{"title":"Answers to the invited commentaries on 'Conservative REflux Elimination Device (CREED): The Virtual Phlebectomy' by S. Ricci","authors":"S. Ricci","doi":"10.24019/jtavr.137","DOIUrl":"https://doi.org/10.24019/jtavr.137","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79879069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sclerotherapy is, by definition, a destructive treatment and, as such, it is conceptually long far away from the basic principles of the conservative hemodynamic cure for venous insufficiency (CHIVA cure). Accordingly, Phlebologists and Vascular Surgeons who practice the CHIVA cure at most acknowledge the use of sclerotherapy after the CHIVA cure for the aesthetical refinement or for the control over time of small calibre recurrences. However, intraoperative sclerotherapy can be used in association with the CHIVA cure in those cases in which the surgical gesture foreseen by the CHIVA cure would not be able to flush disconnect escape points at the level of the deep venous system and, as a consequence, it would leave non-draining stumps, which are a source of recurrences. Further, under some particular circumstances, sclerotherapy can be used instead of the CHIVA cure for the treatment of type II shunts or as the 1st step of the CHIVA 2 strategy for the treatment of type III shunts. This paper describes the use of intraoperative sclerotherapy for the treatment of escape points from the deep venous system difficult to treat by surgery, such as perforator veins, some anatomic presentations of the saphenous-popliteal junction and some pelvic shunts. This paper also describes the use of sclerotherapy alone for the treatment of type II shunts or for modelling saphenous hemodynamics in type III shunts before completing the treatment by surgery.
{"title":"CHIVA cure and sclerotherapy","authors":"M. Cappelli, R. Molino Lova","doi":"10.24019/jtavr.129","DOIUrl":"https://doi.org/10.24019/jtavr.129","url":null,"abstract":"Sclerotherapy is, by definition, a destructive treatment and, as such, it is conceptually long far away from the basic principles of the conservative hemodynamic cure for venous insufficiency (CHIVA cure). Accordingly, Phlebologists and Vascular Surgeons who practice the CHIVA cure at most acknowledge the use of sclerotherapy after the CHIVA cure for the aesthetical refinement or for the control over time of small calibre recurrences. However, intraoperative sclerotherapy can be used in association with the CHIVA cure in those cases in which the surgical gesture foreseen by the CHIVA cure would not be able to flush disconnect escape points at the level of the deep venous system and, as a consequence, it would leave non-draining stumps, which are a source of recurrences. Further, under some particular circumstances, sclerotherapy can be used instead of the CHIVA cure for the treatment of type II shunts or as the 1st step of the CHIVA 2 strategy for the treatment of type III shunts. This paper describes the use of intraoperative sclerotherapy for the treatment of escape points from the deep venous system difficult to treat by surgery, such as perforator veins, some anatomic presentations of the saphenous-popliteal junction and some pelvic shunts. This paper also describes the use of sclerotherapy alone for the treatment of type II shunts or for modelling saphenous hemodynamics in type III shunts before completing the treatment by surgery.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74386274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biomedical science is experiencing a reassessment of its practices of healthcare management where more appropriate cost-benefit profiles are being combined with improvements in knowledge, effectiveness, and safety of diagnostic/therapeutic procedures to drive the advances in medicine. This review aims to assess: (a) possible biases of the scientific literature and research, (b) the clinical value and the cost-effectiveness of the principal medical practices and (c) the possible contribution of integrative and translational medicine. Literature shows that current medical research has cognitive (mostly industry-induced) biases that negatively impact clinical practice: the ever-increasing use of drugs and technologies, united with a certain inattention to the basic mechanisms of pathophysiology are paving the way of reductionism in medical practice. A critical view of innovations in medicine, together with a sound understanding and application of the scientific method, would improve the effectiveness, safety and sustainability of therapies. Translational and integrative medicine can contribute to develop a new patient-centered approach. Conversely, reductionism, eminence/reimbursement-based medical decisions, lack of patient education, industry-influenced science, and limited awareness from physicians may compromise the efficacy, safety, appropriateness, and cost-effectiveness of diagnostic and therapeutic processes.
