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1.
J Coll Physicians Surg Pak ; 32(8): 1009-1013, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35932124

RESUMO

OBJECTIVE: To evaluate the outcomes of radiofrequency ablation (RFA) therapy performed on patients with great saphenous vein insufficiency. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Bahcelievler State Hospital, Istanbul, Turkey, between January 2018 and May 2021 Methodology: A total of 709 patients (382 females, 327 males), who were treated with radiofrequency ablation (RFA) in the clinic, were included in the study. The demographic, anthropometric, clinical, laboratory, and radiological data of the patients were obtained retrospectively from the medical records. Pre and post treatment clinical, etiologic, anatomical, pathophysiologic (CEAP) scores, the venous clinical severity score (VCSS), and the visual analog scale (VAS) were evaluated. RESULTS: The median age of the patients was 48 (19-65) years, and the median follow-up period was 36 (6-53) months. At follow-up, after treatment, 673 (94.9%) of the patients had a CEAP clinical score of C0. Postoperative complications were recorded in 56 (7.9%) patients. Significant improvement was observed in the patients' CEAP, VAS, and VCSS scores at the follow-up (p<0.001). CONCLUSION: There was a high success rate in achieving short- and long-term venous occlusion in varicose vein treatment with RFA. Characterized by a fast recovery, good perioperative and postoperative outcomes, and a low frequency of side effects, RFA is effective and safe in the treatment of varicose veins. KEY WORDS: Chronic venous insufficiency, Radiofrequency ablation, Patient-reported outcomes.


Assuntos
Ablação por Cateter , Ablação por Radiofrequência , Varizes , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/cirurgia , Fatores de Tempo , Resultado do Tratamento , Varizes/cirurgia
3.
J Med Life ; 15(4): 563-569, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35646185

RESUMO

There are problems of postoperative relapse of veins after radiofrequency ablation (RFA). The study aims to analyze the causes of postoperative recurrence of veins after RFA. 928 patients with varicose veins of the lower extremities, clinical classes C2-C4 according to the CEAP classification, were treated in the ambulatory surgery centers using RFA. The causes of varicose recurrence showed that it was caused by: a) high fusion of the anterior accessory great saphenous vein (AAGSV) with great saphenous vein (GSV) directly in the saphenofemoral junction (SFJ), which was not revealed by preoperative ultrasound (1.7%); a long stump of the GSV after the RFA (7.8%); progression of varicose disease with the small saphenous vein (SSV) and formation of new reflux associated with insufficiency of the saphenopopliteal junction (SPJ) (4.7%); d) insufficiency of perforating veins of the tibioperoneal group (Sherman, Boyd), as well as Gunter (3.8%); e) neovascularization with dilation of small vessels in the area of the saphenofemoral junction (0.97%). A comparative assessment of the quality of life (QL) after different surgery methods 3 years after implementation was carried out. Thus, QL in all patients who underwent surgery significantly improved than before surgery. However, after the RFA GSV+AAGSV, the patients had better QL by all scales than those who underwent only RFA GSV. Operations performed simultaneously on GSV and AAGSV have better functionality than GSV-only RFA.


Assuntos
Ablação por Cateter , Ablação por Radiofrequência , Varizes , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Humanos , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Varizes/diagnóstico por imagem , Varizes/cirurgia
4.
BMJ Open ; 12(6): e061530, 2022 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-35732403

RESUMO

INTRODUCTION: To date, there are no prospective studies evaluating the prevention of recurrent veins by the simultaneous treatment of a sufficient anterior accessory saphenous vein (AASV) in patients undergoing endovenous laser ablation (EVLA) of an insufficient great saphenous vein (GSV). This study will provide important information about the impact of the AASV on the development of recurrent veins after EVLA of the GSV. Additionally, it will be clarified whether patients benefit from a preventive ablation of a sufficient AASV. METHODS AND ANALYSIS: This is a multicentre, prospective, controlled, exploratory clinical study in 1150 patients with a medical indication for EVLA of a refluxing great saphenous vein. Patients will be enrolled into two study groups: in half of the patients EVLA will be performed on the insufficient GSV only. In the other half of the patients EVLA will be performed on the insufficient GSV and additionally on the sufficient AASV. Within seven study visits, patients will be followed-up over a time period of 5 years. Primary study endpoint is the recurrence rate; secondary endpoints include inter alia, complication rate, postoperative pain intensity, quality of life and patient satisfaction. ETHICS AND DISSEMINATION: Before initiation of the study, the protocol was presented and approved by the independent ethics committee of the medical faculty of the University of Heidelberg (Ethics approval number S-596/2018). This study was prospectively registered at the German Clinical Trial Register (https://www.germanctr.de/). Research findings will be disseminated in a peer-reviewed journal and at relevant conferences. TRIAL REGISTRATION NUMBER: German Clinical Trial Registry (DRKS00015486).


