The Risk of Varicose Veins in Standing Female Workers

Background: Varicose veins often occur in employees who have to work in a position of standing work. The purpose of this study to determine risk factors for varicose veins and leg or foot among women workers.Methods: In this cross-sectional study in January-March 2010 the samples were selected purposively who met inclusion criteria among female workers who work in the position of standing work. Data were collected by interview, physical examination and observation of the position of standing work. To determine the dominant factors for varicose veins, data processing was using relative risk approach. Results: A number 111 out of 152 employees worked in a lot of work standing position participated the study, and who had varicose veins and leg or foot as was 52.3% (53 people). The majority of respondents aged 18-35 years, had total work period of 3-17 years, and worked in a lot of work standing position. Those who had a family history of varicose veins were 13.5%, taking oral contraceptive were 11.71%, has a habit of exercise (18.0%), and high heels (11.7%). Age, use of oral contraceptives, use of high heels, exercise habits, work standing position, place of work, and working period did not associate with varicose veins. Employees who had than did not have family history of varicose veins had 69% higher risk of suffering from varicose veins [relative risk (RR) = 1.69, P = 0.121].Conclusion: Employees who had family history of varicose veins had higher risk suffering varicose veins. (Health Science Indones 2013;1:47-50

Prevalence of Chronic Venous Diseases in Students of Ivano-Frankivsk National Medical University

The Objective of the Research was to increase the frequency of detecting chronic venous disorders in young people by surveing the students using a specially designed questionnaire with an analysis of its results for timely treatment.          Materials and Methods. To detect lower extremity chronic venous disorders, 1,007 students of the Ivano-Frankivsk National Medical University were interviewed using questionnaire that was based on the VEIN-TERM, the Venous Clinical Severity Score, the Chronic Venous Insufficiency Quality of Life Questionnaire. In the surveyed people, there were estimated the following data: age; gender; objective symptoms of chronic venous disorders such as telangiectasia, reticular (spider) veins, varicose veins and leg swelling; 11 most common symptoms of chronic venous disorders; risk factors such as the presence of lower extremity varicose veins in parents, previous childbirth and frequent or rare use of high heels in females.          Results. In 617 (61.3%; 95 CI, 58.2 - 64.3%) respondents, phlebopathy was detected; 63 (6.3%, 95 CI 4.8 - 7.9%) students reported lower extremity telangiectasias; 11 (1.1%; 95 CI 0.5 - 1.9%) students reported reticular veins. Varicose veins were detected in 33 (3.3%; 95 CI 2.3 - 4.6%) cases. Among them, there were 14 (1.4%, 95 CI 0.8 - 2.3%) cases of leg swelling. Only two symptoms, namely calf cramps (p=0.01) and leg pain (p=0.04) turned out to occur significantly more frequent in the respondents with varicose veins. Varicose veins were more often found in the students whose fathers suffered from varicose veins as compared to those whose mothers had varicose veins – 12.1% (95% CI 5.4 - 22.5%) versus 4.2% (95% CI 2.1 - 7.5%), respectively (p=0.008). Among females without lower extremity varicose veins, 34.1% (95% CI 29.7 - 38.3%) of the respondents indicated wearing high heels (above 5 cm) which was approximately 3 times more often as compared to female respondents with varicose veins - 11.2% (95% CI 0.0 - 21.7%) of women (p=0.001).          Conclusions. 1. Leg pain and calf cramps can be considered as the most important subjective symptoms for early diagnosis of lower extremity varicose veins in young people. 2. The presence of lower extremity varicose veins in a father results in higher risk of detecting this pathology in the respondent than the presence of lower extremity varicose veins in a mother: 12.1% (95% CI 5.4-22.5%) versus 4.2% (95% CI 2.1 - 7.5%) (p = 0.008). 3. Early diagnostics of lower extremity varicose veins in young people with the aim of further adequate treatment to prevent their progression and the development of complications can be implemented by questioning students in different educational institutions

