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

Objective: The study aims to elucidate clinical and ultrasonographic characteristics of female patients diagnosed with pelvic varicose veins (PVVs) and to assess potential risk factors associated with incidences of chronic pelvic pain (CPP) in this population.

Methods: Clinical and ultrasound data were retrospectively collected from female patients with PVVs at Beijing Shijitan Hospital between December 2017 and October 2022. Patient cohorts were divided into two groups based on whether they had been experiencing non-periodic pelvic pain over 6 months, consistent with the symptoms of CPP. Comparative analyses were conducted between the two groups, utilizing both univariate and multivariate logistic regression methodologies to identify risk factors for CPP.

Results: The study included a total of 236 patients: 89 patients in the CPP group and 147 patients in the non-CPP group. No statistically significant differences were found between the two groups with regard to demographic parameters including age, height, weight, age of menarche, and number of pregnancies and births. However, the CPP group showed a higher menstrual volume score and a greater incidence of varicose veins, coupled with a lower body mass index. Transabdominal ultrasonography revealed that patients with CPP had a significantly larger diameter in the left ovarian vein (LOV) (6.2 ± 1.9 mm vs 5.0 ±2.3 mm; P < .05), and a higher prevalence of left internal iliac vein incompetence (21.3% vs 8.8%). Moreover, positive rates for LOV incompetence were markedly higher (94.4% vs 23.1%; P < .05), even in the absence of left common iliac vein compression and nutcracker phenomenon. Multivariate logistic regression analysis discerned that the LOV reflux (odds ratio [OR], 9.102; 95% confidence interval [CI], 4.578-18.099; P < .05), lower body mass index (OR, 0.646; 95% CI, 0.502-0.83; P < .05), elevated menstrual bleeding (OR, 1.182; 95% CI, 1.131-1.234; P < .05), and concomitant varicose veins (OR, 3.140; 95% CI, 1.067-9.273; P < .05) are independent risk factors for the manifestations of CPP in our patient cohorts.

Conclusions: Ultrasonography serves as an efficacious modality for evaluating abdomino-pelvic vascular pathology in patients with PVVs. Notably, LOV and internal iliac vein incompetence emerge as independent risk factors for CPP, thus offering a pivotal point of reference for clinical diagnosis and therapeutic management of PVVs.

Background: Portal venous system aneurysms (PVAs) are increasingly diagnosed on cross-sectional computed tomography imaging. However, the natural history of these aneurysms is poorly understood, and reports are limited to small case series.

Methods: Terms relevant to PVAs were searched in radiology reports (2010-2022), with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5 cm in patients without cirrhosis and 1.9 cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size, whereas aneurysm regression was defined as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups.

Results: Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n = 18; 47.4%), splenic vein (n = 10; 26.3%), superior mesenteric vein (n = 3; 7.9%), and portal confluence (n = 7; 18.4%). Although 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n = 20; 52.6%) and prior liver transplant (n = 4; 10.5%). The median growth was 0.2 cm (range, -2.6 to 2.4 cm) over median follow up over 5.0 years (range, 0.3-16.6 years). Five PVAs (13.2%) regressed and were largely idiopathic (80.0%; P = .03). Thirteen PVAs (34.2%) grew and were associated with portal hypertension (n = 11; 84.6%; P = .003) and thrombosis (n = 6; 46.2%; P = .05). Nine PVAs (23.7%) thrombosed, predominantly in males (n =7; 77.8%). The median growth was 1.0 cm (range, -0.7 to 1.9 cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n = 2; 22.2%), intestinal ischemia (n = 1; 11.1%), and variceal bleeding (n = 2; 22.2%). Four patients (44.4%) were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVAs initially identified with and without radiographic follow up, five (8.6%) underwent intervention with a median diameter of 4.0 cm (range, 3.4-5 cm). Intervention included vein ligation (n = 1; 20.0%), aneurysmorrhaphy (n = 1; 20.0%), and aneurysmectomy (n = 3; 60.0%). There was one case of aneurysm recurrence 20 years following resection and one postoperative mortality.

