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1.
Angiol Sosud Khir ; 25(4): 108-115, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855207

RESUMO

AIM: The purpose of the study was to compare the results of using compression knitwear and elastic bandaging in the postoperative period after endovasal laser coagulation in patients with varicose veins. PATIENTS AND METHODS: A total of forty 20-to-55-year-old women with a body mass index of ≤ 35 kg/m2 and CEAP class C2-C3 lower limb varicose veins were randomized into two numerically equal groups. The Study Group included those receiving postoperative compression on the operated leg with the help an elastic stocking, whereas in the Comparison Group compression was achieved by laying an elastic bandage. Both group women underwent laser coagulation of the great saphenous vein and removal of separate veins with the help of Mueller hooks. Efficacy of compression therapy was comparatively assessed based on the results of interviewing the patients prior to intervention and 1 month thereafter, as well as by the level of pain syndrome according to the visual analogue scale at 24 and 48 postoperative hours, by the time spent by the personnel for bandaging of the limb or putting on the compression stocking intraoperatively and at the first dressing, by the degree of lower limb oedema and dynamics of regression thereof, by the area of postoperative haematoma and its dynamics after 2, 7 days and at 1 month. Besides, we evaluated the findings of ultrasonographic angioscanning of lower limb veins at one month postoperatively. RESULTS: The obtained findings demonstrated that efficacy of using a medical compression stocking after the procedure of endovasal laser coagulation in women with varicose veins was comparable to that of elastic bandaging. By the incidence rate and area of extension of postoperative haematomas, degree of pain syndrome, patient-oriented assessment using the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), condition of veins according to the findings of ultrasonographic angioscanning no significant differences were revealed between the two methods of elastic compression of the leg. However, using a medical stocking appeared to promote a statistically significant 1.4-1.6-fold reduction in the time spent for formation of elastic compression of the lower limb, as well as a decrease in the incidence rate and degree of local oedema of the lower limb in the postoperative period.


Assuntos
Bandagens Compressivas , Fotocoagulação a Laser/métodos , Varizes/terapia , Procedimentos Endovasculares , Feminino , Humanos , Qualidade de Vida , Meias de Compressão , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/etiologia , Insuficiência Venosa/cirurgia , Insuficiência Venosa/terapia
2.
Khirurgiia (Mosk) ; (6): 111-116, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317950

RESUMO

We present a case report of atypical hand ischemia probably caused by a combination of venous insufficiency and steal syndrome in patient with arteriovenous fistula for hemodialysis. Unclear clinical symptoms may be due to severe trophic disorders (delayed treatment) or combination of two complications (steal syndrome and venous insufficiency). At the same time, we did not get any diagnostic data confirming organic injury of the upper limb veins or central veins. AVF closure did not result positive changes. Angiography made it possible to assess veins patency, to detect additional patent AVF and to close it. It was previously assumed that this previously created AVF was completely occluded. Therefore, positive changes were observed: rapid healing of trophic ulcers, complete disappearance of pain and gradual restoration of function.


Assuntos
Fístula Arteriovenosa/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Embolização Terapêutica/métodos , Mãos/irrigação sanguínea , Isquemia/cirurgia , Insuficiência Venosa/cirurgia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Mãos/cirurgia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Diálise Renal/instrumentação , Veias/diagnóstico por imagem , Insuficiência Venosa/etiologia
3.
Angiol Sosud Khir ; 25(2): 96-101, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31149995

