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Ribeiro AJA, Mendes-Pinto D, Erzinger FL, Fiorelli RKA, Fiorelli SKA, Ribeiro ACDO, Marques MA. Thromboprophylaxis in lower limb varicose vein surgery in Brazil. J Vasc Bras 2022; 21:e20210172. [PMID: 35677747 PMCID: PMC9136684 DOI: 10.1590/1677-5449.202101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.
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Affiliation(s)
| | | | | | | | | | | | - Marcos Arêas Marques
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Rio de Janeiro, RJ, Brasil.
- Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil.
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Ribeiro AJA, Mendes-Pinto D, Erzinger FL, Fiorelli RKA, Fiorelli SKA, Ribeiro ACDO, Marques MA. Thromboprophylaxis in lower limb varicose vein surgery in Brazil. J Vasc Bras 2022. [DOI: 10.1590/1677-5449.202101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Background Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.
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Affiliation(s)
| | | | | | | | | | | | - Marcos Arêas Marques
- Universidade Federal do Estado do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
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Boyle E, Reid J, O’Donnell M, Harkin D, Badger S. Thromboprophylaxis for varicose vein procedures – A national survey. Phlebology 2019; 34:598-603. [DOI: 10.1177/0268355519828931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Venous thromboembolism is rare following varicose vein ablation procedures, but uncertainty about its incidence combined with a lack of evidence-based clinical guidelines regarding thromboprophylaxis has led to debate about best practice. We conducted a national survey to investigate current practice among Irish vascular surgeons. Methods An anonymous online questionnaire was emailed to all members of the Irish Association of Vascular Surgeons and the Northern Ireland Vascular Society. Results Response rate was 60%. With regard to procedure type, 36.7% of respondents use only endovenous techniques and 53% use a combination of open and endovenous. Formal duplex imaging on all patients is obtained by 53.3%. With regard to VTE prevention, 73.3% always give thromboprophylaxis. For those who give it selectively, a variety of factors were considered as risks. Pharmacological agents used are enoxaparin in 73.3% of cases or tinzaparin, and 71.4% use a single dose (either 20/40 mg or 3500/4500 IU respectively). If patients are already taking anticoagulation, this is continued by 46.7% of respondents. Routine post procedure duplex imaging is carried out by 23.1% of recipients, either by the surgeon or formally and 80% review patients clinically. Moreover, 43.3% of respondents claim to know their post-operative VTE rate and this varies from 0 to 1% with one mortality reported. Conclusions The majority of respondents use single-dose thromboprophylaxis periprocedurally for varicose vein ablation procedures. VTE rates are low but the true incidence may be unknown.
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Affiliation(s)
- Emily Boyle
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Julie Reid
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Mark O’Donnell
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Denis Harkin
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
| | - Stephen Badger
- Department of Vascular Surgery, Royal Victoria Hospital, Belfast, UK
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Bond R, Whyman MR, Wilkins DC, Walker AJ, Ashley S. A Randomised Trial of Different Compression Dressings following Varicose Vein Surgery. Phlebology 2016. [DOI: 10.1177/026835559901400103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: TED antiembolism stockings, Panelast self-adhesive elasticated bandages and Medi Plus class II stockings are three different dressings commonly used to provide compression following surgery for varicose veins. The aim of this study was to determine which of the three dressings was most acceptable to patients. Design: Forty-two patients undergoing bilateral varicose vein surgery were randomised to receive a different dressing on each leg in order to determine if a particular type of dressing was superior in its ability to reduce postoperative pain and provide adequate comfort without reducing mobility. The dressings were worn for 1 week, during which daily pain scores were recorded for each leg followed by a simple questionnaire to determine comfort and mobility. Results: There was a significant reduction of mobility experienced by patients wearing Panelast bandages compared with the other two dressings ( p<0.05). However, there were no significant differences between the dressings with regard to the degree of postoperative pain experienced, and in all other respects the dressings were equally tolerated. Conclusion: The choice of compression dressings used for varicose vein surgery should depend primarily on the personal preference of surgeons as well as financial considerations.
