Venous vascular diseases – an urgent issue in clinical medicine

Czech version

Authors: P. Gavorník ^{1 3}; A. Dukát ^1,3; Ľ. Gašpar ^1,3; X. Faktorová ^1,2; E. Cikatricisová ^1,2; D. Medová ^1,2; I. Subota ^1,2; P. Sabaka ^1,3
Authors‘ workplace: II. interná klinika LF UK a UN Bratislava ¹; Prvé angiologické pracovisko II. internej kliniky LF UK a UN Bratislava ²; Angiologická sekcia Slovenskej lekárskej komory ³
Published in: Kardiol Rev Int Med 2015, 17(4): 345-353
Category: Cardiology Review

Overview

The global prevalence and incidence of chronic and acute venous vascular disease has been shown to be very high, in both industrialised and developing countries. Venous diseases of lower extremities are an integral part of the third millennium’s deadly angiopandemy. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1%) as has been assumed so far. Pelvic congestion syndrome/ varicocele is a combination of chronic symptoms, which may include pelvic pain, perineal heaviness, urgency of micturition, and post‑coital pain, caused by ovarian/testicular and/ or pelvic vein reflux and/ or obstruction, and which may be associated with vulvar, perineal, and/ or lower extremity varices/ varicocele. Among venoactive drugs, micronised purified flavonoid fraction of diosmin hesperidin remains the agent with the highest degree of recommendation and it is also indicated as pharmaceutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compression sclerotherapy with liquid or foam is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants represent one of the therapeutic and preventive options for deep venous thrombosis and venous thromboembolism with a limitation in patients with malignant conditions and in pregnancy. The most effective method is triple simultaneous pharmaco‑ kinezio‑ mechano‑ phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are also indicated to anticoagulant therapy.

Keywords:
angiology/vascular medicine – phlebology/venous medicine – vein – venous vascular disease – management – present – future

Sources

1. Nicolaides A, Kakkos S, Eklof B et al. Management of chronic venous disorders of the lower limbs. Guidelines according to scientific evidence. Int Angiol 2014; 33: 87– 208.

2. Zdravotnícka ročenka Slovenskej republiky 2012. Bratislava: Národné centrum zdravotníckych informácií 2014: 77.

3. Rabe E, Guex JJ, Puskas A et al. The VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol 2012; 31: 105– 115.

4. Gavorník P. Najčastejšie choroby vénového cievneho systému. 1. vyd. Bratislava: Univerzita Komenského 2014: 129.

5. Eklof B, Perrin M, Delis KT et al. Updated terminology of chronic venous disorders: The VEIN‑ TERM transatlantic interdisciplinary consensus document. J Vasc Surg 2011; 49: 498– 501. doi: 10.1016/ j.jvs.2008.09.014.

6. Taylor HC jr. Vascular congestion and hyperaemia; their effect on structure and function in the female reproductive system. Am J Obstet Gynecol 1949; 57: 211– 230.

7. Bekou V, Zollikofer C, Nieuwkamp N et al. A therapeutic option in nutcracker syndrome and ovarian vein insufficiency. Phlebology 2014; 29: 1– 6. doi:10.1177/ 0268355512474253.

8. Phillips D, Deipolyi AR, Hesketh RL et al. Pelvic congestion syndrome: etiology of pain, diagnosis, and clinical management. J Vasc Interv Radiol 2014; 25: 725– 733. doi: 10.1016/ j.jvir.2014.01.030.

9. Dos Santos SJ, Holdstock JM, Harrison CC et al. Ovarian vein diameter cannot be used as an indicator of ovarian venous reflux. Eur J Vasc Endovasc Surg 2015; 49: 90– 94. doi: 10.1016/ j.ejvs.2014.10.013.

10. Eklöf B, Rutherford RB, Bergan JJ et al. American Venous Forum International Ad Hoc Committee for Revision of the CEAP Classification. Revision of the CEAP classification for venous disorders: consensus statement. J Vasc Surg 2004; 40: 1248– 1252.

11. Partsch H. The role of leg compression in the treatment of deep vein thrombosis. Phlebology 2014; 29 (Suppl 1): 66– 70. doi: 10.1177/ 0268355514528128.

