Retrospective study on 56 patients (24 males, 32 females) with chronic venous insufficiency of the lower limbs that CEAP classification from 2 to 5 degree. Most of them got a job needed long standing as textile employee, teacher. 58.9% had been dissected by ligation the venous tranks with stripping them, 25% had been Muller operation alone for other branches. Good result was 92%, complications was not serious, the rate of damage of tranks neuvous was 7,2% in internal ankle area - To reduce the treatment of internal medicine
Venous Insufficiency ; Lower Extremity ; Disease ; Therapeutics ; surgery

OBJECTIVETo analyze anatomy data of popliteal veins (PV), with the purpose of selection of popliteal venous valves construction segment via venography, and to evaluate the surgical results.

METHODSFrom February 1998 to November 2010, after analyzing the popliteal vessel anatomy data of 39 limbs and related phlebography research of 862 cases, 102 patients (69 male and 33 female patients, aged from 48 to 71 years, mean 59 years) with severe deep venous insufficiency were selected for popliteal venous valve construction procedures. Doppler ultrasound, continuous dynamic venography, and intraoperative venous pressure measurements were used to assess the hemodynamic changes pre- and postoperatively. Venous clinical severity score (VCSS) were used to evaluate long-term results of deep venous valve construction procedures.

RESULTIn the 102 patients, 93.7% patients had one pair of valves in popliteal vein (PV), locating in the distal 1/3 segment of PV, with gastrocnemius veins (GV) joining with PV above PV valves. Postoperative blood flow volume of the PV was significantly higher than the preoperative volume (732.3 ml/min vs. 150.2 ml/min, t = 8.979, P < 0.001). The proximal pressure was significantly lower than the distal pressure ((12 ± 3) cm H(2)O vs. (15 ± 3) cm H(2)O, 1 cm H(2)O = 0.098 kPa, t = 8.049, P < 0.001). VCSS score was significantly lower after the surgery ((34 ± 15) cm H(2)O vs. (41 ± 14) cm H(2)O, t = 59.780, P < 0.001). Pre- and postoperative hemodynamic changes and VCSS scores were statistically significant (9.3 ± 1.9 vs. 1.8 ± 1.0, t = 59.780, P < 0.001). Mean follow-up were 8.9 years with an ulcer recovery rate of 96.3%, and a 3.7% ulcer recurrent rate.

CONCLUSIONSPopliteal vessel anatomy study and venography research provide critical information for the PV valve construction part selection, which stayed proximal to the communications of GV and PV. Restoration of gastrocnemius pump function and satisfactory long-term efficacy are received after valve construction.

Aged ; Female ; Hemodynamics ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Popliteal Vein ; anatomy & histology ; surgery ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery ; Venous Valves ; surgery

OBJECTIVETo study the role and curative effect of encircling construction of the popliteal vein and ligation of the profunda femoral vein (PFV) to treat profunda femoral vein insufficiency (PFVI).

METHODSThirty-four patients were diagnosed as having PFVI through phlebography and color ultrasound system. (CEAP clinical scale: C(4) 31, C(5) 1, C(6) 2). The forms of the profunda femoral veins (PFV) were Raju grouping, type II: 22, type III: 10, type IV: 2. Thirty-two patients' popliteal veins were annularly constructed in the distal communication of the PFV and the popliteal vein, and in the abouchement of gastrocnemius vein into the popliteal vein. The other two PFV trunks were ligated at the communication of PFV trunk and the popliteal vein.

RESULTSThirty-one patients (91.1%), 4, 6-year follow-up in average, threw off their aching pain in the leg. Pigmentation from the ankle to the middle of the leg subsided; the ulcers were healed and did not relapse. The postoperative ambulatory venous pressure detected was distinguishable from the preoperative data (P < 0.01), venous pressure recovery time > 22 seconds. A standing position (60 degrees from the vertical) is used in the postoperative phlebography. And the development time of the contrast media reaching the superior margin of patellar level, together with the regurgitation volume per minute of the popliteal vein detected through color ultrasound system in a standing position, was recorded. The patients' physical status had been greatly improved after the surgery (P < 0.01).

CONCLUSIONSThe back flow caused by PFVI has a deep impact on the hemodynamics of the lower limb. In the popliteal fossa, it is operable and effective to use encircling construction of popliteal vein and the ligation of the PFV to treat PFVI.

