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1.
Khirurgiia (Mosk) ; (1): 90-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395518

RESUMO

We report a complex reconstruction of arteriovenous fistula (AVF). Proximal stenosis of cephalic vein was followed by aneurysms of fistulous veins (distal segment of cephalic vein and median cubital vein) complicated by AVF thrombosis. Blood outflow from AVF was retrograde. One week after thrombosis, an aneurysm of median cubital vein containing dense clots was excised. We resected cephalic vein wall and repaired the vessel. Anastomosis with the brachial artery was created distal to the last anastomosis. Proximal cephalic vein repair was performed using resected aneurysm walls. After a year, AVF has been successfully used for hemodialysis.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Diálise Renal , Doenças Vasculares/cirurgia , Veias/cirurgia , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Artéria Braquial/diagnóstico por imagem , Humanos , Resultado do Tratamento , Doenças Vasculares/etiologia , Grau de Desobstrução Vascular , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Trombose Venosa/cirurgia
2.
Ann Vasc Surg ; 70: 109-115, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32603845

RESUMO

BACKGROUND: Venous leg ulceration (VLU) represents the most advanced form of chronic venous insufficiency (CVI). Persistent VLU that fails to respond to noninvasive treatment requires a minimally invasive endovascular treatment, which may include chemical (ultrasound-guided foam sclerotherapy [UGFS]) and thermal ablation (endovenous laser therapy [EVLT] or radiofrequency ablation [RFA]) targeting incompetent veins. Current guidelines suggest ablation of incompetent perforating veins (IPVs) juxtaposed to active or healed VLU; however, the ideal treatment modality is unknown. We hypothesize that similar to incompetent superficial vein treatment options therapies, VLU healing will be equivalent across minimally invasive IPV treatment options. METHODS: Using the Vascular Low Frequency Disease Consortium, adults with VLU across 11 medical centers were retrospectively reviewed (2013-2017). We included those who underwent IPV therapies. The primary outcome was complete ulcer healing over time compared with cumulative hazard curves, log-rank testing, and multivariable Cox proportional hazard regression. Secondary outcomes included number of subsequent procedures, which were compared using negative binomial regression. RESULTS: Of the 832 adults with VLU, 158 (19%) were exclusively treated conservatively, and 232 (28%) underwent index treatment for IPV and constitute the full and final cohort. The mean age was 60 ± 14 years, 57% were men, and the mean ulcer area was 3.0 cm2 (interquartile range, 1-6 cm2). Ninety-one (39%) were treated with EVLT, 127 (55%) RFA, and 14 (6%) UGFS. Patients treated with RFA were older (RFA 62 ± 14 years; EVLT 59 ± 14 years; UGFS 52 ± 9 years; P = 0.01), more likely to be men (RFA 68%, n = 86; EVLT 41%, n = 37; UGFS 64%, n = 9; P < 0.001), with a higher frequency of anticoagulation (RFA 36%, n = 46; EVLT 18%, n = 16; UGFS 14%, n = 2; P = 0.005). VLU did not significantly differ in size between groups (RFA 6.2 ± 8; EVLT 4.2 ± 5.4; UGFS 6.1 ± 8; P < 0.001). There were no differences in 1-year ulcer healing rates between groups (P = 0.18). The number of subsequent procedures did not differ by treatment modality (P = 0.47). CONCLUSIONS: This multi-institutional retrospective study does not demonstrate any association of IPV treatment modality with differing rates of VLU healing or number of subsequent procedures.


Assuntos
Técnicas de Ablação , Úlcera Varicosa/cirurgia , Insuficiência Venosa/cirurgia , Cicatrização , Técnicas de Ablação/efeitos adversos , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
3.
Angiol Sosud Khir ; 26(3): 69-73, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063754

RESUMO

Presented herein is a clinical case report regarding successful treatment of a trophic ulcer of the right tibia by means of endovenous mechanochemical ablation of the great saphenous vein using the FlebogrifTM device. According to ultrasonography findings, the patient was found to have insufficiency of the saphenofemoral junction, axial truncal reflux, and the absence of incompetent perforator veins in the area of trophic disorders. Taking into account the clinical and ultrasound picture of the disease, the decision was made on the feasibility of performing crossectomy and retrograde mechanochemical ablation of the great saphenous vein. The chosen modality of the invasive intervention did not require tumescent anesthesia, allowed a catheter to be placed under the ulcer bed and, unlike thermal methods, excluded the risk of damage to the subcutaneous nerves and soft tissues. The operation made it possible to eliminate pathological truncal reflux along the entire length, which contributed to rapid healing of the trophic ulcer, relief of varicose disease symptoms, and significant improvement of the patient's quality of life. This clinical case report indicates the possibility of application of retrograde endovenous mechanochemical ablation in a patient with varicose disease, axial reflux and open venous ulcer (C6) and warrants further research in this direction.


