Journal of vascular surgery. Venous and lymphatic disorders最新文献_第4页

Events of Interest

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/S2213-333X(24)00454-2

引用次数: 0

A composite risk assessment model for venous thromboembolism 静脉血栓栓塞综合风险评估模型。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101968

Mary Sixian Lin MD , Hilary Hayssen MD , Minerva Mayorga-Carlin MPH , Shalini Sahoo MA , Tariq Siddiqui MS , Georges Jreij MD , Brian R. Englum MD , Phuong Nguyen PhD , Yelena Yesha PhD , John David Sorkin MD, PhD , Brajesh K. Lal MD

Objective

Venous thromboembolism (VTE) is a preventable cause of hospitalization-related morbidity and mortality. VTE prevention requires accurate risk stratification. Federal agencies mandated VTE risk assessment for all hospital admissions. We have shown that the widely used Caprini (30 risk factors) and Padua (11 risk factors) VTE risk-assessment models (RAMs) have limited predictive ability for VTE when used for all general hospital admissions. Here, we test whether combining the risk factors from all 23 available VTE RAMs improves VTE risk prediction.

Methods

We analyzed data from the first hospitalizations of 1,282,014 surgical and non-surgical patients admitted to 1298 Veterans Affairs facilities nationwide between January 2016 and December 2021. We used logistic regression to predict VTE within 90 days of admission using risk factors from all 23 available VTE RAMs. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were used to quantify the predictive power of our models. The metrics were computed at two diagnostic thresholds that maximized (1) the value of sensitivity + specificity-1; and (2) PPV and were compared using McNemar’s test. The Delong-Delong test was used to compare AUCs.

Results

After excluding those with missing data, 1,185,633 patients (mean age, 66 years; 93% male; and 72% White) were analyzed, of whom 33,253 (2.8%) had a VTE (deep venous thrombosis [DVT], n = 19,218, 1.6%; pulmonary embolism [PE], n = 10,190, 0.9%; PE + DVT, n = 3845, 0.3%). Our composite RAM included 102 risk factors and improved prediction of VTE compared with the Caprini RAM risk factors (AUC composite model: 0.74; AUC Caprini risk-factor model: 0.63; P < .0001). When the sum of sensitivity and specificity-1 was maximized, the composite model demonstrated small improvements in sensitivity, specificity and PPV; NPV was high in both models. When PPV was maximized, the PPV of the composite model was improved but remained low. The nature of the relationship between NPV and PPV precluded any further gain in PPV by sacrificing NPV and sensitivity.

Conclusions

Using a composite of 102 risk factors from all available VTE RAMs, we improved VTE prediction in a large, national cohort of >1 million general hospital admissions. However, neither model has a sensitivity or PPV that permits it to be a reliable predictor of VTE. We demonstrate the limits of currently available VTE risk prediction tools; no available RAM is ready for widespread use in the general hospital population.

目的：静脉血栓栓塞症（VTE）是可预防的住院相关发病率和死亡率的原因之一。预防 VTE 需要准确的风险分级。联邦机构强制要求对所有入院患者进行 VTE 风险评估。我们已经证明，广泛使用的 Caprini（30 个风险因素）和 Padua（11 个风险因素）VTE 风险评估模型 (RAM) 在用于所有普通入院患者时，对 VTE 的预测能力有限。在此，我们检验了将所有 23 种可用的 VTE 风险评估模型中的风险因子结合在一起是否能提高 VTE 风险预测能力：我们分析了 2016 年 1 月至 2021 年 12 月期间全国 1,298 家退伍军人事务机构收治的 1,282,014 名手术和非手术患者的首次住院数据。我们采用逻辑回归法，利用所有 23 个可用的 VTE RAM 中的风险因子来预测入院 90 天内的 VTE。受体运行特征曲线下面积（AUC）、灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）用于量化我们模型的预测能力。这些指标是在两个诊断阈值下计算的，这两个阈值分别是：1）灵敏度+特异性-1 的值最大化；2）PPV 最大化，并使用 McNemar 检验进行比较。德隆-德隆检验用于比较AUC：排除数据缺失者后，分析了 1,185,633 名患者（平均年龄 66 岁，93% 为男性，72% 为白人），其中 33,253 人（2.8%）患有 VTE（DVT[深静脉血栓]，19,218 人，1.6%；PE[肺栓塞]，10,190 人，0.9%；PE+DVT，3,845 人，0.3%）。我们的复合 RAM 包括 102 个风险因子，与 Caprini RAM 风险因子相比，对 VTE 的预测更准确（AUC 复合模型：0.74；AUC Caprini RAM：0.74）：0.74；AUC Caprini 风险因子模型：0.63；pConclusions：0.63; p结论：使用来自所有可用 VTE RAM 的 102 个风险因子的复合模型，我们改进了对全国超过 100 万普通医院住院患者的 VTE 预测。然而，这两个模型的灵敏度或 PPV 都不足以成为预测 VTE 的可靠指标。我们证明了目前可用的 VTE 风险预测工具的局限性；没有一种可用的 RAM 可以在普通医院人群中广泛使用。

