Abstract
What is the relationship of varicose vein pathogenesis with collagen fibers?
Kocarslan S, Kocarslan A, Doganer A, Yasim A. Niger J Clin Pract. 2022 Mar;25(3):304-309.
The authors studied in 20 patients with primary varicose veins and in healthy venous tissues samples (control) the densities of collagen 1 and collagen 4; collagens 1 and 4 are an effective vascular component in the remodeling of varicose veins. Immunohistochemical staining was performed using collagen 1 and collagen 4 antibodies. Histochemical staining was performed using Masson’s trichrome. In the immunohistochemical analysis of varicose samples with collagen 1 immunostaining, there was no statistically significant difference between both groups (p > .05). In varicose samples, collagen 4 immunostaining was negative in 20% and positive in 80%. In the control group, collagen 4 immunostaining was negative in 65% and positive in 35%. This revealed significant difference (p = .03). In the histochemical analysis of varicose samples, Masson’s trichrome staining was negative in 20% and positive in 80%. In the control samples, Masson’s trichrome staining was negative in 90% and positive in 10%. This too was statistically significant concerning collagen 4 immunostaining (p = .01).
The authors concluded that the change in the density of collagen types plays an important role in vein wall remodeling.
Treatment of recurrent symptomatic saphenous trunk reflux with catheter-directed foam sclerotherapy and tumescent anesthesia
Hernando LL, Bielsa AA, Fletes Lacayo JC. EJVES Vasc Forum. 2022 Jan 22;55:1-4.
The authors’ aim of this prospective observational study was to assess short/midterm efficacy and safety of catheter-directed foam sclerotherapy (CDFS) with tumescent anesthesia in 21 consecutive patients with recurrent symptomatic saphenous reflux; these patients were referred with recurrent symptomatic varicose veins (Feb 2018–Feb 2019). Standing duplex ultrasound (DUS) with saphenous vein diameter measurement 3 cm from the terminal valve was performed pre-operatively. Under local anesthesia, utilizing the modified Seldinger technique and ultrasound guidance, a 5F Berenstein catheter was inserted through a 5F introducer sheath. Peri-saphenous tumescent anesthesia (PSTA) was performed under ultrasound guidance. Sclerosant foam was prepared with sodium tetradecyl sulfate 3% or polidocanol 3% using the Tessari method. Concomitant phlebectomies were performed in 52%. There were 11 men and 10 women (median age 52 years). The great saphenous vein was treated in 18 patients. The median vein diameter was 6.8 mm. Previous procedures were Cure conservatrice et Hemodynamique de l'Insuffisance Veineuse en Ambulatoire, mechanochemical ablation, thermal ablation, and cyanoacrylate closure. The distribution of the clinical class was C2-16, C3-3, and C4-2 limbs. Immediate technical success was 100%. There were no complications in the early post-operative period. The median follow-up was 8 months. The occlusion rate demonstrated by DUS was 100% (21/21) at 1 week, 100% (21/21) at 6 months, and 86% (18/21) at 12 months.
The authors concluded that combining CDFS with PSTA achieves good short- and medium-term venous occlusion rates, associated with few complications in patients with recurrent symptomatic saphenous reflux.
An estimate of the economic burden of venous leg ulcers associated with deep venous disease
Kolluri R, Lugli M, Villalba L, Varcoe R, Maleti O, Gallardo F, Black S, Forgues F, Lichtenberg M, Hinahara J, Ramakrishnan S, Beckman JA. Vasc Med. 2022 Feb;27
The authors’ objective of this study was to assess the economic burden of deep venous reflux (DRV) across Australia, France, Germany, Italy, Spain, the UK, and the USA. A comprehensive literature review was undertaken to identify publications documenting the incidence and prevalence of venous leg ulcers (VLU) and DRV, medical resource utilization, and associated costs of DRV. Total annual incidence of new or recurrent DRV in Australia, France, Germany, Italy, Spain, UK, and the US are estimated at 122,000, 263,000, 345,000, 253,000, 85,000, 230,000, and 643,000 events, respectively, in 2019. Incidence ranges from 0.73 to 3.12 per 1000 persons per year. The estimated annual direct medical costs for patients managed conservatively in these geographies total ∼ $10.73 billion (USD) or $5527 per person per year.
The authors concluded that the availability of published data on the costs of VLU care varies widely across countries. Although country-specific VLU practice patterns vary, there is a uniform pattern of high-cost care.
Thrombus extension after cyanoacrylate closure of incompetent saphenous veins
Sermsathanasawadi N, Pruekprasert K, Prapassaro T, Puangpunngam N, Hongku K, Hahtapornsawan S, Chinsakchai K, Wongwanit C, Ruangsetakit C. Int Angiol 2022 Apr;41(2):143-148.
