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127-437: Varicose veins have no specific cause. Risk factors include obesity , lack of exercise, leg trauma, and family history of the condition. They also develop more commonly during pregnancy . Occasionally they result from chronic venous insufficiency . Underlying causes include weak or damaged valves in the veins. They are typically diagnosed by examination, including observation by ultrasound . By contrast, spider veins affect

254-578: A gastric balloon or surgery may be performed to reduce stomach volume or length of the intestines, leading to feeling full earlier, or a reduced ability to absorb nutrients from food. Many do not realize that metabolic surgery is not only about reducing intake, it has also been shown to alter gut hormones for a period of time. Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children . In 2022, over 1 billion people lived with obesity worldwide (879 million adults and 159 million children), representing more than

381-467: A randomised controlled trial on patients with and without routine ultrasound have shown a significant difference in recurrence rate and reoperation rate at 2 and 7 years of follow-up. The CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) Classification, developed in 1994 by an international ad hoc committee of the American Venous Forum , outlines these stages Each clinical class

508-655: A 1.67-fold greater risk of obesity compared with those without the risk allele . The differences in BMI between people that are due to genetics varies depending on the population examined from 6% to 85%. Obesity is a major feature in several syndromes, such as Prader–Willi syndrome , Bardet–Biedl syndrome , Cohen syndrome , and MOMO syndrome . (The term "non-syndromic obesity" is sometimes used to exclude these conditions.) In people with early-onset severe obesity (defined by an onset before 10 years of age and body mass index over three standard deviations above normal), 7% harbor

635-477: A BMI of 30–35 kg/m reduces life expectancy by two to four years, while severe obesity (BMI ≥ 40 kg/m ) reduces life expectancy by ten years. Obesity increases the risk of many physical and mental conditions. These comorbidities are most commonly shown in metabolic syndrome , a combination of medical disorders which includes: diabetes mellitus type 2 , high blood pressure , high blood cholesterol , and high triglyceride levels . A study from

762-513: A GSV stripping, laser ablation or after its ligation at the sapheno-femoral junction, the Giacomini vein will drain into the SSV, with a retrograde flow. When there is a GSV thrombosis or other cause of insufficiency, the Giacomini vein can divert the blood flow to the SSV and from there to the popliteal vein. Where surgery, other than stripping or laser ablation is intended, the examiner will make reference to

889-409: A bypass between two distinct points of the same vein. This compartmentalization is useful in an ultrasonographic examination because it makes systematization, mapping execution, and any surgery strategic, easier. Being protected between two fasciae, the superficial veins belonging to compartment N3 very rarely become sinuous. So that when a sinuous vein is detected, the sonographer will suspect that it

1016-401: A cause of recurrent varicose veins. There is increasing evidence for the role of incompetent perforator veins (or "perforators") in the formation of varicose veins. and recurrent varicose veins. Varicose veins could also be caused by hyperhomocysteinemia in the body, which can degrade and inhibit the formation of the three main structural components of the artery: collagen , elastin and

1143-401: A deep knowledge of this subject. Also, unlike ultrasonography of deep venous thrombosis , the procedure focuses mainly on superficial veins. Also, unlike the arterial ultrasound examination, blood velocity in veins has no diagnostic meaning. Veins are a draining system similar to a low pressure hydraulic system , with a laminar flow and a low velocity. This low velocity is responsible for

1270-558: A double of adult cases (and four times higher than cases among children) registered in 1990. Obesity is more common in women than in men. Today, obesity is stigmatized in most of the world. Conversely, some cultures, past and present, have a favorable view of obesity, seeing it as a symbol of wealth and fertility. The World Health Organization , the US, Canada, Japan, Portugal, Germany, the European Parliament and medical societies, e.g.

1397-671: A greater prevalence of labor-saving technology in the home. In children, there appear to be declines in levels of physical activity (with particularly strong declines in the amount of walking and physical education), likely due to safety concerns, changes in social interaction (such as fewer relationships with neighborhood children), and inadequate urban design (such as too few public spaces for safe physical activity). World trends in active leisure time physical activity are less clear. The World Health Organization indicates people worldwide are taking up less active recreational pursuits, while research from Finland found an increase and research from

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1524-586: A high social class were less likely to be obese. No significant differences were seen among men of different social classes. In the developing world, women, men, and children from high social classes had greater rates of obesity. In 2007 repeating the same research found the same relationships, but they were weaker. The decrease in strength of correlation was felt to be due to the effects of globalization . Among developed countries, levels of adult obesity, and percentage of teenage children who are overweight, are correlated with income inequality . A similar relationship

1651-757: A lack of physical activity as the cause of most cases of obesity. A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness. In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet, increased reliance on cars , and mechanized manufacturing. Some other factors have been proposed as causes towards rising rates of obesity worldwide, including insufficient sleep , endocrine disruptors , increased usage of certain medications (such as atypical antipsychotics ), increases in ambient temperature, decreased rates of smoking , demographic changes, increasing maternal age of first-time mothers, changes to epigenetic dysregulation from

1778-564: A lower BMI than Caucasians , some nations have redefined obesity; Japan has defined obesity as any BMI greater than 25 kg/m while China uses a BMI of greater than 28 kg/m . The preferred obesity metric in scholarly circles is the body fat percentage (BF%) – the ratio of the total weight of person's fat to his or her body weight, and BMI is viewed merely as a way to approximate BF%. According to American Society of Bariatric Physicians , levels in excess of 32% for women and 25% for men are generally considered to indicate obesity. BMI

1905-424: A majority of people living with obesity at any given time attempt to lose weight and are often successful, maintaining weight loss long-term is rare. There is no effective, well-defined, evidence-based intervention for preventing obesity. Obesity prevention requires a complex approach, including interventions at medical, societal, community, family, and individual levels. Changes to diet as well as exercising are

