Lower Deep Vein Disease

Introduction. The current surgical techniques for the treatment of post-thrombotic disease are at the design phase, are performed in individual cases, not always result in an unambiguous outcome, and cannot completely solve this complex clinical problem. The use of drugs with a pleiotropic mechanism of action that act on various links in the pathogenesis of chronic venous insufficiency show promise.Objective of the study. Assess the clinical efficacy of a drug based on deproteinized hemoderivative obtained from calf blood used to treat the initial manifestations of chronic venous insufficiency affected by post-thrombotic disease.Materials and methods. Results of examination and treatment of 64 patients (30 men, 34 women) with lower extremity post-thrombotic disease and initial manifestations of chronic venous insufficiency (C1-C3). Treatment with a drug based on deproteinized hemoderivative obtained from calf blood at a dosage of 1200 mg per day (intravenous infusion, 30 ml of the drug diluted with 400 ml of Normal Saline) for 10 days. Then, per os at a dose of 1200 mg per day (2 tablets t.i.d.) for 30 days at the outpatient stage. Monotherapy was carried out without the addition of phlebotonics.Results. The therapy resulted in a significant edema syndrome decrease in the ankle area. This indicator decreased from 27.12 ± 0.41 cm to 24.95 ± 0.38 cm (p <0.05). Patients’ complaints about pins and needles decreased from 5.76 ± 0.81 to 2.31 ± 0.65 points (p < 0.05), the frequency and intensity of seizures decreased from 6.53 ± 1.40 to 3.19 ± 0, 94 points (p < 0.05). The intensity of the edema syndrome significantly decreased from 8.13 ± 1.73 to 4.31 ± 1.19 points (p < 0.05), pain syndrome – from 7.94 ± 1.86 to 3.11 ± 1.44 points (p < 0.05), heaviness in the lower extremities – from 8.54 ± 1.72 to 3.90 ± 1.46 points (p < 0.05), the overall patients’ quality of life improved (the integral indicator decreased from 63.29 ± 1.84 to 44.31 ± 1.18 points, p < 0.05).Conclusions. The use of pleiotropic drugs is justified in the early stages of chronic venous insufficiency in patients with post-thrombotic disease, as the therapy produces a complex effect on the microcirculatory bloodstream, metabolic processes in tissues and the rheological properties of blood.

The postthrombotic syndrome in relation to venous hemodynamics, as measured by means of duplex scanning and strain-gauge plethysmography

Objectives: To define the significance of perforator and deep vein pathology in patients with chronic venous disease (CVD). Methods: Consecutive patients with CVD were referred for venous evaluation (group A). Both saphenous veins and all the deep veins including those in the calf area were evaluated. A separate group of patients with deep venous reflux and/or obstruction was identified from our database and analysed separately (group B). The CEAP classification (clinical, aetiological, anatomical and pathological) was used to grade the clinical severity of CVD. Results: Age, duration of disease and history of thrombosis increased significantly with disease severity ( P <0.02). Reflux in the superficial veins was the most common pathology in group A and it was present in 75% of limbs in group B. The overall contribution of deep venous disease was 26% in group A and it increased significantly with the severity of disease in both groups. Isolated deep vein disease in group A was significantly less compared with group B (8% vs 23%, P<0.0001). Reflux in deep veins of post-thrombotic limbs was significantly longer compared with those with primary disease. The prevalence of incompetent perforator veins was higher in patients with skin damage from both groups. No patient had isolated perforator vein reflux. Reflux was the most common pathology in both groups, while obstruction alone was rare. Other than superficial reflux, which is very common, ipsilateral recurrent deep venous thrombosis (DVT), combined reflux and obstruction, and popliteal vein reflux were the strongest predictors for development of skin damage. Conclusions: Perforator and deep vein involvement increases significantly with the severity of CVD. Isolated deep vein disease in post-thrombotic limbs is more common than in consecutive venous patients. Reflux is the most common pathology and obstruction alone is rare. In post-thrombotic limbs, the most important predictors for skin damage are ipsilateral recurrent DVT, popliteal vein reflux and a combination of reflux and obstruction.

The relationship between increased body mass index and primary venous disease severity and concomitant deep primary venous reflux.

Varicose veins Hemodynamics Venous insufficiencyIn the patient with chronic venous disease, venous hypertension occur which result in inability of calf pumps and conduits in the venous system to maintain a normal pressure and normal flow towards the heart.Venous hypertension is caused by venous reflux, obstruction, a combination of reflux and obstruction or arterio-venous fistula.Compensation for obstruction are the development of collateral vein circulation and lymphatic drainage.The clinical symptoms and signs are a result of the venous hypertension and the lack of compensation.Inability to quantitate these factors in individual patients contributes to an incomplete understanding of the pathophysiology, leading to controversies and significant challenges in managing chronic venous disease.

Perimalleolar subcutaneous tissue pressure effects of elastic compression stockings

Perimalleolar subcutaneous tissue pressure effects of elastic compression stockings

A noninvasive screening test to detect "critical" deep venous reflux.

