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1.
Ann Vasc Surg ; 62: 263-267, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394220

RESUMO

BACKGROUND: Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) due to the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). METHODS: This was a single-center, office-based, retrospective study over the course of 5 years, in which 3,218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9 years. At the time of each individual intervention, 24, 212, 3,620, 4,806, 200, and 1,167 patients had Clinical-Etiology-Anatomy-Pathophysiology disease 1, 2, 3, 4, 5, and 6, respectively. RESULTS: There was a total of 3,983 EVLT and 6,091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as type 1 as per the Kabnick classification. Endovenous ablation performed via RFA resulted in significantly more cases of EHIT than of EVLT (109 vs. 77; P = 0.034; odds ratio = 1.52), which was confirmed by a multivariate analysis. CONCLUSIONS: In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT than of EVLT.


Assuntos
Terapia a Laser/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/epidemiologia , Humanos , Incidência , New York/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/epidemiologia , Trombose Venosa/diagnóstico por imagem
2.
Ann Vasc Surg ; 62: 498.e1-498.e5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449935

RESUMO

Takayasu arteritis (TA) is a nonspecific and chronic inflammatory vasculitis that mainly affects the aorta and its main branches, resulting in stenosis or occlusion of the aorta or its main branches with related symptoms. Up to 60% of TA patients have renal artery involvement, which often lead to refractory hypertension and impaired renal function. Surgical repair and endovascular intervention are commonly employed in clinical practice. Surgical bypass with prosthetic or autologous vein graft is preferred for complicated lesions not suitable for endovascular intervention or patients who are allergic to contrast. Restenosis of bypass graft is one of the complications that vascular surgeons need to fix. Restenosis of graft is consistently eliminated by angioplasty based on the current studies. Limited literature reported surgical repair of restenosis of bypass graft. We report a patient with TA-induced bilateral renal arteries stenosis who underwent aorta-renal artery bypass and suffered from restenosis of bilateral grafts in a short period. Twice surgical bypass with saphenous vein graft for the initial treatment and with prosthetic graft for the second restenosis elimination was performed. The details of procedures, choice of graft, and analysis of restenosis will be discussed.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular , Oclusão de Enxerto Vascular/cirurgia , Obstrução da Artéria Renal/cirurgia , Artéria Renal/cirurgia , Veia Safena/transplante , Arterite de Takayasu/complicações , Enxerto Vascular/efeitos adversos , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Recidiva , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Obstrução da Artéria Renal/fisiopatologia , Reoperação , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Arterite de Takayasu/diagnóstico por imagem , Resultado do Tratamento , Grau de Desobstrução Vascular , Adulto Jovem
3.
Vasc Endovascular Surg ; 54(1): 47-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31581906

RESUMO

OBJECTIVES: Cyanoacrylate glue is injected for incompetent great saphenous vein (GSV) treatment 5 cm distal to the saphenofemoral junction (SFJ). Although a few reports have investigated the postprocedural remnant stump length, none have focused on the factors affecting glue extension length and the consequent remnant stump length. METHODS: Seventy-nine patients undergoing cyanoacrylate closure using the VenaSeal system at our clinic between August 2018 and November 2018 were investigated. The GSV diameter was measured just before treatment in the supine position 3 cm distal to the SFJ. Cyanoacrylate glue was injected 5 cm distal to the SFJ. RESULTS: The mean glue extension length was 1.13 ± 1.12 cm. The GSV diameter and glue extension length exhibited a significant inversely proportional relationship (P < .001). More specifically, patients with a GSV diameter ≥0.7 cm had a longer remnant stump length than those with a smaller GSV diameter (P < .001). CONCLUSIONS: An increased GSV diameter is likely associated with a decreased glue extension length and, consequently, a longer remnant stump.


Assuntos
Cianoacrilatos/administração & dosagem , Veia Safena , Adesivos Teciduais/administração & dosagem , Varizes/terapia , Adulto , Cianoacrilatos/efeitos adversos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
4.
Vasc Endovascular Surg ; 54(3): 272-277, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31858897

RESUMO

INTRODUCTION: The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. METHODS AND SURGICAL TECHNIQUE: Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a "Y-shaped" bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. RESULTS: No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. CONCLUSION: The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.


