Aim. The aim of this cross-sectional prospective study was investigate whether there is a correlation between age, BMI and severity of chronic venous disease (CVD), evaluated clinically (CEAP classification) and anatomically (extent of the epifascial venous reflux).Methods. 213 patients, 65 males (30.5%, mean age 45.1±13.9 years) and 148 females (69.5%, mean age 47.5±13.5 years) were divided into three age categories: 18-40 years (40.8%), 41-74 years (56.3%) and ≥75years (2.8%). BMI was classified as normal weight (18.5 -<25 kg/m 2 ), overweight (25 -<30 kg/m 2 ) and obesity (≥30 kg/m 2 ). Clinical examination of the lower limbs assessed presence and severity of venous signs as included in the CEAP classification. BMI was calculated. Anatomical extent of CVD was described as the number of segments of the superficial and perforating veins with documented reflux by duplex imaging.Results. Median age increased the number of insufficient venous segments (1 insufficient venous segment -median age 41.0 years, 5 insufficient venous segments -median age 51.0 years). The frequency of reflux in the superficial and perforating veins sign i ficantly increased with age (p<0.05). A statistically significan correlation was also found between age and the CEAP classification (p<0.01). This was more significant than the correlation between age and number of insufficient venous segments. In the whole group and in women the Spearman's correlation analysis revealed only a weak positive correlation between BMI and reflux in the superficial veins (r=0.145 respectively r=0.264) (p<0.05). No correlation was found in men (r=0.091). Weak positive correlation between BMI and stage of venous insufficiency (CEAP classification) was demonstrated for the whole group of patients (r=0.229, p<0.01), for women (r=0.293, p<0.05) and for men (r=0.245, p<0.01). Multiple linear regression showed age (p<0.0001) and BMI (p=0.049) as significant predictors of clinical grade according to the CEAP classification and the CEAP clinical class (p<0.0001) as a significant predictor of extent of the epifascial venous reflux.Conclusions. The study confirmed the relationship between age, clinical (CEAP clinical class) and pathophysiological (extent of the venous reflux) severity of CVD. Older age means an increased number of insufficient venous segments and increased risk of the clinical progression of CVD from varicose veins to chronic venous insufficiency (C 3 -C 6 , trophic skin changes and venous ulcers). Our results support the BMI, in term of frequency of venous reflux, as a risk factor in the whole group of patients but only in women but not in men. Multiple linear regression showed BMI together with age as significant predictors of clinical grade of CVD (p<0.05) according to the CEAP classification. As regards the influence of BMI on clinical severity/grade of CVD (CEAP), the results of our study support BMI as an important risk factor.

Aims This study was aimed to investigate the prevalence of venous thromboembolism in patients with chronic venous disease and the impact of some intrinsic and extrinsic risk factors. Methods A retrospective study on 641 outpatients (489 women) with primary chronic venous disease (C-C). The prevalence of venous thromboembolism was evaluated according to sex, age, BMI, the presence of ≥1 first-degree siblings diagnosed with venous thromboembolism, CEAP clinical class, smoking and the use of hormone therapy. Results Venous thromboembolism episodes occurred in 32 patients (5%) with no gender predominance (OR 1.49, 95% CI = 0.90-2.45; p = 0.146). There was no increased RR of venous thromboembolism in the age group 46-69 years compared with patients aged ≤45 years ( p = 0.350). In persons aged ≥70 years, the risk of venous thromboembolism was 3.2 times higher than in patients aged 46-69 years and 4.78 times higher than in patients aged ≤45 years. The risk of venous thromboembolism rose very significantly in obese compared with normostenic patients ( p = 0.002). There were significantly more venous thromboembolism episodes in patients with chronic venous insufficiency (55.3%) than patients with varicose veins (44.7%) ( p < 0.001). A family history of venous thromboembolism ( p = 0.12), smoking ( p = 0.905) and hormone therapy ( p = 0.326) were not associated with increased risk of venous thromboembolism. Smoking was a risk factor in obese patients ( p = 0.033), but the combination of obesity, smoking, estrogens in women did not increase the risk of venous thromboembolism. Conclusions The 5% prevalence of venous thromboembolism episodes in patients was comparable with the prevalence of venous thromboembolism in the general European population. Age ≥70 years and obesity were strongly associated with an occurrence of venous thromboembolism. Obese patients with chronic venous disease were at higher risk for venous thromboembolism than obese people in the general population. A family history of venous thromboembolism, smoking and estrogens alone or in combination were not revealed as significant risk factors.

Summary:Background: Primary chronic venous disease (CVD) is associated with an increased risk of superfi cial vein thrombosis (SVT). While CVD is a predominant factor in SVT, there is a range of additional predisposing factors. The objective was to investigate the association between age, gender, BMI, smoking, oestrogen hormone therapy, family history of venous thromboembolism (VTE) and CEAP clinical classifi cation in patients with CVD and a history of SVT. Patients and methods: In a retrospective observational study on consecutive patients with primary CVD, 641 outpatients were enrolled (152 men, 23.7 %; 489 women, 76.3 %). The prevalence of SVT was evaluated according to age, BMI, smoking, presence of family history of VTE, use of hormone therapy, and clinical class of CVD. Results: Risk of SVT was signifi cantly increased in women (OR 1.68, 95 % CI = 1.02 -2.76; p = 0.041), older patients (46 -69 years, OR 1.57, 95% CI = 1.03 -2.4; p = 0.036, ≥ 70 years, OR 2.93, 95 % CI = 1.5 -5.76; p = 0.001), smokers (OR 1.69, 95 % CI = 1.1 -2.58; p = 0.015) and in persons with fi rst-degree siblings diagnosed with VTE (OR 2,28, 95 % CI = 1.28 -4.05; p = 0.004). The risk was signifi cantly increased in older male smokers (p -0.042). In women, smoking and oestrogen therapy (p = 0.495) did not increase the risk of SVT even older women or in those with increased BMI. In CVD (C0 -C3), a history of episodes of SVT was found in 103/550 (18.7 %), in chronic venous insuffi ciency (CVI) in 27/91 (29.7 %). There was a signifi cantly higher prevalence of SVT in patients with CVI (OR 1.70, 95% CI = 1.1 -2.5; p = 0.016). Conclusions: In patients with primary CVD, SVT was signifi cantly associated with female gender. In men, older age, smoking and positive family history of VTE were relevant SVT risk factors. In women, risk factors were older age, BMI ≥ 25 kg/m 2 and positive family history of VTE. Compared with C0 -C3 clinical classes, CVI signifi cantly increases the risk of SVT.

