Phlebology最新文献

Introduction: Venous leg ulcers (VLU) are the most severe manifestation of venous insufficiency and carry a poor prognosis because of delayed healing and recurrent ulceration. Pentoxifylline (PTX) is an example of a vasoactive medication that can be used alongside compression therapy to help improve ulcer healing rates. A previous review highlighted improved healing of VLU with PTX, although no analysis was made for complete ulcer healing and recurrence following treatment.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, MEDLINE and Cochrane databases were searched for all relevant English-language human studies between January 1980 and August 2023. Two independent authors screened and reviewed all articles for inclusion, performed data extraction and assessed methodological quality according to Cochrane's risk of bias tool. Primary outcomes included complete ulcer healing and recurrence rates in the ipsilateral limb.

Results: Ten studies were eligible for analysis, of which nine were randomised trials and one was an observational cohort study. There were a total of 1,025 participants, with 515 having received PTX. In those receiving 1200 mg PTX, venous leg ulcers healed in 62% (315 participants). Compared to controls, PTX administration was associated with a significantly higher likelihood of complete ulcer healing (OR 2.56, 95% CI 1.97-3.32, p < .001). The rate and time of ulcer recurrence were not recorded in any of the studies included.

Conclusion: The evidence demonstrates that PTX may have a significant beneficial impact on the rate of complete ulcer healing. Little evidence is currently present in the literature evaluating the recurrence rates of ulcers following PTX treatment. Large scale, high quality RCTs with an adequate follow-up period are needed to evaluate this and assess whether treatment with PTX shows a significant benefit in prevention of recurrence in venous ulcers.

Objective: A single-center retrospective cohort study was conducted to identify potential risk factors that lead to increased incidence of intravascular coagulum (IC) observed in clinical practice using polidocanol endovenous microfoam (PEM 1%, Varithena^TM [polidocanol injectable microfoam], Boston Scientific, Marlborough, Mass).

Methods: Patients (n = 119) who received polidocanol endovenous microfoam (PEM) treatment for chronic venous insufficiency between December 2021 and January 2024 at a private outpatient vascular surgery clinic were observed to identify potential risk factors in the development of IC. The patients were stratified into two groups: IC (n = 16) versus non-IC (n = 103). Patients who returned with increased pain and irritation at the treatment site in the early post ablation period within 2-6 weeks of treatment and had coagulum aspirated at the subsequent follow-up visit met the study criteria and were included in the IC group. In addition, patient demographics, comorbidities, and duplex ultrasound reports were analyzed using deidentified chart records.

Results: There were 119 patients treated in the study period with a mean age of 62 years. Females were the most common sex 66% (n = 78) and Latinos represented the largest ethnicity 60% (n = 71). Overall, 13% (n = 16) of the patients developed an intravascular coagulum. The mean time to onset of IC was 45 days (range: 7-106 days) post-ablation. There was no difference between the groups (IC vs non-IC) for age, sex, ethnicity, or index VCSS scores. On univariate analysis, patients who developed IC had lower PEM injection volumes when compared to non-IC patients (4.1 vs 6.3 mL, p = .04). High reflux at the GSV (>1800 ms) and Latino ethnicity were also found to be significant risk factors. When these factors were evaluated in multivariate analysis, lower PEM injection volumes was the only factor that remained significant for the development of IC (p = .006).

Conclusion: Lower polidocanol endovenous microfoam injection volumes is a risk factor for developing intravascular coagulum. Further studies are needed to identify the ideal injection volume per segment of vein treated.

Introduction: Vascular malformations (VascM) are difficult to diagnose and manage because of their heterogeneous presentations. Ultrasound represents the first imaging exam for patients with vascular malformations. In some cases, additional and sometimes functional imaging will be necessary to confirm the diagnosis or to highlight a vascular network of drainage. Doppler ultrasound could be not enough and a certain number of complementary examinations are then required. Contrast-enhanced ultrasound (CEUS) is used in current practice in the vascular field and in particular the monitoring of aortic stents.

Method: We present here the interest of using CEUS in VascM through a review of the literature. The search was carried out from Pubmed from 1975 to 2023 using the following keywords « vascular malformation » and « contrast enhanced ultrasound » / « venous malformation" and "contrast enhanced ultrasound"/ "venous malformation and contrast enhanced ultrasound".

Results: The first search found 887 articles. Among them, 124 articles were retained after the selection of the formats. After reading the abstracts, only 9 articles were retained due to the non-selection of articles dealing with other explorations or irrelevance, as they did not deal with vascular malformation. At the end, 17 articles were selected.

