Related Articles

  • ReviewOctober 30, 2002

    0 20 396

    Varicose Veins in the Legs

    Bo Yang Suh, M.D.

    J Korean Soc Phlebol 2002; 1(1): 3-8
    Abstract
    Varicose veins are one of the most common vascular problems seen in out patient clinic. They affect about 15% of the adult population. Most varicose veins are the result of a congenital or familial predisposition that lead to loss of elasticity in the vein wall and the absence or incompetence of venous valves. These primary varicosities generally progress downward in the greater saphenous system. Secondary or acquired varicosities occur when the venous valves have been damaged by trauma, deep vein thrombosis, or inflammation. The basic pathophysiology of varicose veins are summarized and the initial lower extremity venous examination is described. The author focuses on the diagnosis and treatment of varicose veins in the legs including new treatment trends. (J Korean Soc Phlebol 2002;1:3-8)
  • Review ArticleJune 30, 2015

    0 21 319

    Mechanism of Dilatation and Tortuosity of Veins

    Sang Jun Park

    J Korean Soc Phlebol 2015; 14(1): 8-10
    Abstract
    Tortuosity and dilatation of veins is a typical sign of varicose veins. Mechanism of tortuosity development and vein dilatation is the major pathogenesis of varicose vein and therefore it is closely related to the risk factors for varicose vein. The greatest known risk factor for varicose vein is body posture to increase hydrostatic pressure. Recent research shows that an increase in venous hydrostatic pressure is sufficient to promote venous remodeling by increasing wall stress and activating venous endothelial and smooth muscle cells. Mechanical forces can alter molecular environment and the activator protein 1 (AP-1) is suggested a prerequisite for venous remodeling. So-called biomechanical mechanism is one of the basic concepts that describe abnormal tortuosity and dilatation of veins. But the most fundamental and significant method for prevention and treatment of varicose vein is still to reduce the venous filling pressure despite the fact that many molecular mechanisms can provide the explanation for the causes of varicose vein. (Korean J Phlebology 2015;14:8-10)
  • Review ArticleJune 30, 2022

    0 415 1833

    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.
  • Original ArticleJune 30, 2022

    0 251 277

    Prophylactic Antibiotics for Combined Endovenous Ablation and Phlebectomy, Necessary or Not?: A Propensity Score Matching Case-Control Study

    Kilsoo Yie, M.D., A-Rom Shin, R.A. and Eun-Hee Jeong, R.A.

    Ann Phlebology 2022; 20(1): 30-36
    Abstract
    Objective: Current guidelines recommend that prophylactic antibiotics should not be used in endovenous surgery. However, it remains unclear whether prophylactic antibiotics are necessary for the combined endovenous procedure with concomitant phlebectomy.
    Methods: We conducted a propensity score-matched case-control study to assess post-procedural infection rates based on the use or non-use of prophylactic antibiotics. Initially, the study included 587 patients (mean age of 55.8 ±14.2 and 296 (50.4%) women) undergoing combined endovenous surgery with concomitant phlebectomy from 2018 to 2022. All procedures were performed under local anesthesia without any sedation. The primary outcome was to compare the incidence of surgical site wound infection (SSWI) after the combined procedure between the prophylactic antibiotic use (PA group) and non-use group (nPA group). The secondary outcomes were to analyze requirement of antibiotics due to any cause three months postoperatively and determine the incidence of thrombophlebitis requiring antibiotic treatment. After propensity score matching, 201 patients who received prophylactic antibiotics (PA group) and 201 who did not (nPA group) were selected, and the present study analyzed 402 participants.
    Results: The mean number of concomitant phlebectomies was 3.54±2.3 in the nPA group and 3.68±2.40 in the PA group (p=ns). The type of endovenous treatment (p=0.79 for VenaSeal, p=0.42 for radiofrequency ablation, p=0.52 for endovenous laser ablation, and p=0.38 for ultrasonographic foam sclerotherapy) and number of phlebectomies (3.61±2.3 in no SSWI group vs. 4.40±5.0 in SSWI group) were not associated with postoperative SSWI incidence. In the logistic regression test, the preoperative great saphenous vein size was a unique risk factor for postoperative SSWI (odds ratio 1.442, 95% confidence interval 1.12∼1.80, p=0.004).
    Conclusion: Both nPA and PA strategies had a very low and comparable incidence of SSWI after combined endovenous surgery and concomitant phlebectomy for chronic venous disease treatment. The nPA strategy did not increase post-procedural SSWI. An optimized and individualized protocol for the use of antibiotics is needed.
  • Brief communicationDecember 31, 2022

    0 94 189

    Introduction of a New Device Using Impedance Controlled Radiofrequency Ablation (IC-RFA) Technique for the Treatment of Chronic Venous Disease

    Insoo Park, M.D., Junseong Kwon, M.D. and Sujin Park, M.D.

