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Background There is growing interest in the comorbidity of vascular and neurodegenerative pathologies in patients with cerebrovascular disease (CVD) beyond cerebral amyloid angiopathy (CAA). However, the relationship between amyloid-β and vascular cognitive impairment (VCI) remains debated. Objective To investigate the association between VCI and amyloid-β deposition in non-CAA CVD patients. Methods PubMed, Embase, Web of Science, PsycINFO and CENTRAL databases were systematically searched. Observational studies, including case–control and cohort studies, associating cognitive scores with amyloid load measured by positron emission tomography were selected. Meta-analyses were performed to assess the strength of amyloid–cognition associations across CVD subtypes and cognitive domains. A random-effects model using the inverse variance method was used, with heterogeneity evaluated by Q-statistics and I2 statistics. Meta-regression analyses were conducted to examine the influence of moderators, and publication bias was assessed using funnel plots and Egger's test. All statistical analyses were performed using StataMP 18. Results Twenty-seven eligible studies encompassing 2894 participants were included. Among non-CAA CVD patients, global cognitive performance was significantly lower in those with higher amyloid-β deposition (standardized mean difference = −0.43, P < 0.001). The correlation strength varied across cognitive domains (executive function: r = −0.41; language: r = −0.36; memory: r = −0.29; all P < 0.001). The correlation was significant in patients with subcortical vascular disease (r = −0.43, P < 0.001) but not post-stroke patients (r = −0.19, P > 0.05). Conclusions Amyloid-β load is associated with cognitive decline in non-CAA CVD patients. This is more pronounced in patients with subcortical vascular disease than in post-stroke patients. Executive function is the most susceptible domain in VCI when the level of amyloid-β increases. [ABSTRACT FROM AUTHOR]

Objective: Lower extremity edema is characteristic of C3 chronic venous disease. We developed a new clinical and duplex ultrasound (DUS) methodology for the detection and quantification of leg edema and prospectively evaluated its usefulness. Methods: Forty-seven venous patients (94 legs) were evaluated for ankle edema using an Edema RulerTM and DUS using a modified Suehiro grading scale. Results: Interobserver reliability for the use of the Edema RulerTM was 0.985 (p <.001) and 0.883 (p <.001) for the Modified Suehiro Grade. The Edema RulerTM had stronger significant correlations with Edema rVCSS (0.842; p <.001) compared to DUS: (0.474; p <.001) with Edema rVCSS. There were significant differences between the edema pitting depth in CEAP classification of C1 and C2 compared to C3, C4a, and C4c. DUS analysis only had significant differences between CEAP classification C2 and C4a. Conclusions: The Edema RulerTM provides a quantitative measurement of lower extremity edema with high reliability which can be easily integrated into clinical practice. While both methods had good inter-observer reliability, the Edema RulerTM had stronger correlations to Edema rVCSS and showed significant differences in pitting depths between lower CEAP scores (C1-2) compared to higher CEAP scores (C3-4c). [ABSTRACT FROM AUTHOR]

Copyright of Folia Pharmaceutica Cassoviensia is the property of University of Veterinary Medicine & Pharmacy in Kosice and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resumen: La insuficiencia venosa representa un problema de salud frecuente en la población actual, con una gran repercusión en la calidad de vida del paciente. El diagnóstico temprano, así como el inicio de las medidas terapéuticas condiciona en gran medida su evolución y la repercusión a largo plazo sobre el paciente. Es por este motivo por el cual consideramos de vital interés un estudio exhaustivo de dicha entidad. En esta revisión nos centraremos en datos de interés clínico y diagnósticos relevantes. Abordaremos el tratamiento médico de dicha enfermedad y los posibles abordajes invasivos disponibles en la actualidad. Abstract: Venous insufficiency represents a frequent health problem in the current population, with a great impact on the patient's quality of life. Early diagnosis and early start of treatment determines the evolution and the long-term impact on the patient. That is why we consider that; an exhaustive study of this pathology can be of vital interest. In this review we will focus on data of clinical interest and relevant diagnostics. We will talk about the medical treatment of this disease and the possible invasive approaches currently available.

Chronic varicose veins disease is widespread worldwide (up to 60% in the adult population), with a significant impact on patients' quality of life and a high cost to society, both due to treatment and the limitation of physical activity imposed by the disease. This article presents a retrospective study on a number of 14 patients treated in Arestetic Clinic in Galati, for a period of one year. The patients included in the study presented reticular and varicose veins up to 6 mm in diameter and under 14 mm on the saphenous vein. Patients completed the Aberdeen Varicose Disease Questionnaire (excluding the first part of the questionnaire) and the Venous Clinical Severity Score was used by the physician. Doppler ultrasound was used for preoperative evaluation and postoperative monitoring. Polidocanol was administered in concentrations of 0.5% and 2%, with the patients being monitored one year after treatment. All patients were declared satisfied with the results and 1 year after treatment no recurrences were found. Polidocanol sclerotherapy is a safe, easy-to-administer, low-cost treatment with no healing time and can be administered multiple times if needed, with minimal risks of complications. Aesthetic results are good, with an important symptom remission rate and high patient satisfaction. Complications were rare and minor (represented by local hyperpigmentation and hardening of the injected path), and the recurrence rate is comparable to surgical treatment.

