Journal of vascular surgery. Venous and lymphatic disorders最新文献_第8页

Comparative effectiveness of non-compounded polidocanol 1% endovenous microfoam (Varithena) ablation versus endovenous thermal ablation utilizing a systematic review and network meta-analysis 非复方 Polidocanol 1% 静脉内微泡沫（Varithena）消融与静脉内热消融的疗效比较：系统综述与网络 Meta 分析》。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-26 DOI: 10.1016/j.jvsv.2024.101896

<div><h3>Objective</h3><div>We compared the effectiveness and safety of polidocanol 1% endovenous microfoam ablation vs endovenous thermal ablation with radiofrequency or laser energy for treatment of venous insufficiency caused by lower extremity truncal vein incompetence via network meta-analysis of published comparative evidence.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature review following best practices, including a prospective protocol. We screened studies published in English from 2000 to 2023 for randomized and nonrandomized studies reporting direct or indirect comparisons between polidocanol 1% endovenous microfoam and endovenous thermal ablation. Thirteen studies met our eligibility criteria for the network meta-analysis. The co-primary effectiveness outcomes were the closure rate ≥3 months after procedure and the average change in the Venous Clinical Severity Score. For the subgroup of venous ulcer patients, the ulcer healing rate was the primary effectiveness outcome. The secondary outcomes included safety and patient-reported outcomes. Network meta-analyses were conducted on outcomes having sufficient data. Categorical outcomes were summarized using odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity tests and estimates of network inconsistency were used to investigate the robustness of our meta-analysis.</div></div><div><h3>Results</h3><div>We found that polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure (OR, 0.65; 95% CI, 0.36-1.18; <em>P</em> = .16). Although not the primary aim of the study, the network meta-analysis also provided evidence to confirm our supposition that polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds for vein closure (OR, 2.91; 95% CI, 1.58-5.37; <em>P</em> < .01). A sensitivity analysis using the longest available time point for closure in each study, with a minimum of 12 months of follow-up (median, 48 months; range, 12-72 months), showed results similar to those of the main analysis. No association was found between the risk of deep vein thrombosis and the treatment received. The available data were insufficient for a network meta-analysis of Venous Clinical Severity Score improvement and ulcer healing rates.</div></div><div><h3>Conclusions</h3><div>Polidocanol 1% endovenous microfoam was not significantly different statistically from endovenous thermal ablation for venous closure and deep vein thrombosis risk for chronic venous insufficiency treatment, based on a network meta-analysis of published evidence. Polidocanol 1% endovenous microfoam was significantly differentiated statistically from physician-compounded foam, with higher odds of vein closure. A sensitivity analysis found venous closure findings were robust at follow-up intervals of 12 months or greater and for up to 6 years. New evidence

目的通过对已发表的比较证据进行网络荟萃分析，比较 1%波利多卡醇静脉腔内微泡沫消融术与使用射频或激光能量的静脉腔内热消融术治疗下肢截静脉瓣膜功能不全引起的静脉功能不全的有效性和安全性：我们按照包括前瞻性方案在内的最佳实践进行了系统性文献综述。我们筛选了 2000 年至 2023 年期间用英语发表的随机或非随机研究，这些研究报告了 1%polidocanol 静脉内微泡沫与静脉内热消融之间的直接或间接比较。有 13 项研究符合我们进行网络荟萃分析的资格标准。共同主要有效性结果为术后至少 3 个月的闭合率和静脉临床严重程度评分的平均变化。对于静脉溃疡患者分组，溃疡愈合率是主要疗效结果。次要结果包括安全性和患者报告结果。对有足够数据的结果进行了网络荟萃分析。分类结果采用几率和 95% 置信区间进行总结。为了研究荟萃分析的稳健性，我们采用了敏感性测试和网络不一致性估计：我们发现，在静脉闭合方面，1% 波利多卡诺静脉腔内微泡沫疗法与静脉腔内热消融疗法没有统计学差异（OR 0.65，95% CI 0.36 至 1.18，P=0.16）。虽然这不是研究的主要目的，但网络荟萃分析也提供了证据，证实了我们的推测，即1% Polidocanol 静脉内微泡沫与医生配制的泡沫在统计学上存在差异，静脉闭合的几率更高（OR 2.91，95% CI 1.58 至 5.37，PC 结论：1% Polidocanol 静脉内微泡沫与医生配制的泡沫在统计学上存在差异，静脉闭合的几率更高）：根据已发表证据的网络荟萃分析，在慢性静脉功能不全治疗的静脉闭合和深静脉血栓风险方面，1% Polidocanol 静脉内微泡沫与静脉内热消融没有统计学差异。1% Polidocanol 静脉内微泡沫与医生配制的泡沫在统计学上有显著差异，静脉闭合的几率更高。一项敏感性分析发现，静脉闭合结果在随访间隔为12个月或更长时间以及长达6年的情况下都是可靠的。符合本综述纳入标准的新证据将定期纳入动态网络荟萃分析。

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引用次数: 0

Application of the ankle pump method in a sitting position to evaluate calf perforating veins by color Doppler ultrasound 应用坐姿踝泵法，通过彩色多普勒超声波检查评估小腿穿孔静脉。

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-26 DOI: 10.1016/j.jvsv.2024.101897

Peipei Liu MBBS , Jianxing Huang MBBS , Xueju Zhang PhD, MD , Ruolin Yang MBBS , Shiyuan Yang PhD, MD , Lingli Chen MBBS , Yongyan Gao PhD, MD

Objective

We investigated the feasibility and efficacy of assessing calf perforating veins (PVs) using the ankle pump in a sitting position (AP-sit) method by color Doppler ultrasound.

Methods

We performed a multicenter prospective clinical trial between November 2022 and October 2023. Eligible patients with chronic venous disease and healthy controls were enrolled. The calf PVs were assessed using three different methods: manual compression in a standing position, manual compression in a sitting position, and AP-sit method. The reflux durations and detection rate of incompetent PVs (IPVs) were compared among the three methods. The number and diameter of calf PVs and distribution of IPVs were analyzed.

