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Percutaneous venoplasty for chronic cerebrospinal venousinsufficiency in multiple sclerosis P Percutaneous v ercutaneous venoplasty for chronic enoplasty for chronic cerebrospinal v cerebrospinal venousinsufficiency in multiple enous insufficiency in multiple sclerosis sclerosis Interventional procedures guidance Published: 30 January 2019 nice.org.uk/guidance/ipg640 Y Y our responsibility our responsibility This guidance represents the view of NICE, arrived at after careful consideration (...) 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 41 1 Recommendations Recommendations 1.1 Current evidence on percutaneous venoplasty for chronic cerebrospinal venousinsufficiency in multiple sclerosis shows that there are serious complications and that it provides no benefit. Therefore, this procedure should not be used in the management of multiple sclerosis. 2 2 The condition, current treatments and procedure
Percutaneous transluminal angioplasty for treatment of chronic cerebrospinal venousinsufficiency (CCSVI) in people with multiple sclerosis. Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis (...) of MS. This condition has been named 'chronic cerebrospinal venousinsufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS
Balneotherapy for chronic venousinsufficiency. Chronic venousinsufficiency (CVI) is a progressive and common disease that affects the superficial and deep venous systems of the lower limbs. CVI is characterised by valvular incompetence, reflux, venous obstruction, or a combination of these with consequent distal venous hypertension. Clinical manifestations of CVI include oedema, pain, skin changes, ulcerations and dilated skin veins in the lower limbs. It can result in a large financial (...) burden on health systems. There is a wide variety of treatment options or therapies for CVI, ranging from surgery and medication to compression and physiotherapy. Balneotherapy (treatments involving water) is a relatively cheap option and potentially efficient way to deliver physical therapy for people with CVI.To assess the efficacy and safety of balneotherapy for the treatment of people with chronic venousinsufficiency (CVI).The Cochrane Vascular Information Specialist searched the Cochrane
Cyanoacrylate embolisation for the treatment of varicose veins due to chronic venousinsufficiency 1 Public Summary Document Application No. 1472 - Cyanoacrylate embolisation for the treatment of varicose veins due to chronic venousinsufficiency Applicant: Medtronic Australasia Pty Ltd Date of MSAC consideration: MSAC 70 th Meeting, 27 July 2017 Context for decision: MSAC makes its advice in accordance with its Terms of Reference, visit the MSAC website 1. Purpose of application An application (...) requesting a new Medicare Benefit Schedule (MBS) listing of cyanoacrylate embolisation (CAE) for the treatment of varicose veins due to chronic venousinsufficiency (CVI) was received by the Department of Health from Medtronic Australasia Pty Ltd. 2. MSAC’s advice to the Minister After considering the evidence presented in relation to the safety, clinical effectiveness and cost-effectiveness MSAC supported MBS listing of cyanoacrylate embolisation for the treatment of varicose veins due to chronic venous
Chronic venousinsufficiency Chronic venousinsufficiency - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Chronic venousinsufficiency Last reviewed: February 2019 Last updated: December 2017 Summary Clinical presentation includes increasing leg pain, fatigue, and heaviness with prolonged standing, associated with dilated tortuous veins. More severe cases exhibit progressive skin changes, venous stasis dermatitis (...) , lipodermatosclerosis, and frank ulceration. Underlying venousinsufficiency is most efficiently documented, localised, and graded by duplex ultrasound. Conservative treatment requires graded compression. Open surgical or endovenous treatment options may be used in highly selected cases. Venous ulceration and bleeding are recognised complications. Definition Chronic venousinsufficiency (CVI) refers to functional changes that may occur in the lower extremity due to persistent elevation of venous pressures
Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venousinsufficiency, the VEINS (venousinsufficiency in South Florida) cohort. Chronic venousinsufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%-2% of adults in the USA. Why some develop VLU and others do not is unclear. VLU have a significant impact on quality (...) of life and are extremely costly and difficult to treat. Moreover, VLU prevalence is increasing, doubling in the last 20 years. In order to characterise the differences between people with CVI and those who ultimately develop VLU, we aim to set up the unique venousinsufficiency in South Florida cohort.Subjects will be recruited from the University of Miami Hospital and Clinic's vascular laboratory database, which began in July 2011. Any adult age 18-95 who has had venous reflux detected on duplex
