Journal of vascular surgery. Venous and lymphatic disorders最新文献

Objective: Venous duplex ultrasound (VDUS) is the accepted initial imaging study to rule out lower extremity deep venous thrombosis (DVT). In accordance with the Intersocietal Accreditation Commission (IAC) vascular laboratory policies, many institutions require technicians to additionally assess the asymptomatic contralateral common femoral vein. There is conflicting literature on whether this policy is needed. Therefore, the aim of this study was to investigate the utility of examining the asymptomatic contralateral common femoral vein in patients undergoing a unilateral lower extremity VDUS to rule out DVT by (1) defining the prevalence of DVT in the contralateral asymptomatic limb and (2) identifying risk factors that predispose patients to develop a DVT in the asymptomatic limb.

Methods: We retrospectively reviewed the results of all unilateral lower extremity VDUS performed on inpatients and outpatients from January 2023 to July 2023. Patient data including age, sex, symptoms, risk factors for DVT, and indications for the study were collected. The primary outcome was the frequency of DVT in the asymptomatic contralateral common femoral vein. Categorical and continuous data were compared using X² and Student's t-tests, respectively. For all tests, a P-value of <0.05 was considered statistically significant.

Results: 371 patients (170 inpatient vs. 201 outpatient) with unilateral DVT symptoms who underwent VDUS during the study period were identified. Right leg symptoms were present in 186 (50%) patients and left leg symptoms were present in 185 (50%) patients. The overall incidence of acute DVT in the symptomatic limb was 17% (17.4% outpatient vs. 16.5% inpatient, p=NS). Outpatients were more likely to have superficial venous thrombosis (7.0% vs. 0.6%, p=0.002) and chronic venous changes (25.4% vs. 1.2%, p<0.001) in the symptomatic limb. 59% of DVTs in the symptomatic limb were documented in the calf veins, 25% in the proximal veins, and 16% in both the proximal and calf veins. There were no incidences of bilateral DVT in our cohort. Moreover, none of the patients had a DVT isolated to the contralateral common femoral vein.

Conclusions: Scanning the asymptomatic contralateral common femoral vein may not be necessary for patients undergoing unilateral VDUS for symptomatic DVT, regardless of thrombotic risk factors. A single-extremity study will suffice in most cases, and if implemented, it will improve vascular laboratory efficiency and decrease costs without a decline in DVT detection.

Background: Pelvic Venous Disorder (PeVD) is increasingly diagnosed with different modalities of treatment.

Patients and methods: This is a retrospective study in which we compared using metallic coil combined with sclerosant foam N-Butyl-2 Cyanoacrylate (NBCA) in females with PeVD in terms of clinical and technical success as well as safety. Adult patients with symptoms suggestive of primary PEVD and confirmed with Doppler US and /Or venography were eligible for the study. Secondary PeVD and lost Follow up were excluded.

Results: this study included 167 patients who were treated with coil and sclerotherapy (n = 87; Group I) or NBCA (n = 80; Group II) embolization. Immediate postoperative veins' closure was achieved in all patients in the two groups. At the 6-month follow-up, there was a statistically significantly higher occlusion rate in Group I (100% compared to 93.8% in Group II, p = 0.018) with five new cases of recanalization. The 6-month VAS score was lower in Group I (median of 1 and mean of 1.14 ± 0.904) than Group II (median of 2 and mean of 1.7 ± 1.32), with a statistically significant difference (p = 0.005).

Conclusion: The study emphasizes the potential advantages of the sclerosant foam and metallic coil combination in achieving favorable outcomes for patients with PeVD.

Objective: To compare the SVS/AVF/AVLS and the ESVS revised CPGs for treatment of C2 VVs by an analysis of content, methodologic, level of evidence and strength of evidence as well as by AGREE II analysis.

Methods: The 2022 SVS/AVF/AVLS (A) guidelines for VVs were compared to the 2022 ESVS (E) CPGs on VVs for: specific methodology, evidence development [ED], strength of recommendation (SOR), and level (quality) of evidence (LOE). Additionally, an AGREE II analysis was performed to compare the two guidelines. These guidelines were scored on 6 different domains as well as overall quality using a 7-point Likert scale according to the AGREE II methodology.

Results: The two CPGs differed in methodology and scope of content. The two guidelines varied significantly on their ratings of levels of evidence as well as their overall strengths of recommendations. The AGREE II analysis found that both guidelines scored as high quality in the domains of scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, editorial independence, and overall assessment. For the domain of applicability, ESVS (65.28%) scored significantly higher than SVS/AVF/AVLS guideline (51.39%), p=<.05.

Conclusion: Although the methodology differed significantly between both guidelines, the overall conclusions remained similar and both guidelines were rated as high quality by AGREE II analysis.

Objective: Diversity, equity, and inclusion (DEI) within the physician workforce is critical to establishing a diverse provider network that accurately represents the patient population served by vascular surgeons. Vascular surgery remains a largely male-dominated surgical specialty, and the number of women in leadership positions in academic surgical specialties continues to be disproportionate. The representation of women in leadership roles differs across vascular surgery societies. The goal of this study is to provide an update on the representation of women and incorporation of DEI topics at American Venous Forum (AVF) annual meetings and across committees.

Methods: A retrospective review was conducted of available scientific meeting programs and abstracts presented at the AVF from 2010 to 2023. The time period was divided into before 2019 and after 2019, as this was the year that the Society for Vascular Surgery (SVS) established the Task Force on DEI. Women's participation and DEI domains were documented for each year. A two-sample unpaired t-test was used to compare mean percentages.