Conclusions: Two-thirds of PVAa, including those with size greater than 3 cm, remain stable on surveillance. Although annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVAs thrombosed, but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVAs.

Objective: Cyanoacrylate closure (CAC) is a minimally invasive technique for treating axial venous reflux. However, the incidence of serious adverse events (AEs) related to CAC is concerning. With an increasing number of patients undergoing CAC and insufficient safety data in Japan, this study aimed to investigate the safety profile of CAC, focusing on the types and incidence of AEs.

Methods: A nationwide survey was conducted by the Japanese Regulatory Committee for Endovascular Treatment of Varicose Veins between November 2023 and December 2023. Data were collected from 1017 institutions, covering 24,209 patients who underwent CAC at 335 institutions between January 2020 and October 2023. Thromboembolism, phlebitis, hypersensitivity reactions, granuloma formation, infection, bleeding, death, and need for glue resection were documented as unfavorable events or outcomes.

Results: Venous thromboembolism developed in 142 patients (0.59%). Pulmonary embolism, proximal deep vein thrombosis, and ablation-related thrombus extension developed in 3 (0.01%), 9 (0.04%), and 95 (0.39%) patients, respectively. Localized phlebitis that required additional treatment was observed in 1656 patients (6.8%). Of the localized hypersensitivity cases, 960 (58%) required oral antihistamines and 268 (16%) required oral and/or intravenous steroids. Furthermore, 65 patients (0.27%) developed systemic hypersensitivity that required systemic steroids. No patients developed a stroke or anaphylaxis. One patient died owing to pulmonary embolism. Glue resection was performed in nine patients with delayed infection (n = 4), hypersensitivity reactions (n = 4), or a foreign body granuloma (n = 1). The incidence of hypersensitivity reactions was similar among institutions. However, the incidence of thrombosis-related events significantly differed between the high-volume and low-volume institutions. The incidence of proximal deep vein thrombosis (0.13% vs 0.01%; P < .001; odds ratio, 12.5; 95% confidence interval, 2.6-60.3) and ablation-related thrombus extension (0.73% vs 0.30%; P < .001; odds ratio, 2.5; 95% confidence interval, 1.66-3.77) was significantly higher in low-volume institutions than in high-volume centers.

Conclusions: A nationwide survey of CAC for varicose veins in Japan demonstrated that it was a safe procedure with a low rate of serious AEs, such as venous thromboembolism. However, hypersensitivity reactions requiring steroid administration and systemic allergic reactions were observed in some patients.

Objective: According to International Lymphology Society guidelines, the severity of lymphedema is determined by the difference in volume between the affected limb and the healthy side divided by the volume of the healthy side. However, this method of measuring volume is time consuming, laborious, and has certain errors in clinical applications. Therefore, this study aims to explore whether machine learning radiomics features based on noncontrast magnetic resonance imaging (MRI) can predict the severity of primary lower limb lymphedema.

Methods: A retrospective analysis of 119 patients with primary lower limb lymphedema. The enrolled patients were divided into a nonsevere group (mild and moderate) and a severe group. Using the semiautomatic threshold method in ITK-snap software on the patient's noncontrast MRI, we filled the area between the subcutaneous tissue and muscle of the edematous site. The PyRadiomics software package was used to extract radiomic features. The radiomic features were analyzed using the t test or Mann-Whitney test. Subsequently, Pearson correlation testing and least absolute shrinkage and selection operator screening were performed. Using Scikit-learn, the remaining features were used to construct five models: logistic regression, support vector machine, random Forest, ExtraTrees, and light gradient boosting machine. The predictive performance were evaluated by the receiver operating characteristic curve, and the sensitivity and specificity of these measures were calculated. The predictive curve was used to evaluate the performance of the predictive model in guiding decisions for nonsevere and severe lymphedema patients.

