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OBJECTIVE: We compared the effectiveness and safety of polidocanol 1% endovenous microfoam ablation vs endovenous thermal ablation with radiofrequency or laser energy for treatment of venous insufficiency caused by lower extremity truncal vein incompetence via network meta-analysis of published comparative evidence. METHODS: We conducted a systematic literature review following best practices, including a prospective protocol. We screened studies published in English from 2000 to 2023 for randomized and nonrandomized studies reporting direct or indirect comparisons between polidocanol 1% endovenous microfoam and endovenous thermal ablation. Thirteen studies met our eligibility criteria for the network meta-analysis. The co-primary effectiveness outcomes were the closure rate ≥3 months after procedure and the average change in the Venous Clinical Severity Score. For the subgroup of venous ulcer patients, the ulcer healing rate was the primary effectiveness outcome. The secondary outcomes included safety and patient-reported outcomes. Network meta-analyses were conducted on outcomes having sufficient data. Categorical outcomes were summarized using odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity tests and estimates of network inconsistency were used to investigate the robustness of our meta-analysis. RESULTS: We found that polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure (OR, 0.65; 95% CI, 0.36-1.18; P = .16). Although not the primary aim of the study, the network meta-analysis also provided evidence to confirm our supposition that polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds for vein closure (OR, 2.91; 95% CI, 1.58-5.37; P < .01). A sensitivity analysis using the longest available time point for closure in each study, with a minimum of 12 months of follow-up (median, 48 months; range, 12-72 months), showed results similar to those of the main analysis. No association was found between the risk of deep vein thrombosis and the treatment received. The available data were insufficient for a network meta-analysis of Venous Clinical Severity Score improvement and ulcer healing rates. CONCLUSIONS: Polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure and deep vein thrombosis risk for chronic venous insufficiency treatment, based on a network meta-analysis of published evidence. Polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds of vein closure. A sensitivity analysis found venous closure findings were robust at follow-up intervals of 12 months or greater and for up to 6 years. New evidence meeting the inclusion criteria for this review will be incorporated at regular intervals into a living network meta-analysis.

Introduction: Endovenous ablation may not always be necessary for every patient with chronic venous insufficiency who has an indication for endovenous ablation. This study investigates whether compression stockings and Daflon® can be as effective for some patients with CEAP two in chronic venous insufficiency. Methods: In this study, 137 patients who had endovenous ablation indication received plethysmographical hemodynamic tests and were divided into two groups. Group 1 had normal venous hemodynamics and received compression stockings and Daflon®. Group 2 had abnormal function and received laser ablation. All patients were reevaluated after 6 months. Results: The study showed that there was no statistically significant difference between Groups 1 and 2 in the 6th month measurements after the treatments. Conclusion: As a result, we do not find it appropriate and do not recommend that every patient with complaints of chronic venous insufficiency and an indication for endovenous ablation undergo ablation without evaluating lower extremity venous hemodynamics. [ABSTRACT FROM AUTHOR]

Background: The SYNCHRONOUS-study investigates simultaneous ASV-ablation with great saphenous vein (GSV) treatment in endovenous laser ablation (EVLA) for preventing varicose vein recurrence. This sub-study examines complication rates associated with prophylactic ASV-ablation. Methods: Among 1173 patients with refluxing GSV, 604 underwent GSV-ablation only, and 569 received additional ASV-ablation. Complication rates were compared over 6 months. Results: Approximately 80% of patients were complication-free with minor bruising and dysesthesia being most common complications. After 6 months, additional prophylactic ASV-ablation did not increase the rate of complications compared to GSV-only treatment. Conclusion: The 6-months follow-up data suggests that prophylactic ASV-closure, alongside GSV-treatment, is safe, with similar complication rates to GSV-only EVLA. [ABSTRACT FROM AUTHOR]

Background: The causal relationship between chronic venous insufficiency (CVI) and cardiovascular diseases (CVDs) has yet to be elucidated. Herein, we implement Mendelian randomization (MR) analysis to investigate the causal association. Methods: A two-sample MR approach using genetic data from FinnGen and genome-wide association studies (GWAS) Catalog was applied to investigate the causal relationship between CVI and CVDs. This study assessed 77 single nucleotide polymorphisms (SNPs) as instrumental variables, employing random-effect inverse-variance-weighted MR, weighted median, Egger regression, Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and Robust Adjusted Profile Score (RAPS) methods. Multivariable MR (MVMR) considered confounding factors. Results: Genetically predicted CVI was associated with reduced heart failure risk (odds ratio (OR) = 0.96, 95% confidence interval (95% CI): 0.93–0.99, p = 0.025) and increased atrial fibrillation risk (OR = 1.06, 95% CI: 1.03–1.09, p = 0.0002). MVMR, adjusting for venous thromboembolism (VTE), lower limb ulceration, obesity, smoking, and alcohol, attenuated these associations. No significant links were found with hypertension, aortic aneurysm, coronary artery disease, myocardial infarction, valvular heart disease, or stroke. Conclusions: This MR study supports an association between CVI and CVDs, which may imply CVI should be monitored during the treatment of heart failure and atrial fibrillation. [ABSTRACT FROM AUTHOR]

Objective: By incorporating an endovascular component into Great Saphenous Vein stripping, EndoVenous-assisted Invaginated Stripping (EVIS) aims to make the procedure minimally invasive. A study was conducted to investigate the surgical intervention. Methods: Sketches and videos were used to illustrate the technical aspects of EVIS. A prospective cohort study included 20 patients with chronic venous insufficiency (CVI). Results: EVIS is performed as a day-surgery. Technical success was 100%, and no complications were recorded. The mean operative time was 45 minutes, intraoperative pain score was 4.8, post-operative pain was 2.5, 1.8, 1.2, 0.5 at 48 hours, 1, 4, and 12 weeks, respectively. The mean blood loss was 15 mL, and the mean length of the GSV strapped was 19 cm. The follow-up duplex showed a reduction in the diameter of the residual GSV stump. Conclusions: EVIS is a combination of standard techniques that may prove valuable in managing CVI. [ABSTRACT FROM AUTHOR]

