A Systematic Review Network Meta-Analysis and Meta-Regression on Surgical and Endovenous Interventions for the Treatment of Lower Limb Venous Ulcer Disease.

BACKGROUND: Venous leg ulcer (VLU) disease constitutes the most severe form of chronic venous insufficiency. We performed a network meta-analysis and meta-regression to investigate the efficacy and safety of the various available interventions in the treatment of VLU. METHODS: We conducted a systematic research corresponding to the instructions by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for studies reporting on surgical or endovenous interventions for the treatment of VLU. Following data extraction, we performed a Bayesian network meta-analysis and meta-regression. Primary endpoints included VLU healing and recurrence. The secondary endpoint was postintervention complications. RESULTS: Seventeen studies evaluating the impact of compression monotherapy, radiofrequency ablation (RFA), endovenous laser ablation (EVLA), sclerotherapy, and saphenous vein surgery on VLU treatment, consisting of 2156 patients (2186 VLU) were included. When compared to compression monotherapy, RFA was the only treatment displaying a statistically-significant impact on ulcer healing, odds ratio (OR) 5.80 (95% credibility interval (CI): 1.08-35.07), while EVLA, RR 0.06 (95% CI: 0.00-0.57), sclerotherapy, RR 0.07 (95% CI: 0.00-0.68) and RFA, RR 0.12 (95% CI: 0.01-0.91) were the 3 interventions reducing VLU recurrence. EVLA (SUCRA, 69.65) ranked as the most efficient intervention concerning ulcer recurrence reduction. Regarding postintervention complications, EVLA was the only intervention displaying a statistically-significant increased risk compared to compression monotherapy, RR 14.3 (95% CI: 2.03-172.56). Meta-regression analysis exploring the impact of perforator treatment on VLU failed to predict healing, ß = -0.27 (95% CI: -2.55 to 1.85), recurrence, ß = -0.02 (95% CI: -2.96 to 2.75) and complication outcomes, ß = -0.089 (95% CI: -3.13 to 2.85). During sensitivity analysis, RFA and sclerotherapy failed to sustain their effects on ulcer healing and ulcer recurrence, respectively. In addition, sclerotherapy displayed statistically-significant inferior outcomes compared to both EVLA and RFA regarding ulcer recurrence. CONCLUSION: This is the first network meta-analysis examining the effect of various interventions on VLU disease. While we have demonstrated the efficacy of RFA and ELVA in ulcer recurrence prevention, our results regarding the impact of RFA and sclerotherapy on VLU healing and recurrence, respectively, should be interpreted with caution. In addition, this review raises questions concerning the value of surgery and perforator interventions in the treatment of VLU. Further research through randomized controlled trials is required. CLINICAL IMPACT: Our review has revealed the significant efficacy of endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in effectively reducing the incidence of ulcer recurrence when compared to compression monotherapy. These outcomes hold the potential to provide relevant insights to both medical practitioners and patients, thereby informing a more prudent and enlightened decision-making approach. Such informed decisions, aimed at mitigating the recurring occurrence of venous leg ulcers, carry profound significance given the considerable socioeconomic implications associated with this medical condition.

Validation of the 3D SYM VEIN Symptom Assessment Tool.

OBJECTIVE: The aim was to validate the SYM VEIN consensus 3D scoring tool in chronic venous disease (CVD). METHODS: This was a prospective cohort study with a total of 35 consecutive patients with CVD. Patients with CVD undergoing saphenectomy were assessed with the revised Venous Clinical Severity Score (r-VCSS), the CIVIQ-20 quality of life score questionnaire, and the SYM VEIN consensus statement 3D system, pre-operatively and four weeks post-operatively. The total 3D score was tested for reliability, construct validity, and responsiveness. RESULTS: The total 3D score demonstrated good reliability and internal consistency (Cronbach's alpha 0.85). Principal component analysis identified three groups of symptoms (paraesthesia, burning pain, and pruritus, vs. heaviness, sensation of swelling and aching/pain, vs. restless leg and throbbing pain) demonstrating a high intragroup correlation and likely to share similar pathophysiology, indicative of adequate construct validity. The total 3D score showed a significant correlation with r-VCSS and CIVIQ-20 score (rho .46, p = .005 and rho .65, p < .001, respectively) indicative of adequate convergent validity. After saphenectomy, significant reductions (p < .001) of the total 3D, and 3D scores for all but two individual venous symptoms were observed, indicative of excellent responsiveness. Median total 3D score was reduced from 31 to 6 (83.8% decrease, p < .001), median r-VCSS was reduced from 6 to 0 (100% decrease, p < .001), and median CIVIQ-20 score was reduced from 24 to 14 (40% decrease, p < .001). The difference of median percentage change between r-VCSS and CIVIQ-20 score vs. total 3D score was significant (p = .005 and p < .001, respectively). CONCLUSION: The total SYM VEIN 3D score has good reliability, construct validity and excellent responsiveness, although less prone to change after saphenectomy compared with r-VCSS.