Frequency and Significance of Perforating VenousInsufficiency in Patients with Chronic VenousInsufficiency of Lower Extremity The aim of this study was to reveal the frequency and impact of perforating venousinsufficiency (PVI) in chronic venousinsufficiency (CVI) of lower extremity (LE).Between 2012 and 2017, a total of 1154 patients [781 females (67.68%) and 373 males (32.32%), 228 (19.76%) unilateral and 926 (80.24%) bilateral LE] were examined using Doppler ultrasound (US). A total (...) of 2080 venous systems of LEs [31.4% male (n=653) and 68.6% female (n=1427); 1056 left LEs (50.77%) and 1024 right LEs (49.23%)] were examined. All patients had symptoms of venousinsufficiency (VI).PVI was revealed in 27.5% (n=571) of LEs. Varicose veins (VVs) related with perforating vein (PV) were revealed in 44.7% of LEs (n=929). PVI was observed in 50.91% of patients with chronic deep venous thrombosis (DVT), 64.41% with deep venousinsufficiency (DVI), 59.81% with great saphenous vein (GSV
Physical exercise for the treatment of non-ulcerated chronic venousinsufficiency. Chronic venousinsufficiency (CVI) is a common disease that causes discomfort and impairs the quality of life of affected persons. Treatments such as physical exercise that aim to increase the movement of the ankle joint and strengthen the muscle pump in the calf of the leg may be useful to reduce the symptoms of CVI.To assess and summarise the existing clinical evidence on the efficacy and safety of physical (...) the data. One study reported no difference between the exercise and control groups whereas the second reported a reduction in symptoms in the exercise group. In one study, increases in change in ejection fraction compared with baseline (mean difference (MD) 4.88%, 95% confidence interval (CI) 3.16 to 6.60; 30 participants; P < 0.00001), half venous refilling time (MD 4.20 seconds, 95% CI 3.28 to 5.12; 23 participants; P < 0.00001) and total venous refilling time (MD 9.40 seconds, 95% CI 7.77 to 11.03
Hemorrhoidal disease and chronic venousinsufficiency: concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research). The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice, and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk
Percutaneous Venous Angioplasty in Patients with Multiple Sclerosis and Chronic Cerebrospinal VenousInsufficiency: A Randomized Wait List Control Study. Venous percutaneous transluminal angioplasty (vPTA) in patients with multiple sclerosis (MS) and chronic cerebrospinal venousinsufficiency (CCSVI) have shown contradictory results. The aim of the study is to evaluate the efficacy of the procedure in a randomized wait list control study.66 adults with neurologist-confirmed diagnosis of MS (...) and sonographic diagnosis of CCSVI were allocated into vPTA-yes group (n = 31) or vPTA-not group (n = 35, control group). vPTA was performed immediately 15 days after randomization in the PTA-yes group and 6 months later in the control group. Evoked potentials (EPs), clinical-functional measures (CFMs), and upper limb kinematic measures (ULKMs) were measured at baseline (T0) and six months after in both groups, just before the venous angioplasty in the vPTA-not group (T1).Comparing the vPTA-yes and vPTA
Compression Therapy Based on Ankle Brachial Index, Toe Brachial Index, or Toe Pressure Measurements in Chronic VenousInsufficiency Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable (...) . TITLE: Compression Therapy Based on Ankle Brachial Index, Toe Brachial Index, or Toe Pressure Measurements in Chronic VenousInsufficiency: Guidelines DATE: 14 April 2015 RESEARCH QUESTION What are the evidence-based guidelines regarding the appropriate use of compression therapy based on ankle brachial index, toe brachial index, or toe pressure values in patients with chronic venousinsufficiency? KEY FINDINGS No relevant literature was identified regarding the appropriate use of compression
Angiocrine FSTL1 (Follistatin-Like Protein 1) Insufficiency Leads to Atrial and Venous Wall Fibrosis via SMAD3 Activation. Angiocrine factors, mediating the endothelial-mural cell interaction in vascular wall construction as well as maintenance, are incompletely characterized. This study aims to investigate the role of endothelial cell-derived FSTL1 (follistatin-like protein 1) in vascular homeostasis. Approach and Results: Using conditional knockout mouse models, we show that loss of FSTL1 (...) findings imply that endothelial FSTL1 is critical for the homeostasis of vascular walls, and its insufficiency may favor cardiovascular fibrosis leading to heart failure.
