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Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an "inverted champagne bottle" appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) is a common condition in women that carries with it significant morbidity. It is commonly seen in patients presenting to obstetrics and gynecology outpatient clinic visits. CPP is a presenting symptom of various pathologies including pelvic varicocele, pelvic adhesions, spastic colon syndrome, uterine fibroids, endometriosis, and psychosomatic disorders. Pelvic congestion syndrome has more recently been termed "pelvic venous insufficiency (PVI)" due to the underlying retrograde flow through incompetent ovarian and pelvic veins that are thought to cause the symptoms of CPP. Pelvic varices can commonly present alongside vulvar, perineal, and lower extremity varices. There are some predictable "escape pathways" for these varices that may present for interventional treatment. This article introduces the reader to current terminology, clinical presentation, diagnosis, and treatment of patients with pelvic varices due to PVI. [ABSTRACT FROM AUTHOR]

Background: Lower extremity varicose veins (LEVVs) are a common venous disorder of venous dilation and tortuosity. The functional integrity of vascular smooth muscle cells (VSMCs), the majority of the cells in venous tissues, and their phenotypic differences play important roles in the occurrence and development of LEVV. However, the underlying mechanism remains unclear. Methods: The expression of estrogen receptors ERα and ERβ and G-protein-coupled receptor 30 (GPR30) in LEVV tissues and the role of GPR30 in VSMC phenotypic switching were examined by Western blotting and quantitative real-time PCR. Finally, the related mechanisms underlying LEVVs were explored by Western blotting. Results: The serum estradiol content was increased in LEVV patients compared with normal control patients, but the mRNA levels of ERα and ERβ were not significantly different. GPR30 was overexpressed in LEVVs, and high expression of GPR30 promoted the maintenance of a synthetic phenotype in which OPN, MMP-1 and MMP-9 were highly expressed and α-SMA was poorly expressed in VSMCs. Finally, the mechanism by which GPR30 promotes the phenotypic switching of VSMCs is dependent on the ERK1/2 and AKT pathways. Conclusion: GPR30 may contribute to the pathogenesis of LEVVs by promoting the maintenance of a synthetic phenotype in VSMCs by activating the ERK1/2 and AKT pathways, and GPR30 might be a novel therapeutic target for clinical LEVV treatment. [ABSTRACT FROM AUTHOR]

Pelvic venous insufficiency is now a well-characterized etiology of pelvic congestion syndrome (PCS). The prevalence of CPP is 15% in females aged 18 to 50 years in the United States and up to 43.4% worldwide. In addition to individual physical, emotional, and quality-of-life implications of CPP, there are profound healthcare and socio-economic expenses with estimated annual direct and indirect costs in the United States in excess of 39 billion dollars. PCS consists of clinical symptoms with concomitant anatomic and physiologic abnormalities originating in venous insufficiency. The etiology of PCS is diverse involving both mechanical and hormonal factors contributing to venous dilatation (>5 mm) and insufficiency. Factors affecting the diagnosis of PCS include variance of causes and clinical presentations of pelvic pain and relatively low sensitivity of noninvasive diagnostic imaging and laparoscopy to identify insufficiency compared with catheter venogram. A systematic review of the literature evaluating patient outcomes following percutaneous treatment of PCS is presented. [ABSTRACT FROM AUTHOR]

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Venous reflux often originates from saphenous trunks and their tributaries. In about 10% of the patients reflux derived from non-saphenous veins (NSV) such as those located in the buttock, postero-lateral thigh, vulva, lower posterior thigh, popliteal fossa, knee or along the peripheral nerves such as the tibial and sciatic nerve. It is also important to note that patients who had saphenous vein stripping or ablation have higher odds of presenting with NSV reflux. The majority of patients with NSV reflux have varicose veins and lower extremity oedema; however, about 10% of those patients present with skin damage. This paper analyses the patterns and types of NSV reflux for diagnosis and treatment purposes. [ABSTRACT FROM AUTHOR]

