Phlebology最新文献

BackgroundRecurrence of superficial venous incompetence is common following interventional treatment and a classification system (Recurrent Varices After Surgery, REVAS) has been developed. However, it is not known whether specific, predictable patterns of reflux occur following treatment nor how these may vary by treatment modality. This study aimed to explore varicose vein recurrence patterns according to procedural technique.MethodsFollowing PRISMA guidelines and a registered protocol (CRD42023455512), MEDLINE, Embase, and ClinTrials.gov were searched for randomized control trials (RCTs) on surgical or endovenous treatment of primary saphenous vein insufficiency with at least 1-year follow-up, and assessment of recurrence patterns. The primary outcome was reflux recurrence as per the REVAS classification. A random-effects network meta-analysis was conducted in R, calculating risk ratios and 95% confidence intervals (CIs).ResultsThe 3467 records identified yielded 23 unique RCTs, investigating 8 different modalities. Recurrence rates varied by anatomical section: saphenofemoral junction (SFJ) showed 23.6% cumulative recurrence, thigh perforators 7.6%, and lower leg perforators 4.7% recurrence. Endovenous laser ablation (EVLA) and foam sclerotherapy (FS) had higher risk of SFJ recurrence compared to HLS with a risk ratio of 2.29 (1.40-3.76) and 2.09 (1.20-3.62) (I² = 47.7%). EVLA was associated with a reduced risk of thigh perforator recurrence compared to HLS (0.45, (0.21-0.93)) (I² = 0%). FS was associated with higher risk of recanalization compared to HLS (4.05 (2.23-7.35)), and EVLA (3.14 (1.82-5.41)), Both EVLA and FS were associated with lower risk of neovascularization, compared to HLS; 0.28 (0.18-0.43) and 0.18 (0.08-0.40), respectively (I² = 0%).ConclusionRecurrence patterns varied by treatment modality, with HLS showing lower SFJ and ASV recurrence, while endovenous methods had less neovascularization and thigh perforator recurrence. Concerningly, only 13% of RCTs reported recurrence using REVAS. Improved reporting of varicose vein recurrence to delineate reflux sources will allow better technical outcome assessment and enhanced patient care.

BackgroundA novel PAI-1 inhibitor, MDI-2268, has been recently developed. The aim of the study was to evaluate the antithrombotic effects and safety of the MDI-2268 in acute venous thrombosis (VT) in vivo.MethodsC57BL/6 mice, 10-12 weeks old, weighing 20-25g, were used in electrolytic model of VT (EIM). MDI-2268 1.5 mg/kg (Group 1), MDI-2268 3 mg/kg (Group 2), enoxaparin 7.3 mg/kg (Group 3), and MDI-2268 1.5 mg/kg plus enoxaparin 1.8 mg/kg (Group 4) were compared to the controls (sham surgery). Animals were sacrificed on Day 2. Thrombus weight and tail bleeding time were measured.ResultsTW was 6.9 ± 3.3 (p > .05), 5.5 ± 1.6 (p = .016), 3.8 ± 1.3 (p = .032), and 4.8 ± 2.4 mg (p = .016) for groups 1, 2, 3, and 4, respectively, compared to the controls. Bleeding time was not significantly affected by the MDI-2268.ConclusionsMDI-2268 is a novel pro-fibrinolytic agent that demonstrates strong antithrombotic properties without prolongation of bleeding time in this experimental model.

