Phlebology最新文献

BackgroundThe incidence of deep vein thrombosis (DVT) of the lower extremities is threatening people's health. The development of drug targets for the treatment of DVT is necessary.MethodsWe mainly conducted a proteome-wide Mendelian randomization (MR) study to explore the causal associations of plasma proteins with DVT of the lower extremities. Protein quantitative trait locis were derived from DECODE with 35,559 participants. Multiple analysis methods and two replication analyses were implemented to guarantee the reliability of the results. Mediation MR, protein-protein associations and pathway enrichment analyses were used to reveal the potential mechanisms. Finally, druggability evaluation and phenome-wide MR analysis were performed to assess the priority for drug development of these drug targets.ResultsWe identified 12 plasma proteins showing significant causal associations with DVT of the lower extremities. Genetically predicted higher serum concentration of MAP1LC3A, LRP12, VWF, F2, SYK, F11, KLKB1, and LRP4 were associated with an increased risk of DVT, while higher levels of the serum SERPINE2, XXYLT1, PMVK, and RGS18 can act as protective factors for DVT. LRP12 and F11 had the highest convincing evidence. In mediation analysis, we found four pathways, including F2-Triglycerides-DVT, LRP4-Triglycerides-DVT, MAP1LC3A-eGFR-DVT, and MAP1LC3A-Creatinine-DVT. In druggability evaluation, F11, F2, KLKB1, SYK, and VWF have been developed as drugs related to coagulation.ConclusionThis study identified 12 protein targets associated with DVT of the lower extremities and offered promising insights for developing therapeutic agents and biomarkers for DVT screening.

BackgroundEndovenous laser ablation (EVLA) in truncal veins uses a constant power and smooth pull-back. In short veins (ie: incompetent perforator veins or neovascular tissue) power can be pulsed, allowing tissue cooling between pulses and reduction of thermal spread, protecting surrounding tissues. Power meter measurements suggest it takes over 2 seconds for a diode laser to reach 90% of maximum power output. Hence pulses shorter than 2 seconds might result in less energy being deposited into target tissues than indicated on the console. The aim of this study is to compare the power emitted from the tip of the laser device during continuous or pulsed use to that displayed on the console.MethodsA 600 micron radial fibre connected to a 1470 nm EVLA diode console was fired at 10 W onto a sensor connected to a power meter, until 100 J had been emitted, for each of the following: continuous; pulsed 1 sec on, 1 sec off; pulsed 0.5 sec on, 1 sec off. Each was repeated 5 times, and the power recorded every 0.1 sec.ResultsThe power meter recorded reduced peak powers in the pulsed experiments as expected, due to delay in reaching maximum output. However, all three protocols resulted in 94% of the total energy being emitted from the tip of the EVLA device. Analysis of the power data suggested that there was a delay in the power being recorded by the sensor and power meter both when activating and deactivating the laser.ConclusionPulsing the laser power did not affect the total energy emitted from the tip of the EVLA device. The delay in reaching maximum power recorded by the power meter appears to be due to a sensor delay responding to incident laser energy, rather than the output from the laser diode and console.

BackgroundTo describe and analyze technical and clinical outcomes of High Intensity Focused Ultrasound (HIFU) in treating perforator veins (PVs) pathological incompetence.Material and MethodsPatients with isolated PVs incompetence determining varicose veins underwent focal HIFU of the PV. The primary endpoint was the rate of PV shrinkage or closure after 1 year.Resultsfrom December 2021 to January 2025, 467 legs in 416 patients were treated with HIFU. Among these, 25 pathological isolated PVs in 25 patients were treated and included in the analysis. No new PV pathological reflux was seen in 90.8%, 92.8%, 90%, and 100% of patients at 1 week, 3 months, 6 months, and 12 months from HIFU, respectively.ConclusionHIFU could be a valid alternative in treating PVs. Due to the pivotal nature of these data, further studies are needed to strengthen the results and compare HIFU with other methods.

ObjectiveTo characterise the microscopic structure of thrombus induced by direct effect of sclerosants (sclerothrombus) compared with that of post-sclerotherapy retained coagulum (trapped blood; sclerocoagulum) and thrombus in acute superficial venous thrombosis (SVT).MethodsScanning electron microscopy (SEM) and fluorescence microscopy were used to assess the structural architecture of thrombus samples. Sclerothrombus samples were generated in vitro following incubation of whole blood or platelet-rich plasma with detergent sclerosants sodium tetradecyl sulphate (STS) or polidocanol (POL). Sclerocoagulum samples were collected from patients treated for varicose veins with STS 1.5% foam. Samples of naturally occurring thrombus were collected from patients with SVT.ResultsAcute sclerothrombus contained a mesh-like distribution of branched fibrin fibers dispersed with red cells and microparticles. STS-induced sclerothrombus showed thicker fibrin strands with less branching and contained more microparticles when compared to POL-induced clots. Sclerothrombus at 1 week exhibited a fibrin sponge structure. Sclerocoagulum showed a disorganised distribution of thin, tortuous and branching fibers containing large gaps dispersed with haemolysed red cells and cell debris. SVT contained a smooth fibrin mesh of relatively thick fibrin strands with scarce branching and fewer microparticles.ConclusionThe three entities of sclerothrombus, sclerocoagulum and SVT are distinct and distinguishable entities. Whilst sclerothrombus and SVT demonstrate features of a fibrin clot, sclerocoagulum is haemolysed blood containing disorganised fibrin strands.

