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1.
Nihon Shokakibyo Gakkai Zasshi ; 118(12): 1160-1166, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34897146

RESUMO

A 67-year-old man with a history of esophageal and gastric varices that were treated endoscopically was treated for Budd-Chiari syndrome and immunoglobulin G4-related sclerosing cholangitis in our facility. Varices in the second portion of the duodenum were revealed in follow-up upper endoscopy. The draining vein formed a venous plexus that was detected on computed tomography. Treatment with interventional radiology was difficult;therefore, endoscopic injection sclerotherapy (EIS) was performed instead. No recurrence has been observed to date. Thus, in this case, EIS for duodenal varices was effective.


Assuntos
Escleroterapia , Varizes , Idoso , Duodeno/diagnóstico por imagem , Gastroscopia , Humanos , Masculino , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Varizes/diagnóstico por imagem , Varizes/terapia
2.
Cardiol Clin ; 39(4): 567-581, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34686268

RESUMO

Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.


Assuntos
Varizes , Insuficiência Venosa , Doença Crônica , Humanos , Prevalência , Varizes/epidemiologia , Varizes/terapia , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/terapia
3.
Angiol Sosud Khir ; 27(3): 77-83, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528591

RESUMO

AIM: The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins. PATIENTS AND METHODS: We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2). Due to paucity of the participants, from the subsequent analysis we excluded the groups MPFF + endovasal laser coagulation, patients not receiving MPFF (n=16) and MPFF + topical treatment. All further statistical data are shown for the remaining 687 patients. RESULTS: Comparing the groups of patients undergoing conservative treatment alone and those subjected to surgical intervention demonstrated no statistically significant differences in dynamics of crural oedema. In both groups at every subsequent visit there was a statistically significant decrease in the ankle volume (p<0.001). During the whole period of follow up the crural volume in patients from the group of conservative treatment totally decreased by 0.201±0.158 L and in the operated patients by 0.236±0.189 L (p=0.021). The QOL assessed by the CIVIQ-14 global index score statistically significantly improved in the unoperated patients from 31.5±19.2 to 12.0±10.1 (p<0.001). In the operated patients, the baseline and final values of the QOL of the global index score amounted to 33.4±17.8 and 7.7±9.2, respectively (p<0.001). In the groups with and without topical treatment, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 28.5±17.4 and 36.2±18.6, respectively. During the follow-up period, we observed statistically significant positive dynamics of all parameters of quality of life. The final visit demonstrated improvement of the CIVIQ-14 global index score to 9.4±9.2 in patients without topical treatment and 10.1±10.4 in those receiving topical treatment (p=0.367), with the mean value of this parameter during treatment in both groups decreased significantly (p<0.001). A statistically significant decrease in the ankle volume in both groups was registered at every visit, finally amounting to 0.223±0.166 L and 0.248±0.174 L (p=0.118) for patients not receiving and receiving topical treatment, respectively. In groups of patients not receiving and those receiving compression therapy, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 21.4±14.2 and 33.1±18.5 (p<0.001), respectively. At the final visit, these indices statistically significantly (p<0.001) decreased to 7.3±9.1 and 9.9±9.9 (p=0.106). Compared with the baseline values, the ankle volume at the final visit in groups of patients with and without compression therapy statistically significantly decreased by 0.187±0.14 L and 0.238±0.17 L respectively (p=0.204). During the study, there were no adverse events related to the administration of MPFF and use of Detragel. CONCLUSION: MPFF and Detragel appear to be effective and safe components of comprehensive conservative therapy of chronic oedema induced by primary varicose veins of lower extremities.


Assuntos
Varizes , Insuficiência Venosa , Doença Crônica , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico , Varizes/terapia , Veias , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/terapia
4.
Obstet Gynecol ; 138(3): 482-486, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352832

RESUMO

BACKGROUND: Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy. CASE: A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications. CONCLUSION: Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.


Assuntos
Colo do Útero/irrigação sanguínea , Complicações Hematológicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Hemorragia Uterina/diagnóstico , Varizes/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessários , Gravidez , Complicações Hematológicas na Gravidez/terapia , Segundo Trimestre da Gravidez , Hemorragia Uterina/terapia , Varizes/terapia
5.
Vasc Health Risk Manag ; 17: 379-387, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239304

RESUMO

Objective: This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). Design: Prospective, single-centre, analytical cohort. Materials and Methods: Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. Results: The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. Conclusion: Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.