Results

A total of 50 patients with chronic venous disease and 50 healthy controls were included. There were 173 calves analyzed, including 97 healthy calves and 76 calves with chronic venous disease. The number of PVs per calf was higher in the diseased calves (median, 7.0; interquartile range [IQR], 6.0-8.0) than in the healthy calves (median, 5.0; IQR, 3.0-6.0; P < .001). The diameter of IPVs (median, 2.3 mm; IQR, 2.0-3.1 mm) was larger than that of competent PVs (median, 1.4 mm; IQR, 1.2-1.7 mm). Most of the IPVs (78.8%) were located in the medial and posterior middle of the calf. The reflux duration induced by the AP-sit method was greater than that induced by the manual compression methods (P < .001). Although the AP-sit method had a higher detection rate (92.0%) of IPVs than the manual compression methods (71.7% and 74.3% for standing and sitting, respectively; P < .001), especially in the distal lower leg, the manual compression methods found IPVs not found using the AP-sit method.

Conclusions

Diseased calves with chronic venous disease have more PVs than do healthy calves. IPVs are commonly larger than competent PVs, with most IPVs located in the medial and posterior middle of the calf. Most importantly, the AP-sit method provides a convenient and effective approach for assessing the calf PVs, especially those located in the distal calf, as an alternative or complementary method to traditional manual compression, which is valuable in the daily practice of sonographers.

目的通过彩色多普勒超声波检查，研究在坐姿下使用踝泵法评估小腿穿孔静脉的可行性和有效性：我们在2022年11月至2023年10月期间进行了一项多中心前瞻性临床试验。符合条件的慢性静脉疾病患者和健康对照组均被纳入其中。通过三种不同的方法对小腿穿孔静脉进行评估，即站立位手动压迫、坐位手动压迫和坐位踝泵。比较了三种方法的回流持续时间和无功能穿孔静脉的检出率。分析了小腿穿孔静脉的数量和直径以及无功能穿孔静脉的分布情况：结果：共纳入 50 名慢性静脉疾病患者和 50 名健康对照组。共分析了 173 头小牛，包括 97 头健康小牛和 76 头患有慢性静脉疾病的小牛。患病犊牛每头穿孔静脉的中位数（7.0，四分位间范围 6.0-8.0）高于健康犊牛（5.0，3.0-6.0）（P < 0.001）。无功能穿孔静脉的直径（2.3，2.0-3.1 毫米）大于有功能穿孔静脉的直径（1.4，1.2-1.7 毫米）。大部分无功能穿孔静脉（78.8%）位于小腿内侧和后中部。踝泵法引起的回流持续时间比手动加压法引起的回流持续时间长（P < 0.001）。虽然踝泵法对无功能穿孔静脉的检出率（92.0%）高于人工按压法（站立位和坐位的检出率分别为 71.7% 和 74.3%）（p < 0.001），尤其是在小腿远端，但人工按压法发现了踝泵法未显示的无功能穿孔静脉：结论：患有慢性静脉疾病的小腿比健康小腿有更多的穿孔静脉。结论：患有慢性静脉疾病的患病小腿比健康小腿有更多的穿孔静脉，不称职的小腿穿孔静脉通常比称职的穿孔静脉大，大多数不称职的小腿穿孔静脉位于小腿内侧和后中部。最重要的是，AP-坐姿法为评估小腿穿孔静脉，尤其是位于小腿远端的穿孔静脉提供了一种方便有效的方法，可替代或补充传统的人工按压法，这对超声技师的日常工作非常有价值。

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引用次数: 0

Experimental multiparametric magnetic resonance imaging characterization of iliocaval venous thrombosis pathological changes 髂静脉血栓病理变化的实验性多参数磁共振成像特征描述

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-26 DOI: 10.1016/j.jvsv.2024.101895

Louis Magnus MD, MSc , Adeline Schwein MD, PhD , Ponraj Chinnadurai MBBS-MSST , Killian Fontaine MD , Kyle Autry RT(R) , Dipan J. Shah MD , Kathryn Jane Grande-Allen PhD , Nabil Chakfé MD, PhD , Jean Bismuth MD

<div><h3>Objective</h3><p>Iliocaval thrombotic obstruction is a challenging condition, especially because thrombus age and corresponding pathological remodeling at presentation are unknown, which directly impacts management. Our aim was to assess the ability of magnetic resonance imaging (MRI) in determining age thresholds of experimentally created inferior vena cava (IVC) thrombosis in pigs.</p></div><div><h3>Methods</h3><p>We used a previously described swine model of IVC thrombosis. The animals underwent MRI at baseline, immediately after thrombosis creation, and after a follow-up period extending from 2 to 28 days. Thirteen pigs were divided into three groups according to disease chronicity: acute group (AG; n = 5), subacute group (SAG; n = 4), and chronic group (CG; n = 4), with a mean thrombosis age of 6.4 ± 2.5 days, 15.7 ± 2.8 days, and 28 ± 5.7 days, respectively. A T<sub>1</sub>-weighted volumetric interpolated breath-hold examination sequence was used to anatomically delineate IVC thrombus as a region of interest. Three other MRI sequences were used to assess the thrombus signal.</p></div><div><h3>Results</h3><p>The Kruskal-Wallis test showed a statistically significant difference in T<sub>1</sub> relaxation times after contrast injection (<em>P</em> = .026) between the three groups of chronicity. The AG (360.2 ± 102.5 ms) was significantly different from the CG (336.7 ± 55.2 ms; <em>P</em> = .003), and the SAG (354.1 ± 89.7 ms) was significantly different from the AG (<em>P</em> = .027). There was a statistically significant difference in native T<sub>2</sub> relaxation times (<em>P</em> = .038) between the three groups. The AG (160 ± 86.7 ms) was significantly different from the SAG (142.3 ± 55.4 ms; <em>P</em> = .027), and the SAG was significantly different from the CG (178.4 ± 11.7 ms; <em>P</em> = .004).</p></div><div><h3>Conclusions</h3><p>This study highlighted MRI characteristics in a swine model that might have the potential to significantly differentiate subacute and chronic stages from an acute stage of deep vein thrombosis in humans. Further clinical studies in humans are warranted.</p></div><div><h3>Clinical Relevance</h3><p>In addition to providing a better understanding of venous thrombosis remodeling over time, magnetic resonance imaging has the potential to be a tool that could allow us to characterize the composition of venous thrombus over an interval, allowing for a refined analysis of the local evolution of venous thrombosis. We propose a noninvasive and innovative method to characterize different thresholds of chronicity with magnetic resonance imaging features of central deep vein thrombosis of the inferior vena cava experimentally obtained using a totally endovascular in vivo swine model, mimicking human pathophysiology. Being able to determine these features noninvasively is critical for vascular specialists when it comes to choosing between fibrinolytic therapy, percutaneous thrombectomy, or surgical manageme

