Pub Date : 2024-08-17DOI: 10.1016/S2213-333X(24)00316-0
{"title":"Events of interest","authors":"","doi":"10.1016/S2213-333X(24)00316-0","DOIUrl":"10.1016/S2213-333X(24)00316-0","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 5","pages":"Article 101954"},"PeriodicalIF":2.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213333X24003160/pdfft?md5=09af76fa7dfd4850f1a3357fc0292553&pid=1-s2.0-S2213333X24003160-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997504","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 : 2024-08-17DOI: 10.1016/S2213-333X(24)00315-9
{"title":"Information for Readers","authors":"","doi":"10.1016/S2213-333X(24)00315-9","DOIUrl":"10.1016/S2213-333X(24)00315-9","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 5","pages":"Article 101953"},"PeriodicalIF":2.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213333X24003159/pdfft?md5=eb3721fdf554c6efa3e72daaa1b5fb83&pid=1-s2.0-S2213333X24003159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997503","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 : 2024-08-06DOI: 10.1016/j.jvsv.2024.101962
Sara Babapour, Clarissa Lee, Erin Kim, JacqueLyn R Kinney, James Fanning, Dhruv Singhal, Leo L Tsai
Objective: To assess changes in noncontrast magnetic resonance imaging (MRI)-based biomarkers after upper extremity lymphedema surgery.
Methods: We retrospectively identified secondary upper extremity lymphedema patients who underwent vascularized lymph node transplant (VLNT), debulking lipectomy, or VLNT with a prior debulking (performed separately). All patients with both preoperative and postoperative MRIs were compared. An MRI-based edema scoring system was used: 0 (no edema), 1 (<50% fluid from myofascial to dermis), and 2 (≥50% fluid from myofascial to dermis). Edema scores and subcutaneous thickness (ST) were obtained along four quadrants across the upper and lower third of the arm and forearm each-for a total of 16 anatomical locations-and compared before and after surgery. Net changes in edema scores and ST were then correlated with Lymphoedema Quality-of-Life Questionnaire scores, L-Dex (bioimpedance), and limb volume difference by perometry.
Results: Patients who underwent lymphatic surgeries between January 2017 and December 2022 and successfully completed preoperative and postoperative MRI were included, resulting in a total of 33 unilateral secondary upper extremity lymphedema patients m(mean age, 63 ± 14 years; 32 female). The median postoperative follow-up times were 12.5 months (range, 6-19 months) for VLNT, 13.5 months (range, 12-40 months) for debulking, and 12.0 months (range, 12-24 months) for patients who underwent VLNT after debulking surgery. There was a decrease in mean ST in 15 of 16 anatomical segments of the upper extremity after debulking (P < .001), and the edema score increased in 7 of 16 segments (P ≤ .001-.020). Edema stage did not change in patients who underwent VLNT only or VLNT after debulking. ST decreased only along the radial forearm in patients who underwent VLNT after debulking despite an improvement in the Lymphoedema Quality-of-Life Questionnaire score in the former group. There was correlation between a decrease in ST with a decrease in volume within the debulking group (r = 0.79; P < .001). A decrease in ST also correlated with improved lymphedema quality of life questionnaires in the debulking group (r = 0.49; P = .04).
Conclusions: A decrease in ST was demonstrated in most anatomical segments after liposuction debulking, whereas edema stage was increased. Fewer changes were seen with VLNT, possibly a reflection of more gradual changes within this short follow-up period, with the radial forearm potentially revealing the earliest response.
{"title":"Changes on noncontrast magnetic resonance imaging following lymphatic surgery for upper extremity secondary lymphedema.","authors":"Sara Babapour, Clarissa Lee, Erin Kim, JacqueLyn R Kinney, James Fanning, Dhruv Singhal, Leo L Tsai","doi":"10.1016/j.jvsv.2024.101962","DOIUrl":"10.1016/j.jvsv.2024.101962","url":null,"abstract":"<p><strong>Objective: </strong>To assess changes in noncontrast magnetic resonance imaging (MRI)-based biomarkers after upper extremity lymphedema surgery.</p><p><strong>Methods: </strong>We retrospectively identified secondary upper extremity lymphedema patients who underwent vascularized lymph node transplant (VLNT), debulking lipectomy, or VLNT with a prior debulking (performed separately). All patients with both preoperative and postoperative MRIs were compared. An MRI-based edema scoring system was used: 0 (no edema), 1 (<50% fluid from myofascial to dermis), and 2 (≥50% fluid from myofascial to dermis). Edema scores and subcutaneous thickness (ST) were obtained along four quadrants across the upper and lower third of the arm and forearm each-for a total of 16 anatomical locations-and compared before and after surgery. Net changes in edema scores and ST were then correlated with Lymphoedema Quality-of-Life Questionnaire scores, L-Dex (bioimpedance), and limb volume difference by perometry.</p><p><strong>Results: </strong>Patients who underwent lymphatic surgeries between January 2017 and December 2022 and successfully completed preoperative and postoperative MRI were included, resulting in a total of 33 unilateral secondary upper extremity lymphedema patients m(mean age, 63 ± 14 years; 32 female). The median postoperative follow-up times were 12.5 months (range, 6-19 months) for VLNT, 13.5 months (range, 12-40 months) for debulking, and 12.0 months (range, 12-24 months) for patients who underwent VLNT after debulking surgery. There was a decrease in mean ST in 15 of 16 anatomical segments of the upper extremity after debulking (P < .001), and the edema score increased in 7 of 16 segments (P ≤ .001-.020). Edema stage did not change in patients who underwent VLNT only or VLNT after debulking. ST decreased only along the radial forearm in patients who underwent VLNT after debulking despite an improvement in the Lymphoedema Quality-of-Life Questionnaire score in the former group. There was correlation between a decrease in ST with a decrease in volume within the debulking group (r = 0.79; P < .001). A decrease in ST also correlated with improved lymphedema quality of life questionnaires in the debulking group (r = 0.49; P = .04).</p><p><strong>Conclusions: </strong>A decrease in ST was demonstrated in most anatomical segments after liposuction debulking, whereas edema stage was increased. Fewer changes were seen with VLNT, possibly a reflection of more gradual changes within this short follow-up period, with the radial forearm potentially revealing the earliest response.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"101962"},"PeriodicalIF":4.6,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.jvsv.2024.101961
Matthew Leverich, Ahmed M Afifi, Meghan Wandtke Barber, Ali Baydoun, Joseph Sferra, Gang Ren, Munier Nazzal
Objectives: Studies have shown that coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Studies have yet to examine the interconnectedness between COVID-19, hypercoagulability, and socioeconomics. The aim of this work was to investigate socioeconomic factors that may be associated with pulmonary embolism (PE), deep vein thrombosis (DVT), and COVID-19 in the United States.
