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

{"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":"10.1016/j.jvsv.2024.102162","url":null,"abstract":"<p><strong>Objective: </strong>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) after vein ablation may help guide clinical decision-making but remain limited. We developed machine learning (ML) algorithms that predict 1-year LCI after varicose vein ablation.</p><p><strong>Methods: </strong>The Vascular Quality Initiative database was used to identify patients who underwent endovenous or surgical varicose vein treatment for Clinical-Etiological-Anatomical-Pathophysiological (CEAP) C2 to C4 disease between 2014 and 2024. We identified 226 predictive features (111 preoperative [demographic/clinical], 100 intraoperative [procedural], and 15 postoperative [immediate postoperative course/complications]). The primary outcome was 1-year LCI, defined as a preoperative VCSS, Venous Clinical Severity Score (VCSS) minus postoperative VCSS of ≤0, indicating no clinical improvement after vein ablation. The data were divided into training (70%) and test (30%) sets. Six ML models were trained using preoperative 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 intraoperative and postoperative features. The focus was on preoperative features, whereas intraoperative and postoperative features were of secondary importance, because preoperative predictions offer the most potential to mitigate risk, such as deciding whether to proceed with intervention. Model calibration was assessed using calibration plots, and 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.</p><p><strong>Results: </strong>Overall, 33,924 patients underwent varicose vein treatment (30,602 endovenous [90.2%] and surgical 3322 [9.8%]) during the study period and 5619 (16.6%) experienced 1-year LCI. Patients who developed the primary outcome were older, more likely to be socioeconomically disadvantaged, and less likely to use compression therapy routinely. They also had less severe disease as characterized by lower preoperative VCSS, Varicose Vein Symptom Questionnaire scores, and CEAP classifications. The best preoperative prediction model was XGBoost, achieving an AUROC of 0.94 (95% confidence interval [CI], 0.93-0.95). In comparison, logistic regression had an AUROC of 0.71 (95% CI, 0.70-0.73). The XGBoost model had marginally improved performance at the intraoper","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":"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 undergoing 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 1017 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 or outcomes.</p><p><strong>Results: </strong>Venous thromboembolism developed in 142 patients (0.59%). Pulmonary embolism, proximal deep vein thrombosis, and ablation-related thrombus extension developed in 3 (0.01%), 9 (0.04%), and 95 (0.39%) patients, respectively. Localized phlebitis that required additional treatment was observed in 1656 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 owing 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 deep vein thrombosis (0.13% vs 0.01%; P < .001; odds ratio, 12.5; 95% confidence interval, 2.6-60.3) and ablation-related thrombus extension (0.73% vs 0.30%; P < .001; odds ratio, 2.5; 95% confidence interval, 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 venous thromboembolism. 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":"Noncontrast 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":"10.1016/j.jvsv.2024.102161","url":null,"abstract":"<p><strong>Objective: </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 noncontrast magnetic resonance imaging (MRI) 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 noncontrast MRI, 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 least absolute shrinkage and selection operator screening were performed. Using Scikit-learn, the remaining features were used to construct five models: logistic regression, support vector machine, random Forest, ExtraTrees, and light gradient boosting machine. The predictive performance were evaluated by the receiver operating characteristic 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 lymphedema (grade I), 38 patients with moderate lymphedema (grade II), and 53 patients with severe lymphedema (grade III) was conducted. A total of 1196 features were extracted, and after Pearson correlation testing and least absolute shrinkage and selection operator screening, 21 nonzero features were selected. The ExtraTree model performed the best, with an area under the curve of 0.974 (95% confidence interval, 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% confidence interval, 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>Conclusions: </strong>All five models performed well in distinguishing between the nonsevere group and the severe group. Noncontrast MRI-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}

