Turkish Journal of Vascular Surgery最新文献

{"title":"Is there a place for a (Virtual) European Network and reference centers on Pelvic Venous Disease (PeVD)? Thinktank?","authors":"Marald Wikkeling","doi":"10.9739/tjvs.1970.01.216","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.216","url":null,"abstract":"The creation of a virtual European network and reference centers, targeted at Pelvic venous disease, holds promising potential for the medical and research communities. Nevertheless, effective implementation of the initiative necessitates prudent planning, funding, and support. The establishment of such networks and reference centers requires certain considerations. We will elaborate on these considerations and are there best practices? The development from reference centers into (virtual) networks and even thinktanks is a precarious process of which is making its way from infancy to adulthood.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of duplex ultrasound in the diagnosis of pelvic venous disease","authors":"I. T. Toonder","doi":"10.9739/tjvs.1970.01.215","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.215","url":null,"abstract":"Recently there is an increased awareness of the possibility of pelvic venous disorders in patients with phlebological disease. The pathophysiology involves venous reflux or obstruction or a combination of both. It has been recommended that valvular function should be determined by the duration of reflux with the patient in an upright position. However the term ‘reflux’ is being used avidly by those assessing magnetic resonance imaging and computer tomography where patients are in a supine position. Venous compression is a common finding when the patient is supine and does not necessarily mean pathology. Duplex ultrasound is probably the only diagnostic tool which allows for examination in both supine and upright positions.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient reported outcome measures (PROMS) and patient reported experience measures (PREMS): Measuring outcomes in pelvic venous disorders","authors":"Sriram Narayanan","doi":"10.9739/tjvs.1970.01.224","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.224","url":null,"abstract":"Pelvic venous disorders (PeVD) present with a range of heterogenous symptoms that arise from altered venous hemodynamics in the pelvis. Many of these symptoms lead to mental health and quality of life issues and are not limited to the pelvic region. The nutcracker phenomenon causing left renal vein compression and left ovarian venous hypertension as well as the compression of the left common iliac vein by the overlying right common iliac artery are often stated as the common underlying pathologies. As a result, there has been a sudden increase in the number of ovarian vein coil embolizations and iliac vein stents placed. In truth however, the altered venous hemodynamics in PeVD is more complex. There appears to be little correlation between the symptoms patients experience and the obvious image detected anatomical lesions being treated. In addition, these anatomical lesions are very commonly seen in asymptomatic and especially muti-parous women as well. To compare outcomes of these and other more extensive procedures being performed for these commonly seen anatomical changes in the pelvic veins, objective assessments of the outcomes as seen from the symptom relief they bring to patients treated is essential. Validated Patient-reported outcome measures (PROMS) can be an important tool to compare outcomes across interventions for PeVD. However, as the impact of similar symptoms on different patients’ quality of life (QoL) can vary, developing a validated PROM that can be used to compare procedural outcomes in PeVD is a challenge. On the other hand, complications and procedural success as reported by physician do not assess the effect on a patient’s QoL. This paper provides a narrative review of PROMs, patient reported experience measures (PREMs) and individualized-PROMs. It also suggests a process for how a validated PROM for comparing procedural outcomes in PeVD may be developed. This could provide a framework that incorporates the recently adopted Symptoms-Varices-Pathophysiology (SVP) classification of pelvic venous disorders into the PROM development process to ensure that a like-for-like comparison is made between procedures being performed on a very heterogenous, but long-suffering group of patients.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139018915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic escape points: Bottom- up is the way to go!","authors":"Aleksandra Jaworucka-Kaczorowska","doi":"10.9739/tjvs.1970.01.223","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.223","url":null,"abstract":"Varicose veins (VVs) of pelvic origin are one of the clinical presentations of pelvic venous disorders (PeVD) and are increasingly being diagnosed in patients in phlebological offices these days. To investigate VVs potentially resulting from pelvic vein incompetence (PVI), a usual full duplex ultrasonography (DUS) of lower extremity veins in the upright position is recommended as well as DUS for evaluation of pelvic escape points (PELVs). Seven PELVs have been described, connecting the