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

{"title":"Morphofunctional evaluation of great saphenous vein's tributaries after thermoablation: A case series.","authors":"Flávia Lins Bezerra de Souza Fonseca, Esdras Marques Lins, Emmanuelle Tenório Albuquerque Godoi, Henrique Jorge Guedes, Ana Júlia Xavier de Mendoza, Camila Beatriz Serrano de Oliveira","doi":"10.1016/j.jvsv.2024.101986","DOIUrl":"10.1016/j.jvsv.2024.101986","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates hemodynamic and anatomic changes in great saphenous vein (GSV) tributaries after endovenous laser ablation (EVLA).</p><p><strong>Methods: </strong>This case series analyzed 112 areas in 28 lower limbs of 25 patients who underwent EVLA from April 2022 to June 2023 at the Hospital das Clínicas de Pernambuco/UFPE. All patients were evaluated by Doppler ultrasound preoperatively and 3 months after the surgical treatment. The parameters studied were GSV diameter and patency, GSV tributary diameter, patency and flow direction, and the Venous Clinical Severity Score after EVLA. The GSV characteristics were evaluated in four regions: saphenous-femoral junction, medium thigh, knee, and medium leg. The tributary veins were grouped in four areas: anterior thigh, posterior thigh, anterior leg, and posterior leg.</p><p><strong>Results: </strong>The results included 28 lower limbs from 23 patients; 18 patients (67.9%) were women, and the average age was 49 years; 2 patients were lost to follow-up. Ninety days after EVLA, all treated GSVs were occluded. The average diameter of GSV decreased in all four regions studied: saphenous-femoral junction, medium thigh, knee, and medium leg (P ≤ .001). We analyzed 101 GSV tributaries. In the analysis of GSV tributaries by area, we identified a mean diameter decrease in all groups of tributaries (P < .001). Considering the tributaries with reflux, we also identified a reduction in the number of tributaries with reflux in all four groups (P ≤ .001). All tributaries were patent preoperatively; at 3 months after the surgical treatment, GSV tributaries occlusion was infrequent, except for the anterior thigh group. There was a decrease from 9 to 5 points in Venous Clinical Severity Score after EVLA (P < .001).</p><p><strong>Conclusions: </strong>This study demonstrated that, after GSV laser ablation, there was a statistically significant decrease in the diameters of all tributary groups, and the number of tributaries with decreased reflux; however, the occlusion of tributaries was not a frequent finding.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406575","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":"Protocol-based treatment of spontaneous hemorrhage from varicose veins prevents recurrence of bleeding.","authors":"Richard Bock, Danielle Fontenot, Spencer Bock, Gwyn Eiler, Kristie Worley-Fry, John Blebea","doi":"10.1016/j.jvsv.2024.101988","DOIUrl":"10.1016/j.jvsv.2024.101988","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous hemorrhage from erosion of varicose veins through the skin is a serious and occasionally fatal complication of varicose vein disease. Various treatments, both acute and delayed, have been advocated. Our two-step clinical protocol was designed to prevent further hemorrhage without delay and to provide durable freedom from recurrent bleeding.</p><p><strong>Methods: </strong>All patients referred to our surgical vein practice with hemorrhage from varicose veins were entered into a prospective registry. On presentation, all patients underwent diagnostic duplex ultrasound for venous reflux. Immediate treatment consisted of ultrasound-guided polidocanol/CO₂ foam sclerotherapy of the bleeding varicosity and adjacent veins. Subsequent endovenous ablation of underlying incompetent axial veins, with concurrent microphlebectomy when indicated, was scheduled and performed within 8 weeks.</p><p><strong>Results: </strong>Fifty-nine patients were referred with recent hemorrhage from varicose veins over a period of 4 years. Fifty-six (95%) had an ultrasound-identified tributary varicosity underlying the point of bleeding, and three had a skin-surface erosion only and no ultrasound-identified underlying tributary. Of the 59 study patients, 52 underwent prompt polidocanol/CO₂ foam sclerotherapy, targeted to both the underlying tributary (when present) as well as the cutaneous bleeding varicosity. The remaining seven either declined sclerotherapy or were ineligible. Underlying incompetence of axial (great, small, or anterior saphenous) veins was found in 54 patients (92%). Of these patients with truncal vein incompetence, 48 underwent ablation-5 declined and 1 was too frail for any further intervention. There were no recurrent bleeds in the interval between immediate sclerotherapy and scheduled ablation. During a mean follow-up of 2.2 years, 55 of the 59 patients (93%) had no recurrence of bleeding. Four patients (7%) had late, recurrent hemorrhage: one had failed to return for their scheduled ablation, two were on chronic anticoagulation, and one had severe right heart failure. All four were retreated without further recurrence.