Risk Factors of Varicose Veins

Suonikohjutaudilla on useita riskitekijöitä Suonikohjutauti on yleinen länsimaissa. Suomessa suonikohjujen vallitsevuudeksi on arvioitu 10 20% miehillä ja 25 40% naisilla tutkitusta ikäryhmästä riippuen. Suonikohjujen yleisyydestä huolimatta suonikohjujen syntyyn vaikuttavat tekijät tunnetaan huonosti. Väitöstutkimuksessa selvitettiin synnyttäneisyyden, ehkäisypillereiden käytön, hormonikorvaushoidon, joidenkin elämäntapatekijöiden sekä lähisukulaisten suonikohjujen merkitystä suonikohjujen ilmaantuvuuteen. Tutkimus on osa Tampereen suonikohjututkimusta, jossa kohdeväestönä oli kolme tamperelaisista miehistä ja naisista koostuvaa ikäkohorttia, yhteensä 6874 henkilöä. Tutkimuksen alussa vuonna 1989 tutkittavat olivat 40-, 50- tai 60-vuotiaita. Tiedot kerättiin postitetuilla kyselylomakkeilla tutkimuksen alussa ja uudelleen viiden vuoden kuluttua. Seuranta-aikana 157 aiemmin tervettä henkilöä raportoi saaneensa suonikohjuja. Niitä ilmaantui merkitsevästi enemmän niille, jotka olivat synnyttäneet vähintään kolme lasta, kun heitä verrattiin synnyttämättömiin. Tutkimuksessa havaittiin yhteys myös tupakoinnin ja suonikohjujen välillä. Erityisesti henkilöillä, jotka olivat tupakoineet paljon (?15 savuketta päivässä) oli suurentunut riski saada suonikohjuja. Yhteys havaittiin myös alkoholinkäytön ja suonikohjujen välillä, ja selvemmin naisilla kuin miehillä. Sen sijaan hormonikorvaushoidolla tai ehkäisypillereiden käytöllä ei todettu vaikutusta suonikohjujen ilmaantuvuuteen. Niillä tutkituilla, jotka raportoivat lähisukulaisilla suonikohjuja oli noin kaksinkertainen riski saada suonikohjut seuranta-aikana verrattuna henkilöihin, jotka eivät raportoineet lähisukulaisilla suonikohjuja. Aiemmissa tutkimuksissa on yliarvioitu lähisukulaisten suonikohjujen merkitystä suonikohjujen riskitekijänä johtuen puutteellisista tutkimusmenetelmistä.The aim of the study was to evaluate a range of potential risk factors in the etiology of varicose veins by a longitudinal follow-up study in a general middle-aged population. Studied factors were parity, use of oral contraceptives and hormone replacement therapy, lifestyle factors and self-reported family history of varicose veins. The purpose was also to evaluate misclassification in self-reported family history of varicose veins. The five-year follow-up data was obtained through postal questionnaires from three cohorts of residents of the city of Tampere in Finland. The number of original target population of 40-, 50- and 60-year-olds was 6,874. The response rate was 81% (5,568) at entry. An almost identical questionnaire was sent five years later to those who had responded to the first questionnaire and the response rate was 88% (4,903). The questionnaire included questions related to medical conditions, lifestyle, varicose veins and family history of varicose veins. A sub-sample of subjects underwent a physical examination but family members were not clinically examined. Incidence of varicose veins was studied as an indicator of risk in those free of varicose veins at entry. It was found that new varicose veins appeared more often in women with three or more births than in nulliparous women, incidence odds ratio, IOR 2.0 (95% confidence interval, CI: 1.0 3.9). Subjects who consumed alcohol weekly had a higher incidence of varicose veins compared to non-users, IOR 1.5 (95% CI: 1.05 2.3). The result was statistically significant only in women. Compared to non-smokers, subjects who had ever smoked for over a year, and of these heavier smokers (≥15 cigarettes a day), had higher risk of varicose veins, IORs 1.3 (95% CI: 0.9 1.8) and 1.8 (95% CI: 1.1 2.8) respectively. Daily use of meat seemed to decrease the risk of varicose veins compared to infrequent use (0 2 meals a week) of meat, particularly in women. Dietary fiber intake, use of contraceptive pills or hormone replacement therapy did not have an effect on the incidence of varicose veins. In those with a positive family history of varicose veins the risk of varicose veins was increased compared to those with negative family history, IOR 1.6 (95% CI: 1.1 2.3). When genders were studied separately, the higher risk was statistically significant only in women, IOR 1.8 (95% CI: 1.1 2.8), but not in men, IOR 1.4 (95% CI: 0.7 2.6). The estimates of the risk were much lower than our prevalence results (OR 6.6 in men and OR 4.9 in women, respectively) and also those usually reported in the literature based on cross-sectional studies with prevalence estimates. Subject s own varicose vein status or change in it was associated with self-reported family history of varicose veins. For example, if a person who at entry reported negative family history developed varicose veins during follow-up, the risk of reporting a family member with varicose veins after the follow-up was sixfold, OR 6.0 (95% CI: 2.0 47.8). If another person reported varicose veins at entry and at the end of the follow-up, the risk of reporting a new family member with varicose veins was less than 1 (OR 0.8 (95% CI: 0.6 0.9)). In conclusion, in women, multiparity, alcohol consumption and positive family history of varicose veins increase the risk of varicose veins, whereas meals containing meat may reduce the risk. Smoking is likely a risk factor of varicose veins in both genders. The strong effect of family history on the risk of varicose veins in the literature is affected by differential misclassification bias

