Vein Recanalization Research Articles

Left-sided portal hypertension: what an interventional radiologist can offer?

Left-sided portal hypertension (LPH) refers to increased splenic venous pressure caused by splenic vein stenosis or occlusion. Pancreatitis is the leading cause of LPH. Typically, LPH remains asymptomatic, but it can lead to life-threatening hemorrhage from ruptured fundal varices in about 10% of patients. Further, it may be complicated by hypersplenism. Interventional radiology plays an essential role in LPH patients with failed endoscopic treatment. Variceal embolization is an effective salvage measure in bleeding gastric varices, but it carries a risk of recurrence and worsening of hypersplenism. Considering the pathophysiology, splenic vein recanalization (SVR) appears to be the best treatment; nevertheless, its lower technical success rate limits its utility only to a subgroup of LPH patients. Partial splenic embolization (PSE), a non-surgical alternative to splenectomy, reduces the splenic volume and venous outflow, thereby lowering variceal pressure. PSE is technically easier, which may explain its widespread use. Nonetheless, PSE can be complicated by life-threatening sepsis and portal vein thrombosis. Despite all attempts, some LPH patients eventually require a splenectomy. Importantly, the choice of therapy requires multidisciplinary discussion and is often influenced by availability, expertise, and clinical context. This article discusses various interventional strategies for managing LPH with the available evidence. KEY POINTS: Question Pressure within the main portal vein is normal in left-sided portal hypertension; thus, transjugular intrahepatic portosystemic shunt is ineffective. Findings Splenic vein stent placement can restore hepatopetal splenic blood flow and decompress splenic venous pressure. Clinical relevance Partial splenic embolization (PSE) is the most widely used interventional approach to manage left-sided portal hypertension-related complications.

Long-term Outcomes of Stenting Superior Cava and Brachio-cephalic Vein Occlusion in Hemodialysis Patients with Arteriovenous Fistulas

Central vein occlusion (CVO) is a significant complication in patients undergoing chronic hemodialysis, often leading to dialysis inefficacy, disabling symptoms, and, most critically, major risk of access failure. While stenting has been proposed as a technique to maintain vascular access patency following the recanalization of occluded central veins, the data supporting its long-term efficacy remains limited. This study aims to evaluate the long-term effectiveness of stenting occluded superior vena cava (SVC) and/or brachiocephalic veins (BCV) to preserve vascular access patency, ensure continued dialysis efficacy and relieve SVC syndrome. This study retrospectively reviewed all hemodialysis patients who underwent stent placement for central venous occlusion between January 2017 and August 2024 at two vascular centers in Reunion Island. The primary endpoints of the study were the primary, assisted primary, and secondary patency rates of the vascular circuit during follow-up. Additionally, patient demographics, medical comorbidities, post-operative complications, definitive access abandonment and re-interventions were analyzed. This study included 21 patients with a mean age of 67 years. CVO stenting initially provided symptomatic relief for all patients, resolving symptoms such as superior vena cava or arm swelling in symptomatic patients. Over a median follow-up period of 41 months (range: 3-80 months), the primary patency rates were 67% at 12 months, 42% at 24 months and 38% at 36 months, while the secondary patency rates were 90%, 79%, and 60% at these same intervals. Twelve patients (62%) experienced clinically significant stent restenosis, necessitating one or several additional percutaneous transluminal angioplasty (PTA) during follow-up, while five patients (24%) developed acute access thrombosis requiring thrombectomy and PTA, with central stent involved for 3 patients. Three patients (14%) required extra-anatomic bypasses due to definitive stent occlusion, five patients (14%) had definitive access failure and five patients (24%) died from unrelated causes. This review suggests that hemodialysis patients with symptomatic central vein occlusion can often be successfully recanalized and treated with stenting, leading to symptom resolution and, importantly, achieving promising secondary patency rates. Our long-term results highlight the necessity for regular reintervention and close follow-up, as a significant number of patients will experience restenosis, and ultimately definitive access failure. Therefore, CVO stenting should be considered a temporary solution, although for some patients, this strategy may prove highly effective, maintaining long-term patency without any restenosis.

