RESUMEN
BACKGROUND: Patients with varicose veins are prevented from prolonged standing. Considering that exercise can be implemented in different positions, the aim of the current study was to compare the effects of training at standing and lying positions on quality of life, and clinical symptoms in women with mild varicose veins. METHODS: Twenty-five women with mild varicose veins aged 35-50 years were randomly assigned to three groups; exercise at standing position (n=10), exercise at lying position (n=8) and control (no treatment) group (n=7). Each exercise program involved 6 weeks of training. Quality of life, pain severity, ankle swelling, and lower leg and ankle circumferences were measured using the Aberdeen Varicose Vein Questionnaire, Visual Analog Scale (VAS), four-point pitting edema grading scale, and tape measure, respectively at baseline and at the end of the study. Data were analyzed using one-way analysis of variance (ANOVA) and the least significant difference (LSD) as post hoc test. RESULTS: Following a 6-week exercise program, there was a significant improvement in the quality of life of the participants in both exercise groups, and a significant reduction in pain, ankle swelling, and lower leg and ankle circumferences compared to pre-training and control group (P <0.05). However, there was no significant difference between two exercise groups in terms of study variables (P >0.05). CONCLUSIONS: The current study showed that exercise program comprising standing position exercises can significantly reduce the symptoms of mild varicose veins.
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Terapia por Ejercicio , Calidad de Vida , Várices , Humanos , Femenino , Várices/terapia , Persona de Mediana Edad , Adulto , Terapia por Ejercicio/métodos , Encuestas y Cuestionarios , Postura/fisiología , Dimensión del Dolor , Posición de PieAsunto(s)
Enbucrilato , Hemorragia Gastrointestinal , Adhesivos Tisulares , Várices , Humanos , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Várices/terapia , Várices/complicaciones , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Adhesivos Tisulares/administración & dosificación , Recto/irrigación sanguínea , Masculino , Hemostasis Endoscópica/métodos , Persona de Mediana Edad , Femenino , Colonoscopía/métodosRESUMEN
Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for antegrade transvenous obliteration. Given the absence of consensus and guidelines, a multidisciplinary team approach is essential for the individualized management of ectopic varices. Interventional radiologists must be knowledgeable about the anatomy and hemodynamic characteristics of ectopic varices based on CT images and be prepared to consider appropriate options for each specific situation. ©RSNA, 2024 Supplemental material is available for this article.
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Hemorragia Gastrointestinal , Derivación Portosistémica Intrahepática Transyugular , Humanos , Derivación Portosistémica Intrahepática Transyugular/métodos , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiología , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/terapia , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/complicaciones , Várices/diagnóstico por imagen , Várices/terapia , Radiografía Intervencional/métodos , Radiología Intervencionista/métodos , Embolización Terapéutica/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Cyanoacrylate adhesive closure (CAC) systems are widely used to treat varicose veins. In terms of efficacy and safety, these nonthermal, non-tumescent methods are noninferior to endovenous thermal ablation techniques. However, no published studies have compared products that use CAC systems. VenaSeal® (Medtronic, Santa Rosa, CA, USA) and VenaBlock® (Invamed) are the most commonly used CAC-based products worldwide. This study aimed to focus on the efficacy of these two commonly used products, with little emphasis on safety. Published full-text articles on the VenaBlock® and VenaSeal® systems were searched. Data for each product were evaluated by comparing them with each other in terms of effectiveness. In total, 1882 extremities from 11 studies using VenaBlock® and 524 extremities from eight studies using VenaSeal® were included and compared. Both devices were effective, and their cumulative recanalization-free survival rates were similar (P=0.188) at the 6-, 12-, 24-, 36-, and 60-month follow-ups. Both products improved the venous clinical severity score (VCSS) and quality of life (QoL) scores. VenaBlock® and VenaSeal® are effective in terms of cumulative recanalization-free survival rates, and no significant difference was found between the two groups (P=0.188). Both significantly improve the VCSS and QoL scores. CAC is feasible for the treatment of varicose veins.
