Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations

OBJECTIVE: To compare the clinical outcome between ultrasound-guided foam sclerotherapy (UGFS) and ultrasound-guided liquid form sclerotherapy (UGLS) in patients with venous malformations (VM). METHODS: Eighty-nine patients with symptomatic VM were treated with ultrasound-guided sclerotherapy. There were 22 males and 67 females with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) or 10% ethanolamine oleate (EO). POL was injected predominantly into smaller, superficial lesions, whereas EO was used for large, deeper lesions. Foam sclerosing solution was provided using Tessari's method. Patients were randomized to receive either UGFS or UGLS. Post-sclerotherapy surveillance was done at 6 months after last session using duplex ultrasound. Findings obtained by duplex scanning were divided into four groups: (1) disappeared group: the venous space was occluded and was totally shrunk; (2) partially recanalized group: the venous space was partially recanalized and was partially shrunk; (3) totally recanalized group: the venous space was totally recanalized and returned at the same size; and (4) worsened group: the venous space was totally recanalized and became worse. RESULTS: Forty-nine patients were treated with UGFS and the remaining 40 were treated with UGLS. There were no significant differences in age and men:women ratio. There was no significant difference in the anatomic distribution of VMs between the two groups. The amount of POL was significantly smaller in patients who were treated with UGFS (P = .022). Similarly, there was a significant reduction in the use of EO in patients treated with UGFS (P = .005). The proportion of VM with total disappearance and partial recanalization was significantly higher in patients treated with UGFS (P = .002). No major complications related to sclerotherapy were encountered in both groups. CONCLUSIONS: These findings suggest that UGFS could have greater promise compared with UGLS in the treatment of VMs.     

Foam sclerotherapy for the treatment of superficial venous insufficiency

Foam sclerotherapy has been refined over the past decade to become a safe and effective treatment for varicose veins and venous insufficiency. Using duplex ultrasound guidance, it can be used to treat large and small varicosities, saphenous trunks, incompetent perforating veins, and venous stasis ulcerations. Serious complications are rare, and in experienced hands, efficacy rivals that of traditional surgical ligation and stripping. Disadvantages of the technique are the need in many cases for more than one treatment session, and lack of US Food and Drug Administration approval of all currently available sclerosants. Foam sclerotherapy offers advantages of low cost, quick patient recovery, and ease of use; as such, it is an important tool for modern vein treatment.     

无水乙醇联合泡沫硬化治疗儿童体表静脉畸形

目的观察无水乙醇联合泡沫硬化治疗体表静脉畸形(VM)患儿的有效性及安全性。方法回顾性分析接受DSA引导下无水乙醇联合聚桂醇泡沫硬化治疗的42例体表VM患儿,术后随访观察治疗效果及不良反应。结果共行79次硬化治疗,平均每例(1.1±0.2)次;总有效率97.62%(41/42)。79例次硬化治疗中,24例次术后疼痛明显,65例次术后病灶明显肿胀;12例次术后低热,对症治疗缓解或自行缓解;1例次术后局部坏死,经对症治疗3个月后瘢痕愈合;未发生过敏、异位栓塞及肺动脉高压等严重并发症。结论无水乙醇联合泡沫硬化治疗儿童体表VM安全有效。     

泡沫硬化剂注射治疗下肢慢性静脉功能不全

目的 探讨泡沫硬化剂注射治疗下肢慢性静脉功能不全(CVI)的临床疗效.方法 2011年3月至2012年1月,对我院行泡沫硬化剂注射治疗的95例CVI患者(131条患肢,CEAP分级为C2～5级)的临床资料进行回顾性分析.结果 131条患肢均成功治疗,平均每条肢体应用泡沫硬化剂15.5 ml.31条(23.7％)肢体于治疗后2周复诊时实施了第2次注射治疗,其中3条(2.3％)肢体于治疗后1个月复诊时实施了第3次注射治疗.无严重并发症发生.结论 泡沫硬化疗法对各种类型的下肢CVI都有效,且简单易行,应扩大其临床适应证.     

Prevention or reversal of deep venous insufficiency by aggressive treatment of superficial venous disease

Background

This study of patients who received either aggressive or less-aggressive treatment for superficial venous disease was undertaken to determine its effects on deep venous insufficiency (DVI).

