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

英文中文

Surgical outcomes for occluded venous thoracic outlet syndrome following transaxillary first rib resection 经腋窝第一肋骨切除术后闭塞性胸廓出口静脉综合征的手术效果。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-22 DOI: 10.1016/j.jvsv.2024.101925

Objective

Surgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to evaluate the outcomes of TFRR based on chronicity of completely occluded axillosubclavian veins in VTOS.

Methods

We performed a retrospective institutional review of all patients who underwent TFRR for VTOS and had a completely occluded axillosubclavian vein between 2003 and 2022. Patients were categorized into three groups based on the time of inciting VTOS event to TFRR acuity of their venous occlusion: <4 weeks, 4 to 12 weeks, and >12 weeks. We evaluated the association of TFRR timing with 1-year outcomes, including patency and symptomatic improvement. We used the χ² test to compare baseline characteristics and postoperative outcomes.

Results

Overall, 103 patients underwent TFRR for VTOS with a completely occluded axillosubclavian vein (median age, 30.0 years; 42.7% female; 8.8% non-White), of whom 28 had occlusion at <4 weeks, 36 had occlusion at 4 to 12 weeks, and 39 had occlusion at >12 weeks. Postoperative venogram performed 2 to 3 weeks after TFRR demonstrated that 78.6% in the <4 weeks group, 72.2% in the 4- to 12-weeks group, and 61.5% in the >12 weeks group had some degree of recanalization (P = .76). Postoperative balloon angioplasty was successfully performed in 60 patients with stenosed or occluded axillosubclavian vein at the time of postoperative venogram. At the 10- to 14-month follow-up, 79.2% of the <4 weeks group, 73.3% of the 4- to 12-weeks group, and 73.3% of the >12 weeks group had patent axillosubclavian veins based on duplex ultrasound examination (P = .86). Among patients who underwent postoperative balloon angioplasty, 80.0%, 85.0% and 100% in the <4 weeks, 4- to 12-weeks, and >12 weeks groups respectively demonstrated patency at 10 to 14 months (P = .31). Symptomatic improvement was reported in 95.7% in the <4 weeks group, 96.7% in the 4- to 12-weeks group, and 93.5% in the >12 weeks group (P = .84).

Conclusions

TFRR offers excellent postoperative outcomes for patients with symptomatic VTOS, even in cases of completely occluded axillosubclavian veins, regardless of the chronicity of the occlusion. By 14 months, 95.2% of patients experienced symptomatic improvement, and 75% attained venous patency.

目的：经腋窝第一肋骨切除术（TFRR）通常用于胸廓出口静脉综合征（VTOS）患者的手术减压。我们旨在根据 VTOS 中完全闭塞的腋下-锁骨下静脉的慢性程度评估 TFRR 的效果：我们对 2003 年至 2022 年期间因 VTOS 而接受 TFRR 且腋下锁骨下静脉完全闭塞的所有患者进行了回顾性机构审查。根据引发 VTOS 事件的时间到静脉闭塞的 TFRR 清晰度（12 周），将患者分为三组。我们评估了 TFRR 时间与一年预后（包括通畅和症状改善）之间的关系。我们使用卡方检验比较基线特征和术后结果：共有 103 例因腋下锁骨下静脉完全闭塞的 VTOS 患者接受了 TFRR（中位年龄 30.0 岁，42.7% 为女性，8.8% 为非白人），其中 28 例患者闭塞时间小于 4 周，36 例患者闭塞时间为 4-12 周，39 例患者闭塞时间大于 12 周。TFRR 术后 2-3 周进行的静脉造影显示，12 周组中 78.6% 的患者有一定程度的再闭塞（P=0.76）。在术后静脉造影时，60 名腋下锁骨静脉狭窄/闭塞的患者成功进行了术后球囊血管成形术。在10-14个月的随访中，根据双相超声检查，12周组中79.2%的患者腋下锁骨静脉通畅（P=0.86）。在术后接受球囊血管成形术的患者中，12周组分别有80.0%、85.0%和100%的患者在10-14个月时显示血管通畅（P=0.31）。据报告，症状改善率分别为：小于 4 周组 95.7%，4-12 周组 96.7%，大于 12 周组 93.5%（P=0.84）：结论：TFRR为有症状的VTOS患者提供了良好的术后疗效，即使是完全闭塞的腋下锁骨下静脉，无论其慢性闭塞程度如何。14个月后，95.2%的患者症状得到改善，75%的患者获得静脉通畅。

