Journal of vascular surgery. Venous and lymphatic disorders最新文献_第7页

Longitudinal impact of Intersocietal Accreditation Commission vein treatment center accreditation on practice patterns, safety metrics, and patient outcomes IAC静脉治疗中心认证对实践模式、安全指标和患者预后的纵向影响。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-15 DOI: 10.1016/j.jvsv.2025.102315

Fedor Lurie MD, PhD , Mohamed Osman MD , Marlin Schul MD , Jeffery P. Schoonover MD , Kelly Hallett RVT, CCT , Mary Beth Farrell CNMT , Mark H. Meissner MD

Objective

With health care rapidly expanding and patient accessibility needs increasing, there has been an influx of providers often lacking formal training in venous disease management. The aim of this study was to determine if centers that participate in an accreditation program exhibit increased quality, safety outcomes, and overall practice standards.

Methods

Of 325 accredited vein centers, 287 underwent reaccreditation within 3 years. Fifty-nine of them were compliant with Intersocietal Accreditation Commission (IAC) standards at the time of initial accreditation. Fifty-nine IAC-accredited centers participated in the American Vein and Lymphatic Society Pro Vein registry and had patient-level data. Sixteen were initially compliant with IAC standards (group 1; 4977 patients) and 43 had deficiencies (group 2; 11,179 patients). A stratified before-and-after design was used to analyze center-level and patient-level data (demographics, body mass index, and disease severity scores [Clinical-Etiological-Anatomical-Pathophysiological and revised Venous Clinical Severity Score (VCSS)]. Primary outcomes included compliance with IAC standards, treatment results (eg, VCSS changes, complications, endothermal heat-induced thrombosis >2), and interventional practice patterns, such as intervention rate and Utilization Index.

Results

Of the 287 IAC-accredited vein centers who pursued reaccreditation, 59 were compliant initially and at reaccreditation. The remaining centers (n = 229) had multiple deficiencies, with safety issues persisting in some centers at reaccreditation. Before accreditation, group 2 centers treated younger, lower body mass index patients with less severe disease, and group 1 centers saw more advanced cases. Over time, group 2 centers began treating more severe cases. Group 1 had higher intervention rates and lower use indices before accreditation. Post-treatment complication and endothermal heat-induced thrombosis rates were low and similar across both groups. Group 1 showed a greater VCSS score change after treatment, partly owing to higher baseline scores. Over time, group 2 showed a decrease in Utilization Index, without a post-treatment decrease in the revised VCSS change aligning with group 1, indicating improved practice patterns after accreditation.

Conclusions

IAC accreditation plays a meaningful role in standardizing and improving the quality of outpatient venous care. It promotes safer procedural environments, encourages more selective use of interventions, and is associated with improved clinical outcomes—particularly among initially noncompliant centers. These findings support the expansion of accreditation programs and underscore their importance in maintaining high standards of care in an increasingly heterogeneous field.

目的：随着医疗保健的迅速扩大和患者的可及性需求的增加，有大量的提供者往往缺乏正规的静脉疾病管理培训。本研究的目的是确定参与认证计划的中心是否表现出更高的质量、安全结果和整体实践标准。方法：325个经认证的静脉中心中，287个在3年内进行了重新认证。其中59个在初步认可时符合国际咨询委员会的标准。59家IAC认可的中心参与了AVLS Pro静脉登记，并获得了患者水平的数据。16例最初符合IAC标准（第1组，4977例），43例存在缺陷（第2组，11179例）。采用分层前后设计分析中心水平和患者水平的数据（人口统计学、BMI、疾病严重程度评分（CEAP和rVCSS））。主要结局包括是否符合IAC标准、治疗结果（如VCSS改变、并发症、EHIT >2）和干预实践模式（如干预率和利用指数）。结果：在287家iac认可的静脉中心中，有59家在最初和重新认证时都是合规的。其余229家中心存在多重缺陷，一些中心在重新认证时仍存在安全问题。在获得认证之前，第二组中心治疗的是较年轻、bmi较低且病情较轻的患者，而第一组中心治疗的是更多晚期病例。随着时间的推移，第二组中心开始治疗更严重的病例。1组干预率较高，认可前利用指标较低。两组治疗后并发症和EHIT发生率均较低且相似。第1组治疗后VCSS评分变化较大，部分原因是基线评分较高。随着时间的推移，第2组的利用率指数下降，治疗后rVCSS变化没有下降，与第1组一致，表明认证后的实践模式有所改善。结论：IAC认证对规范和提高门诊静脉护理质量具有重要意义。它促进了更安全的程序环境，鼓励更有选择性地使用干预措施，并与改善的临床结果有关，特别是在最初不合规的中心。这些发现支持了认证项目的扩展，并强调了它们在日益多样化的领域中保持高标准护理的重要性。

