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1.
Clin Ter ; 172(5): 395-406, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34625767

RESUMO

Abstract: Chronic venous insufficiency (CVI) and varicose veins (VVs) of the lower limbs are very frequent vascular diseases in Western countri-es. One possible complication of these conditions is skin ulceration and its consequent rupture, which can be spontaneous or due to mild or trivial trauma. In some cases, the resulting hemorrhage is fatal. When the victim is found dead, a large amount of blood around the body might lead to the hypothesis of violent death. The Forensic Pa-thologist needs to be very careful in the corpse's examination, in order to exclude any alternative cause of death. Herein, an illustrative case is reported, as well as a literature review of the literature concerning sudden hemorrhages from VVs. We found 27 scientific papers, the total reported cases of VVs rupture with profuse hemorrhages were 36, 32 of which were fatal. The main characteristics of such forensic scenario have been collected. Corpse examination of the victims showed pallor of the skin and mucous membranes, as well as marked pallor of organs as a sign of hemorrhagic shock, but these pathological findings are unspecific. Usually, the skin near the ulcer presented color alteration (discoloration and atrophy or pigmentation and hyperemia). Besides, the histological examination of the skin could be a valid instrument to demonstrate the presence of the ulcer, even if it could be very difficult to sample, because of its small size. An important limit of our study is the small number of collected cases. More studies in this field are needed to improve evidence concerning death due to VVs rupture.


Assuntos
Úlcera , Varizes , Causas de Morte , Medicina Legal , Hemorragia , Humanos , Varizes/complicações
2.
Medicina (Kaunas) ; 57(10)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34684078

RESUMO

The objective of this review is to describe the effectiveness of laparoscopy in the diagnosis and treatment of pelvic congestion syndrome (PCS). PCS is a cause of chronic pelvic pain (CPP) and is associated with dysfunction of the pelvic venous system. PCS is more common in women of reproductive age, and hormonal changes are associated with its development along with other reasons (e.g., working and living habits). There is an urgent need to establish an effective algorithm for the diagnosis and treatment of CPP, which could have a dramatic effect in patients' everyday life. This algorithm should be able to overcome known issues that lead to the underdiagnosis of PCS, such as the overlap of its symptoms with other diseases. Here, we present our findings from literature articles about the methods used in practice today for the diagnosis of this syndrome. We also compare the methods to propose the most promising technique for providing a diagnosis with high accuracy. In our understanding, laparoscopy is superior when compared to other methods. It can provide a diagnosis of PCS while excluding or identifying other comorbidities and can also lead toward the next steps for the treatment of PCS.


Assuntos
Dor Crônica , Laparoscopia , Varizes , Feminino , Humanos , Dor Pélvica/etiologia , Pelve , Varizes/diagnóstico , Varizes/cirurgia
3.
Cardiol Clin ; 39(4): 567-581, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34686268

RESUMO

Chronic venous disease is a worldwide problem associated with significant morbidity and is expected to increase in prevalence as the current population ages. This is a comprehensive review of the anatomy, pathophysiology, genomics, clinical classification, and treatment modalities of chronic venous disease.


Assuntos
Varizes , Insuficiência Venosa , Doença Crônica , Humanos , Prevalência , Varizes/epidemiologia , Varizes/terapia , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/terapia
4.
Zhonghua Yi Xue Za Zhi ; 101(39): 3232-3237, 2021 Oct 26.
Artigo em Chinês | MEDLINE | ID: mdl-34689536

RESUMO

Objective: To explore the efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities. Methods: A total of 214 patients with primary varicose veins of the lower extremities in the First Affiliated Hospital of Sun Yat-sen University from January 2017 to November 2019 were included and divided into microwave ablation group (n=128) and high ligation with microwave ablation group (n=86) according to surgical approach. Further subgroups including subgroup S (diameter<10 mm) and subgroup L (diameter≥10 mm) were established. The surgical success rate, postoperative incidence and recovery of local skin numbness and ecchymosis, and the postoperative recovery of active skin ulcer were compared between the two groups and subgroups. Results: The surgical success rate was 96% (136/141) in microwave ablation group, 100% in subgroup S (116/116), and 80% in subgroup L (20/25), respectively. In addition, the surgical success rate in high ligation with microwave ablation group, subgroup S, and subgroup L was all 100% (90/90, 73/73, and 17/17). In subgroup L of microwave ablation group, the diameter of 5 great saphenous veins in patients who failed the microwave ablation was 13.0-17.1 mm. The mean follow-up time was (24±4) months in microwave ablation group and (36±6) months in high ligation with microwave ablation group, respectively. In the microwave ablation group and high ligation with microwave ablation group, the incidence of postoperative skin numbness was 15.6% and 14.4%, respectively, and the incidence of skin ecchymosis was 5.7% and 3.3%, respectively, with no statistically significant difference between the two groups (both P>0.05). The rate of active skin ulcer in the two groups was 6.4% and 15.6%, respectively, and the difference was statistically significant (P=0.020). Local skin ecchymosis in the two groups recovered within 1 month after operation. Local skin numbness in both groups recovered within the maximum 2 years of follow-up, and active skin ulcer in both groups recovered within the maximum 1 years of follow-up. Conclusion: The endovenous microwave ablation is safe and effective, especially combining with high ligation of great saphenous vein. Good follow-up results can be achieved for great saphenous vein with diameter smaller than 10 mm. However, for those with diameter greater than 10 mm, the surgical success rate of endovenous microwave ablation decreases.


