Abstract
Varicose veins are a risk factor for deep venous thrombosis in general practice patients
U Müller-Bühl, R Leutgeb, P Engeser, E Achankeng, J Szecsenyi and G Laux
Vasa 2012;
The authors wanted to determine the relationship (risk factor) of varicose veins (VV) and deep venous thrombosis (DVT) by looking at these variables in a retrospective chart review. There were 5.6% DVT episodes among patients with VV compared with 0.9% in the patient cohort without VV (P < 0.0001). An increased risk of DVT was associated with previous DVT, hospitalization during the last 6 months) and malignancy. The authors concluded that in a general practice population with documented VV, there were robust associations between VV and DVT. Attention is required for patients with VV, a history of previous DVT, comorbid malignancy and recent hospital discharge.
Late follow-up of saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy in patients with venous ulcers
M Figueiredo, S P de Araujo and M F Figueiredo
Ann Vasc Surg 2012;
The authors report their prospective observational data (45–68 months follow-up) on a group of 35 patients with venous ulcers, chronic venous insufficiency and were treated with saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy. The following were assessed: wound healing, ultrasound findings and venous clinical severity scores. The following ultrasound findings were observed: total and partial recanalization in 19 patients (treatment failure) and occlusion in 13 patients (treatment success). There were 26% failures as shown by ultrasound. Regardless, ulcers healed between 1–2 months and stayed closed for a mean period of 48 months. The analysis of clinical severity scores (pain, oedema, pigmentation, lipodermatosclerosis and inflammation revealed significant improvement when comparing pre- and post-treatment results. The authors concluded that saphenofemoral junction ligation combined with ultrasound-guided foam sclerotherapy is a feasible palliative treatment method for these patients.
Embolization to treat pelvic congestion syndrome and vulval varicose veins
C J van der Vleuten, J A van Kempen and L J Schultze-Kool
Int J Gynaecol Obstet 2012;
The authors studied 21 women with pelvic congestion syndrome who were treated with embolization. Patients were sent a questionnaire about their symptoms before embolization and two months after the first embolization. Two months after the first embolization 66.7% women had some degree of improvement of symptoms. In all, 42.9% patients underwent a second embolization. At the time the survey was conducted, 76.2% patients had some degree of improvement of symptoms. In addition to improvements in varicose veins and pelvic pain, there was improvement of haemorrhoids. The authors concluded that embolization of pelvic varicosities may be an effective treatment in patients with pelvic congestion syndrome (PCS). If there is no improvement of symptoms after initial embolization, a second procedure is unlikely to be effective.
Post-thrombotic syndrome: feasibility of a strategy of imaging-guided endovascular intervention
L Nayak, C F Hildebolt and S Vedantham
J Vasc Interv Radiol 2012;
A total of 183 patients’ medical records with venous disease were retrospectively reviewed with inclusion criteria: endovascular intervention performed to treat established post-thrombotic syndrome (PTS), patient age greater than 18 years and availability of follow-up records. A total of 44 patients with PTS who had received 72 interventions (iliac vein stent placement [n = 52] and endovenous laser ablation [EVLA; n = 20]) were identified. A blinded reviewer evaluated the records; recorded the presence or absence of pain, swelling, and active ulceration; and categorized the degree of symptom improvement. Of 45 treated limbs in 40 patients with available follow-up, complete, partial or no improvement of overall symptoms was observed in 46.7%, 33.3% and 20.0%, respectively. The proportions of limbs with pain (35.0% after treatment versus 82.5% before and swelling (50.0% after treatment versus 90.0% before) were significantly reduced after treatment with iliac vein stent placement and/or EVLA. Six of seven ulcerated limbs showed significant healing. The authors concluded that the use of endovascular procedures to treat PTS patients were associated with complete or partial symptom relief in 80% of patients.
Variation in thromboembolic complications among patients undergoing commonly performed cancer operations
R R De Martino, P P Goodney, E L Spangler, J B Wallaert, M A Corriere, E M Rzucidlo, D B Walsh and D H Stone
J Vasc Surg 2012;
The investigators investigated the relationship between various cancers and the incidence of thromboembolic complications after surgical intervention. The authors queried the National Surgical Quality Improvement Program database from 2007 to 2009 for deep vein thrombosis (DVT), pulmonary embolism (PE) and overall venous thromboembolic events (VTE) within one month of the index procedure. Over the two-year time period, 43,808 procedures were performed. The incidence for the combined endpoint of DVT, PE and VTE varied from 0.12% for breast resections to 7.3% for oesophagectomies. Compared with breast cancer, gastrectomies and hysterectomies had a 1.31 and 2.68-fold increase in VTE development respectively. Multivariate analysis indicated that inpatient status, steriod use, advance age over 60, morbid obesity, blood transfusion, re-intubation, cardiac arrest, postoperative infectious complications and prolonged hospitalization were independently associated with increased VTE risk.
Placement of retrievable inferior vena cava filter for deep venous thrombosis in term pregnancy
Y Liu, Y Sun, S Zhang and X Jin
J Vasc Surg 2012;
The authors retrospectively reviewed 15 term pregnant patients with deep venous thrombosis who had retrievable filters (OptEase, CordisCorp, New Brunswick, NJ, USA) placed prophylactically for pulmonary embolism prophylaxis during delivery. The filters were place supra-renal immediately prior to c-section via an internal jugular approach and removed postdelivery via a femoral vein approach. Two patients had evidence of thrombus in the filter at the time of retrieval. One filter was left as a permanent filter and the second was removed after treatment with low-molecular weight heparin. The authors concluded that retrieval was safe and that prophylactic use may be justified in this patient population.
Short-term outcome analysis of radiofrequency ablation using ClosurePlus versus ClosureFast catheters in the treatment of incompetent great saphenous vein
J M R Zuniga, A Hingorani, E Ascher, A Shiferson, D Jung, R Jiminez, N Marks and T McIntire
J Vasc Surg 2012;
The authors compared the short-term outcomes of radiofrequency (RFA) endovenous ablation with two types of RFA catheters: VNUS ClosurePlus(CP) and ClosureFast (CF) from 2005 to 2009. CP catheters were used in 312 patients and CF in 355. At one-week post ablation complete obliteration of the great saphenous vein (GSV) was noted in 98% of CF patients and 88% of CP patients (P < 0.001). No deep vein thrombosis (DVTs) were noted in CF patients whereas 3.5% of CP patients had evidence of DVT by ultrasound. Thrombus extension was 7% and 6% in CF and CP patients, respectively (P = 0.80). The authors concluded that CF catheters are superior to CP catheters for GSV obliteration and postoperative DVT prevention.