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

Abstract

Welcome to the November issue of the Journal of Vascular Surgery: Venous and Lymphatic Disorders. We are highlighting several papers that we believe you will especially want to read, but we also encourage you to read the entire issue of JVS-VL. The Editors' Choice for this issue is a paper by Marston and other investigators from the HP802-247 Study Group entitled “Baseline factors affecting closure of venous leg ulcers”. Three separate, but nearly identical, randomized trials investigated a novel topical cell therapy for venous leg ulcers. Although the cell therapy did not facilitate wound healing, the authors used the pooled data from the control arm of the study, which used standard compression therapy, to determine the factors in a venous leg ulcer that predicted wound healing. The study found that the size of the wound, location of the wound on the leg, and the duration of the leg ulcer were all predictors of wound healing when standard compression with a four-layer compression dressing was used. In addition, women were more likely than men to heal their venous leg ulcers. These data help clinicians predict the time anticipated for venous leg ulcer wound healing based on the characteristics of the wound. One of the most challenging deep venous problems is chronic cerebrovascular venous insufficiency due to outflow obstruction. Giaquinta and coauthors from Italy and the United Kingdom in their paper entitled “Factors influencing the hemodynamic response to balloon angioplasty in the treatment of outflow anomalies of the internal jugular veins” investigated technical factors that affected initial success and long-term patency of internal jugular balloon angioplasty. They performed nearly 800 procedures and studied the characteristics most associated with success. They found that younger patients with transverse venous defects and high-flow predilatation were most likely to respond to balloon angioplasty and remain patent, while those with hypoplasia or longitudinal defects were less likely to respond well to percutaneous transluminal angioplasty. The authors recommended using anatomic characteristics and patient age when selecting patients for balloon angioplasty of the internal jugular vein. The CME paper for this issue is “Contemporary outcomes of elective iliocaval and infrainguinal venous intervention for post-thrombotic chronic venous occlusive disease” by Rollo and co-authors from UCLA. They reviewed their experience using an aggressive interventional approach to patients with chronic venous occlusions, treating 31 patients with endovascular approaches, including lysis, supra-, and infrainguinal angioplasty and stenting, as well as removal of previously placed vena caval filters. They showed a high initial recanalization success, a significant improvement in CEAP score postprocedure, a patency at 1 year of ∼70%, and improvement in symptoms and swelling in most patients. Several stents were extended below the inguinal ligament with good patency. The authors recommend attempting to remove all vena caval filters to improve patency, and extending the stent below the inguinal ligament, when needed to treat all stenotic disease to obtain the best patency. The final paper highlighted today is “Superimposition of elastic and nonelastic compression bandages” by Chassagne and coauthors from France. They investigated the pressure of superimposed bandages and compared them to the pressure applied by single-component bandages. Six different bandages, composed of one elastic bandage, one nonelastic bandage, or both, were applied in a spiral pattern on both legs of 25 patients at risk of venous thrombosis. Pressure was measured on the leg in the supine, sitting, and standing positions. The two single bandages applied similar pressure in the supine position, but their superimposition showed different pressure levels, with a similar static stiffness index depending on the order in which the bandage components were applied on the leg. They concluded that the order of bandage application has a significant impact on interface pressure, but there was a poor correlation between the pressure applied by each bandage component and the pressure resulting from their superimposition. We hope you enjoy these and the other papers in this issue of the JVS-VL. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJkZjY1MzhlYmYzMmIzZTkwOTE5MDQ0MjZkYmExN2I4MiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4NDczMjI3fQ.l4wf6nMuwDiwJ3ud7MYvoGw-qTjOY6QKG1BuV8UvtcUzogRH16z10-OTDzIrqFT7BhNZMz_i19uqpA5ylYzCov8589sSViInfM9QrUDS7ORZBqQxUvNZRSwGSG-tq4eKLItAwTBowSa7RIr8I3AKWUCkYaGc2U_zFIwymrI-yxEcC9u28I11_RAH7jJtgM_3yvYZFk-o8IHPH0BhdOOM75rb7Z1gZYw2a_d9MaNGqcyDaKh1bQN64ptjUqEQHFYloZfG7Oq3Wt_XwIH1xjdj8MnviTSoSFK5pTcEEHMHSNgBFO5yehwzrv7ULfXAaIDVUiv1izIVshhvzCc_4_NdGA Download .mp4 (89.84 MB) Help with .mp4 files Video