Abstract
Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation
Bissacco D, Malloggi C, Domanin M, Lomazzi C, Tolva V, Odero Jr A, Trimarchi S, Casana R. Vascular 2021 Dec 15
The authors’ aims of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA) with 1297 consecutive patients from 2009–2018. The primary outcome was GSV recanalization rate at 1 week; secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation C4 and 5, preoperative GSV diameter >6 mm, and history of smoking were independent predictors of recanalization. Additionally, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors.
The authors concluded that RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.
Treatment of chronic venous disorder: A comprehensive review
Chaitidis N, Kokkinidis DG, Papadopoulou Z, Kyriazopoulou M, Schizas D, Bakoyiannis C. Dermatol Ther. 2021 Dec 3: e15238.
The authors examined the currently available data to provide an updated, comprehensive review on treatment options of Chronic Venous Disorder. The authors searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials and OpenGrey databases for relevant articles in English published until November 2020.
The authors made several conclusions: 1. Compression treatment is the mainstay of conservative treatment. 2. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. 3. Transcutaneous Lacer treatment is an effective alternative option to sclerotherapy for treatment of C1 stage. 4. Interventional treatment of saphenous insufficiency should not be withheld in favor of conservative treatment when indications for intervention are present. 5. High ligation and stripping, ultrasound-guided foam sclerotherepy, endovenous thermal ablation (EVTA) systems and non-thermal non-tumescent ablation systems are safe and efficacious first-line options for treatment of saphenous insufficiency. 6. Interventional treatment of co-existing incompetent perforator veins is not recommended by contemporary evidence. 7. Regarding deep venous insufficiency, treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting produced encouraging results.
Injection sclerotherapy for varicose veins
Oliveira RA, Riera R, Vasconcelos V, Baptista-Silva JC. Cochrane Database Syst Rev. 2021 Dec 10; 12(12): CD001732
The objective of this updated Cochrane review was to assess the effectiveness and safety of injection sclerotherapy for the treatment of varicose veins. For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialized Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, and LILACS databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries, on 20 July 2021.
The authors made several conclusions, as follows: 1. There is a very low to low-certainty evidence that, compared to placebo, sclerotherapy is an effective and safe treatment for varicose veins concerning cosmetic appearance, residual varicose veins, QoL, and persistence of symptoms. 2. Rates of deep venous thrombosis (DVT) may be slightly increased and there were no data concerning recurrent varicose veins. 3. There was limited or no evidence for one concentration of foam compared to another; foam compared to liquid sclerotherapy; foam compared to any other substance; or one technique compared to another. 4. There is a need for high-quality trials using standardized sclerosant doses, with clearly defined core outcome sets, and measurement time points to increase the certainty of the evidence.
Endovascular treatment of pelvic congestion syndrome: visual analog scale follow-up
Senechal Q, Echegut P, Bravetti M, Florin M, Jarboui L, Bouaboua M, Teriitehau C, Feignoux J, Legou F, Pessis E. Front Cardiovasc Med. 2021 Nov 17; 8: 751178.
The authors’ objective of this study was to evaluate medium-term clinical outcomes of transcatheter embolization and stenting in 327 consecutive women referred to the interventional radiology unit from January 2014 to December 2019, with several pelvic venous disorders responsible for chronic pelvic pain and varicose veins of the lower limbs. The entire cohort consisted of patients with the following: chronic pelvic congestion (27.83%), lower limb varices (4.59%), or a combination of both (67.58%). Preprocedural pelvic, transvaginal Doppler ultrasound (US), and MRI were conducted in all the patients and revealed anatomical varicosities and incompetent pelvic veins in 312 patients. In all the patients, selective catheterization demonstrated uterine venous engorgement, ovarian plexus congestion, or pelvic vein filling. Retrograde flow was detected on catheter venography in the left ovarian vein (78%), the right ovarian vein (26%), the left internal iliac vein (68%), and the right internal iliac vein (57%). Patients were followed-up at 1, 6, and 12 months, and years thereafter systematically by the referring angiologist and the interventional radiologist of center. They were contacted by telephone in November and December 2020 to assess pain perception and quality of life by using the visual analog scales from 0 to 10 with assessments made at the baseline and last follow-up. Of the 327 patients (mean age, 42 ± 12 years), 312 patients were suffering from pelvic congestion syndrome and 236 patients were suffering from lower limb varices. All underwent embolization by using ethylene vinyl alcohol copolymer (Onyx®). Eighty-five right ovarian veins, 249 left ovarian veins, 510 tributaries of the right internal iliac vein, and 624 tributaries of the left internal iliac vein were embolized. A cohort of patients also underwent nutcracker syndrome angioplasty (6.7%) and May-Thurner syndrome angioplasty (14%) with a stent placement. The initial technical success rate was 80.9% for embolization of pathological veins and 100% for stenting of stenoses. Overall, 307 patients attended 12-month follow-up visits and 82% of patients completed the telephone survey at mean 39 (±18)-month postintervention. Main pelvic pain significantly improved from 6.9 (±2.4) pre-to 2.0 (±2.4) postembolization (p < 0.001), as did specific symptoms in each category. Improvement or disappearance of pain was achieved in 92.36% patients with improved quality of life in 95.8% in patients. There were 16 minor and 4 major adverse events reported on the follow-up.
