Phlebology最新文献

IntroductionPostsclerotherapy hyperpigmentation (PSH) is a common side effect of sclerotherapy that can persist in a small proportion of patients. Up to now, hemosiderin has been the only histologically proven causative pigment, making laser treatment the primary therapeutic option.ObjectivesThe aim of the study was to identify the origin of pigment in post-sclerotherapy hyperpigmentation based on histopathological findings.MethodsWe analyzed 20 skin biopsies from 19 patients including identification of the type of pigment and pigment location. 10 biopsies were taken from patients with PSH >3 months and 10 from those with PSH <3 months. The analyses included hematoxylin-eosin, Prussian blue, Masson-Fontana and CD68 staining.ResultsHemosiderin was detected in all biopsies, predominantly in the reticular dermis and in the subcutis, with a particular prevalence in newer PSH cases. Epidermal melanin was enhanced in three patients, whereas dermal melanin was increased in seven patients, three of whom also exhibited a decrease in epidermal pigment.ConclusionHemosiderin and postinflammatory hyperpigmentation with increased dermal or epidermal melanin contribute to the development of PSH in some patients.

BackgroundEndovenous laser ablation (EVLA) is a first line recommended treatment for incompetent truncal veins in the legs. The current "industry standard" is a single ring radially firing catheter, using a 1470 nm diode laser. It is common for doctors to treat more than one vein, and they often clean the catheter tip before re-introduction. We have observed some doctors using normal saline for this, but others using povidone-iodine. The aim of this in vitro study was to determine whether povidone-iodine reduces the power being emitted from the catheter tip.MethodsFive radial catheters were tested, each connected in turn to a 1470 nm diode laser set at 10 W. Power emission was measured by a laser power detector connected to a power meter. The power meter recorded an average (mode) of the readings once the laser had reached a steady state. Each catheter was tested firing in air, after dipping in normal saline, then povidone-iodine and finally after wiping the povidone-iodine off the tip with a surgical gauze.ResultsThe emitted power recorded for air (9.05 W) was significantly (p < .05) more than for normal saline (8.90 W), povidone-iodine (8.69 W) and post-wiping off povidone-iodine (8.87 W). The power emitted with povidone-iodine on the tip was significantly less than with normal saline, which mimics the situation of the catheter in a vein surrounded by tumescence anaesthesia.ConclusionIn a laboratory setting, povidone-iodine on the tip of a radially firing catheter transmitting laser energy at 1470 nm, significantly reduces the power being emitted. As this was a laboratory-based study, clinical studies are required to see if this translates into a significant problem during EVLA treatment.

BackgroundLymphedema, particularly in cancer survivors, is a chronic, debilitating condition that lacks a definitive cure. Current management strategies are complex and focus on symptom control. Health coaching (HC) has emerged as a promising intervention to enhance patient self-management and quality of life in chronic diseases, but its specific role in lymphedema care remains underexplored.MethodsThis review synthesized findings from existing literature reviews and systematic reviews examining HC's effectiveness in improving health outcomes in chronic conditions, including lymphedema. Databases searched included MEDLINE, Cochrane Central, Scopus, PEDro, and Web of Science, with no date limitations. Five relevant studies were identified, each evaluating HC's impact on quality of life, mental health, physical activity, self-management, and decision-making.ResultsThe reviewed studies consistently indicated that HC enhances quality of life, reduces mental distress, and supports self-management in chronic conditions. Improvements were also noted in patient engagement in physical activity and informed decision-making. However, outcomes varied in sustainability and were influenced by HC delivery method and duration.ConclusionsThe findings suggest that HC, delivered within multidisciplinary teams, could be a valuable addition to lymphedema management by empowering patients, improving adherence to care routines, and enhancing psychological resilience. Future research should standardize HC protocols and assess their long-term benefits specifically for lymphedema. This review highlights HC's potential in chronic disease care and the need for tailored interventions in lymphedema.

BackgroundSymptoms of Orthostatic Hypotension have been well-documented for decades, but identifying the cause is often elusive. While many cases are attributed to autonomic dysfunction, drug side effects, and systemic diseases, there remain a significant number of cases where a clear etiology is not found.MethodsMedical records of 646 patients at our vein clinics with venous insufficiency were retrospectively reviewed from 2013 to 2019. Orthostatic vitals were measures at initial visit and post venous ablations. We measured the degree of decrease in systolic BP, diastolic BP, and increase in heart rate associated with change of position from sit to stand. Positive orthostatic was assigned for systolic drop of 20 mmHg or diastolic drop of 10 mmHg or heart rate increase of 10 bpm. Patients had their initial and final vital sign fluctuations analyzed with statistical regression.ResultsOf the 178 positive patients out of 646 total), 59 showed a Systolic drop of 20 mmHg or greater, 24 showed a Diastolic drop of 10 mmHg or greater, and 123 showed a rise in HR by 10 bpm or greater. Data regression showed that after ablative vein treatments, the magnitude of drop in BP (systolic or diastolic), or increase in HR, were significantly reduced (systolic pressure (p ≤ 0.001), diastolic pressure (p ≤ 0.001), and heart rate spike (p ≤ 0.001).ConclusionOur data suggests that venous ablative leg vein treatments might play a significant role in improving orthostatic vital signs. Venous assessment and treatment may offer a potential therapeutic avenue for patients with resistant orthostatic intolerance. However, venous insufficiency needs more investigation in patients with OH to further understand the underlying physiological mechanism.

