Phlebology最新文献

Background: While leg ulceration is common, data regarding long-term is limited. Historical data indicate that approximately 50% of leg ulcer patients die within 5 years of presentation. However, little is known regarding survival outcomes in contemporary patient populations. This retrospective study aimed to assess 5-year survival in patients attending a vascular leg ulcer clinic. Objectives: To evaluate 5-year survival among patients with leg ulcers and to analyse the effect of ulcer aetiology and patient co-morbidities on survival. Methods: Over 30 months (2016 to 2018), 119 new patients were assessed at the leg ulcer clinic and followed over 5 years. Baseline co-morbidities, ulcer type, interventions performed, and 5-year survival were recorded. Survival was calculated using Kaplan-Meier curves. Co-morbid burden and survival were compared between venous and arterial/mixed patients. Results: Overall 5-year survival was 74%. Venous patients fared better than arterial/mixed patients (5-year mortality 16/88 vs 15/31; p < .01 log-rank test). Arterial/mixed patients had a greater burden of co-morbidities. In multivariate regression modelling, the presence of three or more co-morbidities at presentation was the only significant predictor of mortality. Conclusions: Overall, 5-year survival for leg ulcer patients has improved compared to historical data but remains static for arterial/mixed patients.

Objectives: The aim of this study was to understand the prevalence of chronic venous disease (CVD) of lower limbs in young men at high-altitude in Xizang, and to provide prevention measures.

Methods: The convenient sampling method was used to conduct a questionnaire survey among males aged 18 to 40 above an altitude of 3000 meters in Xizang in April 2023. The contents of the questionnaire included basic information, symptoms of CVD of lower limbs, protection status and training needs. Multivariate logistic regression model was calculated to evaluate the risk factors for CVD.

Results: A total of 350 survey questionnaires were received, and 326 valid samples were collected. The prevalence of CVD of lower limbs (C1-C6) was 37.42% (95%CI: 32.17%-42.68%), the ratio of C0 to C5 were 62.58%, 27.30%, 3.07%, 4.60%, 2.15% and 0.31%, respectively, no one reached C6. The top three symptoms of CVD were lower limb fatigue (18.10%), heaviness (15.34%) and pain (13.19%). 46.01% of respondents were unaware of CVD, and 12.88% of respondents did not have any protective measures of CVD. Multivariate logistic regression showed that age (OR = 1.076, 95%CI: 1.018-1.137, p = .009), preference for spicy food (OR = 1.747, 95%CI: 1.083-2.818, p = .022), unbalanced diet (OR = 1.877, 95%CI: 1.049-3.358, p = .034) and physical exercise (OR 0.610, 95%CI: 0.377-0.986, p = .044) were the independent risk factors for CVD.

Conclusions: This study provided data on the prevalence of CVD in young men at high-altitude and the risk factors for CVD. The findings of this study may facilitate the development of individualized clinical assessments and targeted prevention programs.

Objectives: This study compares Endovenous Laser Ablation (EVLA) alone versus combined with ultrasound-guided foam sclerotherapy (UGFS) for Great Saphenous Vein (GSV) insufficiency. Methods: Sixty patients were randomly allocated to EVLA or EVLA-UGFS groups which focused on GSV occlusion rates, complications, additional treatments, and quality of life (QoL) changes. Results: Among 55 participants, the EVLA group had higher 12-month occlusion rates (92.3% vs. 75.8%, p = 0.11). Nervous injury (NI) was rarer in EVLA-UGFS (3.4% vs. 23.1%, p = 0.04). No significant difference in other complication rates (p > 0.05). QoL improved in both groups (p < 0.001). EVLA-UGFS required more subsequent procedures (24.1% vs. 7.7%, p = 0.03). Conclusions: EVLA and EVLA-UGFS effectively treat GSV insufficiency, enhancing QoL. The combined method reduces NI risk but may require more follow-up procedures.

Objective: To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity.

Methods: 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion.

Results: In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p < .01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p > .05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow.

Conclusion: The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated.

Background: Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity.

Objectives: To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents.

Methods: An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations.

Results: Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended.

Conclusion: Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.

Bacground: Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography.

Method: The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography.

Result: This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise.

Conclusion: Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.

Background: In recent years, tumescent ablative techniques have been joined by non-tumescent ablative techniques. The aim of the research is to study and compare the effects produced by the different endovascular ablative techniques, from the histological point of view, at the level of the venous wall (endothelium, tunica media and adventitia).

Method: The study involves the use of three ablative endovascular techniques (EVLA, MOCA, CGO) on bench for the treatment of the great saphenous vein. The bench procedure was performed in the same way as described in the instructions for use (IFU) of the technical specifications. Tissue samples were formalin-fixed and paraffin-embedded (FFPE). They were stained with hematoxylin and eosin and, in a case, with anti-ERG antibody (MA5-26,245, Termo Fisher).

Result: No perivascular tissue was present. No hematoma or perforation of the vein wall was observed. Histopathological changes after EVLA indicated that the intima including the endothelium and sub-endothelium was completely necrotized. It was observed that the thermal-energy-induced injury in the intima did not reach deeper than the media. Overview shows that in this case the damage is homogenously spread along the entire perimeter. The most evident change in the sample treated with mechanical-chemical ablation (MOCA) technique was the endothelial damage with loss of endothelial cells. Specifically, with the ERG immunostaining it was possible to observe the presence of numerous nuclei exposed towards the lumen of the vein. In the sample treated with cyanoacrylate (CGO), no significant structural alterations were observed. However, an almost complete collapse of the endoluminal walls and the presence of cyanoacrylate residues were observed.

Conclusion: Different histological patterns characterize the individual treatments. However, all techniques have a common feature: the damage is not transmural and the three different layers of the venous walls are always recognizable.

Purpose: This trial analyzed the effect of sub-ulcer foam sclerotherapy in patients with venous leg ulcer (VLU).

Design: Randomized controlled trial.

Methods: This trial recruited patients with VLUs to receive either sub-ulcer foam sclerotherapy and compression therapy (study group) or compression therapy only (control group). The primary outcome of this study was the change in the venous ulcer area at 4 weeks. The feasibility, safety, and complications of the sub-ulcer foam sclerotherapy were recorded.

Results: Of 23 patients included, 12 were randomized to study group and 11 to control group. Preoperatively, the average ulcer areas were 5.8 cm² in both groups. At 4 weeks, the average reductions in ulcer areas were 4.0 cm² (SD 3.1) in the study group (95% CI 2.0 to 5.9, p = .001) and 2.0 cm² (SD 3.1) in the control group (95% CI: -0.1 to 4.1, p = .051). No differences in complications were recorded.

Conclusions: At 1-month sub-ulcer foam sclerotherapy and compression therapy reduced the ulcer area statistically significantly, whereas compression therapy alone did not. Sub-ulcer foam sclerotherapy could be a good addition to superficial venous insufficiency treatment in patients with VLU.ClinicalTrials.gov identifier NCT03795064.