Hemodynamic surgery of varicose veins of the lower extremities with the introduction of modern technologies

Minimaly invasive and pathogenetically based methods are currently prevalent in phlebology, as they are in other fields of surgery. CHIVA (Сure conservatrice et hemodynamiу que de l’insuffisance veineuse en ambulatoire) hemodynamic surgery is one of these popular minimally invasive surgical procedures. The execution technique relies on the findings of a duplex ultrasound scan that is used to analyse the hemodynamics of the superficial venous network. The CHIVA strategy aims to preserve the venous material while also restoring normal distal venous pressure and venous function. However, this technique has a number of disadvantages, including the possibility of vein recanalisation and relapses, as well as the fact that the immediate cosmetic outcome is not always satisfactory. Objective — to compare the outcomes of lower extremity varicose vein treatment based on the employed method: the CHIVA method executed via open surgery versus the CHIVA method combined with other minimally invasive methods (sclerotherapy, endovenous laser coagulation (EVLC)). Materials and methods. A randomised prospective study was conducted on 52 patients with varicose veins of the lower extremities categorised as C1‑C3 according to the CEAR classification. The patients were divided into 2 groups of 26 patients each, with one group undergoing the CHIVA procedure using the classic open technique, and the other group receiving a combination of CHIVA with EVLC and sclerotherapy. To evaluate the results, we used Hobb’s criteria, measured the diameter of the great saphenous vein via ultrasound, analysed alterations in the Venous Clinical Severity Scoring (VCSS) , studied data from the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ 20), and determined the incidence of relapses. Results. After CHIVA and CHIVA + EVLC + sclerotherapy, the normalisation of hemodynamics and interruption of the venous shunt led to a substantial reduction in the diameter of the great saphenous vein within 6 months after the operation (p<0.01). Both groups had an improvement in VCSS 6 months after surgery. No statistical difference was observed between the treatment groups. All methods had a positive impact on the quality of life of patients, as shown by the CIVIQ 20 questionnaire. Of the 52 operated patients, there were 4 relapses (7.7%). No relapses were noted in the group receiving CHIVA with EVLC and sclerotherapy (p=0.039). As evaluated by Hobb’s criteria, patients exhibited greater satisfaction with the outcomes of hemodynamic surgery combined with EVLC and sclerotherapy due to its better and faster aesthetic outcomes (р=0.012 and 0.05). Conclusions. All 52 patients exhibited favourable treatment outcomes, demonstrating a reduction in CVI symptoms during a comprehensive clinical assessment using ultrasound within 6 months and 1 year. The combination of CHIVA with EVLC and sclerotherapy showed distinct advantages in the treatment of varicose veins, yielding the most favourable cosmetic outcomes according to Hobb’s criteria and achieving a reccurence rate of 0%.

Anchoring guide catheter to facilitate recanalising occluded pulmonary vein in small children: a novel technique.

Transcatheter pulmonary vein recanalisation is challenging. Herein, we described a novel technique facilitating the recanalisation of occluded three pulmonary veins in two small children. This technique enhances the catheter's alignment and stability during the recanalisation process. Referred to as the "anchoring guide catheter" technique, it can be applied only when the ipsilateral vein is patent.

What is the place of portal vein recanalisation in the management of non-cirrhotic portal hypertension?

What is the place of portal vein recanalisation in the management of non-cirrhotic portal hypertension?

Transjugular mesenteric-caval shunt for portal vein cavernous transformation with recurrent variceal bleeding: preliminary results.