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Background and Objectives: Chronic venous insufficiency negatively affects the quality of life and reduces the job performance of nurses, who are important components of the healthcare system. The aim of this study was to assess the risk factors of venous insufficiency according to demographic characteristics among nurses working at a foundation university hospital. Materials and Methods: This study used an analytical cross-sectional approach. The sample consisted of 100 nurses working at a foundation university hospital in a metropolitan city of Turkey. Data were collected using a demographic characteristics form, VEINESQOL/Sym, and a CEAP classification form. The condition of varicose veins among the nurses was diagnosed by a cardiovascular surgeon using Doppler ultrasonography. Results: The prevalence of chronic venous insufficiency (CVI) among nurses was 65%, with 48% at a C1 level according to the CEAP classification. CVI was higher among those with chronic diseases (p = 0.027) and those who had pregnancy (p = 0.021). In addition, the risk of CVI (+) was 7.68 times higher among those aged older than 26.5 years and 36.14 times higher for women (p < 0.001). A 0.9-fold increase in the risk of CVI (+) among nurses produced a one-unit decrease in venous-insufficiency-related quality of life (p = 0.006, OR = 0.94, 95% CI:(0.896–0.982)). Conclusions: The prevalence of CVI among nurses was found to be high, especially among women, those with chronic diseases, and pregnant individuals. In this context, it is recommended to implement risk screening and prevention education programs for CVI among nurses. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: Varicose veins in the lower limbs are common, particularly among those with prolonged standing occupations, contributing to chronic venous insufficiency (CVI). CVI affects about 60% of adults, with varicose veins present in 25–33% of women and 10–20% of men, increasing with age. Understanding and addressing this condition is crucial as it impacts daily life and raises the risk of thrombosis. Effective treatments are essential to alleviate these health issues. State of Knowledge: Varicose veins result from a mix of genetic, hemodynamic, and vein wall factors. Family history plays a significant role, increasing susceptibility. Hemodynamic issues include malfunctioning venous valves and elevated venous pressure. Vein wall changes and thrombotic activity also contribute. Symptoms range from cosmetic concerns to pain and complications like venous ulcers. Understanding these factors is key for effective management. Conclusions: Surgical treatments like high ligation and stripping are standard but have drawbacks such as scarring and long recovery. Valvuloplasty addresses deep venous valve issues but is limited. Minimally invasive options, such as endovenous laser therapy and sclerotherapy, offer promising alternatives but with some recurrence risk. Compression therapies, including elastic stockings and pneumatic compression, aid recovery and symptom relief. Elastic bandage therapy is effective but requires precise application to avoid complications. Each method has pros and cons, underscoring the need for tailored treatment approaches. [ABSTRACT FROM AUTHOR]

Abstract Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p

Nonthrombotic iliac vein lesions (NIVLs) are significant causes of chronic venous insufficiency (CVI) in the left lower limb and symptom recurrence following left lower limb varicose vein treatment. The goal of this study was to explore the haemodynamic and morphological characteristics of iliac veins in patients with NIVLs. Pressure at the caudal end of the stenotic left common iliac vein (LCIV) segment, local blood flow velocity, and time-averaged wall shear stress in the stenotic segment exhibited positive correlations with the clinical CVI classification (R = 0.92, p < 0.001; R = 0.94, p < 0.001; R = 0.87, p < 0.001), while the relative retention time showed a negative correlation (R = -0.94, p < 0.001). The pressure difference (∆P) between the two ends of the stenotic segment and the velocity difference (∆V) between the stenotic segment and the caudal end were positively correlated with the clinical classification (R = 0.92, p < 0.001; R = 0.9, p < 0.001). The cross-sectional area stenosis rate and length of the stenotic LCIV segment were positively correlated with the clinical classification (R = 0.93, p < 0.001; R = 0.63, p < 0.001). The results suggest that haemodynamic assessment of the iliac vein could effectively portray blood flow disturbances in stenotic segments of the LCIV, potentially reflecting the degree of iliac vein stenosis. Haemodynamic indicators are correlated with the severity of clinical CVI symptoms. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the impact of post-interventional compression therapy on clinical outcomes after endovenous laser ablation (EVLA) of incompetent saphenous veins. Methods: This prospective, controlled, multicenter study in Germany involved 493 varicose vein patients followed-up for 6 months. Results: Compression therapy significantly reduced symptoms compared to no compression (VCSS: 1.4 ± 1.6 vs 2.2 ± 2.2; p =.007). Post-interventional therapy duration of up to 14 days was found to be most effective for improving patient-reported disease severity (p <.001) and higher quality of life (p =.001). Patient compliance was high (82%), and non-compliance was linked to worse disease severity (VCSS 1.4 ± 1.5 vs 2.1 ± 2.3, p =.009). Conclusion: In conclusion, post-interventional compression therapy is beneficial by reducing symptoms and improving quality of life. High patient compliance with the therapy is observed, and non-compliance is associated with worse disease severity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Chronic venous insufficiency (CVI) is a common condition especially among those of advance age that is often neglected. As the disease severity progresses, it increases the healthcare cost and resources required, while diminishing the quality of life of the persons. Health-related Quality of Life (HRQoL) among CVI patients begins to decline once the symptom starts to appear, and reduces it further as the symptoms worsens. MATERIALS AND METHODS: This is a prospective, multi-centred, cross-sectional study on consenting symptomatic CVI patients who presented to the International Islamic University of Malaysia (IIUM) teaching hospital in Pahang, Malaysia. The diagnosis of CVI was confirmed on duplex imaging. Clinical grading was performed using Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification. Patients completed generic validated Malay language Short Form 36 (SF36) HRQoL instrument. RESULTS: One hundred and ten patients (62% male) with a mean age of 57 years, Malays (60%), Chinese (25%) and Indian (15%) were recruited. The most frequent CVD symptoms reported were pain (42%). The clinical, aetiological, anatomical, and pathophysiological (CEAP) classification placed most patients in the C2 class (34%). Apart from partaking in social functions, all other elements of mental and physical health component of SF 36 showed a marked deterioration as the disease progressed. CONCLUSIONS: We found a significant decline in the HRQoL among symptomatic CVI patients presenting to IIUM hospital in a multi-ethnic developing country. [ABSTRACT FROM AUTHOR]

