Abstract
1. CONCENTRATED GROWTH FACTORS (CGF) FOR VENOUS ULCERS TREATMENT
1Azienda Sanitaria Locale NA3-Sud Distretto di Nola (ITALY)
2Casa di Cura Villa del Sole, Caserta (ITALY)
Objectives
Treatment with platelet growth factors may be helpful in healing stasis ulcers as already observed with platelet rich plasma.1 Concentrated growth factors (CGF) is an innovative platelet concentrate with leukocytes and CD34+ cells, embedded in a fibrin scaffold,2,3 obtained with a standardized procedure without additives. Aim of this study was to evaluate the efficacy of CGF in the treatment of hard-to-heal venous ulcers, a topic for which there are no published papers yet.
Methods
In this retrospective cohort study, 10 hard to heal venous ulcers (no improvement after eight weeks of standard therapy) treated with CGF were compared with a group of 10 similar control ulcers. The CGF was obtained with the device Medifuge (Silfradent, Italy). The dressing was completed with soaked gauzes, sterile gauze and multi-component bandage. The control group was treated with advanced dressing and multi-component bandage. The outcomes were healing time, pain variation (VAS scale) and scar quality (from 1-poor to 5-very good). Statistical analysis was done with the ANOVA test.
Results
The treated group and controls did not differ in age (mean ± SD 72.1 ± 9.16 and 70.4 ± 8.1 years), wound age (21.7 ± 10.1 and 20 ± 10.5 weeks) and ulcer surface (30.26 ± 18.5 and 31.2 ± 19.9 cm2). The healing time (12.3 ± 5.8 and 16.3 ± 7.8 weeks, p < 0.05) and the quality of the scar (3.4 ± 1.0 and 2.8 ± 0.8, p < 0.05) were better in the CGF group compared to the control. The VAS scale showed a significant improvement compared to the starting value in both groups (CGF from 7.0 ± 1.7 to 3.7 ± 1.0, p < 0.01; controls from 6.8 ± 2.0 to 3.8 ± 1.2, p < 0.01), but no difference was detectable between the two groups.
Conclusions
CGF is a safe, simple and effective treatment method for the hard to heal venous ulcers with an advantage over standard healing time and scar quality. A multi-center RCT study on the use of CGF in cutaneous ulcers is ongoing.4
References
2. VENOUS THROMBO-EMBOLIC COMPLICATIONS AFTER ENDOVENOUS THERMAL ABLATION FOR VARICOSE VEINS AND ROLE OF DUPLEX SCAN
1Japanese Endovenous Ablation Committee for Varicose Veins (JAPAN)
2Yokohama Minami Kyosai Hospital (JAPAN)
3Hyogo College of Medicine (JAPAN)
4Tokyo Medical and Dental University (JAPAN)
5International University of Health and Welfare (JAPAN)
6Nara Medical College (JAPAN)
7Tokyo Women’s Medical College (JAPAN)
8Fukushima Daiichi Hospital (JAPAN)
Objectives
This nationwide survey aimed to determine the incidence of venous thromboembolism (VTE) complications after endovenous thermal ablation (EVA) for varicose veins in Japan.
Methods
A questionnaire survey was conducted, targeting cases of EVA performed between 2011 and 2013.
Results
Survey responses were collected from 213 institutions. EVA was performed for 43.203 patients. Endovenous Heat Induced Thrombosis (EHIT) type 2 was reported in 318 cases, EHIT type 3 in 50, EHIT type 4 in 7 cases. Deep venous thrombosis was reported in 24 patients. Pulmonary embolism in 3. The incidence was 1% for EHIT type 2, 0.11% for EHIT type 3, 0.013% for EHIT type 4, 0.063% for other DVT, and 0.0067% for PE. Lower-extremity venous ultrasonography was performed within 72 hours postoperatively. Of 50 patients with EHIT type 3, 35 had an EHIT during the first postoperative ultrasound session. In one patient, EHIT type 3 progressed to EHIT type 4 despite initiation of anticoagulation. Of seven patients with EHIT type 4, only one had EHIT type 4 at the first postoperative ultrasound. Of three patients with pulmonary embolism, two developed it before ultrasonography, and EHIT was not detected in the other before the occurrence of pulmonary embolism.
Conclusions
The incidence of VTE complications after EVA is low. The value of performing postoperative ultrasonography for VTE management seems to be low.
