International AngiologyPub Date : 2023-12-01Epub Date: 2023-12-11DOI: 10.23736/S0392-9590.23.05138-6
Edoardo Cervi, Daniele Bissacco
{"title":"5G-based robot-assisted remote ultrasound in vascular disease: a new era is coming!","authors":"Edoardo Cervi, Daniele Bissacco","doi":"10.23736/S0392-9590.23.05138-6","DOIUrl":"10.23736/S0392-9590.23.05138-6","url":null,"abstract":"","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"537-538"},"PeriodicalIF":1.4,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138794289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reduction of lower-limb edema in patients with chronic venous disease by micronized purified flavonoid fraction: a systematic literature review and meta-analysis.","authors":"Eberharde Rabe, Vanessa Blanc-Guillemaud, Marie-Blanche Onselaer, Yoann Blangero, Hurrem-Pelin Yaltirik, Andrew Nicolaides","doi":"10.23736/S0392-9590.23.05084-8","DOIUrl":"10.23736/S0392-9590.23.05084-8","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of lower limb edema is high among patients with chronic venous disease (CVD). Several clinical studies with various designs have assessed the effect of micronized purified flavonoid fraction (MPFF) on edema. The aim of this work was to provide a comprehensive and accurate evaluation of the reduction in ankle and calf circumference as an indicator of lower limb edema reduction in patients with CVD treated with MPFF by combining studies that use different designs in a single group meta-analysis.</p><p><strong>Evidence acquisition: </strong>We conducted a systematic literature review in April 2022 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria to identify prospective studies investigating the effect of oral MPFF treatment 1000 mg/day on ankle and calf circumference in patients with CVD. Studies with population including at least one patient with an ulcer were excluded. All prospective studies irrespectively of design (i.e., interventional and non-interventional studies, randomized controlled trials (RCTs), non-randomized studies, studies without a control or reference treatment) were eligible. The Medline, Embase and Cochrane databases were searched. Endpoints were ankle and calf circumference measurements and their overall mean change from baseline estimated with random-effects meta-analysis methods. The evaluation criterion feeling of swelling was also analyzed as a standardized mean change (SMC) with 95% confidence intervals after combination of quantitative scales.</p><p><strong>Evidence synthesis: </strong>Among 861 articles identified, eight studies (five RCTs including one placebo-controlled, three non-comparative studies) met the criteria. The overall population consisted of 1635 patients, predominantly female (89% ranging from 64% to 94%) with a mean age of 47 years ranging from 41 to 48 years. Mean reduction in ankle circumference was 6.0 mm (95%CI: 3.6 to 8.4; P<0.001) and 7.0 mm (95%CI: 0.9 to 13.1; P=0.024) after two and at least six months of treatment respectively. The results were similar when considering the study type RCTs and non-RCTs. Mean reduction in calf circumference was 5.7 mm (95%CI: 2.8 to 8.6; P<0.001) and 6.7 mm (95%CI: 5.2 to 8.1; P<0.001), at two months and at the last post-baseline evaluation respectively. Heterogeneity among studies was statistically significant (degree of consistency I<sup>2</sup>=93.5%; P<0.001 and I<sup>2</sup>=81.1%, P<0.01 for ankle and calf circumference, respectively). In the three studies reporting the effect on feeling of swelling a significant standardized mean change (SMC) reduction of 2.2 (95%CI: 0.2 to 4.2; P=0.028) on a quantitative scale was observed after two months of treatment with MPFF.</p><p><strong>Conclusions: </strong>MPFF appeared to be effective in reducing ankle and calf circumference as well as feeling of swelling irrespective of study design. The circumference reduction is p","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"488-502"},"PeriodicalIF":1.5,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138829574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"TEVAR for aortic arch lesions combining physician-modified endograft and in-situ fenestration.","authors":"Yuxi Zhao, Zhaoxiang Zeng, Xianhao Bao, Mingwei Wu, Jiaxuan Feng, Zaiping Jing, Rui Feng","doi":"10.23736/S0392-9590.23.05063-0","DOIUrl":"10.23736/S0392-9590.23.05063-0","url":null,"abstract":"<p><strong>Background: </strong>The aim of this retrospective study was to investigate the outcomes of combining physician-modified endograft (PMEG) and in-situ fenestration (ISF) for aortic arch repair.