Journal of vascular surgery. Venous and lymphatic disorders最新文献_第9页

Repair of a popliteal vein aneurysm following a torn meniscus 半月板撕裂后腘静脉动脉瘤的修复。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-11 DOI: 10.1016/j.jvsv.2025.102301

Jack Petroski BS , Raj Patel BS , Gurpreet Singh DO , Raghuram Gorti MD

引用次数: 0

A predictive model for early detection of concomitant pulmonary embolism in patients with deep vein thrombosis immediately upon hospital admission 深静脉血栓患者入院后立即并发肺栓塞的早期检测预测模型

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-08-05 DOI: 10.1016/j.jvsv.2025.102299

Maofeng Gong MD , Rui Jiang MD , Kang Guo MBBS , Xu He MD , Jianping Gu MBBS

Objective

To develop and validate a predictive model for the early identification of concomitant pulmonary embolism (PE) in patients with deep vein thrombosis (DVT) upon hospital admission.

Methods

We retrospectively collected data from a cohort of patients diagnosed with DVT, including baseline demographics, clinical characteristics, laboratory parameters, and imaging-based measurements of compression of the iliac vein to develop a predictive model. The least absolute shrinkage and selection operator regression, widely used in clinical decision-making algorithms for its ability to perform variable selection and regularization simultaneously, was used for variables selection. A multivariate logistic regression was then conducted to construct a predictive model. The model's discriminatory ability was assessed using the area under the curve. Calibration analysis and decision curve analysis were performed.

Results

Patients were randomly divided into a development dataset (69.8% [143 with PE and 130 without PE]) and a validation dataset (30.2% [63 with PE and 55 without PE]) for model construction and internal validation. Seven predictors, including female gender, hypertension, cardiovascular disease, fracture, age, D-dimer, and compression of the iliac vein percentage were identified by least absolute shrinkage and selection operator regression and finally incorporated into the nomogram. The model achieved an area under the curve of 0.727 (95% confidence interval, 0.667-0.787) in the training set, and 0.707 (95% confidence interval, 0.611-0.803) in the validation set. The model was well-calibrated, and decision curve analysis demonstrated a net benefit for predicting PE at threshold probabilities ranged between 18% and 80%.

Conclusions

A novel predictive model with strong calibration and discriminative power was developed for assessing concomitant PE risk in patients with DVT. This model may facilitate early estimating of PE probability before obtaining definitive CT angiography results and support timely management processes.

目的：建立并验证深静脉血栓形成（DVT）患者入院时高危合并肺栓塞（PE）的早期识别预测模型。材料和方法：我们回顾性收集了一组诊断为DVT的患者的数据，包括基线人口统计学、临床特征、实验室参数和基于成像的髂静脉压迫（CIV）测量，以建立预测模型。最小绝对收缩和选择算子（LASSO）回归因其同时进行变量选择和正则化的能力而广泛应用于临床决策算法，用于变量选择。然后进行多元逻辑回归，以构建nomogram。用曲线下面积（AUC）评价模型的判别能力。标定分析和决策曲线分析(DCA)。结果：将患者随机分为发展数据集（69.8%，143例PE， 130例未PE）和验证数据集（30.2%，63例PE， 55例未PE）进行模型构建和内部验证。通过LASSO回归确定女性性别、高血压、心血管疾病、骨折、年龄、d -二聚体和CIV百分比等7个预测因子，并将其纳入nomogram。该模型在训练集中的AUC为0.727 (95% CI, 0.667-0.787)，在测试集中的AUC为0.707 （95% CI, 0.611-0.803）。该模型经过了很好的校准，DCA证明了在阈值概率范围为18%到80%的情况下预测PE的净收益。结论：建立了一种新的预测模型，具有较强的校准和判别能力，可用于评估深静脉血栓患者合并PE的风险。该模型有助于在获得明确的CT结果之前对PE概率进行早期估计，并支持及时的管理过程。

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引用次数: 0

Rapid post exercise venous refilling time is an independent contributor to chronic venous insufficiency 快速运动后静脉补充时间是慢性静脉功能不全的独立因素。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-23 DOI: 10.1016/j.jvsv.2025.102292

Hossam Elbenawi MD , Atefeh Ghorbanzadeh MD , David Liedl RNP , Thom Rooke MD , Paul Wennberg MD , Robert McBane MD , Damon E. Houghton MD, MS

Background

Chronic venous insufficiency (CVI) results in complications such as pain, swelling, edema, skin changes, and ulcerations of the lower extremities. Valvular incompetence and venous obstruction are well-recognized contributors to CVI. Post-exercise venous refilling time (P-EVRT), the time to refill veins after calf muscle contractions during venous plethysmography study, is an understudied contributor to CVI.