目的：静脉血栓性阻塞是一种具有挑战性的疾病，尤其是因为血栓年龄和发病时相应的病理重塑情况不明，这直接影响了治疗。我们的目的是评估磁共振成像（MRI）在确定猪实验性下腔静脉（IVC）血栓年龄阈值方面的能力：我们使用了之前描述过的猪下腔静脉血栓形成模型。动物在基线、血栓形成后立即和随访 2-28 天后接受磁共振成像。13 只动物根据疾病的慢性程度分为 3 组：急性组（AG，N1 = 5）、亚急性组（SAG，N2 = 4）和慢性组（CG，N3 = 4），平均血栓形成年龄分别为 6.4 ± 2.5 天、15.7 ± 2.8 天和 28 ± 5.7 天。采用 T1 加权容积插值屏气检查序列，将 IVC 血栓作为感兴趣区进行解剖学划分。其他三种磁共振成像序列用于评估血栓信号：Kruskal-Wallis显示，3组慢性病患者注射造影剂后的T1弛豫时间差异有统计学意义（P = .026）：AG（360.2 ± 102.5）与 CG（336.7 ± 55.2 ms；P = .003）有显著差异，SAG（354.1 ± 89.7 ms）与 AG（P = .027）有显著差异。三组之间的原生 T2 松弛时间差异有统计学意义（P = .038）：AG（160 ± 86.7 ms）与 SAG（142.3 ± 55.4 ms；P = .027）显著不同，SAG 与 CG（178.4 ± 11.7 ms；P = .004）显著不同：本研究强调了猪模型的核磁共振成像特征，这些特征有可能显著区分人类深静脉血栓的亚急性和慢性阶段与急性阶段。有必要在人类中开展进一步的临床研究。

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引用次数: 0

A scoping review of scores or grading systems for pelvic venous disorders 盆腔静脉疾病（PeVD）评分或分级系统范围综述

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-25 DOI: 10.1016/j.jvsv.2024.101901

Background

Pelvic venous disorders (PeVD) encompass a variety of conditions linked to chronic pelvic pain in women. However, PeVD remain underdiagnosed due to the absence of universally accepted diagnostic criteria. The complexity of PeVD classifications across specialties leads to delays in treatment. This scoping review aims to fill a gap in PeVD diagnosis and management by identifying all existing scoring or grading systems to lay the foundation for standardized clinical scoring tools for PeVD.

Methods

This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews. Online databases were searched up to April 2023. Studies implementing a scoring or grading system for patients with confirmed or suspected PeVD were included. Scores or grading systems were classified into four main categories based on their use in the study: screening, diagnosis, measure of disease severity, and measure of response to treatment.

Results

Of the 2976 unique records identified, 82 were reviewed in full, and 20 were included in this study. The publication dates ranged from 1984 to 2023 (median, 2018; interquartile range, 2003-2022). A total of 21 scores and/or grading systems were identified. Of these 21 scores, 10 (47.6%) were clinical scores, and 10 (47.6%) were scores based on radiological findings; one study included a score that used both clinical and radiological findings. The identified scores were used in various settings. Of the 21 scores, 2 (9.52%) were used for screening in a tertiary care setting; 3 (14.3%) were used to establish the PeVD diagnosis; 8 (38.1%) were used to assess disease severity; and 8 (38.1%) were used as measures of response to treatment. Of the eight scores assessing disease severity, four (50.0%) assessed the degree of dilatation of pelvic veins and four (50%) assessed the severity of reflux. Only three of the scores were validated.

Conclusions

This scoping review identified a range of scoring and grading systems for PeVD. We note a lack of a validated scoring system, both clinical and radiological, for screening and assessment of disease severity. This is an important first step in developing validated disease-specific scoring systems for patient screening, appropriate referral, assessment of symptom severity, and assessment of the response to treatment.

背景盆腔静脉疾病（Pelvic venous disorders，PVD）包括多种与女性慢性盆腔疼痛有关的疾病。然而，由于缺乏公认的诊断标准，PeVD 的诊断率仍然偏低。各专科对 PeVD 分类的复杂性导致了治疗的延误。本范围界定综述旨在通过确定所有现有的评分或分级系统来填补 PeVD 诊断和管理方面的空白，从而为 PeVD 的标准化临床评分工具奠定基础。对截至 2023 年 4 月的在线数据库进行了检索。纳入了对确诊或疑似 PeVD 患者实施评分或分级系统的研究。评分或分级系统根据其在研究中的应用分为四大类：筛查、诊断、疾病严重程度测量和治疗反应测量。发表日期从 1984 年到 2023 年不等（中位数为 2018 年；四分位间范围为 2003-2022 年）。共确定了 21 项评分和/或分级系统。在这21个评分中，10个（47.6%）是临床评分，10个（47.6%）是基于放射学检查结果的评分；有一项研究的评分同时使用了临床和放射学检查结果。已确定的评分在不同的环境中使用。在 21 个评分中，2 个（9.52%）用于三级医疗机构的筛查；3 个（14.3%）用于确定 PeVD 诊断；8 个（38.1%）用于评估疾病严重程度；8 个（38.1%）用于衡量对治疗的反应。在评估疾病严重程度的八项评分中，四项（50.0%）评估盆腔静脉的扩张程度，四项（50%）评估回流的严重程度。结论本次范围界定审查发现了一系列针对 PeVD 的评分和分级系统。我们注意到在临床和放射学方面都缺乏一个有效的评分系统来筛查和评估疾病的严重程度。这是为患者筛查、适当转诊、症状严重程度评估和治疗反应评估开发有效的特定疾病评分系统迈出的重要的第一步。