2032-628: A man's risk increases by 4% per child. This could be partly explained by the fact that having dependent children decreases physical activity in Western parents. In the developing world urbanization is playing a role in increasing rate of obesity. In China overall rates of obesity are below 5%; however, in some cities rates of obesity are greater than 20%. In part, this may be because of urban design issues (such as inadequate public spaces for physical activity). Time spent in motor vehicles, as opposed to active transportation options such as cycling or walking,

2159-450: A multidisciplinary team rather than "eat less, move more" being the answer as for most living with obesity, diet & exercise have failed them countless times. There is now a scientific realization where 5% of people with this disease are able to lose & maintain loss through this method as the body will adapt & reach a plateau where for most, it begins to push back towards set point. Also that bodies react differently to energy. So too

2286-487: A natural agent, fast recovery to daily activities). ELA and ERA require specialized training for doctors and special equipment. ELA is performed as an outpatient procedure and does not require an operating theatre, nor does the patient need a general anaesthetic . Doctors use high-frequency ultrasound during the procedure to visualize the anatomical relationships between the saphenous structures. Some practitioners also perform phlebectomy or ultrasound-guided sclerotherapy at

2413-496: A pathology. The presence of a reflux is likewise of note; a reflux when not isolated in a vein (as simply retrograde), means that the blood flow is bi-directional where once the flow had been only antegrade. No contraindications are known for this examination. Ultrasonography does not involve the use of ionizing radiation , and the procedure is harmless and can be safely used on anybody of any age. A World Health Organization report published in 1998 supports this. No preparation

2540-404: A phenomenon known as the obesity survival paradox. The paradox was first described in 1999 in overweight and obese people undergoing hemodialysis and has subsequently been found in those with heart failure and peripheral artery disease (PAD). In people with heart failure, those with a BMI between 30.0 and 34.9 had lower mortality than those with a normal weight. This has been attributed to

2667-449: A probe will depend on the depth needed to be studied. For example, the superficial venous system (SVS) can be very well examined using a high frequency probe of 12 MHz. For patients who have thick adipose tissue a probe of 7.5 MHz will be required. Deep veins require probes of around 6 MHz whilst the abdominal vessels are better studied with probes of between 4 and 6 MHz. In summary, three probes are needed together with

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2794-576: A recurrence rate of 33%, to open surgery, which had a recurrence rate of 23%. Steam treatment consists in injection of pulses of steam into the sick vein. This treatment which works with a natural agent (water) has results similar to laser or radiofrequency. The steam presents a lot of post-operative advantages for the patient (good aesthetic results, less pain, etc.) Steam is a very promising treatment for both doctors (easy introduction of catheters, efficient on recurrences, ambulatory procedure, easy and economic procedure) and patients (less post-operative pain,

2921-488: A significant effect on an individual's weight. Those who quit smoking gain an average of 4.4 kilograms (9.7 lb) for men and 5.0 kilograms (11.0 lb) for women over ten years. However, changing rates of smoking have had little effect on the overall rates of obesity. In the United States, the number of children a person has is related to their risk of obesity. A woman's risk increases by 7% per child, while

3048-419: A significant impact on many specialties, including radiology , obstetrics , gynecology , angiology and cardiology , and have provided even greater scope for ultrasound investigations. Since 1970, real-time scanners and pulsed Doppler, have enabled the use of ultrasound to study the function of the venous system. The first demonstration of color Doppler was achieved by Geoff Stevenson. Further progress in

3175-950: A single point DNA mutation. Studies that have focused on inheritance patterns rather than on specific genes have found that 80% of the offspring of two obese parents were also obese, in contrast to less than 10% of the offspring of two parents who were of normal weight. Different people exposed to the same environment have different risks of obesity due to their underlying genetics. The thrifty gene hypothesis postulates that, due to dietary scarcity during human evolution, people are prone to obesity. Their ability to take advantage of rare periods of abundance by storing energy as fat would be advantageous during times of varying food availability, and individuals with greater adipose reserves would be more likely to survive famine . This tendency to store fat, however, would be maladaptive in societies with stable food supplies. This theory has received various criticisms, and other evolutionarily-based theories such as

3302-434: A small incision and no hospital stay, medical super glue has generated great interest within the last years, with a success rate of about 96.8%. A follow-up consultation is required after this treatment, just like any other one, in order to re-assess the diseased vein and further treat it if needed. In the field of varicose veins, the latest medical innovation is high-intensity focused ultrasound therapy ( HIFU ). This method

3429-403: A top level scanner. Also, the proper use of the scanner calls for a high level of expertise, so that the examiner must be well qualified and experienced in order to give effective results. In contrast to arterial ultrasonography the wall of the vein is not relevant and importance is given to the hemodynamic conclusions that the examiner can obtain in order to provide a valuable report. (Hemodynamics

3556-419: A vein wall disease or when normal functioning of the valves, which serve to keep blood flowing to the heart and to prevent reflux, become damaged and/or incompetent (the dilation of a vein will prevent valves to close properly). This incompetence will result in a reversed blood flow through the affected vein or veins. It can result in varicose veins , and in severe cases venous ulcer . The reversed blood pools in

3683-711: Is 39 months. Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency ablation (ERA) compared to open surgery. Myers wrote that open surgery for small saphenous vein reflux is obsolete. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. By comparison ERA has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. Complications for ERA include burns, paraesthesia, clinical phlebitis and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%). One 3-year study compared ERA, with

3810-537: Is a major cause of disability and is correlated with various diseases and conditions , particularly cardiovascular diseases , type 2 diabetes , obstructive sleep apnea , certain types of cancer , and osteoarthritis . Obesity has individual, socioeconomic, and environmental causes. Some known causes are diet, physical activity, automation , urbanization , genetic susceptibility , medications , mental disorders , economic policies , endocrine disorders , and exposure to endocrine-disrupting chemicals . While