Objectives: The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention measures. Methods: The convenient sampling method was used to conduct a questionnaire survey among males aged 18 to 40 above an altitude of 3000 meters in Xizang in April 2023. The contents of the questionnaire included basic information, symptoms of CVD of lower limbs, protection status and training needs. Multivariate logistic regression model was calculated to evaluate the risk factors for CVD. Results: A total of 350 survey questionnaires were received, and 326 valid samples were collected. The prevalence of CVD of lower limbs (C1-C6) was 37.42% (95%CI: 32.17%–42.68%), the ratio of C0 to C5 were 62.58%, 27.30%, 3.07%, 4.60%, 2.15% and 0.31%, respectively, no one reached C6. The top three symptoms of CVD were lower limb fatigue (18.10%), heaviness (15.34%) and pain (13.19%). 46.01% of respondents were unaware of CVD, and 12.88% of respondents did not have any protective measures of CVD. Multivariate logistic regression showed that age (OR = 1.076, 95%CI: 1.018–1.137, p =.009), preference for spicy food (OR = 1.747, 95%CI: 1.083–2.818, p =.022), unbalanced diet (OR = 1.877, 95%CI: 1.049–3.358, p =.034) and physical exercise (OR 0.610, 95%CI: 0.377–0.986, p =.044) were the independent risk factors for CVD. Conclusions: This study provided data on the prevalence of CVD in young men at high-altitude and the risk factors for CVD. The findings of this study may facilitate the development of individualized clinical assessments and targeted prevention programs. [ABSTRACT FROM AUTHOR]

Managing venous ulcers poses significant challenges for nursing personnel. This article outlines the current strategies employed in addressing venous ulcers, with particular emphasis on the updated T.I.M.E.R.S. wound assessment tool and compression therapy. Diagnosis should consider risk factors associated with chronic venous disease as well as other conditions such arterial ischaemia, ulcers related to diabetic neuropathy, or cancer. Doppler duplex ultrasound is typically conducted to validate the diagnosis. In the treatment of chronic wounds, implementing the updated wound assessment strategy T.I.M.E.R.S. is recommended. Optimal wound management requires tailored dressings and usage of antimicrobial agents. Application of local antibiotics on wounds should be avoided, with the exception of gentamicin embedded in a collagen matrix presented in the form of a sponge. Correctly adjusted com-pression therapy is a gold standard of treatment. Pentoxifylline is advised as an oral treatment to expedite the rate of ulcer healing.

Background: To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio®, VB Devices, Barcelona, Spain). Methods: Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months. Results: 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization. Conclusion: The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to comparatively assess volume changes related to daily occupation of the whole leg (WLv), of the lower leg (LLv) and of the upper leg (ULv) in subject with no venous and lymphatic disorders. Method: WLv, LLv, and Ulv were evaluated by water displacement volumetry (WDV) in the morning and in the evening in 20 healthy subjects. Results: In the legs with occupational edema (OE), WLv increased by 7.07%, LLv by 5.25%, and ULv by 9.80%. In legs without clear OE, WLv increased by 2.41%, LLv by 1.35, and ULv by 3.38%. Conclusions: Surprisingly, the increase of ULv was greater than that of LLv. An evening increase in the leg volume also occurred in legs with no clear OE. In our series, a clinically evident OE was related to an increase of the WLv, LLv, and ULv greater than 5.83%, 8.68%, and 1.88%, respectively. [ABSTRACT FROM AUTHOR]

The article discusses the significant clinical and socioeconomic burden of venous leg ulcers (VLUs), the most severe form of chronic venous disease, which impacts patients' quality of life and strains healthcare resources. Topics include the recommended management strategies for VLUs, emphasizing wound care, compression therapy, and the treatment of venous insufficiency; the importance of proper assessment and timely referrals for optimal healing.

Background: To investigate the use of high intensity focused ultrasound (HIFU) for great saphenous vein (GSV) incompetence. Material and methods: Patients with GSV incompetence underwent HIFU. The primary endpoint was the rate of GSV target segment shrinkage or closure after 1 year. Results: Out of 188 limbs treated, the GSV treated segment shrinkage/closure rate at 1 week, 3 months, 6 months, and 12 months was 93.3%, 98.2%, 97.6%, and 98.3%, respectively. Conclusion: These preliminary results suggest that HIFU holds promise for the treatment of GSV incompetence. Further trials are needed to compare it with other techniques and assess long-term outcomes. [ABSTRACT FROM AUTHOR]

Chronic varicose veins disease is widespread worldwide (up to 60% in the adult population), with a significant impact on patients' quality of life and a high cost to society, both due to treatment and the limitation of physical activity imposed by the disease. This article presents a retrospective study on a number of 14 patients treated in Arestetic Clinic in Galati, for a period of one year. The patients included in the study presented reticular and varicose veins up to 6 mm in diameter and under 14 mm on the saphenous vein. Patients completed the Aberdeen Varicose Disease Questionnaire (excluding the first part of the questionnaire) and the Venous Clinical Severity Score was used by the physician. Doppler ultrasound was used for preoperative evaluation and postoperative monitoring. Polidocanol was administered in concentrations of 0.5% and 2%, with the patients being monitored one year after treatment. All patients were declared satisfied with the results and 1 year after treatment no recurrences were found. Polidocanol sclerotherapy is a safe, easy-to-administer, low-cost treatment with no healing time and can be administered multiple times if needed, with minimal risks of complications. Aesthetic results are good, with an important symptom remission rate and high patient satisfaction. Complications were rare and minor (represented by local hyperpigmentation and hardening of the injected path), and the recurrence rate is comparable to surgical treatment. [ABSTRACT FROM AUTHOR]

Aim: Chronic venous disease is a common pathology characterized by valvular incompetence and venous hypertension. The venous network of the lymph nodes at the Scarpa triangle connects the superficial and the deep venous systems. This study aimed to describe infrainguinal intranodal venous dilatations and to evaluate the connection with peripheral venous disease. Material and methods: The study included 183 subjects (116 women, 67 men) who underwent Doppler ultrasound examinations of the venous system of the inferior limb in the context of chronic venous disease. The diagnosis of lymph node varices was based on well-defined criteria and the severity of the lymph node varices was established using an original classification. Results: There was a statistically significant, moderately strong association, between the presence of intranodal varices and the great saphenous vein reflux (φ=0.341, p=0.000). There was a moderate-to-high positive correlation between intranodal varices and the chronic venous disease stage (rrb=0.457, p=0.000). Conclusions: Patients with more advanced stages of chronic venous insufficiency have a higher probability of presenting intranodal varices. Lymph node venous network identification could considerably impact clinical decision-making and treatment choices. [ABSTRACT FROM AUTHOR]