Purpose: To compare femoral endovenectomy with the creation of an arteriovenous fistula (FE + AVF), versus iliofemoral endovenous stenting with the concurrent extended femoral vein (FV-S) stenting in patients with chronic iliofemoral venous obstruction (IFVO). Materials and Methods: In a randomized prospective single-center study, 48 received (FV-S), while the other 54 had (FE + AVF). Results: There were no statistically significant differences in the primary outcomes between the two groups (FV-S) and (FE + AVF) (59% vs 56.8%, 75% vs 79.1%, respectively). At a median of 13 months after the treatment. However, the FV-S group's patients experienced fewer postoperative problems (p = .012), shorter procedures (p = .001), and shorter stays in the hospital (p = .025). Conclusion: There is no difference between the efficacy and symptomatic resolution of the FV-S group and the FE + AVF group at the same time, FV-S has lower postoperative complications and a shorter procedure duration and hospital stay. [ABSTRACT FROM AUTHOR]

Summary: This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell 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 insufficiency (CVI) represents a risk factor for cardiovascular events. The first-line treatment includes the use of compression stockings and lifestyle changes. Natural products, such as flavonoids, could be used to improve the effects of compression therapy due to their anti-inflammatory and anti-oxidant properties. This study aims to evaluate the effects of a dietary supplement containing baicalin, bromeline and escin in CVI patients. A retrospective cohort study was performed by using the medical records of CVI affected outpatients. Patients treated with the dietary supplement were defined as "users". A modified Venous Clinical Severity Score (VCSS) was calculated, including pain, inflammation, vessels induration and skin pigmentation. All clinical variables were evaluated at baseline (T0), after 30 (T1) and 90(T2) days in "users" and "non-users". Out of 62 patients, 30 (48.4%) were "users". No difference was observed between groups at baseline. A lower VCSS value was recorded in "users" than that observed in "non-users" at T2 (7.0 (4.0–9.0) vs. 9.0 (5.0–10.0); p = 0.025). Vessels' induration and pain significantly reduced in 53.3% and 43.3% of "users" and in 18.8% and 9.4% of "non-users". Only "users" (33.3%) showed a reduction of the inflammatory signs as well as a decrease in malleolar circumference, from 29.0 (26.5–30.0) to 27.5 (26.0–28.5) (p < 000.1). A reduction of C-reactive Protein levels was found in "users" compared to "non-users" at T2 (1.0 (0.9–1.2) vs. 1.3 (1.0–1.5); p = 0.006). These findings suggest that implementation of a dietary supplement could improve the clinical outcomes of CVI patients. [ABSTRACT FROM AUTHOR]

Objectives: To determine the demographics, outcomes, and healthcare utilization of patients with chronic venous insufficiency-associated lymphedema (CVI-LED) and the prevalence of lymphedema-specific therapy use after venous intervention. Methods: The IBM MarketScan Commercial and Medicare Claims Databases were examined for patients with CVI-LED. Patient demographics and the use of lymphedema-specific therapy before and after venous intervention were collected. Results: Of 85,601 LED patients identified, 8,406 also had a diagnosis of CVI. In the CVI-LED group, 1051 underwent endovenous ablation or venous stent placement. The use of lymphedema-specific therapy before and after venous intervention was 52% and 39%, respectively (p <.05). The mean time of initiation of LED-specific therapy following venous intervention was 265 days after ablation and 347 days after stent placement. Conclusion: Treating venous hypertension improves certain venous-related signs and symptoms of CVI. However, a significant proportion of patients have persistent edema which may reflect underlying, sub-optimally treated LED. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage. Methods: A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated. Results: Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein. Conclusions: Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated. [ABSTRACT FROM AUTHOR]

Background: The decision to treat a refluxing anterior saphenous vein (ASV) should be a clinical decision based on the assessment on the ASV's contribution to patient's signs and symptoms. Once the decision to treat has been made, there are anatomic, clinical, and technical considerations in treatment planning. Methods: Clinical scenarios were discussed by a panel of experts and common anatomic, clinical, and technical considerations were identified. Results: There are unique clinical considerations such as whether both the great saphenous vein (GSV) and ASV should be concomitantly treated, if a normal ASV should be treated when treating a refluxing GSV and when and how to treat the associated tributary varicose tributaries. Being aware of the anatomic, clinical, and technical considerations allows development of a treatment plan that optimizes long-term outcomes in patients with ASV reflux. Conclusion: Ultimately the treatment plan should be tailored to address these types of variables in a patient-centered discussion. [ABSTRACT FROM AUTHOR]

The foot and calf muscle pump, collectively known as the venous muscle pump, plays a crucial role in the circulatory system (veins, arteries, and lymphatics), particularly in the return of blood from the lower extremities to the heart. Further, the venous muscle pump is crucial to lymphatic health and essential in chronic edema/lymphedema management. This article will highlight the significance of the venous pump and review the functional anatomy and physiology of the foot and calf, integrating the connection to venous and lymphatic health. The complementary importance of mobility, exercise, and breathing will also be explored. [ABSTRACT FROM AUTHOR]