Results: The enrolled patients including 28 patients with mild lymphedema (grade I), 38 patients with moderate lymphedema (grade II), and 53 patients with severe lymphedema (grade III) was conducted. A total of 1196 features were extracted, and after Pearson correlation testing and least absolute shrinkage and selection operator screening, 21 nonzero features were selected. The ExtraTree model performed the best, with an area under the curve of 0.974 (95% confidence interval, 0.9437-1.0000) in the training set, a sensitivity of 89.2%, and a specificity of 95.7%. In the test set, these values were 0.938 (95% confidence interval, 0.8539-1.0000), 75%, and 100%, respectively. The decision curve showed that when the predicted probability was between 16% and 78%, the net benefit of the ExtraTree model was greater than that of the two extreme curves, indicating strong clinical value in guiding decisions for nonsevere and severe lymphedema patients.

Conclusions: All five models performed well in distinguishing between the nonsevere group and the severe group. Noncontrast MRI-based machine learning radiomics signature can predict the severity of primary lower limb lymphedema.

Objective: Intracardiopulmonary migration of an inferior vena cava (IVC) filter is an uncommon but potentially life-threatening complication. A previous systematic review including data through 2008 found that the most common cause for migration was operator error and that open thoracotomy was the best first option for management. The aim of this study was to assess the clinical presentation and causes of intracardiopulmonary filter migration, as well as the most commonly used management strategies over the past 15 years.

Methods: A systematic search of the literature was conducted to identify studies pertaining to intracardiopulmonary IVC filter migration that were published between November 2008 and June 2024, and data were collected regarding clinical presentation, complications, type and location of filter migration, and management strategies.

Results: A total of 156 cases of intracardiopulmonary migration of IVC filters were identified in 88 publications. Of the 66 patients whose symptoms status was listed, 50 patients had symptoms and 16 patients were asymptomatic. In the remaining patients, the symptom status was not listed. The most frequently reported symptom was chest pain (68.0%; 34/50). Of the 156 patients, 34 (22.8%) experienced intracardiopulmonary migration of the entire filter body, and the remaining 122 (78.2%) experienced filter fracture with migration of the fractured struts. Complications were reported in 30.1% of patients (47/156); these complications included myocardial injury (n = 37), damage of tricuspid valve (n = 12), and hemopericardium (n = 21). Endovascular (16 filters and 56 struts) or surgical (13 filters and 16 struts) retrieval was the primary management strategy for intracardiopulmonary migration of the filter or fractured strut.

Conclusions: The main cause of intracardiopulmonary migration of an IVC filter is filter fracture. Endovascular retrieval is gradually becoming the preferred management option for intracardiopulmonary migration of IVC filters.

Objective: Demonstrate the effectiveness of complex decongestive therapy (CDT) in patients with chronic venous insufficiency (CVI).

Methods: A single-blind randomized controlled trial was conducted, where the participants were patients with CVI (n = 21/42) were assigned randomly to an experimental group (n = 11/22) or a control group (n = 9/18). A treatment of CDT (manual lymphatic drainage, intermittent pneumatic presotherapy, bilayer bandage) was applied to the experimental group for 4 weeks 2 days per week and no treatment was applied to the control group. The patients were evaluated at baseline (t0), 1 week after finishing the intervention (t1), and 6 weeks after the intervention (t2). The effectiveness of the treatment on symptoms and quality of life (QoL) (heaviness, pain and Chronic Venous Insufficiency Quality of Life [CIVIQ-20] questionary), edema, venous flow, and impedanciometry measurements was evaluated.

Results: An improvement in the patient's QoL was observed: there was a decrease in symptoms such as heaviness and pain, an increase in the average velocity of the left femoral vein and left internal saphenous vein (ISV), a decrease in the ISV diameter in both extremities and a decrease in body mass index and fat mass in both extremities. These results were maintained when following up at 6 weeks, except for the improvement of QoL.

Conclusions: CDT treatment improves the CIVIQ-20 and Venous Clinical Severity Scores. It also improves symptoms (pain and heaviness), venous flow velocity (superficial veins and deep veins [common femoral vein, femoral vein, popliteal vein]) and decreases body mass index, fat mass, and ISV diameter.