Phlebology最新文献

ObjectiveEndovenous thermal ablation (EVTA) is the preferred treatment for symptomatic incompetent truncal varicose veins. Radiofrequency ablation (RFA) and laser ablation are commonly used. RFA devices can be either monopolar (F-Care) or bipolar/segmental (ClosureFast). Limited data is available on the comparison between these two modalities of treatment, which suggest that the Great saphenous vein (GSV) ablation is incomplete with the monopolar system. This study compares the results of RFA with the two systems (monopolar and bipolar) with regard to early outcomes of treatment and vein closure rates at 1 year and describes a method that could improve results with monopolar system.MethodsA prospective audit of 66 limbs (52 patients) undergoing RFA, either monopolar (33limbs) or bipolar (33 limbs) was carried out.ResultsCEAP C4 was the most common clinical stage (41.5% in ClosureFast group and 60.6% in F-Care group). Preoperative VCSS ranged from 3 to 21 (mean 7.48 ± 3.53) in both groups. All patients underwent adjuvant treatment with either foam sclerotherapy (FS) or a combination of FS with concomitant phlebectomy. Procedural complications were infrequent in both treatment groups. Primary outcome at 1 year showed one subject (3.0%) in each group had complete failure. Three subjects (9.1%) in the F-Care group and one subject (3.0%) in the ClosureFast group were found to have partial failure. GSV occlusion rate at 1 year was 97%. Overall, VCSS had significantly improved in both the groups from preoperative values.ConclusionMonopolar and bipolar RFA had similar primary closure rates for truncal veins at 1 year. Both are safe and had the same effect with minimal complications. However, F-Care system requires catheter removal, cleaning and reintroduction to achieve similar ablation.

ObjectiveNeovascularisation in the region of the saphenofemoral junction after high ligation and stripping of the great saphenous vein is a well-known issue. Even after a re-crossectomy, new recurrences can occur. The aim of this study was to assess the occurrence of recurrent varicose veins after re-crossectomy with barrier implantation at the saphenofemoral junction.MethodsPatients who had undergone re-crossectomy with barrier implantation were examined in follow-up visits. During follow-up, detailed duplex sonographic examinations of the treated legs were performed, with a focus on the saphenofemoral junction.ResultsA total of 135 patients with 173 re-crossectomies and barrier implantations were examined. The interval between re-crossectomy with barrier implantation and follow-up examination was 11.06 years (±2.04 years). Dacron was used as the barrier material in 26 cases (15.0%), while PTFE was used in 147 cases (85.0%). Duplex sonographic examination detected neovascularisation in 109 legs (63.0%), with five cases (2.9%) having a diameter greater than 5 mm, which were classified as haemodynamically relevant.ConclusionNeovascularisation in the saphenofemoral junction after varicose vein surgery is common. The pathological mechanism of neovascularisation remains unclear. Further prospective randomised studies are necessary to assess the long-term success of re-crossectomy with barrier implantation.

As clinicians, our comprehension of venous and lymphatic medicine pathophysiology and treatment methodologies have dramatically increased over the past century. The catalyst for these developments were visionary leadership and mentorship opportunities provided by our national societies, focused graduate medical education training, the development of breakthrough medical devices and disruptive technologies and traditional benchwork research resulting in clinical innovations. This keynote address will address the impact of each of these events and speculate on possible future directions for the growth and maturation in the field of Venous and Lymphatic Medicine.