</p><p><strong>Methods: </strong>A retrospective analysis was performed in 12 patients with aortic arch pathologies who underwent thoracic endovascular aortic repair with PMEG and ISF between June 2019 and February 2020.</p><p><strong>Results: </strong>Revascularizations of supra-aortic arteries were successfully performed in 91.7% patients (11/12). One patient with aberrant right subclavian artery was unsuccessful because of tortuosity and sharp angle. One patient received endovascular exclusion by Viabahn due to artery injury of the femoral access. During the follow-up (mean 22.7 months), one patient underwent Bentall surgery because of retrograde type A aortic dissection, and one patient received coils embolization due to occurrence of a type I endoleak. In addition, one patient died of myocardial infarction 13 months after surgery. Results obtained after computed tomography angiography confirmed patency of all the supra-aortic arteries.</p><p><strong>Conclusions: </strong>Combining PMEG and ISF could be a feasible option for aortic arch lesions in selected patients. Long-term durability concerns require further evaluation.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"412-419"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92153678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-06-28DOI: 10.23736/S0392-9590.23.05055-1
Mario Salerno, Daniele Bissacco, Yung-Wei Chi, Sriram Narayanan, Alessandro Addis, Claudia Dellavia, Elena Canciani, Marco Gard, Sergio Gianesini
{"title":"Empty vein ablation innovative technique for chronic venous disease treatment: proof of concept and ex-vivo analysis.","authors":"Mario Salerno, Daniele Bissacco, Yung-Wei Chi, Sriram Narayanan, Alessandro Addis, Claudia Dellavia, Elena Canciani, Marco Gard, Sergio Gianesini","doi":"10.23736/S0392-9590.23.05055-1","DOIUrl":"10.23736/S0392-9590.23.05055-1","url":null,"abstract":"<p><strong>Background: </strong>Sclerotherapy is among the mainstays of chronic venous disease treatment, yet its occlusion rate remains suboptimal compared to thermal tumescent techniques. An innovative three-balloons catheter has been developed to allow sclerotherapy in empty vein conditions (empty vein ablation technique, EVA). Aim of this investigation was to describe the EVA technical aspects and related ex-vivo effects on vein wall.</p><p><strong>Methods: </strong>Two samples from jugular veins of an adult sheep were treated by EVA or foam sclerotherapy (FS, Tessari method). Primary outcome was the percentage of circumferential intima treated by EVA or FS; secondary outcomes were intima and media thickness modifications after treatment.</p><p><strong>Results: </strong>Intact circumferential residual intima were 6.07±2.94% and 16.55±0.70% after EVA and FS, respectively (P=0.020). Despite the average intima and media thickness did not differ between treatments, EVA demonstrated a homogenous damage throughout the vein segment, while FS effect was less destructive distally to the injection site, because moving away from the injection site and floating, it has a less contact with internal surface of the vein.</p><p><strong>Conclusions: </strong>EVA seems to overcome chemical ablation limits as flushing effect and the increases vein wall/sclerosant agent contact effect compared to FS. Ex-vivo encouraging results need in-vivo validation to evaluate other points like deactivation of sclerosing agent by blood protein and the contact time control between SA and the vein wall. If we have further confirmations in vivo we might think we have a potential higher occlusion rate compared to FS, paving the way for future clinical trials.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"420-426"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9684325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-10-23DOI: 10.23736/S0392-9590.23.05085-X
Isabel Machado, Joana Ferreira, Carlos Magalhães, Pedro Sousa, Lúcia Dias, Daniel Santarém, Nelson Sousa, Hugo Paredes, Catarina Abrantes