Methods: We performed a 1-year (2020) analysis of the National Inpatient Sample database. We identified all adult patients diagnosed with COVID-19, acute PE, or acute DVT using unweighted samples. We calculated the correlation and odds ratio (OR) between COVID-19 and (1) PE and (2) DVT. We executed a univariate analysis followed by a multivariate analysis to examine the effect of different factors on PE and DVT during the COVID-19 pandemic.
Results: We identified 322,319 patients with COVID-19; 78,101 and 67,826 patients were identified with PE and DVT, respectively. PE and DVT, as well as inpatient mortality associated with both conditions, are significantly correlated with COVID-19. The OR between COVID-19 and PE was 2.04, while the OR between COVID-19 and DVT was 1.44. Using multivariate analysis, COVID-19 was associated with a higher incidence of PE (coefficient, 2.05) and DVT (coefficient, 1.42). Other factors that were significantly associated (P < .001) with increased incidence of PE and DVT along with their coefficients, respectively, include Black race (95% confidence interval [CI], 1.23-1.14), top quartile income (95% CI, 1.08-1.16), west region (95% CI, 1.10-1.04), urban teaching facilities (95% CI, 1.09-1.63), large bed size hospitals (95% CI, 1.08-1.29), insufficient insurance (95% CI, 1.88-2.19), hypertension (95% CI, 1.24-1.32), and obesity (95% CI, 1.41-1.25). Factors that were significantly associated (P < .001) with decreased incidence of PE and DVT along with their coefficients, respectively, include Asians/Pacific Islanders (95% CI, 0.52-0.53), female sex (95% CI, 0.79-0.74), homelessness (95% CI, 0.62-0.61), and diabetes mellitus (0.77-0.90).
Conclusions: In the Nationwide Inpatient Sample, COVID-19 is correlated positively with venous thromboembolism, including its subtypes, PE and DVT. Using a multivariate analysis, Black race, male sex, top quartile income, west region, urban teaching facilities, large bed size hospitals, and insufficient social insurance were associated significantly with an increased incidence of PE and DVT. Asians/Pacific Islanders, female sex, homelessness, and diabetes mellitus were significantly associated decreased incidence of PE and DVT.
导言/目标：研究表明，冠状病毒病 2019（COVID-19）与高凝状态有关。目前尚未有研究探讨 COVID-19、高凝状态和社会经济之间的相互联系。本研究旨在调查美国可能与肺栓塞（PE）、深静脉血栓（DVT）和 COVID-19 相关的社会经济因素：我们对全国住院病人抽样数据库进行了为期一年（2020 年）的分析。我们使用非加权样本确定了所有确诊为 COVID-19、急性 PE 或急性深静脉血栓的成年患者。我们计算了 COVID-19 与 1) PE 和 2) 深静脉血栓之间的相关性和几率比 (OR)。我们进行了单变量分析和多变量分析，以研究 COVID-19 大流行期间不同因素对 PE 和深静脉血栓的影响：结果：322 319 名患者被确认为 COVID-19 患者，78 101 名患者被确认为 PE 患者，67 826 名患者被确认为深静脉血栓患者。PE 和深静脉血栓以及与这两种疾病相关的住院病人死亡率与 COVID-19 显著相关。COVID-19 与 PE 之间的 OR 值为 2.04，而 COVID-19 与 DVT 之间的 OR 值为 1.44。通过多变量分析，COVID-19 与 PE（系数 2.05）和 DVT（系数 1.42）的发病率较高相关。其他因素也有明显相关性（p结论：在美国全国住院病人样本中，COVID-19 与静脉血栓栓塞（包括其亚型：肺栓塞和深静脉血栓）呈正相关。通过多变量分析，黑人种族、男性性别、收入前四分之一、西部地区、城市教学设施、大床位规模医院和社会保险不足与 PE 和深静脉血栓的发病率增加显著相关。而亚洲人/太平洋岛民、女性、无家可归者和糖尿病则与 PE 和 DVT 发病率的降低有明显相关性。
{"title":"Social disparities in pulmonary embolism and deep vein thrombosis during the coronavirus disease 2019 pandemic from the Nationwide inpatient Sample.","authors":"Matthew Leverich, Ahmed M Afifi, Meghan Wandtke Barber, Ali Baydoun, Joseph Sferra, Gang Ren, Munier Nazzal","doi":"10.1016/j.jvsv.2024.101961","DOIUrl":"10.1016/j.jvsv.2024.101961","url":null,"abstract":"<p><strong>Objectives: </strong>Studies have shown that coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Studies have yet to examine the interconnectedness between COVID-19, hypercoagulability, and socioeconomics. The aim of this work was to investigate socioeconomic factors that may be associated with pulmonary embolism (PE), deep vein thrombosis (DVT), and COVID-19 in the United States.</p><p><strong>Methods: </strong>We performed a 1-year (2020) analysis of the National Inpatient Sample database. We identified all adult patients diagnosed with COVID-19, acute PE, or acute DVT using unweighted samples. We calculated the correlation and odds ratio (OR) between COVID-19 and (1) PE and (2) DVT. We executed a univariate analysis followed by a multivariate analysis to examine the effect of different factors on PE and DVT during the COVID-19 pandemic.</p><p><strong>Results: </strong>We identified 322,319 patients with COVID-19; 78,101 and 67,826 patients were identified with PE and DVT, respectively. PE and DVT, as well as inpatient mortality associated with both conditions, are significantly correlated with COVID-19. The OR between COVID-19 and PE was 2.04, while the OR between COVID-19 and DVT was 1.44. Using multivariate analysis, COVID-19 was associated with a higher incidence of PE (coefficient, 2.05) and DVT (coefficient, 1.42). Other factors that were significantly associated (P < .001) with increased incidence of PE and DVT along with their coefficients, respectively, include Black race (95% confidence interval [CI], 1.23-1.14), top quartile income (95% CI, 1.08-1.16), west region (95% CI, 1.10-1.04), urban teaching facilities (95% CI, 1.09-1.63), large bed size hospitals (95% CI, 1.08-1.29), insufficient insurance (95% CI, 1.88-2.19), hypertension (95% CI, 1.24-1.32), and obesity (95% CI, 1.41-1.25). Factors that were significantly associated (P < .001) with decreased incidence of PE and DVT along with their coefficients, respectively, include Asians/Pacific Islanders (95% CI, 0.52-0.53), female sex (95% CI, 0.79-0.74), homelessness (95% CI, 0.62-0.61), and diabetes mellitus (0.77-0.90).