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  • Review ArticleDecember 31, 2022

    392 239
    Abstract
    The calf muscle pump is the motive force enhancing venous blood return from the lower extremity to the heart. It causes displacement of venous blood in both vertical and horizontal directions, generates ambulatory pressure gradient between the thigh and lower leg veins, and bidirectional streaming within calf perforators. Ambulatory pressure gradient triggers venous reflux in incompetent veins, inducing ambulatory venous hypertension in the lower leg and foot. Bidirectional flow in calf perforators enables quick pressure equalization between deep and superficial veins of the lower leg; the outward (into the superficial veins) oriented component of the bidirectional flow taking place during calf muscle contraction is not a pathological reflux but a physiological centripetal flow streaming via the great saphenous vein into the femoral vein. Calf perforators are communicating channels between both systems, making them conjoined vessels; they are not involved in generating pathological hemodynamic situations and do not cause ambulatory venous hypertension. Pressure gradient arising during calf pump activity between the femoral vein and the saphenous remnant after abolishing saphenous reflux triggers biophysical and biochemical events, which might induce recurrence. Thus, abolishing saphenous reflux removes the hemodynamic disturbance but simultaneously generates a precondition for reflux recurrence and the return of the previous pathological situation; this chain of events has been termed the hemodynamic paradox. But this review showed that varicose veins could be improved quickly through lower leg muscles (especially calf muscle) regeneration by increasing mitochondrial cellular energy (adenosine triphosphate) of leg muscles without removing varicose veins.
  • Review ArticleDecember 31, 2022

    322 417

    Patterns of Saphenous Vein Reflux and Treatment Plan

    Nicos Labropoulos, Ph.D. and Hyangkyoung Kim, M.D., Ph.D.

    Ann Phlebology 2022; 20(2): 52-57
    Abstract
    Varicose vein is a prevalent disease and a cause of substantial morbidity. Venous reflux often originates from saphenous trunks and their tributaries. The great saphenous vein and small saphenous vein have major anatomical variations due to their embryological origin. Understanding of anatomic variation and reflux pattern is important to decide the target lesions for treatment and treatment modalities for symptom relief effectively and to prevent the future complications and recurrence. In this review, we purposed to review the reflux pattern of the saphenous origin and the corresponding treatment methods.
  • Review ArticleJune 30, 2022

    251 2529

    Surgical Embolectomy of Acute Pulmonary Embolism

    Tae Sik Kim, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 15-18
    Treatment for acute pulmonary embolism includes anticoagulation, thrombolysis, catheter-directed therapy, and surgical pulmonary embolectomy. Surgical embolectomy is indicated in select patients based on a risk/benefit assessment and when other treatment options are contraindicated. A multidisciplinary approach along with a meticulous surgical technique might significantly lower the mortality associated with surgical embolectomy.
  • Review ArticleDecember 31, 2023

    209 264

    Guideline Development - The 2023 Korean Society for Phlebology Clinical Practice Guidelines for the Ultrasonographic Evaluation of Varicose Veins of the Lower Extremities

    Tae Sik Kim, M.D., Sangchul Yun, M.D., Wooshik Kim, M.D., Heangjin Ohe, M.D., Seung Cheol Lee, M.D., Sung Ho Lee, M.D. and Sang Seob Yun, M.D.

    Ann Phlebology 2023; 21(2): 53-59
    Abstract
    Varicose vein is a disease with a high prevalence that is commonly seen in everyday life. Accurate diagnosis using ultrasound is essential for venous diseases, but due to the nature of the disease and ultrasonographic techniques, there are a lot of intervention in subjective judgment. Therefore, it is necessary to establish clear standards for the diagnosis methods and standardize procedures of varicose veins. Recently, the diagnosis and treatment of venous diseases has increased rapidly, and the resulting social costs have become a problem. In celebration of its 20th anniversary, the Korean Society for Phlebology published this guideline, ‘The 2023 Korean Society for Phlebology clinical practice guidelines for the ultrasonographic evaluation of varicose veins of the lower extremities’ because it was determined that the establishment of accurate diagnostic standards using ultrasonography was urgently needed.
  • Review ArticleJune 30, 2022

    189 453

    Practical Use of Venoactive Drugs for Chronic Venous Disease in Korea

    Sangchul Yun, M.D., Ph.D., R.P.V.I., R.V.T.

    Ann Phlebology 2022; 20(1): 1-5
    Abstract
    Venoactive drugs can be used as a first-line treatment in all stages of chronic venous disease. In a more advanced stage, drugs can be used together with surgery or endovascular procedures. However, there is a lack of correlation between these clinical symptoms and varicose veins, so surgical treatment is recommended for patients with C2 or higher who are accompanied by symptoms and reflux. In other patients, with non-varicose pain in mind, first, conservative treatment should be provided to control symptoms. Currently used drugs are flavonoids including diosmin, micronized purified flavonoid fraction, rutin and troxerutin, and saponins including horse chestnut seed extract and Ruscus extract such as butcher’s broom, anthocyans, and synthetic drugs. There is a difference in the mechanism of action of each drug, and these drugs seem to be selectively used according to the symptoms mentioned by patients. The drug indications according to the guidelines and research and precautions are summarized in this review.
  • Review ArticleJune 30, 2022

    163 1805

    The 2020 Update of the CEAP Classification: Updated Contents and Background

    Ki-Pyo Hong, M.D., Ph.D.