Chronic superficial venous disease, including superficial venous insufficiency, superficial venous thrombosis, and aneurysms, are prevalent conditions that affect millions of individuals worldwide. With chronic venous insufficiency specifically, the advent of office-based minimally invasive procedures in recent decades has significantly expanded access to outpatient treatment. However, as venous insufficiency is rarely life- or limb-threatening, the clinical diagnosis, diagnostic evaluation, and treatment indications should be considered carefully when recommending elective intervention. Appropriateness of care guidelines intend to aid providers and patients in the decision-making process, based on the available evidence in the scientific literature, to select the best care for the patient when treating their superficial venous disease. [ABSTRACT FROM AUTHOR]

BackgroundVaricose veins are a common issue for employees in jobs that require prolonged standing compared with all other employees. However, its relationship with presentations of traditional Chinese medicine constitution is unknown. This study aimed to investigate their association.Material and methodsData in the study were obtained from questionnaires of patients in Taiwan Biobank, enrolled from 2008 to 2020. The responses to the statement “I can see distorted blood vessels on my four limbs (varicose veins).” were categorized into none, mild, moderate, severe. and more severe, and the same scale was also used to classify breathing difficulties and hypotension.ResultsA total of 11,293 participants were enrolled in the study. The prevalence of women was higher in the studied group compared with the control. Patients complained of breathing difficulties with moderate (30.49%) and severe discomfort (12.44%) in the diseased group. Regarding hypotension, 28.81% and 9.82% of the patients presented with moderate and severe hypotension, respectively. The cofactor odds ratio was 1.775 for severe breathing difficulty/moderate hypotension and 2.235 for severe breathing difficulty/severe hypotension, with statistical significance. The combined impact of breathing difficulties and hypotension increased with severity.ConclusionsVaricose veins had a higher association with breathing difficulties and hypotension as the severity of the condition worsened. The combined impact of breathing difficulties and hypotension increased as the disease progressed. Therefore, self-reported assessments can be a useful tool for evaluating patients with asymptomatic varicose veins before the development of “heart-failure-like symptoms” to reduce the risk of underdiagnosis.

The rise of technology has heightened work demands, adversely impacting mental health and fitness. The COVID-19 pandemic exacerbates psychological stress, emphasizing the need for non-pharmacological interventions like yoga. Yoga positively influences the autonomic nervous system, benefiting cardio-respiratory health, metabolic efficiency, and conditions like Type-2 diabetes, Chronic Venous disease, and obesity. This study employs a dataset with 100 samples and 43 features related to Chronic Venous Insufficiency (CVI). Logistic and Random Forest classifiers are validated using K-fold cross-validation, with feature selection optimizing prediction accuracy. Hybrid models, enhanced with optimization algorithms, predict Venous Clinical Severity Score (VCSS) before, one, and three months after yoga practices. The Random Forest classifier, particularly RFGT, proves highly accurate in categorizing baseline severity and identifying Mild and Moderate CVI cases. RFGT demonstrated AUC score of 0.9072, 0.8714, 0.7709, and 0.7200 in Absent, Mild, Moderate, and Severe patient groups classification before yoga practices (VCSS-Pre). These values were 0.9158, 0.8644, 0.8142, and 0.6333 for VCSS-1 and reported as 0.9269, 0.8399, 0.7838, and 0.7500 for patients’ classification in VCSS-3. Predicting VCSS scores before yoga intervention assists in categorizing participants for personalized care and efficient resource allocation. The RFC-based models, notably RFGT, show high accuracy in identifying baseline severity, enabling early intervention for high-risk individuals. These models, especially RFGT, perform well in classifying Mild and Moderate CVI cases, informing lifestyle modifications. Predicting VCSS-1 scores evaluates the short-term impact of yoga practices, identifying individuals requiring additional support. RFGT aids in personalized recommendations based on specific factors, crucial for severe conditions. Predicting VCSS-3 scores assesses the sustained impact over three months, identifying intervention responders, particularly in Severe and Moderate groups. RFGT demonstrates optimal predictions, contributing to future interventions tailored to individual responses and improved outcomes.

This literature review analyzes relationships and correlations between obesity and chronic venous diseases. The search of scien tific publications was carried out in the Cochrane Library, PubMed, Medscape and Medline databases in accordance with the PRISMA guidelines. The review includes only publications, which were particularly relevant to our focus of research and where a significance difference between “experience and control” groups was found based on the results of statistical analysis. All studies included in the analysis defined obesity as a body mass index of 30.0 kg/m2 or more, and overweight as a BMI from 25 to 30 kg/m2 according to the criteria of the World Health Organization. The findings of publication analysis show that excess body weight, and especially obesity, is a major independent risk factor for the development and progression of chronic venous diseases and their complications. In addition, a direct cause-and-effect relationship between body weight and the severity of chronic venous insufficiency was observed. Increased intra-abdominal pressure associated with the visceral fat deposition is one of the key features of the pathogenesis of chronic venous diseases in patients with overweight and obesity. In this context, bariatric surgery, after which weight loss correlates with falling into a lower clinical class of chronic venous diseases is the most effective method for improving phlebological status. Along with bariatric surgery, the pharmacotherapeutic options are considered in patients with chronic venous diseases with underlying overweight and burdened comorbidities anamnesis. In this regard, the role of hesperidin combined and diosmin that have been shown to be most effective phlebotropic drug is discussed. Recent studies demonstrate that hesperidin has independent pluripotent properties, among which the mechanisms of action of this substance on lipid metabolism accompanied by a decrease in subjects’ body weight and visceral fat volume are a matter of interest. After completion of full-fledged clinical studies this action of hesperidin can be implemented in various treatment-and-prophylactic protocols on the management of patients with chronic venous diseases, related to underlying overweight and morbid obesity. Venarus® contains two micronized components hesperidin and diosmin at standardized dosages: 10% hesperidin and 90% diosmin, which can be used as an argument in favour of choosing this drug to treat patients with chronic venous diseases, related to underlying obesity or overweight.