Assuntos
Aneurisma/cirurgia , Artéria Renal/cirurgia , Veia Safena/transplante , Enxerto Vascular/métodos , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Artéria Renal/fisiopatologia , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Heart Lung Circ ; 28(11): 1735-1739, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31631861

RESUMO

BACKGROUND: Despite increased use of arterial grafts, the long saphenous vein (LSV) is often utilised as conduit for coronary artery bypass graft (CABG). Preoperative ultrasound (U/S) vein assessment is limited to patients with varicosities, clinical signs suggestive of poor vein conduits and a history of cardiac or vascular surgery. The aim of this study was to evaluate the usefulness and logistics of the surgeon incorporating intraoperative U/S assessment of the LSV into their regular practice. METHODS: All patients undergoing coronary artery revascularisation and open vein harvest in our institution were recruited from July 2016 to February 2017. Demographics, including known risk factors for wound complications were documented, in addition to surgical details such as harvest time, vein length and surgical repairs of the conduit. Focussed U/S assessment was performed intraoperatively by the surgical registrar before beginning the procedure. The diameter of the leg pre and postoperatively, as well as the incidence, type and severity of wound complications were documented for further statistical analysis. RESULTS: A total of 103 patients were included in this study. Two patients died perioperatively and were excluded from the study. The remaining 101 patients were separated in two cohorts-U/S group (n=32) and blind technique group (n=69). Demographics were similar between the groups, whilst other risk factors for harvest complications, such as presence of superficial varicosities on clinical examination and renal failure were significantly more frequent in the U/S group. The median harvest time was significantly lower within the U/S group (25 mins versus 40 mins; p=0.001), as was the rate of overall wound complications (6.2% vs 23.2%; p=0.04). CONCLUSIONS: Ultrasound assessment of the LSV by the surgical team intraoperatively is feasible, easy to learn and does not demand extra costs or delays. It significantly reduces surgical harvest time and it is associated with a reduced incidence of wound complications, swelling and postoperative mobility impairment.


Assuntos
Ponte de Artéria Coronária/métodos , Veia Safena/diagnóstico por imagem , Infecção da Ferida Cirúrgica/prevenção & controle , Coleta de Tecidos e Órgãos/métodos , Ultrassonografia/métodos , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Veia Safena/transplante , Austrália do Sul/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
6.
Trials ; 20(1): 392, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269978

RESUMO

BACKGROUND: Ambulatory phlebectomies and foam sclerotherapy are two of the most common treatments for varicose vein tributaries. Many studies have been published on these treatments, but few comparative studies have attempted to determine their relative effectiveness. METHODS/DESIGN: This is a prospective single-centre randomised clinical trial. Patients with primary truncal vein incompetence and varicose vein tributaries requiring treatment will be assigned randomly to either ambulatory phlebectomies or foam sclerotherapy. The primary outcome measure is the re-intervention rate for the varicose vein tributaries during the study period. The secondary outcomes include the degree of pain during the first two post-operative weeks and the time to return to usual activities or work. Improvements in clinical scores, quality of life scores, occlusion rates and cost-effectiveness for each intervention are other secondary outcomes. The re-intervention rate will be considered from the third month. DISCUSSION: This study compares ambulatory phlebectomies and foam sclerotherapy in the treatment of varicose vein tributaries. The re-intervention rates, safety, patient experience and the cost-effectiveness of each intervention will be assessed. This study aims to recruit 160 patients and is expected to be completed by the end of 2019. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03416413 . Registered on 31 January 2018.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Veia Safena/cirurgia , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Varizes/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Humanos , Londres , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Retratamento , Veia Safena/diagnóstico por imagem , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares/efeitos adversos
7.
J Dermatol ; 46(10): 902-906, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31353631

RESUMO

The effect of alcohol intake on varicose veins (VV) has not been determined by its consumption level. The aim of this study was to investigate the association between alcohol intake and VV in an elderly general population. Using a cross-sectional approach, the Shimane CoHRE Study data, comprising a total of 1060 participants, were analyzed. By multivariate regression analysis adjusted with basic characteristics, past work history, lifestyle-related factors and medical history, compared with non-drinkers, mild drinkers (<20.0 g/day) showed a significantly lower adjusted odds ratio (aOR) of VV (aOR = 0.64, P = 0.036). In a similar way, regular drinkers (1-5 days/week) showed a significantly lower aOR of VV when compared with occasional drinkers (aOR = 0.57, P = 0.032). VV and alcohol intake showed J-curve relationships. In a stratified analysis by alcohol consumption levels, the association of smoking and VV were also observed in moderate to heavy drinkers and habitual drinkers. These findings can provide better understanding of pathophysiological mechanism and be used for evidence-based patient education.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Fumar/efeitos adversos , Varizes/epidemiologia , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Japão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Fatores de Risco , Veia Safena/diagnóstico por imagem , Ultrassonografia , Varizes/etiologia , Varizes/prevenção & controle
9.
Einstein (Sao Paulo) ; 17(2): eAO4526, 2019 May 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31066792