12. Zimmet SE, Min RJ, Comerota AJ et al. Core content for training in venous and lymphatic medicine. Phlebology 2014; 29: 587– 593. doi: 10.1177/ 0268355514545120.

13. Partsch H, Lee BB. Phlebology and lymphology – a family affair. Phlebology 2014; 29: 645– 647. doi: 10.1177/ 0268355514551514.

14. Rabe E, Breu FX, Cavezzi A et al. The Guideline group. European guidelines for sclerotherapy in chronic venous disorders. Phlebology 2014; 29: 338– 354. doi: 10.1177/ 0268355513483280.

15. Kuet ML, Lane TR, Anwar MA et al. Comparison of disease‑ specific quality of life tools in patients with chronic venous disease. Phlebology 2014; 29: 648– 653. doi: 10.1177/ 0268355513501302.

16. Van der Velden SK, Shadid NH, Nelemans PJ et al. How specific are venous symptoms for diagnosis of chronic venous disease? Phlebology 2014; 29: 580– 586. doi: 10.1177/ 0268355513515859.

17. Matic PA, Vlajinac HD, Marinkovic JM et al. Chronic venous disease: Correlation between ultrasound findings and the clinical, etiologic, anatomic and pathophysiologic classification. Phlebology 2014; 29: 522– 527. doi: 10.1177/ 0268355513497360.

18. Chi YW, Schul M, Gibson K et al. Chronic venous disorder registry: A new perspective. Phlebology 2014; 29: 415– 427. doi: 10.1177/ 0268355513484143.

19. Dharmarajah B, Lane TR, Moore HM et al. The future of phlebology in Europe. Phlebology 2014; 29 (Suppl 1): 181– 185. doi: 10.1177/ 0268355514527046.

20. Rathbun S, Norris A, Morrison N et al. Performance of endovenous foam sclerotherapy in the USA for the treatment of venous disorders: ACP/ SVM/ AVF/ SIR quality improvement guidelines. Phlebology 2014; 29: 76– 82. doi: 10.1177/ 0268355512471920.

21. Cho SJ, Lee TH, Shim KY et al. Pelvic congestion syndrome diagnosed using endoscopic ultrasonography. Phlebology 2014; 29: 126– 128. doi: 10.1258/ PHLEB.2012.012067.

22. Lattimer CR, Kalodiki E, Azzam M et al. Responsiveness of individual questions from the venous clinical severity score (VCSs) and the Aberdeen varicose vein questionnaire (AVVQ). Phlebology 2014; 29: 43– 51. doi: 10.1258/ phleb.2012.012080.

23. Gavorník P. Angiológia 1 pre všeobecných praktických lekárov – Flebológia. 1. vyd. Bratislava: Vydavateľstvo Dr. Josef Raabe 2013: 125.

24. Gavorník P. Angiológia 2 pre všeobecných praktických lekárov – Arteriológia. 1. vyd. Bratislava: Vydavateľstvo Dr. Josef Raabe 2014: 174.

25. Kahn SR, Comerota AJ, Cushman M et al. The American Heart Association Council on Peripheral Vascular Disease, Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. The postthrombotic syndrome: evidence‑based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 2014; 130: 1636– 1661. doi: 10.1161/ CIR.0000000000000130.

26. Gavorník P, Holomáň K, Gašpar Ľ et al. Syndróm vénovej panvovej kongescie – diagnóza a manažment. Odporúčanie Angiologickej sekcie Slovenskej lekárskej komory (2015). Vnitř Lék 2015; 61: 244– 250.

27. Gavorník P. Rehabilitácia a interná medicína. Interná med 2013; 13: 498– 501.

28. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation 2014; 130: 333– 346. doi: 10.1161/ CIRCULATIONAHA.113.006898.

29. Mazzaccaro D, Malacrida G, Nano G. Variability of origin of splanchnic and renal vessels from the thoracoabdominal aorta. Eur J Vasc Endovasc Surg 2015; 49: 33– 38. doi: 10.1016/ j.ejvs.2014.10.005.

30. Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg 2006; 31: 410– 416. doi: 10.1016/ j.ejvs.2005.05.045.

31. Shin JI, Lee JS, Kim MJ. The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg 2006; 32: 335– 336. doi: 10.1016/ j.ejvs.2006.04.030.