{"title":"Six-month effects of supervised exercise on walking ability and health-related factors in peripheral arterial disease: a pilot study.","authors":"Isabel Machado, Joana Ferreira, Carlos Magalhães, Pedro Sousa, Lúcia Dias, Daniel Santarém, Nelson Sousa, Hugo Paredes, Catarina Abrantes","doi":"10.23736/S0392-9590.23.05085-X","DOIUrl":"10.23736/S0392-9590.23.05085-X","url":null,"abstract":"<p><strong>Background: </strong>In peripheral arterial disease (PAD) patients with intermittent claudication (IC), the combination of aerobic and resistance exercises could counteract muscle loss and attenuate disease progression. This study analyzed the effects of six months of a combined exercise program on walking ability, lower limb body composition, cardiovascular risk factors, and Ankle-Brachial Index (ABI).</p><p><strong>Methods: </strong>Twenty-three patients (age 63.2±1.5 years and ABI 0.58±0.07) with PAD and IC were allocated to a control group (CG) or a supervised exercise group (SUP). Ten patients underwent six months of treadmill walking combined with resistance exercises, three times a week. The CG (N.=13) received a recommendation for walking. All patients were measured at baseline (M0), after three months (M3), and six months (M6).</p><p><strong>Results: </strong>During constant treadmill protocol, the claudication onset time/distance (COT/COD), absolute claudication time/distance (ACT/ACD), and number of pauses of overall patients significantly improved at M3 and M6. Between groups were found significant differences in COT and COD at M6 (P=0.005 and P=0.007, respectively); and in ACT and ACD at M3 (P=0.003 for both) and at M6 (P=0.005 and P=0.005, respectively), with major improvements in the SUP. Over the six months, a significant group effect was found in fat-free mass (P=0.041) and predicted muscle mass (P=0.039) of the lower ABI leg, with greater improvements in the SUP.</p><p><strong>Conclusions: </strong>A supervised exercise program that combines aerobic and resistance training improves PAD symptoms and has additional benefits for patients. Patients in the program showed improvements in walking ability, lower-limb body composition, perceived exertion, and heart rate during treadmill walking.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"371-381"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49690362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-11-09DOI: 10.23736/S0392-9590.23.05101-5
Andrea Kahlberg, Victor Bilman, Carlotta Bugna, Enrico Rinaldi, Daniele Mascia, Diletta Loschi, Roberto Chiesa, Germano Melissano
{"title":"Silver acetate and Triclosan Antimicrobial Graft Evaluation for surgical Repair of aortic disease (STAGER Study).","authors":"Andrea Kahlberg, Victor Bilman, Carlotta Bugna, Enrico Rinaldi, Daniele Mascia, Diletta Loschi, Roberto Chiesa, Germano Melissano","doi":"10.23736/S0392-9590.23.05101-5","DOIUrl":"10.23736/S0392-9590.23.05101-5","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess perioperative and late performance of a silver acetate and triclosan impregnated antimicrobial vascular graft (Intergard Synergy, Intervascular SAS, La Ciotat, France) during open surgical repair of abdominal aortic aneurysms (AAA), and to compare it with standard polyester grafts ones.</p><p><strong>Methods: </strong>This retrospective single-centre study (STAGER Study, clinicaltrials.gov: NCT04557254) included patients undergone non-infectious AAA surgical repair between 2012 and 2019, divided into two groups according to the implanted aortic prosthesis: standard polyester graft (PolyG) and silver-triclosan graft (SynG). Early primary endpoints were 30-day mortality, major adverse events (MAEs), and reintervention rates; late primary endpoints were overall and aortic-related survival, reintervention-free survival, and graft infection rate at a mean follow-up (FU) of 49.4±26.8 months.</p><p><strong>Results: </strong>Five hundred forty-seven patients were included [PolyG 49%, and SynG 51%]. Both groups were substantially homogeneous in risk factors and demographics. Two patients died within 30 days. In-hospital MAE rate [PolyG 14.2% vs. SynG 10.7%; P=.248] and 30-day reintervention rate were not significantly different [PolyG 2.6% vs. SynG 1.4%; P=.374]. At 5 years, overall survival in the PolyG and SynG groups were 85% and 84%, respectively. Reintervention-free survival was 82% for both groups. Aortic-related survival was 95% and 96%, respectively. Graft infection was observed in 8 (3.3%) PolyG patients and 5 (1.8%) SynG patients.</p><p><strong>Conclusions: </strong>Silver acetate and triclosan impregnated grafts demonstrated good early and mid-term results, being considered safe and durable for AAA open repair. Similar graft infection and related death rates were observed compared to polyester standard grafts, supporting non-superiority of one graft over the other.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"402-411"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-11-14DOI: 10.23736/S0392-9590.23.05061-7
Ahmet K Bozkurt, Marie J VAN Rijn, Eliete Bouskela, Giacomo Gastaldi, Frederic Glauser, Hermann Haller, Juan Rosas-Saucedo, Daniel Zingg, Alessandra Calabrese, Eberhard Rabe, Armando Mansilha