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引用次数: 0

Protocol-based treatment of spontaneous hemorrhage from varicose veins prevents recurrence of bleeding 基于方案的静脉曲张自发性出血治疗可预防出血复发。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101988

Richard Bock MD , Danielle Fontenot MD , Spencer Bock MS , Gwyn Eiler RVT , Kristie Worley-Fry CMA , John Blebea MD, MB

Background

Spontaneous hemorrhage from erosion of varicose veins through the skin is a serious and occasionally fatal complication of varicose vein disease. Various treatments, both acute and delayed, have been advocated. Our two-step clinical protocol was designed to prevent further hemorrhage without delay and to provide durable freedom from recurrent bleeding.

Methods

All patients referred to our surgical vein practice with hemorrhage from varicose veins were entered into a prospective registry. On presentation, all patients underwent diagnostic duplex ultrasound for venous reflux. Immediate treatment consisted of ultrasound-guided polidocanol/CO₂ foam sclerotherapy of the bleeding varicosity and adjacent veins. Subsequent endovenous ablation of underlying incompetent axial veins, with concurrent microphlebectomy when indicated, was scheduled and performed within 8 weeks.

Results

Fifty-nine patients were referred with recent hemorrhage from varicose veins over a period of 4 years. Fifty-six (95%) had an ultrasound-identified tributary varicosity underlying the point of bleeding, and three had a skin-surface erosion only and no ultrasound-identified underlying tributary. Of the 59 study patients, 52 underwent prompt polidocanol/CO₂ foam sclerotherapy, targeted to both the underlying tributary (when present) as well as the cutaneous bleeding varicosity. The remaining seven either declined sclerotherapy or were ineligible. Underlying incompetence of axial (great, small, or anterior saphenous) veins was found in 54 patients (92%). Of these patients with truncal vein incompetence, 48 underwent ablation—5 declined and 1 was too frail for any further intervention. There were no recurrent bleeds in the interval between immediate sclerotherapy and scheduled ablation. During a mean follow-up of 2.2 years, 55 of the 59 patients (93%) had no recurrence of bleeding. Four patients (7%) had late, recurrent hemorrhage: one had failed to return for their scheduled ablation, two were on chronic anticoagulation, and one had severe right heart failure. All four were retreated without further recurrence.

Conclusions

A two-step protocol of immediate ultrasound-guided foam sclerotherapy, followed within 8 weeks by endovenous ablation of incompetent axial veins and concurrent microphlebectomy, provided rapid and efficient treatment with durable freedom from subsequent hemorrhage.

