Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part II

Nicolaides, Andrew; Kakkos, Stavros K.; Bækgaard, N; Comerota, Anthony J.; Maeseneer, M. De; Eklöf, B; Giannoukas, Athanasios D.; Lugli, Marzia; Maleti, Oscar; Mansilha, Armando; Myers, Kenneth A.; Nelzén, Olle; Partsch, Hugo; Perrin, Michel

doi:10.23736/s0392-9590.20.04388-6

Cited by 136 publications

(175 citation statements)

References 171 publications

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“…Chronic venous disease (CVD) is one of the most prevalent diseases worldwide. Varicose veins (Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification class C2; see Table 1) are present in 25-40% of adults, depending on risk factors [1], whereas the more serious condition of chronic venous insufficiency (CVI; CEAP C3-C6) has a prevalence 17-20% [1,2]. CVD tends to worsen over time, especially if left untreated.…”

Section: Key Summary Pointsmentioning

confidence: 99%

“…Aberrant hemodynamics and reflux activate the venous endothelium, leading to infiltration of activated leukocytes into the vein walls and surrounding tissues, where inflammatory cytokines and mediators are released [4]. These events, along with persistent vein dilatation, lead to further Options for management of patients at the early stages of CVD (C0s to C2) include venoactive drugs (VAD), which may be used alone or in conjunction with interventional treatment of varices such as sclerotherapy, surgery, or endovenous treatments [1]. Management objectives for patients with CVD are to alleviate venous symptoms and signs, break the inflammatory cascade, and prevent progression into a higher CEAP clinical class.…”

Section: Key Summary Pointsmentioning

confidence: 99%

“…It improves CVD symptoms, venous tone, skin trophic disorders and quality of life (QoL). It also reduces leg edema and speeds ulcer healing [1,4,6]. In the latest international guidelines, MPFF was given a grade 1B recommendation for overall relief of symptoms and edema associated with all CEAP classes of CVD (C0s to C6), and a grade 1A or 1B for individual symptoms, QoL (1A), and ulcer healing (1A).…”

Section: Key Summary Pointsmentioning

confidence: 99%

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Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to Endovenous Treatments

Mansilha

2020

Adv Ther

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Chronic venous disease (CVD) is one of the most prevalent diseases worldwide. The health condition of most patients with early stage CVD will worsen over time, and this progression increases the burden as well as the costs of treatment and reduces patient quality of life (QoL). This highlights the importance and the likely cost-effectiveness of treatment of patients with early stage CVD. Options for managing the early stages of CVD include lifestyle changes together with venoactive drugs (VAD); VADs may be used alone or in conjunction with interventional treatment of varices such as sclerotherapy, surgery, or endovenous treatments. Micronized purified flavonoid fraction (MPFF; Daflon Ò ) is a well-studied VAD which has anti-inflammatory activities, reduces endothelial activation and leukocyte adhesion, and increases capillary resistance and integrity, to eventually improve venous tone, CVD symptoms and QoL. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by the author.

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Section: Key Summary Pointsmentioning

confidence: 99%

Section: Key Summary Pointsmentioning

confidence: 99%

Section: Key Summary Pointsmentioning

confidence: 99%

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Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to Endovenous Treatments

Mansilha

2020

Adv Ther

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“…Различные авторы отмечают, что флавоноидные соединения целесообразно назначать в виде монотерапии [13]. За достаточно долгое время изучения поднятой в данной статье проблемы накопилось огромное число публикаций, посвященных эффективности тех или иных флебопротекторов [4,14,15]. Но на сегодняшний день единственным препаратом с экспериментально доказанной эффективностью, подавляющим лейкоцитарно-эндотелиальную реакцию, защищающим венозные клапаны, а также нормализирующим уровень простагландина (ПГ) E2, является МОФФ (микронизированная очищенная флавоноидная фракция) [13,16].…”

Section: Author Informationunclassified

“…д. ), хирургическое вмешательство, флебосклерозирующие методы и фармакотерапию флеботропными препаратами [1,4]. При этом использование лекарственных препаратов является не только неотъемлемой частью современных схем лечения, но и средством повышения толерантности венозной системы нижних конечностей к неблагоприятным факторам [5].…”

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Review of modern phlebotrophic preparations based on flavonoids as perspective endothelioprotectors in the treatment of chronic diseases of the veins

Voronkov

Gamzeleva

2019

Stacionarozameshchayushchie tekhnologii: Ambulatornaya khirurgi

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Информация об авторах Воронков Андрей Владиславовичд.м.н., доцент, заведующий кафедрой фармакологии с курсом клинической фармакологии Пятигорского медикофармацевтического институтафилиала государственного бюджетного образовательного учреждения высшего профессионального образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации;

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Randomized clinical trial of endovenous laser ablationversusdirect and indirect radiofrequency ablation for the treatment of great saphenous varicose veins

Hamann

Mik

Fritschy

et al. 2019

British Journal of Surgery

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Background The current treatment strategy for many patients with varicose veins is endovenous thermal ablation. The most common forms of this are endovenous laser ablation (EVLA) and radiofrequency ablation (RFA). However, at present there is no clear consensus on which of these treatments is superior. The objective of this study was to compare EVLA with two forms of RFA: direct RFA (dRFA; radiofrequency‐induced thermotherapy) and indirect RFA (iRFA; VNUS ClosureFast™). Methods Patients with symptomatic great saphenous vein (GSV) incompetence were randomized to receive EVLA, dRFA or iRFA. Patients were followed up at 2 weeks, 6 and 12 months. The primary outcome was GSV occlusion rate. Secondary outcomes included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) score and adverse events. Results Some 450 patients received the allocated treatment (EVLA, 148; dRFA, 152; iRFA, 150). The intention‐to‐treat analysis showed occlusion rates of 75·0 (95 per cent c.i. 68·0 to 82·0), 59·9 (52·1 to 67·7) and 81·3 (75·1 to 87·6) per cent respectively after 1 year ( P = 0·007 for EVLA versus dRFA, P < 0·001 for dRFA versus iRFA, P = 0·208 for EVLA versus iRFA). VCSS improved significantly for all treatments with no significant differences between them. AVVQ scores also improved significantly for all treatments, but iRFA had significantly better scores than dRFA at 12 months. Significantly more adverse events were reported after treatment with EVLA (103) than after dRFA (61) and iRFA (65), especially more pain. Conclusion Primary GSV occlusion rates were better after iRFA and EVLA than dRFA. All three interventions were effective in improving the clinical severity of varicose veins at 1 year.

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Management of chronic venous disorders of the lower limbs. Guidelines According to Scientific Evidence. Part II

Cited by 136 publications

References 171 publications

Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to Endovenous Treatments

Early Stages of Chronic Venous Disease: Medical Treatment Alone or in Addition to Endovenous Treatments

Review of modern phlebotrophic preparations based on flavonoids as perspective endothelioprotectors in the treatment of chronic diseases of the veins

Randomized clinical trial of endovenous laser ablationversusdirect and indirect radiofrequency ablation for the treatment of great saphenous varicose veins

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