{"title":"Enhancing identification and treatment of patients with concomitant chronic venous insufficiency and diabetes mellitus. A modified Delphi study from the CODAC (ChrOnic venous disease and Diabetes Advisory Council) group.","authors":"Ahmet K Bozkurt, Marie J VAN Rijn, Eliete Bouskela, Giacomo Gastaldi, Frederic Glauser, Hermann Haller, Juan Rosas-Saucedo, Daniel Zingg, Alessandra Calabrese, Eberhard Rabe, Armando Mansilha","doi":"10.23736/S0392-9590.23.05061-7","DOIUrl":"10.23736/S0392-9590.23.05061-7","url":null,"abstract":"<p><strong>Background: </strong>Chronic venous insufficiency (CVI) and diabetes mellitus (DM) pose significant burdens to patients and healthcare systems. While the two diseases share a number of commonalities in risk factors and pathophysiology, they are often assessed and managed separately. This can lead to a worsening of comorbidities and limitations in a patient's quality of life. This project aims to develop recommendations to enhance the identification and treatment of patients with concomitant CVI and DM.</p><p><strong>Methods: </strong>Using a modified Delphi method, a panel of experts developed 38 Likert Scale and two multiple choice questions across six key themes. These were used to form an online survey which was disseminated through a convenience sampling approach to CVI and DM healthcare professionals across Europe, Central America, South America, and the Middle East. The threshold for consensus was set at ≥75%.</p><p><strong>Results: </strong>A total of 238 responses were received. 27/38 statements attained >90% agreement, nine of 38 attained between 75-90%, and two failed to meet the threshold (<75%). The awareness around the impact of the two diseases was high, but a gap was highlighted in the identification of patients with concomitant CVI and DM.</p><p><strong>Conclusions: </strong>The high level of agreement shows that healthcare professionals are aware of the gaps in identification and treatment of patients with concomitant CVI and DM, and of the need to approach this as a combined therapy area. An algorithm is proposed to help the identification of at-risk patients and to provide recommendations on the management of patients with concomitant disease.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"427-435"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92153677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-11-09DOI: 10.23736/S0392-9590.23.05111-8
Lawrence Nip, Nicholas Evans, Suparna Bali, Colin Hopper, Anthie Papadopoulou, Mohamed Khalifa, George Hamilton, Chung S Lim, Jocelyn Brookes
{"title":"Early experience of thalidomide therapy for high-grade peripheral and facial arteriovenous malformations.","authors":"Lawrence Nip, Nicholas Evans, Suparna Bali, Colin Hopper, Anthie Papadopoulou, Mohamed Khalifa, George Hamilton, Chung S Lim, Jocelyn Brookes","doi":"10.23736/S0392-9590.23.05111-8","DOIUrl":"10.23736/S0392-9590.23.05111-8","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformations (AVMs) are developmental defects in the vascular system with abnormal connections between arteries and veins. A minority of AVMs are characterized by aggressive growth and continue to proliferate despite maximal surgical and interventional therapy. We report our outcomes with the use of thalidomide as the only UK specialist center adopting this novel approach for the management of AVMs refractory to conventional therapy.</p><p><strong>Methods: </strong>This was a retrospective case series which included only complex and proliferative AVM lesions (Schobinger grade III and IV). All patients prescribed thalidomide on a compassionate basis between September 2006 and August 2022 after attempts at embolosclerotherapy without satisfactory response were reviewed.</p><p><strong>Results: </strong>Eleven patients were included in our study. The median total duration of thalidomide use was 10 months. Two thirds of patients with pain (six of nine) reported an improvement, three quarters reported a reduction in swelling (six of eight) and all who presented with bleeding reported improvement in overall volume or frequency (four of four). Over the study period, 45% achieved a non-proliferative state with no further target vessel demonstrable on angiography. Mild, tolerable side effects such as fatigue were common (73%). There was only one major adverse reaction (neutropenia) necessitating cessation of therapy.</p><p><strong>Conclusions: </strong>We can conclude that thalidomide is able to reduce the symptom burden for patients with complex and proliferative AVMs that were refractory to established treatment modalities. Adverse effects are common, but the benefit achieved from taking thalidomide in otherwise treatment resistant cases outweighs the risks, most of which are manageable.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"448-456"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-10-12DOI: 10.23736/S0392-9590.23.05110-6
