Compliance with compression therapy in primary chronic venous disease: Results from a tropical country

Objectives To describe compliance rates of compression therapy in a cohort of patients with chronic venous disease and also to describe frequent causes of non-compliance. Methods A total of 889 patients with primary chronic venous disease were prescribed compression therapy after being evaluated by vascular surgeons. Subjects had a first visit during which time compression therapy was prescribed in addition to a follow-up visit. Strength of compression, type, prescription duration, and reasons of non-compliance were queried at follow-up. Results Only 31.8% of the patients reported wearing compression therapy as prescribed, 31.4% reported wearing compression most days, 28.3% reported wearing compression intermittently, and 8.5% of the patients reported not wearing compression at all. The main reasons of non-compliance were: uncomfortable (49.4%), too difficult to put on (34.5%), skin problems (itching) (21.5%), and unattractive (19.8%). Conclusions Compliance with compression therapy in chronic venous disease is still a subject of concern as most patients are not using compression therapy as prescribed.

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

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.

Risk factors for superficial vein thrombosis in patients with primary chronic venous disease

Background: Primary chronic venous disease (CVD) is associated with an increased risk of superficial vein thrombosis (SVT). While CVD is a predominant factor in SVT, there is a range of additional predisposing factors. The objective was to investigate the association between age, gender, BMI, smoking, oestrogen hormone therapy, family history of venous thromboembolism (VTE) and CEAP clinical classification in patients with CVD and a history of SVT. Patients and methods: In a retrospective observational study on consecutive patients with primary CVD, 641 outpatients were enrolled (152 men, 23.7 %; 489 women, 76.3 %). The prevalence of SVT was evaluated according to age, BMI, smoking, presence of family history of VTE, use of hormone therapy, and clinical class of CVD. Results: Risk of SVT was significantly increased in women (OR 1.68, 95 % CI = 1.02 - 2.76; p = 0.041), older patients (46 - 69 years, OR 1.57, 95% CI = 1.03 - 2.4; p = 0.036, ≥ 70 years, OR 2.93, 95 % CI = 1.5 - 5.76; p = 0.001), smokers (OR 1.69, 95 % CI = 1.1 - 2.58; p = 0.015) and in persons with first-degree siblings diagnosed with VTE (OR 2,28, 95 % CI = 1.28 - 4.05; p = 0.004). The risk was significantly increased in older male smokers (p - 0.042). In women, smoking and oestrogen therapy (p = 0.495) did not increase the risk of SVT even older women or in those with increased BMI. In CVD (C0 - C3), a history of episodes of SVT was found in 103/550 (18.7 %), in chronic venous insufficiency (CVI) in 27/91 (29.7 %). There was a significantly higher prevalence of SVT in patients with CVI (OR 1.70, 95% CI = 1.1 - 2.5; p = 0.016). Conclusions: In patients with primary CVD, SVT was significantly associated with female gender. In men, older age, smoking and positive family history of VTE were relevant SVT risk factors. In women, risk factors were older age, BMI ≥ 25 kg/m2 and positive family history of VTE. Compared with C0 - C3 clinical classes, CVI significantly increases the risk of SVT.

Serum homocysteine is associated with the severity of primary chronic venous disease

Objective This study was conducted to assess whether serum homocysteine concentration was associated with the severity of primary chronic venous disease. Design Cross-sectional study. Methods A total of 282 primary chronic venous disease patients were enrolled from outpatient vascular services. The severity of venous disease was graded using the Clinical Etiology Anatomy Pathophysiology classification system. The association of serum homocysteine concentration with advanced primary chronic venous disease (C4-6) was assessed using the Mann Whitney U test and logistic regression analysis. Results Median (interquartile range) serum homocysteine concentrations were 9.10 µM (7.55–10.75) and 10.40 µM (8.85–13.10) in patients with primary chronic venous disease classified by C1-3 (n = 209) and C4-6 (n = 73) grades, respectively, p < 0.001. Serum homocysteine concentration was positively associated with clinical grade 4–6 after adjusting for other risk factors including age, diabetes, male sex, hypertension, recurrent varicose veins and stroke. Patients with serum homocysteine in the third (odds ratio, 2.76, 95% confidence interval, 1.01–7.54) and fourth (odds ratio 3.29, 95% confidence interval 1.15–9.43) quartiles were more likely to have grade C4-6 chronic venous disease than subjects with serum homocysteine in the first quartile. Conclusions Serum homocysteine is positively associated with the severity of primary chronic venous disease and therefore could play a role in promoting chronic venous disease complications.

Sclerofoam assisted laser therapy for saphenous refluxes: an innovative tumescence-free technique

Endovenous laser (EL) and radiofrequency devices have continuously increased their appealing in the last decade. Even if miniinvasive, such procedure still requires multiple high volume injections of tumescent anesthesia: a medical act that is not totally complications- free. Aim of the present investigation is to evaluate the feasibility of a hybrid technique (so called sclerofoam assisted laser therapy, SFALT) combining foam sclerotherapy (FS) and EL in a tumescence free approach. Fourty primary chronic venous disease patients (8 males, 32 females, C2-4EpAsPr) presenting a sapheno-femoral reflux both at the Valsalva and compression/relaxation maneuver underwent a SFALT procedure. Diameters were measured at mid-thigh in supine. It consists in a EL fiber introduction into the great saphenous vein (GSV), shrinking it for a single cm at 200 J/cm. After a shrunk plug is created, keeping the fiber stuck in it, 5 cc of foam sclerotherapy [Tessari method, 1% polidocanol (POL) or 1% sodium tetradecyl sulfate (STS)] are injected through the same 6 Fr EL introducer. The consequent spasm allows a following EL mediated shrinkage by means of a significantly reduced fluence. Clinical and sonographic follow up were performed at one and three weeks. At 3 weeks follow up all the 40 cases presented a shrunk GSV, without recanalization signs. Neither major nor minor complications were reported. At the mid-thigh the standing GSV caliber decreased from a preoperative mean value of 0.6±0.2 cm to a post FS injection 0.3±0.1 cm value (P&lt;0.05), showing no statistical difference among STS and POL. SFALT approach is feasible, safe and with potentially interesting outcomes. More investigations are needed in order to define the proper fluence parameters and the chance of eliminating the even mild sedation. This technique offers the chance of a possible tumescence free GSV treatment, even in case of major calibers vessels.

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

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.