Aged ; Female ; Femoral Vein ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery

OBJECTIVE: To observe the effect of subfascial endoscopic perforator vein surgery (SEPS) in the treatment of chronic venous ulceration of the legs. METHODS: Chronic venous ulceration for 91 patients with 102 limbs was treated by SEPS from January 2005 to July 2008. The effect of SEPS on chronic venous ulceration of the leg, the symptoms during and after the operation, and the durations of hospital treatment were analyzed. RESULTS: The symptoms of the 102 legs conducted by SEPS operation, except the pigmentation, were obviously improved (P<0.01). Its cicatrisation rate, the recrudesce rate, and the cut infection rate were 93.1%, 1.96%, and 1.0%, respectively. The time of the operation was short and the hemorrhage was small during the surgery. The durations of hospitalization and the cicatrisation time of ulceration were (6.5+/-3.4) d and (12.2+/-13.7) d, respectively. CONCLUSION SEPS is simple and effective in treating chronic venous ulceration of the leg, and particularly effective for patients classified into C5 and C6 in clinical-etiological-anatomical-pathophysiology (CEAP).
Aged ; Angioscopy ; methods ; Fasciotomy ; Female ; Humans ; Male ; Middle Aged ; Varicose Ulcer ; surgery ; Varicose Veins ; surgery ; Vascular Surgical Procedures ; Venous Insufficiency ; complications ; surgery

OBJECTIVE: We wanted to evaluate the effectiveness of endovenous ablation of the incompetent vein of Giacomini using a 980-nm diode laser. MATERIALS AND METHODS: A total of 18 patients (18 limbs, 4%) had the incompetent vein of Giacomini. Retrograde reflux originating from the great saphenous vein was noted in sixteen limbs and paradoxical diastolic anterograde reflux from the saphenopopliteal junction was observed in two limbs. After tumescent anesthesia, laser ablation using a 980-nm wavelength laser fiber was performed under ultrasound and/or fluoroscopic guidance. Patients were evaluated clinically and with duplex ultrasound at one week and at one, three, six and twelve months after laser ablation for the technical and clinical success. RESULTS: In the 18 limbs, the technical success rate was 100%. Continued closure of the vein of Giacomini was seen in 18 of 18 limbs after one month, in 12 of 12 limbs after three and six months and in six of six limbs after twelve months. No recanalization of the vein and no major complications occurred. CONCLUSION: Endovenous laser ablation with a 980-nm wavelength is an effective and safe procedure for treating an incompetent vein of Giacomini.
Adult ; Female ; Fluoroscopy ; Humans ; Laser Therapy/*methods ; Lasers, Semiconductor ; Leg/*blood supply ; Male ; Middle Aged ; Saphenous Vein/*surgery ; Treatment Outcome ; Venous Insufficiency/*surgery

Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation (EVLA) is a frequently used method. A newly developed alternative, based on thermal therapy, is endovenous microwave ablation (EMA). This study evaluated the effect of the two procedures, in terms of coagulation and histological changes, in occluding lateral veins in goats. Twelve animals were randomized into two group, with 6 treated with EMA (EMA group), and the rest 6 with EVLA (EVLA group). Results of coagulation, including coagulation, fibrinolysis and platelet activation, were assessed at three or four different time points: before, immediately after, 24 h (and 48 h) after ablation. The diameter change, a measure of efficacy, was ultrasonographically measured before and 1 month after the ablation. Histological changes were grossly and microscopically evaluated immediately, 1 and 3 month(s) after the ablation. The length of the ablated vein and preoperative average diameter were comparable between the two groups. In both EMA and EVLA groups, several coagulation parameters, fibrinolysis and platelet activation parameters only underwent slight changes. Ultrasound imaging displayed that the diameter reduction of the veins treated by EMA was significantly larger than by EVLA, in consistent with the results of macroscopic examination. Microscopic examination revealed necrosis and thickening of the vein wall, and occlusion of the lumen within 3 months after ablation in both EMA and EVLA groups. It is concluded that EMA is a minimally invasive therapy, which appears to be safe and effective for treatment of lateral veins in goats.
Animals ; Female ; Fibrinolysis ; Fibrosis ; etiology ; Goats ; Laser Coagulation ; adverse effects ; instrumentation ; methods ; Male ; Microwaves ; therapeutic use ; Necrosis ; etiology ; Platelet Activation ; Postoperative Complications ; Venous Insufficiency ; etiology ; surgery

OBJECTIVETo verify the role and effect of external vavuloplasty in the treatment of chronic venous insufficiency (CVI) of lower extremity.