Assuntos
Terapia a Laser , Varizes , Veia Femoral , Humanos , Extremidade Inferior , Micro-Ondas , Veia Safena , Resultado do Tratamento , Varizes/cirurgia
5.
Eur J Radiol ; 144: 109984, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34638080

RESUMO

PURPOSE: To assess whether CT (computed tomography)-derived quantitative parameters of liver lobe volume can predict severe esophageal varices (EV) and the risk of first varicealhemorrhage (FVH) in patients with liver cirrhosis. METHODS: A total of 217 endoscopically confirmed EV patients were included in this retrospective study and were divided into a low-risk EV group (mild-to-moderate EV, n = 83) and a high-risk EV group (severe EV, n = 134), a FVH group (n = 17) and a non-FVH group (n = 27), patients' clinical findings were recorded. The left, right, caudate lobe, total liver volume and the corresponding functional volume were measured respectively, and the ratio of caudate volume/total volume (CV/TV), caudate functional volume/total functional volume (CFV/TFV) were calculated. Univariate and multivariate logistic analysis were used to determine the independent factors and the receiver operating characteristic (ROC) curves were performed to evaluate the diagnostic performance. RESULTS: CV, CFV, CV/TV, CFV/TFV were significantly different in the EV severity study and FVH study (p < 0.05). Multivariate analysis indicated that CV/TV and ascites were independent predictive factors for severe EV, a predictive model combing those two factors revealed a satisfactory diagnostic performance (area under the curve (AUC), 0.853, 95 %CI 0.797-0.905). Furthermore, CV/TV and the presence of red color sign under endoscopy were found to be independent predictive factors for FVH, and the former showed a better discriminative performance than the latter (AUC, 0.851 vs 0.779). CONCLUSIONS: CT-derived quantitative parameters of CV, CFV, CV/TV, CFV/TFV may be used as an alternative to endoscopy in predicting severe varices and the risk of bleeding.


Assuntos
Varizes Esofágicas e Gástricas , Varizes , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Urologiia ; (4): 53-60, 2021 09.
Artigo em Russo | MEDLINE | ID: mdl-34486275

RESUMO

INTRODUCTION: Chronic prostatitis is the most common urological disease. The morphological outcome of chronic inflammation is sclerosis, leading to the loss of functional active tissue. Venous congestion of the small pelvis can act as a trigger factor in the development of prostate sclerosis. Venotonics in combination with antioxidants may be considered for organoprotection of the prostate in pelvic varicose veins. PURPOSE: to evaluate the protective effect of an antioxidant, venotonic and their combination on the process of formation of connective tissue in the prostate gland against the background of pelvic varicose veins in a chronic experiment. MATERIALS AND METHODS: The experiment was carried out on a proven model of chronic venous congestion of the small pelvis and was carried out on 64 sexually mature rabbits weighing 2.6-3.2 kg. 5 groups have been identified. In the first group (n=15), an assessment of the effect of isolated antioxidant (resveratrol) was carried out. In the second group (n=15), an assessment of the effect of isolated venotonic (diosmin) was studied. In the third group (n=15), the effect of a combination of an antioxidant (resveratrol) and venotonic (diosmin) was evaluated. An aqueous solution of the preparations was injected daily for 180 days. In the fourth group (n=15), changes in the prostate were assessed against the background of venous congestion without exposure. In the fifth group (n=4), animals performed to provide data on normal anatomy. The animals were taken out of the experiment at 30, 90, 180 days. Prostate tissue was collected for histological examination and morphometry. In prostate samples, the concentration of hydroxyproline, a marker of connective tissue development, was investigated. RESULTS: the isolated administration of resveratrol, as well as diosmin, does not sufficiently compensate for the changes in the hemodynamics of the small pelvis and the toxic effect of metabolic products. With morphometry on day 180, the proportion of glandular tissue in the gland / fibrosis ratio was significantly higher, and fibrosis was lower in Group 3 (79.36 / 9.08 (p<0.01) than in Group 1 (63.1 / 22.74) and Group 2 (65.52 / 21.0) .Quantitative study of hydroxyproline showed lower concentrations in the samples of Group 3 18.44 mg% (p<0.01), relative to Groups 1 and 2 (39.7 and 34.44 mg%) There were no statistically significant differences in the studied parameters between Groups 1 and 2. CONCLUSION: the use of a combination of diosmin and resveratrol against the background of chronic venous hyperemia allowed, in the course of the presented experiment, to reduce the lesion volume and the growth of fibrous tissue in the prostate gland. The approach itself requires further study.


Assuntos
Diosmina , Prostatite , Varizes , Animais , Humanos , Masculino , Pelve , Coelhos , Varizes/tratamento farmacológico
8.
J Craniofac Surg ; 32(6): e562-e563, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34516063

RESUMO

ABSTRACT: Orbital varix is uncommon disease entity, accounting for less than 1% of orbital tumor. Authors report a case of tumor mimicking lower eyelid varix of inferior palpebral vein induced by forced closure of the patient's eyelids. A 21-year-old female visited our institution with a complaint of eyelid mass that only appeared on frowning. A 0.5 × 1.0 cm2 sized soft, nontender and nonpulsating mass was observed at her left lower eyelid when she frowned. Preoperative ultrasound imaging revealed a hypoechoic cystic lesion above orbicularis oculi muscle. A surgical resection through transconjunctival approach was performed. Congestion of perforating inferior palpebral vein caused by contraction of orbicularis oculi muscle was observed intraoperatively. Histopathology has confirmed dilated venous structures. The symptom was immediately resolved after surgery. No sign of recurrence was detected after two years of follow-up.