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引用次数: 0

Impact of native iliac vein aspect ratio on initial clinical presentation and outcomes following stenting for symptomatic chronic iliofemoral venous obstruction 原生髂静脉长宽比对症状性慢性髂股静脉阻塞支架置入术后初期临床表现和疗效的影响

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-25 DOI: 10.1016/j.jvsv.2024.101900

<div><h3>Objective</h3><p>Venous stenting has become the first line of treatment for patients with symptomatic chronic iliofemoral venous obstruction (CIVO) in whom conservative therapy has failed. Intravascular ultrasound (IVUS) interrogation with the use of normal minimal luminal diameters or areas has become the standard to confirm the diagnosis and determine the adequacy of stenting. However, the aspect ratio (ratio between the maximal and minimal luminal diameters) has also been put forth as a possible metric for determining stent adequacy. This study explores the utility of the native iliac vein and stent aspect ratios in determining the initial presentation and outcomes after stenting.</p></div><div><h3>Methods</h3><p>A retrospective analysis of contemporaneously entered data from patients who underwent stenting for quality of life (QoL)-impairing clinical manifestations of CIVO for whom conservative therapy had failed formed the study cohort. The limbs were grouped into three at the time of intervention using the IVUS-determined native vein aspect ratio: group I, those with a ratio of ≤1.4; group II, those with a ratio of 1.41 to 1.99; and group III, those with a ratio of ≥2. The characteristics appraised initially and after stenting included the venous clinical severity score, grade of swelling (GOS), visual analog scale (VAS) for pain score, and the CIVIQ-20 QoL score. Analysis of variance and paired and unpaired <em>t</em> tests were used for comparison of clinical and QoL variables, and Kaplan-Meier analysis was used to evaluate stent patency, with the log-rank test used to discriminate between different curves.</p></div><div><h3>Results</h3><p>There were a total of 236 limbs (236 patients). The median age for the entire cohort was 62 years (range, 16-92 years). There were 161 women in the study, and left laterality was more common (137 limbs). Post-thrombotic obstruction was noted in 201 limbs (86%). The median body mass index was 36 kg/m<sup>2</sup>. There were 54 (23%), 64 (27%), and 118 (50%) limbs in groups I, II, and III, respectively. The median follow-up was 65 months. For the entire cohort, after stenting, the venous clinical severity score improved from 6 to 4 (<em>P</em> < .0001) at 3 months and remained at 4 at 6 months (<em>P</em> < .0001), 12 months (<em>P</em> < .0001), and 24 months (<em>P</em> < .0001). The GOS for the entire cohort improved from 3 to 1 (<em>P</em> < .0001) at 3 months and remained at 1 at 6 months (<em>P</em> < .0001), 12 months (<em>P</em> < .0001), and 24 months (<em>P</em> < .0001). The VAS for pain score for the entire cohort improved from 7 to 0 (<em>P</em> < .0001) at 3 months, increased to 2 (<em>P</em> < .0001) at 6 months, and remained at 2 (<em>P</em> < .0001) at 12 months. At 24 months, the VAS for pain score worsened to 3 (<em>P</em> < .0001). For the entire cohort, the CIVIQ-20 score improved from 62 to 40 (<em>P</em> < .0001). There was no differen

目的静脉支架植入术已成为保守治疗无效的无症状慢性髂股静脉阻塞（CIVO）患者的一线治疗方法。使用正常最小管腔直径或面积进行血管内超声（IVUS）检查已成为确诊和确定支架植入是否充分的标准。然而，长径比（最大管腔直径与最小管腔直径之比）也被认为是判断支架是否足够的一个可能指标。本研究探讨了原生髂静脉和支架长径比在确定支架术后的初始表现和预后方面的实用性。研究方法：对因生活质量（QoL）受影响的 CIVO 临床表现而接受支架术且保守治疗无效的患者的同期输入数据进行回顾性分析，形成研究队列。介入治疗时，根据IVUS确定的原生静脉长宽比将肢体分为三组：第一组，长宽比≤1.4；第二组，长宽比在1.41至1.99之间；第三组，长宽比≥2。最初和支架植入后的特征评估包括静脉临床严重程度评分、肿胀等级（GOS）、疼痛视觉模拟量表（VAS）评分和 CIVIQ-20 QoL 评分。方差分析、配对和非配对 t 检验用于比较临床和 QoL 变量，Kaplan-Meier 分析用于评估支架的通畅性，log-rank 检验用于区分不同的曲线。整个组群的中位年龄为 62 岁（16-92 岁）。研究中有 161 名女性，左侧肢体更常见（137 例）。血栓后阻塞的肢体有 201 例（86%）。体重指数中位数为 36 kg/m2。I 组、II 组和 III 组分别有 54 条（23%）、64 条（27%）和 118 条（50%）肢体。中位随访时间为 65 个月。就整个组别而言，支架植入术后，静脉临床严重程度评分在 3 个月时从 6 分降至 4 分（P < .0001），在 6 个月（P < .0001）、12 个月（P < .0001）和 24 个月（P < .0001）时仍为 4 分。整个组群的 GOS 在 3 个月时从 3 分降至 1 分（P < .0001），并在 6 个月（P < .0001）、12 个月（P < .0001）和 24 个月（P < .0001）时保持在 1 分。整个组群的疼痛 VAS 评分在 3 个月时从 7 分降至 0 分（P < .0001），在 6 个月时升至 2 分（P < .0001），在 12 个月时保持在 2 分（P < .0001）。24 个月时，VAS 疼痛评分恶化为 3（P < .0001）。整个组群的 CIVIQ-20 评分从 62 分提高到 40 分（P < .0001）。在基线或干预后 6、12 和 24 个月，两组的 GOS、VAS 疼痛评分或 CIVIQ-20 评分均无差异。60 个月时，I 组的主要支架通畅率为 89%，II 组为 80%，III 组为 75%（P = .85）。I 组的主要辅助支架通畅率为 100%，II 组为 98%，III 组为 98%（P = .5）。II组和III组的二次通畅率为100%（P = .5）。结论原生静脉长宽比似乎并不决定最初的临床表现或 QoL，也不影响 CIVO 支架置入术后的临床或 QoL 结果。支架术后，没有患者的纵横比为2，97%的患者纵横比≤1.4，其余3%的患者纵横比为1.41至1.99。IVUS确定的最小横截面管腔面积而非纵横比应用于确诊CIVO和评估支架植入的充分性。