Assuntos
Terapia a Laser , Varizes , Humanos , Terapia a Laser/métodos , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Qualidade de Vida , Recidiva , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/cirurgia
5.
Semin Vasc Surg ; 35(2): 172-179, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35672107

RESUMO

Open bypass surgery remains a major tool for limb salvage in chronic limb-threatening ischemia (CLTI). Although rest pain and tissue loss both fall into the category of CLTI, goals of revascularization are markedly different for each context. Rest pain mandates long-term patency considerations. Tissue loss, however, requires consideration of infection risks and patency enough to heal the wound. Of the major conduit options, autologous saphenous vein graft continues to be the conduit of choice, given both superior patency and low risk of infection. When saphenous vein graft is not available or not available in appropriate length, arm vein, small saphenous vein, and spliced combinations of these have acceptable patency rates. Heparin-bonded polytetrafluoroethylene and Dacron grafts are prosthetic conduits with excellent patency rates when vein is not available. For infected wounds without other options, cryovein continues to provide acceptable patency for limb salvage. Creation of a bypass is only part of CLTI management. Appropriate postoperative surveillance with noninvasive studies, including ankle-brachial index and duplex ultrasound, can alert to impending graft failure, with a drop in ankle-brachial index of 0.15 and velocity ratios of 3 or more suggestive of significant stenoses. Anticoagulation has only been found in limited contexts (such as poor conduit or poor outflow) to offer some patency benefit, however, findings from the VOYAGER PAD (Vascular Outcomes Study of ASA [Acetylsalicylic Acid] Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial were a major breakthrough, showing a reduction in the composite outcome of major adverse limb, cardiac, and cerebrovascular events in revascularized patients taking low-dose rivaroxaban in conjunction with aspirin, without a substantial increase in bleeding risk.


Assuntos
Isquemia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro , Extremidade Inferior/irrigação sanguínea , Dor/cirurgia , Estudos Retrospectivos , Fatores de Risco , Rivaroxabana , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Khirurgiia (Mosk) ; (6): 116-126, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35658143

RESUMO

OBJECTIVE: To compare the outcomes of thermal and mechanochemical endovenous ablative techniques in patients with varicose veins. MATERIAL AND METHODS: We searched the PubMed, EMBASE and Cochrane Library databases for studies devoted to mechanochemical and thermal endovenous ablative techniques from inception until July 2021. The primary outcome was anatomical success. Secondary endpoints were intraoperative pain syndrome, complications, modification of disease severity and quality of life. RESULTS: This meta-analysis enrolled 10 comparative studies and 1.252 participants after truncal ablations. The follow-up period ranged from 4 weeks to 36 months. With regard to overall anatomical success, 245 out of 267 (91.8%) patients after mechanochemical ablation and 249 out of 266 (93.6%) patients after thermal ablation had favorable results after a month (low-quality evidence; odds ratio [OR] 0.79; 95% CI 0.40-1.55). No statistical heterogeneity was identified (χ2=1.48; df=2; p=0.48; I2=0%). Further analysis identified different incidence of total occlusion after 12 months or later (OR 0.36; 95% CI 0.11-1.21; p=0.05; I2=68%). Mechanochemical ablation resulted less intraoperative pain. Mean difference was -1.3 (95% CI -2.53- -0.07; p=0.00001). MOCA was followed by fewer incidence of nerve injury, hematoma, deep vein thrombosis and phlebitis. There were more cases of skin pigmentation compared to thermal ablation (low-quality evidence, p>0.05). Subsequent assessment of disease severity identified significant between-group difference of means (-0.64 (95% CI -1.82-0.53; p=0.004) and -0.16 (95% CI -0.43-0.11; p=0.005) after 6 and 12 months, respectively). Further assessment of quality of life revealed no between-group differences. These data were characterized by moderate methodological quality. CONCLUSION: Mechanochemical ablation is as effective as standard TA within the first postoperative month. However, this approach is associated with lesser anatomical success after 12 months. In most studies, pain syndrome was less severe in case of mechanochemical ablation. These data suggest that mechanochemical ablation is a safe alternative for varicose veins. However, further large-scale trials are required to define the role of MOCA.


