Phlebology最新文献

ObjectiveChronic pelvic pain (CPP) is a debilitating condition affecting a quarter of premenopausal women and has been associated with pelvic vein incompetence (PVI). Catheter venography (CV) is the standard investigation, although transvaginal duplex (TVDU) ultrasound has emerged as a promising alternative. The accuracy of TVDU compared to CV is undefined and the optimal reflux time measured by TVDU to diagnose PVI is unknown. This study aimed to establish the diagnostic accuracy of TVDU in those with suspected PVI.MethodsThis cohort study included women enrolled into a randomised controlled trial comparing pelvic vein embolisation to no treatment, who underwent both TVDU and CV. Three consultant vascular interventional radiologists, blinded to TVDU results, independently reviewed catheter venograms. Reflux in bilateral ovarian and internal iliac veins was reported as a binary outcome. Pelvic reflux times, in both supine and semi-standing positions, were retrieved from TVDU reports. Diagnostic accuracy of TVDU was assessed using CV as the comparator. Sensitivity, specificity and area under the ROC curve (AUC) were calculated.Results124 pelvic veins were analysed in 31 women. For a diagnostic reflux time threshold of 500 ms, TVDU had a sensitivity of 64% and specificity of 78% (AUI 0.71,95%CI 0.66-0.76). For a threshold of 700 ms, TVDU had a sensitivity of 74% and a specificity of 78% (AUI 0.76,95%CI 0.71-0.80). For a threshold of 700 ms, TVDU performed semi-standing had a sensitivity of 78% and specificity of 78% (AUC of 0.78,95%CI 0.72-0.84) as compared to TVDU performed supine which had a sensitivity of 70% and specificity of 78% (AUC 0.74,95%CI 0.67-0.80).ConclusionsTVDU demonstrates good diagnostic accuracy for PVI using a 700 ms reflux time threshold. Performing the test in a semi-standing position optimises accuracy. TVDU has potential as a diagnostic tool and may eliminate unnecessary invasive investigations, thus preserving catheter venography for intention to treat.

IntroductionVenous leg ulcers (VLUs) pose significant challenges that adversely affect patients' quality of life and result in considerable economic burdens. While existing compression therapies are effective, they are often hindered by complexity, discomfort, and environmental concerns.ObjectivesThis study aimed to evaluate the performance and safety of the adjustable Velcro system Compreflex®, an alternative to traditional four-layer bandaging, for patients with chronic venous leg ulcers. The evaluation was conducted through a clinical follow-up trial.MethodsThis prospective, non-randomized, multicenter, single-arm study included 98 patients with VLUs. The Compreflex® Standard Calf and Foot device was assessed based on wound closure rates, patient satisfaction, and edema reduction. Patients were followed up at specific intervals: after 1, 12, and 26 weeks. ResultsOf the 98 enrolled patients, 19 discontinued participation. The mean ulcer area decreased from 52.9 cm² (95% CI, 35.9-69.9 cm²) to 37.4 cm² (95% CI, 20.0-54.7 cm²) at 26 weeks (p < .001). The wound closure rate at 26 weeks was 24.3% (95% CI, 16.6-34.9%). Challenges related to self-application were minimal, highlighting the device's usability. A patient satisfaction rate of 76.8% was reported, based on a satisfaction score of six or higher.ConclusionThis study provides valuable real-world evidence supporting the effectiveness and usability of the Compreflex® device, as demonstrated by the high patient satisfaction rate, and highlights its potential as a promising alternative in compression therapy for venous leg ulcers.

ObjectiveTo compare the efficacy of Autologous Platelet-Rich Fibrin (PRF) versus Normal Saline (NS) dressings in healing Chronic Venous Leg Ulcers (CVLUs), focusing on ulcer area reduction and quality of life.MethodsA randomized controlled trial was conducted at a tertiary care center involving 74 patients with chronic venous leg ulcers (CVLUs). Patients were randomized into two groups: Group A (n = 36) received autologous platelet-rich fibrin (PRF) dressings with four-layer compression therapy, while Group B (n = 38) received Normal Saline (NS) dressings with four-layer compression therapy. Ulcer area and Quality of Life were assessed at baseline and at predefined intervals up to 4 weeks, with continued follow-up for 6 months. The quality of life was assessed using the Charing Cross Venous Ulcer Questionnaire (CCVUQ) and the EuroQol-5 Dimension-5 Level (EQ-5D-5L) scores.ResultsBoth groups showed a reduction in ulcer area over time. In the PRF group, mean ulcer area decreased significantly from baseline to 4 weeks (17.46 ± 11.52 cm² to 9.92 ± 8.73 cm²; p = 0.007), whereas the reduction in the saline group was not statistically significant (14.07 ± 14.43 cm² to 11.45 ± 12.02 cm²; p = 0.913). Between-group comparison at 4 weeks was not significant; however, from 4 weeks onward, the PRF group consistently demonstrated smaller mean ulcer areas, with the greatest difference observed at 6 months. CCVUQ and EQ-5D-5L scores improved over time in both groups, with a transient between-group difference favoring PRF at 4 weeks for CCVUQ but no sustained head-to-head superiority in quality-of-life outcomes.ConclusionAutologous PRF, when used as an adjunct to standard compression therapy, is associated with earlier and sustained reduction in ulcer area and improvement in ulcer-related Quality-of-Life in patients with chronic venous leg ulcers. No treatment related adverse events were observed during the study period.