Background: Our study aims to enhance the understanding of lymph node venous networks (LNVNs) by summarising their anatomical, sonographic features, and reflux patterns. Method: We examined 241 legs from 141 patients with primary chronic venous disease (CVD) using duplex ultrasound. Results: The findings indicated variations in the shape, size, vascularity, and echogenicity of LNVN. The superficial inguinal lymph node with reflux appeared slightly larger, exhibiting higher velocities in the hilar artery. Regarding connections, venous flow within LNVN was predominantly drained through the saphenofemoral junction (SFJ), anterior accessory great saphenous vein (AAGSV), and great saphenous vein (GSV). A significant number of LNVNs were observed to be associated with anterolateral thigh tributaries. The study also identified valve cusps within LNVN. Conclusion: This study revealed a 12% prevalence of primary LNVN. Understanding the anatomical and haemodynamic features of LNVN informs treatment strategies and potentially helps prevent the recurrence of varicose veins. [ABSTRACT FROM AUTHOR]

bjective: To analyze the effects of lower limb muscle strengthening on interface pressure (IP), static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) in older adults undergoing inelastic compression therapy. Method: Forty-three healthy older adults of both sexes (Age: 66.2 ± 4.4 years) met the eligibility criteria and completed all stages of the study (Resistance Training -- RT: N = 20; Control -- CONT: N = 23). Body composition, strength and functional mobility of lower limbs, IP, SSI, DSI, and WPA were evaluated before and after intervention. Results: The two-way ANOVA with repeated measures demonstrated a significant time-group interaction effect on muscular strength for 1-RM [F (1, 41) = 21.091; p ≤ 0.001], IP in the orthostatic position [F (1, 41) = 5.124; p ≤ 0.05], minimum WPA [F (1, 41) = 10.999; p ≤ 0.05], maximum WPA [F (1, 41) = 8.315; p ≤ 0.05], DSI minimum (F (1, 41) = 4.608; p ≤ 0.05), DSI maximum (F (1, 41) = 8.926; p ≤ 0.05), and on the delta DSI (F (1, 41) = 7.891; p ≤ 0.05). Conclusions: In RT group, the increase in lower limb muscle strength was accompanied by an increase in IP in foot dorsiflexion and plantar flexion maneuvers, both in the standing position (DSI) and during gait (WPA). [ABSTRACT FROM AUTHOR]

Varicose veins (VVs) are the most common manifestation of chronic venous disease (CVD) and appear as abnormally enlarged and tortuous superficial veins. VVs result from functional abnormalities in the venous circulation of the lower extremities, such as venous hypertension, venous valve incompetence, and venous reflux. Previous studies indicate that enhanced angiogenesis and inflammation contribute to the progression and onset of VVs; however, dysregulations in signaling pathways associated with these processes in VVs patients are poorly understood. Therefore, in our study, we aimed to identify key regulators of angiogenesis and inflammation that are dysregulated in patients with VVs. Expression levels of 18 genes were analyzed in peripheral blood mononuclear cells (PBMC) using real-time PCR, as well as plasma levels of 6 proteins were investigated using ELISA. Higher levels of CCL5, PDGFA, VEGFC, TGF-alpha, TGF-beta 1, and VEGF-A, as well as lower levels of VEGFB and VEGF-C, were found to be statistically significant in the VV group compared to the control subjects without VVs. None of the analyzed factors was associated with the venous localization of the varicosities. The presented study identified dysregulations in key angiogenesis- and inflammation-related factors in PBMC and plasma from VVs patients, providing new insight into molecular mechanisms that could contribute to the development of VVs and point out promising candidates for circulatory biomarkers of this disease. [ABSTRACT FROM AUTHOR]

Post-thrombotic syndrome (PTS) is the main long-term complication of deep vein thrombosis (DVT). Several therapies are being evaluated to prevent or to treat PTS. Identifying the patients most likely to benefit from these therapies presents a significant challenge. The objective of this review was to identify risk factors for PTS during the acute phase of DVT. We searched the PubMed and Cochrane databases for studies published between January 2000 and January 2021, including randomized clinical trials, meta-analyses, systematic reviews and observational studies. Risk factors for PTS such as proximal location of DVT, obesity, chronic venous disease, history of DVT are associated with higher risk of PTS. On the initial ultrasound-Doppler, a high thrombotic burden appears to be a predictor of PTS. Among the evaluated biomarkers, some inflammatory markers such as ICAM-1, MMP-1 and MMP-8 appear to be associated with a higher risk of developing PTS. Coagulation disorders are not associated with risk of developing PTS. Role of endothelial biomarkers in predicting PTS has been poorly explored. Lastly, vitamin K antagonist was associated with a higher risk of developing PTS when compared to direct oral anticoagulants and low molecular weight heparin. Several risk factors during the acute phase of VTE are associated with an increased risk of developing PTS. There is a high-unmet medical need to identify potential biomarkers for early detection of patients at risk of developing PTS after VTE. Inflammatory and endothelial biomarkers should be explored in larger prospective studies to identify populations that could benefit from new therapies. • Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT). • To date, the pathophysiology of PTS is poorly understood. • There is a high unmet need for the early identification of patients who will develop PTS. • Proximal DVT, obesity, previous venous insufficiency, history of DVT are associated with risk of PTS. • No routine biological markers are associated with risk of PTS. [ABSTRACT FROM AUTHOR]

