Phlebology最新文献

{"title":"Risk acceptance for deep venous interventions of the lower limb.","authors":"George Hudson, Desmond Chan, Robert Hinchliffe, Baris Ozdemir","doi":"10.1177/02683555251326711","DOIUrl":"https://doi.org/10.1177/02683555251326711","url":null,"abstract":"<p><p><b>Objectives:</b> To discover the maximum risk acceptable to patients and clinicians for complications typical to endovascular interventions in the setting of proximal deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS).<b>Design:</b> This was an observational study comparing patient/clinician risk acceptances in interviews using validated Standard Gamble methodology.<b>Methods:</b> 30 patients with previous DVT and 30 vascular clinicians were given a scenario describing a hypothetical case of a patient being managed with acute iliofemoral DVT and another with PTS. Subjects were asked to provide the maximum risk they would accept for individual complications to cure the condition. To interpret variability, the Venous Clinical Severity Score, SF-36 domains and VEINES-QoL for each patient were plotted against their risk acceptance for major bleeding in the DVT scenario.<b>Results:</b> For the DVT scenario, patients accepted high median risks compared to clinicians for major bleeding (40% vs 5%, <i>p</i> < .001), bleeding at other sites (50% vs 5%, <i>p</i> < .001), damage to blood vessels (60% vs 5%, <i>p</i> < .001), further procedures (80% vs 20%, <i>p</i> < .001), and treatment failure (75-80% vs 10-20%, <i>p</i> < .001). However, the gap was lower for intracranial bleeding (5% vs 1%, <i>p</i> = .004), pulmonary embolism (5 vs 5%, <i>p</i> = .39) or death (1% vs 0.75%, <i>p</i> = .77). For the PTS scenario, there were similar results again with a lower difference for pulmonary embolism (10% vs 5%, <i>p</i> = .02) and death (0.5% vs 1%, <i>p</i> = .72). Importantly, patient risk acceptance for major bleeding was negatively correlated to the emotional wellbeing (Rho = -0.43, <i>p</i> = .018) and social functioning (Rho = -0.38, <i>p</i> = .042) SF-36 domains.<b>Conclusion:</b> Overall, patients accepted a greater chance of most adverse events compared with clinicians. Patients prepared to accept greater risk were those with poorer emotional wellbeing and social functioning. It is important to take these issues into account when making shared decisions with patients about the management of their DVT/PTS.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"2683555251326711"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630285","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 efficacy of aspirin compared to low molecular weight heparin as thromboprophylaxis after orthopedic surgery: A systematic review and meta-analysis.","authors":"Feng Chen, Jing Guo","doi":"10.1177/02683555251325415","DOIUrl":"https://doi.org/10.1177/02683555251325415","url":null,"abstract":"<p><p><b>Background:</b> Aspirin has increasingly gained attention as a thromboprophylaxis agent for patients undergoing orthopedic surgery; however, the results of recent clinical trials remain controversial. Therefore, in this meta-analysis, we compared the safety and efficacy of aspirin with those of low molecular weight heparin (LMWH) for patients undergoing major orthopedic surgeries leading to significant immobility and necessitating anticoagulants to prevent thromboembolic events. <b>Methods:</b> PubMed, Web of Science, Scopus, and the Cochrane Library were systematically searched from the inception to April 20, 2024, to identify clinical trials and randomized controlled trials comparing the effect of aspirin and LMWH on deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), venous thromboembolism (VTE), major bleeding, short-term postoperative mortality, and adherence to treatment. VTE included DVT and PE in this study. A random-effects model (<i>DerSimonian-Laird</i>) was employed to pool data. <b>Results:</b> In total, 8 randomized controlled trials with 23,540 participants were included in this study. Compared to LMWH, the use of aspirin was associated with a significantly increased risk of DVT (RR 1.56, 95% CI (1.30-1.86), I² = 0.00%), whereas no significant changes were observed in drug adherence (RR 1.04, 95% CI (0.94-1.14), I² = 94.02%) and risk of PTE (RR 1.18, 95% CI (0.64-2.15), I² = 58.64%), VTE (RR 1.51, 95% CI (0.89-2.57), I² = 24.69%), major bleeding (RR 0.96, 95% CI (0.88-1.04), I² = 0.00%), and mortality (RR 1.07, 95% CI (0.89-1.29), I² = 0.00%) after orthopedic surgery. <b>Conclusion:</b> Aspirin is generally as safe as LMWH for preventing thromboembolic events among patients undergoing orthopedic surgery; however, aspirin can increase the risk of DVT.