Contribuição para a criação de um modelo experimental de varizes

Resumo ! Apesar dos conhecimentos alcançados, a causa das varizes dos membros inferiores ainda é desconhecida. Muitas causas têm sido apontadas, a mais evidenciada é a hipertensão venosa. É uma doença comum e exclusiva da espécie humana. Este facto levanta muitas dificuldades no estudo e investigação da doença. Com um modelo animal será mais fácil compreender a etiologia da doença, a sua evolução e estudar novos tratamentos. Este projecto tem como objectivo provocar varizes num animal, produzindo hipertensão venosa numa veia em ortostatismo, fazendo depois um estudo comparativo entre as lesões descritas no homem e as provocadas neste modelo. Foram usados 18 coelhos da raça Belier-francês, machos, com três meses de idade. Na orelha esquerda foi produzida cirurgicamente hipertensão venosa com a oclusão da veia auricular intermediária e o controlo foi efectuado com a orelha direita, não intervencionada. Os resultados obtidos mostram claramente uma alteração morfológica significativa das veias, causada pela cirurgia efectuada. Estas alterações não são constantes ao longo do tempo e têm uma variação considerável, de animal para animal. O modelo proposto é capaz de induzir alterações morfológicas e funcionais nas veias da orelha do animal em teste, que se aproximam das descritas nas varizes da espécie humana

Association between Anthropometric Measurements and Vascular Disease: A Cross Sectional Study

The aim of this article is to assess the most studied anthropometric measurements in a population of patients with vascular disease (VD) such as chronic venous disease (CVD), carotid stenosis (CS), abdominal aortic aneurysm (AAA), and peripheral artery disease (PAD). This is a cross sectional study that recruited consecutive patients with VD (CVD, CS, AAA, PAD) referred to Vascular Surgery Units of two hospitals in the period July 2019–March 2022. Several anthropometric measurements such as height, weight, body mass index (BMI), waist circumference, waist-to-BMI, waist-to-hip ratio (WHR), A Body Shape Index (ABSI), waist-to-stature ratio (WSR) were recorded. In a one-way ANOVA test, no statistical significance for all anthropometric variables were found, but the post hoc analysis performed with Tuckey test, show significant difference for height (p-value: 0.017) and WHR (p-value: 0.005) when compared AAA and CS groups with CVD, respectively. Height seems positively associated with AAA, and negatively associated with CVD. WHR seems positively associated with CS and negatively associated with CVD. Further studies are needed to clarify the role of anthropometric measures as independent predictors for vascular disease onset, progression, and response to treatments