</p><p><strong>Conclusions: </strong>In the Nationwide Inpatient Sample, COVID-19 is correlated positively with venous thromboembolism, including its subtypes, PE and DVT. Using a multivariate analysis, Black race, male sex, top quartile income, west region, urban teaching facilities, large bed size hospitals, and insufficient social insurance were associated significantly with an increased incidence of PE and DVT. Asians/Pacific Islanders, female sex, homelessness, and diabetes mellitus were significantly associated decreased incidence of PE and DVT.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"101961"},"PeriodicalIF":2.8,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.jvsv.2024.101960
Mahmoud M Nasser, Baker Ghoneim, Walid El Daly, Hossam El Mahdy
Background: To date, the most commonly used endothermal ablation method is endovenous laser ablation (EVLA). The objective of this work is to assess the initial and short-term outcomes of a 1940 nm diode laser compared with 1470 nm diode laser utilization for the treatment of lower limb varicose veins.
Methods: This is a randomized controlled prospective study that included patients with varicose veins. The allocated patients were randomized according to the technique used: group I, which was treated using EVLA with a 1940 nm diode laser, and group II, which was treated using EVLA with a 1470 nm diode laser.
Results: This study initially included 216 patients. After the exclusion of patients lost during follow-up, group I consisted of 105 patients, and group II consisted of 101 patients. There were high rates of anatomical success in the two groups with obliteration of the treated vessels at the 1-month follow-up (100% and 99%, respectively) and the 6-month follow-up (100% and 99%, respectively). A very low rate of adverse events was encountered (1%). Group II showed obviously longer median days to return for usual activities (11.5 compared with 7 days). They showed significantly higher pain scores, which was evident at the 7-day and 1-month follow-ups (P < .001).
Conclusions: Both lasers provided excellent outcomes in terms of anatomical success and low rates of adverse events. The 1940 nm diode laser was associated with lower median days to return for usual activities and significantly lower pain scores. Evidently, lower power and linear endovenous energy density were required for this laser.
{"title":"Comparative study between endovenous laser ablation (EVLA) with 1940 nm versus EVLA with 1470 nm for treatment of incompetent great saphenous vein and short saphenous vein: a randomized controlled trial.","authors":"Mahmoud M Nasser, Baker Ghoneim, Walid El Daly, Hossam El Mahdy","doi":"10.1016/j.jvsv.2024.101960","DOIUrl":"10.1016/j.jvsv.2024.101960","url":null,"abstract":"<p><strong>Background: </strong>To date, the most commonly used endothermal ablation method is endovenous laser ablation (EVLA). The objective of this work is to assess the initial and short-term outcomes of a 1940 nm diode laser compared with 1470 nm diode laser utilization for the treatment of lower limb varicose veins.</p><p><strong>Methods: </strong>This is a randomized controlled prospective study that included patients with varicose veins. The allocated patients were randomized according to the technique used: group I, which was treated using EVLA with a 1940 nm diode laser, and group II, which was treated using EVLA with a 1470 nm diode laser.</p><p><strong>Results: </strong>This study initially included 216 patients. After the exclusion of patients lost during follow-up, group I consisted of 105 patients, and group II consisted of 101 patients. There were high rates of anatomical success in the two groups with obliteration of the treated vessels at the 1-month follow-up (100% and 99%, respectively) and the 6-month follow-up (100% and 99%, respectively). A very low rate of adverse events was encountered (1%). Group II showed obviously longer median days to return for usual activities (11.5 compared with 7 days). They showed significantly higher pain scores, which was evident at the 7-day and 1-month follow-ups (P < .001).</p><p><strong>Conclusions: </strong>Both lasers provided excellent outcomes in terms of anatomical success and low rates of adverse events. The 1940 nm diode laser was associated with lower median days to return for usual activities and significantly lower pain scores. Evidently, lower power and linear endovenous energy density were required for this laser.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"101960"},"PeriodicalIF":2.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.jvsv.2024.101958
Junji Tsukagoshi MD , Benjamin Wick BS , Abbas Karim BS , Kamil Khanipov PhD , Mitchell W. Cox MD
Objective
Thrombolytic therapy has been a mainstay of treatment for massive or submassive pulmonary embolism (PE), a common and highly morbid pathology. New percutaneous mechanical thrombectomy (PMT) devices have recently become widely available and have been used increasingly for the treatment of acute PE, but evidence demonstrating its efficacy over standard catheter-directed lytic protocol remains limited.
