Journal of Vascular Surgery: Venous and Lymphatic Disorders – July 2017 Audiovisual Summary

Abstract

Hello and welcome to the July issue of the JVS-VL. We have four interesting papers to tell you about, which are featured in this month's JVS-VL. First is a paper by Brownson and colleagues from Yale, “Characteristics of provoked deep vein thrombosis in a tertiary care center”. The authors retrospectively studied 425 patients over an 18-month period at their institution with provoked deep vein thrombosis (DVT) and divided them into those with transient risk factors, such as surgery that resolved in 2 weeks and those with permanent risk factors such as cancer, long-term immobilization, or a hypercoagulable state. They found that those with transient risk factors were younger and had more calf DVT as well as a significantly lower risk of recurrent DVT and death at 7 months. The authors question whether those with transient risk factors who develop DVT should be treated differently and have a shorter period of anticoagulation. The next paper “Clinical characteristics and prognostic features of intravenous leiomyomatosis with inferior vena cava or intracardiac extension” by Zhang and colleagues from Beijing, China is a retrospective analysis of 38 patients with intravenous leiomyomatosis, whose mean age was 44 years. Fifty-eight percent of patients had a history of uterine leiomyoma and 24% had a history of uterine leiomyoma without extension into the deep veins. The most common symptoms were chest tightness, lower limb swelling, palpitation, dizziness, and abdominal distention. Sixty percent underwent one-stage surgery and 40% underwent two-stage surgery and 72% received postoperative antiestrogen hormone therapy. Unfortunately, at a median follow-up of 12 months, 50% showed evidence of recurrence. Postoperative antiestrogen hormone therapy, duration of postoperative hormonal therapy, and heart involvement were not associated with recurrence. The authors conclude that this rare disease requires surgery as the primary treatment, and although the recurrence rate is high, postoperative antiestrogen hormone therapy is not correlated with recurrence. The next paper is the Editors' Choice and is titled “Clinical presentation of women with pelvic source varicose veins in the perineum as first steps in the development of a disease-specific patient assessment tool” by Gibson and coauthors from Bellevue and Seattle, Washington and Boston, Massachusetts. They prospectively studied 72 women with symptomatic pelvic source varicose veins and compared them to 1160 women with saphenous vein incompetence alone. The severity of disease was objectively evaluated using the revised Venous Clinical Severity Score (rVCSS). The study revealed that those with pelvic source varicose veins were younger and thinner than those with saphenous incompetence and also had large infants. The most common symptoms were aching in 68%, throbbing in 47%, and heaviness 35%, and premenopausal women noted that symptoms were worse during menses. Since the VCSS is poorly associated with patient-reported discomfort, it is not good for evaluating pelvic source varicose veins. A disease-specific tool for the evaluation of pelvic source varicose veins is critically needed. The final highlighted paper is by Marston and coauthors from North Carolina and is titled “Incidence of venous leg ulcer healing and recurrence after treatment with endovenous laser ablation”. They retrospectively reviewed all open and healed venous ulcer patients treated with laser ablation. Laser ablation of the great saphenous vein, small saphenous vein, or both was performed on 173 limbs. Deep venous insufficiency was present in 31% and concomitant phlebectomy was performed in 34%. At a median follow-up of 25 months, venous ulcers healed after laser ablation in 57% at 3 months, 74% at 6 months, and 78% at 12 months, but ulcers recurred in 9% at 1 year, 20% at 2 years, and 29% at 3 years. Ulcers recurred more often in patients with deep venous insufficiency and in those patients who did not undergo phlebectomy of associated varicose veins at the time of laser ablation. The authors suggest phlebectomy at the time of laser ablation for patients with open or healed venous ulcers and particularly in those with isolated superficial venous insufficiency. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5YmFjY2E4ZWRkYzM5YzMwMGM0YzcxNzAwZWE3MTdjMCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3OTM3OTE2fQ.gSrZb5TQHy5bf-ns-ZZTj19DBn0yNrQw0UuGnDH0RYwFFbVbW7Ke2UL5BFHo4LftO-mQtyCBkLh-w9tmqqKz7UUKR85RBSrnHQ0wPjR4FFUClwLo_LdHtK_No6JZoUAvrF4P9g75SryQ0c1kUYo16aX_kjYgWgS1hpu9rLL_WnHgSBj3w4qNgwArBgKhw4hnkLzsa_LtmHYU8iHTb9kLOWWjyQBUS0rdmC-yV5gzH7cxtMcuLPV5hgFqnV_-jaM9gu3V75SN0QtdroudvJQ4DNlUJESOMfiZRTKDuHhLVHtfgR0MeJ2xiPAqOxmH1by8E7Pd-6s55HwQ0Jc42shRYw Download .mp4 (332.17 MB) Help with .mp4 files Video