{"title":"Biomedical science limitations and flaws: why not choose wisely?","authors":"A. Cavezzi, G. D'errico, R. Colucci","doi":"10.24019/jtavr.142","DOIUrl":"https://doi.org/10.24019/jtavr.142","url":null,"abstract":"Biomedical science is experiencing a reassessment of its practices of healthcare management where more appropriate cost-benefit profiles are being combined with improvements in knowledge, effectiveness, and safety of diagnostic/therapeutic procedures to drive the advances in medicine. This review aims to assess: (a) possible biases of the scientific literature and research, (b) the clinical value and the cost-effectiveness of the principal medical practices and (c) the possible contribution of integrative and translational medicine. Literature shows that current medical research has cognitive (mostly industry-induced) biases that negatively impact clinical practice: the ever-increasing use of drugs and technologies, united with a certain inattention to the basic mechanisms of pathophysiology are paving the way of reductionism in medical practice. A critical view of innovations in medicine, together with a sound understanding and application of the scientific method, would improve the effectiveness, safety and sustainability of therapies. Translational and integrative medicine can contribute to develop a new patient-centered approach. Conversely, reductionism, eminence/reimbursement-based medical decisions, lack of patient education, industry-influenced science, and limited awareness from physicians may compromise the efficacy, safety, appropriateness, and cost-effectiveness of diagnostic and therapeutic processes.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85600238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Pizzamiglio, A. González García, César Aparicio Martínez, Patricia Lorena Torres Lebruno, Jennifer Díaz Cruz, C. Mengis, Jesús Manuel Gallego Bustos, F. Tomé-Bermejo, L. Álvarez Galovich
Objective:Evaluate access related complications contributing to adverse outcomes in patients undergoing retroperitoneal anterior lumbar interbody fusion (ALIF). MethodsA retrospective analysis was conducted of prospectively collected data on patients undergoing ALIF in a multidisciplinary setting at our institution from January 2007 to December 2021. Patients’ demographics, comorbidities, exposure related and postoperative complications within 30 days were included. Main outcome measures included vascular and visceral injuries requiring repair, nerve injuries, blood transfusion requirements, myocardial infarction, stroke, erectile dysfunction, retrograde ejaculation, length of stay and death. ResultsSeventy-four consecutive patients were included. Forty-seven were female and 27 male. The median body mass index was of 25.46 ± 4.76. Mean age was of 45.74 years. Twelve had a history of previous abdominal surgery and 31 a previous spinal surgery. The level operated on was L5/S1 in 58 patients (78.37%), L4/L5 in 2 patients (2.7%) and multi-level in 14 patients (18.91%). Sixteen patients had both anterior and posterior approach. There were no major intra-operative vascular injuries. Two patients had an intestine serosal tear. Seven patients had sexual dysfunction after surgery, of which 5 suffered impotence and 4 retrograde ejaculation. Two patients had both. There were no cases of disc space infections. There were no postoperative deaths. ConclusionsIn a multidisciplinary setting, ALIF can be performed safely with a reasonably low overall complication rate. Impotence and retrograde ejaculation are, even if generally temporary, important issues that have to be informed to the patient and inquired at follow up.