Purpose: To detect the influence of pelvic vein incompetence (PVI) on pain levels in patients with varicosity of the lower limb. Materials and methods: Women of child-bearing age with symptomatic primary or recurrent varicosity of the greater saphenous vein (GSV) were prospectively included in two groups depending on the presence or absence of phlebographic signs of PVI. Pain assessment was carried out with the help of a visual analogue scale (VAS). Results: Forty women were included in the study. Nineteen of them had phlebographic evidence of PVI (group A), whereas 21 were included in the control group (group B). Patients of group A reported a higher median total pain level than patients of group B (group A median 62, range 25-100; group B median 32, range 0-100; P = 0.001). In group A, patients experienced a median level of pain of 67.2 at the lower limb in the standing position (range 40-100) versus a median of 50.3 (range 36-81) in patients of group B (P = NS). The median level of leg pain in the sitting position was 41.2 (range 0-67) in patients of group A and 38.1 (range 0-46) in women of group B (P = NS). Pelvic pain level in the standing position was higher (P = NS) in patients of group A (median 72.2, range 50-91), than in women of group B (median 20.1, range 0-41). In patients of group A, statistically significant (P = 0.0001) higher VAS scores for pelvic pain level in sitting (group = A median 67.2, range 59-71; group B median 18.1 range 0-35) were reported. Conclusions: In a small population of patients with GSV varicosity, overall pain levels were significantly higher in a subgroup of patients with phlebographic signs of PVI. This finding suggests that the presence of PVI might influence the intensity of varicosity symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Mounting evidence suggests that pelvic vein reflux is an important contributing factor to recurrent varicose veins. We compared the incidence in our specialist private unit (Unit A) with that of a District General Hospital (Unit B). Methods: Results of all female patient lower limb duplex ultrasound (LLDUS) and transvaginal pelvic ultrasound (TVUS) scans performed over a one-year period were retrospectively reviewed. Patients with refluxing veins emanating from the abdomen or pelvis on LLDUS (non-saphenous reflux) routinely proceeded to TVUS in Unit A. Results: In Unit A, non-saphenous reflux on LLDUS was present in 90-462 female patients (19.5%). In 81.1% of these, TVUS confirmed reflux in truncal pelvic veins (incidence 15.8%). In Unit B, non-saphenous reflux was present in 60-279 female patients (21.5%). Conclusion: One in five women presenting with varicose veins have reflux of non-saphenous origin. This is the case in specialist and non-specialist units. One in six has associated pelvic vein reflux. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the survey concerning the short and long-term side-effects of sclerotherapy, the impact of Varisolve treatment to patient with detectable gas emboli in the middle cerebral artery (MCA), and the capacity of two sclerosing agents and placebo for sclerotherapy of C1-varicose veins.

Objectives: Tostudy the clinical spectrum of recurrent varices after surgery (REVAS) and the efficacy of sclerotherapy under the comprehensive objective mapping, precise image-guided injection, antireflux positioning and sequential sclerotherapy (COMPASS) technique in their management. Methods: Design: prospective open study with 1.5-5.7-year follow up. Patients: 253 legs of 168 consecutive patients who had received previous surgery for primary varicosity. Main outcome measures: obliteration, recanalization, residual reflux, neovascularization, venous dysfunction score and cumulative obliteration. Results: REVAS presents as a symptomatic chronic venous disease of women in their fifties, a decade later than primary varicosities are reported. Almost 75% of REVAS occurred at the groin, mostly with features of chronic venous disease. The COMPASS technique achieved sustained obliteration in 97% of the groin varices and in 100% of the thigh and isolated refluxes around the popliteal fossa. The cumulative obliteration rate was sustained at >90% and obliteration of perforator reflux was sustained. There was a significant decrease in the venous dysfunction score. In the mean 3.1±1.7 years of follow up, only 3% possible neovascularization was seen. There were no serious adverse experiences reported. Conclusions: REVAS is a symptomatic chronic venous disease requiring skilled medical attention. The COMPASS technique appears to be more efficacious than the presently available surgical approaches to its long-term management. [ABSTRACT FROM AUTHOR]

