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

{"title":"Coil occlusion combined with sclerotherapy versus N-butyl-2 cyanoacrylate (NBCA) embolization in patients with pelvic venous disorders (PeVD): A single center retrospective study.","authors":"Hossam Zaghloul, Mahmoud Nasser, Hisham Abd El-Mawgoud, Baker Ghoneim, Mohammed Ali","doi":"10.1016/j.jvsv.2025.102241","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102241","url":null,"abstract":"<p><strong>Background: </strong>Pelvic Venous Disorder (PeVD) is increasingly diagnosed with different modalities of treatment.</p><p><strong>Patients and methods: </strong>This is a retrospective study in which we compared using metallic coil combined with sclerosant foam N-Butyl-2 Cyanoacrylate (NBCA) in females with PeVD in terms of clinical and technical success as well as safety. Adult patients with symptoms suggestive of primary PEVD and confirmed with Doppler US and /Or venography were eligible for the study. Secondary PeVD and lost Follow up were excluded.</p><p><strong>Results: </strong>this study included 167 patients who were treated with coil and sclerotherapy (n = 87; Group I) or NBCA (n = 80; Group II) embolization. Immediate postoperative veins' closure was achieved in all patients in the two groups. At the 6-month follow-up, there was a statistically significantly higher occlusion rate in Group I (100% compared to 93.8% in Group II, p = 0.018) with five new cases of recanalization. The 6-month VAS score was lower in Group I (median of 1 and mean of 1.14 ± 0.904) than Group II (median of 2 and mean of 1.7 ± 1.32), with a statistically significant difference (p = 0.005).</p><p><strong>Conclusion: </strong>The study emphasizes the potential advantages of the sclerosant foam and metallic coil combination in achieving favorable outcomes for patients with PeVD.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102241"},"PeriodicalIF":2.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753460","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":"A comparison and AGREE II analysis of the revised SVS/AVF/AVLS and ESVS clinical practice guidelines in the management of varicose veins.","authors":"Alexandra Tedesco, Thomas F O'Donnell, Isaac Gendelman, Payam Salehi","doi":"10.1016/j.jvsv.2025.102238","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102238","url":null,"abstract":"<p><strong>Objective: </strong>To compare the SVS/AVF/AVLS and the ESVS revised CPGs for treatment of C2 VVs by an analysis of content, methodologic, level of evidence and strength of evidence as well as by AGREE II analysis.</p><p><strong>Methods: </strong>The 2022 SVS/AVF/AVLS (A) guidelines for VVs were compared to the 2022 ESVS (E) CPGs on VVs for: specific methodology, evidence development [ED], strength of recommendation (SOR), and level (quality) of evidence (LOE). Additionally, an AGREE II analysis was performed to compare the two guidelines. These guidelines were scored on 6 different domains as well as overall quality using a 7-point Likert scale according to the AGREE II methodology.</p><p><strong>Results: </strong>The two CPGs differed in methodology and scope of content. The two guidelines varied significantly on their ratings of levels of evidence as well as their overall strengths of recommendations. The AGREE II analysis found that both guidelines scored as high quality in the domains of scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, editorial independence, and overall assessment. For the domain of applicability, ESVS (65.28%) scored significantly higher than SVS/AVF/AVLS guideline (51.39%), p=<.05.</p><p><strong>Conclusion: </strong>Although the methodology differed significantly between both guidelines, the overall conclusions remained similar and both guidelines were rated as high quality by AGREE II analysis.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102238"},"PeriodicalIF":2.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743308","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":"Advancing Opportunity and Representation in the American Venous Forum.","authors":"Lucy Yang, Ruth L Bush, Kathleen Ozsvath, Misty D Humphries, Karem Harth","doi":"10.1016/j.jvsv.2025.102239","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102239","url":null,"abstract":"<p><strong>Objective: </strong>Diversity, equity, and inclusion (DEI) within the physician workforce is critical to establishing a diverse provider network that accurately represents the patient population served by vascular surgeons. Vascular surgery remains a largely male-dominated surgical specialty, and the number of women in leadership positions in academic surgical specialties continues to be disproportionate. The representation of women in leadership roles differs across vascular surgery societies. The goal of this study is to provide an update on the representation of women and incorporation of DEI topics at American Venous Forum (AVF) annual meetings and across committees.