Presence Of Varicose Veins Research Articles

Cognitive Function Changes in Older People. Results of Second Wave of Cognition of Older People, Education, Recreational Activities, NutritIon, Comorbidities, fUnctional Capacity Studies (COPERNICUS).

BackgroundCognitive reserve explains why subjects with more years of education, professional achievement, or participation in recreational activities show less cognitive decline with aging. We hypothesize that levels of recreational travel, education, occupation, systemic health, physical performance, and current cognitive activity levels affect the trajectory of cognitive function in older, healthy people in Poland.Materials and MethodsHealthy, older people (N = 205) were examined and followed-up at 2 years. Participants completed physical and cognitive function assessments: including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF), and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning were also examined.ResultsThe MMSE result significantly decreased over 2 years. No significant decrease in other cognitive tests was noted. However, the trajectory of cognitive tests results varied between individual participants. Percentage of variance of change was explained by the following predictors: 21 in MMSE, 24 in MoCA, 8 in DR, 25 in VF, and 24 in TMT B. Age and the presence of varicose veins were significantly linked to negative changes in MMSE and MoCA scores, while working in a professional occupational status associated with a higher score. The subgroup with varicose veins did worse on the Delayed Recall subtest of MoCA.ConclusionCognitive reserve could be extended by proxies of reserve that are related to systemic health and travel activity. The latter is a combination of social, physical, and cognitive activity and potentially might serve as an intervention to improve cognitive function in older people. However, due to the limitations of this study, results should be interpreted with caution and needs to be replicated in the further studies.

The place of endoscopy in the tactics of restoring the viability of patients with gastroesophageal bleeding in portal hypertension (literature review)

Portal hypertension is a symptom complex that develops as a result of impaired blood flow in the portal system, the leading symptom of which is an increase in pressure in the portal vein over 12 mm Hg. Art. According to statistics in developed countries, 90% of cases of portal hypertension are associated with liver cirrhosis. The most formidable and fatal complication of portal hypertension is bleeding from varicose veins of the esophagus and stomach. The risk of bleeding is 4–5% per year, and in the presence of varicose veins of the esophagus from 15 to 30% or more, the mortality rate is 50%, with a recurrence rate of 50 to 90%. And the fact that today there is no unified approach to solving this problem in the world prompted us to take a short literary review on this topic.

Thrombolytic Therapy in Normotensive Patients with Pulmonary Embolism (Data from the Retrospective Study)

Background. The thrombolytic therapy is absolutely recommended for patients in shock or hypotension because the benefits are clearly outweighing the risks. However, in hemodynamically stable patients, including those with acute right ventricular dysfunction and/or myocardial damage, thrombolysis has a significantly lower evidence level.Aim. To study the criteria based on which doctors decide to conduct thrombolytic therapy in normotensive patients in real clinical practice according to the retrospective data.Material and methods. A single-center retrospective cohort study analyzed medical records of patients hospitalized in 2006-2017 with a verified diagnosis of pulmonary embolism (PE) and who had a systolic blood pressure >90 mm Hg at the time of admission.Results. The present study population included 299 patients with a verified diagnosis of PE from 2006 to 2017 years. Patients were divided into two groups: with thrombolysis (group 1) and without thrombolysis (group 2). Logistic regression analysis showed that age younger than 60 years, the presence of varicose veins of the lower extremities, skin cyanosis, syncope in the debut of PE were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis. Increased troponin I, right ventricular dysfunction, and the severity of PE according to the PESI score showed no significant impact on this decision. In-hospital mortality in the group 2 was 1.9% (5 patients), while there were no deaths in the group 1. But the analysis of the association of thrombolysis with survival was difficult to perform due to the low incidence of deaths and the small number of patients in the group with thrombolysis (odds ratio 0.34; 95% confidence interval 0.03-8.18; р=0.856). No major bleeding was registered in any group.Conclusion. We were not able to clearly identify independent clinical or instrumental factors that influence the decision to perform thrombolysis in patients with PE outside the framework of evidence-based medicine. Further research is needed.

Sonographic evolution of the superficial vein thrombosis of the lower extremity.

