Venous Procedures Research Articles

An early economic evaluation of WireSafe™ to prevent guidewire retention in central venous catheter procedures

Background Guidewire retention (GWR) poses a patient safety risk during Central Venous Catheter (CVC) insertions and is listed as a ‘Never Event’ by the National Health Service England (NHSE). WireSafe™ is an intervention to prevent GWR, but its cost-effectiveness is uncertain. This study is an early economic evaluation comparing WireSafe™ to standard care from a UK healthcare perspective. Methods We conducted (i) a primary analysis of GWR related NHSE Never Events data in England between 2016 and 2020; and (ii) a cost-utility analysis, including healthcare costs and quality-adjusted life years (QALYS) for populations receiving CVC-insertions. We applied a cost-effectiveness threshold of £30,000 per QALY and considered three WireSafe™ costing scenarios (£18.50, £4.50, and £2.50). Results NHSE Never Events data showed 61 GWR cases, averaging 1 per month. Most incidents (92%) were identified during hospital stays, with one serious adverse outcome reported (peri-arrest). In a population of 200,000, we estimate WireSafe™ would prevent 59.92 wire retentions, 5.61 procedural adverse events, 0.3 cardiac adverse events, and 0.19 deaths, improving QALYs by 4.87. In the base case analysis WireSafe™ was not cost-effective and had an economically justifiable price of £2.44. There were high levels of uncertainty in the lowest cost-scenario (ICER 95% credible interval: Dominant; £793,398). Conclusions The health benefits of WireSafe™ are limited due to low GWR rates and high identification rates, making WireSafe™ viable only at low costs. Future research should prioritise obtaining more precise estimates of these parameter values which are key determinants of cost-effectiveness.

The effect of three different nonpharmacological methods on cannulation success during peripheral intravenous catheter placement in the emergency unit: a randomized controlled trial

BackgroundPeripheral intravenous catheterization is frequently performed in emergency units, but it is a procedure which is difficult for healthcare professionals and painful for patients. The primary objective of the present study was to examine the effect on venous dilation, procedure duration and pain severity of local heat, cold and vibration applications performed on the intervention area before peripheral intravenous catheterization in adults. The second objective of the study was to examine the effects of age and gender variables on the participants’ pain intensity levels.MethodsA single-blinded randomized controlled trial. The study included 120 adults who were randomly selected between March and August 2023. One application group (n = 30) received local heat application, one group (n = 30) received local cold application, and one (n = 30) received local vibration using the Buzzy® device. The applications, to the site of the peripheral intravenous catheterization, lasted one minute. The control group (n = 30) received standard peripheral intravenous catheterization application. The groups’ vein dilation was assessed with the vein assessment scale, pain felt during catheterization with the visual analog scale, and the duration of the procedure with a chronometer.ResultsIt was found that the venous dilation of the cold application group was significantly higher (p = 0.010, p = 0.015 respectively) and procedure duration was shorter (p = 0.013, p < 0.001 respectively) than that of the heat and vibration application groups, and its pain severity was significantly lower (p = 0.002, p = 0.001 and p = 0.001 respectively) than that of the control group and the heat and vibration application groups.ConclusionsIt was determined that local cold application for one minute to the area of peripheral intravenous catheterization increased venous dilation, shortened application time, and reduced pain.Trial registrationClinicalTrials.gov ID NCT06378424, retrospectively registered 20/04/2024.

Stent-Induced Inflammation: A Comparative Cross-Sectional Study of Post-Implantation Syndrome in Venous and Arterial Procedures