</p><p><strong>Methods: </strong>A retrospective review was conducted of available scientific meeting programs and abstracts presented at the AVF from 2010 to 2023. The time period was divided into before 2019 and after 2019, as this was the year that the Society for Vascular Surgery (SVS) established the Task Force on DEI. Women's participation and DEI domains were documented for each year. A two-sample unpaired t-test was used to compare mean percentages.</p><p><strong>Results: </strong>Specifically, within the American Venous Forum (AVF), women's representation across all roles (presenters, senior authors, moderators, committee chairs, committee members, and officers) has increased when comparing prior years (2010-2019) to a more recent time period (2020-2023). The largest increase was observed for moderators (12.6% vs. 30.2%, +17.6%) and the smallest increase was observed for presenters (21.1% vs. 28.9%, +7.8%). When comparing the same time periods, the mean percentage of DEI domains (access to care, race and ethnicity, gender, age, health literacy, and socioeconomic status) highlighted in research presentations at AVF annual meetings has increased numerically over time but is not statistically significant except for the DEI domain of age (1.34% vs 3.28%; p=0.0008).</p><p><strong>Conclusions: </strong>While there have been positive improvements in the proportion of women in leadership roles at the AVF, the integration of DEI domains at AVF annual meetings continues to show slow progress. This study reflects an opportunity for AVF leaders and councils to prioritize strategies to incorporate important DEI domains into our annual meetings and mission-related efforts. Intentional progress in these areas will ultimately contribute to more successfully carrying out the AVF Core Values (VEINS: Values and integrity, Education, Inclusivity, equity, diversity, Nurturing, Scientific excellence and research).</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102239"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730596","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":"Efficacy of Ultrasound-Guided Microwave Ablation for Vascular Malformations in Children.","authors":"Shuting Huang, Fenglin Xu, Xin Li, Hongxia Zhang, Jingyu Chen, Zhenzhen Zhao, Jun Zhang, Liang Peng, Xiangru Kong","doi":"10.1016/j.jvsv.2025.102240","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102240","url":null,"abstract":"<p><strong>Objective: </strong>To report our center's experience in treating pediatric vascular malformations using ultrasound-guided microwave ablation.</p><p><strong>Methods: </strong>Twenty-two symptomatic children with vascular malformations underwent ultrasound-guided microwave ablation. All patients received ultrasound follow-up after microwave ablation, while MRI follow-up was conducted depending on the disease's condition. The Visual Analog Scale (VAS) and the PedsQL4.0 Chinese Version was utilized to assess the changes in pain severity, limb motion evaluation, and quality of life before and after treatment.</p><p><strong>Results: </strong>The study included 22 cases, comprising 4 Arteriovenous Malformations (AVM), 9 Venous Malformations (VM), 2 diffuse microcystic Lymphatic Malformations (LM), 2 cases of Klippel-Trenaunay syndrome (K-T syndrome), and 5 cases of Fibro Adipose Vascular Anomaly (FAVA). All children presented with pain at the affected site (22 cases, 100%). The malformations were located in the limbs in 17 cases (77%), subcutaneous and intramuscular tissues of the buttocks in 1 case (4.5%), subcutaneous tissue of the abdominal wall in 1 case (4.5%), and retroperitoneal in 3 cases (14%). All 22 patients (100%) experienced pain. Additionally, 20 cases (91%) exhibited swelling at the affected site or developed swelling after physical activity. Limb hypertrophy was observed in 5 cases (23%), while another 5 cases (23%) showed signs of limb atrophy. Joint mobility restrictions were present in 4 cases (18%). Among these 22 patients, 17 cases (77.3%) experienced complete resolution of pain and local lesion appearance changes, while 4 cases (18.2%) reported pain relief. However, in 1 case (4.5%) of KT syndrome, postoperative improvement was observed at the treatment site, but a new centripetal malformation developed within the treated region. This patient subsequently underwent surgical intervention, resulting in an improvement in clinical symptoms. The pre-treatment malformation volume was 209.85 ± 343.17 cm³, which reduced to 32.95 ± 66.04 cm³ one year after ablation. The volume reduction was statistically significant (t=2.374, P=0.026, P<0.05), with an average volume reduction rate of 85.51%. No major complications were found, such as nerve damage or skin burns.