Assuntos
Veia Safena , Insuficiência Venosa , Veia Femoral , Humanos , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Ultrassonografia , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/cirurgia
4.
Khirurgiia (Mosk) ; (8): 42-48, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869614

RESUMO

OBJECTIVE: To analyze AVF patency rates after balloon angioplasty and palliative open surgery in patients with native AVF and central vein stenosis. MATERIAL AND METHODS: The study included 39 patients who underwent percutaneous balloon angioplasty (main group) and 41 patients who underwent palliative interventions (comparison group): thrombectomy, proximalization of arteriovenous anastomosis, AVF blood flow reduction. All patients were diagnosed with stenosis of subclavian vein, innominate vein, inferior vena cava or multiple lesions. RESULTS: Primary annual patency rate in the main group was 15.4% [95% CI 6.2; 28.3], in the comparison group - 0% (p=0.0011). Secondary annual patency rate was 66.7% [95% CI 49.6; 79.1] and 19.5% [95% CI 9.2; 32.7], respectively (p<0.0001). In the main group, a strong negative correlation between primary patency rate and stenosis-free period was revealed (r= -0.627 [95%CI -0.787; -0.388], p<0.0001). We did not find such correlation in the comparison group (r=0,049 [95% CI -0.262; 0.351], p=0.7599). Thus, balloon angioplasty is less effective for delayed stenosis. This feature should be considered in planning vascular approach. Different primary and secondary patency rates in the comparison group indicate that AVF blood flow reduction is an effective palliative treatment. CONCLUSION: Balloon angioplasty can significantly increase duration of AVF patency. Effectiveness of this procedure significantly depends on the period of manifestation of central vein stenosis. Balloon angioplasty cannot be considered a radical method in case of significant stenosis. This method only prolongs period for creation of new permanent contralateral vascular approach. Reduction of AVF blood flow can significantly reduce clinical severity of central vein stenosis and slightly extends the period of AVF patency.


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Constrição Patológica/cirurgia , Insuficiência Venosa/cirurgia , Humanos , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
5.
Vasc Endovascular Surg ; 54(8): 687-691, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32744168

RESUMO

BACKGROUND: To investigate the influence of superficial venous ablation on deep venous dilation and reflux in patients with saphenous varicose veins, and to elucidate the association between superficial venous reflux and deep venous morphology and hemodynamics. METHODS: The data of 154 patients with 223 limbs, who underwent endovenous radiofrequency ablation (RFA) of the great saphenous vein for primary varicose veins between September 2014 and March 2016 in Eniwa Midorino Clinic, were retrospectively analyzed. Overall venous hemodynamics of the leg, including functional venous volume (VV) and venous filling index (VFI), was assessed using air-plethysmography. Saphenous and deep vein reflux and diameter were evaluated with duplex scanning. RESULTS: Hemodynamic and morphologic changes were evaluated before and 1 month after RFA. The VV and VFI were significantly decreased in postoperative values than in preoperative values (P < .001). Limbs with deep venous reflux significantly decreased postoperatively than preoperatively (P < .001). There were significant differences in the diameter of the common femoral vein (CFV) and popliteal vein (PV) between the preoperative and postoperative values (P < .001). There were strong to moderate correlations between the VV and the diameter of the CFV or PV (CFV, r = 0.47, P < .001; PV, r = 0.35, P < .001), while there were moderate to weak correlations between the VFI and the diameter of the CFV or PV (CFV, r = 0.23, P < .001; PV, r = 0.33, P <.001). CONCLUSIONS: Superficial venous ablation significantly reduced deep venous dilation and reflux in patients with saphenous varicose veins. Significant correlations existed between the VV or VFI, which reflected superficial venous reflux, and the diameter of the deep veins. These findings reveal that volume overload due to superficial venous reflux is associated with deep venous morphology and hemodynamics.