Pier Luigi Antignani, Mauro Gargiulo, Giacomo Gastaldi, Arkadiusz Jawien, Armando Mansilha, Pavel Poredos
{"title":"Lower extremity arterial disease perspective: IUA consensus document on \"lead management\". Part 1.","authors":"Pier Luigi Antignani, Mauro Gargiulo, Giacomo Gastaldi, Arkadiusz Jawien, Armando Mansilha, Pavel Poredos","doi":"10.23736/S0392-9590.23.05110-6","DOIUrl":"10.23736/S0392-9590.23.05110-6","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or lower extremity arterial disease (LEAD) also named peripheral arterial disease (PAD). ASCVD is considered to be of atherosclerotic origin and is the leading cause of morbidity and mortality mainly for individuals with diabetes mellitus (DM). In this consensus document of the International Union of Angiology the authors discuss epidemiology, risk factors, primary and secondary prophylaxis, the correlation between diabetes mellitus and LEAD, conservative and surgical treatment.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"382-395"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41199838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
International AngiologyPub Date : 2023-10-01Epub Date: 2023-10-05DOI: 10.23736/S0392-9590.23.05082-4
Mariana Miranda, Joel Sousa, Armando Mansilha
{"title":"PREVAIT after modern open surgery and endothermal ablation: a systematic review.","authors":"Mariana Miranda, Joel Sousa, Armando Mansilha","doi":"10.23736/S0392-9590.23.05082-4","DOIUrl":"10.23736/S0392-9590.23.05082-4","url":null,"abstract":"<p><strong>Introduction: </strong>Presence of varices after operative treatment (PREVAIT) is a common finding after varicose vein surgery, and has been shown to significantly reduce the quality of life of those it affects. As such, long-term results after varicose vein interventions have to be taken into account when choosing a technique. This study aims to systematically review current evidence on the recurrence of varicose veins after three different techniques: conventional surgery (HLS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA).</p><p><strong>Evidence acquisition: </strong>A literature search was performed on the PubMed and Web of Science databases, which returned 546 studies. Fourteen studies were included. Data were extracted using predefined forms.</p><p><strong>Evidence synthesis: </strong>A total of 2795 patients were included, for a total of 3056 legs treated. 503 legs (16.5%) were treated by HLS, 1791 (58.6%) by EVLA and 762 (25.0%) by RFA. PREVAIT was reported in 34.4% for patients treated by HLS, for a mean follow-up comprised between 18 months and 5 years; 16.6% by EVLA, for a mean follow-up between 112 days and 5 years and 6.7% of those treated by RFA, for a mean follow-up between 106 days and 5 years. Regarding patterns of recurrence, the development of new varicose veins was the most commonly reported mechanism of recurrence after HLS (range: 29.8-91%) and EVLA (range: 40-81.6%), but not RFA, where recanalization of the occluded saphenous trunk accounted for up to 67.0% of the cases. Only one study reported quality of life related recurrence, and included patients treated by HLS and EVLA, but not RFA. Aberdeen Varicose Vein Questionnaire (AVVQ) score, physical functioning domains of the SF-36 score and patient satisfaction were significantly worse in patients with clinical recurrence. Re-intervention rates after recurrence were reported in 5 studies, ranging between 7.7% and 37.7% for HLS and 0-57.0% for EVLA. Only one study reported data on re-intervention for RFA patients, which was 6.67%.</p><p><strong>Conclusions: </strong>Recurrence is a reliable indicator of long-term efficacy of a varicose vein treatment and appears to occur more frequently after HLS. Although there are several mechanisms of recurrence, the development of new varicose veins was the most commonly observed. There is clear heterogeneity among definitions of recurrence and follow-up periods in literature.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"436-447"},"PeriodicalIF":1.4,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41118250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}