3937-476: Is a medical condition, sometimes considered a disease , in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health . People are classified as obese when their body mass index (BMI)—a person's weight divided by the square of the person's height—is over 30  kg / m ; the range 25–30  kg / m is defined as overweight . Some East Asian countries use lower values to calculate obesity. Obesity

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4064-515: Is a tributary. The sapheno-femoral junction is tested by the Valsalva maneuver with the use of color Doppler being helpful at this stage. The wall thickness of the vein is significantly increased in venous reflux, being approximately 0.58 mm in venous reflux, compared to up to 0.45 mm normally. The accessory saphenous vein (ASV), either anterior or posterior, is an important GSV collateral frequently responsible for varicose veins located on

4191-430: Is an advanced non-surgical treatment for varicose veins during which a solution is injected into the diseased vein through a small catheter and under the assistance of ultrasound-guided imagery. The "super glue" solution is made of cyanoacrylate, aiming at sealing the vein and rerouting the blood flow to other healthy veins. Post-treatment, the body will naturally absorb the treated vein which will disappear. Involving only

4318-553: Is an indication that gut flora can affect the metabolic potential. This apparent alteration is believed to confer a greater capacity to harvest energy contributing to obesity. Whether these differences are the direct cause or the result of obesity has yet to be determined unequivocally. The use of antibiotics among children has also been associated with obesity later in life. An association between viruses and obesity has been found in humans and several different animal species. The amount that these associations may have contributed to

4445-427: Is based on the principle that sound can pass through human body tissues and is reflected by the tissue interfaces in the same way that light can reflect back on itself, from a mirror. Tissue in the body will offer varying degrees of resistance, known as acoustic impedance , to the path of the ultrasound beam. When there is a high impedance difference between two tissues, the interface between them will strongly reflect

4572-571: Is believed to be contributing to the rising rates of obesity and to an increased risk of metabolic syndrome and type 2 diabetes . Vitamin D deficiency is related to diseases associated with obesity. As societies become increasingly reliant on energy-dense , big-portions, and fast-food meals, the association between fast-food consumption and obesity becomes more concerning. In the United States, consumption of fast-food meals tripled and food energy intake from these meals quadrupled between 1977 and 1995. Agricultural policy and techniques in

4699-523: Is chronic alcohol consumption due to the vasodilatation side effect in relation to gravity and blood viscosity. Clinical tests that may be used include: Traditionally, varicose veins were investigated using imaging techniques only if there was a suspicion of deep venous insufficiency, if they were recurrent, or if they involved the saphenopopliteal junction. This practice is now less widely accepted. People with varicose veins should now be investigated using lower limbs venous ultrasonography . The results from

4826-399: Is completely non-invasive and is not necessarily performed in an operating room, unlike existing techniques. This is because the procedure involves treating from outside the body, able to penetrate the skin without damage, to treat the veins in a targeted area. This leaves no scars and allows the patient to return to their daily life immediately. Varicose veins are most common after age 50. It

4953-462: Is correlated with increased risk of obesity. Malnutrition in early life is believed to play a role in the rising rates of obesity in the developing world . Endocrine changes that occur during periods of malnutrition may promote the storage of fat once more food energy becomes available. The study of the effect of infectious agents on metabolism is still in its early stages. Gut flora has been shown to differ between lean and obese people. There

5080-498: Is drawn on paper and then drawn on the patient before surgery. The use of ultrasonography in a medical application was first used in the late 1940s in the United States. This use was soon followed in other countries with further research and development being carried out. The first report on Doppler ultrasound as a diagnostic tool for vascular disease was published in 1967–1968. Rapid advances since then in electronics, has greatly improved ultrasound transmission tomography . It allows

5207-441: Is further characterized by a subscript depending upon whether the patient is symptomatic (S) or asymptomatic (A), e.g. C2S. Treatment can be either active or conservative. Treatment options include surgery, laser and radiofrequency ablation , and ultrasound-guided foam sclerotherapy . Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. No real difference could be found between

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5334-490: Is more prevalent in females. There is a hereditary role. It has been seen in smokers, those who have chronic constipation , and in people with occupations which necessitate long periods of standing such as wait staff, nurses, conductors (musical and bus), stage actors, umpires (cricket, javelin, etc.), the King's guards, lectern orators, security guards, traffic police officers, vendors, surgeons, etc. Obesity Obesity

5461-408: Is normally necessary for this examination, but if a complementary study of abdominal veins is also required, the patient will be asked to fast for 12 hours beforehand. The sensitivity and specificity measurements are around 90%. The ultrasound equipment must be of sufficiently high quality in order to give a correct image processing result, which can then provide invaluable information, mainly at

5588-626: Is not known if sclerotherapy decreases the chance of varicose veins returning (recurrent varicose veins). It is also not known which type of substance (liquid or foam) used for the sclerotherapy procedure is more effective and comes with the lowest risk of complications. Complications of sclerotherapy are rare, but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound-guided sclerotherapy when an unusually large dose of sclerosant foam

5715-892: Is not regarded as a psychiatric disorder, and therefore is not listed in the DSM-IVR as a psychiatric illness. The risk of overweight and obesity is higher in patients with psychiatric disorders than in persons without psychiatric disorders. Obesity and depression influence each other mutually, with obesity increasing the risk of clinical depression, and also depression leading to a higher chance of developing obesity. Certain medications may cause weight gain or changes in body composition ; these include insulin , sulfonylureas , thiazolidinediones , atypical antipsychotics , antidepressants , steroids , certain anticonvulsants ( phenytoin and valproate ), pizotifen , and some forms of hormonal contraception . While genetic influences are important to understanding obesity, they cannot completely explain

5842-414: Is now viewed as outdated in numerous countries. It ignores variations between individuals in amounts of lean body mass, particularly muscle mass. Individuals involved in heavy physical labor or sports may have high BMI values despite having little fat. For example, more than half of all NFL players are classified as "obese" (BMI ≥ 30), and 1 in 4 are classified as "extremely obese" (BMI ≥ 35), according to