Assuntos
Ablação por Cateter , Procedimentos Endovasculares , Varizes , Insuficiência Venosa , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Dor/etiologia , Dor/cirurgia , Qualidade de Vida , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico , Varizes/cirurgia , Insuficiência Venosa/cirurgia
7.
BMJ Open ; 12(5): e059213, 2022 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-35613801

RESUMO

INTRODUCTION: Endovenous microwave ablation (EMA) is a relatively novel thermal ablation treatment for great saphenous vein (GSV) varicosis, and its efficacy and safety are rarely reported. This study aims to explore whether EMA can be comparable to endovenous laser ablation (EVLA), which is a widely used thermal ablation treatment in clinical practice. METHODS AND ANALYSIS: This is a multicentre, randomised controlled non-inferiority trial to compare the efficacy and safety of EMA and EVLA in patients with GSV varicosis. We will recruit 180 patients in 6 centres and randomly assign them into treatment group (EMA group) and control group (EVLA group) in a 1:1 ratio. The patients will return to the hospitals at 7 days, 3 months, 6 months and 12 months, and will be called at 1 month after the treatment for follow-up visits. The primary outcome is the occlusion rate of GSV immediately, at 6 months, and at 12 months after the treatment. The secondary outcomes are Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) Score, operation time and instrument performance evaluation. ETHICS AND DISSEMINATION: This protocol has been approved by the Clinical Trial Ethics Committee of Beijing Hospital (2020BJYYEC-126-02), Peking Union Medical College Hospital (KS2020393), Beijing Tsinghua Changgung Hospital (No.20279-2-02), Beijing Luhe Hospital.Capital Medical University (2020-LHYW-030-01), the First Hospital of Hebei Medical University (No.2020249), and the First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2021LSY-12). The trial results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04726124.


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Veia Safena , Varizes , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Estudos de Equivalência como Asunto , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Micro-Ondas/uso terapêutico , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/cirurgia
8.
Int J Surg ; 101: 106641, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35490951

RESUMO

OBJECTIVE: This study aimed to investigate the short-term outcomes of three endovenous procedures in patients with varicose veins (VVs) and severe iliac vein compression syndrome (IVCS). METHODS: A total of 158 consecutive patients were included in this multicenter retrospective study from May 2017 to December 2019; 54 patients underwent endovenous laser ablation (EVLA) alone, 47 patients underwent EVLA and balloon angioplasty (BA), and 57 patients underwent EVLA and stenting angioplasty (SA). Clinical outcomes and complications were assessed at one and twelve months post-surgery. The Quality of life (QoL) was assessed by the venous clinical severity score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ). RESULTS: Patients who underwent the SA procedure were older (P < 0.05). Incidence of laser ablation complications was similar among the three procedures; closure rates of the great saphenous vein were 96.8%, 98.0%, and 98.4%, respectively, at 12 months. Reflux times in the SA procedure were lower than those in the EVLA and BA procedures at 12 months, while ulcer healing time was faster with the SA procedure (P < 0.05) than with the other procedures. The VCSS and AVVQ values were significantly improved post-procedure (P < 0.05), with lower AVVQ scores in the SA procedure than in the EVLA and BA procedures at 12 months post-surgery. The EVLA and BA procedures (stenosis >70%) caused a significantly higher symptom recurrence than the SA procedure, with an odds ratios of 14.04 (95% confidence interval (CI), 1.99-99.18) and 10.50 (95% CI, 1.26-87.15), respectively. CONCLUSIONS: Our results demonstrate that EVLA and SA procedures relieve symptoms, improve the QoL, and decrease symptom recurrence in patients with VVs and severe IVCS (stenosis >70%).


