Phlebology最新文献

Background: Postoperative fibrosis is a common and significant complication following liposuction for lipedema, often leading to tissue induration, pain, and compromised aesthetic results. This fibrosis can jeopardize the overall success of the procedure by reducing skin elasticity and altering the intended body contour.Objective: This study aims to evaluate the efficacy of early shockwave therapy (SWT) initiated 1 week after surgery to reduce postoperative fibrosis and preserve the functional and aesthetic outcomes of liposuction in lipedema patients. Methods: A prospective study was conducted on 50 female patients with stage II-III lipedema who underwent power-assisted liposuction (PAL). Patients received SWT sessions three times per week for 3 weeks, starting 7 days postoperatively. Outcomes were compared to a control group of 25 patients who did not receive SWT. Primary endpoints included fibrosis severity assessed by ultrasound elastography, skin elasticity measurements, and patient-reported outcomes on pain and satisfaction. The SWT group exhibited a significant reduction in fibrosis (2.1 ± 0.3 vs 3.8 ± 0.5, p < .001), improved skin elasticity (1.5 ± 0.2 mm vs 1.0 ± 0.3 mm, p < .01), and lower pain scores (2.3 ± 0.8 vs 4.7 ± 1.2, p < .001) compared to the control group. Results: Patient satisfaction was also higher in the SWT group (92% vs 68%, p < .01). Conclusion: Early postoperative shockwave therapy is an effective and safe treatment to reduce fibrosis after liposuction for lipedema. By modulating fibroblast activity, reducing pro-inflammatory cytokines, and improving tissue perfusion, SWT preserves the surgical outcomes and enhances patient satisfaction. These findings suggest that integrating SWT into postoperative protocols could be a valuable strategy to optimize liposuction results in lipedema patients.

ObjectivesAcute pulmonary embolism (PE) is one of the most serious forms of venous thromboembolism (VTE) with high mortality and morbidity. PE may present with right ventricular dysfunction and hemodynamic disturbances. Early diagnosis and appropriate treatment approaches play a critical role in improving survival. In this study, we evaluated the efficacy and safety of catheter-mediated thrombolytic therapy in intermediate-high-risk PE patients.MethodsOur retrospective study was conducted at Ankara University between 2015 and 2020 and 66 intermediate-high-risk PE patients were analyzed. Clinical, biochemical and echocardiographic data of the patients were analyzed and their response to treatment was evaluated. The primary endpoint was 30-day mortality and secondary endpoints were hemodynamic improvement, length of hospitalization and complication rates.ResultsThe mean age of the patients was 65 years and all of them presented with a diagnosis of symptomatic PE. After treatment, significant improvement was observed in right ventricular function, RV/LV ratio, ProBNP and Troponin I levels decreased significantly. Pulmonary artery pressures decreased and hemodynamic parameters improved. The early mortality rate after the procedure was 3% and the rate of major bleeding was low.ConclusionsCatheter-mediated thrombolytic therapy provides hemodynamic improvement in intermediate-high-risk PE patients, while offering a low bleeding risk. Our results suggest that this therapy may be a safe and effective alternative. However, long-term results should be evaluated in large-scale, randomized studies.