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引用次数: 0

Safety and efficacy of endovenous ablation in patients with a history of deep vein thrombosis 静脉内消融术对有深静脉血栓病史患者的安全性和有效性

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-25 DOI: 10.1016/j.jvsv.2024.101898

<div><h3>Objective</h3><p>Endovenous ablation is the standard of care for patients with symptomatic superficial venous insufficiency. For patients with a history of deep vein thrombosis (DVT), concern exists for an increased risk of postprocedural complications, particularly venous thromboembolism. The objective of this study was to evaluate the safety and efficacy of endovenous thermal ablation in patients with a history of DVT.</p></div><div><h3>Methods</h3><p>The national Vascular Quality Initiative Varicose Vein Registry was queried for superficial venous procedures performed from January 2014 to July 2021. Limbs treated with radiofrequency or laser ablation were compared between patients with and without a DVT history. The primary safety end point was incident DVT or endothermal heat-induced thrombosis (EHIT) II-IV in the treated limb at <3 months of follow-up. The secondary safety end points included any proximal thrombus extension (ie, EHIT I-IV), major bleeding, hematoma, pulmonary embolism, and death due to the procedure. The primary efficacy end point was technical failure (ie, recanalization at <1 week of follow-up). Secondary efficacy end points included the risk of recanalization over time and the postprocedural change in quality-of-life measures. Outcomes stratified by preoperative use of anticoagulation (AC) were also compared among those with prior DVT.</p></div><div><h3>Results</h3><p>Among 33,892 endovenous thermal ablations performed on 23,572 individual patients aged 13 to 90 years, 1698 patients (7.2%) had a history of DVT. Patients with prior DVT were older (<em>P</em> < .001), had a higher body mass index (<em>P</em> < .001), were more likely to be male at birth (<em>P</em> < .001) and Black/African American (<em>P</em> < .001), and had greater CEAP classifications (<em>P</em> < .001). A history of DVT conferred a higher risk of new DVT (1.4% vs 0.8%; <em>P</em> = .03), proximal thrombus extension (2.3% vs 1.6%; <em>P</em> = .045), and bleeding (0.2% vs 0.04%; <em>P</em> = .03). EHIT II-IV, pulmonary embolism, and hematoma risk did not differ by DVT history (<em>P</em> = NS). No deaths from treatment occurred in either group. Continuing preoperative AC in patients with prior DVT did not change the risk of any complications after endovenous ablation (<em>P</em> = NS) but did confer an increased hematoma risk among all endovenous thermal ablations and surgeries (<em>P</em> = .001). Technical failure was similar between groups (2.0% vs 1.2%; <em>P</em> = .07), although a history of DVT conferred an increased recanalization risk over time (hazard ratio, 1.90; 95% confidence interval, 1.46, 2.46; <em>P</em> < .001). The groups had comparable improvements in postprocedural venous clinical severity scores and Heaviness, Aching, Swelling, Throbbing, and Itching scores (<em>P</em> = NS).</p></div><div><h3>Conclusions</h3><p>Endovenous thermal ablation for patients with a history of DVT was effective. However,

目的静脉内消融术是治疗症状性浅静脉功能不全患者的标准方法。对于有深静脉血栓（DVT）病史的患者来说，担心术后并发症（尤其是静脉血栓栓塞）的风险会增加。本研究的目的是评估静脉内热消融术对有深静脉血栓形成病史患者的安全性和有效性。方法查询了国家血管质量倡议静脉曲张注册中心在 2014 年 1 月至 2021 年 7 月期间进行的浅静脉手术。对有深静脉血栓病史和无深静脉血栓病史的患者采用射频或激光消融术治疗的肢体进行了比较。主要安全终点是随访3个月时，接受治疗的肢体发生深静脉血栓或内热诱发血栓（EHIT）II-IV。次要安全性终点包括任何近端血栓扩展（即 EHIT I-IV）、大出血、血肿、肺栓塞以及手术导致的死亡。主要疗效终点是技术失败（即随访 1 周时的再闭塞）。次要疗效终点包括随着时间推移再闭塞的风险以及术后生活质量的变化。结果在为23572名年龄在13至90岁之间的患者实施的33892例静脉腔内热消融术中，有1698名患者（7.2%）有深静脉血栓病史。有深静脉血栓病史的患者年龄更大（P < .001），体重指数更高（P < .001），出生时更可能是男性（P < .001）和黑人/非洲裔美国人（P < .001），CEAP 分级更高（P < .001）。有深静脉血栓病史者发生新的深静脉血栓（1.4% vs 0.8%；P = .03）、近端血栓扩展（2.3% vs 1.6%；P = .045）和出血（0.2% vs 0.04%；P = .03）的风险较高。EHIT II-IV、肺栓塞和血肿风险在深静脉血栓史上没有差异（P = NS）。两组均无治疗死亡病例。既往有深静脉血栓的患者术前继续使用 AC 不会改变静脉腔内消融术后的并发症风险（P = NS），但会增加所有静脉腔内热消融术和手术中的血肿风险（P = .001）。两组的技术失败率相似（2.0% vs 1.2%；P = .07），但有深静脉血栓病史的患者随着时间的推移再血栓形成的风险增加（危险比，1.90；95% 置信区间，1.46, 2.46；P < .001）。两组患者术后静脉临床严重程度评分和沉重感、疼痛感、肿胀感、刺痛感和瘙痒感评分的改善程度相当（P = NS）。有深静脉血栓病史的患者接受静脉腔内热消融治疗效果显著，但对深静脉血栓风险升高（尽管仍然很低）的患者进行适当的咨询至关重要。应根据具体情况决定术前继续还是暂停静脉热消融。