</p><p><strong>Conclusions: </strong>A two-step protocol of immediate ultrasound-guided foam sclerotherapy, followed within 8 weeks by endovenous ablation of incompetent axial veins and concurrent microphlebectomy, provided rapid and efficient treatment with durable freedom from subsequent hemorrhage.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406576","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":"Retraction notice to \"Australian and New Zealand Society for Vascular Surgery clinical practice guidelines on venous outflow Obstruction of the femoral-iliocaval veins\" [J Vasc Surg Venous Lymphat Disord 11 (2023) 832 - 842].","authors":"Laurencia Villalba, Iman Bayat, Steven Dubenec, Philip Puckridge, Shannon D Thomas, Ramon L Varcoe, Thodur Vasudevan, Ramesh K Tripathi","doi":"10.1016/j.jvsv.2024.101982","DOIUrl":"10.1016/j.jvsv.2024.101982","url":null,"abstract":"","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381183","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":"Nutcracker syndrome (a Delphi consensus).","authors":"Floor Heilijgers, Peter Gloviczki, Gerry O'Sullivan, Bertrand Chavent, Efthymios D Avgerinos, Karem Harth, Stephen A Black, Young M Erben, Joris I Rotmans, Toby Richards, Rabih A Chaer, Laurencia Villalba, Arjun Jayaraj, Rafael D Malgor, Ramesh K Tripathi, Anahita Dua, Erin Murphy, Simon Rinckenbach, Suresh Vedantham, Jaap F Hamming, Joost R van der Vorst","doi":"10.1016/j.jvsv.2024.101970","DOIUrl":"10.1016/j.jvsv.2024.101970","url":null,"abstract":"<p><strong>Background: </strong>Nutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.</p><p><strong>Methods: </strong>A three-stage modified Delphi consensus was performed. A steering committee developed 37 statements covering 3 categories for patients with NCS: diagnosis, management, and follow-up. These statements were reported individually by 20 international experts in the management of venous disease, using a 5-point Likert scale. Consensus was defined if ≥70% of respondents rated the statement between 1 and 2 (agreement) and between 4 and 5 (disagreement). Those statements without consensus were recirculated in a second round of voting. A third round of the questionnaire was performed with 14 additional statements to clarify diagnostic values of NCS.</p><p><strong>Results: </strong>Responses were returned by 20 of 20 experts (100%) in round one and 17 of 20 (85%) in round two. Initial consensus was reached in 24 of 37 statements (65%) spread over all categories. Round two achieved a further consensus on 5 out of 10 statements (50%). No categories reported consensus on all statements. In round two consensus was reached in the category of follow-up (4/5 statements [80%]). The final round reached consensus on 5 out of 14 statements (36%). Experts agreed that imaging is obligated to confirm NCS. Experts did not agree on specific diagnostic cut-off values. There was a consensus that the first choice of operative treatment is left renal vein transposition and that the risk of stent migration outweighs the advantages of a percutaneous procedure.</p><p><strong>Conclusions: </strong>Consensus was achieved on most statements concerning the assessment and management of NCS. This Delphi consensus identified those areas in which further research is needed, such as antiplatelet therapy, endovascular treatment, and renal autotransplantation. A rare disease registry to improve data and reports of patient outcomes is warranted.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372207","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":"Optimizing strategies for lymphaticovenular anastomosis in lower secondary extremity lymphedema.","authors":"Liqi Yi, YanFei Jiang, Lei Xu, Minxiang Zheng, Youmao Zheng, Junbo Liang, Chong Liu","doi":"10.1016/j.jvsv.2024.101984","DOIUrl":"10.1016/j.jvsv.2024.101984","url":null,"abstract":"<p><strong>Background: </strong>Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with secondary extremity lymphedema. The objective of this study was to optimize strategies for lower secondary extremity lymphedema using LVA techniques, with the aim of enhancing patient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 121 patients who underwent LVA at Taizhou Hospital of Zhejiang Province from January 2020 to December 2023. Preoperative and postoperative assessments included intraoperative observations, functional parameters, and clinical outcomes. The efficacy of LVA was evaluated based on circumferential reduction, quality of life improvements (Lymphoedema Quality of Life Questionnaire), and postoperative complications.