BackgroundMay-Thurner syndrome (MTS) is an anatomical anomaly characterized by compression of the left common iliac vein (LCIV) by the right common iliac artery (RCIA) presenting with left lower extremity swelling and venous hypertension. Persistent symptoms after MTS treatment often lead to referral for lymphedema workup to explore non-venous causes. We aimed to describe the presentation of MTS and the findings from the lymphedema workup.MethodsA retrospective review was conducted of patients with MTS and lower extremity lymphedema workup between 2013 and 2022 at a public academic hospital. Demographic data, diagnostic information, treatment details, and outcomes were collected. Descriptive statistical analysis was performed.ResultsOf 523 patients identified, 390(75%) were female, 133(25%) male with a mean BMI of 29.6 kg/m². Mean age at diagnosis and symptom onset was 54.9(±17.1) and 47.6 (±18.2 )years, respectively. 465 patients (89%) were treated operatively with a combination of stenting, venoplasty, and thrombolysis while 47 (9%) were managed conservatively with compression garments and/or anticoagulation only. The LCIV was most commonly affected, followed by the left external iliac vein. The predominant symptoms were lower extremity deep vein thrombosis in 341 (65%) patients, lower limb edema in 286 (54%), and varicose veins in 129 (24.6%). Of six patients with lymphedema workup, three(50%) showed asymmetric or delayed uptake on lymphoscintigraphy and the remaining three had normal studies.ConclusionIn our study, May-Thurner syndrome was an uncommon but significant cause of lower extremity swelling and venous thromboembolism, especially in middle-aged females. Patients with persistent symptoms after intervention may benefit from diagnostic workup for lymphedema and treatment. More research is needed on the co-occurrence of lymphedema with MTS and its pathophysiology.

ObjectivesLower leg edema is common in the late afternoon even in healthy individuals and could involve venous blood flows. Women appear more likely to develop lower leg edema, possibly due to the menstrual cycle. However, this phenomenon has not been quantitatively investigated using imaging. This study therefore used sonography to investigate sex-dependent impacts on physiological lower leg edema, in relation to venous blood flows in the legs and the menstrual cycle.MethodsParticipants comprised 54 healthy young adults (30 men, 24 women; mean age, 21 ± 1 years). Thickness of the papillary dermis and thickness and echogenicity of the subcutaneous adipose tissue were measured in the lower leg. Popliteal vein hemodynamics were investigated using Doppler sonography. Values were compared between late afternoon and morning. Each comparison was performed for men, women in the follicular, and women in the luteal phase.ResultsFor women in the luteal phase, papillary dermis and subcutaneous adipose tissue were thicker (median 0.20 mm, interquartile range [IQR] 0.12-0.25 mm vs median 0.33 mm, IQR 0.25-0.35 mm; p < .001 and median 5.0 mm, IQR 4.3-5.5 mm vs median 5.2 mm, IQR 4.5-6.2 mm; p = .013, respectively) and subcutaneous adipose tissue echogenicity was higher (median 66.9 IQR 64.1-70.5 vs median 71.7, IQR 65.0-76.7; p = .007) in the late afternoon than in the morning. The popliteal vein velocity-time integral (VTI) was lower in the late afternoon (median 33.0 cm, IQR 27.3-40.5 cm) than in the morning (median 26.1 cm, IQR 23.5-39.6 cm; p = .043). A significant negative correlation was observed between VTI and echogenicity (r = -0.549, p = .005). These findings were reduced in women in the follicular phase, and absent in men.ConclusionLate-afternoon lower leg edema may be associated with decreased leg blood flow in women, particularly in the luteal phase.

Objectives: This study aimed to examine the effects of a multimodal exercise program on edema, pain, exercise capacity, lower extremity muscle strength, and function in patients with lipedema.Methods: The patients diagnosed with lipedema were randomly assigned to either the exercise (n: 11) or control (n: 11) groups. The exercise group participated in supervised group exercises focusing on aerobic and strengthening, twice a week for 6 weeks. The control group received training on physical activity additionally lipedema management. Sociodemographic and clinical characteristics were recorded. Edema (circumference measurements and local tissue water-LTW%), pain intensity (Visual Analogue Scale-VAS) and pressure pain threshold (Algometer), functional exercise capacity (Six minute walk test-6MWT), lower extremity muscle strength (Handheld dynamometer), lower extremity muscle strength/endurance (Sit-to-stand test) and lower extremity function (Lower Extremity Functional Scale-LEFS) were evaluated.Results: In the exercise group, significant reductions in pain during rest, activity, and nighttime, 6MWT distance, quadriceps and hip muscle strength, lower extremity strength/endurance, and function were observed (p < .05). When comparing the groups, no significant differences were found (p > .05); however, clinically, there were differences in limb volumes, pain reduction, muscle strength, and functional improvements, with medium to large effect sizes.Conclusion: The main findings of this study highlight the benefits of structured multimodal exercises for patients with lipedema to improve pain, limb volumes, exercise capacity, lower extremity muscle strength, endurance, and functionality.Clinical trials number: NCT06811961.