Results: Specifically, within the American Venous Forum (AVF), women's representation across all roles (presenters, senior authors, moderators, committee chairs, committee members, and officers) has increased when comparing prior years (2010-2019) to a more recent time period (2020-2023). The largest increase was observed for moderators (12.6% vs. 30.2%, +17.6%) and the smallest increase was observed for presenters (21.1% vs. 28.9%, +7.8%). When comparing the same time periods, the mean percentage of DEI domains (access to care, race and ethnicity, gender, age, health literacy, and socioeconomic status) highlighted in research presentations at AVF annual meetings has increased numerically over time but is not statistically significant except for the DEI domain of age (1.34% vs 3.28%; p=0.0008).

Conclusions: While there have been positive improvements in the proportion of women in leadership roles at the AVF, the integration of DEI domains at AVF annual meetings continues to show slow progress. This study reflects an opportunity for AVF leaders and councils to prioritize strategies to incorporate important DEI domains into our annual meetings and mission-related efforts. Intentional progress in these areas will ultimately contribute to more successfully carrying out the AVF Core Values (VEINS: Values and integrity, Education, Inclusivity, equity, diversity, Nurturing, Scientific excellence and research).

Objective: To report our center's experience in treating pediatric vascular malformations using ultrasound-guided microwave ablation.

Methods: Twenty-two symptomatic children with vascular malformations underwent ultrasound-guided microwave ablation. All patients received ultrasound follow-up after microwave ablation, while MRI follow-up was conducted depending on the disease's condition. The Visual Analog Scale (VAS) and the PedsQL4.0 Chinese Version was utilized to assess the changes in pain severity, limb motion evaluation, and quality of life before and after treatment.

Results: The study included 22 cases, comprising 4 Arteriovenous Malformations (AVM), 9 Venous Malformations (VM), 2 diffuse microcystic Lymphatic Malformations (LM), 2 cases of Klippel-Trenaunay syndrome (K-T syndrome), and 5 cases of Fibro Adipose Vascular Anomaly (FAVA). All children presented with pain at the affected site (22 cases, 100%). The malformations were located in the limbs in 17 cases (77%), subcutaneous and intramuscular tissues of the buttocks in 1 case (4.5%), subcutaneous tissue of the abdominal wall in 1 case (4.5%), and retroperitoneal in 3 cases (14%). All 22 patients (100%) experienced pain. Additionally, 20 cases (91%) exhibited swelling at the affected site or developed swelling after physical activity. Limb hypertrophy was observed in 5 cases (23%), while another 5 cases (23%) showed signs of limb atrophy. Joint mobility restrictions were present in 4 cases (18%). Among these 22 patients, 17 cases (77.3%) experienced complete resolution of pain and local lesion appearance changes, while 4 cases (18.2%) reported pain relief. However, in 1 case (4.5%) of KT syndrome, postoperative improvement was observed at the treatment site, but a new centripetal malformation developed within the treated region. This patient subsequently underwent surgical intervention, resulting in an improvement in clinical symptoms. The pre-treatment malformation volume was 209.85 ± 343.17 cm³, which reduced to 32.95 ± 66.04 cm³ one year after ablation. The volume reduction was statistically significant (t=2.374, P=0.026, P<0.05), with an average volume reduction rate of 85.51%. No major complications were found, such as nerve damage or skin burns.

Conclusion: Ultrasound-guided microwave ablation is a relatively safe and effective technique for treating pediatric vascular malformations. Further multicenter studies are recommended to validate these findings.

Introduction: Varicose vein treatments are increasingly employing ambulatory endovenous procedures under local anesthesia. Despite their safety and feasibility, these procedures may induce significant psychological distress-a concern not currently addressed by exist guidelines. This study investigates the necessity for family presence (FP) during endovenous procedures and its effects on the disease treatment process, hypothesizing that FP can provide emotional support and enhance patient trust in medical staff.

Methods: This single-center, prospective observational study, conducted from September 2022 to March 2024, enrolled 175 patients scheduled for outpatient endovenous treatments. Participants were divided based on their preference for family presence during the surgery into FP (n=61, 34.9%) and No Family Presence (NFP, n=114, 65.1%) groups. The primary outcome was the influence of preoperative anxiety on the preference for FP, with secondary outcomes focusing on its impact on perioperative pain and postoperative satisfaction. Data collection followed the STROBE guidelines for observational studies, with preoperative anxiety assessed using a modified Amsterdam Preoperative Anxiety and Information Scale (mAPAIS).

Results: There were no significant demographic or clinical differences between the FP and NFP groups. In the NFP group, common reasons for declining FP included concerns about displaying anxiety (36%) and a perceived lack of necessity (29.8%). The FP group reported significantly higher mAPAIS scores (5.2±1.7 vs. 4.4±1.5, p=0.003) and a stronger preference for FP (3.4±1.1 vs. 2.1±0.8, p=0.001). Logistic regression analysis identified higher preoperative anxiety as a significant predictor of opting for FP (OR = 1.41, 95% CI: 1.07-1.88, p = 0.015). Most FP patients (78.7%) and guardians (85.2%) reported reduced anxiety, enhanced emotional support, and greater trust in the medical team. However, FP did not affect perioperative pain (p = 0.52) or postoperative three-month satisfaction scores (p = 0.42). Adverse events led to FP discontinuation in two (3.3%) of cases (one due to nausea, one due to syncope).

Conclusion: FP during endovenous procedures plays a crucial role in reducing preoperative anxiety and enhancing patient comfort. These findings suggest the potential for integrating family presence into clinical guidelines for minimally invasive procedures, promoting a more patient-centered approach in surgical care. Future studies should investigate the conditions under which FP is most beneficial, taking into account both patient preferences and procedural specifics.