Chronic Venous Insufficiency in Workers without Risks Factors who Remain Long Hours Standing

Revisiones[ES] La insuficiencia venosa crónica (IVC) es una patología prevalente en la sociedad actual. Los problemas derivados de ella, son una causa importante de gasto económico y absentismo laboral. Las condiciones laborales actuales, como jornadas de larga duración, con largas horas en bipedestación, inadecuada carga de pesos y malas condiciones de humedad y temperatura, contribuyen al desarrollo de esta patología. En este trabajo se ha realizado una revisión sistemática de la bibliografía existente en relación a la insuficiencia venosa crónica y el tiempo en bipedestación de las jornadas laborales. Para determinar el nivel de evidencia de los estudios evaluados, se han seguido los criterios del Scottish Intercollegiate Guidelines Network (SIGN). En particular, se ha concluido que existe una asociación significativamente positiva entre el tiempo prolongado en bipedestación y el riesgo de padecer insuficiencia venosa crónica. Sin embargo, la literatura actual no permite establecer un umbral que determine el número de horas considerado como bipedestación prolongada.Para poder valorar si la insuficiencia venosa crónica debería considerarse una enfermedad profesional, es necesario diseñar y llevar a cabo nuevos estudios de investigación en esta dirección. Estos estudios son necesarios para poder establecer evidencias de cara a concienciar a la sociedad y generar campañas de prevención y promoción de la salud que disminuyan los costes económicos y mejoren la calidad de vida de la población. [EN] The chronic venous insufficiency (CVI) is a prevalent pathology in the today’s society. The arising problems represent an important cause of economic costs and absenteeism in the workplace. Current working conditions, such as long working hours, standing for long periods of time, inadequate load weight as well as bad humidity and temperature conditions, contribute to the development of this pathology.In this essay, a systematic review of existing bibliography related to chronic venous insufficiency and standing up long time at working hours has been conducted. In order to determine the evidence level of the evaluated studies the criteria established by the Scottish Intercollegiate Guidelines Network (SIGN) has been considered. In particular, a significant positive link between long period of time standing and a risk for suffering chronic venous insufficiency has been found. However, the existing literature is not specific enough to establish a threshold that determines the number of working hours required to be considered an extreme period of time standing.In order to determine if the chronic venous insufficiency should be considered an occupational disease, it is required to design and conduct further research on this topic. These studies are necessary to establish new evidence in order to make the society aware and generate new health prevention and promotion campaigns so that economic costs and quality of life could continue improving.N

An RCT of clinical and cost effectiveness of endovenous laser therapy in the treatment of varicose veins secondary to isolated saphenopopliteal incompetence and small saphenous reflux

