| 1. |
- Blomgren, Lena, 1957-
(författare)
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Residual incompetent tributaries after varicose vein surgery increased the need for reintervention after 8 years
- 2020
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 2213-3348. ; 8:3, s. 372-382
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to determine whether residual incompetent tributaries after varicose vein surgery affected the reintervention rate after longer follow-up.METHODS: The study is a retrospective review of data from a cohort of a previous randomized controlled study comparing surgery with and without preoperative duplex ultrasound, with follow-up after 2 months, 2 years, and 5 to 9 years clinically and with duplex ultrasound. The cohort was subdivided according to the duplex ultrasound findings 2 months after surgery: no venous incompetence, residual incompetent tributaries only, truncal incompetence, and combined truncal and tributary incompetence. Reintervention rates were compared between groups.RESULTS: There were 280 patients (326 legs) who attended follow-up 2 months postoperatively and 164 patients (190 legs) after a median of 8 years (5-9 years). Another 53 patients (62 legs) were interviewed by telephone or had been reoperated on earlier during follow-up; thus, information was available for 217 patients (252 legs). Of the 252 legs, 56 (22%) were reoperated on during follow-up. In the subgroup with no venous incompetence at all 2 months postoperatively, 4 of 74 legs (5%) were reoperated on; and in the group with residual incompetent tributaries without truncal incompetence, 16 of 56 legs (29%) were reoperated on (P = .000). There was no significant difference in reintervention rate of the group with incompetent tributaries only compared with those with truncal incompetence without incompetent tributaries (12/42 legs [29%]; P = 1) or with combined incompetence of truncal vein and tributaries (22/64 legs [34%]; P = .495). The presence of perforating vein incompetence at 2 months postoperatively did not significantly alter the rate of reoperations (P = .159). In legs that had not been reoperated on, more incompetent veins could be seen progressively. In the group without any incompetent veins postoperatively, 37% still had normal findings at 8 years.CONCLUSIONS: Residual incompetent tributaries after treatment of varicose veins will increase the reintervention rate in the long term, as much as leaving a trunk vein untreated. Patients should be informed about the increased risk of reintervention if not all incompetent veins are targeted.
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| 2. |
- Hultman, Karolina Helczynska, et al.
(författare)
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Validation of a Swedish version of a short Patient-Reported-Outcome-Measure for superficial venous insufficiency
- 2021
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 2213-3348 .- 2213-333X. ; 9:2, s. 416-422.e4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Patient-reported-outcome-measures (PROM) are increasingly used to measure symptoms and treatment effects thereof, and a short PROM is more user friendly. The aim of this study was to test whether a Swedish 7-item version of the PROM used in the Vascular Quality Initiative Varicose Vein Registry can be used to measure quality of life in a Swedish cohort of patients with superficial venous insufficiency (SVI) equally well as the 26-item VEINES-QOL/Sym-S, and measure treatment effect.METHODS: Consecutive patients with SVI and CEAP C-class ≥ 2 were recruited at three private clinics and one county hospital between January 2018 and October 2019. The patients were asked to answer both the VEINES-QOL/Sym-S, and the Swedish 7-item version, called VARIShort, at two assessment points: baseline (Cohort 1, 252 patients) and one week later (Cohort 2, 138 patients), and the VARIShort at baseline and eight weeks after an endovenous procedure (Cohort 3, 106 patients). The mean age was 58.3 (range 20 - 93), 61.4 (range 20-93) and 57.2 (range 20-89) years, the majority were female (59%, 55% and 64%), and most were C4 (39%, 46% and 38%) in Cohorts 1, 2 and 3, respectively. The VARIShort was evaluated with regards to its validity, test-retest reliability, internal consistency reliability, as well as sensitivity and responsiveness.RESULTS: There was a strong correlation between the VEINES-QOL-S and the VARIShort (rs = -.816, p < .001). The VARIShort showed both excellent internal consistency with Cronbach's α = 0.93 and a high response to clinical change as measured with Cohen's d, overall score of 1.17.CONCLUSIONS: The Swedish 7-item PROM, the VARIShort, may be used for assessment of symptoms of SVI and outcome after treatment in Swedish SVI patients. The short PROM shows degree of SVI symptom impact on quality of life in the same manner as the 26-item VEINES-QOL/Sym-S.