    Ann Phlebology 2022; 20(2): 111-112
    Abstract
    Chronic venous disease with incompetent saphenous veins has variable treatment methods, including radiofrequency ablation (RFA) technique. RFA is a thermal treatment technique that is widely used worldwide with excellent treatment outcomes reported in many studies and currently recommended as the preferred treatment in guidelines of chronic venous diseases. Recently, in Korea, IC-RFA technique, which has different concept and principle from the existing RFA, has been developed and used in clinical practice. Unlike RFA that uniformly reproduces the ablation time and energy in incompetent saphenous veins, IC-RFA automatically controls the ablation time and energy according to the surrounding intravascular conditions. This technique has a theoretical benefit of transferring more energy for veins with larger diameters and reduced energy for small veins. Herein, we briefly introduce IC-RFA.
  • Original ArticleJune 30, 2023

    0 79 191

    Short-Term Results of Radiofrequency Thermal Ablation Using VENISTAR in Treatment of Varicose Veins

    Byeonggoon Kim, M.D. and Changsoo Kim, M.D.

    Ann Phlebology 2023; 21(1): 18-22
    Abstract
    Objective: Radiofrequency thermal ablation is an effective and safe treatment for varicose veins. Existing radiofrequency thermal ablation devices in Korea detect the temperature of the catheter to adjust the radiofrequency output. In contrast, VENISTAR, a new radiofrequency thermal ablation device, detects the resistance of the vein wall during ablation to adjust the radiofrequency output. Herein, the safety and effects of VENISTAR were assessed.
    Methods: A total of 60 patients with varicose veins who were treated using VENISTAR from January 2021 to September 2022 at our institution were retrospectively analyzed. In this study, 60 patients (41 males and 19 females) were treated with VENISTAR.
    Results: The mean age was 46.2±11.7 years for males and 52.7±14.2 years for females. CEAP classification was as follows: 28, 26, 4, and 2 patients had C2, C3, C4a, and C4c, respectively. A total of 89 truncal veins were treated, including 79 cases of the great saphenous vein and 10 cases of the small saphenous vein. The mean follow-up period was 190±130 days, and the success rate of treatment with VENISTAR was 97.7%. Complications included 20 cases of bruising, 3 cases of phlebitis, 2 cases of recanalization, and 1 case of neovascularization.
    Conclusion: VENISTAR, the new radiofrequency thermal ablation device, was effective and safe for treatment of varicose veins. However, as the follow up duration of the participants was relatively short, generalization of the findings was limited. In the future, long-term studies must be conducted.
  • Review ArticleDecember 31, 2023

    0 196 211

    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

    0 141 186

    What are the Standard Recommendations for Ultrasound Documentation of Varicose Veins? - The 2023 Korean Society for Phlebology Clinical Practice Guidelines

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

    Ann Phlebology 2023; 21(2): 70-73
    Abstract
    In diagnosing varicose veins, accurate ultrasound examinations and meticulous recording of findings are crucial, as they play a significant role in determining treatment methods. Therefore, the Korean Society of Phlebology, in collaboration with related societies, has developed guidelines for the ultrasound diagnosis of varicose veins, including standard recommendations for documenting examination records. After examining varicose veins, it is mandatory to record in writing the name of the blood vessel that was measured. For penetrating veins, it is also necessary to precisely record both the size and location. Additionally, during a provocation test involving compression, the augmented waveform and the regurgitation waveform must be documented so that they are distinctly visible in opposite directions around the baseline. Lastly, the reflux time should be specified in seconds or milliseconds.
  • Review ArticleDecember 31, 2023

    0 194 186

    Prevalence and Clinical Implication of Nonsaphenous Vein Reflux with or without Pelvic Venous Disease

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

    Ann Phlebology 2023; 21(2): 74-79
    Abstract
    Non-saphenous veins refer to veins other than the great saphenous vein or small saphenous vein. Emerging evidence suggests that non-saphenous vein reflux may be more prevalent than previously thought, occurring in 9∼35% of patients with chronic venous disease. We purposed to review the anatomical distribution, diagnostic methods, and treatment options for non-saphenous vein reflux and the importance of differentiating it from saphenous vein reflux in clinical practice. Various types of non-saphenous vein reflux are discussed, including posterolateral thigh perforator vein reflux, vulvar vein reflux, gluteal vein reflux, sciatic nerve/tibial nerve vein reflux, popliteal fossa vein reflux, and knee perforator vein reflux. Individualized treatment approaches are recommended, with sclerotherapy and phlebectomy being common options. Increasing awareness and understanding of non-saphenous vein reflux can lead to improved diagnosis, management, and outcomes for patients with venous disease.
  • Review ArticleDecember 31, 2023

    0 426 172

    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.
AP
Vol.22 No.1 Jun 30, 2024, pp. 1~38

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