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  • Review ArticleJune 30, 2022

    0 106 516

    Ultrasound Examination of Venous Malformation

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

    Ann Phlebology 2022; 20(1): 24-29
    Venous malformations (VM) are the most common congenital vascular malformations (CVM). Varicose veins (VVs) and VM of the lower extremities can present as dilated veins and accompanying chronic venous disease symptoms, including pain and heaviness in the legs. VM can be distinguished from VVs by accurate clinical history taking, physical examination, and, most importantly, imaging. Discrimination between both diseases is critical for devising management. This review focuses on ultrasound imaging of VMs.
  • Original ArticleJune 30, 2023

    0 73 170

    Reflux Distribution and Anatomical Location of the Great Saphenous Vein: Implications for Venous Disease Management

    Su-kyung Kwon, M.D., Jin Hyun Joh, M.D., Ph.D. and Hyangkyoung Kim, M.D., Ph.D.

    Ann Phlebology 2023; 21(1): 33-36
    Abstract
    Objective: Endovenous ablation can sometimes be challenged by the anatomical factors of the great saphenous vein (GSV). We aimed to evaluate the distribution of reflux and anatomical location of the GSV.
    Methods: We retrospectively reviewed ultrasound images of limbs with varicose veins who underwent surgery. We evaluated the distribution of reflux and depth of the GSV, as well as the access site or ablated extent.
    Results: A total of 549 limbs with GSV reflux in 450 patients were included in this study. The distal end of reflux was located in upper thigh in 9 (1.6%) limbs, mid-thigh in 41 (7.5%) limbs, lower thigh in 157 (28.6%) limbs, and below the knee segment in 290 (52.9%) limbs. The depth of the GSV was greater than 5 mm in upper thigh only in 25 (4.6%) limbs, from the junction to mid-thigh in 49 (8.9%) limbs, to lower thigh in 82 (14.9%) limbs, to the knee in 22 (4.0%) limbs, below the knee in 75 (13.7%) limbs, and in the entire length of the leg in 296 (53.9%) limbs. Lower thigh was the most frequently accessed site for the endovenous treatment.
    Conclusion: Although reflux was distributed to the BK segment of the GSV in the majority of limbs, the ablation segments were often limited by the superficial location of the GSV.
  • EditorialDecember 31, 2022

    0 73 245

    Lower Extremity Venous Reflux Ultrasound

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

    Ann Phlebology 2022; 20(2): 49-51
  • Review ArticleDecember 31, 2023

    0 134 192

    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

    0 389 239
    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

    0 36 167

    The “C0s” Patient, What Do We Have to Know?

    HaengJin Ohe, M.D., Ph.D.

    Ann Phlebology 2022; 20(2): 78-80
    Abstract
    Functional chronic venous disease (FCVD; C0 category of clinical manifestation, etiology, anatomic distribution, and pathophysiology classifications) is an underestimated syndrome that affects up to 20% of the general population. FCVD is based on the presence of venous symptoms without instrumental evidence of anatomical or morphological changes. The prevalence of FCVD is underestimated owing to a lack of awareness in Western countries. Given the inflammatory nature of FCVD, we speculate that noninvasive treatments including vasoactive drugs and elastic stockings would easily relieve C0 symptoms.
  • Review ArticleDecember 31, 2023

    0 82 140

    Chronic Venous Disease is a Progressive Disease that Requires Early Intervention

    Sangchul Yun, MD, PhD, RPVI, RVT

    Ann Phlebology 2023; 21(2): 80-84
    Abstract
    Chronic venous disease is a progressive condition, and long-term follow-up is essential for a comprehensive understanding. In clinical practice, conducting extended follow-ups of patients is realistically challenging, and there is still much to learn about the clinical course of varicose veins. Given the gradual progression of chronic venous disease, gaining a precise understanding is crucial for guiding patient treatment. Chronic venous disease is progressive, and early interventions such as lifestyle modifications, medication, compression stockings, or surgery help slow and prevent the progression of the disease. Our objective is to review existing long-term follow-up studies to enhance the treatment approach for patients with varicose veins.
  • Original ArticleDecember 31, 2022

    0 41 145
    Abstract
    Background: This study aimed to explore the current practices and views of members of the Korean Society for Phlebology regarding incompetent small saphenous veins (SSV).
    Methods: A questionnaire was sent to the Korean Society for Phlebology members via email. Of 291 members contacted, 47 responded.
    Results: Preoperative duplex ultrasonography was performed by 85% of the respondents who were operating surgeons, and 92% marked the course of the SSV preoperatively using ultrasound guidance. The same treatment option was performed for all cases, regardless of anatomy or insurance coverage, by 21%. Seven members performed flush ligation at the saphenopopliteal junction (SPJ) during the surgical treatment. Four members reported positioning the terminal end of the catheter at the SPJ during the endovenous treatment. Three respondents performed endovenous thermal ablation (ETA) without tumescent instillation, and three injected tumescent solutions without ultrasound guidance. Twelve respondents performed high ligation during the ETA.
    Conclusion: We verified various approaches to managing SSV among the Korean Society for Phlebology members. Evidence-based practical guidelines and education regarding the management of SSV are necessary for proper management.
  • Review ArticleDecember 31, 2023