5969-420: Is of most benefit; in confirming varicose disease, making an assessment of the hemodynamics, and charting the progression of the disease and its response to treatment. It has become the reference standard for examining the condition and hemodynamics of the lower limb veins. Particular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and

6096-451: Is seen among US states: more adults, even in higher social classes, are obese in more unequal states. Many explanations have been put forth for associations between BMI and social class. It is thought that in developed countries, the wealthy are able to afford more nutritious food, they are under greater social pressure to remain slim, and have more opportunities along with greater expectations for physical fitness . In undeveloped countries

6223-445: Is seen in the overweight and obese. One study found that the improved survival could be explained by the more aggressive treatment obese people receive after a cardiac event. Another study found that if one takes into account chronic obstructive pulmonary disease (COPD) in those with PAD, the benefit of obesity no longer exists. The " a calorie is a calorie " model of obesity posits a combination of excessive food energy intake and

6350-571: Is seen to align with the femoral vessels. On ultrasound at the saphenofemoral junction in the groin , the common femoral vein (CFV) with the GSV and the common femoral artery (CFA) create an image called the Mickey Mouse sign . The CFV represents the head, and the CFA and GSV represent the ears. The examination report will include details of the deep and the superficial vein systems, and their mapping. The mapping

6477-426: Is still somewhat controversial, and there is no clear evidence that foams are superior. Sclerotherapy has been used in the treatment of varicose veins for over 150 years. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger varicose veins, including

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6604-403: Is supported both by tests of people carried out in a calorimeter room and by direct observation. A sedentary lifestyle may play a significant role in obesity. Worldwide there has been a large shift towards less physically demanding work, and currently at least 30% of the world's population gets insufficient exercise. This is primarily due to increasing use of mechanized transportation and

6731-546: Is the result of an interplay between genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose to obesity when sufficient food energy is present. As of 2006, more than 41 of these sites on the human genome have been linked to the development of obesity when a favorable environment is present. People with two copies of the FTO gene (fat mass and obesity associated gene) have been found on average to weigh 3–4 kg more and have

6858-483: Is the study of blood flow and of the laws that govern the circulation of blood in the blood vessels). It follows that the examiner knowledge of venous hemodynamics is crucial, which can be a real barrier to a radiologist untrained in this field, who might wish to carry out these examinations. Specialized training in venous ultrasonography is not undertaken in some countries, which undermines best practice, mainly when varicose veins need to be examined. Ultrasonography

6985-448: Is widely used in confirming venous pathology diagnoses. The imaging capability needed, was made possible with the developments of Doppler and color Doppler. Doppler measurements using Doppler effect can show the direction of the blood flow and its relative velocity and color Doppler is the provision of color to help interpret the image, showing for example, the blood flow towards the probe in one color and that flowing away another. Whilst

7112-525: The American Medical Association , classify obesity as a disease. Others, such as the UK , do not. Obesity is typically defined as a substantial accumulation of body fat that could impact health. Medical organizations tend to classify people living with obesity as based on body mass index (BMI) – a ratio of a person's weight in kilograms to the square of their height in meters . For adults,

7239-492: The Endocrine Society , there is "growing evidence suggesting that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight". Excess appetite for palatable, high-calorie food (especially fat, sugar, and certain animal proteins) is seen as the primary factor driving obesity worldwide, likely because of imbalances in neurotransmitters affecting

7366-490: The RAK Hospital found that obese people are at a greater risk of developing long COVID . The CDC has found that obesity is the single strongest risk factor for severe COVID-19 illness. Complications are either directly caused by obesity or indirectly related through mechanisms sharing a common cause such as a poor diet or a sedentary lifestyle . The strength of the link between obesity and specific conditions varies. One of

7493-502: The World Health Organization (WHO) defines " overweight " as a BMI 25 or higher, and "obesity" as a BMI 30 or higher. The U.S. Centers for Disease Control and Prevention (CDC) further subdivides obesity based on BMI, with a BMI 30 to 35 called class 1 obesity; 35 to 40, class 2 obesity; and 40+, class 3 obesity. For children, obesity measures take age into consideration along with height and weight. For children aged 5–19,

7620-447: The accessory saphenous vein (ASV), form an image resembling an eye which is referred to as the "eye sign" or "eye image". . All veins which are between the skin and the superficial fascia are tributaries and all veins which cross the deep fascia to join the deep venous system are perforator veins. Three anatomic compartments can be described, as networks: Some authors describe one more compartment N4, containing collaterals which form

7747-695: The capillaries and are smaller. Treatment may involve lifestyle changes or medical procedures with the goal of improving symptoms and appearance. Lifestyle changes may include wearing compression stockings , exercising, elevating the legs, and weight loss. Possible medical procedures include sclerotherapy , laser surgery , and vein stripping . However, recurrence is common following treatment. Varicose veins are very common, affecting about 30% of people at some point in their lives. They become more common with age. Women develop varicose veins about twice as often as men. Varicose veins have been described throughout history and have been treated with surgery since at least

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7874-507: The common femoral vein (CFV) these three create an image, the so-called " Mickey Mouse sign ". Some authors, inspired by this sign (presented for the first time at CHIVA's 2002 meeting in Berlin), described a "Mickey Mouse view" at the groin, an image formed by the common femoral vein, the GSV and the superficial femoral artery. When the ASV is incompetent, its flow becomes retrograde and tries to drain in

8001-543: The drifty gene hypothesis and the thrifty phenotype hypothesis have also been proposed. Certain physical and mental illnesses and the pharmaceutical substances used to treat them can increase risk of obesity. Medical illnesses that increase obesity risk include several rare genetic syndromes (listed above) as well as some congenital or acquired conditions: hypothyroidism , Cushing's syndrome , growth hormone deficiency , and some eating disorders such as binge eating disorder and night eating syndrome . However, obesity