{"title":"Efficacy of complex decongestive therapy on venous flow, internal saphenous diameter, edema, fat mass of the limbs and quality of life in patients with chronic venous insufficiency: A randomized clinical trial.","authors":"Ana Martín Jiménez, Beatriz María Bermejo Gil, Alejandro Santos-Lozano, Francisco Jose Pinto-Fraga, Carolina García Barroso, Leonardo Raul Vittori, Aurymar Fraino, Héctor Menéndez Alegre","doi":"10.1016/j.jvsv.2024.102005","DOIUrl":"10.1016/j.jvsv.2024.102005","url":null,"abstract":"<p><strong>Objective: </strong>Demonstrate the effectiveness of complex decongestive therapy (CDT) in patients with chronic venous insufficiency (CVI).</p><p><strong>Methods: </strong>A single-blind randomized controlled trial was conducted, where the participants were patients with CVI (n = 21/42) were assigned randomly to an experimental group (n = 11/22) or a control group (n = 9/18). A treatment of CDT (manual lymphatic drainage, intermittent pneumatic presotherapy, bilayer bandage) was applied to the experimental group for 4 weeks 2 days per week and no treatment was applied to the control group. The patients were evaluated at baseline (t0), 1 week after finishing the intervention (t1), and 6 weeks after the intervention (t2). The effectiveness of the treatment on symptoms and quality of life (QoL) (heaviness, pain and Chronic Venous Insufficiency Quality of Life [CIVIQ-20] questionary), edema, venous flow, and impedanciometry measurements was evaluated.</p><p><strong>Results: </strong>An improvement in the patient's QoL was observed: there was a decrease in symptoms such as heaviness and pain, an increase in the average velocity of the left femoral vein and left internal saphenous vein (ISV), a decrease in the ISV diameter in both extremities and a decrease in body mass index and fat mass in both extremities. These results were maintained when following up at 6 weeks, except for the improvement of QoL.</p><p><strong>Conclusions: </strong>CDT treatment improves the CIVIQ-20 and Venous Clinical Severity Scores. It also improves symptoms (pain and heaviness), venous flow velocity (superficial veins and deep veins [common femoral vein, femoral vein, popliteal vein]) and decreases body mass index, fat mass, and ISV diameter.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102005"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622332","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":"Residual popliteal vein thrombosis after endovascular treatment of mixed-type lower extremity deep vein thrombosis is relevant to post-thrombotic syndrome.","authors":"Jingluo Qiu, Wenjia Ai, Wenduo Gu, Shaomang Lin, Jianbin Xiao, Yinqian Huang, Tao Qiu, Baohui Xu, Zhihui Zhang","doi":"10.1016/j.jvsv.2024.102002","DOIUrl":"10.1016/j.jvsv.2024.102002","url":null,"abstract":"<p><strong>Objective: </strong>Patients with mixed-type lower extremity deep vein thrombosis (DVT) have a higher incidence of post-thrombotic syndrome (PTS) after endovascular treatment (EVT). This study aimed to identify risk factors associated with PTS in these patients after EVT.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with acute mixed-type lower extremity DVT who underwent EVT between January 2020 and December 2022. Patient assessments were conducted using ultrasound examination and the Villalta scale. Baseline characteristics, management details, and follow-up findings were compared between patients who developed PTS and those who did not at 6 months after EVT. Cox regression and nomogram analyses were performed to identify risk factors associated with the development of PTS.</p><p><strong>Results: </strong>The study enrolled 118 patients, of which 103 completed the follow-up. Among them, 24.3% developed post-thrombotic syndrome (PTS) within 6 months. Significant differences between the PTS and non-PTS groups were found concerning residual thrombosis in the popliteal, common femoral, and femoral veins. Multivariate Cox regression analysis indicated that residual popliteal vein thrombosis (RPVT) (hazard ratio [HR], 4.93; 95% confidence interval [CI], 1.61-15.11) and preoperative iliac vein stenosis (HR, 3.21; 95% CI, 1.11-9.33) were significant risk factors for PTS. Additionally, subgroup analysis for preoperative iliac vein stenosis and sensitivity analysis confirmed that RPVT remained a risk factor for PTS (HR, 4.48; 95% CI, 1.27-15.84).</p><p><strong>Conclusions: </strong>Our study demonstrated a positive association between RPVT and PTS in patients with extensive mixed-type lower extremity DVT after EVT. These findings suggest that intensive monitoring and aggressive therapeutic interventions may be required for patients with RPVT to decrease the risk of PTS.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102002"},"PeriodicalIF":2.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622265","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":"Magnetic resonance imaging features of primary lower extremity lymphedema: A retrospective analysis of 228 patients.","authors":"Mengke Liu, Dingyuan Luo, Xingpeng Li, Yimeng Zhang, Rengui Wang","doi":"10.1016/j.jvsv.2024.102004","DOIUrl":"10.1016/j.jvsv.2024.102004","url":null,"abstract":"<p><strong>Background: </strong>The value of magnetic resonance imaging (MRI) presentation of primary lower extremity lymphedema in assessing the severity of lower extremity lymphedema is uncertain. The purpose of this study was to assess the role of MRI presentation in staging primary lower extremity lymphedema.</p><p><strong>Methods: </strong>We enrolled 228 patients with clinically diagnosed primary lower limb lymphoedema from January 2018 to December 2019 in our hospital retrospectively. Patients were divided into stages I, II, and III based on the 2020 International Society of Lymphology clinical staging standards. Two radiologists assessed the following characteristics of the short-term inversion recovery sequence: the extent of edema (longitudinally and transversely); the frequency of MRI manifestations, including the presence of dermal thickening; and the morphology of edema (grid, honeycomb, parallel lines, banded, crescent, and lymphatic lake). The kappa test was used to assess interobserver agreement. The χ² test was used to compare the frequency differences of MRI manifestations between different clinical stages. The Spearman test evaluated the correlation between edema extent and clinical stage.</p><p><strong>Results: </strong>The extent of edema was correlated positively with clinical stage, both longitudinally and transversely. When comparing stages, the incidence of dermal thickening in stages II and III was significantly higher than in stage I. The incidence of parallel lines in stage I was significantly higher than that in stages II and III. The grid and banded sign incidence in stages I and II were significantly higher than in stage III. The incidence of honeycomb in stages II and III was significantly higher than in stage I. The incidence of lymphatic lake and crescent in stage III was significantly higher than in stages I and II (P < .001).</p><p><strong>Conclusions: </strong>Short-term inversion recovery can sensitively diagnose lymphedema and assist in clinical staging. MRI manifestations of primary lower extremity lymphedema in different stages have specific MRI features.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"102004"},"PeriodicalIF":2.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622338","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":"In-human clinical experience with direct stick embolization of low-flow vascular malformations using a mammalian target of rapamycin inhibitor.","authors":"Valentina Restrepo-Espinosa, Alfred I Lee, Stephanie Prozora, Prashant Patel, Naiem Nassiri","doi":"10.1016/j.jvsv.2024.101997","DOIUrl":"10.1016/j.jvsv.2024.101997","url":null,"abstract":"<p><strong>Background: </strong>Although direct stick embolization (DSE) of low-flow vascular malformations (LFVMs) with off-label embolotherapeutic compounds is the current mainstay of therapy, systemic oral mammalian target of rapamycin (mTOR) inhibition has evolved into an important adjunctive therapy that is associated with frequent blood draws, systemic toxicity, and rebound signs and symptoms upon cessation. We herein report our experience with in-human DSE of LFVMs with an mTOR inhibitor for direct, intralesional targeting of the culprit mutated pathway without repeated systemic exposure.</p><p><strong>Methods: </strong>Since 2020, 33 procedures involving DSE were performed in 25 patients with LFVMs using a patented formulation and technique involving the intravenously compatible mTOR inhibitor Yale-OCR7737, used as a liquid compound in a collagen matrix emulsion for added viscosity and intralesional residence. Data were maintained prospectively and reviewed retrospectively for technical success (successful catheterization of the lesion and intralesional delivery of compound), clinical success (improvement in signs/symptoms with radiologically documented reduction in flow and/or volume of treated lesion), complications, side effects, and reinterventions.</p><p><strong>Results: </strong>From 2020 to 2023, 33 procedures involving DSE were performed using Yale-OCR7737 in 25 patients (10 men [40%]; 15 women [60%]; mean age, 28 years [range, 1-70 years]) with LFMVs involving the head/neck (48%) and limbs (40%); 88% were nonsyndromic and 12% had Klippel-Trenaunay syndrome; 68% exhibited venous malformations, and 32% had lymphatic malformations. Technical and clinical success rates were 100%. Mean DSE sessions per patient was 1.4 (range, 1-5). Localized intravascular coagulopathy was present after 16 DSE procedures (49%); D-dimer improved after DSE in 7 cases. No perioperative or delayed complications occurred. Side effects were seven cases (21%) of self-limited, transient, oral aphthous ulcers.</p><p><strong>Conclusions: </strong>Our findings suggest that DSE of LFVMs with mTOR inhibitors (Yale-OCR7737) may be safe and effective. This may represent the new embolotherapeutic frontier in the endovascular treatment of LFMVs.</p>","PeriodicalId":17537,"journal":{"name":"Journal of vascular surgery. Venous and lymphatic disorders","volume":" ","pages":"101997"},"PeriodicalIF":2.8,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622333","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}