BACKGROUNDLower limb varicosities are common and cause significant impairment of quality of life to the sufferers. Patients with small saphenous incompetence form a small but significant part of this group who have traditionally been treated by surgical ligation with or without stripping of small saphenous vein (SSV). Within the last decade however, this has been challenged by endovenous thermal and chemical ablation interventions. No randomized clinical trial comparing treatment options for SSV incompetence exists, and there is no clear evidence that this axis behaves the same as the great saphenous vein (GSV) following treatment. This means that the existing literature base, centred on the treatment of GSV incompetence cannot simply be extrapolated to inform the management of SSV insufficiency.OBJECTIVESThis trial aimed to compare the technical efficacy, safety and clinical effectiveness of minimally invasive endovenous laser ablation (EVLA) with the gold standard treatment of conventional surgery (CS) in the management of SSV incompetence.Costs and utilities of EVLA and CS were compared to establish the most cost-effective treatment.The risks and benefits of stripping SSV in the surgical treatment; and efficacy of EVLA in relation to the site of SSV access was also evaluated to establish best practice in both these interventions.METHODSPatients with unilateral, primary saphenopopliteal junction (SPJ) incompetence and SSV reflux were randomized equally into parallel groups receiving either Surgery or EVLA, with concomitant phlebectomies of tributary veins. Patients were assessed at baseline and weeks 1, 6, 12 & 52. Outcomes included: successful abolition of axial reflux on duplex scan (Primary outcome); Visual analogue pain scores; recovery time; complication rates; Venous Clinical Severity Score (VCSS) and Quality of life (QoL) profiling.For cost-effectiveness analysis, the hospital, general practice, patient costs incurred until full recovery and the indirect cost to society due to sickness leave after treatment, were calculated to indicate mean cost per patient under each treatment category. EQ-5D health utility index was calculated from EuroQol generic QoL questionnaire, and quality adjusted life years (QALYs) were generated by calculating the area under curve. Cost/QALY and incremental cost effective ratio (ICER) was calculated for both treatment groups to determine the more cost-effective treatment.For patients undergoing surgical treatment, the aim was for SPJ ligation (SPL) and stripping of SSV in each case, but in a proportion this was not possible. Hence, patients were retrospectively sub grouped into SPL with short segment excision ≤ 5 cm and SPL with extended stripping > 5 cm. Clinical and QoL outcomes including recurrence and complications were compared between these surgical subgroups.Patients undergoing EVLA (810 nm, 14 W diode laser) for small saphenous incompetence were retrospectively divided into two subgroups: access gained at or above mid-calf (AMC) and below mid-calf (BMC), based on the level of endovenous access gained at the lowest site of truncal reflux. Similar clinical and QoL outcomes including recanalization and sensory disturbance were compared between the EVLA subgroups.RESULTS106 patients were recruited and randomized to Surgery (n=53) or EVLA (n=53). The primary outcome of abolition of SSV reflux was significantly higher following EVLA 96.2% vs. Surgery 71.7% (P0.05).Of the 53 EVLA patients, access was gained above mid-calf in 30 (57%) and below mid-calf in 23 (43%). SSV occlusion was equally high in both subgroups with no significant difference in complications or recurrence rates (P>0.05). Patient satisfaction with overall treatment declined in the AMC subgroup (P=0.011). Both EVLA subgroups demonstrated significant improvement in venous severity and QoL measures over the follow-up period (P>0.05).CONCLUSIONSEVLA produced the same clinical benefits as conventional surgery, but was more effective in addressing the underlying pathophysiology and was associated with less peri-procedural morbidity, allowing a faster recovery for patients. Of the two interventions, EVLA is the more cost-effective option in the short-term, feasible in an outpatient setting under tumescent local anaesthesia. These findings support the adoption of EVLA with concomitant phlebectomy as the standard treatment for primary small saphenous insufficiency

Incidence of varicose veins, chronic venous insufficiency and venous reflux in the general population and associated risk factors: the Edinburgh Vein Study follow up

