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Objective To test the in vivo haemodynamic performance of graduated elastic compression (GEC) stockings using air-plethysmography (APG) in healthy volunteers (controls) and patients with varicose veins (VVs), post-thrombotic syndrome (PTS), or lymphoedema. Responsiveness data were used to determine which group benefited the most from GEC. Methods There were 12 patients per group compared using no compression, knee-length Class 1 (18–21 mmHg) compression, and Class 2 (23–32 mmHg) compression. Stocking/leg interface pressures (mmHg) were measured supine in two places using an air-sensor transducer. Stocking performance parameters, investigated before and after GEC, included the standard APG tests (working venous volume [wVV], venous filling index [VFI], venous drainage index [VDI], ejection fraction [EF]) and the occlusion plethysmography tests (incremental pressure causing the maximal increase in calf volume [IPMIV], outflow fraction [OF]). Results were expressed as median and interquartile range. Results Significant graduated compression was achieved in all four groups with higher interface pressures at the ankle. Only the VVs patients had a significant reduction in their wVV (without: 133 [109–146] vs. class1: 93 [74–113] mL) and the VFI (without: 4.6 [3–7.1] vs. class1: 3.1 [1.9–5] mL/s), both at p <.05. The IPMIV improved significantly in all groups except in the PTS group ( p <.05). The OF improved only in the controls (without: 43 [38–51] vs. class1: 50 [48–53] %) and the VVs patients (without: 47 [39–58] vs. class1: 56 [50–64] %), both at p <.05. There were no significant differences in the VDI or the EF with GEC. Compression dose-response relationships were not observed. Conclusion Patients with varicose veins improved the most, whereas those with PTS improved the least. Performance seemed to depend more on disease pathophysiology than compression strength. However, the lack of responsiveness to compression strength may be related to the low external pressures used. Stocking performance tests may have value in selecting those patients who benefit most from compression. [ABSTRACT FROM AUTHOR]

Objectives: Graduated elastic compression (GEC) stockings reduce reflux and venous volume but their performance on augmenting venous return is unproven. The aim of this study was to quantify the ability of stockings to increase venous outflow from the leg. Design: A prospective study comparing venous emptying without compression, versus class 1 (18–21 mmHg) and class 2 (23–32 mmHg) compression, using air-plethysmography (APG). Methods: The right legs of 20 healthy subjects were studied supine. A 12-cm thigh-cuff was inflated in 10 mmHg steps from 0 to 80 mmHg while the corresponding increase in calf volume was recorded using the APG sensor calf-cuff. At the 80 mmHg plateau, the thigh-cuff was released suddenly to measure the unrestricted venous emptying. Venous return was assessed by: (a) identifying the incremental thigh-cuff pressure causing the maximal incremental increase in calf volume (IPMIV); (b) measuring the percentage reduction in calf volume in 1 second following thigh-cuff release – outflow fraction (OF); (c) time to empty 90% of the venous volume – venous emptying time (VET90). Results: Median and inter-quartile range (IQR) baseline values of IPMIV, OF, and VET90 without compression were 20 mmHg (range: 20–30 mmHg), 44% (39–50%) and 13 seconds (8.8–15.9 seconds), respectively. These improved significantly with all stockings. The application of any stocking raised the median IPMIV by 30 mmHg. The change from a class 2 stocking compared with no stocking versus the change from a class 1 stocking to no stocking had a more pronounced effect (p < .005). After sudden thigh-cuff deflation, the venous emptying was 41–45% greater and 9–10 seconds faster with all stockings (p < .005). Conclusions: This is the first study to quantify the venous return of below-knee GEC stockings. Assessments of stockings in augmenting venous return may be of use as a way of optimising compression for individual patients unresponsive to standard conservative treatment. [Copyright &y& Elsevier]

Abstract: Objectives: Quantify endovenous laser ablation (EVLA) with concurrent phlebectomies and ultrasound-guided foam sclerotherapy (UGFS) in cost and effectiveness at 3 weeks and 3 months. Design: Single-centre, prospective, randomised controlled trial. Patients: One hundred patients (100 legs), C2–6, age 21–78, M:F 42:58, with primary varicose veins received either EVLA under local anaesthetic or UGFS. Methods: Assessments included duplex, Aberdeen varicose vein questionnaire (AVVQ), venous clinical severity score (VCSS), venous filling index (VFI), visual analogue 7-day pain score and analgesia requirements. Additional treatments with UGFS were performed, if required. Micro-costing, using individually timed treatments, was based on consumables, staff pay and overheads. Results: Changes in AVVQ, VCSS and VFI values (3 months) did not demonstrate any significant difference between groups. At 3 months, the above-knee GSV occlusion rate (without co-existing reflux) was not significantly different between the groups (74% vs 69%; EVLA vs UGFS; P = .596). Of the 9 haemodynamic failures in each group, 7 EVLA patients and 4 UGFS patients had co-existing cross-sectional above-knee GSV occlusion at some point. However, UGFS significantly outperformed EVLA in cost, treatment duration, pain, analgesia requirements and recovery. Conclusions: UGFS is 3.15 times less expensive than EVLA (£230.24 vs £724.72) with comparable effectiveness but 56% (versus 6%) required additional foam (ISRCTN:03080206). [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate a duplex-derived score for varicose vein treatments using numerical values of haemodynamic effectiveness. Design: The saphenous treatment score (STS) was developed prospectively to compare the effect of endovenous treatments on reflux within saphenous segments. Patients: Sixty-six patients were randomised to endovenous laser ablation (EVLA) or ultrasound-guided foam sclerotherapy (UGFS) to the great saphenous vein (GSV). Methods: Assessments included the Aberdeen varicose vein severity score (AVVSS), the venous clinical severity score (VCSS), the venous filling index (VFI) and the STS. Results: A mean STS of 5.70 decreased to 3.30, P < .0005, post-treatment. The median (IQR) AVVSS, VCSS and VFI (ml/sec) decreased from 21.52(15.48) to 18.86(11.27), P = .14, from 6(4) to 3(4), P < .0005 and from 7.1(6.9) to 1.9(.9) P < .0005, respectively. In 15 patients requiring additional UGFS the mean STS values decreased from 5.8 to 4.13 and then to 2.6 P < .0005, respectively. The individual above and below knee mean treatment differences in STS on 38 EVLA and 28 UGFS patients were 1.92 and .87 (EVLA) compared to 1.57and .29 (UGFS) P = .001, respectively. Conclusions: The STS has been shown to grade the haemodynamic effects of different treatments as well as ongoing treatments on the GSV. [Copyright &y& Elsevier]