Assuntos
Ablação por Cateter , Procedimentos Endovasculares , Veia Femoral/fisiopatologia , Hemodinâmica , Veia Poplítea/fisiopatologia , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Veia Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
6.
Eur J Vasc Endovasc Surg ; 60(4): 587-593, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32739105

RESUMO

OBJECTIVE: The aim was to validate the SYM VEIN consensus 3D scoring tool in chronic venous disease (CVD). METHODS: This was a prospective cohort study with a total of 35 consecutive patients with CVD. Patients with CVD undergoing saphenectomy were assessed with the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ-20 quality of life score questionnaire, and the SYM VEIN consensus statement 3D system, pre-operatively and four weeks post-operatively. The total 3D score was tested for reliability, construct validity, and responsiveness. RESULTS: The total 3D score demonstrated good reliability and internal consistency (Cronbach's alpha 0.85). Principal component analysis identified three groups of symptoms (paraesthesia, burning pain, and pruritus, vs. heaviness, sensation of swelling and aching/pain, vs. restless leg and throbbing pain) demonstrating a high intragroup correlation and likely to share similar pathophysiology, indicative of adequate construct validity. The total 3D score showed a significant correlation with r-VCSS and CIVIQ-20 score (rho .46, p = .005 and rho .65, p < .001, respectively) indicative of adequate convergent validity. After saphenectomy, significant reductions (p < .001) of the total 3D, and 3D scores for all but two individual venous symptoms were observed, indicative of excellent responsiveness. Median total 3D score was reduced from 31 to 6 (83.8% decrease, p < .001), median r-VCSS was reduced from 6 to 0 (100% decrease, p < .001), and median CIVIQ-20 score was reduced from 24 to 14 (40% decrease, p < .001). The difference of median percentage change between r-VCSS and CIVIQ-20 score vs. total 3D score was significant (p = .005 and p < .001, respectively). CONCLUSION: The total SYM VEIN 3D score has good reliability, construct validity and excellent responsiveness, although less prone to change after saphenectomy compared with r-VCSS.


Assuntos
Avaliação de Sintomas , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Adulto , Idoso , Doença Crônica , Feminino , Nível de Saúde , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Veia Safena/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia
7.
PLoS One ; 15(7): e0235656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628724

RESUMO

AIM: To assess the feasibility and technical success of endovenous laser ablation (EVLA) of recurrent varicose veins arising from the former sapheno-femoral junction (SFJ). METHODS: We retrospectively analyzed all EVLA procedures treated in our institution by one surgeon between March 2019 and April 2020 and selected all consecutive cases with SFJ recurrence occuring after surgical high ligation and stripping or endovenous thermal ablation for incompetence of the great saphenous vein (GSV) in superficial venous insufficiency. The feasibility, technical success as determined by duplex ultrasound on the postoperative visit, complications and rate of endothermal heat-induced thrombosis (EHIT) were recorded. A subgroup definition was performed based on sonographic morphology of the recurrence and resulting strategy of ablation. RESULTS: Thirty-five limbs with SFJ recurrence in 34 patients were treated with EVLA in order to shut down the highest refluxing point. In 22 interventions, it was required to switch off a short stump or a neovascularization by direct puncture (Subgroup 1). In 13 treatments, the presence of residual GSV segments, or persistent, varicose transformed major tributaries like the anterior accessory great saphenous vein, enabled cannulation and advancing the laser fiber from distal to the former SFJ (Subgroup 2). The EVLA procedures could be successfully carried out in all 35 cases. There were no major complications, no thromboembolism or EHIT, and no local groin complications. In one case, the patient developed a phlebitic response that required temporary medication. Technical success was achieved with 34/35 treatments (97.1%). When comparing the subgroups, the morphological pattern of the SFJ recurrence and the resulting technique of puncture, cannulation and ablation did not influence the result. CONCLUSIONS: The results of this case series suggest that SFJ recurrences can also be successfully treated in situations where there are tortuous or short stumps that require direct puncture and ablation.


Assuntos
Procedimentos Endovasculares/métodos , Varizes/cirurgia , Adulto , Idoso , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Fisiológica , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Veia Safena/patologia , Insuficiência Venosa/patologia , Insuficiência Venosa/cirurgia
8.
J Med Vasc ; 45(3): 130-146, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402427

RESUMO

Venous insufficiency is a very common disease affecting about 25% of the French population (if we combine all stages of its progression). It is a complex disease and its aetiology has not yet been fully elucidated. Some of its causes are well known, such as valvular dysfunction, vein wall defect, and the suctioning effect common to all varicose veins. These factors are generally associated and together lead to dysfunction of one or more of the saphenous veins. Saphenous vein dysfunction is revealed by ultrasound scan, a reflux lasting more than 0.5 seconds indicating venous incompetence. The potential consequences of saphenous vein dysfunction over time include: symptoms (heaviness, swellings, restlessness, cramps, itching of the lower limbs), acute complications (superficial venous thrombosis, varicose bleeding), chronic complications (changes in skin texture and colour, stasis dermatitis, eczema, vein atresia, leg ulcer), and appearance of unaesthetic varicose veins. It is not possible to repair an incompetent saphenous vein. The only therapeutic options at present are ultrasound-guided foam sclerotherapy, physical removal of the vein (saphenous stripping), or its thermal ablation (by laser or radiofrequency treatment), the latter strategy having now become the gold standard as recommended by international guidelines. Recommendations concerning thermal ablation of saphenous veins were published in 2014 by the Société française de médecine vasculaire. Our society has now decided to update these recommendations, taking this opportunity to discuss unresolved issues and issues not addressed in the original guidelines. Thermal ablation of an incompetent saphenous vein consists in destroying this by means of a heating element introduced via ultrasound-guided venous puncture. The heating element comprises either a laser fibre or a radiofrequency catheter. The practitioner must provide the patient with full information about the procedure and obtain his/her consent prior to its implementation. The checklist concerning the interventional procedure issued by the HAS should be validated for each patient (see the appended document).


