Phlebology: The Journal of Venous Disease

To test the hypothesis that sapheno-femoral recurrence of varicose veins may be prevented by containment of neovascularization.

Prospective minimum 4-year follow-up by surgical exploration and morphological examination of recurrent vessels in all limbs with clinical or phlebographic evidence of sapheno-femoral recurrence.

Varicose vein clinic of a teaching hospital.

Sapheno-femoral ligation and multiple ligation (group 1); sapheno-femoral ligation, interposition of cribriform fascia and multiple ligation (group 2); sapheno-femoral ligation, interposition of artificial implant and stripping (group 3).

Incidence of sapheno-femoral recurrence.

The incidence of sapheno-femoral recurrence through neovascularization was lower (p < 0.001) in groups 2 and 3 after containment of neovascularization at the sapheno-femoral junction by cribriform fascia or artificial implant than in group 1 after ligation alone (3% and 1% vs 25%, respectively). The incidence of recurrent or persistent varices distal to the groin was lower (p < 0.001) after stripping (group 3, 57%) than after multiple ligation (group 1, 93%; group 2, 81%).

Sapheno-femoral ligation, interposition of cribriform fascia or artificial implant at the sapheno-femoral junction, and stripping is a more effective treatment of varicose veins than sapheno-femoral ligation and multiple ligation.

Recurrence is common after varicose vein surgery. Neovascularization may be one cause of recurrent veins. This was a study of PTFE patch saphenoplasty to try and prevent recurrent veins.

Prospective cohort study of patients treated in a vascular surgical unit.

Fifty patients having surgery for symptomatic long saphenous varicose veins (66 legs, 51 primary and 15 recurrent veins) had a PTFE patch sutured over the saphenous opening after flush saphenofemoral ligation.

The rate of varicose vein recurrence and neovascularization 1 year after surgery were determined using clinical examination and venous duplex imaging.

Forty patients (80%) remained pleased with the results of their surgery. Recurrent veins were visible in 14 (21%) legs: 10 were principally due to neovascularization, two to sapheno-popliteal incompetence and two to an incompetent mid-thigh perforating vein. Three other legs had neovascularization but no recurrent veins. Both recurrent veins (47% versus 14%) and neovascularization (40% versus 14%) were significantly more common in patients having surgery for recurrent veins.

PTFE patching was safe but did not abolish neovascularization. Neovascularization was the principal cause of recurrent veins in this study and perseverance with investigations into other barrier methods is worthwhile.

To employ standardized techniques to measure and characterize the pain associated with leg ulcers of defined causes.

Patients attending leg ulcer clinics were interviewed by one research nurse using a structured questionnaire. Ulcers were classified as venous, arterial or mixed depending on the clinical assessment and ankle–brachial systolic pressure index. Pain was assessed objectively using two validated instruments for scoring pain: a verbal rating scale and a pain-intensity visual analogue scale. The significance of the observations was tested using either the Mann-Whitney U-test (unpaired observations) or the Wilcoxon signed-rank test (paired observations). A profile of the quality of pain was obtained using the short-form McGill Pain Questionnaire (SF-MPQ). Quality of life was assessed using the COOP Chart System.

We assessed 38 patients with venous ulcers, three patients with mixed arterial/venous ulceration and 10 patients with arterial disease.

Pain scores on verbal rating scales and visual analogue scales.

Venous leg ulcers are painful. Although pain scores are greater in arterial ulcers, most patients with venous ulceration suffer at least moderate pain. Night pain disturbed sleep in 73% of all patients and pain affected mood in more than 50%. Dressing changes exacerbated pain.

Pain reduces the quality of life in most patients with leg ulcers. Pain control is an essential consideration in all patients with leg ulcers.

To compare healing rates and associated treatment costs of four-layer high-compression bandaging (HCB) and conventional management (CM), as available on FP10, in the treatment of venous leg ulcers.

Randomized prospective study in which patients were allocated to one of two treatment groups.

Hospital-based leg ulcer service and community.

Thirty-six patients presenting with venous leg ulcers (30 compilers): 16 patients (nine female) in the HCB group and 14 patients (10 female) in the CM group.

