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Objective To evaluate the heredity factor of the chronic venous disorders and odds ratio linked to maternal or paternal heredity. Methods Cross-sectional epidemiological study conducted in daily practice of medical practitioners on all patients consulting them. The practitioners described the venous status of all patients consulting them and recorded the familial past history of venous disease. Results Among 21319 patients, 60.4% have a familial history of chronic venous disorder: unilateral paternal 7.5%, unilateral maternal 40.9% and bilateral: 12.0%. Chronic venous disorder prevalence is 58.8% in the global population, 38.2% in the absence of parental history, 67.0% for unilateral paternal, 71.3% for unilateral maternal and 79.2% for bilateral (p < 0.0001). After adjustment on age and sex, results show significant (p < 0.0001) odds ratio of 3.2 for unilateral paternal, of 3.4 for unilateral maternal and of 5.6 for a history in both parents. In the context of a history in both parents, the odds ratio increased to 5.6 for women and 8.4 for men. Conclusion This large cross-sectional study confirms the association between heredity and venous disease, but its results could call into question the maternal predominant character of the chronic venous disorder heredity. [ABSTRACT FROM AUTHOR]

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Aim: Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy., Methods: This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7-10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines., Results: This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Aim: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification., Methods: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6. The program enrolled 6232 GPs 91545 subjects were analysed. Their mean age was 50.6±16.9 years, younger patients being in the Middle East and older ones in Europe, and the proportion of women was higher than that of men., Results: The worldwide prevalence of CVD was 83.6%: 63.9% of the subjects ranging C1 to C6, and 19.7% being C0s subjects. C0s patients were more frequently men whatever the age and the geographical zone. C1-C3 appeared to be more frequent among women whatever the country but the rate of severe stages (C4-C6) did not differ between men and women. GPs consider CVD subjects as patients eligible to specialist referral beginning from C2 but some geographical disparities were observed., Conclusion: The VCP survey provides reliable results on CVD global epidemiology and shows that CVD affects a significant part of the populations worldwide, underlining the importance of adequate screening for CVD and training of both GPs and specialist physicians.

Aim: The present study assessed the effect of Ruscus aculeatus, hesperidin methyl-chalcone and ascorbic acid (HMC-AA), in the treatment of chronic venous disorders (CVD) in Latin American patients., Methods: This study is an observational, single arm, multicentric and prospective trial. Patients suffering from CVD and belonging to C0s-C3 Clinical Etiological Anatomical and Physiopathological (CEAP) classes were included. Patient profiles, risk factors, clinical symptomatology and quality of life (QoL) assessed by SF-12 and CIVIQ questionnaires were evaluated at inclusion and after 12-week treatment., Results: The main factors influencing the previous management of patients were age, gender, body mass index (BMI), familial history, physical activity, exposure to heat, heavy loads lifting, profession and clinical characteristics. All clinical symptoms significantly improved with treatment and, as BMI and CEAP classes increased. Ankle circumferences decreased over time, correlating with BMI and CEAP classes. The physical and psychological dimensions of the SF-12 score significantly increased over time and improved within each CEAP class. The CIVIQ score significantly improved over time, correlating with age and CEAP classes., Conclusion: A 12-week treatment with Ruscus aculeatus HMC-AA showed a significant decrease in the clinical symptoms and a significant improvement in the QoL of patients with CVD.

Background: Chronic venous disorders (CVD) have an impact on quality of life (QoL), both physically and psychologically. As of now, several vein specific QoL scales exist, but no patient-reported outcome (PRO) is available which takes into account altogether symptoms, impairment of activities, appearance of the legs and concerns regarding health risk. Since clinical severity and disability are mostly evaluated in severe patients, where the main outcome - namely skin changes - is obvious but rare, the authors considered that a reproducible and clinically relevant survey that could account for specific patients' complaints was needed, particularly for CEAP C0s-C3 patients., Objectives: The objective of this study was to build a specific autoquestionnaire and to establish its statistical validity and clinical relevance., Methods: A review of existing questionnaires and an analysis of relevant literature were carried out by a committee of experts. The committee then developed a questionnaire of 46 items, with special attention to relevance for venous disorders and patients' main complaints. After construction, the French version was field-tested and results statistically analyzed. In the specific QoL & Outcome Response - Venous (SQOR-V), each item is given a value by the patient and items are grouped in five dimensions. Each dimension is weighed to a maximum value of 20, yielding an overall maximum score of 100., Results: Two hundred and two questionnaires were analyzed for the initial evaluation and 152 at a second (test-retest). Determination of the Cronbach's alpha coefficient (0.96) and structural analysis demonstrated an excellent internal and structural coherence. Test-retest comparisons confirmed good reproducibility. Comparison with SF-12 and CED-D questionnaires and with CEAP classification groups verified both structural and clinical validity., Conclusions: This study demonstrates QoL impairment in patients suffering from chronic venous disorders (CVD). It also verifies the statistical validity of the SQOR-V questionnaire. More studies are needed to demonstrate the improvement in specificity and accuracy this questionnaire provides compared to existing vein-specific QoL scales, and to determine its ability to assess efficacy of any kind of treatment at any stage of the disease. Provided adequate acknowledgment of its authors, the use of SQOR-V is free. An English version is available, currently pending validation.