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引用次数: 0

Risk factors of moderate to severe post-thrombotic syndrome within 2 years in patients with subacute thrombosis: A case-control study 亚急性血栓形成患者 2 年内出现中重度血栓后综合征的风险因素：病例对照研究。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-19 DOI: 10.1016/j.jvsv.2024.101933

Objective

The aim of this study was to study the risk factors influencing the occurrence of moderate to severe post-thrombotic syndrome (PTS) within 2 years in patients with subacute lower extremity deep vein thrombosis (DVT).

Methods

Seventy patients who developed moderate to severe PTS within 2 years after subacute lower extremity DVT from June 2018 to June 2022 were retrospectively selected as the case group. They were matched 1:1 by sex and age (±5 years) with 70 patients who did not develop moderate to severe PTS during the same follow-up period as the control group. Multiple logistic regression, stratified analysis, and interaction analyses were used to explore the risk factors for moderate to severe PTS.

Results

The multiple logistic regression model showed that patients with iliofemoral vein thrombosis had a significantly increased risk of developing moderate to severe PTS within 2 years. Patients who underwent intraluminal intervention treatment during hospitalization had a significantly reduced risk. The odds ratios were 4.000 (95% confidence interval, 1.597-10.016) for the femoral-popliteal vein thrombosis and 0.262 (95% confidence interval, 0.106-0.647) for the anticoagulation treatment group. The stratified analysis showed that intraluminal intervention treatment was a protective factor against moderate to severe PTS within 2 years across different strata of hypertension, thrombus type, body mass index, duration of anticoagulation, and wearing compression stockings. Additionally, there was an interaction between thrombus type and treatment method, with intraluminal intervention treatment having a more pronounced effect on preventing moderate to severe PTS in patients with iliofemoral vein thrombosis.

Conclusions

Iliofemoral vein thrombosis is a risk factor for the development of moderate to severe PTS within 2 years in patients with subacute lower extremity DVT. Intraluminal intervention treatment can reduce the risk of moderate to severe PTS, especially in patients with iliofemoral vein thrombosis.

目的研究影响亚急性下肢深静脉血栓（DVT）患者2年内发生中重度血栓后综合征（PTS）的风险因素：回顾性选取2018年6月至2022年6月亚急性下肢深静脉血栓形成后2年内发生中重度PTS的70例患者作为病例组。按性别和年龄（±5 岁）与同一随访期内未发生中重度 PTS 的 70 例患者进行 1:1 配对，作为对照组。采用多元逻辑回归、分层分析和交互分析来探讨中度重度 PTS 的风险因素：多重逻辑回归模型显示，髂股静脉血栓患者在两年内发生中重度 PTS 的风险明显增加。住院期间接受腔内介入治疗的患者风险明显降低。股-腘静脉血栓形成组的几率比（ORs）为4.000（95%CI 1.597∼10.016），抗凝治疗组的几率比（ORs）为0.262（95%CI 0.106∼0.647）。分层分析表明，在高血压、血栓类型、体重指数、抗凝时间和穿弹力袜等不同分层中，腔内介入治疗是2年内中度-重度PTS的保护因素。此外，血栓类型与治疗方法之间存在交互作用，腔内介入治疗对预防髂股静脉血栓患者的中度-重度PTS具有更明显的效果：结论：髂股静脉血栓是亚急性下肢深静脉血栓患者在两年内发生中重度 PTS 的危险因素。腔内介入治疗可降低中度-重度 PTS 的风险，尤其是髂股静脉血栓患者。

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引用次数: 0

Luminal changes between woven versus nonwoven stents 有纺与无纺支架的管腔变化

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-18 DOI: 10.1016/j.jvsv.2024.101894

Ruojia Debbie Li MD, MS , Ruth Bush MD, JD, MPH

引用次数: 0

Events of interest 感兴趣的活动

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-18 DOI: 10.1016/j.jvsv.2024.101931

