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Transverse view of common femoral vein and artery in the right groin: 'Mickey Mouse' view; CFA, common femoral artery; CFV, common femoral vein; SFJ, sapheno– femoral junction (from the archive of PCS).
Source publication
Objectives. Duplex ultrasound investigation has become the reference standard in assessing the morphology and haemodynamics of the lower limb veins. The project described in this paper was an initiative of the Union Internationale de Phlébologie (UIP). The aim was to obtain a consensus of international experts on the methodology to be used for asse...
Context in source publication
Context 1
... the scan in the groin of the first limb to be examined. Use a transverse view to identify the GSV and the common femoral vein, both lying medial to the common femoral artery, using the 'Mickey Mouse' sign ( Fig. 3). If the junction is not present after surgery to remove the GSV, then 'Mickey's' medial ear is missing. Several veins can be visualised in the region of the saphenofemoral junction (SFJ) and two GSV valves (terminal and pre-terminal) can be imaged near the SFJ. It is important to assess these tributaries and GSV valves as several ...
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Introduction:
The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently there is a lack of clarity on contra-indications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients.
Methods:
The project aimed to optimize pre...
Citations
... На практике, это соотношение между венами и оболочкой напоминает египетский глаз, который можно увидеть на ультразвуковом изображении. Почти у половины пациентов ствол подкожной вены простирается от лодыжки до паха, по всему подкожному отделу [16,18]. ...
... ниже паховой связки, на дистальном конце бедренного канала, проходит сквозь медиальную фасцию бедра и в сопровождении одноимѐнной артерии и подкожного нерва пересекает коленный сустав с медиальной стороны. Под коленным суставом она разделяется на краниальную и каудальную ветви [18,19]. Большая подкожная вена в большеберцовой области имеет два притока: задний отросток (ранее известный как вена Леонардо) и передний отросток (также называемый передней добавочной подкожной веной). ...
Варикозное расширение вен нижних конечностей – это распространенное заболевание, которое характеризуется структурными и функциональными изменениями вен нижних конечностей. Оно является одной из наиболее важных проблем общественного здравоохранения, так как поражает значительную часть населения. Анатомия, диагностика и методы лечения варикозного расширения вен активно изучаются в медицинской литературе, с целью поиска оптимальных решений для предотвращения данного заболевания и возможных осложнений, связанных с ним (тромбозам и тромбоэмболии легочной артерии, кровотечению из расширенных вен и кровотечению из трофических язв, флебиту). Для диагностики данной патологии используются ультразвуковая допплерография и венография, которые позволяют оценить структурные изменения вен и определить распространенность поражения. Уделяя особое внимание повышению осведомленности читателей, в обзоре рассматривается анатомия вен нижних конечностей и классификация варикозного расширения вен нижних конечностей. Понимание анатомических особенностей системы венозного кровообращения позволяет уточнить механизм развития заболевания и определить возможности его профилактики и лечения. Существует множество методов лечения варикозного расширения вен, которые выбираются исходя из степени тяжести заболевания и индивидуальных особенностей пациента. К ним относятся консервативное лечение, хирургические методы и минимально инвазивные процедуры. Каждый из этих методов имеет свои преимущества и недостатки, которые необходимо учитывать при выборе оптимального варианта лечения. Этот обзор литературы по анатомии, диагностике и методам лечения варикозного расширения вен представляет собой систематизацию существующих исследований и опыта, а также анализ применяемых подходов и результатов, что позволяет сформировать полное представление о текущем состоянии заболевания и определить наиболее эффективные направления дальнейших исследований. Таким образом, данный обзор литературы по анатомии, диагностике и методам лечения варикозного расширения вен является важным этапом для понимания сущности данной патологии и разработки оптимальных подходов к пониманию, предотвращению, диагностике и лечению.
The underpinning of Chronic Venous Insufficiency (CVI) is valvular dysfunction, which manifests on a spectrum depending on the severity of insufficiency and duration of the disease. The mainstay of treatment relies on compression therapy of a proper type and intensity. In older adults, special consideration must be taken during the patient encounter to account for age-related factors. This review discusses the clinical presentation, diagnosis, and mimicking of CVI, focusing mainly on older adults. The epidemiology, risk factors, disease burden, and grave complications -- such as thrombosis and ulceration, are reviewed. The physiological impacts of CVI are described, providing the background for treatment strategies, including non-invasive, medical, and surgical therapies. The findings show advanced age to be an important risk factor contributing to CVI and that other age-related factors add to the risk of severe complications. Clinical assessments combined with objective measurements that assess localized skin water using tissue dielectric constant values or whole limb assessments may aid in the differential diagnosis. Furthermore, understanding the mechanism of action of compression therapy, the mainstay of CVI treatment, and its physiological impacts, allows for its informed use in geriatric patients with increased risks of potential compression-related side effects.
Recently collated scientific data on the management of C1 clinical class of chronic venous disorders; wide prevalence of the disease and high variability amongst medical practitioners in relation to managing this category of patients and absence of any regulatory documents has prompted the development of clinical guidelines for the treatment of patients with reticular varicose veins and telangiectasias of the lower extremities and various parts of the body. These guidelines have been developed by a self-regulated organization Association “The National College of Phlebology”. The purpose of the de novo guidelines is to systematize the existing evidence and offer minimal standards of care for chronic venous disorders in C1 patients.