3. EVALUATION OF ABERDEEN VARICOSE VEIN QUESTIONNAIRE AS A TOOL TO EVALUATE AESTHETIC OUTCOMES IN C1 PATIENTS.
1Instituto de Varizes e Laser, Goiania, Goias (BRAZIL)
2Clinica Albernaz, Novo Hamburgo, Rio Grande do sul (BRAZIL)
3Clinica fleboestetica, Feira de santana, Bahia (BRAZIL)
4Clinica Reis, Santos, São Paulo (BRAZIL)
5Clinica Miyake, São Paulo(BRAZIL)
6University of California Davis, Medical Center, Sacramento (USA)
Objectives
Reticular veins and telangiectasias affect millions of people worldwide, causing significant cosmetic concerns, and ultimately lead to the search for medical care.1 To the best of our knowledge, very few data existed regarding the performance of specific patient reported outcome questionnaires to evaluate outcome after cosmetic varicose vein treatment. The objective of this investigation is to evaluate the Aberdeen Varicose Vein Questionnaire (AVVQ) performance in measuring quality of life outcomes in patients with cosmetic complaints
Methods
From October 2016 to May 2017, female CEAP 1 patients with cosmetic complaints were enrolled to treatment of reticular veins and telangiectasias via 1064 nm transdermal laser and hypertonic dextrose sclerotherapy (CLaCs) in a private clinic in Brazil. Patients were asked to complete AVVQ and state their perception before and 3 months after treatment. VCSS pre and post treatment were also noted. A sample power calculation determined that a minimal of 14 patients was required for analysis. The categorical and continuous variables were analyzed using Mann Whitney, Kruskal- Wallis and Spearman test respectively. Before and after treatment scores were evaluated using Wilcoxon test. A significance level of 5% was considered.
Results
A total of 50 patients participated in the study. No major complications occurred. There was a significant reduction of AVVQ median scores from pre to post treatment (11.7 versus 5.8; p < 0,001; 95%CI) and a statistically significant correlation between the percentage of improvement in AVVQ and the percentage of improvement perceived by the patient (P = 0.002). There was no statistical correlation between pre and post VCSS and AVVQ (p = 0.07)
Conclusions
Based on our findings, the AVVQ is an excellent tool to evaluate outcome in C1 patients with aesthetic complaints
Reference
4. REDUCING THE INCIDENCE OF HYPERPIGMENTATION AFTER SCLEROTHERAPY
1Instituto Mexicano Seguro Social (IMSS-12)(MEXICO)
2Instituto Seguridad Social Servicio Trabajadores Estado Baja California (MEXICO)
3Instituto Seguridad Social Servicio Trabajadores Estado (MEXICO)
4Hospital General Tijuana (MEXICO)
5Instituto Mexicano Seguro Social (MEXICO)
Background
We previously reported the results of a single center, prospective, clinical trial showing the benefit of Sulodexide (Vessel Due F, Alfasigma), a drug with antithrombotic properties, to reduce the incidence of hyperpigmentation after sclerotherapy. Trying to confirm this result, we performed a new study with a larger population. Herein we report the 12-month midterm results.
Methods
This prospective, multicentric, clinical trial included 320 patients with telangiectasia, reticular and/or varicose veins, candidates for sclerotherapy. Patients were randomized in two groups: standard sclerotherapy protocol (SSP) using polidocanol (n = 155) or the sulodexide study group (SSS) receiving 500 mg/day for 3 months (n = 165) during the polidocanol sclerotherapy treatment. The treated area was photographed and recorded. Follow up assessment was at 1 and 3 months, reporting the intensity of pigmentation, vein disappearance and presence of mayor bleeding. Photographs were evaluated using a dedicated computer software aimed to determine any color change of the skin. Student's t-test and chi-square test were used for statistical analysis.
Results
A total of 287 patients completed the follow-up. Patients using sulodexide (n = 138) developed an average area of pigmentations of 11.58% vs 17.23% in the control group (n = 149) at 1-month (p = 0.004), which persisted in 3.46% vs 5.4% at 3 months (P = .002), respectively. Patient satisfaction and overall vein disappearance was similar in both groups. There was no mayor bleeding reported in any group.
Conclusions
This midterm analysis shows the benefit of using Sulodexide for reducing the incidence of hyperpigmentation after sclerotherapy and shows a faster clearance of pigmentation compared to the control group, without affecting patient’s satisfaction, vein disappearance or increasing the risk of mayor bleeding.
5. CLINICAL AND COST-EFFECTIVENESS ANALYSIS OF TUMESCENCE-ASSISTED FOAM SCLEROTHERAPY FOR LARGE VEINS
1Surgery Center “Jaworuccy”, Gorzów Wlkp. (POLAND)
2Center of Phlebology “Angelius”, Katowice (POLAND)
3Silesia University, Krakow (POLAND)
Background
Perivenous infiltration of the vein surrounding tissues by the tumescent solution results in the vein lumen compression as well as the decrease of the foam volume required for the successful vein obliteration. In the study, the clinical efficacy as well as the cost effectiveness of the tumescent assisted foam sclerotherapy (TAFS) of the saphenous vein was evaluated.
Methods
Two-hundred-thirty-three patients undergoing saphenous vein TAFS were prospectively evaluated and followed at least 12 months. Two methods of sclerotherapy based on short (group A) or long catheter (group B) implementation were used.
Results
After one year follow up, the saphenous vein occlusion was confirmed in 90% of the treated patients, including 89% in the group A and 93.9% in the group B. Partial vein occlusion was noticed in another 4.7% in the group A and in 4.8% in the group B. In both groups no serious adverse events related to the tumescent solution administration were noticed and, in comparison with the historical cohorts treated without TAFS, a significant foam volume decrease was noticed. The factors related to the treatment failure were: post-thrombotic veins and saphenous vein diameter >1 cm. The cost comparison with all novel endovenous techniques suggest the potential advantage of TAFS, especially in countries where no reimbursement for novel ablation methods is available.
Conclusions
TAFS is a safe and cost-effective closure method of the large superficial veins treated by sclerotherapy. The implementation of the tumescent solution decreases the foam volume required for the successful saphenous vein obliteration with satisfactory clinical efficacy.