Vascular malformations are abnormal growth or development of the vascular structure that result from genetic mutations during early vascular development. Traditional invasive treatment for vascular malformations includes embolo-sclerotherapy, cryotherapy, laser therapy and surgery. However, surgical or minimally invasive treatment is rarely optimal due to the risk of treatment complications, and a complete cure is often difficult to achieve. Targeted therapy can be guided by the current understanding of molecular signalling pathways and disease classifications. Existing and novel medical treatments target the major cellular signalling pathways implicated in the pathogenesis of vascular malformations: mTOR inhibitors, phosphatidylinositol-4,5-biphsophate 3-kinase catalytic subunit alpha (PIK3CA) inhibitors, and AKT inhibitors are being developed to target the Phosphoinositide 3-Kinase (PI3K)/AKT/mTOR pathway, while mitogen-activated protein kinase (MEK) inhibitors and BRAF inhibitor are being researched to target the RAS/RAF/MEK/ERK pathway. Angiogenesis inhibitors are also utilised in the treatment of vascular abnormalities. This review aims to discuss the evolving medical therapy available in the treatment of Vascular Malformations.

ObjectiveWe aimed to investigate demographic and clinical characteristics associated with lymphedema volume in this patient population.MethodsThis was a single centre, cross-sectional study. Eighty-six patients with unilateral lower extremity lymphedema were included. The dependent variable was lymphedema volume. The independent variables were age, body mass index, gender, employment status, smoking status, duration of lymphedema, history of infection, type of lymphedema, and the interactions between history of infection and smoking status and between history of infection and type of lymphedema.ResultsThe interactions between history of infection and smoking status (B = 25.04, 95% CI [8.87, 41.22], p < .01) and between history of infection and type of lymphedema (B = 13.11, 95% CI [0.62, 25.60], p = .04) were associated with lymphedema volume. Being employed was associated with lower lymphedema volume (B = -10.53, 95% CI [-18.36, -2.70], p < .01). Age, body mass index, gender, and duration of lymphedema were not associated with lymphedema volume (p > .05).ConclusionsIn patients with unilateral lower extremity lymphedema, smokers or patients with primary lymphedema tend to have higher lymphedema volume when they experience an infection. Employed patients exhibit lower lymphedema volume compared to non-employed patients. Age, body mass index, gender, and duration of lymphedema are not associated with lymphedema volume.

Background and ObjectivesMany overweight individuals develop obesity-associated functional venous insufficiency (OA-FVI), also known as obesity-associated dependency syndrome. This study investigates the impact of medical compression stockings (MCS) on the symptoms.Patients and MethodsA total of 49 patients, 37 female and 12 male, with a body-mass-index (BMI) of 30-40 kg/m² and a clinical presentation of OA-FVI corresponding to chronic venous insufficiency (CVI) stages C3-C5 were included. During the intervention phase, patients wore knee-length MCS compression class 2 (CCL2). In the first week, flat-knit MCS was worn on the left leg, round-knit MCS on the right leg. In the following 3 weeks, patients wore the MCS of their choice on both legs.ResultsThe average patient age was 54.0 years, and the mean BMI was 35.6 kg/m². The average daily wearing time of the MCS was 9.6 hours. Among 40 patients with analyzable data, the VVSymQ score was reduced to 57% of the baseline value (p < .00001), particularly for the key symptoms of swelling, heaviness and achiness as well as throbbing. Edema was initially present in 22 patients. During the MCS intervention, the edema healed in 73% of the affected patients. The fit and comfort of the MCS was assessed as good or very good by 98% of the patients, donning and doffing was assessed as good or very good by 89% and 78% of the patients.ConclusionsThe symptoms of OA-FVI can be effectively reduced using MCS. The obese patients showed good compliance.Trial registry nameDeutsches Register Klinischer Studien; URL: https://drks.de/search/de/trial/DRKS00015468; registration number: DRKS00015468.

ObjectiveThe objective of this systematic review is to evaluate the different imaging techniques used to assess thrombus chronicity in patients with deep venous thrombosis (DVT).MethodsA systematic search of Medline, EMBASE, CENTRAL and Web of Science databases was performed to identify meta-analyses, systematic reviews, randomised controlled trials or observational studies investigating imaging techniques for assessing DVT chronicity.ResultsOverall, 56 studies were reviewed. Various imaging modalities have been explored to assess DVT chronicity. Ultrasound parameters such as echogenicity and vein diameter proved unreliable, though elastography showed promise by quantifying thrombus stiffness. Computed Tomography (CT) studies were limited. In contrast, Magnetic Resonance Imaging (MRI) demonstrated potential for differentiating thrombus age, and nuclear imaging with targeted radiotracers, along with techniques like photoacoustic imaging and Optical coherence tomography (OCT), offered high diagnostic accuracy.ConclusionThis review evaluated various imaging techniques for thrombus aging. No single modality is ideal, but MRI shows the greatest potential for advancement. In select populations, it may enhance cost-effectiveness and improve outcomes for catheter-based DVT interventions.