1
|
Chervonski E, Muqri F, Jacobowitz GR, Rockman CB, Maldonado TS, Berland TL, Garg K, Cayne NS, Sadek M. Safety and efficacy of endovenous ablation in patients with a history of deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12:101898. [PMID: 38677553 DOI: 10.1016/j.jvsv.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Endovenous ablation is the standard of care for patients with symptomatic superficial venous insufficiency. For patients with a history of deep vein thrombosis (DVT), concern exists for an increased risk of postprocedural complications, particularly venous thromboembolism. The objective of this study was to evaluate the safety and efficacy of endovenous thermal ablation in patients with a history of DVT. METHODS The national Vascular Quality Initiative Varicose Vein Registry was queried for superficial venous procedures performed from January 2014 to July 2021. Limbs treated with radiofrequency or laser ablation were compared between patients with and without a DVT history. The primary safety end point was incident DVT or endothermal heat-induced thrombosis (EHIT) II-IV in the treated limb at <3 months of follow-up. The secondary safety end points included any proximal thrombus extension (ie, EHIT I-IV), major bleeding, hematoma, pulmonary embolism, and death due to the procedure. The primary efficacy end point was technical failure (ie, recanalization at <1 week of follow-up). Secondary efficacy end points included the risk of recanalization over time and the postprocedural change in quality-of-life measures. Outcomes stratified by preoperative use of anticoagulation (AC) were also compared among those with prior DVT. RESULTS Among 33,892 endovenous thermal ablations performed on 23,572 individual patients aged 13 to 90 years, 1698 patients (7.2%) had a history of DVT. Patients with prior DVT were older (P < .001), had a higher body mass index (P < .001), were more likely to be male at birth (P < .001) and Black/African American (P < .001), and had greater CEAP classifications (P < .001). A history of DVT conferred a higher risk of new DVT (1.4% vs 0.8%; P = .03), proximal thrombus extension (2.3% vs 1.6%; P = .045), and bleeding (0.2% vs 0.04%; P = .03). EHIT II-IV, pulmonary embolism, and hematoma risk did not differ by DVT history (P = NS). No deaths from treatment occurred in either group. Continuing preoperative AC in patients with prior DVT did not change the risk of any complications after endovenous ablation (P = NS) but did confer an increased hematoma risk among all endovenous thermal ablations and surgeries (P = .001). Technical failure was similar between groups (2.0% vs 1.2%; P = .07), although a history of DVT conferred an increased recanalization risk over time (hazard ratio, 1.90; 95% confidence interval, 1.46, 2.46; P < .001). The groups had comparable improvements in postprocedural venous clinical severity scores and Heaviness, Aching, Swelling, Throbbing, and Itching scores (P = NS). CONCLUSIONS Endovenous thermal ablation for patients with a history of DVT was effective. However, appropriate patient counseling regarding a heightened DVT risk, albeit still low, is critical. The decision to continue or withhold AC preoperatively should be tailored on a case-by-case basis.
Collapse
Affiliation(s)
| | - Furqan Muqri
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Glenn R Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Caron B Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Todd L Berland
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Neal S Cayne
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY.
| |
Collapse
|
2
|
Zhang DD, He XY, Yang L, Wu BS, Fu Y, Liu WS, Guo Y, Fei CJ, Kang JJ, Feng JF, Cheng W, Tan L, Yu JT. Exome sequencing identifies novel genetic variants associated with varicose veins. PLoS Genet 2024; 20:e1011339. [PMID: 38980841 PMCID: PMC11233024 DOI: 10.1371/journal.pgen.1011339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 06/13/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Varicose veins (VV) are one of the common human diseases, but the role of genetics in its development is not fully understood. METHODS We conducted an exome-wide association study of VV using whole-exome sequencing data from the UK Biobank, and focused on common and rare variants using single-variant association analysis and gene-level collapsing analysis. FINDINGS A total of 13,823,269 autosomal genetic variants were obtained after quality control. We identified 36 VV-related independent common variants mapping to 34 genes by single-variant analysis and three rare variant genes (PIEZO1, ECE1, FBLN7) by collapsing analysis, and most associations between genes and VV were replicated in FinnGen. PIEZO1 was the closest gene associated with VV (P = 5.05 × 10-31), and it was found to reach exome-wide significance in both single-variant and collapsing analyses. Two novel rare variant genes (ECE1 and METTL21A) associated with VV were identified, of which METTL21A was associated only with females. The pleiotropic effects of VV-related genes suggested that body size, inflammation, and pulmonary function are strongly associated with the development of VV. CONCLUSIONS Our findings highlight the importance of causal genes for VV and provide new directions for treatment.
Collapse
Affiliation(s)
- Dan-Dan Zhang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Xiao-Yu He
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bang-Sheng Wu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Wei-Shi Liu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Guo
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chen-Jie Fei
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ju-Jiao Kang
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Wei Cheng
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Computer Science, University of Warwick, Coventry, United Kingdom
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Wiske C, Chervonski E, Rockman CB, Jacobowitz GR, Sadek M. Venous ablation procedures by provider type, including advanced practice providers. J Vasc Surg Venous Lymphat Disord 2024; 12:101872. [PMID: 38518987 DOI: 10.1016/j.jvsv.2024.101872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE The necessary training and certification of providers performing venous ablation has become a topic of debate in recent years. As venous interventions have shifted away from the hospital, the diversity of provider backgrounds has increased. We aimed to characterize superficial venous ablation practice patterns associated with different provider types. METHODS We analyzed Medicare Fee-For-Service data from 2010 through 2018. Procedures were identified by their Current Procedural Terminology code and included radiofrequency ablation, endovenous laser ablation, chemical adhesive ablation (ie, VenaSeal; Medtronic, Inc), and mechanochemical ablation. These procedures were correlated with the practitioner type to identify provider-specific trends. RESULTS Between 2010 and 2018, the number of ablation procedures increased by 107% from 114,197 to 236,558 per year (P < .001). Most procedures were performed by surgeons without vascular board certification (28.7%; 95% confidence interval [CI], 28.7%-28.8%), followed by vascular surgeons (27.1%; 95% CI, 27.0%-27.2%). Traditionally noninterventional specialties, which exclude surgeons, cardiologists, and interventional radiologists, accounted for 14.1% (95% CI, 14.1%-14.2%), and APPs accounted for 3.5% (95% CI, 3.4%-3.5%) of all ablation procedures during the study period. The total number of ablations increased by 9.7% annually (95% CI, 9.7%-9.8%), whereas procedures performed by APPs increased by 62.0% annually (95% CI, 61.6%-62.4%). There were significant differences between specialties in the use of nonthermal ablation modalities: APPs had the highest affinity for nonthermal ablation (odds ratio [OR], 2.60; 95% CI, 2.51-2.69). Cardiologists were also more likely to use nonthermal ablation (OR, 1.62; 95% CI, 1.59-1.66). Similarly, the uptake of new nonthermal technology (ie, chemical adhesives) was greatest among APPs (OR, 3.57; 95% CI, 3.43-3.70) and cardiologists (OR, 1.86; 95% CI, 1.81-1.91). Vascular surgeons were less likely to use nonthermal modalities (OR, 0.95; 95% CI, 0.92-0.97), including new nonthermal technology in the first year of availability (OR, 0.93; 95% CI, 0.90-0.95). CONCLUSIONS The use of venous procedures has increased rapidly during the past decade, particularly as endovenous ablations have been performed by a wider practitioner base, including APPs and noninterventionalists. Practice patterns differ by provider type, with APPs and cardiologists skewing more toward nonthermal modalities, including more rapid uptake of new nonthermal technology. Provider-specific biases for specific ablation modalities might reflect differences in training, skill set, the need for capital equipment, clinical privileges, or reimbursement. These data could help to inform training paradigms, the allocation of resources, and evaluation of appropriateness in a real-world setting.
Collapse
Affiliation(s)
- Clay Wiske
- Division of Vascular & Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY; Division of Vascular & Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
| | | | - Caron B Rockman
- Division of Vascular & Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Glenn R Jacobowitz
- Division of Vascular & Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular & Endovascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| |
Collapse
|
4
|
Fu S, Chen L, Lin H, Jiang X, Zhang S, Zhong F, Liu D. Prediction Model for Delayed Behavior of Early Ambulation After Surgery for Varicose Veins of the Lower Extremity: A Prospective Case-Control Study. Arch Phys Med Rehabil 2024:S0003-9993(24)01064-5. [PMID: 38909739 DOI: 10.1016/j.apmr.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To analyze influencing factors and establish a prediction model for delayed behavior of early ambulation after surgery for varicose veins of the lower extremity (VVLE). DESIGN A prospective case-control study. SETTING Patients with VVLE were recruited from 2 local hospitals. PARTICIPANTS In total, 498 patients with VVLE were selected using convenience sampling and divided into a training set and a test set. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We collected information from the selected participants before surgery and followed up until the day after surgery, then divided them into a normal and delayed ambulation group. Propensity score matching was applied to all participants by type of surgery and anesthesia. All the characteristics in the 2 groups were compared using logistic regression, back propagation neural network (BPNN), and decision tree models. The accuracy, sensitivity, specificity, and area under the curve (AUC) values of the 3 models were compared to determine the optimal model. RESULTS A total of 406 participants were included after propensity score matching. The AUC values for the training sets of logistic regression, BPNN, and decision tree models were 0.850, 0.932, and 0.757, respectively. The AUC values for the test sets were 0.928, 0.984, and 0.776, respectively. A BPNN was the optimal model. Social Support Rating Scale score, preoperative 30-second sit-stand test score, Clinical-Etiology-Anatomy-Pathophysiology (CEAP) grade, Medical Coping Modes Questionnaire score, and whether you know the need for early ambulation, in descending order of the result of a BPNN model. A probability value greater than 0.56 indicated delayed behavior of early ambulation. CONCLUSIONS Clinicians should pay more attention to those with lower Social Support Rating Scale scores, poor lower limb strength, a higher CEAP grade, and poor medical coping ability, and make patients aware of the necessity and importance of early ambulation, thereby assisting decision-making regarding postoperative rehabilitation. Further research is needed to improve the method, add more variables, and transform the model into a scale to screen and intervene in the delayed behavior of early ambulation of VVLE in advance.
Collapse
Affiliation(s)
- Shuiqin Fu
- The School of Nursing, Fujian Medical University, China; Department of Surgery, The Second Affiliated Hospital of Xiamen Medical College, China
| | - Lanzhen Chen
- Department of Nursing, The Second Affiliated Hospital of Xiamen Medical College, China
| | - Hairong Lin
- Department of Nursing, The Second Affiliated Hospital of Xiamen Medical College, China
| | - Xiaoxiang Jiang
- Intensive Care Unit, The Second Affiliated Hospital of Xiamen Medical College, China
| | - Suzhen Zhang
- Department of General surgery, Zhongshan Hospital Xiamen University, China
| | - Fuxiu Zhong
- Department of Surgery, Fujian Medical University Union Hospital, China
| | - Dun Liu
- The School of Nursing, Fujian Medical University, China.
| |
Collapse
|
5
|
Şirin G, Karaveli Cakir S, Eryiğit S, Toz H, Pirhan O, Erpolat Taşabat S, Çalişkan İ. Photoplethysmography-based assessment of varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics. Phlebology 2024:2683555241258308. [PMID: 38887802 DOI: 10.1177/02683555241258308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACGROUND Impaired venous return is observed in healthcare professionals who spend long periods standing and sitting. This descriptive cross-sectional study was conducted to evaluate varicose vein-related risk factors, exercise health beliefs, and venous refill time in healthcare professionals working in operating rooms and outpatient clinics by photoplethysmography. METHOD The study sample consisted of 100 healthcare professionals without a diagnosis of peripheral venous insufficiency. Data were collected using a descriptive characteristics form, the Health Belief Model Scale for Exercise, the Short-Form McGill Pain Questionnaire, and photoplethysmography. RESULT This study found that OR nurses had shorter venous refill times and experienced more pain due to prolonged standing, despite their high health beliefs about exercise. CONCLUSION Healthcare professionals working in operating rooms should be screened for venous insufficiency and trained regarding the practices to prevent venous insufficiency, such as lying down, elevating legs, and using elastic stockings.