8128-553: The proteoglycans . Homocysteine permanently degrades cysteine disulfide bridges and lysine amino acid residues in proteins , gradually affecting function and structure. Simply put, homocysteine is a 'corrosive' of long-living proteins, i.e. collagen or elastin , or lifelong proteins, i.e. fibrillin . These long-term effects are difficult to establish in clinical trials focusing on groups with existing artery decline. Klippel–Trenaunay syndrome and Parkes Weber syndrome are relevant for differential diagnosis . Another cause

8255-411: The small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein . These veins are deep veins . Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described (as networks), (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as

8382-470: The 1960s commercially available systems were introduced. Soon, other advances in electronics and piezoelectric materials enabled further improvements which meant that ultrasound was quickly adopted for use in medicine due to its rapid, accurate diagnostic capabilities which offered the possibility of prompt treatment. Alongside the improving imaging technology, acoustic Doppler velocimetry and medical ultrasonography color Doppler were developed, which have had

8509-469: The 1970s was made with the arrival of the microchip , and the ensuing exponential increase in processing power has meant the development of fast and powerful systems. These systems involving digital beamforming and greater signal enhancement, have introduced new methods of interpreting and displaying data Rapid technical advancements in transmission tomography made possible the very good specificity and sensitivity capability of this technique, enabling

8636-599: The BMI metric. However, their mean body fat percentage , 14%, is well within what is considered a healthy range. Similarly, Sumo wrestlers may be categorized by BMI as "severely obese" or "very severely obese" but many Sumo wrestlers are not categorized as obese when body fat percentage is used instead (having <25% body fat). Some Sumo wrestlers were found to have no more body fat than a non-Sumo comparison group, with high BMI values resulting from their high amounts of lean body mass. Canada utilises BMI sparingly within their method of defining levels of obesity through use of

8763-634: The BioSHaRE– EU Healthy Obese Project (sponsored by Maelstrom Research, a team under the Research Institute of the McGill University Health Centre ) came up with two definitions for healthy obesity , one more strict and one less so: To come up with these criteria, BioSHaRE controlled for age and tobacco use, researching how both may effect the metabolic syndrome associated with obesity, but not found to exist in

8890-482: The Edmonton Scale (for adult obesity). This scale also introduces factors such as Quality of Life, Mental Health & Mobility amongst others. In recent years, Canada chose to allow both Chilli & Ireland to adapt their obesity guidelines to suit both countries' health systems. In Ireland, obesity is now defined as "a Complex, Chronic & Relapsing Disease". Therefore it is now viewed as requiring intervention from

9017-435: The GSV collaterals, (the veins that run parallel), drain the abdominal wall and have a flow from top to bottom so that when an examiner tests the saphenofemoral junction , a false positive diagnosis might be made; secondly, in the flow from the sole of the foot venous network around 10% drains to the dorsal venous arch of the foot , going therefore against the norm, from deep to superficial veins. Attention will be focused on

9144-527: The United States and Europe have led to lower food prices . In the United States, subsidization of corn, soy, wheat, and rice through the U.S. farm bill has made the main sources of processed food cheap compared to fruits and vegetables. Calorie count laws and nutrition facts labels attempt to steer people toward making healthier food choices, including awareness of how much food energy is being consumed. Obese people consistently under-report their food consumption as compared to people of normal weight. This

9271-455: The United States found leisure-time physical activity has not changed significantly. Physical activity in children may not be a significant contributor. In both children and adults, there is an association between television viewing time and the risk of obesity. Increased media exposure increases the rate of childhood obesity, with rates increasing proportionally to time spent watching television. Like many other medical conditions, obesity

9398-889: The United States increased from 14.5% to 30.9%. During the same period, an increase occurred in the average amount of food energy consumed. For women, the average increase was 335 calories (1,400 kJ) per day (1,542 calories (6,450 kJ) in 1971 and 1,877 calories (7,850 kJ) in 2004), while for men the average increase was 168 calories (700 kJ) per day (2,450 calories (10,300 kJ) in 1971 and 2,618 calories (10,950 kJ) in 2004). Most of this extra food energy came from an increase in carbohydrate consumption rather than fat consumption. The primary sources of these extra carbohydrates are sweetened beverages, which now account for almost 25 percent of daily food energy in young adults in America, and potato chips. Consumption of sweetened beverages such as soft drinks, fruit drinks, and iced tea

9525-515: The United States, Aethoxysklerol in Australia), sodium tetradecyl sulphate (STS), Sclerodex (Canada), hypertonic saline, glycerin and chromated glycerin. STS (branded Fibrovein in Australia) liquids can be mixed at varying concentrations of sclerosant and varying sclerosant/gas proportions, with air or CO 2 or O 2 to create foams. Foams may allow more veins to be treated per session with comparable efficacy. Their use in contrast to liquid sclerosant

9652-625: The WHO defines obesity as a BMI two standard deviations above the median for their age (a BMI around 18 for a five-year old; around 30 for a 19-year old). For children under five, the WHO defines obesity as a weight three standard deviations above the median for their height. Some modifications to the WHO definitions have been made by particular organizations. The surgical literature breaks down class II and III or only class III obesity into further categories whose exact values are still disputed. As Asian populations develop negative health consequences at

9779-450: The ability to afford food, high energy expenditure with physical labor, and cultural values favoring a larger body size are believed to contribute to the observed patterns. Attitudes toward body weight held by people in one's life may also play a role in obesity. A correlation in BMI changes over time has been found among friends, siblings, and spouses. Stress and perceived low social status appear to increase risk of obesity. Smoking has

9906-407: The anterior and lateral aspect of the thigh. The anterior ASV is more anterior than the ASV and is outside the femoral vessels plan. The two veins terminate in a common trunk near the groin, the sapheno-femoral junction. Here, the ASV can be located aligned with the femoral vessels at the "alignment sign". Also, at the groin it can be seen at the outside of the great saphenous vein, and together with