Methods

In this cross-sectional study of 4755 patients who were evaluated with venous air plethysmography, 9510 lower limbs were categorized based on P-EVRT into two groups: rapid (<20 seconds; n = 5256) and normal (n = 4254).

Results

Rapid P-EVRT was associated with higher mean CEAP scores (3.2 vs 2.5; P < .001) and a higher prevalence of active/prior ulcers (11.6 vs 4.1%; P < .001). Univariable analysis showed that age, male sex, the severity of incompetence, obstruction, calf pump function, and rapid P-EVRT were all significantly associated with active/prior ulcers. After multivariable adjustment for these significant factors, rapid P-EVRT was an independent contributor to active/prior ulcers (odds ratio, 1.44; 95% confidence interval, 1.17-1.77). Among limbs without other venous pathology by plethysmography (incompetence, obstruction, reduced calf pump function), rapid P-EVRT remained significantly associated with higher mean CEAP scores (P < .001) and a higher prevalence of venous ulcers than limbs with normal P-EVRT (5.7% vs 2.7%; P = .001).

Conclusions

In this large contemporary study using venous air plethysmography, we demonstrate that rapid P-EVRT is an important and unique venous physiologic parameter that informs our understanding of the clinical severity of CVI.

背景：慢性静脉功能不全（CVI）可导致疼痛、肿胀、水肿、皮肤变化和下肢溃疡等并发症。瓣膜功能不全和静脉阻塞是公认的CVI的诱因。运动后静脉充盈时间（P-EVRT），即静脉体积描记研究中小腿肌肉收缩后静脉充盈的时间，是CVI的一个未被充分研究的因素。方法和结果：在这项横断面研究中，4,755例患者进行了静脉空气体积描记术评估，9,510例下肢根据运动后静脉再填充时间（P-EVRT）分为两组：快速组(< 20秒；N = 5256)和normal （N = 4254）。快速P-EVRT与较高的平均CEAP评分相关（3.2 vs 2.5）。结论：在这项使用静脉空气体积描记术的大型当代研究中，我们证明运动后快速静脉再填充是一个重要且独特的静脉生理参数，可以帮助我们了解CVI的临床严重程度。

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引用次数: 0

Robotic-assisted left renal vein transposition with distal gonadal vein anastomosis: A novel technique for dual venous drainage in nutcracker syndrome 机器人辅助左肾静脉转位与性腺远端静脉吻合：胡桃夹子综合征双静脉引流的新技术。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-17 DOI: 10.1016/j.jvsv.2025.102289

JinBin Xu MD, Sam Un Cheong MD, GengGuo Deng MD, Zifeng Xu MD, ZhanSen Huang MD, Yuedian Ye MD, Hua Wang MD, Weihao Liu MD, Xiaoming Li MD, Jiang Li MD, Qunxiong Huang MD, Tengcheng Li MD, Jinming Di MD

Objective

To evaluate the feasibility and outcomes of a novel robotic-assisted laparoscopic technique—Di's II robotic-assisted left renal vein (LRV) transposition with distal gonadal vein (GV) anastomosis—creating dual venous drainage for treating nutcracker syndrome (NCS).

Methods

Between December 2023 and October 2024, three male patients (median age, 14 years) with NCS underwent robotic-assisted LRV transposition using the Di's II technique. Key procedural innovations included selective occlusion of the infrarenal inferior vena cava (IVC) and LRV without right renal vein clamping, combined with distal GV anastomosis to enhance venous drainage. Operative parameters, including anastomosis time, blood loss, and postoperative outcomes, were analyzed retrospectively.

Results

All procedures were successfully completed robotically. Median total operative time was 145 minutes (range, 135-160 minutes), with LRV and GV anastomosis times of 25 minutes (range, 24-27 minutes). The median estimated blood loss was 40 mL (range, 30-50 mL). Postoperative imaging confirmed resolution of LRV compression, with pressure gradients reduced to ≤2.8 mm Hg. Symptoms (hematuria, proteinuria, and varicocele) resolved within 6 months, and no perioperative complications occurred during follow-up.

Conclusions

The Di's II technique represents a safe and effective minimally invasive approach for NCS, combining robotic precision with dual venous drainage to alleviate LRV hypertension and pelvic congestion. Preliminary outcomes demonstrate technical feasibility, a lower ischemia risk, and symptom resolution, supporting further validation in larger cohorts.

