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1.
Rev Med Suisse ; 16(718): 2387-2390, 2020 Dec 09.
Artigo em Francês | MEDLINE | ID: mdl-33300699

RESUMO

Congenital venous malformations (VMs) are the most common vascular abnormalities. Their treatment can be complex, depending on their size and surrounding tissues involvement. To date, sclerotherapy is considered the gold standard for the treatment of VMs. This technique, which aims to destroy the endothelium and thus cause fibrosis and retraction of the vascular lesion, is less effective in voluminous VMs. Endovenous thermal ablation is a widely validated treatment in the management of venous insufficiency, showing better efficacy than sclerotherapy in terms of trans-parietal vessel destruction. This approach has therefore also been described in the treatment of VMs. This technique has been introduced for the treatment of complex VMs at the Centre for Malformations and Rare Vascular Diseases of the CHUV.


Assuntos
Terapia a Laser , Malformações Vasculares/terapia , Humanos , Escleroterapia , Veias/cirurgia , Insuficiência Venosa/terapia
2.
Internist (Berl) ; 61(12): 1230-1237, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33141265

RESUMO

Chronic venous diseases belong to the most frequent diseases. They can be asymptomatic, cause subjective symptoms or lead to objectif alterations, such as edema, cutaneous alterations and venous leg ulcers. This ultimately results in chronic venous insufficiency (CVI). Varicose veins are a progressive degenerative disease of the venous walls in the superficial venous system of the legs, which can decisively impair the quality of life of those affected. The classification of chronic venous diseases is carried out with the CEAP classification according to clinical, etiological, anatomical and pathophysiological criteria. Instruments, such as the venous clinical severity score, are used for assessment of the severity. The treatment of chronic venous diseases targets the improvement of the subjective complaints and objectifiable alterations. In addition, complications, such as phlebitis and formation of ulcers should be avoided. Invasive procedures, compression treatment and pharmaceutical treatment are complementary and a combination of these procedures can be meaningful. General physical measures, such as propping up the legs and frequent walking, are part of the basic measures for every patient with venous diseases. Compression therapy with medical compression stockings is the gold standard in the noninvasive treatment of symptomatic venous diseases, possibly supplemented by anti-inflammatory drugs. A varicose vein should be eliminated whenever possible. Stripping operations and the less invasive endovenous thermal ablation show comparable results for saphenous vein varicosis. Foam sclerotherapy and percutaneous phlebectomy are the methods of choice for elimination of side branch varicosis; however, recurrences of varicose veins are frequent.


Assuntos
Varizes/terapia , Insuficiência Venosa/terapia , Técnicas de Ablação , Humanos , Qualidade de Vida , Escleroterapia , Meias de Compressão , Resultado do Tratamento , Varizes/diagnóstico , Insuficiência Venosa/diagnóstico
3.
Artigo em Russo | MEDLINE | ID: mdl-33054008

RESUMO

New prospects associated with the use of laser radiation of different wavelengths in the ultraviolet (365 nm) and the green emission spectrum (525 nm) have appeared in recent years. The high prevalence of the trophic leg ulcers necessitates the search for more effective methods of conservative treatment. PURPOSE OF THE STUDY: Development and scientific justification for the low-intensity laser radiation of different wavelengths combined use in patients with trophic leg ulcers and chronic venous insufficiency (CVI). MATERIAL AND METHODS: 102 patients with trophic leg ulcers and CVI were examined. They were divided into 3 equal groups using simple randomization. Patients in the control group received only traditional conservative therapy; comparison group - traditional conservative therapy and an intravenous laser blood irradiation (ILBI) (λ - 635 nm); the main group - traditional conservative therapy and different wavelengths laser therapy (LT) course. RESULTS AND CONCLUSION: A more significant improvement in the clinical condition occurred under the influence of the course application of combined different wavelengths laser therapy in patients with trophic venous leg ulcers. Compared to patients who received traditional conservative therapy and in combination with ILBI 635 nm, the speed of reparative regeneration of trophic ulcers increased, the time for cleansing trophic ulcers from devitalized tissues was reduced. Computer capillaroscopy data showed that the positive effect of laser exposure on all parts of the microcirculation underlies its therapeutic efficacy.