ObjectiveTo evaluate the effectiveness and safety of High-Intensity Focused Ultrasound (HIFU) treatment in Chronic Venous Insufficiency (CVI) using a hemodynamic approach.MethodsThis real-world, observational, and retrospective study analyzed 80 patients with CVI from stage C2 to C5 (Clinical, Etiological, Anatomical, and Pathophysiological (CEAP) classification). A single vascular surgeon included and treated all patients consecutively between September 2022 and July 2023. Outcomes were assessed by Doppler ultrasound at 1-month and 1-year. The primary outcome was technical success (complete/partial occlusion by reducing reflux involving reduction in vein diameter >50%); the secondary outcomes included clinical improvement, measured by the Aberdeen varicose vein questionnaire (AVVQ) with visual analogue scale (VAS) and adverse effects. Descriptive statistics include 95% confidence intervals (CI). Subgroups were compared using Chi-squared/Fisher's or Student's t-test/Wilcoxon tests.ResultsTreated veins included great saphenous veins (GSV), small saphenous veins (SSV), anterior accessory saphenous veins (AASV), leg perforating veins (LPV), thigh perforating veins (TPV), perineal veins and GSV neocrosses. At 1-month follow-up, technical success reached 80.6% (95% CI 74.8-85.5%) of cases, with optimal outcomes for LPV (94.4%) and GSV (87.5%). Clinical improvement occurred in 78.8% of patients (68.81-86.54%). At baseline, patients were stratified into subgroups according to their CEAP stage. No significant difference in improvement rates was found across these subgroups (C2S: 78.7%, C3: 83.3%, C4: 75%, C5: 85.7%, p = 0.83). However, adverse events occurred in 21.8% of cases, the most frequent being neuropathic pain (5%) and skin burns (5%), all quickly resolved.One-year per-protocol analysis showed maintained technical success at 79% (73.8-83.9%) and clinical improvement at 95.2% (84.2-99.4%) despite the attrition of 36% of participants.ConclusionHIFU treatment demonstrates lasting effectiveness for CVI, particularly on LPV and GSV, with an acceptable safety profile. Limitations include a steep learning curve and anatomical constraints. Further studies are necessary for confirmation.

BackgroundEndothermal ablation (ETA) is a well-established treatment for chronic venous insufficiency (CVI). However, its effectiveness in patients with concomitant lipedema remains poorly described. Given the distinct pathophysiological features and symptom burden of lipedema, outcomes may differ in this subgroup.MethodsWe conducted a prospective cohort study of patients with CVI alone and those with CVI plus lipedema. All patients underwent ETA, with adjunctive phlebectomies as indicated. Quality of life (QoL) was assessed using the EQ-5D-VAS and CIVIQ-20 questionnaires before surgery and at 3 months postoperatively. Demographic and clinical variables included age, body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and symptom profile. The primary outcome was the change in CIVIQ-20 score at 3 months. Secondary outcomes included changes in EQ-5D-VAS and postoperative complications (hematoma, paresthesia, superficial and deep vein thrombosis).ResultsA total of 48 patients were included (32 with CVI alone, 16 with CVI and lipedema). Preoperative QoL impairment was significantly greater in the lipedema cohort (median CIVIQ-20: 61.0 [49.5-69.5]) compared with CVI alone (46.0 [33.0-56.0], p = .001). At 3 months, both groups demonstrated significant improvement (p < .001 for within-group change). However, the magnitude of improvement was greater in CVI alone (median reduction: -13.5 [-19.5 to -5.0]) than in CVI plus lipedema (-4.0 [-7.0 to -1.5]; p = .012). Multivariable regression identified higher baseline CIVIQ-20 (β = 0.60; SE = 0.09; p < .001) and lipedema status (β = 12.44; SE = 2.43; p < .001) as independent predictors of poorer postoperative CIVIQ-20 outcomes. Paresthesia was more frequent in lipedema patients (25.0% vs 18.8% at 1 month; 12.5% vs 6.2% at 3 months).ConclusionWhile ETA significantly improves QoL in patients with CVI, those with concomitant lipedema experience smaller gains and a higher rate of postoperative paresthesia. These findings highlight the importance of setting realistic expectations and counseling lipedema patients regarding potential outcomes of venous interventions.

