Vein Surgery Research Articles

Positive effects of Pycnogenol®-Centellicum® on venous elasticity: an ex-vivo concept study.

The aim of this ex-vivo study was to evaluate the efficacy of Pycnogenol®-Centellicum® oral supplementation on vein segments, retrieved from graft harvesting or from vein surgery. The parameters assessed were elasticity and recovery after dynamic tests: 1) an enlargement stress; 2) an elongation stress; and 3) elasticity after torsion. The tests were made in standardized conditions, less than 3 hours after explant, at 22 °C by the same operator with surgical and microsurgical experience. Veins of 59 subjects were included in the study: 17 subjects with normal veins with a planned bypass graft and 42 subjects with varicose veins. Of the subjects with normal veins, 8 subjects followed standard management (group 1) and 9 took Pycnogenol®-Centellicum® for 4 weeks before surgery (group 2). In the group with varicose veins, 22 subjects served as controls (group 3) and 20 were supplemented with Pycnogenol®-Centellicum® for 4 weeks before surgery (group 4). No side effects or tolerability problems were observed in the supplementation period before surgery and veins harvesting. The full return to initial shape/sizes after dynamic stress was evaluated in 1 min after removing the stress. In group 1, 4 out of 8 vein segments recovered their size after forced enlargement vs. 7/9 in the Pycnogenol®-Centellicum® group 2 (P<0.05). In the elongation test, 3/8 normal control vein segments recovered their length (group 1) vs. 7/9 in the supplement group (group 2) (P<0.05). In the torsion test, 4/8 (group 1) veins recovered their shape after torsion vs. 9/9 veins in Pycnogenol®-Centellicum®-pretreated segments (group 2) (P<0.05). Only 45.8% of normal, control vein segments (group 1) recovered their shape/size in comparison with 85.2% of normal vein segments in the supplement group (group 2) (P<0.05). In group 3 and 4 (segments of varicose veins), the proportion of vein segments with enlargements, elongation and torsion were significantly lower at the end of the test (P<0.05) in the Pycnogenol®-Centellicum® group 4 with 51.7% of the vein segments recovering their shape in the Pycnogenol®-Centellicum® vs. 16.6% of the vein segments recovering their shape in control segments (P<0.05). Results show that Pycnogenol®-Centellicum® supplementation allows vein segments to better return to their original shape/size after a morphological alteration of shape (in different directions). This could be an expression of an improved wall tone and elasticity of the veins. No vein was teared or damaged during the 59 tests indicating that all stresses were well within the normal wall tensile characteristics of the veins. In this study, Pycnogenol®-Centellicum® improved vein elasticity in subjects with normal and varicose veins as vein segments were more elastic (able to recover length and shape) and less passively dilated by high pressure or dynamic stresses. This study indicates that the protective effects of Pycnogenol®-Centellicum® may partially stop passive dilatation of veins to varicose veins over time by improving vein elasticity. Pycnogenol®-Centellicum® managed vein segments return more rapidly back to the initial dimensions, shapes and diameters after a dynamic stress.

Possibilities of Applying Viscoelastics in Vitreoretinal Surgery

Viscoelastic substances (VS) are an integral part of modern ophthalmic surgery. This review briefly highlights the main characteristics, classification of VS, their areas of application, and their effect on platelet aggregation. In the scientific literature, little attention has been paid to the use of VE in surgery of the posterior segment of the eye; therefore, the main goal of this review was a detailed presentation of the possibilities and prospects for the use of VS in various pathologies of the retina and vitreous body. In vitreoretinal surgery (VRS), cohesive VS are more widely used due to the ease of their removal from the vitreal cavity compared to dispersed VS. The main disadvantage of using VS is their effect on ophthalmotonus, which requires careful monitoring of the completeness of the removal of VEs from the eye at the end of the operation. The review deals with the use of VE in macular pathology for the purpose of mechanical and chemical protection of the retina when working with a luxed lens or introducing dyes that have a toxic effect on the retinal tissue. In macular hole surgery, VS can be used to stabilize the ILM flap, as well as to prevent subretinal migration of retinal dye. The possibilities of using VS in VRS in pediatric practice for the purpose of viscodelamination of retrolental strictures during vitrectomy in eyes with traction vitreoretinopathy and preservation of the native lens are described. Special attention is paid to the use of VS in the most complex surgical pathology requiring VRS — proliferative diabetic retinopathy. Their advantages have been demonstrated in terms of reducing the time of intervention, which, in turn, reduces the risk of intraoperative complications. The use of the viscodissection technique makes it possible to increase the safety of surgery during the most traumatic stages of the operation: separation of the posterior hyaloid membrane and, in particular, when working with proliferative fibrovascular membranes. The advent of the VS staining method opened up new prospects for the use of viscodissection and viscodelamination techniques.