Assuntos
Recidiva Local de Neoplasia , Varizes , Adulto , Pálpebras/diagnóstico por imagem , Pálpebras/cirurgia , Músculos Faciais , Feminino , Humanos , Ultrassonografia , Varizes/diagnóstico por imagem , Varizes/cirurgia , Adulto Jovem
9.
Angiol Sosud Khir ; 27(3): 68-76, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528590

RESUMO

AIM: The study was aimed at assessing the incidence of arteriovenous compression in women with chronic venous insufficiency of the inferior vena cava and at developing an optimal diagnostic algorithm. PATIENTS AND METHODS: During the period 2019-2020, we performed a cross-sectional study including a total of sixty-six 18-to-55-year-old (mean 33.5±5.0) women with clinical manifestations of chronic venous insufficiency of the basin of the inferior vena cava. A diagnostic algorithm included questionnaire, transvaginal ultrasound examination, multislice computed tomography, direct phlebography in combination with phlebotonometry. RESULTS: Chronic venous insufficiency of lower limbs was diagnosed in 66 (100%) cases and was presented by the following clinical classes according to the CEAP classification: C0 - 4.5%, C1 - 60.6%, C2 - 27.2%, C3 - 3%. Symptoms of pelvic venous plethora were revealed in 36 (55.5%) examined patients. Arteriovenous compression syndrome according to the findings of multislice computed tomography was verified in 16 (24%) women, including May-Turner syndrome in 5 (7.6%), aortomesenteric compression syndrome in 8 (12%) women, with a combination of both syndromes observed in 3 cases; the frequency of their detection did not differ statistically in subgroups of women with and without clinical signs pelvic varicose veins. Direct phlebography in combination with phlebotonometry was performed in 9 women, the diagnosis of arteriovenous compression (May-Thurner syndrome) was confirmed in 1 case only. CONCLUSION: In women with signs of chronic venous insufficiency in the system of the inferior vena cava the frequency of detecting arteriovenous compression on multislice computed tomography may reach 24% and does not depend on the presence of symptoms of pelvic venous plethora. The proportion of arteriovenous compression according to the findings of direct phlebography and phlebotonometry in the structure of causes of the development of pelvic varicose veins did not exceed 11%. An algorithm for diagnosing arteriovenous compression syndromes should obligatorily include multislice computed tomography, direct phlebography and phlebotonometry.


Assuntos
Varizes , Insuficiência Venosa , Estudos Transversais , Feminino , Humanos , Flebografia , Varizes/complicações , Varizes/diagnóstico , Veias , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/etiologia
10.
Angiol Sosud Khir ; 27(3): 77-83, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34528591

RESUMO

AIM: The study was aimed at assessing efficacy and safety of micronized purified flavonoid fraction (MPFF, Detralex) in comprehensive treatment of chronic venous oedema induced by lower limb varicose veins. PATIENTS AND METHODS: We performed a post hoc analysis of the results of treatment of 708 patients included into the observational programme VAP-PRO-C3 (ClinicalTrials.gov. NCT03722836). These patients, depending on the type of treatment, were divided into 8 subgroups: MPFF (n=32); MPFF + compression (n=145); MPFF + compression + topical treatment (n=158); MPFF + compression + topical treatment + endovasal laser coagulation (n=197); MPFF + endovasal laser coagulation (n=3); MPFF + compression + endovasal laser coagulation (n=152), patients not receiving MPFF (n=16); MPFF + topical treatment (n=2). Due to paucity of the participants, from the subsequent analysis we excluded the groups MPFF + endovasal laser coagulation, patients not receiving MPFF (n=16) and MPFF + topical treatment. All further statistical data are shown for the remaining 687 patients. RESULTS: Comparing the groups of patients undergoing conservative treatment alone and those subjected to surgical intervention demonstrated no statistically significant differences in dynamics of crural oedema. In both groups at every subsequent visit there was a statistically significant decrease in the ankle volume (p<0.001). During the whole period of follow up the crural volume in patients from the group of conservative treatment totally decreased by 0.201±0.158 L and in the operated patients by 0.236±0.189 L (p=0.021). The QOL assessed by the CIVIQ-14 global index score statistically significantly improved in the unoperated patients from 31.5±19.2 to 12.0±10.1 (p<0.001). In the operated patients, the baseline and final values of the QOL of the global index score amounted to 33.4±17.8 and 7.7±9.2, respectively (p<0.001). In the groups with and without topical treatment, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 28.5±17.4 and 36.2±18.6, respectively. During the follow-up period, we observed statistically significant positive dynamics of all parameters of quality of life. The final visit demonstrated improvement of the CIVIQ-14 global index score to 9.4±9.2 in patients without topical treatment and 10.1±10.4 in those receiving topical treatment (p=0.367), with the mean value of this parameter during treatment in both groups decreased significantly (p<0.001). A statistically significant decrease in the ankle volume in both groups was registered at every visit, finally amounting to 0.223±0.166 L and 0.248±0.174 L (p=0.118) for patients not receiving and receiving topical treatment, respectively. In groups of patients not receiving and those receiving compression therapy, the baseline values of the QOL assessed by CIVIQ-14 global index score amounted to 21.4±14.2 and 33.1±18.5 (p<0.001), respectively. At the final visit, these indices statistically significantly (p<0.001) decreased to 7.3±9.1 and 9.9±9.9 (p=0.106). Compared with the baseline values, the ankle volume at the final visit in groups of patients with and without compression therapy statistically significantly decreased by 0.187±0.14 L and 0.238±0.17 L respectively (p=0.204). During the study, there were no adverse events related to the administration of MPFF and use of Detragel. CONCLUSION: MPFF and Detragel appear to be effective and safe components of comprehensive conservative therapy of chronic oedema induced by primary varicose veins of lower extremities.