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| 3. |
- Ivanics, Tommy, et al.
(författare)
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Contemporary management of chronic indwelling inferior vena cava filters
- 2021
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 2213-3348. ; 9:1, s. 163-169
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite increasing retrieval rates of the inferior vena cava (IVC) filter, less than one-third are removed within the recommended timeline. Prolonged filter dwell times may increase the technical difficulty of retrieval and filter-related complications. We sought to evaluate the contemporary outcomes of patients with chronic indwelling IVC filters at a tertiary care center.Methods: A retrospective analysis was performed from August 2015 through August 2019 of all patients who were referred for removal of a prolonged IVC filter with a dwell time >1 year. Descriptive analysis was used to evaluate patients' characteristics and procedural outcomes, which were reviewed through electronic medical records. Data were expressed as median with interquartile range (IQR) or number and percentage, as appropriate.Results: A total of 47 patients were identified with a median filter dwell time of 10.0 years (IQR, 6-13 years); 34 patients underwent IVC filter removal, and 13 patients refused retrieval. The median age of patients was 54.9 years (IQR, 42.5-64.0 years); the majority were female (57%) and white (53%). The most common indication for filter placement was high risk despite anticoagulation (49%), followed by venous thromboembolism prophylaxis (21%). The majority of patients were symptomatic (72%). If symptomatic, the most common reason for retrieval was IVC penetration (94%), and the chief complaint was pain (56%). Retrieval success was 97%, with a median length of stay of 0 days. The majority of retrievals were performed through an endovascular approach (97%). There was one postprocedural complication (3%).Conclusions: Despite prolonged dwell times, IVC filter retrieval can be performed safely and effectively in carefully selected patients at a tertiary referral center.
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| 4. |
- Nasser, Hassan, et al.
(författare)
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Severe phlebitis-like abnormal reaction following great saphenous vein cyanoacrylate closure
- 2019
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Ingår i: Journal of Vascular Surgery. - : Elsevier. - 2213-3348. ; 7:4, s. 578-582
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Tidskriftsartikel (refereegranskat)abstract
- The VenaSeal closure system is a nonthermal, nontumescent technique that was approved by the U.S. Food and Drug Administration in 2015 for the treatment of superficial venous insufficiency. Studies have demonstrated a comparable efficacy and safety profile to thermal ablation procedures. We report a case of a middle-aged woman who developed a severe, prolonged phlebitis-like reaction requiring treatment with steroids and antihistamines after cyanoacrylate adhesive embolization. This adverse reaction is uncommon but usually self-limiting and is believed to be a type IV hypersensitivity reaction to the cyanoacrylate compound. Knowledge of this potential complication and its treatment are key, because the reaction may be severe with significant morbidity.
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| 5. |
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| 6. |
- Kuna, Vijay Kumar, 1987, et al.