This study aimed to evaluate the feasibility, safety, and efficacy of the transjugular mesenteric-caval shunt (TMCS) as a treatment for the cavernous transformation of the portal vein (CTPV) and recurrent variceal bleeding. This retrospective case series was conducted with approval from the institutional review board. It involved seven patients diagnosed with CTPV and recurrent variceal bleeding who underwent the TMCS procedure. We analyzed the rate of procedural complications, incidents of rebleeding, stent stenosis, hepatic encephalopathy, and overall survival to assess treatment outcomes. The TMCS was successfully performed in all seven patients without any life-threatening complications. Postoperatively, one patient developed a lung infection and pleural effusion, which resolved with appropriate treatment. Additionally, two patients experienced an increase in total bilirubin levels, but there was no further deterioration in liver function. The median portal pressure gradient significantly decreased from a preoperative value of 27 mmHg (range 20-36 mmHg) to a postoperative value of 6 mmHg (range 4-11 mmHg). A notable improvement was observed in one cirrhotic patient, with liver function progressing from Child-Pugh class B (score 9) to class A (score 6). Over a median follow-up period of 14 months (range 7-18 months), none of the patients encountered rebleeding, stent stenosis, hepatic encephalopathy, or mortality. The TMCS appears to be a viable and effective alternative for managing CTPV with recurrent variceal bleeding. Its long-term outcome requires further evaluation. TMCS provides a promising treatment for patients with life-threatening CTPV complications when occluded portal vein cannot be recanalized and portal vein recanalization TIPS is not an option. Performing TIPS in patients with portal vein cavernoma is complex due to the requirement for recanalization of the occluded portal vein. Creating a mesenteric-caval shunt through a transjugular approach is a feasible technique. Establishing a TMCS provides a means to manage life-threatening complications arising from portal vein cavernoma.

Interventional Management of Variceal Bleeding: Techniques and Emerging Concepts

AbstractDespite technical advancements and disease understanding, variceal bleeding remains the leading cause of mortality in patients with cirrhosis. Endoscopic therapies are the main cornerstone of therapy in variceal bleeding. Interventional radiology (IR) plays a significant role in managing variceal bleeding, especially in cases where endoscopic therapies are not feasible or failed. Cross-sectional imaging is often critical to identify relevant anatomy before IR therapies. Transjugular intrahepatic portosystemic shunt (TIPS) is indicated as salvage therapy in patients with refractory variceal bleeding. Retrograde transvenous variceal embolization (RTO) procedures provide superior bleeding control in patients with gastric and ectopic varices, however, without increasing the risk of hepatic encephalopathy and liver function deterioration. Antegrade transvenous obliteration is a viable alternative when RTO is not feasible. Left-sided portal hypertension is a distinct entity resulting from splenic vein stenosis or occlusion, and variceal bleeding in left-sided portal hypertension does not respond to TIPS, requiring variceal embolization, partial splenic embolization, or splenic vein recanalization. Occasionally, endovascular splenorenal or mesorenal shunt and splenic vein occlusion with distal splenorenal diversion are performed to control variceal bleeding. This article entails the basic concepts and procedural aspects of various interventional radiological procedures performed in patients with variceal bleeding.

Feasibility and long-term outcomes of hepatic vein recanalization in Budd-Chiari syndrome through intrahepatic collateral pathways.

To investigate the feasibility and long-term outcomes of hepatic vein (HV) recanalization using intrahepatic collateral pathways in patients with Budd-Chiari syndrome (BCS) with HV obstruction. Clinical data of 29 BCS patients with HV obstruction and intrahepatic collateral pathways were reviewed. All patients underwent HV recanalization through the intrahepatic collaterals. Follow-up was performed at 1, 3, 6, and 12 months after treatment and annually thereafter. Cumulative patency and survival rates were assessed using Kaplan-Meier curves. The independent predictors of patency were determined using a Cox regression model. HV recanalization was successful in 28 of the 29 patients (96.6%), with no complications. Of the 28 cases, simultaneous recanalization of the accessory HV and right HV was achieved in 11 patients, accessory HV and middle HV in six, accessory HV and left HV in three, right HV and middle HV in five, and left HV and middle HV in three. Twenty-eight patients were followed from 4 to 87 (mean, 53.6 ± 26.7) months after treatment, and six patients developed reocclusion. The overall cumulative 1-, 3-, 5-, and 7-year primary HV patency rates were 96.3, 82.9, 74.6, and 59.7%, respectively. The cumulative 1-, 3-, 5-, and 7-year survival rates were 100, 95.8, 95.8, and 86.3%, respectively. Interventional treatment of HV obstruction in BCS patients through intrahepatic collateral approaches is well tolerated and feasible and can result in excellent long-term patency and survival rates.