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引用次数: 0

SAVVE US pivotal study of patients with severe chronic insufficiency due to deep valvular venous reflux: One-year results after VenoValve implantation SAVVE®美国对深瓣膜静脉反流导致的严重慢性功能不全患者的关键研究：静脉瓣膜植入后一年的结果

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-12 DOI: 10.1016/j.jvsv.2025.102314

Cassius Iyad Ochoa Chaar MD, MPH, MS , Eric S. Hager MD , Claire L. Griffin MD , Matthew R. Smeds MD , SAVVE Trial Investigators

Objective

Failure of deep venous valves and associated reflux leads to the progression of chronic venous insufficiency (CVI), culminating in painful, clinically challenging, and costly leg ulcers. Traditional CVI treatments have primarily focused on symptom management, or interventions for superficial veins. This study aimed to show that bioprosthetic valve implantation yields clinically meaningful health improvements and offers a safe and effective treatment for deep venous CVI by addressing the root cause of the condition.

Methods

SAVVE (Surgical Antireflux Venous Valve Endoprosthesis) was a prospective, single-arm, multicenter study to evaluate the performance of a bioprosthetic venous valve device (VenoValve; enVVeno Medical), for femoral vein implantation in patients with venous disease (Clinical-Etiology-Anatomy-Pathophysiology clinical classifications C4b, C4c, C5, and C6) unresponsive to standard of care therapy. Outcome measures included duplex-derived reflux time, the Revised Venous Clinical Severity Score (rVCSS), pain, disease-specific (VEINES-QoL/Sym) and general health-related quality of life (EuroQol 5 Dimensions) measures, technical success of device implantation, ulcer healing (C6 patients), and ulcer recurrence (in C5 and C6 patients). Clinically meaningful improvement was defined as a decrease in rVCSS of at least 3 points.

Results

Between October 2021 and September 2023, 75 patients were enrolled (median age, 65 years; interquartile range, 57-70 years) at 23 institutions. Of the enrolled patients, 61 (81.3%) were men and 16 (21.3%) were Black, Hispanic, or Latino. The device was implanted in 73 patients (97.3%). At 6 months, 23 of 67 implanted patients (34.3%) had a 30% or greater improvement in duplex-derived reflux time. Average rVCSS score improvements were clinically meaningful and statistically significant at 3, 6, and 12 months. At 12 months, 84.6% of implanted patients achieved clinically meaningful improvement, with an average improvement of 7.9 points in rVCSS. Statistically significant improvements in pain and health-related quality of life were reported through 12 months of follow-up. Among patients with C6 disease, healing was observed for 91.6% of ulcers that had a duration of less than 12 months. No unanticipated device-related adverse events were reported. The perioperative major adverse events rate was 30.7% with no mortality. Most patients with major adverse events achieved clinically meaningful improvement in symptoms.

Conclusions

Implantation of the bioprosthetic venous valve yielded important clinical and health-related quality of life benefits in patients with severe CVI.

目的：深静脉瓣膜失效和相关的反流导致慢性静脉功能不全（CVI）的进展，最终导致疼痛、临床挑战和代价高昂的腿部溃疡。传统的CVI治疗主要集中在症状管理，或对浅静脉的干预。本研究旨在表明生物人工瓣膜植入术可以改善临床健康状况，并通过解决深层静脉CVI的根本原因，为其提供安全有效的治疗方法。方法：SAVVE研究是一项前瞻性、单臂、多中心研究，旨在评估生物假体静脉瓣膜装置（VenoValve; enVVeno Medical, Irvine, California）用于对标准治疗无反应的静脉疾病（CEAP临床分类C4b、C4c、C5和C6）患者股静脉植入的性能。结果测量包括双源性反流时间、修订静脉临床严重程度评分（rVCSS）、疼痛、疾病特异性（veins - qol /Sym）和一般健康相关生活质量（EQ-5D）测量、装置植入的技术成功、溃疡愈合（C6患者）和溃疡复发（C5和C6患者）。临床意义的改善定义为rVCSS降低至少3个点。结果：在2021年10月至2023年9月期间，共有23家机构的75名患者入组（中位年龄65岁，四分位数范围为57至70岁）。在纳入的患者中，61例（81.3%）为男性，16例（21.3%）为黑人、西班牙裔或拉丁裔。植入术73例（97.3%）。6个月时，67例植入患者中有23例（34.3%）双源性反流时间改善30%或以上。平均rVCSS评分改善在3、6和12个月时具有临床意义和统计学意义。在12个月时，84.6%的植入患者获得了有临床意义的改善，rVCSS平均改善7.9分。在12个月的随访中，疼痛和健康相关生活质量均有统计学上的显著改善。在C6疾病患者中，91.6%的溃疡持续愈合。结论：生物假静脉瓣膜的植入对严重CVI患者的临床和健康相关的生活质量有重要的益处。

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引用次数: 0

Paradigm shift and long-term results in the diagnosis and treatment of pelvic venous disorder 盆腔静脉疾病诊断和治疗的模式转变和长期结果。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-12 DOI: 10.1016/j.jvsv.2025.102318

Fabio Henrique Rossi MD, PhD, Antonio Massamitsu Kambara PhD

Objective

Pelvic venous disorder (PeVD) is a heterogeneous condition with a range of presentations, including chronic pelvic pain (CPP), hematuria, flank pain, dyspareunia, pelvic, and lower extremity varicose veins. The clinical, anatomical, and hemodynamic diversity of PeVD complicates standardized management. We developed a personalized diagnostic and therapeutic protocol and evaluated its long-term outcomes.

