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Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of <0.7 were excluded. Debridement, exercise, venoactive drugs, and a four-layer bandage system were performed for all patients. The primary outcome was to assess the ulcer healing, and the secondary outcome was to obtain the recurrence rate and the treatment compatibility of patients. Results: The mean age of the patients was 60.73±11.3 (28-91) years and 77.9% were male. Body Mass Index (BMI) was 30.4±7.7 kg/m² (min:18-max:51 kg/m²). The mean follow-up period was 18.82±13.4 weeks. Pseudomonas aeruginosa (38%) and Staphylococcus aureus (31.8%) were the most identified microorganisms. Four patients experienced recurrence of the CVU (3.5%). The older patients had larger ulcers than the younger patients. Female patients had larger-sized ulcers (p=0.001). Completely healed ulcers were 26.5% of the total. The four-layer compression bandage was applied 12 times for per patient. The mean healing period was 23.2±13.8 weeks. The mean healing rate was 4.17±3.78% for a week. The multivariant analysis revealed that age and pain had negatively affected the ulcer healing. Conclusion: The management of CVU is challenging and needs a multidisciplinary approach. Compression is the main goal of the treatment. Surgical or endovenous therapies may be beneficial for decreasing ulcer recurrence. For patients with slow ulcer healing, adjuvant treatment modalities such as patient education, smoking cessation, diet and lifestyle modification, and exercise should be recommended. [ABSTRACT FROM AUTHOR]

Aim: Chronic Venous Ulcer (CVU) accounts for nearly 70% of all chronic leg ulcers (CLU), seriously impacting the quality of life and creating a heavy economic burden. Here, we present CVU therapy with a four-layer bandage system in 113 patients retrospectively treated by the General Surgery Chronic Wound Unit and Cardiovascular Surgery Department. Material and Methods: From January 2022 to January 2023, 113 patients with CVU were evaluated retrospectively. All patients were documented by color Doppler ultrasonography (CDUS), ulcer size, and demographics. If there were multiple ulcers, the largest one was assessed. Immobile patients and patients with an Ankle Brachial Index (ABI) of [Turk J Vasc Surg 2023; 32(3.000): 147-52]

Introduction: Venous varices are vascular lesions caused by vasodilatation. These oral cavity lesions are usually seen as papules or dark blue nodules on the tongue's ventral surface buccal and retro-commissural mucosae. They are generally asymptomatic but may cause problems such as bleeding on trauma or lack of esthetics. Although many treatment modalities exist for these lesions, the laser is a novel and less invasive method. It secures patient satisfaction more than other methods due to the lack of bleeding and pain. Unlike previous laser therapy methods used for cutting and excision of small vascular lesions, in this lesson, the coagulation properties of laser are employed to eliminate the lesion. Case Presentation: To illustrate, a 70-year-old female person was admitted to the dental clinic of the Semnan University of Medical Sciences, Iran, for a dental examination. She has no systemic problems. During the extra-oral examination, the lesion was visualized on the right side of her lower lip, and the initial diagnosis of a venous lake was made. The lesion was asymptomatic and had been present for several years. Likewise, after obtaining informed consent, treatment with a 940-diode laser was performed. Immediately after the irradiation, the lesion disappeared, and after four weeks, the lip's texture was completely normal. Conclusions: Exploiting the coagulation properties of the laser to eliminate venous lakes is advantageous over other methods because of the lack of bleeding or pain. Furthermore, this method has a shorter healing time. [ABSTRACT FROM AUTHOR]

The incidence of cardiovascular diseases is continuously increasing around the world. Therefore, the study of new methods for diagnosing cardiovascular diseases is very important. Early diagnosis and evaluation of the effectiveness of treatments are among the most important tasks. In this work, we study changes in vascular compliance and vascular tone of the lower extremities in a patient diagnosed with an early stage of varicose veins. The study is based on recording the bioimpedance signals of the lower extremities and their parts using the Rheo-32 multichannel device. Registration in the monitoring system takes place in two stages: the first in a state of relaxation, and the second after applying a local massage on one of the legs for five minutes. The results indicate a change in the type of vascular tone of the lower extremities after the massage, while the type of vascular tone changes and shifts on average towards the normotonic type. The method proposed in this study makes it possible to quantitatively and qualitatively assess changes in the tone of the vessels of the extremities. [ABSTRACT FROM AUTHOR]

Background: Varicosity is a complex venous pathology affecting the lower extremities.It affects 5 to 30% of adult population. Varicose veins arise due to incompetence in valves of deep, superficial and/or perforating veins . The exact etiology and pathophysiology of varicose vein disease remain,however unclear. This study aims to look at the histopathological changes in wall of varicose veins and to correlate the changes with normal vessels also. Material and Methods: A total of 120 vein specimens were collected from 42 patients ( 6 trauma cases and 36 varicose vein cases) at Govt Medical College& Hospital,Jammu for a period of 4 years June 2015 to May 2019. 108 vein specimens were collected from proximal thigh long saphenous vein (LSV) and distal calf varicosites in 36 primary varicose vein patients and 12 specimens from the normal, 6 vascular trauma patients which acted as normal controls while the primary varicose vein patients consisted of 12 females and 24 male patients. Results: In our study, varicose vein was more common in younger age group and in males( 66.6%) as compared to females (33.3%).50% were in occupations involving prolonged standing.The family history of varicose veins was present in 2.7%. 30.5% patients had a history of smoking. Amongst female patients,22.2% were multipare and 5.5% had a history of OC pills use. The most common complain was swelling of vein followed by pain and presentation was mainly of varicosity.In varicose vein patients, sections from proximal LSV and distal calf varicosities showed varying degrees of dilation of the lumen,irregular intimal surface and marked hypertrophy of the intima,which was thrown into folds. Conclusion:The present study suggests that the main abnormalities in the wall of varicose vein is intimal hypertrophy,thining of muscle layer. [ABSTRACT FROM AUTHOR]