pelvic veins to the veins of the genital region and/or legs. There are two possible treatment options for pelvic origin VVs, top-down treatment such as pelvic vein embolization or treatment of iliac/renal vein compression if it is the cause of PVI and bottom-up treatment of PELVs and related VVs. The idea of the latter approach is to treat the causes of the external pelvic VVs in the genital region and VVs in the legs without having to treat asymptomatic pelvic veins within the pelvis. The most common methods of bottom- up treatment are sclerotherapy, surgical ligation and miniphlebectomy. The efficacy of such treatment approach for VVs of pelvic origin has been reported in the literature, whereas studies have failed to demonstrate good results of top- down treatment in the context of eliminating VVs of pelvic origin as well as minimizing the risk of VVs recurrence. Bottom-up treatment is a useful option to avoid unnecessary and more expensive pelvic vein embolization and should be considered as an initial therapeutic approach. Only if bottom-up treatment fails, if the VVs recur rapidly, or if the patient develops pelvic symptoms due to PVI, pelvic veins embolization can be considered.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138991738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term follow-up in PeVD with compression syndromes","authors":"Marald Wikkeling, Marianne Witte, H. Jalaie","doi":"10.9739/tjvs.1970.01.218","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.218","url":null,"abstract":"Long-term follow-up is crucial for patients with Pelvic venous disease (PeVD) and compression syndromes, regardless of the chosen treatment. The specific condition of the patient and the performed treatments will determine the frequency of follow-up appointments. The frequency of follow-up appointments can vary based on the severity of the condition, the type of treatments performed, and individual patient factors. Some patients may require more frequent check-ups initially, with the possibility of spacing them out as their condition stabilizes. Long-term follow-up is a crucial component of the comprehensive care of patients with PeVD and compression syndromes. It enables healthcare providers to monitor the patient's progress, address any emerging issues, and optimize treatment strategies for better long-term outcomes.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic venous disease; knowledge gap","authors":"Marie Josee E Van Rijn, Clark J Zeebregts","doi":"10.9739/tjvs.1970.01.217","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.217","url":null,"abstract":"Good quality data is lacking for pelvic venous disease (PeVD) and there are knowledge gaps in several topics. While we know that multiple pregnancies, hormonal factors and compression syndromes are risk factors, less is known about environmental and lifestyle factors. Most studies investigated the effect of coil embolization in relation to pain, but outcomes missing are quality of life (QOL), recurrence, complications, cost- effectiveness and predictors of a good response. There are no studies comparing different embolization techniques and hardly any studies on alternative treatment modalities or pharmacological treatment. It is important to distinguish different symptoms PeVD can cause when reporting patient related outcomes. Most studies use VAS scores, however, there is more to PeVD than pain. Concomitant diseases are common and may impact QoL by itself and must be taken into consideration as well. Finally, there are gaps in patient education and awareness. A scoring system would help in identifying patients. Recently, such a screening score was proposed. In conclusion, research in the field of PeVD is still in its infancy creating gaps in knowledge and awareness. Closing these gaps is essential for PeVD diagnosis and treatment.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apples and oranges in pelvic venous disorders: Heterogeneity and best practice","authors":"S. Gianesini","doi":"10.9739/tjvs.1970.01.221","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.221","url":null,"abstract":"Pelvic venous disorder represents an as common as challenging clinical scenario because of the blurred borders between pelvic region and lower limb treatment target, because of the subtle and aspecific signs and symptoms, because of the lack of large randomized comparative trials providing clarity on the best practice and strong recommendations. Herein we present pathophysiology and clinical considerations on the lower limb varicosities of pelvic origin, suggesting possible management strategies based on clinical manifestation, ultrasound detection and targeted sclerotherapy. Large studies are needed to identify the best diagnostic parameters guiding the best strategy and highlighting the most reliable reported outcomes from such heterogeneous patients.