Introduction. Despite the active introduction of minimally invasive techniques into modern phlebology, the problem of surgical treatment of chronic venous insufficiency (CVI) in the stage of trophic disorders is still far from being finally resolved, especially problems of horizontal reflux. Aim. Тo comparatively evaluate the results of using various tactics of minimally invasive surgical treatment in patients with lower extremitiesʹs CVI in the stage of trophic disorders.Materials and methods. A study at 139 patients with CVI at the stage of trophic disorders was carried out. Group 1 (n = 79) included patients who underwent endovasal laser coagulation of the trunks of the great and small saphenous veins (GSV and SSV) with microfoam sclerotherapy of varicose perforating veins. In group 2 (n = 60) – method of intervention was determined by the diameter of Cockettʹs perforants.Results. Indicators of the early postoperative period in the study groups were comparable. After 2 months, no cases of relapse in the GSV and SSV were registered. Recurrence of horizontal reflux was observed only in 6 (7.6%) people in group 1. In long-term postoperative follow-up, decrease in the severity of the disease according to the VCSS scale was found in both groups (p < 0.001). The persistence of pathological reflux along was observed in 16 (22.5%) patients of group 1. Moreover, in 62.5% and 68.75% cases of relapses, the perforants had, respectively, a large diameter and high blood flowʹs speed.Discussion. In general, minimally invasive techniques used demonstrated comparable clinical results and high efficiency. At the same time, the importance of preoperative assessment and taking into account the properties of perforants has been proven.Conclusion. The claimed method should be considered as an effective and safety method of obliteration of incompetent perforating veins at severe forms of CVI.

Pasita Palakornkitti, Teerapong Rattananukrom Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Teerapong Rattananukrom, Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand, Tel +662-201-1141, Fax +662-201-1211, Email teerpongrattananukrom@gmail.comAbstract: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction which exhibits a diverse range of presentations. We described a 48-year-old man diagnosed with acute generalized exanthematous pustulosis (AGEP)-like DRESS following the administration of diosmin and hesperidin. To our knowledge, diosmin and hesperidin-induced DRESS are exceptionally rare. This aims to raise awareness of potential severe cutaneous side effects in patients taking these agents.Keywords: chronic venous insufficiency, daflon, facial edema, flavonoid, severe cutaneous adverse reactions

Abstract Introduction Medium-term clinical outcome data are lacking for cyanoacrylate glue (CAG) ablation for symptomatic varicose veins, especially from the Asian population. Objectives Aim was to determine the 3-year symptomatic relief gained from using the VenaSeal™ device to close refluxing truncal veins from the Singaporean ASVS prospective registry. Methods The revised Venous Clinical Severity Score (rVCSS) and three quality of life (QoL) questionnaires were completed to assess clinical improvement in venous disease symptoms along with a dedicated patient satisfaction survey. 70 patients (107 limbs; 40 females; mean age of 60.9 ± 13.6 years) were included at 3 years. Results At 3 years, rVCSS showed sustained improvement from baseline (5.00 to 0.00; p

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/dL, p

Despite the large arsenal of diagnostic methods for studying the lymphatic system, there are isolated works on its morpho-functional state in chronic venous insufluciency. The purpose of the study was to study the anatomical and physiological state of the surface lymphatic system of the lower extremities in persons with different clinical classes of chronic vein diseases using fluorescence lifography. The study was conducted in 105 patients divided into six groups according to the clinical class of chronic diseases of the veins of the lower extremities according to the CEAP classiffication. We used fluorescent lymphography using sodium fluorescein to study the anatomical and functional capabilities of the lymphotone. The study revealed that morphofunctional changes in superficial lymphatic vessels in chronic lower extremity vein diseases depend on venous system decompensation. With an increase in the clinical class of chronic diseases of the veins of the lower extremities, the rate of lymph flow through the superficial lymphatic vessels is statistically significantly reduced. At the same time, the antegrade lymph cell is completely absent in С5-С6, with the appearance of retrograde outflow and discharge of the lymph into the deep lymph vessels. Thus, the progression of chronic venous insufficiency leads to proportional progression of morphofunctional changes in the superficial lymphatic system, which leads to the formation of lymphovenous insufficiency.

Aim: Chronic venous insufficiency (CVI) is a condition that results from obstruction, valve insufficiency, dysfunction of calf muscle pump, or their combinations. This study analyzed the risk factors and demographic characteristics of CVI in nurses in Turkiye. Additionally, it seeks to identify the total number of patients treated at medical centers in 2022 and assess the prevalence of CVI. Material and Methods: This multicenter, descriptive, and cross-sectional study was conducted with the participation of nurses working in 18 centers. Nurses completed a questionnaire that included their demographic information and venous insufficiency risk factors, and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life Questionnaire. Researchers also completed the Standard CEAP Form Section C. The cases were divided into 2 groups: CVI (-) group (n=776, 43.5%) and CVI (+) group (n=1010, 56.5%). Results: A total of 1786 nurses participated in this study. Older age (>30-39 years), female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession (>5-15 years), family history, and night cramps were identified as risk factors for CVI (p0.05). Hypertension, diabetes, and a history of deep vein thrombosis were the most common coexisting diseases. With a one-unit increase in age, risk of CVI increased 1.1-fold, family history of VV increased CVI risk 1.9-fold and presence of nocturnal night cramps increased risk of CVI 2.6-fold. The prevalence of CVI in 2022 was found to be 22.66% in this study. Conclusion: Older age, female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession, family history, and night cramps are identified as risk factors for CVI in nurses. Common comorbid diseases include hypertension, diabetes, and a history of DVT. Pregnancy, particularly with multiple occurrences, stands out as a critical period for CVI. Reported symptoms in CVI (+) nurses include leg pain, swelling, heaviness, restless legs, and throbbing. Nurses demonstrate a higher incidence of CVI compared to other professions, highlighting an occupational risk. These findings stress the importance of preventive measures for nurses. [Turk J Vasc Surg 2024; 33(1.000): 1-9]

Abstract Obstruction and/or reflux compromise during venous emptying can facilitate different pathophysiologies in chronic venous insufficiency (CVI). We present a patient with persistent lower limb CVI edema caused by post-thrombotic syndrome (PTS), who responded well to femoral vein valve therapy via axillary vein bypass after unsuccessful valvuloplasty, and led a normal life. During a 12 month observation period, bridging vessels completely restored original anatomical structures. In a literature study, no similar surgeries were reported, but we show that this operation may be feasible in selected patients.