Assuntos
Terapia a Laser , Úlcera Varicosa , Insuficiência Venosa , Doença Crônica , Humanos , Lasers , Úlcera Varicosa/terapia , Insuficiência Venosa/complicações , Insuficiência Venosa/terapia
5.
J Vasc Surg Venous Lymphat Disord ; 8(4): 565-571, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381472

RESUMO

OBJECTIVE: Symptoms of chronic venous insufficiency secondary to obstructive iliofemoral disease are often bilateral. The impact of iliofemoral stenting of the more symptomatic lower extremity on clinical outcomes in the less affected contralateral extremity is not clear. Such benefit, secondary to offloading of collaterals, may potentially be of the magnitude that the contralateral extremity does not require intervention. METHODS: A retrospective review of contemporaneously entered electronic medical record data of 368 patients/limbs with initial unilateral iliocaval stents (240 left and 128 right) placed during a 3-year period from 2015 to 2017 was performed. Patients who underwent simultaneous bilateral stenting or had occlusive disease were excluded. Of the remainder, the impact of stenting on contralateral leg symptoms was evaluated by analyzing visual analog scale (VAS) pain score (1-10), grade of swelling (1-3), and Venous Clinical Severity Score (VCSS). The duration of any improvement and need for intervention on the contralateral side were also appraised. Kaplan-Meier analysis was used to assess stent patency after intervention, whereas paired t-tests were used to examine clinical outcomes. RESULTS: Of the 368 limbs that underwent stenting with a combination of a Wallstent (Boston Scientific, Marlborough, Mass) with a Z stent (Cook Medical, Bloomington, Ind) for stenotic lesions, 304 patients (89 men and 215 women) had contralateral symptoms (200 left and 104 right). The cause was post-thrombotic syndrome in 229 limbs and May-Thurner syndrome or nonthrombotic iliac vein lesion in 75 limbs. In this contralateral group, at 12 months, the VAS pain score improved from 5 to 0 (P < .0001), the grade of swelling went from 3 to 1 (P < .0001), and VCSS went from 5 to 3 (P < .0001) after stenting of the ipsilateral side. During the median follow-up of 20 months, 15 contralateral limbs underwent stenting. Median time to stenting of the contralateral limb after ipsilateral stenting was 9 months. The median VAS pain score, grade of swelling, and VCSS in this group before stenting were 6.5, 2, and 5 compared with 0 (P < .0001), 1 (P = .27), and 3 (P = .0021), respectively, in those members of the contralateral group who did not require stenting. Primary and primary assisted patencies at 12 months after contralateral stenting were 78% and 100%, respectively. There were no stent occlusions after contralateral stenting. CONCLUSIONS: Patients with bilateral obstructive iliofemoral venous lesions often experience improvement of the contralateral limb symptoms (95%) after stenting of the worse ipsilateral limb. Only 15 of 304 (5%) symptomatic contralateral limbs had to undergo stenting during the follow-up period because of a worsening clinical picture. Based on this, a staged approach to iliofemoral stenting in patients with bilateral symptoms focusing initially on the more symptomatic limb is suggested.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Stents , Insuficiência Venosa/terapia , Doença Crônica , Circulação Colateral , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
6.
Ann Vasc Surg ; 68: 569.e1-569.e7, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32283303

