Phlebology最新文献

Introduction: To date, the problem of venous thromboembolism and its consequences remains relevant, despite significant progress in the development of phlebology and technologies.

Aim: In our study, we tried to assess the "danger" of floating DVTs, methods and features of conservative and surgical treatment of patients with floating DVTs, analyze the results of treatment of this group of patients, and draw conclusions based on our data.

Materials and methods: The results of treatment of 1297 patients with venous thromboembolism for the period 2011-2022 were analyzed. 104 patients were treated with floating deep vein thrombosis, 1193 patients had occlusive proximal venous thrombosis.

Results: In our study, we determined the danger of floating DVT by comparing the facts of the migration of thrombotic masses in the proximal direction according to the results of treatment in two groups of patients. The first group consisted of 10 patients with proximal floating venous thromboses who were implanted with cava filters, the second group consisted of 28 patients with occlusive proximal venous thrombosis who were implanted with cava filters. Embolism occurred in 40.0% of cases floating DVT, while no cases of embolism were detected in occluding DVT (p < 0.01). Groups of patients with the length of the floating part of the thrombus up to 5 cm were analyzed. Anticoagulant therapy was used in 42 cases; thrombectomy was performed in 52 cases. There was no case of pulmonary embolism when treated with both conservative and surgical methods.

Conclusions: Based on our research, it can be stated that floating thrombosis of deep veins of proximal venous segments is a type of thrombosis that has an increased risk of thromboembolic complications when the length of the floating part is 5 cm or more.

Objectives: Venous leg ulcers (VLU) are prevalent and require a large investment of resources to manage. We investigated whether the introduction of a rapid access see-and-treat clinic for VLU patients affected rates of unplanned inpatient admissions with VLU.

Methods: The Hospital Inpatient Enquiry database was consulted for data on admission rates, length of stay, bed-days used, and costs, across a 4-year period; 2 years since the introduction of the clinic, and the 2 years prior as a control.

Results: Two hundred and eighteen patients admitted with VLU accounted for 2,529 inpatient bed-days, 4.5 (2-6) admissions per month, and a median hospital stay of 7 (4-13) days across the study period. Median admissions decreased from 6 (2.5-8.5) per month before, to 3.5 (2-5) after introduction of the clinic (p = 0.04). Bed-day usage fell from 62.5 (27-92.5), to 36.5 (21-44) days per month (p = 0.035).

Conclusions: Admissions and bed-day usage for inpatient management of VLU fell after commencing a one-stop, rapid access clinic.

Objectives: We aimed to elucidate whether lower limb extra-fascial compartment and muscle areas affect the calf muscle pumping action on lower limbs.

Method: This study included 90 patients (180 limbs) who underwent preoperative air plethysmography (APG) and preoperative non-contrast computed tomography (CT) of the lower limbs for diagnosis of unilateral or bilateral primary varicose veins. A correlation between cross-sectional CT images and preoperative APG was confirmed. Cross-sectional CT was used to measure the extra-fascial compartment and muscle areas of the calf. The lower limbs were divided into two groups: those that were normal and those with primary varicose veins.

Results: The extra-fascial compartment area was significantly correlated with the ejection fraction in normal (r = 0.388, n = 53, p = 0.004) and varicose limbs (r = 0.232, n = 91, p = 0.027).

Conclusions: In normal and varicose limbs, evaluation of ejection fraction, an indicator of muscle pumping, requires consideration of the extra-fascial compartment area.

Background: The treatment of lymphoedema requires a multi-professional and interdisciplinary approach. Despite being prescribed in the management of lymphatic disorders, the effectiveness of the phlebological insoles is still under investigation.

Aim: This scoping review aims to identify and analyse evidence regarding the efficacy of phlebological insoles as a conservative intervention for lower limb lymphoedema.

Method: The following databases were searched up to November 2022: PubMed, Cochrane Library, CINAHL Complete, PEDro and Scopus. Preventive and conservative interventions were considered. Studies considering people with lower limb oedema, of any age and type of oedema, were eligible for inclusion. No restrictions in terms of language, year of publication, study design and type of publication were applied. Additional studies were sought through grey literature.

Results: From 117 initial records, 3 studies met the inclusion criteria. Two quasi-experimental studies and one randomised cross-over study were included. The results of the examined studies confirmed the positive effects of insoles usage and foot and ankle mobility on the venous return.

Conclusion: This scoping review provided an overview of the topic. The studies analysed in this scoping review have shown that insoles seem to be beneficial in reducing the lower limb oedema in healthy individuals. However, there are still no comprehensive trials confirming this evidence on people with lymphoedema. The small number of identified articles, the selection of participants not affected by lymphoedema, the use of heterogeneous devices in terms of modifications and materials highlight the need of further investigations. Future trails should include people affected by lymphoedema, address the choice of materials in manufacturing the insoles and take in consideration the patients' adherence to the device and concordance to the treatment.

Objective: This study aimed to investigate the feasibility and effectiveness of 3D printing personalized guide plate in the management of recurrent intramuscular venous malformations (IVM).

Methods: Fifteen patients with recurrent IVM were retrospectively assessed. 3D-slicer software was used to extract and reconstruct the imaging data from CT and/or MRI to highlight the morphology, size, and puncture depth of the lesion. With the guidance of personalized plate, complete excision of the IVM was adopted along the pre-marked (methylene blue, MB) margin.

Results: Personalized guide plate matched involved extremity well, and MB-puncture approach was consistent with preoperative design. All IVMs were removed radically in one single session. Complete pain relief was obtained in all cases postoperatively.

Conclusion: The application of 3D printing guide plate can be safe, effective, and reliable to confirming the precise margin of IVM, renders a promising technique with a high practical value in resection of recurrent lesion.

Objective: The purpose of the study is to translate the Aberdeen Varicose Vein Questionnaire (AVVQ) into Spanish and evaluate the feasibility and reliability of the Spanish-translated AVVQ in patients with chronic venous disease.

Methods: Reliability was assessed by test and retest of the Spanish translated AVVQ in a sample of 77 patients. The questionnaires were answered within a 2-week interval.

Results: There was a 100% test and retest response. The AVVQ showed 6.5% of missing responses. Cronbach's alpha was 0.71 indicating an adequate level of internal consistency. Spearman's rho showed a significant strong association between test and retest scores (rho = 0.84, p < 0.0001).

Conclusions: The Spanish-translated AVVQ is a reliable tool in our daily clinical practice in order to measure the impact of venous disease in the quality of life.