Unresolved questions on venous thromboembolic disease. Therapeutic management of superficial vein thrombosis (SVT). Consensus statement of the French Society for Vascular Medicine (SFMV).

Superficial vein thrombosis (SVT), a manifestation of venous thromboembolism (VTE), is a common condition, yet of all the types of VTE, it has been the least well studied. Recent studies have challenged the conception that SVT is a benign disease, showing that its risk factors overlap with those of deep-vein thrombosis (DVT) and that it is frequently associated with DVT or pulmonary embolism (PE). In 2010, the CALISTO trial demonstrated the benefit of treatment with fondaparinux at the dose of 2.

25 mm Hg versus 35 mm Hg elastic compression stockings to prevent post-thrombotic syndrome after deep vein thrombosis (CELEST): a randomised, double-blind, non-inferiority trial.

Background: The optimal strength of compression needed to prevent post-thrombotic syndrome (PTS) after a proximal deep vein thrombosis (DVT) is debated. We aimed to assess whether 25 mm Hg elastic compression stockings (ECS) are non-inferior to 35 mm Hg ECS in preventing PTS after a DVT.

Methods: In this multicentre, double-blind, non-inferiority, randomised controlled trial, we enrolled adults (≥18 years) with a first ipsilateral proximal DVT attending 46 French vascular medicine hospital departments or private practices.

Compression stockings to prevent postthrombotic syndrome: Literature overview and presentation of the CELEST trial.

Postthrombotic syndrome (PTS) is a burdensome and costly complication of deep vein thrombosis (DVT) that develops in 20%-40% of patients within 2 years after proximal DVT. In the absence of effective curative treatment, management of PTS relies on its prevention after DVT. The effectiveness of elastic compression stockings (ECS) to prevent PTS is uncertain.

Update of the SFMV (French society of vascular medicine) guidelines on the conditions and safety measures necessary for thermal ablation of the saphenous veins and proposals for unresolved issues.

Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins.

Effect of anticoagulant treatment on pain in distal deep vein thrombosis: an ancillary analysis from the cactus trial.

Essentials Management of patients with calf deep vein thrombosis remains controversial. We conducted a post-hoc analysis of a placebo controlled LMWH randomized clinical trial. Pain was assessed using visual analogue scale at inclusion, one and six weeks.

[Questions--answers on the use of rivaroxaban for the treatment of venous thromboembolic disease].

Rivaroxaban is a direct oral anticoagulant targeting factor Xa. Efficacy and safety of rivaroxaban were evaluated through the phase 3 EINSTEIN program, consisting in three clinical trials regarding the treatment of deep vein thrombosis (EINSTEIN DVT), pulmonary embolism (EINSTEIN PE), and in secondary prevention after a first episode of venous thromboembolic disease (EISNTEIN EXT). Rivaroxaban was recently approved both by the European and the French Health agencies for the treatment of DVT and prevention of deep vein thrombosis recurrence.

[Compression therapy and deep-vein thrombosis: a clinical practice survey].

Background: Compression therapy constitutes the cornerstone of prevention of post-thrombotic syndrome in patients with deep-vein thrombosis (DVT). However, no consensus has been reached regarding the optimal timing for initiation, duration, and strength of compression therapy.

Objective: To document prescribing practices of compression therapy in case of DVT by French Vascular Medicine physicians.

Efficacy of polidocanol foam versus liquid in sclerotherapy of the great saphenous vein: a multicentre randomised controlled trial with a 2-year follow-up.

Objective: To compare the relative efficacy of polidocanol (Aetoxisclerol, Kreussler, Germany) when used as a foam or liquid in the treatment of saphenous incompetence.

Materials And Methods: Multicentre, prospective, randomised controlled trial conducted in patients with incompetence of the great saphenous vein (GSV) with a truncal diameter of 4-8 mm. The great saphenous vein was injected using a single injection 2-2.

Comparison of 1% and 3% polidocanol foam in ultrasound guided sclerotherapy of the great saphenous vein: a randomised, double-blind trial with 2 year-follow-up. "The 3/1 Study".

Objectives: To compare 1% and 3% POL foam in treating the great saphenous vein (GSV) by ultrasound guided sclerotherapy.

Design: Multicentre, prospective, randomised, double-blind trial with 2 year-follow-up.

