Phlebology最新文献

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.

BackgroundSupratrochlear and supraorbital veins are a frequent cosmetic concern in aesthetic dermatology, with limited efficacy/safety prospective data on noninvasive treatments. The long-pulsed 1064-nm Nd:YAG laser offers deeper tissue penetration and low melanin absorption, potentially enabling safe and effective management of these vessels.MethodsThis prospective, single-center pilot study included 10 adult patients with visible supratrochlear and supraorbital veins deemed aesthetically undesirable. All participants underwent two sessions of long-pulsed 1064-nm Nd:YAG laser treatment (6-mm spot, 70-90 J/cm², 40 ms) at 30-days intervals, with dynamic skin cooling. The primary efficacy outcome was the quantitative ultrasonographic analysis of venous caliber reduction. Co-primary outcomes included blinded evaluator photographic assessments and safety evaluation. Secondary outcomes comprised patient-reported outcomes via a satisfaction questionnaire.ResultsUltrasonographic measurements demonstrated a significant reduction in venous caliber after treatment (0.17 ± 0.05 cm vs 0.12 ± 0.05 cm; p < 0.001). No significant differences were detected by blinded evaluators between pre- and post-treatment photographs (κ = 0.176). No skin alterations occurred at any time point. Nine patients (90%) rated the results as "very good" or "excellent," with none rating them as "poor" or "very poor".ConclusionLong-pulsed 1064-nm Nd:YAG laser treatment of supratrochlear and supraorbital veins led to a significant ultrasonographic reduction in venous caliber and high patient satisfaction without adverse cutaneous effects.

BackgroundDeep vein thrombosis (DVT) remains a frequent and potentially life-threatening complication among hospitalized patients, necessitating timely diagnosis. The Wells score is widely used for assessing DVT probability; however, its performance in inpatient populations remains uncertain. This study aimed to evaluate the diagnostic accuracy of the Wells criteria for lower extremity DVT among hospitalized patients.MethodsIn this case-control study conducted at two teaching hospitals between 2017 and 2020, 240 patients with confirmed DVT were compared with 240 age- and sex-matched controls without DVT. All participants underwent standardized clinical evaluation and duplex ultrasonography within 24 h of admission. Wells scores were calculated based on predefined clinical parameters. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.ResultsOf 480 participants (mean age 51.9 ± 11.6 years; 54.4% female), DVT was confirmed in 240 (50%). A Wells score ≥2 classified patients as likely DVT. This threshold yielded a sensitivity of 86.3%, specificity of 70.0%, PPV of 74.2%, and NPV of 83.8%. Significant predictors included recent surgery or prolonged hospitalization (p < 0.001), calf swelling >3 cm (p < 0.001), and pitting edema confined to the symptomatic leg (p < 0.001).ConclusionThe Wells criteria demonstrated good sensitivity and moderate specificity for diagnosing DVT in hospitalized patients, supporting their role as an initial clinical assessment tool. However, they should not replace confirmatory testing such as ultrasonography or D-dimer assays. Larger multicenter studies are warranted to further validate these findings.

BackgroundMechanochemical endovenous ablation (MOCA) is an established non-thermal technique for treating varicose veins of the great and small saphenous veins, GSV and SSV, with diameters under 12 mm. However, its safety and efficacy in treating anterior saphenous vein (ASV) incompetence remain unclear. This study evaluated the feasibility, safety, and effectiveness of MOCA for ASV reflux.MethodsIn this prospective single-centre registry, 30 patients with symptomatic ASV incompetence underwent MOCA using the ClariVein® system. Anatomical success, clinical improvement (VCSS), pain scores, return to normal activities, and complications were assessed at 30-days and 12-months follow-up. Procedural duration and duplex ultrasound results were also recorded.ResultsTechnical success was achieved in 93.3% (28/30) of patients. Median procedure time was 9.0 min (IQR 7.0-11.5). Median peri-procedural and postoperative pain scores were 3.0 and 1.0, respectively, and most patients resumed normal activities within 1 day. At 30 days, anatomical success was 96.3%, and median VCSS improved from 5.0 to 3.0. At 12 months, duplex ultrasound was available in 25 patients, with evaluable data in 23. Complete occlusion was observed in 82.6%, partial in 4.3%, and no occlusion in 13.0%. Minor complications occurred in 25.0%, and one deep vein thrombosis was recorded. At 1 year, the mean AVVQ score improved by 6.7 points, and RAND-36 scores showed favourable outcomes in pain (81), mental health (85), and general health (64).ConclusionMOCA with the ClariVein® system appears safe, effective, and well-tolerated for ASV incompetence. Larger studies with longer follow-up are warranted.