Abstract
Pilot trial of neuromuscular stimulation in human subjects with chronic venous disease
Williams KJ, Moore HM, Ellis M, Davies AH. Vasc Health Risk Manag. 2021 Dec 1;17:771-778. DOI: 10.2147/VHRM.S320883
The authors explored neuromuscular stimulation (NMES), which increases blood flow, and assessed the effect of bilateral leg NMES in chronic venous disease symptoms. Their study included 40 subjects in 4 groups: healthy, superficial insufficiency, deep insufficiency, and deep obstruction. Every subject received NMES for 4-6 hours per day, for 6 weeks. Ultrasound hemodynamic venous measurements from the right femoral vein and laser Doppler fluximetry from the left hand and foot were recorded at week 1and 6. Quality of life questionnaires were taken at week 0, 6 and 8. The mean age was 48.7, BMI 28.6kg/m2. NMES increased femoral vein peak velocity, TAMV and volume flow by 55%, 20%, 36% at 20 minutes (all p<0.05), which was enhanced at week 6 (PV and TAMV p<0.05). Mean increases in arm and leg fluximetry were 71% and 194%. Leg swelling was reduced by 338.9 mL (16%, p<0.05) in venous disease. Quality of life questionnaires improved. Those with C4-6 disease benefitted the most.
The authors concluded that NMES improves venous hemodynamic parameters in chronic venous disease, reduces leg edema, improves blood supply to the skin of the foot, and positively affects quality of life.
A systematic review on the incidence of stent migration in the treatment of acute and chronic iliofemoral disease using dedicated venous stents
Badesha AS, Siddiqui MM, Bains BRS, Bains PRS, Khan T. Ann Vasc Surg. 2022 Jan 17:S0890-5096(22)00009-7. DOI: 10.1016/j.avsg.2021.12.084
The authors’ aim was to investigate the incidence of stent migration as well as clinical and stent patency outcomes in patients with acute and chronic deep venous iliofemoral disease treated with dedicated stents. MEDLINE and Embase were searched for literature published from January 2012 to December 2021. Forty-two studies were included. 570 patients with acute DVT and 2,859 with chronic disease were included. 6 subjects had stent migration (0.17%); three were a closed-cell stent and one a hybrid-design stent. Primary patency in DVT at 12 months ranged from 86 to 88%, and secondary patency was 96%. In patients with CVD primary and secondary patency ranged from 59% to 94%, and 87% to 100%, respectively. The pooled 12-month primary and secondary stent patency rates were 73.8% and 91.5%, respectively.
The authors concluded that iliofemoral stenting with dedicated venous stents has a low rate of migration, and that surveillance protocols need to be implemented.
Advances in engineering venous valves: the pursuit of a definite solution for chronic venous disease
Fernández-Colino A, Jockenhoevel S. Tissue Eng Part B Rev. 2021 Jun;27(3):253-265. DOI: 10.1089/ten.TEB.2020.0131
In this study, the authors critically discuss the approaches attempted in the past years to correct venous valve malfunction. They highlight the potential of tissue engineering to offer new avenues for valve fabrication. Chronic venous disease (CVD) can produce venous valve malfunction which can result in painful swelling, varicosities, edema, ulcerations and chronic wounds. Surgical correction of damaged venous valves has proven to be effective; however, the absence of intact leaflets in many patients limits the applicability of this strategy. Prosthetic valves have shown acceptable results in animal models but not in clinical trials; in addition, no single prosthetic venous valve is commercially available. Venous valve prosthesis offers the potential to restore normal venous flow and improve chronic venous disease, although current venous valve replacements are associated with poor outcomes.
The authors conclude that a deeper understanding of the approaches attempted is essential to establish the next steps toward valve development, and more importantly, tissue engineering constitutes a unique toolbox to advance in this quest.