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Cianoacrilatos , Procedimientos Endovasculares , Insuficiencia Venosa , Humanos , Cianoacrilatos/efectos adversos , Cianoacrilatos/uso terapéutico , Cianoacrilatos/administración & dosificación , Insuficiencia Venosa/terapia , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Enfermedad Crónica , Resultado del Tratamiento , Extremidad Inferior/irrigación sanguínea , Estudios de Factibilidad , Masculino , Femenino , Várices/terapia , Persona de Mediana Edad , Calidad de Vida , Adhesivos Tisulares/uso terapéutico , AdultoRESUMEN
BACKGROUND: Recurrence of incompetent saphenous veins after treatment is associated with remnant reflux to the branches close to the saphenofemoral or saphenopopliteal junctions, which originate from the residual patent stump after saphenous vein treatment. This study aimed to determine the factors affecting residual stump length after cyanoacrylate closure. METHODS: This retrospective study used prospectively collected data of patients who underwent cyanoacrylate closure. Postoperative Duplex scanning was performed to evaluate occlusion of the target vein, stump length, and the presence of endovenous glue-induced thrombosis. The clinical outcomes and patient characteristics were also evaluated. RESULTS: Seventy procedures for incompetent saphenous veins were performed in 67 limbs of 47 patients. The average patient age was 43 (range, 43-89) years; 34 (72%) were female patients. Target vein occlusion was achieved in all patients and endovenous glue-induced thrombosis occurred in 1.5 % of patients. The mean stump length was 18.3 mm. Total occlusion from the junction was observed in 13 vessels (19%). Particularly, higher total occlusion rate was found in treatments of the small saphenous vein compared with those of the great saphenous vein (GSV). In 6 GSV treatments, longer stumps (>45 mm) remained. Those with a stump >45 mm were all female patients, with significantly shorter height and higher Body Mass Index compared with those with stump lengths <45 mm. CONCLUSIONS: Body figure should be considered when performing cyanoacrylate closure to treat insufficient saphenous varicose veins. However, further investigations are to be warranted.
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Cianoacrilatos , Vena Safena , Várices , Humanos , Femenino , Várices/cirugía , Várices/terapia , Várices/diagnóstico por imagen , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Masculino , Vena Safena/diagnóstico por imagen , Vena Safena/cirugía , Adulto , Cianoacrilatos/efectos adversos , Cianoacrilatos/uso terapéutico , Anciano de 80 o más Años , Resultado del Tratamiento , Recurrencia , Ultrasonografía Doppler Dúplex , Insuficiencia Venosa/terapia , Insuficiencia Venosa/cirugía , Insuficiencia Venosa/diagnóstico por imagenAsunto(s)
Cianoacrilatos , Embolización Terapéutica , Várices Esofágicas y Gástricas , Embolia Pulmonar , Humanos , Cianoacrilatos/uso terapéutico , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/diagnóstico por imagen , Embolización Terapéutica/métodos , Femenino , Resultado del Tratamiento , Masculino , Várices/terapia , Várices/diagnóstico por imagen , Persona de Mediana EdadAsunto(s)
Várices , Humanos , Resultado del Tratamiento , Femenino , Masculino , Várices/cirugía , Várices/terapia , Reino Unido/epidemiología , Persona de Mediana Edad , AncianoRESUMEN
OBJECTIVE: To identify the effects of patient risk factors and pelvic venous reflux (PVR) patterns on treatment outcomes of Pelvic Vein Embolisation (PVE) for Pelvic Venous Disorder (PeVD). METHODS: We performed a retrospective cohort review assessing population, intervention, comparison, and outcomes (PICO) for women undergoing PVE for PVR January 2017-January 2021. We identified 190 patients who had completed both questionnaires and who had given consent for their information to be used for research (Median age 46, IQR 40-52). The distribution of pathological pelvic venous reflux found on transvaginal duplex ultrasound (TVDUS) was analysed for all patients. Pre- and post-procedure symptom burden scores were studied using a standardised questionnaire protocol. We used inferential univariate non-parametric statistics to describe our data. RESULTS: 190 cases were reviewed; 62.6% (119/190) premenopausal, 11.1% (21/190) perimenopausal, 25.3% (48/190) postmenopausal and menopausal status not documented 1% (2/190). 10.1% (19/188) were nulliparous (average age 34 years; range 20-55 years). There was a statistically significant improvement in all symptoms and in the appearance of varicosities on TVDUS post-PVE (P < 0.05) of the ovarian vein plexus, uterus plexus, arcuate veins, vaginal wall, peri-urethral, peri-anal, haemorrhoids, labial and proximal thigh. The locations of veins requiring embolisation having demonstrated reflux were analysed; 82.8% (154/186) underwent embolisation of at least one internal iliac vein tributary and ovarian vein embolisation. Age, parity, menopausal status and previous laparoscopy did not affect symptom improvement (P > 0.05). No significant complications such as coil migration were observed. CONCLUSIONS: PVE is an effective treatment for pelvic pain due to PeVD and its diagnosis should not be limited to multiparous women of childbearing age, as a significant proportion of patients who benefited from PVE were either nulliparous and/or postmenopausal.