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引用次数: 0

Single-session catheter-directed lysis using adjunctive clot fragmentation with power pulse spray only is a fast, safe, and effective option for acute pulmonary embolism 仅使用功率脉冲喷射辅助血块破碎的单次导管定向溶栓术是治疗急性肺栓塞的快速、安全和有效的选择

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-25 DOI: 10.1016/j.jvsv.2024.101899

Laurencia Villalba MD, FRACS, FACP , Raeed Deen MD, MMedStats , Brendan Tonson-Older MChD, PhD , Cartan Costello MB, BCD, BAO, FCICM

Objective

Single-session, catheter-directed thrombolysis (CDT) with adjunctive power pulse spray (PPS) only, without thrombectomy, was evaluated for its safety and effectiveness. We performed a single-center, retrospective analysis of prospectively collected data.

Methods

Patients with high-risk or intermediate-risk pulmonary embolism (PE) who met the inclusion criteria and underwent a single session of CDT-PPS were included in the study. The primary outcomes assessed were technical and clinical success and major adverse events. Secondary outcomes included effectiveness based on pre- and postintervention clinical examination, radiographic findings, and reversal of right ventricular dysfunction at 48 hours and 4 weeks after discharge on echocardiography and computed tomography pulmonary angiography. The length of stay in the intensive care unit and overall admission were also analyzed. A return to premorbid exercise tolerance was evaluated at 12 months after the procedure.

Results

Between May 2016 and January 2023, 104 patients at the Wollongong Hospital were diagnosed with high- or intermediate-risk PE and underwent CDT-PPS. Of the 104 patients, 49 (47%) were considered to have high-risk PE and 55 (53%) intermediate-risk PE. Eleven patients (11%) had absolute contraindications and 49 patients (47%) had relative contraindications to systemic thrombolysis. Technical success was achieved in 102 patients (98%). Survival was 99% at 48 hours, 96% at 4 weeks, and 91% at 12 months. At 4 weeks, echocardiography showed 98% of patients had no evidence of right heart dysfunction, and computed tomography pulmonary angiography showed complete resolution of PE in 72%. There were no major adverse events at 48 hours. The median intensive care unit length of stay was 1 day, and the overall length of stay was 6 days. At 12 months, 96% had returned to their premorbid status.

Conclusions

The CDT-PPS technique is fast, safe, and effective in the treatment of high- and intermediate-risk PE, even in patients with a high bleeding risk, and should be considered as first-line management when the skills and resources are available. Further multicenter prospective studies are needed to corroborate these results.

目的评估单次导管引导溶栓疗法（CDT）的安全性和有效性，该疗法仅辅助动力脉冲喷射（PPS），不进行血栓切除术。我们对前瞻性收集的数据进行了单中心回顾性分析。方法研究纳入了符合纳入标准并接受了单次 CDT-PPS 治疗的高危或中危肺栓塞（PE）患者。评估的主要结果是技术和临床成功率以及主要不良事件。次要结果包括干预前后临床检查的有效性、放射学检查结果以及出院 48 小时和 4 周后超声心动图和计算机断层扫描肺血管造影显示的右心室功能障碍逆转情况。此外，还对重症监护室的住院时间和整个入院时间进行了分析。结果在2016年5月至2023年1月期间，卧龙岗医院有104名患者被诊断为高危或中危PE，并接受了CDT-PPS治疗。在 104 名患者中，49 人（47%）被认为患有高危 PE，55 人（53%）被认为患有中危 PE。11名患者（11%）有全身溶栓的绝对禁忌症，49名患者（47%）有相对禁忌症。102名患者（98%）获得了技术成功。48小时存活率为99%，4周存活率为96%，12个月存活率为91%。4周时，超声心动图显示98%的患者没有右心功能不全的迹象，计算机断层扫描肺血管造影显示72%的患者PE完全消退。48 小时内未发生重大不良事件。重症监护室的中位住院时间为1天，总住院时间为6天。结论 CDT-PPS 技术在治疗高危和中危 PE 方面快速、安全、有效，即使是出血风险较高的患者也不例外，在技术和资源允许的情况下，应将其视为一线治疗方法。需要进一步的多中心前瞻性研究来证实这些结果。