Superficial venous thrombosis (SVT) is a common clinical problem across various treatment settings. SVT shares risk factors with deep venous thrombosis (DVT) and carries a risk of thromboembolic complications, greater than previously expected. Little is known about the pathophysiology, resolution and recurrence of this disease. The objective of the present study was to describe the natural course of SVT, and factors correlated with the progression or resolution of the thrombus. We included 218 patients with a recent diagnosis of SVT that were consecutively referred to a thrombosis clinic from the Emergency Department (ED) between January 2016 and April of 2018. The resolution of the thrombus prior to discharge was correlated to gender (female 73.8% vs. male 57.5%, p = 0.015), presence of varicose veins (62.4% vs. 46.4, p = 0.026), absence of family or personal history of thrombosis (98% vs. 91.3%, p = 0.021). The factor most correlated to thrombus resolution prior to discharge was the result of the 2nd ultrasound (improvement 83.9% vs. 16.1%, p < 0.001) immediately after initiation of heparin treatment. In the multivariate analysis, a high thrombus burden in the early follow-up ultrasound was the most significant predictive variable with prior to discharge recanalization (B = 20.9, 95% CI 9.8-44.7; p < 0.001). The follow-up of SVT with duplex lower extremity ultrasound allows us to monitor the evolution and early identify residual thrombosis, as a marker of hypercoagulability and recurrence. This study offers new perspectives for future research, necessary to improve the management of this disease, to reduce long-term complications.

Presence of Varicose Veins is the Most Important Risk Factor for Developing PTS.

Presence of Varicose Veins is the Most Important Risk Factor for Developing PTS.

Venous Stenting in Proximal Venous Outflow Obstruction: Outcome Predictors

The objective of this study was to identify risk factors, including patient and surgical characteristics, associated with postoperative outcomes after iliac vein stenting for chronic proximal venous outflow obstruction (PVOO). The study is based on a composite retrospective and prospective database of 628 patients who underwent iliac vein stent placement for chronic PVOO at a single institution from January 2013 to April 2017. Patient characteristics, clinical presentation, and outcomes at 30 days, 90 days, 6 months, 1 year, and >1 year were queried. Univariate and multivariate ordinal regression, with stepwise backward elimination, was used to determine predictors of postoperative outcomes at various time points. Demographic characteristics included 351 (55.9%) women and mean age of 59.7 years. Edema was present in 568 (93%) patients. History of varicose veins or presence of varicose veins at the time of surgery was observed in 431 (70.4%) patients. Active ulceration was present in 94 (15%) patients. Clinical, Etiology, Anatomy, and Pathophysiology class 3 was noted for 69.4%. Bilateral stenting was performed in 385 (63.2%) patients. Univariate analysis showed that improvement in outcomes at 30 days was associated with edema (odds ratio [OR], 2.7; confidence interval [CI], 1.4-5.0; P = .002) and active ulceration (OR, 1.6; CI, 1.0-2.6; P = .03). Poorer outcomes at 30 days were associated with bilateral stenting (OR, 0.62; CI, 0.44-0.88; P = .007). At 90 days, improvement was associated with varicose veins (OR, 1.6; CI, 1.0-2.4; P = .03), edema (OR, 3.2; CI, 1.5-6.8; P = .002), and history of vein surgery (OR, 1.7; CI, 1.2-2.5; P = .008). At 6 months, univariate analysis demonstrated that being female (OR, 0.62; CI, 0.40-1.00; P = .03) resulted in poorer outcomes. Patients who had edema had better outcomes at 1 year (OR, 5.5; CI, 1.8-17.4; P = .003) and at >1 year (OR, 6; CI, 1.5-24.5; P = .013). At 30 days, multivariate analysis showed that the effects of edema and bilateral stenting persisted. At 90 days, the effects of edema and history of vein surgery persisted. In addition, multivariate analysis revealed that a history of deep venous thrombosis (DVT; OR, 0.405; CI, 0.213-0.771; P = .0059) resulted in poorer outcomes at 90 days, whereas active ulcerations (OR, 2.447; CI, 1.337-4.479; P = .0037) resulted in better outcomes. The effect of sex on outcomes at 6 months persisted. At outcomes >1 year, multivariate analysis revealed that acute DVT (OR, 0.111; CI, 0.015-0.838; P = .0331), DVT history (OR, 0.313; CI, 0.116-0.843; P = .0216), and bilateral stenting (OR, 0.349; CI, 0.132-0.921; P = .0335) were associated with poorer outcomes. Outcomes of iliac vent stenting are affected by multiple factors. Patients with edema are likely to benefit from iliac vein stenting. The benefits of venous stenting in active ulcers warrant further investigation as unreported here is the frequency of negative venography and IVUS among patients with active ulcers. Our findings may guide selection of patients and better counsel patients about the outcomes of venous stents in chronic PVOO.