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Affiliation(s)
- R. Bond
- Vascular Surgical Unit, Derriford Hospital, Plymouth, UK
| | - M. R. Whyman
- Vascular Surgical Unit, Derriford Hospital, Plymouth, UK
| | - D. C. Wilkins
- Vascular Surgical Unit, Derriford Hospital, Plymouth, UK
| | - A. J. Walker
- Vascular Surgical Unit, Derriford Hospital, Plymouth, UK
| | - S. Ashley
- Vascular Surgical Unit, Derriford Hospital, Plymouth, UK
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Qureshi MI, Davies AH. Thromboprophylaxis following superficial venous intervention. Phlebology 2015; 31:77-80. [PMID: 26163506 DOI: 10.1177/0268355515594502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mahim I Qureshi
- Section of Vascular Surgery, Imperial College London, London, UK
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Chen K, Yu GF, Huang JY, Huang LD, Su X, Ni HZ, Pan LM, Zheng XT. Incidence and risk factors of early deep venous thrombosis after varicose vein surgery with routine use of a tourniquet. Thromb Res 2015; 135:1052-6. [PMID: 25921935 DOI: 10.1016/j.thromres.2015.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/12/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The incidence of early deep venous thrombosis (DVT) following varicose vein surgery (traditional open stripping) with routine use of a tourniquet remains unknown. MATERIALS AND METHODS A retrospective analysis of all patients who underwent varicose vein surgery with a tourniquet in the authors' unit between 1 January 2012 and 30 November 2013 was undertaken. Cases of postoperative DVT were identified from the unit database, and re-assessments conducted 1, 3 and 6 months after the initial diagnosis were recorded from the outpatient department. RESULTS Out of 1461 patients, 113 (7.7%) developed postoperative DVT. Nineteen (1.3%) patients had proximal DVT, and 94 (6.4%) patients had isolated distal DVT. The risk factors for postoperative DVT included old age (≥65 years), female sex and gastrocnemius vein dilation (GVD). GVD was found to be a significant independent risk factor for the occurrence of DVT, with an odds ratio of 2.437 (95% confidence interval 1.644-3.611). Five patients with distal DVT (5.7%) and eight patients with proximal DVT (44.4%) still exhibited a thrombus at 6-month follow-up, but with decreased size and at various stages of resolution. CONCLUSIONS This study found a higher incidence of postoperative DVT (7.7%) with routine use of a tourniquet during varicose vein surgery than has been reported previously. Among the factors examined, GVD had the highest predictive power for postoperative DVT. Both distal and proximal DVT were associated with acceptable outcomes.
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Affiliation(s)
- Kai Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guan-Feng Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li-Dong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Su
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hai-Zhen Ni
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Le-Men Pan
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Tao Zheng
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Wang H, Sun Z, Jiang W, Zhang Y, Li X, Wu Y. Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV). Vasc Med 2015; 20:117-21. [PMID: 25601917 DOI: 10.1177/1358863x14564592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To analyze the necessity of venous thromboembolism (VTE) prophylaxis for patients undergoing high ligation and stripping of the great saphenous vein (GSV) and to estimate the efficacy and safety of different anticoagulant protocols in a single-center randomized controlled trial with large sample size. A total of 2196 patients undergoing high ligation and stripping of the GSV were randomized to one of the following postoperative VTE prophylaxis protocols: group A, no VTE prophylaxis (n=542); group B, subcutaneous low-dose unfractionated heparin (LDUH) hypodermic injection, 125 U/kg per day in three divided doses (n=531); group C, low-molecular-weight heparin (LMWH) 6000 IU once a day (n=573); and group D, LMWH 4000 IU twice daily (n=550). Groups were compared for the incidence of VTE and major hemorrhage within 1 month following surgery. Varicose vein severity was classified by CEAP (Clinical, Etiologic, Anatomic, Pathophysiologic elements) score. The clinical characteristics of the patients were equally matched between groups. Postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) were significantly higher in group A (DVT 5.17%, PE 1.48%) compared to groups B (0.56%, 0%), C (0.35%, 0%) and D (0.36%, 0%) (p<0.01). The incidence of VTE did not differ between the three active chemoprophylaxis arms. Hemorrhagic complications were low for each group but higher in group B (0.75%) compared to the other groups (group A 0.18%; group C 0.17%; group D 0.18%, p<0.01). Hemorrhagic complications did not differ amongst groups A, C and D. In conclusion, postoperative VTE chemoprophylaxis following high ligation and GSV stripping effectively reduces the venous thrombosis complications of this procedure. Of the three active strategies tested, no difference in efficacy was noted; however, thrice daily LDUH did increase bleeding complications.