Chronic venous disease (CVD) is an umbrella term for a group of morphological and functional disorders of the venous system. Clinical signs of CVD may range from telangiectasia and reticular veins to active venous ulcers; therefore, earlier diagnosis and management of CVD may delay disease progression and reduce the burden of CVD on patients, caregivers, and healthcare systems. In this podcast discussion, Professor Andrew Nicolaides, Professor Stavros Kakkos, and Dr Gerardo Estrada-Guerrero share the key highlights from their symposium at the 2023 European Venous Forum. This symposium, titled "Chronic venous disease: what if everything started with early care?", discussed the clinical significance of "functional CVD," evidence and risk factors for CVD progression, and real-world strategies to facilitate earlier diagnosis and management of CVD. Together, these topics highlight the importance of early care to improve long-term outcomes for people with CVD. Plain language summary: Chronic venous disease (CVD) occurs when the blood vessels that carry blood back to the heart are damaged. In the early stages of CVD, people may have visible or swollen veins in their legs and feet, and may feel pain, heaviness, burning, itching, and cramping. Without treatment, people with CVD may develop open sores (ulcers) that are hard to heal and could get infected, so it is important that CVD is diagnosed and treated early. In this podcast, three doctors who specialize in CVD answer questions about a presentation they gave at a recent medical conference. In their presentation, the doctors talked about people who experience feelings of CVD but without any visible signs, and looked at programs that might help doctors diagnose CVD earlier. The doctors agree that it is important to diagnose and treat CVD early, so that people can avoid the long-term effects of this disease. [ABSTRACT FROM AUTHOR]

Aim: to assess perinatal maternal and fetal outcomes in women with iron deficiency anemia (IDA), based on the therapeutic approach and timing. Materials and Methods. A non-interventional cohort study was conducted to assess the effectiveness of treatment with intravenously administered iron preparation in 65 pregnant women diagnosed with moderate-to-severe IDA: at 20–40 weeks of gestation 32 patients received treatment with intravenous iron (main group), 33 women received oral therapy (comparison group). Comparatively analyzed pregnancy course and outcomes based on the therapy protocol were assessed. At the gestational age of 20–23 and 35–40 weeks, clinical data, routine hemogram parameters (hemoglobin level, hematocrit, erythrocyte concentration, erythrocyte indices, total iron binding capacity), serum ferritin-related iron balance, blood viscosity indices within high and low shear rates were investigated. Results. The groups turned out to be comparable in terms of the major indicators – age, parity, the time of anemia diagnosis, and the average hemoglobin level at the follow-up onset. In main group, after a course of intravenous administration of iron carboxymaltosate, the average hemoglobin level increased from 82.3 ± 6.1 g/L to 98.8 ± 6.8 g/L, for ferritin level – from 9.45 ± 0.28 µg/L to 28.35 ± 0.21 µg/L, total iron binding capacity decreased from 87.5 ± 1.72 mmol/L to 69.8 ± 1.03 mmol/L. In comparison group, the dynamics of indicators was markedly lower: the average hemoglobin level decreased from 87.5 ± 6.4 g/L to 84.5 ± 8.1 g/L, ferritin level decreased from 11.26 ± 0.12 µg/L to 9.47 ± 0.56 µg/L, whereas total iron binding capacity increased from 88.4 ± 0.18 µmol/L to 91.2 ± 1.2 µmol /L. Inter-group perinatal complications differed as well: in comparison vs. main group more often were observed untimely discharge of amniotic fluid (54.5 % vs. 28.1 %; p = 0.031), injuries to the soft tissues of the birth canal (28.1 % vs. 9.1 %; p = 0.048), obstetric bleeding (21.2% vs. 3.1%; p = 0.027), post-delivery infectious complications (24.2 % vs. 6.25 %; p = 0.045). Moreover, in comparison vs. main group there was a higher percentage of neonatal pathologies: fetal growth retardation (39.4 % vs. 15.6 %; p = 0.033), asphyxia at birth (45.5 % vs. 18.8 %; p = 0.015), hemorrhagic disorders (24.2 % vs. 6.3 %; p = 0.045). It was found that IDA was accompanied by deteriorated blood rheological properties manifested as increased viscosity at low shear rates (main group: at a rate of 3 s–1, the viscosity of whole blood was 6.63 ± 0.17 cPs, comparison group – 6.6 ± 0.13 cPs) in contrast to healthy pregnant women (5.54 ± 0.28 cPs) (p < 0.05). After intravenous iron therapy, blood viscosity at a shear rate of 3 s–1 decreased in main group to 5.68 ± 0.23 cPs and did not differ from control (p > 0.05). At the same time, blood viscosity in patients treated with oral drugs had no positive effect and remained at the level of 6.27 ± 0.12 cPs. Conclusion. The use of intravenous iron carboxymaltosate in pregnant women in the second trimester is an effective approach to treat anemia that alleviates rate of perinatal complications and has a beneficial effect on blood rheological properties.

Varicose veins usually present in the superficial veins of the lower extremities and are one of the main clinical presentations of chronic venous disease (CVD). Patients’ symptoms may vary according to the pathophysiology, location, and severity of CVD. The prevalence of CVD in Korea has been increasing gradually. However, due to its broad clinical spectrum and the subjective nature of its diagnosis using ultrasound, discrepancies in diagnostic and treatment quality may exist among treating physicians. There have been recent efforts to improve the quality of the diagnosis and treatment of varicose veins in Korea by standardizing the diagnostic criteria and the indications for treatment. This study is a comprehensive review of the clinical manifestations and diagnostic criteria of CVD based on the most recent international and domestic guidelines and reports.

Chronic venous disease is a common condition causing pain, discomfort, and skin changes that effect quality of life and productivity. Various treatment modalities have been developed to manage retrograde venous blood flow and its associated complications, ranging from conservative therapy to more invasive techniques such as endothermal ablation and cyanoacrylate closure (CAC). Recently, CAC has gained popularity due to its faster recovery time and lower incidence of postprocedure discomfort and complications. The most commonly reported side effects include phlebitis, access site bruising or pain, and dermatitis. We present a case of phlebitis caused by Acinetobacter pittii following a CAC procedure using the VenaSeal device (Medtronic) in a patient with diabetes. The patient required surgical resection of the affected vein and prolonged antibiotic therapy. Bacterial contamination of the cyanoacrylate adhesive within a vein poses a significant treatment challenge with antibiotics alone due to biofilm production. Aggressive source control with removal of the adhesive-treated vein could be required for treatment of endovascular infections resulting from these common procedures.