RESUMO

Over the period from 2015 to 2016, a total of 409 patients presenting with CEAP C4-C6 class chronic venous diseases and lower limb varicose veins were examined and operated on. Depending on technical peculiarities of the operations performed, all patients were divided into 2 groups. Group 1 patients (n=212) underwent thermal obliteration of major veins, miniphlebectomy and administration of a sclerosant into varicose veins under the zone of trophic impairments of the crural skin. Group 2 patients (Control group, n=197) underwent only phlebectomy, ligation of perforant veins and miniphlebectomy, with no use of sclerosants. In order to decrease the traumatic nature of the intervention we devised an original phlebextractor for mobilization of subcutaneous and perforant veins without skin incision. A structural element of the phlebextractor is a hook made in the form of a rod-coaxial tip whose acute angle is within the range of 72-78 degrees, thus ensuring minimally traumatic penetration of the hook through tissues and satisfactory holding of the major vein inside the hook. The proposed minimally traumatic radical method of surgical treatment for varicose veins makes it possible to improve the aesthetic results of the operation and to eliminate functional manifestations of chronic venous insufficiency.


Assuntos
Varizes , Procedimentos Cirúrgicos Vasculares , Insuficiência Venosa , Humanos , Extremidade Inferior , Resultado do Tratamento , Varizes/cirurgia , Veias , Insuficiência Venosa/cirurgia
4.
Cochrane Database Syst Rev ; 5: CD009903, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-31150100

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a leading cause of neurological disability in young adults. The most widely accepted hypothesis regarding its pathogenesis is that it is an immune-mediated disease. It has been hypothesised that intraluminal defects, compression, or hypoplasia in the internal jugular or azygos veins may be important factors in the pathogenesis of MS. This condition has been named 'chronic cerebrospinal venous insufficiency' (CCSVI). It has been suggested that these intraluminal defects restrict the normal blood flow from the brain and spinal cord, causing the deposition of iron in the brain and the eventual triggering of an auto-immune response. The proposed treatment for CCSVI is venous percutaneous transluminal angioplasty (PTA), which is claimed to improve the blood flow in the brain thereby alleviating some of the symptoms of MS. This is an update of a review first published in 2012. OBJECTIVES: To assess the benefit and safety of venous PTA in people with MS and CCSVI. SEARCH METHODS: We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group's Specialised Register up to 30 August 2018, CENTRAL (in the Cochrane Library 2018, issue 8), MEDLINE up to 30 August 2018, Embase up to 30 August 2018, metaRegister of Controlled Trials, ClinicalTrials.gov., the Australian New Zealand Clinical Trials Registry, and the World Health Organization (WHO) International Clinical Trials Registry platform. We examined the bibliographies of the included and excluded studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in which PTA and sham interventions were compared in adults with MS and CCSVI. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias, and extracted data. We reported results as risk ratios (RR) with 95% confidence intervals (CI). We performed statistical analyses using the random-effects model; and we assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included three RCTs (238 participants) in this update. One hundred and thirty-four participants were randomised to PTA and 104 to sham treatment. We attributed low risk of bias to two (67%) studies for sequence generation and two (67%) studies for performance bias. All studies were at a low risk of detection bias, attrition bias, reporting bias and other potential sources of bias.There was moderate-quality evidence to suggest that venous PTA did not increase the proportion of patients who had operative or post-operative serious adverse events compared with the sham procedure (RR 3.33, 95% CI 0.36 to 30.44; 3 studies, 238 participants); nor did it increase the proportion of patients who improved on a functional composite measure including walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity over 12-month follow-up (RR 0.84, 95% CI 0.55 to 1.30; 1 study, 110 participants); nor did it reduce the proportion of patients who experienced new relapses at six- or 12-month follow-up (RR 0.87, 95% CI 0.51 to 1.49; 3 studies, 235 participants). There was no effect of venous PTA on disability worsening measured by the Expanded Disability Status Scale, which was reported at follow-up intervals of six months (one study), 11 months (one study) and 12 months (one study). Quality of life was reported in two studies with no difference between treatment groups. Moderate or severe pain during or post venography was reported in both PTA and sham-procedure participants in all included studies. Venous PTA was not effective in restoring blood flow assessed at one-month (one study) or 12-month follow-up (one study). AUTHORS' CONCLUSIONS: This systematic review identified moderate-quality evidence that, compared with sham procedure, venous PTA intervention did not provide benefit on patient-centred outcomes (disability, physical or cognitive functions, relapses, quality of life) in people with MS. Venous PTA has proven to be a safe technique but in view of the available evidence of its ineffectiveness, this intervention cannot be recommended in people with MS. All ongoing trials were withdrawn or terminated and hence this updated review is conclusive. No further randomised clinical studies are needed.