Endovenous electric welding as an effective minimally invasive surgery of varicose veins of big diameter

Endovenous electric welding as an effective minimally invasive surgery of varicose veins of big diameter

Our experience with vein and hemorrhoid surgery 14 months after introducing microwave thermoablation

Our experience with vein and hemorrhoid surgery 14 months after introducing microwave thermoablation

Antithrombotic therapy in patients with coronary heart disease and atrial fibrillation after direct myocardial revascularization

Aim. To evaluate the clinical efficacy and safety of direct oral anticoagulants versus warfarin as part of antithrombotic therapy (ATT), namely, to study the frequency of bleeding and thromboembolic complications in patients with atrial fibrillation (AF) after direct myocardial revascularization in combination with radiofrequency isolation of pulmonary veins.Material and Methods. A total of 44 patients (36 men) aged 44–77 years (average age of 63.5 ± 7.8 years) with coronary heart disease, indications for direct myocardial revascularization, and AF were included in the study from 2014 to 2016. The observation period was 24 months.Results. Warfarin was one of the components of ATT in 20 patients (48%). However, the target values of international normalized ratio (INR) within the therapeutic range for over 70% of the time were achieved only in seven patients. Two patients who were taking warfarin without achieving target INR values for 24 months suffered from ischemic stroke. One patient taking warfarin (without regular INR control) had gastrointestinal bleeding requiring hospitalization and conservative therapy; ten patients had minor bleedings (nasal and gingival bleeding). All patients, who suffered from thromboembolic and hemorrhagic complications and had inadequate warfarin intake, were recommended to switch to direct oral anticoagulants (DOAC). Thirteen patients (29%) were administered with DOAC: five patients took rivaroxaban 20 mg/day, four patients took dabigatran 300 mg/day, and four patients took apixaban 10 mg/day. DOAC therapy was administered in combination with one of the antiplatelet drugs (aspirin or clopidogrel). In the case of DOAC administration, only minor bleedings were observed: one patient had hemorrhoidal bleeding and four patients had nasal bleedings, which did not require hospitalization, medical intervention, or suspension of anticoagulant therapy. There were no other adverse events in patients taking DOAC.Conclusions. Patients administered with DOAC as a part of antithrombotic therapy after coronary bypass surgery and surgical epicardial radiofrequency isolation of the pulmonary veins had lower incidence rates of thromboembolic and hemorrhagic complications compared with the rates in patients taking warfarin. However, no statistically significant differences were found between the groups due to the small sample size.

Возможности и перспективы гемодинамической хирургии варикозной болезни в эпоху эндовазальной термической облитерации

Долгое время единственным эффективным способом хирургического лечения варикозной болезни нижних конечностей считалось полное удаление ствола подкожной вены. Со временем помимо модификаций удаления вен с помощью зондов появились также эндовенозные термические методы облитерации, однако общим во всех этих методиках оставалось полное иссечение\облитерация несостоятельного сегмента ствола. Данная концепция начала претерпевать изменения только после появления и развития дуплексного ультразвукового сканирования сосудов, благодаря которому появилась возможность более глубокой оценки гемодинамики венозной системы и, как следствие, определения дальнейшего необходимого способа лечения отдельно взятого пациента. Именно благодаря подробному изучению венозной гемодинамики в 1988 г. французский ангиолог Клод Франчески предложил метод амбулаторной консервативной гемодинамической коррекции венозной недостаточности (Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire), ставший известным в мире как метод CHIVA. Данный способ подразумевает устранение столба гидростатического давления в вене, устранение механизма рециркуляции крови, сохранение механизма re-entry и удаление притоков, не имеющих связи с точкой re-entry. В результате выполнения CHIVA происходит восстановление нормального физиологического тока крови путем устранения рефлюкса из глубокой вены в поверхностную и сохранения дренажа из поверхностных вен в глубокие. В представленном обзоре подробно рассматриваются достоинства и недостатки метода CHIVA, а также проведен сравнительный анализ методики с другими существующими на данный момент способами лечения варикозной болезни.