背景：静脉曲张侵蚀皮肤引起的自发性出血是静脉曲张疾病的一种严重并发症，有时甚至是致命的并发症。目前已提出了各种急性和延迟治疗方法。我们的两步临床方案旨在毫不拖延地防止进一步出血，并持久避免再次出血：方法：所有因静脉曲张出血而转诊到我们静脉外科诊所的患者都被纳入前瞻性登记册。所有患者在就诊时都接受了静脉回流的双工超声诊断。即时治疗包括在超声引导下对出血的曲张静脉和邻近静脉进行聚多卡诺醇/二氧化碳泡沫硬化剂治疗。随后在八周内安排并实施了静脉内消融术，以治疗下腔无力的中轴静脉，并在必要时同时进行微静脉切除术：49名患者是在四年内因静脉曲张大出血而转诊的。56人（95%）的出血点下有超声波确定的支静脉曲张，3人只有皮肤表面糜烂，没有超声波确定的支静脉曲张。在 59 位接受研究的患者中，有 52 位接受了及时的聚多卡诺/二氧化碳泡沫硬化剂治疗，治疗的目标既包括潜在的支流（如果存在），也包括皮肤出血曲张。其余 7 人要么拒绝接受硬化剂治疗，要么不符合条件。54例（92%）患者被发现患有轴向（大隐静脉、小隐静脉或前隐静脉）静脉功能不全。在这些躯干静脉功能不全的患者中，有 48 人接受了消融治疗，其中 5 人拒绝接受，1 人因身体虚弱无法接受进一步干预。从立即进行硬化疗法到计划进行消融术的间隔期间，没有再发生出血。在平均 2.2 年的随访期间，有 4 名患者（7%）出现了晚期复发性出血：其中一名患者未能按时接受消融术，两名患者正在接受长期抗凝治疗，一名患者患有严重的右心衰竭。所有四名患者都接受了再治疗，没有再复发：超声引导下立即进行泡沫硬化剂治疗，然后在八周内对闭锁的轴静脉进行静脉腔内消融术，并同时进行微静脉切除术，这种两步疗法既快速又有效，而且能持久避免再次出血。

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引用次数: 0

Early experience with diclofenac topical gel for moderate to severe postablation phlebitis 双氯芬酸局部凝胶治疗中度至重度消融术后静脉炎的早期经验。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101994

Francisco J. Melesio BS , Mariam Mesa-Damiano BS , Jailenne I. Quinones-Rodriguez PhD, MA , Shawn M. Staudaher PhD , Cassius I. Ochoa Chaar MD, MPH, MS , Limael E. Rodriguez MD

Objective

Oral (PO) nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat phlebitis and thrombus extension postendovenous ablation. Few studies have evaluated diclofenac topical gel for treating postablation phlebitis. This study assesses diclofenac 1% topical gel as a first-line treatment for patients with moderate to severe phlebitis after ablation.

Methods

From December 2021 to March 2024, a retrospective cohort study was performed to identify patients who developed postablation phlebitis and were treated with either diclofenac topical gel (with or without PO NSAIDs) vs PO NSAIDs alone. All patients were evaluated with a numeric pain rating scale (NPRS, 0-10) at four time intervals (1, 7, 14, and 30 days) after initiating treatment.

Results

Overall, 45 patients were included in the study, with 38 in the diclofenac ± PO NSAIDs group (9 males and 29 females) and 7 in the PO NSAIDs alone group (all females). NPRS scores showed similar pain reduction trends at all time intervals. Topical diclofenac gel was noninferior to PO treatments and resulted in partial to complete relief in most patients at 30 days. At the 30-day follow-up interview, 57% of patients preferred the diclofenac topical gel owing to its ease of use and immediate local pain reduction.

Conclusions

Patients with moderate to severe postablation phlebitis respond well to diclofenac topical gel with or without PO NSAIDs. Moreover, patients often had significant pain relief without additional need for PO NSAIDs. Longitudinal studies are needed to support the use of diclofenac topical gel for postablation phlebitis.

目的：口服（PO）非甾体抗炎药（NSAIDs）常用于治疗静脉内消融术后的静脉炎和血栓扩展。很少有研究对双氯芬酸局部凝胶治疗消融术后静脉炎进行评估。本研究评估了 1% (%) 双氯芬酸局部凝胶作为消融术后中度至重度静脉炎患者的一线治疗方法：方法：从 2021 年 12 月到 2024 年 3 月，我们进行了一项回顾性队列研究，以确定发生消融术后静脉炎并接受双氯芬酸局部凝胶（联合或不联合 PO 非甾体抗炎药）治疗的患者与仅接受 PO 非甾体抗炎药治疗的患者。所有患者在开始治疗后的四个时间间隔（1、7、14 和 30 天）都接受了疼痛评分量表（NPRS，0-10）的评估：共有 45 名患者参与了研究，其中 38 人属于双氯芬酸 +/- PO 非甾体抗炎药组（9 名男性和 29 名女性），7 人属于单用 PO 非甾体抗炎药组（均为女性）。在所有时间间隔内，NPRS 评分都显示出相似的疼痛减轻趋势。外用双氯芬酸凝胶的疗效并不比口服药物差，大多数患者的疼痛在 30 天后得到部分或完全缓解。在30天的随访中，57%的患者更喜欢使用双氯芬酸局部凝胶，因为它使用方便，能立即减轻局部疼痛：结论：中重度消融术后静脉炎患者对双氯芬酸局部凝胶联合或不联合 PO 非甾体抗炎药反应良好。此外，患者往往能明显缓解疼痛，而无需额外服用 PO 非甾体抗炎药。需要进行纵向研究，以支持使用双氯芬酸局部凝胶治疗剥脱术后静脉炎。