Assuntos
Angioplastia/métodos , Circulação Cerebrovascular/fisiologia , Esclerose Múltipla/complicações , Insuficiência Venosa/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Insuficiência Venosa/etiologia
5.
Vasc Endovascular Surg ; 53(5): 373-378, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30935347

RESUMO

OBJECTIVE: To evaluate the long-term results in endovascular treatment of iliofemoral venous obstructive lesions. METHODS: From January 2009 to March 2017, 75 patients were admitted for endovascular treatment of chronic obstructive lesions of the iliofemoral veins. Of these, 60 patients underwent stenting of postthrombotic obstructions and 15 patients stenting of nonthrombotic obstructive lesions of the iliac veins (May-Thurner syndrome in 11, for tumor-induced compression and cicatricial stenosis in 4). Dynamic control of stent patency was carried out by means of duplex ultrasound. Efficacy of endovascular intervention was evaluated by measuring the venous pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS: Technical success of endovascular intervention in postthrombotic occlusions of iliac vein was 92% and in nonthrombotic iliac vein lesions was 100%. Cumulative primary and secondary patency in postthrombotic lesions at 60 months amounted to 72% and 81%, respectively, in nonthrombotic lesions to 85% (primary patency). Reinterventions were successfully performed in 6 patients including catheter-directed thrombolysis (3 patients) and stenting (3 patients). The mean VCSS score fell from 14.2 (4.2) to 7.5 (2.6; P < .001). The quality of life was improved; its mean score decreased from 62.6 (18.7) to 48.7 (12.8; P < .01). CONCLUSION: Endovascular angioplasty and stenting for obstructive lesions of the iliofemoral veins is a minimally invasive, safe, and highly effective method of treatment, which is confirmed by a significant improvement of the limb's condition and good long-term results of patency of the restored venous segments.


Assuntos
Angioplastia com Balão , Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Síndrome Pós-Trombótica/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/cirurgia , Adolescente , Adulto , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Velocidade do Fluxo Sanguíneo , Doença Crônica , Angiografia por Tomografia Computadorizada , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/fisiopatologia , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Grau de Desobstrução Vascular , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Pressão Venosa , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
6.
Braz J Med Biol Res ; 52(4): e8330, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30970086

RESUMO

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.


Assuntos
Procedimentos Endovasculares/métodos , Terapia a Laser/métodos , Insuficiência Venosa/cirurgia , Adulto , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fotólise , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/patologia
8.
Ann Vasc Surg ; 58: 302-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769060

RESUMO

BACKGROUND: The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). METHODS: Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. RESULTS: A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). CONCLUSIONS: Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.


Assuntos
Anestesia Local , Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Anestesia Local/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Ligadura , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
9.
Int Angiol ; 38(2): 96-101, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810002