10033-471: The association of BMI and waist circumference with mortality is U- or J-shaped, while the association between waist-to-hip ratio and waist-to-height ratio with mortality is more positive. In Asians the risk of negative health effects begins to increase between 22 and 25 kg/m . In 2021, the World Health Organization estimated that obesity caused at least 2.8 million deaths annually. On average, obesity reduces life expectancy by six to seven years,

10160-490: The benefits towards "healthier living" having physical benefits without dynamic shifts on the scales. Plus living with stigma surrounding the shape of one's body or actual treatments for the disease of obesity, be they medicinal or surgical, has been shown to greatly exacerbate the issue. Obesity increases a person's risk of developing various metabolic diseases, cardiovascular disease , osteoarthritis , Alzheimer disease , depression , and certain types of cancer. Depending on

10287-494: The bio-engineering group at the University of Washington who conducted research on Doppler ultrasound as a diagnostic tool for vascular disease, published their first work in 1967. The first report published about the venous system appeared around 1967–1968. A few years later in 1977, Claude Franceschi published the very first book about vascular ultrasonography, L’investigation vasculaire par ultrasonographie Doppler . From

10414-426: The blood flow direction in this vein, as it will be of importance. Perforator veins play a very special role in the venous system, carrying blood from superficial to deep veins. During the muscular systole their valves close and stop any blood flow coming from the deep to the superficial veins. When their valves become insufficient, they are responsible for a rapid deterioration in existing varicose disease and for

10541-446: The body's response to insulin, potentially leading to insulin resistance . Increased fat also creates a proinflammatory state , and a prothrombotic state. Newer research has focused on methods of identifying healthier obese people by clinicians, and not treating obese people as a monolithic group. Obese people who do not experience medical complications from their obesity are sometimes called (metabolically) healthy obese , but

10668-587: The degree of obesity and the presence of comorbid disorders, obesity is associated with an estimated 2–20 year shorter life expectancy. High BMI is a marker of risk for, but not a direct cause of, diseases caused by diet and physical activity. Obesity is one of the leading preventable causes of death worldwide. The mortality risk is lowest at a BMI of 20–25 kg/m in non-smokers and at 24–27 kg/m in current smokers, with risk increasing along with changes in either direction. This appears to apply in at least four continents. Other research suggests that

10795-455: The development of venous ulcers. Detection of insufficient perforators is important because they need to be ligatured. However, the detection of competent ones is as important because they may be used strategically in new techniques of conservative surgery, for example a minimally invasive CHIVA . The ultrasonography report will include insufficient and continent perforators, which will also be shown on venous mapping. To test these veins properly,

10922-405: The direction of the blood flow in both of the venous systems, and in the perforator veins, as well as being focused on shunt detection. A shunting of blood from the thigh veins back into the lower leg veins will give a reflux situation. The veins most often found to be incompetent are the saphenous veins and the perforators communicating with the deep veins of the thigh. Venous ultrasonography of

11049-517: The dramatic increase seen within specific countries or globally. Though it is accepted that energy consumption in excess of energy expenditure leads to increases in body weight on an individual basis, the cause of the shifts in these two factors on the societal scale is much debated. There are a number of theories as to the cause but most believe it is a combination of various factors. The correlation between social class and BMI varies globally. Research in 1989 found that in developed countries women of

11176-517: The drive to eat. Dietary energy supply per capita varies markedly between different regions and countries. It has also changed significantly over time. From the early 1970s to the late 1990s the average food energy available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654 calories (15,290 kJ) per person in 1996. This increased further in 2003 to 3,754 calories (15,710 kJ). During

11303-482: The environment, increased phenotypic variance via assortative mating , social pressure to diet , among others. According to one study, factors like these may play as big of a role as excessive food energy intake and a lack of physical activity; however, the relative magnitudes of the effects of any proposed cause of obesity is varied and uncertain, as there is a general need for randomized controlled trials on humans before definitive statement can be made. According to

11430-419: The equipment itself is costly, the procedure is not. Apart from the scanner, different probes are required according to the depth to be studied. A gel is used with the probe to make a good acoustic impedance contact. The training and expertise of the examiner is important because of the many technical complications that can present. Venous anatomy for example, is not constant, for example a patient's vein layout of

11557-445: The examiner to evaluate the gross anatomy of the venous networks as well as the blood flow direction, which is crucial in determining vein pathology. It has become the reference standard used in the assessment of the condition and hemodynamics of the veins of the lower limbs. The normal physiological blood flow is antegrade, flowing from the periphery towards the heart, so that the evidence of an opposite, retrograde flow might indicate

11684-486: The examiner will need to use some techniques like the Paraná maneuver, toe and foot flexion, and hyper-extension on tip toes. After performing this examination, the physician writes a report in which some points are crucial: This enables surgeons to plan interventions, in a stage known as virtual dissection. Drawn on paper, after the examination, it will be drawn over the patient's skin before surgery. The Doppler effect

11811-493: The existence of metabolically healthy obesity—the metabolically healthy obese are often found to have low amounts of ectopic fat (fat stored in tissues other than adipose tissue) despite having overall fat mass equivalent in weight to obese people with metabolic syndrome . Although the negative health consequences of obesity in the general population are well supported by the available research evidence, health outcomes in certain subgroups seem to be improved at an increased BMI,

11938-658: The extent to which this group exists (especially among older people) is in dispute. The number of people considered metabolically healthy depends on the definition used, and there is no universally accepted definition. There are numerous obese people who have relatively few metabolic abnormalities, and a minority of obese people have no medical complications. The guidelines of the American Association of Clinical Endocrinologists call for physicians to use risk stratification with obese patients when considering how to assess their risk of developing type 2 diabetes. In 2014,

