Phlebology: The Journal of Venous Disease

The main objective of this study was to investigate the efficacy of complex decongestive therapy in patients with chronic venous insufficiency. Secondly, the suitability of manual lymphatic drainage, bandaging, and sequential pneumatic compression therapy – as key compression modalities of complex decongestive therapy – was examined.

A search strategy was conducted in the Medline and Web of Knowledge electronic databases. The terms “chronic venous insufficiency”, “chronic venous disease”, “varicose veins”, “kinesio taping”, “pneumatic compression”, “multilayer bandage”, “manual lymphatic drainage”, and “complex decongestive therapy” were combined with of the Boolean Operators “OR” and “AND”.

Ten articles exploring the efficacy of complex decongestive therapy in patients with chronic venous insufficiency were retrieved. The efficacy of the treatment and also the effectiveness of each of the maneuvers that make up the complex decongestive therapy studied separately as investigated.

Two researchers extracted the data from each study independently and cross-checked the results to eliminate any errors. The characteristics of each study were collected, including participants, demographic characteristics, intervention measures and performance, and study design.

manual lymphatic drainage treatment decreased the venous reflux, edema, clinical severity, symptoms, and quality of life. Kinesio taping improved peripheral venous flow, ankle function, edema, pain, quality of life, venous symptoms, venous severity disease, and mental health. Sequential pneumatic compression increased venous blood flow and quality of life, while complex decongestive therapy reduced limb volume and pain intensity and improved activities of daily living.

The combined use of these techniques is proposed in the symptomatic treatment of VI, just as they are used in the treatment of lymphedema. However, further studies are needed to effectively assess CDT and define its treatment parameters.

Paradoxical reflux, which is most commonly seen in the Giacomini vein, is also referred to as Rollercoaster reflux (RCR). RCR is a rare phenomenon, infrequently reported in literature and lacking standardized treatments. The aim of this study was to describe the incidence, treatment variation, and outcomes of RCR in a high-volume centre, specialized in skin and venous disease.

All patients suspected of venous incompetence who presented at Skin and Vein Clinic Oosterwal between July 2022 and July 2023 were retrospectively screened to determine if they had RCR. All eligible patients were invited to participate in the cohort study, regardless of treatment or treatment type (ultrasound-guided foam sclerotherapy [UGFS], endovenous thermal ablation [EVTA], or compression therapy). A duplex-ultrasound was performed and the VEINES-QoL/Sym questionnaire was completed. The primary outcomes were RCR incidence and type of RCR. Secondary outcomes were assessed at 1-year follow-up and included anatomical success rates, complications, quality of life (QoL) and patient-satisfaction scores.

The incidence of RCR was 1.1% (62/5.718 patients). Fifty-one limbs of 50 patients were included. Anatomical success after 1 year was 73.3% for limbs treated with UGFS and 96.6% for limbs treated with EVTA. The most common complication for UGFS was hyperpigmentation (40.0%) and for EVTA was nerve injury (10.3%). QoL improved across all treatment groups and there were no significant differences in patient satisfaction scores.

RCR is a rare phenomenon occurring in only 1.1% of patients suspected of venous incompetence. Although EVTA had a higher anatomical success rate compared to UGFS for the treatment of RCR, QoL improved across all treatment groups.

Lipedema is a chronic and progressive adipose tissue disorder that predominantly affects women. However, despite its high prevalence and severe negative impact on quality of life, it remains significantly underdiagnosed. The aim of this study was to assess the knowledge and awareness of medical doctors in Turkey regarding lipedema.

A cross-sectional study was conducted among 508 medical doctors working in different clinical specialties in Turkey. A questionnaire was designed and validated by a panel of physical medicine and rehabilitation specialists. A total of 22 questions were asked to assess physicians’ age, specialty, clinical experience, and institutional characteristics, as well as their knowledge of the clinical features, diagnostic criteria, and treatment modalities of lipedema.

47.6% of the physicians were between 31 and 40 years of age. 29.3% of the participants had been practicing medicine for 0-5 years. 51% were familiar with the term “lipedema”, but only 29.9% had seen or referred patients with lipedema. 51.4% of the participants answered “no idea” when asked about the lipoedema clinic and 50.9% answered “no idea” when asked about lipoedema treatment.

This study identifies significant gaps in medical professionals’ knowledge and awareness of lipedema in Turkey. The findings emphasize the necessity to incorporate lipedema-specific content in medical education and continuing professional development programs. Moreover, the establishment of multidisciplinary models of care, the dissemination of standardized clinical guidelines, and the promotion of public awareness campaigns are imperative to enhance early recognition and effective management of lipedema, which is often overlooked.

The community prevalence of chronic venous insufficiency is high while complication rates of untreated varicose veins are relatively low. This prevalence / severity disparity leads to large numbers of patients awaiting routine clinic appointments for evaluation of their venous disease. Virtual consultations may partially alleviate this issue. We aimed to determine whether there was in difference in patient outcomes between those seen in a traditional ‘face-to-face’ clinic model compared to those consulted remotely by telephone.

