Phlebology最新文献

Objectives: The aim of this study was to analyze the demographic and clinical characteristics of male patients.

Methods: Retrospective data were collected from the files of 52 male patients with lymphedema. Duration, diagnostic category, localization and stage of lymphedema, and complaints were analyzed and reported. In addition, subgroups based on age, lymphedema etiology and cellulite history were compared in terms of demographic and clinical characteristics.

Results: The most common cause of lymphedema was chronic venous insufficiency (32.7%), followed by cancer-related lymphedema (30.8%). The location of the lymphedema varied, with 46.2% having it in the unilateral lower extremity, 32.7% in both lower extremities, and smaller percentages in the upper extremities, genital area, and head and neck. The median duration of lymphedema was 12 months, and the most common referral source was cardiovascular surgeons. The most common symptoms reported were swelling and feeling of heaviness. Approximately 23.1% of patients had a history of cellulitis. Non-cancer related lymphedema patients had higher body mass index and longer duration, and a third of them had a history of cellulitis, unlike cancer-related lymphedema patients.

Conclusion: It is crucial to acknowledge that lymphedema can also affect men. Prompt diagnosis of men with potential risk factors, such as chronic venous insufficiency and cancer, is vital to prevent lymphedema and its associated complications.

Background: Pelvic venous disorders (PeVD), previously "Pelvic congestion syndrome (PCS)" is usually defined as a female health problem. However, it is our impression that gynaecologists rarely recognise this condition, and most of the research interest appears to be by vascular and venous surgeons, and radiologists. The aim of this study was to investigate if there was evidence to support this view.

Methods: An online search of the PubMed^® database was performed using the search terms "pelvic congestion", "PCS", "pelvic venous disorders" and "PeVD", filtered for relevance to "pelvic veins". Articles were collected from 2013 to 2024 and analysed for which type of journal they appeared in (obstetrics and/or gynaecology, radiology, vascular, venous, angiology, other) and what sort of article each was (original article, review, case report).

Results: We found 281 articles published for PCS and 38 articles for PeVD, a total of 319 overall. There was a general increase in articles over the time course. However, 33.2% appeared in vascular and venous journals, 20.4% in radiology journals and only 11.3% in obstetric and/or gynaecology journals. There was no indication that the percentage of articles on PCS/PeVD was increasing in the female health journals over the time studied.

Conclusion: PeVD/PCS is under represented in obstetrics and/or gynaecology journals. Most articles appear in vascular and venous journals. This gives rise to concern that women suffering from pelvic pain due to PeVD/PCS tend to consult gynaecologists, rather than vascular and venous specialists who are more actively involved in researching the condition.

Objective: To perform a systematic review and meta-analysis to investigate the efficacy of ultrasonography in the diagnosis of pelvic vein insufficiency (PVI).

Results: Seven studies comprised of 802 patients were included. Of these studies, 5 utilised transvaginal ultrasound (TVU), 1 utilised transabdominal ultrasound (TAU) and 1 utilised both ultrasounds as diagnostic tool .The overall pooled sensitivity and specificity was 0.96 and 0.84 respectively. The sensitivity and specificity for TVU were 0.96 and 0.86. The pooled sensitivities between studies employing a <7 mm cutoff in pelvic veins' diameter (PVD) and those employing a >7 mm threshold were 0.99 and 0.94 while the pooled specificities were 0.75 and 0.96 respectively.

Conclusion: The evidence supports the efficacy of ultrasonography in the diagnosis of PVI. A threshold of up to 6 mm in PVD yielded excellent sensitivity outcomes, but it is at the expense of specificity. This meta analysis suggests that a PVD threshold of 7 mm should be employed as a cutoff point in the diagnosis of PVI, displaying both excellent sensitivity and specificity outcomes.

Purpose: Determine the rate of incidence, risk factors, and management for developing venous thromboembolism (VTE) in patients undergoing radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS) for varicose veins.