RESUMO

BACKGROUND: Pelvic congestion syndrome (PCS) is defined as noncyclical pelvic pain or discomfort caused by dilated parauterine, paraovarian, and vaginal veins. PCS is typically characterized by ovarian venous incompetence that may be due to pelvic venous valvular insufficiency, hormonal factors, or mechanical venous obstruction. METHODS: We describe a case of a 38-year-old multiparous female with a history of pelvic pressure, vulvar varices, and dyspareunia. She underwent left gonadal vein coil embolization in 2014 for PCS that lead to symptomatic relief of her pain. Four years later, the patient returned for recurrent symptoms. Magnetic resonance venogram demonstrated dilated pelvic varices. The previously embolized left gonadal vein remained thrombosed, and there was no evidence of right gonadal vein insufficiency. However, catheter-based venography revealed a large, dilated, and incompetent median sacral vein. RESULTS: Pelvic venography demonstrated left gonadal vein embolization without any evidence of reflux. The right gonadal vein was also nondilated without reflux. Internal iliac venography showed large cross-pelvic collaterals and retrograde flow via a large, dilated median sacral vein. Coil embolization of the median sacral vein resulted in a dramatic reduction of pelvic venous reflux and resolution of symptoms. CONCLUSIONS: Recurrence of PCS can occur after ovarian vein embolization through other tributaries in the venous network. The median sacral vein is a rare cause of PCS. We present an interesting case of a successfully treated recurrent PCS with coil embolization of an incompetent median sacral vein.


Assuntos
Embolização Terapêutica , Ovário/irrigação sanguínea , Dor Pélvica/terapia , Pelve/irrigação sanguínea , Varizes/terapia , Insuficiência Venosa/terapia , Adulto , Embolização Terapêutica/instrumentação , Feminino , Humanos , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/fisiopatologia , Recidiva , Retratamento , Síndrome , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/fisiopatologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
7.
J Vasc Surg Venous Lymphat Disord ; 8(4): 617-628.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32335333

RESUMO

BACKGROUND: Obesity is a known risk factor for the development and progression of chronic venous disorders (CVDs). It is currently unknown whether the treatment outcomes, after an intervention for CVDs, are affected by obesity. The purpose of the present investigation was to assess the effectiveness of various CVD treatments in obese patients and determine what level of obesity is associated with poor outcomes. METHODS: Data were prospectively collected in the Center for Vein Restoration electronic medical record system (NexGen Healthcare Information System, Irvine, Calif) and retrospectively analyzed. The patients and limbs were categorized by the following body mass index (BMI) categories: <25, 26 to 30, 31 to 35, 36 to 40, 41 to 45, and >46 kg/m2. The changes in the revised venous clinical severity score and Chronic Venous Insufficiency Quality of Life Questionnaire 20-item (CIVIQ-20) quality of life survey were used to determine the CVD treatment effectiveness for patients who had undergone endovenous thermal ablation (TA), phlebectomy, or ultrasound-guided foam sclerotherapy (USGFS). RESULTS: From January 2015 to December 2017, 65,329 patients (77% female; 23% male) had undergone a venous procedure. Of these patients, 25,592 (39,919 limbs) had undergone ablation alone, ablation with phlebectomy, or ablation with phlebectomy and USGFS. The number of procedures performed was as follows: TA, n = 37,781; USGFS, n = 22,964; and phlebectomy, n = 17,467. The degree of improvement at 6 months after the procedure was progressively less with an increasing BMI for the patients who had undergone TA, and the decrease was more significant for those patients with a BMI >35 kg/m2 (P ≤ .001). The outcomes improved ∼12% with the addition of phlebectomy to TA. The patients who had undergone a combination of TA, phlebectomy, and USGFS demonstrated no additional improvement. Significantly inferior outcomes were noted in patients with a BMI ≥35 kg/m2, with the poorest outcomes observed in patients with a BMI ≥46 kg/m2 (P ≤ .001). The average number of TAs per patient increased with an increasing BMI and was significantly different compared with the number for those with a BMI <30 kg/m2 (P ≤ .001). All pre- and post-CIVIQ-20 quality of life scores, within a BMI category, at 6 months were significantly different (P ≤ .01). No differences in the degree of improvement were observed in patients with a BMI ≥31 kg/m2. Finally, multivariate logistic regression analysis indicated that when controlling for BMI, diabetes, a history of cancer, female gender, and black and Hispanic race were independently associated with poorer outcomes. CONCLUSIONS: Progressive increases in BMI negatively affected CVD-related treatment outcomes as measured using the revised venous clinical severity score and CIVIQ-20. The outcomes progressively worsened with a BMI >35 kg/m2 for patients undergoing CVD treatment. The treatment outcomes for patients with a BMI ≥46 kg/m2 were so poor that weight loss management should be considered before offering CVD treatment.