Phlebolymphoedema (PLE) is characterised by an accumulation of fluid in the interstitial tissues which is caused mostly by a combination of venous (primarily) and of subsequent lymphatic diseases. More rarely also limb lymphedema (LYM) may be considered as a PLE, due to concomitant vein abnormalities.
Zusammenfassung
Die chronische Venenerkrankung ist eine weit verbreitete Krankheit, die in späteren Stadien mit einer Vielzahl an Symptomen, aber auch Komplikationen wie dem Ulcus cruris, einhergeht. Dies wiederum hat weitreichende Auswirkungen auf die Lebensqualität der Patienten wie auch auf das Gesundheitssystem. Für die Diagnostik der chronischen Venenerkrankungen steht eine Auswahl an Verfahren zur Verfügung, wobei sich die farbkodierte Duplexsonographie als Goldstandard etabliert hat. Im Bereich der Therapie kam es in den letzten Jahrzehnten zu großen Fortschritten, sodass heute auch Alternativen zum klassischen Stripping durch die endoluminalen Verfahren zur Verfügung stehen. Die Wahl der Therapieoption ist jedoch weiterhin stark abhängig von mehreren Faktoren, unter anderem von den anatomischen Gegebenheiten und dem Krankheitsstadium. Im folgenden Artikel werden die Anatomie und Pathophysiologie, sowie die aktuellen Standards der Diagnostik und Therapie zusammengefasst.
Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography.
Objectives
The objective of this exploratory study was to find out the correlation of femoral vein diameter (FVD) to central venous pressure (CVP) measurements and to derive a prediction equation to help ascertain the fluid volume status in a critical patient.
Patients and methods
This was a single-centered prospective cohort study designed and conducted by the critical care department of Shifa International hospital in Islamabad, Pakistan. Patients were enrolled from the medical and surgical intensive care units. The inclusion criteria consisted of patients > 18 years of age, and an intrathoracic central venous catheterization (CVC) in place for producing CVP waveform through the transducer. Patients having contraindications to CVP placement and those unable to lie supine were excluded from the study. Critical Care fellows with sufficient training in performing venous ultrasonography measured the FVD. They were blinded to the CVP values of the same patients.
Results
The study included 108 patients. Among these 70/108 (64.8%) were males. Mean age was 53.85 (SD=16.74). The CVP and femoral vein diameter were measured in all patients. Mean CVP was 9.89 cmH2O (SD=3.46) and mean femoral vein diameter was 0.92 cm (SD=0.27). Multiple regression was used to generate a prediction model. FVD, age and sex of the patient were used as predictor variables to predict CVP diameter. The model was statistically significant with a p-value of < 0.000 and an F-value of 104.806. R-squared value for this model came out to be 0.744, thus the model was able to explain about 74.4% of the variance in the values observed for CVP. When controlled for age and sex, FVD was found highly correlated with CVP diameter with a p-value of < 0.000. A regression equation was derived that can be used to generate predicted values of CVP in millimeters of mercury with an R-square of 0.745 if FVD in centimeters is provided; CVP (cmH2O) = -0.039 + 10.718* FVD.
Conclusions
FVD was found highly correlated to CVP measurements and it suggests an alternate non-invasive method of ascertaining the volume status in the critically ill.
Background:
Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system.
Objectives:
To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins.
Search methods:
The Trials Search Co-ordinator of the Cochrane Peripheral Vascular Diseases Group searched the Specialised Register (November 2012), CENTRAL (2012, Issue 10) and clinical trials databases. The review authors searched PubMed and EMBASE (December 2012). There was no language restriction. We contacted study authors to obtain more information when necessary.
Selection criteria:
We included randomized controlled trials (RCTs) that compared the CHIVA method versus any other treatments. Two review authors independently selected and evaluated the studies. One review author extracted data and performed the quantitative analysis.
Data collection and analysis:
Two independent review authors extracted data from the selected papers. We calculated the risk ratio (RR), mean difference (MD), the number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI) using Review Manager 5.
Main results:
We included four RCTs with 796 participants (70.5% women) from the 434 publications identified by the search strategy. Three RCTs compared the CHIVA method with vein stripping, and one RCT compared the CHIVA method with compression dressings in people with venous ulcers. We judged the methodological quality of the included studies as low to moderate. The overall risk of bias across studies was high because neither participants nor outcome assessors were blinded to the interventions. The primary endpoint, clinical recurrence, pooled between studies over a follow-up of 3 to 10 years, showed more favorable results for the CHIVA method than for vein stripping (721 people; RR 0.63; 95% CI 0.51 to 0.78; I(2) = 0%, NNTB 6; 95% CI 4 to 10) or compression dressings (47 people; RR 0.23; 95% CI 0.06 to 0.96; NNTB 3; 95% CI 2 to 17). Only one study reported data on quality of life and these results presented graphically significantly favored the CHIVA method.The vein stripping group had a higher risk of side effects than the CHIVA group; specifically, the RR for bruising was 0.63 (95% CI 0.53 to 0.76; NNTH 4; 95% CI 3 to 6) and the RR for nerve damage was 0.05 (95% CI 0.01 to 0.38; I(2) = 0%; NNTH 12; 95% CI 9 to 20). There were no statistically significant differences between groups regarding the incidence of limb infection and superficial vein thrombosis.
Authors' conclusions:
The CHIVA method reduces recurrence of varicose veins and produces fewer side effects than vein stripping. However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