Methods

Patients presenting with CPP, with or without symptoms of renal or iliac vein obstruction, visual analogue scale (VAS) for pain of >5, and gonadal or pelvic varicose vein incompetence underwent one of the following procedures based on their anatomical, and hemodynamic profiles: (1) ovarian and pelvic varicose vein embolization, (2) spermatic vein embolization, (3) iliac vein stenting, or (4) renal vein stenting. Procedures were performed with intraoperative venography and intravascular ultrasound assessment.

Results

Between January 2012 and May 2022, 175 patients with PeVD were treated, of whom 146 cases (83.4%) were followed for >2 years (mean, 110.0 ± 1.6 months). Treatment methods included iliac vein stenting (78 cases [53.4%]), ovarian vein embolization (45 cases [30.8%]), spermatic vein embolization (17 cases [11.7%]), and renal vein stenting (6 cases [4.1%]). Preoperative and postoperative VAS scores and Short Form-36 quality-of-life scores were as follows: iliac vein stenting: VAS, 8.1 ± 1.8 to 2.89 ± 1.7 (P < .001); Short Form-36, 35.8 ± 23.4 to 78.4 ± 11.8 (P < .001); ovarian vein embolization: VAS, 8.5 ± 1.5 to 3.1 ± 1.1 (P < .001); Short Form-36, 36.7 ± 22.6 to 74.7 ± 11.8 (P < .001); spermatic vein embolization, VAS, 8.3 ± 1.1 to 3.1 ± 0.4 (P < .001); Short Form-36, 33.8 ± 33.8 to 77.4 ± 13.7 (P < .002); renal vein stenting, VAS, 8.7 ± 0.9 to 1.8 ± 1.1 (P < .001); Short Form-36, 48.45 ± 33.8 to 79.4 ± 10.9 (P < .001). Complications included two cases (4.4%) of intraoperative, asymptomatic gonadal vein bleeding with very low-volume static contrast extravasation, which were managed conservatively. The reintervention rates after primary treatment were as follows: iliac vein stenting 10.2%, ovarian vein embolization 13.3%, spermatic vein embolization 0%, and renal vein stenting 16.6%.

Conclusions

PeVD is a heterogeneous clinical condition requiring thorough preoperative assessment of reflux and venous obstruction. Although isolated CPP often benefits from gonadal and pelvic vein embolization, most patients with CPP related to chronic venous disease or renal vein symptoms improve with iliac or renal vein stenting alone, avoiding posterior gonadal vein embolization.

目的：盆腔静脉疾病（PeVD）是一种具有多种表现的异质性疾病，包括慢性盆腔疼痛（CPP）、血尿、侧腹疼痛、性交困难、盆腔和下肢静脉曲张。PeVD的临床、解剖和血流动力学的多样性使标准化治疗复杂化。我们制定了个性化的诊断和治疗方案，并评估了其长期疗效。方法：慢性盆腔疼痛（CPP），伴有或不伴有肾或髂静脉阻塞症状，疼痛视觉模拟量表（VASP） bbb50，性腺或盆腔静脉曲张不全的患者，根据其解剖学和血流动力学特征，接受以下手术之一：1)卵巢和盆腔静脉曲张栓塞，2)精索静脉栓塞，3)髂静脉支架置入，或4)肾静脉支架置入。进行术中静脉造影和IVUS评估。结果：2012年1月至2022年5月，共治疗了175例PeVD患者，其中146例（83.4%）随访超过2年（平均：110±1.6个月）。治疗方法包括髂静脉支架植入术78例（53.4%）、卵巢静脉栓塞术45例（30.8%）、精索静脉栓塞术17例（11.7%）、肾静脉支架植入术6例（4.1%）。术前、术后视觉模拟评分（VAS）评分及SF-36生活质量评分如下：髂静脉支架植入术：VAS: 8.1±1.8 ~ 2.89±1.7 (p < 0.001)；SF-36: 35.8±23.4至78.4±11.8 (p < 0.001)；卵巢静脉栓塞：VAS: 8.5±1.5 ~ 3.1±1.1 (p < 0.001)；SF-36: 36.7±22.6 ~ 74.7±11.8 (p < 0.001)；精索静脉栓塞：VAS: 8.3±1.1 ~ 3.1±0.4 (p < 0.001)；SF-36: 33.8±33.8至77.4±13.7 (p < .002)；肾静脉支架植入术：VAS: 8.7±0.9 ~ 1.8±1.1 (p < 0.001)；SF-36: 48.45±33.8 ~ 79.4±10.9 （p < 0.001）。并发症包括2例（4.4%）术中无症状性腺静脉出血伴非常小体积静态造影剂外渗，均予以保守处理。初次治疗后再干预率：髂静脉支架置入10.2%，卵巢静脉栓塞13.3%，精索静脉栓塞0%，肾静脉支架置入16.6%。结论：盆腔静脉疾病（PeVD）是一种异质性的临床疾病，需要对反流和静脉阻塞进行彻底的术前评估。虽然孤立性CPP通常受益于性腺和盆腔静脉栓塞，但大多数与慢性静脉疾病或肾静脉症状相关的CPP患者仅行髂或肾静脉支架植入术即可改善，避免了性腺后静脉栓塞。