12065-461: The fact that it can only be detected spontaneously with the Doppler effect on the proximal and larger femoral and iliac veins . Here the flow is either modulated by the respiratory rhythm or is continuous in cases where the flow is high. The thinner veins do not have a spontaneous flow. However, in some circumstances the blood flow is so slow that it can be seen as some echogenic material moving within

12192-471: The fact that people often lose weight as they become progressively more ill. Similar findings have been made in other types of heart disease. People with class I obesity and heart disease do not have greater rates of further heart problems than people of normal weight who also have heart disease. In people with greater degrees of obesity, however, the risk of further cardiovascular events is increased. Even after cardiac bypass surgery , no increase in mortality

12319-423: The foot , a superficial vein which connects the small saphenous vein with the GSV. It travels up the leg and medial side of the thigh to reach the groin, where it drains into the common femoral vein. Along the length of the GSV, it receives numerous tributaries, (from the subcutaneous layer) and drains into the deep veins via the perforator veins . When seen in a scan, the GSV and the Giacomini vein, together with

12446-428: The great saphenous and small saphenous veins. There is some evidence that sclerotherapy is a safe and possibly effective treatment option for improving the cosmetic appearance, reducing residual varicose veins, improving the quality of life, and reducing symptoms that may be present due to the varicose veins. There is also weak evidence that this treatment option may have a slightly higher risk of deep vein thrombosis. It

12573-454: The knee joint in the popliteal vein or a little less often in the GSV or other deep muscular veins of the thigh. The use of ultrasonography has allowed a number of variations to be shown at this level; when no contact is made with the popliteal vein it might be seen to drain in the GSV, at a variable level; or, it may merge with the Giacomini vein and drain in the GSV at the superior 1/3 of

12700-485: The late 1990s, Europeans had 3,394 calories (14,200 kJ) per person, in the developing areas of Asia there were 2,648 calories (11,080 kJ) per person, and in sub-Saharan Africa people had 2,176 calories (9,100 kJ) per person. Total food energy consumption has been found to be related to obesity. The widespread availability of dietary guidelines has done little to address the problems of overeating and poor dietary choice. From 1971 to 2000, obesity rates in

12827-701: The legs or ankles. Less commonly, but not exceptionally, varicose veins can be due to other causes, such as post-phlebitic obstruction or incontinence, venous and arteriovenous malformations. Venous reflux is a significant cause. Research has also shown the importance of pelvic vein reflux (PVR) in the development of varicose veins. Varicose veins in the legs could be due to ovarian vein reflux. Both ovarian and internal iliac vein reflux causes leg varicose veins. This condition affects 14% of women with varicose veins or 20% of women who have had vaginal delivery and have leg varicose veins. In addition, evidence suggests that failing to look for and treat pelvic vein reflux can be

12954-488: The low third of legs and feet. Unlike the arterial ultrasound study, when the sonographer studies venous insufficiency, the vein wall itself has no relevance and attention will be focused on the direction of blood flow. The objective of the examination is to see how the veins drain. In this way, venous ultrasonography has at times become a hemodynamic examination which is reserved for experienced sonographers who have completed hemodynamic studies and training and have acquired

13081-790: The lower limbs is the most demanding of the medical complementary examinations. It is dependent on the examiner's expertise and training, and the interpretation of the results is subjective and reliant on an understanding of venous hemodynamics. (A mapping does help the reproducibility and the inter-observer agreement of this examination). The examination is made even more difficult because there can be dilated veins without insufficiency, (by hyper-debit), and non dilated but incompetent veins. Moreover, veins can be discretely incompetent in summer but then be normal in winter. Also, by definition of insufficiency, (insufficient blood flow) blood may be seen to flow freely in both directions, antegrade and retrograde between two valves. Another problem when dealing with

13208-448: The main treatments recommended by health professionals. Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat or sugars, and by increasing the intake of dietary fiber , if these dietary choices are available, affordable, and accessible. Medications can be used, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective,

13335-413: The metabolically healthy obese. Other definitions of metabolically healthy obesity exist, including ones based on waist circumference rather than BMI, which is unreliable in certain individuals. Another identification metric for health in obese people is calf strength , which is positively correlated with physical fitness in obese people. Body composition in general is hypothesized to help explain

13462-443: The patient's skin and so helps the conduction of the sound waves from the transducer into the body. The watery medium also helps to conduct the sound waves. Liquids, including blood have a low impedance, which means that little energy will be reflected and no visualization possible. One of the important exceptions is that when the blood flow is very slow it can in fact be seen, in what is termed "spontaneous contrast". This technology

13589-445: The right limb is not identical to that of the left limb. The probe is an ultrasonic sensor , generally known as a transducer , which functions to send and receive acoustic energy. The emission is generated on piezoelectric crystals by the piezoelectric effect . The reflected ultrasound is received by the probe, transformed into an electric impulse as voltage and sent to the engine for signal processing and conversion to an image on

13716-584: The rising rate of obesity is yet to be determined. Ultrasonography of chronic insufficiency of the legs Ultrasonography of suspected or previously confirmed chronic venous insufficiency of leg veins is a risk-free, non-invasive procedure. It gives information about the anatomy , physiology and pathology of mainly superficial veins . As with heart ultrasound ( echocardiography ) studies, venous ultrasonography requires an understanding of hemodynamics in order to give useful examination reports. In chronic venous insufficiency, sonographic examination

13843-413: The saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen. The ASV which is often responsible for varicose veins, can be located at the 'alignment sign', where it

13970-456: The saphenous main trunks, they are no longer available for use as venous bypass grafts in the future (coronary or leg artery vital disease). Other surgical treatments are: A commonly performed non-surgical treatment for varicose and "spider leg veins" is sclerotherapy , in which medicine called a sclerosant is injected into the veins to make them shrink. The medicines that are commonly used as sclerosants are polidocanol (POL branded Asclera in

