1
|
Xu Y, Lin J, Gao JM, Yuan Y. Ultrasonographic assessment of the risk of free-floating thrombus detachment in the lower extremity deep veins in patients with fracture. Clin Imaging 2024; 115:110302. [PMID: 39317115 DOI: 10.1016/j.clinimag.2024.110302] [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: 05/23/2024] [Revised: 09/13/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE To explore the ultrasonographic features and influencing factors of free-floating thrombus (FFT) detachment in the lower extremity deep veins (LEDVs) of patients with fractures. METHODS Clinical data of patients diagnosed with FFT in the LEDVs and implanted with an inferior vena cava filter (IVCF) in our hospital between July 2021 and August 2023 were retrospectively analysed. The patients were divided into the thrombus detachment group (the experimental group, n = 92) and the non-thrombus detachment group (the control group, n = 103) based on the presence of detached thrombus in the IVCF. The effects of thrombus echogenicity, floating degree, thrombus location, thrombin time, D-dimer and fibrinogen on thrombus shedding were analysed. The nomogram method was used to establish the model and predict the probability of delayed postoperative recovery. RESULTS The proportions of patients with extremely hypoechoic thrombus and medium and high floating degrees increased in the experimental group compared with those in the control group, and the differences between the two groups were statistically significant (P < 0.05). Extremely hypoechoic thrombus (P = 0.021, 95 % CI: 1.109-13.748) and high (P = 0.001, 95 % CI: 3.854-28.573) and medium floating degrees (P = 0.004, 95 % CI: 1.792-13.453) were risk factors for deep veins FFT (DV FFT) detachment. The results of receiver operating characteristic curve analysis showed that the area under the curve of the model was 0.893, with a 95 % CI of 0.856-0.937, indicating a high prediction accuracy. CONCLUSION Ultrasonographic parameters, including thrombus echogenicity and floating degree, are valuable in predicting DV FFT detachment in patients with traumatic fractures, providing references for IVCF implantation.
Collapse
Affiliation(s)
- Yang Xu
- Department of Ultrasound, Tianjin Hospital, Tianjin 300211, China
| | - Jing Lin
- Department of Oncology, Xinjiang Medical University Affiliated Cancer Hospital, Urumqi 830017, China
| | - Jin-Mei Gao
- Department of Ultrasound, Tianjin Hospital, Tianjin 300211, China
| | - Yu Yuan
- Department of Ultrasound, Tianjin Hospital, Tianjin 300211, China.
| |
Collapse
|
2
|
Zieliński A, Jasińska-Sumińska K, Bręborowicz A, Kowalska K, Zabel M, Wysocka T, Khalil RA, Raffetto JD, Urbanek T. Changes of the serum properties and its effect on the endothelial cells restoration in patients with chronic venous disease treated with sulodexide. J Vasc Surg Venous Lymphat Disord 2024; 12:101941. [PMID: 38945361 DOI: 10.1016/j.jvsv.2024.101941] [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: 04/13/2024] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Inflammation and endothelial dysfunction are important venous changes in patients with chronic venous disease (CVD). The use of the venoactive drugs remains an important treatment modality for patients with CVD, reducing the severity of the CVD-related symptoms and swelling but also reducing inflammation and protecting endothelial cells. In this research, the effects of the serum obtained from patients with CVD before and after sulodexide treatment were evaluated for in vivo and in vitro inflammatory markers and endothelial cell function. METHODS Inflammatory markers (IL-6, matrix metalloproteinase-9 [MMP-9], vascular cell adhesion molecule-1 [VCAM-1], and von Willebrand factor [vWF]) from the incompetent great saphenous veins (GSVs) and from the systemic venous circulation were studied in 10 patients with CVD (C2s) before and after 2 months of sulodexide (2 × 500 lipasemic units/d) therapy. Serum obtained from the vein blood before and after sulodexide treatment was evaluated for in vitro cultured human umbilical vein endothelial cell function. RESULTS The serum collected from lower leg incompetent GSVs had significantly elevated levels of VCAM-1 (+29%, P < .001) compared with the serum from the systemic circulation. Endothelial cells exposed to the serum from the incompetent lower leg veins of the untreated CVD patients demonstrated higher stimulated synthesis of MMP-9 (+17%, P < .01), as well as increased markers of senescence (prolongation of population doubling time, β-galactosidase activity, and expression of p21 and p53 genes). CVD serum-induced senescent endothelial cells had a higher expression of genes regulating IL-6, MMP-9, VCAM-1, and vWF synthesis. The overall proinflammatory effect on endothelial cells by the serum collected from the incompetent GSVs was stronger as compared with the serum from the systemic circulation. Serum collected from the veins after sulodexide treatment caused lower levels of endothelial cell inflammatory markers as well as respective gene expression than serum obtained at the beginning of the study (before sulodexide treatment). Sulodexide application also reduced the inflammatory secretory activity of the senescent endothelial cells. Sulodexide treatment resulted in the decrease of the majority of the studied inflammatory parameters in both lower limb incompetent vein and systemic blood. CONCLUSIONS In patients with CVD, there are significant differences between circulating inflammatory markers analyzed from the lower leg incompetent GSV segments compared with the systemic circulation, indicating a higher inflammatory condition in CVD. Treatment with sulodexide reduces the proinflammatory and endothelial cell activation properties of the serum from patients with CVD. CLINICAL RELEVANCE The study documented the significant proinflammatory human vascular endothelial cell activation when exposed to the serum collected from the varicose veins as compared with the serum from the systemic circulation in patients with chronic venous disease (CVD). The inflammatory marker expression, endothelial dysfunction, and endothelial cell senescence transformation can be successfully controlled and downregulated by patients' exposure to the glycosaminoglycan (sulodexide) treatment. Further studies are needed to confirm if glycosaminoglycan application can prevent further CVD clinical progression due to potential CVD-related pathological processes' modulation and their downregulation.
Collapse
Affiliation(s)
- Adam Zieliński
- Section of Surgery, Vascular Surgery and Phlebology, doktorA Medical Center, Warsaw, Poland
| | | | - Andrzej Bręborowicz
- Department of Pathophysiology, Poznan University of Medical Sciences, Poznań, Poland; Department of Anatomy and Histology, University of Zielona Góra, Zielona Góra, Poland
| | - Katarzyna Kowalska
- Department of Histology and Embryology, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Zabel
- Department of Anatomy and Histology, University of Zielona Góra, Zielona Góra, Poland
| | - Teresa Wysocka
- Department of Anatomy and Histology, University of Zielona Góra, Zielona Góra, Poland
| | - Raouf A Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA
| | - Joseph D Raffetto
- VA Boston Healthcare System, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Tomasz Urbanek
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland.
| |
Collapse
|
3
|
Villalba LM, Bayat I, Dubenec S, Puckridge P, Thomas S, Varcoe R, Vasudevan T, Tripathi R. Review of the literature supporting international clinical practice guidelines on iliac venous stenting and their applicability to Australia and New Zealand practice. J Vasc Surg Venous Lymphat Disord 2024; 12:101843. [PMID: 38316289 DOI: 10.1016/j.jvsv.2024.101843] [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: 11/21/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The overall goal of this report is to provide a high-level, practical approach to managing venous outflow obstruction (VOO). METHODS A group of vascular surgeons from Australia and New Zealand with specific interest, training, and experience in the management of VOO were surveyed to assess current local practices. The results were analyzed and areas of disagreement identified. After this, the group performed a literature review of consensus guidelines published by leading international organizations focused on the management of chronic venous disease, namely, the Society for Vascular Surgery, American Venous Forum, European Society for Vascular Surgery, American Vein and Lymphatic Society, Cardiovascular and Interventional Radiology Society of Europe, and American Heart Association. These guidelines were compared against the consensus statements obtained through the surveys to determine how they relate to Australian and New Zealand practice. In addition, selected key studies, reviews, and meta-analyses on venous stenting were discussed and added to the document. A selection of statements with >75% agreement was voted on, and barriers to the guideline's applicability were identified. The final recommendations were further reviewed and endorsed by another group of venous experts. RESULTS The document addresses two key areas: patient selection and technical aspects of venous stenting. Regarding patient selection, patients with clinically relevant VOO, a Clinical-Etiologic-Anatomic-Physiologic score of ≥3 or a Venous Clinical Severity Score for pain of ≥2, or both, including venous claudication, with evidence of >50% stenosis should be considered for venous stenting (Level of Recommendation Ib). Patients with chronic pelvic pain, deep dyspareunia, postcoital pain affecting their quality of life, when other causes have been ruled out, should also be considered for venous stenting (Level of Recommendation Ic). Asymptomatic patients should not be offered venous stenting (Level of Recommendation IIIc). Patients undergoing thrombus removal for acute iliofemoral deep vein thrombosis, in whom a culprit stenotic lesion of >50% has been uncovered, should be considered for venous stenting (Level of Recommendation Ib). CONCLUSIONS Patients with VOO have been underdiagnosed and undertreated for decades; however, in recent years, interest from physicians and industry has grown substantially. International guidelines aimed at developing standards of care to avoid undertreating and overtreating patients are applicable to Australia and New Zealand practice and will serve as an educational platform for future developments.
Collapse
Affiliation(s)
- Laurencia Maria Villalba
- Vascular Surgery, University of Wollongong, Wollongong, New South Wales, Australia; Vascular Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia.
| | - Iman Bayat
- Vascular Surgery, The Northern Hospital, Melbourne, Victoria, Australia
| | - Steven Dubenec
- Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Philip Puckridge
- Vascular Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Shannon Thomas
- Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ramon Varcoe
- Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia; Vascular Surgery, University of New South Wales, Sydney, Australia
| | | | - Ramesh Tripathi
- Vascular Surgery, University of Queensland, Brisbane, Australia
| |
Collapse
|
4
|
Guven H. Fluid dynamics and venous hemodynamics in the lower extremities. VASA 2024; 53:308-313. [PMID: 39141365 DOI: 10.1024/0301-1526/a001141] [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: 08/15/2024]
Abstract
Chronic venous disease is a vascular disorder characterized by impaired venous return and a progressive dysfunction of the venous system. Pathological reflux can occur due to abnormal dilation and weakening of the vein wall. The circulatory system is a natural structure in which physical laws, such as the law of closed containers and gravity, operate. The malfunctions in the system also adhere to these laws of nature. This article explains how the principles of fluid dynamics apply to the flow of blood in the veins of the legs. I am discussing the principles of Pascal's law, Torricelli's law, Bernoulli's law, and Poiseuille's law, and how they are relating to the anatomy and physiology of the venous system.
Collapse
Affiliation(s)
- Hakan Guven
- Department of Cardiovascular Surgery, Heart an Arrythmia Hospital, Bursa, Turkey
| |
Collapse
|
5
|
Wasan S. Chronic Venous Insufficiency Evaluation and Medical Management. Curr Cardiol Rep 2024:10.1007/s11886-024-02119-1. [PMID: 39215951 DOI: 10.1007/s11886-024-02119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW This review will focus on comprehensive evaluation of chronic venous insufficiency (CVI), nuances in diagnostic testing and advances in medical therapies to provide improvement in patient specific outcomes. RECENT FINDINGS Chronic venous insufficiency of the lower extremities represents an often underrecognized source of morbidity. Comprehensive evaluation focuses on personal and family history of deep vein thrombosis and varicose veins. Diagnostic testing is initially with a thorough duplex ultrasound, but advanced imaging with CT scan and MRV may be indicated in selected patients who might benefit from more invasive intervention. Compression therapy, wraps and garments, remains the mainstay of conservative therapy for patients with CVI. In addition, there is renewed interest in lifestyle and nutritional supplements, most commonly micronized purified flavanoid fraction (MPFF), in relieving symptoms and preventing morbidity. A holistic approach to patients with CVI provides the best opportunity for enduring improvement in quality of life.
Collapse
Affiliation(s)
- Suman Wasan
- Department of Medicine, University of North Carolina, Rex Vascular Specialists UNC Health, 4414 Lake Boone Trail, Suite 505, Chapel Hill, NC, 27607, USA.
| |
Collapse
|
6
|
Galanaud JP, Krebs-Drouot L, Genty-Vermorel C, Geerts W, Abdulrehman J, Blaise S, Böge G, Carpentier P, Rolland C, Sevestre-Pietri MA, Pernod G, Giai J, Bosson JL. Very long-term risk of moderate-to-severe postthrombotic syndrome after deep vein thrombosis. J Thromb Haemost 2024:S1538-7836(24)00438-0. [PMID: 39122193 DOI: 10.1016/j.jtha.2024.07.020] [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: 01/30/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Postthrombotic syndrome (PTS) refers to manifestations of chronic venous insufficiency after a deep vein thrombosis (DVT). The risk of developing moderate-to-severe PTS in the very long term is largely unknown and particularly in case of distal DVT. Furthermore, the impact of DVT vs other causes of chronic venous insufficiency on long-term manifestations of PTS is also unknown. OBJECTIVES To assess the very long-term risk of moderate-to-severe PTS after DVT and the role that DVT plays in PTS symptoms. METHODS Patients with lower-limb DVT enrolled in the multicenter Optimisation de l'interrogatoire dans l'evaluation du risque thromboembolique veineux (OPTIMEV) study underwent a very long-term telephone follow-up. We assessed i) the proportion of moderate-to-severe PTS (assessed with the patient-reported Villalta score) according to DVT extent and ii) the population attributable fraction that DVT plays in patients' moderate-to-severe PTS manifestations. RESULTS Fourteen years after DVT, moderate-to-severe PTS developed in 35 of 185 patients with distal DVT (18.9%; 95% CI, 13.5%-25.3%), 11 of 47 patients with popliteal DVT (23.4%; 95% CI, 12.3%-38.0%), and 27 of 74 patients with iliofemoral DVT (36.5%; 95% CI, 25.6%-48.5%). The population attributable fraction of DVT in moderate-to-severe symptoms of PTS was 25.7% (-18.1% to 53.3%) in patients with distal DVT, 27.3% (-63.7% to 67.7%) in patients with popliteal DVT, and 43.1% (+0.7%-67.4%) in patients with iliofemoral DVT. CONCLUSION In the very long term after DVT, a quarter of patients have moderate-to-severe PTS manifestations. However, the impact of the DVT on these manifestations appears nonpredominant and varies according to DVT extent. Distal DVT does not significantly increase the risk of developing moderate-to-severe PTS.
