Pub Date : 2025-09-22DOI: 10.1016/j.jvsv.2025.102325
Oscar Moreno MD , Nathaniel Parchment MD , Kate Micallef BS , Sabrina Rocco MS , Amber Clay RVT, RDCS , Catherine Luke LVT , Kiran Kumar BS , Jorge H. Ulloa MD , Thomas Wakefield MD , Andrea Obi MD , Peter Henke MD
Post-thrombotic syndrome (PTS) is a long-term sequela of deep venous thrombosis. This review summarizes the best currently available biomarker candidates to identify high-risk progression patients. We examined indexed literature, including clinical studies and review articles, to identify biomarkers indicating the progression of deep venous thrombosis to PTS. Among the most studied biomarkers, associations between PTS and intercellular adhesion molecule 1 and IL-10 were consistently found to be associated with PTS development, whereas D-dimer, C-reactive protein, and IL-6 showed inconsistent results. Other less-studied biomarkers, including cell adhesion molecules, adipokines, thrombotic/fibrinolytic molecules, and novel imaging modalities, have been associated with PTS. Further clinical research on PTS biomarkers is warranted with standardized study designs to compare outcomes. A panel of biomarkers adjusted by age and body mass index, including inflammatory (IL-10), coagulation (D-dimer), adhesion (intercellular adhesion molecule 1), remodeling (matrix metalloproteinase-1/8), and metabolic molecules (adiponectin/leptin) in conjunction with imaging, is recommended for future studies.
{"title":"Predictive biomarkers for post-thrombotic syndrome","authors":"Oscar Moreno MD , Nathaniel Parchment MD , Kate Micallef BS , Sabrina Rocco MS , Amber Clay RVT, RDCS , Catherine Luke LVT , Kiran Kumar BS , Jorge H. Ulloa MD , Thomas Wakefield MD , Andrea Obi MD , Peter Henke MD","doi":"10.1016/j.jvsv.2025.102325","DOIUrl":"10.1016/j.jvsv.2025.102325","url":null,"abstract":"<div><div>Post-thrombotic syndrome (PTS) is a long-term sequela of deep venous thrombosis. This review summarizes the best currently available biomarker candidates to identify high-risk progression patients. We examined indexed literature, including clinical studies and review articles, to identify biomarkers indicating the progression of deep venous thrombosis to PTS. Among the most studied biomarkers, associations between PTS and intercellular adhesion molecule 1 and IL-10 were consistently found to be associated with PTS development, whereas D-dimer, C-reactive protein, and IL-6 showed inconsistent results. Other less-studied biomarkers, including cell adhesion molecules, adipokines, thrombotic/fibrinolytic molecules, and novel imaging modalities, have been associated with PTS. Further clinical research on PTS biomarkers is warranted with standardized study designs to compare outcomes. A panel of biomarkers adjusted by age and body mass index, including inflammatory (IL-10), coagulation (D-dimer), adhesion (intercellular adhesion molecule 1), remodeling (matrix metalloproteinase-1/8), and metabolic molecules (adiponectin/leptin) in conjunction with imaging, is recommended for future studies.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102325"},"PeriodicalIF":2.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137909","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 : 2025-09-19DOI: 10.1016/j.jvsv.2025.102326
Taleen A. MacArthur MD , Bernardo C. Mendes MD , Jill J. Colglazier MD , David M. Nagorney MD , Randall R. DeMartino MD, MS , Peter Gloviczki MD , Manju Kalra MBBS , Mark J. Truty MD, MS , Todd E. Rasmussen MD , Fahad Shuja MBBS , Melinda S. Schaller MD , Kenneth J. Cherry Jr. MD , Thomas C. Bower MD
Objective
To describe early and late outcomes of segmental resection and graft replacement of the inferior vena cava (IVC) for malignant disease over three decades.
Methods
All patients who had IVC resection with graft replacement from 1990 to 2024 at a single institution were retrospectively reviewed. Patients with tangential excision and primary or patch venorrhaphy were excluded. End points were early (<30 days) mortality, major adverse events, graft-related complications, primary patency, overall survival, and freedom from local recurrence.