</p><p><strong>Conclusion: </strong>Ultrasound-guided microwave ablation is a relatively safe and effective technique for treating pediatric vascular malformations. Further multicenter studies are recommended to validate these findings.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102240"},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730598","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":"EFficacy of Family presence in the Operating Room during endovenous Treatment - An EFFORT Prospective Observational Study.","authors":"Kilsoo Yie, A-Rom Shin, Eun-Hee Jeong, Bo-Mi Kim, Eun-Jung Hwang","doi":"10.1016/j.jvsv.2025.102237","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102237","url":null,"abstract":"<p><strong>Introduction: </strong>Varicose vein treatments are increasingly employing ambulatory endovenous procedures under local anesthesia. Despite their safety and feasibility, these procedures may induce significant psychological distress-a concern not currently addressed by exist guidelines. This study investigates the necessity for family presence (FP) during endovenous procedures and its effects on the disease treatment process, hypothesizing that FP can provide emotional support and enhance patient trust in medical staff.</p><p><strong>Methods: </strong>This single-center, prospective observational study, conducted from September 2022 to March 2024, enrolled 175 patients scheduled for outpatient endovenous treatments. Participants were divided based on their preference for family presence during the surgery into FP (n=61, 34.9%) and No Family Presence (NFP, n=114, 65.1%) groups. The primary outcome was the influence of preoperative anxiety on the preference for FP, with secondary outcomes focusing on its impact on perioperative pain and postoperative satisfaction. Data collection followed the STROBE guidelines for observational studies, with preoperative anxiety assessed using a modified Amsterdam Preoperative Anxiety and Information Scale (mAPAIS).</p><p><strong>Results: </strong>There were no significant demographic or clinical differences between the FP and NFP groups. In the NFP group, common reasons for declining FP included concerns about displaying anxiety (36%) and a perceived lack of necessity (29.8%). The FP group reported significantly higher mAPAIS scores (5.2±1.7 vs. 4.4±1.5, p=0.003) and a stronger preference for FP (3.4±1.1 vs. 2.1±0.8, p=0.001). Logistic regression analysis identified higher preoperative anxiety as a significant predictor of opting for FP (OR = 1.41, 95% CI: 1.07-1.88, p = 0.015). Most FP patients (78.7%) and guardians (85.2%) reported reduced anxiety, enhanced emotional support, and greater trust in the medical team. However, FP did not affect perioperative pain (p = 0.52) or postoperative three-month satisfaction scores (p = 0.42). Adverse events led to FP discontinuation in two (3.3%) of cases (one due to nausea, one due to syncope).</p><p><strong>Conclusion: </strong>FP during endovenous procedures plays a crucial role in reducing preoperative anxiety and enhancing patient comfort. These findings suggest the potential for integrating family presence into clinical guidelines for minimally invasive procedures, promoting a more patient-centered approach in surgical care. Future studies should investigate the conditions under which FP is most beneficial, taking into account both patient preferences and procedural specifics.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102237"},"PeriodicalIF":2.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710430","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":"Comparative Early Outcomes Following Primary Radiofrequency Ablation and Polidocanol Microfoam Ablation of Symptomatic, Incompetent Small Saphenous Veins.","authors":"Mokhshan Ramachandran, Peter F Lawrence, Steven M Farley, David A Rigberg, Johnathon Rollo, Vincent L Rowe, Juan Carlos Jimenez","doi":"10.1016/j.jvsv.2025.102234","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102234","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Radiofrequency ablation (RFA) of symptomatic, incompetent small saphenous veins (SSV) is supported by clinical practice guidelines, but polidocanol microfoam ablation (MFA) is not addressed in these guidelines due to the absence of high-quality clinical data. However, some anatomic variations and clinical scenarios in patients with SSV reflux may be associated with equivalent or superior results when MFA is used compared to RFA. This study aims to compare early outcomes following the treatment of SSV incompetence in patients with CEAP 2-6 disease using either RFA or MFA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of a prospectively