scholarly journals Cytokines Produced by Lymphocytes in the Incompetent Great Saphenous Vein

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ewa Grudzińska ◽  
Andrzej Lekstan ◽  
Ewelina Szliszka ◽  
Zenon P. Czuba
Keyword(s):  
Saphenous Vein ◽  
Oscillatory Flow ◽  
Great Saphenous Vein ◽  
Interleukin 1 ◽  
Lymphocyte Culture ◽  
Chronic Venous Disease ◽  
Control Group ◽  
Venous Disease ◽  
Culture Supernatants ◽  
Necrosis Factor

The pathogenesis of chronic venous disease (CVD) remains unclear, but lately inflammation is suggested to have an important role in its development. This study is aimed at assessing cytokines released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting oscillatory flow (reflux) in GSV, blood was derived from the cubital vein and from the incompetent sapheno-femoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Interleukins (IL) 1β, 2, 4, 10, 12 (p70), and 17A; interleukin 1 receptor α (IL-1ra); tumor necrosis factor-α (TNF-α); interferon-gamma (IFN-γ); and RANTES were assessed in culture supernatants by the Bio-Plex assay. In both stimulated and unstimulated samples, in the examined group, IL-1β and IFN-γ had higher concentrations and RANTES had lower concentrations when compared to those in the control group. In the examined group, IL-4 and IL-17A had higher concentrations without stimulation and TNF-α had higher concentrations with stimulation. The GSV samples had higher IL-2, IL-4, IL-12 (p70), and IFN-γ concentrations without stimulation and lower IL-2 and TNF-α concentrations with stimulation when compared to those of the upper limb in the examined group. These observations indicate that the oscillatory flow present in incompetent veins causes changes in the cytokine production by lymphocytes, promoting a proinflammatory profile. However, the relations between immunological cells, cytokines, and the endothelium require more insight.

Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

2015 ◽  
Vol 31 (5) ◽  
pp. 334-343 ◽  
Author(s):  
Jean Francois Uhl ◽  
Miguel Lo Vuolo ◽  
Nicos Labropoulos
Keyword(s):  
Lymph Node ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Normal Subjects ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Anatomical Dissection ◽  
Anatomical Finding

Objective To describe the anatomy of the lymph node venous networks of the groin and their assessment by ultrasonography. Material and methods Anatomical dissection of 400 limbs in 200 fresh cadavers following latex injection as well as analysis of 100 CT venograms. Routine ultrasound examinations were done in patients with chronic venous disease. Results Lymph node venous networks were found in either normal subjects or chronic venous disease patients with no history of operation. These networks have three main characteristics: they cross the nodes, are connected to the femoral vein by direct perforators, and join the great saphenous vein and/or anterior accessory great saphenous vein. After groin surgery, lymph node venous networks are commonly seen as a dilated and refluxing network with a dystrophic aspect. We found dilated lymph node venous networks in about 15% of the dissected cadavers. Conclusion It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks. Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods

2014 ◽  
Vol 30 (10) ◽  
pp. 700-705 ◽  
Author(s):  
V Starodubtsev ◽  
M Lukyanenko ◽  
A Karpenko ◽  
P Ignatenko
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Chronic Venous Disease ◽  
Proximal Segment ◽  
Venous Disease ◽  
Endovenous Laser Ablation ◽  
Safety And Efficacy ◽  
Wide Diameter ◽  
Saphenous Veins

Objective To estimate the safety and efficacy of using the laser 1560 nm wavelength for treatment of chronic venous disease in patients with wide diameters of the proximal segment of the great saphenous vein. Methods In the study 88 patients with lower limb varicose veins were included. Maximum diameter of the great saphenous vein proximal segment varied from 15 to 34 mm (22 ± 2.3) in all patients. In the 1st group in 34 cases crossektomy and endovenous laser ablation (EVLA) were performed. In the 2nd group in 30 cases EVLA regardless diameter of the great saphenous vein proximal segment was performed. In the 3rd group in 34 cases EVLA taking into account the diameter of the great saphenous vein proximal segment was performed. The laser 1560 nm wavelength was used. Linear endovenous energy density in the 1st and 2nd groups was 90 J/cm for the proximal segment and trunk of great saphenous vein. Linear endovenous energy density in the 3rd group was personalized on the size of the veins: 100 J/cm for diameter of great saphenous vein proximal segment 15–20 mm, 150 J/cm for diameter 20–30 mm, 90 J/cm for middle and distal segments of great saphenous vein. Results In the 1st group obliteration of the trunk of the great saphenous veins and accessory great saphenous veins in all cases without additional interventions was reached. In the 2nd group at four cases (13.3%) the second procedure EVLA was carried out, after which the obliteration of the trunk was achieved. In the 3rd group the obliteration of the trunk of great saphenous vein was achieved without additional interventions. Conclusion Our experience of using the laser 1560 nm wavelength for the treatment of the chronic venous disease in patients with wide diameter of the proximal segment of great saphenous vein shows the safety and efficacy of this technique. EVLA has to be personalized on the size of the segments of vein in patients with wide proximal segment of great saphenous vein.