Methods
Using TriNetX Data Network, a global federated database of >250 million patients, we conducted a retrospective cohort study of patients from January 2017 to August 2023 with a diagnosis of PE, treated with either PMT or catheter-directed thrombolysis (CDT). Eligible patients were 1:1 propensity score-matched for preoperative covariates including demographics and comorbidities. We calculated and compared the 30-day outcomes of all-cause mortality, bleeding complications (blood transfusion, gastrointestinal bleed, and intracranial hemorrhage), diagnosis of acute respiratory failure (RF), myocardial infarction (MI), and pulmonary hypertension (PH) using odds ratios (OR) with 95% confidence intervals (CIs). Also, the 5-year outcomes of all-cause mortality, a composite outcome of chronic PH (chronic PE, chronic cor pulmonale, chronic thromboembolic PH), right heart failure (RHF), RF, and emergency department visits, were compared using hazard ratios (HRs) with 95% CIs.
Results
We identified 2978 patients treated with PMT and 1137 patients treated with CDT. After matching, we compared 1102 patients in each cohort. For 30-day outcomes, all-cause mortality, acute RF, and blood transfusion were similar between the two groups. However, compared with CDT, PMT was associated with a better safety profile, including lower bleeding risk for both ICH (OR, 0.46; 95% CI, 0.24-0.890) and gastrointestinal bleed (OR, 0.42; 95% CI, 0.28-0.63). PMT also demonstrated better immediate functional outcomes, with less PH (OR, 0.53; 95% CI, 0.41-0.68) and MI (OR, 0.54; 95% CI, 0.41-0.76). At 5 years, the all-cause mortality and RF for both procedures were similar, but PMT was associated with lower rates of chronic PH (HR, 0.70; 95% CI, 0.55-0.90), RHF (HR 0.49; 95% CI, 0.37-0.65), and emergency department visits (348 for PMT vs 426 for CDT; P < .01).
Conclusions
In patients undergoing catheter-based therapy for PE, PMT has an improved procedural safety profile vs CDT and results in significantly fewer 30-day postoperative complications, with fewer bleeding events, and is also associated with fewer periprocedural MIs and less acute PH. Perhaps, more important, PMT also demonstrated improved long-term outcomes with significantly fewer chronic PH and RHF diagnoses with fewer emergency department visits.
{"title":"Perioperative and intermediate outcomes of patients with pulmonary embolism undergoing catheter-directed thrombolysis vs percutaneous mechanical thrombectomy","authors":"Junji Tsukagoshi MD , Benjamin Wick BS , Abbas Karim BS , Kamil Khanipov PhD , Mitchell W. Cox MD","doi":"10.1016/j.jvsv.2024.101958","DOIUrl":"10.1016/j.jvsv.2024.101958","url":null,"abstract":"<div><h3>Objective</h3><div>Thrombolytic therapy has been a mainstay of treatment for massive or submassive pulmonary embolism (<em>PE</em>), a common and highly morbid pathology. New percutaneous mechanical thrombectomy (<em>PMT</em>) devices have recently become widely available and have been used increasingly for the treatment of acute PE, but evidence demonstrating its efficacy over standard catheter-directed lytic protocol remains limited.</div></div><div><h3>Methods</h3><div>Using TriNetX Data Network, a global federated database of >250 million patients, we conducted a retrospective cohort study of patients from January 2017 to August 2023 with a diagnosis of PE, treated with either PMT or catheter-directed thrombolysis (<em>CDT</em>). Eligible patients were 1:1 propensity score-matched for preoperative covariates including demographics and comorbidities. We calculated and compared the 30-day outcomes of all-cause mortality, bleeding complications (blood transfusion, gastrointestinal bleed, and intracranial hemorrhage), diagnosis of acute respiratory failure (<em>RF</em>), myocardial infarction (<em>MI</em>), and pulmonary hypertension (<em>PH</em>) using odds ratios (<em>OR</em>) with 95% confidence intervals (<em>CIs</em>). Also, the 5-year outcomes of all-cause mortality, a composite outcome of chronic PH (chronic PE, chronic cor pulmonale, chronic thromboembolic PH), right heart failure (<em>RHF</em>), RF, and emergency department visits, were compared using hazard ratios (<em>HRs</em>) with 95% CIs.</div></div><div><h3>Results</h3><div>We identified 2978 patients treated with PMT and 1137 patients treated with CDT. After matching, we compared 1102 patients in each cohort. For 30-day outcomes, all-cause mortality, acute RF, and blood transfusion were similar between the two groups. However, compared with CDT, PMT was associated with a better safety profile, including lower bleeding risk for both ICH (OR, 0.46; 95% CI, 0.24-0.890) and gastrointestinal bleed (OR, 0.42; 95% CI, 0.28-0.63). PMT also demonstrated better immediate functional outcomes, with less PH (OR, 0.53; 95% CI, 0.41-0.68) and MI (OR, 0.54; 95% CI, 0.41-0.76). At 5 years, the all-cause mortality and RF for both procedures were similar, but PMT was associated with lower rates of chronic PH (HR, 0.70; 95% CI, 0.55-0.90), RHF (HR 0.49; 95% CI, 0.37-0.65), and emergency department visits (348 for PMT vs 426 for CDT; <em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>In patients undergoing catheter-based therapy for PE, PMT has an improved procedural safety profile vs CDT and results in significantly fewer 30-day postoperative complications, with fewer bleeding events, and is also associated with fewer periprocedural MIs and less acute PH. Perhaps, more important, PMT also demonstrated improved long-term outcomes with significantly fewer chronic PH and RHF diagnoses with fewer emergency department visits.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 6","pages":"Article 101958"},"PeriodicalIF":2.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902179","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 : 2024-08-03DOI: 10.1016/j.jvsv.2024.101959