maintained database was conducted in patients who underwent treatment of incompetent SSVs with either RFA or MFA. Limbs that underwent concomitant phlebectomy were included. All patients underwent postoperative duplex ultrasound at 48-72 hours and at least one follow-up visit by a vascular surgery provider. Primary outcomes were immediate SSV closure and ablation-related thrombus extension (ARTE). Secondary outcomes analyzed included demographic data, CEAP clinical class, venous clinical severity score (VCSS), deep venous thrombosis (DVT), and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between March 2018 and July 2024, 182 SSVs treated for symptomatic reflux with either RFA (n=120) or MFA (n=62) were identified. Age, gender, body mass index, reflux times, and SSV diameters were similar between both groups. Mean preoperative VCSS were 9.4 + 3.0 and 10.8 + 3.7 in the RFA and MFA groups, respectively (p=0.05). More venous ulcers were present at the time of MFA (n=16, 26%) than RFA (n=14, 12%) (p=0.015). Median follow-up was 164.5 days in the RFA cohort and 156 days following MFA. Symptomatic improvement after RFA and MFA was 91% and 88%, respectively. Mean postoperative VCSS decreased from 9.4 to 7.3 in the RFA group (p&lt;0.001) and 10.9 to 9.2 following MFA (p&lt;0.001). Immediate vein closure was achieved in 98% of limbs in both groups; two late recanalizations occurred following MFA but none following RFA. The number of ulcers healed at last follow-up was higher following MFA (n=13, 81% vs. n=10, 71%; p=0.02). The incidence of ARTE was 4.8% (n=3) following MFA and 1.7% (n=2) following RFA (p=0.52). One gastrocnemius DVT occurred in the MFA group. No pulmonary emboli or central nervous complications occurred. All adverse thrombotic events were asymptomatic and resolved with short-term anticoagulation. Superficial phlebitis was higher following MFA (n=11, 17.7% vs. n=5, 4.2%; p=0.002) One postoperative sural neuralgia occurred after RFA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;RFA and MFA are both safe and effective treatments for patients with symptomatic, incompetent SSV's. Both resulted in excellent clinical relief and early truncal vein closure rates. The number of ulcers healed was higher in the MFA group but this difference was significant on univariate analysis only. Adverse ","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102234"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692496","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":"A Venous Hemodynamic Model and Measurement of Venous Reflux in the Lower Limb During Walking-Proof of Concept.","authors":"Oscar Maleti, Marzia Lugli, Giorgio Bergamo, Andrew Nicolaides","doi":"10.1016/j.jvsv.2025.102236","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102236","url":null,"abstract":"<p><strong>Objective: </strong>Air-plethysmography (APG) is an established plethysmographic method of measuring leg volume changes in absolute units (ml or ml/s) during tiptoeing. However, tiptoe movements use different muscles from walking and the question of how physiological APG measurements during tiptoeing are has never been answered. The recent development of a commercially available wireless APG enables one to obtain measurements during walking. The aim of our pilot study was (a) to validate a venous hemodynamic model of blood volume changes in the leg during walking and (b) determine the magnitude of reflux per step in patients with venous reflux using this model.</p><p><strong>Methods: </strong>A total of 20 limbs were included into the study. Ten patients with 10 limbs that had axial reflux in the deep veins on duplex scanning without any outflow obstruction or residual thrombosis on venography were selected. Standard measurements were initially made using tiptoeing as the form of exercise. Venous volume measurements made when walking was the exercise were volume on standing (V₀) in ml, volume at steady state when walking (Vss) in ml, residual volume fraction during steady state (RVFss) as a percentage, ejection fraction (EF) as a percentage and inflow into the leg (I) which included reflux and arterial inflow in ml/step.</p><p><strong>Results: </strong>There was an exponential reduction in volume during the first 7-9 steps indicating a constant EF and supported the assumptions for the volume hemodynamic model. V0, EF and I were higher in limbs with reflux compared with limbs without reflux by 67% (P < 0.007), 44% (P = 0.009) and 156% (P < 0.001) respectively.</p><p><strong>Conclusions: </strong>The results of this pilot study indicate that the model and method used provide a practical noninvasive method of measuring reflux during walking. The increase in V₀ and EF indicates a compensatory mechanism. This is the first time such a measurement has been possible because of the availability of wireless air-plethysmography. It offers an opportunity for further studies to answer questions such as what the effect of iliac stenting or valvuloplasty are on reflux during walking.