Phlebology最新文献

ObjectivesTo compare gait parameters, functionality (muscle strength, balance, exercise capacity) and health status (kinesiophobia, fatigue, quality of life) in lower extremity lymphedema patients and healthy controls and to determine correlations between exercise capacity, gait parameters, muscle strength, balance, quality of life and lymphedema severity.MethodsTwenty-two lymphedema patients and 20 healthy controls participated in the study. Participants' demographic and medical characteristics were recorded. Muscle strength, endurance, balance, functional exercise capacity, gait parameters, kinesiophobia, fatigue and quality of life were assessed with dynamometer, 30-s chair stand test, Biodex, 6-min walk test (6MWT), 8-m test (8-MWT), Tampa Scale, Fatigue Severity Scale and Short Form-36, respectively.ResultsLymphedema patients had lower muscle strength and endurance, 6MWT distance, speed, cadence and stride length, 8-mWT speed, cadence and left stance phase, and higher swing phase-left and single support phase-right compared to healthy controls (p < .05). Balance parameters were worse in lymphedema patients compared to healthy controls (p < .05). Quality of life was lower and kinesiophobia and fatigue levels were higher in lymphedema patients compared to healthy controls (p < .05). Significant correlations were found between 6MWT distance, speed and stride length, 8-mWT speed and stride lengths and lymphedema severity, muscle strength, balance, and quality of life (p < .05). Multiple regression analyses identified balance and lymphedema severity as predictors for 6MWT distance, speed, and stride length.ConclusionsLymphedema patients have reduced muscle strength, exercise capacity, quality of life, and increased kinesiophobia and fatigue. Lymphedema negatively impacts gait and balance. Gait parameters are correlated with muscle strength, balance, quality of life and lymphedema severity in lymphedema patients.

BackgroundTwo-component cohesive compression systems are available for compression therapy.ObjectivesTo assess the sub-bandage pressure and stiffness of the two-component compression systems, Coban and CoFlex, and to investigate how an additional partial compression layer after two hours and the experience of the therapist impact these outcomes.MethodsThe study examined 19 patients whose lower limbs were bandaged by either a trainee or an experienced physical therapist. Sub-bandage pressures were measured using PicoPress® sensors placed 10 cm and 25 cm proximal to the medial malleolus. Additionally, the Static Stiffness Index (SSI) and Dynamic Stiffness Index (DSI) were calculated.ResultsThe addition of a partial compression layer on the ventral side of the leg significantly increased sub-bandage pressure and DSI. SSI effects were significant at 10 cm, but not at 25 cm height. Coban generated significantly higher pressures than CoFlex, while the level of experience of the therapist showed no significant influence.ConclusionsThe addition of a partial compression layer effectively increases sub-bandage pressure, with Coban exerting higher pressure than CoFlex. However, the level of experience of the therapist does not significantly influence the compression outcomes.

BackgroundDeep vein thrombosis (DVT) is a significant health concern, early diagnosis and treatment are essential for reducing morbidity and mortality. Over recent years, ultrasound has become the preferred diagnostic tool for DVT due to its non-invasive nature, real-time imaging capability, and high accuracy. This study aims to assess the state of ultrasound-based DVT research through bibliometric analysis.MethodsA bibliometric analysis was conducted on publications related to ultrasonographic research in DVT between 1995 and 2024. Data were retrieved from the Web of Science Core Collection using specific search terms. The analysis employed tools such as VOSviewer, R-bibliometrix, and CiteSpace to assess publication trends, country and institutional contributions, collaboration networks, and emerging research topics.ResultsA total of 10,669 publications were identified, with an annual growth rate of 12.61%. The USA had the highest number of publications (2689), and Harvard University was the most productive institution with 470 publications. The most prolific author was Gary S. Mintz (96). The leading journal in the field was the Journal of Vascular Surgery, with 261 publications. Keyword analysis identified "thrombosis," "ultrasound," and "diagnosis" as central themes. The frequency of these keywords indicates that the research primarily focuses on various aspects of thrombosis formation mechanisms, diagnosis, management, prevention, and treatment.ConclusionThis bibliometric study provides a comprehensive overview of the growing field of ultrasound-based DVT research, highlighting key contributions from leading countries and institutions. The continued advancement of imaging technologies and a focus on personalized treatments are expected to drive future research.

