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Parsi K, van Rij AM, Meissner MH, Davies AH, Maeseneer MD, Gloviczki P, Benson S, Bottini O, Canata VM, Dinnen P, Gasparis A, Gianesini S, Huber D, Jenkins D, Lal BK, Kabnick L, Lim A, Marston W, Granados AM, Morrison N, Nicolaides A, Paraskevas P, Patel M, Roberts S, Rogan C, Schul MW, Komlos P, Stirling A, Thibault S, Varghese R, Welch HJ, Wittens CHA. Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS) : A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI) This consensus document has been co-published in Phlebology [DOI: 10.1177/0268355520930884] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.05.002]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/). Phlebology 2020; 35:550-555. [PMID: 32639862 PMCID: PMC7441329 DOI: 10.1177/0268355520930884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.
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Affiliation(s)
- Kurosh Parsi
- International Union of Phlebology
(UIP)
- Australasian College of Phlebology
(ACP)
| | | | - Mark H Meissner
- International Union of Phlebology
(UIP)
- American Venous Forum (AVF)
- American Vein and Lymphatic Society
(AVLS)
| | - Alun H Davies
- Imperial College London, Charing
Cross and St Mary’s Hospital, London, UK
| | | | - Peter Gloviczki
- Division of Vascular and
Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | | | | - Adrian Lim
- Australasian College of Phlebology
(ACP)
| | | | | | - Nick Morrison
- International Union of Phlebology
(UIP)
- American Vein and Lymphatic Society
(AVLS)
| | | | | | | | | | - Christopher Rogan
- Australasian College of Phlebology
(ACP)
- Interventional Radiology Society
of Australasia (IRSA)
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Parsi K, Roberts S, Kang M, Benson S, Baker L, Berman I, Bester LJ, Connor DE, Dinnen P, Grace J, Stirling A, Ibrahim N, Lekich C, Lim A, Matar L, Nadkarni S, Paraskevas P, Rogan C, Thibault PK, Thibault S, van Rij A, Yang A. Cyanoacrylate closure for peripheral veins: Consensus document of the Australasian College of Phlebology. Phlebology 2019; 35:153-175. [PMID: 31368408 DOI: 10.1177/0268355519864755] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.
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Affiliation(s)
- Kurosh Parsi
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Mina Kang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Luke Baker
- Department of Medical Imaging, Westmead Hospital, Sydney, Australia
| | | | | | - David E Connor
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre, Gold Coast, Australia
| | | | | | - Nabeel Ibrahim
- Sydney Centre for Venous Disease, Sydney, Australia.,Macquarie University Hospital, Sydney, Australia
| | | | - Adrian Lim
- Department of Dermatology, The Royal North Shore Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | | | | | - Christopher Rogan
- Macquarie University Hospital, Sydney, Australia.,Department of Medical Imaging, Sydney Adventist Hospital, Sydney, Australia.,Department of Medical Imaging, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul K Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Simon Thibault
- Central Vein and Cosmetic Medical Centre, Newcastle, Australia
| | - Andre van Rij
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anes Yang
- Department of Dermatology, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales.,Dermatology, Phlebology and Fluid Mechanics Laboratory, St Vincent's Centre for Applied Medical Research, Sydney, Australia
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Parmenter B, Baker M, Mavros Y, Gates N, Simpson K, Meiklejohn J, Saigal N, Wilson G, Kay S, Zhao R, Wang Y, Dos-Santos-Correa A, Valenzuela M, Sachdev P, Singh N, Baune B, Suo C, Foroughi N, Climstein M, O’Sullivan A, Blair S, Dinnen P, Lusby R, Raymond J, Singh MF. Muscle Strength Is Impaired In Peripheral Arterial Disease And Predicts Flat Ground Walking Ability. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000494315.34964.6b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parmenter BJ, Raymond J, Dinnen P, Lusby RJ, Fiatarone Singh MA. High-Intensity Progressive Resistance Training Improves Flat-Ground Walking in Older Adults with Symptomatic Peripheral Arterial Disease. J Am Geriatr Soc 2013; 61:1964-70. [DOI: 10.1111/jgs.12500] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Belinda J. Parmenter
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
- Exercise Physiology Unit; Faculty of Medicine; University of New South Wales; Kensington New South Wales Australia
| | - Jacqueline Raymond
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
| | - Paul Dinnen
- Gold Coast Vascular Centre; Ashmore Queensland Australia
| | - Robert J. Lusby
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - Maria A. Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences; University of Sydney; Lidcombe New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Hebrew SeniorLife; and Jean Mayer USDA Human Nutrition Research Center on Aging; Tufts University; Boston Massachusetts
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