Collapse
Affiliation(s)
- Jean-Philippe Galanaud
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
| | - Lila Krebs-Drouot
- University Grenoble-Alpes, Centre National de Recherche en Sante, Department of Public Health, Grenoble-Alpes University Hospital and, Technique de l Imagerie Medicale et de la Complexite, Grenoble, France
| | - Céline Genty-Vermorel
- University Grenoble-Alpes, Centre National de Recherche en Sante, Department of Public Health, Grenoble-Alpes University Hospital and, Technique de l Imagerie Medicale et de la Complexite, Grenoble, France
| | - William Geerts
- Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Jameel Abdulrehman
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Gudrun Böge
- Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France
| | - Patrick Carpentier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Carole Rolland
- University Grenoble-Alpes, Centre National de Recherche en Sante, Department of Public Health, Grenoble-Alpes University Hospital and, Technique de l Imagerie Medicale et de la Complexite, Grenoble, France
| | | | - Gilles Pernod
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Joris Giai
- University Grenoble-Alpes, Centre National de Recherche en Sante, Department of Public Health, Grenoble-Alpes University Hospital and, Technique de l Imagerie Medicale et de la Complexite, Grenoble, France
| | - Jean-Luc Bosson
- University Grenoble-Alpes, Centre National de Recherche en Sante, Department of Public Health, Grenoble-Alpes University Hospital and, Technique de l Imagerie Medicale et de la Complexite, Grenoble, France
| |
Collapse
|
7
|
Anuforo A, Evbayekha E, Agwuegbo C, Okafor TL, Antia A, Adabale O, Ugoala OS, Okorare O, Phagoora J, Alagbo HO, Shamaki GR, Disreal Bob-Manuel T. Superficial Venous Disease-An Updated Review. Ann Vasc Surg 2024; 105:106-124. [PMID: 38583765 DOI: 10.1016/j.avsg.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND This review article provides an updated review of a relatively common pathology with various manifestations. Superficial venous diseases (SVDs) are a broad spectrum of venous vascular disease that predominantly affects the body's lower extremities. The most serious manifestation of this disease includes varicose veins, chronic venous insufficiency, stasis dermatitis, venous ulcers, superficial venous thrombosis, reticular veins, and spider telangiectasias. METHODS The anatomy, pathophysiology, and risk factors of SVD were discussed during this review. The risk factors for developing SVD were related to race, age, sex, lifestyle, and certain genetic conditions as well as comorbid deep vein thrombosis. Various classification systems were listed, focusing on the most common one-the revised Clinical-Etiology-Anatomy-Pathophysiology classification. The clinical features including history and physical examination findings elicited in SVD were outlined. RESULTS Imaging modalities utilized in SVD were highlighted. Duplex ultrasound is the first line in evaluating SVD but magnetic resonance imaging and computed tomography venography, plethysmography, and conventional venography are feasible options in the event of an ambiguous venous duplex ultrasound study. Treatment options highlighted in this review ranged from conservative treatment with compression stockings, which could be primary or adjunctive to pharmacologic topical and systemic agents such as azelaic acid, diuretics, plant extracts, medical foods, nonsteroidal anti-inflammatory drugs, anticoagulants and skin substitutes for different stages of SVD. Interventional treatment modalities include thermal ablative techniques like radiofrequency ablationss, endovenous laser ablation, endovenous steam ablation, and endovenous microwave ablation as well as nonthermal strategies such as the Varithena (polidocanol microfoam) sclerotherapy, VenaSeal (cyanoacrylate) ablation, and Endovenous mechanochemical ablation. Surgical treatments are also available and include debridement, vein ligation, stripping, and skin grafting. CONCLUSIONS SVDs are prevalent and have varied manifestations predominantly in the lower extremities. Several studies highlight the growing clinical and financial burden of these diseases. This review provides an update on the pathophysiology, classification, clinical features, and imaging findings as well as the conservative, pharmacological, and interventional treatment options indicated for different SVD pathologies. It aims to expedite the timely deployment of therapies geared toward reducing the significant morbidity associated with SVD especially varicose veins, venous ulcers, and venous insufficiency, to improve the quality of life of these patients and prevent complications.
Collapse
Affiliation(s)
- Anderson Anuforo
- Internal Medicine, SUNY Upstate Medical University, Syracuse, NY.
| | | | - Charles Agwuegbo
- Internal Medicine Resident, Temecula Valley Hospital, Temecula, CA
| | - Toochukwu Lilian Okafor
- Internal Medicine Resident, Quinnipiac University, Frank H Netter MD School of Medicine/St Vincent's Medical Center, North Haven, CT
| | - Akanimo Antia
- Internal Medicine Resident, Lincoln Medical and Mental Health Center, Bronx, NY
| | | | - Onyinye Sylvia Ugoala
- Internal Medicine Resident, Texas Tech University Health Sciences Center, Amarillo, TX
| | - Ovie Okorare
- Internal Medicine Resident, Nuvance Health Vassar brothers Medical Center, Poughkeepsie, NY
| | - Jaskomal Phagoora
- Internal Medicine Resident, Touro College of Osteopathic Medicine, Harlem, NY
| | - Habib Olatunji Alagbo
- Internal Medicine Resident, V. N. Karazin Kharkiv National University, School of Medicine, Kharkiv, Ukraine
| | | | | |
Collapse
|
8
|
Kienzl P, Deinsberger J, Weber B. Chronic Venous Disease: Pathophysiological Aspects, Risk Factors, and Diagnosis. Hamostaseologie 2024; 44:277-286. [PMID: 38991541 DOI: 10.1055/a-2315-6206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Chronic venous disease (CVD) is highly prevalent in the general population and encompasses a range of pathological and hemodynamic changes in the veins of the lower extremities. These alterations give rise to a variety of symptoms, with more severe forms resulting in venous ulceration, which causes morbidity and high socioeconomic burden. The origins and underlying mechanisms of CVD are intricate and multifaceted, involving environmental factors, genetics, hormonal factors, and immunological factors that bring about structural and functional alterations in the venous system. This review offers the latest insights into the epidemiology, pathophysiology, and risk factors of CVD, aiming to provide a comprehensive overview of the current state of knowledge. Furthermore, the diagnostic approach for CVD is highlighted and current diagnostic tools are described.
Collapse
Affiliation(s)
- Philip Kienzl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
9
|
Chao S, Kuan C, Lin Y, Tai H, Cheng N. Lymphovenous Bypass as an Alternative Strategy for Managing Phleboedema and Venous Leg Ulcers: Preliminary Results. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6064. [PMID: 39148508 PMCID: PMC11326461 DOI: 10.1097/gox.0000000000006064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/21/2024] [Indexed: 08/17/2024]
Abstract
Background Chronic venous leg ulcers (VLUs) are a common manifestation of chronic venous insufficiency, accounting for up to 70% of all chronic leg ulcers. Patients sustained refractory ulcers and persistent phleboedema even with a combination of different treatment methods. Lymphovenous bypass (LVB) has shown promising results in patients with lymphedema. We hypothesize that LVB could potentially alleviate VLUs and phleboedema, given their symptom similarities with lymphedema. Methods From May 2021 to June 2023, we prospectively deployed LVB in patients with nonhealing stasis ulcers after 4-week traditional care, or in those with persistent phleboedema despite prior surgery for vein etiologies. Demographics, healing course and recurrence, lymphoscintigraphy, and VLU quality of life (QoL) questionnaires were collected. Results Thirty-one patients were treated with LVB and additional skin grafting as necessary. Their mean age was 62.6 ± 14.7 years, with male predominance (20, 64.5%), and most patients sustained clinical, etiologic, anatomic, pathophysiologic classification C6 (25, 80.6%). Postoperatively, wound healing and phleboedema decongestion were observed mostly within 2 months. The VLU QoL questionnaire (39.3% response rate) showed improvement in QoL in activities, and psychological and symptom distress aspects. Conclusions Using LVB for chronic venous insufficiency showed an increase in the success rate of ulcer healing and decompression of the swollen limbs with durable results. Patient-reported outcome measures disclosed the potential benefits of LVB. Large-scale randomized controlled trials and pathophysiological studies are warranted to elucidate its efficacy.
Collapse
Affiliation(s)
- Sungchuan Chao
- From the Department of Traumatology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chenhisang Kuan
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yingsheng Lin
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Yunlin, Taiwan
| | - Haochih Tai
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Naichen Cheng
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
10
|
Guven H. Effect of Micronized Purified Flavonoid Fraction on Venous Hemodynamics Evaluated Using Digital Photoplethysmography in Patients with Chronic Venous Disease. Ann Vasc Surg 2024; 109:284-290. [PMID: 39025225 DOI: 10.1016/j.avsg.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/20/2024] [Accepted: 06/09/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Micronized purified flavonoid fraction (MPFF) is the most widely prescribed and well-studied venoactive drug available for the treatment of chronic venous disease (CVD). Photoplethysmography (PPG) is used to quantitatively measure venous hemodynamics and provide information about the overall function of the venous system. The aim of this study was to use digital PPG to evaluate the effects of MPFF on venous hemodynamics in patients with CVD. METHODS Patients diagnosed with CVD at an outpatient clinic in Bursa, Turkey between February 2018 and July 2020 were assessed for inclusion in this retrospective analysis. Patients who complied with the advised treatment strategy (MPFF 1,000 mg tablets taken orally once daily and compression garments) and attended follow-up visits were included in the analysis. Digital PPG was used to measure venous refilling time (VRT) and venous pumping capacity (VPC) at diagnosis and 6 months of follow-up. The Venous Clinical Severity Score (VCSS) was also obtained at these visits, and patients completed the 20-item Chronic Venous Insufficiency Questionnaire (CIVIQ-20). RESULTS In total, 721 patients (mean age 52 years) with C0-C4 CVD were included in the study. PPG showed that VRT and VPC increased significantly from 19.0 sec to 2.0%, respectively, at diagnosis to 27.4 and 4.9%, respectively, at 6 months (both P < 0.05). Mean VCSS improved significantly from 7.9 at diagnosis to 3.1 at 6 months (P < 0.05). Mean CIVIQ-20 score also improved significantly at the 6-month follow-up (20.1 vs 38.6 at diagnosis; P < 0.01). CONCLUSIONS In patients with C0-C4 CVD, 6 months of MPFF treatment plus the wearing of compression garments was associated with statistically significant improvements in venous hemodynamic parameters measured by PPG, as well as measures of clinical severity and quality of life.
Collapse
Affiliation(s)
- Hakan Guven
- Cardiovascular Surgery Department, Bursa Heart and Arrhythmia Hospital, Bursa, Turkey.
| |
Collapse
|
11
|
Yoo KC, Park HS, Shin CS, Lee T. The Incidence and Characteristics of Pelvic-Origin Varicosities in Patients with Complex Varices Evaluated by Ultrasonography. Tomography 2024; 10:1159-1167. [PMID: 39058060 PMCID: PMC11280516 DOI: 10.3390/tomography10070088] [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: 06/11/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the incidence of gonadal vein refluxes associated with lower-extremity varicose veins with Doppler ultrasonography (DUS). METHOD A total of 6279 patients with venous disease-related symptoms of the lower extremity were evaluated with DUS in the vascular lab. Gonadal vein reflux using abdominal ultrasound was further evaluated in patients with unusual varices, defined as varices in the inguinal, inner or upper thigh and the vulvar area without refluxes in the saphenofemoral junction (SPJ). Those patients who showed gonadal vein reflux were diagnosed as having pelvic-origin varicosity. RESULTS Unusual varices were found in a total of 237 patients (3.8%), and of these patients, pelvic-origin varicosity was discovered with transabdominal ultrasound in 156 (65.8%). A total of 66.7% (n = 38/57) of unusual varix patients with pelvic pain had gonadal vein reflux. The measurement of gonadal vein diameter was larger in ultrasonography than CT scans (8.835 vs. 8.81, p < 0.001). Two patients with severe symptoms but no obstructive venous diseases were treated with gonadal vein embolization. CONCLUSION The incidence of pelvic-origin varicosities was 2.5% (n = 156/6279). However, more than half of the patients with unusual varices had gonadal vein reflux and 24.4% of these patients also presented with pelvic pain. The evaluation of pelvic-origin varicosities should be performed in patients who present with unusual forms of varices of the lower extremity.