Background: Postimplantation syndrome (PIS) is a known inflammatory response following endovascular stent placement, yet comparative data between venous and arterial stenting remains limited. This study seeks to evaluate the incidence, characteristics, and clinical implications of PIS across these two distinct vascular territories. Methods: We retrospectively analyzed 191 patients who underwent either venous (n = 36) or arterial (n = 155) stent placement. Data collection encompassed demographic profiles, perioperative laboratory findings, and clinical outcomes. The primary endpoint was the incidence of PIS, defined as the presence of fever (≥38 °C), leukocytosis, and elevated C-reactive protein (CRP) within 30 days postprocedure. Secondary outcomes included length of hospital and ICU stay, incidence of endoleaks, reintervention rates, and 30-day mortality. Comparative statistical analyses were conducted to assess differences between the venous and arterial stent groups. Results: PIS was observed more frequently in arterial stent patients, as evidenced by significantly elevated postoperative white blood cell counts at 24 and 48 h (p = 0.046 and p = 0.014, respectively), along with borderline CRP increases (p = 0.052). Fever occurrence peaked at 72 and 96 h postprocedure, predominantly in the arterial cohort. Furthermore, patients with arterial stents had significantly longer hospital stays (5.59 ± 0.46 days vs. 3.42 ± 0.36 days; p = 0.0018) and a higher rate of 30-day endoleaks (7.1% vs. 0%; p = 0.005). Despite similar mortality and major adverse cardiac event (MACE) rates between groups, arterial stent patients exhibited a greater need for reintervention. While PIS was less common among venous stent recipients, its potential impact on postoperative recovery warrants careful monitoring. Conclusions: Arterial stenting is associated with a higher incidence of PIS and a more pronounced systemic inflammatory response, contributing to longer hospitalization and increased postoperative complications. Although venous stent patients experience PIS less frequently, its occurrence should not be overlooked, as it may influence overall recovery and clinical outcomes. Recognition and management of PIS in both venous and arterial stent patients are critical to improving patient care and optimizing procedural success.

Current state of education in venous diseases within vascular surgery training programs in Italy: A national web-based survey among residents

Background To analyze the perception of vascular surgery trainees from Italian schools of Vascular Surgery regarding the level of practical and theoretical education in venous diseases. Methods An anonymous electronic survey was sent to Italian vascular surgery residents affiliated with 19 universities, asking about their training and experience in the management of venous diseases. The survey gathered information on the residents’ personal and demographic details, their university’s teaching program, operative experience in phlebology, as well as their confidence levels in performing various venous procedures, with the goal of analyzing the training and learning programs provided by Italian vascular surgery schools. Results The analysis showed that 28% of programs do not include phlebology in the curriculum, and more than 40% of residents are unable to independently perform venous duplex ultrasound or treat venous ulcers. Additionally, most residents (over 70%) have limited weekly exposure to phlebology cases, with only 5% having access to a dedicated phlebology operating room. The vast majority of residents (96%) expressed a strong desire to deepen their knowledge and skills in this field, particularly in areas such as endovascular ablation techniques, venous duplex ultrasound, and management of deep venous disease. Conclusions The survey reveals significant limitations in phlebology education and hands-on experience within the current training programs, highlighting the need to standardize and enhance venous disease management education in order to ensure that future vascular surgeons are adequately equipped to provide high-quality care for patients with a wide range of venous disorders.

Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants.

Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.

A rare femoral venous ladder encircling the femoral artery.

Femoral vein is increasingly used for venous cannulation procedures. Its anomalies in the femoral triangle could complicate these procedures. We report an extremely rare type of femoral venous ladder observed during routine cadaveric dissections. The variation was found in the left lower limb of an adult male cadaver aged 70 years. The femoral vein was a single vein in initial 3cm and terminal 4cm of its course. The middle part of the vein showed a duplication and a complex ladder pattern and encircled the femoral artery in the femoral triangle. This anomaly could predispose the vein for deep vein thrombosis. Knowledge of this anomaly could be useful during radiological procedures, femoral hernia repair and femoral triangle abscess and lymph node clearance.

Application of the Symptoms-Varices-Pathophysiology classification system in patients with pelvic venous disorders.