14097-403: The screen. The depth reached by the ultrasound beam is dependent on the frequency of the probe used. The higher the frequency the lesser the depth reached. The patient will need to be in an upright position to enable a proper study of blood flow direction Chronic venous insufficiency is where the veins cannot pump enough blood back to the heart. It results when the vein dilates secondary to

14224-725: The second century BC, when Plutarch tells of such treatment performed on the Roman leader Gaius Marius. People with varicose veins might have a positive D-dimer blood test result due to chronic low-level thrombosis within dilated veins ( varices ). Most varicose veins are reasonably benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb. Varicose veins are more common in women than in men and are linked with heredity . Other related factors are pregnancy , obesity , menopause , aging , prolonged standing, leg injury and abdominal straining. Varicose veins are unlikely to be caused by crossing

14351-406: The sound. When the ultrasound beam meets air, or solid tissue such as bone, their impedance difference is so great that most of the acoustic energy is reflected making it impossible to see any underlying structures. The examiner will see just a shadow, instead of the image expected. Air will impede sound waves which is why a gel is used. The gel prevents air bubbles from forming between the probe, and

14478-493: The strongest is the link with type 2 diabetes . Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women. Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis , obstructive sleep apnea , social stigmatization) and those due to the increased number of fat cells ( diabetes , cancer , cardiovascular disease , non-alcoholic fatty liver disease ). Increases in body fat alter

14605-438: The superficial level. It must be able to provide both color and Doppler imaging; technologies that developed alongside the development of ultrasound. The use of Doppler measurements which trace the echoes of the generated soundwaves received by the probe, enable the direction and the velocity of the blood flow, to be depicted. The overlay of color onto the Doppler information lets these images be seen more clearly. The choice of

14732-411: The superficial venous system, is that venous anatomy is not constant; the position of veins can vary in different patients; also in the same patient the right lower limb is not identical to the left lower limb. As a further complication to the examination, where venous insufficiency is evidenced, the examination needs to be done with the probe in the transversal position but the mapping must be done showing

14859-411: The superior fibular perforator, at the side of the knee, or sometimes it runs down towards the ankle to drain in the inferior fibular perforator. The small saphenous vein (SSV), runs along the posterior aspect of the leg as far as the popliteal region, in the upper calf. Here it enters the popliteal space which is located between the two heads of the gastrocnemius muscle where it usually drains above

14986-475: The thigh. It can also but rarely, drain in the vein of the semimembranosus (thigh muscle) (shown below). Usually though, it connects with a perforator vein at its middle 1/3. To check for insufficiency, the Paraná maneuver is very useful. The Giacomini vein mostly acts as a bypass between the GSV and SSV territories. Usually its flow is in the normal antegrade direction, from bottom to top. However it can become retrograde without pathology. For example, after

15113-470: The time of endovenous treatment. This is also known as an ambulatory phlebectomy . The distal veins are removed following the complete ablation of the proximal vein. This treatment is most commonly used for varicose veins off of the great saphenous vein, small saphenous vein, and pudendal veins. Follow-up treatment to smaller branch varicose veins is often needed in the weeks or months after the initial procedure. Also called medical super glue, medical adhesive

15240-436: The treatment of varicose veins." It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury, and paraesthesia, post-operative infections, and haematomas, appears to be greater after ligation and stripping than after EVLT". Complications for ELA include minor skin burns (0.4%) and temporary paresthesia (2.1%). The longest study of endovenous laser ablation

15367-467: The treatments, except that radiofrequency ablation could have a better long-term benefit. The National Institute for Health and Clinical Excellence (NICE) produced clinical guidelines in July 2013 recommending that all people with symptomatic varicose veins (C2S) and worse should be referred to a vascular service for treatment. Conservative treatments such as support stockings should not be used unless treatment

15494-465: The vein, in "spontaneous contrast". This material can easily be mistaken for a thrombus, but can also easily be discounted by testing the vein's compressibility. To evidence the blood flow direction there are some techniques that the examiner can use to accelerate blood flow and show valvular function: Normal blood flow is antegrade (going to the heart), and from superficial to deep veins via perforator veins. However, there are two exceptions: firstly,

15621-425: The veins in their longitudinal aspect. This demands a rapid extrapolation by the physician from the transversal images seen to the longitudinal drawing needed. The dynamic maneuvers also need to be well executed. The need of a specialized training is mandatory which is a huge problem for many countries today. The GSV a superficial vein, is the longest vein in the body. It has its origin in the dorsal venous arch of

15748-502: The world. In the mid-1950s more research was undertaken by Professor Ian Donald et al., in Glasgow, which advanced the practical technology and applications of ultrasound. In 1963, in France, Léandre Pourcelot started on his thesis, which was presented in 1964, and used pulsed Doppler for blood flow calculation as its subject. This was followed up by Peronneau in 1969. Dr. Gene Strandness and

15875-486: Was first described by Christian Doppler in 1843. Nearly forty years later in 1880, the piezoelectric effect was discovered and confirmed by Pierre and Jacques Curie . Both of these findings were used in the development of ultrasonography. The first ultrasound was applied to the human body for medical purposes by Dr.  George Ludwig , University of Pennsylvania, in the late 1940s. The use of ultrasonography in medicine soon followed in different locations around

16002-426: Was injected. There are three kinds of endovenous thermal ablation treatment possible: laser, radiofrequency, and steam. The Australian Medical Services Advisory Committee (MSAC) in 2008 determined that endovenous laser treatment /ablation (ELA) for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for

16129-576: Was not possible. The symptoms of varicose veins can be controlled to an extent with the following: Stripping consists of removal of all or part the saphenous vein ( great/long or lesser/short ) main trunk. The complications include deep vein thrombosis (5.3%), pulmonary embolism (0.06%), and wound complications including infection (2.2%). There is evidence for the great saphenous vein regrowing after stripping. For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5% to 60%. In addition, since stripping removes

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