Thromboembolism following cesarean section: a retrospective study

ABSTRACTObjectives: As thromboembolism (TE) continues to be one of the principal causes of death in obstetrical patients and as the postpartum period is associated with the highest risk for TE, we sought to determine the risk factors associated with TE following cesarean section (CS).Methods: A retrospective analysis of patients who had CS at a large tertiary referral center was conducted. Patients were identified through hospital medical records and were contacted approximately 1 year following their CS. Medical records and a questionnaire were used to identify features that were potentially associated with TE. Univariate analysis was used to determine the risk associated with these characteristics.Results: A total of 2206 patients had a CS, of which 1377 (62%) participated. Of the respondents, 137 patients received heparin (94% received a prophylactic dose, 6% received a therapeutic dose) and the remainder, 1233 patients, did not receive heparin. Seven patients (0.5%) developed a TE and 86% developed a TE within 7 days of CS. The odds ratio (OR) for TE for women with hypertension prior to pregnancy compared to patients who did not receive anticoagulation was 21.28 [95% confidence interval (CI) 4.64–90.13] and for patients who had varicose veins with superficial thrombophlebitis when compared to patients who had received heparin postpartum was 21.01 (95% CI 1.55–288.24).Discussion: Hypertension and the presence of varicose veins were associated with TE following CS. Larger cohort analyses are required to confirm these associations so that risk scores incorporating these characteristics may accurately predict the occurrence of TE.

Towards a Classification of Left Common Iliac Vein Compression Based on Triplanar Phlebography

Introduction: There is currently no consistent classification of the extent of left common iliac vein compression syndromes such that clinicians working in the area have a common terminology. Hypothesis: To create a classification of left common iliac vein compression based on the end point of triplanar pelvic phlebogrpahy. Methods: Based on 61 consecutive patients found to have left common iliac vein compression on triplanar phlebography in the course of treatment of venous disease, clinical presentation and symptomatology were retrospectively used to create a classification of left common iliac vein compression. Treatment of left common iliac vein compression was also retrospectively correlated with staging. Results: The following classification was arrived at: Stage 0, no compression and no intraluminal fibrous bands; Stage 1, evidence of compression by surrounding anatomical structures with or without the presence of fibrous bands; Stage 2: evidence of compression with or without fibrous bands as evidenced by cross-pelvic collaterals; Stage 3: compression of the left common iliac vein. Fibrous bands replaced by localised occlusion, with collateralisation and no involvement of adjacent venous segments; Stage 4a: as for Stage 3 but with the addition of thrombotic involvement of adjacent venous segments; Stage 4b: as for Stage 4a but with involvement of distal venous segments, femoral and popliteal. Stages 3, 4a or 4b correlated well with clinical presentations of DVT, PE, venous ulceration, vulval or cross-pelvic collaterals, ipsilateral limb swelling and claudication. The presence of varicose veins or recurrent varicose veins was a common finding amongst all groups. Conclusion: Acceptance of this classification system would provide a common terminology to allow more transparent assessment of modalities of treatment for this condition.