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"2683555251325415"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627319","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":"Breaking the cycle: Addressing the drucebo effect in lymphedema care.","authors":"Roberto Tedeschi","doi":"10.1177/02683555251326698","DOIUrl":"https://doi.org/10.1177/02683555251326698","url":null,"abstract":"<p><p>The drucebo effect, a lesser-known counterpart to the nocebo effect, arises from negative perceptions specifically related to medical interventions and healthcare settings. This phenomenon can significantly influence the management of lymphedema, a chronic and often debilitating condition characterized by fluid retention and tissue swelling. The drucebo effect not only exacerbates symptom perception but also negatively impacts adherence to therapy and overall patient prognosis. This report explores the mechanisms underlying the drucebo effect in lymphedema management, the role of healthcare provider communication, and strategies to mitigate its impact. Addressing the drucebo effect is critical to optimizing therapeutic outcomes and enhancing patient satisfaction.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"2683555251326698"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607597","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":"A hemodynamic screening tool for symptomatic internal jugular vein stenosis in J3 segment.","authors":"Min Li, Xiaogang Gao, Yaqiong Jia, Yang Wang, Xunming Ji, Ran Meng","doi":"10.1177/02683555251326031","DOIUrl":"https://doi.org/10.1177/02683555251326031","url":null,"abstract":"<p><p>ObjectivesThe aim of this study was to formulate an ultrasonic diagnostic criterion for stenosis in the J3 segment of internal jugular vein (IJV) and probe into the effects of stenosis in the J3 segment on intracranial pressure (ICP) and the cerebral drainage pattern.MethodsParticipants who exhibited narrowing in the J3 segment of IJV on neuroimaging and reported symptoms correlated with IJV stenosis (IJVS) were enlisted from Xuanwu Hospital. Clinical data were retrospectively amassed.ResultsA total of 163 subjects including 57 IJVS subjects and 106 control subjects were recruited. We unearthed an inverse relationship between the pressure gradient and the flow velocity. Flow velocity at or below 27.5 cm/s coincided with pressure gradient values of 4 mmHg or greater. There is no significant correlation between IJVS and ICP. Additionally, a linear correlation was identified between the bilateral flow volume in the J3 segment and ICP. Values exceeding 425 mL/min were indicative of intracranial hypertension. There was an increase in diameter, flow volume and flow velocity in the bilateral vertebral veins in participants with IJVS.ConclusionsThe J3 segment of IJV displays right dominance. Stenosis can be deduced when the flow velocity in the J3 segment is at or below 27.5 cm/s. Stenosis in the J3 segment yielded a diminished outflow in the IJV and an augmented outflow in the vertebral veins. When bilateral flow volume in the J3 segment exceeds 425 mL/min, it denotes intracranial hypertension.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"2683555251326031"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607596","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 impact of stent protrusion into the inferior vena cava or jailing of the contralateral iliac vein on the incidence of contralateral deep vein thrombosis following venous stenting.","authors":"Duy Nguyen, Karl Pappas, Shreya Mahadevan, Levan Sulakvelidze, Richard Kennedy, Gaurav Lakhanpal, Sanjiv Lakhanpal, Peter J Pappas","doi":"10.1177/02683555241273752","DOIUrl":"10.1177/02683555241273752","url":null,"abstract":"<p><strong>Objective: </strong>Iliac vein stenting is the standard of care for patients with pelvic venous disorders secondary to symptomatic iliac vein outflow obstruction. Venous stents are often extended proximally into the inferior vena cava (IVC) which may result in partial or complete coverage of the contralateral iliac vein. The purpose of this investigation is to determine if extension of iliac vein stents into the IVC results in increased risk of contralateral deep venous thrombosis (DVT).