    0 114 134

    Post-Operative Follow-Up with Ultrasound after Varicose Vein Ablation

    Sangchul Yun, M.D., Ph.D. and Mi-Ok Hwang, RVT

    Ann Phlebology 2023; 21(2): 85-89
    Abstract
    The objectives of ultrasound follow-up encompass several critical aspects. Primarily, ultrasound is employed post-surgery to assess the efficacy of the treatment and ascertain the potential occurrence of complications and recurrence. Furthermore, the gathered data serves as valuable material for research and facilitates outcome analysis. Fundamentally, long-term follow-up aids in comprehending the natural progression of varicose veins. Immediate postoperative observation is typically conducted within a week to a month following surgery, with the primary aim of verifying the success of the ablation procedure. Late follow-up, typically conducted after one month, focuses on varicose vein recurrence and assesses the long-term outcomes of the surgery. Short-term recurrence (occurring in less than one year), often serves as a predictor for long-term recurrence, extending beyond five years. Given the low incidence of deep vein thrombosis after saphenous ablation, routine surveillance may not be deemed cost-effective. While long-term follow-up may be conducted as needed, it serves a dual purpose of not only monitoring treatment effectiveness and potential recurrences but also contributing to our understanding of the natural course of chronic venous disease, which is often associated with aging.
  • Original ArticleDecember 31, 2022

    0 33 148
    Abstract
    Objective: To establish trust between patients and medical staff, and to reduce patient and guardian anxiety before surgery, we have developed and implemented the “Next of Kin Observation of Surgery Intervention” (NoKOSI). It includes a comprehensive process with sufficient explanation prior to surgery, especially attendance of family guardian during the operation.
    Methods: We conducted a pilot study to evaluate the possibility of using the NoKOSI system before conducting the main study which will identify whether this system reduces anxiety and determine any clinical significance. The study included 133 patients (mean age, 52.3±13.8 and majority female gender, 88 [66.2%]) who underwent varicose vein surgery under local anesthesia between May 2022 and August 2022. The primary outcome was the actual observation rate of the participants with the NoKOSI system. The secondary outcomes were to analyze differences in modified Amsterdam Preoperative Anxiety and Information Score (mAPAIS) between the observing group (Group O) and non-observing group (Group NO).
    Results: Of the 133 surgeries, 44 (33%) voluntarily participated in NoKOSI (Group O). There was no difference between the two groups in relation to age, sex, comorbidity, Chronic Venous Insufficiency, Quality of Life Scale-14 score, Venous Clinical Severity Score (VCSS), patient-reported symptom severity score (0~5), and surgical method. There was no statistical correlation between the preoperative mAPAIS score and the operative Visual Analogue Scale in all patients (r=0.013, p=ns). However, the preoperative anxiety score was significantly correlated with the Family Guardian Observation Request Scale (r=0.474, p=0.000). Of the 11 patients who reported their impression, ten gave a positive opinion and one a negative opinion. Of the 49 reported guardian responses, 38 (77.6%) were positive and 11 (22.4%) were negative.
    Conclusion: In varicose vein surgeries performed under local anesthesia, 33% of family or guardians participated in NoKOSI. The necessity and efficacy of NoKOSI should be further investigated in larger prospective studies.
  • Review ArticleDecember 31, 2023

    0 122 160

    Cases of Venous Stent Failure in Lower Extremities

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

    Ann Phlebology 2023; 21(2): 90-94
    Abstract
    Iliofemoral venous outflow obstruction, arising from nonthrombotic iliac vein lesions (NIVLs) or post-thrombotic disease (PTs), is a frequent culprit behind chronic venous signs and symptoms. In response, the adoption of deep venous stenting has gained traction, demonstrating commendable technical success and acceptable complication rates in the management of both acute and chronic venous obstruction. However, the focus on venous stent failure has intensified due to concerns related to in-stent restenosis or thrombosis. Such complications elevate the risks of symptom recurrence and thrombosis relapse, necessitating a judicious approach. The identified contributors to venous stent failure encompass multifaceted factors, including insufficient coverage of the affected area, inadequate vein inflow, inappropriate stent sizing, suboptimal drug therapy, patient non-compliance, stent migration, or fracture. This paper provides a comprehensive exploration of these factors associated with venous stent failure, shedding light on the complexities surrounding the efficacy and longevity of deep venous stenting in the context of iliofemoral venous outflow obstruction.
AP
Vol.21 No.2 Dec 31, 2023, pp. 53~101

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