Collapse
Affiliation(s)
- Gökçe Şirin
- Medicana Hospital, Cardiovascular Surgeon, İstanbul, Türkiye
| | - Selda Karaveli Cakir
- Health Sciences Faculty, Nursing Department, Kastamonu University, Kastamonu, Türkiye
| | - Sinem Eryiğit
- Acıbadem Bakırköy Hospital Cardiovascular Intensive Care Unit, Nurse, İstanbul, Türkiye
| | - Hasan Toz
- Cardiovascular Surgeon, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Osman Pirhan
- Cardiovascular Surgeon, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | | | - İlknur Çalişkan
- Nursing Department, İzmir Tınaztepe University, İzmir, Türkiye
| |
Collapse
|
6
|
Nadasy GL, Patai BB, Molnar AA, Hetthessy JR, Tokes AM, Varady Z, Dornyei G. Vicious Circle With Venous Hypertension, Irregular Flow, Pathological Venous Wall Remodeling, and Valve Destruction in Chronic Venous Disease: A Review. Angiology 2024:33197241256680. [PMID: 38839285 DOI: 10.1177/00033197241256680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Substantial advances occurred in phlebological practice in the last two decades. With the use of modern diagnostic equipment, the patients' venous hemodynamics can be examined in detail in everyday practice. Application of venous segments for arterial bypasses motivated studies on the effect of hemodynamic load on the venous wall. New animal models have been developed to study hemodynamic effects on the venous system. In vivo and in vitro studies revealed cellular phase transitions of venous endothelial, smooth muscle, and fibroblastic cells and changes in connective tissue composition, under hemodynamic load and at different locations of the chronically diseased venous system. This review is an attempt to integrate our knowledge from epidemiology, paleoanthropology and anthropology, clinical and experimental hemodynamic studies, histology, cell physiology, cell pathology, and molecular biology on the complex pathomechanism of this frequent disease. Our conclusion is that the disease is initiated by limited genetic adaptation of mankind not to bipedalism but to bipedalism in the unmoving standing or sitting position. In the course of the disease several pathologic vicious circles emerge, sustained venous hypertension inducing cellular phase transitions, chronic wall inflammation, apoptosis of cells, pathologic dilation, and valvular damage which, in turn, further aggravate the venous hypertension.
Collapse
Affiliation(s)
- Gyorgy L Nadasy
- Department of Physiology, Semmelweis University, Budapest, Hungary
| | | | - Andrea A Molnar
- Department of Cardiology, Semmelweis University, Budapest, Hungary
| | | | - Anna-Maria Tokes
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gabriella Dornyei
- Department of Morphology and Physiology, Health Science Faculty, Semmelweis University, Budapest, Hungary
| |
Collapse
|
7
|
Ngatchou W, Barche B, Temgoua M, Metouguena SE, Jutcha I, Mvondo CM, Kamdem F, Dzudie A, Ndjoh S, Johne M, Metogo J, Ndom MS, Sango J, Ngo Yon C, Moulium S, Lade V, Kuaté LM, Menanga AP, Sobngwi E, Njock R, Blazquez SB, Ngowe Ngowe M. Prevalence, clinical presentation, and risk factors of chronic venous disease in Cameroon: A general population-based study. Phlebology 2024; 39:259-266. [PMID: 38158837 DOI: 10.1177/02683555231224111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. METHODS We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. RESULTS A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). CONCLUSION Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.
Collapse
Affiliation(s)
- William Ngatchou
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Blaise Barche
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
| | - Mazou Temgoua
- Department of Cardiology, Faculty of Medicine, University of Toulouse-Rangueil, Toulouse, France
| | - Serge Erwich Metouguena
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ivan Jutcha
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Charles Mve Mvondo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Félicité Kamdem
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Douala, Cameroon
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Samuel Ndjoh
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marcel Johne
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Junette Metogo
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Marie Solange Ndom
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Joseph Sango
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Carole Ngo Yon
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sidick Moulium
- Department of Cardiology General Hospital, Douala, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Viche Lade
- Department of Cardiology General Hospital, Douala, Cameroon
| | - Liliane Mfeukeu Kuaté
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Alain Patrick Menanga
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Eugène Sobngwi
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Richard Njock
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | - Marcelin Ngowe Ngowe
- Department of Surgery and Specialities, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| |
Collapse
|
8
|
Kraus AL, Rabe E, Kowall B, Schuldt K, Bock E, Stang A, Jöckel KH, Pannier F. Differences in risk profile associated with varicose veins and chronic venous insufficiency - results from the Bonn Vein Study 1. VASA 2024; 53:145-154. [PMID: 38426384 DOI: 10.1024/0301-1526/a001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background: The aim of this publication is to demonstrate similarities and differences in the association of risk factors with the prevalence of different manifestations of chronic venous disease (CVD), like varicose veins (VV), venous oedema (C3) and severe chronic venous insufficiency (CVI) in the population-based cross-sectional Bonn Vein Study 1 (BVS). Patients and methods: In the BVS 1 between 13.11.2000 and 15.3.2002, 3.072 participants, 1350 men and 1722 women, from a simple random sample of the general population of the city of Bonn and two rural townships aged 18-79 years were included. The overall response proportion was 59%. All participants answered a standardized questionnaire including information about socio-economic data, lifestyle, physical activity, medical history, and quality of life. Venous investigations were performed clinically and by a standardized duplex examination by trained investigators. The CEAP classification in the version of 1996 was used to classify the findings. Logistic regression models were performed for the association of possible risk factors with VV, venous edema (C3) and severe CVI (C4-C6). The predictive risk (PR) describes the association of the diseases and the possible influencing factors. Results: VV, venous oedema (C3) and severe CVI (C4-C6) have common risk factors like higher age, number of pregnancies, family history of VV and overweight or obesity. Female gender is significantly associated with VV and C3 but not with severe CVI (C4-C6). High blood pressure and urban living are only associated with C3 and C4-C6 disease whereas prolonged sitting is associated with C3 and lower social class with C4-C6 exclusively. Discussion: In many epidemiological studies risk factors were associated with chronic venous disorders in general. Our data show that VV, venous edema and severe CVI may have different risk profiles. Venous edema is more often associated with arterial hypertension and sedentary lifestyle whereas lower social class seems to be a risk factor for severe CVI including venous ulcers. Conclusions: The differences in the association of risk factors to VV, venous edema and severe CVI should be considered if prevention and treatment of chronic venous diseases are planned. As examples, compression stockings could be proposed in sitting profession to prevent oedema, VV patients with risk factors like obesity might benefit from early treatment for VV and obesity. More longitudinal evaluation of risk factors is necessary to evaluate the true risk profile of CVD.
Collapse
Affiliation(s)
- Anna-Lena Kraus
- Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen Friedrich-Wilhelms-Universität Bonn, Germany
| | - Eberhard Rabe
- Klinik und Poliklinik für Dermatologie und Allergologie der Rheinischen Friedrich-Wilhelms-Universität Bonn, Germany
| | - Bernd Kowall
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Katrin Schuldt
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Eva Bock
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Andreas Stang
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Karl-Heinz Jöckel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Germany
| | - Felizitas Pannier
- Private Practice Phlebology & Dermatology, Bonn, Germany
- Klinik für Dermatologie und Venerologie, Uniklinik Köln, Cologne, Germany
| |
Collapse
|
9
|
Almutiri BM, Alshammari AM, Alharbi SB, Alamri LM, Alsuhaibani AN, Alenazi RS, Alfarhan GK. Evaluating the Prevalence and Risk Factors of Varicose Veins in Surgeons and Operating Room Staff at Buraidah Center Hospital. Cureus 2024; 16:e51706. [PMID: 38187031 PMCID: PMC10768938 DOI: 10.7759/cureus.51706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/09/2024] Open
Abstract
Background Varicose veins (VVs), which are characterized by visible, convoluted veins in the lower limbs, are a prevalent disorder that afflicts a substantial portion of the population. The purpose of this cross-sectional study was to look at the prevalence and risk factors for VVs among surgeons and operating room personnel at Buraidah Central Hospital in Saudi Arabia. They usually become worse over time once they develop, which highlights the importance of early intervention and preventive actions. Methodology Data from 91 participants were collected from diverse healthcare professionals between August 2023 and September 2023 via an online questionnaire covering demographics, health, and occupational factors. The chi-square and Fisher's exact tests were employed to examine the correlation between these variables and the occurrence of VVs. Results The data analysis revealed that several specific factors displayed notable associations. Occupations as Surgical Physicians, OR Staff, or Nurse (p=0.009), the number of days worked in the operating room (p=0.040), the role in the operating room, especially those mainly standing (p=0.001), contraceptive pill usage (p=0.000), and vaginal delivery (p=0.037) displayed statistically significant relationships with VVs. In contrast, factors like gender, age group, ethnicity, family history of VVs, social status, smoking habits, exercise frequency, BMI, lifting heavy objects, and years in the field did not reveal substantial associations with VVs, as indicated by p-values exceeding 0.05. Conclusion The study identified a low VV diagnosis prevalence, with an equal distribution among male and female respondents. Key factors that contribute to the risk of developing VVs include the number of days worked in the operating room, the role in the operating room, a family history of VVs, contraceptive pill usage, and the method of delivery.
Collapse
Affiliation(s)
| | - Ahmed M Alshammari
- General Surgery, Saudi Commission for Health Specialties, Buraidah Central Hospital, Buraidah, SAU
| | | | | | | | | | | |
Collapse
|
10
|
Béliard S, Ferreira D, Thomas H, Mourot L, Tordi N. High Physical Activity Volume Is Associated With an Increase in the Calibre of the Lower Limb Veins Without Impact on Functional Discomfort: the VARISPORT Study. Eur J Vasc Endovasc Surg 2023; 66:856-863. [PMID: 37562761 DOI: 10.1016/j.ejvs.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The relationship between physical activity and lower limb veins is complex. If a sedentary lifestyle is considered to be negative on lower limb veins, specific information on physical activity varicose vein volume is sparse, especially the effect of high physical activity volume. The main objective of the VARISPORT study was to evaluate lower limb veins (clinically, morphologically, and haemodynamically) and chronic venous disease symptoms in subjects exposed to high physical activity volume compared with a group of non-exposed subjects. METHODS A cross sectional study compared a group of high exercise training volume volunteers (more than eight hours of uninterrupted vigorous intensity physical activity per week for more than six months: high physical activity volume group, HPAV group) with a volunteer control group matched for age, sex, and body mass index. Clinical examination was performed to determine the Clinical, Etiological, Anatomical, Pathophysiological (CEAP) classification of each subject and the Carpentier score was used to assess symptoms related to possible chronic venous disease. Duplex ultrasonography was used to assess vein diameters and reflux in the deep and superficial veins. RESULTS One hundred and nineteen subjects were included in each group. The lower limb veins (deep and superficial) were significantly more dilated in the HPAV group. More reflux was found in the great saphenous veins and non-saphenous veins in the HPAV group. High physical activity volume was associated with a higher frequency of visible varicose veins (stage C2 of the CEAP classification), odds ratio 3.37 (95% confidence interval 1.66 - 7.25) without impact on functional discomfort (44 subjects with a Carpentier score ≥ 1 in each group). CONCLUSION The VARISPORT study reported an increase in the calibre of the lower limb veins without impact on functional discomfort. Further studies are needed to determine whether these athletic veins are truly pathological varicose veins or simply an adaptation to high physical activity volumes.
Collapse
Affiliation(s)
- Samuel Béliard
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France; Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France.
| | - David Ferreira
- Anaesthetics and Intensive Care Department, CHU Besançon, Besançon, France; Laboratoire de Neurosciences Intégratives et Cliniques EA 481, Université de Franche-Comté, Besançon, France
| | - Hélène Thomas
- Service Médecine Vasculaire, Centre Hospitalier Louis Pasteur, Dole, France
| | - Laurent Mourot
- EA3920 Marqueurs Pronostiques et Facteurs de Régulations des Pathologies Cardiaques et Vasculaires, Platform Exercise Performance Health Innovation (EPHI Université de Franche-Comté, Besançon, France
| | - Nicolas Tordi
- Université de Franche-Comté, PEPITE, EPSI, Besançon, France
| |
Collapse
|
11
|
Hurmerinta-Kurkijärvi O, Weselius EM, Halmesmäki K, Vikatmaa P, Vikatmaa L, Venermo M. Femoral nerve blockade during endovenous laser ablation of great saphenous vein decreases pain but does not affect the use of opioids during the procedure. J Vasc Surg Venous Lymphat Disord 2023; 11:921-927. [PMID: 37142055 DOI: 10.1016/j.jvsv.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Endovenous laser ablation (EVLA) using tumescent anesthesia for treatment of an insufficient great saphenous vein (GSV) can be painful and require intravenous pain management and, sometimes, sedation with propofol. Femoral nerve blockade (FNB) anesthetizes the femoral nerve distribution and is usually used for anterior thigh and knee procedures. It is easy to inject with ultrasound guidance because the nerve is easy to visualize in the groin. The aim of the present double-blind, randomized controlled trial was to determine whether FNB before tumescent anesthesia decreases the pain of GSV EVLA combined with local phlebectomy. METHODS Eighty patients who underwent GSV EVLA combined with local phlebectomy under tumescent anesthesia were randomized into two groups. The placebo group (control group; 40 patients) was given placebo FNB with 0.9% saline before tumescent injection. The FNB group (intervention group; 40 patients) received 1% lidocaine with adrenaline for FNB before tumescent injection. Only the study nurse, who performed the randomization, knew which patients were in which group. The patients and operating surgeon were unaware of the randomization group. FNB was performed under ultrasound guidance. The effectiveness of anesthesia was tested 10 minutes after injection using the pin-prick test and a numeric rating scale (NRS). The NRS was completed before and during tumescent anesthesia and during EVLA ablation and local phlebectomy. The motor function of the femoral nerve was tested at the end of the procedure and 1 hour after using the Bromage method. Patients had a follow-up visit 1 month after the procedure, and their need for pain medication and the duration of sick leave were recorded. RESULTS No differences were found in the gender distribution, age, or GSV dimensions at baseline. The mean length of the treated GSV segment was 28 cm and 30 cm and the mean energy used was 1911 J and 2059 J in the placebo and FNB groups, respectively. The median NRS score for pain during tumescent injection around the GSV was 2 (interquartile range [IQR], 1-4) in the placebo group compared with 1 (IQR, 1-3) in the FNB group. Very little pain was experienced during laser ablation. The median NRS score was 0 (IQR, 0-0) and 0 (IQR, 0-0.75) in the placebo and FNB groups, respectively. The most painful stage was injection of tumescence to the local phlebectomy sites in both groups. The median NRS score was 4 (IQR, 3-7) in the placebo group and 2 (IQR, 1-4) in the FNB group (P = .01). During local phlebectomy, the NRS score was 2 (IQR, 0-4) vs 1 (IQR, 0-3) in the placebo and FNB groups, respectively. Only the difference in pain during injection of tumescence before local phlebectomy was significant. CONCLUSIONS FNB seems to decrease pain during EVLA combined with local phlebectomy. Patients experienced the highest pain when tumescence was injected before local phlebectomy, and those in the FNB group experienced significantly less pain than the placebo group. No indication for routine use of FNB is indicated. However, it could be used to decrease the pain for patients who experience strong pain during varicose vein surgery, especially if extensive local phlebectomies are required.