{"title":"Paradigm shift and long-term results in the diagnosis and treatment of pelvic venous disorder","authors":"Fabio Henrique Rossi MD, PhD, Antonio Massamitsu Kambara PhD","doi":"10.1016/j.jvsv.2025.102318","DOIUrl":"10.1016/j.jvsv.2025.102318","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic venous disorder (PeVD) is a heterogeneous condition with a range of presentations, including chronic pelvic pain (CPP), hematuria, flank pain, dyspareunia, pelvic, and lower extremity varicose veins. The clinical, anatomical, and hemodynamic diversity of PeVD complicates standardized management. We developed a personalized diagnostic and therapeutic protocol and evaluated its long-term outcomes.</div></div><div><h3>Methods</h3><div>Patients presenting with CPP, with or without symptoms of renal or iliac vein obstruction, visual analogue scale (VAS) for pain of >5, and gonadal or pelvic varicose vein incompetence underwent one of the following procedures based on their anatomical, and hemodynamic profiles: (1) ovarian and pelvic varicose vein embolization, (2) spermatic vein embolization, (3) iliac vein stenting, or (4) renal vein stenting. Procedures were performed with intraoperative venography and intravascular ultrasound assessment.</div></div><div><h3>Results</h3><div>Between January 2012 and May 2022, 175 patients with PeVD were treated, of whom 146 cases (83.4%) were followed for >2 years (mean, 110.0 ± 1.6 months). Treatment methods included iliac vein stenting (78 cases [53.4%]), ovarian vein embolization (45 cases [30.8%]), spermatic vein embolization (17 cases [11.7%]), and renal vein stenting (6 cases [4.1%]). Preoperative and postoperative VAS scores and Short Form-36 quality-of-life scores were as follows: iliac vein stenting: VAS, 8.1 ± 1.8 to 2.89 ± 1.7 (<em>P</em> < .001); Short Form-36, 35.8 ± 23.4 to 78.4 ± 11.8 (<em>P</em> < .001); ovarian vein embolization: VAS, 8.5 ± 1.5 to 3.1 ± 1.1 (<em>P</em> < .001); Short Form-36, 36.7 ± 22.6 to 74.7 ± 11.8 (<em>P</em> < .001); spermatic vein embolization, VAS, 8.3 ± 1.1 to 3.1 ± 0.4 (<em>P</em> < .001); Short Form-36, 33.8 ± 33.8 to 77.4 ± 13.7 (<em>P</em> < .002); renal vein stenting, VAS, 8.7 ± 0.9 to 1.8 ± 1.1 (<em>P</em> < .001); Short Form-36, 48.45 ± 33.8 to 79.4 ± 10.9 (<em>P</em> < .001). Complications included two cases (4.4%) of intraoperative, asymptomatic gonadal vein bleeding with very low-volume static contrast extravasation, which were managed conservatively. The reintervention rates after primary treatment were as follows: iliac vein stenting 10.2%, ovarian vein embolization 13.3%, spermatic vein embolization 0%, and renal vein stenting 16.6%.</div></div><div><h3>Conclusions</h3><div>PeVD is a heterogeneous clinical condition requiring thorough preoperative assessment of reflux and venous obstruction. Although isolated CPP often benefits from gonadal and pelvic vein embolization, most patients with CPP related to chronic venous disease or renal vein symptoms improve with iliac or renal vein stenting alone, avoiding posterior gonadal vein embolization.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102318"},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065117","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}

引用次数: 0

Comparison of long-term outcomes and quality of life following radiofrequency ablation, endovenous laser ablation, and N-butyl cyanoacrylate treatment of greater saphenous vein insufficiency 射频消融、静脉内激光消融和氰基丙烯酸丁酯治疗大隐静脉的长期预后和生活质量的比较İnsufficiency。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-12 DOI: 10.1016/j.jvsv.2025.102316

Hasan Toz MD, Yusuf Kuserli MD

Objective

To compare the long-term clinical outcomes and quality of life after radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and N-butyl cyanoacrylate (NBCA) treatments in patients with chronic venous insufficiency.