Immunological possibilities of diagnostics and prognosis of aseptic and infected local complications of acute pancreatitis development

The aim. To substantiate the possibility of diagnosis and prediction of aseptic and infected local complications of acute pancreatitis (AP) by determining the level of immunoglobulins of class G. Materials and methods. 30 patients with AP (oedematous and necrotic form) were examined. The control group consisted of patients scheduled for inguinal hernia, varicose vein and breast fibroadenoma surgery (n = 10). Laboratory and immunological studies were carried out three times: the 1st study – upon admission; the 2nd – on the 7th day; the 3 – on the 14th day. An enzyme-linked immunoglobulin analysis of IgG subclasses (G1, G2, G3, G4) was performed in the main study group. Results . Median survival time is 12 days (95 % CI 2.0–28.0) among all examined patients. This time decreases in immunoglobulins deficiency and is 10 days (95 % CI 10.0–71.0) in total IgG level decrease. When comparing groups with a lower level of immunoglobulins and normal, this trend is reflected in all subclasses, and a statistically significant difference between them is detected for IgG4. There is a significant difference (p = 0.049) in Kaplan-Mayer's curves in terms of reducing survival without complications in patients with low IgG4 level (median survival 2.0 days, 95 % CI 1.0–17.0) compared to normal and high its level (Me = 28.0; 95 % CI 10.0–7.0). Survival without complications of the examined patients increases statistically significantly with an increase in the total level of immunoglobulins – RR = 0.91 (95 % CI 0.11–0.98). The probability of complication in and after hospitalization for a patient with GP is lower with the most increase in IgG4 – RR = 0.02 (95 % CI 0.001–0.650). Consequently, the higher level of immunoglobulins in patients, the less the risk of getting complications. Patients with low IgG4 level are more likely to develop complications than patients with normal or elevated IgG4 level. That is, the level of subclass IgG4 can be considered as a diagnostic criterion of complications development and one of their occurrence predictors. Conclusions. Definition of IgG dynamics in patients with AP provides new opportunities for predicting the development of local complications of AP. The level of IgG4 may serve as an additional diagnostic criterion for the local AP complications development.

Vein diameter and vein surgery

Vein diameter and vein surgery

Current practice in treating chronic venous disease by Canadian vascular surgeons.

Objective To evaluate the practice patterns and interests of vascular surgeons in Canada in the treatment of chronic venous disorder. Methods A web-based 19-question survey was sent to 155 active members of the Canadian Society for Vascular Surgery. Questions assessed training background, interest in venous disease, practice site, venous treatments offered, and obstacles to therapy. Results A total of 64 responses (41%) were acquired. Respondents were roughly equal from academic (55%) and community (45%) sites with an even distribution of years in practice. Only 43% offered full range of therapy, which includes compression stockings, sclerotherapy, vein surgery, and endovenous ablation. The main challenges hindering venous practice include lack of time due to overwhelming arterial pathologies (67%), equipment cost/office space limitations (53%), and lack of knowledge or skills in contemporary procedures (28%). The majority of surgeons felt that their residency and fellowship did not prepare them for an active venous practice (69%). Fifty-four percent of the respondents perceived barriers in getting venous ultrasound imaging for their patients. Only 19% of the surgeons find venous disease interesting. Characteristics of these interested surgeons were analyzed and found to be very different from surgeons who did not expressed interest. An overwhelming 92% of all respondents believe that vascular surgeons should be leaders in delivering care for venous disease. Conclusion The treatment of chronic venous disorder has advanced over the last few decades but significant obstacles exist for Canadian surgeons to deliver venous therapy in accordance with current guidelines.