Background: Varicosity is a complex venous pathology affecting the lower extremities. It affects 5 to 30% of adult population. Varicose veins arise due to incompetence in valves of deep, superficial and/or perforating veins. The exact etiology and pathophysiology of varicose vein disease remain, however unclear. Aim: This study aims to look at the histopathological changes in wall of varicose veins and to correlate the changes with normal vessels also. Material and Methods: A total of 120 vein specimens were collected from 42 patients (6 trauma cases and 36 varicose vein cases) at Govt Medical College & Hospital, Jammu for a period of 4 years June 2015 to May 2019. 108 vein specimens were collected from proximal thigh long saphenous vein (LSV) and distal calf varicosities in 36 primary varicose vein patients and 12 specimens from the normal, 6 vascular trauma patients which acted as normal controls while the primary varicose vein patients consisted of 12 females and 24 male patients. Results: In our study, varicose vein was more common in younger age group and in males (66.6%) as compared to females (33.3%).50% were in occupations involving prolonged standing. The family history of varicose veins was present in 2.7%. 30.5% patients had a history of smoking. Amongst female patients ,22.2% were multipara and 5.5% had a history of OC pills use. The most common complaint was swelling of vein followed by pain and presentation was mainly of varicosity. In varicose vein patients, sections from proximal LSV and distal calf varicosities showed varying degrees of dilation of the lumen, irregular intimal surface and marked hypertrophy of the intima, which was thrown into folds. Conclusion: The present study suggests that the main abnormalities in the wall of varicose vein is intimal hypertrophy, thinning of muscle layer.

The incidence of cardiovascular diseases is continuously increasing around the world. Therefore, the study of new methods for diagnosing cardiovascular diseases is very important. Early diagnosis and evaluation of the effectiveness of treatments are among the most important tasks. In this work, we study changes in vascular compliance and vascular tone of the lower extremities in a patient diagnosed with an early stage of varicose veins. The study is based on recording the bioimpedance signals of the lower extremities and their parts using the Rheo-32 multichannel device. Registration in the monitoring system takes place in two stages: the first in a state of relaxation, and the second after applying a local massage on one of the legs for five minutes. The results indicate a change in the type of vascular tone of the lower extremities after the massage, while the type of vascular tone changes and shifts on average towards the normotonic type. The method proposed in this study makes it possible to quantitatively and qualitatively assess changes in the tone of the vessels of the extremities.

Objectives: The aim of this study is to detect the anatomical variations of the saphenous fascia (SF) around the great saphenous vein (GSV) in the Omani population and compare it to published studies in other populations. The extent of the SF has been documented to vary between certain populations. There are no such studies from the Arabian Gulf population. Methods: Following ethical approval, bilateral lower limbs of 100 consecutive consenting volunteers at our tertiary care university hospital were scanned using an ultrasound scan. The GSV was traced from the groin to ankle, and the point of exit from the SF was noted. Results: The results showed that the majority of the Omani population had a SF ending at the upper thigh (39.5%). The next most common location was at the mid-thigh (26.5%). Conclusions: This study found that the course of the GSV within the SF can differ between populations. This has important implications in the pathophysiology and endovenous treatment options offered to Omani patients seeking treatment for varicose veins.

Introduction: Regarding to the lack of reports about the prevalence of pregnancy varicose in Iran and the adverse effects of this type of varicose on pregnancy and childbirth, this study was performed with aim to evaluate the prevalence of pregnancy varicose and its related factors. Methods: This analytical-cross-sectional study was performed on 275 pregnant women in gynecology hospitals of Tabriz in 2018. The CEAP checklist was used to determine the severity of varicose symptoms. Data were collected by the researcher after completion. Data were analyzed by SPSS software (version 20) and spearman correlation test. P

Varicose veins are the most common vascular disease in humans. Veins have valves that help the blood return gradually to the heart without leaking blood. When these valves become weak, blood and fluid collect and pool by pressing against the walls of the veins, causing varicose veins. In the cardiovascular system, mechanical forces are important determinants of vascular homeostasis and pathological processes. Blood vessels are constantly exposed to a variety of hemodynamic forces, including shear stress and environmental strains caused by the blood flow. In varicose veins within the leg, venous blood pressure rises in the vein of the lower extremities due to prolonged standing, creating a peripheral tension in the vessel wall thereby causing mechanical stimulation of endothelial cells and vascular smooth muscle. Studies have shown that long-term increased exposure to vascular wall tension is associated with the overexpression of HIF-1α and HIF-2α and increased levels of MMP-2 and MMP-9, thereby reducing venous contraction and progressive venous dilatation, which is involved in the development of varicose veins. Following the expression of metalloproteinase, the expression of type 1 collagen increases, and the amount of type 3 collagen decreases. Therefore, collagen imbalance will cause the varicose veins to not stretch. Loss of structural proteins (type 3 collagen and elastin) in the vessel wall causes the loss of the biophysical properties of the varicose vein wall. This review article tries to elaborate on the effect of mechanical forces and sensors of these forces on the vascular wall in creating the mechanism of mechanosignaling, as well as the role of the onset of molecular signaling cascades in the pathology of varicose veins. [ABSTRACT FROM AUTHOR]