Aim: To determine the percentage of varicose vein recurrence after compression sclerotherapy of a specific primary varicose vein, the anterolateral thigh vein (lateral accessory saphenous vein), without saphenofemoral junction (SFJ) incompetence at yearly intervals in a long-term follow-up study, and to investigate factors influencing recurrence. Patients and methods: Of 117 patients recruited, 11 were lost to follow up; therefore 106 patients were evaluated: 97 women, mean age 42 years (range 21-72) and nine men, mean age 47 years (range 21-67). If SFJ incompetence was present, surgical ligation of the junction was performed. Primary varicose veins were treated with compression sclerotherapy using polidocanol. A total of 111 limbs were studied. Results: Recurrent varicose veins were found after six months in 6% of cases, after one year in 18% (cumulative percentage), after two years in 28%, after three years in 36%, after four years in 46%and after five years in 54%. No differences could be detected between the recurrence group and the group without recurrence regarding length of varicose veins, amount of polidocanol used, number of injections, circumference of the leg or age of the patient. The varicose vein diameter was significantly larger in the recurrence group. Conclusions: Compression sclerotherapy with polidocanol of the anterolateral thigh vein (lateral accessory saphenous vein) without SFJ incompetence results in a high recurrence rate. Recurrence depends only on the vessel diameter, and not on the length of the varicose vein, amount of sclerosant used or patient age. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of subjective symptoms, grade of disability and axial reflux in superficial veins in different clinical stages of varicose veins (VVs). Methods: A total of 172 legs with primary venous insufficiency from 126 patients were studied. The examination involved evaluation of the CEAP clinical class and clinical disability score (CDS), recording of any symptoms of varicose disease, and a hand-held Doppler (HHD) examination of the superficial veins. Colour-flow duplex imaging (CFDI) was also performed in 22% of the legs. Results: The rate of insufficiency of the great saphenous vein (GSV) was 83% in complicated legs (C4-6), and 68% in uncomplicated legs (C2-3), (P > 0.05). There was a difference between complicated and uncomplicated legs in the insufficiency of the whole GSV [C4-6: n = 18 (39%) versus C2-3: n = 12 (12%), P < 0.005]. Sensation of pain was noted in 68% of the legs in class C1, 60% of those in class C2-3 and 81% of those in class C4-6. Sensation of oedema was recorded in 70% of the legs in class C1, 65% of those in class C2-3 and 86% of those in class C4-6, respectively. CDS classes 2-3 were significantly more frequent among complicated legs (C4-6: 54% versus C2-3 12%, P < 0.005). Conclusions: Leg symptoms are frequent throughout classes C1-6. Their clinical usefulness is therefore limited. CDS parallels well with the clinical classification. In complicated disease the whole saphenous vein is more frequently insufficient. [ABSTRACT FROM AUTHOR]

Ovarian veins system insufficiency is one of the most common reasons for pelvic venous insufficiency (PVI). PVI is a hemodynamic phenomenon responsible for the occurrence of venous insufficiency of the lower extremities and recurrent varicose veins in nulliparous and parous women, as well as for a set of symptoms described as pelvic congestion syndrome (PCS). In the years 2017–2019, 535 patients admitted to our center with symptoms of venous insufficiency of the lower extremities, underwent complete ultrasound diagnostics (color-duplex ultrasound) of the venous system of the abdomen, pelvis and lower limbs, as well as extended imaging diagnostics using computed tomography (CT) or magnetic resonance (MR) venography. On the basis of the obtained results, the authors proposed a 4-grade hemodynamic and radiological classification (grades I-IV) defining the stratification of ovarian veins insufficiency. Using the above mentioned classification approx. 32% patients were identified as Grade I and I/II, approximately 35% revealed morphological and hemodynamic changes corresponding to Grade II and II/III, approximately 25% were classified as Grade III, whereas the remaining 8% were assessed as Grade IV. The described classification allows for the grading of ovarian veins insufficiency based on transparent radiological criteria, making it easy to use in everyday clinical practice. According to the authors, the proposed classification could facilitate communication between diagnostic physicians, specialists dealing with the treatment of venous insufficiency and gynecologists, who admit patients with symptoms suggesting venous insufficiency of the pelvis. [ABSTRACT FROM AUTHOR]