Low-intensity LED therapy (λ 640 ± 20 nm) on saphenectomy healing in patients who underwent coronary artery bypass graft: a randomized, double-blind study.

Myocardial revascularization surgery (CABG) is the most appropriate treatment for coronary artery disease. Currently, the great challenge is to reduce postoperative complications, such as wound infections, dehiscence, pain, and patients' quality of life. The saphenectomy is the target of complications in 10% of cases, which can cause greater morbidity, time, and cost of hospitalization. Studies show that low-intensity laser or light-emitted diode (LED) therapy promotes positive biomodulation of the tissue repair process, culminating in a lower incidence of dehiscence, pain reduction, and improvement in quality of life. The objective of the present study was to evaluate clinically the saphenous tissue repair after LED therapy. Forty subjects of both genders who underwent CABG with extracorporeal circulation were randomly divided into two groups: the placebo (PG) and experimental (EG). The experimental group underwent low-intensity LED therapy (λ 640 ± 20 nm, 6 J/cm2) on saphenectomy. The tissue repair was analyzed by digital photogrammetry on the first and fifth postoperative day. The border closure was blindly evaluated by three researchers. The hematoma and hyperemia area was quantitatively analyzed using ImageJ© software. The results showed that in the experimental group, there were less bleeding points and no dehiscence in saphenectomy, as compared to the placebo group. There was also a smaller area of hematoma and hyperemia in the experimental group (p < 0.0009). These data lead to the conclusion that the type of phototherapy protocol employed can assist in tissue repair.

Effectiveness of Low-Intensity Laser Therapy on Tissue Repair Following Saphenectomy in Patients Who Underwent Coronary Artery Bypass Graft: A Randomized, Double-Blind Study.

OBJECTIVE: To verify the effectiveness of low-intensity laser therapy (LLLT) on tissue repair following saphenectomy during postoperative period in patients having undergone coronary artery bypass graft (CABG). MATERIALS AND METHODS: A randomized clinical trial, controlled and double-blind study was conducted with 40 volunteers, divided into 2 groups: a placebo group (PG, n = 20) and a laser group (LG, n = 20). The patients in the LG group were irradiated with laser during saphenectomy (InGaAlP, λ 660 nm, energy density 6 J/cm2) daily from the first to the fourth postoperative day. The surgical incision was clinically evaluated and imaged at the beginning and at the end of the treatment. The areas of hematoma and hyperemia were evaluated using the software ImageJ 1.4©, and border closure was evaluated by three researchers, who were blinded concerning the allocation of the participants. RESULTS: The LG group presented a reduction of the areas of hematoma and hyperemia (p = 0.0003) and better border closure (p = 0.009), when compared with the PG group. CONCLUSIONS: The proposed LLLT protocol improved the tissue repair following saphenectomy in CABG patients.

Neuralgia del nervio safeno interno en pacientes operados de várices esenciales en miembros inferiores / Neuralgia of the Internal Saphenous Nerve in Patients Operated on for Essential Varicose Veins of the Lower Limbs

Introducción: La neuralgia del nervio safeno interno, possafenectomía, constituye la expresión natural de una lesión nerviosa de tipo troncular periférico y constituye un síndrome clínico frecuente pero poco estudiado desde todos los puntos de vista. Objetivo: Valorar la neuralgia del safeno interno en los pacientes operados de várices esenciales en miembros inferiores. Método: Se realizó un estudio descriptivo- retrospectivo en 60 pacientes operados (stripping o flebo-extracción) en el servicio de Angiología y Cirugía Vascular del Hospital Docente Clinicoquirúrgico "General Freyre de Andrade" con el diagnóstico de várices esenciales en los miembros inferiores y presencia de neuralgia del nervio safeno interno. El estudio se realizó de enero a diciembre de 2017. Las variables estudiadas fueron: sexo, localización de la safenectomía (izquierda, derecha, bilateral), presencia de neuralgia en el nervio safeno interno. Se trabajó con valores de frecuencias absolutas y relativas. Resultados: 40 por ciento de las safenectomías fueron bilaterales; 31,6 por ciento en miembro inferior derecho y 28,3 por ciento en el miembro inferior izquierdo. El 80 por ciento eran mujeres (25 por ciento lado izquierdo, 25 por ciento lado derecho y 50 por ciento bilateral) y el 20 por ciento hombres (58,3 por ciento lado derecho y 41,7 por ciento lado izquierdo). Pacientes con neuralgia del safeno interno 23,3 por ciento (41,7 por ciento hombres y 18,8 por ciento mujeres). Conclusión: El reconocimiento adecuado de la neuralgia del safeno interno permite excluir otras complicaciones de tipo vascular y establecer medidas profilácticas para evitarla(AU)