Chronic venous disease may affect even 60% of the population. Manifestation of this condition may vary from no symptoms to an active venous ulcer. The treatment of this disease may improve patient’s quality of life. A large number of new studies have been carried out since the guidelines publication of the Society for Vascular Surgery, American Venous Forum and European Society for Vascular Surgery considering chronic venous disease treatment. There is also available a 2 year follow-up of the study described in the guidelines. New non- thermal techniques like Mechanochemical ablation (MOCA) and Cyanoacrylate closure (CAC) are very effective, less painful and safe. The use of endovenous non- thermal ablation techniques doesn’t require tumescent anaesthesia which works as a heat sink protecting surrounding tissues from damage in thermal techniques. This eliminates the risk of bleeding and pain associated with multiple needle injections along the vein section to be treated. New studies show that MOCA and CAC techniques have high closure rates directly after the procedure and in the follow-up periods.

Background and aim : Professional nursing is a high risk of developing varicose leg. Threfore the aim of this study was to determine the effect of education based on health belief model on preventive behaviors of Varicose vein in nurses. Methods: This is a quasi-experimental study that was carried out on 100 nurses were selected and divided randomly into two case and control groups. Participants in two stages (before and three months after treatment) were tested. Educational intervention through lectures, question and answer booklets were held. Data ghathering with questionnaire was a researcher made based on the health belief model and the data were analyzed with the use of statistical tests chi-suare, T-test, T-paredtest. Results: Funding showed that 3 months after intervention, construct of health belief model significant difference in the intervention group compared to the control group (p

According to World Health Organisation, Chronical diseases are long-term diseases that develop slowly over time, often progressing in severity, requires rehabilitation and can often be controlled, but rarely cured. In this group belong the vascular diseases. The most common cause of chronic venous disease is directly correlated with hereditary factors bad habits and the lifestyle. The secondary varicose is caused by malformations, traumatism and deep vein thrombosis. The concept of chronic venous diseases encompasses a wide range of venous diseases, from ordinary telangiectasia (spider veins), reticular veins to varicose veins. The limb edema is often caused by diminished venous wall function accompanied by flap dysfunction. The complications of chronical venous diseases are trophic skin changes with hyperpigmentation, lipodermatosclerosis, the appearance of varicose ulcers and superficial thrombophlebitis. The more serious forms of chronic venous disease are referred to as chronic venous insufficiency. According to this definition, clinical manifestations of chronic venous diseases, such as skin hyperpigmentation, venous eczema, lipodermosclerosis, white atrophy, and healing venous ulcers, fall into the chronic venous insufficiency category. The first sign of chronic venous insufficiency is swelling of the limb even when the varicose is missing. The principle reasons for chronic venous insufficiency appearance are heredity and the style of life. The principle way of treatment in such cases is the surgery. As in the every one case of surgical intervention, the early and correct uplift of the patient is very important. Of great importance is the postoperative prophylaxis, to avoid recurrences and complications - active venous ulcers and thrombophlebitis. Purpose: the task of this investigation is to analyse and to appreciate the reasons for chronic venous insufficiency. Methodology: for this purpose the questionnaire was made for the patients with chronic venous insufficiency. The patients have to fill in questions about factors as heredity, style of life, profession, bad habits, sex, age, weight and other diseases. Results: the actual investigation is at the beginning, so at this time I do not have my own results. The first intermediate results have to be published in the next vol. Conclusions: as a cause of occurrence of the chronic venous insufficiency, hereditary burden, lifestyle, occupation, bad habits, sex, age, weight and concomitant diseases will be considered as the cause of chronic venous insufficiency. [ABSTRACT FROM AUTHOR]

Introduction: Endovascular ablation of varicose vein either by radiofrequency ablationor laser delivers sufficient thermal energy to incompetent vein segments to produce irreversible occlusion, fibrosis and ultimately disappearance of the vein. Materials and Methods: Three hundred patients with varicosities due to primary or recurrent sapheno-femoral or sapheno-popliteal junction and great or small saphenous veinreflux underwent out-patient and in-patient endovenous thermal ablation between January 2015 to December 2017.The great saphenous vein was ablated from 2-2.5 cm below sapheno-femoral junction to knee and the small saphenous vein was ablated from mid-calf to the sapheno-popliteal junction. Results: Patient returning time to normal activity was 0–1 days returning to normal daily activity were immediately after 4 hours. Duplex ultrasound follow-up (median 3-months) confirmed abolition of sapheno-femoral junction/great saphenous vein and sapheno-popliteal junction/small saphenous vein reflux in all limbs. There were no instances of skin burns or deep vein thrombosis, but, 7 patients developed transient cutaneous numbness involving sural nerve and 1 developed endovenous heat induced thrombosis 3. Conclusions: This is likely to be more effective than conventional surgery, although long-term follow up is required. Despite being expensive in comparison to open surgery, endovenous thermal ablation is superior in terms of: minimizing pain, avoiding incision, early mobilisation and discharge. Changing the treatment distance from 2 cm to 2.5 cm peripheral to the Deep veins junction may result in a diminished incidence of endovenous heat induced thrombosis 3.