目的：评价机器人辅助腹腔镜下左肾静脉（LRV）移位与性腺远端静脉吻合双静脉引流治疗胡桃钳综合征（NCS）的可行性和效果。方法：在2023年12月至2024年10月期间，3名NCS男性患者（中位年龄：14岁）使用Di's II技术进行了机器人辅助的LRV转位。关键的手术创新包括选择性阻断肾下腔静脉（IVC）和LRV，不夹持右肾静脉，结合性腺远端静脉吻合术加强静脉引流。回顾性分析手术参数，包括吻合时间、出血量和术后结果。结果：所有手术均成功完成。中位总手术时间145分钟（范围135 ~ 160），LRV与性腺静脉吻合时间25分钟（范围24 ~ 27）。中位失血量为40 mL（范围：30-50）。术后影像学证实LRV压缩分辨率，压力梯度降至≤2.8 mmHg。症状（血尿、蛋白尿、精索静脉曲张）在6个月内消失，随访期间无围手术期并发症发生。结论：Di’s II技术是一种安全有效的微创治疗NCS的方法，结合机器人精度和双静脉引流来缓解LRV高血压和盆腔充血。初步结果显示技术可行性，缺血风险降低，症状缓解，支持在更大的队列中进一步验证。

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引用次数: 0

Pigmentation after foam or cryo-laser cryo-sclerotherapy for lower limb reticular veins: A within-patient randomized trial 泡沫或冷冻激光冷冻硬化治疗下肢网状静脉后的色素沉着：一项患者试验。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-11 DOI: 10.1016/j.jvsv.2025.102285

Anelise Rodrigues MD , Juliana Puggina MD, PhD , Viviane Santana da Silva BSc , Camilla Moreira Ribeiro PhD , Fabrício Rodrigues Santiago MD, PhD , Samantha Neves MD, PhD , Gabriel Henrique Simoni MS4 , Maria Fernanda Portugal MD, PhD , Eduardo Ramacciotti MD, PhD

Objective

Skin hyperpigmentation is a common complication after leg vein sclerotherapy and a primary concern for patients with cosmetic complaints. The aim of this study was to determine if cryo-laser cryo-sclerotherapy technique (CLaCS) presents a lower incidence and intensity pigmentation after procedure compared with 0.5% polidocanol foam sclerotherapy, 60 days after a single treatment of reticular veins.

Methods

This was an open-label, prospective, within-patient, randomized, active controlled, safety trial with blind evaluators. Interventions took place from August through September 2021, with a 2-month follow-up. Interventions were performed in a private clinic. Eligible patients were volunteers over 18 years old, with aesthetic discomfort related to bilateral lower limb reticular veins, similar length and distribution, with veins' internal diameter up to 2.2 mm in B-mode ultrasound. Patients underwent consecutive CLaCS treatment in one limb and 0.5% polidocanol foam in the contralateral limb on the same day. The primary outcome was the presence of post-procedure pigmentation in treated areas 60 days after a single treatment, determined through photo evaluation and objective measurement of skin color dissimilarity between the treated area and the adjacent skin, using a precision colorimeter. Patients’ aesthetic satisfaction improvement, vein diameter reduction, and minor/major adverse events were also assessed.

Results

Twenty-three women (46 limbs) were treated, and two were lost to follow-up. No significant statistical difference in the number of limbs that developed posttreatment pigmentation was found for both photo (7 CLaCS vs 5 foam; P = .8906) and colorimetric (9 CLaCS vs 13 foam; P = .1445) evaluations. The CLaCS group had significantly lower intensity of pigmentation in colorimetry (mean ΔE of 1.30 for CLaCS vs 1.44 for foam; P = .02735). No significant difference in veins’ diameter reduction was found. Both groups presented substantial improvement in patients’ satisfaction with their leg appearance.

Conclusions

Although no statistical difference was found regarding the number of limbs that developed hypercromia after treatment of the reticular veins, CLaCS resulted in a lower intensity of skin color dissimilarity, less microthrombi formation and drainage, less bruising and lower volume of sclerosant needed, without difference in diameter reduction rates, compared with polidocanol foam sclerotherapy. No major adverse events were reported.