scholarly journals Damage to Cranial Extension of the Small Saphenous Vein and Vein of Giacomini in Lower Limb Varicose Vein Disease

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
Rostyslav Vasyliovych Sabadosh
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Subsequent Development ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Primary Chronic Venous Disease ◽  
Antegrade Flow

Abstract. The vein of Giacomini is often identified with the cranial extension of the small saphenous vein despite the fact that according to the international interdisciplinary anatomical nomenclature they are distinguished from one another.The objective of the research was to improve the results of treatment of patients with lower limb primary chronic venous disease disease studying the variation in anatomy and pathology of the vein of Giacomini and the cranial extension of the small saphenous vein with subsequent development of differential surgical tactics.Materials and methods. 502 patients with primary chronic venous disease on 605 legs were examined and treated. Each patient underwent preoperative ultrasonographic triplex scanning of the lower limb venous system.Results. Varicose dilatation of the vein of Giacomini was observed in 3.8% of patients (95% CI 2.4-5.6 %), and the pathology of the cranial extension of the small saphenous vein was detected in 1.7% of patients (95% CI 0.8-3.0%). When the arch of the small saphenous vein was present the following variations in the pathology of the vein of Giacomini were observed: 1) the spread of reflux from the great saphenous vein to the vein of Giacomini; 2) reflux from the terminal valve of the small saphenous vein intensified the antegrade flow of blood within the vein of Giacomini resulting in reflux in the great saphenous vein distal to the point where the vein of Giacomini drained into the great saphenous vein. The causes of failure of the valves in the trunk of the cranial extension of the small saphenous vein included: 1) reflux from the ostium of the cranial extension of the small saphenous vein; 2) perforating vein reflux; 3) reflux from the terminal valve of the small saphenous vein.Conclusions.  The pathology of the vein of Giacomini and the cranial extension of the small saphenous vein is not homogeneous; therefore, surgical tactics in every patient has to be hemodynamically justified and differentiated depending on the pathways of pathological reflux spreading. 

Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy

2019 ◽  
Vol 35 (1) ◽  
pp. 46-55 ◽  
Author(s):  
Orlando Adas Saliba Júnior ◽  
Hamilton Almeida Rollo ◽  
Orlando Saliba ◽  
Marcone Lima Sobreira
Keyword(s):  
Pregnant Women ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Intervention Group ◽  
Signs And Symptoms ◽  
Lower Limbs ◽  
Control Group ◽  
Venous Disease ◽  
Compression Stockings

Objectives To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women. Method A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated. Results Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p < 0.0001) in the right leg and 0.28 cm and 0.38 cm (p < 0.0001) in the control group. CEAP classification presented worsening in the control group (p < 0.0001). The signs and symptoms in the control vs. intervention group: pain (86.67% vs. 23.33%; p < 0.0001), edema (70.00% vs. 33.33%; p = 0.0045), and leg heaviness (93.33% vs. 13.33%; p < 0.0001). Conclusions Compression stockings were effective in controlling the varicose veins related to pregnancy.

Anatomical and clinical factors favoring the performance of saphenous ablation and microphlebectomy or sclerotherapy as a single-stage procedure

2014 ◽  
Vol 30 (9) ◽  
pp. 627-631 ◽  
Author(s):  
AA Kokkosis ◽  
H Schanzer
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Class I ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Class Iii ◽  
Endovenous Ablation ◽  
Secondary Procedures ◽  
Extensive Class