Aim: To assess the safety and efficacy of endovenous ablation of great saphenous varicose veins with flush ablation at the saphenofemoral junction.Methods: A retrospective study was conducted on consecutive patients with varicose veins related to the great saphenous vein (GSV) and undergoing endovenous thermal ablation between January 2020 and July 2024. All patients underwent either endovenous laser or microwave ablation. Primary endpoints included technical success and absence of endothermal heat-induced thrombosis (EHIT) ≥ 2. Secondary endpoints included deep vein thrombosis (DVT), pulmonary embolism (PE), recurrence, days to return to normal daily activity, and reintervention. Follow-up was performed at 1 week, 6 months, and annually thereafter. Technical success was defined as successful flush catheter placement at the SFJ under duplex guidance. Recurrence was assessed through clinical examination and duplex ultrasound.Results: 69 patients (79 limbs) were included with a mean age of 39.1 ± 12.5 y, and 30 were of male sex (43.5%). Technical success was achieved in all limbs. EHIT ≥2 was not documented at the first postoperative outpatient visit, and no DVT or PE were noted during follow-up (20.4 ± 11 months). Recurrence was documented in 2 limbs (2.5%). One limb required surgical reintervention, and the days to return to daily activity recorded a median of 15 days (IQR 10 - 30).Conclusion: Flush endovenous ablation may be a safe and effective technique for treating great saphenous varicose veins, demonstrating a low incidence of recurrence and deep vein thrombosis while maintaining high technical and clinical success rates. Our findings contribute to the growing body of evidence supporting flush ablation strategies and highlight the need for further research to optimise procedural guidelines.

ObjectiveThe physiological effects produced by the calf pump are essential in multiple aspects of vascular health, and their absence leads to stasis which directly relates to venous insufficiency. Therefore, muscle activity has been considered a key element in calf pump function. In the present study, we used a mechanical foot board with passive range of motion including stimulated dorsiflexion and plantar flexion and compared the hemodynamic effects to those obtained during active voluntary movement.Methods11 healthy adult volunteers participated in an intervention study. In Intervention 1, the participants performed voluntary dorsiflexion and plantar flexion, and in Intervention 2, the same participants used the passive PumpCare^® device (OAK Healthtech, Brazil). Both legs were examined, but data were collected from the right leg. Femoral vein blood flow was assessed by ultrasound, and venous pump capacity (V₀) by photoplethysmography. Anthropometric data were collected to investigate their correlation with femoral vein blood volume.ResultsThe mean femoral vein blood flow was 286 mL/min with active calf movements and 288 mL/min with passive calf movements (p = .929). Flow peaks were produced during dorsiflexion, that is, during stretching of the posterior muscle groups, returning to baseline levels after stopping the movement in both interventions. The mean maximal venous pump capacity measured by photoplethysmography was 3.7% with active calf movements and 3.5% with passive calf movements (p = .141).ConclusionIn this study, passive calf movements were able to promote a mean femoral vein volume flow comparable to the physiological effect produced by active calf movements in healthy adults. This appears to contradict the current understanding of the importance of calf muscle contraction in producing venous return.

The venous system plays a key role in clinical practice but remains underassessed due to the limited accessibility of conventional imaging tools. Near-infrared reflection illumination (NIRI) devices ("vein finders"), though recently introduced to assist venipuncture, have potential for broader vascular assessment. Our aim was to investigate the feasibility of a NIRI device to quantify the morphology of superficial hand veins and evaluate their response to a transient hemodynamic stress induced by suprasystolic limb occlusion. The dorsal hand veins of 14 healthy adults (21.5 ± 4.2 y.o.) were continuously recorded during a procedure consisting of a 5 min baseline, 3 min arm occlusion (200 mmHg), and 3 min recovery phases. Morphological parameters including vein width, branching angles, asymmetry indices, junctional exponent deviation, and optimality ratio, were extracted from three metacarpal veins and their tributaries. Nonparametric statistics were used to compare parameters between phases (p < .05). Occlusion led to a significant increase in the width of both receiving and tributary veins (p < .001), reflecting venous pooling. However, branching geometry remained largely unchanged, suggesting structural resilience. Junctional exponent deviation remained low, in agreement with Murray's law. Near-infrared vein finders enable real-time, non-invasive assessment of superficial venous morphology and compliance. Their sensitivity to dynamic vascular changes, combined with potential for integration with automated analysis tools, supports their broader use in vascular diagnostics, preoperative planning, and bedside monitoring.