    Ann Phlebology 2022; 20(1): 19-23
    Abstract
    The following are included in the 2020 update of the CEAP classification: addition of the modifier “r” to the C2 and C6 recurrent disease, addition of corona phlebectatica to the C4 class as a separate subclass (C4c,) subcategorization of ES (secondary etiology) into ESi (intravenous secondary etiology) and Ese (extravenous secondary etiology), and the use of anatomic abbreviations instead of numbering the venous segments in the anatomical classification. Researchers should understand the definition of the recurrence of varicose veins and the diagnostic criteria of corona phlebectatica.
  • Review ArticleDecember 31, 2023

    143 202

    Proper Preparations for the Ultrasonographic Evaluation of Varicose Veins of the Lower Extremities - The 2023 Korean Society for Phlebology Clinical Practice Guidelines

    Wooshik Kim, M.D., Tae Sik Kim, M.D., Sangchul Yun, M.D., Heangjin Ohe, M.D., Seung Chul Lee, M.D., Sung Ho Lee, M.D. and Sang Seob Yun, M.D.

    Ann Phlebology 2023; 21(2): 60-62
    Abstract
    In the diagnosis of varicose veins, duplex ultrasound scanning is recommended as the diagnostic test of choice. Both superficial and deep veins must be tested accurately and consistently in a standardized manner. Ultrasonography, while effective, is highly dependent on the examiner and requires standardization. To ensure reliable results, it is crucial to obtain high-quality images of superficial veins using a high-frequency linear array transducer during ultrasound examinations of the lower extremities. Image optimization techniques should be employed to minimize artificial images and enhance diagnostic quality. When conducting ultrasound examinations of the lower extremities, specifically for varicose veins, performing the venous reflux test in a standing position is essential. This positioning allows for testing under conditions more similar to physiological ones, ensuring a more accurate assessment of pathological reflux influence.
  • Review ArticleDecember 31, 2023

    134 187

    Ultrasonographic Reflux Findings of Varicose Veins of the Lower Extremities - The 2023 Korean Society for Phlebology Clinical Practice Guidelines

    Sangchul Yun, M.D., Tae Sik Kim, M.D., Wooshik Kim, M.D., Heangjin Ohe, M.D., Seung Chul Lee, M.D., Sung Ho Lee, M.D. and Sang Seob Yun, M.D.

    Ann Phlebology 2023; 21(2): 66-69
    Abstract
    Treatment decision of varicose veins should be made based on the patient’s symptoms, but it is important to confirm the presence of reflux when selecting a treatment method. The definition of reflux, which is the core of ultrasound diagnosis of varicose veins, is recommended as follows. In the case of the great saphenous vein, anterior and posterior accessory saphenous vein, small saphenous vein, perforating vein, tibial vein, and deep femoral vein, reverse flow of more than 0.5 seconds is considered as reflux. In the case of the common femoral vein, femoral vein, and popliteal vein, reverse flow of more than 1.0 seconds is considered as reflux. In cases of reticular veins, spider veins, and telangiectasia, because the clinical significance of measuring reflux through ultrasound has not yet been proven and they are often observed regardless of saphenous vein reflux, ultrasound diagnostic criteria are not provided.
  • Review ArticleDecember 31, 2023

    134 193

    Ultrasonographic Image Acquisitions of Varicose Veins of the lower Extremities - The 2023 Korean Society for Phlebology Clinical Practice Guidelines

    HeangJin Ohe, M.D., Tae Sik Kim, M.D., Wooshik Kim, M.D., Sangchul Yun, M.D., Seung Chul Lee, M.D., Sung Ho Lee, M.D. and Sang Seob Yun, M.D.

    Ann Phlebology 2023; 21(2): 63-65
    Abstract
    Venous flow normally circulates from the skin to superficial veins, which drain into the deep veins and the heart. Venous reflux refers to blood flow that flows in the opposite direction. Venous reflux is caused by gravity and valvular insufficiency. Diagnosing venous reflux is important to determine treatment for lower extremity venous disease. Unlike arteries, venous reflux is greatly affected by the relative position of the probe and the vessel. Standardized ultrasound images are required to verify venous reflux using ultrasound. It is important to perform the reflux provocation test using the standardized posture and method.
  • Review ArticleDecember 31, 2022

    123 318

    Image Optimization in Venous Ultrasound Examination

    Hyangkyoung Kim, M.D., Ph.D. and Nicos Labropoulos, Ph.D.

    Ann Phlebology 2022; 20(2): 64-67
    Abstract
    Ultrasound is a diagnostic tool of choice for venous disease. As treatment is based on ultrasound results, accurate examination is essential and image optimization is necessary to provide objective information. Understanding the physical properties and knobology of ultrasound helps to obtain good images. To begin with, comfortable placement of the ultrasound for the examiner to use and the appropriate positioning of the patient is also important. The next step for an optimal ultrasound image is to attain good resolution to a given depth. It is also essential to appropriately utilize the provocation maneuvers when diagnosing a suspected disease, especially for the chronic venous disease.
AP
Vol.21 No.2 Dec 31, 2023, pp. 53~101

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