Factors associated with idiopathic adolescent scoliosis in female population - preliminary results

Introduction/Objective. Idiopathic scoliosis (IS) is an orthopedic condition of multifactorial origin. The aim of our study was to evaluate the factors that are associated with IS in female population and factors associated with varicose veins in females with IS. Methods. This retrospective-prospective cross-section study included 89 patients (the study group) and 87 controls. The following parameters were analyzed: body weight, body height, presence and the degree of varicose veins (the first, second, and third degree), and age (group in the range of 17?26 years, in the range of 27?36 years, and in the range of 37?46 years). Results. The study group has significantly lower body weight (p = 0.046), significantly higher proportion of varicose veins (p &lt; 0.001) compared to controls, significantly lower proportion of patients aged 27?36 years (p = 0.014), and significantly higher proportion of patients aged 37?46 years (p = 0.025) compared to controls. There is significantly higher proportion of patients in the study group with the first degree of varicose veins (p = 0.007). There is weak positive correlation between body weight and body height in the group of patients without varicose veins (R = 0.456) and in the group with the second degree of varicose veins (R = 0.291), while for the group with the first degree of varicose veins there is moderate positive correlation (R = 0.543). Conclusion. Our preliminary findings point out that lower body weight and presence of varicose veins are significantly associated with IS. The group of patients with IS above 37 years of age tends to have significantly higher proportion of varicose veins.

VKORC1 -1639 G>A Polymorphism in Romanian Patients With Deep Vein Thrombosis.

The purpose of the research was to study the influence of several genetic factors, especially the -1693 G>A polymorphism of the VKORC1 gene, on the risk of acute unprovoked lower extremity deep vein thrombosis (DVT). The study included 127 patients (median age 63 [53.2; 72] years; 61 [48%] women and 66 [52%] men) who were diagnosed with acute lower extremity DVT and 114 controls (median age 62 [53; 73] years; 64 [56.1%] women and 50 [43.9%] men) without DVT. We recorded data regarding the history of DVT and the presence of varicose veins. We determined the genotypes for factor V Leiden (FVL) mutation, prothrombin G20210A mutation, VKORC1 -1639 G>A mutation, and PAI-1 -675 4G/5G polymorphism. Varicose veins were found in 67 (52.8%) patients and 29 (25.4%) controls (P < .001). FVL was present in 29 (22.8%) patients and 10 (8.8%) controls (P = .005). The VKORC1 (-1693 G>A) GG genotype was found in 42 (33.1%) patients and 41 (36%) controls, the GA genotype in 71 (55.9%) patients and 47 (41.2%) controls, and AA genotype in 14 (11%) patients and 26 (22.8%) controls (P = .020). Multivariate analysis showed that the presence of varicose veins, FVL, and VKORC1 -1639 G>A was independently associated with the risk of DVT. The VKORC1 (-1693 G>A) AA genotype was associated with fewer cases of DVT (odds ratio = 0.435; 95% confidence interval 0.205-0.991; P = .031).

Extending Abdominal Aortic Aneurysm Detection to Older Age Groups: Preliminary Results from the Liège Screening Programme

There is evident benefit in terms of reduced aneurysm-related mortality from screening programs of abdominal aortic aneurysm (AAA) in men aged 65 years and more. Recent studies in the United Kingdom and Sweden have shown a decline of the prevalence of AAA in the general population. Current screening policies (e.g., men aged 65-74years), however, do not account for aging and increased life expectancy of Western populations. This study investigated AAA detection by extending the target population to older age groups (75-85years). AAA screening was conducted in the County of Chaudfontaine (Liège, Belgium) on the population of elderly (n=3,054). The participation rate was 36%. The 1,101 participants (722 men aged 65-85 years and 379 women aged 74-85years) were examined by ultrasound scan. AAA was defined as an infrarenal aortic outer-outer diameter of at least 3cm. Demographics, clinical parameters, and risk factors were also recorded. AAA prevalence was estimated, and patients with and without AAA were compared by logistic regression. The overall AAA prevalence was 3.6% (n=40). In female participants, AAA prevalence was low (1.3%). In men, it amounted 2.7% in the 65-74 age group but rose to 7.3% in the age-extended group (75-85years). Further in addition to age, height, current smoking, history of coronary artery disease, hypercholesterolemia, peripheral artery disease of the lower limbs, and varicose veins were significantly associated with the presence of AAA. These preliminary findings, based on a representative sample of the elderly population of the Liège region, support the idea that current AAA screening policies should be updated to cover an increasingly aging population. The presence of varicose veins as a potential risk factor for AAA should also be considered during screening.