重要性：皮肤色素沉着是腿部静脉硬化治疗后的常见并发症，也是美容投诉患者的主要关注点。目的：确定冷冻激光冷冻硬化治疗技术（CLaCS）在网状静脉单次治疗后60天，与0.5%聚多醇泡沫硬化治疗相比，是否出现了更低的发生率和强度的色素沉着。设计：开放标签，前瞻性，患者内，随机，主动对照，盲评价安全性试验。2021年8月至9月进行干预，随访两个月。环境：干预在一家私人诊所进行。对象：年龄在18岁以上，双侧下肢网状静脉美学不适，长度分布相似，b超静脉内径达2.2mm的志愿者。干预措施：患者在同一天接受单侧肢体连续CLaCS治疗，对侧肢体连续0.5%聚多醇泡沫治疗。主要结果和措施：主要结果是单次治疗后60天治疗区域是否存在术后色素沉着，通过照片评估和使用精密比色仪客观测量治疗区域与邻近皮肤之间的肤色差异来确定。患者的审美满意度改善、静脉内径缩小、轻微/严重不良事件也进行了评估。结果：治疗23例（46条肢体），2例失访。在照片（7个CLaCS vs 5个泡沫p=0.8906）和比色（9个CLaCS vs 13个泡沫p= 0.1445）评估中，出现治疗后色素沉着的肢体数量均无显著统计学差异。在比色法中，CLaCS组的色素沉着强度显著降低（CLaCS组的平均ΔE为1.30，而泡沫组为1.44,p=0.02735）。两组间静脉直径减小无显著性差异。两组患者对腿部外观的满意度均有显著改善。结论及相关性：虽然网静脉治疗后发生高血肿的肢体数量没有统计学差异，但与聚多醇泡沫硬化治疗相比，CLaCS导致皮肤颜色差异强度更低，微血栓形成更少，所需硬化剂体积更小，直径缩小率没有差异。无重大不良事件报告。试验注册：ReBEC: RBR-88mcd4c https://ensaiosclinicos.gov.br/rg/RBR-88mcd4c UTN U1111-1265-8900。

{"title":"Pigmentation after foam or cryo-laser cryo-sclerotherapy for lower limb reticular veins: A within-patient randomized trial","authors":"Anelise Rodrigues MD , Juliana Puggina MD, PhD , Viviane Santana da Silva BSc , Camilla Moreira Ribeiro PhD , Fabrício Rodrigues Santiago MD, PhD , Samantha Neves MD, PhD , Gabriel Henrique Simoni MS4 , Maria Fernanda Portugal MD, PhD , Eduardo Ramacciotti MD, PhD","doi":"10.1016/j.jvsv.2025.102285","DOIUrl":"10.1016/j.jvsv.2025.102285","url":null,"abstract":"<div><h3>Objective</h3><div>Skin hyperpigmentation is a common complication after leg vein sclerotherapy and a primary concern for patients with cosmetic complaints. The aim of this study was to determine if cryo-laser cryo-sclerotherapy technique (CLaCS) presents a lower incidence and intensity pigmentation after procedure compared with 0.5% polidocanol foam sclerotherapy, 60 days after a single treatment of reticular veins.</div></div><div><h3>Methods</h3><div>This was an open-label, prospective, within-patient, randomized, active controlled, safety trial with blind evaluators. Interventions took place from August through September 2021, with a 2-month follow-up. Interventions were performed in a private clinic. Eligible patients were volunteers over 18 years old, with aesthetic discomfort related to bilateral lower limb reticular veins, similar length and distribution, with veins' internal diameter up to 2.2 mm in B-mode ultrasound. Patients underwent consecutive CLaCS treatment in one limb and 0.5% polidocanol foam in the contralateral limb on the same day. The primary outcome was the presence of post-procedure pigmentation in treated areas 60 days after a single treatment, determined through photo evaluation and objective measurement of skin color dissimilarity between the treated area and the adjacent skin, using a precision colorimeter. Patients’ aesthetic satisfaction improvement, vein diameter reduction, and minor/major adverse events were also assessed.</div></div><div><h3>Results</h3><div>Twenty-three women (46 limbs) were treated, and two were lost to follow-up. No significant statistical difference in the number of limbs that developed posttreatment pigmentation was found for both photo (7 CLaCS vs 5 foam; <em>P</em> = .8906) and colorimetric (9 CLaCS vs 13 foam; <em>P</em> = .1445) evaluations. The CLaCS group had significantly lower intensity of pigmentation in colorimetry (mean ΔE of 1.30 for CLaCS vs 1.44 for foam; <em>P</em> = .02735). No significant difference in veins’ diameter reduction was found. Both groups presented substantial improvement in patients’ satisfaction with their leg appearance.</div></div><div><h3>Conclusions</h3><div>Although no statistical difference was found regarding the number of limbs that developed hypercromia after treatment of the reticular veins, CLaCS resulted in a lower intensity of skin color dissimilarity, less microthrombi formation and drainage, less bruising and lower volume of sclerosant needed, without difference in diameter reduction rates, compared with polidocanol foam sclerotherapy. No major adverse events were reported.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 6","pages":"Article 102285"},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transvaginal ultrasound approach for diagnosing pelvic venous disorders 经阴道超声诊断盆腔静脉疾病。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-11 DOI: 10.1016/j.jvsv.2025.102286

