Journal of vascular surgery. Venous and lymphatic disorders最新文献

{"title":"Computed tomography scanning in the diagnosis of lower extremity phlebolymphedema.","authors":"David Thaggard, Thomas Powell, Arjun Jayaraj","doi":"10.1016/j.jvsv.2024.102166","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102166","url":null,"abstract":"<p><strong>Objectives: </strong>Phlebolymphedema, the most common cause of secondary lymphedema in Western societies, seldom gets the attention it deserves. Diagnosis is often missed and when evaluated is through lymphoscintigraphy (LSG) which is cumbersome. This study aims to assess the role of computed tomography (CT) scanning in the diagnosis of phlebolymphedema of the lower extremities by comparing CT characteristics to the International Society of Lymphology (ISL) grading system and LSG.</p><p><strong>Methods: </strong>Patients presenting with chronic venous disease who underwent a CT scan and LSG of the lower extremities (diagnostic testing) formed the study cohort. Three assessors blinded to the patients' ISL stage and lymphoscintigraphy results evaluated the CT for skin thickening (present/absent), subcutaneous interstitial edema (honeycombing; graded 0-2), and muscle compartment edema (graded 0-2), in the thigh (20 cm above apex of patella), leg (10 cm below apex of patella) and ankle (5 cm above lateral malleolus). Agreement from 2 of 3 raters determined the value used for analysis. Additionally, the final score used for each variable for each limb was determined by taking the most severe value of the three levels. The three CT variables were then compared independently and together to ISL stage and LSG to determine their diagnostic potential for phlebolymphedema. Also assessed was the severity of each CT variable across each limb in addition to the evaluation of the extent of their interrater agreement.</p><p><strong>Results: </strong>Of the 35 patients (50 limbs), 28 were female, with left laterality noted in 22 limbs. CEAP clinical class for the cohort included C0-2: 4 limbs (8%), C3: 13 limbs (26%), C4: 17 limbs (34%), C5: 9 limbs (18%), C6: 7 limbs (14%). 31 limbs underwent stenting for CIVO after having failed conservative therapy. Of the 50 limbs, 8 (16%) were ISL stage 0, 10 (20%) ISL stage 1, 2 (4%) ISL stage 2, and 30 (60%) ISL stage 3. With LSG, 6 (12%) had a normal study, 21 (42%) mild disease, 0 (0%) moderate disease, and 23 (46%) severe disease. Correlation between LSG and ISL stage was poor (r = 0.18; p=0.20). With ISL Stage as reference, sensitivity/specificity/accuracy of CT in diagnosing phlebolymphedema: skin thickening (95%/75%/92%), honeycombing (100%/0%/84%), muscle compartment edema (100%/0%/84%), any one CT variable (100%/0%/84%), any two CT variables (100%/0%/84%) and all 3 CT variables (93%/63%/88%). With LSG as reference, sensitivity/specificity/accuracy of CT in diagnosing phlebolymphedema: skin thickening (82% /0%/72%), honeycombing (100%/0%/88%), muscle compartment edema (100%/0%/88%), any one CT variable (100%/0%/88%), any two CT variables (100%/0%/88%) and all 3 CT variables (82%/0%/72%). For CT variables, there was no significant difference between skin thickening in the thigh versus calf versus ankle (p=0.5). Muscle compartment edema however worsened from thigh to calf (p<0.0001) without a difference be","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102166"},"PeriodicalIF":2.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Approach to Penile Pain and Engorged Superficial Dorsal Vein in a Young Male.","authors":"Amarseen Mikael, Steven Elias","doi":"10.1016/j.jvsv.2024.102164","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102164","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102164"},"PeriodicalIF":2.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Natural History of Portal Venous System Aneurysms.","authors":"Mary A Binko, Elizabeth A Andraska, Katherine M Reitz, Robert M Handzel, Michael J Singh, Natalie D Sridharan, Rabih A Chaer, Eric S Hager","doi":"10.1016/j.jvsv.2024.102163","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102163","url":null,"abstract":"<p><strong>Background: </strong>Portal venous system aneurysms (PVA) are increasingly diagnosed on cross-sectional computed tomography (CT) imaging. However, the natural history of these aneurysms is poorly understood and reports are limited to small case series.</p><p><strong>Methods: </strong>Terms relevant to PVA were searched in radiology reports (2010-2022) with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5 cm in patients without cirrhosis and 1.9 cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size while aneurysm regression as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups.</p><p><strong>Results: </strong>Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n=18, 47.4%), splenic vein (n=10, 26.3%), superior mesenteric vein (n=3, 7.9%), and portal confluence (n=7, 18.4%). While 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n=20, 52.6%) and prior liver transplant (n=4, 10.5%). The median growth was 0.2 cm (-2.6-2.4 cm) over median follow up over 5.0 years (0.3-16.6). Five (13.2%) PVA regressed and were largely idiopathic (80.0%, p=0.03). Thirteen (34.2%) PVA grew and were associated with portal hypertension (n=11, 84.6%, p=0.003) and thrombosis (n=6, 46.2%, p=0.05). Nine (23.7%) PVA thrombosed, predominantly in males (n=7, 77.8%). The median growth was 1.0 cm (-0.7-1.9 cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n=2, 22.2%), intestinal ischemia (n=1, 11.1%), and variceal bleeding (n=2, 22.2%). Four (44.4%) patients were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVA initially identified with and without radiographic follow up, 5 (8.6%) underwent intervention with a median diameter of 4.0 cm (3.4-5 cm). Intervention included vein ligation (n=1, 20.0%), aneurysmorrhaphy (n=1, 20.0%) and aneurysmectomy (n=3, 60.0%). There was one case of aneurysm recurrence 20 years following resection and one post-operative mortality.</p><p><strong>Conclusion: </strong>Two-thirds of PVA, including size greater than 3 cm, remain stable on surveillance. While annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVA thrombosed but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVA.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102163"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound characteristics and risk factors of female patients with pelvic varicose veins and concomitant chronic pelvic pain.","authors":"Binyu Zheng, Gaorui Liu, Yong Liu","doi":"10.1016/j.jvsv.2024.102165","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102165","url":null,"abstract":"<p><strong>Objective: </strong>The study aims to elucidate clinical and ultrasonographic characteristics of female patients diagnosed with pelvic varicose veins (PVV) and to assess potential risk factors associated with incidences of chronic pelvic pain (CPP) in this population.</p><p><strong>Methods: </strong>Clinical and ultrasound data were retrospectively collected from female patients with PVV at Beijing Shijitan Hospital between December 2017 and October 2022. Patient cohorts were divided into two groups based on whether they had been experiencing non-periodic pelvic pain over six months, consistent with the symptoms of CPP. Comparative analyses were conducted between the two groups, utilizing both univariate and multivariate logistic regression methodologies to identify risk factors for CPP.</p><p><strong>Results: </strong>(1) The study included a total of 236 patients: 89 patients in the CPP group and 147 patients in the non-CPP group. No statistically significant differences were found between the two groups with regard to demographic parameters including age, height, weight, age of menarche, and number of pregnancies and births. However, the CPP group showed a higher menstrual volume score and a greater incidence of varicose veins, coupled with a lower Body Mass Index (BMI). (2) Transabdominal ultrasonography revealed that patients with CPP had a significantly larger diameter in the left ovarian vein (6.2 ± 1.9 mm vs 5.0 ±2.3mm, P <0.05), and a higher prevalence of left internal iliac vein incompetence (21.3 vs 8.8%). Moreover, positive rates for left ovarian vein incompetence were markedly higher (94.4% vs 23.1%, P <0.05) even in the absence of left common iliac vein compression and nutcracker phenomenon. (3) Multivariate logistic regression analysis discerned that the left ovarian vein reflux (Odds Ratio [OR] = 9.102, 95% Confidence Interval [CI]: 4.578-18.099; P <0.05), lower BMI (OR= 0.646, 95% CI: 0.502-0.83; P <0.05), elevated menstrual bleeding (OR = 1.182, 95% CI: 1.131-1.234; P <0.05), and concomitant varicose veins (OR= 3.140, 95% CI:1.067-9.273; P <0.05) are independent risk factors for the manifestations of CPP in our patient cohorts.</p><p><strong>Conclusions: </strong>Ultrasonography serves as an efficacious modality for evaluating abdomino-pelvic vascular pathology in PVV patients. Notably, left ovarian vein and internal iliac vein incompetence emerge as independent risk factors for CPP, thus offering a pivotal point of reference for clinical diagnosis and therapeutic management of PVV.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102165"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting lack of clinical improvement following varicose vein ablation using machine learning.","authors":"Ben Li, Naomi Eisenberg, Derek Beaton, Douglas S Lee, Leen Al-Omran, Duminda N Wijeysundera, Mohamad A Hussain, Ori D Rotstein, Charles de Mestral, Muhammad Mamdani, Graham Roche-Nagle, Mohammed Al-Omran","doi":"10.1016/j.jvsv.2024.102162","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102162","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Varicose vein ablation is generally indicated in patients with active/healed venous ulcers. However, patient selection for intervention in individuals without venous ulcers is less clear. Tools that predict lack of clinical improvement (LCI) following vein ablation may help guide clinical decision-making but remain limited. We developed