Methods

This retrospective study included 600 patients treated with RFA, EVLA, or NBCA for chronic venous insufficiency at a single center between February 2015 and February 2025. Patients were divided into 3 groups of 200 according to the treatment modality. Clinical and procedural parameters, complication rates, pain scores, time to return to daily activities, Venous Clinical Severity Scores (VCSS), and great saphenous vein (GSV) occlusion rates were compared among groups.

Results

Statistically significant differences were found among the groups regarding complication rates, pain scores at 6 hours, procedure duration, time to return to daily activities, long-term GSV occlusion, and 5-year VCSS values (all P < .05). Complication-free rates were highest in the RFA group (89.5%), followed by NBCA (86.0%), and were lowest in the EVLA group (69.0%) (P < .001). EVLA had more frequent pigmentation, paresthesia, and phlebitis. NBCA had the shortest procedure time (13.7 minutes) and the greatest postprocedural pain and delayed return to daily activities. At 5 years, RFA showed the highest GSV occlusion rate (88.4%), whereas NBCA and EVLA had lower rates (70.6% and 75.0%, respectively) (P < .001). VCSS values at 5 years were more favorable in the RFA and NBCA groups compared with the EVLA group (P = .036).

Conclusions

All three endovenous techniques are effective and safe for the treatment of GSV insufficiency. However, the choice of modality should consider differences in complication rates, patient comfort, and long-term vein occlusion outcomes.

目的：比较慢性静脉功能不全患者射频消融术（RFA）、静脉内激光消融术（EVLA）和氰基丙烯酸正丁酯（NBCA）治疗后的长期临床结果和生活质量。方法：本回顾性研究纳入了2015年2月至2025年2月在单一中心接受RFA、EVLA或NBCA治疗慢性静脉功能不全的600例患者。根据治疗方式将患者分为三组，每组200例。比较两组患者的临床和手术参数、并发症发生率、疼痛评分、恢复日常活动时间、静脉临床严重程度评分（VCSS）和大隐静脉（GSV）闭塞率。结果：在并发症发生率、6小时疼痛评分、手术时间、恢复日常活动时间、长期GSV闭塞和5年VCSS值方面，组间差异有统计学意义（均为p）。结论：三种内静脉技术治疗大隐静脉功能不全均有效且安全。然而，模式的选择应考虑并发症发生率、患者舒适度和长期静脉阻塞结果的差异。

{"title":"Comparison of long-term outcomes and quality of life following radiofrequency ablation, endovenous laser ablation, and N-butyl cyanoacrylate treatment of greater saphenous vein insufficiency","authors":"Hasan Toz MD, Yusuf Kuserli MD","doi":"10.1016/j.jvsv.2025.102316","DOIUrl":"10.1016/j.jvsv.2025.102316","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the long-term clinical outcomes and quality of life after radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and N-butyl cyanoacrylate (NBCA) treatments in patients with chronic venous insufficiency.</div></div><div><h3>Methods</h3><div>This retrospective study included 600 patients treated with RFA, EVLA, or NBCA for chronic venous insufficiency at a single center between February 2015 and February 2025. Patients were divided into 3 groups of 200 according to the treatment modality. Clinical and procedural parameters, complication rates, pain scores, time to return to daily activities, Venous Clinical Severity Scores (VCSS), and great saphenous vein (GSV) occlusion rates were compared among groups.</div></div><div><h3>Results</h3><div>Statistically significant differences were found among the groups regarding complication rates, pain scores at 6 hours, procedure duration, time to return to daily activities, long-term GSV occlusion, and 5-year VCSS values (all <em>P</em> < .05). Complication-free rates were highest in the RFA group (89.5%), followed by NBCA (86.0%), and were lowest in the EVLA group (69.0%) (<em>P</em> < .001). EVLA had more frequent pigmentation, paresthesia, and phlebitis. NBCA had the shortest procedure time (13.7 minutes) and the greatest postprocedural pain and delayed return to daily activities. At 5 years, RFA showed the highest GSV occlusion rate (88.4%), whereas NBCA and EVLA had lower rates (70.6% and 75.0%, respectively) (<em>P</em> < .001). VCSS values at 5 years were more favorable in the RFA and NBCA groups compared with the EVLA group (<em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>All three endovenous techniques are effective and safe for the treatment of GSV insufficiency. However, the choice of modality should consider differences in complication rates, patient comfort, and long-term vein occlusion outcomes.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102316"},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065135","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}

引用次数: 0

Long-term outcomes of radiofrequency ablation versus cyanoacrylate closure for isolated small saphenous vein insufficiency: A comparative study 射频消融与氰基丙烯酸酯封闭治疗孤立性小隐静脉功能不全的长期疗效比较研究。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-12 DOI: 10.1016/j.jvsv.2025.102317

Hyangkyoung Kim MD, PhD , Sungsin Cho MD, PhD , Se Jun Kim MD , Jin Hyun Joh MD, PhD

Background

Endovenous ablation is widely recommended for treating small saphenous vein (SSV) insufficiency, but isolated SSV (iSSV) reflux remains less frequently studied, especially in comparative settings. This study aimed to evaluate the clinical and anatomical outcomes of radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) in patients with iSSV insufficiency.