Abstract: Objectives: Electrical stimulation of calf muscles has been shown to be effective in prevention of DVT. The aim was to determine: (a) dependence of venous blood velocity and ejected volume on the rates of stimulated calf contractions: (b) clinical factors affecting efficacy in healthy individuals. Methods: The maximum intensity stimulus tolerated was applied to calfs of 24 volunteers. In popliteal veins, Peak Systolic Velocities (PSV), ejected volume per individual stimulus (Stroke Volume SV) and ejected Total Volume Flow per minute (TVF) of expelled blood were determined using ultrasound. Stimulation rates from 2 to 120 Beats Per Minute (bpm) were applied. Results: Mean baseline popliteal PSV was 10 cm/s. For stimulation rates between 2 and 8 bpm, the PSV was 10 times higher and reached 96–105 cm/s. Stroke volume (SV) per individual stimulus decreased in a similar fashion. With increasing rates of stimulation the TVF increased by a factor of 12 times (from 20 ml/min to 240 ml/min). Conclusion: Electrical stimulation is an effective method of activating the calf muscle pump. Enhancements of popliteal blood velocity and volume flow are key factors in the prevention of venous stasis and DVT. Further studies are justified to determine the stimulation rates in those with a compromised venous system. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that the SCD EXPRESS™ intermittent pneumatic compression applied in combination with a four-layer bandage in patients with venous ulcers increases popliteal vein volume flow and velocity. Design: Twenty limbs of 18 patients with venous leg ulcers were studied, median age 76 years. The Total Volume Flow (TVF) and the Peak Systolic Velocity (PSV) were recorded in the popliteal vein using duplex ultrasonography. Measurements were made (i) without bandage, (ii) with four layer bandage and (iii) following the application of the SCD Compression System on top of a four-layer bandage for at least 15 minutes. Results: The median VCSS was 17 (range, 12–22) while the median VSDS for reflux was 4.5 (range, 1–7.5). The median TVF was 71mL/min (inter-quartile range 57–101) without bandage, 112 (IQR 89–148) with four-layer bandage and 291 (IQR 241–392) with the addition of the SCD System (P <.001, Wilcoxon signed ranks test). The median PSV was 8.4cm/sec (IQR 6.8–14) without bandage, 13 (9.0–19) with four-layer bandage and 27 (21–31) with the addition of the SCD System (P <.001, Wilcoxon signed ranks test). Both TVF and PSV increased slightly with the addition of the four-layer bandage. However, with the addition of the SCD System these parameters increased three fold. Conclusions: The SCD EXPRESS Compression System accelerates venous flow in the legs of patients with venous ulcers already treated with a four-layer bandage. The combination of four-layer compression with the SCD System on healing venous ulcers needs to be tested by a clinical effectiveness study. [Copyright &y& Elsevier]

The 7th annual meeting of the European Venous Forum (EVF) was held in London at the Royal Society of Medicine (RSM) from the 29th June to 1st July with great success under the presidency of Alun H Davies. It is the 1st time that the EVF joint forces with two other established venous societies: the Venous Forum of the RSM and the American Venous Forum (AVF). It was awarded 17 credit hours by the European Board of Vascular Surgery and 5 Continuing Professional development credits by the RSM. The meeting was a great success, attended by nearly 400 delegates from the UK, Europe, USA and Australia. More information about the meeting and the details of the scientific program appear in the eEJVES http://www.ejvesextra.com. [Copyright &y& Elsevier]

Abstract: The 6th meeting of the European venous forum (EVF) was held recently in Heraklion, Crete. The EVF was founded in 2000 modelling itself on the American venous forum with the aim of presenting selected papers of high scientific quality on venous disease. These societies emphasise the aspects of discussion of scientific work and equal time is given to presentation and subsequent discussion of papers presented. A local organiser Prof A. Katsamouris with his team, made arrangements for the congress. However, the registration, selection of papers and printing of the scientific program was done centrally from the organising committee of the EVF whose president is Professor A.N. Nicolaides. The meeting opened with sessions on ‘the swollen leg’ and ‘prophylaxis of VTE’. During the three days of the meeting 30 papers on wide range of venous disease were presented. The next meeting of the EVF will be held in London between 29th June and 1st July 2006. Mr Alun Davies is the local organiser for this meeting. [Copyright &y& Elsevier]