(författare)
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Successful tissue engineering of competent allogeneic venous valves
- 2015
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Ingår i: Journal of Vascular Surgery. - : Elsevier Inc.. - 0741-5214. ; 3:4, s. 421-430
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Tidskriftsartikel (refereegranskat)abstract
- Objective The purpose of this study was to evaluate whether tissue-engineered human allogeneic vein valves have a normal closure time (competency) and tolerate reflux pressure in vitro. Methods Fifteen human allogeneic femoral vein segments containing valves were harvested from cadavers. Valve closure time and resistance to reflux pressure (100 mm Hg) were assessed in an in vitro model to verify competency of the vein valves. The segments were tissue engineered using the technology of decellularization (DC) and recellularization (RC). The decellularized and recellularized vein segments were characterized biochemically, immunohistochemically, and biomechanically. Results Four of 15 veins with valves were found to be incompetent immediately after harvest. In total, 2 of 4 segments with incompetent valves and 10 of 11 segments with competent valves were further decellularized using detergents and DNAse. DC resulted in significant decrease in host DNA compared with controls. DC scaffolds, however, retained major extracellular matrix proteins and mechanical integrity. RC resulted in successful repopulation of the lumen and valves of the scaffold with endothelial and smooth muscle cells. Valve mechanical parameters were similar to the native tissue even after DC. Eight of 10 veins with competent valves remained competent even after DC and RC, whereas the two incompetent valves remained incompetent even after DC and RC. The valve closure time to reflux pressure of the tissue-engineered veins was <0.5 second. Conclusions Tissue-engineered veins with valves provide a valid template for future preclinical studies and eventual clinical applications. This technique may enable replacement of diseased incompetent or damaged deep veins to treat axial reflux and thus reduce ambulatory venous hypertension. Copyright © 2015 by the Society for Vascular Surgery. Published by Elsevier Inc.
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| 7. |
- Shaydakov, Maxim E., et al.
(författare)
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Extended anticoagulation for venous thromboembolism : A survey of the American Venous Forum and the European Venous Forum
- 2022
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Ingår i: Journal of Vascular Surgery: Venous and Lymphatic Disorders. - : Elsevier BV. - 2213-333X. ; 10:5, s. 3-1020
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Extended anticoagulation therapy should always be considered after standard treatment of an unprovoked episode of venous thromboembolism (VTE). It can also be considered for selected patients with provoked VTE. However, the evidence-based protocols suggested by some clinical guidelines and risk assessment tools to guide this practice are limited and ambiguous. The goal of the present survey research was to analyze current practices in applying extended anticoagulation therapy for patients with VTE among members of the American Venous Forum (AVF) and European Venous Forum (EVF). Methods: An online survey was created by the AVF Research Committee. The survey consisted of 16 questions to identify the country of practice, specialty, experience of the participating physicians, and their clinical practice patterns in applying extended anticoagulation therapy for VTE patients. The survey was distributed via e-mail to the members of the AVF and EVF. Results: A total of 144 practitioners, 48 AVF members (33%) and 96 EVF members (66%), participated in the survey. Most of the respondents identified themselves as vascular specialists with primary certification in vascular surgery (70%), vascular medicine or angiology (9%), and venous disease or phlebology (3%). Of the 144 respondents, 72% believed that the risk of VTE recurrence will generally overweigh the risk of bleeding for patients with unprovoked VTE. Extended anticoagulation therapy might be used by 97% of providers. Different patterns in real world clinical practice were identified. More than one half of the practitioners estimated the VTE recurrence and bleeding risk subjectively. The antithrombotic drugs most commonly used for secondary prophylaxis were rivaroxaban, apixaban, warfarin, dabigatran, and aspirin, in decreasing order of frequency. Among the reasons selected for not regularly considering extended anticoagulation therapy were the lack of specific clinical practice guidelines (24%), lack of reported evidence (9%), and absence of valid VTE and/or bleeding risk prediction calculators (8%). Twelve participants (8%) stated that extended anticoagulation therapy would not be beneficial for most patients with VTE. Ten participants (7%) indicated that prescribing extended anticoagulation therapy was outside the scope of their specialty. Conclusions: Different practice patterns exist regarding extending anticoagulation therapy beyond the standard treatment for patients with VTE. Major gaps in knowledge remain a serious challenge at least partially explaining the inaccuracy and inconsistency in long-term VTE management. Appropriately designed studies are needed to evaluate risk stratification tools when contemporary best medical therapy is used, accurately predict VTE recurrence and its long-term outcomes, and tailor safe and effective secondary prophylaxis.
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| 8. |
- Skoog, Johan, et al.
