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Journal: Phlebology / Venous Forum of the Royal Society of Medicine


No existing patient-reported outcome instrument focuses solely on assessment of varicose veins symptoms that are bothersome to patients.

Concepts: Varicose veins, Sclerotherapy


OBJECTIVES: Heterotopic ossification is defined as the abnormal formation of true bone within extra-skeletal soft tissues. It may be associated with a variety of clinical conditions, but is most frequently seen with musculoskeletal trauma, neurologic injury or genetic abnormalities. It has also been described in patients with chronic venous insufficiency; however, it often goes underdiagnosed due to chronic ulceration that masks exam findings. To date, few reports of heterotopic ossification due to chronic venous disease exist within the literature with the most recent dating back to the 1970s. METHODS: We present a case study of a man presenting with extensive leg ulceration and a history of chronic venous insufficency. He had a large non-healing venous stasis ulcer of the left lower extremity with extensive heterotopic ossification discovered intraoperatively. RESULTS: The patient was managed with serial wound debridement, innovative woundcare and eventual split thickness skin grafting that achieved limb salvage despite the complexity of his wound. CONCLUSIONS: Our discussion focuses on the epidemiology, pathophysiology, diagnostic work-up and management of heterotopic ossification in the setting of chronic venous insufficiency. We propose that heterotopic ossification be included in any future modifications of the clinical, aetiology, anatomy and pathophysiology system classification as a complication of chronic venous disease.

Concepts: Medicine, Epidemiology, Patient, Tissues, Soft tissue, Heterotopic ossification, Myositis ossificans, Chronic venous insufficiency


BACKGROUND: Endovenous Laser Ablation (EVLA) is one of the most accepted treatment options for varicose veins. The aim of this study was to investigate the efficacy and safety of the new radial fiber slim (ELVeS-radial-slim kit™) for the 1470 nm diode laser in perforator veins with a 1 month follow-up. METHODS: Our prospective observational cohort study comprised 69 perforating veins in 55 patients. Ninety percent of all patients were in the CEAP-stage C3-C6. The radial fiber slim was used to occlude the perforating vein and the great or small saphenous vein in the same procedure. The primary efficacy endpoint of the study was ultrasonographically proven elimination of venous reflux in the perforating vein after at least one month. Secondary efficacy and further safety end points after one month were as follows: (1) sonographic exclusion of recanalization of the treated vein segments, (2) deep vein thrombosis (DVT), clinical pulmonary embolism (PE), or superficial vein thrombosis (SVT) as defined by objective testing, (3) death from any cause, (4) persistent clinical complaints such as pain and paresthesia. RESULTS: Follow-up could be completed in all patients. In all treated perforating varicose veins, occlusion with elimination of reflux could be demonstrated immediately after the procedure. After one month 95.6% of the treated veins were still occluded (67/69). During follow-up, we did not diagnose any DVT, PE or SVT in the area related to the treated perforating vein. No patient died. One patient reported paresthesia distally of the puncture site. CONCLUSION: Endovenous laser treatment of varicose perforating veins with 1470 nm diode laser using the radial fiber slim is effective and safe with low recanalization rates during 1-month follow-up.

Concepts: Vein, Great saphenous vein, Deep vein thrombosis, Deep vein, Vascular surgery, Varicose veins, Sclerotherapy, Superficial vein


To evaluate the utility of a transcranial brain photoplethysmography parameter as a potential marker for patients with multiple sclerosis.

Concepts: Neuron, Brain, Cerebral cortex, Cerebrum, Hippocampus, Cerebellum, Thalamus, Neocortex


The aim of this article is to present a new technique for minimally invasive treatment of varicose veins disease of lower extremities.

Concepts: Minimally invasive, Varicose veins, Sclerotherapy


Right atrial thrombus in the setting of a large pulmonary embolus is rare and is associated with serious adverse events. This case report presents the role played by EKOS EkoSonic ultrasound system in successfully treating right atrial thrombus and massive pulmonary embolism.

Concepts: Stroke, Pulmonary embolism, Fibrinolysis, Hematology, Thrombus, Tissue plasminogen activator, Thrombolysis, Embolism


Endovenous laser ablation is an established alternative to surgery with stripping for the treatment of varicose veins. Ecchymoses and pain are frequently reported side effects of endovenous laser ablation. Device-related complications are rare but serious. We describe here an exceptional complication, necessitating an additional surgical procedure to remove a segment of laser fiber that had migrated into the pelvic cavity. Fortunately, severe damage had not occurred. This case highlights the importance of checking the completeness of the guidewire, catheter, and laser fiber after endovenous laser ablation.

Concepts: Medicine, Surgery, Laser, Anesthesia, Iatrogenesis, Varicose veins, Sclerotherapy, Laser surgery


We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series.

Concepts: Epidemiology, Randomized controlled trial, Vein, Great saphenous vein, Varicose veins, Sclerotherapy, Saphenous nerve, Superficial vein


Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer treatments appear that are suitable for more complex problems.

Concepts: Blood, Thrombosis, Vein, Inferior vena cava, Deep vein thrombosis, Deep vein, Thrombolysis, Superior vena cava


AIM:: Endovenous thermal ablation (ETA) procedures are catheter-directed, ultrasound (US)-guided thermal methods for treatment in varicose veins disease. Radiofrequency, laser or steam energy thermally denatures vein wall collagen, leading first to vein wall inflammation, then fibrosis and finally to occlusion. The aim of this guideline is to give evidence-based recommendations for ETA procedures.

Concepts: Varicose veins, Sclerotherapy, Radiofrequency ablation, Endovenous laser treatment