Assuntos
Ablação por Cateter , Veia Safena/cirurgia , Escleroterapia , Varizes/terapia , Adulto , Assistência Ambulatorial , Ablação por Cateter/efeitos adversos , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
6.
Cochrane Database Syst Rev ; 7: CD008819, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271595

RESUMO

BACKGROUND: Compression hosiery or stockings are often the first line of treatment for varicose veins in people without either healed or active venous ulceration. Evidence is required to determine whether the use of compression stockings can effectively manage and treat varicose veins in the early stages. This is the second update of a review first published in 2011. OBJECTIVES: To assess the effectiveness of compression stockings for the only and initial treatment of varicose veins in people without healed or active venous ulceration. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 May 2020. We also checked references of studies identified from the literature searches. SELECTION CRITERIA: We included randomised controlled trials (RCTs) involving people diagnosed with primary trunk varicose veins without healed or active venous ulceration (Clinical, Etiology, Anatomy, Pathophysiology (CEAP) classification C2 to C4). Included trials assessed compression stockings versus no treatment or placebo stockings, or compression stockings plus drug intervention versus drug intervention alone. We also included trials comparing different lengths and pressures of stockings. We excluded trials involving other types of treatment for varicose veins (either as a comparator to stockings or as an initial non-randomised treatment), including sclerotherapy and surgery. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. Two review authors independently assessed trials for inclusion, extracted data, assessed risk of bias and assessed the certainty of the evidence using GRADE. Outcomes of interest were change in symptoms; physiological measures; complications; compliance; comfort, tolerance and acceptability of wearing stockings; and quality of life. MAIN RESULTS: We included 13 studies with 1021 participants with varicose veins without healed or active venous ulceration. One study included pregnant women while other studies included participants who had sought medical intervention for their varicose veins by being on surgical waiting lists, or attending vascular surgery or dermatology clinics or outpatient departments. The stockings used in the studies exerted different levels of pressure, ranging from 10 mmHg to 50 mmHg. Five studies assessed compression stockings versus no compression stockings or placebo stockings. Three of these studies used knee-length stockings, one used full-length stockings and one used full tights. Eight studies compared different types or pressures of knee-length stockings. The risk of bias of many included trials was unclear, mainly because of inadequate reporting. We were unable to pool studies as they did not report the same outcomes or used different ways to assess them. Many studies were small and there were differences in the populations studied. The certainty of the evidence was therefore low to very low. Compression stockings compared with no treatment or placebo stockings All four studies that reported change in symptoms found a subjective improvement by the end of the study. However, change in symptoms was not always analysed by comparing the randomised arms of the studies and was therefore subject to bias. Two studies assessed physiological measures using either ankle circumference or duplex sonography to measure oedema. Ankle circumference showed no clear difference between baseline and follow-up while oedema was reduced in the stocking group compared with the placebo stocking group. Three studies reported complications or side effects with itching and irritation the main side effects reported. None of the trials reported severe side effects. Reports of compliance varied between studies. One study reported a high dropout rate with low levels of compliance due to discomfort, application and appearance; two studies reported generally good levels of compliance in the stocking group compared to placebo/no treatment. Two studies reported comfort, tolerance and acceptability with outcomes affected by the study population. Compression tights were increasingly rejected by pregnant women as their pregnancy progressed, while in one study of non-pregnant women, the stockings group showed no more hindrance of normal activities and daytime discomfort when compared with placebo stockings. One study reported quality of life showing no clear differences between the stocking and placebo stocking groups. Compression stockings compared with different compression stockings All five studies that reported change in symptoms found a subjective improvement in symptoms by the end of the study. Change in symptoms was not always analysed comparing the randomised arms of the trials and was therefore subject to bias. Five studies reported a variety of physiological measures such as foot volumetry, volume reduction and change in diameter. Generally, there were no clear differences between study arms. Four studies reported complications or side effects, including sweating, itching, skin dryness, and constriction and tightness. None of the trials reported severe side effects. Two studies reported compliance showing no difference in compliance rates between stockings groups, although one study reported high initial levels of dropout due to discomfort, appearance, non-effectiveness and irritation. Four studies reported comfort, tolerance and acceptability. Two studies reported similar levels of tolerance and discomfort between groups. Discomfort was the main reason for indicating a preference for one type of stocking over another. None of the studies assessed quality of life. No conclusions regarding the optimum length or pressure of compression stockings could be made as there were no conclusive results from the included studies. AUTHORS' CONCLUSIONS: There is insufficient high-certainty evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type. Future research should consist of large RCTs of participants with trunk varices either wearing or not wearing compression stockings to assess the efficacy of this intervention. If compression stockings are found to be beneficial, further studies assessing which length and pressure is the most efficacious could then take place.