{"title":"Single-session catheter-directed lysis using adjunctive clot fragmentation with power pulse spray only is a fast, safe, and effective option for acute pulmonary embolism","authors":"Laurencia Villalba MD, FRACS, FACP , Raeed Deen MD, MMedStats , Brendan Tonson-Older MChD, PhD , Cartan Costello MB, BCD, BAO, FCICM","doi":"10.1016/j.jvsv.2024.101899","DOIUrl":"10.1016/j.jvsv.2024.101899","url":null,"abstract":"<div><h3>Objective</h3><p>Single-session, catheter-directed thrombolysis (CDT) with adjunctive power pulse spray (PPS) only, without thrombectomy, was evaluated for its safety and effectiveness. We performed a single-center, retrospective analysis of prospectively collected data.</p></div><div><h3>Methods</h3><p>Patients with high-risk or intermediate-risk pulmonary embolism (PE) who met the inclusion criteria and underwent a single session of CDT-PPS were included in the study. The primary outcomes assessed were technical and clinical success and major adverse events. Secondary outcomes included effectiveness based on pre- and postintervention clinical examination, radiographic findings, and reversal of right ventricular dysfunction at 48 hours and 4 weeks after discharge on echocardiography and computed tomography pulmonary angiography. The length of stay in the intensive care unit and overall admission were also analyzed. A return to premorbid exercise tolerance was evaluated at 12 months after the procedure.</p></div><div><h3>Results</h3><p>Between May 2016 and January 2023, 104 patients at the Wollongong Hospital were diagnosed with high- or intermediate-risk PE and underwent CDT-PPS. Of the 104 patients, 49 (47%) were considered to have high-risk PE and 55 (53%) intermediate-risk PE. Eleven patients (11%) had absolute contraindications and 49 patients (47%) had relative contraindications to systemic thrombolysis. Technical success was achieved in 102 patients (98%). Survival was 99% at 48 hours, 96% at 4 weeks, and 91% at 12 months. At 4 weeks, echocardiography showed 98% of patients had no evidence of right heart dysfunction, and computed tomography pulmonary angiography showed complete resolution of PE in 72%. There were no major adverse events at 48 hours. The median intensive care unit length of stay was 1 day, and the overall length of stay was 6 days. At 12 months, 96% had returned to their premorbid status.</p></div><div><h3>Conclusions</h3><p>The CDT-PPS technique is fast, safe, and effective in the treatment of high- and intermediate-risk PE, even in patients with a high bleeding risk, and should be considered as first-line management when the skills and resources are available. Further multicenter prospective studies are needed to corroborate these results.</p></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"12 4","pages":"Article 101899"},"PeriodicalIF":3.2,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213333X24002178/pdfft?md5=6df6f1bf93022df4069ea44d2c1aca66&pid=1-s2.0-S2213333X24002178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Overlapping lockup lymphovenous anastomosis: Responding to comments by Depypere et al 重叠锁定淋巴管吻合术：回应 Depypere 等人的评论

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-22 DOI: 10.1016/j.jvsv.2024.101847

Youmao Zheng BA , Liqi Yi BA , Cheng Wang BA , Shilin Gu BA , Chong Liu MD

引用次数: 0

The value of the dermal rim sign on nonenhanced magnetic resonance imaging for predicting dermal backflow in patients with primary lower extremity lymphedema 非增强核磁共振成像上的真皮边缘标志对原发性下肢淋巴水肿患者真皮回流的预测价值。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-16 DOI: 10.1016/j.jvsv.2024.101890

Purpose

The dermal rim sign (DRS) on nonenhanced magnetic resonance imaging has been shown to predict dermal backflow (DBF) in patients with secondary upper limb lymphedema. However, whether the DRS has the same effects on primary lower extremity lymphedema (PLEL) has not been clearly reported. Therefore, this study aimed to explore whether the DRS can be used to diagnose DBF on lymphoscintigraphy in patients with PLEL.

Methods

A total of 94 patients who were diagnosed with PLEL were recruited for this retrospective study from January 2022 to December 2023. All the patients were divided into two groups according to the lymphoscintigraphy findings: no DBF and DBF. The magnetic resonance imaging data of the two groups were recorded and statistically compared for the following indicators: range of lymphedema involvement (left, right, whole lower limbs, only thigh, only calf and ankle), signs of lymphedema (notable thickening of skin, parallel line sign, grid sign, honeycomb sign, band sign, lymph lake sign, crescent sign, DRS), and lymphedema measurement (skin thickness, band width). The DRS is characterized by notable thickening of the skin plus the grid sign and/or honeycomb sign, plus the band sign.

Results

The following statistically significant differences in the following indicators were found between the two groups (P < .05): notable skin thickening, parallel line sign, grid sign, honeycomb sign, band sign, DRS, skin thickness, and band width. The sensitivity, specificity, and accuracy for predicting for DBF with the DRS was 82%, 64%, and 77%, respectively.

Conclusions

This study confirmed good consistency between the DRS and DBF from the perspective of imaging. This tool is suitable for children, adolescents, and patients with contraindications to lymphoscintigraphy. The DRS has important value in assessing the severity of PLEL. The DRS is suggested for the clinical use of combined surgical treatment of PLEL.

目的非增强磁共振成像上的真皮边缘征（DRS）已被证明可预测继发性上肢淋巴水肿患者的真皮回流（DBF）。然而，DRS是否对原发性下肢淋巴水肿（PLEL）具有同样的作用还没有明确的报道。因此，本研究旨在探讨 DRS 是否可用于诊断 PLEL 患者淋巴窥镜图上的 DBF。根据淋巴管造影结果将所有患者分为两组：无 DBF 组和 DBF 组。记录两组患者的磁共振成像数据，并对以下指标进行统计学比较：淋巴水肿累及范围（左、右、整个下肢、仅大腿、仅小腿和踝关节）、淋巴水肿体征（皮肤明显增厚、平行线征、网格征、蜂窝征、带征、淋巴湖征、新月征、DRS）和淋巴水肿测量（皮肤厚度、带宽）。DRS的特征是皮肤明显增厚，加上网格状标志和/或蜂窝状标志，再加上带状标志。结果发现两组患者在以下指标上差异有统计学意义（P <.05）：皮肤明显增厚、平行线标志、网格状标志、蜂窝状标志、带状标志、DRS、皮肤厚度和带宽。使用 DRS 预测 DBF 的敏感性、特异性和准确性分别为 82%、64% 和 77%。该工具适用于儿童、青少年和有淋巴管造影禁忌症的患者。DRS 在评估 PLEL 的严重程度方面具有重要价值。建议将 DRS 用于 PLEL 的联合手术治疗。

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引用次数: 0

Longitudinal assessment of health-related quality of life and clinical outcomes with at home advanced pneumatic compression treatment of lower extremity lymphedema 在家高级气压疗法治疗下肢淋巴水肿的健康相关生活质量和临床疗效纵向评估。