RESUMO

BACKGROUND: The aim of this work was to evaluate the frequency, structure and characteristics of complications after endovenous laser ablation (EVLA). METHODS: The study included 1247 consecutive patients (1417 limbs) with superficial venous insufficiency, treated with EVLA procedures with a wavelength of 1470 nm and automatic pull-back traction of the fiber. Control examinations using Duplex ultrasound were carried out on the second day after EVLA, and in 2 weeks and 1 month after the EVLA procedure. In certain situations, including the detection of complications, timing of the follow-up visits varied. RESULTS: In the postoperative period (up to 1 month after the procedure) complications were detected in 69 cases (4.87% of the EVLA procedures). Complications included the following: deep vein thrombosis (1.55%), pulmonary embolism (0.07%), pain syndrome (1.41%), abscess (0.07%), seroma (0.21%), fragmentations of the laser fiber (0.14%), hyperpigmentation (0.14%), and burn of the skin (0.07%) of the total number of EVLA procedures. CONCLUSIONS: EVLA is not a unique surgical method of treatment, and it has the same complications as any other surgical intervention. The complications rate in patients was 4.87% of EVLA procedures. Most complications can be avoided by developing a standard regulation on their detection and treatment as early as possible.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Terapia a Laser/efeitos adversos , Dor Pós-Operatória/etiologia , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Adolescente , Adulto , Feminino , Humanos , Lasers/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Embolia Pulmonar , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Insuficiência Venosa/diagnóstico por imagem , Adulto Jovem
11.
ABC., imagem cardiovasc ; 32(1): 14-18, jan.-mar. 2019. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-969861

RESUMO

A correta identificação dos pontos de refluxo no estudo das varizes primárias dos membros inferiores é importante na abordagem terapêutica desses pacientes. Objetivo: Avaliar a associação entre a insuficiência de veias perfurantes anteriores do joelho e a insuficiência de veia safena magna em pacientes com varizes primárias de membros inferiores. Métodos: Foram avaliados 886 pacientes, correspondendo a 1.772 membros inferiores, em pacientes acima de 18 anos, de ambos os sexos, submetidos ao mapeamento venoso superficial pela ecografia vascular. Resultados: Os pacientes apresentaram idade média de 46,1 ± 14,5 anos, sendo 81,7% do sexo feminino. A insuficiência de veia safena magna foi encontrada em 38,8% dos casos. A insuficiência da perfurante anterior do joelho foi encontrada em 146 membros inferiores (8,2%), com diâmetro médio de 1,7 ± 0,15 mm, sendo predominante a localização infrapatelar (86,4%). A tributária anterior da veia safena magna originou o refluxo na perna em 34%, com relação direta desta tributária com a perfurante anterior do joelho em 79,4%. Observou-se associação entre a presença de perfurante anterior do joelho e insuficiência de veia safena magna (p = 0,0001) e sexo masculino (p = 0,001). Conclusão: Houve associação entre insuficiência de perfurante anterior do joelho e insuficiência de veia safena magna em pacientes com varizes primárias dos membros inferiores submetidos à ecografia vascular, sendo que a correta identificação desta perfurante pode ser importante na abordagem terapêutica desses pacientes


The accurate identification of reflux points in the study of primary varicose veins of the lower limbs is important in the therapeutic approach of these patients. Objective: To evaluate the association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs. Methods: The study included 886 patients, corresponding to 1,772 lower limbs, in patients older than 18, of both sexes, undergoing superficial venous mapping using vascular ultrasound. Results: The mean age of the patients was 46.1 ± 14.5 and 81.7% were females. Great saphenous vein insufficiency was found in 38.8% of the cases. Insufficiency of the anterior perforator vein of the knee was found in 146 lower limbs (8.2%), with a mean diameter of 1.7 ± 0.15 mm, prevailing in the infrapatellar area (86.4%). The anterior tributary vein of the great saphenous vein originated leg reflux in 34%, with a direct relation of this tributary vein with the anterior perforator vein of the knee in 79.4%. An association between the presence of anterior perforator vein of the knee and great saphenous vein insufficiency (p = 0.0001) and male gender (p = 0.001). Conclusion: There was an association between insufficiency of the anterior perforator vein of the knee and great saphenous vein insufficiency in patients with primary varicose veins of the lower limbs at vascular ultrasound, and the accurate identification of this perforator vein may be important in the therapeutic approach of these patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Veia Safena/fisiopatologia , Varizes/diagnóstico por imagem , Insuficiência Venosa/cirurgia , Extremidade Inferior/cirurgia , Diagnóstico por Imagem/métodos , Fatores Sexuais , Doença Crônica , Prevalência , Estudos Transversais , Ultrassonografia/métodos
12.
Minim Invasive Ther Allied Technol ; 28(1): 6-14, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29671660