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Embolización Terapéutica , Pelvis , Insuficiencia Venosa , Humanos , Estudios Retrospectivos , Embolización Terapéutica/efectos adversos , Persona de Mediana Edad , Femenino , Adulto , Resultado del Tratamiento , Factores de Riesgo , Pelvis/irrigación sanguínea , Insuficiencia Venosa/terapia , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Adulto Joven , Várices/terapia , Várices/diagnóstico por imagen , Várices/fisiopatología , Medición de Riesgo , Factores de Tiempo , Flujo Sanguíneo Regional , Venas/diagnóstico por imagen , Venas/fisiopatologíaRESUMEN
Background: The risk of developing deep vein thrombosis (DVT) after endovenous ablation of varicose veins varies in the literature. Little is known about the characteristics of this complication and associated factors. This study aimed: 1) to study the occurrence of DVT after ultrasound-guided foam sclerotherapy (UGFS) alone or combined with endovenous laser ablation (EVLA) for lower-limb varicose veins; 2) to identify factors associated with DVT. Patients and methods: The study included all outpatients aged 18 years or older who underwent UGFS and EVLA or UGFS alone at the University Hospital of Zurich between 2011 and 2015. Data were extracted from the hospital electronic medical record. Patients were surveyed about their level of pain after the procedure and their level of satisfaction with the procedure. Duplex ultrasound was used to assess the deep venous system 7-10 days and 6-8 months after the procedure. Regression analysis was used to examine the association of patient and procedure characteristics with the development of DVT. Results: A total of 334 patients (561 procedures performed in 393 different sessions) were included: 73% of the patients underwent combined UGFS and EVLA and 27% underwent UGFS alone. DVT occurred in 24 (7.2%) patients, of whom 88% underwent combined procedures and 17% underwent interventions involving both the great and small saphenous veins on the same session. DVT occurred in 8.2% of patients receiving thromboprophylaxis and in 9.5% of patients not receiving thromboprophylaxis. DVT occurred in 5.2% of women and 11.9% of men. No factors associated with a diagnosis of DVT after intervention were identified. Pain and satisfaction levels did not differ between patients with and without DVT. Conclusions: This study adds to the knowledge of the risk of DVT following UGFS alone or combined with EVLA. Further studies are needed to revise thromboprophylaxis.
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Procedimientos Endovasculares , Terapia por Láser , Escleroterapia , Ultrasonografía Intervencional , Várices , Trombosis de la Vena , Humanos , Várices/cirugía , Várices/terapia , Escleroterapia/efectos adversos , Femenino , Masculino , Terapia por Láser/efectos adversos , Persona de Mediana Edad , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/prevención & control , Resultado del Tratamiento , Factores de Riesgo , Adulto , Anciano , Procedimientos Endovasculares/efectos adversos , Factores de Tiempo , Satisfacción del Paciente , Ultrasonografía Doppler Dúplex , Hospitales Universitarios , Estudios Retrospectivos , Terapia Combinada , Registros Electrónicos de SaludRESUMEN
OBJECTIVES: This study aimed to investigate the impact of post-interventional compression therapy on clinical outcomes after endovenous laser ablation (EVLA) of incompetent saphenous veins. METHODS: This prospective, controlled, multicenter study in Germany involved 493 varicose vein patients followed-up for 6 months. RESULTS: Compression therapy significantly reduced symptoms compared to no compression (VCSS: 1.4 ± 1.6 vs 2.2 ± 2.2; p = .007). Post-interventional therapy duration of up to 14 days was found to be most effective for improving patient-reported disease severity (p < .001) and higher quality of life (p = .001). Patient compliance was high (82%), and non-compliance was linked to worse disease severity (VCSS 1.4 ± 1.5 vs 2.1 ± 2.3, p = .009). CONCLUSION: In conclusion, post-interventional compression therapy is beneficial by reducing symptoms and improving quality of life. High patient compliance with the therapy is observed, and non-compliance is associated with worse disease severity.