Assuntos
Terapia a Laser/normas , Ablação por Radiofrequência/normas , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Lista de Checagem/normas , Tomada de Decisão Clínica , Consenso , Humanos , Terapia a Laser/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem
9.
Ann Vasc Surg ; 68: 172-178, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32339689

RESUMO

BACKGROUND: To describe the occlusion rate and clinical response of a redo ablative procedure in symptomatic patients with recanalization of saphenous vein after endovascular thermal ablation. METHODS: A retrospective cohort study was performed in a prospectively collected data of symptomatic patients with recanalization of the great saphenous vein (GSV) or small saphenous vein (SSV) after endovascular thermal ablation who underwent a secondary ablation (SA) from June 2015 to May 2018. RESULTS: Ten patients (15 limbs) with recanalization of the GSV or SSV were treated with SA. The median age was 67 years and 60% were men. The median time from the first ablation was 7.3 years (interquartile range [IQR] 6.5-9.6). For SA, radiofrequency ablation was performed in 12 limbs (80%) and ultrasound-guided foam sclerotherapy in 3 cases (20%). The GSV was the treated vessel in 14 cases (93.3%). No complications were reported. Median follow-up was 13 months. Preoperative and 1-year follow-up Venous Clinical Severity Score was 9 (IQR 5-10) and 4 (IQR 2-8), respectively. Duplex ultrasound evaluation after 1 year showed an occlusion rate of 93.3% evidencing a partially recanalized vein in 1 treated limb. CONCLUSIONS: In this study, the occlusion rate was 93.3% at 1 year after SA; clinical improvement and no complications were reported. SA appears to be a valid option for the treatment of symptomatic patients with recanalized GSV or SSV.


Assuntos
Técnicas de Ablação , Procedimentos Endovasculares , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Idoso , Doença Crônica , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem
10.
Angiol Sosud Khir ; 26(1): 56-61, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32240137

RESUMO

AIM: The purpose of the present study was to assess the possibility of carrying out endovenous laser obliteration (EVLO) with radial light guides on a laser device operating at a wavelength of 1470 nm, using for tumescence only cold normal saline solution without additional sedation or narcosis in patients with allergy to local anaesthetics. PATIENTS AND METHODS: Our prospective non-comparative single-centre study consecutively included 37 patients who from November 2014 to June 2019 underwent a total of 41 isolated EVLO procedures without simultaneous miniphlebectomy or sclerotherapy of tributaries. Given the previous history of allergy to amide-group local anaesthetics and/or multiple allergic reactions to other agents, these patients received as anaesthesia and tumescence exclusively normal saline solution cooled to a temperature of +3-6ºC, without addition of local anaesthetics or any other therapeutic agents, with neither sedation nor narcosis. RESULTS: The great saphenous vein was subjected to coagulation in 33 (80.5%) cases, the anterior accessory saphenous vein in 5 (12.2%), and the small saphenous vein in 3 (7.3%) cases. The median of the mean diameter of the veins at 3 cm from the saphenofemoral or saphenopopliteal junction amounted to 10 mm (1st quartile 8.2; 3rd quartile 11). The median of the mean length of the coagulated vein - 45 cm (1st quartile 22; 3rd quartile 51), the median of the average amount of the administered normal saline solution - 300 ml (1st quartile 200; 3rd quartile 450), the median of the average amount of normal saline per 1 centimetre of the venous length - 8.7 ml (1st quartile 7.5; 3rd quartile 10). All patients without exception tolerated the intervention. The process of laser obliteration was not discontinued due to pronounced perioperative pain syndrome in any case. All patients after the procedure answered the question 'Would you repeat a similar intervention if the need arises?' in the affirmative. All the 41 (100 %) veins subjected to coagulation were obliterated at early terms of follow up, with no ultrasonographic evidence of recanalization. CONCLUSION: The obtained findings suggest a possibility of performing EVLO in patients with an allergy-burdened history in relation to local anaesthetics using for tumescence exclusively normal saline solution chilled to a temperature of +3-6ºC, with no additional sedation or narcosis. Such an approach makes it possible, on the one hand, not to change the organization of outpatient phlebological care and on the other hand to refuse from involving anaesthesiological support. Besides, it is absolutely safe in relation to the risk for the development of allergic reactions.