Francine Freitas Fernandes MD , Joana Storino MD, MSc , Fanilda Souto Barros MD , Manuella Barreto Silva MD , Nathalia Cardoso Oliveira MD, MSc , Isabela Rodrigues Tavares MD, MSc

Background

This article presents a detailed, step-by-step protocol for performing transvaginal ultrasound (TVUS) examination to assess the pelvic veins, emphasizing its importance in the diagnosis of pelvic venous disorders (PeVDs).

Methods

The protocol outlines the anatomical landmarks, scanning techniques, and key ultrasound findings associated with PeVDs. It also provides practical recommendations for optimizing image acquisition and interpretation. TVUS examination provides enhanced visualization of pelvic venous structures, with a particular emphasis on the pelvic venous plexuses, tributaries of the internal iliac vein, and gonadal veins.

Results

This protocol is designed to assist practitioners in the accurate assessment of PeVDs by guiding the evaluation of the periuterine, perivaginal, gonadal, and iliac veins. It also includes techniques for identifying venous reflux and post-thrombotic changes. The advantages, limitations, and specific considerations for obtaining and interpreting TVUS images are also discussed.

Conclusions

The proposed standardized TVUS protocol offers a practical and reproducible approach to evaluating pelvic venous anatomy and function. It enhances diagnostic accuracy in PeVDs, particularly in detecting venous reflux and post-thrombotic changes, and supports more effective clinical decision-making.

这篇文章提出了一个详细的，一步一步的协议执行经阴道超声（TVUS）评估盆腔静脉，强调其在盆腔静脉疾病（PeVD）诊断的重要性。该方案概述了与PeVD相关的解剖标志、扫描技术和关键超声结果。它还为优化图像采集和解释提供了实用的建议。概述：TVUS增强了盆腔静脉结构的可视化，特别强调盆腔静脉丛、髂内静脉分支和性腺静脉。该方案旨在通过指导子宫周围、阴道周围、性腺和髂静脉的评估，帮助医生准确评估PeVD。它还包括识别静脉回流和血栓后变化的技术。还讨论了获取和解释TVUS图像的优点、局限性和具体注意事项。结论：该方案的整合使临床医生能够通过系统和标准化的TVUS方法提高PeVD的诊断准确性。此外，在评估PeVD时提高跨学科意识和使用TVUS可能会显著改善患者管理结果。

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引用次数: 0

Predictive factors for complete recovery of post-thrombotic syndrome 6 months after venous recanalization 静脉再通6个月后血栓形成综合征完全恢复的预测因素。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-11 DOI: 10.1016/j.jvsv.2025.102287

Lina Khider MD, PhD , Costantino Del Giudice MD, PhD , Nicolas Gendron MD, PhD , Chloé Gobert MD , Benjamin Planquette MD, PhD , Marc Al Ahmar MD , Guillaume Goudot MD, PhD , Emmanuel Messas MD, PhD , Marc Sapoval MD, PhD , Tristan Mirault MD, PhD

Objective

Endovascular recanalization is considered for severely symptomatic patients with post-thrombotic syndrome (PTS) to alleviate symptoms. However, data on complete recovery and its predictors remain limited. This study aimed to assess persistent PTS 6 months after venous recanalization and identify predictive factors.

Design

Single-center retrospective outcome-oriented cohort study.

Methods

We reviewed electronic medical records of patients referred for endovascular venous recanalization between January 1, 2015, and September 30, 2019. Inclusion criteria were PTS defined by a Villalta score of ≥5 or a leg ulcer ≥6 months after a deep vein thrombosis episode. Complete PTS recovery was defined as a Villalta score of <5.

Results

Sixty-seven patients (median age, 40 years; interquartile range, 32-51 years; 78% women; 18% obese) were included. The initial Villalta score was 10 (interquartile range, 7-14). At 6 months, primary and secondary patency rates were 75% and 81%, respectively. Complete recovery was observed in 67% of patients. Multivariate analysis identified the initial Villalta score (odds ratio, 1.36; 95% confidence interval, 1.12-1.65; P = .002) and femoral vein obstruction (odds ratio, 3.79; 95% confidence interval, 1.06-13.61; P = .041) as predictors of persistent PTS, whereas long-term anticoagulation was not significant.