ObjectiveLower extremity varicose veins are a common chronic venous disorder, affecting approximately 23% of adults globally. Although endovenous thermal ablation, particularly radiofrequency ablation (RFA), has become the preferred treatment, post-procedural deep vein thrombosis (DVT) remains a concern. The necessity of pharmacologic prophylaxis following RFA remains controversial. This study aimed to assess the efficacy and safety of short-term prophylactic rivaroxaban for DVT prevention after RFA.MethodsIn this single-centre, randomized controlled trial, patients with lower extremity varicose veins undergoing RFA, with or without Trivex-assisted phlebectomy, were recruited between August 2020 and December 2024. Participants were randomized to receive either rivaroxaban (10 mg daily for 5 days postoperatively) or standard preventive care including early ambulation and compression. All patients were followed for 1 month, with DVT incidence evaluated by B-mode ultrasonography.ResultsA total of 298 patients were enrolled. No DVT events occurred in the rivaroxaban group, while four cases (2.7%) were observed in the standard care group (p = .04). No major bleeding events were reported. Minor bleeding occurred in 4.7% of the rivaroxaban group and 2.7% of the control group (p = .35).ConclusionsShort-term prophylactic rivaroxaban significantly reduced DVT risk following RFA, with no significant increase in bleeding complications. These findings support its potential role in optimising perioperative thromboprophylaxis for varicose vein patients undergoing thermal ablation.

ObjectiveRisk of venous thromboembolism (VTE) is classically associated with recent surgery; additionally, long-haul air travel is a known VTE risk factor. This meta-analysis aimed to estimate the post-operative VTE risk associated with recent air travel.MethodsEmbase, Medline, Cochrane and Scopus databases were accessed from inception to May 2024. Inclusion criteria were any study design of participants undergoing surgical intervention with recent air travel, reporting VTE incidence. Papers were screened and data extracted independently by two reviewers, then pooled using fixed and random effects. The primary outcome was pooled VTE rate, with secondary outcomes of pooled rate of deep vein thrombosis (DVT) and pulmonary embolism (PE). Subgroup analyses of pre- and post-operative flight, flight >4 h and high VTE risk surgery were conducted. The ROBINS-I tool was used to assess risk of bias.ResultsSeven retrospective studies were included in the analysis, totalling 24,975 patients. The pooled VTE odds ratio (OR) in the flying plus surgery group was 1.96 (95% CI: 0.54-7.08). For surgery with post-operative flight, the VTE OR was 1.31 (95% CI: 0.63-2.71), whilst for surgery with pre-operative flight the OR was 7.86 (95% CI: 0.23-265.26). In a subgroup analysis of air travel >4 h, the VTE OR was 2.35 (95% CI: 0.29-19.36). In the subgroup analysis of high VTE risk surgery, the VTE OR was 1.20 (95% CI: 0.45-3.20). Three studies reported DVT/PE incidence specifically. For surgery and recent air travel, the pooled DVT rate was 0.67% (95% CI: 0.31%-1.51%) versus 0.45% (95% CI: 0.10%-2.00%) in surgery alone. For surgery and recent air travel, the pooled PE rate was 0.41 (95% CI: 0.00%-1.29%) versus 0.55% (95% CI: 0.31%-0.86%) for surgery alone.ConclusionThis meta-analysis suggests that air travel confers no additional VTE risk for patients undergoing surgical intervention. However, this does not account for confounding factors. Future research should risk score then propensity match participants to generate higher quality evidence.