Venous disorders encompass a diverse range of manifestations and diseases, impacting a significant portion of the population. While life-threatening conditions are uncommon in non-thrombotic disorders, like telangiectasias or uncomplicated varicose veins (VVs), these conditions still have a substantial impact on affected individuals. Ensuring that patients are well informed about their venous disorder is a crucial step in their treatment journey. Providing them with valuable information regarding the disease's natural progression and available therapeutic options plays a pivotal role in optimizing their care. When patients are diagnosed with venous disorders, they often have numerous questions and concerns they want to discuss with their healthcare providers. Addressing these inquiries not only improves patients' knowledge and understanding but also influences their treatment compliance and overall outcomes. Therefore, it is of utmost importance to provide comprehensive explanations that address any doubts, uncertainties, and areas of confusion that patients may have. This report aims to present a concise, practical, and informative guide to venous disorders, focusing specifically on the common questions frequently raised by patients in everyday clinical practice. By serving as a valuable resource for healthcare professionals working in the field of venous diseases, this guide equips them with the necessary tools to effectively address patients' concerns and provide optimal care. By bridging the gap between patients' inquiries and medical expertise, this guide strives to enhance therapeutic outcomes and improve the overall management of venous disorders, ultimately empowering patients in their treatment journey. [ABSTRACT FROM AUTHOR]

Introduction: Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. Methods: We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. Results: A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8–22.9) and the prevalence of chronic venous insufficiency (C3–C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p <.001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04–1.56; p =.021), retired people (aOR: 46.9; 95% CI: 12.6–174.5; p <.001), hypertension (aOR: 289.5; 95%CI: 169.69–493.1; p <.001), diabetes (aOR: 2.19; 95% CI: 1.21–3.96; p =.009), obesity (aOR: 10.22; 95%CI: 7.67–13.62; p <.001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10–0.30; p <.001). Conclusion: Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact. [ABSTRACT FROM AUTHOR]

This prospective, observational, multicenter study assessed the tolerance of Dobenox Forte®, the first approved over-the-counter product containing calcium dobesilate, in 1795 outpatients with chronic venous disease (CVD) in daily clinical practice. In addition, the effectiveness (decrease in circumferences of a more affected limb at the ankle and middle part of the calf, and changes in the severity of CVD signs) was assessed. No adverse events related to use of the preparation were reported in a period of 64 ± 20 days. Dobenox Forte® use was associated with a reduction in calf circumference by 13.1 mm (95%CI: 12.2–14.1) and in ankle circumference by 9.7 mm (95%CI: 9.2–11.0) in patients reporting swelling of the lower legs (60.0% of the cohort). A reduction in calf and ankle circumference by at least 1 cm was achieved in 34.9% and 24.9% of patients, respectively. The percentages of patients reporting moderate to very severe lower limb heaviness decreased from 96.6% to 56.0%, calf cramps decreased from 91.0% to 41.0%, calf pain decreased from 89.2% to 43.7%, swelling decreased from 86.1% to 38.8%, and burning sensation that worsens when standing decreased from 79.0% to 33.7%. The medicinal product Dobenox Forte® is well tolerated by patients and seems to effectively reduce the symptoms of CVD. [ABSTRACT FROM AUTHOR]

Copyright of Revista Mexicana de Angiología is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic venous disease (CVD) and hemorrhoidal disease (HD) are among the most common vascular diseases in the world, with CVD affecting 22–41% of the population in Europe and HD having a point prevalence of 11–39%. The burden is substantial in terms of the effect of symptoms on patients' health-related quality of life (HRQoL) and direct/indirect medical costs. Treatment begins with lifestyle changes, compression in CVD and topical therapies in HD, and escalates as needed through oral therapies first and eventually to surgery for severe disease. CVD and HD share etiological features and pathological changes affecting the structure and function of the tissue extracellular matrix. Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate, has been demonstrated to positively impact the underlying causes of CVD and HD, regenerating the glycocalyx and restoring endothelial function, in addition to having antithrombotic, profibrinolytic, anti-inflammatory, antiedema and wound-healing effects. In clinical trials, oral mesoglycan reduced the severity of CVD signs and symptoms, improved HRQoL, and accelerated ulcer healing. In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding. In patients undergoing excisional hemorrhoidectomy, adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone. The clinical effects of mesoglycan in patients with CVD or HD are consistent with the agent's known mechanisms of action. [ABSTRACT FROM AUTHOR]

Objectives: Chronic venous insufficiency (CVI) is one of the most common venous diseases. CVI is an important clinical picture with a high prevalence, low quality of life, and high diagnosis and treatment costs. Therefore, diagnosis, follow-up, and treatment are important for the patient's socioeconomic and life quality. In this study, we aimed to better examine a test used in the diagnosis, treatment, and follow-up of CVI. Methods: In this retrospective study, 683 patients diagnosed with CVI, who had endovenous laser ablation (EVLA) indications were evaluated between June 2013 and November 2018. EVLA procedure performed on all patients. Preoperative, postoperative 1st and 6th month Doppler USG (ultrasonography), plethysmography, and VCSS (Venous Clinical Severity Score) questionnaire was made to all patients. Results: As a result of our study, we found that there was a significant difference between the preoperative plethysmography and VCSS results of the patients and the postoperative 1st and 6th month results. With the significant difference in the VCSS questionnaire, we have shown that plethysmography gives accurate results in the diagnosis and treatment of CVI since it is an individual, quantitative, and easy test. Conclusions: EVLA is an effective and safe method in patients with venous insufficiency. Since Doppler USG is person and device dependent, we think that plethysmography, which can be used in every clinical setting and provides quantitative results independent of the person, can be used more frequently in the diagnosis and treatment of venous insufficiency. In addition, we think that plethysmography can be used as a valuable additional method in the diagnosis and follow-up of such patients, due to the venous hemodynamic data that Doppler USG cannot provide. [ABSTRACT FROM AUTHOR]

The article discusses the indications and safe volumes for sclerotherapy in the treatment of chronic venous disease, emphasizing the need for careful patient selection and tailored treatment approaches. Topics include contraindications for sclerotherapy, diagnostic evaluation using duplex ultrasound, and recommendations for sclerosant type and concentration based on target vessel characteristics.