Methods

A retrospective review was conducted using prospectively collected data from patients undergoing either modality for iSSV. Preoperative duplex ultrasound examination assessed anatomical patterns and reflux. Ablation strategies were tailored to anatomical variations. Follow-up duplex ultrasound examinations were performed at 6 months, 12 months, and up to 24 months in some patients (median follow-up, 12 months; range, 6-24 months). Outcomes included procedure time, vein occlusion rate, symptom improvement, complications, and changes in the Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire.

Results

A total of 379 limbs in 306 patients were treated (85 with RFA and 294 with CAC). CAC had a longer procedure time than RFA (P < .001) and a higher occlusion rate at follow-up (99.3% vs 91.8%; P = .006). Both groups showed significant improvement in Venous Clinical Severity Score, Aberdeen Varicose Vein Questionnaire score, and pain scores (P < .001). Sural nerve injury occurred in two limbs treated with RFA and none with cyanoacrylate. Thrombus extension into the deep vein occurred in both groups, without a significant difference.

Conclusions

Both RFA and CAC were effective and safe for treating iSSV insufficiency. Tailoring treatment to individual venous anatomy may improve outcomes and minimize complications such as sural nerve injury.

背景：静脉内消融被广泛推荐用于治疗小隐静脉（SSV）功能不全，但孤立性SSV （iSSV）反流的研究仍然较少，特别是在比较环境中。本研究旨在评估射频消融和氰基丙烯酸酯封闭治疗iSSV功能不全患者的临床和解剖学结果。方法：采用前瞻性收集的两种方式的iSSV患者数据进行回顾性研究。术前超声检查解剖形态及反流。消融策略根据解剖变化量身定制。一些患者在6个月、12个月和24个月时进行双工超声随访（中位随访12个月，范围6-24个月）。结果包括手术时间、静脉闭塞率、症状改善、并发症、静脉临床严重程度评分（VCSS）和阿伯丁静脉曲张问卷（AVVQ）的变化。结果：306例患者共379条肢体接受治疗（射频消融术85例，氰基丙烯酸酯封闭术294例）。氰基丙烯酸酯封闭术比RFA手术时间更长（P < 0.001），随访时闭塞率更高（99.3%比91.8%,P = 0.006）。两组VCSS、AVVQ和疼痛评分均有显著改善（P < 0.001）。射频消融术治疗的两肢发生腓肠神经损伤，氰基丙烯酸酯治疗的两肢未发生腓肠神经损伤。两组血栓延伸至深静脉无显著性差异。结论：射频消融术和氰基丙烯酸酯封闭术治疗iSSV功能不全是安全有效的。针对个体静脉解剖进行量身定制的治疗可以改善结果并减少并发症，如腓肠神经损伤。

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引用次数: 0

Direct Percutaneous Abdominal Venous Access for Endovascular Therapy 腹内静脉直接通路的可行性、安全性及临床应用。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-09-01 DOI: 10.1016/j.jvsv.2025.102309

Mohammad A. Amarneh MD, Kyung Rae Kim MD, Mohammed H. Alomari MD, Ahmad I. Alomari MD

Objective

To evaluate the feasibility, safety, and clinical applications of ultrasound-guided direct percutaneous access to ectatic abdominal veins for the embolization of vascular malformations.

Methods

Medical records, imaging studies, and procedural details were retrospectively reviewed for patients who underwent embolization procedures for vascular malformations with ultrasound-guided percutaneous access to intra-abdominal veins, including the pelvic, retroperitoneal, and portomesenteric veins.

Results

A total of 38 direct percutaneous vein accesses were performed across 25 procedures in 9 patients (age range, 3-58 years). Access sites included retroperitoneal veins (n = 12), dilated and tortuous internal iliac vein branches (n = 8), the superior mesenteric vein (n = 8), the inferior mesenteric vein (n = 1), ileocolic vein (n = 8), and right colic vein (n = 1). Catheter sizes ranged from 3F to 5F. All procedures were technically successful. Seven minor access-related complications occurred; all were managed conservatively.

Conclusions

Ultrasound-guided percutaneous access to dilated intra-abdominal veins is feasible and associated with minimal morbidity. It offers a valuable alternative for patients with complex vascular malformations requiring access to deep abdominal veins.