Methods: All charts of patients undergoing venous ablation from 2016 to 2023 were reviewed at a rural vein treatment clinic. The incidence of VTE was noted and a chart review was completed to identify risk factors for VTE, EHIT score, EFIT score, and management.

Results: Patients underwent 14,172 UGFS procedures and 4865 RFAs. VTE was noted in 45 patients (0.24%), with no pulmonary embolisms and no fatal outcomes among the patient population. Patients diagnosed with VTE had a median CEAP score of 3 and a modified Caprini risk score of 7.2. Increased risk of VTE was noted in patients with prior history of DVT, patients undergoing UGFS, patients with higher Caprini scores. 90% of patients diagnosed with VTE had a prior history of DVT (p < 0.05). Patients who received UGFS treatments had a higher modified Caprini Risk Score than patients who received an RFA and UGFS, 8.7 and 6.8 respectively (p < 0.05). Increased risk of VTE was noted in patients with swollen legs prior to treatment (0.92%), visible varicose veins (0.92%), obesity (0.49%), and surgery within the prior 3 months to vein treatment (0.41%).

Conclusion: The modified Caprini score is a useful tool for risk stratification for VTE and its incidence is low for patients undergoing RFA and UGFS. Prior history of VTE represents a significant risk for recurrence in patients undergoing RFA and UGFS.

Background: Chronic venous disease has a major impact on the quality of life of millions of patients. Large randomized controlled trials have established ultrasound-guided foam sclerotherapy (UGFS) as a safe and effective treatment option for both saphenous vein insufficiency and tributary disease. Ultrasound guidance is a critical component of sclerotherapy of non-visible veins.Method: An expert panel of the American Vein and Lymphatic Society (AVLS) was convened to review the literature and write a Position Statement with recommendations for the use of UGFS with physician-compounded foam for patients with venous insufficiency.Result: Consensus recommendations from the expert panel highlight the advantages and safety of high-quality physician-compounded foam. These recommendations were reviewed, edited and approved by the Guidelines Committee of the AVLS.Conclusion: UGFS with in-office, physician-compounded foam is a safe primary treatment option for varicose, tributary, and truncal veins of the lower extremities and is an important adjunct therapy for tributary disease following or concomitant to endovenous ablation procedures.

The article presents the technique of duplex ultrasound study (DUS) of the pelvic veins in patients with pelvic venous disorders (PeVDs). It provides basics of anatomy of pelvic veins and describes hemodynamic and anatomical parameters that should be assessed during DUS of pelvic veins.

Introduction: The increasing reliance on Internet search engines for health-related queries requires a thorough evaluation of the public's engagement with medical information. This study aims to analyze global trends in interest in lymphedema over the past decade using Google Trends (GT).

Methods: A physiatrist with expertise in lymphedema management identified and analyzed 12 key search terms according to the International Society of Lymphology (ISL) guidelines. These terms included 'lymphedema swelling', 'lymphedema treatment', 'lymphedema stages', 'compression therapy for lymphedema', 'manual lymphatic drainage (MLD)', 'complete decongestive therapy (CDT)', 'pneumatic compression pump', 'lymphovenous anastomosis (LVA)', 'lymphedema surgery', 'liposuction for lymphedema', 'lymphedema prevention' and 'post-cancer lymphedema'. GT data was collected using filters set to 'web search', 'all categories', and 'worldwide' to provide a comprehensive overview. The analysis was conducted for two five-year intervals: 1 September 2014 to 31 August 2019 and 1 September 2019 to 31 August 2024. Relative search volume (RSV) was calculated for each term and compared to quantify changes over time.

Results: Significant increases in search activity were observed for 'lymphedema swelling', 'lymphedema treatment', 'lymphedema stages', 'manual lymphatic drainage', 'lymphedema surgery', and 'post-cancer lymphedema' in the second period (p = 0.001 for each). The average GT score increased from 19 in 2014-2019 to 29 in 2019-2024 (p = 0.001), reflecting a significant increase in public awareness and interest.

