Abstract
Factors associated with lack of clinical improvement after vein ablation in the Vascular Quality Initiative
Rodríguez PP, Fassler M, Obi A, Osborne NH, Robinson ST, Jacobs BN, Aziz F, Nguyen KP, Gwozdz AM, Rodriguez LE, Fukaya E, Sachdev U, Chaar CIO, Research Committee of the American Venous Forum. J Vasc Surg Venous Lymphat Disord. 2024 Mar 27
The authors’ aim of this 3,544-patient retrospective study was to identify factors associated with a lack of clinical improvement (LCI) in patients with less severe chronic venous disease (CVD) without ulceration undergoing vein ablation (VA) to improve patient selection for treatment. They performed a retrospective analysis of patients undergoing VA for CEAP C2 - C4 disease in the Vascular Quality Initiative (VQI) varicose veins database from 2014 - 2023. Patients who required intervention in multiple veins, had undergone prior interventions, or presented with CEAP C5 to C6 disease were excluded. The difference (Δ) in venous clinical severity score (VCSS; VCSS before minus after the procedure) was used to categorize the patients. Patients with a ΔVCSS of ≤0 were defined as having LCI after VA, and patients with ≥1 point decrease in the VCSS after VA (ΔVCSS ≥ 1) as having some benefit from the procedure and, therefore, “clinical improvement.” The characteristics of both groups were compared. A second analysis was performed based on the VVSymQ instrument. Patients with LCI showed no improvement in any of the five symptoms, and those with clinical improvement had a decrease in severity of at least one symptom. Of the 3,544 patients who had a single VA, 2,607 had VCSSs available before and after VA, and 420 (16.1%) had LCI based on the ΔVCSS. Patients with LCI were more likely to be significantly older and African American and have CEAP C2 disease compared with patients with clinical improvement. Patients with clinical improvement were more likely to have reported using compression stockings before treatment. The vein diameters were not different between the two groups. The incidence of complications was overall low, with minor differences between the two groups. However, the patients with LCI were significantly more likely to have symptoms after intervention than those with improvement. Patients with LCI were more likely to have technical failure, defined as vein recanalization. On multivariable regression, age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02) and obesity (OR, 1.47; 95% CI, 1.09-2.00) were independently associated with LCI, as was treatment of less severe disease (CEAP C2; OR, 1.82; 95% CI, 1.30-2.56) compared with more advanced disease (C4). The lack of compression therapy before intervention was also associated with LCI (OR, 6.05; 95% CI, 4.30-8.56). The analysis based on the VVSymQ showed similar results.
The authors concluded that the lack of clinical improvement after vein ablation is associated with treating patients with a lower CEAP class (C2 vs C4) and a lack of compression therapy before intervention. Moreover, there was no significant association between vein size and clinical improvement.
Comparative efficacy of postoperative compression methods after EVLT for great saphenous vein insufficiency
Tadayon N, Mousavizadeh M, Yousefimoghaddam F, Jadidian F, Mirhosseini M, Hadavand N. J Lasers Med Sci. 2024 Feb 28
The authors’ aim of this prospective randomized clinical study was to evaluate the efficacy of eccentric compression therapy compared to alternative post-operative care methods following endovenous laser treatment (EVLT) for great saphenous vein (GSV) insufficiency. Eighty-eight EVLT GSV ablation procedures divided into 2 groups were analyzed. Each group received a different postoperative compression method and were evaluated over a specified period. The primary outcome was the pain scale after EVLT; secondary outcome was the rate of GSV closure. At the one-month duplex ultrasound (DUS) follow-up, the sapheno-femoral junction occlusion rates were 97% (43 out of 44) for group A (eccentric compression plus gradual compression stocking) and 95% (42 out of 44) for group B (only gradual compression stocking). Ecchymosis was observed in only 12 patients across both groups, accounting for an overall occurrence of 13.6%. Group A patients reported significantly lower analgesic usage (10%) compared to group B (18%), although this difference did not reach statistical significance. Analysis of postoperative pain data utilizing the visual analog scale (VAS) showed a median value of 5.5 in group B patients, which decreased to 3.1 with the application of eccentric compression. Moreover, there was less ecchymosis in group A observed by 1 week.
The authors concluded that this study contributes to the ongoing discourse on the efficacy of postoperative compression in varicose vein treatment.
The combination of hyaluronic acid and collagenase in the treatment of skin ulcers: An open, multicenter clinical study assessing safety and tolerability of Bionect Start®
Fino P, Chello C, Latini C, Occhionorelli S, Moruzzi M, Scuderi N, Pellacani G. Eur Rev Med Pharmacol Sci. 2024 Apr;28(7):2894-2905
The authors’ aim of this study was to confirm the safety and tolerability of daily application of hyaluronic acid collagenase in patients suffering from cutaneous ulcers of different etiologies, efficacy of the treatment, and its impact on patients’ quality of life. Ninety-six patients (m = 71 years) with a clinical diagnosis of skin ulcer with devitalized/fibrinous/slough tissue that could delay the healing process were enrolled in the study. The hyaluronic acid/collagenase ointment was applied topically until wound closure or total debridement of non-viable tissue was achieved, however, with a limit of 30 days. Monitoring was performed weekly, either through outpatient visits or telephone surveys. Assessments included adverse events, local irritation reactions, pain at dressing changes, and wound bed status. Patients were also requested to complete a quality-of-life questionnaire. Ulcer etiologies were traumatic (21.9%), venous (15.6%), or pressure ulcers (12.5%); in 26% of cases, ulcers had mixed etiology. In approximately 32% of patients, the ulcer had been present for more than 6 months, and 18.1% of subjects had previously undergone surgical wound debridement. The following results were ascertained: (i) absence of adverse events related to the use of the product; (ii) significant reduction in the degree of localized irritation and pain at dressing changes; (iii) significant support to wound bed preparation; (iv) trend towards improvement in the quality of life and health status of the patients.