Lucas Mota MD, John N. Tomeo BS, Sai Divya Yadavalli MD, Andy Lee MD, Patric Liang MD, Allen D. Hamdan MD, Mark C. Wyers MD, Marc L. Schermerhorn MD, Lars Stangenberg MD, PhD
Objective
Venous thoracic outlet syndrome (vTOS) is caused by compression of the subclavian vein at the costoclavicular space, which may lead to vein thrombosis. Current treatment includes thoracic outlet decompression with or without venolysis. However, given its relatively low prevalence, the existing literature is limited. Here, we report our single-institution experience in the treatment of vTOS.
Methods
We performed a retrospective review of all patients who underwent rib resection for vTOS at our institution from 2007 to 2022. Demographic, procedural details, and perioperative and long-term outcomes were reviewed.
Results
A total of 76 patients were identified. The mean age was 36 years. Swelling was the most common symptom (93%), followed by pain (6.6%). Ninety percent of patients had associated deep vein thrombosis, with 99% of these patients starting anticoagulation preoperatively. A total of 91% of patients underwent rib resection via the infraclavicular approach, 2% via the paraclavicular approach (due to a neurogenic component), and 7% via the transaxillary approach. Eighty-three percent of patients had endovascular intervention before or at the time of the rib resection, with catheter-directed thrombolysis (87%), followed by angioplasty (71%) and rheolytic thrombectomy (57%) being the most common interventions. The median time from endovascular intervention to rib resection was 14 days, with 25% at the same admission. The median postoperative stay was 3 days (2-5 days). There was no perioperative mortality or nerve injury. Fourteen percent of patients had postoperative complications, with bleeding complications (12%) being the most common. Waiting more than 30 days between initial endovascular intervention and rib resection was not associated with decreased risk of bleeding complications. Patients were seen postoperatively at 1-month (physical examination) and 6-month (duplex) intervals or for any new or recurrent symptoms. Twenty-two percent of our overall patient population underwent reintervention, most commonly angioplasty (21%). At last follow-up, 97% of subclavian veins were patent, and 93% of patients were symptom free.
Conclusions
Over the last decade, we have transitioned to an infraclavicular approach for isolated vTOS, with low perioperative morbidity and good patency rates. These results support the adoption of the infraclavicular approach with adjunct endovascular techniques as a safe and efficacious treatment of vTOS.
{"title":"Management and outcomes of venous thoracic outlet decompression: A transition to the infraclavicular approach","authors":"Lucas Mota MD, John N. Tomeo BS, Sai Divya Yadavalli MD, Andy Lee MD, Patric Liang MD, Allen D. Hamdan MD, Mark C. Wyers MD, Marc L. Schermerhorn MD, Lars Stangenberg MD, PhD","doi":"10.1016/j.jvsv.2024.101959","DOIUrl":"10.1016/j.jvsv.2024.101959","url":null,"abstract":"<div><h3>Objective</h3><div>Venous thoracic outlet syndrome (vTOS) is caused by compression of the subclavian vein at the costoclavicular space, which may lead to vein thrombosis. Current treatment includes thoracic outlet decompression with or without venolysis. However, given its relatively low prevalence, the existing literature is limited. Here, we report our single-institution experience in the treatment of vTOS.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of all patients who underwent rib resection for vTOS at our institution from 2007 to 2022. Demographic, procedural details, and perioperative and long-term outcomes were reviewed.</div></div><div><h3>Results</h3><div>A total of 76 patients were identified. The mean age was 36 years. Swelling was the most common symptom (93%), followed by pain (6.6%). Ninety percent of patients had associated deep vein thrombosis, with 99% of these patients starting anticoagulation preoperatively. A total of 91% of patients underwent rib resection via the infraclavicular approach, 2% via the paraclavicular approach (due to a neurogenic component), and 7% via the transaxillary approach. Eighty-three percent of patients had endovascular intervention before or at the time of the rib resection, with catheter-directed thrombolysis (87%), followed by angioplasty (71%) and rheolytic thrombectomy (57%) being the most common interventions. The median time from endovascular intervention to rib resection was 14 days, with 25% at the same admission. The median postoperative stay was 3 days (2-5 days). There was no perioperative mortality or nerve injury. Fourteen percent of patients had postoperative complications, with bleeding complications (12%) being the most common. Waiting more than 30 days between initial endovascular intervention and rib resection was not associated with decreased risk of bleeding complications. Patients were seen postoperatively at 1-month (physical examination) and 6-month (duplex) intervals or for any new or recurrent symptoms. Twenty-two percent of our overall patient population underwent reintervention, most commonly angioplasty (21%). At last follow-up, 97% of subclavian veins were patent, and 93% of patients were symptom free.