Introduction: Varicose veins, a common form of chronic venous disease, arise from the dysfunction of veins in the lower limbs due to increased pressure and impaired blood flow. Regular physical activity and a balanced diet are crucial in managing and potentially improving symptoms of this condition. Material and methods: We have gathered the available materials and scientific reports, analyzing and summarizing them in a single study. Aim of study: We aimed to evaluate how physical activity and lifestyle changes impact the progression and management of varicose veins and chronic venous disease. Conclusion: The study underscores the significant role of physical activity and lifestyle changes in managing varicose veins and chronic venous disease. By enhancing calf muscle function and improving venous blood flow, these interventions can help reduce symptoms, prevent disease progression, and potentially decrease the need for surgical treatments.

Sclerotherapy is the treatment of choice for telangiectasias and reticular veins. The most common side effects of this procedure are hyperpigmentation and matting, which are feared owing to their aesthetic damage and difficulty of treatment. Combined treatments with laser and hypertonic glucose sclerotherapy have been described with excellent results, but limited to treatment of veins of ≤2 mm in diameter. Cryo laser after foam sclerotherapy is a procedure to treat reticular veins in the lower extremities that utilizes first foam sclerotherapy with polidocanol than immediately followed by transdermal Nd:YAG 1064 laser treatment and we can treat veins ≤5 mm. This report presents a successful case of varicose vein treatment using combined transdermal laser and sclerotherapy with foam sclerotherapy with polidocanol to treat veins >2.5 mm in diameter.

Background. Vasoactive drugs are considered an important therapeutic tool in managing phlebolymphologic disease. The current study was performed to evaluate the results of a high-dose diosmin-based combination (Venoplant 2g) in symptomatic patients with chronic venous disease (CVD), treated with endovascular venous surgery, regarding the efficacy of this treatment and the clinical signs and patients’ compliance. Methods: We identified, between April 2022 and March 2023, 50 patients with symptomatic CVD who underwent endovenous ablation and additionally were administered high-dose micronized diosmin. Parameters analyzed in the pre- and post-operative period were the venous clinical severity score (VCSS), the calf circumference, and a VEINES-QOL/Sym questionnaire. Treatment efficacy was assessed in post-operative follow-ups at 1 month and 2 months. Results: Quality-of-life analysis showed a significant improvement between t1 and t2 in both tests administered (VEINES-QOL/Sym: 55.2 ± 2.9, 39.2 ± 12.3, p: 0.001) (VCSS: 6.6 ± 1, 5.1 ± 0.7, p: 0.001). At the secondary endpoint, the results maintained the same improvement trend. Calf circumference was significantly reduced between t1 and t3 (41.7 ± 5.1, 38.3 ± 3.4, p: 0.001). Conclusion: High-dose diosmin, combined with sweet clover 320 mg, Centella asiatica 40 mg, and Vitamin C 200 mg, in patients treated with endovenous ablation, can be significantly effective in terms of clinical results in treating superficial venous disease. A patient’s calf circumference was also found to have decreased considerably during follow-up. No adverse effects have been recorded to date.

Abstract Background An observational study involving patients recovered from COVID-19 was conducted in order to evaluate the presence/absence of vein wall thickness increasing, according to the severity of pulmonary involvement quantified with a CT-scoring system. Methods The venous wall thickness (VWT) of 31 patients (23 males and 8 females) with COVID 19 previously admitted to Federico II University Hospital of Naples was evaluated through ultrasound measurement of the common femoral Vein 1 cm proximal to the saphenous-femoral junction and the popliteal Vein 1 cm distal to the confluence of gemellary veins. Measurements were taken with an automated tool to avoid human error. All patients were evaluated in the supine position. Patients were then stratified into two groups, VWT > 1 mm and VWT 1 mm group was 7.4 (S.D. 4.83), whilst the mean value of the COVID score in the VWT

Background: An observational study involving patients recovered from COVID-19 was conducted in order to evaluate the presence/absence of vein wall thickness increasing, according to the severity of pulmonary involvement quantified with a CT-scoring system. Methods: The venous wall thickness (VWT) of 31 patients (23 males and 8 females) with COVID 19 previously admitted to Federico II University Hospital of Naples was evaluated through ultrasound measurement of the common femoral Vein 1 cm proximal to the saphenous-femoral junction and the popliteal Vein 1 cm distal to the confluence of gemellary veins. Measurements were taken with an automated tool to avoid human error. All patients were evaluated in the supine position. Patients were then stratified into two groups, VWT > 1 mm and VWT < 1 mm. Lung damage was assessed through thoracic High Resolution Computer Tomography and subsequently quantified using the scoring system set out by Chung et al. CEAP-C class was calculated for all patients. Results: The mean value of COVID score in VWT > 1 mm group was 7.4 (S.D. 4.83), whilst the mean value of the COVID score in the VWT < 1 mm group was 3.82 (S.D 3.34). These findings were determined to be statistically significant in a two-tie Student-T test. The linear regression test between VWT and Covid score values demonstrated a direct relationship between the two variables. Conclusion: These results demonstrate a link between two different aspects of the pathological effects on the vessels during a SARS-COV 2 infection. As such a common primum movens can be hypothesized in both micro-thrombotic and inflammatory processes relating to COVID 19. [ABSTRACT FROM AUTHOR]

