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Since 1981, Vein Clinics of America has been committed to furthering the advancement of research within the field of varicose vein disease. Please feel free to read through our published research.

Restless Legs Syndrome & Chronic Venous Disorders

The conclusion of this study was that patients who suffer from Restless Legs Syndrome typically have other venous leg disorders such as venous insufficiency and chronic venous disorders.

Restless legs syndrome in patients with chronic venous disorders: an untold story

McDonagh B*, King T+, Guptan RC++ *Illinois Phlebology group; + Indiana Phlebology; ++The Department of Clinical Research, Venous Research Foundation, Schaumburg, IL, USA.

Objectives: To perform a prospective study of the occurrence of Restless Legs Syndrome (RLS) in patients who are evaluated in a phlebology practice.

Methods: A prospective questionnaire and clinical evaluation were used. In total, 174 consecutive patients and 174 matched controls were included in the study. The International RLS Study Group (IRLSSG) 4-point criteria were used to objectively establish the diagnosis of RLS. The symptom severity of those who had RLS was assessed with the 10-point IRLSSG severity questionnaire. Detailed history, physical, and Duplex ultrasound evaluations were performed to establish the presence or absence of venous insufficiency (reflux > 0.5 seconds on compression/augmentation) and chronic venous disorder (CVD), according to current clinical, etiologic, anatomic, and pathologic (CEAP) criteria.

Results: Of the 174 consecutive patients studied (22M: 152F), 63 (36%) met the clinical criteria for having RLS. This compared with only 34 of 174 (19%) in the control group (P<0.05). In the RLS-positive study group, 62 of 63 (98%) were found to have venous insufficiency and CVD. By comparison, 31 of 34 (91%) of the RLS-positive control group were found to have CVD. Thus, the prevalence of CVD in both the RLS-positive study and control groups was similar; however, this was significantly more than the prevalence of CVD in the RLS-negative controls (P<0.01). There were only 3 (9%) of the RLS-negative controls who had CVD. RLS-positive patients were typically women (P<0.01 vs. men) who were more than 40 years of age (P<0.01 vs. less than 40). It should be noted that a history of leg cramps was significantly more common in the RLS-positive patients (P<0.01). It should also be noted that none of the RLS patients gave a history of anemia, chronic renal failure, or had an established psychiatric or neurologic disorder that others have described as being highly associated with the diagnosis of RLS.

Conclusion: RLS appears to be a clinical syndrome that commonly overlaps in patients with venous insufficiency and CVD. Prospective, blinded therapeutic trials are underway to evaluate the effect of definitive treatment for CVD on sequential RLS scores.

Endovenous Laser Treatment

This research tested the effectiveness of endovenous laser treatment with ultrasound-guided foam Sclerotherapy in unhealthy small saphenous veins and great saphenous veins, which are large leg veins. 100 percent of the patient participants who underwent a combination of both treatments reported an elimination of reflux within one to five months and an improvement in their quality of life. A study with additional cases and more long-term follow-up is in progress.

International Angiology 2005; 24:151

Efficacy Of Endovenous Laser Treatment With Ultrasound-guided Foam Sclerotherapy In Small Saphenous and Non-Great Saphenous Reflux

King T1, Eaton T2, Featherston M3, Cohen A1, Sorenson S1, Schul M4, Putterman P3, Harry JL1, Vayuvegula S1, McDonagh B1, Guptan RC5. Illinois Phlebology Group1, Wisconsin Phlebology Medical Group2, North Carolina Phlebology3, Indiana Phlebology4 and Venous Research Foundation5, USA.

Background: Endovenous Laser Treatment (ELT) has proven to be an effective alternative to stripping and ligation surgery for Great Saphenous Vein (GSV) reflux. However, the use of ELT in the treatment of Small Saphenous Vein (SSV) reflux has been limited due to laser fiber size requirements and the higher prevalence of anomalous anatomical presentations of the SSV compared to the GSV.

Method: In this prospective series (n=29), 21 SSV’s, four Antero-lateral branches and four Postero-medial branches of the GSV were treated with ELT and ultrasound-guided foam sclerotherapy. All patients had physical evidence of chronic venous insufficiency (CVI) with a CEAP clinical class of C1-6. The Aberdeen venous score was used to assess the quality of life of the study patients.