Background: Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P

Objective: We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. Methods: This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. Results: 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. Conclusion: The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency. [ABSTRACT FROM AUTHOR]

Crisaborole ointment, 2%, is a nonsteroidal topical phosphodiesterase 4 inhibitor approved for the treatment of mild-to-moderate atopic dermatitis. To evaluate the efficacy and safety of crisaborole in stasis dermatitis (SD). In this randomized, double-blind, vehicle-controlled, decentralized phase 2a study (NCT04091087), 65 participants aged ≥45 years with SD without active ulceration received crisaborole or vehicle (1:1) twice-daily for 6 weeks. The primary end point was percentage change from baseline in total sign score at week 6 based on in-person assessment. Crisaborole-treated participants had significantly reduced total sign score from baseline versus vehicle based on in-person (nondermatologist) assessment (−32.4% vs −18.1%, P =.0299) and central reader (dermatologists) assessment of photographs (−52.5% vs −10.3%, P =.0004). Efficacy according to success and improvement per Investigator's Global Assessment score and lesional percentage body surface area reached statistical significance based on central reader but not in-person assessments. Skin and subcutaneous tissue disorders were common all-causality treatment-emergent adverse events with crisaborole. Small sample size and short treatment duration were key limitations. In-person assessment was not conducted by dermatologists. Crisaborole improved signs and symptoms of SD and was well tolerated. Central reader assessment represents a promising approach for siteless clinical research. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado 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.)

Introduction: Medium-term clinical outcome data are lacking for cyanoacrylate glue (CAG) ablation for symptomatic varicose veins, especially from the Asian population. Objectives: Aim was to determine the 3-year symptomatic relief gained from using the VenaSeal™ device to close refluxing truncal veins from the Singaporean ASVS prospective registry. Methods: The revised Venous Clinical Severity Score (rVCSS) and three quality of life (QoL) questionnaires were completed to assess clinical improvement in venous disease symptoms along with a dedicated patient satisfaction survey. 70 patients (107 limbs; 40 females; mean age of 60.9 ± 13.6 years) were included at 3 years. Results: At 3 years, rVCSS showed sustained improvement from baseline (5.00 to 0.00; p < 0.001) and 51/70 (72.9%) had improvement by at least 2 or more CEAP categories. Freedom from reintervention was 90% and 85.7% patients were extremely satisfied with the treatment outcome. No further reports of further hypersensitivity reactions after one year. Conclusion: The 3-year follow-up results of the ASVS registry demonstrated continued and sustained clinical efficacy with few reinterventions following CAG embolization in Asian patients with chronic venous insufficiency. Trial registration: ClinicalTrials.gov Registration: NCT03893201. [ABSTRACT FROM AUTHOR]

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers' instructions. An Independent samples t-test was used to compare group difference, and p-value =0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/dL, p<0.001), hsCRP (1.34±1.01 mg/L vs. 3.78±1.67 mg/L, p<0.001), IL-6 (2.65±1.07 pg/mL vs. 4.17±1.51 pg/mL, p<0.001), vWF (90.73±16.72% vs. 127.30±19.92, p<0.001). D-dimer was also substantially higher in samples extracted from leg VV than in systemic blood (105.87±17.72 ng/mL vs. 85.61±18.18 ng/mL, p<0.001). Conclusion: Blood from VV has shown a higher level of several inflammatory markers and signs of endothelial dysfunction. This is most likely the result of worsening venous pressure and dilated, convoluted superficial veins that restrict blood flow. The procoagulant qualities of the local blood and damage to the venous wall, leading to a chronic inflammatory response, may accelerate the disease's progression and thrombotic consequences. [ABSTRACT FROM AUTHOR]

Introduction: Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. Methods: Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. Results: A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. Conclusions: In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions. [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 insufficiency (CVI) is a chronic lower limb progressive disorder with significant burden. Graduated compression therapy is the gold‐standard treatment, but its underutilisation, as indicated in recent literature, may be contributing to the growing burden of CVI. The aim of this systematic review is to determine the reasons for poor compliance in patients who are prescribed graduated compression therapy in the management of chronic venous insufficiency. A systematic review of the literature was conducted to identify the reasons for non‐compliance in wearing graduated compression therapy in the management of chronic venous insufficiency. The keyword search was conducted through Medline, PubMed, CINAHL, Cochrane library, AMED, and Embase databases from 2000 to April 2023. Qualitative and quantitative studies were included with no study design or language limits imposed on the search. The study populations were restricted to adults aged over 18 years, diagnosed with chronic venous insufficiency. Of the 856 studies found, 80 full‐text articles were reviewed, with 14 being eligible for the review. Due to the variability in study designs, the results were summarised rather than subjected to meta‐analysis. There are five main overarching themes for non‐compliance, which are physical limitations, health literacy, discomfort, financial issues, and psychosocial issues with emerging sub‐themes. Graduated compression therapy has the potential to reduce the burden of chronic venous insufficiency if patients are more compliant with their prescription. [ABSTRACT FROM AUTHOR]