Background. Type 2 diabetes mellitus (DM2) is a risk factor for arteriosclerosis of the lower extremities, and the relationship with the state of the feet venous vascular territory remains insufficiently studied, the effectiveness of surgical treatment of patients with varicose veins is not defined. Objective: to analyze the clinical course of foot varicose veins and the effectiveness of medical measures on the background of DM2. Materials and methods. The study included 302 patients (227 men and 75 women aged 29–72 years old), 16 % of which had previous phlebothrombosis and the prevalece of II, III, IV, V and VI class of venous insufficiency was 10, 14, 37 16 and 23 %, respectively. 263 patients underwent endovenous laser coagulation, and 39 — the traditional phlebectomy and ligation of perforating veins. Results. Among the examined patients with varicose veins of lower extremities DM2 was diagnosed in 9 % of cases, more often in males and elderly patients on the background of atherosclerosis of the foot vessels (iliac, femoral, tibial, popliteal artery), which was accompanied by more frequent involvement of the great saphenous vein in the process and its gate extension, the prevalence of severe grades of venous insufficiency, significantly worse the results of surgical treatment of varicose veins and greater frequency of complications, despite more frequent using of rivaroxaban and low molecular weight heparins, and the effectiveness of endovenous laser ablation after four weeks of its implementation is inferior to that in the group without DM2, while glycemic index inversely correlated with the surface tension of the venous blood, which has prognostic significance in the context of future medical interventions. Conclusions. The presence of DM2 is a risk factor for more severe feet varicose veins, is a negative predictive factor in the effectiveness of surgical treatment of the disease and the complications number.

Background: In the present study, it is aimed to determine the intervention-related change in the mean platelet volume (MPV) and platelet count in saphenous vein embolization performed using cyanoacrylate in chronic venous stasis and varicose treatment, as well as explaining the possible venous thromboembolism events. Methods: 60 patients involved in the present study were selected from the patients, who had varicose and chronic venous stasis and who applied to the Cardiovascular Surgery Polyclinic of Medical Faculty of Adıyaman University. The files of patients undergone saphenous vein embolization using CA were performed digitally and their USG and laboratory results were analyzed. Among 437 patients, 60 patients' undergone hemogram and biochemical examination before and after the intervention were involved in the present study. The preoperative (pre-op) and postoperative (post-op) platelet counts and mean platelet volumes of the patients were analyzed. Results: When compared to the pre-op period, no significant change was observed on 1st post-ophour and 1stpost-op month (p > 0.05), however the MPV value observed on the 3rd post-op day was significantly higher than the pre-op period (p < 0.05). The MPV value observed on the 3rd post-op day was statistically higher than on 1st post-op hour (p < 0.05) and the MPV value observed on the 1st post-op month was statistically significantly lower than on 3rd post-op day (p < 0.05). Conclusion: MPV did not significantly increase from the normal values on the 1st postoperative day, whereas it significantly increased on the 3rd postoperative day. Assuming that MPV is related with the increasing thrombogenicity, it can be stated that the saphenous vein embolization by using CA that is one of the minimally invasive methods used in varicose treatment may cause thromboembolic events in the early pre-op period (in the first week). [ABSTRACT FROM AUTHOR]

Varicose veins are tortuous, winded veins in the subcutaneous tissues of legs. These veins are visible and can be easily diagnosed clinically. The varicose veins are usually incompetent and may result in the reflux of blood and ultimately venous hypertension. Varicose veins are usually found asymptomatic however it may result in local pain, heaviness in the limb, change in the color, itching, dryness and may develop ankle swelling including cramps. Conditions that increase pressure on leg veins such as obesity, sedentary life style, lack of activity or exercise, hormonal fluctuations during pregnancy, menopause, smoking, heavy weight lifting may lead to varicose veins. [ABSTRACT FROM AUTHOR]

Background: To review published evidence regarding an n-butyl-cyanoacrylate (NBCA) injection device for great (GSV) and small (SSV) saphenous vein incompetence in terms of occlusion rate, postoperative complications and quality of life improvement. Material and methods: International bibliographic databases (PubMed, EMBASE, Scopus) were searched to identify possible target articles. The only inclusion criterion was the use of the Variclose® system (Biolas, Ankara, Turkey) for superficial vein insufficiency. Exclusion criteria were case reports, review, meta-analysis, article with <6-month follow-up data, abstracts and congress presentations. PRISMA guidelines were used to lead articles selection. Results: Seven studies were included in the final data analysis. A total of 918 patients (1000 limbs) underwent an NBCA procedure for GSV (947 cases) or SSV (53 cases) incompetence. The average procedure duration was 11.7 min. The most common postoperative complications were postoperative pain (4.8%) and superficial vein thrombosis (2.1%). No deep vein thrombosis or pulmonary embolism cases were described. The occlusion rates at six, 12 and 30 months were 97.3%, 96.8% and 94.1%, respectively. Conclusion: NBCA injection with the Variclose device seems to be a feasible, effective and safe treatment in GSV incompetence. Long-term follow-up studies and randomized controlled trials are needed to achieve high-quality evidence. [ABSTRACT FROM AUTHOR]