</p><p><strong>Methods: </strong>We retrospectively reviewed prospectively collected data from 409 patients who underwent iliac vein stenting at the Center for Vascular Medicine (CVM) from 2019 to 2020. Stent type, covered territories, initial and follow-up consults, ultrasound and operative reports were reviewed to assess for incidence of post-implantation DVT. Patients were stratified into three groups: Iliac vein stents which protruded into the IVC, stents that completely covered the orifice of the contralateral iliac vein and those with no stent protrusion into the IVC.</p><p><strong>Results: </strong>Out of 409 patients, the average age was 53.96 ± 13.40 years with 94 males and 315 females. All stents placed were Venovo stents and all iliac vein lesions were non-thrombotic stenoses. The average follow-up period was 14.35 ± 10.09 months. The most common territories stented were the IVC-LCIV-LEIV (<i>n</i> = , 74%) and the IVC-RCIV-REIV (<i>n</i> = , 26%). Stent protrusion and distance into the IVC in millimeters (mm) was the following: Partial protrusion (<i>n</i> = 314, 77%, 27.6 ± 19.1), jailing of the contralateral iliac vein (<i>n</i> = 78, 19%, 45.9 ± 18.6), no protrusion (<i>n</i> = 16, 4%). The overall DVT rate post-implantation was 0.49% (<i>n</i> = 2). No DVTs ipsilateral to the index stent were identified and both DVTs were contralateral DVTs. A hypercoaguable disorder was reported in 6 patients (1.5%). There were no significant differences in prevalence of contralateral DVT between the three groups. (<i>p</i> = .35).</p><p><strong>Conclusion: </strong>The rate of contralateral DVTs post iliac vein stenting with Nitonol based stents is extremely low. Partial or complete coverage of the contralateral iliac vein via stenting does not result in an increased incidence of contralateral DVT in the short-term. Longer follow up is needed to determine if contralateral DVTs occur after long-term implantation.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"80-87"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977616","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":"Selected phlebological abstracts.","authors":"Lowell S Kabnick, Kathleen Ozsvath, Jorge H Ulloa","doi":"10.1177/02683555251317274","DOIUrl":"10.1177/02683555251317274","url":null,"abstract":"","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"137-139"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070643","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":"Analysis of the efficacy of angiojet percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis versus catheter-directed thrombolysis alone in the treatment of subacute iliofemoral deep venous thrombosis in elderly patients.","authors":"Luyi Cong, Lihua Huang, Benfang Fan, Xin Hong, Lingyu Ma, Tianan Huang","doi":"10.1177/02683555241273064","DOIUrl":"10.1177/02683555241273064","url":null,"abstract":"<p><strong>Purpose: </strong>To analysis the clinical efficacy of Angiojet percutaneous mechanical thrombectomy (PMT) combined with Catheter-Directed Thrombolysis (CDT) compared to CDT in treatment of subacute iliofemoral deep venous thrombosis (IFDVT) in elderly patients.</p><p><strong>Methods: </strong>A retrospective analysis of the clinical data of 117 elderly patients hospitalized for subacute IFDVT was conducted. The patients'basic perioperative data and 2-years follow-up data were compared.</p><p><strong>Results: </strong>Group A (PMT + CDT) had a more patients reaching Grade III thrombus clearance, and a lower thrombolysis time, dosage of thrombolytic drugs, hospital stay, and bleeding incidence compared to Group B (CDT). There was a statistically significant difference in the occurrence rate of severe PTS within 2 years (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>In treating elderly patients with subacute IFDVT, PMT + CDT effectively reduces the thrombus burden and the dosage of thrombolytic drugs, shortens the hospital stay, and importantly, reduces the occurrence rate of severe PTS within 2 years.