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102236"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692472","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":"Systemic Exogenous Progestins With or Without Estrogens are Associated with Decreased Rates of Venous Procedures for Varicose Veins.","authors":"Paarth Jain, Adam Ostrovsky, Paul DiMuzio, Luis Eraso, Michael Nooromid, Dawn Salvatore, Babak Abai","doi":"10.1016/j.jvsv.2025.102235","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102235","url":null,"abstract":"<p><strong>Objectives: </strong>Risk factors for varicose veins (VV) such as female sex, pregnancy, and obesity are high estrogen-states, yet the role of systemic progestins with or without estrogens (SPE) in VV management is not well characterized. This study investigates how SPE use affects rates of venous procedures for patients with VV.</p><p><strong>Methods: </strong>The TriNetX database was queried for subjects with ICD-10 diagnoses of asymptomatic VV, chronic venous insufficiency, and complicated VV (inflammation, ulceration). Patients were divided into a control cohort with no subsequent SPE use, a progestin-only cohort, and a combined estrogen-progestin (CEP) cohort. Further stratification by VV symptomology and premenopausal status (age<40) was also performed. Cohorts were 1:1 propensity-matched on known and theorized risk factors for VV including age, race, prior pregnancy, and BMI. The outcomes of interest were DVT, pregnancy, stab phlebectomy, endovenous ablation, and sclerotherapy.</p><p><strong>Results: </strong>Database query yielded 674838 controls, 7597 CEP patients, and 13758 progestin-only patients before matching. After propensity matching, compared to controls, the CEP cohort received fewer stab phlebectomies (RR=0.52, 95% CI 0.42-0.64, p<0.001), endovenous ablations (RR=0.50, 95% CI 0.43-0.59, p<0.001) or any venous interventions (RR=0.68, 95% CI= 0.61-0.76, p<0.001), with no difference in sclerotherapy (p=0.12). Similarly, the progestin-only cohort was less likely to receive stab phlebectomy (RR=0.37, 95% CI = 0.31-0.43, p<0.001), endovenous ablation (RR=0.35, 95% CI = 0.31-0.40, p<0.001), sclerotherapy (RR=0.65, 95% CI= 0.56-0.75, p<0.001) and any venous procedure (RR=0.57, 95% CI = 0.52-0.62, p<0.001). Compared to the progestin-only cohort, the CEP cohort had higher rates of sclerotherapy (RR=1.38, 95% CI- 1.12-1.72, p=0.003) and overall venous procedures (RR=1.16, 95% CI= 1.00-1.34, p= 0.048). When possible, analysis stratified by symptomatic status and menopausal status revealed similar findings for sub-cohorts. Finally, the CEP cohort had lower risk of pregnancy than controls during the first 1200 days of observation, but subsequently had greater risk of pregnancy (RR=1.38 (1.21-1.57), p<0.001). Kaplan-Meier analysis showed rates of venous intervention were lower throughout the observation period.</p><p><strong>Conclusions: </strong>This large, population-based cohort study demonstrated that despite variable risk of DVT and pregnancy for estrogen-progestin and progestin-only treatment cohorts, both SPE formulations were associated with significantly fewer venous procedures for VV than controls, with progestin-only cohorts undergoing the fewest procedures. This warrants further investigation into the role of SPE in VV disease progression and the utility of systemic progestins as an adjunct therapy for VV.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102235"},"PeriodicalIF":2.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692497","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":"HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT FOR THE CHRONIC VENOUS DISEASE BASED ON THE CHIVA STRATEGY.","authors":"Luis Miguel Izquierdo Lamoca, Teresa Reyero Postigo, Sonia Morán Escalona, Juan Francisco Giráldez Arranz, Ana Aguinaco Acosta","doi":"10.1016/j.jvsv.2025.102233","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102233","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic venous disease management has significantly advanced with minimally invasive techniques like endovenous thermal ablation. High-intensity focused ultrasound (HIFU) is a non-invasive alternative thermal ablation method enabling targeted vein closure without percutaneous access. This study evaluates the efficacy of HIFU treatment, combined with the CHIVA strategy, in occluding leak points in patients with superficial venous reflux.