HOXD9 regulated mitophagy to promote endothelial progenitor cells angiogenesis and deep vein thrombosis recanalization and resolution

BackgroundDeep vein thrombosis (DVT) is a common vascular surgical disease caused by the coagulation of blood in the deep veins, and predominantly occur in the lower limbs. Endothelial progenitor cells (EPCs) are multi-functional stem cells, which are precursors of vascular endothelial cells. EPCs have gradually evolved into a promising treatment strategy for promoting deep vein thrombus dissolution and recanalization through the stimulation of various physical and chemical factors.MethodsIn this study, we utilized a mouse DVT model and performed several experiments including qRT-PCR, Western blot, tube formation, wound healing, Transwell assay, immunofluorescence, flow cytometry analysis, and immunoprecipitation to investigate the role of HOXD9 in the function of EPCs cells. The therapeutic effect of EPCs overexpressing HOXD9 on the DVT model and its mechanism were also explored.ResultsOverexpression of HOXD9 significantly enhanced the angiogenesis and migration abilities of EPCs, while inhibiting cell apoptosis. Additionally, results indicated that HOXD9 specifically targeted the HRD1 promoter region and regulated the downstream PINK1-mediated mitophagy. Interestingly, intravenous injection of EPCs overexpressing HOXD9 into mice promoted thrombus dissolution and recanalization, significantly decreasing venous thrombosis.ConclusionsThe findings of this study reveal that HOXD9 plays a pivotal role in stimulating vascular formation in endothelial progenitor cells, indicating its potential as a therapeutic target for DVT management.Graphical

Pelvic vein thrombosis in patients with pelvic venous disorders.

To assess the incidence of pelvic vein thrombosis (PVT) and outcomes of anticoagulant therapy for PVT in patients with pelvic venous disorders (PeVDs). This prospective cohort study included 588 female patients with PeVDs underwent clinical examination followed by duplex ultrasound of the pelvic veins in 2021-2023. Patients with PVT were administered with anticoagulant therapy in an outpatient setting using low molecular weight heparins at a therapeutic dose. PVT was detected in 7.6% of patients with PeVDs and was symptomatic in 28.8% of them. The majority of asymptomatic patients had thrombosis in only one of the parametrial veins (90.6%). Anticoagulant therapy resulted in the PVT symptoms relief in all patients within 10 days and recanalization of the pelvic veins in 1-3 months. In our study, PVT was diagnosed in 7.6% of patients with PeVDs. Anticoagulant therapy is effective and safe in resolving PVT symptoms.

Recanalization of right brachiocephalic vein for treatment of gastroesophageal reflux disease caused by superior vena cava syndrome

Recanalization of right brachiocephalic vein for treatment of gastroesophageal reflux disease caused by superior vena cava syndrome

Systemic Thrombolysis of Acute Portal Venous System Thrombosis in Patients with Liver Cirrhosis: A Pilot Study

Background The prevalence of Portal Vein Thrombosis (PVT) is highly variable at different stages of liver disease: in compensated patients 10%, in decompensated patients 17%, in acute decompensated cirrhosis 9%, and in post-liver transplantation patients 2-26%. Aim The aim of the study was to assess the efficacy and safety of systemic thrombolysis in acute portal vein thrombosis in patients with liver cirrhosis. Methods A total of 10 compensated cirrhotic patients with acute portal vein thrombosis were examined by abdominal ultrasonography with color Doppler and Contrast-enhanced computerized tomography. Continuous intravenous infusion of recombinant tissue plasminogen activator(r-tPA.) and Low molecular weight heparin (LMWH) was used to treat all patients for a maximum of 7 days. Patients were followed up for improvement of clinical symptoms and radiological by abdominal ultrasound with color Doppler and contrast-enhanced computerized tomography. Results The regimen of therapy was found to be well-tolerated by all the patients. At the end of the seven days, six patients (60%) had full recanalization of the portal vein, while three had partial recanalization (30%) and no recanalization in only one patient (10%). Conclusion The preliminary data indicate that systemic thrombolytic therapy combined with low molecular weight heparin for the treatment of PVT appears to be safe and effective over a few days with no clinically significant side effects.

Laser Atherectomy as a Novel Revascularization tool in Chronic Venous Occlusion

We describe a 66-year-old male who was complaining of worsening left leg sweeling and pain due to chronic bilateral common femoral venous occlusion due to prior abdominal surgery fifteen years ago. He was treated by endovascular intervention where novel endovascular recanalization of the ilio-femoral veins using balloon venoplasty with adjunctive use of Laser atherectomy safely and effectively was demonstrated.