目的：探讨超声引导下经皮腹扩张静脉栓塞治疗血管畸形的可行性、安全性及临床应用价值。方法：回顾性分析超声引导下经皮腹腔静脉栓塞治疗血管畸形患者的病历、影像学检查和手术细节，包括盆腔静脉、腹膜后静脉和肠系膜静脉。结果：9例患者（年龄范围：3-58岁）共进行了25次手术，共38次直接经皮静脉通路。进入部位包括腹膜后静脉（n=12）、扩张和弯曲的髂内静脉分支（n=8）、肠系膜上静脉（n=8）、肠系膜下静脉（n=1）、回结肠静脉（n=8）和右结肠静脉（n=1）。导管尺寸从3到5法国不等。所有手术在技术上都是成功的。发生7例轻微的通路相关并发症，均采用保守治疗。结论：超声引导下经皮腹腔静脉扩张术是可行的，且发病率低。它为需要进入深腹静脉的复杂血管畸形患者提供了一个有价值的选择。

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引用次数: 0

Ablation length, not modality type, determines healing outcomes in venous leg ulcers 消融术长度，而非方式类型，决定下肢静脉性溃疡的愈合结果。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-29 DOI: 10.1016/j.jvsv.2025.102308

Misaki M. Kiguchi MD, MBA , Christian Anthony Campat DO , Deeptha Bejugam BS , Juan Carlos Jimenez MD , Ulka Sachdev MD , Niyati Bhatt MD , Alexander Rothstein BM, BA , Julie Bitner PA-C, BA , Leigh Ann O'Banion MD

Objective

Early endovenous intervention of the saphenous system improves healing and recurrence of venous leg ulcers (Clinical-Etiology-Anatomy-Pathophysiology class 6). As ablative methods continue to evolve, it is essential to identify outcome differences between the various techniques. This study aims to compare wound healing rates between primary nonthermal ablation (cyanoacrylate glue [CAG] or commercial polidocanol microfoam ablation [MFA]) and thermal ablation with adjunct MFA.

Methods

In this multicenter retrospective cohort study, patients with healed venous ulcers after nonthermal endovenous treatment were identified from four tertiary referral US institutions. Demographics, comorbidities, procedural, and wound data were collected. Patients whose full-length great saphenous vein was treated with a single nonthermal modality (CAG or MFA) were compared with those treated with radiofrequency ablation plus MFA of the below-knee segment. Multivariate linear regression was performed to identify predictors of wound healing.

Results

We identified 55 patients (27 primary CAG or MFA and 28 radiofrequency ablation plus MFA). The average age was 70 ± 12 years, 56% were male, and 53% had a body mass index of >30 kg/m². Comorbidities were similar between the cohorts. The median ulcer size was 3 cm². The median time to wound healing was 61 days (interquartile range, 30-258 days) with no significant difference between treatment modalities (P = .37), irrespective of ulcer size category. The rate of ulcer recurrence was 16% and did not differ between the cohorts (P = .46). Multivariate linear regression identified proximal access site as the only independent predictor of prolonged wound healing (P = .03).

Conclusions

Treatment of the full-length great saphenous vein with a single nonthermal modality (CAG or MFA) or a thermal modality plus MFA below the knee have comparable times to wound healing. This finding suggests that comprehensive treatment, irrespective of modality, of the entire great saphenous vein to the ankle is the preferred approach for optimal wound healing in Clinical-Etiology-Anatomy-Pathophysiology class 6 patients.

目的：隐静脉系统早期静脉内介入治疗可改善下肢静脉性溃疡的愈合和复发（CEAP-6）。随着烧蚀方法的不断发展，确定各种技术之间的结果差异是至关重要的。本研究旨在比较初级非热[氰基丙烯酸酯胶（CAG）或商业聚多元醇微泡沫消融（MFA）]和热辅助MFA的伤口愈合率。方法：在这项多中心回顾性队列研究中，来自美国四家三级转诊机构的经非热静脉内治疗后静脉溃疡愈合的患者。收集了人口统计学、合并症、手术和伤口数据。将全长大隐静脉（GSV）采用单一非热方式（CAG或MFA）治疗的患者与采用膝下段RFA + MFA治疗的患者进行比较。采用多元线性回归来确定伤口愈合的预测因素。结果：55例确诊患者（27例原发性CAG或MFA， 28例RFA+MFA）。平均年龄70±12岁，男性占56%，体重指数bb0 ~ 30kg/m2占53%。两组患者的合并症相似。溃疡中位数为3cm2。伤口愈合的中位时间为61天（IQR 30-258），治疗方式之间无显著差异（p=0.37），与溃疡大小类别无关（图1）。溃疡复发率为16%，两组间无差异（p=0.46）。多元线性回归发现近端通路是伤口愈合时间延长的唯一独立预测因子（p=0.03）。结论：采用单一非热方式（CAG或MFA）或膝关节以下热加MFA治疗全长GSV的伤口愈合时间相当。这表明，对于CEAP-6患者而言，无论采用何种方式，对踝关节的整个GSV进行综合治疗是最佳伤口愈合的首选方法。