PurposeTo evaluate the safety and efficacy of interstitial bleomycin sclerotherapy for treating small painful venous malformations (VMs) in the lower extremities.MethodsBetween September 2022 and August 2024, 256 patients underwent 420 sclerotherapy sessions for slow-flow vascular malformations. Exclusions included sponge-form VMs, lymphatic malformations, fibroadipose vascular anomalies, and syndromic vascular anomalies. Thirteen patients with solid VMs in the lower extremities, unresponsive to prior foam sclerotherapy (n = 6) or with vascular access challenges due to the lesion's solid nature (n = 7), underwent 19 interstitial bleomycin sclerotherapy sessions. Pre- and post-treatment assessments included visual analog scale (VAS) scores and imaging findings for lesion diameter and vascularity.ResultsNineteen bleomycin sclerotherapy sessions were conducted in 13 patients. VMs were intramuscular (n = 11), in the sub-fascial fat layer (n = 1), or both (n = 1). The mean interval between prior foam and bleomycin sclerotherapy was 818 days, with a 254-day follow-up after treatment. Pain improved in 92% of patients, with a VAS score reduction from 8.5 to 2.8 (p = .0001). One patient showed no improvement after three sessions. Among six patients with vascularity detected on Doppler ultrasound pre-treatment, all demonstrated resolution post-treatment (p = .0313). Mean diameter reduction of 0.27 cm was not statistically significant (p = .0573). Three minor/moderate adverse events occurred: allergic reactions and skin pigmentation.ConclusionInterstitial bleomycin sclerotherapy is a safe and effective option for reducing pain and vascularity in lower extremity solid VMs unresponsive to foam sclerotherapy or presenting poor vascular access.

ObjectivesNegative pressure wound therapy (NPWT) is a useful adjunct to optimization of wound healing. We aimed to evaluate the benefits of NPWT in the management of refractory non-healing venous leg ulcers (VLU), in conjunction with compression therapy (CT).MethodsA randomised controlled trial where 50 patients with chronic VLU were randomised to either NPWT with CT, or to CT alone, on a 1:1 ratio, for 12 weeks. Sample size was calculated to detect a minimum of 19 days with a standard deviation of 12 days and a power of 95% (α = 5%). Patients were followed-up for 1 year. Patients with mixed aetiology were excluded.ResultsDemographics, risk factors were similar in both groups. All ulcers were CEAP C_6,s.Mean time to full healing was 64.3 days ±4.2 days in NPWT + CT patients and 83.2 days ±8.4 days in compression patients (p < .001). At 12 weeks, 80% of NPWT + CT managed ulcers (n = 20/25) were completely healed, compared to 36% of CCD ulcers (n = 9/25) (p < .001). Mean reduction in ulcer surface area at 12 weeks was 79% in NPWT + CT patients, compared to 58% in the compression group (p < .001). At 12 months follow-up, one recurrence occurred in the NPWT group, compared to two of the compression healed ulcers (p = .375). No local or systemic complications were encountered in either treatment group. NPWT + CT participants experienced an improvement in their physical functioning component. Total cost was 80,187.50 euros for NPWT + CT as opposed to 88,135.00 euros for CT participants.ConclusionsNPWT reduces healing time, improves wound size reduction, reduce bacterial colonization in VLUs and enhances patient quality of life compared to compression alone. It achieves this while being cost-neutral compared to compression therapy alone with better quality of life by reducing complications and hospital stays.

ObjectiveThe aim of this preclinical study is to investigate in-vivo veins effects including histological analysis following endovenous cavitation by Non-Thermal High-Intensity Focused Ultrasound (NT-HIFU).MethodsFour lateral saphenous veins (LSV) in two sheep were sonicated using ultrasound guided NT-HIFU device inducing cavitation (Veinsound, Lyon, France) during 30s in 2 LSV (protocol A), 20s in 1 LSV (protocol B), and 10s in 1 LSV (protocol C). Clinical and ultrasound follow-up was performed at 3 and 7 days, venous sampling at 10 days. Four vein sections were available in each LSV. Histological analysis considered percentage of vein lumen obliteration. Vein wall damage was qualified as destruction, fibrosis, and immune infiltration.ResultsObliteration was observed by Duplex Ultrasound in all LSV. Histologic analysis showed total or partial obliteration of the LSV in respectively 15 (93.8%) and 1 case (6.2%). Destruction was observed in the intima in all 16 histology sections, in the media in 11 sections (68.8%) and in the adventitia in five sections (31.2%). Fibrosis was observed in the media in all 16 sections, in the intima in seven sections (43.8%) and in the adventitia in five sections (31.2%). Immune infiltration was observed in the adventitia in eight sections (50%), in the media in five sections (31.2%) and in the intima in one section (6.2%). Resolutive skin damage was observed in one case (protocol A) and mild perivenous tissue remodeling in 3 cases (protocol A and B).ConclusionThis study demonstrated that endovenous cavitation allows to cause vein occlusion in sheep with significant destruction lesions of intima and fibrosis of the media. Appropriate sonication time avoids side effects.