Introduction: Post-saphenectomy neuralgia of the internal saphenous nerve is the natural expression of a peripheral truncal nerve injury and constitutes a frequent clinical syndrome; however, it is rarely studied, from all points of view. Objective: To assess neuralgia of the internal saphenous nerve in patients operated on for essential varicose veins of the lower limbs. Method: A descriptive-retrospective study was carried out in 60 surgically intervened patients (stripping or phlebo-extraction) in the angiology and vascular surgery service of Freyre de Andrade Clinical-Surgical Teaching Hospital for a diagnosis of essential varicose veins of the lower limbs and manifestation of neuralgia of the internal saphenous nerve. The study was carried out from January to December 2017. The variables studied were sex, location of the saphenectomy (left, right, or bilateral), and manifestation of neuralgia in the internal saphenous nerve. We worked with absolute and relative frequency values. Results: 40 percent of the saphenectomies were bilateral, 31.6 percent were performed in the lower right limb, and 28.3percent corresponded to the lower left limb. 80 percent were women (left side: 25 percent, right side: 25 percent, and bilateral: 50 percent) and 20 percent were men (right side: 58.3 percent, and left side: 41.7 percent). Patients with neuralgia of the internal saphenous never accounted for 23.3 percent (41.7 percent were men and 18.8 percent were women). Conclusion: The correct identification of neuralgia of the internal saphenous nerve allows to exclude other vascular complications and to establish prophylactic measures to avoid it(AU)

Divided saphenectomy for varicose vein in ambulatory surgery.

We performed divided saphenectomy (DS) for varicose vein in ambulatory surgery with minimal incisions. Under tumescent local anesthesia, this procedure ligates all perforators in the thigh, preserving a route of venous drainage, and reduces bruising by ligating all tributaries. Also, DS does not need any special surgical instrument. Subcutaneous inguinal hemorrhage was observed in 4.9% (3/61), mild bruises were observed in 19.7% (12/61), and saphenous nerve neuralgia was 1.6% (1/61). Wound infection, deep venous thrombosis, and edema were not observed. DS is a minimally invasive, simple, and cost-effective procedure.

A rare case of acute compartment syndrome after saphenectomy.

Saphenectomy is one of the most validated criteria to treat varicose veins of the lower legs. Although many complications were well described, little is known about compartment syndrome due to muscle ischemia caused by constrictive bandages applied after stripping of varicose veins. We presented a case of successful conservative treatment of compartment syndrome after saphenectomy. Rehabilitation was found effective in improving fatigue, stiffness and tenderness showing the effectiveness of the combined conservative-rehabilitative treatment. However conservative treatment could not be considered the treatment of choice in daily practice. A severity score assessment of compartment syndrome should be useful to assess to which patients is allowed to not perform fasciotomy.

Radiofrequency thermal ablation versus conventional saphenectomy / Ablação térmica por radiofrequência versus safenectomia convencional

Varicose veins of the lower limbs have a high prevalence worldwide. New treatment techniques have been developed with the objectives of improving patients' quality of life and reducing recovery times. OBJECTIVE: To evaluate patients with incompetent saphenous veins treated using conventional saphenectomy or radiofrequency ablation (RF), in terms of postoperative status. METHODS: From May 2012 to April 2013 146 varicose veins patients with saphenous insufficiency, 90 of whom were treated with conventional surgery (G1) and 56 with RF ablation (G2), were evaluated prospectively. RESULTS: In G1, 88.61% of patients complained of postoperative pain and needed to take analgesics, compared with 28.85% in G2 (p<0.05). Mean pain rating on an analog scale from 0 to 10 was 3.91±2.13 points for G1 and 1.76±3.01 points for G2 (p<0.05). Recovery periods ranged from 26.63±13.3 days to 18.26±19.37 days, for G1 and G2 respectively. Mean time taken to become totally asymptomatic was 66.78±60.9 days for G1 and 38.38±46.8 days for G2 (p<0.05). CONCLUSIONS: The RF treatment method caused less postoperative pain and resulted in earlier recovery, when compared to conventional saphenectomy...