Factors associated with lack of clinical improvement after vein ablation in the vascular quality initiative

BackgroundInsurance companies have adopted variable and inconsistent approval criteria for chronic venous disease (CVD) treatment. Although vein ablation (VA) is accepted as the standard of care for venous ulcers, the treatment criteria for patients with milder forms of CVD remain controversial. This study aims to identify factors associated with a lack of clinical improvement (LCI) in patients with less severe CVD without ulceration undergoing VA to improve patient selection for treatment. MethodsWe performed a retrospective analysis of patients undergoing VA for CEAP C2 to C4 disease in the Vascular Quality Initiative varicose veins database from 2014 to 2023. Patients who required intervention in multiple veins, had undergone prior interventions, or presented with CEAP C5 to C6 disease were excluded. The difference (Δ) in venous clinical severity score (VCSS; VCSS before minus after the procedure) was used to categorize the patients. Patients with a ΔVCSS of ≤0 were defined as having LCI after VA, and patients with ≥1 point decrease in the VCSS after VA (ΔVCSS ≥1) as having some benefit from the procedure and, therefore, “clinical improvement.” The characteristics of both groups were compared, and multivariable regression analysis was performed to identify factors independently associated with LCI. A second analysis was performed based on the VVSymQ instrument, which measures patient-reported outcomes using five specific symptoms (ie, heaviness, achiness, swelling, throbbing pain, and itching). Patients with LCI showed no improvement in any of the five symptoms, and those with clinical improvement had a decrease in severity of at least one symptom. ResultsA total of 3544 patients underwent initial treatment of CVD with a single VA. Of the 3544 patients, 2607 had VCSSs available before and after VA, and 420 (16.1%) had LCI based on the ΔVCSS. Patients with LCI were more likely to be significantly older and African American and have CEAP C2 disease compared with patients with clinical improvement. Patients with clinical improvement were more likely to have reported using compression stockings before treatment. The vein diameters were not different between the two groups. The incidence of complications was overall low, with minor differences between the two groups. However, the patients with LCI were significantly more likely to have symptoms after intervention than those with improvement. Patients with LCI were more likely to have technical failure, defined as vein recanalization. On multivariable regression, age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02) and obesity (OR, 1.47; 95% CI, 1.09-2.00) were independently associated with LCI, as was treatment of less severe disease (CEAP C2; OR, 1.82; 95% CI, 1.30-2.56) compared with more advanced disease (C4). The lack of compression therapy before intervention was also associated with LCI (OR, 6.05; 95% CI, 4.30-8.56). The analysis based on the VVSymQ showed similar results. ConclusionsLCI after VA is associated with treating patients with a lower CEAP class (C2 vs C4) and a lack of compression therapy before intervention. Importantly, no significant association between vein size and clinical improvement was observed.

The choice of surgical correction method depending on the etiology of decompensated chronic venous insufficiency

Aim. To evaluate the immediate and distant results of treatment depending on the etiology of chronic venous insufficiency in the stage of decompensation. Materials and methods. This work presents an analysis of the results of treatment of 342 patients of CEAP 6 with manifestations of chronic vein insufficiency on the background of varicose disease (VD) and post-thrombotic syndrome (PTS) in the surgical clinic of the Transcarpathian Regional Clinical Hospital named after A. Novak (Uzhhorod) for the last 10 years. At least 169 patients had VD (CEAP 6). Post-thrombotic syndrome (occlusive form) was observed in 173 patients (CEAP 6). The ratio of women to men in VD was 3:1, and in PTS was 3:2. Results. In patients of group I (crossectomy + short stripping + distal scleroobliteration), postoperative complications developed in only 2 (4.3 %) patients in the form of suppuration of the operative wound on the thigh and lymphorrhea. With extended venectomy + SEPS, early postoperative complications were observed in 5 (6 %) patients: three patients had suppuration of the postoperative wound on the thigh, and two patients had lymphorrhea. In classical venectomy + Linton’s operation, inguinal wound suppuration occurred in 2 (5.3 %), lymphorrhea in 3 (7.9 %) patients. Suppuration of the postoperative wound on the lower leg was observed in another 3 (7.9 %) patients. The long-term outcomes in the patients of the group I were: 9 (19.1 %) patients had partial recanalization of the perforated veins of the group of great saphenous vein (GSV) on the lower leg, and one (2.1 %) had complete recanalization. Trophic ulcer (TU) did not heal in one patient after conservative treatment, relapse of TU occurred in 7 (4.1 %) patients. In patients of the group II thrombosis of the cross autovenous shunt (during Palma’s operation) in the early postoperative period was observed in 5 (8.5 %) patients, during autovenous shunting and Husni’s operation (transposition of the GSV into the popliteal vein) in no case. During Linton’s operation, suppuration of the postoperative wound was observed in 7 (15.9 %) cases. TU did not heal with conservative treatment in 5 (56 %) patients. Conclusions. In the stage of decompensation of VD, pathogenetically justified treatment is crossectomy, venectomy with elimination of horizontal reflux in the zone of trophic ulcer. Trophic ulcers <5 cm and >2 cm deep I–II degrees are treated conservatively after surgery and heal independently within a year. Phlebectomy and CE of the affected limb are contraindicated in PTS. Pathogenetically justified method of treatment is reconstructive and restorative surgery to restore main blood flow with elimination of horizontal reflux in the zone of trophic ulcer.