Collapse
Affiliation(s)
- Kwon Cheol Yoo
- College of Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea;
- Department of Surgery, Chungbuk National University Hospital, Cheongju 28644, Republic of Korea
| | - Hyung Sub Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Surgery, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Chang Sik Shin
- Department of Surgery, Uijeongbu Eulji Medical Center, Uijeongbu 11759, Republic of Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
- Department of Surgery, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| |
Collapse
|
12
|
Kedwai BJ, Geiger JT, Lehane DJ, Glocker RJ, Newhall KA, Pitcher GS, Ellis JL, Doyle AJ. Strategies to reduce rates of severe endothermal heat-induced thrombosis following radiofrequency ablation. J Vasc Surg Venous Lymphat Disord 2024; 12:101864. [PMID: 38518986 DOI: 10.1016/j.jvsv.2024.101864] [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: 11/15/2023] [Revised: 01/31/2024] [Accepted: 02/22/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Endothermal heat-induced thrombosis (EHIT) is a potential complication of radiofrequency ablation (RFA). Data on effective prophylaxis of EHIT are limited. In 2018, a high-volume, single institution implemented strategies to decrease the incidence of EHIT, including a single periprocedural prophylactic dose of low-molecular-weight heparin to patients with a great saphenous vein (GSV) diameter of ≥8 mm or saphenofemoral junction (SFJ) diameter of ≥10 mm and limiting treatment to one vein per procedure. The size threshold was derived from existing literature. The study objective was to evaluate the effects of these institutional changes on thrombotic complication rates after RFA. METHODS A retrospective cohort control study was conducted using the Vascular Quality Initiative database. Data were collected for patients who underwent RFA with a GSV diameter of ≥8 mm or SFJ diameter of ≥10 mm from January 2015 to July 2022. The clinical end points were thrombotic complications (ie, thrombophlebitis, EHIT, deep vein thrombosis) and bleeding complications. Patient demographic and procedural variables were included in the analysis, and significant variables after univariable logistic regression were included in a multivariable logistic regression. RESULTS After the policy change, the overall vein center EHIT rate decreased from 2.6% to 1.5%, with a trend toward significance (P = .096). The inclusion criterion of a GSV diameter of ≥8 mm or an SFJ diameter of ≥10 mm yielded 845 patients, of whom 298 were treated before the policy change and 547 after. There was a significant reduction in the rate of EHIT classified as class ≥III (2.34 vs 0.366; P = .020) after the institutional changes. Treatment of two or more veins and an increased vein diameter were associated with an increased risk of EHIT (P = .049 and P < .001, respectively). No significant association was found between periprocedural anticoagulation and all-cause thrombotic complications or EHIT (P = .563 and P = .885, respectively). CONCLUSIONS The institutional policy changes have led to lower rates of EHIT, with a reduction in severe EHIT rates in patients with an ≥8-mm diameter GSV or a ≥10-mm diameter SFJ treated with RFA. Of the changes implemented, restricting treatment to one vein was associated with a reduction in severe EHIT. No association was found with periprocedural low-molecular-weight heparin, although a type 2 error might have occurred. Alternative strategies to prevent thrombotic complications should be explored, such as increasing the dosage and duration of periprocedural anticoagulation, antiplatelet use, and nonpharmacologic strategies.
Collapse
Affiliation(s)
- Baqir J Kedwai
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Joshua T Geiger
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Daniel J Lehane
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Roan J Glocker
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Karina A Newhall
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Grayson S Pitcher
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Jennifer L Ellis
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY
| | - Adam J Doyle
- Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY.
| |
Collapse
|
13
|
Chan SM, Tabari A, Rudié E, D'Amore B, Cox M, Mugahid A, Iqbal S, Daye D. Disparities in access to endovenous treatment options in chronic lower extremity superficial venous insufficiency: A national 7-year analysis. J Vasc Surg Venous Lymphat Disord 2024; 12:101867. [PMID: 38452897 DOI: 10.1016/j.jvsv.2024.101867] [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: 06/21/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The goal of this study was to analyze trends in treatment access for chronic superficial venous disease and to identify disparities in care. METHODS This retrospective study was exempt from institutional review board approval. The American College of Surgeon National Surgical Quality Improvement Program database was used to identify patients who underwent vein stripping (VS) and endovenous procedures for treatment of chronic superficial venous disease. Endovenous options included radiofrequency ablation (RFA) and laser ablation. Data was available from 2011 to 2018 and demographic information was extracted for each patient identified by Current Procedural Terminology codes. For all racial and ethnic groups, trend lines were plotted, and the relative rate of change was determined within each specified demographic. RESULTS There were 21,025 patients included in the analysis. The overall mean age was 54.2 years, and the majority of patients were female (64.8%). In total, 27.9%, 55.2%, and 16.9% patients underwent VS, RFA, and laser ablation, respectively. Patients who received laser ablation were older (P < .001). Hispanic ethnicity was associated with significantly lower odds of receiving endovascular thermal ablation (EVTA) over VS (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.64-0.78; P < .001). American Indian/Alaska Native patients were more likely to receive EVTA over VS (OR, 4.02; 95% CI, 2.48-6.86); similarly, Native Hawaiian/Pacific Islander patients were more likely to receive EVTA over VS, although this difference was not statistically significant (OR, 1.44; 95% CI, 0.93-2.27). On multinomial regression, Hispanic patients were less likely to receive RFA over VS, whereas American Indian/Alaskan Native patients were more likely to receive RFA over VS. In all racial and ethnic groups, the percentage of endovenous procedures increased, whereas vein stripping decreased. CONCLUSIONS Based on a hospital-based dataset, demographic indicators, including age, sex, race, and ethnicity, are associated with differences in endovenous treatments for chronic superficial venous insufficiency suggesting disparities in obtaining minimally invasive treatment options among certain patient groups.
Collapse
Affiliation(s)
- Shin Mei Chan
- UCSF Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Emma Rudié
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brian D'Amore
- Drexel University College of Medicine, Philadelphia, PA
| | - Meredith Cox
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Duke University School of Medicine, Durham, NC
| | - Ayah Mugahid
- UCSF Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA
| | - Shams Iqbal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Türkmen U. Single-center clinical experience of cyanoacrylate embolization method for incompetent perforating veins in treating CEAP-6 patients. J Vasc Surg Venous Lymphat Disord 2024:101939. [PMID: 38960130 DOI: 10.1016/j.jvsv.2024.101939] [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: 02/17/2024] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE The most severe form of chronic venous insufficiency includes venous leg ulcers in the CEAP-6 stage. The aim of this study is to evaluate the relationship between incompetent perforator veins occluding with cyanoacrylate and closure of perforator veins and healing of venous leg ulcers in patients at the CEAP-6 stage. METHODS A total of 187 patients who underwent cyanoacrylate application to incompetent perforator veins due to venous leg ulcers from 2018 to 2021 were retrospectively reviewed. Twelve months after the procedure, patients were evaluated for perforator vein closure, ulcer diameter, and Venous Clinical Severity Scale. Receiver operating characteristic analysis was used to estimate the probability of postoperative nonocclusion of the perforating vein based on the preoperative ulcers' diameters and the perforating veins' mean diameters. Univariate and multivariate binary logistic regression analyses were conducted to identify the risk factors associated with incomplete closure of the perforating vein. RESULTS At the 12 months, 87.1% of patients experienced incompetent perforator veins closure, leading to complete healing of venous leg ulcers. Preoperative ulcer diameter significantly decreased from 7.20 ± 3.48 cm2 to 0.28 ± 0.77 cm2 after the procedure (P < .001). On average, 3.5 ± 1.01 perforating veins were treated, with a diameter of 4.09 ± 0.41 mm. No postoperative paresthesia or deep vein thrombosis occurred. Preoperative Venous Clinical Severity Scale scores decreased significantly from 17.85 ± 3.06 to 8.03 ± 3.53 postoperatively (P < .001). Patients with nonoccluded perforating veins had larger preoperative ulcer diameters (13.77 ± 1.78 cm2) than those with occluded perforating veins (6.24 ± 2.47 cm2; P < .001). The mean perforating vein diameter was also larger in nonoccluded perforating veins patients (4.45 ± 0.41 mm) than in occluded perforating veins patients (4.04 ± 0.38 mm; P < .001). The sensitivity, specificity, and accuracy of the preoperative ulcer diameter cutoff point of 11.25 cm2 for the possibility of postoperative nonocclusion of perforating veins were 100% each. In contrast, those for the preoperative mean perforating vein diameter cutoff point of 4.15 mm were determined as 66.7%, 79.1%, and 77.5%, respectively. The presence of diabetes mellitus increased the likelihood of incompetent perforator veins, remaining open by 3.4 times (95% confidence interval: 1.11-10.44; P = .032), whereas a 1 mm larger mean perforating vein diameter increased this likelihood by 9.36 times (95% confidence interval: 3.47-25.29; P < .001). CONCLUSIONS This study demonstrates that occlusion of incompetent perforator veins with cyanoacrylate is effective, safe, and associated with low complication rates in CEAP-6 patients. The findings support that cyanoacrylate occlusion of perforator veins may be a valuable option in the treatment of venous leg ulcers.
Collapse
Affiliation(s)
- Ufuk Türkmen
- Department of Cardiovascular Surgery, Hitit University Faculty of Medicine, Corum, Türkiye.
| |
Collapse
|
15
|
Yosipovitch G, Jackson JM, Nedorost ST, Friedman AJ, Adiri R, Cha A, Canosa JM. Stasis Dermatitis: The Burden of Disease, Diagnosis, and Treatment. Dermatitis 2024; 35:337-344. [PMID: 37782143 DOI: 10.1089/derm.2022.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Stasis dermatitis (SD), an inflammatory dermatosis occurring on the lower extremities, is a cutaneous manifestation of chronic venous insufficiency (CVI). SD is associated with a significant burden of disease. Symptoms such as pain, swelling, and itching can be debilitating for patients, leading to poor sleep, loss of mobility, and the inability to perform daily activities, and can interfere with work and leisure activities. Moreover, SD is a progressive disease with serious secondary complications such as ulcerations, which increase the patients' morbidity, reduce their quality of life, and increase health care burden. Challenges in diagnosing patients may have both short- and long-term sequalae for the patients due to unnecessary treatment and management. In addition, misdiagnosis may result in hospitalizations, placing additional burden on health care professionals in terms of time and financial burden on the health care system. Compression therapy and leg elevation represent the mainstay of treatment for CVI; however, it is also difficult to self-manage, which places a substantial burden on patients and caregivers. Moreover, compression therapy may cause discomfort and exacerbate itching. Subsequent nonadherence may result in disease progression that places additional burden on the physicians who manage these patients and the health care system in terms of resources required and costs incurred. A large proportion of patients with SD develop allergic contact dermatitis because of innate immune signals and altered skin barrier predisposing to sensitization to topical prescriptions, over-the-counter medications, and compression devices used to treat SD. Other than topical corticosteroids, there are no approved pharmacological options to treat inflammation in SD.
Collapse
Affiliation(s)
- Gil Yosipovitch
- From the Miami Itch Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - J Mark Jackson
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Susan T Nedorost
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Adam J Friedman
- George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Roni Adiri
- Pfizer Pharmaceuticals Ltd., Herzliya Pituah, Israel
| | - Amy Cha
- Pfizer Inc., New York, New York, USA
| | | |
Collapse
|
16
|
Ghorbanzadeh A, Abud A, Liedl D, Rooke T, Wennberg P, Wysokinski W, McBane R, Houghton DE. Reduced calf muscle pump function is not explained by handgrip strength measurements. J Vasc Surg Venous Lymphat Disord 2024; 12:101869. [PMID: 38460817 DOI: 10.1016/j.jvsv.2024.101869] [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: 11/17/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Reduced calf muscle pump function (CPF) is an independent risk factor for venous thromboembolism and mortality. We aimed to evaluate the relationship between handgrip strength (HGS) and CPF. METHODS Patients referred to the Gonda Vascular Laboratory for noninvasive venous studies were identified and consented. Patients underwent standard venous air plethysmography protocol. CPF (ejection fraction) was measured in each lower extremity of ambulatory patients by comparing refill volume after ankle flexes and passive refill volumes. The cutoff for reduced CPF (rCPF) was defined as an ejection fraction of <45%. Maximum HGS bilaterally was obtained (three trials per hand) using a dynamometer. HGS and CPF were compared (right hand to calf, left hand to calf) and the correlation between the measures was evaluated. RESULTS 115 patients (mean age, 59.2 ± 17.4 years; 67 females, mean body mass index, 30.83 ± 6.46) were consented and assessed for HGS and CPF. rCPF was observed in 53 right legs (46%) and 67 left legs (58%). CPF was reduced bilaterally in 45 (39%) and unilaterally in 30 (26%) patients. HGS was reduced bilaterally in 74 (64.3%), unilaterally in 23 (20%), and normal in 18 (15.7%) patients. Comparing each hand/calf pair, no significant correlations were seen between HGS and CPF. The Spearman's rank correlation coefficients test yielded values of 0.16 for the right side and 0.10 for the left side. CONCLUSIONS There is no significant correlation between HGS and CPF, demonstrating that HGS measurements are not an acceptable surrogate for rCPF, indicating different pathophysiological mechanisms for each process.
Collapse
Affiliation(s)
- Atefeh Ghorbanzadeh
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Abdi Abud
- University of Missouri-Columbia School of Medicine, Columbia, MO
| | - David Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Thom Rooke
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Paul Wennberg
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Waldemar Wysokinski
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Robert McBane
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Damon E Houghton
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Mayo Clinic, Rochester, MN; Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
17
|
Pisharody VA, West AB, Rajani RR, Ramos C, Garcia-Toca M, Benarroch-Gampel J. Vein diameter, obesity, and rates of recanalization after mechanochemical ablation. J Vasc Surg Venous Lymphat Disord 2024:101935. [PMID: 38945360 DOI: 10.1016/j.jvsv.2024.101935] [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: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE A large vein diameter is associated with higher recanalization rates after endovenous thermal ablation procedures of the great saphenous vein (GSV) and small saphenous vein (SSV). However, relatively few studies have explored the relationship between vein diameter and recanalization rates after mechanochemical ablation (MOCA). METHODS We conducted a retrospective review of patients with chronic venous insufficiency who underwent MOCA of the GSV or SSV from 2017 to 2021 at a single hospital. Patients with no follow-up ultrasound examination were excluded. Patients were classified as having a large (≥1 cm) or small (<1 cm) treated vein. The primary outcomes were 2-year recanalization and reintervention of the treated segment. RESULTS A total of 186 MOCA procedures during the study period were analyzed. There was no differences in age, gender, history of venous thromboembolic events, use of anticoagulation, obesity, or length of treated segment between the cohorts. Patients with large veins were less likely to have stasis ulcers compared with those with small veins (3.2% vs 21.5%; P < .05 on Fisher exact test). Patients with large veins had a higher incidence of postoperative local complications (24.2% vs 7.2%, P < .05 on χ2 test). A survival analysis with Cox proportional hazards showed no significant difference in recanalization rates with larger vein diameters. However, obesity was found to correlate significantly with recanalization. CONCLUSIONS A large vein diameter was not associated with higher recanalization rates after MOCA of the GSVs and SSVs. However, obesity was found to correlate with recanalization rates.