A 12-week treatment period with either a four-layer HCB regime or CM.

The significance of the difference between the number of ulcers healed, and associated treatment costs, was investigated using the Mann–Whitney U-test and survival analysis.

Four-layer HCB achieves a significantly (p = 0.003) higher healing rate of ulcers (75% of patients versus 21%) over a 12-week period. Weekly treatment costs for the four-layer therapy was significantly less than that of CM (mean difference in cost = £6.45, 95% CI = £1.22–11.68; p = 0.042).

It is more efficacious and economical for nurse specialists to treat patients presenting with leg ulcers with a four-layer HCB regime than for district nurses to carry out the standard palliative treatments available on GP prescription form FP10.

To evaluate the pressure under short-stretch and elastic bandages.

Prospective study in 20 healthy volunteers, comparing the two different kinds of bandages.

Department of Surgery, Aichi Prefectural College of Nursing, Nagoya, Japan.

Pressure measurements were made beneath the bandages with different initial pressures of 10, 20, 30, 40, 50, 60, and 70 mmHg, during supine resting, standing, tip-toe exercise and walking.

Short-stretch bandages showed a significant increase in pressure during standing and exercise at lower initial pressures compared with elastic bandages. In analysing the pressure waveform during tip-toe exercise and walking, a significantly greater pressure difference between muscle contraction and relaxation was noted for short-stretch bandages compared with elastic bandages at any initial pressures.

Short-stretch bandages produce a higher working pressure and a larger pressure difference during exercise. However, the effect depends on the initial pressures at the time of application. In clinical practice, prevention of a decrease in pressure with time and uniform application of bandages are important.

To study the histological changes in varicosities after injection of 5% ethanolamine.

A prospective study in nine groups of six patients awaiting bilateral varicose vein surgery.

Each patient had a below-knee incompetent perforating vein injected with either 0.5, 1.0 or 2.0 ml 5% ethanolamine. The contralateral varicosity received a similar volume of normal saline.

The patients wore elasticated stockings until admitted for operation at 2, 4 or 8 weeks after the injections. The injected varicosity was then dissected out.

Each vein was reported on by a histologist who did not know which had received ethanolamine or saline. The histologist graded each vein according to the severity of change from 0 (no effect) to 5 (total obliteration of vein).

Ethanolamine at 0.5, 1.0 and 2.0 ml caused extensive histological damage to the varicosity. After 8 weeks most varicosities had been destroyed.

Ethanolamine, unlike sodium tetradecyl sulphate, causes complete destruction of a varicosity. A dose of 0.5 ml is just as effective as 2.0 ml.

The aim of this study was to determine whether an increased body mass index should influence the choice of continuous-wave Doppler probe frequency in the clinical assessment of patients with varicose veins.

Prospective assessment of the effect of raised body mass index on the accuracy of clinical assessment of venous reflux using 4 and 8 MHz Doppler probes compared with duplex scanning.

The ultrasound department of a university teaching hospital.

Seventy-two patients with symptomatic primary varicose veins (108 limbs), who had not undergone previous injection sclerotherapy or surgical treatment.

Measurement of body mass index and assessment of reflux with hand-held Doppler using 4 and 8 MHz probes immediately followed by duplex scanning.

There was no significant difference between the 4 and 8 MHz Doppler probes in the accuracy of detection of reflux at the sapheno-femoral junction, in the long saphenous vein or at the sapheno-popliteal junction in the whole patient group or in the obese subgroup.

Body mass index should not influence the choice of probe frequency (between 4 and 8 MHz) in the clinical assessment of patients with primary previously untreated varicose veins.

To report a case of neonatal renal vein thrombosis diagnosed by duplex scan and treated successfully with intravenous heparin.

Case report.

Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain.

Conservative treatment with short-term intravenous heparin.

Colour Doppler imaging rapidly assesses flow within the renal veins and inferior vena cava, and should be used as the first line of investigation in evaluating venous thrombosis in the neonatal period. In view of the few reports in the literature assessing the different therapeutic modalities of this entity, we advocate short-term anticoagulation in unilateral renal vein thrombosis in the newborn.