Varicose remodeling of the venous wall primarily occurs in the lower extremities and is often associated with venous insufficiency. Although a large part of the western population shows various degrees of varicosis, little is known about the mechanisms driving their formation. In recent years, experimental animal models have spurred the identificatoin of target molecules and cellular mechanisms that control varicose remodeling processes. Thus, the chronic increase in venous wall tension appears to be a crucial determinant to stimulate signal cascades, culminating in increased proteolytic and proliferative activity of venous wall cells. The pharmacological inhibition of key molecules in these processes may provide a way to influence the course and severity of varicosis. This review article gives a brief insight into this topic. [ABSTRACT FROM AUTHOR]

A 25-year-old female was referred to the Interventional Radiology Department for investigation and treatment of a rectal venous malformation (RVM) causing large recurrent episodes of rectal bleeding and chronic anaemia. Magnetic resonance imaging (MRI) demonstrated a large venous malformation affecting the rectum, lower pelvis and left thigh. After three failed attempts at injection foam sclerotherapy using fluoroscopic colonoscopy, a multidisciplinary team proposed an embolization procedure of the arterial inflow to the venous malformation. Following discussion with the patient, embolization of the superior rectal arteries was undertaken with immediate on-table fluoroscopic improvement in the RVM. Post-treatment, a significant reduction in bleeding, was reported by day 10 with subsequent return to activities of daily living and full employment. Follow-up MRI at 1 year demonstrated significant reduction in bowel-wall thickening. [ABSTRACT FROM AUTHOR]

Aims: Varicose veins of lower limb remain common affecting 5% or more of the adult population. The aim of this study was to compare the different modalities of treatment that it is available in our Institution. Materials and Methods : All patients with varicose veins of lower limb undergoing treatment in Surgery Deptt of Fakhruddin Ali Ahmed Medical College at Barpeta, Assam from 1st of January 2015 to 31st December 2017 were included in this study. 67 cases of varicose veins of lower limbs were treated during this period and out of this 23 cases were treated by surgery and rest were treated conservatively . Cases were analysed prospectively for a period of 6 to 18 months. Morbidity and potential factors influencing the complication rate were recorded. Results: 67 cases of varicose veins of lower limbs were treated during the period. Most commonly affected age group was 21 to 40 years. The most commonest symptoms was aching in the veins at the end of the day, after prolonged standing. Out 67 cases 23 cases were operated. Saphenofemoral junction flush ligation with ligation of all tributaries with ligation of incompetent perforator of GSV was the most commonly done surgical procedures. Compressive elastic stocking is the best method of conservative treatment. Conclusion: There are different modalities of treatment for varicose veins. Saphenofemoral junction flush ligation with ligation of all tributaries with ligation of incompetent perforator of GSV was the most commonly done surgical procedures. It is an easy, effective and definitive method of treatment. [ABSTRACT FROM AUTHOR]

The transmembrane semaphorin Sema-1a acts as both a ligand and a receptor to regulate axon-axon repulsion during neural development. Pebble (Pbl), a Rho guanine nucleotide exchange factor, mediates Sema-1a reverse signaling through association with the N-terminal region of the Sema-1a intracellular domain (ICD), resulting in cytoskeletal reorganization. Here, we uncover two additional Sema-1a interacting proteins, varicose (Vari) and cheerio (Cher), each with neuronal functions required for motor axon pathfinding. Vari is a member of the membrane-associated guanylate kinase (MAGUK) family of proteins, members of which can serve as scaffolds to organize signaling complexes. Cher is related to actin filament cross-linking proteins that regulate actin cytoskeleton dynamics. The PDZ domain binding motif found in the most C-terminal region of the Sema-1a ICD is necessary for interaction with Vari, but not Cher, indicative of distinct binding modalities. Pbl/Sema-1a-mediated repulsive guidance is potentiated by both vari and cher. Genetic analyses further suggest that scaffolding functions of Vari and Cher play an important role in Pbl-mediated Sema-1a reverse signaling. These results define intracellular components critical for signal transduction from the Sema-1a receptor to the cytoskeleton and provide insight into mechanisms underlying semaphorin-induced localized changes in cytoskeletal organization. [ABSTRACT FROM AUTHOR]