RESUMO

BACKGROUND: To review published evidence regarding an n-butyl-cyanoacrylate (NBCA) injection device for great (GSV) and small (SSV) saphenous vein incompetence in terms of occlusion rate, postoperative complications and quality of life improvement. MATERIAL AND METHODS: International bibliographic databases (PubMed, EMBASE, Scopus) were searched to identify possible target articles. The only inclusion criterion was the use of the Variclose® system (Biolas, Ankara, Turkey) for superficial vein insufficiency. Exclusion criteria were case reports, review, meta-analysis, article with <6-month follow-up data, abstracts and congress presentations. PRISMA guidelines were used to lead articles selection. RESULTS: Seven studies were included in the final data analysis. A total of 918 patients (1000 limbs) underwent an NBCA procedure for GSV (947 cases) or SSV (53 cases) incompetence. The average procedure duration was 11.7 min. The most common postoperative complications were postoperative pain (4.8%) and superficial vein thrombosis (2.1%). No deep vein thrombosis or pulmonary embolism cases were described. The occlusion rates at six, 12 and 30 months were 97.3%, 96.8% and 94.1%, respectively. CONCLUSION: NBCA injection with the Variclose device seems to be a feasible, effective and safe treatment in GSV incompetence. Long-term follow-up studies and randomized controlled trials are needed to achieve high-quality evidence.


Assuntos
Embucrilato/administração & dosagem , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adesivos , Humanos , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Resultado do Tratamento
14.
Dermatol Surg ; 45(4): 573-580, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30550518

RESUMO

BACKGROUND: Endovenous heat-induced thrombosis (EHIT) is a thrombus that extends from an ablated saphenous vein into the common femoral vein after endovenous radiofrequency ablation (RFA). OBJECTIVE: To investigate the incidence, progression, treatment, and risk factors associated with EHIT-2 or greater after RFA. MATERIALS AND METHODS: This retrospective study included patients diagnosed with symptomatic superficial venous incompetence that were treated by RFA of the great saphenous vein or anterior accessory saphenous vein during the July 2012 to December 2016 study period. Duplex ultrasound scanning was performed at 1 week, 1 month, 3 months, and every year after RFA to detect EHIT. RESULTS: A total of 317 legs from 274 patients were included. The incidence of EHIT-2 or greater was 7.0%, including 5.4% EHIT-2, 1.3% EHIT-3, and 0.3% EHIT-4. No symptomatic pulmonary embolism was found. The independent risk factors for EHIT-2 or greater were vein diameter (p = .027) and concomitant sclerotherapy (p = .037). CONCLUSION: The risk factors found to be independently associated with EHIT-2 or greater were large vein size and concomitant sclerotherapy. Screening for EHIT should be performed in patients with one or both of these risk factors within 1 week after RFA and in patients with postoperative symptoms suggestive of venous thromboembolism.


Assuntos
Ablação por Radiofrequência/efeitos adversos , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Idoso , Progressão da Doença , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Temperatura Alta/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Trombose/classificação , Trombose/diagnóstico por imagem , Trombose/etiologia , Ultrassonografia Doppler Dupla , Insuficiência Venosa/diagnóstico por imagem
15.
Vascular ; 27(1): 27-32, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30193551

RESUMO

OBJECTIVES: To investigate the initial outcomes of 1940 nm diode laser in the treatment of incompetent saphenous veins. METHODS: This was a prospective observational study. We treated 89 patients with 160 incompetent saphenous veins using a 1940 nm diode laser and bare fiber. The laser's power was set to 4.5 W with a mean linear endovenous energy density of 50.4 J/cm. RESULTS: The one-month closure rate was 100%. The post-procedural pain score at 6 h, 1 day, 10 days, and 1 month was 0.85 ± 1.04, 0.65 ± 1.01, 0.82 ± 1.25, and 0.47 ± 0.82, respectively. Complications encountered included paresthesia (3.8%) and thrombophlebitis (4.4%), whereas no cases of endovenous heat-induced thrombosis were observed. CONCLUSION: The 1940 nm laser and bare fiber at 50.4 J/cm showed satisfactory initial outcomes with less pain and fewer complications, in the treatment of incompetent saphenous veins.