A renewed interest for surgery of the large veins

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Thromboembolic disease - Etiological factors and diagnostic approach

Background: The aim of the article was to define etiological factors for the occurrence of thromboembolism venous and arterial segments and preview of the sensitivity and specificity of diagnostic procedures in the treatment algorithm. Patients and Methods: The study included 60 patients during the 4-year period. The patients are classified into two groups according to the type of thromboembolism, in the group under the diagnosis of venous thromboembolism and group under the diagnosis of arterial thromboembolism. Results: Statistical analysis showed that arterial thromboembolisms occurred statistically significant later in comparison to venous (t = 4.0969; P = 0.0001). The mortality relationship with all analyzed parameters (age, erythrocytes, hemoglobin, platelets, gender, D-dimer, fibrinogen, immobility, veins surgery, pregnancy, smoking, orthopedic trauma, neoplasms, and pulmonary embolism) showed that statistically significant association was observed only in the case of pulmonary embolism. Conclusion: Biochemical parameters of the blood of patients; red blood cell count, hemoglobin concentration, and platelet counts in the study conducted showed a positive relationship with the occurrence of venous thromboembolism while D-dimer and fibrinogen present in increased values in most patients with venous and arterial thromboembolism. Pulmonary embolism directly affects the outcome of patients with thromboembolic diseases taking into account that in the study conducted in venous thrombosis complicated pulmonary embolism resulted in deaths.

Сосудистые трансплантаты в реконструктивной хирургии магистральных вен.

Сосудистые трансплантаты в реконструктивной хирургии магистральных вен.

Analysis of postoperative recurrence of varicose veins of lower extremity in 81 cases

Objective To discuss the cause of relapse after the first surgery of varicose veins of lower limb, and corresponding prevention and treatment methods. Methods The data of 81 cases of recurrence varicose veins of lower limb in Department of Vascular Surgery, Yanzhou First People′s Hospital from September 2010 to October 2016 were analyzed retrospectively, all patients receded ascending phlebography for deep veins Postoperative follow-up of 6 to 48 months was followed by the combination of outpatient and telephone follow-up, with the symptoms, signs and blood vessels of the lower extremities as the follow-up. Results Remnant of the main trunk or tributaries of great saphenous vein in 19 cases, 31 limbs of deep venous incompetent, incompetent perforator veins 25 limbs, the residual of small saphenous vein were 3 cases, crockett’s syndrome 10 cases, sequelae of deep venous thrombosis belongs to the residual 5 limbs, Klippel-Trenaunay syndrome 1 limbs. There were some patients who suffered from 2 reasons or more than two reasons simultaneously.After surgery again, the cure vate was 100% and no serious complications such as deep vein throm-bosis.During the follow-up, 12 patients showed different degrees of subcutaneous stasis, oral drug observation, and later regression. Local subcutaneous hematoma was 5 cases, 2 cases of pure syringe were treated with pressure after suction, 3 routine local incision was removed to remove stitches, drainage change and delayed healing. Six patients showed the sensory impairment of skin numbness in the leg boot area, and oral related neurotrophic drugs improved within 1 to 6 months after surgery. The remaining patients recovered well after operation. Conclusions Various causes can lead to the varicose vein of lower limb, a varicose vein of lower limb is a common clinical symptoms of many different diseases. Preoperative comprehensive examination to clarify the cause, this will help to reduce the probability of recurrence of lower extremity varicose veins. Key words: Recurrence, cause; Angiography; Varicose veins

Abstract 530: In vivo DVT Inflammation Presages Vein Wall Injury, and is Ameliorated by Statin Therapy