Assuntos
Meias de Compressão , Varizes/terapia , Adulto , Viés , Edema/diagnóstico , Feminino , Humanos , Masculino , Gravidez , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Úlcera Varicosa
7.
J Stroke Cerebrovasc Dis ; 30(9): 105954, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217069

RESUMO

OBJECTIVES: An isolated intraventricular cerebral varix is a rare entity. Although it is generally asymptomatic, there have been reports of symptomatic cases. Here, we report a case of right hemiplegia and aphasia due to venous infarction caused by thrombosis of the intraventricular varix. CASE PRESENTATION: A 79-year-old woman presented with right-sided hemiplegia and aphasia accompanied by conjugate eye deviation to the left. She had a history of hypertension, dyslipidemia, and asymptomatic isolated cerebral varix located in the left lateral ventricle. Blood analysis indicated no abnormalities in coagulation or fibrinolysis. Plain head computed tomography showed an intraventricular varix in the form of a high-density mass, indicating acute phase thrombosis, and contrast-enhanced computed tomography depicted a filling defect in the varix. In addition, fluid-attenuated inversion recovery imaging showed hyperintense lesions in the deep white matter of the frontal-parietal lobe, indicating venous infarction due to occlusion of the varix of the thalamostriate vein. Glycerol and prophylactic levetiracetam were administered, and she was transferred to another hospital for rehabilitation 23 days after treatment initiation. CONCLUSION: This is the first reported case in which a typically asymptomatic condition, intraventricular cerebral varix, caused venous infarction due to thrombosis and occlusion of the varix of the thalamostriate vein. Careful selection of the treatment strategy is required on a case-by-case basis because an intraventricular varix can cause both bleeding and infarction, which are treated differently.


Assuntos
Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Varizes/complicações , Trombose Venosa/etiologia , Idoso , Afasia/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Feminino , Hemiplegia/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
8.
Tech Vasc Interv Radiol ; 24(1): 100730, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147196

RESUMO

The term pelvic venous disorders (PeVD) describes a group of related clinical entities with overlapping clinical presentations that were previously characterized by separate imprecise syndromic terminology. The clinical manifestations of PeVD may variously include chronic pelvic pain; pelvic origin extrapelvic lower extremity and genital varices; lower extremity pain and swelling; and left flank pain and hematuria. This manuscript focuses on the primary manifestations of PeVD in women - chronic pelvic pain and pelvic origin lower extremity and vulvar varices - and will review the underlying pathophysiology and related complicating factors (such as maladaptive pain responses) to explain the variety of clinical presentations.


Assuntos
Dor Crônica/etiologia , Dor Pélvica/etiologia , Pelve/irrigação sanguínea , Varizes/etiologia , Insuficiência Venosa/complicações , Vulva/irrigação sanguínea , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Feminino , Humanos , Dor Pélvica/diagnóstico , Dor Pélvica/fisiopatologia , Dor Pélvica/terapia , Prognóstico , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Varizes/terapia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia
9.
Tech Vasc Interv Radiol ; 24(1): 100732, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34147199

RESUMO

Pelvic Venous Disease (PeVD) is characterized by pelvic varicosities and chronic pelvic pain, defined as noncyclic pelvic pain that persists for more than 6 months. Pain and discomfort related to PeVD typically worsen with upright positioning and occur more frequently in multiparous and premenopausal women. The most common cause of PeVD is pelvic venous insufficiency (PVI) due to incompetent valves. Noninvasive imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging, and invasive catheter-based venography can help characterize varicosities and venous insufficiency, supporting the diagnosis of PeVD. In patients with PeVD, ovarian and/or internal iliac vein embolization demonstrate excellent technical and clinical success rates with relatively low complication rates and should be considered as standard management, in conjunction with medical therapy. Appropriate diagnostic work-up and patient selection are important prior to any intervention for achieving therapeutic success, as multiparous women have a higher success rate compared to patients with dyspareunia after embolization therapy. Post-procedure follow-up is critical for assessing symptom improvement and need for repeat intervention. However, further research is needed to identify additional predictors of successful outcomes after embolization therapy. This article aims to provide an overview of patient selection, interventional technique, challenges, and outcomes of ovarian vein embolization.