Assuntos
Terapia a Laser , Varizes/diagnóstico , Insuficiência Venosa/cirurgia , Humanos , Estudos Prospectivos , Solução Salina , Veia Safena/diagnóstico por imagem , Resultado do Tratamento
11.
Interv Cardiol Clin ; 9(2): 255-263, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147125

RESUMO

Chronic venous insufficiency is a common and a highly prevalent vascular disorder, that occurs as a result of venous reflux owing to defective venous valves, which in turn causes venous hypertension with significant symptom burden that can interfere with quality of life. Therapeutic strategy involves lowering the venous pressure by lifestyle changes, compression therapy, and conventional catheter-based thermal ablation and novel nonthermal, nontumescent techniques of ablating the affected veins.


Assuntos
Ablação por Cateter/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/cirurgia , Doença Crônica , Humanos , Índice de Gravidade de Doença , Insuficiência Venosa/diagnóstico
12.
Georgian Med News ; (298): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141840

RESUMO

Acute thrombophlebitis of the superficial veins is an urgent problem as it can spread to the deep veins with the subsequent development of pulmonary embolism. The social implications of varicotrombophlebitis are the long-term disability of most patients up to complete disability, so finding the least invasive methods of correction of the discussed disease is a pressing issue of modern phlebology. The research objective is to carry out a comparative analysis of the quality of life of patients with acute ascending thrombophlebitis of the great sapheneous vein after treatment with high-frequency endovenous welding and standard phlebectomy. The results of treatment of 63 patients with acute ascending thrombophlebitis of great saphenous vein (GSV) with III and IV class of thrombophlebitis, who were hospitalized in the surgical wards of the Municipal Clinical Hospital No. 8 of Kyiv from 2017 to 2018, were analyzed. Welding of the thrombotic vein segment was performed using an endovenous welding catheter (WC). Quality of life (QOL) results were assessed using CIVIQ2 (Chronic Venous Insufficiency Questionnaire). According to ultrasound duplex scanning, complete vein ablation occurred in 97.22% of patients after endovenous welding (EW) of thrombotic GSV. In all patients of Group I already on day 2, the total rate of QOL by all factors (pain, physical, social, psychological) significantly (p<0.05) exceeded the presurgery values and was 79.3%, when before treatment this indicator was 4.3% higher. At follow-up, QOL values continued to improve over all observation periods compared to the previous term (p <0.05). Quality of life restriction in connection with pain, social and psychological factors after EW decreased 2.1 times(p<0.05), when in control group patients - only 1.2 times. The revealed advantages of the method of high-frequency endovenous welding by all indicators of quality of life over standard phlebectomy allow recommending this method for wide practical application.


Assuntos
Ablação por Cateter , Terapia a Laser , Qualidade de Vida/psicologia , Veia Safena/cirurgia , Tromboflebite/cirurgia , Insuficiência Venosa/cirurgia , Soldagem , Humanos , Tromboflebite/psicologia , Resultado do Tratamento , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico
13.
J Vasc Surg Venous Lymphat Disord ; 8(5): 805-813, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32205128

RESUMO

BACKGROUND: Treatment of pathologic perforator veins (PPVs) can shorten time to healing and reduce recurrence of ulcers in patients with advanced venous disease. Because of limited clinical evidence and device options, widespread adoption of PPV treatment is controversial. The objective of this study was to evaluate the safety and efficacy of endovenous laser therapy using a 400-µm optical fiber to treat PPVs. METHODS: This study was a single-arm, prospective, seven-center, nonblinded clinical study examining patients with advanced skin changes or healed or active ulceration (Clinical, Etiology, Anatomy, and Pathophysiology clinical class C4b, C5, and C6). Patients received treatment with a 1470-nm laser. Procedural technical success and 10-day primary closure were evaluated. All device-related adverse events were reported. Follow-up of patients was continued for 12 months after initial ablation. RESULTS: The primary PPV closure (at 10-day visit) rate was 76.9% (95% confidence interval, 70.3%-82.4%). Successful primary closure rates of 75.7%, 70.3%, 62.1%, 68.8%, and 71.3% of PPVs were achieved at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. Statistically significant improvements (P < .05) were seen in patients' quality of life at 1 month, 3 months, 6 months, 9 months, and 12 months compared with screening. The percentage of patients with ulcers (22.9% at screening, 14.1% at 1 month, 13.7% at 3 months, 10.1% at 6 months, 12.3% at 9 months, and 11.1% at 12 months) displayed improvement during the course of the study. Tibial deep venous thrombosis and procedural pain were the only device-related adverse events observed. CONCLUSIONS: Endovenous laser therapy for PPV using the 400-µm optical fiber with the 1470-nm laser yielded safe and effective outcomes with no major adverse sequelae.