Objective: Inflammation mediates early venous thrombosis (VT) resolution and can induce vein wall scarring (VWS), a key driver of the morbid post-thrombotic syndrome (PTS). Statins exhibit anti-inflammatory properties, and may positively impact VWS after VT. However, whether early inflammation contributes to this process and can be detected is not known. In this study, we hypothesized that early VT inflammation detected by 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) could predict subsequent VWS and that both VT inflammation and VWS would be attenuated by statin therapy. Methods: Stasis VT was induced by complete ligation in male C57BL/6J mice (n=55) in either the infrarenal inferior vena cava (IVC, n=42) or right jugular vein (n=13). IVC VT mice were randomized to statin or control groups. Statin (rosuvastatin 5mg/kg) was given by oral gavage starting one day prior to VT induction; control mice received PBS. All mice underwent survival FDG-PET/CT venography imaging on day 2. FDG-PET inflammation signals (standard uptake value (SUV), SUVmax, target-to-background ratios (TBR)) were measured. Picrosirius red staining of day 14 VT sections measured vein wall collagen/thickness. Ex vivo VT tissue gamma counting of a subgroup was performed at day 2. Whole-thrombus protein/mRNA and VT tissue sections assessed neutrophil content. Results: FDG-PET/CT at day 2 revealed increased FDG uptake in jugular VT over the contralateral sham surgery vein (p&lt;0.001). Statin-treated mice showed a decrease in FDG-PET SUV, SUVmax and TBR (p&lt;0.05 for all). Whole-thrombus analyses and tissue section immunostaining showed reduced thrombus neutrophil content at day 2, without reducing GLUT1 or MPO expression (p&gt;0.05). At day 14, statin therapy significantly reduced VWS (p=0.02). In mice undergoing survival imaging, the day 2 FDG-PET VT inflammation signal correlated significantly with the magnitude of day 14 VWS (IVC VT r=0.74, p&lt;0.001) and jugular models of VT (r=0.62, p=0.02). Conclusions: Quantitative FDG inflammation imaging demonstrates that early VT inflammation presages subsequent VWS, and is ameliorated by prophylactic statin therapy. The overall findings support the concept that statins and could reduce VWS and PTS.

EVALUATION OF THE RESULTS OF PHLEBECTOMY WITHOUT LIGATION OF INCOMPETENT PERFORATING VEINS IN PRIMARY VARICOSE VEINS OF LOWER EXTREMITIES

Current approach to operative treatment of varicose veins of lower extremities doesn’t suggest interventions on perforating veins due to the fact that they restore their function following surgery in majority of cases. The article presents the results of 2-year of follow-up study after phlebectomy without ligation of perforating veins the shin in patients with varicose veins of lower extremities C2-C3. Localization and extension of venous reflux were evaluated by duplex scanning. The main sign of incompetent perforating vein is a retrograde blood flow more than 0,5 sec. Varicose tributaries of incompetent perforating veins were preoperatively marked and removed using Muller’s hooks in zone not more than 1 cm from perforating vein. Postoperative duplex scanning showed 1 /3 of all perforating veins (surgery mainly resulted in Cockett ligation of perforating veins above mascular fascia). Visual signs of varicose disease relapse weren’t noted at examination of the patients, but according to duplex scanning the retrograde blood flow on perforating veins in proximal compression was kept in 45,1% of cases.

Comparative Study of Endovenous Laser Ablation over Conventional Surgery of Varicose Veins of Lower Limbs

Comparative Study of Endovenous Laser Ablation over Conventional Surgery of Varicose Veins of Lower Limbs

Prospective Follow-up of 709 interventions for Varicose Veins Carried out Under Tumescent Local Anesthesia Using Innovating Computer Software of “patient Follow-up”

Objectives: The surgery of the varicose veins under tumescent local anesthesia is not very widespread. We sought to evaluate the feasibility and the short-term results of this technique. The patient filled follow-up questionnaires by connecting on a secure server via his email. Materials and Methods: This twin centers prospective study relating to 603 patients and 707 interventions was conducted from January 1st to December 31st, 2014. All the patients operated for varicose veins under tumescent local anesthesia with or without sedation and having a valid email address were included. The collection of the postoperative data was carried out using dedicated software sending the questionnaires to the patients from D0 till D7, then at D15 and D30 about their pain, bleeding, functional capacity and satisfaction. Results: The population comprised 72.8%of women, with amean age of 51 years and a BMI of 24.4. Recurrence was present in 24.2% of the patients. The average score of clinical severity (VCSS) was 4.5/30, the preoperative pain reached 2.53 on an analogical visual scale (AVS) and the CEAP was: C11⁄41%, C21⁄453%, C31⁄414%, C41⁄46%, C51⁄40.7%, C61⁄40.6%. A local anesthesia without any sedation was carried out in 79%of the cases. Amean of 20 phlebectomies was carried out. The additional procedures were: crossectomy in 15% of the cases, stripping in 19%, radio frequency in 26%, laser in 3%, foam sclerotherapy in 10%, embolization in 0.4%, perforating vein ligation in 0.3%, and redo crossectomy in 0.7%. No peroperative complication resulted in stopping the procedure. At D0 and D1 the rates of respondents were 66% and 57%, respectively. The average AVSwas 1.73 and 1.24, respectively. The activity was regarded as normal or subnormal in respectively 85% and 93% of the cases. 99.6% of the patients were satisfied or very satisfied at D0. At D30, we observed 0.1% of infection, 0.3% of superficial venous thrombosis, no major venous thrombosis, no hematoma, no lymphorrhea, and 0.1% of neurological complications. Conclusion: The surgery of varicose veins under tumescent local anesthesia with or without sedation can be carried out without risk. It gives excellent immediate results in terms of pain, functional recovery and satisfaction without major complications. The data-processing tool for evaluation we used seems to be a mode of collection of medical data extremely useful and reliable.