Assuntos
Dor Crônica/terapia , Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/terapia , Pelve/irrigação sanguínea , Radiografia Intervencionista , Varizes/terapia , Veias/diagnóstico por imagem , Insuficiência Venosa/terapia , Dor Crônica/diagnóstico por imagem , Dor Crônica/fisiopatologia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
13.
Pol Przegl Chir ; 93(2): 43-52, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33949321

RESUMO

The current limitations of surgical treatment, as well as restrictions on professional and sport activities related to COVID-19 pandemic require seeking therapeutic solutions for the vast population of patients with chronic venous insufficiency (CVI, chronic venous insufficiency). To understand the principles of pharmacotherapy of this disease, the authors used data related to epidemiology and pathophysiology of CVI. They provided the latest data on venoactive drugs and recommendations that should be followed and summarized the literature based on the EBM. The article should provide the answer to the question of how to deal with patients with varicose veins or, more broadly, chronic venous insufficiency during the pandemic.


Assuntos
COVID-19/epidemiologia , Tratamento Conservador/estatística & dados numéricos , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia , Fatores Etários , Doença Crônica , Humanos , Varizes/fisiopatologia , Varizes/terapia , Insuficiência Venosa/epidemiologia
14.
Medicine (Baltimore) ; 100(20): e25921, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011062

RESUMO

ABSTRACT: To review the various quality of life (QoL) scales specific for chronic venous diseases (CVDs) and provide guidance and a reference for researchers to select the ideal measurement scale before studying QoL in patients with CVDs.The EBSCO, Ovid, PubMed, Wanfang, and CNKI databases were searched for the keywords "vein," "quality of life," and "scale/questionnaire," and various scales used to measure QoL in patients with CVDs. The QoL aspects were investigated and researched, and then, the search results were screened and summarized.A total of 10 major scales related to the QoL in patients with CVDs were included. The scales differed in dimension, reliability, validity, scoring method, evaluation method, and scope of application.The investigator should select the chronic venous disease QoL scale according to the research purpose and subjects, and then implement the scale to compare the specific aspects of QoL in patients with different CVDs.


Assuntos
Psicometria/métodos , Qualidade de Vida , Telangiectasia/psicologia , Varizes/psicologia , Insuficiência Venosa/psicologia , Doença Crônica/psicologia , Doença Crônica/terapia , Humanos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Telangiectasia/complicações , Telangiectasia/diagnóstico , Telangiectasia/terapia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico , Varizes/terapia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/terapia
15.
Phlebology ; 36(8): 620-626, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33813962

RESUMO

OBJECTIVE: This study evaluated the effect of low-energy radiofrequency thermocoagulation added to standard liquid sclerotherapy on clinical outcomes of patients with venous insufficiency. PATIENTS AND METHOD: We included 111 patients with spider veins CEAP/C1 stage. The patients were randomized into sclerotherapy (Group 1) and sclerotherapy + sclerotherapy immediately followed by low energy percutaneous RF thermocoagulation (Group 2) groups and followed up with same protocols prospectively. RESULTS: The study groups did not differ in terms of the mean age, body mass index, the number of spider veins and pre-interventional venous clinical severity scores (VCSS). Patients' self-assessed satisfaction ratings of cosmetic outcomes were found to be higher compared to the baseline (p = 0.001). While both techniques caused a significant decline in VCSS at postprocedural third month, it was observed that the type of applied intervention did not affect the VCSS (p = 0.43 and p = 0.93, respectively). There was a significant difference in hyperpigmentation and trapped blood between the two groups after the procedure (p = 0.009 and p = 0.02, respectively), there was no statistically significant difference in terms of skin necrosis (p = 0.52). A significant difference in the self-assessed cosmetic outcomes was observed in patients treated with sclerotherapy followed by low energy percutaneous RF thermocoagulation compared with patients whom sclerotherapy performed alone (p = 0.001). DISCUSSION: This study suggests that radiofrequency thermocoagulation added to the sclerotherapy provides better cosmetic outcomes with less treatment sessions and no additional complication rates.


Assuntos
Telangiectasia , Varizes , Eletrocoagulação , Humanos , Perna (Membro) , Projetos Piloto , Veia Safena , Escleroterapia , Resultado do Tratamento , Varizes/terapia
16.
BMC Womens Health ; 21(1): 181, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906668

