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Belramman A, Bootun R, Lane TRA, Davies AH. COmpressioN following endovenous TreatmenT of Incompetent varicose veins by sclerotherapy (CONFETTI). J Vasc Surg Venous Lymphat Disord 2024; 12:101729. [PMID: 38081513 DOI: 10.1016/j.jvsv.2023.101729] [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: 07/19/2023] [Revised: 11/13/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The evidence for post-foam sclerotherapy compression stockings for varicose veins is limited. Thus, we examined the effects of post-procedural compression stockings on varicose vein patients undergoing foam sclerotherapy. METHODS The CONFETTI study was a prospective, single-center, randomized controlled trial. Patients with foam sclerotherapy-suitable varicose veins were randomly assigned to the compression group (CG) or the no compression stockings group (NCG) for 7 days. The primary outcome was post-procedural pain measured on a 100-mm visual analog scale for 10 days. Secondary outcomes included clinical severity, generic and disease-specific quality of life scores, return to normal activities and/or work, occlusion rates, degree of ecchymosis, CG compliance, and complications. Patients were reviewed at 2 weeks and 6 months. RESULTS A total of 139 patients were consented to and randomly assigned. The intention-to-treat analysis included 15 patients who did not receive the allocated intervention. Both groups had similar baseline characteristics. Of the patients, 63.3% and 55.4% returned for follow-up at 2 weeks and 6 months, respectively. Most of the veins treated were tributaries. The CG experienced significantly lower pain scores than the NCG, with median scores of 7 mm and 19 mm, respectively (Mann-Whitney U-test; P = .001). At 2 weeks, no differences were observed in ecchymosis or the time to return to normal activities or work. Both groups showed improvements in clinical severity and quality of life, and occlusion rates were comparable. The NCG experienced one deep venous thrombosis and superficial thrombophlebitis, whereas the CG experienced two superficial thrombophlebitis. CONCLUSIONS The CONFETTI study suggests that short-term post-procedural compression stockings are beneficial for reducing post-procedure pain.
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Affiliation(s)
- Amjad Belramman
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Faculty of Medicine, Omar Al-Mukhtar University, Derna, Libya
| | - Roshan Bootun
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Vascular Surgery Specialty Training Registrar in the East of England Deanery, London, United Kingdom
| | - Tristan R A Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom.
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Kikuchi R, Nhuch C, Drummond DAB, Santiago FR, Coelho F, Mauro FDO, Silveira FT, Peçanha GP, Merlo I, Corassa JM, Stambowsky L, Figueiredo M, Takayanagi M, Gomes Flumignan RL, Evangelista SSM, Campos W, Joviliano EE, de Araujo WJB, de Oliveira JCP. Brazilian guidelines on chronic venous disease of the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230064. [PMID: 38021274 PMCID: PMC10648055 DOI: 10.1590/1677-5449.202300642] [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: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.
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Affiliation(s)
- Rodrigo Kikuchi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Faculdade de Ciências Médicas Santa Casa de São Paulo – FCMSCSP, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
| | - Claudio Nhuch
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Vascular, Porto Alegre, RS, Brasil.
| | - Daniel Autran Burlier Drummond
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Rio de Janeiro – PUC-Rio, Departamento de Ciências da Computação, Rio de Janeiro, RJ, Brasil.
| | - Fabricio Rodrigues Santiago
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Instituto de Excelência Vascular, Londrina, PR, Brasil.
- Instituto de Doenças Venosas e Linfáticas – IDVL, Goiânia, GO, Brasil.
| | - Felipe Coelho
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Pontifícia Universidade Católica do Paraná – PUCPR, Departamento de Cirurgia, Londrina, PR, Brasil.
| | | | | | | | - Ivanesio Merlo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Jose Marcelo Corassa
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Leonardo Stambowsky
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Marcondes Figueiredo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Miriam Takayanagi
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
| | - Ronald Luiz Gomes Flumignan
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal de São Paulo – UNIFESP, Departamento de Cirurgia, São Paulo, SP, Brasil.
| | - Solange Seguro Meyge Evangelista
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Clínica Varizemed, Belo Horizonte, MG, Brasil.
| | - Walter Campos
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina, Disciplina de Cirurgia Vascular, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade de São Paulo – USP, Faculdade de Medicina – FMRP, Departamento de Cirurgia e Anatomia, São Paulo, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Paraná – UFPR, Residência em Angiorradiologia e Cirurgia Vascular, Hospital de Clínicas, Curitiba, PR, Brasil.
| | - Julio Cesar Peclat de Oliveira
- Sociedade Brasileira de Angiologia e Cirurgia Vascular – SBACV, São Paulo, SP, Brasil.
- Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Departamento de Cirurgia Geral e Especializada, Rio de Janeiro, RJ, Brasil.
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Yie K, Jeong EH, Hwang EJ, Shin AR. Stocking-only versus additional eccentric compression after below-the-knee truncal vein sclerotherapy: A SOVAECS prospective randomized within-person trial. J Vasc Surg Venous Lymphat Disord 2023; 11:1122-1129.e3. [PMID: 37536560 DOI: 10.1016/j.jvsv.2023.07.009] [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: 04/07/2023] [Revised: 06/08/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE After foam sclerotherapy in the truncal saphenous vein, the clinical effects of additional eccentric compression has not yet been explored. METHODS Between April 2020 and February 2021, we enrolled 42 patients (84 limbs) who underwent bilateral endovenous combined therapy for great saphenous vein (GSV) reflux. Each patient received the same type of endovenous ablation in both above-the-knee GSVs (laser, radiofrequency, cyanoacrylate glue), and combined foam sclerotherapy was performed on both below-the-knee GSVs. Subsequently, we conducted a prospective randomized, single-blind, within-person study in which each patient's bilateral truncal saphenous vein of the calves underwent two different compression therapies: wearing of a regular class II compression stocking on one side (RC group) and additional eccentric compression on the other side (AC group). The primary end point was the occlusion range (score, 0-10) of the below-the-knee truncal GSV after foam sclerotherapy. The secondary outcomes were the pain score (visual analog scale score range, 0-10) of the paired limb, the required number of additional foam sclerotherapy sessions, compliance with compression therapy, and procedure-related complications. RESULTS For the above-the-knee GSV, endovenous laser treatment (n = 44), endovenous radiofrequency ablation (n = 14), and endovenous cyanoacrylate glue ablation (n = 26) were performed. The mean subcompression pressure of the medial calf in the supine and standing positions were 16.7 ± 2.34 mm Hg and 24.5 ± 6.6 mm Hg in the RC group and 38.5 ± 5.5 mm Hg and 45.3 ± 8.2 mm Hg in the AC group, respectively (P = .000). The secondary outcomes of pain score, number of additional foam sclerotherapy sessions, and pigmentation were not significantly different statistically between the two groups. The patient-reported satisfaction scores (range, 0-10) on compression at 24 hours postoperatively were 8.03 ± 1.9 for the AC group and 7.98 ± 1.9 for the RC group (P = .317; Wilcoxon signed ranks test). In both groups, the closure rate of the above-the-knee GSV at 1 month postoperatively was 100%. No procedure-related complications were identified within 1 month postoperatively, including no deep vein thrombosis, numbness, or skin necrosis requiring additional medical attention. CONCLUSIONS The 24 hours of additional eccentric compression on the truncal GSV compared with the use of a conventional knee-level stocking only did not yield any clinical advantages in terms of the occlusion range, postoperative pain, need for additional sclerotherapy, or skin pigmentation after foam sclerotherapy. The decision on which type of compression therapy to perform after foam sclerotherapy in the truncal vein should be comprehensively determined.
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Affiliation(s)
- Kilsoo Yie
- Department of Surgery, College of Medicine, Pusan National University, and Jeju Soo Cardiovascular Center, Jeju, South Korea.
| | - Eun-Hee Jeong
- Department of Surgery, College of Medicine, Pusan National University, and Jeju Soo Cardiovascular Center, Jeju, South Korea
| | - Eun-Jung Hwang
- Department of Surgery, College of Medicine, Pusan National University, and Jeju Soo Cardiovascular Center, Jeju, South Korea
| | - A-Rom Shin
- Department of Surgery, College of Medicine, Pusan National University, and Jeju Soo Cardiovascular Center, Jeju, South Korea
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