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引用次数: 0

Recanalization of right brachiocephalic vein for treatment of gastroesophageal reflux disease caused by superior vena cava syndrome 为治疗上腔静脉综合征引起的胃食管反流病而进行右侧肱脑静脉再通术。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101906

Jibo Sun MD , Yu Liu MS , Zhiqiang Duan MS , Tianlei Cui PhD

引用次数: 0

Drop the bias, design prospective randomized studies, use the SVP classification system, and let's try to get some real answers! 放弃偏见，设计前瞻性随机研究，使用SVP分类系统，让我们尝试得到一些真正的答案！

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.102000

Julianne Stoughton MD, FACS

引用次数: 0

Anatomical variation types of the deep femoral vein and its tributaries 股深静脉及其支流的解剖变异类型。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101966

Shiyu Tang , Mengxi Yang , Qicheng Shu , Liujun Yong PhD

Background

The deep femoral vein generally has individual differences in origin, course, tributary, caliber, and quantity. However, systematic research on deep femoral vein variations remains insufficient. Given this, this study used anatomical observation to reveal the types and ratios of variations in the deep femoral vein and its tributaries.

Methods

This study selected 63 gross specimens of intact lower extremities and dissected their 126 lower limbs layer by layer to explore variations in the deep femoral vein and its tributaries.

Results

A total of 15 lower limbs exhibit variations in the deep femoral vein and its tributaries, of which 93% were unilateral. No correlation was found between the mutations and gender. They can be generally classified into three types: variations in the small saphenous vein branch of the deep femoral vein (7.14%), variations in the popliteal vein branch of the deep femoral vein (3.96%), and multiple deep femoral vein variations (0.79%).

Conclusions

Variations in the deep femoral vein and its tributaries are not rare and can achieve a variation rate of 11.9%. Moreover, 93% of the variations involve tributaries of the deep femoral vein, among which 60% occur in the small saphenous vein branch, and approximately 30% are related to the popliteal vein branch. The variation diversity can lay a theoretical foundation for clinical diagnosis and treatment.

背景：股深静脉一般在起源、走向、支流、口径和数量上存在个体差异。然而，关于股深静脉变异的系统研究仍然不足。有鉴于此，本研究采用解剖观察法揭示股深静脉及其支流变异的类型和比例：方法：本研究选取了 63 个完整下肢的大体标本，对其 126 个下肢进行逐层解剖，以探讨股深静脉及其支流的变异：结果：共有15个下肢的股深静脉及其支流出现变异，其中93%为单侧变异。变异与性别之间没有相关性。这些变异一般可分为三种类型：股深静脉小隐静脉分支变异（7.14%）；股深静脉腘静脉分支变异（3.96%）；多股深静脉变异（0.79%）：结论：股深静脉及其支流的变异并不罕见，变异率高达11.9%。此外，93%的变异涉及股深静脉的支流，其中60%发生在小隐静脉分支，约30%与腘静脉分支有关。变异的多样性可为临床诊断和治疗奠定理论基础。