RESUMO

OBJECTIVE: To compare the use of the radiofrequency thermoablation of the saphenous vein with the ligation technique, and complete removal of the saphenous vein, from the saphenofemoral junction to the ankle. METHODS: A total of 49 patients with chronic venous disease in the Comprehensive Classification System for Chronic Venous Disorders (CEAP) classes 2 to 4 for clinical signs, etiology, anatomic distribution and pathophysiology, were assessed at baseline, after 4 weeks, and after 1 year. The parameters assessed were complications, period of absence from activities, Venous Clinical Severity Score (VCSS) and quality of life scores according to Aberdeen Varicose Veins Questionnaire (AVVQ). They were re-examined 1 and 3 years after treatment to evaluate recurrence rates. RESULTS: The success rate per limb (p=0.540), VCSS (p=0.636), AVVQ (p=0.163), and clinical complications were similar in the two treatment groups. Nevertheless, the radiofrequency thermoablation group had significant shorter length of hospital stay (0.69±0.47) and absence from activities (8.62±4.53), p<000.1. CONCLUSION: Patients submitted to radiofrequency thermoablation had an occlusion rate, clinical recurrence and improvement in quality of life comparable to removal of the saphenous vein. However, these patients spent less time hospitalized and away from their daily activities during recovering.


Assuntos
Ablação por Radiofrequência/métodos , Veia Safena/cirurgia , Doenças Vasculares/cirurgia , Absenteísmo , Adulto , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Tempo de Internação , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Recidiva , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Doenças Vasculares/diagnóstico por imagem , Adulto Jovem
10.
J Vasc Access ; 20(6): 782-785, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31006336

RESUMO

We devised a method that enables blood removal/return by creating a fistula between the skin and the great saphenous vein to insert the dialysis needle sheath in the femoral vein under ultrasonography guidance with respect to each dialysis. We report the principles, methods, and cases. A skin-great saphenous vein fistula is created under local anesthesia. It is used for blood removal/return during maintenance hemodialysis performed immediately after creating the fistula. Ten limbs of 10 patients (three men and seven women; mean age, 77.6 ± 4.8 years; dialysis history, 9.9 ± 13.0 years), where skin-great saphenous vein fistulas were created in our hospital between May 2017 and June 2018, were included. In all the cases, an arteriovenous fistula or arteriovenous graft was difficult to create because of the general condition and/or vascular fitness of the patients. During or after the fistula-creating surgery, no serious complications were found. No complications such as blood removal failure, infection, or hemorrhage were found during the follow-up period. The primary patency rates by the Kaplan-Meier method were 100% at 3 months and 67.5% at 6 months. This method is considered a valuable substitute method for cases with difficulty in creating a vascular access.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veia Safena/cirurgia , Idoso , Idoso de 80 Anos ou mais , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
J Vasc Interv Radiol ; 30(7): 1075-1080, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30948325

RESUMO

A retrospective analysis of endovenous glue-closure therapy (EVGC) performed in 76 greater saphenous veins (GSVs) from February 2016 to December 2017 was conducted to assess the incidence and characteristics of endovenous glue-induced thrombosis (EGIT), a phenomenon unique to nonthermal EVGC for GSV insufficiency. Kabnick and Lawrence classifications for endovenous heat-induced thrombosis were adopted. Seven instances of EGIT were detected among 54 patients (13%), with median/mode Kabnick and Lawrence classifications of 2/2 and 4/5, respectively. EGIT resolved with observation within an average of 5.2 wk after detection (range, 2-8 wk) without deep vein thrombosis or pulmonary embolism. EGIT was associated with significantly greater mean age (+7.75 y; P = .0308).


Assuntos
Cianoacrilatos/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Veia Safena , Insuficiência Venosa/terapia , Trombose Venosa/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cianoacrilatos/administração & dosagem , Bases de Dados Factuais , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem
12.
Turk Kardiyol Dern Ars ; 47(3): 232-234, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30982827

RESUMO

Coronary artery bifurcation disease of a saphenous vein graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft (CABG) surgery, a high rate of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Presently described is use of the simultaneous kissing stent technique to treat inverted Y SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome.


Assuntos
Ponte de Artéria Coronária , Oclusão de Enxerto Vascular/cirurgia , Veia Safena/cirurgia , Stents , Idoso , Ecocardiografia , Desenho de Equipamento , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Humanos , Veia Safena/diagnóstico por imagem
13.
Ann Vasc Surg ; 59: 231-236, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009711

RESUMO

BACKGROUND: The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations. METHODS: Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site. RESULTS: Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period. CONCLUSIONS: The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.


Assuntos
Procedimentos Endovasculares/instrumentação , Polidocanol/administração & dosagem , Veia Safena , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , Stents , Varizes/terapia , Idoso , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol/efeitos adversos , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
14.
J Clin Ultrasound ; 47(7): 439-441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30900749

RESUMO

Several anatomical variations involving the great saphenous vein have been described in the literature. Some of them concern the saphenofemoral junction, including duplication, ectasia, and different numbers of tributaries. In this case series, a rare, distinct variation, the inter-arterial saphenofemoral junction was reported.