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"88-94"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977615","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":"A randomized controlled study to evaluate the safety and feasibility of concomitant transluminal injection of foam sclerosant combined with endovenous laser ablation in patients with incompetent small saphenous veins.","authors":"Satoshi Watanabe, Atsunori Okamura, Mutsumi Iwamoto, Akinori Sumiyoshi, Kota Tanaka, Heitaro Watanabe, Yoshitaka Iwanaga, Katsuomi Iwakura","doi":"10.1177/02683555241276709","DOIUrl":"10.1177/02683555241276709","url":null,"abstract":"<p><strong>Objectives: </strong>To compare foam sclerotherapy through the access sheath (transluminal foam sclerotherapy [TLFS]) combined with endovenous laser ablation (EVLA) with EVLA alone in terms of safety and one-year venous clinical severity score (VCSS) changes in patients with small saphenous vein incompetence.</p><p><strong>Methods: </strong>During EVLA, the sheath tip was placed around the targeted tributary vein, and the sclerosant was injected via the side port. Outcomes assessed at 1 day, 1 week, 1 month, and 1 year included VCSS changes, residual or recurrent reflux, the need for secondary interventions, and other related complications.</p><p><strong>Results: </strong>The change in VCSS did not reach the minimum clinically important difference. Otherwise, TLFS reduced residual or recurrent reflux of the tributary using the TLFS (3/74 legs) compared with the EVLA alone (12/77 legs) (<i>p</i> = .027).</p><p><strong>Conclusions: </strong>TLFS is a safe and feasible procedure that reduces residual or recurrent reflux of the tributary vein compared with truncal EVLA alone.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"116-125"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116799","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 open vein hypothesis - is it the whole story?","authors":"Benedict Rh Turner, Marwah Salih, Jessica Shea, Adam M Gwozdz, Alun H Davies","doi":"10.1177/02683555241271914","DOIUrl":"10.1177/02683555241271914","url":null,"abstract":"","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"63-65"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997167","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":"Efficacy of ultrasound in the evaluation of iliac vein stenting.","authors":"Hannah Clode, Elizabeth Brooke Spencer, Jacqueline Nelson, Elisabeth S Horne","doi":"10.1177/02683555241276565","DOIUrl":"10.1177/02683555241276565","url":null,"abstract":"<p><p><b>Objectives:</b> The current study evaluated the efficacy of iliac and IVC ultrasound alone for follow-up evaluation of iliac vein stents in patients with pelvic venous disorders or iliac occlusion from chronic deep vein thrombosis. <b>Methods:</b> A retrospective single site cohort study was conducted by evaluating the most recent 100 iliac vein and inferior vena cava ultrasounds in patients who had undergone iliac vein stenting. Inclusion criteria included a history of iliac vein stent placement. Exclusion criteria included patients under 18-years-old, duplicates of the same patient, and pregnancy at the time of ultrasound. The degree of visualization for color flow, gray scale, and phasicity were determined and classified into the following categories: complete, partial, or none. In addition, each chart was assessed for external compression, in-stent narrowing, and requirements for further imaging. <b>Results:</b> Of the 100 iliac vein and IVC ultrasounds assessed in this review, 99 of the ultrasounds were sufficient for evaluation during follow-up visits without requiring further investigation. Within this study cohort, the average follow-up time was 22 months. The average participant body mass index was 27.6. One iliac vein and IVC ultrasound was considered inadequate for follow-up evaluation and required further imaging. <b>Conclusion:</b> The use of iliac and IVC venous doppler ultrasound alone in the follow-up evaluation of iliac stent patency is effective and noninvasive and avoids unnecessary radiation exposure and cost.</p>","PeriodicalId":94350,"journal":{"name":"Phlebology","volume":" ","pages":"110-115"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074920","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}