Chronic venous insufficiency, cardiovascular disease, and mortality: a population study
Prochaska JH, Arnold N, Falcke A, Kopp S, Schulz A, Buch G, Moll S, Panova-Noeva M, Jünger C, Eggebrecht L, Pfeiffer N, Beutel M, Binder H, Grabbe S, Lackner KJ, Ten Cate-Hoek A, Espinola-Klein C, Münzel T, Wild PS. Eur Heart J. 2021 Oct 21;42(40):4157-4165. DOI: 10.1093/eurheartj/ehab495
The authors, in this study, focus on the fact that evidence regarding the health burden of chronic venous insufficiency (CVI) and impact of clinical determinants is scarce. Systematic phenotyping of CVI according to CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic) classification was performed in 12,423 participants (age range: 40-80 years) of the Gutenberg Health Study from April 2012 to April 2017. Survival analyses were carried out to assess the CVI-associated risk of death. The prevalence of telangiectasia/reticular, varicose veins, and CVI was 36.5% [35.6-37.4%], 13.3% [12.6-13.9%], and 40.8% [39.9-41.7%], respectively. Age, female sex, arterial hypertension, obesity, smoking, and clinically overt cardiovascular disease were identified as clinical determinants of CVI. Higher CEAP classes were associated with a higher predicted 10-year risk for incident cardiovascular disease in individuals free of cardiovascular disease (n = 9923). During a mean follow-up of 6.4 ± 1.6 years, CVI was a strong predictor of all-cause death independent of the concomitant clinical profile and medication HR 1.46 (95% CI 1.19-1.79).
The authors conclude that chronic venous insufficiency is highly prevalent and associated with cardiovascular risk factors and disease. Individuals with CVI have an elevated risk of death, independent of age and sex, and present cardiovascular risk factors and comorbidities.
The association between chronic venous disease and measures of physical performance in older people: a population based study
Sinikumpu SP, Karanen MH, Jokelainen J, Kiukaanniemi SK, Huilaja L. BMC Geriatr 2021 Oct 14; 21 (1) 556
The authors studied 552 patients over 70 years of age who were examined with the Short Physical Performance Battery (SPPB) and 10 m walk test to determine the prevalence of chronic venous disease (CVD). They found the incidence and degree of venous disease increased with increasing age. More males presented with CEAP 4-6 disease. Patient with CVD had significantly lower total SPPB scores and longer times in the 10 m walk test. The walk test times were associated with CVD when adjusted for sex and age, but not after adjusting for BMI.
The authors concluded that a good physical examination of the skin on the legs will help identify patients at risk of CVD. They suggest that there may be an association between CVD and gait speed.
Socioeconomic status and clinical stage of patients presenting for treatment of chronic venous disease.
Natour AK, Rteil A, Corcoran P, Weaver M, Ahsan S, Kabbani L. Ann Vasc Surg 2021 Dec 22, S0890-5096(21)00958-4. doi: 10.1016/j.avsg.2021.12.010.Online ahead of print.
The authors’ goal was to study the influence of socioeconomic status (SES) on the clinical stage of patients presenting with chronic venous disease. They retrospectively collected data on 449 patients. The mean age was 58 years old, 67% were female, and 60% were white. Those patients from lower SES tended to have higher CEAP scores at presentation.
The authors concluded that patents with lower SES could be delayed in seeking care for venous disease.
Thrombotic events following COVID 19 vaccines compared to influenza vaccines
Vallone MG, Falcon AL, Castro HM, Ferraris A, Cantarella RF, Staneloni MI, Aliperti VI, Ferlone A, Mezzarobba D, Vazquez FJ, Ratti MFG. EJIM 2022 Mar 9. S0953-6205(22)00092-9. doi: 10.1016/j.ejim.2022.03.002.Online ahead of print.
The authors retrospectively studied patients receiving the first dose of the Covid vaccine compared to those who received the influenza vaccine. Primary endpoints were symptomatic thrombotic events at 30 days including deep vein thrombosis (DVT), pulmonary embolism (PE), acute ischemic stroke (AIS), acute coronary syndrome (ACS), or arterial thrombosis. Thirty six patients in the Covid vaccination group (out of 29,918) and 15 patients out of 24,753 in the influenza vaccination group presented with at least one thrombotic event.
The authors concluded that the cumulative incidence of any thrombotic event at 30 days was 12 per 10,000 for the Covid vaccination group and 6 per 10,000 for the influenza vaccination group. They warned that these results should be interpreted with caution.
Utility of high frequency ultrasound in assessing cutaneous edema in venous ulcer patients
Pragasam S, Kumari R, Munisamy M, Thappa DM. Skin Res Technol 2021 sep 27 (5) 904-908
The authors studied 20 patients with venous ulcers. They measured cutaneous edema at baseline and after 2 weeks of compression therapy. They used high frequency ultrasound (HFUS) at the dorsum of the foot, 4 cm proximal to the medial malleolus, and the medial aspect of the calf between the malleolus and the knee. The authors found that there was a significant reduction in subepidermal low echogenic band measurements after compression therapy.
The authors concluded that cutaneous ultrasound aids in accurate assessment of level and severity of edema.