Phlebology最新文献

Background: Compared to the great saphenous vein, there is a relative paucity of data in the literature focused on treating the small saphenous vein (SSV). Our goal was to evaluate and analyze national registry data related to the diagnosis and treatment of the SSV and identify practice patterns and clinical outcomes.

Method: Subjects undergoing SSV interventions between April 2014 and March 2023 were identified in the AVLS PRO Venous Registry. Data points included Clinical, Etiological, Anatomical, Pathological (CEAP) classifications; Venous Clinical Severity Score (VCSS), Venous Quality of Life (VVSymQ®) instrument scores, Heaviness, Aching, Swelling, Throbbing, Itching (HASTI) symptoms, and Short Form Health Survey (SF-36.) Duplex ultrasound findings included vein diameter, length, and the overall recanalization rate.

Result: A total of 92,175 SSV interventions were identified. Over two-thirds of subjects presented with a CEAP classification of C3 (31%) and C4 (C4 40%). Clinical results demonstrated significant improvement immediately after treatment in the first month and maintained beneficial results at 1 year or longer (p < 0.001.) This improvement was reflected in the significant decrease in VCSS scores (6 ± 3.4 to 5 ± 2.9; p < 0.0001), VVSymQ (9.5 ± 6.0 to 5.9 ± 4.4; p < 0.0001), and HASTI (9.4 ± 5.9 to 6.6 ± 5.2; p < 0.0001). The recanalization rate at any follow-up was 3%; 48% of those occurring within the first year. Predictors associated with recanalization were larger vein diameter (mean 4.0 mm, 95% CI 3.9-4.1, p < 0.0001) and shorter SSV length (mean 15.27 mm, 95 % CI 14.4-16.1, p < 0.0001).

Conclusion: Treatment of SSV insufficiency improved clinical outcomes by both patient and physician-derived outcome measures. Only 3% of SSV demonstrated recanalization, and nearly half occurred within the first year following the procedure. Predictors of recanalization included larger pre-procedure vein diameters and treatment of a shorter length of SSV.

Background: The terminology in compression therapy is not always consistent. Confusion arises from layers, components, materials, whether elastic or inelastic, stiff or not stiff, compression class, and other terms. The aim of this paper is to define a standard terminology for compression therapy.

Method: the International Compression Club (ICC) board members prepared a draft consensus paper, which was circulated among the ICC members and refined by GM according to the comments and suggestions received.

Results: All the terms used in compression therapy, from the definition to the materials, compression kits or systems, their physical properties, compression pressure, compression characteristics, and components and layers, were considered and agreed upon.

Conclusions: The given definitions allow for consistent classification of compression materials or devices. The International Compression Club hopes that the proposed terminology will be widely accepted and that papers and congress presentations on compression will use precise terminology.

Introduction: Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment.

Objective: The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure.

Methods: 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05.

Results: Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference.

Conclusion: Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.

Background: One of the most debatable phlebology community's issue is the choice of the optimal tactics for endovenous varicose tributaries correction after truncal ablation. Which tactic will be most effective? There is practically no data concerning treatment tactics' choice for varicose tributary depending on its diameter. Therefore, the comparison of staged versus one-stage treatment of varicose veins is relevant problem in modern phlebology. Research on this topic will make possible determination of advantages and potential disadvantages of the proposed tactics.

Methods: The study included a prospective analysis of the combined treatment of 295 patients with primary varicose veins who underwent outpatient treatment.

Results: Simultaneous EVLA of saphenous trunks and ligation (gentle phlebectomy) of visible large-diameter tributaries (6 mm or more) with staged sclerotherapy after a month, has significant potential benefits.

Conclusion: The use of staged varicose veins treatment minimizes the traumatic intervention and discomfort for the patient, while achieving satisfactory treatment results without affecting the quality of life.

Background: Increasing the levels of physical activity (PA) is widely recommended for people with chronic venous insufficiency (CVI). However, studies investigating the patterns of PA and adherence to PA guidelines using objective measures are lacking.

Objective: The primary aim was to examine the patterns of PA and adherence to PA guidelines among patients with CVI. A secondary aim was to identify whether adherence to PA recommendations differed according to patients' sociodemographic and clinical characteristics.