AimTo analyse the patterns of reflux in incompetent left ovarian veins (LOV) in women with associated symptoms and/or signs, to assess whether the progression of reflux is descending or ascending.MethodsWe retrospectively reviewed pelvic venous duplex ultrasound reports from women assessed for suspected pelvic venous reflux (PVR) and/or pelvic venous disorders (PeVD) (previously pelvic congestion syndrome) at our unit between January 2016 and July 2017. All examinations included transvaginal duplex ultrasonography (TVUS) and transabdominal duplex ultrasonography (TADUS), performed by vascular technologists using our published protocol. LOV reflux was categorised as: (i) total reflux, (ii) distal reflux with proximal competence, or (iii) proximal reflux with distal competence.ResultsIn total, 317 women presenting with leg varicose veins with duplex evidence of reflux coming from the pelvis and/or symptoms of PeVD underwent TVUS and TADUS. Of these, 165 had reflux in the left ovarian vein (LOV); 108/165 (65%) demonstrated total LOV incompetence, 2/165 (1%) had proximal reflux without any distal reflux, and 55/165 (33%) showed distal-only LOV reflux. However, two of the distal-only LOV reflux had collaterals arising from the renal venous system. One of these has a true nutcracker syndrome. Of the two patients with proximal-only LOV reflux, one had symptomatic nutcracker syndrome, and the other had previously undergone left oophorectomy and was missing the distal LOV.ConclusionsThese results show that two reflux patterns predominated: total LOV reflux and distal-only LOV reflux. Isolated proximal reflux was rare. This distribution is consistent with a distal-to-proximal (ascending) pattern of reflux progression within the LOV. However, further prospective longitudinal studies are required to determine whether distal-only reflux represents an early stage in an ascending progression pathway.

BackgroundEndovenous laser ablation (EVLA) has become a standard treatment for saphenous trunk reflux. However, its application to tributary varicose veins-referred to as varicose vein ablation (VVA)-has not been well recognized. Early reports using bare-tip fibers were associated with relatively high rates of postoperative complications, including skin burns and nerve injuries, which limited worldwide acceptance of this approach.MethodsThis narrative review summarizes 14 relevant publications, including a recent Japanese multicenter study and guideline development initiatives. Particular attention is given to the introduction of a 1470-nm radial 2-ring slim fiber (R2SF), its technical characteristics, and nationwide clinical experience in Japan. Educational and certification programs initiated by the Japanese Society of Phlebology are also reviewed.ResultsThe R2SF enables uniform endovenous laser ablation via a 16-G venous needle without skin incisions. A Japanese multicenter study involving 400 cases demonstrated complete vein occlusion at 1 month in all treated veins, with no severe complications. Based on accumulating clinical data, the 2025 Japanese guidelines recognized VVA as the third treatment option alongside stab avulsion and sclerotherapy. The author's experience of over 1700 cases further supports low complication rates and favorable cosmetic outcomes. Transient subdermal induration is relatively common but resolves spontaneously without infection or skin damage.ConclusionsVVA using an R2SF represents a safe, minimally invasive, and incision-free approach for treating tributary varicose veins. The Japanese experience, supported by guideline endorsement and national training systems, suggests that VVA may complement some limitations of stab avulsion. Long-term observation and international validation are necessary.