Conclusions

Endovascular recanalization achieved PTS resolution in two-thirds of patients at 6 months, particularly in those with a low initial Villalta score and no femoral vein obstruction. A risk score incorporating these factors may aid clinicians in patient counseling regarding the expected benefits of the procedure.

目的：血管内再通术被认为可以缓解严重症状的血栓后综合征（PTS）患者的症状。然而，关于完全恢复及其预测指标的数据仍然有限。本研究旨在评估静脉再通术后6个月的持续性PTS，并确定预测因素。设计：单中心回顾性结果导向队列研究。方法：回顾2015年1月1日至2019年9月30日进行血管内静脉再通术的患者的电子病历。纳入标准是由Villalta评分≥5分或深静脉血栓（DVT）发作后至少6个月出现腿部溃疡定义的PTS。完全PTS恢复定义为Villalta评分< 5。结果：纳入67例患者（中位年龄：40岁[IQR 32-51]， 78%为女性，18%为肥胖）。比利亚尔塔队最初的比分是10分[IQR 7-14]。6个月时，原发性和继发性通畅率分别为75%和81%。67%的患者完全康复。多因素分析发现，初始Villalta评分（OR 1.36, 95% CI 1.12-1.65, p = 0.002）和股静脉阻塞（OR 3.79, 95% CI 1.06-13.61, p = 0.041）是持续性PTS的预测因子，而长期抗凝治疗则无显著意义。结论：三分之二的患者在6个月时实现了血管内再通治疗，特别是那些初始Villalta评分较低且没有股静脉阻塞的患者。纳入这些因素的风险评分可以帮助临床医生就手术的预期益处对患者进行咨询。

{"title":"Predictive factors for complete recovery of post-thrombotic syndrome 6 months after venous recanalization","authors":"Lina Khider MD, PhD , Costantino Del Giudice MD, PhD , Nicolas Gendron MD, PhD , Chloé Gobert MD , Benjamin Planquette MD, PhD , Marc Al Ahmar MD , Guillaume Goudot MD, PhD , Emmanuel Messas MD, PhD , Marc Sapoval MD, PhD , Tristan Mirault MD, PhD","doi":"10.1016/j.jvsv.2025.102287","DOIUrl":"10.1016/j.jvsv.2025.102287","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular recanalization is considered for severely symptomatic patients with post-thrombotic syndrome (PTS) to alleviate symptoms. However, data on complete recovery and its predictors remain limited. This study aimed to assess persistent PTS 6 months after venous recanalization and identify predictive factors.</div></div><div><h3>Design</h3><div>Single-center retrospective outcome-oriented cohort study.</div></div><div><h3>Methods</h3><div>We reviewed electronic medical records of patients referred for endovascular venous recanalization between January 1, 2015, and September 30, 2019. Inclusion criteria were PTS defined by a Villalta score of ≥5 or a leg ulcer ≥6 months after a deep vein thrombosis episode. Complete PTS recovery was defined as a Villalta score of <5.</div></div><div><h3>Results</h3><div>Sixty-seven patients (median age, 40 years; interquartile range, 32-51 years; 78% women; 18% obese) were included. The initial Villalta score was 10 (interquartile range, 7-14). At 6 months, primary and secondary patency rates were 75% and 81%, respectively. Complete recovery was observed in 67% of patients. Multivariate analysis identified the initial Villalta score (odds ratio, 1.36; 95% confidence interval, 1.12-1.65; <em>P</em> = .002) and femoral vein obstruction (odds ratio, 3.79; 95% confidence interval, 1.06-13.61; <em>P</em> = .041) as predictors of persistent PTS, whereas long-term anticoagulation was not significant.</div></div><div><h3>Conclusions</h3><div>Endovascular recanalization achieved PTS resolution in two-thirds of patients at 6 months, particularly in those with a low initial Villalta score and no femoral vein obstruction. A risk score incorporating these factors may aid clinicians in patient counseling regarding the expected benefits of the procedure.</div></div>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":"13 6","pages":"Article 102287"},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness and safety of sirolimus in the treatment of venous malformations: A meta-analysis of prospective studies 西罗莫司治疗静脉畸形的有效性和安全性：前瞻性研究的荟萃分析。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-07-05 DOI: 10.1016/j.jvsv.2025.102284

Guoyong Wang MD, Wei Lu MD, Yingjie Zhu MD, Chaonan Wang MD, PhD, Xiaonan Yang MD, PhD

Background

Venous malformations are prevalent vascular anomalies. Recent clinical studies have explored the use of sirolimus for these conditions, particularly in patients who are not candidates for, or have shown limited response to, traditional treatments such as sclerotherapy and surgery. This meta-analysis systematically evaluates the efficacy and safety of sirolimus in treating venous malformations.