Collapse
Affiliation(s)
| | - Eeva-Maija Weselius
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Karoliina Halmesmäki
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Leena Vikatmaa
- Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
12
|
Zil-E-Ali A, DeHaven C, Alamarie B, Paracha AW, Aziz F. Black or African American patients undergo great saphenous vein ablation procedures for advanced venous disease and have the least improvement in their symptoms after these procedures. J Vasc Surg Venous Lymphat Disord 2023; 11:904-912.e1. [PMID: 37343786 DOI: 10.1016/j.jvsv.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Chronic venous insufficiency is an increasingly prevalent problem in the United States, with >25 million individuals currently affected. Previous work has shown that racial minorities and low socioeconomic status are associated with a worse clinical presentation and response to treatment. The present study aimed to determine the relationship between race, patient variables, hospital outcomes, and response to treatment for patients presenting for chronic venous insufficiency intervention. METHODS We performed a retrospective analysis of all patients who underwent endovenous ablation (radiofrequency or laser) of the great saphenous vein to treat symptomatic, chronic venous insufficiency using Vascular Quality Initiative data from 2014 to 2020. Patient characteristics and outcomes were analyzed stratified by patient race. The χ2 test and the Kruskal-Wallis equality-of-populations rank test were used to measure the study outcomes. The primary outcomes were an improved venous clinical severity score and improvement in patient-reported outcomes. Patient characteristics, CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, prior venous interventions, length of stay, and time to follow-up were compared between races. RESULTS The database consisted of 9009 predominantly female patients (n = 6041; 67.1%), with a mean age distribution of 56 years. Of the 9009 patients, 7892 are White (87.6%), 627 Hispanic (6.9%), and 490 Black or African American (18.3%). The Hispanic cohort was younger than their White and Black/African American counterparts. Black/African American patients presented with more advanced clinical stages than did the White and Hispanic groups. The clinical stage according to race was as follows: C3-Black/African American, 32.9%; Hispanic, 38.9%; White, 46%; C5-Black/African American, 4.7%; Hispanic, 2.1%; White, 2.3%; and C6-Black/African American, 12.7%; Hispanic, 3.2%; White, 6.2%. Black/African American patients were more likely to present as overweight or obese (66%; P < .001) and less likely to be taking anticoagulation medication preoperatively (11%; P < .001). Non-White race was associated with a higher probability of treatment in the hospital setting (Black/African American, 63.6%; Hispanic, 87.5%; P < .001). Black/African American patients (3.25 ± 4.4; P < .001) demonstrated lower mean improvement postoperatively in both the venous clinical severity score and patient-reported outcomes than their White (4.25 ± 4.13, P <.001) and Hispanic (4.42 ± 3.78; P < .001) counterparts. CONCLUSIONS Differences exist in the clinical severity and symptom presentation based on race. Black/African American patients present with more advanced chronic venous insufficiency than do their White and Hispanic counterparts. Furthermore, the postprocedural analysis showed inferior clinical and self-reported improvement in chronic venous insufficiency for the Black/African American patients. Although the Hispanic population was younger, the White and Hispanic patients experienced similar responses to treatment.
Collapse
Affiliation(s)
- Ahsan Zil-E-Ali
- Division of Vascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | | | - Billal Alamarie
- Office of Medical Education, Pennsylvania State University, Hershey, PA
| | | | - Faisal Aziz
- Division of Vascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| |
Collapse
|
13
|
Chen IC, Huang YL, Kang YN, Chiu WK, Wang HJ, Chen C. Endovascular Occlusive or Sclerosing Agent Monotherapy for Varicose Veins: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Angiology 2023:33197231199027. [PMID: 37649310 DOI: 10.1177/00033197231199027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
This systematic review and network meta-analysis investigated the clinical efficacy and safety of chemical agent injections in patients with varicose veins. PubMed, Embase, and Cochrane databases were searched for eligible studies where patients administered endovascular agents comprised an intervention group, and patients administered other interventions comprised the comparison group. The endovascular agents included foam and liquid form sclerotherapy or cyanoacrylate glue. The other interventions in this study included surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and placebo. A network meta-analysis for treatment effectiveness was performed. In addition, we illustrated the P-score lines of success rate and complication rate sorted by the P-score. Our results showed that at all postprocedural time intervals, cyanoacrylate glue therapy exhibited a significantly higher success rate compared with foam and liquid sclerotherapy. According to the plot of P-score lines, cyanoacrylate glue had an overall tendency of higher success rate and lower complication rate compared with foam and liquid sclerotherapy. Comparing with the other invasive treatments, cyanoacrylate glue may be non-inferior and could be considered as an option for treating varicose veins. However, the clinical benefits and safety of endovascular agents for the treatment of varicose veins require further corroboration through randomized control trials.
Collapse
Affiliation(s)
- I-Chun Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Taiwan
| | - Ya-Li Huang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Evidence-Based Medicine Center, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuan Chiu
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taipei, Taiwan
| | - Hsian-Jenn Wang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
14
|
Mirakhmedova S, Amirkhanov A, Seliverstov E, Efremova O, Zolotukhin I. Daily Duration of Compression Treatment in Chronic Venous Disease Patients: A Systematic Review. J Pers Med 2023; 13:1316. [PMID: 37763085 PMCID: PMC10533179 DOI: 10.3390/jpm13091316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Background: There are no data on the daily regimen of compression therapy in patients with chronic venous disease. This systematic review aimed to establish the optimal daily duration of compression treatment. Methods: A systematic search of CENTRAL and MEDLINE was performed to identify RCTs, non-RCTs, reviews, systematic reviews, meta-analyses, and guidelines evaluating the use of compression regimens in the treatment of varicose veins. Results: Thirty-two RCTs, three non-RCTs, four observational studies, and two crossover trials reporting the duration and regimes of compression treatment fulfilled the inclusion criteria. The daily duration of compression was reported in patients after invasive treatment, for venous ulcer treatment, in patients with venous symptoms. The quality of the studies varied. We could not conduct a meta-analysis due to the heterogeneity of the research data and their quality. Twenty-three studies reported results of compression usage after invasive procedures. Eight studies reported daily duration regimens in patients with venous ulcers. Nine studies reported the impact of compression on venous symptoms and/or edema or limb volume change. One study was conducted to assess if compression improves QoL in venous patients. While there was a clear difference found in the daily duration depending on the clinical scenario, no data in support of exact regimens were found. Conclusions: There are no reliable data supporting exact daily regimens of compression treatment in various cohorts of CVD patients.
Collapse
Affiliation(s)
| | | | | | | | - Igor Zolotukhin
- Department of Surgery, Pirogov Russian National Research Medical University, Moscow 117997, Russia; (S.M.); (A.A.); (E.S.); (O.E.)
| |
Collapse
|
15
|
Jarošíková R, Roztočil K, Husáková J, Dubský M, Bém R, Wosková V, Fejfarová V. Chronic Venous Disease and Its Intersections With Diabetes Mellitus. Physiol Res 2023; 72:280-286. [PMID: 37449742 PMCID: PMC10668996 DOI: 10.33549/physiolres.935033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/28/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic venous disease (CVD) is a vascular disorder in which blood return is severely compromised and CVD is usually characterized by venous hypertension. Along with obesity and diabetes mellitus, CVD is one of the most common civilization diseases. In general, the estimated prevalence of CVD ranges from 60-80 %. Early diagnosis and adequate treatment are important for preventing progression to more severe stages of the disease like venous leg ulcers. Clinical manifestations of CVD in initial stages of the disease are often asymptomatic. However, as CVD progresses, symptoms begin to develop. Treatment of CVD could be divided into conservative and surgical. Conservative therapy consists of compression, pharmacological treatment and lifestyle change. In cases where conservative therapy is ineffective, surgical or endovascular treatment may be required. The intersections between diabetes mellitus (DM) and CVD are not to be underestimated. CVD and DM have often the same risk factors. Symptoms of CVD can be modified by late complications of DM, but the incidence of different CVD degrees seems to be the same as in diabetics as in non-diabetics population. We are particularly concerned in diabetics about worse compliance with treatment due to their often-poorer adherence to treatment of DM and lifestyle changes. Moreover, there exist a higher risk of CVD and peripheral arterial disease in diabetics patients. Patients with CVD should always be inspected for the presence of DM, considering its presence can have a bearing on CVD symptoms, diagnostic procedures, and therapeutic strategies.
Collapse
Affiliation(s)
- R Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Praha 4, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
16
|
Langan EA, Wienandt M, Bayer A, Ellebrecht L, Kahle B. Effect of obesity on venous blood flow in the lower limbs. J Dtsch Dermatol Ges 2023. [PMID: 37190846 DOI: 10.1111/ddg.15062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/19/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Although obesity is a recognized risk factor for the development of lower limb venous disease, less attention has been paid to objectively measuring the effect of centripetal obesity on blood flow in the lower limbs. PATIENTS AND METHODS The diameter of lower limb veins and venous blood flow were measured in 44 patients (65.6 ± 12.5 years, 25 females, 19 males) with centripetal obesity and chronic venous disease. RESULTS The mean diameter of both common femoral veins (CFV) increased significantly in the semi-supine position following elevation of the panniculus (right: ∆0.73 ± 1.21 mm; p ≤ 0.001, left: ∆1.16 ± 1.42 mm; p ≤ 0.001). Moreover, there was a significant increase in venous flow volume in the left CFV (∆62.96 ± 117.85 ml/min; p = 0.001). Similarly, there was an increase in the diameter of left great saphenous vein (∆0.24 ± 0.41 mm; p = 0.002), measured at the mid-thigh, when the patient lifted their abdominal panniculus. Finally, the grade of obesity correlated with the extent of the venous disease. CONCLUSIONS These data provide preliminary evidence that centripetal obesity results in both structural and hemodynamic changes in the lower limb veins, even in the absence of classical reflux.
Collapse
Affiliation(s)
- Ewan A Langan
- Professor Birgit Kahle 1, Department of Dermatology, University Clinic Schleswig-Holstein, Luebeck, Germany
- Dermatological Sciences, University of Manchester, Manchester, United Kingdom
| | - Malte Wienandt
- Professor Birgit Kahle 1, Department of Dermatology, University Clinic Schleswig-Holstein, Luebeck, Germany
| | - Andreas Bayer
- Institute for Anatomy, University of Kiel, Kiel, Germany
| | - Lena Ellebrecht
- Professor Birgit Kahle 1, Department of Dermatology, University Clinic Schleswig-Holstein, Luebeck, Germany
| | - Birgit Kahle
- Professor Birgit Kahle 1, Department of Dermatology, University Clinic Schleswig-Holstein, Luebeck, Germany
| |
Collapse
|
17
|
Klein A, Ennis W, Fukaya E. Characteristics of venous leg ulcer patients at a tertiary wound care center. J Vasc Surg Venous Lymphat Disord 2023; 11:270-279.e1. [PMID: 36410701 DOI: 10.1016/j.jvsv.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to assess patient, wound, care, and reflux characteristics of venous leg ulcers (VLUs) to update and improve knowledge of disease etiology, identify barriers to healing, and improve treatment. METHODS Patients diagnosed with VLUs treated at the Stanford Advanced Wound Care Center between 2018 and 2019 were identified from the Healogics iHeal database. We identified 327 VLU entries, of which 133 were patients who had multiple or recurring wounds. An additional 27 patients were labeled as misdiagnosis, resulting in a final patient sample of 167. Patient demographics, wound, care, and ultrasound data for these patients were extracted from the Stanford electronic medical records regarding characteristics. The initial data analysis suggested possible differences in VLU characteristics depending on patient age and body mass index (BMI), which was then further analyzed. RESULTS Of the 167 VLU patients assessed, 53.9% were male and 46.1% were female. The mean age was 74.7 years, and the average BMI was 30.2 kg/m2, including 41.1% of patients with a BMI over 30 kg/m2. Approximately 50% of wounds were presented in multiples, had cellulitis, or were recurring, and 39.5% were caused by trauma. Most common venous reflux patterns on duplex ultrasound examination were below-knee great saphenous vein reflux and calf perforator reflux, which was identified in 37.7% and 29.3% of the patients, respectively. Axial great saphenous vein reflux was detected in 14.4% of patients. When looking at the patient sample under 60 years of age, 67.7% were male, 61.3% presented with venous skin changes, and 51.6% had diabetes. In the patients older than 60, only 51.9% were male, 37.6% presented with venous skin changes, and 31.6% had diabetes. BMI was greater in the patients under age 60, with an average of 39.2 kg/m2, compared with 28.2 kg/m2 in those above 60. Of the patients with a BMI ≥30 kg/m2, 64.3% had multiple wounds, 61.4% had recurring wounds, and 56.5% had venous skin changes. In contrast, in patients with BMI <30 kg/m2, 47.4% had multiple wounds, 39.2% had recurring wounds, and 32.0% had venous skin changes. CONCLUSIONS VLU pathology appears to differ depending on patient demographics and characteristics. Different drivers may influence disease cause, progression, and prognosis, making a standard approach to VLUs difficult. Our findings suggest that identifying different subtypes of VLUs and adapting an algorithm of care with a personalized treatment may help optimize management of these patients.