The authors confirmed the safety, tolerability, and defined efficacy of daily application of hyaluronic acid and collagenase in patients suffering from leg ulcers of different etiologies.
Efficacy and safety of pentoxifylline for venous leg ulcers: An updated meta - analysis
Sun SY, Li Y, Gao YY, Ran XW. Int J Low Extrem Wounds. 2024 Jun;23(2):264-274
The authors evaluated the efficacy and safety of pentoxifylline (PTX) in an updated meta-analysis of randomized placebo-controlled trials of PTX in the treatment of venous leg ulcers. To identify eligible studies electronic data bases were searched: PubMed, Web of Science, Embase, the Cochrane Library, the Cochrane Central Register of Controlled Trials, China Science and Technology Journal Database, WanFang Data, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Database. Randomized clinical trials of PTX versus placebo treatment in patients with venous leg ulcers were considered for inclusion. Primary outcomes included ulcer healing rate and the incidence of adverse events after treatment. Secondary outcomes were the ulcer significant improvement (the ulcer size shrank by more than 60% after treatment) rate, mean duration of complete wound healing and changes in mean ulcer size. A meta-analysis and qualitative analysis were conducted. Thirteen randomized clinical trials, including 921 individuals, were included. Compared with placebo, PTX significantly improved the ulcer healing rate (RR = 1.59, 95%CI 1.22 to 2.07, p < .001) and significant improvement rate (RR = 2.36, 95%CI 1.31 to 4.24, p = .004) while increased the incidence of gastrointestinal disturbances (RR = 2.29, 95%CI 1.04 to 5.03, p = .04) at the same time. Moreover, PTX also shortened mean duration of complete wound healing (p = .007) and shrank ulcer size (p = .02).
The authors concluded that the current evidence suggests that PTX could help venous leg ulcers heal more quickly and effectively; however, the evidence is insufficient to prove the results due to moderate-certainty evidence.
Effect of hyperbaric oxygen therapy on the patients with venous leg ulcer: A systematic review and meta-analysis
Bai Z, Wang H, Sun H, Cui L. 2023 Asian J Surg Oct 46 (10) 4131-4137
The authors, in this systematic review and meta-analysis, aimed to explore the adjuvant effect of hyperbaric oxygen therapy (HBOT) in patients with venous leg ulcer (VLU) undergoing surgeries and non-surgeries. They included 11 studies, totaling 617 patients. Results indicated that 313 patients in the HBOT group who had surgical interventions in combination with HBOT had a shorter ulcer healing time. HBOT without surgical intervention was associated with higher ulcer percent area reduction.
The authors concluded that HBOT had a good adjuvant effect in combination with surgical interventions when treating venous ulcers.
Use of a prescribed exercise intervention as an adjunct to improve venous leg ulcer healing
Quirk K. Br J Nurs. 2023 Aug 17 32 (15) S34-38
This is a review article exploring the use of unsupervised prescribed exercise intervention (PEI) as an adjunct to improve venous ulcer (VLU) healing. The author identified 5 randomized controlled trials. The author found that a PEI that is designed to engage the calf muscle pump does improve VLU healing in combination with compression therapy.
The author recommends PEI for housebound patients as a community nursing holistic model of care in VLU patients, along with compression therapy.
The impact of nutritional condition and compression treatment on venous ulcer recovery: A systematic review
Alsharif AT, Alanazi OI, Alqarni RA, Alahmadi HO, Alassiri LA, Alamri SA, Khalifa RM, Alshehab EA, Alzahrani RB, Wahbi AA. Cureus 2024 Apr 16 (4) e 57407
The authors conducted a systematic review to study how nutrition and compression therapy can help venous ulcer healing. They identified 12 articles that fulfilled the inclusion criteria. They found that deficits in protein, vitamin C, Zinc, Folate, and vitamin B 12 have been associated with higher ulcer recurrence rates.
The authors concluded that addressing the nutritional deficits in combination with compression management may reduce the size of venous leg ulcers. They also note that the type of compression treatment used and level of pressure applied may lead to variable outcomes.
Randomized prospective comparative study of platelet rich plasma versus conventional compression in treatment of post phlebitis venous ulcer
Shebab AW, Eleshra A, Fouda E, Elwakeel H, Faraq M. Vascular 2023 Dec 31 (6) 1222-1229
The authors conducted a single center randomized controlled trial on patients with chronic post phlebitis lower extremity venous ulcers (CLU). There was a significant decrease in the ulcer area in the patients with platelet rich plasma (PRP) group compared to the control group. Additionally, the pain scores were diminished in the PRP group.
The authors recommend PRP in combination with compression therapy as a safe adjunct to treatment with improvement in ulcer healing and pain scores.