引用次数: 0

Confronting microaggressions in the medical field for a more inclusive future 正视医学领域的微观诽谤，创造更具包容性的未来

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-18 DOI: 10.1016/j.jvsv.2024.101818

Omar Abdel Kerim MPH , Anil Hingorani MD

引用次数: 0

Complex decongestive therapy and phlebolymphedema: Content of the treatment and measurement of limb volume 复合减充血疗法和腓肠肌水肿：治疗内容和肢体体积测量

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-18 DOI: 10.1016/j.jvsv.2024.101840

Musa Baklaci MD, Sibel Eyigor

引用次数: 0

Info for readers 读者须知

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-06-18 DOI: 10.1016/j.jvsv.2024.101930

引用次数: 0

Varicose vein surgery after acute isolated superficial vein thrombosis in daily practice: INSIGHTS-SVT study 日常实践中急性孤立浅静脉血栓形成后的静脉曲张手术：INSIGHTS-SVT 研究。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-05-29 DOI: 10.1016/j.jvsv.2024.101917

Objective

The aim of this study was to assess the utilization of surgical interventions in patients diagnosed with superficial vein thrombosis (SVT) and its potential association with the occurrence of venous thromboembolism (VTE) and bleeding events.

Methods

INSIGHTS-SVT, a prospective, non-interventional, multicenter study in Germany, investigated the management and outcomes of patients with acute SVT who received conservative and/or invasive treatments at the discretion of the treating physician.

Results

Among the 872 patients with 12-month data, 657 had medical therapy only, and 215 patients underwent vascular surgery (70 within 3 months of SVT diagnosis, 136 between months 4 and 12, and nine had an intervention in both periods). The most commonly performed procedures included endovenous thermal ablation, ligation of the saphenofemoral or saphenopopliteal junction, and vein stripping. The primary outcome of symptomatic VTE was observed in 5.8% of conservatively treated patients and 6.3% of those who underwent surgical intervention. Additionally, the secondary outcome of recurrent or extended SVT was documented in 4.7% of conservatively treated patients and 5.3% of invasively treated patients. Bleeding events occurred in 1.4% of conservatively treated patients and 2.1% of surgically treated patients. These differences were statistically not significant. Furthermore, our analysis indicated a potential protective effect associated with surgical treatments, such as ligation of the saphenofemoral or saphenopopliteal junction, stripping and endovenous thermal ablation, concerning the endpoint of VTE for patients when applied after 3 months from the index SVT event.

Conclusions

In line with previous research, our study suggests that surgical interventions are not frequently employed in the management of SVT, although they may be warranted in select cases. Nevertheless, additional research is essential to gain a deeper understanding of the indications, criteria, and benefit of surgical interventions in the treatment of SVT.

研究目的本研究旨在评估被诊断为浅静脉血栓形成（SVT）的患者使用外科干预的情况及其与静脉血栓栓塞（VTE）和出血事件发生的潜在关联：INSIGHTS-SVT是一项在德国进行的前瞻性、非干预性、多中心研究，它调查了由主治医生决定接受保守和/或侵入性治疗的急性SVT患者的治疗方法和结果：在 872 名获得 12 个月数据的患者中，657 名仅接受了药物治疗，215 名接受了血管外科手术（70 名在 SVT 诊断后三个月内接受，136 名在第 4 个月至第 12 个月之间接受，9 名在这两个时期都接受了介入治疗）。最常见的手术包括静脉腔内热消融术（EVTA）、隐股动脉或隐腘动脉交界处（SFJ/SPJ）结扎术和静脉剥脱术。在接受保守治疗的患者中，5.8% 出现了症状性 VTE，而在接受手术干预的患者中，6.3% 出现了症状性 VTE。此外，4.7%的保守治疗患者和 5.3%的侵入治疗患者出现了 SVT 复发或扩展的次要结果。1.4%的保守治疗患者和2.1%的手术治疗患者发生了出血事件。这些差异在统计学上并不显著。此外，我们的分析表明，手术治疗（如 SFJ/SPJ 结扎、剥离和 EVTA）在发生 SVT 事件 3 个月后对患者的 VTE 终点具有潜在的保护作用：与之前的研究一致，我们的研究表明，手术干预在 SVT 的治疗中并不常用，但在某些情况下可能是有必要的。尽管如此，要想更深入地了解手术干预治疗 SVT 的适应症、标准和益处，还必须开展更多的研究。