Temporary transection of innominate vein in surgery of midtracheal tumor.

In this case, a patient presented with a large primary midtracheal tumor posterior to the innominate vein and brachiocephalic artery. The left innominate vein (LIV) was temporarily transected to attain proper access to the tumor. After complete removal of the tumor, the vessel was reanastomosed. The operation was uneventful, and the patient recovered well. Temporary transection of the LIV appears to be a reasonable alternative to surgical resection in such a large cross-border midtracheal tumor.

Behavioural recovery following treatments for varicose veins: developing a measure of outcome and process

The endpoints of recovery are frequently reported, but the process of recovery has received less attention. To investigate the process of recovery in the CLASS trial (Comparison of Laser, Surgery and foam Sclerotherapy) comparing treatments for varicose veins, we developed an instrument to assess patient-valued outcomes such as return to normal activities to identify potential modifiers of the effect of treatment. To develop this instrument, we interviewed 17 patients who been treated for varicose veins (laser, surgery or foam sclerotherapy) 6-12 weeks previously. We used a topic guide to elicit personally significant behavioural milestones (eg driving, going out socially). All participants gave informed consent. Interviews were audio-taped and transcribed verbatim. Analysis involved highlighting each utterance that referred to a specific behaviour, developing labels to describe behaviours (eg bending the legs) and quantifying the number of times a particular behaviour was mentioned. In a Discriminant Content Validation exercise based on the WHO International Classification of Functioning, Disability and Health (ICF), behaviours were independently coded as Activity, participation, or both. The behaviours identified were used to generate questionnaire items. Response scales were designed to assess both the relevance of each behaviour and how soon, after treatment, it was first performed. Preliminary versions of the questionnaire were piloted. Wording and formatting were refined in response to this testing. The questionnaire has since been used to assess behavioural recovery in the CLASS trial and preliminary results will be presented. These methods could be used to develop other treatment-specific behavioural recovery questionnaires.

Surgery Cancelation on the Day of Surgery in Same-Day Admission in a Finnish Hospital

Surgery cancelations cause inappropriate use of hospital resources and additional financial and psychological stress to patients. Cancelation rates have been described to be even more than 10% of scheduled cases. Preoperative anesthesia evaluation clinics have been initialized to decrease cancelation rates. At Hyvinkää hospital, 95% of elective surgical patients are admitted on the morning of operation, and only 25% of these patients visit preoperative anesthesia evaluation clinic prior to surgery. Cancelation rate in Finnish hospitals has not been described. We studied retrospectively 12,205 scheduled elective same-day admission surgical cases at Helsinki and Uusimaa Hospital District, Hyvinkää hospital for a period of 2 years. Obstetric cases, emergency cases, and a few inpatient cases were excluded. A case was considered as canceled if surgery was canceled after the finalization of operation room schedule for the next day. Cancelation rates among different specialties and reasons for cancelation were analyzed. A total of 12,205 surgeries were scheduled during the study period, and 551 (4.5%) of these were canceled. The highest cancelation rate was in hand surgery, with 8.2% of scheduled cases, followed by orthopedic surgery with 5.4%, and pediatric surgery with 5.1% cancelation rate. Endocrinology had no cancelations, and breast, urology, and vein surgery also had less than 2% of canceled cases. Patient-related issues caused 72.4% of cancelations, and operation no longer being necessary caused 26% of all cancelations. Day of surgery cancelation rate was low in same-day admission, although it varied between specialties. Specialties having explicit surgery indications had fewer cancelations than specialties having surgery indications based on more subjective diagnostic. Process improvements need to be considered continuously to further decrease cancelation rate.