Conclusion: All the patients (100%) had sustained elimination of reflux (range: one-five months) and improvement in their quality of life. The combination of ELT and ultrasound-guided foam sclerotherapy demonstrates a successful adaptation of two treatment modalities that safely and effectively treats the SSV and larger tributaries of the GSV. A study with additional cases and more long-term follow-up is in progress.

Venous Stasis Ulcer 2005

This study found that below-the-knee compression therapy combined with sequential duplex ultrasound-guided sclerotherapy is highly effective for venous stasis ulcer management.

Phlebology 2005; 20:2 (The official Journal of the Venous Forum of the Royal Society of Medicine and Societas Phlebologica Scandinavica, Members of the Union Internationale de Phlebologie)

B. McDonagh1, S. Sorenson1, A. Cohen1, T. Eaton1, D.E. Huntley1, M. Schul1, C. Martin1, C. Gray1, P. Putterman1, T. King1, J.L. Harry1, R.C. Guptan2 1Illinois Phlebology Group, Chicago, Illinois, USA and 2Department of Clinical Research, Venous Research Foundation, Schaumburg, Illinois, USA

Objectives: Venous stasis ulcer is a major public health problem in the U.S. Subcutaneous endoscopic perforator surgery, tissue graft, hyperbaric oxygen and granulocyte-macrophage colony-stimulating factor therapy have remained experimental. There is a need for effective minimally invasive therapies. Non-elastic, ambulatory, below knee (BK) compression aggressively counters the impact of reflux on venous pump failure and is complemented by sequential duplex ultrasound-guided sclerotherapy.

Methods: Eighteen U.S. centers were studied retrospectively. 1,142 leg ulcer cases from 1984 to 2004 were available. Inclusion: CEAP class 6, evidence of chronic venous insufficiency, photograph, treated with non-elastic, ambulatory, BK compression and sequential duplex ultrasound-guided sclerotherapy. Exclusion: Arterial disease, DM and varicose surgery.

Outcomes assessment: CEAP classification, sustained healing (>6 months), DVT and amputation incidence. Comprehensive objective mapping (Phlebology 2003; 4:173-185) was used to quantify reflux.

Results: To date, data from 123 patients is available (62M: 61F). The sexes were comparable in age. The mean duration of ulceration was 4.98 months. Most ulcers, 101 (82%), were in the gaiter area. Non-elastic, BK, ambulatory compression was applied every 2.7 days for 4.7 months. In a majority of active ulcers, 75/103 (73%) showed evidence of healing after compression. After 5 sclerotherapy treatments 86/103 (83%) had sustained healing. None had DVT or required amputation at the last follow up but 23/103 (22%) had recurrent reflux, which required sequential duplex ultrasound-guided sclerotherapy.
Conclusion: Non-elastic, BK, ambulatory compression with sequential duplex ultrasound-guided sclerotherapy appears to be highly efficacious in venous stasis ulcer management. A detailed survey is planned to estimate long-term outcomes.

Klippel-Trenaunay Syndrome

This study demonstrated the effectiveness of sequential ultrasound-guided foam sclerotherapy to manage KTS, a circulatory disorder characterized by abnormal growth on the skin consisting of masses of blood vessels, arteriovenous abscesses and varicose veins.

Phlebology 2005; 20:63-81. (The official journal of the Venous Forum of the Royal Society of Medicine and Societas Phlebologica Scandinavica, Members of the Union Internationale de Phlebologie)

B. McDonagh*, T. King*, S. Sorenson*, A. Cohen*, T. Eaton*, D. E. Huntley*, S. La Baer*, K. Campbell*, and R.C. Guptan^ *Illinois Phlebology Group, Schaumburg, Illinois, USA and ^Department of Clinical Research, Venous Research Foundation, Chicago, Illinois, USA

Objectives: To study the clinical presentation of patients with Klippel-Trenaunay syndrome (KTS) and the management of their venous malformations (VMs)/varicose veins with ultrasound-guided foam sclerotherapy using the compass technique.
Methods: In this open prospective series, there were eleven consecutive patients seeking treatment for KTS at a multi-site Phlebology group practice. Seven (64%) of the patients had had previous surgical vein treatment procedures.