Collapse
Affiliation(s)
- Alyssa Klein
- Division of Vascular Surgery, Stanford University, Palo Alto, CA
| | - William Ennis
- Section of Wound Healing & Tissue Repair, University of Illinois, Chicago, IL
| | - Eri Fukaya
- Division of Vascular Surgery, Stanford University, Palo Alto, CA.
| |
Collapse
|
18
|
Andercou O, Stancu B, Coman HF, Cucuruz B, Noppeney T, Marian D. Radiofrequency Thermal Ablation for the Treatment of Chronic Insufficiency of the Saphenous Vein-A Comparative Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3308. [PMID: 36834003 PMCID: PMC9964993 DOI: 10.3390/ijerph20043308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The broad spectrum of chronic venous disease encompasses varicose veins, edema, hyperpigmentation and venous ulcers. Radiofrequency thermal ablation is indicated for the treatment of superficial venous reflux of the lower limb. Our research is a comparative clinical study that aims to identify the most effective and safest therapeutic method in the management of chronic venous insufficiency of the lower limbs. MATERIALS AND METHODS Patients admitted to the Department of Surgery of the University of Medicine and Pharmacy in Cluj-Napoca, Romania, with the clinical diagnosis of varicose veins of the lower limbs, treated by thermal ablation with radiofrequency or by open surgical techniques during the year 2022, were included. RESULTS A percentage of 50.9% of the patients were treated by the radiofrequency thermal ablation procedure and 49.1% by surgical treatment. More than half of them were hospitalized for 2 days. The duration of hospitalization was significantly longer in patients who had postoperative complications (p < 0.001). The chance of being treated by open surgical treatment for a small saphenous vein is 10.11 times higher than by radiofrequency thermal ablation. CONCLUSION According to the applied tests, there is no statistical difference between the group treated by radiofrequency thermal ablation and the one surgically treated in terms of sex, age, origin, CEAP clinical stage at hospitalization, clinical diagnosis at hospitalization and affected lower limb.
Collapse
Affiliation(s)
- Octavian Andercou
- Department of Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, Romania
| | - Bogdan Stancu
- Department of Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, Romania
| | - Horațiu Flaviu Coman
- Department of Vascular Surgery, County Emergency Hospital, 400347 Cluj-Napoca, Romania
| | - Beatrix Cucuruz
- Department of Vascular Surgery, Martha Maria Hospital Nuremberg, 90491 Nuremberg, Germany
| | - Thomas Noppeney
- Department of Vascular and Endovascular Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Dorin Marian
- Department of Surgery, University of Medicine and Pharmacy “George Palade”, 540142 Targu Mures, Romania
| |
Collapse
|
19
|
Kokkinidis DG, Ochoa Chaar CI, Mena-Hurtado CI, Attaran RR. Correlation between reflux time and venous clinical severity score in patients undergoing saphenous vein ablation: A prospective study. Phlebology 2023; 38:62-66. [PMID: 36524895 DOI: 10.1177/02683555221146730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES It is unclear whether reflux time independently correlates with severity of symptoms in patients with great saphenous vein reflux. METHODS Eighty patients (mean age 64+/-12.7 years, 56% female) undergoing great saphenous vein (GSV) ablation for symptomatic reflux were assessed prospectively. Fifty-seven underwent ablation with radiofrequency, 23 with cyanoacrylate adhesive. Venous clinical severity score (VCSS) was assessed at, or prior to the time of ablation. The highest reflux time in the GSV was selected. RESULTS VCSS values ranged from 2 to 20 (median 7). Mean reflux time was 5.3 s (+/-3.3). The Spearman rank correlation yielded a value of rs = -0.123, p (2-tailed) = .279, which was not significant. The patients with concomitant deep vein reflux had higher VCSS (p < .05). Analysis of patients with only superficial vein reflux (n = 45) also demonstrated a poor correlation between VCSS and reflux time (rs = -0.051, p (2-tailed) = .741). CONCLUSION This prospective study did not demonstrate a correlation between reflux time and VCSS.
Collapse
Affiliation(s)
| | - Cassius I Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, 5755Yale University, New Haven, CT, USA
| | - Carlos I Mena-Hurtado
- Vascular Medicine Outcomes Program, Department of Internal Medicine, Section of Cardiovascular Medicine, 5755Yale University, New Haven, CT, USA
| | - Robert R Attaran
- Section of Cardiovascular Medicine, 5755Yale University, New Haven, CT, USA
| |
Collapse
|
20
|
da Silva MFA, Louzada ACS, Teivelis MP, Leiderman DBD, Portugal MFC, Stabellini N, Amaro E, Wolosker N. Varicose Vein Stripping in 66,577 patients in 11 years in public hospitals in São Paulo. Rev Assoc Med Bras (1992) 2022; 68:1657-1662. [PMID: 36449789 PMCID: PMC9779958 DOI: 10.1590/1806-9282.20220565] [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: 08/07/2022] [Accepted: 08/25/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, São Paulo. METHODS Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of São Paulo, Brazil. RESULTS Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in São Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure. CONCLUSION Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).
Collapse
Affiliation(s)
| | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein – São Paulo (SP), Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, School of Medicine – São Paulo (SP), Brasil
| | | | | | - Nickolas Stabellini
- Faculdade Israelita de Ciências da Saúde Albert Einstein, School of Medicine – São Paulo (SP), Brasil
| | - Edson Amaro
- Hospital Israelita Albert Einstein – São Paulo (SP), Brasil.,Univerisdade de São Paulo, Medical School – São Paulo (SP), Brasil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein – São Paulo (SP), Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein, School of Medicine – São Paulo (SP), Brasil.,Univerisdade de São Paulo, Medical School – São Paulo (SP), Brasil
| |
Collapse
|
21
|
Thibert A, Briche N, Vernizeau BD, Mougin-Guillaume F, Béliard S. Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1385-1400. [PMID: 35810994 DOI: 10.1016/j.jvsv.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/04/2022] [Accepted: 05/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic venous disease (CVD), comprising impaired lower limb venous return, will lead to chronic distal venous pressure overload manifested by various clinical signs and symptoms and resulting in diminished quality of life. The CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification of CVD distinguishes six stages (C0-C6) using clinical, etiologic, anatomic, and pathophysiologic parameters. In the present study, we analyzed the effects of adapted physical activity (APA) and patient-oriented therapeutic education (PTE) programs on the clinical signs, symptoms, and quality of life of patients with CVD. METHODS Our analysis, in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations, included a search of PubMed, CINAHL and LiSSa databases, using a single search equation. RESULTS A total of 21 studies were selected for analysis. The analysis revealed first, that patients at stage C0 to C5 had had access to an APA program. This therapy alleviated the clinical signs and symptoms and improved the patients' quality of life. The beneficial effects of APA were greater in the programs that had included aquatic activities than in the program that were exclusively dry-land programs. Second, patients at stage C6 had predominantly followed a PTE program. This therapy showed beneficial effects on the clinical signs and symptoms. However, the quality of life had rarely been assessed. CONCLUSIONS At present, APA and PTE programs comprise useful and complementary therapeutic options for the care of patients with CVD. Two of the studies included in our review had evaluated the effects of combining these two approaches, notably in the context of balneotherapy, and reported promising results.
Collapse
Affiliation(s)
- Axelle Thibert
- Independent Adapted Physical Activity Teacher, Dole, France; Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | - Nicolas Briche
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France
| | | | - Fabienne Mougin-Guillaume
- EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France
| | - Samuel Béliard
- Functional Unit of Vascular Medicine, Hospital Centre Louis-Pasteur, Dole, France; EA3920, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, CHRU Jean Minjoz, Besançon, France; PEPITE EA4267, Platform Exercise Performance Health Innovation, University of Bourgogne Franche-Comté, Besançon, France.
| | | |
Collapse
|
22
|
Mok Y, Ishigami J, Sang Y, Kucharska-Newton AM, Salameh M, Schrack JA, Palta P, Coresh J, Windham BG, Lutsey PL, Folsom AR, Matsushita K. Clinically Recognized Varicose Veins and Physical Function in Older Individuals: The ARIC Study. J Gerontol A Biol Sci Med Sci 2022; 77:1637-1643. [PMID: 34606610 PMCID: PMC9373961 DOI: 10.1093/gerona/glab287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although a few studies reported an association between varicose veins and physical function, this potentially bidirectional association has not been systematically evaluated in the general population. METHOD In 5 580 participants (aged 71-90 years) from the Atherosclerosis Risk in Communities study, varicose veins were identified in outpatient and inpatient administrative data prior to (prevalent cases) and after (incident cases) visit 5 (2011-2013). Physical function was evaluated by the Short Physical Performance Battery (SPPB, score ranging from 0 to 12). We evaluated (i) cross-sectional association between prevalent varicose veins and physical function, (ii) association of prevalent varicose veins with subsequent changes in physical function from visit 5 to visits 6 (2016-2017) and 7 (2018-2019), and (iii) association of physical function at visit 5 with incident varicose veins during a median follow-up of 3.6 years (105 incident varicose veins among 5 350 participants without prevalent cases at baseline). RESULTS At baseline, varicose veins were recognized in 230 (4.1%) participants and cross-sectionally associated with reduced physical function. Longitudinally, prevalent varicose veins were not significantly associated with a decline in SPPB over time. In contrast, a low SPPB ≤6 was associated with a greater incidence of varicose veins compared to SPPB ≥10 (adjusted hazard ratio 2.13 [95% confidence interval = 1.19, 3.81]). CONCLUSION In community-dwelling older adults, varicose veins and low physical function were associated cross-sectionally. Longitudinally, low physical function was a risk factor for incident varicose veins, but not vice versa. Our findings suggest an etiological contribution of low physical function to incident varicose veins.
Collapse
Affiliation(s)
- Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, ,North Carolina, USA
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Maya Salameh
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| | - B Gwen Windham
- Department of Medicine, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, ,Baltimore, Maryland, USA
| |
Collapse
|
23
|
Rusinovich Y, Rusinovich V. Earth’s gravity field and prevalence of varicose veins and chronic venous disease: Systematic review. Phlebology 2022; 37:486-495. [DOI: 10.1177/02683555221090054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim This study examines the influence of Earth’s gravity field on the prevalence of varicose veins in geophysical area. Material and Methods We performed a systematic review (OVID and Google Scholar) of studies focusing on prevalence of varicose veins to determine the influence of Earth’s gravity field—GRACE GGM05S gravity model—on the disease prevalence. PROSPERO: CRD42021279513. Results 81 studies met inclusion and quality criteria. Areas with stronger gravity have significantly higher prevalence of varicose veins with adjustment for age, gender and body mass index (BMI) ( p-values < 0.02). Adjusted for age, prevalence of varicose veins in areas with gravity field +20 mGal and more is 1.37 time higher than in areas with gravity field less than +20 mGal, p-value 0.005 (95% CI: −12.5 to −2.4): mean disease prevalence for gravity field +20 mGal and more—27.5% (mean age, 40.1 years; mean gravity field, +27.1 mGal; 63.9% females, 37 studies, 123,164 participants) vs mean disease prevalence for gravity field less than +20 mGal – 20.1% (mean age, 42.2 years; mean gravity field, +5.7 mGal; 56.8% females, 44 studies, 205,925 participants). Older age is the main risk factor for varicose veins ( p-values < 0.005). Female gender and high BMI are insignificantly associated with high prevalence of varicose veins ( p-values > 0.4 for gender, p-values > 0.2 for BMI). Conclusion Stronger gravity field is significantly associated with higher prevalence of varicose veins—risk factor. The potential mechanism of this phenomenon is that high gravity field alters systemic venous return, pooling blood and fluid in the peripheral, gravity-dependent regions of the body in upright humans constantly living in the defined geophysical area.