RESUMO

BACKGROUND: Due to the scarcity of adequately powered, randomized controlled trials and internationally standardized diagnostic criteria, evidence on the diagnosis and treatment of pelvic congestion syndrome (PCS) is limited. Earlier epidemiologic observations led to the attribution of PCS to the premenopausal state, and a remission of symptoms after menopause is frequently described a hallmark of the pathology. This concept has currently been challenged by radiological studies reporting a notable prevalence of ovarian venous congestion in adult female patients of advanced age. PCS as a pathology of postmenopausal women, however, has not been acknowledged by systematic research to date, impeding appropriate diagnostics and therapy for affected patients. CASE PRESENTATION: A 69-year-old postmenopausal patient presented with newly diagnosed dilated and insufficient pelvic veins in combination with characteristic pain anamnesis, thereby fulfilling the diagnostic criteria of PCS. Interventional coil embolization of both ovarian veins as a standard treatment previously described for premenopausal patients was successfully performed, resulting in prompt alleviation of symptoms. The patient remained symptom-free at the 18-month follow-up visit. CONCLUSIONS: Given this first systematically documented case of a patient with postmenopausal symptomatic PCS in the light of recently published data on the prevalence of ovarian venous congestion in patients of advanced age, it may be assumed that PCS is not to be considered a pathology strictly limited to premenopausal state. Further clinical studies expanding the diagnostic scope beyond menopause may help to substantiate evidence and subsequently define standardized therapeutic approaches for affected postmenopausal patients.


Assuntos
Dor Crônica , Embolização Terapêutica , Varizes , Adulto , Idoso , Feminino , Humanos , Dor Pélvica/etiologia , Pelve , Pós-Menopausa , Varizes/complicações , Varizes/terapia
17.
Phlebology ; 36(9): 676-677, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33896255
18.
Ann R Coll Surg Engl ; 103(6): 452-458, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33851890

RESUMO

INTRODUCTION: Several treatment modalities have been postulated to improve the efficacy of varicose vein treatment. Addition of glycerine to the sclerosing material has been documented to increase its viscosity and subsequently prolong the duration of stability, in addition to the direct sclerosing effect of glycerine. This histological and immunohistochemical study investigated the efficacy of addition of glycerine 72% to sclerotherapy on the human varicose vein. METHODS: After surgical stripping of great saphenous veins, three equal segments were resected between two clamps. Specimen 1 was injected with saline only, specimen 2 was exposed to foam sclerosant 2%, and specimen 3 was exposed to a mixture of foam sclerosant 2% and glycerine 72%. All segments were left for 5min. Vein segments were then processed for histological and immunohistochemical study. RESULTS: Microscopically, haematoxylin and eosin-stained specimen 1 showed endothelial swelling, cytoplasmic eosinophilia and pyknotic nuclei. The media showed sarcoplasm vacuolisation and necrosis. Specimen 3 showed hypereosinophilic sarcoplasm of the smooth muscle fibres. Oedema was less evident, with a relative decrease in the thickness of the wall compared with specimen 2. Immunohistochemically, the expression of smooth muscle actin was weak in specimen 3 compared with specimens 1 and 2. Expression of CD31 antibody was much reduced in specimen 2 which showed conserved islands of endothelial cells. By contrast, there was a complete loss of endothelial cells in specimen 3. CONCLUSION: Addition of glycerine 72% to foam sclerosant has a more damaging effect on human vein wall.


Assuntos
Edema/patologia , Glicerol/farmacologia , Polidocanol/farmacologia , Veia Safena/patologia , Soluções Esclerosantes/farmacologia , Actinas/metabolismo , Combinação de Medicamentos , Endotélio/efeitos dos fármacos , Endotélio/metabolismo , Endotélio/patologia , Glicerol/uso terapêutico , Humanos , Imuno-Histoquímica , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Polidocanol/uso terapêutico , Veia Safena/efeitos dos fármacos , Veia Safena/metabolismo , Soluções Esclerosantes/uso terapêutico , Varizes/terapia , Viscosidade
20.
Phlebology ; 36(8): 665-667, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33673744

RESUMO

Duplex ultrasound is an important tool in the assessment and management of patients with varicose veins. Over the past two decades several minimally-invasive therapeutic options have become available for the treatment of these patients. Consequently, the ultrasonographic assessment and the parameters to consider have changed accordingly. Ultrasound parameters, such as the diameter of superficial incompetent veins or their depth from the skin surface amongst others, have become of paramount importance for planning a tailored either operative or non-operative treatment. However, in daily practice there is a wide variety of ultrasound parameters described in the report. This variety can be explained by several factors, such as the background of the healthcare professional performing the exam or the available treatments as per the local national healthcare service guidelines or insurance reimbursement plans. The standardisation of the reporting of the ultrasound findings in patients with varicose veins will improve communication between healthcare professionals and the management of these patients.


Assuntos
Varizes , Insuficiência Venosa , Humanos , Extremidade Inferior , Veia Safena/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Varizes/terapia , Veias/diagnóstico por imagem
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