Abstract
Diagnostic value of the femoral vein flow pattern for the detection of an iliocaval venous obstruction
SI Kayılıoglu, C Köksoy and I Alaçayır
J Vasc Surg: Venous and Lym Dis 2016; 4: 2–8
The purpose of this study was to establish the diagnostic value of the femoral vein waveform in detecting chronic iliocaval venous lesions. Medical records of consecutive patients classified as C3-6 between March 2011 and December 2012 were assessed retrospectively. The results of common femoral vein duplex ultrasound examinations, based on the presence or absence of respiratory variation in the femoral flow as well as its response to the Valsalva maneuver, were compared with contrast venography and intravascular ultrasound imaging of the inferior vena cava and the bilateral common and external iliac veins. Three types of flow patterns in the common femoral vein were identified with duplex ultrasound examination: phasic flow correlated with respiration, minimally phasic flow (showing some phasicity but no cessation with respiration), and monophasic flow (continuous flattened flow). In addition, three types of responses to the Valsalva maneuver were recorded: complete cessation of flow, reversal of flow, and continuation of flow. The study evaluated 86 patients (63 men, 23 women) with a mean age 40.3% 1.5 years. Contrast venography and intravascular ultrasound imaging were used to detect venous obstructions in the inferior vena cava and the right and left iliac veins in 16.3%, 32.6%, and 80.2% of patients, respectively. When various flow parameters were evaluated, the combination of common femoral vein monophasic flow at rest and continuous flow during the Valsalva maneuver had the highest diagnostic value for iliocaval venous obstructions. The sensitivity, specificity, positive predictive value, and negative predictive value of the combination of monophasic flow at rest and unceasing forward flow during the Valsalva maneuver for the diagnosis of any degree of iliac venous obstruction were 38.1%, 100%, 100%, and 55.8%, respectively. The sensitivity and negative predictive value of these diagnostic parameters increased as the degree of obstruction increased. The investigators concluded that Doppler examination of the common femoral vein can be used as a screening test for iliocaval venous obstructions. The monophasic flow of the common femoral vein is a reliable diagnostic tool for the detection of possible iliac vein obstructions.
Cost-effectiveness of radiofrequency ablation versus laser for varicose veins
AC Shepherd, M Ortega-Ortega, MS Gohel, Epstein D, Brown LC and Davies AH
Int J Technol Assess Health Care 2015: 1–8
In a randomized cost-effectiveness study comparing radiofrequency (RFA) to endovenous ablation (EVLA), 131 patients were randomized, of which 110 complied with a six-month follow-up (EVLA n = 54; RFA n = 56). There were no differences between groups achieved at six weeks and maintained at six months comparing AVVQ, SF-12v2, and the Venous Clinical Severity Score. There were no differences in treatment failure rates. There were small differences in favor of EVLA in terms of costs and six-month health-related quality of life (HRQOL), but these were not statistically significant. However, RFA is associated with less pain at up to 10 days.
The authors conclude that EVLA and RFA result in comparable and significant gains in quality of life and clinical improvements at six months. EVLA is more likely to be cost effective than RFA but absolute differences in costs and HRQOL are slight.