Results
One hundred sixty-seven patients (54% female; mean age at operation 55 ±14 years) had IVC resection and graft replacement. Primary IVC leiomyosarcoma occurred in 69 patients (41%) and other secondary malignancies in 97 (58%). Preoperative performance status (Eastern Cooperative Oncology Group) was good or excellent in 153 patients (92%). Resection of multiple IVC segments was required in 94 patients (56%), 41 who needed renal vein reconstruction or implantation (25%) and 6 (3.6%) who had hepatic vein implantation. Graft replacement was with ringed polytetrafluoroethylene in 163 patients (98%). Two patients died of intraoperative hemorrhage. Six others died within 4 months; three were procedure-related. One or more major adverse events occurred in 28 patients (17%). Intra-abdominal hemorrhage requiring transfusion was the most common complication, occurring in 10 patients (5.9%). Only one patient developed permanent renal or liver failure. Two patients (1.2%) had asymptomatic subsegmental pulmonary emboli. Over a mean follow-up of 5.5 ± 5.8 years (median 3.2 [1.2, 7.5] years), 10 patients experienced graft occlusion (5.9%). Two occlusions were within 1 month of graft placement, two were within 1 year, and 6 were over 1 year, with one at 23 years postoperatively. Four patients had stents placed to treat asymptomatic high-grade stenoses, one early and three late. There were four graft infections, all related to small bowel leaks. The median overall survival was 52% and 36% at 5 and 10 years, respectively (range, 0-27 years). Freedom from local recurrence was 85%, 71%, and 54% at 1, 5, and 10 years, respectively. Kaplan-Meier estimates of IVC graft primary patency were 96%, 95%, and 88% at 1, 5, and 10 years, respectively.
Conclusions
IVC resection and graft replacement for malignant disease are safe and durable, and provide excellent local control of the tumor, offering a chance for long-term survival in select patients.
{"title":"Early and late outcomes of patients treated with graft replacement of the inferior vena cava for malignant disease: A single-center experience over three decades","authors":"Taleen A. MacArthur MD , Bernardo C. Mendes MD , Jill J. Colglazier MD , David M. Nagorney MD , Randall R. DeMartino MD, MS , Peter Gloviczki MD , Manju Kalra MBBS , Mark J. Truty MD, MS , Todd E. Rasmussen MD , Fahad Shuja MBBS , Melinda S. Schaller MD , Kenneth J. Cherry Jr. MD , Thomas C. Bower MD","doi":"10.1016/j.jvsv.2025.102326","DOIUrl":"10.1016/j.jvsv.2025.102326","url":null,"abstract":"<div><h3>Objective</h3><div>To describe early and late outcomes of segmental resection and graft replacement of the inferior vena cava (IVC) for malignant disease over three decades.</div></div><div><h3>Methods</h3><div>All patients who had IVC resection with graft replacement from 1990 to 2024 at a single institution were retrospectively reviewed. Patients with tangential excision and primary or patch venorrhaphy were excluded. End points were early (<30 days) mortality, major adverse events, graft-related complications, primary patency, overall survival, and freedom from local recurrence.</div></div><div><h3>Results</h3><div>One hundred sixty-seven patients (54% female; mean age at operation 55 ±14 years) had IVC resection and graft replacement. Primary IVC leiomyosarcoma occurred in 69 patients (41%) and other secondary malignancies in 97 (58%). Preoperative performance status (Eastern Cooperative Oncology Group) was good or excellent in 153 patients (92%). Resection of multiple IVC segments was required in 94 patients (56%), 41 who needed renal vein reconstruction or implantation (25%) and 6 (3.6%) who had hepatic vein implantation. Graft replacement was with ringed polytetrafluoroethylene in 163 patients (98%). Two patients died of intraoperative hemorrhage. Six others died within 4 months; three were procedure-related. One or more major adverse events occurred in 28 patients (17%). Intra-abdominal hemorrhage requiring transfusion was the most common complication, occurring in 10 patients (5.9%). Only one patient developed permanent renal or liver failure. Two patients (1.2%) had asymptomatic subsegmental pulmonary emboli. Over a mean follow-up of 5.5 ± 5.8 years (median 3.2 [1.2, 7.5] years), 10 patients experienced graft occlusion (5.9%). Two occlusions were within 1 month of graft placement, two were within 1 year, and 6 were over 1 year, with one at 23 years postoperatively. Four patients had stents placed to treat asymptomatic high-grade stenoses, one early and three late. There were four graft infections, all related to small bowel leaks. The median overall survival was 52% and 36% at 5 and 10 years, respectively (range, 0-27 years). Freedom from local recurrence was 85%, 71%, and 54% at 1, 5, and 10 years, respectively. Kaplan-Meier estimates of IVC graft primary patency were 96%, 95%, and 88% at 1, 5, and 10 years, respectively.</div></div><div><h3>Conclusions</h3><div>IVC resection and graft replacement for malignant disease are safe and durable, and provide excellent local control of the tumor, offering a chance for long-term survival in select patients.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102326"},"PeriodicalIF":2.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113695","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 : 2025-09-19DOI: 10.1016/j.jvsv.2025.102319
Jack K. Donohue BA , Emily Mosher MD , Michael Knapp MD , Nuzhat Kabir MD , Nishant Agrawal MD , Robert Handzel MD , Natalie D. Sridharan MD , Eric S. Hager MD
Objective
Ultrasound-guided foam sclerotherapy is commonly used for superficial venous disease but carries a small risk of deep vein thrombosis (DVT). The management of tibial vein thrombosis after sclerotherapy remains controversial, with practices ranging from anticoagulation and antiplatelet therapy to observation alone. We sought to characterize the natural history of tibial DVTs identified after foam sclerotherapy and evaluate outcomes based on management strategy.