Methods

We conducted searches in PubMed, Cochrane Library, Web of Science, and the Cochrane Database of Systematic Reviews until August 10, 2024. The quality of the included prospective studies (including both randomized and single-arm pre-post trials) was assessed using the Cochrane risk of bias tool. Statistical analyses were performed with Review Manager (Version 5.4).

Results

Our analysis included eight prospective studies involving 74 patients. Primary outcomes measured changes in the volume and size of the malformations. Secondary outcomes assessed were functional disability scores, hemoglobin levels, coagulation indices, transfusion requirements, patient quality of life, and radiologic responses. Sirolimus demonstrated significant therapeutic benefits, with an odds ratio of 0.02 (95% confidence interval, 0.00-0.08) across six studies evaluating dichotomous variables. Results for continuous variables were consistent. Sirolimus showed safety in short-to medium-term use, with reversible mild to moderate side effects such as oral ulcers and liver function abnormalities. No severe adverse events (grade 3-5) were reported.

Conclusions

Sirolimus is effective and safe for treating venous malformations, especially in patients unresponsive to conventional therapies. Future studies should explore long-term effects, optimal dosages, and administration techniques.

背景：静脉畸形是一种常见的血管异常。最近的临床研究探索了西罗莫司在这些疾病中的应用，特别是在不适合或对硬化疗法和手术等传统治疗反应有限的患者中。目的：本荟萃分析系统评价西罗莫司治疗静脉畸形的疗效和安全性。方法：截止到2024年8月10日，我们在PubMed、Cochrane Library、Web of Science和Cochrane Database of Systematic Reviews中进行了检索。使用Cochrane偏倚风险工具评估纳入的前瞻性研究（包括随机和单臂前后试验）的质量。使用Review Manager （Version 5.4）进行统计分析。结果：我们的分析纳入了8项前瞻性研究，涉及74例患者。主要结果测量畸形的体积和大小的变化。评估的次要结果是功能障碍评分、血红蛋白水平、凝血指数、输血要求、患者生活质量和放射反应。西罗莫司显示出显著的治疗效果，在6项评估二分类变量的研究中，比值比为0.02[0.00,0.08]。连续变量的结果一致。西罗莫司在中短期使用中表现出安全性，具有可逆性轻至中度副作用，如口腔溃疡和肝功能异常。无严重不良事件（3-5级）报告。结论：西罗莫司治疗静脉畸形安全有效，尤其适用于对常规治疗无反应的患者。未来的研究应该探索长期效果、最佳剂量和给药技术。

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引用次数: 0

Predictors of inferior vena cava filter retrieval in a population-based Canadian cohort 在以人群为基础的加拿大队列中，下腔静脉过滤器检索的预测因素。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-06-26 DOI: 10.1016/j.jvsv.2025.102283

Serena Ip BSc, BHSc , Konrad Salata MD, PhD , Jin Luo MSc , Charles de Mestral MDCM, PhD , Graham Roche-Nagle MD, MBA

Background

The objective of this study was to determine the predictors of inferior vena cava (IVC) filter retrieval in a contemporary North American cohort of patients who received an IVC filter.

Methods

A retrospective population-based cohort study was conducted using Ontario administrative health data. Physician service fee codes were used to identify all adults with an IVC filter placement from January 1, 2010, to December 31, 2019. The cumulative incidence of filter retrieval over time was calculated, accounting for death as a competing risk. Multivariable sub-distribution hazard regression models were constructed to quantify the association between covariates and the likelihood of filter retrieval.

Results

A total of 5617 people received an IVC filter during the study period. Median follow-up was 1.8 years (interquartile range, 0.2-5.4 years). The probability of filter retrieval plateaued under 40% with most retrievals (96%; n = 2049 of 2135) occurring within 1 year of placement. Filter placement in a teaching hospital (hazard ratio, 1.85; 95% confidence interval, 1.60-2.02), and placement after 2016 were associated with a greater likelihood of filter retrieval. Older age and greater comorbidity were associated with a lower likelihood of filter retrieval.

Conclusions

In this population-based study of IVC filter retrieval, less than 40% of filters were retrieved, mostly within 1 year of insertion. Better coordination and standardization of services responsible for follow-up of patients with IVC filters are needed.

