Abstract
Endoluminal laser delivery mode and wavelength effects on varicose veins in an Ex vivo model
AB Massaki, MG Kiripolsky, SP Detwiler and MP Goldman
Lasers Surg Med 2013;
The authors aimed to determine the effects of various endovenous laser wavelengths and delivery modes on ex vivo human vein both macroscopically and microscopically. In addition, they evaluated whether covered-tip fibers, consisting reduced vein wall perforations compared to bare-fibers. Six laser fiber combinations were tested: 810 nm continuous wave (CW) diode laser with a flat tip bare-fiber, 810 CW diode laser with a covered-fiber, 1320 nm pulsed Nd:YAG laser, 1310 nm CW diode laser, 1470 nm CW diode laser and 2100 nm pulsed Ho:YAG laser. Perforation or full thickness necrosis of a portion of the vein wall was observed in 5/11 (45%), 0/11 (0%), 3/22 (14%), 7/11 (64%), 4/6 (67%) and 5/10 (50%) of cross-sections of veins treated with the 810 nm CW diode laser with a flat tip bare-fiber, the 810 CW diode laser with a covered-tip fiber, the 1320 nm pulsed Nd:YAG laser, the 1310 nm CW diode laser, the 1470 nm CW diode laser, and the 2100 nm pulsed Ho:YAG laser, respectively. The authors’ results show that the delivery mode, pulsed Nd:YAG versus CW, may be just as important as the wavelength. Therefore, the 1310 nm CW laser may not be equivalent to the 1320 nm pulsed laser. In addition, covered-tip fibers and 810 nm wavelength may be less likely to yield wall perforations than their non-protected counterparts.
Histology of saphenous veins after treatment with the ClariVein® device – an ex-vivo experiment
M Kendler, M Averbeck, JC Simon and M Ziemer
J Dtsch Dermatol Ges. 2013 Feb 26. doi: 10.1111/ddg.12022. [Epub ahead of print]
The authors studied what the mechanical tip does to the wall of the saphenous vein in five specimens. These specimens were obtained atraumatically by crossectomy. Then the veins were treated ex vivo with the ClariVeinAE catheter without sclerotherapy. The activated catheter’s rotating tip (3500 U/min) was steadily withdrawn at 1–2 mm per second. Subsequently, histological and immunohistochemical investigations of treated (cv) and untreated specimens (plain) were performed. A four-point score was calculated to compare the results. The mechanical part of the catheter caused a subtle incomplete destruction of the endothelium (endothelium cv: 2.2 vs. plain: 1, p = 0.04). Changes in the media or adventitia were not seen. Immunohistochemical presentation of the endothelium of the intima was demonstrated with antibodies against CD31 (cv: 3.4 vs. plain: 2.8), CD34 (cv: 3.8 vs. plain: 3.2) and factor VIII (cv: 2.2 vs. plain: 1, p = 0.004). The authors believe that the mechanical part of the ClariVeinAE catheter caused a subtle incomplete destruction of endothelium.
Late response to patient-reported outcome questionnaires after surgery was associated with worse outcome
A Hutchings, K Grosse Frie, J Neuburger, J van der Meulen and N Black
J Clin Epidemiol 2013;66:218–25
The authors’ aim was to gauge the potential impact of nonresponse bias by comparing the outcomes of early and late responders to patient-reported outcomes This study compares 59,565 early and 20,735 late responders who underwent a hip or knee replacement, hernia repair or varicose vein surgery. The association between timeliness of response and three outcomes (the mean postoperative disease-specific PRO and generic PRO scores and the proportion reporting a fair or poor result) was examined by regression analysis. The authors conclude from their study that nonresponse to PRO questionnaires introduces slight bias; therefore, differences in response rates between hospitals should be taken into account when making comparisons so as to avoid overestimating the performance of those with lower response rates and failing to detect poor performing hospitals.