Collapse
Affiliation(s)
| | - Anna Beth West
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Ravi R Rajani
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Christopher Ramos
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Manuel Garcia-Toca
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Jaime Benarroch-Gampel
- Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
| |
Collapse
|
18
|
Zalewski D, Chmiel P, Kołodziej P, Kocki M, Feldo M, Kocki J, Bogucka-Kocka A. Key Regulators of Angiogenesis and Inflammation Are Dysregulated in Patients with Varicose Veins. Int J Mol Sci 2024; 25:6785. [PMID: 38928491 PMCID: PMC11204110 DOI: 10.3390/ijms25126785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Varicose veins (VVs) are the most common manifestation of chronic venous disease (CVD) and appear as abnormally enlarged and tortuous superficial veins. VVs result from functional abnormalities in the venous circulation of the lower extremities, such as venous hypertension, venous valve incompetence, and venous reflux. Previous studies indicate that enhanced angiogenesis and inflammation contribute to the progression and onset of VVs; however, dysregulations in signaling pathways associated with these processes in VVs patients are poorly understood. Therefore, in our study, we aimed to identify key regulators of angiogenesis and inflammation that are dysregulated in patients with VVs. Expression levels of 18 genes were analyzed in peripheral blood mononuclear cells (PBMC) using real-time PCR, as well as plasma levels of 6 proteins were investigated using ELISA. Higher levels of CCL5, PDGFA, VEGFC, TGF-alpha, TGF-beta 1, and VEGF-A, as well as lower levels of VEGFB and VEGF-C, were found to be statistically significant in the VV group compared to the control subjects without VVs. None of the analyzed factors was associated with the venous localization of the varicosities. The presented study identified dysregulations in key angiogenesis- and inflammation-related factors in PBMC and plasma from VVs patients, providing new insight into molecular mechanisms that could contribute to the development of VVs and point out promising candidates for circulatory biomarkers of this disease.
Collapse
Affiliation(s)
- Daniel Zalewski
- Chair and Department of Biology and Genetics, Medical University of Lublin, 4a Chodźki St., 20-093 Lublin, Poland; (P.C.); (A.B.-K.)
| | - Paulina Chmiel
- Chair and Department of Biology and Genetics, Medical University of Lublin, 4a Chodźki St., 20-093 Lublin, Poland; (P.C.); (A.B.-K.)
| | - Przemysław Kołodziej
- Laboratory of Diagnostic Parasitology, Chair and Department of Biology and Genetics, Medical University of Lublin, 4a Chodźki St., 20-093 Lublin, Poland;
| | - Marcin Kocki
- Department of Neonatology and Neonatal Intensive Care, Independent Public Hospital No. 4 in Lublin, 8 Jaczewski St., 20-954 Lublin, Poland;
| | - Marcin Feldo
- Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, 11 Staszica St., 20-081 Lublin, Poland;
| | - Janusz Kocki
- Department of Clinical Genetics, Chair of Medical Genetics, Medical University of Lublin, 11 Radziwiłłowska St., 20-080 Lublin, Poland;
| | - Anna Bogucka-Kocka
- Chair and Department of Biology and Genetics, Medical University of Lublin, 4a Chodźki St., 20-093 Lublin, Poland; (P.C.); (A.B.-K.)
| |
Collapse
|
19
|
Drago SFA, Rottura M, Molonia A, Gianguzzo VM, Pallio G, Irrera N, Orlando L, De Fazio MG, Isgrò M, Zirilli N, Arcoraci V, Imbalzano E. Effects of a Dietary Supplement Composed of Baicalin, Bromelain and Escin for Venous Chronic Insufficiency Treatment: Insights from a Retrospective Observational Study. Pharmaceuticals (Basel) 2024; 17:779. [PMID: 38931445 PMCID: PMC11206508 DOI: 10.3390/ph17060779] [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: 04/12/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic venous insufficiency (CVI) represents a risk factor for cardiovascular events. The first-line treatment includes the use of compression stockings and lifestyle changes. Natural products, such as flavonoids, could be used to improve the effects of compression therapy due to their anti-inflammatory and anti-oxidant properties. This study aims to evaluate the effects of a dietary supplement containing baicalin, bromeline and escin in CVI patients. A retrospective cohort study was performed by using the medical records of CVI affected outpatients. Patients treated with the dietary supplement were defined as "users". A modified Venous Clinical Severity Score (VCSS) was calculated, including pain, inflammation, vessels induration and skin pigmentation. All clinical variables were evaluated at baseline (T0), after 30 (T1) and 90(T2) days in "users" and "non-users". Out of 62 patients, 30 (48.4%) were "users". No difference was observed between groups at baseline. A lower VCSS value was recorded in "users" than that observed in "non-users" at T2 (7.0 (4.0-9.0) vs. 9.0 (5.0-10.0); p = 0.025). Vessels' induration and pain significantly reduced in 53.3% and 43.3% of "users" and in 18.8% and 9.4% of "non-users". Only "users" (33.3%) showed a reduction of the inflammatory signs as well as a decrease in malleolar circumference, from 29.0 (26.5-30.0) to 27.5 (26.0-28.5) (p < 000.1). A reduction of C-reactive Protein levels was found in "users" compared to "non-users" at T2 (1.0 (0.9-1.2) vs. 1.3 (1.0-1.5); p = 0.006). These findings suggest that implementation of a dietary supplement could improve the clinical outcomes of CVI patients.
Collapse
Affiliation(s)
- Selene Francesca Anna Drago
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Michelangelo Rottura
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Antonino Molonia
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Viviana Maria Gianguzzo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy;
| | - Giovanni Pallio
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Luana Orlando
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Marianna Gigliotti De Fazio
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Marilena Isgrò
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Natalia Zirilli
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125 Messina, Italy; (S.F.A.D.); (M.R.); (A.M.); (N.I.); (L.O.); (M.G.D.F.); (M.I.); (N.Z.); (E.I.)
| |
Collapse
|
20
|
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
|
21
|
McBane RD, Liedl D, Wysokinski W, Wennberg PW, Casanegra AI, Ghorbanzadeh A, Arruda-Olson A, Scott CG, Lee AT, Ahmed A, Rooke TW, Houghton DE. Calf rEF: Impact of Calf Muscle Pump Dysfunction With Reduced Ejection Fraction on All-Cause Mortality. Mayo Clin Proc 2024; 99:902-912. [PMID: 38661596 DOI: 10.1016/j.mayocp.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To evaluate mortality outcomes by varying degrees of reduced calf muscle pump (CMP) ejection fraction (EF). PATIENTS AND METHODS Consecutive adult patients who underwent venous air plethysmography testing at the Mayo Clinic Gonda Vascular Laboratory (January 1, 2012, through December 31, 2022) were divided into groups based on CMP EF for the assessment of all-cause mortality. Other venous physiology included measures of valvular incompetence and clinical venous disease (CEAP [clinical presentation, etiology, anatomy, and pathophysiology] score). Mortality rates were calculated using the Kaplan-Meier method. RESULTS During the study, 5913 patients met the inclusion criteria. During 2.84-year median follow-up, there were 431 deaths. Mortality rates increased with decreasing CMP EF. Compared with EF of 50% or higher, the hazard ratios (95% CIs) for mortality were as follows: EF of 40% to 49%, 1.4 (1.0 to 2.0); EF of 30% to 39%, 1.6 (1.2 to 2.4); EF of 20% to 29%, 1.7 (1.2 to 2.4); EF of 10% to 19%, 2.4 (1.7 to 3.3) (log-rank P≤.001). Although measures of venous valvular incompetence did not independently predict outcomes, venous disease severity assessed by CEAP score was predictive. After adjusting for several clinical covariates, both CMP EF and clinical venous disease severity assessed by CEAP score remained independent predictors of mortality. CONCLUSION Mortality rates are higher in patients with reduced CMP EF and seem to increase with each 10% decrement in CMP EF. The mortality mechanism does not seem to be impacted by venous valvular incompetence and may represent variables intrinsic to muscular physiology.
Collapse
Affiliation(s)
- Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - David Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Waldemar Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Paul W Wennberg
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Atefeh Ghorbanzadeh
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Alex T Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Azza Ahmed
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thom W Rooke
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Damon E Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
22
|
Genet M, Labropoulos N, Gasparis A, O'Donnell T, Desai K. The clinical and economic impact of chronic venous insufficiency-associated lymphedema and the prevalence of persistent edema after venous intervention. Phlebology 2024; 39:353-358. [PMID: 38345282 DOI: 10.1177/02683555241233355] [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: 05/27/2024]
Abstract
OBJECTIVES To determine the demographics, outcomes, and healthcare utilization of patients with chronic venous insufficiency-associated lymphedema (CVI-LED) and the prevalence of lymphedema-specific therapy use after venous intervention. METHODS The IBM MarketScan Commercial and Medicare Claims Databases were examined for patients with CVI-LED. Patient demographics and the use of lymphedema-specific therapy before and after venous intervention were collected. RESULTS Of 85,601 LED patients identified, 8,406 also had a diagnosis of CVI. In the CVI-LED group, 1051 underwent endovenous ablation or venous stent placement. The use of lymphedema-specific therapy before and after venous intervention was 52% and 39%, respectively (p < .05). The mean time of initiation of LED-specific therapy following venous intervention was 265 days after ablation and 347 days after stent placement. CONCLUSION Treating venous hypertension improves certain venous-related signs and symptoms of CVI. However, a significant proportion of patients have persistent edema which may reflect underlying, sub-optimally treated LED.
Collapse
Affiliation(s)
- Matthew Genet
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Centre, New York, NY, USA
| | - Antonios Gasparis
- Department of Surgery, Stony Brook University Medical Centre, New York, NY, USA
| | | | - Kush Desai
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, IL, USA
| |
Collapse
|
23
|
Gültekin O, Lohr MJ, Bechtel GN, Rausch MK. "What makes blood clots break off?" A Back-of-the-Envelope Computation Toward Explaining Clot Embolization. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00733-2. [PMID: 38771453 DOI: 10.1007/s13239-024-00733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE One in four deaths worldwide is due to thromboembolic disease; that is, one in four people die from blood clots first forming and then breaking off or embolizing. Once broken off, clots travel downstream, where they occlude vital blood vessels such as those of the brain, heart, or lungs, leading to strokes, heart attacks, or pulmonary embolisms, respectively. Despite clots' obvious importance, much remains to be understood about clotting and clot embolization. In our work, we take a first step toward untangling the mystery behind clot embolization and try to answer the simple question: "What makes blood clots break off?" METHODS To this end, we conducted experimentally-informed, back-of-the-envelope computations combining fracture mechanics and phase-field modeling. We also focused on deep venous clots as our model problem. RESULTS Here, we show that of the three general forces that act on venous blood clots-shear stress, blood pressure, and wall stretch-induced interfacial forces-the latter may be a critical embolization force in occlusive and non-occlusive clots, while blood pressure appears to play a determinant role only for occlusive clots. Contrary to intuition and prior reports, shear stress, even when severely elevated, appears unlikely to cause embolization. CONCLUSION This first approach to understanding the source of blood clot bulk fracture may be a critical starting point for understanding blood clot embolization. We hope to inspire future work that will build on ours and overcome the limitations of these back-of-the-envelope computations.
Collapse
Affiliation(s)
- Osman Gültekin
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Matthew J Lohr
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Grace N Bechtel
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Manuel K Rausch
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, TX, 78712, USA.
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA.
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, 78712, USA.
| |
Collapse
|
24
|
Du HC, Deng BY. Obesity-Related Traits Mediate the Effects of Educational Attainment on the Risk of Varicose Veins, Venous Thromboembolism, and Phlebitis. Thromb Haemost 2024. [PMID: 38729190 DOI: 10.1055/s-0044-1786970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND The extent to which educational attainment (EA) influences the risk of varicose veins (VVs), venous thromboembolism (VTE), and phlebitis occurrence, whether this pathway is mediated by obesity-related traits, and the proportion of their mediation is unknown. METHODS A Mendelian randomization (MR) design was used to genetically investigate the causal effects of EA on the risk of VV, VTE, and phlebitis and to assess the mediating effect of obesity-related traits. Causal effects were estimated using primarily the multiplicative random-effects inverse variance-weighted method. This was supplemented by Cochran's Q-statistic, MR-Egger regression, MR funnel plots, and leave-one-out test to evaluate the reliability of the results. For the individual mediation effect, the coefficient product method was mainly utilized to estimate. RESULTS An increase in genetically predicted EA was associated with a lower risk of VV, VTE, and phlebitis, as well as lower body mass index, basal metabolic rate, hip circumference, and waist circumference. As genetically predicted body mass index, basal metabolic rate, hip circumference, and waist circumference increased, the risk of developing VV, VTE, and phlebitis increased, respectively. Body mass index, basal metabolic rate, hip circumference, and waist circumference were identified as mediators of the protective effects of EA on VV, VTE, and phlebitis. CONCLUSION The findings support a causal relationship between higher EA and lower risk of VV, VTE, and phlebitis. Obesity-related traits play a significant mediating role in these pathways, and there are interactions between them, with hip circumference mediating these pathways relatively independently from the other three.