Aim:This study was performed to assess the contribution of the width of the anechogenous lumen of the great saphenous vein (GSV) in the groin measured by ultrasound (US) to the diagnostics of haemodynamically signifi cant refl ux (HSR) in the sapheno-femoral junction (SFJ).Methods: We examined 200 lower limbs with primary varicose veins in 182 patients. Duplex scanning was performed with the patients in the supine position. Longitudinaly imaging (B-mode) the inner anechogenous diameter of GSV was measured 4-5 cm distal to SFJ. PW Doppler sampling volume was placed at the same distance. The refl ux was elicited by Valsalve manoeuvre. The HSR was defi ned as a backfl ow lasting ≥ 1 s with a velocity of Vmax ≥ 10 cm/s.Results: The mean width of the GSV with HSR (n=152) was 6.39 mm, median 6.0 mm, SD ± 2.21 mm. The mean width of GSV without HSR (n = 48) was 4.41 mm, median 4.4 mm, SD ± 0.96 mm. The diff erence between the mean widths of GSV was statistically signifi cant (p < 0.01). In GSV < 5 mm (n = 77) HSR (V max ≥ 10 cm/s) was confi rmed in 46 cases (59.7 %), in GSV ≥ 5 mm (n = 123) in 106 cases (86.2 %). The sensitivity of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 69.7 %, specifi city 64.6 %. PPV (positive predictive value) of dilatation of GSV ≥ 5 mm for the presence of HSR in SFJ was 86.2 %, NPV (negative predictive value) was 40.3 %, and the diagnostic accuracy of dilatation of GSV ≥ 5 mm was 68.5 %.Conclusions: Measurement of anechogenous lumen GSV under the groin in B-mode is less sensitive (69.7 %) and less specifi c (64.6 %) in the diagnostics of HSR in SFJ. Only 68.5 % of all measurements of the width of the GSV below the groin in B-mode provided accurate indirect assessment of the functions of valves in SFJ. US scanning of the width of anechogenous lumen of GSV below the groin may serve only for ancillary examination. INTRODUCTIONIn ultrasound examination for venous insuffi ciency of the lower extremities we use duplex scanning to assess the function of venous valves and search for the refl ux. Morphological evaluation of the vein in B-mode (when we focus on the measurement of the anechogenous venous lumen) is only secondary. In case of venous dilatation we consider venous insuffi ciency. Sometimes it is possible to scan venous valves, their motility and reaction to Valsalva manoeuvre or manual compression. However, minor venous valves are diffi cult to scan. The new generation of ultrasonographic devices makes it possible to follow their function and blood-fl ow under both physiological and pathological conditions 12 . In lower extremities with primary varicose veins we can observe insuffi ciency of the sapheno-femoral junction (SFJ) most frequently 7,15 . The cause of trunk varices of the great saphenous vein (GSV) is refl ux in the terminal and preterminal valves in the sapheno-femoral junction 3 . Recent work has already evaluated the relation between the width of GSV and the occurrence of the refl ux in SFJ, and found a statistically

Cévní centrum, I. interní klinika -kardiologická FN a LF Olomouc Jednou z nejzávažnějších komplikací akutní infekce je žilní tromboembolická nemoc (TEN). Ke vzniku žilní trombózy dochází prozánětlivou reakcí organismu a aktivací lokální a systémové koagulace. Prozánětlivou odpovědí je tvorba prozánětlivých cytokinů a proteinů komplementového systému. Aktivace lokální a systémové koagulace se odvíjí od exprese tkáňového faktoru (TF) na endotelových buňkách a monocytech/makrofázích, od aktivace trombocytů a neutrofilů. Klíčovou roli při vzniku trombózy má tkáňový faktor (TF). Proniknutí infekce do organismu vede k tvorbě komplexu TF -f.VIIa na buněčných površích i v krevním oběhu, který zahajuje iniciální fázi koagulace aktivováním faktorů IX a X. Syntézu a expresi TF na endotelových buňkách a monocytech stimulují bakteriální lipopolysacharidy. U akutních nozokomiálních a komunitních infekcí riziko TEN výrazně narůstá 2-4 týdny od začátku onemocnění, potom postupně klesá, ale zůstává významně zvýšené v průběhu celého roku. S nejvyšším rizikem TEN jsou spojené respirační infekce. Pro tromboprofylaxi u pacientů hospitalizovaných s akutní infekcí, akutním interním onemocněním komplikovaným nozokomiální infekcí a u kriticky nemocných pacientů s infekcí, včetně pacientů s covid-19, stále platí ACCP doporučení z roku 2012 o podávání profylaktických dávek LMWH, UFH nebo fondaparinuxu, které bylo aktualizováno expertním panelem v roce 2020. DOAC ani protidestičkové léky se nedoporučují.