BackgroundRadiofrequency ablation (RFA) has been recommended as the first-line treatment with primary great saphenous vein (GSV) incompetence. A multicenter randomized controlled trial was performed to evaluate the performance, efficacy, and safety of the new radiofrequency ablation system (AcoArt Cedar^TM) with ClosureFast^TM RFA system (Medtronic).MethodsConsecutive eligible patients with primary GSV incompetence were randomized 1:1 to treatment with AcoArt Cedar^TM or ClosureFast^TM at multiple sites. The primary endpoint was the total occlusion rate of GSV 6 months after the procedure. Secondary outcomes included device success, immediate technical success, performance evaluation of the devices, and the mean change of the Revised Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) scores from baseline to 6 months post-treatment. Safety endpoint was device-related adverse events (AEs). All adverse events were recorded in the study.ResultsA total of 188 eligible patients were randomly assigned to treatment with AcoArt Cedar^TM or ClosureFast^TM. All patients achieved 100% device and immediate technical success. The performance of the RFA catheter and generator was evaluated as excellent for both groups. The total GSV occlusion rates at 6 months were 97.78% (88/90) versus 98.86% (87/88) for AcoArt Cedar^TM and ClosureFast^TM, respectively (p = 1.000). Changes in AVVQ and VCSS scores from baseline to 6 months after treatment were similar in the two groups: AVVQ (p = 0.802) and VCSS (p = 0.984). Procedure-related adverse events occurred in 9.6% (9/94) versus 7.5% (7/93) of patients, for AcoArt Cedar^TM and ClosureFast^TM, respectively (p = 0.9928). No device-related AEs or SAEs were found.ConclusionThe AcoArt Cedar^TM is a device associated with non-inferior effectiveness and safety compared to ClosureFast^TM, with similar complete occlusion rates in the GSV with a low incidence of AEs.Trial registry nameClinicalTrials.gov; URL: https://clinicaltrials.gov/study/NCT04658901?term=NCT04658901&rank=1; registration number: NCT04658901.

IntroductionThis study assessed the relationship between venous leg ulcers (VLUs) and overall survival among patients treated for chronic venous insufficiency.MethodsPatients with CEAP C2-C6 disease who underwent superficial venous interventions at a single center from May 2016-April 2024 were identified from the Vascular Quality Initiative Varicose Vein Registry. Demographics, comorbidities, and venous disease severity were recorded at the index database procedure. Mortality was recorded from the electronic health record and Social Security Death Index. Patient characteristics and all-cause mortality were compared between VLU (C5-C6) and non-VLU (C2-C4) cohorts.ResultsAmong 7084 patients, 8.9% (n = 632) had a VLU history. Compared with non-VLU patients, those with a VLU history were older (p < .001) and disproportionately male (p < .001), Black/African American (p < .001), and Medicaid-insured (p = .009). They had greater body mass indices (p < .001), revised venous clinical severity scores (rVCSS) (p < .001), HASTI scores (p = .015), and work/activity limitations (p < .001). Prior venous thromboembolism (p < .001), anticoagulation use (p < .001), previous varicose vein (VV) treatment (p = .042), and deep venous reflux (DVR) (p < .001) were also more common. Mortality was higher among VLU patients than non-VLU patients (3.6% vs 0.7%, p < .001) over a similar mean follow-up (2.8 vs 3.0 years, p = .070). VLU history was associated with worse survival (HR 5.03, 95% CI [2.96-8.53], p < .001), in addition to older age (p < .001), male sex (p = .003), White race (p = .003), no prior VV treatment (p = .026), anticoagulation use (p < .001), higher rVCSS (p < .001), and DVR (p = .016). After adjusting for these latter variables, VLU history remained independently associated with mortality (adjusted HR 2.01, 95% CI [1.00-4.01], p = .049). Compared with C2, only C6 -not C3-C5 -was associated with increased mortality after multivariable adjustment (adjusted HR 3.40, 95% CI [1.08, 10.69], p = .036).ConclusionAmong patients undergoing superficial venous interventions, VLUs were associated with a two-fold hazard of all-cause death. The mechanism driving their increased mortality warrants further study.