</div></div><div><h3>Conclusions</h3><div>Over the last decade, we have transitioned to an infraclavicular approach for isolated vTOS, with low perioperative morbidity and good patency rates. These results support the adoption of the infraclavicular approach with adjunct endovascular techniques as a safe and efficacious treatment of vTOS.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 6","pages":"Article 101959"},"PeriodicalIF":2.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893712","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 : 2024-07-29DOI: 10.1016/j.jvsv.2024.101943
Ben Li MD , Naomi Eisenberg PT, MEd, CCRP , Derek Beaton PhD , Douglas S. Lee MD, PhD , Leen Al-Omran MD(c) , Duminda N. Wijeysundera MD, PhD , Mohamad A. Hussain MD, PhD , Ori D. Rotstein MD, MSc , Charles de Mestral MD, PhD , Muhammad Mamdani PharmD, MA, MPH , Graham Roche-Nagle MD, MBA , Mohammed Al-Omran MD, MSc
<div><h3>Objective</h3><div>Inferior vena cava (<em>IVC</em>) filter placement is associated with important long-term complications. Predictive models for filter-related complications may help guide clinical decision-making but remain limited. We developed machine learning (<em>ML</em>) algorithms that predict 1-year IVC filter complications using preoperative data.</div></div><div><h3>Methods</h3><div>The Vascular Quality Initiative database was used to identify patients who underwent IVC filter placement between 2013 and 2024. We identified 77 preoperative demographic and clinical features from the index hospitalization when the filter was placed. The primary outcome was 1-year filter-related complications (composite of filter thrombosis, migration, angulation, fracture, and embolization or fragmentation, vein perforation, new caval or iliac vein thrombosis, new pulmonary embolism, access site thrombosis, or failed retrieval). The data were divided into training (70%) and test (30%) sets. Six ML models were trained using preoperative features with 10-fold cross-validation (Extreme Gradient Boosting, random forest, Naïve Bayes classifier, support vector machine, artificial neural network, and logistic regression). The primary model evaluation metric was area under the receiver operating characteristic curve (<em>AUROC</em>). Model robustness was assessed using calibration plot and Brier score. Performance was evaluated across subgroups based on age, sex, race, ethnicity, rurality, median Area Deprivation Index, planned duration of filter, landing site of filter, and presence of prior IVC filter placement.</div></div><div><h3>Results</h3><div>Overall, 14,476 patients underwent IVC filter placement and 584 (4.0%) experienced 1-year filter-related complications. Patients with a primary outcome were younger (59.3 ± 16.7 years vs 63.8 ± 16.0 years; <em>P</em> < .001) and more likely to have thrombotic risk factors including thrombophilia, prior venous thromboembolism (<em>VTE</em>), and family history of VTE. The best prediction model was Extreme Gradient Boosting, achieving an AUROC of 0.93 (95% confidence interval, 0.92-0.94). In comparison, logistic regression had an AUROC of 0.63 (95% confidence interval, 0.61-0.65). Calibration plot showed good agreement between predicted/observed event probabilities with a Brier score of 0.07. The top 10 predictors of 1-year filter-related complications were (1) thrombophilia, (2) prior VTE, (3) antiphospholipid antibodies, (4) factor V Leiden mutation, (5) family history of VTE, (6) planned duration of IVC filter (temporary), (7) unable to maintain therapeutic anticoagulation, (8) malignancy, (9) recent or active bleeding, and (10) age. Model performance remained robust across all subgroups.</div></div><div><h3>Conclusions</h3><div>We developed ML models that can accurately predict 1-year IVC filter complications, performing better than logistic regression. These algorithms have potential to guide patient s
{"title":"Predicting inferior vena cava filter complications using machine learning","authors":"Ben Li MD , Naomi Eisenberg PT, MEd, CCRP , Derek Beaton PhD , Douglas S. Lee MD, PhD , Leen Al-Omran MD(c) , Duminda N. Wijeysundera MD, PhD , Mohamad A. Hussain MD, PhD , Ori D. Rotstein MD, MSc , Charles de Mestral MD, PhD , Muhammad Mamdani PharmD, MA, MPH , Graham Roche-Nagle MD, MBA , Mohammed Al-Omran MD, MSc","doi":"10.1016/j.jvsv.2024.101943","DOIUrl":"10.1016/j.jvsv.2024.101943","url":null,"abstract":"<div><h3>Objective</h3><div>Inferior vena cava (<em>IVC</em>) filter placement is associated with important long-term complications. Predictive models for filter-related complications may help guide clinical decision-making but remain limited. We developed machine learning (<em>ML</em>) algorithms that predict 1-year IVC filter complications using preoperative data.