Relationship between development of post-thrombotic syndrome and serial ultrasound, D-dimer, and factor VIII activity after a first deep venous thrombosis
LN Roberts, RK Patel, DE Goss, Chitongo P, Bonner L and Arya R
J Vasc Surg: Venous and Lym Dis 2016; 4: 28–35
The aim of this study was to evaluate the relationship of post-thrombotic syndrome (PTS) with residual vein thrombosis, deep venous reflux (DVT), D-dimer, and factor VIII (FVIII) after a first deep venous thrombosis (DVT). There were 133 participants with objectively confirmed DVT, of whom 114 were observed for six months after completion of anticoagulation. Ultrasound, D-dimer, and FVIII evaluations were undertaken at six weeks after completion of anticoagulation and at the end of follow-up. PTS was considered present in those with a score of >5 on the Villalta scale at either assessment. The cumulative incidence of PTS was 51.8%, with median duration of follow-up of 11 months. Median D-dimer and FVIII in those with PTS were significantly higher at both time points compared with those without. Similarly, residual vein thrombosis and deep venous reflux were more prevalent in those with PTS at both study assessments. On multivariable analysis, only FVIII at end of study remained significantly associated with PTS with an odds ratio of 2.83 (95% confidence interval (CI), 1.09–7.42; P = .034). Ultrasound markers and D-dimer were not significantly associated with PTS after adjustment for age, body mass index, Charlson Index >1, and proximal extent of DVT. The authors concluded that FVIII activity at end of follow-up was independently associated with PTS, suggesting underlying activation of coagulation.
Effect of diameter of saphenous vein on stump length after radiofrequency ablation for varicose vein
J Kim, S Cho, JH Joh, HJ Ahn and HC Park
Vasc Specialist Int 2015; 31: 125–129
A two-year retrospective review was performed in 201 patients undergoing saphenous radiofrequency ablation (RFA) patients. Pre- and postoperatively (one week and six months, the saphenous vein diameter was measured. Ablation was initiated 2 cm distal from the junction. After two years, 74 treated veins were measured from the deep junction to the leading point of occlusion. Endovenous heat-induced thrombosis developed in three patients (1.5%). The mean diameter and stump length of the saphenous vein were 6.7 ± 1.8 mm and 12.5 ± 8.5 mm, respectively. Correlation analysis showed that the Pearson correlation coefficient of these factors was −0.017. The authors concluded that there is no correlation between the diameter of saphenous vein and stump length.
A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy versus multilayer compression therapy alone in the treatment of venous leg ulcers
TE Serena, MJ Carter, LT Le, MJ Sabo and DT DiMarco; EpiFix VLU Study Group
Wound Repair Regen 2014; 22: 688–693
Eighty-four venous ulcer patients participated in a multicenter, randomized, controlled study to evaluate the safety and efficacy of one or two applications of dehydrated human amnion/chorion membrane allograft and multilayer compression therapy versus multilayer compression therapy alone in the treatment of venous leg ulcers. The primary study outcome was the proportion of patients achieving 40% wound closure at four weeks. Of the 84 participants enrolled, 53 were randomized to receive allograft and 31 were randomized to the control group of multilayer compression therapy alone. At four weeks, 62% in the allograft group and 32% in the control group showed a greater than 40% wound closure (p = 0.005), thus showing a significant difference between the allograft-treated groups and the multilayer compression therapy alone group. After four weeks, wounds treated with allograft had reduced in size a mean of 48.1% compared with 19.0% for controls. The authors concluded that venous leg ulcers treated with allograft had a significant improvement in healing at four weeks compared with multilayer compression therapy alone.
Low molecular weight heparin improves healing of chronic venous ulcers especially in the elderly
R Serra, G Buffone, V Molinari, et al.
Int Wound J 2015; 12: 150–153
The authors wanted to determine in their 284 venous ulcer patients study, four-year period, whether low molecular weight heparin (LMWH) administration improves extracellular matrix functioning, by heparin administration, as a way to support wound healing. All patients were subjected to the most appropriate treatment after considering their preference (compression therapy followed or not by vein surgery). Two hundred and eighty four patients were randomized into two groups of 142 in each: group A received administration of nadroparin 2850 IU/0.3 ml through subcutaneous injection per day for 12 months plus basic treatment; group B patients received basic treatment alone. Healing was assessed by means of direct ulcer tracing with computerized planimetry. Group A showed a healing rate of 83.80% at 12 months; group B showed a healing rate of 60.56%. The older patients subscribed more to the long-term treatment with low molecular weight heparin; this group also had lowest recurrence rate. The authors concluded from their study that LMWH improves healing of chronic venous ulcers especially in the elderly.