Collapse
Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Volha Rusinovich
- Institute of Hygiene and Environmental Medicine, University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
24
|
Espeit L, Rimaud D, Le Mat F, Cudel C, Micol I, Bertoletti L, Chaigneau C, Millet GY, Lapole T. Fatigue, physical activity and quality of life in people self-reporting symptoms of chronic venous disease. J Vasc Surg Venous Lymphat Disord 2022; 10:1147-1154.e1. [PMID: 35714904 DOI: 10.1016/j.jvsv.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to quantify fatigue and quality of life (QoL) in people self-reporting chronic venous disease (CVD) symptoms or at risk of CVD within a large cohort representative of the French population. The relationship between self-reported physical activity and both fatigue and QoL was also investigated. We hypothesised that a greater fatigue and impaired QoL would exist in participants self-reporting CVD symptoms, with the impairments being attenuated in those with greater level of physical activity. METHODS Using a web-based, custom and adaptive survey, 3,008 participants were asked to self-report the presence of common symptoms and risk factors of CVD. Fatigue, QoL and physical activity were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-14) and the Godin-Shepard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), respectively. RESULTS 32% of the participants were categorized as having CVD symptoms whereas 50% were categorized as at risk of CVD. Fatigue was greater in participants with CVD symptoms than non-CVD participants (p < 0.001), with the score of participants at risk of CVD being intermediate (p ≤ 0.001). QoL was more impaired in participants with CVD symptoms compared to participants at risk of CVD (p < 0.001). In participants with CVD symptoms, there were relationships between fatigue and QoL (p < 0.001) and between physical activity and fatigue (p < 0.001). Despite the relationship between physical activity and QoL not reaching significance (p = 0.067), a lower QoL was found in insufficiently active as compared to active (p < 0.001) and moderately active (p < 0.001) participants with CVD symptoms. CONCLUSIONS Participants self-reporting CVD symptoms suffer from greater fatigue and impaired QoL. In this population, a higher level of physical activity is associated with reduced fatigue and a tendency toward improved QoL.
Collapse
Affiliation(s)
- Loïc Espeit
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Diana Rimaud
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Franck Le Mat
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France
| | - Claire Cudel
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Isabelle Micol
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, CHU Saint-Etienne, Saint-Etienne, France; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, SAINBIOSE, UJM Saint-Etienne, F-42055, Saint-Etienne, France; INSERM, CIC1408, CHU Saint-Etienne, F-42055, Saint-Etienne, France
| | - Cyril Chaigneau
- SIGVARIS SAS, Z.I. Sud d'Andrézieux Rue Barthélémy Thimonnier, 42170 St-Just St-Rambert Cedex, France
| | - Guillaume Y Millet
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France; Institut Universitaire de France (IUF)
| | - Thomas Lapole
- Université de Lyon, UJM-Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, F-42023, Saint-Etienne, France.
| |
Collapse
|
25
|
Ali SA, Najmi WK, Hakami FM, Almubarak AA, Alhassan RA, Maafa SH, Al-Amer MA, Dighriri IM. Prevalence of Varicose Veins Among Nurses in Different Departments in Jazan Public Hospitals, Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e24462. [PMID: 35637826 PMCID: PMC9131706 DOI: 10.7759/cureus.24462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
Varicose veins (VV) in the lower limbs are the most prevalent vascular condition in humans. They can cause significant signs and symptoms and, in extreme cases, death. This study aims to investigate the prevalence and identify the risk factors for varicose veins among nurses working in multiple departments at Jazan King Fahd Central Hospital and Prince Muhammad bin Nasser Hospital. A cross-sectional study was conducted by sending a questionnaire to female and male nurses in these hospitals. This study included 482 nurses, 415 (86.1%) of whom were female and 67 (13.9%) male. The prevalence of varicose veins among the nurses of both hospitals was 76 (15.8%), compared with 406 (84.2%) not diagnosed with varicose veins. The prevalence of varicose veins was 67 (88.2%) in female nurses, compared with 9 (11.8%) in male nurses. The risk factors associated with varicose veins were ethnicity (p = 0.007), carrying heavy items (p = 0.001), lack of exercise (p = 0.031), family history (p = 0.001), use of hormonal therapy (p = 0.001), use of contraceptive pills (p = 0.0035), type of delivery (p = 0.002), number of children (p = 0.004), and hours sitting per shift (p = 0.002). The comorbidities associated with varicose veins were deep vein thrombosis (p = 0.001), hypertension (p = 0.002), chronic constipation (p = 0.006), diabetes (p = 0.001), kidney disease (p = 0.001), rheumatoid arthritis (p = 0.001), coronary artery disease, and severe occupational injury to the lower extremities (p = 0.001). Nurses are responsible for most of the health system's services. Increasing the number of nursing workers for patient care, encouraging physical exercise, and lowering the pension age appear to be required to avoid the occurrence and development of varicose veins among nurses.
Collapse
Affiliation(s)
- Suhaila A Ali
- Family and Community Medicine Department, Jazan University, Jazan, SAU
| | - Waad K Najmi
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Shahad H Maafa
- Medicine, College of Medicine, Jazan University, Jazan, SAU
| | | | | |
Collapse
|
26
|
Juré J, Vuylsteke ME. Management of chronic venous disease in general practice: a cross-sectional study of first line care in Belgium. INT ANGIOL 2022; 41:232-239. [PMID: 35179342 DOI: 10.23736/s0392-9590.22.04774-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this observational study is to examine how general practitioners (GP) in Belgium treat patients with Chronic Venous Disease (CVD). METHODS This cross-sectional study was carried out in Belgium by GPs who recruited 15 consecutive patients who were consulting them and suffered from CVD. By following a standardized questionnaire, they collected information on patient characteristics, risk factors, signs and symptoms, and how they were being managed. RESULTS 253 GPs recruited 3055 patients, who were predominantly female (75.6%), with a mean age of 62.7 (SD 14.6). 20.1% of the population suffered from CVD without clinical signs (C0s). 8.7% of the population had advanced disease (C5-C6). Most common symptoms were respectively 'heavy legs' (43,7%), 'swollen feeling' (28%) and 'pain' (24,1%). The primary care physicians decided 95.3% of patients needed therapy of some sort. The most used treatment option used in 83.3% of subjects was the use of venoactive medication. Lifestyle advice was recommended in 64.5% of patients and recommendations regarding compression stockings was given in 46.9% of patients. Referral to a specialist was warranted for 24.5% of the population. Patients with a lower C-classification were more often treated conservatively compared to those with a higher C-classification. CONCLUSIONS Most patients were treated conservatively, which includes lifestyle changes, medication, and compression. Only one in four patients is referred to a vascular specialist and this referral is significantly positively correlated with the C-classification.
Collapse
Affiliation(s)
- Jochen Juré
- Department of Vascular Surgery, Sint-Andriesziekenhuis, Tielt, Belgium -
| | - Marc E Vuylsteke
- Department of Vascular Surgery, Sint-Andriesziekenhuis, Tielt, Belgium
| |
Collapse
|
27
|
Galeandro AI, Galeandro C, Scicchitano P, Clima R, Ritacco IA, Dellisanti Fabiano Vilardi M, Di Ponzio E, Annichiarico A, Ciciarello F, Contursi V, Wegierska AE, Ciccone MM. The Application of MEVEC 3D Doppler Ultrasound Technique for a New Classification of Morpho-Functional Phenotypes in Lower Limbs Venous Diseases. Vasc Health Risk Manag 2022; 18:81-87. [PMID: 35250272 PMCID: PMC8892712 DOI: 10.2147/vhrm.s333507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction MEVEC 2.1 is a novel 3D mapping software dedicated to the evaluation of the venous vascular three of the lower limbs. It has already proven as a sensitive, specific, and accurate technique able to provide better morphologic and functional details of the lower limb venous system than standard reports. The aim of this study was to identify specific morpho-functional graphic phenotypes in lower limb venous diseases by means of MEVEC 2.1. Materials Three-hundred eleven consecutive outpatients underwent lower limb Doppler ultrasound examination by means of the MEVEC 2.1 technique. All of them showed at least one among these pathological findings: venous insufficiency, thrombosis, incompressibility, and/or incompetent. Results We tried to evaluate possible clusters among the different morpho-functional findings from the venous maps in order to outline reproducible phenotypes. Correlation indexes allowed us to provide a classification in morpho-functional phenotypes in order to standardize the data from examinations performed by different physicians. Twelve phenotypes had been proposed. Conclusion The study showed that the MEVEC 2.1 technique provides a standardized classification that allows physicians identifying phenotypes yielded by 3D mapping of the veins of the lower limbs.
Collapse
Affiliation(s)
- Aldo Innocente Galeandro
- Unit of Technological Medical Research of the Parco Scientifico-Tecnologico, University of Bari “A. Moro”, Bari, Italy
| | - Cristina Galeandro
- Section of Vascular Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Pietro Scicchitano
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- Correspondence: Pietro Scicchitano, Section of Cardiovascular Diseases, Cardio-Thoracic Department, University of Bari “A. Moro”, Piazza G. Cesare, Bari, 11 – 70124, Italy, Email ;
| | - Rosanna Clima
- BROWSer S.r.l. - Bioinformatics Resource for Omics Wide Services, Dipartimento di Bioscienze, Biotecnologie e Biofarmaceutica, University of Bari “A. Moro”, Bari, Italy
| | - Ilenia Annunziata Ritacco
- Section of Cardiac Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Egidio Di Ponzio
- Unit of Technological Medical Research of the Parco Scientifico-Tecnologico, University of Bari “A. Moro”, Bari, Italy
| | - Annamaria Annichiarico
- Unit of Technological Medical Research of the Parco Scientifico-Tecnologico, University of Bari “A. Moro”, Bari, Italy
| | - Francesco Ciciarello
- Department of Cardiovascular, Respiratory, Geriatric and Morphologic Sciences of “Umberto I” Polyclinic of Rome, “Sapienza” University, Rome, Italy
| | | | - Angelika Elzbieta Wegierska
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| |
Collapse
|
28
|
Carpentier PH, Satger B, Sandrin B. Patient Education in Spa Resorts: Experience from a French National Program for Patients with Chronic Venous Insufficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031176. [PMID: 35162199 PMCID: PMC8834367 DOI: 10.3390/ijerph19031176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
The prognosis of chronic venous insufficiency (CVI) is greatly depending upon the ability of the patients to optimize their health-related behaviors (mainly compliance to compression stockings, physical activity and diet). As this is usually challenging for the patients, we developed a therapeutic education program (TEP) aiming at helping them to achieve these optimizations. We report here the preliminary results obtained with this program. This structured TEP was developed by a working group of 15 health professionals to be used during the regular French spa 3-week treatment course for CVI patients. The program included three interactive workshops aiming at improving the patients’ knowledge, skills and motivation, two educational consultations allowing to set and follow-up their personal action plans and a built-in evaluation. It was implemented in spa resorts specialized in CVI. Among the first 150 patients (116 women and 34 men, mean age 69 years old (SD 8 years), 49% had post-thrombotic disease. Compliance to the education workshops was 98%. After a 3-month follow-up, 83% of the patients fully achieved at least one behavioral objective. Quality of life, as assessed by the CIVIQ 2 auto-questionnaire, improved at 3 months (p = 0.0024) and 9 months (p = 0.018). These results demonstrate the feasibility of a TEP for CVI patients and its ability to improve their health-related behaviors, opening the way for the development of similar programs for other chronic diseases in the setting of spa resorts.
Collapse
Affiliation(s)
- Patrick H. Carpentier
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
- Correspondence: ; Tel.: +33-4-7922-6265
| | - Bernadette Satger
- Centre de Recherche Universitaire de La Léchère, Université Grenoble-Alpes, 73260 La Léchère, France;
| | - Brigitte Sandrin
- Association Française pour le Développement de l’Education Thérapeutique 18, Passage de la Bonne Graine, 75011 Paris, France;
| |
Collapse
|
29
|
OUP accepted manuscript. Br J Surg 2022; 109:679-685. [DOI: 10.1093/bjs/znac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
|
30
|
Saliba-Júnior OA, Rollo HA, Saliba O, Sobreira ML. Percepção positiva e eficácia das meias de compressão na prevenção de edema em membros inferiores de gestantes. J Vasc Bras 2022; 21:e20210101. [PMID: 35399341 PMCID: PMC8958436 DOI: 10.1590/1677-5449.210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pregnancy is characterized by physiological changes that can contribute to development of varicose veins, venous insufficiency, and leg edema. Objectives To evaluate the effect of compression stocking on lower limb edema in pregnant women and their perceptions of wearing them. Methods This was a randomized, controlled, prospective, parallel, blinded clinical trial conducted with 60 pregnant women randomly distributed into two groups: an intervention group (n = 30) wearing compression stockings and a control group (n = 30). Standardized ankle and calf measurements were taken of all 120 lower limbs using a tape measure. At the end of the study, a questionnaire was administered to identify perceived difficulties and advantages related to wearing compression stockings. Results Pregnant women in the intervention group had a significantly smaller increase (p < 0.05) in calf and ankle diameters compared to those in the control group. The mean differences from the beginning to the end of gestation in the diameters of the right calf, left calf, right ankle, and left ankle respectively were 0.30 cm, 0.30 cm, 0.15, cm and 0.15 cm in the intervention group and 1.95 cm, 1.95 cm, 1.73 cm, and 1.87 cm in the control group. Most of the pregnant women had no difficulty wearing the compression stockings and all reported that they felt a difference in leg symptoms and would wear stockings again. Conclusions Compression stockings were effective for preventing lower limb edema in pregnant women, who had a positive perception of wearing them.