The authors in this retrospective study of 101 patients (126 saphenous veins) aimed to investigate the incidence, risk factors for, and management of thrombus extension after cyanoacrylate closure (TEACAC) of incompetent saphenous veins in patients with chronic venous disease. In this study, the following veins were subject to treatment: great saphenous vein, anterior accessory saphenous vein, or small saphenous vein. TEACAC occurred in 4.9% of patients, and in 3.9% of treated saphenous veins. Utilizing the Kabnick classification of endovenous heat-induced thrombosis (EHIT), the following TEACAC grades were observed: grade I (N.= 2), grade II (N.= 1), grade III (N.= 2), and grade IV (N.= 0). No patient or procedural predictive factors for TEACAC were identified. In patients with TEACAC-1 or TEACAC-2, the thrombus spontaneously disappeared by the 2-week follow-up. Patients with TEACAC-3 received therapeutic rivaroxaban or dabigatran, which resolved the thrombus within 2–4 weeks. No deep vein thrombosis or symptomatic pulmonary embolism was found.
The authors concluded that TEACAC was found not to be a rare complication after CAC. Treatment of TEACAC class 1–3 following EHIT guideline seems to be both safe and effective.
Stump length changes after endovenous cyanoacrylate closure of radiofrequency ablation for saphenous vein incompetence
Ko H, Min S, Ahn S, Han A, Kim J, Min SK. Vasc Specialist Int 2021. 37 (4) 14-21
The authors retrospectively analyzed data from patients, 97 veins (64 great saphenous and 33 small saphenous), who underwent either radiofrequency ablation (RFA) or cyanoacrylate closure (CAC). They reviewed stump lengths at 1 month and at 6 months post-treatment. They also utilized the venous clinical severity score (VCSS) and Aberdeen varicose vein questionnaire (AVVQ). The authors found that there was no difference in stump length at 1 month; however, at 6 months, the CAC group had significantly longer stump lengths compared to the RFA group. They found no difference in the VCSS and AVVQ between the two treatment grounds. Both scores greatly improved after both procedures.
The authors warn that a longer stump length could lead to recanalization and recurrence.
Correlation between restless leg syndrome and superficial venous reflux
Dezube AR, Rauh J, Dezube M, Iafrati M, Rigo J, Muto P. Int J Angiol. 2021 Aug 30 (4) 285-291
The authors retrospectively studied patients with restless leg syndrome (RLS) symptoms presenting to a vein center. Symptoms associated with RLS were more common in patients with venous reflux, both superficial and superficial in combination with deep venous reflux. The authors studied 207 patients and found that those patients with superficial venous reflux and family history of venous reflux were associated with RLS symptoms. Patients with RLS underwent ablation. Out of the 99 patients, 87% reported RLS symptom improvement.
The authors suggest that patients with RLS should be further studied for the presence of venous disease.
Clinical presentation and long-term follow-up of 45 patients with Mondor disease: a single-center longitudinal study
Kreuzpointer R, Johner F, Roth-Zetzsche S, Kucher N, Barco S. Vasc Med 2021 Aug 26 (4) 409-414
Acute painful thrombophlebitis occurring at specific anatomic sites characterizes Mondor disease. The authors collected data on 45 patients who had active cancer at the time, or within 1 year of diagnosis of Mondor disease. Patients were separated into 3 subgroups: thoracic, penile, and axillary. The authors found that 1 in 5 patients with Mondor disease had a concurrent diagnosis of cancer.
The authors suggest that patients with Mondor disease should be carefully screened for cancer as well.
Thrombosis with thrombocytopenia syndrome associated with COVID-19 vaccines
Long B, Bridwell R, Gottlieg M. Am J Emerg Med 2021 Nov 49 58-61.
Current vaccines have efficacy and low risk of complications. However, thrombosis with thrombocytopenia syndrome associated with adenovirus vector vaccines has caused concern. Although quite rare, 4–30 days post-exposure to ChAdOx1 n CoV-19 (Oxford-AstraZeneca) and AD26.COV2-S (Johnson and Johnson), patients present with thrombosis, thrombocytopenia, and positive platelet factor-4 (PF4)-heparin enzyme-linked immunosorbent assay (ELISA). The thrombosis is found in unusual anatomic sites such as cerebral venous thrombosis and splanchnic vein thrombosis. Testing should include complete blood count, peripheral smear, D-dimer, fibrinogen, coagulation panel, renal and liver function, and electrolytes, as well as PF4 heparin ELISA if it is available. The authors recommend hematology consultation. The treatment includes intravenous immunoglobulin and anticoagulation. Heparin-based agents and platelet transfusion should be avoided.
The authors suggest that clinicians faced with treating these patients must be aware of this condition.