Venous Disease Research Articles

Comparing easywrap with six other adjustable wraps for compression therapy in venous and lymphatic disease by variation in pressure, stiffness and elasticity.

There is no clear guidance or comprehensive comparative evidence to help clinicians select between adjustable wraps for compression therapy. However, adjustable wraps could be compared with three metrics used for compression bandages: variation in pressure, stiffness and elasticity. To determine whether easywrap (Haddenham Healthcare) had lower standard deviation (SD) in lying pressure, greater static stiffness index (SSI) and/or a greater mean elongation ratio than six other adjustable wraps. In this preliminary exploratory study, seven adjustable wraps were tested in vivo 20 times each (140 tests in total), on 20 people (with a variable number of readings per participant), to give the SD in lying pressure and mean SSI. The same wraps were tested in vitro five times each to give the mean elongation ratio. Of all seven adjustable wraps, easywrap had the second lowest SD in lying pressure at 5.9 mmHg, compared with 8.9 mmHg overall; the highest mean SSI at 13.2 mmHg, compared with 9.5 mmHg overall; and the highest mean elongation ratio at 137.0%, compared with 107.1% overall. These metrics suggest that easywrap has clinical advantages over other adjustable wraps. A lower variation in lying pressure suggests more consistent application of pressures within intended therapeutic levels. Higher SSI indicates greater resistance to stretching, which is linked to improved venous function and oedema reduction. Higher elongation ratio demonstrates greater tensile strength, which should maintain therapeutic pressure for longer without readjustment.

Lupus and Total Knee Arthroplasty: A Systematic Review of Inpatient Outcomes

Introduction An increasing number of people diagnosed with systemic lupus erythematosus (SLE) will undergo total knee arthroplasty (TKA) for end-stage knee osteoarthritis. The purpose of this systematic review was to assess the cumulative inpatient complications of those with SLE who underwent TKA in comparison to those without this diagnosis. Methods A thorough review of 3 databases was performed to evaluate all potential complications of those who underwent TKA with and without a diagnosis of SLE. Following the completion of our search and review of manuscripts, we found 4 studies that were included in this systematic review consisting of 55,381 arthroplasties in patients with a diagnosis of SLE with 12,835,627 arthroplasties in the comparison cohort. Results The SLE cohort had an overall higher complication rate (25% versus 22%; p = 0.001). This cohort had a higher chance of postoperative anemia (11.7 versus 10.6%; p = 0.001) and a subsequent need for transfusion (11.1 versus 10.1%; p = 0.001), prosthetic joint infection (0.17 versus 0.11%; p = 0.001), wound infection (0.13 versus 0.09%; p = 0.001), pneumonia (0.5 versus 0.34%; p = 0.001), and cerebrovascular accident (0.03 versus 0.01%; p = 0.001). Mortality risk was lower within the SLE cohort ((0.04 versus 0.06%; p = 0.047). There was no difference in the risk of acute kidney injury (p = 0.15), venous thromboembolic disease (p = 0.33), periprosthetic fracture (p = 0.23), prosthetic dislocation (p = 0.53), and myocardial infarction (p = 0.11). Discussion Our results show that a diagnosis of SLE confers a higher risk of overall complications and multiple specific complications. However, SLE patients had a lower rate of mortality. Furthermore, there were multiple complications that those with SLE were not found to have a higher risk of suffering. Future studies should focus on how to optimize the safety and efficacy of TKA in the short- and long-term outcomes of patients with a diagnosis of SLE.

Comparing easywrap with six other adjustable wraps for compression therapy in venous and lymphatic disease by variation in pressure, stiffness and elasticity.

There is no clear guidance or comprehensive comparative evidence to help clinicians select between adjustable wraps for compression therapy. However, adjustable wraps could be compared with three metrics used for compression bandages: variation in pressure, stiffness and elasticity. To determine whether easywrap (Haddenham Healthcare) had lower standard deviation (SD) in lying pressure, greater static stiffness index (SSI) and/or a greater mean elongation ratio than six other adjustable wraps. In this preliminary exploratory study, seven adjustable wraps were tested in vivo 20 times each (140 tests in total), on 20 people (with a variable number of readings per participant), to give the SD in lying pressure and mean SSI. The same wraps were tested in vitro five times each to give the mean elongation ratio. Of all seven adjustable wraps, easywrap had the second lowest SD in lying pressure at 5.9 mmHg, compared with 8.9 mmHg overall; the highest mean SSI at 13.2 mmHg, compared with 9.5 mmHg overall; and the highest mean elongation ratio at 137.0%, compared with 107.1% overall. These metrics suggest that easywrap has clinical advantages over other adjustable wraps. A lower variation in lying pressure suggests more consistent application of pressures within intended therapeutic levels. Higher SSI indicates greater resistance to stretching, which is linked to improved venous function and oedema reduction. Higher elongation ratio demonstrates greater tensile strength, which should maintain therapeutic pressure for longer without readjustment.