Chronic venous disease (CVD) is a common problem in the western world, causes considerable morbidity and has a substantial impact on the health care system in terms of cost of treatment. Most epidemiological research has focussed on the prevalence of varicose veins and ulceration. As such, evidence on the incidence and risk factors is limited. The aim of this study was to measure the incidence of C2 varicose veins, C3-C6 chronic venous insufficiency (CVI) and venous reflux ≥ 0.5 seconds duration in an adult population, and to investigate risk factors associated with the development of these conditions. The Edinburgh Vein Study was a prospective cohort study in which 1,566 men and women aged 18-64 years randomly sampled from the general population underwent an examination comprising clinical and photographic classification of CVD, duplex scanning of the deep and superficial systems of both legs, and completed a questionnaire on lifestyle and medical history. After a 13 year period, invitations were sent to the 1456 survivors to attend a follow up examination. In total, 880 participated in the follow up study, giving a response rate of 60.4%. The overall incidence of C2 varicose veins was 18.2% (95% CI 15.2-21.6), equivalent to an annual incidence rate of 1.4% (95% CI 1.1-1.7). There were no gender differences (p=0.78). Age was associated with the development of new C2 varicose veins the 13 year incidence rose from 9.8% in those aged 18-34 years to 25.7% in those aged 55-64 years (p<0.001). New cases of C3-C6 CVI developed in 9.2% (95% CI 7.0-11.9) of the study sample over 13 years, an annual incidence rate of 0.7% (95% CI 0.5-0.9). There were no gender differences: the 13 year incidence was 10.7% (95% CI 7.2-15.5) and 8.1% (95% CI 5.7-11.6) in men and women respectively (p=0.32). The incidence increased consistently with age, from 2.1% in those aged under 35 years to 17.1% in those aged over 55 years (p<0.001). Of all C3-C6 conditions, C3 corona phlebectatica had the highest incidence (5.3%, 95% CI 3.7-7.5). C5-C6 venous ulceration had the lowest incidence, affecting only 0.5% (95% CI 0.2-1.6) of the study sample over the 13 years. Overall, 12.7% of participants developed new venous reflux ≥0.5 seconds duration from baseline to follow up. The 13 year incidence of superficial, deep and combined venous reflux was 8.8%, 2.6% and 1.3% respectively. Neither age nor sex were associated with the incidence of venous reflux (p>0.05). The highest incidence of reflux was in the great saphenous vein in the lower third of the thigh (4.2%, 95% CI 2.4-7.1). Venous reflux at baseline was associated with the development of new C2 varicose veins at follow up: the incidence creased linearly in those with no reflux, deep, superficial and combined reflux respectively (p<0.001). Family history of venous disease was a significant risk factor for C2 varicose veins (age and sex-adjusted OR 1.7, 95% CI 1.1-2.7) while obesity was associated with the development of CVI (age and sex adjusted OR 4.5 (95% CI 3.3-6.9). Pregnancy appeared to be associated with the development of varicose veins but the association was not statistically significant due to small numbers. No risk factor was associated with the development of venous reflux. The Edinburgh Vein Study is one of a few cohort studies to report the incidence of C2 varicose veins, C3-C6 CVI and venous reflux ≥0.5 seconds duration, and investigate risk factors associated with these conditions. While the results on incidence are consistent with the limited evidence from other studies, the exact effect of risk factors remains unknown. Genetic studies would help clarify whether CVD is an inherited or acquired condition. For other risk factors, results of this study could be combined with other population-based studies in a meta-analysis. The overall estimate of effect would identify the most important risk factors associated with the development of CVD and venous reflux. Finally the natural history and progression of CVD needs to be assessed. The Edinburgh Vein Follow Up Study has examined this relationship and results will help to identify those most likely to progress to more severe disease and, in turn, those who will benefit most from treatment. Appropriate, clinically proven, effective and cost-effective treatments can then be administered in an attempt to reduce the burden of CVD

Influence of body mass index on developing ulceration in patients with venous disease: A case control study