Anatomical Predictors of Venous Thromboembolism Recurrence after Isolated Superficial Vein Thrombosis

Background: Isolated superficial vein thrombosis (iSVT) (i.e. without concurrent deep-vein thrombosis or pulmonary embolism) is a frequent event. Its clinical significance and management are controversial. Data on long-term follow-up are scarce and the impact of anatomical characteristics of iSVT on the risk of venous thromboembolism (VTE) (DVT and/or PE) recurrence has not been assessed.Objective: To determine the impact of anatomical characteristics of iSVT on the long-term risk of VTE recurrence.Methods: Using data from the The OPTIMEV (OPTimisation de l'Interrogatoire dans l'_evaluation du risque throMbo-Embolique Veineux) study, a prospective, observational, multicenter study, we assessed at 3 years in patients recruited for an objectively confirmed iSVT i) cumulative rates of DVT, PE and SVT recurrences using the Kaplan-Meier method; and ii) anatomical predictors of VTE recurrence (SVT involving the sapheno-femoral junction (i.e. ≤3 cm), SVT of the trunk of the great saphenous vein, bilateral SVT, SVT occurring in a varicose vein (i.e. C≥2 according to CEAP classification) using a Cox multivariable model adjusted for age, sex, cancer and personal history of VTE. At baseline, all patients with SVT underwent a complete bilateral swhole leg ultrasound to exclude concurrent DVT and during follow-up, all suspected VTE recurrences were confirmed/ruled out with objective tests. All recurrences were centrally adjudicated by the study's expert committee.Results: Among the 479 recruited patients with iSVT, 12.5% (n=60) had a thrombotic recurrence during the 3 years of follow-up. Cumulative rates of recurrence as a PE, DVT and iSVT were 1.9%, 4.8% and 5.8%, respectively. In multivariate analysis, a thrombus involving the sapheno-femoral junction at baseline independently increased the risk of VTE recurrence (HR=3.34 [1.5-7.2]). Presence of varicose veins also increased the risk but this result did not reach statistical significance (HR=1.8 [0.9 - 3.9], p=0.11).Conclusion: In an unselected population of patients with iSVT, long-term risk of VTE recurrence is substantial. Involvement of the sapheno-femoral junction is a strong independent predictor of VTE during the subsequent 3 years. Our results suggest the need for more aggressive management and follow-up of patients with iSVT exhibiting this anatomical characteristic. DisclosuresGalanaud:Daichi: Membership on an entity's Board of Directors or advisory committees, Research Funding; bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding. Sevestre:bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Daichi: Membership on an entity's Board of Directors or advisory committees, Research Funding. Pernod:pfizer: Consultancy; leo: Consultancy; bristol meyers: Consultancy; Daichi: Consultancy; bayer: Consultancy. Brisot:bayer: Membership on an entity's Board of Directors or advisory committees; daichi: Membership on an entity's Board of Directors or advisory committees. Quéré:3-M: Research Funding; thuasne: Research Funding; aspen: Research Funding; daichi: Membership on an entity's Board of Directors or advisory committees; bayer: Membership on an entity's Board of Directors or advisory committees; leo: Membership on an entity's Board of Directors or advisory committees.

Associação entre aplasia segmentar de veia safena magna e varizes em membros inferiores avaliada pelo ecocolor Doppler

