S.K. van der Velden

Five-year results of a randomized clinical trial of conventional surgery, endovenous laser ablation and ultrasound-guided foam sclerotherapy in patients with great saphenous varicose veins

A variety of techniques exist for the treatment of patients with great saphenous vein (GSV) varicosities. Few data exist on the long‐term outcomes of these interventions.

How specific are venous symptoms for diagnosis of chronic venous disease

Objective The objective of this study is to evaluate whether and which ‘venous’ symptoms are characteristic for patients affected with chronic venous disease compared to patients with other diseases of the lower limbs (e.g. arthrosis, peripheral arterial disease, spinal disc herniation). Methods A cross-sectional study was performed to compare the frequency of venous symptoms among 76 patients with chronic venous disease and reflux and 74 patients with other diseases of the legs without reflux. The VEINES-Sym of the VEINES-QOL/Sym questionnaire was used to evaluate the frequency of symptoms. Demographic, clinical classification and ultrasound findings were also noted. Results A total of 122 patients were included for analysis (response rate of 87%). Presence of venous symptoms was slightly more often reported in the chronic venous disease group than in the non-chronic venous disease group, but differences were small and statistically non-significant. Severity of chronic venous disease as classified by the CEAP classification was not associated with higher proportions of patients reporting symptoms than in non-chronic venous disease patients, except for swelling (p = .016) and itching (p = .007) in C3-C6 patients. The largest difference between the chronic venous disease and non-chronic venous disease group was observed for the time of the day at which symptoms were most intense; patients with chronic venous disease were more likely to experience symptoms at the end of the day (p < .001). Conclusions The small differences in prevalence of reported ‘venous’ symptoms between chronic venous disease patients and patients with other diseases of the legs suggest that these symptoms may be less specific for patients with chronic venous disease and refluxing veins than is usually assumed.

The post-thrombotic syndrome and compression therapy

Compression therapy is still the cornerstone in the treatment of PTS. The therapy is primarily focused on the decrease of the AVP, enhancement of the microcirculation and reduction of the edema. In our practice, most patients are initially treated with short stretch bandage to reduce the edema. Medical Elastic Compression Stockings (MECS) class II (CEN 23–32 mm Hg)or class III (CEN 34–46 mm Hg) with a high stiffness index are prescribed after the edema is disappeared. The prescription will be for a lifelong usage of stockings. Correction of saphenous reflux, deobstructing and stenting might be considered in certain patients with PTS.

Towards an individualized management strategy for patients with chronic venous disease: Results of a Delphi consensus:

Objective To obtain consensus on management criteria for symptomatic patients with chronic venous disease (CVD; C2–C6) and superficial venous reflux. Method We used a Delphi method by means of 36 statements sent by email to experts in the field of phlebology across the world over the course of three rounds. The statements addressed criteria for different venous treatments in patients with different characteristics (e.g. extensive comorbidities, morbid obesity and peripheral arterial disease). If at least 70% of the ratings for a specific statement were between 6 and 9 (agreement) or between 1 and 3 (disagreement), experts’ consensus was reached. Results Twenty-five experts were invited to participate, of whom 24 accepted and completed all three rounds. Consensus was reached in 25/32 statements (78%). However, several statements addressing UGFS, single phlebectomies, patients with extensive comorbidities and morbid obesity remained equivocal. Conclusion Considerable consensus was reached within a group of experts but also some gaps in available research were highlighted.

Reply to Letter: Complexity of venous symptoms.

Dear Editor, With great interest we have read the letter to the editor of Dr. Yetkin. In his letter, he questioned whether our study population is a good representation of the average varicose vein population. To his opinion most patients attending a Dermatology Department are presenting with complaints of itch or aesthetic concerns. This opinion is rather based on a general assumption and there is no evidence substantiating this statement. In our hospital, all patients with symptoms and signs of chronic venous disease (CVD) are referred to the Department of Dermatology. The same is true for many other hospitals in the Netherlands. In our study, over 89% of the patients had mild to severe CVD (C2 to C6), including 17 patients (27%) with active venous ulceration (C6). Over 65% of the CVD patients complained either of heavy legs, aching legs or night cramps. At duplex ultrasound examination all patients had truncal reflux. Considering the oversampling of C6 disease in our cohort, the severity of CVD in our study population may even have been worse than what can be expected in a typical CVD population. In view of the above, we reconfirm that our cohort of CVD patients was indeed representative, contrarily to what has been suggested in Dr. Yetkin’s letter.

In vivo effects of foam sclerotherapy on coagulation

Objective: The aim of this study was to evaluate whether foam sclerotherapy (FS) induces changes in CAT (calibrated automated thrombinography) and other coagulation parameters which could indicate an increased risk of thrombotic events. Methods: Blood samples from eight patients treated with FS were taken before treatment and 30 minutes, one and four hours and one week after treatment. CAT parameters (ETPln, Peakln, Lag time 1), thrombin antithrombin complexes (TAT), d-dimers, fibrinogen, Von Willebrand (vWf Ag) factor and platelet-derived microparticles (MIPAs) were measured. Results: Significant changes over time for Peakln, fibrinogen, d-dimers, vWfAg and TAT complexes were observed. CAT parameters decreased over time, except for Lag time 1. D-dimers and TAT complexes increased and fibrinogen, vWf Ag, MIPAs decreased during the first hours. Conclusion: The findings in this study support the hypothesis that FS initiate coagulation pathways, but there is no evidence that this activation results in an increased thrombosis risk.