Collapse
Affiliation(s)
- Hong-Cheng Du
- Graduate School of Guangxi University of Chinese Medicine, Nanning, China
| | - Bai-Yang Deng
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| |
Collapse
|
25
|
Özhan A, Günaydın F. Impact of static foot disorders on the conservative treatment success in chronic venous disease patients without wounds. J Vasc Surg Venous Lymphat Disord 2024; 12:101849. [PMID: 38350496 DOI: 10.1016/j.jvsv.2024.101849] [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: 07/17/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE Chronic venous disease (CVD) and static foot disorders (SFDs) are prevalent conditions that commonly cause lower extremity pain. These conditions share common factors such as age and weight in their etiology. This study aimed to investigate the impact of SFDs on the treatment response of patients undergoing conservative treatment for CVD without wounds. MATERIALS AND METHODS A retrospective evaluation was conducted on 328 patients (60 males, 268 females) with CVD. Parameters including age, gender, affected side, body mass index, Visual Analog Scale (VAS), Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, and revised Venous Clinical Severity Score (rVCSS) were considered for evaluation. Radiological measurements of calcaneal pitch angle (CPA) were analyzed as a determinant of SFDs. RESULTS VAS and rVCSS of the patients were evaluated before and after conservative treatment of CVD without concomitant treatment of SFDs. The presence of SFDs was associated with decreased treatment success (P < .001). Among different types of SFDs, the pes cavus group exhibited the lowest change in VAS and rVCSS scores before and after conservative CVD treatment. In contrast, the normal group demonstrated the highest improvement. Patients with a normal foot medial arch consistently achieved the best treatment outcomes compared with patients with other SFDs. CONCLUSIONS In conclusion, SFDs affect outcomes of conservative treatment of CVD in CEAP 0 to 3 patients, with the efficacy of treatment dependent upon the severity of SFDs.
Collapse
Affiliation(s)
- Abdulkerim Özhan
- Department of Cardiovascular Surgery, Göztepe Prof Dr Süleyman Yalçın State Hospital, İstanbul, Turkey
| | - Fatih Günaydın
- Department of Orthopaedic Surgery, Mersin Training and Research State Hospital, Mersin, Turkey.
| |
Collapse
|
26
|
Victoria M GE, Rujano A AJ, Zilipo GM. Laser-sclerosing foam hybrid treatment, a non-tumescent technique for insufficient great saphenous vein ablation. Phlebology 2024; 39:267-272. [PMID: 38182555 DOI: 10.1177/02683555231226264] [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: 01/07/2024]
Abstract
OBJECTIVE We aim to report on the Laser-Sclerosing Foam Hybrid Treatment (LSFHT) and its outcomes when used on patients with great saphenous vein (GSV) insufficiency. METHODS This was a single center retrospective cohort study on patients with GSV insufficiency that were treated with the LSFHT technique, a surgical procedure that comprises the use of both sclerosing foam and endovenous ablation and avoids the use of tumescent anesthesia. Occlusion rates and complications were reported. RESULTS 139 legs from 106 patients were operated, achieving a 100% occlusion rate, while only a small burn and 2 popliteal vein thrombosis cases occurred. CONCLUSION The study suggests that the LSFHT is a feasible fast procedure that proved both effective and safe for the treatment of GSV insufficiency.
Collapse
|
27
|
Li M, Jin M, Yang H. Remodelers of the vascular microenvironment: The effect of biopolymeric hydrogels on vascular diseases. Int J Biol Macromol 2024; 264:130764. [PMID: 38462100 DOI: 10.1016/j.ijbiomac.2024.130764] [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: 12/19/2023] [Revised: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Vascular disease is the leading health problem worldwide. Vascular microenvironment encompasses diverse cell types, including those within the vascular wall, blood cells, stromal cells, and immune cells. Initiation of the inflammatory state of the vascular microenvironment and changes in its mechanics can profoundly affect vascular homeostasis. Biomedical materials play a crucial role in modern medicine, hydrogels, characterized by their high-water content, have been increasingly utilized as a three-dimensional interaction network. In recent times, the remarkable progress in utilizing hydrogels and understanding vascular microenvironment have enabled the treatment of vascular diseases. In this review, we give an emphasis on the utilization of hydrogels and their advantages in the various vascular diseases including atherosclerosis, aneurysm, vascular ulcers of the lower limbs and myocardial infarction. Further, we highlight the importance and advantages of hydrogels as artificial microenvironments.
Collapse
Affiliation(s)
- Minhao Li
- School of Intelligent Medicine, China Medical University, No.77, Puhe Road, Shenyang 110122, Liaoning Province, China
| | - Meiqi Jin
- School of Intelligent Medicine, China Medical University, No.77, Puhe Road, Shenyang 110122, Liaoning Province, China
| | - Huazhe Yang
- School of Intelligent Medicine, China Medical University, No.77, Puhe Road, Shenyang 110122, Liaoning Province, China.
| |
Collapse
|
28
|
Chen J, Zhang J, Wang Q, Chen S, Sun M, Liu P, Ye Z. Efficacy and safety of mechanochemical ablation versus laser ablation in the treatment of primary great saphenous vein reflux: A randomized, open, parallel controlled clinical trial. Vascular 2024:17085381241244865. [PMID: 38562025 DOI: 10.1177/17085381241244865] [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: 04/04/2024]
Abstract
OBJECTIVE To evaluate the efficacy of a new mechanochemical ablation (MOCA) device versus endovenous laser ablation (EVLA) for primary great saphenous vein (GSV) reflux. MATERIALS AND METHODS Prospectively analyze the demographics, treatment detail and outcomes data of 57 primary GSV reflux patients. Patients were randomly assigned to MOCA or EVLA group with random envelope method. Primary endpoint was 6-month closure rate of GSV. Secondary endpoint including technical success rate, the venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ-20) score and visual analogue scale (VAS) for pain. RESULTS The procedures were well tolerated according to the VAS score. The 6-month closure rate was 85.71% in MOCA and 96.55% in EVLA group (p = .194). Significant changes were observed in regard of VCSS and CIVIQ-20 score at 6-month follow-up. Skin paresthesia occurred in 0 in MOCA and 5 in EVLA group. CONCLUSION The new MOCA device is safe and effective in treating primary great saphenous vein reflux. The 6-month closure rate is non-inferior compared with EVLA. However, the long-term results need further follow-up.
Collapse
Affiliation(s)
- Jie Chen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianbin Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Qian Wang
- Department of Interventional Vascular Surgery, Peking University 8th School of Clinical Medicine, Peking University International Hospital, Beijing, China
| | - Shu Chen
- Department of Interventional Radiology, Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Mingsheng Sun
- Department of Vascular Surgery, Capital Medical University, Beijing Chao-Yang Hospital, Beijing, China
| | - Peng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
29
|
Moore E, Wohlauer MV, Dorosh J, Kabeil M, Malgor RD, O'Banion LA, Lopez-Pena G, Gillette R, Colborn K, Cuff RF, Lucero L, Ali A, Koleilat I, Batarseh P, Talathi S, Rivera A, Humphries MD, Ly K, Harroun N, Smith BK, Darelli-Anderson AM, Choudhry A, Hammond E, Costanza M, Khetarpaul V, Cosentino A, Watson J, Afifi R, Mouawad NJ, Tan TW, Sharafuddin M, Quevedo JP, Nkansah R, Shibale P, Shalhub S, Lin JC. Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease. Vascular 2024:17085381241240679. [PMID: 38520224 DOI: 10.1177/17085381241240679] [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: 03/25/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. METHODS The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. RESULTS A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78 days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. CONCLUSIONS Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.
Collapse
Affiliation(s)
- Ethan Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Dorosh
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| | - Mahmood Kabeil
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rafael D Malgor
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Leigh A O'Banion
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Gabriel Lopez-Pena
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Riley Gillette
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert F Cuff
- Department of Surgery, Spectrum Health/Michigan State University, Grand Rapids, MI, USA
| | - Leah Lucero
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Amna Ali
- Department of Surgery, University of California San Francisco Fresno, Fresno, CA, USA
| | - Issam Koleilat
- Department of Surgery, RWJ/Barnabas Health, Toms River, NJ, USA
| | - Paola Batarseh
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Sonia Talathi
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Aksim Rivera
- Department of Surgery, Jacobi Medical Center, Albert Einstein School of Medicine, Bronx, NY, USA
| | - Misty D Humphries
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin Ly
- Department of Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Nikolai Harroun
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brigitte K Smith
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Asad Choudhry
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Eric Hammond
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Michael Costanza
- Department of Surgery, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Vipul Khetarpaul
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley Cosentino
- Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Watson
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Nicolas J Mouawad
- Department of Vascular and Endovascular Surgery, McLaren Center for Research and Innovation, Bay City, MI, USA
| | - Tze-Woei Tan
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mel Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Judith P Quevedo
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Reggie Nkansah
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Palcah Shibale
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Sherene Shalhub
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Judith C Lin
- Deparment of Surgery, McLaren Greater Lansing at Michigan State University, East Lansing, MI, USA
| |
Collapse
|
30
|
Guven H. Plethysmography: A game changer for chronic venous insufficiency diagnosis, treatment, and follow-up. Vascular 2024:17085381241240870. [PMID: 38509041 DOI: 10.1177/17085381241240870] [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: 03/22/2024]
Abstract
OBJECTIVE Chronic Venous Insufficiency (CVI) presents a various clinical symptoms and treatment options. Although it is generally known which treatment option is more appropriate in which situations in CVI, it is even more difficult to find the right option in some uncertain situations. In this study, we aimed to evaluate the potential contribution of Digital Photoplethysmography (D-PPG) in the diagnosis of CVI and especially in the selection of treatment options. PATIENTS AND METHOD This retrospective study was conducted at Bursa Heart and Arrhythmia Hospital, involving 721 consecutive patients diagnosed with CVI and with Endovenous Laser Ablation (EVLA) indication. The patients were divided into 2 groups according to the extent of the failure in Doppler USG. In Group 1, the insufficiency ended above the knee, and in Group 2, the insufficiency progressed to below the knee. Patients were evaluated based on anamnesis, physical examination, Doppler USG, and D-PPG. Clinical classification, Venous Clinic Severity Score (VCSS), Quality of Life (QoL) assessment, venous pump capacity (VPC), and venous refill time (VRT) were measured. RESULTS The study included 263 male and 458 female patients with a mean age of 52.37 ± 12.26 years. Significant differences were observed between Group 1 (above knee reflux) and Group 2 (below knee reflux) patients in terms of VCSS, QoL, VPC, and VRT values. The mean values of VCSS, patient complaints, VPC, and VRT were higher in Group 2 patients. Similar findings were observed within the CEAP 2 subgroup. CONCLUSION D-PPG shows potential as a valuable tool in the diagnosis and treatment of CVI. By providing information about venous hemodynamics and volume changes, it can assist in optimizing treatment decisions, including saphenous vein preservation. Combining D-PPG with Doppler USG may improve the comprehensive assessment of CVI and change the treatment option, especially for CEAP 2 patients. More research is needed to confirm these findings and explore wider applications of plethysmographic methods in the management of CVI.
Collapse
Affiliation(s)
- Hakan Guven
- Department of Cardiovascular Surgery, Heart an Arrythmia Hospital, Bursa, Türkiye
| |
Collapse
|
31
|
de Moraes Silva MA, Nelson A, Bell-Syer SE, Jesus-Silva SGD, Miranda F. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 2024; 3:CD002303. [PMID: 38451842 PMCID: PMC10919450 DOI: 10.1002/14651858.cd002303.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Up to 1% of adults will have a leg ulcer at some time. Most leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or damaged valves. Venous ulcer prevention and treatment typically involves the application of compression bandages/stockings to improve venous return and thus reduce pressure in the legs. Other treatment options involve removing or repairing veins. Most venous ulcers heal with compression therapy, but ulcer recurrence is common. For this reason, clinical guidelines recommend that people continue with compression treatment after their ulcer has healed. This is an update of a Cochrane review first published in 2000 and last updated in 2014. OBJECTIVES To assess the effects of compression (socks, stockings, tights, bandages) for preventing recurrence of venous leg ulcers. SEARCH METHODS In August 2023, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, three other databases, and two ongoing trials registries. We also scanned the reference lists of included studies and relevant reviews and health technology reports. There were no restrictions on language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated compression bandages or hosiery for preventing the recurrence of venous ulcers. DATA COLLECTION AND ANALYSIS At least two review authors independently selected studies, assessed risk of bias, and extracted data. Our primary outcome was reulceration (ulcer recurrence anywhere on the treated leg). Our secondary outcomes included duration of reulceration episodes, proportion of follow-up without ulcers, ulceration on the contralateral leg, noncompliance with compression therapy, comfort, and adverse effects. We assessed the certainty of evidence using GRADE methodology. MAIN RESULTS We included eight studies (1995 participants), which were published between 1995 and 2019. The median study sample size was 249 participants. The studies evaluated different classes of compression (UK class 2 or 3 and European (EU) class 1, 2, or 3). Duration of follow-up ranged from six months to 10 years. We downgraded the certainty of the evidence for risk of bias (lack of blinding), imprecision, and indirectness. EU class 3 compression stockings may reduce reulceration compared with no compression over six months (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.76; 1 study, 153 participants; low-certainty evidence). EU class 1 compression stockings compared with EU class 2 compression stockings may have little or no effect on reulceration over 12 months (RR 1.70, 95% CI 0.67 to 4.32; 1 study, 99 participants; low-certainty evidence). There may be little or no difference in rates of noncompliance over 12 months between people using EU class 1 stockings and people using EU class 2 stockings (RR 1.22, 95% CI 0.40 to 3.75; 1 study, 99 participants; low-certainty evidence). UK class 2 hosiery compared with UK class 3 hosiery may be associated with a higher risk of reulceration over 18 months to 10 years (RR 1.55, 95% CI 1.26 to 1.91; 5 studies, 1314 participants; low-certainty evidence). People who use UK class 2 hosiery may be more compliant with compression treatment than people who use UK class 3 hosiery over 18 months to 10 years (RR for noncompliance 0.69, 95% CI 0.49 to 0.99; 5 studies, 1372 participants; low-certainty evidence). There may be little or no difference between Scholl UK class 2 compression stockings and Medi UK class 2 compression stockings in terms of reulceration (RR 0.77, 95% CI 0.47 to 1.28; 1 study, 166 participants; low-certainty evidence) and noncompliance (RR 0.97, 95% CI 0.84.1 to 12; 1 study, 166 participants; low-certainty evidence) over 18 months. No studies compared different lengths of compression (e.g. below-knee versus above-knee), and no studies measured duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. AUTHORS' CONCLUSIONS Compression with EU class 3 compression stockings may reduce reulceration compared with no compression over six months. Use of EU class 1 compression stockings compared with EU class 2 compression stockings may result in little or no difference in reulceration and noncompliance over 12 months. UK class 3 compression hosiery may reduce reulceration compared with UK class 2 compression hosiery; however, higher compression may lead to lower compliance. There may be little to no difference between Scholl and Medi UK class 2 compression stockings in terms of reulceration and noncompliance. There was no information on duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. More research is needed to investigate acceptable modes of long-term compression therapy for people at risk of recurrent venous ulceration. Future trials should consider interventions to improve compliance with compression treatment, as higher compression may result in lower rates of reulceration.