Background: endovenous laser ablation (EVLA) represents the gold standard in treating both great and small saphenous veins (GSV and SSV) incompetence. To achieve a "no-scalpel" procedure in patients with chronic venous insufficiency (CVI, CEAP C3-C6), concomitant phlebectomies could be replaced by ultrasound-guided foam sclerotherapy (UGFS) into varicose tributaries. The aim of this study is to present a single-centre experience on EVLA + UGFS for patients with CVI secondary to varicose veins and saphenous trunk incompetence, analysing ling-term outcomes. Methods: all consecutive patients with CVI and treated by EVLA + UGFS from 2010 to 2022 were included in the analysis. EVLA was performed using a 1470-nm diode laser (LASEmaR® 1500, Eufoton, Trieste, Italy), adapting the linear endovenous energy density (LEED) depending on saphenous trunk diameter. Tessari method was used for UGFS. Patients were evaluated clinically and by duplex scanning at 1, 3 and 6 months, and annually up to 4 years, to assess treatment efficacy and adverse reactions. Results: 5500 procedures in 4895 patients (3818 women, 1077 men) with a mean age of 51.4 years were analysed during the study period. A total of 3950 GSVs and 1550 SSVs were treated with EVLA + UGFS (C3 59%, C4 23%, C5 17% and C6 1%). Neither deep vein thrombosis nor pulmonary embolism were detected during follow-up, as well as superficial burns. Ecchymoses (7%), transitory paraesthesia (2%), palpable vein induration/superficial vein thrombosis (15%) and transient dyschromia (1%) were registered. Saphenous and tributaries closure rate at 30 days, 1 and 4 years were 99.1%, 98.3% and 97.9%, respectively. Conclusions: EVLA + UGFS for an extremely minimally invasive procedure appears to be a safe technique, with only minor effects and acceptable long-term outcomes, in patients with CVI. Further prospective randomized studies are needed to confirm the role of this combined therapy in such patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to examine the role of flavonoids, particularly diosmin, as a therapeutic agent for stasis dermatitis (SD) through discussion of pathophysiology, current treatment paradigms, potential mechanisms of action, and a systematic review of evidence on clinical efficacy. METHODS: In addition to articles on pathophysiology and standard treatment, a search of PubMed was conducted using the following query: ("Diosmin" OR "MPFF" OR "Micronized Purified Flavonoid Fraction" OR "Flavonoid") AND ("Stasis Dermatitis" OR "Venous Ulcer" OR "Lipodermatosclerosis"). Emphasis was placed on studies that were randomized controlled trials examining an oral flavonoid against a placebo or standard of care. RESULTS: Diosmin is effective at improving stasis changes, increasing ulcer healing frequency, decreasing the time to ulcer healing, and reducing tissue edema. They also cause significant improvement in patient quality of life and reduction of venous symptoms. Diosmin has been shown to have a favorable safety profile with very few mild adverse events which did not differ significantly from placebo. Flavonoids also appear to be effective for other dermatologic conditions, including rosacea and senile purpura. CONCLUSION: There is a growing body of evidence indicating that diosmin has therapeutic efficacy in managing stasis dermatitis. Data from studies in diseases with pathogenic similarities suggests the potential for even broader dermatologic applications. [ABSTRACT FROM AUTHOR]

Background: To evaluate an innovative class I compression stocking with predetermined uniform pressure in comparison to a graduated class III compression stocking system, regarding edema reduction, interface pressure, and patient comfort. Method: Twenty-five patients with chronic venous disease, were randomized: 12 to investigational stocking, 13 to comparator stocking. Data collected at baseline and after 14 days. Results: Edema was significantly equal reduced to follow-up; mean −129.0 cm3 (SD 105; p =.004, Class I) and −223.7 cm3 (SD 120; p =.002, Class III), respectively. The investigational stocking lost significantly less compression pressure than the comparator stocking (p ≤.013). Participants in both groups perceived significant improvement regarding leg heaviness, leg swelling, and feelings of tightness and tingling (p ≤.016). Conclusion: The innovative investigational class I stocking appears to offer similar edema reduction and benefits to the comparator class III stocking. However, a larger and prolonged study is required. The study was registered in the ISRCTN-registry, ISRCTN17356077, https://www.isrctn.com/ISRCTN17356077. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evidence suggests that chronic venous disease (CVD) may be a cardiovascular disorder, as patients with CVD are prone to developing arterial (atherosclerosis) and venous (thromboembolism) diseases. This may be partly explained by shared risk factors. Thus, patients with CVD or cardiovascular disease require careful history-taking and physical assessment to identify coexisting pathologies and risk factors. This article summarises a symposium at the XIX World Congress of the International Union of Phlebology held in Istanbul, Turkey, in September 2022. Common pathophysiological features of CVD and cardiovascular disease are endothelial injury, hypercoagulability and systemic inflammation. In CVD, inflammation primarily affects the microcirculation, with changes in capillary permeability, vein wall and valve remodelling and increase in oxidative stress. Once patients develop symptoms/signs of CVD, they tend to reduce their physical activity, which may contribute to increased risk of cardiovascular disease. Data show that the presence of CVD is associated with an increased risk of cardiovascular disease, including peripheral arterial disease and heart failure (HF), and the risk of adverse cardiovascular events increases with CVD severity. In addition, patients with cardiovascular disease, particularly those with HF, are at increased risk of venous thromboembolism (VTE) and should be assessed for VTE risk if they are hospitalised with cardiovascular disease. Therefore, CVD management must include a multi-specialty approach to assess risk factors associated with both the venous and arterial systems. Ideally, treatment should focus on the resolution of endothelial inflammation to control both CVD and cardiovascular disease. International guidelines recommend various conservative treatments, including venoactive drugs (VADs), to improve the symptoms/signs of CVD. Micronized purified flavonoid fraction (MPFF) is a VAD, with high-quality evidence supporting its use in relieving symptoms/signs of CVD and improving quality of life. Moreover, in large-scale observational studies, MPFF has shown superior effectiveness in real-world populations compared with other VADs. 3qqUjcBFSDSz8_qvuiGNf1 Video Abstract. (MP4 97173 kb) Plain Language Summary: Blood vessel disease can affect both arteries and veins; when it affects arteries, it is called cardiovascular disease, and when it affects veins, it is called chronic venous disease (CVD). In most cases, the underlying disease process is similar, irrespective of the type of blood vessels affected, and the risk of both CVD and cardiovascular disease is increased by age, smoking, overweight/obesity and diabetes. If cardiovascular disease affects arteries in the legs, the symptoms can be similar to that of CVD, with pain, feelings of leg heaviness or tiredness and skin changes. CVD and cardiovascular disease are usually treated by different specialists. A symposium was held at the XIX World Congress of the International Union of Phlebology in Istanbul, Turkey, in September 2022, to raise awareness of the relationship between the two conditions. The speakers described the common disease processes in CVD and cardiovascular disease, and how patients with CVD are at increased risk of cardiovascular disease, and vice versa. They reiterated the importance of thoroughly assessing patients with either cardiovascular disease or CVD to see if both arterial and venous disease were present. When patients have CVD, international treatment guidelines recommend various conservative treatments, including venoactive drugs, to improve symptoms and signs. There is high-quality evidence to support the use of the venoactive drug, micronized purified flavonoid fraction (MPFF), to improve quality of life and relieve a broad range of CVD symptoms/signs. Large-scale observational studies support the effectiveness of MPFF in a real-world population of patients with CVD compared with other venoactive drugs. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the presence of sexual dysfunction (SD) in patients with Chronic Venous Disease (CVD) and if CVD treatments may have an impact on SD evolution in these patients. Methods: Inclusion criteria were patients of both sexes and genders, with minimum age of 18, with first diagnosis of CVD. Exclusion criteria were presence of known sexual dysfunction of organic origin, arterial system diseases, malignancies and endocrine system diseases. Included patients were administered the ASEX (Arizona Sexual Experience) questionnaire that was administered at the moment of study inclusion (T0), and for patients that resulted affected from sexual dysfunction, were administered also, after CVD treatments at 6 months (T1) and after 12 months (T2). Results: A total of 649 patients with CVD were recruited. After the administration of the ASEX questionnaire, 122 patients (18.8 %) resulted affected from SD. Female sex, C3–C6 clinical stages, and the presence of Coronary Artery Disease (CAD), hypertension, and hyperlipidemia were more associated with the presence of SD. SD improved in all patients’ population, especially after CVD treatment at T2. Conclusions: CVD patients may experience SD, especially in female sex, in more advanced disease stages. SD in CVD patients appears to improve after adequate CVD treatment.