ResumoContextoHá diferenças individuais no diâmetro da veia safena magna (VSM) em membros normais e doentes; sendo possível a identificação dessas alterações pelo ecocolor Doppler.ObjetivoAvaliar a associação da aplasia segmentar da VSM com a presença de varizes e/ou insuficiência da mesma em membros inferiores, usando o ecocolor Doppler em pacientes com clínica de doença venosa crônica (DVC).Métodos1.408 pacientes com queixas compatíveis de DVC de membros inferiores, sendo 1.286 do sexo feminino, com idade entre 17 e 85 anos, examinados com ecocolor Doppler. Foram incluídos aqueles com classificação CEAP clínica C0 a C4. Pela avaliação clínica, a amostra foi distribuída em grupo A, pacientes com varizes, e grupo B, aqueles sem varizes. O ecocolor Doppler determinou se havia aplasia da VSM pela análise do seu trajeto no compartimento safeno e presença de veias varicosas nos diferentes sítios. Para estatística, foram considerados os testes Qui-quadrado ou Exato de Fisher e uma análise de resíduos em tabelas, com nível de significância de 5%.ResultadosNo grupo A houve 479 (83,9%) de VSM insuficientes, 169 (38,2%) com aplasia e 71 (80,7%) com insuficiência e aplasia associadas. No grupo B, houve 92 (16,1%) de VSM insuficientes, 273 (61,8%) com aplasia e 17 (19,3%) com insuficiência e aplasia associadas.ConclusãoA aplasia segmentar da VSM ocorre mais em membros inferiores que não apresentam varizes e/ou insuficiência da mesma, mas considerando-se a presença da associação de aplasia e insuficiência, houve maior incidência no grupo de membros que apresentavam varizes.

Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Ciostek P, Kowalski M, Woźniak W, Miłek T, Myrcha P, Migda B. Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review. 2015;23(3):72-77. doi:10.5114/pr.2015.57466. APA Ciostek, P., Kowalski, M., Woźniak, W., Miłek, T., Myrcha, P., & Migda, B. (2015). Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review, 23(3), 72-77. https://doi.org/10.5114/pr.2015.57466 Chicago Ciostek, Piotr, Marcin Kowalski, Witold Woźniak, Tomasz Miłek, Piotr Myrcha, and Bartosz Migda. 2015. "Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study". Phlebological Review 23 (3): 72-77. doi:10.5114/pr.2015.57466. Harvard Ciostek, P., Kowalski, M., Woźniak, W., Miłek, T., Myrcha, P., and Migda, B. (2015). Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review, 23(3), pp.72-77. https://doi.org/10.5114/pr.2015.57466 MLA Ciostek, Piotr et al. "Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study." Phlebological Review, vol. 23, no. 3, 2015, pp. 72-77. doi:10.5114/pr.2015.57466. Vancouver Ciostek P, Kowalski M, Woźniak W, Miłek T, Myrcha P, Migda B. Phlebogriffe – a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review. 2015;23(3):72-77. doi:10.5114/pr.2015.57466.

Risk stratification and prevention of venous thromboembolic disease in cancerology

Patients with cancer are at high risk of venous thromboembolism (VTE), which leads to significantly increased morbidity and mortality. The rates of VTE vary between 0.5% and 20% per year and depend mainly on cancer-specific and treatment-related risk factors. Also individual risk factors related to patientś characteristics contribute to occurrence of cancer-associated VTE. Risk factors and biomarkers may help identify patients at high risk of developing VTE. In several clinical studies, risk factors for the occurrence of VTE events in patients with cancer have been investigated. The type and stage of cancer have been found to be amongst the most important risk factor for VTE occurrence. Also the histological grade of a tumor has been reported to be associated with the occurrence of VTE. In other investigations, venous diseases including a history of previous VTE, a history of superficial thrombophlebitis and the presence of varicose veins, have been associated with the risk of VTE. Some studies have recently focused on the identification of biomarkers or laboratory parameters predictive of future VTE occurrence. Parameters of blood count analysis (such as elevated leukocyte and platelet count and decreased hemoglobin) have turned out to be useful in risk stratification for VTE. In a prospective and observational cohort study, the Vienna Cancer and Thrombosis Study (CATS), associations between elevated levels and risk of future VTE have been found for D-dimer, prothrombin fragment 1 + 2, and soluble P-selectin and also for clotting factor VIII and the thrombin generation potential. The role of circulating microparticles for predicting risk of VTE in patients with cancer is unclear and has to be further investigated. Risk assessment models for prediction of VTE were developed including clinical and laboratory markers. First, Khorana and colleagues published a risk assessment score that incorporates readily available parameters: primary site of cancer, pre-chemotherapy platelet count of 350 × 109/L or more, haemoglobin level less than 10 g/dL and/or use of erythropoiesis stimulating agents, pre-chemotherapy leukocyte count of more than 11 × 109/L, and a body mass index of 35 kg/m2 or more. This score was validated in other studies. In CATS the score was expanded by adding two biomarkers (D-dimer and soluble P-selectin), and the prediction of VTE was considerably improved. In the high risk categories, patients with a VTE rate up to a 20% or higher within 6 months can be identified. In recent randomized controlled trials including cancer patients with different malignancies – without applying specific VTE risk assessment – it was shown that thromboprophylaxis is safe and effective. However, the overall VTE rates were low in these studies. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorized into high-risk groups on the basis of risk assessment scores. In conclusion, risk stratification for VTE is feasible in cancer patients. Further improvement in risk stratification would help better identify patients for VTE prevention using anticoagulant agents. However, interventional studies are needed to investigate the safety and efficacy of thromboprophylaxis in a high-risk cancer population.