Results: The most common presenting complaint (100%) was pain. All but one patient (91%) presented with VMs/varicose veins. Chronic venous insufficiency (CVI) was seen in seven (64%). Soft tissue and bone deformity was present in all (100%). Limb lengthening was seen in eight (73%); limb thickening occurred in six (54%). A very unusual presentation was seen in one patient (9%) who had severe thinning and shortening of the leg. The primary vascular problem was venous malformation and was seen in nine patients (82%). This was followed by capillary malformation (CM)/port wine stain in seven (64%) and isolated lymphatic malformation (LM) in two (18%). The lateral embryonic Klippel-Trenaunay (KT) vein was detected in 10 patients (91%). Deep vein deformity was not detected in any of them. All of the patients had vascular deformities of the lower limb (100%); two (18%) had deformities of the thorax and one (9%) had a gastrointestinal (GI) malformation. None of the patients were aware of a history of KTS in their families; however, five (45%) had a family history of varicose veins. Eight patients (73%) completed the therapeutic plan and had a mean follow-up of 5 ± 3.9 years. Six of these eight patients (75%) felt that they had good-to-excellent results from their treatment. They described their quality of life as being good. Their therapeutic course was uneventful. Follow-up duplex ultrasound evaluation was used to reveal any evolving refluxing tracts that required further sequential treatment.

Conclusions: The results in this series demonstrate the effectiveness of sequential ultrasound-guided foam sclerotherapy using the compass technique in the management of KTS. The chronic nature of the VMs in KTS makes strict clinical monitoring and sequential treatment a necessity.

REVAS: Recurrent Varices After Surgery

This study examined the effects of invasive veins surgery, especially vein stripping. By studying 168 patients who suffered from REVAS, or Recurrent Varices After Surgery, the study found that Repeat surgery fails in 50 to 80 percent of cases. A lasting reduction in patients’ venous dysfunction scores suggests that the COMPASS technique appears to be more effective than currently available surgical approaches in the long-term management of REVAS.

Phlebology 2003;18:173-86 (The official journal of the Venous Forum of the Royal Society of Medicine and Societas Phlebologica Scandinavica, Members of the Union Internationale de Phlebologie)

B. McDonagh*, S. Sorenson*, C. Gray*, D.E. Huntley*, P. Putterman*, T. King*, T. Eaton*, C. Martin*, J.L. Harry*, A. Cohen* and R.C. Guptan† *Illinois Phlebology Group, Schaumburg, Illinois, USA; †Department of Clinical Research, Venous Research Foundation, Chicago, Illinois, USA.

Objectives: To study the efficacy of ultrasound-guided sclerotherapy using the COMPASS (comprehensive objective mapping, precise image-guided injection, anti-reflux positioning, and sequential sclerotherapy) technique in the management of recurrent varices after surgery (REVAS) and determine its impact on the venous dysfunction scoring of the treated patients.

Methods: A prospective open study involving 168 consecutively treated patients (253 limbs) with REVAS who had originally been treated with surgery for their varicose disease. Follow up was 1.5-5.7 years (mean: 3.1+/-1.7 years).

Results: REVAS presented most commonly in women in their fifties who had symptoms related to their chronic venous disease and complications due to chronic venous insufficiency (CVI). The COMPASS technique attained sustained obliteration in 97% of varices in the groin. There was 100% obliteration of isolated refluxing veins in the thigh and around the popliteal fossa. The cumulative obliteration rate, including obliteration of perforator reflux, was greater than 90%. Decrease in venous dysfunction scoring (anatomical, clinical, and disability) was significant. No serious adverse sequelae were observed.

Conclusions: REVAS is a symptomatic chronic venous disease that requires skilled medical care. It is a major complication of varicose vein surgery, especially vein stripping. Repeat surgery fails in 50-80% of cases. The etiology of REVAS is poorly understood and minimally invasive therapeutic options have not been well studied. The COMPASS technique achieved sustained obliteration in 97-100% of recurrent varices. A lasting reduction in patients’ venous dysfunction scores suggests that the COMPASS technique appears to be more effective than currently available surgical approaches in the long-term management of REVAS.

Correspondence: Dr. Amy Leigh Davis, DBA, MBA, Clinical Research Specialist, 1901 Butterfield Road, Suite 220, Downers Grove, IL 60515, USA.

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