Varicose veins (VV) are enlarged veins of the subcutaneous tissue, usually caused by faulty or damaged venous valves leading to impaired blood flow. Blood stasis, excessive clotting disorder and alterations in the vein walls are symptoms of Virchow's triad which may affect the morphotic elements of blood, including erythrocytes. The aim of this study was to investigate alterations in the properties of the erythrocytes taken from varicose veins in comparison to those from antecubital vein of patients with chronic venous disease. The investigation was conducted on whole erythrocytes using spin labeling method in EPR spectroscopy and flow cytometry. The internal viscosity of cells was determined by Tempamine. The conformation state of internal proteins, mainly hemoglobin and membrane proteins was determined by maleimide spin label (MSL, 4-maleimido-2,2,6,6-tetramethylpiperidine-1-oxyl). The plasma membrane fluidity was measured using two spin labeled fatty acids (5- and 16-doxylstearic acid), while conformational state of membrane protein was measured using two covalently bound spin labels MSL and ISL [4-(2-iodoacetamido)-2,2,6,6-tetramethylpiperidine-1-oxyl]. The osmotic fragility and the shape and size of the erythrocytes were also determined. A decrease in internal viscosity of the erythrocytes from varicose vein was observed. A significant decrease in lipid membrane fluidity indicated by 5-DS, which is located at the polar region of lipid layer was found in the erythrocytes from varicose vein in comparison to normal vein. A significant decrease in the motion of MSL and ISL attached to erythrocyte membrane proteins from varicose vein was found. Changes in the plasma membrane of the erythrocytes from varicose vein were also confirmed by measuring osmotic fragility. These cells were more sensitive to hemolysis than red blood cells from the peripheral blood vein. Meanwhile, no significant differences in size and shape were observed between the erythrocytes taken from varicose veins and those from peripheral veins. In conclusion, the erythrocytes from varicose veins exhibited decreased intracellular viscosity and decreased plasma membrane fluidity. At the same time, conformational changes of membrane proteins and higher osmotic fragility of these cells were found in comparison to the erythrocytes obtained from peripheral veins in the same patients with chronic venous disease. Our findings strongly suggest that presented abnormalities in the erythrocyte plasma membrane may have significant pathophysiological implications, including shortened cell survival and alterations in the hemorheology of the varicose vein blood. [ABSTRACT FROM AUTHOR]

Objective This study evaluated the concept of percutaneous closure of insufficient veins using the VeinScrew principle. Methods The VeinScrew is designed to place a spring-shaped implant that contracts and clamps around the vein. The ability of the device to occlude adequately was tested in a bench model experiment. The feasibility of accurate placement and adequate venous occlusion was evaluated in an animal experiment and in a human cadaveric experiment. Results The VeinScrew implant occluded up to a pressure of 135 mmHg. In vivo studies confirmed that deployment was challenging but technically feasible, and subsequent phlebography showed closure of the vein. The cadaveric study showed that percutaneous placement of the evolved VeinScrew around the great saphenous vein was feasible and accurate. Conclusions The current studies show the feasibility of the VeinScrew concept. Future developments and translational studies are necessary to determine the potential of this technique as a new option in the phlebologist's toolbox. [ABSTRACT FROM AUTHOR]

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Background: A common varicose vein of the lower organs occurs for women four times more than men and nearly half of them are from a family suffering from varicose veins. This disease causes ambiguous ache, feeling pressure on feet after long time standing, feeling heaviness on feet, mild edema on ankle, skin ulceration near ankle. It seldom causes varicose veins to tear and bleed. Objective: The aim of this research is to survey how to provide herbaceous medicine containing the extract of Indian chestnut to treat varicose and its related primary clinical study. Methods: the extract of Indian chestnut was prepared and different formulations a suitable topical gel has been produced. After the standardization of the product, the drug and placebo effects on those suffering from varicose veins through random sampling has been evaluated. Results: The amount of the extract of Indian chestnut has determined 5.4%. In the performed clinical study the effect of the medicine in comparison with placebo about reducing ache, inflammation, feeling weight on feet values p < 0.000, edema valiums p < 0.05 and itching values p < 0.007 was meaningful and 86.4% of the consumers are generally satisfied with the product. Conclution: Drug from Aseculus hippocastanum extract can be useful in prevention and treatment of Varicose disease symptoms.

Objectives Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI. Methods This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. Results High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m2 vs 26.37 ± 5.16 kg/m2, p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p < 0.001). CAVI was significantly higher in patients with CVI than controls (7.94 ± 1.37 vs 6.73 ± 1.16, p < 0.001). Mean arterial pressure (MAP) was significantly higher in patients with CVI than control group (105.41 ± 10.77 mmHg vs 99.70 ± 11.17 mmHg, p = 0.001). CAVI (p < 0.001, Odds ratio (OR) = 2.033, 95% Confidence interval (CI) = 1.493–2.768), ABI (p = 0.003, OR = 0.003, 95% CI = 0.001–0.137), female sex (p < 0.001, OR = 3.949, 95% CI = 1.613–9.663), and HDL (p < 0.001, OR = 0.923, 95% CI = 0.883–0.964) were the independent predictors of CVI. A CAVI value > 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723–0.849, p < 0.001). Conclusion CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated. [ABSTRACT FROM AUTHOR]

Objective: Varicose vein has become enlarged and twisted and, consequently, has lost its mechanical strength. As a result of the varicose saphenous vein (SV) mechanical alterations, the hemodynamic parameters of the blood flow, such as blood velocity as well as vein wall stress and strain, would change accordingly. However, little is known about stress and strain and there consequences under experimental conditions on blood flow and velocity within normal and varicose veins. In this study, a three-dimensional (3D) computational fluid-structure interaction (FSI) model of a human healthy and varicose SVs was established to determine the hemodynamic characterization of the blood flow as a function of vein wall mechanical properties, i.e. elastic and hyperelastic.Methods: The mechanical properties of the human healthy and varicose SVs were experimentally measured and implemented into the computational model. The fully coupled fluid and structure models were solved using the explicit dynamics finite element code LS-DYNA.Results: The results revealed that, regardless of healthy and varicose, the elastic walls reach to the ultimate strength of the vein wall, whereas the hyperelastic wall can tolerate more stress. The highest von Mises stress compared to the healthy ones was seen in the elastic and hyperelastic varicose SVs with 1.412 and 1.535 MPa, respectively. In addition, analysis of the resultant displacement in the vein wall indicated that the varicose SVs experienced a higher displacement compared to the healthy ones irrespective of elastic and hyperelastic material models. The highest blood velocity was also observed for the healthy hyperelastic SV wall.Conclusion: The findings of this study may have implications not only for determining the role of the vein wall mechanical properties in the hemodynamic alterations of the blood, but also for employing as a null information in balloon-angioplasty and bypass surgeries. [ABSTRACT FROM AUTHOR]