Assuntos
Veia Femoral/anatomia & histologia , Veia Safena/anatomia & histologia , Adulto , Artérias/diagnóstico por imagem , Artérias/patologia , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/patologia , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/patologia , Telangiectasia/diagnóstico por imagem , Telangiectasia/patologia , Ultrassonografia Doppler em Cores , Varizes/diagnóstico por imagem , Varizes/patologia
15.
Eur J Vasc Endovasc Surg ; 57(4): 570-577, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30898493

RESUMO

OBJECTIVES: Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. MATERIALS AND METHODS: This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. RESULTS: The clinical part of the CEAP classification was: C0 = 3, C1 = 4, C2 = 5, C3 = 1, C4a = 1, C4b = 6, C5 = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p < .0005), VFI (p = .001), and PDC (p = .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r = .532, p = .015), VFI (r = .489, p = .025) and PDC (r = -.474, p = .030); RCI vs. VFI (r = .446, p = .043) and PDC (r = -.527, p = .014). CONCLUSIONS: Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.


Assuntos
Hemodinâmica , Pletismografia , Veia Safena/diagnóstico por imagem , Ultrassonografia/métodos , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Veia Safena/fisiopatologia , Índice de Gravidade de Doença , Varizes/fisiopatologia , Insuficiência Venosa/fisiopatologia
16.
J Clin Ultrasound ; 47(7): 436-438, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30896046

RESUMO

Lower extremity superficial venous aneurysms are occasionally encountered by clinicians and are almost always located above the knee. Very few cases of aneurysm of the medial marginal vein in the most distal part, near the origin of the great saphenous vein, have been reported. We present a case of partially thrombosed aneurysm of the medial marginal vein, and briefly review the imaging characteristics and treatment options of this entity. Being aware of the existence of superficial venous aneurysms may help clinicians in their differential diagnosis of foot masses and choice of appropriate treatment.


Assuntos
Aneurisma/diagnóstico por imagem , Trombose/diagnóstico por imagem , Aneurisma/patologia , Tornozelo/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Doenças do Pé/diagnóstico por imagem , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Veia Safena/diagnóstico por imagem , Veia Safena/patologia , Trombose/patologia
17.
Eur J Vasc Endovasc Surg ; 57(6): 851-857, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30850282

RESUMO

OBJECTIVE/BACKGROUND: The aim was to summarise the evidence for the relationship between vein diameters and clinical severity, and elucidate the relationship between diameters and health related quality of life (HRQoL) METHODS: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The MEDLINE and Embase databases were searched from 1946 to 31 August 2018. Reference lists of included studies were searched for further relevant papers. Full text studies in English reporting the relationship between great and small saphenous vein diameters and clinical severity and/or HRQoL scores measured using validated instruments were included. All study designs were included. Studies that did not include relationships between these parameters, non-English studies, and studies focusing on non-truncal veins were excluded. Two reviewers independently performed the study selection, data extraction, and risk of bias assessment. RESULTS: Eleven eligible studies were identified, reporting on 2,732 limbs (range 22-681). Four studies correlated truncal vein diameter with both clinical severity and HRQoL, while seven reported only on clinical severity measures. Multiple instruments were used to quantify HRQoL and clinical severity. Seven studies assessed the relationship with CEAP class, with the majority observing a positive correlation between vein diameter and disease severity. Four studies found weak correlations with VCSS, with one showing correlations with VCSS components. No significant relationship between diameters and HRQoL scores was reported. One study also revealed no correlation with Aberdeen Varicose Vein Questionnaire improvements post-treatment. The majority of studies failed to include C0 and C1 participants. CONCLUSIONS: While further studies are required to improve the level of evidence, the existing literature suggests that truncal vein diameters correlate with clinical severity. Diameters are a poor predictor of HRQoL, with no relationship to patients' perceived impact of chronic venous disease. As such, vein diameter should not be used as a measure to decide who needs venous intervention.


Assuntos
Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/psicologia , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Doença Crônica , Tomada de Decisão Clínica , Humanos , Seleção de Pacientes , Doenças Vasculares Periféricas/terapia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários
19.
Int Angiol ; 38(2): 96-101, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30810002

RESUMO

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


Assuntos
Procedimentos Endovasculares/efeitos adversos , Terapia a Laser/efeitos adversos , Dor Pós-Operatória/etiologia , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Trombose Venosa/etiologia , Adolescente , Adulto , Feminino , Humanos , Lasers/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Embolia Pulmonar , Veia Safena/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Insuficiência Venosa/diagnóstico por imagem , Adulto Jovem
20.
Ann Vasc Surg ; 58: 302-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769060

RESUMO

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


Assuntos
Anestesia Local , Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Anestesia Local/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Ligadura , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
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