A prospective multi-site cohort study involved random allocation of six hundred ‘non-urgent’ referrals to virtual or face to face appointments for initial consultation regarding varicose veins.

Initial virtual consultations for varicose veins were as effective as face-to-face consultations with respect to patient consultation outcomes. Similar proportions, about one-third, of face-to-face and virtual patients opted for surgical intervention (p = .726), compression hosiery (p = .17) or surveillance (p = .296). Factors including pain, phlebitis, ulcers and leg swelling may influence patients’ willingness to utilise virtual consultations.

Virtual consultations provided an equally effective method of delivering initial consultations for varicose veins while facilitating patients for whom travelling long distances poses a challenge.

This study examines the role of the inguinal lymph node venous network (LNVN) in recurrent varicose veins.

Seventy-five patients with recurrent varicose veins were assessed using color Doppler ultrasound and dynamic lymph node venography. Primary outcomes included LNVN reflux identification, and secondary outcomes analyzed recurrence rates and associations with venous pathology.

LNVN involvement was detected in 41.3% of cases, significantly correlating with shorter recurrence-free intervals (median: 8 months vs 12 months, p = 0.04). Coexisting risk factors included neovascularization (18.2%), incomplete treatment (25%), and inadequate surgical technique (13.6%).

LNVN reflux is a significant contributor to varicose vein recurrence, with distinct imaging features that should be integrated into routine diagnostic protocols. Further research is needed to establish standardized diagnostic criteria and optimize management strategies.

The aim of this study is to present our results with an innovative extracorporeal thermal therapy using High Intensity Focused Ultrasound (HIFU) to treat Superficial Venous Insufficiency (SVI).

Observational retrospective study with prospective data collection.

A total of 102 consecutive patients were included. All types of incompetent veins that met the HIFU-device criteria were treated. The primary endpoint of our analysis was vein occlusion rate. As secondary endpoints, shrinkage, absence of reflux, clinical improvement and complications related to the treatment were analyzed. Clinical and Ultrasound (US) follow-up was planned at 15 days, 3 months, 6 months, and 12 months. For clinical assessment, simplify CEAP classification and Venous Clinical Severity Score (VCSS) were registered.

A total of 164 veins were treated: 92 saphenous trunks [65 Great Saphenous Veins (GSV), 15 Short Saphenous Veins (SSV), 12 Anterior Accessory Saphenous Veins (AASV)], 48 perforator veins and 24 other veins (15 tributaries, 4 Giacomini veins, 5 neovascularizations). For all types of veins, occlusion rates were 85% to 96% at early follow-up and from 85% to 90% twelve months after the treatment. Regarding reflux-free rate, it ranged from 85% to 96% 2 weeks after treatment, and from 85% to 93% at twelve months. Finally, shrinkage rates ranged from 96% to 97% 2 weeks after the treatment, and from 94% to 97% at twelve months. All patients showed statistically significant clinical improvement in VCSS and CEAP classification trough the different follow-ups. No major adverse events were observed.

Treatment of varicose veins with the HIFU therapy seems to be competitive with the state-of-the-art techniques and has shown to be effective and safe in our initial 102 patients’ data analysis. Nevertheless, further studies are needed for stronger evidence.

Venous leg ulcers (VLUs) affect approximately 1% of the adult population and incur significant morbidity and healthcare costs. Endovenous interventions, such as endovenous laser ablation (EVLA) and ultrasound-guided foam sclerotherapy (UGFS), have shown benefits in treating venous insufficiency in patients with VLUs. However, the effect of specifically targeting the sub-ulcer venous plexus with foam sclerotherapy remains poorly understood.

The FINNULCER trial is investigating the addition of sub-ulcer foam sclerotherapy to conventional endovenous treatment (EVLA + UGFS) for managing superficial venous insufficiency in patients with VLUs. The primary aim is to evaluate the effect of sub-ulcer foam sclerotherapy in promoting ulcer healing.

Patients with VLUs are being screened at four vascular surgery units in Finland. Eligible participants who provide informed consent are randomized into the study group to receive sub-ulcer foam sclerotherapy + EVLA + UGFS or into the control group to receive EVLA + UGFS. The primary outcome is the time to ulcer healing during 1 year of follow-up from randomization. Secondary outcomes include quality of life assessments and procedure-related outcomes.

ClinicalTrials.gov (NCT04737941).

Enlarged forehead veins are common, with the supratrochlear vein being a frequent patient concern. Given the potential morbidity of sclerotherapy and phlebectomy, endovenous laser ablation (EVLA) may be a viable treatment option.

We present a patient with an enlarged right supratrochlear forehead vein treated with a single session of 1320 nm EVLA.

Clinical eradication was demonstrated at 3 months posttreatment with only self-limited edema and delayed ecchymosis.

Pilot preliminary evidence demonstrates that EVLA of the supratrochlear vein has a high benefit-to-risk ratio.