Conclusion: The study shows a significant increase in global public interest in lymphedema and its minimally invasive treatments over the past 5 years, suggesting a growing awareness of the condition. These findings highlight the need for improved patient education and research to meet the increasing demand for lymphedema care.

Objective: This study measured the diameter change of the popliteal vein under a rated pressure gradient and evaluated the relationship between popliteal vein functional diameter and severity of chronic venous disease.

Methods: Ultrasound examination was performed on 173 lower limbs of 173 patients admitted from June 2023 to January 2024. The diameter of the popliteal vein was measured before and after compression with the thigh inflatable cuff. The correlation between popliteal vein functional diameter and venous clinical severity score ( VCSS ) was statistically analyzed.

Results: Venous clinical severity score values ranged from 1 to 28 (median 7). The Spearman correlation analysis between venous clinical severity score and functional diameter had an rs value of -0.222, p (double-tailed) < .001. The correlation between VCSS and popliteal vein diameter variation index yielded rs = -0.633, p (double-tailed) < .001.

Conclusion: This study found that popliteal vein functional diameter negatively correlated with the severity of chronic venous disease. Popliteal vein functional diameter and diameter variation index can be used as disease-specific indicators to quantify the severity of chronic venous disease. (Clinicaltrials.gov Identifier: NCT06175481).

Objectives: The primary aim of this study was to evaluate the reliability and efficiency of a 3D laser scanner as a tool for volumetric measurement of the upper limbs, comparing it with the gold standard method of non-reflux water displacement. The study sought to determine whether the 3D scanner could serve as a reliable and time-efficient alternative in clinical settings, particularly for managing conditions like lymphedema.

Methods: A total of 30 healthy participants (18 women, 12 men) were recruited, and volumetric measurements were taken using both the 3D scanner and water displacement methods. Inter-rater and intra-rater reliability were calculated using the Intraclass Correlation Coefficient (ICC), and agreement between the methods was assessed using a Bland-Altman plot. The time required for each measurement and data processing were recorded and compared between the two methods.

Results: The 3D scanner demonstrated excellent inter-rater (ICC = 0.995) and intra-rater (ICC = 0.991) reliability, surpassing the water displacement method (ICC = 0.973 and 0.968, respectively). The Bland-Altman plot showed good agreement between the two methods, with only two measurements outside the 95% confidence limits. However, the 3D scanner required significantly more time for both measurement and data processing (28.55 seconds and 120 seconds, respectively) compared to water displacement (9.64 seconds).

Conclusions: The 3D scanner offers high reliability and precision for upper limb volumetric measurements, potentially improving clinical management of conditions such as lymphedema. Despite longer acquisition times, its accuracy and versatility make it a promising tool for future clinical use, especially in scenarios where precise monitoring is crucial.

Objective: To present the 8-year results of 180 patients on whom we performed endovenous occlusion using N-butyl cyanoacrylate in 2014.

Methods: We have previously published the 30-month results for 168 patients available for follow-up. Thirteen more patients were lost to follow-up in the 8-year research period. The remaining 155 patients underwent clinical examinations and their Venous Clinical Severity Score (VCSS) values were recorded. Doppler ultrasonography was performed, and whether the saphenous vein was occluded, or whether partial or complete recanalization were present was evaluated.

Results: The mean age of the 155 patients we were able to follow-up was 47.4 ± 11.8 years. Sixty-eight of the patients were men, and 87 were women. Mean VCSS scores were 10.2 before the procedure, 2.7 at 30 months, and 2.6 ± 0.7 at 8 years. Complete recanalization was observed in seven patients over the 8 years, and partial recanalization in six. Occlusion rates were 94.1% at 30 months and 91.7% at 8 years.

Conclusion: The long-term results of the use of N-butyl cyanoacrylate in the treatment of patients with varices are highly satisfying in terms of a high ablation rate.