Utilization of a Novel Scoring System in Predicting 30-day Mortality in Acute Pulmonary Embolism, the CLOT-5 Pilot Study.

To construct a new scoring system utilizing biomarkers, vitals, and imaging data to predict 30-day mortality in acute pulmonary embolism (PE). Acute PE, a well-known manifestation of venous thromboembolic disease, is responsible for over 100,000 deaths worldwide yearly. Contemporary management algorithms rely on a multidisciplinary approach to care via PE response teams (PERT) in the identification of low, intermediate, and high-risk patients. The PESI and sPESI scores have been used as cornerstones of the triage process in assigning risk of 30-day mortality for patients presenting with acute PE; however, the specificity of these scoring systems has often come into question. This study retrospectively analyzed 488 patients with acute PE who were managed at a tertiary care institution with either conservative therapy consisting of low molecular weight or unfractionated heparin, advanced therapies consisting of catheter directed therapies, aspiration thrombectomy, or a combination of these therapies, or surgical embolectomy. The CLOT-5 score was designed to include vital signs, biomarkers, and imaging data to predict 30-day mortality in patients presenting with acute PE. The CLOT-5 score had an area under the curve (AUC) of 0.901 with a standard error of 0.29, while the PESI and sPESI scores had an AUC and standard errors of 0.793 ±- 0.43 and 0.728 ± 0.55, respectively. When incorporated into the management algorithms of national PERT programs, the CLOT-5 score may allow for rapid and comprehensive assessment of patients with acute PE at high risk for clinical decompensation, leading to early escalation of care where appropriate.

Intravascular ultrasound use in peripheral arterial and deep venous interventions: Multidisciplinary expert opinion from SCAI/AVF/AVLS/SIR/SVM/SVS

Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable’s aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.

Validation of the RIETE, Kuijer, and HAS-BLED Models to Assess 3-Month Bleeding Risk in Anticoagulated Patients Diagnosed with Venous Thromboembolic Disease.

To evaluate the discriminative ability and calibration of the RIETE, Kuijer, and HAS-BLED models for predicting 3-month bleeding risk in patients anticoagulated for venous thromboembolism (VTE). External validation study of a prediction model based on a retrospective cohort of patients with VTE seen at the Hospital Universitario San Ignacio, Bogotá (Colombia) between July 2021 and June 2023. The calibration of the scales was evaluated using the Hosmer-Lemeshow test and the ratio of observed to expected events (ROE) within each risk category. Discriminatory ability was assessed using the area under the curve (AUC) of a ROC curve. We analyzed 470 patients (median age 65 years, female sex 59.3%) with a diagnosis of deep vein thrombosis in most cases (57.4%), 5.7% bleeding events were observed. Regarding calibration, adequate calibration cannot be ruled out given the limited number of events. The discriminatory ability was limited with an area under the curve (AUC) of 0.48 (CI 0.37-0.59) for Kuijer Score, 0.58 (CI 0.47-0.70) for HAS-BLED and 0.64 (CI 0.51-0.76) for RIETE. The Kuijer, HAS-BLED, and RIETE models in patients with VTE generally do not adequately estimate the risk of bleeding at three months, with a low ability to discriminate high-risk patients. Cautious interpretation is recommended until further evidence is available.

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Functional Capacity of Patients with Venous Thromboembolic Disease Six to Twelve Months after Treatment

Artificial Intelligence Based Application Accuracy in Diagnostics of C1-C2 Chronic Venous Disease

Artificial Intelligence Based Application Accuracy in Diagnostics of C1-C2 Chronic Venous Disease

Disparity in Stent Sizing for Iliac Vein Obstruction Measured by Intravascular Ultrasound and Venogram: A Retrospective Study at a Single Institution

