Abstract
Possibilities of using the Colibri system for endovenous laser ablation
DA Borsuk, AA Fokin
Angiol Sosud Khir 2020; 26(2): 103–109.
The authors in a non-comparative prospective trial studied the efficacy of endovenous laser ablation of saphenous veins utilizing the Mediola single-ring radial fiber with the use of the connector (Colibri). Utilizing the optical hand piece, the standard laser fiber length was shortened and a different laser connector were able to decrease the cost by 30-50%. 430 consecutive patients underwent a total of 511 endovenous laser ablation procedures from January 2018 to March 2019. The great saphenous vein was subjected to obliteration in 343 (67.1%) cases, the anterior accessory saphenous vein in 94 (18.4%) cases, and the small saphenous vein in 74 (14.5%) cases. In this cohort, there were 170 (39.5%) men and 260 (60.5%) women, with a mean age of 52 ± 12.8 years. 1 day postoperative, a follow-up duplex revealed occlusion of all 511 targeted veins. At 2 months, the authors examined 411 (95.6%) people with a total of 484 (94.7%) treated veins. After 6 months, 399 (92.8%) people with 472 (92.4%) veins were examined. Recanalization with pathological reflux during the entire follow-up period was registered in 6 (1.3%) cases. Hence, the long-term rate of obliteration amounted to 98.7%.
The authors concluded at 6 month follow-up that by utilizing the Mediola 1470 nm laser unit, a single-ring radial fiber, and the connector (Colibri) made it possible to achieve obliteration of the target vein in 98.7% of cases.
Diagnostic value of pelvic venography in female patients with pelvic varicose veins and vulvar varicosities
SG Gavrilov, A Vasiliev, Y Moskaleno, N Mishakina.
Int Angiol 2020. Epub ahead of print, doi: 10.23736/S0392-9590.20.04402-8.
The authors studied the diagnostic value of ovarian and pelvic venography in female patients with pelvic varicose veins (PVV) and vulvar varicosities (VV). 62 women with PVV were examined and allocated into two groups with or pelvic symptoms. Group 1 with pelvic symptoms (n = 30) had concomitant VV (13.3%) and valvular incompetence of the left (83.3%) or right (16.7%) gonadal veins, parametrial (100%) and uterine (70%) veins, according to the duplex ultrasound scanning (DUS). Group 2 patients without pelvic symptoms (n = 32) had valvular incompetence of the left gonadal vein (9.4%), parametrial (100%), uterine (3.1%), and vulvar veins (100%), according to the DUS. All patients underwent ovarian and pelvic venography (OPV) for imaging of the pelvic-perineal reflux. In Group 1, dilation and valvular incompetence of the gonadal and parametrial veins were confirmed by the OPV in 100% of patients. The imaging of the obturator vein (OV) was obtained in 6.6% patients and internal pudendal vein (IPV) in 6.6% patients; no reflux of the contrast agent in the vulvar veins was observed. In Group 2, the OPV confirmed the valvular incompetence of the left gonadal vein in 9.4% patients and parametrial vein in 100% patients. The contrast agent in the OV was found in 9.4%, and in the IPV in 6.3% patients, while no reflux of the contrast agent in the dilated vulvar veins was observed.
The authors concluded that pelvic venography is not a mandatory component of the examination of women with pelvic and vulvar varicose veins without varicose veins of the lower extremities, who do not have symptoms valvular incompetence of the gonadal veins according to the DUS.
Endothermal heat-induced thrombosis after endovenous laser ablation: A single-center experience
HH AlGhofili, AA Aljasser, IA Alyahya, HA Almohsen, SA Alwabel, AA Alhumaid, K Iqbal, TA Altuwaijri, A Altoijry.
Semin Vasc Surg 2020; 32(3–4): 89–93.
The authors conducted a retrospective study from 2006-2018 to identify the risk factors and incidence of Endothermal Heat Induced Thrombosis (EHIT). Patients were assessed by clinical examination and duplex ultrasound imaging after endovenous laser ablation (EVLA), and patient demographic characteristics and procedural factors predictive of EHIT were determined. Following EVLA, 11,070 duplex ultrasound examinations were performed for 1,230 limbs, and EHIT defined as thrombus extending beyond the saphenofemoral junction into the common femoral vein was detected in 65 (5.3%) limbs in 60 (6.8%) patients. Essentially all EHIT cases were detected in the first week (n = 63; 96.9%) and thrombus regression occurred between 1-4 weeks. There were no significant differences in patient demographic characteristics or procedural factors between the EHIT and non-EHIT groups, except for the percentage of women (86% v 73%; P = .02), maximum GSV diameter (6.7 ± 2.7 mm v 6.0 ± 2.1 mm; P = .04), and percentage of patients with a competent saphenofemoral junction (41% v 37%; P < .001).
The authors concluded that EHIT was associated with female sex, large maximum GSV diameter, and competent saphenofemoral junction. Venous duplex imaging after EVLA is recommended because EHIT is asymptomatic in most patients.
Severe varicose veins and the risk of mortality: A nationwide population-based cohort study
NC Wu, ZC Chen, IJ Feng, CY Chiang, JJ Wang, WT Chang.