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引用次数: 0

Clinical outcomes after treatment of incompetent saphenous vein combined with segmental popliteal vein reflux 治疗无功能隐静脉合并节段性腘静脉反流后的临床效果。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-05-27 DOI: 10.1016/j.jvsv.2024.101918

Objective

This study aimed to evaluate whether differences exist in the quality of life changes and complication rates after treatment of incompetent saphenous vein (ISV) based on the presence of segmental popliteal vein reflux (SPVR).

Methods

Patients who underwent treatment for ISV from July 2016 to July 2021 were included and divided into two groups: patients without deep venous reflux (DVR) and patients with SPVR. Patients with axial DVR, a history of deep vein thrombosis, a history of orthopedic surgery, previous venous treatment, and no postoperative follow-up were excluded from the study. Duplex ultrasound examination was performed preoperatively and at 6 and 12 months postoperatively.

Results

The study included 233 patients (398 limbs), and 50 (64 limbs) had SPVR. Differences were not observed in gender, age, body mass index, distribution of clinical class according to Clinical-Etiology-Anatomy-Physiology classification, laterality, treatment method, and preoperative Venous Clinical Severity Score or Aberdeen Varicose Vein Questionnaire scores between the two groups with SPVR or without DVR. Furthermore, the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire scores at 6 and 12 months postoperatively were improved in both groups, although without significant differences. A significant difference was not observed in the rate of postoperative complications between the groups based on the presence of SPVR (1.8% vs 1.6%: P = .896). The SPVR improvement rate after ISV treatment was 25% (16/64), and patient-reported outcomes in patients combined with SPVR improved independent of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.

Conclusions

Complication rates and clinical outcomes after ISV treatment did not differ in the presence of SPVR. In patients with SPVR, after ISV treatment, quality of life improved regardless of treatment modality, saphenous vein treatment section, and postoperative SPVR improvement.

研究目的本研究旨在评估隐静脉闭锁（ISV）治疗后，生活质量的变化和并发症发生率是否因是否存在节段性腘静脉反流（SPVR）而存在差异：纳入2016年7月至2021年7月期间接受ISV治疗的患者，并将其分为两组：无深静脉回流（DVR）患者和有SPVR患者。有轴向深静脉回流、深静脉血栓（DVT）病史、骨科手术史、既往接受过静脉治疗以及术后未随访的患者不在研究范围内。术前、术后 6 个月和 12 个月进行了双相超声检查：研究共纳入 233 名患者（398 条肢体），其中 50 人（64 条肢体）进行了 SPVR。接受 SPVR 或未接受 DVR 的两组患者在性别、年龄、体重指数（BMI）、根据临床-病因-解剖-生理学（CEAP）分类的临床分级分布、侧位、治疗方法以及术前静脉临床严重程度评分（VCSS）或阿伯丁静脉曲张问卷（AVVQ）评分方面均未发现差异。此外，两组患者术后 6 个月和 12 个月的 VCSS 和 AVVQ 评分均有所改善，但无显著差异。根据是否存在 SPVR，两组的术后并发症发生率无明显差异（1.8% 对 1.6%：P = 1.00）。ISV治疗后的SPVR改善率为25%（16/64），合并SPVR患者的患者报告结果有所改善，与治疗方式、隐静脉治疗部位和术后SPVR改善情况无关：结论：ISV治疗后的并发症发生率和临床疗效与SPVR没有差异。对于合并 SPVR 的患者，ISV 治疗后生活质量的改善与治疗方式、隐静脉治疗部位和术后 SPVR 改善无关。

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引用次数: 0

Saphena varix: The venous golf ball. 静脉曲张：静脉高尔夫球。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-05-27 DOI: 10.1016/j.jvsv.2024.101916

Parth Joshi, Sanjay Desai, A R Chandrashekhar, M Sriram, Gowda Suhas S, H S Nimeesh

引用次数: 0

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