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Affiliation(s)
- Haitao Wang
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Zhanfeng Sun
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Weiliang Jiang
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yingnan Zhang
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Xianwei Li
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yalei Wu
- Department of Vascular Surgery, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China
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Yu DY, Chen HC, Chang SY, Hsiao YC, Chang CJ. Comparing the Effectiveness of 1064 vs. 810 nm Wavelength Endovascular Laser for Chronic Venous Insufficiency (Varicose Veins). Laser Ther 2013; 22:247-53. [PMID: 24511201 DOI: 10.5978/islsm.13-or-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to compare the efficacy and safety of Endovenous Laser Photocoagulation (EVLP) at wavelengths of 1064 nm versus 810 nm for chronic venous insufficiency (varicose veins) in a large series of patients. STUDY DESIGN/MATERIALS AND METHODS A retrospective review was conducted of 108 patients with chronic venous insufficiency treated over a 8-year period. Subjects' ages ranged between 16 to 79 years; there were 83 females and 25 males, all of whom were Asian. Patients (n=54) received EVLP at wavelengths of 1064 nm (EVLP-1064 nm), Nd:YAG laser. Subsequent patients (n=54) received 810 nm (EVLP-810 nm), Diode laser. The primary efficacy measurement was the quantitative assessment of final outcome for 1064 nm versus 810 nm. Patients were monitored for adverse effects as well. RESULTS Complications were observed at 3 weeks (early), 6 weeks (late) and 6 months after EVLP. In both groups, the commonest complication in early convalescence was swelling. This was followed by Local paraesthesia, pigmentation, superficial burns, superficial phlebitis, and localized hematomas. At 6 weeks postoperatively, local paraesthesia, persistent hyperpigmentation, and minimal scarring were presented. These problems all disappeared completely after the 6 months study period. Based on chi-squared analysis, there were clinical, and statistically significant differences in the severity score of final results favoring the EVLP-810 nm group. CONCLUSION All patients achieved good or excellent improvement after EVLP-1064nm and EVLP-810nm. However, the difference of final outcome was significant, and indicates that improvement was greater in the Diode group. Further studies of different wavelengths and optimization of cryogen spray cooling (CSC) may lead to improved results in the eradication of varicose veins.
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Affiliation(s)
- De-Yi Yu
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Hung-Chang Chen
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Shu-Ying Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yen-Chang Hsiao
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Cheng-Jen Chang
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
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Dua A, Neiva S, Sutherland A. Does previous varicose vein surgery alter deep vein thrombosis risk after lower limb arthroplasty? Orthop Surg 2013; 4:222-6. [PMID: 23109306 DOI: 10.1111/os.12003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total knee arthroplasty (TKA) and total hip arthroplasty (THA) in patients who have had previous varicose vein (VV) surgery. METHODS Data on 57,364 patients who had undergone THAs and 51,859 patients who had undergone TKAs were obtained from the Scottish Arthroplasty Project and cross-referenced with patients for whom DVT/PE events had been recorded (Scottish Morbidity Database). RESULTS The THA DVT rate in patients who had previously undergone VV surgery was 0.8% (27/3478), and in those with no previous VV diagnosis or surgery was 0.8% (428/53,659). In patients with a previous VV diagnosis but no VV surgery, the THA DVT rate was 3.1% (7/227) (Pearson χ2 test, χ2 = 14.8, degrees of freedom = 2, P = 0.001). No significant difference was found for the corresponding data in the TKA cohort. The THA PE rate in patients who had previously undergone VV surgery was 0.7% (26/3478), and in those with no previous VV diagnosis or surgery 0.7% (376/53,659). No correlation was found between prior VV interventions and PE rates. CONCLUSION Untreated VVs are associated with an increased risk of DVT after THA. Therefore, patients with VVs should consider having them treated prior to undergoing orthopedic interventions.
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Affiliation(s)
- Anahita Dua
- Center for Translational Injury Research, Houston, Texas, USA
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Testroote MJG, Wittens CHA. Prevention of venous thromboembolism in patients undergoing surgical treatment of varicose veins. Phlebology 2013; 28 Suppl 1:86-90. [DOI: 10.1177/0268355512475121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: There is no consensus among surgeons with regard to prevention of venous thromboembolism (VTE) in patients undergoing surgical treatment of varicose veins. We performed a systematic review of the available literature. Methods: We systematically searched the online database from PubMed for studies about the incidence of VTE and thromboprophylaxis in varicose vein surgery. We included 13 papers for review. Results: The incidence of VTE after varicose vein surgery remains unclear. Most retrospective case series report an incidence of deep venous thrombosis (DVT) of approximately 1%, based on a clinical diagnosis. However, three prospective studies have systematically detected DVT by means of duplex ultrasound and showed that the true incidence might be 5–10 times higher than expected on a clinical basis. Discussion: More data on the incidence of VTE, and the need for postoperative thromboprophylaxis are necessary to formulate evidence-based clinical guidelines. Therefore, high-quality randomised clinical trials, with high numbers of included patients, and ideally comparing prophylaxis to placebo are warranted.