Collapse
Affiliation(s)
- Melissa Andreia de Moraes Silva
- Interdisciplinary Surgical Science Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Vascular Surgery, Hospital de Clinicas de Itajuba - MG, Itajuba, Brazil
| | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Fausto Miranda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
| |
Collapse
|
32
|
Ma X, Shen E, Yuan J, Gong L, Kong W, Jin Z, Tao C, Liu X. Volumetric B-mode ultrasound and Doppler Imaging: Automatic Tracking With One Single Camera. ULTRASONIC IMAGING 2024; 46:90-101. [PMID: 38041446 DOI: 10.1177/01617346231213385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Vascular diseases may occur in the upper extremities, and the lesions can span the entire length of the blood vessel. One of the most popular methods to identify vascular disorders is ultrasound Doppler imaging. However, traditional two-dimensional (2D) ultrasound Doppler imaging cannot capture the entire length of a long vessel in one image. Medical professionals often have to painstakingly reconstruct three-dimensional (3D) data using 2D ultrasound images to locate the lesions, especially for large blood vessels. 3D ultrasound Doppler imaging can display the morphological structure of blood vessels and the distribution of lesions more directly, providing a more comprehensive view compared to 2D imaging. In this work, we propose a wide-range 3D volumetric ultrasound Doppler imaging system with dual modality, in which a high-definition camera is adopted to automatically track the movement of the ultrasound transducer, simultaneously capturing a corresponding sequence of 2D ultrasound Doppler images. We conducted experiments on human arms using our proposed system and separately with X-ray computerized tomography (X-CT). The comparison results prove the potential value of our proposed system in the diagnosis of arm vascular diseases.
Collapse
Affiliation(s)
- Xiaoli Ma
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Enxiang Shen
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jie Yuan
- School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Li Gong
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wentao Kong
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhibin Jin
- Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chao Tao
- School of Physics, Nanjing University, Nanjing, China
| | - Xiaojun Liu
- School of Physics, Nanjing University, Nanjing, China
| |
Collapse
|
33
|
Guo B, Chen C, Li Y, Lv Q, Li X, Guo D, Shi Z, Fu W, Zhang WW. Principles of Optimal Antithrombotic Therapy for Iliac VEnous Stenting (POATIVES): A national expert-based Delphi consensus study. J Vasc Surg Venous Lymphat Disord 2024; 12:101739. [PMID: 38242205 DOI: 10.1016/j.jvsv.2023.101739] [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: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Management of antithrombotic therapy in patients undergoing venous stents has not yet reached consensus, and there are not any recommendations from published guidelines. We undertook a Delphi consensus from Chinese experts to develop recommendations regarding the preferred antithrombotic therapy in patients following venous stenting. METHODS The phase 1 questionnaire was comprised of three clinical scenarios of venous stenting for non-thrombotic iliac vein lesions (NIVL), acute deep vein thrombosis (DVT), and post-thrombotic syndrome (PTS) and was sent to venous practitioners across China. In phase 2, the results of phase 1 were distributed to a panel of experts for evaluation along with a questionnaire encompassing a series of statements produced during phase 1. A modified Delphi method was used to reach consensus on recommendations through two rounds of surveys. RESULTS The phase 1 questionnaire was completed by 283 respondents. In phase 2, an expert panel consisting of 28 vascular surgeons and interventional radiologists was assembled and voted 17 statements relating to antithrombotic management after venous stenting for NIVL (4 statements), DVT (6 statements), and PTS (7 statements). The majority of the statements about the antithrombotic agent selection received a high consensus strength. CONCLUSIONS Based on the national Delphi consensus of Chinese experts regarding antithrombotic therapy following iliac venous stenting in three common scenarios, most of the statements could be used to guide antithrombotic management following venous stenting. Further studies are required to clarify controversial issues including the dose and duration of anticoagulants, the role of antiplatelet agents, especially in patients with NIVL.
Collapse
Affiliation(s)
- Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanli Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Wayne W Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Washington and Puget Sound VA Health Care System, Seattle, WA
| |
Collapse
|
34
|
Devulapalli KK. Interventional radiologists and OBLs: An excellent match. Tech Vasc Interv Radiol 2024; 27:100952. [PMID: 39025608 DOI: 10.1016/j.tvir.2024.100952] [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: 07/20/2024]
Abstract
While office-based laboratories (OBLs) have been increasing in popularity, only a small proportion of the current interventional radiology (IR) workforce works in an OBL. With the relative lack of an IR presence in OBLs compared to other endovascular specialists, combined with the growth of the OBL space, the presence of IR within OBLs will likely increase in the coming years. This article addresses the value interventional radiologists (IRs) can bring to the OBL, with primary impacts being the ability to impact a larger proportion of the population than is traditionally cared for in most hospital settings, the ability to positively influence multidisciplinary care teams and the financial leverage inherent in procedural diversification not readily afforded by other specialists working in the OBL space. IR-specific pitfalls in the OBL space are also addressed, including difficulties in obtaining patient referrals, investor relationships, and group practice arrangements. Despite potential challenges, IRs have a lot to offer within the OBL space, and conversely, the OBL space provides a mechanism for IRs to increase their reach and improve career longevity.
Collapse
|
35
|
Larkin TA, Deen R, Amirnezami T, Shvartsbart A, Villalba L. Pharmacomechanical thrombectomy of iliofemoral deep vein thrombosis is associated with a low incidence of post-thrombotic syndrome and perioperative complications. ANZ J Surg 2024; 94:438-444. [PMID: 38010842 DOI: 10.1111/ans.18795] [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: 02/20/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Iliofemoral deep venous thrombosis (IFDVT) is associated with an incidence of post-thrombotic syndrome (PTS) of up to 50%. PTS is associated with high morbidity, impaired quality of life and a significant economic burden. The aim of the current study was to assess the impact of a single session pharmacomechanical thrombectomy (PMT), dedicated venous stents and a risk mitigation protocol on the rate of PTS. METHODS Between 2015 and 2022, patients presenting with acute or subacute IFDVT treated with the same protocol of single session PMT, dedicated venous stents, and risk-mitigation measures were included. Procedural success rate, complications, stent patency and incidence of PTS were determined. RESULTS Of 60 patients (58 ± 19 years; 65% male), the procedural success rate was 93%, with 7% of patients experiencing complications but no long-term sequelae or mortality. Most (n = 52; 87%) patients were stented, including 46% across the inguinal ligament. At 3 months post-procedure, primary, assisted primary and secondary stent patency rates were 89%, 93% and 98%, respectively, with no loss of patency or re-interventions after that. At latest follow-up of a median 48 months (n = 32), stent patency rate was 97%, with only three patients (9%) experiencing symptoms of PTS. CONCLUSION Single session PMT, dedicated venous stents and a risk-mitigation protocol results in high success rate, excellent long-term stent patency and low incidence of PTS without compromising safety. These results support early intervention for iliofemoral DVT.
Collapse
Affiliation(s)
- Theresa A Larkin
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Raeed Deen
- The Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Taraneh Amirnezami
- The Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Alisa Shvartsbart
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Laurencia Villalba
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- The Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| |
Collapse
|
36
|
Girdhani B, Savlania A, Vaddavalli VV, Behera A, Gorsi U, Kaman L, Soundarajan R. Assessment of skin and associated soft tissue changes with ultrasonography in chronic venous disease. Phlebology 2024; 39:125-131. [PMID: 37961751 DOI: 10.1177/02683555231211404] [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: 11/15/2023]
Abstract
OBJECTIVE Chronic venous disease (CVD) is accompanied by a spectrum of skin changes. The aim of this study was to assess skin changes in CVD in different classes of the classifications such as the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification using ultrasound (US). METHODS This study was conducted from July 2020 to July 2021 after obtaining approval from Institutional Ethical Committee. Patients with chronic venous insufficiency were enrolled after taking informed consent. Assessment of cutaneous layer (CL), subcutaneous layer (SCL), dermo-hypodermal junction (D-HJ), and other significant US findings were noted. RESULTS Ninety-eight limbs were evaluated. Most common skin finding was dermal edema in 59 (60.2%) legs. Other findings included infiltrates, CL thickening, hyper echogenicity and thickening of SCL, anechoic lacunae, disappearance of D-HJ, and epidermal loss or change in thickness of epidermis. Notably, US detected dermal edema in 15 and infiltrates in five C2 legs (normal on inspection). CONCLUSION US evaluation of skin changes adds insight to clinical assessment and may reveal skin changes in legs affected with CVD that may appear normal on clinical examination.
Collapse
Affiliation(s)
- Bhavna Girdhani
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajay Savlania
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Arunanshu Behera
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Lileshwar Kaman
- Department of Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Raghuraman Soundarajan
- Department of Radiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
37
|
Vemuri C, Gibson KD, Pappas PJ, Sadek M, Ting W, Obi AT, Mouawad NJ, Etkin Y, Gasparis AP, McDonald T, Sahoo S, Sorkin JD, Lal BK. Effect of junctional reflux on the venous clinical severity score in patients with insufficiency of the great saphenous vein (JURY study). J Vasc Surg Venous Lymphat Disord 2024; 12:101700. [PMID: 37956904 PMCID: PMC10939725 DOI: 10.1016/j.jvsv.2023.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Effective treatment options are available for chronic venous insufficiency associated with superficial venous reflux. Although many patients with C2 and C3 disease based on the CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification have combined great saphenous vein (GSV) and saphenofemoral junction (SFJ) reflux, some may not have concomitant SFJ reflux. Several payors have determined that symptom severity in patients without SFJ reflux does not warrant treatment. In patients planned for venous ablation, we tested whether Venous Clinical Severity Scores (VCSS) are equivalent in those with GSV reflux alone compared with those with both GSV and SFJ reflux. METHODS This cross-sectional study was conducted at 10 centers. Inclusion criteria were: candidate for endovenous ablation as determined by treating physician; 18 to 80 years of age; GSV reflux with or without SFJ reflux on ultrasound; and C2 or C3 disease. Exclusion criteria were prior deep vein thrombosis; prior vein ablation on the index limb; ilio-caval obstruction; and renal, hepatic, or heart failure requiring prior hospitalization. An a priori sample size was calculated. We used multiple linear regression (adjusted for patient characteristics) to compare differences in VCSS scores of the two groups at baseline, and to test whether scores were equivalent using a priori equivalence boundaries of +1 and -1. In secondary analyses, we tested differences in VCSS scores in patients with C2 and C3 disease separately. RESULTS A total of 352 patients were enrolled; 64.2% (n = 226) had SFJ reflux, and 35.8% (n = 126) did not. The two groups did not differ by major clinical characteristics. The mean age of the cohort was 53.9 ± 14.3 years; women comprised 74.2%; White patients 85.8%; and body mass index was 27.8 ± 6.1 kg/m2. The VCSS scores in patients with and without SFJ reflux were found to be equivalent; SFJ reflux was not a significant predictor of VCSS score; and mean VCSS scores did not differ significantly (6.4 vs 6.6, respectively, P = .40). In secondary subset analyses, VCSS scores were equivalent between C2 patients with and without SFJ reflux, and VCSS scores of C3 patients with SFJ reflux were lower than those without SFJ reflux. CONCLUSIONS Symptom severity is equivalent in patients with GSV reflux with or without SFJ reflux. The absence of SFJ reflux alone should not determine the treatment paradigm in patients with symptomatic chronic venous insufficiency. Patients with GSV reflux who meet clinical criteria for treatment should have equivalent treatment regardless of whether or not they have SFJ reflux.