</p><p><strong>Results: </strong>This study enrolled 121 patients with lower secondary extremity lymphedema, with an average age of 58.19 years. The results revealed significant associations between incision depth, lymphatic vessel size, the number of LVAs performed, and the number of incisions per patient, all of which correlated with postoperative volume reduction. The resulted analysis that identified optimal incision depths of 10 to 15 mm, lymphatic vessel size of 0.4 to 0.6 mm, and a recommended number of 6 to 8 LVAs. After LVA, there was a marked improvement in patient quality of life, with particularly notable enhancements in functionality and appearance.</p><p><strong>Conclusions: </strong>This study's findings optimizing the strategy for LVA surgery recommend the depth of incision, the size of lymphatic vessels, and the number of anastomoses to improve the quality of life and limb volume in patients with secondary lymphedema of the lower limbs.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349249","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":"Assessing the quality of ChatGPT's responses to questions related to radiofrequency ablation for varicose veins.","authors":"Muhammad Anees, Fareed Ahmed Shaikh, Hafsah Shaikh, Nadeem Ahmed Siddiqui, Zia Ur Rehman","doi":"10.1016/j.jvsv.2024.101985","DOIUrl":"10.1016/j.jvsv.2024.101985","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the accuracy and reproducibility of information provided by ChatGPT, in response to frequently asked questions about radiofrequency ablation (RFA) for varicose veins.</p><p><strong>Methods: </strong>This cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan. A set of 18 frequently asked questions regarding RFA for varicose veins were compiled from credible online sources and presented to ChatGPT twice, separately, using the new chat option. Twelve experienced vascular surgeons (with >2 years of experience and ≥20 RFA procedures performed annually) independently evaluated the accuracy of the responses using a 4-point Likert scale and assessed their reproducibility.</p><p><strong>Results: </strong>Most evaluators were males (n = 10/12 [83.3%]) with an average of 12.3 ± 6.2 years of experience as a vascular surgeon. Six evaluators (50%) were from the UK followed by three from Saudi Arabia (25.0%), two from Pakistan (16.7%), and one from the United States (8.3%). Among the 216 accuracy grades, most of the evaluators graded the responses as comprehensive (n = 87/216 [40.3%]) or accurate but insufficient (n = 70/216 [32.4%]), whereas only 17.1% (n = 37/216) were graded as a mixture of both accurate and inaccurate information and 10.8% (n = 22/216) as entirely inaccurate. Overall, 89.8% of the responses (n = 194/216) were deemed reproducible. Of the total responses, 70.4% (n = 152/216) were classified as good quality and reproducible. The remaining responses were poor quality with 19.4% reproducible (n = 42/216) and 10.2% nonreproducible (n = 22/216). There was nonsignificant inter-rater disagreement among the vascular surgeons for overall responses (Fleiss' kappa, -0.028; P = .131).</p><p><strong>Conclusions: </strong>ChatGPT provided generally accurate and reproducible information on RFA for varicose veins; however, variability in response quality and limited inter-rater reliability highlight the need for further improvements. Although it has the potential to enhance patient education and support healthcare decision-making, improvements in its training, validation, transparency, and mechanisms to address inaccurate or incomplete information are essential.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349248","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":"Renal autotransplant as a definitive treatment for nutcracker syndrome: A multicenter retrospective study.","authors":"Jennifer L Philip, Jessica Saben, Ece Meram, Tracy Steinberg, Kate Lauer, John Malamon, Elizabeth Pomfret, Trevor Nydam, David P Foley, Thomas Pshak","doi":"10.1016/j.jvsv.2024.101983","DOIUrl":"10.1016/j.jvsv.2024.101983","url":null,"abstract":"<p><strong>Objective: </strong>Nutcracker syndrome is a rare condition that involves mechanical compression of the left renal vein, leading to chronic and debilitating left flank pain. The etiology of the pain is misdiagnosed frequently, and patients usually require long-term opioid use to manage their pain. Multiple therapeutic options for nutcracker syndrome have been described in the literature but the reports are limited by small numbers of patients, and the lack of convincing data demonstrating consistently improved outcomes. Here we report the largest series to date of patients undergoing renal autotransplantation for the treatment of nutcracker syndrome.</p><p><strong>Methods: </strong>We performed a multicenter retrospective cohort review of patients 105 patients with nutcracker syndrome who underwent renal autotransplantation as a primary or salvage therapy.