Assuntos
Terapia a Laser , Obesidade/complicações , Ablação por Radiofrequência , Veia Safena/cirurgia , Escleroterapia , Insuficiência Venosa/terapia , Índice de Massa Corporal , Doença Crônica , Registros Eletrônicos de Saúde , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Obesidade/diagnóstico , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
9.
J Vasc Surg Venous Lymphat Disord ; 8(4): 667-675, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32234293

RESUMO

OBJECTIVE: Venous disease is common in Latin America, with an estimated 68.11% prevalence of chronic venous disease. The diverse social, political, and economic characteristics of the many nations that make up Latin America mean that different conditions affect how these diseases are diagnosed and treated, which may differ markedly from the way they are treated by the health care systems of the United States and Europe. Our goal was to review the current state of treatment of chronic venous insufficiency (CVI) in Latin America. METHODS: This is a narrative review of the medical literature on the subject and synthesizes sometimes fragmentary information on CVI across a large and diverse region. RESULTS: CVI represents an unmet medical need in Latin America. Conservative treatments, such as compression stockings, may be used at first, and there are nonpharmacologic and complementary and alternative medicine approaches in use. Endovenous approaches, such as endovenous thermal ablation, have largely replaced surgical interventions. In Europe and the United States, such procedures are mainly carried out in ambulatory facilities, whereas they are mainly performed in the hospital in Latin America. CONCLUSIONS: Recent strong economic growth in Latin America and improvements in social security and health care suggest that innovative approaches to chronic venous disease and CVI will be implemented.


Assuntos
Técnicas de Ablação , Fármacos Cardiovasculares/uso terapêutico , Procedimentos Endovasculares , Escleroterapia , Meias de Compressão , Úlcera Varicosa/terapia , Insuficiência Venosa/terapia , Técnicas de Ablação/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fármacos Cardiovasculares/efeitos adversos , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , América Latina/epidemiologia , Masculino , Escleroterapia/efeitos adversos , Meias de Compressão/efeitos adversos , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Úlcera Varicosa/epidemiologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/epidemiologia
10.
J Wound Ostomy Continence Nurs ; 47(2): 97-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150136

RESUMO

This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.


Assuntos
Extremidade Inferior/irrigação sanguínea , Insuficiência Venosa/complicações , Cicatrização/efeitos dos fármacos , Guias como Assunto , Humanos , Extremidade Inferior/fisiopatologia , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia , Cicatrização/fisiologia
11.
J Vasc Surg Venous Lymphat Disord ; 8(3): 342-352, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32113854

RESUMO

The CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification is an internationally accepted standard for describing patients with chronic venous disorders and it has been used for reporting clinical research findings in scientific journals. Developed in 1993, updated in 1996, and revised in 2004, CEAP is a classification system based on clinical manifestations of chronic venous disorders, on current understanding of the etiology, the involved anatomy, and the underlying venous pathology. As the evidence related to these aspects of venous disorders, and specifically of chronic venous diseases (CVD, C2-C6) continue to develop, the CEAP classification needs periodic analysis and revisions. In May of 2017, the American Venous Forum created a CEAP Task Force and charged it to critically analyze the current classification system and recommend revisions, where needed. Guided by four basic principles (preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based, and practical for clinical use), the Task Force has adopted the revised Delphi process and made several changes. These changes include adding Corona phlebectatica as the C4c clinical subclass, introducing the modifier "r" for recurrent varicose veins and recurrent venous ulcers, and replacing numeric descriptions of the venous segments by their common abbreviations. This report describes all these revisions and the rationale for making these changes.