Background & Aims: The purpose of this study was to compare the safety and efficacy of monitored anaesthesia care(MAC) using dexmedetomidine with spinal anaesthesia(SA) using ropivacaine in day care varicose vein surgery in terms of patient satisfaction and postoperative ambulatory and discharge time. Methods: 64 patients who underwent varicose vein surgery were randomly divided into two groups. GROUP I MAC(n=32) GROUP II SA(n=32). In the MAC group, a loading dose of 1µg/kg dexmedetomidine was administered followed by 0.6µg/kg/min maintainance infusion which was then titrated according to sedation. Fentanyl was given as rescue anagesia. In the SA group, SAwas given with 10mg of 0.5 % ropivacaine by a median/paramedian approach in L3/L4 interspace with 25G Quincke spinal needle. Patient's satisfaction to anaesthesia and post operative ambulatory time and discharge time were recorded. Results: Significantly higher verbal numerical rating scale for patient's satisfaction to anaesthesia' was observed in patients of Group I as compared to Group II. Ambulatory time was significantly earlier in Group I as compared to Group II. Range of ambulatory time in Group I was 2 to 5 hours while that in Group II was 4 to 6:30 hours. Group I patients were discharged earlier than Group II though significant differences were not found. Conclusion: Monitored anaesthesia care using dexmedetomidine with fentanyl as rescue analgesia isa better alternative for day care varicose vein surgery due to its association with better patient satisfaction and early ambulatory time and early discharge compared to spinal anaesthesia using ropivacaine. [ABSTRACT FROM AUTHOR]

Saphenous Vein (SV) due to fatness, age, inactiveness, etc. can be afflicted with varicose. The main reason of the varicose vein is believed to be related to the leg muscle pump which is unable to return the blood to the heart in contradiction of the effect of gravity. As a result of the varicose vein, both the structure and mechanical properties of the vein wall would alter. However, so far there is a lack of knowledge on the mechanical properties of the varicose vein. In this study, a comparative study was carried out to measure the elastic and hyperelastic mechanical properties of the healthy and varicose SVs. Healthy and varicose SVs were removed at autopsy and surgery from seven individuals and then axial tensile load was applied to them up to the failure point. In order to investigate the mechanical behaviour of the vein, this study was benefitted from three different stress definitions, such as 2nd Piola-Kichhoff, engineering and true stresses and four different strain definitions, i.e. Almansi-Hamel, Green-St. Venant, engineering and true strains, to determine the linear mechanical properties of the SVs. A Digital Image Correlation (DIC) technique was used to measure the true strain of the vein walls during load bearing. The non-linear mechanical behaviour of the SVs was also computationally evaluated via the Mooney-Rivlin material model. The true/Cauchy stress–strain diagram exhibited the elastic modulus of the varicose SVs as 45.11% lower than that of the healthy ones. Furthermore, by variation of the stress a significant alteration on the maximum stress of the healthy SVs was observed, but then not for the varicose veins. Additionally, the highest stresses of 4.99 and 0.65 MPa were observed for the healthy and varicose SVs, respectively. These results indicate a weakness in the mechanical strength of the SV when it becomes varicose, owing to the degradation of the elastin and collagen content of the SV. The Mooney-Rivlin hyperelastic and the Finite Element (FE) data were finally well compared to the experimental data. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this systematic review and meta-analysis is to synthesise the available evidence of randomised controlled trials comparing endovenous laser therapy to traditional open surgery, high ligation and stripping, for the treatment of great saphenous vein varicose veins in terms of clinical effectiveness, patient satisfaction and peri-operative complications.Methods: MEDLINE, CINAHL, EMBASE and the Cochrane library were searched to identify eligible studies. All randomised controlled trials comparing endovenous laser therapy to high ligation and stripping that used ultrasound examination as an outcome measure and had follow up of one year or more were included. The Cochrane Collaboration's tool for assessing risk of bias was also used to assess the methodological quality of the included studies. Pooled risk ratios with 95% confidence intervals were used as the measure of effect for each dichotomous outcome.Findings: Nine eligible publications relating to six randomised controlled trials were identified. The total enrolment of the studies was 1289 limbs. The clinical efficacy of endovenous laser therapy is comparable to that of surgery in the relatively short follow up period described in the studies. Meta-analysis revealed a trend towards a higher risk of ultrasound recurrence after endovenous laser therapy at 12 months. Quality of life questionnaires reveal similar outcomes for endovenous laser therapy and surgery. There is low quality evidence to suggest surgery is associated with more pain, sensory complications and infection.Conclusion: Endovenous laser therapy is a safe alternative to traditional open surgery. There is some weak evidence to suggest that endovenous laser therapy has a higher risk of ultrasound-detected recurrence at 12 months following treatment compared to open surgery. However, it may be associated with less sensory complications, pigmentation and infection. [ABSTRACT FROM AUTHOR]

Minimally invasive treatment of varicose veins is becoming increasingly popular with both patients and physicians. Endovenous laser therapy has been shown to be safe and effective but the rare complication of iatrogenic creation of arteriovenous fistulas has been described. One case of fistulation between the external iliac artery and vein has been published. We report two further cases and describe their management. [ABSTRACT FROM PUBLISHER]

Spacer fabrics found vast applications as medical textile due to their intrinsic and unique properties such as good air permeability, breathability, compressibility and comfort. The aim of this study is to utilize weft knitted spacer fabric as pressure garment to apply more uniform interface pressure on limb than common commercial fabrics. Initially, different weft knitted spacer fabrics by varying the spacer fabric thickness (0.8, 1.2 and 1.8 mm) and elastane yarn content (25, 30, 35 and 40%) were produced. Then, mean interface pressure was obtained through conducting the Mannequin test. Based on the Mannequin test results, spacer fabrics with similar applied interface pressure to commercial one were selected to perform human limb test. According to the results, the spacer fabric with the thickness of 1.8 mm and elastane yarn content of 25% not only applied interface pressure comparable to commercial fabric, but also exhibited the most uniform interface pressure mapping on human limb among those studied. Also experimental results showed the superior performance of spacer knitted fabrics with elastane yarn than the single jersey knitted fabrics as pressure garments. [ABSTRACT FROM AUTHOR]

A retrospective study of patients with varicose veins which is a very common problem is being presented. 200 patients of varicose veins who were treated at Govt. Medical college Srinagar between 2013-2015 were reviewed and their treatment strategies were analyzed with a regular follow up. Out of the 200 patients who were offered treatment only 25 varying degrees of recurrence were seen which were adequately dealt. Good results with foam sclerotherapy and radio frequency ablation were analyzed. varicose vein require multimodality treatment. Treatment options are shifting from invasive to less invasive modalities (sclerotherapy and endovenous ablations). [ABSTRACT FROM AUTHOR]

Emergencies during phlebology procedures are rare. Nonetheless, a phlebologist needs to be prepared to manage such a situation (like syncope due to anaphylaxis) if it occurs, to distinguish a true emergency from a more benign scenario (like vasovagal syncope), and even to manage an emergency unrelated causally to the procedure itself (like a heart dysrhythmia which happens to occur during sclerotherapy). The focus of such preparations should be actions and information which affect patient outcomes. Physician mental and even medical team rehearsal of such scenarios can improve phlebologist and team responses. This article discusses the differential diagnosis and management of the patient with syncope in a phlebology practice, with emphasis on anaphylaxis. [ABSTRACT FROM PUBLISHER]

The article examines clinical aspects of chronic venous insufficiency (CVI) with a focus on the diagnostic and therapeutic options. Topics discussed include a description of normal venous anatomy and function to better understand the pathophysiology of CVI, the development of venous pathology which is when venous pressure is increased and return of blood is impaired, and the importance of a complete history and physical examination in establishing a proper diagnosis of CVI.

Introduction: Varicose veins affect one-third of the adult population in western countries, but their pathogenesis is incompletely characterized. One of the most controversial issues is the role of inflammation. It is well known that inflammation involves an increased expression/activity of inflammatory mediators. Objective: The aim of this study was to investigate the presence or absence of mediators of inflammation in varicose as compared to healthy veins. Methods and results: Using immunohistofluorescence on varicose and healthy veins, we investigated the presence of inflammatory cells. They were not detectable. Venous wall C-reactive protein (CRP), fibrinogen (EIA) and pentraxin-3 (Western blot) content were measured. CRP was significantly lower in varicose veins, but no difference was found for fibrinogen or pentraxin-3 between varicose and healthy veins. No difference was observed for enzymes involved in inflammation and responsible for arachidonic acid metabolism such as the acute phase reactant secreted phospholipase A-IIA and cyclooxygenase-2, as determined in varicose and healthy veins by Western blot and real-time qRT-PCR. Conclusions: Our experiments demonstrate no increase in the presence of mediators of inflammation in varicose as compared to healthy veins, suggesting that inflammation may not be an important contributor to the pathogenesis of varicose veins. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study is to report our experience about endovenous laser treatment ( EVLT) for lower extremity varices in our centre which was followed by ultrasonography during the 6-month period. Methods During a 1-year period, 46 patients who were treated by EVLT with the 940-nm diode laser for venous insufficiency enrolled in the study. The diagnosis of greater saphenous vein ( GSV) incompetence with reflux was made by clinical evaluation and duplex Doppler examinations. Clinical outcomes, complications and duplex ultrasound of the GSV were assessed within 1 week, 1 month, 3 months and 6 months, after the endovascular laser treatment. Results The mean age of our patients was 44 ± 11 years (24-70), and among them, 23 (50%) were male. Improvement in visible varicosity was seen in 39 (84.8%) patients after 6 months ( P value = 0.011). The baseline mean diameter of GSV was 4.9 ± 1.6 mm and it dropped to 3.5 ± 1.3 after 6 months ( P < 0.0001). After 6 months, 95.7% of our patients were satisfied and recommended this procedure to others. Conclusions Endovascular laser ablation seems to be a safe and effective method for the treatment of lower limb varices. [ABSTRACT FROM AUTHOR]