Assuntos
Procedimentos Endovasculares/instrumentação , Terapia a Laser/instrumentação , Fibras Ópticas , Úlcera Varicosa/cirurgia , Veias/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/fisiopatologia , Veias/diagnóstico por imagem , Veias/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Cicatrização
14.
Vascular ; 28(5): 591-596, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32216537

RESUMO

OBJECTIVES: The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is still a popular technique. Although this procedure is considered to be fast and simple, side effects such as headaches, vomiting, and urinary retention could occur. These side effects make the recovery period difficult for the patient. The patient's age, gender, and procedural risk factors such as needle sizes and types are important parameters that affect the occurrence and rate of undesirable outcomes. This retrospective study aims to evaluate the endovenous thermal ablation method for the management of incompetent great saphenous veins under spinal anesthesia. METHODS: A total of 128 patients with incompetent varicose veins who were treated with an endovenous thermal ablation method under spinal anesthesia were retrospectively investigated between January 2016 and January 2019. The pre-, intra-, post-procedural, and follow-up data of the patients were collected and retrospectively compared. RESULTS: A total of 128 patients (69 males, 59 females; mean age 45.8 ± 11.8 years; range 21-71 years) were included in the study. The average preprocedural great saphenous vein diameters were 7.41 ± 18.8 mm (range: 5.5-13.0). The average ablated vein length was 25.3 ± 3.4 (range: 15-35) cm. The average tumescent anesthesia use was 300.9 ± 52.6 (range: 150-500) mL. The average procedure time was 18.2 ± 1.8 (range: 11-25) min. The venous clinical severity scores and the chronic venous insufficiency quality of life questionnaire scores declined significantly (p for venous clinical severity scores: 0.001, p for chronic venous insufficiency quality of life questionnaire scores: 0.001). There was no postoperative paresis or paresthesia. There was one case of deep venous thrombosis and three cases of bruising. The total of three months' occlusion rates was 96.9% (124/128).The overall post-dural puncture headache ratio was 18%. Women significantly suffered from more headaches than men (27% vs. 10%, p = 0.013). The extreme age intervals (pertaining to ages between 18 and 30 or 50+) were almost significantly less affected by headaches in comparison to the group with the age interval between 31 and 50 (11.3%, 24.2%, p: 0.056). A percentage of 12.5 patients suffered from vomiting. It was recorded that female patients suffered from vomiting more so than the males (20.3%, 5.8%, p: 0.013). Pertaining to vomiting, there was no significant difference between the two age interval groups (p: 0.14). Urinary retention was observed in 6.3% of the patients. The female gender had a higher ratio of urinary retention, but the difference was insignificant. (8.5%, 4.3%, p: 0.46). There was no significant difference between the age interval groups in terms of urinary retention. CONCLUSIONS: The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is a fast and effective treatment option for the management of incompetent saphenous veins. However, side effects such as headaches, vomiting, and urinary retention that are affected by gender types, age-intervals, and procedural characteristics should be kept in mind.


Assuntos
Técnicas de Ablação/efeitos adversos , Raquianestesia/efeitos adversos , Cefaleia Pós-Punção Dural/etiologia , Náusea e Vômito Pós-Operatórios/etiologia , Veia Safena/cirurgia , Retenção Urinária/etiologia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico , Adulto Jovem
15.
Eur J Vasc Endovasc Surg ; 59(4): 625-634, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32008931

RESUMO

OBJECTIVE: The subcutaneous venous network (SVN) is difficult to see with the naked eye. Near infrared illumination (NIr-I) claims to improve this. The aims of this observational study were to investigate whether there are differences between the different methods; to quantify the length and diameter of SVNs; and to confirm if they differ between C0A and C1 CEAP limbs. METHODS: In total, 4 796 images, half of them from the visible spectrum (VS) and the other half from the nearninfrared spectrum (NIrS), belonging to 109 females (C0A: n = 50; C1 CEAP: n = 59) were used to establish the morphological characteristics of the SVN by visual analysis. With Photoshop CS4, SVN diameters and lengths were obtained by digital analysis of 3 052 images, once the images of whole extremities were excluded. RESULTS: On NIr-I, the diameters, trajectories, and colouration of SVNs of C1 limbs appeared more irregular than SVNs of C0A limbs. Compared with the VS images, NIr-I allowed visualisation of a greater length of the SVN in both groups (p < .010). This capacity varied from 2.6 ± 0.9 times (C1) to 16.2 ± 11.9 (C0A). While the SVN length seen in the VS images from C1 limbs was greater than observed in C0A limbs (p < .001), differences between NIr-I images only existed in the lateral part of the lower leg (p = .016). With NIr-I, the median diameter of the C1 CEAP SVN veins was 5.8 mm (interquartile range [IQR] 4.3-7.5 mm), while the median diameter in C0A SVN limbs was 2.6 mm (IQR 2.0-3.6 mm) (p < .001). CONCLUSION: The NIr-I reveals the characteristics of the SVN better than the naked eye. Further studies are required to determine the significance of the changes in the SVN in C0A and C1 limbs, and the factors causing them.