Patients And Methods: 148 patients with GSV reflux (saphenous trunk diameter 4-8 mm) were randomised to undergo ultrasound guided foam sclerotherapy using either 1% or 3% POL foam in a single session.

Evaluation of the efficacy of polidocanol in the form of foam compared with liquid form in sclerotherapy of the greater saphenous vein: initial results.

Background: Foamed sclerosing agents have been used with enthusiasm by phlebologists for more than 5 decades. Any type of varicose veins can and has been treated with this technique. Numerous publications have stressed the advantages of foamed sclerosing agents on the basis of empiric and experimental criteria and have described various individual techniques to prepare foams.

Benefit of a 2-month treatment with a micronized, purified flavonoidic fraction on venous ulcer healing. A randomized, double-blind, controlled versus placebo trial.

Objective: To assess the efficacy of a micronized purified flavonoid fraction (Daflon 500 mg = Dios) in venous leg ulcer healing, in addition to compression therapy and standardized local care.

Design: Double-blind, multicentre, randomized, parallel groups, controlled versus placebo trial; stratification according to ulcer size.

Subjects: 107 patients, with venous ulcer of the leg for at least 3 months, and accepting bandaging therapy.

Efficacy of Daflon 500 mg in venous leg ulcer healing: a double-blind, randomized, controlled versus placebo trial in 107 patients.

The objective of this study was to evaluate the efficacy of Daflon 500 mg (Dios)* in venous ulcers. A multicenter, double-blind, randomized, controlled versus placebo (Plac) trial was conducted, with stratification according to the size of ulcer (< or = 10 cm and > 10 cm). The protocol called for a two-month treatment with Dios (one tablet = 450 mg micronized purified Diosmin) or a placebo, two tablets/day, in addition to compression therapy.

[Echography and sclerotherapy].

Duplex-scanning represents major progress in diagnosis of venous insufficiency. It now permits also amelioration of sclerotherapy, by direct visual reference to the Doppler screen by which means we guide puncture of the vein and control the injection, whether the vein is deep or the location difficult. It permits us also to follow up the results rigorously.

[Lymphatic complications from variceal surgery].

Introduction: Lymphatic injuries are unavoidable during varicose vein surgery. However these injuries seldom lead to complications. This study was held to try to find an explanation to this contradiction which seems to be only noticeable.

[Ultrasonography of the popliteal fossa. Survey of a small saphenous arteriole before sclerotherapy].

Routine investigation by ultrasonography with pulsed Doppler was carried out in 125 patients, candidates for sclerosing injections of the short saphenous. Study of the contents of the popliteal fossa, of the short saphenous, of the position of its junction in relation to the joint line of the knee, as well as detection of a possible satellite arteriole of the short saphenous was undertaken from a hemodynamic and topographic standpoint. A small calibre satellite arteriole of the short saphenous was a virtually constant finding, situated deep to the junction of the short saphenous, parallel to the latter at its origin, and interposed between the popliteal and short saphenous veins.

[Distal obliterating arteriopathy of the lower limbs in a systemic disease. Treatment with normovolemic hemodilution. [Report of one case]].

The authors report on a 31 year old man with a generalised illness consisting of: buccal aphthous ulcers, distal arteriopathy, multiform cutaneous lesions (necrotising vasculitis, folliculitis, nodules), hypersensitivity at the site of puncture, Raynaud's syndrome and superficial venous thromboses. After the failure of various therapies (calcium heparin, ticlopidine, colchicine, corticoids, immunostimulants), the patient was successfully treated by normovolemic haemodilution on 20 occasions, obtaining each time healing of the skin lesions within 2 to 4 weeks.

[A trial of silver sulfadiazine in the local treatment of venous ulcer].

Silver sulfadiazine, in cream form, has been mostly used in the treatment of burns. Its trial in the treatment of leg ulcers has been satisfactory. This preparation is well tolerated, and effective on wound cleansing and granulation tissue formation.

[Stripping using invagination over a calibrated stent].

After crossectomy which remains the most important stage, a short stripping is performed in an upward direction, substituting a packing for the olive shaped knob normally used. The width of this gauze packing depends on the diameter of the saphenous vein. Traction of the lower end of the stripper, at the ankle, pulls down the packing within the saphenous vein, causing its invagination.