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Terapia por Láser , Cooperación del Paciente , Calidad de Vida , Várices , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Várices/cirugía , Várices/terapia , Anciano , Adulto , Resultado del Tratamiento , Procedimientos Endovasculares , Estudios de Seguimiento , Vena Safena/cirugíaRESUMEN
OBJECTIVES: We explored the connection between varicose vein and edema, by investigating extracellular water ratio (E/T) using bioelectrical impedance analysis. METHODS: In a prospective cohort study 120 patients underwent varicose vein surgery with extracellular fluid to total body water ratio (E/T) and E/T postop divided by E/Tpreop (E/T ratio) measured using a body composition analyzer. Edema was defined as E/T ≥0.390. Seventy-nine patients received unilateral treatment, while 41 underwent bilateral. p < .05 is statistically significant. RESULTS: Preoperatively, patients exhibited edema (E/T) in the treated leg (0.394 ± 0.009), untreated leg (0.392 ± 0.009), trunk (0.390 ± 0.007), and whole body (0.391 ± 0.007). Postoperatively, E/T decreased across body (p < .05). The lowest E/T ratio was observed in the treated leg (0.991 ± 0.012), followed by the untreated leg (0.994 ± 0.012), the trunk (0.995 ± 0.009), and the whole body (0.994 ± 0.009). E/T ratio of bilateral group were lower than unilateral group (p < .05). CONCLUSION: Varicose vein contributes to generalized edema, and treatment alleviates edema in the treated leg and the entire body.
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Edema , Várices , Humanos , Várices/terapia , Várices/cirugía , Femenino , Persona de Mediana Edad , Masculino , Estudios Prospectivos , Adulto , Anciano , Pierna/irrigación sanguínea , Impedancia EléctricaAsunto(s)
Procedimientos Endovasculares , Humanos , Procedimientos Endovasculares/efectos adversos , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Várices/terapia , Trombosis de la Vena/prevención & control , Trombosis de la Vena/etiología , Femenino , Anticoagulantes/uso terapéuticoAsunto(s)
Embolización Terapéutica , Endosonografía , Hemorragia Gastrointestinal , Humanos , Embolización Terapéutica/métodos , Endosonografía/métodos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Cirrosis Hepática/complicaciones , Masculino , Várices/terapia , Várices/complicaciones , Persona de Mediana Edad , Ultrasonografía Intervencional , Várices Esofágicas y Gástricas/terapia , Várices Esofágicas y Gástricas/etiologíaRESUMEN
BACKGROUND: To describe the treatment of patients with great saphenous vein (GSV) incompetence and varicose veins (VVs), utilizing an Automated Microfoam Preparation System (AMPS, Varixio®, VB Devices, Barcelona, Spain). METHODS: Adults between January and June 2021 were included. The AMPS system was used for foam preparation. Sclerotherapy treatment followed international recommendations. The primary endpoint was GSV closure rate after 36 months. RESULTS: 164 patients were enrolled. During the 7-day follow-up period, all GSVs showed complete closure, which was maintained at the 1-year mark. No major complications were reported. A cumulative complete GSV recanalization rate of 6.1% and a partial recanalization rate of 26.8% after 36 months were noted. Some patients (9.7%) required additional treatment. A higher BMI was associated with complete recanalization. CONCLUSION: The AMPS offers an easy-to-use and standardized procedure, potentially enhancing treatment outcomes if compared with manual preparation. Caution is advised when treating obese patients.