32. Renal nutckraker syndrome (left renal vein entrapment syndrome; ORPHA71273). [online] Available from: http:/ / www.orpha.net/ consor/ cgi‑ bin/ OC_Exp.php?lng=en&Expert=71273.

33. Hansrani V, Abbas A, Bhandari S et al. Trans‑venous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 185: 156– 163. doi: 10.1016/ j.ejogrb.2014.12.011.

34. Clemens RK, Pfammatter T, Meier TO et al. Vascular malformations revisited. Vasa 2015; 44: 5– 22. doi: 10.1024/ 0301‑ 1526/ a000402.

35. Willenberg T. Treatment of varicose veins. Rev Vasc Med 2014; 2: 67– 72. doi: 10.1016/ j.rvm.2014.01.002.

36. Gavorník P, Mátyás K. Flebotromboemboloprofylaxia vénovej tromboembólie – 3. verzia odporúčaní AS SLK, 2014. Medikom/ MediNews 2014; 4: 12– 14.

37. Gavorník P, Gašpar Ľ, Dukát A. Kombinovaná kinezio‑ flebotromboemboloprofylaxia, mechano‑ flebotromboemboloprofylaxia a farmako‑ flebotromboemboloporofylaxia vénovej tromboembólie v internej medicíne. Vnitř Lék 2012; 58: 851– 855.

38. Guyatt GH, Akl EA, Crowther M et al. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians evidence‑based clinical practice guidelines. Chest 2012; 141 (Suppl 2): 1S– 801S. doi: 10.1378/ chest.11‑ 2289.

39. Nicolaides AN, Fareed J, Kakkar AK et al. Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol 2013; 32: 111– 260.

40. Michiels JJ, Moosdorff W, Maasland H et al. Duplex ultrasound, clinical score, thrombotic risk, and D‑dimer testing for evidence based diagnosis and management deep vein thrombosis and alternative diagnoses in the primary care setting and outpatients ward. Int Angiol 2014; 33: 1– 19.

41. Alotabi G, Alsaleh K, Wu C et al. Dabigatran, rivaroxaban and apixaban for extended venous thromboembolism treatment: network meta‑analysis. Int Angiol 2014; 33: 301– 308.

42. Hlásenský J, Mihalová Z, Špinar J et al. Skórovací systémy u tromboembolické nemoci. Kardiol Rev Int Med 2015; 17: 126– 130.

43. Partsch H. Compression therapy for deep vein thrombosis. Vasa 2014; 43: 305– 307. doi: 10.1024/ 0301‑ 1526/ a000368.

44. Hirschl M, Kundi M. New oral anticoagulants in the treatment of acute venous thromboembolism – a systematic review with indirect comparisons. Vasa 2014; 43: 353– 364. doi: 10.1024/ 0301‑ 1526/ a000373.

45. Remková A et al. Žilová trombóza a pľúcna embólia. 1. vyd. Bratislava: Vydavateľstvo Samedi 2013: 264.

46. Konstantinides SV, Torbicki A, Agnelli G et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. The task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Endorsed by European Respiratory Society (ERS). Eur Heart J 2014; 35: 3033– 3069. doi: 10.1093.eurheartj.ehu283.

47. Gavorník P, Dukát A, Gašpar Ľ. Manažment povrchovej tromboflebitídy. Odporúčania Angiologickej sekcie Slovenskej lekárskej komory (2013). Vnitř Lék 2013; 59: 1009– 1016.

48. Smilowitz NR, Mega JL, Berger JS. Duration of anticoagulation for venous thromboembolic events. Circulation 2014; 130: 2343– 2348. doi: 10.1161/ CIRCULATIONAHA.114.010456.

49. Zakai NA, McClure LA, Judd SE et al. Racial and regional differences in venous thromboembolism in the United States in 3 cohorts. Circulation 2014; 129: 1502– 1509. doi: 10.1161/ CIRCULATIONAHA.113.006472.

50. Goldhaber SZ. Race and venous thromboembolisms: nature or nurture? Circulation 2014; 129: 1463– 1465. doi: 10.1161/ CIRCULATIONAHA.114.008799.

51. Wadhera RK, Russell CE, Piazza G. Warfarin versus novel oral anticoagulants: how to choose? Circulation 2014; 130: 191– 193. doi: 10.1161/ CIRCULATIONAHA.114.010426.