Vulval Varicose Veins During Pregnancy
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Varicose veins are one of mankind's commonest afflictions. Physicians are confronted frequently by varices and their complications. Varicosities of pregnancy have a distinct pattern which is quite different from the varices in nonpregnant individuals. The varicose veins usually appear during the second or third month of pregnancy and become progressively larger until the last trimester. They may be unilateral or scattered over both thighs and legs. They frequently involve the vulva. The importance of pregnancy is emphasized by the fact that 62% of the women attending a varicose vein clinic first sought medical advice because of pregnancy, and the varicosities were diagnosed as incidental findings.1Susceptible individuals develop progressively larger varices with each succeeding pregnancy. The veins have a characteristic scattered distribution and give the appearance of multiple incompetent perforators. Varices can become huge after multiple pregnancies. If the varicose veins of pregnancy are effectively compressed, all symptoms andKeywords:
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Objectives/Hypothesis To establish risk of hemorrhage in patients with varices compared to those without, determine additional risk factors, and make evidence‐based treatment recommendations. Study Design Retrospective cohort study. Methods Patients who were vocal performers presenting for care during a 24‐month period were analyzed to determine incidence of hemorrhage. Patients with varices were compared to those without. Demographic information and examination findings (presence, location, character, and size of varices; presence of mucosal lesions or paresis) were analyzed to determine predictors of hemorrhage. Results A total of 513 patients (60.4% female, mean age 36.6 years ± 13.95 years) were evaluated; 14 patients presenting with hemorrhage were excluded. One hundred and twelve (22.4%) patients had varices; 387 (77.6%) did not. The rate of hemorrhage in patients with varices was 2.68% at 12 months compared to 0.8% in patients without. Cox proportional hazard regression analysis revealed a hazard ratio of 10.1 for patients with varix developing hemorrhage compared to nonvarix patients ( P < 0.0001). The incidence rate of hemorrhage was 3.3 cases per 1,000 person‐months for varix patients compared to 0.5 cases per 1,000 person‐months in the nonvarix group. There was no significant difference in the incidence of paresis, mucosal lesions, location of varix (left or right side; medial or lateral), or varix morphology (pinpoint, linear, lake) between patients who hemorrhaged and those that did not. Conclusion The presence of varices increases the risk of hemorrhage. Varix patients had 10 times the rate of hemorrhage compared to nonvarix patients, although the overall incidence is low. This data may be used to inform treatment of patients with varices. Level of Evidence 4. Laryngoscope , 126:1163–1168, 2016
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Gastric varices
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Gastric varices
Liver disease
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To assess whether Valsalva9s manoeuvre might cause variceal bleeding, 22 patients with oesophageal varices were studied. In 12 patients who received no previous treatment to their varices the median pressure gradient across the varix wall at rest was 19 (6-36) mmHg, and in 10 patients whose varices were thrombosed at their distal end the median pressure gradient in the proximal patent varix was 8 (1-6) mmHg. In untreated patients groups, the pressure gradient rose by 6-12 mmHg during Valsalva9s manoeuvre in four patients, fell by 4-11 mmHg in five patients and was virtually unchanged in the remainder. These changes seem unlikely to cause variceal bleeding. Patients who repeated Valsalva9s manoeuvre showed similar changes on each occasion. Six patients in the untreated group also received hyoscinbutylbromide 20 mg iv. No change was seen in the pressure gradient in five patients, suggesting that it is of little value in preventing variceal bleeding.
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Pressure gradient
Valsalva maneuver
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A rare case of giant cerebral varix with venous angioma and intracerebral hemorrhage, surgically treated with good outcome, is reported. Varices and venous angiomas are infrequent in the clinical practice and are usually asymptomatic. Giant venous varices are less rarely associated with vein of Galen aneurysms or high flow arteriovenous shunts, whereas isolated giant varices are exceptional. Association of varix and venous angioma has been reported only in three instances. The radiological diagnosis of the cerebral venous malformation is briefly discussed.
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Vascular malformation
Arteriovenous malformation
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AIM The advanced CEAP classification allows one to differentiate between isolated varicose veins (C2) and complicated varicose veins (C2, 3 - C2, 3, 4 - C2, 4 or C2, 3, 4, 5 etc) named (C2+). METHODS The main objective of this study was to identify when using the advanced classification the prevalence of isolated varicose veins (C2) and complicated varicose veins (C2+) among patients consulting vascular specialists and to compare their symptomatic status and the data issued from the advanced CEAP including also the headings, Anatomy (A), Etiology (E) and Pathophysiology (P). RESULTS 171 patients were evaluated, 100 in France and 71 in Italy. The prevalence of C2 and C2+ was the same in both countries: 64.4% in France and 63.3% in Italy. Also no difference was found in the prevalence of other descriptors: etiology, anatomy or pathophysiology. The time to complete the advanced form was less than 5 minutes for 65% of the investigators. CONCLUSION The advanced CEAP is easy to use in daily pratice. We have the same prevalence of patients in France and in Italy, who consulted for isolated varicose veins or associated with other signs of chronic venous disorders.
Etiology
Chronic Venous Insufficiency
Pathophysiology
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An examination was made of 10 samples of the great saphenous vein, removed from persons without varices and serving as the control group. A further 20 samples of typical varices, as well as 20 samples of normal veins obtained from persons with varices, were examined. The venous walls were tested for activities of certain hydrolytic enzymes and dehydrogenase systems. In both the varicose veins and the normal veins obtained from persons with varices it was found that structural changes occur and histochemical tests show a marked increase in the activity of acid phosphatase and decreased activities of malate dehydrogenase, non-specific esterase, ATPase, and 5-nucleotidase. An increased activity of the lactate dehydrogenase was found only in 55 % of the cases. In normal veins obtained from persons with varices, these changes were less pronounced. The layer of the circular muscle cells of the media is the zone of a varicose vein which sustains the heaviest damage.
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We incidentally hypothesized that placing Kinesio tapes over the bulging varicose veins patients had immediate clinical benefit. Refilling Time prolongation after taping seems the explanation of this effect. Fifteen patients were investigated via a clinical questionnaire and photoplethysmography trying to demonstrate the possibility of this type of temporary selective varices compression as a conservative treatment of varicose veins incompetence syndrome. The results were very encouraging suggesting a rapid divulgation of this simple and cheap method.
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Varicose veins are one of mankind's commonest afflictions. Physicians are confronted frequently by varices and their complications. Varicosities of pregnancy have a distinct pattern which is quite different from the varices in nonpregnant individuals. The varicose veins usually appear during the second or third month of pregnancy and become progressively larger until the last trimester. They may be unilateral or scattered over both thighs and legs. They frequently involve the vulva. The importance of pregnancy is emphasized by the fact that 62% of the women attending a varicose vein clinic first sought medical advice because of pregnancy, and the varicosities were diagnosed as incidental findings.1Susceptible individuals develop progressively larger varices with each succeeding pregnancy. The veins have a characteristic scattered distribution and give the appearance of multiple incompetent perforators. Varices can become huge after multiple pregnancies. If the varicose veins of pregnancy are effectively compressed, all symptoms and
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