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Síndrome de May-Thurner , Varizes , Constrição Patológica/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Veia Ilíaca/cirurgia , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Síndrome de May-Thurner/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/cirurgia
9.
Ann Ital Chir ; 93: 235-240, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35503057

RESUMO

OBJECTIVE: The present study aims to investigate the therapeutic effect and safety of radiofrequency ablation (RFA) of the great saphenous vein in the treatment of varicose veins of the lower extremities. METHODS: Sixty-nine affected limbs of 45 patients were treated with RFA of the great saphenous vein. All patients underwent retrograde puncture of the distal great saphenous vein under the guidance of B-ultrasound. An RFA catheter was introduced 1 cm below the junction of the great saphenous vein and the femoral vein. A tumescent solution was injected around the femoral vein, and the great saphenous vein was ablated section by section from the upper part to the lower part. Twelve months after RFA, color Doppler ultrasound was used to evaluate the closure of great saphenous vein, and changes in the clinical class, etiology, anatomy, pathology (CEAP) classification before and after treatment were compared. The visual analogue score (VAS) was used to evaluate the local pain on the first and third day after operation. The incidence of complications (e.g., phlebitis, thrombosis, infection) was also evaluated. RESULTS: The ablation of the 69 affected limbs in all the 45 patients was successful. Instant B-ultrasound revealed occlusion of the great saphenous vein and the disappearance of blood flow immediately after ablation. There was no reoccurrence in all patients at the 12 month follow-up. The CEAP classification grade after treatment was significantly lower than that before the treatment, and the difference was statistically significant (χ2 = 4.188, P<0.05). The VAS scores on the first and third days after operation were 1.85 ± 0.35 and 0.59 ± 0.21, respectively. Pain was mild, and only two patients required painkillers. No complications were noted, with the exception of five cases of local ecchymosis. CONCLUSION: RFA of the great saphenous vein may represent an effective method for treating varicose veins of the lower extremities. RFA has the advantages of producing less trauma, fewer complications, and a lower incidence of recurrence. KEY WORDS: B-ultrasonography, Pain, Radiofrequency ablation, Varicose veins.


Assuntos
Ablação por Radiofrequência , Varizes , Insuficiência Venosa , Veia Femoral , Humanos , Extremidade Inferior , Dor/etiologia , Ablação por Radiofrequência/efeitos adversos , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/etiologia , Varizes/cirurgia , Insuficiência Venosa/cirurgia
10.
Vasa ; 51(4): 222-228, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35532031

RESUMO

Background: This single center prospective randomized study was performed to compare the effect of endovenous laser flush ablation (EVLAf) of the great saphenous vein (GSV) close to the sapheno-femoral junction (SFJ) with a standard ablation (EVLAs) up to two cm distally of the SFJ on reflux in the GSV stump. Patients and methods: Between April 2013 and January 2016, 146 legs in 146 consecutive patients, meeting the inclusion/exclusion criteria, were treated by EVLA. All patients were randomized into 2 groups. In group 1 EVLAf started from the SFJ level, and in group 2 EVLAs started two cm below the SFJ. The primary endpoint was reflux in the GSV stump after 900 days. Secondary endpoints were reflux in the anterior accessory saphenous vein (AASV), proximal clinically recurrent varicose veins related to reflux in the stump and/or the AASV. Results: At day 900, 27 patients were lost to follow-up. Reflux in the stump was detected in 3.6% in group 1 and in 22.2% in group 2 (p<0.05). Reflux in the AASV was present in 7.1% in group 1 and in 17.46% in group 2 (p=0.09). Proximal clinically recurrent varicose veins were observed in 8.9% in group 1 and in 19.1% in group 2 (p=0.12). The greatest diameter of the stump was significantly larger in group 2 (group 1: 0.41 cm, group 2: 0.6 cm, p<0.001). Conclusions: EVLAf is associated with a significantly lower incidence of reflux in the GSV stump, with a trend to a lower incidence of reflux in the AASV and with a lower incidence of proximal recurrent varicose veins after 900 days follow-up compared to EVLAs. EVLAf may improve the clinical recurrence rate after EVLA of the GSV.


