CEAP classification. All patients underwent duplex ultrasound (DUS) of the lower extremities and pelvis. Based on the clinical examination and DUS findings, the patients were allocated into two groups: group 1 (n = 30 patients with isolated VVLE without the signs of PCS and pelvic veins lesions) and group 2 (n = 45 patients with concomitant PCS, VVP and VVLE). The rates and severity of varicose, pain, and edema syndromes, and leg heaviness were assessed. RESULTS: The patients of the group 2 had significantly more severe clinical manifestations of CVD, 4 times higher risk of leg pain (odds ratio [OR] 4.23; 95% CI 1.57-11.39), 7 times higher risk of leg edema (OR 7.42; 95% CI 2.23-24.78), 5 times higher risk of leg heaviness (OR 5.3; 95% CI 1.85-15.07), and in general 2 times more severe varicose veins, compared with the group 1. CONCLUSION: The PCS is associated with an increase in the incidence and severity of the CVD symptoms.


Assuntos
Hiperemia/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Dor Pélvica/fisiopatologia , Pelve/irrigação sanguínea , Varizes/fisiopatologia , Adulto , Estudos de Casos e Controles , Edema/etiologia , Edema/fisiopatologia , Feminino , Humanos , Hiperemia/complicações , Dor/etiologia , Dor/fisiopatologia , Dor Pélvica/etiologia , Períneo/irrigação sanguínea , Veia Safena , Ultrassonografia , Varizes/complicações , Vulva/irrigação sanguínea
20.
Khirurgiia (Mosk) ; (10): 69-74, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31626242

RESUMO

Varicose veins of lower extremities, varicocele and varicose dilation of pelvic veins including ovaricovaricocele are the most common non-inflammatory diseases of venous system. The same mechanisms determined varicose dilatation regardless localization of the vein. First of all, these are wall weakness and valvular insufficiency combined with hereditary collagen fiber defectiveness in case of undifferentiated connective tissue syndrome. Imbalance between different types of collagen in vascular wall (especially types I and III) also results wall weakness. Other important mechanisms are smooth muscle cells dysfunction followed by excessive intracellular synthesis and intramuscular fibrosis and imbalance of protease system due to overproduction of metalloproteinases. We consider that different forms of varicose veins (varicose veins of lower extremities, varicocele, ovaricovaricocele) may be unified within one pathology (varicose vein disease).


Assuntos
Varizes/fisiopatologia , Veias/fisiopatologia , Colágeno/fisiologia , Dilatação Patológica , Humanos , Extremidade Inferior , Masculino , Varizes/etiologia
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