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Affiliation(s)
- M J G Testroote
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C H A Wittens
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Universiteitssingel 50, The Netherlands
- Klinik für Gefäßchirurgie, Universitätsklinikum Aachen, Aachen, Germany
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Fibular Nerve Injury After Small Saphenous Vein Surgery. Ann Vasc Surg 2012; 26:729.e11-5. [DOI: 10.1016/j.avsg.2011.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/05/2011] [Accepted: 11/15/2011] [Indexed: 11/18/2022]
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Hinterhuber G, Böhler K, Kittler H, Quehenberger P. Extended monitoring of hemostatic activation after varicose vein surgery under general anesthesia. Dermatol Surg 2006; 32:632-9. [PMID: 16706757 DOI: 10.1111/j.1524-4725.2006.32134.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative heparin prophylaxis after stripping of the long saphenous vein is a matter of controversial discussion, and practices vary by surgeon and country. OBJECTIVE The aim of this study was to assess the extent of hypercoagulability by continued monitoring of activation markers of coagulation and fibrinolysis for a period of 3 weeks after stripping of the long saphenous vein and concomitant phlebectomy. METHODS Including 21 patients, the following markers were measured preoperatively and on postoperative day 1, 2, 3, 7, 14, and 21: Activation products of coagulation: thrombin-antithrombin complex (TAT), thrombus precursor protein (TPP), and prothrombin-fragment F1+2 (F1+2), and markers of fibrinolysis: plasmin-alpha(2)-antiplasmin complexes (PAP), D-Dimer, tissue plasminogen activator (t-PA) antigen, and plasminogen activator inhibitor 1 (PAI-1) antigen. RESULTS TAT levels increased significantly until day 3 (p=.008) and normalized within 14 days. TPP levels increased significantly until day 7 (p=.02), decreasing to initial values within 21 days. PAP complexes increased significantly until day 2 (p=.02) reducing to baseline within the observation period. D-Dimer levels increased immediately after surgery (p<.001) until day 14 (p<.001) and returned to baseline until day 21. CONCLUSIONS Significant hemostatic activation after varicose vein surgery was observed and persisted until 3 weeks postoperatively, indicating that heparin prophylaxis for 2 to 3 weeks is advisable for at-risk patients.
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Affiliation(s)
- Gabriele Hinterhuber
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria.
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13
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Extended Monitoring of Hemostatic Activation After Varicose Vein Surgery Under General Anesthesia. Dermatol Surg 2006. [DOI: 10.1097/00042728-200605000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- R J Beale
- Vascular Surgical Unit, The General Infermary at Leeds, Great George Street, Leeds LS1 3EX, UK
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15
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Autar R. The management of deep vein thrombosis: the Autar DVT risk assessment scale re-visited. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1361-3111(03)00051-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND AND OBJECTIVES Untreated varicose veins have significant morbidity and potential mortality. Treatment aims to relieve symptoms, improve appearance, and to prevent deterioration. Current therapeutic options include graduated compression stockings, sclerotherapy, ambulatory phlebectomy, surgical ligation, and stripping. Results of laser photocoagulation of vascular anomalies have been encouraging. Applying these concepts of laser-tissue interactions, we developed a new method of treatment for varicose veins of the lower extremities. STUDY DESIGN/MATERIALS AND METHODS One hundred and forty-nine patients with 252 varicose greater saphenous veins underwent endovenous laser photocoagulation (EVLP) from January 1996 to January 2000. Subject's age ranged between 23 years 9 months and 80 years 7 months with a mean age of 50 years 8 months. There were 122 females and 27 males. Only patients with primary varicose veins and saphenofemoral reflux documented by Duplex ultrasound were treated. All patients received surgical ligation of the saphenofemoral junction (SFJ). EVLP was performed using the neodymium:yttrium-aluminium-garnet (Nd:YAG) (1,064 nm) laser, delivered with a 600 microm optical fiber. Laser power was set at 10 or 15 W, delivered with a pulse duration of 10 seconds. The outcome was compared before and after EVLP, based on the score of severity of the varicose veins by Hach's classification. RESULTS The range of total delivered energy is from 9,200 to 20,100 J. The entire procedure was completed in 95-175 minutes (mean 122.33 minutes) for bilateral procedures, and 65-100 minutes (mean 81.07 minutes) for unilateral procedures. The follow-up period ranged from 12 to 28 months with a mean of 19 months. One hundred and forty-one patients with 244 legs involved (96.8%) demonstrated remarkable improvement (P < 0.05). Common early complications of EVLP are: local paraesthesia of the treated area in 92 legs (36.5%), ecchymosis and dyschromia in 58 legs (23.0%), superficial burn injury in 12 legs (4.8%), superficial phlebitis in four legs (1.6%), and localized hematoma in two legs (0.8%) at 3 weeks post-operatively. The final outcome showed no significant morbidity or mortality. All patients recovered completely. CONCLUSIONS EVLP is a simple effective treatment modality for varicose veins. This less invasive method can minimize the complications of conventional surgery.