{"title":"Anatomical variation types of the deep femoral vein and its tributaries","authors":"Shiyu Tang , Mengxi Yang , Qicheng Shu , Liujun Yong PhD","doi":"10.1016/j.jvsv.2024.101966","DOIUrl":"10.1016/j.jvsv.2024.101966","url":null,"abstract":"<div><h3>Background</h3><div>The deep femoral vein generally has individual differences in origin, course, tributary, caliber, and quantity. However, systematic research on deep femoral vein variations remains insufficient. Given this, this study used anatomical observation to reveal the types and ratios of variations in the deep femoral vein and its tributaries.</div></div><div><h3>Methods</h3><div>This study selected 63 gross specimens of intact lower extremities and dissected their 126 lower limbs layer by layer to explore variations in the deep femoral vein and its tributaries.</div></div><div><h3>Results</h3><div>A total of 15 lower limbs exhibit variations in the deep femoral vein and its tributaries, of which 93% were unilateral. No correlation was found between the mutations and gender. They can be generally classified into three types: variations in the small saphenous vein branch of the deep femoral vein (7.14%), variations in the popliteal vein branch of the deep femoral vein (3.96%), and multiple deep femoral vein variations (0.79%).</div></div><div><h3>Conclusions</h3><div>Variations in the deep femoral vein and its tributaries are not rare and can achieve a variation rate of 11.9%. Moreover, 93% of the variations involve tributaries of the deep femoral vein, among which 60% occur in the small saphenous vein branch, and approximately 30% are related to the popliteal vein branch. The variation diversity can lay a theoretical foundation for clinical diagnosis and treatment.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 1","pages":"Article 101966"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140455","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}

引用次数: 0

Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations 腹腔淋巴畸形患者急腹症的临床特征和风险因素。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101969

Congxia Yang MD , Tong Qiu MD , Min Yang MD , Jiangyuan Zhou MD , Xue Gong MD , Kaiying Yang MD , Zixin Zhang MD , Yuru Lan MD , Xuepeng Zhang MD , Zilong Zhou MD , Yujia Zhang MD , Shanshan Xiang MD , Siyuan Chen MD, PhD , Yi Ji MD, PhD

Objective

The diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports and series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs.

Methods

We reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses.

Results

This study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P = .002; odds ratio, 5.128; 95% confidence interval, 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P = .023; odds ratio, 2.926; 95% confidence interval, 1.157-7.400).

Conclusions

ALMs are rare with an insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal mesenteric LMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.

目的：腹腔淋巴畸形（ALM）的诊断在临床实践中常常被忽视。然而，有关腹腔淋巴畸形的文献报道仅限于样本量较小的病例报告/系列报道。本研究旨在回顾现有数据，描述腹腔淋巴畸形的临床特征，并评估由腹腔淋巴畸形引发急腹症的风险因素：我们回顾了2008年12月至2023年1月期间在我院确诊的ALM患者的病历。方法：我们回顾了本院2008年12月至2023年1月期间确诊的ALM患者的病历，根据单因素和多变量逻辑回归分析，分析了急腹症与ALM之间的关联：本研究共纳入 345 例经病理证实的 ALM 患者，其中女性略占多数，比例为 1:1.4。约39.1%（135/345）的患者无症状，24.6%（85/345）的患者出现急腹症。队列中的ALM中，42.6%（147/345）为腹膜后淋巴畸形（LM）。急腹症患者和非急腹症患者的病灶最大尺寸分别为10.0厘米和7.8厘米，多变量分析结果显示两者无显著差异。儿童患急腹症的几率高于成人（P=0.002；几率比 [OR]，5.128；95% 置信区间 [CI]，1.835-14.326）。伴随急腹症的ALM更常见于累及小肠系膜的病变（P=0.023；OR，2.926；95% CI，1.157-7.400）：腹膜后小肠系膜瘤是最常见的腹膜后小肠系膜瘤，其次是空肠系膜瘤。我们的回顾性分析表明，年轻和小肠系膜淋巴畸形是急腹症合并 ALM 的独立危险因素。

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引用次数: 0

Long-term outcomes of mechanochemical ablation using the Clarivein device for the treatment of great saphenous vein incompetence 使用 Clarivein® 设备进行机械化学消融治疗大隐静脉瓣膜功能不全的长期疗效。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101967

Sharon Oud MD , Tamana Alozai MD, PhD , Yee Lai Lam MD, PhD , Çağdaş Ünlü MD, PhD , Michael Mooij MD , Michiel A. Schreve MD, PhD

Objective

The short-term anatomical success rates of mechanochemical ablation using the Clarivein device (Merit Medical) in the treatment of great saphenous vein (GSV) incompetence are high. However, the anatomical success rates seem to drop over time. The aim of this study was to determine the long-term outcomes of GSV treatment using the Clarivein and to assess whether specific anatomical features better correlate with clinical or quality of life (QoL)-related outcomes.