Collapse
Affiliation(s)
| | | | - Orlando Saliba
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brasil
| | | |
Collapse
|
31
|
Silva MJ, Louzada ACS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N. Epidemiology of 869,220 varicose vein surgeries over 12 years in Brazil: trends, costs and mortality rate: Epidemiology of 869220 varicose vein surgeries. Ann Vasc Surg 2021; 82:1-6. [PMID: 34942339 DOI: 10.1016/j.avsg.2021.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND varicose vein surgeries are the most commonly performed vascular procedure to treat the most prevalent vascular disease, chronic venous disease. However, nationwide studies on the epidemiology of varicose vein surgeries are scarce, none in developing countries. Therefore, we designed this study to assess the total number of varicose vein surgeries performed between 2008 and 2019 in the Public Health System, which exclusively insures more than 160 million Brazilians, their trends, costs and mortality rates. METHODS public and open data referring to all surgeries to treat chronic venous disease between 2008 and 2019 were extracted from the Brazilian Ministry of Health database. RESULTS 869,220 surgeries were performed to treat chronic venous disease in Brazilian public hospitals and outpatient clinics, with an average rate of 4.5 surgeries per 10,000 inhabitants per year. Starting in 2015, we observed a slight non-significant downward trend in the total number of procedures. The total amount reimbursed by the government was US$ 232,775,518.11. A total of 49 deaths were reported after varicose vein surgery, corresponding to a mortality rate of 0.0056%. CONCLUSIONS 869,220 surgeries were performed to treat chronic venous disease over twelve years, with an overall rate of 4.52 procedures per 10,000 population per year. The mortality rate was very low, 0.0056%.
Collapse
Affiliation(s)
| | | | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil; São Paulo University Medical School, São Paulo, Brazil
| |
Collapse
|
32
|
Yildiz ÇŞ, Özlü ZK. Examınatıon of self-care agency and quality of life in individuals with chronic venous disease. JOURNAL OF VASCULAR NURSING 2021; 39:114-119. [PMID: 34865721 DOI: 10.1016/j.jvn.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
AIM This study aims to investigate self-care agency and quality of life (QoL) in persons with chronic venous disease of the lower extremities. METHODS This descriptive study was carried out between December 2014 and September 2016. The study population consisted of patients admitted to Erzurum Regional Training and Research Hospital Clinic of Surgical Cardiovascular Diseases and who had been diagnosed with lower extremity venous disease. The study sample comprised 312 patients who meet the inclusion criteria among this population admitted at the said dates. For data collection, the Patient Information Form, Self-Care Agency Scale, and Venous Insufficiency Epidemiological and Economic Study - Quality of Life/Symptoms Scale (VEINES-QOL/SYM) were used. The data were evaluated using percentage distribution, means, analysis of variance, post-hoc test, t-test, Mann-Whitney U-test and Kruskal-Wallis test. RESULTS The mean Self-Care Agency Scale score of the patients with lower extremity venous disease was 102.33±18.20, and their mean VEINES-QOL/Sym score was 74.95±12.86, indicating a moderate level. CONCLUSION As a result, this study found the factors that significantly affected mean Self-Care Agency scores and mean QoL scores of the patients in terms of their level of education, employment status, BMI, smoking habits, and conditions about chronic diseases. Positive correlation was found between mean Self-Care Agency scores and QoL scores of the patients.
Collapse
Affiliation(s)
| | - Zeynep Karaman Özlü
- Department of Surgical Nursing, Faculty of Nursing, Anesthesiology Clinical Research Office, Atatürk University, Erzurum, Turkey.
| |
Collapse
|
33
|
Kirsten N, Mohr N, Gensel F, Alhumam A, Bruning G, Augustin M. Population-Based Epidemiologic Study in Venous Diseases in Germany - Prevalence, Comorbidity, and Medical Needs in a Cohort of 19,104 Workers. Vasc Health Risk Manag 2021; 17:679-687. [PMID: 34744435 PMCID: PMC8566002 DOI: 10.2147/vhrm.s323084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Data on the prevalence of chronic venous disorders (CVD) at the national level in Germany are scarce. Methods We performed a population-based observational study based on clinical examinations, personal history, and technical examinations. Data were collected from 2006 to 2015. Descriptive data analysis was done to determine CVD and chronic venous insufficiency (CVI) prevalence and occurrence of potential risk factors. Chi-squared tests were performed to estimate the influence of risk factors on the prevalence of CVD. Results In total, 19,104 employees from different branches were included. The majority of the examined people were doing office work (n = 8157; 80.2%). A total of 4038 persons (21.1%) show at least one sign of CVD. At least one sign of CVI could be found in 679 persons (3.6%). Being female was found to be protective with an odds ratio of 0.66 (95% CI 0.59-0.73). Conclusion There is clear indication for active venous treatment in 22.3% of the adult working population in Germany.
Collapse
Affiliation(s)
- Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Franziska Gensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Aminah Alhumam
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Dermatology, College of Medicine, King Faisal University, Hofuf, Al Ahsa, Saudi Arabia
| | - Guido Bruning
- Department of Vein and Dermatosurgery, Tabea Hospital GmbH and Co KG, Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
34
|
Chronic venous disorders - common and yet unknown - a study of public awareness and primary symptoms in a selected group of patients. Postepy Dermatol Alergol 2021; 38:585-589. [PMID: 34658698 PMCID: PMC8501441 DOI: 10.5114/ada.2021.108911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic venous disorder (CVD) is thoroughly spread across the globe. It affects about 40% of the Polish population. European guidelines underline that there are no data on the percentage of people who have first symptoms of chronic venous insufficiency. Aim To determine the frequency and pattern of first symptoms and examine public knowledge on CVD in a selected group of patients. Material and methods Our study group consists of 175 patients who took part in preventive assessment of nevi. To determine public knowledge on CVD, we constructed a questionnaire, which consisted of two sections: one part to be completed by the patient and the other by the doctor. Results The median age was 41 years. From 175 patients, about 40% claimed that they do not recognize CVD. Only about half of them knew how to diagnose and treat it. Most of them associate telangiectasia and varicose veins as primary signs and symptoms of CVD. Conclusions Despite the fact that the disease itself is common, the level of public awareness is astonishingly low. Majority of patients tested could not associate first signs and symptoms, even though most of them had primary symptoms of the disease. In order to avoid high-cost treatment of ulcers and varicose veins, we should spread the knowledge on CVD.
Collapse
|
35
|
Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2021; 9:CD009648. [PMID: 34590305 PMCID: PMC8481765 DOI: 10.1002/14651858.cd009648.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (in French 'cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire' (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is the second update of the review first published in 2013. OBJECTIVES To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, and the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries to 19 October 2020. We also searched PUBMED to 19 October 2020 and checked the references of relevant articles to identify additional studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared CHIVA to other therapeutic techniques to treat varicose veins. DATA COLLECTION AND ANALYSIS Two review authors independently assessed and selected studies, extracted data, and performed quantitative analysis from the selected papers. A third author solved any disagreements. We assessed the risk of bias in included trials with the Cochrane risk of bias tool. We calculated the risk ratio (RR), mean difference (MD), number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI). We evaluated the certainty of the evidence using GRADE. The main outcomes of interest were the recurrence of varicose veins and side effects. MAIN RESULTS For this update, we identified two new additional studies. In total, we included six RCTs with 1160 participants (62% women) and collected from them eight comparisons. Three RCTs compared CHIVA with vein stripping. One RCT compared CHIVA with compression dressings in people with venous ulcers. The new studies included three comparisons, one compared CHIVA with vein stripping and radiofrequency ablation (RFA), and one compared CHIVA with vein stripping and endovenous laser therapy. We judged the certainty of the evidence for our outcomes as low to very low due to inconsistency, imprecision caused by the low number of events and risk of bias. The overall risk of bias across studies was high because neither participants nor personnel were blinded to the interventions. Two studies attempted to blind outcome assessors, but the characteristics of the surgery limited concealment. Five studies reported the outcome clinical recurrence of varicose veins with a follow-up of 18 months to 10 years. CHIVA may make little or no difference to the recurrence of varicose veins in the lower limb compared to stripping (RR 0.74, 95% CI 0.46 to 1.20; 5 studies, 966 participants; low-certainty evidence). We are uncertain whether CHIVA reduced recurrence compared to compression dressing (RR 0.23, 95% CI 0.06 to 0.96; 1 study, 47 participants; very low-certainty evidence). CHIVA may make little or no difference to clinical recurrence compared to RFA (RR 2.02, 95% CI 0.74 to 5.53; 1 study, 146 participants; low-certainty evidence) and endovenous laser (RR 0.20, 95% CI 0.01 to 4.06; 1 study, 100 participants; low-certainty evidence). We found no clear difference between CHIVA and stripping for the side effects of limb infection (RR 0.83, 95% CI 0.33 to 2.10; 3 studies, 746 participants; low-certainty evidence), and superficial vein thrombosis (RR 1.05, 95% CI 0.51 to 2.17; 4 studies, 846 participants; low-certainty evidence). CHIVA may reduce slightly nerve injury (RR 0.14, 95% CI 0.02 to 0.98; NNTH 9, 95% CI 5 to 100; 4 studies, 846 participants; low-certainty evidence) and hematoma compared to stripping (RR 0.59, 95% CI 0.37 to 0.97; NNTH 11, 95% CI 5 to 100; 2 studies, 245 participants; low-certainty evidence). For bruising, one study found no differences between groups while another study found reduced rates of bruising in the CHIVA group compared to the stripping group. Compared to RFA, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma, but may cause more bruising (RR 1.15, 95% CI 1.04 to 1.28; NNTH 8, CI 95% 5 to 25; 1 study, 144 participants; low-certainty evidence). Compared to endovenous laser, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma. The study comparing CHIVA versus compression did not report side effects. AUTHORS' CONCLUSIONS There may be little or no difference in the recurrence of varicose veins when comparing CHIVA to stripping (low-certainty evidence), but CHIVA may slightly reduce nerve injury and hematoma in the lower limb (low-certainty evidence). Very limited evidence means we are uncertain of any differences in recurrence when comparing CHIVA with compression (very low-certainty evidence). CHIVA may make little or no difference to recurrence compared to RFA (low-certainty evidence), but may result in more bruising (low-certainty evidence). CHIVA may make little or no difference to recurrence and side effects compared to endovenous laser therapy (low-certainty evidence). However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed, and the results were imprecise due to the low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
Collapse
Affiliation(s)
- Sergi Bellmunt-Montoya
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jose Maria Escribano
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Cristina Tello-Díaz
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
36
|
Zawadzki P, Nowak A, Dzieciuchowicz L. Factors affecting D-dimer levels in patients with uncomplicated primary varicose veins. POLISH JOURNAL OF SURGERY 2021; 93:1-5. [PMID: 34552026 DOI: 10.5604/01.3001.0014.9658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives The diagnosis of deep venous thrombosis (DVT) is hampered in patients with primary varicose veins due to similarity of symptoms of DVT and PVV and elevated levels of D-dimers. The purpose of this study was to analyze factors that influence the D-dimer concentration in patients with PVV in order to redefine its diagnostic value. Methods Forty- one patients with non-complicated PVV were enrolled in the study, in whom D-dimer level was determined by immunoturbidimetric assay. The influence of selected clinical factors on the concentration of D-dimers was determined with univariate and bivariate analysis. Besides descriptive statistics the D-dimers levels were compared to the age -adjusted cutoff values. Results The median concentration of D-dimer was 630.0 ng/ml (440.0-1140.0 ng/ml) and was above the age-adjusted level in 21 (52%) of patients. There was a positive correlation between the patient's age and and D-dimer concentration (p = 0.035, Spearman correlation coefficient rs=0,33. The bivariate analysis showed a significant interaction between age and weight p=0,02. Conclusions In patients with PVV the diagnostic value of D-dimers is limited especially in older and overweight subjects.
Collapse
Affiliation(s)
- Paweł Zawadzki
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Anita Nowak
- Department of Vascular Surgery and Vascular Diseases, Collegium Medicum, Univeristy of Zielona Gora, Zielona Gora, Poland
| | - Lukasz Dzieciuchowicz
- Department of Vascular Surgery and Vascular Diseases, Collegium Medicum, Univeristy of Zielona Gora, Zielona Gora, Poland
| |
Collapse
|
37
|
Orak Y, Eroğlu E, Baylan FA, Yıldız S, Boran ÖF, Doganer A, Altun A. Effects of acupuncture on pain and levels of IL-17 and IL-23 in the treatment of non-thermal endovenous ablation: A randomized clinical trial. Vascular 2021; 30:532-541. [PMID: 33977797 DOI: 10.1177/17085381211013980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Acupuncture is one of the oldest therapeutic interventions in the world for the treatment of pain, musculoskeletal diseases, and inflammation. This study aimed to investigate the effect of acupuncture on pain and IL-17 and IL-23 levels in the treatment of endovenous ablation. METHODS The study was a randomized controlled trial. Patients were divided into group C (Control, n = 35) and group A (Acupuncture, n = 35). Group A patients were treated with acupuncture 24 h preoperatively. Follow-up checkups were conducted intraoperatively, postoperatively, and on the third day. RESULTS There was no difference between men; there was a difference between women. Visual analog scale score was lower in group A at the intraoperative third and fifth minutes (0.00 vs. 1 and 0.00 vs. 0.5). Analgesic consumption was lower in group A at the end of third day (p = 0.024). Postoperative IL-17 levels were higher than preoperative levels in group A (23.58 vs. 19.33). Postoperative IL-23 levels were lower than preoperative levels in group A (13.66 vs. 29.51). Group C showed increased postoperative IL-23 levels (28.81 vs. 33.51). Preoperative IL-17 and postoperative IL-23 levels were lower in group A than in group C (19.33 vs. 27.69 and 13.66 vs. 33.51). Although no difference was observed between group A and group C in preoperative saphenous vein diameter, postoperative saphenous vein diameter was smaller in group A (p = 0.008). Saphenous vein diameter was smaller on day 3 in group A than in group C (p = 0.043). CONCLUSION Acupuncture is effective on acute pain and level of IL-23 in the treatment of endovenous ablation using cyanoacrylate.