BackgroundPelvic venous compression syndromes (PVCS) are often underdiagnosed causes of chronic venous disease and deep vein thrombosis. This study evaluates whether duplex ultrasound and venography predict significant pelvic vein compression confirmed by intravascular ultrasound (IVUS).MethodRetrospective cohort of 237 adults with lower extremity symptoms undergoing duplex ultrasound including continuous spectral doppler waveform identification without volumetric flow, venography, and IVUS. Patients were classified by presence of ≥50% stenosis on IVUS. Logistic regression identified predictors.ResultReduced compressibility of the common femoral vein predicted ≥50% stenosis on venography bilaterally (left p = .025; right p = .014). The presence of thrombosis predicted ≥50% stenosis bilaterally (left p = .015; right p = .009), and abnormal spontaneity on the right also predicted ≥50% stenosis (p = .033). On duplex ultrasound, the absence of reflux (p = .008) and normal valvular competency (p = .008) on the left were associated with ≥50% stenosis on IVUS. Conversely, continuous phasicity (p = .036) and continuous flow (p = .035) on the left predicted <50% stenosis on IVUS.ConclusionCertain duplex ultrasound features may serve as early noninvasive markers of PVCS, aiding timely IVUS referral and intervention. Prospective studies are warranted.

ObjectiveTo report a single-center experience using the Lightning 12 and Lightning Flash 16 computer-assisted vacuum thrombectomy (CAVT) Indigo System devices for acute proximal lower extremity deep vein thrombosis (DVT).MethodsA retrospective review was conducted of all consecutive patients treated with CAVT for acute (<14 days) proximal lower extremity DVT between January 2023 and September 2024 at academic single center. The primary outcome was technical success, defined as >70% thrombus removal on final completion venography, assessed by at least two different operators.ResultsTwenty-four patients (median age 55.5 years; 58.3% female) with 29 affected limbs were included. Classical May-Thurner syndrome was present in 37.5%. Thrombosis involved the left iliofemoral segment in 44.8%, right iliofemoral in 31.0%, isolated common iliac vein in 6.8%, and inferior vena cava extension in 17.2%. Devices used included Lightning 12 (25.0%) and Lightning Flash 16 (75.0%). Iliac vein stents were placed in 82.8% of limbs. Median operative time was 120 min, blood loss 750 cc, and hospital stay 2 days. No intraoperative complications occurred. Two non-procedure-related deaths occurred within 30 days. Median follow-up was 9 months; three additional late deaths were unrelated to the procedure. The median Villalta score was 1, and VCSS was 1. No significant outcome differences were observed between the two device types.ConclusionThe CAVT Indigo System appears to be a safe and effective treatment option for acute proximal lower extremity DVT, demonstrating high technical success and low complication rates.

ObjectivesCellulitis is a common and often recurrent bacterial skin infection. Antibiotics are the first-line treatment for cellulitis and antibiotic prophylaxis is a known preventive measure for frequent recurrence. Evidence for other interventions targeting known risk factors (secondary prevention) remains unclear. This review evaluates the evidence for managing risk factors to prevent recurrent limb cellulitis.Study designA systematic review of studies on cellulitis risk factor management, excluding antibiotic prophylaxis, was conducted. Five databases were searched in February 2023 and June 2024. Eligible studies underwent narrative synthesis and quality assessment. Databases searched included MEDLINE, Scopus, Web of Science, CINAHL, and EMBASE, for the time period 1996-June 2024.Data synthesisSummary of major results; Of 1,116 screened papers, 25 met the criteria. Study designs varied, with only one randomized controlled trial. Nearly all studies addressed lymphoedema, showing that its management, particularly with compression, consistently reduced cellulitis recurrence. Although cellulitis guidelines detail the need to address many risk factors to reduce cellulitis, including tinea and ulcers, we did not find studies that linked the management of these conditions with cellulitis recurrence.ConclusionsEvidence strongly supports lymphoedema management in preventing cellulitis recurrence, studies on other risk factors including skin integrity, are lacking. Studies to support strategies beyond antibiotic prophylaxis are needed.