Methods
We retrospectively analyzed patients who underwent physician-compounded foam sclerotherapy (Asclera) at a multi-institutional health care system between January 2016 and January 2022 and developed duplex-diagnosed tibial DVT. Patients underwent standardized follow-up duplex examinations at approximately 2, 4, and 6 weeks after the procedure. Thrombus evolution (resolution, reduction, stability, enlargement, propagation, and embolization) and clinical symptoms were recorded. Outcomes were compared across management groups: antiplatelet therapy, anticoagulation, and observation. Statistical analyses used Kruskal-Wallis and χ2 tests.
Results
Of 877 foam sclerotherapy patients, 622 had follow-up imaging, and 54 patients (55 legs; 9%) developed tibial DVT, forming the study cohort (median age 53 years; 51% female). At initial duplex ultrasound imaging (median 14 days postprocedure), all thrombi were ipsilateral to treatment, with concurrent proximal DVT in 5 cases (4 popliteal and 1 femoral; 9%). Initial management of the tibial thrombus included antiplatelet therapy (55%), anticoagulation (26%), or observation (20%). At final follow-up (median 35 days), thrombus completely resolved in 53%, decreased in 20%, and remained stable in 27%. No patients had enlargement or pulmonary embolism. Symptom resolution was achieved in 87% of patients, with no significant differences between management strategies.
Conclusions
In our series, tibial DVTs after foam sclerotherapy demonstrate a benign clinical course regardless of management strategy. Routine anticoagulation or antiplatelet therapy may not be necessary in asymptomatic patients with isolated distal thrombus. Prospective studies are required to confirm these findings and guide evidence-based recommendations.
{"title":"Tibial vein thrombosis after foam sclerotherapy: A single-institution case series","authors":"Jack K. Donohue BA , Emily Mosher MD , Michael Knapp MD , Nuzhat Kabir MD , Nishant Agrawal MD , Robert Handzel MD , Natalie D. Sridharan MD , Eric S. Hager MD","doi":"10.1016/j.jvsv.2025.102319","DOIUrl":"10.1016/j.jvsv.2025.102319","url":null,"abstract":"<div><h3>Objective</h3><div>Ultrasound-guided foam sclerotherapy is commonly used for superficial venous disease but carries a small risk of deep vein thrombosis (DVT). The management of tibial vein thrombosis after sclerotherapy remains controversial, with practices ranging from anticoagulation and antiplatelet therapy to observation alone. We sought to characterize the natural history of tibial DVTs identified after foam sclerotherapy and evaluate outcomes based on management strategy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who underwent physician-compounded foam sclerotherapy (Asclera) at a multi-institutional health care system between January 2016 and January 2022 and developed duplex-diagnosed tibial DVT. Patients underwent standardized follow-up duplex examinations at approximately 2, 4, and 6 weeks after the procedure. Thrombus evolution (resolution, reduction, stability, enlargement, propagation, and embolization) and clinical symptoms were recorded. Outcomes were compared across management groups: antiplatelet therapy, anticoagulation, and observation. Statistical analyses used Kruskal-Wallis and χ<sup>2</sup> tests.</div></div><div><h3>Results</h3><div>Of 877 foam sclerotherapy patients, 622 had follow-up imaging, and 54 patients (55 legs; 9%) developed tibial DVT, forming the study cohort (median age 53 years; 51% female). At initial duplex ultrasound imaging (median 14 days postprocedure), all thrombi were ipsilateral to treatment, with concurrent proximal DVT in 5 cases (4 popliteal and 1 femoral; 9%). Initial management of the tibial thrombus included antiplatelet therapy (55%), anticoagulation (26%), or observation (20%). At final follow-up (median 35 days), thrombus completely resolved in 53%, decreased in 20%, and remained stable in 27%. No patients had enlargement or pulmonary embolism. Symptom resolution was achieved in 87% of patients, with no significant differences between management strategies.</div></div><div><h3>Conclusions</h3><div>In our series, tibial DVTs after foam sclerotherapy demonstrate a benign clinical course regardless of management strategy. Routine anticoagulation or antiplatelet therapy may not be necessary in asymptomatic patients with isolated distal thrombus. Prospective studies are required to confirm these findings and guide evidence-based recommendations.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102319"},"PeriodicalIF":2.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113707","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 : 2025-09-15DOI: 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.