Introduction: In 2021, the American Vein and Lymphatic Society convened a multi-disciplinary group to develop a valid and reliable discriminative instrument for the classification of patients suffering from pelvic venous disorders (PeVD) referred to as the Symptoms-Varices-Pathophysiology (SVP) system. Limited data exists regarding the utility of this instrument in the care of patients with PeVD. The goal of this investigation is to apply the SVP classification system to a group of patients treated for PeVDs. Methods: From January 2018 to January 2019, we retrospectively reviewed the records of 70 female patients treated for a PeVD at the Center for Vascular Medicine. Age, race, gender, medical/surgical histories, CEAP classification and intervention types were assessed and patients were categorized according to their SVP classification. The prevalence of each S and V class, their association with gonadal or iliac vein obstructive lesions and the prevalence of lower extremity varicosities was evaluated. Results: The average age of the entire cohort was 47.4 ± 13.4. The race distribution was as follows: African American (6), Hispanic (1), and Caucasian (63). Of the 140 limbs, 57% were C3 or greater with an average rVCSS score of 4.53. At the time of intervention, 54 patients (77%) demonstrated CEAP class 2 disease or greater with 25 patients (35%) demonstrating lower extremity varicosities. Medical co-morbidities included the following: Endometriosis (n = 1), Uterine Fibroids (n = 1), Ovarian cysts (n = 4), history of venous thrombosis (n = 2) and prior lower extremity venous procedures (n = 3). Overall, 47 patients (67.1%) demonstrated S2 disease secondary to dyspareunia, post-coital pain, or dysmenorrhea. S2 alone was observed in 17 patients (24.3%), S2,3a and S2,3a,3b in nine patients each (12.9%), and S2,3b was in 12 patients (17.1%). Thirteen patients presented with isolated extra-pelvic symptoms (19%); four (5.7%) were classified as S3a,3b, and nine (12.9%) were classified as S3b only. Finally, 10 patients (14%) had no pelvic symptoms and thus were classified as S0. V0 disease was observed in 17 patients (24.3%) secondary to a high incidence of iliac vein stenoses (IVS). V1 disease was observed in 1 patient (1.43%). V2 disease was observed in 53 patients (74.3%) secondary to iliac or ovarian vein reflux. Of these, 45 patients (64.3%) presented with reflux in the iliac veins. Sixteen patients had reflux in the common iliac veins, 17 patients exhibited reflux of the external iliac veins, and 41 patients demonstrated reflux of the internal iliac veins. Thirty-two patients (45.7%) presented with V2 disease secondary to reflux of the ovarian veins, 8 of whom presented with isolated ovarian vein reflux without IVS. Bilateral ovarian vein reflux was observed in 6 patients (9%) and unilaterally in 26 (37%) patients with concomitant ovarian vein reflux and IVS observed in 31 patients (44%). In patients with ovarian vein reflux, 89% had a concomitant iliac vein stenosis: (96.9% in the common iliac vein, 81.3% in the external iliac vein and 3.1% in the internal iliac vein). Conclusion: In our patient cohort, 70 women demonstrated 14 different SV classifications. The most common was S2V2, found in 10 patients. Chronic pelvic pain of venous origin, S2 disease, was the most common symptom, present in 47 patients (67.1%); followed by extra-pelvic symptoms as 22 patients demonstrated symptoms of the external genitalia (S3a), and 21 patients had symptoms secondary to the non-saphenous leg veins (S3b). Pelvic varicosities, V2, were also the most common variceal pattern seen in 53 patients, and 17 patients did not have any varices noted by venogram. Non-thrombotic IVS either alone or with ovarian vein reflux was the most common cause of PeVD in this cohort and may reflect referral patterns to our center. To determine the true incidence of these SVP patterns, larger cohort studies are necessary.

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

Systemic Hormonal Contraceptive Use and Rates of Venous Procedures for Varicose Veins

Systemic Hormonal Contraceptive Use and Rates of Venous Procedures for Varicose Veins

Pre-procedural and intra-procedural computerized tomography: providing a roadmap for successful adrenal venous sampling procedures

Background and purposeAdrenal venous sampling (AVS) is used for the diagnosis of primary hyperaldosteronism. Technical difficulties with right adrenal vein (RAV) catheterization can lead to erroneous results. Our purpose was to delineate the location of the RAV on pre-procedural CT imaging in relation to the location identified during AVS and to report on the impact of successful RAV cannulation with and without the use of intra-procedural CT scanning.MethodsRetrospective case series including patients who underwent AVS from October 2000 to September 2022. Clinical and laboratory values were abstracted from the electronic medical record. Successful cannulation of the RAV was defined as a selectivity index > 3.Results110 patients underwent 124 AVS procedures. Pre-AVS CT imaging was available for 118 AVS procedures. The RAV was identified in 61 (51.7%) CT datasets. Biochemical confirmation of successful RAV cannulation occurred in 98 (79.0%) of 124 AVS procedures. There were 52 (85.2%) procedures in which the RAV was identified on pre-AVS CT and there was biochemical confirmation of successful RAV sampling. Among these 52 procedures, the RAV was localized during AVS at the same anatomic level or within 1 vertebral body level cranial to the level identified on pre-AVS CT in 98.1% of cases. The rate of successful RAV cannulation was higher in patients who underwent intra-procedural CT (93.8% versus 63.9%), P < 0.01.ConclusionsPre-AVS and intra-procedural CT images provide an invaluable roadmap that resulted in a higher rate of accurate identification of the RAV and successful AVS procedures; in particular, search for the RAV orifice during AVS can be limited to 1 vertebral body cranial to the level identified on pre-AVS CT imaging and successful cannulation can be confidently verified with intra-procedural CT.