Plantar vein thrombosis: 17-year longitudinal study of consecutive patients from a Swiss academic center

BackgroundPlantar vein thrombosis (PVT) is a rare condition. Less than 50 cases have been described in the literature. Evidence from interventional and observational studies is sparse or lacking. ObjectivesTo describe a consecutive cohort of patients diagnosed with PVT at a single academic institution over the past 17 years. MethodsWe searched medical charts from patients managed at the University Hospital Zurich between 2005 and 2022. PVT was detected through sonography (eg, in the presence of a noncompressible deep vein) and/or magnetic resonance (eg, a vein with a filling defect on non–contrast-enhanced or contrast-enhanced imaging). The study was approved by the local ethics commission. ResultsWe identified 45 patients who had been assessed for PVT. After manual check of these cases, we selected 16 patients with a confirmed, objective diagnosis. Median age was 62 (25th-75th percentiles, 46-73) years, and 9 (56%) patients were women. All patients were symptomatic, usually reporting local pain in the foot (100%) and swelling (67%). The most frequent risk factors were cancer (n = 6; 38%) and prior deep vein thrombosis (n = 4; 25%). Overall, 80% of patients received oral anticoagulation and 20% received parenteral anticoagulation for a median of 90 days. Over a median follow-up of 17 months, 2 (12.5%) recurrent venous thromboembolism events were recorded following the discontinuation of anticoagulation. Index vein recanalization occurred in all 15 survivors. One patient died from cancer 2 years after PVT diagnosis. ConclusionWe provided initial information on the clinical characteristics, treatment, and course of PVT, which partly resembles that of distal deep vein thrombosis.

Risk factors for recanalization of truncal veins following endoluminal ablation

BackgroundRecanalization of target veins after treatment of superficial venous incompetence has clinical implications and may depend on the type of intervention. The aim of this study was to evaluate patient and procedural factors associated with truncal vein recanalization in a large study cohort using the Vascular Quality Initiative (VQI) Varicose Vein Registry. MethodsWe performed a retrospective review using the VQI Varicose Vein Registry from 2014 to 2018. We evaluated all procedures performed for truncal venous insufficiency. Demographic data and information about treatment modality were collected. Patients were separated into recanalization and nonrecanalization groups based on the status of the treated vein at follow-up ultrasound examination. The vein was only considered recanalized if the VQI noted complete recanalization of the target vein. Univariate and multivariate comparisons were performed as appropriate. ResultsA total of 10,604 procedures were performed in 7403 patients. The average age was 55.9 years and 70.3% of the patients were female. Patients with recanalization were more likely to have a history of phlebitis (P < .001) and had a higher mean body mass index (30.5 vs 32., kg/m2 ; P = .006) compared with those without recanalization. There was no difference in the use of compression therapy, anticoagulation, deep venous reflux, number of pregnancies, prior deep vein thrombosis, Venous Clinical Severity Score, and clinical-etiology-anatomy-pathophysiology between patients with and without recanalization. The number of truncal veins treated per procedure was higher in the recanalization group compared with the nonrecanalization group (2.36 vs 1.88; P = .001). After multivariate logistic regression, laser ablation was associated with higher rate of recanalization compared with radiofrequency ablation (P = .017). ConclusionsThis study is the first to use VQI based data to describe risk factors for recanalization following treatment of truncal venous reflux. The use of laser ablation for truncal veins is associated with a higher risk for recanalization compared with radiofrequency ablation. Obesity, prior phlebitis, and number of veins treated were independently associated with increased rate of recanalization.