The authors concluded that pelvic vein embolization (Onyx®) is an effective and safe procedure with high clinical success and quality of life improvement rates.
Central catheter-associated deep vein thrombosis in cancer: Clinical course, prophylaxis, treatment
Marin A, Bull L, Kinzie M, Andresen M. BJ Support Palliat Care 2021. Dec (4): 371–380
Thrombosis associated with central catheters in patients with cancer can be challenging. The authors reviewed both prospective and retrospective studies dealing with catheter related thrombosis (CRT). They found that predisposing risks include patient underlying pathology, devices used, and techniques for insertion. The CRT events tend to be more common during the first month of implantation. Left sided insertion and subclavian vein access have been thought to increase the risk of CRT. Studies showed that polyurethane catheters have seemingly lower risk compared to silicone ports. Appropriate tip placement of the catheter has also been protective against venous thromboembolism (VTE). There is no consensus regarding prophylactic anticoagulation. Most guidelines recommend anticoagulation for the treatment of CRT. For intraluminal thrombosis, the instillation of 2 mg of tissue plasminogen activator is recommended.
The authors concluded that anticoagulation must be balanced with hemorrhagic risks. They stated that while low molecular heparin alone, or as a bridge to warfarin is used most commonly, the benefit of using other anticoagulants remains unclear. Treatment duration is suggested to be a period of 3 months. Removal of the catheter should be considered in the presence of infection, a defective line, or if the line is no longer needed.
Ovarian vein thrombosis in the postnatal period
Dunphy L, Tang AW. BMJ case rep 2021 Jun 25 14(6).
Ovarian Vein Thrombosis can occur during the puerperal period. It can also occur in endometritis, pelvic inflammatory disease, Crohn’s disease, pelvic/gynecologic surgeries, and in thrombophilia. Hypercoagulable conditions such as antiphospholipid syndrome, systemic lupus erythematosus, factor V Leiden, and protein C/S deficiency can all be risk factors. It is a rare event occurring in 0.05% of all pregnancies, and the incidence peaks at 2–6 days post delivery. Complications include sepsis and thrombus extension into the inferior vena cava or left renal vein, and pulmonary embolism. The authors presented a case of a 27 year old woman with lower abdominal patient 5 weeks after elective caesarean section. She was treated with low molecular weight heparin. The authors stated that a high index of suspicion is required to identify this patient population.
Calf vein thrombosis outcomes comparing patients with and without cancer
Pasha, AK, Kuczmik W, Wysokinski W, Casanegra AI, Houghton D, Vlazny DT, Mertzig A, Hirao-Try U, White L, Hodge D, McBane R. Thromb Thrombolysis 2021. May 51 (4) 1059-1066.
The authors retrospectively studied consecutive patients with ultrasound confirmed acute calf DVT in 830 patients with (243) and without (587) cancer. The most common cancers were hematologic malignancies (20.6%), lung (11.5%), gastrointestinal (10.3%), and ovarian/gynecologic (9.1%). Nearly half of the cancer patients had metastatic disease (43.8%) and 57% were undergoing chemotherapy. Venous Thromboembolism rates were similar for patients with cancer and without cancer. Major bleeding complications occurred more often in cancer patients.
The authors concluded that cancer patients with calf DVT have similar rates of VTE recurrence, but higher major bleeding outcomes compared to patients without cancer.
Predictive factors of venous recanalization in upper extremity vein thrombosis
Piotin G, Brebion N, Guyomarch B, Pistorius MA, Connault J, Hersant J, Raimbeau A, Bergere G, Artifoni M, Durant C, Gautier G, Dumont R, Kubina JM, Toquet C. Espitia O. Pols One 2021; 16(5): e 0251269
Upper extremity venous thrombosis (UEVT) represents 10% of venous thromboembolic disease. The authors’ goal was to investigate venous recanalization after UEVT. The study included 494 UEVT. Locations included proximal (304) and distal (190). Hematologic malignancy was present in 40.7%, solid cancer in 14.2%, and 49.9% had an infectious or inflammatory etiology. Venous catheter or pacemakers were present in 86.4%. The rate of recanalization without sequalae was 38%.
The authors found that the factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with central venous catheter, thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization.