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

Objective: In patients with ilio-femoral deep vein thrombosis (DVT), early thrombus removal reduces the risk of post-thrombotic syndrome (PTS). It remains uncertain if mechanical thrombectomy (MT) using the ClotTriever™ system may offer advantages as compared to rheolytic thrombectomy (RT) using the AngioJet ZelanteDVT™.

Methods: In our multicenter, retrospective, observational study, we included 122 patients (mean age 48 years, 57% women) with ilio-femoral (78%) or ilio-caval DVT (22%). All underwent early thrombus removal with either MT (n=40) or RT (n=82) and had a minimum of 3-month follow-up. Periprocedural outcomes included periprocedural thrombolytic use, access complications, and stent placement rate. Clinical outcomes included stent patency rate and freedom from PTS.

Results: Median follow-up was 25 months (IQR 11-52). Compared to RT, MT was associated with lower periprocedural thrombolytic use (38% vs 95%, p<0.01) and a lower rate of stent placement (70% vs 98%, p<0.01). Post-procedural access-site thrombosis of the popliteal vein occurred in 5 (13%) MT patients and in none of the RT patients. At one year, primary and secondary patency rates were 80% (95%CI: 67- 95%) and 97% (95%CI: 93-100%) in the MT group, and 88% (95%CI: 81-96%) and 97% (95%CI: 94-100%) in the RT group, respectively. Freedom from PTS at latest follow-up was observed in 98% (95% CI: 93-100%) in the MT group and 94% (95% CI: 87-100%) RT patients.

Conclusions: Both MT and RT were associated with high patency rates and freedom from PTS. MT may reduce the need for thrombolysis and venous stent placement. Popliteal vein thrombosis from large-bore access in MT patients requires further investigation.

Objective: Current risk stratification for lower extremity deep vein thrombosis (DVT) remains limited, often failing to identify high-risk patients for impending pulmonary embolism (PE) while leading to non-guideline-concordant overtreatment. We aimed to develop and validate a novel artificial intelligence (AI) system that processes dynamic digital subtraction angiography (DSA) radiomics, with the potential to guide precision therapy during endovascular intervention.

Methods: In a retrospective cohort study of 168 patients treated at a single vascular surgery center (2019-2023), we developed a hybrid deep-learning model integrating a Transformer-UNet for spatial feature extraction and a long short-term memory (LSTM) network for temporal hemodynamic analysis. This model processed intraprocedural dynamic DSA sequences to quantify novel thrombus kinematic parameters (e.g., displacement velocity, oscillation angle θ) and hemodynamic parameters venous (quantitative flow ratio, QFR). The model's performance for predicting subsequent PE was compared against the Wells Score. Its impact on clinical decision-making and 12-month outcomes was rigorously evaluated.

Results: The AI model demonstrated significantly superior discriminative performance for predicting PE compared to the Wells Score (area under the curve [AUC] 0.88, 95% CI: : 0.85-0.92 vs. 0.76, 95% CI: 0.70-0.83; P = 0.026). Implementation of the AI-guided strategy was associated with markedly improved clinical outcomes at 12-month follow-up: a 54% lower incidence of PE (3.4% vs. 11.1%; relative risk [RR]=0.46, 95% CI: 0.08-0.82; P = 0.005), a 62% lower incidence of severe post-thrombotic syndrome (PTS) (Villalta score ≥10; 8.0% vs. 21.0%; RR=0.38, 95% CI: 0.17-0.86; P=0.008), and a lower prevalence of pre-existing IVC filters in the AI-stratified high-risk group (25.3% vs. 44.4%; RR=0.57, 95% CI: 0.36-0.89; P<0.001), without a significant increase in major bleeding events (2.3% vs. 7.4%; P=0.096).

Conclusions: An AI-Guided risk stratification system based on dynamic DSA radiomics accurately identifies thrombus instability and hemodynamic impairment in real-time, and suggests its potential to help enable more personalized therapeutic decisions during intervention. In this retrospective analysis, AI-based risk stratification was associated with a significantly lower incidence of PE and severe PTS while safely curbing the overuse of IVC filters, representing a transformative advancement in the precision management of acute DVT.

Objective: Endovenous stenting is the standard of care for symptomatic iliofemoral venous obstruction with good short-term patency. We present our long-term outcomes in a Southeast Asian cohort.

Methods: We conducted a single-center retrospective review of 76 patients (98 limbs) who underwent iliofemoral venous stenting between 2015 and 2020. Clinical data and stent outcomes were analyzed over a median follow-up of 65.3 months. Primary, assisted-primary, and secondary patency were reviewed using Kaplan-Meier analysis. Stent-related complications, long-term clinical outcomes and factors associated with stent occlusion, were assessed.