Collapse
Affiliation(s)
- Chandu Vemuri
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Kathleen D Gibson
- Department of Surgery, Lake Washington Vascular Surgeons, Bellevue, WA
| | - Peter J Pappas
- Department of Surgery, Center for Vein Restoration, Morristown, NJ
| | - Mikel Sadek
- Department of Surgery, NYU Langone Health, New York, NY
| | - Windsor Ting
- Department of Surgery, Mount Sinai, New York, NY
| | - Andrea T Obi
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Yana Etkin
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY
| | | | - Tara McDonald
- Department of Surgery, University of Maryland, Baltimore, MD
| | - Shalini Sahoo
- Department of Surgery, University of Maryland, Baltimore, MD
| | - John D Sorkin
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Brajesh K Lal
- Department of Surgery, University of Maryland, Baltimore, MD.
| |
Collapse
|
38
|
Pratap Shankar KM, Ashwathykutty V. Effectiveness of herbal drug Terminalia Arjuna in chronic venous insufficiency - A prospective observational study. JOURNAL OF VASCULAR NURSING 2024; 42:53-59. [PMID: 38555178 DOI: 10.1016/j.jvn.2023.11.009] [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: 04/29/2023] [Revised: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Chronic venous insufficiency (CVI) manifests in various clinical presentations ranging from asymptomatic but cosmetic problems to severe symptoms, such as lower limb edema, skin trophic changes, and ulceration. CVI substantially affects the quality of life and work productivity of the patients. Ayurveda, an ancient traditional medicine in India, evaluates the various pathological stages of CVI with a wide range of pathological conditions such as Siragranthi (venous abnormalities), Raktavaritavāta (disorders of vāta occluded by rakta ∼ blood), ApanaVaigunya (vitiated apānavāyu), Arsha (hemorrhoids), VataRakta (rheumatism due to rakta), Kushtha (integumentary disease) and Dushta Vrana (putrefied wound) depending upon the presentations of the patient. Ayurvedic texts mention Terminalia arjuna as a potential herb for treating various conditions related to the circulatory system. The drug is an effective anti-inflammatory, anti-oxidant, and anti-hypertensive and has a definite role in improving cardiovascular hemodynamics and wound healing. These attributes suggest that the potential of Terminalia arjuna needs to be explored as a promising venoactive drug. METHODS This prospective observational study included 25 patients (31 limbs) with CVI who were treated with Tab Terminalia arjuna (Bark extract of Terminalia arjuna in a dose of 500 mg, given twice a day) and were observed on two visits on day 30 and day 90. Follow-up was carried out for three months to evaluate post-treatment complications or adverse effects. The clinical outcome assessment was done using Venous Clinical Severity Score (VCSS), and clinical grading was performed using clinical classification (C0 - C6) of CEAP (Clinical-Etiology-Anatomy-Pathophysiology) classification. RESULTS The median VCSS score (of both limbs) during the third visit was comparatively lower than the first, with a statistically significant improvement at 0.05 level. Further, there was a substantial positive improvement in the clinical classification of CEAP among the patients in pre and post treatment phase. CONCLUSION The prospective observational study shows that Tab Terminalia arjuna is safe and effective in CVI, reducing the symptoms like pain, edema, inflammation, pigmentation, induration and also expediting ulcer healing.
Collapse
Affiliation(s)
- K M Pratap Shankar
- Research Officer (Ay), NARIP, Cheruthurthy, CCRAS, Ministry of Ayush, Govt of India, 679531, India.
| | - V Ashwathykutty
- Research Officer (Ay), NARIP, Cheruthurthy, CCRAS, Ministry of Ayush, Govt of India, 679531, India; Research Officer (Ay), CCRAS, Ministry of Ayush, Govt of India, 679531, India
| |
Collapse
|
39
|
Mulita F, Dimopoulos P, Verras GI, Mustaqe P, Jaho J, Leivaditis V, Tchabashvili L, Tasios K, Antzoulas A, Pitros C, Papadoulas S, Katsakiori PF. Demographic and clinical characteristics of patients with varicose veins in Albania: a retrospective, single-centre analysis. Arch Med Sci Atheroscler Dis 2024; 9:e41-e46. [PMID: 38846060 PMCID: PMC11155458 DOI: 10.5114/amsad/183653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction Chronic venous disease (CVD) constitutes a frequently underdiagnosed pathological condition that progressively diminishes patients' quality of life and imposes an escalating strain on healthcare resources. This study aims to comprehensively investigate the epidemiological landscape of varicose vein disease, examining age group distributions, gender patterns, residence influences, marital status correlations, weight considerations, educational impacts, and various aspects related to varicose veins. Material and methods This was a single-centre retrospective analysis, in Albania from May 2018 to September 2023. Data were collected retrospectively through hospital records. Data collection involved administering a structured questionnaire to study participants, categorically organised into three sections. The first section focused on collecting demographic information, the second section involved self-perception of identifying risk factors associated with varicose veins, and the final section included inquiries about the history of variceal surgery. Results The CEAP classification distribution in our cohort revealed a predominant presence of C2 (varicose veins) in 53.3% of patients, followed by C3 (oedema) at 29.2%, and C4 (changes in skin and subcutaneous tissue secondary to CVD) at 10.5%, whereas C5 (healed venous ulcer) and C6 (active venous ulcer) were less frequent. Based on the body mass index (BMI) scale, data from patients indicated that 9.7% were in the category of underweight, 54.8% had a normal BMI, and 35.5% were categorised as overweight. Conclusions The study's thorough exploration of patient perspectives, risk factors, and treatment choices contributes to a holistic understanding of varicose vein management, emphasising the importance of personalised approaches that account for demographic variations and individual beliefs.
Collapse
Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Platon Dimopoulos
- Department of Interventional Radiology, General University Hospital of Patras, Patras, Greece
| | | | - Petraq Mustaqe
- University of Vlore “Ismail Qemali”, Faculty of Health, Scientific Research Center for Public Health, Vlore, Albania
- Department of Vascular Surgery, General Hospital of Vlore, Vlore, Albania
| | - Jerina Jaho
- University of Vlore “Ismail Qemali”, Faculty of Health, Scientific Research Center for Public Health, Vlore, Albania
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Christos Pitros
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | - Spyros Papadoulas
- Department of Vascular Surgery, General University Hospital of Patras, Patras, Greece
| | | |
Collapse
|
40
|
Kim J, Stechmiller J, Weaver M, James G, Stewart PS, Lyon D. Associations Among Wound-Related Factors Including Biofilm, Wound-Related Symptoms and Systemic Inflammation in Older Adults with Chronic Venous Leg Ulcers. Adv Wound Care (New Rochelle) 2024. [PMID: 38183636 DOI: 10.1089/wound.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024] Open
Abstract
Objective: The purposes of this observational prospective study were to (1) characterize the wound-related factors (wound area, the presence of biofilm, and total bacteria), wound-related symptoms (fatigue, pain, exudate, itching, and edema or swelling), and systemic inflammation (level of serum C-reactive protein [CRP]), and (2) explore associations between wound-related factors, wound-related symptoms, and systemic inflammation in older individuals with chronic venous leg ulcers (CVLUs) over 8 weeks of wound treatment. Approach: A total of 117 participants who received standardized care (weekly sharp debridement) for chronic venous ulcer were enrolled. We collected clinical data every 2 weeks during the 8 weeks of the study period or until the wound was healed (if healed before 8 weeks). Associations among variables were estimated using a Bayesian approach applied to general linear mixed models. Results: Based on Bayes factor (BF) value, there was extremely strong evidence for the association of biofilm with mean total bacteria (BF >1,000). There was moderate evidence of a direct association between biofilm presence and levels of CRP (BF 4.3) and moderate evidence of direct associations between biofilm and wound-related symptoms, pain and exudate (BF 5.12, 8.49, respectively). Innovation: Wound-related symptoms and the level of systemic CRP were associated with biofilm among patients who were receiving weekly sharp debridement. Symptom severity associated with CVLUs requires assessment and management of wound-related factors and levels of inflammation in addition to symptom assessment. Conclusion: This study is the first to examine associations among biofilm, as wound-related factors, systemic inflammation, wound-related symptoms, and wound healing in clinical settings. Symptom severity, level of systemic CRP, and wound-related factors should be considered as well as assessment of biofilm in CVLU in older individuals with CVLU.
Collapse
Affiliation(s)
- Junglyun Kim
- Chungnam National University College of Nursing, Daejeon, Korea
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Joyce Stechmiller
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Michael Weaver
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Garth James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, USA
| | - Philip S Stewart
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, USA
| | - Debra Lyon
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| |
Collapse
|
41
|
Farkas K, Stanek A, Zbinden S, Borea B, Ciurica S, Moore V, Maguire P, Abola MTB, Alajar EB, Marcoccia A, Erer D, Casanegra AI, Sharebiani H, Sprynger M, Kavousi M, Catalano M. Vascular Diseases in Women: Do Women Suffer from Them Differently? J Clin Med 2024; 13:1108. [PMID: 38398419 PMCID: PMC10889109 DOI: 10.3390/jcm13041108] [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: 01/13/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
According to the World Health Organization, cardiovascular disease (CVD) is the leading cause of death among women worldwide, yet its magnitude is often underestimated. Biological and gender differences affect health, diagnosis, and healthcare in numerous ways. The lack of sex and gender awareness in health research and healthcare is an ongoing issue that affects not only research but also treatment and outcomes. The importance of recognizing the impacts of both sex and gender on health and of knowing the differences between the two in healthcare is beginning to gain ground. There is more appreciation of the roles that biological differences (sex) and sociocultural power structures (gender) have, and both sex and gender affect health behavior, the development of diseases, their diagnosis, management, and the long-term effects of an illness. An important issue is the knowledge and awareness of women about vascular diseases. The risk of cardiovascular events is drastically underestimated by women themselves, as well as by those around them. The purpose of this review is to draw attention to improving the medical care and treatment of women with vascular diseases.
Collapse
Affiliation(s)
- Katalin Farkas
- Department of Angiology, Szent Imre University Teaching Hospital, Tétényi út 12-16, 1115 Budapest, Hungary
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 Street, 41-902 Bytom, Poland
| | - Stephanie Zbinden
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology, Zurich University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Borea
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Angiology and Haemostasis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Simina Ciurica
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, Marie Curie Civil Hospital, CHU Charleroi, Chaussée de Bruxelles 140, 6042 Lodelinsart, Belgium
| | - Vanessa Moore
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Peggy Maguire
- European Institute of Women’s Health, Ashgrove House, Kill Avenue, Dún Laoghaire, A96 N9K0 Dublin, Ireland; (V.M.); (P.M.)
| | - Maria Teresa B. Abola
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Clinical Research Department, Education, Training and Research Services, Philippine Heart Center, University of the Philippines College of Medicine, 547 Pedro Gil Street, Manila 1000, Metro Manila, Philippines
| | - Elaine B. Alajar
- Manila Doctors Hospital, 667 United Nations Ave, Ermita, Manila 1000, Metro Manila, Philippines;
| | - Antonella Marcoccia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Angiology and Autoimmunity Medical Unit, Rare Diseases Reference Center for Systemic Sclerosis, Sandro Pertini Hospital, 00157 Rome, Italy
| | - Dilek Erer
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Gazi University Hospital, Mevlana Blv. No:29, Yenimahalle, Ankara 06560, Turkey
| | - Ana I. Casanegra
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55901, USA;
| | - Hiva Sharebiani
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Support Association of Patients of Buerger’s Disease, Buerger’s Disease NGO, Mashhad 9183785195, Iran
| | - Muriel Sprynger
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Cardiology, University Hospital of Liège, Hospital Boulevard, 4000 Liege, Belgium
| | - Maryam Kavousi
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Via GB Grassi 74, 20157 Milan, Italy; (A.S.); (S.Z.); (B.B.); (S.C.); (M.T.B.A.); (A.M.); (D.E.); (H.S.); (M.S.); (M.K.); (M.C.)
- Department of Biomedical and Clinical Science, Inter-University Research Center on Vascular Disease, University of Milan, GB Grassi 74, 20157 Milan, Italy
| |
Collapse
|
42
|
Nasu T, Matsumoto S, Fujimoto W, Numazaki H, Morino Y. The safety and efficacy of compression therapy in patients with stable heart failure. IJC HEART & VASCULATURE 2024; 50:101343. [PMID: 38304726 PMCID: PMC10830501 DOI: 10.1016/j.ijcha.2024.101343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
Background Compression therapy is widely used as a therapeutic option for edema; however, concerns regarding its safety in patients with heart failure (HF) arose, particularly due to increased venous return, which increases pulmonary artery blood pressure. This study aimed to investigate the safety of compression therapy in patients with chronic HF. Methods This study retrospectively enrolled patients with stable chronic HF who initiated treatment with compression therapy for lower extremity edema. The primary outcome was New York Heart Association (NYHA) class changes after 1 month of compression therapy, and adverse events were evaluated. Results We analyzed 101 patients who initiated compression therapy. The number of patients continuing compression therapy at one month was 86. Overall, 61.6 % were female and the median age was 81 years. The proportion of patients with heart failure and preserved ejection fraction (HFpEF) was 50.4 %. Brain natriuretic peptide levels were significantly lower than baseline levels at 1 month, (baseline vs 1 month: 486 (360-696) vs 311 (211-511), p < 0.001), with a lower NYHA III prevalence (baseline vs 1 month: 53.5 % vs 32.6 %, p < 0.001), without any adverse events related to compression therapy initiation. Additionally, multivariate logistic analysis indicated an association between HFpEF and significant BNP reduction after compression therapy (odds ratio: 4.70; 95 % confidence interval: 1.63-13.6). Conclusions Compression therapy was associated with decreased BNP levels and improved symptoms, especially in HFpEF, without any adverse events in stable chronic HF. These findings indicate that compression therapy is safe for patients with stable chronic HF.