Assuntos
Síndrome Pós-Trombótica/classificação , Terminologia como Assunto , Varizes/classificação , Veias , Insuficiência Venosa/classificação , Doença Crônica , Consenso , Técnica Delfos , Medicina Baseada em Evidências , Humanos , Síndrome Pós-Trombótica/diagnóstico , Síndrome Pós-Trombótica/fisiopatologia , Síndrome Pós-Trombótica/terapia , Valor Preditivo dos Testes , Prognóstico , Índice de Gravidade de Doença , Varizes/diagnóstico , Varizes/fisiopatologia , Varizes/terapia , Veias/fisiopatologia , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/fisiopatologia , Insuficiência Venosa/terapia
12.
J Vasc Surg Venous Lymphat Disord ; 8(5): 799-804, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32179038

RESUMO

PURPOSE: Chronic venous insufficiency is an important health problem; small saphenous vein (SSV) insufficiency is one of the leading causes and may affect up to 20% of adults. In addition to conventional treatment methods, endovenous treatment techniques have become popular in treatment of varicose veins. Herein, we report the outcomes of ultrasound-guided foam sclerotherapy (UGFS) in patients with symptomatic SSV insufficiency. METHODS: From January 2014 to June 2018, patients with primary SSV insufficiency treated with UGFS were followed to assess the effectiveness and safety of the procedure. A total of 31 lower limbs of 30 patients (18 females and 12 males), who attended control visits at 1 week, 1, 3, and 6 months, and yearly, after undergoing UGFS, were included in the study. The clinical results, occlusion rates, and the patients' preprocedure and postprocedure Venous Clinical Severity Scores were recorded. RESULTS: The records show that, during the procedure, severe pain occurred at the time of injection in one patient (3%), vasovagal syncope in one patient (3%), hyperpigmentation in five patients (16%), and phlebitis in three patients (9%). It was also recorded that during follow-up 24 legs (78%) showed complete thrombosis and 7 legs (22%) had partial thrombosis. The mean Venous Clinical Severity Score for the patients before UGFS was 8.58 ± 3.78, and 7.25 ± 3.17 after the procedure. No major complications, including sural nerve injury and deep venous thrombosis, were seen during the follow-up period. CONCLUSIONS: The results of this study show that UGFS is a simple, safe, and effective procedure for treatment in patients with symptomatic SSV insufficiency with acceptable side effects.


Assuntos
Polidocanol/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Ultrassonografia de Intervenção , Insuficiência Venosa/terapia , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
13.
J Vasc Surg Venous Lymphat Disord ; 8(5): 789-798.e3, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32205126