(författare)
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Quantifiable remaining reflux 1 year after treatment of superficial venous incompetence is associated with impaired clinical outcome
- 2023
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Ingår i: JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS. - : ELSEVIER. - 2213-333X. ; 11:6, s. 1130-1138
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Remaining symptoms after treatment of superficial venous incompetence is a common problem. Duplex ultrasound is often used during follow-up, but does not permit an overall quantification of venous function. We have developed a plethysmographic method using occlusion cuffs for separation of superficial and deep venous reflux. By assessing the superficial component it is possible to quantify a potential suboptimal hemodynamic treatment in patients with superficial venous incompetence. The aim was to examine whether patients with hemodynamically quantifiable remaining reflux after treatment experience impaired clinical outcomes.Methods: This single-center prospective cohort study evaluated 156 limbs with great saphenous vein incompetence treated with radiofrequency ablation or high ligation and stripping. Duplex ultrasound and strain-gauge plethysmog-raphy (SGP) with and without selective superficial occlusion were performed before and one-year after treatment. Time taken (seconds) to reach 50% of the venous volume (T-50) was evaluated. A difference in the T(50 )of >5 seconds between postoperative strain-gauge plethysmography with and without superficial occlusion was defined as remaining reflux. The Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) were evaluated and compared between patients with and without remaining reflux. Multivariable logistic regression was used to evaluate risk factors for remaining plethysmographic reflux.Results: In all patients, median (25th, 75th percentile) T-50 increased preoperatively from 7 seconds (3, 12 seconds) to 17 seconds (11, 28 seconds) (P < .001)1 year after treatment. The VCSS and AVVQ were reduced (VCSS, 8.0 [6.0, 10.0] vs 3.0 [1.0, 5.0] [P < .001]; AVVQ, 21.8 [15.8, 32.1] vs 6.4 [2.2, 11.0] [P < .001]). Of the 156 limbs, 87 (56%) demonstrated remaining reflux 1 year after treatment. Patients with remaining plethysmographic reflux displayed higher median (25th, 75th percentile) VCSS (3.0 [2.0, 5.0] vs 2.0 [1.0, 4.0]; P= .012) and AVVQ (7.5 [2.7, 14.9] vs 4.7 [1.6, 9.2]; P= .025). Multivariate logistic regression showed that higher preoperative C in the Clinical Etiology Anatomy Pathophysiology classification (CEAP) (odds ratio [OR], 2.9 [95% confidence interval [CI], 1.34-6.46), age (OR, 1.03; 95% CI, 1.001-1.065), small saphenous vein incompetence (OR, 4.2; 95% CI, 1.30-13.73) and postoperative great saphenous vein reflux below the treated area (OR, 2.16; 95% CI, 1.02-4.56) were significant risk factors for remaining plethysmographic reflux.Conclusions: A majority of treated limbs showed quantifiable reflux 1 year after intervention and these patients displayed worse patient related outcomes assessed with the VCSS and AVVQ. Remaining plethysmographic reflux was associated with preoperative small saphenous vein incompetence and reflux below the treated area as well as advanced age and higher C in CEAP.
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| 9. |
- Wassélius, Johan, et al.
(författare)
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Treatment of mesenteric vein thrombosis with transjugular mechanical thrombectomy and subsequent simultaneous arterial and venous thrombolysis
- 2014
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Ingår i: Journal of Vascular Surgery: Venous and Lymphatic Disorders. - : Elsevier BV. - 2213-333X. ; 2:3, s. 3-320
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Tidskriftsartikel (refereegranskat)abstract
- Mesenteric vein thrombosis may induce intestinal ischemia and gangrene. In severe cases, it is necessary to restore venous outflow from the small intestine rapidly. We describe a severe case of mesenteric vein thrombosis that was resolved successfully by mechanical thrombectomy from a transjugular approach followed by selective simultaneous venous and arterial thrombolysis via the superior mesenteric vein and artery. In conclusion, the transjugular intrahepatic portosystemic approach was a feasible and safe access for mechanical thrombectomy and thrombolysis of the mesenteric vein in our patient.
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