Methods

From 1998 to 2004, we treated 1,500 consecutive patients with superficial venous disease at our outpatient care center. A total of 100 patients were available for the study; the remaining patients were not available for the complete follow-up duplex scans 6 months after therapy, irrespective of the therapeutic results. Sixty-four patients underwent aggressive therapy, which included high ligation with partial selective perforation-invagination (PIN) axial stripping of the greater saphenous vein, ambulatory stab phlebectomy of the varicose veins, and transdermal treatment of the spider veins. Thirty-six patients underwent less-aggressive treatment, which included high ligation with selective partial PIN axial stripping of the greater saphenous vein and ambulatory phlebectomy of varicose vein clusters but no spider vein treatment.

Results

Follow-up duplex scanning after aggressive treatment of superficial venous disease showed improvement or complete reversal of DVI in the majority of patients. This improvement was defined as a marked decrease in the size of the deep veins in 80% of patients and a decrease of the reflux closure time of the deep venous valves in 83% of patients. Only 28% of patients receiving less-aggressive treatment without transdermal laser therapy of the spider veins showed improvement in their reflux valve closure time; the remaining 72% were unchanged or deteriorated.

Conclusions

Aggressive treatment of superficial venous disease can prevent or even eliminate deep vein insufficiency (DVI).     

Postthrombotic or non-postthrombotic severe venous insufficiency: impact of removal of superficial venous reflux with or without subcutaneous fasciotomy

BACKGROUND: Severe chronic venous insufficiency is often associated with therapy-resistant or recurrent venous leg ulcers, either as a result of deep vein thrombosis (DVT)- (postthrombotic syndrome [PTS]) or superficial venous insufficiency (SVI). Frequently present dermatoliposclerosis affects the skin as well as the subcutaneous and subfascial structures, which may impact tissue pressures and compromise skin perfusion. This study was undertaken to measure tissue pressures in PTS and SVI limbs and to evaluate the impact of removal of superficial venous reflux with or without concomitant subcutaneous fasciotomy. MATERIAL: In eight patients with recurrent, therapy-resistant venous leg ulcers, due to PTS (11 limbs, 12 ulcers) and 14 patients with severe SVI (14 limbs, 14 ulcers), subcutaneous fasciotomy was performed in addition to removal of superficial reflux. They were compared with eight patients with PTS (11 limbs, 11 ulcers) and 10 patients with SVI (13 limbs, 13 ulcers) who did not have fasciotomy in addition to removal of their superficial venous reflux. Intramuscular (i.m.) and subcutaneous (s.c.) tissue pressures and transcutaneous oxygen tension (TcPO(2)) were measured prior to, immediately after, and 3 months following the surgical intervention. Healing of ulcer (spontaneous or by skin grafting) at 3 months was also observed. RESULTS: There were no statistical differences between the groups regarding gender and age distribution or ulcer age at the time of surgery. All patients had in addition to surgery compression stockings class II (30 mm Hg). The i.m. tissue pressure was higher in patients with PTS compared with SVI patients, while s.c. tissue pressure and TcPO(2) did not differ between the groups. When fasciotomy was performed, i.m. and s.c. tissue pressures decreased and TcPO(2) increased significantly. Without fasciotomy, only s.c. tissue pressure decreased first at 3 months postoperatively. In the SVI-group, i.m tissue pressure was significantly decreased at 3 months in the group without fasciotomy. CONCLUSIONS: Patients with severe chronic venous insufficiency with therapy-resistant or recurrent ulcer disease due to deep and superficial insufficiency have higher i.m. tissue pressures than patients with only superficial venous reflux, even though both groups have higher i.m. and s.c. tissue pressures compared with normal values. Eradication of all superficial reflux lowers s.c. tissue pressure, while additional fasciotomy lowers both i.m. and s.c. tissue pressures and increases TcPO(2), which seems to promote ulcer healing.     

Foam sclerotherapy: an overview of use for primary venous insufficiency

Ultrasound-guided sclerotherapy with foam is able to suppress blood flow in almost all types of varicose veins. The technique is efficient, simple, safe, inexpensive, and easily repeatable, although it requires training and skill. It should be considered as the best primary treatment for most varicose patients. Evaluation of long-term results, with regard to comparison with other techniques, should take into account all advantages and drawbacks and evaluate cost-effectiveness from a life-long point of view.     