</div></div><div><h3>Methods</h3><div>The Vascular Quality Initiative database was used to identify patients who underwent IVC filter placement between 2013 and 2024. We identified 77 preoperative demographic and clinical features from the index hospitalization when the filter was placed. The primary outcome was 1-year filter-related complications (composite of filter thrombosis, migration, angulation, fracture, and embolization or fragmentation, vein perforation, new caval or iliac vein thrombosis, new pulmonary embolism, access site thrombosis, or failed retrieval). The data were divided into training (70%) and test (30%) sets. Six ML models were trained using preoperative features with 10-fold cross-validation (Extreme Gradient Boosting, random forest, Naïve Bayes classifier, support vector machine, artificial neural network, and logistic regression). The primary model evaluation metric was area under the receiver operating characteristic curve (<em>AUROC</em>). Model robustness was assessed using calibration plot and Brier score. Performance was evaluated across subgroups based on age, sex, race, ethnicity, rurality, median Area Deprivation Index, planned duration of filter, landing site of filter, and presence of prior IVC filter placement.</div></div><div><h3>Results</h3><div>Overall, 14,476 patients underwent IVC filter placement and 584 (4.0%) experienced 1-year filter-related complications. Patients with a primary outcome were younger (59.3 ± 16.7 years vs 63.8 ± 16.0 years; <em>P</em> < .001) and more likely to have thrombotic risk factors including thrombophilia, prior venous thromboembolism (<em>VTE</em>), and family history of VTE. The best prediction model was Extreme Gradient Boosting, achieving an AUROC of 0.93 (95% confidence interval, 0.92-0.94). In comparison, logistic regression had an AUROC of 0.63 (95% confidence interval, 0.61-0.65). Calibration plot showed good agreement between predicted/observed event probabilities with a Brier score of 0.07. The top 10 predictors of 1-year filter-related complications were (1) thrombophilia, (2) prior VTE, (3) antiphospholipid antibodies, (4) factor V Leiden mutation, (5) family history of VTE, (6) planned duration of IVC filter (temporary), (7) unable to maintain therapeutic anticoagulation, (8) malignancy, (9) recent or active bleeding, and (10) age. Model performance remained robust across all subgroups.</div></div><div><h3>Conclusions</h3><div>We developed ML models that can accurately predict 1-year IVC filter complications, performing better than logistic regression. These algorithms have potential to guide patient s","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 6","pages":"Article 101943"},"PeriodicalIF":2.8,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860215","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 : 2024-07-16DOI: 10.1016/j.jvsv.2024.101946
Matthew K.H. Tan MBBS, BSc(Hons), MRCS, AFHEA , Roshan Bootun BSc, MBBS, MRCS, PhD , Roy Wang MBBS, BSc , Sarah Onida BSc (Hons), PhD, FRCS , Tristan Lane MBBS, BSc, FRCA , Alun H. Davies MA, DM, DSc, FRCS, FHEA, FEBVS, FACPh
Objective
Patients with chronic venous disease (CVD) can present with different underlying hemodynamic abnormalities affecting the deep, superficial, and perforator veins. This review explores the relationship between reflux patterns, extent of venous reflux, and clinical manifestations of CVD.
Methods
The Medline and EMBASE databases were searched systematically from 1946 to April 1, 2024. References of shortlisted papers were searched for relevant articles. Studies were included if they were in English language, included participants ≥16 years of age, documented reflux patterns in two or more of the following: deep, superficial, and/or perforator systems, and related patterns to presentation or severity. Exclusion criteria included patients with isolated deep venous thrombosis, post-thrombotic syndrome or stenotic or obstructive disease.
Results
We identified 18 studies (11,177 participants; range, 55-3016). Meta-analysis showed significant odds ratios (OR) for C4-6 disease being associated with deep reflux (OR, 2.41; 95% confidence interval [CI], 1.53-3.78) and perforator reflux (OR, 3.37; 95% CI, 2.16-5.27), but not superficial reflux (OR, 2.11; 95% CI, 0.87-5.14), vs C0-3 disease. Severe CVD (C4-6) was significantly associated with isolated deep, combined deep and superficial, and combined superficial and perforator reflux. The greatest risk of CVD progression (defined as de novo development of varicose veins and progression to greater CVD severity) was shown by two studies to be related to combined deep and superficial reflux.
Conclusions
Although limited by the heterogenous nature of the studies, this review confirms that reflux pattern is a significant predictor of clinical class, and higher clinical, etiological, anatomical, and pathophysiological stages are associated with a higher prevalence of superficial, deep, and perforator reflux. Isolated deep and combined reflux also seem to be to predict the onset of leg ulceration. Future studies should relate reflux patterns to treatment outcomes, including recurrence risk. This work could help to inform health policies and management guidelines so that reflux patterns, in conjunction with other demographic and hemodynamic parameters, could be used to risk stratify patients and identify individuals who may benefit from earlier treatment.