Aim: There is growing interest for patient-reported outcomes (PROs) in clinical research. Application of quality of life (QoL) questionnaires to patients suffering from chronic venous disease (CVD) is thought to be an important improvement in the assessment of results in these complex disorders. The aims of the study were to describe the health status of female patients suffering from CVD, and to assess the care impact through QoL questionnaires., Methods: Symptomatic female patients suffering from CVD (all CEAP clinical classes), aged over 18, newly treated by their general practitioner with a phlebotropic drug were enrolled in the study. Every patient had to complete a self-questionnaire including the SF-12, the CES-D, the Epworth and the CIVIQ scales at day 0 (D0), day 3 (D3) and day 7 (D7). The CIVIQ scale assesses pain and the psychological, physical and social consequences of CVD. The SF-12 is a generic measure of health status. The CES-D scale studies presence of depressive symptoms (DS) in the general population. The Epworth scale measures daytime sleepiness., Results: A total of 765 physicians took part in the survey from April to August 2003. The results of the study concern 1 045 patients. Analyses are realized on the 399 patients who filled out all 3 questionnaires. Mean age was 45 years (SD=11), patients average height was 164.39 cm (SD=5.99) for an average weight of 65.2 kg (SD=12.5). Concerning change in QoL between inclusion and Day 7, the mean CIVIQ total scores at inclusion were 26.7 in the CEAP class 0-2 group and 36.3 in the CEAP class 3-6 group. The mean CIVIQ total scores at D7 were 18.5 in the CEAP class 0-2 group and 27.3 in the CEAP class 3-6 group. The mean CIVIQ total scores demonstrated that QoL is more impaired for patients in the CEAP class 3-6 group. In both groups, an improvement in patients' QoL was observed following patient management (P<0.001). At inclusion time, MCS-12 and PCS-12 were respectively 44.7 (SD=10.6) and 46.4 (SD=8.4): at day 3 and day 7, these dimensions were respectively: D3: 46.5 (SD=10.2) and 46.2 (SD=8) D7: 48 (SD=10.3) and 46.2 (SD=7.8). For the mental dimension, the difference was statistically significant (P=0.0001). In our study a possible DS (score ?17) was reported for 36.3%, 32.3% and 29% respectively at day 0, D3 and D7 (P<0.01, n=328). Concerning daytime sleepiness the Epworth mean total score showed a decrease in daytime sleepiness for patients with severe CVD (C3-C6) between day 0 and D 7 (P=0.02)., Conclusions: Our study demonstrates the high impact of CVD on health status and the validity of QoL questionnaires in this pathology. They show a significant improvement of the QoL after one week of medical management.

Background: Modern sclerotherapy, using ultrasound guidance and foam sclerosants, is a reference treatment of varices of the lower limbs. Like all other techniques it should be employed in the safest, precisely described and reproducible conditions. Therefore, its contra indications must be clearly known., Methods: Contra indications of sclerotherapy can be defined in legal notices provided by the manufacturers in compliance with regulatory standards, developed empirically, extrapolated from theoretical mechanisms, or analyzed from controlled studies., Results: Contra indications can be patient-, method-, or sclerosing agent-related. Legal notices (France) are different for the different available sclerosing agents, and often outdated. We can note principally: hypersensitivity, fever, phlebitis, childhood, and pregnancy. Chromated glycerin should be avoided in patients with chronic renal insufficiency. Intra-arterial injections are prohibited (obviously), and the treatment of huge veins as well. Association with disulfirame is contra indicated. We must of course add: bed rest, severe systemic diseases, poor patient understanding, needle phobia, short life expectancy, late stage cancer, known allergy to the sclerosing agent, and treatment with tamoxifen. Previous medical history of deep vein thrombosis and thrombophilia could be theoretical contra indications and are currently under evaluation. Oral anticoagulation is not a contra indication provided the situation is stable and the causal disease is not a contra indication in itself. Pregnancy is not usually a period when sclerotherapy is useful or urgent, according to some authors it can be carried out anyway. In children, sclerotherapy of venous malformation is now a reference treatment. Thanks to progress in ultrasound guided sclerotherapy with foam, the size of the veins is no more an issue, neither is a difficult access to the varix., Conclusions: Sclerotherapy is now based on seriously documented evidence. It is safe and efficient. Its contra indications are exceptional, usually non-specific. It can be used safely for fragile or elderly patients.