Objective To identify the anatomical and clinical parameters that predict lack of regression of superficial varicosities after ablation of the great saphenous vein. Methods Symptomatic patients treated with endovenous ablation from August 2006 to July 2013, by a single surgeon, were included. Recorded parameters included age, sex, size, and extent of varicosities (class I–IV) (patient standing), and diameter and length (patient supine) of treated great saphenous vein. Varicose vein classification was defined as: class I ≤6 mm and localized to thigh or leg, class II ≤6 mm and present in the thigh and leg (extensive), class III >6 mm and localized to the thigh or leg, and class IV >6 mm and extensive. “Excellent” results were defined as complete resolution of varicosities, “good” results as incomplete resolution, and “poor” results as no improvement. Results A total of 267 patients and 302 consecutive limbs were included in the study. There were 175 females (65.5%), and the mean age was 54 years old (22–92). The CEAP classification was as follows: C2 (81.5%), C3 (6.3%), C4 (7.9%), C5 (2.0%), and C6 (2.3%). Great saphenous vein diameters was significantly larger in patients with C3–C6 (proximal 0.84 ± 0.25 versus 0.65 ± 0.21, p = < 0.0001, distal 0.58 ± 0.18 versus 0.44 ± 0.13, p < 0.0001) or class III–IV varicose veins (proximal 0.85 ± 0.25 versus 0.75 ± 0.27, p = 0.012, distal 0.62 ± 0.62 versus 0.50 ± 0.17, p < 0.0001). Class III–IV limbs had a “good/poor” result 69.8% of the time, as compared to 51.9% of the limbs class I–II varicose veins (p = 0.002). Conclusions Advanced chronic venous disease (C3–C6) patients have larger diameter great saphenous veins, reflecting the progressive nature of the disease. Patients with more severe varicosities regardless of CEAP class were more likely to require a secondary procedure. The severity of the varicosities may not correlate with the degree of venous disease, but it is an indication of which patients should undergo secondary procedures, possibly with a one-stage approach.

scholarly journals A Case of Successful Iliofemoral Vein Stenting from Great Saphenous Vein Access

2018 ◽  
Vol 21 (6) ◽  
pp. E472-E475
Author(s):  
Hae Won Jung ◽  
Chul-Min Ahn ◽  
Young-Guk Ko
Keyword(s):  
Clinical Significance ◽  
Treatment Option ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Good Alternative ◽  
Iliac Vein ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Access ◽  
Successful Case

Chronic venous disease is strongly associated with morbidity and leads to considerable medical costs. Therefore, its clinical significance is very important. Currently, iliac vein stenting is the first treatment option for chronic venous disease due to iliac vein obstruction. For iliac vein stenting, ipsilateral femoral or popliteal vein access is common. However, great saphenous vein access may be a good alternative if there is obstruction in the ipsilateral femoropopliteal vein. Until now, there has been no reported case of successful iliac vein stenting using great saphenous vein access. We report the first successful case of iliofemoral vein stenting from great saphenous vein access.

scholarly journals Altered velocity gradient in lower limb chronic venous disease

2018 ◽  
Vol 34 (1) ◽  
pp. 17-24
Author(s):  
Sergio Gianesini ◽  
Francesco Sisini ◽  
Erica Menegatti ◽  
Giovanni Di Domenico ◽  
Mauro Gambaccini ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Velocity Gradient ◽  
Great Saphenous Vein ◽  
Venous Drainage ◽  
Chronic Venous Disease ◽  
Velocity Variation ◽  
Venous Disease ◽  
Group A ◽  
The One ◽  
Group B

Background In physiology, velocity of the deep venous compartment is higher than the one in the saphenous compartment which is higher than the one in the tributaries. Considering that velocity variation is associated with changes in the pressure gradient, aim of the present study is to assess changes in venous kinetics in case of superficial chronic venous disease, so to provide further clues in venous drainage direction determination. Methods Venous ultrasound scanning was performed on 40 lower limbs of 28 chronic venous disease patients (C2-6Ep,As,Pr). Velocities were measured in three different venous segments: great saphenous vein at 2 cm above the origin of the incompetent tributary (Group-A). great saphenous vein at 2 cm below the origin of tributary (Group-B). tributary at 2 cm from its origin from the great saphenous vein (Group-C.) Results Diastolic time average velocity was higher in group-C (−21.3 ± 8.5 cm/s) than in group-A (−15.7 ± 5.2 cm/s; p = .0001) and group-B (−11.1 ± 2.9 cm/s; p = .0001), thus indicating an inversion of the physiological velocity gradient in chronic venous disease patients. Discussion Chronic venous disease presents a subverted velocity gradient. These data introduce objective hemodynamics data, paving the way for further investigation in venous drainage direction determination.