Results: Of 98 limbs, 82.6% had non-thrombotic iliac vein lesions (NIVL), 9.2% post-thrombotic syndrome (PTS), and 8.2% acute deep vein thrombosis (DVT). 100% technical success was achieved. Five-year cumulative primary, assisted-primary, and secondary patency rates were 88.2%, 92.5%, and 98.9%, respectively. Primary patency for stenting for NIVL, PTS and DVT was 92.0%, 77.8% and 62.5%. Loss of patency occurred mainly within the first year, largely from noncompliance and inadequate anticoagulation. Stent-related complications were rare (fracture 1.3%, migration 1.3%). The rate of stent occlusion (per limb) was 8.2%. At five years, ulcer-free rate was 82.7%, pain relief 91.8%, and sustained swelling relief 53.1%. No patient required major amputation, and all-cause mortality was unrelated to venous disease.

Conclusions: Dedicated venous stenting for symptomatic iliofemoral obstruction is safe and durable, with good long-term patency and clinical outcomes in this Southeast Asian cohort. Most reinterventions occurred early, highlighting the importance of procedural technique, inflow optimization, and adherence to antithrombotic therapy. These data support endovenous stenting as a long-term treatment strategy for iliofemoral venous obstruction.

Objective: Reflux within the superficial microvenous network may play a critical role in the development of skin changes associated with chronic venous insufficiency. This study aimed to extend previous ex vivo observations to determine the in vivo utility of near infrared fluorescence (NIRF) imaging to assess superficial venous reflux in the leg.

Methods: A total of 28 limbs were examined in 17 participants. These included limbs with (CEAP C2, n = 6; C3, n = 1; and C4, n = 15) and without (CEAP C0, n = 6) venous disease. Indocyanine green (5 mL at 0.1 mg/mL) was infused via an (antegrade) cannula in the distal great saphenous vein and the medial leg imaged using NIRF. Venous reflux was assessed using the Valsalva maneuver, with or without superficial outflow obstruction (thigh cuff inflated to 50 mmHg).

Results: Consistent with our previous ex vivo study, NIRF imaging visualized a wide range of different microvenous reflux patterns in vivo. These included focal and diffuse regions of fluorescence within the skin, the extent of which appeared to be associated with venous disease (CEAP C classification) severity. The observed reflux patterns also appeared to be functional correlates of perforator vein or saphenofemoral junctional incompetence.

Conclusions: This preliminary in vivo study provides proof-of-principle observations suggesting a potential novel method for investigating microvenous reflux in superficial venous disease.

Clinical relevance: This study reports the first in vivo use of near-infrared fluorescence (NIRF) imaging with indocyanine green to assess superficial microvenous reflux within intact limbs. This preliminary data suggests that the extent and distribution of skin fluorescence may be associated with venous disease severity (CEAP Clinical classification). It also provides potential mechanistic insight, identifying reflux patterns that appear to be functional correlates of venous incompetence. This study suggests that NIRF imaging could provide a novel tool for investigating microvenous contributions to chronic venous disease and its skin manifestations.

Objective: This study aimed to determine the prevalence of chronic venous disorders (CVDs) and identify the associated risk factors among rural adults in Tamil Nadu, South India.

Methods: This cross-sectional study was conducted in four rural villages in Tamil Nadu, involving 1151 participants aged ≥18 years. A two-stage cluster sampling approach was used, selecting one large village from each Primary Health Centre area and enrolling all eligible adults from consecutive streets until the sample size was met. Repeated visits ensured inclusion of temporarily absent individuals. Data were collected using structured interviews and clinical assessments, including anthropometric measurements. The prevalence of CVD and associated factors, such as socioeconomic status, smoking, alcohol consumption, parity, diet, and BMI, was assessed. Logistic regression analysis was used to identify independent predictors of CVD.

Results: The prevalence of CVD was 7.2% (95% confidence interval [CI], 5.7%-8.8%). The most common forms of CVD were varicose veins (4.5%) and telangiectasias (2.1%). Among women, multivariate logistic regression analysis identified parity of one or less (adjusted odd ratio [aOR], 0.07; 95% CI, 0.01-0.53; P = .010) and daily fruit consumption (aOR, 0.26; 95% CI, 0.14-0.49; P < .001) as factors independently associated with lower odds of CVD.

Conclusions: CVDs are prevalent in rural Tamil Nadu, with varicose veins and telangiectasia being the most common. Parity of one or less and daily fruit intake were identified as factors independently associated with a lower odds of CVD. Public health interventions that promote healthy lifestyle choices, including weight management and improved dietary habits, could play a crucial role in preventing CVD in rural populations.