As varizes dos membros inferiores têm elevada prevalência mundial e as técnicas convencionais de tratamento têm seus resultados bem definidos há décadas. O advento de novas tecnologias nos obriga a avaliar os resultados e compará-los com métodos tradicionais. OBJETIVO: Avaliar o tratamento de pacientes com varizes dos membros inferiores e insuficiência de safenas por safenectomia convencional (SF) ou ablação por radiofrequência (RF), quanto aos sintomas pós-operatórios. MATERIAIS E MÉTODOS: Entre maio/2011 e abril/2013, foram avaliados prospectivamente 146 pacientes com varizes dos membros inferiores e insuficiência de safenas, sendo 90 por SF (G1) e 56 por RF (G2). RESULTADOS: Quanto aos quesitos avaliados, o G1 evidenciou 88,61% dos pacientes com queixa de dor pós-operatória com necessidade do uso de analgésicos e o G2, 28,85% (p<0,05). A média da graduação da dor através da escala analógica - de 0 a 10 - foi de 3,91±2,13 pontos no G1 e de 1,76±3,01 pontos no G2 (p<0,05). O período de recuperação variou de 26,63±13,3 dias para o G1 e 18,26±19,37 dias para o G2. O tempo médio até tornar-se assintomático foi 66,78±60,9 dias para G1 e 38,38±46,8 dias para G2. CONCLUSÃO: A RF propiciou menor dor pós-operatória e recuperação mais precoce quando comparada à SF...

Cuidados de enfermería al paciente con herida de safenectomía / Nursing care for patients with saphenectomy wound", "_i": "

Uno de los objetivos del profesional de enfermería durante el proceso de atención a pacientes es el de contribuir a la recuperación de la salud del enfermo, por lo que resulta indispensable que los procesos que se encuentran a su cargo se realicen de forma unificada y estandarizada para proporcionar cuidados seguros y de calidad, que eviten complicaciones derivadas de éstos. Ante esta perspectiva se propone el siguiente proceso de cuidados de enfermería al paciente con herida de safenectomía por cirugía de revascularización coronaria con hemoductos venosos de safena.

One of the objectives of the professional of nursing during the process of attention to patients is the one to contribute to the recovery of the health of the patient, reason why it is indispensable who the processes that are their position are realised of form unified and standardized to provide safe cares and of quality, that they avoid complications derived from these. Before this perspective the following process of well-taken care of from nursing sets out to the hurt patient with of safenectomia by surgery of coronary revascularization with venous hemoductos of safena.

Textiloma inguinal después de safenectomía simulador de neoplasia / Groin textiloma after saphenectomy: resemblance to neoplasm

Introducción: Los textilomas pueden confundirse con neoplasias malignas y ocurrir en ubicaciones inverosímiles. Caso clínico: Mujer de 73 años de edad, quien acudió por un tumor en la ingle derecha de tres años de evolución, que apareció después de safenectomía bilateral. A la exploración física: ingle derecha con tumor oval de 8 cm, de consistencia renitente, abajo del ligamento inguinal y sobre los vasos femorales. Un ultrasonido y una tomografía computarizada evidenciaron un tumor quístico mixto. A la exploración quirúrgica: tumor de 8 cm adherido a la vena femoral; se llevó a cabo reseccción en bloque. El examen histopatológico indicó textiloma. La evolución posoperatoria fue satisfactoria. Conclusiones: El textiloma es capaz de simular una neoplasia; su ubicación en la ingle es excepcional.

BACKGROUND: Textilomas may mimic a malignant neoplasm and may occur in rare locations. CLINICAL CASE: A 73-year-old female presented a groin tumor of 3 years duration after saphenectomy. Physical exam of the right groin area demonstrated an 8-cm oval tumor below the inguinal ligament and above the femoral vessels. An ultrasound and a CT scan showed a mixed cyst. During surgical exploration of the groin, an 8-cm tumor fixed to the femoral vein was extirpated en bloc. Histopathological results reported a textiloma. The patient had an uneventful postoperative evolution. CONCLUSIONS: Textilomas may mimic a neoplasm, but their occurrence in the groin is exceptional.