BackgroundStiffness is an independent determinant of compression therapy efficacy, beyond compression pressure alone. Three indices - static stiffness index (SSI), dynamic stiffness index (DSI), and walking pressure amplitude (WPA) - quantify stiffness. This study evaluated in vivo stiffness in eight compression stocking models to assess whether those marketed as "strong-elastic" differ significantly from those marketed as "light-elastic".MethodsIn a prospective, open-label pilot study, 10 healthy participants were each fitted with eight off-the-shelf AG II compression stocking models (4 "strong-elastic", 4 "light-elastic"). Continuous pressure monitoring was conducted at four standardized anatomical sites (B, B1, C, D) of the right lower extremity using the Picopress® system. A total of 320 measurement cycles were completed. Data were analyzed by comparing grouped results for "strong" vs. "elastic" stockings.ResultsThe SSI did not differ significantly between "strong-elastic" (stMCS) and "light-elastic" (elMCS) stockings at any site (p > .05). However, stMCS showed significantly higher DSI at sites B (4.55 ± 2.00 mmHg vs 3.90 ± 1.63 mmHg; p = .028), C (5.83 ± 2.28 mmHg vs 5.10 ± 1.82 mmHg; p = .015), and D (2.33 ± 1.16 mmHg vs 1.58 ± 0.87 mmHg; p < .001). For WPA, stMCS exhibited significantly higher stiffness at B1 (6.75 ± 2.26 mmHg vs 6.03 ± 2.27 mmHg; p = .018), C (4.33 ± 2.31 mmHg vs 3.73 ± 2.24 mmHg; p = .020), and D (6.25 ± 2.07 mmHg vs 4.23 ± 1.59 mmHg; p < .001). Mean lower leg circumference increased from 0.50 cm (D) to 1.05 cm (C), depending on movement.ConclusionAt B1, no significant differences in SSI or DSI were found between "strong-elastic" and "light-elastic" stockings, whereas WPA significantly differentiated both groups. Overall stiffness values exceeded previous reports, indicating both stMCS and elMCS possess substantial stiffness and likely improve venous hemodynamics.

ObjectiveTo compare the clinical efficacy of two postoperative compression methods at 48 h after endovenous radiofrequency ablation (RFA) of the great saphenous vein on complications, quality of life, return-to-work time, and patient satisfaction.MethodsIn this prospective, single-center randomized controlled trial, 210 patients with duplex ultrasound-confirmed great saphenous vein incompetence (C2-C5) underwent RFA and were randomized to receive either elastic stockings (study group) or multilayer bandage compression (control group) for 48 h postoperatively. Primary outcomes included postoperative complications assessed at 2 h, 1 day, 2 days, 7 days, and 1 month. Secondary outcomes included pain (VAS), quality of life (CIVIQ-14), venous clinical severity score (VCSS), satisfaction (10-point scale), and time to return to normal work. Follow-up rates were 98% at 7 days and 96% at 1 month.ResultsMinor but statistically significant differences were observed in complications such as pain, ecchymosis, edema, and itching between groups. The study group returned to work sooner (2.11 ± 1.19 days) than the control group (4.39 ± 2.55 days, p < 0.01). Patient satisfaction at 1 month and changes in CIVIQ-14 and VCSS scores showed no significant between-group differences.ConclusionElastic stockings worn for 48 h after RFA provided certain advantages over multilayer bandage compression, particularly in reducing early postoperative complications and shortening time to return to work.

BackgroundThis study aimed to develop multiple machine learning (ML) models to predict DVT stability based on clinical and computed tomography (CT) texture features.MethodsA total of 108 patients diagnosed with DVT by clinical examination and ultrasonography in this study. Patients were divided into the DVT with acute pulmonary embolism (APE) (thrombus unstable group) and DVT without APE (thrombus stable group) groups based on whether their computed tomography pulmonary angiography examination was combined with APE. The region of interest was manually delineated on the CT images using the 3D-Slicer software to extract the textural features of the thrombus. The patients were divided into training and validation sets in a ratio of 7:3. The least absolute shrinkage and selection operator and ten-fold cross-validation were applied to obtain texture features with nonzero coefficients in the training set. Clinical data were used as variables to screen for independent risk factors predicting DVT stability using univariate and multivariate logistic regression analyses. Four machine learning algorithms, logistic regression (LR), support vector machine (SVM), K-nearest neighbor (KNN), and extreme gradient boosting (XGBooST), were used to develop a DVT stability prediction model based on a combination of nonzero feature parameters and clinical features. The performance of the models was assessed and compared using the accuracy, precision, recall, F1 score, specificity, positive prediction rate, negative prediction rate, and area under the curve (AUC), calibration curves, and decision curves.ResultsThe combined AUC, calibration curve, decision curve, and other evaluation metrics showed that the LR model outperformed other ML models [AUC: 0.87 (0.73∼0.87), Accuracy: 0.79, Precision: 0.75, F1 Score: 0.77, Recall: 0.80, Specificity: 0.87, Probability of Positive Prediction: 0.82, Probability of Negative Prediction: 0.75], with the best prediction performance.ConclusionsML models based on clinical and CT texture features can be used to predict DVT stability.