{"title":"Longitudinal impact of Intersocietal Accreditation Commission vein treatment center accreditation on practice patterns, safety metrics, and patient outcomes","authors":"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","doi":"10.1016/j.jvsv.2025.102315","DOIUrl":"10.1016/j.jvsv.2025.102315","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102315"},"PeriodicalIF":2.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081067","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 : 2025-09-12DOI: 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。
{"title":"SAVVE US pivotal study of patients with severe chronic insufficiency due to deep valvular venous reflux: One-year results after VenoValve implantation","authors":"Cassius Iyad Ochoa Chaar MD, MPH, MS , Eric S. Hager MD , Claire L. Griffin MD , Matthew R. Smeds MD , SAVVE Trial Investigators","doi":"10.1016/j.jvsv.2025.102314","DOIUrl":"10.1016/j.jvsv.2025.102314","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>Implantation of the bioprosthetic venous valve yielded important clinical and health-related quality of life benefits in patients with severe CVI.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102314"},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064814","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 : 2025-09-12DOI: 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.
{"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}
Pub Date : 2025-09-12DOI: 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.
{"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}
Pub Date : 2025-09-12DOI: 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.
{"title":"Long-term outcomes of radiofrequency ablation versus cyanoacrylate closure for isolated small saphenous vein insufficiency: A comparative study","authors":"Hyangkyoung Kim MD, PhD , Sungsin Cho MD, PhD , Se Jun Kim MD , Jin Hyun Joh MD, PhD","doi":"10.1016/j.jvsv.2025.102317","DOIUrl":"10.1016/j.jvsv.2025.102317","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < .001) and a higher occlusion rate at follow-up (99.3% vs 91.8%; <em>P</em> = .006). Both groups showed significant improvement in Venous Clinical Severity Score, Aberdeen Varicose Vein Questionnaire score, and pain scores (<em>P</em> < .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102317"},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065152","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 : 2025-09-01DOI: 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.
{"title":"Direct Percutaneous Abdominal Venous Access for Endovascular Therapy","authors":"Mohammad A. Amarneh MD, Kyung Rae Kim MD, Mohammed H. Alomari MD, Ahmad I. Alomari MD","doi":"10.1016/j.jvsv.2025.102309","DOIUrl":"10.1016/j.jvsv.2025.102309","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility, safety, and clinical applications of ultrasound-guided direct percutaneous access to ectatic abdominal veins for the embolization of vascular malformations.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102309"},"PeriodicalIF":2.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992954","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 : 2025-08-29DOI: 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.
{"title":"Ablation length, not modality type, determines healing outcomes in venous leg ulcers","authors":"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","doi":"10.1016/j.jvsv.2025.102308","DOIUrl":"10.1016/j.jvsv.2025.102308","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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/m<sup>2</sup>. Comorbidities were similar between the cohorts. The median ulcer size was 3 cm<sup>2</sup>. The median time to wound healing was 61 days (interquartile range, 30-258 days) with no significant difference between treatment modalities (<em>P</em> = .37), irrespective of ulcer size category. The rate of ulcer recurrence was 16% and did not differ between the cohorts (<em>P</em> = .46). Multivariate linear regression identified proximal access site as the only independent predictor of prolonged wound healing (<em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"14 1","pages":"Article 102308"},"PeriodicalIF":2.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958999","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号