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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
“Varicose” veins are superficial veins that have enlarged and elongated, producing ropy, convoluted venous masses in the subdermal fat layer just under the skin surface, usually in the lower extremities. The saphenous veins are often implicated in forming complex varicosities. Hemorrhoids, scrotal varicoceles, and venous masses forming in the female labia can also be considered varicosities; varicosities may occasionally form over any part of the body. Insufficiency (reverse leakage) of venous valves is a frequent cause of leg varicosities. Varicose veins are usually patent, with blood flow bringing deep body warmth to the skin surface. Leg varicosities without thrombophlebitis may appear warm when engorged, but should flatten and have a reduced thermal appearance if the limb is raised above heart level. If clots form in a varicose vein, the resulting thrombophlebitis releases NO, causing the skin over the affected vein to appear warmer. Clotting in varicose veins may be induced therapeutically by intravenous injection of sclerosing agents; if successful, the vein no longer carries warm venous blood, becoming cooler. Because of their superficial location, thermography provides an excellent way to find, evaluate, map, and monitor treatment of varicose veins.
Chronic Venous Disease
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
What treatments do NICE recommend for varicose veins?“For people with confirmed varicose veins and truncal reflux, they should be offered endothermal ablation. If endothermal ablation is unsuitable, the patient should be offered ultrasound-guided foam sclerotherapy. If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery. If incompetent varicose tributaries are to be treated, consider treating them at the same time.”
Vascular Surgery
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Varicose veins are a clinical diagnosis, and investigations are used to rule out secondary causes (e.g. D-dimer for DVT, abdominal/pelvic USS looking for masses) if suggested by the clinical scenario. ABPI should be completed to exclude peripheral arterial disease before recommending compression hosiery.
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Pelvic Venous Disorders manifests in many clinical presentations. Pelvic Congestion Syndrome is a common condition occurring worldwide, in which a significant proportion of cases remain undiagnosed and symptoms reported by women are often underestimated, due to poor knowledge of the condition. It is an important cause of chronic pelvic pain in female patients. It can also present with superficial varicose veins as the only symptom as well as in combination with pain. Symptoms can be non-specific and difficult to distinguish from other diseases. Certain diagnosis of the PCS is very challenging, due to its multiformity. Determining which patients suffer from symptoms associated with PCS is hard, but also extremely important to implement appropriate and targeted treatment. Future randomised trials on embolisation management are needed. A common treatment algorithm for trials based on an understanding of the mechanisms leading to symptoms would be particularly helpful in objectively evaluating outcomes.
Analysis of the vein wall destruction under endovenous laser ablation in an ex vivo model
Published in Journal of Cosmetic and Laser Therapy, 2021
Natalia Ignatieva, Olga Zakharkina, Alexander Kurkov, Maxim Molchanov, Konstantin Mazayshvili
By histological analysis, control saphenous vein was characterized by three subsystems (tunica intima, tunica media, and tunica adventitia), and also their finer structure (Figure 1) The intima consisted of endothelium and a very thin subendothelial layer of a loose fibrous connective tissue. The media consisted of 2 layers of smooth muscle cells embedded in an extracellular matrix. The adventitia consisted of irregularly oriented bundles of loose connective tissue (Figure 1b,e). Vasa vasorum were traced from the adventitia through the outer part of the media to the inner part of the media. The extracellular matrix of connective tissue in the three subsystems of the vein wall was composed of collagen and elastic fibers mainly. Under polarized light, collagen exhibited birefringence (Figure 1c,f) resulting from both the anisotropy of molecules and the anisotropy inherent in the orderly arrangement of collagen fibers. Varicose vein demonstrated regional variability in wall thickness. As compared with the control specimen, some decrease in the amount of smooth muscle cells and thinning and loosening of collagen fibers were observed in the media; fibrosis was noted in the intima (Figure 1d). The amount of the elastic fibers decreased (Figure 1e).
What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches
Published in Acta Chirurgica Belgica, 2021
Emre Kubat, Celal Selçuk Ünal, Onur Geldi, Erdem Çetin, Aydın Keskin
Neovascularization, disease progression, recanalization, and technical or tactical errors have been blamed for the physiopathology of postoperative recurrent varicose veins [1]. In a study investigating the physiopathology of recurrent varicose veins, conventional surgery and endovenous treatment yielded a similar symptom rate of varicose veins, although the main cause of recurrence was different (neovascularization versus recanalization) [13]. In our study, surgical technique was the only factor which affected the recurrence rate at 1 year. Our findings showed that HLS, EVLA at 1,470 nm wavelength and RFA were similar recurrence rate of varicose vein treatment in patients with a GSV diameter of ≥10 mm. In addition, the efficacy of EVLA at 980 nm wavelength and CAC was statistically significantly lower than the other techniques. In addition, the occlusion rate of EVLA at 1,470 nm wavelength and RFA was statistically significantly higher than the other endovascular techniques. The most common cause of recurrence in endovascular techniques was recanalization in accordance with the literature [1,13].