Abstract Introduction: Accurately assessing the location, degree of stenosis, and size requirements for stenting, as well as delineating the venous anatomy to identify optimal landing zones, are crucial elements for achieving successful outcomes in deep venous stenting procedures. Aim: Is to compare and analyse the sizing of stents used in iliac vein obstruction, specifically between venography and IVUS (intravascular ultrasound) guidance. Materials and Methods: A review of retrospectively collected data at JIVAS between 2016 and 2023[the selected time frame was determined based on the comprehensive availability of data.]conducted on procedural data that were contemporaneously entered into an electronic medical records database for iliac vein stent placements, including attempted cases (N=26), for iliac vein obstruction. The analysis focused on 23 limbs from 23 patients. Out of these, 14 patients underwent stent placement guided by venography, while 9 patients had stent placement guided by intravascular ultrasound (IVUS). Three out of the 26 patients who were to undergo stenting based on Venography were not included since intraoperative IVUS revealed no evidence of compression. Results: The distribution of interventions showed that venography was employed in 61% of cases, while IVUS was used in 39% of cases. Regarding the etiology of the condition, 83% of cases were attributed to NIVL, 13% to NIVL+PTS, and 4.3% to PTS. The Stent length variable had a mean of 92.6 (with a standard deviation of 29.4) and a median of 80.0 [80.0; 110]. The range for Stent length spanned from 40.0 to 150. The median length of the intervention was significantly different between the two groups (p<0.01, Mann-Whitney test). Conclusion: The inclusion of intravascular ultrasound (IVUS) as a primary tool appears to influence the selection of stent lengths in the management of both thrombotic and non-thrombotic Iliac venous disease. The collective evidence underscores the multifaceted nature of iliac vein stenting, urging continued research and clinical exploration to refine strategies for optimal patient outcomes.

Comparison of Blood Biomarkers in Systemic Blood and Varicose Veins: A Cross-sectional Study

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/ dL, p<0.001), hsCRP (1.34±1.01 mg/L vs. 3.78±1.67 mg/L, p<0.001), IL-6 (2.65±1.07 pg/mL vs. 4.17±1.51 pg/mL, p<0.001), vWF (90.73±16.72% vs. 127.30±19.92, p<0.001). D-dimer was also substantially higher in samples extracted from leg VV than in systemic blood (105.87±17.72 ng/mL vs. 85.61±18.18 ng/mL, p<0.001). Conclusion: Blood from VV has shown a higher level of several inflammatory markers and signs of endothelial dysfunction. This is most likely the result of worsening venous pressure and dilated, convoluted superficial veins that restrict blood flow. The procoagulant qualities of the local blood and damage to the venous wall, leading to a chronic inflammatory response, may accelerate the disease’s progression and thrombotic consequences.

Cryostripping Versus Conventional Safenectomy in Chronic Venous Disease Treatment: A Single Center Retrospective Cohort Study.

This study presents a comparative analysis of cryostripping to conventional saphenectomy. Materials and Methods: The study included 2191 patients admitted in the Phlebology Department, 1st Surgical Department, Emergency County Hospital Timisoara, between September 2013 and April 2023, between September 2013 and April 2023, who underwent saphenectomy by cryostripping (1327 patients) or conventionally (864 patients). We compared the duration and costs of the procedure, hospitalization period, post-operative results, method feasibility, as well as the technical advantages of cryostripping compared to conventional surgery. Results: A smaller proximal incision, compared to the classic operation, as well the fact that distal counter incision is not necessary, represents technical advantages of this procedure. Average duration of the intervention was 41 +- 12.8 minutes, consumables costs were about 52 +- 10 EUR/intervention, with an average hospitalization period was 1.05 +- 0.41 days. The post-operative results were favourable, early complications rate being reduced (ecchymoses Phi; 2 cm - 33.23%; hematoma - 2.11%; deep vein thrombosis - 0.15%; transient paresthesias 3.01%). Compared to classic saphenectomy, the costs of consumables/intervention are similar, intervention time, hospitalization period and complication rate being statistically significantly lower. An advantage of the method is the fact that the cryo-probes can be sterilized, being reusable; from the economic point of view, the technique perfectly fits in both public hospitals and private clinics. Conclusions: Cryostripping is a radical surgical procedure which bring a significant number of advantages compared to the classic saphenectomy, being an effective alternative in CVD treatment.

ХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ВЕН КАК МУЛЬТИДИСЦИПЛИНАРНАЯ ПРОБЛЕМА: ОТ ЕДИНОГО ПАТОГЕНЕЗА К СИСТЕМНОМУ ПОДХОДУ

Chronic venous diseases (CVD) are examined in this review from the perspective of the continuity of the venous system of the lower extremities and pelvis. The review emphasizes the most clinically significant manifestations of venous insufficiency in the lower extremities, pelvic veins, and varicose veins of the scrotum and hemorrhoids. Due to the unity of pathogenesis and similarity of symptoms of venous stasis in different locations, the review stresses the need for a multidisciplinary approach in managing this category of patients. Assessing venous symptoms in the presence of comorbidities such as osteoarthritis, diabetes mellitus, and arteriosclerosis obliterans of the lower extremities is one of the most essential clinical tasks facing a phlebologist. At the same time, the modern trend in the treatment of CVD, regardless of the anatomical location, is endovenous and minimally invasive technologies that combine surgical radicalism with minimally invasive interventions. This review is based on analyzing published materials in the three most common electronic databases: PubMed, Web of Science, and EMBASE. The primary search query strategy included the following keywords: chronic venous disease, venous insufficiency, pelvic venous disorders, hemorrhoidal disease, and varicocele. Keywords: Chronic venous diseases, varicose veins of the lower extremities, pelvic vein diseases, varicocele, hemorrhoids.

