• Review ArticleJune 30, 2023

    0 64 215

    The Teupitz Shunt Classification for CHIVA Strategy

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

    Ann Phlebology 2023; 21(1): 1-4
    Venous hypertension, caused by venous reflux, often leads to heaviness, swelling, and pain in the legs. However, the hemodynamics of venous flow are complex and incomprehensible, with a frequently unclear correlation between reflux and symptoms. Regarding treatment options, removal of saphenous veins (SVs) based on a few seconds of reflux can adversely affect patients. Further, indiscriminate removal of SVs in aging populations may complicate future treatment of arterial diseases. Patients should be treated selectively based on ultrasound examinations and hemodynamic principles. The CHIVA strategy, which involves treating patients without removing SVs, is a potential treatment option for patients with mild chronic venous insufficiency. In this context, we introduce the Teupitz shunt classification, which forms the basis for hemodynamic correction.
  • Review ArticleJune 30, 2023

    0 70 235

    Optimal Diagnosis and Therapy of Venous Ulcer

    Kyung Bok Lee, M.D., Ph.D.

    Ann Phlebology 2023; 21(1): 5-13
    Venous ulcer, a condition caused by chronic venous disorder, is the most common form of leg ulcer, accounting for approximately 70% of all leg ulcer cases. The prevalence of venous ulcer is known to range between approximately 0.06% and 2%, and even when treated, it is known to recur in approximately 75% of cases. Reflux and obstruction caused by a venous disorder are both key pathophysiological factors of venous ulcer, and in particular, obstruction causes venous ulcer at a high frequency. The diagnosis of venous ulcer is based mostly on medical history, clinical presentations, and physical examination. Venous ulcers typically occur in the gaiter region and are often accompanied by telangiectasia, corona phlebectatica, atrophie blanche, and lipodermatosclerosis. Duplex ultrasonography is the most commonly used method for diagnosing chronic venous insufficiency (CVI) and assessing its causes. It can also be used to diagnose reflux and obstruction and evaluate the severity and distribution of reflux. However, although longer reflux time is typically observed in CVI, it is not always consistent with the clinical presentations. Recently, intravascular ultrasound is being adopted rapidly since it is capable of providing more accurate diagnosis and being very helpful in endovascular intervention. Treatment for venous ulcer involves reducing edema, promoting healing, and preventing recurrence of ulcer. Compression therapy is the standard therapy for CVI and venous ulcer. Elastic compression therapy is more effective than inelastic compression therapy because it offers the advantage of maintaining compression both at rest and during activities, adjusting to changes in leg size. Compressive stockings, which comprise the core component of elastic compression therapy, help to reduce residual volume fraction, an indicator of calf muscle pump improvement, and promote healing of venous ulcers by reducing reflux in venous segments. Proper wound care and dressings play a vital role in venous ulcer treatment. The wound should be kept moist at all times, while various dressings can be applied to promote healing of the ulcer. Moreover, faster healing of venous ulcer can be achieved by compression therapy with additional intravenous or surgical treatment, as compared to compression therapy alone.
  • Review ArticleJune 30, 2023

    0 56 187

    Clarifying Misnomers in Venous Diseases

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

    Ann Phlebology 2023; 21(1): 14-17
    Misnomers, erroneous or inappropriate designations, are a common occurrence in the medical field, often leading to confusion, misdiagnosis, and misguided treatment approaches. Within the realm of venous diseases, misnomers frequently arise in the form of inaccurate names assigned to conditions or clinical findings. The use of accurate terminology becomes essential in facilitating effective communication between venous specialists and patients. Employing precise and descriptive language improves the accuracy of diagnoses, enabling the implementation of appropriate treatment strategies and reduces cost and use of staff resources. This article aims to present prevalent misnomers in venous disease and to rectify them by employing the correct terminology, thereby enhancing patient care.
  • Original ArticleJune 30, 2023

    0 46 177

    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
    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.
  • Original ArticleJune 30, 2023

    0 48 177

    Analysis of Clinical Experience of Patients with Lower Extremity Edema

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

    Ann Phlebology 2023; 21(1): 23-27
    Objective: Edema of the lower extremities can occur in various situations. We aim to identify the causes of edema commonly encountered in clinical practice and determine the role of vascular specialists in lower extremity edema.
    Methods: From January 1, 2019, to September 30, 2019, 112 medical records were reviewed retrospectively. We referred to the algorithm for leg edema. We proposed a final diagnosis based on the medical history, physical examination, laboratory tests, imaging studies, and consultation with other specialists.
    Results: Among the 112 patients, 42 (37.5%) patients were diagnosed with chronic vascular disease. Overall, 28 (25%) patients had no clearly identified causes and were considered idiopathic. Another 28 (25%) patients had musculoskeletal disorders and 10 (2.9%) patients had medical disease. There were 4 isolated cases of dermatitis, insect bites, pregnancy, and morbid obesity. 24 cases (21.4%) of the 112 patients were diagnosed with lower-extremity varicose veins, with 17 (15.2%) patients showing reflux in the saphenous vein on Doppler ultrasound.
    Conclusion: In this study, various leg edema indicated the need for interdisciplinary consultations and differential diagnoses. Chronic venous disease treatment does not seem to have an absolute significance in lower extremity edema. But, vascular specialists play the role of a control tower in diagnosing lower extremity edema.
  • Original ArticleJune 30, 2023

    0 44 193
    Objective: This study aimed to determine the correlation between nocturnal leg cramps and duplex ultrasound scanning (DUS) findings in patients with lower-extremity chronic venous disease with incompetent saphenous veins.
    Methods: A total of 1668 limbs from 888 patients with signs and symptoms of chronic venous disease (CVD) were evaluated using DUS from April 2017 to December 2020. Limbs with saphenous vein reflux were selected for this study. Patients with a history of treatment for varicose veins, including sclerotherapy, were excluded from the study. The clinical data and DUS results were obtained retrospectively from medical records and analyzed.
    Results: Nine hundred and forty limbs from 582 patients were included in this study, 66% were female patients, and the mean age was 55 (19∼86) years. There were no statistically significant differences in the distribution of sex, laterality, and CEAP clinical stage between the legs with or without nocturnal leg cramps. Age and body mass index were significantly different between legs with and without nocturnal leg cramps (p=0.02 for age and p=0.03 for BMI), but the correlations were weak (Cramer’s V=0.11 for age and 0.08 for BMI). The distribution of incompetent saphenous veins, deep vein insufficiency, and the diameter and reflux duration of incompetent saphenous veins did not correlate with nocturnal leg cramps.
    Conclusion: Nocturnal leg cramps were not correlated with the distribution of valve failure in the venous system of the lower extremities.
  • 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
    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.
  • Brief communicationJune 30, 2023

    0 49 167

    Vascular Pain - Pain in Venous Disease

    Mi Jin Kim, M.D.

    Ann Phlebology 2023; 21(1): 37-39
    The pain associated with such issues with venous blood flow is expressed in various ways. Such pain in venous insufficiency is voiced as the main reason for decreased quality of life in patients. However, the exact cause of venous pain, which appears in various aspects, is unknown. Therefore, It is not easy to understanding venous pain yet. More research on this is expected to be needed in the future.

Annals of Phlebology