Methods

This is a single-center, prospective cohort study in follow-up of a multicenter, randomized controlled trial using Clarivein with liquid polidocanol for the treatment of GSV incompetence. The primary outcome was anatomical success (AS), defined as complete occlusion or a recanalized segment, irrespective of reflux, of <10 cm in length. In addition, reflux-free anatomical success (RF-AS) was determined, and defined as complete occlusion or a recanalized segment with <10 cm of reflux. Clinical success was assessed using the Venous Clinical Severity Score (VCSS), and QoL was assessed using the Dutch version of the Aberdeen Varicose Vein Questionnaire (DAVVQ) and the 36-Item Short Form Health Survey (SF-36). Subgroup analyses were performed based on whether AS or RF-AS was achieved or not.

Results

A total of 109 patients (115 limbs) were included. The mean follow-up time was 8.4 ± 0.9 years (range, 5.5-10.3 years). AS was seen in 60.5% of limbs, and RF-AS was seen in 72.8% of limbs. Compared with baseline, the overall mean VCSS improved from 5.3 ± 2.4 to 4.1 ± 2.4, and the overall median DAVVQ score from 13.5 (interquartile range [IQR], 8.7-20.0) to 10.5 (IQR, 5.3-16.2) (P < .001). Improvement in VCSS was only significant in patients with successful treatment: from 5.5 ± 2.7 to 3.7 ± 2.5 (P < .001) if AS was achieved and from 5.0 ± 1.7 to 4.5 ± 1.9 (P = .20) if AS was not achieved. The same results were found for DAVVQ scores: improvement from13.5 (IQR, 8.7-20.6) to 10.3 (IQR, 3.0-14.5) (P < .01) if AS was achieved and from 12.9 (IQR, 8.3-19.3) to 10.8 (IQR, 6.7-18.2) (P = .35) if AS was not achieved. Regarding the overall SF-36 scores, the domains of vitality, mental health, and general health worsened significantly.

Conclusions

In over 8 years of follow-up, the anatomical success rate after the treatment of GSV incompetence using the Clarivein device decreased to 60.5%. However, clinical scores and disease-specific QoL still improved significantly compared with baseline. We found no convincing evidence that the absence of reflux correlates better with clinical and QoL-related outcomes compared with recanalization irrespective of reflux.

目的：使用 Clarivein 设备（美国犹他州南乔丹市 Merit Medical 公司）进行机械化学消融术（MOCA）治疗大隐静脉（GSV）瓣膜功能不全的短期解剖成功率很高。然而，随着时间的推移，解剖成功率似乎在下降。本研究的目的是确定使用克拉里维因治疗大隐静脉不通的长期疗效，并评估特定解剖特征是否与临床或 QoL 相关疗效有更好的相关性：这是一项单中心前瞻性队列研究，是一项多中心随机对照试验的后续研究，该试验使用克拉里维因和液态聚多巴酚治疗胃总静脉功能不全。研究的主要结果是解剖学成功率（AS），其定义是无论是否存在反流，都能成功闭塞或再通：共纳入 109 名患者（115 条肢体）。平均随访时间为 8.4 ± 0.9 年（5.5-10.3 年不等）。60.5%的肢体出现 AS，72.8%的肢体出现 RF-AS。与基线相比，VCSS 的总体平均值从 5.3 ± 2.4 改善到 4.1 ± 2.4，DAVVQ 的总体中位值从 13.1（7.3-19.4）降低到 10.5（4.8-15.8）（p 结论：在长达八年多的随访中，使用 Clarivein 装置治疗 GSV 闭锁后的解剖学成功率降至 60.5%。然而，与基线相比，临床评分和疾病特异性 QoL 仍有显著改善。我们没有发现令人信服的证据表明，与无论有无反流的再通术相比，无反流与临床和生活质量相关的结果有更好的相关性。

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引用次数: 0

Assessing the quality of ChatGPT's responses to questions related to radiofrequency ablation for varicose veins 评估 ChatGPT 对静脉曲张射频消融相关问题的答复质量。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-01-01 DOI: 10.1016/j.jvsv.2024.101985

Muhammad Anees MBBS , Fareed Ahmed Shaikh MBBS, MRCSEd, FCPS , Hafsah Shaikh MBBS , Nadeem Ahmed Siddiqui MBBS, FCPS, FRCS , Zia Ur Rehman MBBS, FCPS, FRCS

Objective

This study aimed to evaluate the accuracy and reproducibility of information provided by ChatGPT, in response to frequently asked questions about radiofrequency ablation (RFA) for varicose veins.