Cryo-laser and cryo-sclerotherapy guided by Augmented Reality

SummaryBackground: This study is about CLaCS, a new technique to treat telangiectasias and feeder veins.Method: A series of 140 cases were treated under Augmented Reality guidance in a completely different way. Sclerosis was achieved by combination of thermal and chemical agents: laser and dextrose. Patients were classified according to two questions: presence of varicose veins and/or reflux on the saphenous vein; presence of telangiectasias and/or feeder veins (Score 9–1). Duplex ultra-sound and Augmented Reality (VeinViewer) were used to detect reflux and feeder veins, respectively. Feeder veins and telangiectasias were treated the same way, in the same procedure, by a combination of Nd:YAG 1064 nm with spot sizes of 6mm, 15 msec pulse and fluence of up to 80 J/cm2 followed by injection sclerotherapy of Dextrose 75%. Both techniques were done under forced air skin cooling (Cryo5). A thorough photodocumentation was done prior and after each procedure and results were obtained by comparing before and after photos on two iPads. Response to the treatment was rated on: total or partial improvement with patient satisfaction (Group 1); partial improvement or lack of resolution, without patient satisfaction (Group 2).Results: A total of 466 patients visited the clinic during the study and exclusion criteria left a total of 140 patients for analysis. Mean age of patients was 37 years (16 to 72), with prevalence of women (98 %). No allergic reactions, systemic reactions, skin burns, post-sclerotherapy mattings, infections or crustings were observed. Temporary ecchymosis were observed in 30 % of the cases, and intravenous coagula in 14 % of them. No frostbite was registered due to cold air blowing. Partial or total lesion improvement was obtained in 121 patients (86 %), with satisfactory cosmetic results. Unsatisfactory outcome was observed in 19 patients (14 %) due to no response or lesion worsening, thus crochet hook phlebectomy was indicated.Conclusion: CLaCS guided by Augmented Reality is a very effective option to treat telangiectasias, reticular and feeder veins. It is a safe method based on the employment of technology and an organic sclerosing agent. It dispenses the use of any other medication, thus being free of risk of anaphylaxis or embolism.

Risk factors for venous thromboembolism in cancer: novel findings from the Vienna Cancer and Thrombosis Study (CATS)

Venous thromboembolism (VTE) occurs frequently in patients with cancer and contributes to elevated morbidity and mortality. Risk factors for the occurrence of VTE events in patients with cancer have been investigated in numerous clinical studies. For now more than 10 years, the Vienna Cancer and Thrombosis Study (CATS) has focused on the identification of parameters predictive of future VTE occurrence. CATS has contributed to new findings, which may help identify patients at high risk of developing VTE, by means of biomarkers (such as D-dimer, prothrombin fragment 1+2, soluble P-selectin, platelet count, coagulation factor VIII activity, thrombin generation potential, etc.). The association of tissue factor bearing microparticles and the mean platelet volume with the risk of VTE was also elaborately investigated in the framework of CATS. More recently CATS has researched clinical and clinicopathologic parameters which contribute to identification of patients at risk of VTE. The type of cancer is one of the most important risk factor for VTE occurrence. Also the stage of cancer and the histological grade of a tumor have been found to be associated with the occurrence of cancer-related VTE. In further investigations, venous diseases including a history of previous VTE, a history of superficial thrombophlebitis and the presence of varicose veins, have been associated with the risk of VTE in CATS.

