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Casian D, Bzovii F, Culiuc V, Gutu E. Urgent surgery versus anticoagulation for treatment of superficial vein thrombosis in patients with varicose veins. VASA 2022; 51:174-181. [DOI: 10.1024/0301-1526/a001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: We performed a prospective observational study to compare the results of surgery and anticoagulation in patients with superficial vein thrombosis (SVT). Patients and methods: A total of 190 patients (195 limbs) with varicose veins and SVT were included and treated by anticoagulation or by surgery. Patients were followed-up during 6 months. The primary outcome for treatment efficacy was the composite rate of SVT extension/recurrence; deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE). The primary outcome for safety was the rate of wound complications and rate of bleedings. Results: Surgery was performed in 85 (44.7%) patients and 105 patients (5 with bilateral SVT) were treated conservatively. In the whole study cohort the primary outcome for treatment efficacy was registered in 15 (7.6%) cases: 9/85 (10.5%) in surgical group and 6/110 (5.4%) in anticoagulation group. Nine patients treated with surgery were diagnosed with postoperative DVT. In anticoagulation group SVT extension occurred in 3 limbs; SVT recurrence in 2 and DVT in one. There were no cases of PE or death during the follow-up. Time-to-event analysis demonstrated no significant difference between groups (HR 0.48; 95% CI 0.17–1.34). The total length of the thrombus was associated with primary efficacy outcome in surgical group (HR 1.07; 95% CI 1.02–1.11); and duration of anticoagulation (HR 0.91 per day; 95% CI 0.83–0.99) and value of Caprini score (HR 1.86; 95% CI 1.1–3.14) in anticoagulation group. Six (7%) wound complications were registered after surgery and 6 (5.71%) bleedings during anticoagulation. Conclusions: Urgent surgery is not associated with reduction of venous thromboembolism compared to anticoagulation in treatment of patients with SVT and varicose veins during 6-months follow-up. However, in patients with isolated thrombosis of varicose tributaries or with limited involvement of the saphenous trunk surgery is relatively safe.
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Affiliation(s)
- Dumitru Casian
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Florin Bzovii
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Vasile Culiuc
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
- Division of Vascular Surgery, Institute of Emergency Medicine, Chisinau, Moldova
| | - Evghenii Gutu
- Department of General Surgery nr. 3, Vascular Surgery Clinic, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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Die LaVaCro-Studie: Langzeitergebnisse der Varizenoperation mit Crossektomie und Stripping der V. saphena magna. PHLEBOLOGIE 2018. [DOI: 10.12687/phleb2139-5-2013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungHintergrund: Multizentrische Langzeitstudien mit hohen Fallzahlen nach Crossektomie und Stripping der Vena saphena magna (VSM) liegen nicht vor. Den in mehreren Studien und Registern erhobenen Daten zu den Rezidivraten der endovenösen Therapieverfahren stehen außerordentlich heterogene Daten der operativen Therapie gegenüber.Methode: In einer von der Arbeitsgemeinschaft für Venenoperationen (VOP-AG) der Deutschen Gesellschaft für Phlebologie (DGP) initiierten prospektiven Multizenterstudie wurden in 12 Zentren 841 Patienten (1 070 Extremitäten) mit einer Stammvarikose der VSM aufgenommen und entsprechend einem streng standardisierten Protokoll operiert. Primärer Endpunkt ist das hämodynamisch relevante saphenofemorale Rezidiv, definiert als eine Vene in der Crossenregion (Durchmesser >5 mm, Reflux >0,5 sec) mit einer Verbindung zur V. femoralis communis Sekundäre Endpunkte sind die Rate duplexsonografisch nachweisbarer pathologischer Crossenrefluxe (Durchmesser <5 mm, Reflux >0,5 sec.), perioperative Komplikationen und neu aufgetretene Varizen nach dem REVAS Klassifikation. Die klinischen und duplexsonografischen Kontrollen erfolgten 7 bis 14 Tage, 3 bis 4 Monate und ein Jahr postoperativ. Hiernach sind jährliche Kontrollen vorgesehen.Ergebnis: Die Rate klinischer Rezidive lag 3–4 Monate postoperativ bei 1,1 % und ein Jahr postoperativ bei 6,4 %. Die Rate duplexsonografischer Rezidive im Crossenbereich betrug nach 3–4 Monaten 0,53 % und nach einem Jahr 2,24 %. Davon waren lediglich zwei (0,29 %) ein Jahr postoperativ hämodynamisch relevant (Durchmesser >5 mm).Schlussfolgerung: Die unter standardisierten Bedingungen vorgenommene Crossektomie und Stripping-Operation weist im Verlauf bis zu einem Jahr eine geringe Rezidivrate auf.
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Ambrogi V, Bossavy JP, Venier AG, Jarno P, Aupée M, Perennec-Olivier M, Parneix P, Malavaud S. Surgical Site Infections (SSI) after Lower Limb Varicose Vein Surgery: Redo Surgery Doubles the Risk of SSI. Ann Vasc Surg 2015; 31:253-4. [PMID: 26597244 DOI: 10.1016/j.avsg.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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