Molecular characterization of post-thrombotic syndrome

The Effect of Superficial Venous Incompetence Treatment on Combined Segmental Deep Venous Reflux

Restless leg syndrome (RLS) is a common cause of lower extremity discomfort. We hypothesized that patients with RLS symptoms have higher rates of deep and superficial venous reflux (SVR). Retrospective review of patients ≥18 years of age evaluated in a venous center from December 2018 to February 2019. Differences in rates of RLS symptoms, demographics, comorbidities, and clinical and radiologic presence of venous disease were analyzed. Overall, 207 patients were analyzed; 140 (67.6%) reported RLS symptoms ( n = 25 with prior RLS diagnosis). RLS symptoms were more common with superficial or combined superficial and deep venous reflux (DVR) compared with those without reflux ( p < 0.001). Patients with RLS symptoms as opposed to those without had similar demographics and comorbidities (all p > 0.05) but increased rates of venous pain, phlebitis, family history of venous disease, lower extremity swelling and SVR, and combined SVR and DVR (all p < 0.05). Our multivariable logistic regression found presence of SVR, and family history of venous reflux was associated with RLS symptomatology (all p < 0.001). Ninety-nine patients with RLS underwent ablation; of them, 93 had duplex-proven reflux resolution of which 81 (87%) reported RLS symptom improvement. This included 13 of 16 (81.3%) with prior RLS diagnosis. SVR is associated with increased rates of RLS symptoms in a vein center population. Therefore, RLS symptoms should trigger a targeted venous evaluation. Our results suggest that venous ablation may lead to resolution of RLS symptoms in patients with SVR, but randomized prospective trials with strict RLS definition criteria are warranted to confirm these outcomes.

Plethysmography as a method for studying peripheral circulatory system was first proposed by wletney in 1953. In Russia, the first most significant research studies on the feasibility of plethysmography in studying peripheral blood flow and circulatory physiology taken together were conducted at the St. Petersburg Pavlov Institute of Physiology in 1961. From this time onwards, the possibilities of plethysmography as a non-invasive objective method for the diagnosis of hemodynamic disorders, particularly in arterial pathology, were studied intensively. These parameters were not determined for the venous blood flow, but in 1980s the authors were able to establish plethysmographic criteria not only for various forms of venous pathology, but also for degrees of chronic venous insufficiency using a device significantly improved by V.N. Pavlov and V.E. Maslov.The purpose of this publication is to analyze the literature data on the use of aerial plethysmography and photoplethysmography in the study of hemodynamic disorders in patients with chronic diseases of the veins of the lower extremities. At present, in order to assess the venous blood flow in condition of air plethysmography, indicators of functional venous volume (VV), maximum venous outflow (MVO), venous filling index (VFI), evacuation volume (EV) and residual volume (RV), as well as an integral indicator – residual volume fraction (RVF) are determined in the world. A venous reflux test (VRT) is performed as part of photoplethysmography. The data published today show the high statistical reliability of the comparative analysis and the great scientific significance of the research. According to many foreign authors the use of plethysmographic methods of diagnosis allow to assess violations of venous blood flow in patients with chronic venous diseases of various clinical classes according to CEAP more precisely and to give a global assessment of disorders of the venous outflow from thrombotic occlusion of segmental to hypervolemia in patients with varicose veins in different forms of manifestations of chronic venous insufficiency. The analysis of the literature data allows to make a conclusion about the prospects of further research using these non-invasive methods of evaluation of venous blood flow in the lower extremities.

Morphometric assessment of the dermal microcirculation in patients with chronic venous insufficiency

The aim of this study was to reveal the frequency and impact of perforating venous insufficiency (PVI) in chronic venous insufficiency (CVI) of lower extremity (LE). Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venous insufficiency (VI). PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venous insufficiency (DVI), 59.81% with great saphenous vein (GSV) insufficiency, 68.49% with small saphenous vein (SSV) insufficiency, 58.65% with accessory GSV insufficiency, and 58.77% with PV associated with VVs. There was a statistically significant relationship between PVI and chronic DVT, DVI, GSV, SSV, and accessory GSV insufficiency (p<0.001). A significant relationship was observed between the increase in PV diameter and the presence of PVI (p<0.001). PVI is quite common in combined VI, and PV evaluation should be a part of LE venous system examination.

Chronic venous disease, whether caused by superficial and/or deep venous insufficiency, is an incredibly common condition that affects a significant portion of the population in the United States and the Western world. Being one of the most common chronic medical conditions, it is a cause of significant morbidity as well as an important socioeconomic and public health issue. It is estimated that more than 50% of patients over the age of 40 have spider and larger varicose veins. The prevalence of varicose veins is estimated to affect approximately 30% of the population, but variable figures exist in the literature, with 2–56% of men and <1–60% of women being affected. Additionally, the Bonn Vein study suggests that chronic venous disease is a progressive disease, and if left untreated, a significant proportion of patients will progress from varicose veins to edema, to skin changes, and to ulceration. Prevention of disease progression then is vitally important, as is consideration of the effect of chronic venous disease on quality of life.