Abstract
Polidocanol-foam treatment of varicose veins: Quality-of-life impact compared to conventional surgery
Sakugawa LS, Portela FSO, Louzada ACS, Portugal MFC, Teivelis MP, Mendes C, Pinheiro LL, da Silva MFA, Fioranelli A, Wolosker N. Clinics (Sao Paulo). 2024 Apr 3:79:100346.
The authors designed this study to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of patient-reported outcome measures (PROMs). This study was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < .05); however, surgery showed greater improvements in VCSS (on average 4.02-points improvement, p < .001), VEINES-QoL (average eight-points improvement, p < .001), and VEINES-Sym (average 11.66 points improvement, p < .001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy.
The authors concluded that both polidocanol foam sclerotherapy and conventional surgery positively impact patients’ quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.
The controversy of using insufficient great saphenous veins in coronary artery bypass grafting: A comparative morphological analysis of healthy and insufficient veins related to the possibility of using them as a graft
Părău AF, Manzur AR, Mihaicuta S, Petrache IA. Biomedicines. 2024 Feb 21;12(3):476.
The authors’ purpose for this study was to comprehensively analyze the morphological characteristics of varicose veins, exploring their potential utilization in coronary bypass arterial graft compared to healthy veins. 178 patients were categorized into two groups based on healthy and varicose veins. Morphological parameters, including maximum venous diameter, wall thickness, and specific changes in tunica intima (TI), tunica media (TM), and tunica adventitia (TA), were analyzed through microscopic evaluation. Varicose veins exhibited a significantly larger maximum venous diameter (p = .0001) and increased wall thickness (p = .0001) compared to healthy veins. Although varicose veins showed thickening in TI and TM, the differences were not statistically significant. Notably, disorganized smooth muscle bundles were more prevalent in varicose veins (p = .001), suggesting potential wall weakness. The absence of vasa vasorum in TA was significantly higher in varicose veins (p = .050), influencing vascularization considerations.
The authors concluded that the comparative morphological microscopic analysis of the specimens of healthy and varicose veins revealed significant differences between the groups, which suggests the avoidance of varicose veins for bypass grafting.
Endovenous thermal ablation in the treatment of large great saphenous veins of diameters >12 mm: A systematic review meta-analysis and meta-regression
Bontinis V, Bontinis A, Koutsoumpelis A, Potouridis A, Giannopoulos A, Rafailidis V, Chorti A, Ktenidis K. Vasc Med. 2023 Oct;28(5):449-457.
The authors studied the safety and efficacy of endovenous thermal ablation (EVTA) in treating the great saphenous veins (GSV) greater than 12 mm in diameter. A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) for comparative and noncomparative studies depicting EVTA in the treatment of GSV >12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). A comparative analysis was conducted between GSV >12 mm and <12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV <12 mm and one exclusively for GSV >12 mm. Seven studies, including 2564 GSV, utilizing radiofrequency (RFA) or endovenous laser ablation (EVLA) were included. GSV >12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6–97.8), 99.9% (95% CI: 98.9–100.0), 0.04% (95% CI: 0.0–3.4), and 1.6% (95% CI: 0.3–3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset (p < .01). The >12 mm groups (p = .04), GSV diameter and technical success for both groups (p < .01), (p = .016), and GSV diameter and EHIT only for the whole dataset (p = .02). The comparative analysis between GSV <12 mm and GSV >12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25-2.56) favoring small GSV.
The authors reported excellent occlusion and technical success results for the EVTA of GSV >12 mm. Nonetheless, meta-regression analysis illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes. Although the negative effect of diameter on occlusion and technical success extended beyond the threshold of 12 mm, this was not true for the EHIT occurrence, suggesting the lack of a definitive GSV diameter cut-off.
Compression for preventing recurrence of venous ulcers
de Moraes Silva MA, Nelson A, Bell-Syer SE, Jesus-Silva SG, Miranda F Jr. Cochrane Database Syst Rev. 2024 Mar 7
The authors’ aim of this review is to assess the effects of compression (socks, stockings, tights, bandages) for preventing recurrence of venous leg ulcers. In August 2023 included in this review, the authors searched the Cochrane Wounds Specialized Register, CENTRAL, MEDLINE, Embase, three other databases, and two ongoing trials registries. They also scanned the reference lists of included studies and relevant reviews and health technology reports. There were no restrictions on language, date of publication, or study setting. Included were randomized controlled trials (RCTs) that evaluated compression bandages or hosiery for preventing the recurrence of venous ulcers. At least two review authors independently selected studies, assessed risk of bias, and extracted data. The primary outcome was recurrent ulceration (ulcer recurrence anywhere on the treated leg). The secondary outcomes included duration of recurrent ulceration episodes, proportion of follow-up without ulcers, ulceration on the contralateral leg, noncompliance with compression therapy, comfort, and adverse effects. The certainty of evidence was assessed using GRADE methodology. Eight studies (1995 participants), which were published between 1995 and 2019, were included. The median study sample size was 249 participants. The studies evaluated different classes of compression (UK class 2. 18 - 24 or 3. 25 – 35mmHg and European (EU) class 1. 15 –21mmHg, 2. 23 – 32mmHg, or 3. 34 – 46mmHg). Duration of follow-up ranged from 6 months to 10 years. We downgraded the certainty of the evidence for risk of bias (lack of blinding), imprecision, and indirectness. EU class 3 compression stockings may reduce recurrent ulceration compared with no compression over 6 months (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.76; one study, 153 participants; low-certainty evidence). EU class 1 compression stockings compared with EU class 2 compression stockings may have little or no effect on recurrent ulceration over 12 months (RR 1.70, 95% CI 0.67 to 4.32; one study, 99 participants; low-certainty evidence). There may be little or no difference in rates of noncompliance over 12 months between people using EU class 1 stockings and people using EU class 2 stockings (RR 1.22, 95% CI 0.40 to 3.75; one study, 99 participants; low-certainty evidence). UK class 2 hosiery compared with UK class 3 hosiery may be associated with a higher risk of recurrent ulceration over 18 months to 10 years (RR 1.55, 95% CI 1.26 to 1.91; 5 studies, 1314 participants; low-certainty evidence). People who use UK class 2 hosiery may be more compliant with compression treatment than people who use UK class 3 hosiery over 18 months to 10 years (RR for noncompliance 0.69, 95% CI 0.49 to 0.99; 5 studies, 1372 participants; low-certainty evidence). There may be little or no difference between Scholl UK class 2 compression stockings and Medi UK class 2 compression stockings in terms of recurrent ulceration (RR 0.77, 95% CI 0.47 to 1.28; one study, 166 participants; low-certainty evidence) and noncompliance (RR 0.97, 95% CI 0.84.1 to 12; one study, 166 participants; low-certainty evidence) over 18 months. No studies compared different lengths of compression (e.g. below-knee vs above-knee), and no studies measured duration of recurrent ulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects.