RESUMO

BACKGROUND: Chronic venous disease (CVD) affects >20 million people in the United States. Despite this huge prevalence, there are few data on whether the effectiveness of current CVD therapies for symptomatic superficial vein reflux is affected by race. The goal of this investigation was to evaluate CVD treatment outcomes in various races in the United States. METHODS: From January 2015 to December 2017, we retrospectively reviewed and prospectively collected data from 66,621 patients who presented for CVD evaluation. We divided patients into five racial groups: African American, Asian, Hispanic, other (race not recorded), and white. Presenting signs and symptoms, treatment modalities, number of procedures per patient, and preintervention and postintervention revised Venous Clinical Severity Scores (rVCSSs) were evaluated. All racial groups were stratified by Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class for subgroup analysis. RESULTS: The average age of the entire cohort was 56.8 ± 14.7 years, with 51,393 women (77%) and 15,228 men (23%). Prevalence by race was 17% African American, 3% Asian, 18% Hispanic, 8% others, and 55% white. There was a higher incidence of C0 disease in whites (44%) and African Americans (31%); C1 and C2 disease in whites (46% and 55%) and Hispanics (28% and 25%); and C3, C4, C5, and C6 disease in whites (60%, 57%, 58%, and 61%) and African Americans (19%, 17%, 19%, and 21%). Pain as an initial presenting symptom was more common in African Americans, Asians, and Hispanics (29%, 29%, and 31%). Swelling was highest in African Americans (18%) and cramping in Hispanics (14%). Skin changes and venous ulcers were most common in African Americans (16% and 21%) and whites (63% and 61%). With regard to the average number of procedures performed, Hispanics (1.98 ± 1.24) and others (2.07 ± 1.25) required fewer stand-alone ablations compared with whites (2.31 ± 1.56), Asians (2.36 ± 1.58), and African Americans (2.27 ± 1.56; P ≤ .0001. With the addition of phlebectomies to ablations, Hispanics (3.78 ± 2.08) continued to require fewer procedures, and Asians required the greatest number of phlebectomies compared with all groups (P ≤ .001). When ultrasound-guided foam sclerotherapy was added to ablation and phlebectomy, African Americans required more procedures compared with all races (4.38 ± 2.59; P ≤ .01). For stand-alone ablations, Hispanics (2.18 ± 2.34) and Asians (1.91 ± 2.35) demonstrated lower postprocedure rVCSSs compared with African Americans (2.79 ± 2.88) and whites (2.8 ± 2.85; P ≤ .0001). For ablations with phlebectomies, all races demonstrated similar results except for Hispanics (2.19 ± 2.14), who did better than whites (2.85 ± 2.75; P ≤ .002). For ablations with phlebectomies and ultrasound-guided foam sclerotherapy, all races had similar results (P ≤ .0001). CONCLUSIONS: In the United States, CVD is primarily observed in white women. There are differences in the incidence and prevalence of disease severity and symptom presentation based on race. The incidence of CVD decreases with age in all racial groups except whites. Hispanics required the fewest procedures and African Americans required the most for optimal results. Postintervention rVCSSs equalized in all races when ablations were combined with phlebectomies and ultrasound-guided foam sclerotherapy.


Assuntos
Técnicas de Ablação , Afro-Americanos , Americanos Asiáticos , Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Hispano-Americanos , Escleroterapia , Procedimentos Cirúrgicos Vasculares , Insuficiência Venosa/etnologia , Insuficiência Venosa/terapia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia , Insuficiência Venosa/diagnóstico
15.
Hautarzt ; 71(4): 301-308, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32100054

RESUMO

For several decades, compression therapy, which is associated with few side effects, has been a basis for the conservative treatment of patients with phlebological and lymphological diseases. For the practical implementation of compression therapy, many different materials are available, some with system-specific advantages and disadvantages. Medical adaptive compression systems (MAK) are still a relatively new treatment option in Germany. Apart from the very good practical experience in clinical everyday life, the compilation of the scientific evidence of compression therapy also shows that the scientific data situation is significantly better than for many other medical areas, especially for the treatment of patients with venous diseases. It is important to note that compression therapy must reliably guarantee adequate compression pressure. If these conditions are met, it can be assumed on the basis of the currently available data that the clinical effectiveness of the different compression systems is comparably good. These aspects have now also been well tested for MAK, so that these analogies can be drawn. Therapists today can therefore choose between different, very effective therapy options and take individual factors, patient wishes and economic aspects into account when making their selection.


Assuntos
Bandagens Compressivas , Pele/irrigação sanguínea , Úlcera Varicosa/terapia , Varizes/terapia , Insuficiência Venosa/terapia , Alemanha , Humanos , Pressão , Meias de Compressão , Resultado do Tratamento
16.
J Vasc Surg Venous Lymphat Disord ; 8(5): 769-774, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32063521