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

BMI Does Not Impact the Outcomes of Venous Ablation Procedures for Superficial Venous Insufficiency

Central Venous Catheter procedures performed at the outpatient clinics of San Giuliano Hospital of ASL Napoli 2 Nord with a brief overview of pharmacoeconomic evaluations on the procedure

The following work concerns a retrospective, single-center analysis of the data cohort collected between January 2022 and December 2023 regarding outpatient services provided by the Vascular Access Management Service at the Giugliano Hospital in Campania, part of the ASL Napoli 2 Nord. The devices used in these practices are essential for the treatment of both hospitalized and non-hospitalized patients. Their widespread use is justified both due to the particular complexity of the therapeutic regimens to which the patient is subjected, and the frequent need for pharmacological support, hydration, periodic blood draws, nutrient and blood product infusions, and hemodynamic monitoring to safeguard their vascular health. The ASL Napoli 2 Nord area records a significant presence of chronic-degenerative and oncological diseases, therefore, to meet the needs of the population and the numerous requests made by hospital departments and districts, it was decided to activate outpatient clinics for the implantation and management of vascular accesses. It is appropriate that every healthcare operator is adequately trained and involved in the various stages of patient recruitment, device implantation, and management. Therefore, in the ASL Napoli 2 Nord area, it was deemed necessary for these professional figures to be involved in drafting procedures to define the correct use of these devices. The cost of individual outpatient procedures in terms of materials used and specialized personnel involved is an indicator of company expenditure. The amount received by the company for each individual service in terms of patient copayments and reimbursement from the Region represents the revenue of the ASL in relation to the services provided. From the results obtained, there is a slight disproportion regarding regional reimbursement; in particular, the data shows that revenue in terms of dressings is lower than that of irrigations despite the direct costs in the former being much higher than in the latter. These outpatient procedures represent an important source of income in relation to the numbers generated solely at the Giugliano Hospital and still find correspondence and proportionality compared to those recorded in the outpatient clinics of other company facilities.

Safety and efficacy of endovenous ablation in patients with a history of deep vein thrombosis

ObjectiveEndovenous ablation is the standard of care for patients with symptomatic superficial venous insufficiency. For patients with a history of deep vein thrombosis (DVT), concern exists for an increased risk of postprocedural complications, particularly venous thromboembolism. The objective of this study was to evaluate the safety and efficacy of endovenous thermal ablation in patients with a history of DVT. MethodsThe national Vascular Quality Initiative Varicose Vein Registry was queried for superficial venous procedures performed from January 2014 to July 2021. Limbs treated with radiofrequency or laser ablation were compared between patients with and without a DVT history. The primary safety end point was incident DVT or endothermal heat-induced thrombosis (EHIT) II-IV in the treated limb at <3 months of follow-up. The secondary safety end points included any proximal thrombus extension (ie, EHIT I-IV), major bleeding, hematoma, pulmonary embolism, and death due to the procedure. The primary efficacy end point was technical failure (ie, recanalization at <1 week of follow-up). Secondary efficacy end points included the risk of recanalization over time and the postprocedural change in quality-of-life measures. Outcomes stratified by preoperative use of anticoagulation (AC) were also compared among those with prior DVT. ResultsAmong 33,892 endovenous thermal ablations performed on 23,572 individual patients aged 13 to 90 years, 1698 patients (7.2%) had a history of DVT. Patients with prior DVT were older (P < .001), had a higher body mass index (P < .001), were more likely to be male at birth (P < .001) and Black/African American (P < .001), and had greater CEAP classifications (P < .001). A history of DVT conferred a higher risk of new DVT (1.4% vs 0.8%; P = .03), proximal thrombus extension (2.3% vs 1.6%; P = .045), and bleeding (0.2% vs 0.04%; P = .03). EHIT II-IV, pulmonary embolism, and hematoma risk did not differ by DVT history (P = NS). No deaths from treatment occurred in either group. Continuing preoperative AC in patients with prior DVT did not change the risk of any complications after endovenous ablation (P = NS) but did confer an increased hematoma risk among all endovenous thermal ablations and surgeries (P = .001). Technical failure was similar between groups (2.0% vs 1.2%; P = .07), although a history of DVT conferred an increased recanalization risk over time (hazard ratio, 1.90; 95% confidence interval, 1.46, 2.46; P < .001). The groups had comparable improvements in postprocedural venous clinical severity scores and Heaviness, Aching, Swelling, Throbbing, and Itching scores (P = NS). ConclusionsEndovenous thermal ablation for patients with a history of DVT was effective. However, appropriate patient counseling regarding a heightened DVT risk, albeit still low, is critical. The decision to continue or withhold AC preoperatively should be tailored on a case-by-case basis.