machine learning (ML) algorithms that predict 1-year LCI following varicose vein ablation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Vascular Quality Initiative (VQI) database was used to identify patients who underwent endovenous or surgical varicose vein treatment for Clinical-Etiological-Anatomical-Pathophysiological (CEAP) C2-C4 disease between 2014-2024. We identified 226 predictive features (111 pre-operative [demographic/clinical], 100 intra-operative [procedural], and 15 post-operative [immediate post-operative course/complications]). The primary outcome was 1-year LCI, defined as a pre-operative venous clinical severity score (VCSS) minus post-operative VCSS ≤ 0, indicating no clinical improvement following vein ablation. The data was divided into training (70%) and test (30%) sets. Six ML models were trained using pre-operative features with 10-fold cross-validation (Extreme Gradient Boosting [XGBoost], random forest, Naïve Bayes classifier, support vector machine, artificial neural network, and logistic regression). The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). The algorithm with the best performance was further trained using intra- and post-operative features. The focus was on pre-operative features, while intra- and post-operative features were of secondary importance, because pre-operative predictions offer the most potential to mitigate risk, such as deciding whether to proceed with intervention. Model calibration was assessed using calibration plots, while the accuracy of probabilistic predictions was evaluated with Brier scores. Performance was evaluated across subgroups based on age, sex, race, ethnicity, rurality, median Area Deprivation Index, prior ipsilateral varicose vein ablation, location of primary vein treated, and treatment type.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 33,924 patients underwent varicose vein treatment (30,602 [90.2%] endovenous and 3,322 [9.8%] surgical) during the study period and 5,619 (16.6%) experienced 1-year LCI. Patients who developed the primary outcome were older, more likely to be socioeconomically disadvantaged, and less likely to routinely use compression therapy. They also had less severe disease as characterized by lower pre-operative VCSS, VVSymQ scores, and CEAP classifications. The best pre-operative prediction model was XGBoost, achieving an AUROC (95% CI) of 0.94 (0.93-0.95). In comparison, logistic regression had an AUROC (95% CI) of 0.71 (0.70-0.73). The XGBoost model had marginally improved performance at the intra- and post-operative stages, both achieving an AUROC","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102162"},"PeriodicalIF":2.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety Assessment of Cyanoacrylate Closure for Treatment of Varicose Veins in a Large-Scale National Survey in Japan.","authors":"Michihisa Umetsu, Masayuki Hirokawa, Eri Fukaya, Eiichi Teshima, Hitoshi Kusagawa, Toshiya Nishibe, Makoto Mo, Tomohiro Ogawa","doi":"10.1016/j.jvsv.2024.102160","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102160","url":null,"abstract":"<p><strong>Objective: </strong>Cyanoacrylate closure (CAC) is a minimally invasive technique for treating axial venous reflux. However, the incidence of serious adverse events (AEs) related to CAC is concerning. With an increasing number of patients receiving CAC and insufficient safety data in Japan, this study aimed to investigate the safety profile of CAC, focusing on the types and incidence of AEs.</p><p><strong>Methods: </strong>A nationwide survey was conducted by the Japanese Regulatory Committee for Endovascular Treatment of Varicose Veins between November 2023 and December 2023. Data were collected from 1,017 institutions, covering 24,209 patients who underwent CAC at 335 institutions between January 2020 and October 2023. Thromboembolism, phlebitis, hypersensitivity reactions, granuloma formation, infection, bleeding, death, and need for glue resection were documented as unfavorable events/outcomes.</p><p><strong>Results: </strong>Venous thromboembolism (VTE) developed in 142 patients (0.59%). Pulmonary embolism, proximal deep vein thrombosis (DVT), and ablation-related thrombus extension (ARTE) developed in 3 (0.01%), 9 (0.04%), and 95 (0.39%) patients, respectively. Localized phlebitis that required additional treatment was observed in 1,656 patients (6.8%). Of the localized hypersensitivity cases, 960 (58%) required oral antihistamines and 268 (16%) required oral and/or intravenous steroids. Furthermore, 65 patients (0.27%) developed systemic hypersensitivity that required systemic steroids. No patients developed a stroke or anaphylaxis. One patient died due to pulmonary embolism. Glue resection was performed in nine patients with delayed infection (n = 4), hypersensitivity reactions (n = 4), or a foreign body granuloma (n = 1). The incidence of hypersensitivity reactions was similar among institutions. However, the incidence of thrombosis-related events significantly differed between the high-volume and low-volume institutions. The incidence of proximal DVT (0.13% vs. 0.01%; p < 0.001; odds ratio [OR], 12.5; 95% confidence interval [CI], 2.6-60.3) and ARTE (0.73% vs. 0.30%; p < 0.001; OR, 2.5; 95% CI, 1.66-3.77) was significantly higher in low-volume institutions than in high-volume centers.