Investigations for identifying and treating iliac venous stenosis

Seshadri RAJU, MD, FACS; The RANE Center for Venous & Lymphatic Diseases, Jackson, Mississippi, USA Abstract Iliac vein stenosis is a commonly present lesion in the general population that remains silent in the majority of individuals. It is, however, a permissive lesion that becomes symptomatic if homeostasis is upset by secondary insults such as trauma, infection, thrombosis, or onset of additional pathology. Duplex ultrasound is useful to rule out acute deep venous thrombosis (DVT), identify associated reflux, and exclude other relatively rare nonstenotic venous pathology such as tumor compression, arteriovenous (A-V) fistula, etc. Iliac vein stenosis is best graded on…

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May-Thurner diagnosis and management

Romulo ARMENTA-FLORES, MD; Cardiothoracic and Vascular Surgery of Central Mexico Abstract May-Thurner syndrome, known for decades as a unique pathology, has been included recently with other pelvic compression maladies in the S-V-P CEAP (symptoms-varicespathophysiology, clinical-etiology-anatomy-pathophysiology) classification sponsored by the American Venous and Lymphatic Society as part of several anatomic lesions in the abdominopelvic region that have variable clinical presentations. This classification will fully characterize and accurately describe a particular lesion; also, it will facilitate clinical interaction and precise treatment and in the long term the development of patient-reported outcome measures and clinical trials. In the interim, epidemiologic data reported so…

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Update on calf vein thrombosis

Pier Luigi ANTIGNANI, MD, PhD, FIUA, MRSM, DFAVF, FESVM, EFACP; President of the International Union of Angiology; Director, Vascular Center, Nuova Villa Claudia, Rome, Italy Abstract Calf deep vein thrombosis, defined as thrombosis confined to the calf veins of the lower limbs, is a frequent finding in symptomatic outpatients and inpatients when the ultrasound examination is extended to the deep veins of the whole leg. The prevalence of the disease is between 5% and 33% of all deep vein thrombosis (DVT) cases detected by ultrasound, low in symptomatic patients and higher in asymptomatic patients at high risk of DVT. Thrombi…

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Phlebolymphedema: an up-to-date review

Jorge H. ULLOA,1 MD, FACS; Sebastian CIFUENTES,2 MD; Valentin FIGUEROA,2 MD; Emelyn Van UDEN,2 MD; Javier A. BRAVO,2 MD; Miguel AMORE,3 MD; Jairo RAMÍREZ,1 MD, FACS 1Vascular Surgery Department, Fundación Santa Fe de Bogotá University Hospital; Universidad de los Andes Medical School. Bogotá, Colombia; 2Universidad de los Andes Medical School, Fundación Santa Fe de Bogotá University Hospital. Bogotá, Colombia; 3Vascular Surgery Department, Fundación Favaloro, Buenos Aires, Argentina Abstract Phlebolymphedema is a vascular condition in which there is damage of the venous and lymphatic systems in the lower limbs. It is secondary to chronic venous insufficiency, which results in venous hypertension…

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The transosseous perforator veins of the knee

Jean-François UHL,1 MD; Marios VALSAMIS,2 MD; Claude GILLOT,3 MD 1Research Director, UNESCO Chair of Digital Anatomy – Paris University, Paris, France 2Phlebologist & Surgeon (private practice), Athens, Greece 3Laboratory of Anatomy – Paris University, Paris, France Abstract The perforator veins (PVs) of the knee can be responsible for reticular veins, telangiectases, and varicosities around the knee, but they are frequently underdiagnosed and missed by the phlebologists and the sonographers because of their tiny size. These PVs are frequently located around the patella and connected with transosseous perforators, well-demonstrated in the anatomical part of this work. This could explain why sclerotherapy…

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VEIN STEP: Chronic VEnous dIsorders maNagement and Treatment Effectiveness Evaluation in Chronic Venous Disease, an International Observational Prospective Study. Results from Morocco

Tazi Mezalek ZOUBIDA, MD1,2 Jorge Hernando ULLOA, MD, FACS3 1Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; 2Clinical Hematology Department, Ibn Sina University Hospital, Rabat, Morocco; 3Fundacion Santa Fe de Bogota, Bogota, Colombia Abstract Aim: VEIN STEP is an international, observational, prospective study assessing the effectiveness of conservative treatments for the relief of chronic venous disease (CVD) symptoms and their impact on quality of life (QOL). This article presents results collected in Moroccan patients. Method: Adult outpatients consulting for symptomatic CVD were categorized via the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification system. Intensity of symptoms and their improvement…

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Iliac vein compression: undervalued or overestimated?

Marc Emmanuel VUYLSTEKE, MD, PhD Vascular Surgeon & Head of Surgical Department, Sint-Andriesziekenhuis, Tielt, Belgium; Visiting professor, Department of Cardiovascular Science, University of Leuven, Belgium Abstract Iliac vein compression (IVC) is a common anatomic disorder affecting more than 20% of the adult population, especially young females. Most of those patients are asymptomatic. Some of them will develop symptoms in their left leg, such as swelling, pain, and heaviness. But progression to venous claudication, skin changes, and even venous ulceration is possible. Intolerance to exercise is an undervalued symptom. The most feared complication is the development of a deep venous thrombosis…

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Micronized purified flavonoid fraction in adjunction to rivaroxaban improves outcomes of popliteal-femoral deep-vein thrombosis at 12-month follow-up

Kirill LOBASTOV,1 MD, PhD; Ilya SCHASTLIVTSEV,1,2 MD, PhD; Victor BARINOV,2 MD, PhD 1Pirogov Russian National Research Medical University, Moscow, Russian Federation; 2Clinical Hospital no.1 of the President’s Administration of the Russian Federation Abstract Aim: To assess the efficacy of the long-term use of micronized purified flavonoid fraction (MPFF) in the treatment of popliteal-femoral deep-vein thrombosis (DVT). Methods: In this pilot, comparative, open-label clinical study, patients with the first episode of popliteal-femoral DVT confirmed by duplex ultrasound scan (DUS) were allocated to two groups: the control group received standard treatment with rivaroxaban for 6 months and compression stockings for 12 months,…

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Influence of age, gender, duration of illness, and symptoms on pigmentation/ulceration in varicose veins of the great saphenous system

Prasesh DHAKAL, MBBS; Robin Man KARMACHARYA, MS; Satish VAIDYA, MS; Amit Kumar SINGH, MS; Pratima THAPA, MBBS; Sushil DAHAL, MBBS; Niroj BHANDARI; Sohail BADE; Prabha SHRESTHA, MSN. Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal Abstract Background: Venous pigmentation and ulceration in varicose veins pose significant financial and psychological burdens and affect quality of life. Not all varicose veins progress to this stage (C4-C6 in CEAP classification), and knowing the predictors for progressing to pigmentation/ulceration in varicose veins helps address high-risk patients early on. Materials and methods: This is a retrospective observational study done in patients diagnosed with…

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Combination therapy in the treatment of varices

Nicholas H. OSBORNE MD, MS1*; Craig BROWN MD, MS1; Christopher O. AUDU MD, PhD1; Danielle C. SUTZKO MD, MS2; Andrea T. OBI MD1; Thomas W. WAKEFIELD MD1 1Section of Vascular Surgery, Department of Surgery, Michigan Medicine; 2Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham Abstract Background: There is significant variation in the treatment of combined truncal-vein reflux and symptomatic varicosities. We sought to use the Vascular Quality Initiative (VQI) Varicose Vein Registry (VVR) to explore the contemporary real-world experience of combined ablation and phlebectomy versus ablation alone. Methods: Using the VQI/VVR database, patients…

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