Background: Some recent publications have emphasized the risk (up to 25%) of deep venous thrombosis (DVT) coexisting with a clinical evidence of superficial venous thrombosis (SVT). However, most papers on this topic are old and do not consider the use of the duplex scanning., Objective: To determine what the spontaneous risk is of venous thrombosis and emboli in varicose patients, in the superficial veins, and in the deep veins; what the risk is of extension or coexistence between superficial and deep thrombosis; and whether the treatments of varicose disease are responsible for thrombosis?, Methods: Review of the literature., Results: The frequency of venous thrombosis appears to be increased in patients with varicose disease., Conclusions: In all cases of clinical SVT a duplex scan examination of both deep and superficial veins is necessary in order to provide a complete diagnosis. The treatment of SVTs depends on the situation and the size of the thrombi. In case of associated DVT, the most important treatment is of the DVT. The interest of heparin or low molecular weight heparin (therapeutic doses) is proved for patients with coexisting DVT, and thought so for ascending SVT. Interest and doses have not been stated in other cases. SVT must be considered as a risk factor of DVT and treated from this point of view. Biological analysis and a complete check-up are mandatory in cases of varicose thrombosis in young patients and in cases of recurrence.

The complex physiopathology of the post-thrombotic syndrome following deep venous thrombophlebitis involves a sequence of hemodynamic and biochemical events; development of the clinical picture, which remains susceptible to change, is a late occurrence following a long free interval. Despite re-establishment of venous patency, residual valvular lesions can cause orthostatic reflux. While residual occlusion generally has few long term repercussions, failure of the calf muscle venous pump is a serious potential consequence of such reflux. The clinical picture is less severe when the popliteal vein valves are not destroyed. The responsibility of wall compliance alterations has been proved as well. The initial thrombosis and/or the reflux may lead to associated incompetency of the perforating veins, then of the superficial venous network, thus aggravating the hemodynamic disturbances. The increased venous pressure results in alterations in upstream circulation, especially in the venous capillaries; the resultant increase in intraluminal pressure reduces fluid reabsorption. Edema remains intermittent so long as the lymphatic network withstands the excess workload. Thereafter, post-thrombotic lymphedema develops; the accompanying tissue fibrosis, a classical feature of the clinical picture, is attributed to the elevated concentration of macromolecules. This stage corresponds to lipo-dermato-sclerosis. The increase in the fibrinogen concentration, the reduction in tissue fibrinolytic activity, and the formation of pericapillary fibrin cuffs have all been considered as possible causes of leg ulceration. In fact, the assumed phenomenon of secondary hypoxia has not been demonstrated, and the fibrin cuffs do not appear to constitute a true barrier.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Polidocanol is a widely used sclerosing agent that was first developed as a local anesthetic. In France it is used in varicose veins as well as in telangiectases., Objective: To improve the knowledge of the effects of polidocanol and provide recommendations for better use., Methods: Based on 12 years of experience in treating nearly 11,000 patients with polidocanol, the author reviews his observations. A theoretical model of dilution of sclerosing agents in injected veins is provided., Results: The author observed: seven cases of minor urticaria, occurrence of grey veil when used under the air-block technique, one case of cutaneous necrosis (5 cm3), and some small epidermic necrosis (1-mm diameter) and neither shock nor severe adverse reaction., Conclusion: Polidocanol is characterized by its spasmogenic action on veins, excellent local tolerance, and a very low incidence of general reactions. Low concentrations (0.3 to 0.6%) can be used for the treatment of quite large varicose veins if an adequate volume is injected.

The full text of the course given at the European School of Phlebology (Paris, France, November 27, 1990), presenting all the aspects of pathology and microsclerosing treatment is offered. Practical technique, material, and hints are presented to help young (or new) practitioners. These protocols are widely used in France and they are based on the works of the Ecole Française de Phlébologie founded by Raymond Tournay. Some differences may appear between our methods and other methods proposed in Europe and the United States but the results are, in fact, proven to be very good with very little postsclerotherapic matting and pigmentation. For instance, we do not recommend compression in these cases because it does not improve the results. In this article, the sclerosing agents we discuss are different from those available in the United States but our reflections remain valid and we hope these products will soon be approved for use outside of France.

There appears to be an increase in the number of HIV-positive patients seeking treatment for varicose veins. This is due to the increase of the incidence of the disease in the population, its spread amongst non-marginalized people and because the patients known that although their long-term prognosis is poor, they do have a latency period during which they can live a normal life. Should HIV-positive varicose patients be considered in the same way as other varicose patients or should they be refused treatment unless this is really indispensable? This is the main pratical question, because many patients are refused treatment, whereas the authors make no distinction in principle. The authors ask what impact will this attitude have on the work of the consultation service and try to give some guidelines.

By way of analysing the leg ulcers treated at his consulting rooms during six months, the author introduces the dermo-epidermal graft, simplified in a way that makes it practicable in the framework of an ambulatory treatment, with maximum ease for both practitioner and patient. The results, altogether satisfactory, prompt him to suggest that this technique be used in the context of routine treatment of leg ulcers of all aetiologies and sizes. The time gain is considerably more significant than the simplicity of the technique would lead one to suppose. The incidence of the method is quite high as it has been used in 15% of cases, but this frequency could easily be increased further with more daring. To all accounts there are no significant accidents to be feared and the author, describing the technique, urges those of his colleagues who have not yet tried the ambulatory dermo-epidermal patch graft to familiarize themselves with it.