</p><p><strong>Conclusions: </strong>A nationwide survey of CAC for varicose veins in Japan demonstrated that it was a safe procedure with a low rate of serious AEs, such as VTE. However, hypersensitivity reactions requiring steroid administration and systemic allergic reactions were observed in some patients.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102160"},"PeriodicalIF":2.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-contrast MRI based machine learning and radiomics signature can predict the severity of primary lower limb lymphedema.","authors":"Jie Ren, Xingpeng Li, Mengke Liu, Tingting Cui, Jia Guo, Rongjie Zhou, Kun Hao, Rengui Wang, Yunlong Yue","doi":"10.1016/j.jvsv.2024.102161","DOIUrl":"https://doi.org/10.1016/j.jvsv.2024.102161","url":null,"abstract":"<p><strong>Purpose: </strong>According to International Lymphology Society guidelines, the severity of lymphedema is determined by the difference in volume between the affected limb and the healthy side divided by the volume of the healthy side. However, this method of measuring volume is time-consuming, laborious, and has certain errors in clinical applications.Therefore, this study aims to explore whether machine learning radiomics features based on non-contrast magnetic resonance imaging (NCMRI) can predict the severity of primary lower limb lymphedema.</p><p><strong>Methods: </strong>A retrospective analysis of 119 patients with primary lower-limb lymphedema. The enrolled patients were divided into a nonsevere group (mild and moderate) and a severe group. Using the semiautomatic threshold method in ITK-snap software on the patient's NCMRI, we filled the area between the subcutaneous tissue and muscle of the edematous site. The PyRadiomics software package was used to extract radiomic features. The radiomic features were analyzed using the t test or Mann‒Whitney test. Subsequently, Pearson correlation testing and Lasso screening were performed. Using Scikit-learn, the remaining features were used to construct five models: Logistic Regression, Support Vector Machine, RandomForest, ExtraTrees, and Light Gradient Boosting Machine. The predictive performance were evaluated by the receiver operating characteristic curve (ROC) curve, and the sensitivity and specificity of these measures were calculated. The predictive curve was used to evaluate the performance of the predictive model in guiding decisions for nonsevere and severe lymphedema patients.</p><p><strong>Results: </strong>The enrolled patients including 28 patients with mild (grade I) lymphedema, 38 patients with moderate (grade II) lymphedema, and 53 patients with severe (grade III) lymphedema was conducted. A total of 1196 features were extracted, and after Pearson correlation testing and Lasso screening, 21 nonzero features were selected. The ExtraTree model performed the best, with an AUC of 0.974 (95% CI: 0.9437-1.0000) in the training set, a sensitivity of 89.2%, and a specificity of 95.7%. In the test set, these values were 0.938 (95% CI: 0.8539-1.0000), 75%, and 100%, respectively. The decision curve showed that when the predicted probability was between 16% and 78%, the net benefit of the ExtraTree model was greater than that of the two extreme curves, indicating strong clinical value in guiding decisions for nonsevere and severe lymphedema patients.</p><p><strong>Conclusion: </strong>All five models performed well in distinguishing between the nonsevere group and the severe group. NCMRI based machine learning radiomics signature can predict the severity of primary lower limb lymphedema.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102161"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum.","authors":"","doi":"10.1016/j.jvsv.2024.102008","DOIUrl":"10.1016/j.jvsv.2024.102008","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102008"},"PeriodicalIF":2.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracardiopulmonary migration of inferior vena cava filters: An updated systematic review.","authors":"Yifei Bai, Kai Wang, Tongqing Xue, Zhongzhi Jia","doi":"10.1016/j.jvsv.2024.102009","DOIUrl":"10.1016/j.jvsv.2024.102009","url":null,"abstract":"<p><strong>Objective: </strong>Intracardiopulmonary migration of an inferior vena cava (IVC) filter is an uncommon but potentially life-threatening complication. A previous systematic review including data through 2008 found that the most common cause for migration was operator error and that open thoracotomy was the best first option for management. The aim of this study was to assess the clinical presentation and causes of intracardiopulmonary filter migration, as well as the most commonly used management strategies over the past 15 years.