METHODSThirty patients with CVI of bilateral lower extremities were enrolled to accept surgical management of vein systems. Both limbs of each patient were randomized into two groups respectively according to the operating style. One limb was given external vavuloplasty of the superficial femoral vein and surgery of superficial venous system (group A), the another limb was only given the surgery of superficial venous system (group B). The effect comparison between both limbs of each patient and two groups by color duplex scanning, color doppler velocity profile (CDVP), air plethysmography and CEAP score system one month and 3 years after operation.

RESULTSAll 60 limbs of 30 cases were CEAP C(2)-C(4) with degree III reflux (Kistner's method) in the deep veins confirmed by color duplex scanning and venography. In 1 month and 3 years after surgery, all the indexes of the limb in the group A were dramatically improved compared with those of the limbs in the group B. The average value of venous reflux degree, reflux volume, and venous filling index (VFI) had significant difference between the two groups (P < 0.001). In 3 years after surgery, there was significant difference between the two groups on ejective fraction (EF)and residual volume fraction (RVF) (P < 0.05) and CEAP clinical score (P < 0.001).

CONCLUSIONExternal vavuloplasty of deep vein may reduce the reflux volume of the affected deep vein and improve the valve function, and can result in better outcomes when combined with surgery of the superficial venous system.

Adult ; Aged ; Chronic Disease ; Female ; Femoral Vein ; surgery ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Popliteal Vein ; surgery ; Prospective Studies ; Saphenous Vein ; surgery ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery

OBJECTIVETo evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI).

METHODSNinety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation.

RESULTSThe difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05).

CONCLUSIONSClinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.

Adult ; Aged ; Aged, 80 and over ; Female ; Femoral Vein ; surgery ; Follow-Up Studies ; Humans ; Ligation ; Male ; Middle Aged ; Saphenous Vein ; surgery ; Treatment Outcome ; Vascular Surgical Procedures ; methods ; Venous Insufficiency ; surgery

OBJECTIVE: To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. MATERIALS AND METHODS: From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. RESULTS: A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. CONCLUSION: Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.
Catheters/adverse effects ; Femoral Vein ; Fluoroscopy/methods ; Humans ; Laser Therapy/methods ; Radiography, Interventional/methods ; *Saphenous Vein/radiography/surgery ; Sclerosing Solutions/*administration & dosage/chemistry ; Sclerotherapy/adverse effects/instrumentation/*methods ; Treatment Outcome ; Varicose Veins/radiography/*therapy ; Venous Insufficiency/surgery

OBJECTIVETo evaluate therapeutic results of endovenous radiofrequency in combination with TriVex in treatment of venous insufficiency in lower extremities.

METHODSOne hundred and fifty patients with chronic venous insufficiency (150 limbs) were randomly assigned to Group A (75 limbs) and Group B (75 limbs). Patients in Group A were treated with long saphenous veins radiofrequency ablation procedures in combination with TriVex. Patients in Group B were treated with long saphenous veins traditional stripping operation in combination with TriVex. The postoperative pain, average hospital stay and short-term results in hospital were compared between the two groups. Self-assessment of the operation 4 weeks after, changes of CEAP classification, venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ) score were compared between the two groups.

RESULTSThe operation time in Group A was (67 +/- 11) min, compared with (59 +/- 9) min in Group B (P > 0.05). Postoperative pain and average hospital stay in Group A were significantly lower than those in Group B (P < 0.05). The scores of self-assessment of the operation in Group A was higher than that in Group B 4 weeks after operation (P < 0.05). The change of CEAP classification, VCSS and quality of life were significant after operation in both groups. The VCSS of Group A decreased by 4.6 +/- 2.5 compared with 4.3 +/- 2.7 in Group B (P > 0.05).

CONCLUSIONSEndovenous radiofrequency combined with TriVex for treatment of venous insufficiency in lower extremity is available, effective and with less trauma and faster recovery. CEAP classification, VCSS and CIVIQ are useful tools for assessing outcomes after radiofrequency in these patients.

Adult ; Aged ; Aged, 80 and over ; Catheter Ablation ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Saphenous Vein ; surgery ; Treatment Outcome ; Venous Insufficiency ; surgery