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

Objective: This study aimed to determine the prevalence of Chronic Venous Disorders(CVD) 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 and older. A two-stage cluster sampling approach was used, selecting one large village from each PHC 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% 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 ≤1 (aOR = 0.07; 95% CI: 0.01-0.53; p = 0.010) and daily fruit consumption (aOR = 0.26; 95% CI: 0.14-0.49; p < 0.001) as factors independently associated with lower odds of CVD.

Conclusions: CVD are prevalent in rural Tamil Nadu, with varicose veins and telangiectasia being the most common. Parity ≤1 and daily fruit intake were identified as factors independently associated with 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.

Background: Pelvic venous disorders (PVD) causing pelvic congestion syndrome are a frequent, underdiagnosed source of chronic pelvic pain. Standard coil/sclerosant embolization may be limited by migration, incomplete occlusion, post-embolization syndrome, symptom recurrence, and cost. Endovenous thermal ablation (EVLA) could provide precise, device-free closure with faster recovery and lower cost.

Objective: Evaluate the feasibility, safety, and early efficacy of basilic-access 1470-nm EVLA for refluxing gonadal veins in women with PVD.

Methods: Prospective, single-center descriptive cohort study (January-June 2025). Ten women (18-50 years) with chronic pelvic pain refractory to conservative therapy and Doppler-confirmed pelvic varices (venous diameter >6 mm, low-flow waveforms, or Valsalva-induced reflux) underwent EVLA. When compressive syndrome was suspected, pre-procedural CT venography was obtained. Procedures used local anesthesia with conscious sedation via right basilic access. A 400-μm, 1470-nm radial fiber delivered 6-8 W with controlled pullback targeting proximal/mid gonadal vein segments. Diagnostic venography of the left renal, left common iliac, and internal iliac veins ruled out compression and mapped reflux/varices; the ureter was identified fluoroscopically for safety.

Primary endpoints: technical success (cessation of reflux/closure on completion venography and 3-month CT) and safety (peri-procedural complications). Secondary endpoints: same-day discharge, pain (VAS), and imaging resolution of pelvic varices.

Follow-up: 48-h clinic visit, 4-week transvaginal Doppler, 3-month venous-phase CT, and 6-month clinical assessment.

Results: Mean age 37 years (28-45). Baseline symptoms: pelvic pain 100%, dysmenorrhea 77%, dyspareunia 94%, postcoital pain 97%; mean VAS 7.8/10. All cases were day-case (hospital stay 0 days). Mean target-vein diameter 14 mm (10-17). All had left gonadal vein reflux (SVP S2V2; non-thrombotic). Procedure time 45-60 min; estimated blood loss ∼10 mL. No intra- or postoperative complications (no perforation, bleeding, ureteral injury, thrombosis, access issues, or contrast reactions). Technical success 100%: 3-month CT confirmed complete occlusion in 10/10 and Doppler showed resolution of pelvic varices. Pain improved rapidly (VAS 1-2/10 at 24 h) and was sustained (0.4/10 at 6 months); no opioids, readmissions, or reinterventions at 30 days. Patient-reported quality of life improved across follow-up.

Conclusions: Basilic-access 1470-nm EVLA of refluxing gonadal veins is feasible, safe, and shows high early technical and clinical success with same-day discharge and no complications in this pilot cohort. Larger multicenter randomized trials with ≥12-month follow-up, blinded imaging review, standardized PROs, and cost-effectiveness analyses are warranted.

Objective: To clarify the effect of prolonged complex decongestive therapy (CDT) on limb volume in patients with lower limb lymphedema (LLL).

Methods: We reviewed patients who first visited our clinic for cancer-related LLL between April 2009 and March 2015 and continued CDT at our clinic for 7 years or longer. At 6- to 12-month intervals, limb volume was calculated from tape measurements, and ultrasonography was performed to evaluate changes in the skin and subcutaneous tissue conditions.

Results: In 52 patients (68 lower limbs) who were on CDT for median 11.2 years, 54% maintained reduced limb volume, while limb volume increased in 46% of patients compared with their initial visits. An increase in circumference was mainly observed in the calf area, where the subcutaneous echo-free space (edema) increased. In multivariate analysis, relevant factors associated with the increase in limb volume were an increase in body mass index (BMI) (odds ratio 1.73 [95% confidence interval 1.15-2.93]), the use of compression devices for fewer than 5 days per week (odds ratio 4.57 [95% CI 1.06-23.53]), and the use of compression devices with interface pressure lower than 20 mmHg (odds ratio 36.47 [95% CI 3.42-1061.90]).

Conclusions: During prolonged CDT, limb volume increased in 46% of limbs with LLL, which was associated with an increase in edema, particularly in the calf area. The factors associated with increased limb volume were the increase in BMI and the use of compression devices < 5 days/week and with interface pressure < 20 mmHg.