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引用次数: 0

Giant primary great saphenous vein aneurysm 巨大原发性大隐静脉动脉瘤。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-29 DOI: 10.1016/j.jvsv.2025.102307

Yan Yang MD , Juan Yang MD , Wen Hao Lu MD

引用次数: 0

Exploring isolated inferior vena cava anomalies beyond the norm 探讨孤立性下腔静脉异常。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-29 DOI: 10.1016/j.jvsv.2025.102306

Micaela R. Cuneo MD, Diane F. Hale MD

引用次数: 0

Timing of outpatient stenting is associated with stent size in nonthrombotic iliac vein lesions 门诊支架置入术的时机与非血栓性髂静脉病变的支架大小有关。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-23 DOI: 10.1016/j.jvsv.2025.102303

Kurt S. Schultz MD , Paula Pinto Rodriguez MD , Sahar Ali MD , Robert R. Attaran MD , Juan Carlos Perez Lozada MD , Steffen Huber MD , Britt Tonnessen MD , Edouard Aboian MD , Raul J. Guzman MD , Cassius Iyad Ochoa Chaar MD, MPH, MS

Objective

Stent placement is commonly used to treat nonthrombotic iliac vein lesions (NIVLs). On the day of surgery, patients typically fast after midnight and may often present with volume deficits and various degrees of dehydration. This study aims to determine if the time of day stenting is performed predicts the size of the iliac vein stent used to treat NIVLs.

Methods

A retrospective study of patients who underwent outpatient stenting and first-time treatment for NIVLs at a single institution from January 2013 to March 2022 was performed. The exposure variable was the time of day the outpatient stenting was performed, serving as a proxy for fasting duration. Stent timing was dichotomized into an early cohort (procedures before 11 am) and a late cohort (procedures after 11 am). Small stent size was defined as 12 to 16 mm, and large stent size was defined as 18 to 22 mm. A multivariable logistic regression analysis evaluated the independent association between the timing of stenting and iliac vein stent size.

Results

Sixty-four patients met the inclusion criteria, with 53% (n = 34) in the late cohort. The median age of the study population was 53 years (interquartile range, 39-64 years). Patients were 75% female, 30% non-White, and 69% non-Hispanic. Although there were no significant differences in baseline characteristics or iliac vein measurements on intravascular ultrasound examination before stenting between the early and late cohorts, patients in the early cohort were significantly more likely to have a large stent size used compared with the late cohort (70% vs 44%; P = .037). On multivariable logistic regression, each additional hour later in the day that stenting was performed was associated with a 28% higher odds of using a smaller venous stent (P = .036). Older age also independently predicted the implantation of a smaller stent (odds ratio, 0.95; 95% confidence interval, 0.91-0.99; P = .022).

Conclusions

Outpatient stenting performed later in the day was associated with a smaller stent size in patients treated for NIVLs. A 9-hour delay in stent placement was associated with a 2-mm reduction in stent diameter (ie, one stent size smaller). Future studies should investigate the role of a preoperative hydration protocol in optimizing stent sizing for patients with iliac vein lesions.

目的：支架置入术是治疗非血栓性髂静脉病变的常用方法。在手术当天，患者通常在午夜后禁食，可能经常出现体积不足和不同程度的脱水。这项研究的目的是确定一天中进行静脉造影的时间是否可以预测用于治疗非血栓性髂静脉病变的髂静脉支架的大小。方法：回顾性研究2013年1月至2022年3月在同一机构接受门诊静脉造影并首次治疗非血栓性髂静脉病变的患者。暴露变量是门诊静脉造影进行的时间，作为禁食时间的代理。静脉造影时间分为“早队列”（上午11点前）和“晚队列”（上午11点后）。小支架尺寸定义为12-16毫米（mm），大支架尺寸定义为18-22毫米。多变量logistic回归分析评估了静脉造影时间与髂静脉支架大小之间的独立关联。结果：64例患者符合纳入标准，其中53% （n=34）属于晚期队列。研究人群的中位年龄为53岁（IQR， 39-64岁）。患者中75%为女性，30%为非白人，69%为非西班牙裔。尽管在早期和晚期队列中，支架植入前的基线特征或髂静脉血管内超声测量值没有显著差异，但与晚期队列相比，早期队列中的患者更有可能使用大支架尺寸（70%对44%，p=0.037）。在多变量logistic回归中，静脉造影时间每晚1小时，使用较小静脉支架的几率增加28% （p = 0.036）。年龄较大也独立预测了较小支架的植入（OR, 0.95; 95% CI, 0.91-0.99; p = 0.022）。结论：当天晚些时候进行门诊静脉造影与接受非血栓性髂静脉病变治疗的患者支架尺寸较小相关。手术时间的9小时差异与支架尺寸减小2mm相关（即支架尺寸减小1个）。未来的研究应探讨术前水化方案在优化髂静脉病变患者支架尺寸中的作用。

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引用次数: 0