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial inflammation and thrombotic risk: From the leg to the pelvis and back","authors":"S. Gianesini, S. Dogancı","doi":"10.9739/tjvs.1970.01.222","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.222","url":null,"abstract":"Pathological shear and stretch stress acting on the endothelium lining following venous reflux has been associated with an increased risk not only of thrombosis, but also of pan-endothelial inflammation. Indeed, varicose veins patients demonstrate an increased risk not only of deep venous thrombosis, but also of pulmonary embolism and peripheral arterial disease. Ex-vivo studies, including the ones on vascular endothelial cells, highlight the correlation between the physical forces and the biochemical related messaging triggering these clinical scenarios. Herein we report insights on the biosignaling following this mechano-transduction involving surface and cytoskeleton structures such as the glycocalyx, involved in endothelial permeability, protection, as well as in vessel tone and coagulation balance in a parallelism between lower limb and pelvic venous district venous thrombo-inflammation.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138992142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible link between pelvic venous disorders and fertility","authors":"Zaza Lazarashvili","doi":"10.9739/tjvs.1970.01.220","DOIUrl":"https://doi.org/10.9739/tjvs.1970.01.220","url":null,"abstract":"Pelvic venous disorders (PeVD) is characterized by chronic pelvic pain for at least 6 months as a result of varices or the insufficiency of pelvic veins. It usually manifests as chronic pelvic pain, dyspareunia, dysmenorrhea and varicosities of atypical localizations. One of the most important issue in this field pertains to the impact of PeVD on female reproductive function, particularly its influence on pregnancy and the significance of timely treatment in this regard. The analysis of the studies presented in current review, despite rather scarce data, indicates that the presence of pelvic venous disorders affects the reproductive activity of women. However, due to the weak evidence, future investigations are extremely needed.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of patient characteristics in cancer-associated venous thrombosis in Türkiye (CAT-TR study)","authors":"Orcun Unal, Hakkı Tankut Akay, Suat Dogancı, Ahmet Kursat Bozkurt, Nevzat Erdil, Mustafa Sirlak, Emrah Uguz, Dilek Erer, Abdullah Ozer, Deniz Serefli, Soner Yavas, Kemal Esref Erdogan, Mustafa Seren, Evren Ozcinar, Emre Kubat, Adil Polat, Kamil Boyacioglu, Cengiz Koksal, Emre Selcuk, Ozan Onur Balkanay, Ismet Tanzer Calkavur, Emrah Oguz, Ismail Yurekli, Koksal Donmez, Erdem Cetin, Celal Selcuk Unal, Kaptaniderya Tayfur, Mehmet Ali Kayfın, Mustafa Edis, Omer Tanyeli, Rifat Ozmen, Okan Ozocak, Senol Yavuz, Kadir Kaan Ozsin","doi":"10.9739/tjvs.2022.12.033","DOIUrl":"https://doi.org/10.9739/tjvs.2022.12.033","url":null,"abstract":"Aim: In cancer patients, the overall risk of venous thromboembolism (VTE) is increased 7-fold, and in cases of certain malignancies, this risk increases to 28-fold. The main objectives of this study are to describe patterns of use of anticoagulants for the treatment of cancer-related VTE in Türkiye and to assess patient characteristics. Material and Methods: This was a multicenter, retrospective, descriptive study utilizing data from 17 centers across Türkiye. We included 2936 patients with a diagnosis of any cancer and a diagnosis of proximal lower-limb deep vein thrombosis (DVT) and/or pulmonary embolism (PE) between January 1, 2016, and December 31, 2019. These patients were only included if the cancer diagnosis was made at least 6 months before the diagnosis of VTE or within 30 days following the diagnosis of VTE. Patients were followed from the day after the index date until the earliest date among the dates of death, the end of the study, or the end of the 6-month treatment period. Results: The study included 2796 patients with VTE between 2016 and 2019. While 41.4% of the participants were female, 58.6% were male, and 66.1% of the patients had DVT while 45.2% had PE. Furthermore, 52.7% had a history of smoking and only three patients had known hereditary thrombophilia. Lung cancer was the most common type of cancer, diagnosed in 872 patients (29.3%), followed by colon cancer diagnosed in 255 patients (8.6%) and breast cancer diagnosed in 202 patients (6.8%). Among these patients, 70.3% were in an advanced stage of the disease. Chemotherapy was administered to 469 (65.7%) patients at the time of disease onset. Among the patients with VTE, 99.5% were treated, and low-molecular-weight heparin was used in 97.5% of these cases while 3% of the patients were treated with direct oral anticoagulants. Bleeding was observed in 1.6% of the patients who participated in this study, and 39.1% of the bleeding events whose type was specified were categorized as major bleeding. Bleeding was most intense in the gastrointestinal tract (56.7%). Recurrence was observed in 1.5% of the patients and improvement was observed in 42.1%. In the first 6 months after diagnosis, 14.3% of the patients died. Causes of mortality could not be obtained from the patients’ records. Conclusion: VTE is common in patients with active cancer and associated with high recurrence and mortality rates. Efforts are needed to prevent VTE, diagnose it in time, and reduce the recurrence rates, especially in the first year after VTE diagnosis.","PeriodicalId":23982,"journal":{"name":"Turkish Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}