Cardiovascular Involvement in Behçet Disease

Behçet's disease is a disease with mixed vascular tropism: venous and arterial. Vasculo-Behçet or angio-Behçet presents a particular patient profile. Vascular involvement, especially pulmonary artery aneurysm, thoracic aortic aneurysm and Budd Chiari syndrome are entities affiliated with the disease and strike the prognosis. Our series is predominantly male, with an average age of 36 years. Venous disease concerns the majority of patients: 40 patients. It is most often a deep vein thrombosis of the lower limbs. In the arterial system, the pulmonary artery aneurysm was found in 7 patients, the most common location of aneurysms. The association of venous and arterial involvement is more important. Corticosteroid therapy is prescribed in three out of four patients. Immunosuppressive treatment such as azathioprine or cyclophosphamide are prescribed in almost half of patients with venous involvement.

A Referral Pathway for Treating Patients With Severe Venous Disease Using Mechanical Thrombectomy

A Referral Pathway for Treating Patients With Severe Venous Disease Using Mechanical Thrombectomy

Quality of Life After Early Clot Removal for Acute Iliofemoral Deep Vein Thrombosis

To evaluate patient reported outcome measures after early clot removal for acute deep vein thrombosis (DVT), using the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) and the Short Form Health Survey (SF-36). Cross sectional design. Patients who underwent early clot removal between June 2012 and November 2021 were asked to complete the two questionnaires once. Lower CIVIQ-20 and higher SF-36 scores indicate better quality of life (QoL). Primary endpoints were the median scores. The one sample Wilcoxon signed rank test was used to compare SF-36 physical and mental component summary (PCS and MCS) to the normative and CIVIQ-20 to the minimum. Secondary, non-parametric independent t test or Fisher's exact test examined how age, sex, body mass index, stent placement, re-intervention, and time of questionnaire completion related to QoL. Multivariable linear regression tested whether various variables were associated with QoL. The response rate was 73.5% (n= 39). Median time of questionnaire completion was 1.8 years (interquartile range [IQR] 3.1) after clot removal. The median CIVIQ-20 of 29.0 (IQR 28.0) was slightly higher than the minimum value 20.0 (p < .001). The median PCS (50.5, IQR 16.6) and median MCS (50.2, IQR 14.2) did not differ from the normative of 50.0. However, wide IQRs indicated impairments for a subgroup of patients. None of the tested variables affected QoL except for the finding that re-interventions had a significantly negative impact on the SF-36 MCS (standardised β coefficient of-0.4, p= .030). Overall patient reported outcome measures were satisfactory after early clot removal, but impaired physical and mental functioning levels were present in a subgroup of patients. Re-interventions were found to have a negative impact on mental QoL. This finding was independent of time that had passed between the procedure and questionnaire completion. This study emphasises that mental functioning deserves attention, besides the widely recognised physical consequences after invasive acute iliofemoral DVT treatment.

The Effect of 18—21 mmHg Compression Knee Socks on Venous Symptoms in Patients with Chronic Venous Diseases: a Randomized Controlled Trial (GOLIATH)

The Effect of 18—21 mmHg Compression Knee Socks on Venous Symptoms in Patients with Chronic Venous Diseases: a Randomized Controlled Trial (GOLIATH)

Lymphatic Outflow and Correction of Appropriate Disorders in Patients with Venous Thrombosis and Chronic Venous Disease

Lymphatic Outflow and Correction of Appropriate Disorders in Patients with Venous Thrombosis and Chronic Venous Disease

Effect of 18—21 mm Hg Compression Knee Socks on Venous Symptoms in Patients with Chronic Venous Disease: a Randomized Controlled Trial GOLIATH

Effect of 18—21 mm Hg Compression Knee Socks on Venous Symptoms in Patients with Chronic Venous Disease: a Randomized Controlled Trial GOLIATH

Chronic Venous Disease is a Progressive Disease that Requires Early Intervention

Chronic Venous Disease is a Progressive Disease that Requires Early Intervention

Prevalence, clinical presentation, and risk factors of chronic venous disease in Cameroon: A general population-based study.

Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. We conducted the first population-based study over a period of 20months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.