Assuntos
Extremidades/irrigação sanguínea , Varizes/diagnóstico por imagem , Veias/diagnóstico por imagem , Insuficiência Venosa/cirurgia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Extremidades/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Ultrassonografia Doppler Dupla/métodos , Varizes/cirurgia , Insuficiência Venosa/diagnóstico por imagem
16.
J Vasc Surg Venous Lymphat Disord ; 8(4): 629-633, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31928957

RESUMO

OBJECTIVE: This study aimed to investigate the prognosis of preoperative reflux in the below-knee great saphenous vein (BK-GSV) after surgical or endovenous treatment of reflux of the above-knee GSV (AK-GSV) with concomitant stab avulsion of tributary varicosities and correlation between the results of preoperative duplex ultrasound (DUS) and postoperative reflux status of the BK-GSV. METHODS: From August 2015 to May 2018, there were 63 limbs (59 patients) with untreated primary varicose vein with reflux in the whole length of the GSV included in this study. The treatment methods were conventional surgery and radiofrequency ablation. Patients underwent DUS and assessment of Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Symptom Severity (AVVSS) score before treatment and at 6 and 12 months after treatment. RESULTS: Reflux in the BK-GSV persisted in 51% (32/63) of limbs at 6 months and 51% (18/35) at 12 months after treatment of reflux of the AK-GSV combined with stab avulsion of tributary varicosities. The reflux status of the BK-GSV after treatment was independent of diameter (P = .65 at 6 months and P = .68 at 12 months) and duration of reflux of the BK-GSV (P = .76 at 6 months and P = .95 at 12 months) on preoperative DUS. The percentage improvement in the VCSS and AVVSS score, respectively, was 46% and 58% in the group of competent BK-GSV and 54% and 80% in the group of incompetent BK-GSV at 6 months (P = .52 for VCSS; P = .28 for AVVSS score) and 95% and 90% in the group of competent BK-GSV and 87% and 92% in the group of incompetent BK-GSV at 12 months (P = .15 for VCSS; P = .84 for AVVSS score). CONCLUSIONS: Although preoperative reflux in the BK-GSV persists in half of limbs after treatment of reflux of the AK-GSV combined with stab avulsion of tributary varicosities, clinical results and quality of life improve regardless of reflux status of the BK-GSV. The postoperative reflux status of the BK-GSV is independent of diameter and duration of reflux of the BK-GSV on preoperative DUS.


Assuntos
Ablação por Radiofrequência , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
17.
J Vasc Surg Venous Lymphat Disord ; 8(4): 610-616, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31987758