BackgroundIt is mostly challenging to ablate great saphenous vein (GSV) completely including the below-knee level.ObjectiveThe aim of this study was to evaluate the effectiveness of cyanoacrylate ablation (CAA) and catheter directed foam sclerotherapy (CDFS) combination in full length ablation of GSV with mid-term results.Materials and MethodsPatients undergoing CAA and CDFS of the GSV between January 2015 and December 2021 were reviewed. Preoperative and postoperative CEAP class, symptoms, recurrence, and Doppler findings were compared.ResultsPostoperative overall closure rate at the first year was 99.5% ± 0.01 and at 5 years was found to be 93.8 ± 0.02%. Symptom free survival rate at the first year was 98.8% ± 0.01 and the cumulative 5-years symptom free survival rate was 73.0 ± 0.10%. Venous Clinical Severity Scores decreased from 5.9 ± 1.3 to 0.8 ± 0.4. Aberdeen Varicose Vein Questionnaire scores decreased from 19.7 ± 6.1 to 4.7 ± 1.8.ConclusionWhen techniques are evaluated, CAA and CDFS combination (Glue + Foam) may be preferable as a simple and shorter application with full-length complete occlusion of GSV and less early postoperative discomfort. Long-term outcomes and cost analyses of larger series still need to be documented.

BackgroundA variety of minimally invasive thermal and non-thermal techniques to treat superficial truncal vein reflux have been introduced over the past 2 decades. Among these has been polidocanol endovenous microfoam (PEM, VarithenaTM). This position statement reviews the clinical results of the use of PEM in chronic venous disease as well as those situations where PEM may have distinct advantages over other endovenous modalities.MethodAn expert panel of the American Vein and Lymphatic Society reviewed the literature, focusing on the clinical outcomes and unique advantages associated with the use of PEM.ResultIn vitro, ex vivo, and clinical studies have shown PEM to have greater stability and efficacy than physician compounded foam, while other studies have demonstrated saphenous closure rates and clinical outcomes similar to those achieved with thermal ablation. Despite the benefits across the spectrum of chronic venous disease, PEM may have advantages in minimizing the risk of nerve injury associated with treatment of the below knee reflux, treating venous ulcers, and managing recurrent varicose veins and difficult saphenous anatomy due to tortuosity or intraluminal synechia.ConclusionAs the only FDA approved foam sclerosant, PEM provides flexibility in treating patients with standard, variant, and recurrent venous anatomy. The American Vein and Lymphatic Society supports PEM as a safe and effective treatment option for the treatment of C2-C6 disease associated with superficial venous reflux.

This study aimed to evaluate the value of ultrasonography in differentiating primary vascular tumors from deep vein thrombosis (DVT), a common misdiagnosis. We retrospectively analyzed the ultrasound data of five patients with primary vascular tumors initially misdiagnosed as DVT who were treated at our hospital from January 2018 to December 2024. Our findings revealed characteristic ultrasound features unique to these tumors; however, these distinguishing features were frequently overlooked or misinterpreted during initial assessments. This study highlighted the importance of careful analysis of ultrasound image characteristics, recommending the following strategies to improve diagnostic accuracy, considering clinical manifestations, using advanced ultrasound techniques (e.g., elastography and contrast-enhanced ultrasound), and strengthening interdisciplinary collaboration between ultrasonographers and vascular surgeons. These insights are of significant importance in improving early diagnosis and reducing misdiagnosis of primary vascular tumors.

ObjectivesTo assess the incidence of secondary telangiectasias (TAEs) after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) and discuss the possible risk factors for its development.MethodThis prospective observational study enrolled 123 lower limbs of 103 patients with varicose veins of C2 or C4 clinical classes who underwent EVLA of the GSV trunk from the saphenofemoral junction to the below knee level without simultaneous removal of varicose tributaries and/or perforating veins. The primary outcome was the occurrence and amount of secondary TAEs (matting) that developed at the medial aspect of the thigh along the treated GSV within a 3-month follow-up. The assessment was made by analysis of before and after photos by three experienced surgeons using a four-point scale. Fleiss' Kappa was used to measure the agreement between the assessors.ResultsSecondary TAE development was reported in 26 limbs (21.1%; 95% CI, 15.0-29.0%). Almost perfect agreement was observed between assessors for any matting (κ = 0.92; p < .0001) and different amounts of it (κ = 0.93, κ = 0.90, κ = 0.85, and κ = 1.00 for the score of 0, 1, 2, and 3, respectively). The most prevalent was a low amount of new TAEs (score of 1 in 17.9%). The only significant difference between the patients with and without secondary TAEs was age: 52.5 (IQR, 43-61) versus 40 (IQR, 34-53) years old.ConclusionsIn most cases (96,8%), secondary TAEs are either absent or could be found in a low amount. Older patients are more predisposed to its development.