Methods: This cross-sectional study included 96 patients with CVI with Clinical-Etiology-Anatomy-Pathology (CEAP) C3 to C6 (69.1% women 59 ± 11 years; 51.5% C5-C6 on CEAP classification). Objective time spent in PA was measured by a triaxial accelerometer. To examine adherence to PA guidelines, patients were grouped as meeting (or) the recommendations if they had at least 150 min/week of moderate to vigorous PA. Sociodemographic and clinic characteristics were obtained by self-report. Binary logistic regression was employed to examine whether sociodemographic and clinical characteristics were associated with adherence to PA guidelines. T-tests were employed to compare PA levels at different intensities according to patients' age.

Results: Patients spent an average of 311.4 ± 91.5 min/week, 42.1 ± 28.0 min/week, and 19.8 ± 17.8 min/week in low-light PA, high-light PA, and moderate-to-vigorous PA, respectively. The proportion of patients meeting PA recommendations was 36.2%, and older patients had lower odds (OR = 0.94; 95%CI: 0.89 to 0.99). Additional analysis reinforced that by showing lower time in high-light PA (51.2 ± 30.0 min/day vs. 31.9 ± 21.8 min/day; p = .001) and moderate-to-vigorous PA (24.3 ± 15.8 min/day vs. 14.8 ± 18.8 min/day; p = .012) among older patients than their peers younger.

Conclusion: Our findings showed that 36,2% of CVI patients met PA recommendations, with lower odds found among older patients. Public health interventions to enhance PA engagement among CVI patients should prioritize those who are older.

Aim: This study aimed to develop a web-based machine learning (ML) model to predict the lifetime likelihood of developing varicose veins using global disease prevalence data.

Methods: We utilized data from a systematic review, registered under PROSPERO (CRD42021279513), which included 81 studies on varicose vein prevalence across various geographic regions. The data used to build the ML model included disease prevalence as the outcome (%), along with the following predictors: mean age, gender distribution (%), mean body mass index (BMI) of the study cohort, and the mean gravity field of the study region (mGal), representing variations in Earth's underground mass distribution that influence blood and fluid redistribution in the human body, affecting disease prevalence. After standardizing the outcome and predictors, the model was trained using neural network regression implemented with the TensorFlow.js library and deployed as a web-based ML application.

Results: After 406 epochs of training, and upon achieving a validation loss (mean squared error) of 0.9, training was stopped due to no further improvement. The achieved test loss was 0.49, and the mean absolute error (MAE) was 0.56, corresponding to an up to 6.7% difference between the predicted and true disease probabilities (calculated as MAE x σ, where σ is the standard deviation of the mean disease prevalence = 0.56 x 11.9 = 6.7). The likelihood of developing varicose veins, as predicted by the model, showed the strongest correlation with age (0.78), followed by gravity anomaly (0.30), BMI (0.27), and gender (0.15).

Conclusion: This study summarizes research on the prevalence of varicose veins by developing a web-based ML model to predict an individual's likelihood of developing the disease. Using data reported in the literature, the ML algorithm provides a non-discriminatory predictive baseline, offering a valuable tool for future investigations into disease epidemiology.

Objective: CEAP categorizes patients based on disease progression and severity. Whether disease severity is associated with specific patterns of reflux is currently unknown. We hypothesize that patterns of reflux in patients with C2 and C5/6 disease will differ.

Design: Multi-center retrospective cohort analysis.

Methods: From January 2015 to December 2020, we performed a retrospective review of reflux patterns in 21 335 patients and 31 727 limbs in symptomatic patients with C2 or C5/6 disease. Patterns of reflux in Great (GSV), Small (SSV), Deep and Perforators (Perf), were analyzed in patients with and without junctional reflux. The GSV and SSV were divided into six and three segments respectively. The number of perforators with reflux were categorized as 1-3 above and below-knee and deep system reflux was divided into three segments.