BACKGROUND: To identify and address the factors which lead to ulceration in patients with chronic venous disease is essential to prevent progression of disease. Obesity is one such controversial factor. The aim of our study was to assess the influence of body mass index on the development of ulceration in patients with venous disease. We also analysed other risk factors that might lead to progression of disease to ulceration. METHODS: This was a prospective case control study conducted at the Vascular Surgery Outpatient department of Christian Medical College, Vellore. All patients enrolled in the study had a documented venous duplex showing venous insufficiency. One hundred and thirty cases with an active or healed venous ulcer were compared with one hundred and thirty controls with no ulceration. A questionnaire was administered to look at the factors that influence the risk of developing ulceration. The patients underwent a clinical examination and the clinical class of venous disease was documented. The patient’s height and weight was measured using standardized instruments and the body mass index was calculated. RESULTS: The mean body mass index of the study population was 29.04. 38.8% of the 260 patients recruited were obese and another 38.8 % were overweight. 45.5% of the obese patients had an active or healed ulcer. 77.8 % of the patients with recurrent ulcers were either overweight or obese. However, on comparing the body mass index between the cases and controls there was no statistically significant difference. On multivariate analysis we found - older age, male gender, deep vein thrombosis and prolonged periods of standing, to have a significant association with ulceration in venous disease. CONCLUSION: Our study suggests that there is no association between body mass index and ulceration in patients with venous disease. Older age, male gender, deep vein thrombosis and periods of prolonged standing are associated with venous ulceration. However, the investigators did consider the possibility of a different pathophysiology of venous disease in the obese and hence, venous duplex alone might not be an adequate diagnostic tool to select obese patients for future studies. We propose that further studies need to be done in this regard and follow up the obese patients in the control arm to see if they develop ulcers in the future in order to establish obesity as risk factor