Assuntos
Terapia a Laser , Varizes , Insuficiência Venosa , Humanos , Terapia a Laser/efeitos adversos , Lasers , Prevalência , Estudos Prospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/epidemiologia , Varizes/cirurgia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/cirurgia
12.
J Healthc Eng ; 2022: 1801099, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35469234

RESUMO

Great saphenous varicose vein (GSVV) is a venous reflux disease of the lower extremity. In order to explore the clinical effect of subfascial endoscopic perforator surgery (SEPS) with endovenous laser treatment (EVLT) in the treatment of GSVV, 80 patients who underwent unilateral saphenous varicose surgery are analyzed. The operation results show that the patients who used SEPS + EVLT have less operation time and mean blood loss, shorter postoperative active time and hospitalization stay, better curative effect, and higher notch aesthetics (P < 0.05). SEPS combined with EVLT has a remarkable curative effect in the treatment of saphenous varicose veins of lower extremity, which can significantly shorten the hospitalization time of patients and improve the coagulation index and stress index.


Assuntos
Veia Safena , Varizes , Humanos , Lasers , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/etiologia , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/métodos
13.
JAMA Surg ; 157(5): 395-404, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35385061

RESUMO

Importance: Endovenous thermal ablations (ETAs) are recommended as first-line treatment for truncal vein reflux, have a short recovery time, and are cost-effective. However, ETAs are associated with discomfort during tumescent anesthesia infiltration. To minimize discomfort, nonthermal, nontumescent ablation techniques had emerged in the form of mechanochemical ablation (MOCA) and cyanoacrylate adhesive injection (CAE). Objective: To assess pain scores immediately after truncal ablation using a 100-mm visual analog scale and 10-point number scale to compare pain-related outcomes following mechanochemical ablation vs cyanoacrylate adhesive treatment. Design, Setting, and Participants: The Multicenter Randomized II Clinical Trial Comparing Mechanochemical Ablation vs Cyanoacrylate Adhesive for the Treatment of Primary Truncal Saphenous Veins Incompetence study was a prospective multicenter randomized clinical trial conducted at 3 sites between November 2017 and January 2020. Inclusion criteria were primary great or small saphenous varicose veins; exclusion criteria included recurrent varicose veins, current deep venous thrombosis, or serious arterial disease. There were 392 participants screened, 225 were excluded, and 167 participants underwent randomization. Four participants did not receive allocated intervention and were included in the intention-to-treat analysis. Follow-up took place at 2 weeks, and 3, 6, and 12 months. Interventions: Patients with primary truncal vein incompetence were randomized to receive either MOCA or CAE. Main Outcomes and Measures: The primary outcome measure was pain score immediately after completing truncal ablation using a 100-mm visual analog scale (VAS) and a 10-point number scale. Secondary outcome measures included degree of ecchymosis, occlusion rates, clinical severity, and generic and disease-specific quality of life (QoL) scores. Results: Of 167 study participants, 99 (59.3%) were women, and the mean (SD) age was 56 (15.8) years. Overall, 155 truncal veins treated (92.8%) were great saphenous veins. Demographic data and baseline status were comparable between treatment groups. A total of 73 patients (47%) underwent adjunctive treatment of varicosities. Overall median (IQR) maximum pain score after truncal treatment was 23 mm (10-44) on the VAS and 3 (2-5) on the number scale, showing no significant difference in median (IQR) pain measured by VAS (MOCA, 24 [11.5-44.7] mm vs CAE, 20 [9.0-42.0] mm; P = .23) or by number scale (MOCA, 4 [2-5] vs CAE, 3 [2-4]; P = .18). Both groups demonstrated significant and comparable improvement in clinical severity, generic and disease-specific QoL scores, and complete occlusion rates. Four patients treated with CAE developed minor complications (superficial thrombophlebitis and thrombus extensions). Conclusions and Relevance: To our knowledge, this was the first randomized clinical trial directly comparing nontumescent ablation techniques. The study demonstrated that the MOCA and CAE techniques have a similar periprocedural pain score. Trial Registration: ClinicalTrials.gov Identifier: NCT03392753.