Assuntos
Varizes , Insuficiência Venosa , Doença Crônica , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Humanos , Qualidade de Vida , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico , Varizes/terapia , Veias , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/terapia
11.
JNMA J Nepal Med Assoc ; 59(235): 267-270, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506441

RESUMO

INTRODUCTION: Varicosity is the common problem of various etiology having simple limb aching to worst complications like oedema, ulcer, and skin changes. Minimal invasive endovenous laser therapy is a noble procedure. The aim of the study is to find out the recurrence of the varicose vein after laser therapy in a tertiary care center. METHODS: This descriptive cross-sectional study was done in 38 patients with varicosity of the lower limb in a tertiary care hospital, from January 2019 to June 2019 after taking ethical clearance from Institutional Review Committee. Convenience sampling was done. Data was collected and entry was done in Statistical Package for the Social Science software version 22, point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: We recorded 38 patients with ablated limb out of which none of the ablated veins showed recanalization in six months follow up. Twenty two (58%) patients were male and 16 (42%) patients were female with a mean age of 40.26 years. Major bulk, 23 (60.5%) resumed activity in second postoperative day and only 1 (2.6%) patient waited for 5 days for normal activity with mean of 2.58 days postoperatively. Sixteen (42.1%) patients developed erythema or ecchymosis, 12 (31.6%) patients had induration along the long saphenous vein course, 7 (18.4%) patients had paresthesia, 2 (5.3%) patients had limb swelling and 1 (2.6%) patient had skin burn. CONCLUSIONS: Endovenous laser ablation has very low rate of recurrence of varicosity and has minor complications.


Assuntos
Terapia a Laser , Varizes , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Recidiva , Veia Safena , Centros de Atenção Terciária , Resultado do Tratamento , Varizes/epidemiologia , Varizes/cirurgia
12.
Cochrane Database Syst Rev ; 9: CD009648, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34590305

RESUMO

BACKGROUND: Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (in French 'cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire' (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is the second update of the review first published in 2013. OBJECTIVES: To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, and the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries to 19 October 2020. We also searched PUBMED to 19 October 2020 and checked the references of relevant articles to identify additional studies. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared CHIVA to other therapeutic techniques to treat varicose veins. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed and selected studies, extracted data, and performed quantitative analysis from the selected papers. A third author solved any disagreements. We assessed the risk of bias in included trials with the Cochrane risk of bias tool. We calculated the risk ratio (RR), mean difference (MD), number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI). We evaluated the certainty of the evidence using GRADE. The main outcomes of interest were the recurrence of varicose veins and side effects. MAIN RESULTS: For this update, we identified two new additional studies. In total, we included six RCTs with 1160 participants (62% women) and collected from them eight comparisons. Three RCTs compared CHIVA with vein stripping. One RCT compared CHIVA with compression dressings in people with venous ulcers. The new studies included three comparisons, one compared CHIVA with vein stripping and radiofrequency ablation (RFA), and one compared CHIVA with vein stripping and endovenous laser therapy. We judged the certainty of the evidence for our outcomes as low to very low due to inconsistency, imprecision caused by the low number of events and risk of bias. The overall risk of bias across studies was high because neither participants nor personnel were blinded to the interventions. Two studies attempted to blind outcome assessors, but the characteristics of the surgery limited concealment. Five studies reported the outcome clinical recurrence of varicose veins with a follow-up of 18 months to 10 years. CHIVA may make little or no difference to the recurrence of varicose veins in the lower limb compared to stripping (RR 0.74, 95% CI 0.46 to 1.20; 5 studies, 966 participants; low-certainty evidence). We are uncertain whether CHIVA reduced recurrence compared to compression dressing (RR 0.23, 95% CI 0.06 to 0.96; 1 study, 47 participants; very low-certainty evidence). CHIVA may make little or no difference to clinical recurrence compared to RFA (RR 2.02, 95% CI 0.74 to 5.53; 1 study, 146 participants; low-certainty evidence) and endovenous laser (RR 0.20, 95% CI 0.01 to 4.06; 1 study, 100 participants; low-certainty evidence). We found no clear difference between CHIVA and stripping for the side effects of limb infection (RR 0.83, 95% CI 0.33 to 2.10; 3 studies, 746 participants; low-certainty evidence), and superficial vein thrombosis (RR 1.05, 95% CI 0.51 to 2.17; 4 studies, 846 participants; low-certainty evidence). CHIVA may reduce slightly nerve injury (RR 0.14, 95% CI 0.02 to 0.98; NNTH 9, 95% CI 5 to 100; 4 studies, 846 participants; low-certainty evidence) and hematoma compared to stripping (RR 0.59, 95% CI 0.37 to 0.97; NNTH 11, 95% CI 5 to 100; 2 studies, 245 participants; low-certainty evidence). For bruising, one study found no differences between groups while another study found reduced rates of bruising in the CHIVA group compared to the stripping group. Compared to RFA, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma, but may cause more bruising (RR 1.15, 95% CI 1.04 to 1.28; NNTH 8, CI 95% 5 to 25; 1 study, 144 participants; low-certainty evidence). Compared to endovenous laser, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma. The study comparing CHIVA versus compression did not report side effects. AUTHORS' CONCLUSIONS: There may be little or no difference in the recurrence of varicose veins when comparing CHIVA to stripping (low-certainty evidence), but CHIVA may slightly reduce nerve injury and hematoma in the lower limb (low-certainty evidence). Very limited evidence means we are uncertain of any differences in recurrence when comparing CHIVA with compression (very low-certainty evidence). CHIVA may make little or no difference to recurrence compared to RFA (low-certainty evidence), but may result in more bruising (low-certainty evidence). CHIVA may make little or no difference to recurrence and side effects compared to endovenous laser therapy (low-certainty evidence). However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed, and the results were imprecise due to the low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.