IF 3.2 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2024-04-16 DOI: 10.1016/j.jvsv.2024.101892

Frank T. Padberg Jr. MD , Areck Ucuzian MD, PhD , Hasan Dosluoglu MD , Glenn Jacobowitz MD , Thomas F. O'Donnell MD

<div><h3>Objective</h3><p>This prospective, longitudinal, pragmatic study describes at home treatment with a proprietary advanced pneumatic compression device (APCD) for patients with lower extremity lymphedema (LED).</p></div><div><h3>Methods</h3><p>Following institutiona review board approval, four participating Veterans Affairs centers enrolled LED patients from 2016 to 2022. The primary outcome measures were health-related quality of life (HR-QoL) questionnaires (lymphedema quality of life-leg and the generic SF-36v2) obtained at baseline and 12, 24, and 52 weeks. The secondary outcome measures were limb circumference, cellulitis events, skin quality, and compliance with APCD and other compression therapies.</p></div><div><h3>Results</h3><p>Because a portion of the trial was conducted during the coronavirus disease 2019 pandemic, 179 patients had 52 weeks of follow-up, and 143 had complete measurements at all time points. The baseline characteristics were a mean age of 66.9 ± 10.8 years, 91% were men, and the mean body mass index was 33.8 ± 6.9 kg/m<sup>2</sup>. LED was bilateral in 92.2% of the patients. Chronic venous insufficiency or phlebolymphedema was the most common etiology of LED (112 patients; 62.6%), followed by trauma or surgery (20 patients; 11.2%). Cancer treatment as a cause was low (4 patients; 2.3%). Patients were classified as having International Society for Lymphology (ISL) stage I (68.4%), II (27.6%), or III (4.1%). Of the primary outcome measures, significant improvements were observed in all lymphedema quality of life-leg domains of function, appearance, symptoms, and emotion and the overall score after 12 weeks of treatment (<em>P</em> < .0001) and through 52 weeks of follow-up. The SF-36v2 demonstrated significant improvement in three domains at 12 weeks and in the six domains of physical function, bodily pain, physical component (<em>P</em> < .0001), social functioning (<em>P</em> = .0181), role-physical (<em>P</em> < .0005), and mental health (<em>P</em> < .0334) at 52 weeks. An SF-36v2 score <40 indicates a substantial reduction in HR-QoL in LED patients compared with U.S. norms. Regarding the secondary outcome measures at 52 weeks, compared with baseline, the mean limb girth decreased by 1.4 cm (<em>P</em> < .0001). The maximal reduction in mean limb girth was 1.9 cm (6.0%) at 12 weeks in ISL stage II and III limbs. New episodes of cellulitis in patients with previous episodes (21.4% vs 6.1%, <em>P</em> = .001) were reduced. The 75% of patients with skin hyperpigmentation at baseline decreased to 40% (<em>P</em> < .01) at 52 weeks. At 52 weeks, compliance, defined as use for 5 to 7 days per week, was reported for the APCD by 72% and for elastic stockings by 74%.</p></div><div><h3>Conclusions</h3><p>This longitudinal study of Veterans Affairs patients with LED demonstrated improved generic and disease-specific HR-QoL through 52 weeks with at home use of an APCD. Limb girth, cellulitis episodes,

这项前瞻性、纵向、务实的研究介绍了使用专有的高级气动加压装置（APCD）对下肢淋巴水肿（LED）患者进行居家治疗的情况。方法在获得机构审查委员会的批准后，四个参与研究的退伍军人事务中心在 2016 年至 2022 年期间招募了 LED 患者。主要结局指标是在基线和 12、24 和 52 周进行的健康相关生活质量（HR-QoL）问卷调查（淋巴水肿生活质量-leg 和通用 SF-36v2）。次要结局指标为肢体周长、蜂窝织炎事件、皮肤质量以及对 APCD 和其他压力疗法的依从性。结果由于部分试验是在 2019 年冠状病毒疾病大流行期间进行的，因此有 179 名患者接受了 52 周的随访，其中 143 名患者在所有时间点都进行了完整的测量。基线特征为平均年龄（66.9 ± 10.8）岁，91%为男性，平均体重指数（33.8 ± 6.9 kg/m2）。92.2%的患者为双侧LED。慢性静脉功能不全或静脉性水肿是LED最常见的病因（112例患者，62.6%），其次是外伤或手术（20例患者，11.2%）。癌症治疗的病因较少（4 名患者；2.3%）。患者被分为国际淋巴学会（ISL）I期（68.4%）、II期（27.6%）或III期（4.1%）。在主要结果指标中，淋巴水肿患者在治疗 12 周后（P <.0001）和随访 52 周后，所有淋巴水肿生活质量--功能、外观、症状和情绪领域以及总分均有明显改善（P <.0001）。SF-36v2 在 12 周时显示三个领域有显著改善，在 52 周时显示身体功能、身体疼痛、身体组成部分（P <.0001）、社会功能（P = .0181）、角色-身体（P <.0005）和心理健康（P <.0334）六个领域有显著改善。与美国标准相比，SF-36v2 得分 40 表明 LED 患者的 HR-QoL 显著下降。关于 52 周时的次要结果测量，与基线相比，平均肢围减少了 1.4 厘米（P <.0001）。在12周时，ISL II期和III期患者肢体平均周长的最大降幅为1.9厘米（6.0%）。曾患蜂窝组织炎的患者新发蜂窝组织炎的比例（21.4% vs 6.1%，P = .001）有所降低。基线期75%的患者皮肤色素沉着率在52周时降至40%（P = .01）。52周时，72%的患者对APCD的依从性（定义为每周使用5至7天）和74%的患者对弹力袜的依从性（定义为每周使用5至7天）均有报告。结论这项针对退伍军人事务局LED患者的纵向研究表明，通过在家中使用APCD，52周后患者的一般和疾病特异性HR-QoL均有所改善。肢围、蜂窝组织炎发作次数和皮肤变色均有所减少，依从性极佳。

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引用次数: 0