The authors conclude that compression with EU class 3 compression stockings may reduce recurrent ulceration compared with no compression over 6 months. Use of EU class 1 compression stockings compared with EU class 2 compression stockings may result in little or no difference in recurrent ulceration and noncompliance over 12 months. UK class 3 compression hosiery may reduce recurrent ulceration compared with UK class 2 compression hosiery; however, higher compression may lead to lower compliance. There may be little to no difference between Scholl and Medi UK class 2 compression stockings in terms of recurrent ulceration and noncompliance. There was no information on duration of recurrent ulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. More research is needed to investigate acceptable modes of long-term compression therapy for people at risk of recurrent venous ulceration. Future trials should consider interventions to improve compliance with compression treatment, as higher compression may result in lower rates of recurrent ulceration.
High physical activity volume is associated with an increase in the caliber of the lower limb veins without impact on functional discomfort: The VARISPORT study
Beliard S, Ferreira D, Thomas H, Mourot L, Tordi N. EJVES 2023 Vol 66 (6) 856-863
The authors studied 119 subjects in each of two groups--a group of high exercise training volunteers (HPAV) who work out more than 8 h/week for more than 6 months, and a control group matched for age, sex, and body mass index. The HPAV group had significantly more dilated veins of the deep and superficial systems. More reflux was found in the great saphenous veins and the non-saphenous veins. Although there was a significant frequency of visible varicosities, this was without impact on functional discomfort.
The authors question if these visible varicosities are pathologic or not.
Early-stage chronic venous disorder as a cause of leg pain overlooked for lumbar spinal disease
Yang DH, Kim M, Yang JW, Cho JM, Park SJ, Kwon HD. 2024 Sci Rep Oct 25. doi: 10.1038/s41598-023-45623-0.
The authors’ aim of this study was to determine the incidence of chronic venous disorder (CVD) in patients visiting a spine center for leg pain. A total of 196 cases underwent ultrasound examination with a diagnosis rate of 85.7%. Most commonly the calf, then the foot, was painful in CVD patients. The calf, then the thigh, was painful in the lumbar spine disease patients. Tingling paresthesia was the most common symptom in all patients. The CVD patients had significant improvement with vasoactive medications.
The authors suggest that early-stage venous reflux is a symptomatic disease that is a possible cause of leg pain.
Xioglican cream in Italian patients with chronic venous disease: A post-marketing study investigating effects on clinical and cutaneous signs and symptoms
Muratori IM, Contorno F, Amato C. Adv Ther 2023 Nov 40 (11) 4972-4986
In this study, patients with CEAP 2-3 disease received 12 weeks of treatment with Xioglican, applied three times daily. Significant reductions in leg circumference and edema, as well as significant improvements in Venous Clinical Severity Scores, with improvements in skin burning, pain, aching and tiredness, were found with the use of Xioglican.
The authors concluded that topical treatment with Xioglican cream improves the signs, symptoms, and quality-of-life of patients with CVD class C2–C3.
Association between systemic immune-inflammation index and risk of lower extremity deep venous thrombosis in hospitalized patients: A 10-years retrospective analysis
Chen X, Ou Y, Wang Z, Liu H, Liu Y, Liu M. Front Cardio Med. 2023 Jun 16:10:1211294. doi: 10.3389/fcvm.2023.1211294.eCollection 2023.
In this study, the authors sought to clarify the relationship and explore the association between the systemic immune-inflammation index (SII), which is a novel inflammatory biomarker, and the risk of lower extremity deep venous thrombosis (LEDVT) in a large sample over a 10-year period. All hospitalized patients undergoing lower extremity compression ultrasonography were consecutively screened. A total of 16,725 patients were studied. 1962 lower extremity deep vein thrombosis (LEDVT) events occurred. The systemic immune inflammation index (SII) was associated with a 36.1% increased risk of LEDVT. The high SII group showed a 1.740-fold risk of LEDVT.
The authors concluded that elevated SII is significantly associated in a nonlinear fashion with increased risk of LEDVT in hospitalized patients.