Late follow-up of saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy in patients with venous ulcers
M Figueiredo, SP de Araujo and MF Figueiredo
Ann Vasc Surg. 2012;26:977–81
This prospective study provides late follow-up data on 35 patients with venous ulcers who present with advanced chronic venous insufficiency who are treated with combined high ligation and saphenofemoral ultrasound-guided foam sclerotherapy. Follow-up period ranged from 45 to 68 months accessing wound healing, ultrasound findings and venous clinical severity scores. By ultrasound, total and partial recanalization in 19 patients (treatment failure) and occlusion in 13 patients (treatment success) are demonstrated. Ulcer healing ranged between 30 and 70 days and remained healed for a mean period of 48 months (Kaplan-Meyer method). The analysis of clinical severity scores (pain, edema, pigmentation, lipodermatosclerosis and inflammation) revealed significant improvement when comparing pre- and post-treatment results. The authors state that preliminary findings support saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy for a simple palliative treatment method for this group of patients.
Assessment of cerebral venous return by a novel plethysmography method
P Zamboni, E Menegatti, P Conforti, S Shepherd, M Tessari and C Beggs
J Vasc Surg 2012;56:677–685
The investigators wanted to develop a method to assess cerebral venous return in patients whom they believed were suffering from chronic cerebrospinal venous insufficiency (CCSVI) due to the lack of sensitivity of MRI or color duplex. The investigators studied 40 healthy controls and 44 patients with multiple sclerosis. The authors measured venous volume, filing time, filling gradient, residual volume, emtying time and emptying gradient with cervical venous plethysmography. Emptying gradient, filling time and filling gradient were all significantly different between controls and CCSVI patients. Receiver operator curve analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839). The authors conclude that cervical plethysmography is a good screening test for patients with possible CCSVI.
Symptomatic venous thromboembolism after femoral vein harvest
RV Dhanisetty, TK Liem, GJ Landry, BC Sheppard, EL Mitchell and GL Moneta
J Vasc Surg 2012;56:696–702.
The authors retrospectively reviewed their outcomes in 58 reconstructions after femoral vein harvest over a five-year period. Indications were arterial reconstruction (53%), and vascular reconstruction after cancer operations (47%), 85% of which were portomesenteric reconstructions. Perioperative VTEs were discovered in 17 of 58 (28%) reconstructions. The incidence of VTE was significantly greater in patients with malignancy. Sixteen ipsilateral VTEs occurred distal to the vein harvest site and five occurred proximal to it. Pulmonary embolism occurred in two patients. No patient developed compartment syndrome. The authors recommend routine venous surveillance and aggressive thromboprophylaxis. VTE after femoral vein harvest occurs frequently in patients with malignancy.
Superficial venous thrombosis and compression ultrasound imaging
I Quere, A Leizorovicz, JP Galanaud, E Presles, MT Barrellier, F Becker, G Despraires, H Guenneguez, P Mismetti, H Decousus; for the prospective observations superficial thrombophlebitis (PSST) study investigators
J Vasc Surg 2012;56:1032–1038
In a multi-center observational study, the authors investigated the incidence of concomitant deep vein thrombosis (DVT) in patients diagnosed with superficial vein thrombosis (SVT). A total of 884 patients were screened for SVT and 99 patients were identified. Of the 884 patients screened, 198 had a concomitant DVT with 41.8% prox-imal. In 83 patients DVT and SVT were not contiguous. Five of 639 had isolated contralateral DVT. Age greater than 75, varicose veins and in-patient status were independent predictors of concomitant DVT. The authors concluded that in patients with symptomatic SVT and complete bilateral deep and superficial venous duplex is warranted.
Influence of high-heeled shoes on venous function in young women
WT Filho, NR Dezzortti, EE Joviliano, T Moriya and CE Piccinato
J Vasc Surg 2012;56:1039–44
The purpose of this investigation was to determine the effect on venous return by various types of high-heeled shoes. Women were evaluated with air plethysmography in four situations: barefoot, medium heels (3.5 cm), stiletto high heels (7 cm) and platform high heels (7 cm). The authors measured the venous filling index (VFI), ejection fractions (EF) and residual volume fraction (RVF). RVF was increased in both high-heel groups. RVF was increased in the medium-heel group compared to the barefoot group. EF was increased in the barefoot group compared to the other three groups. VFI was similar between all groups. The authors concluded that high-heel shoes impair calf muscle pump function leading to venous hypertension-like symptoms in women wearing these types of shoes for prolonged periods of time.