Methods

This cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan. A set of 18 frequently asked questions regarding RFA for varicose veins were compiled from credible online sources and presented to ChatGPT twice, separately, using the new chat option. Twelve experienced vascular surgeons (with >2 years of experience and ≥20 RFA procedures performed annually) independently evaluated the accuracy of the responses using a 4-point Likert scale and assessed their reproducibility.

Results

Most evaluators were males (n = 10/12 [83.3%]) with an average of 12.3 ± 6.2 years of experience as a vascular surgeon. Six evaluators (50%) were from the UK followed by three from Saudi Arabia (25.0%), two from Pakistan (16.7%), and one from the United States (8.3%). Among the 216 accuracy grades, most of the evaluators graded the responses as comprehensive (n = 87/216 [40.3%]) or accurate but insufficient (n = 70/216 [32.4%]), whereas only 17.1% (n = 37/216) were graded as a mixture of both accurate and inaccurate information and 10.8% (n = 22/216) as entirely inaccurate. Overall, 89.8% of the responses (n = 194/216) were deemed reproducible. Of the total responses, 70.4% (n = 152/216) were classified as good quality and reproducible. The remaining responses were poor quality with 19.4% reproducible (n = 42/216) and 10.2% nonreproducible (n = 22/216). There was nonsignificant inter-rater disagreement among the vascular surgeons for overall responses (Fleiss' kappa, −0.028; P = .131).

Conclusions

ChatGPT provided generally accurate and reproducible information on RFA for varicose veins; however, variability in response quality and limited inter-rater reliability highlight the need for further improvements. Although it has the potential to enhance patient education and support healthcare decision-making, improvements in its training, validation, transparency, and mechanisms to address inaccurate or incomplete information are essential.

目的：本研究旨在评估 ChatGPT 针对有关静脉曲张射频消融术（RFA）的常见问题（FAQs）所提供信息的准确性和可重复性：这项横断面研究在巴基斯坦卡拉奇的阿迦汗大学医院进行。研究人员从可靠的在线资料来源收集整理了 18 个有关静脉曲张射频消融的常见问题，并使用 "新聊天 "选项分别向 ChatGPT 演示了两次。12 名经验丰富的血管外科医生（具有 2 年以上经验，每年至少进行 20 次 RFA 手术）使用 4 点李克特量表独立评估了回复的准确性，并评估了回复的可重复性：大多数评估者为男性（10/12，83.3%），平均拥有 12.3 ± 6.2 年的血管外科医生经验。6名（50%）评估者来自英国，其次是3名（25.0%）来自沙特阿拉伯，2名（16.7%）来自巴基斯坦，1名（8.3%）来自美国。在 216 个准确性等级中，大多数评估者将答复评为 "全面"（87/216，40.3%）或 "准确但不充分"（70/216，32.4%），只有 17.1%（37/216）被评为 "既有准确信息也有不准确信息"，10.8%（22/216）被评为 "完全不准确"。总体而言，89.8%（n=194/216）的回答被认为是可重复的。在所有回复中，70.4%（n=152/216）被归类为 "质量好 "和 "可重现"。其余答复为 "质量差"，19.4%（n=42/216）为 "可再现"，10.2%（n=22/216）为 "不可再现"。血管外科医生之间对总体答复的评分者间差异不显著（弗莱斯卡帕：-0.028，P=0.131）：结论：ChatGPT 为静脉曲张的射频消融治疗提供了基本准确和可重复的信息，但是，回答质量的差异和评分者之间有限的可靠性凸显了进一步改进的必要性。虽然它具有加强患者教育和支持医疗决策的潜力，但改进其培训、验证、透明度以及处理不准确或不完整信息的机制也至关重要。

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