背景：本研究的目的是确定当代北美接受下腔静脉过滤器的患者中下腔静脉（IVC）过滤器回收的预测因素。方法：采用安大略省行政卫生资料进行回顾性人群队列研究。2010年1月1日至2019年12月31日期间，使用医生服务收费代码来识别所有使用IVC过滤器的成年人。随着时间的推移，计算过滤器检索的累积发生率，将死亡作为竞争风险。构建多变量亚分布风险回归模型，量化协变量与滤波器检索可能性之间的关联。结果：在研究期间，共有5617人接受了IVC过滤器。中位随访时间为1.8年（四分位数间距为0.2 - 5.4年）。过滤器检索的概率稳定在40%以下，大多数检索，96% (N = 2049 / 2135)，发生在放置后1年内。在教学医院放置过滤器（HR 1.85, 95% CI 1.60, 2.02）和在2016年之后放置过滤器与更大的过滤器回收可能性相关。年龄越大，合并症越多，取滤器的可能性越低。结论：在这项以人群为基础的下腔静脉滤器检索研究中，不到40%的滤器被检索，大多数在插入后1年内。需要更好地协调和标准化负责IVC过滤器患者随访的服务。

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引用次数: 0

Comparison of clinical outcomes among patients with proximal versus isolated distal deep vein thrombosis: A systematic review and meta-analysis 近端与孤立性远端深静脉血栓患者的临床结果比较：一项系统回顾和荟萃分析。

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders

Pub Date : 2025-06-20 DOI: 10.1016/j.jvsv.2025.102281

Siyi Zhang BS, Can Shi PhD, Xia Wang MS, Huilin Xu BS, Ziwei Liu BS, Songhua Chen BS, Tian Wu PhD, Ren Guo PhD

Objective

Deep vein thrombosis (DVT) ranks among the top five most prevalent vascular diseases globally and encompasses proximal deep vein thrombosis (PDVT) and isolated distal deep vein thrombosis (IDDVT). IDDVT affects approximately 50% to 65% of patients with DVT. However, due to a lack of prospective studies and conflicting perspectives on its potential to lead to pulmonary embolism (PE), the management of IDDVT remains contentious. Therefore, this meta-analysis was conducted to compare the clinical outcomes of PDVT and IDDVT.

Method

We searched studies including proximal and isolated distal thrombotic outcomes in the electronic databases PubMed, EMBASE, Cochrane, and Web of Science. The literature was then screened based on title, abstract, and full text to exclude those that did not meet the criteria. A total of 21 cohort and randomized controlled studies were included.

Results

Compared with IDDVT, PDVT was associated with higher rates in recurrent vein thromboembolism (VTE) (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.35-1.93; P < .001), PE (OR, 1.52; 95% CI, 1.16-1.99; P = .002), major bleeding (OR, 1.95; 95% CI, 1.23-3.09; P = .005), and all-cause mortality (OR, 2.02; 95% CI, 1.19-3.44; P = .009). However, no significant differences were found in the rates of any bleeding (OR, 1.57; 95% CI, 0.96-2.58; P = .070) and nonmajor bleeding (OR, 1.03; 95% CI, 0.69-1.54; P = .88).

Conclusions

Compared with patients with PDVT, patients with IDDVT may have lower rates of recurrent VTE, PE, major bleeding events, and all-cause mortality, demonstrating safer clinical outcomes.

目的：深静脉血栓形成（Deep vein thrombosis， DVT）是全球最常见的五大血管疾病之一，包括近端深静脉血栓形成（PDVT）和孤立性远端深静脉血栓形成（IDDVT）。IDDVT影响约50-65%的DVT患者。然而，由于缺乏前瞻性研究和对其导致肺栓塞（PE）的可能性的相互矛盾的观点，IDDVT的管理仍然存在争议。因此，本荟萃分析比较PDVT和IDDVT的临床结果。方法：我们在PubMed、EMBASE、Cochrane和Web of Science的电子数据库中检索了包括近端和孤立的远端血栓结局的研究。然后根据标题、摘要和全文筛选文献，以排除不符合标准的文献。共纳入21项队列和随机对照研究。结果：与IDDVT相比，PDVT与更高的静脉血栓栓塞复发率相关(OR: 1.62；95% CI:1.35-1.93, p < 0.001), PE (OR: 1.52；95% CI: 1.16-1.99, p = 0.002)，大出血(OR: 1.95；95% CI: 1.23-3.09, p = 0.005)和全因死亡率(OR: 2.02；95% CI: 1.19-3.44, p = 0.009)。然而，在任何出血（OR: 1.57 95% CI: 0.96-2.58, p = 0.070）和非大出血(OR: 1.03；95% CI: 0.69-1.54, p = 0.88)。结论：与PDVT相比，IDDVT患者复发性VTE、PE、大出血事件和全因死亡率可能更低，临床结果更安全。

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引用次数: 0