Collapse
Affiliation(s)
- Yavuz Orak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaraş Sutçu Imam University, Kahramanmaraş, Turkey
| | - Erdinç Eroğlu
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaraş Sutçu Imam University, Kahramanmaraş, Turkey
| | - Filiz Alkan Baylan
- Department of Biochemistry, Faculty of Medicine, Kahramanmaraş Sutçu Imam University, Kahramanmaraş, Turkey
| | - Sedat Yıldız
- Private Doctor's Office, Physical Medicine and Rehabilitation Department, Isparta, Turkey
| | - Ömer Faruk Boran
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Kahramanmaraş Sutçu Imam University, Kahramanmaraş, Turkey
| | - Adem Doganer
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kahramanmaraş Sutçu Imam University, Kahramanmaraş, Turkey
| | - Ahmet Altun
- Department of Medical Pharmacology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
38
|
Attaran RR, Bhalla A, Mena-Hurtado CI, Ochoa Chaar CI. Correlation between great saphenous length of treatment zone and diameter with improvement in symptoms after ablation. J Vasc Surg Venous Lymphat Disord 2021; 9:1443-1450. [PMID: 33706000 DOI: 10.1016/j.jvsv.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present study was to examine the relationship between the great saphenous vein (GSV) length of segment ablated and diameter with symptom improvement. METHODS Data from a multicenter, randomized, controlled prospective study of 242 patients undergoing radiofrequency ablation (RFA) or cyanoacrylate closure (CAC) of the GSV were analyzed. The venous clinical severity score (VCSS) was measured at baseline and at 1, 3, 6, 12, 24, and 36 months after ablation. The GSV diameter was evaluated for a correlation with VCSS at each time point. Using the median treatment length of 34 cm, the patients were divided into group I (treatment length ≥34 cm) vs group II (<34 cm) for analysis. The pretreatment VCSS and VCSS improvement (ΔVCSS) after treatment were evaluated with respect to the length of the ablated GSV segment. The postablation VCSS was compared between the pretreatment GSV diameters of <5.5 mm vs ≥5.5 mm. RESULTS The mean GSV length ablated by RFA was 35.3 ± 14 cm vs 32.6 ± 11 cm with CAC (P = NS). No significant difference was found in the VCSS (at baseline or follow-up) between RFA and CAC. The pooled data for all participants (n = 242) demonstrated a correlation between the treated GSV length and pretreatment VCSS and the ΔVCSS at 36 months (R = 0.23; P < .001). Greater VCSS improvement was seen in group I (≥34 cm ablated) than in group II (<34 cm ablated) at ≤36 months of follow-up (P = .003). At baseline, group I had had higher VCSSs (6.21 ± 2.75 vs 4.88 ± 2.33; P < .00001) and CEAP (clinical, etiologic, anatomic, pathophysiologic) and reflux scores. Of the 242 patients, 101 had had a GSV diameter <5.5 mm and 141 had had a GSV diameter of ≥5.5 mm. No significant differences were noted in the VCSSs, either at baseline or at follow-up, between the two groups. Within the study population, a poor correlation was found between the GSV diameter and baseline VCSS (R = -0.004; P = .95) and between the GSV diameter and ΔVCSS for ≤36 months (R = 0.04; P = .55). CONCLUSIONS Longer segments of GSV reflux appeared to correlate with symptom severity. We found a small to moderate correlation between the length of GSV segment ablated and symptom improvement. This might reflect the greater severity of symptoms at baseline in patients with longer segments with reflux. We found a poor correlation between the proximal GSV diameter and symptom improvement after ablation.
Collapse
Affiliation(s)
- Robert R Attaran
- Divisions of Cardiovascular Medicine, Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, Conn.
| | - Aneil Bhalla
- Divisions of Cardiovascular Medicine, Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, Conn
| | - Carlos I Mena-Hurtado
- Divisions of Cardiovascular Medicine, Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, Conn
| | - Cassius I Ochoa Chaar
- Divisions of Cardiovascular Medicine, Vascular Surgery and Endovascular Therapy, Yale School of Medicine, New Haven, Conn
| |
Collapse
|
39
|
Homs-Romero E, Romero-Collado A, Verdú J, Blanch J, Rascón-Hernán C, Martí-Lluch R. Validity of Chronic Venous Disease Diagnoses and Epidemiology Using Validated Electronic Health Records From Primary Care: A Real-World Data Analysis. J Nurs Scholarsh 2021; 53:296-305. [PMID: 33638608 DOI: 10.1111/jnu.12639] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate the validity of lower limb chronic venous disease (CVD) diagnoses entered in a large electronic health record database in primary care in Catalonia, Spain; to investigate the reliability of these data for research purposes; and to estimate the prevalence and incidence of CVD, chronic venous insufficiency (CVI), and venous leg ulcer (VLU). DESIGN Real-world data analysis based on a large electronic health record database in primary care in Catalonia, Spain. METHODS We used a primary care research database (Information System for the Development of Research in Primary Care [SIDIAP]), which contains anonymous data on some 5.8 million people from 279 primary care centers, accounting for more than 80% of the Catalonian population and 15% of the Spanish population. We evaluated the validity of the ICD-10 codes for CVD in SIDIAP for 200 adult patients through the responses of 20 primary care physicians to a questionnaire. FINDINGS The positive predictive value of CVD in SIDIAP was 89.95% (95% confidence interval [CI] 84.99-93.40). The prevalence rates for CVD, CVI, and VLU were 9.54% (95% CI 9.51-9.56), 3.87%, and 0.33%, respectively. The incidence rates for CVD, CVI, and VLU were 7.91/1,000 person-years (95% CI 7.82-8.00), 3.37/1,000 person-years (95% CI 3.31-3.43), and 0.23/1,000 person-years (95% CI 0.21-0.24), respectively. CONCLUSIONS The Catalonian SIDIAP database contains valid CVD diagnoses. The prevalence and incidence rates found using real-world data are low compared with those in the literature, possibly because CVD is an underdiagnosed entity. CLINICAL RELEVANCE Real-world data can inform clinicians on lower limb venous health in a population, show changes as individuals age, and reveal aspects where healthcare can be improved.
Collapse
Affiliation(s)
- Erica Homs-Romero
- Primary Health Care Nurse, Figueres Basic Healthcare Area (Àrea Bàsica de Salut de Figueres)
| | | | - Jose Verdú
- Professor of Nursing, Department of Nursing, University of Alicante, Spain
| | - Jordi Blanch
- Unitat de suport a la recerca de Girona., Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | | | - Ruth Martí-Lluch
- Unitat de suport a la recerca de Girona., Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain.,Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Girona, Spain
| |
Collapse
|
40
|
Kim Y, Png CYM, Sumpio BJ, DeCarlo CS, Dua A. Defining the human and health care costs of chronic venous insufficiency. Semin Vasc Surg 2021; 34:59-64. [PMID: 33757637 DOI: 10.1053/j.semvascsurg.2021.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic venous insufficiency (CVI) affects more than 25 million adults in the United States alone, and more 6 million with advanced stages of venous disease. The high incidence of CVI and the increasing costs of care, place a heavy financial burden on the US health care system. Recent studies estimate the total cost of care at more than $3 billion per year. These staggering numbers highlight the importance of timely diagnosis, treatment, and prevention of CVI. In this article, we review the epidemiology and prevalence of CVI, and its financial impact on national health care budget. Racial disparities in CVI and the impact of socioeconomic status on access to care are also discussed. Finally, we discuss CVI-related screening programs and the importance of preventative measures in venous disease.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Charles S DeCarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA 02114.
| |
Collapse
|
41
|
Time trends and social security burden of temporary work disability due to chronic venous disease in Brazil. BMC Public Health 2020; 20:477. [PMID: 32276612 PMCID: PMC7147047 DOI: 10.1186/s12889-020-08563-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 03/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background Chronic venous disease (CVD) and disability are worldwide problems and have significant socioeconomic implications. This study aims to analyze the time trends and social security burden of temporary work disability due to CVD in Brazil. Methods An ecological time series study using the Brazilian Social Security System database was performed from 2005 to 2014. Data from all benefits granted to workers with temporary disability due to CVD were analyzed. The cases were identified using diagnosis codes I83–I83.9 of the International Classification of Diseases 10th Revision (ICD-10). The time trend analyses were performed by the Joinpoint Regression Model, with sex, age, regions, income, and category of affiliation as variables. Crude and age-standardized rates were calculated. Results A total of 429,438 benefits were granted for temporary work disability due to CVD from 2005 to 2014, with a growing trend and an age-standardized annual percent change (APC) of 3.4 (95% CI: 2.6–4.2) (p < 0.05). Social security expense increased 3.5-fold, and the number of days in benefit doubled from 2005 to 2014. In total, 27,017,818 working days were lost. The average duration of benefits was 55.3 days. The majority of workers were women (68.2%) (p < 0.001), between 30 and 59 years old, employed, had a monthly income ≤2 minimum wages (MW) (83.2%), and lived in the regions southeast (53.6%) and south (29.3%). Significantly higher APCs were observed for women than for men (APC: 4.9, 95% CI: 4.0–5.7 versus APC: 1.2, 95% CI: 0.1–2.4). All regions in Brazil had a significant growing trend, except in the north. No significant growth was observed in the age group of 60–69 years. A decreasing trend was observed in workers with monthly incomes above 2 MW (p < 0.05). Conclusions Temporary work disability due to CVD and social security burden showed increasing trends with millions of working days lost, particularly among women and low-income workers. Preventing disability is challenging, and public policies are needed to reduce the social and economic impact of disability. Therefore, measures for promoting health at the workplace should be encouraged.
Collapse
|
42
|
Global Epidemiology of Chronic Venous Disease: A Systematic Review with Pooled Prevalence Analysis. Ann Surg 2020; 274:971-976. [PMID: 33214466 DOI: 10.1097/sla.0000000000004631] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide an updated estimate of the global prevalence of CVD and to comprehensively evaluate risk factors associated with this condition. BACKGROUND Chronic Venous Disease (CVD) is an important cause of morbidity internationally, but the global burden of this condition is poorly characterised. The burden of CVD must be better characterised to optimise service provision and permit workforce planning to care for patients with different stages of CVD. METHODS A systematic search in Ovid MEDLINE and Embase (1946 - 2019) identified 1271 articles. Full-text, English language articles reporting on the epidemiology of CVD in a general adult population were included. Data extraction was performed by two independent reviewers, in accordance with a pre-registered protocol (PROSPERO: CRD42019153656). STATA and Review Manager were used for quantitative analysis. A crude, unadjusted pooled prevalence was calculated for each Clinical (C) stage in the Clinical, Etiologic, Anatomic, Pathophysiologic (CEAP) classification and across different geographical regions. Qualitative analysis was performed to evaluate associated risk factors in CVD. RESULTS 32 articles across 6 continents were identified. 19 studies were included in the overall pooled prevalence for each Clinical (C) stage; pooled estimates were: C0 s: 9%, C1: 26%, C2: 19%, C3: 8%, C4: 4%, C5: 1%, C6: 0·42%. The prevalence of C2 disease was highest in Western Europe and lowest in the Middle East and Africa. Commonly reported risk factors for CVD included: female gender (OR 2·26, 95% CI 2·16-2·36, p < 0.001), increasing age, obesity, prolonged standing, positive family history, parity and Caucasian ethnicity. There was significant heterogeneity across the included studies. CONCLUSIONS CVD affects a significant proportion of the population globally however there is significant heterogeneity in existing epidemiological studies.
Collapse
|
43
|
Richards T, Anwar M, Beshr M, Davies AH, Onida S. Systematic review of ambulatory selective variceal ablation under local anesthetic technique for the treatment of symptomatic varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:525-535. [PMID: 33137495 DOI: 10.1016/j.jvsv.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The ambulatory selective variceal ablation under local anesthesia (ASVAL) technique subscribes to the "ascending" theory of varicose vein etiology, which recommends primary ambulatory phlebectomy as a treatment for tributary varicosities and truncal vein incompetence. This systematic review explores the efficacy and safety of the ASVAL technique for the treatment of symptomatic varicose veins. METHODS A comprehensive search of the Medline and Embase databases and the Cochrane Register of Controlled Trials in May 2019 revealed 11 original articles that were qualitatively reviewed. The primary outcome was the absence from recurrent varicose veins at 1-year follow-up. Secondary outcomes were resolution of great saphenous vein (GSV) reflux on duplex ultrasound, change in GSV diameter, objective and subjective clinical improvement in chronic venous disease, and patient-reported outcome measures. RESULTS A total of 2106 limbs underwent intervention in 1734 patients reported in two randomized controlled trials, one case control study, three cohort studies, and five case series. Varicosity recurrence at 1 year ranged from 0.5% to 13.5% in patients. Of 1622 limbs with diagnosed GSV incompetence before intervention, 1114 were competent at 1 year (mean, 68.2% [±12.62%]). All studies measuring GSV diameter reported statistically significant reductions in vein size. CONCLUSIONS ASVAL may be considered as a minimally invasive treatment for early stages of chronic venous disease in the presence of truncal reflux. The evidence base should be strengthened by prospective randomized controlled trials that follow standardized procedures and report according to recognized measures of quality of life alongside clinical and hemodynamic data.