Removal of the central venous port system in children. Is this an appropriate training procedure for resident physicians? A single-center retrospective study.

&lt;b&gt;Introduction:&lt;/b&gt; A venous port system consists of a port chamber attached to a central catheter, which is implanted into the central venous system. The removal of the vascular port includes all items of this system. This procedure is usually simple and quick. Complications with port removal are rare but possible.&lt;b&gt;Aim:&lt;/b&gt; The study aimed to summarize venous port removal procedures performed by pediatric surgeons.&lt;b&gt;Material and methods:&lt;/b&gt; The single-center, retrospective study was conducted on 360 pediatric patients treated during the years 2010-2022 in the Department of Pediatric Surgery, Traumatology, and Urology in Poznan.&lt;b&gt;Results:&lt;/b&gt; The port usage time before the removal ranged from 3 days to 8 years and 3 months, with an average of 22 months. The leading cause of vascular port removal was the end of treatment (78.06%). Other less frequent reasons were the infection (13.89%) and mechanical damage of the port (3.33%). There were almost no complications connected with the procedure of vascular port removal (92.2%). If the complications occurred, they included bleeding during surgery (3%), covering the vascular catheter with bone tissue of the clavicle, causing difficulties with the catheter removal from the vein (1.4%), and connected with the previous complications-prolonged clavicle pain after surgery (1.4%) and hematoma after surgery (2%).&lt;b&gt;Conclusions:&lt;/b&gt; Removing the venous port is a safe procedure with a low risk of complications. This procedure can be considered as an appropriate training procedure for young trainees. A more extended period of use of the vascular port before its removal may be associated with more difficulties during surgery.

Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease.

The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.

Venous ablation procedures by provider type, including advanced practice providers

ObjectiveThe necessary training and certification of providers performing venous ablation has become a topic of debate in recent years. As venous interventions have shifted away from the hospital, the diversity of provider backgrounds has increased. We aimed to characterize superficial venous ablation practice patterns associated with different provider types. MethodsWe analyzed Medicare Fee-For-Service data from 2010 through 2018. Procedures were identified by their Current Procedural Terminology code and included radiofrequency ablation, endovenous laser ablation, chemical adhesive ablation (ie, VenaSeal; Medtronic, Inc), and mechanochemical ablation. These procedures were correlated with the practitioner type to identify provider-specific trends. ResultsBetween 2010 and 2018, the number of ablation procedures increased by 107% from 114,197 to 236,558 per year (P < .001). Most procedures were performed by surgeons without vascular board certification (28.7%; 95% confidence interval [CI], 28.7%-28.8%), followed by vascular surgeons (27.1%; 95% CI, 27.0%-27.2%). Traditionally noninterventional specialties, which exclude surgeons, cardiologists, and interventional radiologists, accounted for 14.1% (95% CI, 14.1%-14.2%), and APPs accounted for 3.5% (95% CI, 3.4%-3.5%) of all ablation procedures during the study period. The total number of ablations increased by 9.7% annually (95% CI, 9.7%-9.8%), whereas procedures performed by APPs increased by 62.0% annually (95% CI, 61.6%-62.4%). There were significant differences between specialties in the use of nonthermal ablation modalities: APPs had the highest affinity for nonthermal ablation (odds ratio [OR], 2.60; 95% CI, 2.51-2.69). Cardiologists were also more likely to use nonthermal ablation (OR, 1.62; 95% CI, 1.59-1.66). Similarly, the uptake of new nonthermal technology (ie, chemical adhesives) was greatest among APPs (OR, 3.57; 95% CI, 3.43-3.70) and cardiologists (OR, 1.86; 95% CI, 1.81-1.91). Vascular surgeons were less likely to use nonthermal modalities (OR, 0.95; 95% CI, 0.92-0.97), including new nonthermal technology in the first year of availability (OR, 0.93; 95% CI, 0.90-0.95). ConclusionsThe use of venous procedures has increased rapidly during the past decade, particularly as endovenous ablations have been performed by a wider practitioner base, including APPs and noninterventionalists. Practice patterns differ by provider type, with APPs and cardiologists skewing more toward nonthermal modalities, including more rapid uptake of new nonthermal technology. Provider-specific biases for specific ablation modalities might reflect differences in training, skill set, the need for capital equipment, clinical privileges, or reimbursement. These data could help to inform training paradigms, the allocation of resources, and evaluation of appropriateness in a real-world setting.