{"title":"A systematic review of anatomical reflux patterns in primary chronic venous disease","authors":"Matthew K.H. Tan MBBS, BSc(Hons), MRCS, AFHEA , Roshan Bootun BSc, MBBS, MRCS, PhD , Roy Wang MBBS, BSc , Sarah Onida BSc (Hons), PhD, FRCS , Tristan Lane MBBS, BSc, FRCA , Alun H. Davies MA, DM, DSc, FRCS, FHEA, FEBVS, FACPh","doi":"10.1016/j.jvsv.2024.101946","DOIUrl":"10.1016/j.jvsv.2024.101946","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with chronic venous disease (CVD) can present with different underlying hemodynamic abnormalities affecting the deep, superficial, and perforator veins. This review explores the relationship between reflux patterns, extent of venous reflux, and clinical manifestations of CVD.</div></div><div><h3>Methods</h3><div>The Medline and EMBASE databases were searched systematically from 1946 to April 1, 2024. References of shortlisted papers were searched for relevant articles. Studies were included if they were in English language, included participants ≥16 years of age, documented reflux patterns in two or more of the following: deep, superficial, and/or perforator systems, and related patterns to presentation or severity. Exclusion criteria included patients with isolated deep venous thrombosis, post-thrombotic syndrome or stenotic or obstructive disease.</div></div><div><h3>Results</h3><div>We identified 18 studies (11,177 participants; range, 55-3016). Meta-analysis showed significant odds ratios (OR) for C<sub>4-6</sub> disease being associated with deep reflux (OR, 2.41; 95% confidence interval [CI], 1.53-3.78) and perforator reflux (OR, 3.37; 95% CI, 2.16-5.27), but not superficial reflux (OR, 2.11; 95% CI, 0.87-5.14), vs C<sub>0-3</sub> disease. Severe CVD (C<sub>4-6</sub>) was significantly associated with isolated deep, combined deep and superficial, and combined superficial and perforator reflux. The greatest risk of CVD progression (defined as de novo development of varicose veins and progression to greater CVD severity) was shown by two studies to be related to combined deep and superficial reflux.</div></div><div><h3>Conclusions</h3><div>Although limited by the heterogenous nature of the studies, this review confirms that reflux pattern is a significant predictor of clinical class, and higher clinical, etiological, anatomical, and pathophysiological stages are associated with a higher prevalence of superficial, deep, and perforator reflux. Isolated deep and combined reflux also seem to be to predict the onset of leg ulceration. Future studies should relate reflux patterns to treatment outcomes, including recurrence risk. This work could help to inform health policies and management guidelines so that reflux patterns, in conjunction with other demographic and hemodynamic parameters, could be used to risk stratify patients and identify individuals who may benefit from earlier treatment.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 6","pages":"Article 101946"},"PeriodicalIF":2.8,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700428","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 : 2024-07-14DOI: 10.1016/j.jvsv.2024.101947
Jin-Woo Park, Jung-Min Kang, Sun Young Choi, Kyong-Je Woo
Background: Concomitant iatrogenic proximal venous stenosis increases venous pressure and can be a risk factor for unfavorable outcomes of lymphaticovenular anastomosis (LVA) in extremities with secondary lymphedema. This study investigated the frequency and relevant factors of venous stenosis in patients diagnosed with secondary lymphedema who underwent LVA.
Methods: Patients who underwent preoperative computed tomographic venography (CTV) and LVA for secondary lymphedema of the extremities from October 2018 to March 2022 were included. The incidence of proximal venous stenosis in the affected limb on preoperative CTV and the rate of endovascular intervention were compared between upper and lower extremities. Factors affecting proximal venous stenosis were identified through multivariable analysis using independent variables, including patient age, body mass index, comorbidities, smoking history, radiation therapy, duration of lymphedema, and location of lymphedema.
Results: A total of 211 patients were analyzed, including 83 patients with upper extremity and 128 patients with lower extremity lymphedema. The incidence of proximal venous stenosis in the preoperative CTV was 32.5% and 7.8% in upper extremity, and lower extremity lymphedema, respectively (P < .001). The incidence of venous stenosis requiring endovascular intervention was significantly higher in the upper extremity compared with the lower extremity (16.9% vs 6.3%; P = .014). In multivariable analysis, risk factors affecting incidence of venous stenosis requiring endovascular intervention was the patient age (P = .007) and upper extremity (P = .009).
Conclusions: Preoperative evaluation and treatment of venous stenosis in extremities with secondary lymphedema are necessary before LVA surgery, particularly in upper extremity lymphedema.
{"title":"Comparison of the rate of concomitant proximal venous stenosis between the upper and lower extremities in patients with secondary lymphedema undergoing lymphaticovenous anastomosis.","authors":"Jin-Woo Park, Jung-Min Kang, Sun Young Choi, Kyong-Je Woo","doi":"10.1016/j.jvsv.2024.101947","DOIUrl":"10.1016/j.jvsv.2024.101947","url":null,"abstract":"<p><strong>Background: </strong>Concomitant iatrogenic proximal venous stenosis increases venous pressure and can be a risk factor for unfavorable outcomes of lymphaticovenular anastomosis (LVA) in extremities with secondary lymphedema. This study investigated the frequency and relevant factors of venous stenosis in patients diagnosed with secondary lymphedema who underwent LVA.</p><p><strong>Methods: </strong>Patients who underwent preoperative computed tomographic venography (CTV) and LVA for secondary lymphedema of the extremities from October 2018 to March 2022 were included. The incidence of proximal venous stenosis in the affected limb on preoperative CTV and the rate of endovascular intervention were compared between upper and lower extremities. Factors affecting proximal venous stenosis were identified through multivariable analysis using independent variables, including patient age, body mass index, comorbidities, smoking history, radiation therapy, duration of lymphedema, and location of lymphedema.</p><p><strong>Results: </strong>A total of 211 patients were analyzed, including 83 patients with upper extremity and 128 patients with lower extremity lymphedema. The incidence of proximal venous stenosis in the preoperative CTV was 32.5% and 7.8% in upper extremity, and lower extremity lymphedema, respectively (P < .001). The incidence of venous stenosis requiring endovascular intervention was significantly higher in the upper extremity compared with the lower extremity (16.9% vs 6.3%; P = .014). In multivariable analysis, risk factors affecting incidence of venous stenosis requiring endovascular intervention was the patient age (P = .007) and upper extremity (P = .009).</p><p><strong>Conclusions: </strong>Preoperative evaluation and treatment of venous stenosis in extremities with secondary lymphedema are necessary before LVA surgery, particularly in upper extremity lymphedema.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"101947"},"PeriodicalIF":2.8,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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