BMJ Open 2020; 10(6): e034245. doi: 10.1136/bmjopen-2019-034245
The authors studied the factors associated with overall mortality in patients with varicose veins (VV) with the association between VV severity and cardiovascular and mortality risks. A total of 4644 patients with newly diagnosed VV between 1999-2013 were identified from Taiwan's National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. 9497, 2541 and 5722 age-matched, sex-matched, and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Most of the patients with VV were free from systemic disease; however, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p < 0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p = 0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p = 0.0001) exhibited increased mortality risk. Additionally, compared with controls, patients with VV showed 2.05 times greater risk of major adverse cardiovascular events. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischemic stroke, and venous thromboembolism.
The authors concluded that this nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Their findings suggest that the presence of VV warrants close attention in terms of prognosis and treatment.
The impact of rheolytic percutaneous mechanical thrombectomy on glomerular filtration rate levels
G Decker, AM Sprinkart, K Wolter, HH Schild, DK Thomas.
J Vasc Surg Venous Lymphat Disord 2020; 8(4): 545–550.
Since rheolytic percutaneous mechanical thrombectomy (PMT) has been established as a technique for removal of thrombus, kidney dysfunction has been a concerning postintervention complication. The authors studied 21 venous interventions and 24 arterial interventions. Baseline glomerular filtration rate (GFR) was compared to two postinterventional values. Risk, injury, failure, loss of kidney function, end stage renal disease (RIFLE) criteria was also applied. The authors found no association between duration of procedure and quantity of contrast used. The venous group had a significant drop in GFR and one patient had a complete loss of kidney function and 2 progressed to the risk group with GFR decreases of >25%.
The authors found PMT in the venous system had a significant impact on GFR compared to the arterial cohort, with low risk for clinically important renal dysfunction. They suggest that renal impairment should be considered when offering PMT to patients.
Reasons for patient non-compliance with compression stockings as a treatment for varicose veins in the lower limbs: A qualitative study
JM Gong, JS Du, DM Han, XY Wang, SL Qi.
Plos One 2020; 15(4): e0231218.
The authors studied the reasons for patient non-compliance with graded elastic compression stockings (GECS) in patients with lower extremity varicose veins. A qualitative design was used including semi-structured, in depth, face to face interviews to better understand the reasons affecting compliance. All patients studied suffered from varicose veins for greater than 10 years. A list of interview questions were given, and the Colaizzi method was used to analyze the data and to find identifiable themes. The authors found 4 themes with several subthemes. These included gaps in knowledge, non-standardized methods of prescription and management, difficulty in donning and discomfort, and sociopsychological issues such as aesthetic look and expense.
The authors found that non-compliance is multi-factorial and that established guidelines regarding therapy would greatly help providers in educating and treating patients. They also suggested medical insurance updates to include coverage of compression stockings. Lastly, they suggested that the development of more comfortable materials in the manufacturing of stockings may additionally increase compliance.
Quality of anticoagulant therapy and the incidence of in-stent thrombosis after venous stenting
P Notten P, JHH van Laanen, P Elijgenraam, MAF de Wolf, RKM Kurstjens, H ten Cate, AJ ten Cate-Hoek.
Res Pract Thromb Haemost 2020; 4(4): 594–603.
The authors prospectively studied 79 patients with iliofemoral and/or caval venous stent placement for venous obstruction. All patients were treated postintervention with Vitamin K antagonists (VKA) for a minimum of 3 months, and followed for a minimum of one year. The risk of developing in-stent thrombosis occurred at a time within the therapeutic range (TTR) cutoff point of 49.9%. In-stent thrombosis occurred in 20.3% of patients. The authors found that those patients with international normalized ratio (INR) values of <2.0 were associated with an increased risk of in-stent thrombosis. A high target INR did not provide better protection against in-stent thrombosis.
The authors concluded that the quality of anticoagulation reflected in the TTR following a venous stenting was the important determinant for risk of in-stent thrombosis. Direct oral anticoagulants (DOACs) were not used in this study.
Early stages of chronic venous disease: Medical treatment alone or in addition to endovenous treatments
A Mansilha
Adv Ther 2020; 38 (suppl 1): 13–18.
The author’s goal was to emphasize the importance of treating chronic venous disease (CVD) in the early stages with medical treatment alone or in addition to sclerotherapy, endovenous interventions, or surgery. Micronized purified flavonoid fraction (MPFF) is the most studied venoactive drug (VAD). Anti-inflammatory activities, reduction of endothelial activation and leukocyte adhesion, and increased capillary resistance and integrity are some of the actions of MPFF that are thought to provide benefit to patients with chronic venous disease. In reviewing the literature, there are very few studies that address the use of MPFF treatment. The majority of those studies suggest that treatment with MPFF does improve CVD symptoms. Randomized, placebo-controlled clinical trials are needed. Treatment periprocedurally may also lead to benefit in pain reduction, hemorrhage and CVD-specific symptoms.
The authors concluded that VADs have clinical benefits in patients with CVD and can be used alone or in conjunction with venous interventions; however, more studies are needed.