</p><p><strong>Methods: </strong>A systematic search of the literature was conducted to identify studies pertaining to intracardiopulmonary IVC filter migration that were published between November 2008 and June 2024, and data were collected regarding clinical presentation, complications, type and location of filter migration, and management strategies.</p><p><strong>Results: </strong>A total of 156 cases of intracardiopulmonary migration of IVC filters were identified in 88 publications. Of the 66 patients whose symptoms status was listed, 50 patients had symptoms and 16 patients were asymptomatic. In the remaining patients, the symptom status was not listed. The most frequently reported symptom was chest pain (68.0%; 34/50). Of the 156 patients, 34 (22.8%) experienced intracardiopulmonary migration of the entire filter body, and the remaining 122 (78.2%) experienced filter fracture with migration of the fractured struts. Complications were reported in 30.1% of patients (47/156); these complications included myocardial injury (n = 37), damage of tricuspid valve (n = 12), and hemopericardium (n = 21). Endovascular (16 filters and 56 struts) or surgical (13 filters and 16 struts) retrieval was the primary management strategy for intracardiopulmonary migration of the filter or fractured strut.</p><p><strong>Conclusions: </strong>The main cause of intracardiopulmonary migration of an IVC filter is filter fracture. Endovascular retrieval is gradually becoming the preferred management option for intracardiopulmonary migration of IVC filters.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102009"},"PeriodicalIF":2.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of stenting superior cava and brachio-cephalic vein occlusion in hemodialysis patients with arteriovenous fistulas.","authors":"Florent Porez, Reuben Veerapen, Stéphanie Delelis, Sarah Kirat, Eric Braunberger, Gilles Lerussi, Bruno Delelis","doi":"10.1016/j.jvsv.2024.102007","DOIUrl":"10.1016/j.jvsv.2024.102007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Central vein occlusion (CVO) is a significant complication in patients undergoing chronic hemodialysis, often leading to dialysis inefficacy, disabling symptoms, and, most critically, major risk of access failure. Although stenting has been proposed as a technique to maintain vascular access patency following the recanalization of occluded central veins, the data supporting its long-term efficacy remains limited. This study aims to evaluate the long-term effectiveness of stenting occluded superior vena cava (SVC) and/or brachiocephalic veins to preserve vascular access patency, ensure continued dialysis efficacy, and relieve SVC syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study retrospectively reviewed all hemodialysis patients who underwent stent placement for CVO between January 2017 and August 2024 at two vascular centers in Reunion Island. The primary endpoints of the study were the primary, assisted primary, and secondary patency rates of the vascular circuit during follow-up. Additionally, patient demographics, medical comorbidities, postoperative complications, definitive access abandonment, and reinterventions were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 21 patients with a mean age of 67 years. CVO stenting initially provided symptomatic relief for all patients, resolving symptoms such as SVC or arm swelling in symptomatic patients. Over a median follow-up period of 41 months (range, 3-80 months), the primary patency rates were 67% at 12 months, 42% at 24 months, and 38% at 36 months, whereas the secondary patency rates were 90%, 79%, and 60% at these same intervals. Twelve patients (62%) experienced clinically significant stent restenosis, necessitating one or several additional percutaneous transluminal angioplasties during follow-up, whereas five patients (24%) developed acute access thrombosis requiring thrombectomy and percutaneous transluminal angioplasty, with central stent involved for three patients. Three patients (14%) required extra-anatomic bypasses due to definitive stent occlusion, five patients (14%) had definitive access failure, and five patients (24%) died from unrelated causes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This review suggests that hemodialysis patients with symptomatic CVO can often be successfully recanalized and treated with stenting, leading to symptom resolution and, importantly, achieving promising secondary patency rates. Our long-term results highlight the necessity for regular reintervention and close follow-up, as a significant number of patients will experience restenosis, and ultimately definitive access failure. Therefore, CVO stenting should be considered a temporary solution, although for some patients, this strategy may prove highly effective, maintaining long-term patency without any restenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;We studied central vein stenting for 21 hemodialysis patients with a mean follow-up of 41 months. Long-t","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102007"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}