Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications - A consensus document of the International Union of Phlebology-2023.

Background: Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events.

Objectives: To categorise contraindications to sclerotherapy based on the available scientific evidence.

Clinical Perspectives and Management of Edema in Chronic Venous Disease-What about Ruscus?

Edema is highly prevalent in patients with cardiovascular disease and is associated with various underlying pathologic conditions, making it challenging for physicians to diagnose and manage. We report on presentations from a virtual symposium at the Annual Meeting of the European Venous Forum (25 June 2021), which examined edema classification within clinical practice, provided guidance on making differential diagnoses and reviewed evidence for the use of the treatment combination of extract, hesperidin methyl chalcone and vitamin C. The understanding of the pathophysiologic mechanisms underlying fluid build-up in chronic venous disease (CVD) is limited.

CEAP clinical classes C0S-C4: differences, similarities and role of Ruscus + HMC + vitamin C in patients with chronic venous disease.

Since the publication of the CEAP classification, new research has enriched our knowledge; notably on the heritability of CVD and the genetic and environmental factors involved in this condition, as well as the symptoms apparent within the spectrum of the CEAP clinical classes and the benefits of medical treatment. Using the CEAP classification as a special theme, a symposium with the same title as the present paper was held at the annual meeting of the 2019 European Venous Forum. The lectures presented much valuable information, from which some key points can be extracted.

The driving mechanisms of the carbon cycle perturbations in the late Pliensbachian (Early Jurassic).

The Early Jurassic (late Pliensbachian to early Toarcian) was a period marked by extinctions, climate fluctuations, and oceanic anoxia. Although the causes of the early Toarcian Oceanic Anoxia Event (OAE) have been fairly well studied, the events that lead to the Toarcian OAE, i.e.

Sclerotherapy is a safe method of treatment of chronic venous disorders in older patients: A prospective and comparative study of consecutive patients.

Unlabelled: Objectives An aging population requires evaluation of methods of treatment for older patients. Our objective was to evaluate the indications, practical modalities, safety and tolerability of sclerotherapy in patients 75 years of age and older (group 1) and compare with a control group of patients 18 to74 years of age (group 2). Method This observational, multicentre, prospective and comparative study was conducted by the French Society of Phlebology.

Thermal erosion of cratonic lithosphere as a potential trigger for mass-extinction.

The temporal coincidence between large igneous provinces (LIPs) and mass extinctions has led many to pose a causal relationship between the two. However, there is still no consensus on a mechanistic model that explains how magmatism leads to the turnover of terrestrial and marine plants, invertebrates and vertebrates. Here we present a synthesis of ammonite biostratigraphy, isotopic data and high precision U-Pb zircon dates from the Triassic-Jurassic (T-J) and Pliensbachian-Toarcian (Pl-To) boundaries demonstrating that these biotic crises are both associated with rapid change from an initial cool period to greenhouse conditions.

Cross-sectional study on heredity and venous disorders: the end of the dominant maternal heredity dogma?

Objective: To evaluate the heredity factor of the chronic venous disorders and odds ratio linked to maternal or paternal heredity.

Methods: Cross-sectional epidemiological study conducted in daily practice of medical practitioners on all patients consulting them. The practitioners described the venous status of all patients consulting them and recorded the familial past history of venous disease.

Endovenous chemical (and physical) treatments for varices: what's new?

The constant evolution of endo-venous ablative techniques for varicose veins arises from the need for: better patient's comfort, reduced incidence of side effects, better results at short-, mid- and long-term follow-up, as well as reduction of operating time and technical simplicity. All these goals have been aimed at but so far no new technology has been able to achieve them all or to demonstrate it, furthermore the increase of price must be compensated by a considerable improvement of results and a serious reduction of side effects to be incrementally cost effective. We present in this article several recent evolutions of sclerotherapy (chemical ablation).

European guidelines for sclerotherapy in chronic venous disorders.

Aim: Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy.

Treatment of chronic venous disease with flavonoids: recommendations for treatment and further studies.

Objectives: A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used.

Method: A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment.

Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program.

Aim: The Vein Consult Program is an international, observational, prospective survey aiming to collect global epidemiological data on chronic venous disorders (CVD) based on the CEAP classification, and to identify CVD management worldwide. The survey was organized within the framework of ordinary consultations, with general practitioners (GPs) properly trained on the use of the CEAP classification.

