https://www.srcv.ro/ghiduri/Managementul%20pacientilor%20cu%20boala%20venoasa%20cronica%20-%20Ghidurile%20SVS%20-%20American%20Venous%20Forum.pdf

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Méthodes : Sur une série de 31 femmes présentant des varices périnéales d’origine extrasaphéniennes ayant bénéficié d’une exploration radiologique veineuse pelvienne et de l’embolisation des veines incontinentes nous avons étudié les résultats et les corrélations anatomo-clinique entre les varices et les signes cliniques de l’insuffisance veineuse pelvienne. Un sous-groupe B de 23 patientes présentant une insuffisance veineuse pelvienne et des signes cliniques a été comparé à un groupe A de 4 patientes qui ne présentaient pas d’insuffisance veineuse pelvienne à l’exploration. Nous avons choisi d’étudier 3 signes cliniques : la douleur pelvienne et la douleur des membres inférieurs survenant au début ou pendant les règles ainsi que la dyspareunie. La symptomatologie a été évaluée sur une échelle analogique de 0 à 10 et un score clinique (de 0 à 30) a été établi en ajoutant ces 3 chiffres.

http://link.springer.com/content/pdf/10.1007/BF02973687.pdf

Références bibliographiques: La fibroscopie bronchique

https://repub.eur.nl/pub/78905/Chronic-Venous-Disease.pdf

Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS).

https://www.khanplasticsurgery.com/wp-content/uploads/2016/01/Endovenous-Laser-Treatment-of-SaphenousVein-Reflux.pdf

Endovenous laser treatment of saphenous vein reflux: long-term results.

BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.

https://www.sweathelp.org/pdf/dermatologic-su7-gdlines.pdf

A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee

https://www.jvascsurg.org/article/S0741-5214(02)27349-8/pdf

Endovenous treatment of the greater saphenous vein with a 940-nm diode laser : thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles

background. Despite the clinical efficacy of endovenous laser treatment (EVLT), its mode of action is incompletely understood.



objective. To evaluate the role of intravascular blood for the effective transfer of thermal damage to the vein wall through absorption of laser energy.



methods. Laser energy (15 J/pulse, 940 nm) was endovenously administered to explanted greater saphenous vein (GSV) segments filled with blood (n = 5) or normal saline (n = 5) in addition to GSVs under in vivo conditions immediately prior to stripping. Histopathology was performed on serial sections to examine specific patterns of damage. Furthermore, in vitro generation of steam bubbles by different diode lasers (810, 940, and 980 nm) was examined in saline, plasma, and hemolytic blood.



results. In saline-filled veins, EVLT-induced vessel wall injury was confined to the site of direct laser impact. In contrast, blood-filled veins exhibited thermal damage in more remote areas including the vein wall opposite to the laser impact. Steam bubbles were generated in hemolytic blood by all three lasers, while no bubbles could be produced in normal saline or plasma.



conclusion. Intravascular blood plays a key role for homogeneously distributed thermal damage of the inner vein wall during EVLT.

Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood.

Background. Parameters influencing failure and recanalization rates of endovenous laser treatment (ELT) of the great saphenous vein (GSV) are still to be determined.

Objective. To evaluate treatment-related parameters of ELT with respect to early failure of occlusion or recanalization of GSVs.

Methods. A series of 77 consecutive patients received ELT of 106 GSVs with continuous pullback of the laser fiber. Duplex examination was performed at 1 day, 4 weeks, and 3 months after the procedure. Clinical patient and vessel characteristics as well as technical parameters of the ELT procedure were evaluated via multiple logistic regression analysis.

Results. A median vein length of 60 cm (range of 18 to 90) was treated with a median pullback velocity of 0.6 cm/sec (range of 0.4 to 1.3), resulting in a median energy delivery of 23.4 J/cm (range of 11.8 to 35.5) and a median laser fluence of 11.8 J/cm2 (range of 2.8 to 37.3). At day 1 after ELT, 6 GSVs (6%) were not occluded. At 1 and 3 months after ELT, 9 GSVs (9%) and 11 GSVs (10%), respectively, were found open by color duplex examination. Risk factors for nonocclusion 3 months after ELT, by univariate analysis, were laser fluence, laser energy per centimeter of vein length, diameter of the vein before treatment, and distance of the thrombus to the sapheno-femoral junction at day 1 after treatment. Finally, multiple regression analysis selected laser fluence (p=0.004, odds ratio=0.40 J/cm2) as the relevant risk factor for ELT failure or recanalization.

Conclusion. ELT failure seems to be related to the administration of low laser fluences.

Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent

https://www.jvascsurg.org/article/S0741-5214(03)00420-8/pdf

Infrequent early recanalization of greater saphenous vein after endovenous laser treatment

Objective The primary objective of this study was to assess the feasibility of an endovenous cyanoacrylate (CA) adhesive implant, delivered with a catheter-based administration system engineered with a nonstick surface, for the treatment of incompetent great saphenous veins (GSVs). The primary safety end point was the rate of serious adverse events related to the procedure. The primary efficacy end point was vein occlusion during follow-up. Secondary end points included the rate of all adverse events and the change in Venous Clinical Severity Scores (VCSSs). Methods Thirty-eight incompetent GSVs in 38 symptomatic patients were treated by catheter deployment of CA under ultrasound guidance via a repetitive bolus injection algorithm. By protocol design, perivenous tumescent anesthesia and compression stockings were omitted. Duplex ultrasound imaging and clinical follow-up were performed immediately after the procedure, at 48 hours, and 1, 3, 6, and 12 months. Results The mean total volume of endovenous CA delivered was 1.3 ± 0.4 mL (range, 0.6-2.3 mL). Immediately after the procedure and at the 48-hour follow-up, the 38 patients (100%) demonstrated complete closure of the GSV. One complete and two partial recanalizations were observed during follow-up at 1, 3, and 6 months, respectively. Kaplan-Meier analysis yielded an occlusion rate of 92% at 12 months of follow-up. Side effects were generally mild and self-limited, most frequently, phlebitis in six patients (15.8%) requiring nonsteroidal anti-inflammatory drugs for an average of 5.7 days. Eight patients (21.1%) showed thread-like thrombus extensions into the common femoral vein of a mean length of 12.6 mm (range, 3.5-35 mm), which resolved spontaneously without anticoagulation. VCSS improved in all patients from a mean of 6.1 ± 2.7 at baseline to 1.5 ± 1.4 at 12 months (P  Conclusions The first human use of endovenous CA for closure of insufficient GSVs proved to be feasible, safe, and effective. Endovenous delivery of CA may prove to be an alternative for the correction of saphenous incompetence and may be used without tumescent anesthesia and medical compression stockings.

Thomas M. Proebstle

Papers

Endovenous treatment of the greater saphenous vein with a 940-nm diode laser : thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles

Thermal damage of the inner vein wall during endovenous laser treatment: key role of energy absorption by intravascular blood.

Nonocclusion and Early Reopening of the Great Saphenous Vein After Endovenous Laser Treatment Is Fluence Dependent

Infrequent early recanalization of greater saphenous vein after endovenous laser treatment

First human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence.