Pub Date : 2025-01-01DOI: 10.1016/S2213-333X(24)00456-6
Ronald L. Dalman (Executive Editor), Ruth L. Bush (Editor-in-Chief)
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Several studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term.
Methods
All 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities.
Results
Thirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (P = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), −7.3 to 1.1; P = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, −1.1 to 0.7; P = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, −0.22 to 1.17; P = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, −7.7 to 6.2; P = .83]).
Conclusions
This study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.
{"title":"Longer term follow-up of a randomized controlled trial on the role of compression after radiofrequency ablation of varicose veins","authors":"Chee Yee Hew BMBS, MSc, PG Cert (Med Ed), MRCS , Damien M. McElvenny PhD, Cstat, HonFFOM , Madu Onwudike MBBS, MSc, Med, FRCSEd, FRCS(Gen)","doi":"10.1016/j.jvsv.2024.101963","DOIUrl":"10.1016/j.jvsv.2024.101963","url":null,"abstract":"<div><h3>Objective</h3><div>Several studies have shown that, in the short term, treatment outcomes following endothermal ablation of varicose veins without the prescription of post procedural compression are not inferior to outcomes when compression is routinely prescribed. This follow-up to our randomized controlled trial (RCT) published in 2020 explores whether the non-inferiority persists into the medium to long term.</div></div><div><h3>Methods</h3><div>All 94 patients from the RCT were recalled at 27 months after their initial radiofrequency ablation (RFA) procedure. The procedural details, randomization, and inclusion and exclusion criteria were described in the original RCT paper. Consent was obtained for further venous duplex ultrasound scan at 27 to 61 months after the initial procedure. The successful target vein closure at this juncture represented our primary outcome. Secondary outcomes include disease severity, measured using the Aberdeen Varicose Vein Severity Score (AVSS) and the Revised Venous Clinical Severity Score (RVCSS), post-procedural pain measured using Likert scale, and number of days taken for patients to return to work or normal activities.</div></div><div><h3>Results</h3><div>Thirty-one of 48 patients (64.6%) in the compression group and 29 of 46 patients (63%) in the no-compression group were evaluated. The mean duration of follow-up was 43 and 42 months in the compression and no-compression group, respectively. The target vein occlusion rate evaluated at this longer-term follow up were 80.7% and 79.3% in the compression and no-compression groups, respectively. There was no significant difference between the two groups (<em>P</em> = .37). Secondary outcomes of quality of life and disease severity measured using AVSS and RVCSS showed no significant difference between the two groups (post-procedural AVSS mean score 5.2 in the compression group vs 8.3 in the no-compression group [95% confidence interval (CI), −7.3 to 1.1; <em>P</em> = .14]; post-procedural RVCSS mean score 1.5 in the compression group vs 1.8 in the no-compression group [95% CI, −1.1 to 0.7; <em>P</em> = .59]). Patient satisfaction was similar in both groups (mean score 6.4 in the compression group vs 5.9 in the no-compression group [95% CI, −0.22 to 1.17; <em>P</em> = .18]), and the number of days taken for patients to return to work were also comparable (mean of 11.9 days in the compression group vs 12.6 days in the no-compression group [95% CI, −7.7 to 6.2; <em>P</em> = .83]).</div></div><div><h3>Conclusions</h3><div>This study provided some evidence to support no additional benefit of compression use after RFA at a longer term follow-up of 3 years. However, larger, suitably powered studies would be beneficial to confirm this.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101963"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsv.2024.101970
Floor Heilijgers MD , Peter Gloviczki MD, FACS , Gerry O'Sullivan MD , Bertrand Chavent MD, MS , Efthymios D. Avgerinos MD, PhD, FEBVS , Karem Harth MD, MHS , Stephen A. Black MD , Young M. Erben MD , Joris I. Rotmans MD, PhD , Toby Richards BSc, MBBS, MRCS, MD, FRACS, DiPOM , Rabih A. Chaer MD , Laurencia Villalba MD, FRACS, FACP , Arjun Jayaraj MD, FACS , Rafael D. Malgor MD, MBA , Ramesh K. Tripathi MD, FRCS, FRACS, VASC , Anahita Dua MD, MBA, MSC , Erin Murphy MD , Simon Rinckenbach MD , Suresh Vedantham MD , Jaap F. Hamming MD, PhD , Joost R. van der Vorst PhD, FEBVS
Background
Nutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.
Methods
A three-stage modified Delphi consensus was performed. A steering committee developed 37 statements covering 3 categories for patients with NCS: diagnosis, management, and follow-up. These statements were reported individually by 20 international experts in the management of venous disease, using a 5-point Likert scale. Consensus was defined if ≥70% of respondents rated the statement between 1 and 2 (agreement) and between 4 and 5 (disagreement). Those statements without consensus were recirculated in a second round of voting. A third round of the questionnaire was performed with 14 additional statements to clarify diagnostic values of NCS.
Results
Responses were returned by 20 of 20 experts (100%) in round one and 17 of 20 (85%) in round two. Initial consensus was reached in 24 of 37 statements (65%) spread over all categories. Round two achieved a further consensus on 5 out of 10 statements (50%). No categories reported consensus on all statements. In round two consensus was reached in the category of follow-up (4/5 statements [80%]). The final round reached consensus on 5 out of 14 statements (36%). Experts agreed that imaging is obligated to confirm NCS. Experts did not agree on specific diagnostic cut-off values. There was a consensus that the first choice of operative treatment is left renal vein transposition and that the risk of stent migration outweighs the advantages of a percutaneous procedure.
Conclusions
Consensus was achieved on most statements concerning the assessment and management of NCS. This Delphi consensus identified those areas in which further research is needed, such as antiplatelet therapy, endovascular treatment, and renal autotransplantation. A rare disease registry to improve data and reports of patient outcomes is warranted.
{"title":"Nutcracker syndrome (a Delphi consensus)","authors":"Floor Heilijgers MD , Peter Gloviczki MD, FACS , Gerry O'Sullivan MD , Bertrand Chavent MD, MS , Efthymios D. Avgerinos MD, PhD, FEBVS , Karem Harth MD, MHS , Stephen A. Black MD , Young M. Erben MD , Joris I. Rotmans MD, PhD , Toby Richards BSc, MBBS, MRCS, MD, FRACS, DiPOM , Rabih A. Chaer MD , Laurencia Villalba MD, FRACS, FACP , Arjun Jayaraj MD, FACS , Rafael D. Malgor MD, MBA , Ramesh K. Tripathi MD, FRCS, FRACS, VASC , Anahita Dua MD, MBA, MSC , Erin Murphy MD , Simon Rinckenbach MD , Suresh Vedantham MD , Jaap F. Hamming MD, PhD , Joost R. van der Vorst PhD, FEBVS","doi":"10.1016/j.jvsv.2024.101970","DOIUrl":"10.1016/j.jvsv.2024.101970","url":null,"abstract":"<div><h3>Background</h3><div>Nutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.</div></div><div><h3>Methods</h3><div>A three-stage modified Delphi consensus was performed. A steering committee developed 37 statements covering 3 categories for patients with NCS: diagnosis, management, and follow-up. These statements were reported individually by 20 international experts in the management of venous disease, using a 5-point Likert scale. Consensus was defined if ≥70% of respondents rated the statement between 1 and 2 (agreement) and between 4 and 5 (disagreement). Those statements without consensus were recirculated in a second round of voting. A third round of the questionnaire was performed with 14 additional statements to clarify diagnostic values of NCS.</div></div><div><h3>Results</h3><div>Responses were returned by 20 of 20 experts (100%) in round one and 17 of 20 (85%) in round two. Initial consensus was reached in 24 of 37 statements (65%) spread over all categories. Round two achieved a further consensus on 5 out of 10 statements (50%). No categories reported consensus on all statements. In round two consensus was reached in the category of follow-up (4/5 statements [80%]). The final round reached consensus on 5 out of 14 statements (36%). Experts agreed that imaging is obligated to confirm NCS. Experts did not agree on specific diagnostic cut-off values. There was a consensus that the first choice of operative treatment is left renal vein transposition and that the risk of stent migration outweighs the advantages of a percutaneous procedure.</div></div><div><h3>Conclusions</h3><div>Consensus was achieved on most statements concerning the assessment and management of NCS. This Delphi consensus identified those areas in which further research is needed, such as antiplatelet therapy, endovascular treatment, and renal autotransplantation. A rare disease registry to improve data and reports of patient outcomes is warranted.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101970"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsv.2024.101987
Yasser M. ElKiran MD , Amr ElShafei MD , Ahmed M. Morshed MSc, MD, FRCS , Yasmin Y. Elkiran MBBCh , Ahmed M. Elmetwally MD, FRCS
Objective
The goal of this study was to test the hybrid technique of combined tumescent liposuction and surgical excision in patients with advanced lipolymphedema of the thigh after compression therapy as a gold standard for treatment.
Methods
Between January 2016 and April 2020, 18 female and 1 male patients with massive thigh lipolymphedema were treated with complete decongestive therapy for the whole thigh followed by selective decongestive therapy to the upper and lower thigh to make a lump on the midmedial region. Then, the patient was prepared for surgery. Skin is refashioned and sutured in a manner that leaves no furrows and a cosmetic contour is obtained. Compression therapy is maintained from the day of the surgery starting by compression bandage until full healing of the wound, followed by well-fitted garments.
Results
This study was conducted on 18 female patients and 1 male patient who presented with massive lipolymphedema of the thigh. The age of the patients ranged from 46 to 65 years old with a mean age of 51.38 years. All patients in this study underwent compression therapy as a preparatory stage to turn the massive lipolymphedema into lumpedema, followed by hybrid technique which consisted of combined liposuction and surgical excision.
Conclusions
Conversion of massive thigh lipolymphedema into lumpedema followed by tumescent liposuction and surgical excision has proven to be a safe and effective treatment option with a marvelous cosmetic result and low wound morbidity and should be considered as a solution for all patients with this disorder.
{"title":"Hybrid approach of massive lipolymphedema of the thigh: A novel surgical technique","authors":"Yasser M. ElKiran MD , Amr ElShafei MD , Ahmed M. Morshed MSc, MD, FRCS , Yasmin Y. Elkiran MBBCh , Ahmed M. Elmetwally MD, FRCS","doi":"10.1016/j.jvsv.2024.101987","DOIUrl":"10.1016/j.jvsv.2024.101987","url":null,"abstract":"<div><h3>Objective</h3><div>The goal of this study was to test the hybrid technique of combined tumescent liposuction and surgical excision in patients with advanced lipolymphedema of the thigh after compression therapy as a gold standard for treatment.</div></div><div><h3>Methods</h3><div>Between January 2016 and April 2020, 18 female and 1 male patients with massive thigh lipolymphedema were treated with complete decongestive therapy for the whole thigh followed by selective decongestive therapy to the upper and lower thigh to make a lump on the midmedial region. Then, the patient was prepared for surgery. Skin is refashioned and sutured in a manner that leaves no furrows and a cosmetic contour is obtained. Compression therapy is maintained from the day of the surgery starting by compression bandage until full healing of the wound, followed by well-fitted garments.</div></div><div><h3>Results</h3><div>This study was conducted on 18 female patients and 1 male patient who presented with massive lipolymphedema of the thigh. The age of the patients ranged from 46 to 65 years old with a mean age of 51.38 years. All patients in this study underwent compression therapy as a preparatory stage to turn the massive lipolymphedema into lumpedema, followed by hybrid technique which consisted of combined liposuction and surgical excision.</div></div><div><h3>Conclusions</h3><div>Conversion of massive thigh lipolymphedema into lumpedema followed by tumescent liposuction and surgical excision has proven to be a safe and effective treatment option with a marvelous cosmetic result and low wound morbidity and should be considered as a solution for all patients with this disorder.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101987"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsv.2024.101989
Yulin Wen MD , Guotao Ma MD , Qi Miao MD , Jiang Shao MD , Wei Lu MD , Xingrong Liu MD , Chaoji Zhang MD , Jianzhou Liu MD , Dongyan Cao MD , Ninghai Chen MD , Jinhui Wang MD
Background
Intravenous leiomyomatosis (IVL) is a rare neoplasm; the accumulated knowledge about the characteristics and prognosis of this tumor has been derived mainly from isolated case reports with no comprehensive research. In this study, we reviewed our institution's experience with IVL over a 20-year period and developed a classification system that can be used to guide surgical management.
Methods
The study had a retrospective cohort design and included patients who underwent resection of IVL at our institution between January 2002 and December 2022. Perioperative parameters were then collected among four stages of our proposed classification. The long-term outcomes, oncologic prognosis, and factors associated with recurrence were analyzed.
Results
A total of 216 patients were included (stage 1, n = 92; stage 2, n = 39; stage 3, n = 76; stage 4, n = 9). The mean follow-up duration was 26.34 months, during which 18 patients (9.7%) in the complete resection group had recurrence, and 12 (39.0%) in the incomplete resection group showed disease progression. Recurrence or progression of residual disease was associated with adjuvant aromatase inhibitor therapy and maximum tumor thrombus diameter but not with total hysterectomy and bilateral salpingo-oophorectomy, age, or postoperative treatment with a gonadotropin-releasing hormone agonist therapy.
Conclusions
This is the largest single-center report on IVL published to date and provides valuable information on its clinical features and long-term outcomes, as well as surgical technique. Our classification system can be used to evaluate the extent of lesion involvement and guide surgical management.
{"title":"The largest single-center report on intravenous leiomyomatosis and development of a classification to guide surgical management","authors":"Yulin Wen MD , Guotao Ma MD , Qi Miao MD , Jiang Shao MD , Wei Lu MD , Xingrong Liu MD , Chaoji Zhang MD , Jianzhou Liu MD , Dongyan Cao MD , Ninghai Chen MD , Jinhui Wang MD","doi":"10.1016/j.jvsv.2024.101989","DOIUrl":"10.1016/j.jvsv.2024.101989","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous leiomyomatosis (IVL) is a rare neoplasm; the accumulated knowledge about the characteristics and prognosis of this tumor has been derived mainly from isolated case reports with no comprehensive research. In this study, we reviewed our institution's experience with IVL over a 20-year period and developed a classification system that can be used to guide surgical management.</div></div><div><h3>Methods</h3><div>The study had a retrospective cohort design and included patients who underwent resection of IVL at our institution between January 2002 and December 2022. Perioperative parameters were then collected among four stages of our proposed classification. The long-term outcomes, oncologic prognosis, and factors associated with recurrence were analyzed.</div></div><div><h3>Results</h3><div>A total of 216 patients were included (stage 1, n = 92; stage 2, n = 39; stage 3, n = 76; stage 4, n = 9). The mean follow-up duration was 26.34 months, during which 18 patients (9.7%) in the complete resection group had recurrence, and 12 (39.0%) in the incomplete resection group showed disease progression. Recurrence or progression of residual disease was associated with adjuvant aromatase inhibitor therapy and maximum tumor thrombus diameter but not with total hysterectomy and bilateral salpingo-oophorectomy, age, or postoperative treatment with a gonadotropin-releasing hormone agonist therapy.</div></div><div><h3>Conclusions</h3><div>This is the largest single-center report on IVL published to date and provides valuable information on its clinical features and long-term outcomes, as well as surgical technique. Our classification system can be used to evaluate the extent of lesion involvement and guide surgical management.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101989"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsv.2024.101909
Yong Xie MD, Tian-Shi Lyu MD, Li Song MD, Xiao-Qiang Tong MD, Jian Wang MD, Ying-Hua Zou MD
{"title":"Chest tightness caused by intravenous leiomyomatosis","authors":"Yong Xie MD, Tian-Shi Lyu MD, Li Song MD, Xiao-Qiang Tong MD, Jian Wang MD, Ying-Hua Zou MD","doi":"10.1016/j.jvsv.2024.101909","DOIUrl":"10.1016/j.jvsv.2024.101909","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101909"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141081815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jvsv.2024.101984
Liqi Yi BA , YanFei Jiang BA , Lei Xu BA , Minxiang Zheng BA , Youmao Zheng BA , Junbo Liang BA , Chong Liu PhD, MD
Background
Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with secondary extremity lymphedema. The objective of this study was to optimize strategies for lower secondary extremity lymphedema using LVA techniques, with the aim of enhancing patient outcomes.
Methods
We conducted a retrospective analysis of 121 patients who underwent LVA at Taizhou Hospital of Zhejiang Province from January 2020 to December 2023. Preoperative and postoperative assessments included intraoperative observations, functional parameters, and clinical outcomes. The efficacy of LVA was evaluated based on circumferential reduction, quality of life improvements (Lymphoedema Quality of Life Questionnaire), and postoperative complications.
Results
This study enrolled 121 patients with lower secondary extremity lymphedema, with an average age of 58.19 years. The results revealed significant associations between incision depth, lymphatic vessel size, the number of LVAs performed, and the number of incisions per patient, all of which correlated with postoperative volume reduction. The resulted analysis that identified optimal incision depths of 10 to 15 mm, lymphatic vessel size of 0.4 to 0.6 mm, and a recommended number of 6 to 8 LVAs. After LVA, there was a marked improvement in patient quality of life, with particularly notable enhancements in functionality and appearance.
Conclusions
This study’s findings optimizing the strategy for LVA surgery recommend the depth of incision, the size of lymphatic vessels, and the number of anastomoses to improve the quality of life and limb volume in patients with secondary lymphedema of the lower limbs.
{"title":"Optimizing strategies for lymphaticovenular anastomosis in lower secondary extremity lymphedema","authors":"Liqi Yi BA , YanFei Jiang BA , Lei Xu BA , Minxiang Zheng BA , Youmao Zheng BA , Junbo Liang BA , Chong Liu PhD, MD","doi":"10.1016/j.jvsv.2024.101984","DOIUrl":"10.1016/j.jvsv.2024.101984","url":null,"abstract":"<div><h3>Background</h3><div>Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with secondary extremity lymphedema. The objective of this study was to optimize strategies for lower secondary extremity lymphedema using LVA techniques, with the aim of enhancing patient outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 121 patients who underwent LVA at Taizhou Hospital of Zhejiang Province from January 2020 to December 2023. Preoperative and postoperative assessments included intraoperative observations, functional parameters, and clinical outcomes. The efficacy of LVA was evaluated based on circumferential reduction, quality of life improvements (Lymphoedema Quality of Life Questionnaire), and postoperative complications.</div></div><div><h3>Results</h3><div>This study enrolled 121 patients with lower secondary extremity lymphedema, with an average age of 58.19 years. The results revealed significant associations between incision depth, lymphatic vessel size, the number of LVAs performed, and the number of incisions per patient, all of which correlated with postoperative volume reduction. The resulted analysis that identified optimal incision depths of 10 to 15 mm, lymphatic vessel size of 0.4 to 0.6 mm, and a recommended number of 6 to 8 LVAs. After LVA, there was a marked improvement in patient quality of life, with particularly notable enhancements in functionality and appearance.</div></div><div><h3>Conclusions</h3><div>This study’s findings optimizing the strategy for LVA surgery recommend the depth of incision, the size of lymphatic vessels, and the number of anastomoses to improve the quality of life and limb volume in patients with secondary lymphedema of the lower limbs.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101984"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iliac venous obstruction has been reported as a cause of chronic pelvic pain (CPP), however, there is a paucity of data in the literature reporting outcomes of venous stenting in this population. This study reports on a group of women with CPP and evidence of iliac venous obstruction: (1) the long-term impact of iliac vein stenting on pain scores; (2) the associations of age, stenosis severity, and concurrent presence of ovarian vein reflux (OVR) on pain; and (3) the effect of pregnancy after stenting.