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Vena Safena , Escleroterapia , Várices , Insuficiencia Venosa , Humanos , Várices/terapia , Escleroterapia/métodos , Femenino , Masculino , Persona de Mediana Edad , Estudios de Seguimiento , Adulto , Anciano , Insuficiencia Venosa/terapia , Resultado del TratamientoRESUMEN
BACKGROUND: Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established. CASE SUMMARY: We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death. CONCLUSION: We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
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Coledocostomía , Hemorragia Gastrointestinal , Yeyuno , Escleroterapia , Várices , Humanos , Masculino , Várices/terapia , Várices/cirugía , Coledocostomía/métodos , Coledocostomía/efectos adversos , Escleroterapia/métodos , Escleroterapia/efectos adversos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/diagnóstico , Yeyuno/cirugía , Yeyuno/irrigación sanguínea , Persona de Mediana Edad , Resultado del Tratamiento , Femenino , Anciano , Enbucrilato/administración & dosificación , Enbucrilato/efectos adversos , Hipertensión Portal/cirugía , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico , Soluciones Esclerosantes/administración & dosificación , Soluciones Esclerosantes/efectos adversos , Polidocanol/administración & dosificación , Polidocanol/uso terapéutico , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Endoscopía Gastrointestinal/métodosRESUMEN
BACKGROUND: This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of venous vascular disease that predominantly affects the body's lower extremities. The most serious manifestation of this disease includes varicose veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular veins, and spider telangiectasias. METHODS: The anatomy, pathophysiology, and risk factors of SVD were discussed during this review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep vein thrombosis. Various classification systems were listed, focusing on the most common one-the revised Clinical-Etiology-Anatomy-Pathophysiology classification. The clinical features including history and physical examination findings elicited in SVD were outlined. RESULTS: Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but magnetic resonance imaging and computed tomography venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, nonsteroidal anti-inflammatory drugs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablationss, endovenous laser ablation, endovenous steam ablation, and endovenous microwave ablation as well as nonthermal strategies such as the Varithena (polidocanol microfoam) sclerotherapy, VenaSeal (cyanoacrylate) ablation, and Endovenous mechanochemical ablation. Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting. CONCLUSIONS: SVDs are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared toward reducing the significant morbidity associated with SVD especially varicose veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.
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Várices , Humanos , Factores de Riesgo , Resultado del Tratamiento , Várices/terapia , Várices/fisiopatología , Várices/epidemiología , Insuficiencia Venosa/terapia , Insuficiencia Venosa/fisiopatología , Insuficiencia Venosa/epidemiología , Insuficiencia Venosa/diagnóstico por imagen , Venas/fisiopatología , Venas/diagnóstico por imagen , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Polidocanol endovenous microfoam (PEM) has been used to treat lower extremity venous reflux for almost one decade with specific advantages for below knee (BK) truncal veins where thermal ablation poses a risk of injury to adjacent nerves. The current literature of the BK segment often examines short-term outcomes with modest sample sizes. We aim to identify factors associated with recanalization and reintervention in this subset of patients. METHODS: We performed a retrospective study of a prospectively maintained database of patients from a single institution who underwent 1% PEM ablation for BK great saphenous vein (GSV) and small saphenous vein (SSV) reflux. Patients underwent duplex ultrasound (DU) within 7 days after injection, every 3 to 6 months for 1 year, and every 6 to 12 months thereafter. Patients with symptomatic recanalization underwent reintervention. The 26 patients lost to follow-up without DU after ablation were excluded. The factors associated with recanalization and reintervention were examined by multivariate and nonparametric analyses. RESULTS: Between March 2018 and July 2023, 411 patients (166 male, 245 female) with 573 treated limbs (284 right, 289 left) met the study criteria. Of the 573 included limbs, 457 (79.8%) had undergone prior above knee saphenous ablations. A total of 554 BK GSV and 42 SSV ablations were performed. The most recent DU was performed at a mean of 231 ± 329 days. The overall recanalization rate was 10.6% (55 GSVs and 8 SSVs) at a mean follow-up of 104 ± 180 days. Comparing the closed and recanalized veins, we found no significant difference in age (P = .90), treated laterality (P = .14), patient body mass index (P = .59), preprocedural CEAP (clinical-etiology-anatomy-pathophysiology) score (P = .79), recanalization rate in GSVs vs SSVs (P = .06), or administered PEM volume (P = .24). The recanalized veins had significantly larger preprocedural diameters than the veins that remained closed (recanalized, 4.9 mm; closed, 4.3 mm; P = .001). Men had higher incidence of recanalization than women (men, 14.2%; women, 8%; P = .015). Anticoagulation use was associated with recanalization (odds ratio, 1.96; 95% confidence interval, 1.1-3.6; P = .03). Early recanalization at the first DU accounted for 31 failures (49.2%) and had a significantly lower administered PEM volume compared with later recanalization (early, 4 mL; late, 5 mL; P = .025). There were no significant differences between the 33 recanalized patients requiring reintervention (52.4%) and the 30 who did not. Twenty-four reinterventions were performed with PEM, 100% of which remained closed at a median of 160 days (interquartile range, 257 days). CONCLUSIONS: PEM is successful for the treatment of BK GSV and SSV reflux with a closure rate of 89% at a mean of 231 days and shows promise as salvage therapy. Most cases of recanalization were noted in the early postprocedure period and were associated with a lower PEM volume. A larger vein diameter, male sex, and anticoagulation use are associated with higher rates of recanalization.