Assuntos
Terapia a Laser/métodos , Lasers Semicondutores/uso terapêutico , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Feminino , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
16.
Phlebology ; 34(2): 115-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29788818

RESUMO

OBJECTIVES: The aim is to evaluate venous stent patency, the development of post-thrombotic syndrome, recurrence, quality of life and the optimal post-procedural anticoagulation regimen in the treatment of iliofemoral deep venous thrombosis. METHOD AND RESULTS: EMBASE and Medline databases were interrogated to identify studies in which acute deep venous thrombosis patients were stented. Twenty-seven studies and 542 patients were identified. Primary, assisted primary and secondary patency rates 12 months after stent placement ranged from 74 to 95, 90 to 95 and 84 to 100%, respectively. The observed post-thrombotic syndrome rate was 14.6%. The incidence of stent re-thrombosis was 8%. In 26% of studies, patients received additional antiplatelet therapy. Quality of life questionnaires employed in 11% of studies, demonstrating an improvement in the chronic venous insufficiency questionnaire (22.67 ± 3.01 versus 39.34 ± 6.66). CONCLUSION: Venous stenting appears to be an effective adjunct to early thrombus removal; however, further studies are needed to identify optimal anticoagulant regimen and effect on quality of life.


Assuntos
Extremidade Inferior/irrigação sanguínea , Trombólise Mecânica , Stents , Insuficiência Venosa/cirurgia , Trombose Venosa/cirurgia , Doença Aguda , Doença Crônica , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Insuficiência Venosa/fisiopatologia , Trombose Venosa/fisiopatologia
17.
Phlebology ; 34(4): 246-256, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30227789

RESUMO

BACKGROUND: Iliofemoral vein stenosis or occlusion is a common cause of severe chronic venous insufficiency. Endovascular venous stenting has become a preferred treatment because it is minimally invasive and has a high safety profile. Despite the wide application of the wallstent, it is not specifically designed for veins. There are currently few studies on braided stents in the field of veins. We designed a novel braided vein stent, which has higher radial resistive force and more optimized looped ends structure compared with the wallstent. The purpose of this study was to evaluate the safety and performance of the stent in animals, providing a reference for further clinical trials. METHODS: The Wallstent is used as a control group. The novel stent and the Wallstent were implanted in the iliac vein of sheep. After 30 days and 90 days, vascular injury, thrombus, neointima coverage, and luminal stenosis were evaluated through venous angiography, endoscopic observation of stent specimen and histopathology. Imaging, histology, and integration data were analyzed by t-test for comparisons between the groups. RESULTS: Two groups of stents were successfully implanted. Follow-up observation showed that there was no thrombosis or obstruction >50% occurred in any group and no significant differences in patency, vascular injury, or intimal hyperplasia compared with the Wallstent. CONCLUSION: The novel stent significantly increases the radial resistive force and does not increase vascular injury, thrombus and stent stenosis during 30-day and 90-day follow-up. The next step is to further validate the effectiveness of the stent through long-term animal observation and human clinical trials.