ObjectivesCommercially available cyanoacrylates are known to release formaldehyde during degradation. However, it is unknown whether venous adhesive cyanoacrylates used in the treatment of saphenous veins release formaldehyde. Formaldehyde is a known contact allergen, carcinogen and sensitiser.MethodsVenaSeal^®, VenaBlock^®, Glubran^® Tiss 2, Histoacryl^®, and Supaglue^® were investigated in vitro. All adhesive agents were polymerised in phosphate-buffered saline, sealed in glass bottles and incubated at 37°C for up to 12 weeks. Headspace-gas chromatography mass spectrometry was used to measure formaldehyde release at set time intervals.ResultsPeak levels of formaldehyde were detected in all cyanoacrylate samples within 2 weeks of incubation, with peak levels ranging from 0.05% to 0.17% w/w. These peak concentrations emerged as early as 2 weeks post-polymerisation and remained consistently elevated throughout the 12-week observation period. Glubran Tiss 2 demonstrated the lowest formaldehyde release at 0.05% w/w, while VenaSeal exhibited the highest, reaching a peak of 0.17% w/w at 2 weeks, similar to commercial SupaGlue. Notably, VenaSeal maintained formaldehyde levels above 0.1% w/w for the duration of the 12-week testing period.ConclusionFormaldehyde is released during the post-polymerisation degradation of medical cyanoacrylates. Despite all products containing n-butyl cyanoacrylate (n-BCA), formaldehyde release varied-likely due to undisclosed formulation differences. VenaSeal released the highest level (0.17% w/w) compared to other products tested, suggesting that formulation influences degradation behaviour.

ObjectivesThis study analyzed the maintenance of venous caliber compared to nominal package values following the deployment of venous-specific stents.MethodsThis is a retrospective review of patients undergoing iliac vein stenting with Venovo (BD, Franklin Lakes, NJ) at a single institution. Stent diameters were measured with fluoroscopy, IVUS, and 1-month post-operative duplex sonography. These measurements were compared to nominal package stent diameter.ResultsThe study consists of 35 subjects with 75 stents deployed in the common iliac, external iliac, and/or the common femoral veins. Indications for treatment included post-thrombotic syndrome (57%), non-thrombotic venous obstruction (24%), and acute deep vein thrombosis (16%). For all stents, immediate post-deployment diameter, compared to nominal package diameter, changed by 5.2% by fluoroscopy (p = .01) and 4.4% by IVUS (p < .001). After deployment and venoplasty, post-deployment diameter for 16 mm stents was 14.8 mm by fluoroscopy (7.2% change; p = .004) and 15.0 mm by IVUS (6.3% change; p < .001) and 13.4 mm by fluoroscopy (4.1% change, p = .008) and 13.7 mm by IVUS for 14 mm stents (2.2% change, p = .307). Diameter at 1 month compared to immediate post-procedure stent diameter demonstrates a 5.1 % change (p = .16) and 4.4% change (p = .06).ConclusionVenous-specific stents demonstrate a 4.4% to 5.2% diameter decrease immediately post-deployment for 16 mm stents with no significant further reduction at 1 month. Optimal stent sizing to match expected venous diameters based on patient size is important to consider during venous reconstruction to prevent diameter reduction or stent recoil.