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Polidocanol , Vena Safena , Soluciones Esclerosantes , Insuficiencia Venosa , Humanos , Masculino , Femenino , Polidocanol/administración & dosificación , Estudios Retrospectivos , Vena Safena/cirugía , Vena Safena/diagnóstico por imagen , Persona de Mediana Edad , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/cirugía , Insuficiencia Venosa/terapia , Resultado del Tratamiento , Adulto , Soluciones Esclerosantes/administración & dosificación , Soluciones Esclerosantes/efectos adversos , Anciano , Factores de Tiempo , Factores de Riesgo , Bases de Datos Factuales , Escleroterapia/efectos adversos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Várices/diagnóstico por imagen , Várices/cirugía , Várices/terapia , Ultrasonografía Doppler Dúplex , RecurrenciaRESUMEN
OBJECTIVE: To investigate whether compression therapy after thermal ablation of varicose veins can improve the prognosis of patients. METHODS: Systematic research were applied for Chinese and English electronic databases(PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP Databases). Eligible prospective studies that comparing the efficacy of compression therapy and non-compression therapy on patients after thermal ablation of varicose veins were included. The interest outcome such as pain, quality of life (QOL), venous clinical severity score (VCSS), time to return to work and complications were analyzed. RESULTS: 10 studies were of high quality, and randomized controlled trials involving 1,545 patients met the inclusion criteria for this study. At the same time, the meta-analysis showed that the application of compression therapy improved pain (SMD: -0.51, 95% CI: -0.95, -0.07) but exhibited no statistically significant effect on QOL (SMD: 0.04, 95% CI: -0.08, 0.16), VCSS (MD: -0.05, 95% CI: -1.19, 1.09), time to return to work (MD: -0.43, 95% CI: -0.90, 0.03), total complications (RR: 0.54, 95% CI: 0.27, 1.09), and thrombosis (RR: 0.71, 95% CI: 0.31, 1.62). CONCLUSION: Compression therapy after thermal ablation of varicose veins can slightly relieve pain, but it has not been found to be associated with improvement in other outcomes.
Asunto(s)
Várices , Humanos , Várices/cirugía , Várices/terapia , Calidad de Vida , Vendajes de Compresión , Resultado del Tratamiento , Reinserción al Trabajo/estadística & datos numéricos , Medias de CompresiónRESUMEN
BACKGROUND AND OBJECTIVE: Lower limb varicose veins are a prevalent disease associated with several available treatment options, including conventional surgery and polidocanol foam sclerotherapy. However, few studies have analyzed therapeutic modality outcomes based on Patient-Reported Outcome Measures (PROMs). This large sample-size study was designed to evaluate the outcomes of polidocanol foam sclerotherapy compared to conventional surgery based on an analysis of PROMs. METHODS: This was a prospective, observational, and qualitative study of 205 patients who underwent varicose vein treatment with either polidocanol foam sclerotherapy (57 patients, 90 legs) or conventional surgery (148 patients, 236 legs). Patients were preoperatively assessed and re-evaluated 30 days after the procedure using the Venous Disease Severity Score (VCSS) and specific venous disease quality-of-life questionnaires (VEINES-QoL/Sym). RESULTS: Both treatments significantly improved VCSS and VEINES results 30 days after the procedure (p < 0.05). However, surgery promoted greater improvements in VCSS (on average 4.02-points improvement, p < 0.001), VEINES-QoL (average 8-points improvement, p < 0.001), and VEINES-Sym (average 11.66 points improvement, p < 0.001) than did sclerotherapy. Postoperative pain and aesthetic concerns about the legs were the domains of the questionnaires in which the results varied the most between the treatment modalities, with worse results for sclerotherapy. CONCLUSION: Both polidocanol foam sclerotherapy and conventional surgery positively impact patients' quality of life after 30 days, but the improvement is more significant for patients who undergo conventional surgery.
Asunto(s)
Calidad de Vida , Várices , Humanos , Polidocanol , Polietilenglicoles , Estudios Prospectivos , Vena Safena , Soluciones Esclerosantes/uso terapéutico , Soluciones Esclerosantes/efectos adversos , Escleroterapia/efectos adversos , Resultado del Tratamiento , Várices/cirugía , Várices/terapiaRESUMEN
BACKGROUND: The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. METHODS: The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. RESULTS: The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. CONCLUSIONS: The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.