Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study

Objectives

Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus.

Methods

A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by >67% and >85% of respondents, respectively.

Results

Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements.

Conclusions

The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose.

[Congenital arteriovenous malformation complicated with brachial artery false aneurysm]

Congenital arteriovenous malformations in the upper extremity, mainly in the hand are rare. In this patient an arteriovenous fistula of the hand caused arterial dilatation of the upper limb, and blunt injury of brachial artery resulted in an extreme large false aneurysm. This situation, which threatened with rupture and peripheral embolisation was treated by resection of the false aneurysm with end-to-end direct anastomosis. Complication of a congenital arteriovenous malformation so late, in the ninth decade is almost exceptional. We think that the successful surgical treatment of an infrequent lesion's rare late complication is worth presenting.

[Takayasu's arteritis; rare disease with special considerations]

Takayasu's arteritis is a chronic, non-specific inflammation of unknown aetiology, involving the aorta and its main branches. The authors describe the aetiology, pathomechanism, characteristic symptoms and a series of diagnostic criteria. Classifications used in previous decades and nowadays are listed. The therapy--considering the main principles--is individual, and it can be a combination of medical and surgical treatment or percutaneous angioplasty. Takayasu's arteritis is a rare disease in the western countries. There can not be found a specific examination to diagnose it. Mainly in the case of young female patients with inflammation of unknown origin for early diagnosis, it is essential to consider this particular disease.