喜普妙结合行为疗法与单一疗法治疗青壮年早泄的对比观察

目的比较喜普妙加行为疗法、单用喜普妙和行为疗法治疗早泄的临床效果。方法96例早泄病人随机分成3组：A组（单纯行为疗法组）、B组（喜普妙组）、C组（喜普妙＋行为疗法组）,记录病人治疗前后阴道内射精潜伏期并进行组内和组间比较,同时记录夫妻对性生活的满意程度。结果3组病人治疗后射精潜伏期延长（P〈0.01）,组间比较P值均〈0.01。从夫妻对性生活满意度来看,疗效由低到高也分别为单纯行为疗法组、喜普妙组、喜普妙＋行为疗法组。结论在治疗早泄方面,口服喜普妙结合行为治疗是治疗早泄的一种有效方法。     

Physiotherapy alone or in combination with corticosteroid injection for acute lateral epicondylitis in general practice: A protocol for a randomised, placebo-controlled study

Background  

Lateral epicondylitis is a painful condition responsible for loss of function and sick leave for long periods of time. In many countries, the treatment guidelines recommend a wait-and-see policy, reflecting that no conclusions on the best treatment can be drawn from the available research, published studies and meta-analyses.     

The nature of skin pigmentations in chronic venous insufficiency: a preliminary report.

BACKGROUND: Chronic Venous Insufficiency (CVI) provokes skin pigmentation commonly seen in the gaiter region of the leg. The exact nature and pathogenesis of this are poorly understood. OBJECTIVE: To evaluate the presence of melanin and haemosiderin in histological sections of the skin of limbs with primary varicose veins. METHODS: Histological investigations were performed in 49 biopsies from pigmented and non-pigmented skin of limbs with varicose veins and control limbs. RESULTS: All samples from pigmented skin showed a higher content of melanin than controls. In contrast, haemosiderin was found in only a few biopsies taken from the more severely pigmented skin in areas of lipodermatosclerosis. Erythrocyte diapedesis was observed only where an intense inflammatory process was also present. CONCLUSIONS: Our findings suggest that in the initial phases of skin changes due to venous disease, pigmentation is attributable to melanin. Haemosiderin seems to play a role in the evolution of skin changes toward lipodermatosclerosis and ulceration. Erythrocyte diapedesis is likely to occur only during acute phases of the inflammatory process. Further investigations are needed to explain the cause and the exact cellular and molecular mechanisms responsible for hypermelanisation occurring in early phases of skin changes in CVI.     

腔内射频联合激光和手术治疗下肢静脉功能不全的初步报道

目的评价腔内射频联合激光和手术治疗下肢静脉功能不全的安全性和有效性。方法33例患者34条患肢,单纯性大隐静脉曲张10条,原发性深静脉瓣膜功能不全20条,左髂静脉受压综合征2条,下肢静脉畸形-骨肥大-皮肤血管瘤综合征2条。3种治疗方式：①大隐静脉主干射频闭锁联合股浅静脉瓣膜包窄术、大隐静脉高位结扎和曲张属支浅静脉腔内激光（EVLT）治疗4条肢体：②大隐静脉主干射频闭锁联合大隐静脉高位结扎和EVLT治疗28条肢体;③大隐静脉主干射频闭锁联合外侧畸形静脉高位结扎和EVLT治疗2条肢体。结果随访1～15个月,平均3．27个月,33例患者均取得满意的疗效。结论主干静脉腔内射频治疗下肢静脉功能不全操作简便、安全、有效、微创,联合EVLT和手术治疗,可扩大其应用范围。     

超声在泡沫硬化剂闭合交通静脉治疗下肢静脉性溃疡中的作用

目的 探讨彩色多普勒超声在泡沫硬化剂闭合交通静脉治疗下肢静脉性溃疡中的作用.方法 选择2014年12月-2016年8月在重庆医科大学附属第一医院血管外科接受超声引导下泡沫硬化剂闭合小腿病变交通静脉的静脉性溃疡患者(C6期),观察术后皮肤溃疡的愈合情况并通过彩色多普勒超声对静脉闭合情况进行随访.结果 114例患者共119条患肢(C6期)接受治疗,术前超声检查证实均存在小腿交通静脉病变(1～3支).平均闭合小腿交通静脉2.1条(1～3条).术后平均随访11.3个月(1～21个月),术后1个月溃疡愈合率为100％,病变交通支闭塞率为100％;随访期间,溃疡复发3例(3条患肢),病变交通静脉再通8支.未出现严重并发症.结论 彩色多普勒超声能提高泡沫硬化剂闭合小腿交通静脉治疗下肢静脉性溃疡的疗效和安全性,具有较高的临床实用价值.