Obstruction and/or reflux compromise during venous emptying can facilitate different pathophysiologies in chronic venous insufficiency (CVI). We present a patient with persistent lower limb CVI edema caused by post-thrombotic syndrome (PTS), who responded well to femoral vein valve therapy via axillary vein bypass after unsuccessful valvuloplasty, and led a normal life. During a 12 month observation period, bridging vessels completely restored original anatomical structures. In a literature study, no similar surgeries were reported, but we show that this operation may be feasible in selected patients. [ABSTRACT FROM AUTHOR]

Chronic venous insufficiency (CVI) is a venous disorder characterized by impaired blood flow from the lower extremities back to the heart, leading to various symptoms and complications. Accurate and timely diagnosis of CVI is critical for effective management and prevention of further complications. Deep learning (DL) models have shown results that are promising in the field of medical image analysis tasks over the past few years. This article presents CVINet, a enhanced DL‐based convolutional neural network (CNN) model that has been developed specifically for the purpose of diagnosing CVI utilizing thermal imaging data. The proposed CNN model extracts relevant features from input images using a multi‐layered architecture with convolutional layers and pooling layers. Following feature extraction, data are directed to fully connected layers for performing classification task. To enhance the performance of this model, we employ techniques such as dropout regularization and batch normalization. This model utilizes its ability to automatically learn discriminative features from raw thermal images. A large set of thermal images from both CVI patients and healthy individuals was acquired for training and testing of the model. A comparison between few conventional pre‐trained models was conducted, and the best performing model for classification was examined. Pre‐trained VGG‐16, EfficientNet‐B0, and ResNet‐152 models produced classification accuracies of 94.7%, 95.3%, and 95.8%, respectively. The Proposed CVINet model attained a classification accuracy of 96.8% on binary classification, demonstrating high performance compared with other state‐of‐the‐art networks. Overall, our proposed CNN model offers a promising solution for accurately classifying CVI and normal subjects based on thermal images which outperforms the diagnosis by clinician. The potential benefits include early detection of CVI and personalized treatment strategies that can improve patient outcomes. They improve the accuracy of patient diagnosis, reducing radiologist workload and providing them with a tool that can automatically assess the condition of the lower limb venous condition, lowering the risk of misdiagnosis. Furthermore, improving healthcare service quality and early detection can alter the course of the disease and reduce the morbidity and mortality rate of the disease. [ABSTRACT FROM AUTHOR]

The suggestion that bidirectional flow is a normal feature seen in venous perforators of the lower leg has been a longstanding debate. Newer published evidence has changed the perspective on normal perforator flow and is presented here to resolve the misunderstandings and different viewpoints previously held. [ABSTRACT FROM AUTHOR]

Background: Varicose veins are defined as dilated, tortuous subdermal veins >3 mm in diameter. It is a common entity affecting an estimated 10% of population. Aims and Objectives: The aim was to compare the efficacy of radiofrequency ablation (RFA) with great saphenous vein (GSV) stripping in patients with lower limb varicose veins in terms of disappearance of visible varicosities. Materials and Methods: It was a prospective randomized controlled study, conducted in a tertiary care medical college with the study population consisting of patients suffering from varicose veins. Totally 30 patients were enrolled and divided into 2 groups of 15 patients each. Group A underwent RFA while Group B underwent stripping of GSV with flush ligation of saphenofemoral junction. Results: The mean duration of the procedure in Group A was 53.67±6.6 min while in Group B it was 101.4±11.85 min which was statistically significant (P<0.0001). The mean duration of return to routine activities and work was 2.2±0.41 days in Group A and 3.07±1.16 days in Group B which was statistically significant (P=0.024). Post-operative analgesic requirement was similar in both groups (P=0.224). Complete remission was observed in all patients at 12 months visit and there was no recurrence identified even after a follow-up period of 4 years. Conclusion: RFA was found to be as effective as stripping of GSV in terms of obliteration of veins. The duration of procedure was found to be much less in RFA. Furthermore, cosmetic results, ulcer healing and patient satisfaction rate was better in RFA group. Patient return to normal activity was significantly earlier in RFA group. [ABSTRACT FROM AUTHOR]

• Ayurveda is a traditional medicine in India. Its origin dates back to the first century AD. It has a unique ontological and epistemological origin which is different from that of conventional medicine. • The pathological stages of CVI have been evaluated with a range of pathological conditions in Ayurveda. • Ayurvedic texts mention Terminalia arjuna as a potential herb for treating various conditions related to the cardiovascular system owing to its anti-inflammatory, anti-oxidant, and anti-hypertensive effects. • This prospective observational study shows that T erminalia arjuna is safe and effective in CVI, reducing the symptoms and also expediting ulcer healing. Chronic venous insufficiency (CVI) manifests in various clinical presentations ranging from asymptomatic but cosmetic problems to severe symptoms, such as lower limb edema, skin trophic changes, and ulceration. CVI substantially affects the quality of life and work productivity of the patients. Ayurveda, an ancient traditional medicine in India, evaluates the various pathological stages of CVI with a wide range of pathological conditions such as Siragranthi (venous abnormalities), Raktavaritavāta (disorders of vāta occluded by rakta ∼ blood), ApanaVaigunya (vitiated apānavāyu), Arsha (hemorrhoids), VataRakta (rheumatism due to rakta) , Kushtha (integumentary disease) and Dushta Vrana (putrefied wound) depending upon the presentations of the patient. Ayurvedic texts mention Terminalia arjuna as a potential herb for treating various conditions related to the circulatory system. The drug is an effective anti-inflammatory, anti-oxidant, and anti-hypertensive and has a definite role in improving cardiovascular hemodynamics and wound healing. These attributes suggest that the potential of Terminalia arjuna needs to be explored as a promising venoactive drug. This prospective observational study included 25 patients (31 limbs) with CVI who were treated with Tab Terminalia arjuna (Bark extract of Terminalia arjuna in a dose of 500 mg, given twice a day) and were observed on two visits on day 30 and day 90. Follow-up was carried out for three months to evaluate post-treatment complications or adverse effects. The clinical outcome assessment was done using Venous Clinical Severity Score (VCSS), and clinical grading was performed using clinical classification (C0 – C6) of CEAP (Clinical–Etiology–Anatomy–Pathophysiology) classification. The median VCSS score (of both limbs) during the third visit was comparatively lower than the first, with a statistically significant improvement at 0.05 level. Further, there was a substantial positive improvement in the clinical classification of CEAP among the patients in pre and post treatment phase. The prospective observational study shows that Tab Terminalia arjuna is safe and effective in CVI, reducing the symptoms like pain, edema, inflammation, pigmentation, induration and also expediting ulcer healing. [ABSTRACT FROM AUTHOR]