Assuntos
Terapia a Laser , Úlcera Varicosa , Varizes , Insuficiência Venosa , Trombose Venosa , Feminino , Humanos , Masculino , Úlcera Varicosa/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia
13.
Pol Przegl Chir ; 93(5): 1-5, 2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34552026

RESUMO

Objectives The diagnosis of deep venous thrombosis (DVT) is hampered in patients with primary varicose veins due to similarity of symptoms of DVT and PVV and elevated levels of D-dimers. The purpose of this study was to analyze factors that influence the D-dimer concentration in patients with PVV in order to redefine its diagnostic value. Methods Forty- one patients with non-complicated PVV were enrolled in the study, in whom D-dimer level was determined by immunoturbidimetric assay. The influence of selected clinical factors on the concentration of D-dimers was determined with univariate and bivariate analysis. Besides descriptive statistics the D-dimers levels were compared to the age -adjusted cutoff values. Results The median concentration of D-dimer was 630.0 ng/ml (440.0-1140.0 ng/ml) and was above the age-adjusted level in 21 (52%) of patients. There was a positive correlation between the patient's age and and D-dimer concentration (p = 0.035, Spearman correlation coefficient rs=0,33. The bivariate analysis showed a significant interaction between age and weight p=0,02. Conclusions In patients with PVV the diagnostic value of D-dimers is limited especially in older and overweight subjects.


Assuntos
Varizes , Trombose Venosa , Idoso , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Valor Preditivo dos Testes , Varizes/diagnóstico , Trombose Venosa/diagnóstico
14.
Cochrane Database Syst Rev ; 8: CD005624, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34378180

RESUMO

BACKGROUND: Great saphenous vein (GSV) incompetence, causing varicose veins and venous insufficiency, makes up the majority of lower-limb superficial venous diseases. Treatment options for GSV incompetence include surgery (also known as high ligation and stripping), laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. These techniques avoid the need for a general anaesthetic, and may result in fewer complications and improved quality of life (QoL). These treatments should be compared to inform decisions on treatment for varicosities in the GSV. This is an update of a Cochrane Review first published in 2011. OBJECTIVES: To assess the effects of endovenous laser ablation (EVLA), radiofrequency ablation (RFA), endovenous steam ablation (EVSA), ultrasound-guided foam sclerotherapy (UGFS), cyanoacrylate glue, mechanochemical ablation (MOCA) and high ligation and stripping (HL/S) for the treatment of varicosities of the great saphenous vein (GSV). SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases, and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 2 November 2020. We undertook reference checking to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) treating participants for varicosities of the GSV using EVLA, RFA, EVSA, UGFS, cyanoacrylate glue, MOCA or HL/S. Key outcomes of interest are technical success, recurrence, complications and QoL. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, applied Cochrane's risk of bias tool, and extracted data. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) and assessed the certainty of evidence using GRADE. MAIN RESULTS: We identified 11 new RCTs for this update. Therefore, we included 24 RCTs with 5135 participants. Duration of follow-up ranged from five weeks to eight years. Five comparisons included single trials. For comparisons with more than one trial, we could only pool data for 'technical success' and 'recurrence' due to heterogeneity in outcome definitions and time points reported. All trials had some risk of bias concerns. Here we report the clinically most relevant comparisons. EVLA versus RFA Technical success was comparable up to five years (OR 0.98, 95% CI 0.41 to 2.38; 5 studies, 780 participants; moderate-certainty evidence); over five years, there was no evidence of a difference (OR 0.85, 95% CI 0.30 to 2.41; 1 study, 291 participants; low-certainty evidence). One study reported recurrence, showing no clear difference at three years (OR 1.53, 95% CI 0.78 to 2.99; 291 participants; low-certainty evidence), but a benefit for RFA may be seen at five years (OR 2.77, 95% CI 1.52 to 5.06; 291 participants; low-certainty evidence). EVLA versus UGFS Technical success may be better in EVLA participants up to five years (OR 6.13, 95% CI 0.98 to 38.27; 3 studies, 588 participants; low-certainty evidence), and over five years (OR 6.47, 95% CI 2.60 to 16.10; 3 studies, 534 participants; low-certainty evidence). There was no clear difference in recurrence up to three years and at five years (OR 0.68, 95% CI 0.20 to 2.36; 2 studies, 443 participants; and OR 1.08, 95% CI 0.40 to 2.87; 2 studies, 418 participants; very low-certainty evidence, respectively). EVLA versus HL/S Technical success may be better in EVLA participants up to five years (OR 2.31, 95% CI 1.27 to 4.23; 6 studies, 1051 participants; low-certainty evidence). No clear difference in technical success was seen at five years and beyond (OR 0.93, 95% CI 0.57 to 1.50; 5 studies, 874 participants; low-certainty evidence). Recurrence was comparable within three years and at 5 years (OR 0.78, 95% CI 0.47 to 1.29; 7 studies, 1459 participants; and OR 1.09, 95% CI 0.68 to 1.76; 7 studies, 1267 participants; moderate-certainty evidence, respectively). RFA versus MOCA There was no clear difference in technical success (OR 1.76, 95% CI 0.06 to 54.15; 3 studies, 435 participants; low-certainty evidence), or recurrence (OR 1.00, 95% CI 0.21 to 4.81; 3 studies, 389 participants; low-certainty evidence). Long-term data are not available. RFA versus HL/S No clear difference in technical success was detected up to five years (OR 5.71, 95% CI 0.64 to 50.81; 2 studies, 318 participants; low-certainty evidence); over five years, there was no evidence of a difference (OR 0.88, 95% CI 0.29 to 2.69; 1 study, 289 participants; low-certainty evidence). No clear difference in recurrence was detected up to three years (OR 0.93, 95% CI 0.58 to 1.51; 4 studies, 546 participants; moderate-certainty evidence); but a possible long-term benefit for RFA was seen (OR 0.41, 95% CI 0.22 to 0.75; 1 study, 289 participants; low-certainty evidence). UGFS versus HL/S Meta-analysis showed a possible benefit for HL/S compared with UGFS in technical success up to five years (OR 0.32, 95% CI 0.11 to 0.94; 4 studies, 954 participants; low-certainty evidence), and over five years (OR 0.09, 95% CI 0.03 to 0.30; 3 studies, 525 participants; moderate-certainty evidence). No clear difference was detected in recurrence up to three years (OR 1.81, 95% CI 0.87 to 3.77; 3 studies, 822 participants; low-certainty evidence), and after five years (OR 1.24, 95% CI 0.57 to 2.71; 3 studies, 639 participants; low-certainty evidence). Complications were generally low for all interventions, but due to different definitions and time points, we were unable to draw conclusions (very-low certainty evidence). Similarly, most studies evaluated QoL but used different questionnaires at variable time points. Rates of QoL improvement were comparable between interventions at follow-up (moderate-certainty evidence). AUTHORS' CONCLUSIONS: Our conclusions are limited due to the relatively small number of studies for each comparison and differences in outcome definitions and time points reported. Technical success was comparable between most modalities. EVLA may offer improved technical success compared to UGFS or HL/S. HL/S may have improved technical success compared to UGFS. No evidence of a difference was detected in recurrence, except for a possible long-term benefit for RFA compared to EVLA or HL/S. Studies which provide more evidence on the breadth of treatments are needed. Future trials should seek to standardise clinical terminology of outcome measures and the time points at which they are measured.


Assuntos
Ablação por Cateter , Veia Safena/cirurgia , Escleroterapia/métodos , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena/patologia
15.
Eur Heart J ; 42(40): 4157-4165, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34387673

RESUMO

AIMS: Evidence regarding the health burden of chronic venous insufficiency (CVI), its clinical determinants, and impact on outcome is scarce. METHODS AND RESULTS: Systematic phenotyping of CVI according to established CEAP (Clinical-Etiologic-Anatomic-Pathophysiologic) classification was performed in 12 423 participants (age range: 40-80 years) of the Gutenberg Health Study from April 2012 to April 2017. Prevalence was calculated age- and sex-specifically. Multivariable Poisson regression models were calculated to evaluate the relation of CVI with cardiovascular comorbidities. Survival analyses were carried out to assess the CVI-associated risk of death. Replication of findings was done in an independent cohort study (MyoVasc, NCT04064450). The prevalence of telangiectasia/reticular, varicose veins, and CVI was 36.5% [95% confidence interval (CI), 35.6-37.4%], 13.3% [12.6-13.9%], and 40.8% [39.9-41.7%], respectively. Age, female sex, arterial hypertension, obesity, smoking, and clinically overt cardiovascular disease were identified as clinical determinants of CVI. Higher CEAP classes were associated with a higher predicted 10-year risk for incident cardiovascular disease in individuals free of cardiovascular disease (n = 9923). During a mean follow-up of 6.4 ± 1.6 years, CVI was a strong predictor of all-cause death independent of the concomitant clinical profile and medication [hazard ratio (HR) 1.46 (95% CI 1.19-1.79), P = 0. 0003]. The association of CVI with an increased risk of all-cause death was externally validated in the MyoVasc cohort [HR 1.51 (95% CI 1.11-2.05), P = 0.009]. CONCLUSION: Chronic venous insufficiency is highly prevalent in the population and is associated with the presence of cardiovascular risk factors and disease. Individuals with CVI experience an elevated risk of death, which is independent of age and sex, and present cardiovascular risk factors and comorbidities.


Assuntos
Doenças Cardiovasculares , Varizes , Insuficiência Venosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Insuficiência Venosa/epidemiologia
16.
Obstet Gynecol ; 138(3): 482-486, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352832

RESUMO

BACKGROUND: Cervical varices complicating pregnancy are rare but can cause significant maternal and perinatal morbidity. There is limited evidence regarding the optimal management of bleeding caused by cervical varices during pregnancy. CASE: A 38-year-old woman was admitted to the hospital at 16 weeks of gestation due to vaginal hemorrhage in the setting of cervical varices accompanied by placenta previa. A cervical pessary was placed at 21 weeks of gestation without further bleeding. Magnetic resonance imaging demonstrated variceal reduction after pessary placement, and a cesarean delivery was performed at 36 weeks of gestation without complications. CONCLUSION: Cervical pessary should be considered as conservative option to control the bleeding associated with cervical varices during pregnancy.


Assuntos
Colo do Útero/irrigação sanguínea , Complicações Hematológicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Hemorragia Uterina/diagnóstico , Varizes/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessários , Gravidez , Complicações Hematológicas na Gravidez/terapia , Segundo Trimestre da Gravidez , Hemorragia Uterina/terapia , Varizes/terapia
17.
J Stroke Cerebrovasc Dis ; 30(9): 105954, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217069

RESUMO

OBJECTIVES: An isolated intraventricular cerebral varix is a rare entity. Although it is generally asymptomatic, there have been reports of symptomatic cases. Here, we report a case of right hemiplegia and aphasia due to venous infarction caused by thrombosis of the intraventricular varix. CASE PRESENTATION: A 79-year-old woman presented with right-sided hemiplegia and aphasia accompanied by conjugate eye deviation to the left. She had a history of hypertension, dyslipidemia, and asymptomatic isolated cerebral varix located in the left lateral ventricle. Blood analysis indicated no abnormalities in coagulation or fibrinolysis. Plain head computed tomography showed an intraventricular varix in the form of a high-density mass, indicating acute phase thrombosis, and contrast-enhanced computed tomography depicted a filling defect in the varix. In addition, fluid-attenuated inversion recovery imaging showed hyperintense lesions in the deep white matter of the frontal-parietal lobe, indicating venous infarction due to occlusion of the varix of the thalamostriate vein. Glycerol and prophylactic levetiracetam were administered, and she was transferred to another hospital for rehabilitation 23 days after treatment initiation. CONCLUSION: This is the first reported case in which a typically asymptomatic condition, intraventricular cerebral varix, caused venous infarction due to thrombosis and occlusion of the varix of the thalamostriate vein. Careful selection of the treatment strategy is required on a case-by-case basis because an intraventricular varix can cause both bleeding and infarction, which are treated differently.


Assuntos
Infarto Cerebral/etiologia , Trombose Intracraniana/etiologia , Varizes/complicações , Trombose Venosa/etiologia , Idoso , Afasia/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/terapia , Feminino , Hemiplegia/etiologia , Humanos , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/terapia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/terapia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/terapia
18.
Vasc Health Risk Manag ; 17: 379-387, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239304

RESUMO

Objective: This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). Design: Prospective, single-centre, analytical cohort. Materials and Methods: Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. Results: The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. Conclusion: Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.


Assuntos
Ablação por Cateter , Veia Safena/cirurgia , Escleroterapia , Varizes/terapia , Adulto , Assistência Ambulatorial , Ablação por Cateter/efeitos adversos , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
19.
Eur J Vasc Endovasc Surg ; 62(2): 241-249, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34210599

RESUMO

OBJECTIVE: Management and outcomes of superficial vein thrombosis (SVT) are highly variable and not well described. Therefore, the INvestigating SIGnificant Health TrendS in the management of SVT (INSIGHTS-SVT) study collected prospective data under real life conditions. METHODS: Prospective observational study of objectively confirmed acute isolated SVT. The primary outcome was a composite of symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), and extension or recurrence of SVT at three months. The primary safety outcome was clinically relevant bleeding. RESULTS: A total of 1 150 patients were included (mean age 60.2 ± 14.7 years; 64.9% women; mean BMI 29.4 ± 6.3 kg/m2). SVT was below the knee in 54.5%, above the knee in 26.7%, above and below the knee in 18.8%. At baseline, 93.6% received pharmacological treatment (65.7% fondaparinux, 23.2% heparins, 4.3% direct oral anticoagulants [DOACs], 14.5% analgesics), 77.0% compression treatment, and 1.9% surgery; 6.4% did not receive any anticoagulation. The primary outcome occurred in 5.8%; 4.7% had recurrent or extended SVT, 1.7% DVT, and 0.8% PE. Clinically relevant non-major bleeding occurred in 1.2% and major bleeding in 0.3%. Complete clinical recovery of SVT was reported in 708 patients (62.4%). Primary outcome adjusted by propensity score and for treatment duration was lower with fondaparinux compared with low molecular weight heparin (4.4% vs. 9.6%; hazard ratio [HR] 0.51; 95% confidence interval [CI] 0.3 - 0.9; p = .017). On multivariable analysis, associated factors for primary outcome included another SVT prior to the present SVT event (HR 2.3), age per year (HR 0.97), duration of drug treatment per week (HR 0.92), and thrombus length (HR 1.03). CONCLUSION: At three month follow up, patients with isolated SVT are at risk of thromboembolic complications (mainly recurrent or extended SVT), despite anticoagulation. In this real life study, about one third had received either heparins, oral anticoagulants, or no anticoagulation.