Discussion and conclusion: CEUS allows very usefull dynamic analysis of the perfusion in the diagnosis of VascM . CEUS with time analysis is a promising imaging method for the evaluation of perfusion before and after percutaneous treatment of vascular malformations. Area under the curve reduction indicates therapy-induced changes in perfusion. Nevertheless, CEUS is not yet a standardized test for diagnosing or characterizing peripheral vascular malformations. However, its safety allows it to be used for the diagnosis and even the follow up of the VascM. Unfortunately, we haven't been able to find any randomized studies comparing CESU with other techniques.

Background: to compare different anesthesia protocols during High Intensity Focused Ultrasound (HIFU) for saphenous trunk (GSV/SSV) and/or varicosities incompetence treatment.

Material and methods: patients with GSV/SSV incompetence with varicose veins underwent HIFU under different anesthesia protocols. The primary endpoint was the pain score during HIFU using a 10-point scale.

Results: Out of 262 legs analyzed, main pain score was 1.03 ± 1.27. Intradermal + oral anesthesia treatments resulted in less procedural pain if compared with intradermal ± perivenous protocols (1.30 ± 0.19 vs 0.81 ± 0.09; p = .001). Conversely, perivenous injection decrease early complete recanalization rate.

Conclusion: These preliminary results suggest that HIFU is an almost pain-free procedure. Procedural pain could be further minimized by using specific intradermal + oral anesthesia treatments, despite perivenous anesthetic could improve postoperative outcomes.

Objectives: To analyze the distribution of incompetent segments in the great saphenous vein (GSV) in Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification C2 limbs to provide a reference for appropriate diagnosis and treatment planning.

Methods: We analyzed the distributions of incompetent segments in the GSVs of the C2 lower extremity undergoing duplex ultrasound from September 2017 to December 2023. The examined segments were the saphenofemoral junction (SFJ), GSV at the proximal thigh, GSV at the knee, and GSV below the knee.

Results: A total of 696 lower limbs from 540 patients (male 256, female 440) was analyzed. The mean age was 56 (ranging from 18 to 86), and the mean body mass index (BMI) was 24.0 kg/m². There were 15 types of distribution of incompetent segments within the GSV, with the most common type (32.6%) being reflux from the SFJ to the GSV below the knee. Among the lower limbs with reflux at the SFJ, GSV at the proximal thigh or knee was competent in 10% of lower limbs. In the lower limbs with reflux at the proximal thigh GSV, 26% did not have reflux at the SFJ. The presence of reflux in each segment did not differ by sex, but those with reflux in the below-knee segment were older than those without reflux(p = .003). In each of the three segments above the knee, limbs with reflux had a higher BMI than those without reflux.

Conclusions: The most common distribution type was reflux from the SFJ to the below-knee segment, although this only accounted for about one-third of the cases. Various distribution types of incompetent segments within the GSV were identified, suggesting that reflux testing in multiple segments according to the latest guidelines for ultrasound examination of the lower extremity veins is necessary to avoid unnecessary treatment of segments without reflux.

Although the implantation of the totally implantable venous access ports globally is increasingly sophisticated, there is still a dearth of absolute standardization in the technical choice of each surgical step, with numerous technologies demonstrating significant applicability. This review comprehensively summarizes the diverse choices of implantation procedural techniques related to the pocket location, vein access, port specification, catheterization method, puncture guidance, single-incision technique, catheter tip positioning method, port fixation, skin closure, and first-use period. The aim is to provide surgeons with alternative options when they encounter different problems in each procedure due to the diverse clinical characteristics of patients during venous port implantation.

Objective: Localized intravascular coagulation (LIC) is a unique phenomenon associated with venous malformations (VMs). This study investigated the changes in LIC related indexes following sclerotherapy of VMs and its correlation with therapeutic efficacy.

Methods: From August 2019 to September 2023, patients who met the following criteria were enrolled into this study: (1) individuals with venous malformations accompanied by LIC; (2) those who had undergone a minimum of three sclerotherapy sessions; (3) blood coagulation function tests were conducted prior to each treatment; and (4) magnetic resonance imaging (MRI) scans were conducted both before and after three times of treatment. Those who fail to meet with the previous inclusion criteria were excluded. The coagulation profile prior to each sclerotherapy treatments was assessed. The therapeutic outcomes were evaluated at the end of treatment.

Results: A total of 21 patients were enrolled into the study, with the age ranging from 4 to 61 years old. Elevated D-dimer levels, with or without a decrease in fibrinogen (FIB) and an increase in fibrin degradation products (FDP) are clinical features of VMs with LIC. The coagulation indexes tend to settle down with several sclerotherapy treatments. There were 5 cases in the significantly improved group, 13 cases in the improved group, and 3 cases in the no improved group when it came to efficacy assessment. The better therapeutic efficacy is more pronounced the improvement of LIC.

Conclusions: LIC gradually returns to normal during sclerotherapy, and the degree of recovery is directly related to the treatment's efficacy. One useful metric to evaluate the effectiveness of sclerotherapy for VMs is the improvement of LIC.

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.