</p><p><strong>Results: </strong>During the overall study period, 93.1% of patients treated with autotransplantation had durable, complete flank pain relief at 12 months with both open and robotic surgical approach. After autotransplantation, a statistically significant decrease in the percentage of patients using opioids from 48.6% to 17.0% was demonstrated at 12 months. In those patients using opioids before autotransplantation, a statistically significant decrease in morphine milligram equivalents was demonstrated from an alarming 68.9 ± 15.0 per day to 25.0 ± 11.02 morphine milligram equivalents per day.</p><p><strong>Conclusions: </strong>Our findings suggest that renal autotransplantation, as a primary treatment or a salvage treatment, in patients with nutcracker syndrome provides durable pain relief and a marked decrease in chronic opioid use regardless of surgical approach.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349250","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 composite risk assessment model for venous thromboembolism.","authors":"Mary Sixian Lin, Hilary Hayssen, Minerva Mayorga-Carlin, Shalini Sahoo, Tariq Siddiqui, Georges Jreij, Brian R Englum, Phuong Nguyen, Yelena Yesha, John David Sorkin, Brajesh K Lal","doi":"10.1016/j.jvsv.2024.101968","DOIUrl":"10.1016/j.jvsv.2024.101968","url":null,"abstract":"<p><strong>Objective: </strong>Venous thromboembolism (VTE) is a preventable cause of hospitalization-related morbidity and mortality. VTE prevention requires accurate risk stratification. Federal agencies mandated VTE risk assessment for all hospital admissions. We have shown that the widely used Caprini (30 risk factors) and Padua (11 risk factors) VTE risk-assessment models (RAMs) have limited predictive ability for VTE when used for all general hospital admissions. Here, we test whether combining the risk factors from all 23 available VTE RAMs improves VTE risk prediction.</p><p><strong>Methods: </strong>We analyzed data from the first hospitalizations of 1,282,014 surgical and non-surgical patients admitted to 1298 Veterans Affairs facilities nationwide between January 2016 and December 2021. We used logistic regression to predict VTE within 90 days of admission using risk factors from all 23 available VTE RAMs. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were used to quantify the predictive power of our models. The metrics were computed at two diagnostic thresholds that maximized (1) the value of sensitivity + specificity-1; and (2) PPV and were compared using McNemar's test. The Delong-Delong test was used to compare AUCs.</p><p><strong>Results: </strong>After excluding those with missing data, 1,185,633 patients (mean age, 66 years; 93% male; and 72% White) were analyzed, of whom 33,253 (2.8%) had a VTE (deep venous thrombosis [DVT], n = 19,218, 1.6%; pulmonary embolism [PE], n = 10,190, 0.9%; PE + DVT, n = 3845, 0.3%). Our composite RAM included 102 risk factors and improved prediction of VTE compared with the Caprini RAM risk factors (AUC composite model: 0.74; AUC Caprini risk-factor model: 0.63; P < .0001). When the sum of sensitivity and specificity-1 was maximized, the composite model demonstrated small improvements in sensitivity, specificity and PPV; NPV was high in both models. When PPV was maximized, the PPV of the composite model was improved but remained low. The nature of the relationship between NPV and PPV precluded any further gain in PPV by sacrificing NPV and sensitivity.</p><p><strong>Conclusions: </strong>Using a composite of 102 risk factors from all available VTE RAMs, we improved VTE prediction in a large, national cohort of >1 million general hospital admissions. However, neither model has a sensitivity or PPV that permits it to be a reliable predictor of VTE. We demonstrate the limits of currently available VTE risk prediction tools; no available RAM is ready for widespread use in the general hospital population.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290068","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":"Clinical characteristics and risk factors for acute abdomen in patients with abdominal lymphatic malformations.","authors":"Congxia Yang, Tong Qiu, Min Yang, Jiangyuan Zhou, Xue Gong, Kaiying Yang, Zixin Zhang, Yuru Lan, Xuepeng Zhang, Zilong Zhou, Yujia Zhang, Shanshan Xiang, Siyuan Chen, Yi Ji","doi":"10.1016/j.jvsv.2024.101969","DOIUrl":"10.1016/j.jvsv.2024.101969","url":null,"abstract":"<p><strong>Objective: </strong>The diagnosis of abdominal lymphatic malformations (ALMs) is often overlooked in clinical practice. However, reports in the literature about ALMs are limited to case reports and series with small sample sizes. This study aimed to review our currently available data to describe the clinical characteristics of ALMs and evaluate the risk factors for acute abdomen caused by ALMs.