Apolipoprotein E polymorphism is associated with lower extremity deep venous thrombosis: color-flow Doppler ultrasound evaluation

IntroductionApolipoprotein E (apoE) is a member of apolipoprotein family, and its gene polymorphisms seem to have some impact among patients with cardiovascular disease. However, its role in the lower extremity deep venous thrombosis (LEDVT) has not been well studied. The objective of this study was to investigate the potential association between APOE gene polymorphisms and LEDVT.Materials and methodsA hospital-based case–control study was conducted in 300 patients with LEDVT by color-flow Doppler ultrasound and 300 age- and gender-matched healthy controls. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) assay was applied to assess the APOE gene polymorphisms.ResultsPatients with LEDVT had a significantly higher frequency of APOE E3/E4 genotype [odds ratio (OR) =1.48, 95% confidence interval (CI) = 1.05, 2.10; P = 0.03] than healthy controls. When stratifying by family history of LEDVT, it was found that patients with positive family history of LEDVT had a significantly higher frequency of APOE E3/E4 genotype (OR =1.68, 95% CI = 1.04, 0.95; P = 2.70). When stratifying by smoking status, presence of varicose veins, type 2 diabetes mellitus and any hormone administration before, no significant differences were found in any groups.ConclusionOur study suggested that APOE E3/E4 genotype was associated with a higher LEDVT risk. Additional studies are needed to confirm this finding.

Association between interleukin-10 -1082A/G, -819C/T and -592C/A polymorphisms with deep venous thrombosis

BackgroundDeep venous thrombosis (DVT) and inflammation are two closely related entities. The objective of this study was to evaluate a possible association between interleukin-10 (IL-10) -1082A/G, -819C/T and -592C/A polymorphisms with DVT. MethodsA case-control study was carried out in 660 patients with DVT and 660 age- and gender-matched healthy controls. Polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP) assay was applied to identify the polymorphisms mentioned. ResultsPatients with DVT had a significantly lower frequency of IL-10 -1082GG genotype [odds ratio (OR)=0.59, 95% confidence interval (CI)=0.39, 0.89; P=0.01] than healthy controls. When stratifying by family history of DVT, it was found that patients with positive family history of DVT had a significantly lower frequency of IL-10 -1082GG genotype (OR=0.13, 95% CI=0.02, 0.95; P=0.04). When stratifying by smoking status, presence of varicose veins, type 2 diabetes mellitus and any hormone administration before, no significant differences were found in any groups. ConclusionsThis study provides evidence that IL-10 -1082A/G polymorphism associated with risk of DVT. However, no association of the IL-10 -592C/A or -819C/T polymorphism with DVT risk was found. Additional well-designed large studies were required for the validation of our results.

Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism

Cancer patients are at increased risk of venous thromboembolism (VTE). We investigated the association of a history of VTE, superficial thrombophlebitis, or the presence of varicose veins with the occurrence of VTE during the course of cancer. Cancer patients were recruited in a prospective cohort study, the Vienna Cancer and Thrombosis Study. Patients who had VTE within 3months before study inclusion were excluded. At study inclusion, history of VTE, history of superficial thrombophlebitis, and presence of varicose veins were recorded. Primary end point was the occurrence of symptomatic VTE. Hazard ratios were obtained using the competing risk analysis according to Fine and Gray. The cohort consisted of 1270 patients followed over a median of 590days. A history of VTE was found in 66 patients (5.2%), superficial thrombophlebitis in 79 patients (6.2%), and varicose veins in 160 patients (12.6%). Ninety-eight patients (7.7%) developed VTE during follow-up. The hazard ratios for the risk of VTE in patients with a history of VTE or superficial thrombophlebitis were 1.44 (95% confidence interval: 0.67-3.07) and 1.94 (1.04-3.61), respectively, and 2.01 (1.26-3.21) in those with varicose veins. In multivariable analysis including history of VTE, history of superficial thrombophlebitis, presence of varicose veins, and other patient-related factors, the presence of varicose veins (2.10 [1.29-3.41]) remained significantly associated with an increased risk of VTE. The presence of varicose veins is associated with an elevated risk of VTE in cancer patients. This clinical parameter could be useful for individual risk assessment of VTE in these patients.