Assessment of the Peripheral Venous Cannulation in a Teaching Hospital: A Prospective Study

ABSTRACT Introduction: In today’s healthcare environment, peripheral venous cannulations are frequently performed procedures. Bloodstream infections could occur as a result of the intrusive operation. Peripheral venous cannulas should be inserted and managed according to specific rules. This study compared these standards to the peripheral venous cannulation procedure and results at a teaching hospital institution. Materials and Methods: This study investigated the procedure and results of peripheral venous cannulation in a teaching center using a prospectively completed audit loop study. The “Royal College of Nursing’s criteria for infusion therapy” is one such set of recommendations. After the first phase of the observations, the audit was conducted. Later, after 4 months based on the recommendations, the personnel received training on a variety of cannulation-related topics and the second set of observations for the cannulations was performed. Both observations were made and compared for significance that was considered at. 05 using the ANOVA. Results: During the first phase of the research, 212 cannulations were made, and 314 were made for the second phase to be audited. In the reaudit compared with the initial audit, there was a statistically substantial surge in documentation, cannula cleansing, glove use, suitable site selection, and hand cleanliness, according to comparative exploration. Moreover, there was a statistically substantial decline in recannulations. Conclusion: Even though peripheral intravenous cannulation is a straightforward process, if done incorrectly, it might have serious side effects. Such techniques’ auditing reveals performance flaws. Reaudit results reveal a noticeable increase in performance and outcome following proper personnel retraining.

Rates of completion surgery following venous deprivation procedures (PVE or DVE)

Rates of completion surgery following venous deprivation procedures (PVE or DVE)

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&lt;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.

The Observation of the Effect of Lidocaine Combined with Homemade Warm Compress Sleeve in Alleviating Venous Catheter-Related Injuries in Otolaryngology Surgery Patients

To assess lidocaine’s combined impact with a self-crafted hot compress cuff in diminishing venous indwelling needle injuries during otolaryngology surgeries. 70 patients undergoing otolaryngology surgeries at our hospital between July 2020 and September 2022 were chosen. All underwent venous indwelling needle procedures. Equally divided into an control group (CG) and an experimental group (EG), each with 35 cases, the CG received standard intervention with lidocaine, while the EG received additional self-made hot compress sleeves. Evaluation parameters included changes in skin temperature at the infusion site, needle indwelling duration, phlebitis incidence, needle blockage, pain, and comfort. The EG exhibited significantly higher skin temperatures at the infusion site compared to the CG (P &lt;0.05). Needle indwelling duration was notably prolonged in the EG versus the CG (P &lt;0.05). Phlebitis incidence was notably lower in the EG (14.29%) than the CG (37.14%) (P &lt;0.05). No significant difference was found in needle blockage rates between groups (25.71% in CG, 17.14% in experimental) (P &gt; 0.05). Pain scores were notably lower, and comfort scores were higher in the EG (all, P &lt; 0.05). Combining lidocaine with a self-made hot compress cuff significantly mitigates venous indwelling needle injuries in otolaryngology surgeries. This combined approach enhances skin temperature, extends needle indwelling time, reduces phlebitis and needle blockage risks, alleviates patient discomfort, and elevates overall comfort during venous indwelling needle procedures.