{"title":"Anterior lumbar spine exposure with vascular surgeon assistance","authors":"M. Pizzamiglio, A. González García, César Aparicio Martínez, Patricia Lorena Torres Lebruno, Jennifer Díaz Cruz, C. Mengis, Jesús Manuel Gallego Bustos, F. Tomé-Bermejo, L. Álvarez Galovich","doi":"10.24019/jtavr.150","DOIUrl":"https://doi.org/10.24019/jtavr.150","url":null,"abstract":"Objective:Evaluate access related complications contributing to adverse outcomes in patients undergoing retroperitoneal anterior lumbar interbody fusion (ALIF). MethodsA retrospective analysis was conducted of prospectively collected data on patients undergoing ALIF in a multidisciplinary setting at our institution from January 2007 to December 2021. Patients’ demographics, comorbidities, exposure related and postoperative complications within 30 days were included. Main outcome measures included vascular and visceral injuries requiring repair, nerve injuries, blood transfusion requirements, myocardial infarction, stroke, erectile dysfunction, retrograde ejaculation, length of stay and death. ResultsSeventy-four consecutive patients were included. Forty-seven were female and 27 male. The median body mass index was of 25.46 ± 4.76. Mean age was of 45.74 years. Twelve had a history of previous abdominal surgery and 31 a previous spinal surgery. The level operated on was L5/S1 in 58 patients (78.37%), L4/L5 in 2 patients (2.7%) and multi-level in 14 patients (18.91%). Sixteen patients had both anterior and posterior approach. There were no major intra-operative vascular injuries. Two patients had an intestine serosal tear. Seven patients had sexual dysfunction after surgery, of which 5 suffered impotence and 4 retrograde ejaculation. Two patients had both. There were no cases of disc space infections. There were no postoperative deaths. ConclusionsIn a multidisciplinary setting, ALIF can be performed safely with a reasonably low overall complication rate. Impotence and retrograde ejaculation are, even if generally temporary, important issues that have to be informed to the patient and inquired at follow up.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84757163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invited commentary on 'Conservative REflux Elimination Device (CREED): The Virtual Phlebectomy' by S. Ricci","authors":"F. Passariello","doi":"10.24019/jtavr.136","DOIUrl":"https://doi.org/10.24019/jtavr.136","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75384030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invited commentary on 'Conservative REflux Elimination Device (CREED): The Virtual Phlebectomy' by S. Ricci","authors":"Byung Boong Lee","doi":"10.24019/jtavr.135","DOIUrl":"https://doi.org/10.24019/jtavr.135","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80237498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invited commentary on 'Conservative REflux Elimination Device (CREED): The Virtual Phlebectomy' by S. Ricci","authors":"C. Franceschi","doi":"10.24019/jtavr.133","DOIUrl":"https://doi.org/10.24019/jtavr.133","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85723051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: to assess effectiveness of supplementation with a nutraceutical containing an extract of Maqui berry on symptoms and signs of patients with venous insufficiency of the lower limbs
目的:评估补充含有马桂莓提取物的营养保健品对下肢静脉功能不全患者的症状和体征的有效性
{"title":"Efficacy and safety of a Maqui berry-based nutraceutical in venous insufficiency of the lower limbs","authors":"Elida Mici, A. Prifti, L. Zikaj, A. Kuraj","doi":"10.24019/jtavr.147","DOIUrl":"https://doi.org/10.24019/jtavr.147","url":null,"abstract":"Aims: to assess effectiveness of supplementation with a nutraceutical containing an extract of Maqui berry on symptoms and signs of patients with venous insufficiency of the lower limbs","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74612213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
"Modern" Phlebology was born and developed during the second half of the last century. Some fundamental stages are indicated, above all prevailing the therapy of varicose veins, based on chemical methods (sclerotherapy) or surgical (stripping), without neglecting the progress of pathophysiological knowledge. With the passage of the century, Phlebology seems to be under a strong influence from technology, both at the diagnostic and therapeutic level. However, it does not seem that this development has led to real progress, but rather to make this specialty (still to be explored) more complex, but also less accurate.
{"title":"The Phlebology of the past century, before the 2000 technological�age","authors":"S. Ricci","doi":"10.24019/jtavr.130","DOIUrl":"https://doi.org/10.24019/jtavr.130","url":null,"abstract":"\"Modern\" Phlebology was born and developed during the second half of the last century. Some fundamental stages are indicated, above all prevailing the therapy of varicose veins, based on chemical methods (sclerotherapy) or surgical (stripping), without neglecting the progress of pathophysiological knowledge. With the passage of the century, Phlebology seems to be under a strong influence from technology, both at the diagnostic and therapeutic level. However, it does not seem that this development has led to real progress, but rather to make this specialty (still to be explored) more complex, but also less accurate.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":"6 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90227044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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