Collapse
Affiliation(s)
- Takahito Nasu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
- Department of Biomedical Information Analysis, Institute for Biomedical Sciences, Iwate Medical University, Iwate, Japan
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan
| | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Hyogo, Japan
| | - Harutomo Numazaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| |
Collapse
|
43
|
Grigorean A, Lindenblatt N, Luchsinger I, Hobohm L, Konstantinides SV, Münzel T, Barco S, Keller K. Prevalence and Prognostic Role of Lymphedema in Patients with Deep Venous Thrombosis and Thrombophlebitis. Lymphat Res Biol 2024; 22:20-26. [PMID: 38029369 DOI: 10.1089/lrb.2022.0109] [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: 12/01/2023] Open
Abstract
Background: Deep venous thrombosis (DVT) poses a substantial disease burden. Lymphedema may present with similar symptoms making the diagnosis process more difficult. Data on the epidemiology of lymphedema are lacking. Methods: The German nationwide inpatient sample served to analyze all patients hospitalized owing to DVT and/or thrombophlebitis (referred to as DVT) of the legs in Germany between 2005 and 2020. We stratified these patients for additional lymphedema and analyzed the impact of lymphedema on adverse in-hospital events. Results: Overall, 1,136,574 hospitalizations related to DVT were recorded in Germany during 2005-2020 (53.3% women; 51.3% aged ≥70 years). Lymphedema was coded in 9974 (0.9%) patient-cases (82.0% not elsewhere classified, 17.7% secondary lymphedema). Annual numbers of hospitalizations with lymphedema among DVT patients increased from 450 (2005) to 613 (2016) (β 0.57; 95% confidence interval [CI]: 0.48-0.66], p < 0.001) and decreased thereafter. Despite similar age, DVT patients with lymphedema had higher prevalence of cardiovascular diseases, chronic organ failure, and all types of investigated cancer. Prevalence of pulmonary embolism (PE) with shock/CPR (4.1% vs. 1.5%), acute renal failure (6.7% vs. 2.5%), and stroke (5.2% vs. 4.2%) was higher in DVT patients with lymphedema than without. Lymphedema was independently associated with PE with shock/CPR (OR: 2.1; 95% CI: 1.9-2.3) as well as death (OR: 1.3; 95% CI: 1.2-1.4). Conclusions: Comorbidity conditions like cancer, obesity, and cardiovascular risk factors, and also infectious complications, were more prevalent in DVT patients with lymphedema than in those without. Lymphedema was independently associated with severe in-hospital complications, particularly when its genesis was related to severe comorbidities.
Collapse
Affiliation(s)
| | - Nicole Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Luchsinger
- Dermatology Department, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
44
|
Urbonavicius S, Srinanthalogen R, Sandermann J, Valius M, Kaupinis A, Ludvigsen M. A novel view to varicose veins pathogenesis: Proteomic profiling suggests a pivotal role of extracellular matrix degradation. Phlebology 2024; 39:20-28. [PMID: 37846077 DOI: 10.1177/02683555231206891] [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: 10/18/2023]
Abstract
INTRODUCTION Although morphological and anatomical studies indicate that venous wall weakening and subendothelial fibrosis characterize varicose veins (VV), the pathogenesis of VV remains poorly understood. The aim of this study is to obtain protein expression profiles in patients with VV and thereby get a step closer to understanding the pathogenesis of VV. METHODS Specimens were obtained from total of 10 patients, that is, from 5 patients undergoing VV surgical stripping and from 5 non-VV patients undergoing bypass surgery. Specimens were collected from the same layers of venous wall. Proteins were extracted from each specimen and analyzed by ion mobility spectrometry (IMS-MS). In total, 1387 were identified and 486 proteins were identified in all samples. From these, 15 proteins were differentially expressed between VV and non-VV samples (p < .05) and 12 of these showed a fold change >1.5. RESULTS Interestingly, among the differentially expressed proteins, only two proteins were significantly increased in the VV tissue, that is, GAPDH (p = .028, fold change 2.74), where several proteins involved in maintaining the homeostasis in the extracellular matrix, that is, the CXXC zinc finger protein 5 (CXXC5) and nucleoporin (SEH1) were prominently downregulated (p = .049, fold change 37.8, and p = .040, fold change 3.46). The downregulation in protein expression of CXXC5 and SEH1 as well as upregulation of GAPDH were validated by Western blotting. CONCLUSION The identified differentially expressed proteins suggest an altered profile of the connective tissue proteins as well as an increased proteolytic enzyme activity which both may be central in the pathophysiology of varicose veins.
Collapse
Affiliation(s)
- Sigitas Urbonavicius
- Department of Vascular Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Reshaabi Srinanthalogen
- Department of Vascular Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jes Sandermann
- Department of Vascular Surgery, Vascular Research Unit, Viborg Regional Hospital, Viborg, Denmark
| | - Mindaugas Valius
- Proteomic Center, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
| | - Algirdas Kaupinis
- Proteomic Center, Institute of Biochemistry, Vilnius University, Vilnius, Lithuania
| | - Maja Ludvigsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
45
|
Kim GM, Kim B, Jang M, Park JH, Bae M, Lee CW, Kim JW, Huh U. Benefit in physical function and quality of life to nonsurgical treatment of varicose veins: Pilot study. World J Clin Cases 2024; 12:517-524. [PMID: 38322465 PMCID: PMC10841938 DOI: 10.12998/wjcc.v12.i3.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Studies on varicose veins have focused its effects on physical function; however, whether nonsurgical treatments alter muscle oxygenation or physical function remains unclear. Moreover, the differences in such functions between individuals with varicose veins and healthy individuals remain unclear. AIM To investigate changes in physical function and the quality of life (QOL) following nonsurgical treatment of patients with varicose veins and determine the changes in their muscle oxygenation during activity. METHODS We enrolled 37 participants (those with varicose veins, n = 17; healthy individuals, n = 20). We performed the following measurements pre- and post-nonsurgical treatment in the varicose vein patients and healthy individuals: Calf muscle oxygenation during the two-minute step test, open eyes one-leg stance, 30 s sit-to-stand test, visual analog scale (VAS) for pain, Pittsburgh sleep quality index, physical activity assessment, and QOL assessment. RESULTS Varicose veins patients and healthy individuals differ in most variables (physical function, sleep quality, and QOL). Varicose veins patients showed significant differences between pre- and post-nonsurgical treatment- results in the 30 sit-to-stand test [14.41 (2.45) to 16.35 (4.11), P = 0.018), two-minute step test [162.29 (25.98) to 170.65 (23.80), P = 0.037], VAS for pain [5.35 (1.90) to 3.88 (1.73), P = 0.004], and QOL [39.34 (19.98) to 26.69 (17.02), P = 0.005]; however, no significant difference was observed for muscle oxygenation. CONCLUSION Nonsurgical treatment improved lower extremity function and QOL in varicose veins patients, bringing their condition close to that of healthy individuals. Future studies should include patients with severe varicose veins requiring surgery to confirm our findings.
Collapse
Affiliation(s)
- Gwon-Min Kim
- Medical Research Institute, Pusan National University School of Medicine, Yangsan 50612, South Korea
| | - BoKun Kim
- Future Convergence Research Institute, Changwon National University, Changwon 51140, South Korea
| | - Minwoo Jang
- Department of Convergence Medical Science, School of Medicine, Pusan National University, Yangsan 50612, South Korea
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Miju Bae
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Chung Won Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Jong Won Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Up Huh
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| |
Collapse
|
46
|
Gwozdzinski L, Pieniazek A, Gwozdzinski K. Factors Influencing Venous Remodeling in the Development of Varicose Veins of the Lower Limbs. Int J Mol Sci 2024; 25:1560. [PMID: 38338837 PMCID: PMC10855638 DOI: 10.3390/ijms25031560] [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: 12/16/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
One of the early symptoms of chronic venous disease (CVD) is varicose veins (VV) of the lower limbs. There are many etiological environmental factors influencing the development of chronic venous insufficiency (CVI), although genetic factors and family history of the disease play a key role. All these factors induce changes in the hemodynamic in the venous system of the lower limbs leading to blood stasis, hypoxia, inflammation, oxidative stress, proteolytic activity of matrix metalloproteinases (MMPs), changes in microcirculation and, consequently, the remodeling of the venous wall. The aim of this review is to present current knowledge on CVD, including the pathophysiology and mechanisms related to vein wall remodeling. Particular emphasis has been placed on describing the role of inflammation and oxidative stress and the involvement of extracellular hemoglobin as pathogenetic factors of VV. Additionally, active substances used in the treatment of VV were discussed.
Collapse
Affiliation(s)
- Lukasz Gwozdzinski
- Department of Pharmacology and Toxicology, Medical University of Lodz, 90-752 Lodz, Poland;
| | - Anna Pieniazek
- Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland;
| | - Krzysztof Gwozdzinski
- Department of Oncobiology and Epigenetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland;
| |
Collapse
|
47
|
Mandakhbayar N, Ji Y, El-Fiqi A, Patel KD, Yoon DS, Dashnyam K, Bayaraa O, Jin G, Tsogtbaatar K, Kim TH, Lee JH, Kim HW. Double hits with bioactive nanozyme based on cobalt-doped nanoglass for acute and diabetic wound therapies through anti-inflammatory and pro-angiogenic functions. Bioact Mater 2024; 31:298-311. [PMID: 37637079 PMCID: PMC10458956 DOI: 10.1016/j.bioactmat.2023.08.014] [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: 05/27/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023] Open
Abstract
Regeneration of pathological wounds, such as diabetic ulcers, poses a significant challenge in clinical settings, despite the widespread use of drugs. To overcome clinical side effects and complications, drug-free therapeutics need to be developed to promote angiogenesis while overcoming inflammation to restore regenerative events. This study presents a novel bioactive nanozyme based on cobalt-doped nanoglass (namely, CoNZ), which exhibits high enzymatic/catalytic activity while releasing therapeutic ions. Cobalt oxide "Co3O4" tiny crystallites produced in situ through a chemical reaction with H2O2 within CoNZ nanoparticles play a crucial role in scavenging ROS. Results showed that CoNZ-treatment to full-thickness skin wounds in mice significantly accelerated the healing process, promoting neovascularization, matrix deposition, and epithelial lining while reducing pro-inflammatory signs. Notably, CoNZ was highly effective in treating pathological wounds (streptozotocin-induced diabetic wounds). Rapid scavenging of ROS by CoNZ and down-regulation of pro-inflammatory markers while up-regulating tissue healing signs with proliferative cells and activated angiogenic factors contributed to the observed healing events. In vitro experiments involving CoNZ-cultures with macrophages and endothelial cells exposed to high glucose and ROS-generating conditions further confirmed the effectiveness of CoNZ. CoNZ-promoted angiogenesis was attributed to the release of cobalt ions, as evidenced by the comparable effects of CoNZ-extracted ionic medium in enhancing endothelial migration and tubule formation via activated HIF-1α. Finally, we compared the in vivo efficacy of CoNZ with the clinically-available drug deferoxamine. Results demonstrated that CoNZ was as effective as the drug in closing the diabetic wound, indicating the potential of CoNZ as a novel drug-free therapeutic approach.
Collapse
Affiliation(s)
- Nandin Mandakhbayar
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - YunSeong Ji
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Ahmed El-Fiqi
- Glass Research Department, National Research Centre, Cairo, 12622, Egypt
| | - Kapil D. Patel
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- School of Cellular and Molecular Medicine (CMM), University of Bristol, Bristol, BS8 1TD United Kingdom
| | - Dong Suk Yoon
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Biomedical Science, Hwasung Medi-Science University, Hwaseong‑Si 18274, Gyeonggi‑Do, Republic of Korea
| | - Khandmaa Dashnyam
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Drug Research Institute, Mongolian University of Pharmaceutical Sciences, Ulaanbaatar 14250, Mongolia
| | - Oyunchimeg Bayaraa
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Drug Research Institute, Mongolian University of Pharmaceutical Sciences, Ulaanbaatar 14250, Mongolia
| | - Gangshi Jin
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Khaliunsarnai Tsogtbaatar
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Drug Research Institute, Mongolian University of Pharmaceutical Sciences, Ulaanbaatar 14250, Mongolia
| | - Tae-Hyun Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- R&D Center, TE Bios, Osong, Republic of Korea
| | - Jung-Hwan Lee
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Dankook University, Cheonan, 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, 31116, Republic of Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Republic of Korea
| | - Hae-Won Kim
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, 31116, Republic of Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
- Department of Biomaterials Science, School of Dentistry, Dankook University, Cheonan, 31116, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Dankook University, Cheonan, 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, Cheonan, 31116, Republic of Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Republic of Korea
| |
Collapse
|
48
|
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
|
49
|
Zhang L, Ng K, Pham JP, Thoo S, Yang A, Kang M, Connor D, Kossard S, Parsi K. Pigmentation of lower limbs: Contribution of haemosiderin and melanin in chronic venous insufficiency and related disorders. Phlebology 2023; 38:657-667. [PMID: 37642293 DOI: 10.1177/02683555231196702] [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: 08/31/2023]
Abstract
BACKGROUND To determine the composition of skin pigmentation in chronic venous insufficiency (CVI) and other less common vascular conditions of lower limbs. METHODS Forty-five skin biopsies were obtained from 17 patients. Samples were taken from pigmented regions and compared with control non-lesional samples from the same patient. Perl's Prussian Blue was used to identify haemosiderin and Schmorl's for melanin. RESULTS Seven patients presented with CVI, one with concurrent livedo vasculopathy (LV). One patient had LV only. Two patients had acroangiodermatitis (AAD). Six patients had post-sclerotherapy pigmentation (PSP), one with concurrent post-inflammatory hyperpigmentation (PIH). One patient had PIH only. The predominant pigment in CVI samples was haemosiderin. C5-C6 patients showed increased epidermal melanin. LV, AAD, and PSP samples showed dermal haemosiderin but no increase in epidermal melanin. PIH samples showed prominent epidermal melanin whilst no haemosiderin was detected. CONCLUSION The predominant pigment in CVI and other vascular conditions was haemosiderin. Melanin was present in later stages of CVI (C5-C6) and in PIH.
Collapse
Affiliation(s)
- Lois Zhang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Kate Ng
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - James P Pham
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - Samuel Thoo
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - Anes Yang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - Mina Kang
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - David Connor
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| | - Steven Kossard
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
- Kossard Dermatopathologists, Sydney, NSW, Australia
| | - Kurosh Parsi
- Dermatology, Phlebology and Fluid Mechanics Research Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, St. Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, The University of New South Wales(UNSW), Sydney, NSW, Australia
| |
Collapse
|
50
|
Devulapalli KK, Julien WH. The Future of Interventional Radiology: Point-Why Interventional Radiology Must Become a Stand-Alone Specialty. AJR Am J Roentgenol 2023; 221:732-733. [PMID: 37436034 DOI: 10.2214/ajr.23.29815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
|