Phlebology最新文献

ObjectivesLower leg edema is common in the late afternoon even in healthy individuals and could involve venous blood flows. Women appear more likely to develop lower leg edema, possibly due to the menstrual cycle. However, this phenomenon has not been quantitatively investigated using imaging. This study therefore used sonography to investigate sex-dependent impacts on physiological lower leg edema, in relation to venous blood flows in the legs and the menstrual cycle.MethodsParticipants comprised 54 healthy young adults (30 men, 24 women; mean age, 21 ± 1 years). Thickness of the papillary dermis and thickness and echogenicity of the subcutaneous adipose tissue were measured in the lower leg. Popliteal vein hemodynamics were investigated using Doppler sonography. Values were compared between late afternoon and morning. Each comparison was performed for men, women in the follicular, and women in the luteal phase.ResultsFor women in the luteal phase, papillary dermis and subcutaneous adipose tissue were thicker (median 0.20 mm, interquartile range [IQR] 0.12-0.25 mm vs median 0.33 mm, IQR 0.25-0.35 mm; p < .001 and median 5.0 mm, IQR 4.3-5.5 mm vs median 5.2 mm, IQR 4.5-6.2 mm; p = .013, respectively) and subcutaneous adipose tissue echogenicity was higher (median 66.9 IQR 64.1-70.5 vs median 71.7, IQR 65.0-76.7; p = .007) in the late afternoon than in the morning. The popliteal vein velocity-time integral (VTI) was lower in the late afternoon (median 33.0 cm, IQR 27.3-40.5 cm) than in the morning (median 26.1 cm, IQR 23.5-39.6 cm; p = .043). A significant negative correlation was observed between VTI and echogenicity (r = -0.549, p = .005). These findings were reduced in women in the follicular phase, and absent in men.ConclusionLate-afternoon lower leg edema may be associated with decreased leg blood flow in women, particularly in the luteal phase.

ObjectiveRisk of venous thromboembolism (VTE) is classically associated with recent surgery; additionally, long-haul air travel is a known VTE risk factor. This meta-analysis aimed to estimate the post-operative VTE risk associated with recent air travel.MethodsEmbase, Medline, Cochrane and Scopus databases were accessed from inception to May 2024. Inclusion criteria were any study design of participants undergoing surgical intervention with recent air travel, reporting VTE incidence. Papers were screened and data extracted independently by two reviewers, then pooled using fixed and random effects. The primary outcome was pooled VTE rate, with secondary outcomes of pooled rate of deep vein thrombosis (DVT) and pulmonary embolism (PE). Subgroup analyses of pre- and post-operative flight, flight >4 h and high VTE risk surgery were conducted. The ROBINS-I tool was used to assess risk of bias.ResultsSeven retrospective studies were included in the analysis, totalling 24,975 patients. The pooled VTE odds ratio (OR) in the flying plus surgery group was 1.96 (95% CI: 0.54-7.08). For surgery with post-operative flight, the VTE OR was 1.31 (95% CI: 0.63-2.71), whilst for surgery with pre-operative flight the OR was 7.86 (95% CI: 0.23-265.26). In a subgroup analysis of air travel >4 h, the VTE OR was 2.35 (95% CI: 0.29-19.36). In the subgroup analysis of high VTE risk surgery, the VTE OR was 1.20 (95% CI: 0.45-3.20). Three studies reported DVT/PE incidence specifically. For surgery and recent air travel, the pooled DVT rate was 0.67% (95% CI: 0.31%-1.51%) versus 0.45% (95% CI: 0.10%-2.00%) in surgery alone. For surgery and recent air travel, the pooled PE rate was 0.41 (95% CI: 0.00%-1.29%) versus 0.55% (95% CI: 0.31%-0.86%) for surgery alone.ConclusionThis meta-analysis suggests that air travel confers no additional VTE risk for patients undergoing surgical intervention. However, this does not account for confounding factors. Future research should risk score then propensity match participants to generate higher quality evidence.

Objectives: This study aimed to examine the effects of a multimodal exercise program on edema, pain, exercise capacity, lower extremity muscle strength, and function in patients with lipedema.Methods: The patients diagnosed with lipedema were randomly assigned to either the exercise (n: 11) or control (n: 11) groups. The exercise group participated in supervised group exercises focusing on aerobic and strengthening, twice a week for 6 weeks. The control group received training on physical activity additionally lipedema management. Sociodemographic and clinical characteristics were recorded. Edema (circumference measurements and local tissue water-LTW%), pain intensity (Visual Analogue Scale-VAS) and pressure pain threshold (Algometer), functional exercise capacity (Six minute walk test-6MWT), lower extremity muscle strength (Handheld dynamometer), lower extremity muscle strength/endurance (Sit-to-stand test) and lower extremity function (Lower Extremity Functional Scale-LEFS) were evaluated.Results: In the exercise group, significant reductions in pain during rest, activity, and nighttime, 6MWT distance, quadriceps and hip muscle strength, lower extremity strength/endurance, and function were observed (p < .05). When comparing the groups, no significant differences were found (p > .05); however, clinically, there were differences in limb volumes, pain reduction, muscle strength, and functional improvements, with medium to large effect sizes.Conclusion: The main findings of this study highlight the benefits of structured multimodal exercises for patients with lipedema to improve pain, limb volumes, exercise capacity, lower extremity muscle strength, endurance, and functionality.Clinical trials number: NCT06811961.

ObjectiveLower extremity varicose veins are a common chronic venous disorder, affecting approximately 23% of adults globally. Although endovenous thermal ablation, particularly radiofrequency ablation (RFA), has become the preferred treatment, post-procedural deep vein thrombosis (DVT) remains a concern. The necessity of pharmacologic prophylaxis following RFA remains controversial. This study aimed to assess the efficacy and safety of short-term prophylactic rivaroxaban for DVT prevention after RFA.MethodsIn this single-centre, randomized controlled trial, patients with lower extremity varicose veins undergoing RFA, with or without Trivex-assisted phlebectomy, were recruited between August 2020 and December 2024. Participants were randomized to receive either rivaroxaban (10 mg daily for 5 days postoperatively) or standard preventive care including early ambulation and compression. All patients were followed for 1 month, with DVT incidence evaluated by B-mode ultrasonography.ResultsA total of 298 patients were enrolled. No DVT events occurred in the rivaroxaban group, while four cases (2.7%) were observed in the standard care group (p = .04). No major bleeding events were reported. Minor bleeding occurred in 4.7% of the rivaroxaban group and 2.7% of the control group (p = .35).ConclusionsShort-term prophylactic rivaroxaban significantly reduced DVT risk following RFA, with no significant increase in bleeding complications. These findings support its potential role in optimising perioperative thromboprophylaxis for varicose vein patients undergoing thermal ablation.

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.