BackgroundPelvic venous disorders (PeVD) are a recognized cause of venous origin chronic pelvic pain (VO-CPP) in women. However, the prevalence and management of PeVD in patients with lower extremity varicose veins remain understudied. This study assesses the incidence of PeVD among women with superficial venous insufficiency (SVI) and evaluates the role of transvaginal ultrasound (TVUS) as a screening tool.MethodsA retrospective analysis was conducted on 350 female patients with SVI (CEAP C2-C6) from January 2021 to December 2023. SVI was confirmed by duplex ultrasound (DUS). All patients were evaluated for CPP at the initial visit. In those with CPP, pelvic symptom management preceded any lower limb intervention. Symptomatic patients were assessed using the Pelvic Venous Congestion Symptom Scale (PVCSS), Visual Analog Scale (VAS), and TVUS for features suggestive of PeVD. In confirmed cases, diagnostic venography and ovarian vein embolization were performed, followed by saphenous vein ablation.ResultsPeVD was identified in 11% (37/350) of patients. TVUS revealed pelvic varicosities, ovarian veins dilation >6 mm, and reflux, confirmed by venography. Of the 37 patients, 41% (15/37) underwent embolization, while 59% opted for conservative management. Post-treatment, median PVCSS scores improved from 20 to 2 (p < 0.001), and VAS scores from 8 to 0 (p < 0.001), indicating significant symptom relief. Mean follow-up was 17 months, with assessments at 1, 6, and 12 months. Reintervention-free survival was 86.7%.ConclusionApproximately one in 10 women with SVI have symptomatic PeVD, highlighting the importance of targeted screening. TVUS serves as a useful non-invasive diagnostic tool. Further studies are needed to clarify optimal treatment strategies and long-term outcomes in this population.

ObjectiveTo explore the value of multi-contrast venography with non-enhanced magnetic resonance techniques in diagnosing iliac vein compression syndrome (IVCS).MethodsEighty-seven patients suspected of IVCS were enrolled and underwent T1-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (T1 SPACE) and SPACE FLOW magnetic resonance venography (MRV) scans within 2 days of lower extremity computed tomography venography (CTV). The image qualities of CTV, T1 SPACE and SPACE FLOW were evaluated using a 4-point visual scoring system. Vessel diameters and stenosis rates were compared and pelvic collateral vessels were assessed on CTV and MRV images. With the results of digital subtraction angiography (DSA) as the gold standard, receiver operating characteristic (ROC) analysis was used to calculate diagnostic performances of the stenosis rate combined with collateral vessels both CTV and non-enhanced MRV.ResultsInter-observer agreement on image quality scores was good, with Kappa values of 0.633, 0.756 and 0.769 for CTV, T1 SPACE and SPACE FLOW, respectively. SPACE FLOW and CTV showed comparable image quality, while T1 SPACE had relatively lower quality scores. The stenosis rates measured by T1 SPACE and SPACE FLOW were consistent with CTV results. For the diagnosis of IVCS using stenosis rates and collateral vessels, CTV and MRV showed similar ROC curve areas, with sensitivity/specificity/accuracy of 82.1%/95%/85.1% and 80.6%/95%/83.9%, respectively.ConclusionMulti-contrast MRV with non-enhanced techniques can offer complementary information, clearly depict the degree of iliac vein compression and collateral vessels. It can serve as another auxiliary examination method for clinical diagnosis of IVCS.