RESUMO

BACKGROUND: Chronic compartment syndrome (CCS) secondary to venous hypertension from chronic venous insufficiency is an uncommonly described entity. The measurement of high resting compartment pressure is helpful in establishing the diagnosis of CCS. The effect of deep venous intervention on compartment pressures in patients with chronic venous insufficiency is not well described. This study evaluated a subset of patients with signs and symptoms of venous disease in whom intervention (hyperdilation or new endovenous stent placement) was performed on the iliofemoral-caval venous system. The effect of the specific intervention was objectively measured by documenting preoperative and postoperative compartment pressures in the posterior superficial compartment of the calf at rest in the supine position. METHODS: From January 2018 to January 2019, there were 80 limbs that underwent either hyperdilation (n = 34) or new endovenous stent placement (n = 46). All patients had measurement of compartment pressures before and after intervention with a simple needle manometer system. Values of 15 mm Hg or higher were considered indicative of CCS in the appropriate clinical context. Clinical parameters such as pain, swelling, and Venous Clinical Severity Score were measured preoperatively and postoperatively. RESULTS: Venous intervention in the form of hyperdilation or endovenous stent placement was associated with reduction in compartment pressure of the extremity undergoing the intervention. In the new stent subset, the compartment pressure was reduced from 17.4 (±4.9) mm Hg to 12.6 (±3.7) mm Hg (P < .0001). In the hyperdilation subset, the compartment pressure was reduced from 14.9 (±4.1) mm Hg to 10.3 (±2.7) mm Hg (P < .0001). There was also a significant improvement in pain, swelling, and Venous Clinical Severity Score after intervention. In patients undergoing hyperdilation, there was a significant improvement in the ejection fraction of the calf pump after intervention from 54.8% (±23.1%) to 52.1% (±18.7%; P = .009). CONCLUSIONS: Deep venous intervention in the form of hyperdilation or endovenous stent placement was associated with symptomatic improvement and reduction of compartment pressure of the extremity undergoing intervention.


Assuntos
Angioplastia com Balão , Síndromes Compartimentais/terapia , Veia Femoral/fisiopatologia , Veia Ilíaca/fisiopatologia , Insuficiência Venosa/terapia , Pressão Venosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Doença Crônica , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/fisiopatologia , Adulto Jovem
17.
J Vasc Surg Venous Lymphat Disord ; 8(3): 472-481.e3, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32063522

RESUMO

OBJECTIVE: Several randomized controlled trials (RCTs) have compared different interventions for chronic venous insufficiency (CVI) management, but mixed comparison of these interventions is lacking. The aim of this network meta-analysis was to compare VenaSeal closure system (Medtronic, Minneapolis, Minn) with endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation, sclerotherapy, and surgery for management of CVI to achieve anatomic success (complete closure of treated vein within 6 months after intervention) as the primary outcome and health-related quality of life (HRQoL; EuroQol-5 Dimension, Aberdeen Varicose Vein Questionnaire), Venous Clinical Severity Score (VCSS), pain scores, and adverse events as secondary outcomes. METHODS: A systematic review of journal databases was undertaken, and RCTs between January 1996 and September 2018 comparing different treatment options were included. Risk of bias and quality of publications were assessed using the Cochrane bias tool; Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study selection and reporting. Twenty RCTs comprising 4570 patients were analyzed. Data for anatomic success, VCSS, HRQoL, pain score, and adverse events were extracted and analyzed using mixed treatment comparison in a network meta-analysis. A Bayesian fixed or random effects model was selected for analysis. Rank probability graphs were generated for various treatments and corresponding ranks obtained to estimate their probability of being best. Relative treatment effects were calculated in terms of log odds ratios for anatomic success and adverse events. Mean difference was calculated for VCSS, HRQoL, and pain score. RESULTS: For the primary outcome measure (anatomic success), VenaSeal system had the highest probability of being ranked first (P = .980); RFA was ranked second (P = .365), EVLA third (P = .397), surgery fourth (P = .290), mechanochemical ablation fifth (P = .695), and sclerotherapy sixth (P = .982). For secondary outcome measures, VenaSeal system ranked third for VCSS (P = .332), fifth for EuroQol-5 Dimension (P = .420), and third for Aberdeen Varicose Vein Questionnaire (P = .300). Although, VenaSeal system was slightly inferior to some of the other interventions for HRQoL, the 95% credible interval of log odds ratio indicated insufficient evidence for any concrete conclusion to be drawn. VenaSeal system ranked first in reduction of postoperative pain score from baseline (P = .690) and was lowest in occurrence of adverse events (P = .650). Odds of occurrence of adverse events was 3.3 times in the sclerotherapy arm, 2.7 times in the EVLA arm, 1.6 times with surgery, and 1.1 times with RFA vs VenaSeal system arm. CONCLUSIONS: VenaSeal system is a promising therapeutic option for anatomic success at 6 months, with fewer occurrences of adverse events (wound and groin infection, pulmonary embolism) in CVI patients compared with other interventions in this study. Additional economic analysis including cost-effectiveness analysis would provide interesting perspectives on real-world insights to patients, payers, and providers.