Methods
We conducted a retrospective analysis of prospectively collected data of women with chronic pelvic pain who subsequently underwent iliac vein stenting. Data analyzed included demographics, venous measures (iliac and ovarian veins), visual analog scales, and pregnancy after stenting.
Results
A total of 113 female patients who had a history of chronic pelvic pain and underwent iliac venous stenting were included in analyses. The mean age at the time of stenting was 46.5 ± 15.7 years (range, 17-88 years). The baseline left common iliac vein diameter on duplex was 0.43 ± 0.18 cm and left common iliac vein area stenosis on intravascular ultrasound was 77.4 ± 9.4%. The baseline pain severity was correlated with younger age, degree of stenosis and presence of OVR. At a median follow-up of 5 years after stenting, 98% had improved pain scores and 73% had complete resolution of their pain despite the presence of residual OVR. Pregnancy after stenting did not result in the recurrence of pain and there were no stent-related complications with pregnancy.
Conclusions
Iliac venous stenting provides long-term relief from CPP even with residual OVR and poststent pregnancy. With 73% of women having full pain resolution, and the rest having a mean residual pain score of <3, this study supports venous stenting for the treatment of CPP of venous origin, especially in young women.
{"title":"Iliac venous stenting provides long-term relief from chronic pelvic pain","authors":"Laurencia Villalba MD, FRACS, Vasc , Theresa Larkin PhD","doi":"10.1016/j.jvsv.2024.101993","DOIUrl":"10.1016/j.jvsv.2024.101993","url":null,"abstract":"<div><h3>Objective</h3><div>Iliac venous obstruction has been reported as a cause of chronic pelvic pain (CPP), however, there is a paucity of data in the literature reporting outcomes of venous stenting in this population. This study reports on a group of women with CPP and evidence of iliac venous obstruction: (1) the long-term impact of iliac vein stenting on pain scores; (2) the associations of age, stenosis severity, and concurrent presence of ovarian vein reflux (OVR) on pain; and (3) the effect of pregnancy after stenting.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of prospectively collected data of women with chronic pelvic pain who subsequently underwent iliac vein stenting. Data analyzed included demographics, venous measures (iliac and ovarian veins), visual analog scales, and pregnancy after stenting.</div></div><div><h3>Results</h3><div>A total of 113 female patients who had a history of chronic pelvic pain and underwent iliac venous stenting were included in analyses. The mean age at the time of stenting was 46.5 ± 15.7 years (range, 17-88 years). The baseline left common iliac vein diameter on duplex was 0.43 ± 0.18 cm and left common iliac vein area stenosis on intravascular ultrasound was 77.4 ± 9.4%. The baseline pain severity was correlated with younger age, degree of stenosis and presence of OVR. At a median follow-up of 5 years after stenting, 98% had improved pain scores and 73% had complete resolution of their pain despite the presence of residual OVR. Pregnancy after stenting did not result in the recurrence of pain and there were no stent-related complications with pregnancy.</div></div><div><h3>Conclusions</h3><div>Iliac venous stenting provides long-term relief from CPP even with residual OVR and poststent pregnancy. With 73% of women having full pain resolution, and the rest having a mean residual pain score of <3, this study supports venous stenting for the treatment of CPP of venous origin, especially in young women.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101993"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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