Assuntos
Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Fondaparinux/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/efeitos adversos , Feminino , Fondaparinux/efeitos adversos , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Úlcera da Perna/complicações , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/etiologia , Recidiva , Fatores de Risco , Meias de Compressão , Resultado do Tratamento , Varizes/complicações , Insuficiência Venosa/complicações , Trombose Venosa/etiologia
20.
Ont Health Technol Assess Ser ; 21(8): 1-188, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34211617

RESUMO

Background: Varicose veins are part of the spectrum of chronic venous disease and are a sign of underlying chronic venous insufficiency. Treatments to address varicose veins include surgical vein removal under general anesthesia, or endovenous laser (EVLA) or radiofrequency ablation (RFA) under tumescent anesthesia. Two newer nonthermal endovenous procedures can close veins without any tumescent anesthesia, using either mechanochemical ablation (MOCA, a combination of mechanical and chemical techniques) or cyanoacrylate adhesive closure (CAC). We conducted a health technology assessment of these nonthermal endovenous procedures for people with symptomatic varicose veins, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding MOCA and CAC, and patient preferences and values. Methods: We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias or RoBANS tool, and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Meta-analysis was conducted using Review Manager 5.2, where appropriate.We performed a systematic economic literature search and conducted a cost-utility analysis with a 5-year time horizon from the perspective of Ontario Ministry of Health. In our primary economic evaluation, we assessed the cost-effectiveness of nonthermal endovenous procedures (CAC and MOCA) compared with surgical vein stripping and thermal endovenous therapies (EVLA and RFA). We also analyzed the budget impact of publicly funding nonthermal and thermal endovenous therapies for adults with symptomatic varicose veins in Ontario over the next 5 years. Costs are expressed in 2020 Canadian dollars.To contextualize the potential value of nonthermal endovenous treatments, we spoke with 13 people with varicose veins who had sought various treatment options. We conducted phone interviews and qualitatively analyzed their responses regarding their care journey and the impact of different treatment options; the only nonthermal treatment that participants had experience with was CAC. Results: We included 19 primary studies reported in 25 publications comparing either MOCA or CAC with at least one other invasive treatment for symptomatic varicose veins. No studies compared MOCA with CAC. Based on evidence of low to moderate quality, MOCA resulted in slightly poorer technical outcomes (vein closure and recanalization) than thermal endovenous ablation procedures. However, clinical outcomes, quality of life improvement, and patient satisfaction were similar compared with RFA (GRADE: Very low to Moderate) and EVLA (GRADE: High). Cyanoacrylate adhesive closure resulted in little to no difference in technical outcomes, clinical outcomes, and quality of life improvement compared with RFA and EVLA (GRADE: Moderate). Patient satisfaction may also be similar (GRADE: Low). Recovery time was slightly reduced with nonthermal endovenous procedures compared with thermal ablation (GRADE: Moderate). The effect of CAC compared with surgical vein stripping is very uncertain (GRADE: Very low). Major complications of any procedure were rare, with minor complications occurring as expected and resolving.We included two European studies in the economic evidence review that were partially applicable to the Ontario context. Both studies found that thermal ablation procedures (RFA, EVLA, or steam vein sclerosis) were the most cost-effective treatments, compared with surgical vein stripping and nonthermal therapies. Our cost-utility analysis showed that surgical vein stripping is the least effective and most costly treatment among five treatments for varicose veins. Differences in quality-adjusted life-years (QALYs) between endovenous treatments (CAC, MOCA, RFA, and EVLA) were small. When the willingness-to-pay (WTP) value was $50,000 per QALY gained, the probabilities of being cost-effective were 55.6%, 18.8%, 15.6%, 10.0%, and 0%, for EVLA, CAC, MOCA, RFA, and surgical vein stripping, respectively. When the WTP was $100,000 per QALY gained, the probabilities of being cost-effective were 40.2%, 30.0%, 17.7%, 12.1%, and 0%, for EVLA, CAC, RFA, MOCA, and surgical vein stripping, respectively. Publicly funding endovenous procedures (both nonthermal and thermal) would increase the total volume of treatments, resulting in a total 5-year budget impact of around $17 million.People with varicose veins with whom we spoke reported positively on their experiences with the CAC procedure and its outcomes. They also described geographic and financial barriers to accessing the range of available treatment options. Conclusions: Cyanoacrylate adhesive closure and MOCA produced similar patient-important outcomes, and slightly shorter recovery compared with thermal ablation. Cyanoacrylate adhesive closure yielded similar anatomical outcomes as thermal endovenous ablation, but the technical outcomes of MOCA were slightly poorer.Compared with surgical vein stripping, all endovenous treatments were more effective and less expensive. If we were to look at the most cost-effective strategy (at WTP less than $100,000 per QALY), EVLA is most likely to be cost-effective. Assuming an 80% increase in the number of eligible people over the next 5 years, we estimate that publicly funding nonthermal and thermal endovenous treatments for varicose veins in Ontario would range from $2.59 million in year 1 to $4.35 million in year 5, and that the total 5-year budget impact would be around $17 million.For people with varicose veins, the CAC procedure was seen as a positive treatment method that reduced their symptoms and improved their quality of life.


Assuntos
Terapia a Laser , Varizes , Insuficiência Venosa , Adulto , Humanos , Ontário , Qualidade de Vida , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Varizes/cirurgia , Insuficiência Venosa/cirurgia
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