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Affiliation(s)
- Cheng-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
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Williams EV, Williams RS, Hughes JL, Williams KL, Foster ME, Lewis MH. Prevention of venous thromboembolism in Wales: results of a survey among general surgeons. Postgrad Med J 2002; 78:88-91. [PMID: 11807190 PMCID: PMC1742269 DOI: 10.1136/pmj.78.916.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the current attitudes towards the prevention of venous thromboembolism among a cohort of surgeons. DESIGN A postal survey, comprising a questionnaire covering various aspects of venous thromboembolism prophylaxis was sent to all (n=84) consultant general surgeons in Wales. RESULTS Replies were received from 57 surgeons (68%), all of whom routinely used prophylaxis, the most frequent modalities used being heparin (100%) and graded compression stockings (79%). A combination of physical and pharmacological methods was used by over 89% of surgeons, with 60% starting prophylaxis more than two hours before operation. All surgeons continued prophylaxis after surgery, 53% until patients were mobile, 45% until they were discharged, and one surgeon continued prophylaxis for seven days after discharge. The thrombosis risk factors considered most important by surgeons when deciding about prophylaxis were (i) a previous history of venous thromboembolism, (ii) hypercoagulability, and (iii) malignancy. CONCLUSIONS This study confirms that Welsh surgeons conform to standard methods, but also highlights some uncertainties that are present in current surgical practice. Those who responded all routinely used prophylaxis, the timing of which was variable. The main risk factors identified when considering prophylaxis were previous history of deep vein thrombosis/pulmonary embolism, hypercoagulability, and the presence of malignancy. Suggestions for future practice are made.
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Affiliation(s)
- E V Williams
- Department of Surgery, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, UK.
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Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg 2002; 28:38-42. [PMID: 11991268 DOI: 10.1046/j.1524-4725.2002.01188.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Saphenous vein reflux is often the underlying anatomic cause of varicose veins. It is necessary to eliminate this reflux originating at the saphenofemoral junction (SFJ) to treat the resultant varicose veins. OBJECTIVE To report 2-year follow-up results after closing the incompetent greater saphenous vein starting from its junction (SFJ) with the femoral vein using radiofrequency (RF) endoluminal ablation. METHODS One hundred and forty incompetent greater saphenous veins from 120 patients with an incompetent SFJ and large painful varicosities were treated. Patients were evaluated clinically and with duplex ultrasound at 1 week, 6 weeks, 6 months, 12 months, and 24 months to determine treatment efficacy as well as adverse sequelae. RESULTS Vein occlusion, defined as the absence of any duplex ultrasound-determined flow, was successfully achieved in 137 of 140 (98%) scanned veins at 1-week follow-up. At the 12-month follow-up, none of the treated patients developed recanalization that was not seen at 6 weeks, with a successful outcome in 90%. At the 24 month follow-up, 19 of 21 patients had complete disappearance of the treated saphenous vein, for a success rate of 90%. Side effects were minimal, and no skin burns or thromboses were observed. CONCLUSION RF endovenous occlusion allows patients to obtain treatment with the positive attributes of surgery, that is, a single treatment and low rate of recurrent reflux, but without the morbidity, need for general anesthesia, or extensive convalescence associated with vein stripping and ligation surgery. Patient satisfaction was routinely achieved, with 98% of patients indicating a willingness to recommend the RF endovascular procedure to a friend or family member.
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Affiliation(s)
- Robert A Weiss
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux. Dermatol Surg 2002. [DOI: 10.1097/00042728-200201000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kopański Z, Schlegel-Zawadzka M, Piekoszewski W, Sadlik K, Sibiga W. The disturbances of magnesium in patients with thromboembolic complications after a cholecystectomy. Thromb Res 2000; 99:571-5. [PMID: 10974343 DOI: 10.1016/s0049-3848(00)00278-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Z Kopański
- The Military Clinical Hospital, Kraków, Poland.
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Abstract
The third of this three-part literature review discusses the effects of external compression on deep vein thrombosis formation and suggests design criteria for antiembolism stockings
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Affiliation(s)
- S Thomas
- Surgical Materials Testing Laboratory, Bridgend, UK
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