A study to evaluate patterns of superficial venous reflux in patients with primary chronic venous disease

2014 ◽  
Vol 30 (7) ◽  
pp. 455-461 ◽  
Author(s):  
Mahim I Qureshi ◽  
Manj Gohel ◽  
Louise Wing ◽  
Andrew MacDonald ◽  
Chung S Lim ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Chronic Venous Disease ◽  
Duplex Ultrasonography ◽  
Venous Disease ◽  
Venous Reflux ◽  
History Of ◽  
Primary Chronic Venous Disease ◽  
Saphenofemoral Junction ◽  
Vein Reflux

Objective This study assessed patterns of superficial reflux in patients with primary chronic venous disease. Methods Retrospective review of all patient venous duplex ultrasonography reports at one institution between 2000 and 2009. Legs with secondary, deep or no superficial reflux were excluded. Results In total, 8654 limbs were scanned; 2559 legs from 2053 patients (mean age 52.3 years) were included for analysis. Great saphenous vein reflux predominated (68%), followed by combined great saphenous vein/small saphenous vein reflux (20%) and small saphenous vein reflux (7%). The majority of legs with competent saphenofemoral junction had below-knee great saphenous vein reflux (53%); incompetent saphenofemoral junction was associated with combined above and below-knee great saphenous vein reflux (72%). Isolated small saphenous vein reflux was associated with saphenopopliteal junction incompetence (61%), although the majority of all small saphenous vein reflux limbs had a competent saphenopopliteal junction (57%). Conclusion Superficial venous reflux does not necessarily originate from a saphenous junction. Large prospective studies with interval duplex ultrasonography are required to unravel the natural history of primary chronic venous disease.

scholarly journals Persistent below-knee great saphenous vein reflux after above-knee endovenous laser ablation with 1470-nm laser: a prospective study

2016 ◽  
Vol 15 (2) ◽  
pp. 113-119
Author(s):  
Walter Junior Boim de Araujo ◽  
Jorge Rufino Ribas Timi ◽  
Carlos Seme Nejm Junior ◽  
Fabiano Luiz Erzinger ◽  
Filipe Carlos Caron
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Test Group ◽  
Clinical Severity ◽  
Control Group ◽  
Venous Disease ◽  
Endovenous Laser Ablation ◽  
Venous Clinical Severity Score

Abstract Background In endovenous laser ablation (EVLA), the great saphenous vein (GSV) is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease. Objectives To evaluate clinical and duplex ultrasound (DUS) outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins. Methods Thirty-six patients (59 GSVs) were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS) and a test group (33 GSVs with below-knee reflux). Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS), and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months. Results Mean patient age was 45 years, and 31 patients were women (86.12%). VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month). However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year). Conclusions These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

Manual lymphatic drainage in chronic venous disease: A duplex ultrasound study

2013 ◽  
Vol 29 (10) ◽  
pp. 667-676 ◽  
Author(s):  
Rute Sofia dos Santos Crisóstomo ◽  
Miguel Sandu Candeias ◽  
Ana Margarida Martins Ribeiro ◽  
Catarina da Luz Belo Martins ◽  
Paulo AS Armada-da-Silva
Keyword(s):  
Blood Flow ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Lymphatic Drainage ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Flow Volume ◽  
Manual Lymphatic Drainage ◽  
Venous Flow

Objectives To compare the effect of call-up and reabsorption maneuvers of manual lymphatic drainage on blood flow in femoral vein and great saphenous vein in patients with chronic venous disease and healthy controls. Methods Forty-one subjects participated in this study (mean age: 42.68(15.23)), 23 with chronic venous disease (chronic venous disease group) with clinical classification C1–5 of clinical-etiological-anatomical-pathological (CEAP) and 18 healthy subjects (control group). Call-up and reabsorption maneuvers were randomly applied in the medial aspect of the thigh. The cross-sectional areas, as well as the peak and the mean blood flow velocity at femoral vein and great saphenous vein, were assessed by Duplex ultrasound at the baseline and during maneuvers. The venous flow volume changes were calculated. Results The venous flow volume in femoral vein and great saphenous vein increased during both manual lymphatic drainage maneuvers and in both groups ( P < 0.05). The two maneuvers had a similar effect on femoral vein and great saphenous vein hemodynamics, and in both the chronic venous disease and control groups. As a result of the call-up maneuver, the flow volume augmentations, as a result of call-up maneuver, decreased with the severity of chronic venous disease in those patients measured by the clinical classification of CEAP ( r = −0.64; P = 0.03). Conclusions Manual lymphatic drainage increases the venous blood flow in the lower extremity with a magnitude that is independent from the specific maneuver employed or the presence of chronic venous disease. Therefore, manual lymphatic drainage may be an alternative strategy for the treatment and prevention of venous stasis complications in chronic venous disease.

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