</p><p><strong>Methods: </strong>We reviewed the records of patients with ALMs who were diagnosed between December 2008 and January 2023 in our institution. The associations between acute abdomen and ALMs were analyzed based on single-factor and multivariate logistic regression analyses.</p><p><strong>Results: </strong>This study included 345 patients with pathologically confirmed ALMs, with a slight female predominance of 1:1.4. Approximately 39.1% (135/345) of patients were asymptomatic, and 24.6% (85/345) presented with acute abdomen. Among the ALMs in the cohort, 42.6% (147/345) were retroperitoneal lymphatic malformations (LMs). The maximal lesion dimensions in patients with acute abdomen and nonacute abdomen were 10.0 cm and 7.8 cm, respectively, with no significant difference based on multivariate analyses. Children were more likely to develop acute abdomen than adults were (P = .002; odds ratio, 5.128; 95% confidence interval, 1.835-14.326). ALMs accompanying acute abdomen were more common for lesions involving the small intestinal mesentery (P = .023; odds ratio, 2.926; 95% confidence interval, 1.157-7.400).</p><p><strong>Conclusions: </strong>ALMs are rare with an insidious onset, and retroperitoneal LMs are the most common ALMs, followed by jejunal mesenteric LMs. Our retrospective analysis suggested that young age and small intestinal mesenteric lymphatic malformation are independent risk factors for acute abdomen with ALMs.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290069","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 mechanochemical ablation using the Clarivein device for the treatment of great saphenous vein incompetence.","authors":"Sharon Oud, Tamana Alozai, Yee Lai Lam, Çağdaş Ünlü, Michael Mooij, Michiel A Schreve","doi":"10.1016/j.jvsv.2024.101967","DOIUrl":"10.1016/j.jvsv.2024.101967","url":null,"abstract":"<p><strong>Objective: </strong>The short-term anatomical success rates of mechanochemical ablation using the Clarivein device (Merit Medical) in the treatment of great saphenous vein (GSV) incompetence are high. However, the anatomical success rates seem to drop over time. The aim of this study was to determine the long-term outcomes of GSV treatment using the Clarivein and to assess whether specific anatomical features better correlate with clinical or quality of life (QoL)-related outcomes.</p><p><strong>Methods: </strong>This is a single-center, prospective cohort study in follow-up of a multicenter, randomized controlled trial using Clarivein with liquid polidocanol for the treatment of GSV incompetence. The primary outcome was anatomical success (AS), defined as complete occlusion or a recanalized segment, irrespective of reflux, of <10 cm in length. In addition, reflux-free anatomical success (RF-AS) was determined, and defined as complete occlusion or a recanalized segment with <10 cm of reflux. Clinical success was assessed using the Venous Clinical Severity Score (VCSS), and QoL was assessed using the Dutch version of the Aberdeen Varicose Vein Questionnaire (DAVVQ) and the 36-Item Short Form Health Survey (SF-36). Subgroup analyses were performed based on whether AS or RF-AS was achieved or not.</p><p><strong>Results: </strong>A total of 109 patients (115 limbs) were included. The mean follow-up time was 8.4 ± 0.9 years (range, 5.5-10.3 years). AS was seen in 60.5% of limbs, and RF-AS was seen in 72.8% of limbs. Compared with baseline, the overall mean VCSS improved from 5.3 ± 2.4 to 4.1 ± 2.4, and the overall median DAVVQ score from 13.5 (interquartile range [IQR], 8.7-20.0) to 10.5 (IQR, 5.3-16.2) (P < .001). Improvement in VCSS was only significant in patients with successful treatment: from 5.5 ± 2.7 to 3.7 ± 2.5 (P < .001) if AS was achieved and from 5.0 ± 1.7 to 4.5 ± 1.9 (P = .20) if AS was not achieved. The same results were found for DAVVQ scores: improvement from13.5 (IQR, 8.7-20.6) to 10.3 (IQR, 3.0-14.5) (P < .01) if AS was achieved and from 12.9 (IQR, 8.3-19.3) to 10.8 (IQR, 6.7-18.2) (P = .35) if AS was not achieved. Regarding the overall SF-36 scores, the domains of vitality, mental health, and general health worsened significantly.</p><p><strong>Conclusions: </strong>In over 8 years of follow-up, the anatomical success rate after the treatment of GSV incompetence using the Clarivein device decreased to 60.5%. However, clinical scores and disease-specific QoL still improved significantly compared with baseline. We found no convincing evidence that the absence of reflux correlates better with clinical and QoL-related outcomes compared with recanalization irrespective of reflux.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":null,"pages":null},"PeriodicalIF":2.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290070","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}