Assuntos
Embolização Terapêutica/instrumentação , Terapia a Laser , Ablação por Radiofrequência , Veia Safena/cirurgia , Escleroterapia , Insuficiência Venosa/terapia , Adolescente , Adulto , Idoso , Doença Crônica , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Dor Pós-Operatória/etiologia , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
18.
J Vasc Surg Venous Lymphat Disord ; 8(3): 482-493, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32089498

RESUMO

The lateral marginal vein is an anomalous clinical entity found in association with Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. Although it is reported to affect <20% of patients with Klippel-Trénaunay syndrome, this venous anomaly has been associated with significant morbidity and mortality attributable to venous hypertension and potentially lethal thromboembolic events. Limited literature exists on the diagnosis and management of this rare anomaly, with most of the reports focusing on retrospective clinical experience at a few centers of excellence. Despite these limitations, a systematic approach to diagnosis and treatment of this anomaly is warranted and expounded on herein. When plausible, clinical recommendations based on best available literature are made.


Assuntos
Técnicas de Ablação , Classe I de Fosfatidilinositol 3-Quinases/genética , Embolização Terapêutica , Procedimentos Endovasculares , Síndrome de Klippel-Trenaunay-Weber/terapia , Mutação , Veias/cirurgia , Insuficiência Venosa/terapia , Técnicas de Ablação/efeitos adversos , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Predisposição Genética para Doença , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Síndrome de Klippel-Trenaunay-Weber/genética , Fenótipo , Resultado do Tratamento , Veias/anormalidades , Veias/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/genética
19.
J Dtsch Dermatol Ges ; 18(3): 207-213, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32100962

RESUMO

BACKGROUND: With increasing age, it is increasingly common for patients to develop both chronic venous insufficiency (CVI) and peripheral artery disease (PAD). While there are special compression bandage systems commercially available for individuals thus affected, appropriate compression stockings have previously not been available. In the present study, we investigated the safety and effectiveness of a type of compression stocking specifically designed for this patient group (VenoTrain® angioflow, Bauerfeind Germany, German compression class 1 with high stiffness). PATIENTS AND METHODS: In a prospective case series, we included patients with both CVI (C3-C5 disease according to CEAP classification) and PAD (ankle-brachial index of < 0.9 and > 0.5; absolute ankle systolic pressure of > 60 mmHg). Primary outcome measures consisted of 1) safety in terms of PAD, as determined by measuring acral pressure using acral photoplethysmography (APPG), and 2) effectiveness in terms of CVI symptoms, as assessed by using a suitable questionnaire (VVSymQ). RESULTS: Fifty patients were evaluated (mean age: 67.1; mean ankle-brachial index: 0.75 ± 0.77). Fifteen patients had stage IIa PAD (according to Fontaine); 15, stage IIb; the remainder, stage I disease. Thirty-one patients had stage C3 CVI (according to CEAP classification); 16 patients, stage C4; and three patients, stage C5 disease. Immediately after donning the medical compression stocking, systolic arterial pressure in the big toe increased significantly (from 83.3 mmHg ± 27.6 mmHg to 90.8 mmHg ± 24.1 mmHg) (p = 0.026). The VVSymQ score dropped significantly from 5.0 ± 4.95 points to 1.4 ± 2.26 points (p < 0.001), thus reflecting an improvement in CVI symptoms. CONCLUSIONS: The compression stocking tested herein is safe for individuals with an ankle brachial index ≥ 0.5. Skin damage was not observed.


Assuntos
Doença Arterial Periférica/terapia , Meias de Compressão , Insuficiência Venosa/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fotopletismografia , Estudos Prospectivos
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