Methods: Screening for CVD was to be performed by enrolling in the survey all consecutive outpatients >18 years whatever the reason for consultation, to record patient's data and classify them according to the CEAP, from the stage C0s to C6.

Importance of patient-reported outcomes in chronic venous disorders.

The assessment of outcomes following treatment for chronic venous disease has been greatly improved over the last three decades. The personal opinion of the physician based on assessment of his own results has been replaced by more objective assessment based on well-defined criteria. The author describes and compares a number of different methods currently in use for this purpose.

Quality of life improvement in Latin American patients suffering from chronic venous disorder using a combination of Ruscus aculeatus and hesperidin methyl-chalcone and ascorbic acid (quality study).

Aim: The present study assessed the effect of Ruscus aculeatus, hesperidin methyl-chalcone and ascorbic acid (HMC-AA), in the treatment of chronic venous disorders (CVD) in Latin American patients.

Methods: This study is an observational, single arm, multicentric and prospective trial. Patients suffering from CVD and belonging to C0s-C3 Clinical Etiological Anatomical and Physiopathological (CEAP) classes were included.

The patient's burden of chronic venous disorders: construction of a questionnaire.

Aims: On the one hand, the survey aims at the development and validation of an auto-administered questionnaire designed to measure the everyday burden caused by chronic venous disorders (CVDs). On the other hand, it aims at reporting initial epidemiological and demographic data in CVD patients and their correlations.

Materials And Methods: After identification of 66 possible items, the elimination of redundant and less relevant questions left a questionnaire of 36 simple items, the Assessment of Burden in Chronic-Venous Disease (ABC-V) that has been applied prospectively and consecutively to a population of 328 actual chronic venous disorder (CVD) patients in eight vein-specialized centres in France.

Complications of sclerotherapy: an update.

Objectives: To describe, determine the incidence of, and explain the adverse reactions associated with the use of sclerotherapy and sclerosing agents.

Material And Methods: Review of current literature and personal research, with special attention to the French registry of 12,173 sclerotherapy sessions.

Results: The nature and incidence of side effects of sclerosing agents vary according to the injection form: liquid or foam.

Pathophysiology of visual disturbances occurring after foam sclerotherapy.

Background: Visual disturbances (VDs) are reported with an average rate of 1.4% after foam sclerotherapy (FS). Some clinical clues indicate that they could correspond to migraine with aura (MA).

The French polidocanol study on long-term side effects: a survey covering 3,357 patient years.

Background: AIMS Short- and mid-term side effects of sclerotherapy, in particular with polidocanol (lauromacrogol 400), have been previously described in our registry of 12,173 sessions. The objective of this follow-up registry was to evaluate the long-term incidence of adverse events with polidocanol.

Methods: The physicians involved in the initial French registry were contacted and asked to partake in the follow-up survey.

Complications and side-effects of foam sclerotherapy.

Aims: To describe and report incidence and frequency of side-effects and complications of sclerotherapy with foamed sclerosing agents. To explain, when possible, their pathophysiology and to indicate possible manoeuvres and techniques to limit them.

Methods: Review of current literature and personal research.

Good genes and good luck: ammonoid diversity and the end-Permian mass extinction.

The end-Permian mass extinction removed more than 80% of marine genera. Ammonoid cephalopods were among the organisms most affected by this crisis. The analysis of a global diversity data set of ammonoid genera covering about 106 million years centered on the Permian-Triassic boundary (PTB) shows that Triassic ammonoids actually reached levels of diversity higher than in the Permian less than 2 million years after the PTB.

Assessment of quality of life in Mexican patients suffering from chronic venous disorder - impact of oral Ruscus aculeatus-hesperidin-methyl-chalcone-ascorbic acid treatment - 'QUALITY Study'.

Objectives: The present study assessed the effect of Ruscus aculeatus-hesperidin-methyl-chalcone-ascorbic acid (HMC-AA) on the quality of life (QoL) of patients suffering from chronic venous disorders (CVDs).

Methods: An observational, multicentre and prospective study was performed with 917 Mexican patients suffering from CVD. Patients were treated with R.