Collapse
Affiliation(s)
- Thomas Richards
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Muzaffar Anwar
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Mostafa Beshr
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alun H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sarah Onida
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| |
Collapse
|
44
|
Sawad AB, Turkistani F. Treatment of venous leg ulcers using bilayered living cellular construct. J Comp Eff Res 2020; 9:907-918. [PMID: 32969709 DOI: 10.2217/cer-2020-0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Venous leg ulcers (VLUs) present a significant economic burden on the US healthcare system and payers (US$14.9 billion). Aim: To evaluate the quality of life (QoL) of patients with VLUs; to analyze the limitations of standard of care (SOC) for VLUs; and to explain how using bilayered living cellular construct (BLCC) with SOC for treatment of VLUs can help heal more VLUs faster (than using SOC alone) as well as help improve QoL and help reduce the burden on the US healthcare system and payers. Materials & methods: This is a review study. The search was conducted in February 2020 by way of electronic databases to find relevant articles that provided information related to QoL of patients with VLUs, limitations of SOC for VLUs and economic analyses of using BLCC for treatment of VLUs. Results: VLUs impact patients' physical, functional and psychological status and reduce QoL. A total 75% of VLU patients who used SOC alone failed to achieve healing in a timely fashion, which led to increased healthcare costs and healthcare resource utilization. Although the upfront cost is high, the greater effectiveness of BLCC offsets the added cost of the product during the time period of the studies. Therefore, BLCC helps to improve the QoL of VLU patients. As an example, for every 100 VLU patients in a healthcare plan, the use of BLCC can create cost savings of US$1,349,829.51. Conclusion: Payers' coverage of BLCC results in reduction of the overall medical cost for treating VLU patients.
Collapse
Affiliation(s)
- Aseel Bin Sawad
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Fatema Turkistani
- Clinical & Hospital Pharmacy Department, College of Pharmacy, Taibah University, Medina, Saudi Arabia
| |
Collapse
|
45
|
Rastel D, Crébassa V, Rouvière D, Manéglia B. Physician interpretation of ultrasound in the evaluation of ankle edema. Phlebology 2020; 35:623-630. [DOI: 10.1177/0268355520923195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of this study was to assess inter‑ and intra‑observer agreement of detection and grading of oedema measured by vascular physicians using ultrasonography. Method In this observational study, three investigators read 113 videos of ultrasonography of the medial lower leg of 77 patients using a 15–18 MHz linear probe and reported whether oedema was present or not and, if present, to what extent. The videos were selected by the coordinator and sent every two months for a period of six months to the three investigators. Intra‑ and interobserver agreements were calculated using the Fleiss Kappa coefficient, reported with their 95% confidence interval and interpreted using the Landis and Koch values. Results Inter-observer agreement as to whether oedema was present or not was 0.88 (0.77–0.98), 0.96 (0.89–1.0) and 0.91 (0.80–1.0) for the first, second and third readings, respectively. The concordance was considered to be “excellent.” Inter-observer agreement as to the severity of oedema was 0.52 (0.38–0.65), 0.53 (0.39–0.66) and 0.61 (0.47–0.75) for the first, second and third readings, respectively. The concordance was “moderate”. Intra-observer reliability for the diagnosis of oedema was only 0.89 (0.70–1.0), 0.93 (0.75–1.0) and 0.92 (0.74–1.0) for the first, second and third reader, respectively, which was “excellent”. Conclusions The inter-observer agreement interpreting ultrasound videos using standard probes was excellent. Only moderate agreement in grading the severity of the edema using our arbitrary criteria was shown.
Collapse
|
46
|
Pappas PJ, Pappas SF, Nguyen KQ, Lakhanpal S. Racial disparities in the outcomes of superficial vein treatments for chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2020; 8:789-798.e3. [DOI: 10.1016/j.jvsv.2019.12.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/22/2019] [Indexed: 11/28/2022]
|
47
|
Clinical outcome of short-term compression after sclerotherapy for telangiectatic varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9:435-443. [PMID: 32502730 DOI: 10.1016/j.jvsv.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sclerotherapy is considered to be the method of choice for the treatment of telangiectatic varicose veins (C1 veins). Whereas the use of compression stockings after sclerotherapy is recommended, little is known about the impact of compression on the outcome of sclerotherapy. The aim of this study was to assess the influence of compression on the outcome of injection sclerotherapy of C1 varicose veins. METHODS There were 100 legs of 50 consecutive patients with chronic venous insufficiency (C1) included. After randomization per patient, both legs were treated with sclerotherapy in a predefined area of the thigh (measuring 100 cm2), followed by eccentric compression for 24 hours. Group A received no further compression, whereas group B was additionally equipped with compression stockings of 18 to 20 mm Hg above the ankle and continued wearing these for 1 week. Photodocumentation was performed before, 1 week after, and 4 weeks after sclerotherapy, and the clinical outcome was assessed at these postprocedure follow-up dates. The photographs were reviewed by an internal unblinded rater and an independent blinded external rater. RESULTS There was no discernible difference between the groups in terms of clinical outcome or side effects after 4 weeks. Whereas inter-rater reliability was high, there was no correlation between the raters and patients in terms of outcome. In 55% of the treated legs, the patients deemed the result of the treatment to be good; in 27% of the treated legs, fair; and in 18%, poor. Postprocedure hyperpigmentation occurred in 13% of patients and was comparable in both groups. Compression therapy was found to be comfortable by the majority (58%) of patients. CONCLUSIONS One week of postinterventional compression therapy had no clinical benefit compared with no compression.
Collapse
|
48
|
Wall R, Garcia G, Läubli T, Seibt R, Rieger MA, Martin B, Steinhilber B. Physiological changes during prolonged standing and walking considering age, gender and standing work experience. ERGONOMICS 2020; 63:579-592. [PMID: 32009579 DOI: 10.1080/00140139.2020.1725145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Occupational standing is associated with musculoskeletal and venous disorders. The aim was to investigate whether lower leg oedema and muscle fatigue development differ between standing and walking and whether age, gender and standing work habituation are factors to consider. Sixty participants (15 young females, 15 young males, 15 older males, and 15 young males habituated to standing work) were included and required to stand/walk for 4.5 hours in three periods with two seated breaks. Waterplethysmography/bioelectrical impedance, muscle twitch force and surface electromyography were used to assess lower leg swelling (LLS) and muscle fatigue as well as gastrocnemius muscle activity, respectively. While standing led to LLS and muscle fatigue, walking did not. Low-level medial gastrocnemius activity was not continuous during standing. No significant influence of age, gender and standing habituation was observed. Walking can be an effective prevention measure to counteract the detrimental effects of quasi-static standing.Practitioner summary: Prolonged standing leads to lower leg oedema and muscle fatigue while walking does not. The primary cause of fatigue may be in other muscles than the medial gastrocnemius. Walking may be an effective prevention measure for health risks of occupational standing when included intermittently.Abbreviation: BI: bioelectrical impedance; LLS: lower leg swelling; SEMG: surface electromyography; MTF: muscle twitch force; WP: waterplethysmography; Bsl: Baseline; L: Lunch; E: Evening; MTM: method times measurement; EA: electrical activity; IQR: interquartile range; p: percentile; M: mean; SE: standard error; Adj: adjusted.
Collapse
Affiliation(s)
- Rudolf Wall
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Gabriela Garcia
- Department of Health Sciences and Technology, Sensory-Motor Systems Lab, ETH Zürich, Zurich, Switzerland
- Industrial Engineering Department, Universidad San Francisco de Quito, Quito, Ecuador
| | - Thomas Läubli
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
- Department of Health Sciences and Technology, Sensory-Motor Systems Lab, ETH Zürich, Zurich, Switzerland
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| | - Bernard Martin
- Industrial and Operations Engineering Center for Ergonomics, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital, Tuebingen, Germany
| |
Collapse
|
49
|
Toh MR, Tang TY, Lim HHMN, Venkatanarasimha N, Damodharan K. Review of imaging and endovascular intervention of iliocaval venous compression syndrome. World J Radiol 2020; 12:18-28. [PMID: 32226586 PMCID: PMC7061234 DOI: 10.4329/wjr.v12.i3.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
Iliocaval venous compression syndrome (ICS) is the extrinsic compression of the common iliac vein by the overlying iliac artery against the vertebra. Chronic compression can lead to venous stenosis and stasis, which manifests as chronic venous disease and treatment resistance. Therefore, early recognition of ICS and prompt treatment are essential. Clinical presentations of ICS can be ambiguous and diagnosis requires a high index of suspicion with the relevant imaging studies. The initial imaging test is typically a Duplex ultrasound for vessel assessment and pelvic ultrasound to exclude a compressive mass, which is followed by computed tomography (CT) or magnetic resonance (MR) venography. CT and MRI can identify the anatomical causes for venous compression. In patients with high clinical suspicion for ICS, negative findings on CT and MR venography would still warrant further investigations. Definitive diagnosis can be established using catheter-based venography complemented with intravascular ultrasonography but the nature of their invasiveness limits its utility as a routine imaging modality. In this review paper, we will discuss the evidence, utility and limitations of the existing imaging modalities and endovascular intervention used in the management of ICS.
Collapse
Affiliation(s)
- Ming Ren Toh
- Duke-NUS Medical School, Singapore 544886, Singapore
| | - Tjun Yip Tang
- Department of Vascular surgery, Singapore General Hospital, Singapore 169608, Singapore
| | | | | | | |
Collapse
|
50
|
Cires-Drouet RS, Fangyang L, Rosenberger S, Startzel M, Kidwell M, Yokemick J, McDonald T, Carlin M, Sharma J, Sorkin JD, Lal BK. High prevalence of chronic venous disease among health care workers in the United States. J Vasc Surg Venous Lymphat Disord 2020; 8:224-230. [PMID: 32067727 PMCID: PMC7375188 DOI: 10.1016/j.jvsv.2019.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health care workers spend extended times standing and walking short distances and are at risk for development of chronic venous insufficiency (CVI). We conducted a hospital-wide venous screening program designed to measure the prevalence of and risk factors for clinical manifestations of CVI and ultrasound evidence of venous reflux or obstruction in health care workers. We also determined their risk for deep venous thrombosis (DVT). METHODS Free venous screening and education were offered to all hospital employees; the program started in April 2016, and results are presented from the first year. Demographics, medical history, and use of compression stockings were recorded. A physical examination determined the clinical class of the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification for clinical disease, and an ultrasound test evaluated for reflux or obstruction in the common femoral vein, popliteal vein, and saphenofemoral junction. The Caprini score was recorded to evaluate risk of DVT. Descriptive statistics were reported, and logistic regression was used for multivariate analysis of risk factors. RESULTS We enrolled 636 participants (1272 legs); 93.0% were women. The median age was 42 years (interquartile range, 31-52 years), mean body mass index was 29.2 ± 6.6 kg/m2, and most participants were white (49.1%) or African American (39.5%); 18% reported having hypertension, 7.1% had diabetes, and 6.1% were current smokers. The majority reported occasional leg pain (72.7%) and evening leg swelling (42.3%). Only 2.7% used daily compression stockings. Clinical evidence of CVI was present in at least one leg in 69.1% (C1, 49.0%; C2, 17.7%; C3, 1.9%; C4, 0.2%; C5, 0.2%). Venous reflux was present in at least one leg in 82.1%; obstruction was rare (0.2%). Reflux in either the superficial (saphenofemoral junction) or the deep (femoral or popliteal) venous system was present in the majority (71.0%) of patients with CVI (clinical class ≥C1). Reflux and white race were risk factors for clinical disease; clinical disease, age, female sex, and white race were risk factors for reflux. On the basis of the Caprini score, 14.1% of participants were in the highest risk category for DVT when experiencing a high-risk situation (including 2.2% with history of DVT). CONCLUSIONS Prevalence of clinical CVI and venous reflux is high among health care workers despite a low frequency of cardiovascular comorbidities. Increased awareness about CVI and DVT and preventive strategies for venous disease must be instituted in this high-risk cohort.
Collapse
Affiliation(s)
- Rafael S Cires-Drouet
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Liu Fangyang
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - Sarah Rosenberger
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - Matthew Startzel
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - Margaret Kidwell
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - John Yokemick
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - Tara McDonald
- Baltimore VA Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, Md
| | - Minerva Carlin
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - Jashank Sharma
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md
| | - John D Sorkin
- Baltimore VA Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, Md; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland, Baltimore, Md
| | - Brajesh K Lal
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md; Baltimore VA Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Baltimore, Md.
| |
Collapse
|