A case series of the use of amniotic membrane (AM) for treating chronic nonhealing wounds. It presents five cases of polymorbid patients with a total of nine chronic nonhealing wounds. The patient group consisted of four men and one woman with various comorbidities, aged 45–72 years. The mean initial wound size was 15.8 cm2, and the mean time from the onset of the wound to the first application of AM was 122 weeks. The wounds were caused by chronic venous insufficiency and/or peripheral arterial disease. Wounds were treated in a standardized protocol. AM was applied weekly in the first month and then every two weeks. Photo documentation of the wound and microbiological colonization was carried out at each visit. In three out of five patients, the AM treatment effectively promoted healing up to complete wound closure. In two cases, the wounds stayed unhealed despite numerous AM applications. Pain relief was noted in all patients. The success of the treatment was closely tied to patient factors, such as adherence to the prescribed treatment regimen and individual patient characteristics. In some cases, treatment failure was observed, possibly due to underlying comorbidities, wound parameters, or poor patient compliance. AM treatment has the potential to become a viable treatment option for these nonhealing wounds. However, the effectiveness of the treatment may be influenced by various patient factors and the underlying cause of the wound. Therefore, it is crucial to have an individualized treatment plan that considers these particular factors. [ABSTRACT FROM AUTHOR]

Aim: Chronic venous insufficiency (CVI) is a condition that results from obstruction, valve insufficiency, dysfunction of calf muscle pump, or their combinations. This study analyzed the risk factors and demographic characteristics of CVI in nurses in Türkiye. Additionally, it seeks to identify the total number of patients treated at medical centers in 2022 and assess the prevalence of CVI. Material and Methods: This multicenter, descriptive, and cross-sectional study was conducted with the participation of nurses working in 18 centers. Nurses completed a questionnaire that included their demographic information and venous insufficiency risk factors, and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life Questionnaire. Researchers also completed the Standard CEAP Form Section C. The cases were divided into 2 groups: CVI (-) group (n=776, 43.5%) and CVI (+) group (n=1010, 56.5%). Results: A total of 1786 nurses participated in this study. Older age (>30-39 years), female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession (>5-15 years), family history, and night cramps were identified as risk factors for CVI (p<0.001). No significant difference was found between smoking, body mass index, and CVI status (p>0.05). Hypertension, diabetes, and a history of deep vein thrombosis were the most common coexisting diseases. With a one-unit increase in age, risk of CVI increased 1.1-fold, family history of VV increased CVI risk 1.9-fold and presence of nocturnal night cramps increased risk of CVI 2.6-fold. The prevalence of CVI in 2022 was found to be 22.66% in this study. Conclusion: Older age, female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession, family history, and night cramps are identified as risk factors for CVI in nurses. Common comorbid diseases include hypertension, diabetes, and a history of DVT. Pregnancy, particularly with multiple occurrences, stands out as a critical period for CVI. Reported symptoms in CVI (+) nurses include leg pain, swelling, heaviness, restless legs, and throbbing. Nurses demonstrate a higher incidence of CVI compared to other professions, highlighting an occupational risk. These findings stress the importance of preventive measures for nurses. [ABSTRACT FROM AUTHOR]

Purpose: Chronic venous insufficiency is defined as a progressive disease that impairs the quality of life. Symptomatic patients can be treated with a 97% success rate through endovenous radiofrequency ablation (RFA) procedures. The aim of this study is to evaluate the effect and impact of RFA therapy on both the Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptom Questionnaire (VEINES-QOL/Sym) scale and the VEINES-QOL/Sym severity score in patients with isolated vena saphena magna insufficiency. Methods: Between March and June 2018, a retrospective analysis was conducted on 45 patients with a healthy vena saphena parva. They were divided into two groups based on the diameter of the great saphenous vein (GSV). Patients with GSV < 6 mm were assigned to group I (n = 22, 15 males, 7 females, mean age 52.45 ± 13.98 years), while patients with GSV ≥ 6 mm were assigned to group II (n = 23, 14 males, 9 females, mean age 55.04 ± 10.18 years). The pre-procedural Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification and post-procedural quality of life and symptom assessment at 12–24 months were evaluated using the VEINES-QOL/Sym questionnaire scale. Results: When all patients were assessed in terms of the VEINES-QOL/Sym questionnaire scale, compared to the previous year, it was found that 57.8% of patients (n = 26) still experienced complaints, and 24.4% of patients (n = 14) reported slightly worse symptoms than the previous year. In group II, 56.5% of patients (n = 13) reported experiencing similar complaints as the previous year, while 30.4% (n = 7) noted slightly worse symptoms. Conclusions: Our study findings revealed that the increase in vessel diameter does not significantly impact the severity of symptoms and quality of life outcomes after RFA therapy; however, it does have a notable impact on the improvement of symptom characteristics. As a result, early intervention for symptomatic patients is crucial in order to address their symptoms and improve their quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Baghdad Science Journal is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) 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.)