Elimination of axial venous reflux

Chronic venous disease (CVD), including uncomplicated varicose veins and chronic venous insufficiency, is one of the most common medical conditions in the Western world. The central feature of CVD is venous reflux, which may be primary, congenital, or result from an antecedent event, usually an acute deep venous thrombosis (DVT). When the history of DVT is clear, the clinical manifestations of secondary CVD are commonly referred to as the post-thrombotic syndrome. Regardless of the underlying etiology, the final pathway leading to symptoms is ambulatory venous hypertension. The spectrum of symptoms and signs of CVD ranges from minor cosmetic problems to venous ulceration, which results in considerable morbidity and increased medical costs. Aims of this study were to evaluate the outcome of superficial venous surgery performed with or without preoperative duplex evaluation and venous marking with hand-held doppler, to assess short-term outcome of ultrasound-guided foam sclerotherapy in patients with axial superficial venous incompetence, as well as to compare reflux patterns after catheter-directed and systemic thrombolysis of deep ileofemoral venous thrombosis, and to evaluate the long-term outcome of deep venous reconstructions for severe chronic venous insufficiency. The study consists of five separate retrospective projects and includes 315 patients. Of this, 133 patients had undergone superficial venous surgery 2 to 5 years earlier according to preoperative duplex examination and venous marking, or according to clinical evaluation alone, or to a written plan without venous marking. A total of 112 patients had undergone ultrasound-guided foam sclerotherapy 5.5 to 16.5 months before. In addition, 32 patients had received either catheter-directed or systemic thrombolysis for DVT 2 to 3 years earlier, and 38 patients had undergone deep venous reconstructions 2 to 7 years earlier. In the present studies, some venous reflux was present postoperatively irrespective of the method of evaluation or ablation of the reflux. It seemed, however, that preoperative examination with duplex ultrasound and marking of reflux sites before the operation by the operating surgeon improves the outcome of superficial venous surgery. Ultrasound-guided foam sclerotherapy is effective in elimination of venous reflux in selected cases in short-term follow-up. Catheter-directed thrombolysis for deep iliofemoral venous thrombosis reduces later reflux and most probably the development of post-thrombotic syndrome as well. The outcome of deep venous reconstructions, especially for post-thrombotic deep venous incompetence, is poor. Thus, prevention of valvular damage by active treatment of deep venous thrombosis is important.Alaraajojen laskimoiden vajaatoiminta on yksi tavallisimmista sairauksista länsimaissa; sen esiintyvyys aikuisväestössä on keskimäärin 30-40%. Lieviä muutoksia voidaan todeta jopa 80%:lla ihmisistä. Sairauden tärkein piirre on laskimoiden takaisinvirtaus, joka johtuu joko pinnallisten laskimoiden seinämän laajentumisesta ilman osoitettavaa syytä tai aiemman syvän laskimotukoksen aiheuttamasta syvien laskimoläppien vauriosta (posttromboottinen oireyhtymä). Laskimoiden takaisinvirtaus johtaa ajan myötä laskimopaineen kohoamiseen, joka pitkään jatkuessaan saattaa aiheuttaa laskimolaajentumia eli suonikohjuja, turvotusta, kipua sekä säären ja nilkan alueen ihomuutoksia, kuten laskimoperäisen säärihaavan. Nykyaikainen hoitoa edeltävä diagnostiikka perustuu dupleksikaikututkimukseen, jonka avulla saadaan tarkka käsitys laskimoanatomiasta ja virtauksen suunnasta. Tutkimustulokset pintalaskimoleikkausta edeltävän dupleksitutkimuksen vaikutuksesta hoidon onnistumiseen ovat osittain ristiriitaisia. Pintalaskimoleikkauksiin liittyvät ongelmat, kuten komplikaatiot ja suuri uusiutumisaste sekä uusintaleikkauksiin liittyvät riskit, ovat johtaneet uusien hoitomenetelmien kehittämiseen. Muun muassa ultraääniohjattu vaahtoruiskutushoito on saavuttanut suosiota, koska alustavat hoitotulokset ovat lupaavia ja vakavien komplikaatioiden riski on pieni. Tutkimuksen tavoitteina oli selvittää pintalaskimoleikkausta edeltävän dupleksitutkimuksen vaikutusta tuloksiin ja sitä, voidaanko tutkimuksen tieto siirtää kirurgille kirjallisesti. Tutkittiin myös ultraääniohjatun vaahtoruiskutushoidon lyhytaikaisia tuloksia ja potilastyytyväisyyttä. Lisäksi verrattiin laskimoiden takaisinvirtauksen esiintymistä potilailla, joiden syvä laskimotukos oli hoidettu joko paikallisella katetriohjatulla tai koko elimistöön vaikuttavalla liuotushoidolla. Lopuksi arvioitiin syvien laskimoiden korjausleikkausten tuloksia vaikeaa kroonista laskimovajaatoimintaa sairastavilla potilailla. Tutkimuksen tulosten perusteella leikkausta edeltävä dupleksitutkimus ja takaisinvirtaavien laskimoiden merkitseminen näyttävät parantavat pinnallisen laskimokirurgian tuloksia. Jokaiselle potilaalle, jolle suunnitellaan alaraajalaskimoiden toimenpidettä, tulisikin tehdä huolellinen leikkausta edeltävä dupleksikaikututkimus. Tulokset ovat parhaat, jos leikkaava kirurgi tekee tutkimuksen itse. Ultraääniohjattu vaahtoruiskutushoito vähentää tehokkaasti laskimoiden takaisinvirtausta lyhyessä seurannassa, ja suurin osa potilaista on tyytyväisiä hoitoon. Pitkän seuranta-ajan vertailevia tutkimuksia tarvitaan selkiyttämään tämän hoitomenetelmän asemaa pinnallisen laskimovajaatoiminnan hoidossa. Korkealle ulottuvan syvän laskimotukoksen katetriohjattu liuotus näyttää vähentävän myöhempää takaisinvirtausta ja laskimoläppien vaurioitumista. Koska syvien laskimoiden korjausleikkausten tulokset ovat huonoja varsinkin posttromboottista oireyhtymää sairastavilla, läppävaurion estäminen tehokkaalla äkillisen laskimotukoksen hoidolla on tärkeää. Paikallista liuotushoitoa tulisi ainakin harkita laaja-alaisen laskimotukoksen yhteydessä. Jo kehittyneen oireyhtymän tärkein hoito on edelleen puristussukka