Results: Of the 21 335 patients the average age and female/male distribution was the following: C2 (54.13 ± 13.82, 21 410/5047), C5/6 (64.75 ± 14.75, 1514/1755) (p ≤ .001). When SFJ reflux is present, 6-segment GSV reflux was most prevalent (C2, 14.85% vs C5/6, 27.50). Without junctional reflux, above knee reflux was more common in C2 disease, while below knee reflux was more common in C5/6 disease (p ≤ .01). Three segment SSV reflux was more prevalent in C2 patients (26.67% vs 16.27%, p ≤ .001). Below knee perforator reflux was more prevalent in C5/6 patients (79.56% vs 73.53%, p ≤ .01). Combined CFV/FV/POPV reflux was more prevalent in C5/6 patients (38.5% vs 20.5%, p ≤ .001).

Conclusion: The presence of junctional reflux is more closely associated with disease location (above- vs below-knee) than with disease classification. SFJ reflux is more likely to present with extensive above knee disease. Isolated below-knee reflux is more significantly associated with C5/6 disease, independent of junctional reflux. Conversely, isolated above-knee superficial reflux is significantly associated with C2 disease and junctional reflux.

Purpose: To evaluate longer term outcomes of the Zilver Vena Venous Stent in patients undergoing venous stenting.

Materials and methods: Patients with iliofemoral obstructive venous disease and treated with venous stents were retrospectively enrolled in a physician-led real-world data collection effort. Results were analyzed by etiologies: post-thrombotic syndrome (PTS), non-thrombotic iliac vein lesion (NIVL), and iliocaval acute deep vein thrombosis (aDVT). Patency outcomes (primary, assisted-primary, secondary), reinterventions (in-stent and all), adverse events, and venous clinical outcome measures (VCSS, CEAP, Villalta Score) were reported using Kaplan-Meier estimates and summary statistics.

Results: A total of 219 patients (89.5% women, mean age 45.3 ± 11.9 years) were identified: 56 PTS, 153 NIVL, and 10 aDVT patients. Devices were placed across the inguinal ligament in 80.4%, 0%, and 70.0% of patients in the PTS, NIVL, and aDVT groups, respectively. Through 1-year, Kaplan-Meier estimated primary patency rate was 96.4% for PTS, 99.3% for NIVL, and 100% for aDVT patients, respectively, and followed the same trend through 3 years. Freedom from (FF) all and within stent reinterventions estimated by Kaplan-Meier was 87.9% and 90.1% for PTS, 98.2% and 98.2% for NIVL through 3 years. No reinterventions were reported for the aDVT group. Improved venous clinical outcome measures were seen in all groups at the last follow-up visit. Stent fractures occurred in 2 PTS patients without related reintervention or clinical sequelae. No stent migrations were reported.

Conclusion: Real-world use showed high patency rates and improved venous clinical outcome measures (VCSS, Villalta, and CEAP) after venous stent placement.

Background: Deep vein thrombosis (DVT) of the lower limb is a significant clinical challenge with the potential for recurrence, which can lead to increased morbidity and reduced quality of life.

Methods: A retrospective case-control study was conducted involving 367 patients diagnosed with lower limb DVT from June 2020 to June 2023. Patients were categorized into a recurrence group (n = 121) and a non-recurrence group (n = 246) based on DVT occurrence. Data were systematically collected from medical records, including demographic information, thrombus characteristics, patient compliance, coagulation parameters, inflammatory markers, and quality of life assessments using the CIVIQ-20 and SF-36 scales.

Results: The recurrence group had significantly higher mean age, history of orthopedic diseases, and pregnancy, reduced compliance with compression therapy and anticoagulation, and elevated inflammatory markers including IL-6, IL-8, and TNF-α. Prolonged coagulation times (PT, APTT, TT) were associated with a lower risk of recurrence. The SCI index was significantly lower in the recurrence group. Multivariate logistic regression identified age, IL-6, IL-8, PT, APTT, TT, and SCI index as significant predictors of recurrence. Quality of life scores were lower in the recurrence group, indicating a higher impact on mental and overall health. ROC analyses demonstrated strong predictive capacity (AUC = 0.905) of SCI index.

Conclusion: The study underscores the multifactorial nature of DVT recurrence, highlighting the role of age, systemic inflammation, coagulation times, and compliance with therapeutic interventions. The SCI index emerges as a compelling prognostic marker for assessing the risk of DVT recurrence. These findings emphasize the need for comprehensive management strategies incorporating these parameters to prevent recurrence and improve patients' quality of life.