Calcium dobesilate for the treatment of chronic venousinsufficiency Calcium dobesilate for the treatment of chronic venousinsufficiency Calcium dobesilate for the treatment of chronic venousinsufficiency Brito V, Rey-Ares L, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made (...) for the HTA database. Citation Brito V, Rey-Ares L, Pichon-Riviere A, Augustovski F, García Martí S, Alcaraz A, Bardach A, Ciapponi A, López A. Calcium dobesilate for the treatment of chronic venousinsufficiency. Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de Respuesta Rapida No. 487. 2016 Authors' conclusions Evidence of moderate quality shows that calcium dobesilate does not have a significant clinical impact on the progress of edema and ulcer healing, when
Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venousinsufficiency of the legs The pattern of venous reflux in Thai patients with chronic venousinsufficiency (CVI) was studied in correlation with clinical manifestations.Ultrasonography findings and clinical data were prospectively collected and retrospectively reviewed.CVI was found in 104 legs of 79 patients (mean age 59.8 ± 12.5 years; C4: 24.1%, C5: 8.9%, C6: 67.1%). 6.7% of the legs had (...) a history of deep vein thrombosis (DVT). The prevalence of superficial vein reflux (SVR), deep vein reflux (DVR), and combined SVR and DVR in 90 legs without previous venous surgery was 82.2%, 63.3% and 57.8%, respectively. In legs with SVR, the prevalence of great saphenous vein reflux (GSVR), small saphenous vein reflux (SSVR), and combined GSVR and SSVR was 91.9%, 33.8% and 25.7%, respectively. 77.0% of SVR involved the calf segment. For medial ulceration, 79.6% had GSVR and 35.2% had SSVR
Endovenous Thermal Ablation of Recurrent Varicose Veins due to Residual Great Saphenous VenousInsufficiency After Saphenous Venous Surgery: A Comparative Study. Redo surgery for recurrent varicose veins of the great saphenous vein (GSV) is technically more challenging than the initial surgery.To compare 980 and 1,470-nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) for the treatment of residual GSV insufficiency after saphenofemoral ligation ± stripping.Thirty-seven limbs (...) with that of group A (2.6 ± 0.9). Ecchymosis grade was significantly (p < .017) lower in group C (0.1 ± 0.3) than that in group A (1.6 ± 1.5).Endovenous thermal ablation using EVLA or RFA is safe and effective for treatment of recurrent varicose veins resulting from residual GSV insufficiency after saphenous venous surgery. The RFA is superior to 980-nm EVLA in terms of postprocedural ecchymosis and improvement in VCSS.
Comparative histopathological study of the venous wall of chronic venousinsufficiency and varicose disease. To investigate venous histopathology of chronic venousinsufficiency and varicose patients (C2).Retrospective review of venous histopathology of 52 patients (13, 8, 2, and 28 were C2, C4, C5 and C6).The intimal thickness, intimal fibrosis, total thickness and intimal/total thickness ratio were highest in venous clinical severity score 0, 1 chronic venousinsufficiency (no or minimal (...) varicosity) follow by Venous Clinical Severity Score 2,3 chronic venousinsufficiency (trunkal varice) and C2 veins (mean intimal thickness 62, 36, 26 µm, mean intimal fibrosis 74%, 72%, 65%, mean total thickness 184, 159, 133 µm, mean intimal/total thickness ratio 0.32, 0.20, 0.21). The statistical significances were found when comparing intimal thickness, intimal fibrosis, intimal/total thickness ratio and total thickness of Venous Clinical Severity Score 0, 1 chronic venousinsufficiency veins and C2
LivRelief varicose veins cream in the treatment of chronic venousinsufficiency of the lower limbs: A 6-week single arm pilot study. Chronic Venous Disease is characterized by morphological abnormalities of the venous system. Affected limbs are classified in increasing clinical severity with the Clinical Etiological Anatomical and Pathological system from C0 to C6. Limbs assessed at C3 through C6 meet the criteria of Chronic VenousInsufficiency. Chronic VenousInsufficiency of the Lower Limbs (...) % of all scheduled data. The most significant therapeutic improvement was seen in the results of the Venous Clinical Severity Score where 66% of the treated legs experienced a decrease in severity after 6 weeks of treatment. P values were <0.0001 and 0.0003 for the left and right leg, respectively.It is feasible to recruit and collect data with the chosen outcome assessments within this population. Preliminary results suggest that the product could improve some of the clinical symptoms associated