Assuntos
Varizes , Insuficiência Venosa , Adesivos , Cianoacrilatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos , Qualidade de Vida , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/complicações , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia
14.
Int Angiol ; 41(4): 332-337, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35373939

RESUMO

BACKGROUND: CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a conservative outpatient treatment strategy for chronic venous disease (CVD) that preserves the superficial venous system. A modified two-stage strategy is used in patients with a great saphenous vein (GSV) diameter ≥9 mm with the goal to decrease the risk of symptomatic superficial vein thrombosis (SVT), as the risk of complications is higher when first and second stage is performed simultaneously. METHODS: We conducted a retrospective observational study of 111 patients with CVD and a GVS diameter ≥9 mm treated with two possible stages of the CHIVA strategy, between January 2010 and December 2019. The goal of the first stage was to interrupt the main reflux escape point (incompetent saphenofemoral junction), thereby lowering the venous pressure and achieving a sufficient reduction in GSV diameter to enable, if necessary, a second stage that consists of disconnection of secondary reflux exit point (incompetent saphenous tributaries), with a lower risk of symptomatic SVT when patients do not show significant clinical improvement. Reductions in GSV diameter, postoperative complications and clinical improvement were analyzed. RESULTS: There were 60 men (54.1%) and 51 women (45.9%) with a mean age of 57±11.9 years. All patients undergone first surgical stage, and this interruption of the saphenofemoral junction was the single procedure in 77.5% of cases (86 patients). Mean follow-up time was 19.8 months. The second stage was performed in 25 patients (22.5%). Mean preoperative GSV diameter was 10.2±1.1 mm and this decreased to 7.1±1.5 mm after the first surgery (mean reduction, 3±1.5 mm, P<0.001). Six patients (5.4%) experienced recurrence due to recanalization of the reflux point and 16 patients (14.4%) developed SVT, which was symptomatic in 12 cases (10.8%). CONCLUSIONS: Interruption of the main reflux escape point as a single procedure in patients with a GSV diameter ≥9 mm led to a significant reduction in diameter and sufficient clinical improvement in almost 80% of cases.


Assuntos
Varizes , Insuficiência Venosa , Idoso , Doença Crônica , Feminino , Veia Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/cirurgia
15.
BMC Surg ; 22(1): 138, 2022 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-35397549

RESUMO

BACKGROUND: Inguinal lymphadenectomy (iLAD) is effective for penile carcinoma treatment, but usually results in many complications. This study aims to clinically evaluate the feasibility and clinical significance of a laparoscopic radical iLAD approach partly preserving great saphenous vein branches for penile carcinoma patients. METHODS: A total of 48 patients with penile cancer who underwent laparoscopic radical iLAD with retention of the great saphenous vein in Henan Cancer Hospital from 2012 Jan to 2020 Dec were included in this study. Sixteen penile carcinoma patients who underwent laparoscopic radical iLAD preserving parts of superficial branches of the great saphenous vein were identified as the sparing group, and the matched 32 patients who incised those branches were identified as control group. This new procedure was performed by laparoscopy, preserving parts of superficial branches of the great saphenous vein, superficial lateral and medial femoral veins. Clinicopathological features and perioperative variables were recorded. Postoperative complications, including skin flap necrosis, lymphorrhagia, and lower extremity edema were analyzed retrospectively. RESULTS: We found that the operative time of the sparing group is significantly longer than the control group (p = 0.011). There was no statistical difference in intraoperative blood loss, the lymph node number per side, average time to remove the drainage tube and postoperative hospital stay between the two groups. Compared to the control group, the sparing group showed a significantly decreased incidence of lower extremity edema (p = 0.018). The preservation of parts of superficial branches of the great saphenous vein was mainly decreased the incidence of edema below ankle (p = 0.034). CONCLUSIONS: This study demonstrated that the iLAD with preserving parts of superficial branches of the great saphenous vein, with a decreased incidence of postoperative complications, is a safe and feasible approach for penile cancer.