RESUMO

OBJECTIVE: The objective of this study was to evaluate the efficacy, durability, and safety of radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) of the great saphenous vein (GSV) and small saphenous vein (SSV) to treat symptomatic venous reflux in patients receiving therapeutic anticoagulation. METHODS: Patients treated at a single institution with RFA or EVLA while receiving warfarin (Coumadin) anticoagulation were identified retrospectively along with a consecutive sample of patients not receiving anticoagulation who were similarly treated. Patients' demographics, comorbidities, procedural details, and follow-up data were obtained from electronic medical records. Outcomes of interest included the rates of persistent vein ablation, bleeding, deep venous thrombosis (DVT), and endothermal heat-induced thrombosis. Groups were compared using χ2 tests, Fisher exact test, Kaplan-Meier curves, and Cox proportional hazard modeling. RESULTS: There were 100 procedures performed in 65 patients receiving anticoagulation and 127 procedures in 89 control patients. Mean follow-up time was 467 days. The most common indications for anticoagulation were atrial fibrillation (52%), remote DVT (29%), and mechanical heart valves (8%). Patients receiving anticoagulation were on average older (67 years vs 52 years), were more likely to be male (51% vs 27%), and had higher rates of coronary disease (9% vs 0%) and hypertension (55% vs 20%), although they were more likely to have never smoked (86% vs 69%). There were 127 RFA procedures (56%) and 100 EVLA procedures (44%); 189 procedures treated the GSV or its tributaries (83%), and 38 treated the SSV (17%). At 1 year, the target vessel remained ablated after 96% of procedures performed with anticoagulation and in 99% of controls; at 18 months, rates were 92% vs 95% (P = .96). Rates of persistent ablation did not differ significantly by vessel treated (P = .28), EVLA vs RFA (P = .36), or use of antiplatelet therapy (P = .92). One patient had bleeding from a phlebectomy site 2 days postprocedurally when supratherapeutic on warfarin; this was controlled with pressure. DVT in the ipsilateral leg occurred within 90 days after 1 of 100 (1%) procedures in patients receiving anticoagulation and 2 of 127 (1.6%) procedures in control patients; endothermal heat-induced thrombosis rates were similarly 1 of 100 (1%) procedures in patients receiving anticoagulation and 1 of 127 (0.8%) in control patients. CONCLUSIONS: This is the largest series to date reporting >30-day follow-up for patients undergoing venous ablation procedures while receiving anticoagulation and the longest follow-up reported of any series. Durability, safety, and efficacy of vein ablation in patients receiving anticoagulation are comparable to those in control patients. Anticoagulation should not be considered a contraindication to endothermal ablation of the GSV or SSV for symptomatic venous reflux.


Assuntos
Anticoagulantes/administração & dosagem , Terapia a Laser , Ablação por Radiofrequência , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Varfarina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Bases de Dados Factuais , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/induzido quimicamente , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Varfarina/efeitos adversos
18.
Adv Ther ; 37(Suppl 1): 6-12, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31981107

RESUMO

Contemporary interventional treatment of primary chronic venous disease (CVD) is mainly focused on the treatment of venous reflux. The long-term results of endovenous ablation (EVA) and high ligation and stripping are not different with respect to varicose vein recurrence, and this recurrence appears to be a manifestation of disease progression. Since inflammation is one of the key mechanisms of CVD development and progression, efforts to minimize inflammation and angiogenic potential in endovenous and surgical procedures are worthwhile. As techniques continue to be refined, surgery remains a valid option; in particular, the techniques that minimize trauma can be beneficial regarding recurrence. Medical treatment with venoactive drug therapy such as micronized purified flavonoid fraction (MPFF; Daflon®), which has proven clinical benefits in patients with CVD, can be used before and after EVA or surgery to minimize inflammation, pain, hemorrhage, and reduce CVD symptoms.


Assuntos
Doenças Vasculares/cirurgia , Doença Crônica , Bandagens Compressivas , Diosmina/uso terapêutico , Progressão da Doença , Europa (Continente) , Flavonoides/uso terapêutico , Humanos , Terapia a Laser , Recidiva , Escleroterapia/métodos , Resultado do Tratamento , Úlcera Varicosa/cirurgia , Varizes/cirurgia , Doenças Vasculares/tratamento farmacológico , Doenças Vasculares/patologia , Insuficiência Venosa/cirurgia
19.
Minim Invasive Ther Allied Technol ; 29(1): 35-41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30794000

RESUMO

Introduction: Venous outflow obstruction is a common condition among patients with chronic venous insufficiency. Endovascular treatment is favourable over open surgery. This study aimed to assess stent patency and clinical outcome in venous outflow obstruction of lower limbs, and also to compare it between post-thrombotic syndrome and non-thrombotic iliac vein lesions.Material and methods: The study was a historical cohort study. Patients with chronic deep venous insufficiency referred to our tertiary referral centre who underwent venoplasty were recruited. Patients were divided into two groups: non-thrombotic-iliac-vein-lesions and post-thrombotic syndrome. Stent patency rate, clinical improvement and risk factors were evaluated during a six-months course after venoplasty.Results: One-hundred-sixty-four patients were included. Six-months primary, assisted primary and secondary patency rates were 98.86%, 100% and100% in the non-thrombotic-iliac-vein-lesions group and 88%, 93% and 96% in the post thrombotic syndrome groups (p-value = .005, p-value = .02, and p-value = .09, respectively). Pain, claudication and edema were the most common symptoms in both groups and significantly improved after six months. Early thrombosis in the PTS group was more common (9 vs. 1, P value = .007).Conclusion: Percutaneous stenting in patients with venous outflow obstruction is safe and effective with a high patency rate and significant decrease in clinical score in both post-thrombotic syndrome and non-thrombotic-iliac-vein lesions groups.


Assuntos
Síndrome Pós-Trombótica/cirurgia , Stents , Insuficiência Venosa/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Veia Ilíaca , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Grau de Desobstrução Vascular
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