The cyanoacrylate embolization (CAE) technique for chronic venous disease treatment is less painful and leads to a faster recovery than conventional endovenous thermal treatment. According to the instructions for use (IFU) of the VenaSeal closure system (Medtronic), a representative CAE product, it has only been approved for treating saphenous veins, not non-saphenous veins. Here, we report a case of ignoring the VenaSeal IFU for treating testicular pain using CAE for non-saphenous veins within the abdominal wall, which is a baseless and non-scientific approach nearing malpractice. Hence, it is imperative for physicians to rigorously adhere to the IFU and abstain from experimenting with new treatment methods solely based on personal experience.

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

The article focuses on the management of bleeding varicose veins, highlighting the potential risks and urgent need for medical attention. Topics discussed include first aid measures for patients experiencing bleeding, immediate clinical management in healthcare facilities, and the importance of timely referral to vascular specialists to prevent recurrence and ensure patient safety.

Varicose veins (VVs) are the most common manifestation of chronic venous disease (CVD) and appear as abnormally enlarged and tortuous superficial veins. VVs result from functional abnormalities in the venous circulation of the lower extremities, such as venous hypertension, venous valve incompetence, and venous reflux. Previous studies indicate that enhanced angiogenesis and inflammation contribute to the progression and onset of VVs; however, dysregulations in signaling pathways associated with these processes in VVs patients are poorly understood. Therefore, in our study, we aimed to identify key regulators of angiogenesis and inflammation that are dysregulated in patients with VVs. Expression levels of 18 genes were analyzed in peripheral blood mononuclear cells (PBMC) using real-time PCR, as well as plasma levels of 6 proteins were investigated using ELISA. Higher levels of CCL5, PDGFA, VEGFC, TGF-alpha, TGF-beta 1, and VEGF-A, as well as lower levels of VEGFB and VEGF-C, were found to be statistically significant in the VV group compared to the control subjects without VVs. None of the analyzed factors was associated with the venous localization of the varicosities. The presented study identified dysregulations in key angiogenesis- and inflammation-related factors in PBMC and plasma from VVs patients, providing new insight into molecular mechanisms that could contribute to the development of VVs and point out promising candidates for circulatory biomarkers of this disease.

Introduction: Chronic venous disease (CVD) is characterized by venous hypertension and stasis, which occur because of valvular incompetence and/or venous outflow obstruction. This study aimed to investigate the relationship between CVD clinical presentation and duplex ultrasonography findings in a Thai patient population. Method: This cross-sectional study examined patients diagnosed with CVD at the Chulabhorn Hospital Vascular Clinic (Bangkok, Thailand) between December 1, 2018 and October 1, 2021. Patient data was obtained from the medical records and review of lower limb venous ultrasonography studies. Patients were assessed using the Clinical, Etiological, Anatomical, and Pathological (CEAP) classification of venous disorders: mild-to-moderate CVD was defined as C1 to C3 and severe CVD was defined as C4 to C6. Results: Overall, 260 CVD patients were analyzed (60 men and 200 women). More than 75% of the patients were women and more than 80% had bilateral lower limb involvement. Factors associated with severe CVD were older age, female sex, high body mass index, hypertension, diabetes mellitus, and history of deep venous thrombosis. The most common CEAP classification was C2 (38.8%), followed by C1 (33.85%), C4 (12.2%), C3 (9.23%), C6 (3.46%), and C5 (2.31%). Two-thirds of the patients had great saphenous vein reflux and nearly half had perforator vein reflux. Perforator reflux and small saphenous vein reflux were significantly associated with severe CVD (P