ObjectivesTo synthesize data on the prevalence, incidence proportion, and independent predictors of thromboembolism in adults with definite antiphospholipid syndrome (APS) and those with 'seronegative APS'.MethodsThis systematic review and meta-analysis included relevant studies published between 1 January 2000 and 27 February 2022 retrieved through electronic database (MEDLINE, EMBASE, and Web of Sciences) and hand searches. Data was synthesized narratively and through random-effects aggregate meta-analyses.ResultsWe summarized data from 138 studies involving 21,963 adults with APS. The pooled point prevalence of 'APS-classifying' thromboembolic events in the definite APS population was 74.3% for 'general thromboembolism', 51.3% for venous thromboembolism (VTE), and 36.0% for arterial thromboembolism. The pooled period prevalence of catastrophic APS was 2.2% and that of recurrent events was 22.3% for 'general thromboembolism', 8.2% for arterial thromboembolism, and 14.3% for VTE. Pooled incidence proportions during definite APS follow-up were 20.4%, 15.2%, and 8.9% for 'general thromboembolism', arterial thromboembolism, and VTE, respectively. Based on very low to low level of evidence, lupus anticoagulant (LA) seropositivity and hypertension were major independent predictors of VTE and arterial thromboembolism, respectively. The pooled point prevalence of 'APS-classifying' thromboembolic events in the 'seronegative APS' population was 64.8% for 'general thromboembolism', 19.3% for arterial thromboembolism, and 31.9% for VTE.ConclusionsWe found a high burden of thromboembolism among adults with Sapporo and Sydney criteria-based APS and those with 'seronegative APS'. Based on very low to low level of evidence, LA is potentially an independent predictor of VTE and hypertension an independent predictor of arterial thromboembolism. Additional studies with standard methods are needed to improve the existing prediction models for thromboembolism in individuals with APS.

ObjectivesThrombolytic therapy can eliminate thrombotic masses from the deep veins, but its effectiveness is not always predictable. We hypothesize that blood flow may influence the composition of an acute venous thrombus contributing to unpredictable outcomes. The aim of the study was to take advantage of two available well-established models to compare venous thrombus composition under flow and stasis conditions in vivo.MethodsC57BL/6 mice, 10-12 weeks old, weighing 20-25g, were used in electrolytic (EIM) and ligation (LM) models of VT. Four groups (n = 5) were used to compare the structure of acute (Day (2) and subacute (Day (6) thrombus in the EIM and LM. Venous thrombus was harvested for thrombus weight (TW) measurement and histology. Expression of PAI-1, t-PA, u-PA, and alfa-2-antiplasmin in the vein wall and D-dimer levels in plasma were investigated at Day 2 and 6.ResultsAcute venous thrombus within the EIM was significantly smaller compared to LM (6.2 ± 3.6 vs 26.2 ± 3.6, P < .05). Thrombus formed within the EIM had a significantly higher amount of plasminogen, especially on the surface and in the tail of the thrombus. In addition, a significantly higher concentration of circulating D-Dimer was found within the EIM.ConclusionsRegional venous blood flow pattern may significantly affect the structure and composition of the venous thrombotic masses. Non-occlusive thrombus has a higher potential to be targeted by the fibrinolytic system and fibrinolytic therapy due to a higher plasminogen content and accessibility for plasminogen activators.

BackgroundLipedema is a chronic disorder involving abnormal accumulation of subcutaneous fat, primarily in the lower limbs. Liposuction is an effective treatment, but postoperative complications such as fluid retention and seroma formation are common. While the use of surgical drains is well established in other areas of plastic surgery, their role in lipedema liposuction remains unclear.MethodsThis prospective observational study involved 50 consecutive patients with stage II or III lipedema who underwent lower leg liposuction. A novel passive drainage technique was used, involving glove drains fashioned from sterile, powder-free nitrile gloves and inserted through existing liposuction incisions. Drain duration, postoperative swelling, and complications, particularly seroma formation, were evaluated.ResultsAll patients completed follow-up with no major complications. Glove drains remained in place for an average of 2.4 ± 0.5 days. Only 2 patients (4%) developed seromas requiring single aspiration. No infections, hematomas, or lymphatic complications were recorded. Patients reported reduced swelling and discomfort compared to historical cases without drains.ConclusionPassive glove drains appear to be a simple, safe, and effective method to manage postoperative fluid collections after lipedema liposuction of the lower legs. The technique may lower the risk of seroma formation and promote early recovery, characterized by reduced postoperative edema, improved patient comfort, and an uncomplicated short-term postoperative course. Further controlled studies are needed to validate these findings and establish standardized drainage protocols in lipedema surgery.