</p><p><strong>Methods: </strong>This retrospective study included patients treated for chronic venous disease using the SONOVEIN® device from March 2020 to February 2024. Inclusion criteria were symptomatic patients (CEAP ≥ C2) with ultrasound-confirmed truncal reflux. Patients under 18 years, with <12 months life expectancy or isolated venous flow obstruction were excluded. Treatments followed CHIVA principles, targeting leak points and proximal vein segments for occlusion. Primary endpoints were leak point occlusion rates and procedural safety. In this study, primary efficacy was defined as vein closure with one treatment, while secondary efficacy was defined as the need for more.</p><p><strong>Results: </strong>A total of 204 limbs in 183 patients (131 females, 52 males; mean age 55.2 years) underwent HIFU treatment. Primary leak point occlusion rate at 1 week, 1, 6, 12 and 24 months were 85.1 %, 91.8%, 93.7%, 94.3% and 95.5% respectively. Secondary closure rates at 1 week, 1, 6, 12 and 24 months were 89.6 %, 95.4%, 95.0%, 95.4% and 95.7% respectively. Overall primary and secondary cumulative closure rates at 24 months were 88.1% (95% confidence interval (CI) 77.7-98.4%), and 92.1% (95% CI 83.3-100%) respectively. No major complications were observed.</p><p><strong>Conclusion: </strong>High-intensity focused ultrasound achieves high leak point occlusion rates when applied under CHIVA principles, supporting its role as an effective and safe non-invasive alternative for chronic venous disease treatment. The technique minimizes risks associated with thermal ablation, such as skin burns and nerve damage while addressing limitations of conventional methods. These results highlight high-intensity focused ultrasound potential as a disruptive technology in venous disease management. Further studies should assess its long-term efficacy and safety.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102233"},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673442","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":"A real-world study of sirolimus in the treatment of pediatric head and neck lymphatic malformations.","authors":"Jialu Wang, Yiran Meng, Xuexi Zhang, Yanzhen Li, Nian Sun, Qiaoyin Liu, Yun Peng, Xiaoling Cheng, Yuanhu Liu, Zhiyong Liu, Yuwei Liu, Ge Zhang, Shengcai Wang, Xin Ni","doi":"10.1016/j.jvsv.2025.102230","DOIUrl":"https://doi.org/10.1016/j.jvsv.2025.102230","url":null,"abstract":"<p><strong>Objective: </strong>Sirolimus has shown promise in treating lymphatic malformations (LMs); however, previous studies were all single-arm clinical trials. Prior studies have reported that some LMs lesions can spontaneously reduce, which poses a potential confounding factor in evaluating therapeutic outcomes. Our study aimed to objectively assess the effectiveness and safety of oral sirolimus for LMs in the head and neck by comparing the outcomes in a control group.</p><p><strong>Methods: </strong>This real-world study involved 57 children with LMs from 2020 to 2023 at Beijing Children's Hospital. The patients were divided into non-intervention and oral sirolimus groups. The primary outcome was lesion volume change on MRI, and the secondary outcome was improvement in clinical symptoms. Safety was assessed based on adverse reactions (regular laboratory tests and patient follow-ups) and sirolimus blood concentrations in the oral sirolimus group.</p><p><strong>Results: </strong>Twenty-one children were enrolled in the non-intervention group (M/F = 14/7), with a median age of 33 months (interquartile range [IQR], 9-53.5); 36 children were enrolled in the oral sirolimus group (M/F = 15/21), with a median age of 24 months (IQR, 7.5-51.25). The median volume reduction ratio in the non-intervention group was 0.08 (IQR, 0.30-0.40), and eight cases (38.1%) were effective. The median volume reduction ratio in the oral sirolimus group was 0.67 (IQR, 0.40-0.92), and 33 cases (91.7%) were effective. Clinical symptoms improved in 9 (42.9%) children in the non-intervention group and 35 (97.2%) in the oral sirolimus group. The effective rate and volume changes differed statistically significantly (P < 0.001). The most common adverse reaction in the oral sirolimus group was an increase in myocardial enzyme levels (n = 23, 63.9%), followed by oral ulcers (n = 16, 44.4%). The overall blood concentration of sirolimus was low during the drug administration in the oral sirolimus group, among which 10 (27.8%) children had a mean blood concentration < 5 ng/ml.</p><p><strong>Conclusion: </strong>Sirolimus significantly reduced lesion volume and improved clinical symptoms in most patients with LMs, especially those with macrocystic components. Conservative observations were only helpful in some patients, with relatively modest volume changes.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102230"},"PeriodicalIF":2.8,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670231","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}