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Placebo controlled efficacy of class 2 elastic stockings (23-32 mmHg) in reduction of edema in CVI of the lower limbs
No full textAim. The aim of the study is to compare the efficacy of class II below-knee compression stockings MCS (BSN medical-Jobst® UltraSheer RAL, pressure at the ankle 23 to 32 mmHg) to that of placebo stockings PS (pressure at the ankle 3 to 6 mmHg) in reducing venous edema of the lower limbs in patients consulting in general practice for CVI stage CEAP 3. Methods. A 1-week randomized, placebo-controlled clinical trial comparing the efficacy of MCS to that of PS in reducing venous edema of the lower limb (stage CEAP 3). Treatment efficacy was assessed by the following criteria: the thickness of the subcutaneous tissue with the presence of edema at the ankle (point Bl) and the calf (point C) measured by duplex scan sonography (probe 6-10 mHz); the circumferences of the ankle (point Bl) and the calf (point C). Practicability of use of the MCS compared with the treatment with the PS, including treatment time to reduce oedema, comfort/ discomfort, assessment of tolerability (VAS and modified Venkatraman questionnaire). Data were analyzed using SPSS 13.01 (SPSS, Inc., Chicago, IL, USA), Chi Square test and Student t-tests. Results. Edema was significantly reduced after 3 days of treatment with MCS: 22 patients (84.6%) had no oedema. A further improvement occurred between days 3 and 7 for the MCS treatment groups, edema was reduced in 25 patients (96.2%). The mean time of edema reduction is 3,5 days for MCS. MCS is effective to reduce leg circumference and subcutaneous thickness at point Bl and C, the mean reduction of circumferences at point Bl was 3.4 cm, at point C was 1,23 cm. PS is unable to reduce oedema, leg circumferences and subcutaneous thickness. The differences between the two treatment groups are statistically significative in favour to MCS. Conclusion. Our placebo-controlled clinical trial comparing the efficacy of MCS to that of PS shows that compression stockings (23-32 mmHg at the ankle) are effective and well tolerated in the treatment phase of oedema
Selective high ligation of the sapheno-femoral junction decreases the neovascularization and the recurrent varicose veins in the operated groin
No full textAim: High ligation (HL) and stripping of GSV can be distinguished in Babcock's radical ligation (RHL), and selective (SHL): the new technique consists to ligate the SFJ keeping some of the tributary veins. The study analyzes the neovascularization and recurrence incidence in the groin after the SHL Methods: A retrospective study performed in a center specialized in venous surgery in Italy, it included 360 patients underwent unilateral varicose vein surgery from January 2001 to December 2008 (210 females and 150 males, mean aged 51.9 years, range 18 to 75 years, the limbs were 222 rights and 138 lefts), CEAP classification was C2,s. Operative technique was standardised to SFJ ligation with the SHL, the GSV was stripped to the level of the knee, multiple phlebectomies were performed and the ligation of the incontinent perforating veins was performed if it was necessary. All patients had a venous reflux from terminal valve of SFJ and the femoral valves were continent. All patients were submitted to clinical examination of the lower limbs and Duplex Scanning (DS) in the pre/postoperative period every year after surgery and by two independent operator in 2013. The follow-up is from 5 years for the patients operated in 2008 to 12 years for the patients operated in 2001. Results: The neovascularizations and recurrencies in the groin were founded in 7 patients, the incidence is 1.9% of the total cases. The GSV stump and the left tributaries were open to venous flow, it was no venous reflux from the groin, no venous thrombosis of the GSV stump were detected. Conclusion: The SHL of the SFJ is a reliable technique, decreasing the incidence of neovascularizations and recurrent varicose veins in the operated groi
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