Assuntos
Veia Ilíaca/cirurgia , Desenho de Prótese , Stents , Insuficiência Venosa/cirurgia , Animais , Constrição Patológica/fisiopatologia , Constrição Patológica/cirurgia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Ovinos , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
18.
Clin Hemorheol Microcirc ; 71(2): 117-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30584123

RESUMO

BACKGROUND: Chronic venous disease (CVD) is extremely common worldwide with prevalence increasing with age. It is associated with a reduced quality of life, particularly in relation to pain, physical function and mobility. Symptomatic chronic venous insufficiency (CVI) with venous ulcer at its' endpoint, indicates interventional surgery to cure venous reflux therewith promoting wound healing and preventing recurrence. In this retrospective, single-centre, consecutive case-control study in a single patient population of a university clinic in northern Germany a holistic evaluation of varicose vein surgeries has been undertaken. Part I covered postoperative complications in relation to co-morbidities, co-medication and clinical presentation. Part II of this article presents now the hemodynamic results in relation to the perioperative evolution of CVI specific symptoms. METHODS: Records of n = 429 (467 extremities) patients from 2009-2013 treated with open surgery were analysed with regards to perioperative hemodynamics. Evolution of CVI symptomology was accessed postoperatively with the help of a questionnaire and patient records in the case of complication development. Venous hemodynamics was analysed in the whole patient population and with regards to complication subgroups: no events (NE), neglectable adverse events (NAE) and non-neglectable adverse events (NNAE). RESULTS: Postoperatively, patients' CVI-symptoms like pain (p < 0.001), swelling (p < 0.001) and itching (p = 0.003) significantly improved. The venous refill time and venous pump capacity improved significantly after open vein surgery (p < 0.05). Regardless of the development of postoperative complications there was a significant improvement of venous function at 6 weeks- and one-year postoperative in follow-up (p < 0.05). Symptom regression was strongly correlated with hemodynamic improvement. CONCLUSION: A significant improvement of patients' symptoms was achieved by means of open-surgery, regardless of postoperative complication development. This was in accordance with the improvement of venous hemodynamics. A strong correlation between symptom regression and improvement in venous hemodynamics could be proven.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Úlcera Varicosa/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Doenças Vasculares/etiologia , Adulto Jovem
20.
Angiol Sosud Khir ; 24(4): 90-94, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30531775

RESUMO

OBJECTIVE: The study was aimed at assessing the venous outflow from the small pelvis after surgical correction of pelvioperineal reflux with the use of reference methods of examination. PATIENTS AND METHODS: We examines a total of 43 female patients (aged 41.5±5.2 years) presenting with pelvic varicose veins and subjected to phlebectomy on the external genitalia, perineum and lower limbs. All women had no evidence of pelvic venous plethora. All women underwent the following examinations: ultrasonographic angioscanning of pelvic and lower-limb veins, emission computed tomography of pelvic veins prior to operation, as well as 1, 6 and 12 months after surgical interventions. We evaluated efficacy of phlebectomy in elimination of pelvioperineal reflux and varicose syndrome, the frequency of detecting valvular insufficiency of pelvic and lower-limb veins, dynamics of the coefficient of pelvic congestion syndrome in the immediate and remote postoperative periods. RESULTS AND DISCUSSION: No cases of relapses of valvular, perineal varicosity, repeat appearance of varicose veins on the lower extremities, occurrence of signs of pelvic venous congestion were revealed. The frequency of detecting valvular insufficiency of the parametrial, uterine, gonadal and iliac veins remained unchanged. The coefficient of pelvic congestion syndrome did not alter either (Cpcs=0.8±0.11 at baseline versus Cpcs=0.78±0.1 after 12 months). CONCLUSION: The obtained results are indicative of a steady state of the venous outflow from the small pelvis in women with pelvic varicose veins and pelvioperineal reflux after surgical removal of vulvar, perineal and superficial femoral veins.


Assuntos
Embolização Terapêutica , Pelve Menor , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares , Insuficiência Venosa/cirurgia , Adulto , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Pelve Menor/irrigação sanguínea , Pelve Menor/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Tomografia Computadorizada de Emissão/métodos , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Varizes/diagnóstico , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos , Insuficiência Venosa/diagnóstico
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