Assuntos
Carcinoma , Laparoscopia , Neoplasias Penianas , Carcinoma/cirurgia , Veia Femoral/patologia , Humanos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Masculino , Neoplasias Penianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Veia Safena/patologia , Veia Safena/cirurgia
16.
Surg Technol Int ; 40: 281-286, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35415834

RESUMO

INTRODUCTION: Endovenous laser ablation (EVLA) using 1470 nm, which targets water as its chromophore, has become the standard endovenous thermal treatment for incompetent truncal veins. Recently, there has been growing interest in the use of 1940 nm, due to the greater absorption by water. This increased absorption has led to claims that, with the longer wavelength, less power is needed to achieve the same biological effect during treatment, resulting in fewer adverse post-operative sequelae. METHODS: Review of the current literature comparing 1940 nm and 1470 nm EVLA, which includes both laboratory-based and clinical studies. Reports on the use of 1920 nm were combined with those on 1940 nm. RESULTS: Increased absorption of the longer wavelength by water results in more thermal damage closer to the EVLA device. Thus, there may be an advantage to using the longer wavelength in EVLA of thin-walled veins at low power. However, in saphenous veins, which have thicker walls, there is little evidence that this different energy distribution in the vein wall makes any clinical difference. Reduced pain is likely to be due to reduced power during treatment. This is likely to result in more long-term failures of ablation using 1940 nm. CONCLUSION: There is a difference in the distribution of thermal damage in the vein wall between EVLA at 1470 nm and 1940 nm. However, there is little evidence of any clinically significant difference when used in incompetent saphenous veins. Clinical studies looking for a difference need to report the size and wall thickness of the treated vein, the power used as well as the energy per centimetre (LEED), and long-term ablation rates in addition to early post-operative pain, induration, paraesthesia and ecchymosis. Also, power loss in different laser / fibre systems and technical differences, such as those that might allow blood to remain in the vein being treated, need to be considered.


Assuntos
Terapia a Laser , Varizes , Humanos , Terapia a Laser/métodos , Lasers , Veia Safena/cirurgia , Resultado do Tratamento , Varizes/etiologia , Varizes/cirurgia , Água
17.
Phlebology ; 37(6): 445-451, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35465780

RESUMO

BACKGROUND: This study aimed to determine site-specific mechanical properties of the great saphenous vein (GSV) harvested from various sites in the same cadaver. METHODS: GSV samples were harvested from three sites: the thigh, knee, and lower leg. The thickness and diameter of the samples were measured, and the tensile test was performed to measure stiffness and Young's modulus. RESULTS: The stiffness of the GSV harvested from knees in the longitudinal direction was lower than those from other sites, whereas the stiffness of the GSV harvested from the lower leg in the circumferential direction was lower than that from the thigh. CONCLUSIONS: The GSV has site-specific mechanical properties. Thus, in addition to morphological evaluations such as echo and computed tomography in preoperative graft surgical evaluations, knowledge of the mechanical properties at each site can improve the patency rate and prevent aneurysmal expansion.


Assuntos
Perna (Membro) , Veia Safena , Cadáver , Humanos , Perna (Membro)/irrigação sanguínea , Extremidade Inferior/irrigação sanguínea , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Coxa da Perna
19.
Phlebology ; 37(5): 393-399, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35318865

RESUMO

OBJECTIVES: Whether incompetent perforator veins (IPVs) require treatment remains controversial. We retrospectively evaluated the feasibility of IPV excision performed using the stab avulsion technique without ligation and sutures in patients undergoing endovenous ablation (EA). METHODS: This was a single-center, retrospective, observational cohort study. EA was performed in 1503 consecutive patients, including 33 patients with ulcers, between December 2014 and May 2021. Varicectomy was performed using the stab avulsion technique; IPV cases were included. RESULTS: Stab avulsion was performed at a mean number of 11.4 ± 7.8 sites. No deep vein thromboses or pulmonary emboli were noted. The incidence of nerve injury was 0.3%. All 33 (100%) patients with ulcers achieved healing by 1 year (median: 55.5 days; range: 13-365 days). CONCLUSIONS: IPV excision via stab avulsion may be a viable option for treating varicose veins and ulcers. This technique offers multiple advantages, including simplicity, safety, and reduced healthcare costs.


Assuntos
Varizes , Insuficiência Venosa , Estudos de Viabilidade , Humanos , Estudos Retrospectivos , Veia Safena/cirurgia , Resultado do Tratamento , Úlcera , Varizes/cirurgia , Insuficiência Venosa/cirurgia
20.
Microsurgery ; 42(4): 333-340, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35297112

RESUMO

BACKGROUND: The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. METHOD: A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. RESULTS: In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. CONCLUSION: The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Estudos de Coortes , Feminino , Antebraço/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veia Safena/cirurgia , Transplante de Pele/métodos
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