Results of mechano-chemical obliteration of the trunk of the great saphenous vein in varicose vein disease

Aim: To evaluate the effectiveness of mechano-chemical obliteration in the treatment of varicose enlargement of the great saphenous vein.Material and Methods: The results of mechano-chemical obliteration of 57 patients (49 (85.9%) women, 8 (14.1%) men; average age 27.2±4.1 years) with varicose disease were analyzed. In 39 patients (36 women and 3 men), the second, and in 18 (13 women and 5 men) – the third class of varicose transformation of subcutaneous veins was observed. The average body mass index of patients was 28.2±2.4 kg/m2, and the average duration of varicose disease was 7.6±1.8 years.Results and Discussion: The average diameter of the great saphenous vein was 10.4±2.1 mm. Insufficiency of perforating veins with an average diameter of 3.2±0.8 mm was detected in 31 (54.4%) cases. The technical success of the procedure was 100%. No intraoperative complications occurred in any patient. The average duration of mechanochemical obliteration was 24.2±4.8 minutes, and the entire operation – crossectomy, mechano-chemical obliteration, and excision of dilated tributary veins – lasted 98.5±25.5 minutes. The average length of the great saphenous vein subjected to mechano-chemical obliteration was 94.2±6.1 cm. The level of pain on the first day after surgery was 3.8±0.6 points, decreasing to 0.9±0.1 points before discharge. Only on the day after the intervention, patients required narcotic analgesics (average volume of used anesthetics – 1.5±0.5 ml); on other days, patients received non-steroidal anti-inflammatory drugs (average duration 3.5±0.5 days, volume – 10.5±1.5 ml).Conclusion: Mechano-chemical scleroobliteration is one of the effective methods for eliminating pathological vertical reflux, with its effectiveness observed in the vast majority of patients in the long term.Moreover, due to its minimal invasiveness and capability for repeated application, it can be recommended for widespread clinical use. To improve the results of mechano-chemical obliteration and reduce the frequency of recanalization of the great saphenous vein, it is necessary to supplement the procedure with crossectomy and miniphlebectomy.

Preventing variceal rebleeding in cirrhotic patients with portal vein thrombosis: A systematic review and meta-analysis.

Preventing rebleeding is crucial, but the best prevention technique for patients with cirrhosis and portal vein thrombosis (PVT) remains debatable. Therefore, this systematic review and meta-analysis compared a transjugular intrahepatic portosystemic shunt (TIPS) with endoscopic therapy (ET) plus nonselective beta-blockers (NSBBs) for preventing variceal rebleeding in this patient population. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception until May 18, 2023. The studies were screened using predetermined criteria, relevant data were extracted, and pooled analyses were performed using the Reviewer Manager 5.4.1 software. We retrieved 1032 studies, of which 5 studies comprising a total of 272 patients were included. The postoperative variceal rebleeding rate was significantly lower in the TIPS group than in the ET+NSBBs group (odds ratio [OR]=0.19, 95% confidence interval [CI]=0.11-0.35, P<0.05, I2=0%), but the portal vein recanalization rate was higher (OR=7.92, 95% CI=3.04-20.67, P<0.05, I2=0%). The rates of hepatic encephalopathy (HE) and mortality did not differ between the groups. Our results suggest that TIPS prevents variceal rebleeding without increasing the hepatic encephalopathy risk more effectively than ET plus NSBBs, but this benefit did not translate into improved survival. Thus, it may be preferable to ET plus NSBBs for preventing variceal rebleeding in patients with cirrhosis and PVT. However, more large-scale and multicenter randomized controlled trials involving other patient populations are required to verify the clinical efficacy of both these treatments and ensure generalizability.

Endovascular treatment of deep vein thrombosis of the upper extremities

To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies. We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire. In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively. Endovascular treatment improved postoperative outcomes.